BusinessYear,StateCode,IssuerId,SourceName,VersionNum,ImportDate,BenefitPackageId,IssuerId2,StateCode2,MarketCoverage,DentalOnlyPlan,TIN,StandardComponentId,PlanMarketingName,HIOSProductId,HPID,NetworkId,ServiceAreaId,FormularyId,IsNewPlan,PlanType,MetalLevel,UniquePlanDesign,QHPNonQHPTypeId,IsNoticeRequiredForPregnancy,IsReferralRequiredForSpecialist,SpecialistRequiringReferral,PlanLevelExclusions,IndianPlanVariationEstimatedAdvancedPaymentAmountPerEnrollee,IsHSAEligible,HSAOrHRAEmployerContribution,HSAOrHRAEmployerContributionAmount,ChildOnlyOffering,ChildOnlyPlanId,WellnessProgramOffered,DiseaseManagementProgramsOffered,EHBPediatricDentalApportionmentQuantity,EHBPercentPremiumS4,IsGuaranteedRate,SpecialtyDrugMaximumCoinsurance,InpatientCopaymentMaximumDays,BeginPrimaryCareCostSharingAfterNumberOfVisits,BeginPrimaryCareDeductibleCoinsuranceAfterNumberOfCopays,PlanEffictiveDate,PlanExpirationDate,OutOfCountryCoverage,OutOfCountryCoverageDescription,OutOfServiceAreaCoverage,OutOfServiceAreaCoverageDescription,NationalNetwork,URLForSummaryofBenefitsCoverage,URLForEnrollmentPayment,PlanBrochure,FormularyURL,PlanId,CSRVariationType,IssuerActuarialValue,AVCalculatorOutputNumber,MedicalDrugDeductiblesIntegrated,MedicalDrugMaximumOutofPocketIntegrated,MultipleInNetworkTiers,FirstTierUtilization,SecondTierUtilization,MEHBInnTier1IndividualMOOP,MEHBInnTier1FamilyMOOP,MEHBInnTier2IndividualMOOP,MEHBInnTier2FamilyMOOP,MEHBOutOfNetIndividualMOOP,MEHBOutOfNetFamilyMOOP,MEHBCombInnOonIndividualMOOP,MEHBCombInnOonFamilyMOOP,DEHBInnTier1IndividualMOOP,DEHBInnTier1FamilyMOOP,DEHBInnTier2IndividualMOOP,DEHBInnTier2FamilyMOOP,DEHBOutOfNetIndividualMOOP,DEHBOutOfNetFamilyMOOP,DEHBCombInnOonIndividualMOOP,DEHBCombInnOonFamilyMOOP,TEHBInnTier1IndividualMOOP,TEHBInnTier1FamilyMOOP,TEHBInnTier2IndividualMOOP,TEHBInnTier2FamilyMOOP,TEHBOutOfNetIndividualMOOP,TEHBOutOfNetFamilyMOOP,TEHBCombInnOonIndividualMOOP,TEHBCombInnOonFamilyMOOP,MEHBDedInnTier1Individual,MEHBDedInnTier1Family,MEHBDedInnTier1Coinsurance,MEHBDedInnTier2Individual,MEHBDedInnTier2Family,MEHBDedInnTier2Coinsurance,MEHBDedOutOfNetIndividual,MEHBDedOutOfNetFamily,MEHBDedCombInnOonIndividual,MEHBDedCombInnOonFamily,DEHBDedInnTier1Individual,DEHBDedInnTier1Family,DEHBDedInnTier1Coinsurance,DEHBDedInnTier2Individual,DEHBDedInnTier2Family,DEHBDedInnTier2Coinsurance,DEHBDedOutOfNetIndividual,DEHBDedOutOfNetFamily,DEHBDedCombInnOonIndividual,DEHBDedCombInnOonFamily,TEHBDedInnTier1Individual,TEHBDedInnTier1Family,TEHBDedInnTier1Coinsurance,TEHBDedInnTier2Individual,TEHBDedInnTier2Family,TEHBDedInnTier2Coinsurance,TEHBDedOutOfNetIndividual,TEHBDedOutOfNetFamily,TEHBDedCombInnOonIndividual,TEHBDedCombInnOonFamily,SBCHavingaBabyDeductible,SBCHavingaBabyCopayment,SBCHavingaBabyCoinsurance,SBCHavingaBabyLimit,SBCHavingDiabetesDeductible,SBCHavingDiabetesCopayment,SBCHavingDiabetesCoinsurance,SBCHavingDiabetesLimit,RowNumber
2015,AK,21989,HIOS,4,2014-08-08 08:53:29,1,21989,AK,Individual,Yes,93-0438772,21989AK0030001,Delta Dental Premier,21989AK003,,AKN001,AKS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.00,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,National Network,Yes,,,,,21989AK0030001-00,Standard High Off Exchange Plan,83.10%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AK,21989,HIOS,4,2014-08-08 08:53:29,1,21989,AK,Individual,Yes,93-0438772,21989AK0030001,Delta Dental Premier,21989AK003,,AKN001,AKS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.00,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,National Network,Yes,,,,,21989AK0030001-01,Standard High On Exchange Plan,83.10%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AK,38344,HIOS,8,2014-10-02 12:25:15,1,38344,AK,SHOP (Small Group),Yes,91-0499247,38344AK1020001,Balance Kids' Dental,38344AK102,,AKN002,AKS002,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.55,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,"The out of country provision applies if the member is outside of the US.  For all providers, the member has to pay the provider at the time of service, and send the claim to the insurer along with any other supporting documents.  The insurer provides benefits at the out-of-network benefit level.",Yes,"If the member is outside of Washington, but still in the US, and visit a dentist not in the nationwide network, the insurer pays out of network.  Member has to pay the provider in full, and submit a claim for reimbursement.",Yes,https://www.premera.com/documents/031144_2015.pdf,,https://www.premera.com/documents/031120.pdf,,38344AK1020001-00,Standard High Off Exchange Plan,85.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AK,38344,HIOS,8,2014-10-02 12:25:15,1,38344,AK,SHOP (Small Group),Yes,91-0499247,38344AK1020001,Balance Kids' Dental,38344AK102,,AKN002,AKS002,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.55,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,"The out of country provision applies if the member is outside of the US.  For all providers, the member has to pay the provider at the time of service, and send the claim to the insurer along with any other supporting documents.  The insurer provides benefits at the out-of-network benefit level.",Yes,"If the member is outside of Washington, but still in the US, and visit a dentist not in the nationwide network, the insurer pays out of network.  Member has to pay the provider in full, and submit a claim for reimbursement.",Yes,https://www.premera.com/documents/031144_2015.pdf,,https://www.premera.com/documents/031120.pdf,,38344AK1020001-01,Standard High On Exchange Plan,85.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,Individual,No,93-0989307,73836AK0750002,Be Prosperous (Select),73836AK075,,AKN001,AKS001,AKF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProsperous-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProsperous-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0750002-01,Standard Gold On Exchange Plan,,0.797302067279816,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",15%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$750,$20,"$1,000",$200,$700,$500,$200,$80,9
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0710006,Value 2000 (Select),73836AK071,,AKN001,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99834456491757,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Value_2000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0710006-01,Standard Silver On Exchange Plan,,0.698841989040375,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,600",$200,"$2,000",$600,$300,$80,9
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0710004,Value 4000 (Providence),73836AK071,,AKN002,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998231224433854,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Value_4000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0710004-00,Standard Silver Off Exchange Plan,,0.683441519737244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$20,"$1,000",$200,"$4,000",$200,$90,$80,18
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,Individual,No,93-0989307,73836AK0750003,Be Equipped (Providence),73836AK075,,AKN002,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0750003-06,94% AV Level Silver Plan,,0.939504444599152,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,30%,,,,"$2,700","$5,400",Not Applicable,Not Applicable,$100,$0,$400,$200,$100,$300,$100,$80,18
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,Individual,No,93-0989307,73836AK0750004,Be Equipped (Select),73836AK075,,AKN001,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0750004-00,Standard Silver Off Exchange Plan,,0.719835698604584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",30%,,,,"$2,700","$5,400",Not Applicable,Not Applicable,"$1,350",$20,"$1,850",$200,"$1,350",$700,$250,$80,19
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0710004,Value 4000 (Providence),73836AK071,,AKN002,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998231224433854,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Value_4000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0710004-01,Standard Silver On Exchange Plan,,0.683441519737244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$20,"$1,000",$200,"$4,000",$200,$90,$80,19
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,Individual,No,93-0989307,73836AK0750004,Be Equipped (Select),73836AK075,,AKN001,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0750004-01,Standard Silver On Exchange Plan,,0.719835698604584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",30%,,,,"$2,700","$5,400",Not Applicable,Not Applicable,"$1,350",$20,"$1,850",$200,"$1,350",$700,$250,$80,20
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,Individual,No,93-0989307,73836AK0750004,Be Equipped (Select),73836AK075,,AKN001,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0750004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,21
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,Individual,No,93-0989307,73836AK0750004,Be Equipped (Select),73836AK075,,AKN001,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0750004-03,Limited Cost Sharing Plan Variation,,0.719835698604584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",30%,,,,"$2,700","$5,400",Not Applicable,Not Applicable,"$1,350",$20,"$1,850",$200,"$1,350",$700,$250,$80,22
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,Individual,No,93-0989307,73836AK0750004,Be Equipped (Select),73836AK075,,AKN001,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0750004-04,73% AV Level Silver Plan,,0.739987134933472,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,275","$2,550",30%,,,,"$2,700","$5,400",Not Applicable,Not Applicable,"$1,275",$20,"$1,825",$200,"$1,275",$700,$325,$80,23
2015,AK,58670,HIOS,4,2014-09-04 03:25:43,1,58670,AK,SHOP (Small Group),Yes,57-0523959,58670AK0010001,Group Pediatric EHB,58670AK001,,AKN001,AKS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$76.97,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximums,Yes,Traditional with inside maximums,No,,,,,58670AK0010001-00,Standard High Off Exchange Plan,86.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AK,58670,HIOS,4,2014-09-04 03:25:43,1,58670,AK,SHOP (Small Group),Yes,57-0523959,58670AK0010002,Group Pediatric EHB,58670AK001,,AKN001,AKS001,,New,Indemnity,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$63.62,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximums,Yes,Traditional with inside maximums,No,,,,,58670AK0010002-00,Standard Low Off Exchange Plan,71.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,Individual,No,93-0989307,73836AK0770001,Be Adventurous (Providence),73836AK077,,AKN002,AKS001,AKF002,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,,Yes,National Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAdventurous-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAdventurous-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0770001-00,Standard Bronze Off Exchange Plan,,0.615778207778931,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",35%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,"$4,500",$20,"$1,000",$200,"$4,500",$100,$60,$80,4
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0700006,PPO 500 (Select),73836AK070,,AKN001,AKS001,AKF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998664952977025,,,0,0,0,2015-01-01,,No,Travel Network,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_PPO_500_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0700006-00,Standard Gold Off Exchange Plan,,0.817352592945099,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$20,"$1,400",$200,$500,$500,$200,$80,4
2015,AK,38536,HIOS,4,2014-09-04 03:25:43,1,38536,AK,SHOP (Small Group),Yes,35-0472300,38536AK0010001,Lincoln Dental Connect?,38536AK001,,AKN001,AKS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$53.09,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,38536AK0010001-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AK,38536,HIOS,4,2014-09-04 03:25:43,1,38536,AK,SHOP (Small Group),Yes,35-0472300,38536AK0010002,Lincoln Dental Connect?,38536AK001,,AKN001,AKS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.26,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,38536AK0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AK,38536,HIOS,4,2014-09-04 03:25:43,1,38536,AK,SHOP (Small Group),Yes,35-0472300,38536AK0010005,Lincoln Dental Connect?,38536AK001,,AKN001,AKS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.87,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,38536AK0010005-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AK,38536,HIOS,4,2014-09-04 03:25:43,2,38536,AK,SHOP (Small Group),Yes,35-0472300,38536AK0010004,Lincoln Dental Connect?,38536AK001,,AKN001,AKS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$51.20,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,38536AK0010004-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AK,45858,HIOS,2,2014-08-07 10:00:19,1,45858,AK,SHOP (Small Group),Yes,47-0098400,45858AK0040002,EHB High PPO,45858AK004,,AKN001,AKS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$63.71,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,45858AK0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AK,45858,HIOS,2,2014-08-07 10:00:19,1,45858,AK,SHOP (Small Group),Yes,47-0098400,45858AK0040001,EHB Low PPO,45858AK004,,AKN001,AKS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$38.35,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,45858AK0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AK,45858,HIOS,2,2014-08-07 10:00:19,1,45858,AK,SHOP (Small Group),Yes,47-0098400,45858AK0030002,EHB High Passive,45858AK003,,AKN001,AKS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$73.43,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,45858AK0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AK,45858,HIOS,2,2014-08-07 10:00:19,1,45858,AK,SHOP (Small Group),Yes,47-0098400,45858AK0030001,EHB Low Passive,45858AK003,,AKN001,AKS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$50.49,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,45858AK0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AK,47904,HIOS,2,2014-08-08 08:53:29,1,47904,AK,Individual,Yes,47-0397286,47904AK0070001,"Delta Dental Individual PPO, EHB Certified",47904AK007,,AKN002,AKS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$42.54,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,47904AK0070001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AK,47904,HIOS,2,2014-08-08 08:53:29,1,47904,AK,SHOP (Small Group),Yes,47-0397286,47904AK0090001,"Renaissance Group Dental PPO, EHB Certified",47904AK009,,AKN001,AKS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.13,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,47904AK0090001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AK,47904,HIOS,2,2014-08-08 08:53:29,1,47904,AK,SHOP (Small Group),Yes,47-0397286,47904AK0090002,"Renaissance Group Dental PPO, EHB Certified",47904AK009,,AKN001,AKS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.75,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,47904AK0090002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AK,47904,HIOS,2,2014-08-08 08:53:29,1,47904,AK,Individual,Yes,47-0397286,47904AK0070002,"Delta Dental Individual PPO, EHB Certified",47904AK007,,AKN002,AKS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.66,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,47904AK0070002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AK,47904,HIOS,2,2014-08-08 08:53:29,1,47904,AK,Individual,Yes,47-0397286,47904AK0080001,"Renaissance Individual Dental PPO, EHB Certified",47904AK008,,AKN001,AKS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$48.20,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,47904AK0080001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AK,47904,HIOS,2,2014-08-08 08:53:29,1,47904,AK,Individual,Yes,47-0397286,47904AK0080002,"Renaissance Individual Dental PPO, EHB Certified",47904AK008,,AKN001,AKS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$38.12,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,47904AK0080002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0700006,PPO 500 (Select),73836AK070,,AKN001,AKS001,AKF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998664952977025,,,0,0,0,2015-01-01,,No,Travel Network,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_PPO_500_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0700006-01,Standard Gold On Exchange Plan,,0.817352592945099,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$20,"$1,400",$200,$500,$500,$200,$80,5
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,Individual,No,93-0989307,73836AK0770001,Be Adventurous (Providence),73836AK077,,AKN002,AKS001,AKF002,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,,Yes,National Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAdventurous-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAdventurous-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0770001-01,Standard Bronze On Exchange Plan,,0.615778207778931,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",35%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,"$4,500",$20,"$1,000",$200,"$4,500",$100,$60,$80,5
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,Individual,No,93-0989307,73836AK0770001,Be Adventurous (Providence),73836AK077,,AKN002,AKS001,AKF002,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,,Yes,National Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAdventurous-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAdventurous-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0770001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0700001,PPO 500 (Providence),73836AK070,,AKN002,AKS001,AKF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998664952977025,,,0,0,0,2015-01-01,,No,Travel Network,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_PPO_500_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0700001-00,Standard Gold Off Exchange Plan,,0.817352592945099,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$20,"$1,400",$200,$500,$500,$200,$80,6
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0700001,PPO 500 (Providence),73836AK070,,AKN002,AKS001,AKF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998664952977025,,,0,0,0,2015-01-01,,No,Travel Network,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_PPO_500_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0700001-01,Standard Gold On Exchange Plan,,0.817352592945099,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$20,"$1,400",$200,$500,$500,$200,$80,7
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,Individual,No,93-0989307,73836AK0770001,Be Adventurous (Providence),73836AK077,,AKN002,AKS001,AKF002,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,,Yes,National Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAdventurous-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAdventurous-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0770001-03,Limited Cost Sharing Plan Variation,,0.615778207778931,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",35%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,"$4,500",$20,"$1,000",$200,"$4,500",$100,$60,$80,7
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,Individual,No,93-0989307,73836AK0770002,Be Adventurous (Select),73836AK077,,AKN001,AKS001,AKF002,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,,Yes,National Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAdventurous-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAdventurous-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0770002-00,Standard Bronze Off Exchange Plan,,0.615778207778931,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",35%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,"$4,500",$20,"$1,000",$200,"$4,500",$100,$60,$80,8
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0700007,PPO 1000 (Select),73836AK070,,AKN001,AKS001,AKF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998629504921883,,,0,0,0,2015-01-01,,No,Travel Network,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_PPO_1000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0700007-00,Standard Gold Off Exchange Plan,,0.798416316509247,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,300",$200,"$1,000",$500,$200,$80,8
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0700007,PPO 1000 (Select),73836AK070,,AKN001,AKS001,AKF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998629504921883,,,0,0,0,2015-01-01,,No,Travel Network,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_PPO_1000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0700007-01,Standard Gold On Exchange Plan,,0.798416316509247,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,300",$200,"$1,000",$500,$200,$80,9
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,Individual,No,93-0989307,73836AK0770002,Be Adventurous (Select),73836AK077,,AKN001,AKS001,AKF002,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,,Yes,National Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAdventurous-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAdventurous-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0770002-01,Standard Bronze On Exchange Plan,,0.615778207778931,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",35%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,"$4,500",$20,"$1,000",$200,"$4,500",$100,$60,$80,9
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,Individual,No,93-0989307,73836AK0770002,Be Adventurous (Select),73836AK077,,AKN001,AKS001,AKF002,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,,Yes,National Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAdventurous-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAdventurous-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0770002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,10
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0700002,PPO 1000 (Providence),73836AK070,,AKN002,AKS001,AKF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998629504921883,,,0,0,0,2015-01-01,,No,Travel Network,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_PPO_1000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0700002-00,Standard Gold Off Exchange Plan,,0.798416316509247,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,300",$200,"$1,000",$500,$200,$80,10
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0700002,PPO 1000 (Providence),73836AK070,,AKN002,AKS001,AKF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998629504921883,,,0,0,0,2015-01-01,,No,Travel Network,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_PPO_1000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0700002-01,Standard Gold On Exchange Plan,,0.798416316509247,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,300",$200,"$1,000",$500,$200,$80,11
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,Individual,No,93-0989307,73836AK0770002,Be Adventurous (Select),73836AK077,,AKN001,AKS001,AKF002,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,,Yes,National Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAdventurous-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAdventurous-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0770002-03,Limited Cost Sharing Plan Variation,,0.615778207778931,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",35%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,"$4,500",$20,"$1,000",$200,"$4,500",$100,$60,$80,11
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0700008,PPO 1500 (Select),73836AK070,,AKN001,AKS001,AKF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998597976908069,,,0,0,0,2015-01-01,,No,Travel Network,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_PPO_1500_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0700008-00,Standard Gold Off Exchange Plan,,0.786114931106567,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,200",$200,"$1,500",$400,$200,$80,12
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0700008,PPO 1500 (Select),73836AK070,,AKN001,AKS001,AKF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998597976908069,,,0,0,0,2015-01-01,,No,Travel Network,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_PPO_1500_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0700008-01,Standard Gold On Exchange Plan,,0.786114931106567,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,200",$200,"$1,500",$400,$200,$80,13
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0700003,PPO 1500 (Providence),73836AK070,,AKN002,AKS001,AKF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998597976908069,,,0,0,0,2015-01-01,,No,Travel Network,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_PPO_1500_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0700003-00,Standard Gold Off Exchange Plan,,0.786114931106567,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,200",$200,"$1,500",$400,$200,$80,14
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0700003,PPO 1500 (Providence),73836AK070,,AKN002,AKS001,AKF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998597976908069,,,0,0,0,2015-01-01,,No,Travel Network,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_PPO_1500_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0700003-01,Standard Gold On Exchange Plan,,0.786114931106567,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,200",$200,"$1,500",$400,$200,$80,15
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0700009,PPO 2000 (Select),73836AK070,,AKN001,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998441343111869,,,0,0,0,2015-01-01,,No,Travel Network,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_PPO_2000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0700009-00,Standard Silver Off Exchange Plan,,0.718284964561462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,100",$200,"$2,000",$600,$200,$80,16
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0700009,PPO 2000 (Select),73836AK070,,AKN001,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998441343111869,,,0,0,0,2015-01-01,,No,Travel Network,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_PPO_2000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0700009-01,Standard Silver On Exchange Plan,,0.718284964561462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,100",$200,"$2,000",$600,$200,$80,17
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0700004,PPO 2000 (Providence),73836AK070,,AKN002,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998441343111869,,,0,0,0,2015-01-01,,No,Travel Network,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_PPO_2000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0700004-00,Standard Silver Off Exchange Plan,,0.718284964561462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,100",$200,"$2,000",$600,$200,$80,18
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0700004,PPO 2000 (Providence),73836AK070,,AKN002,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998441343111869,,,0,0,0,2015-01-01,,No,Travel Network,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_PPO_2000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0700004-01,Standard Silver On Exchange Plan,,0.718284964561462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,100",$200,"$2,000",$600,$200,$80,19
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0700010,PPO 3000 (Select),73836AK070,,AKN001,AKS001,AKF003,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998376495983349,,,0,0,0,2015-01-01,,No,Travel Network,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_PPO_3000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0700010-00,Standard Silver Off Exchange Plan,,0.708132565021515,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,$900,$200,"$3,000",$400,$100,$80,20
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0700010,PPO 3000 (Select),73836AK070,,AKN001,AKS001,AKF003,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998376495983349,,,0,0,0,2015-01-01,,No,Travel Network,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_PPO_3000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0700010-01,Standard Silver On Exchange Plan,,0.708132565021515,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,$900,$200,"$3,000",$400,$100,$80,21
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0700005,PPO 3000 (Providence),73836AK070,,AKN002,AKS001,AKF003,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998376495983349,,,0,0,0,2015-01-01,,No,Travel Network,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_PPO_3000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0700005-00,Standard Silver Off Exchange Plan,,0.708132565021515,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,$900,$200,"$3,000",$400,$100,$80,22
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,1,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0700005,PPO 3000 (Providence),73836AK070,,AKN002,AKS001,AKF003,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998376495983349,,,0,0,0,2015-01-01,,No,Travel Network,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_PPO_3000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0700005-01,Standard Silver On Exchange Plan,,0.708132565021515,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,$900,$200,"$3,000",$400,$100,$80,23
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0710005,Value 1500 (Select),73836AK071,,AKN001,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998373207522281,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Value_1500_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0710005-00,Standard Silver Off Exchange Plan,,0.705870747566223,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,700",$200,"$1,500",$700,$300,$80,4
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,Individual,No,93-0989307,73836AK0750001,Be Prosperous (Providence),73836AK075,,AKN002,AKS001,AKF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProsperous-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProsperous-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0750001-00,Standard Gold Off Exchange Plan,,0.797302067279816,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",15%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$750,$20,"$1,000",$200,$700,$500,$200,$80,4
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,Individual,No,93-0989307,73836AK0750001,Be Prosperous (Providence),73836AK075,,AKN002,AKS001,AKF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProsperous-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProsperous-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0750001-01,Standard Gold On Exchange Plan,,0.797302067279816,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",15%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$750,$20,"$1,000",$200,$700,$500,$200,$80,5
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0710005,Value 1500 (Select),73836AK071,,AKN001,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998373207522281,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Value_1500_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0710005-01,Standard Silver On Exchange Plan,,0.705870747566223,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,700",$200,"$1,500",$700,$300,$80,5
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0710001,Value 1500 (Providence),73836AK071,,AKN002,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998373207522281,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Value_1500_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0710001-00,Standard Silver Off Exchange Plan,,0.705870747566223,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,700",$200,"$1,500",$700,$300,$80,6
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,Individual,No,93-0989307,73836AK0750001,Be Prosperous (Providence),73836AK075,,AKN002,AKS001,AKF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProsperous-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProsperous-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0750001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,Individual,No,93-0989307,73836AK0750001,Be Prosperous (Providence),73836AK075,,AKN002,AKS001,AKF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProsperous-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProsperous-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0750001-03,Limited Cost Sharing Plan Variation,,0.797302067279816,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",15%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$750,$20,"$1,000",$200,$700,$500,$200,$80,7
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0710001,Value 1500 (Providence),73836AK071,,AKN002,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998373207522281,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Value_1500_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0710001-01,Standard Silver On Exchange Plan,,0.705870747566223,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,700",$200,"$1,500",$700,$300,$80,7
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0710006,Value 2000 (Select),73836AK071,,AKN001,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99834456491757,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Value_2000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0710006-00,Standard Silver Off Exchange Plan,,0.698841989040375,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,600",$200,"$2,000",$600,$300,$80,8
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,Individual,No,93-0989307,73836AK0750002,Be Prosperous (Select),73836AK075,,AKN001,AKS001,AKF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProsperous-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProsperous-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0750002-00,Standard Gold Off Exchange Plan,,0.797302067279816,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",15%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$750,$20,"$1,000",$200,$700,$500,$200,$80,8
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0710002,Value 2000 (Providence),73836AK071,,AKN002,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99834456491757,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Value_2000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0710002-00,Standard Silver Off Exchange Plan,,0.698841989040375,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,600",$200,"$2,000",$600,$300,$80,10
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,Individual,No,93-0989307,73836AK0750002,Be Prosperous (Select),73836AK075,,AKN001,AKS001,AKF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProsperous-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProsperous-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0750002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,10
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,Individual,No,93-0989307,73836AK0750002,Be Prosperous (Select),73836AK075,,AKN001,AKS001,AKF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProsperous-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProsperous-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0750002-03,Limited Cost Sharing Plan Variation,,0.797302067279816,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",15%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$750,$20,"$1,000",$200,$700,$500,$200,$80,11
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0710002,Value 2000 (Providence),73836AK071,,AKN002,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99834456491757,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Value_2000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0710002-01,Standard Silver On Exchange Plan,,0.698841989040375,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,600",$200,"$2,000",$600,$300,$80,11
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0710007,Value 3000 (Select),73836AK071,,AKN001,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998285587525559,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Value_3000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0710007-00,Standard Silver Off Exchange Plan,,0.691629886627197,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,"$1,300",$200,"$3,000",$400,$200,$80,12
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,Individual,No,93-0989307,73836AK0750003,Be Equipped (Providence),73836AK075,,AKN002,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0750003-00,Standard Silver Off Exchange Plan,,0.719835698604584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",30%,,,,"$2,700","$5,400",Not Applicable,Not Applicable,"$1,350",$20,"$1,850",$200,"$1,350",$700,$250,$80,12
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,Individual,No,93-0989307,73836AK0750003,Be Equipped (Providence),73836AK075,,AKN002,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0750003-01,Standard Silver On Exchange Plan,,0.719835698604584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",30%,,,,"$2,700","$5,400",Not Applicable,Not Applicable,"$1,350",$20,"$1,850",$200,"$1,350",$700,$250,$80,13
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0710007,Value 3000 (Select),73836AK071,,AKN001,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998285587525559,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Value_3000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0710007-01,Standard Silver On Exchange Plan,,0.691629886627197,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,"$1,300",$200,"$3,000",$400,$200,$80,13
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0710003,Value 3000 (Providence),73836AK071,,AKN002,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998285587525559,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Value_3000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0710003-00,Standard Silver Off Exchange Plan,,0.691629886627197,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,"$1,300",$200,"$3,000",$400,$200,$80,14
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,Individual,No,93-0989307,73836AK0750003,Be Equipped (Providence),73836AK075,,AKN002,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0750003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,14
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,Individual,No,93-0989307,73836AK0750003,Be Equipped (Providence),73836AK075,,AKN002,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0750003-03,Limited Cost Sharing Plan Variation,,0.719835698604584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",30%,,,,"$2,700","$5,400",Not Applicable,Not Applicable,"$1,350",$20,"$1,850",$200,"$1,350",$700,$250,$80,15
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0710003,Value 3000 (Providence),73836AK071,,AKN002,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998285587525559,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Value_3000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0710003-01,Standard Silver On Exchange Plan,,0.691629886627197,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,"$1,300",$200,"$3,000",$400,$200,$80,15
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0710008,Value 4000 (Select),73836AK071,,AKN001,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998231224433854,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Value_4000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0710008-00,Standard Silver Off Exchange Plan,,0.683441519737244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$20,"$1,000",$200,"$4,000",$200,$90,$80,16
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,Individual,No,93-0989307,73836AK0750003,Be Equipped (Providence),73836AK075,,AKN002,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0750003-04,73% AV Level Silver Plan,,0.739987134933472,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,275","$2,550",30%,,,,"$2,700","$5,400",Not Applicable,Not Applicable,"$1,275",$20,"$1,825",$200,"$1,275",$700,$325,$80,16
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,Individual,No,93-0989307,73836AK0750003,Be Equipped (Providence),73836AK075,,AKN002,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0750003-05,87% AV Level Silver Plan,,0.878395259380341,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",30%,,,,"$2,700","$5,400",Not Applicable,Not Applicable,$500,$0,$700,$200,$500,$500,$200,$80,17
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0710008,Value 4000 (Select),73836AK071,,AKN001,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998231224433854,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Value_4000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0710008-01,Standard Silver On Exchange Plan,,0.683441519737244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$20,"$1,000",$200,"$4,000",$200,$90,$80,17
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,Individual,No,93-0989307,73836AK0750004,Be Equipped (Select),73836AK075,,AKN001,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0750004-05,87% AV Level Silver Plan,,0.878395259380341,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",30%,,,,"$2,700","$5,400",Not Applicable,Not Applicable,$500,$0,$700,$200,$500,$500,$200,$80,24
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,2,73836,AK,Individual,No,93-0989307,73836AK0750004,Be Equipped (Select),73836AK075,,AKN001,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeEquipped-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0750004-06,94% AV Level Silver Plan,,0.939504444599152,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,30%,,,,"$2,700","$5,400",Not Applicable,Not Applicable,$100,$0,$400,$200,$100,$300,$100,$80,25
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,Individual,No,93-0989307,73836AK0760001,Be Driven (Providence),73836AK076,,AKN002,AKS001,AKF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0760001-00,Standard Silver Off Exchange Plan,,0.693805515766144,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,700",$200,"$2,500",$400,$300,$80,4
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0720004,Beneficial 1500 (Select),73836AK072,,AKN001,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998318667673667,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_1500_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0720004-00,Standard Silver Off Exchange Plan,,0.716978013515472,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,700",$200,"$1,500",$700,$300,$80,4
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0720004,Beneficial 1500 (Select),73836AK072,,AKN001,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998318667673667,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_1500_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0720004-01,Standard Silver On Exchange Plan,,0.716978013515472,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,700",$200,"$1,500",$700,$300,$80,5
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,Individual,No,93-0989307,73836AK0760001,Be Driven (Providence),73836AK076,,AKN002,AKS001,AKF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0760001-01,Standard Silver On Exchange Plan,,0.693805515766144,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,700",$200,"$2,500",$400,$300,$80,5
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,Individual,No,93-0989307,73836AK0760001,Be Driven (Providence),73836AK076,,AKN002,AKS001,AKF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0760001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0720001,Beneficial 1500 (Providence),73836AK072,,AKN002,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998318667673667,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_1500_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0720001-00,Standard Silver Off Exchange Plan,,0.716978013515472,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,700",$200,"$1,500",$700,$300,$80,6
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0720001,Beneficial 1500 (Providence),73836AK072,,AKN002,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998318667673667,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_1500_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0720001-01,Standard Silver On Exchange Plan,,0.716978013515472,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,700",$200,"$1,500",$700,$300,$80,7
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,Individual,No,93-0989307,73836AK0760001,Be Driven (Providence),73836AK076,,AKN002,AKS001,AKF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0760001-03,Limited Cost Sharing Plan Variation,,0.693805515766144,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,700",$200,"$2,500",$400,$300,$80,7
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,Individual,No,93-0989307,73836AK0760001,Be Driven (Providence),73836AK076,,AKN002,AKS001,AKF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0760001-04,73% AV Level Silver Plan,,0.728934049606323,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500",$0,"$2,000",$200,"$1,500",$500,$400,$80,8
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0720005,Beneficial 2000 (Select),73836AK072,,AKN001,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998274399627684,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_2000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0720005-00,Standard Silver Off Exchange Plan,,0.706166386604309,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,600",$200,"$2,000",$600,$300,$80,8
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0720005,Beneficial 2000 (Select),73836AK072,,AKN001,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998274399627684,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_2000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0720005-01,Standard Silver On Exchange Plan,,0.706166386604309,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,600",$200,"$2,000",$600,$300,$80,9
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,Individual,No,93-0989307,73836AK0760001,Be Driven (Providence),73836AK076,,AKN002,AKS001,AKF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0760001-05,87% AV Level Silver Plan,,0.875231981277466,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$750,$0,$550,$200,$750,$300,$150,$80,9
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,Individual,No,93-0989307,73836AK0760001,Be Driven (Providence),73836AK076,,AKN002,AKS001,AKF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0760001-06,94% AV Level Silver Plan,,0.938293218612671,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$250,$0,$300,$200,$250,$150,$40,$80,10
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0720002,Beneficial 2000 (Providence),73836AK072,,AKN002,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998274399627684,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_2000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0720002-00,Standard Silver Off Exchange Plan,,0.706166386604309,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,600",$200,"$2,000",$600,$300,$80,10
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0720002,Beneficial 2000 (Providence),73836AK072,,AKN002,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998274399627684,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_2000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0720002-01,Standard Silver On Exchange Plan,,0.706166386604309,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,600",$200,"$2,000",$600,$300,$80,11
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,Individual,No,93-0989307,73836AK0760002,Be Driven (Select),73836AK076,,AKN001,AKS001,AKF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0760002-00,Standard Silver Off Exchange Plan,,0.693805515766144,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,700",$200,"$2,500",$400,$300,$80,11
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,Individual,No,93-0989307,73836AK0760002,Be Driven (Select),73836AK076,,AKN001,AKS001,AKF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0760002-01,Standard Silver On Exchange Plan,,0.693805515766144,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,700",$200,"$2,500",$400,$300,$80,12
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0720006,Beneficial 3000 (Select),73836AK072,,AKN001,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998189946852836,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_3000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0720006-00,Standard Silver Off Exchange Plan,,0.692025125026703,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,"$1,300",$200,"$3,000",$400,$200,$80,12
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0720006,Beneficial 3000 (Select),73836AK072,,AKN001,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998189946852836,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_3000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0720006-01,Standard Silver On Exchange Plan,,0.692025125026703,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,"$1,300",$200,"$3,000",$400,$200,$80,13
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,Individual,No,93-0989307,73836AK0760002,Be Driven (Select),73836AK076,,AKN001,AKS001,AKF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0760002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,13
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,Individual,No,93-0989307,73836AK0760002,Be Driven (Select),73836AK076,,AKN001,AKS001,AKF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0760002-03,Limited Cost Sharing Plan Variation,,0.693805515766144,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,700",$200,"$2,500",$400,$300,$80,14
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0720003,Beneficial 3000 (Providence),73836AK072,,AKN002,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998189946852836,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_3000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0720003-00,Standard Silver Off Exchange Plan,,0.692025125026703,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,"$1,300",$200,"$3,000",$400,$200,$80,14
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0720003,Beneficial 3000 (Providence),73836AK072,,AKN002,AKS001,AKF002,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998189946852836,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_3000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0720003-01,Standard Silver On Exchange Plan,,0.692025125026703,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,"$1,300",$200,"$3,000",$400,$200,$80,15
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,Individual,No,93-0989307,73836AK0760002,Be Driven (Select),73836AK076,,AKN001,AKS001,AKF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0760002-04,73% AV Level Silver Plan,,0.728934049606323,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500",$0,"$2,000",$200,"$1,500",$500,$400,$80,15
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,Individual,No,93-0989307,73836AK0760002,Be Driven (Select),73836AK076,,AKN001,AKS001,AKF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0760002-05,87% AV Level Silver Plan,,0.875231981277466,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$750,$0,$550,$200,$750,$300,$150,$80,16
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,3,73836,AK,Individual,No,93-0989307,73836AK0760002,Be Driven (Select),73836AK076,,AKN001,AKS001,AKF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeDriven-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0760002-06,94% AV Level Silver Plan,,0.938293218612671,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$250,$0,$300,$200,$250,$150,$40,$80,17
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,4,73836,AK,Individual,No,93-0989307,73836AK0780001,Be Mighty (HSA) (Providence),73836AK078,,AKN002,AKS001,AKF008,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeMighty-HSA-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeMighty-HSA-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0780001-00,Standard Bronze Off Exchange Plan,,0.583061754703522,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",40%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$5,250",$0,$850,$200,"$5,250",$0,$10,$80,4
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,4,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0730004,Beneficial 4000 (Select),73836AK073,,AKN001,AKS001,AKF003,New,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997869686574276,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_4000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0730004-00,Standard Bronze Off Exchange Plan,,0.610244750976563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,"$1,600",$200,"$4,000",$40,$500,$80,4
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,4,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0730004,Beneficial 4000 (Select),73836AK073,,AKN001,AKS001,AKF003,New,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997869686574276,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_4000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0730004-01,Standard Bronze On Exchange Plan,,0.610244750976563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,"$1,600",$200,"$4,000",$40,$500,$80,5
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,4,73836,AK,Individual,No,93-0989307,73836AK0780001,Be Mighty (HSA) (Providence),73836AK078,,AKN002,AKS001,AKF008,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeMighty-HSA-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeMighty-HSA-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0780001-01,Standard Bronze On Exchange Plan,,0.583061754703522,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",40%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$5,250",$0,$850,$200,"$5,250",$0,$10,$80,5
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,4,73836,AK,Individual,No,93-0989307,73836AK0780001,Be Mighty (HSA) (Providence),73836AK078,,AKN002,AKS001,AKF008,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeMighty-HSA-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeMighty-HSA-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0780001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,4,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0730001,Beneficial 4000 (Providence),73836AK073,,AKN002,AKS001,AKF003,New,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997869686574276,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_4000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0730001-00,Standard Bronze Off Exchange Plan,,0.610244750976563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,"$1,600",$200,"$4,000",$40,$500,$80,6
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,4,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0730001,Beneficial 4000 (Providence),73836AK073,,AKN002,AKS001,AKF003,New,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997869686574276,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_4000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0730001-01,Standard Bronze On Exchange Plan,,0.610244750976563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,"$1,600",$200,"$4,000",$40,$500,$80,7
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,4,73836,AK,Individual,No,93-0989307,73836AK0780001,Be Mighty (HSA) (Providence),73836AK078,,AKN002,AKS001,AKF008,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeMighty-HSA-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeMighty-HSA-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0780001-03,Limited Cost Sharing Plan Variation,,0.583061754703522,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",40%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$5,250",$0,$850,$200,"$5,250",$0,$10,$80,7
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,4,73836,AK,Individual,No,93-0989307,73836AK0780002,Be Mighty (HSA) (Select),73836AK078,,AKN001,AKS001,AKF008,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeMighty-HSA-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeMighty-HSA-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0780002-00,Standard Bronze Off Exchange Plan,,0.583061754703522,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",40%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$5,250",$0,$850,$200,"$5,250",$0,$10,$80,8
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,4,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0730005,Beneficial 4500 (Select),73836AK073,,AKN001,AKS001,AKF003,New,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997823747572343,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_4500_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0730005-00,Standard Bronze Off Exchange Plan,,0.604241013526917,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",50%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,"$4,500",$0,"$1,400",$200,"$4,500",$0,$300,$80,8
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,4,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0730005,Beneficial 4500 (Select),73836AK073,,AKN001,AKS001,AKF003,New,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997823747572343,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_4500_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0730005-01,Standard Bronze On Exchange Plan,,0.604241013526917,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",50%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,"$4,500",$0,"$1,400",$200,"$4,500",$0,$300,$80,9
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,4,73836,AK,Individual,No,93-0989307,73836AK0780002,Be Mighty (HSA) (Select),73836AK078,,AKN001,AKS001,AKF008,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeMighty-HSA-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeMighty-HSA-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0780002-01,Standard Bronze On Exchange Plan,,0.583061754703522,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",40%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$5,250",$0,$850,$200,"$5,250",$0,$10,$80,9
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,4,73836,AK,Individual,No,93-0989307,73836AK0780002,Be Mighty (HSA) (Select),73836AK078,,AKN001,AKS001,AKF008,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeMighty-HSA-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeMighty-HSA-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0780002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,10
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,4,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0730002,Beneficial 4500 (Providence),73836AK073,,AKN002,AKS001,AKF003,New,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997823747572343,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_4500_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0730002-00,Standard Bronze Off Exchange Plan,,0.604241013526917,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",50%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,"$4,500",$0,"$1,400",$200,"$4,500",$0,$300,$80,10
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,4,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0730002,Beneficial 4500 (Providence),73836AK073,,AKN002,AKS001,AKF003,New,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997823747572343,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_4500_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0730002-01,Standard Bronze On Exchange Plan,,0.604241013526917,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",50%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,"$4,500",$0,"$1,400",$200,"$4,500",$0,$300,$80,11
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,4,73836,AK,Individual,No,93-0989307,73836AK0780002,Be Mighty (HSA) (Select),73836AK078,,AKN001,AKS001,AKF008,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeMighty-HSA-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeMighty-HSA-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0780002-03,Limited Cost Sharing Plan Variation,,0.583061754703522,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",40%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$5,250",$0,$850,$200,"$5,250",$0,$10,$80,11
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,4,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0730006,Beneficial 5000 (Select),73836AK073,,AKN001,AKS001,AKF003,New,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997792494775994,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_5000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0730006-00,Standard Bronze Off Exchange Plan,,0.599137604236603,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$0,"$1,100",$200,"$5,000",$0,$100,$80,12
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,4,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0730006,Beneficial 5000 (Select),73836AK073,,AKN001,AKS001,AKF003,New,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997792494775994,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_5000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0730006-01,Standard Bronze On Exchange Plan,,0.599137604236603,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$0,"$1,100",$200,"$5,000",$0,$100,$80,13
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,4,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0730003,Beneficial 5000 (Providence),73836AK073,,AKN002,AKS001,AKF003,New,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997792494775994,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_5000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0730003-00,Standard Bronze Off Exchange Plan,,0.599137604236603,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$0,"$1,100",$200,"$5,000",$0,$100,$80,14
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,4,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0730003,Beneficial 5000 (Providence),73836AK073,,AKN002,AKS001,AKF003,New,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997792494775994,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_Beneficial_5000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0730003-01,Standard Bronze On Exchange Plan,,0.599137604236603,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$0,"$1,100",$200,"$5,000",$0,$100,$80,15
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,Individual,No,93-0989307,73836AK0790001,Be Rugged (Providence),73836AK079,,AKN002,AKS001,AKF009,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeRugged-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeRugged-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0790001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,380",$0,$0,$80,4
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0740006,HSA 2000 (Select),73836AK074,,AKN001,AKS001,AKF004,New,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998276991062675,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_HSA_2000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0740006-00,Standard Silver Off Exchange Plan,,0.681752264499664,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,100",$200,"$2,000",$0,$700,$80,4
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0740006,HSA 2000 (Select),73836AK074,,AKN001,AKS001,AKF004,New,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998276991062675,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_HSA_2000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0740006-01,Standard Silver On Exchange Plan,,0.681752264499664,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,100",$200,"$2,000",$0,$700,$80,5
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,Individual,No,93-0989307,73836AK0790001,Be Rugged (Providence),73836AK079,,AKN002,AKS001,AKF009,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeRugged-Providence_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeRugged-Providence_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0790001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,380",$0,$0,$80,5
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,Individual,No,93-0989307,73836AK0790002,Be Rugged (Select),73836AK079,,AKN001,AKS001,AKF009,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeRugged-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeRugged-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0790002-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,380",$0,$0,$80,6
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0740001,HSA 2000 (Providence),73836AK074,,AKN002,AKS001,AKF004,New,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998276991062675,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_HSA_2000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0740001-00,Standard Silver Off Exchange Plan,,0.681752264499664,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,100",$200,"$2,000",$0,$700,$80,6
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0740001,HSA 2000 (Providence),73836AK074,,AKN002,AKS001,AKF004,New,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998276991062675,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_HSA_2000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0740001-01,Standard Silver On Exchange Plan,,0.681752264499664,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,100",$200,"$2,000",$0,$700,$80,7
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,Individual,No,93-0989307,73836AK0790002,Be Rugged (Select),73836AK079,,AKN001,AKS001,AKF009,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeRugged-Select_SBC_AK_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeRugged-Select_AK_2015.pdf,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0790002-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,380",$0,$0,$80,7
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0740007,HSA 3000 (Select),73836AK074,,AKN001,AKS001,AKF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998005847792815,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_HSA_3000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0740007-00,Standard Bronze Off Exchange Plan,,0.619534611701965,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$0,"$1,300",$200,"$3,000",$0,$800,$80,8
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0740007,HSA 3000 (Select),73836AK074,,AKN001,AKS001,AKF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998005847792815,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_HSA_3000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0740007-01,Standard Bronze On Exchange Plan,,0.619534611701965,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$0,"$1,300",$200,"$3,000",$0,$800,$80,9
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0740002,HSA 3000 (Providence),73836AK074,,AKN002,AKS001,AKF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998005847792815,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_HSA_3000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0740002-00,Standard Bronze Off Exchange Plan,,0.619534611701965,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$0,"$1,300",$200,"$3,000",$0,$800,$80,10
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0740002,HSA 3000 (Providence),73836AK074,,AKN002,AKS001,AKF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998005847792815,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_HSA_3000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0740002-01,Standard Bronze On Exchange Plan,,0.619534611701965,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$0,"$1,300",$200,"$3,000",$0,$800,$80,11
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0740008,HSA 4000 (Select),73836AK074,,AKN001,AKS001,AKF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997870614444631,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_HSA_4000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0740008-00,Standard Bronze Off Exchange Plan,,0.597890913486481,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,"$1,000",$200,"$4,000",$0,$500,$80,12
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0740008,HSA 4000 (Select),73836AK074,,AKN001,AKS001,AKF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997870614444631,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_HSA_4000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0740008-01,Standard Bronze On Exchange Plan,,0.597890913486481,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,"$1,000",$200,"$4,000",$0,$500,$80,13
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0740003,HSA 4000 (Providence),73836AK074,,AKN002,AKS001,AKF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997870614444631,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_HSA_4000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0740003-00,Standard Bronze Off Exchange Plan,,0.597890913486481,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,"$1,000",$200,"$4,000",$0,$500,$80,14
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0740003,HSA 4000 (Providence),73836AK074,,AKN002,AKS001,AKF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997870614444631,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_HSA_4000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0740003-01,Standard Bronze On Exchange Plan,,0.597890913486481,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,"$1,000",$200,"$4,000",$0,$500,$80,15
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0740009,HSA 5000 (Select),73836AK074,,AKN001,AKS001,AKF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997754660498885,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_HSA_5000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0740009-00,Standard Bronze Off Exchange Plan,,0.582238554954529,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$0,$700,$200,"$5,000",$0,$90,$80,16
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0740009,HSA 5000 (Select),73836AK074,,AKN001,AKS001,AKF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997754660498885,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_HSA_5000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0740009-01,Standard Bronze On Exchange Plan,,0.582238554954529,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$0,$700,$200,"$5,000",$0,$90,$80,17
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0740004,HSA 5000 (Providence),73836AK074,,AKN002,AKS001,AKF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997754660498885,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_HSA_5000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0740004-00,Standard Bronze Off Exchange Plan,,0.582238554954529,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$0,$700,$200,"$5,000",$0,$90,$80,18
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0740004,HSA 5000 (Providence),73836AK074,,AKN002,AKS001,AKF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997754660498885,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_HSA_5000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0740004-01,Standard Bronze On Exchange Plan,,0.582238554954529,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$0,$700,$200,"$5,000",$0,$90,$80,19
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0740010,HSA 6000 (Select),73836AK074,,AKN001,AKS001,AKF006,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997777386629101,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_HSA_6000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0740010-00,Standard Bronze Off Exchange Plan,,0.586588680744171,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",30%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$200,"$6,000",$0,$0,$80,20
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0740010,HSA 6000 (Select),73836AK074,,AKN001,AKS001,AKF006,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997777386629101,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_HSA_6000_Select.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0740010-01,Standard Bronze On Exchange Plan,,0.586588680744171,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",30%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$200,"$6,000",$0,$0,$80,21
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0740005,HSA 6000 (Providence),73836AK074,,AKN002,AKS001,AKF006,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997777386629101,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_HSA_6000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0740005-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",30%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$200,"$6,000",$0,$0,$80,22
2015,AK,73836,HIOS,15,2015-04-22 11:06:15,5,73836,AK,SHOP (Small Group),No,93-0989307,73836AK0740005,HSA 6000 (Providence),73836AK074,,AKN002,AKS001,AKF006,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997777386629101,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,Yes,https://www.modahealth.com/pdfs/sbcs/ak/2015_SBC_Alaska_HSA_6000_Providence.pdf,,,https://www.modahealth.com/pdfs/ak/pref_drug_list.pdf,73836AK0740005-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",30%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$200,"$6,000",$0,$0,$80,23
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,1,74819,AK,Individual,Yes,95-6042390,74819AK0020001,BESTOne Child Dental Plus,74819AK002,,AKN001,AKS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$65.23,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BESTOne_Child_Dental_Plus_Plan.pdf,,74819AK0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,1,74819,AK,SHOP (Small Group),Yes,95-6042390,74819AK0010001,BEST Life Child Dental Plus,74819AK001,,AKN001,AKS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$52.17,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BEST_Life_Child_Dental_Plus_Plan.pdf,,74819AK0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,2,74819,AK,SHOP (Small Group),Yes,95-6042390,74819AK0010002,BEST Life Child Dental,74819AK001,,AKN001,AKS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$40.40,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BEST_Life_Child_Dental_Plan.pdf,,74819AK0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,2,74819,AK,Individual,Yes,95-6042390,74819AK0020002,BESTOne Child Dental,74819AK002,,AKN001,AKS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$50.49,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BESTOne_Child_Dental_Plan.pdf,,74819AK0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,3,74819,AK,Individual,Yes,95-6042390,74819AK0020003,BESTOne Dental Advantage-Gold,74819AK002,,AKN001,AKS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$65.23,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BESTOne_Dental_Advantage-Gold_Plan.pdf,,74819AK0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,3,74819,AK,SHOP (Small Group),Yes,95-6042390,74819AK0010007,BEST Dental Premium,74819AK001,,AKN001,AKS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$52.17,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BESTDental_Premium_Plan.pdf,,74819AK0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,3,74819,AK,SHOP (Small Group),Yes,95-6042390,74819AK0010007,BEST Dental Premium,74819AK001,,AKN001,AKS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$52.17,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BESTDental_Premium_Plan.pdf,,74819AK0010007-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,3,74819,AK,Individual,Yes,95-6042390,74819AK0020003,BESTOne Dental Advantage-Gold,74819AK002,,AKN001,AKS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$65.23,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BESTOne_Dental_Advantage-Gold_Plan.pdf,,74819AK0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,3,74819,AK,Individual,Yes,95-6042390,74819AK0020004,BESTOne Dental Plus-Gold,74819AK002,,AKN001,AKS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$65.23,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BESTOne_Dental_Plus-Gold_Plan.pdf,,74819AK0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,3,74819,AK,SHOP (Small Group),Yes,95-6042390,74819AK0010008,BEST Dental Standard-H,74819AK001,,AKN001,AKS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$52.17,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BESTDental_Standard-H_Plan.pdf,,74819AK0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,3,74819,AK,SHOP (Small Group),Yes,95-6042390,74819AK0010008,BEST Dental Standard-H,74819AK001,,AKN001,AKS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$52.17,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BESTDental_Standard-H_Plan.pdf,,74819AK0010008-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,3,74819,AK,Individual,Yes,95-6042390,74819AK0020004,BESTOne Dental Plus-Gold,74819AK002,,AKN001,AKS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$65.23,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BESTOne_Dental_Plus-Gold_Plan.pdf,,74819AK0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,3,74819,AK,SHOP (Small Group),Yes,95-6042390,74819AK0010010,BEST Dental Choice-H,74819AK001,,AKN001,AKS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$52.17,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BESTDental_Choice-H_Plan.pdf,,74819AK0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,3,74819,AK,SHOP (Small Group),Yes,95-6042390,74819AK0010010,BEST Dental Choice-H,74819AK001,,AKN001,AKS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$52.17,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BESTDental_Choice-H_Plan.pdf,,74819AK0010010-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,4,74819,AK,SHOP (Small Group),Yes,95-6042390,74819AK0010009,BEST Dental Standard-L,74819AK001,,AKN001,AKS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$40.40,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BESTDental_Standard-L_Plan.pdf,,74819AK0010009-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,4,74819,AK,Individual,Yes,95-6042390,74819AK0020005,BESTOne Dental Plus-Silver,74819AK002,,AKN001,AKS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$50.49,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BESTOne_Dental_Plus-Silver_Plan.pdf,,74819AK0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,4,74819,AK,Individual,Yes,95-6042390,74819AK0020005,BESTOne Dental Plus-Silver,74819AK002,,AKN001,AKS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$50.49,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BESTOne_Dental_Plus-Silver_Plan.pdf,,74819AK0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,4,74819,AK,SHOP (Small Group),Yes,95-6042390,74819AK0010009,BEST Dental Standard-L,74819AK001,,AKN001,AKS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$40.40,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BESTDental_Standard-L_Plan.pdf,,74819AK0010009-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,4,74819,AK,SHOP (Small Group),Yes,95-6042390,74819AK0010011,BEST Dental Choice-L,74819AK001,,AKN001,AKS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$40.40,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BESTDental_Choice-L_Plan.pdf,,74819AK0010011-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,4,74819,AK,Individual,Yes,95-6042390,74819AK0020006,BESTOne Dental Basic-Silver,74819AK002,,AKN001,AKS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$50.49,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BESTOne_Dental_Basic-Silver_Plan.pdf,,74819AK0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,4,74819,AK,Individual,Yes,95-6042390,74819AK0020006,BESTOne Dental Basic-Silver,74819AK002,,AKN001,AKS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$50.49,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BESTOne_Dental_Basic-Silver_Plan.pdf,,74819AK0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,4,74819,AK,SHOP (Small Group),Yes,95-6042390,74819AK0010011,BEST Dental Choice-L,74819AK001,,AKN001,AKS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$40.40,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BESTDental_Choice-L_Plan.pdf,,74819AK0010011-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,4,74819,AK,SHOP (Small Group),Yes,95-6042390,74819AK0010012,BEST Dental Value,74819AK001,,AKN001,AKS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$40.40,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BESTDental_Value_Plan.pdf,,74819AK0010012-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,AK,74819,HIOS,4,2014-09-03 04:28:59,4,74819,AK,SHOP (Small Group),Yes,95-6042390,74819AK0010012,BEST Dental Value,74819AK001,,AKN001,AKS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$40.40,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AK/2015/AK_BESTDental_Value_Plan.pdf,,74819AK0010012-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360003,Humana Silver 4600/Birmingham PPOx,44580AL036,,ALN001,ALS001,ALF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2330484,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2338687,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360003-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,Yes,39-1263473,44580AL0380001,Humana Dental Smart Choice,44580AL038,,ALN003,ALS003,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.40,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541149,,44580AL0380001-00,Standard Low Off Exchange Plan,68.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$35,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360013,Humana Silver 4600/Huntsville PPOx,44580AL036,,ALN002,ALS002,ALF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338700,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330588,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360013-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360013,Humana Silver 4600/Huntsville PPOx,44580AL036,,ALN002,ALS002,ALF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338700,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330588,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360013-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360013,Humana Silver 4600/Huntsville PPOx,44580AL036,,ALN002,ALS002,ALF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338700,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330588,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360013-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360013,Humana Silver 4600/Huntsville PPOx,44580AL036,,ALN002,ALS002,ALF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338700,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330588,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360013-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,3,46944,AL,Individual,No,63-0103830,46944AL0370001,Blue Value Gold,46944AL037,,ALN001,ALS001,ALF005,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueValueGold?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueValueGold?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_635_StandardPrescriptionDL.pdf,46944AL0370001-03,Limited Cost Sharing Plan Variation,78.60%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,"$1,200",20%,$600,"$1,200",20%,$600,"$1,200",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$600,$400,$0,$200,$20,"$1,200",$0,$400,7
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,4,46944,AL,Individual,No,63-0103830,46944AL0410001,Blue Value Silver,46944AL041,,ALN001,ALS001,ALF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueValueSilver?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueValueSilver?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0410001-00,Standard Silver Off Exchange Plan,68.60%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400","$4,800",20%,"$2,400","$4,800",20%,"$2,400","$4,800",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$600,$0,$200,$20,"$1,600",$0,$400,4
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,Yes,39-1263473,44580AL0380001,Humana Dental Smart Choice,44580AL038,,ALN003,ALS003,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.40,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541149,,44580AL0380001-01,Standard Low On Exchange Plan,68.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$35,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360003,Humana Silver 4600/Birmingham PPOx,44580AL036,,ALN001,ALS001,ALF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2330484,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2338687,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360003-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030011,UnitedHealthcare Silver Compass 5000,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030011-04,73% AV Level Silver Plan,72.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,600","$7,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030011,UnitedHealthcare Silver Compass 5000,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030011-05,87% AV Level Silver Plan,86.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030011,UnitedHealthcare Silver Compass 5000,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030011-06,94% AV Level Silver Plan,94.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,4,68259,AL,Individual,No,63-0899562,68259AL0030002,UnitedHealthcare Gold Compass 1000,68259AL003,,ALN006,ALS001,ALF003,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030002-00,Standard Gold Off Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AK,81761,HIOS,2,2014-08-07 10:00:19,1,81761,AK,SHOP (Small Group),Yes,36-0883760,81761AK0040002,EHB High PPO,81761AK004,,AKN001,AKS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$64.60,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,81761AK0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AK,81761,HIOS,2,2014-08-07 10:00:19,1,81761,AK,SHOP (Small Group),Yes,36-0883760,81761AK0040001,EHB Low PPO,81761AK004,,AKN001,AKS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$38.89,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,81761AK0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AK,81761,HIOS,2,2014-08-07 10:00:19,1,81761,AK,SHOP (Small Group),Yes,36-0883760,81761AK0030002,EHB High Passive,81761AK003,,AKN001,AKS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$74.46,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,81761AK0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AK,81761,HIOS,2,2014-08-07 10:00:19,1,81761,AK,SHOP (Small Group),Yes,36-0883760,81761AK0030001,EHB Low Passive,81761AK003,,AKN001,AKS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$51.20,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,81761AK0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AK,84394,HIOS,2,2014-08-08 08:53:29,1,84394,AK,SHOP (Small Group),Yes,42-0127290,84394AK0050001,Principal Plan Dental 70,84394AK005,,AKN001,AKS001,,New,PPO,Low,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$30.82,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,84394AK0050001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AK,84394,HIOS,2,2014-08-08 08:53:29,1,84394,AK,SHOP (Small Group),Yes,42-0127290,84394AK0050002,Principal Plan Dental 80,84394AK005,,AKN001,AKS001,,New,PPO,High,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$37.02,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,84394AK0050002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AK,84859,HIOS,2,2014-08-07 10:00:19,1,84859,AK,SHOP (Small Group),Yes,93-0242990,84859AK0040002,EHB High PPO,84859AK004,,AKN001,AKS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$64.79,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,84859AK0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AK,84859,HIOS,2,2014-08-07 10:00:19,1,84859,AK,SHOP (Small Group),Yes,93-0242990,84859AK0040001,EHB Low PPO,84859AK004,,AKN001,AKS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.00,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,84859AK0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AK,84859,HIOS,2,2014-08-07 10:00:19,1,84859,AK,SHOP (Small Group),Yes,93-0242990,84859AK0030002,EHB High Passive,84859AK003,,AKN001,AKS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$74.68,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,84859AK0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AK,84859,HIOS,2,2014-08-07 10:00:19,1,84859,AK,SHOP (Small Group),Yes,93-0242990,84859AK0030001,EHB Low Passive,84859AK003,,AKN001,AKS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$51.35,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,84859AK0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AK,96211,HIOS,3,2014-09-03 04:28:59,1,96211,AK,SHOP (Small Group),Yes,44-0308260,96211AK0010001,KCL EHB Low PPO,96211AK001,,AKN001,AKS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$77.15,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,96211AK0010001-00,Standard Low Off Exchange Plan,71.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$175,Not Applicable,,,,,$175,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AK,96211,HIOS,3,2014-09-03 04:28:59,1,96211,AK,SHOP (Small Group),Yes,44-0308260,96211AK0010005,KCL Fam Low PPO,96211AK001,,AKN001,AKS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$77.15,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,96211AK0010005-00,Standard Low Off Exchange Plan,71.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$175,Not Applicable,,,,,$175,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AK,96211,HIOS,3,2014-09-03 04:28:59,2,96211,AK,SHOP (Small Group),Yes,44-0308260,96211AK0010002,KCL EHB High PPO,96211AK001,,AKN001,AKS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$92.60,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,96211AK0010002-00,Standard High Off Exchange Plan,84.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AK,96211,HIOS,3,2014-09-03 04:28:59,2,96211,AK,SHOP (Small Group),Yes,44-0308260,96211AK0010006,KCL Fam High PPO,96211AK001,,AKN001,AKS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$92.60,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,96211AK0010006-00,Standard High Off Exchange Plan,84.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,1,12538,AL,SHOP (Small Group),Yes,95-6042390,12538AL0010001,BEST Life Child Dental Plus,12538AL001,,ALN001,ALS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.83,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BEST_Life_Child_Dental_Plus_Plan.pdf,,12538AL0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,1,12538,AL,Individual,Yes,95-6042390,12538AL0020001,BESTOne Child Dental Plus,12538AL002,,ALN001,ALS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$33.54,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BESTOne_Child_Dental_Plus_Plan.pdf,,12538AL0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,2,12538,AL,Individual,Yes,95-6042390,12538AL0020002,BESTOne Child Dental,12538AL002,,ALN001,ALS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.96,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BESTOne_Child_Dental_Plan.pdf,,12538AL0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,2,12538,AL,SHOP (Small Group),Yes,95-6042390,12538AL0010002,BEST Life Child Dental,12538AL001,,ALN001,ALS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$20.76,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BEST_Life_Child_Dental_Plan.pdf,,12538AL0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,3,12538,AL,SHOP (Small Group),Yes,95-6042390,12538AL0010007,BEST Dental Premium,12538AL001,,ALN001,ALS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.83,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BESTDental_Premium_Plan.pdf,,12538AL0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,3,12538,AL,Individual,Yes,95-6042390,12538AL0020003,BESTOne Dental Advantage-Gold,12538AL002,,ALN001,ALS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.54,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BESTOne_Dental_Advantage-Gold_Plan.pdf,,12538AL0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,3,12538,AL,Individual,Yes,95-6042390,12538AL0020003,BESTOne Dental Advantage-Gold,12538AL002,,ALN001,ALS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.54,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BESTOne_Dental_Advantage-Gold_Plan.pdf,,12538AL0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,3,12538,AL,SHOP (Small Group),Yes,95-6042390,12538AL0010007,BEST Dental Premium,12538AL001,,ALN001,ALS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.83,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BESTDental_Premium_Plan.pdf,,12538AL0010007-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,3,12538,AL,SHOP (Small Group),Yes,95-6042390,12538AL0010008,BEST Dental Standard-H,12538AL001,,ALN001,ALS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.83,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BESTDental_Standard-H_Plan.pdf,,12538AL0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,3,12538,AL,Individual,Yes,95-6042390,12538AL0020004,BESTOne Dental Plus-Gold,12538AL002,,ALN001,ALS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.54,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BESTOne_Dental_Plus-Gold_Plan.pdf,,12538AL0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,3,12538,AL,Individual,Yes,95-6042390,12538AL0020004,BESTOne Dental Plus-Gold,12538AL002,,ALN001,ALS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.54,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BESTOne_Dental_Plus-Gold_Plan.pdf,,12538AL0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,3,12538,AL,SHOP (Small Group),Yes,95-6042390,12538AL0010008,BEST Dental Standard-H,12538AL001,,ALN001,ALS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.83,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BESTDental_Standard-H_Plan.pdf,,12538AL0010008-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,3,12538,AL,SHOP (Small Group),Yes,95-6042390,12538AL0010010,BEST Dental Choice-H,12538AL001,,ALN001,ALS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.83,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BESTDental_Choice-H_Plan.pdf,,12538AL0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,3,12538,AL,SHOP (Small Group),Yes,95-6042390,12538AL0010010,BEST Dental Choice-H,12538AL001,,ALN001,ALS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.83,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BESTDental_Choice-H_Plan.pdf,,12538AL0010010-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,4,12538,AL,SHOP (Small Group),Yes,95-6042390,12538AL0010009,BEST Dental Standard-L,12538AL001,,ALN001,ALS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.76,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BESTDental_Standard-L_Plan.pdf,,12538AL0010009-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,4,12538,AL,Individual,Yes,95-6042390,12538AL0020005,BESTOne Dental Plus-Silver,12538AL002,,ALN001,ALS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.96,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BESTOne_Dental_Plus-Silver_Plan.pdf,,12538AL0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,4,12538,AL,Individual,Yes,95-6042390,12538AL0020005,BESTOne Dental Plus-Silver,12538AL002,,ALN001,ALS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.96,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BESTOne_Dental_Plus-Silver_Plan.pdf,,12538AL0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,4,12538,AL,SHOP (Small Group),Yes,95-6042390,12538AL0010009,BEST Dental Standard-L,12538AL001,,ALN001,ALS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.76,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BESTDental_Standard-L_Plan.pdf,,12538AL0010009-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,4,12538,AL,SHOP (Small Group),Yes,95-6042390,12538AL0010011,BEST Dental Choice-L,12538AL001,,ALN001,ALS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.76,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BESTDental_Choice-L_Plan.pdf,,12538AL0010011-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,4,12538,AL,Individual,Yes,95-6042390,12538AL0020006,BESTOne Dental Basic-Silver,12538AL002,,ALN001,ALS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.96,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BESTOne_Dental_Basic-Silver_Plan.pdf,,12538AL0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,4,12538,AL,Individual,Yes,95-6042390,12538AL0020006,BESTOne Dental Basic-Silver,12538AL002,,ALN001,ALS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.96,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BESTOne_Dental_Basic-Silver_Plan.pdf,,12538AL0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,4,12538,AL,SHOP (Small Group),Yes,95-6042390,12538AL0010011,BEST Dental Choice-L,12538AL001,,ALN001,ALS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.76,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BESTDental_Choice-L_Plan.pdf,,12538AL0010011-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,4,12538,AL,SHOP (Small Group),Yes,95-6042390,12538AL0010012,BEST Dental Value,12538AL001,,ALN001,ALS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.76,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BESTDental_Value_Plan.pdf,,12538AL0010012-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,AL,12538,HIOS,5,2014-10-02 12:25:15,4,12538,AL,SHOP (Small Group),Yes,95-6042390,12538AL0010012,BEST Dental Value,12538AL001,,ALN001,ALS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.76,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AL/2015/AL_BESTDental_Value_Plan.pdf,,12538AL0010012-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,AL,17017,HIOS,3,2014-08-03 08:59:32,1,17017,AL,SHOP (Small Group),Yes,57-0523959,17017AL0010001,Group Pediatric EHB Rider,17017AL001,,ALN001,ALS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$27.04,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,17017AL0010001-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,17017,HIOS,3,2014-08-03 08:59:32,1,17017,AL,SHOP (Small Group),Yes,57-0523959,17017AL0010002,Group Pediatric EHB Rider,17017AL001,,ALN001,ALS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$22.16,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,17017AL0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,17540,HIOS,4,2014-08-27 03:27:11,1,17540,AL,SHOP (Small Group),Yes,13-5123390,17540AL0010002,Guardian Pediatric Advantage,17540AL001,,ALN001,ALS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.49,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,17540AL0010002-00,Standard High Off Exchange Plan,84.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,17540,HIOS,4,2014-08-27 03:27:11,1,17540,AL,SHOP (Small Group),Yes,13-5123390,17540AL0020002,Guardian Pediatric Essentials,17540AL002,,ALN001,ALS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$18.96,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,17540AL0020002-00,Standard Low Off Exchange Plan,70.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,17540,HIOS,4,2014-08-27 03:27:11,2,17540,AL,SHOP (Small Group),Yes,13-5123390,17540AL0040002,Guardian Family Advantage,17540AL004,,ALN001,ALS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.49,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,17540AL0040002-00,Standard High Off Exchange Plan,84.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,17540,HIOS,4,2014-08-27 03:27:11,2,17540,AL,SHOP (Small Group),Yes,13-5123390,17540AL0040002,Guardian Family Advantage,17540AL004,,ALN001,ALS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.49,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,17540AL0040002-01,Standard High On Exchange Plan,84.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,17540,HIOS,4,2014-08-27 03:27:11,2,17540,AL,SHOP (Small Group),Yes,13-5123390,17540AL0060002,Guardian Family Essentials,17540AL006,,ALN001,ALS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.96,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,17540AL0060002-00,Standard Low Off Exchange Plan,70.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AL,17540,HIOS,4,2014-08-27 03:27:11,2,17540,AL,SHOP (Small Group),Yes,13-5123390,17540AL0060002,Guardian Family Essentials,17540AL006,,ALN001,ALS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.96,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,17540AL0060002-01,Standard Low On Exchange Plan,70.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AL,18756,HIOS,2,2014-08-05 13:28:44,1,18756,AL,SHOP (Small Group),Yes,13-5581829,18756AL0140001,EHB Basic Dental Plan (Low),18756AL014,,ALN001,ALS001,,New,PPO,Low,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$16.48,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,18756AL0140001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,24682,HIOS,2,2014-08-07 10:00:19,1,24682,AL,SHOP (Small Group),Yes,44-0308260,24682AL0010001,KCL EHB Low PPO,24682AL001,,ALN001,ALS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$31.55,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,24682AL0010001-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,24682,HIOS,2,2014-08-07 10:00:19,1,24682,AL,SHOP (Small Group),Yes,44-0308260,24682AL0010003,KCL EHB Low MAC,24682AL001,,ALN001,ALS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$24.24,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,24682AL0010003-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,24682,HIOS,2,2014-08-07 10:00:19,1,24682,AL,SHOP (Small Group),Yes,44-0308260,24682AL0010005,KCL Fam Low PPO,24682AL001,,ALN001,ALS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$31.55,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,24682AL0010005-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AL,24682,HIOS,2,2014-08-07 10:00:19,1,24682,AL,SHOP (Small Group),Yes,44-0308260,24682AL0010007,KCL Fam Low MAC,24682AL001,,ALN001,ALS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$24.24,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,24682AL0010007-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AL,24682,HIOS,2,2014-08-07 10:00:19,2,24682,AL,SHOP (Small Group),Yes,44-0308260,24682AL0010002,KCL EHB High PPO,24682AL001,,ALN001,ALS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$37.50,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,24682AL0010002-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,24682,HIOS,2,2014-08-07 10:00:19,2,24682,AL,SHOP (Small Group),Yes,44-0308260,24682AL0010004,KCL EHB High MAC,24682AL001,,ALN001,ALS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$29.24,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,24682AL0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,24682,HIOS,2,2014-08-07 10:00:19,2,24682,AL,SHOP (Small Group),Yes,44-0308260,24682AL0010006,KCL Fam High PPO,24682AL001,,ALN001,ALS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$37.50,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,24682AL0010006-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AL,24682,HIOS,2,2014-08-07 10:00:19,2,24682,AL,SHOP (Small Group),Yes,44-0308260,24682AL0010008,KCL Fam High MAC,24682AL001,,ALN001,ALS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$29.24,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,24682AL0010008-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AL,28725,HIOS,2,2014-08-08 08:53:29,1,28725,AL,Individual,Yes,47-0397286,28725AL0080001,"Delta Dental Individual PPO, EHB Certified",28725AL008,,ALN002,ALS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.28,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28725AL0080001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,28725,HIOS,2,2014-08-08 08:53:29,1,28725,AL,SHOP (Small Group),Yes,47-0397286,28725AL0090001,"Renaissance Group Dental PPO, EHB Certified",28725AL009,,ALN001,ALS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.37,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28725AL0090001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,28725,HIOS,2,2014-08-08 08:53:29,1,28725,AL,SHOP (Small Group),Yes,47-0397286,28725AL0090002,"Renaissance Group Dental PPO, EHB Certified",28725AL009,,ALN001,ALS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.53,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28725AL0090002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,28725,HIOS,2,2014-08-08 08:53:29,1,28725,AL,Individual,Yes,47-0397286,28725AL0080002,"Delta Dental Individual PPO, EHB Certified",28725AL008,,ALN002,ALS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.46,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28725AL0080002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,28725,HIOS,2,2014-08-08 08:53:29,1,28725,AL,Individual,Yes,47-0397286,28725AL0100001,"Renaissance Individual Dental PPO, EHB Certified",28725AL010,,ALN001,ALS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.74,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28725AL0100001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AL,28725,HIOS,2,2014-08-08 08:53:29,1,28725,AL,Individual,Yes,47-0397286,28725AL0100002,"Renaissance Individual Dental PPO, EHB Certified",28725AL010,,ALN001,ALS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.32,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28725AL0100002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AL,28732,HIOS,2,2014-08-05 13:28:44,1,28732,AL,SHOP (Small Group),Yes,36-0883760,28732AL0040002,EHB High PPO,28732AL004,,ALN001,ALS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.15,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,28732AL0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,28732,HIOS,2,2014-08-05 13:28:44,1,28732,AL,SHOP (Small Group),Yes,36-0883760,28732AL0040001,EHB Low PPO,28732AL004,,ALN001,ALS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$15.03,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,28732AL0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,28732,HIOS,2,2014-08-05 13:28:44,1,28732,AL,SHOP (Small Group),Yes,36-0883760,28732AL0030002,EHB High Passive,28732AL003,,ALN001,ALS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.97,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,28732AL0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AL,28732,HIOS,2,2014-08-05 13:28:44,1,28732,AL,SHOP (Small Group),Yes,36-0883760,28732AL0030001,EHB Low Passive,28732AL003,,ALN001,ALS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.52,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,28732AL0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AL,28899,HIOS,2,2014-08-03 08:59:32,1,28899,AL,SHOP (Small Group),Yes,47-0098400,28899AL0040002,EHB High PPO,28899AL004,,ALN001,ALS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.71,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,28899AL0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,28899,HIOS,2,2014-08-03 08:59:32,1,28899,AL,SHOP (Small Group),Yes,47-0098400,28899AL0040001,EHB Low PPO,28899AL004,,ALN001,ALS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$14.82,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,28899AL0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,28899,HIOS,2,2014-08-03 08:59:32,1,28899,AL,SHOP (Small Group),Yes,47-0098400,28899AL0030002,EHB High Passive,28899AL003,,ALN001,ALS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.50,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,28899AL0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AL,28899,HIOS,2,2014-08-03 08:59:32,1,28899,AL,SHOP (Small Group),Yes,47-0098400,28899AL0030001,EHB Low Passive,28899AL003,,ALN001,ALS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.26,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,28899AL0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AL,39951,HIOS,3,2014-09-05 03:32:16,1,39951,AL,SHOP (Small Group),Yes,81-0170040,39951AL0010001,Assurant Dental ACAFFO High,39951AL001,,ALN001,ALS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.68,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same coverage as in service area,Yes,,,,,39951AL0010001-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,39951,HIOS,3,2014-09-05 03:32:16,2,39951,AL,SHOP (Small Group),Yes,81-0170040,39951AL0010002,Assurant Dental ACAFFO Low,39951AL001,,ALN001,ALS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.60,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same coverage as in service area,Yes,,,,,39951AL0010002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,2,44580,AL,Individual,No,39-1263473,44580AL0360001,Humana Basic 6600/Birmingham PPOx,44580AL036,,ALN001,ALS001,ALF001,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338479,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330458,http://apps.humana.com/marketing/documents.asp?file=2323880,44580AL0360001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,2,44580,AL,Individual,No,39-1263473,44580AL0360001,Humana Basic 6600/Birmingham PPOx,44580AL036,,ALN001,ALS001,ALF001,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338479,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330458,http://apps.humana.com/marketing/documents.asp?file=2323880,44580AL0360001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,5,46944,AL,SHOP (Small Group),No,63-0103830,46944AL0430001,Blue Saver Bronze for Business,46944AL043,,ALN001,ALS001,ALF010,Existing,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.bcbsal.org/2015/BlueSaverBronze?frm=Shop,https://sso.bcbsal.org/sp/ACS.saml2,https://www.bcbsal.org/2015/BlueSaverBronze?frm=Shop,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0430001-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",40%,,,,"$4,200","$8,400",Not Applicable,Not Applicable,"$4,200",$20,"$1,200",$200,"$1,600",$900,$0,$400,5
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,5,46944,AL,Individual,No,63-0103830,46944AL0420001,Blue Saver Silver,46944AL042,,ALN001,ALS001,ALF009,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueSaverSilver?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueSaverSilver?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0420001-01,Standard Silver On Exchange Plan,68.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$20,$900,$200,$500,"$1,200",$0,$400,5
2015,AL,68707,HIOS,2,2014-08-03 08:59:32,1,68707,AL,SHOP (Small Group),Yes,93-0242990,68707AL0040002,EHB High PPO,68707AL004,,ALN001,ALS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.25,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,68707AL0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,68707,HIOS,2,2014-08-03 08:59:32,1,68707,AL,SHOP (Small Group),Yes,93-0242990,68707AL0040001,EHB Low PPO,68707AL004,,ALN001,ALS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$15.07,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,68707AL0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,68707,HIOS,2,2014-08-03 08:59:32,1,68707,AL,SHOP (Small Group),Yes,93-0242990,68707AL0030002,EHB High Passive,68707AL003,,ALN001,ALS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.07,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,68707AL0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,4,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160022,PPO Silver 30%/30%/$1500,51485AZ016,,AZN001,AZS001,AZF008,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_30_30_1500_6000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_30_30_1500_6000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160022-01,Standard Silver On Exchange Plan,69.30%,0.692543804645538,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,4,51485,AZ,Individual,No,73-0654885,51485AZ0170015,PPO Silver 30%/30%/$1500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF006,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170015-05,87% AV Level Silver Plan,,0.868454873561859,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$350,$700,20%,,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,4,51485,AZ,Individual,No,73-0654885,51485AZ0170015,PPO Silver 30%/30%/$1500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF006,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170015-06,94% AV Level Silver Plan,,0.947218537330627,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$25,$50,10%,,,,$50,$100,Not Applicable,Not Applicable,,,,,,,,,10
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,4,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160023,PPO Silver 30%/30%/$2000,51485AZ016,,AZN001,AZS001,AZF008,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_30_30_2000_5500_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_30_30_2000_5500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160023-00,Standard Silver Off Exchange Plan,68.15%,0.681479394435883,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,4,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160023,PPO Silver 30%/30%/$2000,51485AZ016,,AZN001,AZS001,AZF008,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_30_30_2000_5500_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_30_30_2000_5500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160023-01,Standard Silver On Exchange Plan,68.15%,0.681479394435883,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,4,51485,AZ,Individual,No,73-0654885,51485AZ0170016,PPO Bronze 50%/50%/$5500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF013,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,1,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_bronze_50_50_5500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_bronze_50_50_5500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170016-00,Standard Bronze Off Exchange Plan,,0.59587574005127,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,6,46944,AL,Individual,No,63-0103830,46944AL0460001,Blue Saver Bronze,46944AL046,,ALN001,ALS001,ALF011,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueSaverBronze?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueSaverBronze?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0460001-01,Standard Bronze On Exchange Plan,60.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$6,350","$12,700",Not Applicable,Not Applicable,"$6,400",$0,$0,$200,"$1,600",$900,$0,$400,5
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,6,46944,AL,Individual,No,63-0103830,46944AL0460001,Blue Saver Bronze,46944AL046,,ALN001,ALS001,ALF011,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueSaverBronze?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueSaverBronze?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0460001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$400,6
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,6,46944,AL,Individual,No,63-0103830,46944AL0460001,Blue Saver Bronze,46944AL046,,ALN001,ALS001,ALF011,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueSaverBronze?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueSaverBronze?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0460001-03,Limited Cost Sharing Plan Variation,60.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$6,350","$12,700",Not Applicable,Not Applicable,"$6,400",$0,$0,$200,"$1,600",$900,$0,$400,7
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,7,46944,AL,Individual,No,63-0103830,46944AL0470001,Blue Protect,46944AL047,,ALN001,ALS001,ALF012,Existing,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueProtect?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueProtect?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0470001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$6,600","$13,200",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$4,400",$200,$0,$400,4
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,7,46944,AL,Individual,No,63-0103830,46944AL0470001,Blue Protect,46944AL047,,ALN001,ALS001,ALF012,Existing,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueProtect?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueProtect?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0470001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$6,600","$13,200",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$4,400",$200,$0,$400,5
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,8,46944,AL,Individual,No,63-0103830,46944AL0560001,Blue HSA Bronze,46944AL056,,ALN001,ALS001,ALF015,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueHSABronze?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueHSABronze?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0560001-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$200,"$5,000",$0,$0,$400,4
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,8,46944,AL,Individual,No,63-0103830,46944AL0560001,Blue HSA Bronze,46944AL056,,ALN001,ALS001,ALF015,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueHSABronze?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueHSABronze?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0560001-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$200,"$5,000",$0,$0,$400,5
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,8,46944,AL,Individual,No,63-0103830,46944AL0560001,Blue HSA Bronze,46944AL056,,ALN001,ALS001,ALF015,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueHSABronze?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueHSABronze?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0560001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$400,6
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,8,46944,AL,Individual,No,63-0103830,46944AL0560001,Blue HSA Bronze,46944AL056,,ALN001,ALS001,ALF015,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueHSABronze?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueHSABronze?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0560001-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$200,"$5,000",$0,$0,$400,7
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,1,68259,AL,Individual,No,63-0899562,68259AL0030004,UnitedHealthcare Gold Compass HSA 1300,68259AL003,,ALN006,ALS001,ALF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030004-00,Standard Gold Off Exchange Plan,79.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,AL,77233,HIOS,8,2014-11-14 05:23:27,1,77233,AL,Individual,Yes,75-1233841,77233AL0010001,Dentegra Dental PPO Pediatric Basic Plan,77233AL001,,ALN001,ALS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$19.89,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/al/77233al0010001-15,,77233AL0010001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,77233,HIOS,8,2014-11-14 05:23:27,1,77233,AL,SHOP (Small Group),Yes,75-1233841,77233AL0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,77233AL002,,ALN001,ALS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.68,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/al/77233al0020001-15,,77233AL0020001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,77233,HIOS,8,2014-11-14 05:23:27,2,77233,AL,SHOP (Small Group),Yes,75-1233841,77233AL0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,77233AL002,,ALN001,ALS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.27,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/al/77233al0020004-15,,77233AL0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360003,Humana Silver 4600/Birmingham PPOx,44580AL036,,ALN001,ALS001,ALF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2330484,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2338687,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360003,Humana Silver 4600/Birmingham PPOx,44580AL036,,ALN001,ALS001,ALF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2330484,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2338687,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360003-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360003,Humana Silver 4600/Birmingham PPOx,44580AL036,,ALN001,ALS001,ALF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2330484,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2338687,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360003-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360003,Humana Silver 4600/Birmingham PPOx,44580AL036,,ALN001,ALS001,ALF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2330484,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2338687,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360003-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$25,200","$50,400",Not Applicable,Not Applicable,$900,"$1,800",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360003,Humana Silver 4600/Birmingham PPOx,44580AL036,,ALN001,ALS001,ALF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2330484,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2338687,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360003-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$25,200","$50,400",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,$250,$500,50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360004,Humana Gold 2500/Birmingham PPOx,44580AL036,,ALN001,ALS001,ALF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338557,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330536,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360004-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360004,Humana Gold 2500/Birmingham PPOx,44580AL036,,ALN001,ALS001,ALF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338557,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330536,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360004-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360004,Humana Gold 2500/Birmingham PPOx,44580AL036,,ALN001,ALS001,ALF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338557,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330536,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360004,Humana Gold 2500/Birmingham PPOx,44580AL036,,ALN001,ALS001,ALF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338557,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330536,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360004-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360005,Humana Platinum 1000/Birmingham PPOx,44580AL036,,ALN001,ALS001,ALF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338609,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330549,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360005-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360005,Humana Platinum 1000/Birmingham PPOx,44580AL036,,ALN001,ALS001,ALF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338609,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330549,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360005-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360005,Humana Platinum 1000/Birmingham PPOx,44580AL036,,ALN001,ALS001,ALF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338609,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330549,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360005,Humana Platinum 1000/Birmingham PPOx,44580AL036,,ALN001,ALS001,ALF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338609,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330549,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360005-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360013,Humana Silver 4600/Huntsville PPOx,44580AL036,,ALN002,ALS002,ALF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338700,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330588,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360013-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360013,Humana Silver 4600/Huntsville PPOx,44580AL036,,ALN002,ALS002,ALF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338700,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330588,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360013-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$25,200","$50,400",Not Applicable,Not Applicable,$900,"$1,800",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360013,Humana Silver 4600/Huntsville PPOx,44580AL036,,ALN002,ALS002,ALF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338700,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330588,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360013-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$25,200","$50,400",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,$250,$500,50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360014,Humana Gold 2500/Huntsville PPOx,44580AL036,,ALN002,ALS002,ALF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338583,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330640,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360014-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360014,Humana Gold 2500/Huntsville PPOx,44580AL036,,ALN002,ALS002,ALF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338583,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330640,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360014-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360014,Humana Gold 2500/Huntsville PPOx,44580AL036,,ALN002,ALS002,ALF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338583,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330640,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,28
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360014,Humana Gold 2500/Huntsville PPOx,44580AL036,,ALN002,ALS002,ALF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338583,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330640,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360014-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360015,Humana Platinum 1000/Huntsville PPOx,44580AL036,,ALN002,ALS002,ALF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338635,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330653,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360015-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360015,Humana Platinum 1000/Huntsville PPOx,44580AL036,,ALN002,ALS002,ALF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338635,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330653,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360015-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360015,Humana Platinum 1000/Huntsville PPOx,44580AL036,,ALN002,ALS002,ALF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338635,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330653,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,32
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,1,44580,AL,Individual,No,39-1263473,44580AL0360015,Humana Platinum 1000/Huntsville PPOx,44580AL036,,ALN002,ALS002,ALF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338635,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330653,http://apps.humana.com/marketing/documents.asp?file=2323815,44580AL0360015-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,2,44580,AL,Individual,No,39-1263473,44580AL0360002,Humana Bronze 6300/Birmingham PPOx,44580AL036,,ALN001,ALS001,ALF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338531,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330471,http://apps.humana.com/marketing/documents.asp?file=2323880,44580AL0360002-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,6
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,2,44580,AL,Individual,No,39-1263473,44580AL0360002,Humana Bronze 6300/Birmingham PPOx,44580AL036,,ALN001,ALS001,ALF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338531,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330471,http://apps.humana.com/marketing/documents.asp?file=2323880,44580AL0360002-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,2,44580,AL,Individual,No,39-1263473,44580AL0360002,Humana Bronze 6300/Birmingham PPOx,44580AL036,,ALN001,ALS001,ALF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338531,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330471,http://apps.humana.com/marketing/documents.asp?file=2323880,44580AL0360002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,2,44580,AL,Individual,No,39-1263473,44580AL0360002,Humana Bronze 6300/Birmingham PPOx,44580AL036,,ALN001,ALS001,ALF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338531,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330471,http://apps.humana.com/marketing/documents.asp?file=2323880,44580AL0360002-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,9
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,2,44580,AL,Individual,No,39-1263473,44580AL0360011,Humana Basic 6600/Huntsville PPOx,44580AL036,,ALN002,ALS002,ALF001,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338505,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330562,http://apps.humana.com/marketing/documents.asp?file=2323880,44580AL0360011-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,10
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,2,44580,AL,Individual,No,39-1263473,44580AL0360011,Humana Basic 6600/Huntsville PPOx,44580AL036,,ALN002,ALS002,ALF001,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338505,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330562,http://apps.humana.com/marketing/documents.asp?file=2323880,44580AL0360011-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,11
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,2,44580,AL,Individual,No,39-1263473,44580AL0360012,Humana Bronze 6300/Huntsville PPOx,44580AL036,,ALN002,ALS002,ALF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338544,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330575,http://apps.humana.com/marketing/documents.asp?file=2323880,44580AL0360012-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,12
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,2,44580,AL,Individual,No,39-1263473,44580AL0360012,Humana Bronze 6300/Huntsville PPOx,44580AL036,,ALN002,ALS002,ALF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338544,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330575,http://apps.humana.com/marketing/documents.asp?file=2323880,44580AL0360012-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,13
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,2,44580,AL,Individual,No,39-1263473,44580AL0360012,Humana Bronze 6300/Huntsville PPOx,44580AL036,,ALN002,ALS002,ALF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338544,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330575,http://apps.humana.com/marketing/documents.asp?file=2323880,44580AL0360012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,AL,44580,HIOS,16,2015-01-16 17:32:32,2,44580,AL,Individual,No,39-1263473,44580AL0360012,Humana Bronze 6300/Huntsville PPOx,44580AL036,,ALN002,ALS002,ALF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2338544,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330575,http://apps.humana.com/marketing/documents.asp?file=2323880,44580AL0360012-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,15
2015,AL,46211,HIOS,3,2014-09-04 03:25:43,1,46211,AL,SHOP (Small Group),Yes,35-0472300,46211AL0010001,Lincoln Dental Connect?,46211AL001,,ALN001,ALS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.48,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,46211AL0010001-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,46211,HIOS,3,2014-09-04 03:25:43,1,46211,AL,SHOP (Small Group),Yes,35-0472300,46211AL0010002,Lincoln Dental Connect?,46211AL001,,ALN001,ALS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.41,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,46211AL0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,46211,HIOS,3,2014-09-04 03:25:43,1,46211,AL,SHOP (Small Group),Yes,35-0472300,46211AL0010003,Lincoln Dental Connect?,46211AL001,,ALN001,ALS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.14,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,46211AL0010003-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AL,46211,HIOS,3,2014-09-04 03:25:43,1,46211,AL,SHOP (Small Group),Yes,35-0472300,46211AL0010005,Lincoln Dental Connect?,46211AL001,,ALN001,ALS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.67,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,46211AL0010005-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AL,46211,HIOS,3,2014-09-04 03:25:43,1,46211,AL,SHOP (Small Group),Yes,35-0472300,46211AL0010006,Lincoln Dental Connect?,46211AL001,,ALN001,ALS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.56,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,46211AL0010006-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,AL,46211,HIOS,3,2014-09-04 03:25:43,1,46211,AL,SHOP (Small Group),Yes,35-0472300,46211AL0010007,Lincoln Dental Connect?,46211AL001,,ALN001,ALS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.89,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,46211AL0010007-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,AL,46211,HIOS,3,2014-09-04 03:25:43,2,46211,AL,SHOP (Small Group),Yes,35-0472300,46211AL0010004,Lincoln Dental Connect?,46211AL001,,ALN001,ALS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.05,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,46211AL0010004-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,46211,HIOS,3,2014-09-04 03:25:43,2,46211,AL,SHOP (Small Group),Yes,35-0472300,46211AL0010008,Lincoln Dental Connect?,46211AL001,,ALN001,ALS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.73,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,46211AL0010008-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,1,46944,AL,Individual,No,63-0103830,46944AL0300001,Blue Choice Platinum,46944AL030,,ALN001,ALS001,ALF001,Existing,PPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.998,,,5,0,0,2015-01-01,,Yes,"If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueChoicePlatinum?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueChoicePlatinum?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_635_StandardPrescriptionDL.pdf,46944AL0300001-00,Standard Platinum Off Exchange Plan,88.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,$100,$200,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$300,$0,$200,$0,$800,$0,$400,4
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,1,46944,AL,SHOP (Small Group),No,63-0103830,46944AL0280001,Blue Choice Platinum for Business,46944AL028,,ALN001,ALS001,ALF002,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.998,,,5,0,0,2015-01-01,,Yes,"If a PPO Provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO Provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.bcbsal.org/2015/BlueChoicePlatinum?frm=Shop,https://sso.bcbsal.org/sp/ACS.saml2,https://www.bcbsal.org/2015/BlueChoicePlatinum?frm=Shop,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_635_StandardPrescriptionDL.pdf,46944AL0280001-00,Standard Platinum Off Exchange Plan,88.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,$100,$200,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$300,$0,$200,$20,$800,$0,$400,4
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,1,46944,AL,Individual,Yes,63-0103830,46944AL0500001,Dental Blue Plus,46944AL050,,ALN002,ALS002,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.00,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Benefits are paid toward the lesser of the allowed amount or the dentist's actual charge for the service.,No,,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/DentalBluePlus?frm=Exchange,,46944AL0500001-01,Standard Low On Exchange Plan,69.34%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,1,46944,AL,SHOP (Small Group),Yes,63-0103830,46944AL0530001,Dental Blue Plus for Business,46944AL053,,ALN002,ALS002,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.00,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Benefits are paid toward the lesser of the allowed amount or the dentist's actual charge for the service,Yes,,https://sso.bcbsal.org/sp/ACS.saml2,https://www.bcbsal.org/2015/DentalBluePlusForBusiness?frm=Shop,,46944AL0530001-01,Standard Low On Exchange Plan,69.34%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,1,46944,AL,SHOP (Small Group),No,63-0103830,46944AL0280001,Blue Choice Platinum for Business,46944AL028,,ALN001,ALS001,ALF002,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.998,,,5,0,0,2015-01-01,,Yes,"If a PPO Provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO Provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.bcbsal.org/2015/BlueChoicePlatinum?frm=Shop,https://sso.bcbsal.org/sp/ACS.saml2,https://www.bcbsal.org/2015/BlueChoicePlatinum?frm=Shop,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_635_StandardPrescriptionDL.pdf,46944AL0280001-01,Standard Platinum On Exchange Plan,88.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,$100,$200,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$300,$0,$200,$20,$800,$0,$400,5
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,1,46944,AL,Individual,No,63-0103830,46944AL0300001,Blue Choice Platinum,46944AL030,,ALN001,ALS001,ALF001,Existing,PPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.998,,,5,0,0,2015-01-01,,Yes,"If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueChoicePlatinum?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueChoicePlatinum?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_635_StandardPrescriptionDL.pdf,46944AL0300001-01,Standard Platinum On Exchange Plan,88.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,$100,$200,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$300,$0,$200,$0,$800,$0,$400,5
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,1,46944,AL,Individual,No,63-0103830,46944AL0300001,Blue Choice Platinum,46944AL030,,ALN001,ALS001,ALF001,Existing,PPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.998,,,5,0,0,2015-01-01,,Yes,"If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueChoicePlatinum?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueChoicePlatinum?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_635_StandardPrescriptionDL.pdf,46944AL0300001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$400,6
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,1,46944,AL,Individual,No,63-0103830,46944AL0300001,Blue Choice Platinum,46944AL030,,ALN001,ALS001,ALF001,Existing,PPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.998,,,5,0,0,2015-01-01,,Yes,"If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueChoicePlatinum?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueChoicePlatinum?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_635_StandardPrescriptionDL.pdf,46944AL0300001-03,Limited Cost Sharing Plan Variation,88.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,$100,$200,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$300,$0,$200,$0,$800,$0,$400,7
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,2,46944,AL,Individual,No,63-0103830,46944AL0360001,Blue Access Gold,46944AL036,,ALN001,ALS001,ALF003,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueAccessGold?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueAccessGold?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_635_StandardPrescriptionDL.pdf,46944AL0360001-00,Standard Gold Off Exchange Plan,78.80%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,$500,"$1,000",20%,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$400,$0,$200,$20,"$1,200",$0,$400,4
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,2,46944,AL,SHOP (Small Group),No,63-0103830,46944AL0340001,Blue Access Gold for Business,46944AL034,,ALN001,ALS001,ALF004,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.bcbsal.org/2015/BlueAccessGold?frm=Shop,https://sso.bcbsal.org/sp/ACS.saml2,https://www.bcbsal.org/2015/BlueAccessGold?frm=Shop,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_635_StandardPrescriptionDL.pdf,46944AL0340001-00,Standard Gold Off Exchange Plan,78.80%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,$500,"$1,000",20%,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$400,$0,$200,$20,"$1,200",$0,$400,4
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,2,46944,AL,SHOP (Small Group),No,63-0103830,46944AL0340001,Blue Access Gold for Business,46944AL034,,ALN001,ALS001,ALF004,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.bcbsal.org/2015/BlueAccessGold?frm=Shop,https://sso.bcbsal.org/sp/ACS.saml2,https://www.bcbsal.org/2015/BlueAccessGold?frm=Shop,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_635_StandardPrescriptionDL.pdf,46944AL0340001-01,Standard Gold On Exchange Plan,78.80%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,$500,"$1,000",20%,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$400,$0,$200,$20,"$1,200",$0,$400,5
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,2,46944,AL,Individual,No,63-0103830,46944AL0360001,Blue Access Gold,46944AL036,,ALN001,ALS001,ALF003,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueAccessGold?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueAccessGold?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_635_StandardPrescriptionDL.pdf,46944AL0360001-01,Standard Gold On Exchange Plan,78.80%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,$500,"$1,000",20%,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$400,$0,$200,$20,"$1,200",$0,$400,5
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,2,46944,AL,Individual,No,63-0103830,46944AL0360001,Blue Access Gold,46944AL036,,ALN001,ALS001,ALF003,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueAccessGold?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueAccessGold?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_635_StandardPrescriptionDL.pdf,46944AL0360001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$400,6
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,2,46944,AL,Individual,No,63-0103830,46944AL0360001,Blue Access Gold,46944AL036,,ALN001,ALS001,ALF003,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueAccessGold?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueAccessGold?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_635_StandardPrescriptionDL.pdf,46944AL0360001-03,Limited Cost Sharing Plan Variation,78.80%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,$500,"$1,000",20%,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$400,$0,$200,$20,"$1,200",$0,$400,7
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,3,46944,AL,Individual,No,63-0103830,46944AL0370001,Blue Value Gold,46944AL037,,ALN001,ALS001,ALF005,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueValueGold?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueValueGold?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_635_StandardPrescriptionDL.pdf,46944AL0370001-00,Standard Gold Off Exchange Plan,78.60%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,"$1,200",20%,$600,"$1,200",20%,$600,"$1,200",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$600,$400,$0,$200,$20,"$1,200",$0,$400,4
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,3,46944,AL,SHOP (Small Group),No,63-0103830,46944AL0310001,Blue HSA Gold for Business,46944AL031,,ALN001,ALS001,ALF006,Existing,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.bcbsal.org/2015/BlueHSAGold?frm=Shop,https://sso.bcbsal.org/sp/ACS.saml2,https://www.bcbsal.org/2015/BlueHSAGold?frm=Shop,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_635_StandardPrescriptionDL.pdf,46944AL0310001-00,Standard Gold Off Exchange Plan,,0.781932353973389,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,"$1,500",$0,$600,$200,"$1,500",$0,$400,$400,4
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,3,46944,AL,SHOP (Small Group),No,63-0103830,46944AL0310001,Blue HSA Gold for Business,46944AL031,,ALN001,ALS001,ALF006,Existing,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.bcbsal.org/2015/BlueHSAGold?frm=Shop,https://sso.bcbsal.org/sp/ACS.saml2,https://www.bcbsal.org/2015/BlueHSAGold?frm=Shop,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_635_StandardPrescriptionDL.pdf,46944AL0310001-01,Standard Gold On Exchange Plan,,0.781932353973389,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,"$1,500",$0,$600,$200,"$1,500",$0,$400,$400,5
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,3,46944,AL,Individual,No,63-0103830,46944AL0370001,Blue Value Gold,46944AL037,,ALN001,ALS001,ALF005,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueValueGold?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueValueGold?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_635_StandardPrescriptionDL.pdf,46944AL0370001-01,Standard Gold On Exchange Plan,78.60%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,"$1,200",20%,$600,"$1,200",20%,$600,"$1,200",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$600,$400,$0,$200,$20,"$1,200",$0,$400,5
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,3,46944,AL,Individual,No,63-0103830,46944AL0370001,Blue Value Gold,46944AL037,,ALN001,ALS001,ALF005,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueValueGold?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueValueGold?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_635_StandardPrescriptionDL.pdf,46944AL0370001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$400,6
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,4,68259,AL,Individual,No,63-0899562,68259AL0030002,UnitedHealthcare Gold Compass 1000,68259AL003,,ALN006,ALS001,ALF003,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030002-01,Standard Gold On Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,4,68259,AL,Individual,No,63-0899562,68259AL0030002,UnitedHealthcare Gold Compass 1000,68259AL003,,ALN006,ALS001,ALF003,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,4,68259,AL,Individual,No,63-0899562,68259AL0030002,UnitedHealthcare Gold Compass 1000,68259AL003,,ALN006,ALS001,ALF003,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030002-03,Limited Cost Sharing Plan Variation,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,5,68259,AL,Individual,No,63-0899562,68259AL0030010,UnitedHealthcare Catastrophic Compass 6600,68259AL003,,ALN006,ALS001,ALF002,New,HMO,Catastrophic,No,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030010-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,17454,HIOS,4,2014-08-27 03:27:11,2,17454,AZ,SHOP (Small Group),Yes,13-5123390,17454AZ0040002,Guardian Family Advantage,17454AZ004,,AZN001,AZS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.25,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,17454AZ0040002-01,Standard High On Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,17454,HIOS,4,2014-08-27 03:27:11,2,17454,AZ,SHOP (Small Group),Yes,13-5123390,17454AZ0060002,Guardian Family Essentials,17454AZ006,,AZN001,AZS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.58,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,17454AZ0060002-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AZ,17454,HIOS,4,2014-08-27 03:27:11,2,17454,AZ,SHOP (Small Group),Yes,13-5123390,17454AZ0060002,Guardian Family Essentials,17454AZ006,,AZN001,AZS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.58,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,17454AZ0060002-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AZ,18156,HIOS,3,2014-09-04 03:25:43,1,18156,AZ,SHOP (Small Group),Yes,35-0472300,18156AZ0010001,Lincoln Dental Connect?,18156AZ001,,AZN001,AZS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.24,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,18156AZ0010001-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,18156,HIOS,3,2014-09-04 03:25:43,1,18156,AZ,SHOP (Small Group),Yes,35-0472300,18156AZ0010002,Lincoln Dental Connect?,18156AZ001,,AZN001,AZS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.47,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,18156AZ0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,18156,HIOS,3,2014-09-04 03:25:43,1,18156,AZ,SHOP (Small Group),Yes,35-0472300,18156AZ0010003,Lincoln Dental Connect?,18156AZ001,,AZN001,AZS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.18,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,18156AZ0010003-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AZ,18156,HIOS,3,2014-09-04 03:25:43,1,18156,AZ,SHOP (Small Group),Yes,35-0472300,18156AZ0010005,Lincoln Dental Connect?,18156AZ001,,AZN001,AZS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.85,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,18156AZ0010005-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AZ,18156,HIOS,3,2014-09-04 03:25:43,1,18156,AZ,SHOP (Small Group),Yes,35-0472300,18156AZ0010006,Lincoln Dental Connect?,18156AZ001,,AZN001,AZS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.83,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,18156AZ0010006-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,AZ,18156,HIOS,3,2014-09-04 03:25:43,1,18156,AZ,SHOP (Small Group),Yes,35-0472300,18156AZ0010007,Lincoln Dental Connect?,18156AZ001,,AZN001,AZS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.65,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,18156AZ0010007-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,AZ,18156,HIOS,3,2014-09-04 03:25:43,2,18156,AZ,SHOP (Small Group),Yes,35-0472300,18156AZ0010004,Lincoln Dental Connect?,18156AZ001,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.83,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,18156AZ0010004-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,18156,HIOS,3,2014-09-04 03:25:43,2,18156,AZ,SHOP (Small Group),Yes,35-0472300,18156AZ0010008,Lincoln Dental Connect?,18156AZ001,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.98,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,18156AZ0010008-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,20128,HIOS,5,2014-09-03 04:28:59,1,20128,AZ,SHOP (Small Group),Yes,57-0523959,20128AZ0010001,Group Pediatric Dental EHB Rider,20128AZ001,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$33.93,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,No,,,,,20128AZ0010001-00,Standard High Off Exchange Plan,85.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,4,46944,AL,SHOP (Small Group),No,63-0103830,46944AL0380001,Blue Secure Silver for Business,46944AL038,,ALN001,ALS001,ALF008,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.bcbsal.org/2015/BlueSecureSilver?frm=Shop,https://sso.bcbsal.org/sp/ACS.saml2,https://www.bcbsal.org/2015/BlueSecureSilver?frm=Shop,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0380001-00,Standard Silver Off Exchange Plan,69.00%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,"$2,000","$4,000",20%,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$600,$0,$200,$20,"$1,600",$0,$400,4
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,4,46944,AL,SHOP (Small Group),No,63-0103830,46944AL0380001,Blue Secure Silver for Business,46944AL038,,ALN001,ALS001,ALF008,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.bcbsal.org/2015/BlueSecureSilver?frm=Shop,https://sso.bcbsal.org/sp/ACS.saml2,https://www.bcbsal.org/2015/BlueSecureSilver?frm=Shop,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0380001-01,Standard Silver On Exchange Plan,69.00%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,"$2,000","$4,000",20%,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$600,$0,$200,$20,"$1,600",$0,$400,5
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,4,46944,AL,Individual,No,63-0103830,46944AL0410001,Blue Value Silver,46944AL041,,ALN001,ALS001,ALF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueValueSilver?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueValueSilver?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0410001-01,Standard Silver On Exchange Plan,68.60%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400","$4,800",20%,"$2,400","$4,800",20%,"$2,400","$4,800",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$600,$0,$200,$20,"$1,600",$0,$400,5
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,4,46944,AL,Individual,No,63-0103830,46944AL0410001,Blue Value Silver,46944AL041,,ALN001,ALS001,ALF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueValueSilver?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueValueSilver?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0410001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$400,6
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,4,46944,AL,Individual,No,63-0103830,46944AL0410001,Blue Value Silver,46944AL041,,ALN001,ALS001,ALF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueValueSilver?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueValueSilver?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0410001-03,Limited Cost Sharing Plan Variation,68.60%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400","$4,800",20%,"$2,400","$4,800",20%,"$2,400","$4,800",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$600,$0,$200,$20,"$1,600",$0,$400,7
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,4,46944,AL,Individual,No,63-0103830,46944AL0410001,Blue Value Silver,46944AL041,,ALN001,ALS001,ALF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueValueSilver?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueValueSilver?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0410001-04,73% AV Level Silver Plan,73.80%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",20%,"$1,750","$3,500",20%,"$1,750","$3,500",Not Applicable,Not Applicable,$0,$0,$0,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,750",$600,$0,$200,$20,"$1,600",$0,$400,8
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,4,46944,AL,Individual,No,63-0103830,46944AL0410001,Blue Value Silver,46944AL041,,ALN001,ALS001,ALF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueValueSilver?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueValueSilver?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0410001-05,87% AV Level Silver Plan,87.50%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,20%,$400,$800,20%,$400,$800,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$400,$600,$0,$200,$20,"$1,000",$0,$400,9
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,4,46944,AL,Individual,No,63-0103830,46944AL0410001,Blue Value Silver,46944AL041,,ALN001,ALS001,ALF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueValueSilver?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueValueSilver?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0410001-06,94% AV Level Silver Plan,93.70%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$500,"$1,000",$500,"$1,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,$100,$200,10%,$100,$200,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$100,$200,$0,$200,$20,$400,$0,$400,10
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,5,46944,AL,Individual,No,63-0103830,46944AL0420001,Blue Saver Silver,46944AL042,,ALN001,ALS001,ALF009,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueSaverSilver?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueSaverSilver?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0420001-00,Standard Silver Off Exchange Plan,68.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$20,$900,$200,$500,"$1,200",$0,$400,4
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,5,46944,AL,SHOP (Small Group),No,63-0103830,46944AL0430001,Blue Saver Bronze for Business,46944AL043,,ALN001,ALS001,ALF010,Existing,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.bcbsal.org/2015/BlueSaverBronze?frm=Shop,https://sso.bcbsal.org/sp/ACS.saml2,https://www.bcbsal.org/2015/BlueSaverBronze?frm=Shop,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0430001-00,Standard Bronze Off Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",40%,,,,"$4,200","$8,400",Not Applicable,Not Applicable,"$4,200",$20,"$1,200",$200,"$1,600",$900,$0,$400,4
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,5,46944,AL,Individual,No,63-0103830,46944AL0420001,Blue Saver Silver,46944AL042,,ALN001,ALS001,ALF009,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueSaverSilver?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueSaverSilver?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0420001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$400,6
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,5,46944,AL,Individual,No,63-0103830,46944AL0420001,Blue Saver Silver,46944AL042,,ALN001,ALS001,ALF009,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueSaverSilver?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueSaverSilver?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0420001-03,Limited Cost Sharing Plan Variation,68.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$20,$900,$200,$500,"$1,200",$0,$400,7
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,5,46944,AL,Individual,No,63-0103830,46944AL0420001,Blue Saver Silver,46944AL042,,ALN001,ALS001,ALF009,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueSaverSilver?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueSaverSilver?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0420001-04,73% AV Level Silver Plan,73.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",15%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,$700,$200,$500,$800,$0,$400,8
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,5,46944,AL,Individual,No,63-0103830,46944AL0420001,Blue Saver Silver,46944AL042,,ALN001,ALS001,ALF009,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueSaverSilver?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueSaverSilver?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0420001-05,87% AV Level Silver Plan,87.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$20,$700,$200,$500,$600,$0,$400,9
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,5,46944,AL,Individual,No,63-0103830,46944AL0420001,Blue Saver Silver,46944AL042,,ALN001,ALS001,ALF009,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueSaverSilver?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueSaverSilver?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0420001-06,94% AV Level Silver Plan,95.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,5%,,,,$100,$200,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$100,$20,$400,$200,$100,$400,$20,$400,10
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,6,46944,AL,Individual,No,63-0103830,46944AL0460001,Blue Saver Bronze,46944AL046,,ALN001,ALS001,ALF011,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.ibcbsal.com/2015/BlueSaverBronze?frm=Exchange,https://sso.bcbsal.org/sp/ACS.saml2,https://www.ibcbsal.com/2015/BlueSaverBronze?frm=Exchange,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0460001-00,Standard Bronze Off Exchange Plan,60.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$6,350","$12,700",Not Applicable,Not Applicable,"$6,400",$0,$0,$200,"$1,600",$900,$0,$400,4
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,6,46944,AL,SHOP (Small Group),No,63-0103830,46944AL0570001,Blue HSA Bronze for Business,46944AL057,,ALN001,ALS001,ALF016,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.bcbsal.org/2015/BlueHSABronze?frm=Shop,https://sso.bcbsal.org/sp/ACS.saml2,https://www.bcbsal.org/2015/BlueHSABronze?frm=Shop,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0570001-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$200,"$5,000",$0,$0,$400,4
2015,AL,46944,HIOS,7,2015-07-22 09:15:52,6,46944,AL,SHOP (Small Group),No,63-0103830,46944AL0570001,Blue HSA Bronze for Business,46944AL057,,ALN001,ALS001,ALF016,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.",Yes,"If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.",Yes,https://www.bcbsal.org/2015/BlueHSABronze?frm=Shop,https://sso.bcbsal.org/sp/ACS.saml2,https://www.bcbsal.org/2015/BlueHSABronze?frm=Shop,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_AL_634_PrimeChoiceEssentialPDL.pdf,46944AL0570001-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$200,"$5,000",$0,$0,$400,5
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,1,68259,AL,Individual,No,63-0899562,68259AL0030004,UnitedHealthcare Gold Compass HSA 1300,68259AL003,,ALN006,ALS001,ALF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030004-01,Standard Gold On Exchange Plan,79.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,1,68259,AL,Individual,No,63-0899562,68259AL0030004,UnitedHealthcare Gold Compass HSA 1300,68259AL003,,ALN006,ALS001,ALF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,1,68259,AL,Individual,No,63-0899562,68259AL0030004,UnitedHealthcare Gold Compass HSA 1300,68259AL003,,ALN006,ALS001,ALF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030004-03,Limited Cost Sharing Plan Variation,79.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,1,68259,AL,Individual,No,63-0899562,68259AL0030007,UnitedHealthcare Silver Compass HSA 3600,68259AL003,,ALN006,ALS001,ALF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030007-00,Standard Silver Off Exchange Plan,68.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,1,68259,AL,Individual,No,63-0899562,68259AL0030007,UnitedHealthcare Silver Compass HSA 3600,68259AL003,,ALN006,ALS001,ALF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030007-01,Standard Silver On Exchange Plan,68.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,1,68259,AL,Individual,No,63-0899562,68259AL0030007,UnitedHealthcare Silver Compass HSA 3600,68259AL003,,ALN006,ALS001,ALF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030007-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,1,68259,AL,Individual,No,63-0899562,68259AL0030007,UnitedHealthcare Silver Compass HSA 3600,68259AL003,,ALN006,ALS001,ALF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030007-03,Limited Cost Sharing Plan Variation,68.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,1,68259,AL,Individual,No,63-0899562,68259AL0030007,UnitedHealthcare Silver Compass HSA 3600,68259AL003,,ALN006,ALS001,ALF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030007-04,73% AV Level Silver Plan,72.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,1,68259,AL,Individual,No,63-0899562,68259AL0030007,UnitedHealthcare Silver Compass HSA 3600,68259AL003,,ALN006,ALS001,ALF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030007-05,87% AV Level Silver Plan,86.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,1,68259,AL,Individual,No,63-0899562,68259AL0030007,UnitedHealthcare Silver Compass HSA 3600,68259AL003,,ALN006,ALS001,ALF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030007-06,94% AV Level Silver Plan,93.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,1,68259,AL,Individual,No,63-0899562,68259AL0030009,UnitedHealthcare Bronze Compass HSA 6275,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030009-00,Standard Bronze Off Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,275","$12,550",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,1,68259,AL,Individual,No,63-0899562,68259AL0030009,UnitedHealthcare Bronze Compass HSA 6275,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030009-01,Standard Bronze On Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,275","$12,550",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,1,68259,AL,Individual,No,63-0899562,68259AL0030009,UnitedHealthcare Bronze Compass HSA 6275,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030009-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,17
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,1,68259,AL,Individual,No,63-0899562,68259AL0030009,UnitedHealthcare Bronze Compass HSA 6275,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030009-03,Limited Cost Sharing Plan Variation,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,275","$12,550",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,2,68259,AL,Individual,No,63-0899562,68259AL0030001,UnitedHealthcare Platinum Compass 250,68259AL003,,ALN006,ALS001,ALF003,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030001-00,Standard Platinum Off Exchange Plan,89.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,2,68259,AL,Individual,No,63-0899562,68259AL0030001,UnitedHealthcare Platinum Compass 250,68259AL003,,ALN006,ALS001,ALF003,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030001-01,Standard Platinum On Exchange Plan,89.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,2,68259,AL,Individual,No,63-0899562,68259AL0030001,UnitedHealthcare Platinum Compass 250,68259AL003,,ALN006,ALS001,ALF003,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,2,68259,AL,Individual,No,63-0899562,68259AL0030001,UnitedHealthcare Platinum Compass 250,68259AL003,,ALN006,ALS001,ALF003,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030001-03,Limited Cost Sharing Plan Variation,89.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030003,UnitedHealthcare Gold Compass 1500,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030003-00,Standard Gold Off Exchange Plan,78.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030003,UnitedHealthcare Gold Compass 1500,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030003-01,Standard Gold On Exchange Plan,78.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030003,UnitedHealthcare Gold Compass 1500,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030003-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030003,UnitedHealthcare Gold Compass 1500,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030003-03,Limited Cost Sharing Plan Variation,78.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030005,UnitedHealthcare Silver Compass 2000,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030005-00,Standard Silver Off Exchange Plan,70.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030005,UnitedHealthcare Silver Compass 2000,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030005-01,Standard Silver On Exchange Plan,70.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030005,UnitedHealthcare Silver Compass 2000,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030005-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030005,UnitedHealthcare Silver Compass 2000,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030005-03,Limited Cost Sharing Plan Variation,70.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030005,UnitedHealthcare Silver Compass 2000,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030005-04,73% AV Level Silver Plan,73.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,600","$3,200",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030005,UnitedHealthcare Silver Compass 2000,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030005-05,87% AV Level Silver Plan,86.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030005,UnitedHealthcare Silver Compass 2000,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030005-06,94% AV Level Silver Plan,93.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030006,UnitedHealthcare Silver Compass 4000,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030006-00,Standard Silver Off Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030006,UnitedHealthcare Silver Compass 4000,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030006-01,Standard Silver On Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030006,UnitedHealthcare Silver Compass 4000,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030006-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030006,UnitedHealthcare Silver Compass 4000,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030006-03,Limited Cost Sharing Plan Variation,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030006,UnitedHealthcare Silver Compass 4000,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030006-04,73% AV Level Silver Plan,73.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030006,UnitedHealthcare Silver Compass 4000,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030006-05,87% AV Level Silver Plan,86.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$850,"$1,700",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030006,UnitedHealthcare Silver Compass 4000,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030006-06,94% AV Level Silver Plan,94.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030011,UnitedHealthcare Silver Compass 5000,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030011-00,Standard Silver Off Exchange Plan,68.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030011,UnitedHealthcare Silver Compass 5000,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030011-01,Standard Silver On Exchange Plan,68.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030011,UnitedHealthcare Silver Compass 5000,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030011-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,24
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,3,68259,AL,Individual,No,63-0899562,68259AL0030011,UnitedHealthcare Silver Compass 5000,68259AL003,,ALN006,ALS001,ALF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030011-03,Limited Cost Sharing Plan Variation,68.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400003,Humana Silver 4600/Phoenix HMOx,23307AZ040,,AZN001,AZS001,AZF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339220,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330692,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400003,Humana Silver 4600/Phoenix HMOx,23307AZ040,,AZN001,AZS001,AZF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339220,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330692,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400003-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,4,51485,AZ,Individual,No,73-0654885,51485AZ0170015,PPO Silver 30%/30%/$1500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF006,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170015-04,73% AV Level Silver Plan,,0.727959990501404,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,4,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160022,PPO Silver 30%/30%/$1500,51485AZ016,,AZN001,AZS001,AZF008,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_30_30_1500_6000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_30_30_1500_6000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160022-00,Standard Silver Off Exchange Plan,69.30%,0.692543804645538,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,4,51485,AZ,Individual,No,73-0654885,51485AZ0170016,PPO Bronze 50%/50%/$5500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF013,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,1,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_bronze_50_50_5500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_bronze_50_50_5500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170016-01,Standard Bronze On Exchange Plan,,0.59587574005127,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,4,51485,AZ,Individual,No,73-0654885,51485AZ0170016,PPO Bronze 50%/50%/$5500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF013,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,1,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_bronze_50_50_5500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_bronze_50_50_5500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,13
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,2,51485,AZ,Individual,No,73-0654885,51485AZ0170013,PPO Silver 30%/30%/$1500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF006,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170013-01,Standard Silver On Exchange Plan,,0.682598233222961,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,2,51485,AZ,Individual,No,73-0654885,51485AZ0170013,PPO Silver 30%/30%/$1500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF006,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,2,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160015,PPO Platinum $15/$30/$500,51485AZ016,,AZN001,AZS001,AZF003,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_500_1500_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_500_1500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160015-00,Standard Platinum Off Exchange Plan,88.70%,0.892422020435333,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AZ,24106,HIOS,12,2015-01-16 17:32:32,1,24106,AZ,Individual,Yes,36-3757528,24106AZ0010001,TruAssure Dental Basic Plan,24106AZ001,,AZN001,AZS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.20,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=AZ,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=AZ,,24106AZ0010001-00,Standard Low Off Exchange Plan,68.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$120,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,24106,HIOS,12,2015-01-16 17:32:32,1,24106,AZ,SHOP (Small Group),Yes,36-3757528,24106AZ0030001,TruAssure Dental Small Group Basic Plan,24106AZ003,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.69,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=AZ,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=AZ,,24106AZ0030001-00,Standard High Off Exchange Plan,83.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,24106,HIOS,12,2015-01-16 17:32:32,1,24106,AZ,SHOP (Small Group),Yes,36-3757528,24106AZ0040001,TruAssure Dental Small Group Preferred Plan,24106AZ004,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.69,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=AZ,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=AZ,,24106AZ0040001-00,Standard High Off Exchange Plan,83.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,24106,HIOS,12,2015-01-16 17:32:32,1,24106,AZ,Individual,Yes,36-3757528,24106AZ0010001,TruAssure Dental Basic Plan,24106AZ001,,AZN001,AZS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.20,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=AZ,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=AZ,,24106AZ0010001-01,Standard Low On Exchange Plan,68.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$120,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,24106,HIOS,12,2015-01-16 17:32:32,2,24106,AZ,Individual,Yes,36-3757528,24106AZ0020001,TruAssure Dental Preferred Plan,24106AZ002,,AZN001,AZS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.40,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=AZ,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=AZ,,24106AZ0020001-00,Standard High Off Exchange Plan,83.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,24106,HIOS,12,2015-01-16 17:32:32,2,24106,AZ,Individual,Yes,36-3757528,24106AZ0020001,TruAssure Dental Preferred Plan,24106AZ002,,AZN001,AZS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.40,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=AZ,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=AZ,,24106AZ0020001-01,Standard High On Exchange Plan,83.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,31957,HIOS,4,2014-09-05 03:32:16,1,31957,AZ,SHOP (Small Group),Yes,47-0322111,31957AZ0010002,Certfied Dental Plan 2,31957AZ001,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.89,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,31957AZ0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,31957,HIOS,4,2014-09-05 03:32:16,1,31957,AZ,SHOP (Small Group),Yes,47-0322111,31957AZ0010003,Certfied Dental Plan 3,31957AZ001,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.81,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,31957AZ0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AZ,31957,HIOS,4,2014-09-05 03:32:16,1,31957,AZ,SHOP (Small Group),Yes,47-0322111,31957AZ0010004,Certfied Dental Plan 4,31957AZ001,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.17,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,31957AZ0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AZ,33851,HIOS,4,2014-09-05 03:32:16,1,33851,AZ,Individual,Yes,91-1857813,33851AZ0110001,Smile for Kids (EHB),33851AZ011,,AZN001,AZS001,,Existing,PPO,Low,,Both,,,,See Schedule of Benefits for limitations and exclusions,,,,,Allows Child-Only,,,,$27.39,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.",Yes,www.premierlife.com/azhealthreform,www.premierlife.com/payment,www.premierlife.com/azhealthreform,,33851AZ0110001-00,Standard Low Off Exchange Plan,72.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$200,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,2,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160015,PPO Platinum $15/$30/$500,51485AZ016,,AZN001,AZS001,AZF003,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_500_1500_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_500_1500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160015-01,Standard Platinum On Exchange Plan,88.70%,0.892422020435333,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,2,51485,AZ,Individual,No,73-0654885,51485AZ0170013,PPO Silver 30%/30%/$1500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF006,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170013-03,Limited Cost Sharing Plan Variation,,0.682598233222961,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,2,51485,AZ,Individual,No,73-0654885,51485AZ0170013,PPO Silver 30%/30%/$1500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF006,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170013-04,73% AV Level Silver Plan,,0.727959990501404,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,5,68259,AL,Individual,No,63-0899562,68259AL0030010,UnitedHealthcare Catastrophic Compass 6600,68259AL003,,ALN006,ALS001,ALF002,New,HMO,Catastrophic,No,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030010-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,6,68259,AL,Individual,No,63-0899562,68259AL0030008,UnitedHealthcare Bronze Compass 4200,68259AL003,,ALN006,ALS001,ALF006,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030008-00,Standard Bronze Off Exchange Plan,59.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,6,68259,AL,Individual,No,63-0899562,68259AL0030008,UnitedHealthcare Bronze Compass 4200,68259AL003,,ALN006,ALS001,ALF006,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030008-01,Standard Bronze On Exchange Plan,59.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,6,68259,AL,Individual,No,63-0899562,68259AL0030008,UnitedHealthcare Bronze Compass 4200,68259AL003,,ALN006,ALS001,ALF006,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030008-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AL,68259,HIOS,8,2014-12-11 04:09:12,6,68259,AL,Individual,No,63-0899562,68259AL0030008,UnitedHealthcare Bronze Compass 4200,68259AL003,,ALN006,ALS001,ALF006,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9915,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xal,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xal,68259AL0030008-03,Limited Cost Sharing Plan Variation,59.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,AL,68707,HIOS,2,2014-08-03 08:59:32,1,68707,AL,SHOP (Small Group),Yes,93-0242990,68707AL0030001,EHB Low Passive,68707AL003,,ALN001,ALS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.57,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,68707AL0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AL,77233,HIOS,8,2014-11-14 05:23:27,1,77233,AL,SHOP (Small Group),Yes,75-1233841,77233AL0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,77233AL002,,ALN001,ALS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.68,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/al/77233al0020001-15,,77233AL0020001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,77233,HIOS,8,2014-11-14 05:23:27,1,77233,AL,Individual,Yes,75-1233841,77233AL0010001,Dentegra Dental PPO Pediatric Basic Plan,77233AL001,,ALN001,ALS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$19.89,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/al/77233al0010001-15,,77233AL0010001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,77233,HIOS,8,2014-11-14 05:23:27,2,77233,AL,Individual,Yes,75-1233841,77233AL0010004,Dentegra Dental PPO Family Preferred Plan,77233AL001,,ALN001,ALS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.06,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/al/77233al0010004-15,,77233AL0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,77233,HIOS,8,2014-11-14 05:23:27,2,77233,AL,Individual,Yes,75-1233841,77233AL0010004,Dentegra Dental PPO Family Preferred Plan,77233AL001,,ALN001,ALS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.06,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/al/77233al0010004-15,,77233AL0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,77233,HIOS,8,2014-11-14 05:23:27,2,77233,AL,SHOP (Small Group),Yes,75-1233841,77233AL0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,77233AL002,,ALN001,ALS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.27,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/al/77233al0020004-15,,77233AL0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,77233,HIOS,8,2014-11-14 05:23:27,3,77233,AL,SHOP (Small Group),Yes,75-1233841,77233AL0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,77233AL002,,ALN001,ALS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.04,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/al/77233al0020006-15,,77233AL0020006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,77233,HIOS,8,2014-11-14 05:23:27,3,77233,AL,Individual,Yes,75-1233841,77233AL0010006,Dentegra Dental PPO Family Basic Plan,77233AL001,,ALN001,ALS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.89,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/al/77233al0010006-15,,77233AL0010006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,77233,HIOS,8,2014-11-14 05:23:27,3,77233,AL,Individual,Yes,75-1233841,77233AL0010006,Dentegra Dental PPO Family Basic Plan,77233AL001,,ALN001,ALS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.89,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/al/77233al0010006-15,,77233AL0010006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,77233,HIOS,8,2014-11-14 05:23:27,3,77233,AL,SHOP (Small Group),Yes,75-1233841,77233AL0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,77233AL002,,ALN001,ALS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.04,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/al/77233al0020006-15,,77233AL0020006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,82285,HIOS,8,2014-11-14 05:23:27,1,82285,AL,Individual,Yes,94-2761537,82285AL0010002,Delta Dental PPO Pediatric Preferred Plan,82285AL001,,ALN001,ALS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$22.33,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/al/82285al0010002-15,,82285AL0010002-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,82285,HIOS,8,2014-11-14 05:23:27,1,82285,AL,SHOP (Small Group),Yes,94-2761537,82285AL0020002,Delta Dental PPO Pediatric Preferred Plan for Small Businesses,82285AL002,,ALN001,ALS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.33,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/al/82285al0020002-15,,82285AL0020002-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,82285,HIOS,8,2014-11-14 05:23:27,1,82285,AL,SHOP (Small Group),Yes,94-2761537,82285AL0020002,Delta Dental PPO Pediatric Preferred Plan for Small Businesses,82285AL002,,ALN001,ALS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.33,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/al/82285al0020002-15,,82285AL0020002-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,82285,HIOS,8,2014-11-14 05:23:27,1,82285,AL,Individual,Yes,94-2761537,82285AL0010002,Delta Dental PPO Pediatric Preferred Plan,82285AL001,,ALN001,ALS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$22.33,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/al/82285al0010002-15,,82285AL0010002-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,82285,HIOS,8,2014-11-14 05:23:27,1,82285,AL,Individual,Yes,94-2761537,82285AL0010001,Delta Dental PPO Pediatric Basic Plan,82285AL001,,ALN001,ALS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$17.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/al/82285al0010001-15,,82285AL0010001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AL,82285,HIOS,8,2014-11-14 05:23:27,1,82285,AL,SHOP (Small Group),Yes,94-2761537,82285AL0020001,Delta Dental PPO Pediatric Basic Plan for Small Businesses,82285AL002,,ALN001,ALS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.68,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/al/82285al0020001-15,,82285AL0020001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AL,82285,HIOS,8,2014-11-14 05:23:27,1,82285,AL,SHOP (Small Group),Yes,94-2761537,82285AL0020001,Delta Dental PPO Pediatric Basic Plan for Small Businesses,82285AL002,,ALN001,ALS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.68,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/al/82285al0020001-15,,82285AL0020001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AL,82285,HIOS,8,2014-11-14 05:23:27,1,82285,AL,Individual,Yes,94-2761537,82285AL0010001,Delta Dental PPO Pediatric Basic Plan,82285AL001,,ALN001,ALS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$17.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/al/82285al0010001-15,,82285AL0010001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AL,82285,HIOS,8,2014-11-14 05:23:27,2,82285,AL,Individual,Yes,94-2761537,82285AL0010004,Delta Dental PPO Preferred Plan for Families,82285AL001,,ALN001,ALS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.33,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/al/82285al0010004-15,,82285AL0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,82285,HIOS,8,2014-11-14 05:23:27,2,82285,AL,SHOP (Small Group),Yes,94-2761537,82285AL0020004,Delta Dental PPO Preferred Plan for Families for Small Businesses,82285AL002,,ALN001,ALS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.33,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/al/82285al0020004-15,,82285AL0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,82285,HIOS,8,2014-11-14 05:23:27,2,82285,AL,SHOP (Small Group),Yes,94-2761537,82285AL0020004,Delta Dental PPO Preferred Plan for Families for Small Businesses,82285AL002,,ALN001,ALS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.33,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/al/82285al0020004-15,,82285AL0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,82285,HIOS,8,2014-11-14 05:23:27,2,82285,AL,Individual,Yes,94-2761537,82285AL0010004,Delta Dental PPO Preferred Plan for Families,82285AL001,,ALN001,ALS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.33,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/al/82285al0010004-15,,82285AL0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,82285,HIOS,8,2014-11-14 05:23:27,3,82285,AL,Individual,Yes,94-2761537,82285AL0010006,Delta Dental PPO Basic Plan for Families,82285AL001,,ALN001,ALS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.68,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/al/82285al0010006-15,,82285AL0010006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,82285,HIOS,8,2014-11-14 05:23:27,3,82285,AL,SHOP (Small Group),Yes,94-2761537,82285AL0020006,Delta Dental PPO Basic Plan for Families for Small Businesses,82285AL002,,ALN001,ALS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.68,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/al/82285al0020006-15,,82285AL0020006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AL,82285,HIOS,8,2014-11-14 05:23:27,3,82285,AL,SHOP (Small Group),Yes,94-2761537,82285AL0020006,Delta Dental PPO Basic Plan for Families for Small Businesses,82285AL002,,ALN001,ALS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.68,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/al/82285al0020006-15,,82285AL0020006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AL,82285,HIOS,8,2014-11-14 05:23:27,3,82285,AL,Individual,Yes,94-2761537,82285AL0010006,Delta Dental PPO Basic Plan for Families,82285AL001,,ALN001,ALS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.68,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/al/82285al0010006-15,,82285AL0010006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,12303,HIOS,5,2014-09-03 04:28:59,1,12303,AZ,Individual,Yes,59-0397210,12303AZ0010001,DentaQuest PPO  Pediatric High,12303AZ001,,AZN001,AZS001,,New,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$37.88,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,12303AZ0010001-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,12303,HIOS,5,2014-09-03 04:28:59,1,12303,AZ,SHOP (Small Group),Yes,59-0397210,12303AZ0020003,DentaQuest PPO Family High,12303AZ002,,AZN001,AZS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.66,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,12303AZ0020003-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,12303,HIOS,5,2014-09-03 04:28:59,1,12303,AZ,SHOP (Small Group),Yes,59-0397210,12303AZ0020003,DentaQuest PPO Family High,12303AZ002,,AZN001,AZS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.66,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,12303AZ0020003-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,12303,HIOS,5,2014-09-03 04:28:59,1,12303,AZ,Individual,Yes,59-0397210,12303AZ0010001,DentaQuest PPO  Pediatric High,12303AZ001,,AZN001,AZS001,,New,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$37.88,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,12303AZ0010001-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,12303,HIOS,5,2014-09-03 04:28:59,1,12303,AZ,Individual,Yes,59-0397210,12303AZ0010002,DentaQuest PPO Pediatric Low,12303AZ001,,AZN001,AZS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$27.46,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,12303AZ0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AZ,12303,HIOS,5,2014-09-03 04:28:59,1,12303,AZ,SHOP (Small Group),Yes,59-0397210,12303AZ0020004,DentaQuest PPO Family Low,12303AZ002,,AZN001,AZS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.33,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,12303AZ0020004-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AZ,12303,HIOS,5,2014-09-03 04:28:59,1,12303,AZ,SHOP (Small Group),Yes,59-0397210,12303AZ0020004,DentaQuest PPO Family Low,12303AZ002,,AZN001,AZS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.33,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,12303AZ0020004-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AZ,12303,HIOS,5,2014-09-03 04:28:59,1,12303,AZ,Individual,Yes,59-0397210,12303AZ0010002,DentaQuest PPO Pediatric Low,12303AZ001,,AZN001,AZS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$27.46,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,12303AZ0010002-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AZ,12303,HIOS,5,2014-09-03 04:28:59,2,12303,AZ,Individual,Yes,59-0397210,12303AZ0010003,DentaQuest PPO Family High,12303AZ001,,AZN001,AZS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$37.88,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,12303AZ0010003-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,12303,HIOS,5,2014-09-03 04:28:59,2,12303,AZ,Individual,Yes,59-0397210,12303AZ0010003,DentaQuest PPO Family High,12303AZ001,,AZN001,AZS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$37.88,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,12303AZ0010003-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,12303,HIOS,5,2014-09-03 04:28:59,2,12303,AZ,Individual,Yes,59-0397210,12303AZ0010004,DentaQuest PPO Family Low,12303AZ001,,AZN001,AZS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.46,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,12303AZ0010004-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AZ,12303,HIOS,5,2014-09-03 04:28:59,2,12303,AZ,Individual,Yes,59-0397210,12303AZ0010004,DentaQuest PPO Family Low,12303AZ001,,AZN001,AZS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.46,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,12303AZ0010004-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AZ,13576,HIOS,3,2014-09-05 03:32:16,1,13576,AZ,SHOP (Small Group),Yes,81-0170040,13576AZ0010001,Assurant Dental ACAFFO High,13576AZ001,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$44.35,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same coverage as in service area,Yes,,,,,13576AZ0010001-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,13576,HIOS,3,2014-09-05 03:32:16,2,13576,AZ,SHOP (Small Group),Yes,81-0170040,13576AZ0010002,Assurant Dental ACAFFO Low,13576AZ001,,AZN001,AZS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$37.02,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same coverage as in service area,Yes,,,,,13576AZ0010002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,17100,HIOS,4,2014-08-28 04:23:13,1,17100,AZ,SHOP (Small Group),Yes,13-5581829,17100AZ0160001,EHB Basic Dental Plan (Low),17100AZ016,,AZN001,AZS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$20.98,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48029,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48028,,17100AZ0160001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,17100,HIOS,4,2014-08-28 04:23:13,1,17100,AZ,SHOP (Small Group),Yes,13-5581829,17100AZ0160001,EHB Basic Dental Plan (Low),17100AZ016,,AZN001,AZS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$20.98,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48029,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48028,,17100AZ0160001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,17100,HIOS,4,2014-08-28 04:23:13,2,17100,AZ,SHOP (Small Group),Yes,13-5581829,17100AZ0170001,EHB Enhanced Dental Plan (High),17100AZ017,,AZN002,AZS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$25.76,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49066,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49065,,17100AZ0170001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,17100,HIOS,4,2014-08-28 04:23:13,2,17100,AZ,SHOP (Small Group),Yes,13-5581829,17100AZ0170001,EHB Enhanced Dental Plan (High),17100AZ017,,AZN002,AZS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$25.76,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49066,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49065,,17100AZ0170001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,17100,HIOS,4,2014-08-28 04:23:13,3,17100,AZ,SHOP (Small Group),Yes,13-5581829,17100AZ0180001,Family Basic Dental Plan (Low),17100AZ018,,AZN003,AZS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$20.98,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49068,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49067,,17100AZ0180001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,2,23307,AZ,Individual,No,61-1013183,23307AZ0400011,Humana Basic 6600/Tucson HMOx,23307AZ040,,AZN002,AZS002,AZF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339103,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330770,http://apps.humana.com/marketing/documents.asp?file=2323880,23307AZ0400011-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,2,23307,AZ,Individual,No,61-1013183,23307AZ0400011,Humana Basic 6600/Tucson HMOx,23307AZ040,,AZN002,AZS002,AZF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339103,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330770,http://apps.humana.com/marketing/documents.asp?file=2323880,23307AZ0400011-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170002,PPO Platinum $15/$30/$750 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_750_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_750_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170002-03,Limited Cost Sharing Plan Variation,,0.900174200534821,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$400,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170003,PPO Platinum $15/$30/$500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170003-00,Standard Platinum Off Exchange Plan,,0.881154298782349,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$3,500","$7,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$600,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,AZ,17100,HIOS,4,2014-08-28 04:23:13,3,17100,AZ,SHOP (Small Group),Yes,13-5581829,17100AZ0180001,Family Basic Dental Plan (Low),17100AZ018,,AZN003,AZS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$20.98,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49068,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49067,,17100AZ0180001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,17100,HIOS,4,2014-08-28 04:23:13,4,17100,AZ,SHOP (Small Group),Yes,13-5581829,17100AZ0190001,Family Enhanced Dental Plan (High),17100AZ019,,AZN004,AZS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$25.76,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49070,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49069,,17100AZ0190001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,17100,HIOS,4,2014-08-28 04:23:13,4,17100,AZ,SHOP (Small Group),Yes,13-5581829,17100AZ0190001,Family Enhanced Dental Plan (High),17100AZ019,,AZN004,AZS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$25.76,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49070,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49069,,17100AZ0190001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,17454,HIOS,4,2014-08-27 03:27:11,1,17454,AZ,SHOP (Small Group),Yes,13-5123390,17454AZ0010002,Guardian Pediatric Advantage,17454AZ001,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$29.25,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,17454AZ0010002-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,17454,HIOS,4,2014-08-27 03:27:11,1,17454,AZ,SHOP (Small Group),Yes,13-5123390,17454AZ0020002,Guardian Pediatric Essentials,17454AZ002,,AZN001,AZS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$21.58,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,17454AZ0020002-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,17454,HIOS,4,2014-08-27 03:27:11,2,17454,AZ,SHOP (Small Group),Yes,13-5123390,17454AZ0040002,Guardian Family Advantage,17454AZ004,,AZN001,AZS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.25,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,17454AZ0040002-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,20128,HIOS,5,2014-09-03 04:28:59,1,20128,AZ,SHOP (Small Group),Yes,57-0523959,20128AZ0010002,Group Pediatric Dental EHB Rider,20128AZ001,,AZN001,AZS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$27.87,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,No,,,,,20128AZ0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,21463,HIOS,2,2014-08-08 08:53:29,1,21463,AZ,SHOP (Small Group),Yes,42-0127290,21463AZ0040001,Principal Plan Dental 70,21463AZ004,,AZN001,AZS001,,New,PPO,Low,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$28.17,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,21463AZ0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,21463,HIOS,2,2014-08-08 08:53:29,1,21463,AZ,SHOP (Small Group),Yes,42-0127290,21463AZ0040002,Principal Plan Dental 80,21463AZ004,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$29.84,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,21463AZ0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,30045,HIOS,5,2015-01-21 09:35:36,1,30045,AZ,Individual,Yes,86-0274899,30045AZ0010020,Delta Dental Pediatric Plan,30045AZ001,,AZN001,AZS001,,New,PPO,High,,Both,,,,Coverage not available for anyone over age 18. For a full list of exclusions please see Summary of Benefits & Coverage.,,,,,Allows Child-Only,,,,$34.26,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.",Yes,Traveling out of state and need dental treatment? Delta Dental is there to cover you with America?s largest network of dentists.,Yes,www.deltadentalcoversme.com/plan-options/az-plans,https://auth.deltadentalaz.com/sp/ACS.saml2,www.deltadentalcoversme.com/plan-options/az-plans,,30045AZ0010020-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,30045,HIOS,5,2015-01-21 09:35:36,1,30045,AZ,SHOP (Small Group),Yes,86-0274899,30045AZ0020020,Delta Dental Pediatric Plan,30045AZ002,,AZN001,AZS001,,New,PPO,High,,Both,,,,Coverage not available for anyone over age 18. For a full list of exclusions please see Summary of Benefits & Coverage.,,,,,Allows Child-Only,,,,$32.56,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.",Yes,Traveling out of state and need dental treatment? Delta Dental is there to cover you with America?s largest network of dentists.,Yes,www.deltadentalaz.com/SHOP,https://auth.deltadentalaz.com/sp/ACS.saml2,www.deltadentalaz.com/SHOP,,30045AZ0020020-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,30045,HIOS,5,2015-01-21 09:35:36,1,30045,AZ,SHOP (Small Group),Yes,86-0274899,30045AZ0020020,Delta Dental Pediatric Plan,30045AZ002,,AZN001,AZS001,,New,PPO,High,,Both,,,,Coverage not available for anyone over age 18. For a full list of exclusions please see Summary of Benefits & Coverage.,,,,,Allows Child-Only,,,,$32.56,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.",Yes,Traveling out of state and need dental treatment? Delta Dental is there to cover you with America?s largest network of dentists.,Yes,www.deltadentalaz.com/SHOP,https://auth.deltadentalaz.com/sp/ACS.saml2,www.deltadentalaz.com/SHOP,,30045AZ0020020-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,30045,HIOS,5,2015-01-21 09:35:36,1,30045,AZ,Individual,Yes,86-0274899,30045AZ0010020,Delta Dental Pediatric Plan,30045AZ001,,AZN001,AZS001,,New,PPO,High,,Both,,,,Coverage not available for anyone over age 18. For a full list of exclusions please see Summary of Benefits & Coverage.,,,,,Allows Child-Only,,,,$34.26,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.",Yes,Traveling out of state and need dental treatment? Delta Dental is there to cover you with America?s largest network of dentists.,Yes,www.deltadentalcoversme.com/plan-options/az-plans,https://auth.deltadentalaz.com/sp/ACS.saml2,www.deltadentalcoversme.com/plan-options/az-plans,,30045AZ0010020-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,30045,HIOS,5,2015-01-21 09:35:36,2,30045,AZ,Individual,Yes,86-0274899,30045AZ0010021,Delta Dental Family Essential Plan,30045AZ001,,AZN001,AZS001,,New,PPO,Low,,Both,,,,For a full list of exclusions please see Summary of Benefits & Coverage.,,,,,Allows Adult and Child-Only,,,,$29.56,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.",Yes,Traveling out of state and need dental treatment? Delta Dental is there to cover you with America?s largest network of dentists.,Yes,www.deltadentalcoversme.com/plan-options/az-plans,https://auth.deltadentalaz.com/sp/ACS.saml2,www.deltadentalcoversme.com/plan-options/az-plans,,30045AZ0010021-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,80%,20%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,30045,HIOS,5,2015-01-21 09:35:36,2,30045,AZ,SHOP (Small Group),Yes,86-0274899,30045AZ0020021,Delta Dental Family Essential Plan,30045AZ002,,AZN001,AZS001,,New,PPO,Low,,Both,,,,For a full list of exclusions please see Summary of Benefits & Coverage.,,,,,Allows Adult and Child-Only,,,,$28.09,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.",Yes,Traveling out of state and need dental treatment? Delta Dental is there to cover you with America?s largest network of dentists.,Yes,www.deltadentalaz.com/SHOP,https://auth.deltadentalaz.com/sp/ACS.saml2,www.deltadentalaz.com/SHOP,,30045AZ0020021-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,80%,20%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,30045,HIOS,5,2015-01-21 09:35:36,2,30045,AZ,SHOP (Small Group),Yes,86-0274899,30045AZ0020021,Delta Dental Family Essential Plan,30045AZ002,,AZN001,AZS001,,New,PPO,Low,,Both,,,,For a full list of exclusions please see Summary of Benefits & Coverage.,,,,,Allows Adult and Child-Only,,,,$28.09,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.",Yes,Traveling out of state and need dental treatment? Delta Dental is there to cover you with America?s largest network of dentists.,Yes,www.deltadentalaz.com/SHOP,https://auth.deltadentalaz.com/sp/ACS.saml2,www.deltadentalaz.com/SHOP,,30045AZ0020021-01,Standard Low On Exchange Plan,70.00%,,,,Yes,80%,20%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,30045,HIOS,5,2015-01-21 09:35:36,2,30045,AZ,Individual,Yes,86-0274899,30045AZ0010021,Delta Dental Family Essential Plan,30045AZ001,,AZN001,AZS001,,New,PPO,Low,,Both,,,,For a full list of exclusions please see Summary of Benefits & Coverage.,,,,,Allows Adult and Child-Only,,,,$29.56,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.",Yes,Traveling out of state and need dental treatment? Delta Dental is there to cover you with America?s largest network of dentists.,Yes,www.deltadentalcoversme.com/plan-options/az-plans,https://auth.deltadentalaz.com/sp/ACS.saml2,www.deltadentalcoversme.com/plan-options/az-plans,,30045AZ0010021-01,Standard Low On Exchange Plan,70.00%,,,,Yes,80%,20%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,30045,HIOS,5,2015-01-21 09:35:36,3,30045,AZ,Individual,Yes,86-0274899,30045AZ0010022,Delta Dental Family Select Plan,30045AZ001,,AZN001,AZS001,,New,PPO,High,,Both,,,,For a full list of exclusions please see Summary of Benefits & Coverage.,,,,,Allows Adult and Child-Only,,,,$34.26,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.",Yes,Traveling out of state and need dental treatment? Delta Dental is there to cover you with America?s largest network of dentists.,Yes,www.deltadentalcoversme.com/plan-options/az-plans,https://auth.deltadentalaz.com/sp/ACS.saml2,www.deltadentalcoversme.com/plan-options/az-plans,,30045AZ0010022-00,Standard High Off Exchange Plan,85.00%,,,,Yes,80%,20%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,30045,HIOS,5,2015-01-21 09:35:36,3,30045,AZ,SHOP (Small Group),Yes,86-0274899,30045AZ0020022,Delta Dental Family Select Plan,30045AZ002,,AZN001,AZS001,,New,PPO,High,,Both,,,,For a full list of exclusions please see Summary of Benefits & Coverage.,,,,,Allows Adult and Child-Only,,,,$32.56,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.",Yes,Traveling out of state and need dental treatment? Delta Dental is there to cover you with America?s largest network of dentists.,Yes,www.deltadentalaz.com/SHOP,https://auth.deltadentalaz.com/sp/ACS.saml2,www.deltadentalaz.com/SHOP,,30045AZ0020022-00,Standard High Off Exchange Plan,85.00%,,,,Yes,80%,20%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,30045,HIOS,5,2015-01-21 09:35:36,3,30045,AZ,SHOP (Small Group),Yes,86-0274899,30045AZ0020022,Delta Dental Family Select Plan,30045AZ002,,AZN001,AZS001,,New,PPO,High,,Both,,,,For a full list of exclusions please see Summary of Benefits & Coverage.,,,,,Allows Adult and Child-Only,,,,$32.56,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.",Yes,Traveling out of state and need dental treatment? Delta Dental is there to cover you with America?s largest network of dentists.,Yes,www.deltadentalaz.com/SHOP,https://auth.deltadentalaz.com/sp/ACS.saml2,www.deltadentalaz.com/SHOP,,30045AZ0020022-01,Standard High On Exchange Plan,85.00%,,,,Yes,80%,20%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,30045,HIOS,5,2015-01-21 09:35:36,3,30045,AZ,Individual,Yes,86-0274899,30045AZ0010022,Delta Dental Family Select Plan,30045AZ001,,AZN001,AZS001,,New,PPO,High,,Both,,,,For a full list of exclusions please see Summary of Benefits & Coverage.,,,,,Allows Adult and Child-Only,,,,$34.26,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.",Yes,Traveling out of state and need dental treatment? Delta Dental is there to cover you with America?s largest network of dentists.,Yes,www.deltadentalcoversme.com/plan-options/az-plans,https://auth.deltadentalaz.com/sp/ACS.saml2,www.deltadentalcoversme.com/plan-options/az-plans,,30045AZ0010022-01,Standard High On Exchange Plan,85.00%,,,,Yes,80%,20%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,30884,HIOS,4,2014-09-04 03:25:43,1,30884,AZ,SHOP (Small Group),Yes,95-2371728,30884AZ0020001,PPO MAC,30884AZ002,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.86,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of AZ,Yes,,,,,30884AZ0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,30884,HIOS,4,2014-09-04 03:25:43,1,30884,AZ,Individual,Yes,95-2371728,30884AZ0010001,PPO MAC,30884AZ001,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$34.19,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of AZ,Yes,,,,,30884AZ0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,30884,HIOS,4,2014-09-04 03:25:43,1,30884,AZ,Individual,Yes,95-2371728,30884AZ0010002,PPO MAC,30884AZ001,,AZN001,AZS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of AZ,Yes,,,,,30884AZ0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$100,$300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,30884,HIOS,4,2014-09-04 03:25:43,1,30884,AZ,SHOP (Small Group),Yes,95-2371728,30884AZ0020002,PPO MAC,30884AZ002,,AZN001,AZS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$17.58,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of AZ,Yes,,,,,30884AZ0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$100,$300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,31957,HIOS,4,2014-09-05 03:32:16,1,31957,AZ,SHOP (Small Group),Yes,47-0322111,31957AZ0010001,Certfied Dental Plan 1,31957AZ001,,AZN001,AZS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$14.96,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,31957AZ0010001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400003,Humana Silver 4600/Phoenix HMOx,23307AZ040,,AZN001,AZS001,AZF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339220,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330692,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400003-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400003,Humana Silver 4600/Phoenix HMOx,23307AZ040,,AZN001,AZS001,AZF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339220,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330692,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400003-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400003,Humana Silver 4600/Phoenix HMOx,23307AZ040,,AZN001,AZS001,AZF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339220,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330692,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400003-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400003,Humana Silver 4600/Phoenix HMOx,23307AZ040,,AZN001,AZS001,AZF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339220,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330692,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400003-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400003,Humana Silver 4600/Phoenix HMOx,23307AZ040,,AZN001,AZS001,AZF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339220,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330692,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400003-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400004,Humana Gold 2500/Phoenix HMOx,23307AZ040,,AZN001,AZS001,AZF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339142,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330744,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400004-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400004,Humana Gold 2500/Phoenix HMOx,23307AZ040,,AZN001,AZS001,AZF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339142,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330744,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400004-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400004,Humana Gold 2500/Phoenix HMOx,23307AZ040,,AZN001,AZS001,AZF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339142,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330744,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400004,Humana Gold 2500/Phoenix HMOx,23307AZ040,,AZN001,AZS001,AZF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339142,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330744,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400004-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400005,Humana Platinum 1000/Phoenix HMOx,23307AZ040,,AZN001,AZS001,AZF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339168,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330757,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400005-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400005,Humana Platinum 1000/Phoenix HMOx,23307AZ040,,AZN001,AZS001,AZF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339168,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330757,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400005-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400005,Humana Platinum 1000/Phoenix HMOx,23307AZ040,,AZN001,AZS001,AZF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339168,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330757,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400005,Humana Platinum 1000/Phoenix HMOx,23307AZ040,,AZN001,AZS001,AZF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339168,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330757,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400005-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400013,Humana Silver 4600/Tucson HMOx,23307AZ040,,AZN002,AZS002,AZF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339233,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330796,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400013-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$9,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400013,Humana Silver 4600/Tucson HMOx,23307AZ040,,AZN002,AZS002,AZF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339233,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330796,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400013-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400013,Humana Silver 4600/Tucson HMOx,23307AZ040,,AZN002,AZS002,AZF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339233,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330796,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400013-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400013,Humana Silver 4600/Tucson HMOx,23307AZ040,,AZN002,AZS002,AZF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339233,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330796,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400013-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400013,Humana Silver 4600/Tucson HMOx,23307AZ040,,AZN002,AZS002,AZF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339233,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330796,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400013-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400013,Humana Silver 4600/Tucson HMOx,23307AZ040,,AZN002,AZS002,AZF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339233,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330796,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400013-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400013,Humana Silver 4600/Tucson HMOx,23307AZ040,,AZN002,AZS002,AZF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339233,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330796,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400013-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400014,Humana Gold 2500/Tucson HMOx,23307AZ040,,AZN002,AZS002,AZF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339155,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330861,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400014-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400014,Humana Gold 2500/Tucson HMOx,23307AZ040,,AZN002,AZS002,AZF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339155,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330861,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400014-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400014,Humana Gold 2500/Tucson HMOx,23307AZ040,,AZN002,AZS002,AZF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339155,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330861,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,28
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400014,Humana Gold 2500/Tucson HMOx,23307AZ040,,AZN002,AZS002,AZF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339155,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330861,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400014-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400015,Humana Platinum 1000/Tucson HMOx,23307AZ040,,AZN002,AZS002,AZF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339181,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330874,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400015-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400015,Humana Platinum 1000/Tucson HMOx,23307AZ040,,AZN002,AZS002,AZF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339181,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330874,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400015-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400015,Humana Platinum 1000/Tucson HMOx,23307AZ040,,AZN002,AZS002,AZF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339181,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330874,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,32
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,1,23307,AZ,Individual,No,61-1013183,23307AZ0400015,Humana Platinum 1000/Tucson HMOx,23307AZ040,,AZN002,AZS002,AZF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339181,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330874,http://apps.humana.com/marketing/documents.asp?file=2323815,23307AZ0400015-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,2,23307,AZ,Individual,No,61-1013183,23307AZ0400001,Humana Basic 6600/Phoenix HMOx,23307AZ040,,AZN001,AZS001,AZF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339090,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330666,http://apps.humana.com/marketing/documents.asp?file=2323880,23307AZ0400001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,2,23307,AZ,Individual,No,61-1013183,23307AZ0400001,Humana Basic 6600/Phoenix HMOx,23307AZ040,,AZN001,AZS001,AZF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339090,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330666,http://apps.humana.com/marketing/documents.asp?file=2323880,23307AZ0400001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,3,23307,AZ,Individual,No,61-1013183,23307AZ0400002,Humana Bronze 6300/Phoenix HMOx,23307AZ040,,AZN001,AZS001,AZF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339116,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330679,http://apps.humana.com/marketing/documents.asp?file=2323880,23307AZ0400002-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,3,23307,AZ,Individual,No,61-1013183,23307AZ0400002,Humana Bronze 6300/Phoenix HMOx,23307AZ040,,AZN001,AZS001,AZF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339116,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330679,http://apps.humana.com/marketing/documents.asp?file=2323880,23307AZ0400002-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,3,23307,AZ,Individual,No,61-1013183,23307AZ0400002,Humana Bronze 6300/Phoenix HMOx,23307AZ040,,AZN001,AZS001,AZF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339116,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330679,http://apps.humana.com/marketing/documents.asp?file=2323880,23307AZ0400002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,3,23307,AZ,Individual,No,61-1013183,23307AZ0400002,Humana Bronze 6300/Phoenix HMOx,23307AZ040,,AZN001,AZS001,AZF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339116,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330679,http://apps.humana.com/marketing/documents.asp?file=2323880,23307AZ0400002-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,3,23307,AZ,Individual,No,61-1013183,23307AZ0400012,Humana Bronze 6300/Tucson HMOx,23307AZ040,,AZN002,AZS002,AZF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339129,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330783,http://apps.humana.com/marketing/documents.asp?file=2323880,23307AZ0400012-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,3,23307,AZ,Individual,No,61-1013183,23307AZ0400012,Humana Bronze 6300/Tucson HMOx,23307AZ040,,AZN002,AZS002,AZF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339129,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330783,http://apps.humana.com/marketing/documents.asp?file=2323880,23307AZ0400012-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,3,23307,AZ,Individual,No,61-1013183,23307AZ0400012,Humana Bronze 6300/Tucson HMOx,23307AZ040,,AZN002,AZS002,AZF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339129,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330783,http://apps.humana.com/marketing/documents.asp?file=2323880,23307AZ0400012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,AZ,23307,HIOS,7,2014-09-29 21:43:29,3,23307,AZ,Individual,No,61-1013183,23307AZ0400012,Humana Bronze 6300/Tucson HMOx,23307AZ040,,AZN002,AZS002,AZF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339129,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2330783,http://apps.humana.com/marketing/documents.asp?file=2323880,23307AZ0400012-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,AZ,33851,HIOS,4,2014-09-05 03:32:16,1,33851,AZ,SHOP (Small Group),Yes,91-1857813,33851AZ0120001,Smile for Kids (EHB),33851AZ012,,AZN001,AZS001,,Existing,PPO,Low,,Off the Exchange,,,,See Schedule of Benefits for limitations and exclusions,,,,,Allows Child-Only,,,,$24.14,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.",Yes,www.premierlife.com/azhealthreform,www.premierlife.com/payment,www.premierlife.com/azhealthreform,,33851AZ0120001-00,Standard Low Off Exchange Plan,70.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$200,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,33851,HIOS,4,2014-09-05 03:32:16,1,33851,AZ,Individual,Yes,91-1857813,33851AZ0110001,Smile for Kids (EHB),33851AZ011,,AZN001,AZS001,,Existing,PPO,Low,,Both,,,,See Schedule of Benefits for limitations and exclusions,,,,,Allows Child-Only,,,,$27.39,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.",Yes,www.premierlife.com/azhealthreform,www.premierlife.com/payment,www.premierlife.com/azhealthreform,,33851AZ0110001-01,Standard Low On Exchange Plan,72.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$200,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160008,PPO Silver with pediatric dental 20%/20%/$2000,51485AZ016,,AZN001,AZS001,AZF007,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_20_20_2000_6000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_20_20_2000_6000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160008-00,Standard Silver Off Exchange Plan,69.20%,0.692435383796692,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170007,PPO Platinum $15/$30/$1000 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_1000_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_1000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,6,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160026,Aggregate HSA PPO Silver 20%/20%/$2000/$5000,51485AZ016,,AZN001,AZS001,AZF005,Existing,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_20_20_2000_5000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_20_20_2000_5000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160026-01,Standard Silver On Exchange Plan,70.00%,0.69994056224823,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,6,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160030,PPO Bronze 50%/50%$5500,51485AZ016,,AZN001,AZS001,AZF001,Existing,PPO,Bronze,Yes,Both,NO,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_bronze_50_50_5500_6350_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_bronze_50_50_5500_6350_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160030-00,Standard Bronze Off Exchange Plan,58.00%,0.581544399261475,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,6,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160024,Aggregate HSA PPO Silver 30%/30%/$2000,51485AZ016,,AZN001,AZS001,AZF006,Existing,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_30_30_2000_5000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_30_30_2000_5000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160024-01,Standard Silver On Exchange Plan,68.90%,0.688884735107422,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,6,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160025,Aggregate HSA PPO Silver 20%/20%/$2000/$6350,51485AZ016,,AZN001,AZS001,AZF005,Existing,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_20_20_2000_6350_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_20_20_2000_6350_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160025-00,Standard Silver Off Exchange Plan,68.70%,0.687518894672394,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,6,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160025,Aggregate HSA PPO Silver 20%/20%/$2000/$6350,51485AZ016,,AZN001,AZS001,AZF005,Existing,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_20_20_2000_6350_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_20_20_2000_6350_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160025-01,Standard Silver On Exchange Plan,68.70%,0.687518894672394,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,6,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160026,Aggregate HSA PPO Silver 20%/20%/$2000/$5000,51485AZ016,,AZN001,AZS001,AZF005,Existing,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_20_20_2000_5000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_20_20_2000_5000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160026-00,Standard Silver Off Exchange Plan,70.00%,0.69994056224823,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160007,PPO Silver with pediatric dental 20%/20%/$1500,51485AZ016,,AZN001,AZS001,AZF007,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_20_20_1500_6000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_20_20_1500_6000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160007-00,Standard Silver Off Exchange Plan,71.30%,0.71314263343811,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170007,PPO Platinum $15/$30/$1000 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_1000_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_1000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170007-00,Standard Platinum Off Exchange Plan,,0.916347205638886,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170007,PPO Platinum $15/$30/$1000 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_1000_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_1000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170007-01,Standard Platinum On Exchange Plan,,0.916347205638886,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160007,PPO Silver with pediatric dental 20%/20%/$1500,51485AZ016,,AZN001,AZS001,AZF007,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_20_20_1500_6000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_20_20_1500_6000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160007-01,Standard Silver On Exchange Plan,71.30%,0.71314263343811,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,6,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160030,PPO Bronze 50%/50%$5500,51485AZ016,,AZN001,AZS001,AZF001,Existing,PPO,Bronze,Yes,Both,NO,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_bronze_50_50_5500_6350_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_bronze_50_50_5500_6350_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160030-01,Standard Bronze On Exchange Plan,58.00%,0.581544399261475,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,AZ,52147,HIOS,2,2014-08-07 10:00:19,1,52147,AZ,SHOP (Small Group),Yes,93-0242990,52147AZ0040002,EHB High PPO,52147AZ004,,AZN001,AZS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$42.20,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,52147AZ0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1080004,AZ Blue EverydayHealth HMO 6000 - Alliance Network,53901AZ108,,AZN002,AZS002,AZF034,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth6000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1080004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,46
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1080004,AZ Blue EverydayHealth HMO 6000 - Alliance Network,53901AZ108,,AZN002,AZS002,AZF034,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth6000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1080004-03,Limited Cost Sharing Plan Variation,,0.610330104827881,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$100,$0,$150,$140,"$2,250",$0,$80,47
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1090001,AZ Blue EverydayHealth HMO 1000 - Select Network,53901AZ109,,AZN003,AZS002,AZF024,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth1000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1090001-00,Standard Gold Off Exchange Plan,,0.785332977771759,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$60,$830,$150,$140,"$1,400",$0,$80,48
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1090001,AZ Blue EverydayHealth HMO 1000 - Select Network,53901AZ109,,AZN003,AZS002,AZF024,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth1000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1090001-01,Standard Gold On Exchange Plan,,0.785332977771759,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$60,$830,$150,$140,"$1,400",$0,$80,49
2015,AZ,33851,HIOS,4,2014-09-05 03:32:16,2,33851,AZ,Individual,Yes,91-1857813,33851AZ0110002,PPO Family with EHB,33851AZ011,,AZN001,AZS001,,Existing,PPO,Low,,Both,,,,See Schedule of Benefits for limitations and exclusions,,,,,Allows Adult and Child-Only,,,,$27.39,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the usual, customary and reasonable amount in each geographic area as determined by Premier Access using industry data.",Yes,www.premierlife.com/azhealthreform,www.premierlife.com/payment,www.premierlife.com/azhealthreform,,33851AZ0110002-00,Standard Low Off Exchange Plan,72.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$200,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,33851,HIOS,4,2014-09-05 03:32:16,2,33851,AZ,Individual,Yes,91-1857813,33851AZ0110002,PPO Family with EHB,33851AZ011,,AZN001,AZS001,,Existing,PPO,Low,,Both,,,,See Schedule of Benefits for limitations and exclusions,,,,,Allows Adult and Child-Only,,,,$27.39,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the usual, customary and reasonable amount in each geographic area as determined by Premier Access using industry data.",Yes,www.premierlife.com/azhealthreform,www.premierlife.com/payment,www.premierlife.com/azhealthreform,,33851AZ0110002-01,Standard Low On Exchange Plan,72.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$200,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,33851,HIOS,4,2014-09-05 03:32:16,2,33851,AZ,Individual,Yes,91-1857813,33851AZ0110003,PLUS Family with EHB,33851AZ011,,AZN001,AZS001,,Existing,PPO,Low,,Both,,,,See Schedule of Benefits for limitations and exclusions,,,,,Allows Adult and Child-Only,,,,$27.39,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the usual, customary and reasonable amount in each geographic area as determined by Premier Access using industry data.",Yes,www.premierlife.com/azhealthreform,www.premierlife.com/payment,www.premierlife.com/azhealthreform,,33851AZ0110003-00,Standard Low Off Exchange Plan,72.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$200,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AZ,33851,HIOS,4,2014-09-05 03:32:16,2,33851,AZ,Individual,Yes,91-1857813,33851AZ0110003,PLUS Family with EHB,33851AZ011,,AZN001,AZS001,,Existing,PPO,Low,,Both,,,,See Schedule of Benefits for limitations and exclusions,,,,,Allows Adult and Child-Only,,,,$27.39,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the usual, customary and reasonable amount in each geographic area as determined by Premier Access using industry data.",Yes,www.premierlife.com/azhealthreform,www.premierlife.com/payment,www.premierlife.com/azhealthreform,,33851AZ0110003-01,Standard Low On Exchange Plan,72.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$200,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170001,PPO Platinum $15/$30/$1000 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_1000_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_1000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170001-00,Standard Platinum Off Exchange Plan,,0.916347205638886,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160001,PPO Platinum with pediatric dental $15/$30/$350,51485AZ016,,AZN001,AZS001,AZF003,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_350_2000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_350_2000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160001-00,Standard Platinum Off Exchange Plan,88.20%,0.88204163312912,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,$350,$700,20%,,,,$700,"$1,400",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160001,PPO Platinum with pediatric dental $15/$30/$350,51485AZ016,,AZN001,AZS001,AZF003,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_350_2000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_350_2000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160001-01,Standard Platinum On Exchange Plan,88.20%,0.88204163312912,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,$350,$700,20%,,,,$700,"$1,400",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170001,PPO Platinum $15/$30/$1000 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_1000_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_1000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170001-01,Standard Platinum On Exchange Plan,,0.916347205638886,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170001,PPO Platinum $15/$30/$1000 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_1000_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_1000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160002,PPO Platinum with pediatric dental$15/$30/$500,51485AZ016,,AZN001,AZS001,AZF003,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_500_1500_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_500_1500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160002-00,Standard Platinum Off Exchange Plan,88.70%,0.892422020435333,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160002,PPO Platinum with pediatric dental$15/$30/$500,51485AZ016,,AZN001,AZS001,AZF003,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_500_1500_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_500_1500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160002-01,Standard Platinum On Exchange Plan,88.70%,0.892422020435333,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170001,PPO Platinum $15/$30/$1000 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_1000_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_1000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170001-03,Limited Cost Sharing Plan Variation,,0.916347205638886,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170002,PPO Platinum $15/$30/$750 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_750_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_750_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170002-00,Standard Platinum Off Exchange Plan,,0.900174200534821,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$400,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160003,PPO Platinum with pediatric dental $15/$30/$750,51485AZ016,,AZN001,AZS001,AZF003,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_750_1000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_750_1000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160003-00,Standard Platinum Off Exchange Plan,89.60%,0.896297335624695,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160003,PPO Platinum with pediatric dental $15/$30/$750,51485AZ016,,AZN001,AZS001,AZF003,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_750_1000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_750_1000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160003-01,Standard Platinum On Exchange Plan,89.60%,0.896297335624695,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170002,PPO Platinum $15/$30/$750 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_750_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_750_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170002-01,Standard Platinum On Exchange Plan,,0.900174200534821,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$400,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170002,PPO Platinum $15/$30/$750 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_750_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_750_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160004,PPO Gold with pediatric dental $20/$40/$500,51485AZ016,,AZN001,AZS001,AZF010,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_500_3000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_500_3000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160004-00,Standard Gold Off Exchange Plan,81.60%,0.816055178642273,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160004,PPO Gold with pediatric dental $20/$40/$500,51485AZ016,,AZN001,AZS001,AZF010,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_500_3000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_500_3000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160004-01,Standard Gold On Exchange Plan,81.60%,0.816055178642273,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160005,PPO Gold with pediatric dental $20/$40/$1000,51485AZ016,,AZN001,AZS001,AZF010,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_1000_4000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_1000_4000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160005-00,Standard Gold Off Exchange Plan,78.90%,0.788787424564362,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160005,PPO Gold with pediatric dental $20/$40/$1000,51485AZ016,,AZN001,AZS001,AZF010,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_1000_4000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_1000_4000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160005-01,Standard Gold On Exchange Plan,78.90%,0.788787424564362,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170003,PPO Platinum $15/$30/$500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170003-01,Standard Platinum On Exchange Plan,,0.881154298782349,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$3,500","$7,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$600,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170003,PPO Platinum $15/$30/$500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160006,PPO Gold with pediatric dental $20/$40/$2000,51485AZ016,,AZN001,AZS001,AZF010,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_2000_3500_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_2000_3500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160006-00,Standard Gold Off Exchange Plan,78.50%,0.784225344657898,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160006,PPO Gold with pediatric dental $20/$40/$2000,51485AZ016,,AZN001,AZS001,AZF010,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_2000_3500_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_2000_3500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160006-01,Standard Gold On Exchange Plan,78.50%,0.784225344657898,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170003,PPO Platinum $15/$30/$500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170003-03,Limited Cost Sharing Plan Variation,,0.881154298782349,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$3,500","$7,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$600,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170004,PPO Gold $25/$50/$2500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_2500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_2500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170004-00,Standard Gold Off Exchange Plan,,0.784216344356537,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170004,PPO Gold $25/$50/$2500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_2500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_2500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170004-01,Standard Gold On Exchange Plan,,0.784216344356537,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170004,PPO Gold $25/$50/$2500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_2500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_2500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170004,PPO Gold $25/$50/$2500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_2500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_2500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170004-03,Limited Cost Sharing Plan Variation,,0.784216344356537,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170005,PPO Gold $25/$50/$1500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_1500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_1500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170005-00,Standard Gold Off Exchange Plan,,0.792545437812805,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170005,PPO Gold $25/$50/$1500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_1500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_1500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170005-01,Standard Gold On Exchange Plan,,0.792545437812805,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170005,PPO Gold $25/$50/$1500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_1500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_1500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170005,PPO Gold $25/$50/$1500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_1500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_1500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170005-03,Limited Cost Sharing Plan Variation,,0.792545437812805,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170006,PPO Gold $25/$50/$500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170006-00,Standard Gold Off Exchange Plan,,0.818767607212067,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170006,PPO Gold $25/$50/$500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170006-01,Standard Gold On Exchange Plan,,0.818767607212067,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170006,PPO Gold $25/$50/$500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,1,51485,AZ,Individual,No,73-0654885,51485AZ0170006,PPO Gold $25/$50/$500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170006-03,Limited Cost Sharing Plan Variation,,0.818767607212067,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,2,51485,AZ,Individual,No,73-0654885,51485AZ0170013,PPO Silver 30%/30%/$1500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF006,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170013-00,Standard Silver Off Exchange Plan,,0.682598233222961,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,2,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160014,PPO Platinum $15/$30/$350,51485AZ016,,AZN001,AZS001,AZF003,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_350_2000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_350_2000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160014-00,Standard Platinum Off Exchange Plan,88.20%,0.88204163312912,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,$350,$700,20%,,,,$700,"$1,400",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,2,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160014,PPO Platinum $15/$30/$350,51485AZ016,,AZN001,AZS001,AZF003,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_350_2000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_350_2000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160014-01,Standard Platinum On Exchange Plan,88.20%,0.88204163312912,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,$350,$700,20%,,,,$700,"$1,400",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,2,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160016,PPO Platinum $15/$30/$750,51485AZ016,,AZN001,AZS001,AZF003,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_750_1000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_750_1000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160016-00,Standard Platinum Off Exchange Plan,89.60%,0.896297335624695,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,2,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160016,PPO Platinum $15/$30/$750,51485AZ016,,AZN001,AZS001,AZF003,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_750_1000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_platinum_15_30_750_1000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160016-01,Standard Platinum On Exchange Plan,89.60%,0.896297335624695,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,2,51485,AZ,Individual,No,73-0654885,51485AZ0170013,PPO Silver 30%/30%/$1500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF006,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170013-05,87% AV Level Silver Plan,,0.868454873561859,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$350,$700,20%,,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,2,51485,AZ,Individual,No,73-0654885,51485AZ0170013,PPO Silver 30%/30%/$1500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF006,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170013-06,94% AV Level Silver Plan,,0.947218537330627,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$25,$50,10%,,,,$50,$100,Not Applicable,Not Applicable,,,,,,,,,10
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,2,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160017,PPO Gold $20/$40/$500,51485AZ016,,AZN001,AZS001,AZF010,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_500_3000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_500_3000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160017-00,Standard Gold Off Exchange Plan,81.60%,0.816055178642273,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,2,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160017,PPO Gold $20/$40/$500,51485AZ016,,AZN001,AZS001,AZF010,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_500_3000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_500_3000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160017-01,Standard Gold On Exchange Plan,81.60%,0.816055178642273,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,2,51485,AZ,Individual,No,73-0654885,51485AZ0170014,PPO Bronze 50%/50%/$5500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF013,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,1,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_bronze_50_50_5500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_bronze_50_50_5500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170014-00,Standard Bronze Off Exchange Plan,,0.59587574005127,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,2,51485,AZ,Individual,No,73-0654885,51485AZ0170014,PPO Bronze 50%/50%/$5500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF013,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,1,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_bronze_50_50_5500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_bronze_50_50_5500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170014-01,Standard Bronze On Exchange Plan,,0.59587574005127,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,2,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160018,PPO Gold $20/$40/$1000,51485AZ016,,AZN001,AZS001,AZF010,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_1000_4000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_1000_4000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160018-00,Standard Gold Off Exchange Plan,78.90%,0.788787424564362,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,2,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160018,PPO Gold $20/$40/$1000,51485AZ016,,AZN001,AZS001,AZF010,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_1000_4000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_1000_4000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160018-01,Standard Gold On Exchange Plan,78.90%,0.788787424564362,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,2,51485,AZ,Individual,No,73-0654885,51485AZ0170014,PPO Bronze 50%/50%/$5500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF013,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,1,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_bronze_50_50_5500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_bronze_50_50_5500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,13
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,2,51485,AZ,Individual,No,73-0654885,51485AZ0170014,PPO Bronze 50%/50%/$5500 with Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF013,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,1,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_bronze_50_50_5500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_bronze_50_50_5500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170014-03,Limited Cost Sharing Plan Variation,,0.59587574005127,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,2,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160019,PPO Gold $20/$40/$2000,51485AZ016,,AZN001,AZS001,AZF010,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_2000_3500_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_2000_3500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160019-00,Standard Gold Off Exchange Plan,78.50%,0.784225344657898,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,2,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160019,PPO Gold $20/$40/$2000,51485AZ016,,AZN001,AZS001,AZF010,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_2000_3500_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_gold_20_40_2000_3500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160019-01,Standard Gold On Exchange Plan,78.50%,0.784225344657898,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170007,PPO Platinum $15/$30/$1000 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_1000_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_1000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170007-03,Limited Cost Sharing Plan Variation,,0.916347205638886,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160008,PPO Silver with pediatric dental 20%/20%/$2000,51485AZ016,,AZN001,AZS001,AZF007,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_20_20_2000_6000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_20_20_2000_6000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160008-01,Standard Silver On Exchange Plan,69.20%,0.692435383796692,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160009,PPO Silver with pediatric dental 30%/30%/$1500,51485AZ016,,AZN001,AZS001,AZF008,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_30_30_1500_6000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_30_30_1500_6000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160009-00,Standard Silver Off Exchange Plan,69.30%,0.692543804645538,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170008,PPO Platinum $15/$30/$750 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_750_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_750_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170008-00,Standard Platinum Off Exchange Plan,,0.900174200534821,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$400,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170008,PPO Platinum $15/$30/$750 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_750_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_750_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170008-01,Standard Platinum On Exchange Plan,,0.900174200534821,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$400,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160009,PPO Silver with pediatric dental 30%/30%/$1500,51485AZ016,,AZN001,AZS001,AZF008,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_30_30_1500_6000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_30_30_1500_6000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160009-01,Standard Silver On Exchange Plan,69.30%,0.692543804645538,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160010,PPO Silver with pediatric dental 30%/30%/$2000,51485AZ016,,AZN001,AZS001,AZF008,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_30_30_2000_5500_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_30_30_2000_5500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160010-00,Standard Silver Off Exchange Plan,68.10%,0.681479394435883,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170008,PPO Platinum $15/$30/$750 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_750_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_750_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170008,PPO Platinum $15/$30/$750 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_750_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_750_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170008-03,Limited Cost Sharing Plan Variation,,0.900174200534821,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$400,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160010,PPO Silver with pediatric dental 30%/30%/$2000,51485AZ016,,AZN001,AZS001,AZF008,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_30_30_2000_5500_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_30_30_2000_5500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160010-01,Standard Silver On Exchange Plan,68.10%,0.681479394435883,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170009,PPO Platinum $15/$30/$500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170009-00,Standard Platinum Off Exchange Plan,,0.881154298782349,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$3,500","$7,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$600,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170009,PPO Platinum $15/$30/$500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170009-01,Standard Platinum On Exchange Plan,,0.881154298782349,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$3,500","$7,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$600,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170009,PPO Platinum $15/$30/$500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170009-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170009,PPO Platinum $15/$30/$500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF002,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_platinum_15_30_500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170009-03,Limited Cost Sharing Plan Variation,,0.881154298782349,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$3,500","$7,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$600,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170010,PPO Gold $25/$50/$2500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_2500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_2500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170010-00,Standard Gold Off Exchange Plan,,0.784216344356537,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170010,PPO Gold $25/$50/$2500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_2500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_2500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170010-01,Standard Gold On Exchange Plan,,0.784216344356537,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170010,PPO Gold $25/$50/$2500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_2500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_2500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170010,PPO Gold $25/$50/$2500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_2500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_2500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170010-03,Limited Cost Sharing Plan Variation,,0.784216344356537,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170011,PPO Gold $25/$50/$1500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_1500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_1500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170011-00,Standard Gold Off Exchange Plan,,0.792545437812805,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170011,PPO Gold $25/$50/$1500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_1500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_1500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170011-01,Standard Gold On Exchange Plan,,0.792545437812805,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170011,PPO Gold $25/$50/$1500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_1500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_1500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170011-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170011,PPO Gold $25/$50/$1500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_1500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_1500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170011-03,Limited Cost Sharing Plan Variation,,0.792545437812805,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170012,PPO Gold $25/$50/$500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170012-00,Standard Gold Off Exchange Plan,,0.818767607212067,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170012,PPO Gold $25/$50/$500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170012-01,Standard Gold On Exchange Plan,,0.818767607212067,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170012,PPO Gold $25/$50/$500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170012-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,3,51485,AZ,Individual,No,73-0654885,51485AZ0170012,PPO Gold $25/$50/$500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_gold_25_50_500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170012-03,Limited Cost Sharing Plan Variation,,0.818767607212067,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,4,51485,AZ,Individual,No,73-0654885,51485AZ0170015,PPO Silver 30%/30%/$1500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF006,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170015-00,Standard Silver Off Exchange Plan,,0.682598233222961,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,4,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160020,PPO Silver 20%/20%/$1500,51485AZ016,,AZN001,AZS001,AZF007,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_20_20_1500_6000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_20_20_1500_6000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160020-00,Standard Silver Off Exchange Plan,71.30%,0.71314263343811,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,4,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160020,PPO Silver 20%/20%/$1500,51485AZ016,,AZN001,AZS001,AZF007,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_20_20_1500_6000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_20_20_1500_6000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160020-01,Standard Silver On Exchange Plan,71.30%,0.71314263343811,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,4,51485,AZ,Individual,No,73-0654885,51485AZ0170015,PPO Silver 30%/30%/$1500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF006,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170015-01,Standard Silver On Exchange Plan,,0.682598233222961,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,4,51485,AZ,Individual,No,73-0654885,51485AZ0170015,PPO Silver 30%/30%/$1500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF006,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170015-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,4,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160021,PPO Silver 20%/20%/$2000,51485AZ016,,AZN001,AZS001,AZF007,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_20_20_2000_6000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_20_20_2000_6000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160021-00,Standard Silver Off Exchange Plan,69.20%,0.692435383796692,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,4,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160021,PPO Silver 20%/20%/$2000,51485AZ016,,AZN001,AZS001,AZF007,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_20_20_2000_6000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_silver_20_20_2000_6000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160021-01,Standard Silver On Exchange Plan,69.20%,0.692435383796692,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,4,51485,AZ,Individual,No,73-0654885,51485AZ0170015,PPO Silver 30%/30%/$1500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF006,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170015-03,Limited Cost Sharing Plan Variation,,0.682598233222961,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,4,51485,AZ,Individual,No,73-0654885,51485AZ0170016,PPO Bronze 50%/50%/$5500 without Pediatric Dental,51485AZ017,,AZN001,AZS001,AZF013,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,1,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_bronze_50_50_5500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_ppo_bronze_50_50_5500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0170016-03,Limited Cost Sharing Plan Variation,,0.59587574005127,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,5,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160011,Aggregate HSA PPO Silver with pediatric dental 30%/30%/$2000,51485AZ016,,AZN001,AZS001,AZF006,Existing,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_30_30_2000_5000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_30_30_2000_5000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160011-00,Standard Silver Off Exchange Plan,68.90%,0.688884735107422,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,5,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160011,Aggregate HSA PPO Silver with pediatric dental 30%/30%/$2000,51485AZ016,,AZN001,AZS001,AZF006,Existing,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_30_30_2000_5000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_30_30_2000_5000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160011-01,Standard Silver On Exchange Plan,68.90%,0.688884735107422,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,5,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160012,Aggregate HSA PPO Silver with pediatric dental 20%/20%/$2000/$6350,51485AZ016,,AZN001,AZS001,AZF005,Existing,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_20_20_2000_6350_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_20_20_2000_6350_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160012-00,Standard Silver Off Exchange Plan,68.70%,0.687518894672394,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,5,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160012,Aggregate HSA PPO Silver with pediatric dental 20%/20%/$2000/$6350,51485AZ016,,AZN001,AZS001,AZF005,Existing,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_20_20_2000_6350_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_20_20_2000_6350_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160012-01,Standard Silver On Exchange Plan,68.70%,0.687518894672394,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,5,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160013,Aggregate HSA PPO Silver with pediatric dental 20%/20%/$2000/$5000,51485AZ016,,AZN001,AZS001,AZF005,Existing,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_20_20_2000_5000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_20_20_2000_5000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160013-00,Standard Silver Off Exchange Plan,70.00%,0.69994056224823,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1080002,AZ Blue EverydayHealth HMO 3000 - Alliance Network,53901AZ108,,AZN002,AZS002,AZF032,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth3000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1080002-06,94% AV Level Silver Plan,,0.932036876678467,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$100,$20,$510,$150,$100,$530,$0,$80,36
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1080003,AZ Blue EverydayHealth HMO 4000 - Alliance Network,53901AZ108,,AZN002,AZS002,AZF026,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth4000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1080003-00,Standard Silver Off Exchange Plan,,0.684538066387177,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$80,$230,$150,$140,"$1,600",$0,$80,37
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1100003,AZ Blue EverydayHealth HMO 4000 - Secure Network,53901AZ110,,AZN004,AZS003,AZF026,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth4000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1100003-05,87% AV Level Silver Plan,,0.863474726676941,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,250",$30,$390,$150,$140,$640,$0,$80,86
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1100003,AZ Blue EverydayHealth HMO 4000 - Secure Network,53901AZ110,,AZN004,AZS003,AZF026,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth4000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1100003-06,94% AV Level Silver Plan,,0.93030172586441,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$50,$20,$510,$150,$50,$520,$10,$80,87
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1100004,AZ Blue EverydayHealth HMO 6000 - Secure Network,53901AZ110,,AZN004,AZS003,AZF034,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth6000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1100004-00,Standard Bronze Off Exchange Plan,,0.610330104827881,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$100,$0,$150,$140,"$2,250",$0,$80,88
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1100004,AZ Blue EverydayHealth HMO 6000 - Secure Network,53901AZ110,,AZN004,AZS003,AZF034,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth6000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1100004-01,Standard Bronze On Exchange Plan,,0.610330104827881,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$100,$0,$150,$140,"$2,250",$0,$80,89
2015,AZ,59748,HIOS,3,2014-09-03 04:28:59,1,59748,AZ,SHOP (Small Group),Yes,44-0308260,59748AZ0010001,KCL EHB Low PPO,59748AZ001,,AZN001,AZS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$39.59,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,59748AZ0010001-00,Standard Low Off Exchange Plan,68.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,59748,HIOS,3,2014-09-03 04:28:59,1,59748,AZ,SHOP (Small Group),Yes,44-0308260,59748AZ0010003,KCL EHB Low MAC,59748AZ001,,AZN001,AZS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$34.41,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,59748AZ0010003-00,Standard Low Off Exchange Plan,68.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,59748,HIOS,3,2014-09-03 04:28:59,1,59748,AZ,SHOP (Small Group),Yes,44-0308260,59748AZ0010005,KCL Fam Low PPO,59748AZ001,,AZN001,AZS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$39.59,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,59748AZ0010005-00,Standard Low Off Exchange Plan,68.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AZ,59748,HIOS,3,2014-09-03 04:28:59,1,59748,AZ,SHOP (Small Group),Yes,44-0308260,59748AZ0010007,KCL Fam Low MAC,59748AZ001,,AZN001,AZS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$34.41,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,59748AZ0010007-00,Standard Low Off Exchange Plan,68.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AZ,59748,HIOS,3,2014-09-03 04:28:59,2,59748,AZ,SHOP (Small Group),Yes,44-0308260,59748AZ0010002,KCL EHB High PPO,59748AZ001,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$49.59,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,59748AZ0010002-00,Standard High Off Exchange Plan,86.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,59748,HIOS,3,2014-09-03 04:28:59,2,59748,AZ,SHOP (Small Group),Yes,44-0308260,59748AZ0010004,KCL EHB High MAC,59748AZ001,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$43.85,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,59748AZ0010004-00,Standard High Off Exchange Plan,86.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,5,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160013,Aggregate HSA PPO Silver with pediatric dental 20%/20%/$2000/$5000,51485AZ016,,AZN001,AZS001,AZF005,Existing,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_20_20_2000_5000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_20_20_2000_5000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160013-01,Standard Silver On Exchange Plan,70.00%,0.69994056224823,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,5,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160028,PPO Bronze with pediatric dental 50%/50%$5500,51485AZ016,,AZN001,AZS001,AZF001,Existing,PPO,Bronze,Yes,Both,NO,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_bronze_50_50_5500_6350_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_bronze_50_50_5500_6350_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160028-00,Standard Bronze Off Exchange Plan,58.00%,0.581544399261475,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,5,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160028,PPO Bronze with pediatric dental 50%/50%$5500,51485AZ016,,AZN001,AZS001,AZF001,Existing,PPO,Bronze,Yes,Both,NO,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_bronze_50_50_5500_6350_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_bronze_50_50_5500_6350_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160028-01,Standard Bronze On Exchange Plan,58.00%,0.581544399261475,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,AZ,51485,HIOS,6,2015-04-22 11:06:15,6,51485,AZ,SHOP (Small Group),No,73-0654885,51485AZ0160024,Aggregate HSA PPO Silver 30%/30%/$2000,51485AZ016,,AZN001,AZS001,AZF006,Existing,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Services provided outside network when appropriate,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_30_30_2000_5000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_ppo_hsa_silver_30_30_2000_5000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,51485AZ0160024-00,Standard Silver Off Exchange Plan,68.90%,0.688884735107422,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1090001,AZ Blue EverydayHealth HMO 1000 - Select Network,53901AZ109,,AZN003,AZS002,AZF024,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth1000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1090001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,50
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1090001,AZ Blue EverydayHealth HMO 1000 - Select Network,53901AZ109,,AZN003,AZS002,AZF024,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth1000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1090001-03,Limited Cost Sharing Plan Variation,,0.785332977771759,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$60,$830,$150,$140,"$1,400",$0,$80,51
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ0540001,AZ Blue Essential PPO 1500 - Statewide Network,53901AZ054,,AZN001,AZS001,AZF015,Existing,PPO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Essential1500,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0540001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ0540001,AZ Blue Essential PPO 1500 - Statewide Network,53901AZ054,,AZN001,AZS001,AZF015,Existing,PPO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Essential1500,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0540001-03,Limited Cost Sharing Plan Variation,78.92%,0.780508697032928,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$0,0%,,,,$200,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$70,$730,$150,"$1,080",$730,$0,$80,7
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ0540003,AZ Blue Essential PPO 4000 - Statewide Network,53901AZ054,,AZN001,AZS001,AZF017,Existing,PPO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Essential4000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0540003-00,Standard Silver Off Exchange Plan,69.19%,0.676189064979553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,$400,$0,0%,,,,$400,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$70,$230,$150,"$1,080",$730,$0,$80,8
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ0540003,AZ Blue Essential PPO 4000 - Statewide Network,53901AZ054,,AZN001,AZS001,AZF017,Existing,PPO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Essential4000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0540003-01,Standard Silver On Exchange Plan,69.19%,0.676189064979553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,$400,$0,0%,,,,$400,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$70,$230,$150,"$1,080",$730,$0,$80,9
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ0540003,AZ Blue Essential PPO 4000 - Statewide Network,53901AZ054,,AZN001,AZS001,AZF017,Existing,PPO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Essential4000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0540003-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ0540003,AZ Blue Essential PPO 4000 - Statewide Network,53901AZ054,,AZN001,AZS001,AZF017,Existing,PPO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Essential4000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0540003-03,Limited Cost Sharing Plan Variation,69.19%,0.676189064979553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,$400,$0,0%,,,,$400,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$70,$230,$150,"$1,080",$730,$0,$80,11
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ0540003,AZ Blue Essential PPO 4000 - Statewide Network,53901AZ054,,AZN001,AZS001,AZF017,Existing,PPO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Essential4000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0540003-04,73% AV Level Silver Plan,73.51%,0.719976544380188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$400,$0,0%,,,,$400,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$50,$430,$150,"$1,080",$670,$0,$80,12
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ0540003,AZ Blue Essential PPO 4000 - Statewide Network,53901AZ054,,AZN001,AZS001,AZF017,Existing,PPO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Essential4000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0540003-05,87% AV Level Silver Plan,87.41%,0.865902662277222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$200,$0,0%,,,,$200,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$420,$150,"$1,000",$370,$0,$80,13
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1100003,AZ Blue EverydayHealth HMO 4000 - Secure Network,53901AZ110,,AZN004,AZS003,AZF026,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth4000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1100003-01,Standard Silver On Exchange Plan,,0.684538066387177,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$80,$230,$150,$140,"$1,600",$0,$80,82
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1100003,AZ Blue EverydayHealth HMO 4000 - Secure Network,53901AZ110,,AZN004,AZS003,AZF026,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth4000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1100003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,83
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1100003,AZ Blue EverydayHealth HMO 4000 - Secure Network,53901AZ110,,AZN004,AZS003,AZF026,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth4000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1100003-03,Limited Cost Sharing Plan Variation,,0.684538066387177,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$80,$230,$150,$140,"$1,600",$0,$80,84
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1100003,AZ Blue EverydayHealth HMO 4000 - Secure Network,53901AZ110,,AZN004,AZS003,AZF026,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth4000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1100003-04,73% AV Level Silver Plan,,0.723236978054047,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$70,$330,$150,$140,"$1,500",$0,$80,85
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1100004,AZ Blue EverydayHealth HMO 6000 - Secure Network,53901AZ110,,AZN004,AZS003,AZF034,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth6000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1100004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,90
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1100004,AZ Blue EverydayHealth HMO 6000 - Secure Network,53901AZ110,,AZN004,AZS003,AZF034,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth6000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1100004-03,Limited Cost Sharing Plan Variation,,0.610330104827881,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$100,$0,$150,$140,"$2,250",$0,$80,91
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ0560001,AZ Blue Portfolio HSA PPO 1500 - Statewide Network,53901AZ056,,AZN001,AZS001,AZF003,Existing,PPO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Portfolio1500,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ0560001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ0560001,AZ Blue Portfolio HSA PPO 1500 - Statewide Network,53901AZ056,,AZN001,AZS001,AZF003,Existing,PPO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Portfolio1500,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ0560001-03,Limited Cost Sharing Plan Variation,,0.781491816043854,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,500",$0,$580,$150,"$1,500",$0,$380,$80,7
2015,AZ,52147,HIOS,2,2014-08-07 10:00:19,1,52147,AZ,SHOP (Small Group),Yes,93-0242990,52147AZ0040001,EHB Low PPO,52147AZ004,,AZN001,AZS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.80,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,52147AZ0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,52147,HIOS,2,2014-08-07 10:00:19,1,52147,AZ,SHOP (Small Group),Yes,93-0242990,52147AZ0030002,EHB High Passive,52147AZ003,,AZN001,AZS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.98,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,52147AZ0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AZ,52147,HIOS,2,2014-08-07 10:00:19,1,52147,AZ,SHOP (Small Group),Yes,93-0242990,52147AZ0030001,EHB Low Passive,52147AZ003,,AZN001,AZS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.94,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,52147AZ0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,SHOP (Small Group),No,86-0004538,53901AZ0790001,AZ Blue EverydayHealth PPO 1000 - Statewide Network,53901AZ079,,AZN001,AZS001,AZF027,Existing,PPO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9969,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth1000SHOP,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/SmallGroupBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0790001-00,Standard Gold Off Exchange Plan,,0.785251259803772,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$60,$830,$150,$140,"$1,400",$0,$80,4
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ0530001,AZ Blue EverydayHealth PPO 1000 - Statewide Network,53901AZ053,,AZN001,AZS001,AZF023,Existing,PPO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth1000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0530001-00,Standard Gold Off Exchange Plan,,0.785332977771759,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$60,$830,$150,$140,"$1,400",$0,$80,4
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ0530001,AZ Blue EverydayHealth PPO 1000 - Statewide Network,53901AZ053,,AZN001,AZS001,AZF023,Existing,PPO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth1000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0530001-01,Standard Gold On Exchange Plan,,0.785332977771759,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$60,$830,$150,$140,"$1,400",$0,$80,5
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,SHOP (Small Group),No,86-0004538,53901AZ0790001,AZ Blue EverydayHealth PPO 1000 - Statewide Network,53901AZ079,,AZN001,AZS001,AZF027,Existing,PPO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9969,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth1000SHOP,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/SmallGroupBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0790001-01,Standard Gold On Exchange Plan,,0.785251259803772,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$60,$830,$150,$140,"$1,400",$0,$80,5
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,SHOP (Small Group),No,86-0004538,53901AZ0790002,AZ Blue EverydayHealth PPO 2000 - Statewide Network,53901AZ079,,AZN001,AZS001,AZF025,Existing,PPO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9969,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth2000SHOP,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/SmallGroupBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0790002-00,Standard Silver Off Exchange Plan,,0.716296792030334,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$80,$630,$150,$140,"$1,600",$0,$80,6
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ0530001,AZ Blue EverydayHealth PPO 1000 - Statewide Network,53901AZ053,,AZN001,AZS001,AZF023,Existing,PPO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth1000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0530001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ0530001,AZ Blue EverydayHealth PPO 1000 - Statewide Network,53901AZ053,,AZN001,AZS001,AZF023,Existing,PPO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth1000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0530001-03,Limited Cost Sharing Plan Variation,,0.785332977771759,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$60,$830,$150,$140,"$1,400",$0,$80,7
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,SHOP (Small Group),No,86-0004538,53901AZ0790002,AZ Blue EverydayHealth PPO 2000 - Statewide Network,53901AZ079,,AZN001,AZS001,AZF025,Existing,PPO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9969,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth2000SHOP,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/SmallGroupBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0790002-01,Standard Silver On Exchange Plan,,0.716296792030334,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$80,$630,$150,$140,"$1,600",$0,$80,7
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,SHOP (Small Group),No,86-0004538,53901AZ0790004,AZ Blue EverydayHealth PPO  6000 - Statewide Network,53901AZ079,,AZN001,AZS001,AZF033,Existing,PPO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9969,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth6000SHOP,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/SmallGroupBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0790004-00,Standard Bronze Off Exchange Plan,,0.610330104827881,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,"$6,500","$13,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$100,$0,$150,$140,"$2,250",$0,$80,8
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ0530002,AZ Blue EverydayHealth PPO 3000 - Statewide Network,53901AZ053,,AZN001,AZS001,AZF031,Existing,PPO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth3000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0530002-00,Standard Silver Off Exchange Plan,,0.713595628738403,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$80,$430,$150,$140,"$2,080",$0,$80,8
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ0530002,AZ Blue EverydayHealth PPO 3000 - Statewide Network,53901AZ053,,AZN001,AZS001,AZF031,Existing,PPO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth3000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0530002-01,Standard Silver On Exchange Plan,,0.713595628738403,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$80,$430,$150,$140,"$2,080",$0,$80,9
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,SHOP (Small Group),No,86-0004538,53901AZ0790004,AZ Blue EverydayHealth PPO  6000 - Statewide Network,53901AZ079,,AZN001,AZS001,AZF033,Existing,PPO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9969,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth6000SHOP,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/SmallGroupBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0790004-01,Standard Bronze On Exchange Plan,,0.610330104827881,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,"$6,500","$13,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$100,$0,$150,$140,"$2,250",$0,$80,9
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ0530002,AZ Blue EverydayHealth PPO 3000 - Statewide Network,53901AZ053,,AZN001,AZS001,AZF031,Existing,PPO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth3000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0530002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ0530002,AZ Blue EverydayHealth PPO 3000 - Statewide Network,53901AZ053,,AZN001,AZS001,AZF031,Existing,PPO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth3000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0530002-03,Limited Cost Sharing Plan Variation,,0.713595628738403,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$80,$430,$150,$140,"$2,080",$0,$80,11
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ0530002,AZ Blue EverydayHealth PPO 3000 - Statewide Network,53901AZ053,,AZN001,AZS001,AZF031,Existing,PPO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth3000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0530002-04,73% AV Level Silver Plan,,0.734674096107483,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$70,$630,$150,$140,"$1,740",$0,$80,12
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ0530002,AZ Blue EverydayHealth PPO 3000 - Statewide Network,53901AZ053,,AZN001,AZS001,AZF031,Existing,PPO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth3000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0530002-05,87% AV Level Silver Plan,,0.863824009895325,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,$900,"$1,800",10%,,,,"$1,400","$2,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$900,$40,$430,$150,$140,$920,$0,$80,13
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ0530002,AZ Blue EverydayHealth PPO 3000 - Statewide Network,53901AZ053,,AZN001,AZS001,AZF031,Existing,PPO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth3000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0530002-06,94% AV Level Silver Plan,,0.932036876678467,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$100,$200,10%,,,,$600,"$1,200",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$100,$20,$510,$150,$100,$530,$0,$80,14
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ0530003,AZ Blue EverydayHealth PPO  4000 - Statewide Network,53901AZ053,,AZN001,AZS001,AZF025,Existing,PPO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth4000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0530003-00,Standard Silver Off Exchange Plan,,0.684538066387177,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$80,$230,$150,$140,"$1,600",$0,$80,15
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ0530003,AZ Blue EverydayHealth PPO  4000 - Statewide Network,53901AZ053,,AZN001,AZS001,AZF025,Existing,PPO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth4000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0530003-01,Standard Silver On Exchange Plan,,0.684538066387177,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$80,$230,$150,$140,"$1,600",$0,$80,16
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ0530003,AZ Blue EverydayHealth PPO  4000 - Statewide Network,53901AZ053,,AZN001,AZS001,AZF025,Existing,PPO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth4000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0530003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,17
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ0530003,AZ Blue EverydayHealth PPO  4000 - Statewide Network,53901AZ053,,AZN001,AZS001,AZF025,Existing,PPO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth4000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0530003-03,Limited Cost Sharing Plan Variation,,0.684538066387177,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$80,$230,$150,$140,"$1,600",$0,$80,18
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ0530003,AZ Blue EverydayHealth PPO  4000 - Statewide Network,53901AZ053,,AZN001,AZS001,AZF025,Existing,PPO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth4000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0530003-04,73% AV Level Silver Plan,,0.723236978054047,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$70,$330,$150,$140,"$1,500",$0,$80,19
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ0530003,AZ Blue EverydayHealth PPO  4000 - Statewide Network,53901AZ053,,AZN001,AZS001,AZF025,Existing,PPO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth4000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0530003-05,87% AV Level Silver Plan,,0.863474726676941,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$1,750","$3,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,250",$30,$390,$150,$140,$640,$0,$80,20
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ0530003,AZ Blue EverydayHealth PPO  4000 - Statewide Network,53901AZ053,,AZN001,AZS001,AZF025,Existing,PPO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth4000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0530003-06,94% AV Level Silver Plan,,0.93030172586441,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,$50,$100,10%,,,,$550,"$1,100",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$50,$20,$510,$150,$50,$520,$10,$80,21
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ0530004,AZ Blue EverydayHealth PPO  6000 - Statewide Network,53901AZ053,,AZN001,AZS001,AZF033,Existing,PPO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth6000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0530004-00,Standard Bronze Off Exchange Plan,,0.610330104827881,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,"$6,500","$13,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$100,$0,$150,$140,"$2,250",$0,$80,22
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ0530004,AZ Blue EverydayHealth PPO  6000 - Statewide Network,53901AZ053,,AZN001,AZS001,AZF033,Existing,PPO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth6000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0530004-01,Standard Bronze On Exchange Plan,,0.610330104827881,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,"$6,500","$13,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$100,$0,$150,$140,"$2,250",$0,$80,23
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ0530004,AZ Blue EverydayHealth PPO  6000 - Statewide Network,53901AZ053,,AZN001,AZS001,AZF033,Existing,PPO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth6000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0530004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,24
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ0530004,AZ Blue EverydayHealth PPO  6000 - Statewide Network,53901AZ053,,AZN001,AZS001,AZF033,Existing,PPO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/EverydayHealth6000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0530004-03,Limited Cost Sharing Plan Variation,,0.610330104827881,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,"$6,500","$13,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$100,$0,$150,$140,"$2,250",$0,$80,25
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1080001,AZ Blue EverydayHealth HMO 1000 - Alliance Network,53901AZ108,,AZN002,AZS002,AZF024,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth1000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1080001-00,Standard Gold Off Exchange Plan,,0.785332977771759,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$60,$830,$150,$140,"$1,400",$0,$80,26
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1080001,AZ Blue EverydayHealth HMO 1000 - Alliance Network,53901AZ108,,AZN002,AZS002,AZF024,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth1000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1080001-01,Standard Gold On Exchange Plan,,0.785332977771759,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$60,$830,$150,$140,"$1,400",$0,$80,27
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1080001,AZ Blue EverydayHealth HMO 1000 - Alliance Network,53901AZ108,,AZN002,AZS002,AZF024,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth1000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1080001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,28
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1080001,AZ Blue EverydayHealth HMO 1000 - Alliance Network,53901AZ108,,AZN002,AZS002,AZF024,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth1000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1080001-03,Limited Cost Sharing Plan Variation,,0.785332977771759,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$60,$830,$150,$140,"$1,400",$0,$80,29
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1080002,AZ Blue EverydayHealth HMO 3000 - Alliance Network,53901AZ108,,AZN002,AZS002,AZF032,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth3000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1080002-00,Standard Silver Off Exchange Plan,,0.713595628738403,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$80,$430,$150,$140,"$2,080",$0,$80,30
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1080002,AZ Blue EverydayHealth HMO 3000 - Alliance Network,53901AZ108,,AZN002,AZS002,AZF032,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth3000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1080002-01,Standard Silver On Exchange Plan,,0.713595628738403,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$80,$430,$150,$140,"$2,080",$0,$80,31
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1080002,AZ Blue EverydayHealth HMO 3000 - Alliance Network,53901AZ108,,AZN002,AZS002,AZF032,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth3000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1080002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,32
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1080002,AZ Blue EverydayHealth HMO 3000 - Alliance Network,53901AZ108,,AZN002,AZS002,AZF032,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth3000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1080002-03,Limited Cost Sharing Plan Variation,,0.713595628738403,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$80,$430,$150,$140,"$2,080",$0,$80,33
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1080002,AZ Blue EverydayHealth HMO 3000 - Alliance Network,53901AZ108,,AZN002,AZS002,AZF032,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth3000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1080002-04,73% AV Level Silver Plan,,0.734674096107483,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$70,$630,$150,$140,"$1,740",$0,$80,34
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1080002,AZ Blue EverydayHealth HMO 3000 - Alliance Network,53901AZ108,,AZN002,AZS002,AZF032,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth3000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1080002-05,87% AV Level Silver Plan,,0.863824009895325,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$900,$40,$430,$150,$140,$920,$0,$80,35
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1080003,AZ Blue EverydayHealth HMO 4000 - Alliance Network,53901AZ108,,AZN002,AZS002,AZF026,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth4000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1080003-01,Standard Silver On Exchange Plan,,0.684538066387177,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$80,$230,$150,$140,"$1,600",$0,$80,38
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1080003,AZ Blue EverydayHealth HMO 4000 - Alliance Network,53901AZ108,,AZN002,AZS002,AZF026,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth4000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1080003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,39
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1080003,AZ Blue EverydayHealth HMO 4000 - Alliance Network,53901AZ108,,AZN002,AZS002,AZF026,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth4000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1080003-03,Limited Cost Sharing Plan Variation,,0.684538066387177,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$80,$230,$150,$140,"$1,600",$0,$80,40
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1080003,AZ Blue EverydayHealth HMO 4000 - Alliance Network,53901AZ108,,AZN002,AZS002,AZF026,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth4000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1080003-04,73% AV Level Silver Plan,,0.723236978054047,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$70,$330,$150,$140,"$1,500",$0,$80,41
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1080003,AZ Blue EverydayHealth HMO 4000 - Alliance Network,53901AZ108,,AZN002,AZS002,AZF026,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth4000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1080003-05,87% AV Level Silver Plan,,0.863474726676941,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,250",$30,$390,$150,$140,$640,$0,$80,42
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1080003,AZ Blue EverydayHealth HMO 4000 - Alliance Network,53901AZ108,,AZN002,AZS002,AZF026,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth4000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1080003-06,94% AV Level Silver Plan,,0.93030172586441,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$50,$20,$510,$150,$50,$520,$10,$80,43
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ0540001,AZ Blue Essential PPO 1500 - Statewide Network,53901AZ054,,AZN001,AZS001,AZF015,Existing,PPO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Essential1500,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0540001-00,Standard Gold Off Exchange Plan,78.92%,0.780508697032928,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$0,0%,,,,$200,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$70,$730,$150,"$1,080",$730,$0,$80,4
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ0540001,AZ Blue Essential PPO 1500 - Statewide Network,53901AZ054,,AZN001,AZS001,AZF015,Existing,PPO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Essential1500,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0540001-01,Standard Gold On Exchange Plan,78.92%,0.780508697032928,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$0,0%,,,,$200,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$70,$730,$150,"$1,080",$730,$0,$80,5
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1130004,AZ Blue Essential HMO 6000 - Secure Network,53901AZ113,,AZN004,AZS003,AZF036,New,HMO,Bronze,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential6000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1130004-00,Standard Bronze Off Exchange Plan,61.85%,0.601696074008942,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$90,$0,$150,"$1,080","$1,510",$0,$80,60
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1130004,AZ Blue Essential HMO 6000 - Secure Network,53901AZ113,,AZN004,AZS003,AZF036,New,HMO,Bronze,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential6000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1130004-01,Standard Bronze On Exchange Plan,61.85%,0.601696074008942,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$90,$0,$150,"$1,080","$1,510",$0,$80,61
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1130004,AZ Blue Essential HMO 6000 - Secure Network,53901AZ113,,AZN004,AZS003,AZF036,New,HMO,Bronze,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential6000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1130004-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,62
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1130004,AZ Blue Essential HMO 6000 - Secure Network,53901AZ113,,AZN004,AZS003,AZF036,New,HMO,Bronze,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential6000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1130004-03,Limited Cost Sharing Plan Variation,61.85%,0.601696074008942,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$90,$0,$150,"$1,080","$1,510",$0,$80,63
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ0560001,AZ Blue Portfolio HSA PPO 1500 - Statewide Network,53901AZ056,,AZN001,AZS001,AZF003,Existing,PPO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Portfolio1500,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ0560001-00,Standard Gold Off Exchange Plan,,0.781491816043854,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,500",$0,$580,$150,"$1,500",$0,$380,$80,4
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ0560001,AZ Blue Portfolio HSA PPO 1500 - Statewide Network,53901AZ056,,AZN001,AZS001,AZF003,Existing,PPO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Portfolio1500,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ0560001-01,Standard Gold On Exchange Plan,,0.781491816043854,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,500",$0,$580,$150,"$1,500",$0,$380,$80,5
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1080004,AZ Blue EverydayHealth HMO 6000 - Alliance Network,53901AZ108,,AZN002,AZS002,AZF034,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth6000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1080004-00,Standard Bronze Off Exchange Plan,,0.610330104827881,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$100,$0,$150,$140,"$2,250",$0,$80,44
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1080004,AZ Blue EverydayHealth HMO 6000 - Alliance Network,53901AZ108,,AZN002,AZS002,AZF034,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth6000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1080004-01,Standard Bronze On Exchange Plan,,0.610330104827881,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$100,$0,$150,$140,"$2,250",$0,$80,45
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ0540004,AZ Blue Essential PPO 6000 - Statewide Network,53901AZ054,,AZN001,AZS001,AZF035,Existing,PPO,Bronze,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Essential6000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0540004-01,Standard Bronze On Exchange Plan,61.85%,0.601696074008942,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,"$6,500","$13,000",Not Applicable,Not Applicable,$600,$0,0%,,,,$600,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$90,$0,$150,"$1,080","$1,510",$0,$80,16
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ0540004,AZ Blue Essential PPO 6000 - Statewide Network,53901AZ054,,AZN001,AZS001,AZF035,Existing,PPO,Bronze,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Essential6000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0540004-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,17
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ0540004,AZ Blue Essential PPO 6000 - Statewide Network,53901AZ054,,AZN001,AZS001,AZF035,Existing,PPO,Bronze,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Essential6000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0540004-03,Limited Cost Sharing Plan Variation,61.85%,0.601696074008942,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,"$6,500","$13,000",Not Applicable,Not Applicable,$600,$0,0%,,,,$600,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$90,$0,$150,"$1,080","$1,510",$0,$80,18
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1110001,AZ Blue Essential HMO 1500 - Alliance Network,53901AZ111,,AZN002,AZS002,AZF016,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential1500Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1110001-00,Standard Gold Off Exchange Plan,78.92%,0.780508697032928,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$70,$730,$150,"$1,080",$730,$0,$80,19
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1110001,AZ Blue Essential HMO 1500 - Alliance Network,53901AZ111,,AZN002,AZS002,AZF016,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential1500Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1110001-01,Standard Gold On Exchange Plan,78.92%,0.780508697032928,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$70,$730,$150,"$1,080",$730,$0,$80,20
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1110001,AZ Blue Essential HMO 1500 - Alliance Network,53901AZ111,,AZN002,AZS002,AZF016,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential1500Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1110001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,21
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1110001,AZ Blue Essential HMO 1500 - Alliance Network,53901AZ111,,AZN002,AZS002,AZF016,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential1500Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1110001-03,Limited Cost Sharing Plan Variation,78.92%,0.780508697032928,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$70,$730,$150,"$1,080",$730,$0,$80,22
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1110003,AZ Blue Essential HMO 4000 - Alliance Network,53901AZ111,,AZN002,AZS002,AZF017,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential4000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1110003-00,Standard Silver Off Exchange Plan,69.19%,0.676189064979553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$70,$230,$150,"$1,080",$730,$0,$80,23
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ0560003,AZ Blue Portfolio HSA PPO 3500 - Statewide Network,53901AZ056,,AZN001,AZS001,AZF001,Existing,PPO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Portfolio3500,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ0560003-04,73% AV Level Silver Plan,,0.732454240322113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$5,500","$11,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$3,250","$6,500",Not Applicable,Not Applicable,"$2,750",$0,$0,$150,"$2,750",$0,$0,$80,12
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ0560003,AZ Blue Portfolio HSA PPO 3500 - Statewide Network,53901AZ056,,AZN001,AZS001,AZF001,Existing,PPO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Portfolio3500,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ0560003-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$2,200","$4,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,"$1,600","$3,200",Not Applicable,Not Applicable,"$1,100",$0,$0,$150,"$1,100",$0,$0,$80,13
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1090002,AZ Blue EverydayHealth HMO 3000 - Select Network,53901AZ109,,AZN003,AZS002,AZF032,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth3000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1090002-00,Standard Silver Off Exchange Plan,,0.713595628738403,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$80,$430,$150,$140,"$2,080",$0,$80,52
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1090002,AZ Blue EverydayHealth HMO 3000 - Select Network,53901AZ109,,AZN003,AZS002,AZF032,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth3000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1090002-01,Standard Silver On Exchange Plan,,0.713595628738403,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$80,$430,$150,$140,"$2,080",$0,$80,53
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1090002,AZ Blue EverydayHealth HMO 3000 - Select Network,53901AZ109,,AZN003,AZS002,AZF032,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth3000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1090002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,54
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1090002,AZ Blue EverydayHealth HMO 3000 - Select Network,53901AZ109,,AZN003,AZS002,AZF032,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth3000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1090002-03,Limited Cost Sharing Plan Variation,,0.713595628738403,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$80,$430,$150,$140,"$2,080",$0,$80,55
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1090002,AZ Blue EverydayHealth HMO 3000 - Select Network,53901AZ109,,AZN003,AZS002,AZF032,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth3000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1090002-04,73% AV Level Silver Plan,,0.734674096107483,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$70,$630,$150,$140,"$1,740",$0,$80,56
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1090002,AZ Blue EverydayHealth HMO 3000 - Select Network,53901AZ109,,AZN003,AZS002,AZF032,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth3000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1090002-05,87% AV Level Silver Plan,,0.863824009895325,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$900,$40,$430,$150,$140,$920,$0,$80,57
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1090002,AZ Blue EverydayHealth HMO 3000 - Select Network,53901AZ109,,AZN003,AZS002,AZF032,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth3000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1090002-06,94% AV Level Silver Plan,,0.932036876678467,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$100,$20,$510,$150,$100,$530,$0,$80,58
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1090003,AZ Blue EverydayHealth HMO 4000 - Select Network,53901AZ109,,AZN003,AZS002,AZF026,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth4000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1090003-00,Standard Silver Off Exchange Plan,,0.684538066387177,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$80,$230,$150,$140,"$1,600",$0,$80,59
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1090003,AZ Blue EverydayHealth HMO 4000 - Select Network,53901AZ109,,AZN003,AZS002,AZF026,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth4000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1090003-01,Standard Silver On Exchange Plan,,0.684538066387177,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$80,$230,$150,$140,"$1,600",$0,$80,60
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1090003,AZ Blue EverydayHealth HMO 4000 - Select Network,53901AZ109,,AZN003,AZS002,AZF026,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth4000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1090003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,61
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1090003,AZ Blue EverydayHealth HMO 4000 - Select Network,53901AZ109,,AZN003,AZS002,AZF026,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth4000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1090003-03,Limited Cost Sharing Plan Variation,,0.684538066387177,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$80,$230,$150,$140,"$1,600",$0,$80,62
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1090003,AZ Blue EverydayHealth HMO 4000 - Select Network,53901AZ109,,AZN003,AZS002,AZF026,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth4000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1090003-04,73% AV Level Silver Plan,,0.723236978054047,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$70,$330,$150,$140,"$1,500",$0,$80,63
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1090003,AZ Blue EverydayHealth HMO 4000 - Select Network,53901AZ109,,AZN003,AZS002,AZF026,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth4000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1090003-05,87% AV Level Silver Plan,,0.863474726676941,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,250",$30,$390,$150,$140,$640,$0,$80,64
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1090003,AZ Blue EverydayHealth HMO 4000 - Select Network,53901AZ109,,AZN003,AZS002,AZF026,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth4000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1090003-06,94% AV Level Silver Plan,,0.93030172586441,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$50,$20,$510,$150,$50,$520,$10,$80,65
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1090004,AZ Blue EverydayHealth HMO 6000 - Select Network,53901AZ109,,AZN003,AZS002,AZF034,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth6000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1090004-00,Standard Bronze Off Exchange Plan,,0.610330104827881,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$100,$0,$150,$140,"$2,250",$0,$80,66
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1090004,AZ Blue EverydayHealth HMO 6000 - Select Network,53901AZ109,,AZN003,AZS002,AZF034,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth6000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1090004-01,Standard Bronze On Exchange Plan,,0.610330104827881,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$100,$0,$150,$140,"$2,250",$0,$80,67
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1090004,AZ Blue EverydayHealth HMO 6000 - Select Network,53901AZ109,,AZN003,AZS002,AZF034,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth6000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1090004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,68
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1090004,AZ Blue EverydayHealth HMO 6000 - Select Network,53901AZ109,,AZN003,AZS002,AZF034,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth6000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1090004-03,Limited Cost Sharing Plan Variation,,0.610330104827881,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$100,$0,$150,$140,"$2,250",$0,$80,69
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1100001,AZ Blue EverydayHealth HMO 1000 - Secure Network,53901AZ110,,AZN004,AZS003,AZF024,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth1000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1100001-00,Standard Gold Off Exchange Plan,,0.785332977771759,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$60,$830,$150,$140,"$1,400",$0,$80,70
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1100001,AZ Blue EverydayHealth HMO 1000 - Secure Network,53901AZ110,,AZN004,AZS003,AZF024,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth1000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1100001-01,Standard Gold On Exchange Plan,,0.785332977771759,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$60,$830,$150,$140,"$1,400",$0,$80,71
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1100001,AZ Blue EverydayHealth HMO 1000 - Secure Network,53901AZ110,,AZN004,AZS003,AZF024,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth1000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1100001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,72
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1100001,AZ Blue EverydayHealth HMO 1000 - Secure Network,53901AZ110,,AZN004,AZS003,AZF024,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth1000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1100001-03,Limited Cost Sharing Plan Variation,,0.785332977771759,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$60,$830,$150,$140,"$1,400",$0,$80,73
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1100002,AZ Blue EverydayHealth HMO 3000 - Secure Network,53901AZ110,,AZN004,AZS003,AZF032,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth3000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1100002-00,Standard Silver Off Exchange Plan,,0.713595628738403,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$80,$430,$150,$140,"$2,080",$0,$80,74
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1100002,AZ Blue EverydayHealth HMO 3000 - Secure Network,53901AZ110,,AZN004,AZS003,AZF032,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth3000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1100002-01,Standard Silver On Exchange Plan,,0.713595628738403,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$80,$430,$150,$140,"$2,080",$0,$80,75
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1100002,AZ Blue EverydayHealth HMO 3000 - Secure Network,53901AZ110,,AZN004,AZS003,AZF032,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth3000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1100002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,76
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1100002,AZ Blue EverydayHealth HMO 3000 - Secure Network,53901AZ110,,AZN004,AZS003,AZF032,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth3000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1100002-03,Limited Cost Sharing Plan Variation,,0.713595628738403,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$80,$430,$150,$140,"$2,080",$0,$80,77
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1100002,AZ Blue EverydayHealth HMO 3000 - Secure Network,53901AZ110,,AZN004,AZS003,AZF032,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth3000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1100002-04,73% AV Level Silver Plan,,0.734674096107483,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$70,$630,$150,$140,"$1,740",$0,$80,78
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1100002,AZ Blue EverydayHealth HMO 3000 - Secure Network,53901AZ110,,AZN004,AZS003,AZF032,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth3000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1100002-05,87% AV Level Silver Plan,,0.863824009895325,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$900,$40,$430,$150,$140,$920,$0,$80,79
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1100002,AZ Blue EverydayHealth HMO 3000 - Secure Network,53901AZ110,,AZN004,AZS003,AZF032,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth3000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1100002-06,94% AV Level Silver Plan,,0.932036876678467,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$100,$20,$510,$150,$100,$530,$0,$80,80
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,1,53901,AZ,Individual,No,86-0004538,53901AZ1100003,AZ Blue EverydayHealth HMO 4000 - Secure Network,53901AZ110,,AZN004,AZS003,AZF026,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/EverydayHealth4000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1100003-00,Standard Silver Off Exchange Plan,,0.684538066387177,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$80,$230,$150,$140,"$1,600",$0,$80,81
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ0560003,AZ Blue Portfolio HSA PPO 3500 - Statewide Network,53901AZ056,,AZN001,AZS001,AZF001,Existing,PPO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Portfolio3500,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ0560003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ0560003,AZ Blue Portfolio HSA PPO 3500 - Statewide Network,53901AZ056,,AZN001,AZS001,AZF001,Existing,PPO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Portfolio3500,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ0560003-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$3,500",$0,$0,$150,"$3,500",$0,$0,$80,11
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ0560003,AZ Blue Portfolio HSA PPO 3500 - Statewide Network,53901AZ056,,AZN001,AZS001,AZF001,Existing,PPO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Portfolio3500,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ0560003-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,14
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ0560004,AZ Blue Portfolio HSA PPO 5500 - Statewide Network,53901AZ056,,AZN001,AZS001,AZF001,Existing,PPO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Portfolio5500,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ0560004-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$5,500",$0,$0,$150,"$5,270",$0,$0,$80,15
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ0560004,AZ Blue Portfolio HSA PPO 5500 - Statewide Network,53901AZ056,,AZN001,AZS001,AZF001,Existing,PPO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Portfolio5500,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ0560004-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$5,500",$0,$0,$150,"$5,270",$0,$0,$80,16
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ0560004,AZ Blue Portfolio HSA PPO 5500 - Statewide Network,53901AZ056,,AZN001,AZS001,AZF001,Existing,PPO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Portfolio5500,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ0560004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,17
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ0560004,AZ Blue Portfolio HSA PPO 5500 - Statewide Network,53901AZ056,,AZN001,AZS001,AZF001,Existing,PPO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Portfolio5500,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ0560004-03,Limited Cost Sharing Plan Variation,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$5,500",$0,$0,$150,"$5,270",$0,$0,$80,18
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ0560005,AZ Blue Portfolio HSA PPO 6300 - Statewide Network,53901AZ056,,AZN001,AZS001,AZF001,New,PPO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Portfolio6300,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ0560005-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$6,800","$13,600",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,270",$0,$0,$80,19
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1210002,AZ Blue CopayComplete HMO 40 - Select Network,53901AZ121,,AZN003,AZS002,AZF036,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete40Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1210002-00,Standard Silver Off Exchange Plan,70.26%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$3,560",$0,$150,$0,"$2,390",$0,$80,30
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1210002,AZ Blue CopayComplete HMO 40 - Select Network,53901AZ121,,AZN003,AZS002,AZF036,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete40Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1210002-01,Standard Silver On Exchange Plan,70.26%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$3,560",$0,$150,$0,"$2,390",$0,$80,31
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ0540003,AZ Blue Essential PPO 4000 - Statewide Network,53901AZ054,,AZN001,AZS001,AZF017,Existing,PPO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Essential4000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0540003-06,94% AV Level Silver Plan,93.27%,0.932833552360535,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,$0,$0,10%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$20,$520,$150,$0,$450,$90,$80,14
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ0540004,AZ Blue Essential PPO 6000 - Statewide Network,53901AZ054,,AZN001,AZS001,AZF035,Existing,PPO,Bronze,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Essential6000,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0540004-00,Standard Bronze Off Exchange Plan,61.85%,0.601696074008942,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,"$6,500","$13,000",Not Applicable,Not Applicable,$600,$0,0%,,,,$600,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$90,$0,$150,"$1,080","$1,510",$0,$80,15
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1110003,AZ Blue Essential HMO 4000 - Alliance Network,53901AZ111,,AZN002,AZS002,AZF017,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential4000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1110003-01,Standard Silver On Exchange Plan,69.19%,0.676189064979553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$70,$230,$150,"$1,080",$730,$0,$80,24
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1110003,AZ Blue Essential HMO 4000 - Alliance Network,53901AZ111,,AZN002,AZS002,AZF017,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential4000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1110003-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,25
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1110003,AZ Blue Essential HMO 4000 - Alliance Network,53901AZ111,,AZN002,AZS002,AZF017,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential4000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1110003-03,Limited Cost Sharing Plan Variation,69.19%,0.676189064979553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$70,$230,$150,"$1,080",$730,$0,$80,26
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1110003,AZ Blue Essential HMO 4000 - Alliance Network,53901AZ111,,AZN002,AZS002,AZF017,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential4000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1110003-04,73% AV Level Silver Plan,73.51%,0.719976544380188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$50,$430,$150,"$1,080",$670,$0,$80,27
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1110003,AZ Blue Essential HMO 4000 - Alliance Network,53901AZ111,,AZN002,AZS002,AZF017,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential4000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1110003-05,87% AV Level Silver Plan,87.41%,0.865902662277222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$420,$150,"$1,000",$370,$0,$80,28
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1110003,AZ Blue Essential HMO 4000 - Alliance Network,53901AZ111,,AZN002,AZS002,AZF017,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential4000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1110003-06,94% AV Level Silver Plan,93.27%,0.932833552360535,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$20,$520,$150,$0,$450,$90,$80,29
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1110004,AZ Blue Essential HMO 6000 - Alliance Network,53901AZ111,,AZN002,AZS002,AZF036,New,HMO,Bronze,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential6000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1110004-00,Standard Bronze Off Exchange Plan,61.85%,0.601696074008942,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$90,$0,$150,"$1,080","$1,510",$0,$80,30
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1110004,AZ Blue Essential HMO 6000 - Alliance Network,53901AZ111,,AZN002,AZS002,AZF036,New,HMO,Bronze,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential6000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1110004-01,Standard Bronze On Exchange Plan,61.85%,0.601696074008942,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$90,$0,$150,"$1,080","$1,510",$0,$80,31
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1110004,AZ Blue Essential HMO 6000 - Alliance Network,53901AZ111,,AZN002,AZS002,AZF036,New,HMO,Bronze,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential6000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1110004-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,32
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1110004,AZ Blue Essential HMO 6000 - Alliance Network,53901AZ111,,AZN002,AZS002,AZF036,New,HMO,Bronze,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential6000Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1110004-03,Limited Cost Sharing Plan Variation,61.85%,0.601696074008942,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$90,$0,$150,"$1,080","$1,510",$0,$80,33
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1120001,AZ Blue Essential HMO 1500 - Select Network,53901AZ112,,AZN003,AZS002,AZF016,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential1500Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1120001-00,Standard Gold Off Exchange Plan,78.92%,0.780508697032928,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$70,$730,$150,"$1,080",$730,$0,$80,34
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1120001,AZ Blue Essential HMO 1500 - Select Network,53901AZ112,,AZN003,AZS002,AZF016,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential1500Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1120001-01,Standard Gold On Exchange Plan,78.92%,0.780508697032928,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$70,$730,$150,"$1,080",$730,$0,$80,35
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1120001,AZ Blue Essential HMO 1500 - Select Network,53901AZ112,,AZN003,AZS002,AZF016,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential1500Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1120001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,36
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1120001,AZ Blue Essential HMO 1500 - Select Network,53901AZ112,,AZN003,AZS002,AZF016,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential1500Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1120001-03,Limited Cost Sharing Plan Variation,78.92%,0.780508697032928,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$70,$730,$150,"$1,080",$730,$0,$80,37
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1120003,AZ Blue Essential HMO 4000 - Select Network,53901AZ112,,AZN003,AZS002,AZF017,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential4000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1120003-00,Standard Silver Off Exchange Plan,69.19%,0.676189064979553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$70,$230,$150,"$1,080",$730,$0,$80,38
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1120003,AZ Blue Essential HMO 4000 - Select Network,53901AZ112,,AZN003,AZS002,AZF017,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential4000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1120003-01,Standard Silver On Exchange Plan,69.19%,0.676189064979553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$70,$230,$150,"$1,080",$730,$0,$80,39
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1120003,AZ Blue Essential HMO 4000 - Select Network,53901AZ112,,AZN003,AZS002,AZF017,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential4000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1120003-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,40
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1120003,AZ Blue Essential HMO 4000 - Select Network,53901AZ112,,AZN003,AZS002,AZF017,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential4000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1120003-03,Limited Cost Sharing Plan Variation,69.19%,0.676189064979553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$70,$230,$150,"$1,080",$730,$0,$80,41
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1120003,AZ Blue Essential HMO 4000 - Select Network,53901AZ112,,AZN003,AZS002,AZF017,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential4000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1120003-04,73% AV Level Silver Plan,73.51%,0.719976544380188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$50,$430,$150,"$1,080",$670,$0,$80,42
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1120003,AZ Blue Essential HMO 4000 - Select Network,53901AZ112,,AZN003,AZS002,AZF017,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential4000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1120003-05,87% AV Level Silver Plan,87.41%,0.865902662277222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$420,$150,"$1,000",$370,$0,$80,43
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1120003,AZ Blue Essential HMO 4000 - Select Network,53901AZ112,,AZN003,AZS002,AZF017,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential4000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1120003-06,94% AV Level Silver Plan,93.27%,0.932833552360535,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$20,$520,$150,$0,$450,$90,$80,44
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1120004,AZ Blue Essential HMO 6000 - Select Network,53901AZ112,,AZN003,AZS002,AZF036,New,HMO,Bronze,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential6000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1120004-00,Standard Bronze Off Exchange Plan,61.85%,0.601696074008942,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$90,$0,$150,"$1,080","$1,510",$0,$80,45
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1120004,AZ Blue Essential HMO 6000 - Select Network,53901AZ112,,AZN003,AZS002,AZF036,New,HMO,Bronze,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential6000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1120004-01,Standard Bronze On Exchange Plan,61.85%,0.601696074008942,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$90,$0,$150,"$1,080","$1,510",$0,$80,46
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1120004,AZ Blue Essential HMO 6000 - Select Network,53901AZ112,,AZN003,AZS002,AZF036,New,HMO,Bronze,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential6000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1120004-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,47
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1120004,AZ Blue Essential HMO 6000 - Select Network,53901AZ112,,AZN003,AZS002,AZF036,New,HMO,Bronze,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential6000Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1120004-03,Limited Cost Sharing Plan Variation,61.85%,0.601696074008942,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,170",$90,$0,$150,"$1,080","$1,510",$0,$80,48
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1130001,AZ Blue Essential HMO 1500 - Secure Network,53901AZ113,,AZN004,AZS003,AZF016,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential1500Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1130001-00,Standard Gold Off Exchange Plan,78.92%,0.780508697032928,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$70,$730,$150,"$1,080",$730,$0,$80,49
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1130001,AZ Blue Essential HMO 1500 - Secure Network,53901AZ113,,AZN004,AZS003,AZF016,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential1500Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1130001-01,Standard Gold On Exchange Plan,78.92%,0.780508697032928,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$70,$730,$150,"$1,080",$730,$0,$80,50
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1130001,AZ Blue Essential HMO 1500 - Secure Network,53901AZ113,,AZN004,AZS003,AZF016,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential1500Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1130001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,51
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1130001,AZ Blue Essential HMO 1500 - Secure Network,53901AZ113,,AZN004,AZS003,AZF016,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential1500Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1130001-03,Limited Cost Sharing Plan Variation,78.92%,0.780508697032928,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$70,$730,$150,"$1,080",$730,$0,$80,52
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1130003,AZ Blue Essential HMO 4000 - Secure Network,53901AZ113,,AZN004,AZS003,AZF017,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential4000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1130003-00,Standard Silver Off Exchange Plan,69.19%,0.676189064979553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$70,$230,$150,"$1,080",$730,$0,$80,53
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1130003,AZ Blue Essential HMO 4000 - Secure Network,53901AZ113,,AZN004,AZS003,AZF017,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential4000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1130003-01,Standard Silver On Exchange Plan,69.19%,0.676189064979553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$70,$230,$150,"$1,080",$730,$0,$80,54
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1130003,AZ Blue Essential HMO 4000 - Secure Network,53901AZ113,,AZN004,AZS003,AZF017,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential4000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1130003-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,55
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1130003,AZ Blue Essential HMO 4000 - Secure Network,53901AZ113,,AZN004,AZS003,AZF017,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential4000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1130003-03,Limited Cost Sharing Plan Variation,69.19%,0.676189064979553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$70,$230,$150,"$1,080",$730,$0,$80,56
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1130003,AZ Blue Essential HMO 4000 - Secure Network,53901AZ113,,AZN004,AZS003,AZF017,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential4000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1130003-04,73% AV Level Silver Plan,73.51%,0.719976544380188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$50,$430,$150,"$1,080",$670,$0,$80,57
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1130003,AZ Blue Essential HMO 4000 - Secure Network,53901AZ113,,AZN004,AZS003,AZF017,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential4000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1130003-05,87% AV Level Silver Plan,87.41%,0.865902662277222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$420,$150,"$1,000",$370,$0,$80,58
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,2,53901,AZ,Individual,No,86-0004538,53901AZ1130003,AZ Blue Essential HMO 4000 - Secure Network,53901AZ113,,AZN004,AZS003,AZF017,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Essential4000Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1130003-06,94% AV Level Silver Plan,93.27%,0.932833552360535,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$20,$520,$150,$0,$450,$90,$80,59
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1210001,AZ Blue CopayComplete HMO 25 - Select Network,53901AZ121,,AZN003,AZS002,AZF014,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete25Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1210001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,28
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1210001,AZ Blue CopayComplete HMO 25 - Select Network,53901AZ121,,AZN003,AZS002,AZF014,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete25Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1210001-03,Limited Cost Sharing Plan Variation,78.43%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$2,230",$0,$150,$0,"$1,390",$0,$80,29
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1210002,AZ Blue CopayComplete HMO 40 - Select Network,53901AZ121,,AZN003,AZS002,AZF036,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete40Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1210002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,32
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1210002,AZ Blue CopayComplete HMO 40 - Select Network,53901AZ121,,AZN003,AZS002,AZF036,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete40Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1210002-03,Limited Cost Sharing Plan Variation,70.26%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$3,560",$0,$150,$0,"$2,390",$0,$80,33
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0300001,Meritus Healthy Silver HMO MIHS 4000,60761AZ030,,AZN002,AZS002,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20MIHS%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0300001-01,Standard Silver On Exchange Plan,70.19%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0300001,Meritus Healthy Silver HMO MIHS 4000,60761AZ030,,AZN002,AZS002,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20MIHS%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0300001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,34
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0300001,Meritus Healthy Silver HMO MIHS 4000,60761AZ030,,AZN002,AZS002,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20MIHS%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0300001-03,Limited Cost Sharing Plan Variation,70.19%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0300001,Meritus Healthy Silver HMO MIHS 4000,60761AZ030,,AZN002,AZS002,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20MIHS%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0300001-04,73% AV Level Silver Plan,73.65%,0.710138440132141,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0300001,Meritus Healthy Silver HMO MIHS 4000,60761AZ030,,AZN002,AZS002,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20MIHS%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0300001-05,87% AV Level Silver Plan,87.35%,0.849142491817474,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0300001,Meritus Healthy Silver HMO MIHS 4000,60761AZ030,,AZN002,AZS002,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20MIHS%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0300001-06,94% AV Level Silver Plan,94.06%,0.927993535995483,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,Individual,No,46-1509576,60761AZ0220001,Meritus Healthy Bronze HMO Abrazo 6000,60761AZ022,,AZN004,AZS003,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20I%20Abrazo%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0220001-03,Limited Cost Sharing Plan Variation,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,Individual,No,46-1509576,60761AZ0230001,Meritus Healthy Bronze HMO Pima 6000,60761AZ023,,AZN005,AZS004,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20I%20Pima%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0230001-00,Standard Bronze Off Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,Individual,No,46-1509576,60761AZ0230001,Meritus Healthy Bronze HMO Pima 6000,60761AZ023,,AZN005,AZS004,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20I%20Pima%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0230001-01,Standard Bronze On Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,Individual,No,46-1509576,60761AZ0230001,Meritus Healthy Bronze HMO Pima 6000,60761AZ023,,AZN005,AZS004,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20I%20Pima%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0230001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ0560003,AZ Blue Portfolio HSA PPO 3500 - Statewide Network,53901AZ056,,AZN001,AZS001,AZF001,Existing,PPO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Portfolio3500,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ0560003-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$3,500",$0,$0,$150,"$3,500",$0,$0,$80,8
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ0560003,AZ Blue Portfolio HSA PPO 3500 - Statewide Network,53901AZ056,,AZN001,AZS001,AZF001,Existing,PPO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Portfolio3500,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ0560003-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$3,500",$0,$0,$150,"$3,500",$0,$0,$80,9
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1160003,AZ Blue Portfolio HSA HMO 3500 - Secure Network,53901AZ116,,AZN004,AZS003,AZF002,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio3500Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1160003-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$0,$0,$150,"$3,500",$0,$0,$80,68
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1160003,AZ Blue Portfolio HSA HMO 3500 - Secure Network,53901AZ116,,AZN004,AZS003,AZF002,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio3500Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1160003-04,73% AV Level Silver Plan,,0.732454240322113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750",$0,$0,$150,"$2,750",$0,$0,$80,69
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1160003,AZ Blue Portfolio HSA HMO 3500 - Secure Network,53901AZ116,,AZN004,AZS003,AZF002,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio3500Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1160003-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,100",$0,$0,$150,"$1,100",$0,$0,$80,70
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1160003,AZ Blue Portfolio HSA HMO 3500 - Secure Network,53901AZ116,,AZN004,AZS003,AZF002,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio3500Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1160003-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,71
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1160004,AZ Blue Portfolio HSA HMO 5500 - Secure Network,53901AZ116,,AZN004,AZS003,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio5500Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1160004-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$0,$0,$150,"$5,270",$0,$0,$80,72
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1160004,AZ Blue Portfolio HSA HMO 5500 - Secure Network,53901AZ116,,AZN004,AZS003,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio5500Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1160004-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$0,$0,$150,"$5,270",$0,$0,$80,73
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1220001,AZ Blue CopayComplete HMO 25 - Secure Network,53901AZ122,,AZN004,AZS003,AZF014,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete25Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1220001-01,Standard Gold On Exchange Plan,78.43%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$2,230",$0,$150,$0,"$1,390",$0,$80,38
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1220001,AZ Blue CopayComplete HMO 25 - Secure Network,53901AZ122,,AZN004,AZS003,AZF014,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete25Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1220001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,39
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0480001,Meritus Healthy Silver HMO MIHS 4000,60761AZ048,,AZN002,AZS002,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20G%20MIHS%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0480001-00,Standard Silver Off Exchange Plan,70.20%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0480001,Meritus Healthy Silver HMO MIHS 4000,60761AZ048,,AZN002,AZS002,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20G%20MIHS%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0480001-01,Standard Silver On Exchange Plan,70.20%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ0560005,AZ Blue Portfolio HSA PPO 6300 - Statewide Network,53901AZ056,,AZN001,AZS001,AZF001,New,PPO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Portfolio6300,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ0560005-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$6,800","$13,600",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ0560005,AZ Blue Portfolio HSA PPO 6300 - Statewide Network,53901AZ056,,AZN001,AZS001,AZF001,New,PPO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Portfolio6300,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ0560005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,21
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ0560005,AZ Blue Portfolio HSA PPO 6300 - Statewide Network,53901AZ056,,AZN001,AZS001,AZF001,New,PPO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/Portfolio6300,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ0560005-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$6,800","$13,600",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,270",$0,$0,$80,22
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1140001,AZ Blue Portfolio HSA HMO 1500 - Alliance Network,53901AZ114,,AZN002,AZS002,AZF004,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio1500Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1140001-00,Standard Gold Off Exchange Plan,,0.781491816043854,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$580,$150,"$1,500",$0,$380,$80,23
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1140001,AZ Blue Portfolio HSA HMO 1500 - Alliance Network,53901AZ114,,AZN002,AZS002,AZF004,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio1500Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1140001-01,Standard Gold On Exchange Plan,,0.781491816043854,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$580,$150,"$1,500",$0,$380,$80,24
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1140001,AZ Blue Portfolio HSA HMO 1500 - Alliance Network,53901AZ114,,AZN002,AZS002,AZF004,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio1500Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1140001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,25
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1140001,AZ Blue Portfolio HSA HMO 1500 - Alliance Network,53901AZ114,,AZN002,AZS002,AZF004,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio1500Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1140001-03,Limited Cost Sharing Plan Variation,,0.781491816043854,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$580,$150,"$1,500",$0,$380,$80,26
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1140003,AZ Blue Portfolio HSA HMO 3500 - Alliance Network,53901AZ114,,AZN002,AZS002,AZF002,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio3500Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1140003-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$0,$0,$150,"$3,500",$0,$0,$80,27
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1140003,AZ Blue Portfolio HSA HMO 3500 - Alliance Network,53901AZ114,,AZN002,AZS002,AZF002,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio3500Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1140003-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$0,$0,$150,"$3,500",$0,$0,$80,28
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1140003,AZ Blue Portfolio HSA HMO 3500 - Alliance Network,53901AZ114,,AZN002,AZS002,AZF002,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio3500Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1140003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,29
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1140003,AZ Blue Portfolio HSA HMO 3500 - Alliance Network,53901AZ114,,AZN002,AZS002,AZF002,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio3500Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1140003-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$0,$0,$150,"$3,500",$0,$0,$80,30
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1140003,AZ Blue Portfolio HSA HMO 3500 - Alliance Network,53901AZ114,,AZN002,AZS002,AZF002,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio3500Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1140003-04,73% AV Level Silver Plan,,0.732454240322113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750",$0,$0,$150,"$2,750",$0,$0,$80,31
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1140003,AZ Blue Portfolio HSA HMO 3500 - Alliance Network,53901AZ114,,AZN002,AZS002,AZF002,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio3500Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1140003-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,100",$0,$0,$150,"$1,100",$0,$0,$80,32
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1140003,AZ Blue Portfolio HSA HMO 3500 - Alliance Network,53901AZ114,,AZN002,AZS002,AZF002,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio3500Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1140003-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,33
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1140004,AZ Blue Portfolio HSA HMO 5500 - Alliance Network,53901AZ114,,AZN002,AZS002,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio5500Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1140004-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$0,$0,$150,"$5,270",$0,$0,$80,34
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1140004,AZ Blue Portfolio HSA HMO 5500 - Alliance Network,53901AZ114,,AZN002,AZS002,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio5500Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1140004-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$0,$0,$150,"$5,270",$0,$0,$80,35
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1140004,AZ Blue Portfolio HSA HMO 5500 - Alliance Network,53901AZ114,,AZN002,AZS002,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio5500Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1140004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,36
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1140004,AZ Blue Portfolio HSA HMO 5500 - Alliance Network,53901AZ114,,AZN002,AZS002,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio5500Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1140004-03,Limited Cost Sharing Plan Variation,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$0,$0,$150,"$5,270",$0,$0,$80,37
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1140005,AZ Blue Portfolio HSA HMO 6300 - Alliance Network,53901AZ114,,AZN002,AZS002,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio6300Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1140005-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,270",$0,$0,$80,38
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1140005,AZ Blue Portfolio HSA HMO 6300 - Alliance Network,53901AZ114,,AZN002,AZS002,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio6300Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1140005-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,270",$0,$0,$80,39
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1140005,AZ Blue Portfolio HSA HMO 6300 - Alliance Network,53901AZ114,,AZN002,AZS002,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio6300Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1140005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,40
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1140005,AZ Blue Portfolio HSA HMO 6300 - Alliance Network,53901AZ114,,AZN002,AZS002,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio6300Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1140005-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,270",$0,$0,$80,41
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1150001,AZ Blue Portfolio HSA HMO 1500 - Select Network,53901AZ115,,AZN003,AZS002,AZF004,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio1500Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1150001-00,Standard Gold Off Exchange Plan,,0.781491816043854,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$580,$150,"$1,500",$0,$380,$80,42
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1150001,AZ Blue Portfolio HSA HMO 1500 - Select Network,53901AZ115,,AZN003,AZS002,AZF004,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio1500Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1150001-01,Standard Gold On Exchange Plan,,0.781491816043854,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$580,$150,"$1,500",$0,$380,$80,43
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1150001,AZ Blue Portfolio HSA HMO 1500 - Select Network,53901AZ115,,AZN003,AZS002,AZF004,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio1500Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1150001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,44
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1150001,AZ Blue Portfolio HSA HMO 1500 - Select Network,53901AZ115,,AZN003,AZS002,AZF004,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio1500Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1150001-03,Limited Cost Sharing Plan Variation,,0.781491816043854,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$580,$150,"$1,500",$0,$380,$80,45
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1200001,AZ Blue CopayComplete HMO 25 - Alliance Network,53901AZ120,,AZN002,AZS002,AZF014,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete25Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1200001-01,Standard Gold On Exchange Plan,78.43%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$2,230",$0,$150,$0,"$1,390",$0,$80,16
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1200001,AZ Blue CopayComplete HMO 25 - Alliance Network,53901AZ120,,AZN002,AZS002,AZF014,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete25Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1200001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,17
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1200001,AZ Blue CopayComplete HMO 25 - Alliance Network,53901AZ120,,AZN002,AZS002,AZF014,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete25Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1200001-03,Limited Cost Sharing Plan Variation,78.43%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$2,230",$0,$150,$0,"$1,390",$0,$80,18
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1200002,AZ Blue CopayComplete HMO 40 - Alliance Network,53901AZ120,,AZN002,AZS002,AZF036,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete40Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1200002-00,Standard Silver Off Exchange Plan,70.26%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$3,560",$0,$150,$0,"$2,390",$0,$80,19
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1200002,AZ Blue CopayComplete HMO 40 - Alliance Network,53901AZ120,,AZN002,AZS002,AZF036,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete40Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1200002-01,Standard Silver On Exchange Plan,70.26%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$3,560",$0,$150,$0,"$2,390",$0,$80,20
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1200002,AZ Blue CopayComplete HMO 40 - Alliance Network,53901AZ120,,AZN002,AZS002,AZF036,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete40Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1200002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,21
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1200002,AZ Blue CopayComplete HMO 40 - Alliance Network,53901AZ120,,AZN002,AZS002,AZF036,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete40Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1200002-03,Limited Cost Sharing Plan Variation,70.26%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$3,560",$0,$150,$0,"$2,390",$0,$80,22
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1200002,AZ Blue CopayComplete HMO 40 - Alliance Network,53901AZ120,,AZN002,AZS002,AZF036,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete40Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1200002-04,73% AV Level Silver Plan,73.82%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$2,560",$0,$150,$0,"$2,150",$0,$80,23
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,Individual,No,46-1509576,60761AZ0220001,Meritus Healthy Bronze HMO Abrazo 6000,60761AZ022,,AZN004,AZS003,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20I%20Abrazo%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0220001-01,Standard Bronze On Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,Individual,No,46-1509576,60761AZ0220001,Meritus Healthy Bronze HMO Abrazo 6000,60761AZ022,,AZN004,AZS003,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20I%20Abrazo%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0220001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0450001,Meritus Healthy Bronze HMO Mohave 6000,60761AZ045,,AZN006,AZS005,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20G%20Mohave%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0450001-00,Standard Bronze Off Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0450001,Meritus Healthy Bronze HMO Mohave 6000,60761AZ045,,AZN006,AZS005,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20G%20Mohave%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0450001-01,Standard Bronze On Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,Individual,No,46-1509576,60761AZ0230001,Meritus Healthy Bronze HMO Pima 6000,60761AZ023,,AZN005,AZS004,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20I%20Pima%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0230001-03,Limited Cost Sharing Plan Variation,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,Individual,No,46-1509576,60761AZ0240001,Meritus Healthy Bronze HMO Mohave 6000,60761AZ024,,AZN006,AZS005,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20I%20Mohave%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0240001-00,Standard Bronze Off Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1150003,AZ Blue Portfolio HSA HMO 3500 - Select Network,53901AZ115,,AZN003,AZS002,AZF002,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio3500Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1150003-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$0,$0,$150,"$3,500",$0,$0,$80,46
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1150003,AZ Blue Portfolio HSA HMO 3500 - Select Network,53901AZ115,,AZN003,AZS002,AZF002,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio3500Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1150003-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$0,$0,$150,"$3,500",$0,$0,$80,47
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1150003,AZ Blue Portfolio HSA HMO 3500 - Select Network,53901AZ115,,AZN003,AZS002,AZF002,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio3500Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1150003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,48
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1150003,AZ Blue Portfolio HSA HMO 3500 - Select Network,53901AZ115,,AZN003,AZS002,AZF002,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio3500Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1150003-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$0,$0,$150,"$3,500",$0,$0,$80,49
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1150003,AZ Blue Portfolio HSA HMO 3500 - Select Network,53901AZ115,,AZN003,AZS002,AZF002,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio3500Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1150003-04,73% AV Level Silver Plan,,0.732454240322113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750",$0,$0,$150,"$2,750",$0,$0,$80,50
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1150003,AZ Blue Portfolio HSA HMO 3500 - Select Network,53901AZ115,,AZN003,AZS002,AZF002,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio3500Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1150003-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,100",$0,$0,$150,"$1,100",$0,$0,$80,51
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1150003,AZ Blue Portfolio HSA HMO 3500 - Select Network,53901AZ115,,AZN003,AZS002,AZF002,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio3500Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1150003-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,52
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1150004,AZ Blue Portfolio HSA HMO 5500 - Select Network,53901AZ115,,AZN003,AZS002,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio5500Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1150004-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$0,$0,$150,"$5,270",$0,$0,$80,53
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1150004,AZ Blue Portfolio HSA HMO 5500 - Select Network,53901AZ115,,AZN003,AZS002,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio5500Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1150004-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$0,$0,$150,"$5,270",$0,$0,$80,54
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1150004,AZ Blue Portfolio HSA HMO 5500 - Select Network,53901AZ115,,AZN003,AZS002,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio5500Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1150004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,55
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1150004,AZ Blue Portfolio HSA HMO 5500 - Select Network,53901AZ115,,AZN003,AZS002,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio5500Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1150004-03,Limited Cost Sharing Plan Variation,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$0,$0,$150,"$5,270",$0,$0,$80,56
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1150005,AZ Blue Portfolio HSA HMO 6300 - Select Network,53901AZ115,,AZN003,AZS002,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio6300Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1150005-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,270",$0,$0,$80,57
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1150005,AZ Blue Portfolio HSA HMO 6300 - Select Network,53901AZ115,,AZN003,AZS002,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio6300Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1150005-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,270",$0,$0,$80,58
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1150005,AZ Blue Portfolio HSA HMO 6300 - Select Network,53901AZ115,,AZN003,AZS002,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio6300Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1150005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,59
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1150005,AZ Blue Portfolio HSA HMO 6300 - Select Network,53901AZ115,,AZN003,AZS002,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio6300Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1150005-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,270",$0,$0,$80,60
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1160001,AZ Blue Portfolio HSA HMO 1500 - Secure Network,53901AZ116,,AZN004,AZS003,AZF004,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio1500Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1160001-00,Standard Gold Off Exchange Plan,,0.781491816043854,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$580,$150,"$1,500",$0,$380,$80,61
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1160001,AZ Blue Portfolio HSA HMO 1500 - Secure Network,53901AZ116,,AZN004,AZS003,AZF004,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio1500Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1160001-01,Standard Gold On Exchange Plan,,0.781491816043854,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$580,$150,"$1,500",$0,$380,$80,62
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1160001,AZ Blue Portfolio HSA HMO 1500 - Secure Network,53901AZ116,,AZN004,AZS003,AZF004,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio1500Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1160001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,63
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1160001,AZ Blue Portfolio HSA HMO 1500 - Secure Network,53901AZ116,,AZN004,AZS003,AZF004,New,HMO,Gold,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio1500Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1160001-03,Limited Cost Sharing Plan Variation,,0.781491816043854,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$580,$150,"$1,500",$0,$380,$80,64
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1160003,AZ Blue Portfolio HSA HMO 3500 - Secure Network,53901AZ116,,AZN004,AZS003,AZF002,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio3500Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1160003-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$0,$0,$150,"$3,500",$0,$0,$80,65
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1160003,AZ Blue Portfolio HSA HMO 3500 - Secure Network,53901AZ116,,AZN004,AZS003,AZF002,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio3500Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1160003-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$0,$0,$150,"$3,500",$0,$0,$80,66
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1160003,AZ Blue Portfolio HSA HMO 3500 - Secure Network,53901AZ116,,AZN004,AZS003,AZF002,New,HMO,Silver,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio3500Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1160003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,67
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1160004,AZ Blue Portfolio HSA HMO 5500 - Secure Network,53901AZ116,,AZN004,AZS003,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio5500Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1160004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,74
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1160004,AZ Blue Portfolio HSA HMO 5500 - Secure Network,53901AZ116,,AZN004,AZS003,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio5500Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1160004-03,Limited Cost Sharing Plan Variation,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$0,$0,$150,"$5,270",$0,$0,$80,75
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1160005,AZ Blue Portfolio HSA HMO 6300 - Secure Network,53901AZ116,,AZN004,AZS003,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio6300Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1160005-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,270",$0,$0,$80,76
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1160005,AZ Blue Portfolio HSA HMO 6300 - Secure Network,53901AZ116,,AZN004,AZS003,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio6300Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1160005-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,270",$0,$0,$80,77
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1160005,AZ Blue Portfolio HSA HMO 6300 - Secure Network,53901AZ116,,AZN004,AZS003,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio6300Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1160005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,78
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,3,53901,AZ,Individual,No,86-0004538,53901AZ1160005,AZ Blue Portfolio HSA HMO 6300 - Secure Network,53901AZ116,,AZN004,AZS003,AZF002,New,HMO,Bronze,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/Portfolio6300Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1160005-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,270",$0,$0,$80,79
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,4,53901,AZ,Individual,No,86-0004538,53901AZ0570001,AZ Blue SimpleHealth PPO - Statewide Network,53901AZ057,,AZN001,AZS001,AZF039,Existing,PPO,Catastrophic,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/SimpleHealth,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ0570001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$7,100","$14,200",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,4
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,4,53901,AZ,Individual,No,86-0004538,53901AZ0570001,AZ Blue SimpleHealth PPO - Statewide Network,53901AZ057,,AZN001,AZS001,AZF039,Existing,PPO,Catastrophic,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/SimpleHealth,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ0570001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$7,100","$14,200",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,5
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,4,53901,AZ,Individual,No,86-0004538,53901AZ1170001,AZ Blue SimpleHealth HMO - Alliance Network,53901AZ117,,AZN002,AZS002,AZF040,New,HMO,Catastrophic,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/SimpleHealthAlliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1170001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,6
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,4,53901,AZ,Individual,No,86-0004538,53901AZ1170001,AZ Blue SimpleHealth HMO - Alliance Network,53901AZ117,,AZN002,AZS002,AZF040,New,HMO,Catastrophic,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/SimpleHealthAlliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1170001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,7
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,4,53901,AZ,Individual,No,86-0004538,53901AZ1180001,AZ Blue SimpleHealth HMO - Select Network,53901AZ118,,AZN003,AZS002,AZF040,New,HMO,Catastrophic,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/SimpleHealthSelect,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1180001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,8
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,4,53901,AZ,Individual,No,86-0004538,53901AZ1180001,AZ Blue SimpleHealth HMO - Select Network,53901AZ118,,AZN003,AZS002,AZF040,New,HMO,Catastrophic,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/SimpleHealthSelect,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1180001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,9
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,4,53901,AZ,Individual,No,86-0004538,53901AZ1190001,AZ Blue SimpleHealth HMO - Secure Network,53901AZ119,,AZN004,AZS003,AZF040,New,HMO,Catastrophic,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/SimpleHealthSecure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1190001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,10
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,4,53901,AZ,Individual,No,86-0004538,53901AZ1190001,AZ Blue SimpleHealth HMO - Secure Network,53901AZ119,,AZN004,AZS003,AZF040,New,HMO,Catastrophic,No,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,0,0,3,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/SimpleHealthSecure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectFormulary2015,53901AZ1190001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,11
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ0580001,AZ Blue CopayComplete PPO 25 - Statewide Network,53901AZ058,,AZN001,AZS001,AZF013,Existing,PPO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/CopayComplete25,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0580001-00,Standard Gold Off Exchange Plan,78.43%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,"$2,230",$0,$150,$0,"$1,390",$0,$80,4
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ0580001,AZ Blue CopayComplete PPO 25 - Statewide Network,53901AZ058,,AZN001,AZS001,AZF013,Existing,PPO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/CopayComplete25,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0580001-01,Standard Gold On Exchange Plan,78.43%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,"$2,230",$0,$150,$0,"$1,390",$0,$80,5
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ0580001,AZ Blue CopayComplete PPO 25 - Statewide Network,53901AZ058,,AZN001,AZS001,AZF013,Existing,PPO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/CopayComplete25,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0580001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ0580001,AZ Blue CopayComplete PPO 25 - Statewide Network,53901AZ058,,AZN001,AZS001,AZF013,Existing,PPO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/CopayComplete25,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0580001-03,Limited Cost Sharing Plan Variation,78.43%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,"$2,230",$0,$150,$0,"$1,390",$0,$80,7
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ0580002,AZ Blue CopayComplete PPO 40 - Statewide Network,53901AZ058,,AZN001,AZS001,AZF035,Existing,PPO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/CopayComplete40,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0580002-00,Standard Silver Off Exchange Plan,70.26%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,"$3,560",$0,$150,$0,"$2,390",$0,$80,8
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ0580002,AZ Blue CopayComplete PPO 40 - Statewide Network,53901AZ058,,AZN001,AZS001,AZF035,Existing,PPO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/CopayComplete40,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0580002-01,Standard Silver On Exchange Plan,70.26%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,"$3,560",$0,$150,$0,"$2,390",$0,$80,9
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ0580002,AZ Blue CopayComplete PPO 40 - Statewide Network,53901AZ058,,AZN001,AZS001,AZF035,Existing,PPO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/CopayComplete40,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0580002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ0580002,AZ Blue CopayComplete PPO 40 - Statewide Network,53901AZ058,,AZN001,AZS001,AZF035,Existing,PPO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/CopayComplete40,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0580002-03,Limited Cost Sharing Plan Variation,70.26%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,"$3,560",$0,$150,$0,"$2,390",$0,$80,11
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ0580002,AZ Blue CopayComplete PPO 40 - Statewide Network,53901AZ058,,AZN001,AZS001,AZF035,Existing,PPO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/CopayComplete40,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0580002-04,73% AV Level Silver Plan,73.82%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,"$2,560",$0,$150,$0,"$2,150",$0,$80,12
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ0580002,AZ Blue CopayComplete PPO 40 - Statewide Network,53901AZ058,,AZN001,AZS001,AZF035,Existing,PPO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/CopayComplete40,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0580002-05,87% AV Level Silver Plan,87.50%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$810,$0,$150,$0,"$1,180",$0,$80,13
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ0580002,AZ Blue CopayComplete PPO 40 - Statewide Network,53901AZ058,,AZN001,AZS001,AZF035,Existing,PPO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,All benefits,Yes,http://www.azblue.com/2015plans/CopayComplete40,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ0580002-06,94% AV Level Silver Plan,93.75%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$380,$0,$150,$0,$590,$0,$80,14
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1200001,AZ Blue CopayComplete HMO 25 - Alliance Network,53901AZ120,,AZN002,AZS002,AZF014,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete25Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1200001-00,Standard Gold Off Exchange Plan,78.43%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$2,230",$0,$150,$0,"$1,390",$0,$80,15
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1200002,AZ Blue CopayComplete HMO 40 - Alliance Network,53901AZ120,,AZN002,AZS002,AZF036,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete40Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1200002-05,87% AV Level Silver Plan,87.50%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$810,$0,$150,$0,"$1,180",$0,$80,24
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1200002,AZ Blue CopayComplete HMO 40 - Alliance Network,53901AZ120,,AZN002,AZS002,AZF036,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete40Alliance,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1200002-06,94% AV Level Silver Plan,93.75%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$380,$0,$150,$0,$590,$0,$80,25
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1210001,AZ Blue CopayComplete HMO 25 - Select Network,53901AZ121,,AZN003,AZS002,AZF014,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete25Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1210001-00,Standard Gold Off Exchange Plan,78.43%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$2,230",$0,$150,$0,"$1,390",$0,$80,26
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1210001,AZ Blue CopayComplete HMO 25 - Select Network,53901AZ121,,AZN003,AZS002,AZF014,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete25Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1210001-01,Standard Gold On Exchange Plan,78.43%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$2,230",$0,$150,$0,"$1,390",$0,$80,27
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0310001,Meritus Healthy Silver HMO Mohave 4000,60761AZ031,,AZN006,AZS005,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20Mohave%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0310001-00,Standard Silver Off Exchange Plan,70.19%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0310001,Meritus Healthy Silver HMO Mohave 4000,60761AZ031,,AZN006,AZS005,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20Mohave%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0310001-01,Standard Silver On Exchange Plan,70.19%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0310001,Meritus Healthy Silver HMO Mohave 4000,60761AZ031,,AZN006,AZS005,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20Mohave%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0310001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,41
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0310001,Meritus Healthy Silver HMO Mohave 4000,60761AZ031,,AZN006,AZS005,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20Mohave%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0310001-03,Limited Cost Sharing Plan Variation,70.19%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190005,Assurant Health Silver Plan 001,80863AZ019,,AZN001,AZS002,AZF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190005-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190005,Assurant Health Silver Plan 001,80863AZ019,,AZN001,AZS002,AZF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190005-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190005,Assurant Health Silver Plan 001,80863AZ019,,AZN001,AZS002,AZF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190005-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190005,Assurant Health Silver Plan 001,80863AZ019,,AZN001,AZS002,AZF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190005-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1210002,AZ Blue CopayComplete HMO 40 - Select Network,53901AZ121,,AZN003,AZS002,AZF036,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete40Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1210002-04,73% AV Level Silver Plan,73.82%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$2,560",$0,$150,$0,"$2,150",$0,$80,34
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1210002,AZ Blue CopayComplete HMO 40 - Select Network,53901AZ121,,AZN003,AZS002,AZF036,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete40Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1210002-05,87% AV Level Silver Plan,87.50%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$810,$0,$150,$0,"$1,180",$0,$80,35
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1210002,AZ Blue CopayComplete HMO 40 - Select Network,53901AZ121,,AZN003,AZS002,AZF036,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete40Select,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1210002-06,94% AV Level Silver Plan,93.75%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$380,$0,$150,$0,$590,$0,$80,36
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1220001,AZ Blue CopayComplete HMO 25 - Secure Network,53901AZ122,,AZN004,AZS003,AZF014,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete25Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1220001-00,Standard Gold Off Exchange Plan,78.43%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$2,230",$0,$150,$0,"$1,390",$0,$80,37
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1220001,AZ Blue CopayComplete HMO 25 - Secure Network,53901AZ122,,AZN004,AZS003,AZF014,New,HMO,Gold,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete25Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1220001-03,Limited Cost Sharing Plan Variation,78.43%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$2,230",$0,$150,$0,"$1,390",$0,$80,40
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1220002,AZ Blue CopayComplete HMO 40 - Secure Network,53901AZ122,,AZN004,AZS003,AZF036,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete40Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1220002-00,Standard Silver Off Exchange Plan,70.26%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$3,560",$0,$150,$0,"$2,390",$0,$80,41
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1220002,AZ Blue CopayComplete HMO 40 - Secure Network,53901AZ122,,AZN004,AZS003,AZF036,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete40Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1220002-01,Standard Silver On Exchange Plan,70.26%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$3,560",$0,$150,$0,"$2,390",$0,$80,42
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1220002,AZ Blue CopayComplete HMO 40 - Secure Network,53901AZ122,,AZN004,AZS003,AZF036,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete40Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1220002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,43
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1220002,AZ Blue CopayComplete HMO 40 - Secure Network,53901AZ122,,AZN004,AZS003,AZF036,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete40Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1220002-03,Limited Cost Sharing Plan Variation,70.26%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$3,560",$0,$150,$0,"$2,390",$0,$80,44
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1220002,AZ Blue CopayComplete HMO 40 - Secure Network,53901AZ122,,AZN004,AZS003,AZF036,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete40Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1220002-04,73% AV Level Silver Plan,73.82%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$2,560",$0,$150,$0,"$2,150",$0,$80,45
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1220002,AZ Blue CopayComplete HMO 40 - Secure Network,53901AZ122,,AZN004,AZS003,AZF036,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete40Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1220002-05,87% AV Level Silver Plan,87.50%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$810,$0,$150,$0,"$1,180",$0,$80,46
2015,AZ,53901,HIOS,4,2014-09-04 03:25:43,5,53901,AZ,Individual,No,86-0004538,53901AZ1220002,AZ Blue CopayComplete HMO 40 - Secure Network,53901AZ122,,AZN004,AZS003,AZF036,New,HMO,Silver,Yes,Both,Yes,No,,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.99692332427787,,,4,0,0,2015-01-01,,Yes,Emergencies Only,Yes,"Emergencies, Urgent Care, and Authorized Follow-up Care",No,http://www.azblue.com/2015plans/CopayComplete40Secure,http://www.azblue.com/payment,http://www.azblue.com/2015brochure/IndividualBrochure,http://azblue.com/BlueExchangeSelectTierFormulary2015,53901AZ1220002-06,94% AV Level Silver Plan,93.75%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$380,$0,$150,$0,$590,$0,$80,47
2015,AZ,58292,HIOS,10,2014-11-14 05:23:27,1,58292,AZ,Individual,Yes,75-1233841,58292AZ0010001,Dentegra Dental PPO Pediatric Basic Plan,58292AZ001,,AZN001,AZS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$17.91,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/az/58292az0010001-15,,58292AZ0010001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,58292,HIOS,10,2014-11-14 05:23:27,1,58292,AZ,SHOP (Small Group),Yes,75-1233841,58292AZ0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,58292AZ002,,AZN001,AZS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.05,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/az/58292az0020001-15,,58292AZ0020001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,58292,HIOS,10,2014-11-14 05:23:27,1,58292,AZ,SHOP (Small Group),Yes,75-1233841,58292AZ0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,58292AZ002,,AZN001,AZS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.05,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/az/58292az0020001-15,,58292AZ0020001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,58292,HIOS,10,2014-11-14 05:23:27,1,58292,AZ,Individual,Yes,75-1233841,58292AZ0010001,Dentegra Dental PPO Pediatric Basic Plan,58292AZ001,,AZN001,AZS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$17.91,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/az/58292az0010001-15,,58292AZ0010001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,58292,HIOS,10,2014-11-14 05:23:27,2,58292,AZ,Individual,Yes,75-1233841,58292AZ0010004,Dentegra Dental PPO Family Preferred Plan,58292AZ001,,AZN001,AZS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.84,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/az/58292az0010004-15,,58292AZ0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,58292,HIOS,10,2014-11-14 05:23:27,2,58292,AZ,SHOP (Small Group),Yes,75-1233841,58292AZ0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,58292AZ002,,AZN001,AZS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/az/58292az0020004-15,,58292AZ0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,58292,HIOS,10,2014-11-14 05:23:27,2,58292,AZ,SHOP (Small Group),Yes,75-1233841,58292AZ0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,58292AZ002,,AZN001,AZS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/az/58292az0020004-15,,58292AZ0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,58292,HIOS,10,2014-11-14 05:23:27,2,58292,AZ,Individual,Yes,75-1233841,58292AZ0010004,Dentegra Dental PPO Family Preferred Plan,58292AZ001,,AZN001,AZS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.84,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/az/58292az0010004-15,,58292AZ0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,58292,HIOS,10,2014-11-14 05:23:27,3,58292,AZ,Individual,Yes,75-1233841,58292AZ0010006,Dentegra Dental PPO Family Basic Plan,58292AZ001,,AZN001,AZS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.91,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/az/58292az0010006-15,,58292AZ0010006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,58292,HIOS,10,2014-11-14 05:23:27,3,58292,AZ,SHOP (Small Group),Yes,75-1233841,58292AZ0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,58292AZ002,,AZN001,AZS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.05,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/az/58292az0020006-15,,58292AZ0020006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,58292,HIOS,10,2014-11-14 05:23:27,3,58292,AZ,SHOP (Small Group),Yes,75-1233841,58292AZ0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,58292AZ002,,AZN001,AZS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.05,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/az/58292az0020006-15,,58292AZ0020006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,58292,HIOS,10,2014-11-14 05:23:27,3,58292,AZ,Individual,Yes,75-1233841,58292AZ0010006,Dentegra Dental PPO Family Basic Plan,58292AZ001,,AZN001,AZS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.91,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/az/58292az0010006-15,,58292AZ0010006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,59748,HIOS,3,2014-09-03 04:28:59,2,59748,AZ,SHOP (Small Group),Yes,44-0308260,59748AZ0010006,KCL Fam High PPO,59748AZ001,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$49.59,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,59748AZ0010006-00,Standard High Off Exchange Plan,86.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AZ,59748,HIOS,3,2014-09-03 04:28:59,2,59748,AZ,SHOP (Small Group),Yes,44-0308260,59748AZ0010008,KCL Fam High MAC,59748AZ001,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$43.85,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,59748AZ0010008-00,Standard High Off Exchange Plan,86.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,Individual,No,46-1509576,60761AZ0200001,Meritus Healthy Bronze Complete HMO 6000,60761AZ020,,AZN001,AZS001,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20Complete%20HMO%20I%206000%20%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0200001-00,Standard Bronze Off Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0400001,Meritus Healthy Bronze Complete HMO 6000,60761AZ040,,AZN001,AZS001,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20Complete%20HMO%20G%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0400001-00,Standard Bronze Off Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0400001,Meritus Healthy Bronze Complete HMO 6000,60761AZ040,,AZN001,AZS001,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20Complete%20HMO%20G%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0400001-01,Standard Bronze On Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,Individual,No,46-1509576,60761AZ0200001,Meritus Healthy Bronze Complete HMO 6000,60761AZ020,,AZN001,AZS001,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20Complete%20HMO%20I%206000%20%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0200001-01,Standard Bronze On Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,Individual,No,46-1509576,60761AZ0200001,Meritus Healthy Bronze Complete HMO 6000,60761AZ020,,AZN001,AZS001,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20Complete%20HMO%20I%206000%20%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0200001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0410001,Meritus Healthy Bronze HMO MIHS 6000,60761AZ041,,AZN002,AZS002,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20G%20MIHS%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0410001-00,Standard Bronze Off Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0410001,Meritus Healthy Bronze HMO MIHS 6000,60761AZ041,,AZN002,AZS002,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20G%20MIHS%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0410001-01,Standard Bronze On Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,Individual,No,46-1509576,60761AZ0200001,Meritus Healthy Bronze Complete HMO 6000,60761AZ020,,AZN001,AZS001,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20Complete%20HMO%20I%206000%20%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0200001-03,Limited Cost Sharing Plan Variation,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,Individual,No,46-1509576,60761AZ0210001,Meritus Healthy Bronze HMO Banner 6000,60761AZ021,,AZN003,AZS003,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20I%20Banner%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0210001-00,Standard Bronze Off Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0420001,Meritus Healthy Bronze HMO Banner 6000,60761AZ042,,AZN003,AZS003,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20G%20Banner%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0420001-00,Standard Bronze Off Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0420001,Meritus Healthy Bronze HMO Banner 6000,60761AZ042,,AZN003,AZS003,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20G%20Banner%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0420001-01,Standard Bronze On Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,Individual,No,46-1509576,60761AZ0210001,Meritus Healthy Bronze HMO Banner 6000,60761AZ021,,AZN003,AZS003,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20I%20Banner%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0210001-01,Standard Bronze On Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,Individual,No,46-1509576,60761AZ0210001,Meritus Healthy Bronze HMO Banner 6000,60761AZ021,,AZN003,AZS003,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20I%20Banner%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0210001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0430001,Meritus Healthy Bronze HMO Abrazo 6000,60761AZ043,,AZN004,AZS003,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20G%20Abrazo%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0430001-00,Standard Bronze Off Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0430001,Meritus Healthy Bronze HMO Abrazo 6000,60761AZ043,,AZN004,AZS003,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20G%20Abrazo%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0430001-01,Standard Bronze On Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,Individual,No,46-1509576,60761AZ0210001,Meritus Healthy Bronze HMO Banner 6000,60761AZ021,,AZN003,AZS003,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20I%20Banner%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0210001-03,Limited Cost Sharing Plan Variation,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,Individual,No,46-1509576,60761AZ0220001,Meritus Healthy Bronze HMO Abrazo 6000,60761AZ022,,AZN004,AZS003,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20I%20Abrazo%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0220001-00,Standard Bronze Off Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0440001,Meritus Healthy Bronze HMO Pima 6000,60761AZ044,,AZN005,AZS004,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20G%20Pima%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0440001-00,Standard Bronze Off Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0440001,Meritus Healthy Bronze HMO Pima 6000,60761AZ044,,AZN005,AZS004,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20G%20Pima%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0440001-01,Standard Bronze On Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,Individual,No,46-1509576,60761AZ0240001,Meritus Healthy Bronze HMO Mohave 6000,60761AZ024,,AZN006,AZS005,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20I%20Mohave%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0240001-01,Standard Bronze On Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,Individual,No,46-1509576,60761AZ0240001,Meritus Healthy Bronze HMO Mohave 6000,60761AZ024,,AZN006,AZS005,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20I%20Mohave%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0240001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,1,60761,AZ,Individual,No,46-1509576,60761AZ0240001,Meritus Healthy Bronze HMO Mohave 6000,60761AZ024,,AZN006,AZS005,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Bronze%20HMO%20I%20Mohave%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0240001-03,Limited Cost Sharing Plan Variation,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0260001,Meritus Healthy Silver Complete HMO 4000,60761AZ026,,AZN001,AZS001,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20Complete%20HMO%20I%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0260001-00,Standard Silver Off Exchange Plan,70.19%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0470001,Meritus Healthy Silver Complete HMO 4000,60761AZ047,,AZN001,AZS001,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20Complete%20HMO%20G%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0470001-00,Standard Silver Off Exchange Plan,70.20%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0470001,Meritus Healthy Silver Complete HMO 4000,60761AZ047,,AZN001,AZS001,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20Complete%20HMO%20G%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0470001-01,Standard Silver On Exchange Plan,70.20%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0290001,Meritus Healthy Silver HMO Pima 4000,60761AZ029,,AZN005,AZS004,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20PIMA%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0290001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,27
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0290001,Meritus Healthy Silver HMO Pima 4000,60761AZ029,,AZN005,AZS004,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20PIMA%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0290001-03,Limited Cost Sharing Plan Variation,70.19%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0290001,Meritus Healthy Silver HMO Pima 4000,60761AZ029,,AZN005,AZS004,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20PIMA%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0290001-04,73% AV Level Silver Plan,73.65%,0.710138440132141,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0290001,Meritus Healthy Silver HMO Pima 4000,60761AZ029,,AZN005,AZS004,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20PIMA%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0290001-05,87% AV Level Silver Plan,87.35%,0.849142491817474,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0290001,Meritus Healthy Silver HMO Pima 4000,60761AZ029,,AZN005,AZS004,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20PIMA%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0290001-06,94% AV Level Silver Plan,94.06%,0.927993535995483,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0300001,Meritus Healthy Silver HMO MIHS 4000,60761AZ030,,AZN002,AZS002,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20MIHS%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0300001-00,Standard Silver Off Exchange Plan,70.19%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0310001,Meritus Healthy Silver HMO Mohave 4000,60761AZ031,,AZN006,AZS005,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20Mohave%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0310001-04,73% AV Level Silver Plan,73.65%,0.710138440132141,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0310001,Meritus Healthy Silver HMO Mohave 4000,60761AZ031,,AZN006,AZS005,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20Mohave%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0310001-05,87% AV Level Silver Plan,87.35%,0.849142491817474,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0340001,Meritus Healthy Gold HMO Plus Banner 2000,60761AZ034,,AZN003,AZS003,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9706,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20I%20Plus%20Banner%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0340001-03,Limited Cost Sharing Plan Variation,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,$0,$0,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0350001,Meritus Healthy Gold HMO Plus Abrazo 2000,60761AZ035,,AZN004,AZS003,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9702,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20I%20Plus%20Abrazo%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0350001-00,Standard Gold Off Exchange Plan,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,$0,$0,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0310001,Meritus Healthy Silver HMO Mohave 4000,60761AZ031,,AZN006,AZS005,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20Mohave%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0310001-06,94% AV Level Silver Plan,94.06%,0.927993535995483,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0330001,Meritus Healthy Gold Complete HMO Plus 2000,60761AZ033,,AZN001,AZS001,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9734,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20Complete%20HMO%20I%20Plus%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0330001-00,Standard Gold Off Exchange Plan,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,$0,$0,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0540001,Meritus Healthy Gold Complete HMO Plus 2000,60761AZ054,,AZN001,AZS001,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9731,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20Complete%20HMO%20G%20Plus%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0540001-00,Standard Gold Off Exchange Plan,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0540001,Meritus Healthy Gold Complete HMO Plus 2000,60761AZ054,,AZN001,AZS001,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9731,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20Complete%20HMO%20G%20Plus%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0540001-01,Standard Gold On Exchange Plan,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0330001,Meritus Healthy Gold Complete HMO Plus 2000,60761AZ033,,AZN001,AZS001,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9734,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20Complete%20HMO%20I%20Plus%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0330001-01,Standard Gold On Exchange Plan,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,$0,$0,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0330001,Meritus Healthy Gold Complete HMO Plus 2000,60761AZ033,,AZN001,AZS001,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9734,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20Complete%20HMO%20I%20Plus%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0330001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0550001,Meritus Healthy Gold HMO Plus MIHS 2000,60761AZ055,,AZN002,AZS002,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9649,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20G%20Plus%20MIHS%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0550001-00,Standard Gold Off Exchange Plan,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0550001,Meritus Healthy Gold HMO Plus MIHS 2000,60761AZ055,,AZN002,AZS002,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9649,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20G%20Plus%20MIHS%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0550001-01,Standard Gold On Exchange Plan,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0260001,Meritus Healthy Silver Complete HMO 4000,60761AZ026,,AZN001,AZS001,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20Complete%20HMO%20I%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0260001-01,Standard Silver On Exchange Plan,70.19%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0260001,Meritus Healthy Silver Complete HMO 4000,60761AZ026,,AZN001,AZS001,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20Complete%20HMO%20I%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0260001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0260001,Meritus Healthy Silver Complete HMO 4000,60761AZ026,,AZN001,AZS001,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20Complete%20HMO%20I%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0260001-03,Limited Cost Sharing Plan Variation,70.19%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0260001,Meritus Healthy Silver Complete HMO 4000,60761AZ026,,AZN001,AZS001,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20Complete%20HMO%20I%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0260001-04,73% AV Level Silver Plan,73.65%,0.710138440132141,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0490001,Meritus Healthy Silver HMO Banner 4000,60761AZ049,,AZN003,AZS003,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20G%20Banner%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0490001-00,Standard Silver Off Exchange Plan,70.20%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0490001,Meritus Healthy Silver HMO Banner 4000,60761AZ049,,AZN003,AZS003,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20G%20Banner%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0490001-01,Standard Silver On Exchange Plan,70.20%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0260001,Meritus Healthy Silver Complete HMO 4000,60761AZ026,,AZN001,AZS001,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20Complete%20HMO%20I%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0260001-05,87% AV Level Silver Plan,87.35%,0.849142491817474,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0260001,Meritus Healthy Silver Complete HMO 4000,60761AZ026,,AZN001,AZS001,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20Complete%20HMO%20I%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0260001-06,94% AV Level Silver Plan,94.06%,0.927993535995483,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0500001,Meritus Healthy Silver HMO Abrazo 4000,60761AZ050,,AZN004,AZS003,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20G%20Abrazo%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0500001-00,Standard Silver Off Exchange Plan,70.20%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0500001,Meritus Healthy Silver HMO Abrazo 4000,60761AZ050,,AZN004,AZS003,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20G%20Abrazo%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0500001-01,Standard Silver On Exchange Plan,70.20%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0330001,Meritus Healthy Gold Complete HMO Plus 2000,60761AZ033,,AZN001,AZS001,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9734,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20Complete%20HMO%20I%20Plus%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0330001-03,Limited Cost Sharing Plan Variation,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,$0,$0,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0340001,Meritus Healthy Gold HMO Plus Banner 2000,60761AZ034,,AZN003,AZS003,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9706,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20I%20Plus%20Banner%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0340001-00,Standard Gold Off Exchange Plan,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,$0,$0,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0560001,Meritus Healthy Gold HMO Plus Banner 2000,60761AZ056,,AZN003,AZS003,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9702,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20G%20Plus%20Banner%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0560001-00,Standard Gold Off Exchange Plan,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0560001,Meritus Healthy Gold HMO Plus Banner 2000,60761AZ056,,AZN003,AZS003,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9702,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20G%20Plus%20Banner%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0560001-01,Standard Gold On Exchange Plan,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0340001,Meritus Healthy Gold HMO Plus Banner 2000,60761AZ034,,AZN003,AZS003,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9706,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20I%20Plus%20Banner%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0340001-01,Standard Gold On Exchange Plan,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,$0,$0,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0340001,Meritus Healthy Gold HMO Plus Banner 2000,60761AZ034,,AZN003,AZS003,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9706,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20I%20Plus%20Banner%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0340001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0570001,Meritus Healthy Gold HMO Plus Abrazo 2000,60761AZ057,,AZN004,AZS003,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9699,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20G%20Plus%20Abrazo%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0570001-00,Standard Gold Off Exchange Plan,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0570001,Meritus Healthy Gold HMO Plus Abrazo 2000,60761AZ057,,AZN004,AZS003,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9699,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20G%20Plus%20Abrazo%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0570001-01,Standard Gold On Exchange Plan,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0270001,Meritus Healthy Silver HMO Banner 4000,60761AZ027,,AZN003,AZS003,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20Banner%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0270001-00,Standard Silver Off Exchange Plan,70.19%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0270001,Meritus Healthy Silver HMO Banner 4000,60761AZ027,,AZN003,AZS003,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20Banner%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0270001-01,Standard Silver On Exchange Plan,70.19%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0510001,Meritus Healthy Silver HMO Pima 4000,60761AZ051,,AZN005,AZS004,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20G%20Pima%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0510001-00,Standard Silver Off Exchange Plan,70.20%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0510001,Meritus Healthy Silver HMO Pima 4000,60761AZ051,,AZN005,AZS004,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20G%20Pima%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0510001-01,Standard Silver On Exchange Plan,70.20%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0270001,Meritus Healthy Silver HMO Banner 4000,60761AZ027,,AZN003,AZS003,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20Banner%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0270001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0270001,Meritus Healthy Silver HMO Banner 4000,60761AZ027,,AZN003,AZS003,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20Banner%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0270001-03,Limited Cost Sharing Plan Variation,70.19%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0520001,Meritus Healthy Silver HMO Mohave 4000,60761AZ052,,AZN006,AZS005,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20G%20Mohave%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0520001-00,Standard Silver Off Exchange Plan,70.20%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0520001,Meritus Healthy Silver HMO Mohave 4000,60761AZ052,,AZN006,AZS005,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20G%20Mohave%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0520001-01,Standard Silver On Exchange Plan,70.20%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0270001,Meritus Healthy Silver HMO Banner 4000,60761AZ027,,AZN003,AZS003,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20Banner%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0270001-04,73% AV Level Silver Plan,73.65%,0.710138440132141,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0270001,Meritus Healthy Silver HMO Banner 4000,60761AZ027,,AZN003,AZS003,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20Banner%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0270001-05,87% AV Level Silver Plan,87.35%,0.849142491817474,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0270001,Meritus Healthy Silver HMO Banner 4000,60761AZ027,,AZN003,AZS003,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20Banner%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0270001-06,94% AV Level Silver Plan,94.06%,0.927993535995483,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0280001,Meritus Healthy Silver HMO Abrazo 4000,60761AZ028,,AZN004,AZS003,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20Abrazo%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0280001-00,Standard Silver Off Exchange Plan,70.19%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0280001,Meritus Healthy Silver HMO Abrazo 4000,60761AZ028,,AZN004,AZS003,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20Abrazo%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0280001-01,Standard Silver On Exchange Plan,70.19%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0280001,Meritus Healthy Silver HMO Abrazo 4000,60761AZ028,,AZN004,AZS003,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20Abrazo%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0280001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0370001,Meritus Healthy Gold HMO Plus Mohave 2000,60761AZ037,,AZN006,AZS005,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9706,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20I%20Plus%20Mohave%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0370001-01,Standard Gold On Exchange Plan,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,$0,$0,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0370001,Meritus Healthy Gold HMO Plus Mohave 2000,60761AZ037,,AZN006,AZS005,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9706,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20I%20Plus%20Mohave%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0370001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0370001,Meritus Healthy Gold HMO Plus Mohave 2000,60761AZ037,,AZN006,AZS005,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9706,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20I%20Plus%20Mohave%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0370001-03,Limited Cost Sharing Plan Variation,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,$0,$0,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0690001,Meritus Healthy Platinum Complete HMO Plus 500,60761AZ069,,AZN001,AZS001,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9777,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20Complete%20HMO%20I%20Plus%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0690001-00,Standard Platinum Off Exchange Plan,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0690001,Meritus Healthy Platinum Complete HMO Plus 500,60761AZ069,,AZN001,AZS001,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9777,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20Complete%20HMO%20I%20Plus%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0690001-01,Standard Platinum On Exchange Plan,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0690001,Meritus Healthy Platinum Complete HMO Plus 500,60761AZ069,,AZN001,AZS001,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9777,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20Complete%20HMO%20I%20Plus%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0690001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,26
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0690001,Meritus Healthy Platinum Complete HMO Plus 500,60761AZ069,,AZN001,AZS001,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9777,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20Complete%20HMO%20I%20Plus%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0690001-03,Limited Cost Sharing Plan Variation,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0710001,Meritus Healthy Platinum HMO Plus Banner 500,60761AZ071,,AZN003,AZS003,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9753,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20I%20Plus%20Banner%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0710001-00,Standard Platinum Off Exchange Plan,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0280001,Meritus Healthy Silver HMO Abrazo 4000,60761AZ028,,AZN004,AZS003,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20Abrazo%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0280001-03,Limited Cost Sharing Plan Variation,70.19%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0280001,Meritus Healthy Silver HMO Abrazo 4000,60761AZ028,,AZN004,AZS003,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20Abrazo%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0280001-04,73% AV Level Silver Plan,73.65%,0.710138440132141,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0280001,Meritus Healthy Silver HMO Abrazo 4000,60761AZ028,,AZN004,AZS003,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20Abrazo%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0280001-05,87% AV Level Silver Plan,87.35%,0.849142491817474,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0280001,Meritus Healthy Silver HMO Abrazo 4000,60761AZ028,,AZN004,AZS003,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20Abrazo%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0280001-06,94% AV Level Silver Plan,94.06%,0.927993535995483,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0290001,Meritus Healthy Silver HMO Pima 4000,60761AZ029,,AZN005,AZS004,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20PIMA%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0290001-00,Standard Silver Off Exchange Plan,70.19%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,2,60761,AZ,Individual,No,46-1509576,60761AZ0290001,Meritus Healthy Silver HMO Pima 4000,60761AZ029,,AZN005,AZS004,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Silver%20HMO%20I%20PIMA%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0290001-01,Standard Silver On Exchange Plan,70.19%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0580001,Meritus Healthy Gold HMO Plus Pima 2000,60761AZ058,,AZN005,AZS004,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9681,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20G%20Plus%20Pima%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0580001-00,Standard Gold Off Exchange Plan,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0580001,Meritus Healthy Gold HMO Plus Pima 2000,60761AZ058,,AZN005,AZS004,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9681,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20G%20Plus%20Pima%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0580001-01,Standard Gold On Exchange Plan,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190004,Assurant Health Silver Plan 001,80863AZ019,,AZN001,AZS001,AZF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190004-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190005,Assurant Health Silver Plan 001,80863AZ019,,AZN001,AZS002,AZF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190005-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,Individual,No,46-1509576,60761AZ0100001,Meritus Community Network Silver HMO Pima,60761AZ010,,AZN005,AZS004,AZF005,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9908,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Community%20Network%20Silver%20HMO%20I%20Pima%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0100001-04,73% AV Level Silver Plan,73.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,$0,$0,Not Applicable,Not Applicable,"$2,200","$4,400",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,Individual,No,46-1509576,60761AZ0100001,Meritus Community Network Silver HMO Pima,60761AZ010,,AZN005,AZS004,AZF005,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9908,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Community%20Network%20Silver%20HMO%20I%20Pima%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0100001-05,87% AV Level Silver Plan,87.72%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,Individual,No,46-1509576,60761AZ0100001,Meritus Community Network Silver HMO Pima,60761AZ010,,AZN005,AZS004,AZF005,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9908,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Community%20Network%20Silver%20HMO%20I%20Pima%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0100001-06,94% AV Level Silver Plan,93.28%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,AZ,65441,HIOS,4,2014-11-11 04:41:18,1,65441,AZ,Individual,No,20-2706634,65441AZ0040001,Phoenix Choice,65441AZ004,,AZN001,AZS001,AZF001,New,HMO,Gold,No,Both,No,Yes,"007 Allergy and Immunology, 008 Cardiovascular Disease, 010 Chiropractor, 011 Dermatology, 012 Endocrinology, 013 ENT/Otolaryngology, 014 Gastroenterology, 015 General Surgery, 017 Infectious Diseases, 018 Nephrology, 019 Neurology, 020 Neurological Surgery, 021 Medical Oncology & Surgical Oncology, 022 Radiation Oncology, 023 Ophthalmology, 025 Orthopedic Surgery, 026 Physical Medicine & Rehabilitation, 027 Plastic Surgery, 028 Podiatrist, 029 Psychiatry, 030 Pulmonary Disease, 031 Rheumatology, 033 Urology, 034 Vascular Surgery, 035 Cardiothoracic Surgery, 000-Oral Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.phxchoice.com/HMOGold,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ,,https://www.phxchoice.com/Formulary,65441AZ0040001-00,Standard Gold Off Exchange Plan,,0.789304614067078,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,4,77352,AZ,SHOP (Small Group),Yes,95-6042390,77352AZ0010009,BEST Dental Standard-L,77352AZ001,,AZN001,AZS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.74,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BESTDental_Standard-L_Plan.pdf,,77352AZ0010009-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,4,77352,AZ,Individual,Yes,95-6042390,77352AZ0020005,BESTOne Dental Plus-Silver,77352AZ002,,AZN001,AZS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.43,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BESTOne_Dental_Plus-Silver_Plan.pdf,,77352AZ0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,4,77352,AZ,Individual,Yes,95-6042390,77352AZ0020005,BESTOne Dental Plus-Silver,77352AZ002,,AZN001,AZS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.43,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BESTOne_Dental_Plus-Silver_Plan.pdf,,77352AZ0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,4,77352,AZ,SHOP (Small Group),Yes,95-6042390,77352AZ0010009,BEST Dental Standard-L,77352AZ001,,AZN001,AZS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.74,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BESTDental_Standard-L_Plan.pdf,,77352AZ0010009-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,4,77352,AZ,SHOP (Small Group),Yes,95-6042390,77352AZ0010011,BEST Dental Choice-L,77352AZ001,,AZN001,AZS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.74,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BESTDental_Choice-L_Plan.pdf,,77352AZ0010011-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,4,77352,AZ,Individual,Yes,95-6042390,77352AZ0020006,BESTOne Dental Basic-Silver,77352AZ002,,AZN001,AZS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.43,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BESTOne_Dental_Basic-Silver_Plan.pdf,,77352AZ0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,4,77352,AZ,Individual,Yes,95-6042390,77352AZ0020006,BESTOne Dental Basic-Silver,77352AZ002,,AZN001,AZS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.43,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BESTOne_Dental_Basic-Silver_Plan.pdf,,77352AZ0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,4,77352,AZ,SHOP (Small Group),Yes,95-6042390,77352AZ0010011,BEST Dental Choice-L,77352AZ001,,AZN001,AZS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.74,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BESTDental_Choice-L_Plan.pdf,,77352AZ0010011-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,4,77352,AZ,SHOP (Small Group),Yes,95-6042390,77352AZ0010012,BEST Dental Value,77352AZ001,,AZN001,AZS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.74,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BESTDental_Value_Plan.pdf,,77352AZ0010012-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,4,77352,AZ,SHOP (Small Group),Yes,95-6042390,77352AZ0010012,BEST Dental Value,77352AZ001,,AZN001,AZS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.74,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BESTDental_Value_Plan.pdf,,77352AZ0010012-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,AZ,79500,HIOS,4,2014-09-06 03:39:47,1,79500,AZ,SHOP (Small Group),Yes,41-0808596,79500AZ0010001,"Plan 1. Passive PPO, $1000 Annual Maximum, no Ortho",79500AZ001,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,79500AZ0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,79500,HIOS,4,2014-09-06 03:39:47,1,79500,AZ,SHOP (Small Group),Yes,41-0808596,79500AZ0010002,"Plan 2.  Passive PPO, $1000 Annual Maximum, Ortho",79500AZ001,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,79500AZ0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,22,70239,AZ,Individual,No,46-2210067,70239AZ0010031,Health Choice Essential Silver,70239AZ001,,AZN001,AZS008,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010031-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,22,70239,AZ,Individual,No,46-2210067,70239AZ0010031,Health Choice Essential Silver,70239AZ001,,AZN001,AZS008,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010031-03,Limited Cost Sharing Plan Variation,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,22,70239,AZ,Individual,No,46-2210067,70239AZ0010031,Health Choice Essential Silver,70239AZ001,,AZN001,AZS008,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010031-04,73% AV Level Silver Plan,,0.727276206016541,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$5,200","$10,400","$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$1,300","$2,600","$1,300","$2,600",,,,,,,,,8
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,9,70239,AZ,Individual,No,46-2210067,70239AZ0010012,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS003,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,9,70239,AZ,Individual,No,46-2210067,70239AZ0010012,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS003,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010012-03,Limited Cost Sharing Plan Variation,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,10,70239,AZ,Individual,No,46-2210067,70239AZ0010014,Health Choice Essential Gold,70239AZ001,,AZN001,AZS004,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010014-00,Standard Gold Off Exchange Plan,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,22,70239,AZ,Individual,No,46-2210067,70239AZ0010031,Health Choice Essential Silver,70239AZ001,,AZN001,AZS008,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010031-05,87% AV Level Silver Plan,,0.861733675003052,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$2,000","$4,000","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,$400,$800,20%,,,,$400,$800,$400,$800,,,,,,,,,9
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,22,70239,AZ,Individual,No,46-2210067,70239AZ0010031,Health Choice Essential Silver,70239AZ001,,AZN001,AZS008,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010031-06,94% AV Level Silver Plan,,0.93137127161026,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,$75,$150,10%,,,,$75,$150,$75,$150,,,,,,,,,10
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,23,70239,AZ,Individual,No,46-2210067,70239AZ0010032,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS008,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010032-00,Standard Bronze Off Exchange Plan,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,23,70239,AZ,Individual,No,46-2210067,70239AZ0010032,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS008,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010032-01,Standard Bronze On Exchange Plan,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,23,70239,AZ,Individual,No,46-2210067,70239AZ0010032,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS008,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010032-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,23,70239,AZ,Individual,No,46-2210067,70239AZ0010032,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS008,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010032-03,Limited Cost Sharing Plan Variation,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,24,70239,AZ,Individual,No,46-2210067,70239AZ0010033,Health Choice Essential Basic,70239AZ001,,AZN001,AZS001,AZF004,New,HMO,Catastrophic,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010033-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,4
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190002,Assurant Health Bronze Plan 001,80863AZ019,,AZN001,AZS002,AZF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,10
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190002,Assurant Health Bronze Plan 001,80863AZ019,,AZN001,AZS002,AZF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190002-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0640001,Meritus Healthy Platinum HMO Plus Abrazo 500,60761AZ064,,AZN004,AZS003,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9747,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20G%20Plus%20Abrazo%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0640001-00,Standard Platinum Off Exchange Plan,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0640001,Meritus Healthy Platinum HMO Plus Abrazo 500,60761AZ064,,AZN004,AZS003,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9747,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20G%20Plus%20Abrazo%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0640001-01,Standard Platinum On Exchange Plan,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,2,70239,AZ,Individual,No,46-2210067,70239AZ0010003,Health Choice Essential Silver,70239AZ001,,AZN001,AZS001,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010003-05,87% AV Level Silver Plan,,0.861733675003052,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$2,000","$4,000","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,$400,$800,20%,,,,$400,$800,$400,$800,,,,,,,,,9
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,2,70239,AZ,Individual,No,46-2210067,70239AZ0010003,Health Choice Essential Silver,70239AZ001,,AZN001,AZS001,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010003-06,94% AV Level Silver Plan,,0.93137127161026,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,$75,$150,10%,,,,$75,$150,$75,$150,,,,,,,,,10
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,14,70239,AZ,Individual,No,46-2210067,70239AZ0010019,Health Choice Essential Silver,70239AZ001,,AZN001,AZS005,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010019-00,Standard Silver Off Exchange Plan,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,14,70239,AZ,Individual,No,46-2210067,70239AZ0010019,Health Choice Essential Silver,70239AZ001,,AZN001,AZS005,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010019-01,Standard Silver On Exchange Plan,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,24,70239,AZ,Individual,No,46-2210067,70239AZ0010033,Health Choice Essential Basic,70239AZ001,,AZN001,AZS001,AZF004,New,HMO,Catastrophic,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010033-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,25,70239,AZ,Individual,No,46-2210067,70239AZ0010034,Health Choice Essential Basic,70239AZ001,,AZN001,AZS002,AZF004,New,HMO,Catastrophic,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010034-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,25,70239,AZ,Individual,No,46-2210067,70239AZ0010034,Health Choice Essential Basic,70239AZ001,,AZN001,AZS002,AZF004,New,HMO,Catastrophic,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010034-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,26,70239,AZ,Individual,No,46-2210067,70239AZ0010035,Health Choice Essential Basic,70239AZ001,,AZN001,AZS003,AZF004,New,HMO,Catastrophic,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010035-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,26,70239,AZ,Individual,No,46-2210067,70239AZ0010035,Health Choice Essential Basic,70239AZ001,,AZN001,AZS003,AZF004,New,HMO,Catastrophic,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010035-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,27,70239,AZ,Individual,No,46-2210067,70239AZ0010036,Health Choice Essential Basic,70239AZ001,,AZN001,AZS004,AZF004,New,HMO,Catastrophic,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010036-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,4
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0350001,Meritus Healthy Gold HMO Plus Abrazo 2000,60761AZ035,,AZN004,AZS003,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9702,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20I%20Plus%20Abrazo%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0350001-01,Standard Gold On Exchange Plan,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,$0,$0,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0350001,Meritus Healthy Gold HMO Plus Abrazo 2000,60761AZ035,,AZN004,AZS003,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9702,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20I%20Plus%20Abrazo%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0350001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0590001,Meritus Healthy Gold HMO Plus Mohave 2000,60761AZ059,,AZN006,AZS005,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9702,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20G%20Plus%20Mohave%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0590001-00,Standard Gold Off Exchange Plan,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0590001,Meritus Healthy Gold HMO Plus Mohave 2000,60761AZ059,,AZN006,AZS005,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9702,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20G%20Plus%20Mohave%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0590001-01,Standard Gold On Exchange Plan,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0350001,Meritus Healthy Gold HMO Plus Abrazo 2000,60761AZ035,,AZN004,AZS003,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9702,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20I%20Plus%20Abrazo%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0350001-03,Limited Cost Sharing Plan Variation,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,$0,$0,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0360001,Meritus Healthy Gold HMO Plus Pima 2000,60761AZ036,,AZN005,AZS004,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9684,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20I%20Plus%20Pima%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0360001-00,Standard Gold Off Exchange Plan,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,$0,$0,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0360001,Meritus Healthy Gold HMO Plus Pima 2000,60761AZ036,,AZN005,AZS004,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9684,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20I%20Plus%20Pima%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0360001-01,Standard Gold On Exchange Plan,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,$0,$0,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0360001,Meritus Healthy Gold HMO Plus Pima 2000,60761AZ036,,AZN005,AZS004,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9684,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20I%20Plus%20Pima%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0360001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0360001,Meritus Healthy Gold HMO Plus Pima 2000,60761AZ036,,AZN005,AZS004,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9684,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20I%20Plus%20Pima%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0360001-03,Limited Cost Sharing Plan Variation,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,$0,$0,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0370001,Meritus Healthy Gold HMO Plus Mohave 2000,60761AZ037,,AZN006,AZS005,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9706,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Gold%20HMO%20I%20Plus%20Mohave%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0370001-00,Standard Gold Off Exchange Plan,78.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,$0,$0,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0710001,Meritus Healthy Platinum HMO Plus Banner 500,60761AZ071,,AZN003,AZS003,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9753,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20I%20Plus%20Banner%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0710001-01,Standard Platinum On Exchange Plan,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0710001,Meritus Healthy Platinum HMO Plus Banner 500,60761AZ071,,AZN003,AZS003,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9753,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20I%20Plus%20Banner%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0710001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,30
2015,AZ,65441,HIOS,4,2014-11-11 04:41:18,2,65441,AZ,Individual,No,20-2706634,65441AZ0040002,Phoenix Choice,65441AZ004,,AZN001,AZS001,AZF002,New,HMO,Silver,No,Both,No,Yes,"007 Allergy and Immunology, 008 Cardiovascular Disease, 010 Chiropractor, 011 Dermatology, 012 Endocrinology, 013 ENT/Otolaryngology, 014 Gastroenterology, 015 General Surgery, 017 Infectious Diseases, 018 Nephrology, 019 Neurology, 020 Neurological Surgery, 021 Medical Oncology & Surgical Oncology, 022 Radiation Oncology, 023 Ophthalmology, 025 Orthopedic Surgery, 026 Physical Medicine & Rehabilitation, 027 Plastic Surgery, 028 Podiatrist, 029 Psychiatry, 030 Pulmonary Disease, 031 Rheumatology, 033 Urology, 034 Vascular Surgery, 035 Cardiothoracic Surgery, 000-Oral Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.phxchoice.com/HMOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ,,https://www.phxchoice.com/Formulary,65441AZ0040002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,AZ,65441,HIOS,4,2014-11-11 04:41:18,2,65441,AZ,Individual,No,20-2706634,65441AZ0040002,Phoenix Choice,65441AZ004,,AZN001,AZS001,AZF002,New,HMO,Silver,No,Both,No,Yes,"007 Allergy and Immunology, 008 Cardiovascular Disease, 010 Chiropractor, 011 Dermatology, 012 Endocrinology, 013 ENT/Otolaryngology, 014 Gastroenterology, 015 General Surgery, 017 Infectious Diseases, 018 Nephrology, 019 Neurology, 020 Neurological Surgery, 021 Medical Oncology & Surgical Oncology, 022 Radiation Oncology, 023 Ophthalmology, 025 Orthopedic Surgery, 026 Physical Medicine & Rehabilitation, 027 Plastic Surgery, 028 Podiatrist, 029 Psychiatry, 030 Pulmonary Disease, 031 Rheumatology, 033 Urology, 034 Vascular Surgery, 035 Cardiothoracic Surgery, 000-Oral Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.phxchoice.com/HMOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ,,https://www.phxchoice.com/Formulary,65441AZ0040002-03,Limited Cost Sharing Plan Variation,,0.690098643302917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,8,70239,AZ,Individual,No,46-2210067,70239AZ0010011,Health Choice Essential Silver,70239AZ001,,AZN001,AZS003,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010011-00,Standard Silver Off Exchange Plan,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,8,70239,AZ,Individual,No,46-2210067,70239AZ0010011,Health Choice Essential Silver,70239AZ001,,AZN001,AZS003,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010011-01,Standard Silver On Exchange Plan,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,8,70239,AZ,Individual,No,46-2210067,70239AZ0010011,Health Choice Essential Silver,70239AZ001,,AZN001,AZS003,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,18,70239,AZ,Individual,No,46-2210067,70239AZ0010024,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS006,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010024-00,Standard Bronze Off Exchange Plan,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,18,70239,AZ,Individual,No,46-2210067,70239AZ0010024,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS006,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010024-01,Standard Bronze On Exchange Plan,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,5
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190005,Assurant Health Silver Plan 001,80863AZ019,,AZN001,AZS002,AZF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190005-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190005,Assurant Health Silver Plan 001,80863AZ019,,AZN001,AZS002,AZF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,25
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0710001,Meritus Healthy Platinum HMO Plus Banner 500,60761AZ071,,AZN003,AZS003,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9753,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20I%20Plus%20Banner%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0710001-03,Limited Cost Sharing Plan Variation,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0720001,Meritus Healthy Platinum HMO Plus Abrazo 500,60761AZ072,,AZN004,AZS003,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.975,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20I%20Plus%20Abrazo%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0720001-00,Standard Platinum Off Exchange Plan,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0720001,Meritus Healthy Platinum HMO Plus Abrazo 500,60761AZ072,,AZN004,AZS003,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.975,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20I%20Plus%20Abrazo%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0720001-01,Standard Platinum On Exchange Plan,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0720001,Meritus Healthy Platinum HMO Plus Abrazo 500,60761AZ072,,AZN004,AZS003,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.975,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20I%20Plus%20Abrazo%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0720001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,34
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0720001,Meritus Healthy Platinum HMO Plus Abrazo 500,60761AZ072,,AZN004,AZS003,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.975,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20I%20Plus%20Abrazo%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0720001-03,Limited Cost Sharing Plan Variation,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0730001,Meritus Healthy Platinum HMO Plus Pima 500,60761AZ073,,AZN005,AZS004,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9734,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20I%20Plus%20Pima%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0730001-00,Standard Platinum Off Exchange Plan,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,10,70239,AZ,Individual,No,46-2210067,70239AZ0010014,Health Choice Essential Gold,70239AZ001,,AZN001,AZS004,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010014-01,Standard Gold On Exchange Plan,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,10,70239,AZ,Individual,No,46-2210067,70239AZ0010014,Health Choice Essential Gold,70239AZ001,,AZN001,AZS004,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,10,70239,AZ,Individual,No,46-2210067,70239AZ0010014,Health Choice Essential Gold,70239AZ001,,AZN001,AZS004,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010014-03,Limited Cost Sharing Plan Variation,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,11,70239,AZ,Individual,No,46-2210067,70239AZ0010015,Health Choice Essential Silver,70239AZ001,,AZN001,AZS004,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010015-00,Standard Silver Off Exchange Plan,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,11,70239,AZ,Individual,No,46-2210067,70239AZ0010015,Health Choice Essential Silver,70239AZ001,,AZN001,AZS004,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010015-01,Standard Silver On Exchange Plan,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,11,70239,AZ,Individual,No,46-2210067,70239AZ0010015,Health Choice Essential Silver,70239AZ001,,AZN001,AZS004,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010015-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,11,70239,AZ,Individual,No,46-2210067,70239AZ0010015,Health Choice Essential Silver,70239AZ001,,AZN001,AZS004,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010015-03,Limited Cost Sharing Plan Variation,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,11,70239,AZ,Individual,No,46-2210067,70239AZ0010015,Health Choice Essential Silver,70239AZ001,,AZN001,AZS004,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010015-04,73% AV Level Silver Plan,,0.727276206016541,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$5,200","$10,400","$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$1,300","$2,600","$1,300","$2,600",,,,,,,,,8
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190006,Assurant Health Silver Plan 001,80863AZ019,,AZN001,AZS003,AZF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190006-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,2,80863,AZ,Individual,No,39-0658730,80863AZ0190007,Assurant Health Bronze Plan 002,80863AZ019,,AZN001,AZS001,AZF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190007-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0730001,Meritus Healthy Platinum HMO Plus Pima 500,60761AZ073,,AZN005,AZS004,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9734,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20I%20Plus%20Pima%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0730001-01,Standard Platinum On Exchange Plan,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0730001,Meritus Healthy Platinum HMO Plus Pima 500,60761AZ073,,AZN005,AZS004,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9734,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20I%20Plus%20Pima%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0730001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,38
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0730001,Meritus Healthy Platinum HMO Plus Pima 500,60761AZ073,,AZN005,AZS004,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9734,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20I%20Plus%20Pima%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0730001-03,Limited Cost Sharing Plan Variation,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0740001,Meritus Healthy Platinum HMO Plus Mohave 500,60761AZ074,,AZN006,AZS005,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9753,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20I%20Plus%20Mohave%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0740001-00,Standard Platinum Off Exchange Plan,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0740001,Meritus Healthy Platinum HMO Plus Mohave 500,60761AZ074,,AZN006,AZS005,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9753,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20I%20Plus%20Mohave%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0740001-01,Standard Platinum On Exchange Plan,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0740001,Meritus Healthy Platinum HMO Plus Mohave 500,60761AZ074,,AZN006,AZS005,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9753,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20I%20Plus%20Mohave%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0740001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,42
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,3,60761,AZ,Individual,No,46-1509576,60761AZ0740001,Meritus Healthy Platinum HMO Plus Mohave 500,60761AZ074,,AZN006,AZS005,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9753,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20I%20Plus%20Mohave%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0740001-03,Limited Cost Sharing Plan Variation,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,Individual,No,46-1509576,60761AZ0080001,Meritus Neighborhood Network Silver HMO MIHS,60761AZ008,,AZN002,AZS002,AZF005,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9899,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Neighborhood%20Network%20Silver%20HMO%20I%20MIHS%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0080001-00,Standard Silver Off Exchange Plan,68.92%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$250,$500,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0610001,Meritus Healthy Platinum Complete HMO Plus 500,60761AZ061,,AZN001,AZS001,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9774,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20Complete%20HMO%20G%20Plus%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0610001-00,Standard Platinum Off Exchange Plan,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0610001,Meritus Healthy Platinum Complete HMO Plus 500,60761AZ061,,AZN001,AZS001,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9774,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20Complete%20HMO%20G%20Plus%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0610001-01,Standard Platinum On Exchange Plan,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,Individual,No,46-1509576,60761AZ0080001,Meritus Neighborhood Network Silver HMO MIHS,60761AZ008,,AZN002,AZS002,AZF005,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9899,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Neighborhood%20Network%20Silver%20HMO%20I%20MIHS%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0080001-01,Standard Silver On Exchange Plan,68.92%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$250,$500,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,Individual,No,46-1509576,60761AZ0080001,Meritus Neighborhood Network Silver HMO MIHS,60761AZ008,,AZN002,AZS002,AZF005,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9899,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Neighborhood%20Network%20Silver%20HMO%20I%20MIHS%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0080001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0680001,Meritus Healthy Platinum HMO Plus MIHS 500,60761AZ068,,AZN002,AZS002,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9705,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20G%20Plus%20MIHS%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0680001-00,Standard Platinum Off Exchange Plan,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0680001,Meritus Healthy Platinum HMO Plus MIHS 500,60761AZ068,,AZN002,AZS002,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9705,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20G%20Plus%20MIHS%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0680001-01,Standard Platinum On Exchange Plan,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,Individual,No,46-1509576,60761AZ0080001,Meritus Neighborhood Network Silver HMO MIHS,60761AZ008,,AZN002,AZS002,AZF005,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9899,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Neighborhood%20Network%20Silver%20HMO%20I%20MIHS%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0080001-03,Limited Cost Sharing Plan Variation,68.92%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$250,$500,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,Individual,No,46-1509576,60761AZ0080001,Meritus Neighborhood Network Silver HMO MIHS,60761AZ008,,AZN002,AZS002,AZF005,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9899,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Neighborhood%20Network%20Silver%20HMO%20I%20MIHS%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0080001-04,73% AV Level Silver Plan,73.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,$0,$0,Not Applicable,Not Applicable,"$2,200","$4,400",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0630001,Meritus Healthy Platinum HMO Plus Banner 500,60761AZ063,,AZN003,AZS003,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.975,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20G%20Plus%20Banner%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0630001-00,Standard Platinum Off Exchange Plan,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0630001,Meritus Healthy Platinum HMO Plus Banner 500,60761AZ063,,AZN003,AZS003,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.975,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20G%20Plus%20Banner%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0630001-01,Standard Platinum On Exchange Plan,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,Individual,No,46-1509576,60761AZ0080001,Meritus Neighborhood Network Silver HMO MIHS,60761AZ008,,AZN002,AZS002,AZF005,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9899,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Neighborhood%20Network%20Silver%20HMO%20I%20MIHS%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0080001-05,87% AV Level Silver Plan,87.72%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,Individual,No,46-1509576,60761AZ0080001,Meritus Neighborhood Network Silver HMO MIHS,60761AZ008,,AZN002,AZS002,AZF005,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9899,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Neighborhood%20Network%20Silver%20HMO%20I%20MIHS%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0080001-06,94% AV Level Silver Plan,93.28%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,Individual,No,46-1509576,60761AZ0090001,Meritus Community Network Silver HMO Banner,60761AZ009,,AZN003,AZS003,AZF005,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9914,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Community%20Network%20Silver%20HMO%20I%20Banner%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0090001-00,Standard Silver Off Exchange Plan,68.92%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$250,$500,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,Individual,No,46-1509576,60761AZ0090001,Meritus Community Network Silver HMO Banner,60761AZ009,,AZN003,AZS003,AZF005,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9914,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Community%20Network%20Silver%20HMO%20I%20Banner%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0090001-01,Standard Silver On Exchange Plan,68.92%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$250,$500,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0650001,Meritus Healthy Platinum HMO Plus Pima 500,60761AZ065,,AZN005,AZS004,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9732,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20G%20Plus%20Pima%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0650001-00,Standard Platinum Off Exchange Plan,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0650001,Meritus Healthy Platinum HMO Plus Pima 500,60761AZ065,,AZN005,AZS004,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9732,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20G%20Plus%20Pima%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0650001-01,Standard Platinum On Exchange Plan,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,Individual,No,46-1509576,60761AZ0090001,Meritus Community Network Silver HMO Banner,60761AZ009,,AZN003,AZS003,AZF005,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9914,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Community%20Network%20Silver%20HMO%20I%20Banner%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0090001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,Individual,No,46-1509576,60761AZ0090001,Meritus Community Network Silver HMO Banner,60761AZ009,,AZN003,AZS003,AZF005,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9914,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Community%20Network%20Silver%20HMO%20I%20Banner%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0090001-03,Limited Cost Sharing Plan Variation,68.92%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$250,$500,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0660001,Meritus Healthy Platinum HMO Plus Mohave 500,60761AZ066,,AZN006,AZS005,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.975,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20G%20Plus%20Mohave%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0660001-00,Standard Platinum Off Exchange Plan,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,SHOP (Small Group),No,46-1509576,60761AZ0660001,Meritus Healthy Platinum HMO Plus Mohave 500,60761AZ066,,AZN006,AZS005,AZF004,New,HMO,Platinum,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.975,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Healthy%20Platinum%20HMO%20G%20Plus%20Mohave%20500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0660001-01,Standard Platinum On Exchange Plan,88.28%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,Individual,No,46-1509576,60761AZ0090001,Meritus Community Network Silver HMO Banner,60761AZ009,,AZN003,AZS003,AZF005,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9914,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Community%20Network%20Silver%20HMO%20I%20Banner%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0090001-04,73% AV Level Silver Plan,73.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,$0,$0,Not Applicable,Not Applicable,"$2,200","$4,400",0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,Individual,No,46-1509576,60761AZ0090001,Meritus Community Network Silver HMO Banner,60761AZ009,,AZN003,AZS003,AZF005,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9914,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Community%20Network%20Silver%20HMO%20I%20Banner%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0090001-05,87% AV Level Silver Plan,87.72%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,Individual,No,46-1509576,60761AZ0090001,Meritus Community Network Silver HMO Banner,60761AZ009,,AZN003,AZS003,AZF005,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9914,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Community%20Network%20Silver%20HMO%20I%20Banner%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0090001-06,94% AV Level Silver Plan,93.28%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,Individual,No,46-1509576,60761AZ0100001,Meritus Community Network Silver HMO Pima,60761AZ010,,AZN005,AZS004,AZF005,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9908,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Community%20Network%20Silver%20HMO%20I%20Pima%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0100001-00,Standard Silver Off Exchange Plan,68.92%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$250,$500,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,Individual,No,46-1509576,60761AZ0100001,Meritus Community Network Silver HMO Pima,60761AZ010,,AZN005,AZS004,AZF005,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9908,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Community%20Network%20Silver%20HMO%20I%20Pima%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0100001-01,Standard Silver On Exchange Plan,68.92%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$250,$500,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,Individual,No,46-1509576,60761AZ0100001,Meritus Community Network Silver HMO Pima,60761AZ010,,AZN005,AZS004,AZF005,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9908,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Community%20Network%20Silver%20HMO%20I%20Pima%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0100001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,AZ,60761,HIOS,13,2015-01-21 09:35:36,4,60761,AZ,Individual,No,46-1509576,60761AZ0100001,Meritus Community Network Silver HMO Pima,60761AZ010,,AZN005,AZS004,AZF005,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Cardiac Surgeon, Dermatologist, Genetist, Nutritionist, Orthopedic Surgeon, Pain Management, Plastic Surgeon, Podiatrist, Psychiatrist, Psycologist",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9908,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Community%20Network%20Silver%20HMO%20I%20Pima%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,60761AZ0100001-03,Limited Cost Sharing Plan Variation,68.92%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,$0,$0,Not Applicable,Not Applicable,$250,$500,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,AZ,65441,HIOS,4,2014-11-11 04:41:18,1,65441,AZ,Individual,No,20-2706634,65441AZ0040001,Phoenix Choice,65441AZ004,,AZN001,AZS001,AZF001,New,HMO,Gold,No,Both,No,Yes,"007 Allergy and Immunology, 008 Cardiovascular Disease, 010 Chiropractor, 011 Dermatology, 012 Endocrinology, 013 ENT/Otolaryngology, 014 Gastroenterology, 015 General Surgery, 017 Infectious Diseases, 018 Nephrology, 019 Neurology, 020 Neurological Surgery, 021 Medical Oncology & Surgical Oncology, 022 Radiation Oncology, 023 Ophthalmology, 025 Orthopedic Surgery, 026 Physical Medicine & Rehabilitation, 027 Plastic Surgery, 028 Podiatrist, 029 Psychiatry, 030 Pulmonary Disease, 031 Rheumatology, 033 Urology, 034 Vascular Surgery, 035 Cardiothoracic Surgery, 000-Oral Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.phxchoice.com/HMOGold,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ,,https://www.phxchoice.com/Formulary,65441AZ0040001-01,Standard Gold On Exchange Plan,,0.789304614067078,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,65441,HIOS,4,2014-11-11 04:41:18,1,65441,AZ,Individual,No,20-2706634,65441AZ0040001,Phoenix Choice,65441AZ004,,AZN001,AZS001,AZF001,New,HMO,Gold,No,Both,No,Yes,"007 Allergy and Immunology, 008 Cardiovascular Disease, 010 Chiropractor, 011 Dermatology, 012 Endocrinology, 013 ENT/Otolaryngology, 014 Gastroenterology, 015 General Surgery, 017 Infectious Diseases, 018 Nephrology, 019 Neurology, 020 Neurological Surgery, 021 Medical Oncology & Surgical Oncology, 022 Radiation Oncology, 023 Ophthalmology, 025 Orthopedic Surgery, 026 Physical Medicine & Rehabilitation, 027 Plastic Surgery, 028 Podiatrist, 029 Psychiatry, 030 Pulmonary Disease, 031 Rheumatology, 033 Urology, 034 Vascular Surgery, 035 Cardiothoracic Surgery, 000-Oral Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.phxchoice.com/HMOGold,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ,,https://www.phxchoice.com/Formulary,65441AZ0040001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,AZ,65441,HIOS,4,2014-11-11 04:41:18,1,65441,AZ,Individual,No,20-2706634,65441AZ0040001,Phoenix Choice,65441AZ004,,AZN001,AZS001,AZF001,New,HMO,Gold,No,Both,No,Yes,"007 Allergy and Immunology, 008 Cardiovascular Disease, 010 Chiropractor, 011 Dermatology, 012 Endocrinology, 013 ENT/Otolaryngology, 014 Gastroenterology, 015 General Surgery, 017 Infectious Diseases, 018 Nephrology, 019 Neurology, 020 Neurological Surgery, 021 Medical Oncology & Surgical Oncology, 022 Radiation Oncology, 023 Ophthalmology, 025 Orthopedic Surgery, 026 Physical Medicine & Rehabilitation, 027 Plastic Surgery, 028 Podiatrist, 029 Psychiatry, 030 Pulmonary Disease, 031 Rheumatology, 033 Urology, 034 Vascular Surgery, 035 Cardiothoracic Surgery, 000-Oral Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.phxchoice.com/HMOGold,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ,,https://www.phxchoice.com/Formulary,65441AZ0040001-03,Limited Cost Sharing Plan Variation,,0.789304614067078,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,65441,HIOS,4,2014-11-11 04:41:18,2,65441,AZ,Individual,No,20-2706634,65441AZ0040002,Phoenix Choice,65441AZ004,,AZN001,AZS001,AZF002,New,HMO,Silver,No,Both,No,Yes,"007 Allergy and Immunology, 008 Cardiovascular Disease, 010 Chiropractor, 011 Dermatology, 012 Endocrinology, 013 ENT/Otolaryngology, 014 Gastroenterology, 015 General Surgery, 017 Infectious Diseases, 018 Nephrology, 019 Neurology, 020 Neurological Surgery, 021 Medical Oncology & Surgical Oncology, 022 Radiation Oncology, 023 Ophthalmology, 025 Orthopedic Surgery, 026 Physical Medicine & Rehabilitation, 027 Plastic Surgery, 028 Podiatrist, 029 Psychiatry, 030 Pulmonary Disease, 031 Rheumatology, 033 Urology, 034 Vascular Surgery, 035 Cardiothoracic Surgery, 000-Oral Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.phxchoice.com/HMOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ,,https://www.phxchoice.com/Formulary,65441AZ0040002-00,Standard Silver Off Exchange Plan,,0.690098643302917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,65441,HIOS,4,2014-11-11 04:41:18,2,65441,AZ,Individual,No,20-2706634,65441AZ0040002,Phoenix Choice,65441AZ004,,AZN001,AZS001,AZF002,New,HMO,Silver,No,Both,No,Yes,"007 Allergy and Immunology, 008 Cardiovascular Disease, 010 Chiropractor, 011 Dermatology, 012 Endocrinology, 013 ENT/Otolaryngology, 014 Gastroenterology, 015 General Surgery, 017 Infectious Diseases, 018 Nephrology, 019 Neurology, 020 Neurological Surgery, 021 Medical Oncology & Surgical Oncology, 022 Radiation Oncology, 023 Ophthalmology, 025 Orthopedic Surgery, 026 Physical Medicine & Rehabilitation, 027 Plastic Surgery, 028 Podiatrist, 029 Psychiatry, 030 Pulmonary Disease, 031 Rheumatology, 033 Urology, 034 Vascular Surgery, 035 Cardiothoracic Surgery, 000-Oral Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.phxchoice.com/HMOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ,,https://www.phxchoice.com/Formulary,65441AZ0040002-01,Standard Silver On Exchange Plan,,0.690098643302917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,65441,HIOS,4,2014-11-11 04:41:18,2,65441,AZ,Individual,No,20-2706634,65441AZ0040002,Phoenix Choice,65441AZ004,,AZN001,AZS001,AZF002,New,HMO,Silver,No,Both,No,Yes,"007 Allergy and Immunology, 008 Cardiovascular Disease, 010 Chiropractor, 011 Dermatology, 012 Endocrinology, 013 ENT/Otolaryngology, 014 Gastroenterology, 015 General Surgery, 017 Infectious Diseases, 018 Nephrology, 019 Neurology, 020 Neurological Surgery, 021 Medical Oncology & Surgical Oncology, 022 Radiation Oncology, 023 Ophthalmology, 025 Orthopedic Surgery, 026 Physical Medicine & Rehabilitation, 027 Plastic Surgery, 028 Podiatrist, 029 Psychiatry, 030 Pulmonary Disease, 031 Rheumatology, 033 Urology, 034 Vascular Surgery, 035 Cardiothoracic Surgery, 000-Oral Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.phxchoice.com/HMOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ,,https://www.phxchoice.com/Formulary,65441AZ0040002-04,73% AV Level Silver Plan,,0.738057255744934,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,65441,HIOS,4,2014-11-11 04:41:18,2,65441,AZ,Individual,No,20-2706634,65441AZ0040002,Phoenix Choice,65441AZ004,,AZN001,AZS001,AZF002,New,HMO,Silver,No,Both,No,Yes,"007 Allergy and Immunology, 008 Cardiovascular Disease, 010 Chiropractor, 011 Dermatology, 012 Endocrinology, 013 ENT/Otolaryngology, 014 Gastroenterology, 015 General Surgery, 017 Infectious Diseases, 018 Nephrology, 019 Neurology, 020 Neurological Surgery, 021 Medical Oncology & Surgical Oncology, 022 Radiation Oncology, 023 Ophthalmology, 025 Orthopedic Surgery, 026 Physical Medicine & Rehabilitation, 027 Plastic Surgery, 028 Podiatrist, 029 Psychiatry, 030 Pulmonary Disease, 031 Rheumatology, 033 Urology, 034 Vascular Surgery, 035 Cardiothoracic Surgery, 000-Oral Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.phxchoice.com/HMOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ,,https://www.phxchoice.com/Formulary,65441AZ0040002-05,87% AV Level Silver Plan,,0.87871515750885,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,65441,HIOS,4,2014-11-11 04:41:18,2,65441,AZ,Individual,No,20-2706634,65441AZ0040002,Phoenix Choice,65441AZ004,,AZN001,AZS001,AZF002,New,HMO,Silver,No,Both,No,Yes,"007 Allergy and Immunology, 008 Cardiovascular Disease, 010 Chiropractor, 011 Dermatology, 012 Endocrinology, 013 ENT/Otolaryngology, 014 Gastroenterology, 015 General Surgery, 017 Infectious Diseases, 018 Nephrology, 019 Neurology, 020 Neurological Surgery, 021 Medical Oncology & Surgical Oncology, 022 Radiation Oncology, 023 Ophthalmology, 025 Orthopedic Surgery, 026 Physical Medicine & Rehabilitation, 027 Plastic Surgery, 028 Podiatrist, 029 Psychiatry, 030 Pulmonary Disease, 031 Rheumatology, 033 Urology, 034 Vascular Surgery, 035 Cardiothoracic Surgery, 000-Oral Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.phxchoice.com/HMOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ,,https://www.phxchoice.com/Formulary,65441AZ0040002-06,94% AV Level Silver Plan,,0.945839047431946,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,65441,HIOS,4,2014-11-11 04:41:18,3,65441,AZ,Individual,No,20-2706634,65441AZ0040003,Phoenix Choice,65441AZ004,,AZN001,AZS001,AZF003,New,HMO,Bronze,No,Both,No,Yes,"007 Allergy and Immunology, 008 Cardiovascular Disease, 010 Chiropractor, 011 Dermatology, 012 Endocrinology, 013 ENT/Otolaryngology, 014 Gastroenterology, 015 General Surgery, 017 Infectious Diseases, 018 Nephrology, 019 Neurology, 020 Neurological Surgery, 021 Medical Oncology & Surgical Oncology, 022 Radiation Oncology, 023 Ophthalmology, 025 Orthopedic Surgery, 026 Physical Medicine & Rehabilitation, 027 Plastic Surgery, 028 Podiatrist, 029 Psychiatry, 030 Pulmonary Disease, 031 Rheumatology, 033 Urology, 034 Vascular Surgery, 035 Cardiothoracic Surgery, 000-Oral Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.phxchoice.com/HMOBronze,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ,,https://www.phxchoice.com/Formulary,65441AZ0040003-00,Standard Bronze Off Exchange Plan,,0.614295899868011,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,65441,HIOS,4,2014-11-11 04:41:18,3,65441,AZ,Individual,No,20-2706634,65441AZ0040003,Phoenix Choice,65441AZ004,,AZN001,AZS001,AZF003,New,HMO,Bronze,No,Both,No,Yes,"007 Allergy and Immunology, 008 Cardiovascular Disease, 010 Chiropractor, 011 Dermatology, 012 Endocrinology, 013 ENT/Otolaryngology, 014 Gastroenterology, 015 General Surgery, 017 Infectious Diseases, 018 Nephrology, 019 Neurology, 020 Neurological Surgery, 021 Medical Oncology & Surgical Oncology, 022 Radiation Oncology, 023 Ophthalmology, 025 Orthopedic Surgery, 026 Physical Medicine & Rehabilitation, 027 Plastic Surgery, 028 Podiatrist, 029 Psychiatry, 030 Pulmonary Disease, 031 Rheumatology, 033 Urology, 034 Vascular Surgery, 035 Cardiothoracic Surgery, 000-Oral Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.phxchoice.com/HMOBronze,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ,,https://www.phxchoice.com/Formulary,65441AZ0040003-01,Standard Bronze On Exchange Plan,,0.614295899868011,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,65441,HIOS,4,2014-11-11 04:41:18,3,65441,AZ,Individual,No,20-2706634,65441AZ0040003,Phoenix Choice,65441AZ004,,AZN001,AZS001,AZF003,New,HMO,Bronze,No,Both,No,Yes,"007 Allergy and Immunology, 008 Cardiovascular Disease, 010 Chiropractor, 011 Dermatology, 012 Endocrinology, 013 ENT/Otolaryngology, 014 Gastroenterology, 015 General Surgery, 017 Infectious Diseases, 018 Nephrology, 019 Neurology, 020 Neurological Surgery, 021 Medical Oncology & Surgical Oncology, 022 Radiation Oncology, 023 Ophthalmology, 025 Orthopedic Surgery, 026 Physical Medicine & Rehabilitation, 027 Plastic Surgery, 028 Podiatrist, 029 Psychiatry, 030 Pulmonary Disease, 031 Rheumatology, 033 Urology, 034 Vascular Surgery, 035 Cardiothoracic Surgery, 000-Oral Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.phxchoice.com/HMOBronze,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ,,https://www.phxchoice.com/Formulary,65441AZ0040003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,65441,HIOS,4,2014-11-11 04:41:18,3,65441,AZ,Individual,No,20-2706634,65441AZ0040003,Phoenix Choice,65441AZ004,,AZN001,AZS001,AZF003,New,HMO,Bronze,No,Both,No,Yes,"007 Allergy and Immunology, 008 Cardiovascular Disease, 010 Chiropractor, 011 Dermatology, 012 Endocrinology, 013 ENT/Otolaryngology, 014 Gastroenterology, 015 General Surgery, 017 Infectious Diseases, 018 Nephrology, 019 Neurology, 020 Neurological Surgery, 021 Medical Oncology & Surgical Oncology, 022 Radiation Oncology, 023 Ophthalmology, 025 Orthopedic Surgery, 026 Physical Medicine & Rehabilitation, 027 Plastic Surgery, 028 Podiatrist, 029 Psychiatry, 030 Pulmonary Disease, 031 Rheumatology, 033 Urology, 034 Vascular Surgery, 035 Cardiothoracic Surgery, 000-Oral Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.phxchoice.com/HMOBronze,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ,,https://www.phxchoice.com/Formulary,65441AZ0040003-03,Limited Cost Sharing Plan Variation,,0.614295899868011,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,65441,HIOS,4,2014-11-11 04:41:18,4,65441,AZ,Individual,No,20-2706634,65441AZ0040004,Phoenix Choice,65441AZ004,,AZN001,AZS001,AZF004,New,HMO,Catastrophic,No,Both,No,Yes,"007 Allergy and Immunology, 008 Cardiovascular Disease, 010 Chiropractor, 011 Dermatology, 012 Endocrinology, 013 ENT/Otolaryngology, 014 Gastroenterology, 015 General Surgery, 017 Infectious Diseases, 018 Nephrology, 019 Neurology, 020 Neurological Surgery, 021 Medical Oncology & Surgical Oncology, 022 Radiation Oncology, 023 Ophthalmology, 025 Orthopedic Surgery, 026 Physical Medicine & Rehabilitation, 027 Plastic Surgery, 028 Podiatrist, 029 Psychiatry, 030 Pulmonary Disease, 031 Rheumatology, 033 Urology, 034 Vascular Surgery, 035 Cardiothoracic Surgery, 000-Oral Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,No,,No,,No,https://www.phxchoice.com/HMOCatastrophic,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ,,https://www.phxchoice.com/Formulary,65441AZ0040004-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,65441,HIOS,4,2014-11-11 04:41:18,4,65441,AZ,Individual,No,20-2706634,65441AZ0040004,Phoenix Choice,65441AZ004,,AZN001,AZS001,AZF004,New,HMO,Catastrophic,No,Both,No,Yes,"007 Allergy and Immunology, 008 Cardiovascular Disease, 010 Chiropractor, 011 Dermatology, 012 Endocrinology, 013 ENT/Otolaryngology, 014 Gastroenterology, 015 General Surgery, 017 Infectious Diseases, 018 Nephrology, 019 Neurology, 020 Neurological Surgery, 021 Medical Oncology & Surgical Oncology, 022 Radiation Oncology, 023 Ophthalmology, 025 Orthopedic Surgery, 026 Physical Medicine & Rehabilitation, 027 Plastic Surgery, 028 Podiatrist, 029 Psychiatry, 030 Pulmonary Disease, 031 Rheumatology, 033 Urology, 034 Vascular Surgery, 035 Cardiothoracic Surgery, 000-Oral Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,No,,No,,No,https://www.phxchoice.com/HMOCatastrophic,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ,,https://www.phxchoice.com/Formulary,65441AZ0040004-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,66105,HIOS,13,2015-01-16 17:32:32,1,66105,AZ,Individual,Yes,39-1263473,66105AZ0620001,Humana Dental Smart Choice,66105AZ062,,AZN001,AZS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.70,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541162,,66105AZ0620001-00,Standard Low Off Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$90,Not Applicable,,,,,$90,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,66105,HIOS,13,2015-01-16 17:32:32,1,66105,AZ,Individual,Yes,39-1263473,66105AZ0620001,Humana Dental Smart Choice,66105AZ062,,AZN001,AZS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.70,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541162,,66105AZ0620001-01,Standard Low On Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$90,Not Applicable,,,,,$90,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,66915,HIOS,2,2014-08-07 10:00:19,1,66915,AZ,SHOP (Small Group),Yes,36-0883760,66915AZ0040002,EHB High PPO,66915AZ004,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$42.07,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,66915AZ0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,66915,HIOS,2,2014-08-07 10:00:19,1,66915,AZ,SHOP (Small Group),Yes,36-0883760,66915AZ0040001,EHB Low PPO,66915AZ004,,AZN001,AZS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.74,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,66915AZ0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,66915,HIOS,2,2014-08-07 10:00:19,1,66915,AZ,SHOP (Small Group),Yes,36-0883760,66915AZ0030002,EHB High Passive,66915AZ003,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.84,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,66915AZ0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AZ,66915,HIOS,2,2014-08-07 10:00:19,1,66915,AZ,SHOP (Small Group),Yes,36-0883760,66915AZ0030001,EHB Low Passive,66915AZ003,,AZN001,AZS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.86,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,66915AZ0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,1,70239,AZ,Individual,No,46-2210067,70239AZ0010002,Health Choice Essential Gold,70239AZ001,,AZN001,AZS001,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010002-00,Standard Gold Off Exchange Plan,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,1,70239,AZ,Individual,No,46-2210067,70239AZ0010002,Health Choice Essential Gold,70239AZ001,,AZN001,AZS001,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010002-01,Standard Gold On Exchange Plan,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,1,70239,AZ,Individual,No,46-2210067,70239AZ0010002,Health Choice Essential Gold,70239AZ001,,AZN001,AZS001,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,1,70239,AZ,Individual,No,46-2210067,70239AZ0010002,Health Choice Essential Gold,70239AZ001,,AZN001,AZS001,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010002-03,Limited Cost Sharing Plan Variation,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,2,70239,AZ,Individual,No,46-2210067,70239AZ0010003,Health Choice Essential Silver,70239AZ001,,AZN001,AZS001,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010003-00,Standard Silver Off Exchange Plan,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,2,70239,AZ,Individual,No,46-2210067,70239AZ0010003,Health Choice Essential Silver,70239AZ001,,AZN001,AZS001,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010003-01,Standard Silver On Exchange Plan,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,2,70239,AZ,Individual,No,46-2210067,70239AZ0010003,Health Choice Essential Silver,70239AZ001,,AZN001,AZS001,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,2,70239,AZ,Individual,No,46-2210067,70239AZ0010003,Health Choice Essential Silver,70239AZ001,,AZN001,AZS001,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010003-03,Limited Cost Sharing Plan Variation,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,2,70239,AZ,Individual,No,46-2210067,70239AZ0010003,Health Choice Essential Silver,70239AZ001,,AZN001,AZS001,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010003-04,73% AV Level Silver Plan,,0.727276206016541,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$5,200","$10,400","$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$1,300","$2,600","$1,300","$2,600",,,,,,,,,8
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,3,70239,AZ,Individual,No,46-2210067,70239AZ0010004,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS001,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010004-00,Standard Bronze Off Exchange Plan,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,3,70239,AZ,Individual,No,46-2210067,70239AZ0010004,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS001,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010004-01,Standard Bronze On Exchange Plan,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,3,70239,AZ,Individual,No,46-2210067,70239AZ0010004,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS001,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,3,70239,AZ,Individual,No,46-2210067,70239AZ0010004,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS001,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010004-03,Limited Cost Sharing Plan Variation,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,4,70239,AZ,Individual,No,46-2210067,70239AZ0010006,Health Choice Essential Gold,70239AZ001,,AZN001,AZS002,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010006-00,Standard Gold Off Exchange Plan,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,4,70239,AZ,Individual,No,46-2210067,70239AZ0010006,Health Choice Essential Gold,70239AZ001,,AZN001,AZS002,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010006-01,Standard Gold On Exchange Plan,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,4,70239,AZ,Individual,No,46-2210067,70239AZ0010006,Health Choice Essential Gold,70239AZ001,,AZN001,AZS002,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,4,70239,AZ,Individual,No,46-2210067,70239AZ0010006,Health Choice Essential Gold,70239AZ001,,AZN001,AZS002,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010006-03,Limited Cost Sharing Plan Variation,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,5,70239,AZ,Individual,No,46-2210067,70239AZ0010007,Health Choice Essential Silver,70239AZ001,,AZN001,AZS002,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010007-00,Standard Silver Off Exchange Plan,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,5,70239,AZ,Individual,No,46-2210067,70239AZ0010007,Health Choice Essential Silver,70239AZ001,,AZN001,AZS002,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010007-01,Standard Silver On Exchange Plan,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,5,70239,AZ,Individual,No,46-2210067,70239AZ0010007,Health Choice Essential Silver,70239AZ001,,AZN001,AZS002,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,5,70239,AZ,Individual,No,46-2210067,70239AZ0010007,Health Choice Essential Silver,70239AZ001,,AZN001,AZS002,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010007-03,Limited Cost Sharing Plan Variation,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,5,70239,AZ,Individual,No,46-2210067,70239AZ0010007,Health Choice Essential Silver,70239AZ001,,AZN001,AZS002,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010007-04,73% AV Level Silver Plan,,0.727276206016541,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$5,200","$10,400","$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$1,300","$2,600","$1,300","$2,600",,,,,,,,,8
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,5,70239,AZ,Individual,No,46-2210067,70239AZ0010007,Health Choice Essential Silver,70239AZ001,,AZN001,AZS002,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010007-05,87% AV Level Silver Plan,,0.861733675003052,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$2,000","$4,000","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,$400,$800,20%,,,,$400,$800,$400,$800,,,,,,,,,9
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,5,70239,AZ,Individual,No,46-2210067,70239AZ0010007,Health Choice Essential Silver,70239AZ001,,AZN001,AZS002,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010007-06,94% AV Level Silver Plan,,0.93137127161026,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,$75,$150,10%,,,,$75,$150,$75,$150,,,,,,,,,10
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,6,70239,AZ,Individual,No,46-2210067,70239AZ0010008,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS002,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010008-00,Standard Bronze Off Exchange Plan,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,6,70239,AZ,Individual,No,46-2210067,70239AZ0010008,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS002,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010008-01,Standard Bronze On Exchange Plan,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,6,70239,AZ,Individual,No,46-2210067,70239AZ0010008,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS002,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,6,70239,AZ,Individual,No,46-2210067,70239AZ0010008,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS002,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010008-03,Limited Cost Sharing Plan Variation,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,7,70239,AZ,Individual,No,46-2210067,70239AZ0010010,Health Choice Essential Gold,70239AZ001,,AZN001,AZS003,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010010-00,Standard Gold Off Exchange Plan,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,7,70239,AZ,Individual,No,46-2210067,70239AZ0010010,Health Choice Essential Gold,70239AZ001,,AZN001,AZS003,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010010-01,Standard Gold On Exchange Plan,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,7,70239,AZ,Individual,No,46-2210067,70239AZ0010010,Health Choice Essential Gold,70239AZ001,,AZN001,AZS003,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,7,70239,AZ,Individual,No,46-2210067,70239AZ0010010,Health Choice Essential Gold,70239AZ001,,AZN001,AZS003,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010010-03,Limited Cost Sharing Plan Variation,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,8,70239,AZ,Individual,No,46-2210067,70239AZ0010011,Health Choice Essential Silver,70239AZ001,,AZN001,AZS003,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010011-03,Limited Cost Sharing Plan Variation,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,8,70239,AZ,Individual,No,46-2210067,70239AZ0010011,Health Choice Essential Silver,70239AZ001,,AZN001,AZS003,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010011-04,73% AV Level Silver Plan,,0.727276206016541,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$5,200","$10,400","$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$1,300","$2,600","$1,300","$2,600",,,,,,,,,8
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,8,70239,AZ,Individual,No,46-2210067,70239AZ0010011,Health Choice Essential Silver,70239AZ001,,AZN001,AZS003,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010011-05,87% AV Level Silver Plan,,0.861733675003052,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$2,000","$4,000","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,$400,$800,20%,,,,$400,$800,$400,$800,,,,,,,,,9
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,8,70239,AZ,Individual,No,46-2210067,70239AZ0010011,Health Choice Essential Silver,70239AZ001,,AZN001,AZS003,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010011-06,94% AV Level Silver Plan,,0.93137127161026,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,$75,$150,10%,,,,$75,$150,$75,$150,,,,,,,,,10
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,9,70239,AZ,Individual,No,46-2210067,70239AZ0010012,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS003,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010012-00,Standard Bronze Off Exchange Plan,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,9,70239,AZ,Individual,No,46-2210067,70239AZ0010012,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS003,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010012-01,Standard Bronze On Exchange Plan,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,11,70239,AZ,Individual,No,46-2210067,70239AZ0010015,Health Choice Essential Silver,70239AZ001,,AZN001,AZS004,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010015-05,87% AV Level Silver Plan,,0.861733675003052,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$2,000","$4,000","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,$400,$800,20%,,,,$400,$800,$400,$800,,,,,,,,,9
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,11,70239,AZ,Individual,No,46-2210067,70239AZ0010015,Health Choice Essential Silver,70239AZ001,,AZN001,AZS004,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010015-06,94% AV Level Silver Plan,,0.93137127161026,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,$75,$150,10%,,,,$75,$150,$75,$150,,,,,,,,,10
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,12,70239,AZ,Individual,No,46-2210067,70239AZ0010016,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS004,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010016-00,Standard Bronze Off Exchange Plan,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,12,70239,AZ,Individual,No,46-2210067,70239AZ0010016,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS004,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010016-01,Standard Bronze On Exchange Plan,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,12,70239,AZ,Individual,No,46-2210067,70239AZ0010016,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS004,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,12,70239,AZ,Individual,No,46-2210067,70239AZ0010016,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS004,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010016-03,Limited Cost Sharing Plan Variation,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,13,70239,AZ,Individual,No,46-2210067,70239AZ0010018,Health Choice Essential Gold,70239AZ001,,AZN001,AZS005,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010018-00,Standard Gold Off Exchange Plan,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,13,70239,AZ,Individual,No,46-2210067,70239AZ0010018,Health Choice Essential Gold,70239AZ001,,AZN001,AZS005,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010018-01,Standard Gold On Exchange Plan,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,13,70239,AZ,Individual,No,46-2210067,70239AZ0010018,Health Choice Essential Gold,70239AZ001,,AZN001,AZS005,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010018-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,13,70239,AZ,Individual,No,46-2210067,70239AZ0010018,Health Choice Essential Gold,70239AZ001,,AZN001,AZS005,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010018-03,Limited Cost Sharing Plan Variation,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,14,70239,AZ,Individual,No,46-2210067,70239AZ0010019,Health Choice Essential Silver,70239AZ001,,AZN001,AZS005,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010019-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,14,70239,AZ,Individual,No,46-2210067,70239AZ0010019,Health Choice Essential Silver,70239AZ001,,AZN001,AZS005,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010019-03,Limited Cost Sharing Plan Variation,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,14,70239,AZ,Individual,No,46-2210067,70239AZ0010019,Health Choice Essential Silver,70239AZ001,,AZN001,AZS005,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010019-04,73% AV Level Silver Plan,,0.727276206016541,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$5,200","$10,400","$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$1,300","$2,600","$1,300","$2,600",,,,,,,,,8
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,14,70239,AZ,Individual,No,46-2210067,70239AZ0010019,Health Choice Essential Silver,70239AZ001,,AZN001,AZS005,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010019-05,87% AV Level Silver Plan,,0.861733675003052,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$2,000","$4,000","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,$400,$800,20%,,,,$400,$800,$400,$800,,,,,,,,,9
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,14,70239,AZ,Individual,No,46-2210067,70239AZ0010019,Health Choice Essential Silver,70239AZ001,,AZN001,AZS005,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010019-06,94% AV Level Silver Plan,,0.93137127161026,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,$75,$150,10%,,,,$75,$150,$75,$150,,,,,,,,,10
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,15,70239,AZ,Individual,No,46-2210067,70239AZ0010020,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS005,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010020-00,Standard Bronze Off Exchange Plan,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,15,70239,AZ,Individual,No,46-2210067,70239AZ0010020,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS005,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010020-01,Standard Bronze On Exchange Plan,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,15,70239,AZ,Individual,No,46-2210067,70239AZ0010020,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS005,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010020-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,15,70239,AZ,Individual,No,46-2210067,70239AZ0010020,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS005,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010020-03,Limited Cost Sharing Plan Variation,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,16,70239,AZ,Individual,No,46-2210067,70239AZ0010022,Health Choice Essential Gold,70239AZ001,,AZN001,AZS006,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010022-00,Standard Gold Off Exchange Plan,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,16,70239,AZ,Individual,No,46-2210067,70239AZ0010022,Health Choice Essential Gold,70239AZ001,,AZN001,AZS006,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010022-01,Standard Gold On Exchange Plan,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,16,70239,AZ,Individual,No,46-2210067,70239AZ0010022,Health Choice Essential Gold,70239AZ001,,AZN001,AZS006,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010022-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,16,70239,AZ,Individual,No,46-2210067,70239AZ0010022,Health Choice Essential Gold,70239AZ001,,AZN001,AZS006,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010022-03,Limited Cost Sharing Plan Variation,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,17,70239,AZ,Individual,No,46-2210067,70239AZ0010023,Health Choice Essential Silver,70239AZ001,,AZN001,AZS006,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010023-00,Standard Silver Off Exchange Plan,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,17,70239,AZ,Individual,No,46-2210067,70239AZ0010023,Health Choice Essential Silver,70239AZ001,,AZN001,AZS006,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010023-01,Standard Silver On Exchange Plan,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,17,70239,AZ,Individual,No,46-2210067,70239AZ0010023,Health Choice Essential Silver,70239AZ001,,AZN001,AZS006,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010023-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,17,70239,AZ,Individual,No,46-2210067,70239AZ0010023,Health Choice Essential Silver,70239AZ001,,AZN001,AZS006,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010023-03,Limited Cost Sharing Plan Variation,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,17,70239,AZ,Individual,No,46-2210067,70239AZ0010023,Health Choice Essential Silver,70239AZ001,,AZN001,AZS006,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010023-04,73% AV Level Silver Plan,,0.727276206016541,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$5,200","$10,400","$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$1,300","$2,600","$1,300","$2,600",,,,,,,,,8
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,17,70239,AZ,Individual,No,46-2210067,70239AZ0010023,Health Choice Essential Silver,70239AZ001,,AZN001,AZS006,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010023-05,87% AV Level Silver Plan,,0.861733675003052,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$2,000","$4,000","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,$400,$800,20%,,,,$400,$800,$400,$800,,,,,,,,,9
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,17,70239,AZ,Individual,No,46-2210067,70239AZ0010023,Health Choice Essential Silver,70239AZ001,,AZN001,AZS006,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010023-06,94% AV Level Silver Plan,,0.93137127161026,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,$75,$150,10%,,,,$75,$150,$75,$150,,,,,,,,,10
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,18,70239,AZ,Individual,No,46-2210067,70239AZ0010024,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS006,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010024-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,18,70239,AZ,Individual,No,46-2210067,70239AZ0010024,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS006,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010024-03,Limited Cost Sharing Plan Variation,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,19,70239,AZ,Individual,No,46-2210067,70239AZ0010026,Health Choice Essential Gold,70239AZ001,,AZN001,AZS007,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010026-00,Standard Gold Off Exchange Plan,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,19,70239,AZ,Individual,No,46-2210067,70239AZ0010026,Health Choice Essential Gold,70239AZ001,,AZN001,AZS007,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010026-01,Standard Gold On Exchange Plan,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,19,70239,AZ,Individual,No,46-2210067,70239AZ0010026,Health Choice Essential Gold,70239AZ001,,AZN001,AZS007,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010026-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,19,70239,AZ,Individual,No,46-2210067,70239AZ0010026,Health Choice Essential Gold,70239AZ001,,AZN001,AZS007,AZF003,Existing,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010026-03,Limited Cost Sharing Plan Variation,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,20,70239,AZ,Individual,No,46-2210067,70239AZ0010027,Health Choice Essential Silver,70239AZ001,,AZN001,AZS007,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010027-00,Standard Silver Off Exchange Plan,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,20,70239,AZ,Individual,No,46-2210067,70239AZ0010027,Health Choice Essential Silver,70239AZ001,,AZN001,AZS007,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010027-01,Standard Silver On Exchange Plan,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,20,70239,AZ,Individual,No,46-2210067,70239AZ0010027,Health Choice Essential Silver,70239AZ001,,AZN001,AZS007,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010027-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,20,70239,AZ,Individual,No,46-2210067,70239AZ0010027,Health Choice Essential Silver,70239AZ001,,AZN001,AZS007,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010027-03,Limited Cost Sharing Plan Variation,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,20,70239,AZ,Individual,No,46-2210067,70239AZ0010027,Health Choice Essential Silver,70239AZ001,,AZN001,AZS007,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010027-04,73% AV Level Silver Plan,,0.727276206016541,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$5,200","$10,400","$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$1,300","$2,600","$1,300","$2,600",,,,,,,,,8
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,20,70239,AZ,Individual,No,46-2210067,70239AZ0010027,Health Choice Essential Silver,70239AZ001,,AZN001,AZS007,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010027-05,87% AV Level Silver Plan,,0.861733675003052,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$2,000","$4,000","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,$400,$800,20%,,,,$400,$800,$400,$800,,,,,,,,,9
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,20,70239,AZ,Individual,No,46-2210067,70239AZ0010027,Health Choice Essential Silver,70239AZ001,,AZN001,AZS007,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010027-06,94% AV Level Silver Plan,,0.93137127161026,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,$75,$150,10%,,,,$75,$150,$75,$150,,,,,,,,,10
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,21,70239,AZ,Individual,No,46-2210067,70239AZ0010028,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS007,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010028-00,Standard Bronze Off Exchange Plan,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,21,70239,AZ,Individual,No,46-2210067,70239AZ0010028,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS007,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010028-01,Standard Bronze On Exchange Plan,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,21,70239,AZ,Individual,No,46-2210067,70239AZ0010028,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS007,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010028-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,21,70239,AZ,Individual,No,46-2210067,70239AZ0010028,Health Choice Essential Bronze,70239AZ001,,AZN001,AZS007,AZF001,Existing,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010028-03,Limited Cost Sharing Plan Variation,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,22,70239,AZ,Individual,No,46-2210067,70239AZ0010031,Health Choice Essential Silver,70239AZ001,,AZN001,AZS008,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010031-00,Standard Silver Off Exchange Plan,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,22,70239,AZ,Individual,No,46-2210067,70239AZ0010031,Health Choice Essential Silver,70239AZ001,,AZN001,AZS008,AZF002,Existing,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010031-01,Standard Silver On Exchange Plan,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,27,70239,AZ,Individual,No,46-2210067,70239AZ0010036,Health Choice Essential Basic,70239AZ001,,AZN001,AZS004,AZF004,New,HMO,Catastrophic,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010036-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,28,70239,AZ,Individual,No,46-2210067,70239AZ0010037,Health Choice Essential Basic,70239AZ001,,AZN001,AZS005,AZF004,New,HMO,Catastrophic,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010037-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,28,70239,AZ,Individual,No,46-2210067,70239AZ0010037,Health Choice Essential Basic,70239AZ001,,AZN001,AZS005,AZF004,New,HMO,Catastrophic,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010037-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,29,70239,AZ,Individual,No,46-2210067,70239AZ0010038,Health Choice Essential Basic,70239AZ001,,AZN001,AZS006,AZF004,New,HMO,Catastrophic,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010038-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,29,70239,AZ,Individual,No,46-2210067,70239AZ0010038,Health Choice Essential Basic,70239AZ001,,AZN001,AZS006,AZF004,New,HMO,Catastrophic,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010038-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,30,70239,AZ,Individual,No,46-2210067,70239AZ0010039,Health Choice Essential Basic,70239AZ001,,AZN001,AZS007,AZF004,New,HMO,Catastrophic,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010039-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,30,70239,AZ,Individual,No,46-2210067,70239AZ0010039,Health Choice Essential Basic,70239AZ001,,AZN001,AZS007,AZF004,New,HMO,Catastrophic,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010039-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,31,70239,AZ,Individual,No,46-2210067,70239AZ0010040,Health Choice Essential Basic,70239AZ001,,AZN001,AZS008,AZF004,New,HMO,Catastrophic,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010040-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,31,70239,AZ,Individual,No,46-2210067,70239AZ0010040,Health Choice Essential Basic,70239AZ001,,AZN001,AZS008,AZF004,New,HMO,Catastrophic,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010040-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,32,70239,AZ,Individual,No,46-2210067,70239AZ0010041,Health Choice Value Gold,70239AZ001,,AZN002,AZS008,AZF003,New,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010041-00,Standard Gold Off Exchange Plan,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,32,70239,AZ,Individual,No,46-2210067,70239AZ0010041,Health Choice Value Gold,70239AZ001,,AZN002,AZS008,AZF003,New,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010041-01,Standard Gold On Exchange Plan,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,32,70239,AZ,Individual,No,46-2210067,70239AZ0010041,Health Choice Value Gold,70239AZ001,,AZN002,AZS008,AZF003,New,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010041-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,32,70239,AZ,Individual,No,46-2210067,70239AZ0010041,Health Choice Value Gold,70239AZ001,,AZN002,AZS008,AZF003,New,HMO,Gold,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010041-03,Limited Cost Sharing Plan Variation,,0.781310081481934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,33,70239,AZ,Individual,No,46-2210067,70239AZ0010042,Health Choice Value Silver,70239AZ001,,AZN002,AZS008,AZF002,New,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010042-00,Standard Silver Off Exchange Plan,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,33,70239,AZ,Individual,No,46-2210067,70239AZ0010042,Health Choice Value Silver,70239AZ001,,AZN002,AZS008,AZF002,New,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010042-01,Standard Silver On Exchange Plan,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,33,70239,AZ,Individual,No,46-2210067,70239AZ0010042,Health Choice Value Silver,70239AZ001,,AZN002,AZS008,AZF002,New,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010042-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,33,70239,AZ,Individual,No,46-2210067,70239AZ0010042,Health Choice Value Silver,70239AZ001,,AZN002,AZS008,AZF002,New,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010042-03,Limited Cost Sharing Plan Variation,,0.682222545146942,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",20%,,,,"$1,600","$3,200","$1,600","$3,200",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,33,70239,AZ,Individual,No,46-2210067,70239AZ0010042,Health Choice Value Silver,70239AZ001,,AZN002,AZS008,AZF002,New,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010042-04,73% AV Level Silver Plan,,0.727276206016541,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$5,200","$10,400","$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$1,300","$2,600","$1,300","$2,600",,,,,,,,,8
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,33,70239,AZ,Individual,No,46-2210067,70239AZ0010042,Health Choice Value Silver,70239AZ001,,AZN002,AZS008,AZF002,New,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010042-05,87% AV Level Silver Plan,,0.861733675003052,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$2,000","$4,000","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,$400,$800,20%,,,,$400,$800,$400,$800,,,,,,,,,9
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,33,70239,AZ,Individual,No,46-2210067,70239AZ0010042,Health Choice Value Silver,70239AZ001,,AZN002,AZS008,AZF002,New,HMO,Silver,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010042-06,94% AV Level Silver Plan,,0.93137127161026,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$1,000","$2,000","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,$75,$150,10%,,,,$75,$150,$75,$150,,,,,,,,,10
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,34,70239,AZ,Individual,No,46-2210067,70239AZ0010043,Health Choice Value Bronze,70239AZ001,,AZN002,AZS008,AZF001,New,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010043-00,Standard Bronze Off Exchange Plan,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,34,70239,AZ,Individual,No,46-2210067,70239AZ0010043,Health Choice Value Bronze,70239AZ001,,AZN002,AZS008,AZF001,New,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010043-01,Standard Bronze On Exchange Plan,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,5
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,34,70239,AZ,Individual,No,46-2210067,70239AZ0010043,Health Choice Value Bronze,70239AZ001,,AZN002,AZS008,AZF001,New,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010043-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,34,70239,AZ,Individual,No,46-2210067,70239AZ0010043,Health Choice Value Bronze,70239AZ001,,AZN002,AZS008,AZF001,New,HMO,Bronze,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010043-03,Limited Cost Sharing Plan Variation,,0.586735725402832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,7
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,35,70239,AZ,Individual,No,46-2210067,70239AZ0010044,Health Choice Value Basic,70239AZ001,,AZN002,AZS008,AZF004,New,HMO,Catastrophic,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010044-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,4
2015,AZ,70239,HIOS,7,2015-06-19 13:25:37,35,70239,AZ,Individual,No,46-2210067,70239AZ0010044,Health Choice Value Basic,70239AZ001,,AZN002,AZS008,AZF004,New,HMO,Catastrophic,No,Both,No,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services,Yes,Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services,No,http://www.healthchoiceessential.com/members/member_benefits,https://www.healthchoiceessential.com/EnrollmentPayment,http://www.healthchoiceessential.com/members,http://www.healthchoiceessential.com/members/rxdrugs,70239AZ0010044-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$6,600","$13,200","$6,600","$13,200",,,,,,,,,5
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,1,77352,AZ,SHOP (Small Group),Yes,95-6042390,77352AZ0010001,BEST Life Child Dental Plus,77352AZ001,,AZN001,AZS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$34.55,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BEST_Life_Child_Dental_Plus_Plan.pdf,,77352AZ0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,1,77352,AZ,Individual,Yes,95-6042390,77352AZ0020001,BESTOne Child Dental Plus,77352AZ002,,AZN001,AZS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$43.19,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BESTOne_Child_Dental_Plus_Plan.pdf,,77352AZ0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,2,77352,AZ,Individual,Yes,95-6042390,77352AZ0020002,BESTOne Child Dental,77352AZ002,,AZN001,AZS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$33.43,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BESTOne_Child_Dental_Plan.pdf,,77352AZ0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,2,77352,AZ,SHOP (Small Group),Yes,95-6042390,77352AZ0010002,BEST Life Child Dental,77352AZ001,,AZN001,AZS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.74,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BEST_Life_Child_Dental_Plan.pdf,,77352AZ0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,3,77352,AZ,SHOP (Small Group),Yes,95-6042390,77352AZ0010007,BEST Dental Premium,77352AZ001,,AZN001,AZS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BESTDental_Premium_Plan.pdf,,77352AZ0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,3,77352,AZ,Individual,Yes,95-6042390,77352AZ0020003,BESTOne Dental Advantage-Gold,77352AZ002,,AZN001,AZS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$43.19,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BESTOne_Dental_Advantage-Gold_Plan.pdf,,77352AZ0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,3,77352,AZ,Individual,Yes,95-6042390,77352AZ0020003,BESTOne Dental Advantage-Gold,77352AZ002,,AZN001,AZS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$43.19,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BESTOne_Dental_Advantage-Gold_Plan.pdf,,77352AZ0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,3,77352,AZ,SHOP (Small Group),Yes,95-6042390,77352AZ0010007,BEST Dental Premium,77352AZ001,,AZN001,AZS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BESTDental_Premium_Plan.pdf,,77352AZ0010007-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,3,77352,AZ,SHOP (Small Group),Yes,95-6042390,77352AZ0010008,BEST Dental Standard-H,77352AZ001,,AZN001,AZS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BESTDental_Standard-H_Plan.pdf,,77352AZ0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,3,77352,AZ,Individual,Yes,95-6042390,77352AZ0020004,BESTOne Dental Plus-Gold,77352AZ002,,AZN001,AZS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$43.19,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BESTOne_Dental_Plus-Gold_Plan.pdf,,77352AZ0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,3,77352,AZ,Individual,Yes,95-6042390,77352AZ0020004,BESTOne Dental Plus-Gold,77352AZ002,,AZN001,AZS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$43.19,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BESTOne_Dental_Plus-Gold_Plan.pdf,,77352AZ0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,3,77352,AZ,SHOP (Small Group),Yes,95-6042390,77352AZ0010008,BEST Dental Standard-H,77352AZ001,,AZN001,AZS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BESTDental_Standard-H_Plan.pdf,,77352AZ0010008-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,3,77352,AZ,SHOP (Small Group),Yes,95-6042390,77352AZ0010010,BEST Dental Choice-H,77352AZ001,,AZN001,AZS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BESTDental_Choice-H_Plan.pdf,,77352AZ0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,AZ,77352,HIOS,4,2014-09-03 04:28:59,3,77352,AZ,SHOP (Small Group),Yes,95-6042390,77352AZ0010010,BEST Dental Choice-H,77352AZ001,,AZN001,AZS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AZ/2015/AZ_BESTDental_Choice-H_Plan.pdf,,77352AZ0010010-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,AZ,79500,HIOS,4,2014-09-06 03:39:47,1,79500,AZ,SHOP (Small Group),Yes,41-0808596,79500AZ0010003,"Plan 3. Passive PPO, $1500 Annual Maximum, no Ortho",79500AZ001,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,79500AZ0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AZ,79500,HIOS,4,2014-09-06 03:39:47,1,79500,AZ,SHOP (Small Group),Yes,41-0808596,79500AZ0010004,"Plan 4.  Passive PPO, $1500 Annual Maximum, Ortho",79500AZ001,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,79500AZ0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AZ,79500,HIOS,4,2014-09-06 03:39:47,1,79500,AZ,SHOP (Small Group),Yes,41-0808596,79500AZ0010005,"Plan 5.  Passive PPO, $2000 Annual Maximum, Ortho",79500AZ001,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,79500AZ0010005-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,AZ,79500,HIOS,4,2014-09-06 03:39:47,1,79500,AZ,SHOP (Small Group),Yes,41-0808596,79500AZ0010006,"Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho",79500AZ001,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,79500AZ0010006-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,AZ,79500,HIOS,4,2014-09-06 03:39:47,1,79500,AZ,SHOP (Small Group),Yes,41-0808596,79500AZ0010007,"Plan 7. Graded Passive PPO, $1000 Annual Maximum, Ortho",79500AZ001,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,79500AZ0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,AZ,79500,HIOS,4,2014-09-06 03:39:47,1,79500,AZ,SHOP (Small Group),Yes,41-0808596,79500AZ0010008,"Plan 8. MAC PPO, $1000 Annual Maximum, no Ortho",79500AZ001,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,79500AZ0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,AZ,79500,HIOS,4,2014-09-06 03:39:47,1,79500,AZ,SHOP (Small Group),Yes,41-0808596,79500AZ0010009,"Plan 9. MAC PPO, $1500 Annual Maximum, Ortho",79500AZ001,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,79500AZ0010009-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,AZ,79500,HIOS,4,2014-09-06 03:39:47,1,79500,AZ,SHOP (Small Group),Yes,41-0808596,79500AZ0010010,"Plan 10. Graded MAC PPO, $1000 Annual Maximum, no Ortho",79500AZ001,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,79500AZ0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,13
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190001,Assurant Health Bronze Plan 001,80863AZ019,,AZN001,AZS001,AZF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190001-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,3,86830,AZ,Individual,No,59-1031071,86830AZ0040005,myCigna Health Flex 1500,86830AZ004,7730182962,AZN001,AZS001,AZF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,2,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-1500,http://www.cigna.com/ifp-drug-list,86830AZ0040005-00,Standard Silver Off Exchange Plan,69.10%,0.704952836036682,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,3,86830,AZ,Individual,No,59-1031071,86830AZ0040005,myCigna Health Flex 1500,86830AZ004,7730182962,AZN001,AZS001,AZF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,2,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-1500,http://www.cigna.com/ifp-drug-list,86830AZ0040005-01,Standard Silver On Exchange Plan,69.10%,0.704952836036682,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,3,86830,AZ,Individual,No,59-1031071,86830AZ0040005,myCigna Health Flex 1500,86830AZ004,7730182962,AZN001,AZS001,AZF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,2,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-1500,http://www.cigna.com/ifp-drug-list,86830AZ0040005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,3,86830,AZ,Individual,No,59-1031071,86830AZ0040005,myCigna Health Flex 1500,86830AZ004,7730182962,AZN001,AZS001,AZF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,2,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-1500,http://www.cigna.com/ifp-drug-list,86830AZ0040005-03,Limited Cost Sharing Plan Variation,69.10%,0.704952836036682,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190006,Assurant Health Silver Plan 001,80863AZ019,,AZN001,AZS003,AZF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,32
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190006,Assurant Health Silver Plan 001,80863AZ019,,AZN001,AZS003,AZF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190006-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190017,Assurant Health Platinum Plan 002,80863AZ019,,AZN001,AZS002,AZF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,43
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190017,Assurant Health Platinum Plan 002,80863AZ019,,AZN001,AZS002,AZF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190017-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190018,Assurant Health Platinum Plan 002,80863AZ019,,AZN001,AZS003,AZF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190018-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190018,Assurant Health Platinum Plan 002,80863AZ019,,AZN001,AZS003,AZF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190018-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,46
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190001,Assurant Health Bronze Plan 001,80863AZ019,,AZN001,AZS001,AZF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190001-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190001,Assurant Health Bronze Plan 001,80863AZ019,,AZN001,AZS001,AZF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190001,Assurant Health Bronze Plan 001,80863AZ019,,AZN001,AZS001,AZF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190001-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190002,Assurant Health Bronze Plan 001,80863AZ019,,AZN001,AZS002,AZF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190002-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190002,Assurant Health Bronze Plan 001,80863AZ019,,AZN001,AZS002,AZF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190002-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190003,Assurant Health Bronze Plan 001,80863AZ019,,AZN001,AZS003,AZF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190003-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190003,Assurant Health Bronze Plan 001,80863AZ019,,AZN001,AZS003,AZF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190003-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,2,80863,AZ,Individual,No,39-0658730,80863AZ0190009,Assurant Health Bronze Plan 002,80863AZ019,,AZN001,AZS003,AZF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190009-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190010,Assurant Health Silver Plan 002,80863AZ019,,AZN001,AZS001,AZF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190010-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,4,91450,AZ,Individual,No,36-3097810,91450AZ0080028,CommunityCare HMO Platinum $15/$30/$3000 without Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF001,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_platinum_15_30_3000_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_platinum_15_30_3000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080028-01,Standard Platinum On Exchange Plan,,0.880567669868469,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,4,91450,AZ,Individual,No,36-3097810,91450AZ0080028,CommunityCare HMO Platinum $15/$30/$3000 without Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF001,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_platinum_15_30_3000_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_platinum_15_30_3000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080028-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190018,Assurant Health Platinum Plan 002,80863AZ019,,AZN001,AZS003,AZF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190018-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,47
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190018,Assurant Health Platinum Plan 002,80863AZ019,,AZN001,AZS003,AZF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190018-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,AZ,83130,HIOS,2,2014-08-08 08:53:29,1,83130,AZ,Individual,Yes,47-0397286,83130AZ0040001,"Delta Dental Individual PPO, EHB Certified",83130AZ004,,AZN002,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.92,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,83130AZ0040001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,83130,HIOS,2,2014-08-08 08:53:29,1,83130,AZ,SHOP (Small Group),Yes,47-0397286,83130AZ0060001,"Renaissance Group Dental PPO, EHB Certified",83130AZ006,,AZN001,AZS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.78,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,83130AZ0060001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,83130,HIOS,2,2014-08-08 08:53:29,1,83130,AZ,SHOP (Small Group),Yes,47-0397286,83130AZ0060002,"Renaissance Group Dental PPO, EHB Certified",83130AZ006,,AZN001,AZS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.35,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,83130AZ0060002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,83130,HIOS,2,2014-08-08 08:53:29,1,83130,AZ,Individual,Yes,47-0397286,83130AZ0040002,"Delta Dental Individual PPO, EHB Certified",83130AZ004,,AZN002,AZS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.99,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,83130AZ0040002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,83130,HIOS,2,2014-08-08 08:53:29,1,83130,AZ,Individual,Yes,47-0397286,83130AZ0050001,"Renaissance Individual Dental PPO, EHB Certified",83130AZ005,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$37.99,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,83130AZ0050001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AZ,83130,HIOS,2,2014-08-08 08:53:29,1,83130,AZ,Individual,Yes,47-0397286,83130AZ0050002,"Renaissance Individual Dental PPO, EHB Certified",83130AZ005,,AZN001,AZS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.82,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,83130AZ0050002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,1,84251,AZ,Individual,No,06-6033492,84251AZ0070002,Aetna Banner Health Network Bronze $20 Copay,84251AZ007,,AZN001,AZS001,AZF009,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070002-00,Standard Bronze Off Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,1,84251,AZ,Individual,No,06-6033492,84251AZ0070002,Aetna Banner Health Network Bronze $20 Copay,84251AZ007,,AZN001,AZS001,AZF009,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070002-01,Standard Bronze On Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,1,84251,AZ,Individual,No,06-6033492,84251AZ0070002,Aetna Banner Health Network Bronze $20 Copay,84251AZ007,,AZN001,AZS001,AZF009,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,1,84251,AZ,Individual,No,06-6033492,84251AZ0070002,Aetna Banner Health Network Bronze $20 Copay,84251AZ007,,AZN001,AZS001,AZF009,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070002-03,Limited Cost Sharing Plan Variation,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190011,Assurant Health Silver Plan 002,80863AZ019,,AZN001,AZS002,AZF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190011-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190011,Assurant Health Silver Plan 002,80863AZ019,,AZN001,AZS002,AZF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190011-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190011,Assurant Health Silver Plan 002,80863AZ019,,AZN001,AZS002,AZF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,13
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190011,Assurant Health Silver Plan 002,80863AZ019,,AZN001,AZS002,AZF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190011-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190011,Assurant Health Silver Plan 002,80863AZ019,,AZN001,AZS002,AZF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190011-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190011,Assurant Health Silver Plan 002,80863AZ019,,AZN001,AZS002,AZF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190011-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,3,84251,AZ,Individual,No,06-6033492,84251AZ0070009,Aetna Banner Health Network Silver $10 Copay,84251AZ007,,AZN001,AZS001,AZF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070009-06,94% AV Level Silver Plan,93.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,4,84251,AZ,Individual,No,06-6033492,84251AZ0070011,Aetna Banner Health Network Silver $5 Copay 2750,84251AZ007,,AZN001,AZS001,AZF015,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070011-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,4,84251,AZ,Individual,No,06-6033492,84251AZ0070011,Aetna Banner Health Network Silver $5 Copay 2750,84251AZ007,,AZN001,AZS001,AZF015,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070011-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,4,84251,AZ,Individual,No,06-6033492,84251AZ0070011,Aetna Banner Health Network Silver $5 Copay 2750,84251AZ007,,AZN001,AZS001,AZF015,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070011-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,4,84251,AZ,Individual,No,06-6033492,84251AZ0070011,Aetna Banner Health Network Silver $5 Copay 2750,84251AZ007,,AZN001,AZS001,AZF015,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070011-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,4,84251,AZ,Individual,No,06-6033492,84251AZ0070011,Aetna Banner Health Network Silver $5 Copay 2750,84251AZ007,,AZN001,AZS001,AZF015,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070011-04,73% AV Level Silver Plan,72.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190003,Assurant Health Bronze Plan 001,80863AZ019,,AZN001,AZS003,AZF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,14
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190003,Assurant Health Bronze Plan 001,80863AZ019,,AZN001,AZS003,AZF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190003-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190004,Assurant Health Silver Plan 001,80863AZ019,,AZN001,AZS001,AZF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190004-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190004,Assurant Health Silver Plan 001,80863AZ019,,AZN001,AZS001,AZF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190004-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190004,Assurant Health Silver Plan 001,80863AZ019,,AZN001,AZS001,AZF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,18
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190004,Assurant Health Silver Plan 001,80863AZ019,,AZN001,AZS001,AZF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190004-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190004,Assurant Health Silver Plan 001,80863AZ019,,AZN001,AZS001,AZF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190004-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190004,Assurant Health Silver Plan 001,80863AZ019,,AZN001,AZS001,AZF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190004-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190006,Assurant Health Silver Plan 001,80863AZ019,,AZN001,AZS003,AZF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190006-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190006,Assurant Health Silver Plan 001,80863AZ019,,AZN001,AZS003,AZF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190006-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,1,86830,AZ,Individual,No,59-1031071,86830AZ0040004,myCigna Health Savings 3400,86830AZ004,7730182962,AZN001,AZS001,AZF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services covered,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-savings-3400,http://www.cigna.com/ifp-drug-list,86830AZ0040004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,1,86830,AZ,Individual,No,59-1031071,86830AZ0040004,myCigna Health Savings 3400,86830AZ004,7730182962,AZN001,AZS001,AZF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services covered,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-savings-3400,http://www.cigna.com/ifp-drug-list,86830AZ0040004-03,Limited Cost Sharing Plan Variation,68.40%,0.684268593788147,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,1,86830,AZ,Individual,No,59-1031071,86830AZ0040004,myCigna Health Savings 3400,86830AZ004,7730182962,AZN001,AZS001,AZF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services covered,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-savings-3400,http://www.cigna.com/ifp-drug-list,86830AZ0040004-04,73% AV Level Silver Plan,73.20%,0.731574892997742,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,1,86830,AZ,Individual,No,59-1031071,86830AZ0040004,myCigna Health Savings 3400,86830AZ004,7730182962,AZN001,AZS001,AZF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services covered,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-savings-3400,http://www.cigna.com/ifp-drug-list,86830AZ0040004-05,87% AV Level Silver Plan,86.60%,0.865731179714203,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,1,86830,AZ,Individual,No,59-1031071,86830AZ0040004,myCigna Health Savings 3400,86830AZ004,7730182962,AZN001,AZS001,AZF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services covered,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-savings-3400,http://www.cigna.com/ifp-drug-list,86830AZ0040004-06,94% AV Level Silver Plan,94.30%,0.942874848842621,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$350,$700,0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,2,86830,AZ,Individual,No,59-1031071,86830AZ0040002,myCigna Health Flex 5500,86830AZ004,7730182962,AZN001,AZS001,AZF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,2,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-5500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-5500,http://www.cigna.com/ifp-drug-list,86830AZ0040002-00,Standard Bronze Off Exchange Plan,60.30%,0.629223048686981,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,2,86830,AZ,Individual,Yes,59-1031071,86830AZ0050002,myCigna Dental Family + Pediatric,86830AZ005,7730182962,AZN002,AZS002,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,All Services,Yes,,,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/dental-family-ped,,86830AZ0050002-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$150,$300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,2,86830,AZ,Individual,No,59-1031071,86830AZ0040002,myCigna Health Flex 5500,86830AZ004,7730182962,AZN001,AZS001,AZF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,2,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-5500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-5500,http://www.cigna.com/ifp-drug-list,86830AZ0040002-01,Standard Bronze On Exchange Plan,60.30%,0.629223048686981,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,2,86830,AZ,Individual,No,59-1031071,86830AZ0040002,myCigna Health Flex 5500,86830AZ004,7730182962,AZN001,AZS001,AZF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,2,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-5500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-5500,http://www.cigna.com/ifp-drug-list,86830AZ0040002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,2,86830,AZ,Individual,No,59-1031071,86830AZ0040002,myCigna Health Flex 5500,86830AZ004,7730182962,AZN001,AZS001,AZF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,2,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-5500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-5500,http://www.cigna.com/ifp-drug-list,86830AZ0040002-03,Limited Cost Sharing Plan Variation,60.30%,0.629223048686981,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190006,Assurant Health Silver Plan 001,80863AZ019,,AZN001,AZS003,AZF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190006-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,1,80863,AZ,Individual,No,39-0658730,80863AZ0190006,Assurant Health Silver Plan 001,80863AZ019,,AZN001,AZS003,AZF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190006-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,2,80863,AZ,Individual,No,39-0658730,80863AZ0190007,Assurant Health Bronze Plan 002,80863AZ019,,AZN001,AZS001,AZF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190007-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,2,80863,AZ,Individual,No,39-0658730,80863AZ0190007,Assurant Health Bronze Plan 002,80863AZ019,,AZN001,AZS001,AZF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,2,80863,AZ,Individual,No,39-0658730,80863AZ0190007,Assurant Health Bronze Plan 002,80863AZ019,,AZN001,AZS001,AZF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190007-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,2,80863,AZ,Individual,No,39-0658730,80863AZ0190008,Assurant Health Bronze Plan 002,80863AZ019,,AZN001,AZS002,AZF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190008-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,2,80863,AZ,Individual,No,39-0658730,80863AZ0190008,Assurant Health Bronze Plan 002,80863AZ019,,AZN001,AZS002,AZF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190008-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,2,80863,AZ,Individual,No,39-0658730,80863AZ0190008,Assurant Health Bronze Plan 002,80863AZ019,,AZN001,AZS002,AZF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190008-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,10
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,2,80863,AZ,Individual,No,39-0658730,80863AZ0190008,Assurant Health Bronze Plan 002,80863AZ019,,AZN001,AZS002,AZF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190008-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,2,80863,AZ,Individual,No,39-0658730,80863AZ0190009,Assurant Health Bronze Plan 002,80863AZ019,,AZN001,AZS003,AZF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190009-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,2,80863,AZ,Individual,No,39-0658730,80863AZ0190009,Assurant Health Bronze Plan 002,80863AZ019,,AZN001,AZS003,AZF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190009-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,2,80863,AZ,Individual,No,39-0658730,80863AZ0190009,Assurant Health Bronze Plan 002,80863AZ019,,AZN001,AZS003,AZF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,80863AZ0190009-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,14
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190010,Assurant Health Silver Plan 002,80863AZ019,,AZN001,AZS001,AZF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190010-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190010,Assurant Health Silver Plan 002,80863AZ019,,AZN001,AZS001,AZF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190010-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190010,Assurant Health Silver Plan 002,80863AZ019,,AZN001,AZS001,AZF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190010-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190010,Assurant Health Silver Plan 002,80863AZ019,,AZN001,AZS001,AZF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190010-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190010,Assurant Health Silver Plan 002,80863AZ019,,AZN001,AZS001,AZF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190010-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190010,Assurant Health Silver Plan 002,80863AZ019,,AZN001,AZS001,AZF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190010-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190011,Assurant Health Silver Plan 002,80863AZ019,,AZN001,AZS002,AZF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190011-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190012,Assurant Health Silver Plan 002,80863AZ019,,AZN001,AZS003,AZF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190012-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190012,Assurant Health Silver Plan 002,80863AZ019,,AZN001,AZS003,AZF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190012-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190012,Assurant Health Silver Plan 002,80863AZ019,,AZN001,AZS003,AZF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190012-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,20
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190012,Assurant Health Silver Plan 002,80863AZ019,,AZN001,AZS003,AZF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190012-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190012,Assurant Health Silver Plan 002,80863AZ019,,AZN001,AZS003,AZF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190012-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190012,Assurant Health Silver Plan 002,80863AZ019,,AZN001,AZS003,AZF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190012-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190012,Assurant Health Silver Plan 002,80863AZ019,,AZN001,AZS003,AZF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190012-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190013,Assurant Health Gold Plan 002,80863AZ019,,AZN001,AZS001,AZF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190013-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190013,Assurant Health Gold Plan 002,80863AZ019,,AZN001,AZS001,AZF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190013-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190013,Assurant Health Gold Plan 002,80863AZ019,,AZN001,AZS001,AZF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,27
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190013,Assurant Health Gold Plan 002,80863AZ019,,AZN001,AZS001,AZF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190013-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190014,Assurant Health Gold Plan 002,80863AZ019,,AZN001,AZS002,AZF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190014-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190014,Assurant Health Gold Plan 002,80863AZ019,,AZN001,AZS002,AZF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190014-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190014,Assurant Health Gold Plan 002,80863AZ019,,AZN001,AZS002,AZF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,31
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190014,Assurant Health Gold Plan 002,80863AZ019,,AZN001,AZS002,AZF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190014-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190015,Assurant Health Gold Plan 002,80863AZ019,,AZN001,AZS003,AZF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190015-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190015,Assurant Health Gold Plan 002,80863AZ019,,AZN001,AZS003,AZF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190015-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190015,Assurant Health Gold Plan 002,80863AZ019,,AZN001,AZS003,AZF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190015-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,35
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190015,Assurant Health Gold Plan 002,80863AZ019,,AZN001,AZS003,AZF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190015-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190016,Assurant Health Platinum Plan 002,80863AZ019,,AZN001,AZS001,AZF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190016-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190016,Assurant Health Platinum Plan 002,80863AZ019,,AZN001,AZS001,AZF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190016-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190016,Assurant Health Platinum Plan 002,80863AZ019,,AZN001,AZS001,AZF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,39
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190016,Assurant Health Platinum Plan 002,80863AZ019,,AZN001,AZS001,AZF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190016-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190017,Assurant Health Platinum Plan 002,80863AZ019,,AZN001,AZS002,AZF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190017-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,AZ,80863,HIOS,8,2014-11-13 10:25:37,3,80863,AZ,Individual,No,39-0658730,80863AZ0190017,Assurant Health Platinum Plan 002,80863AZ019,,AZN001,AZS002,AZF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_AZ_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-AZ.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,80863AZ0190017-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,42
2015,AZ,88925,HIOS,5,2015-01-23 09:32:01,1,88925,AZ,Individual,No,45-4370907,88925AZ0010058,Bronze Canyon,88925AZ001,,AZN001,AZS001,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist",See Evidence of Coverage,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,"$6,600",0,0,0,2015-01-01,,No,,Yes,"Contracted providers only, except in emergencies.",No,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-BC-SBC-ONEX-OFEX-2015.pdf,http://www.uamarketplace.com/FFMInitialPayment.aspx,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-SOB-BC-STD-ONEX-OFEX-2015.pdf,http://uamarketplace.com/Admin/ContentDocuments/UHM/UAHP_HIXFormulary.pdf,88925AZ0010058-01,Standard Bronze On Exchange Plan,61.60%,0.650946617126465,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,400","$12,800",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,60%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,88925,HIOS,5,2015-01-23 09:32:01,1,88925,AZ,Individual,No,45-4370907,88925AZ0010058,Bronze Canyon,88925AZ001,,AZN001,AZS001,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist",See Evidence of Coverage,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,"$6,600",0,0,0,2015-01-01,,No,,Yes,"Contracted providers only, except in emergencies.",No,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-BC-SBC-ONEX-OFEX-2015.pdf,http://www.uamarketplace.com/FFMInitialPayment.aspx,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-SOB-BC-STD-ONEX-OFEX-2015.pdf,http://uamarketplace.com/Admin/ContentDocuments/UHM/UAHP_HIXFormulary.pdf,88925AZ0010058-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,AZ,88925,HIOS,5,2015-01-23 09:32:01,1,88925,AZ,Individual,No,45-4370907,88925AZ0010058,Bronze Canyon,88925AZ001,,AZN001,AZS001,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist",See Evidence of Coverage,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,"$6,600",0,0,0,2015-01-01,,No,,Yes,"Contracted providers only, except in emergencies.",No,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-BC-SBC-ONEX-OFEX-2015.pdf,http://www.uamarketplace.com/FFMInitialPayment.aspx,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-SOB-BC-STD-ONEX-OFEX-2015.pdf,http://uamarketplace.com/Admin/ContentDocuments/UHM/UAHP_HIXFormulary.pdf,88925AZ0010058-03,Limited Cost Sharing Plan Variation,61.60%,0.650946617126465,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,400","$12,800",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,60%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,88925,HIOS,5,2015-01-23 09:32:01,1,88925,AZ,Individual,No,45-4370907,88925AZ0010060,Gold Canyon,88925AZ001,,AZN001,AZS001,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist",See Evidence of Coverage,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,"$6,600",0,0,0,2015-01-01,,No,,Yes,"Contracted providers only, except in emergencies.",No,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-GC-SBC-ONEX-OFEX-2015.pdf,http://www.uamarketplace.com/FFMInitialPayment.aspx,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-SOB-GC-STD-ONEX-OFEX-2015.pdf,http://uamarketplace.com/Admin/ContentDocuments/UHM/UAHP_HIXFormulary.pdf,88925AZ0010060-00,Standard Gold Off Exchange Plan,81.90%,0.818763673305511,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,"$1,200",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,3,91450,AZ,Individual,No,36-3097810,91450AZ0080011,CommunityCare HMO Bronze  40%/40%/$5000 With Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF010,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_hsa_bronze_40_40_5000_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_hsa_bronze_40_40_5000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080011-03,Limited Cost Sharing Plan Variation,,0.600753664970398,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,3,91450,AZ,Individual,No,36-3097810,91450AZ0080012,CommunityCare HMO Basic 0%/0%/$6350 With Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF011,Existing,HMO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,3,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_basic_0_0_6350_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_basic_0_0_6350_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080012-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,8
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,3,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090011,CommunityCare Embedded HSA Bronze with pediatric dental 40%/40%/$5000,91450AZ009,,AZN001,AZS001,AZF009,Existing,HMO,Bronze,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_bronze_40_40_5000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_bronze_40_40_5000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090011-00,Standard Bronze Off Exchange Plan,60.10%,0.600753664970398,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,3,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090011,CommunityCare Embedded HSA Bronze with pediatric dental 40%/40%/$5000,91450AZ009,,AZN001,AZS001,AZF009,Existing,HMO,Bronze,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_bronze_40_40_5000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_bronze_40_40_5000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090011-01,Standard Bronze On Exchange Plan,60.10%,0.600753664970398,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,3,91450,AZ,Individual,No,36-3097810,91450AZ0080012,CommunityCare HMO Basic 0%/0%/$6350 With Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF011,Existing,HMO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,3,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_basic_0_0_6350_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_basic_0_0_6350_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080012-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,9
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,4,91450,AZ,Individual,No,36-3097810,91450AZ0080028,CommunityCare HMO Platinum $15/$30/$3000 without Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF001,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_platinum_15_30_3000_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_platinum_15_30_3000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080028-00,Standard Platinum Off Exchange Plan,,0.880567669868469,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,4,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090013,CommunityCare HMO Platinum $15/$30/$3000,91450AZ009,,AZN001,AZS001,AZF002,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_15_30_3000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_15_30_3000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090013-00,Standard Platinum Off Exchange Plan,88.50%,0.882889628410339,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,4,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090013,CommunityCare HMO Platinum $15/$30/$3000,91450AZ009,,AZN001,AZS001,AZF002,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_15_30_3000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_15_30_3000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090013-01,Standard Platinum On Exchange Plan,88.50%,0.882889628410339,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,2,84251,AZ,Individual,No,06-6033492,84251AZ0070004,Aetna Banner Health Network Bronze HSA Eligible,84251AZ007,,AZN001,AZS001,AZF013,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070004-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,2,84251,AZ,Individual,No,06-6033492,84251AZ0070004,Aetna Banner Health Network Bronze HSA Eligible,84251AZ007,,AZN001,AZS001,AZF013,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070004-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,2,84251,AZ,Individual,No,06-6033492,84251AZ0070004,Aetna Banner Health Network Bronze HSA Eligible,84251AZ007,,AZN001,AZS001,AZF013,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,2,84251,AZ,Individual,No,06-6033492,84251AZ0070004,Aetna Banner Health Network Bronze HSA Eligible,84251AZ007,,AZN001,AZS001,AZF013,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070004-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,3,84251,AZ,Individual,No,06-6033492,84251AZ0070009,Aetna Banner Health Network Silver $10 Copay,84251AZ007,,AZN001,AZS001,AZF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070009-00,Standard Silver Off Exchange Plan,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,3,84251,AZ,Individual,No,06-6033492,84251AZ0070009,Aetna Banner Health Network Silver $10 Copay,84251AZ007,,AZN001,AZS001,AZF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070009-01,Standard Silver On Exchange Plan,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,3,84251,AZ,Individual,No,06-6033492,84251AZ0070009,Aetna Banner Health Network Silver $10 Copay,84251AZ007,,AZN001,AZS001,AZF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070009-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,3,84251,AZ,Individual,No,06-6033492,84251AZ0070009,Aetna Banner Health Network Silver $10 Copay,84251AZ007,,AZN001,AZS001,AZF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070009-03,Limited Cost Sharing Plan Variation,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,3,84251,AZ,Individual,No,06-6033492,84251AZ0070009,Aetna Banner Health Network Silver $10 Copay,84251AZ007,,AZN001,AZS001,AZF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070009-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,3,84251,AZ,Individual,No,06-6033492,84251AZ0070009,Aetna Banner Health Network Silver $10 Copay,84251AZ007,,AZN001,AZS001,AZF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070009-05,87% AV Level Silver Plan,86.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,4,84251,AZ,Individual,No,06-6033492,84251AZ0070011,Aetna Banner Health Network Silver $5 Copay 2750,84251AZ007,,AZN001,AZS001,AZF015,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070011-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,4,84251,AZ,Individual,No,06-6033492,84251AZ0070011,Aetna Banner Health Network Silver $5 Copay 2750,84251AZ007,,AZN001,AZS001,AZF015,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070011-06,94% AV Level Silver Plan,93.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,5,84251,AZ,Individual,No,06-6033492,84251AZ0070007,Aetna Banner Health Network Gold $5 Copay,84251AZ007,,AZN001,AZS001,AZF001,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070007-00,Standard Gold Off Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,5,84251,AZ,Individual,No,06-6033492,84251AZ0070007,Aetna Banner Health Network Gold $5 Copay,84251AZ007,,AZN001,AZS001,AZF001,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070007-01,Standard Gold On Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,5,84251,AZ,Individual,No,06-6033492,84251AZ0070007,Aetna Banner Health Network Gold $5 Copay,84251AZ007,,AZN001,AZS001,AZF001,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070007-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,5,84251,AZ,Individual,No,06-6033492,84251AZ0070007,Aetna Banner Health Network Gold $5 Copay,84251AZ007,,AZN001,AZS001,AZF001,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070007-03,Limited Cost Sharing Plan Variation,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,6,84251,AZ,Individual,No,06-6033492,84251AZ0070005,Aetna Banner Health Network Catastrophic 100%,84251AZ007,,AZN001,AZS001,AZF012,Existing,POS,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070005-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,84251,HIOS,8,2014-11-11 04:41:18,6,84251,AZ,Individual,No,06-6033492,84251AZ0070005,Aetna Banner Health Network Catastrophic 100%,84251AZ007,,AZN001,AZS001,AZF012,Existing,POS,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998418649177502,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/arizona-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1531355744,84251AZ0070005-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,1,86830,AZ,Individual,No,59-1031071,86830AZ0040001,myCigna Health Savings 6100,86830AZ004,7730182962,AZN001,AZS001,AZF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services covered,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-savings-6100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-savings-6100,http://www.cigna.com/ifp-drug-list,86830AZ0040001-00,Standard Bronze Off Exchange Plan,58.20%,0.5818812251091,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,1,86830,AZ,Individual,Yes,59-1031071,86830AZ0050001,myCigna Dental Pediatric,86830AZ005,7730182962,AZN002,AZS002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$31.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,All Services,Yes,,,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/dental-pediatric,,86830AZ0050001-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$150,$300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,1,86830,AZ,Individual,Yes,59-1031071,86830AZ0050001,myCigna Dental Pediatric,86830AZ005,7730182962,AZN002,AZS002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$31.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,All Services,Yes,,,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/dental-pediatric,,86830AZ0050001-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$150,$300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,1,86830,AZ,Individual,No,59-1031071,86830AZ0040001,myCigna Health Savings 6100,86830AZ004,7730182962,AZN001,AZS001,AZF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services covered,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-savings-6100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-savings-6100,http://www.cigna.com/ifp-drug-list,86830AZ0040001-01,Standard Bronze On Exchange Plan,58.20%,0.5818812251091,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,1,86830,AZ,Individual,No,59-1031071,86830AZ0040001,myCigna Health Savings 6100,86830AZ004,7730182962,AZN001,AZS001,AZF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services covered,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-savings-6100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-savings-6100,http://www.cigna.com/ifp-drug-list,86830AZ0040001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,1,86830,AZ,Individual,No,59-1031071,86830AZ0040001,myCigna Health Savings 6100,86830AZ004,7730182962,AZN001,AZS001,AZF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services covered,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-savings-6100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-savings-6100,http://www.cigna.com/ifp-drug-list,86830AZ0040001-03,Limited Cost Sharing Plan Variation,58.20%,0.5818812251091,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,1,86830,AZ,Individual,No,59-1031071,86830AZ0040004,myCigna Health Savings 3400,86830AZ004,7730182962,AZN001,AZS001,AZF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services covered,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-savings-3400,http://www.cigna.com/ifp-drug-list,86830AZ0040004-00,Standard Silver Off Exchange Plan,68.40%,0.684268593788147,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,1,86830,AZ,Individual,No,59-1031071,86830AZ0040004,myCigna Health Savings 3400,86830AZ004,7730182962,AZN001,AZS001,AZF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services covered,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-savings-3400,http://www.cigna.com/ifp-drug-list,86830AZ0040004-01,Standard Silver On Exchange Plan,68.40%,0.684268593788147,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,3,86830,AZ,Individual,No,59-1031071,86830AZ0040005,myCigna Health Flex 1500,86830AZ004,7730182962,AZN001,AZS001,AZF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,2,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-1500,http://www.cigna.com/ifp-drug-list,86830AZ0040005-04,73% AV Level Silver Plan,72.50%,0.739069283008575,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,3,86830,AZ,Individual,No,59-1031071,86830AZ0040005,myCigna Health Flex 1500,86830AZ004,7730182962,AZN001,AZS001,AZF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,2,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-1500,http://www.cigna.com/ifp-drug-list,86830AZ0040005-05,87% AV Level Silver Plan,86.30%,0.867470383644104,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$725,"$1,450",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,3,86830,AZ,Individual,No,59-1031071,86830AZ0040005,myCigna Health Flex 1500,86830AZ004,7730182962,AZN001,AZS001,AZF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,2,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-1500,http://www.cigna.com/ifp-drug-list,86830AZ0040005-06,94% AV Level Silver Plan,93.40%,0.936385273933411,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$575,"$1,150",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,4,86830,AZ,Individual,No,59-1031071,86830AZ0040003,myCigna Health Flex 5100,86830AZ004,7730182962,AZN001,AZS001,AZF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-5100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-5100,http://www.cigna.com/ifp-drug-list,86830AZ0040003-00,Standard Bronze Off Exchange Plan,62.00%,0.635634362697601,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,100","$10,200",40%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,4,86830,AZ,Individual,No,59-1031071,86830AZ0040003,myCigna Health Flex 5100,86830AZ004,7730182962,AZN001,AZS001,AZF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-5100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-5100,http://www.cigna.com/ifp-drug-list,86830AZ0040003-01,Standard Bronze On Exchange Plan,62.00%,0.635634362697601,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,100","$10,200",40%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,4,86830,AZ,Individual,No,59-1031071,86830AZ0040003,myCigna Health Flex 5100,86830AZ004,7730182962,AZN001,AZS001,AZF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-5100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-5100,http://www.cigna.com/ifp-drug-list,86830AZ0040003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,4,86830,AZ,Individual,No,59-1031071,86830AZ0040003,myCigna Health Flex 5100,86830AZ004,7730182962,AZN001,AZS001,AZF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-5100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-5100,http://www.cigna.com/ifp-drug-list,86830AZ0040003-03,Limited Cost Sharing Plan Variation,62.00%,0.635634362697601,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,100","$10,200",40%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,5,86830,AZ,Individual,No,59-1031071,86830AZ0040006,myCigna Health Flex 2750,86830AZ004,7730182962,AZN001,AZS001,AZF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-2750,http://www.cigna.com/ifp-drug-list,86830AZ0040006-00,Standard Silver Off Exchange Plan,68.60%,0.693857848644257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,5,86830,AZ,Individual,No,59-1031071,86830AZ0040006,myCigna Health Flex 2750,86830AZ004,7730182962,AZN001,AZS001,AZF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-2750,http://www.cigna.com/ifp-drug-list,86830AZ0040006-01,Standard Silver On Exchange Plan,68.60%,0.693857848644257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,5,86830,AZ,Individual,No,59-1031071,86830AZ0040006,myCigna Health Flex 2750,86830AZ004,7730182962,AZN001,AZS001,AZF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-2750,http://www.cigna.com/ifp-drug-list,86830AZ0040006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,5,86830,AZ,Individual,No,59-1031071,86830AZ0040006,myCigna Health Flex 2750,86830AZ004,7730182962,AZN001,AZS001,AZF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-2750,http://www.cigna.com/ifp-drug-list,86830AZ0040006-03,Limited Cost Sharing Plan Variation,68.60%,0.693857848644257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,5,86830,AZ,Individual,No,59-1031071,86830AZ0040006,myCigna Health Flex 2750,86830AZ004,7730182962,AZN001,AZS001,AZF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-2750,http://www.cigna.com/ifp-drug-list,86830AZ0040006-04,73% AV Level Silver Plan,72.40%,0.731655895709991,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,5,86830,AZ,Individual,No,59-1031071,86830AZ0040006,myCigna Health Flex 2750,86830AZ004,7730182962,AZN001,AZS001,AZF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-2750,http://www.cigna.com/ifp-drug-list,86830AZ0040006-05,87% AV Level Silver Plan,86.00%,0.867251932621002,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,5,86830,AZ,Individual,No,59-1031071,86830AZ0040006,myCigna Health Flex 2750,86830AZ004,7730182962,AZN001,AZS001,AZF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-2750,http://www.cigna.com/ifp-drug-list,86830AZ0040006-06,94% AV Level Silver Plan,93.10%,0.932631492614746,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$575,"$1,150",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,5,86830,AZ,Individual,No,59-1031071,86830AZ0040007,myCigna Health Flex 3500,86830AZ004,7730182962,AZN001,AZS001,AZF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-3500,,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-3500,http://www.cigna.com/ifp-drug-list,86830AZ0040007-00,Standard Silver Off Exchange Plan,70.40%,0.715655326843262,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,5,86830,AZ,Individual,No,59-1031071,86830AZ0040007,myCigna Health Flex 3500,86830AZ004,7730182962,AZN001,AZS001,AZF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-3500,,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-3500,http://www.cigna.com/ifp-drug-list,86830AZ0040007-01,Standard Silver On Exchange Plan,70.40%,0.715655326843262,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,5,86830,AZ,Individual,No,59-1031071,86830AZ0040007,myCigna Health Flex 3500,86830AZ004,7730182962,AZN001,AZS001,AZF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-3500,,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-3500,http://www.cigna.com/ifp-drug-list,86830AZ0040007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,5,86830,AZ,Individual,No,59-1031071,86830AZ0040007,myCigna Health Flex 3500,86830AZ004,7730182962,AZN001,AZS001,AZF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-3500,,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-3500,http://www.cigna.com/ifp-drug-list,86830AZ0040007-03,Limited Cost Sharing Plan Variation,70.40%,0.715655326843262,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,5,86830,AZ,Individual,No,59-1031071,86830AZ0040007,myCigna Health Flex 3500,86830AZ004,7730182962,AZN001,AZS001,AZF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-3500,,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-3500,http://www.cigna.com/ifp-drug-list,86830AZ0040007-04,73% AV Level Silver Plan,72.70%,0.737606406211853,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,900","$5,800",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,5,86830,AZ,Individual,No,59-1031071,86830AZ0040007,myCigna Health Flex 3500,86830AZ004,7730182962,AZN001,AZS001,AZF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-3500,,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-3500,http://www.cigna.com/ifp-drug-list,86830AZ0040007-05,87% AV Level Silver Plan,86.50%,0.872981011867523,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,5,86830,AZ,Individual,No,59-1031071,86830AZ0040007,myCigna Health Flex 3500,86830AZ004,7730182962,AZN001,AZS001,AZF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-3500,,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-3500,http://www.cigna.com/ifp-drug-list,86830AZ0040007-06,94% AV Level Silver Plan,93.40%,0.935106635093689,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$620,"$1,240",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,5,86830,AZ,Individual,No,59-1031071,86830AZ0040009,myCigna Health Flex 1250,86830AZ004,7730182962,AZN001,AZS001,AZF008,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-1250,,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-1250,http://www.cigna.com/ifp-drug-list,86830AZ0040009-00,Standard Gold Off Exchange Plan,78.10%,0.784373342990875,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,5,86830,AZ,Individual,No,59-1031071,86830AZ0040009,myCigna Health Flex 1250,86830AZ004,7730182962,AZN001,AZS001,AZF008,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-1250,,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-1250,http://www.cigna.com/ifp-drug-list,86830AZ0040009-01,Standard Gold On Exchange Plan,78.10%,0.784373342990875,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,5,86830,AZ,Individual,No,59-1031071,86830AZ0040009,myCigna Health Flex 1250,86830AZ004,7730182962,AZN001,AZS001,AZF008,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-1250,,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-1250,http://www.cigna.com/ifp-drug-list,86830AZ0040009-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,AZ,86830,HIOS,9,2014-09-06 03:39:47,5,86830,AZ,Individual,No,59-1031071,86830AZ0040009,myCigna Health Flex 1250,86830AZ004,7730182962,AZN001,AZS001,AZF008,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/arizona/health-flex-1250,,http://www.cigna.com/individuals-families/2015-plans/sob/arizona/health-flex-1250,http://www.cigna.com/ifp-drug-list,86830AZ0040009-03,Limited Cost Sharing Plan Variation,78.10%,0.784373342990875,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,AZ,88925,HIOS,5,2015-01-23 09:32:01,1,88925,AZ,Individual,No,45-4370907,88925AZ0010058,Bronze Canyon,88925AZ001,,AZN001,AZS001,AZF001,New,HMO,Bronze,Yes,Both,Yes,Yes,"Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist",See Evidence of Coverage,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,"$6,600",0,0,0,2015-01-01,,No,,Yes,"Contracted providers only, except in emergencies.",No,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-BC-SBC-ONEX-OFEX-2015.pdf,http://www.uamarketplace.com/FFMInitialPayment.aspx,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-SOB-BC-STD-ONEX-OFEX-2015.pdf,http://uamarketplace.com/Admin/ContentDocuments/UHM/UAHP_HIXFormulary.pdf,88925AZ0010058-00,Standard Bronze Off Exchange Plan,61.60%,0.650946617126465,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,400","$12,800",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,60%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,4,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090014,CommunityCare HMO Platinum $20/$40/$2000,91450AZ009,,AZN001,AZS001,AZF005,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_20_40_2000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_20_40_2000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090014-00,Standard Platinum Off Exchange Plan,88.40%,0.884117007255554,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,4,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090014,CommunityCare HMO Platinum $20/$40/$2000,91450AZ009,,AZN001,AZS001,AZF005,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_20_40_2000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_20_40_2000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090014-01,Standard Platinum On Exchange Plan,88.40%,0.884117007255554,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,4,91450,AZ,Individual,No,36-3097810,91450AZ0080028,CommunityCare HMO Platinum $15/$30/$3000 without Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF001,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_platinum_15_30_3000_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_platinum_15_30_3000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080028-03,Limited Cost Sharing Plan Variation,,0.880567669868469,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,4,91450,AZ,Individual,No,36-3097810,91450AZ0080029,CommunityCare HMO Gold $30/$60/$6000/$375 without Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF005,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_gold_30_60_6000_375_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_gold_30_60_6000_375_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080029-00,Standard Gold Off Exchange Plan,,0.78236848115921,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$450,$900,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,4,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090015,CommunityCare HMO Platinum $20/$40/$4000,91450AZ009,,AZN001,AZS001,AZF004,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,5,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_20_40_4000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_20_40_4000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090015-00,Standard Platinum Off Exchange Plan,89.10%,0.891058743000031,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,4,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090015,CommunityCare HMO Platinum $20/$40/$4000,91450AZ009,,AZN001,AZS001,AZF004,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,5,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_20_40_4000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_20_40_4000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090015-01,Standard Platinum On Exchange Plan,89.10%,0.891058743000031,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,4,91450,AZ,Individual,No,36-3097810,91450AZ0080029,CommunityCare HMO Gold $30/$60/$6000/$375 without Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF005,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_gold_30_60_6000_375_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_gold_30_60_6000_375_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080029-01,Standard Gold On Exchange Plan,,0.78236848115921,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$450,$900,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,4,91450,AZ,Individual,No,36-3097810,91450AZ0080029,CommunityCare HMO Gold $30/$60/$6000/$375 without Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF005,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_gold_30_60_6000_375_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_gold_30_60_6000_375_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080029-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,4,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090016,CommunityCare HMO Gold $30/$60/$6000/$500,91450AZ009,,AZN001,AZS001,AZF013,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,5,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_30_60_6000_500_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_30_60_6000_500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090016-00,Standard Gold Off Exchange Plan,78.20%,0.782358825206757,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,4,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090016,CommunityCare HMO Gold $30/$60/$6000/$500,91450AZ009,,AZN001,AZS001,AZF013,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,5,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_30_60_6000_500_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_30_60_6000_500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090016-01,Standard Gold On Exchange Plan,78.20%,0.782358825206757,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,4,91450,AZ,Individual,No,36-3097810,91450AZ0080029,CommunityCare HMO Gold $30/$60/$6000/$375 without Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF005,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_gold_30_60_6000_375_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_gold_30_60_6000_375_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080029-03,Limited Cost Sharing Plan Variation,,0.78236848115921,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$450,$900,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,4,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090017,CommunityCare HMO Gold $30/$60/$6000/$750,91450AZ009,,AZN001,AZS001,AZF012,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_30_60_6000_750_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_30_60_6000_750_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090017-00,Standard Gold Off Exchange Plan,79.60%,0.795998811721802,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,AZ,88925,HIOS,5,2015-01-23 09:32:01,1,88925,AZ,Individual,No,45-4370907,88925AZ0010060,Gold Canyon,88925AZ001,,AZN001,AZS001,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist",See Evidence of Coverage,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,"$6,600",0,0,0,2015-01-01,,No,,Yes,"Contracted providers only, except in emergencies.",No,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-GC-SBC-ONEX-OFEX-2015.pdf,http://www.uamarketplace.com/FFMInitialPayment.aspx,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-SOB-GC-STD-ONEX-OFEX-2015.pdf,http://uamarketplace.com/Admin/ContentDocuments/UHM/UAHP_HIXFormulary.pdf,88925AZ0010060-01,Standard Gold On Exchange Plan,81.90%,0.818763673305511,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,"$1,200",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,88925,HIOS,5,2015-01-23 09:32:01,1,88925,AZ,Individual,No,45-4370907,88925AZ0010060,Gold Canyon,88925AZ001,,AZN001,AZS001,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist",See Evidence of Coverage,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,"$6,600",0,0,0,2015-01-01,,No,,Yes,"Contracted providers only, except in emergencies.",No,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-GC-SBC-ONEX-OFEX-2015.pdf,http://www.uamarketplace.com/FFMInitialPayment.aspx,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-SOB-GC-STD-ONEX-OFEX-2015.pdf,http://uamarketplace.com/Admin/ContentDocuments/UHM/UAHP_HIXFormulary.pdf,88925AZ0010060-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,4,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090017,CommunityCare HMO Gold $30/$60/$6000/$750,91450AZ009,,AZN001,AZS001,AZF012,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_30_60_6000_750_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_30_60_6000_750_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090017-01,Standard Gold On Exchange Plan,79.60%,0.795998811721802,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,4,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090018,CommunityCare HMO Gold $25/$50/$5000/$600,91450AZ009,,AZN001,AZS001,AZF012,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,5,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_25_50_5000_600_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_25_50_5000_600_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090018-00,Standard Gold Off Exchange Plan,80.90%,0.808559119701386,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,AZ,88925,HIOS,5,2015-01-23 09:32:01,1,88925,AZ,Individual,No,45-4370907,88925AZ0010060,Gold Canyon,88925AZ001,,AZN001,AZS001,AZF003,New,HMO,Gold,Yes,Both,Yes,Yes,"Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist",See Evidence of Coverage,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,"$6,600",0,0,0,2015-01-01,,No,,Yes,"Contracted providers only, except in emergencies.",No,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-GC-SBC-ONEX-OFEX-2015.pdf,http://www.uamarketplace.com/FFMInitialPayment.aspx,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-SOB-GC-STD-ONEX-OFEX-2015.pdf,http://uamarketplace.com/Admin/ContentDocuments/UHM/UAHP_HIXFormulary.pdf,88925AZ0010060-03,Limited Cost Sharing Plan Variation,81.90%,0.818763673305511,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,"$1,200",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AZ,88925,HIOS,5,2015-01-23 09:32:01,1,88925,AZ,Individual,No,45-4370907,88925AZ0010059,Silver Canyon,88925AZ001,,AZN001,AZS001,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist",See Evidence of Coverage,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,"$6,600",0,0,0,2015-01-01,,No,,Yes,"Contracted providers only, except in emergencies.",No,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-SC-SBC-ONEX-OFEX-2015.pdf,http://www.uamarketplace.com/FFMInitialPayment.aspx,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-SOB-SC-STD-ONEX-OFEX-2015.pdf,http://uamarketplace.com/Admin/ContentDocuments/UHM/UAHP_HIXFormulary.pdf,88925AZ0010059-00,Standard Silver Off Exchange Plan,72.00%,0.719961166381836,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300","$4,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,AZ,88925,HIOS,5,2015-01-23 09:32:01,1,88925,AZ,Individual,No,45-4370907,88925AZ0010059,Silver Canyon,88925AZ001,,AZN001,AZS001,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist",See Evidence of Coverage,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,"$6,600",0,0,0,2015-01-01,,No,,Yes,"Contracted providers only, except in emergencies.",No,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-SC-SBC-ONEX-OFEX-2015.pdf,http://www.uamarketplace.com/FFMInitialPayment.aspx,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-SOB-SC-STD-ONEX-OFEX-2015.pdf,http://uamarketplace.com/Admin/ContentDocuments/UHM/UAHP_HIXFormulary.pdf,88925AZ0010059-01,Standard Silver On Exchange Plan,72.00%,0.719961166381836,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300","$4,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,AZ,88925,HIOS,5,2015-01-23 09:32:01,1,88925,AZ,Individual,No,45-4370907,88925AZ0010059,Silver Canyon,88925AZ001,,AZN001,AZS001,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist",See Evidence of Coverage,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,"$6,600",0,0,0,2015-01-01,,No,,Yes,"Contracted providers only, except in emergencies.",No,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-SC-SBC-ONEX-OFEX-2015.pdf,http://www.uamarketplace.com/FFMInitialPayment.aspx,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-SOB-SC-STD-ONEX-OFEX-2015.pdf,http://uamarketplace.com/Admin/ContentDocuments/UHM/UAHP_HIXFormulary.pdf,88925AZ0010059-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,AZ,88925,HIOS,5,2015-01-23 09:32:01,1,88925,AZ,Individual,No,45-4370907,88925AZ0010059,Silver Canyon,88925AZ001,,AZN001,AZS001,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist",See Evidence of Coverage,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,"$6,600",0,0,0,2015-01-01,,No,,Yes,"Contracted providers only, except in emergencies.",No,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-SC-SBC-ONEX-OFEX-2015.pdf,http://www.uamarketplace.com/FFMInitialPayment.aspx,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-SOB-SC-STD-ONEX-OFEX-2015.pdf,http://uamarketplace.com/Admin/ContentDocuments/UHM/UAHP_HIXFormulary.pdf,88925AZ0010059-03,Limited Cost Sharing Plan Variation,72.00%,0.719961166381836,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300","$4,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,AZ,88925,HIOS,5,2015-01-23 09:32:01,1,88925,AZ,Individual,No,45-4370907,88925AZ0010059,Silver Canyon,88925AZ001,,AZN001,AZS001,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist",See Evidence of Coverage,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,"$6,600",0,0,0,2015-01-01,,No,,Yes,"Contracted providers only, except in emergencies.",No,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-SC-SBC-ONEX-OFEX-2015.pdf,http://www.uamarketplace.com/FFMInitialPayment.aspx,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-SOB-SC-STD-ONEX-OFEX-2015.pdf,http://uamarketplace.com/Admin/ContentDocuments/UHM/UAHP_HIXFormulary.pdf,88925AZ0010059-04,73% AV Level Silver Plan,74.00%,0.739974319934845,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,200","$4,400",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,AZ,88925,HIOS,5,2015-01-23 09:32:01,1,88925,AZ,Individual,No,45-4370907,88925AZ0010059,Silver Canyon,88925AZ001,,AZN001,AZS001,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist",See Evidence of Coverage,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,"$6,600",0,0,0,2015-01-01,,No,,Yes,"Contracted providers only, except in emergencies.",No,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-SC-SBC-ONEX-OFEX-2015.pdf,http://www.uamarketplace.com/FFMInitialPayment.aspx,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-SOB-SC-STD-ONEX-OFEX-2015.pdf,http://uamarketplace.com/Admin/ContentDocuments/UHM/UAHP_HIXFormulary.pdf,88925AZ0010059-05,87% AV Level Silver Plan,87.60%,0.875743567943573,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,"$1,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,AZ,88925,HIOS,5,2015-01-23 09:32:01,1,88925,AZ,Individual,No,45-4370907,88925AZ0010059,Silver Canyon,88925AZ001,,AZN001,AZS001,AZF002,New,HMO,Silver,Yes,Both,Yes,Yes,"Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist",See Evidence of Coverage,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,"$6,600",0,0,0,2015-01-01,,No,,Yes,"Contracted providers only, except in emergencies.",No,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-SC-SBC-ONEX-OFEX-2015.pdf,http://www.uamarketplace.com/FFMInitialPayment.aspx,http://www.uamarketplace.com/Admin/ContentDocuments/UHM-1000-SOB-SC-STD-ONEX-OFEX-2015.pdf,http://uamarketplace.com/Admin/ContentDocuments/UHM/UAHP_HIXFormulary.pdf,88925AZ0010059-06,94% AV Level Silver Plan,94.60%,0.948301911354065,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,AZ,90264,HIOS,2,2014-08-07 10:00:19,1,90264,AZ,SHOP (Small Group),Yes,47-0098400,90264AZ0040002,EHB High PPO,90264AZ004,,AZN001,AZS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$41.49,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,90264AZ0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,90264,HIOS,2,2014-08-07 10:00:19,1,90264,AZ,SHOP (Small Group),Yes,47-0098400,90264AZ0040001,EHB Low PPO,90264AZ004,,AZN001,AZS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,90264AZ0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AZ,90264,HIOS,2,2014-08-07 10:00:19,1,90264,AZ,SHOP (Small Group),Yes,47-0098400,90264AZ0030002,EHB High Passive,90264AZ003,,AZN001,AZS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.21,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,90264AZ0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AZ,90264,HIOS,2,2014-08-07 10:00:19,1,90264,AZ,SHOP (Small Group),Yes,47-0098400,90264AZ0030001,EHB Low Passive,90264AZ003,,AZN001,AZS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.52,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,90264AZ0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,1,91450,AZ,Individual,No,36-3097810,91450AZ0080025,CommunityCare HMO Platinum $15/$30/$3000 with Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF001,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_platinum_15_30_3000_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_platinum_15_30_3000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080025-00,Standard Platinum Off Exchange Plan,,0.880567669868469,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,1,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090001,CommunityCare HMO Platinum with pediatric dental $15/$30/$3000,91450AZ009,,AZN001,AZS001,AZF002,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_15_30_3000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_15_30_3000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090001-00,Standard Platinum Off Exchange Plan,88.50%,0.882889628410339,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,1,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090001,CommunityCare HMO Platinum with pediatric dental $15/$30/$3000,91450AZ009,,AZN001,AZS001,AZF002,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_15_30_3000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_15_30_3000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090001-01,Standard Platinum On Exchange Plan,88.50%,0.882889628410339,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,1,91450,AZ,Individual,No,36-3097810,91450AZ0080025,CommunityCare HMO Platinum $15/$30/$3000 with Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF001,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_platinum_15_30_3000_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_platinum_15_30_3000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080025-01,Standard Platinum On Exchange Plan,,0.880567669868469,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,1,91450,AZ,Individual,No,36-3097810,91450AZ0080025,CommunityCare HMO Platinum $15/$30/$3000 with Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF001,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_platinum_15_30_3000_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_platinum_15_30_3000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080025-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,1,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090002,CommunityCare HMO Platinum with pediatric dental $20/$40/$2000,91450AZ009,,AZN001,AZS001,AZF005,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_20_40_2000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_20_40_2000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090002-00,Standard Platinum Off Exchange Plan,88.40%,0.884117007255554,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,1,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090002,CommunityCare HMO Platinum with pediatric dental $20/$40/$2000,91450AZ009,,AZN001,AZS001,AZF005,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_20_40_2000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_20_40_2000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090002-01,Standard Platinum On Exchange Plan,88.40%,0.884117007255554,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,1,91450,AZ,Individual,No,36-3097810,91450AZ0080025,CommunityCare HMO Platinum $15/$30/$3000 with Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF001,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_platinum_15_30_3000_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_platinum_15_30_3000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080025-03,Limited Cost Sharing Plan Variation,,0.880567669868469,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,1,91450,AZ,Individual,No,36-3097810,91450AZ0080026,CommunityCare HMO Gold $30/$60/$6000/$375 with Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF005,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_gold_30_60_6000_375_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_gold_30_60_6000_375_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080026-00,Standard Gold Off Exchange Plan,,0.78236848115921,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$450,$900,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,1,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090003,CommunityCare HMO Platinum with pediatric dental $20/$40/$4000,91450AZ009,,AZN001,AZS001,AZF004,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,5,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_20_40_4000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_20_40_4000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090003-00,Standard Platinum Off Exchange Plan,89.10%,0.891058743000031,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,1,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090003,CommunityCare HMO Platinum with pediatric dental $20/$40/$4000,91450AZ009,,AZN001,AZS001,AZF004,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,5,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_20_40_4000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_platinum_20_40_4000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090003-01,Standard Platinum On Exchange Plan,89.10%,0.891058743000031,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,1,91450,AZ,Individual,No,36-3097810,91450AZ0080026,CommunityCare HMO Gold $30/$60/$6000/$375 with Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF005,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_gold_30_60_6000_375_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_gold_30_60_6000_375_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080026-01,Standard Gold On Exchange Plan,,0.78236848115921,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$450,$900,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,1,91450,AZ,Individual,No,36-3097810,91450AZ0080026,CommunityCare HMO Gold $30/$60/$6000/$375 with Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF005,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_gold_30_60_6000_375_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_gold_30_60_6000_375_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080026-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,1,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090004,CommunityCare HMO Gold with pediatric dental $30/$60/$6000/$500,91450AZ009,,AZN001,AZS001,AZF013,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,5,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_30_60_6000_500_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_30_60_6000_500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090004-00,Standard Gold Off Exchange Plan,78.20%,0.782358825206757,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,1,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090004,CommunityCare HMO Gold with pediatric dental $30/$60/$6000/$500,91450AZ009,,AZN001,AZS001,AZF013,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,5,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_30_60_6000_500_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_30_60_6000_500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090004-01,Standard Gold On Exchange Plan,78.20%,0.782358825206757,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,1,91450,AZ,Individual,No,36-3097810,91450AZ0080026,CommunityCare HMO Gold $30/$60/$6000/$375 with Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF005,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_gold_30_60_6000_375_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_gold_30_60_6000_375_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080026-03,Limited Cost Sharing Plan Variation,,0.78236848115921,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$450,$900,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,1,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090005,CommunityCare HMO Gold with pediatric dental $30/$60/$6000/$750,91450AZ009,,AZN001,AZS001,AZF012,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_30_60_6000_750_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_30_60_6000_750_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090005-00,Standard Gold Off Exchange Plan,79.60%,0.795998811721802,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,1,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090005,CommunityCare HMO Gold with pediatric dental $30/$60/$6000/$750,91450AZ009,,AZN001,AZS001,AZF012,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,3,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_30_60_6000_750_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_30_60_6000_750_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090005-01,Standard Gold On Exchange Plan,79.60%,0.795998811721802,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,1,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090006,CommunityCare HMO Gold with pediatric dental $25/$50/$5000/$600,91450AZ009,,AZN001,AZS001,AZF012,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,5,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_25_50_5000_600_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_25_50_5000_600_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090006-00,Standard Gold Off Exchange Plan,80.90%,0.808559119701386,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,1,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090006,CommunityCare HMO Gold with pediatric dental $25/$50/$5000/$600,91450AZ009,,AZN001,AZS001,AZF012,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,5,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_25_50_5000_600_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_25_50_5000_600_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090006-01,Standard Gold On Exchange Plan,80.90%,0.808559119701386,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,2,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090007,CommunityCare HMO Silver with pediatric dental $45/$65/$1500,91450AZ009,,AZN001,AZS001,AZF010,Existing,HMO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_silver_45_65_1500_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_silver_45_65_1500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090007-00,Standard Silver Off Exchange Plan,69.70%,0.697469711303711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,2,91450,AZ,Individual,No,36-3097810,91450AZ0080027,CommunityCare HMO Silver $30/$50/$4500 with Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080027-00,Standard Silver Off Exchange Plan,,0.685573160648346,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,2,91450,AZ,Individual,No,36-3097810,91450AZ0080027,CommunityCare HMO Silver $30/$50/$4500 with Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080027-01,Standard Silver On Exchange Plan,,0.685573160648346,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,2,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090007,CommunityCare HMO Silver with pediatric dental $45/$65/$1500,91450AZ009,,AZN001,AZS001,AZF010,Existing,HMO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_silver_45_65_1500_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_silver_45_65_1500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090007-01,Standard Silver On Exchange Plan,69.70%,0.697469711303711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,2,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090008,CommunityCare HMO Silver with pediatric dental $30/$50/$2000,91450AZ009,,AZN001,AZS001,AZF010,Existing,HMO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_silver_30_50_2000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_silver_30_50_2000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090008-00,Standard Silver Off Exchange Plan,70.40%,0.704474925994873,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,2,91450,AZ,Individual,No,36-3097810,91450AZ0080027,CommunityCare HMO Silver $30/$50/$4500 with Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080027-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,2,91450,AZ,Individual,No,36-3097810,91450AZ0080027,CommunityCare HMO Silver $30/$50/$4500 with Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080027-03,Limited Cost Sharing Plan Variation,,0.685573160648346,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,2,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090008,CommunityCare HMO Silver with pediatric dental $30/$50/$2000,91450AZ009,,AZN001,AZS001,AZF010,Existing,HMO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_silver_30_50_2000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_silver_30_50_2000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090008-01,Standard Silver On Exchange Plan,70.40%,0.704474925994873,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,2,91450,AZ,Individual,No,36-3097810,91450AZ0080027,CommunityCare HMO Silver $30/$50/$4500 with Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080027-04,73% AV Level Silver Plan,,0.737020075321198,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,2,91450,AZ,Individual,No,36-3097810,91450AZ0080027,CommunityCare HMO Silver $30/$50/$4500 with Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080027-05,87% AV Level Silver Plan,,0.87472015619278,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$50,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,2,91450,AZ,Individual,No,36-3097810,91450AZ0080027,CommunityCare HMO Silver $30/$50/$4500 with Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080027-06,94% AV Level Silver Plan,,0.947494506835938,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,3,91450,AZ,Individual,No,36-3097810,91450AZ0080011,CommunityCare HMO Bronze  40%/40%/$5000 With Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF010,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_hsa_bronze_40_40_5000_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_hsa_bronze_40_40_5000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080011-00,Standard Bronze Off Exchange Plan,,0.600753664970398,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,3,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090009,CommunityCare Aggregate HSA Silver with pediatric dental 20%/20%/$2000,91450AZ009,,AZN001,AZS001,AZF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_silver_20_20_2000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_silver_20_20_2000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090009-00,Standard Silver Off Exchange Plan,68.70%,0.687518894672394,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,3,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090009,CommunityCare Aggregate HSA Silver with pediatric dental 20%/20%/$2000,91450AZ009,,AZN001,AZS001,AZF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_silver_20_20_2000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_silver_20_20_2000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090009-01,Standard Silver On Exchange Plan,68.70%,0.687518894672394,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,3,91450,AZ,Individual,No,36-3097810,91450AZ0080011,CommunityCare HMO Bronze  40%/40%/$5000 With Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF010,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_hsa_bronze_40_40_5000_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_hsa_bronze_40_40_5000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080011-01,Standard Bronze On Exchange Plan,,0.600753664970398,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,3,91450,AZ,Individual,No,36-3097810,91450AZ0080011,CommunityCare HMO Bronze  40%/40%/$5000 With Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF010,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_hsa_bronze_40_40_5000_ped_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_hsa_bronze_40_40_5000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,3,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090010,CommunityCare Embedded HSA Bronze with pediatric dental 40%/40%/$3500,91450AZ009,,AZN001,AZS001,AZF009,Existing,HMO,Bronze,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_bronze_40_40_3500_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_bronze_40_40_3500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090010-00,Standard Bronze Off Exchange Plan,61.80%,0.618339717388153,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,3,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090010,CommunityCare Embedded HSA Bronze with pediatric dental 40%/40%/$3500,91450AZ009,,AZN001,AZS001,AZF009,Existing,HMO,Bronze,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_bronze_40_40_3500_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_bronze_40_40_3500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090010-01,Standard Bronze On Exchange Plan,61.80%,0.618339717388153,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,4,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090018,CommunityCare HMO Gold $25/$50/$5000/$600,91450AZ009,,AZN001,AZS001,AZF012,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,5,0,0,2015-01-01,,No,,Yes,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_25_50_5000_600_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_gold_25_50_5000_600_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090018-01,Standard Gold On Exchange Plan,80.90%,0.808559119701386,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,5,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090019,CommunityCare HMO Silver $45/$65/$1500,91450AZ009,,AZN001,AZS001,AZF010,Existing,HMO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_silver_45_65_1500_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_silver_45_65_1500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090019-00,Standard Silver Off Exchange Plan,69.70%,0.697469711303711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,5,91450,AZ,Individual,No,36-3097810,91450AZ0080030,CommunityCare HMO Silver $30/$50/$4500 without Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080030-00,Standard Silver Off Exchange Plan,,0.685573160648346,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,5,91450,AZ,Individual,No,36-3097810,91450AZ0080030,CommunityCare HMO Silver $30/$50/$4500 without Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080030-01,Standard Silver On Exchange Plan,,0.685573160648346,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,5,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090019,CommunityCare HMO Silver $45/$65/$1500,91450AZ009,,AZN001,AZS001,AZF010,Existing,HMO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_silver_45_65_1500_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_silver_45_65_1500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090019-01,Standard Silver On Exchange Plan,69.70%,0.697469711303711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,5,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090020,CommunityCare HMO Silver $30/$50/$2000,91450AZ009,,AZN001,AZS001,AZF010,Existing,HMO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_silver_30_50_2000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_silver_30_50_2000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090020-00,Standard Silver Off Exchange Plan,70.40%,0.704474925994873,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,5,91450,AZ,Individual,No,36-3097810,91450AZ0080030,CommunityCare HMO Silver $30/$50/$4500 without Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080030-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,5,91450,AZ,Individual,No,36-3097810,91450AZ0080030,CommunityCare HMO Silver $30/$50/$4500 without Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080030-03,Limited Cost Sharing Plan Variation,,0.685573160648346,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,5,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090020,CommunityCare HMO Silver $30/$50/$2000,91450AZ009,,AZN001,AZS001,AZF010,Existing,HMO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_silver_30_50_2000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_silver_30_50_2000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090020-01,Standard Silver On Exchange Plan,70.40%,0.704474925994873,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,5,91450,AZ,Individual,No,36-3097810,91450AZ0080030,CommunityCare HMO Silver $30/$50/$4500 without Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080030-04,73% AV Level Silver Plan,,0.737020075321198,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,5,91450,AZ,Individual,No,36-3097810,91450AZ0080030,CommunityCare HMO Silver $30/$50/$4500 without Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080030-05,87% AV Level Silver Plan,,0.87472015619278,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$50,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,5,91450,AZ,Individual,No,36-3097810,91450AZ0080030,CommunityCare HMO Silver $30/$50/$4500 without Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_silver_30_50_4500_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080030-06,94% AV Level Silver Plan,,0.947494506835938,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,6,91450,AZ,Individual,No,36-3097810,91450AZ0080023,CommunityCare HMO Bronze  40%/40%/$5000 Without Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF010,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_hsa_bronze_40_40_5000_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_hsa_bronze_40_40_5000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080023-00,Standard Bronze Off Exchange Plan,,0.600753664970398,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,6,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090021,CommunityCare Aggregate HSA Silver 20%/20%/$2000,91450AZ009,,AZN001,AZS001,AZF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_silver_20_20_2000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_silver_20_20_2000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090021-00,Standard Silver Off Exchange Plan,68.70%,0.687518894672394,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,6,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090021,CommunityCare Aggregate HSA Silver 20%/20%/$2000,91450AZ009,,AZN001,AZS001,AZF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_silver_20_20_2000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_silver_20_20_2000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090021-01,Standard Silver On Exchange Plan,68.70%,0.687518894672394,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,6,91450,AZ,Individual,No,36-3097810,91450AZ0080023,CommunityCare HMO Bronze  40%/40%/$5000 Without Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF010,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_hsa_bronze_40_40_5000_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_hsa_bronze_40_40_5000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080023-01,Standard Bronze On Exchange Plan,,0.600753664970398,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,6,91450,AZ,Individual,No,36-3097810,91450AZ0080023,CommunityCare HMO Bronze  40%/40%/$5000 Without Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF010,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_hsa_bronze_40_40_5000_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_hsa_bronze_40_40_5000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080023-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,6,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090022,CommunityCare Embedded HSA Bronze  40%/40%/$3500,91450AZ009,,AZN001,AZS001,AZF009,Existing,HMO,Bronze,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_bronze_40_40_3500_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_bronze_40_40_3500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090022-00,Standard Bronze Off Exchange Plan,61.80%,0.618339717388153,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,6,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090022,CommunityCare Embedded HSA Bronze  40%/40%/$3500,91450AZ009,,AZN001,AZS001,AZF009,Existing,HMO,Bronze,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_bronze_40_40_3500_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_bronze_40_40_3500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090022-01,Standard Bronze On Exchange Plan,61.80%,0.618339717388153,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,6,91450,AZ,Individual,No,36-3097810,91450AZ0080023,CommunityCare HMO Bronze  40%/40%/$5000 Without Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF010,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_hsa_bronze_40_40_5000_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_hsa_bronze_40_40_5000_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080023-03,Limited Cost Sharing Plan Variation,,0.600753664970398,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,6,91450,AZ,Individual,No,36-3097810,91450AZ0080024,CommunityCare HMO Basic 0%/0%/$6350 Without Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF011,Existing,HMO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,3,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_basic_0_0_6350_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_basic_0_0_6350_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080024-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,8
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,6,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090023,CommunityCare Embedded HSA Bronze  40%/40%/$5000,91450AZ009,,AZN001,AZS001,AZF009,Existing,HMO,Bronze,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_bronze_40_40_5000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_bronze_40_40_5000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090023-00,Standard Bronze Off Exchange Plan,60.10%,0.600753664970398,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,6,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0090023,CommunityCare Embedded HSA Bronze  40%/40%/$5000,91450AZ009,,AZN001,AZS001,AZF009,Existing,HMO,Bronze,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_bronze_40_40_5000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_cc_hmo_hsa_bronze_40_40_5000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0090023-01,Standard Bronze On Exchange Plan,60.10%,0.600753664970398,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,6,91450,AZ,Individual,No,36-3097810,91450AZ0080024,CommunityCare HMO Basic 0%/0%/$6350 Without Pediatric Dental,91450AZ008,,AZN004,AZS004,AZF011,Existing,HMO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,3,0,2015-01-01,,No,,Yes,Emergent services covered,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_basic_0_0_6350_sbc_iex.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/2015_az_ifp_cc_hmo_basic_0_0_6350_iex.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0080024-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,9
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,7,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160001,HMO Platinum with pediatric dental $15/$30/$350,91450AZ016,,AZN002,AZS002,AZF003,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_350_2000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_350_2000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160001-00,Standard Platinum Off Exchange Plan,88.20%,0.88204163312912,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,7,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160001,HMO Platinum with pediatric dental $15/$30/$350,91450AZ016,,AZN002,AZS002,AZF003,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_350_2000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_350_2000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160001-01,Standard Platinum On Exchange Plan,88.20%,0.88204163312912,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,7,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160002,HMO Platinum with pediatric dental $15/$30/$500,91450AZ016,,AZN002,AZS002,AZF003,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_500_1500_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_500_1500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160002-00,Standard Platinum Off Exchange Plan,88.70%,0.892422020435333,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,7,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160002,HMO Platinum with pediatric dental $15/$30/$500,91450AZ016,,AZN002,AZS002,AZF003,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_500_1500_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_500_1500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160002-01,Standard Platinum On Exchange Plan,88.70%,0.892422020435333,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,7,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160003,HMO Platinum with pediatric dental $15/$30/$750,91450AZ016,,AZN002,AZS002,AZF003,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_750_1000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_750_1000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160003-00,Standard Platinum Off Exchange Plan,89.60%,0.896297335624695,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,7,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160003,HMO Platinum with pediatric dental $15/$30/$750,91450AZ016,,AZN002,AZS002,AZF003,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_750_1000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_750_1000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160003-01,Standard Platinum On Exchange Plan,89.60%,0.896297335624695,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,7,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160004,HMO Gold with pediatric dental $20/$40/$500,91450AZ016,,AZN002,AZS002,AZF010,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_500_3000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_500_3000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160004-00,Standard Gold Off Exchange Plan,81.60%,0.816055178642273,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,7,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160004,HMO Gold with pediatric dental $20/$40/$500,91450AZ016,,AZN002,AZS002,AZF010,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_500_3000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_500_3000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160004-01,Standard Gold On Exchange Plan,81.60%,0.816055178642273,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,7,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160005,HMO Gold with pediatric dental $20/$40/$1000,91450AZ016,,AZN002,AZS002,AZF010,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_1000_4000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_1000_4000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160005-00,Standard Gold Off Exchange Plan,78.90%,0.788787424564362,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,7,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160005,HMO Gold with pediatric dental $20/$40/$1000,91450AZ016,,AZN002,AZS002,AZF010,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_1000_4000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_1000_4000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160005-01,Standard Gold On Exchange Plan,78.90%,0.788787424564362,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,7,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160006,HMO Gold with pediatric dental $20/$40/$2000,91450AZ016,,AZN002,AZS002,AZF010,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_2000_3500_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_2000_3500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160006-00,Standard Gold Off Exchange Plan,78.50%,0.784225344657898,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,7,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160006,HMO Gold with pediatric dental $20/$40/$2000,91450AZ016,,AZN002,AZS002,AZF010,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_2000_3500_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_2000_3500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160006-01,Standard Gold On Exchange Plan,78.50%,0.784225344657898,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,8,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160007,HMO Silver with pediatric dental $30/$50/$2000/$5000,91450AZ016,,AZN002,AZS002,AZF011,Existing,HMO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_2000_5000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_2000_5000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160007-00,Standard Silver Off Exchange Plan,72.00%,0.71975713968277,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,8,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160007,HMO Silver with pediatric dental $30/$50/$2000/$5000,91450AZ016,,AZN002,AZS002,AZF011,Existing,HMO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_2000_5000_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_2000_5000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160007-01,Standard Silver On Exchange Plan,72.00%,0.71975713968277,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,8,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160008,HMO Silver with pediatric dental $30/$50/$1500,91450AZ016,,AZN002,AZS002,AZF010,Existing,HMO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_1500_6350_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_1500_6350_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160008-00,Standard Silver Off Exchange Plan,71.40%,0.713577926158905,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,8,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160008,HMO Silver with pediatric dental $30/$50/$1500,91450AZ016,,AZN002,AZS002,AZF010,Existing,HMO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_1500_6350_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_1500_6350_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160008-01,Standard Silver On Exchange Plan,71.40%,0.713577926158905,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,8,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160009,HMO Silver with pediatric dental $30/$50/$2000/$6350,91450AZ016,,AZN002,AZS002,AZF010,Existing,HMO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_2000_6350_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_2000_6350_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160009-00,Standard Silver Off Exchange Plan,70.40%,0.703834652900696,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,8,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160009,HMO Silver with pediatric dental $30/$50/$2000/$6350,91450AZ016,,AZN002,AZS002,AZF010,Existing,HMO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_2000_6350_ped_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_2000_6350_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160009-01,Standard Silver On Exchange Plan,70.40%,0.703834652900696,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,9,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160010,HMO Platinum $15/$30/$350,91450AZ016,,AZN002,AZS002,AZF003,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_350_2000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_350_2000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160010-00,Standard Platinum Off Exchange Plan,88.20%,0.88204163312912,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,9,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160010,HMO Platinum $15/$30/$350,91450AZ016,,AZN002,AZS002,AZF003,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_350_2000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_350_2000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160010-01,Standard Platinum On Exchange Plan,88.20%,0.88204163312912,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,9,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160011,HMO Platinum $15/$30/$500,91450AZ016,,AZN002,AZS002,AZF003,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_500_1500_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_500_1500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160011-00,Standard Platinum Off Exchange Plan,88.70%,0.892422020435333,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,9,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160011,HMO Platinum $15/$30/$500,91450AZ016,,AZN002,AZS002,AZF003,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_500_1500_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_500_1500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160011-01,Standard Platinum On Exchange Plan,88.70%,0.892422020435333,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,9,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160012,HMO Platinum $15/$30/$750,91450AZ016,,AZN002,AZS002,AZF003,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_750_1000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_750_1000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160012-00,Standard Platinum Off Exchange Plan,89.60%,0.896297335624695,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,9,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160012,HMO Platinum $15/$30/$750,91450AZ016,,AZN002,AZS002,AZF003,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_750_1000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_platinum_15_30_750_1000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160012-01,Standard Platinum On Exchange Plan,89.60%,0.896297335624695,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,9,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160013,HMO Gold $20/$40/$500,91450AZ016,,AZN002,AZS002,AZF010,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_500_3000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_500_3000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160013-00,Standard Gold Off Exchange Plan,81.60%,0.816055178642273,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,9,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160013,HMO Gold $20/$40/$500,91450AZ016,,AZN002,AZS002,AZF010,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_500_3000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_500_3000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160013-01,Standard Gold On Exchange Plan,81.60%,0.816055178642273,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,9,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160014,HMO Gold $20/$40/$1000,91450AZ016,,AZN002,AZS002,AZF010,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_1000_4000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_1000_4000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160014-00,Standard Gold Off Exchange Plan,78.90%,0.788787424564362,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,9,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160014,HMO Gold $20/$40/$1000,91450AZ016,,AZN002,AZS002,AZF010,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_1000_4000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_1000_4000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160014-01,Standard Gold On Exchange Plan,78.90%,0.788787424564362,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,9,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160015,HMO Gold $20/$40/$2000,91450AZ016,,AZN002,AZS002,AZF010,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_2000_3500_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_2000_3500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160015-00,Standard Gold Off Exchange Plan,78.50%,0.784225344657898,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,9,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160015,HMO Gold $20/$40/$2000,91450AZ016,,AZN002,AZS002,AZF010,Existing,HMO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_2000_3500_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_gold_20_40_2000_3500_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160015-01,Standard Gold On Exchange Plan,78.50%,0.784225344657898,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,10,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160016,HMO Silver $30/$50/$2000/$5000,91450AZ016,,AZN002,AZS002,AZF011,Existing,HMO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_2000_5000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_2000_5000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160016-00,Standard Silver Off Exchange Plan,72.00%,0.71975713968277,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,10,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160016,HMO Silver $30/$50/$2000/$5000,91450AZ016,,AZN002,AZS002,AZF011,Existing,HMO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_2000_5000_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_2000_5000_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160016-01,Standard Silver On Exchange Plan,72.00%,0.71975713968277,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,10,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160017,HMO Silver $30/$50/$1500,91450AZ016,,AZN002,AZS002,AZF010,Existing,HMO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_1500_6350_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_1500_6350_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160017-00,Standard Silver Off Exchange Plan,71.40%,0.713577926158905,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,10,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160017,HMO Silver $30/$50/$1500,91450AZ016,,AZN002,AZS002,AZF010,Existing,HMO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_1500_6350_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_1500_6350_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160017-01,Standard Silver On Exchange Plan,71.40%,0.713577926158905,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,10,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160018,HMO Silver $30/$50/$2000/$6350,91450AZ016,,AZN002,AZS002,AZF010,Existing,HMO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_2000_6350_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_2000_6350_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160018-00,Standard Silver Off Exchange Plan,70.40%,0.703834652900696,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,91450,HIOS,7,2015-04-22 11:06:15,10,91450,AZ,SHOP (Small Group),No,36-3097810,91450AZ0160018,HMO Silver $30/$50/$2000/$6350,91450AZ016,,AZN002,AZS002,AZF010,Existing,HMO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,No,Emergent services covered.,No,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_2000_6350_sbc_shop.pdf,https://www.healthnet.com/exchange/az,https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/2015_az_sbg_hmo_oa_silver_30_50_2000_6350_shop.pdf,www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf,91450AZ0160018-01,Standard Silver On Exchange Plan,70.40%,0.703834652900696,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,2,92045,AZ,SHOP (Small Group),No,27-3835905,92045AZ0330001,Meritus Choice Silver PPO Plus 4000,92045AZ033,,AZN001,AZS001,AZF002,New,PPO,Silver,Yes,Both,No,Yes,"Genetics, Pain Management, Plastic Surgeon",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9757,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Choice%20Silver%20PPO%20G%20Plus%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0330001-01,Standard Silver On Exchange Plan,70.19%,0.712467849254608,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,2,92045,AZ,Individual,No,27-3835905,92045AZ0270001,Meritus Choice Silver PPO Plus 4000,92045AZ027,,AZN001,AZS001,AZF002,New,PPO,Silver,Yes,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9759,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Choice%20Silver%20PPO%20I%20Plus%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0270001-01,Standard Silver On Exchange Plan,70.20%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,4,92045,AZ,Individual,No,27-3835905,92045AZ0300001,Meritus Saver Silver PPO HSA Plus 2000,92045AZ030,,AZN001,AZS001,AZF007,New,PPO,Silver,No,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9756,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Saver%20Silver%20PPO%20I%20HSA%20Plus%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0300001-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,4,92045,AZ,Individual,No,27-3835905,92045AZ0300001,Meritus Saver Silver PPO HSA Plus 2000,92045AZ030,,AZN001,AZS001,AZF007,New,PPO,Silver,No,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9756,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Saver%20Silver%20PPO%20I%20HSA%20Plus%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0300001-06,94% AV Level Silver Plan,,0.944938838481903,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,2,92045,AZ,Individual,No,27-3835905,92045AZ0270001,Meritus Choice Silver PPO Plus 4000,92045AZ027,,AZN001,AZS001,AZF002,New,PPO,Silver,Yes,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9759,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Choice%20Silver%20PPO%20I%20Plus%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0270001-06,94% AV Level Silver Plan,94.06%,0.927023768424988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$19,800","$39,600",Not Applicable,Not Applicable,$150,$300,0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,3,92045,AZ,Individual,No,27-3835905,92045AZ0280001,Meritus Choice Gold PPO Plus 2000,92045AZ028,,AZN001,AZS001,AZF003,New,PPO,Gold,Yes,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9795,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Choice%20Gold%20PPO%20I%20Plus%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0280001-00,Standard Gold Off Exchange Plan,78.94%,0.766902148723602,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000",Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,3,92045,AZ,SHOP (Small Group),No,27-3835905,92045AZ0340001,Meritus Choice Gold PPO Plus 2000,92045AZ034,,AZN001,AZS001,AZF003,New,PPO,Gold,Yes,Both,No,Yes,"Genetics, Pain Management, Plastic Surgeon",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9793,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Choice%20Gold%20PPO%20G%20Plus%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0340001-00,Standard Gold Off Exchange Plan,78.94%,0.799769937992096,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000",Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,3,92045,AZ,SHOP (Small Group),No,27-3835905,92045AZ0340001,Meritus Choice Gold PPO Plus 2000,92045AZ034,,AZN001,AZS001,AZF003,New,PPO,Gold,Yes,Both,No,Yes,"Genetics, Pain Management, Plastic Surgeon",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9793,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Choice%20Gold%20PPO%20G%20Plus%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0340001-01,Standard Gold On Exchange Plan,78.94%,0.799769937992096,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000",Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,4,92045,AZ,Individual,No,27-3835905,92045AZ0290001,Meritus Saver Bronze PPO HSA Plus 6300,92045AZ029,,AZN001,AZS001,AZF006,New,PPO,Bronze,No,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9705,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Saver%20Bronze%20PPO%20I%20HSA%20Plus%206300%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0290001-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,4,92045,AZ,Individual,No,27-3835905,92045AZ0290001,Meritus Saver Bronze PPO HSA Plus 6300,92045AZ029,,AZN001,AZS001,AZF006,New,PPO,Bronze,No,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9705,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Saver%20Bronze%20PPO%20I%20HSA%20Plus%206300%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0290001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,4,92045,AZ,SHOP (Small Group),No,27-3835905,92045AZ0360001,Meritus Saver Silver PPO HSA Plus 2000,92045AZ036,,AZN001,AZS001,AZF007,New,PPO,Silver,No,Both,No,Yes,"Genetics, Pain Management, Plastic Surgeon",Refer to policy for details,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9753,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Saver%20Silver%20PPO%20G%20HSA%20Plus%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0360001-00,Standard Silver Off Exchange Plan,,0.687288999557495,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,4,92045,AZ,SHOP (Small Group),No,27-3835905,92045AZ0360001,Meritus Saver Silver PPO HSA Plus 2000,92045AZ036,,AZN001,AZS001,AZF007,New,PPO,Silver,No,Both,No,Yes,"Genetics, Pain Management, Plastic Surgeon",Refer to policy for details,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9753,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Saver%20Silver%20PPO%20G%20HSA%20Plus%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0360001-01,Standard Silver On Exchange Plan,,0.687288999557495,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,4,92045,AZ,Individual,No,27-3835905,92045AZ0290001,Meritus Saver Bronze PPO HSA Plus 6300,92045AZ029,,AZN001,AZS001,AZF006,New,PPO,Bronze,No,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9705,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Saver%20Bronze%20PPO%20I%20HSA%20Plus%206300%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0290001-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,4,92045,AZ,Individual,No,27-3835905,92045AZ0300001,Meritus Saver Silver PPO HSA Plus 2000,92045AZ030,,AZN001,AZS001,AZF007,New,PPO,Silver,No,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9756,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Saver%20Silver%20PPO%20I%20HSA%20Plus%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0300001-00,Standard Silver Off Exchange Plan,,0.687288999557495,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,4,92045,AZ,SHOP (Small Group),No,27-3835905,92045AZ0370001,Meritus Saver Gold PPO HSA Plus 1500,92045AZ037,,AZN001,AZS001,AZF008,New,PPO,Gold,No,Both,No,Yes,"Genetics, Pain Management, Plastic Surgeon",Refer to policy for details,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9791,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Saver%20Gold%20PPO%20G%20HSA%20Plus%201500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0370001-00,Standard Gold Off Exchange Plan,,0.781938672065735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,4,92045,AZ,SHOP (Small Group),No,27-3835905,92045AZ0370001,Meritus Saver Gold PPO HSA Plus 1500,92045AZ037,,AZN001,AZS001,AZF008,New,PPO,Gold,No,Both,No,Yes,"Genetics, Pain Management, Plastic Surgeon",Refer to policy for details,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9791,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Saver%20Gold%20PPO%20G%20HSA%20Plus%201500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0370001-01,Standard Gold On Exchange Plan,,0.781938672065735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,4,92045,AZ,Individual,No,27-3835905,92045AZ0300001,Meritus Saver Silver PPO HSA Plus 2000,92045AZ030,,AZN001,AZS001,AZF007,New,PPO,Silver,No,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9756,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Saver%20Silver%20PPO%20I%20HSA%20Plus%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0300001-01,Standard Silver On Exchange Plan,,0.687288999557495,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,4,92045,AZ,Individual,No,27-3835905,92045AZ0300001,Meritus Saver Silver PPO HSA Plus 2000,92045AZ030,,AZN001,AZS001,AZF007,New,PPO,Silver,No,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9756,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Saver%20Silver%20PPO%20I%20HSA%20Plus%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0300001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,4,92045,AZ,Individual,No,27-3835905,92045AZ0310001,Meritus Saver Gold PPO HSA Plus 1500,92045AZ031,,AZN001,AZS001,AZF008,New,PPO,Gold,No,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9793,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Saver%20Gold%20PPO%20I%20HSA%20Plus%201500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0310001-00,Standard Gold Off Exchange Plan,,0.781938672065735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,4,92045,AZ,Individual,No,27-3835905,92045AZ0310001,Meritus Saver Gold PPO HSA Plus 1500,92045AZ031,,AZN001,AZS001,AZF008,New,PPO,Gold,No,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9793,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Saver%20Gold%20PPO%20I%20HSA%20Plus%201500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0310001-01,Standard Gold On Exchange Plan,,0.781938672065735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,4,92045,AZ,Individual,No,27-3835905,92045AZ0310001,Meritus Saver Gold PPO HSA Plus 1500,92045AZ031,,AZN001,AZS001,AZF008,New,PPO,Gold,No,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9793,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Saver%20Gold%20PPO%20I%20HSA%20Plus%201500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0310001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,17
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,4,92045,AZ,Individual,No,27-3835905,92045AZ0310001,Meritus Saver Gold PPO HSA Plus 1500,92045AZ031,,AZN001,AZS001,AZF008,New,PPO,Gold,No,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9793,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Saver%20Gold%20PPO%20I%20HSA%20Plus%201500%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0310001-03,Limited Cost Sharing Plan Variation,,0.781938672065735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,1,98971,AZ,SHOP (Small Group),No,35-1665915,98971AZ0010065,UnitedHealthcare Gold Choice Plus  500,98971AZ001,,AZN002,AZS001,AZF007,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shopaz,,,www.uhc.com/xaz,98971AZ0010065-00,Standard Gold Off Exchange Plan,80.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,1,98971,AZ,Individual,No,35-1665915,98971AZ0020008,UnitedHealthcare Silver Compass Plus HSA 2600,98971AZ002,,AZN006,AZS001,AZF003,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/shopaz,98971AZ0020008-00,Standard Silver Off Exchange Plan,68.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,1,98971,AZ,Individual,No,35-1665915,98971AZ0020008,UnitedHealthcare Silver Compass Plus HSA 2600,98971AZ002,,AZN006,AZS001,AZF003,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/shopaz,98971AZ0020008-01,Standard Silver On Exchange Plan,68.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020006,UnitedHealthcare Platinum Compass Plus 250,98971AZ002,,AZN006,AZS001,AZF002,New,PPO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/shopaz,98971AZ0020006-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020006,UnitedHealthcare Platinum Compass Plus 250,98971AZ002,,AZN006,AZS001,AZF002,New,PPO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/shopaz,98971AZ0020006-03,Limited Cost Sharing Plan Variation,89.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,$500,"$1,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$250,$250,,,,,,,,,,,,,,,,,,,7
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,1,98971,AZ,SHOP (Small Group),No,35-1665915,98971AZ0010065,UnitedHealthcare Gold Choice Plus  500,98971AZ001,,AZN002,AZS001,AZF007,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shopaz,,,www.uhc.com/xaz,98971AZ0010065-01,Standard Gold On Exchange Plan,80.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,1,98971,AZ,Individual,No,35-1665915,98971AZ0020008,UnitedHealthcare Silver Compass Plus HSA 2600,98971AZ002,,AZN006,AZS001,AZF003,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/shopaz,98971AZ0020008-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,1,98971,AZ,Individual,No,35-1665915,98971AZ0020008,UnitedHealthcare Silver Compass Plus HSA 2600,98971AZ002,,AZN006,AZS001,AZF003,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/shopaz,98971AZ0020008-03,Limited Cost Sharing Plan Variation,68.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,1,98971,AZ,Individual,No,35-1665915,98971AZ0020008,UnitedHealthcare Silver Compass Plus HSA 2600,98971AZ002,,AZN006,AZS001,AZF003,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/shopaz,98971AZ0020008-04,73% AV Level Silver Plan,73.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800",0%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,8
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,1,98971,AZ,Individual,No,35-1665915,98971AZ0020008,UnitedHealthcare Silver Compass Plus HSA 2600,98971AZ002,,AZN006,AZS001,AZF003,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/shopaz,98971AZ0020008-05,87% AV Level Silver Plan,87.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$550,"$1,100",0%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,1,98971,AZ,Individual,No,35-1665915,98971AZ0020008,UnitedHealthcare Silver Compass Plus HSA 2600,98971AZ002,,AZN006,AZS001,AZF003,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/shopaz,98971AZ0020008-06,94% AV Level Silver Plan,93.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$75,$150,0%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,10
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,1,98971,AZ,Individual,No,35-1665915,98971AZ0020010,UnitedHealthcare Silver Compass Plus HSA 1600,98971AZ002,,AZN006,AZS001,AZF006,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020010-00,Standard Silver Off Exchange Plan,69.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",0%,,,,"$3,200","$6,400",Not Applicable,Not Applicable,,,,,,,,,11
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,1,98971,AZ,Individual,No,35-1665915,98971AZ0020010,UnitedHealthcare Silver Compass Plus HSA 1600,98971AZ002,,AZN006,AZS001,AZF006,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020010-01,Standard Silver On Exchange Plan,69.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",0%,,,,"$3,200","$6,400",Not Applicable,Not Applicable,,,,,,,,,12
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,1,98971,AZ,Individual,No,35-1665915,98971AZ0020010,UnitedHealthcare Silver Compass Plus HSA 1600,98971AZ002,,AZN006,AZS001,AZF006,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020010-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,1,92045,AZ,Individual,No,27-3835905,92045AZ0260001,Meritus Choice Bronze PPO Plus 6000,92045AZ026,,AZN001,AZS001,AZF001,New,PPO,Bronze,Yes,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9738,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Choice%20Bronze%20PPO%20I%20Plus%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0260001-00,Standard Bronze Off Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,1,92045,AZ,SHOP (Small Group),No,27-3835905,92045AZ0320001,Meritus Choice Bronze PPO Plus 6000,92045AZ032,,AZN001,AZS001,AZF001,New,PPO,Bronze,Yes,Both,No,Yes,"Genetics, Pain Management, Plastic Surgeon",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9736,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Choice%20Bronze%20PPO%20G%20Plus%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp?start=makePayment&clientKey=cchn,,http://www.meritusaz.com/formulary.html,92045AZ0320001-00,Standard Bronze Off Exchange Plan,61.81%,0.608798265457153,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,1,92045,AZ,SHOP (Small Group),No,27-3835905,92045AZ0320001,Meritus Choice Bronze PPO Plus 6000,92045AZ032,,AZN001,AZS001,AZF001,New,PPO,Bronze,Yes,Both,No,Yes,"Genetics, Pain Management, Plastic Surgeon",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9736,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Choice%20Bronze%20PPO%20G%20Plus%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp?start=makePayment&clientKey=cchn,,http://www.meritusaz.com/formulary.html,92045AZ0320001-01,Standard Bronze On Exchange Plan,61.81%,0.608798265457153,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,1,92045,AZ,Individual,No,27-3835905,92045AZ0260001,Meritus Choice Bronze PPO Plus 6000,92045AZ026,,AZN001,AZS001,AZF001,New,PPO,Bronze,Yes,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9738,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Choice%20Bronze%20PPO%20I%20Plus%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0260001-01,Standard Bronze On Exchange Plan,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,1,92045,AZ,Individual,No,27-3835905,92045AZ0260001,Meritus Choice Bronze PPO Plus 6000,92045AZ026,,AZN001,AZS001,AZF001,New,PPO,Bronze,Yes,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9738,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Choice%20Bronze%20PPO%20I%20Plus%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0260001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,1,92045,AZ,Individual,No,27-3835905,92045AZ0260001,Meritus Choice Bronze PPO Plus 6000,92045AZ026,,AZN001,AZS001,AZF001,New,PPO,Bronze,Yes,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9738,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Choice%20Bronze%20PPO%20I%20Plus%206000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0260001-03,Limited Cost Sharing Plan Variation,61.81%,0.601110696792603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,2,92045,AZ,Individual,No,27-3835905,92045AZ0270001,Meritus Choice Silver PPO Plus 4000,92045AZ027,,AZN001,AZS001,AZF002,New,PPO,Silver,Yes,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9759,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Choice%20Silver%20PPO%20I%20Plus%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0270001-00,Standard Silver Off Exchange Plan,70.20%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,2,92045,AZ,SHOP (Small Group),No,27-3835905,92045AZ0330001,Meritus Choice Silver PPO Plus 4000,92045AZ033,,AZN001,AZS001,AZF002,New,PPO,Silver,Yes,Both,No,Yes,"Genetics, Pain Management, Plastic Surgeon",Refer to policy for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9757,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Choice%20Silver%20PPO%20G%20Plus%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0330001-00,Standard Silver Off Exchange Plan,70.19%,0.712467849254608,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,2,92045,AZ,Individual,No,27-3835905,92045AZ0270001,Meritus Choice Silver PPO Plus 4000,92045AZ027,,AZN001,AZS001,AZF002,New,PPO,Silver,Yes,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9759,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Choice%20Silver%20PPO%20I%20Plus%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0270001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,2,92045,AZ,Individual,No,27-3835905,92045AZ0270001,Meritus Choice Silver PPO Plus 4000,92045AZ027,,AZN001,AZS001,AZF002,New,PPO,Silver,Yes,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9759,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Choice%20Silver%20PPO%20I%20Plus%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0270001-03,Limited Cost Sharing Plan Variation,70.20%,0.66124564409256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,2,92045,AZ,Individual,No,27-3835905,92045AZ0270001,Meritus Choice Silver PPO Plus 4000,92045AZ027,,AZN001,AZS001,AZF002,New,PPO,Silver,Yes,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9759,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Choice%20Silver%20PPO%20I%20Plus%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0270001-04,73% AV Level Silver Plan,73.65%,0.710138440132141,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,2,92045,AZ,Individual,No,27-3835905,92045AZ0270001,Meritus Choice Silver PPO Plus 4000,92045AZ027,,AZN001,AZS001,AZF002,New,PPO,Silver,Yes,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9759,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Choice%20Silver%20PPO%20I%20Plus%204000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0270001-05,87% AV Level Silver Plan,87.35%,0.847645401954651,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$19,800","$39,600",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,3,92045,AZ,Individual,No,27-3835905,92045AZ0280001,Meritus Choice Gold PPO Plus 2000,92045AZ028,,AZN001,AZS001,AZF003,New,PPO,Gold,Yes,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9795,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Choice%20Gold%20PPO%20I%20Plus%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0280001-01,Standard Gold On Exchange Plan,78.94%,0.766902148723602,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000",Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,3,92045,AZ,Individual,No,27-3835905,92045AZ0280001,Meritus Choice Gold PPO Plus 2000,92045AZ028,,AZN001,AZS001,AZF003,New,PPO,Gold,Yes,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9795,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Choice%20Gold%20PPO%20I%20Plus%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0280001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,3,92045,AZ,Individual,No,27-3835905,92045AZ0280001,Meritus Choice Gold PPO Plus 2000,92045AZ028,,AZN001,AZS001,AZF003,New,PPO,Gold,Yes,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9795,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Choice%20Gold%20PPO%20I%20Plus%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0280001-03,Limited Cost Sharing Plan Variation,78.94%,0.766902148723602,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000",Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,4,92045,AZ,Individual,No,27-3835905,92045AZ0290001,Meritus Saver Bronze PPO HSA Plus 6300,92045AZ029,,AZN001,AZS001,AZF006,New,PPO,Bronze,No,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9705,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Saver%20Bronze%20PPO%20I%20HSA%20Plus%206300%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0290001-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,4,92045,AZ,SHOP (Small Group),No,27-3835905,92045AZ0350001,Meritus Saver Bronze PPO HSA Plus 6300,92045AZ035,,AZN001,AZS001,AZF006,New,PPO,Bronze,No,Both,No,Yes,"Genetics, Pain Management, Plastic Surgeon",Refer to policy for details,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9702,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Saver%20Bronze%20PPO%20G%20HSA%20Plus%206300%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0350001-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,4,92045,AZ,SHOP (Small Group),No,27-3835905,92045AZ0350001,Meritus Saver Bronze PPO HSA Plus 6300,92045AZ035,,AZN001,AZS001,AZF006,New,PPO,Bronze,No,Both,No,Yes,"Genetics, Pain Management, Plastic Surgeon",Refer to policy for details,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9702,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Saver%20Bronze%20PPO%20G%20HSA%20Plus%206300%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0350001-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,4,92045,AZ,Individual,No,27-3835905,92045AZ0300001,Meritus Saver Silver PPO HSA Plus 2000,92045AZ030,,AZN001,AZS001,AZF007,New,PPO,Silver,No,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9756,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Saver%20Silver%20PPO%20I%20HSA%20Plus%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0300001-03,Limited Cost Sharing Plan Variation,,0.687288999557495,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,AZ,92045,HIOS,8,2015-01-21 09:35:36,4,92045,AZ,Individual,No,27-3835905,92045AZ0300001,Meritus Saver Silver PPO HSA Plus 2000,92045AZ030,,AZN001,AZS001,AZF007,New,PPO,Silver,No,Both,No,Yes,"Genetists, Pain Managemen, Plastic Surgeon",Refer to policy for details,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,0.9756,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency services only,No,http://www.meritusaz.com/sites/default/files/2015%20Meritus%20Saver%20Silver%20PPO%20I%20HSA%20Plus%202000%20SBC.pdf,https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs,,http://www.meritusaz.com/formulary.html,92045AZ0300001-04,73% AV Level Silver Plan,,0.736745297908783,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,1,98971,AZ,Individual,No,35-1665915,98971AZ0020010,UnitedHealthcare Silver Compass Plus HSA 1600,98971AZ002,,AZN006,AZS001,AZF006,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020010-03,Limited Cost Sharing Plan Variation,69.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",0%,,,,"$3,200","$6,400",Not Applicable,Not Applicable,,,,,,,,,14
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,1,98971,AZ,Individual,No,35-1665915,98971AZ0020010,UnitedHealthcare Silver Compass Plus HSA 1600,98971AZ002,,AZN006,AZS001,AZF006,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020010-04,73% AV Level Silver Plan,72.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,"$3,200","$6,400",Not Applicable,Not Applicable,,,,,,,,,15
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,1,98971,AZ,Individual,No,35-1665915,98971AZ0020010,UnitedHealthcare Silver Compass Plus HSA 1600,98971AZ002,,AZN006,AZS001,AZF006,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020010-05,87% AV Level Silver Plan,86.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,"$3,200","$6,400",Not Applicable,Not Applicable,,,,,,,,,16
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,1,98971,AZ,Individual,No,35-1665915,98971AZ0020010,UnitedHealthcare Silver Compass Plus HSA 1600,98971AZ002,,AZN006,AZS001,AZF006,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020010-06,94% AV Level Silver Plan,93.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,"$3,200","$6,400",Not Applicable,Not Applicable,,,,,,,,,17
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,1,98971,AZ,Individual,No,35-1665915,98971AZ0020002,UnitedHealthcare Bronze Compass Plus HSA 4900,98971AZ002,,AZN006,AZS001,AZF006,New,PPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020002-00,Standard Bronze Off Exchange Plan,58.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,"$9,800","$19,600",Not Applicable,Not Applicable,,,,,,,,,18
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,1,98971,AZ,Individual,No,35-1665915,98971AZ0020002,UnitedHealthcare Bronze Compass Plus HSA 4900,98971AZ002,,AZN006,AZS001,AZF006,New,PPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020002-01,Standard Bronze On Exchange Plan,58.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,"$9,800","$19,600",Not Applicable,Not Applicable,,,,,,,,,19
2015,FL,12438,HIOS,3,2014-09-05 03:32:16,1,12438,FL,SHOP (Small Group),Yes,81-0170040,12438FL0010001,Assurant Dental ACAFFO High,12438FL001,,FLN001,FLS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.87,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same coverage as in service area,Yes,,,,,12438FL0010001-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,12438,HIOS,3,2014-09-05 03:32:16,2,12438,FL,SHOP (Small Group),Yes,81-0170040,12438FL0010002,Assurant Dental ACAFFO Low,12438FL001,,FLN001,FLS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.12,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same coverage as in service area,Yes,,,,,12438FL0010002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,15833,HIOS,10,2015-01-16 17:32:32,1,15833,FL,SHOP (Small Group),Yes,13-5123390,15833FL0080002,Managed DentalGuard FL Child Essentials 1,15833FL008,,FLN002,FLS003,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$9.02,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,15833FL0080002-00,Standard Low Off Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,15833,HIOS,10,2015-01-16 17:32:32,1,15833,FL,Individual,Yes,13-5123390,15833FL0120001,Managed DentalGuard FL Essentials 1,15833FL012,,FLN002,FLS002,,New,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$9.02,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,https://mydental.guardianlife.com/exchange/florida,,https://mydental.guardianlife.com/exchange/florida,,15833FL0120001-00,Standard Low Off Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,15833,HIOS,10,2015-01-16 17:32:32,1,15833,FL,Individual,Yes,13-5123390,15833FL0120001,Managed DentalGuard FL Essentials 1,15833FL012,,FLN002,FLS002,,New,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$9.02,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,https://mydental.guardianlife.com/exchange/florida,,https://mydental.guardianlife.com/exchange/florida,,15833FL0120001-01,Standard Low On Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,15833,HIOS,10,2015-01-16 17:32:32,2,15833,FL,SHOP (Small Group),Yes,13-5123390,15833FL0090002,Managed DentalGuard FL10 Family Plan,15833FL009,,FLN002,FLS003,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$9.02,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,15833FL0090002-00,Standard Low Off Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,1,16842,FL,Individual,No,59-2015694,16842FL0070073,BlueOptions Everyday Health 1423,16842FL007,,FLN001,FLS001,FLF004,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1423_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1423_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070073-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,1,16842,FL,SHOP (Small Group),No,59-2015694,16842FL0010002,BlueOptions Essential Health S1401,16842FL001,,FLN001,FLS001,FLF001,Existing,EPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,www.bcbsfl.com/DocumentLibrary/SBC/2015/S1401.pdf,,www.bcbsfl.com/DocumentLibrary/MiniSummary/2015/S1401.pdf,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0010002-00,Standard Gold Off Exchange Plan,,0.782234013080597,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,1,16842,FL,SHOP (Small Group),No,59-2015694,16842FL0010002,BlueOptions Essential Health S1401,16842FL001,,FLN001,FLS001,FLF001,Existing,EPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,www.bcbsfl.com/DocumentLibrary/SBC/2015/S1401.pdf,,www.bcbsfl.com/DocumentLibrary/MiniSummary/2015/S1401.pdf,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0010002-01,Standard Gold On Exchange Plan,,0.782234013080597,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,1,16842,FL,Individual,No,59-2015694,16842FL0070073,BlueOptions Everyday Health 1423,16842FL007,,FLN001,FLS001,FLF004,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1423_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1423_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070073-03,Limited Cost Sharing Plan Variation,68.65%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,1,16842,FL,Individual,No,59-2015694,16842FL0070073,BlueOptions Everyday Health 1423,16842FL007,,FLN001,FLS001,FLF004,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1423_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1423_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070073-00,Standard Silver Off Exchange Plan,68.65%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,1,16842,FL,SHOP (Small Group),No,59-2015694,16842FL0010001,BlueOptions Essential Health S1400,16842FL001,,FLN001,FLS001,FLF001,Existing,EPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,www.bcbsfl.com/DocumentLibrary/SBC/2015/S1400.pdf,,www.bcbsfl.com/DocumentLibrary/MiniSummary/2015/S1400.pdf,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0010001-00,Standard Silver Off Exchange Plan,,0.696754574775696,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,1,16842,FL,SHOP (Small Group),No,59-2015694,16842FL0010001,BlueOptions Essential Health S1400,16842FL001,,FLN001,FLS001,FLF001,Existing,EPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,www.bcbsfl.com/DocumentLibrary/SBC/2015/S1400.pdf,,www.bcbsfl.com/DocumentLibrary/MiniSummary/2015/S1400.pdf,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0010001-01,Standard Silver On Exchange Plan,,0.696754574775696,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,1,16842,FL,Individual,No,59-2015694,16842FL0070073,BlueOptions Everyday Health 1423,16842FL007,,FLN001,FLS001,FLF004,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1423_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1423_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070073-01,Standard Silver On Exchange Plan,68.65%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,1,16842,FL,Individual,No,59-2015694,16842FL0120033,BlueSelect Everyday Health 1456,16842FL012,,FLN002,FLS002,FLF021,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1456_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1456_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120033-05,87% AV Level Silver Plan,86.46%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,$750,"$1,500",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,1,16842,FL,Individual,No,59-2015694,16842FL0120033,BlueSelect Everyday Health 1456,16842FL012,,FLN002,FLS002,FLF021,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1456_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1456_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120033-06,94% AV Level Silver Plan,93.22%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,1,16842,FL,Individual,No,59-2015694,16842FL0070073,BlueOptions Everyday Health 1423,16842FL007,,FLN001,FLS001,FLF004,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1423_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1423_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070073-04,73% AV Level Silver Plan,73.14%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,500","$25,000",Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,1,16842,FL,Individual,No,59-2015694,16842FL0070073,BlueOptions Everyday Health 1423,16842FL007,,FLN001,FLS001,FLF004,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1423_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1423_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070073-05,87% AV Level Silver Plan,86.46%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,$750,"$1,500",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,1,16842,FL,Individual,No,59-2015694,16842FL0070073,BlueOptions Everyday Health 1423,16842FL007,,FLN001,FLS001,FLF004,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1423_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1423_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070073-06,94% AV Level Silver Plan,93.22%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,1,16842,FL,Individual,No,59-2015694,16842FL0120033,BlueSelect Everyday Health 1456,16842FL012,,FLN002,FLS002,FLF021,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1456_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1456_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120033-00,Standard Silver Off Exchange Plan,68.65%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,1,16842,FL,Individual,No,59-2015694,16842FL0120033,BlueSelect Everyday Health 1456,16842FL012,,FLN002,FLS002,FLF021,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1456_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1456_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120033-01,Standard Silver On Exchange Plan,68.65%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,1,16842,FL,Individual,No,59-2015694,16842FL0120033,BlueSelect Everyday Health 1456,16842FL012,,FLN002,FLS002,FLF021,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1456_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1456_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120033-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,1,16842,FL,Individual,No,59-2015694,16842FL0120033,BlueSelect Everyday Health 1456,16842FL012,,FLN002,FLS002,FLF021,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1456_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1456_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120033-03,Limited Cost Sharing Plan Variation,68.65%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,1,16842,FL,Individual,No,59-2015694,16842FL0120033,BlueSelect Everyday Health 1456,16842FL012,,FLN002,FLS002,FLF021,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1456_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1456_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120033-04,73% AV Level Silver Plan,73.14%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,500","$25,000",Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,1,98971,AZ,Individual,No,35-1665915,98971AZ0020002,UnitedHealthcare Bronze Compass Plus HSA 4900,98971AZ002,,AZN006,AZS001,AZF006,New,PPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,1,98971,AZ,Individual,No,35-1665915,98971AZ0020002,UnitedHealthcare Bronze Compass Plus HSA 4900,98971AZ002,,AZN006,AZS001,AZF006,New,PPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020002-03,Limited Cost Sharing Plan Variation,58.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,"$9,800","$19,600",Not Applicable,Not Applicable,,,,,,,,,21
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020006,UnitedHealthcare Platinum Compass Plus 250,98971AZ002,,AZN006,AZS001,AZF002,New,PPO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/shopaz,98971AZ0020006-00,Standard Platinum Off Exchange Plan,89.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,$500,"$1,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$250,$250,,,,,,,,,,,,,,,,,,,4
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,SHOP (Small Group),No,35-1665915,98971AZ0010066,UnitedHealthcare Silver Choice Plus  3500,98971AZ001,,AZN002,AZS001,AZF009,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shopaz,,,www.uhc.com/xaz,98971AZ0010066-00,Standard Silver Off Exchange Plan,69.8%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$3,500","$7,000",10%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,SHOP (Small Group),No,35-1665915,98971AZ0010066,UnitedHealthcare Silver Choice Plus  3500,98971AZ001,,AZN002,AZS001,AZF009,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shopaz,,,www.uhc.com/xaz,98971AZ0010066-01,Standard Silver On Exchange Plan,69.8%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$3,500","$7,000",10%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020006,UnitedHealthcare Platinum Compass Plus 250,98971AZ002,,AZN006,AZS001,AZF002,New,PPO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/shopaz,98971AZ0020006-01,Standard Platinum On Exchange Plan,89.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,$500,"$1,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$250,$250,,,,,,,,,,,,,,,,,,,5
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020004,UnitedHealthcare Gold Compass Plus 1250,98971AZ002,,AZN006,AZS001,AZF003,New,PPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/shopaz,98971AZ0020004-00,Standard Gold Off Exchange Plan,79.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$500,$500,,,,,,,,,,,,,,,,,,,8
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020004,UnitedHealthcare Gold Compass Plus 1250,98971AZ002,,AZN006,AZS001,AZF003,New,PPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/shopaz,98971AZ0020004-01,Standard Gold On Exchange Plan,79.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$500,$500,,,,,,,,,,,,,,,,,,,9
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020004,UnitedHealthcare Gold Compass Plus 1250,98971AZ002,,AZN006,AZS001,AZF003,New,PPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/shopaz,98971AZ0020004-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020004,UnitedHealthcare Gold Compass Plus 1250,98971AZ002,,AZN006,AZS001,AZF003,New,PPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/shopaz,98971AZ0020004-03,Limited Cost Sharing Plan Variation,79.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$500,$500,,,,,,,,,,,,,,,,,,,11
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020005,UnitedHealthcare Gold Compass Plus 500,98971AZ002,,AZN006,AZS001,AZF003,New,PPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/shopaz,98971AZ0020005-00,Standard Gold Off Exchange Plan,79.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$250,$250,,,,,,,,,,,,,,,,,,,12
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020005,UnitedHealthcare Gold Compass Plus 500,98971AZ002,,AZN006,AZS001,AZF003,New,PPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/shopaz,98971AZ0020005-01,Standard Gold On Exchange Plan,79.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$250,$250,,,,,,,,,,,,,,,,,,,13
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020005,UnitedHealthcare Gold Compass Plus 500,98971AZ002,,AZN006,AZS001,AZF003,New,PPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/shopaz,98971AZ0020005-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020005,UnitedHealthcare Gold Compass Plus 500,98971AZ002,,AZN006,AZS001,AZF003,New,PPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/shopaz,98971AZ0020005-03,Limited Cost Sharing Plan Variation,79.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$250,$250,,,,,,,,,,,,,,,,,,,15
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020007,UnitedHealthcare Silver Compass Plus 2000,98971AZ002,,AZN006,AZS001,AZF006,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020007-00,Standard Silver Off Exchange Plan,70.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$500,$500,,,,,,,,,,,,,,,,,,,16
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,2,16842,FL,Individual,No,59-2015694,16842FL0070084,BlueOptions Essential (HSA) 1419,16842FL007,,FLN001,FLS001,FLF011,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1419_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1419_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070084-00,Standard Bronze Off Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,2,16842,FL,Individual,No,59-2015694,16842FL0070084,BlueOptions Essential (HSA) 1419,16842FL007,,FLN001,FLS001,FLF011,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1419_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1419_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070084-01,Standard Bronze On Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,8,16842,FL,Individual,No,59-2015694,16842FL0070114,BlueOptions Everyday Health 1410,16842FL007,,FLN001,FLS001,FLF007,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1410_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1410_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070114-06,94% AV Level Silver Plan,93.51%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$23,000","$25,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,8,16842,FL,Individual,No,59-2015694,16842FL0120072,BlueSelect Everyday Health 1443,16842FL012,,FLN002,FLS002,FLF018,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1443_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1443_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120072-00,Standard Silver Off Exchange Plan,68.92%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$23,000","$25,000",Not Applicable,Not Applicable,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,7,16842,FL,Individual,No,59-2015694,16842FL0120070,BlueSelect All Copay 1457,16842FL012,,FLN002,FLS002,FLF013,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1457_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1457_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120070-00,Standard Platinum Off Exchange Plan,88.75%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,7,16842,FL,Individual,No,59-2015694,16842FL0120070,BlueSelect All Copay 1457,16842FL012,,FLN002,FLS002,FLF013,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1457_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1457_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120070-01,Standard Platinum On Exchange Plan,88.75%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,7,16842,FL,Individual,No,59-2015694,16842FL0120070,BlueSelect All Copay 1457,16842FL012,,FLN002,FLS002,FLF013,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1457_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1457_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120070-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,7,16842,FL,Individual,No,59-2015694,16842FL0120070,BlueSelect All Copay 1457,16842FL012,,FLN002,FLS002,FLF013,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1457_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1457_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120070-03,Limited Cost Sharing Plan Variation,88.75%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020007,UnitedHealthcare Silver Compass Plus 2000,98971AZ002,,AZN006,AZS001,AZF006,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020007-01,Standard Silver On Exchange Plan,70.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$500,$500,,,,,,,,,,,,,,,,,,,17
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020007,UnitedHealthcare Silver Compass Plus 2000,98971AZ002,,AZN006,AZS001,AZF006,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020007-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020007,UnitedHealthcare Silver Compass Plus 2000,98971AZ002,,AZN006,AZS001,AZF006,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020007-03,Limited Cost Sharing Plan Variation,70.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$500,$500,,,,,,,,,,,,,,,,,,,19
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020007,UnitedHealthcare Silver Compass Plus 2000,98971AZ002,,AZN006,AZS001,AZF006,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020007-04,73% AV Level Silver Plan,73.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,400",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$500,$500,,,,,,,,,,,,,,,,,,,20
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020007,UnitedHealthcare Silver Compass Plus 2000,98971AZ002,,AZN006,AZS001,AZF006,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020007-05,87% AV Level Silver Plan,87.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$250,$250,,,,,,,,,,,,,,,,,,,21
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020007,UnitedHealthcare Silver Compass Plus 2000,98971AZ002,,AZN006,AZS001,AZF006,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020007-06,94% AV Level Silver Plan,93.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$100,$100,,,,,,,,,,,,,,,,,,,22
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020009,UnitedHealthcare Silver Compass Plus 3500,98971AZ002,,AZN006,AZS001,AZF004,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020009-00,Standard Silver Off Exchange Plan,70.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$1000,$1000,,,,,,,,,,,,,,,,,,,23
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020009,UnitedHealthcare Silver Compass Plus 3500,98971AZ002,,AZN006,AZS001,AZF004,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020009-01,Standard Silver On Exchange Plan,70.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$1000,$1000,,,,,,,,,,,,,,,,,,,24
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020009,UnitedHealthcare Silver Compass Plus 3500,98971AZ002,,AZN006,AZS001,AZF004,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020009-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,25
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020009,UnitedHealthcare Silver Compass Plus 3500,98971AZ002,,AZN006,AZS001,AZF004,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020009-03,Limited Cost Sharing Plan Variation,70.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$1000,$1000,,,,,,,,,,,,,,,,,,,26
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020009,UnitedHealthcare Silver Compass Plus 3500,98971AZ002,,AZN006,AZS001,AZF004,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020009-04,73% AV Level Silver Plan,73.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$500,$500,,,,,,,,,,,,,,,,,,,27
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020009,UnitedHealthcare Silver Compass Plus 3500,98971AZ002,,AZN006,AZS001,AZF004,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020009-05,87% AV Level Silver Plan,87.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$250,$250,,,,,,,,,,,,,,,,,,,28
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,2,98971,AZ,Individual,No,35-1665915,98971AZ0020009,UnitedHealthcare Silver Compass Plus 3500,98971AZ002,,AZN006,AZS001,AZF004,New,PPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020009-06,94% AV Level Silver Plan,93.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$100,$100,,,,,,,,,,,,,,,,,,,29
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,3,98971,AZ,Individual,No,35-1665915,98971AZ0020003,UnitedHealthcare Catastrophic Compass Plus 6600,98971AZ002,,AZN006,AZS001,AZF001,New,PPO,Catastrophic,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/shopaz,98971AZ0020003-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,3,98971,AZ,Individual,No,35-1665915,98971AZ0020003,UnitedHealthcare Catastrophic Compass Plus 6600,98971AZ002,,AZN006,AZS001,AZF001,New,PPO,Catastrophic,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/shopaz,98971AZ0020003-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,4,98971,AZ,Individual,No,35-1665915,98971AZ0020001,UnitedHealthcare Bronze Compass Plus 5500,98971AZ002,,AZN006,AZS001,AZF006,New,PPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020001-00,Standard Bronze Off Exchange Plan,61.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,4,98971,AZ,Individual,No,35-1665915,98971AZ0020001,UnitedHealthcare Bronze Compass Plus 5500,98971AZ002,,AZN006,AZS001,AZF006,New,PPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020001-01,Standard Bronze On Exchange Plan,61.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,4,98971,AZ,Individual,No,35-1665915,98971AZ0020001,UnitedHealthcare Bronze Compass Plus 5500,98971AZ002,,AZN006,AZS001,AZF006,New,PPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AZ,98971,HIOS,7,2014-12-10 11:54:40,4,98971,AZ,Individual,No,35-1665915,98971AZ0020001,UnitedHealthcare Bronze Compass Plus 5500,98971AZ002,,AZN006,AZS001,AZF006,New,PPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xaz,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xaz,98971AZ0020001-03,Limited Cost Sharing Plan Variation,61.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AZ,99180,HIOS,2,2014-09-05 03:32:16,1,99180,AZ,SHOP (Small Group),Yes,86-0307623,99180AZ0220001,Smile for Health Certified Basic Option Plus (90-50-50),99180AZ022,,AZN001,AZS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$3.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,99180AZ0220001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,99180,HIOS,2,2014-09-05 03:32:16,2,99180,AZ,SHOP (Small Group),Yes,86-0307623,99180AZ0240001,Smile for Health Certified High Option Plus (100-50-50),99180AZ024,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$7.35,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,99180AZ0240001-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,99180,HIOS,2,2014-09-05 03:32:16,3,99180,AZ,SHOP (Small Group),Yes,86-0307623,99180AZ0260001,Smile for Health Certified Low Option Plus (100-100-100),99180AZ026,,AZN001,AZS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$3.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,99180AZ0260001-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,99180,HIOS,2,2014-09-05 03:32:16,4,99180,AZ,SHOP (Small Group),Yes,86-0307623,99180AZ0210001,Smile for Health Certified Basic Option (90-50-50),99180AZ021,,AZN001,AZS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$0.74,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,99180AZ0210001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,99180,HIOS,2,2014-09-05 03:32:16,5,99180,AZ,SHOP (Small Group),Yes,86-0307623,99180AZ0230001,Smile for Health Certified High Option (100-50-50),99180AZ023,,AZN001,AZS001,,New,PPO,High,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$4.41,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,99180AZ0230001-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AZ,99180,HIOS,2,2014-09-05 03:32:16,6,99180,AZ,SHOP (Small Group),Yes,86-0307623,99180AZ0250001,Smile for Health Certified Low Option (100-100-100),99180AZ025,,AZN001,AZS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$0.74,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,99180AZ0250001-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,3,16842,FL,Individual,No,59-2015694,16842FL0120060,BlueSelect Everyday Health 1464,16842FL012,,FLN002,FLS002,FLF014,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1464_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1464_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120060-01,Standard Silver On Exchange Plan,68.36%,0.683605074882507,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,000",Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,3,16842,FL,Individual,No,59-2015694,16842FL0120060,BlueSelect Everyday Health 1464,16842FL012,,FLN002,FLS002,FLF014,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1464_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1464_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120060-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,3,16842,FL,Individual,No,59-2015694,16842FL0120060,BlueSelect Everyday Health 1464,16842FL012,,FLN002,FLS002,FLF014,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1464_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1464_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120060-03,Limited Cost Sharing Plan Variation,68.36%,0.683605074882507,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,000",Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,3,16842,FL,Individual,No,59-2015694,16842FL0120060,BlueSelect Everyday Health 1464,16842FL012,,FLN002,FLS002,FLF014,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1464_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1464_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120060-04,73% AV Level Silver Plan,73.54%,0.735352694988251,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,800","$25,000",Not Applicable,Not Applicable,"$3,500","$7,000",10%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,3,16842,FL,Individual,No,59-2015694,16842FL0120060,BlueSelect Everyday Health 1464,16842FL012,,FLN002,FLS002,FLF014,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1464_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1464_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120060-05,87% AV Level Silver Plan,86.80%,0.898064911365509,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,800","$25,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,3,16842,FL,Individual,No,59-2015694,16842FL0120060,BlueSelect Everyday Health 1464,16842FL012,,FLN002,FLS002,FLF014,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1464_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1464_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120060-06,94% AV Level Silver Plan,94.35%,0.945072710514069,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,800","$25,000",Not Applicable,Not Applicable,$600,"$1,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,4,16842,FL,Individual,No,59-2015694,16842FL0070102,BlueOptions Everyday Health 1418,16842FL007,,FLN001,FLS001,FLF002,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1418_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1418_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070102-00,Standard Platinum Off Exchange Plan,88.34%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800",Not Applicable,Not Applicable,$800,"$1,600",10%,,,,"$2,400","$4,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,4,16842,FL,Individual,No,59-2015694,16842FL0070102,BlueOptions Everyday Health 1418,16842FL007,,FLN001,FLS001,FLF002,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1418_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1418_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070102-01,Standard Platinum On Exchange Plan,88.34%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800",Not Applicable,Not Applicable,$800,"$1,600",10%,,,,"$2,400","$4,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,4,16842,FL,Individual,No,59-2015694,16842FL0070102,BlueOptions Everyday Health 1418,16842FL007,,FLN001,FLS001,FLF002,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1418_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1418_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070102-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,4,16842,FL,Individual,No,59-2015694,16842FL0070102,BlueOptions Everyday Health 1418,16842FL007,,FLN001,FLS001,FLF002,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1418_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1418_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070102-03,Limited Cost Sharing Plan Variation,88.34%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800",Not Applicable,Not Applicable,$800,"$1,600",10%,,,,"$2,400","$4,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,4,16842,FL,Individual,No,59-2015694,16842FL0120062,BlueSelect Everyday Health 1451,16842FL012,,FLN002,FLS002,FLF010,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1451_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1451_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120062-00,Standard Platinum Off Exchange Plan,88.34%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800",Not Applicable,Not Applicable,$800,"$1,600",10%,,,,"$2,400","$4,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,4,16842,FL,Individual,No,59-2015694,16842FL0120062,BlueSelect Everyday Health 1451,16842FL012,,FLN002,FLS002,FLF010,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1451_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1451_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120062-01,Standard Platinum On Exchange Plan,88.34%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800",Not Applicable,Not Applicable,$800,"$1,600",10%,,,,"$2,400","$4,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,4,16842,FL,Individual,No,59-2015694,16842FL0120062,BlueSelect Everyday Health 1451,16842FL012,,FLN002,FLS002,FLF010,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1451_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1451_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120062-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,4,16842,FL,Individual,No,59-2015694,16842FL0120062,BlueSelect Everyday Health 1451,16842FL012,,FLN002,FLS002,FLF010,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1451_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1451_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120062-03,Limited Cost Sharing Plan Variation,88.34%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800",Not Applicable,Not Applicable,$800,"$1,600",10%,,,,"$2,400","$4,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,FL,15833,HIOS,10,2015-01-16 17:32:32,2,15833,FL,SHOP (Small Group),Yes,13-5123390,15833FL0090002,Managed DentalGuard FL10 Family Plan,15833FL009,,FLN002,FLS003,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$9.02,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,15833FL0090002-01,Standard Low On Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,15833,HIOS,10,2015-01-16 17:32:32,2,15833,FL,SHOP (Small Group),Yes,13-5123390,15833FL0100002,Managed DentalGuard FL20 Family Plan,15833FL010,,FLN002,FLS003,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$9.02,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,15833FL0100002-00,Standard Low Off Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,FL,15833,HIOS,10,2015-01-16 17:32:32,2,15833,FL,SHOP (Small Group),Yes,13-5123390,15833FL0110002,Managed DentalGuard FL30 Family Plan,15833FL011,,FLN002,FLS003,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$9.02,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,15833FL0110002-00,Standard Low Off Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,FL,15833,HIOS,10,2015-01-16 17:32:32,3,15833,FL,SHOP (Small Group),Yes,13-5123390,15833FL0010002,Guardian Pediatric Advantage,15833FL001,,FLN001,FLS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.69,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,15833FL0010002-00,Standard High Off Exchange Plan,84.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,15833,HIOS,10,2015-01-16 17:32:32,3,15833,FL,SHOP (Small Group),Yes,13-5123390,15833FL0020002,Guardian Pediatric Essentials,15833FL002,,FLN001,FLS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$18.96,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,15833FL0020002-00,Standard Low Off Exchange Plan,71.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,15833,HIOS,10,2015-01-16 17:32:32,4,15833,FL,SHOP (Small Group),Yes,13-5123390,15833FL0040002,Guardian Family Advantage,15833FL004,,FLN001,FLS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.69,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,15833FL0040002-00,Standard High Off Exchange Plan,84.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,15833,HIOS,10,2015-01-16 17:32:32,4,15833,FL,SHOP (Small Group),Yes,13-5123390,15833FL0040002,Guardian Family Advantage,15833FL004,,FLN001,FLS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.69,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,15833FL0040002-01,Standard High On Exchange Plan,84.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,15833,HIOS,10,2015-01-16 17:32:32,4,15833,FL,SHOP (Small Group),Yes,13-5123390,15833FL0060002,Guardian Family Essentials,15833FL006,,FLN001,FLS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.96,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,15833FL0060002-00,Standard Low Off Exchange Plan,71.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,FL,15833,HIOS,10,2015-01-16 17:32:32,4,15833,FL,SHOP (Small Group),Yes,13-5123390,15833FL0060002,Guardian Family Essentials,15833FL006,,FLN001,FLS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.96,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,15833FL0060002-01,Standard Low On Exchange Plan,71.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,FL,15980,HIOS,11,2015-01-16 17:32:32,1,15980,FL,Individual,Yes,39-1263473,15980FL0160001,Humana Dental Smart Choice,15980FL016,,FLN001,FLS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.10,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541188,,15980FL0160001-00,Standard Low Off Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,15980,HIOS,11,2015-01-16 17:32:32,1,15980,FL,Individual,Yes,39-1263473,15980FL0160001,Humana Dental Smart Choice,15980FL016,,FLN001,FLS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.10,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541188,,15980FL0160001-01,Standard Low On Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,5,16842,FL,Individual,No,59-2015694,16842FL0120066,BlueSelect Everyday Health Premier 1451V,16842FL012,,FLN002,FLS002,FLF010,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.9455,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1451V_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1451V_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120066-00,Standard Platinum Off Exchange Plan,88.34%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800",Not Applicable,Not Applicable,$800,"$1,600",10%,,,,"$2,400","$4,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,5,16842,FL,Individual,No,59-2015694,16842FL0120066,BlueSelect Everyday Health Premier 1451V,16842FL012,,FLN002,FLS002,FLF010,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.9455,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1451V_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1451V_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120066-01,Standard Platinum On Exchange Plan,88.34%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800",Not Applicable,Not Applicable,$800,"$1,600",10%,,,,"$2,400","$4,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,5,16842,FL,Individual,No,59-2015694,16842FL0120066,BlueSelect Everyday Health Premier 1451V,16842FL012,,FLN002,FLS002,FLF010,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.9455,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1451V_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1451V_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120066-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,5,16842,FL,Individual,No,59-2015694,16842FL0120066,BlueSelect Everyday Health Premier 1451V,16842FL012,,FLN002,FLS002,FLF010,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.9455,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1451V_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1451V_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120066-03,Limited Cost Sharing Plan Variation,88.34%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800",Not Applicable,Not Applicable,$800,"$1,600",10%,,,,"$2,400","$4,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,6,16842,FL,Individual,No,59-2015694,16842FL0070108,BlueOptions Everyday Health 1416,16842FL007,,FLN001,FLS001,FLF003,Existing,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1416_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1416_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070108-00,Standard Bronze Off Exchange Plan,60.20%,0.607653260231018,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,6,16842,FL,Individual,No,59-2015694,16842FL0070108,BlueOptions Everyday Health 1416,16842FL007,,FLN001,FLS001,FLF003,Existing,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1416_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1416_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070108-01,Standard Bronze On Exchange Plan,60.20%,0.607653260231018,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,6,16842,FL,Individual,No,59-2015694,16842FL0070108,BlueOptions Everyday Health 1416,16842FL007,,FLN001,FLS001,FLF003,Existing,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1416_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1416_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070108-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,6,16842,FL,Individual,No,59-2015694,16842FL0070108,BlueOptions Everyday Health 1416,16842FL007,,FLN001,FLS001,FLF003,Existing,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1416_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1416_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070108-03,Limited Cost Sharing Plan Variation,60.20%,0.607653260231018,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,8,16842,FL,Individual,No,59-2015694,16842FL0070114,BlueOptions Everyday Health 1410,16842FL007,,FLN001,FLS001,FLF007,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1410_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1410_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070114-00,Standard Silver Off Exchange Plan,68.92%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$23,000","$25,000",Not Applicable,Not Applicable,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,8,16842,FL,Individual,No,59-2015694,16842FL0070114,BlueOptions Everyday Health 1410,16842FL007,,FLN001,FLS001,FLF007,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1410_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1410_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070114-01,Standard Silver On Exchange Plan,68.92%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$23,000","$25,000",Not Applicable,Not Applicable,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,1,27357,FL,Individual,No,59-3315064,27357FL1820022,HF Bronze HMO Select 100 1251,27357FL182,,FLN001,FLS001,FLF001,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9767,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820022-03,Limited Cost Sharing Plan Variation,59.20%,0.590581178665161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,1,27357,FL,Individual,No,59-3315064,27357FL1820024,HF Bronze HMO Select 80 1261,27357FL182,,FLN001,FLS001,FLF004,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9777,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820024-00,Standard Bronze Off Exchange Plan,61.50%,0.607556462287903,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,1,27357,FL,Individual,No,59-3315064,27357FL1820022,HF Bronze HMO Select 100 1251,27357FL182,,FLN001,FLS001,FLF001,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9767,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820022-00,Standard Bronze Off Exchange Plan,59.20%,0.590581178665161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,1,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840001,HF Platinum HMO Select 100 5002,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9843,,,4,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.HealthFirstHealthPlans.org/MHS,www.HealthFirstHealthPlans.org/MHS,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840001-00,Standard Platinum Off Exchange Plan,90.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,1,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840001,HF Platinum HMO Select 100 5002,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9843,,,4,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.HealthFirstHealthPlans.org/MHS,www.HealthFirstHealthPlans.org/MHS,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840001-01,Standard Platinum On Exchange Plan,90.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,1,27357,FL,Individual,No,59-3315064,27357FL1820022,HF Bronze HMO Select 100 1251,27357FL182,,FLN001,FLS001,FLF001,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9767,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820022-01,Standard Bronze On Exchange Plan,59.20%,0.590581178665161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,1,27357,FL,Individual,No,59-3315064,27357FL1820022,HF Bronze HMO Select 100 1251,27357FL182,,FLN001,FLS001,FLF001,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9767,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820022-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,1,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850001,HF Platinum POS Select 100 5003,27357FL185,,FLN001,FLS001,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9855,,,4,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850001-00,Standard Platinum Off Exchange Plan,90.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,1,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850001,HF Platinum POS Select 100 5003,27357FL185,,FLN001,FLS001,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9855,,,4,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850001-01,Standard Platinum On Exchange Plan,90.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,2,16842,FL,Individual,No,59-2015694,16842FL0070084,BlueOptions Essential (HSA) 1419,16842FL007,,FLN001,FLS001,FLF011,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1419_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1419_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070084-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,2,16842,FL,Individual,No,59-2015694,16842FL0070084,BlueOptions Essential (HSA) 1419,16842FL007,,FLN001,FLS001,FLF011,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1419_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1419_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070084-03,Limited Cost Sharing Plan Variation,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,2,16842,FL,Individual,No,59-2015694,16842FL0120044,BlueSelect Essential (HSA) 1452,16842FL012,,FLN002,FLS002,FLF020,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1452_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1452_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120044-00,Standard Bronze Off Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,2,16842,FL,Individual,No,59-2015694,16842FL0120044,BlueSelect Essential (HSA) 1452,16842FL012,,FLN002,FLS002,FLF020,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1452_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1452_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120044-01,Standard Bronze On Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,2,16842,FL,Individual,No,59-2015694,16842FL0120044,BlueSelect Essential (HSA) 1452,16842FL012,,FLN002,FLS002,FLF020,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1452_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1452_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120044-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,2,16842,FL,Individual,No,59-2015694,16842FL0120044,BlueSelect Essential (HSA) 1452,16842FL012,,FLN002,FLS002,FLF020,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1452_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1452_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120044-03,Limited Cost Sharing Plan Variation,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,3,16842,FL,Individual,No,59-2015694,16842FL0070100,BlueOptions Everyday Health 1431,16842FL007,,FLN001,FLS001,FLF006,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1431_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1431_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070100-00,Standard Silver Off Exchange Plan,68.36%,0.683605074882507,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,000",Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,3,16842,FL,Individual,No,59-2015694,16842FL0070100,BlueOptions Everyday Health 1431,16842FL007,,FLN001,FLS001,FLF006,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1431_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1431_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070100-01,Standard Silver On Exchange Plan,68.36%,0.683605074882507,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,000",Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,3,16842,FL,Individual,No,59-2015694,16842FL0070100,BlueOptions Everyday Health 1431,16842FL007,,FLN001,FLS001,FLF006,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1431_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1431_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070100-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,3,16842,FL,Individual,No,59-2015694,16842FL0070100,BlueOptions Everyday Health 1431,16842FL007,,FLN001,FLS001,FLF006,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1431_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1431_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070100-03,Limited Cost Sharing Plan Variation,68.36%,0.683605074882507,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,000",Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,3,16842,FL,Individual,No,59-2015694,16842FL0070100,BlueOptions Everyday Health 1431,16842FL007,,FLN001,FLS001,FLF006,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1431_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1431_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070100-04,73% AV Level Silver Plan,73.54%,0.735352694988251,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,800","$25,000",Not Applicable,Not Applicable,"$3,500","$7,000",10%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,3,16842,FL,Individual,No,59-2015694,16842FL0070100,BlueOptions Everyday Health 1431,16842FL007,,FLN001,FLS001,FLF006,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1431_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1431_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070100-05,87% AV Level Silver Plan,86.80%,0.898064911365509,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,800","$25,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,3,16842,FL,Individual,No,59-2015694,16842FL0070100,BlueOptions Everyday Health 1431,16842FL007,,FLN001,FLS001,FLF006,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1431_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1431_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070100-06,94% AV Level Silver Plan,94.35%,0.945072710514069,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,800","$25,000",Not Applicable,Not Applicable,$600,"$1,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,3,16842,FL,Individual,No,59-2015694,16842FL0120060,BlueSelect Everyday Health 1464,16842FL012,,FLN002,FLS002,FLF014,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1464_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1464_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120060-00,Standard Silver Off Exchange Plan,68.36%,0.683605074882507,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,000",Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,5,16842,FL,Individual,No,59-2015694,16842FL0070106,BlueOptions Everyday Health Premier 1418V,16842FL007,,FLN001,FLS001,FLF002,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.9455,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1418V_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1418V_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070106-00,Standard Platinum Off Exchange Plan,88.34%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800",Not Applicable,Not Applicable,$800,"$1,600",10%,,,,"$2,400","$4,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,5,16842,FL,Individual,No,59-2015694,16842FL0070106,BlueOptions Everyday Health Premier 1418V,16842FL007,,FLN001,FLS001,FLF002,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.9455,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1418V_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1418V_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070106-01,Standard Platinum On Exchange Plan,88.34%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800",Not Applicable,Not Applicable,$800,"$1,600",10%,,,,"$2,400","$4,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,5,16842,FL,Individual,No,59-2015694,16842FL0070106,BlueOptions Everyday Health Premier 1418V,16842FL007,,FLN001,FLS001,FLF002,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.9455,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1418V_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1418V_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070106-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,5,16842,FL,Individual,No,59-2015694,16842FL0070106,BlueOptions Everyday Health Premier 1418V,16842FL007,,FLN001,FLS001,FLF002,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.9455,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1418V_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1418V_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070106-03,Limited Cost Sharing Plan Variation,88.34%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800",Not Applicable,Not Applicable,$800,"$1,600",10%,,,,"$2,400","$4,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,6,16842,FL,Individual,No,59-2015694,16842FL0120068,BlueSelect Everyday Health 1449,16842FL012,,FLN002,FLS002,FLF012,Existing,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1449_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1449_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120068-00,Standard Bronze Off Exchange Plan,60.20%,0.607653260231018,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,6,16842,FL,Individual,No,59-2015694,16842FL0120068,BlueSelect Everyday Health 1449,16842FL012,,FLN002,FLS002,FLF012,Existing,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1449_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1449_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120068-01,Standard Bronze On Exchange Plan,60.20%,0.607653260231018,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,6,16842,FL,Individual,No,59-2015694,16842FL0120068,BlueSelect Everyday Health 1449,16842FL012,,FLN002,FLS002,FLF012,Existing,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1449_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1449_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120068-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,6,16842,FL,Individual,No,59-2015694,16842FL0120068,BlueSelect Everyday Health 1449,16842FL012,,FLN002,FLS002,FLF012,Existing,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1449_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1449_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120068-03,Limited Cost Sharing Plan Variation,60.20%,0.607653260231018,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,7,16842,FL,Individual,No,59-2015694,16842FL0070110,BlueOptions All Copay 1424,16842FL007,,FLN001,FLS001,FLF005,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1424_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1424_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070110-00,Standard Platinum Off Exchange Plan,88.75%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,7,16842,FL,Individual,No,59-2015694,16842FL0070110,BlueOptions All Copay 1424,16842FL007,,FLN001,FLS001,FLF005,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1424_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1424_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070110-01,Standard Platinum On Exchange Plan,88.75%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,7,16842,FL,Individual,No,59-2015694,16842FL0070110,BlueOptions All Copay 1424,16842FL007,,FLN001,FLS001,FLF005,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1424_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1424_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070110-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,7,16842,FL,Individual,No,59-2015694,16842FL0070110,BlueOptions All Copay 1424,16842FL007,,FLN001,FLS001,FLF005,Existing,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1424_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1424_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070110-03,Limited Cost Sharing Plan Variation,88.75%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,8,16842,FL,Individual,No,59-2015694,16842FL0070114,BlueOptions Everyday Health 1410,16842FL007,,FLN001,FLS001,FLF007,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1410_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1410_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070114-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,8,16842,FL,Individual,No,59-2015694,16842FL0070114,BlueOptions Everyday Health 1410,16842FL007,,FLN001,FLS001,FLF007,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1410_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1410_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070114-03,Limited Cost Sharing Plan Variation,68.92%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$23,000","$25,000",Not Applicable,Not Applicable,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,1,27357,FL,Individual,No,59-3315064,27357FL1820024,HF Bronze HMO Select 80 1261,27357FL182,,FLN001,FLS001,FLF004,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9777,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820024-01,Standard Bronze On Exchange Plan,61.50%,0.607556462287903,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,1,27357,FL,Individual,No,59-3315064,27357FL1820024,HF Bronze HMO Select 80 1261,27357FL182,,FLN001,FLS001,FLF004,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9777,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820024-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,1,27357,FL,Individual,No,59-3315064,27357FL1820024,HF Bronze HMO Select 80 1261,27357FL182,,FLN001,FLS001,FLF004,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9777,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820024-03,Limited Cost Sharing Plan Variation,61.50%,0.607556462287903,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,1,27357,FL,Individual,No,59-3315064,27357FL1830022,HF Bronze POS Select 100 1252,27357FL183,,FLN001,FLS001,FLF001,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9781,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830022-00,Standard Bronze Off Exchange Plan,59.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,1,27357,FL,Individual,No,59-3315064,27357FL1830022,HF Bronze POS Select 100 1252,27357FL183,,FLN001,FLS001,FLF001,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9781,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830022-01,Standard Bronze On Exchange Plan,59.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,1,27357,FL,Individual,No,59-3315064,27357FL1830022,HF Bronze POS Select 100 1252,27357FL183,,FLN001,FLS001,FLF001,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9781,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830022-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,1,27357,FL,Individual,No,59-3315064,27357FL1830022,HF Bronze POS Select 100 1252,27357FL183,,FLN001,FLS001,FLF001,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9781,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830022-03,Limited Cost Sharing Plan Variation,59.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,8,16842,FL,Individual,No,59-2015694,16842FL0070114,BlueOptions Everyday Health 1410,16842FL007,,FLN001,FLS001,FLF007,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1410_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1410_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070114-04,73% AV Level Silver Plan,73.57%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$23,000","$25,000",Not Applicable,Not Applicable,"$4,000","$9,000",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,8,16842,FL,Individual,No,59-2015694,16842FL0070114,BlueOptions Everyday Health 1410,16842FL007,,FLN001,FLS001,FLF007,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1410_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1410_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070114-05,87% AV Level Silver Plan,87.61%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$23,000","$25,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,1,27357,FL,Individual,No,59-3315064,27357FL1830024,HF Bronze POS Select 80 1262,27357FL183,,FLN001,FLS001,FLF004,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.979,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830024-03,Limited Cost Sharing Plan Variation,61.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,2,27357,FL,Individual,No,59-3315064,27357FL1820025,HF Bronze HMO Select 70 1265,27357FL182,,FLN001,FLS001,FLF005,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.977,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent care only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820025-00,Standard Bronze Off Exchange Plan,61.30%,0.609520673751831,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,600","$9,200",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,2,27357,FL,Individual,No,59-3315064,27357FL1820025,HF Bronze HMO Select 70 1265,27357FL182,,FLN001,FLS001,FLF005,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.977,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent care only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820025-01,Standard Bronze On Exchange Plan,61.30%,0.609520673751831,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,600","$9,200",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,2,27357,FL,Individual,No,59-3315064,27357FL1820025,HF Bronze HMO Select 70 1265,27357FL182,,FLN001,FLS001,FLF005,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.977,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent care only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820025-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,2,27357,FL,Individual,No,59-3315064,27357FL1820025,HF Bronze HMO Select 70 1265,27357FL182,,FLN001,FLS001,FLF005,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.977,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent care only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820025-03,Limited Cost Sharing Plan Variation,61.30%,0.609520673751831,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,600","$9,200",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,2,27357,FL,Individual,No,59-3315064,27357FL1830025,HF Bronze POS Select 70 1266,27357FL183,,FLN001,FLS001,FLF005,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9784,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent care only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830025-00,Standard Bronze Off Exchange Plan,61.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,600","$9,200",30%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,2,27357,FL,Individual,No,59-3315064,27357FL1830025,HF Bronze POS Select 70 1266,27357FL183,,FLN001,FLS001,FLF005,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9784,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent care only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830025-01,Standard Bronze On Exchange Plan,61.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,600","$9,200",30%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,2,27357,FL,Individual,No,59-3315064,27357FL1830025,HF Bronze POS Select 70 1266,27357FL183,,FLN001,FLS001,FLF005,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9784,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent care only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830025-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,2,27357,FL,Individual,No,59-3315064,27357FL1830025,HF Bronze POS Select 70 1266,27357FL183,,FLN001,FLS001,FLF005,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9784,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent care only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830025-03,Limited Cost Sharing Plan Variation,61.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,600","$9,200",30%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,3,27357,FL,Individual,No,59-3315064,27357FL1820023,HF Bronze HMO Select 90 1254,27357FL182,,FLN001,FLS001,FLF007,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9785,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820023-00,Standard Bronze Off Exchange Plan,61.80%,0.616467893123627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,3,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840003,HF Platinum HMO Select 100 5016,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9842,,,4,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840003-00,Standard Platinum Off Exchange Plan,90.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,8,16842,FL,Individual,No,59-2015694,16842FL0120072,BlueSelect Everyday Health 1443,16842FL012,,FLN002,FLS002,FLF018,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1443_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1443_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120072-01,Standard Silver On Exchange Plan,68.92%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$23,000","$25,000",Not Applicable,Not Applicable,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,8,16842,FL,Individual,No,59-2015694,16842FL0120072,BlueSelect Everyday Health 1443,16842FL012,,FLN002,FLS002,FLF018,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1443_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1443_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120072-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,8,16842,FL,Individual,No,59-2015694,16842FL0120072,BlueSelect Everyday Health 1443,16842FL012,,FLN002,FLS002,FLF018,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1443_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1443_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120072-03,Limited Cost Sharing Plan Variation,68.92%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$23,000","$25,000",Not Applicable,Not Applicable,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,8,16842,FL,Individual,No,59-2015694,16842FL0120072,BlueSelect Everyday Health 1443,16842FL012,,FLN002,FLS002,FLF018,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1443_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1443_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120072-04,73% AV Level Silver Plan,73.57%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$23,000","$25,000",Not Applicable,Not Applicable,"$4,000","$9,000",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,8,16842,FL,Individual,No,59-2015694,16842FL0120072,BlueSelect Everyday Health 1443,16842FL012,,FLN002,FLS002,FLF018,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1443_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1443_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120072-05,87% AV Level Silver Plan,87.61%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$23,000","$25,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,8,16842,FL,Individual,No,59-2015694,16842FL0120072,BlueSelect Everyday Health 1443,16842FL012,,FLN002,FLS002,FLF018,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1443_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1443_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120072-06,94% AV Level Silver Plan,93.51%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$23,000","$25,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,4,27357,FL,Individual,No,59-3315064,27357FL1830026,HF Catastrophic POS Select 1269,27357FL183,,FLN001,FLS001,FLF001,New,POS,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9646,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830026-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,4,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860004,FHCA Platinum HMO Enhanced 100 5027,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.984,,,4,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860004-00,Standard Platinum Off Exchange Plan,88.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,4,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860004,FHCA Platinum HMO Enhanced 100 5027,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.984,,,4,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860004-01,Standard Platinum On Exchange Plan,88.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,4,27357,FL,Individual,No,59-3315064,27357FL1830026,HF Catastrophic POS Select 1269,27357FL183,,FLN001,FLS001,FLF001,New,POS,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9646,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830026-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,4,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850004,HF Platinum POS Select 100 5024,27357FL185,,FLN001,FLS001,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9852,,,4,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850004-00,Standard Platinum Off Exchange Plan,88.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,4,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850004,HF Platinum POS Select 100 5024,27357FL185,,FLN001,FLS001,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9852,,,4,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850004-01,Standard Platinum On Exchange Plan,88.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,4,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870004,FHCA Platinum POS Enhanced 100 5028,27357FL187,,FLN002,FLS002,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9852,,,4,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870004-00,Standard Platinum Off Exchange Plan,88.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,4,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870004,FHCA Platinum POS Enhanced 100 5028,27357FL187,,FLN002,FLS002,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9852,,,4,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870004-01,Standard Platinum On Exchange Plan,88.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,5,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840005,HF Platinum HMO Select 90 5030,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9842,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840005-00,Standard Platinum Off Exchange Plan,89.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,5,27357,FL,Individual,No,59-3315064,27357FL1820028,HF Platinum HMO Select 100 1300,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9873,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820028-00,Standard Platinum Off Exchange Plan,88.10%,0.925224006175995,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,5,27357,FL,Individual,No,59-3315064,27357FL1820028,HF Platinum HMO Select 100 1300,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9873,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820028-01,Standard Platinum On Exchange Plan,88.10%,0.925224006175995,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,5,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840005,HF Platinum HMO Select 90 5030,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9842,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840005-01,Standard Platinum On Exchange Plan,89.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,5,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860005,FHCA Platinum HMO Enhanced 90 5034,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9842,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860005-00,Standard Platinum Off Exchange Plan,89.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,5,27357,FL,Individual,No,59-3315064,27357FL1820028,HF Platinum HMO Select 100 1300,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9873,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820028-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,9,16842,FL,Individual,No,59-2015694,16842FL0070120,BlueOptions All Copay 1505,16842FL007,,FLN001,FLS001,FLF002,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1505_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1505_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070120-00,Standard Gold Off Exchange Plan,81.94%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,9,16842,FL,Individual,No,59-2015694,16842FL0070120,BlueOptions All Copay 1505,16842FL007,,FLN001,FLS001,FLF002,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1505_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1505_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070120-01,Standard Gold On Exchange Plan,81.94%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,9,16842,FL,Individual,No,59-2015694,16842FL0070120,BlueOptions All Copay 1505,16842FL007,,FLN001,FLS001,FLF002,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1505_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1505_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070120-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,9,16842,FL,Individual,No,59-2015694,16842FL0070120,BlueOptions All Copay 1505,16842FL007,,FLN001,FLS001,FLF002,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1505_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1505_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0070120-03,Limited Cost Sharing Plan Variation,81.94%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,9,16842,FL,Individual,No,59-2015694,16842FL0120076,BlueSelect All Copay 1535,16842FL012,,FLN002,FLS002,FLF010,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1535_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1535_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120076-00,Standard Gold Off Exchange Plan,81.94%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,9,16842,FL,Individual,No,59-2015694,16842FL0120076,BlueSelect All Copay 1535,16842FL012,,FLN002,FLS002,FLF010,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1535_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1535_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120076-01,Standard Gold On Exchange Plan,81.94%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,9,16842,FL,Individual,No,59-2015694,16842FL0120076,BlueSelect All Copay 1535,16842FL012,,FLN002,FLS002,FLF010,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1535_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1535_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120076-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,16842,HIOS,6,2015-05-20 14:11:45,9,16842,FL,Individual,No,59-2015694,16842FL0120076,BlueSelect All Copay 1535,16842FL012,,FLN002,FLS002,FLF010,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered services as outlined in the member contract.,Yes,Covered services as outlined in the member contract.,Yes,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1535_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1535_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,16842FL0120076-03,Limited Cost Sharing Plan Variation,81.94%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,1,18628,FL,Individual,No,59-2411584,18628FL0120001,Aetna Bronze $20 Copay Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF010,New,HMO,Bronze,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120001-00,Standard Bronze Off Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,1,18628,FL,Individual,No,59-2411584,18628FL0120001,Aetna Bronze $20 Copay Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF010,New,HMO,Bronze,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120001-01,Standard Bronze On Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,1,18628,FL,Individual,No,59-2411584,18628FL0120001,Aetna Bronze $20 Copay Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF010,New,HMO,Bronze,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,1,18628,FL,Individual,No,59-2411584,18628FL0120001,Aetna Bronze $20 Copay Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF010,New,HMO,Bronze,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120001-03,Limited Cost Sharing Plan Variation,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,3,18628,FL,Individual,No,59-2411584,18628FL0120002,Aetna Bronze Deductible Only HSA Eligible Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF011,New,HMO,Bronze,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120002-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,3,18628,FL,Individual,No,59-2411584,18628FL0120002,Aetna Bronze Deductible Only HSA Eligible Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF011,New,HMO,Bronze,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120002-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,3,18628,FL,Individual,No,59-2411584,18628FL0120002,Aetna Bronze Deductible Only HSA Eligible Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF011,New,HMO,Bronze,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,3,18628,FL,Individual,No,59-2411584,18628FL0120002,Aetna Bronze Deductible Only HSA Eligible Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF011,New,HMO,Bronze,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120002-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,7,18628,FL,Individual,No,59-2411584,18628FL0120005,Aetna Silver $10 Copay Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF014,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120005-00,Standard Silver Off Exchange Plan,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,$500,$0,,,,,,,,,,,,,,,,,,,4
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,7,18628,FL,Individual,No,59-2411584,18628FL0120005,Aetna Silver $10 Copay Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF014,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120005-01,Standard Silver On Exchange Plan,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,5
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,7,18628,FL,Individual,No,59-2411584,18628FL0120005,Aetna Silver $10 Copay Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF014,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120005-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,7,18628,FL,Individual,No,59-2411584,18628FL0120005,Aetna Silver $10 Copay Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF014,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120005-03,Limited Cost Sharing Plan Variation,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,7
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,7,18628,FL,Individual,No,59-2411584,18628FL0120005,Aetna Silver $10 Copay Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF014,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120005-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,8
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,7,18628,FL,Individual,No,59-2411584,18628FL0120005,Aetna Silver $10 Copay Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF014,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120005-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,7,18628,FL,Individual,No,59-2411584,18628FL0120005,Aetna Silver $10 Copay Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF014,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120005-06,94% AV Level Silver Plan,93.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,9,18628,FL,Individual,No,59-2411584,18628FL0120006,Aetna Silver $5 Copay 2750 Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF015,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120006-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,9,18628,FL,Individual,No,59-2411584,18628FL0120006,Aetna Silver $5 Copay 2750 Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF015,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120006-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,9,18628,FL,Individual,No,59-2411584,18628FL0120006,Aetna Silver $5 Copay 2750 Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF015,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,9,18628,FL,Individual,No,59-2411584,18628FL0120006,Aetna Silver $5 Copay 2750 Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF015,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120006-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,9,18628,FL,Individual,No,59-2411584,18628FL0120006,Aetna Silver $5 Copay 2750 Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF015,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120006-04,73% AV Level Silver Plan,72.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,9,18628,FL,Individual,No,59-2411584,18628FL0120006,Aetna Silver $5 Copay 2750 Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF015,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120006-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,9,18628,FL,Individual,No,59-2411584,18628FL0120006,Aetna Silver $5 Copay 2750 Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF015,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120006-06,94% AV Level Silver Plan,93.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,12,18628,FL,Individual,No,59-2411584,18628FL0120004,Aetna Gold $5 Copay Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF013,New,HMO,Gold,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120004-00,Standard Gold Off Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,$250,$0,,,,,,,,,,,,,,,,,,,4
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,12,18628,FL,Individual,No,59-2411584,18628FL0120004,Aetna Gold $5 Copay Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF013,New,HMO,Gold,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120004-01,Standard Gold On Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,$250,$500,,,,,,,,,,,,,,,,,,,5
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,12,18628,FL,Individual,No,59-2411584,18628FL0120004,Aetna Gold $5 Copay Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF013,New,HMO,Gold,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120004-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,12,18628,FL,Individual,No,59-2411584,18628FL0120004,Aetna Gold $5 Copay Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF013,New,HMO,Gold,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120004-03,Limited Cost Sharing Plan Variation,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,$250,$500,,,,,,,,,,,,,,,,,,,7
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,14,18628,FL,Individual,No,59-2411584,18628FL0120003,Aetna Catastrophic 100% Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF012,New,HMO,Catastrophic,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120003-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,18628,HIOS,6,2014-09-06 03:39:47,14,18628,FL,Individual,No,59-2411584,18628FL0120003,Aetna Catastrophic 100% Savings Plus HMO,18628FL012,,FLN001,FLS001,FLF012,New,HMO,Catastrophic,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/florida-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1557441903,18628FL0120003-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,1,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870001,FHCA Platinum POS Enhanced 100 5007,27357FL187,,FLN002,FLS002,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9855,,,4,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870001-00,Standard Platinum Off Exchange Plan,90.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,1,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870001,FHCA Platinum POS Enhanced 100 5007,27357FL187,,FLN002,FLS002,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9855,,,4,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870001-01,Standard Platinum On Exchange Plan,90.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,1,27357,FL,Individual,No,59-3315064,27357FL1830024,HF Bronze POS Select 80 1262,27357FL183,,FLN001,FLS001,FLF004,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.979,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830024-00,Standard Bronze Off Exchange Plan,61.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,1,27357,FL,Individual,No,59-3315064,27357FL1830024,HF Bronze POS Select 80 1262,27357FL183,,FLN001,FLS001,FLF004,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.979,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830024-01,Standard Bronze On Exchange Plan,61.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,1,27357,FL,Individual,No,59-3315064,27357FL1830024,HF Bronze POS Select 80 1262,27357FL183,,FLN001,FLS001,FLF004,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.979,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830024-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,18
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,3,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840003,HF Platinum HMO Select 100 5016,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9842,,,4,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840003-01,Standard Platinum On Exchange Plan,90.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,3,27357,FL,Individual,No,59-3315064,27357FL1820023,HF Bronze HMO Select 90 1254,27357FL182,,FLN001,FLS001,FLF007,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9785,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820023-01,Standard Bronze On Exchange Plan,61.80%,0.616467893123627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,3,27357,FL,Individual,No,59-3315064,27357FL1820023,HF Bronze HMO Select 90 1254,27357FL182,,FLN001,FLS001,FLF007,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9785,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820023-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,3,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860003,FHCA Platinum HMO Enhanced 100 5020,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9842,,,4,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860003-00,Standard Platinum Off Exchange Plan,90.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,3,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860003,FHCA Platinum HMO Enhanced 100 5020,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9842,,,4,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860003-01,Standard Platinum On Exchange Plan,90.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,3,27357,FL,Individual,No,59-3315064,27357FL1820023,HF Bronze HMO Select 90 1254,27357FL182,,FLN001,FLS001,FLF007,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9785,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820023-03,Limited Cost Sharing Plan Variation,61.80%,0.616467893123627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,3,27357,FL,Individual,No,59-3315064,27357FL1830023,HF Bronze POS Select 90 1255,27357FL183,,FLN001,FLS001,FLF007,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9796,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830023-00,Standard Bronze Off Exchange Plan,61.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$6,000","$12,000",10%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$350,$700,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,3,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850003,HF Platinum POS Select 100 5017,27357FL185,,FLN001,FLS001,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9854,,,4,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850003-00,Standard Platinum Off Exchange Plan,90.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,3,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850003,HF Platinum POS Select 100 5017,27357FL185,,FLN001,FLS001,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9854,,,4,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850003-01,Standard Platinum On Exchange Plan,90.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,3,27357,FL,Individual,No,59-3315064,27357FL1830023,HF Bronze POS Select 90 1255,27357FL183,,FLN001,FLS001,FLF007,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9796,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830023-01,Standard Bronze On Exchange Plan,61.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$6,000","$12,000",10%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$350,$700,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,3,27357,FL,Individual,No,59-3315064,27357FL1830023,HF Bronze POS Select 90 1255,27357FL183,,FLN001,FLS001,FLF007,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9796,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830023-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,3,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870003,FHCA Platinum POS Enhanced 100 5021,27357FL187,,FLN002,FLS002,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9854,,,4,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870003-00,Standard Platinum Off Exchange Plan,90.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,3,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870003,FHCA Platinum POS Enhanced 100 5021,27357FL187,,FLN002,FLS002,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9854,,,4,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870003-01,Standard Platinum On Exchange Plan,90.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,3,27357,FL,Individual,No,59-3315064,27357FL1830023,HF Bronze POS Select 90 1255,27357FL183,,FLN001,FLS001,FLF007,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9796,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830023-03,Limited Cost Sharing Plan Variation,61.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$6,000","$12,000",10%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$350,$700,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,4,27357,FL,Individual,No,59-3315064,27357FL1820026,HF Catastrophic HMO Select 1268,27357FL182,,FLN001,FLS001,FLF001,New,HMO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9626,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820026-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,4,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840004,HF Platinum HMO Select 100 5023,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.984,,,4,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840004-00,Standard Platinum Off Exchange Plan,88.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,4,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840004,HF Platinum HMO Select 100 5023,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.984,,,4,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840004-01,Standard Platinum On Exchange Plan,88.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,4,27357,FL,Individual,No,59-3315064,27357FL1820026,HF Catastrophic HMO Select 1268,27357FL182,,FLN001,FLS001,FLF001,New,HMO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9626,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820026-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,5,27357,FL,Individual,No,59-3315064,27357FL1820028,HF Platinum HMO Select 100 1300,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9873,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820028-03,Limited Cost Sharing Plan Variation,88.10%,0.925224006175995,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,5,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860005,FHCA Platinum HMO Enhanced 90 5034,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9842,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860005-01,Standard Platinum On Exchange Plan,89.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,5,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850005,HF Platinum POS Select 90 5031,27357FL185,,FLN001,FLS001,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9855,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850005-00,Standard Platinum Off Exchange Plan,89.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,5,27357,FL,Individual,No,59-3315064,27357FL1830028,HF Platinum POS Select 100 1303,27357FL183,,FLN001,FLS001,FLF008,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9883,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830028-00,Standard Platinum Off Exchange Plan,88.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$800,"$1,600",0%,,,,"$1,600","$3,200",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,5,27357,FL,Individual,No,59-3315064,27357FL1830028,HF Platinum POS Select 100 1303,27357FL183,,FLN001,FLS001,FLF008,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9883,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830028-01,Standard Platinum On Exchange Plan,88.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$800,"$1,600",0%,,,,"$1,600","$3,200",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,5,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850005,HF Platinum POS Select 90 5031,27357FL185,,FLN001,FLS001,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9855,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850005-01,Standard Platinum On Exchange Plan,89.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,5,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870005,FHCA Platinum POS Enhanced 90 5035,27357FL187,,FLN002,FLS002,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9855,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870005-00,Standard Platinum Off Exchange Plan,89.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,5,27357,FL,Individual,No,59-3315064,27357FL1830028,HF Platinum POS Select 100 1303,27357FL183,,FLN001,FLS001,FLF008,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9883,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830028-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,5,27357,FL,Individual,No,59-3315064,27357FL1830028,HF Platinum POS Select 100 1303,27357FL183,,FLN001,FLS001,FLF008,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9883,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830028-03,Limited Cost Sharing Plan Variation,88.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$800,"$1,600",0%,,,,"$1,600","$3,200",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,5,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870005,FHCA Platinum POS Enhanced 90 5035,27357FL187,,FLN002,FLS002,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9855,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870005-01,Standard Platinum On Exchange Plan,89.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,Individual,No,59-3315064,27357FL1830002,HF Gold POS Select 90 1006,27357FL183,,FLN001,FLS001,FLF002,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9854,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830002-03,Limited Cost Sharing Plan Variation,78.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,Individual,No,59-3315064,27357FL1830010,HF Gold POS Select 50 1040,27357FL183,,FLN001,FLS001,FLF006,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9858,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830010-00,Standard Gold Off Exchange Plan,79.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,Individual,No,59-3315064,27357FL1830010,HF Gold POS Select 50 1040,27357FL183,,FLN001,FLS001,FLF006,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9858,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830010-01,Standard Gold On Exchange Plan,79.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,Individual,No,59-3315064,27357FL1830010,HF Gold POS Select 50 1040,27357FL183,,FLN001,FLS001,FLF006,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9858,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830010-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,18
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,Individual,No,59-3315064,27357FL1830010,HF Gold POS Select 50 1040,27357FL183,,FLN001,FLS001,FLF006,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9858,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830010-03,Limited Cost Sharing Plan Variation,79.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,Individual,No,59-3315064,27357FL1820003,HF Gold HMO Select 90 1009,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9847,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820003-00,Standard Gold Off Exchange Plan,78.80%,0.781295835971832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840010,HF Platinum HMO Select 90 5065,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9839,,,0,3,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.HealthFirstHealthPlans.org/MHS,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840010-00,Standard Platinum Off Exchange Plan,89.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,6,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840006,HF Platinum HMO Select 80 5037,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.984,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840006-00,Standard Platinum Off Exchange Plan,88.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,6,27357,FL,Individual,No,59-3315064,27357FL1820030,HF Platinum HMO Select 80 1302,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9873,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820030-00,Standard Platinum Off Exchange Plan,89.40%,0.891158998012543,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$450,$900,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,6,27357,FL,Individual,No,59-3315064,27357FL1820030,HF Platinum HMO Select 80 1302,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9873,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820030-01,Standard Platinum On Exchange Plan,89.40%,0.891158998012543,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$450,$900,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,6,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840006,HF Platinum HMO Select 80 5037,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.984,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840006-01,Standard Platinum On Exchange Plan,88.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,6,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850006,HF Platinum POS Select 80 5038,27357FL185,,FLN001,FLS001,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.985,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850006-00,Standard Platinum Off Exchange Plan,88.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,6,27357,FL,Individual,No,59-3315064,27357FL1820030,HF Platinum HMO Select 80 1302,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9873,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820030-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,6,27357,FL,Individual,No,59-3315064,27357FL1820030,HF Platinum HMO Select 80 1302,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9873,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820030-03,Limited Cost Sharing Plan Variation,89.40%,0.891158998012543,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$450,$900,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,6,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850006,HF Platinum POS Select 80 5038,27357FL185,,FLN001,FLS001,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.985,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850006-01,Standard Platinum On Exchange Plan,88.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,6,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870006,FHCA Platinum POS Enhanced 80 5042,27357FL187,,FLN002,FLS002,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.985,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870006-00,Standard Platinum Off Exchange Plan,88.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,6,27357,FL,Individual,No,59-3315064,27357FL1820029,HF Platinum HMO Select 90 1301,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9873,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820029-00,Standard Platinum Off Exchange Plan,89.30%,0.887947142124176,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,6,27357,FL,Individual,No,59-3315064,27357FL1820029,HF Platinum HMO Select 90 1301,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9873,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820029-01,Standard Platinum On Exchange Plan,89.30%,0.887947142124176,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,6,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870006,FHCA Platinum POS Enhanced 80 5042,27357FL187,,FLN002,FLS002,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.985,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870006-01,Standard Platinum On Exchange Plan,88.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,6,27357,FL,Individual,No,59-3315064,27357FL1820029,HF Platinum HMO Select 90 1301,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9873,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820029-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,6,27357,FL,Individual,No,59-3315064,27357FL1820029,HF Platinum HMO Select 90 1301,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9873,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820029-03,Limited Cost Sharing Plan Variation,89.30%,0.887947142124176,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,6,27357,FL,Individual,No,59-3315064,27357FL1830029,HF Platinum POS Select 90 1304,27357FL183,,FLN001,FLS001,FLF009,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9881,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830029-00,Standard Platinum Off Exchange Plan,89.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000",Not Applicable,Not Applicable,$750,"$1,500",10%,,,,"$2,250","$4,500",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,6,27357,FL,Individual,No,59-3315064,27357FL1830029,HF Platinum POS Select 90 1304,27357FL183,,FLN001,FLS001,FLF009,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9881,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830029-01,Standard Platinum On Exchange Plan,89.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000",Not Applicable,Not Applicable,$750,"$1,500",10%,,,,"$2,250","$4,500",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,6,27357,FL,Individual,No,59-3315064,27357FL1830029,HF Platinum POS Select 90 1304,27357FL183,,FLN001,FLS001,FLF009,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9881,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830029-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,6,27357,FL,Individual,No,59-3315064,27357FL1830029,HF Platinum POS Select 90 1304,27357FL183,,FLN001,FLS001,FLF009,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9881,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830029-03,Limited Cost Sharing Plan Variation,89.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000",Not Applicable,Not Applicable,$750,"$1,500",10%,,,,"$2,250","$4,500",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,6,27357,FL,Individual,No,59-3315064,27357FL1830030,HF Platinum POS Select 80 1305,27357FL183,,FLN001,FLS001,FLF009,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9881,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830030-00,Standard Platinum Off Exchange Plan,89.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"$5,100","$10,200",Not Applicable,Not Applicable,$450,$900,20%,,,,"$1,350","$2,700",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,6,27357,FL,Individual,No,59-3315064,27357FL1830030,HF Platinum POS Select 80 1305,27357FL183,,FLN001,FLS001,FLF009,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9881,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830030-01,Standard Platinum On Exchange Plan,89.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"$5,100","$10,200",Not Applicable,Not Applicable,$450,$900,20%,,,,"$1,350","$2,700",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,6,27357,FL,Individual,No,59-3315064,27357FL1830030,HF Platinum POS Select 80 1305,27357FL183,,FLN001,FLS001,FLF009,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9881,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830030-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,6,27357,FL,Individual,No,59-3315064,27357FL1830030,HF Platinum POS Select 80 1305,27357FL183,,FLN001,FLS001,FLF009,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9881,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830030-03,Limited Cost Sharing Plan Variation,89.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"$5,100","$10,200",Not Applicable,Not Applicable,$450,$900,20%,,,,"$1,350","$2,700",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,7,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840007,HF Platinum HMO Select 80 5044,27357FL184,,FLN001,FLS001,FLF008,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.984,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840007-00,Standard Platinum Off Exchange Plan,88.10%,,No,No,No,100%,,$800,"$1,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,7,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840007,HF Platinum HMO Select 80 5044,27357FL184,,FLN001,FLS001,FLF008,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.984,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840007-01,Standard Platinum On Exchange Plan,88.10%,,No,No,No,100%,,$800,"$1,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,7,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860007,FHCA Platinum HMO Enhanced 80 5048,27357FL186,,FLN002,FLS002,FLF008,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.984,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860007-00,Standard Platinum Off Exchange Plan,88.10%,,No,No,No,100%,,$800,"$1,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,7,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860007,FHCA Platinum HMO Enhanced 80 5048,27357FL186,,FLN002,FLS002,FLF008,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.984,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860007-01,Standard Platinum On Exchange Plan,88.10%,,No,No,No,100%,,$800,"$1,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,7,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850007,HF Platinum POS Select 80 5045,27357FL185,,FLN001,FLS001,FLF008,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9852,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850007-00,Standard Platinum Off Exchange Plan,88.10%,,No,No,No,100%,,$800,"$1,600",,,"$1,600","$3,200",Not Applicable,Not Applicable,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,7,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850007,HF Platinum POS Select 80 5045,27357FL185,,FLN001,FLS001,FLF008,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9852,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850007-01,Standard Platinum On Exchange Plan,88.10%,,No,No,No,100%,,$800,"$1,600",,,"$1,600","$3,200",Not Applicable,Not Applicable,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,7,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870007,FHCA Platinum POS Enhanced 80 5049,27357FL187,,FLN002,FLS002,FLF008,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9852,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870007-00,Standard Platinum Off Exchange Plan,88.10%,,No,No,No,100%,,$800,"$1,600",,,"$1,600","$3,200",Not Applicable,Not Applicable,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,7,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870007,FHCA Platinum POS Enhanced 80 5049,27357FL187,,FLN002,FLS002,FLF008,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9852,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870007-01,Standard Platinum On Exchange Plan,88.10%,,No,No,No,100%,,$800,"$1,600",,,"$1,600","$3,200",Not Applicable,Not Applicable,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,8,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840008,HF Platinum HMO Select 80 5051,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9839,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840008-00,Standard Platinum Off Exchange Plan,88.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,8,27357,FL,Individual,No,59-3315064,27357FL1820001,HF Gold HMO Select 100 1002,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9847,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820001-00,Standard Gold Off Exchange Plan,78.20%,0.786139011383057,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,8,27357,FL,Individual,No,59-3315064,27357FL1820001,HF Gold HMO Select 100 1002,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9847,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820001-01,Standard Gold On Exchange Plan,78.20%,0.786139011383057,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,8,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840008,HF Platinum HMO Select 80 5051,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9839,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840008-01,Standard Platinum On Exchange Plan,88.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,8,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850008,HF Platinum POS Select 80 5052,27357FL185,,FLN001,FLS001,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.985,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850008-00,Standard Platinum Off Exchange Plan,88.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,8,27357,FL,Individual,No,59-3315064,27357FL1820001,HF Gold HMO Select 100 1002,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9847,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,8,27357,FL,Individual,No,59-3315064,27357FL1820001,HF Gold HMO Select 100 1002,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9847,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820001-03,Limited Cost Sharing Plan Variation,78.20%,0.786139011383057,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,8,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850008,HF Platinum POS Select 80 5052,27357FL185,,FLN001,FLS001,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.985,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850008-01,Standard Platinum On Exchange Plan,88.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,8,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870008,FHCA Platinum POS Enhanced 80 5056,27357FL187,,FLN002,FLS002,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.985,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870008-00,Standard Platinum Off Exchange Plan,88.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,8,27357,FL,Individual,No,59-3315064,27357FL1830001,HF Gold POS Select 100 1003,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9857,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830001-00,Standard Gold Off Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$5,600","$11,200",Not Applicable,Not Applicable,"$2,600","$5,200",0%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,8,27357,FL,Individual,No,59-3315064,27357FL1830001,HF Gold POS Select 100 1003,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9857,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830001-01,Standard Gold On Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$5,600","$11,200",Not Applicable,Not Applicable,"$2,600","$5,200",0%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,8,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870008,FHCA Platinum POS Enhanced 80 5056,27357FL187,,FLN002,FLS002,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.985,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870008-01,Standard Platinum On Exchange Plan,88.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,8,27357,FL,Individual,No,59-3315064,27357FL1830001,HF Gold POS Select 100 1003,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9857,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,8,27357,FL,Individual,No,59-3315064,27357FL1830001,HF Gold POS Select 100 1003,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9857,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830001-03,Limited Cost Sharing Plan Variation,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$5,600","$11,200",Not Applicable,Not Applicable,"$2,600","$5,200",0%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,Individual,No,59-3315064,27357FL1820002,HF Gold HMO Select 90 1005,27357FL182,,FLN001,FLS001,FLF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9844,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820002-00,Standard Gold Off Exchange Plan,78.20%,0.767817795276642,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840009,HF Platinum HMO Select 100 5058,27357FL184,,FLN001,FLS001,FLF008,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9841,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840009-00,Standard Platinum Off Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840009,HF Platinum HMO Select 100 5058,27357FL184,,FLN001,FLS001,FLF008,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9841,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840009-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,Individual,No,59-3315064,27357FL1820002,HF Gold HMO Select 90 1005,27357FL182,,FLN001,FLS001,FLF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9844,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820002-01,Standard Gold On Exchange Plan,78.20%,0.767817795276642,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,Individual,No,59-3315064,27357FL1820002,HF Gold HMO Select 90 1005,27357FL182,,FLN001,FLS001,FLF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9844,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860009,FHCA Platinum HMO Enhanced 100 5062,27357FL186,,FLN002,FLS002,FLF008,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9841,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860009-00,Standard Platinum Off Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860009,FHCA Platinum HMO Enhanced 100 5062,27357FL186,,FLN002,FLS002,FLF008,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9841,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860009-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,Individual,No,59-3315064,27357FL1820002,HF Gold HMO Select 90 1005,27357FL182,,FLN001,FLS001,FLF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9844,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820002-03,Limited Cost Sharing Plan Variation,78.20%,0.767817795276642,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,Individual,No,59-3315064,27357FL1820010,HF Gold HMO Select 50 1039,27357FL182,,FLN001,FLS001,FLF006,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9847,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820010-00,Standard Gold Off Exchange Plan,79.80%,0.796176671981812,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850009,HF Platinum POS Select 100 5059,27357FL185,,FLN001,FLS001,FLF008,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9853,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850009-00,Standard Platinum Off Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$2,400","$4,800",Not Applicable,Not Applicable,$900,"$1,800",0%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850009,HF Platinum POS Select 100 5059,27357FL185,,FLN001,FLS001,FLF008,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9853,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850009-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$2,400","$4,800",Not Applicable,Not Applicable,$900,"$1,800",0%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,Individual,No,59-3315064,27357FL1820010,HF Gold HMO Select 50 1039,27357FL182,,FLN001,FLS001,FLF006,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9847,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820010-01,Standard Gold On Exchange Plan,79.80%,0.796176671981812,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,Individual,No,59-3315064,27357FL1820010,HF Gold HMO Select 50 1039,27357FL182,,FLN001,FLS001,FLF006,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9847,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820010-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870009,FHCA Platinum POS Enhanced 100 5063,27357FL187,,FLN002,FLS002,FLF008,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9853,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870009-00,Standard Platinum Off Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$2,400","$4,800",Not Applicable,Not Applicable,$900,"$1,800",0%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870009,FHCA Platinum POS Enhanced 100 5063,27357FL187,,FLN002,FLS002,FLF008,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9853,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870009-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$2,400","$4,800",Not Applicable,Not Applicable,$900,"$1,800",0%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,Individual,No,59-3315064,27357FL1820010,HF Gold HMO Select 50 1039,27357FL182,,FLN001,FLS001,FLF006,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9847,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820010-03,Limited Cost Sharing Plan Variation,79.80%,0.796176671981812,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,Individual,No,59-3315064,27357FL1830002,HF Gold POS Select 90 1006,27357FL183,,FLN001,FLS001,FLF002,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9854,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830002-00,Standard Gold Off Exchange Plan,78.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,Individual,No,59-3315064,27357FL1830002,HF Gold POS Select 90 1006,27357FL183,,FLN001,FLS001,FLF002,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9854,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830002-01,Standard Gold On Exchange Plan,78.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,9,27357,FL,Individual,No,59-3315064,27357FL1830002,HF Gold POS Select 90 1006,27357FL183,,FLN001,FLS001,FLF002,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9854,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840010,HF Platinum HMO Select 90 5065,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9839,,,0,3,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.HealthFirstHealthPlans.org/MHS,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840010-01,Standard Platinum On Exchange Plan,89.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,Individual,No,59-3315064,27357FL1820003,HF Gold HMO Select 90 1009,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9847,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820003-01,Standard Gold On Exchange Plan,78.80%,0.781295835971832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,Individual,No,59-3315064,27357FL1820003,HF Gold HMO Select 90 1009,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9847,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820003-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860010,FHCA Platinum HMO Enhanced 90 5069,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9839,,,0,3,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860010-00,Standard Platinum Off Exchange Plan,89.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860010,FHCA Platinum HMO Enhanced 90 5069,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9839,,,0,3,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860010-01,Standard Platinum On Exchange Plan,89.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,Individual,No,59-3315064,27357FL1820003,HF Gold HMO Select 90 1009,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9847,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820003-03,Limited Cost Sharing Plan Variation,78.80%,0.781295835971832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,Individual,No,59-3315064,27357FL1820008,HF Gold HMO Select 70 1031,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9845,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820008-00,Standard Gold Off Exchange Plan,78.00%,0.793372571468353,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850010,HF Platinum POS Select 90 5066,27357FL185,,FLN001,FLS001,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9851,,,0,3,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850010-00,Standard Platinum Off Exchange Plan,89.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850010,HF Platinum POS Select 90 5066,27357FL185,,FLN001,FLS001,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9851,,,0,3,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850010-01,Standard Platinum On Exchange Plan,89.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,Individual,No,59-3315064,27357FL1820008,HF Gold HMO Select 70 1031,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9845,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820008-01,Standard Gold On Exchange Plan,78.00%,0.793372571468353,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,Individual,No,59-3315064,27357FL1820008,HF Gold HMO Select 70 1031,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9845,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820008-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870010,FHCA Platinum POS Enhanced 90 5070,27357FL187,,FLN002,FLS002,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9851,,,0,3,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870010-00,Standard Platinum Off Exchange Plan,89.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870010,FHCA Platinum POS Enhanced 90 5070,27357FL187,,FLN002,FLS002,FLF009,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9851,,,0,3,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870010-01,Standard Platinum On Exchange Plan,89.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,Individual,No,59-3315064,27357FL1820008,HF Gold HMO Select 70 1031,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9845,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820008-03,Limited Cost Sharing Plan Variation,78.00%,0.793372571468353,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,Individual,No,59-3315064,27357FL1830003,HF Gold POS Select 90 1010,27357FL183,,FLN001,FLS001,FLF008,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9857,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830003-00,Standard Gold Off Exchange Plan,78.80%,0.781295835971832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,Individual,No,59-3315064,27357FL1830003,HF Gold POS Select 90 1010,27357FL183,,FLN001,FLS001,FLF008,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9857,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830003-01,Standard Gold On Exchange Plan,78.80%,0.781295835971832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,Individual,No,59-3315064,27357FL1830003,HF Gold POS Select 90 1010,27357FL183,,FLN001,FLS001,FLF008,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9857,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830003-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,Individual,No,59-3315064,27357FL1830003,HF Gold POS Select 90 1010,27357FL183,,FLN001,FLS001,FLF008,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9857,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830003-03,Limited Cost Sharing Plan Variation,78.80%,0.781295835971832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,Individual,No,59-3315064,27357FL1830008,HF Gold POS Select 70 1032,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9856,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830008-00,Standard Gold Off Exchange Plan,78.00%,0.793372571468353,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,"$5,800","$11,600",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,Individual,No,59-3315064,27357FL1830008,HF Gold POS Select 70 1032,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9856,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830008-01,Standard Gold On Exchange Plan,78.00%,0.793372571468353,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,"$5,800","$11,600",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,Individual,No,59-3315064,27357FL1830008,HF Gold POS Select 70 1032,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9856,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830008-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,10,27357,FL,Individual,No,59-3315064,27357FL1830008,HF Gold POS Select 70 1032,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9856,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830008-03,Limited Cost Sharing Plan Variation,78.00%,0.793372571468353,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,"$5,800","$11,600",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,11,27357,FL,Individual,No,59-3315064,27357FL1820004,HF Gold HMO Select 80 1012,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.985,,,0,0,5,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820004-00,Standard Gold Off Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,11,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840011,HF Gold HMO Select 90 5072,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9817,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.HealthFirstHealthPlans.org/MHS,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840011-00,Standard Gold Off Exchange Plan,81.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$650,"$1,300",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,11,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840011,HF Gold HMO Select 90 5072,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9817,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.HealthFirstHealthPlans.org/MHS,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840011-01,Standard Gold On Exchange Plan,81.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$650,"$1,300",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,11,27357,FL,Individual,No,59-3315064,27357FL1820004,HF Gold HMO Select 80 1012,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.985,,,0,0,5,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820004-01,Standard Gold On Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,11,27357,FL,Individual,No,59-3315064,27357FL1820004,HF Gold HMO Select 80 1012,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.985,,,0,0,5,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820004-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,11,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860011,FHCA Gold HMO Enhanced 90 5076,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9817,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860011-00,Standard Gold Off Exchange Plan,81.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$650,"$1,300",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,11,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860011,FHCA Gold HMO Enhanced 90 5076,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9817,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860011-01,Standard Gold On Exchange Plan,81.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$650,"$1,300",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,11,27357,FL,Individual,No,59-3315064,27357FL1820004,HF Gold HMO Select 80 1012,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.985,,,0,0,5,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820004-03,Limited Cost Sharing Plan Variation,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,11,27357,FL,Individual,No,59-3315064,27357FL1830004,HF Gold POS Select 80 1013,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9859,,,0,0,5,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830004-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,11,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850011,HF Gold POS Select 90 5073,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850011-00,Standard Gold Off Exchange Plan,81.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,$650,"$1,300",10%,,,,"$1,300","$2,600",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,11,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850011,HF Gold POS Select 90 5073,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850011-01,Standard Gold On Exchange Plan,81.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,$650,"$1,300",10%,,,,"$1,300","$2,600",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,11,27357,FL,Individual,No,59-3315064,27357FL1830004,HF Gold POS Select 80 1013,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9859,,,0,0,5,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830004-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,11,27357,FL,Individual,No,59-3315064,27357FL1830004,HF Gold POS Select 80 1013,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9859,,,0,0,5,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830004-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,11,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870011,FHCA Gold POS Enhanced 90 5077,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870011-00,Standard Gold Off Exchange Plan,81.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,$650,"$1,300",10%,,,,"$1,300","$2,600",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,11,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870011,FHCA Gold POS Enhanced 90 5077,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870011-01,Standard Gold On Exchange Plan,81.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,$650,"$1,300",10%,,,,"$1,300","$2,600",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,11,27357,FL,Individual,No,59-3315064,27357FL1830004,HF Gold POS Select 80 1013,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9859,,,0,0,5,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830004-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,12,27357,FL,Individual,No,59-3315064,27357FL1820005,HF Gold HMO Select 80 1016,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9853,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820005-00,Standard Gold Off Exchange Plan,78.50%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,12,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840012,HF Gold HMO Select 90 5079,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.HealthFirstHealthPlans.org/MHS,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840012-00,Standard Gold Off Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,12,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840012,HF Gold HMO Select 90 5079,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.HealthFirstHealthPlans.org/MHS,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840012-01,Standard Gold On Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,12,27357,FL,Individual,No,59-3315064,27357FL1820005,HF Gold HMO Select 80 1016,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9853,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820005-01,Standard Gold On Exchange Plan,78.50%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,12,27357,FL,Individual,No,59-3315064,27357FL1820005,HF Gold HMO Select 80 1016,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9853,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820005-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,12,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860012,FHCA Gold HMO Enhanced 90 5083,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860012-00,Standard Gold Off Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,12,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860012,FHCA Gold HMO Enhanced 90 5083,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860012-01,Standard Gold On Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,12,27357,FL,Individual,No,59-3315064,27357FL1820005,HF Gold HMO Select 80 1016,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9853,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820005-03,Limited Cost Sharing Plan Variation,78.50%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,12,27357,FL,Individual,No,59-3315064,27357FL1830005,HF Gold POS Select 80 1017,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9861,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830005-00,Standard Gold Off Exchange Plan,78.50%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,600",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,12,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850012,HF Gold POS Select 90 5080,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.983,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850012-00,Standard Gold Off Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$800,"$1,600",10%,,,,"$1,600","$3,200",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,12,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850012,HF Gold POS Select 90 5080,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.983,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850012-01,Standard Gold On Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$800,"$1,600",10%,,,,"$1,600","$3,200",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,12,27357,FL,Individual,No,59-3315064,27357FL1830005,HF Gold POS Select 80 1017,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9861,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830005-01,Standard Gold On Exchange Plan,78.50%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,600",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,12,27357,FL,Individual,No,59-3315064,27357FL1830005,HF Gold POS Select 80 1017,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9861,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830005-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,12,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870012,FHCA Gold POS Enhanced 90 5084,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.983,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870012-00,Standard Gold Off Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$800,"$1,600",10%,,,,"$1,600","$3,200",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,12,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870012,FHCA Gold POS Enhanced 90 5084,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.983,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870012-01,Standard Gold On Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$800,"$1,600",10%,,,,"$1,600","$3,200",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,12,27357,FL,Individual,No,59-3315064,27357FL1830005,HF Gold POS Select 80 1017,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9861,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830005-03,Limited Cost Sharing Plan Variation,78.50%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,600",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,13,27357,FL,Individual,No,59-3315064,27357FL1820006,HF Gold HMO Select 80 1020,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9852,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820006-00,Standard Gold Off Exchange Plan,81.60%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,13,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840013,HF Gold HMO Select 80 5086,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9818,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.HealthFirstHealthPlans.org/MHS,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840013-00,Standard Gold Off Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,13,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840013,HF Gold HMO Select 80 5086,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9818,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.HealthFirstHealthPlans.org/MHS,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840013-01,Standard Gold On Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,13,27357,FL,Individual,No,59-3315064,27357FL1820006,HF Gold HMO Select 80 1020,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9852,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820006-01,Standard Gold On Exchange Plan,81.60%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,13,27357,FL,Individual,No,59-3315064,27357FL1820006,HF Gold HMO Select 80 1020,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9852,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820006-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,13,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860013,FHCA Gold HMO Enhanced 80 5090,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9818,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860013-00,Standard Gold Off Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,13,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860013,FHCA Gold HMO Enhanced 80 5090,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9818,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860013-01,Standard Gold On Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,13,27357,FL,Individual,No,59-3315064,27357FL1820006,HF Gold HMO Select 80 1020,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9852,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820006-03,Limited Cost Sharing Plan Variation,81.60%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,13,27357,FL,Individual,No,59-3315064,27357FL1830006,HF Gold POS Select 80 1021,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9862,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830006-00,Standard Gold Off Exchange Plan,81.60%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,13,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850013,HF Gold POS Select 80 5087,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850013-00,Standard Gold Off Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,13,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850013,HF Gold POS Select 80 5087,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850013-01,Standard Gold On Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,13,27357,FL,Individual,No,59-3315064,27357FL1830006,HF Gold POS Select 80 1021,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9862,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830006-01,Standard Gold On Exchange Plan,81.60%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,13,27357,FL,Individual,No,59-3315064,27357FL1830006,HF Gold POS Select 80 1021,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9862,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830006-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,13,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870013,FHCA Gold POS Enhanced 80 5091,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870013-00,Standard Gold Off Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,13,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870013,FHCA Gold POS Enhanced 80 5091,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870013-01,Standard Gold On Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,13,27357,FL,Individual,No,59-3315064,27357FL1830006,HF Gold POS Select 80 1021,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9862,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830006-03,Limited Cost Sharing Plan Variation,81.60%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,14,27357,FL,Individual,No,59-3315064,27357FL1820007,HF Gold HMO Select 80 1024,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9846,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820007-00,Standard Gold Off Exchange Plan,78.10%,0.778484284877777,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,14,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840014,HF Gold HMO Select 80 5093,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.HealthFirstHealthPlans.org/MHS,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840014-00,Standard Gold Off Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,14,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840014,HF Gold HMO Select 80 5093,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.HealthFirstHealthPlans.org/MHS,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840014-01,Standard Gold On Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,14,27357,FL,Individual,No,59-3315064,27357FL1820007,HF Gold HMO Select 80 1024,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9846,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820007-01,Standard Gold On Exchange Plan,78.10%,0.778484284877777,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,14,27357,FL,Individual,No,59-3315064,27357FL1820007,HF Gold HMO Select 80 1024,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9846,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820007-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,14,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860014,FHCA Gold HMO Enhanced 80 5097,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860014-00,Standard Gold Off Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,14,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860014,FHCA Gold HMO Enhanced 80 5097,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860014-01,Standard Gold On Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,14,27357,FL,Individual,No,59-3315064,27357FL1820007,HF Gold HMO Select 80 1024,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9846,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820007-03,Limited Cost Sharing Plan Variation,78.10%,0.778484284877777,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,14,27357,FL,Individual,No,59-3315064,27357FL1830007,HF Gold POS Select 80 1025,27357FL183,,FLN001,FLS001,FLF008,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9855,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830007-00,Standard Gold Off Exchange Plan,78.10%,0.778484284877777,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,14,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850014,HF Gold POS Select 80 5094,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.983,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850014-00,Standard Gold Off Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,14,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850014,HF Gold POS Select 80 5094,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.983,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850014-01,Standard Gold On Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,14,27357,FL,Individual,No,59-3315064,27357FL1830007,HF Gold POS Select 80 1025,27357FL183,,FLN001,FLS001,FLF008,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9855,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830007-01,Standard Gold On Exchange Plan,78.10%,0.778484284877777,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,14,27357,FL,Individual,No,59-3315064,27357FL1830007,HF Gold POS Select 80 1025,27357FL183,,FLN001,FLS001,FLF008,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9855,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830007-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,14,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870014,FHCA Gold POS Enhanced 80 5098,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.983,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870014-00,Standard Gold Off Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,14,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870014,FHCA Gold POS Enhanced 80 5098,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.983,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870014-01,Standard Gold On Exchange Plan,81.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,14,27357,FL,Individual,No,59-3315064,27357FL1830007,HF Gold POS Select 80 1025,27357FL183,,FLN001,FLS001,FLF008,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9855,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830007-03,Limited Cost Sharing Plan Variation,78.10%,0.778484284877777,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,15,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840015,HF Gold HMO Select 50 5100,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9814,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.HealthFirstHealthPlans.org/MHS,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840015-00,Standard Gold Off Exchange Plan,81.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,15,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840015,HF Gold HMO Select 50 5100,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9814,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.HealthFirstHealthPlans.org/MHS,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840015-01,Standard Gold On Exchange Plan,81.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,15,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860015,FHCA Gold HMO Enhanced 50 5106,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9814,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860015-00,Standard Gold Off Exchange Plan,81.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,15,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860015,FHCA Gold HMO Enhanced 50 5106,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9814,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860015-01,Standard Gold On Exchange Plan,81.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,15,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850015,HF Gold POS Select 50 5101,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850015-00,Standard Gold Off Exchange Plan,81.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,15,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850015,HF Gold POS Select 50 5101,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850015-01,Standard Gold On Exchange Plan,81.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,15,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870015,FHCA Gold POS Enhanced 50 5107,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870015-00,Standard Gold Off Exchange Plan,81.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,15,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870015,FHCA Gold POS Enhanced 50 5107,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870015-01,Standard Gold On Exchange Plan,81.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,16,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840016,HF Gold HMO Select 80 5109,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9817,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.HealthFirstHealthPlans.org/MHS,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840016-00,Standard Gold Off Exchange Plan,81.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,16,27357,FL,Individual,No,59-3315064,27357FL1820009,HF Gold HMO Select 70 1035,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.985,,,0,0,4,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820009-00,Standard Gold Off Exchange Plan,79.00%,0.813004016876221,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,16,27357,FL,Individual,No,59-3315064,27357FL1820009,HF Gold HMO Select 70 1035,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.985,,,0,0,4,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820009-01,Standard Gold On Exchange Plan,79.00%,0.813004016876221,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,16,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840016,HF Gold HMO Select 80 5109,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9817,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.HealthFirstHealthPlans.org/MHS,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840016-01,Standard Gold On Exchange Plan,81.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,16,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860016,FHCA Gold HMO Enhanced80 5113,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9817,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860016-00,Standard Gold Off Exchange Plan,81.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,16,27357,FL,Individual,No,59-3315064,27357FL1820009,HF Gold HMO Select 70 1035,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.985,,,0,0,4,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,16,27357,FL,Individual,No,59-3315064,27357FL1820009,HF Gold HMO Select 70 1035,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.985,,,0,0,4,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820009-03,Limited Cost Sharing Plan Variation,79.00%,0.813004016876221,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,16,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860016,FHCA Gold HMO Enhanced80 5113,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9817,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860016-01,Standard Gold On Exchange Plan,81.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,16,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850016,HF Gold POS Select 80 5110,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850016-00,Standard Gold Off Exchange Plan,81.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,16,27357,FL,Individual,No,59-3315064,27357FL1830009,HF Gold POS Select 70 1036,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.986,,,0,0,4,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830009-00,Standard Gold Off Exchange Plan,79.00%,0.813004016876221,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,16,27357,FL,Individual,No,59-3315064,27357FL1830009,HF Gold POS Select 70 1036,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.986,,,0,0,4,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830009-01,Standard Gold On Exchange Plan,79.00%,0.813004016876221,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,16,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850016,HF Gold POS Select 80 5110,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850016-01,Standard Gold On Exchange Plan,81.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,16,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870016,FHCA Gold POS Enhanced 80 5114,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870016-00,Standard Gold Off Exchange Plan,81.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,16,27357,FL,Individual,No,59-3315064,27357FL1830009,HF Gold POS Select 70 1036,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.986,,,0,0,4,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,16,27357,FL,Individual,No,59-3315064,27357FL1830009,HF Gold POS Select 70 1036,27357FL183,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.986,,,0,0,4,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830009-03,Limited Cost Sharing Plan Variation,79.00%,0.813004016876221,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,16,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870016,FHCA Gold POS Enhanced 80 5114,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870016-01,Standard Gold On Exchange Plan,81.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840017,HF Gold HMO Select 80 5116,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9811,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840017-00,Standard Gold Off Exchange Plan,81.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1820011,HF Silver HMO Select 100 1046,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9816,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820011-00,Standard Silver Off Exchange Plan,69.80%,0.70931214094162,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400","$8,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1820011,HF Silver HMO Select 100 1046,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9816,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820011-01,Standard Silver On Exchange Plan,69.80%,0.70931214094162,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400","$8,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840017,HF Gold HMO Select 80 5116,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9811,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840017-01,Standard Gold On Exchange Plan,81.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860017,FHCA Gold HMO Enhanced 80 5130,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9811,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860017-00,Standard Gold Off Exchange Plan,81.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1820011,HF Silver HMO Select 100 1046,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9816,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820011-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1820011,HF Silver HMO Select 100 1046,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9816,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820011-03,Limited Cost Sharing Plan Variation,69.80%,0.70931214094162,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400","$8,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860017,FHCA Gold HMO Enhanced 80 5130,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9811,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860017-01,Standard Gold On Exchange Plan,81.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850017,HF Gold POS Select 80 5117,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9822,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850017-00,Standard Gold Off Exchange Plan,81.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1820011,HF Silver HMO Select 100 1046,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9816,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820011-04,73% AV Level Silver Plan,72.10%,0.714978694915771,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,200","$6,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1820011,HF Silver HMO Select 100 1046,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9816,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820011-05,87% AV Level Silver Plan,86.10%,0.889067769050598,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850017,HF Gold POS Select 80 5117,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9822,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850017-01,Standard Gold On Exchange Plan,81.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870017,FHCA Gold POS Enhanced 80 5132,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9822,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870017-00,Standard Gold Off Exchange Plan,81.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1820011,HF Silver HMO Select 100 1046,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9816,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820011-06,94% AV Level Silver Plan,93.20%,0.959493219852448,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1820013,HF Silver HMO Select 90 1070,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9818,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820013-00,Standard Silver Off Exchange Plan,70.70%,0.707950115203857,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870017,FHCA Gold POS Enhanced 80 5132,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9822,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870017-01,Standard Gold On Exchange Plan,81.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1820013,HF Silver HMO Select 90 1070,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9818,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820013-01,Standard Silver On Exchange Plan,70.70%,0.707950115203857,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1820013,HF Silver HMO Select 90 1070,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9818,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820013-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1820013,HF Silver HMO Select 90 1070,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9818,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820013-03,Limited Cost Sharing Plan Variation,70.70%,0.707950115203857,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1820013,HF Silver HMO Select 90 1070,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9818,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820013-04,73% AV Level Silver Plan,72.90%,0.728095889091492,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1820013,HF Silver HMO Select 90 1070,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9818,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820013-05,87% AV Level Silver Plan,86.10%,0.861941039562225,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1820013,HF Silver HMO Select 90 1070,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9818,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820013-06,94% AV Level Silver Plan,93.20%,0.932596266269684,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1820014,HF Silver HMO Select 90 1082,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820014-00,Standard Silver Off Exchange Plan,70.90%,0.70907074213028,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,600","$5,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1820014,HF Silver HMO Select 90 1082,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820014-01,Standard Silver On Exchange Plan,70.90%,0.70907074213028,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,600","$5,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1820014,HF Silver HMO Select 90 1082,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820014-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1820014,HF Silver HMO Select 90 1082,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820014-03,Limited Cost Sharing Plan Variation,70.90%,0.70907074213028,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,600","$5,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1820014,HF Silver HMO Select 90 1082,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820014-04,73% AV Level Silver Plan,73.20%,0.73281067609787,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,100","$4,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1820014,HF Silver HMO Select 90 1082,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820014-05,87% AV Level Silver Plan,86.10%,0.864562749862671,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1820014,HF Silver HMO Select 90 1082,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820014-06,94% AV Level Silver Plan,93.30%,0.933251917362213,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1830011,HF Silver POS Select 100 1050,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830011-00,Standard Silver Off Exchange Plan,69.80%,0.70931214094162,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$9,200","$18,400",Not Applicable,Not Applicable,"$4,400","$8,800",0%,,,,"$8,800","$17,600",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1830011,HF Silver POS Select 100 1050,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830011-01,Standard Silver On Exchange Plan,69.80%,0.70931214094162,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$9,200","$18,400",Not Applicable,Not Applicable,"$4,400","$8,800",0%,,,,"$8,800","$17,600",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1830011,HF Silver POS Select 100 1050,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830011-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,27
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1830011,HF Silver POS Select 100 1050,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830011-03,Limited Cost Sharing Plan Variation,69.80%,0.70931214094162,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$9,200","$18,400",Not Applicable,Not Applicable,"$4,400","$8,800",0%,,,,"$8,800","$17,600",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1830011,HF Silver POS Select 100 1050,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830011-04,73% AV Level Silver Plan,72.10%,0.714978694915771,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$9,200","$18,400",Not Applicable,Not Applicable,"$3,200","$6,400",0%,,,,"$8,800","$17,600",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1830011,HF Silver POS Select 100 1050,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830011-05,87% AV Level Silver Plan,86.10%,0.889067769050598,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$9,200","$18,400",Not Applicable,Not Applicable,$900,"$1,800",0%,,,,"$8,800","$17,600",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1830011,HF Silver POS Select 100 1050,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830011-06,94% AV Level Silver Plan,93.20%,0.959493219852448,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,"$9,200","$18,400",Not Applicable,Not Applicable,$150,$300,0%,,,,"$8,800","$17,600",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1830013,HF Silver POS Select 90 1074,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830013-00,Standard Silver Off Exchange Plan,70.70%,0.707950115203857,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1830013,HF Silver POS Select 90 1074,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830013-01,Standard Silver On Exchange Plan,70.70%,0.707950115203857,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1830013,HF Silver POS Select 90 1074,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830013-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,34
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1830013,HF Silver POS Select 90 1074,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830013-03,Limited Cost Sharing Plan Variation,70.70%,0.707950115203857,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1830013,HF Silver POS Select 90 1074,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830013-04,73% AV Level Silver Plan,72.90%,0.728095889091492,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,500","$5,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1830013,HF Silver POS Select 90 1074,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830013-05,87% AV Level Silver Plan,86.10%,0.861941039562225,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,000","$24,000",Not Applicable,Not Applicable,$350,$700,10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1830013,HF Silver POS Select 90 1074,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830013-06,94% AV Level Silver Plan,93.20%,0.932596266269684,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1830014,HF Silver POS Select 90 1086,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830014-00,Standard Silver Off Exchange Plan,70.90%,0.70907074213028,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,600","$5,200",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1830014,HF Silver POS Select 90 1086,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830014-01,Standard Silver On Exchange Plan,70.90%,0.70907074213028,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,600","$5,200",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1830014,HF Silver POS Select 90 1086,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830014-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,41
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1830014,HF Silver POS Select 90 1086,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830014-03,Limited Cost Sharing Plan Variation,70.90%,0.70907074213028,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,600","$5,200",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1830014,HF Silver POS Select 90 1086,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830014-04,73% AV Level Silver Plan,73.20%,0.73281067609787,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,100","$4,200",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1830014,HF Silver POS Select 90 1086,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830014-05,87% AV Level Silver Plan,86.10%,0.864562749862671,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,700","$25,400",Not Applicable,Not Applicable,$250,$500,10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,17,27357,FL,Individual,No,59-3315064,27357FL1830014,HF Silver POS Select 90 1086,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830014-06,94% AV Level Silver Plan,93.30%,0.933251917362213,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$12,700","$25,400",Not Applicable,Not Applicable,$0,$0,10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,18,27357,FL,Individual,No,59-3315064,27357FL1820012,HF Silver HMO Select 100 1058,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9818,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820012-00,Standard Silver Off Exchange Plan,69.20%,0.70519632101059,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,800","$7,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,18,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840018,HF Gold HMO Select 80 5120,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9816,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840018-00,Standard Gold Off Exchange Plan,81.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,18,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840018,HF Gold HMO Select 80 5120,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9816,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840018-01,Standard Gold On Exchange Plan,81.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,18,27357,FL,Individual,No,59-3315064,27357FL1820012,HF Silver HMO Select 100 1058,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9818,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820012-01,Standard Silver On Exchange Plan,69.20%,0.70519632101059,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,800","$7,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,18,27357,FL,Individual,No,59-3315064,27357FL1820012,HF Silver HMO Select 100 1058,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9818,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820012-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,18,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860018,FHCA Gold HMO Enhanced 80 5131,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9816,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860018-00,Standard Gold Off Exchange Plan,81.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,18,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860018,FHCA Gold HMO Enhanced 80 5131,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9816,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860018-01,Standard Gold On Exchange Plan,81.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,18,27357,FL,Individual,No,59-3315064,27357FL1820012,HF Silver HMO Select 100 1058,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9818,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820012-03,Limited Cost Sharing Plan Variation,69.20%,0.70519632101059,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,800","$7,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,18,27357,FL,Individual,No,59-3315064,27357FL1820012,HF Silver HMO Select 100 1058,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9818,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820012-04,73% AV Level Silver Plan,72.30%,0.734036564826965,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900","$5,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,18,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850018,HF Gold POS Select 80 5121,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9827,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850018-00,Standard Gold Off Exchange Plan,81.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,18,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850018,HF Gold POS Select 80 5121,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9827,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850018-01,Standard Gold On Exchange Plan,81.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,18,27357,FL,Individual,No,59-3315064,27357FL1820012,HF Silver HMO Select 100 1058,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9818,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820012-05,87% AV Level Silver Plan,86.50%,0.871407449245453,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,18,27357,FL,Individual,No,59-3315064,27357FL1820012,HF Silver HMO Select 100 1058,27357FL182,,FLN001,FLS001,FLF008,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9818,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820012-06,94% AV Level Silver Plan,93.30%,0.958438336849213,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,18,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870018,FHCA Gold POS Enhanced 80 5133,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9827,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870018-00,Standard Gold Off Exchange Plan,81.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,18,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870018,FHCA Gold POS Enhanced 80 5133,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9827,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870018-01,Standard Gold On Exchange Plan,81.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,18,27357,FL,Individual,No,59-3315064,27357FL1830012,HF Silver POS Select 100 1062,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830012-00,Standard Silver Off Exchange Plan,69.20%,0.70519632101059,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$3,800","$7,600",0%,,,,"$7,600","$15,200",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,18,27357,FL,Individual,No,59-3315064,27357FL1830012,HF Silver POS Select 100 1062,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830012-01,Standard Silver On Exchange Plan,69.20%,0.70519632101059,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$3,800","$7,600",0%,,,,"$7,600","$15,200",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,18,27357,FL,Individual,No,59-3315064,27357FL1830012,HF Silver POS Select 100 1062,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830012-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,18,27357,FL,Individual,No,59-3315064,27357FL1830012,HF Silver POS Select 100 1062,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830012-03,Limited Cost Sharing Plan Variation,69.20%,0.70519632101059,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$3,800","$7,600",0%,,,,"$7,600","$15,200",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,18,27357,FL,Individual,No,59-3315064,27357FL1830012,HF Silver POS Select 100 1062,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830012-04,73% AV Level Silver Plan,72.30%,0.734036564826965,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,900","$5,800",0%,,,,"$7,600","$15,200",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,18,27357,FL,Individual,No,59-3315064,27357FL1830012,HF Silver POS Select 100 1062,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830012-05,87% AV Level Silver Plan,86.50%,0.871407449245453,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$8,000","$16,000",Not Applicable,Not Applicable,$900,"$1,800",0%,,,,"$7,600","$15,200",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,18,27357,FL,Individual,No,59-3315064,27357FL1830012,HF Silver POS Select 100 1062,27357FL183,,FLN001,FLS001,FLF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830012-06,94% AV Level Silver Plan,93.30%,0.958438336849213,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,"$8,000","$16,000",Not Applicable,Not Applicable,$100,$200,0%,,,,"$7,600","$15,200",Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,19,27357,FL,Individual,No,59-3315064,27357FL1820016,HF Silver HMO Select 85 1110,27357FL182,,FLN001,FLS001,FLF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9821,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820016-00,Standard Silver Off Exchange Plan,71.70%,0.706839680671692,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,19,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840019,HF Gold HMO Select 70 5125,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9814,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840019-00,Standard Gold Off Exchange Plan,81.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,19,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840019,HF Gold HMO Select 70 5125,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9814,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840019-01,Standard Gold On Exchange Plan,81.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,19,27357,FL,Individual,No,59-3315064,27357FL1820016,HF Silver HMO Select 85 1110,27357FL182,,FLN001,FLS001,FLF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9821,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820016-01,Standard Silver On Exchange Plan,71.70%,0.706839680671692,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,19,27357,FL,Individual,No,59-3315064,27357FL1820016,HF Silver HMO Select 85 1110,27357FL182,,FLN001,FLS001,FLF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9821,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820016-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,19,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860019,FHCA Gold HMO Enhanced 70 5134,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9814,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860019-00,Standard Gold Off Exchange Plan,81.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,19,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860019,FHCA Gold HMO Enhanced 70 5134,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9814,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860019-01,Standard Gold On Exchange Plan,81.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,19,27357,FL,Individual,No,59-3315064,27357FL1820016,HF Silver HMO Select 85 1110,27357FL182,,FLN001,FLS001,FLF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9821,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820016-03,Limited Cost Sharing Plan Variation,71.70%,0.706839680671692,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,19,27357,FL,Individual,No,59-3315064,27357FL1820016,HF Silver HMO Select 85 1110,27357FL182,,FLN001,FLS001,FLF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9821,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820016-04,73% AV Level Silver Plan,73.80%,0.726663887500763,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,19,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850019,HF Gold POS Select 70 5126,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850019-00,Standard Gold Off Exchange Plan,81.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,19,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850019,HF Gold POS Select 70 5126,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850019-01,Standard Gold On Exchange Plan,81.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,19,27357,FL,Individual,No,59-3315064,27357FL1820016,HF Silver HMO Select 85 1110,27357FL182,,FLN001,FLS001,FLF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9821,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820016-05,87% AV Level Silver Plan,86.50%,0.851155042648315,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,19,27357,FL,Individual,No,59-3315064,27357FL1820016,HF Silver HMO Select 85 1110,27357FL182,,FLN001,FLS001,FLF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9821,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820016-06,94% AV Level Silver Plan,93.20%,0.920382678508759,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,19,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870019,FHCA Gold POS Enhanced 70 5135,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870019-00,Standard Gold Off Exchange Plan,81.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,19,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870019,FHCA Gold POS Enhanced 70 5135,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870019-01,Standard Gold On Exchange Plan,81.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,19,27357,FL,Individual,No,59-3315064,27357FL1830016,HF Silver POS Select 85 1114,27357FL183,,FLN001,FLS001,FLF003,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9832,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830016-00,Standard Silver Off Exchange Plan,71.70%,0.706839680671692,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,19,27357,FL,Individual,No,59-3315064,27357FL1830016,HF Silver POS Select 85 1114,27357FL183,,FLN001,FLS001,FLF003,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9832,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830016-01,Standard Silver On Exchange Plan,71.70%,0.706839680671692,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,19,27357,FL,Individual,No,59-3315064,27357FL1830016,HF Silver POS Select 85 1114,27357FL183,,FLN001,FLS001,FLF003,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9832,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830016-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,19,27357,FL,Individual,No,59-3315064,27357FL1830016,HF Silver POS Select 85 1114,27357FL183,,FLN001,FLS001,FLF003,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9832,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830016-03,Limited Cost Sharing Plan Variation,71.70%,0.706839680671692,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,19,27357,FL,Individual,No,59-3315064,27357FL1830016,HF Silver POS Select 85 1114,27357FL183,,FLN001,FLS001,FLF003,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9832,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830016-04,73% AV Level Silver Plan,73.80%,0.726663887500763,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",15%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,19,27357,FL,Individual,No,59-3315064,27357FL1830016,HF Silver POS Select 85 1114,27357FL183,,FLN001,FLS001,FLF003,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9832,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830016-05,87% AV Level Silver Plan,86.50%,0.851155042648315,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,15%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,19,27357,FL,Individual,No,59-3315064,27357FL1830016,HF Silver POS Select 85 1114,27357FL183,,FLN001,FLS001,FLF003,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9832,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830016-06,94% AV Level Silver Plan,93.20%,0.920382678508759,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,15%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,20,27357,FL,Individual,No,59-3315064,27357FL1820015,HF Silver HMO Select 80 1094,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9808,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820015-00,Standard Silver Off Exchange Plan,68.30%,0.698091864585876,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,20,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840020,HF Gold HMO Select 50 5137,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9816,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840020-00,Standard Gold Off Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,20,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840020,HF Gold HMO Select 50 5137,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9816,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840020-01,Standard Gold On Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,20,27357,FL,Individual,No,59-3315064,27357FL1820015,HF Silver HMO Select 80 1094,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9808,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820015-01,Standard Silver On Exchange Plan,68.30%,0.698091864585876,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,20,27357,FL,Individual,No,59-3315064,27357FL1820015,HF Silver HMO Select 80 1094,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9808,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820015-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,20,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860020,FHCA Gold HMO Enhanced 50 5141,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9816,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860020-00,Standard Gold Off Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,20,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860020,FHCA Gold HMO Enhanced 50 5141,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9816,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860020-01,Standard Gold On Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,20,27357,FL,Individual,No,59-3315064,27357FL1820015,HF Silver HMO Select 80 1094,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9808,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820015-03,Limited Cost Sharing Plan Variation,68.30%,0.698091864585876,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,20,27357,FL,Individual,No,59-3315064,27357FL1820015,HF Silver HMO Select 80 1094,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9808,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820015-04,73% AV Level Silver Plan,72.00%,0.729831039905548,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,20,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850020,HF Gold POS Select 50 5138,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850020-00,Standard Gold Off Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,20,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850020,HF Gold POS Select 50 5138,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850020-01,Standard Gold On Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,20,27357,FL,Individual,No,59-3315064,27357FL1820015,HF Silver HMO Select 80 1094,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9808,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820015-05,87% AV Level Silver Plan,86.10%,0.875485479831696,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$700,"$1,400",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,20,27357,FL,Individual,No,59-3315064,27357FL1820015,HF Silver HMO Select 80 1094,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9808,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820015-06,94% AV Level Silver Plan,93.40%,0.943954944610596,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,20,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870020,FHCA Gold POS Enhanced 50 5142,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870020-00,Standard Gold Off Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,20,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870020,FHCA Gold POS Enhanced 50 5142,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870020-01,Standard Gold On Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,20,27357,FL,Individual,No,59-3315064,27357FL1830015,HF Silver POS Select 80 1098,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.982,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830015-00,Standard Silver Off Exchange Plan,68.30%,0.698091864585876,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,20,27357,FL,Individual,No,59-3315064,27357FL1830015,HF Silver POS Select 80 1098,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.982,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830015-01,Standard Silver On Exchange Plan,68.30%,0.698091864585876,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,20,27357,FL,Individual,No,59-3315064,27357FL1830015,HF Silver POS Select 80 1098,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.982,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830015-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,20,27357,FL,Individual,No,59-3315064,27357FL1830015,HF Silver POS Select 80 1098,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.982,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830015-03,Limited Cost Sharing Plan Variation,68.30%,0.698091864585876,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,20,27357,FL,Individual,No,59-3315064,27357FL1830015,HF Silver POS Select 80 1098,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.982,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830015-04,73% AV Level Silver Plan,72.00%,0.729831039905548,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,20,27357,FL,Individual,No,59-3315064,27357FL1830015,HF Silver POS Select 80 1098,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.982,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830015-05,87% AV Level Silver Plan,86.10%,0.875485479831696,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,700","$25,400",Not Applicable,Not Applicable,$700,"$1,400",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,20,27357,FL,Individual,No,59-3315064,27357FL1830015,HF Silver POS Select 80 1098,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.982,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830015-06,94% AV Level Silver Plan,93.40%,0.943954944610596,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,$200,$400,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,21,27357,FL,Individual,No,59-3315064,27357FL1820018,HF Silver HMO Select 70 1158,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.981,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820018-00,Standard Silver Off Exchange Plan,68.60%,0.702797472476959,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,21,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840021,HF Gold HMO Select 50 5144,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9812,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840021-00,Standard Gold Off Exchange Plan,80.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,21,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840021,HF Gold HMO Select 50 5144,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9812,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840021-01,Standard Gold On Exchange Plan,80.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,21,27357,FL,Individual,No,59-3315064,27357FL1820018,HF Silver HMO Select 70 1158,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.981,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820018-01,Standard Silver On Exchange Plan,68.60%,0.702797472476959,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,21,27357,FL,Individual,No,59-3315064,27357FL1820018,HF Silver HMO Select 70 1158,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.981,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820018-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,21,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860021,FHCA Gold HMO Enhanced 50 5150,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9812,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860021-00,Standard Gold Off Exchange Plan,80.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,21,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860021,FHCA Gold HMO Enhanced 50 5150,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9812,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860021-01,Standard Gold On Exchange Plan,80.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,21,27357,FL,Individual,No,59-3315064,27357FL1820018,HF Silver HMO Select 70 1158,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.981,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820018-03,Limited Cost Sharing Plan Variation,68.60%,0.702797472476959,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,21,27357,FL,Individual,No,59-3315064,27357FL1820018,HF Silver HMO Select 70 1158,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.981,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820018-04,73% AV Level Silver Plan,72.40%,0.739767491817474,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,21,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850021,HF Gold POS Select 50 5145,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9825,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850021-00,Standard Gold Off Exchange Plan,80.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,21,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850021,HF Gold POS Select 50 5145,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9825,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850021-01,Standard Gold On Exchange Plan,80.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,21,27357,FL,Individual,No,59-3315064,27357FL1820018,HF Silver HMO Select 70 1158,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.981,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820018-05,87% AV Level Silver Plan,86.10%,0.879186511039734,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,21,27357,FL,Individual,No,59-3315064,27357FL1820018,HF Silver HMO Select 70 1158,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.981,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820018-06,94% AV Level Silver Plan,93.20%,0.941559851169586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,21,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870021,FHCA Gold POS Enhanced 50 5151,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9825,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870021-00,Standard Gold Off Exchange Plan,80.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,21,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870021,FHCA Gold POS Enhanced 50 5151,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9825,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870021-01,Standard Gold On Exchange Plan,80.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,21,27357,FL,Individual,No,59-3315064,27357FL1830018,HF Silver POS Select 70 1162,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9821,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830018-00,Standard Silver Off Exchange Plan,68.60%,0.702797472476959,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,21,27357,FL,Individual,No,59-3315064,27357FL1830018,HF Silver POS Select 70 1162,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9821,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830018-01,Standard Silver On Exchange Plan,68.60%,0.702797472476959,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,21,27357,FL,Individual,No,59-3315064,27357FL1830018,HF Silver POS Select 70 1162,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9821,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830018-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,21,27357,FL,Individual,No,59-3315064,27357FL1830018,HF Silver POS Select 70 1162,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9821,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830018-03,Limited Cost Sharing Plan Variation,68.60%,0.702797472476959,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,21,27357,FL,Individual,No,59-3315064,27357FL1830018,HF Silver POS Select 70 1162,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9821,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830018-04,73% AV Level Silver Plan,72.40%,0.739767491817474,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$1,200","$2,400",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,21,27357,FL,Individual,No,59-3315064,27357FL1830018,HF Silver POS Select 70 1162,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9821,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830018-05,87% AV Level Silver Plan,86.10%,0.879186511039734,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,21,27357,FL,Individual,No,59-3315064,27357FL1830018,HF Silver POS Select 70 1162,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9821,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830018-06,94% AV Level Silver Plan,93.20%,0.941559851169586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,22,27357,FL,Individual,No,59-3315064,27357FL1820020,HF Silver HMO Select 70 1222,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820020-00,Standard Silver Off Exchange Plan,71.10%,0.716611325740814,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,22,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840022,HF Gold HMO Select 80 5153,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9809,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840022-00,Standard Gold Off Exchange Plan,80.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,22,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840022,HF Gold HMO Select 80 5153,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9809,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840022-01,Standard Gold On Exchange Plan,80.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,22,27357,FL,Individual,No,59-3315064,27357FL1820020,HF Silver HMO Select 70 1222,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820020-01,Standard Silver On Exchange Plan,71.10%,0.716611325740814,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,22,27357,FL,Individual,No,59-3315064,27357FL1820020,HF Silver HMO Select 70 1222,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820020-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,22,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860022,FHCA Gold HMO Enhanced 80 5157,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9809,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860022-00,Standard Gold Off Exchange Plan,80.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,22,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860022,FHCA Gold HMO Enhanced 80 5157,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9809,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860022-01,Standard Gold On Exchange Plan,80.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,22,27357,FL,Individual,No,59-3315064,27357FL1820020,HF Silver HMO Select 70 1222,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820020-03,Limited Cost Sharing Plan Variation,71.10%,0.716611325740814,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,22,27357,FL,Individual,No,59-3315064,27357FL1820020,HF Silver HMO Select 70 1222,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820020-04,73% AV Level Silver Plan,73.30%,0.7375368475914,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300","$2,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,22,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850022,HF Gold POS Select 80 5154,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.982,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850022-00,Standard Gold Off Exchange Plan,80.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,22,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850022,HF Gold POS Select 80 5154,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.982,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850022-01,Standard Gold On Exchange Plan,80.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,22,27357,FL,Individual,No,59-3315064,27357FL1820020,HF Silver HMO Select 70 1222,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820020-05,87% AV Level Silver Plan,86.20%,0.874036192893982,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,22,27357,FL,Individual,No,59-3315064,27357FL1820020,HF Silver HMO Select 70 1222,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820020-06,94% AV Level Silver Plan,93.20%,0.941559851169586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,22,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870022,FHCA Gold POS Enhanced 80 5158,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.982,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870022-00,Standard Gold Off Exchange Plan,80.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,22,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870022,FHCA Gold POS Enhanced 80 5158,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.982,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870022-01,Standard Gold On Exchange Plan,80.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,22,27357,FL,Individual,No,59-3315064,27357FL1830020,HF Silver POS Select 70 1226,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.983,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830020-00,Standard Silver Off Exchange Plan,71.10%,0.716611325740814,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$9,200","$18,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,22,27357,FL,Individual,No,59-3315064,27357FL1830020,HF Silver POS Select 70 1226,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.983,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830020-01,Standard Silver On Exchange Plan,71.10%,0.716611325740814,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$9,200","$18,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,22,27357,FL,Individual,No,59-3315064,27357FL1830020,HF Silver POS Select 70 1226,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.983,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830020-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,22,27357,FL,Individual,No,59-3315064,27357FL1830020,HF Silver POS Select 70 1226,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.983,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830020-03,Limited Cost Sharing Plan Variation,71.10%,0.716611325740814,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$9,200","$18,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,22,27357,FL,Individual,No,59-3315064,27357FL1830020,HF Silver POS Select 70 1226,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.983,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830020-04,73% AV Level Silver Plan,73.30%,0.7375368475914,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,300","$2,600",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,22,27357,FL,Individual,No,59-3315064,27357FL1830020,HF Silver POS Select 70 1226,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.983,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830020-05,87% AV Level Silver Plan,86.20%,0.874036192893982,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$9,200","$18,400",Not Applicable,Not Applicable,$0,$0,30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,22,27357,FL,Individual,No,59-3315064,27357FL1830020,HF Silver POS Select 70 1226,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.983,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830020-06,94% AV Level Silver Plan,93.20%,0.941559851169586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$9,200","$18,400",Not Applicable,Not Applicable,$0,$0,30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,23,27357,FL,Individual,No,59-3315064,27357FL1820017,HF Silver HMO Select 70 1126,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.981,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820017-00,Standard Silver Off Exchange Plan,68.90%,0.70455127954483,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,23,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840023,HF Gold HMO Select 50 5160,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9814,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840023-00,Standard Gold Off Exchange Plan,80.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,23,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840023,HF Gold HMO Select 50 5160,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9814,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840023-01,Standard Gold On Exchange Plan,80.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,23,27357,FL,Individual,No,59-3315064,27357FL1820017,HF Silver HMO Select 70 1126,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.981,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820017-01,Standard Silver On Exchange Plan,68.90%,0.70455127954483,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,23,27357,FL,Individual,No,59-3315064,27357FL1820017,HF Silver HMO Select 70 1126,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.981,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820017-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,23,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860023,FHCA Gold HMO Enhanced 50 5166,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9814,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860023-00,Standard Gold Off Exchange Plan,80.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,23,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860023,FHCA Gold HMO Enhanced 50 5166,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9814,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860023-01,Standard Gold On Exchange Plan,80.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,23,27357,FL,Individual,No,59-3315064,27357FL1820017,HF Silver HMO Select 70 1126,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.981,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820017-03,Limited Cost Sharing Plan Variation,68.90%,0.70455127954483,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,23,27357,FL,Individual,No,59-3315064,27357FL1820017,HF Silver HMO Select 70 1126,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.981,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820017-04,73% AV Level Silver Plan,72.10%,0.732900261878967,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,23,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850023,HF Gold POS Select 50 5161,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850023-00,Standard Gold Off Exchange Plan,80.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,23,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850023,HF Gold POS Select 50 5161,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850023-01,Standard Gold On Exchange Plan,80.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,23,27357,FL,Individual,No,59-3315064,27357FL1820017,HF Silver HMO Select 70 1126,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.981,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820017-05,87% AV Level Silver Plan,86.10%,0.880177676677704,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,23,27357,FL,Individual,No,59-3315064,27357FL1820017,HF Silver HMO Select 70 1126,27357FL182,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.981,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1820017-06,94% AV Level Silver Plan,93.20%,0.940430879592896,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,23,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870023,FHCA Gold POS Enhanced 50 5167,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870023-00,Standard Gold Off Exchange Plan,80.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,23,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870023,FHCA Gold POS Enhanced 50 5167,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870023-01,Standard Gold On Exchange Plan,80.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,23,27357,FL,Individual,No,59-3315064,27357FL1830017,HF Silver POS Select 70 1130,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.982,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830017-00,Standard Silver Off Exchange Plan,68.90%,0.70455127954483,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,23,27357,FL,Individual,No,59-3315064,27357FL1830017,HF Silver POS Select 70 1130,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.982,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830017-01,Standard Silver On Exchange Plan,68.90%,0.70455127954483,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,23,27357,FL,Individual,No,59-3315064,27357FL1830017,HF Silver POS Select 70 1130,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.982,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830017-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,23,27357,FL,Individual,No,59-3315064,27357FL1830017,HF Silver POS Select 70 1130,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.982,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830017-03,Limited Cost Sharing Plan Variation,68.90%,0.70455127954483,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,23,27357,FL,Individual,No,59-3315064,27357FL1830017,HF Silver POS Select 70 1130,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.982,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830017-04,73% AV Level Silver Plan,72.10%,0.732900261878967,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,23,27357,FL,Individual,No,59-3315064,27357FL1830017,HF Silver POS Select 70 1130,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.982,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830017-05,87% AV Level Silver Plan,86.10%,0.880177676677704,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,$800,"$1,600",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,23,27357,FL,Individual,No,59-3315064,27357FL1830017,HF Silver POS Select 70 1130,27357FL183,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.982,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,No,,No,www.myHFHP.org/MHI_2015,https://premium.health-first.org/premium,www.myHFHP.org/MHI_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1830017-06,94% AV Level Silver Plan,93.20%,0.940430879592896,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$12,700","$25,400",Not Applicable,Not Applicable,$0,$0,30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,24,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840024,HF Gold HMO Select 70 5169,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9817,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840024-00,Standard Gold Off Exchange Plan,80.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,24,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840024,HF Gold HMO Select 70 5169,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9817,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840024-01,Standard Gold On Exchange Plan,80.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,24,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860024,FHCA Gold HMO Enhanced 70 5173,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9817,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860024-00,Standard Gold Off Exchange Plan,80.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,24,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860024,FHCA Gold HMO Enhanced 70 5173,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9817,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860024-01,Standard Gold On Exchange Plan,80.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,24,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850024,HF Gold POS Select 70 5170,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850024-00,Standard Gold Off Exchange Plan,80.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$750,"$1,500",30%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,24,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850024,HF Gold POS Select 70 5170,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850024-01,Standard Gold On Exchange Plan,80.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$750,"$1,500",30%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,24,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870024,FHCA Gold POS Enhanced 70 5174,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870024-00,Standard Gold Off Exchange Plan,80.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$750,"$1,500",30%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,24,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870024,FHCA Gold POS Enhanced 70 5174,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870024-01,Standard Gold On Exchange Plan,80.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$750,"$1,500",30%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,25,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840025,HF Gold HMO Select 70 5176,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9814,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840025-00,Standard Gold Off Exchange Plan,81.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,25,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840025,HF Gold HMO Select 70 5176,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9814,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840025-01,Standard Gold On Exchange Plan,81.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,25,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860025,FHCA Gold HMO Enhanced 70 5180,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9814,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860025-00,Standard Gold Off Exchange Plan,81.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,25,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860025,FHCA Gold HMO Enhanced 70 5180,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9814,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860025-01,Standard Gold On Exchange Plan,81.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,25,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850025,HF Gold POS Select 70 5177,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850025-00,Standard Gold Off Exchange Plan,81.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,25,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850025,HF Gold POS Select 70 5177,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850025-01,Standard Gold On Exchange Plan,81.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,25,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870025,FHCA Gold POS Enhanced 70 5181,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870025-00,Standard Gold Off Exchange Plan,81.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,25,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870025,FHCA Gold POS Enhanced 70 5181,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870025-01,Standard Gold On Exchange Plan,81.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,26,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840026,HF Gold HMO Select 80 5183,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9808,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840026-00,Standard Gold Off Exchange Plan,79.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,26,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840026,HF Gold HMO Select 80 5183,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9808,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840026-01,Standard Gold On Exchange Plan,79.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,26,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860026,FHCA Gold HMO Enhanced 80 5187,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9808,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860026-00,Standard Gold Off Exchange Plan,79.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,26,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860026,FHCA Gold HMO Enhanced 80 5187,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9808,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860026-01,Standard Gold On Exchange Plan,79.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,26,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850026,HF Gold POS Select 80 5184,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9821,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850026-00,Standard Gold Off Exchange Plan,79.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,26,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850026,HF Gold POS Select 80 5184,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9821,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850026-01,Standard Gold On Exchange Plan,79.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,26,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870026,FHCA Gold POS Enhanced 80 5188,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9821,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870026-00,Standard Gold Off Exchange Plan,79.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,26,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870026,FHCA Gold POS Enhanced 80 5188,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9821,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870026-01,Standard Gold On Exchange Plan,79.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,28,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840028,HF Gold HMO Select 80 5197,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9807,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840028-00,Standard Gold Off Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,28,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840028,HF Gold HMO Select 80 5197,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9807,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840028-01,Standard Gold On Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,28,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860028,FHCA Gold HMO Enhanced 80 5201,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9807,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860028-00,Standard Gold Off Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,28,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860028,FHCA Gold HMO Enhanced 80 5201,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9807,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860028-01,Standard Gold On Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,28,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850028,HF Gold POS Select 80 5198,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850028-00,Standard Gold Off Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,28,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850028,HF Gold POS Select 80 5198,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850028-01,Standard Gold On Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,28,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870028,FHCA Gold POS Enhanced 80 5202,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870028-00,Standard Gold Off Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,28,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870028,FHCA Gold POS Enhanced 80 5202,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870028-01,Standard Gold On Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,29,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840029,HF Gold HMO Select 80 5204,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9807,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840029-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,29,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840029,HF Gold HMO Select 80 5204,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9807,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840029-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,29,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860029,FHCA Gold HMO Enhanced 80 5208,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9807,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860029-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,29,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860029,FHCA Gold HMO Enhanced 80 5208,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9807,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860029-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,29,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850029,HF Gold POS Select 80 5205,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850029-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,29,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850029,HF Gold POS Select 80 5205,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850029-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,29,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870029,FHCA Gold POS Enhanced 80 5209,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870029-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,29,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870029,FHCA Gold POS Enhanced 80 5209,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9819,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870029-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,30,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840030,HF Gold HMO Select 80 5211,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9805,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840030-00,Standard Gold Off Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,30,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840030,HF Gold HMO Select 80 5211,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9805,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840030-01,Standard Gold On Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,30,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860030,FHCA Gold HMO Enhanced 80 5215,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9805,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860030-00,Standard Gold Off Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,30,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860030,FHCA Gold HMO Enhanced 80 5215,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9805,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860030-01,Standard Gold On Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,30,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850030,HF Gold POS Select 80 5212,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9817,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850030-00,Standard Gold Off Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,30,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850030,HF Gold POS Select 80 5212,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9817,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850030-01,Standard Gold On Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,30,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870030,FHCA Gold POS Enhanced 80 5216,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9817,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870030-00,Standard Gold Off Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,30,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870030,FHCA Gold POS Enhanced 80 5216,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9817,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870030-01,Standard Gold On Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,31,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840031,HF Gold HMO Select 70 5218,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9804,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840031-00,Standard Gold Off Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,31,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840031,HF Gold HMO Select 70 5218,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9804,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840031-01,Standard Gold On Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,31,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860031,FHCA Gold HMO Enhanced 70 5224,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9804,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860031-00,Standard Gold Off Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,31,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860031,FHCA Gold HMO Enhanced 70 5224,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9804,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860031-01,Standard Gold On Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,31,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850031,HF Gold POS Select 70 5219,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9817,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850031-00,Standard Gold Off Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$900,"$1,800",30%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,31,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850031,HF Gold POS Select 70 5219,27357FL185,,FLN001,FLS001,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9817,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850031-01,Standard Gold On Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$900,"$1,800",30%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,31,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870031,FHCA Gold POS Enhanced 70 5225,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9817,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870031-00,Standard Gold Off Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$900,"$1,800",30%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,31,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870031,FHCA Gold POS Enhanced 70 5225,27357FL187,,FLN002,FLS002,FLF009,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9817,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870031-01,Standard Gold On Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$900,"$1,800",30%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840035,HF Silver HMO Select 85 5248,27357FL184,,FLN001,FLS001,FLF003,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9773,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840035-00,Standard Silver Off Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840035,HF Silver HMO Select 85 5248,27357FL184,,FLN001,FLS001,FLF003,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9773,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840035-01,Standard Silver On Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840037,HF Silver HMO Select 80 5264,27357FL184,,FLN001,FLS001,FLF004,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9771,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840037-00,Standard Silver Off Exchange Plan,71.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840037,HF Silver HMO Select 80 5264,27357FL184,,FLN001,FLS001,FLF004,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9771,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840037-01,Standard Silver On Exchange Plan,71.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840036,HF Silver HMO Select 100 5257,27357FL184,,FLN001,FLS001,FLF001,New,HMO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9772,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840036-00,Standard Silver Off Exchange Plan,71.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840036,HF Silver HMO Select 100 5257,27357FL184,,FLN001,FLS001,FLF001,New,HMO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9772,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840036-01,Standard Silver On Exchange Plan,71.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840038,HF Silver HMO Select 70 5271,27357FL184,,FLN001,FLS001,FLF005,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9769,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840038-00,Standard Silver Off Exchange Plan,71.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840038,HF Silver HMO Select 70 5271,27357FL184,,FLN001,FLS001,FLF005,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9769,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840038-01,Standard Silver On Exchange Plan,71.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840042,HF Silver HMO Select 90 5307,27357FL184,,FLN001,FLS001,FLF002,New,HMO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9767,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840042-00,Standard Silver Off Exchange Plan,70.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840042,HF Silver HMO Select 90 5307,27357FL184,,FLN001,FLS001,FLF002,New,HMO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9767,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840042-01,Standard Silver On Exchange Plan,70.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840046,HF Silver HMO Select 70 5341,27357FL184,,FLN001,FLS001,FLF005,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.976,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840046-00,Standard Silver Off Exchange Plan,68.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840046,HF Silver HMO Select 70 5341,27357FL184,,FLN001,FLS001,FLF005,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.976,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840046-01,Standard Silver On Exchange Plan,68.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860035,FHCA Silver HMO Enhanced 85 5254,27357FL186,,FLN002,FLS002,FLF003,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9773,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860035-00,Standard Silver Off Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860035,FHCA Silver HMO Enhanced 85 5254,27357FL186,,FLN002,FLS002,FLF003,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9773,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860035-01,Standard Silver On Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860037,FHCA Silver HMO Enhanced 80 5268,27357FL186,,FLN002,FLS002,FLF004,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9771,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860037-00,Standard Silver Off Exchange Plan,71.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860037,FHCA Silver HMO Enhanced 80 5268,27357FL186,,FLN002,FLS002,FLF004,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9771,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860037-01,Standard Silver On Exchange Plan,71.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860036,FHCA Silver HMO Enhanced 100 5261,27357FL186,,FLN002,FLS002,FLF001,New,HMO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9772,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860036-00,Standard Silver Off Exchange Plan,71.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860036,FHCA Silver HMO Enhanced 100 5261,27357FL186,,FLN002,FLS002,FLF001,New,HMO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9772,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860036-01,Standard Silver On Exchange Plan,71.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860038,FHCA Silver HMO Enhanced 70 5277,27357FL186,,FLN002,FLS002,FLF005,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9769,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860038-00,Standard Silver Off Exchange Plan,71.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860038,FHCA Silver HMO Enhanced 70 5277,27357FL186,,FLN002,FLS002,FLF005,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9769,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860038-01,Standard Silver On Exchange Plan,71.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860042,FHCA Silver HMO Enhanced 90 5313,27357FL186,,FLN002,FLS002,FLF002,New,HMO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9767,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860042-00,Standard Silver Off Exchange Plan,70.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,24
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860042,FHCA Silver HMO Enhanced 90 5313,27357FL186,,FLN002,FLS002,FLF002,New,HMO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9767,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860042-01,Standard Silver On Exchange Plan,70.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860046,FHCA Silver HMO Enhanced 70 5347,27357FL186,,FLN002,FLS002,FLF005,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.976,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860046-00,Standard Silver Off Exchange Plan,68.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,26
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,32,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860046,FHCA Silver HMO Enhanced 70 5347,27357FL186,,FLN002,FLS002,FLF005,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.976,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860046-01,Standard Silver On Exchange Plan,68.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,27
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,33,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840032,HF Silver HMO Select 80 5227,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.977,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840032-00,Standard Silver Off Exchange Plan,70.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,150","$12,300",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,33,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840032,HF Silver HMO Select 80 5227,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.977,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840032-01,Standard Silver On Exchange Plan,70.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,150","$12,300",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,33,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840033,HF Silver HMO Select 80 5234,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.977,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840033-00,Standard Silver Off Exchange Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,33,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840033,HF Silver HMO Select 80 5234,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.977,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840033-01,Standard Silver On Exchange Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,33,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860032,FHCA Silver HMO Enhanced 80 5231,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.977,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860032-00,Standard Silver Off Exchange Plan,70.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,150","$12,300",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,33,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860032,FHCA Silver HMO Enhanced 80 5231,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.977,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860032-01,Standard Silver On Exchange Plan,70.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,150","$12,300",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,33,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860033,FHCA Silver HMO Enhanced 80 5238,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.977,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860033-00,Standard Silver Off Exchange Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,33,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860033,FHCA Silver HMO Enhanced 80 5238,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.977,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860033-01,Standard Silver On Exchange Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,33,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850032,HF Silver POS Select 80 5228,27357FL185,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.978,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850032-00,Standard Silver Off Exchange Plan,70.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$6,150","$12,300",20%,,,,"$12,300","$24,600",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,33,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850032,HF Silver POS Select 80 5228,27357FL185,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.978,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850032-01,Standard Silver On Exchange Plan,70.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$6,150","$12,300",20%,,,,"$12,300","$24,600",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,33,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850033,HF Silver POS Select 80 5235,27357FL185,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9781,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850033-00,Standard Silver Off Exchange Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,33,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850033,HF Silver POS Select 80 5235,27357FL185,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9781,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850033-01,Standard Silver On Exchange Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,33,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870032,FHCA Silver POS Enhanced 80 5232,27357FL187,,FLN002,FLS002,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.978,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870032-00,Standard Silver Off Exchange Plan,70.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$6,150","$12,300",20%,,,,"$12,300","$24,600",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,33,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870032,FHCA Silver POS Enhanced 80 5232,27357FL187,,FLN002,FLS002,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.978,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870032-01,Standard Silver On Exchange Plan,70.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$6,150","$12,300",20%,,,,"$12,300","$24,600",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,33,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870033,FHCA Silver POS Enhanced 80 5239,27357FL187,,FLN002,FLS002,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9781,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870033-00,Standard Silver Off Exchange Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,33,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870033,FHCA Silver POS Enhanced 80 5239,27357FL187,,FLN002,FLS002,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9781,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870033-01,Standard Silver On Exchange Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,34,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840034,HF Silver HMO Select 80 5241,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9779,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840034-00,Standard Silver Off Exchange Plan,71.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,34,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840034,HF Silver HMO Select 80 5241,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9779,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840034-01,Standard Silver On Exchange Plan,71.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,34,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860034,FHCA Silver HMO Enhanced 80 5245,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9779,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860034-00,Standard Silver Off Exchange Plan,71.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,34,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860034,FHCA Silver HMO Enhanced 80 5245,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9779,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860034-01,Standard Silver On Exchange Plan,71.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,34,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850034,HF Silver POS Select 80 5242,27357FL185,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.979,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850034-00,Standard Silver Off Exchange Plan,71.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,34,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850034,HF Silver POS Select 80 5242,27357FL185,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.979,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850034-01,Standard Silver On Exchange Plan,71.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,34,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870034,FHCA Silver POS Enhanced 80 5246,27357FL187,,FLN002,FLS002,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.979,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870034-00,Standard Silver Off Exchange Plan,71.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,34,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870034,FHCA Silver POS Enhanced 80 5246,27357FL187,,FLN002,FLS002,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.979,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870034-01,Standard Silver On Exchange Plan,71.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,35,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840039,HF Silver HMO Select 70 5279,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.977,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840039-00,Standard Silver Off Exchange Plan,71.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,35,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840039,HF Silver HMO Select 70 5279,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.977,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840039-01,Standard Silver On Exchange Plan,71.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,35,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860039,FHCA Silver HMO Enhanced 70 5285,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.977,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860039-00,Standard Silver Off Exchange Plan,71.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,35,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860039,FHCA Silver HMO Enhanced 70 5285,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.977,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860039-01,Standard Silver On Exchange Plan,71.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,35,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850039,HF Silver POS Select 70 5280,27357FL185,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9784,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850039-00,Standard Silver Off Exchange Plan,71.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$9,200","$18,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,35,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850039,HF Silver POS Select 70 5280,27357FL185,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9784,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850039-01,Standard Silver On Exchange Plan,71.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$9,200","$18,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,35,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870039,FHCA Silver POS Enhanced 70 5286,27357FL187,,FLN002,FLS002,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9784,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870039-00,Standard Silver Off Exchange Plan,71.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$9,200","$18,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,35,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870039,FHCA Silver POS Enhanced 70 5286,27357FL187,,FLN002,FLS002,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9784,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870039-01,Standard Silver On Exchange Plan,71.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$9,200","$18,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,36,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840040,HF Silver HMO Select 50 5289,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9759,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840040-00,Standard Silver Off Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,650","$5,300",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,36,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840040,HF Silver HMO Select 50 5289,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9759,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840040-01,Standard Silver On Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,650","$5,300",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,36,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840041,HF Silver HMO Select 50 5298,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9759,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840041-00,Standard Silver Off Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,36,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840041,HF Silver HMO Select 50 5298,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9759,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840041-01,Standard Silver On Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,36,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860040,FHCA Silver HMO Enhanced 50 5295,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9759,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860040-00,Standard Silver Off Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,650","$5,300",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,36,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860040,FHCA Silver HMO Enhanced 50 5295,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9759,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860040-01,Standard Silver On Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,650","$5,300",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,36,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860041,FHCA Silver HMO Enhanced 50 5304,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9759,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860041-00,Standard Silver Off Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,36,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860041,FHCA Silver HMO Enhanced 50 5304,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9759,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860041-01,Standard Silver On Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,36,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850040,HF Silver POS Select 50 5290,27357FL185,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9773,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850040-00,Standard Silver Off Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,650","$5,300",50%,,,,"$5,300","$10,600",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,36,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850040,HF Silver POS Select 50 5290,27357FL185,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9773,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850040-01,Standard Silver On Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,650","$5,300",50%,,,,"$5,300","$10,600",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,36,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850041,HF Silver POS Select 50 5299,27357FL185,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9773,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850041-00,Standard Silver Off Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,36,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850041,HF Silver POS Select 50 5299,27357FL185,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9773,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850041-01,Standard Silver On Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,36,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870040,FHCA Silver POS Enhanced 50 5296,27357FL187,,FLN002,FLS002,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9773,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870040-00,Standard Silver Off Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,650","$5,300",50%,,,,"$5,300","$10,600",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,36,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870040,FHCA Silver POS Enhanced 50 5296,27357FL187,,FLN002,FLS002,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9773,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870040-01,Standard Silver On Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,650","$5,300",50%,,,,"$5,300","$10,600",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,36,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870041,FHCA Silver POS Enhanced 50 5305,27357FL187,,FLN002,FLS002,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9773,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870041-00,Standard Silver Off Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,36,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870041,FHCA Silver POS Enhanced 50 5305,27357FL187,,FLN002,FLS002,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9773,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870041-01,Standard Silver On Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840043,HF Silver HMO Select 50 5316,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9768,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840043-00,Standard Silver Off Exchange Plan,69.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840043,HF Silver HMO Select 50 5316,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9768,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840043-01,Standard Silver On Exchange Plan,69.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840044,HF Silver HMO Select 70 5325,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9766,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840044-00,Standard Silver Off Exchange Plan,69.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840044,HF Silver HMO Select 70 5325,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9766,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840044-01,Standard Silver On Exchange Plan,69.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840045,HF Silver HMO Select 50 5334,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9763,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840045-00,Standard Silver Off Exchange Plan,68.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,200","$4,400",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840045,HF Silver HMO Select 50 5334,27357FL184,,FLN001,FLS001,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9763,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840045-01,Standard Silver On Exchange Plan,68.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,200","$4,400",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860043,FHCA Silver HMO Enhanced 50 5322,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9768,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860043-00,Standard Silver Off Exchange Plan,69.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860043,FHCA Silver HMO Enhanced 50 5322,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9768,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860043-01,Standard Silver On Exchange Plan,69.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860044,FHCA Silver HMO Enhanced 70 5331,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9766,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860044-00,Standard Silver Off Exchange Plan,69.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860044,FHCA Silver HMO Enhanced 70 5331,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9766,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860044-01,Standard Silver On Exchange Plan,69.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860045,FHCA Silver HMO Enhanced 50 5338,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9763,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860045-00,Standard Silver Off Exchange Plan,68.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,200","$4,400",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860045,FHCA Silver HMO Enhanced 50 5338,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9763,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860045-01,Standard Silver On Exchange Plan,68.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,200","$4,400",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850043,HF Silver POS Select 50 5317,27357FL185,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9782,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850043-00,Standard Silver Off Exchange Plan,69.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,"$2,000","$4,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850043,HF Silver POS Select 50 5317,27357FL185,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9782,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850043-01,Standard Silver On Exchange Plan,69.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,"$2,000","$4,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850044,HF Silver POS Select 70 5326,27357FL185,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.978,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850044-00,Standard Silver Off Exchange Plan,69.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850044,HF Silver POS Select 70 5326,27357FL185,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.978,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850044-01,Standard Silver On Exchange Plan,69.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850045,HF Silver POS Select 50 5335,27357FL185,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9776,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850045-00,Standard Silver Off Exchange Plan,68.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,200","$4,400",50%,,,,"$4,400","$8,800",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850045,HF Silver POS Select 50 5335,27357FL185,,FLN001,FLS001,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9776,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850045-01,Standard Silver On Exchange Plan,68.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,200","$4,400",50%,,,,"$4,400","$8,800",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870043,FHCA Silver POS Enhanced 50 5323,27357FL187,,FLN002,FLS002,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9782,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870043-00,Standard Silver Off Exchange Plan,69.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,"$2,000","$4,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870043,FHCA Silver POS Enhanced 50 5323,27357FL187,,FLN002,FLS002,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9782,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870043-01,Standard Silver On Exchange Plan,69.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,"$2,000","$4,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870044,FHCA Silver POS Enhanced 70 5332,27357FL187,,FLN002,FLS002,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.978,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870044-00,Standard Silver Off Exchange Plan,69.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870044,FHCA Silver POS Enhanced 70 5332,27357FL187,,FLN002,FLS002,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.978,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870044-01,Standard Silver On Exchange Plan,69.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870045,FHCA Silver POS Enhanced 50 5339,27357FL187,,FLN002,FLS002,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9776,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870045-00,Standard Silver Off Exchange Plan,68.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,200","$4,400",50%,,,,"$4,400","$8,800",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,37,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870045,FHCA Silver POS Enhanced 50 5339,27357FL187,,FLN002,FLS002,FLF009,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9776,,,0,0,4,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870045-01,Standard Silver On Exchange Plan,68.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,200","$4,400",50%,,,,"$4,400","$8,800",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,38,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840047,HF Bronze HMO Select 80 5350,27357FL184,,FLN001,FLS001,FLF004,New,HMO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9718,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840047-00,Standard Bronze Off Exchange Plan,61.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,38,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840047,HF Bronze HMO Select 80 5350,27357FL184,,FLN001,FLS001,FLF004,New,HMO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9718,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840047-01,Standard Bronze On Exchange Plan,61.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,38,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840050,HF Bronze HMO Select 70 5371,27357FL184,,FLN001,FLS001,FLF005,New,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9714,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840050-00,Standard Bronze Off Exchange Plan,61.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,38,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840050,HF Bronze HMO Select 70 5371,27357FL184,,FLN001,FLS001,FLF005,New,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9714,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840050-01,Standard Bronze On Exchange Plan,61.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,38,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840051,HF Bronze HMO Select 100 5378,27357FL184,,FLN001,FLS001,FLF001,New,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9715,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840051-00,Standard Bronze Off Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,38,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840051,HF Bronze HMO Select 100 5378,27357FL184,,FLN001,FLS001,FLF001,New,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9715,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840051-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,38,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840052,HF Bronze HMO Select 100 5385,27357FL184,,FLN001,FLS001,FLF001,New,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9706,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840052-00,Standard Bronze Off Exchange Plan,59.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,38,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840052,HF Bronze HMO Select 100 5385,27357FL184,,FLN001,FLS001,FLF001,New,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9706,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840052-01,Standard Bronze On Exchange Plan,59.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,38,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840048,HF Bronze HMO Select 50 5357,27357FL184,,FLN001,FLS001,FLF006,New,HMO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9722,,,0,0,3,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840048-00,Standard Bronze Off Exchange Plan,61.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,700","$11,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,38,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840048,HF Bronze HMO Select 50 5357,27357FL184,,FLN001,FLS001,FLF006,New,HMO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9722,,,0,0,3,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840048-01,Standard Bronze On Exchange Plan,61.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,700","$11,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,38,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860047,FHCA Bronze HMO Enhanced 80 5354,27357FL186,,FLN002,FLS002,FLF004,New,HMO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9718,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860047-00,Standard Bronze Off Exchange Plan,61.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,38,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860047,FHCA Bronze HMO Enhanced 80 5354,27357FL186,,FLN002,FLS002,FLF004,New,HMO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9718,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860047-01,Standard Bronze On Exchange Plan,61.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,38,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860050,FHCA Bronze HMO Enhanced 70 5375,27357FL186,,FLN002,FLS002,FLF005,New,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9714,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860050-00,Standard Bronze Off Exchange Plan,61.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,38,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860050,FHCA Bronze HMO Enhanced 70 5375,27357FL186,,FLN002,FLS002,FLF005,New,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9714,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860050-01,Standard Bronze On Exchange Plan,61.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,38,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860051,FHCA Bronze HMO Enhanced 100 5382,27357FL186,,FLN002,FLS002,FLF001,New,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9715,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860051-00,Standard Bronze Off Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,38,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860051,FHCA Bronze HMO Enhanced 100 5382,27357FL186,,FLN002,FLS002,FLF001,New,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9715,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860051-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,38,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860052,FHCA Bronze HMO Enhanced 100 5389,27357FL186,,FLN002,FLS002,FLF001,New,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9706,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860052-00,Standard Bronze Off Exchange Plan,59.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,38,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860052,FHCA Bronze HMO Enhanced 100 5389,27357FL186,,FLN002,FLS002,FLF001,New,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9706,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860052-01,Standard Bronze On Exchange Plan,59.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,38,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860048,FHCA Bronze HMO Enhanced 50 5361,27357FL186,,FLN002,FLS002,FLF006,New,HMO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9722,,,0,0,3,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860048-00,Standard Bronze Off Exchange Plan,61.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,700","$11,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,38,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860048,FHCA Bronze HMO Enhanced 50 5361,27357FL186,,FLN002,FLS002,FLF006,New,HMO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9722,,,0,0,3,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860048-01,Standard Bronze On Exchange Plan,61.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,700","$11,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,39,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840049,HF Bronze HMO Select 90 5364,27357FL184,,FLN001,FLS001,FLF007,New,HMO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9728,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840049-00,Standard Bronze Off Exchange Plan,61.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,39,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840049,HF Bronze HMO Select 90 5364,27357FL184,,FLN001,FLS001,FLF007,New,HMO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9728,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840049-01,Standard Bronze On Exchange Plan,61.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,39,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860049,FHCA Bronze HMO Enhanced 90 5368,27357FL186,,FLN002,FLS002,FLF007,New,HMO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9728,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860049-00,Standard Bronze Off Exchange Plan,61.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,39,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860049,FHCA Bronze HMO Enhanced 90 5368,27357FL186,,FLN002,FLS002,FLF007,New,HMO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9728,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860049-01,Standard Bronze On Exchange Plan,61.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,39,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850049,HF Bronze POS Select 90 5365,27357FL185,,FLN001,FLS001,FLF007,New,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9742,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850049-00,Standard Bronze Off Exchange Plan,61.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$6,000","$12,000",10%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$350,$700,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,39,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850049,HF Bronze POS Select 90 5365,27357FL185,,FLN001,FLS001,FLF007,New,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9742,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850049-01,Standard Bronze On Exchange Plan,61.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$6,000","$12,000",10%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$350,$700,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,39,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870049,FHCA Bronze POS Enhanced 90 5369,27357FL187,,FLN002,FLS002,FLF007,New,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9742,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870049-00,Standard Bronze Off Exchange Plan,61.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$6,000","$12,000",10%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$350,$700,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,39,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870049,FHCA Bronze POS Enhanced 90 5369,27357FL187,,FLN002,FLS002,FLF007,New,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9742,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870049-01,Standard Bronze On Exchange Plan,61.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$6,000","$12,000",10%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$350,$700,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,40,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860006,FHCA Platinum HMO Enhanced 80 5041,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.984,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860006-00,Standard Platinum Off Exchange Plan,88.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,40,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860006,FHCA Platinum HMO Enhanced 80 5041,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.984,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860006-01,Standard Platinum On Exchange Plan,88.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,40,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860008,FHCA Platinum HMO Enhanced 80 5055,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9839,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860008-00,Standard Platinum Off Exchange Plan,88.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,40,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860008,FHCA Platinum HMO Enhanced 80 5055,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9839,,,5,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860008-01,Standard Platinum On Exchange Plan,88.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,41,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860001,FHCA Platinum HMO Enhanced 100 5006,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9843,,,4,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860001-00,Standard Platinum Off Exchange Plan,90.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,41,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860001,FHCA Platinum HMO Enhanced 100 5006,27357FL186,,FLN002,FLS002,FLF009,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9843,,,4,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860001-01,Standard Platinum On Exchange Plan,90.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,42,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840002,HF Platinum HMO Select 100 5009,27357FL184,,FLN001,FLS001,FLF008,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9841,,,0,0,0,2015-01-01,,Yes,Emergency & UrgentCare Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840002-00,Standard Platinum Off Exchange Plan,90.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,42,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840002,HF Platinum HMO Select 100 5009,27357FL184,,FLN001,FLS001,FLF008,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9841,,,0,0,0,2015-01-01,,Yes,Emergency & UrgentCare Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840002-01,Standard Platinum On Exchange Plan,90.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,42,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860002,FHCA Platinum HMO Enhanced 100 5013,27357FL186,,FLN002,FLS002,FLF008,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9841,,,0,0,0,2015-01-01,,Yes,Emergency & UrgentCare Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860002-00,Standard Platinum Off Exchange Plan,90.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,42,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860002,FHCA Platinum HMO Enhanced 100 5013,27357FL186,,FLN002,FLS002,FLF008,New,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9841,,,0,0,0,2015-01-01,,Yes,Emergency & UrgentCare Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860002-01,Standard Platinum On Exchange Plan,90.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,42,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850002,HF Platinum POS Select 100 5010,27357FL185,,FLN001,FLS001,FLF008,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9853,,,0,0,0,2015-01-01,,Yes,Emergency & UrgentCare Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850002-00,Standard Platinum Off Exchange Plan,90.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,42,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850002,HF Platinum POS Select 100 5010,27357FL185,,FLN001,FLS001,FLF008,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9853,,,0,0,0,2015-01-01,,Yes,Emergency & UrgentCare Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850002-01,Standard Platinum On Exchange Plan,90.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,42,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870002,FHCA Platinum POS Enhanced 100 5014,27357FL187,,FLN002,FLS002,FLF008,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9853,,,0,0,0,2015-01-01,,Yes,Emergency & UrgentCare Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870002-00,Standard Platinum Off Exchange Plan,90.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,42,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870002,FHCA Platinum POS Enhanced 100 5014,27357FL187,,FLN002,FLS002,FLF008,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9853,,,0,0,0,2015-01-01,,Yes,Emergency & UrgentCare Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870002-01,Standard Platinum On Exchange Plan,90.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,43,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850047,HF Bronze POS Select 80 5351,27357FL185,,FLN001,FLS001,FLF004,New,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9735,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850047-00,Standard Bronze Off Exchange Plan,61.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,43,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850047,HF Bronze POS Select 80 5351,27357FL185,,FLN001,FLS001,FLF004,New,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9735,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850047-01,Standard Bronze On Exchange Plan,61.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,43,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850050,HF Bronze POS Select 70 5372,27357FL185,,FLN001,FLS001,FLF005,New,POS,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9731,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850050-00,Standard Bronze Off Exchange Plan,61.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,43,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850050,HF Bronze POS Select 70 5372,27357FL185,,FLN001,FLS001,FLF005,New,POS,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9731,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850050-01,Standard Bronze On Exchange Plan,61.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,43,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850051,HF Bronze POS Select 100 5379,27357FL185,,FLN001,FLS001,FLF001,New,POS,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9732,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850051-00,Standard Bronze Off Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,43,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850051,HF Bronze POS Select 100 5379,27357FL185,,FLN001,FLS001,FLF001,New,POS,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9732,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850051-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,43,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850052,HF Bronze POS Select 100 5386,27357FL185,,FLN001,FLS001,FLF001,New,POS,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9723,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850052-00,Standard Bronze Off Exchange Plan,59.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,43,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850052,HF Bronze POS Select 100 5386,27357FL185,,FLN001,FLS001,FLF001,New,POS,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9723,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850052-01,Standard Bronze On Exchange Plan,59.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,43,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850048,HF Bronze POS Select 50 5358,27357FL185,,FLN001,FLS001,FLF006,New,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9738,,,0,0,3,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850048-00,Standard Bronze Off Exchange Plan,61.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,700","$11,400",,,"$11,400","$22,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",50%,,,,"$10,600","$21,200",Not Applicable,Not Applicable,,,,,,,,,12
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,43,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850048,HF Bronze POS Select 50 5358,27357FL185,,FLN001,FLS001,FLF006,New,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9738,,,0,0,3,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850048-01,Standard Bronze On Exchange Plan,61.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,700","$11,400",,,"$11,400","$22,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",50%,,,,"$10,600","$21,200",Not Applicable,Not Applicable,,,,,,,,,13
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,43,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870047,FHCA Bronze POS Enhanced 80 5355,27357FL187,,FLN002,FLS002,FLF004,New,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9735,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870047-00,Standard Bronze Off Exchange Plan,61.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,43,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870047,FHCA Bronze POS Enhanced 80 5355,27357FL187,,FLN002,FLS002,FLF004,New,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9735,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870047-01,Standard Bronze On Exchange Plan,61.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,43,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870050,FHCA Bronze POS Enhanced 70 5376,27357FL187,,FLN002,FLS002,FLF005,New,POS,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9731,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870050-00,Standard Bronze Off Exchange Plan,61.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,43,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870050,FHCA Bronze POS Enhanced 70 5376,27357FL187,,FLN002,FLS002,FLF005,New,POS,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9731,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870050-01,Standard Bronze On Exchange Plan,61.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,43,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870051,FHCA Bronze POS Enhanced 100 5383,27357FL187,,FLN002,FLS002,FLF001,New,POS,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9732,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870051-00,Standard Bronze Off Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,43,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870051,FHCA Bronze POS Enhanced 100 5383,27357FL187,,FLN002,FLS002,FLF001,New,POS,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9732,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870051-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,43,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870052,FHCA Bronze POS Enhanced 100 5390,27357FL187,,FLN002,FLS002,FLF001,New,POS,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9723,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870052-00,Standard Bronze Off Exchange Plan,59.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,43,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870052,FHCA Bronze POS Enhanced 100 5390,27357FL187,,FLN002,FLS002,FLF001,New,POS,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9723,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870052-01,Standard Bronze On Exchange Plan,59.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,43,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870048,FHCA Bronze POS Enhanced 50 5362,27357FL187,,FLN002,FLS002,FLF006,New,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9738,,,0,0,3,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870048-00,Standard Bronze Off Exchange Plan,61.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,700","$11,400",,,"$11,400","$22,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",50%,,,,"$10,600","$21,200",Not Applicable,Not Applicable,,,,,,,,,22
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,43,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870048,FHCA Bronze POS Enhanced 50 5362,27357FL187,,FLN002,FLS002,FLF006,New,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9738,,,0,0,3,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870048-01,Standard Bronze On Exchange Plan,61.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,700","$11,400",,,"$11,400","$22,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",50%,,,,"$10,600","$21,200",Not Applicable,Not Applicable,,,,,,,,,23
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850035,HF Silver POS Select 85 5249,27357FL185,,FLN001,FLS001,FLF003,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9787,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850035-00,Standard Silver Off Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850035,HF Silver POS Select 85 5249,27357FL185,,FLN001,FLS001,FLF003,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9787,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850035-01,Standard Silver On Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850037,HF Silver POS Select 80 5265,27357FL185,,FLN001,FLS001,FLF004,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9786,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850037-00,Standard Silver Off Exchange Plan,71.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850037,HF Silver POS Select 80 5265,27357FL185,,FLN001,FLS001,FLF004,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9786,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850037-01,Standard Silver On Exchange Plan,71.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850036,HF Silver POS Select 100 5258,27357FL185,,FLN001,FLS001,FLF001,New,POS,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9787,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850036-00,Standard Silver Off Exchange Plan,71.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850036,HF Silver POS Select 100 5258,27357FL185,,FLN001,FLS001,FLF001,New,POS,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9787,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850036-01,Standard Silver On Exchange Plan,71.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850038,HF Silver POS Select 70 5272,27357FL185,,FLN001,FLS001,FLF005,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9785,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850038-00,Standard Silver Off Exchange Plan,71.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850038,HF Silver POS Select 70 5272,27357FL185,,FLN001,FLS001,FLF005,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9785,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850038-01,Standard Silver On Exchange Plan,71.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850042,HF Silver POS Select 90 5308,27357FL185,,FLN001,FLS001,FLF002,New,POS,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9781,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850042-00,Standard Silver Off Exchange Plan,70.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850042,HF Silver POS Select 90 5308,27357FL185,,FLN001,FLS001,FLF002,New,POS,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9781,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850042-01,Standard Silver On Exchange Plan,70.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850046,HF Silver POS Select 70 5342,27357FL185,,FLN001,FLS001,FLF005,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9776,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850046-00,Standard Silver Off Exchange Plan,68.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850046,HF Silver POS Select 70 5342,27357FL185,,FLN001,FLS001,FLF005,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9776,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850046-01,Standard Silver On Exchange Plan,68.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870035,FHCA Silver POS Enhanced 85 5255,27357FL187,,FLN002,FLS002,FLF003,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9787,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870035-00,Standard Silver Off Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870035,FHCA Silver POS Enhanced 85 5255,27357FL187,,FLN002,FLS002,FLF003,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9787,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870035-01,Standard Silver On Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870037,FHCA Silver POS Enhanced 80 5269,27357FL187,,FLN002,FLS002,FLF004,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9786,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870037-00,Standard Silver Off Exchange Plan,71.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870037,FHCA Silver POS Enhanced 80 5269,27357FL187,,FLN002,FLS002,FLF004,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9786,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870037-01,Standard Silver On Exchange Plan,71.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870036,FHCA Silver POS Enhanced 100 5262,27357FL187,,FLN002,FLS002,FLF001,New,POS,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9787,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870036-00,Standard Silver Off Exchange Plan,71.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870036,FHCA Silver POS Enhanced 100 5262,27357FL187,,FLN002,FLS002,FLF001,New,POS,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9787,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870036-01,Standard Silver On Exchange Plan,71.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870038,FHCA Silver POS Enhanced 70 5278,27357FL187,,FLN002,FLS002,FLF005,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9785,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870038-00,Standard Silver Off Exchange Plan,71.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870038,FHCA Silver POS Enhanced 70 5278,27357FL187,,FLN002,FLS002,FLF005,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9785,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870038-01,Standard Silver On Exchange Plan,71.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870042,FHCA Silver POS Enhanced 90 5314,27357FL187,,FLN002,FLS002,FLF002,New,POS,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9781,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870042-00,Standard Silver Off Exchange Plan,70.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870042,FHCA Silver POS Enhanced 90 5314,27357FL187,,FLN002,FLS002,FLF002,New,POS,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9781,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870042-01,Standard Silver On Exchange Plan,70.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870046,FHCA Silver POS Enhanced 70 5348,27357FL187,,FLN002,FLS002,FLF005,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9776,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870046-00,Standard Silver Off Exchange Plan,68.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,44,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870046,FHCA Silver POS Enhanced 70 5348,27357FL187,,FLN002,FLS002,FLF005,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9776,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870046-01,Standard Silver On Exchange Plan,68.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,45,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840027,HF Gold HMO Select 100 5190,27357FL184,,FLN001,FLS001,FLF001,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9804,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840027-00,Standard Gold Off Exchange Plan,78.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,45,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1840027,HF Gold HMO Select 100 5190,27357FL184,,FLN001,FLS001,FLF001,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9804,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1840027-01,Standard Gold On Exchange Plan,78.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,45,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860027,FHCA Gold HMO Enhanced 100 5194,27357FL186,,FLN002,FLS002,FLF001,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9804,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860027-00,Standard Gold Off Exchange Plan,78.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,45,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1860027,FHCA Gold HMO Enhanced 100 5194,27357FL186,,FLN002,FLS002,FLF001,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9804,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1860027-01,Standard Gold On Exchange Plan,78.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,45,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850027,HF Gold POS Select 100 5191,27357FL185,,FLN001,FLS001,FLF001,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9818,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850027-00,Standard Gold Off Exchange Plan,78.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,45,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1850027,HF Gold POS Select 100 5191,27357FL185,,FLN001,FLS001,FLF001,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9818,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,www.myHFHP.org/MHS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1850027-01,Standard Gold On Exchange Plan,78.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,45,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870027,FHCA Gold POS Enhanced 100 5195,27357FL187,,FLN002,FLS002,FLF001,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9818,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870027-00,Standard Gold Off Exchange Plan,78.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,FL,27357,HIOS,7,2015-02-13 08:19:48,45,27357,FL,SHOP (Small Group),No,59-3315064,27357FL1870027,FHCA Gold POS Enhanced 100 5195,27357FL187,,FLN002,FLS002,FLF001,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9818,,,0,0,0,2015-01-01,,Yes,Emergency & Urgent Care Only,No,,No,http://www.myFHCA.org/FHMHS_2015,www.myHFHP.org/Premium,http://www.myFHCA.org/FHMHS_2015,http://www.myHFHP.org/MP_formulary_2015,27357FL1870027-01,Standard Gold On Exchange Plan,78.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,FL,30115,HIOS,6,2014-10-02 12:25:15,1,30115,FL,Individual,Yes,58-2876465,30115FL0010001,BlueDental Copayment Q,30115FL001,,FLN001,FLS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$20.92,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Out of service area benefits are available as defined in the policy but may have a higher cost share,No,http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Copayment_Q_Plan_Benefit_Summary.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Copayment_Q_Plan_Brochure.pdf,,30115FL0010001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,30115,HIOS,6,2014-10-02 12:25:15,1,30115,FL,Individual,Yes,58-2876465,30115FL0010001,BlueDental Copayment Q,30115FL001,,FLN001,FLS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$20.92,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Out of service area benefits are available as defined in the policy but may have a higher cost share,No,http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Copayment_Q_Plan_Benefit_Summary.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Copayment_Q_Plan_Brochure.pdf,,30115FL0010001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,30115,HIOS,6,2014-10-02 12:25:15,2,30115,FL,Individual,Yes,58-2876465,30115FL0020001,BlueDental Choice Q,30115FL002,,FLN001,FLS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$34.99,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Out of service area benefits are available as defined in the policy but may have a higher cost share,Yes,http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_Q_Plan_Benefit_Summary.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_Q_Plan_Brochure.pdf,,30115FL0020001-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,7,30252,FL,Individual,No,59-2403696,30252FL0020070,BlueCare Everyday Health 1477,30252FL002,,FLN001,FLS001,FLF008,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1477_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1477_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020070-01,Standard Silver On Exchange Plan,68.92%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,7,30252,FL,Individual,No,59-2403696,30252FL0020070,BlueCare Everyday Health 1477,30252FL002,,FLN001,FLS001,FLF008,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1477_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1477_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020070-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,30115,HIOS,6,2014-10-02 12:25:15,2,30115,FL,Individual,Yes,58-2876465,30115FL0020001,BlueDental Choice Q,30115FL002,,FLN001,FLS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$34.99,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Out of service area benefits are available as defined in the policy but may have a higher cost share,Yes,http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_Q_Plan_Benefit_Summary.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_Q_Plan_Brochure.pdf,,30115FL0020001-01,Standard High On Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,30115,HIOS,6,2014-10-02 12:25:15,4,30115,FL,Individual,Yes,58-2876465,30115FL0040001,BlueDental Copayment QF,30115FL004,,FLN001,FLS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.92,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Out of service area benefits are available as defined in the policy but may have a higher cost share,Yes,http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Copayment_QF_Plan_Benefit_Summary.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Copayment_QF_Plan_Brochure.pdf,,30115FL0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,30115,HIOS,6,2014-10-02 12:25:15,4,30115,FL,Individual,Yes,58-2876465,30115FL0040001,BlueDental Copayment QF,30115FL004,,FLN001,FLS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.92,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Out of service area benefits are available as defined in the policy but may have a higher cost share,Yes,http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Copayment_QF_Plan_Benefit_Summary.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Copayment_QF_Plan_Brochure.pdf,,30115FL0040001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,30115,HIOS,6,2014-10-02 12:25:15,5,30115,FL,Individual,Yes,58-2876465,30115FL0050001,BlueDental Choice QF,30115FL005,,FLN001,FLS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.99,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Out of service area benefits are available as defined in the policy but may have a higher cost share,Yes,http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_QF_Plan_Benefit_Summary.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_QF_Plan_Brochure.pdf,,30115FL0050001-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,8,30252,FL,Individual,No,59-2403696,30252FL0020074,BlueCare All Copay 1565,30252FL002,,FLN001,FLS001,FLF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1565_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1565_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020074-00,Standard Gold Off Exchange Plan,81.94%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,8,30252,FL,Individual,No,59-2403696,30252FL0020074,BlueCare All Copay 1565,30252FL002,,FLN001,FLS001,FLF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1565_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1565_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020074-01,Standard Gold On Exchange Plan,81.94%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,8,30252,FL,Individual,No,59-2403696,30252FL0020074,BlueCare All Copay 1565,30252FL002,,FLN001,FLS001,FLF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1565_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1565_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020074-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,8,30252,FL,Individual,No,59-2403696,30252FL0020074,BlueCare All Copay 1565,30252FL002,,FLN001,FLS001,FLF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1565_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1565_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020074-03,Limited Cost Sharing Plan Variation,81.94%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160032,Humana Silver 4600/Volusia HUMx (HMOx),35783FL116,,FLN004,FLS005,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339805,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2326935,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160032-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160032,Humana Silver 4600/Volusia HUMx (HMOx),35783FL116,,FLN004,FLS005,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339805,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2326935,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160032-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160032,Humana Silver 4600/Volusia HUMx (HMOx),35783FL116,,FLN004,FLS005,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339805,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2326935,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160032-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160032,Humana Silver 4600/Volusia HUMx (HMOx),35783FL116,,FLN004,FLS005,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339805,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2326935,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160032-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160032,Humana Silver 4600/Volusia HUMx (HMOx),35783FL116,,FLN004,FLS005,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339805,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2326935,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160032-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160032,Humana Silver 4600/Volusia HUMx (HMOx),35783FL116,,FLN004,FLS005,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339805,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2326935,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160032-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160004,Humana Silver 4600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339779,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331264,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,36
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160004,Humana Silver 4600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339779,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331264,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160004-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,2,48121,FL,Individual,No,59-1031071,48121FL0020012,myCigna Health Flex 5000 Bronze,48121FL002,7730182962,FLN001,FLS001,FLF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-5000-bronze,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-5000-bronze,http://www.cigna.com/ifp-drug-list,48121FL0020012-01,Standard Bronze On Exchange Plan,61.60%,0.61153107881546,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,2,48121,FL,Individual,No,59-1031071,48121FL0020012,myCigna Health Flex 5000 Bronze,48121FL002,7730182962,FLN001,FLS001,FLF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-5000-bronze,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-5000-bronze,http://www.cigna.com/ifp-drug-list,48121FL0020012-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,2,48121,FL,Individual,No,59-1031071,48121FL0020012,myCigna Health Flex 5000 Bronze,48121FL002,7730182962,FLN001,FLS001,FLF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-5000-bronze,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-5000-bronze,http://www.cigna.com/ifp-drug-list,48121FL0020012-03,Limited Cost Sharing Plan Variation,61.60%,0.61153107881546,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,3,48121,FL,Individual,No,59-1031071,48121FL0020005,myCigna Health Flex 1500,48121FL002,7730182962,FLN001,FLS001,FLF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-1500,http://www.cigna.com/ifp-drug-list,48121FL0020005-00,Standard Silver Off Exchange Plan,69.10%,0.709242641925812,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,3,48121,FL,Individual,No,59-1031071,48121FL0020005,myCigna Health Flex 1500,48121FL002,7730182962,FLN001,FLS001,FLF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-1500,http://www.cigna.com/ifp-drug-list,48121FL0020005-01,Standard Silver On Exchange Plan,69.10%,0.709242641925812,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,3,48121,FL,Individual,No,59-1031071,48121FL0020005,myCigna Health Flex 1500,48121FL002,7730182962,FLN001,FLS001,FLF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-1500,http://www.cigna.com/ifp-drug-list,48121FL0020005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,3,48121,FL,Individual,No,59-1031071,48121FL0020005,myCigna Health Flex 1500,48121FL002,7730182962,FLN001,FLS001,FLF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-1500,http://www.cigna.com/ifp-drug-list,48121FL0020005-03,Limited Cost Sharing Plan Variation,69.10%,0.709242641925812,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,3,48121,FL,Individual,No,59-1031071,48121FL0020005,myCigna Health Flex 1500,48121FL002,7730182962,FLN001,FLS001,FLF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-1500,http://www.cigna.com/ifp-drug-list,48121FL0020005-04,73% AV Level Silver Plan,72.50%,0.742465913295746,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,3,48121,FL,Individual,No,59-1031071,48121FL0020005,myCigna Health Flex 1500,48121FL002,7730182962,FLN001,FLS001,FLF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-1500,http://www.cigna.com/ifp-drug-list,48121FL0020005-05,87% AV Level Silver Plan,86.30%,0.867775917053223,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$725,"$1,450",30%,,,,"$2,900","$5,800",Not Applicable,Not Applicable,,,,,,,,,9
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,3,48121,FL,Individual,No,59-1031071,48121FL0020005,myCigna Health Flex 1500,48121FL002,7730182962,FLN001,FLS001,FLF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-1500,http://www.cigna.com/ifp-drug-list,48121FL0020005-06,94% AV Level Silver Plan,93.40%,0.93521922826767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$575,"$1,150",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,30%,,,,$800,"$1,600",Not Applicable,Not Applicable,,,,,,,,,10
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160005,Humana Gold 2500/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339623,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331355,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160005-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160006,Humana Platinum 1000/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339675,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331368,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160006-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160006,Humana Platinum 1000/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339675,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331368,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160006-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160006,Humana Platinum 1000/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339675,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331368,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,47
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160032,Humana Silver 4600/Volusia HUMx (HMOx),35783FL116,,FLN004,FLS005,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339805,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2326935,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160032-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160033,Humana Gold 2500/Volusia HUMx (HMOx),35783FL116,,FLN004,FLS005,FLF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339649,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2326987,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160033-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160033,Humana Gold 2500/Volusia HUMx (HMOx),35783FL116,,FLN004,FLS005,FLF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339649,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2326987,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160033-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160033,Humana Gold 2500/Volusia HUMx (HMOx),35783FL116,,FLN004,FLS005,FLF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339649,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2326987,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160033-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,FL,30115,HIOS,6,2014-10-02 12:25:15,5,30115,FL,Individual,Yes,58-2876465,30115FL0050001,BlueDental Choice QF,30115FL005,,FLN001,FLS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.99,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Out of service area benefits are available as defined in the policy but may have a higher cost share,Yes,http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_QF_Plan_Benefit_Summary.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_QF_Plan_Brochure.pdf,,30115FL0050001-01,Standard High On Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,30219,HIOS,5,2014-08-28 04:23:13,1,30219,FL,SHOP (Small Group),Yes,65-0073323,30219FL0030001,Family Basic Dental Plan (Low),30219FL003,,FLN003,FLS001,,Existing,HMO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$10.46,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.,No,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48033,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48032,,30219FL0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,30219,HIOS,5,2014-08-28 04:23:13,1,30219,FL,SHOP (Small Group),Yes,65-0073323,30219FL0030001,Family Basic Dental Plan (Low),30219FL003,,FLN003,FLS001,,Existing,HMO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$10.46,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.,No,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48033,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48032,,30219FL0030001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,30219,HIOS,5,2014-08-28 04:23:13,2,30219,FL,SHOP (Small Group),Yes,65-0073323,30219FL0040001,Family Enhanced Dental Plan (High),30219FL004,,FLN004,FLS001,,Existing,HMO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$13.77,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.,No,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49074,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49073,,30219FL0040001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,30219,HIOS,5,2014-08-28 04:23:13,2,30219,FL,SHOP (Small Group),Yes,65-0073323,30219FL0040001,Family Enhanced Dental Plan (High),30219FL004,,FLN004,FLS001,,Existing,HMO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$13.77,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.,No,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49074,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49073,,30219FL0040001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,1,30252,FL,Individual,No,59-2403696,30252FL0020033,BlueCare Everyday Health 1490,30252FL002,,FLN001,FLS001,FLF003,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1490_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1490_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020033-00,Standard Silver Off Exchange Plan,68.65%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,1,30252,FL,SHOP (Small Group),No,59-2403696,30252FL0010001,BlueCare Essential Health S1450,30252FL001,,FLN001,FLS001,FLF001,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,www.bcbsfl.com/DocumentLibrary/SBC/2015/S1450.pdf,,www.bcbsfl.com/DocumentLibrary/MiniSummary/2015/S1450.pdf,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0010001-00,Standard Silver Off Exchange Plan,,0.696754574775696,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,1,30252,FL,SHOP (Small Group),No,59-2403696,30252FL0010001,BlueCare Essential Health S1450,30252FL001,,FLN001,FLS001,FLF001,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,www.bcbsfl.com/DocumentLibrary/SBC/2015/S1450.pdf,,www.bcbsfl.com/DocumentLibrary/MiniSummary/2015/S1450.pdf,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0010001-01,Standard Silver On Exchange Plan,,0.696754574775696,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,1,30252,FL,Individual,No,59-2403696,30252FL0020033,BlueCare Everyday Health 1490,30252FL002,,FLN001,FLS001,FLF003,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1490_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1490_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020033-01,Standard Silver On Exchange Plan,68.65%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,1,30252,FL,Individual,No,59-2403696,30252FL0020033,BlueCare Everyday Health 1490,30252FL002,,FLN001,FLS001,FLF003,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1490_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1490_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020033-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,1,30252,FL,SHOP (Small Group),No,59-2403696,30252FL0010002,BlueCare Essential Health S1451,30252FL001,,FLN001,FLS001,FLF001,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,www.bcbsfl.com/DocumentLibrary/SBC/2015/S1451.pdf,,www.bcbsfl.com/DocumentLibrary/MiniSummary/2015/S1451.pdf,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0010002-00,Standard Gold Off Exchange Plan,,0.782234013080597,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,1,30252,FL,SHOP (Small Group),No,59-2403696,30252FL0010002,BlueCare Essential Health S1451,30252FL001,,FLN001,FLS001,FLF001,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,www.bcbsfl.com/DocumentLibrary/SBC/2015/S1451.pdf,,www.bcbsfl.com/DocumentLibrary/MiniSummary/2015/S1451.pdf,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0010002-01,Standard Gold On Exchange Plan,,0.782234013080597,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,1,30252,FL,Individual,No,59-2403696,30252FL0020033,BlueCare Everyday Health 1490,30252FL002,,FLN001,FLS001,FLF003,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1490_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1490_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020033-03,Limited Cost Sharing Plan Variation,68.65%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,1,30252,FL,Individual,No,59-2403696,30252FL0020033,BlueCare Everyday Health 1490,30252FL002,,FLN001,FLS001,FLF003,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1490_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1490_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020033-04,73% AV Level Silver Plan,73.14%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,1,30252,FL,Individual,No,59-2403696,30252FL0020033,BlueCare Everyday Health 1490,30252FL002,,FLN001,FLS001,FLF003,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1490_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1490_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020033-05,87% AV Level Silver Plan,86.46%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,1,30252,FL,Individual,No,59-2403696,30252FL0020033,BlueCare Everyday Health 1490,30252FL002,,FLN001,FLS001,FLF003,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1490_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1490_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020033-06,94% AV Level Silver Plan,93.22%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,2,30252,FL,Individual,No,59-2403696,30252FL0020044,BlueCare Essential (HSA) 1486,30252FL002,,FLN001,FLS001,FLF010,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1486_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1486_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020044-00,Standard Bronze Off Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,2,30252,FL,Individual,No,59-2403696,30252FL0020044,BlueCare Essential (HSA) 1486,30252FL002,,FLN001,FLS001,FLF010,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1486_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1486_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020044-01,Standard Bronze On Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,2,30252,FL,Individual,No,59-2403696,30252FL0020044,BlueCare Essential (HSA) 1486,30252FL002,,FLN001,FLS001,FLF010,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1486_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1486_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020044-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,2,30252,FL,Individual,No,59-2403696,30252FL0020044,BlueCare Essential (HSA) 1486,30252FL002,,FLN001,FLS001,FLF010,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1486_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1486_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020044-03,Limited Cost Sharing Plan Variation,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,3,30252,FL,Individual,No,59-2403696,30252FL0020060,BlueCare Everyday Health 1498,30252FL002,,FLN001,FLS001,FLF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1498_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1498_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020060-00,Standard Silver Off Exchange Plan,68.36%,0.683605074882507,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,3,30252,FL,Individual,No,59-2403696,30252FL0020060,BlueCare Everyday Health 1498,30252FL002,,FLN001,FLS001,FLF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1498_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1498_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020060-01,Standard Silver On Exchange Plan,68.36%,0.683605074882507,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,3,30252,FL,Individual,No,59-2403696,30252FL0020060,BlueCare Everyday Health 1498,30252FL002,,FLN001,FLS001,FLF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1498_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1498_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020060-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,3,30252,FL,Individual,No,59-2403696,30252FL0020060,BlueCare Everyday Health 1498,30252FL002,,FLN001,FLS001,FLF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1498_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1498_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020060-03,Limited Cost Sharing Plan Variation,68.36%,0.683605074882507,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,3,30252,FL,Individual,No,59-2403696,30252FL0020060,BlueCare Everyday Health 1498,30252FL002,,FLN001,FLS001,FLF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1498_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1498_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020060-04,73% AV Level Silver Plan,73.54%,0.735352694988251,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,3,30252,FL,Individual,No,59-2403696,30252FL0020060,BlueCare Everyday Health 1498,30252FL002,,FLN001,FLS001,FLF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1498_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1498_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020060-05,87% AV Level Silver Plan,86.80%,0.898064911365509,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,3,30252,FL,Individual,No,59-2403696,30252FL0020060,BlueCare Everyday Health 1498,30252FL002,,FLN001,FLS001,FLF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1498_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1498_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020060-06,94% AV Level Silver Plan,94.35%,0.945072710514069,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,"$1,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,4,30252,FL,Individual,No,59-2403696,30252FL0020062,BlueCare Everyday Health 1485,30252FL002,,FLN001,FLS001,FLF002,Existing,HMO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1485_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1485_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020062-00,Standard Platinum Off Exchange Plan,88.34%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,4,30252,FL,Individual,No,59-2403696,30252FL0020062,BlueCare Everyday Health 1485,30252FL002,,FLN001,FLS001,FLF002,Existing,HMO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1485_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1485_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020062-01,Standard Platinum On Exchange Plan,88.34%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,4,30252,FL,Individual,No,59-2403696,30252FL0020062,BlueCare Everyday Health 1485,30252FL002,,FLN001,FLS001,FLF002,Existing,HMO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1485_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1485_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020062-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,4,30252,FL,Individual,No,59-2403696,30252FL0020062,BlueCare Everyday Health 1485,30252FL002,,FLN001,FLS001,FLF002,Existing,HMO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1485_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1485_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020062-03,Limited Cost Sharing Plan Variation,88.34%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,5,30252,FL,Individual,No,59-2403696,30252FL0020066,BlueCare Everyday Health 1483,30252FL002,,FLN001,FLS001,FLF004,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1483_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1483_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020066-00,Standard Bronze Off Exchange Plan,60.20%,0.607653260231018,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,5,30252,FL,Individual,No,59-2403696,30252FL0020066,BlueCare Everyday Health 1483,30252FL002,,FLN001,FLS001,FLF004,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1483_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1483_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020066-01,Standard Bronze On Exchange Plan,60.20%,0.607653260231018,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,5,30252,FL,Individual,No,59-2403696,30252FL0020066,BlueCare Everyday Health 1483,30252FL002,,FLN001,FLS001,FLF004,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1483_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1483_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020066-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,5,30252,FL,Individual,No,59-2403696,30252FL0020066,BlueCare Everyday Health 1483,30252FL002,,FLN001,FLS001,FLF004,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1483_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1483_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020066-03,Limited Cost Sharing Plan Variation,60.20%,0.607653260231018,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,6,30252,FL,Individual,No,59-2403696,30252FL0020068,BlueCare All Copay 1491,30252FL002,,FLN001,FLS001,FLF005,Existing,HMO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1491_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1491_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020068-00,Standard Platinum Off Exchange Plan,88.75%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,6,30252,FL,Individual,No,59-2403696,30252FL0020068,BlueCare All Copay 1491,30252FL002,,FLN001,FLS001,FLF005,Existing,HMO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1491_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1491_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020068-01,Standard Platinum On Exchange Plan,88.75%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,6,30252,FL,Individual,No,59-2403696,30252FL0020068,BlueCare All Copay 1491,30252FL002,,FLN001,FLS001,FLF005,Existing,HMO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1491_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1491_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020068-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,6,30252,FL,Individual,No,59-2403696,30252FL0020068,BlueCare All Copay 1491,30252FL002,,FLN001,FLS001,FLF005,Existing,HMO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1491_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1491_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020068-03,Limited Cost Sharing Plan Variation,88.75%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,7,30252,FL,Individual,No,59-2403696,30252FL0020070,BlueCare Everyday Health 1477,30252FL002,,FLN001,FLS001,FLF008,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1477_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1477_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020070-00,Standard Silver Off Exchange Plan,68.92%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,7,30252,FL,Individual,No,59-2403696,30252FL0020070,BlueCare Everyday Health 1477,30252FL002,,FLN001,FLS001,FLF008,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1477_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1477_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020070-03,Limited Cost Sharing Plan Variation,68.92%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,7,30252,FL,Individual,No,59-2403696,30252FL0020070,BlueCare Everyday Health 1477,30252FL002,,FLN001,FLS001,FLF008,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1477_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1477_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020070-04,73% AV Level Silver Plan,73.57%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$9,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,7,30252,FL,Individual,No,59-2403696,30252FL0020070,BlueCare Everyday Health 1477,30252FL002,,FLN001,FLS001,FLF008,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1477_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1477_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020070-05,87% AV Level Silver Plan,87.61%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,FL,30252,HIOS,6,2014-12-10 11:54:40,7,30252,FL,Individual,No,59-2403696,30252FL0020070,BlueCare Everyday Health 1477,30252FL002,,FLN001,FLS001,FLF008,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Accident and emergency services.,Yes,Accident and emergency services.,No,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1477_menu/,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2015/1477_menu/,http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf,30252FL0020070-06,94% AV Level Silver Plan,93.51%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160018,Humana Platinum 1000/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339688,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331498,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160018-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,90
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160018,Humana Platinum 1000/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339688,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331498,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160018-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,91
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160017,Humana Gold 2500/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339636,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331485,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160017-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,88
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160017,Humana Gold 2500/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339636,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331485,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160017-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,89
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,3,35783,FL,Individual,No,61-1103898,35783FL1160003,Humana Bronze 4850/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339532,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331238,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160003-00,Standard Bronze Off Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,3,35783,FL,Individual,No,61-1103898,35783FL1160003,Humana Bronze 4850/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339532,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331238,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160003-01,Standard Bronze On Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,4,48121,FL,Individual,No,59-1031071,48121FL0020006,myCigna Health Flex 2750,48121FL002,7730182962,FLN001,FLS001,FLF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-2750,http://www.cigna.com/ifp-drug-list,48121FL0020006-03,Limited Cost Sharing Plan Variation,68.60%,0.693712592124939,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,4,48121,FL,Individual,No,59-1031071,48121FL0020006,myCigna Health Flex 2750,48121FL002,7730182962,FLN001,FLS001,FLF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-2750,http://www.cigna.com/ifp-drug-list,48121FL0020006-04,73% AV Level Silver Plan,72.50%,0.73218709230423,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",20%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,4,48121,FL,Individual,No,59-1031071,48121FL0020006,myCigna Health Flex 2750,48121FL002,7730182962,FLN001,FLS001,FLF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-2750,http://www.cigna.com/ifp-drug-list,48121FL0020006-05,87% AV Level Silver Plan,86.00%,0.865245342254639,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,4,48121,FL,Individual,No,59-1031071,48121FL0020006,myCigna Health Flex 2750,48121FL002,7730182962,FLN001,FLS001,FLF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-2750,http://www.cigna.com/ifp-drug-list,48121FL0020006-06,94% AV Level Silver Plan,93.10%,0.933359861373901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$575,"$1,150",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,$800,"$1,600",Not Applicable,Not Applicable,,,,,,,,,10
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,4,48121,FL,Individual,No,59-1031071,48121FL0020007,myCigna Health Flex 5000,48121FL002,7730182962,FLN001,FLS001,FLF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-5000,http://www.cigna.com/ifp-drug-list,48121FL0020007-00,Standard Silver Off Exchange Plan,69.40%,0.70461243391037,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,4,48121,FL,Individual,No,59-1031071,48121FL0020007,myCigna Health Flex 5000,48121FL002,7730182962,FLN001,FLS001,FLF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-5000,http://www.cigna.com/ifp-drug-list,48121FL0020007-01,Standard Silver On Exchange Plan,69.40%,0.70461243391037,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,4,48121,FL,Individual,No,59-1031071,48121FL0020007,myCigna Health Flex 5000,48121FL002,7730182962,FLN001,FLS001,FLF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-5000,http://www.cigna.com/ifp-drug-list,48121FL0020007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,4,48121,FL,Individual,No,59-1031071,48121FL0020007,myCigna Health Flex 5000,48121FL002,7730182962,FLN001,FLS001,FLF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-5000,http://www.cigna.com/ifp-drug-list,48121FL0020007-03,Limited Cost Sharing Plan Variation,69.40%,0.70461243391037,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,4,48121,FL,Individual,No,59-1031071,48121FL0020007,myCigna Health Flex 5000,48121FL002,7730182962,FLN001,FLS001,FLF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-5000,http://www.cigna.com/ifp-drug-list,48121FL0020007-04,73% AV Level Silver Plan,72.00%,0.717439651489258,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,4,48121,FL,Individual,No,59-1031071,48121FL0020007,myCigna Health Flex 5000,48121FL002,7730182962,FLN001,FLS001,FLF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-5000,http://www.cigna.com/ifp-drug-list,48121FL0020007-05,87% AV Level Silver Plan,86.20%,0.866659820079803,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,450","$2,900",0%,,,,"$5,800","$11,600",Not Applicable,Not Applicable,,,,,,,,,16
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,3,35783,FL,Individual,No,61-1103898,35783FL1150003,Humana Bronze 4850/HMO Premier,35783FL115,,FLN001,FLS001,FLF002,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339519,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331108,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1150003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,3,35783,FL,Individual,No,61-1103898,35783FL1150003,Humana Bronze 4850/HMO Premier,35783FL115,,FLN001,FLS001,FLF002,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339519,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331108,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1150003-03,Limited Cost Sharing Plan Variation,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160033,Humana Gold 2500/Volusia HUMx (HMOx),35783FL116,,FLN004,FLS005,FLF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339649,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2326987,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160033-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160034,Humana Platinum 1000/Volusia HUMx (HMOx),35783FL116,,FLN004,FLS005,FLF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339701,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327000,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160034-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160034,Humana Platinum 1000/Volusia HUMx (HMOx),35783FL116,,FLN004,FLS005,FLF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339701,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327000,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160034-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160034,Humana Platinum 1000/Volusia HUMx (HMOx),35783FL116,,FLN004,FLS005,FLF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339701,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327000,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160034-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160034,Humana Platinum 1000/Volusia HUMx (HMOx),35783FL116,,FLN004,FLS005,FLF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339701,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327000,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160034-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1150004,Humana Silver 4600/HMO Premier,35783FL115,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339766,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331121,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1150004-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160040,Humana Platinum 1000/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339675,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331368,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160040-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,60
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160040,Humana Platinum 1000/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339675,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331368,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160040-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,61
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160040,Humana Platinum 1000/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339675,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331368,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160040-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,62
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160040,Humana Platinum 1000/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339675,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331368,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160040-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,63
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160044,Humana Silver 4600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339779,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331264,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160044-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,64
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160044,Humana Silver 4600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339779,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331264,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160044-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,65
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160044,Humana Silver 4600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339779,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331264,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160044-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,66
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160044,Humana Silver 4600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339779,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331264,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160044-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,67
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160002,Humana Bronze 6300/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339571,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331225,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160002-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160002,Humana Bronze 6300/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339571,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331225,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160002-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1150004,Humana Silver 4600/HMO Premier,35783FL115,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339766,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331121,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1150004-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1150004,Humana Silver 4600/HMO Premier,35783FL115,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339766,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331121,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1150004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1150004,Humana Silver 4600/HMO Premier,35783FL115,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339766,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331121,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1150004-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1150004,Humana Silver 4600/HMO Premier,35783FL115,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339766,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331121,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1150004-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1150004,Humana Silver 4600/HMO Premier,35783FL115,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339766,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331121,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1150004-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1150004,Humana Silver 4600/HMO Premier,35783FL115,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339766,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331121,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1150004-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1150005,Humana Gold 2500/HMO Premier,35783FL115,,FLN001,FLS001,FLF004,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339610,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331186,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1150005-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1150005,Humana Gold 2500/HMO Premier,35783FL115,,FLN001,FLS001,FLF004,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339610,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331186,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1150005-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1150005,Humana Gold 2500/HMO Premier,35783FL115,,FLN001,FLS001,FLF004,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339610,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331186,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1150005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,28
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1150005,Humana Gold 2500/HMO Premier,35783FL115,,FLN001,FLS001,FLF004,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339610,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331186,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1150005-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1150006,Humana Platinum 1000/HMO Premier,35783FL115,,FLN001,FLS001,FLF004,Existing,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339662,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331199,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1150006-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1150006,Humana Platinum 1000/HMO Premier,35783FL115,,FLN001,FLS001,FLF004,Existing,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339662,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331199,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1150006-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1150006,Humana Platinum 1000/HMO Premier,35783FL115,,FLN001,FLS001,FLF004,Existing,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339662,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331199,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1150006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,32
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1150006,Humana Platinum 1000/HMO Premier,35783FL115,,FLN001,FLS001,FLF004,Existing,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339662,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331199,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1150006-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160004,Humana Silver 4600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339779,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331264,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160004-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160004,Humana Silver 4600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339779,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331264,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160004-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160004,Humana Silver 4600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339779,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331264,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160004-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160004,Humana Silver 4600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339779,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331264,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160004-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160004,Humana Silver 4600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339779,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331264,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160004-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160005,Humana Gold 2500/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339623,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331355,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160005-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160005,Humana Gold 2500/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339623,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331355,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160005-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160005,Humana Gold 2500/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339623,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331355,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,43
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160006,Humana Platinum 1000/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339675,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331368,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160006-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160038,Humana Silver 4600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339779,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331264,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160038-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,49
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160031,Humana Bronze 6300/Volusia HUMx (HMOx),35783FL116,,FLN004,FLS005,FLF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339597,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2326922,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160031-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160031,Humana Bronze 6300/Volusia HUMx (HMOx),35783FL116,,FLN004,FLS005,FLF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339597,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2326922,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160031-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,5,48121,FL,Individual,No,59-1031071,48121FL0020008,myCigna Copay Assure Silver,48121FL002,7730182962,FLN001,FLS001,FLF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/copay-assure-silver,http://www.cigna.com/ifp-drug-list,48121FL0020008-05,87% AV Level Silver Plan,87.20%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,5,48121,FL,Individual,No,59-1031071,48121FL0020008,myCigna Copay Assure Silver,48121FL002,7730182962,FLN001,FLS001,FLF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/copay-assure-silver,http://www.cigna.com/ifp-drug-list,48121FL0020008-06,94% AV Level Silver Plan,93.90%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,5,48121,FL,Individual,No,59-1031071,48121FL0020011,myCigna Copay Assure Gold,48121FL002,7730182962,FLN001,FLS001,FLF005,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/copay-assure-gold,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/copay-assure-gold,http://www.cigna.com/ifp-drug-list,48121FL0020011-00,Standard Gold Off Exchange Plan,78.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,5,48121,FL,Individual,No,59-1031071,48121FL0020011,myCigna Copay Assure Gold,48121FL002,7730182962,FLN001,FLS001,FLF005,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/copay-assure-gold,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/copay-assure-gold,http://www.cigna.com/ifp-drug-list,48121FL0020011-01,Standard Gold On Exchange Plan,78.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,5,48121,FL,Individual,No,59-1031071,48121FL0020011,myCigna Copay Assure Gold,48121FL002,7730182962,FLN001,FLS001,FLF005,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/copay-assure-gold,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/copay-assure-gold,http://www.cigna.com/ifp-drug-list,48121FL0020011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,5,48121,FL,Individual,No,59-1031071,48121FL0020011,myCigna Copay Assure Gold,48121FL002,7730182962,FLN001,FLS001,FLF005,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/copay-assure-gold,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/copay-assure-gold,http://www.cigna.com/ifp-drug-list,48121FL0020011-03,Limited Cost Sharing Plan Variation,78.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,FL,48129,HIOS,4,2014-11-13 10:25:37,1,48129,FL,Individual,Yes,47-0397286,48129FL0070001,"Delta Dental Individual PPO, EHB Certified",48129FL007,,FLN002,FLS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.97,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,48129FL0070001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,48129,HIOS,4,2014-11-13 10:25:37,1,48129,FL,SHOP (Small Group),Yes,47-0397286,48129FL0100001,"Renaissance Group Dental PPO, EHB Certified",48129FL010,,FLN001,FLS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.74,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,48129FL0100001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,48129,HIOS,4,2014-11-13 10:25:37,1,48129,FL,SHOP (Small Group),Yes,47-0397286,48129FL0100002,"Renaissance Group Dental PPO, EHB Certified",48129FL010,,FLN001,FLS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.26,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,48129FL0100002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,48129,HIOS,4,2014-11-13 10:25:37,1,48129,FL,Individual,Yes,47-0397286,48129FL0070002,"Delta Dental Individual PPO, EHB Certified",48129FL007,,FLN002,FLS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.10,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,48129FL0070002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,48129,HIOS,4,2014-11-13 10:25:37,1,48129,FL,Individual,Yes,47-0397286,48129FL0080001,"Renaissance Individual Dental PPO, EHB Certified",48129FL008,,FLN001,FLS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.27,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,48129FL0080001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,FL,48129,HIOS,4,2014-11-13 10:25:37,1,48129,FL,Individual,Yes,47-0397286,48129FL0080002,"Renaissance Individual Dental PPO, EHB Certified",48129FL008,,FLN001,FLS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.83,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,48129FL0080002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,FL,48129,HIOS,4,2014-11-13 10:25:37,1,48129,FL,Individual,Yes,47-0397286,48129FL0130001,"Renaissance Individual Dental PPO, EHB Certified (Exchange)",48129FL013,,FLN001,FLS001,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/FL_EHB_High_2015,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/48129,http://www.renaissancedental.com/FL_EHB_High_2015,,48129FL0130001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,FL,48129,HIOS,4,2014-11-13 10:25:37,1,48129,FL,Individual,Yes,47-0397286,48129FL0130002,"Renaissance Individual Dental PPO, EHB Certified (Exchange)",48129FL013,,FLN001,FLS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.27,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/FL_EHB_Low_2015,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/48129,http://www.renaissancedental.com/FL_EHB_Low_2015,,48129FL0130002-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160038,Humana Silver 4600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339779,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331264,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160038-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,50
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160038,Humana Silver 4600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339779,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331264,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160038-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,51
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160038,Humana Silver 4600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339779,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331264,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160038-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,52
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160038,Humana Silver 4600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339779,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331264,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160038-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,53
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160038,Humana Silver 4600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339779,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331264,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160038-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,54
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160038,Humana Silver 4600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339779,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331264,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160038-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,55
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160039,Humana Gold 2500/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339623,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331355,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160039-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,56
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160039,Humana Gold 2500/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339623,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331355,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160039-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,57
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160039,Humana Gold 2500/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339623,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331355,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160039-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,58
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160039,Humana Gold 2500/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339623,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331355,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160039-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,59
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160044,Humana Silver 4600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339779,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331264,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160044-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,68
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160044,Humana Silver 4600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339779,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331264,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160044-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,69
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160044,Humana Silver 4600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339779,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331264,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160044-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,70
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160045,Humana Gold 2500/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339623,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331355,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160045-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,71
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160045,Humana Gold 2500/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339623,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331355,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160045-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,72
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160045,Humana Gold 2500/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339623,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331355,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160045-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,73
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160045,Humana Gold 2500/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339623,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331355,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160045-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,74
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160046,Humana Platinum 1000/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339675,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331368,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160046-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,75
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160046,Humana Platinum 1000/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339675,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331368,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160046-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,76
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160046,Humana Platinum 1000/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339675,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331368,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160046-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,77
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160046,Humana Platinum 1000/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339675,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331368,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160046-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,78
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160016,Humana Silver 4600/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339792,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331433,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160016-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,79
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160016,Humana Silver 4600/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339792,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331433,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160016-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,80
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160016,Humana Silver 4600/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339792,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331433,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160016-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,81
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160016,Humana Silver 4600/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339792,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331433,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160016-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,82
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160016,Humana Silver 4600/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339792,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331433,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160016-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,83
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160016,Humana Silver 4600/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339792,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331433,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160016-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,84
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160016,Humana Silver 4600/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339792,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331433,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160016-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,85
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160017,Humana Gold 2500/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339636,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331485,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160017-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,86
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160017,Humana Gold 2500/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339636,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331485,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160017-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,87
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160018,Humana Platinum 1000/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339688,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331498,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160018-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,92
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,1,35783,FL,Individual,No,61-1103898,35783FL1160018,Humana Platinum 1000/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339688,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331498,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160018-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,93
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160030,Humana Basic 6600/Volusia HUMx (HMOx),35783FL116,,FLN004,FLS005,FLF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339506,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2326844,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160030-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160030,Humana Basic 6600/Volusia HUMx (HMOx),35783FL116,,FLN004,FLS005,FLF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339506,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2326844,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160030-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160031,Humana Bronze 6300/Volusia HUMx (HMOx),35783FL116,,FLN004,FLS005,FLF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339597,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2326922,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160031-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160031,Humana Bronze 6300/Volusia HUMx (HMOx),35783FL116,,FLN004,FLS005,FLF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339597,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2326922,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160031-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1150001,Humana Basic 6600/HMO Premier,35783FL115,,FLN001,FLS001,FLF001,Existing,HMO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339467,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331082,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1150001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1150001,Humana Basic 6600/HMO Premier,35783FL115,,FLN001,FLS001,FLF001,Existing,HMO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339467,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331082,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1150001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1150002,Humana Bronze 6300/HMO Premier,35783FL115,,FLN001,FLS001,FLF001,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339558,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331095,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1150002-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1150002,Humana Bronze 6300/HMO Premier,35783FL115,,FLN001,FLS001,FLF001,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339558,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331095,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1150002-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1150002,Humana Bronze 6300/HMO Premier,35783FL115,,FLN001,FLS001,FLF001,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339558,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331095,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1150002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1150002,Humana Bronze 6300/HMO Premier,35783FL115,,FLN001,FLS001,FLF001,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339558,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331095,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1150002-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160001,Humana Basic 6600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339480,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331212,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160001,Humana Basic 6600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339480,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331212,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160002,Humana Bronze 6300/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339571,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331225,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160002,Humana Bronze 6300/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339571,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331225,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160002-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160035,Humana Basic 6600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339480,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331212,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160035-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160035,Humana Basic 6600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339480,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331212,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160035-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160036,Humana Bronze 6300/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339571,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331225,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160036-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,24
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160036,Humana Bronze 6300/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339571,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331225,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160036-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,1,48121,FL,Individual,No,59-1031071,48121FL0020001,myCigna Health Savings 6100,48121FL002,7730182962,FLN001,FLS001,FLF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-savings-6100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-savings-6100,http://www.cigna.com/ifp-drug-list,48121FL0020001-01,Standard Bronze On Exchange Plan,58.20%,0.5818812251091,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,1,48121,FL,Individual,Yes,59-1031071,48121FL0030001,myCigna Dental Pediatric,48121FL003,7730182962,FLN002,FLS002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$26.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,,,http://www.cigna.com/individuals-families/2015-plans/sob/florida/dental-pediatric,,48121FL0030001-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$150,$300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,1,48121,FL,Individual,No,59-1031071,48121FL0020001,myCigna Health Savings 6100,48121FL002,7730182962,FLN001,FLS001,FLF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-savings-6100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-savings-6100,http://www.cigna.com/ifp-drug-list,48121FL0020001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,1,48121,FL,Individual,No,59-1031071,48121FL0020001,myCigna Health Savings 6100,48121FL002,7730182962,FLN001,FLS001,FLF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-savings-6100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-savings-6100,http://www.cigna.com/ifp-drug-list,48121FL0020001-03,Limited Cost Sharing Plan Variation,58.20%,0.5818812251091,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,1,48121,FL,Individual,No,59-1031071,48121FL0020004,myCigna Health Savings 3400,48121FL002,7730182962,FLN001,FLS001,FLF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-savings-3400,http://www.cigna.com/ifp-drug-list,48121FL0020004-00,Standard Silver Off Exchange Plan,68.40%,0.684268593788147,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,1,48121,FL,Individual,No,59-1031071,48121FL0020004,myCigna Health Savings 3400,48121FL002,7730182962,FLN001,FLS001,FLF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-savings-3400,http://www.cigna.com/ifp-drug-list,48121FL0020004-01,Standard Silver On Exchange Plan,68.40%,0.684268593788147,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,1,48121,FL,Individual,No,59-1031071,48121FL0020004,myCigna Health Savings 3400,48121FL002,7730182962,FLN001,FLS001,FLF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-savings-3400,http://www.cigna.com/ifp-drug-list,48121FL0020004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,1,48121,FL,Individual,No,59-1031071,48121FL0020004,myCigna Health Savings 3400,48121FL002,7730182962,FLN001,FLS001,FLF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-savings-3400,http://www.cigna.com/ifp-drug-list,48121FL0020004-03,Limited Cost Sharing Plan Variation,68.40%,0.684268593788147,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,1,48121,FL,Individual,No,59-1031071,48121FL0020004,myCigna Health Savings 3400,48121FL002,7730182962,FLN001,FLS001,FLF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-savings-3400,http://www.cigna.com/ifp-drug-list,48121FL0020004-04,73% AV Level Silver Plan,73.20%,0.731574892997742,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,"$10,400","$20,800",Not Applicable,Not Applicable,,,,,,,,,12
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,1,48121,FL,Individual,No,59-1031071,48121FL0020004,myCigna Health Savings 3400,48121FL002,7730182962,FLN001,FLS001,FLF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-savings-3400,http://www.cigna.com/ifp-drug-list,48121FL0020004-05,87% AV Level Silver Plan,86.60%,0.865731179714203,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160036,Humana Bronze 6300/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339571,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331225,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160036-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,26
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160036,Humana Bronze 6300/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339571,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331225,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160036-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,27
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160041,Humana Basic 6600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339480,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331212,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160041-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,28
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160041,Humana Basic 6600/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339480,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331212,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160041-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,29
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160042,Humana Bronze 6300/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339571,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331225,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160042-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,30
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160042,Humana Bronze 6300/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339571,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331225,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160042-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,31
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160042,Humana Bronze 6300/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339571,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331225,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160042-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,32
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160042,Humana Bronze 6300/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339571,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331225,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160042-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,33
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160013,Humana Basic 6600/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339493,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331394,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160013-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,34
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160013,Humana Basic 6600/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339493,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331394,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160013-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,35
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160014,Humana Bronze 6300/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339584,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331407,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160014-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,36
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160014,Humana Bronze 6300/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339584,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331407,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160014-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,37
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160014,Humana Bronze 6300/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339584,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331407,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,38
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,2,35783,FL,Individual,No,61-1103898,35783FL1160014,Humana Bronze 6300/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339584,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331407,http://apps.humana.com/marketing/documents.asp?file=2323828,35783FL1160014-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,39
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,3,35783,FL,Individual,No,61-1103898,35783FL1150003,Humana Bronze 4850/HMO Premier,35783FL115,,FLN001,FLS001,FLF002,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339519,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331108,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1150003-00,Standard Bronze Off Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,3,35783,FL,Individual,No,61-1103898,35783FL1150003,Humana Bronze 4850/HMO Premier,35783FL115,,FLN001,FLS001,FLF002,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2339519,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331108,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1150003-01,Standard Bronze On Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,4,48121,FL,Individual,No,59-1031071,48121FL0020010,myCigna Health Flex 1000,48121FL002,7730182962,FLN001,FLS001,FLF005,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-1000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-1000,http://www.cigna.com/ifp-drug-list,48121FL0020010-03,Limited Cost Sharing Plan Variation,78.00%,0.783578336238861,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,5,48121,FL,Individual,No,59-1031071,48121FL0020008,myCigna Copay Assure Silver,48121FL002,7730182962,FLN001,FLS001,FLF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/copay-assure-silver,http://www.cigna.com/ifp-drug-list,48121FL0020008-00,Standard Silver Off Exchange Plan,71.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,5,48121,FL,Individual,No,59-1031071,48121FL0020008,myCigna Copay Assure Silver,48121FL002,7730182962,FLN001,FLS001,FLF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/copay-assure-silver,http://www.cigna.com/ifp-drug-list,48121FL0020008-01,Standard Silver On Exchange Plan,71.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,5,48121,FL,Individual,No,59-1031071,48121FL0020008,myCigna Copay Assure Silver,48121FL002,7730182962,FLN001,FLS001,FLF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/copay-assure-silver,http://www.cigna.com/ifp-drug-list,48121FL0020008-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,5,48121,FL,Individual,No,59-1031071,48121FL0020008,myCigna Copay Assure Silver,48121FL002,7730182962,FLN001,FLS001,FLF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/copay-assure-silver,http://www.cigna.com/ifp-drug-list,48121FL0020008-03,Limited Cost Sharing Plan Variation,71.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,5,48121,FL,Individual,No,59-1031071,48121FL0020008,myCigna Copay Assure Silver,48121FL002,7730182962,FLN001,FLS001,FLF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/copay-assure-silver,http://www.cigna.com/ifp-drug-list,48121FL0020008-04,73% AV Level Silver Plan,73.90%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,FL,48129,HIOS,4,2014-11-13 10:25:37,2,48129,FL,Individual,Yes,47-0397286,48129FL0110001,"Renaissance Individual Dental Pediatric-Only, EHB Certified",48129FL011,,FLN001,FLS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$29.27,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,48129FL0110001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,48129,HIOS,4,2014-11-13 10:25:37,2,48129,FL,Individual,Yes,47-0397286,48129FL0110002,"Renaissance Individual Dental Pediatric-Only, EHB Certified",48129FL011,,FLN001,FLS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$22.83,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,48129FL0110002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,48129,HIOS,4,2014-11-13 10:25:37,2,48129,FL,Individual,Yes,47-0397286,48129FL0150001,"Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)",48129FL015,,FLN001,FLS001,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$33.10,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/FL_Ped_High_2015,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/48129,http://www.renaissancedental.com/FL_Ped_High_2015,,48129FL0150001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,FL,48129,HIOS,4,2014-11-13 10:25:37,2,48129,FL,Individual,Yes,47-0397286,48129FL0150002,"Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)",48129FL015,,FLN001,FLS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$25.68,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/FL_Ped_Low_2015,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/48129,http://www.renaissancedental.com/FL_Ped_Low_2015,,48129FL0150002-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,FL,49193,HIOS,2,2014-09-05 03:32:16,1,49193,FL,SHOP (Small Group),Yes,86-0307623,49193FL0220001,Smile for Health Certified Basic Option Plus (90-50-50),49193FL022,,FLN001,FLS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$3.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,49193FL0220001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,1,56503,FL,Individual,No,26-3238817,56503FL1300003,IND Essential Plus Catastrophic HMO 36,56503FL130,7265435496,FLN001,FLS001,FLF005,Existing,HMO,Catastrophic,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1300003-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1300003-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1300003-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",100%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,350",$0,$0,$150,"$5,270",$0,$0,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,1,56503,FL,Individual,No,26-3238817,56503FL1320003,IND Essential Plus Catastrophic POS 37,56503FL132,7265435496,FLN001,FLS001,FLF005,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1320003-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1320003-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1320003-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",100%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,"$6,350",$0,$0,$150,"$5,270",$0,$0,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,1,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1680002,SMAG Essential Plus Bronze POS 42,56503FL168,7265435496,FLN001,FLS001,FLF002,Existing,POS,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1680002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1680002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1680002-00,Standard Bronze Off Exchange Plan,,0.608909845352173,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",55%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$4,500",$20,"$1,520",$150,"$2,850",$0,"$1,330",$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,1,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1680002,SMAG Essential Plus Bronze POS 42,56503FL168,7265435496,FLN001,FLS001,FLF002,Existing,POS,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1680002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1680002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1680002-01,Standard Bronze On Exchange Plan,,0.608909845352173,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",55%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$4,500",$20,"$1,520",$150,"$2,850",$0,"$1,330",$80,7
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,3,35783,FL,Individual,No,61-1103898,35783FL1160003,Humana Bronze 4850/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339532,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331238,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,3,35783,FL,Individual,No,61-1103898,35783FL1160003,Humana Bronze 4850/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS007,FLF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339532,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331238,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160003-03,Limited Cost Sharing Plan Variation,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,3,35783,FL,Individual,No,61-1103898,35783FL1160043,Humana Bronze 4850/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339532,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331238,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160043-00,Standard Bronze Off Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,3,35783,FL,Individual,No,61-1103898,35783FL1160043,Humana Bronze 4850/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339532,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331238,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160043-01,Standard Bronze On Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,3,35783,FL,Individual,No,61-1103898,35783FL1160043,Humana Bronze 4850/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339532,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331238,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160043-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,3,35783,FL,Individual,No,61-1103898,35783FL1160043,Humana Bronze 4850/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS002,FLF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339532,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331238,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160043-03,Limited Cost Sharing Plan Variation,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,3,35783,FL,Individual,No,61-1103898,35783FL1160037,Humana Bronze 4850/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339532,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331238,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160037-00,Standard Bronze Off Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,3,35783,FL,Individual,No,61-1103898,35783FL1160037,Humana Bronze 4850/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339532,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331238,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160037-01,Standard Bronze On Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,3,35783,FL,Individual,No,61-1103898,35783FL1160037,Humana Bronze 4850/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339532,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331238,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160037-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,3,35783,FL,Individual,No,61-1103898,35783FL1160037,Humana Bronze 4850/South Florida HUMx (HMOx),35783FL116,,FLN002,FLS006,FLF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339532,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331238,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160037-03,Limited Cost Sharing Plan Variation,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,3,35783,FL,Individual,No,61-1103898,35783FL1160015,Humana Bronze 4850/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF002,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339545,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331420,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160015-00,Standard Bronze Off Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,3,35783,FL,Individual,No,61-1103898,35783FL1160015,Humana Bronze 4850/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF002,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339545,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331420,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160015-01,Standard Bronze On Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,3,35783,FL,Individual,No,61-1103898,35783FL1160015,Humana Bronze 4850/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF002,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339545,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331420,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,FL,35783,HIOS,10,2015-01-16 17:32:32,3,35783,FL,Individual,No,61-1103898,35783FL1160015,Humana Bronze 4850/Tampa Bay HUMx (HMOx),35783FL116,,FLN003,FLS003,FLF002,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339545,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331420,http://apps.humana.com/marketing/documents.asp?file=2571647,35783FL1160015-03,Limited Cost Sharing Plan Variation,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,FL,38897,HIOS,8,2015-01-16 17:32:32,1,38897,FL,Individual,Yes,36-3757528,38897FL0010001,TruAssure Dental Basic Plan,38897FL001,,FLN001,FLS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.67,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=FL,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=FL,,38897FL0010001-00,Standard Low Off Exchange Plan,68.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$115,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,38897,HIOS,8,2015-01-16 17:32:32,1,38897,FL,SHOP (Small Group),Yes,36-3757528,38897FL0030001,TruAssure Dental Small Group Basic Plan,38897FL003,,FLN001,FLS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.91,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=FL,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=FL,,38897FL0030001-00,Standard High Off Exchange Plan,83.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,38897,HIOS,8,2015-01-16 17:32:32,1,38897,FL,SHOP (Small Group),Yes,36-3757528,38897FL0040001,TruAssure Dental Small Group Preferred Plan,38897FL004,,FLN001,FLS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.91,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=FL,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=FL,,38897FL0040001-00,Standard High Off Exchange Plan,83.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,38897,HIOS,8,2015-01-16 17:32:32,1,38897,FL,Individual,Yes,36-3757528,38897FL0010001,TruAssure Dental Basic Plan,38897FL001,,FLN001,FLS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.67,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=FL,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=FL,,38897FL0010001-01,Standard Low On Exchange Plan,68.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$115,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,38897,HIOS,8,2015-01-16 17:32:32,2,38897,FL,Individual,Yes,36-3757528,38897FL0020001,TruAssure Dental Preferred Plan,38897FL002,,FLN001,FLS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.83,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=FL,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=FL,,38897FL0020001-00,Standard High Off Exchange Plan,83.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,38897,HIOS,8,2015-01-16 17:32:32,2,38897,FL,Individual,Yes,36-3757528,38897FL0020001,TruAssure Dental Preferred Plan,38897FL002,,FLN001,FLS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.83,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=FL,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=FL,,38897FL0020001-01,Standard High On Exchange Plan,83.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,43274,HIOS,5,2015-02-20 06:27:36,1,43274,FL,Individual,Yes,14-1917982,43274FL0010001,EssentialSmile Ped 221,43274FL001,,FLN001,FLS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.94,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Available only for emergency services to treat an Emergency Condition.,Yes,Out of network coverage is available to members at the out of network cost share levels.,Yes,www.solsticecare.com,www.solsticecare.com,www.solsticecare.com,,43274FL0010001-00,Standard Low Off Exchange Plan,71.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,43274,HIOS,5,2015-02-20 06:27:36,1,43274,FL,SHOP (Small Group),Yes,14-1917982,43274FL0020002,EssentialSmile 222,43274FL002,,FLN001,FLS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.82,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Available only for emergency services to treat an Emergency Condition.,Yes,Out of network coverage is available to members at the out of network cost share levels.,Yes,www.solsticecare.com,www.solsticecare.com,www.solsticecare.com,,43274FL0020002-00,Standard Low Off Exchange Plan,71.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,$70,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,43274,HIOS,5,2015-02-20 06:27:36,1,43274,FL,Individual,Yes,14-1917982,43274FL0010001,EssentialSmile Ped 221,43274FL001,,FLN001,FLS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.94,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Available only for emergency services to treat an Emergency Condition.,Yes,Out of network coverage is available to members at the out of network cost share levels.,Yes,www.solsticecare.com,www.solsticecare.com,www.solsticecare.com,,43274FL0010001-01,Standard Low On Exchange Plan,71.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,43274,HIOS,5,2015-02-20 06:27:36,2,43274,FL,Individual,Yes,14-1917982,43274FL0010002,EssentialSmile 221,43274FL001,,FLN001,FLS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.94,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Available only for emergency services to treat an Emergency Condition.,Yes,Out of network coverage is available to members at the out of network cost share levels.,Yes,www.solsticecare.com,www.solsticecare.com,www.solsticecare.com,,43274FL0010002-00,Standard Low Off Exchange Plan,71.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,43274,HIOS,5,2015-02-20 06:27:36,2,43274,FL,SHOP (Small Group),Yes,14-1917982,43274FL0040002,EssentialSmile 212,43274FL004,,FLN002,FLS002,,New,EPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.85,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Only for palliative care where a network provider is not available.,No,www.solsticecare.com,www.solsticecare.com,www.solsticecare.com,,43274FL0040002-00,Standard Low Off Exchange Plan,70.86%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$30,Not Applicable,,,,,Not Applicable,Not Applicable,$30,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,43274,HIOS,5,2015-02-20 06:27:36,2,43274,FL,Individual,Yes,14-1917982,43274FL0010002,EssentialSmile 221,43274FL001,,FLN001,FLS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.94,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Available only for emergency services to treat an Emergency Condition.,Yes,Out of network coverage is available to members at the out of network cost share levels.,Yes,www.solsticecare.com,www.solsticecare.com,www.solsticecare.com,,43274FL0010002-01,Standard Low On Exchange Plan,71.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,43274,HIOS,5,2015-02-20 06:27:36,3,43274,FL,Individual,Yes,14-1917982,43274FL0030002,EssentialSmile211,43274FL003,,FLN002,FLS002,,New,EPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.65,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Only for palliative care where a network provider is not available.,No,www.solsticecare.com,www.solsticecare.com,www.solsticecare.com,,43274FL0030002-00,Standard Low Off Exchange Plan,70.86%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$30,Not Applicable,,,,,Not Applicable,Not Applicable,$30,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,43274,HIOS,5,2015-02-20 06:27:36,3,43274,FL,Individual,Yes,14-1917982,43274FL0030002,EssentialSmile211,43274FL003,,FLN002,FLS002,,New,EPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.65,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Only for palliative care where a network provider is not available.,No,www.solsticecare.com,www.solsticecare.com,www.solsticecare.com,,43274FL0030002-01,Standard Low On Exchange Plan,70.86%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$30,Not Applicable,,,,,Not Applicable,Not Applicable,$30,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,1,48121,FL,Individual,Yes,59-1031071,48121FL0030001,myCigna Dental Pediatric,48121FL003,7730182962,FLN002,FLS002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$26.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,,,http://www.cigna.com/individuals-families/2015-plans/sob/florida/dental-pediatric,,48121FL0030001-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$150,$300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,1,48121,FL,Individual,No,59-1031071,48121FL0020001,myCigna Health Savings 6100,48121FL002,7730182962,FLN001,FLS001,FLF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-savings-6100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-savings-6100,http://www.cigna.com/ifp-drug-list,48121FL0020001-00,Standard Bronze Off Exchange Plan,58.20%,0.5818812251091,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,1,48121,FL,Individual,No,59-1031071,48121FL0020004,myCigna Health Savings 3400,48121FL002,7730182962,FLN001,FLS001,FLF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-savings-3400,http://www.cigna.com/ifp-drug-list,48121FL0020004-06,94% AV Level Silver Plan,94.30%,0.942874848842621,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$350,$700,0%,,,,"$1,400","$2,800",Not Applicable,Not Applicable,,,,,,,,,14
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,2,48121,FL,Individual,No,59-1031071,48121FL0020012,myCigna Health Flex 5000 Bronze,48121FL002,7730182962,FLN001,FLS001,FLF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-5000-bronze,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-5000-bronze,http://www.cigna.com/ifp-drug-list,48121FL0020012-00,Standard Bronze Off Exchange Plan,61.60%,0.61153107881546,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,2,48121,FL,Individual,Yes,59-1031071,48121FL0030002,myCigna Dental Family + Pediatric,48121FL003,7730182962,FLN002,FLS002,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,,,http://www.cigna.com/individuals-families/2015-plans/sob/florida/dental-family-ped,,48121FL0030002-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$150,$300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,4,48121,FL,Individual,No,59-1031071,48121FL0020006,myCigna Health Flex 2750,48121FL002,7730182962,FLN001,FLS001,FLF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-2750,http://www.cigna.com/ifp-drug-list,48121FL0020006-00,Standard Silver Off Exchange Plan,68.60%,0.693712592124939,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,4,48121,FL,Individual,No,59-1031071,48121FL0020006,myCigna Health Flex 2750,48121FL002,7730182962,FLN001,FLS001,FLF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-2750,http://www.cigna.com/ifp-drug-list,48121FL0020006-01,Standard Silver On Exchange Plan,68.60%,0.693712592124939,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,4,48121,FL,Individual,No,59-1031071,48121FL0020006,myCigna Health Flex 2750,48121FL002,7730182962,FLN001,FLS001,FLF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-2750,http://www.cigna.com/ifp-drug-list,48121FL0020006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,4,48121,FL,Individual,No,59-1031071,48121FL0020007,myCigna Health Flex 5000,48121FL002,7730182962,FLN001,FLS001,FLF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-5000,http://www.cigna.com/ifp-drug-list,48121FL0020007-06,94% AV Level Silver Plan,93.40%,0.93491131067276,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",0%,,,,"$2,400","$4,800",Not Applicable,Not Applicable,,,,,,,,,17
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,4,48121,FL,Individual,No,59-1031071,48121FL0020010,myCigna Health Flex 1000,48121FL002,7730182962,FLN001,FLS001,FLF005,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-1000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-1000,http://www.cigna.com/ifp-drug-list,48121FL0020010-00,Standard Gold Off Exchange Plan,78.00%,0.783578336238861,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,4,48121,FL,Individual,No,59-1031071,48121FL0020010,myCigna Health Flex 1000,48121FL002,7730182962,FLN001,FLS001,FLF005,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-1000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-1000,http://www.cigna.com/ifp-drug-list,48121FL0020010-01,Standard Gold On Exchange Plan,78.00%,0.783578336238861,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,FL,48121,HIOS,15,2015-01-16 17:32:32,4,48121,FL,Individual,No,59-1031071,48121FL0020010,myCigna Health Flex 1000,48121FL002,7730182962,FLN001,FLS001,FLF005,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All Services,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/florida/health-flex-1000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/florida/health-flex-1000,http://www.cigna.com/ifp-drug-list,48121FL0020010-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,1,56503,FL,Individual,No,26-3238817,56503FL1320003,IND Essential Plus Catastrophic POS 37,56503FL132,7265435496,FLN001,FLS001,FLF005,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1320003-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1320003-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1320003-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",100%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,"$6,350",$0,$0,$150,"$5,270",$0,$0,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,2,56503,FL,Individual,No,26-3238817,56503FL1300001,Gym Access IND Essential Plus Catastrophic HMO 36,56503FL130,7265435496,FLN001,FLS001,FLF005,Existing,HMO,Catastrophic,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1300001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1300001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1300001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",100%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,350",$0,$0,$150,"$5,270",$0,$0,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,2,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1600001,Gym Access SMAG Essential Plus Bronze HMO 41,56503FL160,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1600001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1600001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1600001-00,Standard Bronze Off Exchange Plan,,0.608597338199615,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",60%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$20,"$1,520",$150,"$2,850",$0,"$1,330",$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,2,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1600001,Gym Access SMAG Essential Plus Bronze HMO 41,56503FL160,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1600001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1600001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1600001-01,Standard Bronze On Exchange Plan,,0.608597338199615,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",60%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$20,"$1,520",$150,"$2,850",$0,"$1,330",$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,5,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1690002,SMAG Essential Plus Gold POS 64,56503FL169,7265435496,FLN001,FLS001,FLF002,Existing,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1690002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1690002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1690002-00,Standard Gold Off Exchange Plan,,0.80064070224762,No,No,No,100%,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,600","$3,200",10%,,,,"$3,200","$6,400",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,600",$60,$300,$150,"$1,270",$800,$0,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,5,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1690002,SMAG Essential Plus Gold POS 64,56503FL169,7265435496,FLN001,FLS001,FLF002,Existing,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1690002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1690002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1690002-01,Standard Gold On Exchange Plan,,0.80064070224762,No,No,No,100%,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,600","$3,200",10%,,,,"$3,200","$6,400",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,600",$60,$300,$150,"$1,270",$800,$0,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,5,56503,FL,Individual,No,26-3238817,56503FL1330002,IND Essential Plus Silver HMO 53,56503FL133,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1330002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1330002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1330002-01,Standard Silver On Exchange Plan,,0.699878931045532,No,No,No,100%,,"$3,950","$7,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,700","$3,400",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,720",$0,"$2,220",$150,$400,$360,$970,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,5,56503,FL,Individual,No,26-3238817,56503FL1330002,IND Essential Plus Silver HMO 53,56503FL133,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1330002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1330002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1330002-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,5,56503,FL,Individual,No,26-3238817,56503FL1330002,IND Essential Plus Silver HMO 53,56503FL133,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1330002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1330002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1330002-03,Limited Cost Sharing Plan Variation,,0.699878931045532,No,No,No,100%,,"$3,950","$7,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,700","$3,400",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,720",$0,"$2,220",$150,$400,$360,$970,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,5,56503,FL,Individual,No,26-3238817,56503FL1330002,IND Essential Plus Silver HMO 53,56503FL133,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1330002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1330002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1330002-04,73% AV Level Silver Plan,,0.727572679519653,No,No,No,100%,,"$3,400","$6,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,650","$3,300",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,650",$0,"$1,750",$150,$250,$390,$970,$80,8
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,5,56503,FL,Individual,No,26-3238817,56503FL1330002,IND Essential Plus Silver HMO 53,56503FL133,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1330002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1330002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1330002-05,87% AV Level Silver Plan,,0.865751326084137,No,No,No,100%,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$250,$500,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$250,$0,"$1,500",$150,$150,$390,$970,$80,9
2015,FL,54172,HIOS,7,2014-08-31 07:07:13,2,54172,FL,Individual,No,26-0155137,54172FL0010002,Molina Marketplace Silver Plan,54172FL001,,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.992223581790811,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,54172FL0010002-04,73% AV Level Silver Plan,,0.739861905574799,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,"$5,200","$10,400","$1,700","$3,400",30%,,,,Not Applicable,Not Applicable,"$1,700","$3,400",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,FL,54172,HIOS,7,2014-08-31 07:07:13,2,54172,FL,Individual,No,26-0155137,54172FL0010002,Molina Marketplace Silver Plan,54172FL001,,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.992223581790811,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,54172FL0010002-05,87% AV Level Silver Plan,,0.874694764614105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,"$2,250","$4,500",$250,$500,20%,,,,Not Applicable,Not Applicable,$250,$500,$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,FL,54172,HIOS,7,2014-08-31 07:07:13,2,54172,FL,Individual,No,26-0155137,54172FL0010002,Molina Marketplace Silver Plan,54172FL001,,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.992223581790811,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,54172FL0010002-06,94% AV Level Silver Plan,,0.943551361560822,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,"$2,250","$4,500",$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,54172,HIOS,7,2014-08-31 07:07:13,3,54172,FL,Individual,No,26-0155137,54172FL0010003,Molina Marketplace Bronze Plan,54172FL001,,FLN001,FLS001,FLF003,Existing,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,54172FL0010003-00,Standard Bronze Off Exchange Plan,,0.619724571704865,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,4
2015,FL,54172,HIOS,7,2014-08-31 07:07:13,3,54172,FL,Individual,No,26-0155137,54172FL0010003,Molina Marketplace Bronze Plan,54172FL001,,FLN001,FLS001,FLF003,Existing,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,54172FL0010003-01,Standard Bronze On Exchange Plan,,0.619724571704865,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,5
2015,FL,54172,HIOS,7,2014-08-31 07:07:13,3,54172,FL,Individual,No,26-0155137,54172FL0010003,Molina Marketplace Bronze Plan,54172FL001,,FLN001,FLS001,FLF003,Existing,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,54172FL0010003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,2,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1680001,Gym Access SMAG Essential Plus Bronze POS 42,56503FL168,7265435496,FLN001,FLS001,FLF002,Existing,POS,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1680001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1680001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1680001-00,Standard Bronze Off Exchange Plan,,0.608909845352173,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",55%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$4,500",$20,"$1,520",$150,"$2,850",$0,"$1,330",$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,2,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1680001,Gym Access SMAG Essential Plus Bronze POS 42,56503FL168,7265435496,FLN001,FLS001,FLF002,Existing,POS,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1680001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1680001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1680001-01,Standard Bronze On Exchange Plan,,0.608909845352173,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",55%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$4,500",$20,"$1,520",$150,"$2,850",$0,"$1,330",$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,6,56503,FL,Individual,No,26-3238817,56503FL1410001,Gym Access IND Essential Plus Silver POS 54,56503FL141,7265435496,FLN001,FLS001,FLF002,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1410001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1410001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1410001-01,Standard Silver On Exchange Plan,,0.693996667861938,No,No,No,100%,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,350","$4,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,020",$0,"$1,420",$150,"$1,410",$360,$380,$80,12
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,6,56503,FL,Individual,No,26-3238817,56503FL1410001,Gym Access IND Essential Plus Silver POS 54,56503FL141,7265435496,FLN001,FLS001,FLF002,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1410001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1410001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1410001-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,6,56503,FL,Individual,No,26-3238817,56503FL1410001,Gym Access IND Essential Plus Silver POS 54,56503FL141,7265435496,FLN001,FLS001,FLF002,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1410001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1410001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1410001-03,Limited Cost Sharing Plan Variation,,0.693996667861938,No,No,No,100%,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,350","$4,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,020",$0,"$1,420",$150,"$1,410",$360,$380,$80,14
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,6,56503,FL,Individual,No,26-3238817,56503FL1410001,Gym Access IND Essential Plus Silver POS 54,56503FL141,7265435496,FLN001,FLS001,FLF002,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1410001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1410001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1410001-04,73% AV Level Silver Plan,,0.738668143749237,No,No,No,100%,,"$3,400","$6,800",,,"$6,800","$13,600",Not Applicable,Not Applicable,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,700","$3,400",30%,,,,"$3,400","$6,800",Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,720",$0,"$1,510",$150,"$1,410",$360,$380,$80,15
2015,FL,54172,HIOS,7,2014-08-31 07:07:13,3,54172,FL,Individual,No,26-0155137,54172FL0010003,Molina Marketplace Bronze Plan,54172FL001,,FLN001,FLS001,FLF003,Existing,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,54172FL0010003-03,Limited Cost Sharing Plan Variation,,0.619724571704865,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,1,56503,FL,Individual,No,26-3238817,56503FL1300003,IND Essential Plus Catastrophic HMO 36,56503FL130,7265435496,FLN001,FLS001,FLF005,Existing,HMO,Catastrophic,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1300003-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1300003-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1300003-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",100%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,350",$0,$0,$150,"$5,270",$0,$0,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,1,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1600002,SMAG Essential Plus Bronze HMO 41,56503FL160,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1600002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1600002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1600002-00,Standard Bronze Off Exchange Plan,,0.608597338199615,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",60%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$20,"$1,520",$150,"$2,850",$0,"$1,330",$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,1,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1600002,SMAG Essential Plus Bronze HMO 41,56503FL160,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1600002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1600002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1600002-01,Standard Bronze On Exchange Plan,,0.608597338199615,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",60%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$20,"$1,520",$150,"$2,850",$0,"$1,330",$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,2,56503,FL,Individual,No,26-3238817,56503FL1300001,Gym Access IND Essential Plus Catastrophic HMO 36,56503FL130,7265435496,FLN001,FLS001,FLF005,Existing,HMO,Catastrophic,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1300001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1300001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1300001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",100%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,350",$0,$0,$150,"$5,270",$0,$0,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,2,56503,FL,Individual,No,26-3238817,56503FL1320001,Gym Access IND Essential Plus Catastrophic POS 37,56503FL132,7265435496,FLN001,FLS001,FLF005,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1320001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1320001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1320001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",100%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,"$6,350",$0,$0,$150,"$5,270",$0,$0,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,6,56503,FL,Individual,No,26-3238817,56503FL1330001,Gym Access IND Essential Plus Silver HMO 53,56503FL133,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1330001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1330001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1330001-05,87% AV Level Silver Plan,,0.865751326084137,No,No,No,100%,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$250,$500,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$250,$0,"$1,500",$150,$150,$390,$970,$80,9
2015,FL,49193,HIOS,2,2014-09-05 03:32:16,2,49193,FL,SHOP (Small Group),Yes,86-0307623,49193FL0240001,Smile for Health Certified High Option Plus (100-50-50),49193FL024,,FLN001,FLS001,,New,PPO,High,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$7.35,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,49193FL0240001-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,49193,HIOS,2,2014-09-05 03:32:16,3,49193,FL,SHOP (Small Group),Yes,86-0307623,49193FL0260001,Smile for Health Certified Low Option Plus (100-100-100),49193FL026,,FLN001,FLS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$3.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,49193FL0260001-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,49193,HIOS,2,2014-09-05 03:32:16,4,49193,FL,SHOP (Small Group),Yes,86-0307623,49193FL0210001,Smile for Health Certified Basic Option (90-50-50),49193FL021,,FLN001,FLS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$0.74,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,49193FL0210001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,3,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1550002,SMAG Essential Plus Silver HMO 53,56503FL155,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1550002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1550002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1550002-01,Standard Silver On Exchange Plan,,0.702355802059174,No,No,No,100%,,"$3,950","$7,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,600","$3,200",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,620",$0,"$2,260",$150,"$1,550",$360,$510,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,3,56503,FL,Individual,No,26-3238817,56503FL1380002,IND Essential Plus Bronze HMO 41,56503FL138,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1380002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1380002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1380002-01,Standard Bronze On Exchange Plan,,0.608597338199615,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",60%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$20,"$1,520",$150,"$2,850",$0,"$1,330",$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,3,56503,FL,Individual,No,26-3238817,56503FL1380002,IND Essential Plus Bronze HMO 41,56503FL138,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1380002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1380002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1380002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,60%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,3,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1630002,SMAG Essential Plus Silver POS 54,56503FL163,7265435496,FLN001,FLS001,FLF002,Existing,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1630002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1630002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1630002-00,Standard Silver Off Exchange Plan,,0.709819197654724,No,No,No,100%,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,350","$4,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,600","$3,200",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,620",$0,"$1,540",$150,"$1,410",$360,$380,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,3,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1630002,SMAG Essential Plus Silver POS 54,56503FL163,7265435496,FLN001,FLS001,FLF002,Existing,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1630002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1630002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1630002-01,Standard Silver On Exchange Plan,,0.709819197654724,No,No,No,100%,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,350","$4,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,600","$3,200",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,620",$0,"$1,540",$150,"$1,410",$360,$380,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,3,56503,FL,Individual,No,26-3238817,56503FL1380002,IND Essential Plus Bronze HMO 41,56503FL138,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1380002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1380002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1380002-03,Limited Cost Sharing Plan Variation,,0.608597338199615,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",60%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$20,"$1,520",$150,"$2,850",$0,"$1,330",$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,3,56503,FL,Individual,No,26-3238817,56503FL1460002,IND Essential Plus Bronze POS 42,56503FL146,7265435496,FLN001,FLS001,FLF002,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1460002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1460002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1460002-00,Standard Bronze Off Exchange Plan,,0.608909845352173,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",55%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$4,500",$20,"$1,520",$150,"$2,850",$0,"$1,330",$80,8
2015,FL,49193,HIOS,2,2014-09-05 03:32:16,5,49193,FL,SHOP (Small Group),Yes,86-0307623,49193FL0230001,Smile for Health Certified High Option (100-50-50),49193FL023,,FLN001,FLS001,,New,PPO,High,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$4.41,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,49193FL0230001-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,49193,HIOS,2,2014-09-05 03:32:16,6,49193,FL,SHOP (Small Group),Yes,86-0307623,49193FL0250001,Smile for Health Certified Low Option (100-100-100),49193FL025,,FLN001,FLS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$0.74,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,49193FL0250001-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,51398,HIOS,10,2015-01-16 17:32:32,1,51398,FL,Individual,No,59-1419293,51398FL0650002,GOLD PREMIER BX DADE,51398FL065,,FLN002,FLS001,FLF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,"All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,For medically necessary emergency services only. Authorization for all services required.,Yes,For medically necessary emergency services only. Authorization for all services required.,No,www.pmpmarketplace.com/gold-2015,https://www.pmpmarketplace.com/plans/payment,https://www.pmpmarketplace.com/plans,https://www.pmpmarketplace.com/formulary,51398FL0650002-00,Standard Gold Off Exchange Plan,79.70%,,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,100%,$0,$0,100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$1,800",$0,$500,$0,"$1,800",$60,$200,4
2015,FL,51398,HIOS,10,2015-01-16 17:32:32,1,51398,FL,Individual,No,59-1419293,51398FL0650002,GOLD PREMIER BX DADE,51398FL065,,FLN002,FLS001,FLF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,"All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,For medically necessary emergency services only. Authorization for all services required.,Yes,For medically necessary emergency services only. Authorization for all services required.,No,www.pmpmarketplace.com/gold-2015,https://www.pmpmarketplace.com/plans/payment,https://www.pmpmarketplace.com/plans,https://www.pmpmarketplace.com/formulary,51398FL0650002-01,Standard Gold On Exchange Plan,79.70%,,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,100%,$0,$0,100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$1,800",$0,$500,$0,"$1,800",$60,$200,5
2015,FL,51398,HIOS,10,2015-01-16 17:32:32,1,51398,FL,Individual,No,59-1419293,51398FL0650002,GOLD PREMIER BX DADE,51398FL065,,FLN002,FLS001,FLF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,"All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,For medically necessary emergency services only. Authorization for all services required.,Yes,For medically necessary emergency services only. Authorization for all services required.,No,www.pmpmarketplace.com/gold-2015,https://www.pmpmarketplace.com/plans/payment,https://www.pmpmarketplace.com/plans,https://www.pmpmarketplace.com/formulary,51398FL0650002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,FL,51398,HIOS,10,2015-01-16 17:32:32,1,51398,FL,Individual,No,59-1419293,51398FL0650002,GOLD PREMIER BX DADE,51398FL065,,FLN002,FLS001,FLF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,"All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,For medically necessary emergency services only. Authorization for all services required.,Yes,For medically necessary emergency services only. Authorization for all services required.,No,www.pmpmarketplace.com/gold-2015,https://www.pmpmarketplace.com/plans/payment,https://www.pmpmarketplace.com/plans,https://www.pmpmarketplace.com/formulary,51398FL0650002-03,Limited Cost Sharing Plan Variation,79.70%,,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,100%,$0,$0,100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$1,800",$0,$500,$0,"$1,800",$60,$200,7
2015,FL,51398,HIOS,10,2015-01-16 17:32:32,1,51398,FL,Individual,No,59-1419293,51398FL0650012,SILVER DELUXE AX DADE,51398FL065,,FLN001,FLS001,FLF002,Existing,HMO,Silver,Yes,Both,Yes,Yes,"All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,For medically necessary emergency services only. Authorization for all services required.,Yes,For medically necessary emergency services only. Authorization for all services required.,No,www.pmpmarketplace.com/silver-ax-2015,https://www.pmpmarketplace.com/plans/payment,https://www.pmpmarketplace.com/plans,https://www.pmpmarketplace.com/formulary,51398FL0650012-00,Standard Silver Off Exchange Plan,69.40%,,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",100%,"$4,600","$9,200",100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",100%,"$2,000","$4,000",100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,800",$0,$500,"$1,700","$1,000",$0,$200,8
2015,FL,51398,HIOS,10,2015-01-16 17:32:32,1,51398,FL,Individual,No,59-1419293,51398FL0650012,SILVER DELUXE AX DADE,51398FL065,,FLN001,FLS001,FLF002,Existing,HMO,Silver,Yes,Both,Yes,Yes,"All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,For medically necessary emergency services only. Authorization for all services required.,Yes,For medically necessary emergency services only. Authorization for all services required.,No,www.pmpmarketplace.com/silver-ax-2015,https://www.pmpmarketplace.com/plans/payment,https://www.pmpmarketplace.com/plans,https://www.pmpmarketplace.com/formulary,51398FL0650012-01,Standard Silver On Exchange Plan,69.40%,,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",100%,"$4,600","$9,200",100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",100%,"$2,000","$4,000",100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,800",$0,$500,"$1,700","$1,000",$0,$200,9
2015,FL,51398,HIOS,10,2015-01-16 17:32:32,1,51398,FL,Individual,No,59-1419293,51398FL0650012,SILVER DELUXE AX DADE,51398FL065,,FLN001,FLS001,FLF002,Existing,HMO,Silver,Yes,Both,Yes,Yes,"All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,For medically necessary emergency services only. Authorization for all services required.,Yes,For medically necessary emergency services only. Authorization for all services required.,No,www.pmpmarketplace.com/silver-ax-2015,https://www.pmpmarketplace.com/plans/payment,https://www.pmpmarketplace.com/plans,https://www.pmpmarketplace.com/formulary,51398FL0650012-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,FL,51398,HIOS,10,2015-01-16 17:32:32,1,51398,FL,Individual,No,59-1419293,51398FL0650012,SILVER DELUXE AX DADE,51398FL065,,FLN001,FLS001,FLF002,Existing,HMO,Silver,Yes,Both,Yes,Yes,"All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,For medically necessary emergency services only. Authorization for all services required.,Yes,For medically necessary emergency services only. Authorization for all services required.,No,www.pmpmarketplace.com/silver-ax-2015,https://www.pmpmarketplace.com/plans/payment,https://www.pmpmarketplace.com/plans,https://www.pmpmarketplace.com/formulary,51398FL0650012-03,Limited Cost Sharing Plan Variation,69.40%,,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",100%,"$4,600","$9,200",100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",100%,"$2,000","$4,000",100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,800",$0,$500,"$1,700","$1,000",$0,$200,11
2015,FL,51398,HIOS,10,2015-01-16 17:32:32,1,51398,FL,Individual,No,59-1419293,51398FL0650012,SILVER DELUXE AX DADE,51398FL065,,FLN001,FLS001,FLF002,Existing,HMO,Silver,Yes,Both,Yes,Yes,"All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,For medically necessary emergency services only. Authorization for all services required.,Yes,For medically necessary emergency services only. Authorization for all services required.,No,www.pmpmarketplace.com/silver-ax-2015,https://www.pmpmarketplace.com/plans/payment,https://www.pmpmarketplace.com/plans,https://www.pmpmarketplace.com/formulary,51398FL0650012-04,73% AV Level Silver Plan,72.30%,,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$3,200","$6,400","$3,200","$6,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",100%,"$1,500","$3,000",100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",100%,"$1,500","$3,000",100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,800",$0,$500,"$1,500","$1,000",$60,$200,12
2015,FL,51398,HIOS,10,2015-01-16 17:32:32,1,51398,FL,Individual,No,59-1419293,51398FL0650012,SILVER DELUXE AX DADE,51398FL065,,FLN001,FLS001,FLF002,Existing,HMO,Silver,Yes,Both,Yes,Yes,"All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,For medically necessary emergency services only. Authorization for all services required.,Yes,For medically necessary emergency services only. Authorization for all services required.,No,www.pmpmarketplace.com/silver-ax-2015,https://www.pmpmarketplace.com/plans/payment,https://www.pmpmarketplace.com/plans,https://www.pmpmarketplace.com/formulary,51398FL0650012-05,87% AV Level Silver Plan,86.90%,,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$2,100","$4,200","$2,100","$4,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,100%,$0,$0,100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,100%,$0,$0,100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$400,$0,$500,$0,"$1,400",$50,$200,13
2015,FL,51398,HIOS,10,2015-01-16 17:32:32,1,51398,FL,Individual,No,59-1419293,51398FL0650012,SILVER DELUXE AX DADE,51398FL065,,FLN001,FLS001,FLF002,Existing,HMO,Silver,Yes,Both,Yes,Yes,"All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,For medically necessary emergency services only. Authorization for all services required.,Yes,For medically necessary emergency services only. Authorization for all services required.,No,www.pmpmarketplace.com/silver-ax-2015,https://www.pmpmarketplace.com/plans/payment,https://www.pmpmarketplace.com/plans,https://www.pmpmarketplace.com/formulary,51398FL0650012-06,94% AV Level Silver Plan,93.20%,,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,100%,$0,$0,100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,100%,$0,$0,100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$200,$0,$500,$0,$700,$50,$200,14
2015,FL,51398,HIOS,10,2015-01-16 17:32:32,1,51398,FL,Individual,No,59-1419293,51398FL0650015,SILVER DELUXE CX DADE,51398FL065,,FLN002,FLS001,FLF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,"All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,For medically necessary emergency services only. Authorization for all services required.,Yes,For medically necessary emergency services only. Authorization for all services required.,No,www.pmpmarketplace.com/silver-cx-2015,https://www.pmpmarketplace.com/plans/payment,https://www.pmpmarketplace.com/plans,https://www.pmpmarketplace.com/formulary,51398FL0650015-00,Standard Silver Off Exchange Plan,69.00%,,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",100%,"$5,000","$10,000",100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",100%,"$1,500","$3,000",100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,800",$0,$500,"$1,500","$1,000",$60,$200,15
2015,FL,51398,HIOS,10,2015-01-16 17:32:32,1,51398,FL,Individual,No,59-1419293,51398FL0650015,SILVER DELUXE CX DADE,51398FL065,,FLN002,FLS001,FLF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,"All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,For medically necessary emergency services only. Authorization for all services required.,Yes,For medically necessary emergency services only. Authorization for all services required.,No,www.pmpmarketplace.com/silver-cx-2015,https://www.pmpmarketplace.com/plans/payment,https://www.pmpmarketplace.com/plans,https://www.pmpmarketplace.com/formulary,51398FL0650015-01,Standard Silver On Exchange Plan,69.00%,,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",100%,"$5,000","$10,000",100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",100%,"$1,500","$3,000",100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,800",$0,$500,"$1,500","$1,000",$60,$200,16
2015,FL,51398,HIOS,10,2015-01-16 17:32:32,1,51398,FL,Individual,No,59-1419293,51398FL0650015,SILVER DELUXE CX DADE,51398FL065,,FLN002,FLS001,FLF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,"All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,For medically necessary emergency services only. Authorization for all services required.,Yes,For medically necessary emergency services only. Authorization for all services required.,No,www.pmpmarketplace.com/silver-cx-2015,https://www.pmpmarketplace.com/plans/payment,https://www.pmpmarketplace.com/plans,https://www.pmpmarketplace.com/formulary,51398FL0650015-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,FL,51398,HIOS,10,2015-01-16 17:32:32,1,51398,FL,Individual,No,59-1419293,51398FL0650015,SILVER DELUXE CX DADE,51398FL065,,FLN002,FLS001,FLF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,"All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,For medically necessary emergency services only. Authorization for all services required.,Yes,For medically necessary emergency services only. Authorization for all services required.,No,www.pmpmarketplace.com/silver-cx-2015,https://www.pmpmarketplace.com/plans/payment,https://www.pmpmarketplace.com/plans,https://www.pmpmarketplace.com/formulary,51398FL0650015-03,Limited Cost Sharing Plan Variation,69.00%,,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",100%,"$5,000","$10,000",100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",100%,"$1,500","$3,000",100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,800",$0,$500,"$1,500","$1,000",$60,$200,18
2015,FL,51398,HIOS,10,2015-01-16 17:32:32,1,51398,FL,Individual,No,59-1419293,51398FL0650015,SILVER DELUXE CX DADE,51398FL065,,FLN002,FLS001,FLF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,"All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,For medically necessary emergency services only. Authorization for all services required.,Yes,For medically necessary emergency services only. Authorization for all services required.,No,www.pmpmarketplace.com/silver-cx-2015,https://www.pmpmarketplace.com/plans/payment,https://www.pmpmarketplace.com/plans,https://www.pmpmarketplace.com/formulary,51398FL0650015-04,73% AV Level Silver Plan,72.30%,,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$3,200","$6,400","$3,200","$6,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",100%,"$1,500","$3,000",100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",100%,"$1,500","$3,000",100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,800",$0,$500,"$1,500","$1,100",$60,$200,19
2015,FL,51398,HIOS,10,2015-01-16 17:32:32,1,51398,FL,Individual,No,59-1419293,51398FL0650015,SILVER DELUXE CX DADE,51398FL065,,FLN002,FLS001,FLF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,"All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,For medically necessary emergency services only. Authorization for all services required.,Yes,For medically necessary emergency services only. Authorization for all services required.,No,www.pmpmarketplace.com/silver-cx-2015,https://www.pmpmarketplace.com/plans/payment,https://www.pmpmarketplace.com/plans,https://www.pmpmarketplace.com/formulary,51398FL0650015-05,87% AV Level Silver Plan,86.90%,,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$2,100","$4,200","$2,100","$4,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,100%,$0,$0,100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,100%,$0,$0,100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$400,$0,$500,$0,"$1,400",$50,$200,20
2015,FL,51398,HIOS,10,2015-01-16 17:32:32,1,51398,FL,Individual,No,59-1419293,51398FL0650015,SILVER DELUXE CX DADE,51398FL065,,FLN002,FLS001,FLF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,"All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,For medically necessary emergency services only. Authorization for all services required.,Yes,For medically necessary emergency services only. Authorization for all services required.,No,www.pmpmarketplace.com/silver-cx-2015,https://www.pmpmarketplace.com/plans/payment,https://www.pmpmarketplace.com/plans,https://www.pmpmarketplace.com/formulary,51398FL0650015-06,94% AV Level Silver Plan,93.20%,,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,100%,$0,$0,100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,100%,$0,$0,100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$200,$0,$500,$0,$700,$50,$200,21
2015,FL,51398,HIOS,10,2015-01-16 17:32:32,1,51398,FL,Individual,No,59-1419293,51398FL0650019,BRONZE SELECT AX DADE,51398FL065,,FLN001,FLS001,FLF004,Existing,HMO,Bronze,Yes,Both,Yes,Yes,"All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,For medically necessary emergency services only. Authorization for all services required.,Yes,For medically necessary emergency services only. Authorization for all services required.,No,www.pmpmarketplace.com/bronze-ax-2015,https://www.pmpmarketplace.com/plans/payment,https://www.pmpmarketplace.com/plans,https://www.pmpmarketplace.com/formulary,51398FL0650019-00,Standard Bronze Off Exchange Plan,60.90%,,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,"$6,600","$13,200",100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$800,"$1,200",$500,"$2,000","$1,100",$0,$200,22
2015,FL,51398,HIOS,10,2015-01-16 17:32:32,1,51398,FL,Individual,No,59-1419293,51398FL0650019,BRONZE SELECT AX DADE,51398FL065,,FLN001,FLS001,FLF004,Existing,HMO,Bronze,Yes,Both,Yes,Yes,"All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,For medically necessary emergency services only. Authorization for all services required.,Yes,For medically necessary emergency services only. Authorization for all services required.,No,www.pmpmarketplace.com/bronze-ax-2015,https://www.pmpmarketplace.com/plans/payment,https://www.pmpmarketplace.com/plans,https://www.pmpmarketplace.com/formulary,51398FL0650019-01,Standard Bronze On Exchange Plan,60.90%,,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,"$6,600","$13,200",100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$800,"$1,200",$500,"$2,000","$1,100",$0,$200,23
2015,FL,51398,HIOS,10,2015-01-16 17:32:32,1,51398,FL,Individual,No,59-1419293,51398FL0650019,BRONZE SELECT AX DADE,51398FL065,,FLN001,FLS001,FLF004,Existing,HMO,Bronze,Yes,Both,Yes,Yes,"All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,For medically necessary emergency services only. Authorization for all services required.,Yes,For medically necessary emergency services only. Authorization for all services required.,No,www.pmpmarketplace.com/bronze-ax-2015,https://www.pmpmarketplace.com/plans/payment,https://www.pmpmarketplace.com/plans,https://www.pmpmarketplace.com/formulary,51398FL0650019-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,24
2015,FL,51398,HIOS,10,2015-01-16 17:32:32,1,51398,FL,Individual,No,59-1419293,51398FL0650019,BRONZE SELECT AX DADE,51398FL065,,FLN001,FLS001,FLF004,Existing,HMO,Bronze,Yes,Both,Yes,Yes,"All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,For medically necessary emergency services only. Authorization for all services required.,Yes,For medically necessary emergency services only. Authorization for all services required.,No,www.pmpmarketplace.com/bronze-ax-2015,https://www.pmpmarketplace.com/plans/payment,https://www.pmpmarketplace.com/plans,https://www.pmpmarketplace.com/formulary,51398FL0650019-03,Limited Cost Sharing Plan Variation,60.90%,,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,"$6,600","$13,200",100%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$800,"$1,200",$500,"$2,000","$1,100",$0,$200,25
2015,FL,54172,HIOS,7,2014-08-31 07:07:13,1,54172,FL,Individual,No,26-0155137,54172FL0010001,Molina Marketplace Gold Plan,54172FL001,,FLN001,FLS001,FLF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,54172FL0010001-00,Standard Gold Off Exchange Plan,,0.797688901424408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,FL,54172,HIOS,7,2014-08-31 07:07:13,1,54172,FL,Individual,No,26-0155137,54172FL0010001,Molina Marketplace Gold Plan,54172FL001,,FLN001,FLS001,FLF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,54172FL0010001-01,Standard Gold On Exchange Plan,,0.797688901424408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,FL,54172,HIOS,7,2014-08-31 07:07:13,1,54172,FL,Individual,No,26-0155137,54172FL0010001,Molina Marketplace Gold Plan,54172FL001,,FLN001,FLS001,FLF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,54172FL0010001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,54172,HIOS,7,2014-08-31 07:07:13,1,54172,FL,Individual,No,26-0155137,54172FL0010001,Molina Marketplace Gold Plan,54172FL001,,FLN001,FLS001,FLF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,54172FL0010001-03,Limited Cost Sharing Plan Variation,,0.797688901424408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,FL,54172,HIOS,7,2014-08-31 07:07:13,2,54172,FL,Individual,No,26-0155137,54172FL0010002,Molina Marketplace Silver Plan,54172FL001,,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.992223581790811,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,54172FL0010002-00,Standard Silver Off Exchange Plan,,0.706084549427032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$200,$400,30%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,4
2015,FL,54172,HIOS,7,2014-08-31 07:07:13,2,54172,FL,Individual,No,26-0155137,54172FL0010002,Molina Marketplace Silver Plan,54172FL001,,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.992223581790811,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,54172FL0010002-01,Standard Silver On Exchange Plan,,0.706084549427032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$200,$400,30%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,5
2015,FL,54172,HIOS,7,2014-08-31 07:07:13,2,54172,FL,Individual,No,26-0155137,54172FL0010002,Molina Marketplace Silver Plan,54172FL001,,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.992223581790811,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,54172FL0010002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,54172,HIOS,7,2014-08-31 07:07:13,2,54172,FL,Individual,No,26-0155137,54172FL0010002,Molina Marketplace Silver Plan,54172FL001,,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.992223581790811,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,54172FL0010002-03,Limited Cost Sharing Plan Variation,,0.706084549427032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$200,$400,30%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,6,56503,FL,Individual,No,26-3238817,56503FL1410001,Gym Access IND Essential Plus Silver POS 54,56503FL141,7265435496,FLN001,FLS001,FLF002,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1410001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1410001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1410001-05,87% AV Level Silver Plan,,0.872972667217255,No,No,No,100%,,"$1,000","$2,000",,,"$2,500","$5,000",Not Applicable,Not Applicable,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$250,$500,30%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$150,$300,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$250,$0,"$1,500",$150,$400,$390,$610,$80,16
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,6,56503,FL,Individual,No,26-3238817,56503FL1410001,Gym Access IND Essential Plus Silver POS 54,56503FL141,7265435496,FLN001,FLS001,FLF002,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1410001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1410001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1410001-06,94% AV Level Silver Plan,,0.934227645397186,No,No,No,100%,,$500,"$1,000",,,"$2,500","$5,000",Not Applicable,Not Applicable,$250,$500,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$50,$100,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$25,$50,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$50,$0,$700,$150,$80,$280,$390,$80,17
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,14,56503,FL,Individual,No,26-3238817,56503FL2080001,Gym Access IND Bronze HMO 6600,56503FL208,7265435496,FLN001,FLS001,FLF004,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2080001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2080001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2080001-00,Standard Bronze Off Exchange Plan,,0.618174195289612,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,340",$0,"$2,260",$150,"$1,270",$720,$0,$850,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,14,56503,FL,Individual,No,26-3238817,56503FL2080001,Gym Access IND Bronze HMO 6600,56503FL208,7265435496,FLN001,FLS001,FLF004,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2080001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2080001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2080001-01,Standard Bronze On Exchange Plan,,0.618174195289612,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,340",$0,"$2,260",$150,"$1,270",$720,$0,$850,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,14,56503,FL,Individual,No,26-3238817,56503FL2080001,Gym Access IND Bronze HMO 6600,56503FL208,7265435496,FLN001,FLS001,FLF004,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2080001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2080001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2080001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$0,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,14,56503,FL,Individual,No,26-3238817,56503FL2080001,Gym Access IND Bronze HMO 6600,56503FL208,7265435496,FLN001,FLS001,FLF004,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2080001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2080001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2080001-03,Limited Cost Sharing Plan Variation,,0.618174195289612,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,340",$0,"$2,260",$150,"$1,270",$720,$0,$850,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,19,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2190002,SMAG Platinum POS 3000,56503FL219,7265435496,FLN001,FLS001,FLF002,New,POS,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2190002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2190002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2190002-01,Standard Platinum On Exchange Plan,,0.895551264286041,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$450,$0,$150,$0,$600,$250,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,19,56503,FL,Individual,No,26-3238817,56503FL2060002,IND Silver HMO 6600,56503FL206,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2060002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2060002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2060002-04,73% AV Level Silver Plan,,0.736115396022797,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,820",$50,$250,$150,"$1,670",$560,$0,$80,8
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,28,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2290001,Gym Access SMAG Silver HMO 6600,56503FL229,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2290001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2290001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2290001-00,Standard Silver Off Exchange Plan,,0.700484275817871,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,490",$50,$50,$150,"$2,270",$570,$0,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,2,56503,FL,Individual,No,26-3238817,56503FL1320001,Gym Access IND Essential Plus Catastrophic POS 37,56503FL132,7265435496,FLN001,FLS001,FLF005,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,3,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1320001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1320001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1320001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",100%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,"$6,350",$0,$0,$150,"$5,270",$0,$0,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,3,56503,FL,Individual,No,26-3238817,56503FL1380002,IND Essential Plus Bronze HMO 41,56503FL138,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1380002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1380002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1380002-00,Standard Bronze Off Exchange Plan,,0.608597338199615,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",60%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$20,"$1,520",$150,"$2,850",$0,"$1,330",$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,3,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1550002,SMAG Essential Plus Silver HMO 53,56503FL155,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1550002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1550002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1550002-00,Standard Silver Off Exchange Plan,,0.702355802059174,No,No,No,100%,,"$3,950","$7,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,600","$3,200",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,620",$0,"$2,260",$150,"$1,550",$360,$510,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,3,56503,FL,Individual,No,26-3238817,56503FL1460002,IND Essential Plus Bronze POS 42,56503FL146,7265435496,FLN001,FLS001,FLF002,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1460002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1460002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1460002-01,Standard Bronze On Exchange Plan,,0.608909845352173,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",55%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$4,500",$20,"$1,520",$150,"$2,850",$0,"$1,330",$80,9
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,3,56503,FL,Individual,No,26-3238817,56503FL1460002,IND Essential Plus Bronze POS 42,56503FL146,7265435496,FLN001,FLS001,FLF002,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1460002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1460002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1460002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,55%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,8,56503,FL,Individual,No,26-3238817,56503FL1470001,Gym Access IND Essential Plus Gold POS 64,56503FL147,7265435496,FLN001,FLS001,FLF002,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1470001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1470001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1470001-00,Standard Gold Off Exchange Plan,,0.80064070224762,No,No,No,100%,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,600","$3,200",10%,,,,"$3,200","$6,400",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,600",$60,$300,$150,"$1,270",$800,$0,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,8,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1620001,Gym Access SMAG Essential Plus Platinum HMO 65,56503FL162,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Platinum,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1620001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1620001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1620001-00,Standard Platinum Off Exchange Plan,,0.903126001358032,No,No,No,100%,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$190,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,8,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1620001,Gym Access SMAG Essential Plus Platinum HMO 65,56503FL162,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Platinum,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1620001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1620001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1620001-01,Standard Platinum On Exchange Plan,,0.903126001358032,No,No,No,100%,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$190,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,8,56503,FL,Individual,No,26-3238817,56503FL1470001,Gym Access IND Essential Plus Gold POS 64,56503FL147,7265435496,FLN001,FLS001,FLF002,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1470001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1470001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1470001-01,Standard Gold On Exchange Plan,,0.80064070224762,No,No,No,100%,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,600","$3,200",10%,,,,"$3,200","$6,400",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,600",$60,$300,$150,"$1,270",$800,$0,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,8,56503,FL,Individual,No,26-3238817,56503FL1470001,Gym Access IND Essential Plus Gold POS 64,56503FL147,7265435496,FLN001,FLS001,FLF002,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1470001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1470001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1470001-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,10%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,8,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1700001,GYM Access SMAG Essential Plus Platinum POS 66,56503FL170,7265435496,FLN001,FLS001,FLF002,Existing,POS,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1700001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1700001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1700001-00,Standard Platinum Off Exchange Plan,,0.902972877025604,No,No,No,100%,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$670,$150,$0,$600,$190,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,8,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1700001,GYM Access SMAG Essential Plus Platinum POS 66,56503FL170,7265435496,FLN001,FLS001,FLF002,Existing,POS,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1700001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1700001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1700001-01,Standard Platinum On Exchange Plan,,0.902972877025604,No,No,No,100%,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$670,$150,$0,$600,$190,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,3,56503,FL,Individual,No,26-3238817,56503FL1460002,IND Essential Plus Bronze POS 42,56503FL146,7265435496,FLN001,FLS001,FLF002,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1460002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1460002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1460002-03,Limited Cost Sharing Plan Variation,,0.608909845352173,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",55%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$4,500",$20,"$1,520",$150,"$2,850",$0,"$1,330",$80,11
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,4,56503,FL,Individual,No,26-3238817,56503FL1380001,Gym Access IND Essential Plus Bronze HMO 41,56503FL138,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1380001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1380001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1380001-00,Standard Bronze Off Exchange Plan,,0.608597338199615,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",60%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$20,"$1,520",$150,"$2,850",$0,"$1,330",$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,4,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1550001,Gym Access SMAG Essential Plus Silver HMO 53,56503FL155,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1550001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1550001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1550001-00,Standard Silver Off Exchange Plan,,0.702355802059174,No,No,No,100%,,"$3,950","$7,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,600","$3,200",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,620",$0,"$2,260",$150,"$1,550",$360,$510,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,4,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1550001,Gym Access SMAG Essential Plus Silver HMO 53,56503FL155,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1550001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1550001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1550001-01,Standard Silver On Exchange Plan,,0.702355802059174,No,No,No,100%,,"$3,950","$7,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,600","$3,200",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,620",$0,"$2,260",$150,"$1,550",$360,$510,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,4,56503,FL,Individual,No,26-3238817,56503FL1380001,Gym Access IND Essential Plus Bronze HMO 41,56503FL138,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1380001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1380001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1380001-01,Standard Bronze On Exchange Plan,,0.608597338199615,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",60%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$20,"$1,520",$150,"$2,850",$0,"$1,330",$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,4,56503,FL,Individual,No,26-3238817,56503FL1380001,Gym Access IND Essential Plus Bronze HMO 41,56503FL138,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1380001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1380001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1380001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,60%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,4,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1630001,Gym Access SMAG Essential Plus Silver POS 54,56503FL163,7265435496,FLN001,FLS001,FLF002,Existing,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1630001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1630001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1630001-00,Standard Silver Off Exchange Plan,,0.709819197654724,No,No,No,100%,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,350","$4,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,600","$3,200",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,620",$0,"$1,540",$150,"$1,410",$360,$380,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,4,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1630001,Gym Access SMAG Essential Plus Silver POS 54,56503FL163,7265435496,FLN001,FLS001,FLF002,Existing,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1630001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1630001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1630001-01,Standard Silver On Exchange Plan,,0.709819197654724,No,No,No,100%,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,350","$4,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,600","$3,200",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,620",$0,"$1,540",$150,"$1,410",$360,$380,$80,7
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220010,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS004,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220010-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,77
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220019,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS001,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220019-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,17
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220019,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS001,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220019-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220019,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS001,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220019-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220019,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS001,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220019-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220020,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS002,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220020-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220020,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS002,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220020-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,24
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,9,56503,FL,Individual,No,26-3238817,56503FL1390002,IND Essential Plus Gold HMO 63,56503FL139,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1390002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1390002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1390002-01,Standard Gold On Exchange Plan,,0.800574660301209,No,No,No,100%,,"$2,400","$4,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,"$1,250",$150,$800,$200,$200,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,9,56503,FL,Individual,No,26-3238817,56503FL1390002,IND Essential Plus Gold HMO 63,56503FL139,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1390002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1390002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1390002-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,9,56503,FL,Individual,No,26-3238817,56503FL1390002,IND Essential Plus Gold HMO 63,56503FL139,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1390002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1390002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1390002-03,Limited Cost Sharing Plan Variation,,0.800574660301209,No,No,No,100%,,"$2,400","$4,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,"$1,250",$150,$800,$200,$200,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,10,56503,FL,Individual,No,26-3238817,56503FL1390001,Gym Access IND Essential Plus Gold HMO 63,56503FL139,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1390001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1390001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1390001-00,Standard Gold Off Exchange Plan,,0.800574660301209,No,No,No,100%,,"$2,400","$4,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,"$1,250",$150,$800,$200,$200,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,4,56503,FL,Individual,No,26-3238817,56503FL1380001,Gym Access IND Essential Plus Bronze HMO 41,56503FL138,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1380001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1380001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1380001-03,Limited Cost Sharing Plan Variation,,0.608597338199615,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",60%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$20,"$1,520",$150,"$2,850",$0,"$1,330",$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,4,56503,FL,Individual,No,26-3238817,56503FL1460001,Gym Access IND Essential Plus Bronze POS 42,56503FL146,7265435496,FLN001,FLS001,FLF002,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1460001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1460001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1460001-00,Standard Bronze Off Exchange Plan,,0.608909845352173,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",55%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$4,500",$20,"$1,520",$150,"$2,850",$0,"$1,330",$80,8
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,4,56503,FL,Individual,No,26-3238817,56503FL1460001,Gym Access IND Essential Plus Bronze POS 42,56503FL146,7265435496,FLN001,FLS001,FLF002,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1460001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1460001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1460001-01,Standard Bronze On Exchange Plan,,0.608909845352173,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",55%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$4,500",$20,"$1,520",$150,"$2,850",$0,"$1,330",$80,9
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,4,56503,FL,Individual,No,26-3238817,56503FL1460001,Gym Access IND Essential Plus Bronze POS 42,56503FL146,7265435496,FLN001,FLS001,FLF002,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1460001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1460001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1460001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,55%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,4,56503,FL,Individual,No,26-3238817,56503FL1460001,Gym Access IND Essential Plus Bronze POS 42,56503FL146,7265435496,FLN001,FLS001,FLF002,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1460001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1460001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1460001-03,Limited Cost Sharing Plan Variation,,0.608909845352173,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",55%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$4,500",$20,"$1,520",$150,"$2,850",$0,"$1,330",$80,11
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,5,56503,FL,Individual,No,26-3238817,56503FL1330002,IND Essential Plus Silver HMO 53,56503FL133,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1330002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1330002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1330002-00,Standard Silver Off Exchange Plan,,0.699878931045532,No,No,No,100%,,"$3,950","$7,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,700","$3,400",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,720",$0,"$2,220",$150,$400,$360,$970,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,5,56503,FL,Individual,No,26-3238817,56503FL1330002,IND Essential Plus Silver HMO 53,56503FL133,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1330002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1330002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1330002-06,94% AV Level Silver Plan,,0.930559694766998,No,No,No,100%,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$50,$100,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$25,$50,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$50,$0,$700,$150,$30,$170,$560,$80,10
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,5,56503,FL,Individual,No,26-3238817,56503FL1410002,IND Essential Plus Silver POS 54,56503FL141,7265435496,FLN001,FLS001,FLF002,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1410002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1410002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1410002-00,Standard Silver Off Exchange Plan,,0.693996667861938,No,No,No,100%,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,350","$4,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,020",$0,"$1,420",$150,"$1,410",$360,$380,$80,11
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,5,56503,FL,Individual,No,26-3238817,56503FL1410002,IND Essential Plus Silver POS 54,56503FL141,7265435496,FLN001,FLS001,FLF002,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1410002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1410002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1410002-01,Standard Silver On Exchange Plan,,0.693996667861938,No,No,No,100%,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,350","$4,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,020",$0,"$1,420",$150,"$1,410",$360,$380,$80,12
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,5,56503,FL,Individual,No,26-3238817,56503FL1410002,IND Essential Plus Silver POS 54,56503FL141,7265435496,FLN001,FLS001,FLF002,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1410002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1410002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1410002-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,5,56503,FL,Individual,No,26-3238817,56503FL1410002,IND Essential Plus Silver POS 54,56503FL141,7265435496,FLN001,FLS001,FLF002,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1410002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1410002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1410002-03,Limited Cost Sharing Plan Variation,,0.693996667861938,No,No,No,100%,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,350","$4,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,020",$0,"$1,420",$150,"$1,410",$360,$380,$80,14
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,5,56503,FL,Individual,No,26-3238817,56503FL1410002,IND Essential Plus Silver POS 54,56503FL141,7265435496,FLN001,FLS001,FLF002,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1410002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1410002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1410002-04,73% AV Level Silver Plan,,0.738668143749237,No,No,No,100%,,"$3,400","$6,800",,,"$6,800","$13,600",Not Applicable,Not Applicable,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,700","$3,400",30%,,,,"$3,400","$6,800",Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,720",$0,"$1,510",$150,"$1,410",$360,$380,$80,15
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,5,56503,FL,Individual,No,26-3238817,56503FL1410002,IND Essential Plus Silver POS 54,56503FL141,7265435496,FLN001,FLS001,FLF002,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1410002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1410002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1410002-05,87% AV Level Silver Plan,,0.872972667217255,No,No,No,100%,,"$1,000","$2,000",,,"$2,500","$5,000",Not Applicable,Not Applicable,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$250,$500,30%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$150,$300,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$250,$0,"$1,500",$150,$400,$390,$610,$80,16
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,5,56503,FL,Individual,No,26-3238817,56503FL1410002,IND Essential Plus Silver POS 54,56503FL141,7265435496,FLN001,FLS001,FLF002,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1410002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1410002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1410002-06,94% AV Level Silver Plan,,0.934227645397186,No,No,No,100%,,$500,"$1,000",,,"$2,500","$5,000",Not Applicable,Not Applicable,$250,$500,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$50,$100,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$25,$50,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$50,$0,$700,$150,$80,$280,$390,$80,17
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,11,56503,FL,Individual,No,26-3238817,56503FL1400002,IND Essential Plus Platinum HMO 65,56503FL140,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Platinum,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1400002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1400002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1400002-01,Standard Platinum On Exchange Plan,,0.903126001358032,No,No,No,100%,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$190,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,11,56503,FL,Individual,No,26-3238817,56503FL1400002,IND Essential Plus Platinum HMO 65,56503FL140,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Platinum,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1400002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1400002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1400002-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,11,56503,FL,Individual,No,26-3238817,56503FL1400002,IND Essential Plus Platinum HMO 65,56503FL140,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Platinum,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1400002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1400002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1400002-03,Limited Cost Sharing Plan Variation,,0.903126001358032,No,No,No,100%,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$190,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,11,56503,FL,Individual,No,26-3238817,56503FL1480002,IND Essential Plus Platinum POS 66,56503FL148,7265435496,FLN001,FLS001,FLF002,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1480002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1480002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1480002-00,Standard Platinum Off Exchange Plan,,0.902972877025604,No,No,No,100%,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$670,$150,$0,$600,$190,$80,8
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,11,56503,FL,Individual,No,26-3238817,56503FL1480002,IND Essential Plus Platinum POS 66,56503FL148,7265435496,FLN001,FLS001,FLF002,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1480002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1480002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1480002-01,Standard Platinum On Exchange Plan,,0.902972877025604,No,No,No,100%,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$670,$150,$0,$600,$190,$80,9
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,11,56503,FL,Individual,No,26-3238817,56503FL1480002,IND Essential Plus Platinum POS 66,56503FL148,7265435496,FLN001,FLS001,FLF002,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1480002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1480002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1480002-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,11,56503,FL,Individual,No,26-3238817,56503FL1480002,IND Essential Plus Platinum POS 66,56503FL148,7265435496,FLN001,FLS001,FLF002,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1480002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1480002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1480002-03,Limited Cost Sharing Plan Variation,,0.902972877025604,No,No,No,100%,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$670,$150,$0,$600,$190,$80,11
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,6,56503,FL,Individual,No,26-3238817,56503FL1330001,Gym Access IND Essential Plus Silver HMO 53,56503FL133,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1330001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1330001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1330001-00,Standard Silver Off Exchange Plan,,0.699878931045532,No,No,No,100%,,"$3,950","$7,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,700","$3,400",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,720",$0,"$2,220",$150,$400,$360,$970,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,6,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1690001,Gym Access SMAG Essential Plus Gold POS 64,56503FL169,7265435496,FLN001,FLS001,FLF002,Existing,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1690001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1690001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1690001-00,Standard Gold Off Exchange Plan,,0.80064070224762,No,No,No,100%,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,600","$3,200",10%,,,,"$3,200","$6,400",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,600",$60,$300,$150,"$1,270",$800,$0,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,6,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1690001,Gym Access SMAG Essential Plus Gold POS 64,56503FL169,7265435496,FLN001,FLS001,FLF002,Existing,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1690001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1690001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1690001-01,Standard Gold On Exchange Plan,,0.80064070224762,No,No,No,100%,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,600","$3,200",10%,,,,"$3,200","$6,400",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,600",$60,$300,$150,"$1,270",$800,$0,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,6,56503,FL,Individual,No,26-3238817,56503FL1330001,Gym Access IND Essential Plus Silver HMO 53,56503FL133,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1330001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1330001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1330001-01,Standard Silver On Exchange Plan,,0.699878931045532,No,No,No,100%,,"$3,950","$7,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,700","$3,400",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,720",$0,"$2,220",$150,$400,$360,$970,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,6,56503,FL,Individual,No,26-3238817,56503FL1330001,Gym Access IND Essential Plus Silver HMO 53,56503FL133,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1330001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1330001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1330001-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,6,56503,FL,Individual,No,26-3238817,56503FL1330001,Gym Access IND Essential Plus Silver HMO 53,56503FL133,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1330001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1330001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1330001-03,Limited Cost Sharing Plan Variation,,0.699878931045532,No,No,No,100%,,"$3,950","$7,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,700","$3,400",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,720",$0,"$2,220",$150,$400,$360,$970,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,6,56503,FL,Individual,No,26-3238817,56503FL1330001,Gym Access IND Essential Plus Silver HMO 53,56503FL133,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1330001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1330001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1330001-04,73% AV Level Silver Plan,,0.727572679519653,No,No,No,100%,,"$3,400","$6,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,650","$3,300",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,650",$0,"$1,750",$150,$250,$390,$970,$80,8
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,6,56503,FL,Individual,No,26-3238817,56503FL1330001,Gym Access IND Essential Plus Silver HMO 53,56503FL133,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1330001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1330001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1330001-06,94% AV Level Silver Plan,,0.930559694766998,No,No,No,100%,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$50,$100,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$25,$50,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$50,$0,$700,$150,$30,$170,$560,$80,10
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,6,56503,FL,Individual,No,26-3238817,56503FL1410001,Gym Access IND Essential Plus Silver POS 54,56503FL141,7265435496,FLN001,FLS001,FLF002,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1410001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1410001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1410001-00,Standard Silver Off Exchange Plan,,0.693996667861938,No,No,No,100%,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,350","$4,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,020",$0,"$1,420",$150,"$1,410",$360,$380,$80,11
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,20,56503,FL,Individual,No,26-3238817,56503FL2060001,Gym Access IND Silver HMO 6600,56503FL206,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2060001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2060001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2060001-00,Standard Silver Off Exchange Plan,,0.700484275817871,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,490",$50,$50,$150,"$2,270",$570,$0,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,20,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2180001,Gym Access SMAG Platinum HMO 3000,56503FL218,7265435496,FLN001,FLS001,FLF002,New,HMO,Platinum,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2180001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2180001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2180001-00,Standard Platinum Off Exchange Plan,,0.895551264286041,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$450,$0,$150,$0,$600,$250,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,28,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2290001,Gym Access SMAG Silver HMO 6600,56503FL229,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2290001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2290001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2290001-01,Standard Silver On Exchange Plan,,0.700484275817871,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,490",$50,$50,$150,"$2,270",$570,$0,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,29,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2300002,SMAG Silver HMO 6400,56503FL230,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2300002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2300002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2300002-00,Standard Silver Off Exchange Plan,,0.707475304603577,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$640,$0,$150,"$1,270",$700,$0,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,7,56503,FL,Individual,No,26-3238817,56503FL1470002,IND Essential Plus Gold POS 64,56503FL147,7265435496,FLN001,FLS001,FLF002,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1470002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1470002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1470002-00,Standard Gold Off Exchange Plan,,0.80064070224762,No,No,No,100%,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,600","$3,200",10%,,,,"$3,200","$6,400",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,600",$60,$300,$150,"$1,270",$800,$0,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,7,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1620002,SMAG Essential Plus Platinum HMO 65,56503FL162,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Platinum,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1620002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1620002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1620002-00,Standard Platinum Off Exchange Plan,,0.903126001358032,No,No,No,100%,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$190,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,7,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1620002,SMAG Essential Plus Platinum HMO 65,56503FL162,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Platinum,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1620002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1620002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1620002-01,Standard Platinum On Exchange Plan,,0.903126001358032,No,No,No,100%,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$190,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,7,56503,FL,Individual,No,26-3238817,56503FL1470002,IND Essential Plus Gold POS 64,56503FL147,7265435496,FLN001,FLS001,FLF002,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1470002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1470002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1470002-01,Standard Gold On Exchange Plan,,0.80064070224762,No,No,No,100%,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,600","$3,200",10%,,,,"$3,200","$6,400",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,600",$60,$300,$150,"$1,270",$800,$0,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,7,56503,FL,Individual,No,26-3238817,56503FL1470002,IND Essential Plus Gold POS 64,56503FL147,7265435496,FLN001,FLS001,FLF002,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1470002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1470002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1470002-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,10%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,7,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1700002,SMAG Essential Plus Platinum POS 66,56503FL170,7265435496,FLN001,FLS001,FLF002,Existing,POS,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1700002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1700002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1700002-00,Standard Platinum Off Exchange Plan,,0.902972877025604,No,No,No,100%,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$670,$150,$0,$600,$190,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,7,56503,FL,SHOP (Small Group),No,26-3238817,56503FL1700002,SMAG Essential Plus Platinum POS 66,56503FL170,7265435496,FLN001,FLS001,FLF002,Existing,POS,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1700002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1700002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1700002-01,Standard Platinum On Exchange Plan,,0.902972877025604,No,No,No,100%,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$670,$150,$0,$600,$190,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,7,56503,FL,Individual,No,26-3238817,56503FL1470002,IND Essential Plus Gold POS 64,56503FL147,7265435496,FLN001,FLS001,FLF002,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1470002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1470002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1470002-03,Limited Cost Sharing Plan Variation,,0.80064070224762,No,No,No,100%,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,600","$3,200",10%,,,,"$3,200","$6,400",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,600",$60,$300,$150,"$1,270",$800,$0,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,8,56503,FL,Individual,No,26-3238817,56503FL1470001,Gym Access IND Essential Plus Gold POS 64,56503FL147,7265435496,FLN001,FLS001,FLF002,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1470001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1470001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1470001-03,Limited Cost Sharing Plan Variation,,0.80064070224762,No,No,No,100%,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,600","$3,200",10%,,,,"$3,200","$6,400",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,600",$60,$300,$150,"$1,270",$800,$0,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,9,56503,FL,Individual,No,26-3238817,56503FL1390002,IND Essential Plus Gold HMO 63,56503FL139,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1390002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1390002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1390002-00,Standard Gold Off Exchange Plan,,0.800574660301209,No,No,No,100%,,"$2,400","$4,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,"$1,250",$150,$800,$200,$200,$80,4
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220001,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS001,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220001-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220009,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS003,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220009-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,70
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220010,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS004,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220010-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,71
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220010,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS004,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220010-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,72
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220010,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS004,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,73
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220010,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS004,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220010-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,76
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,10,56503,FL,Individual,No,26-3238817,56503FL1390001,Gym Access IND Essential Plus Gold HMO 63,56503FL139,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1390001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1390001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1390001-01,Standard Gold On Exchange Plan,,0.800574660301209,No,No,No,100%,,"$2,400","$4,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,"$1,250",$150,$800,$200,$200,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,18,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2120001,Gym Access SMAG Silver HMO HSA  2000/6450,56503FL212,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2120001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2120001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2120001-01,Standard Silver On Exchange Plan,,0.68043714761734,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$20,$950,$150,"$2,000",$280,$250,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,18,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2130001,Gym Access SMAG Silver POS HSA  2000/6450,56503FL213,7265435496,FLN001,FLS001,FLF003,New,POS,Silver,No,Both,No,No,,,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2130001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2130001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2130001-00,Standard Silver Off Exchange Plan,,0.68043714761734,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,$950,$150,"$2,000",$280,$250,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,18,56503,FL,Individual,No,26-3238817,56503FL2040001,Gym Access IND Silver HMO 6400,56503FL204,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2040001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2040001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2040001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,18,56503,FL,Individual,No,26-3238817,56503FL2040001,Gym Access IND Silver HMO 6400,56503FL204,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2040001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2040001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2040001-03,Limited Cost Sharing Plan Variation,,0.707475304603577,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$640,$0,$150,"$1,270",$700,$0,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,18,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2130001,Gym Access SMAG Silver POS HSA  2000/6450,56503FL213,7265435496,FLN001,FLS001,FLF003,New,POS,Silver,No,Both,No,No,,,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2130001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2130001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2130001-01,Standard Silver On Exchange Plan,,0.68043714761734,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,$950,$150,"$2,000",$280,$250,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,18,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2140001,Gym Access SMAG Bronze HMO HSA 4500/6450,56503FL214,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2140001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2140001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2140001-00,Standard Bronze Off Exchange Plan,,0.608792543411255,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$20,$670,$150,"$4,500",$80,$50,$80,8
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,30,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2300001,Gym Access SMAG Silver HMO 6400,56503FL230,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2300001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2300001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2300001-00,Standard Silver Off Exchange Plan,,0.707475304603577,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$640,$0,$150,"$1,270",$700,$0,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,37,56503,FL,Individual,No,26-3238817,56503FL1980002,IND Platinum HMO 4000,56503FL198,7265435496,FLN001,FLS001,FLF002,New,HMO,Platinum,Yes,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1980002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1980002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1980002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,37,56503,FL,Individual,No,26-3238817,56503FL1980002,IND Platinum HMO 4000,56503FL198,7265435496,FLN001,FLS001,FLF002,New,HMO,Platinum,Yes,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1980002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1980002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1980002-03,Limited Cost Sharing Plan Variation,88.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$250,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,37,56503,FL,Individual,No,26-3238817,56503FL1990002,IND Platinum POS 4000,56503FL199,7265435496,FLN001,FLS001,FLF002,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1990002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1990002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1990002-00,Standard Platinum Off Exchange Plan,88.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$250,$80,8
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,37,56503,FL,Individual,No,26-3238817,56503FL1990002,IND Platinum POS 4000,56503FL199,7265435496,FLN001,FLS001,FLF002,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1990002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1990002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1990002-01,Standard Platinum On Exchange Plan,88.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$250,$80,9
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,37,56503,FL,Individual,No,26-3238817,56503FL1990002,IND Platinum POS 4000,56503FL199,7265435496,FLN001,FLS001,FLF002,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1990002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1990002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1990002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220019,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS001,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220019-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220019,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS001,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220019-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,10,56503,FL,Individual,No,26-3238817,56503FL1390001,Gym Access IND Essential Plus Gold HMO 63,56503FL139,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1390001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1390001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1390001-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,10,56503,FL,Individual,No,26-3238817,56503FL1390001,Gym Access IND Essential Plus Gold HMO 63,56503FL139,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1390001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1390001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1390001-03,Limited Cost Sharing Plan Variation,,0.800574660301209,No,No,No,100%,,"$2,400","$4,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,"$1,250",$150,$800,$200,$200,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,11,56503,FL,Individual,No,26-3238817,56503FL1400002,IND Essential Plus Platinum HMO 65,56503FL140,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Platinum,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1400002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1400002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1400002-00,Standard Platinum Off Exchange Plan,,0.903126001358032,No,No,No,100%,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$190,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,12,56503,FL,Individual,No,26-3238817,56503FL1400001,Gym Access IND Essential Plus Platinum HMO 65,56503FL140,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Platinum,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1400001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1400001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1400001-00,Standard Platinum Off Exchange Plan,,0.903126001358032,No,No,No,100%,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$190,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,18,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2150001,Gym Access SMAG Bronze POS HSA 4500/6450,56503FL215,7265435496,FLN001,FLS001,FLF003,New,POS,Bronze,No,Both,No,No,,,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2150001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2150001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2150001-01,Standard Bronze On Exchange Plan,,0.608792543411255,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,500",$20,$670,$150,"$4,500",$80,$50,$80,11
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,18,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2160001,Gym Access SMAG Bronze HMO HSA 6000/6450,56503FL216,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2160001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2160001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2160001-00,Standard Bronze Off Exchange Plan,,0.586631178855896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$20,$70,$150,"$5,130",$0,$0,$80,12
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,18,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2160001,Gym Access SMAG Bronze HMO HSA 6000/6450,56503FL216,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2160001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2160001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2160001-01,Standard Bronze On Exchange Plan,,0.586631178855896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$20,$70,$150,"$5,130",$0,$0,$80,13
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,18,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2170001,Gym Access SMAG Bronze POS HSA 6000/6450,56503FL217,7265435496,FLN001,FLS001,FLF003,New,POS,Bronze,No,Both,No,No,,,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2170001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2170001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2170001-00,Standard Bronze Off Exchange Plan,,0.586631178855896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$16,000","$32,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$6,000",$20,$70,$150,"$5,130",$0,$0,$80,14
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,18,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2170001,Gym Access SMAG Bronze POS HSA 6000/6450,56503FL217,7265435496,FLN001,FLS001,FLF003,New,POS,Bronze,No,Both,No,No,,,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2170001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2170001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2170001-01,Standard Bronze On Exchange Plan,,0.586631178855896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$16,000","$32,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$6,000",$20,$70,$150,"$5,130",$0,$0,$80,15
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,19,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2180002,SMAG Platinum HMO 3000,56503FL218,7265435496,FLN001,FLS001,FLF002,New,HMO,Platinum,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2180002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2180002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2180002-00,Standard Platinum Off Exchange Plan,,0.895551264286041,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$450,$0,$150,$0,$600,$250,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,19,56503,FL,Individual,No,26-3238817,56503FL2060002,IND Silver HMO 6600,56503FL206,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2060002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2060002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2060002-00,Standard Silver Off Exchange Plan,,0.700484275817871,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,490",$50,$50,$150,"$2,270",$570,$0,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,19,56503,FL,Individual,No,26-3238817,56503FL2060002,IND Silver HMO 6600,56503FL206,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2060002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2060002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2060002-01,Standard Silver On Exchange Plan,,0.700484275817871,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,490",$50,$50,$150,"$2,270",$570,$0,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,26,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2340001,Gym Access SMAG Gold POS 5500,56503FL234,7265435496,FLN001,FLS001,FLF002,New,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2340001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2340001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2340001-01,Standard Gold On Exchange Plan,,0.785113334655762,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$550,$0,$150,$0,$600,$250,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,27,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2290002,SMAG Silver HMO 6600,56503FL229,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2290002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2290002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2290002-00,Standard Silver Off Exchange Plan,,0.700484275817871,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,490",$50,$50,$150,"$2,270",$570,$0,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,27,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2290002,SMAG Silver HMO 6600,56503FL229,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2290002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2290002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2290002-01,Standard Silver On Exchange Plan,,0.700484275817871,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,490",$50,$50,$150,"$2,270",$570,$0,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,35,56503,FL,Individual,No,26-3238817,56503FL2260002,IND Bronze HMO HSA 6000/6450,56503FL226,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2260002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2260002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2260002-03,Limited Cost Sharing Plan Variation,,0.586631178855896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$20,$70,$150,"$5,130",$0,$0,$80,12
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,12,56503,FL,Individual,No,26-3238817,56503FL1400001,Gym Access IND Essential Plus Platinum HMO 65,56503FL140,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Platinum,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1400001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1400001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1400001-01,Standard Platinum On Exchange Plan,,0.903126001358032,No,No,No,100%,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$190,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,12,56503,FL,Individual,No,26-3238817,56503FL1400001,Gym Access IND Essential Plus Platinum HMO 65,56503FL140,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Platinum,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1400001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1400001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1400001-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,12,56503,FL,Individual,No,26-3238817,56503FL1400001,Gym Access IND Essential Plus Platinum HMO 65,56503FL140,7265435496,FLN001,FLS001,FLF002,Existing,HMO,Platinum,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1400001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1400001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1400001-03,Limited Cost Sharing Plan Variation,,0.903126001358032,No,No,No,100%,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$190,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,12,56503,FL,Individual,No,26-3238817,56503FL1480001,Gym Access IND Essential Plus Platinum POS 66,56503FL148,7265435496,FLN001,FLS001,FLF002,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1480001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1480001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1480001-00,Standard Platinum Off Exchange Plan,,0.902972877025604,No,No,No,100%,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$670,$150,$0,$600,$190,$80,8
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,12,56503,FL,Individual,No,26-3238817,56503FL1480001,Gym Access IND Essential Plus Platinum POS 66,56503FL148,7265435496,FLN001,FLS001,FLF002,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1480001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1480001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1480001-01,Standard Platinum On Exchange Plan,,0.902972877025604,No,No,No,100%,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$670,$150,$0,$600,$190,$80,9
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,12,56503,FL,Individual,No,26-3238817,56503FL1480001,Gym Access IND Essential Plus Platinum POS 66,56503FL148,7265435496,FLN001,FLS001,FLF002,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1480001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1480001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1480001-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,12,56503,FL,Individual,No,26-3238817,56503FL1480001,Gym Access IND Essential Plus Platinum POS 66,56503FL148,7265435496,FLN001,FLS001,FLF002,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1480001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1480001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1480001-03,Limited Cost Sharing Plan Variation,,0.902972877025604,No,No,No,100%,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,15%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$670,$150,$0,$600,$190,$80,11
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,13,56503,FL,Individual,No,26-3238817,56503FL2080002,IND Bronze HMO 6600,56503FL208,7265435496,FLN001,FLS001,FLF004,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2080002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2080002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2080002-00,Standard Bronze Off Exchange Plan,,0.618174195289612,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,340",$0,"$2,260",$150,"$1,270",$720,$0,$850,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,13,56503,FL,Individual,No,26-3238817,56503FL2080002,IND Bronze HMO 6600,56503FL208,7265435496,FLN001,FLS001,FLF004,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2080002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2080002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2080002-01,Standard Bronze On Exchange Plan,,0.618174195289612,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,340",$0,"$2,260",$150,"$1,270",$720,$0,$850,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,13,56503,FL,Individual,No,26-3238817,56503FL2080002,IND Bronze HMO 6600,56503FL208,7265435496,FLN001,FLS001,FLF004,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2080002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2080002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2080002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,100%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$0,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,13,56503,FL,Individual,No,26-3238817,56503FL2080002,IND Bronze HMO 6600,56503FL208,7265435496,FLN001,FLS001,FLF004,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2080002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2080002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2080002-03,Limited Cost Sharing Plan Variation,,0.618174195289612,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,340",$0,"$2,260",$150,"$1,270",$720,$0,$850,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,15,56503,FL,Individual,No,26-3238817,56503FL2100002,IND Catastrophic HMO 6600,56503FL210,7265435496,FLN001,FLS001,FLF005,New,HMO,Catastrophic,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2100002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2100002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2100002-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$4,370",$0,$0,$850,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,15,56503,FL,Individual,No,26-3238817,56503FL2100002,IND Catastrophic HMO 6600,56503FL210,7265435496,FLN001,FLS001,FLF005,New,HMO,Catastrophic,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2100002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2100002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2100002-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$4,370",$0,$0,$850,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,16,56503,FL,Individual,No,26-3238817,56503FL2100001,Gym Access IND Catastrophic HMO 6600,56503FL210,7265435496,FLN001,FLS001,FLF005,New,HMO,Catastrophic,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2100001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2100001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2100001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$4,370",$0,$0,$850,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,16,56503,FL,Individual,No,26-3238817,56503FL2100001,Gym Access IND Catastrophic HMO 6600,56503FL210,7265435496,FLN001,FLS001,FLF005,New,HMO,Catastrophic,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2100001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2100001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2100001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$4,370",$0,$0,$850,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,17,56503,FL,Individual,No,26-3238817,56503FL2040002,IND Silver HMO 6400,56503FL204,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2040002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2040002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2040002-00,Standard Silver Off Exchange Plan,,0.707475304603577,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$640,$0,$150,"$1,270",$700,$0,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,17,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2120002,SMAG Silver HMO HSA  2000/6450,56503FL212,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2120002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2120002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2120002-00,Standard Silver Off Exchange Plan,,0.68043714761734,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$20,$950,$150,"$2,000",$280,$250,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,17,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2120002,SMAG Silver HMO HSA  2000/6450,56503FL212,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2120002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2120002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2120002-01,Standard Silver On Exchange Plan,,0.68043714761734,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$20,$950,$150,"$2,000",$280,$250,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,17,56503,FL,Individual,No,26-3238817,56503FL2040002,IND Silver HMO 6400,56503FL204,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2040002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2040002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2040002-01,Standard Silver On Exchange Plan,,0.707475304603577,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$640,$0,$150,"$1,270",$700,$0,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,17,56503,FL,Individual,No,26-3238817,56503FL2040002,IND Silver HMO 6400,56503FL204,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2040002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2040002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2040002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,17,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2130002,SMAG Silver POS HSA  2000/6450,56503FL213,7265435496,FLN001,FLS001,FLF003,New,POS,Silver,No,Both,No,No,,,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2130002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2130002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2130002-00,Standard Silver Off Exchange Plan,,0.68043714761734,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,$950,$150,"$2,000",$280,$250,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,17,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2130002,SMAG Silver POS HSA  2000/6450,56503FL213,7265435496,FLN001,FLS001,FLF003,New,POS,Silver,No,Both,No,No,,,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2130002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2130002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2130002-01,Standard Silver On Exchange Plan,,0.68043714761734,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,$950,$150,"$2,000",$280,$250,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,17,56503,FL,Individual,No,26-3238817,56503FL2040002,IND Silver HMO 6400,56503FL204,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2040002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2040002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2040002-03,Limited Cost Sharing Plan Variation,,0.707475304603577,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$640,$0,$150,"$1,270",$700,$0,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,17,56503,FL,Individual,No,26-3238817,56503FL2040002,IND Silver HMO 6400,56503FL204,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2040002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2040002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2040002-04,73% AV Level Silver Plan,,0.734737038612366,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,200","$8,400",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$640,$0,$150,"$1,270",$700,$0,$80,8
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,17,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2140002,SMAG Bronze HMO HSA 4500/6450,56503FL214,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2140002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2140002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2140002-00,Standard Bronze Off Exchange Plan,,0.608792543411255,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$20,$670,$150,"$4,500",$80,$50,$80,8
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,17,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2140002,SMAG Bronze HMO HSA 4500/6450,56503FL214,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2140002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2140002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2140002-01,Standard Bronze On Exchange Plan,,0.608792543411255,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$20,$670,$150,"$4,500",$80,$50,$80,9
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,17,56503,FL,Individual,No,26-3238817,56503FL2040002,IND Silver HMO 6400,56503FL204,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2040002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2040002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2040002-05,87% AV Level Silver Plan,,0.865411698818207,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$750,$600,$100,$80,9
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,17,56503,FL,Individual,No,26-3238817,56503FL2040002,IND Silver HMO 6400,56503FL204,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2040002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2040002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2040002-06,94% AV Level Silver Plan,,0.933471858501434,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$500,$0,$150,$150,$270,$80,$80,10
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,17,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2150002,SMAG Bronze POS HSA 4500/6450,56503FL215,7265435496,FLN001,FLS001,FLF003,New,POS,Bronze,No,Both,No,No,,,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2150002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2150002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2150002-00,Standard Bronze Off Exchange Plan,,0.608792543411255,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,500",$20,$670,$150,"$4,500",$80,$50,$80,10
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,17,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2150002,SMAG Bronze POS HSA 4500/6450,56503FL215,7265435496,FLN001,FLS001,FLF003,New,POS,Bronze,No,Both,No,No,,,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2150002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2150002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2150002-01,Standard Bronze On Exchange Plan,,0.608792543411255,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,500",$20,$670,$150,"$4,500",$80,$50,$80,11
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,17,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2160002,SMAG Bronze HMO HSA 6000/6450,56503FL216,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2160002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2160002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2160002-00,Standard Bronze Off Exchange Plan,,0.586631178855896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$20,$70,$150,"$5,130",$0,$0,$80,12
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,17,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2160002,SMAG Bronze HMO HSA 6000/6450,56503FL216,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2160002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2160002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2160002-01,Standard Bronze On Exchange Plan,,0.586631178855896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$20,$70,$150,"$5,130",$0,$0,$80,13
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,17,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2170002,SMAG Bronze POS HSA 6000/6450,56503FL217,7265435496,FLN001,FLS001,FLF003,New,POS,Bronze,No,Both,No,No,,,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2170002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2170002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2170002-00,Standard Bronze Off Exchange Plan,,0.586631178855896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$16,000","$32,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$6,000",$20,$70,$150,"$5,130",$0,$0,$80,14
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,17,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2170002,SMAG Bronze POS HSA 6000/6450,56503FL217,7265435496,FLN001,FLS001,FLF003,New,POS,Bronze,No,Both,No,No,,,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2170002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2170002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2170002-01,Standard Bronze On Exchange Plan,,0.586631178855896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$16,000","$32,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$6,000",$20,$70,$150,"$5,130",$0,$0,$80,15
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,18,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2120001,Gym Access SMAG Silver HMO HSA  2000/6450,56503FL212,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2120001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2120001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2120001-00,Standard Silver Off Exchange Plan,,0.68043714761734,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$20,$950,$150,"$2,000",$280,$250,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,18,56503,FL,Individual,No,26-3238817,56503FL2040001,Gym Access IND Silver HMO 6400,56503FL204,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2040001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2040001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2040001-00,Standard Silver Off Exchange Plan,,0.707475304603577,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$640,$0,$150,"$1,270",$700,$0,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,18,56503,FL,Individual,No,26-3238817,56503FL2040001,Gym Access IND Silver HMO 6400,56503FL204,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2040001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2040001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2040001-01,Standard Silver On Exchange Plan,,0.707475304603577,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$640,$0,$150,"$1,270",$700,$0,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,18,56503,FL,Individual,No,26-3238817,56503FL2040001,Gym Access IND Silver HMO 6400,56503FL204,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2040001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2040001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2040001-04,73% AV Level Silver Plan,,0.734737038612366,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,200","$8,400",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$640,$0,$150,"$1,270",$700,$0,$80,8
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,18,56503,FL,Individual,No,26-3238817,56503FL2040001,Gym Access IND Silver HMO 6400,56503FL204,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2040001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2040001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2040001-05,87% AV Level Silver Plan,,0.865411698818207,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$750,$600,$100,$80,9
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,18,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2140001,Gym Access SMAG Bronze HMO HSA 4500/6450,56503FL214,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2140001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2140001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2140001-01,Standard Bronze On Exchange Plan,,0.608792543411255,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$20,$670,$150,"$4,500",$80,$50,$80,9
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,18,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2150001,Gym Access SMAG Bronze POS HSA 4500/6450,56503FL215,7265435496,FLN001,FLS001,FLF003,New,POS,Bronze,No,Both,No,No,,,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2150001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2150001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2150001-00,Standard Bronze Off Exchange Plan,,0.608792543411255,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,500",$20,$670,$150,"$4,500",$80,$50,$80,10
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,18,56503,FL,Individual,No,26-3238817,56503FL2040001,Gym Access IND Silver HMO 6400,56503FL204,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2040001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2040001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2040001-06,94% AV Level Silver Plan,,0.933471858501434,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$500,$0,$150,$150,$270,$80,$80,10
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,19,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2180002,SMAG Platinum HMO 3000,56503FL218,7265435496,FLN001,FLS001,FLF002,New,HMO,Platinum,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2180002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2180002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2180002-01,Standard Platinum On Exchange Plan,,0.895551264286041,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$450,$0,$150,$0,$600,$250,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,19,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2190002,SMAG Platinum POS 3000,56503FL219,7265435496,FLN001,FLS001,FLF002,New,POS,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2190002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2190002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2190002-00,Standard Platinum Off Exchange Plan,,0.895551264286041,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$450,$0,$150,$0,$600,$250,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,19,56503,FL,Individual,No,26-3238817,56503FL2060002,IND Silver HMO 6600,56503FL206,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2060002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2060002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2060002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,19,56503,FL,Individual,No,26-3238817,56503FL2060002,IND Silver HMO 6600,56503FL206,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2060002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2060002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2060002-03,Limited Cost Sharing Plan Variation,,0.700484275817871,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,490",$50,$50,$150,"$2,270",$570,$0,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,19,56503,FL,Individual,No,26-3238817,56503FL2060002,IND Silver HMO 6600,56503FL206,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2060002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2060002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2060002-05,87% AV Level Silver Plan,,0.869457066059113,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,600","$3,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$820,$40,$770,$150,"$1,000",$590,$90,$80,9
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,19,56503,FL,Individual,No,26-3238817,56503FL2060002,IND Silver HMO 6600,56503FL206,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2060002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2060002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2060002-06,94% AV Level Silver Plan,,0.939866721630096,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$40,$340,$150,$200,$250,$50,$80,10
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,20,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2180001,Gym Access SMAG Platinum HMO 3000,56503FL218,7265435496,FLN001,FLS001,FLF002,New,HMO,Platinum,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2180001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2180001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2180001-01,Standard Platinum On Exchange Plan,,0.895551264286041,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$450,$0,$150,$0,$600,$250,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,20,56503,FL,Individual,No,26-3238817,56503FL2060001,Gym Access IND Silver HMO 6600,56503FL206,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2060001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2060001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2060001-01,Standard Silver On Exchange Plan,,0.700484275817871,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,490",$50,$50,$150,"$2,270",$570,$0,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,20,56503,FL,Individual,No,26-3238817,56503FL2060001,Gym Access IND Silver HMO 6600,56503FL206,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2060001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2060001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2060001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,20,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2190001,Gym Access SMAG Platinum POS 3000,56503FL219,7265435496,FLN001,FLS001,FLF002,New,POS,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2190001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2190001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2190001-00,Standard Platinum Off Exchange Plan,,0.895551264286041,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$450,$0,$150,$0,$600,$250,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,20,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2190001,Gym Access SMAG Platinum POS 3000,56503FL219,7265435496,FLN001,FLS001,FLF002,New,POS,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2190001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2190001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2190001-01,Standard Platinum On Exchange Plan,,0.895551264286041,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$450,$0,$150,$0,$600,$250,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,20,56503,FL,Individual,No,26-3238817,56503FL2060001,Gym Access IND Silver HMO 6600,56503FL206,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2060001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2060001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2060001-03,Limited Cost Sharing Plan Variation,,0.700484275817871,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,490",$50,$50,$150,"$2,270",$570,$0,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,20,56503,FL,Individual,No,26-3238817,56503FL2060001,Gym Access IND Silver HMO 6600,56503FL206,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2060001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2060001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2060001-04,73% AV Level Silver Plan,,0.736115396022797,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,820",$50,$250,$150,"$1,670",$560,$0,$80,8
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,20,56503,FL,Individual,No,26-3238817,56503FL2060001,Gym Access IND Silver HMO 6600,56503FL206,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2060001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2060001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2060001-05,87% AV Level Silver Plan,,0.869457066059113,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,600","$3,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$820,$40,$770,$150,"$1,000",$590,$90,$80,9
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,20,56503,FL,Individual,No,26-3238817,56503FL2060001,Gym Access IND Silver HMO 6600,56503FL206,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2060001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2060001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2060001-06,94% AV Level Silver Plan,,0.939866721630096,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$40,$340,$150,$200,$250,$50,$80,10
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,21,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2280002,SMAG Gold HMO 4500,56503FL228,7265435496,FLN001,FLS001,FLF002,New,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2280002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2280002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2280002-00,Standard Gold Off Exchange Plan,,0.798820316791534,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$200,$300,$50,$150,$0,$650,$140,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,21,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2280002,SMAG Gold HMO 4500,56503FL228,7265435496,FLN001,FLS001,FLF002,New,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2280002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2280002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2280002-01,Standard Gold On Exchange Plan,,0.798820316791534,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$200,$300,$50,$150,$0,$650,$140,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,22,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2280001,Gym Access SMAG Gold HMO 4500,56503FL228,7265435496,FLN001,FLS001,FLF002,New,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2280001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2280001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2280001-00,Standard Gold Off Exchange Plan,,0.798820316791534,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$200,$300,$50,$150,$0,$650,$140,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,22,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2280001,Gym Access SMAG Gold HMO 4500,56503FL228,7265435496,FLN001,FLS001,FLF002,New,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2280001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2280001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2280001-01,Standard Gold On Exchange Plan,,0.798820316791534,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$200,$300,$50,$150,$0,$650,$140,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,23,56503,FL,Individual,No,26-3238817,56503FL2000002,IND Gold HMO 5500,56503FL200,7265435496,FLN001,FLS001,FLF002,New,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2000002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2000002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2000002-00,Standard Gold Off Exchange Plan,,0.785113334655762,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$550,$0,$150,$0,$600,$250,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,23,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2310002,SMAG Gold HMO 5000,56503FL231,7265435496,FLN001,FLS001,FLF002,New,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2310002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2310002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2310002-00,Standard Gold Off Exchange Plan,,0.797208309173584,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$50,$590,$150,$0,$600,$250,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,23,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2310002,SMAG Gold HMO 5000,56503FL231,7265435496,FLN001,FLS001,FLF002,New,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2310002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2310002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2310002-01,Standard Gold On Exchange Plan,,0.797208309173584,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$50,$590,$150,$0,$600,$250,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,23,56503,FL,Individual,No,26-3238817,56503FL2000002,IND Gold HMO 5500,56503FL200,7265435496,FLN001,FLS001,FLF002,New,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2000002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2000002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2000002-01,Standard Gold On Exchange Plan,,0.785113334655762,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$550,$0,$150,$0,$600,$250,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,23,56503,FL,Individual,No,26-3238817,56503FL2000002,IND Gold HMO 5500,56503FL200,7265435496,FLN001,FLS001,FLF002,New,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2000002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2000002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2000002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$0,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,23,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2320002,SMAG Gold POS 5000,56503FL232,7265435496,FLN001,FLS001,FLF002,New,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2320002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2320002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2320002-00,Standard Gold Off Exchange Plan,,0.797208309173584,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$15,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$50,$590,$150,$0,$600,$250,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,23,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2320002,SMAG Gold POS 5000,56503FL232,7265435496,FLN001,FLS001,FLF002,New,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2320002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2320002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2320002-01,Standard Gold On Exchange Plan,,0.797208309173584,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$15,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$50,$590,$150,$0,$600,$250,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,23,56503,FL,Individual,No,26-3238817,56503FL2000002,IND Gold HMO 5500,56503FL200,7265435496,FLN001,FLS001,FLF002,New,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2000002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2000002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2000002-03,Limited Cost Sharing Plan Variation,,0.785113334655762,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$550,$0,$150,$0,$600,$250,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,23,56503,FL,Individual,No,26-3238817,56503FL2010002,IND Gold POS 5500,56503FL201,7265435496,FLN001,FLS001,FLF002,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2010002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2010002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2010002-00,Standard Gold Off Exchange Plan,,0.785113334655762,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$550,$0,$150,$0,$600,$250,$80,8
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,23,56503,FL,Individual,No,26-3238817,56503FL2010002,IND Gold POS 5500,56503FL201,7265435496,FLN001,FLS001,FLF002,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2010002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2010002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2010002-01,Standard Gold On Exchange Plan,,0.785113334655762,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$550,$0,$150,$0,$600,$250,$80,9
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,23,56503,FL,Individual,No,26-3238817,56503FL2010002,IND Gold POS 5500,56503FL201,7265435496,FLN001,FLS001,FLF002,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2010002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2010002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2010002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$0,10
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,23,56503,FL,Individual,No,26-3238817,56503FL2010002,IND Gold POS 5500,56503FL201,7265435496,FLN001,FLS001,FLF002,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2010002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2010002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2010002-03,Limited Cost Sharing Plan Variation,,0.785113334655762,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$550,$0,$150,$0,$600,$250,$80,11
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,24,56503,FL,Individual,No,26-3238817,56503FL2000001,Gym Access IND Gold HMO 5500,56503FL200,7265435496,FLN001,FLS001,FLF002,New,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2000001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2000001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2000001-00,Standard Gold Off Exchange Plan,,0.785113334655762,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$550,$0,$150,$0,$600,$250,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,24,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2310001,Gym Access SMAG Gold HMO 5000,56503FL231,7265435496,FLN001,FLS001,FLF002,New,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2310001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2310001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2310001-00,Standard Gold Off Exchange Plan,,0.797208309173584,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$50,$590,$150,$0,$600,$250,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,24,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2310001,Gym Access SMAG Gold HMO 5000,56503FL231,7265435496,FLN001,FLS001,FLF002,New,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2310001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2310001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2310001-01,Standard Gold On Exchange Plan,,0.797208309173584,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$50,$590,$150,$0,$600,$250,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,24,56503,FL,Individual,No,26-3238817,56503FL2000001,Gym Access IND Gold HMO 5500,56503FL200,7265435496,FLN001,FLS001,FLF002,New,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2000001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2000001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2000001-01,Standard Gold On Exchange Plan,,0.785113334655762,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$550,$0,$150,$0,$600,$250,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,24,56503,FL,Individual,No,26-3238817,56503FL2000001,Gym Access IND Gold HMO 5500,56503FL200,7265435496,FLN001,FLS001,FLF002,New,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2000001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2000001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2000001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$0,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,24,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2320001,Gym Access SMAG Gold POS 5000,56503FL232,7265435496,FLN001,FLS001,FLF002,New,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2320001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2320001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2320001-00,Standard Gold Off Exchange Plan,,0.797208309173584,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$15,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$50,$590,$150,$0,$600,$250,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,24,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2320001,Gym Access SMAG Gold POS 5000,56503FL232,7265435496,FLN001,FLS001,FLF002,New,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2320001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2320001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2320001-01,Standard Gold On Exchange Plan,,0.797208309173584,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$15,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$50,$590,$150,$0,$600,$250,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,24,56503,FL,Individual,No,26-3238817,56503FL2000001,Gym Access IND Gold HMO 5500,56503FL200,7265435496,FLN001,FLS001,FLF002,New,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2000001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2000001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2000001-03,Limited Cost Sharing Plan Variation,,0.785113334655762,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$550,$0,$150,$0,$600,$250,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,24,56503,FL,Individual,No,26-3238817,56503FL2010001,Gym Access IND Gold POS 5500,56503FL201,7265435496,FLN001,FLS001,FLF002,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2010001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2010001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2010001-00,Standard Gold Off Exchange Plan,,0.785113334655762,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$550,$0,$150,$0,$600,$250,$80,8
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,24,56503,FL,Individual,No,26-3238817,56503FL2010001,Gym Access IND Gold POS 5500,56503FL201,7265435496,FLN001,FLS001,FLF002,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2010001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2010001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2010001-01,Standard Gold On Exchange Plan,,0.785113334655762,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$550,$0,$150,$0,$600,$250,$80,9
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,24,56503,FL,Individual,No,26-3238817,56503FL2010001,Gym Access IND Gold POS 5500,56503FL201,7265435496,FLN001,FLS001,FLF002,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2010001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2010001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2010001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$0,10
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,24,56503,FL,Individual,No,26-3238817,56503FL2010001,Gym Access IND Gold POS 5500,56503FL201,7265435496,FLN001,FLS001,FLF002,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2010001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2010001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2010001-03,Limited Cost Sharing Plan Variation,,0.785113334655762,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$550,$0,$150,$0,$600,$250,$80,11
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,25,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2330002,SMAG Gold HMO 5500,56503FL233,7265435496,FLN001,FLS001,FLF002,New,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2330002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2330002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2330002-00,Standard Gold Off Exchange Plan,,0.785113334655762,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$550,$0,$150,$0,$600,$250,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,25,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2330002,SMAG Gold HMO 5500,56503FL233,7265435496,FLN001,FLS001,FLF002,New,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2330002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2330002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2330002-01,Standard Gold On Exchange Plan,,0.785113334655762,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$550,$0,$150,$0,$600,$250,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,25,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2340002,SMAG Gold POS 5500,56503FL234,7265435496,FLN001,FLS001,FLF002,New,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2340002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2340002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2340002-00,Standard Gold Off Exchange Plan,,0.785113334655762,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$550,$0,$150,$0,$600,$250,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,25,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2340002,SMAG Gold POS 5500,56503FL234,7265435496,FLN001,FLS001,FLF002,New,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2340002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2340002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2340002-01,Standard Gold On Exchange Plan,,0.785113334655762,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$550,$0,$150,$0,$600,$250,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,26,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2330001,Gym Access SMAG Gold HMO 5500,56503FL233,7265435496,FLN001,FLS001,FLF002,New,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2330001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2330001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2330001-00,Standard Gold Off Exchange Plan,,0.785113334655762,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$550,$0,$150,$0,$600,$250,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,26,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2330001,Gym Access SMAG Gold HMO 5500,56503FL233,7265435496,FLN001,FLS001,FLF002,New,HMO,Gold,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2330001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2330001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2330001-01,Standard Gold On Exchange Plan,,0.785113334655762,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$550,$0,$150,$0,$600,$250,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,26,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2340001,Gym Access SMAG Gold POS 5500,56503FL234,7265435496,FLN001,FLS001,FLF002,New,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2340001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2340001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2340001-00,Standard Gold Off Exchange Plan,,0.785113334655762,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$550,$0,$150,$0,$600,$250,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,29,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2300002,SMAG Silver HMO 6400,56503FL230,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2300002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2300002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2300002-01,Standard Silver On Exchange Plan,,0.707475304603577,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$640,$0,$150,"$1,270",$700,$0,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,37,56503,FL,Individual,No,26-3238817,56503FL1990002,IND Platinum POS 4000,56503FL199,7265435496,FLN001,FLS001,FLF002,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1990002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1990002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1990002-03,Limited Cost Sharing Plan Variation,88.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$250,$80,11
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,38,56503,FL,Individual,No,26-3238817,56503FL1980001,Gym Access IND Platinum HMO 4000,56503FL198,7265435496,FLN001,FLS001,FLF002,New,HMO,Platinum,Yes,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1980001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1980001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1980001-00,Standard Platinum Off Exchange Plan,88.30%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$250,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,38,56503,FL,Individual,No,26-3238817,56503FL1980001,Gym Access IND Platinum HMO 4000,56503FL198,7265435496,FLN001,FLS001,FLF002,New,HMO,Platinum,Yes,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1980001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1980001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1980001-01,Standard Platinum On Exchange Plan,88.30%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$250,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,38,56503,FL,Individual,No,26-3238817,56503FL1980001,Gym Access IND Platinum HMO 4000,56503FL198,7265435496,FLN001,FLS001,FLF002,New,HMO,Platinum,Yes,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1980001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1980001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1980001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,38,56503,FL,Individual,No,26-3238817,56503FL1980001,Gym Access IND Platinum HMO 4000,56503FL198,7265435496,FLN001,FLS001,FLF002,New,HMO,Platinum,Yes,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1980001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1980001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1980001-03,Limited Cost Sharing Plan Variation,88.30%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$250,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,38,56503,FL,Individual,No,26-3238817,56503FL1990001,Gym Access Platinum POS 4000,56503FL199,7265435496,FLN001,FLS001,FLF002,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1990001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1990001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1990001-00,Standard Platinum Off Exchange Plan,88.30%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$250,$80,8
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,38,56503,FL,Individual,No,26-3238817,56503FL1990001,Gym Access Platinum POS 4000,56503FL199,7265435496,FLN001,FLS001,FLF002,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1990001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1990001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1990001-01,Standard Platinum On Exchange Plan,88.30%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$250,$80,9
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,1,57451,FL,Individual,No,65-0986441,57451FL0070003,Coventry Bronze $20 Copay Carelink HMO,57451FL007,,FLN001,FLS001,FLF003,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48614,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070003-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220002,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS002,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220002-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220003,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS003,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220003-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220003,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS003,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220003-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220003,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS003,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,25
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220010,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS004,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220010-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,74
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220010,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS004,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220010-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,75
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,30,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2300001,Gym Access SMAG Silver HMO 6400,56503FL230,7265435496,FLN001,FLS001,FLF003,New,HMO,Silver,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2300001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2300001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2300001-01,Standard Silver On Exchange Plan,,0.707475304603577,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$640,$0,$150,"$1,270",$700,$0,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,31,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2200002,SMAG Platinum HMO 4000,56503FL220,7265435496,FLN001,FLS001,FLF002,New,HMO,Platinum,Yes,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2200002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2200002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2200002-00,Standard Platinum Off Exchange Plan,88.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$250,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,31,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2200002,SMAG Platinum HMO 4000,56503FL220,7265435496,FLN001,FLS001,FLF002,New,HMO,Platinum,Yes,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2200002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2200002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2200002-01,Standard Platinum On Exchange Plan,88.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$250,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,31,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2210002,SMAG Platinum POS 4000,56503FL221,7265435496,FLN001,FLS001,FLF002,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2210002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2210002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2210002-00,Standard Platinum Off Exchange Plan,88.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$250,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,31,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2210002,SMAG Platinum POS 4000,56503FL221,7265435496,FLN001,FLS001,FLF002,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2210002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2210002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2210002-01,Standard Platinum On Exchange Plan,88.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$250,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,32,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2200001,Gym Access SMAG Platinum HMO 4000,56503FL220,7265435496,FLN001,FLS001,FLF002,New,HMO,Platinum,Yes,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2200001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2200001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2200001-00,Standard Platinum Off Exchange Plan,88.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$250,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,32,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2200001,Gym Access SMAG Platinum HMO 4000,56503FL220,7265435496,FLN001,FLS001,FLF002,New,HMO,Platinum,Yes,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2200001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2200001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2200001-01,Standard Platinum On Exchange Plan,88.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$250,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,32,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2210001,Gym Access SMAG Platinum POS 4000,56503FL221,7265435496,FLN001,FLS001,FLF002,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2210001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2210001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2210001-00,Standard Platinum Off Exchange Plan,88.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$250,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,32,56503,FL,SHOP (Small Group),No,26-3238817,56503FL2210001,Gym Access SMAG Platinum POS 4000,56503FL221,7265435496,FLN001,FLS001,FLF002,New,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2210001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2210001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2210001-01,Standard Platinum On Exchange Plan,88.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$250,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,35,56503,FL,Individual,No,26-3238817,56503FL2240002,IND Bronze HMO HSA 4500/6450,56503FL224,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2240002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2240002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2240002-00,Standard Bronze Off Exchange Plan,,0.608792543411255,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$20,$670,$150,"$4,500",$80,$50,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,35,56503,FL,Individual,No,26-3238817,56503FL2240002,IND Bronze HMO HSA 4500/6450,56503FL224,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2240002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2240002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2240002-01,Standard Bronze On Exchange Plan,,0.608792543411255,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$20,$670,$150,"$4,500",$80,$50,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,35,56503,FL,Individual,No,26-3238817,56503FL2240002,IND Bronze HMO HSA 4500/6450,56503FL224,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2240002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2240002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2240002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,35,56503,FL,Individual,No,26-3238817,56503FL2240002,IND Bronze HMO HSA 4500/6450,56503FL224,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2240002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2240002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2240002-03,Limited Cost Sharing Plan Variation,,0.608792543411255,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$20,$670,$150,"$4,500",$80,$50,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,35,56503,FL,Individual,No,26-3238817,56503FL2260002,IND Bronze HMO HSA 6000/6450,56503FL226,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2260002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2260002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2260002-00,Standard Bronze Off Exchange Plan,,0.586631178855896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$20,$70,$150,"$5,130",$0,$0,$80,9
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,35,56503,FL,Individual,No,26-3238817,56503FL2260002,IND Bronze HMO HSA 6000/6450,56503FL226,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2260002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2260002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2260002-01,Standard Bronze On Exchange Plan,,0.586631178855896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$20,$70,$150,"$5,130",$0,$0,$80,10
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,35,56503,FL,Individual,No,26-3238817,56503FL2260002,IND Bronze HMO HSA 6000/6450,56503FL226,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2260002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2260002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2260002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,11
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,36,56503,FL,Individual,No,26-3238817,56503FL2240001,Gym Access IND Bronze HMO HSA 4500/6450,56503FL224,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2240001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2240001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2240001-00,Standard Bronze Off Exchange Plan,,0.608792543411255,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$20,$670,$150,"$4,500",$80,$50,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,36,56503,FL,Individual,No,26-3238817,56503FL2240001,Gym Access IND Bronze HMO HSA 4500/6450,56503FL224,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2240001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2240001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2240001-01,Standard Bronze On Exchange Plan,,0.608792543411255,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$20,$670,$150,"$4,500",$80,$50,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,36,56503,FL,Individual,No,26-3238817,56503FL2240001,Gym Access IND Bronze HMO HSA 4500/6450,56503FL224,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2240001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2240001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2240001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,36,56503,FL,Individual,No,26-3238817,56503FL2240001,Gym Access IND Bronze HMO HSA 4500/6450,56503FL224,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2240001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2240001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2240001-03,Limited Cost Sharing Plan Variation,,0.608792543411255,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$20,$670,$150,"$4,500",$80,$50,$80,7
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,36,56503,FL,Individual,No,26-3238817,56503FL2260001,Gym Access IND Bronze HMO HSA 6000/6450,56503FL226,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2260001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2260001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2260001-00,Standard Bronze Off Exchange Plan,,0.586631178855896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$20,$70,$150,"$5,130",$0,$0,$80,9
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,36,56503,FL,Individual,No,26-3238817,56503FL2260001,Gym Access IND Bronze HMO HSA 6000/6450,56503FL226,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2260001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2260001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2260001-01,Standard Bronze On Exchange Plan,,0.586631178855896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$20,$70,$150,"$5,130",$0,$0,$80,10
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,36,56503,FL,Individual,No,26-3238817,56503FL2260001,Gym Access IND Bronze HMO HSA 6000/6450,56503FL226,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2260001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2260001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2260001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,11
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,36,56503,FL,Individual,No,26-3238817,56503FL2260001,Gym Access IND Bronze HMO HSA 6000/6450,56503FL226,7265435496,FLN001,FLS001,FLF003,New,HMO,Bronze,No,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL2260001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL2260001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL2260001-03,Limited Cost Sharing Plan Variation,,0.586631178855896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$20,$70,$150,"$5,130",$0,$0,$80,12
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,37,56503,FL,Individual,No,26-3238817,56503FL1980002,IND Platinum HMO 4000,56503FL198,7265435496,FLN001,FLS001,FLF002,New,HMO,Platinum,Yes,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1980002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1980002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1980002-00,Standard Platinum Off Exchange Plan,88.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$250,$80,4
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,37,56503,FL,Individual,No,26-3238817,56503FL1980002,IND Platinum HMO 4000,56503FL198,7265435496,FLN001,FLS001,FLF002,New,HMO,Platinum,Yes,Both,No,Yes,"The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1980002-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1980002-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1980002-01,Standard Platinum On Exchange Plan,88.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$250,$80,5
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,38,56503,FL,Individual,No,26-3238817,56503FL1990001,Gym Access Platinum POS 4000,56503FL199,7265435496,FLN001,FLS001,FLF002,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1990001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1990001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1990001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,FL,56503,HIOS,7,2014-11-15 04:52:41,38,56503,FL,Individual,No,26-3238817,56503FL1990001,Gym Access Platinum POS 4000,56503FL199,7265435496,FLN001,FLS001,FLF002,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,"Emergency and Urgent Care only, unless pre-authorized by Issuer.",Yes,http://www.fhcp.com/ISBC/2015/56503FL1990001-01.pdf,https://fhcp.softheon.com/Marketplace/,http://www.fhcp.com/ISOB/2015/56503FL1990001-01.pdf,http://www.fhcp.com/members/plansAndBenefits/2015-exchange-formulary.pdf,56503FL1990001-03,Limited Cost Sharing Plan Variation,88.30%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$600,$0,$150,$0,$600,$250,$80,11
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,1,57451,FL,Individual,No,65-0986441,57451FL0070003,Coventry Bronze $20 Copay Carelink HMO,57451FL007,,FLN001,FLS001,FLF003,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48614,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070003-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,1,57451,FL,Individual,No,65-0986441,57451FL0070003,Coventry Bronze $20 Copay Carelink HMO,57451FL007,,FLN001,FLS001,FLF003,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48614,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070003-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,1,57451,FL,Individual,No,65-0986441,57451FL0070003,Coventry Bronze $20 Copay Carelink HMO,57451FL007,,FLN001,FLS001,FLF003,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48614,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220003,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS003,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220003-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220004,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS004,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220004-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220011,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS005,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220011-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,78
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220011,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS005,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220011-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,79
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220033,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS003,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220033-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,25
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220033,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS003,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220033-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220034,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS004,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220034-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220034,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS004,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220034-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,4,57451,FL,Individual,No,65-0986441,57451FL0070004,Coventry Bronze Ded Only HSA Eligible Carelink HMO,57451FL007,,FLN001,FLS001,FLF004,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48630,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070004-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,4,57451,FL,Individual,No,65-0986441,57451FL0070004,Coventry Bronze Ded Only HSA Eligible Carelink HMO,57451FL007,,FLN001,FLS001,FLF004,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48630,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070004-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,4,57451,FL,Individual,No,65-0986441,57451FL0070004,Coventry Bronze Ded Only HSA Eligible Carelink HMO,57451FL007,,FLN001,FLS001,FLF004,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48630,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,4,57451,FL,Individual,No,65-0986441,57451FL0070004,Coventry Bronze Ded Only HSA Eligible Carelink HMO,57451FL007,,FLN001,FLS001,FLF004,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48630,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070004-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,7,57451,FL,Individual,No,65-0986441,57451FL0070002,Coventry Silver $10 Copay Carelink HMO,57451FL007,,FLN001,FLS001,FLF002,Existing,HMO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48604,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070002-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,7,57451,FL,Individual,No,65-0986441,57451FL0070002,Coventry Silver $10 Copay Carelink HMO,57451FL007,,FLN001,FLS001,FLF002,Existing,HMO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48604,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070002-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,7,57451,FL,Individual,No,65-0986441,57451FL0070002,Coventry Silver $10 Copay Carelink HMO,57451FL007,,FLN001,FLS001,FLF002,Existing,HMO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48604,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,7,57451,FL,Individual,No,65-0986441,57451FL0070002,Coventry Silver $10 Copay Carelink HMO,57451FL007,,FLN001,FLS001,FLF002,Existing,HMO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48604,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070002-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,7,57451,FL,Individual,No,65-0986441,57451FL0070002,Coventry Silver $10 Copay Carelink HMO,57451FL007,,FLN001,FLS001,FLF002,Existing,HMO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48604,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070002-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,7,57451,FL,Individual,No,65-0986441,57451FL0070002,Coventry Silver $10 Copay Carelink HMO,57451FL007,,FLN001,FLS001,FLF002,Existing,HMO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48604,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070002-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,450","$2,900",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,7,57451,FL,Individual,No,65-0986441,57451FL0070002,Coventry Silver $10 Copay Carelink HMO,57451FL007,,FLN001,FLS001,FLF002,Existing,HMO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48604,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070002-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,10,57451,FL,Individual,No,65-0986441,57451FL0070006,Coventry Silver $5 Copay 2750 Carelink HMO,57451FL007,,FLN001,FLS001,FLF005,New,HMO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48634,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070006-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,10,57451,FL,Individual,No,65-0986441,57451FL0070006,Coventry Silver $5 Copay 2750 Carelink HMO,57451FL007,,FLN001,FLS001,FLF005,New,HMO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48634,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070006-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,10,57451,FL,Individual,No,65-0986441,57451FL0070006,Coventry Silver $5 Copay 2750 Carelink HMO,57451FL007,,FLN001,FLS001,FLF005,New,HMO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48634,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,10,57451,FL,Individual,No,65-0986441,57451FL0070006,Coventry Silver $5 Copay 2750 Carelink HMO,57451FL007,,FLN001,FLS001,FLF005,New,HMO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48634,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070006-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,10,57451,FL,Individual,No,65-0986441,57451FL0070006,Coventry Silver $5 Copay 2750 Carelink HMO,57451FL007,,FLN001,FLS001,FLF005,New,HMO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48634,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070006-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,10,57451,FL,Individual,No,65-0986441,57451FL0070006,Coventry Silver $5 Copay 2750 Carelink HMO,57451FL007,,FLN001,FLS001,FLF005,New,HMO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48634,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070006-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,450","$2,900",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,10,57451,FL,Individual,No,65-0986441,57451FL0070006,Coventry Silver $5 Copay 2750 Carelink HMO,57451FL007,,FLN001,FLS001,FLF005,New,HMO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48634,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070006-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,13,57451,FL,Individual,No,65-0986441,57451FL0070001,Coventry Gold $5 Copay Carelink HMO,57451FL007,,FLN001,FLS001,FLF001,Existing,HMO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48600,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070001-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,13,57451,FL,Individual,No,65-0986441,57451FL0070001,Coventry Gold $5 Copay Carelink HMO,57451FL007,,FLN001,FLS001,FLF001,Existing,HMO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48600,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070001-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,13,57451,FL,Individual,No,65-0986441,57451FL0070001,Coventry Gold $5 Copay Carelink HMO,57451FL007,,FLN001,FLS001,FLF001,Existing,HMO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48600,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,57451,HIOS,7,2014-10-05 17:13:14,13,57451,FL,Individual,No,65-0986441,57451FL0070001,Coventry Gold $5 Copay Carelink HMO,57451FL007,,FLN001,FLS001,FLF001,Existing,HMO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999993041330908,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/FL48600,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,57451FL0070001-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,59667,HIOS,5,2014-09-05 03:32:16,1,59667,FL,Individual,Yes,65-0743731,59667FL0010001,DentaQuest EPO Pediatric High,59667FL001,7891798028,FLN001,FLS001,,Existing,EPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$26.94,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,Dentaquest.com/marketplace/fl,https://paydirect.dentaquest.com,Dentaquest.com/marketplace/fl,,59667FL0010001-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,59667,HIOS,5,2014-09-05 03:32:16,1,59667,FL,SHOP (Small Group),Yes,65-0743731,59667FL0020003,DentaQuest EPO Family High,59667FL002,7891798028,FLN001,FLS001,,Existing,EPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.90,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/fl/,,http://www.dentaquest.com/marketplace/fl/,,59667FL0020003-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,59667,HIOS,5,2014-09-05 03:32:16,1,59667,FL,SHOP (Small Group),Yes,65-0743731,59667FL0020003,DentaQuest EPO Family High,59667FL002,7891798028,FLN001,FLS001,,Existing,EPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.90,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/fl/,,http://www.dentaquest.com/marketplace/fl/,,59667FL0020003-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,59667,HIOS,5,2014-09-05 03:32:16,1,59667,FL,Individual,Yes,65-0743731,59667FL0010001,DentaQuest EPO Pediatric High,59667FL001,7891798028,FLN001,FLS001,,Existing,EPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$26.94,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,Dentaquest.com/marketplace/fl,https://paydirect.dentaquest.com,Dentaquest.com/marketplace/fl,,59667FL0010001-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,59667,HIOS,5,2014-09-05 03:32:16,1,59667,FL,Individual,Yes,65-0743731,59667FL0010002,DentaQuest EPO Pediatric Low,59667FL001,7891798028,FLN001,FLS001,,Existing,EPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$19.92,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,Dentaquest.com/marketplace/fl,https://paydirect.dentaquest.com,Dentaquest.com/marketplace/fl,,59667FL0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,FL,59667,HIOS,5,2014-09-05 03:32:16,1,59667,FL,SHOP (Small Group),Yes,65-0743731,59667FL0020004,DentaQuest EPO Family Low,59667FL002,7891798028,FLN001,FLS001,,Existing,EPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$13.97,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/fl/,,http://www.dentaquest.com/marketplace/fl/,,59667FL0020004-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,FL,59667,HIOS,5,2014-09-05 03:32:16,1,59667,FL,SHOP (Small Group),Yes,65-0743731,59667FL0020004,DentaQuest EPO Family Low,59667FL002,7891798028,FLN001,FLS001,,Existing,EPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$13.97,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/fl/,,http://www.dentaquest.com/marketplace/fl/,,59667FL0020004-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,FL,59667,HIOS,5,2014-09-05 03:32:16,1,59667,FL,Individual,Yes,65-0743731,59667FL0010002,DentaQuest EPO Pediatric Low,59667FL001,7891798028,FLN001,FLS001,,Existing,EPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$19.92,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,Dentaquest.com/marketplace/fl,https://paydirect.dentaquest.com,Dentaquest.com/marketplace/fl,,59667FL0010002-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,FL,59667,HIOS,5,2014-09-05 03:32:16,2,59667,FL,Individual,Yes,65-0743731,59667FL0010003,DentaQuest EPO Family High,59667FL001,7891798028,FLN001,FLS001,,Existing,EPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.94,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,Dentaquest.com/marketplace/fl,https://paydirect.dentaquest.com,Dentaquest.com/marketplace/fl,,59667FL0010003-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,59667,HIOS,5,2014-09-05 03:32:16,2,59667,FL,Individual,Yes,65-0743731,59667FL0010003,DentaQuest EPO Family High,59667FL001,7891798028,FLN001,FLS001,,Existing,EPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.94,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,Dentaquest.com/marketplace/fl,https://paydirect.dentaquest.com,Dentaquest.com/marketplace/fl,,59667FL0010003-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,59667,HIOS,5,2014-09-05 03:32:16,2,59667,FL,Individual,Yes,65-0743731,59667FL0010004,DentaQuest EPO Family Low,59667FL001,7891798028,FLN001,FLS001,,Existing,EPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.92,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,Dentaquest.com/marketplace/fl,https://paydirect.dentaquest.com,Dentaquest.com/marketplace/fl,,59667FL0010004-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,FL,59667,HIOS,5,2014-09-05 03:32:16,2,59667,FL,Individual,Yes,65-0743731,59667FL0010004,DentaQuest EPO Family Low,59667FL001,7891798028,FLN001,FLS001,,Existing,EPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.92,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,Dentaquest.com/marketplace/fl,https://paydirect.dentaquest.com,Dentaquest.com/marketplace/fl,,59667FL0010004-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,FL,75196,HIOS,3,2014-08-28 04:23:13,1,75196,FL,SHOP (Small Group),Yes,93-0242990,75196FL0040002,EHB High PPO,75196FL004,,FLN001,FLS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.41,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,75196FL0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,75196,HIOS,3,2014-08-28 04:23:13,1,75196,FL,SHOP (Small Group),Yes,93-0242990,75196FL0040001,EHB Low PPO,75196FL004,,FLN001,FLS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.39,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,75196FL0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,75196,HIOS,3,2014-08-28 04:23:13,1,75196,FL,SHOP (Small Group),Yes,93-0242990,75196FL0030002,EHB High Passive,75196FL003,,FLN001,FLS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$43.41,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,75196FL0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,1,77150,FL,Individual,No,45-3131932,77150FL1100007,HF Gold PPO Select 50 1041,77150FL110,,FLN001,FLS001,FLF006,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9865,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100007-03,Limited Cost Sharing Plan Variation,79.80%,0.796176671981812,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,1,77150,FL,Individual,No,45-3131932,77150FL1100015,HF Bronze PPO Select 80 1263,77150FL110,,FLN001,FLS001,FLF004,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.98,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100015-00,Standard Bronze Off Exchange Plan,61.50%,0.607556462287903,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,1,77150,FL,Individual,No,45-3131932,77150FL1100015,HF Bronze PPO Select 80 1263,77150FL110,,FLN001,FLS001,FLF004,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.98,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100015-01,Standard Bronze On Exchange Plan,61.50%,0.607556462287903,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,1,77150,FL,Individual,No,45-3131932,77150FL1100015,HF Bronze PPO Select 80 1263,77150FL110,,FLN001,FLS001,FLF004,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.98,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100015-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,14
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100013,HF Silver PPO Select 70 1230,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9837,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100013-06,94% AV Level Silver Plan,93.20%,0.934012055397034,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$9,200","$18,400",Not Applicable,Not Applicable,$0,$0,30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,6,77150,FL,Individual,No,45-3131932,77150FL1100006,HF Gold PPO Select 70 1037,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9866,,,0,0,4,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100006-00,Standard Gold Off Exchange Plan,79.00%,0.803512334823608,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,6,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110007,HF Silver PPO Select 85 5250,77150FL111,,FLN001,FLS001,FLF003,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9797,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110007-00,Standard Silver Off Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,6,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110007,HF Silver PPO Select 85 5250,77150FL111,,FLN001,FLS001,FLF003,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9797,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110007-01,Standard Silver On Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220001,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS001,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220001-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220001,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS001,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,17
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220001,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS001,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220001-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220002,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS002,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220002-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220002,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS002,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220002-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220002,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS002,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,21
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220004,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS004,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220004-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220004,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS004,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,29
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220004,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS004,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220004-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220005,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS005,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220005-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220005,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS005,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220005-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220005,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS005,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,33
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220005,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS005,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220005-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220006,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS006,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220006-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220006,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS006,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220006-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220006,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS006,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,37
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220006,Assurant Health Bronze Plan 001,62662FL022,,FLN001,FLS006,FLF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220006-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220007,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS001,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220007-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,50
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220016,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS004,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220016-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220016,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS004,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220016-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,29
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220019,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS001,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220019-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220020,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS002,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220020-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100011,HF Silver PPO Select 70 1166,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100011-05,87% AV Level Silver Plan,86.10%,0.871295988559723,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100011,HF Silver PPO Select 70 1166,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100011-06,94% AV Level Silver Plan,93.20%,0.934012055397034,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100013,HF Silver PPO Select 70 1230,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9837,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100013-00,Standard Silver Off Exchange Plan,71.10%,0.716611325740814,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$9,200","$18,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100013,HF Silver PPO Select 70 1230,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9837,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100013-01,Standard Silver On Exchange Plan,71.10%,0.716611325740814,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$9,200","$18,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220016,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS004,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220016-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220017,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS005,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220017-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220007,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS001,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220007-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,51
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220007,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS001,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,52
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220007,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS001,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220007-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,53
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220007,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS001,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220007-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,54
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220007,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS001,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220007-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,55
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220007,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS001,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220007-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220008,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS002,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220008-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,57
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220008,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS002,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220008-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,58
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220008,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS002,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,59
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220008,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS002,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220008-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,60
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220008,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS002,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220008-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,61
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220008,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS002,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220008-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,62
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220008,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS002,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220008-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,63
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220009,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS003,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220009-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,64
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220009,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS003,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220009-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,65
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220009,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS003,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,66
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220009,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS003,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220009-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,67
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220009,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS003,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220009-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,68
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220009,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS003,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220009-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,69
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220011,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS005,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,80
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220011,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS005,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220011-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,81
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220011,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS005,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220011-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,82
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220011,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS005,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220011-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,83
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220011,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS005,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220011-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,84
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220012,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS006,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220012-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,85
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220012,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS006,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220012-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,86
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220012,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS006,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,87
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220012,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS006,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220012-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,88
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220012,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS006,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220012-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,89
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220012,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS006,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220012-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,90
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,1,62662,FL,Individual,No,39-0658730,62662FL0220012,Assurant Health Silver Plan 001,62662FL022,,FLN001,FLS006,FLF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220012-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,91
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220013,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS001,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220013-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220013,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS001,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220013-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220013,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS001,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220013-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,17
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220013,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS001,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220013-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220014,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS002,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220014-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220014,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS002,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220014-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220014,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS002,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220014-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,21
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220014,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS002,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220014-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220015,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS003,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220015-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220015,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS003,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220015-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220015,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS003,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220015-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,25
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220015,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS003,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220015-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220016,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS004,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220016-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220017,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS005,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220017-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220017,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS005,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220017-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,33
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220017,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS005,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220017-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220018,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS006,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220018-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220018,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS006,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220018-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220018,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS006,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220018-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,37
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,4,62662,FL,Individual,No,39-0658730,62662FL0220018,Assurant Health Bronze Plan 002,62662FL022,,FLN001,FLS006,FLF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,62662FL0220018-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220020,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS002,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220020-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220020,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS002,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220020-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,1,77150,FL,Individual,No,45-3131932,77150FL1100007,HF Gold PPO Select 50 1041,77150FL110,,FLN001,FLS001,FLF006,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9865,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100007-01,Standard Gold On Exchange Plan,79.80%,0.796176671981812,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,1,77150,FL,Individual,No,45-3131932,77150FL1100007,HF Gold PPO Select 50 1041,77150FL110,,FLN001,FLS001,FLF006,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9865,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,10
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,6,77150,FL,Individual,No,45-3131932,77150FL1100006,HF Gold PPO Select 70 1037,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9866,,,0,0,4,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100006-01,Standard Gold On Exchange Plan,79.00%,0.803512334823608,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,6,77150,FL,Individual,No,45-3131932,77150FL1100006,HF Gold PPO Select 70 1037,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9866,,,0,0,4,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100006-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,6,77150,FL,Individual,No,45-3131932,77150FL1100006,HF Gold PPO Select 70 1037,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9866,,,0,0,4,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100006-03,Limited Cost Sharing Plan Variation,79.00%,0.803512334823608,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,7,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110008,HF Silver PPO Select 70 5273,77150FL111,,FLN001,FLS001,FLF005,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9795,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110008-00,Standard Silver Off Exchange Plan,71.30%,0.708689212799072,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220020,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS002,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220020-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220020,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS002,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220020-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220021,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS003,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220021-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220021,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS003,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220021-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220021,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS003,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220021-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,31
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220021,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS003,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220021-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220021,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS003,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220021-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220021,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS003,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220021-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220021,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS003,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220021-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220022,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS004,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220022-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220022,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS004,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220022-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220022,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS004,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220022-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,38
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220022,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS004,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220022-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220022,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS004,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220022-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220022,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS004,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220022-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220022,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS004,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220022-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,42
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220023,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS005,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220023-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,43
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220023,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS005,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220023-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220023,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS005,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220023-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,45
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220023,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS005,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220023-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,46
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220023,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS005,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220023-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,47
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220023,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS005,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220023-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220023,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS005,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220023-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220024,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS006,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220024-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,50
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220024,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS006,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220024-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,51
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220024,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS006,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220024-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,52
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220024,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS006,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220024-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,53
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220024,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS006,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220024-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,54
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220024,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS006,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220024-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,55
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220024,Assurant Health Silver Plan 002,62662FL022,,FLN001,FLS006,FLF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220024-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220025,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS001,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220025-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,79
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220025,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS001,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220025-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,80
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220025,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS001,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220025-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,81
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220025,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS001,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220025-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,82
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220026,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS002,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220026-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,83
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220026,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS002,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220026-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,84
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220026,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS002,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220026-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,85
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220026,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS002,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220026-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,86
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220027,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS003,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220027-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,87
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,10,77150,FL,Individual,No,45-3131932,77150FL1100010,HF Silver PPO Select 70 1134,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100010-05,87% AV Level Silver Plan,86.10%,0.904925048351288,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,$800,"$1,600",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,10,77150,FL,Individual,No,45-3131932,77150FL1100010,HF Silver PPO Select 70 1134,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100010-06,94% AV Level Silver Plan,93.20%,0.937231838703156,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$12,700","$25,400",Not Applicable,Not Applicable,$0,$0,30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,11,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110013,HF Silver PPO Select 50 5318,77150FL111,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9792,,,0,0,4,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110013-00,Standard Silver Off Exchange Plan,69.70%,0.707643866539001,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,"$2,000","$4,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,11,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110013,HF Silver PPO Select 50 5318,77150FL111,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9792,,,0,0,4,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110013-01,Standard Silver On Exchange Plan,69.70%,0.707643866539001,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,"$2,000","$4,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,12,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110014,HF Silver PPO Select 70 5327,77150FL111,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.979,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110014-00,Standard Silver Off Exchange Plan,69.80%,0.700502693653107,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,12,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110014,HF Silver PPO Select 70 5327,77150FL111,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.979,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110014-01,Standard Silver On Exchange Plan,69.80%,0.700502693653107,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,3,86382,FL,Individual,No,20-8937577,86382FL0010008,Ambetter Balanced Care 4,86382FL001,,FLN001,FLS001,FLF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0010008-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,4
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,3,86382,FL,Individual,No,20-8937577,86382FL0010008,Ambetter Balanced Care 4,86382FL001,,FLN001,FLS001,FLF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0010008-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,5
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220027,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS003,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220027-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,88
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220027,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS003,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220027-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,89
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220027,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS003,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220027-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,90
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220028,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS004,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220028-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,91
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220028,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS004,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220028-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,92
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220028,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS004,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220028-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,93
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220028,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS004,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220028-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,94
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220029,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS005,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220029-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,95
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220029,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS005,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220029-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,96
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220029,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS005,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220029-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,97
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220029,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS005,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220029-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,98
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220030,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS006,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220030-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,99
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220030,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS006,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220030-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,100
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220030,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS006,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220030-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,101
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,6,62662,FL,Individual,No,39-0658730,62662FL0220030,Assurant Health Gold Plan 002,62662FL022,,FLN001,FLS006,FLF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220030-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,102
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220031,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS001,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220031-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220031,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS001,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220031-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220031,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS001,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220031-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,17
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220031,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS001,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220031-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220032,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS002,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220032-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220032,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS002,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220032-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220032,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS002,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220032-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,21
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220032,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS002,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220032-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220033,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS003,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220033-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220033,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS003,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220033-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220034,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS004,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220034-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,29
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220034,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS004,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220034-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220035,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS005,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220035-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220035,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS005,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220035-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220035,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS005,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220035-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,33
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220035,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS005,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220035-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,7,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110008,HF Silver PPO Select 70 5273,77150FL111,,FLN001,FLS001,FLF005,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9795,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110008-01,Standard Silver On Exchange Plan,71.30%,0.708689212799072,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,8,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110009,HF Silver PPO Select 70 5281,77150FL111,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9794,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110009-00,Standard Silver Off Exchange Plan,71.10%,0.716611325740814,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$9,200","$18,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,8,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110009,HF Silver PPO Select 70 5281,77150FL111,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9794,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110009-01,Standard Silver On Exchange Plan,71.10%,0.716611325740814,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$9,200","$18,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,9,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110011,HF Silver PPO Select 50 5300,77150FL111,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9784,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110011-00,Standard Silver Off Exchange Plan,70.40%,0.715611696243286,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,2,86382,FL,Individual,No,20-8937577,86382FL0010017,Ambetter Essential Care 1,86382FL001,,FLN001,FLS001,FLF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0010017-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,2,86382,FL,Individual,No,20-8937577,86382FL0010017,Ambetter Essential Care 1,86382FL001,,FLN001,FLS001,FLF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0010017-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,2,86382,FL,Individual,No,20-8937577,86382FL0010017,Ambetter Essential Care 1,86382FL001,,FLN001,FLS001,FLF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0010017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,2,86382,FL,Individual,No,20-8937577,86382FL0010017,Ambetter Essential Care 1,86382FL001,,FLN001,FLS001,FLF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0010017-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,3,86382,FL,Individual,No,20-8937577,86382FL0010008,Ambetter Balanced Care 4,86382FL001,,FLN001,FLS001,FLF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0010008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,3,86382,FL,Individual,No,20-8937577,86382FL0010008,Ambetter Balanced Care 4,86382FL001,,FLN001,FLS001,FLF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0010008-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,7
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,3,86382,FL,Individual,No,20-8937577,86382FL0010008,Ambetter Balanced Care 4,86382FL001,,FLN001,FLS001,FLF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0010008-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,8
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,3,86382,FL,Individual,No,20-8937577,86382FL0010008,Ambetter Balanced Care 4,86382FL001,,FLN001,FLS001,FLF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0010008-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,9
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220036,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS006,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220036-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220036,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS006,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220036-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220036,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS006,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220036-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,37
2015,FL,62662,HIOS,4,2014-11-09 04:38:15,7,62662,FL,Individual,No,39-0658730,62662FL0220036,Assurant Health Platinum Plan 002,62662FL022,,FLN001,FLS006,FLF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_FL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-FL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,62662FL0220036-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,FL,65476,HIOS,2,2014-08-03 08:59:32,1,65476,FL,SHOP (Small Group),Yes,47-0098400,65476FL0040002,EHB High PPO,65476FL004,,FLN001,FLS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$38.75,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,65476FL0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,65476,HIOS,2,2014-08-03 08:59:32,1,65476,FL,SHOP (Small Group),Yes,47-0098400,65476FL0040001,EHB Low PPO,65476FL004,,FLN001,FLS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.07,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,65476FL0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,65476,HIOS,2,2014-08-03 08:59:32,1,65476,FL,SHOP (Small Group),Yes,47-0098400,65476FL0030002,EHB High Passive,65476FL003,,FLN001,FLS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$42.68,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,65476FL0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,FL,65476,HIOS,2,2014-08-03 08:59:32,1,65476,FL,SHOP (Small Group),Yes,47-0098400,65476FL0030001,EHB Low Passive,65476FL003,,FLN001,FLS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.77,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,65476FL0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,1,68398,FL,Individual,No,59-1293865,68398FL0030005,United Healthcare Gold Compass H.S.A. 1300,68398FL003,,FLN006,FLS003,FLF001,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030005-00,Standard Gold Off Exchange Plan,79.10%,0.791,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,1,68398,FL,SHOP (Small Group),No,59-1293865,68398FL0010074,UnitedHealthcare Gold Navigate 1500 - 1,68398FL001,,FLN005,FLS001,FLF006,Existing,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,No,No,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/shopfl,,,www.uhc.com/shopfl,68398FL0010074-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,1,68398,FL,SHOP (Small Group),No,59-1293865,68398FL0010074,UnitedHealthcare Gold Navigate 1500 - 1,68398FL001,,FLN005,FLS001,FLF006,Existing,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,No,No,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/shopfl,,,www.uhc.com/shopfl,68398FL0010074-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,1,68398,FL,Individual,No,59-1293865,68398FL0030005,United Healthcare Gold Compass H.S.A. 1300,68398FL003,,FLN006,FLS003,FLF001,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030005-01,Standard Gold On Exchange Plan,79.10%,0.791,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,1,68398,FL,Individual,No,59-1293865,68398FL0030005,United Healthcare Gold Compass H.S.A. 1300,68398FL003,,FLN006,FLS003,FLF001,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,1,68398,FL,SHOP (Small Group),No,59-1293865,68398FL0010005,UnitedHealthcare Gold Navigate 1500 - 1,68398FL001,,FLN005,FLS002,FLF006,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,No,No,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/shopfl,,,www.uhc.com/shopfl,68398FL0010005-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,1,68398,FL,SHOP (Small Group),No,59-1293865,68398FL0010005,UnitedHealthcare Gold Navigate 1500 - 1,68398FL001,,FLN005,FLS002,FLF006,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,No,No,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/shopfl,,,www.uhc.com/shopfl,68398FL0010005-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,1,68398,FL,Individual,No,59-1293865,68398FL0030005,United Healthcare Gold Compass H.S.A. 1300,68398FL003,,FLN006,FLS003,FLF001,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030005-03,Limited Cost Sharing Plan Variation,79.10%,0.791,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,1,68398,FL,Individual,No,59-1293865,68398FL0030007,United Healthcare Silver Compass H.S.A. 3600,68398FL003,,FLN006,FLS003,FLF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030007-00,Standard Silver Off Exchange Plan,68.30%,0.683,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,1,68398,FL,Individual,No,59-1293865,68398FL0030007,United Healthcare Silver Compass H.S.A. 3600,68398FL003,,FLN006,FLS003,FLF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030007-01,Standard Silver On Exchange Plan,68.30%,0.683,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,1,68398,FL,Individual,No,59-1293865,68398FL0030007,United Healthcare Silver Compass H.S.A. 3600,68398FL003,,FLN006,FLS003,FLF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,1,68398,FL,Individual,No,59-1293865,68398FL0030007,United Healthcare Silver Compass H.S.A. 3600,68398FL003,,FLN006,FLS003,FLF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030007-03,Limited Cost Sharing Plan Variation,68.30%,0.683,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,1,68398,FL,Individual,No,59-1293865,68398FL0030007,United Healthcare Silver Compass H.S.A. 3600,68398FL003,,FLN006,FLS003,FLF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030007-04,73% AV Level Silver Plan,73.00%,0.73,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,1,68398,FL,Individual,No,59-1293865,68398FL0030007,United Healthcare Silver Compass H.S.A. 3600,68398FL003,,FLN006,FLS003,FLF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030007-05,87% AV Level Silver Plan,87.00%,0.87,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,1,68398,FL,Individual,No,59-1293865,68398FL0030007,United Healthcare Silver Compass H.S.A. 3600,68398FL003,,FLN006,FLS003,FLF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030007-06,94% AV Level Silver Plan,94.00%,0.94,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,1,68398,FL,Individual,No,59-1293865,68398FL0030009,United Healthcare Bronze Compass H.S.A. 6275,68398FL003,,FLN006,FLS003,FLF004,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030009-00,Standard Bronze Off Exchange Plan,62.00%,0.62,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,275","$12,550",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,1,68398,FL,Individual,No,59-1293865,68398FL0030009,United Healthcare Bronze Compass H.S.A. 6275,68398FL003,,FLN006,FLS003,FLF004,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030009-01,Standard Bronze On Exchange Plan,62.00%,0.62,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,275","$12,550",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,1,68398,FL,Individual,No,59-1293865,68398FL0030009,United Healthcare Bronze Compass H.S.A. 6275,68398FL003,,FLN006,FLS003,FLF004,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030009-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,17
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,1,68398,FL,Individual,No,59-1293865,68398FL0030009,United Healthcare Bronze Compass H.S.A. 6275,68398FL003,,FLN006,FLS003,FLF004,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030009-03,Limited Cost Sharing Plan Variation,62.00%,0.62,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,275","$12,550",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,2,68398,FL,Individual,No,59-1293865,68398FL0030004,United Healthcare Gold Compass 1500-3,68398FL003,,FLN006,FLS003,FLF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030004-00,Standard Gold Off Exchange Plan,79.40%,0.794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,2,68398,FL,SHOP (Small Group),No,59-1293865,68398FL0010052,UnitedHealthcare Silver Navigate 2000 - 1,68398FL001,,FLN005,FLS001,FLF007,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,No,No,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/shopfl,,,www.uhc.com/shopfl,68398FL0010052-00,Standard Silver Off Exchange Plan,69.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,2,68398,FL,SHOP (Small Group),No,59-1293865,68398FL0010052,UnitedHealthcare Silver Navigate 2000 - 1,68398FL001,,FLN005,FLS001,FLF007,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,No,No,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/shopfl,,,www.uhc.com/shopfl,68398FL0010052-01,Standard Silver On Exchange Plan,69.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,2,68398,FL,Individual,No,59-1293865,68398FL0030004,United Healthcare Gold Compass 1500-3,68398FL003,,FLN006,FLS003,FLF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030004-01,Standard Gold On Exchange Plan,79.40%,0.794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,2,68398,FL,Individual,No,59-1293865,68398FL0030004,United Healthcare Gold Compass 1500-3,68398FL003,,FLN006,FLS003,FLF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030004-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,2,68398,FL,SHOP (Small Group),No,59-1293865,68398FL0010059,UnitedHealthcare Silver Navigate 2000 - 1,68398FL001,,FLN005,FLS002,FLF007,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,No,No,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/shopfl,,,www.uhc.com/shopfl,68398FL0010059-00,Standard Silver Off Exchange Plan,69.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,2,68398,FL,SHOP (Small Group),No,59-1293865,68398FL0010059,UnitedHealthcare Silver Navigate 2000 - 1,68398FL001,,FLN005,FLS002,FLF007,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,No,No,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/shopfl,,,www.uhc.com/shopfl,68398FL0010059-01,Standard Silver On Exchange Plan,69.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,2,68398,FL,Individual,No,59-1293865,68398FL0030004,United Healthcare Gold Compass 1500-3,68398FL003,,FLN006,FLS003,FLF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030004-03,Limited Cost Sharing Plan Variation,79.40%,0.794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,3,68398,FL,Individual,No,59-1293865,68398FL0030002,United Healthcare Platinum Compass 250,68398FL003,,FLN006,FLS003,FLF003,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030002-00,Standard Platinum Off Exchange Plan,89.20%,0.892,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,3,68398,FL,Individual,No,59-1293865,68398FL0030002,United Healthcare Platinum Compass 250,68398FL003,,FLN006,FLS003,FLF003,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030002-01,Standard Platinum On Exchange Plan,89.20%,0.892,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,3,68398,FL,Individual,No,59-1293865,68398FL0030002,United Healthcare Platinum Compass 250,68398FL003,,FLN006,FLS003,FLF003,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,3,68398,FL,Individual,No,59-1293865,68398FL0030002,United Healthcare Platinum Compass 250,68398FL003,,FLN006,FLS003,FLF003,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030002-03,Limited Cost Sharing Plan Variation,89.20%,0.892,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,4,68398,FL,Individual,No,59-1293865,68398FL0030006,United Healthcare Silver Compass 4000,68398FL003,,FLN006,FLS003,FLF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030006-00,Standard Silver Off Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,4,68398,FL,Individual,No,59-1293865,68398FL0030006,United Healthcare Silver Compass 4000,68398FL003,,FLN006,FLS003,FLF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030006-01,Standard Silver On Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,4,68398,FL,Individual,No,59-1293865,68398FL0030006,United Healthcare Silver Compass 4000,68398FL003,,FLN006,FLS003,FLF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030006-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,4,68398,FL,Individual,No,59-1293865,68398FL0030006,United Healthcare Silver Compass 4000,68398FL003,,FLN006,FLS003,FLF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030006-03,Limited Cost Sharing Plan Variation,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,4,68398,FL,Individual,No,59-1293865,68398FL0030006,United Healthcare Silver Compass 4000,68398FL003,,FLN006,FLS003,FLF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030006-04,73% AV Level Silver Plan,73.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,4,68398,FL,Individual,No,59-1293865,68398FL0030006,United Healthcare Silver Compass 4000,68398FL003,,FLN006,FLS003,FLF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030006-05,87% AV Level Silver Plan,87.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$850,"$1,700",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,4,68398,FL,Individual,No,59-1293865,68398FL0030006,United Healthcare Silver Compass 4000,68398FL003,,FLN006,FLS003,FLF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030006-06,94% AV Level Silver Plan,94.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,5,68398,FL,Individual,No,59-1293865,68398FL0030008,United Healthcare Bronze Compass 4200,68398FL003,,FLN006,FLS003,FLF002,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030008-00,Standard Bronze Off Exchange Plan,59.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,5,68398,FL,Individual,No,59-1293865,68398FL0030008,United Healthcare Bronze Compass 4200,68398FL003,,FLN006,FLS003,FLF002,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030008-01,Standard Bronze On Exchange Plan,59.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,5,68398,FL,Individual,No,59-1293865,68398FL0030008,United Healthcare Bronze Compass 4200,68398FL003,,FLN006,FLS003,FLF002,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030008-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,5,68398,FL,Individual,No,59-1293865,68398FL0030008,United Healthcare Bronze Compass 4200,68398FL003,,FLN006,FLS003,FLF002,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030008-03,Limited Cost Sharing Plan Variation,59.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,6,68398,FL,Individual,No,59-1293865,68398FL0030010,United Healthcare Catastrophic Compass 6600,68398FL003,,FLN006,FLS003,FLF005,New,HMO,Catastrophic,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030010-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,68398,HIOS,13,2015-07-22 09:15:52,6,68398,FL,Individual,No,59-1293865,68398FL0030010,United Healthcare Catastrophic Compass 6600,68398FL003,,FLN006,FLS003,FLF005,New,HMO,Catastrophic,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9965,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xfl,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xfl,68398FL0030010-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,71675,HIOS,2,2014-08-08 08:53:29,1,71675,FL,SHOP (Small Group),Yes,42-0127290,71675FL0040001,Principal Plan Dental 70,71675FL004,,FLN001,FLS001,,New,PPO,Low,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$25.55,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,71675FL0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,71675,HIOS,2,2014-08-08 08:53:29,1,71675,FL,SHOP (Small Group),Yes,42-0127290,71675FL0040002,Principal Plan Dental 80,71675FL004,,FLN001,FLS001,,New,PPO,High,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$27.04,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,71675FL0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,75196,HIOS,3,2014-08-28 04:23:13,1,75196,FL,SHOP (Small Group),Yes,93-0242990,75196FL0030001,EHB Low Passive,75196FL003,,FLN001,FLS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.17,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,75196FL0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,1,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110002,HF Gold PPO Select 80 5118,77150FL111,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110002-00,Standard Gold Off Exchange Plan,81.20%,0.788223385810852,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,1,77150,FL,Individual,No,45-3131932,77150FL1100001,HF Gold PPO Select 90 1007,77150FL110,,FLN001,FLS001,FLF002,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9861,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100001-00,Standard Gold Off Exchange Plan,78.20%,0.767817795276642,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,1,77150,FL,Individual,No,45-3131932,77150FL1100001,HF Gold PPO Select 90 1007,77150FL110,,FLN001,FLS001,FLF002,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9861,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100001-01,Standard Gold On Exchange Plan,78.20%,0.767817795276642,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,1,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110002,HF Gold PPO Select 80 5118,77150FL111,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,5,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110002-01,Standard Gold On Exchange Plan,81.20%,0.788223385810852,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,1,77150,FL,Individual,No,45-3131932,77150FL1100001,HF Gold PPO Select 90 1007,77150FL110,,FLN001,FLS001,FLF002,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9861,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,1,77150,FL,Individual,No,45-3131932,77150FL1100001,HF Gold PPO Select 90 1007,77150FL110,,FLN001,FLS001,FLF002,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9861,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100001-03,Limited Cost Sharing Plan Variation,78.20%,0.767817795276642,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,1,77150,FL,Individual,No,45-3131932,77150FL1100007,HF Gold PPO Select 50 1041,77150FL110,,FLN001,FLS001,FLF006,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9865,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100007-00,Standard Gold Off Exchange Plan,79.80%,0.796176671981812,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,1,77150,FL,Individual,No,45-3131932,77150FL1100015,HF Bronze PPO Select 80 1263,77150FL110,,FLN001,FLS001,FLF004,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.98,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100015-03,Limited Cost Sharing Plan Variation,61.50%,0.607556462287903,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,1,77150,FL,Individual,No,45-3131932,77150FL1100009,HF Silver PPO Select 85 1118,77150FL110,,FLN001,FLS001,FLF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.984,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100009-00,Standard Silver Off Exchange Plan,71.70%,0.706839680671692,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,1,77150,FL,Individual,No,45-3131932,77150FL1100009,HF Silver PPO Select 85 1118,77150FL110,,FLN001,FLS001,FLF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.984,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100009-01,Standard Silver On Exchange Plan,71.70%,0.706839680671692,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,1,77150,FL,Individual,No,45-3131932,77150FL1100009,HF Silver PPO Select 85 1118,77150FL110,,FLN001,FLS001,FLF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.984,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100009-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,18
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,10,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110012,HF Silver PPO Select 90 5309,77150FL111,,FLN001,FLS001,FLF002,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9791,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110012-01,Standard Silver On Exchange Plan,70.10%,0.688046276569366,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,10,77150,FL,Individual,No,45-3131932,77150FL1100010,HF Silver PPO Select 70 1134,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100010-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,10,77150,FL,Individual,No,45-3131932,77150FL1100010,HF Silver PPO Select 70 1134,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100010-03,Limited Cost Sharing Plan Variation,68.90%,0.70455127954483,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,10,77150,FL,Individual,No,45-3131932,77150FL1100010,HF Silver PPO Select 70 1134,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100010-04,73% AV Level Silver Plan,72.10%,0.744338512420654,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,1,77150,FL,Individual,No,45-3131932,77150FL1100009,HF Silver PPO Select 85 1118,77150FL110,,FLN001,FLS001,FLF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.984,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100009-03,Limited Cost Sharing Plan Variation,71.70%,0.706839680671692,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,1,77150,FL,Individual,No,45-3131932,77150FL1100009,HF Silver PPO Select 85 1118,77150FL110,,FLN001,FLS001,FLF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.984,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100009-04,73% AV Level Silver Plan,73.80%,0.706839680671692,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",15%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,1,77150,FL,Individual,No,45-3131932,77150FL1100009,HF Silver PPO Select 85 1118,77150FL110,,FLN001,FLS001,FLF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.984,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100009-05,87% AV Level Silver Plan,86.50%,0.842639803886414,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,15%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,1,77150,FL,Individual,No,45-3131932,77150FL1100009,HF Silver PPO Select 85 1118,77150FL110,,FLN001,FLS001,FLF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.984,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100009-06,94% AV Level Silver Plan,93.20%,0.905693709850311,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,15%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,2,77150,FL,Individual,No,45-3131932,77150FL1100002,HF Gold PPO Select 80 1014,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9866,,,0,0,5,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100002-00,Standard Gold Off Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,2,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110003,HF Gold PPO Select 70 5127,77150FL111,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9834,,,0,0,4,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110003-00,Standard Gold Off Exchange Plan,81.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,2,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110003,HF Gold PPO Select 70 5127,77150FL111,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9834,,,0,0,4,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110003-01,Standard Gold On Exchange Plan,81.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,2,77150,FL,Individual,No,45-3131932,77150FL1100002,HF Gold PPO Select 80 1014,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9866,,,0,0,5,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100002-01,Standard Gold On Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,2,77150,FL,Individual,No,45-3131932,77150FL1100002,HF Gold PPO Select 80 1014,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9866,,,0,0,5,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,2,77150,FL,Individual,No,45-3131932,77150FL1100002,HF Gold PPO Select 80 1014,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9866,,,0,0,5,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100002-03,Limited Cost Sharing Plan Variation,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,3,77150,FL,Individual,No,45-3131932,77150FL1100003,HF Gold PPO Select 80 1018,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9868,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100003-00,Standard Gold Off Exchange Plan,78.50%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,600",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,3,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110004,HF Gold PPO Select 50 5146,77150FL111,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9833,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110004-00,Standard Gold Off Exchange Plan,80.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,3,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110004,HF Gold PPO Select 50 5146,77150FL111,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9833,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110004-01,Standard Gold On Exchange Plan,80.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,3,77150,FL,Individual,No,45-3131932,77150FL1100003,HF Gold PPO Select 80 1018,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9868,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100003-01,Standard Gold On Exchange Plan,78.50%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,600",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,3,77150,FL,Individual,No,45-3131932,77150FL1100003,HF Gold PPO Select 80 1018,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9868,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100003-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,3,77150,FL,Individual,No,45-3131932,77150FL1100003,HF Gold PPO Select 80 1018,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9868,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100003-03,Limited Cost Sharing Plan Variation,78.50%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,600",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,4,77150,FL,Individual,No,45-3131932,77150FL1100004,HF Gold PPO Select 80 1022,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9868,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100004-00,Standard Gold Off Exchange Plan,81.60%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,4,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110005,HF Gold PPO Select 50 5162,77150FL111,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9835,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110005-00,Standard Gold Off Exchange Plan,80.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,1,86382,FL,Individual,No,20-8937577,86382FL0010007,Ambetter Balanced Care 3,86382FL001,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0010007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,1,86382,FL,Individual,No,20-8937577,86382FL0010007,Ambetter Balanced Care 3,86382FL001,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0010007-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,14
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,1,86382,FL,Individual,No,20-8937577,86382FL0010007,Ambetter Balanced Care 3,86382FL001,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0010007-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,15
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,1,86382,FL,Individual,No,20-8937577,86382FL0010007,Ambetter Balanced Care 3,86382FL001,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0010007-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,16
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,1,86382,FL,Individual,No,20-8937577,86382FL0010007,Ambetter Balanced Care 3,86382FL001,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0010007-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,17
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,1,86382,FL,Individual,No,20-8937577,86382FL0010002,Ambetter Secure Care 2,86382FL001,,FLN001,FLS001,FLF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0010002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,18
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,1,86382,FL,Individual,No,20-8937577,86382FL0010002,Ambetter Secure Care 2,86382FL001,,FLN001,FLS001,FLF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0010002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,19
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,1,86382,FL,Individual,No,20-8937577,86382FL0010002,Ambetter Secure Care 2,86382FL001,,FLN001,FLS001,FLF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0010002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,20
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,1,86382,FL,Individual,No,20-8937577,86382FL0010002,Ambetter Secure Care 2,86382FL001,,FLN001,FLS001,FLF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0010002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,21
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,2,86382,FL,Individual,No,20-8937577,86382FL0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,86382FL001,,FLN001,FLS001,FLF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0010004-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,2,86382,FL,Individual,No,20-8937577,86382FL0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,86382FL001,,FLN001,FLS001,FLF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0010004-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,2,86382,FL,Individual,No,20-8937577,86382FL0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,86382FL001,,FLN001,FLS001,FLF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0010004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,2,86382,FL,Individual,No,20-8937577,86382FL0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,86382FL001,,FLN001,FLS001,FLF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0010004-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,2,86382,FL,Individual,No,20-8937577,86382FL0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,86382FL001,,FLN001,FLS001,FLF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0010012-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,4,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110005,HF Gold PPO Select 50 5162,77150FL111,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9835,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110005-01,Standard Gold On Exchange Plan,80.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,4,77150,FL,Individual,No,45-3131932,77150FL1100004,HF Gold PPO Select 80 1022,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9868,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100004-01,Standard Gold On Exchange Plan,81.60%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,4,77150,FL,Individual,No,45-3131932,77150FL1100004,HF Gold PPO Select 80 1022,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9868,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100004-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,4,77150,FL,Individual,No,45-3131932,77150FL1100004,HF Gold PPO Select 80 1022,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9868,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100004-03,Limited Cost Sharing Plan Variation,81.60%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100005,HF Gold PPO Select 70 1033,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9862,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100005-00,Standard Gold Off Exchange Plan,78.00%,0.793372571468353,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,"$5,800","$11,600",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110006,HF Gold PPO Select 70 5220,77150FL111,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110006-00,Standard Gold Off Exchange Plan,78.20%,0.79435271024704,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$900,"$1,800",30%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110006,HF Gold PPO Select 70 5220,77150FL111,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9826,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110006-01,Standard Gold On Exchange Plan,78.20%,0.79435271024704,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$900,"$1,800",30%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100005,HF Gold PPO Select 70 1033,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9862,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100005-01,Standard Gold On Exchange Plan,78.00%,0.793372571468353,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,"$5,800","$11,600",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100005,HF Gold PPO Select 70 1033,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9862,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100005-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100005,HF Gold PPO Select 70 1033,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9862,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100005-03,Limited Cost Sharing Plan Variation,78.00%,0.793372571468353,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,"$5,800","$11,600",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100008,HF Silver PPO Select  80 1102,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100008-00,Standard Silver Off Exchange Plan,68.30%,0.698091864585876,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100008,HF Silver PPO Select  80 1102,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100008-01,Standard Silver On Exchange Plan,68.30%,0.698091864585876,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100008,HF Silver PPO Select  80 1102,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100008-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100008,HF Silver PPO Select  80 1102,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100008-03,Limited Cost Sharing Plan Variation,68.30%,0.698091864585876,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100008,HF Silver PPO Select  80 1102,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100008-04,73% AV Level Silver Plan,72.00%,0.729831039905548,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100008,HF Silver PPO Select  80 1102,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100008-05,87% AV Level Silver Plan,86.10%,0.872135043144226,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,700","$25,400",Not Applicable,Not Applicable,$700,"$1,400",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100008,HF Silver PPO Select  80 1102,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100008-06,94% AV Level Silver Plan,93.40%,0.943954944610596,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,$200,$400,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100011,HF Silver PPO Select 70 1166,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100011-00,Standard Silver Off Exchange Plan,68.60%,0.702797472476959,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100011,HF Silver PPO Select 70 1166,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100011-01,Standard Silver On Exchange Plan,68.60%,0.702797472476959,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100011,HF Silver PPO Select 70 1166,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100011-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100011,HF Silver PPO Select 70 1166,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100011-03,Limited Cost Sharing Plan Variation,68.60%,0.702797472476959,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100011,HF Silver PPO Select 70 1166,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9829,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100011-04,73% AV Level Silver Plan,72.40%,0.724774599075317,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$1,200","$2,400",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100013,HF Silver PPO Select 70 1230,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9837,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100013-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100013,HF Silver PPO Select 70 1230,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9837,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100013-03,Limited Cost Sharing Plan Variation,71.10%,0.716611325740814,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$9,200","$18,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100013,HF Silver PPO Select 70 1230,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9837,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100013-04,73% AV Level Silver Plan,73.30%,0.716611325740814,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,300","$2,600",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,5,77150,FL,Individual,No,45-3131932,77150FL1100013,HF Silver PPO Select 70 1230,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9837,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100013-05,87% AV Level Silver Plan,86.20%,0.866145670413971,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$9,200","$18,400",Not Applicable,Not Applicable,$0,$0,30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,3,86382,FL,Individual,No,20-8937577,86382FL0010008,Ambetter Balanced Care 4,86382FL001,,FLN001,FLS001,FLF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0010008-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,10
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,4,86382,FL,Individual,No,20-8937577,86382FL0010014,Ambetter Balanced Care 2,86382FL001,,FLN001,FLS001,FLF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0010014-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,4
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,4,86382,FL,Individual,No,20-8937577,86382FL0010014,Ambetter Balanced Care 2,86382FL001,,FLN001,FLS001,FLF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0010014-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,5
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,4,86382,FL,Individual,No,20-8937577,86382FL0010014,Ambetter Balanced Care 2,86382FL001,,FLN001,FLS001,FLF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0010014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,9,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110011,HF Silver PPO Select 50 5300,77150FL111,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9784,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110011-01,Standard Silver On Exchange Plan,70.40%,0.715611696243286,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,10,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110012,HF Silver PPO Select 90 5309,77150FL111,,FLN001,FLS001,FLF002,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9791,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110012-00,Standard Silver Off Exchange Plan,70.10%,0.688046276569366,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,10,77150,FL,Individual,No,45-3131932,77150FL1100010,HF Silver PPO Select 70 1134,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100010-00,Standard Silver Off Exchange Plan,68.90%,0.70455127954483,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,10,77150,FL,Individual,No,45-3131932,77150FL1100010,HF Silver PPO Select 70 1134,77150FL110,,FLN001,FLS001,FLF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9828,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100010-01,Standard Silver On Exchange Plan,68.90%,0.70455127954483,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,13,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110015,HF Silver PPO Select 70 5343,77150FL111,,FLN001,FLS001,FLF005,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9786,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110015-00,Standard Silver Off Exchange Plan,68.80%,0.681318581104279,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,13,77150,FL,SHOP (Small Group),No,45-3131932,77150FL1110015,HF Silver PPO Select 70 5343,77150FL111,,FLN001,FLS001,FLF005,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9786,,,0,0,0,2015-01-01,,Yes,Emergency and Urgent Care Only,Yes,All covered services subject to copays and coinsurance,No,www.myHFHP.org/MPS_2015,www.myHFHP.org/Premium,www.myHFHP.org/MPS_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1110015-01,Standard Silver On Exchange Plan,68.80%,0.681318581104279,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,15,77150,FL,Individual,No,45-3131932,77150FL1100016,HF Catastrophic PPO Select 1270,77150FL110,,FLN001,FLS001,FLF001,New,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9662,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100016-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,FL,77150,HIOS,8,2015-01-21 09:35:36,15,77150,FL,Individual,No,45-3131932,77150FL1100016,HF Catastrophic PPO Select 1270,77150FL110,,FLN001,FLS001,FLF001,New,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, Pregnancy",,0.9662,,,0,0,3,2015-01-01,,Yes,Emergency and Urgent Care only,Yes,All covered services subject to copays and coinsurances,No,www.myHFHP.org/MPI_2015,https://premiumb.health-first.org/premiumb,www.myHFHP.org/MPI_2015,http://www.myHFHP.org/MP_formulary_2015,77150FL1100016-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,FL,84141,HIOS,2,2014-08-05 13:28:44,1,84141,FL,SHOP (Small Group),Yes,36-0883760,84141FL0040002,EHB High PPO,84141FL004,,FLN001,FLS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.29,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,84141FL0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,5,86382,FL,Individual,No,20-8937577,86382FL0010015,Ambetter Balanced Care 1,86382FL001,,FLN001,FLS001,FLF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0010015-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,8
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,5,86382,FL,Individual,No,20-8937577,86382FL0010015,Ambetter Balanced Care 1,86382FL001,,FLN001,FLS001,FLF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0010015-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,9
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,5,86382,FL,Individual,No,20-8937577,86382FL0010015,Ambetter Balanced Care 1,86382FL001,,FLN001,FLS001,FLF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0010015-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,10
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,6,86382,FL,Individual,No,20-8937577,86382FL0020009,Ambetter Balanced Care 5 + Vision,86382FL002,,FLN001,FLS001,FLF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981519203606625,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/formulary,86382FL0020009-00,Standard Silver Off Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,4
2015,FL,84141,HIOS,2,2014-08-05 13:28:44,1,84141,FL,SHOP (Small Group),Yes,36-0883760,84141FL0040001,EHB Low PPO,84141FL004,,FLN001,FLS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.34,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,84141FL0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,84141,HIOS,2,2014-08-05 13:28:44,1,84141,FL,SHOP (Small Group),Yes,36-0883760,84141FL0030002,EHB High Passive,84141FL003,,FLN001,FLS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$43.28,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,84141FL0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,FL,84141,HIOS,2,2014-08-05 13:28:44,1,84141,FL,SHOP (Small Group),Yes,36-0883760,84141FL0030001,EHB Low Passive,84141FL003,,FLN001,FLS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.10,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,84141FL0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,FL,85019,HIOS,9,2015-01-16 17:32:32,1,85019,FL,SHOP (Small Group),Yes,27-0963551,85019FL0010001,LIBERTY Dental Plan FL Pediatric Low with Adult Option,85019FL001,,FLN001,FLS001,,New,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$11.99,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,,,http://www.libertydentalplan.com/Resources/Documents/LIBERTY_Dental_Plan_Florida_Pediatric_Low_With_Adult_Option.pdf,,85019FL0010001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,85019,HIOS,9,2015-01-16 17:32:32,1,85019,FL,SHOP (Small Group),Yes,27-0963551,85019FL0010001,LIBERTY Dental Plan FL Pediatric Low with Adult Option,85019FL001,,FLN001,FLS001,,New,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$11.99,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,,,http://www.libertydentalplan.com/Resources/Documents/LIBERTY_Dental_Plan_Florida_Pediatric_Low_With_Adult_Option.pdf,,85019FL0010001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,85543,HIOS,3,2014-09-04 03:25:43,1,85543,FL,SHOP (Small Group),Yes,35-0472300,85543FL0010001,Lincoln Dental Connect?,85543FL001,,FLN001,FLS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.89,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,85543FL0010001-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,85543,HIOS,3,2014-09-04 03:25:43,1,85543,FL,SHOP (Small Group),Yes,35-0472300,85543FL0010002,Lincoln Dental Connect?,85543FL001,,FLN001,FLS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.91,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,85543FL0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,85543,HIOS,3,2014-09-04 03:25:43,1,85543,FL,SHOP (Small Group),Yes,35-0472300,85543FL0010003,Lincoln Dental Connect?,85543FL001,,FLN001,FLS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.60,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,85543FL0010003-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,FL,85543,HIOS,3,2014-09-04 03:25:43,1,85543,FL,SHOP (Small Group),Yes,35-0472300,85543FL0010005,Lincoln Dental Connect?,85543FL001,,FLN001,FLS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.65,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,85543FL0010005-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,FL,85543,HIOS,3,2014-09-04 03:25:43,1,85543,FL,SHOP (Small Group),Yes,35-0472300,85543FL0010006,Lincoln Dental Connect?,85543FL001,,FLN001,FLS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.33,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,85543FL0010006-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,FL,85543,HIOS,3,2014-09-04 03:25:43,1,85543,FL,SHOP (Small Group),Yes,35-0472300,85543FL0010007,Lincoln Dental Connect?,85543FL001,,FLN001,FLS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.11,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,85543FL0010007-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,FL,85543,HIOS,3,2014-09-04 03:25:43,2,85543,FL,SHOP (Small Group),Yes,35-0472300,85543FL0010004,Lincoln Dental Connect?,85543FL001,,FLN001,FLS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.58,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,85543FL0010004-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,85543,HIOS,3,2014-09-04 03:25:43,2,85543,FL,SHOP (Small Group),Yes,35-0472300,85543FL0010008,Lincoln Dental Connect?,85543FL001,,FLN001,FLS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.63,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,85543FL0010008-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,1,86382,FL,Individual,No,20-8937577,86382FL0010009,Ambetter Balanced Care 5,86382FL001,,FLN001,FLS001,FLF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/formulary,86382FL0010009-00,Standard Silver Off Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,4
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,1,86382,FL,Individual,No,20-8937577,86382FL0010009,Ambetter Balanced Care 5,86382FL001,,FLN001,FLS001,FLF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/formulary,86382FL0010009-01,Standard Silver On Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,5
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,1,86382,FL,Individual,No,20-8937577,86382FL0010009,Ambetter Balanced Care 5,86382FL001,,FLN001,FLS001,FLF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/formulary,86382FL0010009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,1,86382,FL,Individual,No,20-8937577,86382FL0010009,Ambetter Balanced Care 5,86382FL001,,FLN001,FLS001,FLF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/formulary,86382FL0010009-03,Limited Cost Sharing Plan Variation,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,7
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,1,86382,FL,Individual,No,20-8937577,86382FL0010009,Ambetter Balanced Care 5,86382FL001,,FLN001,FLS001,FLF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/formulary,86382FL0010009-04,73% AV Level Silver Plan,73.24%,0.732411444187164,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$2,920",$350,$0,$80,8
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,1,86382,FL,Individual,No,20-8937577,86382FL0010009,Ambetter Balanced Care 5,86382FL001,,FLN001,FLS001,FLF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/formulary,86382FL0010009-05,87% AV Level Silver Plan,87.97%,0.879661500453949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$410,$0,$150,$600,$520,$0,$80,9
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,1,86382,FL,Individual,No,20-8937577,86382FL0010009,Ambetter Balanced Care 5,86382FL001,,FLN001,FLS001,FLF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/formulary,86382FL0010009-06,94% AV Level Silver Plan,93.34%,0.933413624763489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$120,$0,$150,$0,$450,$0,$80,10
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,1,86382,FL,Individual,No,20-8937577,86382FL0010007,Ambetter Balanced Care 3,86382FL001,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0010007-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,11
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,1,86382,FL,Individual,No,20-8937577,86382FL0010007,Ambetter Balanced Care 3,86382FL001,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0010007-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,12
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,2,86382,FL,Individual,No,20-8937577,86382FL0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,86382FL001,,FLN001,FLS001,FLF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0010012-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,2,86382,FL,Individual,No,20-8937577,86382FL0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,86382FL001,,FLN001,FLS001,FLF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0010012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,2,86382,FL,Individual,No,20-8937577,86382FL0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,86382FL001,,FLN001,FLS001,FLF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0010012-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,2,86382,FL,Individual,No,20-8937577,86382FL0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,86382FL001,,FLN001,FLS001,FLF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0010013-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,2,86382,FL,Individual,No,20-8937577,86382FL0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,86382FL001,,FLN001,FLS001,FLF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0010013-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,2,86382,FL,Individual,No,20-8937577,86382FL0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,86382FL001,,FLN001,FLS001,FLF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0010013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,2,86382,FL,Individual,No,20-8937577,86382FL0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,86382FL001,,FLN001,FLS001,FLF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0010013-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,2,86382,FL,Individual,No,20-8937577,86382FL0010016,Ambetter Essential Care 2,86382FL001,,FLN001,FLS001,FLF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0010016-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,2,86382,FL,Individual,No,20-8937577,86382FL0010016,Ambetter Essential Care 2,86382FL001,,FLN001,FLS001,FLF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0010016-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,2,86382,FL,Individual,No,20-8937577,86382FL0010016,Ambetter Essential Care 2,86382FL001,,FLN001,FLS001,FLF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0010016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,2,86382,FL,Individual,No,20-8937577,86382FL0010016,Ambetter Essential Care 2,86382FL001,,FLN001,FLS001,FLF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0010016-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,4,86382,FL,Individual,No,20-8937577,86382FL0010014,Ambetter Balanced Care 2,86382FL001,,FLN001,FLS001,FLF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0010014-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,7
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,4,86382,FL,Individual,No,20-8937577,86382FL0010014,Ambetter Balanced Care 2,86382FL001,,FLN001,FLS001,FLF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0010014-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,8
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,4,86382,FL,Individual,No,20-8937577,86382FL0010014,Ambetter Balanced Care 2,86382FL001,,FLN001,FLS001,FLF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0010014-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,9
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,4,86382,FL,Individual,No,20-8937577,86382FL0010014,Ambetter Balanced Care 2,86382FL001,,FLN001,FLS001,FLF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0010014-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,10
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,5,86382,FL,Individual,No,20-8937577,86382FL0010015,Ambetter Balanced Care 1,86382FL001,,FLN001,FLS001,FLF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0010015-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,4
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,5,86382,FL,Individual,No,20-8937577,86382FL0010015,Ambetter Balanced Care 1,86382FL001,,FLN001,FLS001,FLF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0010015-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,5
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,5,86382,FL,Individual,No,20-8937577,86382FL0010015,Ambetter Balanced Care 1,86382FL001,,FLN001,FLS001,FLF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0010015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,5,86382,FL,Individual,No,20-8937577,86382FL0010015,Ambetter Balanced Care 1,86382FL001,,FLN001,FLS001,FLF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0010015-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,7
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,6,86382,FL,Individual,No,20-8937577,86382FL0020009,Ambetter Balanced Care 5 + Vision,86382FL002,,FLN001,FLS001,FLF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981519203606625,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/formulary,86382FL0020009-01,Standard Silver On Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,5
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,6,86382,FL,Individual,No,20-8937577,86382FL0020009,Ambetter Balanced Care 5 + Vision,86382FL002,,FLN001,FLS001,FLF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981519203606625,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/formulary,86382FL0020009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,6,86382,FL,Individual,No,20-8937577,86382FL0020009,Ambetter Balanced Care 5 + Vision,86382FL002,,FLN001,FLS001,FLF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981519203606625,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/formulary,86382FL0020009-03,Limited Cost Sharing Plan Variation,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,7
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,6,86382,FL,Individual,No,20-8937577,86382FL0020009,Ambetter Balanced Care 5 + Vision,86382FL002,,FLN001,FLS001,FLF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981519203606625,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/formulary,86382FL0020009-04,73% AV Level Silver Plan,73.24%,0.732411444187164,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$2,920",$350,$0,$80,8
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,6,86382,FL,Individual,No,20-8937577,86382FL0020009,Ambetter Balanced Care 5 + Vision,86382FL002,,FLN001,FLS001,FLF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981519203606625,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/formulary,86382FL0020009-05,87% AV Level Silver Plan,87.97%,0.879661500453949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$410,$0,$150,$600,$520,$0,$80,9
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,6,86382,FL,Individual,No,20-8937577,86382FL0020009,Ambetter Balanced Care 5 + Vision,86382FL002,,FLN001,FLS001,FLF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981519203606625,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/formulary,86382FL0020009-06,94% AV Level Silver Plan,93.34%,0.933413624763489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$120,$0,$150,$0,$450,$0,$80,10
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,6,86382,FL,Individual,No,20-8937577,86382FL0020007,Ambetter Balanced Care 3 + Vision,86382FL002,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981519563496125,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0020007-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,11
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,6,86382,FL,Individual,No,20-8937577,86382FL0020007,Ambetter Balanced Care 3 + Vision,86382FL002,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981519563496125,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0020007-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,12
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,6,86382,FL,Individual,No,20-8937577,86382FL0020007,Ambetter Balanced Care 3 + Vision,86382FL002,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981519563496125,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0020007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,6,86382,FL,Individual,No,20-8937577,86382FL0020007,Ambetter Balanced Care 3 + Vision,86382FL002,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981519563496125,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0020007-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,14
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,6,86382,FL,Individual,No,20-8937577,86382FL0020007,Ambetter Balanced Care 3 + Vision,86382FL002,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981519563496125,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0020007-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,15
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,6,86382,FL,Individual,No,20-8937577,86382FL0020007,Ambetter Balanced Care 3 + Vision,86382FL002,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981519563496125,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0020007-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,16
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,6,86382,FL,Individual,No,20-8937577,86382FL0020007,Ambetter Balanced Care 3 + Vision,86382FL002,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981519563496125,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0020007-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,17
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,6,86382,FL,Individual,No,20-8937577,86382FL0020002,Ambetter Secure Care 2 + Vision,86382FL002,,FLN001,FLS001,FLF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.980452416398081,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0020002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,18
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,6,86382,FL,Individual,No,20-8937577,86382FL0020002,Ambetter Secure Care 2 + Vision,86382FL002,,FLN001,FLS001,FLF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.980452416398081,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0020002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,19
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,6,86382,FL,Individual,No,20-8937577,86382FL0020002,Ambetter Secure Care 2 + Vision,86382FL002,,FLN001,FLS001,FLF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.980452416398081,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0020002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,20
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,6,86382,FL,Individual,No,20-8937577,86382FL0020002,Ambetter Secure Care 2 + Vision,86382FL002,,FLN001,FLS001,FLF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.980452416398081,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0020002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,21
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,7,86382,FL,Individual,No,20-8937577,86382FL0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,86382FL002,,FLN001,FLS001,FLF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.980452437022914,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0020004-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,7,86382,FL,Individual,No,20-8937577,86382FL0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,86382FL002,,FLN001,FLS001,FLF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.980452437022914,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0020004-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,7,86382,FL,Individual,No,20-8937577,86382FL0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,86382FL002,,FLN001,FLS001,FLF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.980452437022914,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0020004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,7,86382,FL,Individual,No,20-8937577,86382FL0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,86382FL002,,FLN001,FLS001,FLF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.980452437022914,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0020004-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,7,86382,FL,Individual,No,20-8937577,86382FL0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,86382FL002,,FLN001,FLS001,FLF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981032466300095,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0020012-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,7,86382,FL,Individual,No,20-8937577,86382FL0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,86382FL002,,FLN001,FLS001,FLF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981032466300095,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0020012-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,7,86382,FL,Individual,No,20-8937577,86382FL0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,86382FL002,,FLN001,FLS001,FLF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981032466300095,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0020012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,7,86382,FL,Individual,No,20-8937577,86382FL0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,86382FL002,,FLN001,FLS001,FLF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981032466300095,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0020012-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,7,86382,FL,Individual,No,20-8937577,86382FL0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,86382FL002,,FLN001,FLS001,FLF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981032545047753,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0020013-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,7,86382,FL,Individual,No,20-8937577,86382FL0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,86382FL002,,FLN001,FLS001,FLF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981032545047753,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0020013-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,7,86382,FL,Individual,No,20-8937577,86382FL0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,86382FL002,,FLN001,FLS001,FLF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981032545047753,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0020013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,7,86382,FL,Individual,No,20-8937577,86382FL0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,86382FL002,,FLN001,FLS001,FLF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981032545047753,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0020013-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,7,86382,FL,Individual,No,20-8937577,86382FL0020016,Ambetter Essential Care 2 + Vision,86382FL002,,FLN001,FLS001,FLF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981032466300095,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0020016-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,7,86382,FL,Individual,No,20-8937577,86382FL0020016,Ambetter Essential Care 2 + Vision,86382FL002,,FLN001,FLS001,FLF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981032466300095,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0020016-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,7,86382,FL,Individual,No,20-8937577,86382FL0020016,Ambetter Essential Care 2 + Vision,86382FL002,,FLN001,FLS001,FLF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981032466300095,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0020016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,7,86382,FL,Individual,No,20-8937577,86382FL0020016,Ambetter Essential Care 2 + Vision,86382FL002,,FLN001,FLS001,FLF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981032466300095,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0020016-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,7,86382,FL,Individual,No,20-8937577,86382FL0020017,Ambetter Essential Care 1 + Vision,86382FL002,,FLN001,FLS001,FLF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981032449596969,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0020017-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,7,86382,FL,Individual,No,20-8937577,86382FL0020017,Ambetter Essential Care 1 + Vision,86382FL002,,FLN001,FLS001,FLF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981032449596969,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0020017-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,7,86382,FL,Individual,No,20-8937577,86382FL0020017,Ambetter Essential Care 1 + Vision,86382FL002,,FLN001,FLS001,FLF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981032449596969,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0020017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,7,86382,FL,Individual,No,20-8937577,86382FL0020017,Ambetter Essential Care 1 + Vision,86382FL002,,FLN001,FLS001,FLF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981032449596969,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0020017-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,8,86382,FL,Individual,No,20-8937577,86382FL0020008,Ambetter Balanced Care 4 + Vision,86382FL002,,FLN001,FLS001,FLF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981245649727735,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0020008-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,4
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,8,86382,FL,Individual,No,20-8937577,86382FL0020008,Ambetter Balanced Care 4 + Vision,86382FL002,,FLN001,FLS001,FLF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981245649727735,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0020008-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,5
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,8,86382,FL,Individual,No,20-8937577,86382FL0020008,Ambetter Balanced Care 4 + Vision,86382FL002,,FLN001,FLS001,FLF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981245649727735,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0020008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,8,86382,FL,Individual,No,20-8937577,86382FL0020008,Ambetter Balanced Care 4 + Vision,86382FL002,,FLN001,FLS001,FLF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981245649727735,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0020008-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,7
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,8,86382,FL,Individual,No,20-8937577,86382FL0020008,Ambetter Balanced Care 4 + Vision,86382FL002,,FLN001,FLS001,FLF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981245649727735,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0020008-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,8
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,8,86382,FL,Individual,No,20-8937577,86382FL0020008,Ambetter Balanced Care 4 + Vision,86382FL002,,FLN001,FLS001,FLF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981245649727735,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0020008-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,9
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,8,86382,FL,Individual,No,20-8937577,86382FL0020008,Ambetter Balanced Care 4 + Vision,86382FL002,,FLN001,FLS001,FLF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981245649727735,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0020008-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,10
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,9,86382,FL,Individual,No,20-8937577,86382FL0020014,Ambetter Balanced Care 2 + Vision,86382FL002,,FLN001,FLS001,FLF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981557291808464,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0020014-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,4
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,9,86382,FL,Individual,No,20-8937577,86382FL0020014,Ambetter Balanced Care 2 + Vision,86382FL002,,FLN001,FLS001,FLF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981557291808464,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0020014-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,5
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,9,86382,FL,Individual,No,20-8937577,86382FL0020014,Ambetter Balanced Care 2 + Vision,86382FL002,,FLN001,FLS001,FLF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981557291808464,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0020014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,9,86382,FL,Individual,No,20-8937577,86382FL0020014,Ambetter Balanced Care 2 + Vision,86382FL002,,FLN001,FLS001,FLF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981557291808464,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0020014-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,7
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,9,86382,FL,Individual,No,20-8937577,86382FL0020014,Ambetter Balanced Care 2 + Vision,86382FL002,,FLN001,FLS001,FLF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981557291808464,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0020014-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,8
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,9,86382,FL,Individual,No,20-8937577,86382FL0020014,Ambetter Balanced Care 2 + Vision,86382FL002,,FLN001,FLS001,FLF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981557291808464,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0020014-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,9
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,9,86382,FL,Individual,No,20-8937577,86382FL0020014,Ambetter Balanced Care 2 + Vision,86382FL002,,FLN001,FLS001,FLF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981557291808464,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0020014-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,10
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,10,86382,FL,Individual,No,20-8937577,86382FL0020015,Ambetter Balanced Care 1 + Vision,86382FL002,,FLN001,FLS001,FLF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981626979478255,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0020015-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,4
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,10,86382,FL,Individual,No,20-8937577,86382FL0020015,Ambetter Balanced Care 1 + Vision,86382FL002,,FLN001,FLS001,FLF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981626979478255,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0020015-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,5
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,10,86382,FL,Individual,No,20-8937577,86382FL0020015,Ambetter Balanced Care 1 + Vision,86382FL002,,FLN001,FLS001,FLF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981626979478255,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0020015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,10,86382,FL,Individual,No,20-8937577,86382FL0020015,Ambetter Balanced Care 1 + Vision,86382FL002,,FLN001,FLS001,FLF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981626979478255,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0020015-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,7
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,10,86382,FL,Individual,No,20-8937577,86382FL0020015,Ambetter Balanced Care 1 + Vision,86382FL002,,FLN001,FLS001,FLF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981626979478255,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0020015-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,8
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,10,86382,FL,Individual,No,20-8937577,86382FL0020015,Ambetter Balanced Care 1 + Vision,86382FL002,,FLN001,FLS001,FLF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981626979478255,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0020015-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,9
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,10,86382,FL,Individual,No,20-8937577,86382FL0020015,Ambetter Balanced Care 1 + Vision,86382FL002,,FLN001,FLS001,FLF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981626979478255,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0020015-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,10
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,11,86382,FL,Individual,No,20-8937577,86382FL0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.950919335229625,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/formulary,86382FL0030009-00,Standard Silver Off Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,4
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,11,86382,FL,Individual,No,20-8937577,86382FL0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.950919335229625,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/formulary,86382FL0030009-01,Standard Silver On Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,5
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,11,86382,FL,Individual,No,20-8937577,86382FL0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.950919335229625,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/formulary,86382FL0030009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,11,86382,FL,Individual,No,20-8937577,86382FL0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.950919335229625,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/formulary,86382FL0030009-03,Limited Cost Sharing Plan Variation,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,7
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,11,86382,FL,Individual,No,20-8937577,86382FL0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.950919335229625,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/formulary,86382FL0030009-04,73% AV Level Silver Plan,73.24%,0.732411444187164,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$2,920",$350,$0,$80,8
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,11,86382,FL,Individual,No,20-8937577,86382FL0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.950919335229625,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/formulary,86382FL0030009-05,87% AV Level Silver Plan,87.97%,0.879661500453949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$410,$0,$150,$600,$520,$0,$80,9
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,11,86382,FL,Individual,No,20-8937577,86382FL0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.950919335229625,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare5,http://ambetter.sunshinehealth.com/formulary,86382FL0030009-06,94% AV Level Silver Plan,93.34%,0.933413624763489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$120,$0,$150,$0,$450,$0,$80,10
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,11,86382,FL,Individual,No,20-8937577,86382FL0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.950919983857349,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0030007-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,11
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,11,86382,FL,Individual,No,20-8937577,86382FL0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.950919983857349,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0030007-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,12
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,11,86382,FL,Individual,No,20-8937577,86382FL0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.950919983857349,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0030007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,11,86382,FL,Individual,No,20-8937577,86382FL0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.950919983857349,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0030007-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,14
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,11,86382,FL,Individual,No,20-8937577,86382FL0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.950919983857349,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0030007-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,15
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,11,86382,FL,Individual,No,20-8937577,86382FL0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.950919983857349,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0030007-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,16
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,11,86382,FL,Individual,No,20-8937577,86382FL0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.950919983857349,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0030007-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,17
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,11,86382,FL,Individual,No,20-8937577,86382FL0030002,Ambetter Secure Care 2 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.948165646083584,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0030002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,18
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,11,86382,FL,Individual,No,20-8937577,86382FL0030002,Ambetter Secure Care 2 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.948165646083584,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0030002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,19
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,11,86382,FL,Individual,No,20-8937577,86382FL0030002,Ambetter Secure Care 2 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.948165646083584,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0030002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,20
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,11,86382,FL,Individual,No,20-8937577,86382FL0030002,Ambetter Secure Care 2 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.948165646083584,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0030002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,21
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,12,86382,FL,Individual,No,20-8937577,86382FL0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF008,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.948165666612176,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0030004-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,12,86382,FL,Individual,No,20-8937577,86382FL0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF008,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.948165666612176,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0030004-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,12,86382,FL,Individual,No,20-8937577,86382FL0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF008,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.948165666612176,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0030004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,12,86382,FL,Individual,No,20-8937577,86382FL0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF008,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.948165666612176,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=SecureCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0030004-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,12,86382,FL,Individual,No,20-8937577,86382FL0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.949668988654942,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0030012-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,12,86382,FL,Individual,No,20-8937577,86382FL0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.949668988654942,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0030012-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,12,86382,FL,Individual,No,20-8937577,86382FL0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.949668988654942,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0030012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,12,86382,FL,Individual,No,20-8937577,86382FL0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.949668988654942,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare3,http://ambetter.sunshinehealth.com/formulary,86382FL0030012-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,12,86382,FL,Individual,No,20-8937577,86382FL0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.949669191991193,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0030013-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,12,86382,FL,Individual,No,20-8937577,86382FL0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.949669191991193,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0030013-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,12,86382,FL,Individual,No,20-8937577,86382FL0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.949669191991193,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0030013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,12,86382,FL,Individual,No,20-8937577,86382FL0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.949669191991193,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0030013-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,12,86382,FL,Individual,No,20-8937577,86382FL0030016,Ambetter Essential Care 2 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.949668988654942,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0030016-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,12,86382,FL,Individual,No,20-8937577,86382FL0030016,Ambetter Essential Care 2 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.949668988654942,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0030016-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,12,86382,FL,Individual,No,20-8937577,86382FL0030016,Ambetter Essential Care 2 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.949668988654942,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0030016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,12,86382,FL,Individual,No,20-8937577,86382FL0030016,Ambetter Essential Care 2 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.949668988654942,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0030016-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,12,86382,FL,Individual,No,20-8937577,86382FL0030017,Ambetter Essential Care 1 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94966894060498,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0030017-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,12,86382,FL,Individual,No,20-8937577,86382FL0030017,Ambetter Essential Care 1 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94966894060498,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0030017-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,12,86382,FL,Individual,No,20-8937577,86382FL0030017,Ambetter Essential Care 1 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94966894060498,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0030017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,12,86382,FL,Individual,No,20-8937577,86382FL0030017,Ambetter Essential Care 1 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94966894060498,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=EssentialCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0030017-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,13,86382,FL,Individual,No,20-8937577,86382FL0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.950217451993224,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0030008-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,4
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,13,86382,FL,Individual,No,20-8937577,86382FL0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.950217451993224,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0030008-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,5
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,13,86382,FL,Individual,No,20-8937577,86382FL0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.950217451993224,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0030008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,13,86382,FL,Individual,No,20-8937577,86382FL0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.950217451993224,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0030008-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,7
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,13,86382,FL,Individual,No,20-8937577,86382FL0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.950217451993224,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0030008-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,8
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,13,86382,FL,Individual,No,20-8937577,86382FL0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.950217451993224,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0030008-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,9
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,13,86382,FL,Individual,No,20-8937577,86382FL0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.950217451993224,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare4,http://ambetter.sunshinehealth.com/formulary,86382FL0030008-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,10
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,14,86382,FL,Individual,No,20-8937577,86382FL0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.951016883387065,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0030014-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,4
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,14,86382,FL,Individual,No,20-8937577,86382FL0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.951016883387065,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0030014-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,5
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,14,86382,FL,Individual,No,20-8937577,86382FL0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.951016883387065,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0030014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,14,86382,FL,Individual,No,20-8937577,86382FL0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.951016883387065,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0030014-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,7
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,14,86382,FL,Individual,No,20-8937577,86382FL0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.951016883387065,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0030014-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,8
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,14,86382,FL,Individual,No,20-8937577,86382FL0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.951016883387065,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0030014-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,9
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,14,86382,FL,Individual,No,20-8937577,86382FL0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.951016883387065,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare2,http://ambetter.sunshinehealth.com/formulary,86382FL0030014-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,10
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,15,86382,FL,Individual,No,20-8937577,86382FL0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.951194597161325,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0030015-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,4
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,15,86382,FL,Individual,No,20-8937577,86382FL0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.951194597161325,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0030015-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,5
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,15,86382,FL,Individual,No,20-8937577,86382FL0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.951194597161325,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0030015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,15,86382,FL,Individual,No,20-8937577,86382FL0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.951194597161325,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0030015-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,7
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,15,86382,FL,Individual,No,20-8937577,86382FL0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.951194597161325,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0030015-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,8
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,15,86382,FL,Individual,No,20-8937577,86382FL0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.951194597161325,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0030015-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,9
2015,FL,86382,HIOS,6,2015-02-19 06:21:02,15,86382,FL,Individual,No,20-8937577,86382FL0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,86382FL003,,FLN001,FLS001,FLF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.951194597161325,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/payments,http://ambetter.sunshinehealth.com/brochures/?plan=BalancedCare1,http://ambetter.sunshinehealth.com/formulary,86382FL0030015-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,10
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,1,97725,FL,Individual,Yes,94-2761537,97725FL0010002,Delta Dental PPO Pediatric Preferred Plan,97725FL001,,FLN001,FLS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$27.90,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/fl/97725fl0010002-15,,97725FL0010002-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,1,97725,FL,Individual,Yes,94-2761537,97725FL0010002,Delta Dental PPO Pediatric Preferred Plan,97725FL001,,FLN001,FLS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$27.90,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/fl/97725fl0010002-15,,97725FL0010002-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,1,97725,FL,Individual,Yes,94-2761537,97725FL0010001,Delta Dental PPO Pediatric Basic Plan,97725FL001,,FLN001,FLS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.85,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/fl/97725fl0010001-15,,97725FL0010001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,1,97725,FL,Individual,Yes,94-2761537,97725FL0010001,Delta Dental PPO Pediatric Basic Plan,97725FL001,,FLN001,FLS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.85,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/fl/97725fl0010001-15,,97725FL0010001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,2,97725,FL,Individual,Yes,94-2761537,97725FL0010004,Delta Dental PPO Preferred Plan for Families,97725FL001,,FLN001,FLS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.90,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/fl/97725fl0010004-15,,97725FL0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,2,97725,FL,SHOP (Small Group),Yes,94-2761537,97725FL0020004,Delta Dental PPO Preferred Plan for Families for Small Businesses,97725FL002,,FLN001,FLS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.90,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/fl/97725fl0020004-15,,97725FL0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,2,97725,FL,SHOP (Small Group),Yes,94-2761537,97725FL0020004,Delta Dental PPO Preferred Plan for Families for Small Businesses,97725FL002,,FLN001,FLS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.90,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/fl/97725fl0020004-15,,97725FL0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,2,97725,FL,Individual,Yes,94-2761537,97725FL0010004,Delta Dental PPO Preferred Plan for Families,97725FL001,,FLN001,FLS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.90,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/fl/97725fl0010004-15,,97725FL0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,3,97725,FL,Individual,Yes,94-2761537,97725FL0010006,Delta Dental PPO Basic Plan for Families,97725FL001,,FLN001,FLS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.85,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/fl/97725fl0010006-15,,97725FL0010006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,3,97725,FL,SHOP (Small Group),Yes,94-2761537,97725FL0020006,Delta Dental PPO Basic Plan for Families for Small Businesses,97725FL002,,FLN001,FLS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.32,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/fl/97725fl0020006-15,,97725FL0020006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,3,97725,FL,SHOP (Small Group),Yes,94-2761537,97725FL0020006,Delta Dental PPO Basic Plan for Families for Small Businesses,97725FL002,,FLN001,FLS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.32,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/fl/97725fl0020006-15,,97725FL0020006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,3,97725,FL,Individual,Yes,94-2761537,97725FL0010006,Delta Dental PPO Basic Plan for Families,97725FL001,,FLN001,FLS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.85,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/fl/97725fl0010006-15,,97725FL0010006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,4,97725,FL,Individual,Yes,94-2761537,97725FL0030002,DeltaCare USA Pediatric Preferred Plan,97725FL003,,FLN002,FLS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Child-Only,,,,$16.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/fl/97725fl0030002-15,,97725FL0030002-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,4,97725,FL,Individual,Yes,94-2761537,97725FL0030002,DeltaCare USA Pediatric Preferred Plan,97725FL003,,FLN002,FLS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Child-Only,,,,$16.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/fl/97725fl0030002-15,,97725FL0030002-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,4,97725,FL,Individual,Yes,94-2761537,97725FL0030001,DeltaCare USA Pediatric Basic Plan,97725FL003,,FLN002,FLS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$14.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/fl/97725fl0030001-15,,97725FL0030001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,4,97725,FL,Individual,Yes,94-2761537,97725FL0030001,DeltaCare USA Pediatric Basic Plan,97725FL003,,FLN002,FLS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$14.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/fl/97725fl0030001-15,,97725FL0030001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,5,97725,FL,Individual,Yes,94-2761537,97725FL0030004,DeltaCare USA Preferred Plan for Families,97725FL003,,FLN002,FLS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/fl/97725fl0030004-15,,97725FL0030004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,5,97725,FL,SHOP (Small Group),Yes,94-2761537,97725FL0040004,DeltaCare USA Preferred Plan for Families for Small Businesses,97725FL004,,FLN002,FLS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,,deltadentalins.com/hcx/fl/97725fl0040004-15,,97725FL0040004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,5,97725,FL,SHOP (Small Group),Yes,94-2761537,97725FL0040004,DeltaCare USA Preferred Plan for Families for Small Businesses,97725FL004,,FLN002,FLS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,,deltadentalins.com/hcx/fl/97725fl0040004-15,,97725FL0040004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,5,97725,FL,Individual,Yes,94-2761537,97725FL0030004,DeltaCare USA Preferred Plan for Families,97725FL003,,FLN002,FLS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/fl/97725fl0030004-15,,97725FL0030004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,6,97725,FL,Individual,Yes,94-2761537,97725FL0030006,DeltaCare USA Basic Plan for Families,97725FL003,,FLN002,FLS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$14.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/fl/97725fl0030006-15,,97725FL0030006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,6,97725,FL,SHOP (Small Group),Yes,94-2761537,97725FL0040006,DeltaCare USA Basic Plan for Families for Small Businesses,97725FL004,,FLN002,FLS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$14.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,,deltadentalins.com/hcx/fl/97725fl0040006-15,,97725FL0040006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,6,97725,FL,SHOP (Small Group),Yes,94-2761537,97725FL0040006,DeltaCare USA Basic Plan for Families for Small Businesses,97725FL004,,FLN002,FLS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$14.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,,deltadentalins.com/hcx/fl/97725fl0040006-15,,97725FL0040006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,97725,HIOS,8,2014-11-14 05:23:27,6,97725,FL,Individual,Yes,94-2761537,97725FL0030006,DeltaCare USA Basic Plan for Families,97725FL003,,FLN002,FLS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$14.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/fl/97725fl0030006-15,,97725FL0030006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200003,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS003,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,38
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200003,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS003,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200003-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200005,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS005,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200005-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200005,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS005,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200005-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200009,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS001,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,30
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200009,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS001,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200009-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200010,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS002,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200010-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200010,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS002,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,37
2015,FL,98534,HIOS,3,2014-08-28 04:23:13,1,98534,FL,SHOP (Small Group),Yes,13-5581829,98534FL0240001,Family Basic Dental Plan (Low),98534FL024,,FLN003,FLS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$18.47,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48035,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48034,,98534FL0240001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,98534,HIOS,3,2014-08-28 04:23:13,1,98534,FL,SHOP (Small Group),Yes,13-5581829,98534FL0240001,Family Basic Dental Plan (Low),98534FL024,,FLN003,FLS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$18.47,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48035,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48034,,98534FL0240001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,98534,HIOS,3,2014-08-28 04:23:13,2,98534,FL,SHOP (Small Group),Yes,13-5581829,98534FL0250001,Family Enhanced Dental Plan (High),98534FL025,,FLN004,FLS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$23.06,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49072,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49071,,98534FL0250001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,98534,HIOS,3,2014-08-28 04:23:13,2,98534,FL,SHOP (Small Group),Yes,13-5581829,98534FL0250001,Family Enhanced Dental Plan (High),98534FL025,,FLN004,FLS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$23.06,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49072,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49071,,98534FL0250001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,99787,HIOS,9,2014-11-14 05:23:27,1,99787,FL,Individual,Yes,75-1233841,99787FL0010001,Dentegra Dental PPO Pediatric Basic Plan,99787FL001,,FLN001,FLS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$22.24,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/fl/99787fl0010001-15,,99787FL0010001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,99787,HIOS,9,2014-11-14 05:23:27,1,99787,FL,Individual,Yes,75-1233841,99787FL0010001,Dentegra Dental PPO Pediatric Basic Plan,99787FL001,,FLN001,FLS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$22.24,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/fl/99787fl0010001-15,,99787FL0010001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,99787,HIOS,9,2014-11-14 05:23:27,2,99787,FL,Individual,Yes,75-1233841,99787FL0010004,Dentegra Dental PPO Family Preferred Plan,99787FL001,,FLN001,FLS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.27,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/fl/99787fl0010004-15,,99787FL0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,99787,HIOS,9,2014-11-14 05:23:27,2,99787,FL,SHOP (Small Group),Yes,75-1233841,99787FL0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,99787FL002,,FLN001,FLS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/fl/99787fl0020004-15,,99787FL0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,99787,HIOS,9,2014-11-14 05:23:27,2,99787,FL,SHOP (Small Group),Yes,75-1233841,99787FL0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,99787FL002,,FLN001,FLS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/fl/99787fl0020004-15,,99787FL0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,99787,HIOS,9,2014-11-14 05:23:27,2,99787,FL,Individual,Yes,75-1233841,99787FL0010004,Dentegra Dental PPO Family Preferred Plan,99787FL001,,FLN001,FLS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.27,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/fl/99787fl0010004-15,,99787FL0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,99787,HIOS,9,2014-11-14 05:23:27,3,99787,FL,Individual,Yes,75-1233841,99787FL0010006,Dentegra Dental PPO Family Basic Plan,99787FL001,,FLN001,FLS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.24,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/fl/99787fl0010006-15,,99787FL0010006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,99787,HIOS,9,2014-11-14 05:23:27,3,99787,FL,SHOP (Small Group),Yes,75-1233841,99787FL0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,99787FL002,,FLN001,FLS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.41,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/fl/99787fl0020006-15,,99787FL0020006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,FL,99787,HIOS,9,2014-11-14 05:23:27,3,99787,FL,SHOP (Small Group),Yes,75-1233841,99787FL0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,99787FL002,,FLN001,FLS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.41,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/fl/99787fl0020006-15,,99787FL0020006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,FL,99787,HIOS,9,2014-11-14 05:23:27,3,99787,FL,Individual,Yes,75-1233841,99787FL0010006,Dentegra Dental PPO Family Basic Plan,99787FL001,,FLN001,FLS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.24,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/fl/99787fl0010006-15,,99787FL0010006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,17382,HIOS,4,2014-09-03 04:28:59,1,17382,GA,SHOP (Small Group),Yes,57-0523959,17382GA0010001,Group Pediatric Dental EHB Rider,17382GA001,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$32.67,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,17382GA0010001-00,Standard High Off Exchange Plan,84.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,17382,HIOS,4,2014-09-03 04:28:59,1,17382,GA,SHOP (Small Group),Yes,57-0523959,17382GA0010002,Group Pediatric Dental EHB Rider,17382GA001,,GAN001,GAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.73,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,17382GA0010002-00,Standard Low Off Exchange Plan,69.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,19419,HIOS,2,2014-08-06 08:27:55,1,19419,GA,SHOP (Small Group),Yes,44-0308260,19419GA0010001,KCL EHB Low PPO,19419GA001,,GAN001,GAS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$43.55,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,19419GA0010001-00,Standard Low Off Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,19419,HIOS,2,2014-08-06 08:27:55,1,19419,GA,SHOP (Small Group),Yes,44-0308260,19419GA0010003,KCL EHB Low MAC,19419GA001,,GAN001,GAS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$33.35,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,19419GA0010003-00,Standard Low Off Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200011,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS003,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,44
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200011,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS003,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200011-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200011,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS003,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200011-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,42
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200011,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS003,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200011-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,43
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200004,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS004,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200004-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200004,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS004,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200004-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200004,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS004,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,42
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200004,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS004,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200004-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,43
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200011,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS003,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200011-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200012,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS004,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200012-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200006,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS006,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200006-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200006,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS006,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200006-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200009,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS001,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200009-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200009,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS001,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200009-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200009,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS001,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200009-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200010,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS002,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200010-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200011,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS003,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200011-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,46
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200011,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS003,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200011-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,47
2015,GA,19419,HIOS,2,2014-08-06 08:27:55,1,19419,GA,SHOP (Small Group),Yes,44-0308260,19419GA0010005,KCL Fam Low PPO,19419GA001,,GAN001,GAS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$43.55,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,19419GA0010005-00,Standard Low Off Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,GA,19419,HIOS,2,2014-08-06 08:27:55,1,19419,GA,SHOP (Small Group),Yes,44-0308260,19419GA0010007,KCL Fam Low MAC,19419GA001,,GAN001,GAS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$33.35,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,19419GA0010007-00,Standard Low Off Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,GA,19419,HIOS,2,2014-08-06 08:27:55,2,19419,GA,SHOP (Small Group),Yes,44-0308260,19419GA0010002,KCL EHB High PPO,19419GA001,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$52.57,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,19419GA0010002-00,Standard High Off Exchange Plan,85.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,19419,HIOS,2,2014-08-06 08:27:55,2,19419,GA,SHOP (Small Group),Yes,44-0308260,19419GA0010004,KCL EHB High MAC,19419GA001,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$41.22,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,19419GA0010004-00,Standard High Off Exchange Plan,85.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,19419,HIOS,2,2014-08-06 08:27:55,2,19419,GA,SHOP (Small Group),Yes,44-0308260,19419GA0010006,KCL Fam High PPO,19419GA001,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$52.57,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,19419GA0010006-00,Standard High Off Exchange Plan,85.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,GA,19419,HIOS,2,2014-08-06 08:27:55,2,19419,GA,SHOP (Small Group),Yes,44-0308260,19419GA0010008,KCL Fam High MAC,19419GA001,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$41.22,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,19419GA0010008-00,Standard High Off Exchange Plan,85.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200001,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS001,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200001-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200001,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS001,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200001-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200001,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS001,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,30
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200001,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS001,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200001-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200002,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS002,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200002-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200002,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS002,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200002-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200002,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS002,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,34
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200002,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS002,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200002-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200003,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS003,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200003-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200003,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS003,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200003-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200005,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS005,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,46
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200005,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS005,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200005-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,47
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200015,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS007,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200015-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,72
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200015,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS007,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200015-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,73
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200015,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS007,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200015-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,74
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200015,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS007,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200015-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,75
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200015,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS007,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200015-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,76
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200016,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS008,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200016-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,77
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200027,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS003,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200027-01,Standard Silver On Exchange Plan,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,43
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200027,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS003,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200027-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,44
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200038,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS006,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200038-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200038,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS006,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200038-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,50
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200030,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS006,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200030-01,Standard Silver On Exchange Plan,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,64
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200030,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS006,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200030-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,65
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200047,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS007,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200047-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,54
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,4,45495,GA,Individual,No,20-3174593,45495GA0010014,Ambetter Balanced Care 2,45495GA001,,GAN001,GAS001,GAF008,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0010014-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,9
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200012,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS004,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200012-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,52
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200012,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS004,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200012-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,53
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200012,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS004,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200012-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,54
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200012,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS004,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200012-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,55
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200013,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS005,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200013-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200013,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS005,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200013-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,57
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200013,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS005,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,58
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200013,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS005,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200013-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,59
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200006,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS006,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,50
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200006,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS006,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200006-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,51
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200007,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS007,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200007-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,52
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200007,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS007,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200007-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,53
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200007,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS007,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,54
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200007,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS007,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200007-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,55
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200008,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS008,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200008-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200008,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS008,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200008-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,57
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200008,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS008,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,58
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,1,20544,GA,Individual,No,39-0658730,20544GA0200008,Assurant Health Bronze Plan 001,20544GA020,,GAN001,GAS008,GAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200008-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,59
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200009,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS001,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200009-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200009,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS001,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200009-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200025,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS001,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200025-01,Standard Silver On Exchange Plan,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200025,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS001,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200025-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,30
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200025,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS001,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200025-03,Limited Cost Sharing Plan Variation,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200025,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS001,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200025-04,73% AV Level Silver Plan,,0.729618310928345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200025,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS001,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200025-05,87% AV Level Silver Plan,,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200025,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS001,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200025-06,94% AV Level Silver Plan,,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200010,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS002,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200010-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200010,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS002,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200010-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200010,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS002,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200010-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200010,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS002,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200010-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200012,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS004,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200012-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,50
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200012,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS004,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,51
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200013,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS005,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200013-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,60
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200013,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS005,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200013-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,61
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200013,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS005,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200013-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,62
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200014,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS006,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200014-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,63
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200014,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS006,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200014-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,64
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200014,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS006,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,65
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200014,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS006,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200014-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,66
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200014,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS006,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200014-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,67
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200014,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS006,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200014-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,68
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200014,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS006,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200014-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,69
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200015,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS007,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200015-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,70
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200015,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS007,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200015-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,71
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200016,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS008,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200016-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,78
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200016,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS008,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,79
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200016,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS008,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200016-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,80
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200016,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS008,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200016-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,81
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200016,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS008,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200016-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,82
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,2,20544,GA,Individual,No,39-0658730,20544GA0200016,Assurant Health Silver Plan 001,20544GA020,,GAN001,GAS008,GAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200016-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,83
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200019,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS003,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200019-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200019,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS003,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200019-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200019,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS003,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200019-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,38
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200019,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS003,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200019-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200020,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS004,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200020-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200020,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS004,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200020-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200020,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS004,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200020-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,42
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200020,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS004,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200020-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,43
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200017,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS001,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200017-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200017,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS001,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200017-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200017,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS001,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200017-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,30
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200017,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS001,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200017-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200018,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS002,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200018-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200018,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS002,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200018-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200018,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS002,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200018-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,34
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200018,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS002,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200018-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200021,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS005,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200021-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200021,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS005,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200021-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200021,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS005,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200021-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,46
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200021,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS005,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200021-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,47
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200022,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS006,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200022-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200022,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS006,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200022-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200022,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS006,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200022-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,50
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200022,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS006,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200022-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,51
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200027,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS003,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200027-03,Limited Cost Sharing Plan Variation,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200027,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS003,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200027-04,73% AV Level Silver Plan,,0.729618310928345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,46
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200027,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS003,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200027-05,87% AV Level Silver Plan,,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,47
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200027,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS003,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200027-06,94% AV Level Silver Plan,,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200028,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS004,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200028-00,Standard Silver Off Exchange Plan,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200028,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS004,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200028-01,Standard Silver On Exchange Plan,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,50
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200023,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS007,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200023-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,52
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200023,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS007,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200023-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,53
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200023,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS007,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200023-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,54
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200023,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS007,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200023-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,55
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200024,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS008,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200024-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200024,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS008,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200024-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,57
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200024,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS008,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200024-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,58
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,7,20544,GA,Individual,No,39-0658730,20544GA0200024,Assurant Health Bronze Plan 002,20544GA020,,GAN001,GAS008,GAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,20544GA0200024-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,59
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200026,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS002,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200026-06,94% AV Level Silver Plan,,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200027,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS003,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200027-00,Standard Silver Off Exchange Plan,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,42
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200025,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS001,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200025-00,Standard Silver Off Exchange Plan,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200026,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS002,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200026-00,Standard Silver Off Exchange Plan,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200026,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS002,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200026-01,Standard Silver On Exchange Plan,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200041,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS001,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200041-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200034,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS002,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200034-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200034,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS002,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200034-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,34
2015,GA,31291,HIOS,3,2014-08-08 08:53:29,2,31291,GA,Individual,Yes,72-0977315,31291GA0020001,AlwaysCare All-Star Family Dental Plan,31291GA002,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.64,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,31291GA0020001-00,Standard High Off Exchange Plan,86.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,31291,HIOS,3,2014-08-08 08:53:29,2,31291,GA,Individual,Yes,72-0977315,31291GA0020002,AlwaysCare All-Star Family Dental Plan,31291GA002,,GAN001,GAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.71,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,31291GA0020002-00,Standard Low Off Exchange Plan,71.27%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,31291,HIOS,3,2014-08-08 08:53:29,2,31291,GA,SHOP (Small Group),Yes,72-0977315,31291GA0030002,AlwaysCare Small Group Dental - Adults,31291GA003,,GAN001,GAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.73,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,31291GA0030002-00,Standard Low Off Exchange Plan,71.27%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,2,45495,GA,Individual,No,20-3174593,45495GA0010016,Ambetter Essential Care 2,45495GA001,,GAN001,GAS001,GAF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0010016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,2,45495,GA,Individual,No,20-3174593,45495GA0010016,Ambetter Essential Care 2,45495GA001,,GAN001,GAS001,GAF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0010016-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,2,45495,GA,Individual,No,20-3174593,45495GA0010017,Ambetter Essential Care 1,45495GA001,,GAN001,GAS001,GAF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0010017-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,2,45495,GA,Individual,No,20-3174593,45495GA0010017,Ambetter Essential Care 1,45495GA001,,GAN001,GAS001,GAF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0010017-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200041,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS001,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200041-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200041,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS001,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200041-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,30
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200041,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS001,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200041-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200042,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS002,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200042-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,1,43802,GA,Individual,No,58-1653544,43802GA0040005,UnitedHealthcare Silver Compass HSA 3600,43802GA004,,GAN001,GAS001,GAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040005-00,Standard Silver Off Exchange Plan,68.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,1,43802,GA,Individual,No,58-1653544,43802GA0040005,UnitedHealthcare Silver Compass HSA 3600,43802GA004,,GAN001,GAS001,GAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040005-01,Standard Silver On Exchange Plan,68.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,1,43802,GA,Individual,No,58-1653544,43802GA0040005,UnitedHealthcare Silver Compass HSA 3600,43802GA004,,GAN001,GAS001,GAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040005-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,1,43802,GA,Individual,No,58-1653544,43802GA0040005,UnitedHealthcare Silver Compass HSA 3600,43802GA004,,GAN001,GAS001,GAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040005-03,Limited Cost Sharing Plan Variation,68.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,1,43802,GA,Individual,No,58-1653544,43802GA0040005,UnitedHealthcare Silver Compass HSA 3600,43802GA004,,GAN001,GAS001,GAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040005-04,73% AV Level Silver Plan,73.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,1,43802,GA,Individual,No,58-1653544,43802GA0040005,UnitedHealthcare Silver Compass HSA 3600,43802GA004,,GAN001,GAS001,GAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040005-05,87% AV Level Silver Plan,87.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,1,43802,GA,Individual,No,58-1653544,43802GA0040005,UnitedHealthcare Silver Compass HSA 3600,43802GA004,,GAN001,GAS001,GAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040005-06,94% AV Level Silver Plan,94.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,1,43802,GA,Individual,No,58-1653544,43802GA0040009,UnitedHealthcare Bronze Compass HSA 5000,43802GA004,,GAN001,GAS001,GAF003,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040009-00,Standard Bronze Off Exchange Plan,60.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,1,43802,GA,Individual,No,58-1653544,43802GA0040009,UnitedHealthcare Bronze Compass HSA 5000,43802GA004,,GAN001,GAS001,GAF003,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040009-01,Standard Bronze On Exchange Plan,60.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,1,43802,GA,Individual,No,58-1653544,43802GA0040009,UnitedHealthcare Bronze Compass HSA 5000,43802GA004,,GAN001,GAS001,GAF003,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040009-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,17
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,1,43802,GA,Individual,No,58-1653544,43802GA0040009,UnitedHealthcare Bronze Compass HSA 5000,43802GA004,,GAN001,GAS001,GAF003,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040009-03,Limited Cost Sharing Plan Variation,60.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200026,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS002,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200026-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,37
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200026,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS002,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200026-03,Limited Cost Sharing Plan Variation,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200026,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS002,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200026-04,73% AV Level Silver Plan,,0.729618310928345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200026,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS002,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200026-05,87% AV Level Silver Plan,,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200028,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS004,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200028-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,51
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200028,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS004,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200028-03,Limited Cost Sharing Plan Variation,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,52
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200028,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS004,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200028-04,73% AV Level Silver Plan,,0.729618310928345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,53
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200028,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS004,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200028-05,87% AV Level Silver Plan,,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,54
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200028,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS004,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200028-06,94% AV Level Silver Plan,,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,55
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200029,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS005,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200029-00,Standard Silver Off Exchange Plan,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200029,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS005,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200029-01,Standard Silver On Exchange Plan,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,57
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200029,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS005,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200029-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,58
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,6,43802,GA,Individual,No,58-1653544,43802GA0040004,UnitedHealthcare Silver Compass 2000,43802GA004,,GAN001,GAS001,GAF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040004-00,Standard Silver Off Exchange Plan,70.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,6,43802,GA,Individual,No,58-1653544,43802GA0040004,UnitedHealthcare Silver Compass 2000,43802GA004,,GAN001,GAS001,GAF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040004-01,Standard Silver On Exchange Plan,70.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,6,43802,GA,Individual,No,58-1653544,43802GA0040004,UnitedHealthcare Silver Compass 2000,43802GA004,,GAN001,GAS001,GAF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040004-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,6,43802,GA,Individual,No,58-1653544,43802GA0040004,UnitedHealthcare Silver Compass 2000,43802GA004,,GAN001,GAS001,GAF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040004-03,Limited Cost Sharing Plan Variation,70.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200029,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS005,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200029-03,Limited Cost Sharing Plan Variation,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,59
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200029,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS005,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200029-04,73% AV Level Silver Plan,,0.729618310928345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,60
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200029,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS005,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200029-05,87% AV Level Silver Plan,,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,61
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200029,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS005,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200029-06,94% AV Level Silver Plan,,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,62
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200030,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS006,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200030-00,Standard Silver Off Exchange Plan,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,63
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200030,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS006,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200030-03,Limited Cost Sharing Plan Variation,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,66
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200030,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS006,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200030-04,73% AV Level Silver Plan,,0.729618310928345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,67
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200030,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS006,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200030-05,87% AV Level Silver Plan,,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,68
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200030,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS006,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200030-06,94% AV Level Silver Plan,,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,69
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200031,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS007,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200031-00,Standard Silver Off Exchange Plan,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,70
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200031,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS007,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200031-01,Standard Silver On Exchange Plan,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,71
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200031,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS007,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200031-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,72
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200031,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS007,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200031-03,Limited Cost Sharing Plan Variation,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,73
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200031,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS007,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200031-04,73% AV Level Silver Plan,,0.729618310928345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,74
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200031,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS007,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200031-05,87% AV Level Silver Plan,,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,75
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200031,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS007,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200031-06,94% AV Level Silver Plan,,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,76
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200032,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS008,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200032-00,Standard Silver Off Exchange Plan,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,77
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200032,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS008,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200032-01,Standard Silver On Exchange Plan,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,78
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200032,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS008,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200032-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,79
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200032,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS008,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200032-03,Limited Cost Sharing Plan Variation,,0.707189202308655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,80
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200032,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS008,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200032-04,73% AV Level Silver Plan,,0.729618310928345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,81
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200032,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS008,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200032-05,87% AV Level Silver Plan,,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,82
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,9,20544,GA,Individual,No,39-0658730,20544GA0200032,Assurant Health Silver Plan 002,20544GA020,,GAN001,GAS008,GAF006,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200032-06,94% AV Level Silver Plan,,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,83
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200033,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS001,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200033-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200033,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS001,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200033-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200033,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS001,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200033-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,30
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200033,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS001,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200033-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200034,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS002,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200034-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200034,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS002,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200034-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200035,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS003,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200035-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200035,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS003,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200035-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200035,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS003,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200035-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,38
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200035,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS003,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200035-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200036,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS004,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200036-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200036,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS004,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200036-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200036,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS004,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200036-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,42
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200036,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS004,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200036-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,43
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200037,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS005,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200037-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200037,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS005,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200037-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200037,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS005,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200037-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,46
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200037,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS005,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200037-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,47
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200038,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS006,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200038-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200038,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS006,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200038-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,51
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200039,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS007,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200039-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,52
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200039,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS007,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200039-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,53
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200039,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS007,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200039-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,54
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200039,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS007,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200039-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,55
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200040,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS008,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200040-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200046,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS006,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200046-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,51
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200047,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS007,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200047-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,52
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200047,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS007,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200047-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,53
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,4,45495,GA,Individual,No,20-3174593,45495GA0010014,Ambetter Balanced Care 2,45495GA001,,GAN001,GAS001,GAF008,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0010014-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,10
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200040,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS008,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200040-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,57
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200040,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS008,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200040-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,58
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,11,20544,GA,Individual,No,39-0658730,20544GA0200040,Assurant Health Gold Plan 002,20544GA020,,GAN001,GAS008,GAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200040-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,59
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,3,45495,GA,Individual,No,20-3174593,45495GA0010008,Ambetter Balanced Care 4,45495GA001,,GAN001,GAS001,GAF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0010008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,$0,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,3,45495,GA,Individual,No,20-3174593,45495GA0010008,Ambetter Balanced Care 4,45495GA001,,GAN001,GAS001,GAF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0010008-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,7
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,3,45495,GA,Individual,No,20-3174593,45495GA0010008,Ambetter Balanced Care 4,45495GA001,,GAN001,GAS001,GAF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0010008-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,8
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,3,45495,GA,Individual,No,20-3174593,45495GA0010008,Ambetter Balanced Care 4,45495GA001,,GAN001,GAS001,GAF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0010008-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,9
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,3,45495,GA,Individual,No,20-3174593,45495GA0010008,Ambetter Balanced Care 4,45495GA001,,GAN001,GAS001,GAF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0010008-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,10
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,4,45495,GA,Individual,No,20-3174593,45495GA0010014,Ambetter Balanced Care 2,45495GA001,,GAN001,GAS001,GAF008,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0010014-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,4
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,4,45495,GA,Individual,No,20-3174593,45495GA0010014,Ambetter Balanced Care 2,45495GA001,,GAN001,GAS001,GAF008,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0010014-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,5
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,4,45495,GA,Individual,No,20-3174593,45495GA0010014,Ambetter Balanced Care 2,45495GA001,,GAN001,GAS001,GAF008,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0010014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,4,45495,GA,Individual,No,20-3174593,45495GA0010014,Ambetter Balanced Care 2,45495GA001,,GAN001,GAS001,GAF008,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0010014-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,7
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,4,45495,GA,Individual,No,20-3174593,45495GA0010014,Ambetter Balanced Care 2,45495GA001,,GAN001,GAS001,GAF008,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0010014-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,8
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,5,45495,GA,Individual,No,20-3174593,45495GA0010015,Ambetter Balanced Care 1,45495GA001,,GAN001,GAS001,GAF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0010015-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,4
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,5,45495,GA,Individual,No,20-3174593,45495GA0010015,Ambetter Balanced Care 1,45495GA001,,GAN001,GAS001,GAF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0010015-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,5
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200048,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS008,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200048-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,59
2015,GA,22500,HIOS,10,2015-01-16 17:32:32,1,22500,GA,SHOP (Small Group),Yes,36-3757528,22500GA0030001,TruAssure Dental Small Group Basic Plan,22500GA003,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$44.90,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=GA,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=GA,,22500GA0030001-00,Standard High Off Exchange Plan,83.30%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,22500,HIOS,10,2015-01-16 17:32:32,1,22500,GA,Individual,Yes,36-3757528,22500GA0010001,TruAssure Dental Basic Plan,22500GA001,,GAN001,GAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.67,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All covered Benefits,Yes,https://www.truassure.com/plan-information2?state=GA,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=GA,,22500GA0010001-00,Standard Low Off Exchange Plan,68.10%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$115,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,22500,HIOS,10,2015-01-16 17:32:32,1,22500,GA,Individual,Yes,36-3757528,22500GA0010001,TruAssure Dental Basic Plan,22500GA001,,GAN001,GAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.67,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All covered Benefits,Yes,https://www.truassure.com/plan-information2?state=GA,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=GA,,22500GA0010001-01,Standard Low On Exchange Plan,68.10%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$115,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,22500,HIOS,10,2015-01-16 17:32:32,1,22500,GA,SHOP (Small Group),Yes,36-3757528,22500GA0040001,TruAssure Dental Small Group Preferred Plan,22500GA004,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$44.90,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=GA,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=GA,,22500GA0040001-00,Standard High Off Exchange Plan,83.30%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,22500,HIOS,10,2015-01-16 17:32:32,2,22500,GA,Individual,Yes,36-3757528,22500GA0020001,TruAssure Dental Preferred Plan,22500GA002,,GAN001,GAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$42.71,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=GA,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=GA,,22500GA0020001-00,Standard High Off Exchange Plan,83.20%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$35,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,22500,HIOS,10,2015-01-16 17:32:32,2,22500,GA,Individual,Yes,36-3757528,22500GA0020001,TruAssure Dental Preferred Plan,22500GA002,,GAN001,GAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$42.71,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=GA,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=GA,,22500GA0020001-01,Standard High On Exchange Plan,83.20%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$35,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,28167,HIOS,9,2014-11-14 05:23:27,1,28167,GA,SHOP (Small Group),Yes,75-1233841,28167GA0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,28167GA002,,GAN001,GAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.59,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ga/28167ga0020001-15,,28167GA0020001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,28167,HIOS,9,2014-11-14 05:23:27,1,28167,GA,Individual,Yes,75-1233841,28167GA0010001,Dentegra Dental PPO Pediatric Basic Plan,28167GA001,,GAN001,GAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$23.42,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ga/28167ga0010001-15,,28167GA0010001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,28167,HIOS,9,2014-11-14 05:23:27,1,28167,GA,Individual,Yes,75-1233841,28167GA0010001,Dentegra Dental PPO Pediatric Basic Plan,28167GA001,,GAN001,GAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$23.42,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ga/28167ga0010001-15,,28167GA0010001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,28167,HIOS,9,2014-11-14 05:23:27,1,28167,GA,SHOP (Small Group),Yes,75-1233841,28167GA0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,28167GA002,,GAN001,GAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.59,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ga/28167ga0020001-15,,28167GA0020001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,28167,HIOS,9,2014-11-14 05:23:27,2,28167,GA,SHOP (Small Group),Yes,75-1233841,28167GA0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,28167GA002,,GAN001,GAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.85,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ga/28167ga0020004-15,,28167GA0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200042,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS002,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200042-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200042,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS002,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200042-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,34
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200042,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS002,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200042-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200043,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS003,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200043-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200043,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS003,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200043-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200043,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS003,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200043-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,38
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200043,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS003,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200043-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200044,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS004,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200044-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200044,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS004,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200044-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200044,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS004,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200044-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,42
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200044,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS004,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200044-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,43
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200045,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS005,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200045-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200045,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS005,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200045-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200045,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS005,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200045-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,46
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200045,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS005,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200045-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,47
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200046,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS006,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200046-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200046,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS006,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200046-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200046,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS006,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200046-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,50
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200047,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS007,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200047-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,55
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200048,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS008,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200048-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200048,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS008,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200048-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,57
2015,GA,20544,HIOS,5,2014-11-12 05:24:58,12,20544,GA,Individual,No,39-0658730,20544GA0200048,Assurant Health Platinum Plan 002,20544GA020,,GAN001,GAS008,GAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_GA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-GA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,20544GA0200048-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,58
2015,GA,28167,HIOS,9,2014-11-14 05:23:27,2,28167,GA,Individual,Yes,75-1233841,28167GA0010004,Dentegra Dental PPO Family Preferred Plan,28167GA001,,GAN001,GAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.61,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ga/28167ga0010004-15,,28167GA0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,28167,HIOS,9,2014-11-14 05:23:27,2,28167,GA,Individual,Yes,75-1233841,28167GA0010004,Dentegra Dental PPO Family Preferred Plan,28167GA001,,GAN001,GAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.61,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ga/28167ga0010004-15,,28167GA0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,28167,HIOS,9,2014-11-14 05:23:27,2,28167,GA,SHOP (Small Group),Yes,75-1233841,28167GA0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,28167GA002,,GAN001,GAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.85,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ga/28167ga0020004-15,,28167GA0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,28167,HIOS,9,2014-11-14 05:23:27,3,28167,GA,SHOP (Small Group),Yes,75-1233841,28167GA0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,28167GA002,,GAN001,GAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.59,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ga/28167ga0020006-15,,28167GA0020006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,28167,HIOS,9,2014-11-14 05:23:27,3,28167,GA,Individual,Yes,75-1233841,28167GA0010006,Dentegra Dental PPO Family Basic Plan,28167GA001,,GAN001,GAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.42,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ga/28167ga0010006-15,,28167GA0010006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,28167,HIOS,9,2014-11-14 05:23:27,3,28167,GA,Individual,Yes,75-1233841,28167GA0010006,Dentegra Dental PPO Family Basic Plan,28167GA001,,GAN001,GAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.42,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ga/28167ga0010006-15,,28167GA0010006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,28167,HIOS,9,2014-11-14 05:23:27,3,28167,GA,SHOP (Small Group),Yes,75-1233841,28167GA0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,28167GA002,,GAN001,GAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.59,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ga/28167ga0020006-15,,28167GA0020006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,31291,HIOS,3,2014-08-08 08:53:29,1,31291,GA,SHOP (Small Group),Yes,72-0977315,31291GA0040001,AlwaysCare Small Group - Child,31291GA004,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$28.96,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,31291GA0040001-00,Standard High Off Exchange Plan,86.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,31291,HIOS,3,2014-08-08 08:53:29,1,31291,GA,Individual,Yes,72-0977315,31291GA0010001,AlwaysCare All-Star Kids Dental Plan,31291GA001,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.64,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,31291GA0010001-00,Standard High Off Exchange Plan,86.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,1,45495,GA,Individual,No,20-3174593,45495GA0010007,Ambetter Balanced Care 3,45495GA001,,GAN001,GAS001,GAF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0010007-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,14
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,1,45495,GA,Individual,No,20-3174593,45495GA0010007,Ambetter Balanced Care 3,45495GA001,,GAN001,GAS001,GAF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0010007-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,15
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,1,45495,GA,Individual,No,20-3174593,45495GA0010007,Ambetter Balanced Care 3,45495GA001,,GAN001,GAS001,GAF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0010007-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,16
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,1,45495,GA,Individual,No,20-3174593,45495GA0010007,Ambetter Balanced Care 3,45495GA001,,GAN001,GAS001,GAF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0010007-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,17
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,1,45495,GA,Individual,No,20-3174593,45495GA0010002,Ambetter Secure Care 2,45495GA001,,GAN001,GAS001,GAF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0010002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,18
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,1,45495,GA,Individual,No,20-3174593,45495GA0010002,Ambetter Secure Care 2,45495GA001,,GAN001,GAS001,GAF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0010002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,19
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,1,45495,GA,Individual,No,20-3174593,45495GA0010002,Ambetter Secure Care 2,45495GA001,,GAN001,GAS001,GAF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0010002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,20
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,1,45495,GA,Individual,No,20-3174593,45495GA0010002,Ambetter Secure Care 2,45495GA001,,GAN001,GAS001,GAF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0010002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,21
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,2,45495,GA,Individual,No,20-3174593,45495GA0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,45495GA001,,GAN001,GAS001,GAF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0010004-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,2,45495,GA,Individual,No,20-3174593,45495GA0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,45495GA001,,GAN001,GAS001,GAF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0010004-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,GA,31291,HIOS,3,2014-08-08 08:53:29,1,31291,GA,Individual,Yes,72-0977315,31291GA0010002,AlwaysCare All-Star Kids Dental Plan,31291GA001,,GAN001,GAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$21.71,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,31291GA0010002-00,Standard Low Off Exchange Plan,71.27%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,31291,HIOS,3,2014-08-08 08:53:29,1,31291,GA,SHOP (Small Group),Yes,72-0977315,31291GA0040002,AlwaysCare Small Group - Child,31291GA004,,GAN001,GAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$23.73,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,31291GA0040002-00,Standard Low Off Exchange Plan,71.27%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,31291,HIOS,3,2014-08-08 08:53:29,2,31291,GA,SHOP (Small Group),Yes,72-0977315,31291GA0030001,AlwaysCare Small Group Dental - Adults,31291GA003,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.96,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,31291GA0030001-00,Standard High Off Exchange Plan,86.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,37001,HIOS,15,2015-01-16 17:32:32,1,37001,GA,Individual,Yes,39-1263473,37001GA0540001,Humana Dental Smart Choice,37001GA054,,GAN002,GAS002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.20,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541201,,37001GA0540001-00,Standard Low Off Exchange Plan,71.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,37001,HIOS,15,2015-01-16 17:32:32,1,37001,GA,Individual,Yes,39-1263473,37001GA0540001,Humana Dental Smart Choice,37001GA054,,GAN002,GAS002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.20,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541201,,37001GA0540001-01,Standard Low On Exchange Plan,71.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,1,43802,GA,Individual,No,58-1653544,43802GA0040003,UnitedHealthcare Gold Compass HSA 1300,43802GA004,,GAN001,GAS001,GAF003,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040003-00,Standard Gold Off Exchange Plan,79.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,1,43802,GA,Individual,No,58-1653544,43802GA0040003,UnitedHealthcare Gold Compass HSA 1300,43802GA004,,GAN001,GAS001,GAF003,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040003-01,Standard Gold On Exchange Plan,79.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,1,43802,GA,Individual,No,58-1653544,43802GA0040003,UnitedHealthcare Gold Compass HSA 1300,43802GA004,,GAN001,GAS001,GAF003,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,1,43802,GA,Individual,No,58-1653544,43802GA0040003,UnitedHealthcare Gold Compass HSA 1300,43802GA004,,GAN001,GAS001,GAF003,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040003-03,Limited Cost Sharing Plan Variation,79.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,1,43802,GA,Individual,No,58-1653544,43802GA0040008,UnitedHealthcare Bronze Compass HSA 6275,43802GA004,,GAN001,GAS001,GAF002,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040008-00,Standard Bronze Off Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,275","$12,550",60%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,1,43802,GA,Individual,No,58-1653544,43802GA0040008,UnitedHealthcare Bronze Compass HSA 6275,43802GA004,,GAN001,GAS001,GAF002,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040008-01,Standard Bronze On Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,275","$12,550",60%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,1,43802,GA,Individual,No,58-1653544,43802GA0040008,UnitedHealthcare Bronze Compass HSA 6275,43802GA004,,GAN001,GAS001,GAF002,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040008-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,21
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,1,43802,GA,Individual,No,58-1653544,43802GA0040008,UnitedHealthcare Bronze Compass HSA 6275,43802GA004,,GAN001,GAS001,GAF002,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040008-03,Limited Cost Sharing Plan Variation,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,275","$12,550",60%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,2,43802,GA,Individual,No,58-1653544,43802GA0040007,UnitedHealthcare Bronze Compass 4200,43802GA004,,GAN001,GAS001,GAF004,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040007-00,Standard Bronze Off Exchange Plan,59.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,2,43802,GA,Individual,No,58-1653544,43802GA0040007,UnitedHealthcare Bronze Compass 4200,43802GA004,,GAN001,GAS001,GAF004,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040007-01,Standard Bronze On Exchange Plan,59.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,2,43802,GA,Individual,No,58-1653544,43802GA0040007,UnitedHealthcare Bronze Compass 4200,43802GA004,,GAN001,GAS001,GAF004,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040007-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,2,43802,GA,Individual,No,58-1653544,43802GA0040007,UnitedHealthcare Bronze Compass 4200,43802GA004,,GAN001,GAS001,GAF004,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040007-03,Limited Cost Sharing Plan Variation,59.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,3,43802,GA,Individual,No,58-1653544,43802GA0040010,UnitedHealthcare Catastrophic Compass 6600,43802GA004,,GAN001,GAS001,GAF005,New,HMO,Catastrophic,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040010-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,3,43802,GA,Individual,No,58-1653544,43802GA0040010,UnitedHealthcare Catastrophic Compass 6600,43802GA004,,GAN001,GAS001,GAF005,New,HMO,Catastrophic,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040010-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,4,43802,GA,Individual,No,58-1653544,43802GA0040002,UnitedHealthcare Gold Compass 1000,43802GA004,,GAN001,GAS001,GAF001,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040002-00,Standard Gold Off Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,4,43802,GA,Individual,No,58-1653544,43802GA0040002,UnitedHealthcare Gold Compass 1000,43802GA004,,GAN001,GAS001,GAF001,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040002-01,Standard Gold On Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,4,43802,GA,Individual,No,58-1653544,43802GA0040002,UnitedHealthcare Gold Compass 1000,43802GA004,,GAN001,GAS001,GAF001,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,4,43802,GA,Individual,No,58-1653544,43802GA0040002,UnitedHealthcare Gold Compass 1000,43802GA004,,GAN001,GAS001,GAF001,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040002-03,Limited Cost Sharing Plan Variation,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,5,45495,GA,Individual,No,20-3174593,45495GA0010015,Ambetter Balanced Care 1,45495GA001,,GAN001,GAS001,GAF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0010015-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,10
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,6,45495,GA,Individual,No,20-3174593,45495GA0020009,Ambetter Balanced Care 5 + Vision,45495GA002,,GAN001,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976336745241374,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/formulary,45495GA0020009-00,Standard Silver Off Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,4
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,6,45495,GA,Individual,No,20-3174593,45495GA0020009,Ambetter Balanced Care 5 + Vision,45495GA002,,GAN001,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976336745241374,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/formulary,45495GA0020009-01,Standard Silver On Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,5
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,6,45495,GA,Individual,No,20-3174593,45495GA0020009,Ambetter Balanced Care 5 + Vision,45495GA002,,GAN001,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976336745241374,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/formulary,45495GA0020009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,5,43802,GA,Individual,No,58-1653544,43802GA0040001,UnitedHealthcare Platinum Compass 250,43802GA004,,GAN001,GAS001,GAF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040001-00,Standard Platinum Off Exchange Plan,89.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,5,43802,GA,Individual,No,58-1653544,43802GA0040001,UnitedHealthcare Platinum Compass 250,43802GA004,,GAN001,GAS001,GAF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040001-01,Standard Platinum On Exchange Plan,89.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,5,43802,GA,Individual,No,58-1653544,43802GA0040001,UnitedHealthcare Platinum Compass 250,43802GA004,,GAN001,GAS001,GAF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,5,43802,GA,Individual,No,58-1653544,43802GA0040001,UnitedHealthcare Platinum Compass 250,43802GA004,,GAN001,GAS001,GAF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040001-03,Limited Cost Sharing Plan Variation,89.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,6,43802,GA,Individual,No,58-1653544,43802GA0040004,UnitedHealthcare Silver Compass 2000,43802GA004,,GAN001,GAS001,GAF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040004-04,73% AV Level Silver Plan,73.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,600","$3,200",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,6,43802,GA,Individual,No,58-1653544,43802GA0040004,UnitedHealthcare Silver Compass 2000,43802GA004,,GAN001,GAS001,GAF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040004-05,87% AV Level Silver Plan,87.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,6,43802,GA,Individual,No,58-1653544,43802GA0040004,UnitedHealthcare Silver Compass 2000,43802GA004,,GAN001,GAS001,GAF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040004-06,94% AV Level Silver Plan,94.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,6,43802,GA,Individual,No,58-1653544,43802GA0040006,UnitedHealthcare Silver Compass 5000,43802GA004,,GAN001,GAS001,GAF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040006-00,Standard Silver Off Exchange Plan,68.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,6,43802,GA,Individual,No,58-1653544,43802GA0040006,UnitedHealthcare Silver Compass 5000,43802GA004,,GAN001,GAS001,GAF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040006-01,Standard Silver On Exchange Plan,68.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,6,43802,GA,Individual,No,58-1653544,43802GA0040006,UnitedHealthcare Silver Compass 5000,43802GA004,,GAN001,GAS001,GAF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040006-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,6,43802,GA,Individual,No,58-1653544,43802GA0040006,UnitedHealthcare Silver Compass 5000,43802GA004,,GAN001,GAS001,GAF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040006-03,Limited Cost Sharing Plan Variation,68.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,6,43802,GA,Individual,No,58-1653544,43802GA0040006,UnitedHealthcare Silver Compass 5000,43802GA004,,GAN001,GAS001,GAF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040006-04,73% AV Level Silver Plan,73.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,600","$7,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,6,43802,GA,Individual,No,58-1653544,43802GA0040006,UnitedHealthcare Silver Compass 5000,43802GA004,,GAN001,GAS001,GAF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040006-05,87% AV Level Silver Plan,87.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,GA,43802,HIOS,8,2014-12-11 04:09:12,6,43802,GA,Individual,No,58-1653544,43802GA0040006,UnitedHealthcare Silver Compass 5000,43802GA004,,GAN001,GAS001,GAF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xga,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xga,43802GA0040006-06,94% AV Level Silver Plan,94.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,1,45495,GA,Individual,No,20-3174593,45495GA0010009,Ambetter Balanced Care 5,45495GA001,,GAN001,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/formulary,45495GA0010009-00,Standard Silver Off Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,4
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,1,45495,GA,Individual,No,20-3174593,45495GA0010009,Ambetter Balanced Care 5,45495GA001,,GAN001,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/formulary,45495GA0010009-01,Standard Silver On Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,5
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,1,45495,GA,Individual,No,20-3174593,45495GA0010009,Ambetter Balanced Care 5,45495GA001,,GAN001,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/formulary,45495GA0010009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,1,45495,GA,Individual,No,20-3174593,45495GA0010009,Ambetter Balanced Care 5,45495GA001,,GAN001,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/formulary,45495GA0010009-03,Limited Cost Sharing Plan Variation,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,7
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,1,45495,GA,Individual,No,20-3174593,45495GA0010009,Ambetter Balanced Care 5,45495GA001,,GAN001,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/formulary,45495GA0010009-04,73% AV Level Silver Plan,73.24%,0.732411444187164,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$2,920",$350,$0,$80,8
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,1,45495,GA,Individual,No,20-3174593,45495GA0010009,Ambetter Balanced Care 5,45495GA001,,GAN001,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/formulary,45495GA0010009-05,87% AV Level Silver Plan,87.97%,0.879661500453949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$410,$0,$150,$600,$520,$0,$80,9
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,1,45495,GA,Individual,No,20-3174593,45495GA0010009,Ambetter Balanced Care 5,45495GA001,,GAN001,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/formulary,45495GA0010009-06,94% AV Level Silver Plan,93.34%,0.933413624763489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$120,$0,$150,$0,$450,$0,$80,10
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,1,45495,GA,Individual,No,20-3174593,45495GA0010007,Ambetter Balanced Care 3,45495GA001,,GAN001,GAS001,GAF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0010007-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,11
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,1,45495,GA,Individual,No,20-3174593,45495GA0010007,Ambetter Balanced Care 3,45495GA001,,GAN001,GAS001,GAF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0010007-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,12
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,1,45495,GA,Individual,No,20-3174593,45495GA0010007,Ambetter Balanced Care 3,45495GA001,,GAN001,GAS001,GAF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0010007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,2,45495,GA,Individual,No,20-3174593,45495GA0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,45495GA001,,GAN001,GAS001,GAF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0010004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,2,45495,GA,Individual,No,20-3174593,45495GA0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,45495GA001,,GAN001,GAS001,GAF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0010004-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,2,45495,GA,Individual,No,20-3174593,45495GA0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,45495GA001,,GAN001,GAS001,GAF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0010012-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,2,45495,GA,Individual,No,20-3174593,45495GA0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,45495GA001,,GAN001,GAS001,GAF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0010012-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,2,45495,GA,Individual,No,20-3174593,45495GA0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,45495GA001,,GAN001,GAS001,GAF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0010012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,2,45495,GA,Individual,No,20-3174593,45495GA0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,45495GA001,,GAN001,GAS001,GAF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0010012-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,2,45495,GA,Individual,No,20-3174593,45495GA0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,45495GA001,,GAN001,GAS001,GAF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0010013-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,2,45495,GA,Individual,No,20-3174593,45495GA0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,45495GA001,,GAN001,GAS001,GAF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0010013-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,2,45495,GA,Individual,No,20-3174593,45495GA0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,45495GA001,,GAN001,GAS001,GAF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0010013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,2,45495,GA,Individual,No,20-3174593,45495GA0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,45495GA001,,GAN001,GAS001,GAF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0010013-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,2,45495,GA,Individual,No,20-3174593,45495GA0010016,Ambetter Essential Care 2,45495GA001,,GAN001,GAS001,GAF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0010016-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,2,45495,GA,Individual,No,20-3174593,45495GA0010016,Ambetter Essential Care 2,45495GA001,,GAN001,GAS001,GAF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0010016-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,2,45495,GA,Individual,No,20-3174593,45495GA0010017,Ambetter Essential Care 1,45495GA001,,GAN001,GAS001,GAF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0010017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,2,45495,GA,Individual,No,20-3174593,45495GA0010017,Ambetter Essential Care 1,45495GA001,,GAN001,GAS001,GAF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0010017-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,3,45495,GA,Individual,No,20-3174593,45495GA0010008,Ambetter Balanced Care 4,45495GA001,,GAN001,GAS001,GAF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0010008-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,4
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,3,45495,GA,Individual,No,20-3174593,45495GA0010008,Ambetter Balanced Care 4,45495GA001,,GAN001,GAS001,GAF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0010008-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,5
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,5,45495,GA,Individual,No,20-3174593,45495GA0010015,Ambetter Balanced Care 1,45495GA001,,GAN001,GAS001,GAF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0010015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,5,45495,GA,Individual,No,20-3174593,45495GA0010015,Ambetter Balanced Care 1,45495GA001,,GAN001,GAS001,GAF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0010015-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,7
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,5,45495,GA,Individual,No,20-3174593,45495GA0010015,Ambetter Balanced Care 1,45495GA001,,GAN001,GAS001,GAF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0010015-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,8
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,5,45495,GA,Individual,No,20-3174593,45495GA0010015,Ambetter Balanced Care 1,45495GA001,,GAN001,GAS001,GAF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0010015-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,9
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,6,45495,GA,Individual,No,20-3174593,45495GA0020009,Ambetter Balanced Care 5 + Vision,45495GA002,,GAN001,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976336745241374,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/formulary,45495GA0020009-03,Limited Cost Sharing Plan Variation,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,7
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,6,45495,GA,Individual,No,20-3174593,45495GA0020009,Ambetter Balanced Care 5 + Vision,45495GA002,,GAN001,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976336745241374,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/formulary,45495GA0020009-04,73% AV Level Silver Plan,73.24%,0.732411444187164,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$2,920",$350,$0,$80,8
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,6,45495,GA,Individual,No,20-3174593,45495GA0020009,Ambetter Balanced Care 5 + Vision,45495GA002,,GAN001,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976336745241374,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/formulary,45495GA0020009-05,87% AV Level Silver Plan,87.97%,0.879661500453949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$410,$0,$150,$600,$520,$0,$80,9
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,6,45495,GA,Individual,No,20-3174593,45495GA0020009,Ambetter Balanced Care 5 + Vision,45495GA002,,GAN001,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976336745241374,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/formulary,45495GA0020009-06,94% AV Level Silver Plan,93.34%,0.933413624763489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$120,$0,$150,$0,$450,$0,$80,10
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,6,45495,GA,Individual,No,20-3174593,45495GA0020007,Ambetter Balanced Care 3 + Vision,45495GA002,,GAN001,GAS001,GAF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976336538699598,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0020007-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,11
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,6,45495,GA,Individual,No,20-3174593,45495GA0020007,Ambetter Balanced Care 3 + Vision,45495GA002,,GAN001,GAS001,GAF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976336538699598,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0020007-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,12
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,6,45495,GA,Individual,No,20-3174593,45495GA0020007,Ambetter Balanced Care 3 + Vision,45495GA002,,GAN001,GAS001,GAF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976336538699598,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0020007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,6,45495,GA,Individual,No,20-3174593,45495GA0020007,Ambetter Balanced Care 3 + Vision,45495GA002,,GAN001,GAS001,GAF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976336538699598,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0020007-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,14
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,6,45495,GA,Individual,No,20-3174593,45495GA0020007,Ambetter Balanced Care 3 + Vision,45495GA002,,GAN001,GAS001,GAF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976336538699598,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0020007-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,15
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,6,45495,GA,Individual,No,20-3174593,45495GA0020007,Ambetter Balanced Care 3 + Vision,45495GA002,,GAN001,GAS001,GAF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976336538699598,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0020007-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,16
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,6,45495,GA,Individual,No,20-3174593,45495GA0020007,Ambetter Balanced Care 3 + Vision,45495GA002,,GAN001,GAS001,GAF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976336538699598,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0020007-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,17
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,6,45495,GA,Individual,No,20-3174593,45495GA0020002,Ambetter Secure Care 2 + Vision,45495GA002,,GAN001,GAS001,GAF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974597414737881,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0020002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,18
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,6,45495,GA,Individual,No,20-3174593,45495GA0020002,Ambetter Secure Care 2 + Vision,45495GA002,,GAN001,GAS001,GAF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974597414737881,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0020002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,19
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,6,45495,GA,Individual,No,20-3174593,45495GA0020002,Ambetter Secure Care 2 + Vision,45495GA002,,GAN001,GAS001,GAF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974597414737881,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0020002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,20
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,6,45495,GA,Individual,No,20-3174593,45495GA0020002,Ambetter Secure Care 2 + Vision,45495GA002,,GAN001,GAS001,GAF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974597414737881,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0020002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,21
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,7,45495,GA,Individual,No,20-3174593,45495GA0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,45495GA002,,GAN001,GAS001,GAF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974596635152213,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0020004-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,7,45495,GA,Individual,No,20-3174593,45495GA0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,45495GA002,,GAN001,GAS001,GAF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974596635152213,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0020004-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,7,45495,GA,Individual,No,20-3174593,45495GA0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,45495GA002,,GAN001,GAS001,GAF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974596635152213,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0020004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,7,45495,GA,Individual,No,20-3174593,45495GA0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,45495GA002,,GAN001,GAS001,GAF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974596635152213,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0020004-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,7,45495,GA,Individual,No,20-3174593,45495GA0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,45495GA002,,GAN001,GAS001,GAF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.975597921533767,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0020012-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,7,45495,GA,Individual,No,20-3174593,45495GA0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,45495GA002,,GAN001,GAS001,GAF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.975597921533767,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0020012-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,7,45495,GA,Individual,No,20-3174593,45495GA0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,45495GA002,,GAN001,GAS001,GAF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.975597921533767,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0020012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,7,45495,GA,Individual,No,20-3174593,45495GA0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,45495GA002,,GAN001,GAS001,GAF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.975597921533767,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0020012-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,7,45495,GA,Individual,No,20-3174593,45495GA0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,45495GA002,,GAN001,GAS001,GAF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.975597765620206,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0020013-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,7,45495,GA,Individual,No,20-3174593,45495GA0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,45495GA002,,GAN001,GAS001,GAF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.975597765620206,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0020013-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,7,45495,GA,Individual,No,20-3174593,45495GA0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,45495GA002,,GAN001,GAS001,GAF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.975597765620206,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0020013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,7,45495,GA,Individual,No,20-3174593,45495GA0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,45495GA002,,GAN001,GAS001,GAF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.975597765620206,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0020013-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,7,45495,GA,Individual,No,20-3174593,45495GA0020016,Ambetter Essential Care 2 + Vision,45495GA002,,GAN001,GAS001,GAF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.975597921533767,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0020016-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,7,45495,GA,Individual,No,20-3174593,45495GA0020016,Ambetter Essential Care 2 + Vision,45495GA002,,GAN001,GAS001,GAF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.975597921533767,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0020016-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,7,45495,GA,Individual,No,20-3174593,45495GA0020016,Ambetter Essential Care 2 + Vision,45495GA002,,GAN001,GAS001,GAF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.975597921533767,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0020016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,7,45495,GA,Individual,No,20-3174593,45495GA0020016,Ambetter Essential Care 2 + Vision,45495GA002,,GAN001,GAS001,GAF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.975597921533767,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0020016-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,7,45495,GA,Individual,No,20-3174593,45495GA0020017,Ambetter Essential Care 1 + Vision,45495GA002,,GAN001,GAS001,GAF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.975597961368239,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0020017-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,7,45495,GA,Individual,No,20-3174593,45495GA0020017,Ambetter Essential Care 1 + Vision,45495GA002,,GAN001,GAS001,GAF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.975597961368239,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0020017-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,7,45495,GA,Individual,No,20-3174593,45495GA0020017,Ambetter Essential Care 1 + Vision,45495GA002,,GAN001,GAS001,GAF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.975597961368239,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0020017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,7,45495,GA,Individual,No,20-3174593,45495GA0020017,Ambetter Essential Care 1 + Vision,45495GA002,,GAN001,GAS001,GAF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.975597961368239,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0020017-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,8,45495,GA,Individual,No,20-3174593,45495GA0020008,Ambetter Balanced Care 4 + Vision,45495GA002,,GAN001,GAS001,GAF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.975928515661703,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0020008-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,4
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,8,45495,GA,Individual,No,20-3174593,45495GA0020008,Ambetter Balanced Care 4 + Vision,45495GA002,,GAN001,GAS001,GAF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.975928515661703,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0020008-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,5
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,8,45495,GA,Individual,No,20-3174593,45495GA0020008,Ambetter Balanced Care 4 + Vision,45495GA002,,GAN001,GAS001,GAF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.975928515661703,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0020008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,8,45495,GA,Individual,No,20-3174593,45495GA0020008,Ambetter Balanced Care 4 + Vision,45495GA002,,GAN001,GAS001,GAF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.975928515661703,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0020008-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,7
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,8,45495,GA,Individual,No,20-3174593,45495GA0020008,Ambetter Balanced Care 4 + Vision,45495GA002,,GAN001,GAS001,GAF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.975928515661703,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0020008-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,8
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,8,45495,GA,Individual,No,20-3174593,45495GA0020008,Ambetter Balanced Care 4 + Vision,45495GA002,,GAN001,GAS001,GAF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.975928515661703,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0020008-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,9
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,8,45495,GA,Individual,No,20-3174593,45495GA0020008,Ambetter Balanced Care 4 + Vision,45495GA002,,GAN001,GAS001,GAF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.975928515661703,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0020008-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,10
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,9,45495,GA,Individual,No,20-3174593,45495GA0020014,Ambetter Balanced Care 2 + Vision,45495GA002,,GAN001,GAS001,GAF008,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976392451316675,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0020014-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,4
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,9,45495,GA,Individual,No,20-3174593,45495GA0020014,Ambetter Balanced Care 2 + Vision,45495GA002,,GAN001,GAS001,GAF008,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976392451316675,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0020014-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,5
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,9,45495,GA,Individual,No,20-3174593,45495GA0020014,Ambetter Balanced Care 2 + Vision,45495GA002,,GAN001,GAS001,GAF008,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976392451316675,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0020014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,9,45495,GA,Individual,No,20-3174593,45495GA0020014,Ambetter Balanced Care 2 + Vision,45495GA002,,GAN001,GAS001,GAF008,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976392451316675,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0020014-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,7
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,9,45495,GA,Individual,No,20-3174593,45495GA0020014,Ambetter Balanced Care 2 + Vision,45495GA002,,GAN001,GAS001,GAF008,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976392451316675,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0020014-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,8
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,9,45495,GA,Individual,No,20-3174593,45495GA0020014,Ambetter Balanced Care 2 + Vision,45495GA002,,GAN001,GAS001,GAF008,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976392451316675,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0020014-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,9
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,9,45495,GA,Individual,No,20-3174593,45495GA0020014,Ambetter Balanced Care 2 + Vision,45495GA002,,GAN001,GAS001,GAF008,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976392451316675,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0020014-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,10
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,10,45495,GA,Individual,No,20-3174593,45495GA0020015,Ambetter Balanced Care 1 + Vision,45495GA002,,GAN001,GAS001,GAF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.97649503304904,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0020015-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,4
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,10,45495,GA,Individual,No,20-3174593,45495GA0020015,Ambetter Balanced Care 1 + Vision,45495GA002,,GAN001,GAS001,GAF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.97649503304904,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0020015-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,5
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,10,45495,GA,Individual,No,20-3174593,45495GA0020015,Ambetter Balanced Care 1 + Vision,45495GA002,,GAN001,GAS001,GAF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.97649503304904,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0020015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,10,45495,GA,Individual,No,20-3174593,45495GA0020015,Ambetter Balanced Care 1 + Vision,45495GA002,,GAN001,GAS001,GAF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.97649503304904,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0020015-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,7
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,10,45495,GA,Individual,No,20-3174593,45495GA0020015,Ambetter Balanced Care 1 + Vision,45495GA002,,GAN001,GAS001,GAF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.97649503304904,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0020015-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,8
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,10,45495,GA,Individual,No,20-3174593,45495GA0020015,Ambetter Balanced Care 1 + Vision,45495GA002,,GAN001,GAS001,GAF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.97649503304904,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0020015-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,9
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,10,45495,GA,Individual,No,20-3174593,45495GA0020015,Ambetter Balanced Care 1 + Vision,45495GA002,,GAN001,GAS001,GAF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.97649503304904,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0020015-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,10
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,11,45495,GA,Individual,No,20-3174593,45495GA0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.93505810255016,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/formulary,45495GA0030009-00,Standard Silver Off Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,4
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,11,45495,GA,Individual,No,20-3174593,45495GA0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.93505810255016,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/formulary,45495GA0030009-01,Standard Silver On Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,5
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,11,45495,GA,Individual,No,20-3174593,45495GA0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.93505810255016,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/formulary,45495GA0030009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,11,45495,GA,Individual,No,20-3174593,45495GA0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.93505810255016,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/formulary,45495GA0030009-03,Limited Cost Sharing Plan Variation,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,7
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,11,45495,GA,Individual,No,20-3174593,45495GA0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.93505810255016,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/formulary,45495GA0030009-04,73% AV Level Silver Plan,73.24%,0.732411444187164,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$2,920",$350,$0,$80,8
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,11,45495,GA,Individual,No,20-3174593,45495GA0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.93505810255016,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/formulary,45495GA0030009-05,87% AV Level Silver Plan,87.97%,0.879661500453949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$410,$0,$150,$600,$520,$0,$80,9
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,11,45495,GA,Individual,No,20-3174593,45495GA0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.93505810255016,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare5,http://ambetter.pshpgeorgia.com/formulary,45495GA0030009-06,94% AV Level Silver Plan,93.34%,0.933413624763489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$120,$0,$150,$0,$450,$0,$80,10
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,11,45495,GA,Individual,No,20-3174593,45495GA0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935057305664195,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0030007-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,11
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,11,45495,GA,Individual,No,20-3174593,45495GA0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935057305664195,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0030007-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,12
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,11,45495,GA,Individual,No,20-3174593,45495GA0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935057305664195,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0030007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,11,45495,GA,Individual,No,20-3174593,45495GA0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935057305664195,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0030007-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,14
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,11,45495,GA,Individual,No,20-3174593,45495GA0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935057305664195,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0030007-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,15
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,11,45495,GA,Individual,No,20-3174593,45495GA0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935057305664195,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0030007-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,16
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,11,45495,GA,Individual,No,20-3174593,45495GA0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935057305664195,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0030007-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,17
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,11,45495,GA,Individual,No,20-3174593,45495GA0030002,Ambetter Secure Care 2 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.930478177219453,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0030002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,18
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,11,45495,GA,Individual,No,20-3174593,45495GA0030002,Ambetter Secure Care 2 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.930478177219453,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0030002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,19
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,11,45495,GA,Individual,No,20-3174593,45495GA0030002,Ambetter Secure Care 2 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.930478177219453,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0030002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,20
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,11,45495,GA,Individual,No,20-3174593,45495GA0030002,Ambetter Secure Care 2 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.930478177219453,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0030002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,21
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,12,45495,GA,Individual,No,20-3174593,45495GA0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.930476152403326,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0030004-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,12,45495,GA,Individual,No,20-3174593,45495GA0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.930476152403326,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0030004-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,12,45495,GA,Individual,No,20-3174593,45495GA0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.930476152403326,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0030004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,12,45495,GA,Individual,No,20-3174593,45495GA0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.930476152403326,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=SecureCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0030004-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,12,45495,GA,Individual,No,20-3174593,45495GA0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.933121345761362,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0030012-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,12,45495,GA,Individual,No,20-3174593,45495GA0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.933121345761362,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0030012-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,12,45495,GA,Individual,No,20-3174593,45495GA0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.933121345761362,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0030012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,12,45495,GA,Individual,No,20-3174593,45495GA0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.933121345761362,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare3,http://ambetter.pshpgeorgia.com/formulary,45495GA0030012-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,12,45495,GA,Individual,No,20-3174593,45495GA0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.933120927890627,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0030013-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,12,45495,GA,Individual,No,20-3174593,45495GA0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.933120927890627,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0030013-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,12,45495,GA,Individual,No,20-3174593,45495GA0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.933120927890627,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0030013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,12,45495,GA,Individual,No,20-3174593,45495GA0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.933120927890627,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0030013-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,12,45495,GA,Individual,No,20-3174593,45495GA0030016,Ambetter Essential Care 2 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.933121345761362,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0030016-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,12,45495,GA,Individual,No,20-3174593,45495GA0030016,Ambetter Essential Care 2 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.933121345761362,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0030016-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,12,45495,GA,Individual,No,20-3174593,45495GA0030016,Ambetter Essential Care 2 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.933121345761362,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0030016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,12,45495,GA,Individual,No,20-3174593,45495GA0030016,Ambetter Essential Care 2 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.933121345761362,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0030016-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,12,45495,GA,Individual,No,20-3174593,45495GA0030017,Ambetter Essential Care 1 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.933121450989283,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0030017-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,12,45495,GA,Individual,No,20-3174593,45495GA0030017,Ambetter Essential Care 1 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.933121450989283,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0030017-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,12,45495,GA,Individual,No,20-3174593,45495GA0030017,Ambetter Essential Care 1 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.933121450989283,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0030017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,12,45495,GA,Individual,No,20-3174593,45495GA0030017,Ambetter Essential Care 1 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.933121450989283,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=EssentialCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0030017-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,13,45495,GA,Individual,No,20-3174593,45495GA0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.933989565822253,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0030008-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,4
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,13,45495,GA,Individual,No,20-3174593,45495GA0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.933989565822253,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0030008-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,5
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,13,45495,GA,Individual,No,20-3174593,45495GA0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.933989565822253,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0030008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,13,45495,GA,Individual,No,20-3174593,45495GA0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.933989565822253,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0030008-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,7
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,13,45495,GA,Individual,No,20-3174593,45495GA0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.933989565822253,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0030008-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,8
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,13,45495,GA,Individual,No,20-3174593,45495GA0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.933989565822253,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0030008-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,9
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,13,45495,GA,Individual,No,20-3174593,45495GA0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.933989565822253,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare4,http://ambetter.pshpgeorgia.com/formulary,45495GA0030008-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,10
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,14,45495,GA,Individual,No,20-3174593,45495GA0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF008,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935203774483261,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0030014-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,4
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,14,45495,GA,Individual,No,20-3174593,45495GA0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF008,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935203774483261,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0030014-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,5
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,14,45495,GA,Individual,No,20-3174593,45495GA0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF008,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935203774483261,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0030014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,14,45495,GA,Individual,No,20-3174593,45495GA0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF008,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935203774483261,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0030014-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,7
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,14,45495,GA,Individual,No,20-3174593,45495GA0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF008,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935203774483261,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0030014-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,8
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,14,45495,GA,Individual,No,20-3174593,45495GA0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF008,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935203774483261,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0030014-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,9
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,14,45495,GA,Individual,No,20-3174593,45495GA0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF008,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935203774483261,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare2,http://ambetter.pshpgeorgia.com/formulary,45495GA0030014-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,10
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,15,45495,GA,Individual,No,20-3174593,45495GA0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935471216778138,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0030015-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,4
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,15,45495,GA,Individual,No,20-3174593,45495GA0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935471216778138,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0030015-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,5
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,15,45495,GA,Individual,No,20-3174593,45495GA0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935471216778138,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0030015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,15,45495,GA,Individual,No,20-3174593,45495GA0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935471216778138,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0030015-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,7
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,15,45495,GA,Individual,No,20-3174593,45495GA0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935471216778138,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0030015-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,8
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,15,45495,GA,Individual,No,20-3174593,45495GA0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935471216778138,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0030015-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,9
2015,GA,45495,HIOS,8,2015-02-19 06:21:02,15,45495,GA,Individual,No,20-3174593,45495GA0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,45495GA003,,GAN001,GAS001,GAF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935471216778138,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/payments,http://ambetter.pshpgeorgia.com/brochures/?plan=BalancedCare1,http://ambetter.pshpgeorgia.com/formulary,45495GA0030015-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,10
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,1,47783,GA,Individual,No,51-0353639,47783GA0510001,Coventry Bronze $20 Copay HMO Albany,47783GA051,,GAN006,GAS006,GAF006,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48155,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510001-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,1,47783,GA,Individual,No,51-0353639,47783GA0510001,Coventry Bronze $20 Copay HMO Albany,47783GA051,,GAN006,GAS006,GAF006,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48155,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510001-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,1,47783,GA,Individual,No,51-0353639,47783GA0510001,Coventry Bronze $20 Copay HMO Albany,47783GA051,,GAN006,GAS006,GAF006,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48155,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,1,47783,GA,Individual,No,51-0353639,47783GA0510001,Coventry Bronze $20 Copay HMO Albany,47783GA051,,GAN006,GAS006,GAF006,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48155,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510001-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,2,47783,GA,Individual,No,51-0353639,47783GA0510002,Coventry Bronze $20 Copay HMO Atlanta,47783GA051,,GAN001,GAS001,GAF007,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48133,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510002-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,2,47783,GA,Individual,No,51-0353639,47783GA0510002,Coventry Bronze $20 Copay HMO Atlanta,47783GA051,,GAN001,GAS001,GAF007,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48133,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510002-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,2,47783,GA,Individual,No,51-0353639,47783GA0510002,Coventry Bronze $20 Copay HMO Atlanta,47783GA051,,GAN001,GAS001,GAF007,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48133,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,2,47783,GA,Individual,No,51-0353639,47783GA0510002,Coventry Bronze $20 Copay HMO Atlanta,47783GA051,,GAN001,GAS001,GAF007,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48133,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510002-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,3,47783,GA,Individual,No,51-0353639,47783GA0510003,Coventry Bronze $20 Copay HMO Columbus,47783GA051,,GAN004,GAS004,GAF008,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48177,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510003-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,3,47783,GA,Individual,No,51-0353639,47783GA0510003,Coventry Bronze $20 Copay HMO Columbus,47783GA051,,GAN004,GAS004,GAF008,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48177,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510003-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,3,47783,GA,Individual,No,51-0353639,47783GA0510003,Coventry Bronze $20 Copay HMO Columbus,47783GA051,,GAN004,GAS004,GAF008,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48177,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,3,47783,GA,Individual,No,51-0353639,47783GA0510003,Coventry Bronze $20 Copay HMO Columbus,47783GA051,,GAN004,GAS004,GAF008,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48177,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510003-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,4,47783,GA,Individual,No,51-0353639,47783GA0510004,Coventry Bronze $20 Copay HMO Hall,47783GA051,,GAN003,GAS003,GAF009,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48111,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510004-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,4,47783,GA,Individual,No,51-0353639,47783GA0510004,Coventry Bronze $20 Copay HMO Hall,47783GA051,,GAN003,GAS003,GAF009,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48111,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510004-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,4,47783,GA,Individual,No,51-0353639,47783GA0510004,Coventry Bronze $20 Copay HMO Hall,47783GA051,,GAN003,GAS003,GAF009,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48111,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,4,47783,GA,Individual,No,51-0353639,47783GA0510004,Coventry Bronze $20 Copay HMO Hall,47783GA051,,GAN003,GAS003,GAF009,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48111,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510004-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,5,47783,GA,Individual,No,51-0353639,47783GA0510005,Coventry Bronze $20 Copay HMO Macon,47783GA051,,GAN008,GAS008,GAF010,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48909,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510005-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,5,47783,GA,Individual,No,51-0353639,47783GA0510005,Coventry Bronze $20 Copay HMO Macon,47783GA051,,GAN008,GAS008,GAF010,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48909,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510005-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,5,47783,GA,Individual,No,51-0353639,47783GA0510005,Coventry Bronze $20 Copay HMO Macon,47783GA051,,GAN008,GAS008,GAF010,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48909,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510005-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,5,47783,GA,Individual,No,51-0353639,47783GA0510005,Coventry Bronze $20 Copay HMO Macon,47783GA051,,GAN008,GAS008,GAF010,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48909,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510005-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,14,47783,GA,Individual,No,51-0353639,47783GA0510006,Coventry Bronze $20 Copay HMO Savannah,47783GA051,,GAN002,GAS002,GAF011,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48931,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510006-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,14,47783,GA,Individual,No,51-0353639,47783GA0510006,Coventry Bronze $20 Copay HMO Savannah,47783GA051,,GAN002,GAS002,GAF011,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48931,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510006-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,14,47783,GA,Individual,No,51-0353639,47783GA0510006,Coventry Bronze $20 Copay HMO Savannah,47783GA051,,GAN002,GAS002,GAF011,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48931,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,14,47783,GA,Individual,No,51-0353639,47783GA0510006,Coventry Bronze $20 Copay HMO Savannah,47783GA051,,GAN002,GAS002,GAF011,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48931,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510006-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,15,47783,GA,Individual,No,51-0353639,47783GA0510007,Coventry Bronze $20 Copay HMO SEGA,47783GA051,,GAN007,GAS007,GAF012,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48953,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510007-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,15,47783,GA,Individual,No,51-0353639,47783GA0510007,Coventry Bronze $20 Copay HMO SEGA,47783GA051,,GAN007,GAS007,GAF012,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48953,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510007-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,15,47783,GA,Individual,No,51-0353639,47783GA0510007,Coventry Bronze $20 Copay HMO SEGA,47783GA051,,GAN007,GAS007,GAF012,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48953,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510007-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,15,47783,GA,Individual,No,51-0353639,47783GA0510007,Coventry Bronze $20 Copay HMO SEGA,47783GA051,,GAN007,GAS007,GAF012,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48953,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510007-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,16,47783,GA,Individual,No,51-0353639,47783GA0510008,Coventry Bronze $20 Copay HMO Valdosta,47783GA051,,GAN005,GAS005,GAF013,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48975,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510008-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,16,47783,GA,Individual,No,51-0353639,47783GA0510008,Coventry Bronze $20 Copay HMO Valdosta,47783GA051,,GAN005,GAS005,GAF013,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48975,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510008-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,16,47783,GA,Individual,No,51-0353639,47783GA0510008,Coventry Bronze $20 Copay HMO Valdosta,47783GA051,,GAN005,GAS005,GAF013,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48975,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510008-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,16,47783,GA,Individual,No,51-0353639,47783GA0510008,Coventry Bronze $20 Copay HMO Valdosta,47783GA051,,GAN005,GAS005,GAF013,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48975,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510008-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,19,47783,GA,Individual,No,51-0353639,47783GA0510009,Coventry Bronze Ded Only HSA Eligible HMO Albany,47783GA051,,GAN006,GAS006,GAF014,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48156,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510009-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,19,47783,GA,Individual,No,51-0353639,47783GA0510009,Coventry Bronze Ded Only HSA Eligible HMO Albany,47783GA051,,GAN006,GAS006,GAF014,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48156,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510009-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,19,47783,GA,Individual,No,51-0353639,47783GA0510009,Coventry Bronze Ded Only HSA Eligible HMO Albany,47783GA051,,GAN006,GAS006,GAF014,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48156,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510009-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,19,47783,GA,Individual,No,51-0353639,47783GA0510009,Coventry Bronze Ded Only HSA Eligible HMO Albany,47783GA051,,GAN006,GAS006,GAF014,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48156,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510009-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,20,47783,GA,Individual,No,51-0353639,47783GA0510010,Coventry Bronze Ded Only HSA Eligible HMO Atlanta,47783GA051,,GAN001,GAS001,GAF015,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48134,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510010-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,20,47783,GA,Individual,No,51-0353639,47783GA0510010,Coventry Bronze Ded Only HSA Eligible HMO Atlanta,47783GA051,,GAN001,GAS001,GAF015,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48134,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510010-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,20,47783,GA,Individual,No,51-0353639,47783GA0510010,Coventry Bronze Ded Only HSA Eligible HMO Atlanta,47783GA051,,GAN001,GAS001,GAF015,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48134,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510010-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,20,47783,GA,Individual,No,51-0353639,47783GA0510010,Coventry Bronze Ded Only HSA Eligible HMO Atlanta,47783GA051,,GAN001,GAS001,GAF015,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48134,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510010-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,21,47783,GA,Individual,No,51-0353639,47783GA0510011,Coventry Bronze Ded Only HSA Eligible HMO Columbus,47783GA051,,GAN004,GAS004,GAF016,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48178,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510011-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,21,47783,GA,Individual,No,51-0353639,47783GA0510011,Coventry Bronze Ded Only HSA Eligible HMO Columbus,47783GA051,,GAN004,GAS004,GAF016,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48178,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510011-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,21,47783,GA,Individual,No,51-0353639,47783GA0510011,Coventry Bronze Ded Only HSA Eligible HMO Columbus,47783GA051,,GAN004,GAS004,GAF016,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48178,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510011-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,21,47783,GA,Individual,No,51-0353639,47783GA0510011,Coventry Bronze Ded Only HSA Eligible HMO Columbus,47783GA051,,GAN004,GAS004,GAF016,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48178,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510011-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,22,47783,GA,Individual,No,51-0353639,47783GA0510012,Coventry Bronze Ded Only HSA Eligible HMO Hall,47783GA051,,GAN003,GAS003,GAF017,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48112,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510012-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,22,47783,GA,Individual,No,51-0353639,47783GA0510012,Coventry Bronze Ded Only HSA Eligible HMO Hall,47783GA051,,GAN003,GAS003,GAF017,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48112,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510012-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,22,47783,GA,Individual,No,51-0353639,47783GA0510012,Coventry Bronze Ded Only HSA Eligible HMO Hall,47783GA051,,GAN003,GAS003,GAF017,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48112,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510012-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,22,47783,GA,Individual,No,51-0353639,47783GA0510012,Coventry Bronze Ded Only HSA Eligible HMO Hall,47783GA051,,GAN003,GAS003,GAF017,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48112,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510012-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,23,47783,GA,Individual,No,51-0353639,47783GA0510013,Coventry Bronze Ded Only HSA Eligible HMO Macon,47783GA051,,GAN008,GAS008,GAF018,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48910,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510013-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,23,47783,GA,Individual,No,51-0353639,47783GA0510013,Coventry Bronze Ded Only HSA Eligible HMO Macon,47783GA051,,GAN008,GAS008,GAF018,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48910,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510013-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,23,47783,GA,Individual,No,51-0353639,47783GA0510013,Coventry Bronze Ded Only HSA Eligible HMO Macon,47783GA051,,GAN008,GAS008,GAF018,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48910,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510013-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,23,47783,GA,Individual,No,51-0353639,47783GA0510013,Coventry Bronze Ded Only HSA Eligible HMO Macon,47783GA051,,GAN008,GAS008,GAF018,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48910,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510013-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,32,47783,GA,Individual,No,51-0353639,47783GA0510014,Coventry Bronze Ded Only HSA Eligible HMO Savannah,47783GA051,,GAN002,GAS002,GAF019,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48932,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510014-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,32,47783,GA,Individual,No,51-0353639,47783GA0510014,Coventry Bronze Ded Only HSA Eligible HMO Savannah,47783GA051,,GAN002,GAS002,GAF019,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48932,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510014-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,32,47783,GA,Individual,No,51-0353639,47783GA0510014,Coventry Bronze Ded Only HSA Eligible HMO Savannah,47783GA051,,GAN002,GAS002,GAF019,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48932,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510014-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,32,47783,GA,Individual,No,51-0353639,47783GA0510014,Coventry Bronze Ded Only HSA Eligible HMO Savannah,47783GA051,,GAN002,GAS002,GAF019,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48932,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510014-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,33,47783,GA,Individual,No,51-0353639,47783GA0510015,Coventry Bronze Ded Only HSA Eligible HMO SEGA,47783GA051,,GAN007,GAS007,GAF020,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48954,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510015-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,33,47783,GA,Individual,No,51-0353639,47783GA0510015,Coventry Bronze Ded Only HSA Eligible HMO SEGA,47783GA051,,GAN007,GAS007,GAF020,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48954,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510015-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,33,47783,GA,Individual,No,51-0353639,47783GA0510015,Coventry Bronze Ded Only HSA Eligible HMO SEGA,47783GA051,,GAN007,GAS007,GAF020,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48954,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510015-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,33,47783,GA,Individual,No,51-0353639,47783GA0510015,Coventry Bronze Ded Only HSA Eligible HMO SEGA,47783GA051,,GAN007,GAS007,GAF020,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48954,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510015-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,34,47783,GA,Individual,No,51-0353639,47783GA0510016,Coventry Bronze Ded Only HSA Eligible HMO Valdosta,47783GA051,,GAN005,GAS005,GAF021,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48976,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510016-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,34,47783,GA,Individual,No,51-0353639,47783GA0510016,Coventry Bronze Ded Only HSA Eligible HMO Valdosta,47783GA051,,GAN005,GAS005,GAF021,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48976,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510016-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,34,47783,GA,Individual,No,51-0353639,47783GA0510016,Coventry Bronze Ded Only HSA Eligible HMO Valdosta,47783GA051,,GAN005,GAS005,GAF021,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48976,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510016-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,34,47783,GA,Individual,No,51-0353639,47783GA0510016,Coventry Bronze Ded Only HSA Eligible HMO Valdosta,47783GA051,,GAN005,GAS005,GAF021,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48976,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510016-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,35,47783,GA,Individual,No,51-0353639,47783GA0510025,Coventry Silver $10 Copay HMO Albany,47783GA051,,GAN006,GAS006,GAF030,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48151,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510025-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,$500,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,35,47783,GA,Individual,No,51-0353639,47783GA0510025,Coventry Silver $10 Copay HMO Albany,47783GA051,,GAN006,GAS006,GAF030,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48151,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510025-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,$500,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,35,47783,GA,Individual,No,51-0353639,47783GA0510025,Coventry Silver $10 Copay HMO Albany,47783GA051,,GAN006,GAS006,GAF030,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48151,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510025-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,35,47783,GA,Individual,No,51-0353639,47783GA0510025,Coventry Silver $10 Copay HMO Albany,47783GA051,,GAN006,GAS006,GAF030,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48151,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510025-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,$500,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,35,47783,GA,Individual,No,51-0353639,47783GA0510025,Coventry Silver $10 Copay HMO Albany,47783GA051,,GAN006,GAS006,GAF030,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48151,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510025-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,35,47783,GA,Individual,No,51-0353639,47783GA0510025,Coventry Silver $10 Copay HMO Albany,47783GA051,,GAN006,GAS006,GAF030,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48151,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510025-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,35,47783,GA,Individual,No,51-0353639,47783GA0510025,Coventry Silver $10 Copay HMO Albany,47783GA051,,GAN006,GAS006,GAF030,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48151,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510025-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,36,47783,GA,Individual,No,51-0353639,47783GA0510026,Coventry Silver $10 Copay HMO Atlanta,47783GA051,,GAN001,GAS001,GAF031,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48129,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510026-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,36,47783,GA,Individual,No,51-0353639,47783GA0510026,Coventry Silver $10 Copay HMO Atlanta,47783GA051,,GAN001,GAS001,GAF031,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48129,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510026-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,36,47783,GA,Individual,No,51-0353639,47783GA0510026,Coventry Silver $10 Copay HMO Atlanta,47783GA051,,GAN001,GAS001,GAF031,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48129,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510026-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,36,47783,GA,Individual,No,51-0353639,47783GA0510026,Coventry Silver $10 Copay HMO Atlanta,47783GA051,,GAN001,GAS001,GAF031,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48129,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510026-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,36,47783,GA,Individual,No,51-0353639,47783GA0510026,Coventry Silver $10 Copay HMO Atlanta,47783GA051,,GAN001,GAS001,GAF031,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48129,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510026-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,36,47783,GA,Individual,No,51-0353639,47783GA0510026,Coventry Silver $10 Copay HMO Atlanta,47783GA051,,GAN001,GAS001,GAF031,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48129,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510026-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,36,47783,GA,Individual,No,51-0353639,47783GA0510026,Coventry Silver $10 Copay HMO Atlanta,47783GA051,,GAN001,GAS001,GAF031,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48129,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510026-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,37,47783,GA,Individual,No,51-0353639,47783GA0510027,Coventry Silver $10 Copay HMO Columbus,47783GA051,,GAN004,GAS004,GAF032,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48173,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510027-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,37,47783,GA,Individual,No,51-0353639,47783GA0510027,Coventry Silver $10 Copay HMO Columbus,47783GA051,,GAN004,GAS004,GAF032,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48173,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510027-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,37,47783,GA,Individual,No,51-0353639,47783GA0510027,Coventry Silver $10 Copay HMO Columbus,47783GA051,,GAN004,GAS004,GAF032,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48173,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510027-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,37,47783,GA,Individual,No,51-0353639,47783GA0510027,Coventry Silver $10 Copay HMO Columbus,47783GA051,,GAN004,GAS004,GAF032,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48173,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510027-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,37,47783,GA,Individual,No,51-0353639,47783GA0510027,Coventry Silver $10 Copay HMO Columbus,47783GA051,,GAN004,GAS004,GAF032,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48173,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510027-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,37,47783,GA,Individual,No,51-0353639,47783GA0510027,Coventry Silver $10 Copay HMO Columbus,47783GA051,,GAN004,GAS004,GAF032,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48173,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510027-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,37,47783,GA,Individual,No,51-0353639,47783GA0510027,Coventry Silver $10 Copay HMO Columbus,47783GA051,,GAN004,GAS004,GAF032,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48173,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510027-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,38,47783,GA,Individual,No,51-0353639,47783GA0510028,Coventry Silver $10 Copay HMO Hall,47783GA051,,GAN003,GAS003,GAF033,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48107,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510028-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,38,47783,GA,Individual,No,51-0353639,47783GA0510028,Coventry Silver $10 Copay HMO Hall,47783GA051,,GAN003,GAS003,GAF033,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48107,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510028-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,38,47783,GA,Individual,No,51-0353639,47783GA0510028,Coventry Silver $10 Copay HMO Hall,47783GA051,,GAN003,GAS003,GAF033,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48107,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510028-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,38,47783,GA,Individual,No,51-0353639,47783GA0510028,Coventry Silver $10 Copay HMO Hall,47783GA051,,GAN003,GAS003,GAF033,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48107,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510028-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,38,47783,GA,Individual,No,51-0353639,47783GA0510028,Coventry Silver $10 Copay HMO Hall,47783GA051,,GAN003,GAS003,GAF033,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48107,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510028-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,38,47783,GA,Individual,No,51-0353639,47783GA0510028,Coventry Silver $10 Copay HMO Hall,47783GA051,,GAN003,GAS003,GAF033,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48107,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510028-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,38,47783,GA,Individual,No,51-0353639,47783GA0510028,Coventry Silver $10 Copay HMO Hall,47783GA051,,GAN003,GAS003,GAF033,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48107,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510028-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,39,47783,GA,Individual,No,51-0353639,47783GA0510029,Coventry Silver $10 Copay HMO Macon,47783GA051,,GAN008,GAS008,GAF034,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48905,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510029-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,39,47783,GA,Individual,No,51-0353639,47783GA0510029,Coventry Silver $10 Copay HMO Macon,47783GA051,,GAN008,GAS008,GAF034,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48905,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510029-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,39,47783,GA,Individual,No,51-0353639,47783GA0510029,Coventry Silver $10 Copay HMO Macon,47783GA051,,GAN008,GAS008,GAF034,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48905,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510029-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,39,47783,GA,Individual,No,51-0353639,47783GA0510029,Coventry Silver $10 Copay HMO Macon,47783GA051,,GAN008,GAS008,GAF034,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48905,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510029-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,39,47783,GA,Individual,No,51-0353639,47783GA0510029,Coventry Silver $10 Copay HMO Macon,47783GA051,,GAN008,GAS008,GAF034,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48905,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510029-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,39,47783,GA,Individual,No,51-0353639,47783GA0510029,Coventry Silver $10 Copay HMO Macon,47783GA051,,GAN008,GAS008,GAF034,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48905,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510029-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,39,47783,GA,Individual,No,51-0353639,47783GA0510029,Coventry Silver $10 Copay HMO Macon,47783GA051,,GAN008,GAS008,GAF034,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48905,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510029-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,48,47783,GA,Individual,No,51-0353639,47783GA0510030,Coventry Silver $10 Copay HMO Savannah,47783GA051,,GAN002,GAS002,GAF035,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48927,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510030-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,48,47783,GA,Individual,No,51-0353639,47783GA0510030,Coventry Silver $10 Copay HMO Savannah,47783GA051,,GAN002,GAS002,GAF035,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48927,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510030-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,48,47783,GA,Individual,No,51-0353639,47783GA0510030,Coventry Silver $10 Copay HMO Savannah,47783GA051,,GAN002,GAS002,GAF035,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48927,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510030-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,48,47783,GA,Individual,No,51-0353639,47783GA0510030,Coventry Silver $10 Copay HMO Savannah,47783GA051,,GAN002,GAS002,GAF035,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48927,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510030-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,48,47783,GA,Individual,No,51-0353639,47783GA0510030,Coventry Silver $10 Copay HMO Savannah,47783GA051,,GAN002,GAS002,GAF035,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48927,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510030-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,48,47783,GA,Individual,No,51-0353639,47783GA0510030,Coventry Silver $10 Copay HMO Savannah,47783GA051,,GAN002,GAS002,GAF035,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48927,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510030-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,48,47783,GA,Individual,No,51-0353639,47783GA0510030,Coventry Silver $10 Copay HMO Savannah,47783GA051,,GAN002,GAS002,GAF035,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48927,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510030-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,49,47783,GA,Individual,No,51-0353639,47783GA0510031,Coventry Silver $10 Copay HMO SEGA,47783GA051,,GAN007,GAS007,GAF036,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48949,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510031-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,49,47783,GA,Individual,No,51-0353639,47783GA0510031,Coventry Silver $10 Copay HMO SEGA,47783GA051,,GAN007,GAS007,GAF036,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48949,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510031-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,49,47783,GA,Individual,No,51-0353639,47783GA0510031,Coventry Silver $10 Copay HMO SEGA,47783GA051,,GAN007,GAS007,GAF036,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48949,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510031-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,49,47783,GA,Individual,No,51-0353639,47783GA0510031,Coventry Silver $10 Copay HMO SEGA,47783GA051,,GAN007,GAS007,GAF036,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48949,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510031-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,49,47783,GA,Individual,No,51-0353639,47783GA0510031,Coventry Silver $10 Copay HMO SEGA,47783GA051,,GAN007,GAS007,GAF036,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48949,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510031-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,49,47783,GA,Individual,No,51-0353639,47783GA0510031,Coventry Silver $10 Copay HMO SEGA,47783GA051,,GAN007,GAS007,GAF036,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48949,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510031-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,49,47783,GA,Individual,No,51-0353639,47783GA0510031,Coventry Silver $10 Copay HMO SEGA,47783GA051,,GAN007,GAS007,GAF036,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48949,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510031-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,50,47783,GA,Individual,No,51-0353639,47783GA0510032,Coventry Silver $10 Copay HMO Valdosta,47783GA051,,GAN005,GAS005,GAF037,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48971,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510032-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,50,47783,GA,Individual,No,51-0353639,47783GA0510032,Coventry Silver $10 Copay HMO Valdosta,47783GA051,,GAN005,GAS005,GAF037,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48971,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510032-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,50,47783,GA,Individual,No,51-0353639,47783GA0510032,Coventry Silver $10 Copay HMO Valdosta,47783GA051,,GAN005,GAS005,GAF037,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48971,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510032-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,50,47783,GA,Individual,No,51-0353639,47783GA0510032,Coventry Silver $10 Copay HMO Valdosta,47783GA051,,GAN005,GAS005,GAF037,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48971,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510032-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,50,47783,GA,Individual,No,51-0353639,47783GA0510032,Coventry Silver $10 Copay HMO Valdosta,47783GA051,,GAN005,GAS005,GAF037,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48971,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510032-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,50,47783,GA,Individual,No,51-0353639,47783GA0510032,Coventry Silver $10 Copay HMO Valdosta,47783GA051,,GAN005,GAS005,GAF037,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48971,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510032-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,50,47783,GA,Individual,No,51-0353639,47783GA0510032,Coventry Silver $10 Copay HMO Valdosta,47783GA051,,GAN005,GAS005,GAF037,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48971,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510032-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,52,47783,GA,Individual,No,51-0353639,47783GA0510033,Coventry Silver $5 Copay 2750 HMO Albany,47783GA051,,GAN006,GAS006,GAF038,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48147,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510033-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,52,47783,GA,Individual,No,51-0353639,47783GA0510033,Coventry Silver $5 Copay 2750 HMO Albany,47783GA051,,GAN006,GAS006,GAF038,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48147,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510033-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,52,47783,GA,Individual,No,51-0353639,47783GA0510033,Coventry Silver $5 Copay 2750 HMO Albany,47783GA051,,GAN006,GAS006,GAF038,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48147,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510033-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,52,47783,GA,Individual,No,51-0353639,47783GA0510033,Coventry Silver $5 Copay 2750 HMO Albany,47783GA051,,GAN006,GAS006,GAF038,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48147,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510033-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,52,47783,GA,Individual,No,51-0353639,47783GA0510033,Coventry Silver $5 Copay 2750 HMO Albany,47783GA051,,GAN006,GAS006,GAF038,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48147,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510033-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,52,47783,GA,Individual,No,51-0353639,47783GA0510033,Coventry Silver $5 Copay 2750 HMO Albany,47783GA051,,GAN006,GAS006,GAF038,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48147,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510033-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,52,47783,GA,Individual,No,51-0353639,47783GA0510033,Coventry Silver $5 Copay 2750 HMO Albany,47783GA051,,GAN006,GAS006,GAF038,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48147,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510033-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,53,47783,GA,Individual,No,51-0353639,47783GA0510034,Coventry Silver $5 Copay 2750 HMO Atlanta,47783GA051,,GAN001,GAS001,GAF039,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48125,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510034-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,53,47783,GA,Individual,No,51-0353639,47783GA0510034,Coventry Silver $5 Copay 2750 HMO Atlanta,47783GA051,,GAN001,GAS001,GAF039,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48125,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510034-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,53,47783,GA,Individual,No,51-0353639,47783GA0510034,Coventry Silver $5 Copay 2750 HMO Atlanta,47783GA051,,GAN001,GAS001,GAF039,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48125,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510034-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,53,47783,GA,Individual,No,51-0353639,47783GA0510034,Coventry Silver $5 Copay 2750 HMO Atlanta,47783GA051,,GAN001,GAS001,GAF039,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48125,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510034-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,53,47783,GA,Individual,No,51-0353639,47783GA0510034,Coventry Silver $5 Copay 2750 HMO Atlanta,47783GA051,,GAN001,GAS001,GAF039,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48125,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510034-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,53,47783,GA,Individual,No,51-0353639,47783GA0510034,Coventry Silver $5 Copay 2750 HMO Atlanta,47783GA051,,GAN001,GAS001,GAF039,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48125,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510034-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,53,47783,GA,Individual,No,51-0353639,47783GA0510034,Coventry Silver $5 Copay 2750 HMO Atlanta,47783GA051,,GAN001,GAS001,GAF039,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48125,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510034-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,54,47783,GA,Individual,No,51-0353639,47783GA0510035,Coventry Silver $5 Copay 2750 HMO Columbus,47783GA051,,GAN004,GAS004,GAF040,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48169,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510035-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,54,47783,GA,Individual,No,51-0353639,47783GA0510035,Coventry Silver $5 Copay 2750 HMO Columbus,47783GA051,,GAN004,GAS004,GAF040,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48169,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510035-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,54,47783,GA,Individual,No,51-0353639,47783GA0510035,Coventry Silver $5 Copay 2750 HMO Columbus,47783GA051,,GAN004,GAS004,GAF040,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48169,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510035-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,54,47783,GA,Individual,No,51-0353639,47783GA0510035,Coventry Silver $5 Copay 2750 HMO Columbus,47783GA051,,GAN004,GAS004,GAF040,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48169,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510035-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,54,47783,GA,Individual,No,51-0353639,47783GA0510035,Coventry Silver $5 Copay 2750 HMO Columbus,47783GA051,,GAN004,GAS004,GAF040,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48169,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510035-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,54,47783,GA,Individual,No,51-0353639,47783GA0510035,Coventry Silver $5 Copay 2750 HMO Columbus,47783GA051,,GAN004,GAS004,GAF040,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48169,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510035-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,54,47783,GA,Individual,No,51-0353639,47783GA0510035,Coventry Silver $5 Copay 2750 HMO Columbus,47783GA051,,GAN004,GAS004,GAF040,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48169,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510035-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,55,47783,GA,Individual,No,51-0353639,47783GA0510036,Coventry Silver $5 Copay 2750 HMO Hall,47783GA051,,GAN003,GAS003,GAF041,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48103,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510036-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,55,47783,GA,Individual,No,51-0353639,47783GA0510036,Coventry Silver $5 Copay 2750 HMO Hall,47783GA051,,GAN003,GAS003,GAF041,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48103,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510036-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,55,47783,GA,Individual,No,51-0353639,47783GA0510036,Coventry Silver $5 Copay 2750 HMO Hall,47783GA051,,GAN003,GAS003,GAF041,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48103,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510036-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,55,47783,GA,Individual,No,51-0353639,47783GA0510036,Coventry Silver $5 Copay 2750 HMO Hall,47783GA051,,GAN003,GAS003,GAF041,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48103,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510036-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,55,47783,GA,Individual,No,51-0353639,47783GA0510036,Coventry Silver $5 Copay 2750 HMO Hall,47783GA051,,GAN003,GAS003,GAF041,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48103,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510036-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,55,47783,GA,Individual,No,51-0353639,47783GA0510036,Coventry Silver $5 Copay 2750 HMO Hall,47783GA051,,GAN003,GAS003,GAF041,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48103,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510036-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,55,47783,GA,Individual,No,51-0353639,47783GA0510036,Coventry Silver $5 Copay 2750 HMO Hall,47783GA051,,GAN003,GAS003,GAF041,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48103,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510036-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,56,47783,GA,Individual,No,51-0353639,47783GA0510037,Coventry Silver $5 Copay 2750 HMO Macon,47783GA051,,GAN008,GAS008,GAF042,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48901,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510037-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,56,47783,GA,Individual,No,51-0353639,47783GA0510037,Coventry Silver $5 Copay 2750 HMO Macon,47783GA051,,GAN008,GAS008,GAF042,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48901,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510037-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,56,47783,GA,Individual,No,51-0353639,47783GA0510037,Coventry Silver $5 Copay 2750 HMO Macon,47783GA051,,GAN008,GAS008,GAF042,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48901,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510037-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,56,47783,GA,Individual,No,51-0353639,47783GA0510037,Coventry Silver $5 Copay 2750 HMO Macon,47783GA051,,GAN008,GAS008,GAF042,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48901,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510037-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,56,47783,GA,Individual,No,51-0353639,47783GA0510037,Coventry Silver $5 Copay 2750 HMO Macon,47783GA051,,GAN008,GAS008,GAF042,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48901,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510037-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,56,47783,GA,Individual,No,51-0353639,47783GA0510037,Coventry Silver $5 Copay 2750 HMO Macon,47783GA051,,GAN008,GAS008,GAF042,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48901,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510037-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,56,47783,GA,Individual,No,51-0353639,47783GA0510037,Coventry Silver $5 Copay 2750 HMO Macon,47783GA051,,GAN008,GAS008,GAF042,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48901,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510037-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,65,47783,GA,Individual,No,51-0353639,47783GA0510038,Coventry Silver $5 Copay 2750 HMO Savannah,47783GA051,,GAN002,GAS002,GAF043,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48923,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510038-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,65,47783,GA,Individual,No,51-0353639,47783GA0510038,Coventry Silver $5 Copay 2750 HMO Savannah,47783GA051,,GAN002,GAS002,GAF043,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48923,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510038-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,65,47783,GA,Individual,No,51-0353639,47783GA0510038,Coventry Silver $5 Copay 2750 HMO Savannah,47783GA051,,GAN002,GAS002,GAF043,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48923,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510038-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,65,47783,GA,Individual,No,51-0353639,47783GA0510038,Coventry Silver $5 Copay 2750 HMO Savannah,47783GA051,,GAN002,GAS002,GAF043,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48923,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510038-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,65,47783,GA,Individual,No,51-0353639,47783GA0510038,Coventry Silver $5 Copay 2750 HMO Savannah,47783GA051,,GAN002,GAS002,GAF043,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48923,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510038-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,65,47783,GA,Individual,No,51-0353639,47783GA0510038,Coventry Silver $5 Copay 2750 HMO Savannah,47783GA051,,GAN002,GAS002,GAF043,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48923,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510038-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,65,47783,GA,Individual,No,51-0353639,47783GA0510038,Coventry Silver $5 Copay 2750 HMO Savannah,47783GA051,,GAN002,GAS002,GAF043,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48923,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510038-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,66,47783,GA,Individual,No,51-0353639,47783GA0510039,Coventry Silver $5 Copay 2750 HMO SEGA,47783GA051,,GAN007,GAS007,GAF044,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48945,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510039-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,66,47783,GA,Individual,No,51-0353639,47783GA0510039,Coventry Silver $5 Copay 2750 HMO SEGA,47783GA051,,GAN007,GAS007,GAF044,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48945,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510039-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,66,47783,GA,Individual,No,51-0353639,47783GA0510039,Coventry Silver $5 Copay 2750 HMO SEGA,47783GA051,,GAN007,GAS007,GAF044,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48945,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510039-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,66,47783,GA,Individual,No,51-0353639,47783GA0510039,Coventry Silver $5 Copay 2750 HMO SEGA,47783GA051,,GAN007,GAS007,GAF044,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48945,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510039-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,66,47783,GA,Individual,No,51-0353639,47783GA0510039,Coventry Silver $5 Copay 2750 HMO SEGA,47783GA051,,GAN007,GAS007,GAF044,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48945,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510039-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,66,47783,GA,Individual,No,51-0353639,47783GA0510039,Coventry Silver $5 Copay 2750 HMO SEGA,47783GA051,,GAN007,GAS007,GAF044,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48945,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510039-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,66,47783,GA,Individual,No,51-0353639,47783GA0510039,Coventry Silver $5 Copay 2750 HMO SEGA,47783GA051,,GAN007,GAS007,GAF044,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48945,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510039-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,67,47783,GA,Individual,No,51-0353639,47783GA0510040,Coventry Silver $5 Copay 2750 HMO Valdosta,47783GA051,,GAN005,GAS005,GAF045,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48967,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510040-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,67,47783,GA,Individual,No,51-0353639,47783GA0510040,Coventry Silver $5 Copay 2750 HMO Valdosta,47783GA051,,GAN005,GAS005,GAF045,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48967,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510040-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,67,47783,GA,Individual,No,51-0353639,47783GA0510040,Coventry Silver $5 Copay 2750 HMO Valdosta,47783GA051,,GAN005,GAS005,GAF045,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48967,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510040-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,67,47783,GA,Individual,No,51-0353639,47783GA0510040,Coventry Silver $5 Copay 2750 HMO Valdosta,47783GA051,,GAN005,GAS005,GAF045,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48967,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510040-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,67,47783,GA,Individual,No,51-0353639,47783GA0510040,Coventry Silver $5 Copay 2750 HMO Valdosta,47783GA051,,GAN005,GAS005,GAF045,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48967,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510040-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,67,47783,GA,Individual,No,51-0353639,47783GA0510040,Coventry Silver $5 Copay 2750 HMO Valdosta,47783GA051,,GAN005,GAS005,GAF045,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48967,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510040-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,67,47783,GA,Individual,No,51-0353639,47783GA0510040,Coventry Silver $5 Copay 2750 HMO Valdosta,47783GA051,,GAN005,GAS005,GAF045,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48967,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510040-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,69,47783,GA,Individual,No,51-0353639,47783GA0510017,Coventry Gold $5 Copay HMO Albany,47783GA051,,GAN006,GAS006,GAF022,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48146,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510017-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,69,47783,GA,Individual,No,51-0353639,47783GA0510017,Coventry Gold $5 Copay HMO Albany,47783GA051,,GAN006,GAS006,GAF022,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48146,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510017-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,69,47783,GA,Individual,No,51-0353639,47783GA0510017,Coventry Gold $5 Copay HMO Albany,47783GA051,,GAN006,GAS006,GAF022,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48146,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510017-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,69,47783,GA,Individual,No,51-0353639,47783GA0510017,Coventry Gold $5 Copay HMO Albany,47783GA051,,GAN006,GAS006,GAF022,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48146,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510017-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,70,47783,GA,Individual,No,51-0353639,47783GA0510018,Coventry Gold $5 Copay HMO Atlanta,47783GA051,,GAN001,GAS001,GAF023,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48124,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510018-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,70,47783,GA,Individual,No,51-0353639,47783GA0510018,Coventry Gold $5 Copay HMO Atlanta,47783GA051,,GAN001,GAS001,GAF023,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48124,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510018-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,70,47783,GA,Individual,No,51-0353639,47783GA0510018,Coventry Gold $5 Copay HMO Atlanta,47783GA051,,GAN001,GAS001,GAF023,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48124,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510018-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,70,47783,GA,Individual,No,51-0353639,47783GA0510018,Coventry Gold $5 Copay HMO Atlanta,47783GA051,,GAN001,GAS001,GAF023,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48124,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510018-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,71,47783,GA,Individual,No,51-0353639,47783GA0510019,Coventry Gold $5 Copay HMO Columbus,47783GA051,,GAN004,GAS004,GAF024,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48168,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510019-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,71,47783,GA,Individual,No,51-0353639,47783GA0510019,Coventry Gold $5 Copay HMO Columbus,47783GA051,,GAN004,GAS004,GAF024,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48168,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510019-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,71,47783,GA,Individual,No,51-0353639,47783GA0510019,Coventry Gold $5 Copay HMO Columbus,47783GA051,,GAN004,GAS004,GAF024,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48168,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510019-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,71,47783,GA,Individual,No,51-0353639,47783GA0510019,Coventry Gold $5 Copay HMO Columbus,47783GA051,,GAN004,GAS004,GAF024,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48168,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510019-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,72,47783,GA,Individual,No,51-0353639,47783GA0510020,Coventry Gold $5 Copay HMO Hall,47783GA051,,GAN003,GAS003,GAF025,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48102,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510020-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,72,47783,GA,Individual,No,51-0353639,47783GA0510020,Coventry Gold $5 Copay HMO Hall,47783GA051,,GAN003,GAS003,GAF025,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48102,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510020-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,72,47783,GA,Individual,No,51-0353639,47783GA0510020,Coventry Gold $5 Copay HMO Hall,47783GA051,,GAN003,GAS003,GAF025,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48102,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510020-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,72,47783,GA,Individual,No,51-0353639,47783GA0510020,Coventry Gold $5 Copay HMO Hall,47783GA051,,GAN003,GAS003,GAF025,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48102,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510020-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,73,47783,GA,Individual,No,51-0353639,47783GA0510021,Coventry Gold $5 Copay HMO Macon,47783GA051,,GAN008,GAS008,GAF026,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48900,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510021-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,73,47783,GA,Individual,No,51-0353639,47783GA0510021,Coventry Gold $5 Copay HMO Macon,47783GA051,,GAN008,GAS008,GAF026,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48900,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510021-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,73,47783,GA,Individual,No,51-0353639,47783GA0510021,Coventry Gold $5 Copay HMO Macon,47783GA051,,GAN008,GAS008,GAF026,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48900,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510021-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,73,47783,GA,Individual,No,51-0353639,47783GA0510021,Coventry Gold $5 Copay HMO Macon,47783GA051,,GAN008,GAS008,GAF026,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48900,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510021-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,82,47783,GA,Individual,No,51-0353639,47783GA0510022,Coventry Gold $5 Copay HMO Savannah,47783GA051,,GAN002,GAS002,GAF027,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48922,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510022-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,82,47783,GA,Individual,No,51-0353639,47783GA0510022,Coventry Gold $5 Copay HMO Savannah,47783GA051,,GAN002,GAS002,GAF027,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48922,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510022-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,82,47783,GA,Individual,No,51-0353639,47783GA0510022,Coventry Gold $5 Copay HMO Savannah,47783GA051,,GAN002,GAS002,GAF027,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48922,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510022-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,82,47783,GA,Individual,No,51-0353639,47783GA0510022,Coventry Gold $5 Copay HMO Savannah,47783GA051,,GAN002,GAS002,GAF027,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48922,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510022-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,83,47783,GA,Individual,No,51-0353639,47783GA0510023,Coventry Gold $5 Copay HMO SEGA,47783GA051,,GAN007,GAS007,GAF028,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48944,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510023-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,83,47783,GA,Individual,No,51-0353639,47783GA0510023,Coventry Gold $5 Copay HMO SEGA,47783GA051,,GAN007,GAS007,GAF028,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48944,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510023-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,83,47783,GA,Individual,No,51-0353639,47783GA0510023,Coventry Gold $5 Copay HMO SEGA,47783GA051,,GAN007,GAS007,GAF028,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48944,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510023-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,83,47783,GA,Individual,No,51-0353639,47783GA0510023,Coventry Gold $5 Copay HMO SEGA,47783GA051,,GAN007,GAS007,GAF028,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48944,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510023-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,84,47783,GA,Individual,No,51-0353639,47783GA0510024,Coventry Gold $5 Copay HMO Valdosta,47783GA051,,GAN005,GAS005,GAF029,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48966,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510024-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,84,47783,GA,Individual,No,51-0353639,47783GA0510024,Coventry Gold $5 Copay HMO Valdosta,47783GA051,,GAN005,GAS005,GAF029,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48966,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510024-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,84,47783,GA,Individual,No,51-0353639,47783GA0510024,Coventry Gold $5 Copay HMO Valdosta,47783GA051,,GAN005,GAS005,GAF029,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48966,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510024-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,GA,47783,HIOS,4,2014-09-06 03:39:47,84,47783,GA,Individual,No,51-0353639,47783GA0510024,Coventry Gold $5 Copay HMO Valdosta,47783GA051,,GAN005,GAS005,GAF029,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/GA48966,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOGA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,47783GA0510024-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,48132,HIOS,3,2014-09-05 03:32:16,1,48132,GA,SHOP (Small Group),Yes,81-0170040,48132GA0010001,Assurant Dental ACAFFO High,48132GA001,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$41.76,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same coverage as in service area,Yes,,,,,48132GA0010001-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,48132,HIOS,3,2014-09-05 03:32:16,2,48132,GA,SHOP (Small Group),Yes,81-0170040,48132GA0010002,Assurant Dental ACAFFO Low,48132GA001,,GAN001,GAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.80,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same coverage as in service area,Yes,,,,,48132GA0010002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,Individual,No,58-1638390,49046GA0410014,BCBSHP Catastrophic Pathway X HMO 6600 0,49046GA041,,GAN002,GAS001,GAF001,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G59,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410014-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420004,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS002,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984414808149623,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420004-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420004,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS002,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984414808149623,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420004-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,Individual,No,58-1638390,49046GA0410014,BCBSHP Catastrophic Pathway X HMO 6600 0,49046GA041,,GAN002,GAS001,GAF001,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G59,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410014-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420005,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS003,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984362020228089,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420005-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420005,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS003,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984362020228089,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420005-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420006,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS004,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984375070854391,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420006-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420006,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS004,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984375070854391,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420006-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420007,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS005,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984393579954628,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420007-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420007,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS005,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984393579954628,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420007-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420008,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS006,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984374468594424,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420008-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420008,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS006,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984374468594424,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420008-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420009,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS007,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984400023766318,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420009-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420009,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS007,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984400023766318,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420009-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420051,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS017,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975471989892847,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420051-00,Standard Bronze Off Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,34
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420051,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS017,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975471989892847,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420051-01,Standard Bronze On Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,35
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,4,49046,GA,Individual,No,58-1638390,49046GA0410017,BCBSHP Bronze Pathway X HMO 4300 20,49046GA041,,GAN002,GAS001,GAF002,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5H,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410017-00,Standard Bronze Off Exchange Plan,61.56%,0.619325935840607,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,4,49046,GA,Individual,No,58-1638390,49046GA0410017,BCBSHP Bronze Pathway X HMO 4300 20,49046GA041,,GAN002,GAS001,GAF002,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5H,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410017-01,Standard Bronze On Exchange Plan,61.56%,0.619325935840607,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,4,49046,GA,Individual,No,58-1638390,49046GA0410017,BCBSHP Bronze Pathway X HMO 4300 20,49046GA041,,GAN002,GAS001,GAF002,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5H,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410017-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,4,49046,GA,Individual,No,58-1638390,49046GA0410017,BCBSHP Bronze Pathway X HMO 4300 20,49046GA041,,GAN002,GAS001,GAF002,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5H,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410017-03,Limited Cost Sharing Plan Variation,61.56%,0.619325935840607,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,5,49046,GA,Individual,No,58-1638390,49046GA0410018,BCBSHP Silver Pathway X HMO 3500 0,49046GA041,,GAN002,GAS001,GAF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5L,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410018-00,Standard Silver Off Exchange Plan,68.16%,0.673658967018127,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,5,49046,GA,Individual,No,58-1638390,49046GA0410018,BCBSHP Silver Pathway X HMO 3500 0,49046GA041,,GAN002,GAS001,GAF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5L,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410018-01,Standard Silver On Exchange Plan,68.16%,0.673658967018127,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,5,49046,GA,Individual,No,58-1638390,49046GA0410018,BCBSHP Silver Pathway X HMO 3500 0,49046GA041,,GAN002,GAS001,GAF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5L,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410018-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,5,49046,GA,Individual,No,58-1638390,49046GA0410018,BCBSHP Silver Pathway X HMO 3500 0,49046GA041,,GAN002,GAS001,GAF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5L,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410018-03,Limited Cost Sharing Plan Variation,68.16%,0.673658967018127,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420010,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS008,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984381936093971,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420010-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420010,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS008,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984381936093971,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420010-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420011,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS009,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984367097181557,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420011-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420011,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS009,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984367097181557,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420011-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,19
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420012,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS010,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984370590938366,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420012-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420012,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS010,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984370590938366,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420012-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420013,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS011,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984397264591763,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420013-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420013,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS011,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984397264591763,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420013-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,23
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420014,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS012,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984393809373326,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420014-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,24
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420014,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS012,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984393809373326,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420014-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,25
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420038,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS004,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975487552214482,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420038-00,Standard Bronze Off Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,8
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420038,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS004,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975487552214482,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420038-01,Standard Bronze On Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,9
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420039,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS005,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975516589360755,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420039-00,Standard Bronze Off Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,10
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420039,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS005,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975516589360755,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420039-01,Standard Bronze On Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,11
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420041,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS007,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975526698436842,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420041-00,Standard Bronze Off Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,14
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420041,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS007,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975526698436842,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420041-01,Standard Bronze On Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,15
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,Individual,No,58-1638390,49046GA0410016,BCBSHP Bronze Pathway X HMO 20 for HSA,49046GA041,,GAN002,GAS001,GAF002,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5E,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410016-01,Standard Bronze On Exchange Plan,61.00%,0.613896250724792,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420036,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS002,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975549892233142,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420036-01,Standard Bronze On Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,5
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420042,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS008,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975498322428233,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420042-00,Standard Bronze Off Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,16
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420042,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS008,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975498322428233,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420042-01,Standard Bronze On Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,17
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420043,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS009,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.97547504308646,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420043-00,Standard Bronze Off Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,18
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420043,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS009,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.97547504308646,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420043-01,Standard Bronze On Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,19
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420044,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS010,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975480524105322,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420044-00,Standard Bronze Off Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,20
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420044,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS010,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975480524105322,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420044-01,Standard Bronze On Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,21
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420015,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS013,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984376848797732,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420015-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,26
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420015,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS013,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984376848797732,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420015-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,27
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420040,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS006,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975486607386773,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420040-00,Standard Bronze Off Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,12
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420040,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS006,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975486607386773,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420040-01,Standard Bronze On Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,13
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420016,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS014,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984388105944116,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420016-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,28
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420016,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS014,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984388105944116,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420016-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,29
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420017,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS015,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984380836301283,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420017-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,30
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420017,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS015,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984380836301283,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420017-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,31
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420018,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS016,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984406507535019,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420018-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,32
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420018,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS016,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.984406507535019,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420018-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,33
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420019,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS017,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98436515098939,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420019-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,34
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,1,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420019,BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus,49046GA042,,GAN004,GAS017,GAF023,Existing,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98436515098939,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEK,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420019-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,35
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420020,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS002,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98031516254681,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420020-00,Standard Silver Off Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,4
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,Individual,No,58-1638390,49046GA0410015,BCBSHP Bronze Pathway X HMO 0 for HSA,49046GA041,,GAN002,GAS001,GAF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5B,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410015-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,Individual,No,58-1638390,49046GA0410015,BCBSHP Bronze Pathway X HMO 0 for HSA,49046GA041,,GAN002,GAS001,GAF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5B,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410015-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420020,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS002,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98031516254681,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420020-01,Standard Silver On Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,5
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420021,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS003,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980248488894996,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420021-00,Standard Silver Off Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,6
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,Individual,No,58-1638390,49046GA0410015,BCBSHP Bronze Pathway X HMO 0 for HSA,49046GA041,,GAN002,GAS001,GAF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5B,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410015-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,Individual,No,58-1638390,49046GA0410015,BCBSHP Bronze Pathway X HMO 0 for HSA,49046GA041,,GAN002,GAS001,GAF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5B,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410015-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420021,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS003,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980248488894996,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420021-01,Standard Silver On Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,7
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420022,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS004,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980264972455794,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420022-00,Standard Silver Off Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,8
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420022,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS004,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980264972455794,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420022-01,Standard Silver On Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,9
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420023,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS005,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980288350328397,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420023-00,Standard Silver Off Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,10
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420023,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS005,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980288350328397,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420023-01,Standard Silver On Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,11
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420024,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS006,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980264211772854,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420024-00,Standard Silver Off Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,12
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420024,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS006,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980264211772854,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420024-01,Standard Silver On Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,13
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420025,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS007,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98029648916858,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420025-00,Standard Silver Off Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,14
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420025,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS007,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98029648916858,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420025-01,Standard Silver On Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,15
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420026,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS008,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980273643579417,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420026-00,Standard Silver Off Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,16
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420026,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS008,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980273643579417,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420026-01,Standard Silver On Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,17
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420027,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS009,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980254901328332,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420027-00,Standard Silver Off Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,18
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420027,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS009,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980254901328332,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420027-01,Standard Silver On Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,19
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420028,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS010,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980259314109102,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420028-00,Standard Silver Off Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,20
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420028,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS010,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980259314109102,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420028-01,Standard Silver On Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,21
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420029,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS011,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980293004200084,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420029-00,Standard Silver Off Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,22
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420029,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS011,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980293004200084,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420029-01,Standard Silver On Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,23
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420030,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS012,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980288640095108,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420030-00,Standard Silver Off Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,24
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420030,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS012,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980288640095108,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420030-01,Standard Silver On Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,25
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420031,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS013,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980267218082669,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420031-00,Standard Silver Off Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,26
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420031,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS013,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980267218082669,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420031-01,Standard Silver On Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,27
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420032,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS014,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980281436393158,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420032-00,Standard Silver Off Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,28
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420032,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS014,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980281436393158,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420032-01,Standard Silver On Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,29
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420033,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS015,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980272254489022,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420033-00,Standard Silver Off Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,30
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420033,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS015,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980272254489022,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420033-01,Standard Silver On Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,31
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420034,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS016,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980304678476366,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420034-00,Standard Silver Off Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,32
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420034,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS016,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.980304678476366,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420034-01,Standard Silver On Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,33
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420035,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS017,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9802524431952,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420035-00,Standard Silver Off Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,34
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,2,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420035,BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus,49046GA042,,GAN004,GAS017,GAF023,Existing,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9802524431952,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KEJ,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420035-01,Standard Silver On Exchange Plan,69.63%,0.725308239459991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,35
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420036,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS002,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975549892233142,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420036-00,Standard Bronze Off Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,4
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,Individual,No,58-1638390,49046GA0410016,BCBSHP Bronze Pathway X HMO 20 for HSA,49046GA041,,GAN002,GAS001,GAF002,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5E,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410016-00,Standard Bronze Off Exchange Plan,61.00%,0.613896250724792,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420037,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS003,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975467078342707,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420037-00,Standard Bronze Off Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,6
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,Individual,No,58-1638390,49046GA0410016,BCBSHP Bronze Pathway X HMO 20 for HSA,49046GA041,,GAN002,GAS001,GAF002,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5E,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410016-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,Individual,No,58-1638390,49046GA0410016,BCBSHP Bronze Pathway X HMO 20 for HSA,49046GA041,,GAN002,GAS001,GAF002,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5E,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410016-03,Limited Cost Sharing Plan Variation,61.00%,0.613896250724792,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420037,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS003,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975467078342707,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420037-01,Standard Bronze On Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,7
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420045,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS011,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975522369833393,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420045-00,Standard Bronze Off Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,22
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420045,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS011,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975522369833393,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420045-01,Standard Bronze On Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,23
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420046,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS012,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975516949273674,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420046-00,Standard Bronze Off Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,24
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420046,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS012,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975516949273674,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420046-01,Standard Bronze On Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,25
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420047,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS013,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975490341458702,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420047-00,Standard Bronze Off Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,26
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420047,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS013,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975490341458702,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420047-01,Standard Bronze On Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,27
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420048,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS014,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975508001712415,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420048-00,Standard Bronze Off Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,28
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420048,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS014,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975508001712415,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420048-01,Standard Bronze On Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,29
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420049,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS015,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975496597069315,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420049-00,Standard Bronze Off Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,30
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420049,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS015,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975496597069315,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420049-01,Standard Bronze On Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,31
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,10,49046,GA,Individual,No,58-1638390,49046GA0410023,BCBSHP Silver Pathway X HMO 2000 25,49046GA041,,GAN002,GAS001,GAF019,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6K,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410023-01,Standard Silver On Exchange Plan,68.20%,0.687045156955719,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,10,49046,GA,Individual,No,58-1638390,49046GA0410023,BCBSHP Silver Pathway X HMO 2000 25,49046GA041,,GAN002,GAS001,GAF019,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6K,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410023-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,10,49046,GA,Individual,No,58-1638390,49046GA0410023,BCBSHP Silver Pathway X HMO 2000 25,49046GA041,,GAN002,GAS001,GAF019,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6K,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410023-03,Limited Cost Sharing Plan Variation,68.20%,0.687045156955719,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,10,49046,GA,Individual,No,58-1638390,49046GA0410023,BCBSHP Silver Pathway X HMO 2000 25,49046GA041,,GAN002,GAS001,GAF019,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6K,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410023-04,73% AV Level Silver Plan,72.11%,0.725008428096771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,10,49046,GA,Individual,No,58-1638390,49046GA0410023,BCBSHP Silver Pathway X HMO 2000 25,49046GA041,,GAN002,GAS001,GAF019,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6K,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410023-05,87% AV Level Silver Plan,86.06%,0.862100780010223,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,10,49046,GA,Individual,No,58-1638390,49046GA0410023,BCBSHP Silver Pathway X HMO 2000 25,49046GA041,,GAN002,GAS001,GAF019,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6K,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410023-06,94% AV Level Silver Plan,93.07%,0.931342959403992,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420050,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS016,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975536870197639,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420050-00,Standard Bronze Off Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,32
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,3,49046,GA,SHOP (Small Group),No,58-1638390,49046GA0420050,BCBSHP Bronze Pathway X Enhanced POS 5000 30 6600 Plus,49046GA042,,GAN004,GAS016,GAF023,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.975536870197639,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage for Urgent and Emergency care Only,Yes,Follows OON Coverage for Urgent and Emergency care Only,No,http://www.sbc.anthem.com/dps/CCD1KDG,,http://sgplans.bcbsga.com/brochure/,www.bcbsga.com/GASelectdrugtier4,49046GA0420050-01,Standard Bronze On Exchange Plan,61.74%,0.646054625511169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$500,"$1,000",$500,"$1,000",,,,,,,,,,,,,,,,,,,33
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,1,50491,GA,Individual,Yes,59-1031071,50491GA0030001,myCigna Dental Pediatric,50491GA003,7730182962,GAN002,GAS002,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$21.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,,,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/dental-pediatric,,50491GA0030001-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$150,$300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,1,50491,GA,Individual,No,59-1031071,50491GA0020001,myCigna Health Savings 6000,50491GA002,7730182962,GAN001,GAS001,GAF001,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-savings-6000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-savings-6000,http://www.cigna.com/ifp-drug-list,50491GA0020001-01,Standard Bronze On Exchange Plan,58.70%,0.586669623851776,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,1,50491,GA,Individual,No,59-1031071,50491GA0020001,myCigna Health Savings 6000,50491GA002,7730182962,GAN001,GAS001,GAF001,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-savings-6000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-savings-6000,http://www.cigna.com/ifp-drug-list,50491GA0020001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,1,50491,GA,Individual,No,59-1031071,50491GA0020001,myCigna Health Savings 6000,50491GA002,7730182962,GAN001,GAS001,GAF001,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-savings-6000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-savings-6000,http://www.cigna.com/ifp-drug-list,50491GA0020001-03,Limited Cost Sharing Plan Variation,58.70%,0.586669623851776,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,1,50491,GA,Individual,No,59-1031071,50491GA0020003,myCigna Health Savings 3400,50491GA002,7730182962,GAN001,GAS001,GAF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-savings-3400,http://www.cigna.com/ifp-drug-list,50491GA0020003-00,Standard Silver Off Exchange Plan,68.60%,0.68620365858078,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,1,50491,GA,Individual,No,59-1031071,50491GA0020003,myCigna Health Savings 3400,50491GA002,7730182962,GAN001,GAS001,GAF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-savings-3400,http://www.cigna.com/ifp-drug-list,50491GA0020003-01,Standard Silver On Exchange Plan,68.60%,0.68620365858078,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,1,50491,GA,Individual,No,59-1031071,50491GA0020003,myCigna Health Savings 3400,50491GA002,7730182962,GAN001,GAS001,GAF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-savings-3400,http://www.cigna.com/ifp-drug-list,50491GA0020003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,1,50491,GA,Individual,No,59-1031071,50491GA0020003,myCigna Health Savings 3400,50491GA002,7730182962,GAN001,GAS001,GAF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-savings-3400,http://www.cigna.com/ifp-drug-list,50491GA0020003-03,Limited Cost Sharing Plan Variation,68.60%,0.68620365858078,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,1,50491,GA,Individual,No,59-1031071,50491GA0020003,myCigna Health Savings 3400,50491GA002,7730182962,GAN001,GAS001,GAF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-savings-3400,http://www.cigna.com/ifp-drug-list,50491GA0020003-04,73% AV Level Silver Plan,73.40%,0.733710885047913,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,1,50491,GA,Individual,No,59-1031071,50491GA0020003,myCigna Health Savings 3400,50491GA002,7730182962,GAN001,GAS001,GAF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-savings-3400,http://www.cigna.com/ifp-drug-list,50491GA0020003-05,87% AV Level Silver Plan,86.80%,0.867887914180756,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,1,50491,GA,Individual,No,59-1031071,50491GA0020003,myCigna Health Savings 3400,50491GA002,7730182962,GAN001,GAS001,GAF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-savings-3400,http://www.cigna.com/ifp-drug-list,50491GA0020003-06,94% AV Level Silver Plan,94.50%,0.944562971591949,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$350,$700,0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,2,50491,GA,Individual,No,59-1031071,50491GA0020002,myCigna Health Flex 5000 Bronze,50491GA002,7730182962,GAN001,GAS001,GAF008,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-flex-5000,http://www.cigna.com/ifp-drug-list,50491GA0020002-00,Standard Bronze Off Exchange Plan,61.80%,0.634452104568481,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,2,50491,GA,Individual,No,59-1031071,50491GA0020002,myCigna Health Flex 5000 Bronze,50491GA002,7730182962,GAN001,GAS001,GAF008,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-flex-5000,http://www.cigna.com/ifp-drug-list,50491GA0020002-01,Standard Bronze On Exchange Plan,61.80%,0.634452104568481,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,2,50491,GA,Individual,No,59-1031071,50491GA0020002,myCigna Health Flex 5000 Bronze,50491GA002,7730182962,GAN001,GAS001,GAF008,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-flex-5000,http://www.cigna.com/ifp-drug-list,50491GA0020002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,2,50491,GA,Individual,No,59-1031071,50491GA0020002,myCigna Health Flex 5000 Bronze,50491GA002,7730182962,GAN001,GAS001,GAF008,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-flex-5000,http://www.cigna.com/ifp-drug-list,50491GA0020002-03,Limited Cost Sharing Plan Variation,61.80%,0.634452104568481,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,3,50491,GA,Individual,No,59-1031071,50491GA0020005,myCigna Health Flex 3000,50491GA002,7730182962,GAN001,GAS001,GAF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-flex-3000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-flex-3000,http://www.cigna.com/ifp-drug-list,50491GA0020005-00,Standard Silver Off Exchange Plan,68.20%,0.689550042152405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,3,50491,GA,Individual,No,59-1031071,50491GA0020005,myCigna Health Flex 3000,50491GA002,7730182962,GAN001,GAS001,GAF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-flex-3000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-flex-3000,http://www.cigna.com/ifp-drug-list,50491GA0020005-01,Standard Silver On Exchange Plan,68.20%,0.689550042152405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,3,50491,GA,Individual,No,59-1031071,50491GA0020005,myCigna Health Flex 3000,50491GA002,7730182962,GAN001,GAS001,GAF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-flex-3000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-flex-3000,http://www.cigna.com/ifp-drug-list,50491GA0020005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,3,50491,GA,Individual,No,59-1031071,50491GA0020005,myCigna Health Flex 3000,50491GA002,7730182962,GAN001,GAS001,GAF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-flex-3000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-flex-3000,http://www.cigna.com/ifp-drug-list,50491GA0020005-03,Limited Cost Sharing Plan Variation,68.20%,0.689550042152405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,3,50491,GA,Individual,No,59-1031071,50491GA0020005,myCigna Health Flex 3000,50491GA002,7730182962,GAN001,GAS001,GAF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-flex-3000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-flex-3000,http://www.cigna.com/ifp-drug-list,50491GA0020005-04,73% AV Level Silver Plan,72.50%,0.732597887516022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,3,50491,GA,Individual,No,59-1031071,50491GA0020005,myCigna Health Flex 3000,50491GA002,7730182962,GAN001,GAS001,GAF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-flex-3000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-flex-3000,http://www.cigna.com/ifp-drug-list,50491GA0020005-05,87% AV Level Silver Plan,87.40%,0.879521429538727,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,3,50491,GA,Individual,No,59-1031071,50491GA0020005,myCigna Health Flex 3000,50491GA002,7730182962,GAN001,GAS001,GAF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-flex-3000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-flex-3000,http://www.cigna.com/ifp-drug-list,50491GA0020005-06,94% AV Level Silver Plan,93.40%,0.937678992748261,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$425,$850,,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,5,49046,GA,Individual,No,58-1638390,49046GA0410018,BCBSHP Silver Pathway X HMO 3500 0,49046GA041,,GAN002,GAS001,GAF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5L,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410018-04,73% AV Level Silver Plan,72.33%,0.713923513889313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,5,49046,GA,Individual,No,58-1638390,49046GA0410018,BCBSHP Silver Pathway X HMO 3500 0,49046GA041,,GAN002,GAS001,GAF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5L,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410018-05,87% AV Level Silver Plan,86.09%,0.858777821063995,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$800,"$1,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,5,49046,GA,Individual,No,58-1638390,49046GA0410018,BCBSHP Silver Pathway X HMO 3500 0,49046GA041,,GAN002,GAS001,GAF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5L,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410018-06,94% AV Level Silver Plan,93.26%,0.930816173553467,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,6,49046,GA,Individual,No,58-1638390,49046GA0410019,BCBSHP Silver Pathway X HMO 10 for HSA,49046GA041,,GAN002,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5S,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410019-00,Standard Silver Off Exchange Plan,68.04%,0.683273017406464,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,200","$6,400",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,6,49046,GA,Individual,No,58-1638390,49046GA0410019,BCBSHP Silver Pathway X HMO 10 for HSA,49046GA041,,GAN002,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5S,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410019-01,Standard Silver On Exchange Plan,68.04%,0.683273017406464,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,200","$6,400",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,6,49046,GA,Individual,No,58-1638390,49046GA0410019,BCBSHP Silver Pathway X HMO 10 for HSA,49046GA041,,GAN002,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5S,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410019-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,6,49046,GA,Individual,No,58-1638390,49046GA0410019,BCBSHP Silver Pathway X HMO 10 for HSA,49046GA041,,GAN002,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5S,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410019-03,Limited Cost Sharing Plan Variation,68.04%,0.683273017406464,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,200","$6,400",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,6,49046,GA,Individual,No,58-1638390,49046GA0410019,BCBSHP Silver Pathway X HMO 10 for HSA,49046GA041,,GAN002,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5S,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410019-04,73% AV Level Silver Plan,72.80%,0.732296049594879,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,6,49046,GA,Individual,No,58-1638390,49046GA0410019,BCBSHP Silver Pathway X HMO 10 for HSA,49046GA041,,GAN002,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5S,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410019-05,87% AV Level Silver Plan,86.17%,0.861683309078217,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,6,49046,GA,Individual,No,58-1638390,49046GA0410019,BCBSHP Silver Pathway X HMO 10 for HSA,49046GA041,,GAN002,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5S,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410019-06,94% AV Level Silver Plan,93.27%,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,7,49046,GA,Individual,No,58-1638390,49046GA0410020,BCBSHP Silver Pathway X HMO 3000 10,49046GA041,,GAN002,GAS001,GAF008,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5Y,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410020-00,Standard Silver Off Exchange Plan,68.39%,0.691072702407837,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,7,49046,GA,Individual,No,58-1638390,49046GA0410020,BCBSHP Silver Pathway X HMO 3000 10,49046GA041,,GAN002,GAS001,GAF008,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5Y,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410020-01,Standard Silver On Exchange Plan,68.39%,0.691072702407837,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,7,49046,GA,Individual,No,58-1638390,49046GA0410020,BCBSHP Silver Pathway X HMO 3000 10,49046GA041,,GAN002,GAS001,GAF008,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5Y,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410020-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,7,49046,GA,Individual,No,58-1638390,49046GA0410020,BCBSHP Silver Pathway X HMO 3000 10,49046GA041,,GAN002,GAS001,GAF008,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5Y,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410020-03,Limited Cost Sharing Plan Variation,68.39%,0.691072702407837,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,7,49046,GA,Individual,No,58-1638390,49046GA0410020,BCBSHP Silver Pathway X HMO 3000 10,49046GA041,,GAN002,GAS001,GAF008,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5Y,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410020-04,73% AV Level Silver Plan,72.75%,0.733580350875854,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,450","$4,900",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,7,49046,GA,Individual,No,58-1638390,49046GA0410020,BCBSHP Silver Pathway X HMO 3000 10,49046GA041,,GAN002,GAS001,GAF008,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5Y,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410020-05,87% AV Level Silver Plan,86.06%,0.862670540809631,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,7,49046,GA,Individual,No,58-1638390,49046GA0410020,BCBSHP Silver Pathway X HMO 3000 10,49046GA041,,GAN002,GAS001,GAF008,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G5Y,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410020-06,94% AV Level Silver Plan,93.03%,0.931498229503632,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,8,49046,GA,Individual,No,58-1638390,49046GA0410021,BCBSHP Bronze Pathway X HMO 30 for HSA,49046GA041,,GAN002,GAS001,GAF017,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6D,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410021-00,Standard Bronze Off Exchange Plan,58.43%,0.585941195487976,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,8,49046,GA,Individual,No,58-1638390,49046GA0410021,BCBSHP Bronze Pathway X HMO 30 for HSA,49046GA041,,GAN002,GAS001,GAF017,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6D,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410021-01,Standard Bronze On Exchange Plan,58.43%,0.585941195487976,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,8,49046,GA,Individual,No,58-1638390,49046GA0410021,BCBSHP Bronze Pathway X HMO 30 for HSA,49046GA041,,GAN002,GAS001,GAF017,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6D,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410021-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,8,49046,GA,Individual,No,58-1638390,49046GA0410021,BCBSHP Bronze Pathway X HMO 30 for HSA,49046GA041,,GAN002,GAS001,GAF017,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6D,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410021-03,Limited Cost Sharing Plan Variation,58.43%,0.585941195487976,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,9,49046,GA,Individual,No,58-1638390,49046GA0410022,BCBSHP Bronze Pathway X HMO 5500 40,49046GA041,,GAN002,GAS001,GAF018,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6G,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410022-00,Standard Bronze Off Exchange Plan,58.89%,0.5899378657341,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,9,49046,GA,Individual,No,58-1638390,49046GA0410022,BCBSHP Bronze Pathway X HMO 5500 40,49046GA041,,GAN002,GAS001,GAF018,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6G,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410022-01,Standard Bronze On Exchange Plan,58.89%,0.5899378657341,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,9,49046,GA,Individual,No,58-1638390,49046GA0410022,BCBSHP Bronze Pathway X HMO 5500 40,49046GA041,,GAN002,GAS001,GAF018,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6G,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410022-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,9,49046,GA,Individual,No,58-1638390,49046GA0410022,BCBSHP Bronze Pathway X HMO 5500 40,49046GA041,,GAN002,GAS001,GAF018,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6G,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410022-03,Limited Cost Sharing Plan Variation,58.89%,0.5899378657341,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,10,49046,GA,Individual,No,58-1638390,49046GA0410023,BCBSHP Silver Pathway X HMO 2000 25,49046GA041,,GAN002,GAS001,GAF019,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6K,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410023-00,Standard Silver Off Exchange Plan,68.20%,0.687045156955719,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,11,49046,GA,Individual,No,58-1638390,49046GA0410024,BCBSHP Silver Pathway X HMO 3500 25,49046GA041,,GAN002,GAS001,GAF020,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6R,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410024-00,Standard Silver Off Exchange Plan,68.01%,0.680074274539948,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,11,49046,GA,Individual,No,58-1638390,49046GA0410024,BCBSHP Silver Pathway X HMO 3500 25,49046GA041,,GAN002,GAS001,GAF020,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6R,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410024-01,Standard Silver On Exchange Plan,68.01%,0.680074274539948,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,11,49046,GA,Individual,No,58-1638390,49046GA0410024,BCBSHP Silver Pathway X HMO 3500 25,49046GA041,,GAN002,GAS001,GAF020,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6R,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410024-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,11,49046,GA,Individual,No,58-1638390,49046GA0410024,BCBSHP Silver Pathway X HMO 3500 25,49046GA041,,GAN002,GAS001,GAF020,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6R,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410024-03,Limited Cost Sharing Plan Variation,68.01%,0.680074274539948,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,11,49046,GA,Individual,No,58-1638390,49046GA0410024,BCBSHP Silver Pathway X HMO 3500 25,49046GA041,,GAN002,GAS001,GAF020,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6R,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410024-04,73% AV Level Silver Plan,72.13%,0.73201721906662,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,650","$9,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,250","$4,500",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,11,49046,GA,Individual,No,58-1638390,49046GA0410024,BCBSHP Silver Pathway X HMO 3500 25,49046GA041,,GAN002,GAS001,GAF020,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6R,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410024-05,87% AV Level Silver Plan,86.27%,0.86702036857605,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,GA,49046,HIOS,19,2015-01-16 17:32:32,11,49046,GA,Individual,No,58-1638390,49046GA0410024,BCBSHP Silver Pathway X HMO 3500 25,49046GA041,,GAN002,GAS001,GAF020,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6R,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0410024-06,94% AV Level Silver Plan,93.16%,0.933961749076843,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,1,50491,GA,Individual,No,59-1031071,50491GA0020001,myCigna Health Savings 6000,50491GA002,7730182962,GAN001,GAS001,GAF001,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-savings-6000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-savings-6000,http://www.cigna.com/ifp-drug-list,50491GA0020001-00,Standard Bronze Off Exchange Plan,58.70%,0.586669623851776,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,3,50491,GA,Individual,No,59-1031071,50491GA0020004,myCigna Health Flex 2000,50491GA002,7730182962,GAN001,GAS001,GAF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-flex-2000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-flex-2000,http://www.cigna.com/ifp-drug-list,50491GA0020004-00,Standard Silver Off Exchange Plan,71.30%,0.720799505710602,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,3,50491,GA,Individual,No,59-1031071,50491GA0020004,myCigna Health Flex 2000,50491GA002,7730182962,GAN001,GAS001,GAF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-flex-2000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-flex-2000,http://www.cigna.com/ifp-drug-list,50491GA0020004-01,Standard Silver On Exchange Plan,71.30%,0.720799505710602,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,3,50491,GA,Individual,No,59-1031071,50491GA0020004,myCigna Health Flex 2000,50491GA002,7730182962,GAN001,GAS001,GAF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-flex-2000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-flex-2000,http://www.cigna.com/ifp-drug-list,50491GA0020004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,3,50491,GA,Individual,No,59-1031071,50491GA0020004,myCigna Health Flex 2000,50491GA002,7730182962,GAN001,GAS001,GAF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-flex-2000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-flex-2000,http://www.cigna.com/ifp-drug-list,50491GA0020004-03,Limited Cost Sharing Plan Variation,71.30%,0.720799505710602,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,3,50491,GA,Individual,No,59-1031071,50491GA0020004,myCigna Health Flex 2000,50491GA002,7730182962,GAN001,GAS001,GAF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-flex-2000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-flex-2000,http://www.cigna.com/ifp-drug-list,50491GA0020004-04,73% AV Level Silver Plan,73.50%,0.742109835147858,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,3,50491,GA,Individual,No,59-1031071,50491GA0020004,myCigna Health Flex 2000,50491GA002,7730182962,GAN001,GAS001,GAF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-flex-2000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-flex-2000,http://www.cigna.com/ifp-drug-list,50491GA0020004-05,87% AV Level Silver Plan,87.70%,0.884138882160187,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,3,50491,GA,Individual,No,59-1031071,50491GA0020004,myCigna Health Flex 2000,50491GA002,7730182962,GAN001,GAS001,GAF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-flex-2000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-flex-2000,http://www.cigna.com/ifp-drug-list,50491GA0020004-06,94% AV Level Silver Plan,94.10%,0.942396461963654,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,3,50491,GA,Individual,No,59-1031071,50491GA0020006,myCigna Health Flex 1000,50491GA002,7730182962,GAN001,GAS001,GAF007,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-flex-1000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-flex-1000,http://www.cigna.com/ifp-drug-list,50491GA0020006-00,Standard Gold Off Exchange Plan,78.20%,0.785270154476166,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,3,50491,GA,Individual,No,59-1031071,50491GA0020006,myCigna Health Flex 1000,50491GA002,7730182962,GAN001,GAS001,GAF007,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-flex-1000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-flex-1000,http://www.cigna.com/ifp-drug-list,50491GA0020006-01,Standard Gold On Exchange Plan,78.20%,0.785270154476166,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,3,50491,GA,Individual,No,59-1031071,50491GA0020006,myCigna Health Flex 1000,50491GA002,7730182962,GAN001,GAS001,GAF007,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-flex-1000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-flex-1000,http://www.cigna.com/ifp-drug-list,50491GA0020006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,GA,50491,HIOS,11,2015-01-16 17:32:32,3,50491,GA,Individual,No,59-1031071,50491GA0020006,myCigna Health Flex 1000,50491GA002,7730182962,GAN001,GAS001,GAF007,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/georgia-localplus/health-flex-1000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/georgia-localplus/health-flex-1000,http://www.cigna.com/ifp-drug-list,50491GA0020006-03,Limited Cost Sharing Plan Variation,78.20%,0.785270154476166,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,GA,50662,HIOS,4,2014-09-04 03:25:43,1,50662,GA,SHOP (Small Group),Yes,35-0472300,50662GA0010001,Lincoln Dental Connect?,50662GA001,,GAN001,GAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.82,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,50662GA0010001-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,50662,HIOS,4,2014-09-04 03:25:43,1,50662,GA,SHOP (Small Group),Yes,35-0472300,50662GA0010002,Lincoln Dental Connect?,50662GA001,,GAN001,GAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.64,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,50662GA0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,50662,HIOS,4,2014-09-04 03:25:43,1,50662,GA,SHOP (Small Group),Yes,35-0472300,50662GA0010003,Lincoln Dental Connect?,50662GA001,,GAN001,GAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.07,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,50662GA0010003-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,GA,50662,HIOS,4,2014-09-04 03:25:43,1,50662,GA,SHOP (Small Group),Yes,35-0472300,50662GA0010005,Lincoln Dental Connect?,50662GA001,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.71,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,50662GA0010005-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,GA,50662,HIOS,4,2014-09-04 03:25:43,1,50662,GA,SHOP (Small Group),Yes,35-0472300,50662GA0010006,Lincoln Dental Connect?,50662GA001,,GAN001,GAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.41,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,50662GA0010006-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,GA,50662,HIOS,4,2014-09-04 03:25:43,2,50662,GA,SHOP (Small Group),Yes,35-0472300,50662GA0010004,Lincoln Dental Connect?,50662GA001,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.21,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,50662GA0010004-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,50662,HIOS,4,2014-09-04 03:25:43,2,50662,GA,SHOP (Small Group),Yes,35-0472300,50662GA0010007,Lincoln Dental Connect?,50662GA001,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.08,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,50662GA0010007-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,50988,HIOS,2,2014-09-05 03:32:16,1,50988,GA,SHOP (Small Group),Yes,86-0307623,50988GA0220001,Smile for Health Certified Basic Option Plus (90-50-50),50988GA022,,GAN001,GAS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$3.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,50988GA0220001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,68806,HIOS,5,2014-09-05 03:32:16,1,68806,GA,Individual,Yes,59-0397210,68806GA0010002,DentaQuest PPO Pediatric Low,68806GA001,,GAN001,GAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.11,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,68806GA0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,GA,68806,HIOS,5,2014-09-05 03:32:16,1,68806,GA,SHOP (Small Group),Yes,59-0397210,68806GA0020002,DentaQuest PPO Pediatric Low,68806GA002,,GAN001,GAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$14.61,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,68806GA0020002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,GA,68806,HIOS,5,2014-09-05 03:32:16,1,68806,GA,SHOP (Small Group),Yes,59-0397210,68806GA0020002,DentaQuest PPO Pediatric Low,68806GA002,,GAN001,GAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$14.61,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,68806GA0020002-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,GA,68806,HIOS,5,2014-09-05 03:32:16,1,68806,GA,Individual,Yes,59-0397210,68806GA0010002,DentaQuest PPO Pediatric Low,68806GA001,,GAN001,GAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.11,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,68806GA0010002-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,GA,68806,HIOS,5,2014-09-05 03:32:16,2,68806,GA,Individual,Yes,59-0397210,68806GA0010003,DentaQuest PPO Family High,68806GA001,,GAN001,GAS001,,New,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$28.89,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,68806GA0010003-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,68806,HIOS,5,2014-09-05 03:32:16,2,68806,GA,SHOP (Small Group),Yes,59-0397210,68806GA0020003,DentaQuest PPO Family High,68806GA002,,GAN001,GAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.00,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,68806GA0020003-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,68806,HIOS,5,2014-09-05 03:32:16,2,68806,GA,SHOP (Small Group),Yes,59-0397210,68806GA0020003,DentaQuest PPO Family High,68806GA002,,GAN001,GAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.00,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,68806GA0020003-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,68806,HIOS,5,2014-09-05 03:32:16,2,68806,GA,Individual,Yes,59-0397210,68806GA0010003,DentaQuest PPO Family High,68806GA001,,GAN001,GAS001,,New,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$28.89,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,68806GA0010003-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,68806,HIOS,5,2014-09-05 03:32:16,2,68806,GA,Individual,Yes,59-0397210,68806GA0010004,DentaQuest PPO Family Low,68806GA001,,GAN001,GAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.11,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,68806GA0010004-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,GA,68806,HIOS,5,2014-09-05 03:32:16,2,68806,GA,SHOP (Small Group),Yes,59-0397210,68806GA0020004,DentaQuest PPO Family Low,68806GA002,,GAN001,GAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$14.61,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,68806GA0020004-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,GA,68806,HIOS,5,2014-09-05 03:32:16,2,68806,GA,SHOP (Small Group),Yes,59-0397210,68806GA0020004,DentaQuest PPO Family Low,68806GA002,,GAN001,GAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$14.61,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,68806GA0020004-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,GA,68806,HIOS,5,2014-09-05 03:32:16,2,68806,GA,Individual,Yes,59-0397210,68806GA0010004,DentaQuest PPO Family Low,68806GA001,,GAN001,GAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.11,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,68806GA0010004-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,GA,73231,HIOS,7,2014-11-12 05:24:58,1,73231,GA,Individual,Yes,47-0397286,73231GA0020001,"Delta Dental Individual PPO, EHB Certified",73231GA002,,GAN002,GAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.81,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,73231GA0020001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,73231,HIOS,7,2014-11-12 05:24:58,1,73231,GA,Individual,Yes,47-0397286,73231GA0020002,"Delta Dental Individual PPO, EHB Certified",73231GA002,,GAN002,GAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.31,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,73231GA0020002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,73231,HIOS,7,2014-11-12 05:24:58,1,73231,GA,SHOP (Small Group),Yes,47-0397286,73231GA0040002,"Renaissance Group Dental PPO, EHB Certified",73231GA004,,GAN001,GAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.86,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,73231GA0040002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,73231,HIOS,7,2014-11-12 05:24:58,1,73231,GA,SHOP (Small Group),Yes,47-0397286,73231GA0090001,"Renaissance Group Dental PPO, EHB Certified (Exchange)",73231GA009,,GAN001,GAS001,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$13.53,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/GA_EHB_Group_High_2015,,http://www.renaissancedental.com/GA_EHB_Group_High_2015,,73231GA0090001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,GA,73231,HIOS,7,2014-11-12 05:24:58,1,73231,GA,Individual,Yes,47-0397286,73231GA0030001,"Renaissance Individual Dental PPO, EHB Certified",73231GA003,,GAN001,GAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.59,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,73231GA0030001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,GA,73231,HIOS,7,2014-11-12 05:24:58,1,73231,GA,Individual,Yes,47-0397286,73231GA0030002,"Renaissance Individual Dental PPO, EHB Certified",73231GA003,,GAN001,GAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.31,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,73231GA0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,GA,73231,HIOS,7,2014-11-12 05:24:58,1,73231,GA,SHOP (Small Group),Yes,47-0397286,73231GA0090002,"Renaissance Group Dental PPO, EHB Certified (Exchange)",73231GA009,,GAN001,GAS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$13.53,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/GA_EHB_Group_Low_2015,,http://www.renaissancedental.com/GA_EHB_Group_Low_2015,,73231GA0090002-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,GA,73231,HIOS,7,2014-11-12 05:24:58,1,73231,GA,SHOP (Small Group),Yes,47-0397286,73231GA0090003,"Renaissance Group Dental PPO, EHB Certified (Exchange)",73231GA009,,GAN001,GAS001,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$13.53,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/GA_50_50_High_2015,,http://www.renaissancedental.com/GA_50_50_High_2015,,73231GA0090003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,GA,73231,HIOS,7,2014-11-12 05:24:58,1,73231,GA,Individual,Yes,47-0397286,73231GA0070001,"Renaissance Individual Dental PPO, EHB Certified (Exchange)",73231GA007,,GAN001,GAS001,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.38,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/GA_EHB_High_2015,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/73231,http://www.renaissancedental.com/GA_EHB_High_2015,,73231GA0070001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,GA,73231,HIOS,7,2014-11-12 05:24:58,1,73231,GA,Individual,Yes,47-0397286,73231GA0070002,"Renaissance Individual Dental PPO, EHB Certified (Exchange)",73231GA007,,GAN001,GAS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.72,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/GA_EHB_Low_2015,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/73231,http://www.renaissancedental.com/GA_EHB_Low_2015,,73231GA0070002-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050009,SimpleCare-0050009,83761GA005,,GAN001,GAS001,GAF004,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050009-01,Standard Silver On Exchange Plan,,0.695679366588593,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$8,000",,,"$12,000","$24,000","$17,200","$34,400",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",80%,,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,21
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050010,SimpleCare-0050010,83761GA005,,GAN001,GAS001,GAF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050010-00,Standard Silver Off Exchange Plan,,0.682817757129669,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$7,600",,,"$12,000","$24,000","$17,800","$31,600",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",80%,,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,22
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040005,SoloCare - 004005,83761GA004,,GAN001,GAS001,GAF013,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,22
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040005,SoloCare - 004005,83761GA004,,GAN001,GAS001,GAF013,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040005-03,Limited Cost Sharing Plan Variation,,0.783551752567291,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,700","$5,400",,,"$9,000","$18,000","$11,700","$24,100",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",80%,,,,"$6,000","$12,000","$7,350","$14,700",,,,,,,,,23
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050010,SimpleCare-0050010,83761GA005,,GAN001,GAS001,GAF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050010-01,Standard Silver On Exchange Plan,,0.682817757129669,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$7,600",,,"$12,000","$24,000","$17,800","$31,600",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",80%,,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,23
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050011,SimpleCare-0050011,83761GA005,,GAN001,GAS001,GAF009,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050011-00,Standard Silver Off Exchange Plan,,0.684926688671112,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",70%,,,,"$9,000","$18,000","$12,000","$24,000",,,,,,,,,24
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040006,SoloCare - 0040006,83761GA004,,GAN001,GAS001,GAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,ww.AHPAssist.com,83761GA0040006-00,Standard Gold Off Exchange Plan,,0.781927883625031,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$9,000","$18,000","$11,800","$23,600",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",90%,,,,"$6,000","$12,000","$7,400","$14,800",,,,,,,,,24
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040006,SoloCare - 0040006,83761GA004,,GAN001,GAS001,GAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,ww.AHPAssist.com,83761GA0040006-01,Standard Gold On Exchange Plan,,0.781927883625031,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$9,000","$18,000","$11,800","$23,600",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",90%,,,,"$6,000","$12,000","$7,400","$14,800",,,,,,,,,25
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050011,SimpleCare-0050011,83761GA005,,GAN001,GAS001,GAF009,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050011-01,Standard Silver On Exchange Plan,,0.684926688671112,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",70%,,,,"$9,000","$18,000","$12,000","$24,000",,,,,,,,,25
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050012,SimpleCare-0050012,83761GA005,,GAN001,GAS001,GAF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,ww.AHPAssist.com,83761GA0050012-00,Standard Silver Off Exchange Plan,,0.683930993080139,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",70%,,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,26
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040006,SoloCare - 0040006,83761GA004,,GAN001,GAS001,GAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,ww.AHPAssist.com,83761GA0040006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,26
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040006,SoloCare - 0040006,83761GA004,,GAN001,GAS001,GAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,ww.AHPAssist.com,83761GA0040006-03,Limited Cost Sharing Plan Variation,,0.781927883625031,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$9,000","$18,000","$11,800","$23,600",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",90%,,,,"$6,000","$12,000","$7,400","$14,800",,,,,,,,,27
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040004,SoloCare - 0040004,83761GA004,,GAN001,GAS001,GAF014,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040004-01,Standard Gold On Exchange Plan,,0.81547600030899,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,200","$4,400",,,"$6,000","$12,000","$8,200","$16,400",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",100%,,,,"$3,000","$6,000","$4,000","$8,000",,,,,,,,,17
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050007,SimpleCare-0050007,83761GA005,,GAN001,GAS001,GAF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050007-01,Standard Silver On Exchange Plan,,0.704832315444946,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",55%,,,,"$3,000","$6,000","$5,000","$10,000",,,,,,,,,17
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050008,SimpleCare-0050008,83761GA005,,GAN001,GAS001,GAF016,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,,www.AHPAssist.com,83761GA0050008-00,Standard Silver Off Exchange Plan,,0.693493962287903,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","$24,600","$49,200",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",80%,,,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,18
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050012,SimpleCare-0050012,83761GA005,,GAN001,GAS001,GAF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,ww.AHPAssist.com,83761GA0050012-01,Standard Silver On Exchange Plan,,0.683930993080139,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",70%,,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,27
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050013,SimpleCare-0050013,83761GA005,,GAN001,GAS001,GAF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,ww.AHPAssist.com,83761GA0050013-00,Standard Silver Off Exchange Plan,,0.681291878223419,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",80%,,,,"$7,500","$15,000","$10,000","$20,000",,,,,,,,,28
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040007,SoloCare - 0040007,83761GA004,,GAN001,GAS001,GAF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040007-00,Standard Silver Off Exchange Plan,,0.687714695930481,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$18,000","$36,000","$23,000","$46,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",55%,,,,"$5,250","$10,500","$7,000","$14,000",,,,,,,,,28
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040007,SoloCare - 0040007,83761GA004,,GAN001,GAS001,GAF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040007-01,Standard Silver On Exchange Plan,,0.687714695930481,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$18,000","$36,000","$23,000","$46,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",55%,,,,"$5,250","$10,500","$7,000","$14,000",,,,,,,,,29
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050013,SimpleCare-0050013,83761GA005,,GAN001,GAS001,GAF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,ww.AHPAssist.com,83761GA0050013-01,Standard Silver On Exchange Plan,,0.681291878223419,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",80%,,,,"$7,500","$15,000","$10,000","$20,000",,,,,,,,,29
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050014,SimpleCare-0050014,83761GA005,,GAN001,GAS001,GAF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,ww.AHPAssist.com,83761GA0050014-00,Standard Silver Off Exchange Plan,,0.683420598506927,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",80%,,,,"$8,250","$16,500","$11,000","$22,000",,,,,,,,,30
2015,GA,50988,HIOS,2,2014-09-05 03:32:16,2,50988,GA,SHOP (Small Group),Yes,86-0307623,50988GA0240001,Smile for Health Certified High Option Plus (100-50-50),50988GA024,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$7.35,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,50988GA0240001-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,50988,HIOS,2,2014-09-05 03:32:16,3,50988,GA,SHOP (Small Group),Yes,86-0307623,50988GA0260001,Smile for Health Certified Low Option Plus (100-100-100),50988GA026,,GAN001,GAS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$3.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,50988GA0260001-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,50988,HIOS,2,2014-09-05 03:32:16,4,50988,GA,SHOP (Small Group),Yes,86-0307623,50988GA0210001,Smile for Health Certified Basic Option (90-50-50),50988GA021,,GAN001,GAS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$0.74,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,50988GA0210001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040008,SoloCare - 0040008,83761GA004,,GAN001,GAS001,GAF016,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040008-00,Standard Silver Off Exchange Plan,,0.685117304325104,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,000","$38,000","$25,600","$51,200",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",80%,,,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,35
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050016,SimpleCare-0050016,83761GA005,,GAN001,GAS001,GAF014,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050016-01,Standard Silver On Exchange Plan,,0.685605704784393,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,300","$6,600",,,"$19,800","$39,600","$23,100","$46,200",,,,,,,,,,,,,,,,,,,,,"$3,300","$6,600",100%,,,,"$9,900","$19,800","$13,200","$26,400",,,,,,,,,35
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050017,SimpleCare-0050017,83761GA005,,GAN001,GAS001,GAF015,New,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050017-00,Standard Bronze Off Exchange Plan,,0.59648185968399,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,500","$39,000","$26,100","$52,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",70%,,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,36
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040008,SoloCare - 0040008,83761GA004,,GAN001,GAS001,GAF016,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040008-01,Standard Silver On Exchange Plan,,0.685117304325104,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,000","$38,000","$25,600","$51,200",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",80%,,,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,36
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040008,SoloCare - 0040008,83761GA004,,GAN001,GAS001,GAF016,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,37
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050017,SimpleCare-0050017,83761GA005,,GAN001,GAS001,GAF015,New,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050017-01,Standard Bronze On Exchange Plan,,0.59648185968399,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,500","$39,000","$26,100","$52,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",70%,,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,37
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050018,SimpleCare-0050018,83761GA005,,GAN001,GAS001,GAF015,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050018-00,Standard Bronze Off Exchange Plan,,0.619937121868134,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$11,500",,,"$31,500","$63,000","$36,750","$74,500",,,,,,,,,,,,,,,,,,,,,"$5,250","$11,500",100%,,,,"$15,750","$31,500","$21,000","$43,000",,,,,,,,,38
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040008,SoloCare - 0040008,83761GA004,,GAN001,GAS001,GAF016,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040008-03,Limited Cost Sharing Plan Variation,,0.685117304325104,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,000","$38,000","$25,600","$51,200",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",80%,,,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,38
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040008,SoloCare - 0040008,83761GA004,,GAN001,GAS001,GAF016,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040008-04,73% AV Level Silver Plan,,0.731641530990601,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$19,000","$38,000","$23,000","$46,100",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",80%,,,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,39
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050018,SimpleCare-0050018,83761GA005,,GAN001,GAS001,GAF015,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050018-01,Standard Bronze On Exchange Plan,,0.619937121868134,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$11,500",,,"$31,500","$63,000","$36,750","$74,500",,,,,,,,,,,,,,,,,,,,,"$5,250","$11,500",100%,,,,"$15,750","$31,500","$21,000","$43,000",,,,,,,,,39
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050019,SimpleCare-0050019,83761GA005,,GAN001,GAS001,GAF015,New,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050019-00,Standard Silver Off Exchange Plan,,0.708218693733215,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",80%,,,,"$6,750","$13,500","$9,000","$18,200",,,,,,,,,40
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040008,SoloCare - 0040008,83761GA004,,GAN001,GAS001,GAF016,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040008-05,87% AV Level Silver Plan,,0.874291658401489,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$19,000","$38,000","$20,250","$40,600",,,,,,,,,,,,,,,,,,,,,$625,"$1,250",80%,,,,"$4,500","$9,000","$5,125","$10,250",,,,,,,,,40
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040008,SoloCare - 0040008,83761GA004,,GAN001,GAS001,GAF016,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040008-06,94% AV Level Silver Plan,,0.942600846290588,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,000","$38,000","$19,500","$39,100",,,,,,,,,,,,,,,,,,,,,$250,$500,80%,,,,"$4,500","$9,000","$4,750","$9,500",,,,,,,,,41
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050019,SimpleCare-0050019,83761GA005,,GAN001,GAS001,GAF015,New,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050019-01,Standard Silver On Exchange Plan,,0.708218693733215,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",80%,,,,"$6,750","$13,500","$9,000","$18,200",,,,,,,,,41
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050020,SimpleCare-0050020,83761GA005,,GAN001,GAS001,GAF015,New,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050020-00,Standard Silver Off Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$18,000","$36,000","$21,000","$42,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",100%,,,,"$9,000","$18,000","$12,000","$24,000",,,,,,,,,42
2015,GA,86637,HIOS,7,2014-11-14 05:23:27,1,86637,GA,SHOP (Small Group),Yes,94-2761537,86637GA0020002,Delta Dental PPO Pediatric Preferred Plan for Small Businesses,86637GA002,,GAN001,GAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.75,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/ga/86637ga0020002-15,,86637GA0020002-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,86637,HIOS,7,2014-11-14 05:23:27,1,86637,GA,SHOP (Small Group),Yes,94-2761537,86637GA0020002,Delta Dental PPO Pediatric Preferred Plan for Small Businesses,86637GA002,,GAN001,GAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.75,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/ga/86637ga0020002-15,,86637GA0020002-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,86637,HIOS,7,2014-11-14 05:23:27,1,86637,GA,Individual,Yes,94-2761537,86637GA0010002,Delta Dental PPO Pediatric Preferred Plan,86637GA001,,GAN001,GAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$25.28,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ga/86637ga0010002-15,,86637GA0010002-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,86637,HIOS,7,2014-11-14 05:23:27,1,86637,GA,Individual,Yes,94-2761537,86637GA0010001,Delta Dental PPO Pediatric Basic Plan,86637GA001,,GAN001,GAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$20.13,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ga/86637ga0010001-15,,86637GA0010001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,GA,86637,HIOS,7,2014-11-14 05:23:27,1,86637,GA,SHOP (Small Group),Yes,94-2761537,86637GA0020001,Delta Dental PPO Pediatric Basic Plan for Small Businesses,86637GA002,,GAN001,GAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.13,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/ga/86637ga0020001-15,,86637GA0020001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,GA,86637,HIOS,7,2014-11-14 05:23:27,1,86637,GA,SHOP (Small Group),Yes,94-2761537,86637GA0020001,Delta Dental PPO Pediatric Basic Plan for Small Businesses,86637GA002,,GAN001,GAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.13,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/ga/86637ga0020001-15,,86637GA0020001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,GA,50988,HIOS,2,2014-09-05 03:32:16,5,50988,GA,SHOP (Small Group),Yes,86-0307623,50988GA0230001,Smile for Health Certified High Option (100-50-50),50988GA023,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$4.41,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,50988GA0230001-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,50988,HIOS,2,2014-09-05 03:32:16,6,50988,GA,SHOP (Small Group),Yes,86-0307623,50988GA0250001,Smile for Health Certified Low Option (100-100-100),50988GA025,,GAN001,GAS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$0.74,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,50988GA0250001-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,55612,HIOS,3,2014-08-28 04:23:13,1,55612,GA,SHOP (Small Group),Yes,13-5581829,55612GA0160001,EHB Basic Dental Plan (Low),55612GA016,,GAN001,GAS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$16.91,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48037,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48036,,55612GA0160001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,55612,HIOS,3,2014-08-28 04:23:13,1,55612,GA,SHOP (Small Group),Yes,13-5581829,55612GA0160001,EHB Basic Dental Plan (Low),55612GA016,,GAN001,GAS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$16.91,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48037,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48036,,55612GA0160001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,55612,HIOS,3,2014-08-28 04:23:13,2,55612,GA,SHOP (Small Group),Yes,13-5581829,55612GA0170001,EHB Enhanced Dental Plan (High),55612GA017,,GAN002,GAS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$21.43,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49076,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49075,,55612GA0170001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,55612,HIOS,3,2014-08-28 04:23:13,2,55612,GA,SHOP (Small Group),Yes,13-5581829,55612GA0170001,EHB Enhanced Dental Plan (High),55612GA017,,GAN002,GAS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$21.43,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49076,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49075,,55612GA0170001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,55612,HIOS,3,2014-08-28 04:23:13,3,55612,GA,SHOP (Small Group),Yes,13-5581829,55612GA0180001,Family Basic Dental Plan (Low),55612GA018,,GAN003,GAS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$16.91,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49078,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49077,,55612GA0180001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,55612,HIOS,3,2014-08-28 04:23:13,3,55612,GA,SHOP (Small Group),Yes,13-5581829,55612GA0180001,Family Basic Dental Plan (Low),55612GA018,,GAN003,GAS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$16.91,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49078,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49077,,55612GA0180001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,55612,HIOS,3,2014-08-28 04:23:13,4,55612,GA,SHOP (Small Group),Yes,13-5581829,55612GA0190001,Family Enhanced Dental Plan (High),55612GA019,,GAN004,GAS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$21.43,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49080,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49079,,55612GA0190001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,55612,HIOS,3,2014-08-28 04:23:13,4,55612,GA,SHOP (Small Group),Yes,13-5581829,55612GA0190001,Family Enhanced Dental Plan (High),55612GA019,,GAN004,GAS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$21.43,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49080,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49079,,55612GA0190001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,63411,HIOS,10,2014-11-09 04:38:15,1,63411,GA,Individual,Yes,58-0469845,63411GA0490003,BCBS GA Dental Pediatric,63411GA049,,GAN001,GAS001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$21.03,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e214666.pdf,,,,63411GA0490003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,63411,HIOS,10,2014-11-09 04:38:15,1,63411,GA,SHOP (Small Group),Yes,58-0469845,63411GA0520003,BCBS GA Dental Pediatric,63411GA052,,GAN001,GAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$21.03,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e214666.pdf,,,,63411GA0520003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,63411,HIOS,10,2014-11-09 04:38:15,1,63411,GA,Individual,Yes,58-0469845,63411GA0550003,BCBS GA Dental Pediatric,63411GA055,,GAN001,GAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$21.03,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e214666.pdf,,,,63411GA0550003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,63411,HIOS,10,2014-11-09 04:38:15,2,63411,GA,Individual,Yes,58-0469845,63411GA0510003,BCBS GA Dental Family,63411GA051,,GAN001,GAS001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.55,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e214664.pdf,,,,63411GA0510003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,63411,HIOS,10,2014-11-09 04:38:15,2,63411,GA,SHOP (Small Group),Yes,58-0469845,63411GA0480003,BCBS GA Dental Family,63411GA048,,GAN001,GAS001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.55,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e214664.pdf,,,,63411GA0480003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,63411,HIOS,10,2014-11-09 04:38:15,2,63411,GA,SHOP (Small Group),Yes,58-0469845,63411GA0480004,BCBS GA Dental Family Enhanced,63411GA048,,GAN001,GAS001,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.60,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e214665.pdf,,,,63411GA0480004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,63411,HIOS,10,2014-11-09 04:38:15,2,63411,GA,Individual,Yes,58-0469845,63411GA0510004,BCBS GA Dental Family Enhanced,63411GA051,,GAN001,GAS001,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.60,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e214665.pdf,,,,63411GA0510004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,63411,HIOS,10,2014-11-09 04:38:15,2,63411,GA,Individual,Yes,58-0469845,63411GA0570003,BCBS GA Dental Family,63411GA057,,GAN001,GAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.55,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e214664.pdf,,,,63411GA0570003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,GA,63411,HIOS,10,2014-11-09 04:38:15,2,63411,GA,SHOP (Small Group),Yes,58-0469845,63411GA0540003,BCBS GA Dental Family,63411GA054,,GAN001,GAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.55,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e214664.pdf,,,,63411GA0540003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,GA,63411,HIOS,10,2014-11-09 04:38:15,2,63411,GA,SHOP (Small Group),Yes,58-0469845,63411GA0540004,BCBS GA Dental Family Enhanced,63411GA054,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.60,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e214665.pdf,,,,63411GA0540004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,GA,63411,HIOS,10,2014-11-09 04:38:15,2,63411,GA,Individual,Yes,58-0469845,63411GA0570004,BCBS GA Dental Family Enhanced,63411GA057,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.60,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e214665.pdf,,,,63411GA0570004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,GA,63940,HIOS,4,2014-08-27 03:27:11,1,63940,GA,SHOP (Small Group),Yes,13-5123390,63940GA0140002,Guardian Pediatric Advantage,63940GA014,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$28.21,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,63940GA0140002-00,Standard High Off Exchange Plan,85.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,63940,HIOS,4,2014-08-27 03:27:11,1,63940,GA,SHOP (Small Group),Yes,13-5123390,63940GA0150002,Guardian Pediatric Essentials,63940GA015,,GAN001,GAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$20.47,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,63940GA0150002-00,Standard Low Off Exchange Plan,68.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,63940,HIOS,4,2014-08-27 03:27:11,2,63940,GA,SHOP (Small Group),Yes,13-5123390,63940GA0170002,Guardian Family Advantage,63940GA017,,GAN001,GAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.21,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,63940GA0170002-00,Standard High Off Exchange Plan,85.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,63940,HIOS,4,2014-08-27 03:27:11,2,63940,GA,SHOP (Small Group),Yes,13-5123390,63940GA0170002,Guardian Family Advantage,63940GA017,,GAN001,GAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.21,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,63940GA0170002-01,Standard High On Exchange Plan,85.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,63940,HIOS,4,2014-08-27 03:27:11,2,63940,GA,SHOP (Small Group),Yes,13-5123390,63940GA0190002,Guardian Family Essentials,63940GA019,,GAN001,GAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.47,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,63940GA0190002-00,Standard Low Off Exchange Plan,68.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,GA,63940,HIOS,4,2014-08-27 03:27:11,2,63940,GA,SHOP (Small Group),Yes,13-5123390,63940GA0190002,Guardian Family Essentials,63940GA019,,GAN001,GAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.47,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,63940GA0190002-01,Standard Low On Exchange Plan,68.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,GA,68687,HIOS,2,2014-08-05 13:28:44,1,68687,GA,SHOP (Small Group),Yes,36-0883760,68687GA0030002,EHB High Passive,68687GA003,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$42.92,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,68687GA0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,68687,HIOS,2,2014-08-05 13:28:44,1,68687,GA,SHOP (Small Group),Yes,36-0883760,68687GA0030001,EHB Low Passive,68687GA003,,GAN001,GAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.94,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,68687GA0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,68806,HIOS,5,2014-09-05 03:32:16,1,68806,GA,Individual,Yes,59-0397210,68806GA0010001,DentaQuest PPO  Pediatric High,68806GA001,,GAN001,GAS001,,New,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$28.89,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,68806GA0010001-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,68806,HIOS,5,2014-09-05 03:32:16,1,68806,GA,SHOP (Small Group),Yes,59-0397210,68806GA0020001,DentaQuest PPO  Pediatric High,68806GA002,,GAN001,GAS001,,New,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$20.00,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,68806GA0020001-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,68806,HIOS,5,2014-09-05 03:32:16,1,68806,GA,SHOP (Small Group),Yes,59-0397210,68806GA0020001,DentaQuest PPO  Pediatric High,68806GA002,,GAN001,GAS001,,New,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$20.00,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,68806GA0020001-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,68806,HIOS,5,2014-09-05 03:32:16,1,68806,GA,Individual,Yes,59-0397210,68806GA0010001,DentaQuest PPO  Pediatric High,68806GA001,,GAN001,GAS001,,New,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$28.89,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,http://www.dentaquest.com/marketplace,,68806GA0010001-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,69677,HIOS,2,2014-08-03 08:59:32,1,69677,GA,SHOP (Small Group),Yes,47-0098400,69677GA0030002,EHB High Passive,69677GA003,,GAN001,GAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$42.33,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,69677GA0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,69677,HIOS,2,2014-08-03 08:59:32,1,69677,GA,SHOP (Small Group),Yes,47-0098400,69677GA0030001,EHB Low Passive,69677GA003,,GAN001,GAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.60,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,69677GA0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,73231,HIOS,7,2014-11-12 05:24:58,1,73231,GA,SHOP (Small Group),Yes,47-0397286,73231GA0040001,"Renaissance Group Dental PPO, EHB Certified",73231GA004,,GAN001,GAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.84,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,73231GA0040001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040004,SoloCare - 0040004,83761GA004,,GAN001,GAS001,GAF014,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,18
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040004,SoloCare - 0040004,83761GA004,,GAN001,GAS001,GAF014,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040004-03,Limited Cost Sharing Plan Variation,,0.81547600030899,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,200","$4,400",,,"$6,000","$12,000","$8,200","$16,400",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",100%,,,,"$3,000","$6,000","$4,000","$8,000",,,,,,,,,19
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050008,SimpleCare-0050008,83761GA005,,GAN001,GAS001,GAF016,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,,www.AHPAssist.com,83761GA0050008-01,Standard Silver On Exchange Plan,,0.693493962287903,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","$24,600","$49,200",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",80%,,,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,19
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050009,SimpleCare-0050009,83761GA005,,GAN001,GAS001,GAF004,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050009-00,Standard Silver Off Exchange Plan,,0.695679366588593,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$8,000",,,"$12,000","$24,000","$17,200","$34,400",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",80%,,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,20
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040005,SoloCare - 004005,83761GA004,,GAN001,GAS001,GAF013,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040005-00,Standard Gold Off Exchange Plan,,0.783551752567291,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,700","$5,400",,,"$9,000","$18,000","$11,700","$24,100",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",80%,,,,"$6,000","$12,000","$7,350","$14,700",,,,,,,,,20
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040005,SoloCare - 004005,83761GA004,,GAN001,GAS001,GAF013,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040005-01,Standard Gold On Exchange Plan,,0.783551752567291,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,700","$5,400",,,"$9,000","$18,000","$11,700","$24,100",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",80%,,,,"$6,000","$12,000","$7,350","$14,700",,,,,,,,,21
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,5,89942,GA,Individual,No,58-1592076,89942GA0050006,KP GA Silver 1750/25%/HSA,89942GA005,,GAN001,GAS002,GAF012,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050006-05,87% AV Level Silver Plan,87.00%,0.865606546401978,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,5,89942,GA,Individual,No,58-1592076,89942GA0050006,KP GA Silver 1750/25%/HSA,89942GA005,,GAN001,GAS002,GAF012,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050006-06,94% AV Level Silver Plan,93.20%,0.935739755630493,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,GA,73231,HIOS,7,2014-11-12 05:24:58,1,73231,GA,SHOP (Small Group),Yes,47-0397286,73231GA0090004,"Renaissance Group Dental PPO, EHB Certified (Exchange)",73231GA009,,GAN001,GAS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$13.53,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/GA_50_50_Low_2015,,http://www.renaissancedental.com/GA_50_50_Low_2015,,73231GA0090004-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,GA,73231,HIOS,7,2014-11-12 05:24:58,2,73231,GA,Individual,Yes,47-0397286,73231GA0060001,"Renaissance Individual Dental Pediatric-Only, EHB Certified",73231GA006,,GAN001,GAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$35.59,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,73231GA0060001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,73231,HIOS,7,2014-11-12 05:24:58,2,73231,GA,Individual,Yes,47-0397286,73231GA0060002,"Renaissance Individual Dental Pediatric-Only, EHB Certified",73231GA006,,GAN001,GAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$30.31,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,73231GA0060002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,73231,HIOS,7,2014-11-12 05:24:58,2,73231,GA,Individual,Yes,47-0397286,73231GA0080001,"Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)",73231GA008,,GAN001,GAS001,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$38.69,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/GA_Ped_High_2015,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/73231,http://www.renaissancedental.com/GA_Ped_High_2015,,73231GA0080001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,GA,73231,HIOS,7,2014-11-12 05:24:58,2,73231,GA,Individual,Yes,47-0397286,73231GA0080002,"Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)",73231GA008,,GAN001,GAS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$32.99,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/GA_Ped_Low_2015,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/73231,http://www.renaissancedental.com/GA_Ped_Low_2015,,73231GA0080002-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,GA,78196,HIOS,3,2014-08-29 03:26:18,1,78196,GA,SHOP (Small Group),Yes,93-0242990,78196GA0030002,EHB High Passive,78196GA003,,GAN001,GAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$43.05,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,78196GA0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,78196,HIOS,3,2014-08-29 03:26:18,1,78196,GA,SHOP (Small Group),Yes,93-0242990,78196GA0030001,EHB Low Passive,78196GA003,,GAN001,GAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.02,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,78196GA0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,83495,HIOS,2,2014-08-08 08:53:29,1,83495,GA,SHOP (Small Group),Yes,42-0127290,83495GA0040001,Principal Plan Dental 70,83495GA004,,GAN001,GAS001,,New,PPO,Low,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$28.61,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,83495GA0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040007,SoloCare - 0040007,83761GA004,,GAN001,GAS001,GAF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,30
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040007,SoloCare - 0040007,83761GA004,,GAN001,GAS001,GAF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040007-03,Limited Cost Sharing Plan Variation,,0.687714695930481,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$18,000","$36,000","$23,000","$46,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",55%,,,,"$5,250","$10,500","$7,000","$14,000",,,,,,,,,31
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050014,SimpleCare-0050014,83761GA005,,GAN001,GAS001,GAF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,ww.AHPAssist.com,83761GA0050014-01,Standard Silver On Exchange Plan,,0.683420598506927,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",80%,,,,"$8,250","$16,500","$11,000","$22,000",,,,,,,,,31
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050015,SimpleCare-0050015,83761GA005,,GAN001,GAS001,GAF014,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050015-01,Standard Silver On Exchange Plan,,0.685941159725189,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",100%,,,,"$7,500","$15,000","$10,000","$20,000",,,,,,,,,33
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050016,SimpleCare-0050016,83761GA005,,GAN001,GAS001,GAF014,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050016-00,Standard Silver Off Exchange Plan,,0.685605704784393,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,300","$6,600",,,"$19,800","$39,600","$23,100","$46,200",,,,,,,,,,,,,,,,,,,,,"$3,300","$6,600",100%,,,,"$9,900","$19,800","$13,200","$26,400",,,,,,,,,34
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040007,SoloCare - 0040007,83761GA004,,GAN001,GAS001,GAF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040007-06,94% AV Level Silver Plan,,0.940180838108063,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$18,000","$18,000","$18,500","$19,000",,,,,,,,,,,,,,,,,,,,,$250,$500,55%,,,,"$5,250","$10,500","$5,500","$11,000",,,,,,,,,34
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040016,SoloCare - 0040016,83761GA004,,GAN001,GAS001,GAF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040016-03,Limited Cost Sharing Plan Variation,,0.681764245033264,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$15,000","$30,000","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$3,100","$6,200",90%,,,,"$12,000","$24,000","$15,100","$30,200",,,,,,,,,94
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040016,SoloCare - 0040016,83761GA004,,GAN001,GAS001,GAF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040016-04,73% AV Level Silver Plan,,0.732072830200195,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$15,000","$30,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",90%,,,,"$12,000","$24,000","$14,500","$29,000",,,,,,,,,95
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040016,SoloCare - 0040016,83761GA004,,GAN001,GAS001,GAF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040016-05,87% AV Level Silver Plan,,0.864327430725098,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$15,000","$30,000","$16,400","$32,800",,,,,,,,,,,,,,,,,,,,,$750,"$1,500",90%,,,,"$12,000","$24,000","$12,750","$25,500",,,,,,,,,96
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040016,SoloCare - 0040016,83761GA004,,GAN001,GAS001,GAF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040016-06,94% AV Level Silver Plan,,0.93430894613266,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$15,000","$30,000","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,$300,$600,90%,,,,"$12,000","$24,000","$12,300","$24,600",,,,,,,,,97
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040017,SoloCare - 0040017,83761GA004,,GAN001,GAS001,GAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,ww.AHPAssist.com,83761GA0040017-00,Standard Silver Off Exchange Plan,,0.680691719055176,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,450","$6,900",,,"$18,000","$36,000","$21,450","$42,900",,,,,,,,,,,,,,,,,,,,,"$3,450","$6,900",100%,,,,"$15,000","$30,000","$18,450","$36,900",,,,,,,,,98
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040017,SoloCare - 0040017,83761GA004,,GAN001,GAS001,GAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,ww.AHPAssist.com,83761GA0040017-01,Standard Silver On Exchange Plan,,0.680691719055176,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,450","$6,900",,,"$18,000","$36,000","$21,450","$42,900",,,,,,,,,,,,,,,,,,,,,"$3,450","$6,900",100%,,,,"$15,000","$30,000","$18,450","$36,900",,,,,,,,,99
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040017,SoloCare - 0040017,83761GA004,,GAN001,GAS001,GAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,ww.AHPAssist.com,83761GA0040017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,100
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040017,SoloCare - 0040017,83761GA004,,GAN001,GAS001,GAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,ww.AHPAssist.com,83761GA0040017-03,Limited Cost Sharing Plan Variation,,0.680691719055176,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,450","$6,900",,,"$18,000","$36,000","$21,450","$42,900",,,,,,,,,,,,,,,,,,,,,"$3,450","$6,900",100%,,,,"$15,000","$30,000","$18,450","$36,900",,,,,,,,,101
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040017,SoloCare - 0040017,83761GA004,,GAN001,GAS001,GAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,ww.AHPAssist.com,83761GA0040017-04,73% AV Level Silver Plan,,0.738774836063385,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$18,000","$36,000","$20,500","$41,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",100%,,,,"$15,000","$30,000","$17,500","$35,000",,,,,,,,,102
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050015,SimpleCare-0050015,83761GA005,,GAN001,GAS001,GAF014,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050015-00,Standard Silver Off Exchange Plan,,0.685941159725189,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",100%,,,,"$7,500","$15,000","$10,000","$20,000",,,,,,,,,32
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040007,SoloCare - 0040007,83761GA004,,GAN001,GAS001,GAF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040007-04,73% AV Level Silver Plan,,0.726933240890503,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$18,000","$36,000","$21,500","$43,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",55%,,,,"$5,250","$10,500","$7,000","$14,000",,,,,,,,,32
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040007,SoloCare - 0040007,83761GA004,,GAN001,GAS001,GAF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040007-05,87% AV Level Silver Plan,,0.870511293411255,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$18,000","$36,000","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,$700,"$1,400",55%,,,,"$5,250","$10,500","$5,950","$11,900",,,,,,,,,33
2015,GA,83495,HIOS,2,2014-08-08 08:53:29,1,83495,GA,SHOP (Small Group),Yes,42-0127290,83495GA0040002,Principal Plan Dental 80,83495GA004,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$30.15,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,83495GA0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,1,83502,GA,SHOP (Small Group),Yes,95-6042390,83502GA0010001,BEST Life Child Dental Plus,83502GA001,,GAN001,GAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$31.96,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BEST_Life_Child_Dental_Plus_Plan.pdf,,83502GA0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,1,83502,GA,Individual,Yes,95-6042390,83502GA0020001,BESTOne Child Dental Plus,83502GA002,,GAN001,GAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$39.94,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BESTOne_Child_Dental_Plus_Plan.pdf,,83502GA0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,2,83502,GA,Individual,Yes,95-6042390,83502GA0020002,BESTOne Child Dental,83502GA002,,GAN001,GAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$31.44,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BESTOne_Child_Dental_Plan.pdf,,83502GA0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,2,83502,GA,SHOP (Small Group),Yes,95-6042390,83502GA0010002,BEST Life Child Dental,83502GA001,,GAN001,GAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.16,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BEST_Life_Child_Dental_Plan.pdf,,83502GA0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,3,83502,GA,SHOP (Small Group),Yes,95-6042390,83502GA0010007,BEST Dental Premium,83502GA001,,GAN001,GAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.96,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BESTDental_Premium_Plan.pdf,,83502GA0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,3,83502,GA,Individual,Yes,95-6042390,83502GA0020003,BESTOne Dental Advantage-Gold,83502GA002,,GAN001,GAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.94,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BESTOne_Dental_Advantage-Gold_Plan.pdf,,83502GA0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,3,83502,GA,Individual,Yes,95-6042390,83502GA0020003,BESTOne Dental Advantage-Gold,83502GA002,,GAN001,GAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.94,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BESTOne_Dental_Advantage-Gold_Plan.pdf,,83502GA0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,3,83502,GA,SHOP (Small Group),Yes,95-6042390,83502GA0010007,BEST Dental Premium,83502GA001,,GAN001,GAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.96,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BESTDental_Premium_Plan.pdf,,83502GA0010007-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,3,83502,GA,SHOP (Small Group),Yes,95-6042390,83502GA0010008,BEST Dental Standard-H,83502GA001,,GAN001,GAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.96,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BESTDental_Standard-H_Plan.pdf,,83502GA0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,3,83502,GA,Individual,Yes,95-6042390,83502GA0020004,BESTOne Dental Plus-Gold,83502GA002,,GAN001,GAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.94,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BESTOne_Dental_Plus-Gold_Plan.pdf,,83502GA0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,3,83502,GA,Individual,Yes,95-6042390,83502GA0020004,BESTOne Dental Plus-Gold,83502GA002,,GAN001,GAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.94,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BESTOne_Dental_Plus-Gold_Plan.pdf,,83502GA0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,3,83502,GA,SHOP (Small Group),Yes,95-6042390,83502GA0010008,BEST Dental Standard-H,83502GA001,,GAN001,GAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.96,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BESTDental_Standard-H_Plan.pdf,,83502GA0010008-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,3,83502,GA,SHOP (Small Group),Yes,95-6042390,83502GA0010010,BEST Dental Choice-H,83502GA001,,GAN001,GAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.96,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BESTDental_Choice-H_Plan.pdf,,83502GA0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,3,83502,GA,SHOP (Small Group),Yes,95-6042390,83502GA0010010,BEST Dental Choice-H,83502GA001,,GAN001,GAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.96,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BESTDental_Choice-H_Plan.pdf,,83502GA0010010-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,4,83502,GA,SHOP (Small Group),Yes,95-6042390,83502GA0010009,BEST Dental Standard-L,83502GA001,,GAN001,GAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.16,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BESTDental_Standard-L_Plan.pdf,,83502GA0010009-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,4,83502,GA,Individual,Yes,95-6042390,83502GA0020005,BESTOne Dental Plus-Silver,83502GA002,,GAN001,GAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.44,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BESTOne_Dental_Plus-Silver_Plan.pdf,,83502GA0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,4,83502,GA,Individual,Yes,95-6042390,83502GA0020005,BESTOne Dental Plus-Silver,83502GA002,,GAN001,GAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.44,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BESTOne_Dental_Plus-Silver_Plan.pdf,,83502GA0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,4,83502,GA,SHOP (Small Group),Yes,95-6042390,83502GA0010009,BEST Dental Standard-L,83502GA001,,GAN001,GAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.16,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BESTDental_Standard-L_Plan.pdf,,83502GA0010009-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,4,83502,GA,SHOP (Small Group),Yes,95-6042390,83502GA0010011,BEST Dental Choice-L,83502GA001,,GAN001,GAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.16,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BESTDental_Choice-L_Plan.pdf,,83502GA0010011-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,4,83502,GA,Individual,Yes,95-6042390,83502GA0020006,BESTOne Dental Basic-Silver,83502GA002,,GAN001,GAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.44,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BESTOne_Dental_Basic-Silver_Plan.pdf,,83502GA0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,4,83502,GA,Individual,Yes,95-6042390,83502GA0020006,BESTOne Dental Basic-Silver,83502GA002,,GAN001,GAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.44,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BESTOne_Dental_Basic-Silver_Plan.pdf,,83502GA0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,4,83502,GA,SHOP (Small Group),Yes,95-6042390,83502GA0010011,BEST Dental Choice-L,83502GA001,,GAN001,GAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.16,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BESTDental_Choice-L_Plan.pdf,,83502GA0010011-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,4,83502,GA,SHOP (Small Group),Yes,95-6042390,83502GA0010012,BEST Dental Value,83502GA001,,GAN001,GAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.16,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BESTDental_Value_Plan.pdf,,83502GA0010012-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,GA,83502,HIOS,5,2014-09-03 04:28:59,4,83502,GA,SHOP (Small Group),Yes,95-6042390,83502GA0010012,BEST Dental Value,83502GA001,,GAN001,GAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.16,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/GA/2015/GA_BESTDental_Value_Plan.pdf,,83502GA0010012-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050001,SimpleCare-0050001,83761GA005,,GAN001,GAS001,GAF011,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050001-00,Standard Gold Off Exchange Plan,,0.804239451885223,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",80%,,,,"$1,500","$3,000","$2,000","$4,000",,,,,,,,,4
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040001,SoloCare - 0040001,83761GA004,,GAN001,GAS001,GAF011,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040001-00,Standard Gold Off Exchange Plan,,0.796582579612732,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,100","$6,200",,,"$9,000","$18,000","$12,100","$24,200",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",80%,,,,"$1,500","$3,000","$2,000","$4,000",,,,,,,,,4
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040001,SoloCare - 0040001,83761GA004,,GAN001,GAS001,GAF011,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040001-01,Standard Gold On Exchange Plan,,0.796582579612732,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,100","$6,200",,,"$9,000","$18,000","$12,100","$24,200",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",80%,,,,"$1,500","$3,000","$2,000","$4,000",,,,,,,,,5
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050001,SimpleCare-0050001,83761GA005,,GAN001,GAS001,GAF011,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050001-01,Standard Gold On Exchange Plan,,0.804239451885223,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",80%,,,,"$1,500","$3,000","$2,000","$4,000",,,,,,,,,5
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050002,SimpleCare-0050002,83761GA005,,GAN001,GAS001,GAF012,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050002-00,Standard Gold Off Exchange Plan,,0.804471969604492,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$7,500","$15,000","$10,100","$20,200",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",100%,,,,"$3,000","$6,000","$4,000","$8,000",,,,,,,,,6
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040001,SoloCare - 0040001,83761GA004,,GAN001,GAS001,GAF011,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040001,SoloCare - 0040001,83761GA004,,GAN001,GAS001,GAF011,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040001-03,Limited Cost Sharing Plan Variation,,0.796582579612732,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,100","$6,200",,,"$9,000","$18,000","$12,100","$24,200",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",80%,,,,"$1,500","$3,000","$2,000","$4,000",,,,,,,,,7
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050002,SimpleCare-0050002,83761GA005,,GAN001,GAS001,GAF012,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050002-01,Standard Gold On Exchange Plan,,0.804471969604492,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$7,500","$15,000","$10,100","$20,200",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",100%,,,,"$3,000","$6,000","$4,000","$8,000",,,,,,,,,7
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050003,SimpleCare-0050003,83761GA005,,GAN001,GAS001,GAF013,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050003-00,Standard Gold Off Exchange Plan,,0.811655163764954,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000",,,,,,,,,,,,,,,,,,,,,$500,"$2,000",90%,,,,"$3,000","$6,000","$3,500","$8,000",,,,,,,,,8
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040002,SoloCare - 0040002,83761GA004,,GAN001,GAS001,GAF012,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040002-00,Standard Gold Off Exchange Plan,,0.782504081726074,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$7,500","$15,000","$10,100","$20,200",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",100%,,,,"$3,000","$6,000","$4,500","$9,000",,,,,,,,,8
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040002,SoloCare - 0040002,83761GA004,,GAN001,GAS001,GAF012,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040002-01,Standard Gold On Exchange Plan,,0.782504081726074,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$7,500","$15,000","$10,100","$20,200",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",100%,,,,"$3,000","$6,000","$4,500","$9,000",,,,,,,,,9
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050003,SimpleCare-0050003,83761GA005,,GAN001,GAS001,GAF013,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050003-01,Standard Gold On Exchange Plan,,0.811655163764954,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000",,,,,,,,,,,,,,,,,,,,,$500,"$2,000",90%,,,,"$3,000","$6,000","$3,500","$8,000",,,,,,,,,9
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050004,SimpleCare-0050004,83761GA005,,GAN001,GAS001,GAF014,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050004-00,Standard Gold Off Exchange Plan,,0.790035724639893,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,100","$24,200",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",100%,,,,"$3,000","$6,000","$4,000","$8,000",,,,,,,,,10
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040002,SoloCare - 0040002,83761GA004,,GAN001,GAS001,GAF012,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040002,SoloCare - 0040002,83761GA004,,GAN001,GAS001,GAF012,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040002-03,Limited Cost Sharing Plan Variation,,0.782504081726074,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$7,500","$15,000","$10,100","$20,200",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",100%,,,,"$3,000","$6,000","$4,500","$9,000",,,,,,,,,11
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050004,SimpleCare-0050004,83761GA005,,GAN001,GAS001,GAF014,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050004-01,Standard Gold On Exchange Plan,,0.790035724639893,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,100","$24,200",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",100%,,,,"$3,000","$6,000","$4,000","$8,000",,,,,,,,,11
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050005,SimpleCare-0050005,83761GA005,,GAN001,GAS001,GAF013,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050005-00,Standard Gold Off Exchange Plan,,0.79733794927597,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","$8,100","$16,200",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",80%,,,,"$5,250","$10,500","$7,000","$14,000",,,,,,,,,12
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040003,SoloCare - 0040003,83761GA004,,GAN001,GAS001,GAF013,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040003-00,Standard Gold Off Exchange Plan,,0.782488703727722,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,100","$6,200",,,"$9,000","$18,000","$12,100","$24,200",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",90%,,,,"$3,000","$6,000","$4,000","$8,000",,,,,,,,,12
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040003,SoloCare - 0040003,83761GA004,,GAN001,GAS001,GAF013,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040003-01,Standard Gold On Exchange Plan,,0.782488703727722,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,100","$6,200",,,"$9,000","$18,000","$12,100","$24,200",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",90%,,,,"$3,000","$6,000","$4,000","$8,000",,,,,,,,,13
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050005,SimpleCare-0050005,83761GA005,,GAN001,GAS001,GAF013,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050005-01,Standard Gold On Exchange Plan,,0.79733794927597,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","$8,100","$16,200",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",80%,,,,"$5,250","$10,500","$7,000","$14,000",,,,,,,,,13
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050006,SimpleCare-0050006,83761GA005,,GAN001,GAS001,GAF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,ww.AHPAssist.com,83761GA0050006-00,Standard Gold Off Exchange Plan,,0.806845307350159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","$8,100","$16,200",,,,,,,,,,,,,,,,,,,,,"$1,500","$2,500",90%,,,,"$3,750","$7,500","$5,250","$10,000",,,,,,,,,14
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040003,SoloCare - 0040003,83761GA004,,GAN001,GAS001,GAF013,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040003,SoloCare - 0040003,83761GA004,,GAN001,GAS001,GAF013,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040003-03,Limited Cost Sharing Plan Variation,,0.782488703727722,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,100","$6,200",,,"$9,000","$18,000","$12,100","$24,200",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",90%,,,,"$3,000","$6,000","$4,000","$8,000",,,,,,,,,15
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050006,SimpleCare-0050006,83761GA005,,GAN001,GAS001,GAF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,ww.AHPAssist.com,83761GA0050006-01,Standard Gold On Exchange Plan,,0.806845307350159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","$8,100","$16,200",,,,,,,,,,,,,,,,,,,,,"$1,500","$2,500",90%,,,,"$3,750","$7,500","$5,250","$10,000",,,,,,,,,15
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050007,SimpleCare-0050007,83761GA005,,GAN001,GAS001,GAF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050007-00,Standard Silver Off Exchange Plan,,0.704832315444946,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$18,000","$36,000","$24,000","$48,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",55%,,,,"$3,000","$6,000","$5,000","$10,000",,,,,,,,,16
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040004,SoloCare - 0040004,83761GA004,,GAN001,GAS001,GAF014,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040004-00,Standard Gold Off Exchange Plan,,0.81547600030899,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,200","$4,400",,,"$6,000","$12,000","$8,200","$16,400",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",100%,,,,"$3,000","$6,000","$4,000","$8,000",,,,,,,,,16
2015,GA,86637,HIOS,7,2014-11-14 05:23:27,1,86637,GA,Individual,Yes,94-2761537,86637GA0010001,Delta Dental PPO Pediatric Basic Plan,86637GA001,,GAN001,GAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$20.13,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ga/86637ga0010001-15,,86637GA0010001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,GA,86637,HIOS,7,2014-11-14 05:23:27,2,86637,GA,Individual,Yes,94-2761537,86637GA0010004,Delta Dental PPO Preferred Plan for Families,86637GA001,,GAN001,GAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.28,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ga/86637ga0010004-15,,86637GA0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,86637,HIOS,7,2014-11-14 05:23:27,2,86637,GA,SHOP (Small Group),Yes,94-2761537,86637GA0020004,Delta Dental PPO Preferred Plan for Families for Small Businesses,86637GA002,,GAN001,GAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.75,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/ga/86637ga0020004-15,,86637GA0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,86637,HIOS,7,2014-11-14 05:23:27,2,86637,GA,SHOP (Small Group),Yes,94-2761537,86637GA0020004,Delta Dental PPO Preferred Plan for Families for Small Businesses,86637GA002,,GAN001,GAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.75,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/ga/86637ga0020004-15,,86637GA0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,86637,HIOS,7,2014-11-14 05:23:27,2,86637,GA,Individual,Yes,94-2761537,86637GA0010004,Delta Dental PPO Preferred Plan for Families,86637GA001,,GAN001,GAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.28,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ga/86637ga0010004-15,,86637GA0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,86637,HIOS,7,2014-11-14 05:23:27,3,86637,GA,Individual,Yes,94-2761537,86637GA0010006,Delta Dental PPO Basic Plan for Families,86637GA001,,GAN001,GAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.13,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ga/86637ga0010006-15,,86637GA0010006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,86637,HIOS,7,2014-11-14 05:23:27,3,86637,GA,SHOP (Small Group),Yes,94-2761537,86637GA0020006,Delta Dental PPO Basic Plan for Families for Small Businesses,86637GA002,,GAN001,GAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.13,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/ga/86637ga0020006-15,,86637GA0020006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,86637,HIOS,7,2014-11-14 05:23:27,3,86637,GA,SHOP (Small Group),Yes,94-2761537,86637GA0020006,Delta Dental PPO Basic Plan for Families for Small Businesses,86637GA002,,GAN001,GAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.13,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/ga/86637ga0020006-15,,86637GA0020006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,86637,HIOS,7,2014-11-14 05:23:27,3,86637,GA,Individual,Yes,94-2761537,86637GA0010006,Delta Dental PPO Basic Plan for Families,86637GA001,,GAN001,GAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.13,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ga/86637ga0010006-15,,86637GA0010006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,3,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060004,KP GA Silver 2000/25/40/S2,89942GA006,,GAN001,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kp.org/health/plans/ga/plans/smallbusiness?contentid=/html/plans/ga/small/entrypage.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060004-00,Standard Silver Off Exchange Plan,71.90%,0.708933770656586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,3,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060004,KP GA Silver 2000/25/40/S2,89942GA006,,GAN001,GAS001,GAF005,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kp.org/health/plans/ga/plans/smallbusiness?contentid=/html/plans/ga/small/entrypage.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060004-01,Standard Silver On Exchange Plan,71.90%,0.708933770656586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,7,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060008,KP GA Bronze  HDHP/4000/25/S2,89942GA006,,GAN001,GAS001,GAF010,Existing,HMO,Bronze,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060008-00,Standard Bronze Off Exchange Plan,60.90%,0.609844267368317,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,7,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060008,KP GA Bronze  HDHP/4000/25/S2,89942GA006,,GAN001,GAS001,GAF010,Existing,HMO,Bronze,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060008-01,Standard Bronze On Exchange Plan,60.90%,0.609844267368317,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710004,Humana Silver 4600/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340351,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331654,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710004-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710006,Humana Gold 2500/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340143,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331732,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710006-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710006,Humana Gold 2500/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340143,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331732,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710006-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710006,Humana Gold 2500/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340143,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331732,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,1,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060002,KP GA Gold 0/0/30/S2,89942GA006,,GAN001,GAS001,GAF002,Existing,HMO,Gold,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060002-00,Standard Gold Off Exchange Plan,81.70%,0.819604516029358,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,4,89942,GA,Individual,No,58-1592076,89942GA0050005,KP GA Silver 2500/30,89942GA005,,GAN001,GAS002,GAF012,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050005-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710007,Humana Platinum 1000/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340208,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331745,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710007-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710007,Humana Platinum 1000/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340208,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331745,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710007-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710007,Humana Platinum 1000/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340208,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331745,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710007,Humana Platinum 1000/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340208,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331745,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710007-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710001,Humana Basic 6600/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339987,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331615,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710002,Humana Bronze 6300/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340078,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331628,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710002-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040009,SoloCare - 0040009,83761GA004,,GAN001,GAS001,GAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040009-00,Standard Silver Off Exchange Plan,,0.680850446224213,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,900","$11,800",,,"$18,000","$36,000","$23,900","$47,800",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",80%,,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,42
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040009,SoloCare - 0040009,83761GA004,,GAN001,GAS001,GAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040009-01,Standard Silver On Exchange Plan,,0.680850446224213,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,900","$11,800",,,"$18,000","$36,000","$23,900","$47,800",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",80%,,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,43
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050020,SimpleCare-0050020,83761GA005,,GAN001,GAS001,GAF015,New,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050020-01,Standard Silver On Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$18,000","$36,000","$21,000","$42,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",100%,,,,"$9,000","$18,000","$12,000","$24,000",,,,,,,,,43
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050021,SimpleCare-0050021,83761GA005,,GAN001,GAS001,GAF015,New,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050021-00,Standard Silver Off Exchange Plan,,0.718143880367279,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$15,000","$30,000","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",100%,,,,"$7,500","$15,000","$10,000","$20,000",,,,,,,,,44
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040009,SoloCare - 0040009,83761GA004,,GAN001,GAS001,GAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,44
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040009,SoloCare - 0040009,83761GA004,,GAN001,GAS001,GAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040009-03,Limited Cost Sharing Plan Variation,,0.680850446224213,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,900","$11,800",,,"$18,000","$36,000","$23,900","$47,800",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",80%,,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,45
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050021,SimpleCare-0050021,83761GA005,,GAN001,GAS001,GAF015,New,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050021-01,Standard Silver On Exchange Plan,,0.718143880367279,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$15,000","$30,000","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",100%,,,,"$7,500","$15,000","$10,000","$20,000",,,,,,,,,45
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050022,SimpleCare-0050022,83761GA005,,GAN001,GAS001,GAF015,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050022-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,000","$50,000","$31,300","$622,600",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",100%,,,,"$12,600","$25,200","$18,900","$37,800",,,,,,,,,46
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040009,SoloCare - 0040009,83761GA004,,GAN001,GAS001,GAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040009-04,73% AV Level Silver Plan,,0.730335474014282,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$18,000","$36,000","$21,500","$43,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",80%,,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,46
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040009,SoloCare - 0040009,83761GA004,,GAN001,GAS001,GAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040009-05,87% AV Level Silver Plan,,0.879092335700989,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$18,000","$36,000","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,$600,"$1,200",80%,,,,"$6,000","$12,000","$6,600","$13,200",,,,,,,,,47
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,SHOP (Small Group),No,58-2335921,83761GA0050022,SimpleCare-0050022,83761GA005,,GAN001,GAS001,GAF015,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,Diabetes,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.ahpassist.com,www.ahpassist.com,www.ahpassist.com,www.AHPAssist.com,83761GA0050022-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,000","$50,000","$31,300","$622,600",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",100%,,,,"$12,600","$25,200","$18,900","$37,800",,,,,,,,,47
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040009,SoloCare - 0040009,83761GA004,,GAN001,GAS001,GAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040009-06,94% AV Level Silver Plan,,0.942646741867065,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$18,000","$36,000","$18,500","$37,000",,,,,,,,,,,,,,,,,,,,,$250,$500,80%,,,,"$6,000","$12,000","$6,250","$12,500",,,,,,,,,48
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040010,SoloCare - 0040010,83761GA004,,GAN001,GAS001,GAF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040010-00,Standard Silver Off Exchange Plan,,0.680692434310913,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,000","$38,000","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",80%,,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,49
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040010,SoloCare - 0040010,83761GA004,,GAN001,GAS001,GAF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040010-01,Standard Silver On Exchange Plan,,0.680692434310913,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,000","$38,000","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",80%,,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,50
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040010,SoloCare - 0040010,83761GA004,,GAN001,GAS001,GAF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,51
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040010,SoloCare - 0040010,83761GA004,,GAN001,GAS001,GAF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040010-03,Limited Cost Sharing Plan Variation,,0.680692434310913,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,000","$38,000","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",80%,,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,52
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040010,SoloCare - 0040010,83761GA004,,GAN001,GAS001,GAF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040010-04,73% AV Level Silver Plan,,0.730810582637787,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$19,000","$38,000","$22,500","$45,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",80%,,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,53
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040010,SoloCare - 0040010,83761GA004,,GAN001,GAS001,GAF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040010-05,87% AV Level Silver Plan,,0.872241258621216,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$19,000","$38,000","$20,200","$40,400",,,,,,,,,,,,,,,,,,,,,$800,"$1,600",80%,,,,"$6,000","$12,000","$6,800","$13,600",,,,,,,,,54
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040010,SoloCare - 0040010,83761GA004,,GAN001,GAS001,GAF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040010-06,94% AV Level Silver Plan,,0.933128476142883,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$19,000","$38,000","$19,600","$39,200",,,,,,,,,,,,,,,,,,,,,$300,$600,80%,,,,"$6,000","$12,000","$6,300","$12,600",,,,,,,,,55
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040011,SoloCare - 0040011,83761GA004,,GAN001,GAS001,GAF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040011-00,Standard Silver Off Exchange Plan,68.00%,0.680049419403076,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,400","$4,800",80%,,,,"$7,200","$14,000","$9,800","$19,200",,,,,,,,,56
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040011,SoloCare - 0040011,83761GA004,,GAN001,GAS001,GAF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040011-01,Standard Silver On Exchange Plan,68.00%,0.680049419403076,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,400","$4,800",80%,,,,"$7,200","$14,000","$9,800","$19,200",,,,,,,,,57
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040011,SoloCare - 0040011,83761GA004,,GAN001,GAS001,GAF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,58
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040011,SoloCare - 0040011,83761GA004,,GAN001,GAS001,GAF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040011-03,Limited Cost Sharing Plan Variation,68.00%,0.680049419403076,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,400","$4,800",80%,,,,"$7,200","$14,000","$9,800","$19,200",,,,,,,,,59
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040011,SoloCare - 0040011,83761GA004,,GAN001,GAS001,GAF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040011-04,73% AV Level Silver Plan,73.78%,0.737841308116913,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,"$15,000","$30,000","$17,900","$35,800",,,,,,,,,,,,,,,,,,,,,"$2,400","$4,800",80%,,,,"$7,200","$14,000","$9,800","$19,200",,,,,,,,,60
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040011,SoloCare - 0040011,83761GA004,,GAN001,GAS001,GAF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040011-05,87% AV Level Silver Plan,87.18%,0.871844530105591,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$15,000","$30,000","$16,200","$32,400",,,,,,,,,,,,,,,,,,,,,$800,"$1,600",80%,,,,"$7,200","$14,000","$8,000","$15,600",,,,,,,,,61
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040011,SoloCare - 0040011,83761GA004,,GAN001,GAS001,GAF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040011-06,94% AV Level Silver Plan,93.26%,0.932608306407928,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$15,000","$30,000","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,$300,$600,80%,,,,"$7,200","$14,000","$7,500","$14,600",,,,,,,,,62
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040012,SoloCare - 0040012,83761GA004,,GAN001,GAS001,GAF014,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040012-00,Standard Silver Off Exchange Plan,,0.701975703239441,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$18,000","$36,000","$21,000","$42,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",100%,,,,"$9,000","$18,000","$12,000","$24,000",,,,,,,,,63
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040012,SoloCare - 0040012,83761GA004,,GAN001,GAS001,GAF014,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040012-01,Standard Silver On Exchange Plan,,0.701975703239441,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$18,000","$36,000","$21,000","$42,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",100%,,,,"$9,000","$18,000","$12,000","$24,000",,,,,,,,,64
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040012,SoloCare - 0040012,83761GA004,,GAN001,GAS001,GAF014,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,65
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040012,SoloCare - 0040012,83761GA004,,GAN001,GAS001,GAF014,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040012-03,Limited Cost Sharing Plan Variation,,0.701975703239441,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$18,000","$36,000","$21,000","$42,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",100%,,,,"$9,000","$18,000","$12,000","$24,000",,,,,,,,,66
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040012,SoloCare - 0040012,83761GA004,,GAN001,GAS001,GAF014,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040012-04,73% AV Level Silver Plan,,0.733946084976196,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$18,000","$36,000","$20,500","$41,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",100%,,,,"$9,000","$18,000","$11,500","$23,000",,,,,,,,,67
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040012,SoloCare - 0040012,83761GA004,,GAN001,GAS001,GAF014,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040012-05,87% AV Level Silver Plan,,0.866427183151245,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$18,000","$36,000","$19,000","$38,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",100%,,,,"$9,000","$18,000","$10,000","$20,000",,,,,,,,,68
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040012,SoloCare - 0040012,83761GA004,,GAN001,GAS001,GAF014,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040012-06,94% AV Level Silver Plan,,0.940209031105042,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,"$18,000","$36,000","$18,400","$36,800",,,,,,,,,,,,,,,,,,,,,$400,$800,100%,,,,"$9,000","$18,000","$9,400","$18,800",,,,,,,,,69
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040013,SoloCare - 0040013,83761GA004,,GAN001,GAS001,GAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,ww.AHPAssist.com,83761GA0040013-00,Standard Silver Off Exchange Plan,,0.682003974914551,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$18,000","$36,000","$22,750","$45,500",,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",80%,,,,"$9,000","$18,000","$11,600","$23,200",,,,,,,,,70
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040013,SoloCare - 0040013,83761GA004,,GAN001,GAS001,GAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,ww.AHPAssist.com,83761GA0040013-01,Standard Silver On Exchange Plan,,0.682003974914551,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$18,000","$36,000","$22,750","$45,500",,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",80%,,,,"$9,000","$18,000","$11,600","$23,200",,,,,,,,,71
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040013,SoloCare - 0040013,83761GA004,,GAN001,GAS001,GAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,ww.AHPAssist.com,83761GA0040013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,72
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040013,SoloCare - 0040013,83761GA004,,GAN001,GAS001,GAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,ww.AHPAssist.com,83761GA0040013-03,Limited Cost Sharing Plan Variation,,0.682003974914551,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$18,000","$36,000","$22,750","$45,500",,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",80%,,,,"$9,000","$18,000","$11,600","$23,200",,,,,,,,,73
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040013,SoloCare - 0040013,83761GA004,,GAN001,GAS001,GAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,ww.AHPAssist.com,83761GA0040013-04,73% AV Level Silver Plan,,0.728755712509155,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$18,000","$36,000","$21,000","$42,000",,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",80%,,,,"$9,000","$18,000","$11,600","$23,200",,,,,,,,,74
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040013,SoloCare - 0040013,83761GA004,,GAN001,GAS001,GAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,ww.AHPAssist.com,83761GA0040013-05,87% AV Level Silver Plan,,0.864505112171173,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$18,000","$36,000","$19,400","$38,800",,,,,,,,,,,,,,,,,,,,,$700,"$1,400",80%,,,,"$9,000","$18,000","$9,700","$19,400",,,,,,,,,75
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040013,SoloCare - 0040013,83761GA004,,GAN001,GAS001,GAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,ww.AHPAssist.com,83761GA0040013-06,94% AV Level Silver Plan,,0.938100397586823,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,"$18,000","$36,000","$18,550","$37,100",,,,,,,,,,,,,,,,,,,,,$275,$550,80%,,,,"$9,000","$18,000","$9,275","$18,550",,,,,,,,,76
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040014,SoloCare - 0040014,83761GA004,,GAN001,GAS001,GAF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040014-00,Standard Silver Off Exchange Plan,,0.681163430213928,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,500","$39,000","$24,500","$49,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",80%,,,,"$9,000","$18,000","$11,500","$23,000",,,,,,,,,77
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040014,SoloCare - 0040014,83761GA004,,GAN001,GAS001,GAF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040014-01,Standard Silver On Exchange Plan,,0.681163430213928,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,500","$39,000","$24,500","$49,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",80%,,,,"$9,000","$18,000","$11,500","$23,000",,,,,,,,,78
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040014,SoloCare - 0040014,83761GA004,,GAN001,GAS001,GAF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,79
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040014,SoloCare - 0040014,83761GA004,,GAN001,GAS001,GAF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040014-03,Limited Cost Sharing Plan Variation,,0.681163430213928,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,500","$39,000","$24,500","$49,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",80%,,,,"$9,000","$18,000","$11,500","$23,000",,,,,,,,,80
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040014,SoloCare - 0040014,83761GA004,,GAN001,GAS001,GAF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040014-04,73% AV Level Silver Plan,,0.731538593769073,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$19,500","$39,000","$22,500","$45,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",80%,,,,"$9,000","$18,000","$11,500","$23,000",,,,,,,,,81
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040014,SoloCare - 0040014,83761GA004,,GAN001,GAS001,GAF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040014-05,87% AV Level Silver Plan,,0.872558832168579,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$19,500","$39,000","$20,800","$41,600",,,,,,,,,,,,,,,,,,,,,$650,"$1,300",80%,,,,"$9,000","$18,000","$9,650","$19,300",,,,,,,,,82
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040014,SoloCare - 0040014,83761GA004,,GAN001,GAS001,GAF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040014-06,94% AV Level Silver Plan,,0.943253040313721,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,500","$39,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,$250,$500,80%,,,,"$9,000","$18,000","$9,250","$18,500",,,,,,,,,83
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040015,SoloCare - 0040015,83761GA004,,GAN001,GAS001,GAF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040015-00,Standard Silver Off Exchange Plan,,0.681062042713165,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$18,000","$36,000","$22,250","$44,500",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",80%,,,,"$12,000","$24,000","$15,000","$30,000",,,,,,,,,84
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040015,SoloCare - 0040015,83761GA004,,GAN001,GAS001,GAF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040015-01,Standard Silver On Exchange Plan,,0.681062042713165,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$18,000","$36,000","$22,250","$44,500",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",80%,,,,"$12,000","$24,000","$15,000","$30,000",,,,,,,,,85
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040015,SoloCare - 0040015,83761GA004,,GAN001,GAS001,GAF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040015-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,86
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040015,SoloCare - 0040015,83761GA004,,GAN001,GAS001,GAF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040015-03,Limited Cost Sharing Plan Variation,,0.681062042713165,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$18,000","$36,000","$22,250","$44,500",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",80%,,,,"$12,000","$24,000","$15,000","$30,000",,,,,,,,,87
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040015,SoloCare - 0040015,83761GA004,,GAN001,GAS001,GAF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040015-04,73% AV Level Silver Plan,,0.731557309627533,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$18,000","$36,000","$21,000","$42,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",80%,,,,"$12,000","$24,000","$14,500","$29,000",,,,,,,,,88
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040015,SoloCare - 0040015,83761GA004,,GAN001,GAS001,GAF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040015-05,87% AV Level Silver Plan,,0.865008652210236,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$18,000","$36,000","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,$750,"$1,500",80%,,,,"$12,000","$24,000","$12,750","$25,500",,,,,,,,,89
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040015,SoloCare - 0040015,83761GA004,,GAN001,GAS001,GAF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040015-06,94% AV Level Silver Plan,,0.933155238628387,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$18,000","$36,000","$18,600","$37,200",,,,,,,,,,,,,,,,,,,,,$300,$600,80%,,,,"$12,000","$24,000","$12,300","$24,600",,,,,,,,,90
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040016,SoloCare - 0040016,83761GA004,,GAN001,GAS001,GAF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040016-00,Standard Silver Off Exchange Plan,,0.681764245033264,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$15,000","$30,000","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$3,100","$6,200",90%,,,,"$12,000","$24,000","$15,100","$30,200",,,,,,,,,91
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040016,SoloCare - 0040016,83761GA004,,GAN001,GAS001,GAF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040016-01,Standard Silver On Exchange Plan,,0.681764245033264,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$15,000","$30,000","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$3,100","$6,200",90%,,,,"$12,000","$24,000","$15,100","$30,200",,,,,,,,,92
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040016,SoloCare - 0040016,83761GA004,,GAN001,GAS001,GAF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,93
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040017,SoloCare - 0040017,83761GA004,,GAN001,GAS001,GAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,ww.AHPAssist.com,83761GA0040017-05,87% AV Level Silver Plan,,0.87020617723465,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$18,000","$36,000","$19,000","$38,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",100%,,,,"$15,000","$30,000","$16,000","$32,000",,,,,,,,,103
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040017,SoloCare - 0040017,83761GA004,,GAN001,GAS001,GAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,ww.AHPAssist.com,83761GA0040017-06,94% AV Level Silver Plan,,0.948858141899109,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$350,$700,,,"$18,000","$36,000","$18,350","$36,700",,,,,,,,,,,,,,,,,,,,,$350,$700,100%,,,,"$15,000","$30,000","$15,350","$30,700",,,,,,,,,104
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040019,SoloCare - 0040019,83761GA004,,GAN001,GAS001,GAF017,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040019-00,Standard Bronze Off Exchange Plan,,0.582763254642487,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$19,500","$39,000","$26,000","$52,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,105
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040019,SoloCare - 0040019,83761GA004,,GAN001,GAS001,GAF017,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040019-01,Standard Bronze On Exchange Plan,,0.582763254642487,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$19,500","$39,000","$26,000","$52,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,106
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040019,SoloCare - 0040019,83761GA004,,GAN001,GAS001,GAF017,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040019-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,107
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040019,SoloCare - 0040019,83761GA004,,GAN001,GAS001,GAF017,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040019-03,Limited Cost Sharing Plan Variation,,0.582763254642487,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$19,500","$39,000","$26,000","$52,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,108
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,3,89942,GA,Individual,No,58-1592076,89942GA0050004,KP GA Silver 1500/30,89942GA005,,GAN001,GAS002,GAF012,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050004-04,73% AV Level Silver Plan,73.80%,0.733147501945496,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,3,89942,GA,Individual,No,58-1592076,89942GA0050004,KP GA Silver 1500/30,89942GA005,,GAN001,GAS002,GAF012,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050004-05,87% AV Level Silver Plan,87.10%,0.86692202091217,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,3,93332,GA,Individual,No,58-2209549,93332GA0720007,Humana Platinum 1000/National POS - OpenAccess,93332GA072,,GAN004,GAS001,GAF007,Existing,POS,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340247,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331602,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0720007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,3,93332,GA,Individual,No,58-2209549,93332GA0720007,Humana Platinum 1000/National POS - OpenAccess,93332GA072,,GAN004,GAS001,GAF007,Existing,POS,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340247,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331602,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0720007-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,2,17575,IN,SHOP (Small Group),Yes,35-0781558,17575IN0890004,Anthem Dental Family Enhanced,17575IN089,,INN009,INS019,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.89,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/in/f0/s0/t0/pw_e213899.pdf,,,,17575IN0890004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,3,17575,IN,SHOP (Small Group),No,35-0781558,17575IN0730003,Anthem Bronze Blue Preferred  X POS 6000 30 6600 Plus,17575IN073,,INN006,INS001,INF002,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991309516966654,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LEU,,http://sgplans.anthem.com/in/brochure/,anthem.com/INSelectdrugtier4,17575IN0730003-00,Standard Bronze Off Exchange Plan,61.62%,0.656103909015656,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$6,000","$12,000",30%,,,,"$12,000","$24,000","$18,000","$36,000",$250,$500,30%,,,,Not Applicable,Not Applicable,$250,$500,,,,,,,,,,,,,,,,,,,4
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,3,17575,IN,Individual,No,35-0781558,17575IN0700023,Anthem Bronze Pathway X 6250 30,17575IN070,,INN002,INS001,INF025,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GET,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700023-00,Standard Bronze Off Exchange Plan,61.53%,0.618361353874207,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,3,17575,IN,Individual,No,35-0781558,17575IN0700023,Anthem Bronze Pathway X 6250 30,17575IN070,,INN002,INS001,INF025,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GET,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700023-01,Standard Bronze On Exchange Plan,61.53%,0.618361353874207,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,3,17575,IN,SHOP (Small Group),No,35-0781558,17575IN0730003,Anthem Bronze Blue Preferred  X POS 6000 30 6600 Plus,17575IN073,,INN006,INS001,INF002,Existing,POS,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991309516966654,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LEU,,http://sgplans.anthem.com/in/brochure/,anthem.com/INSelectdrugtier4,17575IN0730003-01,Standard Bronze On Exchange Plan,61.62%,0.656103909015656,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$6,000","$12,000",30%,,,,"$12,000","$24,000","$18,000","$36,000",$250,$500,30%,,,,Not Applicable,Not Applicable,$250,$500,,,,,,,,,,,,,,,,,,,5
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,3,17575,IN,Individual,No,35-0781558,17575IN0700023,Anthem Bronze Pathway X 6250 30,17575IN070,,INN002,INS001,INF025,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GET,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700023-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040020,SoloCare - 0040020,83761GA004,,GAN001,GAS001,GAF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040020-00,Standard Bronze Off Exchange Plan,,0.585683524608612,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$37,200","$74,400","$43,550","$87,100",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$18,000","$36,000","$24,000","$48,000",,,,,,,,,109
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040020,SoloCare - 0040020,83761GA004,,GAN001,GAS001,GAF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040020-01,Standard Bronze On Exchange Plan,,0.585683524608612,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$37,200","$74,400","$43,550","$87,100",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$18,000","$36,000","$24,000","$48,000",,,,,,,,,110
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040020,SoloCare - 0040020,83761GA004,,GAN001,GAS001,GAF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040020-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,111
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040020,SoloCare - 0040020,83761GA004,,GAN001,GAS001,GAF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040020-03,Limited Cost Sharing Plan Variation,,0.585683524608612,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$37,200","$74,400","$43,550","$87,100",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$18,000","$36,000","$24,000","$48,000",,,,,,,,,112
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040021,SoloCare - 0040021,83761GA004,,GAN001,GAS001,GAF015,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040021-00,Standard Bronze Off Exchange Plan,,0.584212303161621,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,225","$12,450",,,"$39,000","$78,000","$45,225","$90,450",,,,,,,,,,,,,,,,,,,,,"$6,225","$12,650",100%,,,,"$18,675","$37,350","$24,900","$4,900",,,,,,,,,113
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040021,SoloCare - 0040021,83761GA004,,GAN001,GAS001,GAF015,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040021-01,Standard Bronze On Exchange Plan,,0.584212303161621,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,225","$12,450",,,"$39,000","$78,000","$45,225","$90,450",,,,,,,,,,,,,,,,,,,,,"$6,225","$12,650",100%,,,,"$18,675","$37,350","$24,900","$4,900",,,,,,,,,114
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040021,SoloCare - 0040021,83761GA004,,GAN001,GAS001,GAF015,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040021-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,115
2015,GA,83761,HIOS,15,2015-02-18 06:26:47,1,83761,GA,Individual,No,58-2335921,83761GA0040021,SoloCare - 0040021,83761GA004,,GAN001,GAS001,GAF015,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996945445303552,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,In-Network providers available in counties outside the Service Area. Verify participating providers at AHPAssist.com,No,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,www.AHPAssist.com,83761GA0040021-03,Limited Cost Sharing Plan Variation,,0.584212303161621,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,225","$12,450",,,"$39,000","$78,000","$45,225","$90,450",,,,,,,,,,,,,,,,,,,,,"$6,225","$12,650",100%,,,,"$18,675","$37,350","$24,900","$4,900",,,,,,,,,116
2015,GA,86637,HIOS,7,2014-11-14 05:23:27,1,86637,GA,Individual,Yes,94-2761537,86637GA0010002,Delta Dental PPO Pediatric Preferred Plan,86637GA001,,GAN001,GAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$25.28,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ga/86637ga0010002-15,,86637GA0010002-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,4,89942,GA,Individual,No,58-1592076,89942GA0050005,KP GA Silver 2500/30,89942GA005,,GAN001,GAS002,GAF012,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050005-03,Limited Cost Sharing Plan Variation,69.70%,0.684151530265808,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710018,Humana Silver 4600/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340364,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331797,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710018-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710018,Humana Silver 4600/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340364,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331797,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710018-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710018,Humana Silver 4600/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340364,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331797,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710018-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710018,Humana Silver 4600/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340364,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331797,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710018-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710002,Humana Bronze 6300/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340078,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331628,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710002-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710002,Humana Bronze 6300/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340078,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331628,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,1,89942,GA,Individual,No,58-1592076,89942GA0050002,KP GA Gold 0/20,89942GA005,,GAN001,GAS002,GAF011,Existing,HMO,Gold,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,4,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050002-00,Standard Gold Off Exchange Plan,81.10%,0.803444921970367,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,1,89942,GA,Individual,No,58-1592076,89942GA0050002,KP GA Gold 0/20,89942GA005,,GAN001,GAS002,GAF011,Existing,HMO,Gold,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,4,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050002-01,Standard Gold On Exchange Plan,81.10%,0.803444921970367,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,1,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060002,KP GA Gold 0/0/30/S2,89942GA006,,GAN001,GAS001,GAF002,Existing,HMO,Gold,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060002-01,Standard Gold On Exchange Plan,81.70%,0.819604516029358,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,1,89942,GA,Individual,No,58-1592076,89942GA0050002,KP GA Gold 0/20,89942GA005,,GAN001,GAS002,GAF011,Existing,HMO,Gold,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,4,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,1,89942,GA,Individual,No,58-1592076,89942GA0050002,KP GA Gold 0/20,89942GA005,,GAN001,GAS002,GAF011,Existing,HMO,Gold,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,4,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050002-03,Limited Cost Sharing Plan Variation,81.10%,0.803444921970367,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,2,89942,GA,Individual,No,58-1592076,89942GA0050003,KP GA Gold 1000/20,89942GA005,,GAN001,GAS002,GAF011,Existing,HMO,Gold,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050003-00,Standard Gold Off Exchange Plan,78.60%,0.781015992164612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,2,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060003,KP GA Gold 1000/20/30/S2,89942GA006,,GAN001,GAS001,GAF003,Existing,HMO,Gold,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060003-00,Standard Gold Off Exchange Plan,78.40%,0.788664281368256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,2,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060003,KP GA Gold 1000/20/30/S2,89942GA006,,GAN001,GAS001,GAF003,Existing,HMO,Gold,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060003-01,Standard Gold On Exchange Plan,78.40%,0.788664281368256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,2,89942,GA,Individual,No,58-1592076,89942GA0050003,KP GA Gold 1000/20,89942GA005,,GAN001,GAS002,GAF011,Existing,HMO,Gold,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050003-01,Standard Gold On Exchange Plan,78.60%,0.781015992164612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,2,89942,GA,Individual,No,58-1592076,89942GA0050003,KP GA Gold 1000/20,89942GA005,,GAN001,GAS002,GAF011,Existing,HMO,Gold,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050003-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,2,89942,GA,Individual,No,58-1592076,89942GA0050003,KP GA Gold 1000/20,89942GA005,,GAN001,GAS002,GAF011,Existing,HMO,Gold,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050003-03,Limited Cost Sharing Plan Variation,78.60%,0.781015992164612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,3,89942,GA,Individual,No,58-1592076,89942GA0050004,KP GA Silver 1500/30,89942GA005,,GAN001,GAS002,GAF012,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050004-00,Standard Silver Off Exchange Plan,71.30%,0.703077137470245,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,3,89942,GA,Individual,No,58-1592076,89942GA0050004,KP GA Silver 1500/30,89942GA005,,GAN001,GAS002,GAF012,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050004-01,Standard Silver On Exchange Plan,71.30%,0.703077137470245,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,3,89942,GA,Individual,No,58-1592076,89942GA0050004,KP GA Silver 1500/30,89942GA005,,GAN001,GAS002,GAF012,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050004-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,3,89942,GA,Individual,No,58-1592076,89942GA0050004,KP GA Silver 1500/30,89942GA005,,GAN001,GAS002,GAF012,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050004-03,Limited Cost Sharing Plan Variation,71.30%,0.703077137470245,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,3,89942,GA,Individual,No,58-1592076,89942GA0050004,KP GA Silver 1500/30,89942GA005,,GAN001,GAS002,GAF012,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050004-06,94% AV Level Silver Plan,93.70%,0.935387969017029,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,4,89942,GA,Individual,No,58-1592076,89942GA0050005,KP GA Silver 2500/30,89942GA005,,GAN001,GAS002,GAF012,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050005-00,Standard Silver Off Exchange Plan,69.70%,0.684151530265808,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,4,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060005,KP GA Silver  2000/40/40/S2,89942GA006,,GAN001,GAS001,GAF007,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060005-00,Standard Silver Off Exchange Plan,70.60%,0.696543276309967,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,4,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060005,KP GA Silver  2000/40/40/S2,89942GA006,,GAN001,GAS001,GAF007,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060005-01,Standard Silver On Exchange Plan,70.60%,0.696543276309967,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,4,89942,GA,Individual,No,58-1592076,89942GA0050005,KP GA Silver 2500/30,89942GA005,,GAN001,GAS002,GAF012,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050005-01,Standard Silver On Exchange Plan,69.70%,0.684151530265808,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,4,89942,GA,Individual,No,58-1592076,89942GA0050005,KP GA Silver 2500/30,89942GA005,,GAN001,GAS002,GAF012,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050005-04,73% AV Level Silver Plan,73.80%,0.733147501945496,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,4,89942,GA,Individual,No,58-1592076,89942GA0050005,KP GA Silver 2500/30,89942GA005,,GAN001,GAS002,GAF012,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050005-05,87% AV Level Silver Plan,87.10%,0.86692202091217,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,4,89942,GA,Individual,No,58-1592076,89942GA0050005,KP GA Silver 2500/30,89942GA005,,GAN001,GAS002,GAF012,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050005-06,94% AV Level Silver Plan,93.70%,0.935387969017029,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,5,89942,GA,Individual,No,58-1592076,89942GA0050006,KP GA Silver 1750/25%/HSA,89942GA005,,GAN001,GAS002,GAF012,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050006-00,Standard Silver Off Exchange Plan,68.30%,0.684829592704773,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,5,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060006,KP GA Bronze 4500/25/40/S2,89942GA006,,GAN001,GAS001,GAF009,Existing,HMO,Bronze,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060006-00,Standard Bronze Off Exchange Plan,61.60%,0.615868508815765,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,5,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060006,KP GA Bronze 4500/25/40/S2,89942GA006,,GAN001,GAS001,GAF009,Existing,HMO,Bronze,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060006-01,Standard Bronze On Exchange Plan,61.60%,0.615868508815765,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,5,89942,GA,Individual,No,58-1592076,89942GA0050006,KP GA Silver 1750/25%/HSA,89942GA005,,GAN001,GAS002,GAF012,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050006-01,Standard Silver On Exchange Plan,68.30%,0.684829592704773,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,5,89942,GA,Individual,No,58-1592076,89942GA0050006,KP GA Silver 1750/25%/HSA,89942GA005,,GAN001,GAS002,GAF012,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,5,89942,GA,Individual,No,58-1592076,89942GA0050006,KP GA Silver 1750/25%/HSA,89942GA005,,GAN001,GAS002,GAF012,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050006-03,Limited Cost Sharing Plan Variation,68.30%,0.684829592704773,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,5,89942,GA,Individual,No,58-1592076,89942GA0050006,KP GA Silver 1750/25%/HSA,89942GA005,,GAN001,GAS002,GAF012,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050006-04,73% AV Level Silver Plan,73.30%,0.725752353668213,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,6,89942,GA,Individual,No,58-1592076,89942GA0050007,KP GA Bronze 5000/50,89942GA005,,GAN001,GAS002,GAF013,Existing,HMO,Bronze,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050007-00,Standard Bronze Off Exchange Plan,62.00%,0.615966856479645,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,6,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060007,KP GA Silver HDHP/2000/20/S2,89942GA006,,GAN001,GAS001,GAF006,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060007-00,Standard Silver Off Exchange Plan,68.50%,0.685929417610168,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,6,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060007,KP GA Silver HDHP/2000/20/S2,89942GA006,,GAN001,GAS001,GAF006,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060007-01,Standard Silver On Exchange Plan,68.50%,0.685929417610168,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,6,89942,GA,Individual,No,58-1592076,89942GA0050007,KP GA Bronze 5000/50,89942GA005,,GAN001,GAS002,GAF013,Existing,HMO,Bronze,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050007-01,Standard Bronze On Exchange Plan,62.00%,0.615966856479645,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,6,89942,GA,Individual,No,58-1592076,89942GA0050007,KP GA Bronze 5000/50,89942GA005,,GAN001,GAS002,GAF013,Existing,HMO,Bronze,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050007-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,6,89942,GA,Individual,No,58-1592076,89942GA0050007,KP GA Bronze 5000/50,89942GA005,,GAN001,GAS002,GAF013,Existing,HMO,Bronze,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050007-03,Limited Cost Sharing Plan Variation,62.00%,0.615966856479645,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,7,89942,GA,Individual,No,58-1592076,89942GA0050008,KP GA Bronze 4500/50/HSA,89942GA005,,GAN001,GAS002,GAF014,Existing,HMO,Bronze,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050008-00,Standard Bronze Off Exchange Plan,59.30%,0.592896044254303,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,7,89942,GA,Individual,No,58-1592076,89942GA0050008,KP GA Bronze 4500/50/HSA,89942GA005,,GAN001,GAS002,GAF014,Existing,HMO,Bronze,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050008-01,Standard Bronze On Exchange Plan,59.30%,0.592896044254303,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,7,89942,GA,Individual,No,58-1592076,89942GA0050008,KP GA Bronze 4500/50/HSA,89942GA005,,GAN001,GAS002,GAF014,Existing,HMO,Bronze,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050008-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,7,89942,GA,Individual,No,58-1592076,89942GA0050008,KP GA Bronze 4500/50/HSA,89942GA005,,GAN001,GAS002,GAF014,Existing,HMO,Bronze,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050008-03,Limited Cost Sharing Plan Variation,59.30%,0.592896044254303,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,8,89942,GA,Individual,No,58-1592076,89942GA0050009,KP GA Bronze 5000/30%/HSA,89942GA005,,GAN001,GAS002,GAF015,Existing,HMO,Bronze,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050009-00,Standard Bronze Off Exchange Plan,59.30%,0.583991169929504,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,8,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060009,KP GA Bronze HDHP/4500/40/S2,89942GA006,,GAN001,GAS001,GAF004,Existing,HMO,Bronze,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060009-00,Standard Bronze Off Exchange Plan,59.10%,0.591230452060699,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,8,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060009,KP GA Bronze HDHP/4500/40/S2,89942GA006,,GAN001,GAS001,GAF004,Existing,HMO,Bronze,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060009-01,Standard Bronze On Exchange Plan,59.10%,0.591230452060699,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,8,89942,GA,Individual,No,58-1592076,89942GA0050009,KP GA Bronze 5000/30%/HSA,89942GA005,,GAN001,GAS002,GAF015,Existing,HMO,Bronze,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050009-01,Standard Bronze On Exchange Plan,59.30%,0.583991169929504,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,8,89942,GA,Individual,No,58-1592076,89942GA0050009,KP GA Bronze 5000/30%/HSA,89942GA005,,GAN001,GAS002,GAF015,Existing,HMO,Bronze,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050009-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,8,89942,GA,Individual,No,58-1592076,89942GA0050009,KP GA Bronze 5000/30%/HSA,89942GA005,,GAN001,GAS002,GAF015,Existing,HMO,Bronze,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050009-03,Limited Cost Sharing Plan Variation,59.30%,0.583991169929504,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,9,89942,GA,Individual,No,58-1592076,89942GA0050010,KP GA Catastrophic 6600/0,89942GA005,,GAN001,GAS002,GAF016,Existing,HMO,Catastrophic,No,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,3,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050010-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,9,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060010,KP GA Gold HDHP/2000/40/S2,89942GA006,,GAN001,GAS001,GAF004,Existing,HMO,Gold,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,Yes,Yes,"$1,500.00",Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060010-00,Standard Gold Off Exchange Plan,78.80%,0.788680195808411,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,9,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060010,KP GA Gold HDHP/2000/40/S2,89942GA006,,GAN001,GAS001,GAF004,Existing,HMO,Gold,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,Yes,Yes,"$1,500.00",Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060010-01,Standard Gold On Exchange Plan,78.80%,0.788680195808411,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,9,89942,GA,Individual,No,58-1592076,89942GA0050010,KP GA Catastrophic 6600/0,89942GA005,,GAN001,GAS002,GAF016,Existing,HMO,Catastrophic,No,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,3,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050010-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,10,89942,GA,Individual,No,58-1592076,89942GA0050012,KP GA Gold 1500/20,89942GA005,,GAN001,GAS002,GAF011,New,HMO,Gold,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050012-00,Standard Gold Off Exchange Plan,78.80%,0.78211635351181,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,10,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060011,KP GA Silver HDHP/2000/40/S2,89942GA006,,GAN001,GAS001,GAF004,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,Yes,Yes,$500.00,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060011-00,Standard Silver Off Exchange Plan,70.70%,0.708127915859222,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,10,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060011,KP GA Silver HDHP/2000/40/S2,89942GA006,,GAN001,GAS001,GAF004,Existing,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,Yes,Yes,$500.00,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060011-01,Standard Silver On Exchange Plan,70.70%,0.708127915859222,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,10,89942,GA,Individual,No,58-1592076,89942GA0050012,KP GA Gold 1500/20,89942GA005,,GAN001,GAS002,GAF011,New,HMO,Gold,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050012-01,Standard Gold On Exchange Plan,78.80%,0.78211635351181,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,10,89942,GA,Individual,No,58-1592076,89942GA0050012,KP GA Gold 1500/20,89942GA005,,GAN001,GAS002,GAF011,New,HMO,Gold,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050012-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,10,89942,GA,Individual,No,58-1592076,89942GA0050012,KP GA Gold 1500/20,89942GA005,,GAN001,GAS002,GAF011,New,HMO,Gold,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9911,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care only,Yes,Urgent and Emergency Care only,No,http://info.kaiserpermanente.org/healthplans/georgia/individual/summary-benefits-coverage/,https://www.billerpayments.com/saml/hix/kpgabp,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0050012-03,Limited Cost Sharing Plan Variation,78.80%,0.78211635351181,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,12,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060012,KP GA Gold 1500/0/20/S2,89942GA006,,GAN001,GAS001,GAF001,New,HMO,Gold,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060012-00,Standard Gold Off Exchange Plan,81.90%,0.821767866611481,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,12,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060012,KP GA Gold 1500/0/20/S2,89942GA006,,GAN001,GAS001,GAF001,New,HMO,Gold,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060012-01,Standard Gold On Exchange Plan,81.90%,0.821767866611481,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,13,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060013,KP GA Silver 3000/20/40/S2,89942GA006,,GAN001,GAS001,GAF008,New,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kp.org/health/plans/ga/plans/smallbusiness?contentid=/html/plans/ga/small/entrypage.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060013-00,Standard Silver Off Exchange Plan,68.50%,0.688545525074005,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,89942,HIOS,7,2015-02-19 06:21:02,13,89942,GA,SHOP (Small Group),No,58-1592076,89942GA0060013,KP GA Silver 3000/20/40/S2,89942GA006,,GAN001,GAS001,GAF008,New,HMO,Silver,Yes,Both,No,Yes,"Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care Only,Yes,Urgent and Emergency Care Only,No,http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/summary-benefits-coverage/,,https://businessnet.kp.org/health/plans/ga/plans/smallbusiness?contentid=/html/plans/ga/small/entrypage.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_qualified_plan_formulary_2014.pdf,89942GA0060013-01,Standard Silver On Exchange Plan,68.50%,0.688545525074005,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710004,Humana Silver 4600/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340351,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331654,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710004-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710004,Humana Silver 4600/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340351,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331654,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710004-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710004,Humana Silver 4600/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340351,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331654,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710004,Humana Silver 4600/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340351,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331654,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710004-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710004,Humana Silver 4600/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340351,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331654,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710004-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710004,Humana Silver 4600/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340351,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331654,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710004-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710006,Humana Gold 2500/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340143,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331732,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710006-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710018,Humana Silver 4600/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340364,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331797,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710018-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710042,Humana Gold 2500/Macon HMOx,93332GA071,,GAN005,GAS005,GAF004,New,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2331966,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2340169,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710042-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,58
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710042,Humana Gold 2500/Macon HMOx,93332GA071,,GAN005,GAS005,GAF004,New,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2331966,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2340169,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710042-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,59
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,3,93332,GA,Individual,No,58-2209549,93332GA0720006,Humana Gold 2500/National POS - OpenAccess,93332GA072,,GAN004,GAS001,GAF007,Existing,POS,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340182,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331589,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0720006-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,3,93332,GA,Individual,No,58-2209549,93332GA0720006,Humana Gold 2500/National POS - OpenAccess,93332GA072,,GAN004,GAS001,GAF007,Existing,POS,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340182,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331589,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0720006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,3,93332,GA,Individual,No,58-2209549,93332GA0720006,Humana Gold 2500/National POS - OpenAccess,93332GA072,,GAN004,GAS001,GAF007,Existing,POS,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340182,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331589,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0720006-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,3,93332,GA,Individual,No,58-2209549,93332GA0720007,Humana Platinum 1000/National POS - OpenAccess,93332GA072,,GAN004,GAS001,GAF007,Existing,POS,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340247,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331602,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0720007-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,10,17575,IN,Individual,No,35-0781558,17575IN0700027,Anthem Silver Pathway X 2500 10,17575IN070,,INN002,INS001,INF013,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GF6,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700027-06,94% AV Level Silver Plan,93.23%,0.933515608310699,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,IN,20855,HIOS,9,2015-07-22 09:15:52,1,20855,IN,SHOP (Small Group),No,35-2093563,20855IN0040035,HDHP - 700,20855IN004,,INN001,INS001,INF001,New,HMO,Gold,No,Both,No,Yes,All,,,Yes,Yes,$400.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.9968,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Emergent/urgent care,No,http://www.advantagecdn.com/wp-content/uploads/Gold-HDHP-507_700.pdf,,http://www.advantagecdn.com/wp-content/uploads/ADV_ShopBroSpreads11_14LR1.pdf,www.advantageplan.com,20855IN0040035-00,Standard Gold Off Exchange Plan,,0.786466300487518,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300",$0,"$1,200",$150,"$1,300",$0,$790,$80,4
2015,IN,20855,HIOS,9,2015-07-22 09:15:52,1,20855,IN,SHOP (Small Group),No,35-2093563,20855IN0040035,HDHP - 700,20855IN004,,INN001,INS001,INF001,New,HMO,Gold,No,Both,No,Yes,All,,,Yes,Yes,$400.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.9968,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Emergent/urgent care,No,http://www.advantagecdn.com/wp-content/uploads/Gold-HDHP-507_700.pdf,,http://www.advantagecdn.com/wp-content/uploads/ADV_ShopBroSpreads11_14LR1.pdf,www.advantageplan.com,20855IN0040035-01,Standard Gold On Exchange Plan,,0.786466300487518,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300",$0,"$1,200",$150,"$1,300",$0,$790,$80,5
2015,IN,20855,HIOS,9,2015-07-22 09:15:52,2,20855,IN,SHOP (Small Group),No,35-2093563,20855IN0040036,HDHP - 702,20855IN004,,INN001,INS001,INF003,New,HMO,Bronze,No,Both,No,Yes,All,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.9968,,,0,0,0,2015-01-01,2015-12-31,Yes,emergent/urgent care only,Yes,Emergent/urgent care only,No,http://www.advantagecdn.com/wp-content/uploads/Bronze-HDHP-508_702.pdf,,http://www.advantagecdn.com/wp-content/uploads/ADV_ShopBroSpreads11_14LR1.pdf,www.advantageplan.com,20855IN0040036-00,Standard Bronze Off Exchange Plan,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$460,$150,"$5,000",$0,$50,$80,4
2015,IN,20855,HIOS,9,2015-07-22 09:15:52,2,20855,IN,SHOP (Small Group),No,35-2093563,20855IN0040036,HDHP - 702,20855IN004,,INN001,INS001,INF003,New,HMO,Bronze,No,Both,No,Yes,All,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.9968,,,0,0,0,2015-01-01,2015-12-31,Yes,emergent/urgent care only,Yes,Emergent/urgent care only,No,http://www.advantagecdn.com/wp-content/uploads/Bronze-HDHP-508_702.pdf,,http://www.advantagecdn.com/wp-content/uploads/ADV_ShopBroSpreads11_14LR1.pdf,www.advantageplan.com,20855IN0040036-01,Standard Bronze On Exchange Plan,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$460,$150,"$5,000",$0,$50,$80,5
2015,IN,20855,HIOS,9,2015-07-22 09:15:52,3,20855,IN,SHOP (Small Group),No,35-2093563,20855IN0040037,HDHP - 703,20855IN004,,INN001,INS001,INF004,New,HMO,Bronze,No,Both,No,Yes,All,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.9968,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent/urgent care only,Yes,Emergent/urgent care only,No,http://www.advantagecdn.com/wp-content/uploads/Bronze-HDHP-509_703.pdf,,http://www.advantagecdn.com/wp-content/uploads/ADV_ShopBroSpreads11_14LR1.pdf,www.advantageplan.com,20855IN0040037-00,Standard Bronze Off Exchange Plan,,0.603701531887054,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$680,$150,"$4,000",$0,$80,$80,4
2015,IN,20855,HIOS,9,2015-07-22 09:15:52,3,20855,IN,SHOP (Small Group),No,35-2093563,20855IN0040037,HDHP - 703,20855IN004,,INN001,INS001,INF004,New,HMO,Bronze,No,Both,No,Yes,All,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.9968,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent/urgent care only,Yes,Emergent/urgent care only,No,http://www.advantagecdn.com/wp-content/uploads/Bronze-HDHP-509_703.pdf,,http://www.advantagecdn.com/wp-content/uploads/ADV_ShopBroSpreads11_14LR1.pdf,www.advantageplan.com,20855IN0040037-01,Standard Bronze On Exchange Plan,,0.603701531887054,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$680,$150,"$4,000",$0,$80,$80,5
2015,IN,20855,HIOS,9,2015-07-22 09:15:52,4,20855,IN,SHOP (Small Group),No,35-2093563,20855IN0010059,HMO - 701,20855IN001,,INN001,INS001,INF002,New,HMO,Silver,Yes,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.9968,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent/urgent care only,Yes,Emergenty/urgent care only,No,http://www.advantagecdn.com/wp-content/uploads/Silver-HMO-323_701.pdf,,http://www.advantagecdn.com/wp-content/uploads/ADV_ShopBroSpreads11_14LR1.pdf,www.advantageplan.com,20855IN0010059-00,Standard Silver Off Exchange Plan,70.82%,0,No,No,No,100%,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,100","$2,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$210,"$1,010",$150,"$2,000",$740,$190,$80,4
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710018,Humana Silver 4600/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340364,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331797,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710018-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710018,Humana Silver 4600/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340364,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331797,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710018-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710020,Humana Gold 2500/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340156,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331849,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710020-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710020,Humana Gold 2500/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340156,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331849,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710020-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710020,Humana Gold 2500/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340156,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331849,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710020-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,28
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710020,Humana Gold 2500/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340156,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331849,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710020-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710021,Humana Platinum 1000/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340221,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331862,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710021-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710021,Humana Platinum 1000/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340221,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331862,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710021-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710021,Humana Platinum 1000/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340221,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331862,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710021-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,32
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710021,Humana Platinum 1000/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340221,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331862,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710021-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710046,Humana Silver 4600/Savannah HMOx,93332GA071,,GAN003,GAS004,GAF003,New,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340390,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327039,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710046-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710046,Humana Silver 4600/Savannah HMOx,93332GA071,,GAN003,GAS004,GAF003,New,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340390,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327039,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710046-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710046,Humana Silver 4600/Savannah HMOx,93332GA071,,GAN003,GAS004,GAF003,New,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340390,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327039,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710046-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,36
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710046,Humana Silver 4600/Savannah HMOx,93332GA071,,GAN003,GAS004,GAF003,New,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340390,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327039,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710046-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710046,Humana Silver 4600/Savannah HMOx,93332GA071,,GAN003,GAS004,GAF003,New,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340390,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327039,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710046-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710046,Humana Silver 4600/Savannah HMOx,93332GA071,,GAN003,GAS004,GAF003,New,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340390,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327039,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710046-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710046,Humana Silver 4600/Savannah HMOx,93332GA071,,GAN003,GAS004,GAF003,New,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340390,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327039,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710046-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710047,Humana Gold 2500/Savannah HMOx,93332GA071,,GAN003,GAS004,GAF004,New,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340195,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327091,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710047-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710047,Humana Gold 2500/Savannah HMOx,93332GA071,,GAN003,GAS004,GAF004,New,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340195,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327091,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710047-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710047,Humana Gold 2500/Savannah HMOx,93332GA071,,GAN003,GAS004,GAF004,New,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340195,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327091,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710047-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,43
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710047,Humana Gold 2500/Savannah HMOx,93332GA071,,GAN003,GAS004,GAF004,New,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340195,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327091,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710047-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710048,Humana Platinum 1000/Savannah HMOx,93332GA071,,GAN003,GAS004,GAF004,New,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340260,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327104,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710048-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710048,Humana Platinum 1000/Savannah HMOx,93332GA071,,GAN003,GAS004,GAF004,New,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340260,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327104,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710048-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710048,Humana Platinum 1000/Savannah HMOx,93332GA071,,GAN003,GAS004,GAF004,New,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340260,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327104,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710048-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,47
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710048,Humana Platinum 1000/Savannah HMOx,93332GA071,,GAN003,GAS004,GAF004,New,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340260,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327104,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710048-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710041,Humana Silver 4600/Macon HMOx,93332GA071,,GAN005,GAS005,GAF003,New,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340377,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331901,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710041-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,49
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710041,Humana Silver 4600/Macon HMOx,93332GA071,,GAN005,GAS005,GAF003,New,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340377,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331901,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710041-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,50
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710041,Humana Silver 4600/Macon HMOx,93332GA071,,GAN005,GAS005,GAF003,New,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340377,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331901,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710041-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,51
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710041,Humana Silver 4600/Macon HMOx,93332GA071,,GAN005,GAS005,GAF003,New,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340377,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331901,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710041-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,52
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710041,Humana Silver 4600/Macon HMOx,93332GA071,,GAN005,GAS005,GAF003,New,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340377,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331901,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710041-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,53
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710041,Humana Silver 4600/Macon HMOx,93332GA071,,GAN005,GAS005,GAF003,New,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340377,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331901,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710041-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,54
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,1,17575,IN,SHOP (Small Group),No,35-0781558,17575IN0720009,Anthem Silver Blue Preferred  X HMO 2000 30 5500 Plus,17575IN072,,INN006,INS001,INF001,Existing,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.992557060449545,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LDZ,,http://sgplans.anthem.com/in/brochure/,anthem.com/INSelectdrugtier4,17575IN0720009-00,Standard Silver Off Exchange Plan,68.87%,0.705991268157959,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$250,$500,30%,,,,Not Applicable,Not Applicable,$250,$500,,,,,,,,,,,,,,,,,,,6
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,1,17575,IN,SHOP (Small Group),No,35-0781558,17575IN0720009,Anthem Silver Blue Preferred  X HMO 2000 30 5500 Plus,17575IN072,,INN006,INS001,INF001,Existing,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.992557060449545,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LDZ,,http://sgplans.anthem.com/in/brochure/,anthem.com/INSelectdrugtier4,17575IN0720009-01,Standard Silver On Exchange Plan,68.87%,0.705991268157959,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$250,$500,30%,,,,Not Applicable,Not Applicable,$250,$500,,,,,,,,,,,,,,,,,,,7
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,1,17575,IN,SHOP (Small Group),No,35-0781558,17575IN0720010,Anthem Bronze Blue Preferred  X HMO 6000 30 6600 Plus,17575IN072,,INN006,INS001,INF001,Existing,HMO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991309516966654,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LG1,,http://sgplans.anthem.com/in/brochure/,anthem.com/INSelectdrugtier4,17575IN0720010-00,Standard Bronze Off Exchange Plan,61.62%,0.650992751121521,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$6,000","$12,000",30%,,,,Not Applicable,Not Applicable,"$6,000","$12,000",$250,$500,30%,,,,Not Applicable,Not Applicable,$250,$500,,,,,,,,,,,,,,,,,,,8
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,1,17575,IN,SHOP (Small Group),No,35-0781558,17575IN0720010,Anthem Bronze Blue Preferred  X HMO 6000 30 6600 Plus,17575IN072,,INN006,INS001,INF001,Existing,HMO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991309516966654,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LG1,,http://sgplans.anthem.com/in/brochure/,anthem.com/INSelectdrugtier4,17575IN0720010-01,Standard Bronze On Exchange Plan,61.62%,0.650992751121521,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$6,000","$12,000",30%,,,,Not Applicable,Not Applicable,"$6,000","$12,000",$250,$500,30%,,,,Not Applicable,Not Applicable,$250,$500,,,,,,,,,,,,,,,,,,,9
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,2,17575,IN,SHOP (Small Group),Yes,35-0781558,17575IN0830003,Anthem Dental Family,17575IN083,,INN009,INS019,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.75,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/in/f0/s0/t0/pw_e213898.pdf,,,,17575IN0830003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,2,17575,IN,Individual,Yes,35-0781558,17575IN0920003,Anthem Dental Family,17575IN092,,INN009,INS019,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.75,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/in/f0/s0/t0/pw_e213898.pdf,,,,17575IN0920003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,2,17575,IN,Individual,No,35-0781558,17575IN0700024,Anthem Bronze Pathway X 0 for HSA,17575IN070,,INN002,INS001,INF015,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GES,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700024-00,Standard Bronze Off Exchange Plan,58.16%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,2,17575,IN,Individual,No,35-0781558,17575IN0700024,Anthem Bronze Pathway X 0 for HSA,17575IN070,,INN002,INS001,INF015,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GES,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700024-01,Standard Bronze On Exchange Plan,58.16%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,2,17575,IN,Individual,Yes,35-0781558,17575IN0920004,Anthem Dental Family Enhanced,17575IN092,,INN009,INS019,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.89,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/in/f0/s0/t0/pw_e213899.pdf,,,,17575IN0920004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,2,17575,IN,SHOP (Small Group),Yes,35-0781558,17575IN0830004,Anthem Dental Family Enhanced,17575IN083,,INN009,INS019,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.89,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/in/f0/s0/t0/pw_e213899.pdf,,,,17575IN0830004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,2,17575,IN,SHOP (Small Group),Yes,35-0781558,17575IN0890003,Anthem Dental Family,17575IN089,,INN009,INS019,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.75,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/in/f0/s0/t0/pw_e213898.pdf,,,,17575IN0890003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,2,17575,IN,Individual,Yes,35-0781558,17575IN0860003,Anthem Dental Family,17575IN086,,INN009,INS019,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.75,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/in/f0/s0/t0/pw_e213898.pdf,,,,17575IN0860003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,2,17575,IN,Individual,No,35-0781558,17575IN0700024,Anthem Bronze Pathway X 0 for HSA,17575IN070,,INN002,INS001,INF015,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GES,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700024-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710041,Humana Silver 4600/Macon HMOx,93332GA071,,GAN005,GAS005,GAF003,New,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340377,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331901,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710041-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,55
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710042,Humana Gold 2500/Macon HMOx,93332GA071,,GAN005,GAS005,GAF004,New,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2331966,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2340169,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710042-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,56
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710042,Humana Gold 2500/Macon HMOx,93332GA071,,GAN005,GAS005,GAF004,New,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2331966,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2340169,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710042-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,57
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710043,Humana Platinum 1000/Macon HMOx,93332GA071,,GAN005,GAS005,GAF004,New,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2331979,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2340234,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710043-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,60
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710043,Humana Platinum 1000/Macon HMOx,93332GA071,,GAN005,GAS005,GAF004,New,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2331979,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2340234,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710043-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,61
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710043,Humana Platinum 1000/Macon HMOx,93332GA071,,GAN005,GAS005,GAF004,New,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2331979,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2340234,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710043-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,62
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,1,93332,GA,Individual,No,58-2209549,93332GA0710043,Humana Platinum 1000/Macon HMOx,93332GA071,,GAN005,GAS005,GAF004,New,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2331979,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2340234,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710043-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,63
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710001,Humana Basic 6600/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2339987,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331615,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710002,Humana Bronze 6300/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340078,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331628,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710002-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710015,Humana Basic 6600/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340000,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331758,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710015-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,8,17575,IN,Individual,No,35-0781558,17575IN0700026,Anthem Silver Pathway X 3500 0,17575IN070,,INN002,INS001,INF017,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEY,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700026-05,87% AV Level Silver Plan,86.09%,0.858777821063995,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$800,"$1,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,8,17575,IN,Individual,No,35-0781558,17575IN0700026,Anthem Silver Pathway X 3500 0,17575IN070,,INN002,INS001,INF017,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEY,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700026-06,94% AV Level Silver Plan,93.26%,0.930816173553467,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,9,17575,IN,Individual,No,35-0781558,17575IN0700028,Anthem Silver Pathway X 10 for HSA,17575IN070,,INN002,INS001,INF019,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GF2,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700028-00,Standard Silver Off Exchange Plan,68.25%,0.686577439308167,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,9,17575,IN,Individual,No,35-0781558,17575IN0700028,Anthem Silver Pathway X 10 for HSA,17575IN070,,INN002,INS001,INF019,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GF2,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700028-01,Standard Silver On Exchange Plan,68.25%,0.686577439308167,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,9,17575,IN,Individual,No,35-0781558,17575IN0700028,Anthem Silver Pathway X 10 for HSA,17575IN070,,INN002,INS001,INF019,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GF2,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700028-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,9,17575,IN,Individual,No,35-0781558,17575IN0700028,Anthem Silver Pathway X 10 for HSA,17575IN070,,INN002,INS001,INF019,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GF2,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700028-03,Limited Cost Sharing Plan Variation,68.25%,0.686577439308167,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,9,17575,IN,Individual,No,35-0781558,17575IN0700028,Anthem Silver Pathway X 10 for HSA,17575IN070,,INN002,INS001,INF019,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GF2,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700028-04,73% AV Level Silver Plan,72.80%,0.732296049594879,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,9,17575,IN,Individual,No,35-0781558,17575IN0700028,Anthem Silver Pathway X 10 for HSA,17575IN070,,INN002,INS001,INF019,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GF2,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700028-05,87% AV Level Silver Plan,86.17%,0.861683309078217,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,9,17575,IN,Individual,No,35-0781558,17575IN0700028,Anthem Silver Pathway X 10 for HSA,17575IN070,,INN002,INS001,INF019,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GF2,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700028-06,94% AV Level Silver Plan,93.27%,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,10,17575,IN,Individual,No,35-0781558,17575IN0700027,Anthem Silver Pathway X 2500 10,17575IN070,,INN002,INS001,INF013,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GF6,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700027-00,Standard Silver Off Exchange Plan,70.25%,0.710120856761932,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,10,17575,IN,Individual,No,35-0781558,17575IN0700027,Anthem Silver Pathway X 2500 10,17575IN070,,INN002,INS001,INF013,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GF6,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700027-01,Standard Silver On Exchange Plan,70.25%,0.710120856761932,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,10,17575,IN,Individual,No,35-0781558,17575IN0700027,Anthem Silver Pathway X 2500 10,17575IN070,,INN002,INS001,INF013,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GF6,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700027-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,10,17575,IN,Individual,No,35-0781558,17575IN0700027,Anthem Silver Pathway X 2500 10,17575IN070,,INN002,INS001,INF013,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GF6,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700027-03,Limited Cost Sharing Plan Variation,70.25%,0.710120856761932,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,10,17575,IN,Individual,No,35-0781558,17575IN0700027,Anthem Silver Pathway X 2500 10,17575IN070,,INN002,INS001,INF013,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GF6,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700027-04,73% AV Level Silver Plan,72.75%,0.733580350875854,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,450","$4,900",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710015,Humana Basic 6600/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340000,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331758,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710015-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710016,Humana Bronze 6300/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340091,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331771,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710016-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710016,Humana Bronze 6300/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340091,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331771,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710016-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710016,Humana Bronze 6300/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340091,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331771,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710016,Humana Bronze 6300/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340091,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331771,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710016-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710044,Humana Basic 6600/Savannah HMOx,93332GA071,,GAN003,GAS004,GAF001,New,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340039,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327013,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710044-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710044,Humana Basic 6600/Savannah HMOx,93332GA071,,GAN003,GAS004,GAF001,New,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340039,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327013,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710044-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710045,Humana Bronze 6300/Savannah HMOx,93332GA071,,GAN003,GAS004,GAF001,New,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340130,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327026,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710045-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710045,Humana Bronze 6300/Savannah HMOx,93332GA071,,GAN003,GAS004,GAF001,New,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340130,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327026,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710045-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710045,Humana Bronze 6300/Savannah HMOx,93332GA071,,GAN003,GAS004,GAF001,New,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340130,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327026,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710045-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710045,Humana Bronze 6300/Savannah HMOx,93332GA071,,GAN003,GAS004,GAF001,New,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340130,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327026,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710045-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710039,Humana Basic 6600/Macon HMOx,93332GA071,,GAN005,GAS005,GAF001,New,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340013,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331875,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710039-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710039,Humana Basic 6600/Macon HMOx,93332GA071,,GAN005,GAS005,GAF001,New,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340013,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331875,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710039-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710040,Humana Bronze 6300/Macon HMOx,93332GA071,,GAN005,GAS005,GAF001,New,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340104,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331888,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710040-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,24
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710040,Humana Bronze 6300/Macon HMOx,93332GA071,,GAN005,GAS005,GAF001,New,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340104,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331888,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710040-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710040,Humana Bronze 6300/Macon HMOx,93332GA071,,GAN005,GAS005,GAF001,New,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340104,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331888,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710040-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,26
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,2,93332,GA,Individual,No,58-2209549,93332GA0710040,Humana Bronze 6300/Macon HMOx,93332GA071,,GAN005,GAS005,GAF001,New,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340104,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331888,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0710040-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,27
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,3,93332,GA,Individual,No,58-2209549,93332GA0720004,Humana Silver 4250/National POS - OpenAccess,93332GA072,,GAN004,GAS001,GAF006,Existing,POS,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340338,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331537,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0720004-00,Standard Silver Off Exchange Plan,,0.681853055953979,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$4,250","$8,500",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,3,93332,GA,Individual,No,58-2209549,93332GA0720004,Humana Silver 4250/National POS - OpenAccess,93332GA072,,GAN004,GAS001,GAF006,Existing,POS,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340338,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331537,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0720004-01,Standard Silver On Exchange Plan,,0.681853055953979,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$4,250","$8,500",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,3,93332,GA,Individual,No,58-2209549,93332GA0720004,Humana Silver 4250/National POS - OpenAccess,93332GA072,,GAN004,GAS001,GAF006,Existing,POS,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340338,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331537,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0720004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,3,93332,GA,Individual,No,58-2209549,93332GA0720004,Humana Silver 4250/National POS - OpenAccess,93332GA072,,GAN004,GAS001,GAF006,Existing,POS,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340338,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331537,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0720004-03,Limited Cost Sharing Plan Variation,,0.681853055953979,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$4,250","$8,500",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,3,93332,GA,Individual,No,58-2209549,93332GA0720004,Humana Silver 4250/National POS - OpenAccess,93332GA072,,GAN004,GAS001,GAF006,Existing,POS,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340338,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331537,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0720004-04,73% AV Level Silver Plan,,0.725123465061188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,"$6,500","$13,000",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,3,93332,GA,Individual,No,58-2209549,93332GA0720004,Humana Silver 4250/National POS - OpenAccess,93332GA072,,GAN004,GAS001,GAF006,Existing,POS,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340338,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331537,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0720004-05,87% AV Level Silver Plan,,0.863307356834412,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,3,93332,GA,Individual,No,58-2209549,93332GA0720004,Humana Silver 4250/National POS - OpenAccess,93332GA072,,GAN004,GAS001,GAF006,Existing,POS,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340338,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331537,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0720004-06,94% AV Level Silver Plan,,0.937241017818451,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$250,$500,50%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,3,93332,GA,Individual,No,58-2209549,93332GA0720006,Humana Gold 2500/National POS - OpenAccess,93332GA072,,GAN004,GAS001,GAF007,Existing,POS,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340182,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331589,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0720006-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,3,93332,GA,Individual,No,58-2209549,93332GA0720007,Humana Platinum 1000/National POS - OpenAccess,93332GA072,,GAN004,GAS001,GAF007,Existing,POS,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340247,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331602,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0720007-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,5,17575,IN,Individual,No,35-0781558,17575IN0760002,Anthem Bronze Pathway X POS 5000 40,17575IN076,,INN002,INS001,INF016,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEV,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0760002-03,Limited Cost Sharing Plan Variation,59.26%,0.593849003314972,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$30,000","$60,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,6,17575,IN,Individual,No,35-0781558,17575IN0700025,Anthem Bronze Pathway X 20 for HSA,17575IN070,,INN002,INS001,INF014,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEW,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700025-00,Standard Bronze Off Exchange Plan,59.80%,0.601316511631012,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,6,17575,IN,SHOP (Small Group),No,35-0781558,17575IN0720011,Anthem Gold Blue Preferred  X HMO 1300 10 6000 Plus w HSA,17575IN072,,INN006,INS001,INF003,Existing,HMO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.993387368291252,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LHC,,http://sgplans.anthem.com/in/brochure/,anthem.com/INSelectdrugtier4,17575IN0720011-00,Standard Gold Off Exchange Plan,,0.780109941959381,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,$0,$0,"$1,300","$2,600",,,,,,,,,4
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,6,17575,IN,SHOP (Small Group),No,35-0781558,17575IN0720011,Anthem Gold Blue Preferred  X HMO 1300 10 6000 Plus w HSA,17575IN072,,INN006,INS001,INF003,Existing,HMO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.993387368291252,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LHC,,http://sgplans.anthem.com/in/brochure/,anthem.com/INSelectdrugtier4,17575IN0720011-01,Standard Gold On Exchange Plan,,0.780109941959381,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,$0,$0,"$1,300","$2,600",,,,,,,,,5
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,6,17575,IN,Individual,No,35-0781558,17575IN0700025,Anthem Bronze Pathway X 20 for HSA,17575IN070,,INN002,INS001,INF014,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEW,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700025-01,Standard Bronze On Exchange Plan,59.80%,0.601316511631012,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,6,17575,IN,Individual,No,35-0781558,17575IN0700025,Anthem Bronze Pathway X 20 for HSA,17575IN070,,INN002,INS001,INF014,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEW,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700025-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,6,17575,IN,Individual,No,35-0781558,17575IN0700025,Anthem Bronze Pathway X 20 for HSA,17575IN070,,INN002,INS001,INF014,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEW,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700025-03,Limited Cost Sharing Plan Variation,59.80%,0.601316511631012,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,7,17575,IN,Individual,No,35-0781558,17575IN0700021,Anthem Bronze Pathway X 4300 20,17575IN070,,INN002,INS001,INF014,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEX,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700021-00,Standard Bronze Off Exchange Plan,61.56%,0.585517108440399,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,7,17575,IN,Individual,No,35-0781558,17575IN0700021,Anthem Bronze Pathway X 4300 20,17575IN070,,INN002,INS001,INF014,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEX,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700021-01,Standard Bronze On Exchange Plan,61.56%,0.585517108440399,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,7,17575,IN,Individual,No,35-0781558,17575IN0700021,Anthem Bronze Pathway X 4300 20,17575IN070,,INN002,INS001,INF014,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEX,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700021-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,7,17575,IN,Individual,No,35-0781558,17575IN0700021,Anthem Bronze Pathway X 4300 20,17575IN070,,INN002,INS001,INF014,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEX,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700021-03,Limited Cost Sharing Plan Variation,61.56%,0.585517108440399,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,8,17575,IN,Individual,No,35-0781558,17575IN0700026,Anthem Silver Pathway X 3500 0,17575IN070,,INN002,INS001,INF017,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEY,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700026-00,Standard Silver Off Exchange Plan,70.30%,0.703458368778229,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,8,17575,IN,Individual,No,35-0781558,17575IN0700026,Anthem Silver Pathway X 3500 0,17575IN070,,INN002,INS001,INF017,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEY,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700026-01,Standard Silver On Exchange Plan,70.30%,0.703458368778229,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,8,17575,IN,Individual,No,35-0781558,17575IN0700026,Anthem Silver Pathway X 3500 0,17575IN070,,INN002,INS001,INF017,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEY,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700026-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,4,93332,GA,Individual,No,58-2209549,93332GA0720001,Humana Basic 6600/National POS - OpenAccess,93332GA072,,GAN004,GAS001,GAF005,Existing,POS,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340026,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331511,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0720001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,4,93332,GA,Individual,No,58-2209549,93332GA0720001,Humana Basic 6600/National POS - OpenAccess,93332GA072,,GAN004,GAS001,GAF005,Existing,POS,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340026,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331511,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0720001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,4,93332,GA,Individual,No,58-2209549,93332GA0720002,Humana Bronze 6300/National POS - OpenAccess,93332GA072,,GAN004,GAS001,GAF005,Existing,POS,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340117,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331524,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0720002-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,4,93332,GA,Individual,No,58-2209549,93332GA0720002,Humana Bronze 6300/National POS - OpenAccess,93332GA072,,GAN004,GAS001,GAF005,Existing,POS,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340117,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331524,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0720002-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,4,93332,GA,Individual,No,58-2209549,93332GA0720002,Humana Bronze 6300/National POS - OpenAccess,93332GA072,,GAN004,GAS001,GAF005,Existing,POS,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340117,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331524,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0720002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,4,93332,GA,Individual,No,58-2209549,93332GA0720002,Humana Bronze 6300/National POS - OpenAccess,93332GA072,,GAN004,GAS001,GAF005,Existing,POS,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340117,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331524,http://apps.humana.com/marketing/documents.asp?file=2323880,93332GA0720002-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,9
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,5,93332,GA,Individual,No,58-2209549,93332GA0710003,Humana Bronze 4850/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340052,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331641,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710003-00,Standard Bronze Off Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,5,93332,GA,Individual,No,58-2209549,93332GA0710003,Humana Bronze 4850/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340052,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331641,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710003-01,Standard Bronze On Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,5,93332,GA,Individual,No,58-2209549,93332GA0710003,Humana Bronze 4850/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340052,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331641,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,5,93332,GA,Individual,No,58-2209549,93332GA0710003,Humana Bronze 4850/Atlanta HMOx,93332GA071,,GAN001,GAS002,GAF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340052,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331641,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710003-03,Limited Cost Sharing Plan Variation,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,5,93332,GA,Individual,No,58-2209549,93332GA0710017,Humana Bronze 4850/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340065,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331784,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710017-00,Standard Bronze Off Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,5,93332,GA,Individual,No,58-2209549,93332GA0710017,Humana Bronze 4850/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340065,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331784,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710017-01,Standard Bronze On Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,5,93332,GA,Individual,No,58-2209549,93332GA0710017,Humana Bronze 4850/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340065,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331784,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710017-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,GA,93332,HIOS,10,2014-09-29 21:43:29,5,93332,GA,Individual,No,58-2209549,93332GA0710017,Humana Bronze 4850/Columbus GA HMOx,93332GA071,,GAN002,GAS003,GAF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340065,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2331784,http://apps.humana.com/marketing/documents.asp?file=2323815,93332GA0710017-03,Limited Cost Sharing Plan Variation,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,GA,98239,HIOS,4,2014-09-06 03:39:47,1,98239,GA,SHOP (Small Group),Yes,41-0808596,98239GA0010001,"Plan 1. Graded PPO, $1500 Annual Maximum, no Ortho",98239GA001,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,98239GA0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,GA,98239,HIOS,4,2014-09-06 03:39:47,1,98239,GA,SHOP (Small Group),Yes,41-0808596,98239GA0010002,"Plan 2.  Graded PPO, $1500 Annual Maximum, Ortho",98239GA001,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,98239GA0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,GA,98239,HIOS,4,2014-09-06 03:39:47,1,98239,GA,SHOP (Small Group),Yes,41-0808596,98239GA0010003,"Plan 3. MAC PPO, $1000 Annual Maximum, no Ortho",98239GA001,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,98239GA0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,GA,98239,HIOS,4,2014-09-06 03:39:47,1,98239,GA,SHOP (Small Group),Yes,41-0808596,98239GA0010004,"Plan 4.  MAC PPO, $1500 Annual Maximum, Ortho",98239GA001,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,98239GA0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,GA,98239,HIOS,4,2014-09-06 03:39:47,1,98239,GA,SHOP (Small Group),Yes,41-0808596,98239GA0010005,"Plan 5.  Graded MAC PPO, $1000 Annual Maximum, No Ortho",98239GA001,,GAN001,GAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,98239GA0010005-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,IN,10064,HIOS,2,2014-08-08 08:53:29,1,10064,IN,SHOP (Small Group),Yes,42-0127290,10064IN0050001,Principal Plan Dental 70,10064IN005,,INN001,INS001,,New,PPO,Low,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$27.41,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,10064IN0050001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,10064,HIOS,2,2014-08-08 08:53:29,1,10064,IN,SHOP (Small Group),Yes,42-0127290,10064IN0050002,Principal Plan Dental 80,10064IN005,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$29.03,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,10064IN0050002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,1,17575,IN,SHOP (Small Group),No,35-0781558,17575IN0720008,Anthem Silver Blue Preferred  X HMO 3000 20 4500 Plus,17575IN072,,INN006,INS001,INF001,Existing,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.992490638416169,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LG8,,http://sgplans.anthem.com/in/brochure/,anthem.com/INSelectdrugtier4,17575IN0720008-00,Standard Silver Off Exchange Plan,69.02%,0.705528914928436,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,"$4,500","$9,000","$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,"$3,000","$6,000",$250,$500,30%,,,,Not Applicable,Not Applicable,$250,$500,,,,,,,,,,,,,,,,,,,4
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,1,17575,IN,Individual,Yes,35-0781558,17575IN0900003,Anthem Dental Pediatric,17575IN090,,INN009,INS019,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$19.19,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/in/f0/s0/t0/pw_e213900.pdf,,,,17575IN0900003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,1,17575,IN,SHOP (Small Group),Yes,35-0781558,17575IN0870003,Anthem Dental Pediatric,17575IN087,,INN009,INS019,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$19.19,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/in/f0/s0/t0/pw_e213900.pdf,,,,17575IN0870003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,1,17575,IN,Individual,No,35-0781558,17575IN0700029,Anthem Catastrophic Pathway X 6600 0,17575IN070,,INN002,INS001,INF015,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEQ,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700029-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,1,17575,IN,Individual,No,35-0781558,17575IN0700029,Anthem Catastrophic Pathway X 6600 0,17575IN070,,INN002,INS001,INF015,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEQ,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700029-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,1,17575,IN,SHOP (Small Group),No,35-0781558,17575IN0720008,Anthem Silver Blue Preferred  X HMO 3000 20 4500 Plus,17575IN072,,INN006,INS001,INF001,Existing,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.992490638416169,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LG8,,http://sgplans.anthem.com/in/brochure/,anthem.com/INSelectdrugtier4,17575IN0720008-01,Standard Silver On Exchange Plan,69.02%,0.705528914928436,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,"$4,500","$9,000","$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,"$3,000","$6,000",$250,$500,30%,,,,Not Applicable,Not Applicable,$250,$500,,,,,,,,,,,,,,,,,,,5
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,1,17575,IN,Individual,Yes,35-0781558,17575IN0840003,Anthem Dental Pediatric,17575IN084,,INN009,INS019,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$19.19,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/in/f0/s0/t0/pw_e213900.pdf,,,,17575IN0840003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,2,17575,IN,Individual,No,35-0781558,17575IN0700024,Anthem Bronze Pathway X 0 for HSA,17575IN070,,INN002,INS001,INF015,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GES,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700024-03,Limited Cost Sharing Plan Variation,58.16%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,2,17575,IN,Individual,Yes,35-0781558,17575IN0860004,Anthem Dental Family Enhanced,17575IN086,,INN009,INS019,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.89,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/in/f0/s0/t0/pw_e213899.pdf,,,,17575IN0860004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,3,17575,IN,Individual,No,35-0781558,17575IN0700023,Anthem Bronze Pathway X 6250 30,17575IN070,,INN002,INS001,INF025,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GET,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700023-03,Limited Cost Sharing Plan Variation,61.53%,0.618361353874207,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,4,17575,IN,Individual,No,35-0781558,17575IN0700020,Anthem Bronze Pathway X 5750 20,17575IN070,,INN002,INS001,INF026,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEU,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700020-00,Standard Bronze Off Exchange Plan,61.04%,0.612066566944122,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,4,17575,IN,Individual,No,35-0781558,17575IN0700020,Anthem Bronze Pathway X 5750 20,17575IN070,,INN002,INS001,INF026,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEU,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700020-01,Standard Bronze On Exchange Plan,61.04%,0.612066566944122,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,4,17575,IN,Individual,No,35-0781558,17575IN0700020,Anthem Bronze Pathway X 5750 20,17575IN070,,INN002,INS001,INF026,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEU,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700020-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,4,17575,IN,Individual,No,35-0781558,17575IN0700020,Anthem Bronze Pathway X 5750 20,17575IN070,,INN002,INS001,INF026,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEU,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700020-03,Limited Cost Sharing Plan Variation,61.04%,0.612066566944122,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,5,17575,IN,Individual,No,35-0781558,17575IN0760002,Anthem Bronze Pathway X POS 5000 40,17575IN076,,INN002,INS001,INF016,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEV,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0760002-00,Standard Bronze Off Exchange Plan,59.26%,0.593849003314972,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$30,000","$60,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,5,17575,IN,Individual,No,35-0781558,17575IN0760002,Anthem Bronze Pathway X POS 5000 40,17575IN076,,INN002,INS001,INF016,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEV,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0760002-01,Standard Bronze On Exchange Plan,59.26%,0.593849003314972,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$30,000","$60,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,5,17575,IN,Individual,No,35-0781558,17575IN0760002,Anthem Bronze Pathway X POS 5000 40,17575IN076,,INN002,INS001,INF016,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEV,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0760002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,8,17575,IN,Individual,No,35-0781558,17575IN0700026,Anthem Silver Pathway X 3500 0,17575IN070,,INN002,INS001,INF017,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEY,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700026-03,Limited Cost Sharing Plan Variation,70.30%,0.703458368778229,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,8,17575,IN,Individual,No,35-0781558,17575IN0700026,Anthem Silver Pathway X 3500 0,17575IN070,,INN002,INS001,INF017,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GEY,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700026-04,73% AV Level Silver Plan,72.34%,0.721923649311066,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,150","$8,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,IN,17575,HIOS,14,2014-12-12 09:23:47,10,17575,IN,Individual,No,35-0781558,17575IN0700027,Anthem Silver Pathway X 2500 10,17575IN070,,INN002,INS001,INF013,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GF6,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0700027-05,87% AV Level Silver Plan,86.32%,0.865337550640106,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,IN,20855,HIOS,9,2015-07-22 09:15:52,4,20855,IN,SHOP (Small Group),No,35-2093563,20855IN0010059,HMO - 701,20855IN001,,INN001,INS001,INF002,New,HMO,Silver,Yes,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.9968,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent/urgent care only,Yes,Emergenty/urgent care only,No,http://www.advantagecdn.com/wp-content/uploads/Silver-HMO-323_701.pdf,,http://www.advantagecdn.com/wp-content/uploads/ADV_ShopBroSpreads11_14LR1.pdf,www.advantageplan.com,20855IN0010059-01,Standard Silver On Exchange Plan,70.82%,0,No,No,No,100%,,"$5,500.00","$11,000.00",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,100","$2,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$210,"$1,010",$150,"$2,000",$740,$190,$80,5
2015,IN,21029,HIOS,3,2014-09-05 03:32:16,1,21029,IN,SHOP (Small Group),Yes,81-0170040,21029IN0010001,Assurant Dental ACAFFO High,21029IN001,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$43.53,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same coverage as in service area,Yes,,,,,21029IN0010001-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,21029,HIOS,3,2014-09-05 03:32:16,2,21029,IN,SHOP (Small Group),Yes,81-0170040,21029IN0010002,Assurant Dental ACAFFO Low,21029IN001,,INN001,INS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.25,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same coverage as in service area,Yes,,,,,21029IN0010002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,28856,HIOS,1,2014-06-21 03:20:41,1,28856,IN,Individual,Yes,35-1545647,28856IN0160001,"Delta Dental Individual PPO, EHB Certified",28856IN016,,INN001,INS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.54,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28856IN0160001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,28856,HIOS,1,2014-06-21 03:20:41,1,28856,IN,SHOP (Small Group),Yes,35-1545647,28856IN0190001,"Delta Dental Group PPO, EHB Certified",28856IN019,,INN001,INS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.93,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28856IN0190001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,28856,HIOS,1,2014-06-21 03:20:41,1,28856,IN,SHOP (Small Group),Yes,35-1545647,28856IN0190002,"Delta Dental Group PPO, EHB Certified",28856IN019,,INN001,INS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.15,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28856IN0190002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,28856,HIOS,1,2014-06-21 03:20:41,1,28856,IN,Individual,Yes,35-1545647,28856IN0160002,"Delta Dental Individual PPO, EHB Certified",28856IN016,,INN001,INS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.59,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28856IN0160002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,28856,HIOS,1,2014-06-21 03:20:41,1,28856,IN,SHOP (Small Group),Yes,35-1545647,28856IN0190003,"Delta Dental Group PPO, EHB Certified",28856IN019,,INN001,INS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.93,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28856IN0190003-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IN,28856,HIOS,1,2014-06-21 03:20:41,1,28856,IN,SHOP (Small Group),Yes,35-1545647,28856IN0190004,"Delta Dental Group PPO, EHB Certified",28856IN019,,INN001,INS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.15,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28856IN0190004-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IN,28856,HIOS,1,2014-06-21 03:20:41,1,28856,IN,SHOP (Small Group),Yes,35-1545647,28856IN0200001,"Delta Dental Group PPO Network Only, EHB Certified",28856IN020,,INN002,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.77,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28856IN0200001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,IN,28856,HIOS,1,2014-06-21 03:20:41,1,28856,IN,SHOP (Small Group),Yes,35-1545647,28856IN0200002,"Delta Dental Group PPO Network Only, EHB Certified",28856IN020,,INN002,INS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.46,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28856IN0200002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,IN,28856,HIOS,1,2014-06-21 03:20:41,1,28856,IN,SHOP (Small Group),Yes,35-1545647,28856IN0200003,"Delta Dental Group PPO Network Only, EHB Certified",28856IN020,,INN002,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.77,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28856IN0200003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,IN,28856,HIOS,1,2014-06-21 03:20:41,1,28856,IN,SHOP (Small Group),Yes,35-1545647,28856IN0200004,"Delta Dental Group PPO Network Only, EHB Certified",28856IN020,,INN002,INS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.46,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28856IN0200004-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,IN,28856,HIOS,1,2014-06-21 03:20:41,2,28856,IN,SHOP (Small Group),Yes,35-1545647,28856IN0180001,"Delta Dental Group Pediatric-Only PPO, EHB Certified",28856IN018,,INN001,INS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$29.93,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28856IN0180001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,28856,HIOS,1,2014-06-21 03:20:41,2,28856,IN,Individual,Yes,35-1545647,28856IN0170001,"Delta Dental Individual Pediatric-Only PPO, EHB Certified",28856IN017,,INN001,INS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$31.54,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28856IN0170001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,28856,HIOS,1,2014-06-21 03:20:41,2,28856,IN,Individual,Yes,35-1545647,28856IN0170002,"Delta Dental Individual Pediatric-Only PPO, EHB Certified",28856IN017,,INN001,INS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.59,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28856IN0170002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,28856,HIOS,1,2014-06-21 03:20:41,2,28856,IN,SHOP (Small Group),Yes,35-1545647,28856IN0180002,"Delta Dental Group Pediatric-Only PPO, EHB Certified",28856IN018,,INN001,INS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.15,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28856IN0180002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,28856,HIOS,1,2014-06-21 03:20:41,2,28856,IN,SHOP (Small Group),Yes,35-1545647,28856IN0180003,"Delta Dental Group Pediatric-Only PPO, EHB Certified",28856IN018,,INN001,INS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$29.93,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28856IN0180003-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IN,28856,HIOS,1,2014-06-21 03:20:41,2,28856,IN,SHOP (Small Group),Yes,35-1545647,28856IN0180004,"Delta Dental Group Pediatric-Only PPO, EHB Certified",28856IN018,,INN001,INS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.15,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28856IN0180004-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IN,28856,HIOS,1,2014-06-21 03:20:41,2,28856,IN,SHOP (Small Group),Yes,35-1545647,28856IN0210001,"Delta Dental Group Pediatric-Only PPO Network Only, EHB Certified",28856IN021,,INN002,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$28.77,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28856IN0210001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,IN,28856,HIOS,1,2014-06-21 03:20:41,2,28856,IN,SHOP (Small Group),Yes,35-1545647,28856IN0210002,"Delta Dental Group Pediatric-Only PPO Network Only, EHB Certified",28856IN021,,INN002,INS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.46,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28856IN0210002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,IN,28856,HIOS,1,2014-06-21 03:20:41,2,28856,IN,SHOP (Small Group),Yes,35-1545647,28856IN0210003,"Delta Dental Group Pediatric-Only PPO Network Only, EHB Certified",28856IN021,,INN002,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$28.77,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28856IN0210003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,IN,28856,HIOS,1,2014-06-21 03:20:41,2,28856,IN,SHOP (Small Group),Yes,35-1545647,28856IN0210004,"Delta Dental Group Pediatric-Only PPO Network Only, EHB Certified",28856IN021,,INN002,INS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.46,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28856IN0210004-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020001,IU Health Plans Gold Value,33380IN002,,INN001,INS001,INF001,New,HMO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020001-00,Standard Gold Off Exchange Plan,78.40%,0.76983767747879,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,$750,"$1,500",,,,,,,,,4
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020001,IU Health Plans Gold Value,33380IN002,,INN001,INS001,INF001,New,HMO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020001-01,Standard Gold On Exchange Plan,78.40%,0.76983767747879,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,$750,"$1,500",,,,,,,,,5
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020001,IU Health Plans Gold Value,33380IN002,,INN001,INS001,INF001,New,HMO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020001,IU Health Plans Gold Value,33380IN002,,INN001,INS001,INF001,New,HMO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020001-03,Limited Cost Sharing Plan Variation,78.40%,0.76983767747879,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,$750,"$1,500",,,,,,,,,7
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020002,IU Health Plans Silver HSA,33380IN002,,INN001,INS001,INF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020002-00,Standard Silver Off Exchange Plan,,0.691889405250549,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,"$3,600","$7,200",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",10%,,,,Not Applicable,Not Applicable,"$2,750","$5,500",,,,,,,,,8
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020002,IU Health Plans Silver HSA,33380IN002,,INN001,INS001,INF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020002-01,Standard Silver On Exchange Plan,,0.691889405250549,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,"$3,600","$7,200",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",10%,,,,Not Applicable,Not Applicable,"$2,750","$5,500",,,,,,,,,9
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020002,IU Health Plans Silver HSA,33380IN002,,INN001,INS001,INF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020002,IU Health Plans Silver HSA,33380IN002,,INN001,INS001,INF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020002-03,Limited Cost Sharing Plan Variation,,0.691889405250549,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,"$3,600","$7,200",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",10%,,,,Not Applicable,Not Applicable,"$2,750","$5,500",,,,,,,,,11
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020002,IU Health Plans Silver HSA,33380IN002,,INN001,INS001,INF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020002-04,73% AV Level Silver Plan,,0.728036463260651,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,"$3,600","$7,200",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",,,,,,,,,12
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020002,IU Health Plans Silver HSA,33380IN002,,INN001,INS001,INF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020002-05,87% AV Level Silver Plan,,0.864341616630554,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,Not Applicable,Not Applicable,"$1,200","$2,400",,,,,,,,,,,,,,,,,,,,,$800,"$1,600",10%,,,,Not Applicable,Not Applicable,$800,"$1,600",,,,,,,,,13
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020002,IU Health Plans Silver HSA,33380IN002,,INN001,INS001,INF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020002-06,94% AV Level Silver Plan,,0.933155238628387,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,,,$400,$800,10%,,,,Not Applicable,Not Applicable,$400,$800,,,,,,,,,14
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020003,IU Health Plans Silver Value,33380IN002,,INN001,INS001,INF003,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020003-00,Standard Silver Off Exchange Plan,70.02%,0.667064070701599,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,15
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020003,IU Health Plans Silver Value,33380IN002,,INN001,INS001,INF003,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020003-01,Standard Silver On Exchange Plan,70.02%,0.667064070701599,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,16
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020003,IU Health Plans Silver Value,33380IN002,,INN001,INS001,INF003,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,17
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020003,IU Health Plans Silver Value,33380IN002,,INN001,INS001,INF003,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020003-03,Limited Cost Sharing Plan Variation,70.02%,0.667064070701599,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,18
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020003,IU Health Plans Silver Value,33380IN002,,INN001,INS001,INF003,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020003-04,73% AV Level Silver Plan,72.28%,0.688097655773163,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,19
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020003,IU Health Plans Silver Value,33380IN002,,INN001,INS001,INF003,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020003-05,87% AV Level Silver Plan,86.41%,0.852318346500397,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,"$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,$750,"$1,500",,,,,,,,,20
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020003,IU Health Plans Silver Value,33380IN002,,INN001,INS001,INF003,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020003-06,94% AV Level Silver Plan,93.40%,0.933514714241028,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,$600,"$1,200",,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,21
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020004,IU Health Plans Silver Enhanced,33380IN002,,INN001,INS001,INF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020004-00,Standard Silver Off Exchange Plan,71.29%,0.682639181613922,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,"$5,750","$11,500",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",,,,,,,,,22
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020004,IU Health Plans Silver Enhanced,33380IN002,,INN001,INS001,INF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020004-01,Standard Silver On Exchange Plan,71.29%,0.682639181613922,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,"$5,750","$11,500",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",,,,,,,,,23
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020004,IU Health Plans Silver Enhanced,33380IN002,,INN001,INS001,INF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,24
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020004,IU Health Plans Silver Enhanced,33380IN002,,INN001,INS001,INF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020004-03,Limited Cost Sharing Plan Variation,71.29%,0.682639181613922,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,"$5,750","$11,500",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",,,,,,,,,25
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020004,IU Health Plans Silver Enhanced,33380IN002,,INN001,INS001,INF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020004-04,73% AV Level Silver Plan,73.34%,0.70302152633667,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",,,,,,,,,26
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020004,IU Health Plans Silver Enhanced,33380IN002,,INN001,INS001,INF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020004-05,87% AV Level Silver Plan,86.66%,0.854190707206726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,"$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,$750,"$1,500",,,,,,,,,27
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020004,IU Health Plans Silver Enhanced,33380IN002,,INN001,INS001,INF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020004-06,94% AV Level Silver Plan,93.33%,0.928452551364899,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,$650,"$1,300",,,,,,,,,,,,,,,,,,,,,$150,$300,10%,,,,Not Applicable,Not Applicable,$150,$300,,,,,,,,,28
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020005,IU Health Plans Bronze HSA,33380IN002,,INN001,INS001,INF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020005-00,Standard Bronze Off Exchange Plan,,0.597205400466919,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,29
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020005,IU Health Plans Bronze HSA,33380IN002,,INN001,INS001,INF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020005-01,Standard Bronze On Exchange Plan,,0.597205400466919,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,30
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020005,IU Health Plans Bronze HSA,33380IN002,,INN001,INS001,INF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,31
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020005,IU Health Plans Bronze HSA,33380IN002,,INN001,INS001,INF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020005-03,Limited Cost Sharing Plan Variation,,0.597205400466919,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,32
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020006,IU Health Plans Bronze Value,33380IN002,,INN001,INS001,INF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020006-00,Standard Bronze Off Exchange Plan,,0.582913815975189,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",25%,,,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,33
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020006,IU Health Plans Bronze Value,33380IN002,,INN001,INS001,INF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020006-01,Standard Bronze On Exchange Plan,,0.582913815975189,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",25%,,,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,34
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020006,IU Health Plans Bronze Value,33380IN002,,INN001,INS001,INF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,35
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020006,IU Health Plans Bronze Value,33380IN002,,INN001,INS001,INF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020006-03,Limited Cost Sharing Plan Variation,,0.582913815975189,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",25%,,,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,36
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020007,IU Health Plans Bronze Enhanced,33380IN002,,INN001,INS001,INF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020007-00,Standard Bronze Off Exchange Plan,,0.588415503501892,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,37
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020007,IU Health Plans Bronze Enhanced,33380IN002,,INN001,INS001,INF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020007-01,Standard Bronze On Exchange Plan,,0.588415503501892,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,38
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020007,IU Health Plans Bronze Enhanced,33380IN002,,INN001,INS001,INF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,39
2015,IN,33380,HIOS,9,2015-01-20 13:44:26,1,33380,IN,Individual,No,26-2127080,33380IN0020007,IU Health Plans Bronze Enhanced,33380IN002,,INN001,INS001,INF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency only,No,http://www.iuhealthplans.org/marketplace/benefits,https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.iuhealthplans.org/marketplace,http://client.formularynavigator.com/Search.aspx?siteCode=0574454690,33380IN0020007-03,Limited Cost Sharing Plan Variation,,0.588415503501892,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,40
2015,IN,34537,HIOS,6,2014-09-05 03:32:16,1,34537,IN,SHOP (Small Group),Yes,41-0808596,34537IN0010001,"Plan 1. Passive PPO, $1000 Annual Maximum, no Ortho",34537IN001,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,34537IN0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,34537,HIOS,6,2014-09-05 03:32:16,1,34537,IN,SHOP (Small Group),Yes,41-0808596,34537IN0010002,"Plan 2.  Passive PPO, $1000 Annual Maximum, Ortho",34537IN001,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,34537IN0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,5,35065,IN,Individual,No,39-1821211,35065IN0010015,Ambetter Balanced Care 1,35065IN001,,INN001,INS001,INF014,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/formulary,35065IN0010015-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,8
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,5,35065,IN,Individual,No,39-1821211,35065IN0010015,Ambetter Balanced Care 1,35065IN001,,INN001,INS001,INF014,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/formulary,35065IN0010015-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,9
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,5,35065,IN,Individual,No,39-1821211,35065IN0010015,Ambetter Balanced Care 1,35065IN001,,INN001,INS001,INF014,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/formulary,35065IN0010015-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,10
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,6,35065,IN,Individual,No,39-1821211,35065IN0020009,Ambetter Balanced Care 5 + Vision,35065IN002,,INN001,INS001,INF008,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.98258345805978,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/formulary,35065IN0020009-00,Standard Silver Off Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,4
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,6,35065,IN,Individual,No,39-1821211,35065IN0020009,Ambetter Balanced Care 5 + Vision,35065IN002,,INN001,INS001,INF008,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.98258345805978,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/formulary,35065IN0020009-01,Standard Silver On Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,5
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,6,35065,IN,Individual,No,39-1821211,35065IN0020009,Ambetter Balanced Care 5 + Vision,35065IN002,,INN001,INS001,INF008,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.98258345805978,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/formulary,35065IN0020009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,6,35065,IN,Individual,No,39-1821211,35065IN0020009,Ambetter Balanced Care 5 + Vision,35065IN002,,INN001,INS001,INF008,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.98258345805978,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/formulary,35065IN0020009-03,Limited Cost Sharing Plan Variation,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,7
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,6,35065,IN,Individual,No,39-1821211,35065IN0020009,Ambetter Balanced Care 5 + Vision,35065IN002,,INN001,INS001,INF008,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.98258345805978,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/formulary,35065IN0020009-04,73% AV Level Silver Plan,73.23%,0.732411444187164,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$2,920",$350,$0,$80,8
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,6,35065,IN,Individual,No,39-1821211,35065IN0020009,Ambetter Balanced Care 5 + Vision,35065IN002,,INN001,INS001,INF008,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.98258345805978,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/formulary,35065IN0020009-05,87% AV Level Silver Plan,87.97%,0.879661500453949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$410,$0,$150,$600,$520,$0,$80,9
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,6,35065,IN,Individual,No,39-1821211,35065IN0020009,Ambetter Balanced Care 5 + Vision,35065IN002,,INN001,INS001,INF008,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.98258345805978,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/formulary,35065IN0020009-06,94% AV Level Silver Plan,93.34%,0.933413624763489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$120,$0,$150,$0,$450,$0,$80,10
2015,IN,34537,HIOS,6,2014-09-05 03:32:16,1,34537,IN,SHOP (Small Group),Yes,41-0808596,34537IN0010003,"Plan 3. Passive PPO, $1500 Annual Maximum, no Ortho",34537IN001,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,34537IN0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IN,34537,HIOS,6,2014-09-05 03:32:16,1,34537,IN,SHOP (Small Group),Yes,41-0808596,34537IN0010004,"Plan 4.  Passive PPO, $1500 Annual Maximum, Ortho",34537IN001,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,34537IN0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IN,34537,HIOS,6,2014-09-05 03:32:16,1,34537,IN,SHOP (Small Group),Yes,41-0808596,34537IN0010005,"Plan 5.  Passive PPO, $2000 Annual Maximum, Ortho",34537IN001,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,34537IN0010005-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,IN,34537,HIOS,6,2014-09-05 03:32:16,1,34537,IN,SHOP (Small Group),Yes,41-0808596,34537IN0010006,"Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho",34537IN001,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,34537IN0010006-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,IN,34537,HIOS,6,2014-09-05 03:32:16,1,34537,IN,SHOP (Small Group),Yes,41-0808596,34537IN0010007,"Plan 7. Graded Passive PPO, $1500 Annual Maximum, Ortho",34537IN001,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,34537IN0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,IN,34537,HIOS,6,2014-09-05 03:32:16,1,34537,IN,SHOP (Small Group),Yes,41-0808596,34537IN0010008,"Plan 8. MAC PPO, $1000 Annual Maximum, no Ortho",34537IN001,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,34537IN0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,IN,34537,HIOS,6,2014-09-05 03:32:16,1,34537,IN,SHOP (Small Group),Yes,41-0808596,34537IN0010009,"Plan 9. MAC PPO, $1500 Annual Maximum, Ortho",34537IN001,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,34537IN0010009-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,IN,34537,HIOS,6,2014-09-05 03:32:16,1,34537,IN,SHOP (Small Group),Yes,41-0808596,34537IN0010010,"Plan 10. Graded MAC PPO, $1000 Annual Maximum, no Ortho",34537IN001,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,34537IN0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,13
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,1,35065,IN,Individual,No,39-1821211,35065IN0010009,Ambetter Balanced Care 5,35065IN001,,INN001,INS001,INF008,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/formulary,35065IN0010009-00,Standard Silver Off Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,4
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,1,35065,IN,Individual,No,39-1821211,35065IN0010009,Ambetter Balanced Care 5,35065IN001,,INN001,INS001,INF008,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/formulary,35065IN0010009-01,Standard Silver On Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,5
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,1,35065,IN,Individual,No,39-1821211,35065IN0010009,Ambetter Balanced Care 5,35065IN001,,INN001,INS001,INF008,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/formulary,35065IN0010009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,1,35065,IN,Individual,No,39-1821211,35065IN0010009,Ambetter Balanced Care 5,35065IN001,,INN001,INS001,INF008,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/formulary,35065IN0010009-03,Limited Cost Sharing Plan Variation,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,7
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,1,35065,IN,Individual,No,39-1821211,35065IN0010009,Ambetter Balanced Care 5,35065IN001,,INN001,INS001,INF008,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/formulary,35065IN0010009-04,73% AV Level Silver Plan,73.23%,0.732411444187164,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$2,920",$350,$0,$80,8
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,1,35065,IN,Individual,No,39-1821211,35065IN0010009,Ambetter Balanced Care 5,35065IN001,,INN001,INS001,INF008,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/formulary,35065IN0010009-05,87% AV Level Silver Plan,87.97%,0.879661500453949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$410,$0,$150,$600,$520,$0,$80,9
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,1,35065,IN,Individual,No,39-1821211,35065IN0010009,Ambetter Balanced Care 5,35065IN001,,INN001,INS001,INF008,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/formulary,35065IN0010009-06,94% AV Level Silver Plan,93.34%,0.933413624763489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$120,$0,$150,$0,$450,$0,$80,10
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,1,35065,IN,Individual,No,39-1821211,35065IN0010007,Ambetter Balanced Care 3,35065IN001,,INN001,INS001,INF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/formulary,35065IN0010007-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,11
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,1,35065,IN,Individual,No,39-1821211,35065IN0010007,Ambetter Balanced Care 3,35065IN001,,INN001,INS001,INF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/formulary,35065IN0010007-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,12
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,1,35065,IN,Individual,No,39-1821211,35065IN0010007,Ambetter Balanced Care 3,35065IN001,,INN001,INS001,INF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/formulary,35065IN0010007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,1,35065,IN,Individual,No,39-1821211,35065IN0010007,Ambetter Balanced Care 3,35065IN001,,INN001,INS001,INF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/formulary,35065IN0010007-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,14
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,1,35065,IN,Individual,No,39-1821211,35065IN0010007,Ambetter Balanced Care 3,35065IN001,,INN001,INS001,INF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/formulary,35065IN0010007-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,15
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,1,35065,IN,Individual,No,39-1821211,35065IN0010007,Ambetter Balanced Care 3,35065IN001,,INN001,INS001,INF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/formulary,35065IN0010007-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,16
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,1,35065,IN,Individual,No,39-1821211,35065IN0010007,Ambetter Balanced Care 3,35065IN001,,INN001,INS001,INF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/formulary,35065IN0010007-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,17
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,1,35065,IN,Individual,No,39-1821211,35065IN0010002,Ambetter Secure Care 2,35065IN001,,INN001,INS001,INF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/formulary,35065IN0010002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,18
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,1,35065,IN,Individual,No,39-1821211,35065IN0010002,Ambetter Secure Care 2,35065IN001,,INN001,INS001,INF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/formulary,35065IN0010002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,19
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,1,35065,IN,Individual,No,39-1821211,35065IN0010002,Ambetter Secure Care 2,35065IN001,,INN001,INS001,INF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/formulary,35065IN0010002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,20
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,1,35065,IN,Individual,No,39-1821211,35065IN0010002,Ambetter Secure Care 2,35065IN001,,INN001,INS001,INF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/formulary,35065IN0010002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,21
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,2,35065,IN,Individual,No,39-1821211,35065IN0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,35065IN001,,INN001,INS001,INF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/formulary,35065IN0010004-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,2,35065,IN,Individual,No,39-1821211,35065IN0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,35065IN001,,INN001,INS001,INF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/formulary,35065IN0010004-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,2,35065,IN,Individual,No,39-1821211,35065IN0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,35065IN001,,INN001,INS001,INF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/formulary,35065IN0010004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,2,35065,IN,Individual,No,39-1821211,35065IN0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,35065IN001,,INN001,INS001,INF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/formulary,35065IN0010004-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,2,35065,IN,Individual,No,39-1821211,35065IN0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,35065IN001,,INN001,INS001,INF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/formulary,35065IN0010012-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,2,35065,IN,Individual,No,39-1821211,35065IN0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,35065IN001,,INN001,INS001,INF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/formulary,35065IN0010012-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,2,35065,IN,Individual,No,39-1821211,35065IN0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,35065IN001,,INN001,INS001,INF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/formulary,35065IN0010012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,2,35065,IN,Individual,No,39-1821211,35065IN0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,35065IN001,,INN001,INS001,INF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/formulary,35065IN0010012-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,2,35065,IN,Individual,No,39-1821211,35065IN0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,35065IN001,,INN001,INS001,INF012,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/formulary,35065IN0010013-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,2,35065,IN,Individual,No,39-1821211,35065IN0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,35065IN001,,INN001,INS001,INF012,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/formulary,35065IN0010013-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,2,35065,IN,Individual,No,39-1821211,35065IN0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,35065IN001,,INN001,INS001,INF012,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/formulary,35065IN0010013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,2,35065,IN,Individual,No,39-1821211,35065IN0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,35065IN001,,INN001,INS001,INF012,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/formulary,35065IN0010013-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,2,35065,IN,Individual,No,39-1821211,35065IN0010016,Ambetter Essential Care 2,35065IN001,,INN001,INS001,INF015,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/formulary,35065IN0010016-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,2,35065,IN,Individual,No,39-1821211,35065IN0010016,Ambetter Essential Care 2,35065IN001,,INN001,INS001,INF015,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/formulary,35065IN0010016-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,2,35065,IN,Individual,No,39-1821211,35065IN0010016,Ambetter Essential Care 2,35065IN001,,INN001,INS001,INF015,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/formulary,35065IN0010016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,2,35065,IN,Individual,No,39-1821211,35065IN0010016,Ambetter Essential Care 2,35065IN001,,INN001,INS001,INF015,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/formulary,35065IN0010016-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,2,35065,IN,Individual,No,39-1821211,35065IN0010017,Ambetter Essential Care 1,35065IN001,,INN001,INS001,INF016,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/formulary,35065IN0010017-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,2,35065,IN,Individual,No,39-1821211,35065IN0010017,Ambetter Essential Care 1,35065IN001,,INN001,INS001,INF016,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/formulary,35065IN0010017-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,2,35065,IN,Individual,No,39-1821211,35065IN0010017,Ambetter Essential Care 1,35065IN001,,INN001,INS001,INF016,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/formulary,35065IN0010017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,2,35065,IN,Individual,No,39-1821211,35065IN0010017,Ambetter Essential Care 1,35065IN001,,INN001,INS001,INF016,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/formulary,35065IN0010017-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,3,35065,IN,Individual,No,39-1821211,35065IN0010008,Ambetter Balanced Care 4,35065IN001,,INN001,INS001,INF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/formulary,35065IN0010008-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,4
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,3,35065,IN,Individual,No,39-1821211,35065IN0010008,Ambetter Balanced Care 4,35065IN001,,INN001,INS001,INF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/formulary,35065IN0010008-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,5
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,3,35065,IN,Individual,No,39-1821211,35065IN0010008,Ambetter Balanced Care 4,35065IN001,,INN001,INS001,INF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/formulary,35065IN0010008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,3,35065,IN,Individual,No,39-1821211,35065IN0010008,Ambetter Balanced Care 4,35065IN001,,INN001,INS001,INF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/formulary,35065IN0010008-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,7
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,3,35065,IN,Individual,No,39-1821211,35065IN0010008,Ambetter Balanced Care 4,35065IN001,,INN001,INS001,INF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/formulary,35065IN0010008-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,8
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,3,35065,IN,Individual,No,39-1821211,35065IN0010008,Ambetter Balanced Care 4,35065IN001,,INN001,INS001,INF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/formulary,35065IN0010008-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,9
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,3,35065,IN,Individual,No,39-1821211,35065IN0010008,Ambetter Balanced Care 4,35065IN001,,INN001,INS001,INF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/formulary,35065IN0010008-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,10
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,4,35065,IN,Individual,No,39-1821211,35065IN0010014,Ambetter Balanced Care 2,35065IN001,,INN001,INS001,INF013,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/formulary,35065IN0010014-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,4
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,4,35065,IN,Individual,No,39-1821211,35065IN0010014,Ambetter Balanced Care 2,35065IN001,,INN001,INS001,INF013,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/formulary,35065IN0010014-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,5
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,4,35065,IN,Individual,No,39-1821211,35065IN0010014,Ambetter Balanced Care 2,35065IN001,,INN001,INS001,INF013,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/formulary,35065IN0010014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,4,35065,IN,Individual,No,39-1821211,35065IN0010014,Ambetter Balanced Care 2,35065IN001,,INN001,INS001,INF013,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/formulary,35065IN0010014-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,7
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,4,35065,IN,Individual,No,39-1821211,35065IN0010014,Ambetter Balanced Care 2,35065IN001,,INN001,INS001,INF013,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/formulary,35065IN0010014-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,8
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,4,35065,IN,Individual,No,39-1821211,35065IN0010014,Ambetter Balanced Care 2,35065IN001,,INN001,INS001,INF013,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/formulary,35065IN0010014-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,9
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,4,35065,IN,Individual,No,39-1821211,35065IN0010014,Ambetter Balanced Care 2,35065IN001,,INN001,INS001,INF013,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/formulary,35065IN0010014-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,10
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,5,35065,IN,Individual,No,39-1821211,35065IN0010015,Ambetter Balanced Care 1,35065IN001,,INN001,INS001,INF014,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/formulary,35065IN0010015-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,4
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,5,35065,IN,Individual,No,39-1821211,35065IN0010015,Ambetter Balanced Care 1,35065IN001,,INN001,INS001,INF014,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/formulary,35065IN0010015-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,5
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,5,35065,IN,Individual,No,39-1821211,35065IN0010015,Ambetter Balanced Care 1,35065IN001,,INN001,INS001,INF014,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/formulary,35065IN0010015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,5,35065,IN,Individual,No,39-1821211,35065IN0010015,Ambetter Balanced Care 1,35065IN001,,INN001,INS001,INF014,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/formulary,35065IN0010015-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,7
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,6,35065,IN,Individual,No,39-1821211,35065IN0020007,Ambetter Balanced Care 3 + Vision,35065IN002,,INN001,INS001,INF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982583466835868,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/formulary,35065IN0020007-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,11
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,6,35065,IN,Individual,No,39-1821211,35065IN0020007,Ambetter Balanced Care 3 + Vision,35065IN002,,INN001,INS001,INF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982583466835868,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/formulary,35065IN0020007-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,12
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,6,35065,IN,Individual,No,39-1821211,35065IN0020007,Ambetter Balanced Care 3 + Vision,35065IN002,,INN001,INS001,INF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982583466835868,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/formulary,35065IN0020007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,6,35065,IN,Individual,No,39-1821211,35065IN0020007,Ambetter Balanced Care 3 + Vision,35065IN002,,INN001,INS001,INF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982583466835868,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/formulary,35065IN0020007-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,14
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,6,35065,IN,Individual,No,39-1821211,35065IN0020007,Ambetter Balanced Care 3 + Vision,35065IN002,,INN001,INS001,INF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982583466835868,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/formulary,35065IN0020007-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,15
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,6,35065,IN,Individual,No,39-1821211,35065IN0020007,Ambetter Balanced Care 3 + Vision,35065IN002,,INN001,INS001,INF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982583466835868,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/formulary,35065IN0020007-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,16
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,6,35065,IN,Individual,No,39-1821211,35065IN0020007,Ambetter Balanced Care 3 + Vision,35065IN002,,INN001,INS001,INF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982583466835868,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/formulary,35065IN0020007-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,17
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,6,35065,IN,Individual,No,39-1821211,35065IN0020002,Ambetter Secure Care 2 + Vision,35065IN002,,INN001,INS001,INF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981653863211662,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/formulary,35065IN0020002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,18
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,6,35065,IN,Individual,No,39-1821211,35065IN0020002,Ambetter Secure Care 2 + Vision,35065IN002,,INN001,INS001,INF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981653863211662,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/formulary,35065IN0020002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,19
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,6,35065,IN,Individual,No,39-1821211,35065IN0020002,Ambetter Secure Care 2 + Vision,35065IN002,,INN001,INS001,INF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981653863211662,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/formulary,35065IN0020002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,20
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,6,35065,IN,Individual,No,39-1821211,35065IN0020002,Ambetter Secure Care 2 + Vision,35065IN002,,INN001,INS001,INF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.981653863211662,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/formulary,35065IN0020002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,21
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,7,35065,IN,Individual,No,39-1821211,35065IN0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,35065IN002,,INN001,INS001,INF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98165425706964,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/formulary,35065IN0020004-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,7,35065,IN,Individual,No,39-1821211,35065IN0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,35065IN002,,INN001,INS001,INF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98165425706964,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/formulary,35065IN0020004-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,7,35065,IN,Individual,No,39-1821211,35065IN0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,35065IN002,,INN001,INS001,INF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98165425706964,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/formulary,35065IN0020004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,7,35065,IN,Individual,No,39-1821211,35065IN0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,35065IN002,,INN001,INS001,INF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98165425706964,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/formulary,35065IN0020004-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,7,35065,IN,Individual,No,39-1821211,35065IN0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,35065IN002,,INN001,INS001,INF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.982161406751119,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/formulary,35065IN0020012-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,7,35065,IN,Individual,No,39-1821211,35065IN0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,35065IN002,,INN001,INS001,INF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.982161406751119,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/formulary,35065IN0020012-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,7,35065,IN,Individual,No,39-1821211,35065IN0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,35065IN002,,INN001,INS001,INF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.982161406751119,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/formulary,35065IN0020012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,7,35065,IN,Individual,No,39-1821211,35065IN0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,35065IN002,,INN001,INS001,INF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.982161406751119,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/formulary,35065IN0020012-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,7,35065,IN,Individual,No,39-1821211,35065IN0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,35065IN002,,INN001,INS001,INF012,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9821613549897,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/formulary,35065IN0020013-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,7,35065,IN,Individual,No,39-1821211,35065IN0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,35065IN002,,INN001,INS001,INF012,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9821613549897,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/formulary,35065IN0020013-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,7,35065,IN,Individual,No,39-1821211,35065IN0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,35065IN002,,INN001,INS001,INF012,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9821613549897,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/formulary,35065IN0020013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,7,35065,IN,Individual,No,39-1821211,35065IN0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,35065IN002,,INN001,INS001,INF012,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9821613549897,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/formulary,35065IN0020013-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,7,35065,IN,Individual,No,39-1821211,35065IN0020016,Ambetter Essential Care 2 + Vision,35065IN002,,INN001,INS001,INF015,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.982161406751119,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/formulary,35065IN0020016-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,7,35065,IN,Individual,No,39-1821211,35065IN0020016,Ambetter Essential Care 2 + Vision,35065IN002,,INN001,INS001,INF015,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.982161406751119,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/formulary,35065IN0020016-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,7,35065,IN,Individual,No,39-1821211,35065IN0020016,Ambetter Essential Care 2 + Vision,35065IN002,,INN001,INS001,INF015,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.982161406751119,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/formulary,35065IN0020016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,7,35065,IN,Individual,No,39-1821211,35065IN0020016,Ambetter Essential Care 2 + Vision,35065IN002,,INN001,INS001,INF015,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.982161406751119,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/formulary,35065IN0020016-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,7,35065,IN,Individual,No,39-1821211,35065IN0020017,Ambetter Essential Care 1 + Vision,35065IN002,,INN001,INS001,INF016,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98216135865787,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/formulary,35065IN0020017-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,7,35065,IN,Individual,No,39-1821211,35065IN0020017,Ambetter Essential Care 1 + Vision,35065IN002,,INN001,INS001,INF016,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98216135865787,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/formulary,35065IN0020017-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,7,35065,IN,Individual,No,39-1821211,35065IN0020017,Ambetter Essential Care 1 + Vision,35065IN002,,INN001,INS001,INF016,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98216135865787,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/formulary,35065IN0020017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,7,35065,IN,Individual,No,39-1821211,35065IN0020017,Ambetter Essential Care 1 + Vision,35065IN002,,INN001,INS001,INF016,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98216135865787,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/formulary,35065IN0020017-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,8,35065,IN,Individual,No,39-1821211,35065IN0020008,Ambetter Balanced Care 4 + Vision,35065IN002,,INN001,INS001,INF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982366937651325,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/formulary,35065IN0020008-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,4
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,8,35065,IN,Individual,No,39-1821211,35065IN0020008,Ambetter Balanced Care 4 + Vision,35065IN002,,INN001,INS001,INF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982366937651325,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/formulary,35065IN0020008-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,5
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,8,35065,IN,Individual,No,39-1821211,35065IN0020008,Ambetter Balanced Care 4 + Vision,35065IN002,,INN001,INS001,INF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982366937651325,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/formulary,35065IN0020008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,8,35065,IN,Individual,No,39-1821211,35065IN0020008,Ambetter Balanced Care 4 + Vision,35065IN002,,INN001,INS001,INF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982366937651325,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/formulary,35065IN0020008-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,7
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,8,35065,IN,Individual,No,39-1821211,35065IN0020008,Ambetter Balanced Care 4 + Vision,35065IN002,,INN001,INS001,INF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982366937651325,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/formulary,35065IN0020008-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,8
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,8,35065,IN,Individual,No,39-1821211,35065IN0020008,Ambetter Balanced Care 4 + Vision,35065IN002,,INN001,INS001,INF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982366937651325,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/formulary,35065IN0020008-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,9
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,8,35065,IN,Individual,No,39-1821211,35065IN0020008,Ambetter Balanced Care 4 + Vision,35065IN002,,INN001,INS001,INF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982366937651325,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/formulary,35065IN0020008-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,10
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,9,35065,IN,Individual,No,39-1821211,35065IN0020014,Ambetter Balanced Care 2 + Vision,35065IN002,,INN001,INS001,INF013,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.98261143655734,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/formulary,35065IN0020014-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,4
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,9,35065,IN,Individual,No,39-1821211,35065IN0020014,Ambetter Balanced Care 2 + Vision,35065IN002,,INN001,INS001,INF013,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.98261143655734,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/formulary,35065IN0020014-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,5
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,9,35065,IN,Individual,No,39-1821211,35065IN0020014,Ambetter Balanced Care 2 + Vision,35065IN002,,INN001,INS001,INF013,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.98261143655734,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/formulary,35065IN0020014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,9,35065,IN,Individual,No,39-1821211,35065IN0020014,Ambetter Balanced Care 2 + Vision,35065IN002,,INN001,INS001,INF013,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.98261143655734,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/formulary,35065IN0020014-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,7
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,9,35065,IN,Individual,No,39-1821211,35065IN0020014,Ambetter Balanced Care 2 + Vision,35065IN002,,INN001,INS001,INF013,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.98261143655734,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/formulary,35065IN0020014-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,8
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,9,35065,IN,Individual,No,39-1821211,35065IN0020014,Ambetter Balanced Care 2 + Vision,35065IN002,,INN001,INS001,INF013,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.98261143655734,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/formulary,35065IN0020014-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,9
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,9,35065,IN,Individual,No,39-1821211,35065IN0020014,Ambetter Balanced Care 2 + Vision,35065IN002,,INN001,INS001,INF013,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.98261143655734,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/formulary,35065IN0020014-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,10
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,10,35065,IN,Individual,No,39-1821211,35065IN0020015,Ambetter Balanced Care 1 + Vision,35065IN002,,INN001,INS001,INF014,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982673785092174,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/formulary,35065IN0020015-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,4
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,10,35065,IN,Individual,No,39-1821211,35065IN0020015,Ambetter Balanced Care 1 + Vision,35065IN002,,INN001,INS001,INF014,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982673785092174,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/formulary,35065IN0020015-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,5
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,10,35065,IN,Individual,No,39-1821211,35065IN0020015,Ambetter Balanced Care 1 + Vision,35065IN002,,INN001,INS001,INF014,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982673785092174,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/formulary,35065IN0020015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,10,35065,IN,Individual,No,39-1821211,35065IN0020015,Ambetter Balanced Care 1 + Vision,35065IN002,,INN001,INS001,INF014,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982673785092174,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/formulary,35065IN0020015-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,7
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,10,35065,IN,Individual,No,39-1821211,35065IN0020015,Ambetter Balanced Care 1 + Vision,35065IN002,,INN001,INS001,INF014,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982673785092174,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/formulary,35065IN0020015-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,8
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,10,35065,IN,Individual,No,39-1821211,35065IN0020015,Ambetter Balanced Care 1 + Vision,35065IN002,,INN001,INS001,INF014,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982673785092174,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/formulary,35065IN0020015-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,9
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,10,35065,IN,Individual,No,39-1821211,35065IN0020015,Ambetter Balanced Care 1 + Vision,35065IN002,,INN001,INS001,INF014,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982673785092174,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/formulary,35065IN0020015-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,10
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,11,35065,IN,Individual,No,39-1821211,35065IN0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF008,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941480390578134,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/formulary,35065IN0030009-00,Standard Silver Off Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,4
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,11,35065,IN,Individual,No,39-1821211,35065IN0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF008,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941480390578134,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/formulary,35065IN0030009-01,Standard Silver On Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,5
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,11,35065,IN,Individual,No,39-1821211,35065IN0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF008,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941480390578134,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/formulary,35065IN0030009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,11,35065,IN,Individual,No,39-1821211,35065IN0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF008,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941480390578134,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/formulary,35065IN0030009-03,Limited Cost Sharing Plan Variation,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,7
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,11,35065,IN,Individual,No,39-1821211,35065IN0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF008,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941480390578134,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/formulary,35065IN0030009-04,73% AV Level Silver Plan,73.23%,0.732411444187164,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$2,920",$350,$0,$80,8
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,11,35065,IN,Individual,No,39-1821211,35065IN0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF008,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941480390578134,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/formulary,35065IN0030009-05,87% AV Level Silver Plan,87.97%,0.879661500453949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$410,$0,$150,$600,$520,$0,$80,9
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,11,35065,IN,Individual,No,39-1821211,35065IN0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF008,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941480390578134,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare5,http://ambetter.mhsindiana.com/formulary,35065IN0030009-06,94% AV Level Silver Plan,93.34%,0.933413624763489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$120,$0,$150,$0,$450,$0,$80,10
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,11,35065,IN,Individual,No,39-1821211,35065IN0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941481183200665,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/formulary,35065IN0030007-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,11
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,11,35065,IN,Individual,No,39-1821211,35065IN0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941481183200665,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/formulary,35065IN0030007-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,12
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,11,35065,IN,Individual,No,39-1821211,35065IN0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941481183200665,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/formulary,35065IN0030007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,11,35065,IN,Individual,No,39-1821211,35065IN0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941481183200665,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/formulary,35065IN0030007-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,14
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,11,35065,IN,Individual,No,39-1821211,35065IN0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941481183200665,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/formulary,35065IN0030007-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,15
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,11,35065,IN,Individual,No,39-1821211,35065IN0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941481183200665,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/formulary,35065IN0030007-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,16
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,11,35065,IN,Individual,No,39-1821211,35065IN0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941481183200665,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare3,http://ambetter.mhsindiana.com/formulary,35065IN0030007-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,17
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,11,35065,IN,Individual,No,39-1821211,35065IN0030002,Ambetter Secure Care 2 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.938471160636087,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/formulary,35065IN0030002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,18
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,11,35065,IN,Individual,No,39-1821211,35065IN0030002,Ambetter Secure Care 2 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.938471160636087,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/formulary,35065IN0030002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,19
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,11,35065,IN,Individual,No,39-1821211,35065IN0030002,Ambetter Secure Care 2 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.938471160636087,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/formulary,35065IN0030002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,20
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,11,35065,IN,Individual,No,39-1821211,35065IN0030002,Ambetter Secure Care 2 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.938471160636087,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare2,http://ambetter.mhsindiana.com/formulary,35065IN0030002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,21
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,12,35065,IN,Individual,No,39-1821211,35065IN0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,35065IN003,,INN001,INS001,INF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.938472431162917,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/formulary,35065IN0030004-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,12,35065,IN,Individual,No,39-1821211,35065IN0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,35065IN003,,INN001,INS001,INF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.938472431162917,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/formulary,35065IN0030004-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,12,35065,IN,Individual,No,39-1821211,35065IN0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,35065IN003,,INN001,INS001,INF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.938472431162917,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/formulary,35065IN0030004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,12,35065,IN,Individual,No,39-1821211,35065IN0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,35065IN003,,INN001,INS001,INF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.938472431162917,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=SecureCare1,http://ambetter.mhsindiana.com/formulary,35065IN0030004-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,12,35065,IN,Individual,No,39-1821211,35065IN0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,35065IN003,,INN001,INS001,INF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940126906751365,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/formulary,35065IN0030012-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,12,35065,IN,Individual,No,39-1821211,35065IN0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,35065IN003,,INN001,INS001,INF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940126906751365,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/formulary,35065IN0030012-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,12,35065,IN,Individual,No,39-1821211,35065IN0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,35065IN003,,INN001,INS001,INF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940126906751365,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/formulary,35065IN0030012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,12,35065,IN,Individual,No,39-1821211,35065IN0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,35065IN003,,INN001,INS001,INF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940126906751365,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care3,http://ambetter.mhsindiana.com/formulary,35065IN0030012-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,12,35065,IN,Individual,No,39-1821211,35065IN0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,35065IN003,,INN001,INS001,INF012,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940126755751254,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/formulary,35065IN0030013-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,12,35065,IN,Individual,No,39-1821211,35065IN0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,35065IN003,,INN001,INS001,INF012,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940126755751254,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/formulary,35065IN0030013-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,12,35065,IN,Individual,No,39-1821211,35065IN0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,35065IN003,,INN001,INS001,INF012,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940126755751254,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/formulary,35065IN0030013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,12,35065,IN,Individual,No,39-1821211,35065IN0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,35065IN003,,INN001,INS001,INF012,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940126755751254,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care4,http://ambetter.mhsindiana.com/formulary,35065IN0030013-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,12,35065,IN,Individual,No,39-1821211,35065IN0030016,Ambetter Essential Care 2 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF015,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940126906751365,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/formulary,35065IN0030016-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,12,35065,IN,Individual,No,39-1821211,35065IN0030016,Ambetter Essential Care 2 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF015,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940126906751365,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/formulary,35065IN0030016-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,12,35065,IN,Individual,No,39-1821211,35065IN0030016,Ambetter Essential Care 2 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF015,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940126906751365,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/formulary,35065IN0030016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,12,35065,IN,Individual,No,39-1821211,35065IN0030016,Ambetter Essential Care 2 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF015,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940126906751365,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care2,http://ambetter.mhsindiana.com/formulary,35065IN0030016-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,12,35065,IN,Individual,No,39-1821211,35065IN0030017,Ambetter Essential Care 1 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF016,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940126759119495,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/formulary,35065IN0030017-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,12,35065,IN,Individual,No,39-1821211,35065IN0030017,Ambetter Essential Care 1 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF016,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940126759119495,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/formulary,35065IN0030017-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,12,35065,IN,Individual,No,39-1821211,35065IN0030017,Ambetter Essential Care 1 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF016,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940126759119495,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/formulary,35065IN0030017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,12,35065,IN,Individual,No,39-1821211,35065IN0030017,Ambetter Essential Care 1 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF016,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940126759119495,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=Essential Care1,http://ambetter.mhsindiana.com/formulary,35065IN0030017-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,13,35065,IN,Individual,No,39-1821211,35065IN0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94078788645598,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/formulary,35065IN0030008-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,4
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,13,35065,IN,Individual,No,39-1821211,35065IN0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94078788645598,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/formulary,35065IN0030008-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,5
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,13,35065,IN,Individual,No,39-1821211,35065IN0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94078788645598,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/formulary,35065IN0030008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,13,35065,IN,Individual,No,39-1821211,35065IN0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94078788645598,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/formulary,35065IN0030008-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,7
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,13,35065,IN,Individual,No,39-1821211,35065IN0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94078788645598,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/formulary,35065IN0030008-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,8
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,13,35065,IN,Individual,No,39-1821211,35065IN0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94078788645598,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/formulary,35065IN0030008-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,9
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,13,35065,IN,Individual,No,39-1821211,35065IN0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94078788645598,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare4,http://ambetter.mhsindiana.com/formulary,35065IN0030008-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,10
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,14,35065,IN,Individual,No,39-1821211,35065IN0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF013,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941569374940975,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/formulary,35065IN0030014-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,4
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,14,35065,IN,Individual,No,39-1821211,35065IN0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF013,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941569374940975,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/formulary,35065IN0030014-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,5
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,14,35065,IN,Individual,No,39-1821211,35065IN0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF013,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941569374940975,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/formulary,35065IN0030014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,14,35065,IN,Individual,No,39-1821211,35065IN0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF013,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941569374940975,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/formulary,35065IN0030014-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,7
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,14,35065,IN,Individual,No,39-1821211,35065IN0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF013,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941569374940975,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/formulary,35065IN0030014-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,8
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,14,35065,IN,Individual,No,39-1821211,35065IN0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF013,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941569374940975,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/formulary,35065IN0030014-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,9
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,14,35065,IN,Individual,No,39-1821211,35065IN0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF013,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941569374940975,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare2,http://ambetter.mhsindiana.com/formulary,35065IN0030014-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,10
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,15,35065,IN,Individual,No,39-1821211,35065IN0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF014,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94176612639658,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/formulary,35065IN0030015-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,4
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,15,35065,IN,Individual,No,39-1821211,35065IN0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF014,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94176612639658,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/formulary,35065IN0030015-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,5
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,15,35065,IN,Individual,No,39-1821211,35065IN0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF014,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94176612639658,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/formulary,35065IN0030015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,15,35065,IN,Individual,No,39-1821211,35065IN0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF014,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94176612639658,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/formulary,35065IN0030015-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,7
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,15,35065,IN,Individual,No,39-1821211,35065IN0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF014,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94176612639658,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/formulary,35065IN0030015-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,8
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,15,35065,IN,Individual,No,39-1821211,35065IN0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF014,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94176612639658,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/formulary,35065IN0030015-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,9
2015,IN,35065,HIOS,10,2015-02-19 06:21:02,15,35065,IN,Individual,No,39-1821211,35065IN0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,35065IN003,,INN001,INS001,INF014,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94176612639658,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/payments,http://ambetter.mhsindiana.com/brochures/?plan=BalancedCare1,http://ambetter.mhsindiana.com/formulary,35065IN0030015-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,10
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,1,36373,IN,Individual,No,35-1665915,36373IN0020002,UnitedHealthcare Silver Choice HSA 2600,36373IN002,,INN002,INS001,INF002,New,EPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020002-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,1,36373,IN,Individual,No,35-1665915,36373IN0020002,UnitedHealthcare Silver Choice HSA 2600,36373IN002,,INN002,INS001,INF002,New,EPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020002-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,1,36373,IN,Individual,No,35-1665915,36373IN0020002,UnitedHealthcare Silver Choice HSA 2600,36373IN002,,INN002,INS001,INF002,New,EPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,1,36373,IN,Individual,No,35-1665915,36373IN0020002,UnitedHealthcare Silver Choice HSA 2600,36373IN002,,INN002,INS001,INF002,New,EPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020002-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,1,36373,IN,Individual,No,35-1665915,36373IN0020002,UnitedHealthcare Silver Choice HSA 2600,36373IN002,,INN002,INS001,INF002,New,EPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020002-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,1,36373,IN,Individual,No,35-1665915,36373IN0020002,UnitedHealthcare Silver Choice HSA 2600,36373IN002,,INN002,INS001,INF002,New,EPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020002-05,87% AV Level Silver Plan,86.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$550,"$1,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,1,36373,IN,Individual,No,35-1665915,36373IN0020002,UnitedHealthcare Silver Choice HSA 2600,36373IN002,,INN002,INS001,INF002,New,EPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020002-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$75,$150,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,1,36373,IN,Individual,No,35-1665915,36373IN0020006,UnitedHealthcare Bronze Choice HSA 4900,36373IN002,,INN002,INS001,INF005,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020006-00,Standard Bronze Off Exchange Plan,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,1,36373,IN,Individual,No,35-1665915,36373IN0020006,UnitedHealthcare Bronze Choice HSA 4900,36373IN002,,INN002,INS001,INF005,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020006-01,Standard Bronze On Exchange Plan,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,1,36373,IN,Individual,No,35-1665915,36373IN0020006,UnitedHealthcare Bronze Choice HSA 4900,36373IN002,,INN002,INS001,INF005,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,1,36373,IN,Individual,No,35-1665915,36373IN0020006,UnitedHealthcare Bronze Choice HSA 4900,36373IN002,,INN002,INS001,INF005,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020006-03,Limited Cost Sharing Plan Variation,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020001,UnitedHealthcare Gold Choice 1250,36373IN002,,INN002,INS001,INF002,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020001-00,Standard Gold Off Exchange Plan,79.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020001,UnitedHealthcare Gold Choice 1250,36373IN002,,INN002,INS001,INF002,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020001-01,Standard Gold On Exchange Plan,79.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020001,UnitedHealthcare Gold Choice 1250,36373IN002,,INN002,INS001,INF002,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,5,50816,IN,Individual,No,35-1069321,50816IN0200022,Marquee Select Gold 1000,50816IN020,7831192068,INN002,INS001,INF002,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH22-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200022-03,Limited Cost Sharing Plan Variation,80.53%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IN,51303,HIOS,5,2014-08-08 08:53:29,1,51303,IN,Individual,Yes,72-0977315,51303IN0010001,AlwaysCare All-Star Kids Dental Plan,51303IN001,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$22.43,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,51303IN0010001-00,Standard High Off Exchange Plan,86.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,51303,HIOS,5,2014-08-08 08:53:29,1,51303,IN,SHOP (Small Group),Yes,72-0977315,51303IN0040001,AlwaysCare Small Group - Child,51303IN004,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.18,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,51303IN0040001-00,Standard High Off Exchange Plan,86.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,4,54192,IN,Individual,No,32-0121856,54192IN0010002,CareSource Just4Me Ultra Healthcare with Heart,54192IN001,,INN002,INS002,INF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9947,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010002-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,$0,$0,$0,$0,,,$0,$0,$0,$0,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,4,54192,IN,Individual,No,32-0121856,54192IN0010002,CareSource Just4Me Ultra Healthcare with Heart,54192IN001,,INN002,INS002,INF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9947,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010002-03,Limited Cost Sharing Plan Variation,,0.815527200698853,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,11
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,5,54192,IN,Individual,No,32-0121856,54192IN0020001,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,54192IN002,,INN001,INS001,INF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9489,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020001-00,Standard Gold Off Exchange Plan,,0.815527200698853,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,4
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,5,54192,IN,Individual,No,32-0121856,54192IN0020001,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,54192IN002,,INN001,INS001,INF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9489,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020001-01,Standard Gold On Exchange Plan,,0.815527200698853,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,5
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,5,54192,IN,Individual,No,32-0121856,54192IN0020001,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,54192IN002,,INN001,INS001,INF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9489,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020001-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,$0,$0,$0,$0,,,$0,$0,$0,$0,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,5,54192,IN,Individual,No,32-0121856,54192IN0020001,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,54192IN002,,INN001,INS001,INF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9489,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020001-03,Limited Cost Sharing Plan Variation,,0.815527200698853,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,7
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,5,54192,IN,Individual,No,32-0121856,54192IN0020002,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,54192IN002,,INN002,INS002,INF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9489,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020002-00,Standard Gold Off Exchange Plan,,0.815527200698853,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,8
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020001,UnitedHealthcare Gold Choice 1250,36373IN002,,INN002,INS001,INF002,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020001-03,Limited Cost Sharing Plan Variation,79.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020003,UnitedHealthcare Silver Choice 2000,36373IN002,,INN002,INS001,INF005,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020003-00,Standard Silver Off Exchange Plan,69.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020003,UnitedHealthcare Silver Choice 2000,36373IN002,,INN002,INS001,INF005,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020003-01,Standard Silver On Exchange Plan,69.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020003,UnitedHealthcare Silver Choice 2000,36373IN002,,INN002,INS001,INF005,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020003-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020003,UnitedHealthcare Silver Choice 2000,36373IN002,,INN002,INS001,INF005,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020003-03,Limited Cost Sharing Plan Variation,69.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020003,UnitedHealthcare Silver Choice 2000,36373IN002,,INN002,INS001,INF005,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020003-04,73% AV Level Silver Plan,73.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020003,UnitedHealthcare Silver Choice 2000,36373IN002,,INN002,INS001,INF005,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020003-05,87% AV Level Silver Plan,86.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020003,UnitedHealthcare Silver Choice 2000,36373IN002,,INN002,INS001,INF005,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020003-06,94% AV Level Silver Plan,93.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020004,UnitedHealthcare Silver Choice 3500,36373IN002,,INN002,INS001,INF003,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020004-00,Standard Silver Off Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,2,50816,IN,Individual,No,35-1069321,50816IN0200013,Marquee Select Bronze 4750,50816IN020,7831192068,INN002,INS001,INF006,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH13-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200013-00,Standard Bronze Off Exchange Plan,61.94%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,2,50816,IN,Individual,No,35-1069321,50816IN0200013,Marquee Select Bronze 4750,50816IN020,7831192068,INN002,INS001,INF006,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH13-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200013-01,Standard Bronze On Exchange Plan,61.94%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020004,UnitedHealthcare Silver Choice 3500,36373IN002,,INN002,INS001,INF003,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020004-01,Standard Silver On Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020004,UnitedHealthcare Silver Choice 3500,36373IN002,,INN002,INS001,INF003,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020004-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,3,50816,IN,Individual,No,35-1069321,50816IN0200007,Marquee Select Silver 3500,50816IN020,7831192068,INN002,INS001,INF001,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH07-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200007-00,Standard Silver Off Exchange Plan,68.22%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,3,50816,IN,Individual,No,35-1069321,50816IN0200007,Marquee Select Silver 3500,50816IN020,7831192068,INN002,INS001,INF001,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH07-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200007-01,Standard Silver On Exchange Plan,68.22%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,3,50816,IN,Individual,No,35-1069321,50816IN0200007,Marquee Select Silver 3500,50816IN020,7831192068,INN002,INS001,INF001,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH07-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200007-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,3,50816,IN,Individual,No,35-1069321,50816IN0200007,Marquee Select Silver 3500,50816IN020,7831192068,INN002,INS001,INF001,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH07-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200007-03,Limited Cost Sharing Plan Variation,68.22%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,3,50816,IN,Individual,No,35-1069321,50816IN0200007,Marquee Select Silver 3500,50816IN020,7831192068,INN002,INS001,INF001,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH07-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200007-04,73% AV Level Silver Plan,72.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,700","$7,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020004,UnitedHealthcare Silver Choice 3500,36373IN002,,INN002,INS001,INF003,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020004-03,Limited Cost Sharing Plan Variation,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020004,UnitedHealthcare Silver Choice 3500,36373IN002,,INN002,INS001,INF003,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020004-04,73% AV Level Silver Plan,73.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020004,UnitedHealthcare Silver Choice 3500,36373IN002,,INN002,INS001,INF003,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020004-05,87% AV Level Silver Plan,86.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020004,UnitedHealthcare Silver Choice 3500,36373IN002,,INN002,INS001,INF003,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020004-06,94% AV Level Silver Plan,93.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,3,50816,IN,Individual,No,35-1069321,50816IN0200007,Marquee Select Silver 3500,50816IN020,7831192068,INN002,INS001,INF001,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH07-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200007-05,87% AV Level Silver Plan,86.22%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,950","$3,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,3,50816,IN,Individual,No,35-1069321,50816IN0200007,Marquee Select Silver 3500,50816IN020,7831192068,INN002,INS001,INF001,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH07-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200007-06,94% AV Level Silver Plan,93.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020005,UnitedHealthcare Silver Choice  5000,36373IN002,,INN002,INS001,INF004,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020005-00,Standard Silver Off Exchange Plan,69.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020005,UnitedHealthcare Silver Choice  5000,36373IN002,,INN002,INS001,INF004,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020005-01,Standard Silver On Exchange Plan,69.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,3,50816,IN,Individual,No,35-1069321,50816IN0200016,Marquee Select Bronze 6000,50816IN020,7831192068,INN002,INS001,INF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH16-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200016-00,Standard Bronze Off Exchange Plan,58.74%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,37
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,3,50816,IN,Individual,No,35-1069321,50816IN0200016,Marquee Select Bronze 6000,50816IN020,7831192068,INN002,INS001,INF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH16-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200016-01,Standard Bronze On Exchange Plan,58.74%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,38
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,3,50816,IN,Individual,No,35-1069321,50816IN0200016,Marquee Select Bronze 6000,50816IN020,7831192068,INN002,INS001,INF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH16-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200016-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,39
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,3,50816,IN,Individual,No,35-1069321,50816IN0200016,Marquee Select Bronze 6000,50816IN020,7831192068,INN002,INS001,INF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH16-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200016-03,Limited Cost Sharing Plan Variation,58.74%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,40
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020005,UnitedHealthcare Silver Choice  5000,36373IN002,,INN002,INS001,INF004,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020005-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,24
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020005,UnitedHealthcare Silver Choice  5000,36373IN002,,INN002,INS001,INF004,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020005-03,Limited Cost Sharing Plan Variation,69.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020005,UnitedHealthcare Silver Choice  5000,36373IN002,,INN002,INS001,INF004,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020005-04,73% AV Level Silver Plan,73.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,$750,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020005,UnitedHealthcare Silver Choice  5000,36373IN002,,INN002,INS001,INF004,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020005-05,87% AV Level Silver Plan,86.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,2,36373,IN,Individual,No,35-1665915,36373IN0020005,UnitedHealthcare Silver Choice  5000,36373IN002,,INN002,INS001,INF004,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020005-06,94% AV Level Silver Plan,93.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,3,36373,IN,Individual,No,35-1665915,36373IN0020007,UnitedHealthcare Bronze Choice 5500,36373IN002,,INN002,INS001,INF005,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020007-00,Standard Bronze Off Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,3,36373,IN,Individual,No,35-1665915,36373IN0020007,UnitedHealthcare Bronze Choice 5500,36373IN002,,INN002,INS001,INF005,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020007-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,3,36373,IN,Individual,No,35-1665915,36373IN0020007,UnitedHealthcare Bronze Choice 5500,36373IN002,,INN002,INS001,INF005,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020007-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,IN,36373,HIOS,9,2014-12-11 04:09:12,3,36373,IN,Individual,No,35-1665915,36373IN0020007,UnitedHealthcare Bronze Choice 5500,36373IN002,,INN002,INS001,INF005,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/xin,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xin,36373IN0020007-03,Limited Cost Sharing Plan Variation,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,1,50816,IN,Individual,No,35-1069321,50816IN0200001,Marquee Select Silver 2000,50816IN020,7831192068,INN002,INS001,INF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH01-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200001-00,Standard Silver Off Exchange Plan,71.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,1,50816,IN,Individual,No,35-1069321,50816IN0200001,Marquee Select Silver 2000,50816IN020,7831192068,INN002,INS001,INF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH01-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200001-01,Standard Silver On Exchange Plan,71.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,1,50816,IN,Individual,No,35-1069321,50816IN0200001,Marquee Select Silver 2000,50816IN020,7831192068,INN002,INS001,INF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH01-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,1,50816,IN,Individual,No,35-1069321,50816IN0200001,Marquee Select Silver 2000,50816IN020,7831192068,INN002,INS001,INF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH01-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200001-03,Limited Cost Sharing Plan Variation,71.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,1,50816,IN,Individual,No,35-1069321,50816IN0200001,Marquee Select Silver 2000,50816IN020,7831192068,INN002,INS001,INF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH01-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200001-04,73% AV Level Silver Plan,73.92%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,575","$9,150",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,1,50816,IN,Individual,No,35-1069321,50816IN0200001,Marquee Select Silver 2000,50816IN020,7831192068,INN002,INS001,INF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH01-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200001-05,87% AV Level Silver Plan,86.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$800,"$1,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,1,50816,IN,Individual,No,35-1069321,50816IN0200001,Marquee Select Silver 2000,50816IN020,7831192068,INN002,INS001,INF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH01-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200001-06,94% AV Level Silver Plan,93.22%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,1,50816,IN,Individual,No,35-1069321,50816IN0200004,Marquee Select Silver 2500,50816IN020,7831192068,INN002,INS001,INF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH04-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200004-00,Standard Silver Off Exchange Plan,68.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,1,50816,IN,Individual,No,35-1069321,50816IN0200004,Marquee Select Silver 2500,50816IN020,7831192068,INN002,INS001,INF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH04-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200004-01,Standard Silver On Exchange Plan,68.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,26
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,1,50816,IN,Individual,No,35-1069321,50816IN0200004,Marquee Select Silver 2500,50816IN020,7831192068,INN002,INS001,INF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH04-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,27
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,1,50816,IN,Individual,No,35-1069321,50816IN0200004,Marquee Select Silver 2500,50816IN020,7831192068,INN002,INS001,INF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH04-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200004-03,Limited Cost Sharing Plan Variation,68.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,28
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,1,50816,IN,Individual,No,35-1069321,50816IN0200004,Marquee Select Silver 2500,50816IN020,7831192068,INN002,INS001,INF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH04-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200004-04,73% AV Level Silver Plan,72.27%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,29
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,1,50816,IN,Individual,No,35-1069321,50816IN0200004,Marquee Select Silver 2500,50816IN020,7831192068,INN002,INS001,INF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH04-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200004-05,87% AV Level Silver Plan,86.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$800,"$1,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,30
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,1,50816,IN,Individual,No,35-1069321,50816IN0200004,Marquee Select Silver 2500,50816IN020,7831192068,INN002,INS001,INF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH04-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200004-06,94% AV Level Silver Plan,93.22%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,31
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,2,50816,IN,Individual,No,35-1069321,50816IN0200013,Marquee Select Bronze 4750,50816IN020,7831192068,INN002,INS001,INF006,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH13-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200013-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,2,50816,IN,Individual,No,35-1069321,50816IN0200013,Marquee Select Bronze 4750,50816IN020,7831192068,INN002,INS001,INF006,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH13-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200013-03,Limited Cost Sharing Plan Variation,61.94%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,3,50816,IN,Individual,No,35-1069321,50816IN0200010,Marquee Select Bronze 3000,50816IN020,7831192068,INN002,INS001,INF005,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH10-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200010-00,Standard Bronze Off Exchange Plan,61.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,3,50816,IN,Individual,No,35-1069321,50816IN0200010,Marquee Select Bronze 3000,50816IN020,7831192068,INN002,INS001,INF005,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH10-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200010-01,Standard Bronze On Exchange Plan,61.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,26
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,3,50816,IN,Individual,No,35-1069321,50816IN0200010,Marquee Select Bronze 3000,50816IN020,7831192068,INN002,INS001,INF005,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH10-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200010-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,27
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,3,50816,IN,Individual,No,35-1069321,50816IN0200010,Marquee Select Bronze 3000,50816IN020,7831192068,INN002,INS001,INF005,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH10-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200010-03,Limited Cost Sharing Plan Variation,61.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,28
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,4,50816,IN,Individual,No,35-1069321,50816IN0200025,Marquee Select Catastrophic,50816IN020,7831192068,INN002,INS001,INF001,Existing,HMO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH25-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200025-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,4,50816,IN,Individual,No,35-1069321,50816IN0200025,Marquee Select Catastrophic,50816IN020,7831192068,INN002,INS001,INF001,Existing,HMO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH25-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200025-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,5,50816,IN,Individual,No,35-1069321,50816IN0200022,Marquee Select Gold 1000,50816IN020,7831192068,INN002,INS001,INF002,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH22-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200022-00,Standard Gold Off Exchange Plan,80.53%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,5,50816,IN,Individual,No,35-1069321,50816IN0200022,Marquee Select Gold 1000,50816IN020,7831192068,INN002,INS001,INF002,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH22-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200022-01,Standard Gold On Exchange Plan,80.53%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IN,50816,HIOS,5,2014-10-05 17:13:14,5,50816,IN,Individual,No,35-1069321,50816IN0200022,Marquee Select Gold 1000,50816IN020,7831192068,INN002,INS001,INF002,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.phpni.com/marketplace/individual/sbc?planid=IH22-15,https://secure.phpni.com/SecurePortals/marketplace/payment,http://www.phpni.com/marketplace/individualbrochure,www.phpni.com/pharmacy/pharmacy.aspx,50816IN0200022-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,6,54192,IN,Individual,No,32-0121856,54192IN0020003,CareSource Just4Me Dental and Vision! Healthcare with Heart,54192IN002,,INN001,INS001,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9326,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020003-06,94% AV Level Silver Plan,94.80%,0.942208528518677,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$200,$300,$0,$150,$200,$0,$0,$80,10
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,6,54192,IN,Individual,No,32-0121856,54192IN0020004,CareSource Just4Me Dental and Vision! Healthcare with Heart,54192IN002,,INN002,INS002,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9326,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020004-00,Standard Silver Off Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,11
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,6,54192,IN,Individual,No,32-0121856,54192IN0020004,CareSource Just4Me Dental and Vision! Healthcare with Heart,54192IN002,,INN002,INS002,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9326,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020004-01,Standard Silver On Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,12
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,6,54192,IN,Individual,No,32-0121856,54192IN0020004,CareSource Just4Me Dental and Vision! Healthcare with Heart,54192IN002,,INN002,INS002,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9326,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020004-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,6,54192,IN,Individual,No,32-0121856,54192IN0020004,CareSource Just4Me Dental and Vision! Healthcare with Heart,54192IN002,,INN002,INS002,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9326,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020004-03,Limited Cost Sharing Plan Variation,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,14
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,6,54192,IN,Individual,No,32-0121856,54192IN0020004,CareSource Just4Me Dental and Vision! Healthcare with Heart,54192IN002,,INN002,INS002,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9326,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020004-04,73% AV Level Silver Plan,74.00%,0.739992797374725,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$300,$0,$150,"$2,420",$0,$0,$80,15
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,6,54192,IN,Individual,No,32-0121856,54192IN0020004,CareSource Just4Me Dental and Vision! Healthcare with Heart,54192IN002,,INN002,INS002,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9326,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020004-05,87% AV Level Silver Plan,87.90%,0.880107223987579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$0,$100,$80,16
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,6,54192,IN,Individual,No,32-0121856,54192IN0020004,CareSource Just4Me Dental and Vision! Healthcare with Heart,54192IN002,,INN002,INS002,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9326,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020004-06,94% AV Level Silver Plan,94.80%,0.942208528518677,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$200,$300,$0,$150,$200,$0,$0,$80,17
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,6,54192,IN,Individual,No,32-0121856,54192IN0020005,CareSource Just4Me Dental and Vision! Healthcare with Heart,54192IN002,,INN001,INS001,INF001,New,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.916,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020005-00,Standard Bronze Off Exchange Plan,59.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,18
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,6,54192,IN,Individual,No,32-0121856,54192IN0020005,CareSource Just4Me Dental and Vision! Healthcare with Heart,54192IN002,,INN001,INS001,INF001,New,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.916,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020005-01,Standard Bronze On Exchange Plan,59.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,19
2015,IN,51303,HIOS,5,2014-08-08 08:53:29,1,51303,IN,SHOP (Small Group),Yes,72-0977315,51303IN0040002,AlwaysCare Small Group - Child,51303IN004,,INN001,INS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$21.54,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,51303IN0040002-00,Standard Low Off Exchange Plan,71.27%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,51303,HIOS,5,2014-08-08 08:53:29,1,51303,IN,Individual,Yes,72-0977315,51303IN0010002,AlwaysCare All-Star Kids Dental Plan,51303IN001,,INN001,INS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$18.27,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,51303IN0010002-00,Standard Low Off Exchange Plan,71.27%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,51303,HIOS,5,2014-08-08 08:53:29,2,51303,IN,Individual,Yes,72-0977315,51303IN0020001,AlwaysCare All-Star Family Dental Plan,51303IN002,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.43,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,51303IN0020001-00,Standard High Off Exchange Plan,86.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,56340,HIOS,3,2014-09-04 03:25:43,1,56340,IN,SHOP (Small Group),Yes,35-0472300,56340IN0010001,Lincoln Dental Connect?,56340IN001,,INN001,INS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.76,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,56340IN0010001-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,56340,HIOS,3,2014-09-04 03:25:43,1,56340,IN,SHOP (Small Group),Yes,35-0472300,56340IN0010002,Lincoln Dental Connect?,56340IN001,,INN001,INS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.24,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,56340IN0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,56340,HIOS,3,2014-09-04 03:25:43,1,56340,IN,SHOP (Small Group),Yes,35-0472300,56340IN0010003,Lincoln Dental Connect?,56340IN001,,INN001,INS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.65,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,56340IN0010003-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IN,56340,HIOS,3,2014-09-04 03:25:43,1,56340,IN,SHOP (Small Group),Yes,35-0472300,56340IN0010005,Lincoln Dental Connect?,56340IN001,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.54,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,56340IN0010005-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IN,56340,HIOS,3,2014-09-04 03:25:43,1,56340,IN,SHOP (Small Group),Yes,35-0472300,56340IN0010006,Lincoln Dental Connect?,56340IN001,,INN001,INS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.88,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,56340IN0010006-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,IN,56340,HIOS,3,2014-09-04 03:25:43,1,56340,IN,SHOP (Small Group),Yes,35-0472300,56340IN0010007,Lincoln Dental Connect?,56340IN001,,INN001,INS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.79,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,56340IN0010007-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,IN,56340,HIOS,3,2014-09-04 03:25:43,2,56340,IN,SHOP (Small Group),Yes,35-0472300,56340IN0010004,Lincoln Dental Connect?,56340IN001,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.03,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,56340IN0010004-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,56340,HIOS,3,2014-09-04 03:25:43,2,56340,IN,SHOP (Small Group),Yes,35-0472300,56340IN0010008,Lincoln Dental Connect?,56340IN001,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.08,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,56340IN0010008-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,57874,HIOS,2,2014-06-27 08:32:44,1,57874,IN,Individual,Yes,47-0397286,57874IN0040001,"Delta Dental Individual PPO, EHB Certified",57874IN004,,INN002,INS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.56,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,57874IN0040001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,57874,HIOS,2,2014-06-27 08:32:44,1,57874,IN,SHOP (Small Group),Yes,47-0397286,57874IN0060001,"Renaissance Group Dental PPO, EHB Certified",57874IN006,,INN001,INS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.79,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,57874IN0060001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,57874,HIOS,2,2014-06-27 08:32:44,1,57874,IN,SHOP (Small Group),Yes,47-0397286,57874IN0060002,"Renaissance Group Dental PPO, EHB Certified",57874IN006,,INN001,INS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.74,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,57874IN0060002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,57874,HIOS,2,2014-06-27 08:32:44,1,57874,IN,Individual,Yes,47-0397286,57874IN0040002,"Delta Dental Individual PPO, EHB Certified",57874IN004,,INN002,INS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.33,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,57874IN0040002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,57874,HIOS,2,2014-06-27 08:32:44,1,57874,IN,Individual,Yes,47-0397286,57874IN0050001,"Renaissance Individual Dental PPO, EHB Certified",57874IN005,,INN001,INS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.79,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,57874IN0050001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IN,57874,HIOS,2,2014-06-27 08:32:44,1,57874,IN,Individual,Yes,47-0397286,57874IN0050002,"Renaissance Individual Dental PPO, EHB Certified",57874IN005,,INN001,INS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.04,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,57874IN0050002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IN,59560,HIOS,5,2014-08-27 03:27:11,1,59560,IN,SHOP (Small Group),Yes,13-5123390,59560IN0010002,Guardian Pediatric Advantage,59560IN001,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$19.77,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,59560IN0010002-00,Standard High Off Exchange Plan,83.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,59560,HIOS,5,2014-08-27 03:27:11,1,59560,IN,SHOP (Small Group),Yes,13-5123390,59560IN0020002,Guardian Pediatric Essentials,59560IN002,,INN001,INS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$14.39,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,59560IN0020002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,59560,HIOS,5,2014-08-27 03:27:11,2,59560,IN,SHOP (Small Group),Yes,13-5123390,59560IN0040002,Guardian Family Advantage,59560IN004,,INN001,INS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.77,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,59560IN0040002-00,Standard High Off Exchange Plan,83.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,59560,HIOS,5,2014-08-27 03:27:11,2,59560,IN,SHOP (Small Group),Yes,13-5123390,59560IN0040002,Guardian Family Advantage,59560IN004,,INN001,INS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.77,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,59560IN0040002-01,Standard High On Exchange Plan,83.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,51303,HIOS,5,2014-08-08 08:53:29,2,51303,IN,SHOP (Small Group),Yes,72-0977315,51303IN0030001,AlwaysCare Small Group Dental - Adults,51303IN003,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.18,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,51303IN0030001-00,Standard High Off Exchange Plan,86.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,51303,HIOS,5,2014-08-08 08:53:29,2,51303,IN,SHOP (Small Group),Yes,72-0977315,51303IN0030002,AlwaysCare Small Group Dental - Adults,51303IN003,,INN001,INS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.54,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,51303IN0030002-00,Standard Low Off Exchange Plan,71.27%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,51303,HIOS,5,2014-08-08 08:53:29,2,51303,IN,Individual,Yes,72-0977315,51303IN0020002,AlwaysCare All-Star Family Dental Plan,51303IN002,,INN001,INS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.27,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,51303IN0020002-00,Standard Low Off Exchange Plan,71.27%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,1,54192,IN,Individual,No,32-0121856,54192IN0010003,CareSource Just4Me Healthcare with Heart,54192IN001,,INN001,INS001,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9929,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010003-00,Standard Silver Off Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,4
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,1,54192,IN,Individual,No,32-0121856,54192IN0010003,CareSource Just4Me Healthcare with Heart,54192IN001,,INN001,INS001,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9929,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010003-01,Standard Silver On Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,5
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,1,54192,IN,Individual,No,32-0121856,54192IN0010003,CareSource Just4Me Healthcare with Heart,54192IN001,,INN001,INS001,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9929,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010003-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,1,54192,IN,Individual,No,32-0121856,54192IN0010003,CareSource Just4Me Healthcare with Heart,54192IN001,,INN001,INS001,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9929,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010003-03,Limited Cost Sharing Plan Variation,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,7
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,1,54192,IN,Individual,No,32-0121856,54192IN0010003,CareSource Just4Me Healthcare with Heart,54192IN001,,INN001,INS001,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9929,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010003-04,73% AV Level Silver Plan,74.00%,0.739992797374725,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$300,$0,$150,"$2,420",$0,$0,$80,8
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,1,54192,IN,Individual,No,32-0121856,54192IN0010003,CareSource Just4Me Healthcare with Heart,54192IN001,,INN001,INS001,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9929,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010003-05,87% AV Level Silver Plan,87.90%,0.880107223987579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$0,$100,$80,9
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,1,54192,IN,Individual,No,32-0121856,54192IN0010003,CareSource Just4Me Healthcare with Heart,54192IN001,,INN001,INS001,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9929,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010003-06,94% AV Level Silver Plan,94.80%,0.942208528518677,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$200,$300,$0,$150,$200,$0,$0,$80,10
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,1,54192,IN,Individual,No,32-0121856,54192IN0010004,CareSource Just4Me  Healthcare with Heart,54192IN001,,INN002,INS002,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9929,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010004-00,Standard Silver Off Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,11
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,1,54192,IN,Individual,No,32-0121856,54192IN0010004,CareSource Just4Me  Healthcare with Heart,54192IN001,,INN002,INS002,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9929,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010004-01,Standard Silver On Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,12
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,1,54192,IN,Individual,No,32-0121856,54192IN0010004,CareSource Just4Me  Healthcare with Heart,54192IN001,,INN002,INS002,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9929,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010004-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,1,54192,IN,Individual,No,32-0121856,54192IN0010004,CareSource Just4Me  Healthcare with Heart,54192IN001,,INN002,INS002,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9929,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010004-03,Limited Cost Sharing Plan Variation,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,14
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,1,54192,IN,Individual,No,32-0121856,54192IN0010004,CareSource Just4Me  Healthcare with Heart,54192IN001,,INN002,INS002,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9929,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010004-04,73% AV Level Silver Plan,74.00%,0.739992797374725,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$300,$0,$150,"$2,420",$0,$0,$80,15
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,1,54192,IN,Individual,No,32-0121856,54192IN0010004,CareSource Just4Me  Healthcare with Heart,54192IN001,,INN002,INS002,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9929,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010004-05,87% AV Level Silver Plan,87.90%,0.880107223987579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$0,$100,$80,16
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,1,54192,IN,Individual,No,32-0121856,54192IN0010004,CareSource Just4Me  Healthcare with Heart,54192IN001,,INN002,INS002,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9929,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010004-06,94% AV Level Silver Plan,94.80%,0.942208528518677,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$200,$300,$0,$150,$200,$0,$0,$80,17
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,1,54192,IN,Individual,No,32-0121856,54192IN0010005,CareSource Just4Me Healthcare with Heart,54192IN001,,INN001,INS001,INF001,New,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010005-00,Standard Bronze Off Exchange Plan,59.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,18
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,1,54192,IN,Individual,No,32-0121856,54192IN0010005,CareSource Just4Me Healthcare with Heart,54192IN001,,INN001,INS001,INF001,New,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010005-01,Standard Bronze On Exchange Plan,59.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,19
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,1,54192,IN,Individual,No,32-0121856,54192IN0010005,CareSource Just4Me Healthcare with Heart,54192IN001,,INN001,INS001,INF001,New,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010005-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,1,54192,IN,Individual,No,32-0121856,54192IN0010005,CareSource Just4Me Healthcare with Heart,54192IN001,,INN001,INS001,INF001,New,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010005-03,Limited Cost Sharing Plan Variation,59.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,21
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,1,54192,IN,Individual,No,32-0121856,54192IN0010006,CareSource Just4Me Healthcare with Heart,54192IN001,,INN002,INS002,INF001,New,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010006-00,Standard Bronze Off Exchange Plan,59.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,22
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,1,54192,IN,Individual,No,32-0121856,54192IN0010006,CareSource Just4Me Healthcare with Heart,54192IN001,,INN002,INS002,INF001,New,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010006-01,Standard Bronze On Exchange Plan,59.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,23
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,1,54192,IN,Individual,No,32-0121856,54192IN0010006,CareSource Just4Me Healthcare with Heart,54192IN001,,INN002,INS002,INF001,New,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010006-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,24
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,1,54192,IN,Individual,No,32-0121856,54192IN0010006,CareSource Just4Me Healthcare with Heart,54192IN001,,INN002,INS002,INF001,New,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010006-03,Limited Cost Sharing Plan Variation,59.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,25
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,4,54192,IN,Individual,No,32-0121856,54192IN0010001,CareSource Just4Me Ultra Healthcare with Heart,54192IN001,,INN001,INS001,INF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9947,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010001-00,Standard Gold Off Exchange Plan,,0.815527200698853,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,4
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,4,54192,IN,Individual,No,32-0121856,54192IN0010001,CareSource Just4Me Ultra Healthcare with Heart,54192IN001,,INN001,INS001,INF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9947,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010001-01,Standard Gold On Exchange Plan,,0.815527200698853,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,5
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,4,54192,IN,Individual,No,32-0121856,54192IN0010001,CareSource Just4Me Ultra Healthcare with Heart,54192IN001,,INN001,INS001,INF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9947,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010001-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,$0,$0,$0,$0,,,$0,$0,$0,$0,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,4,54192,IN,Individual,No,32-0121856,54192IN0010001,CareSource Just4Me Ultra Healthcare with Heart,54192IN001,,INN001,INS001,INF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9947,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010001-03,Limited Cost Sharing Plan Variation,,0.815527200698853,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,7
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,4,54192,IN,Individual,No,32-0121856,54192IN0010002,CareSource Just4Me Ultra Healthcare with Heart,54192IN001,,INN002,INS002,INF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9947,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010002-00,Standard Gold Off Exchange Plan,,0.815527200698853,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,8
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,4,54192,IN,Individual,No,32-0121856,54192IN0010002,CareSource Just4Me Ultra Healthcare with Heart,54192IN001,,INN002,INS002,INF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9947,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0010002-01,Standard Gold On Exchange Plan,,0.815527200698853,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,9
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,5,54192,IN,Individual,No,32-0121856,54192IN0020002,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,54192IN002,,INN002,INS002,INF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9489,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020002-01,Standard Gold On Exchange Plan,,0.815527200698853,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,9
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,5,54192,IN,Individual,No,32-0121856,54192IN0020002,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,54192IN002,,INN002,INS002,INF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9489,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020002-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,$0,$0,$0,$0,,,$0,$0,$0,$0,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,5,54192,IN,Individual,No,32-0121856,54192IN0020002,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,54192IN002,,INN002,INS002,INF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9489,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020002-03,Limited Cost Sharing Plan Variation,,0.815527200698853,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,11
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,6,54192,IN,Individual,No,32-0121856,54192IN0020003,CareSource Just4Me Dental and Vision! Healthcare with Heart,54192IN002,,INN001,INS001,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9326,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020003-00,Standard Silver Off Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,4
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,6,54192,IN,Individual,No,32-0121856,54192IN0020003,CareSource Just4Me Dental and Vision! Healthcare with Heart,54192IN002,,INN001,INS001,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9326,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020003-01,Standard Silver On Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,5
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,6,54192,IN,Individual,No,32-0121856,54192IN0020003,CareSource Just4Me Dental and Vision! Healthcare with Heart,54192IN002,,INN001,INS001,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9326,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020003-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,6,54192,IN,Individual,No,32-0121856,54192IN0020003,CareSource Just4Me Dental and Vision! Healthcare with Heart,54192IN002,,INN001,INS001,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9326,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020003-03,Limited Cost Sharing Plan Variation,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,7
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,6,54192,IN,Individual,No,32-0121856,54192IN0020003,CareSource Just4Me Dental and Vision! Healthcare with Heart,54192IN002,,INN001,INS001,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9326,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020003-04,73% AV Level Silver Plan,74.00%,0.739992797374725,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$300,$0,$150,"$2,420",$0,$0,$80,8
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,6,54192,IN,Individual,No,32-0121856,54192IN0020003,CareSource Just4Me Dental and Vision! Healthcare with Heart,54192IN002,,INN001,INS001,INF001,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9326,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020003-05,87% AV Level Silver Plan,87.90%,0.880107223987579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$0,$100,$80,9
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,6,54192,IN,Individual,No,32-0121856,54192IN0020005,CareSource Just4Me Dental and Vision! Healthcare with Heart,54192IN002,,INN001,INS001,INF001,New,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.916,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020005-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,6,54192,IN,Individual,No,32-0121856,54192IN0020005,CareSource Just4Me Dental and Vision! Healthcare with Heart,54192IN002,,INN001,INS001,INF001,New,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.916,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020005-03,Limited Cost Sharing Plan Variation,59.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,21
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,6,54192,IN,Individual,No,32-0121856,54192IN0020006,CareSource Just4Me Dental and Vision! Healthcare with Heart,54192IN002,,INN002,INS002,INF001,New,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.916,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020006-00,Standard Bronze Off Exchange Plan,59.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,22
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,6,54192,IN,Individual,No,32-0121856,54192IN0020006,CareSource Just4Me Dental and Vision! Healthcare with Heart,54192IN002,,INN002,INS002,INF001,New,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.916,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020006-01,Standard Bronze On Exchange Plan,59.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,23
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,6,54192,IN,Individual,No,32-0121856,54192IN0020006,CareSource Just4Me Dental and Vision! Healthcare with Heart,54192IN002,,INN002,INS002,INF001,New,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.916,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020006-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,24
2015,IN,54192,HIOS,9,2014-11-15 04:52:41,6,54192,IN,Individual,No,32-0121856,54192IN0020006,CareSource Just4Me Dental and Vision! Healthcare with Heart,54192IN002,,INN002,INS002,INF001,New,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.916,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/in/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/in,www.caresource.com/just4me/meds,54192IN0020006-03,Limited Cost Sharing Plan Variation,59.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,25
2015,IN,59560,HIOS,5,2014-08-27 03:27:11,2,59560,IN,SHOP (Small Group),Yes,13-5123390,59560IN0060002,Guardian Family Essentials,59560IN006,,INN001,INS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$14.39,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,59560IN0060002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IN,59560,HIOS,5,2014-08-27 03:27:11,2,59560,IN,SHOP (Small Group),Yes,13-5123390,59560IN0060002,Guardian Family Essentials,59560IN006,,INN001,INS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$14.39,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,59560IN0060002-01,Standard Low On Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010001,MDwise Marketplace Plus Bronze,62033IN001,,INN001,INS001,INF001,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/bronze,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010001-00,Standard Bronze Off Exchange Plan,,0.618237614631653,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",35%,"$4,500","$9,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,3000,20,1500,150,3000,890,210,80,4
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010001,MDwise Marketplace Plus Bronze,62033IN001,,INN001,INS001,INF001,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/bronze,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010001-01,Standard Bronze On Exchange Plan,,0.618237614631653,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",35%,"$4,500","$9,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,3000,20,1500,150,3000,890,210,80,5
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010001,MDwise Marketplace Plus Bronze,62033IN001,,INN001,INS001,INF001,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/bronze,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010001,MDwise Marketplace Plus Bronze,62033IN001,,INN001,INS001,INF001,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/bronze,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010001-03,Limited Cost Sharing Plan Variation,,0.618237614631653,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",35%,"$4,500","$9,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,3000,20,1500,150,3000,890,210,80,7
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010002,MDwise Marketplace Plus Silver,62033IN001,,INN001,INS001,INF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/silver,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010002-00,Standard Silver Off Exchange Plan,,0.718512952327728,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500",15%,"$3,200","$9,600",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,1500,470,670,150,1500,740,150,80,8
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010002,MDwise Marketplace Plus Silver,62033IN001,,INN001,INS001,INF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/silver,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010002-01,Standard Silver On Exchange Plan,,0.718512952327728,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500",15%,"$3,200","$9,600",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,1500,470,670,150,1500,740,150,80,9
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010002,MDwise Marketplace Plus Silver,62033IN001,,INN001,INS001,INF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/silver,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010002,MDwise Marketplace Plus Silver,62033IN001,,INN001,INS001,INF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/silver,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010002-03,Limited Cost Sharing Plan Variation,,0.718512952327728,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500",15%,"$3,200","$9,600",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,1500,470,670,150,1500,740,150,80,11
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010002,MDwise Marketplace Plus Silver,62033IN001,,INN001,INS001,INF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/silver,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010002-04,73% AV Level Silver Plan,,0.738637149333954,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,150","$3,450",10%,"$3,200","$6,400",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,1150,470,450,150,1150,820,100,80,12
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010002,MDwise Marketplace Plus Silver,62033IN001,,INN001,INS001,INF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/silver,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010002-05,87% AV Level Silver Plan,,0.877289533615112,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$600,5%,"$1,500","$4,500",20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,200,320,220,150,200,740,50,80,13
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010002,MDwise Marketplace Plus Silver,62033IN001,,INN001,INS001,INF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/silver,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010002-06,94% AV Level Silver Plan,,0.948328852653503,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,$550,"$1,100","$1,500","$3,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,5%,$750,"$2,250",20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,0,220,220,150,0,360,60,80,14
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010003,MDwise Marketplace Plus Gold,62033IN001,,INN001,INS001,INF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/gold,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010003-00,Standard Gold Off Exchange Plan,,0.80497944355011,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$3,250","$6,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,500",10%,"$1,000","$3,000",25%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,500,380,450,150,500,870,100,80,15
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010003,MDwise Marketplace Plus Gold,62033IN001,,INN001,INS001,INF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/gold,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010003-01,Standard Gold On Exchange Plan,,0.80497944355011,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$3,250","$6,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,500",10%,"$1,000","$3,000",25%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,500,380,450,150,500,870,100,80,16
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010003,MDwise Marketplace Plus Gold,62033IN001,,INN001,INS001,INF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/gold,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,17
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010003,MDwise Marketplace Plus Gold,62033IN001,,INN001,INS001,INF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/gold,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010003-03,Limited Cost Sharing Plan Variation,,0.80497944355011,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$3,250","$6,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,500",10%,"$1,000","$3,000",25%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,500,380,450,150,500,870,100,80,18
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010004,MDwise Marketplace Basic Bronze,62033IN001,,INN001,INS001,INF004,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/bronze,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010004-00,Standard Bronze Off Exchange Plan,,0.583132922649384,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,"$6,000","$12,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,5500,20,540,150,5410,0,0,80,19
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010004,MDwise Marketplace Basic Bronze,62033IN001,,INN001,INS001,INF004,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/bronze,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010004-01,Standard Bronze On Exchange Plan,,0.583132922649384,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,"$6,000","$12,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,5500,20,540,150,5410,0,0,80,20
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010004,MDwise Marketplace Basic Bronze,62033IN001,,INN001,INS001,INF004,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/bronze,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,21
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010004,MDwise Marketplace Basic Bronze,62033IN001,,INN001,INS001,INF004,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/bronze,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010004-03,Limited Cost Sharing Plan Variation,,0.583132922649384,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,"$6,000","$12,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,5500,20,540,150,5410,0,0,80,22
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010005,MDwise Marketplace Basic Silver,62033IN001,,INN001,INS001,INF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/silver,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010005-00,Standard Silver Off Exchange Plan,,0.680896282196045,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$6,400","$12,800",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",15%,"$4,750","$9,500",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,2000,490,670,150,2000,690,130,80,23
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010005,MDwise Marketplace Basic Silver,62033IN001,,INN001,INS001,INF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/silver,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010005-01,Standard Silver On Exchange Plan,,0.680896282196045,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$6,400","$12,800",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",15%,"$4,750","$9,500",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,2000,490,670,150,2000,690,130,80,24
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010005,MDwise Marketplace Basic Silver,62033IN001,,INN001,INS001,INF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/silver,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,25
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010005,MDwise Marketplace Basic Silver,62033IN001,,INN001,INS001,INF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/silver,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010005-03,Limited Cost Sharing Plan Variation,,0.680896282196045,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$6,400","$12,800",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",15%,"$4,750","$9,500",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,2000,490,670,150,2000,690,130,80,26
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010005,MDwise Marketplace Basic Silver,62033IN001,,INN001,INS001,INF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/silver,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010005-04,73% AV Level Silver Plan,,0.722985029220581,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,250","$6,500",10%,"$4,000","$8,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,1500,410,450,150,1500,710,100,80,27
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010005,MDwise Marketplace Basic Silver,62033IN001,,INN001,INS001,INF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/silver,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010005-05,87% AV Level Silver Plan,,0.86127382516861,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$2,100",5%,"$1,500","$4,500",20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,700,270,220,150,700,550,50,80,28
2015,IN,62033,HIOS,7,2014-11-15 04:52:41,1,62033,IN,Individual,No,46-5270582,62033IN0010005,MDwise Marketplace Basic Silver,62033IN001,,INN001,INS001,INF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,No,,No,,No,mdwise.org/marketplace/benefits/silver,https://mdwise.softheon.com/payment,mdwise.org/marketplace,mdwise.org/marketplace/pharmacy,62033IN0010005-06,94% AV Level Silver Plan,,0.947592496871948,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,$750,"$1,500","$1,000","$2,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,5%,$750,"$2,250",20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,200,170,220,150,200,360,50,80,29
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,1,67920,IN,SHOP (Small Group),No,35-1694699,67920IN0480001,SIHO Marketplace - SHOP QHP HMO,67920IN048,,INN003,INS002,INF007,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.99977347757822,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/SummaryOfBenefits/,,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0480001-00,Standard Silver Off Exchange Plan,,0.697257518768311,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,1,67920,IN,Individual,No,35-1694699,67920IN0510001,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF010,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510001-00,Standard Bronze Off Exchange Plan,,0.601356148719788,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,1,67920,IN,Individual,No,35-1694699,67920IN0510001,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF010,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510001-01,Standard Bronze On Exchange Plan,,0.601356148719788,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,1,67920,IN,SHOP (Small Group),No,35-1694699,67920IN0480001,SIHO Marketplace - SHOP QHP HMO,67920IN048,,INN003,INS002,INF007,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.99977347757822,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/SummaryOfBenefits/,,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0480001-01,Standard Silver On Exchange Plan,,0.697257518768311,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,1,67920,IN,Individual,No,35-1694699,67920IN0510001,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF010,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,1,67920,IN,Individual,No,35-1694699,67920IN0510001,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF010,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510001-03,Limited Cost Sharing Plan Variation,,0.601356148719788,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,1,67920,IN,Individual,No,35-1694699,67920IN0510003,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF014,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510003-00,Standard Silver Off Exchange Plan,,0.700544476509094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,1,67920,IN,Individual,No,35-1694699,67920IN0510003,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF014,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510003-01,Standard Silver On Exchange Plan,,0.700544476509094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,1,67920,IN,Individual,No,35-1694699,67920IN0510003,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF014,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,1,67920,IN,Individual,No,35-1694699,67920IN0510003,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF014,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510003-03,Limited Cost Sharing Plan Variation,,0.700544476509094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,1,67920,IN,Individual,No,35-1694699,67920IN0510003,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF014,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510003-04,73% AV Level Silver Plan,,0.730297029018402,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,1,67920,IN,Individual,No,35-1694699,67920IN0510003,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF014,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510003-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,1,67920,IN,Individual,No,35-1694699,67920IN0510003,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF014,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510003-06,94% AV Level Silver Plan,,0.938836455345154,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$450,$900,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$450,$900,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,2,67920,IN,Individual,No,35-1694699,67920IN0510004,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510004-00,Standard Silver Off Exchange Plan,,0.702746450901031,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,2,67920,IN,SHOP (Small Group),No,35-1694699,67920IN0480002,SIHO Marketplace - SHOP QHP HMO,67920IN048,,INN003,INS002,INF009,New,HMO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.99977347757822,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/SummaryOfBenefits/,,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0480002-00,Standard Gold Off Exchange Plan,,0.780109941959381,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,2,67920,IN,SHOP (Small Group),No,35-1694699,67920IN0480002,SIHO Marketplace - SHOP QHP HMO,67920IN048,,INN003,INS002,INF009,New,HMO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.99977347757822,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/SummaryOfBenefits/,,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0480002-01,Standard Gold On Exchange Plan,,0.780109941959381,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,2,67920,IN,Individual,No,35-1694699,67920IN0510004,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510004-01,Standard Silver On Exchange Plan,,0.702746450901031,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,2,67920,IN,Individual,No,35-1694699,67920IN0510004,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,2,67920,IN,SHOP (Small Group),No,35-1694699,67920IN0480003,SIHO Marketplace - SHOP QHP HMO,67920IN048,,INN003,INS002,INF010,New,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.99977347757822,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/SummaryOfBenefits/,,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0480003-00,Standard Silver Off Exchange Plan,,0.685117065906525,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,2,67920,IN,SHOP (Small Group),No,35-1694699,67920IN0480003,SIHO Marketplace - SHOP QHP HMO,67920IN048,,INN003,INS002,INF010,New,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.99977347757822,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/SummaryOfBenefits/,,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0480003-01,Standard Silver On Exchange Plan,,0.685117065906525,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,2,67920,IN,Individual,No,35-1694699,67920IN0510004,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510004-03,Limited Cost Sharing Plan Variation,,0.702746450901031,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,2,67920,IN,Individual,No,35-1694699,67920IN0510004,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510004-04,73% AV Level Silver Plan,,0.731438219547272,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,2,67920,IN,Individual,No,35-1694699,67920IN0510004,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510004-05,87% AV Level Silver Plan,,0.87090265750885,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,2,67920,IN,Individual,No,35-1694699,67920IN0510004,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510004-06,94% AV Level Silver Plan,,0.936157047748566,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,2,67920,IN,Individual,No,35-1694699,67920IN0510005,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF015,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510005-00,Standard Gold Off Exchange Plan,,0.783817529678345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,2,67920,IN,Individual,No,35-1694699,67920IN0510005,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF015,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510005-01,Standard Gold On Exchange Plan,,0.783817529678345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,2,67920,IN,SHOP (Small Group),No,35-1694699,67920IN0480004,SIHO Marketplace - SHOP QHP HMO,67920IN048,,INN003,INS002,INF011,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.99977347757822,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/SummaryOfBenefits/,,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0480004-00,Standard Bronze Off Exchange Plan,,0.585966944694519,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,2,67920,IN,SHOP (Small Group),No,35-1694699,67920IN0480004,SIHO Marketplace - SHOP QHP HMO,67920IN048,,INN003,INS002,INF011,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.99977347757822,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/SummaryOfBenefits/,,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0480004-01,Standard Bronze On Exchange Plan,,0.585966944694519,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,2,67920,IN,Individual,No,35-1694699,67920IN0510005,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF015,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,2,67920,IN,Individual,No,35-1694699,67920IN0510005,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF015,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510005-03,Limited Cost Sharing Plan Variation,,0.783817529678345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,3,67920,IN,Individual,No,35-1694699,67920IN0510002,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF013,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510002-00,Standard Bronze Off Exchange Plan,,0.612183570861816,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,3,67920,IN,Individual,No,35-1694699,67920IN0510002,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF013,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510002-01,Standard Bronze On Exchange Plan,,0.612183570861816,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,3,67920,IN,Individual,No,35-1694699,67920IN0510002,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF013,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,IN,67920,HIOS,10,2015-01-16 17:32:32,3,67920,IN,Individual,No,35-1694699,67920IN0510002,SIHO Marketplace - Individual QHP HMO,67920IN051,,INN003,INS002,INF013,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9998,,,0,0,0,2015-01-01,,No,,No,,No,http://www.siho.org/Marketplace/,https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.siho.org/Marketplace/,www.caremark.com/portal/asset/SIHO_DrugList.pdf,67920IN0510002-03,Limited Cost Sharing Plan Variation,,0.612183570861816,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190014,Assurant Health Silver Plan 001,91842IN019,,INN001,INS006,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190014-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,109
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190015,Assurant Health Silver Plan 001,91842IN019,,INN001,INS007,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190015-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,110
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190015,Assurant Health Silver Plan 001,91842IN019,,INN001,INS007,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190015-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,111
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190015,Assurant Health Silver Plan 001,91842IN019,,INN001,INS007,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190015-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,112
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190033,Assurant Health Gold Plan 002,91842IN019,,INN001,INS001,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190033-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,22
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190033,Assurant Health Gold Plan 002,91842IN019,,INN001,INS001,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190033-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190034,Assurant Health Gold Plan 002,91842IN019,,INN001,INS002,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190034-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190034,Assurant Health Gold Plan 002,91842IN019,,INN001,INS002,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190034-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190034,Assurant Health Gold Plan 002,91842IN019,,INN001,INS002,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190034-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,26
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190034,Assurant Health Gold Plan 002,91842IN019,,INN001,INS002,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190034-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,LA,18802,HIOS,7,2014-11-14 05:23:27,2,18802,LA,SHOP (Small Group),Yes,94-2761537,18802LA0020004,Delta Dental PPO Preferred Plan for Families for Small Businesses,18802LA002,,LAN001,LAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.69,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/la/18802la0020004-15,,18802LA0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$35,Not Applicable,$35,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,18802,HIOS,7,2014-11-14 05:23:27,2,18802,LA,SHOP (Small Group),Yes,94-2761537,18802LA0020004,Delta Dental PPO Preferred Plan for Families for Small Businesses,18802LA002,,LAN001,LAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.69,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/la/18802la0020004-15,,18802LA0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$35,Not Applicable,$35,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,18802,HIOS,7,2014-11-14 05:23:27,2,18802,LA,Individual,Yes,94-2761537,18802LA0010004,Delta Dental PPO Preferred Plan for Families,18802LA001,,LAN001,LAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.69,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/la/18802la0010004-15,,18802LA0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$35,Not Applicable,$35,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,18802,HIOS,7,2014-11-14 05:23:27,3,18802,LA,Individual,Yes,94-2761537,18802LA0010006,Delta Dental PPO Basic Plan for Families,18802LA001,,LAN001,LAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.76,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/la/18802la0010006-15,,18802LA0010006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,18802,HIOS,7,2014-11-14 05:23:27,3,18802,LA,SHOP (Small Group),Yes,94-2761537,18802LA0020006,Delta Dental PPO Basic Plan for Families for Small Businesses,18802LA002,,LAN001,LAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.76,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/la/18802la0020006-15,,18802LA0020006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,18802,HIOS,7,2014-11-14 05:23:27,3,18802,LA,SHOP (Small Group),Yes,94-2761537,18802LA0020006,Delta Dental PPO Basic Plan for Families for Small Businesses,18802LA002,,LAN001,LAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.76,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/la/18802la0020006-15,,18802LA0020006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,69051,HIOS,2,2014-08-03 08:59:32,1,69051,IN,SHOP (Small Group),Yes,13-5581829,69051IN0110001,EHB Basic Dental Plan (Low),69051IN011,,INN001,INS001,,Existing,PPO,Low,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$15.92,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,69051IN0110001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,69051,HIOS,2,2014-08-03 08:59:32,2,69051,IN,SHOP (Small Group),Yes,13-5581829,69051IN0120001,EHB Enhanced Dental Plan (High),69051IN012,,INN002,INS001,,Existing,PPO,High,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$20.22,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,69051IN0120001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,69051,HIOS,2,2014-08-03 08:59:32,3,69051,IN,SHOP (Small Group),Yes,13-5581829,69051IN0130001,Family Basic Dental Plan (Low),69051IN013,,INN003,INS001,,Existing,PPO,Low,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$15.92,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,69051IN0130001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,69051,HIOS,2,2014-08-03 08:59:32,4,69051,IN,SHOP (Small Group),Yes,13-5581829,69051IN0140001,Family Enhanced Dental Plan (High),69051IN014,,INN004,INS001,,Existing,PPO,High,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$20.22,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,69051IN0140001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,69572,HIOS,2,2014-08-03 08:59:32,1,69572,IN,SHOP (Small Group),Yes,93-0242990,69572IN0040002,EHB High PPO,69572IN004,,INN001,INS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.98,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,69572IN0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,69572,HIOS,2,2014-08-03 08:59:32,1,69572,IN,SHOP (Small Group),Yes,93-0242990,69572IN0040001,EHB Low PPO,69572IN004,,INN001,INS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.53,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,69572IN0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,69572,HIOS,2,2014-08-03 08:59:32,1,69572,IN,SHOP (Small Group),Yes,93-0242990,69572IN0030002,EHB High Passive,69572IN003,,INN001,INS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$43.13,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,69572IN0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IN,69572,HIOS,2,2014-08-03 08:59:32,1,69572,IN,SHOP (Small Group),Yes,93-0242990,69572IN0030001,EHB Low Passive,69572IN003,,INN001,INS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.77,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,69572IN0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IN,72074,HIOS,4,2014-08-03 08:59:32,1,72074,IN,SHOP (Small Group),Yes,57-0523959,72074IN0010001,Group Pediatric Dental EHB Rider,72074IN001,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$28.92,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,72074IN0010001-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,72074,HIOS,4,2014-08-03 08:59:32,1,72074,IN,SHOP (Small Group),Yes,57-0523959,72074IN0010002,Group Pediatric Dental EHB Rider,72074IN001,,INN001,INS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$23.44,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,72074IN0010002-00,Standard Low Off Exchange Plan,68.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,79503,HIOS,8,2015-01-16 17:32:32,1,79503,IN,Individual,Yes,31-1185262,79503IN0010001,Indiana DentaTrust - PPO Pediatric High Option,79503IN001,,INN001,INS001,,New,PPO,High,,Both,,,,Please refer to the exclusions listed in the Policy for specific level exclusions.,,,,,Allows Child-Only,,,,$44.66,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,No,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,79503IN0010001-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,79503,HIOS,8,2015-01-16 17:32:32,1,79503,IN,SHOP (Small Group),Yes,31-1185262,79503IN0020003,DentaSpan - PPO Family High Option,79503IN002,,INN001,INS001,,New,PPO,High,,Both,,,,Please refer to the exclusions listed in the Policy for specific level exclusions.,,,,,Allows Adult and Child-Only,,,,$38.21,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,No,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,79503IN0020003-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,79503,HIOS,8,2015-01-16 17:32:32,1,79503,IN,SHOP (Small Group),Yes,31-1185262,79503IN0020003,DentaSpan - PPO Family High Option,79503IN002,,INN001,INS001,,New,PPO,High,,Both,,,,Please refer to the exclusions listed in the Policy for specific level exclusions.,,,,,Allows Adult and Child-Only,,,,$38.21,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,No,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,79503IN0020003-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,79503,HIOS,8,2015-01-16 17:32:32,1,79503,IN,Individual,Yes,31-1185262,79503IN0010001,Indiana DentaTrust - PPO Pediatric High Option,79503IN001,,INN001,INS001,,New,PPO,High,,Both,,,,Please refer to the exclusions listed in the Policy for specific level exclusions.,,,,,Allows Child-Only,,,,$44.66,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,No,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,79503IN0010001-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,79503,HIOS,8,2015-01-16 17:32:32,1,79503,IN,Individual,Yes,31-1185262,79503IN0010002,Indiana DentaTrust - PPO Pediatric Low Option,79503IN001,,INN001,INS001,,New,PPO,Low,,Both,,,,Please refer to the exclusions listed in the Policy for specific level exclusions.,,,,,Allows Child-Only,,,,$39.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,No,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,79503IN0010002-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IN,79503,HIOS,8,2015-01-16 17:32:32,1,79503,IN,SHOP (Small Group),Yes,31-1185262,79503IN0020004,DentaSpan - PPO Family Low Option,79503IN002,,INN001,INS001,,New,PPO,Low,,Both,,,,Please refer to the exclusions listed in the Policy for specific level exclusions.,,,,,Allows Adult and Child-Only,,,,$33.52,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,No,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,79503IN0020004-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IN,79503,HIOS,8,2015-01-16 17:32:32,1,79503,IN,SHOP (Small Group),Yes,31-1185262,79503IN0020004,DentaSpan - PPO Family Low Option,79503IN002,,INN001,INS001,,New,PPO,Low,,Both,,,,Please refer to the exclusions listed in the Policy for specific level exclusions.,,,,,Allows Adult and Child-Only,,,,$33.52,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,No,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,79503IN0020004-01,Standard Low On Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IN,79503,HIOS,8,2015-01-16 17:32:32,1,79503,IN,Individual,Yes,31-1185262,79503IN0010002,Indiana DentaTrust - PPO Pediatric Low Option,79503IN001,,INN001,INS001,,New,PPO,Low,,Both,,,,Please refer to the exclusions listed in the Policy for specific level exclusions.,,,,,Allows Child-Only,,,,$39.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,No,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,79503IN0010002-01,Standard Low On Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IN,79503,HIOS,8,2015-01-16 17:32:32,2,79503,IN,Individual,Yes,31-1185262,79503IN0010003,Indiana DentaTrust - PPO Family High Option,79503IN001,,INN001,INS001,,New,PPO,High,,Both,,,,Please refer to the exclusions listed in the Policy for specific level exclusions.,,,,,Allows Adult and Child-Only,,,,$36.67,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,No,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,79503IN0010003-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,79503,HIOS,8,2015-01-16 17:32:32,2,79503,IN,Individual,Yes,31-1185262,79503IN0010003,Indiana DentaTrust - PPO Family High Option,79503IN001,,INN001,INS001,,New,PPO,High,,Both,,,,Please refer to the exclusions listed in the Policy for specific level exclusions.,,,,,Allows Adult and Child-Only,,,,$36.67,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,No,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,79503IN0010003-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,79503,HIOS,8,2015-01-16 17:32:32,2,79503,IN,Individual,Yes,31-1185262,79503IN0010004,Indiana DentaTrust - PPO Family Low Option,79503IN001,,INN001,INS001,,New,PPO,Low,,Both,,,,Please refer to the exclusions listed in the Policy for specific level exclusions.,,,,,Allows Adult and Child-Only,,,,$30.17,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,No,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,79503IN0010004-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IN,79503,HIOS,8,2015-01-16 17:32:32,2,79503,IN,Individual,Yes,31-1185262,79503IN0010004,Indiana DentaTrust - PPO Family Low Option,79503IN001,,INN001,INS001,,New,PPO,Low,,Both,,,,Please refer to the exclusions listed in the Policy for specific level exclusions.,,,,,Allows Adult and Child-Only,,,,$30.17,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,No,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,79503IN0010004-01,Standard Low On Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,1,83557,IN,SHOP (Small Group),Yes,95-6042390,83557IN0010001,BEST Life Child Dental Plus,83557IN001,,INN001,INS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$32.81,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BEST_Life_Child_Dental_Plus_Plan.pdf,,83557IN0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,1,83557,IN,Individual,Yes,95-6042390,83557IN0020001,BESTOne Child Dental Plus,83557IN002,,INN001,INS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$41.01,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BESTOne_Child_Dental_Plus_Plan.pdf,,83557IN0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,2,83557,IN,Individual,Yes,95-6042390,83557IN0020002,BESTOne Child Dental,83557IN002,,INN001,INS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$31.74,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BESTOne_Child_Dental_Plan.pdf,,83557IN0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,2,83557,IN,SHOP (Small Group),Yes,95-6042390,83557IN0010002,BEST Life Child Dental,83557IN001,,INN001,INS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.40,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BEST_Life_Child_Dental_Plan.pdf,,83557IN0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,3,83557,IN,SHOP (Small Group),Yes,95-6042390,83557IN0010007,BEST Dental Premium,83557IN001,,INN001,INS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.81,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BESTDental_Premium_Plan.pdf,,83557IN0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,3,83557,IN,Individual,Yes,95-6042390,83557IN0020003,BESTOne Dental Advantage-Gold,83557IN002,,INN001,INS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$41.01,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BESTOne_Dental_Advantage-Gold_Plan.pdf,,83557IN0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,3,83557,IN,Individual,Yes,95-6042390,83557IN0020003,BESTOne Dental Advantage-Gold,83557IN002,,INN001,INS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$41.01,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BESTOne_Dental_Advantage-Gold_Plan.pdf,,83557IN0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,3,83557,IN,SHOP (Small Group),Yes,95-6042390,83557IN0010007,BEST Dental Premium,83557IN001,,INN001,INS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.81,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BESTDental_Premium_Plan.pdf,,83557IN0010007-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,3,83557,IN,SHOP (Small Group),Yes,95-6042390,83557IN0010008,BEST Dental Standard-H,83557IN001,,INN001,INS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.81,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BESTDental_Standard-H_Plan.pdf,,83557IN0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,3,83557,IN,Individual,Yes,95-6042390,83557IN0020004,BESTOne Dental Plus-Gold,83557IN002,,INN001,INS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$41.01,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BESTOne_Dental_Plus-Gold_Plan.pdf,,83557IN0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,3,83557,IN,Individual,Yes,95-6042390,83557IN0020004,BESTOne Dental Plus-Gold,83557IN002,,INN001,INS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$41.01,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BESTOne_Dental_Plus-Gold_Plan.pdf,,83557IN0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,3,83557,IN,SHOP (Small Group),Yes,95-6042390,83557IN0010008,BEST Dental Standard-H,83557IN001,,INN001,INS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.81,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BESTDental_Standard-H_Plan.pdf,,83557IN0010008-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,3,83557,IN,SHOP (Small Group),Yes,95-6042390,83557IN0010010,BEST Dental Choice-H,83557IN001,,INN001,INS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.81,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BESTDental_Choice-H_Plan.pdf,,83557IN0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,3,83557,IN,SHOP (Small Group),Yes,95-6042390,83557IN0010010,BEST Dental Choice-H,83557IN001,,INN001,INS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.81,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BESTDental_Choice-H_Plan.pdf,,83557IN0010010-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,4,83557,IN,SHOP (Small Group),Yes,95-6042390,83557IN0010009,BEST Dental Standard-L,83557IN001,,INN001,INS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.40,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BESTDental_Standard-L_Plan.pdf,,83557IN0010009-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,4,83557,IN,Individual,Yes,95-6042390,83557IN0020005,BESTOne Dental Plus-Silver,83557IN002,,INN001,INS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.74,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BESTOne_Dental_Plus-Silver_Plan.pdf,,83557IN0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,4,83557,IN,Individual,Yes,95-6042390,83557IN0020005,BESTOne Dental Plus-Silver,83557IN002,,INN001,INS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.74,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BESTOne_Dental_Plus-Silver_Plan.pdf,,83557IN0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,4,83557,IN,SHOP (Small Group),Yes,95-6042390,83557IN0010009,BEST Dental Standard-L,83557IN001,,INN001,INS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.40,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BESTDental_Standard-L_Plan.pdf,,83557IN0010009-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,4,83557,IN,SHOP (Small Group),Yes,95-6042390,83557IN0010011,BEST Dental Choice-L,83557IN001,,INN001,INS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.40,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BESTDental_Choice-L_Plan.pdf,,83557IN0010011-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,4,83557,IN,Individual,Yes,95-6042390,83557IN0020006,BESTOne Dental Basic-Silver,83557IN002,,INN001,INS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.74,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BESTOne_Dental_Basic-Silver_Plan.pdf,,83557IN0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,4,83557,IN,Individual,Yes,95-6042390,83557IN0020006,BESTOne Dental Basic-Silver,83557IN002,,INN001,INS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.74,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BESTOne_Dental_Basic-Silver_Plan.pdf,,83557IN0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,4,83557,IN,SHOP (Small Group),Yes,95-6042390,83557IN0010011,BEST Dental Choice-L,83557IN001,,INN001,INS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.40,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BESTDental_Choice-L_Plan.pdf,,83557IN0010011-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,4,83557,IN,SHOP (Small Group),Yes,95-6042390,83557IN0010012,BEST Dental Value,83557IN001,,INN001,INS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.40,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BESTDental_Value_Plan.pdf,,83557IN0010012-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,IN,83557,HIOS,5,2014-09-03 04:28:59,4,83557,IN,SHOP (Small Group),Yes,95-6042390,83557IN0010012,BEST Dental Value,83557IN001,,INN001,INS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.40,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IN/2015/IN_BESTDental_Value_Plan.pdf,,83557IN0010012-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,IN,87417,HIOS,9,2015-01-16 17:32:32,1,87417,IN,Individual,Yes,36-3757528,87417IN0010001,TruAssure Dental Basic Plan,87417IN001,,INN001,INS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.90,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=IN,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=IN,,87417IN0010001-00,Standard Low Off Exchange Plan,68.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,87417,HIOS,9,2015-01-16 17:32:32,1,87417,IN,SHOP (Small Group),Yes,36-3757528,87417IN0040001,TruAssure Dental Small Group Basic Plan,87417IN004,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.98,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=IN,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=IN,,87417IN0040001-00,Standard High Off Exchange Plan,83.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,87417,HIOS,9,2015-01-16 17:32:32,1,87417,IN,SHOP (Small Group),Yes,36-3757528,87417IN0030001,TruAssure Dental Small Group Preferred Plan,87417IN003,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.98,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=IN,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=IN,,87417IN0030001-00,Standard High Off Exchange Plan,83.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,87417,HIOS,9,2015-01-16 17:32:32,1,87417,IN,Individual,Yes,36-3757528,87417IN0010001,TruAssure Dental Basic Plan,87417IN001,,INN001,INS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.90,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=IN,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=IN,,87417IN0010001-01,Standard Low On Exchange Plan,68.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,87417,HIOS,9,2015-01-16 17:32:32,2,87417,IN,Individual,Yes,36-3757528,87417IN0020001,TruAssure Dental Preferred Plan,87417IN002,,INN001,INS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.16,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=IN,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=IN,,87417IN0020001-00,Standard High Off Exchange Plan,83.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$30,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,87417,HIOS,9,2015-01-16 17:32:32,2,87417,IN,Individual,Yes,36-3757528,87417IN0020001,TruAssure Dental Preferred Plan,87417IN002,,INN001,INS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.16,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=IN,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=IN,,87417IN0020001-01,Standard High On Exchange Plan,83.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$30,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,90613,HIOS,2,2014-08-05 13:28:44,1,90613,IN,SHOP (Small Group),Yes,36-0883760,90613IN0040002,EHB High PPO,90613IN004,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.86,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,90613IN0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,90613,HIOS,2,2014-08-05 13:28:44,1,90613,IN,SHOP (Small Group),Yes,36-0883760,90613IN0040001,EHB Low PPO,90613IN004,,INN001,INS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.47,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,90613IN0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190004,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS004,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190004-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190005,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS005,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190005-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190005,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS005,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190005-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190005,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS005,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,38
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190012,Assurant Health Silver Plan 001,91842IN019,,INN001,INS004,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190012-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,89
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190012,Assurant Health Silver Plan 001,91842IN019,,INN001,INS004,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190012-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,90
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190012,Assurant Health Silver Plan 001,91842IN019,,INN001,INS004,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,91
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190012,Assurant Health Silver Plan 001,91842IN019,,INN001,INS004,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190012-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,92
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190016,Assurant Health Silver Plan 001,91842IN019,,INN001,INS008,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,119
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190016,Assurant Health Silver Plan 001,91842IN019,,INN001,INS008,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190016-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,120
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190016,Assurant Health Silver Plan 001,91842IN019,,INN001,INS008,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190016-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,121
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190016,Assurant Health Silver Plan 001,91842IN019,,INN001,INS008,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190016-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,122
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190016,Assurant Health Silver Plan 001,91842IN019,,INN001,INS008,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190016-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,123
2015,IN,90613,HIOS,2,2014-08-05 13:28:44,1,90613,IN,SHOP (Small Group),Yes,36-0883760,90613IN0030002,EHB High Passive,90613IN003,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$43.00,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,90613IN0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IN,90613,HIOS,2,2014-08-05 13:28:44,1,90613,IN,SHOP (Small Group),Yes,36-0883760,90613IN0030001,EHB Low Passive,90613IN003,,INN001,INS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.69,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,90613IN0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190014,Assurant Health Silver Plan 001,91842IN019,,INN001,INS006,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190014-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,103
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190013,Assurant Health Silver Plan 001,91842IN019,,INN001,INS005,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190013-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,101
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190013,Assurant Health Silver Plan 001,91842IN019,,INN001,INS005,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190013-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,102
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190014,Assurant Health Silver Plan 001,91842IN019,,INN001,INS006,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190014-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,107
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190014,Assurant Health Silver Plan 001,91842IN019,,INN001,INS006,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190014-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,108
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190029,Assurant Health Silver Plan 002,91842IN019,,INN001,INS005,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190029-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,54
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190030,Assurant Health Silver Plan 002,91842IN019,,INN001,INS006,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190030-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,55
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190030,Assurant Health Silver Plan 002,91842IN019,,INN001,INS006,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190030-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190030,Assurant Health Silver Plan 002,91842IN019,,INN001,INS006,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190030-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,57
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190014,Assurant Health Silver Plan 001,91842IN019,,INN001,INS006,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,105
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190014,Assurant Health Silver Plan 001,91842IN019,,INN001,INS006,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190014-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,106
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190014,Assurant Health Silver Plan 001,91842IN019,,INN001,INS006,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190014-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,104
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190001,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS001,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190001-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190001,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS001,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190001-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190001,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS001,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,22
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190001,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS001,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190001-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190002,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS002,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190002-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190002,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS002,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190002-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190002,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS002,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,26
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190002,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS002,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190002-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190003,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS003,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190003-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190003,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS003,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190003-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190003,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS003,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,30
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190003,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS003,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190003-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190004,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS004,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190004-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190004,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS004,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190004-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190004,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS004,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,34
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190005,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS005,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190005-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190006,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS006,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190006-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190006,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS006,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190006-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190006,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS006,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,42
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190006,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS006,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190006-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,43
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190007,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS007,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190007-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190007,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS007,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190007-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190007,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS007,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,46
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190007,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS007,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190007-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,47
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190008,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS008,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190008-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190008,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS008,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190008-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190008,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS008,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,50
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190008,Assurant Health Bronze Plan 001,91842IN019,,INN001,INS008,INF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190008-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,51
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190009,Assurant Health Silver Plan 001,91842IN019,,INN001,INS001,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190009-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,68
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190009,Assurant Health Silver Plan 001,91842IN019,,INN001,INS001,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190009-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,69
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190009,Assurant Health Silver Plan 001,91842IN019,,INN001,INS001,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,70
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190009,Assurant Health Silver Plan 001,91842IN019,,INN001,INS001,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190009-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,71
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190009,Assurant Health Silver Plan 001,91842IN019,,INN001,INS001,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190009-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,72
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190009,Assurant Health Silver Plan 001,91842IN019,,INN001,INS001,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190009-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,73
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190009,Assurant Health Silver Plan 001,91842IN019,,INN001,INS001,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190009-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,74
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190010,Assurant Health Silver Plan 001,91842IN019,,INN001,INS002,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190010-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,75
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190010,Assurant Health Silver Plan 001,91842IN019,,INN001,INS002,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190010-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,76
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190010,Assurant Health Silver Plan 001,91842IN019,,INN001,INS002,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,77
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190010,Assurant Health Silver Plan 001,91842IN019,,INN001,INS002,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190010-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,78
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190010,Assurant Health Silver Plan 001,91842IN019,,INN001,INS002,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190010-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,79
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190010,Assurant Health Silver Plan 001,91842IN019,,INN001,INS002,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190010-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,80
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190010,Assurant Health Silver Plan 001,91842IN019,,INN001,INS002,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190010-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,81
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190011,Assurant Health Silver Plan 001,91842IN019,,INN001,INS003,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190011-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,82
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190011,Assurant Health Silver Plan 001,91842IN019,,INN001,INS003,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190011-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,83
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190011,Assurant Health Silver Plan 001,91842IN019,,INN001,INS003,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,84
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190011,Assurant Health Silver Plan 001,91842IN019,,INN001,INS003,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190011-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,85
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190011,Assurant Health Silver Plan 001,91842IN019,,INN001,INS003,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190011-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,86
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190011,Assurant Health Silver Plan 001,91842IN019,,INN001,INS003,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190011-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,87
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190011,Assurant Health Silver Plan 001,91842IN019,,INN001,INS003,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190011-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,88
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190012,Assurant Health Silver Plan 001,91842IN019,,INN001,INS004,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190012-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,93
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190012,Assurant Health Silver Plan 001,91842IN019,,INN001,INS004,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190012-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,94
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190012,Assurant Health Silver Plan 001,91842IN019,,INN001,INS004,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190012-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,95
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190013,Assurant Health Silver Plan 001,91842IN019,,INN001,INS005,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190013-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,96
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190013,Assurant Health Silver Plan 001,91842IN019,,INN001,INS005,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190013-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,97
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190013,Assurant Health Silver Plan 001,91842IN019,,INN001,INS005,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,98
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190013,Assurant Health Silver Plan 001,91842IN019,,INN001,INS005,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190013-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,99
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190013,Assurant Health Silver Plan 001,91842IN019,,INN001,INS005,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190013-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,100
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190021,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS005,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190021-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,38
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190021,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS005,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190021-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190022,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS006,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190022-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190022,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS006,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190022-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190022,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS006,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190022-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,42
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190022,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS006,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190022-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,43
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190031,Assurant Health Silver Plan 002,91842IN019,,INN001,INS007,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190031-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,64
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190031,Assurant Health Silver Plan 002,91842IN019,,INN001,INS007,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190031-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,65
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190036,Assurant Health Gold Plan 002,91842IN019,,INN001,INS004,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190036-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190037,Assurant Health Gold Plan 002,91842IN019,,INN001,INS005,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190037-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190046,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS006,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190046-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,89
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190046,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS006,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190046-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,90
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190024,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS008,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190024-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,50
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190024,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS008,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190024-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,51
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190031,Assurant Health Silver Plan 002,91842IN019,,INN001,INS007,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190031-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,68
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190032,Assurant Health Silver Plan 002,91842IN019,,INN001,INS008,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190032-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,69
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190032,Assurant Health Silver Plan 002,91842IN019,,INN001,INS008,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190032-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,70
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190032,Assurant Health Silver Plan 002,91842IN019,,INN001,INS008,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190032-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,71
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190037,Assurant Health Gold Plan 002,91842IN019,,INN001,INS005,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190037-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190037,Assurant Health Gold Plan 002,91842IN019,,INN001,INS005,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190037-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,38
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190015,Assurant Health Silver Plan 001,91842IN019,,INN001,INS007,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190015-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,113
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190015,Assurant Health Silver Plan 001,91842IN019,,INN001,INS007,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190015-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,114
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190015,Assurant Health Silver Plan 001,91842IN019,,INN001,INS007,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190015-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,115
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190015,Assurant Health Silver Plan 001,91842IN019,,INN001,INS007,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190015-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,116
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190016,Assurant Health Silver Plan 001,91842IN019,,INN001,INS008,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190016-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,117
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,1,91842,IN,Individual,No,39-0658730,91842IN0190016,Assurant Health Silver Plan 001,91842IN019,,INN001,INS008,INF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190016-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,118
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190017,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS001,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190017-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190017,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS001,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190017-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190017,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS001,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190017-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,22
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190017,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS001,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190017-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190018,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS002,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190018-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190018,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS002,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190018-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190018,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS002,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190018-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,26
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190018,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS002,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190018-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190035,Assurant Health Gold Plan 002,91842IN019,,INN001,INS003,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190035-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190036,Assurant Health Gold Plan 002,91842IN019,,INN001,INS004,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190036-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190045,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS005,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190045-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,87
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190046,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS006,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190046-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,88
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190043,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS003,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190043-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,77
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190043,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS003,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190043-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,78
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190043,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS003,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190043-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,79
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190044,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS004,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190044-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,80
2015,IN,97975,HIOS,2,2014-08-03 08:59:32,1,97975,IN,SHOP (Small Group),Yes,47-0098400,97975IN0040002,EHB High PPO,97975IN004,,INN001,INS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.31,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,97975IN0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,97975,HIOS,2,2014-08-03 08:59:32,1,97975,IN,SHOP (Small Group),Yes,47-0098400,97975IN0040001,EHB Low PPO,97975IN004,,INN001,INS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.19,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,97975IN0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,97975,HIOS,2,2014-08-03 08:59:32,1,97975,IN,SHOP (Small Group),Yes,47-0098400,97975IN0030002,EHB High Passive,97975IN003,,INN001,INS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$42.41,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,97975IN0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0230002,Community Blue copay 80/60,19636LA023,,LAN007,LAS006,LAF002,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230002-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-communityblue-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0230002-00,Standard Gold Off Exchange Plan,79.43%,0.77738881111145,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,000","$3,000",20%,,,,"$5,000","$15,000","$6,000","$18,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$1,023",$60,$694,$150,"$1,500",$245,$54,$79,22
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0230002,Community Blue copay 80/60,19636LA023,,LAN007,LAS006,LAF002,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230002-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-communityblue-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0230002-01,Standard Gold On Exchange Plan,79.43%,0.77738881111145,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,000","$3,000",20%,,,,"$5,000","$15,000","$6,000","$18,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$1,023",$60,$694,$150,"$1,500",$245,$54,$79,23
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190019,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS003,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190019-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190019,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS003,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190019-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190019,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS003,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190019-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,30
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190019,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS003,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190019-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190020,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS004,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190020-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190020,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS004,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190020-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190020,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS004,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190020-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,34
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190020,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS004,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190020-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190021,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS005,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190021-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190021,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS005,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190021-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190023,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS007,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190023-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190023,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS007,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190023-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190023,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS007,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190023-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,46
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190023,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS007,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190023-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,47
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190024,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS008,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190024-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,6,91842,IN,Individual,No,39-0658730,91842IN0190024,Assurant Health Bronze Plan 002,91842IN019,,INN001,INS008,INF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,91842IN0190024-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190025,Assurant Health Silver Plan 002,91842IN019,,INN001,INS001,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190025-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190025,Assurant Health Silver Plan 002,91842IN019,,INN001,INS001,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190025-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190025,Assurant Health Silver Plan 002,91842IN019,,INN001,INS001,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190025-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,22
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190025,Assurant Health Silver Plan 002,91842IN019,,INN001,INS001,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190025-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190025,Assurant Health Silver Plan 002,91842IN019,,INN001,INS001,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190025-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190025,Assurant Health Silver Plan 002,91842IN019,,INN001,INS001,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190025-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190025,Assurant Health Silver Plan 002,91842IN019,,INN001,INS001,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190025-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190026,Assurant Health Silver Plan 002,91842IN019,,INN001,INS002,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190026-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190026,Assurant Health Silver Plan 002,91842IN019,,INN001,INS002,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190026-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190026,Assurant Health Silver Plan 002,91842IN019,,INN001,INS002,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190026-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,29
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190026,Assurant Health Silver Plan 002,91842IN019,,INN001,INS002,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190026-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190026,Assurant Health Silver Plan 002,91842IN019,,INN001,INS002,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190026-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190026,Assurant Health Silver Plan 002,91842IN019,,INN001,INS002,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190026-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190026,Assurant Health Silver Plan 002,91842IN019,,INN001,INS002,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190026-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190027,Assurant Health Silver Plan 002,91842IN019,,INN001,INS003,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190027-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190027,Assurant Health Silver Plan 002,91842IN019,,INN001,INS003,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190027-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190027,Assurant Health Silver Plan 002,91842IN019,,INN001,INS003,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190027-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,36
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190027,Assurant Health Silver Plan 002,91842IN019,,INN001,INS003,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190027-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190027,Assurant Health Silver Plan 002,91842IN019,,INN001,INS003,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190027-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190027,Assurant Health Silver Plan 002,91842IN019,,INN001,INS003,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190027-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190027,Assurant Health Silver Plan 002,91842IN019,,INN001,INS003,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190027-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190028,Assurant Health Silver Plan 002,91842IN019,,INN001,INS004,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190028-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190028,Assurant Health Silver Plan 002,91842IN019,,INN001,INS004,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190028-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,42
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190028,Assurant Health Silver Plan 002,91842IN019,,INN001,INS004,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190028-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,43
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190028,Assurant Health Silver Plan 002,91842IN019,,INN001,INS004,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190028-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190028,Assurant Health Silver Plan 002,91842IN019,,INN001,INS004,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190028-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190028,Assurant Health Silver Plan 002,91842IN019,,INN001,INS004,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190028-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,46
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190028,Assurant Health Silver Plan 002,91842IN019,,INN001,INS004,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190028-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,47
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190029,Assurant Health Silver Plan 002,91842IN019,,INN001,INS005,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190029-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190029,Assurant Health Silver Plan 002,91842IN019,,INN001,INS005,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190029-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190029,Assurant Health Silver Plan 002,91842IN019,,INN001,INS005,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190029-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,50
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190029,Assurant Health Silver Plan 002,91842IN019,,INN001,INS005,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190029-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,51
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190029,Assurant Health Silver Plan 002,91842IN019,,INN001,INS005,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190029-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,52
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190029,Assurant Health Silver Plan 002,91842IN019,,INN001,INS005,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190029-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,53
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190030,Assurant Health Silver Plan 002,91842IN019,,INN001,INS006,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190030-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,58
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190030,Assurant Health Silver Plan 002,91842IN019,,INN001,INS006,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190030-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,59
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190030,Assurant Health Silver Plan 002,91842IN019,,INN001,INS006,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190030-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,60
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190030,Assurant Health Silver Plan 002,91842IN019,,INN001,INS006,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190030-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,61
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190031,Assurant Health Silver Plan 002,91842IN019,,INN001,INS007,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190031-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,62
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190031,Assurant Health Silver Plan 002,91842IN019,,INN001,INS007,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190031-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,63
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190031,Assurant Health Silver Plan 002,91842IN019,,INN001,INS007,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190031-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,66
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190031,Assurant Health Silver Plan 002,91842IN019,,INN001,INS007,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190031-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,67
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190032,Assurant Health Silver Plan 002,91842IN019,,INN001,INS008,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190032-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,72
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190032,Assurant Health Silver Plan 002,91842IN019,,INN001,INS008,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190032-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,73
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190032,Assurant Health Silver Plan 002,91842IN019,,INN001,INS008,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190032-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,74
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,8,91842,IN,Individual,No,39-0658730,91842IN0190032,Assurant Health Silver Plan 002,91842IN019,,INN001,INS008,INF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190032-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,75
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190033,Assurant Health Gold Plan 002,91842IN019,,INN001,INS001,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190033-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190033,Assurant Health Gold Plan 002,91842IN019,,INN001,INS001,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190033-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190035,Assurant Health Gold Plan 002,91842IN019,,INN001,INS003,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190035-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190035,Assurant Health Gold Plan 002,91842IN019,,INN001,INS003,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190035-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190035,Assurant Health Gold Plan 002,91842IN019,,INN001,INS003,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190035-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,30
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190046,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS006,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190046-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,91
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190047,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS007,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190047-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,92
2015,LA,18575,HIOS,2,2014-08-08 08:53:29,1,18575,LA,SHOP (Small Group),Yes,72-0977315,18575LA0080001,AlwaysCare Small Group - Child,18575LA008,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.09,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,18575LA0080001-00,Standard High Off Exchange Plan,86.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,18575,HIOS,2,2014-08-08 08:53:29,1,18575,LA,Individual,Yes,72-0977315,18575LA0050001,AlwaysCare All-Star Kids Dental Plan 2015,18575LA005,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$22.15,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,18575LA0050001-00,Standard High Off Exchange Plan,86.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,18575,HIOS,2,2014-08-08 08:53:29,1,18575,LA,Individual,Yes,72-0977315,18575LA0050002,AlwaysCare All-Star Kids Dental Plan 2015,18575LA005,,LAN001,LAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$18.11,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,18575LA0050002-00,Standard Low Off Exchange Plan,71.27%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0230003,Community Blue copay 70/50 $3000,19636LA023,,LAN007,LAS006,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-communityblue-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0230003-00,Standard Silver Off Exchange Plan,69.67%,0.696720123291016,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$9,000",30%,,,,"$6,000","$18,000","$9,000","$27,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$3,023",$60,$441,$150,"$1,772",$524,$0,$79,26
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0230003,Community Blue copay 70/50 $3000,19636LA023,,LAN007,LAS006,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-communityblue-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0230003-01,Standard Silver On Exchange Plan,69.67%,0.696720123291016,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$9,000",30%,,,,"$6,000","$18,000","$9,000","$27,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$3,023",$60,$441,$150,"$1,772",$524,$0,$79,27
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0230003,Community Blue copay 70/50 $3000,19636LA023,,LAN007,LAS006,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-communityblue-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0230003-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$79,28
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0230003,Community Blue copay 70/50 $3000,19636LA023,,LAN007,LAS006,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-communityblue-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0230003-03,Limited Cost Sharing Plan Variation,69.67%,0.696720123291016,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$9,000",30%,,,,"$6,000","$18,000","$9,000","$27,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$3,023",$60,$441,$150,"$1,772",$524,$0,$79,29
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0230003,Community Blue copay 70/50 $3000,19636LA023,,LAN007,LAS006,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-communityblue-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0230003-04,73% AV Level Silver Plan,73.56%,0.735635995864868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$12,700","$25,400","$17,500","$35,000","$3,000","$9,000",30%,,,,"$6,000","$18,000","$9,000","$27,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$3,023",$60,$441,$150,"$1,772",$524,$0,$79,30
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0230003,Community Blue copay 70/50 $3000,19636LA023,,LAN007,LAS006,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-communityblue-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0230003-05,87% AV Level Silver Plan,86.06%,0.860587000846863,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,700","$25,400","$14,850","$29,700",$750,"$2,250",5%,,,,"$6,000","$18,000","$6,750","$20,250",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,$773,$35,$186,$150,"$1,250",$245,$26,$79,31
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190036,Assurant Health Gold Plan 002,91842IN019,,INN001,INS004,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190036-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190036,Assurant Health Gold Plan 002,91842IN019,,INN001,INS004,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190036-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,34
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190037,Assurant Health Gold Plan 002,91842IN019,,INN001,INS005,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190037-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190038,Assurant Health Gold Plan 002,91842IN019,,INN001,INS006,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190038-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190038,Assurant Health Gold Plan 002,91842IN019,,INN001,INS006,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190038-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190038,Assurant Health Gold Plan 002,91842IN019,,INN001,INS006,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190038-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,42
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190038,Assurant Health Gold Plan 002,91842IN019,,INN001,INS006,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190038-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,43
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190039,Assurant Health Gold Plan 002,91842IN019,,INN001,INS007,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190039-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190039,Assurant Health Gold Plan 002,91842IN019,,INN001,INS007,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190039-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190039,Assurant Health Gold Plan 002,91842IN019,,INN001,INS007,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190039-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,46
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190039,Assurant Health Gold Plan 002,91842IN019,,INN001,INS007,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190039-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,47
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190040,Assurant Health Gold Plan 002,91842IN019,,INN001,INS008,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190040-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190040,Assurant Health Gold Plan 002,91842IN019,,INN001,INS008,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190040-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190040,Assurant Health Gold Plan 002,91842IN019,,INN001,INS008,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190040-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,50
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190040,Assurant Health Gold Plan 002,91842IN019,,INN001,INS008,INF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190040-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,51
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190041,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS001,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190041-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,68
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190041,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS001,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190041-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,69
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190041,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS001,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190041-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,70
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190041,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS001,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190041-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,71
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190042,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS002,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190042-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,72
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190042,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS002,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190042-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,73
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190042,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS002,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190042-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,74
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190042,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS002,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190042-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,75
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190043,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS003,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190043-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,76
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190044,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS004,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190044-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,81
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190044,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS004,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190044-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,82
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190044,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS004,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190044-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,83
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190045,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS005,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190045-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,84
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190045,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS005,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190045-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,85
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190045,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS005,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190045-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,86
2015,LA,18802,HIOS,7,2014-11-14 05:23:27,1,18802,LA,Individual,Yes,94-2761537,18802LA0010001,Delta Dental PPO Pediatric Basic Plan,18802LA001,,LAN001,LAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$19.76,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/la/18802la0010001-15,,18802LA0010001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,LA,18802,HIOS,7,2014-11-14 05:23:27,1,18802,LA,SHOP (Small Group),Yes,94-2761537,18802LA0020001,Delta Dental PPO Pediatric Basic Plan for Small Businesses,18802LA002,,LAN001,LAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.76,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/la/18802la0020001-15,,18802LA0020001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,LA,18802,HIOS,7,2014-11-14 05:23:27,1,18802,LA,SHOP (Small Group),Yes,94-2761537,18802LA0020001,Delta Dental PPO Pediatric Basic Plan for Small Businesses,18802LA002,,LAN001,LAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.76,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/la/18802la0020001-15,,18802LA0020001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,LA,18802,HIOS,7,2014-11-14 05:23:27,1,18802,LA,Individual,Yes,94-2761537,18802LA0010001,Delta Dental PPO Pediatric Basic Plan,18802LA001,,LAN001,LAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$19.76,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/la/18802la0010001-15,,18802LA0010001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,LA,18802,HIOS,7,2014-11-14 05:23:27,2,18802,LA,Individual,Yes,94-2761537,18802LA0010004,Delta Dental PPO Preferred Plan for Families,18802LA001,,LAN001,LAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.69,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/la/18802la0010004-15,,18802LA0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$35,Not Applicable,$35,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,18802,HIOS,7,2014-11-14 05:23:27,3,18802,LA,Individual,Yes,94-2761537,18802LA0010006,Delta Dental PPO Basic Plan for Families,18802LA001,,LAN001,LAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.76,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/la/18802la0010006-15,,18802LA0010006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,1,19636,LA,SHOP (Small Group),No,72-1071369,19636LA0250002,Blue POS copay 80/60 $1000A,19636LA025,,LAN005,LAS007,LAF002,Existing,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,3,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0250002-00,http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx,www.bcbsla.com/smallgroup-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0250002-00,Standard Gold Off Exchange Plan,,0.789866328239441,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$1,000","$3,000",20%,,,,"$2,000","$6,000","$3,000","$9,000",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,000",$62,$694,$150,"$1,000",$630,$54,$79,4
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,1,19636,LA,Individual,No,72-1071369,19636LA0220008,Blue POS 70/50 $3500,19636LA022,,LAN005,LAS007,LAF003,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220008-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0220008-00,Standard Bronze Off Exchange Plan,,0.605709373950958,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$10,500",30%,,,,"$7,000","$21,000","$10,500","$31,500","$3,500",$0,"$1,134",$150,"$3,500",$0,$531,$79,4
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,1,19636,LA,Individual,No,72-1071369,19636LA0220008,Blue POS 70/50 $3500,19636LA022,,LAN005,LAS007,LAF003,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220008-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0220008-01,Standard Bronze On Exchange Plan,,0.605709373950958,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$10,500",30%,,,,"$7,000","$21,000","$10,500","$31,500","$3,500",$0,"$1,134",$150,"$3,500",$0,$531,$79,5
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,1,19636,LA,SHOP (Small Group),No,72-1071369,19636LA0250002,Blue POS copay 80/60 $1000A,19636LA025,,LAN005,LAS007,LAF002,Existing,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,3,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0250002-00,http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx,www.bcbsla.com/smallgroup-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0250002-01,Standard Gold On Exchange Plan,,0.789866328239441,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$1,000","$3,000",20%,,,,"$2,000","$6,000","$3,000","$9,000",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,000",$62,$694,$150,"$1,000",$630,$54,$79,5
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,1,19636,LA,Individual,No,72-1071369,19636LA0220008,Blue POS 70/50 $3500,19636LA022,,LAN005,LAS007,LAF003,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220008-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0220008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$79,6
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,1,19636,LA,Individual,No,72-1071369,19636LA0220008,Blue POS 70/50 $3500,19636LA022,,LAN005,LAS007,LAF003,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220008-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0220008-03,Limited Cost Sharing Plan Variation,,0.605709373950958,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$10,500",30%,,,,"$7,000","$21,000","$10,500","$31,500","$3,500",$0,"$1,134",$150,"$3,500",$0,$531,$79,7
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0240003,Blue Connect copay 70/50 $3000,19636LA024,,LAN006,LAS005,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-blueconnect-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0240003-01,Standard Silver On Exchange Plan,69.67%,0.696720123291016,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$9,000",30%,,,,"$6,000","$18,000","$9,000","$27,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$3,023",$60,$441,$150,"$1,772",$524,$0,$79,38
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0240003,Blue Connect copay 70/50 $3000,19636LA024,,LAN006,LAS005,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-blueconnect-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0240003-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$79,39
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0240003,Blue Connect copay 70/50 $3000,19636LA024,,LAN006,LAS005,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-blueconnect-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0240003-03,Limited Cost Sharing Plan Variation,69.67%,0.696720123291016,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$9,000",30%,,,,"$6,000","$18,000","$9,000","$27,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$3,023",$60,$441,$150,"$1,772",$524,$0,$79,40
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,2,19636,LA,Individual,No,72-1071369,19636LA0220003,Blue POS copay 80/60 $500,19636LA022,,LAN005,LAS007,LAF002,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220003-00,Standard Gold Off Exchange Plan,,0.802798092365265,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$3,000","$1,500","$4,500",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$500,$67,$794,$150,$500,$630,$154,$79,4
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,2,19636,LA,SHOP (Small Group),No,72-1071369,19636LA0250003,Blue POS copay 50/50 $2000,19636LA025,,LAN005,LAS007,LAF001,Existing,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,3,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0250003-00,http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx,www.bcbsla.com/smallgroup-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0250003-00,Standard Silver Off Exchange Plan,,0.704034030437469,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$4,000",50%,,,,"$4,000","$12,000","$6,000","$16,000",$250,$750,10%,,,,$250,$750,$250,$750,,,,,,,,,,,"$2,023",$55,"$1,236",$150,"$1,522",$985,$0,$79,4
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,SHOP (Small Group),No,45-3188075,67202LA0120001,LAHC Platinum,67202LA012,,LAN001,LAS001,LAF001,New,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Platinum_2015SGSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0120001-00,Standard Platinum Off Exchange Plan,,0.881231784820557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$900,"$1,400",$500,$50,$600,"$1,400",12
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,SHOP (Small Group),No,45-3188075,67202LA0120001,LAHC Platinum,67202LA012,,LAN001,LAS001,LAF001,New,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Platinum_2015SGSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0120001-01,Standard Platinum On Exchange Plan,,0.881231784820557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$900,"$1,400",$500,$50,$600,"$1,400",13
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,2,19636,LA,SHOP (Small Group),No,72-1071369,19636LA0250003,Blue POS copay 50/50 $2000,19636LA025,,LAN005,LAS007,LAF001,Existing,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,3,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0250003-00,http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx,www.bcbsla.com/smallgroup-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0250003-01,Standard Silver On Exchange Plan,,0.704034030437469,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$4,000",50%,,,,"$4,000","$12,000","$6,000","$16,000",$250,$750,10%,,,,$250,$750,$250,$750,,,,,,,,,,,"$2,023",$55,"$1,236",$150,"$1,522",$985,$0,$79,5
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,2,19636,LA,Individual,No,72-1071369,19636LA0220003,Blue POS copay 80/60 $500,19636LA022,,LAN005,LAS007,LAF002,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220003-01,Standard Gold On Exchange Plan,,0.802798092365265,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$3,000","$1,500","$4,500",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$500,$67,$794,$150,$500,$630,$154,$79,5
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0240003,Blue Connect copay 70/50 $3000,19636LA024,,LAN006,LAS005,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-blueconnect-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0240003-04,73% AV Level Silver Plan,73.56%,0.735635995864868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$12,700","$25,400","$17,500","$35,000","$3,000","$9,000",30%,,,,"$6,000","$18,000","$9,000","$27,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$3,023",$60,$441,$150,"$1,772",$524,$0,$79,41
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0240003,Blue Connect copay 70/50 $3000,19636LA024,,LAN006,LAS005,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-blueconnect-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0240003-05,87% AV Level Silver Plan,86.06%,0.860587000846863,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,700","$25,400","$14,850","$29,700",$750,"$2,250",5%,,,,"$6,000","$18,000","$6,750","$20,250",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,$773,$35,$186,$150,"$1,250",$245,$26,$79,42
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0240003,Blue Connect copay 70/50 $3000,19636LA024,,LAN006,LAS005,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-blueconnect-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0240003-06,94% AV Level Silver Plan,93.18%,0.937551975250244,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,700","$25,400","$14,850","$29,700",$0,$0,0%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,$23,$35,$0,$150,$500,$245,$0,$79,43
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,4,19636,LA,Individual,No,72-1071369,19636LA0220001,Blue POS copay 100/70A,19636LA022,,LAN005,LAS007,LAF001,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,3,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220001-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220001-00,Standard Platinum Off Exchange Plan,89.71%,0.895074307918549,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$0,$0,0%,,,,"$1,000","$3,000","$1,000","$3,000",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$565,$0,$150,$0,$850,$254,$79,4
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,4,19636,LA,Individual,No,72-1071369,19636LA0220001,Blue POS copay 100/70A,19636LA022,,LAN005,LAS007,LAF001,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,3,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220001-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220001-01,Standard Platinum On Exchange Plan,89.71%,0.895074307918549,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$0,$0,0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$565,$0,$150,$0,$850,$254,$79,5
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,4,19636,LA,Individual,No,72-1071369,19636LA0220001,Blue POS copay 100/70A,19636LA022,,LAN005,LAS007,LAF001,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,3,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220001-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$79,6
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,4,19636,LA,Individual,No,72-1071369,19636LA0220001,Blue POS copay 100/70A,19636LA022,,LAN005,LAS007,LAF001,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,3,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220001-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220001-03,Limited Cost Sharing Plan Variation,89.71%,0.895074307918549,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$0,$0,0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$565,$0,$150,$0,$850,$254,$79,7
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,4,19636,LA,Individual,No,72-1071369,19636LA0220002,Blue POS copay 100/70B,19636LA022,,LAN005,LAS007,LAF002,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,3,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220002-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220002-00,Standard Platinum Off Exchange Plan,88.77%,0.885632157325745,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,"$1,000","$3,000","$1,000","$3,000",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,"$1,067",$0,$150,$0,$630,$254,$79,8
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,4,19636,LA,Individual,No,72-1071369,19636LA0220002,Blue POS copay 100/70B,19636LA022,,LAN005,LAS007,LAF002,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,3,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220002-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220002-01,Standard Platinum On Exchange Plan,88.77%,0.885632157325745,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,"$1,067",$0,$150,$0,$630,$254,$79,9
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190047,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS007,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190047-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,93
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190047,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS007,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190047-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,94
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190047,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS007,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190047-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,95
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190048,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS008,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190048-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,96
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190048,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS008,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190048-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,97
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190048,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS008,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190048-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,98
2015,IN,91842,HIOS,4,2014-11-09 04:38:15,9,91842,IN,Individual,No,39-0658730,91842IN0190048,Assurant Health Platinum Plan 002,91842IN019,,INN001,INS008,INF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,91842IN0190048-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,99
2015,IN,91920,HIOS,7,2014-11-14 05:23:27,1,91920,IN,Individual,Yes,75-1233841,91920IN0010001,Dentegra Dental PPO Pediatric Basic Plan,91920IN001,,INN001,INS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.97,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/in/91920in0010001-15,,91920IN0010001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,91920,HIOS,7,2014-11-14 05:23:27,1,91920,IN,SHOP (Small Group),Yes,75-1233841,91920IN0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,91920IN002,,INN001,INS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.14,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/in/91920in0020001-15,,91920IN0020001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,91920,HIOS,7,2014-11-14 05:23:27,1,91920,IN,SHOP (Small Group),Yes,75-1233841,91920IN0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,91920IN002,,INN001,INS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.14,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/in/91920in0020001-15,,91920IN0020001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,91920,HIOS,7,2014-11-14 05:23:27,1,91920,IN,Individual,Yes,75-1233841,91920IN0010001,Dentegra Dental PPO Pediatric Basic Plan,91920IN001,,INN001,INS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.97,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/in/91920in0010001-15,,91920IN0010001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,91920,HIOS,7,2014-11-14 05:23:27,2,91920,IN,Individual,Yes,75-1233841,91920IN0010004,Dentegra Dental PPO Family Preferred Plan,91920IN001,,INN001,INS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.70,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/in/91920in0010004-15,,91920IN0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,91920,HIOS,7,2014-11-14 05:23:27,2,91920,IN,SHOP (Small Group),Yes,75-1233841,91920IN0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,91920IN002,,INN001,INS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.93,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/in/91920in0020004-15,,91920IN0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,91920,HIOS,7,2014-11-14 05:23:27,2,91920,IN,SHOP (Small Group),Yes,75-1233841,91920IN0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,91920IN002,,INN001,INS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.93,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/in/91920in0020004-15,,91920IN0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,91920,HIOS,7,2014-11-14 05:23:27,2,91920,IN,Individual,Yes,75-1233841,91920IN0010004,Dentegra Dental PPO Family Preferred Plan,91920IN001,,INN001,INS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.70,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/in/91920in0010004-15,,91920IN0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,91920,HIOS,7,2014-11-14 05:23:27,3,91920,IN,Individual,Yes,75-1233841,91920IN0010009,Dentegra Dental PPO Family Basic Plan,91920IN001,,INN001,INS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.97,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/in/91920IN0010009-15,,91920IN0010009-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,91920,HIOS,7,2014-11-14 05:23:27,3,91920,IN,SHOP (Small Group),Yes,75-1233841,91920IN0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,91920IN002,,INN001,INS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.14,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/in/91920IN0020009-15,,91920IN0020009-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,91920,HIOS,7,2014-11-14 05:23:27,3,91920,IN,SHOP (Small Group),Yes,75-1233841,91920IN0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,91920IN002,,INN001,INS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.14,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/in/91920IN0020009-15,,91920IN0020009-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,91920,HIOS,7,2014-11-14 05:23:27,3,91920,IN,Individual,Yes,75-1233841,91920IN0010009,Dentegra Dental PPO Family Basic Plan,91920IN001,,INN001,INS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.97,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/in/91920IN0010009-15,,91920IN0010009-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,97677,HIOS,2,2014-08-05 13:28:44,1,97677,IN,SHOP (Small Group),Yes,44-0308260,97677IN0010001,KCL EHB Low PPO,97677IN001,,INN001,INS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$38.83,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,97677IN0010001-00,Standard Low Off Exchange Plan,69.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,97677,HIOS,2,2014-08-05 13:28:44,1,97677,IN,SHOP (Small Group),Yes,44-0308260,97677IN0010003,KCL EHB Low MAC,97677IN001,,INN001,INS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$28.05,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,97677IN0010003-00,Standard Low Off Exchange Plan,69.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,97677,HIOS,2,2014-08-05 13:28:44,1,97677,IN,SHOP (Small Group),Yes,44-0308260,97677IN0010005,KCL Fam Low PPO,97677IN001,,INN001,INS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$38.83,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,97677IN0010005-00,Standard Low Off Exchange Plan,69.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IN,97677,HIOS,2,2014-08-05 13:28:44,1,97677,IN,SHOP (Small Group),Yes,44-0308260,97677IN0010007,KCL Fam Low MAC,97677IN001,,INN001,INS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$28.05,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,97677IN0010007-00,Standard Low Off Exchange Plan,69.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IN,97677,HIOS,2,2014-08-05 13:28:44,2,97677,IN,SHOP (Small Group),Yes,44-0308260,97677IN0010002,KCL EHB High PPO,97677IN001,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$47.38,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,97677IN0010002-00,Standard High Off Exchange Plan,84.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IN,97677,HIOS,2,2014-08-05 13:28:44,2,97677,IN,SHOP (Small Group),Yes,44-0308260,97677IN0010004,KCL EHB High MAC,97677IN001,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$35.27,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,97677IN0010004-00,Standard High Off Exchange Plan,84.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IN,97677,HIOS,2,2014-08-05 13:28:44,2,97677,IN,SHOP (Small Group),Yes,44-0308260,97677IN0010006,KCL Fam High PPO,97677IN001,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$47.38,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,97677IN0010006-00,Standard High Off Exchange Plan,84.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IN,97677,HIOS,2,2014-08-05 13:28:44,2,97677,IN,SHOP (Small Group),Yes,44-0308260,97677IN0010008,KCL Fam High MAC,97677IN001,,INN001,INS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$35.27,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,97677IN0010008-00,Standard High Off Exchange Plan,84.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IN,97975,HIOS,2,2014-08-03 08:59:32,1,97975,IN,SHOP (Small Group),Yes,47-0098400,97975IN0030001,EHB Low Passive,97975IN003,,INN001,INS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.34,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,97975IN0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,LA,17940,HIOS,2,2014-08-05 13:28:44,1,17940,LA,SHOP (Small Group),Yes,36-0883760,17940LA0030002,EHB High Passive,17940LA003,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.82,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,17940LA0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,17940,HIOS,2,2014-08-05 13:28:44,1,17940,LA,SHOP (Small Group),Yes,36-0883760,17940LA0030001,EHB Low Passive,17940LA003,,LAN001,LAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.99,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,17940LA0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,18575,HIOS,2,2014-08-08 08:53:29,1,18575,LA,SHOP (Small Group),Yes,72-0977315,18575LA0080002,AlwaysCare Small Group - Child,18575LA008,,LAN001,LAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$20.72,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,18575LA0080002-00,Standard Low Off Exchange Plan,71.27%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,18575,HIOS,2,2014-08-08 08:53:29,2,18575,LA,SHOP (Small Group),Yes,72-0977315,18575LA0070001,AlwaysCare Small Group Dental - Adults,18575LA007,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.09,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,18575LA0070001-00,Standard High Off Exchange Plan,86.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,18575,HIOS,2,2014-08-08 08:53:29,2,18575,LA,Individual,Yes,72-0977315,18575LA0060001,AlwaysCare All-Star Family Dental Plan 2015,18575LA006,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.15,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,18575LA0060001-00,Standard High Off Exchange Plan,86.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,18575,HIOS,2,2014-08-08 08:53:29,2,18575,LA,Individual,Yes,72-0977315,18575LA0060002,AlwaysCare All-Star Family Dental Plan 2015,18575LA006,,LAN001,LAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.11,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,18575LA0060002-00,Standard Low Off Exchange Plan,71.27%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,18575,HIOS,2,2014-08-08 08:53:29,2,18575,LA,SHOP (Small Group),Yes,72-0977315,18575LA0070002,AlwaysCare Small Group Dental - Adults,18575LA007,,LAN001,LAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.72,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,18575LA0070002-00,Standard Low Off Exchange Plan,71.27%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,18802,HIOS,7,2014-11-14 05:23:27,1,18802,LA,SHOP (Small Group),Yes,94-2761537,18802LA0020002,Delta Dental PPO Pediatric Preferred Planfor Small Businesses,18802LA002,,LAN001,LAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.69,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/la/18802la0020002-15,,18802LA0020002-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$35,Not Applicable,$35,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,18802,HIOS,7,2014-11-14 05:23:27,1,18802,LA,Individual,Yes,94-2761537,18802LA0010002,Delta Dental PPO Pediatric Preferred Plan,18802LA001,,LAN001,LAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$25.69,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/la/18802la0010002-15,,18802LA0010002-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$35,Not Applicable,$35,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,18802,HIOS,7,2014-11-14 05:23:27,1,18802,LA,Individual,Yes,94-2761537,18802LA0010002,Delta Dental PPO Pediatric Preferred Plan,18802LA001,,LAN001,LAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$25.69,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/la/18802la0010002-15,,18802LA0010002-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$35,Not Applicable,$35,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,18802,HIOS,7,2014-11-14 05:23:27,1,18802,LA,SHOP (Small Group),Yes,94-2761537,18802LA0020002,Delta Dental PPO Pediatric Preferred Planfor Small Businesses,18802LA002,,LAN001,LAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.69,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/la/18802la0020002-15,,18802LA0020002-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$35,Not Applicable,$35,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,1,19636,LA,Individual,No,72-1071369,19636LA0220009,Blue POS 70/50 $4500,19636LA022,,LAN005,LAS007,LAF003,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220009-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0220009-00,Standard Bronze Off Exchange Plan,,0.588353335857391,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$12,700",30%,,,,"$9,000","$25,400","$13,500","$38,100","$4,500",$0,$834,$150,"$4,500",$0,$231,$79,8
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,1,19636,LA,Individual,No,72-1071369,19636LA0220009,Blue POS 70/50 $4500,19636LA022,,LAN005,LAS007,LAF003,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220009-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0220009-01,Standard Bronze On Exchange Plan,,0.588353335857391,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$12,700",30%,,,,"$9,000","$25,400","$13,500","$38,100","$4,500",$0,$834,$150,"$4,500",$0,$231,$79,9
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,1,19636,LA,Individual,No,72-1071369,19636LA0220009,Blue POS 70/50 $4500,19636LA022,,LAN005,LAS007,LAF003,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220009-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0220009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$79,10
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,1,19636,LA,Individual,No,72-1071369,19636LA0220009,Blue POS 70/50 $4500,19636LA022,,LAN005,LAS007,LAF003,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220009-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0220009-03,Limited Cost Sharing Plan Variation,,0.588353335857391,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$12,700",30%,,,,"$9,000","$25,400","$13,500","$38,100","$4,500",$0,$834,$150,"$4,500",$0,$231,$79,11
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,1,19636,LA,Individual,No,72-1071369,19636LA0230004,Community Blue 70/50 $4500,19636LA023,,LAN007,LAS006,LAF003,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230004-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-communityblue-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0230004-00,Standard Bronze Off Exchange Plan,,0.588353335857391,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$12,700",30%,,,,"$9,000","$25,400","$13,500","$38,100","$4,500",$0,$834,$150,"$4,500",$0,$231,$79,12
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,1,19636,LA,Individual,No,72-1071369,19636LA0230004,Community Blue 70/50 $4500,19636LA023,,LAN007,LAS006,LAF003,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230004-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-communityblue-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0230004-01,Standard Bronze On Exchange Plan,,0.588353335857391,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$12,700",30%,,,,"$9,000","$25,400","$13,500","$38,100","$4,500",$0,$834,$150,"$4,500",$0,$231,$79,13
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,1,19636,LA,Individual,No,72-1071369,19636LA0230004,Community Blue 70/50 $4500,19636LA023,,LAN007,LAS006,LAF003,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230004-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-communityblue-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0230004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$79,14
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,1,19636,LA,Individual,No,72-1071369,19636LA0230004,Community Blue 70/50 $4500,19636LA023,,LAN007,LAS006,LAF003,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230004-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-communityblue-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0230004-03,Limited Cost Sharing Plan Variation,,0.588353335857391,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$12,700",30%,,,,"$9,000","$25,400","$13,500","$38,100","$4,500",$0,$834,$150,"$4,500",$0,$231,$79,15
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,1,19636,LA,Individual,No,72-1071369,19636LA0240004,Blue Connect 70/50 $4500,19636LA024,,LAN006,LAS005,LAF003,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240004-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-blueconnect-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0240004-00,Standard Bronze Off Exchange Plan,,0.588353335857391,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$12,700",30%,,,,"$9,000","$25,400","$13,500","$38,100","$4,500",$0,$834,$150,"$4,500",$0,$231,$79,16
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,1,19636,LA,Individual,No,72-1071369,19636LA0240004,Blue Connect 70/50 $4500,19636LA024,,LAN006,LAS005,LAF003,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240004-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-blueconnect-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0240004-01,Standard Bronze On Exchange Plan,,0.588353335857391,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$12,700",30%,,,,"$9,000","$25,400","$13,500","$38,100","$4,500",$0,$834,$150,"$4,500",$0,$231,$79,17
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,1,19636,LA,Individual,No,72-1071369,19636LA0240004,Blue Connect 70/50 $4500,19636LA024,,LAN006,LAS005,LAF003,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240004-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-blueconnect-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0240004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$79,18
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,1,19636,LA,Individual,No,72-1071369,19636LA0240004,Blue Connect 70/50 $4500,19636LA024,,LAN006,LAS005,LAF003,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240004-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-blueconnect-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0240004-03,Limited Cost Sharing Plan Variation,,0.588353335857391,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$12,700",30%,,,,"$9,000","$25,400","$13,500","$38,100","$4,500",$0,$834,$150,"$4,500",$0,$231,$79,19
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,2,19636,LA,Individual,No,72-1071369,19636LA0220003,Blue POS copay 80/60 $500,19636LA022,,LAN005,LAS007,LAF002,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$79,6
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,2,19636,LA,Individual,No,72-1071369,19636LA0220003,Blue POS copay 80/60 $500,19636LA022,,LAN005,LAS007,LAF002,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220003-03,Limited Cost Sharing Plan Variation,,0.802798092365265,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$3,000","$1,500","$4,500",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$500,$67,$794,$150,$500,$630,$154,$79,7
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,2,44965,LA,Individual,No,72-1279235,44965LA0570002,Humana Bronze 6300/New Orleans HMOx,44965LA057,,LAN001,LAS001,LAF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341677,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333136,http://apps.humana.com/marketing/documents.asp?file=2323880,44965LA0570002-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,3,44965,LA,Individual,No,72-1279235,44965LA0580004,Humana Silver 4250/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF006,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341807,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333266,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0580004-00,Standard Silver Off Exchange Plan,,0.681853055953979,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$4,250","$8,500",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,3,44965,LA,Individual,No,72-1279235,44965LA0580004,Humana Silver 4250/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF006,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341807,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333266,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0580004-01,Standard Silver On Exchange Plan,,0.681853055953979,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$4,250","$8,500",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,3,44965,LA,Individual,No,72-1279235,44965LA0580004,Humana Silver 4250/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF006,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341807,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333266,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0580004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0010003,LAHC Silver Plus,67202LA001,,LAN001,LAS001,LAF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_SilverPlus_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0010003-05,87% AV Level Silver Plan,,0.864651799201965,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",15%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,$500,$0,"$1,050","$1,500",$500,$75,$450,"$1,500",17
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0010003,LAHC Silver Plus,67202LA001,,LAN001,LAS001,LAF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_SilverPlus_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0010003-06,94% AV Level Silver Plan,,0.936677038669586,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,10%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,$150,$0,$550,$700,$150,$25,$325,$700,18
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,SHOP (Small Group),No,45-3188075,67202LA0120004,LAHC Bronze,67202LA012,,LAN001,LAS001,LAF004,New,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Bronze_2015SGSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0120004-00,Standard Bronze Off Exchange Plan,,0.612048447132111,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,750",$0,"$1,100","$6,350","$4,500",$300,$100,"$6,350",18
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,SHOP (Small Group),No,45-3188075,67202LA0120004,LAHC Bronze,67202LA012,,LAN001,LAS001,LAF004,New,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Bronze_2015SGSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0120004-01,Standard Bronze On Exchange Plan,,0.612048447132111,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,750",$0,"$1,100","$6,350","$4,500",$300,$100,"$6,350",19
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0010004,LAHC Bronze Plus,67202LA001,,LAN001,LAS001,LAF004,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_BronzePlus_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0010004-00,Standard Bronze Off Exchange Plan,,0.612048447132111,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$4,750",$0,"$1,100","$6,350","$4,500",$300,$100,"$6,350",19
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0010004,LAHC Bronze Plus,67202LA001,,LAN001,LAS001,LAF004,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_BronzePlus_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0010004-01,Standard Bronze On Exchange Plan,,0.612048447132111,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$4,750",$0,"$1,100","$6,350","$4,500",$300,$100,"$6,350",20
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0010004,LAHC Bronze Plus,67202LA001,,LAN001,LAS001,LAF004,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_BronzePlus_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0010004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,21
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0010004,LAHC Bronze Plus,67202LA001,,LAN001,LAS001,LAF004,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_BronzePlus_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0010004-03,Limited Cost Sharing Plan Variation,,0.612048447132111,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$4,750",$0,"$1,100","$6,350","$4,500",$300,$100,"$6,350",22
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0010005,LAHC Catastrophic Plus,67202LA001,,LAN001,LAS001,LAF005,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,3,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_CatastrophicPlus_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0010005-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$4,750",$0,$0,"$6,350","$4,750",$0,$0,"$6,350",23
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0010005,LAHC Catastrophic Plus,67202LA001,,LAN001,LAS001,LAF005,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,3,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_CatastrophicPlus_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0010005-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$4,750",$0,$0,"$6,350","$4,750",$0,$0,"$6,350",24
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,2,19636,LA,Individual,No,72-1071369,19636LA0220004,Blue POS copay 80/60 $750,19636LA022,,LAN005,LAS007,LAF002,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220004-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220004-00,Standard Gold Off Exchange Plan,,0.792409420013428,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$750,"$2,250",20%,,,,"$1,500","$4,500","$2,250","$6,750",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$750,$67,$744,$150,$750,$630,$104,$79,8
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,2,19636,LA,Individual,No,72-1071369,19636LA0220004,Blue POS copay 80/60 $750,19636LA022,,LAN005,LAS007,LAF002,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220004-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220004-01,Standard Gold On Exchange Plan,,0.792409420013428,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$750,"$2,250",20%,,,,"$1,500","$4,500","$2,250","$6,750",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$750,$67,$744,$150,$750,$630,$104,$79,9
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,2,19636,LA,Individual,No,72-1071369,19636LA0220004,Blue POS copay 80/60 $750,19636LA022,,LAN005,LAS007,LAF002,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220004-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$79,10
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,2,19636,LA,Individual,No,72-1071369,19636LA0220004,Blue POS copay 80/60 $750,19636LA022,,LAN005,LAS007,LAF002,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220004-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220004-03,Limited Cost Sharing Plan Variation,,0.792409420013428,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$750,"$2,250",20%,,,,"$1,500","$4,500","$2,250","$6,750",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$750,$67,$744,$150,$750,$630,$104,$79,11
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0220005,Blue POS copay 80/60 $1000,19636LA022,,LAN005,LAS007,LAF002,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220005-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220005-00,Standard Gold Off Exchange Plan,78.95%,0.778812348842621,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,000","$3,000",20%,,,,"$2,000","$6,000","$3,000","$9,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$1,023",$60,$694,$150,"$1,500",$645,$54,$79,4
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0220005,Blue POS copay 80/60 $1000,19636LA022,,LAN005,LAS007,LAF002,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220005-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220005-01,Standard Gold On Exchange Plan,78.95%,0.778812348842621,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,000","$3,000",20%,,,,"$2,000","$6,000","$3,000","$9,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$1,023",$60,$694,$150,"$1,500",$645,$54,$79,5
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0220005,Blue POS copay 80/60 $1000,19636LA022,,LAN005,LAS007,LAF002,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220005-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220005-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$79,6
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0220005,Blue POS copay 80/60 $1000,19636LA022,,LAN005,LAS007,LAF002,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220005-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220005-03,Limited Cost Sharing Plan Variation,78.95%,0.778812348842621,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,000","$3,000",20%,,,,"$2,000","$6,000","$3,000","$9,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$1,023",$60,$694,$150,"$1,500",$645,$54,$79,7
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0220006,Blue POS copay 60/40 $2000,19636LA022,,LAN005,LAS007,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220006-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220006-00,Standard Silver Off Exchange Plan,70.66%,0.706590473651886,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$6,000",40%,,,,"$4,000","$12,000","$6,000","$18,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$2,023",$60,$989,$150,"$1,772",$924,$0,$79,8
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0220006,Blue POS copay 60/40 $2000,19636LA022,,LAN005,LAS007,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220006-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220006-01,Standard Silver On Exchange Plan,70.66%,0.706590473651886,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$6,000",40%,,,,"$4,000","$12,000","$6,000","$18,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$2,023",$60,$989,$150,"$1,772",$924,$0,$79,9
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0220006,Blue POS copay 60/40 $2000,19636LA022,,LAN005,LAS007,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220006-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220006-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$79,10
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0220006,Blue POS copay 60/40 $2000,19636LA022,,LAN005,LAS007,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220006-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220006-03,Limited Cost Sharing Plan Variation,70.66%,0.706590473651886,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$6,000",40%,,,,"$4,000","$12,000","$6,000","$18,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$2,023",$60,$989,$150,"$1,772",$924,$0,$79,11
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0220006,Blue POS copay 60/40 $2000,19636LA022,,LAN005,LAS007,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220006-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220006-04,73% AV Level Silver Plan,72.97%,0.72971111536026,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$12,700","$25,400","$17,500","$35,000","$2,000","$6,000",40%,,,,"$4,000","$12,000","$6,000","$18,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$2,023",$60,$989,$150,"$1,772",$924,$0,$79,12
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0220006,Blue POS copay 60/40 $2000,19636LA022,,LAN005,LAS007,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220006-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220006-05,87% AV Level Silver Plan,86.76%,0.867594659328461,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,700","$25,400","$14,850","$29,700",$750,"$2,250",5%,,,,"$4,000","$12,000","$4,750","$14,250",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,$773,$30,$186,$150,"$1,250",$345,$26,$79,13
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0220006,Blue POS copay 60/40 $2000,19636LA022,,LAN005,LAS007,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220006-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220006-06,94% AV Level Silver Plan,94.03%,0.94514274597168,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,700","$25,400","$14,850","$29,700",$0,$0,0%,,,,"$4,000","$12,000",Not Applicable,Not Applicable,$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,$23,$30,$0,$150,$500,$345,$0,$79,14
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0220007,Blue POS copay 70/50 $3000,19636LA022,,LAN005,LAS007,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220007-00,Standard Silver Off Exchange Plan,69.80%,0.697980642318726,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$9,000",30%,,,,"$6,000","$18,000","$9,000","$27,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$3,023",$60,$441,$150,"$1,772",$924,$0,$79,15
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0220007,Blue POS copay 70/50 $3000,19636LA022,,LAN005,LAS007,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220007-01,Standard Silver On Exchange Plan,69.80%,0.697980642318726,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$9,000",30%,,,,"$6,000","$18,000","$9,000","$27,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$3,023",$60,$441,$150,"$1,772",$924,$0,$79,16
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0220007,Blue POS copay 70/50 $3000,19636LA022,,LAN005,LAS007,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220007-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$79,17
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0220007,Blue POS copay 70/50 $3000,19636LA022,,LAN005,LAS007,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220007-03,Limited Cost Sharing Plan Variation,69.80%,0.697980642318726,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$9,000",30%,,,,"$6,000","$18,000","$9,000","$27,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$3,023",$60,$441,$150,"$1,772",$924,$0,$79,18
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0220007,Blue POS copay 70/50 $3000,19636LA022,,LAN005,LAS007,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220007-04,73% AV Level Silver Plan,73.66%,0.736639440059662,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$12,700","$25,400","$17,500","$35,000","$3,000","$9,000",30%,,,,"$6,000","$18,000","$9,000","$27,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$3,023",$60,$441,$150,"$1,772",$924,$0,$79,19
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0220007,Blue POS copay 70/50 $3000,19636LA022,,LAN005,LAS007,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220007-05,87% AV Level Silver Plan,86.21%,0.862076938152313,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,700","$25,400","$14,850","$29,700",$750,"$2,250",5%,,,,"$6,000","$18,000","$6,750","$20,250",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,$773,$35,$186,$150,"$1,250",$395,$26,$79,20
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0220007,Blue POS copay 70/50 $3000,19636LA022,,LAN005,LAS007,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220007-06,94% AV Level Silver Plan,93.35%,0.939292848110199,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,700","$25,400","$14,850","$29,700",$0,$0,0%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,$23,$35,$0,$150,$500,$395,$0,$79,21
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0230002,Community Blue copay 80/60,19636LA023,,LAN007,LAS006,LAF002,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230002-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-communityblue-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0230002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$79,24
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0230002,Community Blue copay 80/60,19636LA023,,LAN007,LAS006,LAF002,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230002-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-communityblue-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0230002-03,Limited Cost Sharing Plan Variation,79.43%,0.77738881111145,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,000","$3,000",20%,,,,"$5,000","$15,000","$6,000","$18,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$1,023",$60,$694,$150,"$1,500",$245,$54,$79,25
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0230003,Community Blue copay 70/50 $3000,19636LA023,,LAN007,LAS006,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-communityblue-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0230003-06,94% AV Level Silver Plan,93.18%,0.937551975250244,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,700","$25,400","$14,850","$29,700",$0,$0,0%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,$23,$35,$0,$150,$500,$245,$0,$79,32
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0240002,Blue Connect copay 80/60 $1000,19636LA024,,LAN006,LAS005,LAF002,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240002-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-blueconnect-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0240002-00,Standard Gold Off Exchange Plan,79.43%,0.77738881111145,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,000","$3,000",20%,,,,"$5,000","$15,000","$6,000","$18,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$1,023",$60,$694,$150,"$1,500",$245,$54,$79,33
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0240002,Blue Connect copay 80/60 $1000,19636LA024,,LAN006,LAS005,LAF002,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240002-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-blueconnect-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0240002-01,Standard Gold On Exchange Plan,79.43%,0.77738881111145,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,000","$3,000",20%,,,,"$5,000","$15,000","$6,000","$18,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$1,023",$60,$694,$150,"$1,500",$245,$54,$79,34
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0240002,Blue Connect copay 80/60 $1000,19636LA024,,LAN006,LAS005,LAF002,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240002-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-blueconnect-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0240002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$79,35
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0240002,Blue Connect copay 80/60 $1000,19636LA024,,LAN006,LAS005,LAF002,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240002-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-blueconnect-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0240002-03,Limited Cost Sharing Plan Variation,79.43%,0.77738881111145,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,000","$3,000",20%,,,,"$5,000","$15,000","$6,000","$18,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$1,023",$60,$694,$150,"$1,500",$245,$54,$79,36
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,3,19636,LA,Individual,No,72-1071369,19636LA0240003,Blue Connect copay 70/50 $3000,19636LA024,,LAN006,LAS005,LAF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-blueconnect-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0240003-00,Standard Silver Off Exchange Plan,69.67%,0.696720123291016,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$9,000",30%,,,,"$6,000","$18,000","$9,000","$27,000",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$3,023",$60,$441,$150,"$1,772",$524,$0,$79,37
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,4,19636,LA,Individual,No,72-1071369,19636LA0220002,Blue POS copay 100/70B,19636LA022,,LAN005,LAS007,LAF002,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,3,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220002-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$79,10
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,4,19636,LA,Individual,No,72-1071369,19636LA0220002,Blue POS copay 100/70B,19636LA022,,LAN005,LAS007,LAF002,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,3,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220002-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0220002-03,Limited Cost Sharing Plan Variation,88.77%,0.885632157325745,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,"$1,067",$0,$150,$0,$630,$254,$79,11
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,4,19636,LA,Individual,No,72-1071369,19636LA0230001,Community Blue copay 100/70,19636LA023,,LAN007,LAS006,LAF002,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,3,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230001-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-communityblue-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0230001-00,Standard Platinum Off Exchange Plan,89.12%,0.88389128446579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","$12,000","$24,000",$0,$0,0%,,,,"$5,000","$15,000","$5,000","$15,000",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,"$1,067",$0,$150,$0,$280,$254,$79,12
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,4,19636,LA,Individual,No,72-1071369,19636LA0230001,Community Blue copay 100/70,19636LA023,,LAN007,LAS006,LAF002,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,3,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230001-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-communityblue-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0230001-01,Standard Platinum On Exchange Plan,89.12%,0.88389128446579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","$12,000","$24,000",$0,$0,0%,,,,"$5,000","$15,000",Not Applicable,Not Applicable,$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,"$1,067",$0,$150,$0,$280,$254,$79,13
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,4,19636,LA,Individual,No,72-1071369,19636LA0230001,Community Blue copay 100/70,19636LA023,,LAN007,LAS006,LAF002,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,3,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230001-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-communityblue-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0230001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$79,14
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,4,19636,LA,Individual,No,72-1071369,19636LA0230001,Community Blue copay 100/70,19636LA023,,LAN007,LAS006,LAF002,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,3,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230001-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-communityblue-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0230001-03,Limited Cost Sharing Plan Variation,89.12%,0.88389128446579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","$12,000","$24,000",$0,$0,0%,,,,"$5,000","$15,000",Not Applicable,Not Applicable,$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,"$1,067",$0,$150,$0,$280,$254,$79,15
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,4,19636,LA,Individual,No,72-1071369,19636LA0240001,Blue Connect copay 100/70,19636LA024,,LAN006,LAS005,LAF002,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,3,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240001-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-blueconnect-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0240001-00,Standard Platinum Off Exchange Plan,89.12%,0.88389128446579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","$12,000","$24,000",$0,$0,0%,,,,"$5,000","$15,000","$5,000","$15,000",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,"$1,067",$0,$150,$0,$280,$254,$79,16
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,4,19636,LA,Individual,No,72-1071369,19636LA0240001,Blue Connect copay 100/70,19636LA024,,LAN006,LAS005,LAF002,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,3,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240001-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-blueconnect-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0240001-01,Standard Platinum On Exchange Plan,89.12%,0.88389128446579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","$12,000","$24,000",$0,$0,0%,,,,"$5,000","$15,000",Not Applicable,Not Applicable,$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,"$1,067",$0,$150,$0,$280,$254,$79,17
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,4,19636,LA,Individual,No,72-1071369,19636LA0240001,Blue Connect copay 100/70,19636LA024,,LAN006,LAS005,LAF002,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,3,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240001-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-blueconnect-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0240001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$79,18
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,4,19636,LA,Individual,No,72-1071369,19636LA0240001,Blue Connect copay 100/70,19636LA024,,LAN006,LAS005,LAF002,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,3,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to? Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240001-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-blueconnect-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,19636LA0240001-03,Limited Cost Sharing Plan Variation,89.12%,0.88389128446579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","$12,000","$24,000",$0,$0,0%,,,,"$5,000","$15,000",Not Applicable,Not Applicable,$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,"$1,067",$0,$150,$0,$280,$254,$79,19
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,3,44965,LA,Individual,No,72-1279235,44965LA0580006,Humana Gold 2500/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF007,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341690,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333370,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0580006-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,3,44965,LA,Individual,No,72-1279235,44965LA0580006,Humana Gold 2500/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF007,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341690,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333370,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0580006-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0010002,LAHC Gold Plus,67202LA001,,LAN001,LAS001,LAF002,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_GoldPlus_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0010002-03,Limited Cost Sharing Plan Variation,,0.783011674880981,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,500","$17,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,200","$3,000","$1,500",$100,$300,"$3,000",11
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0010003,LAHC Silver Plus,67202LA001,,LAN001,LAS001,LAF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_SilverPlus_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0010003-00,Standard Silver Off Exchange Plan,,0.688694417476654,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,100","$6,000","$2,000",$200,$200,"$6,000",12
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030006,UnitedHealthcare Silver Compass 4000,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030006-00,Standard Silver Off Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030006,UnitedHealthcare Silver Compass 4000,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030006-01,Standard Silver On Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,SHOP (Small Group),No,45-3188075,67202LA0030002,LAHC Gold Plus,67202LA003,,LAN001,LAS001,LAF002,Existing,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_GoldPlus_2015SGSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0030002-00,Standard Gold Off Exchange Plan,,0.783011674880981,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,500","$17,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,200","$3,000","$1,500",$100,$300,"$3,000",6
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,SHOP (Small Group),No,45-3188075,67202LA0030002,LAHC Gold Plus,67202LA003,,LAN001,LAS001,LAF002,Existing,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_GoldPlus_2015SGSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0030002-01,Standard Gold On Exchange Plan,,0.783011674880981,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,500","$17,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,200","$3,000","$1,500",$100,$300,"$3,000",7
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0010001,LAHC Platinum Plus,67202LA001,,LAN001,LAS001,LAF001,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_PlatinumPlus_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0010001-03,Limited Cost Sharing Plan Variation,,0.881231784820557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$500,$0,$900,"$1,400",$500,$50,$600,"$1,400",7
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0010002,LAHC Gold Plus,67202LA001,,LAN001,LAS001,LAF002,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_GoldPlus_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0010002-00,Standard Gold Off Exchange Plan,,0.783011674880981,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,500","$17,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,200","$3,000","$1,500",$100,$300,"$3,000",8
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,SHOP (Small Group),No,45-3188075,67202LA0030003,LAHC Silver Plus,67202LA003,,LAN001,LAS001,LAF003,Existing,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_SilverPlus_2015SGSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0030003-00,Standard Silver Off Exchange Plan,,0.688694417476654,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,100","$6,000","$2,000",$200,$200,"$6,000",8
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,SHOP (Small Group),No,45-3188075,67202LA0030003,LAHC Silver Plus,67202LA003,,LAN001,LAS001,LAF003,Existing,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_SilverPlus_2015SGSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0030003-01,Standard Silver On Exchange Plan,,0.688694417476654,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,100","$6,000","$2,000",$200,$200,"$6,000",9
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0010002,LAHC Gold Plus,67202LA001,,LAN001,LAS001,LAF002,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_GoldPlus_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0010002-01,Standard Gold On Exchange Plan,,0.783011674880981,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,500","$17,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,200","$3,000","$1,500",$100,$300,"$3,000",9
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0010002,LAHC Gold Plus,67202LA001,,LAN001,LAS001,LAF002,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_GoldPlus_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0010002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,5,19636,LA,Individual,No,72-1071369,19636LA0230005,Community Blue copay 100/80 $6250,19636LA023,,LAN007,LAS006,LAF004,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&PlanId=19636LA0230005,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-communityblue-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0230005-00,Standard Bronze Off Exchange Plan,58.95%,0.594586074352264,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,700",0%,,,,"$12,500","$25,400","$18,750","$38,100","$4,494",$60,$0,$150,"$4,121",$0,$0,$79,4
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,5,19636,LA,Individual,No,72-1071369,19636LA0230005,Community Blue copay 100/80 $6250,19636LA023,,LAN007,LAS006,LAF004,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&PlanId=19636LA0230005,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-communityblue-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0230005-01,Standard Bronze On Exchange Plan,58.95%,0.594586074352264,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,700",0%,,,,"$12,500","$25,400","$18,750","$38,100","$4,494",$60,$0,$150,"$4,121",$0,$0,$79,5
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,5,19636,LA,Individual,No,72-1071369,19636LA0230005,Community Blue copay 100/80 $6250,19636LA023,,LAN007,LAS006,LAF004,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&PlanId=19636LA0230005,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-communityblue-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0230005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$79,6
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,5,19636,LA,Individual,No,72-1071369,19636LA0230005,Community Blue copay 100/80 $6250,19636LA023,,LAN007,LAS006,LAF004,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&PlanId=19636LA0230005,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-communityblue-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0230005-03,Limited Cost Sharing Plan Variation,58.95%,0.594586074352264,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,700",0%,,,,"$12,500","$25,400","$18,750","$38,100","$4,494",$60,$0,$150,"$4,121",$0,$0,$79,7
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,4,38499,LA,Individual,No,72-1074008,38499LA0030002,UnitedHealthcare Gold Compass 1000,38499LA003,,LAN006,LAS001,LAF003,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,4,38499,LA,Individual,No,72-1074008,38499LA0030002,UnitedHealthcare Gold Compass 1000,38499LA003,,LAN006,LAS001,LAF003,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030002-03,Limited Cost Sharing Plan Variation,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,5,38499,LA,Individual,No,72-1074008,38499LA0030010,UnitedHealthcare Catastrophic Compass 6600,38499LA003,,LAN006,LAS001,LAF002,New,HMO,Catastrophic,No,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030010-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,5,38499,LA,Individual,No,72-1074008,38499LA0030010,UnitedHealthcare Catastrophic Compass 6600,38499LA003,,LAN006,LAS001,LAF002,New,HMO,Catastrophic,No,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030010-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,6,38499,LA,Individual,No,72-1074008,38499LA0030008,UnitedHealthcare Bronze Compass 4200,38499LA003,,LAN006,LAS001,LAF006,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030008-00,Standard Bronze Off Exchange Plan,59.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,6,38499,LA,Individual,No,72-1074008,38499LA0030008,UnitedHealthcare Bronze Compass 4200,38499LA003,,LAN006,LAS001,LAF006,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030008-01,Standard Bronze On Exchange Plan,59.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,6,38499,LA,Individual,No,72-1074008,38499LA0030008,UnitedHealthcare Bronze Compass 4200,38499LA003,,LAN006,LAS001,LAF006,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030008-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,6,38499,LA,Individual,No,72-1074008,38499LA0030008,UnitedHealthcare Bronze Compass 4200,38499LA003,,LAN006,LAS001,LAF006,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030008-03,Limited Cost Sharing Plan Variation,59.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,LA,42544,HIOS,8,2014-11-14 05:23:27,1,42544,LA,Individual,Yes,75-1233841,42544LA0010001,Dentegra Dental PPO Pediatric Basic Plan,42544LA001,,LAN001,LAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.48,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/la/42544la0010001-15,,42544LA0010001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,42544,HIOS,8,2014-11-14 05:23:27,1,42544,LA,SHOP (Small Group),Yes,75-1233841,42544LA0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,42544LA002,,LAN001,LAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.65,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/la/42544la0020001-15,,42544LA0020001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,42544,HIOS,8,2014-11-14 05:23:27,1,42544,LA,SHOP (Small Group),Yes,75-1233841,42544LA0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,42544LA002,,LAN001,LAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.65,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/la/42544la0020001-15,,42544LA0020001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,42544,HIOS,8,2014-11-14 05:23:27,1,42544,LA,Individual,Yes,75-1233841,42544LA0010001,Dentegra Dental PPO Pediatric Basic Plan,42544LA001,,LAN001,LAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.48,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/la/42544la0010001-15,,42544LA0010001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,42544,HIOS,8,2014-11-14 05:23:27,2,42544,LA,Individual,Yes,75-1233841,42544LA0010004,Dentegra Dental PPO Family Preferred Plan,42544LA001,,LAN001,LAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/la/42544la0010004-15,,42544LA0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,42544,HIOS,8,2014-11-14 05:23:27,2,42544,LA,SHOP (Small Group),Yes,75-1233841,42544LA0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,42544LA002,,LAN001,LAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.24,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/la/42544la0020004-15,,42544LA0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,42544,HIOS,8,2014-11-14 05:23:27,2,42544,LA,SHOP (Small Group),Yes,75-1233841,42544LA0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,42544LA002,,LAN001,LAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.24,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/la/42544la0020004-15,,42544LA0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,42544,HIOS,8,2014-11-14 05:23:27,2,42544,LA,Individual,Yes,75-1233841,42544LA0010004,Dentegra Dental PPO Family Preferred Plan,42544LA001,,LAN001,LAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/la/42544la0010004-15,,42544LA0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,42544,HIOS,8,2014-11-14 05:23:27,3,42544,LA,Individual,Yes,75-1233841,42544LA0010006,Dentegra Dental PPO Family Basic Plan,42544LA001,,LAN001,LAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.48,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/la/42544la0010006-15,,42544LA0010006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,5,19636,LA,Individual,No,72-1071369,19636LA0240005,Blue Connect copay 100/80 $6250,19636LA024,,LAN006,LAS005,LAF004,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&PlanId=19636LA0240005,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-blueconnect-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0240005-00,Standard Bronze Off Exchange Plan,58.95%,0.594586074352264,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,700",0%,,,,"$12,500","$25,400","$18,750","$38,100","$4,494",$60,$0,$150,"$4,121",$0,$0,$79,8
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,5,19636,LA,Individual,No,72-1071369,19636LA0240005,Blue Connect copay 100/80 $6250,19636LA024,,LAN006,LAS005,LAF004,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&PlanId=19636LA0240005,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-blueconnect-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0240005-01,Standard Bronze On Exchange Plan,58.95%,0.594586074352264,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,700",0%,,,,"$12,500","$25,400","$18,750","$38,100","$4,494",$60,$0,$150,"$4,121",$0,$0,$79,9
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,5,19636,LA,Individual,No,72-1071369,19636LA0240005,Blue Connect copay 100/80 $6250,19636LA024,,LAN006,LAS005,LAF004,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&PlanId=19636LA0240005,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-blueconnect-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0240005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$79,10
2015,LA,19636,HIOS,8,2014-12-06 05:18:25,5,19636,LA,Individual,No,72-1071369,19636LA0240005,Blue Connect copay 100/80 $6250,19636LA024,,LAN006,LAS005,LAF004,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&PlanId=19636LA0240005,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-blueconnect-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,19636LA0240005-03,Limited Cost Sharing Plan Variation,58.95%,0.594586074352264,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,700",0%,,,,"$12,500","$25,400","$18,750","$38,100","$4,494",$60,$0,$150,"$4,121",$0,$0,$79,11
2015,LA,25551,HIOS,4,2014-09-05 03:32:16,1,25551,LA,SHOP (Small Group),Yes,81-0170040,25551LA0010001,Assurant Dental ACAFFO High,25551LA001,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$37.65,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same Coverage as in Service Area,Yes,,,,,25551LA0010001-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,25551,HIOS,4,2014-09-05 03:32:16,2,25551,LA,SHOP (Small Group),Yes,81-0170040,25551LA0010002,Assurant Dental ACAFFO Low,25551LA001,,LAN001,LAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.36,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same Coverage as in Service Area,Yes,,,,,25551LA0010002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,28419,HIOS,2,2014-08-08 08:53:29,1,28419,LA,Individual,Yes,47-0397286,28419LA0010001,"Delta Dental Individual PPO, EHB Certified",28419LA001,,LAN002,LAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.89,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28419LA0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,28419,HIOS,2,2014-08-08 08:53:29,1,28419,LA,SHOP (Small Group),Yes,47-0397286,28419LA0030001,"Renaissance Group Dental PPO, EHB Certified",28419LA003,,LAN001,LAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.76,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28419LA0030001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,28419,HIOS,2,2014-08-08 08:53:29,1,28419,LA,SHOP (Small Group),Yes,47-0397286,28419LA0030002,"Renaissance Group Dental PPO, EHB Certified",28419LA003,,LAN001,LAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.28,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28419LA0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,28419,HIOS,2,2014-08-08 08:53:29,1,28419,LA,Individual,Yes,47-0397286,28419LA0010002,"Delta Dental Individual PPO, EHB Certified",28419LA001,,LAN002,LAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.38,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28419LA0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,28419,HIOS,2,2014-08-08 08:53:29,1,28419,LA,Individual,Yes,47-0397286,28419LA0020001,"Renaissance Individual Dental PPO, EHB Certified",28419LA002,,LAN001,LAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.46,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28419LA0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,LA,28419,HIOS,2,2014-08-08 08:53:29,1,28419,LA,Individual,Yes,47-0397286,28419LA0020002,"Renaissance Individual Dental PPO, EHB Certified",28419LA002,,LAN001,LAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.33,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,28419LA0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,LA,33001,HIOS,4,2014-09-06 03:39:47,1,33001,LA,SHOP (Small Group),Yes,41-0808596,33001LA0010001,"Plan 1. Passive PPO, $1000 Annual Maximum, no Ortho",33001LA001,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,33001LA0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,33001,HIOS,4,2014-09-06 03:39:47,1,33001,LA,SHOP (Small Group),Yes,41-0808596,33001LA0010002,"Plan 2.  Passive PPO, $1000 Annual Maximum, Ortho",33001LA001,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,33001LA0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,33001,HIOS,4,2014-09-06 03:39:47,1,33001,LA,SHOP (Small Group),Yes,41-0808596,33001LA0010003,"Plan 3. Passive PPO, $1500 Annual Maximum, no Ortho",33001LA001,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,33001LA0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,LA,33001,HIOS,4,2014-09-06 03:39:47,1,33001,LA,SHOP (Small Group),Yes,41-0808596,33001LA0010004,"Plan 4.  Passive PPO, $1500 Annual Maximum, Ortho",33001LA001,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,33001LA0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,LA,33001,HIOS,4,2014-09-06 03:39:47,1,33001,LA,SHOP (Small Group),Yes,41-0808596,33001LA0010005,"Plan 5.  Passive PPO, $2000 Annual Maximum, Ortho",33001LA001,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,33001LA0010005-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,LA,33001,HIOS,4,2014-09-06 03:39:47,1,33001,LA,SHOP (Small Group),Yes,41-0808596,33001LA0010006,"Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho",33001LA001,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,33001LA0010006-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,LA,33001,HIOS,4,2014-09-06 03:39:47,1,33001,LA,SHOP (Small Group),Yes,41-0808596,33001LA0010007,"Plan 7. Graded Passive PPO, $1500 Annual Maximum, Ortho",33001LA001,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,33001LA0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,LA,33001,HIOS,4,2014-09-06 03:39:47,1,33001,LA,SHOP (Small Group),Yes,41-0808596,33001LA0010008,"Plan 8. MAC PPO, $1000 Annual Maximum, no Ortho",33001LA001,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,33001LA0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,LA,33001,HIOS,4,2014-09-06 03:39:47,1,33001,LA,SHOP (Small Group),Yes,41-0808596,33001LA0010009,"Plan 9. MAC PPO, $1500 Annual Maximum, Ortho",33001LA001,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,33001LA0010009-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,LA,33001,HIOS,4,2014-09-06 03:39:47,1,33001,LA,SHOP (Small Group),Yes,41-0808596,33001LA0010010,"Plan 10. Graded MAC PPO, $1000 Annual Maximum, no Ortho",33001LA001,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,33001LA0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,13
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,1,38499,LA,Individual,No,72-1074008,38499LA0030004,UnitedHealthcare Gold Compass HSA 1300,38499LA003,,LAN006,LAS001,LAF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030004-00,Standard Gold Off Exchange Plan,79.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,1,38499,LA,Individual,No,72-1074008,38499LA0030004,UnitedHealthcare Gold Compass HSA 1300,38499LA003,,LAN006,LAS001,LAF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030004-01,Standard Gold On Exchange Plan,79.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,1,38499,LA,Individual,No,72-1074008,38499LA0030004,UnitedHealthcare Gold Compass HSA 1300,38499LA003,,LAN006,LAS001,LAF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,1,38499,LA,Individual,No,72-1074008,38499LA0030004,UnitedHealthcare Gold Compass HSA 1300,38499LA003,,LAN006,LAS001,LAF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030004-03,Limited Cost Sharing Plan Variation,79.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,1,38499,LA,Individual,No,72-1074008,38499LA0030007,UnitedHealthcare Silver Compass HSA 3600,38499LA003,,LAN006,LAS001,LAF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030007-00,Standard Silver Off Exchange Plan,68.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,1,38499,LA,Individual,No,72-1074008,38499LA0030007,UnitedHealthcare Silver Compass HSA 3600,38499LA003,,LAN006,LAS001,LAF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030007-01,Standard Silver On Exchange Plan,68.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,1,38499,LA,Individual,No,72-1074008,38499LA0030007,UnitedHealthcare Silver Compass HSA 3600,38499LA003,,LAN006,LAS001,LAF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030007-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,1,38499,LA,Individual,No,72-1074008,38499LA0030007,UnitedHealthcare Silver Compass HSA 3600,38499LA003,,LAN006,LAS001,LAF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030007-03,Limited Cost Sharing Plan Variation,68.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,1,38499,LA,Individual,No,72-1074008,38499LA0030007,UnitedHealthcare Silver Compass HSA 3600,38499LA003,,LAN006,LAS001,LAF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030007-04,73% AV Level Silver Plan,72.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,1,38499,LA,Individual,No,72-1074008,38499LA0030007,UnitedHealthcare Silver Compass HSA 3600,38499LA003,,LAN006,LAS001,LAF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030007-05,87% AV Level Silver Plan,86.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,1,38499,LA,Individual,No,72-1074008,38499LA0030007,UnitedHealthcare Silver Compass HSA 3600,38499LA003,,LAN006,LAS001,LAF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030007-06,94% AV Level Silver Plan,93.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,1,38499,LA,Individual,No,72-1074008,38499LA0030009,UnitedHealthcare Bronze Compass HSA 6275,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030009-00,Standard Bronze Off Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,275","$12,550",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,1,38499,LA,Individual,No,72-1074008,38499LA0030009,UnitedHealthcare Bronze Compass HSA 6275,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030009-01,Standard Bronze On Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,275","$12,550",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,1,38499,LA,Individual,No,72-1074008,38499LA0030009,UnitedHealthcare Bronze Compass HSA 6275,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030009-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,17
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,1,38499,LA,Individual,No,72-1074008,38499LA0030009,UnitedHealthcare Bronze Compass HSA 6275,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030009-03,Limited Cost Sharing Plan Variation,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,275","$12,550",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,2,38499,LA,Individual,No,72-1074008,38499LA0030001,UnitedHealthcare Platinum Compass 250,38499LA003,,LAN006,LAS001,LAF003,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030001-00,Standard Platinum Off Exchange Plan,89.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,2,38499,LA,Individual,No,72-1074008,38499LA0030001,UnitedHealthcare Platinum Compass 250,38499LA003,,LAN006,LAS001,LAF003,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030001-01,Standard Platinum On Exchange Plan,89.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,2,38499,LA,Individual,No,72-1074008,38499LA0030001,UnitedHealthcare Platinum Compass 250,38499LA003,,LAN006,LAS001,LAF003,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,2,38499,LA,Individual,No,72-1074008,38499LA0030001,UnitedHealthcare Platinum Compass 250,38499LA003,,LAN006,LAS001,LAF003,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030001-03,Limited Cost Sharing Plan Variation,89.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030003,UnitedHealthcare Gold Compass 1500,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030003-00,Standard Gold Off Exchange Plan,78.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030003,UnitedHealthcare Gold Compass 1500,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030003-01,Standard Gold On Exchange Plan,78.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030003,UnitedHealthcare Gold Compass 1500,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030003-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030003,UnitedHealthcare Gold Compass 1500,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030003-03,Limited Cost Sharing Plan Variation,78.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030005,UnitedHealthcare Silver Compass 2000,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030005-00,Standard Silver Off Exchange Plan,70.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030005,UnitedHealthcare Silver Compass 2000,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030005-01,Standard Silver On Exchange Plan,70.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030005,UnitedHealthcare Silver Compass 2000,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030005-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030005,UnitedHealthcare Silver Compass 2000,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030005-03,Limited Cost Sharing Plan Variation,70.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030005,UnitedHealthcare Silver Compass 2000,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030005-04,73% AV Level Silver Plan,73.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,600","$3,200",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030005,UnitedHealthcare Silver Compass 2000,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030005-05,87% AV Level Silver Plan,86.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030005,UnitedHealthcare Silver Compass 2000,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030005-06,94% AV Level Silver Plan,93.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,2,44965,LA,Individual,No,72-1279235,44965LA0570002,Humana Bronze 6300/New Orleans HMOx,44965LA057,,LAN001,LAS001,LAF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341677,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333136,http://apps.humana.com/marketing/documents.asp?file=2323880,44965LA0570002-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,2,44965,LA,Individual,No,72-1279235,44965LA0570002,Humana Bronze 6300/New Orleans HMOx,44965LA057,,LAN001,LAS001,LAF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341677,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333136,http://apps.humana.com/marketing/documents.asp?file=2323880,44965LA0570002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0010003,LAHC Silver Plus,67202LA001,,LAN001,LAS001,LAF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_SilverPlus_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0010003-01,Standard Silver On Exchange Plan,,0.688694417476654,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,100","$6,000","$2,000",$200,$200,"$6,000",13
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0010003,LAHC Silver Plus,67202LA001,,LAN001,LAS001,LAF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_SilverPlus_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0010003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,SHOP (Small Group),No,45-3188075,67202LA0120002,LAHC Gold,67202LA012,,LAN001,LAS001,LAF002,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Gold_2015SGSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0120002-00,Standard Gold Off Exchange Plan,,0.783011674880981,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,"$1,200","$3,000","$1,500",$100,$300,"$3,000",14
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,SHOP (Small Group),No,45-3188075,67202LA0120002,LAHC Gold,67202LA012,,LAN001,LAS001,LAF002,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Gold_2015SGSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0120002-01,Standard Gold On Exchange Plan,,0.783011674880981,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,"$1,200","$3,000","$1,500",$100,$300,"$3,000",15
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030006,UnitedHealthcare Silver Compass 4000,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030006-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030006,UnitedHealthcare Silver Compass 4000,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030006-03,Limited Cost Sharing Plan Variation,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030006,UnitedHealthcare Silver Compass 4000,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030006-04,73% AV Level Silver Plan,73.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030006,UnitedHealthcare Silver Compass 4000,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030006-05,87% AV Level Silver Plan,86.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$850,"$1,700",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030006,UnitedHealthcare Silver Compass 4000,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030006-06,94% AV Level Silver Plan,94.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030011,UnitedHealthcare Silver Compass 5000,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030011-00,Standard Silver Off Exchange Plan,68.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030011,UnitedHealthcare Silver Compass 5000,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030011-01,Standard Silver On Exchange Plan,68.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030011,UnitedHealthcare Silver Compass 5000,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030011-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,24
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030011,UnitedHealthcare Silver Compass 5000,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030011-03,Limited Cost Sharing Plan Variation,68.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030011,UnitedHealthcare Silver Compass 5000,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030011-04,73% AV Level Silver Plan,72.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,600","$7,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030011,UnitedHealthcare Silver Compass 5000,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030011-05,87% AV Level Silver Plan,86.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,3,38499,LA,Individual,No,72-1074008,38499LA0030011,UnitedHealthcare Silver Compass 5000,38499LA003,,LAN006,LAS001,LAF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030011-06,94% AV Level Silver Plan,94.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,4,38499,LA,Individual,No,72-1074008,38499LA0030002,UnitedHealthcare Gold Compass 1000,38499LA003,,LAN006,LAS001,LAF003,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030002-00,Standard Gold Off Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,LA,38499,HIOS,8,2014-12-11 04:09:12,4,38499,LA,Individual,No,72-1074008,38499LA0030002,UnitedHealthcare Gold Compass 1000,38499LA003,,LAN006,LAS001,LAF003,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9955,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xla,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xla,38499LA0030002-01,Standard Gold On Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,LA,42544,HIOS,8,2014-11-14 05:23:27,3,42544,LA,SHOP (Small Group),Yes,75-1233841,42544LA0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,42544LA002,,LAN001,LAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.65,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/la/42544la0020006-15,,42544LA0020006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,42544,HIOS,8,2014-11-14 05:23:27,3,42544,LA,SHOP (Small Group),Yes,75-1233841,42544LA0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,42544LA002,,LAN001,LAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.65,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/la/42544la0020006-15,,42544LA0020006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,42544,HIOS,8,2014-11-14 05:23:27,3,42544,LA,Individual,Yes,75-1233841,42544LA0010006,Dentegra Dental PPO Family Basic Plan,42544LA001,,LAN001,LAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.48,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/la/42544la0010006-15,,42544LA0010006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,1,44965,LA,Individual,No,72-1279235,44965LA0570003,Humana Silver 4600/New Orleans HMOx,44965LA057,,LAN001,LAS001,LAF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341833,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333149,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0570003-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,1,44965,LA,Individual,Yes,72-1279235,44965LA0590001,Humana Dental Smart Choice,44965LA059,,LAN003,LAS003,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.30,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541279,,44965LA0590001-00,Standard Low Off Exchange Plan,71.30%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,4,44965,LA,Individual,No,72-1279235,44965LA0580005,Humana Silver 3650/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF004,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341794,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333318,http://apps.humana.com/marketing/documents.asp?file=2323880,44965LA0580005-00,Standard Silver Off Exchange Plan,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,10
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,4,44965,LA,Individual,No,72-1279235,44965LA0580005,Humana Silver 3650/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF004,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341794,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333318,http://apps.humana.com/marketing/documents.asp?file=2323880,44965LA0580005-01,Standard Silver On Exchange Plan,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,11
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,4,44965,LA,Individual,No,72-1279235,44965LA0580005,Humana Silver 3650/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF004,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341794,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333318,http://apps.humana.com/marketing/documents.asp?file=2323880,44965LA0580005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,12
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,4,44965,LA,Individual,No,72-1279235,44965LA0580005,Humana Silver 3650/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF004,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341794,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333318,http://apps.humana.com/marketing/documents.asp?file=2323880,44965LA0580005-03,Limited Cost Sharing Plan Variation,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,13
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0110003,LAHC Silver,67202LA011,,LAN001,LAS001,LAF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Silver_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0110003-00,Standard Silver Off Exchange Plan,,0.688694417476654,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$0,"$1,100","$6,000","$2,000",$200,$200,"$6,000",33
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0110003,LAHC Silver,67202LA011,,LAN001,LAS001,LAF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Silver_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0110003-01,Standard Silver On Exchange Plan,,0.688694417476654,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$0,"$1,100","$6,000","$2,000",$200,$200,"$6,000",34
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0110003,LAHC Silver,67202LA011,,LAN001,LAS001,LAF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Silver_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0110003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,35
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0110003,LAHC Silver,67202LA011,,LAN001,LAS001,LAF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Silver_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0110003-03,Limited Cost Sharing Plan Variation,,0.688694417476654,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$0,"$1,100","$6,000","$2,000",$200,$200,"$6,000",36
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0110003,LAHC Silver,67202LA011,,LAN001,LAS001,LAF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Silver_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0110003-04,73% AV Level Silver Plan,,0.72465842962265,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750",$0,"$1,150","$5,200","$1,750",$125,$200,"$5,200",37
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0110003,LAHC Silver,67202LA011,,LAN001,LAS001,LAF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Silver_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0110003-05,87% AV Level Silver Plan,,0.864651799201965,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,"$1,050","$1,500",$500,$75,$450,"$1,500",38
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0110003,LAHC Silver,67202LA011,,LAN001,LAS001,LAF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Silver_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0110003-06,94% AV Level Silver Plan,,0.936677038669586,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$0,$550,$700,$150,$25,$325,$700,39
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0110004,LAHC Bronze,67202LA011,,LAN001,LAS001,LAF004,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Bronze_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0110004-00,Standard Bronze Off Exchange Plan,,0.612048447132111,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,750",$0,"$1,100","$6,350","$4,500",$300,$100,"$6,350",40
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,1,44965,LA,Individual,Yes,72-1279235,44965LA0590001,Humana Dental Smart Choice,44965LA059,,LAN003,LAS003,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.30,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541279,,44965LA0590001-01,Standard Low On Exchange Plan,71.30%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,1,44965,LA,Individual,No,72-1279235,44965LA0570003,Humana Silver 4600/New Orleans HMOx,44965LA057,,LAN001,LAS001,LAF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341833,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333149,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0570003-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,1,44965,LA,Individual,No,72-1279235,44965LA0570003,Humana Silver 4600/New Orleans HMOx,44965LA057,,LAN001,LAS001,LAF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341833,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333149,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0570003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,1,44965,LA,Individual,No,72-1279235,44965LA0570003,Humana Silver 4600/New Orleans HMOx,44965LA057,,LAN001,LAS001,LAF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341833,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333149,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0570003-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,1,44965,LA,Individual,No,72-1279235,44965LA0570003,Humana Silver 4600/New Orleans HMOx,44965LA057,,LAN001,LAS001,LAF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341833,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333149,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0570003-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,1,44965,LA,Individual,No,72-1279235,44965LA0570003,Humana Silver 4600/New Orleans HMOx,44965LA057,,LAN001,LAS001,LAF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341833,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333149,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0570003-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,1,44965,LA,Individual,No,72-1279235,44965LA0570003,Humana Silver 4600/New Orleans HMOx,44965LA057,,LAN001,LAS001,LAF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341833,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333149,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0570003-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,1,44965,LA,Individual,No,72-1279235,44965LA0570004,Humana Gold 2500/New Orleans HMOx,44965LA057,,LAN001,LAS001,LAF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341703,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333201,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0570004-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,1,44965,LA,Individual,No,72-1279235,44965LA0570004,Humana Gold 2500/New Orleans HMOx,44965LA057,,LAN001,LAS001,LAF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341703,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333201,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0570004-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,1,44965,LA,Individual,No,72-1279235,44965LA0570004,Humana Gold 2500/New Orleans HMOx,44965LA057,,LAN001,LAS001,LAF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341703,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333201,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0570004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,1,44965,LA,Individual,No,72-1279235,44965LA0570004,Humana Gold 2500/New Orleans HMOx,44965LA057,,LAN001,LAS001,LAF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341703,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333201,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0570004-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,1,44965,LA,Individual,No,72-1279235,44965LA0570005,Humana Platinum 1000/New Orleans HMOx,44965LA057,,LAN001,LAS001,LAF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341729,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333214,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0570005-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,1,44965,LA,Individual,No,72-1279235,44965LA0570005,Humana Platinum 1000/New Orleans HMOx,44965LA057,,LAN001,LAS001,LAF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341729,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333214,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0570005-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,1,44965,LA,Individual,No,72-1279235,44965LA0570005,Humana Platinum 1000/New Orleans HMOx,44965LA057,,LAN001,LAS001,LAF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341729,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333214,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0570005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,1,44965,LA,Individual,No,72-1279235,44965LA0570005,Humana Platinum 1000/New Orleans HMOx,44965LA057,,LAN001,LAS001,LAF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341729,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333214,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0570005-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,2,44965,LA,Individual,No,72-1279235,44965LA0570001,Humana Basic 6600/New Orleans HMOx,44965LA057,,LAN001,LAS001,LAF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341638,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333123,http://apps.humana.com/marketing/documents.asp?file=2323880,44965LA0570001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,2,44965,LA,Individual,No,72-1279235,44965LA0570001,Humana Basic 6600/New Orleans HMOx,44965LA057,,LAN001,LAS001,LAF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341638,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333123,http://apps.humana.com/marketing/documents.asp?file=2323880,44965LA0570001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,2,44965,LA,Individual,No,72-1279235,44965LA0570002,Humana Bronze 6300/New Orleans HMOx,44965LA057,,LAN001,LAS001,LAF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341677,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333136,http://apps.humana.com/marketing/documents.asp?file=2323880,44965LA0570002-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,3,44965,LA,Individual,No,72-1279235,44965LA0580004,Humana Silver 4250/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF006,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341807,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333266,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0580004-03,Limited Cost Sharing Plan Variation,,0.681853055953979,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$4,250","$8,500",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,3,44965,LA,Individual,No,72-1279235,44965LA0580004,Humana Silver 4250/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF006,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341807,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333266,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0580004-04,73% AV Level Silver Plan,,0.725123465061188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,3,44965,LA,Individual,No,72-1279235,44965LA0580004,Humana Silver 4250/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF006,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341807,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333266,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0580004-05,87% AV Level Silver Plan,,0.863307356834412,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,3,44965,LA,Individual,No,72-1279235,44965LA0580004,Humana Silver 4250/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF006,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341807,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333266,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0580004-06,94% AV Level Silver Plan,,0.937241017818451,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,$250,$500,50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,3,44965,LA,Individual,No,72-1279235,44965LA0580006,Humana Gold 2500/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF007,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341690,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333370,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0580006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,3,44965,LA,Individual,No,72-1279235,44965LA0580006,Humana Gold 2500/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF007,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341690,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333370,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0580006-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,3,44965,LA,Individual,No,72-1279235,44965LA0580007,Humana Platinum 1000/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF007,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341716,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333383,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0580007-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,3,44965,LA,Individual,No,72-1279235,44965LA0580007,Humana Platinum 1000/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF007,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341716,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333383,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0580007-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,3,44965,LA,Individual,No,72-1279235,44965LA0580007,Humana Platinum 1000/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF007,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341716,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333383,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0580007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,3,44965,LA,Individual,No,72-1279235,44965LA0580007,Humana Platinum 1000/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF007,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341716,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333383,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0580007-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,4,44965,LA,Individual,No,72-1279235,44965LA0580001,Humana Basic 6600/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF004,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341625,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333227,http://apps.humana.com/marketing/documents.asp?file=2323880,44965LA0580001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,4,44965,LA,Individual,No,72-1279235,44965LA0580001,Humana Basic 6600/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF004,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341625,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333227,http://apps.humana.com/marketing/documents.asp?file=2323880,44965LA0580001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,4,44965,LA,Individual,No,72-1279235,44965LA0580002,Humana Bronze 6300/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF004,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341664,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333240,http://apps.humana.com/marketing/documents.asp?file=2323880,44965LA0580002-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,6
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,4,44965,LA,Individual,No,72-1279235,44965LA0580002,Humana Bronze 6300/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF004,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341664,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333240,http://apps.humana.com/marketing/documents.asp?file=2323880,44965LA0580002-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,4,44965,LA,Individual,No,72-1279235,44965LA0580002,Humana Bronze 6300/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF004,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341664,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333240,http://apps.humana.com/marketing/documents.asp?file=2323880,44965LA0580002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,4,44965,LA,Individual,No,72-1279235,44965LA0580002,Humana Bronze 6300/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF004,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341664,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333240,http://apps.humana.com/marketing/documents.asp?file=2323880,44965LA0580002-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,9
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,4,44965,LA,Individual,No,72-1279235,44965LA0580005,Humana Silver 3650/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF004,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341794,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333318,http://apps.humana.com/marketing/documents.asp?file=2323880,44965LA0580005-04,73% AV Level Silver Plan,,0.721818149089813,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,920","$5,840",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,920","$5,840",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,14
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,4,44965,LA,Individual,No,72-1279235,44965LA0580005,Humana Silver 3650/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF004,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341794,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333318,http://apps.humana.com/marketing/documents.asp?file=2323880,44965LA0580005-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,15
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,4,44965,LA,Individual,No,72-1279235,44965LA0580005,Humana Silver 3650/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF004,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341794,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333318,http://apps.humana.com/marketing/documents.asp?file=2323880,44965LA0580005-06,94% AV Level Silver Plan,,0.935785233974457,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$475,$950,,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$475,$950,0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,16
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,5,44965,LA,Individual,No,72-1279235,44965LA0580003,Humana Bronze 4850/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF005,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341651,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333253,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0580003-00,Standard Bronze Off Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800",Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,"$9,700","$19,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,5,44965,LA,Individual,No,72-1279235,44965LA0580003,Humana Bronze 4850/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF005,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341651,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333253,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0580003-01,Standard Bronze On Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800",Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,"$9,700","$19,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,5,44965,LA,Individual,No,72-1279235,44965LA0580003,Humana Bronze 4850/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF005,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341651,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333253,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0580003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,LA,44965,HIOS,17,2015-01-16 17:32:32,5,44965,LA,Individual,No,72-1279235,44965LA0580003,Humana Bronze 4850/ChoiceCare Network PPO,44965LA058,,LAN002,LAS002,LAF005,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341651,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333253,http://apps.humana.com/marketing/documents.asp?file=2323815,44965LA0580003-03,Limited Cost Sharing Plan Variation,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800",Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,"$9,700","$19,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,LA,46441,HIOS,3,2014-08-08 08:53:29,1,46441,LA,SHOP (Small Group),Yes,44-0308260,46441LA0010001,KCL EHB Low PPO,46441LA001,,LAN001,LAS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$35.79,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,46441LA0010001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,46441,HIOS,3,2014-08-08 08:53:29,1,46441,LA,SHOP (Small Group),Yes,44-0308260,46441LA0010003,KCL EHB Low MAC,46441LA001,,LAN001,LAS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$24.86,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,46441LA0010003-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,46441,HIOS,3,2014-08-08 08:53:29,1,46441,LA,SHOP (Small Group),Yes,44-0308260,46441LA0010005,KCL Fam Low PPO,46441LA001,,LAN001,LAS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$35.79,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,46441LA0010005-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,LA,46441,HIOS,3,2014-08-08 08:53:29,1,46441,LA,SHOP (Small Group),Yes,44-0308260,46441LA0010007,KCL Fam Low MAC,46441LA001,,LAN001,LAS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$24.86,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,46441LA0010007-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,LA,46441,HIOS,3,2014-08-08 08:53:29,2,46441,LA,SHOP (Small Group),Yes,44-0308260,46441LA0010002,KCL EHB High PPO,46441LA001,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$44.05,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,46441LA0010002-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,46441,HIOS,3,2014-08-08 08:53:29,2,46441,LA,SHOP (Small Group),Yes,44-0308260,46441LA0010004,KCL EHB High MAC,46441LA001,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$31.74,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,46441LA0010004-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,46441,HIOS,3,2014-08-08 08:53:29,2,46441,LA,SHOP (Small Group),Yes,44-0308260,46441LA0010006,KCL Fam High PPO,46441LA001,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$44.05,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,46441LA0010006-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,LA,46441,HIOS,3,2014-08-08 08:53:29,2,46441,LA,SHOP (Small Group),Yes,44-0308260,46441LA0010008,KCL Fam High MAC,46441LA001,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$31.74,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,46441LA0010008-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,LA,58302,HIOS,2,2014-08-03 08:59:32,1,58302,LA,SHOP (Small Group),Yes,93-0242990,58302LA0030002,EHB High Passive,58302LA003,,LAN001,LAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.92,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,58302LA0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,58302,HIOS,2,2014-08-03 08:59:32,1,58302,LA,SHOP (Small Group),Yes,93-0242990,58302LA0030001,EHB Low Passive,58302LA003,,LAN001,LAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.05,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,58302LA0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,65168,HIOS,2,2014-08-03 08:59:32,1,65168,LA,SHOP (Small Group),Yes,47-0098400,65168LA0030002,EHB High Passive,65168LA003,,LAN001,LAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.34,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,65168LA0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,65168,HIOS,2,2014-08-03 08:59:32,1,65168,LA,SHOP (Small Group),Yes,47-0098400,65168LA0030001,EHB Low Passive,65168LA003,,LAN001,LAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.71,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,65168LA0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0010001,LAHC Platinum Plus,67202LA001,,LAN001,LAS001,LAF001,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_PlatinumPlus_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0010001-00,Standard Platinum Off Exchange Plan,,0.881231784820557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$500,$0,$900,"$1,400",$500,$50,$600,"$1,400",4
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,SHOP (Small Group),No,45-3188075,67202LA0030001,LAHC Platinum Plus,67202LA003,,LAN001,LAS001,LAF001,Existing,POS,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_PlatinumPlus_2015SGSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0030001-00,Standard Platinum Off Exchange Plan,,0.881231784820557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$500,$0,$900,"$1,400",$500,$50,$600,"$1,400",4
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,SHOP (Small Group),No,45-3188075,67202LA0030001,LAHC Platinum Plus,67202LA003,,LAN001,LAS001,LAF001,Existing,POS,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_PlatinumPlus_2015SGSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0030001-01,Standard Platinum On Exchange Plan,,0.881231784820557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$500,$0,$900,"$1,400",$500,$50,$600,"$1,400",5
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0010001,LAHC Platinum Plus,67202LA001,,LAN001,LAS001,LAF001,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_PlatinumPlus_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0010001-01,Standard Platinum On Exchange Plan,,0.881231784820557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$500,$0,$900,"$1,400",$500,$50,$600,"$1,400",5
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0010001,LAHC Platinum Plus,67202LA001,,LAN001,LAS001,LAF001,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_PlatinumPlus_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0010001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,SHOP (Small Group),No,45-3188075,67202LA0030004,LAHC Bronze Plus,67202LA003,,LAN001,LAS001,LAF004,Existing,POS,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_BronzePlus_2015SGSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0030004-00,Standard Bronze Off Exchange Plan,,0.612048447132111,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$4,750",$0,"$1,100","$6,350","$4,500",$300,$100,"$6,350",10
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,SHOP (Small Group),No,45-3188075,67202LA0030004,LAHC Bronze Plus,67202LA003,,LAN001,LAS001,LAF004,Existing,POS,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_BronzePlus_2015SGSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0030004-01,Standard Bronze On Exchange Plan,,0.612048447132111,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$4,750",$0,"$1,100","$6,350","$4,500",$300,$100,"$6,350",11
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0010003,LAHC Silver Plus,67202LA001,,LAN001,LAS001,LAF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_SilverPlus_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0010003-03,Limited Cost Sharing Plan Variation,,0.688694417476654,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,100","$6,000","$2,000",$200,$200,"$6,000",15
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0010003,LAHC Silver Plus,67202LA001,,LAN001,LAS001,LAF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_SilverPlus_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0010003-04,73% AV Level Silver Plan,,0.72465842962265,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",20%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,750",$0,"$1,150","$5,200","$1,750",$125,$200,"$5,200",16
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,SHOP (Small Group),No,45-3188075,67202LA0120003,LAHC Silver,67202LA012,,LAN001,LAS001,LAF003,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Silver_2015SGSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0120003-00,Standard Silver Off Exchange Plan,,0.688694417476654,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$0,"$1,100","$6,000","$2,000",$200,$200,"$6,000",16
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,SHOP (Small Group),No,45-3188075,67202LA0120003,LAHC Silver,67202LA012,,LAN001,LAS001,LAF003,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Silver_2015SGSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0120003-01,Standard Silver On Exchange Plan,,0.688694417476654,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$0,"$1,100","$6,000","$2,000",$200,$200,"$6,000",17
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0110001,LAHC Platinum,67202LA011,,LAN001,LAS001,LAF001,New,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Platinum_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0110001-00,Standard Platinum Off Exchange Plan,,0.881231784820557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$900,"$1,400",$500,$50,$600,"$1,400",25
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0110001,LAHC Platinum,67202LA011,,LAN001,LAS001,LAF001,New,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Platinum_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0110001-01,Standard Platinum On Exchange Plan,,0.881231784820557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$900,"$1,400",$500,$50,$600,"$1,400",26
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0110001,LAHC Platinum,67202LA011,,LAN001,LAS001,LAF001,New,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Platinum_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0110001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,27
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0110001,LAHC Platinum,67202LA011,,LAN001,LAS001,LAF001,New,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Platinum_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0110001-03,Limited Cost Sharing Plan Variation,,0.881231784820557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$900,"$1,400",$500,$50,$600,"$1,400",28
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0110002,LAHC Gold,67202LA011,,LAN001,LAS001,LAF002,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Gold_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0110002-00,Standard Gold Off Exchange Plan,,0.783011674880981,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,"$1,200","$3,000","$1,500",$100,$300,"$3,000",29
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0110002,LAHC Gold,67202LA011,,LAN001,LAS001,LAF002,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Gold_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0110002-01,Standard Gold On Exchange Plan,,0.783011674880981,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,"$1,200","$3,000","$1,500",$100,$300,"$3,000",30
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0110002,LAHC Gold,67202LA011,,LAN001,LAS001,LAF002,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Gold_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0110002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,31
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0110002,LAHC Gold,67202LA011,,LAN001,LAS001,LAF002,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Gold_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0110002-03,Limited Cost Sharing Plan Variation,,0.783011674880981,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,"$1,200","$3,000","$1,500",$100,$300,"$3,000",32
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0110004,LAHC Bronze,67202LA011,,LAN001,LAS001,LAF004,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Bronze_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0110004-01,Standard Bronze On Exchange Plan,,0.612048447132111,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,750",$0,"$1,100","$6,350","$4,500",$300,$100,"$6,350",41
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0110004,LAHC Bronze,67202LA011,,LAN001,LAS001,LAF004,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Bronze_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0110004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,42
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0110004,LAHC Bronze,67202LA011,,LAN001,LAS001,LAF004,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,0,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Bronze_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0110004-03,Limited Cost Sharing Plan Variation,,0.612048447132111,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,750",$0,"$1,100","$6,350","$4,500",$300,$100,"$6,350",43
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0110005,LAHC Catastrophic,67202LA011,,LAN001,LAS001,LAF005,New,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,3,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Catastrophic_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0110005-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,350",$0,$0,"$6,350","$4,750",$0,$0,"$6,350",44
2015,LA,67202,HIOS,8,2014-11-14 05:23:27,1,67202,LA,Individual,No,45-3188075,67202LA0110005,LAHC Catastrophic,67202LA011,,LAN001,LAS001,LAF005,New,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,3,3,0,2015-01-01,2015-12-31,No,,Yes,Access to a national network,Yes,http://www.mylahc.org/Files/Repository/LAHC_Catastrophic_2015INDSBC.PDF,https://payment.mylahc.org,http://www.mylahc.org/members,http://www.mylahc.org/formulary,67202LA0110005-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,350",$0,$0,"$6,350","$4,750",$0,$0,"$6,350",45
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,SHOP (Small Group),No,72-1285173,67243LA0100001,AAA011 Vantage SHOP Platinum,67243LA010,7821091072,LAN001,LAS001,LAF001,Existing,POS,Platinum,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,,No,No,,Allows Adult and Child-Only,,Yes,,,0.97417410806774,,,0,0,0,2015-01-01,,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0100001-00,Standard Platinum Off Exchange Plan,,0.897303342819214,No,No,No,100%,,"$6,100","$12,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$928,$0,$150,$0,$520,$226,$39,4
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,Yes,23-7384555,97176LA0390002,"Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50%/50% coinsurance, $50 deductible",97176LA039,,LAN002,LAS002,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.90,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Coverage available for covered benefits,Yes,,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-bluedental-brochure,,97176LA0390002-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0340002,Blue Max 70/50 $0,97176LA034,,LAN001,LAS001,LAF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340002-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$79,6
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030003,UnitedHealthcare Silver Compass 3500-1,16049MO003,,MON006,MOS001,MOF003,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030003-03,Limited Cost Sharing Plan Variation,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030003,UnitedHealthcare Silver Compass 3500-1,16049MO003,,MON006,MOS001,MOF003,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030003-04,73% AV Level Silver Plan,73.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570015,Humana Platinum 1000/Kansas City PPOx,30613MO057,,MON002,MOS002,MOF003,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342223,,http://apps.humana.com/marketing/documents.asp?file=2327325,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570015-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570015,Humana Platinum 1000/Kansas City PPOx,30613MO057,,MON002,MOS002,MOF003,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342223,,http://apps.humana.com/marketing/documents.asp?file=2327325,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570015-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,LA,87390,HIOS,4,2014-08-27 03:27:11,2,87390,LA,SHOP (Small Group),Yes,13-5123390,87390LA0060002,Guardian Family Essentials,87390LA006,,LAN001,LAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.39,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,87390LA0060002-01,Standard Low On Exchange Plan,70.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,SHOP (Small Group),No,23-7384555,97176LA0360010,Group Care copay 80/60 $1000,97176LA036,,LAN001,LAS001,LAF003,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency & non-emergency coverage subject to Blue Card Worldwide rules,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360010-00,http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx,www.bcbsla.com/smallgroup-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0360010-00,Standard Gold Off Exchange Plan,,0.797687530517578,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$1,000","$3,000",20%,,,,"$2,000","$6,000","$3,000","$9,000",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,000",$20,"$1,252",$150,"$1,000","$1,000",$54,$79,4
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,Yes,23-7384555,97176LA0390001,"Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible",97176LA039,,LAN002,LAS002,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.90,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Coverage available for covered benefits,Yes,,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-bluedental-brochure,,97176LA0390001-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0340002,Blue Max 70/50 $0,97176LA034,,LAN001,LAS001,LAF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340002-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340002-00,Standard Gold Off Exchange Plan,,0.791486501693726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$1,000","$3,000","$1,000","$3,000",$0,$0,"$2,184",$150,$0,$0,"$1,581",$79,4
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,SHOP (Small Group),Yes,23-7384555,97176LA0400001,"Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50% coinsurance, $75 deductible",97176LA040,,LAN002,LAS002,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.32,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Coverage available for covered benefits,Yes,,http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx,www.bcbsla.com/group-bluedental-brochure2015,,97176LA0400001-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,SHOP (Small Group),Yes,23-7384555,97176LA0400002,"Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible",97176LA040,,LAN002,LAS002,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.32,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Coverage available for covered benefits,Yes,,http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx,www.bcbsla.com/group-bluedental-brochure2015,,97176LA0400002-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0340002,Blue Max 70/50 $0,97176LA034,,LAN001,LAS001,LAF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340002-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340002-01,Standard Gold On Exchange Plan,,0.791486501693726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,"$2,184",$150,$0,$0,"$1,581",$79,5
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,Yes,23-7384555,97176LA0390001,"Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible",97176LA039,,LAN002,LAS002,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.90,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Coverage available for covered benefits,Yes,,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-bluedental-brochure,,97176LA0390001-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,SHOP (Small Group),No,23-7384555,97176LA0360010,Group Care copay 80/60 $1000,97176LA036,,LAN001,LAS001,LAF003,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency & non-emergency coverage subject to Blue Card Worldwide rules,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360010-00,http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx,www.bcbsla.com/smallgroup-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0360010-01,Standard Gold On Exchange Plan,,0.797687530517578,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$1,000","$3,000",20%,,,,"$2,000","$6,000","$3,000","$9,000",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,000",$20,"$1,252",$150,"$1,000","$1,000",$54,$79,5
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,SHOP (Small Group),No,23-7384555,97176LA0360013,Group Care copay 70/50 $2000,97176LA036,,LAN001,LAS001,LAF003,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency & non-emergency coverage subject to Blue Card Worldwide rules,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360013-00,http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx,www.bcbsla.com/smallgroup-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0360013-00,Standard Silver Off Exchange Plan,,0.708419740200043,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$4,000",30%,,,,"$4,000","$12,000","$6,000","$16,000",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,000",$20,"$1,578",$150,"$1,272","$1,000",$0,$79,6
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,6,32753,MO,Individual,No,86-0257201,32753MO0770019,Anthem Bronze Pathway X 4300 20,32753MO077,,MON002,MOS001,MOF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJ9,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770019-03,Limited Cost Sharing Plan Variation,61.56%,0.619325935840607,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600",20%,,,,"$8,600","$17,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,7,32753,MO,Individual,No,86-0257201,32753MO0770020,Anthem Silver Pathway X 3500 0,32753MO077,,MON002,MOS001,MOF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgenct Care Only,Yes,Emergency/Urgenct Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJC,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770020-00,Standard Silver Off Exchange Plan,70.30%,0.671796858310699,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,4,32753,MO,Individual,No,86-0257201,32753MO0770017,Anthem Bronze Pathway X 0 for HSA,32753MO077,,MON002,MOS001,MOF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJ3,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770017-03,Limited Cost Sharing Plan Variation,58.01%,0.576903939247131,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,200","$12,400",0%,,,,"$12,400","$24,800",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,5,32753,MO,Individual,No,86-0257201,32753MO0770018,Anthem Bronze Pathway X 20 for HSA,32753MO077,,MON002,MOS001,MOF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJ6,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770018-00,Standard Bronze Off Exchange Plan,61.00%,0.613896250724792,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,5,32753,MO,Individual,No,86-0257201,32753MO0770018,Anthem Bronze Pathway X 20 for HSA,32753MO077,,MON002,MOS001,MOF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJ6,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770018-01,Standard Bronze On Exchange Plan,61.00%,0.613896250724792,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,5,32753,MO,Individual,No,86-0257201,32753MO0770018,Anthem Bronze Pathway X 20 for HSA,32753MO077,,MON002,MOS001,MOF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJ6,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770018-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,5,32753,MO,Individual,No,86-0257201,32753MO0770018,Anthem Bronze Pathway X 20 for HSA,32753MO077,,MON002,MOS001,MOF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJ6,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770018-03,Limited Cost Sharing Plan Variation,61.00%,0.613896250724792,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,6,32753,MO,Individual,No,86-0257201,32753MO0770019,Anthem Bronze Pathway X 4300 20,32753MO077,,MON002,MOS001,MOF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJ9,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770019-00,Standard Bronze Off Exchange Plan,61.56%,0.619325935840607,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600",20%,,,,"$8,600","$17,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,6,32753,MO,Individual,No,86-0257201,32753MO0770019,Anthem Bronze Pathway X 4300 20,32753MO077,,MON002,MOS001,MOF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJ9,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770019-01,Standard Bronze On Exchange Plan,61.56%,0.619325935840607,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600",20%,,,,"$8,600","$17,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,6,32753,MO,Individual,No,86-0257201,32753MO0770019,Anthem Bronze Pathway X 4300 20,32753MO077,,MON002,MOS001,MOF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJ9,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770019-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090005,AAA011 Vantage Plus Individual Platinum,67243LA009,7821091072,LAN002,LAS002,LAF001,Existing,POS,Platinum,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090005-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,25
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090005,AAA011 Vantage Plus Individual Platinum,67243LA009,7821091072,LAN002,LAS002,LAF001,Existing,POS,Platinum,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090005-03,Limited Cost Sharing Plan Variation,,0.898633658885956,No,No,No,100%,,"$6,100","$12,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$928,$0,$150,$0,$520,$226,$39,26
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090006,AAA012 Vantage Plus Individual Gold,67243LA009,7821091072,LAN002,LAS002,LAF001,Existing,POS,Gold,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090006-00,Standard Gold Off Exchange Plan,,0.810307025909424,No,No,No,100%,,"$5,700","$11,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$750,"$1,500",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,"$1,833",$0,$150,$750,$900,$105,$39,27
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090006,AAA012 Vantage Plus Individual Gold,67243LA009,7821091072,LAN002,LAS002,LAF001,Existing,POS,Gold,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090006-01,Standard Gold On Exchange Plan,,0.810307025909424,No,No,No,100%,,"$5,700","$11,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$750,"$1,500",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,"$1,833",$0,$150,$750,$900,$105,$39,28
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0340002,Blue Max 70/50 $0,97176LA034,,LAN001,LAS001,LAF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340002-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340002-03,Limited Cost Sharing Plan Variation,,0.791486501693726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,"$2,184",$150,$0,$0,"$1,581",$79,7
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,Yes,23-7384555,97176LA0390002,"Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50%/50% coinsurance, $50 deductible",97176LA039,,LAN002,LAS002,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.90,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Coverage available for covered benefits,Yes,,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-bluedental-brochure,,97176LA0390002-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090006,AAA012 Vantage Plus Individual Gold,67243LA009,7821091072,LAN002,LAS002,LAF001,Existing,POS,Gold,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090006-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,29
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090006,AAA012 Vantage Plus Individual Gold,67243LA009,7821091072,LAN002,LAS002,LAF001,Existing,POS,Gold,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090006-03,Limited Cost Sharing Plan Variation,,0.810307025909424,No,No,No,100%,,"$5,700","$11,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$750,"$1,500",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,"$1,833",$0,$150,$750,$900,$105,$39,30
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090007,AAA013 Vantage Plus Individual Silver,67243LA009,7821091072,LAN002,LAS002,LAF001,Existing,POS,Silver,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090007-00,Standard Silver Off Exchange Plan,,0.709668517112732,No,No,No,100%,,"$5,400","$10,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$2,900","$5,800",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$885,$0,$150,"$1,419",$960,$0,$39,31
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090007,AAA013 Vantage Plus Individual Silver,67243LA009,7821091072,LAN002,LAS002,LAF001,Existing,POS,Silver,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090007-01,Standard Silver On Exchange Plan,,0.709668517112732,No,No,No,100%,,"$5,400","$10,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$2,900","$5,800",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$885,$0,$150,"$1,419",$960,$0,$39,32
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090001,AAA011 Vantage Individual Platinum,67243LA009,7821091072,LAN001,LAS001,LAF001,Existing,POS,Platinum,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090001-00,Standard Platinum Off Exchange Plan,,0.898633658885956,No,No,No,100%,,"$6,100","$12,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$928,$0,$150,$0,$520,$226,$39,4
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090001,AAA011 Vantage Individual Platinum,67243LA009,7821091072,LAN001,LAS001,LAF001,Existing,POS,Platinum,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090001-01,Standard Platinum On Exchange Plan,,0.898633658885956,No,No,No,100%,,"$6,100","$12,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$928,$0,$150,$0,$520,$226,$39,5
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,SHOP (Small Group),No,72-1285173,67243LA0100001,AAA011 Vantage SHOP Platinum,67243LA010,7821091072,LAN001,LAS001,LAF001,Existing,POS,Platinum,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,,No,No,,Allows Adult and Child-Only,,Yes,,,0.97417410806774,,,0,0,0,2015-01-01,,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0100001-01,Standard Platinum On Exchange Plan,,0.897303342819214,No,No,No,100%,,"$6,100","$12,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$928,$0,$150,$0,$520,$226,$39,5
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,SHOP (Small Group),No,72-1285173,67243LA0100002,AAA012 Vantage SHOP Gold,67243LA010,7821091072,LAN001,LAS001,LAF001,Existing,POS,Gold,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,,No,No,,Allows Adult and Child-Only,,Yes,,,0.97417410806774,,,0,0,0,2015-01-01,,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0100002-00,Standard Gold Off Exchange Plan,,0.808322846889496,No,No,No,100%,,"$5,700","$11,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$750,"$1,500",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,"$1,833",$0,$150,$750,$900,$105,$39,6
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090001,AAA011 Vantage Individual Platinum,67243LA009,7821091072,LAN001,LAS001,LAF001,Existing,POS,Platinum,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090001-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090001,AAA011 Vantage Individual Platinum,67243LA009,7821091072,LAN001,LAS001,LAF001,Existing,POS,Platinum,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090001-03,Limited Cost Sharing Plan Variation,,0.898633658885956,No,No,No,100%,,"$6,100","$12,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$928,$0,$150,$0,$520,$226,$39,7
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,SHOP (Small Group),No,72-1285173,67243LA0100002,AAA012 Vantage SHOP Gold,67243LA010,7821091072,LAN001,LAS001,LAF001,Existing,POS,Gold,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,,No,No,,Allows Adult and Child-Only,,Yes,,,0.97417410806774,,,0,0,0,2015-01-01,,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0100002-01,Standard Gold On Exchange Plan,,0.808322846889496,No,No,No,100%,,"$5,700","$11,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$750,"$1,500",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,"$1,833",$0,$150,$750,$900,$105,$39,7
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,SHOP (Small Group),No,72-1285173,67243LA0100003,AAA013 Vantage SHOP Silver,67243LA010,7821091072,LAN001,LAS001,LAF001,Existing,POS,Silver,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,,No,No,,Allows Adult and Child-Only,,Yes,,,0.97417410806774,,,0,0,0,2015-01-01,,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0100003-00,Standard Silver Off Exchange Plan,,0.706132769584656,No,No,No,100%,,"$5,400","$10,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$2,900","$5,800",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$885,$0,$150,"$1,419",$960,$0,$39,8
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090002,AAA012 Vantage Individual Gold,67243LA009,7821091072,LAN001,LAS001,LAF001,Existing,POS,Gold,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090002-00,Standard Gold Off Exchange Plan,,0.810307025909424,No,No,No,100%,,"$5,700","$11,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$750,"$1,500",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,"$1,833",$0,$150,$750,$900,$105,$39,8
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090002,AAA012 Vantage Individual Gold,67243LA009,7821091072,LAN001,LAS001,LAF001,Existing,POS,Gold,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090002-01,Standard Gold On Exchange Plan,,0.810307025909424,No,No,No,100%,,"$5,700","$11,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$750,"$1,500",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,"$1,833",$0,$150,$750,$900,$105,$39,9
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,SHOP (Small Group),No,72-1285173,67243LA0100003,AAA013 Vantage SHOP Silver,67243LA010,7821091072,LAN001,LAS001,LAF001,Existing,POS,Silver,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,,No,No,,Allows Adult and Child-Only,,Yes,,,0.97417410806774,,,0,0,0,2015-01-01,,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0100003-01,Standard Silver On Exchange Plan,,0.706132769584656,No,No,No,100%,,"$5,400","$10,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$2,900","$5,800",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$885,$0,$150,"$1,419",$960,$0,$39,9
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,SHOP (Small Group),No,72-1285173,67243LA0100004,AAA014 Vantage SHOP Bronze,67243LA010,7821091072,LAN001,LAS001,LAF001,Existing,POS,Bronze,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,,No,No,,Allows Adult and Child-Only,,Yes,,,0.97417410806774,,,0,0,0,2015-01-01,,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0100004-00,Standard Bronze Off Exchange Plan,,0.618174254894257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,"$6,600","$13,200",Not Applicable,Not Applicable,"$6,577",$23,$0,$150,"$1,419","$2,803",$0,$39,10
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090002,AAA012 Vantage Individual Gold,67243LA009,7821091072,LAN001,LAS001,LAF001,Existing,POS,Gold,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090002-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090002,AAA012 Vantage Individual Gold,67243LA009,7821091072,LAN001,LAS001,LAF001,Existing,POS,Gold,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090002-03,Limited Cost Sharing Plan Variation,,0.810307025909424,No,No,No,100%,,"$5,700","$11,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$750,"$1,500",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,"$1,833",$0,$150,$750,$900,$105,$39,11
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,SHOP (Small Group),No,72-1285173,67243LA0100004,AAA014 Vantage SHOP Bronze,67243LA010,7821091072,LAN001,LAS001,LAF001,Existing,POS,Bronze,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,,No,No,,Allows Adult and Child-Only,,Yes,,,0.97417410806774,,,0,0,0,2015-01-01,,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0100004-01,Standard Bronze On Exchange Plan,,0.618174254894257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,"$6,600","$13,200",Not Applicable,Not Applicable,"$6,577",$23,$0,$150,"$1,419","$2,803",$0,$39,11
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,SHOP (Small Group),No,72-1285173,67243LA0100005,AAA011 Vantage Plus SHOP Platinum,67243LA010,7821091072,LAN002,LAS002,LAF001,Existing,POS,Platinum,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,,No,No,,Allows Adult and Child-Only,,Yes,,,0.97417410806774,,,0,0,0,2015-01-01,,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0100005-00,Standard Platinum Off Exchange Plan,,0.897303342819214,No,No,No,100%,,"$6,100","$12,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$928,$0,$150,$0,$520,$226,$39,12
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090003,AAA013 Vantage Individual Silver,67243LA009,7821091072,LAN001,LAS001,LAF001,Existing,POS,Silver,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090003-00,Standard Silver Off Exchange Plan,,0.709668517112732,No,No,No,100%,,"$5,400","$10,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$2,900","$5,800",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$885,$0,$150,"$1,419",$960,$0,$39,12
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090003,AAA013 Vantage Individual Silver,67243LA009,7821091072,LAN001,LAS001,LAF001,Existing,POS,Silver,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090003-01,Standard Silver On Exchange Plan,,0.709668517112732,No,No,No,100%,,"$5,400","$10,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$2,900","$5,800",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$885,$0,$150,"$1,419",$960,$0,$39,13
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,SHOP (Small Group),No,72-1285173,67243LA0100005,AAA011 Vantage Plus SHOP Platinum,67243LA010,7821091072,LAN002,LAS002,LAF001,Existing,POS,Platinum,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,,No,No,,Allows Adult and Child-Only,,Yes,,,0.97417410806774,,,0,0,0,2015-01-01,,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0100005-01,Standard Platinum On Exchange Plan,,0.897303342819214,No,No,No,100%,,"$6,100","$12,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$928,$0,$150,$0,$520,$226,$39,13
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,SHOP (Small Group),No,72-1285173,67243LA0100006,AAA012 Vantage Plus SHOP Gold,67243LA010,7821091072,LAN002,LAS002,LAF001,Existing,POS,Gold,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,,No,No,,Allows Adult and Child-Only,,Yes,,,0.97417410806774,,,0,0,0,2015-01-01,,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0100006-00,Standard Gold Off Exchange Plan,,0.808322846889496,No,No,No,100%,,"$5,700","$11,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$750,"$1,500",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,"$1,833",$0,$150,$750,$900,$105,$39,14
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090003,AAA013 Vantage Individual Silver,67243LA009,7821091072,LAN001,LAS001,LAF001,Existing,POS,Silver,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090003-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090003,AAA013 Vantage Individual Silver,67243LA009,7821091072,LAN001,LAS001,LAF001,Existing,POS,Silver,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090003-03,Limited Cost Sharing Plan Variation,,0.709668517112732,No,No,No,100%,,"$5,400","$10,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$2,900","$5,800",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$885,$0,$150,"$1,419",$960,$0,$39,15
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,SHOP (Small Group),No,72-1285173,67243LA0100006,AAA012 Vantage Plus SHOP Gold,67243LA010,7821091072,LAN002,LAS002,LAF001,Existing,POS,Gold,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,,No,No,,Allows Adult and Child-Only,,Yes,,,0.97417410806774,,,0,0,0,2015-01-01,,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0100006-01,Standard Gold On Exchange Plan,,0.808322846889496,No,No,No,100%,,"$5,700","$11,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$750,"$1,500",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,"$1,833",$0,$150,$750,$900,$105,$39,15
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,SHOP (Small Group),No,72-1285173,67243LA0100007,AAA013 Vantage Plus SHOP Silver,67243LA010,7821091072,LAN002,LAS002,LAF001,Existing,POS,Silver,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,,No,No,,Allows Adult and Child-Only,,Yes,,,0.97417410806774,,,0,0,0,2015-01-01,,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0100007-00,Standard Silver Off Exchange Plan,,0.706132769584656,No,No,No,100%,,"$5,400","$10,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$2,900","$5,800",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$885,$0,$150,"$1,419",$960,$0,$39,16
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090003,AAA013 Vantage Individual Silver,67243LA009,7821091072,LAN001,LAS001,LAF001,Existing,POS,Silver,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090003-04,73% AV Level Silver Plan,,0.735981047153473,No,No,No,100%,,"$4,550","$9,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$2,900","$5,800",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$885,$0,$150,"$1,419",$960,$0,$39,16
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090003,AAA013 Vantage Individual Silver,67243LA009,7821091072,LAN001,LAS001,LAF001,Existing,POS,Silver,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090003-05,87% AV Level Silver Plan,,0.877192497253418,No,No,No,100%,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$500,"$1,000",10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,"$1,378",$0,$150,$500,$440,$91,$39,17
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,SHOP (Small Group),No,72-1285173,67243LA0100007,AAA013 Vantage Plus SHOP Silver,67243LA010,7821091072,LAN002,LAS002,LAF001,Existing,POS,Silver,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,,No,No,,Allows Adult and Child-Only,,Yes,,,0.97417410806774,,,0,0,0,2015-01-01,,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0100007-01,Standard Silver On Exchange Plan,,0.706132769584656,No,No,No,100%,,"$5,400","$10,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$2,900","$5,800",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$885,$0,$150,"$1,419",$960,$0,$39,17
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,SHOP (Small Group),No,72-1285173,67243LA0100008,AAA014  Vantage Plus SHOP Bronze,67243LA010,7821091072,LAN002,LAS002,LAF001,Existing,POS,Bronze,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,,No,No,,Allows Adult and Child-Only,,Yes,,,0.97417410806774,,,0,0,0,2015-01-01,,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0100008-00,Standard Bronze Off Exchange Plan,,0.618174254894257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,"$6,600","$13,200",Not Applicable,Not Applicable,"$6,577",$23,$0,$150,"$1,419","$2,803",$0,$39,18
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090003,AAA013 Vantage Individual Silver,67243LA009,7821091072,LAN001,LAS001,LAF001,Existing,POS,Silver,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090003-06,94% AV Level Silver Plan,,0.944734692573547,No,No,No,100%,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$100,$200,5%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$100,$323,$0,$150,$100,$225,$61,$39,18
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090004,AAA014 Vantage Individual Bronze,67243LA009,7821091072,LAN001,LAS001,LAF001,Existing,POS,Bronze,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090004-00,Standard Bronze Off Exchange Plan,,0.618174254894257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,"$6,600","$13,200",Not Applicable,Not Applicable,"$6,577",$23,$0,$150,"$1,419","$2,803",$0,$39,19
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,SHOP (Small Group),No,72-1285173,67243LA0100008,AAA014  Vantage Plus SHOP Bronze,67243LA010,7821091072,LAN002,LAS002,LAF001,Existing,POS,Bronze,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,,No,No,,Allows Adult and Child-Only,,Yes,,,0.97417410806774,,,0,0,0,2015-01-01,,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0100008-01,Standard Bronze On Exchange Plan,,0.618174254894257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,"$6,600","$13,200",Not Applicable,Not Applicable,"$6,577",$23,$0,$150,"$1,419","$2,803",$0,$39,19
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090004,AAA014 Vantage Individual Bronze,67243LA009,7821091072,LAN001,LAS001,LAF001,Existing,POS,Bronze,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090004-01,Standard Bronze On Exchange Plan,,0.618174254894257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,"$6,600","$13,200",Not Applicable,Not Applicable,"$6,577",$23,$0,$150,"$1,419","$2,803",$0,$39,20
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090004,AAA014 Vantage Individual Bronze,67243LA009,7821091072,LAN001,LAS001,LAF001,Existing,POS,Bronze,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,21
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090004,AAA014 Vantage Individual Bronze,67243LA009,7821091072,LAN001,LAS001,LAF001,Existing,POS,Bronze,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090004-03,Limited Cost Sharing Plan Variation,,0.618174254894257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,"$6,600","$13,200",Not Applicable,Not Applicable,"$6,577",$23,$0,$150,"$1,419","$2,803",$0,$39,22
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090005,AAA011 Vantage Plus Individual Platinum,67243LA009,7821091072,LAN002,LAS002,LAF001,Existing,POS,Platinum,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090005-00,Standard Platinum Off Exchange Plan,,0.898633658885956,No,No,No,100%,,"$6,100","$12,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$928,$0,$150,$0,$520,$226,$39,23
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090005,AAA011 Vantage Plus Individual Platinum,67243LA009,7821091072,LAN002,LAS002,LAF001,Existing,POS,Platinum,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090005-01,Standard Platinum On Exchange Plan,,0.898633658885956,No,No,No,100%,,"$6,100","$12,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$928,$0,$150,$0,$520,$226,$39,24
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090007,AAA013 Vantage Plus Individual Silver,67243LA009,7821091072,LAN002,LAS002,LAF001,Existing,POS,Silver,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090007-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,33
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090007,AAA013 Vantage Plus Individual Silver,67243LA009,7821091072,LAN002,LAS002,LAF001,Existing,POS,Silver,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090007-03,Limited Cost Sharing Plan Variation,,0.709668517112732,No,No,No,100%,,"$5,400","$10,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$2,900","$5,800",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$885,$0,$150,"$1,419",$960,$0,$39,34
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090007,AAA013 Vantage Plus Individual Silver,67243LA009,7821091072,LAN002,LAS002,LAF001,Existing,POS,Silver,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090007-04,73% AV Level Silver Plan,,0.735981047153473,No,No,No,100%,,"$4,550","$9,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$2,900","$5,800",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$885,$0,$150,"$1,419",$960,$0,$39,35
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090007,AAA013 Vantage Plus Individual Silver,67243LA009,7821091072,LAN002,LAS002,LAF001,Existing,POS,Silver,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090007-05,87% AV Level Silver Plan,,0.877192497253418,No,No,No,100%,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$500,"$1,000",10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,"$1,378",$0,$150,$500,$440,$91,$39,36
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090007,AAA013 Vantage Plus Individual Silver,67243LA009,7821091072,LAN002,LAS002,LAF001,Existing,POS,Silver,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,3,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090007-06,94% AV Level Silver Plan,,0.944734692573547,No,No,No,100%,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$100,$200,5%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$100,$323,$0,$150,$100,$225,$61,$39,37
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090008,AAA014 Vantage Plus Individual Bronze,67243LA009,7821091072,LAN002,LAS002,LAF001,Existing,POS,Bronze,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090008-00,Standard Bronze Off Exchange Plan,,0.618174254894257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,"$6,600","$13,200",Not Applicable,Not Applicable,"$6,577",$23,$0,$150,"$1,419","$2,803",$0,$39,38
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090008,AAA014 Vantage Plus Individual Bronze,67243LA009,7821091072,LAN002,LAS002,LAF001,Existing,POS,Bronze,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090008-01,Standard Bronze On Exchange Plan,,0.618174254894257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,"$6,600","$13,200",Not Applicable,Not Applicable,"$6,577",$23,$0,$150,"$1,419","$2,803",$0,$39,39
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090008,AAA014 Vantage Plus Individual Bronze,67243LA009,7821091072,LAN002,LAS002,LAF001,Existing,POS,Bronze,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,40
2015,LA,67243,HIOS,8,2015-04-22 11:06:15,1,67243,LA,Individual,No,72-1285173,67243LA0090008,AAA014 Vantage Plus Individual Bronze,67243LA009,7821091072,LAN002,LAS002,LAF001,Existing,POS,Bronze,No,Both,Yes,No,,Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.97690650291566,,,0,0,0,2015-01-01,2015-12-31,Yes,Covered as out-of-network,Yes,Out-of-Network Deductible and Co-insurance,No,http://www.vhpla.com/Reform/PlanDocuments,https://portal.vantagehealthplan.com/HIXPayment,http://www.vhpla.com/Reform/PlanDocuments,https://www.vantagehealthplan.com/Reform/PlanDocuments,67243LA0090008-03,Limited Cost Sharing Plan Variation,,0.618174254894257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,"$6,600","$13,200",Not Applicable,Not Applicable,"$6,577",$23,$0,$150,"$1,419","$2,803",$0,$39,41
2015,LA,72623,HIOS,5,2014-09-05 03:32:16,1,72623,LA,SHOP (Small Group),Yes,47-0322111,72623LA0010001,Certified Dental Plan Policy 1,72623LA001,,LAN001,LAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$17.11,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,72623LA0010001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,72623,HIOS,5,2014-09-05 03:32:16,1,72623,LA,SHOP (Small Group),Yes,47-0322111,72623LA0010002,Certified Dental Plan Policy 2,72623LA001,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.59,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,72623LA0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,72623,HIOS,5,2014-09-05 03:32:16,1,72623,LA,SHOP (Small Group),Yes,47-0322111,72623LA0010003,Certified Dental Plan Policy 3,72623LA001,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.31,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,72623LA0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,LA,72623,HIOS,5,2014-09-05 03:32:16,1,72623,LA,SHOP (Small Group),Yes,47-0322111,72623LA0010004,Certified Dental Plan Policy 4,72623LA001,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.79,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,72623LA0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,LA,75321,HIOS,3,2014-08-05 13:28:44,1,75321,LA,SHOP (Small Group),Yes,57-0523959,75321LA0010001,Group Pediatric Dental EHB Rider,75321LA001,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$29.98,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,75321LA0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,75321,HIOS,3,2014-08-05 13:28:44,1,75321,LA,SHOP (Small Group),Yes,57-0523959,75321LA0010002,Group Pediatric Dental EHB Rider,75321LA001,,LAN001,LAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.11,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,75321LA0010002-00,Standard Low Off Exchange Plan,69.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,75409,HIOS,2,2014-08-05 13:28:44,1,75409,LA,SHOP (Small Group),Yes,13-5581829,75409LA0150001,EHB Basic Dental Plan (Low),75409LA015,,LAN001,LAS001,,Existing,PPO,Low,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$17.33,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,75409LA0150001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,75409,HIOS,2,2014-08-05 13:28:44,2,75409,LA,SHOP (Small Group),Yes,13-5581829,75409LA0160001,EHB Enhanced Dental Plan (High),75409LA016,,LAN002,LAS001,,Existing,PPO,High,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$21.65,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,75409LA0160001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,75409,HIOS,2,2014-08-05 13:28:44,3,75409,LA,SHOP (Small Group),Yes,13-5581829,75409LA0170001,Family Basic Dental Plan (Low),75409LA017,,LAN003,LAS001,,Existing,PPO,Low,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$17.33,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,75409LA0170001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,75409,HIOS,2,2014-08-05 13:28:44,4,75409,LA,SHOP (Small Group),Yes,13-5581829,75409LA0180001,Family Enhanced Dental Plan (High),75409LA018,,LAN004,LAS001,,Existing,PPO,High,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$21.65,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,75409LA0180001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,1,78461,LA,SHOP (Small Group),Yes,95-6042390,78461LA0010001,BEST Life Child Dental Plus,78461LA001,,LAN001,LAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$38.19,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BEST_Life_Child_Dental_Plus_Plan.pdf,,78461LA0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,1,78461,LA,Individual,Yes,95-6042390,78461LA0020001,BESTOne Child Dental Plus,78461LA002,,LAN001,LAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$47.76,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BESTOne_Child_Dental_Plus_Plan.pdf,,78461LA0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,2,78461,LA,Individual,Yes,95-6042390,78461LA0020002,BESTOne Child Dental,78461LA002,,LAN001,LAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$38.99,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BESTOne_Child_Dental_Plan.pdf,,78461LA0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,2,78461,LA,SHOP (Small Group),Yes,95-6042390,78461LA0010002,BEST Life Child Dental,78461LA001,,LAN001,LAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$31.20,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BEST_Life_Child_Dental_Plan.pdf,,78461LA0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,3,78461,LA,SHOP (Small Group),Yes,95-6042390,78461LA0010007,BEST Dental Premium,78461LA001,,LAN001,LAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.19,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BESTDental_Premium_Plan.pdf,,78461LA0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,3,78461,LA,Individual,Yes,95-6042390,78461LA0020003,BESTOne Dental Advantage-Gold,78461LA002,,LAN001,LAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$47.76,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BESTOne_Dental_Advantage-Gold_Plan.pdf,,78461LA0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,3,78461,LA,Individual,Yes,95-6042390,78461LA0020003,BESTOne Dental Advantage-Gold,78461LA002,,LAN001,LAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$47.76,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BESTOne_Dental_Advantage-Gold_Plan.pdf,,78461LA0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,3,78461,LA,SHOP (Small Group),Yes,95-6042390,78461LA0010007,BEST Dental Premium,78461LA001,,LAN001,LAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.19,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BESTDental_Premium_Plan.pdf,,78461LA0010007-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,3,78461,LA,SHOP (Small Group),Yes,95-6042390,78461LA0010008,BEST Dental Standard-H,78461LA001,,LAN001,LAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.19,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BESTDental_Standard-H_Plan.pdf,,78461LA0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,3,78461,LA,Individual,Yes,95-6042390,78461LA0020004,BESTOne Dental Plus-Gold,78461LA002,,LAN001,LAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$47.76,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BESTOne_Dental_Plus-Gold_Plan.pdf,,78461LA0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,3,78461,LA,Individual,Yes,95-6042390,78461LA0020004,BESTOne Dental Plus-Gold,78461LA002,,LAN001,LAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$47.76,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BESTOne_Dental_Plus-Gold_Plan.pdf,,78461LA0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,3,78461,LA,SHOP (Small Group),Yes,95-6042390,78461LA0010008,BEST Dental Standard-H,78461LA001,,LAN001,LAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.19,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BESTDental_Standard-H_Plan.pdf,,78461LA0010008-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,3,78461,LA,SHOP (Small Group),Yes,95-6042390,78461LA0010010,BEST Dental Choice-H,78461LA001,,LAN001,LAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.19,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BESTDental_Choice-H_Plan.pdf,,78461LA0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,3,78461,LA,SHOP (Small Group),Yes,95-6042390,78461LA0010010,BEST Dental Choice-H,78461LA001,,LAN001,LAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.19,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BESTDental_Choice-H_Plan.pdf,,78461LA0010010-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,4,78461,LA,SHOP (Small Group),Yes,95-6042390,78461LA0010009,BEST Dental Standard-L,78461LA001,,LAN001,LAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.20,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BESTDental_Standard-L_Plan.pdf,,78461LA0010009-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,4,78461,LA,Individual,Yes,95-6042390,78461LA0020005,BESTOne Dental Plus-Silver,78461LA002,,LAN001,LAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.99,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BESTOne_Dental_Plus-Silver_Plan.pdf,,78461LA0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,4,78461,LA,Individual,Yes,95-6042390,78461LA0020005,BESTOne Dental Plus-Silver,78461LA002,,LAN001,LAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.99,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BESTOne_Dental_Plus-Silver_Plan.pdf,,78461LA0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,4,78461,LA,SHOP (Small Group),Yes,95-6042390,78461LA0010009,BEST Dental Standard-L,78461LA001,,LAN001,LAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.20,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BESTDental_Standard-L_Plan.pdf,,78461LA0010009-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,4,78461,LA,SHOP (Small Group),Yes,95-6042390,78461LA0010011,BEST Dental Choice-L,78461LA001,,LAN001,LAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.20,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BESTDental_Choice-L_Plan.pdf,,78461LA0010011-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,4,78461,LA,Individual,Yes,95-6042390,78461LA0020006,BESTOne Dental Basic-Silver,78461LA002,,LAN001,LAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.99,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BESTOne_Dental_Basic-Silver_Plan.pdf,,78461LA0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,4,78461,LA,Individual,Yes,95-6042390,78461LA0020006,BESTOne Dental Basic-Silver,78461LA002,,LAN001,LAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.99,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BESTOne_Dental_Basic-Silver_Plan.pdf,,78461LA0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,4,78461,LA,SHOP (Small Group),Yes,95-6042390,78461LA0010011,BEST Dental Choice-L,78461LA001,,LAN001,LAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.20,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BESTDental_Choice-L_Plan.pdf,,78461LA0010011-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,4,78461,LA,SHOP (Small Group),Yes,95-6042390,78461LA0010012,BEST Dental Value,78461LA001,,LAN001,LAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.20,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BESTDental_Value_Plan.pdf,,78461LA0010012-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,LA,78461,HIOS,5,2014-09-03 04:28:59,4,78461,LA,SHOP (Small Group),Yes,95-6042390,78461LA0010012,BEST Dental Value,78461LA001,,LAN001,LAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.20,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/LA/2015/LA_BESTDental_Value_Plan.pdf,,78461LA0010012-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,LA,86868,HIOS,4,2014-09-04 03:25:43,1,86868,LA,SHOP (Small Group),Yes,35-0472300,86868LA0010001,Lincoln Dental Connect?,86868LA001,,LAN001,LAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.89,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,86868LA0010001-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,86868,HIOS,4,2014-09-04 03:25:43,1,86868,LA,SHOP (Small Group),Yes,35-0472300,86868LA0010002,Lincoln Dental Connect?,86868LA001,,LAN001,LAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.35,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,86868LA0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,86868,HIOS,4,2014-09-04 03:25:43,1,86868,LA,SHOP (Small Group),Yes,35-0472300,86868LA0010003,Lincoln Dental Connect?,86868LA001,,LAN001,LAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.45,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,86868LA0010003-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,LA,86868,HIOS,4,2014-09-04 03:25:43,1,86868,LA,SHOP (Small Group),Yes,35-0472300,86868LA0010005,Lincoln Dental Connect?,86868LA001,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.14,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,86868LA0010005-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,LA,86868,HIOS,4,2014-09-04 03:25:43,1,86868,LA,SHOP (Small Group),Yes,35-0472300,86868LA0010006,Lincoln Dental Connect?,86868LA001,,LAN001,LAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.63,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,86868LA0010006-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,LA,86868,HIOS,4,2014-09-04 03:25:43,1,86868,LA,SHOP (Small Group),Yes,35-0472300,86868LA0010007,Lincoln Dental Connect?,86868LA001,,LAN001,LAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.06,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,86868LA0010007-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,LA,86868,HIOS,4,2014-09-04 03:25:43,2,86868,LA,SHOP (Small Group),Yes,35-0472300,86868LA0010004,Lincoln Dental Connect?,86868LA001,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.67,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,86868LA0010004-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,86868,HIOS,4,2014-09-04 03:25:43,2,86868,LA,SHOP (Small Group),Yes,35-0472300,86868LA0010008,Lincoln Dental Connect?,86868LA001,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.28,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,86868LA0010008-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,87390,HIOS,4,2014-08-27 03:27:11,1,87390,LA,SHOP (Small Group),Yes,13-5123390,87390LA0010002,Guardian Pediatric Advantage,87390LA001,,LAN001,LAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.39,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,87390LA0010002-00,Standard High Off Exchange Plan,84.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,87390,HIOS,4,2014-08-27 03:27:11,1,87390,LA,SHOP (Small Group),Yes,13-5123390,87390LA0020002,Guardian Pediatric Essentials,87390LA002,,LAN001,LAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$20.39,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,87390LA0020002-00,Standard Low Off Exchange Plan,70.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,87390,HIOS,4,2014-08-27 03:27:11,2,87390,LA,SHOP (Small Group),Yes,13-5123390,87390LA0040002,Guardian Family Advantage,87390LA004,,LAN001,LAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.39,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,87390LA0040002-00,Standard High Off Exchange Plan,84.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,87390,HIOS,4,2014-08-27 03:27:11,2,87390,LA,SHOP (Small Group),Yes,13-5123390,87390LA0040002,Guardian Family Advantage,87390LA004,,LAN001,LAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.39,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,87390LA0040002-01,Standard High On Exchange Plan,84.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,87390,HIOS,4,2014-08-27 03:27:11,2,87390,LA,SHOP (Small Group),Yes,13-5123390,87390LA0060002,Guardian Family Essentials,87390LA006,,LAN001,LAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.39,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,87390LA0060002-00,Standard Low Off Exchange Plan,70.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,SHOP (Small Group),Yes,23-7384555,97176LA0400003,"Blue Dental Preferred Plus Certified- $1,500 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible",97176LA040,,LAN002,LAS002,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.32,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Coverage available for covered benefits,Yes,,http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx,www.bcbsla.com/group-bluedental-brochure2015,,97176LA0400003-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,SHOP (Small Group),Yes,23-7384555,97176LA0400003,"Blue Dental Preferred Plus Certified- $1,500 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible",97176LA040,,LAN002,LAS002,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.32,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Coverage available for covered benefits,Yes,,http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx,www.bcbsla.com/group-bluedental-brochure2015,,97176LA0400003-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350003,Blue Saver 100/80 $2800,97176LA035,,LAN001,LAS001,LAF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350003-05,87% AV Level Silver Plan,86.55%,0.865523159503937,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"$10,000","$20,000","$11,700","$23,400",,,,,,,,,,,,,,,,,,,,,$800,"$1,600",0%,,,,"$5,600","$11,200","$6,400","$12,800",$800,$0,$0,$150,$800,$0,$0,$79,43
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350003,Blue Saver 100/80 $2800,97176LA035,,LAN001,LAS001,LAF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350003-06,94% AV Level Silver Plan,93.62%,0.93625795841217,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"$10,000","$20,000","$11,700","$23,400",,,,,,,,,,,,,,,,,,,,,$200,$400,0%,,,,"$5,600","$11,200","$5,800","$11,600",$200,$0,$0,$150,$200,$0,$0,$79,44
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030004,UnitedHealthcare Silver Compass 5000,16049MO003,,MON006,MOS001,MOF004,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030004-00,Standard Silver Off Exchange Plan,69.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030004,UnitedHealthcare Silver Compass 5000,16049MO003,,MON006,MOS001,MOF004,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030004-01,Standard Silver On Exchange Plan,69.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030004,UnitedHealthcare Silver Compass 5000,16049MO003,,MON006,MOS001,MOF004,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030004-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,24
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030004,UnitedHealthcare Silver Compass 5000,16049MO003,,MON006,MOS001,MOF004,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030004-03,Limited Cost Sharing Plan Variation,69.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030004,UnitedHealthcare Silver Compass 5000,16049MO003,,MON006,MOS001,MOF004,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030004-04,73% AV Level Silver Plan,73.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,$750,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030004,UnitedHealthcare Silver Compass 5000,16049MO003,,MON006,MOS001,MOF004,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030004-05,87% AV Level Silver Plan,86.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030004,UnitedHealthcare Silver Compass 5000,16049MO003,,MON006,MOS001,MOF004,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030004-06,94% AV Level Silver Plan,93.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,3,16049,MO,Individual,No,35-1665915,16049MO0030006,UnitedHealthcare Bronze Compass 5500,16049MO003,,MON006,MOS001,MOF002,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030006-00,Standard Bronze Off Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,3,16049,MO,Individual,No,35-1665915,16049MO0030006,UnitedHealthcare Bronze Compass 5500,16049MO003,,MON006,MOS001,MOF002,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030006-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,3,16049,MO,Individual,No,35-1665915,16049MO0030006,UnitedHealthcare Bronze Compass 5500,16049MO003,,MON006,MOS001,MOF002,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,3,16049,MO,Individual,No,35-1665915,16049MO0030006,UnitedHealthcare Bronze Compass 5500,16049MO003,,MON006,MOS001,MOF002,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030006-03,Limited Cost Sharing Plan Variation,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,SHOP (Small Group),No,23-7384555,97176LA0360013,Group Care copay 70/50 $2000,97176LA036,,LAN001,LAS001,LAF003,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency & non-emergency coverage subject to Blue Card Worldwide rules,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360013-00,http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx,www.bcbsla.com/smallgroup-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0360013-01,Standard Silver On Exchange Plan,,0.708419740200043,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$4,000",30%,,,,"$4,000","$12,000","$6,000","$16,000",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,000",$20,"$1,578",$150,"$1,272","$1,000",$0,$79,7
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0340007,Blue Max 50/50 $0,97176LA034,,LAN001,LAS001,LAF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340007-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340007-00,Standard Silver Off Exchange Plan,,0.71539831161499,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$1,000","$3,000","$1,000","$3,000",$0,$0,"$3,641",$150,$0,$0,"$2,635",$79,8
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,3,97176,LA,Individual,No,23-7384555,97176LA0340008,Blue Max 70/50 $1500,97176LA034,,LAN001,LAS001,LAF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340008-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340008-06,94% AV Level Silver Plan,,0.938082277774811,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"$10,000","$20,000","$11,700","$23,400",$0,$0,5%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,$23,$0,$363,$150,$500,$245,$121,$79,10
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,4,97176,LA,Individual,No,23-7384555,97176LA0340005,Blue Max copay 80/60 $1000,97176LA034,,LAN001,LAS001,LAF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340005-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340005-00,Standard Gold Off Exchange Plan,,0.79078209400177,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$8,500","$17,000","$12,750","$25,500","$1,000","$3,000",20%,,,,"$2,000","$6,000","$3,000","$9,000",$250,$750,10%,,,,$250,$750,$250,$750,,,,,,,,,,,"$1,023",$0,"$1,252",$150,"$1,250",$673,$54,$79,4
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,1,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780006,Anthem Gold Blue Preferred X 1000 20 5500 Plus,32753MO078,,MON006,MOS004,MOF021,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99205874850647,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LXV,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780006-00,Standard Gold Off Exchange Plan,78.32%,0.783996999263763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,000","$3,000",20%,,,,"$2,000","$4,000","$3,000","$7,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,1,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780006,Anthem Gold Blue Preferred X 1000 20 5500 Plus,32753MO078,,MON006,MOS004,MOF021,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99205874850647,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LXV,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780006-01,Standard Gold On Exchange Plan,78.32%,0.783996999263763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,000","$3,000",20%,,,,"$2,000","$4,000","$3,000","$7,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,1,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780007,Anthem Gold Blue Preferred X 1000 20 5500 Plus,32753MO078,,MON006,MOS005,MOF021,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.992057608140139,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LXV,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780007-00,Standard Gold Off Exchange Plan,78.32%,0.783996999263763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,000","$3,000",20%,,,,"$2,000","$4,000","$3,000","$7,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,1,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780007,Anthem Gold Blue Preferred X 1000 20 5500 Plus,32753MO078,,MON006,MOS005,MOF021,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.992057608140139,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LXV,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780007-01,Standard Gold On Exchange Plan,78.32%,0.783996999263763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,000","$3,000",20%,,,,"$2,000","$4,000","$3,000","$7,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,1,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780008,Anthem Gold Blue Preferred X 1000 20 5500 Plus,32753MO078,,MON006,MOS006,MOF021,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.992063259102651,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LXV,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780008-00,Standard Gold Off Exchange Plan,78.32%,0.783996999263763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,000","$3,000",20%,,,,"$2,000","$4,000","$3,000","$7,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,1,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780008,Anthem Gold Blue Preferred X 1000 20 5500 Plus,32753MO078,,MON006,MOS006,MOF021,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.992063259102651,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LXV,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780008-01,Standard Gold On Exchange Plan,78.32%,0.783996999263763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,000","$3,000",20%,,,,"$2,000","$4,000","$3,000","$7,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,1,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780009,Anthem Gold Blue Preferred X 1000 20 5500 Plus,32753MO078,,MON006,MOS007,MOF021,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.992068040428465,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LXV,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780009-00,Standard Gold Off Exchange Plan,78.32%,0.783996999263763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,000","$3,000",20%,,,,"$2,000","$4,000","$3,000","$7,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,1,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780009,Anthem Gold Blue Preferred X 1000 20 5500 Plus,32753MO078,,MON006,MOS007,MOF021,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.992068040428465,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LXV,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780009-01,Standard Gold On Exchange Plan,78.32%,0.783996999263763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,000","$3,000",20%,,,,"$2,000","$4,000","$3,000","$7,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,1,32753,MO,Individual,No,86-0257201,32753MO0770025,Anthem Catastrophic Pathway X 6600 0,32753MO077,,MON002,MOS001,MOF003,Existing,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GHV,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770025-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,1,32753,MO,SHOP (Small Group),Yes,86-0257201,32753MO0870003,Anthem Dental Pediatric,32753MO087,,MON009,MOS009,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$17.29,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/mo/f0/s0/t0/pw_e214660.pdf,,,,32753MO0870003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,1,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780010,Anthem Gold Blue Preferred X 1000 20 5500 Plus,32753MO078,,MON006,MOS008,MOF021,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.992078093711281,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LXV,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780010-00,Standard Gold Off Exchange Plan,78.32%,0.783996999263763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,000","$3,000",20%,,,,"$2,000","$4,000","$3,000","$7,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,1,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780010,Anthem Gold Blue Preferred X 1000 20 5500 Plus,32753MO078,,MON006,MOS008,MOF021,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.992078093711281,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LXV,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780010-01,Standard Gold On Exchange Plan,78.32%,0.783996999263763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,000","$3,000",20%,,,,"$2,000","$4,000","$3,000","$7,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780011,Anthem Bronze Blue Preferred X 3500 20 6350 Plus w HSA,32753MO078,,MON006,MOS002,MOF022,Existing,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.988543971270227,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LVN,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780011-00,Standard Bronze Off Exchange Plan,60.66%,0.611606061458588,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,4
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,Individual,Yes,86-0257201,32753MO0860003,Anthem Dental Family,32753MO086,,MON009,MOS009,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$16.90,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,http://www.anthem.com/agent/mo/f0/s0/t0/pw_e214658.pdf,,,,32753MO0860003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,4,97176,LA,Individual,No,23-7384555,97176LA0340005,Blue Max copay 80/60 $1000,97176LA034,,LAN001,LAS001,LAF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340005-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340005-01,Standard Gold On Exchange Plan,,0.79078209400177,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$8,500","$17,000","$12,750","$25,500","$1,000","$3,000",20%,,,,"$2,000","$6,000","$3,000","$9,000",$250,$750,10%,,,,$250,$750,$250,$750,,,,,,,,,,,"$1,023",$0,"$1,252",$150,"$1,250",$673,$54,$79,5
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,4,97176,LA,Individual,No,23-7384555,97176LA0340005,Blue Max copay 80/60 $1000,97176LA034,,LAN001,LAS001,LAF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340005-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$79,6
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,4,97176,LA,Individual,No,23-7384555,97176LA0340005,Blue Max copay 80/60 $1000,97176LA034,,LAN001,LAS001,LAF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340005-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340005-03,Limited Cost Sharing Plan Variation,,0.79078209400177,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$8,500","$17,000","$12,750","$25,500","$1,000","$3,000",20%,,,,"$2,000","$6,000","$3,000","$9,000",$250,$750,10%,,,,$250,$750,$250,$750,,,,,,,,,,,"$1,023",$0,"$1,252",$150,"$1,250",$673,$54,$79,7
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,4,97176,LA,Individual,No,23-7384555,97176LA0340010,Blue Max copay 70/50 $2500,97176LA034,,LAN001,LAS001,LAF003,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340010-00,Standard Silver Off Exchange Plan,70.18%,0.692615151405334,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,500","$7,500",30%,,,,"$5,000","$15,000","$7,500","$22,500",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$2,523",$0,"$1,428",$150,"$1,772",$924,$0,$79,8
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,4,97176,LA,Individual,No,23-7384555,97176LA0340010,Blue Max copay 70/50 $2500,97176LA034,,LAN001,LAS001,LAF003,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340010-01,Standard Silver On Exchange Plan,70.18%,0.692615151405334,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,500","$7,500",30%,,,,"$5,000","$15,000","$7,500","$22,500",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$2,523",$0,"$1,428",$150,"$1,772",$924,$0,$79,9
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,4,97176,LA,Individual,No,23-7384555,97176LA0340010,Blue Max copay 70/50 $2500,97176LA034,,LAN001,LAS001,LAF003,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340010-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$79,10
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,4,97176,LA,Individual,No,23-7384555,97176LA0340010,Blue Max copay 70/50 $2500,97176LA034,,LAN001,LAS001,LAF003,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340010-03,Limited Cost Sharing Plan Variation,70.18%,0.692615151405334,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,500","$7,500",30%,,,,"$5,000","$15,000","$7,500","$22,500",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$2,523",$0,"$1,428",$150,"$1,772",$924,$0,$79,11
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,4,97176,LA,Individual,No,23-7384555,97176LA0340010,Blue Max copay 70/50 $2500,97176LA034,,LAN001,LAS001,LAF003,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340010-04,73% AV Level Silver Plan,72.79%,0.719586133956909,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$12,700","$25,400","$17,200","$34,400","$2,500","$7,500",30%,,,,"$5,000","$15,000","$7,500","$22,500",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$2,523",$0,"$1,428",$150,"$1,772",$924,$0,$79,12
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,4,97176,LA,Individual,No,23-7384555,97176LA0340010,Blue Max copay 70/50 $2500,97176LA034,,LAN001,LAS001,LAF003,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340010-05,87% AV Level Silver Plan,86.70%,0.86182028055191,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,700","$25,400","$14,850","$29,700",$400,"$1,200",20%,,,,"$5,000","$15,000","$5,400","$16,200",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,$423,$0,"$1,372",$150,$900,$445,$174,$79,13
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,4,97176,LA,Individual,No,23-7384555,97176LA0340010,Blue Max copay 70/50 $2500,97176LA034,,LAN001,LAS001,LAF003,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340010-06,94% AV Level Silver Plan,94.02%,0.939265310764313,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,700","$25,400","$14,850","$29,700",$100,$300,0%,,,,"$5,000","$15,000","$5,100","$15,300",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,$123,$0,$0,$150,$600,$445,$0,$79,14
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,5,97176,LA,Individual,No,23-7384555,97176LA0340001,Blue Max copay 80/60 $250,97176LA034,,LAN001,LAS001,LAF004,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340001-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340001-00,Standard Platinum Off Exchange Plan,,0.884273827075958,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$250,$750,20%,,,,"$1,000","$3,000","$1,250","$3,750",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$250,$0,"$1,250",$150,$250,$430,$204,$79,4
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,5,97176,LA,Individual,No,23-7384555,97176LA0340001,Blue Max copay 80/60 $250,97176LA034,,LAN001,LAS001,LAF004,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340001-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340001-01,Standard Platinum On Exchange Plan,,0.884273827075958,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$250,$750,20%,,,,"$1,000","$3,000","$1,250","$3,750",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$250,$0,"$1,250",$150,$250,$430,$204,$79,5
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0340007,Blue Max 50/50 $0,97176LA034,,LAN001,LAS001,LAF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340007-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340007-01,Standard Silver On Exchange Plan,,0.71539831161499,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,"$3,641",$150,$0,$0,"$2,635",$79,9
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0340007,Blue Max 50/50 $0,97176LA034,,LAN001,LAS001,LAF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340007-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$79,10
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0340007,Blue Max 50/50 $0,97176LA034,,LAN001,LAS001,LAF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340007-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340007-03,Limited Cost Sharing Plan Variation,,0.71539831161499,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,"$3,641",$150,$0,$0,"$2,635",$79,11
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0340007,Blue Max 50/50 $0,97176LA034,,LAN001,LAS001,LAF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340007-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340007-04,73% AV Level Silver Plan,,0.735449135303497,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,"$12,000","$24,000","$16,900","$33,800",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,"$3,641",$150,$0,$0,"$2,635",$79,12
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0340007,Blue Max 50/50 $0,97176LA034,,LAN001,LAS001,LAF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340007-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340007-05,87% AV Level Silver Plan,,0.867890000343323,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,000","$24,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,"$1,820",$150,$0,$0,"$1,318",$79,13
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0340007,Blue Max 50/50 $0,97176LA034,,LAN001,LAS001,LAF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340007-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340007-06,94% AV Level Silver Plan,,0.937422037124634,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,000","$24,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,$0,$0,5%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,$364,$150,$0,$0,$264,$79,14
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0340011,Blue Max 70/50 $3000,97176LA034,,LAN001,LAS001,LAF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340011-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340011-00,Standard Bronze Off Exchange Plan,,0.616786897182465,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$9,000",30%,,,,"$6,000","$18,000","$9,000","$27,000","$3,000",$0,"$1,284",$150,"$3,000",$0,$681,$79,15
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0340011,Blue Max 70/50 $3000,97176LA034,,LAN001,LAS001,LAF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340011-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340011-01,Standard Bronze On Exchange Plan,,0.616786897182465,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$9,000",30%,,,,"$6,000","$18,000","$9,000","$27,000","$3,000",$0,"$1,284",$150,"$3,000",$0,$681,$79,16
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0340011,Blue Max 70/50 $3000,97176LA034,,LAN001,LAS001,LAF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340011-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$79,17
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0340011,Blue Max 70/50 $3000,97176LA034,,LAN001,LAS001,LAF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340011-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340011-03,Limited Cost Sharing Plan Variation,,0.616786897182465,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$9,000",30%,,,,"$6,000","$18,000","$9,000","$27,000","$3,000",$0,"$1,284",$150,"$3,000",$0,$681,$79,18
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,4,29416,MO,Individual,Yes,95-6042390,29416MO0020006,BESTOne Dental Basic-Silver,29416MO002,,MON001,MOS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.62,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BESTOne_Dental_Basic-Silver_Plan.pdf,,29416MO0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,4,29416,MO,Individual,Yes,95-6042390,29416MO0020006,BESTOne Dental Basic-Silver,29416MO002,,MON001,MOS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.62,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BESTOne_Dental_Basic-Silver_Plan.pdf,,29416MO0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,4,29416,MO,SHOP (Small Group),Yes,95-6042390,29416MO0010011,BEST Dental Choice-L,29416MO001,,MON001,MOS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.29,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BESTDental_Choice-L_Plan.pdf,,29416MO0010011-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,4,29416,MO,SHOP (Small Group),Yes,95-6042390,29416MO0010012,BEST Dental Value,29416MO001,,MON001,MOS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.29,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BESTDental_Value_Plan.pdf,,29416MO0010012-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,4,29416,MO,SHOP (Small Group),Yes,95-6042390,29416MO0010012,BEST Dental Value,29416MO001,,MON001,MOS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.29,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BESTDental_Value_Plan.pdf,,29416MO0010012-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,Yes,39-1263473,30613MO0560001,Humana Dental Smart Choice,30613MO056,,MON001,MOS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$35.90,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541305,,30613MO0560001-00,Standard Low Off Exchange Plan,70.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,4,29416,MO,Individual,Yes,95-6042390,29416MO0020005,BESTOne Dental Plus-Silver,29416MO002,,MON001,MOS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.62,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BESTOne_Dental_Plus-Silver_Plan.pdf,,29416MO0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,4,29416,MO,SHOP (Small Group),Yes,95-6042390,29416MO0010009,BEST Dental Standard-L,29416MO001,,MON001,MOS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.29,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BESTDental_Standard-L_Plan.pdf,,29416MO0010009-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,4,29416,MO,SHOP (Small Group),Yes,95-6042390,29416MO0010011,BEST Dental Choice-L,29416MO001,,MON001,MOS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.29,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BESTDental_Choice-L_Plan.pdf,,29416MO0010011-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0340012,Blue Max 80/60 $4000,97176LA034,,LAN001,LAS001,LAF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340012-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340012-00,Standard Bronze Off Exchange Plan,,0.603681147098541,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,000","$12,000",20%,,,,"$8,000","$24,000","$12,000","$36,000","$4,000",$0,$656,$150,"$4,000",$0,$254,$79,19
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0340012,Blue Max 80/60 $4000,97176LA034,,LAN001,LAS001,LAF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340012-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340012-01,Standard Bronze On Exchange Plan,,0.603681147098541,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,000","$12,000",20%,,,,"$8,000","$24,000","$12,000","$36,000","$4,000",$0,$656,$150,"$4,000",$0,$254,$79,20
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0340012,Blue Max 80/60 $4000,97176LA034,,LAN001,LAS001,LAF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340012-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$79,21
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0340012,Blue Max 80/60 $4000,97176LA034,,LAN001,LAS001,LAF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340012-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340012-03,Limited Cost Sharing Plan Variation,,0.603681147098541,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,000","$12,000",20%,,,,"$8,000","$24,000","$12,000","$36,000","$4,000",$0,$656,$150,"$4,000",$0,$254,$79,22
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0340013,Blue Max 80/60 $5000,97176LA034,,LAN001,LAS001,LAF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340013-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340013-00,Standard Bronze Off Exchange Plan,,0.586139976978302,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400","$15,000","$38,100","$5,000",$0,$456,$150,"$5,000",$0,$54,$79,23
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0340013,Blue Max 80/60 $5000,97176LA034,,LAN001,LAS001,LAF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340013-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340013-01,Standard Bronze On Exchange Plan,,0.586139976978302,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400","$15,000","$38,100","$5,000",$0,$456,$150,"$5,000",$0,$54,$79,24
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0340013,Blue Max 80/60 $5000,97176LA034,,LAN001,LAS001,LAF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340013-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$79,25
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0340013,Blue Max 80/60 $5000,97176LA034,,LAN001,LAS001,LAF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340013-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340013-03,Limited Cost Sharing Plan Variation,,0.586139976978302,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400","$15,000","$38,100","$5,000",$0,$456,$150,"$5,000",$0,$54,$79,26
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350001,Blue Saver 100/80 $1300,97176LA035,,LAN001,LAS001,LAF006,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350001-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350001-00,Standard Gold Off Exchange Plan,81.64%,0.816470444202423,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",0%,,,,"$2,600","$5,200","$3,900","$7,800","$1,300",$0,$0,$150,"$1,300",$0,$0,$79,27
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350001,Blue Saver 100/80 $1300,97176LA035,,LAN001,LAS001,LAF006,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350001-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350001-01,Standard Gold On Exchange Plan,81.64%,0.816470444202423,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",0%,,,,"$2,600","$5,200","$3,900","$7,800","$1,300",$0,$0,$150,"$1,300",$0,$0,$79,28
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350001,Blue Saver 100/80 $1300,97176LA035,,LAN001,LAS001,LAF006,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350001-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$79,29
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350001,Blue Saver 100/80 $1300,97176LA035,,LAN001,LAS001,LAF006,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350001-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350001-03,Limited Cost Sharing Plan Variation,81.64%,0.816470444202423,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",0%,,,,"$2,600","$5,200","$3,900","$7,800","$1,300",$0,$0,$150,"$1,300",$0,$0,$79,30
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350002,Blue Saver 80/60 $1900,97176LA035,,LAN001,LAS001,LAF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350002-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350002-00,Standard Silver Off Exchange Plan,,0.700365960597992,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,100","$8,200",,,"$8,200","$16,400","$12,300","$24,600",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800",20%,,,,"$3,800","$7,600","$5,700","$11,400","$1,900",$0,"$1,076",$150,"$1,900",$0,$674,$79,31
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350002,Blue Saver 80/60 $1900,97176LA035,,LAN001,LAS001,LAF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350002-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350002-01,Standard Silver On Exchange Plan,,0.700365960597992,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,100","$8,200",,,"$8,200","$16,400","$12,300","$24,600",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800",20%,,,,"$3,800","$7,600","$5,700","$11,400","$1,900",$0,"$1,076",$150,"$1,900",$0,$674,$79,32
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350002,Blue Saver 80/60 $1900,97176LA035,,LAN001,LAS001,LAF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350002-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$79,33
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350002,Blue Saver 80/60 $1900,97176LA035,,LAN001,LAS001,LAF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350002-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350002-03,Limited Cost Sharing Plan Variation,,0.700365960597992,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,100","$8,200",,,"$8,200","$16,400","$12,300","$24,600",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800",20%,,,,"$3,800","$7,600","$5,700","$11,400","$1,900",$0,"$1,076",$150,"$1,900",$0,$674,$79,34
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350002,Blue Saver 80/60 $1900,97176LA035,,LAN001,LAS001,LAF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350002-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350002-04,73% AV Level Silver Plan,,0.729028105735779,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,200","$16,400","$11,200","$22,400",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800",20%,,,,"$3,800","$7,600","$5,700","$11,400","$1,900",$0,"$1,076",$150,"$1,900",$0,$674,$79,35
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350002,Blue Saver 80/60 $1900,97176LA035,,LAN001,LAS001,LAF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350002-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350002-05,87% AV Level Silver Plan,,0.86478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$8,200","$16,400","$9,600","$19,200",,,,,,,,,,,,,,,,,,,,,$400,$800,20%,,,,"$3,800","$7,600","$4,200","$8,400",$400,$0,"$1,000",$150,$400,$0,$974,$79,36
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350002,Blue Saver 80/60 $1900,97176LA035,,LAN001,LAS001,LAF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350002-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350002-06,94% AV Level Silver Plan,,0.935482263565063,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$8,200","$16,400","$9,600","$19,200",,,,,,,,,,,,,,,,,,,,,$0,$0,5%,,,,"$3,800","$7,600",Not Applicable,Not Applicable,$0,$0,$364,$150,$0,$0,$264,$79,37
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350003,Blue Saver 100/80 $2800,97176LA035,,LAN001,LAS001,LAF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350003-00,Standard Silver Off Exchange Plan,70.16%,0.701616883277893,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",0%,,,,"$5,600","$11,200","$8,400","$16,800","$2,800",$0,$0,$150,"$2,800",$0,$0,$79,38
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350003,Blue Saver 100/80 $2800,97176LA035,,LAN001,LAS001,LAF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350003-01,Standard Silver On Exchange Plan,70.16%,0.701616883277893,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",0%,,,,"$5,600","$11,200","$8,400","$16,800","$2,800",$0,$0,$150,"$2,800",$0,$0,$79,39
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350003,Blue Saver 100/80 $2800,97176LA035,,LAN001,LAS001,LAF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$79,40
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350003,Blue Saver 100/80 $2800,97176LA035,,LAN001,LAS001,LAF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350003-03,Limited Cost Sharing Plan Variation,70.16%,0.701616883277893,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",0%,,,,"$5,600","$11,200","$8,400","$16,800","$2,800",$0,$0,$150,"$2,800",$0,$0,$79,41
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350003,Blue Saver 100/80 $2800,97176LA035,,LAN001,LAS001,LAF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350003-04,73% AV Level Silver Plan,73.37%,0.733762919902802,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600",0%,,,,"$5,600","$11,200","$7,900","$15,800","$2,300",$0,$0,$150,"$2,300",$0,$0,$79,42
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350004,Blue Saver 70/50 $3300,97176LA035,,LAN001,LAS001,LAF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350004-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350004-00,Standard Bronze Off Exchange Plan,,0.610984742641449,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200","$18,900","$37,800",,,,,,,,,,,,,,,,,,,,,"$3,300","$6,600",30%,,,,"$6,600","$13,200","$9,900","$19,800","$3,300",$0,"$1,194",$150,"$3,300",$0,$591,$79,45
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350004,Blue Saver 70/50 $3300,97176LA035,,LAN001,LAS001,LAF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350004-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350004-01,Standard Bronze On Exchange Plan,,0.610984742641449,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200","$18,900","$37,800",,,,,,,,,,,,,,,,,,,,,"$3,300","$6,600",30%,,,,"$6,600","$13,200","$9,900","$19,800","$3,300",$0,"$1,194",$150,"$3,300",$0,$591,$79,46
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350004,Blue Saver 70/50 $3300,97176LA035,,LAN001,LAS001,LAF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350004-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$79,47
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350004,Blue Saver 70/50 $3300,97176LA035,,LAN001,LAS001,LAF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350004-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350004-03,Limited Cost Sharing Plan Variation,,0.610984742641449,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200","$18,900","$37,800",,,,,,,,,,,,,,,,,,,,,"$3,300","$6,600",30%,,,,"$6,600","$13,200","$9,900","$19,800","$3,300",$0,"$1,194",$150,"$3,300",$0,$591,$79,48
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350005,Blue Saver 100/80 $5000,97176LA035,,LAN001,LAS001,LAF006,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350005-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350005-00,Standard Bronze Off Exchange Plan,60.94%,0.609445869922638,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,"$10,000","$20,000","$15,000","$30,000","$5,000",$0,$0,$150,"$5,000",$0,$0,$79,49
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350005,Blue Saver 100/80 $5000,97176LA035,,LAN001,LAS001,LAF006,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350005-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350005-01,Standard Bronze On Exchange Plan,60.94%,0.609445869922638,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,"$10,000","$20,000","$15,000","$30,000","$5,000",$0,$0,$150,"$5,000",$0,$0,$79,50
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350005,Blue Saver 100/80 $5000,97176LA035,,LAN001,LAS001,LAF006,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350005-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$79,51
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,1,97176,LA,Individual,No,23-7384555,97176LA0350005,Blue Saver 100/80 $5000,97176LA035,,LAN001,LAS001,LAF006,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350005-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0350005-03,Limited Cost Sharing Plan Variation,60.94%,0.609445869922638,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,"$10,000","$20,000","$15,000","$30,000","$5,000",$0,$0,$150,"$5,000",$0,$0,$79,52
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,2,97176,LA,Individual,No,23-7384555,97176LA0340014,Blue Max copay 100/80 $6250,97176LA034,,LAN001,LAS001,LAF006,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340014-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340014-00,Standard Bronze Off Exchange Plan,61.44%,0.614407896995544,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,700",0%,,,,"$12,500","$25,400","$18,750","$38,100","$6,250",$0,$0,$150,"$4,121",$500,$0,$79,4
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,2,97176,LA,Individual,Yes,23-7384555,97176LA0390003,"Blue Dental Value Certified- $500 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $0 deductible",97176LA039,,LAN002,LAS002,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.90,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Coverage available for covered benefits,Yes,,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-bluedental-brochure,,97176LA0390003-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,2,97176,LA,Individual,Yes,23-7384555,97176LA0390003,"Blue Dental Value Certified- $500 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $0 deductible",97176LA039,,LAN002,LAS002,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.90,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Coverage available for covered benefits,Yes,,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-bluedental-brochure,,97176LA0390003-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,2,97176,LA,Individual,No,23-7384555,97176LA0340014,Blue Max copay 100/80 $6250,97176LA034,,LAN001,LAS001,LAF006,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340014-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340014-01,Standard Bronze On Exchange Plan,61.44%,0.614407896995544,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,700",0%,,,,"$12,500","$25,400","$18,750","$38,100","$6,250",$0,$0,$150,"$4,121",$500,$0,$79,5
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,2,97176,LA,Individual,No,23-7384555,97176LA0340014,Blue Max copay 100/80 $6250,97176LA034,,LAN001,LAS001,LAF006,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340014-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340014-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$79,6
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,2,97176,LA,Individual,No,23-7384555,97176LA0340014,Blue Max copay 100/80 $6250,97176LA034,,LAN001,LAS001,LAF006,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340014-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-2tier-formulary2015,97176LA0340014-03,Limited Cost Sharing Plan Variation,61.44%,0.614407896995544,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,700",0%,,,,"$12,500","$25,400","$18,750","$38,100","$6,250",$0,$0,$150,"$4,121",$500,$0,$79,7
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,3,97176,LA,Individual,No,23-7384555,97176LA0340008,Blue Max 70/50 $1500,97176LA034,,LAN001,LAS001,LAF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340008-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340008-00,Standard Silver Off Exchange Plan,,0.708351790904999,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,500","$4,500",30%,,,,"$3,000","$9,000","$4,500","$13,500",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$1,523",$0,"$1,728",$150,"$2,000",$524,$276,$79,4
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,3,97176,LA,Individual,No,23-7384555,97176LA0340008,Blue Max 70/50 $1500,97176LA034,,LAN001,LAS001,LAF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340008-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340008-01,Standard Silver On Exchange Plan,,0.708351790904999,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,500","$4,500",30%,,,,"$3,000","$9,000","$4,500","$13,500",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$1,523",$0,"$1,728",$150,"$2,000",$524,$276,$79,5
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,3,97176,LA,Individual,No,23-7384555,97176LA0340008,Blue Max 70/50 $1500,97176LA034,,LAN001,LAS001,LAF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340008-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$79,6
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,3,97176,LA,Individual,No,23-7384555,97176LA0340008,Blue Max 70/50 $1500,97176LA034,,LAN001,LAS001,LAF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340008-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340008-03,Limited Cost Sharing Plan Variation,,0.708351790904999,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,500","$4,500",30%,,,,"$3,000","$9,000","$4,500","$13,500",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$1,523",$0,"$1,728",$150,"$2,000",$524,$276,$79,7
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,3,97176,LA,Individual,No,23-7384555,97176LA0340008,Blue Max 70/50 $1500,97176LA034,,LAN001,LAS001,LAF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340008-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340008-04,73% AV Level Silver Plan,,0.732662618160248,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000","$13,500","$27,000","$1,500","$4,500",30%,,,,"$3,000","$9,000","$4,500","$13,500",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,"$1,523",$0,"$1,728",$150,"$2,000",$524,$276,$79,8
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,3,97176,LA,Individual,No,23-7384555,97176LA0340008,Blue Max 70/50 $1500,97176LA034,,LAN001,LAS001,LAF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340008-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340008-05,87% AV Level Silver Plan,,0.864212036132813,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"$10,000","$20,000","$11,700","$23,400",$250,$750,30%,,,,"$3,000","$9,000","$3,250","$9,750",$500,"$1,500",10%,,,,$500,"$1,500",$500,"$1,500",,,,,,,,,,,$250,$0,"$1,450",$150,$750,$245,$651,$79,9
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,5,97176,LA,Individual,No,23-7384555,97176LA0340001,Blue Max copay 80/60 $250,97176LA034,,LAN001,LAS001,LAF004,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340001-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$79,6
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,5,97176,LA,Individual,No,23-7384555,97176LA0340001,Blue Max copay 80/60 $250,97176LA034,,LAN001,LAS001,LAF004,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340001-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340001-03,Limited Cost Sharing Plan Variation,,0.884273827075958,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$250,$750,20%,,,,"$1,000","$3,000","$1,250","$3,750",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$250,$0,"$1,250",$150,$250,$430,$204,$79,7
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,5,97176,LA,Individual,No,23-7384555,97176LA0340003,Blue Max copay 80/60 $500,97176LA034,,LAN001,LAS001,LAF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340003-00,Standard Gold Off Exchange Plan,,0.798647105693817,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",$500,"$1,500",20%,,,,"$1,000","$3,000","$1,500","$4,500",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$500,$20,"$1,352",$150,$500,$850,$154,$79,8
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,5,97176,LA,Individual,No,23-7384555,97176LA0340003,Blue Max copay 80/60 $500,97176LA034,,LAN001,LAS001,LAF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340003-01,Standard Gold On Exchange Plan,,0.798647105693817,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",$500,"$1,500",20%,,,,"$1,000","$3,000","$1,500","$4,500",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$500,$20,"$1,352",$150,$500,$850,$154,$79,9
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,5,97176,LA,Individual,No,23-7384555,97176LA0340003,Blue Max copay 80/60 $500,97176LA034,,LAN001,LAS001,LAF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$79,10
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,5,97176,LA,Individual,No,23-7384555,97176LA0340003,Blue Max copay 80/60 $500,97176LA034,,LAN001,LAS001,LAF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340003-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340003-03,Limited Cost Sharing Plan Variation,,0.798647105693817,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",$500,"$1,500",20%,,,,"$1,000","$3,000","$1,500","$4,500",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$500,$20,"$1,352",$150,$500,$850,$154,$79,11
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,5,97176,LA,Individual,No,23-7384555,97176LA0340004,Blue Max copay 80/60 $750,97176LA034,,LAN001,LAS001,LAF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340004-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340004-00,Standard Gold Off Exchange Plan,,0.805073976516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$8,500","$17,000","$12,750","$25,500",$750,"$2,250",20%,,,,"$1,500","$4,500","$2,250","$6,750",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$750,$12,"$1,302",$150,$750,$530,$104,$79,12
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,5,97176,LA,Individual,No,23-7384555,97176LA0340004,Blue Max copay 80/60 $750,97176LA034,,LAN001,LAS001,LAF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340004-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340004-01,Standard Gold On Exchange Plan,,0.805073976516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$8,500","$17,000","$12,750","$25,500",$750,"$2,250",20%,,,,"$1,500","$4,500","$2,250","$6,750",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$750,$12,"$1,302",$150,$750,$530,$104,$79,13
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,5,97176,LA,Individual,No,23-7384555,97176LA0340004,Blue Max copay 80/60 $750,97176LA034,,LAN001,LAS001,LAF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340004-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$79,14
2015,LA,97176,HIOS,8,2014-12-06 05:18:25,5,97176,LA,Individual,No,23-7384555,97176LA0340004,Blue Max copay 80/60 $750,97176LA034,,LAN001,LAS001,LAF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340004-00,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-solutions-brochure2015,www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0340004-03,Limited Cost Sharing Plan Variation,,0.805073976516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$8,500","$17,000","$12,750","$25,500",$750,"$2,250",20%,,,,"$1,500","$4,500","$2,250","$6,750",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$750,$12,"$1,302",$150,$750,$530,$104,$79,15
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570009,Humana Gold 2500/SW Missouri PPOx,30613MO057,,MON003,MOS005,MOF003,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2333591,,http://apps.humana.com/marketing/documents.asp?file=2342197,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570009-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,43
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570009,Humana Gold 2500/SW Missouri PPOx,30613MO057,,MON003,MOS005,MOF003,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2333591,,http://apps.humana.com/marketing/documents.asp?file=2342197,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570009-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,1,16049,MO,Individual,No,35-1665915,16049MO0030001,UnitedHealthcare Silver Compass HSA 2600,16049MO003,,MON006,MOS001,MOF002,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030001-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,1,16049,MO,Individual,No,35-1665915,16049MO0030001,UnitedHealthcare Silver Compass HSA 2600,16049MO003,,MON006,MOS001,MOF002,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030001-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,1,16049,MO,Individual,No,35-1665915,16049MO0030001,UnitedHealthcare Silver Compass HSA 2600,16049MO003,,MON006,MOS001,MOF002,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,1,16049,MO,Individual,No,35-1665915,16049MO0030001,UnitedHealthcare Silver Compass HSA 2600,16049MO003,,MON006,MOS001,MOF002,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030001-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,1,16049,MO,Individual,No,35-1665915,16049MO0030001,UnitedHealthcare Silver Compass HSA 2600,16049MO003,,MON006,MOS001,MOF002,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030001-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,1,16049,MO,Individual,No,35-1665915,16049MO0030001,UnitedHealthcare Silver Compass HSA 2600,16049MO003,,MON006,MOS001,MOF002,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030001-05,87% AV Level Silver Plan,86.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$550,"$1,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,1,16049,MO,Individual,No,35-1665915,16049MO0030001,UnitedHealthcare Silver Compass HSA 2600,16049MO003,,MON006,MOS001,MOF002,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030001-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$75,$150,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,1,16049,MO,Individual,No,35-1665915,16049MO0030005,UnitedHealthcare Bronze Compass HSA 4900,16049MO003,,MON006,MOS001,MOF005,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030005-00,Standard Bronze Off Exchange Plan,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,1,16049,MO,Individual,No,35-1665915,16049MO0030005,UnitedHealthcare Bronze Compass HSA 4900,16049MO003,,MON006,MOS001,MOF005,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030005-01,Standard Bronze On Exchange Plan,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,1,16049,MO,Individual,No,35-1665915,16049MO0030005,UnitedHealthcare Bronze Compass HSA 4900,16049MO003,,MON006,MOS001,MOF005,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030005-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,1,16049,MO,Individual,No,35-1665915,16049MO0030005,UnitedHealthcare Bronze Compass HSA 4900,16049MO003,,MON006,MOS001,MOF005,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030005-03,Limited Cost Sharing Plan Variation,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030007,UnitedHealthcare Gold Compass 500,16049MO003,,MON006,MOS001,MOF002,New,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030007-00,Standard Gold Off Exchange Plan,78.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030007,UnitedHealthcare Gold Compass 500,16049MO003,,MON006,MOS001,MOF002,New,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030007-01,Standard Gold On Exchange Plan,78.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030007,UnitedHealthcare Gold Compass 500,16049MO003,,MON006,MOS001,MOF002,New,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030007-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030007,UnitedHealthcare Gold Compass 500,16049MO003,,MON006,MOS001,MOF002,New,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030007-03,Limited Cost Sharing Plan Variation,78.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030002,UnitedHealthcare Silver Compass 2000,16049MO003,,MON006,MOS001,MOF005,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030002-00,Standard Silver Off Exchange Plan,69.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030002,UnitedHealthcare Silver Compass 2000,16049MO003,,MON006,MOS001,MOF005,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030002-01,Standard Silver On Exchange Plan,69.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030002,UnitedHealthcare Silver Compass 2000,16049MO003,,MON006,MOS001,MOF005,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030002,UnitedHealthcare Silver Compass 2000,16049MO003,,MON006,MOS001,MOF005,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030002-03,Limited Cost Sharing Plan Variation,69.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030002,UnitedHealthcare Silver Compass 2000,16049MO003,,MON006,MOS001,MOF005,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030002-04,73% AV Level Silver Plan,73.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030002,UnitedHealthcare Silver Compass 2000,16049MO003,,MON006,MOS001,MOF005,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030002-05,87% AV Level Silver Plan,86.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030002,UnitedHealthcare Silver Compass 2000,16049MO003,,MON006,MOS001,MOF005,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030002-06,94% AV Level Silver Plan,93.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030003,UnitedHealthcare Silver Compass 3500-1,16049MO003,,MON006,MOS001,MOF003,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030003-00,Standard Silver Off Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030003,UnitedHealthcare Silver Compass 3500-1,16049MO003,,MON006,MOS001,MOF003,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030003-01,Standard Silver On Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030003,UnitedHealthcare Silver Compass 3500-1,16049MO003,,MON006,MOS001,MOF003,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030003-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030003,UnitedHealthcare Silver Compass 3500-1,16049MO003,,MON006,MOS001,MOF003,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030003-05,87% AV Level Silver Plan,86.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,MO,16049,HIOS,9,2014-12-11 04:09:12,2,16049,MO,Individual,No,35-1665915,16049MO0030003,UnitedHealthcare Silver Compass 3500-1,16049MO003,,MON006,MOS001,MOF003,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmo,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmo,16049MO0030003-06,94% AV Level Silver Plan,93.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,MO,28214,HIOS,2,2014-08-07 10:00:19,1,28214,MO,SHOP (Small Group),Yes,44-0308260,28214MO0010001,KCL EHB Low PPO,28214MO001,,MON001,MOS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$38.76,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,28214MO0010001-00,Standard Low Off Exchange Plan,70.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,28214,HIOS,2,2014-08-07 10:00:19,1,28214,MO,SHOP (Small Group),Yes,44-0308260,28214MO0010003,KCL EHB Low MAC,28214MO001,,MON001,MOS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$30.33,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,28214MO0010003-00,Standard Low Off Exchange Plan,70.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,28214,HIOS,2,2014-08-07 10:00:19,1,28214,MO,SHOP (Small Group),Yes,44-0308260,28214MO0010005,KCL Fam Low PPO,28214MO001,,MON001,MOS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$38.76,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,28214MO0010005-00,Standard Low Off Exchange Plan,70.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MO,28214,HIOS,2,2014-08-07 10:00:19,1,28214,MO,SHOP (Small Group),Yes,44-0308260,28214MO0010007,KCL Fam Low MAC,28214MO001,,MON001,MOS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$30.33,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,28214MO0010007-00,Standard Low Off Exchange Plan,70.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MO,28214,HIOS,2,2014-08-07 10:00:19,2,28214,MO,SHOP (Small Group),Yes,44-0308260,28214MO0010002,KCL EHB High PPO,28214MO001,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$47.15,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,28214MO0010002-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,28214,HIOS,2,2014-08-07 10:00:19,2,28214,MO,SHOP (Small Group),Yes,44-0308260,28214MO0010004,KCL EHB High MAC,28214MO001,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$37.71,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,28214MO0010004-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,28214,HIOS,2,2014-08-07 10:00:19,2,28214,MO,SHOP (Small Group),Yes,44-0308260,28214MO0010006,KCL Fam High PPO,28214MO001,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$47.15,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,28214MO0010006-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MO,28214,HIOS,2,2014-08-07 10:00:19,2,28214,MO,SHOP (Small Group),Yes,44-0308260,28214MO0010008,KCL Fam High MAC,28214MO001,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$37.71,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,28214MO0010008-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,1,29416,MO,Individual,Yes,95-6042390,29416MO0020001,BESTOne Child Dental Plus,29416MO002,,MON001,MOS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$32.08,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BESTOne_Child_Dental_Plus_Plan.pdf,,29416MO0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,1,29416,MO,SHOP (Small Group),Yes,95-6042390,29416MO0010001,BEST Life Child Dental Plus,29416MO001,,MON001,MOS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.67,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BEST_Life_Child_Dental_Plus_Plan.pdf,,29416MO0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,2,29416,MO,SHOP (Small Group),Yes,95-6042390,29416MO0010002,BEST Life Child Dental,29416MO001,,MON001,MOS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$21.29,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BEST_Life_Child_Dental_Plan.pdf,,29416MO0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,2,29416,MO,Individual,Yes,95-6042390,29416MO0020002,BESTOne Child Dental,29416MO002,,MON001,MOS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.62,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BESTOne_Child_Dental_Plan.pdf,,29416MO0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,3,29416,MO,Individual,Yes,95-6042390,29416MO0020003,BESTOne Dental Advantage-Gold,29416MO002,,MON001,MOS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.08,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BESTOne_Dental_Advantage-Gold_Plan.pdf,,29416MO0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,3,29416,MO,SHOP (Small Group),Yes,95-6042390,29416MO0010007,BEST Dental Premium,29416MO001,,MON001,MOS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.67,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BESTDental_Premium_Plan.pdf,,29416MO0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,3,29416,MO,SHOP (Small Group),Yes,95-6042390,29416MO0010007,BEST Dental Premium,29416MO001,,MON001,MOS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.67,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BESTDental_Premium_Plan.pdf,,29416MO0010007-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,3,29416,MO,Individual,Yes,95-6042390,29416MO0020003,BESTOne Dental Advantage-Gold,29416MO002,,MON001,MOS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.08,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BESTOne_Dental_Advantage-Gold_Plan.pdf,,29416MO0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,3,29416,MO,Individual,Yes,95-6042390,29416MO0020004,BESTOne Dental Plus-Gold,29416MO002,,MON001,MOS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.08,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BESTOne_Dental_Plus-Gold_Plan.pdf,,29416MO0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,3,29416,MO,SHOP (Small Group),Yes,95-6042390,29416MO0010008,BEST Dental Standard-H,29416MO001,,MON001,MOS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.67,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BESTDental_Standard-H_Plan.pdf,,29416MO0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,3,29416,MO,SHOP (Small Group),Yes,95-6042390,29416MO0010008,BEST Dental Standard-H,29416MO001,,MON001,MOS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.67,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BESTDental_Standard-H_Plan.pdf,,29416MO0010008-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,3,29416,MO,Individual,Yes,95-6042390,29416MO0020004,BESTOne Dental Plus-Gold,29416MO002,,MON001,MOS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.08,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BESTOne_Dental_Plus-Gold_Plan.pdf,,29416MO0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,3,29416,MO,SHOP (Small Group),Yes,95-6042390,29416MO0010010,BEST Dental Choice-H,29416MO001,,MON001,MOS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.67,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BESTDental_Choice-H_Plan.pdf,,29416MO0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,3,29416,MO,SHOP (Small Group),Yes,95-6042390,29416MO0010010,BEST Dental Choice-H,29416MO001,,MON001,MOS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.67,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BESTDental_Choice-H_Plan.pdf,,29416MO0010010-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,4,29416,MO,SHOP (Small Group),Yes,95-6042390,29416MO0010009,BEST Dental Standard-L,29416MO001,,MON001,MOS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.29,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BESTDental_Standard-L_Plan.pdf,,29416MO0010009-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,29416,HIOS,5,2014-10-02 12:25:15,4,29416,MO,Individual,Yes,95-6042390,29416MO0020005,BESTOne Dental Plus-Silver,29416MO002,,MON001,MOS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.62,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MO/2015/MO_BESTOne_Dental_Plus-Silver_Plan.pdf,,29416MO0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570013,Humana Silver 4600/Kansas City PPOx,30613MO057,,MON002,MOS002,MOF002,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342275,,http://apps.humana.com/marketing/documents.asp?file=2327260,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570013-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570013,Humana Silver 4600/Kansas City PPOx,30613MO057,,MON002,MOS002,MOF002,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342275,,http://apps.humana.com/marketing/documents.asp?file=2327260,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570013-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,Yes,39-1263473,30613MO0560001,Humana Dental Smart Choice,30613MO056,,MON001,MOS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$35.90,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541305,,30613MO0560001-01,Standard Low On Exchange Plan,70.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570013,Humana Silver 4600/Kansas City PPOx,30613MO057,,MON002,MOS002,MOF002,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342275,,http://apps.humana.com/marketing/documents.asp?file=2327260,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570013-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780014,Anthem Bronze Blue Preferred X 3500 20 6350 Plus w HSA,32753MO078,,MON006,MOS005,MOF022,Existing,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.988524625532795,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LVN,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780014-01,Standard Bronze On Exchange Plan,60.66%,0.611606061458588,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,11
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780015,Anthem Bronze Blue Preferred X 3500 20 6350 Plus w HSA,32753MO078,,MON006,MOS006,MOF022,Existing,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.988532790188333,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LVN,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780015-00,Standard Bronze Off Exchange Plan,60.66%,0.611606061458588,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,12
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780015,Anthem Bronze Blue Preferred X 3500 20 6350 Plus w HSA,32753MO078,,MON006,MOS006,MOF022,Existing,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.988532790188333,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LVN,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780015-01,Standard Bronze On Exchange Plan,60.66%,0.611606061458588,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,13
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780016,Anthem Bronze Blue Preferred X 3500 20 6350 Plus w HSA,32753MO078,,MON006,MOS007,MOF022,Existing,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.988539698368257,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LVN,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780016-00,Standard Bronze Off Exchange Plan,60.66%,0.611606061458588,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,14
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780016,Anthem Bronze Blue Preferred X 3500 20 6350 Plus w HSA,32753MO078,,MON006,MOS007,MOF022,Existing,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.988539698368257,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LVN,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780016-01,Standard Bronze On Exchange Plan,60.66%,0.611606061458588,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,15
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780017,Anthem Bronze Blue Preferred X 3500 20 6350 Plus w HSA,32753MO078,,MON006,MOS008,MOF022,Existing,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.988554223607931,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LVN,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780017-00,Standard Bronze Off Exchange Plan,60.66%,0.611606061458588,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,16
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780017,Anthem Bronze Blue Preferred X 3500 20 6350 Plus w HSA,32753MO078,,MON006,MOS008,MOF022,Existing,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.988554223607931,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LVN,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780017-01,Standard Bronze On Exchange Plan,60.66%,0.611606061458588,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,17
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,3,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780018,Anthem Silver Blue Preferred X 1500 30 6600 Plus,32753MO078,,MON006,MOS002,MOF021,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991176387611794,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LX6,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780018-00,Standard Silver Off Exchange Plan,69.77%,0.715309619903564,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,3,32753,MO,Individual,No,86-0257201,32753MO0770016,Anthem Bronze Pathway X 6050 25,32753MO077,,MON002,MOS001,MOF020,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJ0,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770016-00,Standard Bronze Off Exchange Plan,60.02%,0.586331903934479,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,050","$12,100",25%,,,,"$12,100","$24,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,3,32753,MO,Individual,No,86-0257201,32753MO0770016,Anthem Bronze Pathway X 6050 25,32753MO077,,MON002,MOS001,MOF020,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJ0,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770016-01,Standard Bronze On Exchange Plan,60.02%,0.586331903934479,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,050","$12,100",25%,,,,"$12,100","$24,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,3,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780018,Anthem Silver Blue Preferred X 1500 30 6600 Plus,32753MO078,,MON006,MOS002,MOF021,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991176387611794,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LX6,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780018-01,Standard Silver On Exchange Plan,69.77%,0.715309619903564,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,3,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780019,Anthem Silver Blue Preferred X 1500 30 6600 Plus,32753MO078,,MON006,MOS003,MOF021,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991169284295683,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LX6,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780019-00,Standard Silver Off Exchange Plan,69.77%,0.715309619903564,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570013,Humana Silver 4600/Kansas City PPOx,30613MO057,,MON002,MOS002,MOF002,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342275,,http://apps.humana.com/marketing/documents.asp?file=2327260,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570013-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570013,Humana Silver 4600/Kansas City PPOx,30613MO057,,MON002,MOS002,MOF002,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342275,,http://apps.humana.com/marketing/documents.asp?file=2327260,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570013-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570013,Humana Silver 4600/Kansas City PPOx,30613MO057,,MON002,MOS002,MOF002,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342275,,http://apps.humana.com/marketing/documents.asp?file=2327260,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570013-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$25,200","$50,400",Not Applicable,Not Applicable,$900,"$1,800",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570013,Humana Silver 4600/Kansas City PPOx,30613MO057,,MON002,MOS002,MOF002,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342275,,http://apps.humana.com/marketing/documents.asp?file=2327260,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570013-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$25,200","$50,400",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,$250,$500,50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570014,Humana Gold 2500/Kansas City PPOx,30613MO057,,MON002,MOS002,MOF003,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342184,,http://apps.humana.com/marketing/documents.asp?file=2327312,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570014-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570014,Humana Gold 2500/Kansas City PPOx,30613MO057,,MON002,MOS002,MOF003,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342184,,http://apps.humana.com/marketing/documents.asp?file=2327312,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570014-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570014,Humana Gold 2500/Kansas City PPOx,30613MO057,,MON002,MOS002,MOF003,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342184,,http://apps.humana.com/marketing/documents.asp?file=2327312,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570014,Humana Gold 2500/Kansas City PPOx,30613MO057,,MON002,MOS002,MOF003,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342184,,http://apps.humana.com/marketing/documents.asp?file=2327312,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570014-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570015,Humana Platinum 1000/Kansas City PPOx,30613MO057,,MON002,MOS002,MOF003,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342223,,http://apps.humana.com/marketing/documents.asp?file=2327325,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570015,Humana Platinum 1000/Kansas City PPOx,30613MO057,,MON002,MOS002,MOF003,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342223,,http://apps.humana.com/marketing/documents.asp?file=2327325,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570015-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570003,Humana Silver 4600/SW Missouri PPOx,30613MO057,,MON003,MOS003,MOF002,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342288,,http://apps.humana.com/marketing/documents.asp?file=2333526,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570003-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570003,Humana Silver 4600/SW Missouri PPOx,30613MO057,,MON003,MOS003,MOF002,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342288,,http://apps.humana.com/marketing/documents.asp?file=2333526,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570003-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570003,Humana Silver 4600/SW Missouri PPOx,30613MO057,,MON003,MOS003,MOF002,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342288,,http://apps.humana.com/marketing/documents.asp?file=2333526,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570003,Humana Silver 4600/SW Missouri PPOx,30613MO057,,MON003,MOS003,MOF002,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342288,,http://apps.humana.com/marketing/documents.asp?file=2333526,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570003-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570003,Humana Silver 4600/SW Missouri PPOx,30613MO057,,MON003,MOS003,MOF002,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342288,,http://apps.humana.com/marketing/documents.asp?file=2333526,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570003-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570003,Humana Silver 4600/SW Missouri PPOx,30613MO057,,MON003,MOS003,MOF002,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342288,,http://apps.humana.com/marketing/documents.asp?file=2333526,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570003-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$25,200","$50,400",Not Applicable,Not Applicable,$900,"$1,800",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570003,Humana Silver 4600/SW Missouri PPOx,30613MO057,,MON003,MOS003,MOF002,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342288,,http://apps.humana.com/marketing/documents.asp?file=2333526,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570003-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$25,200","$50,400",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,$250,$500,50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570004,Humana Gold 2500/SW Missouri PPOx,30613MO057,,MON003,MOS003,MOF003,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342197,,http://apps.humana.com/marketing/documents.asp?file=2333591,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570004-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,1,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780004,Anthem Gold Blue Preferred X 1000 20 5500 Plus,32753MO078,,MON006,MOS002,MOF021,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.992070997812149,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LXV,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780004-00,Standard Gold Off Exchange Plan,78.32%,0.783996999263763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,000","$3,000",20%,,,,"$2,000","$4,000","$3,000","$7,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,1,32753,MO,Individual,Yes,86-0257201,32753MO0840003,Anthem Dental Pediatric,32753MO084,,MON009,MOS009,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$17.29,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/mo/f0/s0/t0/pw_e214660.pdf,,,,32753MO0840003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,1,32753,MO,Individual,Yes,86-0257201,32753MO0900003,Anthem Dental Pediatric,32753MO090,,MON009,MOS009,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$17.29,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/mo/f0/s0/t0/pw_e214660.pdf,,,,32753MO0900003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,1,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780004,Anthem Gold Blue Preferred X 1000 20 5500 Plus,32753MO078,,MON006,MOS002,MOF021,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.992070997812149,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LXV,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780004-01,Standard Gold On Exchange Plan,78.32%,0.783996999263763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,000","$3,000",20%,,,,"$2,000","$4,000","$3,000","$7,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,1,32753,MO,Individual,No,86-0257201,32753MO0770025,Anthem Catastrophic Pathway X 6600 0,32753MO077,,MON002,MOS001,MOF003,Existing,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GHV,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770025-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,1,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780005,Anthem Gold Blue Preferred X 1000 20 5500 Plus,32753MO078,,MON006,MOS003,MOF021,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99206461488278,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LXV,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780005-00,Standard Gold Off Exchange Plan,78.32%,0.783996999263763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,000","$3,000",20%,,,,"$2,000","$4,000","$3,000","$7,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,1,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780005,Anthem Gold Blue Preferred X 1000 20 5500 Plus,32753MO078,,MON006,MOS003,MOF021,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99206461488278,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LXV,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780005-01,Standard Gold On Exchange Plan,78.32%,0.783996999263763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,000","$3,000",20%,,,,"$2,000","$4,000","$3,000","$7,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570004,Humana Gold 2500/SW Missouri PPOx,30613MO057,,MON003,MOS003,MOF003,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342197,,http://apps.humana.com/marketing/documents.asp?file=2333591,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570004-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570004,Humana Gold 2500/SW Missouri PPOx,30613MO057,,MON003,MOS003,MOF003,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342197,,http://apps.humana.com/marketing/documents.asp?file=2333591,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,28
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570004,Humana Gold 2500/SW Missouri PPOx,30613MO057,,MON003,MOS003,MOF003,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342197,,http://apps.humana.com/marketing/documents.asp?file=2333591,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570004-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570005,Humana Platinum 1000/SW Missouri PPOx,30613MO057,,MON003,MOS003,MOF003,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342236,,http://apps.humana.com/marketing/documents.asp?file=2333604,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570005-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570005,Humana Platinum 1000/SW Missouri PPOx,30613MO057,,MON003,MOS003,MOF003,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342236,,http://apps.humana.com/marketing/documents.asp?file=2333604,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570005-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570005,Humana Platinum 1000/SW Missouri PPOx,30613MO057,,MON003,MOS003,MOF003,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342236,,http://apps.humana.com/marketing/documents.asp?file=2333604,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,32
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570005,Humana Platinum 1000/SW Missouri PPOx,30613MO057,,MON003,MOS003,MOF003,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342236,,http://apps.humana.com/marketing/documents.asp?file=2333604,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570005-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570008,Humana Silver 4600/SW Missouri PPOx,30613MO057,,MON003,MOS005,MOF002,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342288,,http://apps.humana.com/marketing/documents.asp?file=2333526,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570008-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570008,Humana Silver 4600/SW Missouri PPOx,30613MO057,,MON003,MOS005,MOF002,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342288,,http://apps.humana.com/marketing/documents.asp?file=2333526,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570008-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570008,Humana Silver 4600/SW Missouri PPOx,30613MO057,,MON003,MOS005,MOF002,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342288,,http://apps.humana.com/marketing/documents.asp?file=2333526,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,36
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570008,Humana Silver 4600/SW Missouri PPOx,30613MO057,,MON003,MOS005,MOF002,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342288,,http://apps.humana.com/marketing/documents.asp?file=2333526,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570008-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570008,Humana Silver 4600/SW Missouri PPOx,30613MO057,,MON003,MOS005,MOF002,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342288,,http://apps.humana.com/marketing/documents.asp?file=2333526,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570008-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570008,Humana Silver 4600/SW Missouri PPOx,30613MO057,,MON003,MOS005,MOF002,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342288,,http://apps.humana.com/marketing/documents.asp?file=2333526,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570008-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$25,200","$50,400",Not Applicable,Not Applicable,$900,"$1,800",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570008,Humana Silver 4600/SW Missouri PPOx,30613MO057,,MON003,MOS005,MOF002,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342288,,http://apps.humana.com/marketing/documents.asp?file=2333526,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570008-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$25,200","$50,400",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,$250,$500,50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570009,Humana Gold 2500/SW Missouri PPOx,30613MO057,,MON003,MOS005,MOF003,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2333591,,http://apps.humana.com/marketing/documents.asp?file=2342197,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570009-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570009,Humana Gold 2500/SW Missouri PPOx,30613MO057,,MON003,MOS005,MOF003,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2333591,,http://apps.humana.com/marketing/documents.asp?file=2342197,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570009-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570010,Humana Platinum 1000/SW Missouri PPOx,30613MO057,,MON003,MOS005,MOF003,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2333604,,http://apps.humana.com/marketing/documents.asp?file=2342236,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570010-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570010,Humana Platinum 1000/SW Missouri PPOx,30613MO057,,MON003,MOS005,MOF003,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2333604,,http://apps.humana.com/marketing/documents.asp?file=2342236,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570010-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570010,Humana Platinum 1000/SW Missouri PPOx,30613MO057,,MON003,MOS005,MOF003,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2333604,,http://apps.humana.com/marketing/documents.asp?file=2342236,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,47
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,1,30613,MO,Individual,No,39-1263473,30613MO0570010,Humana Platinum 1000/SW Missouri PPOx,30613MO057,,MON003,MOS005,MOF003,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2333604,,http://apps.humana.com/marketing/documents.asp?file=2342236,http://apps.humana.com/marketing/documents.asp?file=2323815,30613MO0570010-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780013,Anthem Bronze Blue Preferred X 3500 20 6350 Plus w HSA,32753MO078,,MON006,MOS004,MOF022,Existing,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.988526273161672,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LVN,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780013-01,Standard Bronze On Exchange Plan,60.66%,0.611606061458588,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,9
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780014,Anthem Bronze Blue Preferred X 3500 20 6350 Plus w HSA,32753MO078,,MON006,MOS005,MOF022,Existing,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.988524625532795,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LVN,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780014-00,Standard Bronze Off Exchange Plan,60.66%,0.611606061458588,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,10
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,2,30613,MO,Individual,No,39-1263473,30613MO0570011,Humana Basic 6600/Kansas City PPOx,30613MO057,,MON002,MOS002,MOF001,New,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342119,,http://apps.humana.com/marketing/documents.asp?file=2327234,http://apps.humana.com/marketing/documents.asp?file=2323880,30613MO0570011-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,2,30613,MO,Individual,No,39-1263473,30613MO0570011,Humana Basic 6600/Kansas City PPOx,30613MO057,,MON002,MOS002,MOF001,New,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342119,,http://apps.humana.com/marketing/documents.asp?file=2327234,http://apps.humana.com/marketing/documents.asp?file=2323880,30613MO0570011-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,2,30613,MO,Individual,No,39-1263473,30613MO0570012,Humana Bronze 6300/Kansas City PPOx,30613MO057,,MON002,MOS002,MOF001,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342158,,http://apps.humana.com/marketing/documents.asp?file=2327247,http://apps.humana.com/marketing/documents.asp?file=2323880,30613MO0570012-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,6
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,2,30613,MO,Individual,No,39-1263473,30613MO0570012,Humana Bronze 6300/Kansas City PPOx,30613MO057,,MON002,MOS002,MOF001,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342158,,http://apps.humana.com/marketing/documents.asp?file=2327247,http://apps.humana.com/marketing/documents.asp?file=2323880,30613MO0570012-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,2,30613,MO,Individual,No,39-1263473,30613MO0570012,Humana Bronze 6300/Kansas City PPOx,30613MO057,,MON002,MOS002,MOF001,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342158,,http://apps.humana.com/marketing/documents.asp?file=2327247,http://apps.humana.com/marketing/documents.asp?file=2323880,30613MO0570012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,2,30613,MO,Individual,No,39-1263473,30613MO0570012,Humana Bronze 6300/Kansas City PPOx,30613MO057,,MON002,MOS002,MOF001,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342158,,http://apps.humana.com/marketing/documents.asp?file=2327247,http://apps.humana.com/marketing/documents.asp?file=2323880,30613MO0570012-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,9
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,2,30613,MO,Individual,No,39-1263473,30613MO0570001,Humana Basic 6600/SW Missouri PPOx,30613MO057,,MON003,MOS003,MOF001,New,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342132,,http://apps.humana.com/marketing/documents.asp?file=2333500,http://apps.humana.com/marketing/documents.asp?file=2323880,30613MO0570001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,10
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,2,30613,MO,Individual,No,39-1263473,30613MO0570001,Humana Basic 6600/SW Missouri PPOx,30613MO057,,MON003,MOS003,MOF001,New,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342132,,http://apps.humana.com/marketing/documents.asp?file=2333500,http://apps.humana.com/marketing/documents.asp?file=2323880,30613MO0570001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,11
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,2,30613,MO,Individual,No,39-1263473,30613MO0570002,Humana Bronze 6300/SW Missouri PPOx,30613MO057,,MON003,MOS003,MOF001,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342171,,http://apps.humana.com/marketing/documents.asp?file=2333513,http://apps.humana.com/marketing/documents.asp?file=2323880,30613MO0570002-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,12
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,2,30613,MO,Individual,No,39-1263473,30613MO0570002,Humana Bronze 6300/SW Missouri PPOx,30613MO057,,MON003,MOS003,MOF001,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342171,,http://apps.humana.com/marketing/documents.asp?file=2333513,http://apps.humana.com/marketing/documents.asp?file=2323880,30613MO0570002-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,13
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,2,30613,MO,Individual,No,39-1263473,30613MO0570002,Humana Bronze 6300/SW Missouri PPOx,30613MO057,,MON003,MOS003,MOF001,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342171,,http://apps.humana.com/marketing/documents.asp?file=2333513,http://apps.humana.com/marketing/documents.asp?file=2323880,30613MO0570002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,2,30613,MO,Individual,No,39-1263473,30613MO0570002,Humana Bronze 6300/SW Missouri PPOx,30613MO057,,MON003,MOS003,MOF001,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342171,,http://apps.humana.com/marketing/documents.asp?file=2333513,http://apps.humana.com/marketing/documents.asp?file=2323880,30613MO0570002-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,15
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,2,30613,MO,Individual,No,39-1263473,30613MO0570006,Humana Basic 6600/SW Missouri PPOx,30613MO057,,MON003,MOS005,MOF001,New,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342132,,http://apps.humana.com/marketing/documents.asp?file=2333500,http://apps.humana.com/marketing/documents.asp?file=2323880,30613MO0570006-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,16
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,2,30613,MO,Individual,No,39-1263473,30613MO0570006,Humana Basic 6600/SW Missouri PPOx,30613MO057,,MON003,MOS005,MOF001,New,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342132,,http://apps.humana.com/marketing/documents.asp?file=2333500,http://apps.humana.com/marketing/documents.asp?file=2323880,30613MO0570006-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,17
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,2,30613,MO,Individual,No,39-1263473,30613MO0570007,Humana Bronze 6300/SW Missouri PPOx,30613MO057,,MON003,MOS005,MOF001,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342171,,http://apps.humana.com/marketing/documents.asp?file=2333513,http://apps.humana.com/marketing/documents.asp?file=2323880,30613MO0570007-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,18
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,2,30613,MO,Individual,No,39-1263473,30613MO0570007,Humana Bronze 6300/SW Missouri PPOx,30613MO057,,MON003,MOS005,MOF001,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342171,,http://apps.humana.com/marketing/documents.asp?file=2333513,http://apps.humana.com/marketing/documents.asp?file=2323880,30613MO0570007-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,19
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,2,30613,MO,Individual,No,39-1263473,30613MO0570007,Humana Bronze 6300/SW Missouri PPOx,30613MO057,,MON003,MOS005,MOF001,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342171,,http://apps.humana.com/marketing/documents.asp?file=2333513,http://apps.humana.com/marketing/documents.asp?file=2323880,30613MO0570007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,MO,30613,HIOS,18,2015-01-16 17:32:32,2,30613,MO,Individual,No,39-1263473,30613MO0570007,Humana Bronze 6300/SW Missouri PPOx,30613MO057,,MON003,MOS005,MOF001,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342171,,http://apps.humana.com/marketing/documents.asp?file=2333513,http://apps.humana.com/marketing/documents.asp?file=2323880,30613MO0570007-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,21
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,Individual,No,86-0257201,32753MO0770015,Anthem Bronze Pathway X 5750 20,32753MO077,,MON002,MOS001,MOF019,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GHX,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770015-00,Standard Bronze Off Exchange Plan,60.22%,0.594154477119446,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",20%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,SHOP (Small Group),Yes,86-0257201,32753MO0830003,Anthem Dental Family,32753MO083,,MON009,MOS009,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$16.90,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/mo/f0/s0/t0/pw_e214658.pdf,,,,32753MO0830003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,SHOP (Small Group),Yes,86-0257201,32753MO0830004,Anthem Dental Family Enhanced,32753MO083,,MON009,MOS009,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.46,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/mo/f0/s0/t0/pw_e214659.pdf,,,,32753MO0830004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,Individual,No,86-0257201,32753MO0770015,Anthem Bronze Pathway X 5750 20,32753MO077,,MON002,MOS001,MOF019,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GHX,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770015-01,Standard Bronze On Exchange Plan,60.22%,0.594154477119446,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",20%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,Individual,Yes,86-0257201,32753MO0860004,Anthem Dental Family Enhanced,32753MO086,,MON009,MOS009,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.46,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,http://www.anthem.com/agent/mo/f0/s0/t0/pw_e214659.pdf,,,,32753MO0860004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780011,Anthem Bronze Blue Preferred X 3500 20 6350 Plus w HSA,32753MO078,,MON006,MOS002,MOF022,Existing,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.988543971270227,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LVN,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780011-01,Standard Bronze On Exchange Plan,60.66%,0.611606061458588,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,5
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780012,Anthem Bronze Blue Preferred X 3500 20 6350 Plus w HSA,32753MO078,,MON006,MOS003,MOF022,Existing,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.988534749051665,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LVN,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780012-00,Standard Bronze Off Exchange Plan,60.66%,0.611606061458588,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,6
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,Individual,Yes,86-0257201,32753MO0920003,Anthem Dental Family,32753MO092,,MON009,MOS009,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$16.90,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,http://www.anthem.com/agent/mo/f0/s0/t0/pw_e214658.pdf,,,,32753MO0920003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,Individual,No,86-0257201,32753MO0770015,Anthem Bronze Pathway X 5750 20,32753MO077,,MON002,MOS001,MOF019,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GHX,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770015-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,SHOP (Small Group),Yes,86-0257201,32753MO0890003,Anthem Dental Family,32753MO089,,MON009,MOS009,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$16.90,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/mo/f0/s0/t0/pw_e214658.pdf,,,,32753MO0890003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,SHOP (Small Group),Yes,86-0257201,32753MO0890004,Anthem Dental Family Enhanced,32753MO089,,MON009,MOS009,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.46,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/mo/f0/s0/t0/pw_e214659.pdf,,,,32753MO0890004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,Individual,No,86-0257201,32753MO0770015,Anthem Bronze Pathway X 5750 20,32753MO077,,MON002,MOS001,MOF019,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GHX,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770015-03,Limited Cost Sharing Plan Variation,60.22%,0.594154477119446,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",20%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,Individual,Yes,86-0257201,32753MO0920004,Anthem Dental Family Enhanced,32753MO092,,MON009,MOS009,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.46,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,http://www.anthem.com/agent/mo/f0/s0/t0/pw_e214659.pdf,,,,32753MO0920004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780012,Anthem Bronze Blue Preferred X 3500 20 6350 Plus w HSA,32753MO078,,MON006,MOS003,MOF022,Existing,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.988534749051665,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LVN,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780012-01,Standard Bronze On Exchange Plan,60.66%,0.611606061458588,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,7
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,2,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780013,Anthem Bronze Blue Preferred X 3500 20 6350 Plus w HSA,32753MO078,,MON006,MOS004,MOF022,Existing,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.988526273161672,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LVN,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780013-00,Standard Bronze Off Exchange Plan,60.66%,0.611606061458588,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,8
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,3,32753,MO,Individual,No,86-0257201,32753MO0770016,Anthem Bronze Pathway X 6050 25,32753MO077,,MON002,MOS001,MOF020,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJ0,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770016-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,3,32753,MO,Individual,No,86-0257201,32753MO0770016,Anthem Bronze Pathway X 6050 25,32753MO077,,MON002,MOS001,MOF020,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJ0,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770016-03,Limited Cost Sharing Plan Variation,60.02%,0.586331903934479,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,050","$12,100",25%,,,,"$12,100","$24,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,3,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780019,Anthem Silver Blue Preferred X 1500 30 6600 Plus,32753MO078,,MON006,MOS003,MOF021,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991169284295683,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LX6,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780019-01,Standard Silver On Exchange Plan,69.77%,0.715309619903564,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,3,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780020,Anthem Silver Blue Preferred X 1500 30 6600 Plus,32753MO078,,MON006,MOS004,MOF021,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991162755854624,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LX6,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780020-00,Standard Silver Off Exchange Plan,69.77%,0.715309619903564,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,3,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780020,Anthem Silver Blue Preferred X 1500 30 6600 Plus,32753MO078,,MON006,MOS004,MOF021,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991162755854624,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LX6,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780020-01,Standard Silver On Exchange Plan,69.77%,0.715309619903564,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,3,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780021,Anthem Silver Blue Preferred X 1500 30 6600 Plus,32753MO078,,MON006,MOS005,MOF021,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991161486708796,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LX6,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780021-00,Standard Silver Off Exchange Plan,69.77%,0.715309619903564,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,3,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780021,Anthem Silver Blue Preferred X 1500 30 6600 Plus,32753MO078,,MON006,MOS005,MOF021,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991161486708796,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LX6,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780021-01,Standard Silver On Exchange Plan,69.77%,0.715309619903564,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,3,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780022,Anthem Silver Blue Preferred X 1500 30 6600 Plus,32753MO078,,MON006,MOS006,MOF021,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991167775375937,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LX6,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780022-00,Standard Silver Off Exchange Plan,69.77%,0.715309619903564,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,3,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780022,Anthem Silver Blue Preferred X 1500 30 6600 Plus,32753MO078,,MON006,MOS006,MOF021,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991167775375937,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LX6,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780022-01,Standard Silver On Exchange Plan,69.77%,0.715309619903564,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,3,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780023,Anthem Silver Blue Preferred X 1500 30 6600 Plus,32753MO078,,MON006,MOS007,MOF021,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991173096390996,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LX6,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780023-00,Standard Silver Off Exchange Plan,69.77%,0.715309619903564,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,3,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780023,Anthem Silver Blue Preferred X 1500 30 6600 Plus,32753MO078,,MON006,MOS007,MOF021,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991173096390996,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LX6,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780023-01,Standard Silver On Exchange Plan,69.77%,0.715309619903564,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,3,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780024,Anthem Silver Blue Preferred X 1500 30 6600 Plus,32753MO078,,MON006,MOS008,MOF021,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991184284237078,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LX6,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780024-00,Standard Silver Off Exchange Plan,69.77%,0.715309619903564,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,3,32753,MO,SHOP (Small Group),No,86-0257201,32753MO0780024,Anthem Silver Blue Preferred X 1500 30 6600 Plus,32753MO078,,MON006,MOS008,MOF021,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991184284237078,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LX6,,http://sgplans.anthem.com/mo/brochure/,anthem.com/MOSelectdrugtier4,32753MO0780024-01,Standard Silver On Exchange Plan,69.77%,0.715309619903564,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,4,32753,MO,Individual,No,86-0257201,32753MO0770017,Anthem Bronze Pathway X 0 for HSA,32753MO077,,MON002,MOS001,MOF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJ3,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770017-00,Standard Bronze Off Exchange Plan,58.01%,0.576903939247131,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,200","$12,400",0%,,,,"$12,400","$24,800",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,4,32753,MO,Individual,No,86-0257201,32753MO0770017,Anthem Bronze Pathway X 0 for HSA,32753MO077,,MON002,MOS001,MOF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJ3,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770017-01,Standard Bronze On Exchange Plan,58.01%,0.576903939247131,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,200","$12,400",0%,,,,"$12,400","$24,800",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,4,32753,MO,Individual,No,86-0257201,32753MO0770017,Anthem Bronze Pathway X 0 for HSA,32753MO077,,MON002,MOS001,MOF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJ3,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770017-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,7,32753,MO,Individual,No,86-0257201,32753MO0770020,Anthem Silver Pathway X 3500 0,32753MO077,,MON002,MOS001,MOF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgenct Care Only,Yes,Emergency/Urgenct Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJC,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770020-01,Standard Silver On Exchange Plan,70.30%,0.671796858310699,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,7,32753,MO,Individual,No,86-0257201,32753MO0770020,Anthem Silver Pathway X 3500 0,32753MO077,,MON002,MOS001,MOF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgenct Care Only,Yes,Emergency/Urgenct Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJC,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770020-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,7,32753,MO,Individual,No,86-0257201,32753MO0770020,Anthem Silver Pathway X 3500 0,32753MO077,,MON002,MOS001,MOF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgenct Care Only,Yes,Emergency/Urgenct Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJC,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770020-03,Limited Cost Sharing Plan Variation,70.30%,0.671796858310699,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,7,32753,MO,Individual,No,86-0257201,32753MO0770020,Anthem Silver Pathway X 3500 0,32753MO077,,MON002,MOS001,MOF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgenct Care Only,Yes,Emergency/Urgenct Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJC,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770020-04,73% AV Level Silver Plan,72.33%,0.688815772533417,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,7,32753,MO,Individual,No,86-0257201,32753MO0770020,Anthem Silver Pathway X 3500 0,32753MO077,,MON002,MOS001,MOF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgenct Care Only,Yes,Emergency/Urgenct Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJC,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770020-05,87% AV Level Silver Plan,86.09%,0.854293525218964,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$800,"$1,600",0%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,7,32753,MO,Individual,No,86-0257201,32753MO0770020,Anthem Silver Pathway X 3500 0,32753MO077,,MON002,MOS001,MOF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgenct Care Only,Yes,Emergency/Urgenct Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJC,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770020-06,94% AV Level Silver Plan,93.26%,0.93029797077179,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,8,32753,MO,Individual,No,86-0257201,32753MO0770022,Anthem Silver Pathway X 2500 10,32753MO077,,MON002,MOS001,MOF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJJ,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770022-00,Standard Silver Off Exchange Plan,70.25%,0.684133946895599,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,8,32753,MO,Individual,No,86-0257201,32753MO0770022,Anthem Silver Pathway X 2500 10,32753MO077,,MON002,MOS001,MOF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJJ,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770022-01,Standard Silver On Exchange Plan,70.25%,0.684133946895599,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,8,32753,MO,Individual,No,86-0257201,32753MO0770022,Anthem Silver Pathway X 2500 10,32753MO077,,MON002,MOS001,MOF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJJ,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770022-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,8,32753,MO,Individual,No,86-0257201,32753MO0770022,Anthem Silver Pathway X 2500 10,32753MO077,,MON002,MOS001,MOF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJJ,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770022-03,Limited Cost Sharing Plan Variation,70.25%,0.684133946895599,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,8,32753,MO,Individual,No,86-0257201,32753MO0770022,Anthem Silver Pathway X 2500 10,32753MO077,,MON002,MOS001,MOF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJJ,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770022-04,73% AV Level Silver Plan,72.29%,0.703102350234985,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,450","$4,900",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,8,32753,MO,Individual,No,86-0257201,32753MO0770022,Anthem Silver Pathway X 2500 10,32753MO077,,MON002,MOS001,MOF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJJ,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770022-05,87% AV Level Silver Plan,86.32%,0.859334051609039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,8,32753,MO,Individual,No,86-0257201,32753MO0770022,Anthem Silver Pathway X 2500 10,32753MO077,,MON002,MOS001,MOF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJJ,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770022-06,94% AV Level Silver Plan,93.23%,0.932634234428406,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,9,32753,MO,Individual,No,86-0257201,32753MO0770023,Anthem Silver Pathway X 10 for HSA,32753MO077,,MON002,MOS001,MOF013,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJQ,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770023-00,Standard Silver Off Exchange Plan,68.05%,0.684827923774719,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,100","$8,200",,,"$8,200","$16,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,9,32753,MO,Individual,No,86-0257201,32753MO0770023,Anthem Silver Pathway X 10 for HSA,32753MO077,,MON002,MOS001,MOF013,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJQ,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770023-01,Standard Silver On Exchange Plan,68.05%,0.684827923774719,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,100","$8,200",,,"$8,200","$16,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,9,32753,MO,Individual,No,86-0257201,32753MO0770023,Anthem Silver Pathway X 10 for HSA,32753MO077,,MON002,MOS001,MOF013,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJQ,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770023-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,9,32753,MO,Individual,No,86-0257201,32753MO0770023,Anthem Silver Pathway X 10 for HSA,32753MO077,,MON002,MOS001,MOF013,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJQ,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770023-03,Limited Cost Sharing Plan Variation,68.05%,0.684827923774719,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,100","$8,200",,,"$8,200","$16,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,9,32753,MO,Individual,No,86-0257201,32753MO0770023,Anthem Silver Pathway X 10 for HSA,32753MO077,,MON002,MOS001,MOF013,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJQ,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770023-04,73% AV Level Silver Plan,72.01%,0.725485026836395,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,700","$7,400",,,"$8,200","$16,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,9,32753,MO,Individual,No,86-0257201,32753MO0770023,Anthem Silver Pathway X 10 for HSA,32753MO077,,MON002,MOS001,MOF013,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJQ,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770023-05,87% AV Level Silver Plan,86.17%,0.861683309078217,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"$8,200","$16,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,9,32753,MO,Individual,No,86-0257201,32753MO0770023,Anthem Silver Pathway X 10 for HSA,32753MO077,,MON002,MOS001,MOF013,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJQ,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770023-06,94% AV Level Silver Plan,93.27%,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$8,200","$16,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,10,32753,MO,Individual,No,86-0257201,32753MO0770021,Anthem Silver Pathway X 1850 20,32753MO077,,MON002,MOS001,MOF008,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJW,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770021-00,Standard Silver Off Exchange Plan,68.67%,0.69184798002243,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,850","$3,700",20%,,,,"$3,700","$7,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,10,32753,MO,Individual,No,86-0257201,32753MO0770021,Anthem Silver Pathway X 1850 20,32753MO077,,MON002,MOS001,MOF008,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJW,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770021-01,Standard Silver On Exchange Plan,68.67%,0.69184798002243,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,850","$3,700",20%,,,,"$3,700","$7,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,10,32753,MO,Individual,No,86-0257201,32753MO0770021,Anthem Silver Pathway X 1850 20,32753MO077,,MON002,MOS001,MOF008,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJW,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770021-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,10,32753,MO,Individual,No,86-0257201,32753MO0770021,Anthem Silver Pathway X 1850 20,32753MO077,,MON002,MOS001,MOF008,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJW,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770021-03,Limited Cost Sharing Plan Variation,68.67%,0.69184798002243,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,850","$3,700",20%,,,,"$3,700","$7,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,10,32753,MO,Individual,No,86-0257201,32753MO0770021,Anthem Silver Pathway X 1850 20,32753MO077,,MON002,MOS001,MOF008,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJW,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770021-04,73% AV Level Silver Plan,72.02%,0.725295901298523,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400",20%,,,,"$3,700","$7,400",Not Applicable,Not Applicable,,,,,,,,,8
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,10,32753,MO,Individual,No,86-0257201,32753MO0770021,Anthem Silver Pathway X 1850 20,32753MO077,,MON002,MOS001,MOF008,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJW,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770021-05,87% AV Level Silver Plan,86.08%,0.866306185722351,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",20%,,,,"$3,700","$7,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,10,32753,MO,Individual,No,86-0257201,32753MO0770021,Anthem Silver Pathway X 1850 20,32753MO077,,MON002,MOS001,MOF008,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GJW,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770021-06,94% AV Level Silver Plan,93.77%,0.93895697593689,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,20%,,,,"$3,700","$7,400",Not Applicable,Not Applicable,,,,,,,,,10
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,11,32753,MO,Individual,No,86-0257201,32753MO0770026,Anthem Gold Pathway X 1100 10,32753MO077,,MON002,MOS001,MOF010,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GKB,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770026-00,Standard Gold Off Exchange Plan,78.01%,0.783289432525635,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,600","$11,200",,,"$11,200","$22,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",10%,,,,"$2,200","$4,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,11,32753,MO,Individual,No,86-0257201,32753MO0770026,Anthem Gold Pathway X 1100 10,32753MO077,,MON002,MOS001,MOF010,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GKB,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770026-01,Standard Gold On Exchange Plan,78.01%,0.783289432525635,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,600","$11,200",,,"$11,200","$22,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",10%,,,,"$2,200","$4,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,11,32753,MO,Individual,No,86-0257201,32753MO0770026,Anthem Gold Pathway X 1100 10,32753MO077,,MON002,MOS001,MOF010,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GKB,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770026-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MO,32753,HIOS,20,2015-07-22 09:15:52,11,32753,MO,Individual,No,86-0257201,32753MO0770026,Anthem Gold Pathway X 1100 10,32753MO077,,MON002,MOS001,MOF010,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GKB,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0770026-03,Limited Cost Sharing Plan Variation,78.01%,0.783289432525635,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,600","$11,200",,,"$11,200","$22,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",10%,,,,"$2,200","$4,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,32904,HIOS,5,2014-09-05 03:32:16,1,32904,MO,SHOP (Small Group),Yes,43-1680523,32904MO0210001,PPO - Basic,32904MO021,7306849531,MON001,MOS001,,New,PPO,Low,,Off the Exchange,,,,Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.,,,,,Allows Child-Only,,,,$17.94,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same as in service area,Yes,,,,,32904MO0210001-00,Standard Low Off Exchange Plan,69.43%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,32904,HIOS,5,2014-09-05 03:32:16,2,32904,MO,SHOP (Small Group),Yes,43-1680523,32904MO0220001,PPO - Preferred,32904MO022,7306849531,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.,,,,,Allows Child-Only,,,,$24.39,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same as in service area,Yes,,,,,32904MO0220001-00,Standard High Off Exchange Plan,85.63%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,3,34762,MO,Individual,No,43-1257251,34762MO0150004,Blue & U First Select Silver,34762MO015,7023011258,MON002,MOS002,MOF002,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/firstselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0150004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,3,34762,MO,Individual,No,43-1257251,34762MO0150004,Blue & U First Select Silver,34762MO015,7023011258,MON002,MOS002,MOF002,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/firstselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0150004-03,Limited Cost Sharing Plan Variation,71.05%,0.710463523864746,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,200","$8,400","$4,200","$8,400","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",0%,"$4,200","$8,400",0%,"$4,200","$8,400",Not Applicable,Not Applicable,"$4,200",$0,$0,$200,$300,$700,$0,$40,7
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,1,34762,MO,Individual,No,43-1257251,34762MO0140004,Blue & U First PCB Silver,34762MO014,7023011258,MON001,MOS001,MOF018,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/firstpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0140004-04,73% AV Level Silver Plan,73.74%,0.737449705600739,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,400","$16,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,"$4,200","$8,400",Not Applicable,Not Applicable,"$4,000",$0,$0,$200,$300,$300,$0,$40,8
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,1,34762,MO,Individual,No,43-1257251,34762MO0140004,Blue & U First PCB Silver,34762MO014,7023011258,MON001,MOS001,MOF018,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/firstpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0140004-05,87% AV Level Silver Plan,86.39%,0.863930761814117,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$8,400","$16,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$4,200","$8,400",Not Applicable,Not Applicable,"$1,500",$0,$0,$200,$300,$300,$0,$40,9
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,6,34762,MO,Individual,No,43-1257251,34762MO0180008,Blue & U Saver2 PCB Silver,34762MO018,7023011258,MON001,MOS001,MOF005,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saver2pcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0180008-03,Limited Cost Sharing Plan Variation,,0.684860467910767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",40%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,"$1,800",$20,"$2,100",$200,"$1,800",$500,$100,$40,14
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,6,34762,MO,Individual,No,43-1257251,34762MO0180008,Blue & U Saver2 PCB Silver,34762MO018,7023011258,MON001,MOS001,MOF005,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saver2pcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0180008-04,73% AV Level Silver Plan,,0.722767114639282,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",40%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,"$1,500",$0,"$2,000",$200,"$1,500",$500,$100,$40,15
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,9,34762,MO,Individual,No,43-1257251,34762MO0440001,Blue & U Basic Select Silver,34762MO044,7023011258,MON005,MOS002,MOF019,New,EPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",No,"Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.",No,http://www.bluekc.com/qhp/2015/dp/mo/basicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0440001-06,94% AV Level Silver Plan,,0.934593498706818,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$400,$0,$300,$200,$400,$200,$60,$40,10
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,9,34762,MO,Individual,No,43-1257251,34762MO0440002,Blue & U Basic Select Bronze,34762MO044,7023011258,MON005,MOS002,MOF020,New,EPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",No,"Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.",No,http://www.bluekc.com/qhp/2015/dp/mo/basicselectbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0440002-00,Standard Bronze Off Exchange Plan,,0.619391202926636,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,"$1,200",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,000",$0,$600,$200,$500,"$1,200",$0,$40,11
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,10,44240,MO,Individual,No,75-1296086,44240MO0090012,Coventry Silver $5 Copay 2750 KCPPO,44240MO009,,MON002,MOS002,MOF016,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48428,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090012-00,Standard Silver Off Exchange Plan,68.60%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,"$5,750","$11,500",40%,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,10,44240,MO,Individual,No,75-1296086,44240MO0090012,Coventry Silver $5 Copay 2750 KCPPO,44240MO009,,MON002,MOS002,MOF016,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48428,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090012-01,Standard Silver On Exchange Plan,68.60%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,"$5,750","$11,500",40%,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,10,44240,MO,Individual,No,75-1296086,44240MO0090012,Coventry Silver $5 Copay 2750 KCPPO,44240MO009,,MON002,MOS002,MOF016,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48428,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090012-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,10,44240,MO,Individual,No,75-1296086,44240MO0090012,Coventry Silver $5 Copay 2750 KCPPO,44240MO009,,MON002,MOS002,MOF016,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48428,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090012-03,Limited Cost Sharing Plan Variation,68.60%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,"$5,750","$11,500",40%,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,10,44240,MO,Individual,No,75-1296086,44240MO0090012,Coventry Silver $5 Copay 2750 KCPPO,44240MO009,,MON002,MOS002,MOF016,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48428,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090012-04,73% AV Level Silver Plan,72.70%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$4,500","$9,000",40%,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,10,44240,MO,Individual,No,75-1296086,44240MO0090012,Coventry Silver $5 Copay 2750 KCPPO,44240MO009,,MON002,MOS002,MOF016,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48428,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090012-05,87% AV Level Silver Plan,86.40%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,"$1,500","$3,000",40%,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,10,44240,MO,Individual,No,75-1296086,44240MO0090012,Coventry Silver $5 Copay 2750 KCPPO,44240MO009,,MON002,MOS002,MOF016,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48428,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090012-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$1,100","$2,200","$2,250","$4,500","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,2,34762,MO,Individual,No,43-1257251,34762MO0140006,Blue & U First PCB Bronze,34762MO014,7023011258,MON001,MOS001,MOF007,Existing,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/firstpcbbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0140006-01,Standard Bronze On Exchange Plan,,0.611002326011658,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$6,250","$12,500",Not Applicable,Not Applicable,"$6,200",$0,$0,$200,"$4,500",$0,$0,$40,5
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,2,34762,MO,Individual,No,43-1257251,34762MO0140006,Blue & U First PCB Bronze,34762MO014,7023011258,MON001,MOS001,MOF007,Existing,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/firstpcbbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0140006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,7,34762,MO,Individual,No,43-1257251,34762MO0190008,Blue & U Saver2 Select Silver,34762MO019,7023011258,MON002,MOS002,MOF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saver2selectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0190008-05,87% AV Level Silver Plan,,0.867297947406769,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,200","$2,400","$1,200","$2,400","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",40%,$700,"$1,400",40%,"$1,800","$3,600",Not Applicable,Not Applicable,$700,$0,$500,$200,$700,$200,$200,$40,16
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,7,34762,MO,Individual,No,43-1257251,34762MO0190008,Blue & U Saver2 Select Silver,34762MO019,7023011258,MON002,MOS002,MOF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saver2selectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0190008-06,94% AV Level Silver Plan,,0.936714768409729,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$500,"$1,000",$500,"$1,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,40%,$250,$500,40%,"$1,800","$3,600",Not Applicable,Not Applicable,$200,$0,$200,$200,$200,$40,$200,$40,17
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,11,44240,MO,Individual,No,75-1296086,44240MO0090006,Coventry Silver $5 Copay 2750 PPO,44240MO009,,MON001,MOS001,MOF018,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48453,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090006-03,Limited Cost Sharing Plan Variation,68.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,11,44240,MO,Individual,No,75-1296086,44240MO0090006,Coventry Silver $5 Copay 2750 PPO,44240MO009,,MON001,MOS001,MOF018,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48453,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090006-04,73% AV Level Silver Plan,72.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,6,34762,MO,Individual,No,43-1257251,34762MO0180003,Blue & U Saver PCB Silver,34762MO018,7023011258,MON001,MOS001,MOF005,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saverpcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0180003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,6,34762,MO,Individual,No,43-1257251,34762MO0180003,Blue & U Saver PCB Silver,34762MO018,7023011258,MON001,MOS001,MOF005,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saverpcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0180003-03,Limited Cost Sharing Plan Variation,,0.683055341243744,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,"$2,500",$20,$500,$200,"$2,500",$400,$20,$40,7
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,7,34762,MO,Individual,No,43-1257251,34762MO0190009,Blue & U Saver Select Bronze,34762MO019,7023011258,MON002,MOS002,MOF006,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saverselectbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0190009-00,Standard Bronze Off Exchange Plan,,0.591564774513245,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",10%,"$5,000","$10,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,"$5,000",$20,$200,$200,"$5,000",$0,$0,$40,18
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,7,34762,MO,Individual,No,43-1257251,34762MO0190009,Blue & U Saver Select Bronze,34762MO019,7023011258,MON002,MOS002,MOF006,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saverselectbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0190009-01,Standard Bronze On Exchange Plan,,0.591564774513245,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",10%,"$5,000","$10,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,"$5,000",$20,$200,$200,"$5,000",$0,$0,$40,19
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,1,34762,MO,Individual,No,43-1257251,34762MO0140004,Blue & U First PCB Silver,34762MO014,7023011258,MON001,MOS001,MOF018,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/firstpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0140004-00,Standard Silver Off Exchange Plan,68.42%,0.684202611446381,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$8,400","$16,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",0%,,,,"$4,200","$8,400",Not Applicable,Not Applicable,"$4,200",$0,$0,$200,$300,$300,$0,$40,4
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,1,34762,MO,SHOP (Small Group),No,43-1257251,34762MO0220001,Blue & U First 1500 PCB Gold,34762MO022,7023011258,MON001,MOS001,MOF023,Existing,PPO,Gold,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/sg/mo/firstpcbgold1500.html,www.bluekc.com/qhp/2015/payment.html,www.bluekc.com/qhp/2015/sgbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0220001-00,Standard Gold Off Exchange Plan,,0.792363226413727,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$5,600","$11,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",15%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,"$1,500",$10,$800,$200,$300,$300,$0,$40,4
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,1,34762,MO,SHOP (Small Group),No,43-1257251,34762MO0220001,Blue & U First 1500 PCB Gold,34762MO022,7023011258,MON001,MOS001,MOF023,Existing,PPO,Gold,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/sg/mo/firstpcbgold1500.html,www.bluekc.com/qhp/2015/payment.html,www.bluekc.com/qhp/2015/sgbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0220001-01,Standard Gold On Exchange Plan,,0.792363226413727,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$5,600","$11,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",15%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,"$1,500",$10,$800,$200,$300,$300,$0,$40,5
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,1,34762,MO,Individual,No,43-1257251,34762MO0140004,Blue & U First PCB Silver,34762MO014,7023011258,MON001,MOS001,MOF018,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/firstpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0140004-01,Standard Silver On Exchange Plan,68.42%,0.684202611446381,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$8,400","$16,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",0%,,,,"$4,200","$8,400",Not Applicable,Not Applicable,"$4,200",$0,$0,$200,$300,$300,$0,$40,5
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,1,34762,MO,Individual,No,43-1257251,34762MO0140004,Blue & U First PCB Silver,34762MO014,7023011258,MON001,MOS001,MOF018,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/firstpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0140004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,1,34762,MO,SHOP (Small Group),No,43-1257251,34762MO0220002,Blue & U First 2000 PCB Silver,34762MO022,7023011258,MON001,MOS001,MOF024,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/sg/mo/firstpcbsilver2000.html,www.bluekc.com/qhp/2015/payment.html,www.bluekc.com/qhp/2015/sgbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0220002-00,Standard Silver Off Exchange Plan,,0.698546469211578,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$2,000",$10,"$1,500",$200,$300,$300,$0,$40,6
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,1,34762,MO,SHOP (Small Group),No,43-1257251,34762MO0220002,Blue & U First 2000 PCB Silver,34762MO022,7023011258,MON001,MOS001,MOF024,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/sg/mo/firstpcbsilver2000.html,www.bluekc.com/qhp/2015/payment.html,www.bluekc.com/qhp/2015/sgbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0220002-01,Standard Silver On Exchange Plan,,0.698546469211578,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$2,000",$10,"$1,500",$200,$300,$300,$0,$40,7
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,1,34762,MO,Individual,No,43-1257251,34762MO0140004,Blue & U First PCB Silver,34762MO014,7023011258,MON001,MOS001,MOF018,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/firstpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0140004-03,Limited Cost Sharing Plan Variation,68.42%,0.684202611446381,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$8,400","$16,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",0%,,,,"$4,200","$8,400",Not Applicable,Not Applicable,"$4,200",$0,$0,$200,$300,$300,$0,$40,7
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,1,34762,MO,Individual,No,43-1257251,34762MO0140004,Blue & U First PCB Silver,34762MO014,7023011258,MON001,MOS001,MOF018,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/firstpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0140004-06,94% AV Level Silver Plan,93.74%,0.937447547912598,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$450,$900,,,"$8,400","$16,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$450,$900,0%,,,,"$4,200","$8,400",Not Applicable,Not Applicable,$400,$0,$0,$200,$200,$200,$0,$40,10
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,2,34762,MO,Individual,No,43-1257251,34762MO0140006,Blue & U First PCB Bronze,34762MO014,7023011258,MON001,MOS001,MOF007,Existing,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/firstpcbbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0140006-00,Standard Bronze Off Exchange Plan,,0.611002326011658,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$6,250","$12,500",Not Applicable,Not Applicable,"$6,200",$0,$0,$200,"$4,500",$0,$0,$40,4
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,2,34762,MO,Individual,No,43-1257251,34762MO0140006,Blue & U First PCB Bronze,34762MO014,7023011258,MON001,MOS001,MOF007,Existing,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/firstpcbbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0140006-03,Limited Cost Sharing Plan Variation,,0.611002326011658,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$6,250","$12,500",Not Applicable,Not Applicable,"$6,200",$0,$0,$200,"$4,500",$0,$0,$40,7
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,2,34762,MO,Individual,No,43-1257251,34762MO0150006,Blue & U First Select Bronze,34762MO015,7023011258,MON003,MOS002,MOF008,Existing,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/firstselectbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0150006-00,Standard Bronze Off Exchange Plan,,0.611002326011658,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$6,250","$12,500",Not Applicable,Not Applicable,"$6,200",$0,$0,$200,"$4,500",$0,$0,$40,8
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,2,34762,MO,Individual,No,43-1257251,34762MO0150006,Blue & U First Select Bronze,34762MO015,7023011258,MON003,MOS002,MOF008,Existing,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/firstselectbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0150006-01,Standard Bronze On Exchange Plan,,0.611002326011658,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$6,250","$12,500",Not Applicable,Not Applicable,"$6,200",$0,$0,$200,"$4,500",$0,$0,$40,9
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,2,34762,MO,Individual,No,43-1257251,34762MO0150006,Blue & U First Select Bronze,34762MO015,7023011258,MON003,MOS002,MOF008,Existing,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/firstselectbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0150006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,10
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,2,34762,MO,Individual,No,43-1257251,34762MO0150006,Blue & U First Select Bronze,34762MO015,7023011258,MON003,MOS002,MOF008,Existing,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/firstselectbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0150006-03,Limited Cost Sharing Plan Variation,,0.611002326011658,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$6,250","$12,500",Not Applicable,Not Applicable,"$6,200",$0,$0,$200,"$4,500",$0,$0,$40,11
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,3,34762,MO,Individual,No,43-1257251,34762MO0150004,Blue & U First Select Silver,34762MO015,7023011258,MON002,MOS002,MOF002,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/firstselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0150004-00,Standard Silver Off Exchange Plan,71.05%,0.710463523864746,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,200","$8,400","$4,200","$8,400","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",0%,"$4,200","$8,400",0%,"$4,200","$8,400",Not Applicable,Not Applicable,"$4,200",$0,$0,$200,$300,$700,$0,$40,4
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,3,34762,MO,Individual,No,43-1257251,34762MO0150004,Blue & U First Select Silver,34762MO015,7023011258,MON002,MOS002,MOF002,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/firstselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0150004-01,Standard Silver On Exchange Plan,71.05%,0.710463523864746,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,200","$8,400","$4,200","$8,400","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",0%,"$4,200","$8,400",0%,"$4,200","$8,400",Not Applicable,Not Applicable,"$4,200",$0,$0,$200,$300,$700,$0,$40,5
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,3,34762,MO,Individual,No,43-1257251,34762MO0150004,Blue & U First Select Silver,34762MO015,7023011258,MON002,MOS002,MOF002,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/firstselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0150004-04,73% AV Level Silver Plan,73.05%,0.730520844459534,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,900","$7,800","$3,900","$7,800","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,900","$7,800",0%,"$3,900","$7,800",0%,"$4,200","$8,400",Not Applicable,Not Applicable,"$3,900",$0,$0,$200,$300,$700,$0,$40,8
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,3,34762,MO,Individual,No,43-1257251,34762MO0150004,Blue & U First Select Silver,34762MO015,7023011258,MON002,MOS002,MOF002,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/firstselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0150004-05,87% AV Level Silver Plan,86.23%,0.862267374992371,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,"$1,500","$3,000",0%,"$4,200","$8,400",Not Applicable,Not Applicable,"$1,500",$0,$0,$200,$300,$700,$0,$40,9
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,3,34762,MO,Individual,No,43-1257251,34762MO0150004,Blue & U First Select Silver,34762MO015,7023011258,MON002,MOS002,MOF002,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/firstselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0150004-06,94% AV Level Silver Plan,94.06%,0.940608441829681,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$450,$900,$450,$900,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$450,$900,0%,$450,$900,0%,"$4,200","$8,400",Not Applicable,Not Applicable,$400,$0,$0,$200,$90,$400,$0,$40,10
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,4,34762,MO,Individual,No,43-1257251,34762MO0160002,Blue & U Classic PCB Gold,34762MO016,7023011258,MON001,MOS001,MOF003,Existing,PPO,Gold,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",No,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/classicpcbgold.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0160002-00,Standard Gold Off Exchange Plan,,0.783190906047821,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,"$1,500","$3,000",10%,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100",$900,$0,$200,$0,$900,$0,$40,4
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,4,34762,MO,Individual,No,43-1257251,34762MO0160002,Blue & U Classic PCB Gold,34762MO016,7023011258,MON001,MOS001,MOF003,Existing,PPO,Gold,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",No,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/classicpcbgold.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0160002-01,Standard Gold On Exchange Plan,,0.783190906047821,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,"$1,500","$3,000",10%,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100",$900,$0,$200,$0,$900,$0,$40,5
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,5,34762,MO,Individual,No,43-1257251,34762MO0170004,Blue & U Classic Select Silver,34762MO017,7023011258,MON002,MOS002,MOF004,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/classicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0170004-03,Limited Cost Sharing Plan Variation,,0.684854745864868,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$25,000","$50,000",Not Applicable,Not Applicable,"$5,000","$10,000",10%,"$5,000","$10,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,10%,$0,$0,10%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100","$1,100",$0,$200,$0,"$1,100",$0,$40,11
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,5,34762,MO,Individual,No,43-1257251,34762MO0170004,Blue & U Classic Select Silver,34762MO017,7023011258,MON002,MOS002,MOF004,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/classicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0170004-04,73% AV Level Silver Plan,,0.722744584083557,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$25,000","$50,000",Not Applicable,Not Applicable,"$3,000","$6,000",10%,"$3,000","$6,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,10%,$0,$0,10%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100",$900,$0,$200,$0,"$1,100",$0,$40,12
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,7,34762,MO,Individual,No,43-1257251,34762MO0190008,Blue & U Saver2 Select Silver,34762MO019,7023011258,MON002,MOS002,MOF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saver2selectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0190008-03,Limited Cost Sharing Plan Variation,,0.687736034393311,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",40%,"$1,800","$3,600",40%,"$1,800","$3,600",Not Applicable,Not Applicable,"$1,800",$20,"$2,100",$200,"$1,800",$600,$100,$40,14
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,7,34762,MO,Individual,No,43-1257251,34762MO0190008,Blue & U Saver2 Select Silver,34762MO019,7023011258,MON002,MOS002,MOF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saver2selectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0190008-04,73% AV Level Silver Plan,,0.725340247154236,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",40%,"$1,500","$3,000",40%,"$1,800","$3,600",Not Applicable,Not Applicable,"$1,500",$0,"$2,000",$200,"$1,500",$600,$100,$40,15
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,11,44240,MO,Individual,No,75-1296086,44240MO0090006,Coventry Silver $5 Copay 2750 PPO,44240MO009,,MON001,MOS001,MOF018,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48453,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090006-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,11,44240,MO,Individual,No,75-1296086,44240MO0090006,Coventry Silver $5 Copay 2750 PPO,44240MO009,,MON001,MOS001,MOF018,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48453,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090006-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,13,44240,MO,Individual,No,75-1296086,44240MO0090013,Coventry Silver HSA Eligible KCPPO,44240MO009,,MON002,MOS002,MOF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48434,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090013-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,13,44240,MO,Individual,No,75-1296086,44240MO0090013,Coventry Silver HSA Eligible KCPPO,44240MO009,,MON002,MOS002,MOF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48434,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090013-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,13,44240,MO,Individual,No,75-1296086,44240MO0090013,Coventry Silver HSA Eligible KCPPO,44240MO009,,MON002,MOS002,MOF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48434,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090013-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,13,44240,MO,Individual,No,75-1296086,44240MO0090013,Coventry Silver HSA Eligible KCPPO,44240MO009,,MON002,MOS002,MOF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48434,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090013-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,13,44240,MO,Individual,No,75-1296086,44240MO0090013,Coventry Silver HSA Eligible KCPPO,44240MO009,,MON002,MOS002,MOF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48434,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090013-04,73% AV Level Silver Plan,72.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,8
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,13,44240,MO,Individual,No,75-1296086,44240MO0090013,Coventry Silver HSA Eligible KCPPO,44240MO009,,MON002,MOS002,MOF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48434,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090013-05,87% AV Level Silver Plan,86.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,950","$3,900",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,13,44240,MO,Individual,No,75-1296086,44240MO0090013,Coventry Silver HSA Eligible KCPPO,44240MO009,,MON002,MOS002,MOF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48434,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090013-06,94% AV Level Silver Plan,93.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,600","$3,200",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,10
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,14,44240,MO,Individual,No,75-1296086,44240MO0090014,Coventry Silver HSA Eligible PPO,44240MO009,,MON001,MOS001,MOF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48459,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090014-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,4,34762,MO,Individual,No,43-1257251,34762MO0160002,Blue & U Classic PCB Gold,34762MO016,7023011258,MON001,MOS001,MOF003,Existing,PPO,Gold,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",No,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/classicpcbgold.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0160002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,4,34762,MO,Individual,No,43-1257251,34762MO0160002,Blue & U Classic PCB Gold,34762MO016,7023011258,MON001,MOS001,MOF003,Existing,PPO,Gold,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",No,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/classicpcbgold.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0160002-03,Limited Cost Sharing Plan Variation,,0.783190906047821,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,"$1,500","$3,000",10%,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100",$900,$0,$200,$0,$900,$0,$40,7
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,4,34762,MO,Individual,No,43-1257251,34762MO0160004,Blue & U Classic PCB Silver,34762MO016,7023011258,MON001,MOS001,MOF003,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/classicpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0160004-00,Standard Silver Off Exchange Plan,,0.687625050544739,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$12,500","$25,000",Not Applicable,Not Applicable,"$5,000","$10,000",10%,"$5,000","$10,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100","$1,100",$0,$200,$0,"$1,000",$0,$40,8
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,4,34762,MO,Individual,No,43-1257251,34762MO0160004,Blue & U Classic PCB Silver,34762MO016,7023011258,MON001,MOS001,MOF003,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/classicpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0160004-01,Standard Silver On Exchange Plan,,0.687625050544739,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$12,500","$25,000",Not Applicable,Not Applicable,"$5,000","$10,000",10%,"$5,000","$10,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100","$1,100",$0,$200,$0,"$1,000",$0,$40,9
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,4,34762,MO,Individual,No,43-1257251,34762MO0160004,Blue & U Classic PCB Silver,34762MO016,7023011258,MON001,MOS001,MOF003,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/classicpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0160004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$40,10
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,4,34762,MO,Individual,No,43-1257251,34762MO0160004,Blue & U Classic PCB Silver,34762MO016,7023011258,MON001,MOS001,MOF003,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/classicpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0160004-03,Limited Cost Sharing Plan Variation,,0.687625050544739,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$12,500","$25,000",Not Applicable,Not Applicable,"$5,000","$10,000",10%,"$5,000","$10,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100","$1,100",$0,$200,$0,"$1,000",$0,$40,11
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,4,34762,MO,Individual,No,43-1257251,34762MO0160004,Blue & U Classic PCB Silver,34762MO016,7023011258,MON001,MOS001,MOF003,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/classicpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0160004-04,73% AV Level Silver Plan,,0.723586559295654,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$12,500","$25,000",Not Applicable,Not Applicable,"$3,000","$6,000",10%,"$3,000","$6,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100",$900,$0,$200,$0,"$1,000",$0,$40,12
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,4,34762,MO,Individual,No,43-1257251,34762MO0160004,Blue & U Classic PCB Silver,34762MO016,7023011258,MON001,MOS001,MOF003,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/classicpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0160004-05,87% AV Level Silver Plan,,0.867249190807343,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000","$12,500","$25,000",Not Applicable,Not Applicable,"$1,000","$2,000",10%,"$1,000","$2,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$600,$10,$200,$0,$500,$0,$40,13
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,4,34762,MO,Individual,No,43-1257251,34762MO0160004,Blue & U Classic PCB Silver,34762MO016,7023011258,MON001,MOS001,MOF003,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/classicpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0160004-06,94% AV Level Silver Plan,,0.938696026802063,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$600,"$1,200",$600,"$1,200","$12,500","$25,000",Not Applicable,Not Applicable,$250,$500,10%,$250,$500,10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,$200,$200,$80,$200,$0,$500,$0,$40,14
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,5,34762,MO,Individual,No,43-1257251,34762MO0170002,Blue & U Classic Select Gold,34762MO017,7023011258,MON002,MOS002,MOF004,Existing,PPO,Gold,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",No,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/classicselectgold.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0170002-00,Standard Gold Off Exchange Plan,,0.784480452537537,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$25,000","$50,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,"$1,500","$3,000",10%,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,10%,$0,$0,10%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100",$900,$0,$200,$0,"$1,000",$0,$40,4
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,5,34762,MO,Individual,No,43-1257251,34762MO0170002,Blue & U Classic Select Gold,34762MO017,7023011258,MON002,MOS002,MOF004,Existing,PPO,Gold,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",No,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/classicselectgold.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0170002-01,Standard Gold On Exchange Plan,,0.784480452537537,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$25,000","$50,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,"$1,500","$3,000",10%,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,10%,$0,$0,10%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100",$900,$0,$200,$0,"$1,000",$0,$40,5
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,5,34762,MO,Individual,No,43-1257251,34762MO0170002,Blue & U Classic Select Gold,34762MO017,7023011258,MON002,MOS002,MOF004,Existing,PPO,Gold,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",No,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/classicselectgold.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0170002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,5,34762,MO,Individual,No,43-1257251,34762MO0170002,Blue & U Classic Select Gold,34762MO017,7023011258,MON002,MOS002,MOF004,Existing,PPO,Gold,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",No,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/classicselectgold.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0170002-03,Limited Cost Sharing Plan Variation,,0.784480452537537,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$25,000","$50,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,"$1,500","$3,000",10%,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,10%,$0,$0,10%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100",$900,$0,$200,$0,"$1,000",$0,$40,7
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,5,34762,MO,Individual,No,43-1257251,34762MO0170004,Blue & U Classic Select Silver,34762MO017,7023011258,MON002,MOS002,MOF004,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/classicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0170004-00,Standard Silver Off Exchange Plan,,0.684854745864868,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$25,000","$50,000",Not Applicable,Not Applicable,"$5,000","$10,000",10%,"$5,000","$10,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,10%,$0,$0,10%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100","$1,100",$0,$200,$0,"$1,100",$0,$40,8
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,5,34762,MO,Individual,No,43-1257251,34762MO0170004,Blue & U Classic Select Silver,34762MO017,7023011258,MON002,MOS002,MOF004,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/classicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0170004-01,Standard Silver On Exchange Plan,,0.684854745864868,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$25,000","$50,000",Not Applicable,Not Applicable,"$5,000","$10,000",10%,"$5,000","$10,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,10%,$0,$0,10%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100","$1,100",$0,$200,$0,"$1,100",$0,$40,9
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,5,34762,MO,Individual,No,43-1257251,34762MO0170004,Blue & U Classic Select Silver,34762MO017,7023011258,MON002,MOS002,MOF004,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/classicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0170004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$40,10
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,5,34762,MO,Individual,No,43-1257251,34762MO0170004,Blue & U Classic Select Silver,34762MO017,7023011258,MON002,MOS002,MOF004,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/classicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0170004-05,87% AV Level Silver Plan,,0.86102169752121,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000","$25,000","$50,000",Not Applicable,Not Applicable,"$1,000","$2,000",10%,"$1,000","$2,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,10%,$0,$0,10%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$700,$10,$200,$0,$900,$0,$40,13
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,5,34762,MO,Individual,No,43-1257251,34762MO0170004,Blue & U Classic Select Silver,34762MO017,7023011258,MON002,MOS002,MOF004,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/classicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0170004-06,94% AV Level Silver Plan,,0.935858845710754,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$600,"$1,200",$600,"$1,200","$25,000","$50,000",Not Applicable,Not Applicable,$250,$500,10%,$250,$500,10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,10%,$0,$0,10%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,$200,$200,$80,$200,$0,$600,$0,$40,14
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,6,34762,MO,Individual,No,43-1257251,34762MO0180003,Blue & U Saver PCB Silver,34762MO018,7023011258,MON001,MOS001,MOF005,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saverpcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0180003-00,Standard Silver Off Exchange Plan,,0.683055341243744,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,"$2,500",$20,$500,$200,"$2,500",$400,$20,$40,4
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,6,34762,MO,Individual,No,43-1257251,34762MO0180003,Blue & U Saver PCB Silver,34762MO018,7023011258,MON001,MOS001,MOF005,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saverpcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0180003-01,Standard Silver On Exchange Plan,,0.683055341243744,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,"$2,500",$20,$500,$200,"$2,500",$400,$20,$40,5
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,6,34762,MO,Individual,No,43-1257251,34762MO0180003,Blue & U Saver PCB Silver,34762MO018,7023011258,MON001,MOS001,MOF005,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saverpcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0180003-04,73% AV Level Silver Plan,,0.722182929515839,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,125","$6,250",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,"$2,000",$20,$500,$200,"$2,000",$500,$20,$40,8
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,6,34762,MO,Individual,No,43-1257251,34762MO0180003,Blue & U Saver PCB Silver,34762MO018,7023011258,MON001,MOS001,MOF005,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saverpcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0180003-05,87% AV Level Silver Plan,,0.870086431503296,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$800,"$1,600",10%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$800,$0,$400,$200,$800,$200,$70,$40,9
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,6,34762,MO,Individual,No,43-1257251,34762MO0180003,Blue & U Saver PCB Silver,34762MO018,7023011258,MON001,MOS001,MOF005,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saverpcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0180003-06,94% AV Level Silver Plan,,0.940562903881073,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$200,$0,$200,$200,$200,$90,$50,$40,10
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,6,34762,MO,Individual,No,43-1257251,34762MO0180008,Blue & U Saver2 PCB Silver,34762MO018,7023011258,MON001,MOS001,MOF005,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saver2pcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0180008-00,Standard Silver Off Exchange Plan,,0.684860467910767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",40%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,"$1,800",$20,"$2,100",$200,"$1,800",$500,$100,$40,11
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,6,34762,MO,Individual,No,43-1257251,34762MO0180008,Blue & U Saver2 PCB Silver,34762MO018,7023011258,MON001,MOS001,MOF005,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saver2pcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0180008-01,Standard Silver On Exchange Plan,,0.684860467910767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",40%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,"$1,800",$20,"$2,100",$200,"$1,800",$500,$100,$40,12
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,6,34762,MO,Individual,No,43-1257251,34762MO0180008,Blue & U Saver2 PCB Silver,34762MO018,7023011258,MON001,MOS001,MOF005,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saver2pcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0180008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,13
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,6,34762,MO,Individual,No,43-1257251,34762MO0180008,Blue & U Saver2 PCB Silver,34762MO018,7023011258,MON001,MOS001,MOF005,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saver2pcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0180008-05,87% AV Level Silver Plan,,0.867958784103394,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",40%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,$700,$0,$500,$200,$700,$200,$300,$40,16
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,6,34762,MO,Individual,No,43-1257251,34762MO0180008,Blue & U Saver2 PCB Silver,34762MO018,7023011258,MON001,MOS001,MOF005,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saver2pcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0180008-06,94% AV Level Silver Plan,,0.937017142772675,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,40%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,$200,$0,$200,$200,$200,$20,$200,$40,17
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,6,34762,MO,Individual,No,43-1257251,34762MO0180009,Blue & U Saver PCB Bronze,34762MO018,7023011258,MON001,MOS001,MOF005,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saverpcbbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0180009-00,Standard Bronze Off Exchange Plan,,0.589855790138245,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$5,000",$20,$200,$200,"$5,000",$0,$0,$40,18
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,6,34762,MO,Individual,No,43-1257251,34762MO0180009,Blue & U Saver PCB Bronze,34762MO018,7023011258,MON001,MOS001,MOF005,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saverpcbbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0180009-01,Standard Bronze On Exchange Plan,,0.589855790138245,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$5,000",$20,$200,$200,"$5,000",$0,$0,$40,19
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,6,34762,MO,Individual,No,43-1257251,34762MO0180009,Blue & U Saver PCB Bronze,34762MO018,7023011258,MON001,MOS001,MOF005,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saverpcbbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0180009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,20
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,6,34762,MO,Individual,No,43-1257251,34762MO0180009,Blue & U Saver PCB Bronze,34762MO018,7023011258,MON001,MOS001,MOF005,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saverpcbbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0180009-03,Limited Cost Sharing Plan Variation,,0.589855790138245,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$5,000",$20,$200,$200,"$5,000",$0,$0,$40,21
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,6,34762,MO,Individual,No,43-1257251,34762MO0180010,Blue & U Saver2 PCB Bronze,34762MO018,7023011258,MON001,MOS001,MOF027,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saver2pcbbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0180010-00,Standard Bronze Off Exchange Plan,,0.60889732837677,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,100",$200,"$3,000",$0,"$1,000",$40,22
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,6,34762,MO,Individual,No,43-1257251,34762MO0180010,Blue & U Saver2 PCB Bronze,34762MO018,7023011258,MON001,MOS001,MOF027,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saver2pcbbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0180010-01,Standard Bronze On Exchange Plan,,0.60889732837677,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,100",$200,"$3,000",$0,"$1,000",$40,23
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,6,34762,MO,Individual,No,43-1257251,34762MO0180010,Blue & U Saver2 PCB Bronze,34762MO018,7023011258,MON001,MOS001,MOF027,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saver2pcbbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0180010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,24
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,6,34762,MO,Individual,No,43-1257251,34762MO0180010,Blue & U Saver2 PCB Bronze,34762MO018,7023011258,MON001,MOS001,MOF027,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saver2pcbbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0180010-03,Limited Cost Sharing Plan Variation,,0.60889732837677,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,100",$200,"$3,000",$0,"$1,000",$40,25
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,7,34762,MO,Individual,No,43-1257251,34762MO0190007,Blue & U Saver Select Silver,34762MO019,7023011258,MON002,MOS002,MOF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saverselectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0190007-00,Standard Silver Off Exchange Plan,,0.686542272567749,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,"$2,500","$5,000",10%,"$2,500","$5,000",Not Applicable,Not Applicable,"$2,500",$20,$500,$200,"$2,500",$400,$20,$40,4
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,7,34762,MO,Individual,No,43-1257251,34762MO0190007,Blue & U Saver Select Silver,34762MO019,7023011258,MON002,MOS002,MOF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saverselectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0190007-01,Standard Silver On Exchange Plan,,0.686542272567749,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,"$2,500","$5,000",10%,"$2,500","$5,000",Not Applicable,Not Applicable,"$2,500",$20,$500,$200,"$2,500",$400,$20,$40,5
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,7,34762,MO,Individual,No,43-1257251,34762MO0190007,Blue & U Saver Select Silver,34762MO019,7023011258,MON002,MOS002,MOF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saverselectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0190007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,8,44240,MO,Individual,No,75-1296086,44240MO0090002,Coventry Silver $10 Copay PPO,44240MO009,,MON001,MOS001,MOF010,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48447,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,8,44240,MO,Individual,No,75-1296086,44240MO0090002,Coventry Silver $10 Copay PPO,44240MO009,,MON001,MOS001,MOF010,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48447,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090002-03,Limited Cost Sharing Plan Variation,68.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$16,000","$32,000",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,8,44240,MO,Individual,No,75-1296086,44240MO0090002,Coventry Silver $10 Copay PPO,44240MO009,,MON001,MOS001,MOF010,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48447,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090002-04,73% AV Level Silver Plan,72.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$16,000","$32,000",Not Applicable,Not Applicable,"$3,700","$7,400",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,8,44240,MO,Individual,No,75-1296086,44240MO0090002,Coventry Silver $10 Copay PPO,44240MO009,,MON001,MOS001,MOF010,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48447,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090002-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$16,000","$32,000",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,8,44240,MO,Individual,No,75-1296086,44240MO0090002,Coventry Silver $10 Copay PPO,44240MO009,,MON001,MOS001,MOF010,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48447,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090002-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$16,000","$32,000",Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,11,44240,MO,Individual,No,75-1296086,44240MO0090006,Coventry Silver $5 Copay 2750 PPO,44240MO009,,MON001,MOS001,MOF018,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48453,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090006-00,Standard Silver Off Exchange Plan,68.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,11,44240,MO,Individual,No,75-1296086,44240MO0090006,Coventry Silver $5 Copay 2750 PPO,44240MO009,,MON001,MOS001,MOF018,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48453,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090006-01,Standard Silver On Exchange Plan,68.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,11,44240,MO,Individual,No,75-1296086,44240MO0090006,Coventry Silver $5 Copay 2750 PPO,44240MO009,,MON001,MOS001,MOF018,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48453,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,14,44240,MO,Individual,No,75-1296086,44240MO0090014,Coventry Silver HSA Eligible PPO,44240MO009,,MON001,MOS001,MOF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48459,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090014-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,14,44240,MO,Individual,No,75-1296086,44240MO0090014,Coventry Silver HSA Eligible PPO,44240MO009,,MON001,MOS001,MOF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48459,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090014-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,14,44240,MO,Individual,No,75-1296086,44240MO0090014,Coventry Silver HSA Eligible PPO,44240MO009,,MON001,MOS001,MOF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48459,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090014-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,14,44240,MO,Individual,No,75-1296086,44240MO0090014,Coventry Silver HSA Eligible PPO,44240MO009,,MON001,MOS001,MOF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48459,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090014-04,73% AV Level Silver Plan,72.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,8
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,14,44240,MO,Individual,No,75-1296086,44240MO0090014,Coventry Silver HSA Eligible PPO,44240MO009,,MON001,MOS001,MOF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48459,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090014-05,87% AV Level Silver Plan,86.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,14,44240,MO,Individual,No,75-1296086,44240MO0090014,Coventry Silver HSA Eligible PPO,44240MO009,,MON001,MOS001,MOF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48459,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090014-06,94% AV Level Silver Plan,93.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,600","$3,200",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,10
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,16,44240,MO,Individual,No,75-1296086,44240MO0090007,Coventry Gold $5 Copay KCPPO,44240MO009,,MON002,MOS002,MOF011,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48419,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090007-00,Standard Gold Off Exchange Plan,79.40%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$5,500","$11,000","$6,600","$13,200","$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",30%,"$1,450","$2,900",30%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,16,44240,MO,Individual,No,75-1296086,44240MO0090007,Coventry Gold $5 Copay KCPPO,44240MO009,,MON002,MOS002,MOF011,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48419,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090007-01,Standard Gold On Exchange Plan,79.40%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$5,500","$11,000","$6,600","$13,200","$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",30%,"$1,450","$2,900",30%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,7,34762,MO,Individual,No,43-1257251,34762MO0190007,Blue & U Saver Select Silver,34762MO019,7023011258,MON002,MOS002,MOF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saverselectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0190007-03,Limited Cost Sharing Plan Variation,,0.686542272567749,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,"$2,500","$5,000",10%,"$2,500","$5,000",Not Applicable,Not Applicable,"$2,500",$20,$500,$200,"$2,500",$400,$20,$40,7
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,7,34762,MO,Individual,No,43-1257251,34762MO0190007,Blue & U Saver Select Silver,34762MO019,7023011258,MON002,MOS002,MOF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saverselectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0190007-04,73% AV Level Silver Plan,,0.725526809692383,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,125","$6,250","$3,125","$6,250","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,"$2,000","$4,000",10%,"$2,500","$5,000",Not Applicable,Not Applicable,"$2,000",$20,$500,$200,"$2,000",$500,$20,$40,8
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,7,34762,MO,Individual,No,43-1257251,34762MO0190007,Blue & U Saver Select Silver,34762MO019,7023011258,MON002,MOS002,MOF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saverselectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0190007-05,87% AV Level Silver Plan,,0.868340194225311,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,200","$2,400","$1,200","$2,400","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$800,"$1,600",10%,$800,"$1,600",10%,"$2,500","$5,000",Not Applicable,Not Applicable,$800,$0,$400,$200,$800,$300,$40,$40,9
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,7,34762,MO,Individual,No,43-1257251,34762MO0190007,Blue & U Saver Select Silver,34762MO019,7023011258,MON002,MOS002,MOF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saverselectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0190007-06,94% AV Level Silver Plan,,0.939264476299286,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$500,"$1,000",$500,"$1,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,$250,$500,10%,"$2,500","$5,000",Not Applicable,Not Applicable,$200,$0,$200,$200,$200,$90,$50,$40,10
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,7,34762,MO,Individual,No,43-1257251,34762MO0190008,Blue & U Saver2 Select Silver,34762MO019,7023011258,MON002,MOS002,MOF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saver2selectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0190008-00,Standard Silver Off Exchange Plan,,0.687736034393311,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",40%,"$1,800","$3,600",40%,"$1,800","$3,600",Not Applicable,Not Applicable,"$1,800",$20,"$2,100",$200,"$1,800",$600,$100,$40,11
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,7,34762,MO,Individual,No,43-1257251,34762MO0190008,Blue & U Saver2 Select Silver,34762MO019,7023011258,MON002,MOS002,MOF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saver2selectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0190008-01,Standard Silver On Exchange Plan,,0.687736034393311,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",40%,"$1,800","$3,600",40%,"$1,800","$3,600",Not Applicable,Not Applicable,"$1,800",$20,"$2,100",$200,"$1,800",$600,$100,$40,12
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,7,34762,MO,Individual,No,43-1257251,34762MO0190008,Blue & U Saver2 Select Silver,34762MO019,7023011258,MON002,MOS002,MOF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saver2selectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0190008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,13
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,7,34762,MO,Individual,No,43-1257251,34762MO0190009,Blue & U Saver Select Bronze,34762MO019,7023011258,MON002,MOS002,MOF006,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saverselectbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0190009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,20
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,7,34762,MO,Individual,No,43-1257251,34762MO0190009,Blue & U Saver Select Bronze,34762MO019,7023011258,MON002,MOS002,MOF006,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saverselectbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0190009-03,Limited Cost Sharing Plan Variation,,0.591564774513245,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",10%,"$5,000","$10,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,"$5,000",$20,$200,$200,"$5,000",$0,$0,$40,21
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,7,34762,MO,Individual,No,43-1257251,34762MO0190010,Blue & U Saver2 Select Bronze,34762MO019,7023011258,MON003,MOS002,MOF028,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saver2selectbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0190010-00,Standard Bronze Off Exchange Plan,,0.60889732837677,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,"$3,000","$6,000",50%,"$3,000","$6,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,100",$200,"$3,000",$0,"$1,000",$40,22
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,7,34762,MO,Individual,No,43-1257251,34762MO0190010,Blue & U Saver2 Select Bronze,34762MO019,7023011258,MON003,MOS002,MOF028,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saver2selectbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0190010-01,Standard Bronze On Exchange Plan,,0.60889732837677,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,"$3,000","$6,000",50%,"$3,000","$6,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,100",$200,"$3,000",$0,"$1,000",$40,23
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,7,34762,MO,Individual,No,43-1257251,34762MO0190010,Blue & U Saver2 Select Bronze,34762MO019,7023011258,MON003,MOS002,MOF028,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saver2selectbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0190010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,24
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,7,34762,MO,Individual,No,43-1257251,34762MO0190010,Blue & U Saver2 Select Bronze,34762MO019,7023011258,MON003,MOS002,MOF028,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/mo/saver2selectbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0190010-03,Limited Cost Sharing Plan Variation,,0.60889732837677,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,"$3,000","$6,000",50%,"$3,000","$6,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,100",$200,"$3,000",$0,"$1,000",$40,25
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,9,34762,MO,Individual,No,43-1257251,34762MO0440001,Blue & U Basic Select Silver,34762MO044,7023011258,MON005,MOS002,MOF019,New,EPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",No,"Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.",No,http://www.bluekc.com/qhp/2015/dp/mo/basicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0440001-00,Standard Silver Off Exchange Plan,,0.702799558639526,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$0,"$1,500",$200,$500,$300,$0,$40,4
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,9,34762,MO,Individual,No,43-1257251,34762MO0440001,Blue & U Basic Select Silver,34762MO044,7023011258,MON005,MOS002,MOF019,New,EPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",No,"Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.",No,http://www.bluekc.com/qhp/2015/dp/mo/basicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0440001-01,Standard Silver On Exchange Plan,,0.702799558639526,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$0,"$1,500",$200,$500,$300,$0,$40,5
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,9,34762,MO,Individual,No,43-1257251,34762MO0440001,Blue & U Basic Select Silver,34762MO044,7023011258,MON005,MOS002,MOF019,New,EPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",No,"Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.",No,http://www.bluekc.com/qhp/2015/dp/mo/basicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0440001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,9,34762,MO,Individual,No,43-1257251,34762MO0440001,Blue & U Basic Select Silver,34762MO044,7023011258,MON005,MOS002,MOF019,New,EPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",No,"Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.",No,http://www.bluekc.com/qhp/2015/dp/mo/basicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0440001-03,Limited Cost Sharing Plan Variation,,0.702799558639526,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$0,"$1,500",$200,$500,$300,$0,$40,7
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,9,34762,MO,Individual,No,43-1257251,34762MO0440001,Blue & U Basic Select Silver,34762MO044,7023011258,MON005,MOS002,MOF019,New,EPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",No,"Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.",No,http://www.bluekc.com/qhp/2015/dp/mo/basicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0440001-04,73% AV Level Silver Plan,,0.732099652290344,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,800",$0,"$1,200",$200,$500,$300,$0,$40,8
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,9,34762,MO,Individual,No,43-1257251,34762MO0440001,Blue & U Basic Select Silver,34762MO044,7023011258,MON005,MOS002,MOF019,New,EPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",No,"Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.",No,http://www.bluekc.com/qhp/2015/dp/mo/basicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0440001-05,87% AV Level Silver Plan,,0.861658275127411,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$800,$0,"$1,000",$200,$500,$300,$0,$40,9
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,9,34762,MO,Individual,No,43-1257251,34762MO0440002,Blue & U Basic Select Bronze,34762MO044,7023011258,MON005,MOS002,MOF020,New,EPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",No,"Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.",No,http://www.bluekc.com/qhp/2015/dp/mo/basicselectbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0440002-01,Standard Bronze On Exchange Plan,,0.619391202926636,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,"$1,200",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,000",$0,$600,$200,$500,"$1,200",$0,$40,12
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,9,34762,MO,Individual,No,43-1257251,34762MO0440002,Blue & U Basic Select Bronze,34762MO044,7023011258,MON005,MOS002,MOF020,New,EPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",No,"Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.",No,http://www.bluekc.com/qhp/2015/dp/mo/basicselectbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0440002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$40,13
2015,MO,34762,HIOS,9,2015-01-17 03:15:53,9,34762,MO,Individual,No,43-1257251,34762MO0440002,Blue & U Basic Select Bronze,34762MO044,7023011258,MON005,MOS002,MOF020,New,EPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",No,"Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.",No,http://www.bluekc.com/qhp/2015/dp/mo/basicselectbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/modruglist.html,34762MO0440002-03,Limited Cost Sharing Plan Variation,,0.619391202926636,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,"$1,200",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,000",$0,$600,$200,$500,"$1,200",$0,$40,14
2015,MO,35853,HIOS,2,2014-08-08 08:53:29,1,35853,MO,Individual,Yes,47-0397286,35853MO0010001,"Delta Dental Individual PPO, EHB Certified",35853MO001,,MON002,MOS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.52,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,35853MO0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,35853,HIOS,2,2014-08-08 08:53:29,1,35853,MO,SHOP (Small Group),Yes,47-0397286,35853MO0030001,"Renaissance Group Dental PPO, EHB Certified",35853MO003,,MON001,MOS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.24,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,35853MO0030001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,35853,HIOS,2,2014-08-08 08:53:29,1,35853,MO,SHOP (Small Group),Yes,47-0397286,35853MO0030002,"Renaissance Group Dental PPO, EHB Certified",35853MO003,,MON001,MOS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.02,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,35853MO0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,35853,HIOS,2,2014-08-08 08:53:29,1,35853,MO,Individual,Yes,47-0397286,35853MO0010002,"Delta Dental Individual PPO, EHB Certified",35853MO001,,MON002,MOS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.25,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,35853MO0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,35853,HIOS,2,2014-08-08 08:53:29,1,35853,MO,Individual,Yes,47-0397286,35853MO0020001,"Renaissance Individual Dental PPO, EHB Certified",35853MO002,,MON001,MOS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.79,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,35853MO0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MO,35853,HIOS,2,2014-08-08 08:53:29,1,35853,MO,Individual,Yes,47-0397286,35853MO0020002,"Renaissance Individual Dental PPO, EHB Certified",35853MO002,,MON001,MOS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.98,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,35853MO0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MO,39371,HIOS,5,2014-08-28 04:23:13,1,39371,MO,SHOP (Small Group),Yes,43-1501438,39371MO0020002,Managed DentalGuard MO Child Essentials 1,39371MO002,,MON001,MOS001,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$19.67,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,39371MO0020002-00,Standard Low Off Exchange Plan,68.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,39371,HIOS,5,2014-08-28 04:23:13,2,39371,MO,SHOP (Small Group),Yes,43-1501438,39371MO0030002,Managed DentalGuard MO 10 Family Plan,39371MO003,,MON001,MOS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.67,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,39371MO0030002-00,Standard Low Off Exchange Plan,68.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,39371,HIOS,5,2014-08-28 04:23:13,2,39371,MO,SHOP (Small Group),Yes,43-1501438,39371MO0030002,Managed DentalGuard MO 10 Family Plan,39371MO003,,MON001,MOS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.67,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,39371MO0030002-01,Standard Low On Exchange Plan,68.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,39371,HIOS,5,2014-08-28 04:23:13,2,39371,MO,SHOP (Small Group),Yes,43-1501438,39371MO0040002,Managed DentalGuard MO 20 Family Plan,39371MO004,,MON001,MOS001,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.67,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,39371MO0040002-00,Standard Low Off Exchange Plan,68.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MO,39371,HIOS,5,2014-08-28 04:23:13,2,39371,MO,SHOP (Small Group),Yes,43-1501438,39371MO0050002,Managed DentalGuard MO 30 Family Plan,39371MO005,,MON001,MOS001,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.67,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,39371MO0050002-00,Standard Low Off Exchange Plan,68.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MO,40807,HIOS,3,2014-08-28 04:23:13,1,40807,MO,Individual,Yes,43-0908349,40807MO0260001,Delta Dental Individual and Family - Standard,40807MO026,7497758624,MON002,MOS001,,New,PPO,Low,,Off the Exchange,,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,Allows Adult and Child-Only,,,,$32.72,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same as in USA,Yes,Same as in service area,Yes,,,,,40807MO0260001-00,Standard Low Off Exchange Plan,71.66%,,,,Yes,56%,44%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,$100,Not Applicable,,$100,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,40807,HIOS,3,2014-08-28 04:23:13,1,40807,MO,SHOP (Small Group),Yes,43-0908349,40807MO0280001,Delta Dental - PPO Choice,40807MO028,7497758624,MON002,MOS001,,New,PPO,Low,,Off the Exchange,,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,Allows Adult and Child-Only,,,,$20.51,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same as in USA,Yes,Same as in service area,Yes,,,,,40807MO0280001-00,Standard Low Off Exchange Plan,70.72%,,,,Yes,45%,55%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,$100,Not Applicable,,$100,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,40807,HIOS,3,2014-08-28 04:23:13,1,40807,MO,Individual,Yes,43-0908349,40807MO0270001,Delta Dental Individual and Family - Standard Plus,40807MO027,7497758624,MON002,MOS001,,New,PPO,High,,Off the Exchange,,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,Allows Adult and Child-Only,,,,$38.74,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same as in USA,Yes,Same as in service area,Yes,,,,,40807MO0270001-00,Standard High Off Exchange Plan,84.69%,,,,Yes,56%,44%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,$0,Not Applicable,,$0,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,40807,HIOS,3,2014-08-28 04:23:13,2,40807,MO,Individual,Yes,43-0908349,40807MO0230001,Delta Dental Individual and Family - FFM Basic,40807MO023,7497758624,MON002,MOS001,,New,PPO,Low,,On the Exchange,,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,Allows Adult and Child-Only,,,,$35.48,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same as in USA,Yes,Same as in service area,Yes,https://Individual.deltadentalmo.com/benefits/FFMBasic,https://Individual.deltadentalmo.com/marketplace/FFMBasic,https://Individual.deltadentalmo.com/brochure/FFMBasic,,40807MO0230001-01,Standard Low On Exchange Plan,71.70%,,,,Yes,53%,47%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,$50,Not Applicable,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,40807,HIOS,3,2014-08-28 04:23:13,2,40807,MO,SHOP (Small Group),Yes,43-0908349,40807MO0290001,Delta Dental - PPO Choice Plus,40807MO029,7497758624,MON002,MOS001,,New,PPO,High,,Off the Exchange,,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,Allows Adult and Child-Only,,,,$25.01,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same as in USA,Yes,Same as in service area,Yes,,,,,40807MO0290001-00,Standard High Off Exchange Plan,86.01%,,,,Yes,45%,55%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,$100,Not Applicable,,$100,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,40807,HIOS,3,2014-08-28 04:23:13,3,40807,MO,SHOP (Small Group),Yes,43-0908349,40807MO0300001,Delta Dental - FFM Exclusive,40807MO030,7497758624,MON002,MOS001,,New,EPO,Low,,On the Exchange,,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,Allows Adult and Child-Only,,,,$17.74,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same as in USA,Yes,Same as in service area,Yes,http://www.deltadentalmo.com/FFMExclusive/Benefits,http://www.deltadentalmo.com/FFMExclusive/MarketPlace,http://www.deltadentalmo.com/FFMExclusive/Brochure,,40807MO0300001-01,Standard Low On Exchange Plan,69.99%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,40807,HIOS,3,2014-08-28 04:23:13,3,40807,MO,Individual,Yes,43-0908349,40807MO0240001,Delta Dental Individual and Family - FFM Preferred,40807MO024,7497758624,MON002,MOS001,,New,PPO,Low,,On the Exchange,,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,Allows Adult and Child-Only,,,,$35.48,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same as in USA,Yes,Same as in service area,Yes,https://Individual.deltadentalmo.com/benefits/FFMPreferred,https://Individual.deltadentalmo.com/marketplace/FFMPreferred,https://Individual.deltadentalmo.com/brochure/FFMPreferred,,40807MO0240001-01,Standard Low On Exchange Plan,71.70%,,,,Yes,53%,47%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,$50,Not Applicable,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,40807,HIOS,3,2014-08-28 04:23:13,4,40807,MO,Individual,Yes,43-0908349,40807MO0250001,Delta Dental Individual and Family - FFM Choice,40807MO025,7497758624,MON002,MOS001,,New,PPO,High,,On the Exchange,,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,Allows Adult and Child-Only,,,,$41.09,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same as in USA,Yes,Same as in service area,Yes,https://Individual.deltadentalmo.com/benefits/FFMChoice,https://Individual.deltadentalmo.com/marketplace/FFMChoice,https://Individual.deltadentalmo.com/brochure/FFMChoice,,40807MO0250001-01,Standard High On Exchange Plan,84.30%,,,,Yes,53%,47%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,$75,Not Applicable,,$75,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,40807,HIOS,3,2014-08-28 04:23:13,4,40807,MO,SHOP (Small Group),Yes,43-0908349,40807MO0310001,Delta Dental - FFM Premier,40807MO031,7497758624,MON001,MOS001,,New,PPO,High,,On the Exchange,,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,Allows Adult and Child-Only,,,,$30.32,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same as in USA,Yes,Same as in service area,Yes,http://www.deltadentalmo.com/FFMPremier/Benefits,http://www.deltadentalmo.com/FFMPremier/MarketPlace,http://www.deltadentalmo.com/FFMPremier/Brochure,,40807MO0310001-01,Standard High On Exchange Plan,86.67%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,$125,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,1,44240,MO,Individual,No,75-1296086,44240MO0090009,Coventry Bronze $20 Copay KCPPO,44240MO009,,MON002,MOS002,MOF006,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48412,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090009-00,Standard Bronze Off Exchange Plan,61.80%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,1,44240,MO,Individual,No,75-1296086,44240MO0090009,Coventry Bronze $20 Copay KCPPO,44240MO009,,MON002,MOS002,MOF006,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48412,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090009-01,Standard Bronze On Exchange Plan,61.80%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,1,44240,MO,Individual,No,75-1296086,44240MO0090009,Coventry Bronze $20 Copay KCPPO,44240MO009,,MON002,MOS002,MOF006,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48412,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090009-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,1,44240,MO,Individual,No,75-1296086,44240MO0090009,Coventry Bronze $20 Copay KCPPO,44240MO009,,MON002,MOS002,MOF006,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48412,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090009-03,Limited Cost Sharing Plan Variation,61.80%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,2,44240,MO,Individual,No,75-1296086,44240MO0090003,Coventry Bronze $20 Copay PPO,44240MO009,,MON001,MOS001,MOF015,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48440,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090003-00,Standard Bronze Off Exchange Plan,61.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,900","$11,800",0%,,,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,2,44240,MO,Individual,No,75-1296086,44240MO0090003,Coventry Bronze $20 Copay PPO,44240MO009,,MON001,MOS001,MOF015,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48440,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090003-01,Standard Bronze On Exchange Plan,61.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,900","$11,800",0%,,,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,2,44240,MO,Individual,No,75-1296086,44240MO0090003,Coventry Bronze $20 Copay PPO,44240MO009,,MON001,MOS001,MOF015,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48440,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,2,44240,MO,Individual,No,75-1296086,44240MO0090003,Coventry Bronze $20 Copay PPO,44240MO009,,MON001,MOS001,MOF015,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48440,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090003-03,Limited Cost Sharing Plan Variation,61.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,900","$11,800",0%,,,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,4,44240,MO,Individual,No,75-1296086,44240MO0090010,Coventry Bronze Deductible Only HSA Eligible KCPPO,44240MO009,,MON002,MOS002,MOF013,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48415,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090010-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$14,000","$28,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,4,44240,MO,Individual,No,75-1296086,44240MO0090010,Coventry Bronze Deductible Only HSA Eligible KCPPO,44240MO009,,MON002,MOS002,MOF013,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48415,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090010-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$14,000","$28,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,4,44240,MO,Individual,No,75-1296086,44240MO0090010,Coventry Bronze Deductible Only HSA Eligible KCPPO,44240MO009,,MON002,MOS002,MOF013,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48415,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090010-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,4,44240,MO,Individual,No,75-1296086,44240MO0090010,Coventry Bronze Deductible Only HSA Eligible KCPPO,44240MO009,,MON002,MOS002,MOF013,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48415,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090010-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$14,000","$28,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,5,44240,MO,Individual,No,75-1296086,44240MO0090004,Coventry Bronze Deductible Only HSA Eligible PPO,44240MO009,,MON001,MOS001,MOF014,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48489,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090004-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$14,000","$28,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,5,44240,MO,Individual,No,75-1296086,44240MO0090004,Coventry Bronze Deductible Only HSA Eligible PPO,44240MO009,,MON001,MOS001,MOF014,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48489,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090004-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$14,000","$28,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,5,44240,MO,Individual,No,75-1296086,44240MO0090004,Coventry Bronze Deductible Only HSA Eligible PPO,44240MO009,,MON001,MOS001,MOF014,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48489,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,5,44240,MO,Individual,No,75-1296086,44240MO0090004,Coventry Bronze Deductible Only HSA Eligible PPO,44240MO009,,MON001,MOS001,MOF014,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48489,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090004-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$14,000","$28,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,7,44240,MO,Individual,No,75-1296086,44240MO0090008,Coventry Silver $10 Copay KCPPO,44240MO009,,MON002,MOS002,MOF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48422,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090008-00,Standard Silver Off Exchange Plan,68.80%,,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,000","$32,000",Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,$500,Not Applicable,40%,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,7,44240,MO,Individual,No,75-1296086,44240MO0090008,Coventry Silver $10 Copay KCPPO,44240MO009,,MON002,MOS002,MOF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48422,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090008-01,Standard Silver On Exchange Plan,68.80%,,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,000","$32,000",Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,$500,Not Applicable,40%,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,7,44240,MO,Individual,No,75-1296086,44240MO0090008,Coventry Silver $10 Copay KCPPO,44240MO009,,MON002,MOS002,MOF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48422,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090008-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,7,44240,MO,Individual,No,75-1296086,44240MO0090008,Coventry Silver $10 Copay KCPPO,44240MO009,,MON002,MOS002,MOF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48422,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090008-03,Limited Cost Sharing Plan Variation,68.80%,,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,000","$32,000",Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,$500,Not Applicable,40%,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,7,44240,MO,Individual,No,75-1296086,44240MO0090008,Coventry Silver $10 Copay KCPPO,44240MO009,,MON002,MOS002,MOF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48422,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090008-04,73% AV Level Silver Plan,72.90%,,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$16,000","$32,000",Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$5,000","$10,000",40%,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,$500,Not Applicable,40%,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,7,44240,MO,Individual,No,75-1296086,44240MO0090008,Coventry Silver $10 Copay KCPPO,44240MO009,,MON002,MOS002,MOF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48422,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090008-05,87% AV Level Silver Plan,86.50%,,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$16,000","$32,000",Not Applicable,Not Applicable,$0,$0,30%,"$1,500","$3,000",40%,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,30%,$0,Not Applicable,40%,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,7,44240,MO,Individual,No,75-1296086,44240MO0090008,Coventry Silver $10 Copay KCPPO,44240MO009,,MON002,MOS002,MOF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48422,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090008-06,94% AV Level Silver Plan,93.10%,,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$1,100","$2,200","$2,250","$4,500","$16,000","$32,000",Not Applicable,Not Applicable,$0,$0,10%,$0,$0,20%,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,$0,Not Applicable,20%,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,8,44240,MO,Individual,No,75-1296086,44240MO0090002,Coventry Silver $10 Copay PPO,44240MO009,,MON001,MOS001,MOF010,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48447,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090002-00,Standard Silver Off Exchange Plan,68.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$16,000","$32,000",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,8,44240,MO,Individual,No,75-1296086,44240MO0090002,Coventry Silver $10 Copay PPO,44240MO009,,MON001,MOS001,MOF010,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48447,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090002-01,Standard Silver On Exchange Plan,68.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$16,000","$32,000",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,16,44240,MO,Individual,No,75-1296086,44240MO0090007,Coventry Gold $5 Copay KCPPO,44240MO009,,MON002,MOS002,MOF011,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48419,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090007-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,16,44240,MO,Individual,No,75-1296086,44240MO0090007,Coventry Gold $5 Copay KCPPO,44240MO009,,MON002,MOS002,MOF011,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48419,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/KansasCityPPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090007-03,Limited Cost Sharing Plan Variation,79.40%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$5,500","$11,000","$6,600","$13,200","$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",30%,"$1,450","$2,900",30%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,17,44240,MO,Individual,No,75-1296086,44240MO0090001,Coventry Gold $5 Copay PPO,44240MO009,,MON001,MOS001,MOF017,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48444,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090001-00,Standard Gold Off Exchange Plan,78.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",25%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,17,44240,MO,Individual,No,75-1296086,44240MO0090001,Coventry Gold $5 Copay PPO,44240MO009,,MON001,MOS001,MOF017,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48444,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090001-01,Standard Gold On Exchange Plan,78.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",25%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,17,44240,MO,Individual,No,75-1296086,44240MO0090001,Coventry Gold $5 Copay PPO,44240MO009,,MON001,MOS001,MOF017,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48444,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,MO,44240,HIOS,6,2014-10-03 13:54:42,17,44240,MO,Individual,No,75-1296086,44240MO0090001,Coventry Gold $5 Copay PPO,44240MO009,,MON001,MOS001,MOF017,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48444,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44240MO0090001-03,Limited Cost Sharing Plan Variation,78.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",25%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,1,44527,MO,Individual,No,43-1372307,44527MO0160003,Coventry Bronze $20 Copay Carelink,44527MO016,,MON002,MOS002,MOF005,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48122,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160003-00,Standard Bronze Off Exchange Plan,61.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,900","$11,800",0%,,,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,1,44527,MO,Individual,No,43-1372307,44527MO0160003,Coventry Bronze $20 Copay Carelink,44527MO016,,MON002,MOS002,MOF005,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48122,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160003-01,Standard Bronze On Exchange Plan,61.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,900","$11,800",0%,,,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,1,44527,MO,Individual,No,43-1372307,44527MO0160003,Coventry Bronze $20 Copay Carelink,44527MO016,,MON002,MOS002,MOF005,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48122,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,1,44527,MO,Individual,No,43-1372307,44527MO0160003,Coventry Bronze $20 Copay Carelink,44527MO016,,MON002,MOS002,MOF005,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48122,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160003-03,Limited Cost Sharing Plan Variation,61.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,900","$11,800",0%,,,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,3,44527,MO,Individual,No,43-1372307,44527MO0150003,Coventry Bronze $25 Copay,44527MO015,,MON001,MOS001,MOF022,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150003-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,900","$11,800",0%,,,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,3,44527,MO,Individual,No,43-1372307,44527MO0150003,Coventry Bronze $25 Copay,44527MO015,,MON001,MOS001,MOF022,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150003-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,900","$11,800",0%,,,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,3,44527,MO,Individual,No,43-1372307,44527MO0150003,Coventry Bronze $25 Copay,44527MO015,,MON001,MOS001,MOF022,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,3,44527,MO,Individual,No,43-1372307,44527MO0150003,Coventry Bronze $25 Copay,44527MO015,,MON001,MOS001,MOF022,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150003-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,900","$11,800",0%,,,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,4,44527,MO,Individual,No,43-1372307,44527MO0160006,Coventry Bronze $25 Copay FocusedCare HPN,44527MO016,,MON003,MOS003,MOF023,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48144,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160006-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,900","$11,800",0%,,,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,4,44527,MO,Individual,No,43-1372307,44527MO0160006,Coventry Bronze $25 Copay FocusedCare HPN,44527MO016,,MON003,MOS003,MOF023,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48144,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160006-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,900","$11,800",0%,,,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,4,44527,MO,Individual,No,43-1372307,44527MO0160006,Coventry Bronze $25 Copay FocusedCare HPN,44527MO016,,MON003,MOS003,MOF023,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48144,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,4,44527,MO,Individual,No,43-1372307,44527MO0160006,Coventry Bronze $25 Copay FocusedCare HPN,44527MO016,,MON003,MOS003,MOF023,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48144,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160006-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,900","$11,800",0%,,,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,7,44527,MO,Individual,No,43-1372307,44527MO0150004,Coventry Bronze Deductible Only HSA Eligible,44527MO015,,MON001,MOS001,MOF016,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48103,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150004-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$18,900","$37,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,7,44527,MO,Individual,No,43-1372307,44527MO0150004,Coventry Bronze Deductible Only HSA Eligible,44527MO015,,MON001,MOS001,MOF016,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48103,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150004-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$18,900","$37,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,7,44527,MO,Individual,No,43-1372307,44527MO0150004,Coventry Bronze Deductible Only HSA Eligible,44527MO015,,MON001,MOS001,MOF016,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48103,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,7,44527,MO,Individual,No,43-1372307,44527MO0150004,Coventry Bronze Deductible Only HSA Eligible,44527MO015,,MON001,MOS001,MOF016,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48103,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150004-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$18,900","$37,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,8,44527,MO,Individual,No,43-1372307,44527MO0160004,Coventry Bronze Deductible Only HSA Eligible Carelink,44527MO016,,MON002,MOS002,MOF007,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48125,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160004-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$18,900","$37,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,8,44527,MO,Individual,No,43-1372307,44527MO0160004,Coventry Bronze Deductible Only HSA Eligible Carelink,44527MO016,,MON002,MOS002,MOF007,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48125,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160004-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$18,900","$37,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,8,44527,MO,Individual,No,43-1372307,44527MO0160004,Coventry Bronze Deductible Only HSA Eligible Carelink,44527MO016,,MON002,MOS002,MOF007,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48125,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,8,44527,MO,Individual,No,43-1372307,44527MO0160004,Coventry Bronze Deductible Only HSA Eligible Carelink,44527MO016,,MON002,MOS002,MOF007,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48125,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160004-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$18,900","$37,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,10,44527,MO,Individual,No,43-1372307,44527MO0160007,Coventry Bronze Deductible Only HSA Eligible FocusedCare HPN,44527MO016,,MON003,MOS003,MOF017,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48147,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160007-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$18,900","$37,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,10,44527,MO,Individual,No,43-1372307,44527MO0160007,Coventry Bronze Deductible Only HSA Eligible FocusedCare HPN,44527MO016,,MON003,MOS003,MOF017,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48147,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160007-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$18,900","$37,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,10,44527,MO,Individual,No,43-1372307,44527MO0160007,Coventry Bronze Deductible Only HSA Eligible FocusedCare HPN,44527MO016,,MON003,MOS003,MOF017,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48147,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160007-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,10,44527,MO,Individual,No,43-1372307,44527MO0160007,Coventry Bronze Deductible Only HSA Eligible FocusedCare HPN,44527MO016,,MON003,MOS003,MOF017,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48147,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160007-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$18,900","$37,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,13,44527,MO,Individual,No,43-1372307,44527MO0150006,Coventry Silver $10 Copay 2750,44527MO015,,MON001,MOS001,MOF013,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48110,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150006-00,Standard Silver Off Exchange Plan,68.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,13,44527,MO,Individual,No,43-1372307,44527MO0150006,Coventry Silver $10 Copay 2750,44527MO015,,MON001,MOS001,MOF013,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48110,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150006-01,Standard Silver On Exchange Plan,68.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,13,44527,MO,Individual,No,43-1372307,44527MO0150006,Coventry Silver $10 Copay 2750,44527MO015,,MON001,MOS001,MOF013,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48110,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,13,44527,MO,Individual,No,43-1372307,44527MO0150006,Coventry Silver $10 Copay 2750,44527MO015,,MON001,MOS001,MOF013,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48110,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150006-03,Limited Cost Sharing Plan Variation,68.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,13,44527,MO,Individual,No,43-1372307,44527MO0150006,Coventry Silver $10 Copay 2750,44527MO015,,MON001,MOS001,MOF013,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48110,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150006-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,950","$9,900",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,13,44527,MO,Individual,No,43-1372307,44527MO0150006,Coventry Silver $10 Copay 2750,44527MO015,,MON001,MOS001,MOF013,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48110,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150006-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,13,44527,MO,Individual,No,43-1372307,44527MO0150006,Coventry Silver $10 Copay 2750,44527MO015,,MON001,MOS001,MOF013,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48110,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150006-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,14,44527,MO,Individual,No,43-1372307,44527MO0160009,Coventry Silver $10 Copay 2750 FocusedCare HPN,44527MO016,,MON003,MOS003,MOF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48154,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160009-00,Standard Silver Off Exchange Plan,68.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,14,44527,MO,Individual,No,43-1372307,44527MO0160009,Coventry Silver $10 Copay 2750 FocusedCare HPN,44527MO016,,MON003,MOS003,MOF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48154,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160009-01,Standard Silver On Exchange Plan,68.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,14,44527,MO,Individual,No,43-1372307,44527MO0160009,Coventry Silver $10 Copay 2750 FocusedCare HPN,44527MO016,,MON003,MOS003,MOF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48154,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160009-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,14,44527,MO,Individual,No,43-1372307,44527MO0160009,Coventry Silver $10 Copay 2750 FocusedCare HPN,44527MO016,,MON003,MOS003,MOF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48154,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160009-03,Limited Cost Sharing Plan Variation,68.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,14,44527,MO,Individual,No,43-1372307,44527MO0160009,Coventry Silver $10 Copay 2750 FocusedCare HPN,44527MO016,,MON003,MOS003,MOF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48154,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160009-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,950","$9,900",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,14,44527,MO,Individual,No,43-1372307,44527MO0160009,Coventry Silver $10 Copay 2750 FocusedCare HPN,44527MO016,,MON003,MOS003,MOF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48154,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160009-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,14,44527,MO,Individual,No,43-1372307,44527MO0160009,Coventry Silver $10 Copay 2750 FocusedCare HPN,44527MO016,,MON003,MOS003,MOF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48154,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160009-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,17,44527,MO,Individual,No,43-1372307,44527MO0160002,Coventry Silver $10 Copay Carelink,44527MO016,,MON002,MOS002,MOF025,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48132,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160002-00,Standard Silver Off Exchange Plan,68.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,17,44527,MO,Individual,No,43-1372307,44527MO0160002,Coventry Silver $10 Copay Carelink,44527MO016,,MON002,MOS002,MOF025,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48132,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160002-01,Standard Silver On Exchange Plan,68.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,17,44527,MO,Individual,No,43-1372307,44527MO0160002,Coventry Silver $10 Copay Carelink,44527MO016,,MON002,MOS002,MOF025,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48132,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,17,44527,MO,Individual,No,43-1372307,44527MO0160002,Coventry Silver $10 Copay Carelink,44527MO016,,MON002,MOS002,MOF025,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48132,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160002-03,Limited Cost Sharing Plan Variation,68.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,17,44527,MO,Individual,No,43-1372307,44527MO0160002,Coventry Silver $10 Copay Carelink,44527MO016,,MON002,MOS002,MOF025,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48132,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160002-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,17,44527,MO,Individual,No,43-1372307,44527MO0160002,Coventry Silver $10 Copay Carelink,44527MO016,,MON002,MOS002,MOF025,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48132,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160002-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,17,44527,MO,Individual,No,43-1372307,44527MO0160002,Coventry Silver $10 Copay Carelink,44527MO016,,MON002,MOS002,MOF025,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48132,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160002-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$19,800","$39,600",Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,19,44527,MO,Individual,No,43-1372307,44527MO0150002,Coventry Silver $15 Copay,44527MO015,,MON001,MOS001,MOF029,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48116,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150002-00,Standard Silver Off Exchange Plan,68.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,19,44527,MO,Individual,No,43-1372307,44527MO0150002,Coventry Silver $15 Copay,44527MO015,,MON001,MOS001,MOF029,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48116,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150002-01,Standard Silver On Exchange Plan,68.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,19,44527,MO,Individual,No,43-1372307,44527MO0150002,Coventry Silver $15 Copay,44527MO015,,MON001,MOS001,MOF029,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48116,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,19,44527,MO,Individual,No,43-1372307,44527MO0150002,Coventry Silver $15 Copay,44527MO015,,MON001,MOS001,MOF029,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48116,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150002-03,Limited Cost Sharing Plan Variation,68.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,19,44527,MO,Individual,No,43-1372307,44527MO0150002,Coventry Silver $15 Copay,44527MO015,,MON001,MOS001,MOF029,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48116,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150002-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,19,44527,MO,Individual,No,43-1372307,44527MO0150002,Coventry Silver $15 Copay,44527MO015,,MON001,MOS001,MOF029,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48116,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150002-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,050","$4,100",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,19,44527,MO,Individual,No,43-1372307,44527MO0150002,Coventry Silver $15 Copay,44527MO015,,MON001,MOS001,MOF029,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48116,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150002-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$19,800","$39,600",Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,20,44527,MO,Individual,No,43-1372307,44527MO0160010,Coventry Silver $15 Copay FocusedCare HPN,44527MO016,,MON003,MOS003,MOF028,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48160,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160010-00,Standard Silver Off Exchange Plan,68.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,20,44527,MO,Individual,No,43-1372307,44527MO0160010,Coventry Silver $15 Copay FocusedCare HPN,44527MO016,,MON003,MOS003,MOF028,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48160,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160010-01,Standard Silver On Exchange Plan,68.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,20,44527,MO,Individual,No,43-1372307,44527MO0160010,Coventry Silver $15 Copay FocusedCare HPN,44527MO016,,MON003,MOS003,MOF028,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48160,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160010-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,20,44527,MO,Individual,No,43-1372307,44527MO0160010,Coventry Silver $15 Copay FocusedCare HPN,44527MO016,,MON003,MOS003,MOF028,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48160,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160010-03,Limited Cost Sharing Plan Variation,68.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,20,44527,MO,Individual,No,43-1372307,44527MO0160010,Coventry Silver $15 Copay FocusedCare HPN,44527MO016,,MON003,MOS003,MOF028,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48160,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160010-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,20,44527,MO,Individual,No,43-1372307,44527MO0160010,Coventry Silver $15 Copay FocusedCare HPN,44527MO016,,MON003,MOS003,MOF028,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48160,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160010-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,050","$4,100",,,"$19,800","$39,600",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,20,44527,MO,Individual,No,43-1372307,44527MO0160010,Coventry Silver $15 Copay FocusedCare HPN,44527MO016,,MON003,MOS003,MOF028,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48160,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160010-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$19,800","$39,600",Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,23,44527,MO,Individual,No,43-1372307,44527MO0160011,Coventry Silver $5 Copay 2750 Carelink,44527MO016,,MON002,MOS002,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48138,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160011-00,Standard Silver Off Exchange Plan,68.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,23,44527,MO,Individual,No,43-1372307,44527MO0160011,Coventry Silver $5 Copay 2750 Carelink,44527MO016,,MON002,MOS002,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48138,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160011-01,Standard Silver On Exchange Plan,68.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,23,44527,MO,Individual,No,43-1372307,44527MO0160011,Coventry Silver $5 Copay 2750 Carelink,44527MO016,,MON002,MOS002,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48138,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160011-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,23,44527,MO,Individual,No,43-1372307,44527MO0160011,Coventry Silver $5 Copay 2750 Carelink,44527MO016,,MON002,MOS002,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48138,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160011-03,Limited Cost Sharing Plan Variation,68.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,23,44527,MO,Individual,No,43-1372307,44527MO0160011,Coventry Silver $5 Copay 2750 Carelink,44527MO016,,MON002,MOS002,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48138,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160011-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,23,44527,MO,Individual,No,43-1372307,44527MO0160011,Coventry Silver $5 Copay 2750 Carelink,44527MO016,,MON002,MOS002,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48138,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160011-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,23,44527,MO,Individual,No,43-1372307,44527MO0160011,Coventry Silver $5 Copay 2750 Carelink,44527MO016,,MON002,MOS002,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48138,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160011-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,28,44527,MO,Individual,No,43-1372307,44527MO0150001,Coventry Gold $10 Copay,44527MO015,,MON004,MOS004,MOF034,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48107,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150001-00,Standard Gold Off Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000",Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,28,44527,MO,Individual,No,43-1372307,44527MO0150001,Coventry Gold $10 Copay,44527MO015,,MON004,MOS004,MOF034,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48107,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150001-01,Standard Gold On Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000",Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,28,44527,MO,Individual,No,43-1372307,44527MO0150001,Coventry Gold $10 Copay,44527MO015,,MON004,MOS004,MOF034,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48107,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,28,44527,MO,Individual,No,43-1372307,44527MO0150001,Coventry Gold $10 Copay,44527MO015,,MON004,MOS004,MOF034,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48107,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0150001-03,Limited Cost Sharing Plan Variation,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000",Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,29,44527,MO,Individual,No,43-1372307,44527MO0160008,Coventry Gold $10 Copay FocusedCare HPN,44527MO016,,MON003,MOS003,MOF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48151,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160008-00,Standard Gold Off Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000",Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,29,44527,MO,Individual,No,43-1372307,44527MO0160008,Coventry Gold $10 Copay FocusedCare HPN,44527MO016,,MON003,MOS003,MOF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48151,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160008-01,Standard Gold On Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000",Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,29,44527,MO,Individual,No,43-1372307,44527MO0160008,Coventry Gold $10 Copay FocusedCare HPN,44527MO016,,MON003,MOS003,MOF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48151,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160008-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,29,44527,MO,Individual,No,43-1372307,44527MO0160008,Coventry Gold $10 Copay FocusedCare HPN,44527MO016,,MON003,MOS003,MOF009,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48151,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160008-03,Limited Cost Sharing Plan Variation,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000",Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,32,44527,MO,Individual,No,43-1372307,44527MO0160001,Coventry Gold $5 Copay Carelink,44527MO016,,MON002,MOS002,MOF014,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48129,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160001-00,Standard Gold Off Exchange Plan,78.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,"$16,950","$33,900",Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,32,44527,MO,Individual,No,43-1372307,44527MO0160001,Coventry Gold $5 Copay Carelink,44527MO016,,MON002,MOS002,MOF014,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48129,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160001-01,Standard Gold On Exchange Plan,78.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,"$16,950","$33,900",Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,32,44527,MO,Individual,No,43-1372307,44527MO0160001,Coventry Gold $5 Copay Carelink,44527MO016,,MON002,MOS002,MOF014,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48129,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,MO,44527,HIOS,8,2014-10-05 17:13:14,32,44527,MO,Individual,No,43-1372307,44527MO0160001,Coventry Gold $5 Copay Carelink,44527MO016,,MON002,MOS002,MOF014,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999999373395228,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/MO48129,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMO2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,44527MO0160001-03,Limited Cost Sharing Plan Variation,78.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,"$16,950","$33,900",Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,MO,48616,HIOS,2,2014-08-03 08:59:32,1,48616,MO,SHOP (Small Group),Yes,47-0098400,48616MO0030002,EHB High Passive,48616MO003,,MON001,MOS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$40.53,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,48616MO0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,48616,HIOS,2,2014-08-03 08:59:32,1,48616,MO,SHOP (Small Group),Yes,47-0098400,48616MO0030001,EHB Low Passive,48616MO003,,MON001,MOS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.09,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,48616MO0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,48786,HIOS,4,2014-08-27 03:27:11,1,48786,MO,SHOP (Small Group),Yes,13-5123390,48786MO0090002,Guardian Pediatric Advantage,48786MO009,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$27.28,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,48786MO0090002-00,Standard High Off Exchange Plan,84.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,48786,HIOS,4,2014-08-27 03:27:11,1,48786,MO,SHOP (Small Group),Yes,13-5123390,48786MO0100002,Guardian Pediatric Essentials,48786MO010,,MON001,MOS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$20.72,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,48786MO0100002-00,Standard Low Off Exchange Plan,70.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,48786,HIOS,4,2014-08-27 03:27:11,2,48786,MO,SHOP (Small Group),Yes,13-5123390,48786MO0120002,Guardian Family Advantage,48786MO012,,MON001,MOS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.28,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,48786MO0120002-00,Standard High Off Exchange Plan,84.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,48786,HIOS,4,2014-08-27 03:27:11,2,48786,MO,SHOP (Small Group),Yes,13-5123390,48786MO0120002,Guardian Family Advantage,48786MO012,,MON001,MOS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.28,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,48786MO0120002-01,Standard High On Exchange Plan,84.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,48786,HIOS,4,2014-08-27 03:27:11,2,48786,MO,SHOP (Small Group),Yes,13-5123390,48786MO0140002,Guardian Family Essentials,48786MO014,,MON001,MOS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.72,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,48786MO0140002-00,Standard Low Off Exchange Plan,70.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MO,48786,HIOS,4,2014-08-27 03:27:11,2,48786,MO,SHOP (Small Group),Yes,13-5123390,48786MO0140002,Guardian Family Essentials,48786MO014,,MON001,MOS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.72,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,48786MO0140002-01,Standard Low On Exchange Plan,70.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MO,53204,HIOS,4,2014-09-06 03:39:47,1,53204,MO,SHOP (Small Group),Yes,41-0808596,53204MO0010001,"Plan 1. Passive PPO, $1000 Annual Maximum, no Ortho",53204MO001,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,53204MO0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,53204,HIOS,4,2014-09-06 03:39:47,1,53204,MO,SHOP (Small Group),Yes,41-0808596,53204MO0010002,"Plan 2.  Passive PPO, $1000 Annual Maximum, Ortho",53204MO001,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,53204MO0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,53204,HIOS,4,2014-09-06 03:39:47,1,53204,MO,SHOP (Small Group),Yes,41-0808596,53204MO0010003,"Plan 3. Passive PPO, $1500 Annual Maximum, no Ortho",53204MO001,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,53204MO0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MO,53204,HIOS,4,2014-09-06 03:39:47,1,53204,MO,SHOP (Small Group),Yes,41-0808596,53204MO0010004,"Plan 4.  Passive PPO, $1500 Annual Maximum, Ortho",53204MO001,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,53204MO0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MO,53204,HIOS,4,2014-09-06 03:39:47,1,53204,MO,SHOP (Small Group),Yes,41-0808596,53204MO0010005,"Plan 5.  Passive PPO, $2000 Annual Maximum, Ortho",53204MO001,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,53204MO0010005-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MO,53204,HIOS,4,2014-09-06 03:39:47,1,53204,MO,SHOP (Small Group),Yes,41-0808596,53204MO0010006,"Plan 6. MAC PPO, $1000 Annual Maximum, no Ortho",53204MO001,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,53204MO0010006-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MO,53204,HIOS,4,2014-09-06 03:39:47,1,53204,MO,SHOP (Small Group),Yes,41-0808596,53204MO0010007,"Plan 9. MAC PPO, $1500 Annual Maximum, Ortho",53204MO001,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,53204MO0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,MO,56603,HIOS,3,2014-09-05 03:32:16,1,56603,MO,SHOP (Small Group),Yes,81-0170040,56603MO0010001,Assurant Dental ACAFFO High,56603MO001,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$40.35,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same coverage as in service area,Yes,,,,,56603MO0010001-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,56603,HIOS,3,2014-09-05 03:32:16,2,56603,MO,SHOP (Small Group),Yes,81-0170040,56603MO0010002,Assurant Dental ACAFFO Low,56603MO001,,MON001,MOS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.63,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same coverage as in service area,Yes,,,,,56603MO0010002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,59976,HIOS,3,2014-09-04 03:25:43,1,59976,MO,SHOP (Small Group),Yes,35-0472300,59976MO0010001,Lincoln Dental Connect?,59976MO001,,MON001,MOS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.38,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,59976MO0010001-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,59976,HIOS,3,2014-09-04 03:25:43,1,59976,MO,SHOP (Small Group),Yes,35-0472300,59976MO0010002,Lincoln Dental Connect?,59976MO001,,MON001,MOS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.21,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,59976MO0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,59976,HIOS,3,2014-09-04 03:25:43,1,59976,MO,SHOP (Small Group),Yes,35-0472300,59976MO0010003,Lincoln Dental Connect?,59976MO001,,MON001,MOS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.05,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,59976MO0010003-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MO,59976,HIOS,3,2014-09-04 03:25:43,1,59976,MO,SHOP (Small Group),Yes,35-0472300,59976MO0010005,Lincoln Dental Connect?,59976MO001,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.62,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,59976MO0010005-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MO,59976,HIOS,3,2014-09-04 03:25:43,1,59976,MO,SHOP (Small Group),Yes,35-0472300,59976MO0010006,Lincoln Dental Connect?,59976MO001,,MON001,MOS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.20,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,59976MO0010006-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MO,59976,HIOS,3,2014-09-04 03:25:43,1,59976,MO,SHOP (Small Group),Yes,35-0472300,59976MO0010007,Lincoln Dental Connect?,59976MO001,,MON001,MOS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.97,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,59976MO0010007-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MO,59976,HIOS,3,2014-09-04 03:25:43,2,59976,MO,SHOP (Small Group),Yes,35-0472300,59976MO0010004,Lincoln Dental Connect?,59976MO001,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.16,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,59976MO0010004-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,59976,HIOS,3,2014-09-04 03:25:43,2,59976,MO,SHOP (Small Group),Yes,35-0472300,59976MO0010008,Lincoln Dental Connect?,59976MO001,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.79,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,59976MO0010008-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,68265,HIOS,8,2014-11-14 05:23:27,1,68265,MO,Individual,Yes,75-1233841,68265MO0010007,Dentegra Dental PPO Pediatric Basic Plan,68265MO001,,MON001,MOS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$19.14,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/mo/68265mo0010007-15,,68265MO0010007-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,68265,HIOS,8,2014-11-14 05:23:27,1,68265,MO,SHOP (Small Group),Yes,75-1233841,68265MO0020007,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,68265MO002,,MON001,MOS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.29,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/mo/68265mo0020007-15,,68265MO0020007-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,68265,HIOS,8,2014-11-14 05:23:27,1,68265,MO,SHOP (Small Group),Yes,75-1233841,68265MO0020007,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,68265MO002,,MON001,MOS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.29,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/mo/68265mo0020007-15,,68265MO0020007-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,68265,HIOS,8,2014-11-14 05:23:27,1,68265,MO,Individual,Yes,75-1233841,68265MO0010007,Dentegra Dental PPO Pediatric Basic Plan,68265MO001,,MON001,MOS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$19.14,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/mo/68265mo0010007-15,,68265MO0010007-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,68265,HIOS,8,2014-11-14 05:23:27,2,68265,MO,Individual,Yes,75-1233841,68265MO0010009,Dentegra Dental PPO Family Basic Plan,68265MO001,,MON001,MOS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.14,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/mo/68265mo0010009-15,,68265MO0010009-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,68265,HIOS,8,2014-11-14 05:23:27,2,68265,MO,SHOP (Small Group),Yes,75-1233841,68265MO0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,68265MO002,,MON001,MOS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.29,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/mo/68265mo0020009-15,,68265MO0020009-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,68265,HIOS,8,2014-11-14 05:23:27,2,68265,MO,SHOP (Small Group),Yes,75-1233841,68265MO0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,68265MO002,,MON001,MOS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.29,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/mo/68265mo0020009-15,,68265MO0020009-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,68265,HIOS,8,2014-11-14 05:23:27,2,68265,MO,Individual,Yes,75-1233841,68265MO0010009,Dentegra Dental PPO Family Basic Plan,68265MO001,,MON001,MOS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.14,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/mo/68265mo0010009-15,,68265MO0010009-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,68396,HIOS,3,2014-08-28 04:23:13,1,68396,MO,SHOP (Small Group),Yes,13-5581829,68396MO0190001,Family Basic Dental Plan (Low),68396MO019,,MON003,MOS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$15.07,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48045,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48044,,68396MO0190001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,68396,HIOS,3,2014-08-28 04:23:13,1,68396,MO,SHOP (Small Group),Yes,13-5581829,68396MO0190001,Family Basic Dental Plan (Low),68396MO019,,MON003,MOS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$15.07,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48045,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48044,,68396MO0190001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,4,74483,MO,Individual,No,59-1031071,74483MO0020006,myCigna Copay Assure Silver,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/copay-assure-silver,http://www.cigna.com/ifp-drug-list,74483MO0020006-04,73% AV Level Silver Plan,74.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,4,74483,MO,Individual,No,59-1031071,74483MO0020006,myCigna Copay Assure Silver,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/copay-assure-silver,http://www.cigna.com/ifp-drug-list,74483MO0020006-05,87% AV Level Silver Plan,87.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,4,74483,MO,Individual,No,59-1031071,74483MO0020006,myCigna Copay Assure Silver,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/copay-assure-silver,http://www.cigna.com/ifp-drug-list,74483MO0020006-06,94% AV Level Silver Plan,93.89%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,4,74483,MO,Individual,No,59-1031071,74483MO0020008,myCigna Copay Assure Gold,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/copay-assure-gold,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/copay-assure-gold,http://www.cigna.com/ifp-drug-list,74483MO0020008-00,Standard Gold Off Exchange Plan,81.07%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,4,74483,MO,Individual,No,59-1031071,74483MO0020008,myCigna Copay Assure Gold,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/copay-assure-gold,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/copay-assure-gold,http://www.cigna.com/ifp-drug-list,74483MO0020008-01,Standard Gold On Exchange Plan,81.07%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,4,74483,MO,Individual,No,59-1031071,74483MO0020008,myCigna Copay Assure Gold,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/copay-assure-gold,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/copay-assure-gold,http://www.cigna.com/ifp-drug-list,74483MO0020008-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,4,74483,MO,Individual,No,59-1031071,74483MO0020008,myCigna Copay Assure Gold,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/copay-assure-gold,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/copay-assure-gold,http://www.cigna.com/ifp-drug-list,74483MO0020008-03,Limited Cost Sharing Plan Variation,81.07%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,2,48963,MS,Individual,No,39-1263473,48963MS0490002,Humana Bronze 6300/Memphis PPOx,48963MS049,,MSN002,MSS002,MSF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342457,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333630,http://apps.humana.com/marketing/documents.asp?file=2323880,48963MS0490002-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,12
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,2,48963,MS,Individual,No,39-1263473,48963MS0490002,Humana Bronze 6300/Memphis PPOx,48963MS049,,MSN002,MSS002,MSF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342457,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333630,http://apps.humana.com/marketing/documents.asp?file=2323880,48963MS0490002-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,13
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,2,48963,MS,Individual,No,39-1263473,48963MS0490002,Humana Bronze 6300/Memphis PPOx,48963MS049,,MSN002,MSS002,MSF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342457,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333630,http://apps.humana.com/marketing/documents.asp?file=2323880,48963MS0490002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,2,48963,MS,Individual,No,39-1263473,48963MS0490002,Humana Bronze 6300/Memphis PPOx,48963MS049,,MSN002,MSS002,MSF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342457,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333630,http://apps.humana.com/marketing/documents.asp?file=2323880,48963MS0490002-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,15
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500017,Humana Silver 3650/Mississippi PPOx,48963MS050,,MSN005,MSS005,MSF004,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342704,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327442,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500017-06,94% AV Level Silver Plan,,0.935785233974457,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$475,$950,,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$475,$950,0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,29
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,5,48963,MS,Individual,No,39-1263473,48963MS0500009,Humana Bronze 4850/ChoiceCare PPO,48963MS050,,MSN004,MSS004,MSF005,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342405,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333851,http://apps.humana.com/marketing/documents.asp?file=2323776,48963MS0500009-00,Standard Bronze Off Exchange Plan,,0.616929411888123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800",Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,"$9,700","$19,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,MO,81313,HIOS,2,2014-08-08 08:53:29,1,81313,MO,Individual,Yes,72-0977315,81313MO0010002,AlwaysCare All-Star Kids Dental Plan,81313MO001,,MON001,MOS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$17.09,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,81313MO0010002-00,Standard Low Off Exchange Plan,71.27%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,81313,HIOS,2,2014-08-08 08:53:29,1,81313,MO,SHOP (Small Group),Yes,72-0977315,81313MO0040002,AlwaysCare Small Group - Child,81313MO004,,MON001,MOS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$20.72,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,81313MO0040002-00,Standard Low Off Exchange Plan,71.27%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,81313,HIOS,2,2014-08-08 08:53:29,2,81313,MO,SHOP (Small Group),Yes,72-0977315,81313MO0030001,AlwaysCare Small Group Dental - Adults,81313MO003,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.09,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,81313MO0030001-00,Standard High Off Exchange Plan,86.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490014,Humana Gold 2500/Jackson PPOx,48963MS049,,MSN001,MSS001,MSF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342496,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333799,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490014-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490014,Humana Gold 2500/Jackson PPOx,48963MS049,,MSN001,MSS001,MSF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342496,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333799,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,MO,68396,HIOS,3,2014-08-28 04:23:13,2,68396,MO,SHOP (Small Group),Yes,13-5581829,68396MO0200001,Family Enhanced Dental Plan (High),68396MO020,,MON004,MOS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$19.31,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49094,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49093,,68396MO0200001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,68396,HIOS,3,2014-08-28 04:23:13,2,68396,MO,SHOP (Small Group),Yes,13-5581829,68396MO0200001,Family Enhanced Dental Plan (High),68396MO020,,MON004,MOS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$19.31,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49094,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49093,,68396MO0200001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,71691,HIOS,3,2014-08-05 13:28:44,1,71691,MO,SHOP (Small Group),Yes,57-0523959,71691MO0010001,Group Pediatric Dental EHB Rider,71691MO001,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$29.18,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,71691MO0010001-00,Standard High Off Exchange Plan,86.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,71691,HIOS,3,2014-08-05 13:28:44,1,71691,MO,SHOP (Small Group),Yes,57-0523959,71691MO0010002,Group Pediatric Dental EHB Rider,71691MO001,,MON001,MOS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.17,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,71691MO0010002-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,71691,HIOS,3,2014-08-05 13:28:44,2,71691,MO,SHOP (Small Group),Yes,57-0523959,71691MO0020001,Group Pediatric EHB Policy,71691MO002,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$32.91,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,71691MO0020001-00,Standard High Off Exchange Plan,86.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,71691,HIOS,3,2014-08-05 13:28:44,2,71691,MO,SHOP (Small Group),Yes,57-0523959,71691MO0020002,Group Pediatric EHB Policy,71691MO002,,MON001,MOS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.91,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,71691MO0020002-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,1,74483,MO,Individual,No,59-1031071,74483MO0020001,myCigna Health Savings 6000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-savings-6000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-savings-6000,http://www.cigna.com/ifp-drug-list,74483MO0020001-00,Standard Bronze Off Exchange Plan,58.53%,0.58531641960144,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,1,74483,MO,Individual,Yes,59-1031071,74483MO0030001,myCigna Dental Pediatric,74483MO003,7730182962,MON002,MOS002,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$21.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,,,,,74483MO0030001-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$150,$300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,1,74483,MO,Individual,No,59-1031071,74483MO0020001,myCigna Health Savings 6000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-savings-6000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-savings-6000,http://www.cigna.com/ifp-drug-list,74483MO0020001-01,Standard Bronze On Exchange Plan,58.53%,0.58531641960144,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,1,74483,MO,Individual,No,59-1031071,74483MO0020001,myCigna Health Savings 6000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-savings-6000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-savings-6000,http://www.cigna.com/ifp-drug-list,74483MO0020001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,1,74483,MO,Individual,No,59-1031071,74483MO0020001,myCigna Health Savings 6000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-savings-6000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-savings-6000,http://www.cigna.com/ifp-drug-list,74483MO0020001-03,Limited Cost Sharing Plan Variation,58.53%,0.58531641960144,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,1,74483,MO,Individual,No,59-1031071,74483MO0020003,myCigna Health Savings 3400,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Servcies Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-savings-3400,http://www.cigna.com/ifp-drug-list,74483MO0020003-00,Standard Silver Off Exchange Plan,68.43%,0.684268593788147,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,1,74483,MO,Individual,No,59-1031071,74483MO0020003,myCigna Health Savings 3400,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Servcies Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-savings-3400,http://www.cigna.com/ifp-drug-list,74483MO0020003-01,Standard Silver On Exchange Plan,68.43%,0.684268593788147,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,1,74483,MO,Individual,No,59-1031071,74483MO0020003,myCigna Health Savings 3400,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Servcies Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-savings-3400,http://www.cigna.com/ifp-drug-list,74483MO0020003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,1,74483,MO,Individual,No,59-1031071,74483MO0020003,myCigna Health Savings 3400,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Servcies Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-savings-3400,http://www.cigna.com/ifp-drug-list,74483MO0020003-03,Limited Cost Sharing Plan Variation,68.43%,0.684268593788147,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,1,74483,MO,Individual,No,59-1031071,74483MO0020003,myCigna Health Savings 3400,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Servcies Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-savings-3400,http://www.cigna.com/ifp-drug-list,74483MO0020003-04,73% AV Level Silver Plan,73.16%,0.731574892997742,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,1,74483,MO,Individual,No,59-1031071,74483MO0020003,myCigna Health Savings 3400,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Servcies Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-savings-3400,http://www.cigna.com/ifp-drug-list,74483MO0020003-05,87% AV Level Silver Plan,86.57%,0.865731179714203,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,1,74483,MO,Individual,No,59-1031071,74483MO0020003,myCigna Health Savings 3400,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Servcies Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-savings-3400,http://www.cigna.com/ifp-drug-list,74483MO0020003-06,94% AV Level Silver Plan,94.29%,0.942874848842621,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$350,$700,0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,2,74483,MO,Individual,No,59-1031071,74483MO0020002,myCigna Health Flex 5000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-flex-5000,http://www.cigna.com/ifp-drug-list,74483MO0020002-00,Standard Bronze Off Exchange Plan,61.77%,0.630202949047089,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,2,74483,MO,Individual,No,59-1031071,74483MO0020002,myCigna Health Flex 5000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-flex-5000,http://www.cigna.com/ifp-drug-list,74483MO0020002-01,Standard Bronze On Exchange Plan,61.77%,0.630202949047089,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,2,74483,MO,Individual,No,59-1031071,74483MO0020002,myCigna Health Flex 5000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-flex-5000,http://www.cigna.com/ifp-drug-list,74483MO0020002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,2,74483,MO,Individual,No,59-1031071,74483MO0020002,myCigna Health Flex 5000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-flex-5000,http://www.cigna.com/ifp-drug-list,74483MO0020002-03,Limited Cost Sharing Plan Variation,61.77%,0.630202949047089,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,3,74483,MO,Individual,No,59-1031071,74483MO0020005,myCigna Health Flex 3000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-flex-3000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-flex-3000,http://www.cigna.com/ifp-drug-list,74483MO0020005-00,Standard Silver Off Exchange Plan,68.06%,0.689974963665009,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,3,74483,MO,Individual,No,59-1031071,74483MO0020005,myCigna Health Flex 3000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-flex-3000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-flex-3000,http://www.cigna.com/ifp-drug-list,74483MO0020005-01,Standard Silver On Exchange Plan,68.06%,0.689974963665009,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,3,74483,MO,Individual,No,59-1031071,74483MO0020005,myCigna Health Flex 3000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-flex-3000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-flex-3000,http://www.cigna.com/ifp-drug-list,74483MO0020005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,3,74483,MO,Individual,No,59-1031071,74483MO0020005,myCigna Health Flex 3000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-flex-3000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-flex-3000,http://www.cigna.com/ifp-drug-list,74483MO0020005-03,Limited Cost Sharing Plan Variation,68.06%,0.689974963665009,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,3,74483,MO,Individual,No,59-1031071,74483MO0020005,myCigna Health Flex 3000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-flex-3000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-flex-3000,http://www.cigna.com/ifp-drug-list,74483MO0020005-04,73% AV Level Silver Plan,72.07%,0.730941593647003,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,3,74483,MO,Individual,No,59-1031071,74483MO0020005,myCigna Health Flex 3000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-flex-3000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-flex-3000,http://www.cigna.com/ifp-drug-list,74483MO0020005-05,87% AV Level Silver Plan,86.68%,0.879085421562195,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,3,74483,MO,Individual,No,59-1031071,74483MO0020005,myCigna Health Flex 3000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-flex-3000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-flex-3000,http://www.cigna.com/ifp-drug-list,74483MO0020005-06,94% AV Level Silver Plan,93.30%,0.93751448392868,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$425,$850,,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,3,74483,MO,Individual,No,59-1031071,74483MO0020004,myCigna Health Flex 2000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-flex-2000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-flex-2000,http://www.cigna.com/ifp-drug-list,74483MO0020004-00,Standard Silver Off Exchange Plan,70.96%,0.718941807746887,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,3,74483,MO,Individual,No,59-1031071,74483MO0020004,myCigna Health Flex 2000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-flex-2000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-flex-2000,http://www.cigna.com/ifp-drug-list,74483MO0020004-01,Standard Silver On Exchange Plan,70.96%,0.718941807746887,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,3,74483,MO,Individual,No,59-1031071,74483MO0020004,myCigna Health Flex 2000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-flex-2000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-flex-2000,http://www.cigna.com/ifp-drug-list,74483MO0020004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,3,74483,MO,Individual,No,59-1031071,74483MO0020004,myCigna Health Flex 2000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-flex-2000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-flex-2000,http://www.cigna.com/ifp-drug-list,74483MO0020004-03,Limited Cost Sharing Plan Variation,70.96%,0.718941807746887,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,3,74483,MO,Individual,No,59-1031071,74483MO0020004,myCigna Health Flex 2000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-flex-2000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-flex-2000,http://www.cigna.com/ifp-drug-list,74483MO0020004-04,73% AV Level Silver Plan,73.20%,0.740528106689453,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,3,74483,MO,Individual,No,59-1031071,74483MO0020004,myCigna Health Flex 2000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-flex-2000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-flex-2000,http://www.cigna.com/ifp-drug-list,74483MO0020004-05,87% AV Level Silver Plan,87.23%,0.88244891166687,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,3,74483,MO,Individual,No,59-1031071,74483MO0020004,myCigna Health Flex 2000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-flex-2000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-flex-2000,http://www.cigna.com/ifp-drug-list,74483MO0020004-06,94% AV Level Silver Plan,93.97%,0.942238330841064,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,3,74483,MO,Individual,No,59-1031071,74483MO0020007,myCigna Health Flex 1000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-flex-1000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-flex-1000,http://www.cigna.com/ifp-drug-list,74483MO0020007-00,Standard Gold Off Exchange Plan,78.63%,0.789409816265106,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,3,74483,MO,Individual,No,59-1031071,74483MO0020007,myCigna Health Flex 1000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-flex-1000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-flex-1000,http://www.cigna.com/ifp-drug-list,74483MO0020007-01,Standard Gold On Exchange Plan,78.63%,0.789409816265106,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,3,74483,MO,Individual,No,59-1031071,74483MO0020007,myCigna Health Flex 1000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-flex-1000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-flex-1000,http://www.cigna.com/ifp-drug-list,74483MO0020007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,3,74483,MO,Individual,No,59-1031071,74483MO0020007,myCigna Health Flex 1000,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/health-flex-1000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/health-flex-1000,http://www.cigna.com/ifp-drug-list,74483MO0020007-03,Limited Cost Sharing Plan Variation,78.63%,0.789409816265106,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,4,74483,MO,Individual,No,59-1031071,74483MO0020006,myCigna Copay Assure Silver,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/copay-assure-silver,http://www.cigna.com/ifp-drug-list,74483MO0020006-00,Standard Silver Off Exchange Plan,72.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,4,74483,MO,Individual,No,59-1031071,74483MO0020006,myCigna Copay Assure Silver,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/copay-assure-silver,http://www.cigna.com/ifp-drug-list,74483MO0020006-01,Standard Silver On Exchange Plan,72.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,4,74483,MO,Individual,No,59-1031071,74483MO0020006,myCigna Copay Assure Silver,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/copay-assure-silver,http://www.cigna.com/ifp-drug-list,74483MO0020006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MO,74483,HIOS,7,2015-01-16 17:32:32,4,74483,MO,Individual,No,59-1031071,74483MO0020006,myCigna Copay Assure Silver,74483MO002,7730182962,MON001,MOS001,MOF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/missouri/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/missouri/copay-assure-silver,http://www.cigna.com/ifp-drug-list,74483MO0020006-03,Limited Cost Sharing Plan Variation,72.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,3,48963,MS,Individual,No,39-1263473,48963MS0500012,Humana Gold 2500/ChoiceCare PPO,48963MS050,,MSN004,MSS004,MSF007,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342483,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333968,http://apps.humana.com/marketing/documents.asp?file=2323776,48963MS0500012-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,3,48963,MS,Individual,No,39-1263473,48963MS0500012,Humana Gold 2500/ChoiceCare PPO,48963MS050,,MSN004,MSS004,MSF007,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342483,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333968,http://apps.humana.com/marketing/documents.asp?file=2323776,48963MS0500012-03,Limited Cost Sharing Plan Variation,,0.780732274055481,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,MO,81313,HIOS,2,2014-08-08 08:53:29,1,81313,MO,SHOP (Small Group),Yes,72-0977315,81313MO0040001,AlwaysCare Small Group - Child,81313MO004,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.09,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,81313MO0040001-00,Standard High Off Exchange Plan,86.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,81313,HIOS,2,2014-08-08 08:53:29,1,81313,MO,Individual,Yes,72-0977315,81313MO0010001,AlwaysCare All-Star Kids Dental Plan,81313MO001,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$20.93,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,81313MO0010001-00,Standard High Off Exchange Plan,86.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490014,Humana Gold 2500/Jackson PPOx,48963MS049,,MSN001,MSS001,MSF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342496,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333799,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490014-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490015,Humana Platinum 1000/Jackson PPOx,48963MS049,,MSN001,MSS001,MSF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342535,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333812,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490015-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,MS,49374,HIOS,8,2014-11-14 05:23:27,1,49374,MS,Individual,Yes,94-2761537,49374MS0010002,Delta Dental PPO Pediatric Preferred Plan,49374MS001,,MSN001,MSS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$22.42,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ms/49374ms0010002-15,,49374MS0010002-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MS,49374,HIOS,8,2014-11-14 05:23:27,1,49374,MS,Individual,Yes,94-2761537,49374MS0010001,Delta Dental PPO Pediatric Basic Plan,49374MS001,,MSN001,MSS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$17.44,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ms/49374ms0010001-15,,49374MS0010001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MS,49374,HIOS,8,2014-11-14 05:23:27,1,49374,MS,Individual,Yes,94-2761537,49374MS0010001,Delta Dental PPO Pediatric Basic Plan,49374MS001,,MSN001,MSS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$17.44,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ms/49374ms0010001-15,,49374MS0010001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MS,49374,HIOS,8,2014-11-14 05:23:27,2,49374,MS,Individual,Yes,94-2761537,49374MS0010004,Delta Dental PPO Preferred Plan for Families,49374MS001,,MSN001,MSS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.42,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ms/49374ms0010004-15,,49374MS0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MS,49374,HIOS,8,2014-11-14 05:23:27,2,49374,MS,Individual,Yes,94-2761537,49374MS0010004,Delta Dental PPO Preferred Plan for Families,49374MS001,,MSN001,MSS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.42,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ms/49374ms0010004-15,,49374MS0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MS,49374,HIOS,8,2014-11-14 05:23:27,3,49374,MS,Individual,Yes,94-2761537,49374MS0010006,Delta Dental PPO Basic Plan for Families,49374MS001,,MSN001,MSS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.44,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ms/49374ms0010006-15,,49374MS0010006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MS,49374,HIOS,8,2014-11-14 05:23:27,3,49374,MS,Individual,Yes,94-2761537,49374MS0010006,Delta Dental PPO Basic Plan for Families,49374MS001,,MSN001,MSS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.44,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ms/49374ms0010006-15,,49374MS0010006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,81313,HIOS,2,2014-08-08 08:53:29,2,81313,MO,Individual,Yes,72-0977315,81313MO0020001,AlwaysCare All-Star Family Dental Plan,81313MO002,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.93,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,81313MO0020001-00,Standard High Off Exchange Plan,86.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,81313,HIOS,2,2014-08-08 08:53:29,2,81313,MO,Individual,Yes,72-0977315,81313MO0020002,AlwaysCare All-Star Family Dental Plan,81313MO002,,MON001,MOS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$17.09,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,81313MO0020002-00,Standard Low Off Exchange Plan,71.27%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,81313,HIOS,2,2014-08-08 08:53:29,2,81313,MO,SHOP (Small Group),Yes,72-0977315,81313MO0030002,AlwaysCare Small Group Dental - Adults,81313MO003,,MON001,MOS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.72,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,81313MO0030002-00,Standard Low Off Exchange Plan,71.27%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,82905,HIOS,11,2015-01-16 17:32:32,1,82905,MO,Individual,Yes,36-3757528,82905MO0010001,TruAssure Dental Basic Plan,82905MO001,,MON001,MOS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.19,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=MO,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=MO,,82905MO0010001-00,Standard Low Off Exchange Plan,68.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$105,Not Applicable,,,,,$105,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,82905,HIOS,11,2015-01-16 17:32:32,1,82905,MO,SHOP (Small Group),Yes,36-3757528,82905MO0030001,TruAssure Dental Small Group Basic Plan,82905MO003,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.72,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=MO,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=MO,,82905MO0030001-00,Standard High Off Exchange Plan,83.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,82905,HIOS,11,2015-01-16 17:32:32,1,82905,MO,SHOP (Small Group),Yes,36-3757528,82905MO0040001,TruAssure Dental Small Group Preferred Plan,82905MO004,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.72,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=MO,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=MO,,82905MO0040001-00,Standard High Off Exchange Plan,83.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,82905,HIOS,11,2015-01-16 17:32:32,1,82905,MO,Individual,Yes,36-3757528,82905MO0010001,TruAssure Dental Basic Plan,82905MO001,,MON001,MOS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.19,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=MO,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=MO,,82905MO0010001-01,Standard Low On Exchange Plan,68.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$105,Not Applicable,,,,,$105,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,82905,HIOS,11,2015-01-16 17:32:32,2,82905,MO,Individual,Yes,36-3757528,82905MO0020001,TruAssure Dental Preferred Plan,82905MO002,,MON001,MOS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.77,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=MO,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=MO,,82905MO0020001-00,Standard High Off Exchange Plan,83.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$30,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,82905,HIOS,11,2015-01-16 17:32:32,2,82905,MO,Individual,Yes,36-3757528,82905MO0020001,TruAssure Dental Preferred Plan,82905MO002,,MON001,MOS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.77,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=MO,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=MO,,82905MO0020001-01,Standard High On Exchange Plan,83.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$30,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,86182,HIOS,2,2014-08-03 08:59:32,1,86182,MO,SHOP (Small Group),Yes,93-0242990,86182MO0030002,EHB High Passive,86182MO003,,MON001,MOS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$41.22,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,86182MO0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,86182,HIOS,2,2014-08-03 08:59:32,1,86182,MO,SHOP (Small Group),Yes,93-0242990,86182MO0030001,EHB Low Passive,86182MO003,,MON001,MOS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.48,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,86182MO0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,86779,HIOS,2,2014-08-08 08:53:29,1,86779,MO,SHOP (Small Group),Yes,42-0127290,86779MO0040001,Principal Plan Dental 70,86779MO004,,MON001,MOS001,,New,PPO,Low,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$26.59,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,86779MO0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,86779,HIOS,2,2014-08-08 08:53:29,1,86779,MO,SHOP (Small Group),Yes,42-0127290,86779MO0040002,Principal Plan Dental 80,86779MO004,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$28.16,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,86779MO0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MO,94322,HIOS,2,2014-08-05 13:28:44,1,94322,MO,SHOP (Small Group),Yes,36-0883760,94322MO0030002,EHB High Passive,94322MO003,,MON001,MOS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$41.10,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,94322MO0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MO,94322,HIOS,2,2014-08-05 13:28:44,1,94322,MO,SHOP (Small Group),Yes,36-0883760,94322MO0030001,EHB Low Passive,94322MO003,,MON001,MOS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.41,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,94322MO0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MS,11324,HIOS,5,2014-09-03 04:28:59,1,11324,MS,Individual,Yes,95-6042390,11324MS0020001,BESTOne Child Dental Plus,11324MS002,,MSN001,MSS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$47.22,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MS/2015/MS_BESTOne_Child_Dental_Plus_Plan.pdf,,11324MS0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MS,11324,HIOS,5,2014-09-03 04:28:59,2,11324,MS,Individual,Yes,95-6042390,11324MS0020002,BESTOne Child Dental,11324MS002,,MSN001,MSS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$37.25,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MS/2015/MS_BESTOne_Child_Dental_Plan.pdf,,11324MS0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MS,11324,HIOS,5,2014-09-03 04:28:59,3,11324,MS,Individual,Yes,95-6042390,11324MS0020003,BESTOne Dental Advantage-Gold,11324MS002,,MSN001,MSS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$47.22,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MS/2015/MS_BESTOne_Dental_Advantage-Gold_Plan.pdf,,11324MS0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MS,11324,HIOS,5,2014-09-03 04:28:59,3,11324,MS,Individual,Yes,95-6042390,11324MS0020003,BESTOne Dental Advantage-Gold,11324MS002,,MSN001,MSS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$47.22,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MS/2015/MS_BESTOne_Dental_Advantage-Gold_Plan.pdf,,11324MS0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MS,11324,HIOS,5,2014-09-03 04:28:59,3,11324,MS,Individual,Yes,95-6042390,11324MS0020004,BESTOne Dental Plus-Gold,11324MS002,,MSN001,MSS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$47.22,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MS/2015/MS_BESTOne_Dental_Plus-Gold_Plan.pdf,,11324MS0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MS,11324,HIOS,5,2014-09-03 04:28:59,3,11324,MS,Individual,Yes,95-6042390,11324MS0020004,BESTOne Dental Plus-Gold,11324MS002,,MSN001,MSS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$47.22,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MS/2015/MS_BESTOne_Dental_Plus-Gold_Plan.pdf,,11324MS0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MS,11324,HIOS,5,2014-09-03 04:28:59,4,11324,MS,Individual,Yes,95-6042390,11324MS0020005,BESTOne Dental Plus-Silver,11324MS002,,MSN001,MSS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$37.25,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MS/2015/MS_BESTOne_Dental_Plus-Silver_Plan.pdf,,11324MS0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MS,11324,HIOS,5,2014-09-03 04:28:59,4,11324,MS,Individual,Yes,95-6042390,11324MS0020005,BESTOne Dental Plus-Silver,11324MS002,,MSN001,MSS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$37.25,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MS/2015/MS_BESTOne_Dental_Plus-Silver_Plan.pdf,,11324MS0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MS,11324,HIOS,5,2014-09-03 04:28:59,4,11324,MS,Individual,Yes,95-6042390,11324MS0020006,BESTOne Dental Basic-Silver,11324MS002,,MSN001,MSS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$37.25,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MS/2015/MS_BESTOne_Dental_Basic-Silver_Plan.pdf,,11324MS0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MS,11324,HIOS,5,2014-09-03 04:28:59,4,11324,MS,Individual,Yes,95-6042390,11324MS0020006,BESTOne Dental Basic-Silver,11324MS002,,MSN001,MSS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$37.25,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MS/2015/MS_BESTOne_Dental_Basic-Silver_Plan.pdf,,11324MS0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MS,46300,HIOS,2,2014-08-08 08:53:29,1,46300,MS,Individual,Yes,72-0977315,46300MS0050001,AlwaysCare All-Star Kids Dental Plan 2015,46300MS005,,MSN001,MSS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$23.18,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,46300MS0050001-00,Standard High Off Exchange Plan,85.21%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MS,46300,HIOS,2,2014-08-08 08:53:29,1,46300,MS,Individual,Yes,72-0977315,46300MS0050002,AlwaysCare All-Star Kids Dental Plan 2015,46300MS005,,MSN001,MSS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$18.93,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,46300MS0050002-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MS,46300,HIOS,2,2014-08-08 08:53:29,2,46300,MS,Individual,Yes,72-0977315,46300MS0060001,AlwaysCare All-Star Family Dental Plan 2015,46300MS006,,MSN001,MSS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.18,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,46300MS0060001-00,Standard High Off Exchange Plan,85.21%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MS,46300,HIOS,2,2014-08-08 08:53:29,2,46300,MS,Individual,Yes,72-0977315,46300MS0060002,AlwaysCare All-Star Family Dental Plan 2015,46300MS006,,MSN001,MSS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.93,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,46300MS0060002-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490013,Humana Silver 4600/Jackson PPOx,48963MS049,,MSN001,MSS001,MSF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342717,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333747,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490013-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,Yes,39-1263473,48963MS0510001,Humana Dental Smart Choice,48963MS051,,MSN003,MSS003,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.90,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541318,,48963MS0510001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,Yes,39-1263473,48963MS0510001,Humana Dental Smart Choice,48963MS051,,MSN003,MSS003,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.90,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541318,,48963MS0510001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490013,Humana Silver 4600/Jackson PPOx,48963MS049,,MSN001,MSS001,MSF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342717,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333747,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490013-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490013,Humana Silver 4600/Jackson PPOx,48963MS049,,MSN001,MSS001,MSF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342717,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333747,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490013-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490013,Humana Silver 4600/Jackson PPOx,48963MS049,,MSN001,MSS001,MSF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342717,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333747,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490013-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490013,Humana Silver 4600/Jackson PPOx,48963MS049,,MSN001,MSS001,MSF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342717,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333747,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490013-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490013,Humana Silver 4600/Jackson PPOx,48963MS049,,MSN001,MSS001,MSF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342717,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333747,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490013-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$25,200","$50,400",Not Applicable,Not Applicable,$900,"$1,800",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490013,Humana Silver 4600/Jackson PPOx,48963MS049,,MSN001,MSS001,MSF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342717,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333747,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490013-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$25,200","$50,400",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,$250,$500,50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490014,Humana Gold 2500/Jackson PPOx,48963MS049,,MSN001,MSS001,MSF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342496,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333799,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490014-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,MS,60328,HIOS,8,2014-11-14 05:23:27,1,60328,MS,Individual,Yes,75-1233841,60328MS0010001,Dentegra Dental PPO Pediatric Basic Plan,60328MS001,,MSN001,MSS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$20.81,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ms/60328ms0010001-15,,60328MS0010001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490015,Humana Platinum 1000/Jackson PPOx,48963MS049,,MSN001,MSS001,MSF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342535,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333812,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490015-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490015,Humana Platinum 1000/Jackson PPOx,48963MS049,,MSN001,MSS001,MSF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342535,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333812,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,5,94237,MS,Individual,No,20-8570212,94237MS0020009,Ambetter Balanced Care 5 + Vision,94237MS002,,MSN001,MSS001,MSF003,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977412113584779,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020009-05,87% AV Level Silver Plan,87.97%,0.879661500453949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$410,$0,$150,$600,$520,$0,$80,9
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,5,94237,MS,Individual,No,20-8570212,94237MS0020009,Ambetter Balanced Care 5 + Vision,94237MS002,,MSN001,MSS001,MSF003,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977412113584779,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020009-06,94% AV Level Silver Plan,93.34%,0.933413624763489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$120,$0,$150,$0,$450,$0,$80,10
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,3,48963,MS,Individual,No,39-1263473,48963MS0500012,Humana Gold 2500/ChoiceCare PPO,48963MS050,,MSN004,MSS004,MSF007,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342483,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333968,http://apps.humana.com/marketing/documents.asp?file=2323776,48963MS0500012-01,Standard Gold On Exchange Plan,,0.780732274055481,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,3,48963,MS,Individual,No,39-1263473,48963MS0500018,Humana Gold 2500/Mississippi PPOx,48963MS050,,MSN005,MSS005,MSF007,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342522,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327377,http://apps.humana.com/marketing/documents.asp?file=2323776,48963MS0500018-00,Standard Gold Off Exchange Plan,,0.780732274055481,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,6,94237,MS,Individual,No,20-8570212,94237MS0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,94237MS002,,MSN001,MSS001,MSF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976198242892113,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020012-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,6,94237,MS,Individual,No,20-8570212,94237MS0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,94237MS002,,MSN001,MSS001,MSF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976198242892113,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020012-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,MS,84254,HIOS,2,2014-08-05 13:28:44,1,84254,MS,Individual,Yes,47-0397286,84254MS0010001,"Delta Dental Individual PPO, EHB Certified",84254MS001,,MSN002,MSS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.81,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,84254MS0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490015,Humana Platinum 1000/Jackson PPOx,48963MS049,,MSN001,MSS001,MSF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342535,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333812,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490015-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490003,Humana Silver 4600/Memphis PPOx,48963MS049,,MSN002,MSS002,MSF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342730,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333643,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490003-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490003,Humana Silver 4600/Memphis PPOx,48963MS049,,MSN002,MSS002,MSF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342730,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333643,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490003-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490003,Humana Silver 4600/Memphis PPOx,48963MS049,,MSN002,MSS002,MSF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342730,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333643,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490003,Humana Silver 4600/Memphis PPOx,48963MS049,,MSN002,MSS002,MSF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342730,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333643,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490003-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490003,Humana Silver 4600/Memphis PPOx,48963MS049,,MSN002,MSS002,MSF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342730,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333643,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490003-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490003,Humana Silver 4600/Memphis PPOx,48963MS049,,MSN002,MSS002,MSF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342730,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333643,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490003-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$25,200","$50,400",Not Applicable,Not Applicable,$900,"$1,800",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490003,Humana Silver 4600/Memphis PPOx,48963MS049,,MSN002,MSS002,MSF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342730,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333643,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490003-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$25,200","$50,400",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,$250,$500,50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490004,Humana Gold 2500/Memphis PPOx,48963MS049,,MSN002,MSS002,MSF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342509,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333695,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490004-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490004,Humana Gold 2500/Memphis PPOx,48963MS049,,MSN002,MSS002,MSF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342509,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333695,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490004-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490004,Humana Gold 2500/Memphis PPOx,48963MS049,,MSN002,MSS002,MSF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342509,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333695,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,28
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490004,Humana Gold 2500/Memphis PPOx,48963MS049,,MSN002,MSS002,MSF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342509,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333695,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490004-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490005,Humana Platinum 1000/Memphis PPOx,48963MS049,,MSN002,MSS002,MSF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342548,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333708,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490005-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490005,Humana Platinum 1000/Memphis PPOx,48963MS049,,MSN002,MSS002,MSF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342548,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333708,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490005-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490005,Humana Platinum 1000/Memphis PPOx,48963MS049,,MSN002,MSS002,MSF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342548,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333708,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,32
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,1,48963,MS,Individual,No,39-1263473,48963MS0490005,Humana Platinum 1000/Memphis PPOx,48963MS049,,MSN002,MSS002,MSF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342548,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333708,http://apps.humana.com/marketing/documents.asp?file=2323815,48963MS0490005-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,2,48963,MS,Individual,No,39-1263473,48963MS0490011,Humana Basic 6600/Jackson PPOx,48963MS049,,MSN001,MSS001,MSF001,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342366,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333721,http://apps.humana.com/marketing/documents.asp?file=2323880,48963MS0490011-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,2,48963,MS,Individual,No,39-1263473,48963MS0490011,Humana Basic 6600/Jackson PPOx,48963MS049,,MSN001,MSS001,MSF001,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342366,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333721,http://apps.humana.com/marketing/documents.asp?file=2323880,48963MS0490011-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,2,48963,MS,Individual,No,39-1263473,48963MS0490012,Humana Bronze 6300/Jackson PPOx,48963MS049,,MSN001,MSS001,MSF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342444,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333734,http://apps.humana.com/marketing/documents.asp?file=2323880,48963MS0490012-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,6
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,2,48963,MS,Individual,No,39-1263473,48963MS0490012,Humana Bronze 6300/Jackson PPOx,48963MS049,,MSN001,MSS001,MSF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342444,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333734,http://apps.humana.com/marketing/documents.asp?file=2323880,48963MS0490012-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,2,48963,MS,Individual,No,39-1263473,48963MS0490012,Humana Bronze 6300/Jackson PPOx,48963MS049,,MSN001,MSS001,MSF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342444,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333734,http://apps.humana.com/marketing/documents.asp?file=2323880,48963MS0490012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,2,48963,MS,Individual,No,39-1263473,48963MS0490012,Humana Bronze 6300/Jackson PPOx,48963MS049,,MSN001,MSS001,MSF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342444,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333734,http://apps.humana.com/marketing/documents.asp?file=2323880,48963MS0490012-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,9
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,2,48963,MS,Individual,No,39-1263473,48963MS0490001,Humana Basic 6600/Memphis PPOx,48963MS049,,MSN002,MSS002,MSF001,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342379,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333617,http://apps.humana.com/marketing/documents.asp?file=2323880,48963MS0490001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,10
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,2,48963,MS,Individual,No,39-1263473,48963MS0490001,Humana Basic 6600/Memphis PPOx,48963MS049,,MSN002,MSS002,MSF001,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342379,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333617,http://apps.humana.com/marketing/documents.asp?file=2323880,48963MS0490001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,11
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,3,48963,MS,Individual,No,39-1263473,48963MS0500019,Humana Silver 3200/ChoiceCare PPO,48963MS050,,MSN004,MSS004,MSF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342639,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333864,http://apps.humana.com/marketing/documents.asp?file=2323776,48963MS0500019-00,Standard Silver Off Exchange Plan,69.53%,0.719883143901825,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,"$18,800","$37,600",Not Applicable,Not Applicable,"$3,200","$6,400",20%,,,,"$6,400","$12,800",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,3,48963,MS,Individual,No,39-1263473,48963MS0500019,Humana Silver 3200/ChoiceCare PPO,48963MS050,,MSN004,MSS004,MSF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342639,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333864,http://apps.humana.com/marketing/documents.asp?file=2323776,48963MS0500019-01,Standard Silver On Exchange Plan,69.53%,0.719883143901825,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,"$18,800","$37,600",Not Applicable,Not Applicable,"$3,200","$6,400",20%,,,,"$6,400","$12,800",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,3,48963,MS,Individual,No,39-1263473,48963MS0500019,Humana Silver 3200/ChoiceCare PPO,48963MS050,,MSN004,MSS004,MSF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342639,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333864,http://apps.humana.com/marketing/documents.asp?file=2323776,48963MS0500019-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,3,48963,MS,Individual,No,39-1263473,48963MS0500019,Humana Silver 3200/ChoiceCare PPO,48963MS050,,MSN004,MSS004,MSF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342639,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333864,http://apps.humana.com/marketing/documents.asp?file=2323776,48963MS0500019-03,Limited Cost Sharing Plan Variation,69.53%,0.719883143901825,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,"$18,800","$37,600",Not Applicable,Not Applicable,"$3,200","$6,400",20%,,,,"$6,400","$12,800",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,3,48963,MS,Individual,No,39-1263473,48963MS0500019,Humana Silver 3200/ChoiceCare PPO,48963MS050,,MSN004,MSS004,MSF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342639,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333864,http://apps.humana.com/marketing/documents.asp?file=2323776,48963MS0500019-04,73% AV Level Silver Plan,73.51%,0.738783478736877,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$18,800","$37,600",Not Applicable,Not Applicable,"$2,750","$5,500",20%,,,,"$6,400","$12,800",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,3,48963,MS,Individual,No,39-1263473,48963MS0500019,Humana Silver 3200/ChoiceCare PPO,48963MS050,,MSN004,MSS004,MSF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342639,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333864,http://apps.humana.com/marketing/documents.asp?file=2323776,48963MS0500019-05,87% AV Level Silver Plan,86.76%,0.867647707462311,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$18,800","$37,600",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$6,400","$12,800",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,3,48963,MS,Individual,No,39-1263473,48963MS0500019,Humana Silver 3200/ChoiceCare PPO,48963MS050,,MSN004,MSS004,MSF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342639,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333864,http://apps.humana.com/marketing/documents.asp?file=2323776,48963MS0500019-06,94% AV Level Silver Plan,93.69%,0.93690437078476,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$18,800","$37,600",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$6,400","$12,800",Not Applicable,Not Applicable,$250,$500,50%,,,,$750,"$1,500",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,3,48963,MS,Individual,No,39-1263473,48963MS0500012,Humana Gold 2500/ChoiceCare PPO,48963MS050,,MSN004,MSS004,MSF007,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342483,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333968,http://apps.humana.com/marketing/documents.asp?file=2323776,48963MS0500012-00,Standard Gold Off Exchange Plan,,0.780732274055481,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,MS,60328,HIOS,8,2014-11-14 05:23:27,1,60328,MS,Individual,Yes,75-1233841,60328MS0010001,Dentegra Dental PPO Pediatric Basic Plan,60328MS001,,MSN001,MSS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$20.81,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ms/60328ms0010001-15,,60328MS0010001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MS,60328,HIOS,8,2014-11-14 05:23:27,2,60328,MS,Individual,Yes,75-1233841,60328MS0010004,Dentegra Dental PPO Family Preferred Plan,60328MS001,,MSN001,MSS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.30,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ms/60328ms0010004-15,,60328MS0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,$70,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MS,60328,HIOS,8,2014-11-14 05:23:27,2,60328,MS,Individual,Yes,75-1233841,60328MS0010004,Dentegra Dental PPO Family Preferred Plan,60328MS001,,MSN001,MSS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.30,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ms/60328ms0010004-15,,60328MS0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,$70,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MS,60328,HIOS,8,2014-11-14 05:23:27,3,60328,MS,Individual,Yes,75-1233841,60328MS0010006,Dentegra Dental PPO Family Basic Plan,60328MS001,,MSN001,MSS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.81,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ms/60328ms0010006-15,,60328MS0010006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MS,60328,HIOS,8,2014-11-14 05:23:27,3,60328,MS,Individual,Yes,75-1233841,60328MS0010006,Dentegra Dental PPO Family Basic Plan,60328MS001,,MSN001,MSS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.81,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ms/60328ms0010006-15,,60328MS0010006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,3,48963,MS,Individual,No,39-1263473,48963MS0500018,Humana Gold 2500/Mississippi PPOx,48963MS050,,MSN005,MSS005,MSF007,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342522,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327377,http://apps.humana.com/marketing/documents.asp?file=2323776,48963MS0500018-01,Standard Gold On Exchange Plan,,0.780732274055481,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,3,48963,MS,Individual,No,39-1263473,48963MS0500018,Humana Gold 2500/Mississippi PPOx,48963MS050,,MSN005,MSS005,MSF007,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342522,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327377,http://apps.humana.com/marketing/documents.asp?file=2323776,48963MS0500018-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,3,48963,MS,Individual,No,39-1263473,48963MS0500018,Humana Gold 2500/Mississippi PPOx,48963MS050,,MSN005,MSS005,MSF007,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342522,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327377,http://apps.humana.com/marketing/documents.asp?file=2323776,48963MS0500018-03,Limited Cost Sharing Plan Variation,,0.780732274055481,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500007,Humana Basic 6600/ChoiceCare PPO,48963MS050,,MSN004,MSS004,MSF004,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342353,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333825,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500007-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500007,Humana Basic 6600/ChoiceCare PPO,48963MS050,,MSN004,MSS004,MSF004,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342353,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333825,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500007-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500008,Humana Bronze 6300/ChoiceCare PPO,48963MS050,,MSN004,MSS004,MSF004,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342431,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333838,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500008-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,6
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500008,Humana Bronze 6300/ChoiceCare PPO,48963MS050,,MSN004,MSS004,MSF004,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342431,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333838,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500008-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500008,Humana Bronze 6300/ChoiceCare PPO,48963MS050,,MSN004,MSS004,MSF004,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342431,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333838,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,2,94237,MS,Individual,No,20-8570212,94237MS0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,94237MS001,,MSN001,MSS001,MSF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010004-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,2,94237,MS,Individual,No,20-8570212,94237MS0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,94237MS001,,MSN001,MSS001,MSF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,2,94237,MS,Individual,No,20-8570212,94237MS0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,94237MS001,,MSN001,MSS001,MSF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010004-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,2,94237,MS,Individual,No,20-8570212,94237MS0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,94237MS001,,MSN001,MSS001,MSF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010012-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,2,94237,MS,Individual,No,20-8570212,94237MS0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,94237MS001,,MSN001,MSS001,MSF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010012-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,2,94237,MS,Individual,No,20-8570212,94237MS0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,94237MS001,,MSN001,MSS001,MSF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,2,94237,MS,Individual,No,20-8570212,94237MS0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,94237MS001,,MSN001,MSS001,MSF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010012-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,2,94237,MS,Individual,No,20-8570212,94237MS0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,94237MS001,,MSN001,MSS001,MSF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010013-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,2,94237,MS,Individual,No,20-8570212,94237MS0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,94237MS001,,MSN001,MSS001,MSF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010013-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,2,94237,MS,Individual,No,20-8570212,94237MS0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,94237MS001,,MSN001,MSS001,MSF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500008,Humana Bronze 6300/ChoiceCare PPO,48963MS050,,MSN004,MSS004,MSF004,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342431,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333838,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500008-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,9
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500011,Humana Silver 3650/ChoiceCare PPO,48963MS050,,MSN004,MSS006,MSF004,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342691,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333916,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500011-00,Standard Silver Off Exchange Plan,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,10
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500011,Humana Silver 3650/ChoiceCare PPO,48963MS050,,MSN004,MSS006,MSF004,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342691,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333916,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500011-01,Standard Silver On Exchange Plan,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,11
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500011,Humana Silver 3650/ChoiceCare PPO,48963MS050,,MSN004,MSS006,MSF004,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342691,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333916,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,12
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500011,Humana Silver 3650/ChoiceCare PPO,48963MS050,,MSN004,MSS006,MSF004,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342691,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333916,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500011-03,Limited Cost Sharing Plan Variation,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,13
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500011,Humana Silver 3650/ChoiceCare PPO,48963MS050,,MSN004,MSS006,MSF004,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342691,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333916,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500011-04,73% AV Level Silver Plan,,0.721818149089813,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,920","$5,840",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,920","$5,840",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,14
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500011,Humana Silver 3650/ChoiceCare PPO,48963MS050,,MSN004,MSS006,MSF004,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342691,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333916,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500011-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,15
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500011,Humana Silver 3650/ChoiceCare PPO,48963MS050,,MSN004,MSS006,MSF004,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342691,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333916,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500011-06,94% AV Level Silver Plan,,0.935785233974457,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$475,$950,,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$475,$950,0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,16
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500013,Humana Basic 6600/Mississippi PPOx,48963MS050,,MSN005,MSS005,MSF004,New,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342392,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327338,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500013-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,17
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500013,Humana Basic 6600/Mississippi PPOx,48963MS050,,MSN005,MSS005,MSF004,New,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342392,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327338,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500013-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,18
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500014,Humana Bronze 6300/Mississippi PPOx,48963MS050,,MSN005,MSS005,MSF004,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342470,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327351,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500014-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,19
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500014,Humana Bronze 6300/Mississippi PPOx,48963MS050,,MSN005,MSS005,MSF004,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342470,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327351,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500014-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,20
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500014,Humana Bronze 6300/Mississippi PPOx,48963MS050,,MSN005,MSS005,MSF004,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342470,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327351,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,21
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500014,Humana Bronze 6300/Mississippi PPOx,48963MS050,,MSN005,MSS005,MSF004,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342470,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327351,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500014-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,22
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500017,Humana Silver 3650/Mississippi PPOx,48963MS050,,MSN005,MSS005,MSF004,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342704,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327442,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500017-00,Standard Silver Off Exchange Plan,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,23
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500017,Humana Silver 3650/Mississippi PPOx,48963MS050,,MSN005,MSS005,MSF004,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342704,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327442,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500017-01,Standard Silver On Exchange Plan,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,24
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500017,Humana Silver 3650/Mississippi PPOx,48963MS050,,MSN005,MSS005,MSF004,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342704,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327442,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,25
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500017,Humana Silver 3650/Mississippi PPOx,48963MS050,,MSN005,MSS005,MSF004,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342704,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327442,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500017-03,Limited Cost Sharing Plan Variation,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,26
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500017,Humana Silver 3650/Mississippi PPOx,48963MS050,,MSN005,MSS005,MSF004,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342704,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327442,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500017-04,73% AV Level Silver Plan,,0.721818149089813,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,920","$5,840",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,920","$5,840",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,27
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,4,48963,MS,Individual,No,39-1263473,48963MS0500017,Humana Silver 3650/Mississippi PPOx,48963MS050,,MSN005,MSS005,MSF004,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342704,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327442,http://apps.humana.com/marketing/documents.asp?file=2323841,48963MS0500017-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,28
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,5,48963,MS,Individual,No,39-1263473,48963MS0500009,Humana Bronze 4850/ChoiceCare PPO,48963MS050,,MSN004,MSS004,MSF005,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342405,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333851,http://apps.humana.com/marketing/documents.asp?file=2323776,48963MS0500009-01,Standard Bronze On Exchange Plan,,0.616929411888123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800",Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,"$9,700","$19,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,5,48963,MS,Individual,No,39-1263473,48963MS0500009,Humana Bronze 4850/ChoiceCare PPO,48963MS050,,MSN004,MSS004,MSF005,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342405,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333851,http://apps.humana.com/marketing/documents.asp?file=2323776,48963MS0500009-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,5,48963,MS,Individual,No,39-1263473,48963MS0500009,Humana Bronze 4850/ChoiceCare PPO,48963MS050,,MSN004,MSS004,MSF005,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342405,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333851,http://apps.humana.com/marketing/documents.asp?file=2323776,48963MS0500009-03,Limited Cost Sharing Plan Variation,,0.616929411888123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800",Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,"$9,700","$19,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,5,48963,MS,Individual,No,39-1263473,48963MS0500015,Humana Bronze 4850/Mississippi PPOx,48963MS050,,MSN005,MSS005,MSF005,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342418,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327377,http://apps.humana.com/marketing/documents.asp?file=2323776,48963MS0500015-00,Standard Bronze Off Exchange Plan,,0.616929411888123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800",Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,"$9,700","$19,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,5,48963,MS,Individual,No,39-1263473,48963MS0500015,Humana Bronze 4850/Mississippi PPOx,48963MS050,,MSN005,MSS005,MSF005,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342418,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327377,http://apps.humana.com/marketing/documents.asp?file=2323776,48963MS0500015-01,Standard Bronze On Exchange Plan,,0.616929411888123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800",Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,"$9,700","$19,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,5,48963,MS,Individual,No,39-1263473,48963MS0500015,Humana Bronze 4850/Mississippi PPOx,48963MS050,,MSN005,MSS005,MSF005,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342418,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327377,http://apps.humana.com/marketing/documents.asp?file=2323776,48963MS0500015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,MS,48963,HIOS,16,2015-01-16 17:32:32,5,48963,MS,Individual,No,39-1263473,48963MS0500015,Humana Bronze 4850/Mississippi PPOx,48963MS050,,MSN005,MSS005,MSF005,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2342418,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327377,http://apps.humana.com/marketing/documents.asp?file=2323776,48963MS0500015-03,Limited Cost Sharing Plan Variation,,0.616929411888123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800",Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,"$9,700","$19,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,MS,49374,HIOS,8,2014-11-14 05:23:27,1,49374,MS,Individual,Yes,94-2761537,49374MS0010002,Delta Dental PPO Pediatric Preferred Plan,49374MS001,,MSN001,MSS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$22.42,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ms/49374ms0010002-15,,49374MS0010002-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,6,94237,MS,Individual,No,20-8570212,94237MS0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,94237MS002,,MSN001,MSS001,MSF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974931527950018,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020004-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,6,94237,MS,Individual,No,20-8570212,94237MS0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,94237MS002,,MSN001,MSS001,MSF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974931527950018,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020004-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,6,94237,MS,Individual,No,20-8570212,94237MS0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,94237MS002,,MSN001,MSS001,MSF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974931527950018,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,6,94237,MS,Individual,No,20-8570212,94237MS0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,94237MS002,,MSN001,MSS001,MSF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974931527950018,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020004-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,MS,84254,HIOS,2,2014-08-05 13:28:44,1,84254,MS,Individual,Yes,47-0397286,84254MS0010002,"Delta Dental Individual PPO, EHB Certified",84254MS001,,MSN002,MSS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.51,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,84254MS0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MS,84254,HIOS,2,2014-08-05 13:28:44,1,84254,MS,Individual,Yes,47-0397286,84254MS0020001,"Renaissance Individual Dental PPO, EHB Certified",84254MS002,,MSN001,MSS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.59,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,84254MS0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MS,84254,HIOS,2,2014-08-05 13:28:44,1,84254,MS,Individual,Yes,47-0397286,84254MS0020002,"Renaissance Individual Dental PPO, EHB Certified",84254MS002,,MSN001,MSS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.15,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,84254MS0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,1,94237,MS,Individual,No,20-8570212,94237MS0010009,Ambetter Balanced Care 5,94237MS001,,MSN001,MSS001,MSF003,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010009-00,Standard Silver Off Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,4
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,1,94237,MS,Individual,No,20-8570212,94237MS0010009,Ambetter Balanced Care 5,94237MS001,,MSN001,MSS001,MSF003,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010009-01,Standard Silver On Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,5
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,1,94237,MS,Individual,No,20-8570212,94237MS0010009,Ambetter Balanced Care 5,94237MS001,,MSN001,MSS001,MSF003,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,1,94237,MS,Individual,No,20-8570212,94237MS0010009,Ambetter Balanced Care 5,94237MS001,,MSN001,MSS001,MSF003,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010009-03,Limited Cost Sharing Plan Variation,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,7
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,1,94237,MS,Individual,No,20-8570212,94237MS0010009,Ambetter Balanced Care 5,94237MS001,,MSN001,MSS001,MSF003,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010009-04,73% AV Level Silver Plan,73.24%,0.732411444187164,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$2,920",$350,$0,$80,8
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,1,94237,MS,Individual,No,20-8570212,94237MS0010009,Ambetter Balanced Care 5,94237MS001,,MSN001,MSS001,MSF003,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010009-05,87% AV Level Silver Plan,87.97%,0.879661500453949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$410,$0,$150,$600,$520,$0,$80,9
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,1,94237,MS,Individual,No,20-8570212,94237MS0010009,Ambetter Balanced Care 5,94237MS001,,MSN001,MSS001,MSF003,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010009-06,94% AV Level Silver Plan,93.34%,0.933413624763489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$120,$0,$150,$0,$450,$0,$80,10
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,1,94237,MS,Individual,No,20-8570212,94237MS0010002,Ambetter Secure Care 2,94237MS001,,MSN001,MSS001,MSF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,11
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,1,94237,MS,Individual,No,20-8570212,94237MS0010002,Ambetter Secure Care 2,94237MS001,,MSN001,MSS001,MSF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,12
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,1,94237,MS,Individual,No,20-8570212,94237MS0010002,Ambetter Secure Care 2,94237MS001,,MSN001,MSS001,MSF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,1,94237,MS,Individual,No,20-8570212,94237MS0010002,Ambetter Secure Care 2,94237MS001,,MSN001,MSS001,MSF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,14
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,2,94237,MS,Individual,No,20-8570212,94237MS0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,94237MS001,,MSN001,MSS001,MSF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010004-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,2,94237,MS,Individual,No,20-8570212,94237MS0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,94237MS001,,MSN001,MSS001,MSF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010013-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,2,94237,MS,Individual,No,20-8570212,94237MS0010016,Ambetter Essential Care 2,94237MS001,,MSN001,MSS001,MSF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010016-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,2,94237,MS,Individual,No,20-8570212,94237MS0010016,Ambetter Essential Care 2,94237MS001,,MSN001,MSS001,MSF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010016-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,2,94237,MS,Individual,No,20-8570212,94237MS0010016,Ambetter Essential Care 2,94237MS001,,MSN001,MSS001,MSF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,2,94237,MS,Individual,No,20-8570212,94237MS0010016,Ambetter Essential Care 2,94237MS001,,MSN001,MSS001,MSF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010016-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,2,94237,MS,Individual,No,20-8570212,94237MS0010017,Ambetter Essential Care 1,94237MS001,,MSN001,MSS001,MSF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010017-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,2,94237,MS,Individual,No,20-8570212,94237MS0010017,Ambetter Essential Care 1,94237MS001,,MSN001,MSS001,MSF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010017-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,2,94237,MS,Individual,No,20-8570212,94237MS0010017,Ambetter Essential Care 1,94237MS001,,MSN001,MSS001,MSF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,2,94237,MS,Individual,No,20-8570212,94237MS0010017,Ambetter Essential Care 1,94237MS001,,MSN001,MSS001,MSF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010017-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,3,94237,MS,Individual,No,20-8570212,94237MS0010014,Ambetter Balanced Care 6,94237MS001,,MSN001,MSS001,MSF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010014-00,Standard Silver Off Exchange Plan,,0.718193292617798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,520",$30,"$1,270",$150,"$2,300",$870,$150,$80,4
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,3,94237,MS,Individual,No,20-8570212,94237MS0010014,Ambetter Balanced Care 6,94237MS001,,MSN001,MSS001,MSF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010014-01,Standard Silver On Exchange Plan,,0.718193292617798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,520",$30,"$1,270",$150,"$2,300",$870,$150,$80,5
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,3,94237,MS,Individual,No,20-8570212,94237MS0010014,Ambetter Balanced Care 6,94237MS001,,MSN001,MSS001,MSF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,3,94237,MS,Individual,No,20-8570212,94237MS0010014,Ambetter Balanced Care 6,94237MS001,,MSN001,MSS001,MSF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010014-03,Limited Cost Sharing Plan Variation,,0.718193292617798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,520",$30,"$1,270",$150,"$2,300",$870,$150,$80,7
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,3,94237,MS,Individual,No,20-8570212,94237MS0010014,Ambetter Balanced Care 6,94237MS001,,MSN001,MSS001,MSF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010014-04,73% AV Level Silver Plan,,0.738342940807343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,400",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,220",$30,"$1,270",$150,"$2,000",$870,$220,$80,8
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,3,94237,MS,Individual,No,20-8570212,94237MS0010014,Ambetter Balanced Care 6,94237MS001,,MSN001,MSS001,MSF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010014-05,87% AV Level Silver Plan,,0.877610564231873,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$270,$20,"$1,010",$150,$350,$550,$230,$80,9
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,3,94237,MS,Individual,No,20-8570212,94237MS0010014,Ambetter Balanced Care 6,94237MS001,,MSN001,MSS001,MSF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.997077945019682,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/formulary,94237MS0010014-06,94% AV Level Silver Plan,,0.947545647621155,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$75,$150,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$100,$0,$250,$150,$130,$100,$70,$80,10
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,5,94237,MS,Individual,No,20-8570212,94237MS0020009,Ambetter Balanced Care 5 + Vision,94237MS002,,MSN001,MSS001,MSF003,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977412113584779,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020009-00,Standard Silver Off Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,4
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,5,94237,MS,Individual,No,20-8570212,94237MS0020009,Ambetter Balanced Care 5 + Vision,94237MS002,,MSN001,MSS001,MSF003,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977412113584779,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020009-01,Standard Silver On Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,5
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,5,94237,MS,Individual,No,20-8570212,94237MS0020009,Ambetter Balanced Care 5 + Vision,94237MS002,,MSN001,MSS001,MSF003,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977412113584779,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,5,94237,MS,Individual,No,20-8570212,94237MS0020009,Ambetter Balanced Care 5 + Vision,94237MS002,,MSN001,MSS001,MSF003,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977412113584779,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020009-03,Limited Cost Sharing Plan Variation,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,7
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,5,94237,MS,Individual,No,20-8570212,94237MS0020009,Ambetter Balanced Care 5 + Vision,94237MS002,,MSN001,MSS001,MSF003,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977412113584779,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020009-04,73% AV Level Silver Plan,73.24%,0.732411444187164,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$2,920",$350,$0,$80,8
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,5,94237,MS,Individual,No,20-8570212,94237MS0020002,Ambetter Secure Care 2 + Vision,94237MS002,,MSN001,MSS001,MSF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974931527950018,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,11
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,5,94237,MS,Individual,No,20-8570212,94237MS0020002,Ambetter Secure Care 2 + Vision,94237MS002,,MSN001,MSS001,MSF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974931527950018,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,12
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,5,94237,MS,Individual,No,20-8570212,94237MS0020002,Ambetter Secure Care 2 + Vision,94237MS002,,MSN001,MSS001,MSF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974931527950018,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,5,94237,MS,Individual,No,20-8570212,94237MS0020002,Ambetter Secure Care 2 + Vision,94237MS002,,MSN001,MSS001,MSF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974931527950018,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,14
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,6,94237,MS,Individual,No,20-8570212,94237MS0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,94237MS002,,MSN001,MSS001,MSF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976198242892113,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,6,94237,MS,Individual,No,20-8570212,94237MS0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,94237MS002,,MSN001,MSS001,MSF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976198242892113,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020012-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,6,94237,MS,Individual,No,20-8570212,94237MS0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,94237MS002,,MSN001,MSS001,MSF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976198242892113,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020013-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,6,94237,MS,Individual,No,20-8570212,94237MS0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,94237MS002,,MSN001,MSS001,MSF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976198242892113,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020013-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,6,94237,MS,Individual,No,20-8570212,94237MS0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,94237MS002,,MSN001,MSS001,MSF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976198242892113,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,6,94237,MS,Individual,No,20-8570212,94237MS0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,94237MS002,,MSN001,MSS001,MSF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976198242892113,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020013-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,6,94237,MS,Individual,No,20-8570212,94237MS0020015,Ambetter Essential Care 2 + Vision,94237MS002,,MSN001,MSS001,MSF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976198242892113,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020015-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,6,94237,MS,Individual,No,20-8570212,94237MS0020015,Ambetter Essential Care 2 + Vision,94237MS002,,MSN001,MSS001,MSF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976198242892113,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020015-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,6,94237,MS,Individual,No,20-8570212,94237MS0020015,Ambetter Essential Care 2 + Vision,94237MS002,,MSN001,MSS001,MSF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976198242892113,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020015-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,6,94237,MS,Individual,No,20-8570212,94237MS0020015,Ambetter Essential Care 2 + Vision,94237MS002,,MSN001,MSS001,MSF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976198242892113,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020015-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,6,94237,MS,Individual,No,20-8570212,94237MS0020016,Ambetter Essential Care 1 + Vision,94237MS002,,MSN001,MSS001,MSF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976198242892113,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020016-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,6,94237,MS,Individual,No,20-8570212,94237MS0020016,Ambetter Essential Care 1 + Vision,94237MS002,,MSN001,MSS001,MSF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976198242892113,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020016-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,6,94237,MS,Individual,No,20-8570212,94237MS0020016,Ambetter Essential Care 1 + Vision,94237MS002,,MSN001,MSS001,MSF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976198242892113,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,6,94237,MS,Individual,No,20-8570212,94237MS0020016,Ambetter Essential Care 1 + Vision,94237MS002,,MSN001,MSS001,MSF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976198242892113,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020016-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,7,94237,MS,Individual,No,20-8570212,94237MS0020014,Ambetter Balanced Care 6 + Vision,94237MS002,,MSN001,MSS001,MSF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977412113584779,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020014-00,Standard Silver Off Exchange Plan,,0.718193292617798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,520",$30,"$1,270",$150,"$2,300",$870,$150,$80,4
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,7,94237,MS,Individual,No,20-8570212,94237MS0020014,Ambetter Balanced Care 6 + Vision,94237MS002,,MSN001,MSS001,MSF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977412113584779,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020014-01,Standard Silver On Exchange Plan,,0.718193292617798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,520",$30,"$1,270",$150,"$2,300",$870,$150,$80,5
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,7,94237,MS,Individual,No,20-8570212,94237MS0020014,Ambetter Balanced Care 6 + Vision,94237MS002,,MSN001,MSS001,MSF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977412113584779,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,7,94237,MS,Individual,No,20-8570212,94237MS0020014,Ambetter Balanced Care 6 + Vision,94237MS002,,MSN001,MSS001,MSF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977412113584779,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020014-03,Limited Cost Sharing Plan Variation,,0.718193292617798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,520",$30,"$1,270",$150,"$2,300",$870,$150,$80,7
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,7,94237,MS,Individual,No,20-8570212,94237MS0020014,Ambetter Balanced Care 6 + Vision,94237MS002,,MSN001,MSS001,MSF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977412113584779,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020014-04,73% AV Level Silver Plan,,0.738342940807343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,400",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,220",$30,"$1,270",$150,"$2,000",$870,$220,$80,8
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,7,94237,MS,Individual,No,20-8570212,94237MS0020014,Ambetter Balanced Care 6 + Vision,94237MS002,,MSN001,MSS001,MSF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977412113584779,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020014-05,87% AV Level Silver Plan,,0.877610564231873,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$270,$20,"$1,010",$150,$350,$550,$230,$80,9
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,7,94237,MS,Individual,No,20-8570212,94237MS0020014,Ambetter Balanced Care 6 + Vision,94237MS002,,MSN001,MSS001,MSF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977412113584779,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/formulary,94237MS0020014-06,94% AV Level Silver Plan,,0.947545647621155,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$75,$150,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$100,$0,$250,$150,$130,$100,$70,$80,10
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,8,94237,MS,Individual,No,20-8570212,94237MS0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF003,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.931750910271761,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030009-00,Standard Silver Off Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,4
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,8,94237,MS,Individual,No,20-8570212,94237MS0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF003,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.931750910271761,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030009-01,Standard Silver On Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,5
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,8,94237,MS,Individual,No,20-8570212,94237MS0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF003,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.931750910271761,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,8,94237,MS,Individual,No,20-8570212,94237MS0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF003,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.931750910271761,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030009-03,Limited Cost Sharing Plan Variation,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,7
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,8,94237,MS,Individual,No,20-8570212,94237MS0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF003,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.931750910271761,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030009-04,73% AV Level Silver Plan,73.24%,0.732411444187164,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$2,920",$350,$0,$80,8
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,8,94237,MS,Individual,No,20-8570212,94237MS0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF003,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.931750910271761,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030009-05,87% AV Level Silver Plan,87.97%,0.879661500453949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$410,$0,$150,$600,$520,$0,$80,9
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,8,94237,MS,Individual,No,20-8570212,94237MS0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF003,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.931750910271761,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare5,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030009-06,94% AV Level Silver Plan,93.34%,0.933413624763489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$120,$0,$150,$0,$450,$0,$80,10
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,8,94237,MS,Individual,No,20-8570212,94237MS0030002,Ambetter Secure Care 2 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.923912740858306,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,11
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,8,94237,MS,Individual,No,20-8570212,94237MS0030002,Ambetter Secure Care 2 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.923912740858306,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,12
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,8,94237,MS,Individual,No,20-8570212,94237MS0030002,Ambetter Secure Care 2 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.923912740858306,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,8,94237,MS,Individual,No,20-8570212,94237MS0030002,Ambetter Secure Care 2 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.923912740858306,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,14
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,9,94237,MS,Individual,No,20-8570212,94237MS0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.923912740858306,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030004-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,9,94237,MS,Individual,No,20-8570212,94237MS0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.923912740858306,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030004-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,9,94237,MS,Individual,No,20-8570212,94237MS0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.923912740858306,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,9,94237,MS,Individual,No,20-8570212,94237MS0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.923912740858306,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=SecureCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030004-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,9,94237,MS,Individual,No,20-8570212,94237MS0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.927923637455795,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030012-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,9,94237,MS,Individual,No,20-8570212,94237MS0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.927923637455795,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030012-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,9,94237,MS,Individual,No,20-8570212,94237MS0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.927923637455795,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,9,94237,MS,Individual,No,20-8570212,94237MS0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF006,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.927923637455795,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030012-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,9,94237,MS,Individual,No,20-8570212,94237MS0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.927923637455795,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030013-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,9,94237,MS,Individual,No,20-8570212,94237MS0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.927923637455795,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030013-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,9,94237,MS,Individual,No,20-8570212,94237MS0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.927923637455795,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,9,94237,MS,Individual,No,20-8570212,94237MS0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF007,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.927923637455795,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030013-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,9,94237,MS,Individual,No,20-8570212,94237MS0030015,Ambetter Essential Care 2 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.927923637455795,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030015-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,9,94237,MS,Individual,No,20-8570212,94237MS0030015,Ambetter Essential Care 2 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.927923637455795,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030015-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,9,94237,MS,Individual,No,20-8570212,94237MS0030015,Ambetter Essential Care 2 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.927923637455795,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030015-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,9,94237,MS,Individual,No,20-8570212,94237MS0030015,Ambetter Essential Care 2 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.927923637455795,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030015-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,9,94237,MS,Individual,No,20-8570212,94237MS0030016,Ambetter Essential Care 1 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.927923637455795,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030016-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,9,94237,MS,Individual,No,20-8570212,94237MS0030016,Ambetter Essential Care 1 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.927923637455795,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030016-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,9,94237,MS,Individual,No,20-8570212,94237MS0030016,Ambetter Essential Care 1 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.927923637455795,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,9,94237,MS,Individual,No,20-8570212,94237MS0030016,Ambetter Essential Care 1 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.927923637455795,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030016-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,10,94237,MS,Individual,No,20-8570212,94237MS0030014,Ambetter Balanced Care 6 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.931750910271761,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030014-00,Standard Silver Off Exchange Plan,,0.718193292617798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,520",$30,"$1,270",$150,"$2,300",$870,$150,$80,4
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,10,94237,MS,Individual,No,20-8570212,94237MS0030014,Ambetter Balanced Care 6 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.931750910271761,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030014-01,Standard Silver On Exchange Plan,,0.718193292617798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,520",$30,"$1,270",$150,"$2,300",$870,$150,$80,5
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,10,94237,MS,Individual,No,20-8570212,94237MS0030014,Ambetter Balanced Care 6 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.931750910271761,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,10,94237,MS,Individual,No,20-8570212,94237MS0030014,Ambetter Balanced Care 6 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.931750910271761,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030014-03,Limited Cost Sharing Plan Variation,,0.718193292617798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,520",$30,"$1,270",$150,"$2,300",$870,$150,$80,7
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,10,94237,MS,Individual,No,20-8570212,94237MS0030014,Ambetter Balanced Care 6 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.931750910271761,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030014-04,73% AV Level Silver Plan,,0.738342940807343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,400",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,220",$30,"$1,270",$150,"$2,000",$870,$220,$80,8
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,10,94237,MS,Individual,No,20-8570212,94237MS0030014,Ambetter Balanced Care 6 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.931750910271761,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030014-05,87% AV Level Silver Plan,,0.877610564231873,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$270,$20,"$1,010",$150,$350,$550,$230,$80,9
2015,MS,94237,HIOS,5,2015-04-22 11:06:15,10,94237,MS,Individual,No,20-8570212,94237MS0030014,Ambetter Balanced Care 6 + Vision + Adult Dental,94237MS003,,MSN001,MSS001,MSF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.931750910271761,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/payments,http://ambetter.magnoliahealthplan.com/brochures/?plan=BalancedCare6,http://ambetter.magnoliahealthplan.com/formulary,94237MS0030014-06,94% AV Level Silver Plan,,0.947545647621155,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$75,$150,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$100,$0,$250,$150,$130,$100,$70,$80,10
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,1,97560,MS,Individual,No,63-1036817,97560MS0030002,UnitedHealthcare Bronze Compass HSA 6275,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030002-00,Standard Bronze Off Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,275","$12,550",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,1,97560,MS,Individual,No,63-1036817,97560MS0030002,UnitedHealthcare Bronze Compass HSA 6275,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030002-01,Standard Bronze On Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,275","$12,550",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,1,97560,MS,Individual,No,63-1036817,97560MS0030002,UnitedHealthcare Bronze Compass HSA 6275,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030011,UnitedHealthcare Silver Compass 5000,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030011-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,24
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030011,UnitedHealthcare Silver Compass 5000,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030011-03,Limited Cost Sharing Plan Variation,68.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030011,UnitedHealthcare Silver Compass 5000,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030011-04,73% AV Level Silver Plan,72.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,600","$7,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030011,UnitedHealthcare Silver Compass 5000,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030011-05,87% AV Level Silver Plan,86.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030011,UnitedHealthcare Silver Compass 5000,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030011-06,94% AV Level Silver Plan,94.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,4,97560,MS,Individual,No,63-1036817,97560MS0030005,UnitedHealthcare Gold Compass 1000,97560MS003,,MSN006,MSS001,MSF001,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030005-00,Standard Gold Off Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,4,97560,MS,Individual,No,63-1036817,97560MS0030005,UnitedHealthcare Gold Compass 1000,97560MS003,,MSN006,MSS001,MSF001,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030005-01,Standard Gold On Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,4,97560,MS,Individual,No,63-1036817,97560MS0030005,UnitedHealthcare Gold Compass 1000,97560MS003,,MSN006,MSS001,MSF001,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030005-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,4,97560,MS,Individual,No,63-1036817,97560MS0030005,UnitedHealthcare Gold Compass 1000,97560MS003,,MSN006,MSS001,MSF001,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030005-03,Limited Cost Sharing Plan Variation,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,5,97560,MS,Individual,No,63-1036817,97560MS0030003,UnitedHealthcare Catastrophic Compass 6600,97560MS003,,MSN006,MSS001,MSF006,New,HMO,Catastrophic,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030003-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,1,97560,MS,Individual,No,63-1036817,97560MS0030002,UnitedHealthcare Bronze Compass HSA 6275,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030002-03,Limited Cost Sharing Plan Variation,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,275","$12,550",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,1,97560,MS,Individual,No,63-1036817,97560MS0030006,UnitedHealthcare Gold Compass HSA 1300,97560MS003,,MSN006,MSS001,MSF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030006-00,Standard Gold Off Exchange Plan,79.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,1,97560,MS,Individual,No,63-1036817,97560MS0030006,UnitedHealthcare Gold Compass HSA 1300,97560MS003,,MSN006,MSS001,MSF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030006-01,Standard Gold On Exchange Plan,79.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,1,97560,MS,Individual,No,63-1036817,97560MS0030006,UnitedHealthcare Gold Compass HSA 1300,97560MS003,,MSN006,MSS001,MSF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,1,97560,MS,Individual,No,63-1036817,97560MS0030006,UnitedHealthcare Gold Compass HSA 1300,97560MS003,,MSN006,MSS001,MSF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030006-03,Limited Cost Sharing Plan Variation,79.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,1,97560,MS,Individual,No,63-1036817,97560MS0030009,UnitedHealthcare Silver Compass HSA 3600,97560MS003,,MSN006,MSS001,MSF006,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030009-00,Standard Silver Off Exchange Plan,68.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,1,97560,MS,Individual,No,63-1036817,97560MS0030009,UnitedHealthcare Silver Compass HSA 3600,97560MS003,,MSN006,MSS001,MSF006,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030009-01,Standard Silver On Exchange Plan,68.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,1,97560,MS,Individual,No,63-1036817,97560MS0030009,UnitedHealthcare Silver Compass HSA 3600,97560MS003,,MSN006,MSS001,MSF006,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030009-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,1,97560,MS,Individual,No,63-1036817,97560MS0030009,UnitedHealthcare Silver Compass HSA 3600,97560MS003,,MSN006,MSS001,MSF006,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030009-03,Limited Cost Sharing Plan Variation,68.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,1,97560,MS,Individual,No,63-1036817,97560MS0030009,UnitedHealthcare Silver Compass HSA 3600,97560MS003,,MSN006,MSS001,MSF006,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030009-04,73% AV Level Silver Plan,72.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,1,97560,MS,Individual,No,63-1036817,97560MS0030009,UnitedHealthcare Silver Compass HSA 3600,97560MS003,,MSN006,MSS001,MSF006,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030009-05,87% AV Level Silver Plan,86.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,1,97560,MS,Individual,No,63-1036817,97560MS0030009,UnitedHealthcare Silver Compass HSA 3600,97560MS003,,MSN006,MSS001,MSF006,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030009-06,94% AV Level Silver Plan,93.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,2,97560,MS,Individual,No,63-1036817,97560MS0030007,UnitedHealthcare Platinum Compass 250,97560MS003,,MSN006,MSS001,MSF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030007-00,Standard Platinum Off Exchange Plan,89.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,2,97560,MS,Individual,No,63-1036817,97560MS0030007,UnitedHealthcare Platinum Compass 250,97560MS003,,MSN006,MSS001,MSF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030007-01,Standard Platinum On Exchange Plan,89.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0020104,Blue Options Silver 2000-2,11512NC002,,NCN001,NCS001,NCF026,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$200,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_617_ExchangeEnhancedFormulary4T.pdf,11512NC0020104-01,Standard Silver On Exchange Plan,,0.700456023216248,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060018,Blue Advantage 1000 (broad network),11512NC006,,NCN001,NCS001,NCF002,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060018-03,Limited Cost Sharing Plan Variation,,0.795574724674225,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060019,Blue Advantage 2800 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2800_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060019-00,Standard Silver Off Exchange Plan,71.89%,0.694413840770721,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,800","$5,600",30%,,,,"$5,600","$11,200","$8,400","$16,800",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,12
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0020068,Blue Options Platinum 750-1,11512NC002,,NCN001,NCS001,NCF022,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_617_ExchangeEnhancedFormulary4T.pdf,11512NC0020068-00,Standard Platinum Off Exchange Plan,88.04%,0.875130176544189,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$750,"$1,500",10%,,,,"$1,500","$3,000","$2,250","$4,500",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,2,97560,MS,Individual,No,63-1036817,97560MS0030007,UnitedHealthcare Platinum Compass 250,97560MS003,,MSN006,MSS001,MSF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030007-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,2,97560,MS,Individual,No,63-1036817,97560MS0030007,UnitedHealthcare Platinum Compass 250,97560MS003,,MSN006,MSS001,MSF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030007-03,Limited Cost Sharing Plan Variation,89.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060020,Blue Advantage 3500 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060020-01,Standard Silver On Exchange Plan,71.68%,0.6913902759552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000",30%,,,,"$7,000","$14,000","$10,500","$21,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,20
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060020,Blue Advantage 3500 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060020-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060020,Blue Advantage 3500 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060020-03,Limited Cost Sharing Plan Variation,71.68%,0.6913902759552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000",30%,,,,"$7,000","$14,000","$10,500","$21,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,22
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060020,Blue Advantage 3500 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060020-04,73% AV Level Silver Plan,73.86%,0.72920697927475,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200","$2,700","$5,400",30%,,,,"$5,400","$10,800","$8,100","$16,200",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,23
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060020,Blue Advantage 3500 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060020-05,87% AV Level Silver Plan,86.32%,0.859282314777374,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",$700,"$1,400",30%,,,,"$1,400","$2,800","$2,100","$4,200",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,24
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060020,Blue Advantage 3500 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060020-06,94% AV Level Silver Plan,93.88%,0.93696129322052,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$1,200","$2,400","$1,800","$3,600",$400,$800,30%,,,,$800,"$1,600","$1,200","$2,400",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,25
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060021,Blue Advantage S 5000 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060021-00,Standard Silver Off Exchange Plan,71.84%,0.692591905593872,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,26
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060021,Blue Advantage S 5000 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060021-01,Standard Silver On Exchange Plan,71.84%,0.692591905593872,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,27
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030004,UnitedHealthcare Gold Compass 1500,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030004-00,Standard Gold Off Exchange Plan,78.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030004,UnitedHealthcare Gold Compass 1500,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030004-01,Standard Gold On Exchange Plan,78.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030004,UnitedHealthcare Gold Compass 1500,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030004-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030004,UnitedHealthcare Gold Compass 1500,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030004-03,Limited Cost Sharing Plan Variation,78.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100021,Blue Value 500 (limited network),11512NC010,,NCN002,NCS002,NCF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100021-03,Limited Cost Sharing Plan Variation,,0.883228123188019,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,36
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100022,Blue Value 1000 (limited network),11512NC010,,NCN002,NCS002,NCF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100022-00,Standard Gold Off Exchange Plan,,0.795574724674225,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,37
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100022,Blue Value 1000 (limited network),11512NC010,,NCN002,NCS002,NCF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100022-01,Standard Gold On Exchange Plan,,0.795574724674225,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,38
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100022,Blue Value 1000 (limited network),11512NC010,,NCN002,NCS002,NCF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100022-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,39
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100022,Blue Value 1000 (limited network),11512NC010,,NCN002,NCS002,NCF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100022-03,Limited Cost Sharing Plan Variation,,0.795574724674225,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,40
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100023,Blue Value 2800 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2800_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100023-00,Standard Silver Off Exchange Plan,71.89%,0.694413840770721,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,800","$5,600",30%,,,,"$5,600","$11,200","$8,400","$16,800",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,41
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100023,Blue Value 2800 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2800_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100023-01,Standard Silver On Exchange Plan,71.89%,0.694413840770721,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,800","$5,600",30%,,,,"$5,600","$11,200","$8,400","$16,800",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,42
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100023,Blue Value 2800 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2800_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100023-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,43
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100023,Blue Value 2800 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2800_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100023-03,Limited Cost Sharing Plan Variation,71.89%,0.694413840770721,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,800","$5,600",30%,,,,"$5,600","$11,200","$8,400","$16,800",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,44
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100023,Blue Value 2800 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2800_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100023-04,73% AV Level Silver Plan,73.99%,0.71648234128952,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200","$2,800","$5,600",30%,,,,"$5,600","$11,200","$8,400","$16,800",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,45
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100023,Blue Value 2800 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2800_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100023-05,87% AV Level Silver Plan,87.19%,0.858848929405212,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",$800,"$1,600",30%,,,,"$1,600","$3,200","$2,400","$4,800",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,46
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100023,Blue Value 2800 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2800_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100023-06,94% AV Level Silver Plan,94.23%,0.950159430503845,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,"$1,300","$2,600","$1,950","$3,900",$450,$900,30%,,,,$900,"$1,800","$1,350","$2,700",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,47
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100024,Blue Value 3500 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100024-00,Standard Silver Off Exchange Plan,71.68%,0.6913902759552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000",30%,,,,"$7,000","$14,000","$10,500","$21,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,48
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100024,Blue Value 3500 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100024-01,Standard Silver On Exchange Plan,71.68%,0.6913902759552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000",30%,,,,"$7,000","$14,000","$10,500","$21,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,49
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030008,UnitedHealthcare Silver Compass 2000,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030008-00,Standard Silver Off Exchange Plan,70.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030008,UnitedHealthcare Silver Compass 2000,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030008-01,Standard Silver On Exchange Plan,70.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030008,UnitedHealthcare Silver Compass 2000,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030008-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030008,UnitedHealthcare Silver Compass 2000,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030008-03,Limited Cost Sharing Plan Variation,70.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030008,UnitedHealthcare Silver Compass 2000,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030008-04,73% AV Level Silver Plan,73.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,600","$3,200",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030008,UnitedHealthcare Silver Compass 2000,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030008-05,87% AV Level Silver Plan,86.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030008,UnitedHealthcare Silver Compass 2000,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030008-06,94% AV Level Silver Plan,93.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030010,UnitedHealthcare Silver Compass 4000,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030010-00,Standard Silver Off Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030010,UnitedHealthcare Silver Compass 4000,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030010-01,Standard Silver On Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030010,UnitedHealthcare Silver Compass 4000,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030010-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030010,UnitedHealthcare Silver Compass 4000,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030010-03,Limited Cost Sharing Plan Variation,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030010,UnitedHealthcare Silver Compass 4000,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030010-04,73% AV Level Silver Plan,73.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030010,UnitedHealthcare Silver Compass 4000,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030010-05,87% AV Level Silver Plan,86.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$850,"$1,700",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030010,UnitedHealthcare Silver Compass 4000,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030010-06,94% AV Level Silver Plan,94.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030011,UnitedHealthcare Silver Compass 5000,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030011-00,Standard Silver Off Exchange Plan,68.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,3,97560,MS,Individual,No,63-1036817,97560MS0030011,UnitedHealthcare Silver Compass 5000,97560MS003,,MSN006,MSS001,MSF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030011-01,Standard Silver On Exchange Plan,68.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,5,97560,MS,Individual,No,63-1036817,97560MS0030003,UnitedHealthcare Catastrophic Compass 6600,97560MS003,,MSN006,MSS001,MSF006,New,HMO,Catastrophic,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030003-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,6,97560,MS,Individual,No,63-1036817,97560MS0030001,UnitedHealthcare Bronze Compass 4200,97560MS003,,MSN006,MSS001,MSF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030001-00,Standard Bronze Off Exchange Plan,59.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100034,Blue Value 1000 (limited network),11512NC010,,NCN002,NCS003,NCF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100034-03,Limited Cost Sharing Plan Variation,,0.795574724674225,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,80
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100035,Blue Value 2800 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2800_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100035-00,Standard Silver Off Exchange Plan,71.89%,0.694413840770721,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,800","$5,600",30%,,,,"$5,600","$11,200","$8,400","$16,800",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,81
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100035,Blue Value 2800 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2800_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100035-01,Standard Silver On Exchange Plan,71.89%,0.694413840770721,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,800","$5,600",30%,,,,"$5,600","$11,200","$8,400","$16,800",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,82
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100035,Blue Value 2800 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2800_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100035-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,83
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100035,Blue Value 2800 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2800_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100035-03,Limited Cost Sharing Plan Variation,71.89%,0.694413840770721,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,800","$5,600",30%,,,,"$5,600","$11,200","$8,400","$16,800",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,84
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100035,Blue Value 2800 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2800_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100035-04,73% AV Level Silver Plan,73.99%,0.71648234128952,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200","$2,800","$5,600",30%,,,,"$5,600","$11,200","$8,400","$16,800",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,85
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100035,Blue Value 2800 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2800_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100035-05,87% AV Level Silver Plan,87.19%,0.858848929405212,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",$800,"$1,600",30%,,,,"$1,600","$3,200","$2,400","$4,800",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,86
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100035,Blue Value 2800 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2800_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100035-06,94% AV Level Silver Plan,94.23%,0.950159430503845,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,"$1,300","$2,600","$1,950","$3,900",$450,$900,30%,,,,$900,"$1,800","$1,350","$2,700",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,87
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100036,Blue Value 3500 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100036-00,Standard Silver Off Exchange Plan,71.68%,0.6913902759552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000",30%,,,,"$7,000","$14,000","$10,500","$21,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,88
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100036,Blue Value 3500 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100036-01,Standard Silver On Exchange Plan,71.68%,0.6913902759552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000",30%,,,,"$7,000","$14,000","$10,500","$21,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,89
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100036,Blue Value 3500 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100036-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,90
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100036,Blue Value 3500 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100036-03,Limited Cost Sharing Plan Variation,71.68%,0.6913902759552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000",30%,,,,"$7,000","$14,000","$10,500","$21,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,91
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100036,Blue Value 3500 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100036-04,73% AV Level Silver Plan,73.86%,0.72920697927475,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200","$2,700","$5,400",30%,,,,"$5,400","$10,800","$8,100","$16,200",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,92
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100036,Blue Value 3500 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100036-05,87% AV Level Silver Plan,86.32%,0.859282314777374,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",$700,"$1,400",30%,,,,"$1,400","$2,800","$2,100","$4,200",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,93
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,6,97560,MS,Individual,No,63-1036817,97560MS0030001,UnitedHealthcare Bronze Compass 4200,97560MS003,,MSN006,MSS001,MSF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030001-01,Standard Bronze On Exchange Plan,59.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,6,97560,MS,Individual,No,63-1036817,97560MS0030001,UnitedHealthcare Bronze Compass 4200,97560MS003,,MSN006,MSS001,MSF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MS,97560,HIOS,6,2014-12-11 04:09:12,6,97560,MS,Individual,No,63-1036817,97560MS0030001,UnitedHealthcare Bronze Compass 4200,97560MS003,,MSN006,MSS001,MSF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xms,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xms,97560MS0030001-03,Limited Cost Sharing Plan Variation,59.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060017,Blue Advantage 500 (broad network),11512NC006,,NCN001,NCS001,NCF001,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Platinum_500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060017-00,Standard Platinum Off Exchange Plan,,0.883228123188019,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0020069,Blue Options Platinum 500-1,11512NC002,,NCN001,NCS001,NCF022,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_617_ExchangeEnhancedFormulary4T.pdf,11512NC0020069-00,Standard Platinum Off Exchange Plan,88.11%,0.876364290714264,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0020069,Blue Options Platinum 500-1,11512NC002,,NCN001,NCS001,NCF022,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_617_ExchangeEnhancedFormulary4T.pdf,11512NC0020069-01,Standard Platinum On Exchange Plan,88.11%,0.876364290714264,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060017,Blue Advantage 500 (broad network),11512NC006,,NCN001,NCS001,NCF001,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Platinum_500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060017-01,Standard Platinum On Exchange Plan,,0.883228123188019,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060017,Blue Advantage 500 (broad network),11512NC006,,NCN001,NCS001,NCF001,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Platinum_500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060017-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0020070,Blue Options Gold 1750-1,11512NC002,,NCN001,NCS001,NCF022,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_617_ExchangeEnhancedFormulary4T.pdf,11512NC0020070-00,Standard Gold Off Exchange Plan,,0.790761351585388,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,750","$3,500",20%,,,,"$3,500","$7,000","$5,250","$10,500",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0020070,Blue Options Gold 1750-1,11512NC002,,NCN001,NCS001,NCF022,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_617_ExchangeEnhancedFormulary4T.pdf,11512NC0020070-01,Standard Gold On Exchange Plan,,0.790761351585388,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,750","$3,500",20%,,,,"$3,500","$7,000","$5,250","$10,500",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060017,Blue Advantage 500 (broad network),11512NC006,,NCN001,NCS001,NCF001,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Platinum_500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060017-03,Limited Cost Sharing Plan Variation,,0.883228123188019,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060018,Blue Advantage 1000 (broad network),11512NC006,,NCN001,NCS001,NCF002,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060018-00,Standard Gold Off Exchange Plan,,0.795574724674225,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0020071,Blue Options Gold 1500-1,11512NC002,,NCN001,NCS001,NCF022,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_617_ExchangeEnhancedFormulary4T.pdf,11512NC0020071-00,Standard Gold Off Exchange Plan,78.30%,0.77165150642395,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$1,500","$3,000",20%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0020071,Blue Options Gold 1500-1,11512NC002,,NCN001,NCS001,NCF022,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_617_ExchangeEnhancedFormulary4T.pdf,11512NC0020071-01,Standard Gold On Exchange Plan,78.30%,0.77165150642395,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$1,500","$3,000",20%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060018,Blue Advantage 1000 (broad network),11512NC006,,NCN001,NCS001,NCF002,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060018-01,Standard Gold On Exchange Plan,,0.795574724674225,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060018,Blue Advantage 1000 (broad network),11512NC006,,NCN001,NCS001,NCF002,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060018-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0020104,Blue Options Silver 2000-2,11512NC002,,NCN001,NCS001,NCF026,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$200,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_617_ExchangeEnhancedFormulary4T.pdf,11512NC0020104-00,Standard Silver Off Exchange Plan,,0.700456023216248,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0020068,Blue Options Platinum 750-1,11512NC002,,NCN001,NCS001,NCF022,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_617_ExchangeEnhancedFormulary4T.pdf,11512NC0020068-01,Standard Platinum On Exchange Plan,88.04%,0.875130176544189,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$750,"$1,500",10%,,,,"$1,500","$3,000","$2,250","$4,500",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060019,Blue Advantage 2800 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2800_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060019-01,Standard Silver On Exchange Plan,71.89%,0.694413840770721,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,800","$5,600",30%,,,,"$5,600","$11,200","$8,400","$16,800",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,13
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060019,Blue Advantage 2800 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2800_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060019-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060019,Blue Advantage 2800 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2800_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060019-03,Limited Cost Sharing Plan Variation,71.89%,0.694413840770721,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,800","$5,600",30%,,,,"$5,600","$11,200","$8,400","$16,800",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,15
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060019,Blue Advantage 2800 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2800_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060019-04,73% AV Level Silver Plan,73.99%,0.71648234128952,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200","$2,800","$5,600",30%,,,,"$5,600","$11,200","$8,400","$16,800",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,16
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060019,Blue Advantage 2800 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2800_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060019-05,87% AV Level Silver Plan,87.19%,0.858848929405212,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",$800,"$1,600",30%,,,,"$1,600","$3,200","$2,400","$4,800",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,17
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060019,Blue Advantage 2800 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2800_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060019-06,94% AV Level Silver Plan,94.23%,0.950159430503845,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,"$1,300","$2,600","$1,950","$2,900",$450,$900,30%,,,,$900,"$1,800","$1,350","$2,700",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,18
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060020,Blue Advantage 3500 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060020-00,Standard Silver Off Exchange Plan,71.68%,0.6913902759552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000",30%,,,,"$7,000","$14,000","$10,500","$21,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,19
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060021,Blue Advantage S 5000 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060021-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,28
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060021,Blue Advantage S 5000 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060021-03,Limited Cost Sharing Plan Variation,71.84%,0.692591905593872,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,29
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060021,Blue Advantage S 5000 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060021-04,73% AV Level Silver Plan,73.91%,0.715645134449005,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200","$2,900","$5,800",30%,,,,"$5,800","$11,600","$8,700","$17,400",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,30
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060021,Blue Advantage S 5000 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060021-05,87% AV Level Silver Plan,87.13%,0.857970595359802,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",$900,"$1,800",30%,,,,"$1,800","$3,600","$2,700","$5,400",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,31
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060021,Blue Advantage S 5000 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060021-06,94% AV Level Silver Plan,93.93%,0.946550905704498,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,"$1,400","$2,800","$2,100","$4,200",$500,"$1,000",30%,,,,"$1,000","$2,000","$1,500","$3,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,32
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100021,Blue Value 500 (limited network),11512NC010,,NCN002,NCS002,NCF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100021-00,Standard Platinum Off Exchange Plan,,0.883228123188019,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,33
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100021,Blue Value 500 (limited network),11512NC010,,NCN002,NCS002,NCF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100021-01,Standard Platinum On Exchange Plan,,0.883228123188019,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,34
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100021,Blue Value 500 (limited network),11512NC010,,NCN002,NCS002,NCF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100021-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,35
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100024,Blue Value 3500 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100024-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,50
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100024,Blue Value 3500 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100024-03,Limited Cost Sharing Plan Variation,71.68%,0.6913902759552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000",30%,,,,"$7,000","$14,000","$10,500","$21,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,51
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100024,Blue Value 3500 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100024-04,73% AV Level Silver Plan,73.86%,0.72920697927475,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200","$2,700","$5,400",30%,,,,"$5,400","$10,800","$8,100","$16,200",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,52
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100024,Blue Value 3500 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100024-05,87% AV Level Silver Plan,86.32%,0.859282314777374,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",$700,"$1,400",30%,,,,"$1,400","$2,800","$2,100","$4,200",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,53
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100024,Blue Value 3500 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100024-06,94% AV Level Silver Plan,93.88%,0.93696129322052,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$1,200","$2,400","$1,800","$3,600",$400,$800,30%,,,,$800,"$1,600","$1,200","$2,400",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,54
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100025,Blue Value S 5000 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100025-00,Standard Silver Off Exchange Plan,71.84%,0.692591905593872,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,55
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100025,Blue Value S 5000 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100025-01,Standard Silver On Exchange Plan,71.84%,0.692591905593872,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,56
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100025,Blue Value S 5000 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100025-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,57
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100025,Blue Value S 5000 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100025-03,Limited Cost Sharing Plan Variation,71.84%,0.692591905593872,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,58
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100025,Blue Value S 5000 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100025-04,73% AV Level Silver Plan,73.91%,0.715645134449005,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200","$2,900","$5,800",30%,,,,"$5,800","$11,600","$8,700","$17,400",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,59
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100025,Blue Value S 5000 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100025-05,87% AV Level Silver Plan,87.13%,0.857970595359802,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",$900,"$1,800",30%,,,,"$1,800","$3,600","$2,700","$5,400",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,60
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100025,Blue Value S 5000 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100025-06,94% AV Level Silver Plan,93.93%,0.946550905704498,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,"$1,400","$2,800","$2,100","$4,200",$500,"$1,000",30%,,,,"$1,000","$2,000","$1,500","$3,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,61
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120001,Blue Select 1000 (tiered network),11512NC012,,NCN001,NCS004,NCF010,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120001-00,Standard Gold Off Exchange Plan,,0.798382103443146,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000","$12,000","$24,000","$1,000","$2,000",20%,"$1,000","$2,000",40%,"$2,000","$4,000","$3,000","$6,000",$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,62
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120001,Blue Select 1000 (tiered network),11512NC012,,NCN001,NCS004,NCF010,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120001-01,Standard Gold On Exchange Plan,,0.798382103443146,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000","$12,000","$24,000","$1,000","$2,000",20%,"$1,000","$2,000",40%,"$2,000","$4,000","$3,000","$6,000",$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,63
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120001,Blue Select 1000 (tiered network),11512NC012,,NCN001,NCS004,NCF010,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,64
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120001,Blue Select 1000 (tiered network),11512NC012,,NCN001,NCS004,NCF010,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120001-03,Limited Cost Sharing Plan Variation,,0.798382103443146,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000","$12,000","$24,000","$1,000","$2,000",20%,"$1,000","$2,000",40%,"$2,000","$4,000","$3,000","$6,000",$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,65
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120002,Blue Select 3500 (tiered network),11512NC012,,NCN001,NCS004,NCF012,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120002-00,Standard Silver Off Exchange Plan,71.68%,0.698091685771942,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400","$19,050","$38,100","$3,500","$7,000",30%,"$3,500","$7,000",50%,"$7,000","$14,000","$10,500","$21,000",$200,$200,0%,$0,$0,0%,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,66
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120002,Blue Select 3500 (tiered network),11512NC012,,NCN001,NCS004,NCF012,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120002-01,Standard Silver On Exchange Plan,71.68%,0.698091685771942,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400","$19,050","$38,100","$3,500","$7,000",30%,"$3,500","$7,000",50%,"$7,000","$14,000","$10,500","$21,000",$200,$200,0%,$0,$0,0%,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,67
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120002,Blue Select 3500 (tiered network),11512NC012,,NCN001,NCS004,NCF012,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,68
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120002,Blue Select 3500 (tiered network),11512NC012,,NCN001,NCS004,NCF012,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120002-03,Limited Cost Sharing Plan Variation,71.68%,0.698091685771942,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400","$19,050","$38,100","$3,500","$7,000",30%,"$3,500","$7,000",50%,"$7,000","$14,000","$10,500","$21,000",$200,$200,0%,$0,$0,0%,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,69
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120002,Blue Select 3500 (tiered network),11512NC012,,NCN001,NCS004,NCF012,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120002-04,73% AV Level Silver Plan,73.86%,0.719912648200989,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$10,400","$20,800","$15,600","$31,200","$2,900","$5,800",30%,"$2,900","$5,800",50%,"$5,800","$11,600","$8,700","$17,400",$200,$200,0%,$0,$0,0%,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,70
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120002,Blue Select 3500 (tiered network),11512NC012,,NCN001,NCS004,NCF012,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120002-05,87% AV Level Silver Plan,86.32%,0.858959972858429,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000","$4,000","$8,000","$6,000","$12,000",$900,"$1,800",30%,$900,"$1,800",50%,"$1,800","$3,600","$2,700","$5,400",$200,$200,0%,$0,$0,0%,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,71
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120002,Blue Select 3500 (tiered network),11512NC012,,NCN001,NCS004,NCF012,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120002-06,94% AV Level Silver Plan,93.88%,0.944238901138306,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,$700,"$1,400",$700,"$1,400","$1,400","$2,800","$2,100","$4,200",$500,"$1,000",30%,$500,"$1,000",50%,"$1,000","$2,000","$1,500","$3,000",$200,$200,0%,$0,$0,0%,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,72
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100033,Blue Value 500 (limited network),11512NC010,,NCN002,NCS003,NCF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100033-00,Standard Platinum Off Exchange Plan,,0.883228123188019,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,73
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100033,Blue Value 500 (limited network),11512NC010,,NCN002,NCS003,NCF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100033-01,Standard Platinum On Exchange Plan,,0.883228123188019,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,74
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100033,Blue Value 500 (limited network),11512NC010,,NCN002,NCS003,NCF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100033-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,75
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100033,Blue Value 500 (limited network),11512NC010,,NCN002,NCS003,NCF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100033-03,Limited Cost Sharing Plan Variation,,0.883228123188019,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,76
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100034,Blue Value 1000 (limited network),11512NC010,,NCN002,NCS003,NCF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100034-00,Standard Gold Off Exchange Plan,,0.795574724674225,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,77
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100034,Blue Value 1000 (limited network),11512NC010,,NCN002,NCS003,NCF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100034-01,Standard Gold On Exchange Plan,,0.795574724674225,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,78
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100034,Blue Value 1000 (limited network),11512NC010,,NCN002,NCS003,NCF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100034-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,79
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100036,Blue Value 3500 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100036-06,94% AV Level Silver Plan,93.88%,0.93696129322052,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$1,200","$2,400","$1,800","$3,600",$400,$800,30%,,,,$800,"$1,600","$1,200","$2,400",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,94
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100037,Blue Value S 5000 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100037-00,Standard Silver Off Exchange Plan,71.84%,0.692591905593872,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,95
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100037,Blue Value S 5000 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100037-01,Standard Silver On Exchange Plan,71.84%,0.692591905593872,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,96
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100037,Blue Value S 5000 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100037-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,97
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100037,Blue Value S 5000 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100037-03,Limited Cost Sharing Plan Variation,71.84%,0.692591905593872,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$5,000","$10,000",30%,,,,"$10,000","$20,000","$15,000","$30,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,98
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100037,Blue Value S 5000 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100037-04,73% AV Level Silver Plan,73.91%,0.715645134449005,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200","$2,900","$5,800",30%,,,,"$5,800","$11,600","$8,700","$17,400",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,99
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100037,Blue Value S 5000 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100037-05,87% AV Level Silver Plan,87.13%,0.857970595359802,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",$900,"$1,800",30%,,,,"$1,800","$3,600","$1,700","$3,400",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,100
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100037,Blue Value S 5000 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100037-06,94% AV Level Silver Plan,93.93%,0.946485280990601,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,"$1,400","$2,800","$2,100","$4,200",$500,"$1,000",30%,,,,"$1,000","$2,000","$1,500","$3,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,101
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120003,Blue Select 1000 (tiered network),11512NC012,,NCN001,NCS005,NCF010,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120003-00,Standard Gold Off Exchange Plan,,0.798382103443146,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000","$12,000","$24,000","$1,000","$2,000",20%,"$1,000","$2,000",40%,"$2,000","$4,000","$3,000","$6,000",$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,102
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120003,Blue Select 1000 (tiered network),11512NC012,,NCN001,NCS005,NCF010,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120003-01,Standard Gold On Exchange Plan,,0.798382103443146,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000","$12,000","$24,000","$1,000","$2,000",20%,"$1,000","$2,000",40%,"$2,000","$4,000","$3,000","$6,000",$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,103
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120003,Blue Select 1000 (tiered network),11512NC012,,NCN001,NCS005,NCF010,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,104
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120003,Blue Select 1000 (tiered network),11512NC012,,NCN001,NCS005,NCF010,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120003-03,Limited Cost Sharing Plan Variation,,0.798382103443146,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000","$12,000","$24,000","$1,000","$2,000",20%,"$1,000","$2,000",40%,"$2,000","$4,000","$3,000","$6,000",$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,105
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120004,Blue Select 3500 (tiered network),11512NC012,,NCN001,NCS005,NCF012,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120004-00,Standard Silver Off Exchange Plan,71.62%,0.698091685771942,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400","$19,050","$38,100","$3,500","$7,000",30%,"$3,500","$7,000",50%,"$7,000","$14,000","$10,500","$21,000",$200,$200,0%,$0,$0,0%,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,106
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120004,Blue Select 3500 (tiered network),11512NC012,,NCN001,NCS005,NCF012,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120004-01,Standard Silver On Exchange Plan,71.62%,0.698091685771942,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400","$19,050","$38,100","$3,500","$7,000",30%,"$3,500","$7,000",50%,"$7,000","$14,000","$10,500","$21,000",$200,$200,0%,$0,$0,0%,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,107
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120004,Blue Select 3500 (tiered network),11512NC012,,NCN001,NCS005,NCF012,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120004-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,108
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120004,Blue Select 3500 (tiered network),11512NC012,,NCN001,NCS005,NCF012,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120004-03,Limited Cost Sharing Plan Variation,71.62%,0.698091685771942,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400","$19,050","$38,100","$3,500","$7,000",30%,"$3,500","$7,000",50%,"$7,000","$14,000","$10,500","$21,000",$200,$200,0%,$0,$0,0%,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,109
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120004,Blue Select 3500 (tiered network),11512NC012,,NCN001,NCS005,NCF012,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120004-04,73% AV Level Silver Plan,73.95%,0.719912648200989,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$10,400","$20,800","$15,600","$31,200","$2,900","$5,800",30%,"$2,900","$5,800",50%,"$5,800","$11,600","$8,700","$17,400",$200,$200,0%,$0,$0,0%,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,110
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120004,Blue Select 3500 (tiered network),11512NC012,,NCN001,NCS005,NCF012,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120004-05,87% AV Level Silver Plan,87.04%,0.858959972858429,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000","$4,000","$8,000","$6,000","$12,000",$900,"$1,800",30%,$900,"$1,800",50%,"$1,800","$3,600","$2,700","$5,400",$200,$200,0%,$0,$0,0%,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,111
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120004,Blue Select 3500 (tiered network),11512NC012,,NCN001,NCS005,NCF012,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120004-06,94% AV Level Silver Plan,94.02%,0.944160461425781,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,$700,"$1,400",$700,"$1,400","$1,400","$2,800","$2,100","$4,200",$500,"$1,000",30%,$500,"$1,000",50%,"$1,000","$2,000","$1,500","$3,000",$200,$200,0%,$0,$0,0%,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,112
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0140001,Blue Local 500 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF009,New,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Platinum_500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140001-00,Standard Platinum Off Exchange Plan,,0.883228123188019,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,113
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0140001,Blue Local 500 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF009,New,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Platinum_500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140001-01,Standard Platinum On Exchange Plan,,0.883228123188019,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,114
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0140001,Blue Local 500 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF009,New,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Platinum_500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,115
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0140001,Blue Local 500 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF009,New,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Platinum_500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140001-03,Limited Cost Sharing Plan Variation,,0.883228123188019,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,116
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0140002,Blue Local 1000 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF010,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140002-00,Standard Gold Off Exchange Plan,,0.795574724674225,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,117
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0140002,Blue Local 1000 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF010,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140002-01,Standard Gold On Exchange Plan,,0.795574724674225,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,118
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0140002,Blue Local 1000 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF010,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,119
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0140002,Blue Local 1000 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF010,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Gold_1000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140002-03,Limited Cost Sharing Plan Variation,,0.795574724674225,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,120
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0140003,Blue Local 3500 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF012,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140003-00,Standard Silver Off Exchange Plan,71.68%,0.6913902759552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000",30%,,,,"$7,000","$14,000","$10,500","$21,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,121
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0140003,Blue Local 3500 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF012,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140003-01,Standard Silver On Exchange Plan,71.68%,0.6913902759552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000",30%,,,,"$7,000","$14,000","$10,500","$21,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,122
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0140003,Blue Local 3500 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF012,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140003-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,123
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0140003,Blue Local 3500 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF012,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140003-03,Limited Cost Sharing Plan Variation,71.68%,0.6913902759552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000",30%,,,,"$7,000","$14,000","$10,500","$21,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,124
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0140003,Blue Local 3500 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF012,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140003-04,73% AV Level Silver Plan,73.86%,0.72920697927475,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200","$2,700","$5,400",30%,,,,"$5,400","$10,800","$8,100","$16,200",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,125
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0140003,Blue Local 3500 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF012,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140003-05,87% AV Level Silver Plan,86.32%,0.859282314777374,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",$700,"$1,400",30%,,,,"$1,400","$2,800","$2,100","$4,200",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,126
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0140003,Blue Local 3500 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF012,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_3500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140003-06,94% AV Level Silver Plan,93.88%,0.93696129322052,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$1,200","$2,400","$1,800","$3,600",$400,$800,30%,,,,$800,"$1,600","$1,200","$2,400",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,127
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120005,Blue Select 5500 (tiered network),11512NC012,,NCN001,NCS004,NCF014,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120005-00,Standard Bronze Off Exchange Plan,61.83%,0.652290046215057,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,500","$13,000","$6,500","$13,000","$13,000","$26,000","$19,500","$39,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,"$5,500","$11,000",20%,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,128
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120005,Blue Select 5500 (tiered network),11512NC012,,NCN001,NCS004,NCF014,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120005-01,Standard Bronze On Exchange Plan,61.83%,0.652290046215057,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,500","$13,000","$6,500","$13,000","$13,000","$26,000","$19,500","$39,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,"$5,500","$11,000",20%,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,129
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120005,Blue Select 5500 (tiered network),11512NC012,,NCN001,NCS004,NCF014,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,130
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120005,Blue Select 5500 (tiered network),11512NC012,,NCN001,NCS004,NCF014,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120005-03,Limited Cost Sharing Plan Variation,61.83%,0.652290046215057,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,500","$13,000","$6,500","$13,000","$13,000","$26,000","$19,500","$39,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,"$5,500","$11,000",20%,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,131
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120006,Blue Select 5500 (tiered network),11512NC012,,NCN001,NCS005,NCF014,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120006-00,Standard Bronze Off Exchange Plan,61.83%,0.652290046215057,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,500","$13,000","$6,500","$13,000","$13,000","$26,000","$19,500","$39,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,"$5,500","$11,000",20%,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,132
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120006,Blue Select 5500 (tiered network),11512NC012,,NCN001,NCS005,NCF014,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120006-01,Standard Bronze On Exchange Plan,61.83%,0.652290046215057,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,500","$13,000","$6,500","$13,000","$13,000","$26,000","$19,500","$39,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,"$5,500","$11,000",20%,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,133
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120006,Blue Select 5500 (tiered network),11512NC012,,NCN001,NCS005,NCF014,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,134
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0120006,Blue Select 5500 (tiered network),11512NC012,,NCN001,NCS005,NCF014,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bsplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0120006-03,Limited Cost Sharing Plan Variation,61.83%,0.652290046215057,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,500","$13,000","$6,500","$13,000","$13,000","$26,000","$19,500","$39,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,"$5,500","$11,000",20%,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,135
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060028,Blue Advantage 3000 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060028-00,Standard Silver Off Exchange Plan,69.90%,0.666801512241364,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$3,000","$6,000",30%,,,,"$6,000","$12,000","$9,000","$18,000",$300,$300,0%,,,,$300,$300,$300,$300,,,,,,,,,,,,,,,,,,,136
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060028,Blue Advantage 3000 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060028-01,Standard Silver On Exchange Plan,69.90%,0.666801512241364,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$3,000","$6,000",30%,,,,"$6,000","$12,000","$9,000","$18,000",$300,$300,0%,,,,$300,$300,$300,$300,,,,,,,,,,,,,,,,,,,137
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060028,Blue Advantage 3000 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060028-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,138
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060028,Blue Advantage 3000 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060028-03,Limited Cost Sharing Plan Variation,69.90%,0.666801512241364,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$3,000","$6,000",30%,,,,"$6,000","$12,000","$9,000","$18,000",$300,$300,0%,,,,$300,$300,$300,$300,,,,,,,,,,,,,,,,,,,139
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060028,Blue Advantage 3000 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060028-04,73% AV Level Silver Plan,73.89%,0.714820504188538,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200","$3,000","$6,000",30%,,,,"$6,000","$12,000","$9,000","$18,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,140
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060028,Blue Advantage 3000 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060028-05,87% AV Level Silver Plan,87.07%,0.857283353805542,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000","$1,000","$2,000",30%,,,,"$2,000","$4,000","$3,000","$6,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,141
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0060028,Blue Advantage 3000 (broad network),11512NC006,,NCN001,NCS001,NCF004,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060028-06,94% AV Level Silver Plan,93.73%,0.94484531879425,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,"$1,400","$2,800","$2,100","$4,200",$500,"$1,000",30%,,,,"$1,000","$2,000","$1,500","$3,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,142
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100032,Blue Value 3000 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100032-00,Standard Silver Off Exchange Plan,69.90%,0.666801512241364,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$3,000","$6,000",30%,,,,"$6,000","$12,000","$9,000","$18,000",$300,$300,0%,,,,$300,$300,$300,$300,,,,,,,,,,,,,,,,,,,143
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100032,Blue Value 3000 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100032-01,Standard Silver On Exchange Plan,69.90%,0.666801512241364,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$3,000","$6,000",30%,,,,"$6,000","$12,000","$9,000","$18,000",$300,$300,0%,,,,$300,$300,$300,$300,,,,,,,,,,,,,,,,,,,144
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100032,Blue Value 3000 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100032-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,145
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100032,Blue Value 3000 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100032-03,Limited Cost Sharing Plan Variation,69.90%,0.666801512241364,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$3,000","$6,000",30%,,,,"$6,000","$12,000","$9,000","$18,000",$300,$300,0%,,,,$300,$300,$300,$300,,,,,,,,,,,,,,,,,,,146
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100032,Blue Value 3000 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100032-04,73% AV Level Silver Plan,73.89%,0.714820504188538,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200","$3,000","$6,000",30%,,,,"$6,000","$12,000","$9,000","$18,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,147
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100032,Blue Value 3000 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100032-05,87% AV Level Silver Plan,87.07%,0.857283353805542,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000","$1,000","$2,000",30%,,,,"$2,000","$4,000","$3,000","$6,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,148
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100032,Blue Value 3000 (limited network),11512NC010,,NCN002,NCS002,NCF012,Existing,POS,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100032-06,94% AV Level Silver Plan,93.73%,0.94484531879425,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,"$1,400","$2,800","$2,100","$4,200",$500,"$1,000",30%,,,,"$1,000","$2,000","$1,500","$3,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,149
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100044,Blue Value 3000 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100044-00,Standard Silver Off Exchange Plan,69.90%,0.666801512241364,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$3,000","$6,000",30%,,,,"$6,000","$12,000","$9,000","$18,000",$300,$300,0%,,,,$300,$300,$300,$300,,,,,,,,,,,,,,,,,,,150
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100044,Blue Value 3000 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100044-01,Standard Silver On Exchange Plan,69.90%,0.666801512241364,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$3,000","$6,000",30%,,,,"$6,000","$12,000","$9,000","$18,000",$300,$300,0%,,,,$300,$300,$300,$300,,,,,,,,,,,,,,,,,,,151
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100044,Blue Value 3000 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100044-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,152
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100044,Blue Value 3000 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100044-03,Limited Cost Sharing Plan Variation,69.90%,0.666801512241364,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$3,000","$6,000",30%,,,,"$6,000","$12,000","$9,000","$18,000",$300,$300,0%,,,,$300,$300,$300,$300,,,,,,,,,,,,,,,,,,,153
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100044,Blue Value 3000 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100044-04,73% AV Level Silver Plan,73.89%,0.714820504188538,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200","$3,000","$6,000",30%,,,,"$6,000","$12,000","$9,000","$18,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,154
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100044,Blue Value 3000 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100044-05,87% AV Level Silver Plan,87.07%,0.857283353805542,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000","$1,000","$2,000",30%,,,,"$2,000","$4,000","$3,000","$6,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,155
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0100044,Blue Value 3000 (limited network),11512NC010,,NCN002,NCS003,NCF012,Existing,POS,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100044-06,94% AV Level Silver Plan,93.73%,0.94484531879425,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,"$1,400","$2,800","$2,100","$4,200",$500,"$1,000",30%,,,,"$1,000","$2,000","$1,500","$3,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,156
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0140004,Blue Local 3000 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF012,New,POS,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140004-00,Standard Silver Off Exchange Plan,69.90%,0.666801512241364,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$3,000","$6,000",30%,,,,"$6,000","$12,000","$9,000","$18,000",$300,$300,0%,,,,$300,$300,$300,$300,,,,,,,,,,,,,,,,,,,157
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0140004,Blue Local 3000 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF012,New,POS,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140004-01,Standard Silver On Exchange Plan,69.90%,0.666801512241364,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$3,000","$6,000",30%,,,,"$6,000","$12,000","$9,000","$18,000",$300,$300,0%,,,,$300,$300,$300,$300,,,,,,,,,,,,,,,,,,,158
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0140004,Blue Local 3000 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF012,New,POS,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140004-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,159
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0140004,Blue Local 3000 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF012,New,POS,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140004-03,Limited Cost Sharing Plan Variation,69.90%,0.666801512241364,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$3,000","$6,000",30%,,,,"$6,000","$12,000","$9,000","$18,000",$300,$300,0%,,,,$300,$300,$300,$300,,,,,,,,,,,,,,,,,,,160
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0140004,Blue Local 3000 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF012,New,POS,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140004-04,73% AV Level Silver Plan,73.89%,0.714820504188538,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200","$3,000","$6,000",30%,,,,"$6,000","$12,000","$9,000","$18,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,161
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0140004,Blue Local 3000 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF012,New,POS,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140004-05,87% AV Level Silver Plan,87.07%,0.857283353805542,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000","$1,000","$2,000",30%,,,,"$2,000","$4,000","$3,000","$6,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,162
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,1,11512,NC,Individual,No,56-0894904,11512NC0140004,Blue Local 3000 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF012,New,POS,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_3000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140004-06,94% AV Level Silver Plan,93.73%,0.94484531879425,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,"$1,400","$2,800","$2,100","$4,200",$500,"$1,000",30%,,,,"$1,000","$2,000","$1,500","$3,000",$200,$200,0%,,,,$200,$200,$200,$200,,,,,,,,,,,,,,,,,,,163
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0060022,Blue Advantage G 0 (broad network),11512NC006,,NCN001,NCS001,NCF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060022-00,Standard Gold Off Exchange Plan,,0.806072235107422,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,$250,$750,$250,$750,,,,,,,,,4
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0110015,Blue Select Gold 1000-1,11512NC011,,NCN001,NCS004,NCF021,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0110015-00,Standard Gold Off Exchange Plan,,0.793171405792236,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000","$9,000","$18,000","$1,000","$2,000",20%,"$1,000","$2,000",20%,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,$0,$0,20%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0110015,Blue Select Gold 1000-1,11512NC011,,NCN001,NCS004,NCF021,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0110015-01,Standard Gold On Exchange Plan,,0.793171405792236,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000","$9,000","$18,000","$1,000","$2,000",20%,"$1,000","$2,000",20%,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,$0,$0,20%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0060022,Blue Advantage G 0 (broad network),11512NC006,,NCN001,NCS001,NCF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060022-01,Standard Gold On Exchange Plan,,0.806072235107422,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,$250,$750,$250,$750,,,,,,,,,5
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0060022,Blue Advantage G 0 (broad network),11512NC006,,NCN001,NCS001,NCF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060022-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0110016,Blue Select Gold 1000-1,11512NC011,,NCN001,NCS005,NCF021,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0110016-00,Standard Gold Off Exchange Plan,,0.793171405792236,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000","$9,000","$18,000","$1,000","$2,000",20%,"$1,000","$2,000",20%,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,$0,$0,20%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0110016,Blue Select Gold 1000-1,11512NC011,,NCN001,NCS005,NCF021,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0110016-01,Standard Gold On Exchange Plan,,0.793171405792236,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000","$9,000","$18,000","$1,000","$2,000",20%,"$1,000","$2,000",20%,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,$0,$0,20%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0060022,Blue Advantage G 0 (broad network),11512NC006,,NCN001,NCS001,NCF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060022-03,Limited Cost Sharing Plan Variation,,0.806072235107422,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,$250,$750,$250,$750,,,,,,,,,7
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0060023,"Blue Advantage 2700 (broad network, HSA eligible)",11512NC006,,NCN001,NCS001,NCF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_2700_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060023-00,Standard Bronze Off Exchange Plan,,0.611337840557098,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",50%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,8
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0110017,Blue Select Silver 2000-1,11512NC011,,NCN001,NCS004,NCF018,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0110017-00,Standard Silver Off Exchange Plan,,0.694564640522003,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$12,000","$24,000","$18,000","$36,000","$2,000","$4,000",20%,"$2,000","$4,000",20%,"$4,000","$8,000","$6,000","$12,000",$0,$0,20%,$0,$0,20%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0110017,Blue Select Silver 2000-1,11512NC011,,NCN001,NCS004,NCF018,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0110017-01,Standard Silver On Exchange Plan,,0.694564640522003,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$12,000","$24,000","$18,000","$36,000","$2,000","$4,000",20%,"$2,000","$4,000",20%,"$4,000","$8,000","$6,000","$12,000",$0,$0,20%,$0,$0,20%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0060023,"Blue Advantage 2700 (broad network, HSA eligible)",11512NC006,,NCN001,NCS001,NCF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_2700_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060023-01,Standard Bronze On Exchange Plan,,0.611337840557098,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",50%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,9
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0060023,"Blue Advantage 2700 (broad network, HSA eligible)",11512NC006,,NCN001,NCS001,NCF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_2700_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060023-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0110018,Blue Select Silver 2000-1,11512NC011,,NCN001,NCS005,NCF018,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0110018-00,Standard Silver Off Exchange Plan,,0.694564640522003,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$12,000","$24,000","$18,000","$36,000","$2,000","$4,000",20%,"$2,000","$4,000",20%,"$4,000","$8,000","$6,000","$12,000",$0,$0,20%,$0,$0,20%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0110018,Blue Select Silver 2000-1,11512NC011,,NCN001,NCS005,NCF018,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0110018-01,Standard Silver On Exchange Plan,,0.694564640522003,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$12,000","$24,000","$18,000","$36,000","$2,000","$4,000",20%,"$2,000","$4,000",20%,"$4,000","$8,000","$6,000","$12,000",$0,$0,20%,$0,$0,20%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0060023,"Blue Advantage 2700 (broad network, HSA eligible)",11512NC006,,NCN001,NCS001,NCF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_2700_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060023-03,Limited Cost Sharing Plan Variation,,0.611337840557098,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",50%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,11
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0060024,"Blue Advantage 5500 (broad network, HSA eligible)",11512NC006,,NCN001,NCS001,NCF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060024-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,250","$23,250","$17,750","$34,250",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,12
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0110023,Blue Select Platinum 500-1,11512NC011,,NCN001,NCS004,NCF021,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0110023-00,Standard Platinum Off Exchange Plan,88.46%,0.87951523065567,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$1,250","$2,500","$1,250","$2,500","$2,500","$5,000","$3,750","$7,500",$500,"$1,000",20%,$500,"$1,000",20%,"$1,000","$2,000","$1,500","$3,000",$0,$0,20%,$0,$0,20%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0110023,Blue Select Platinum 500-1,11512NC011,,NCN001,NCS004,NCF021,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0110023-01,Standard Platinum On Exchange Plan,88.46%,0.87951523065567,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$1,250","$2,500","$1,250","$2,500","$2,500","$5,000","$3,750","$7,500",$500,"$1,000",20%,$500,"$1,000",20%,"$1,000","$2,000","$1,500","$3,000",$0,$0,20%,$0,$0,20%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0060024,"Blue Advantage 5500 (broad network, HSA eligible)",11512NC006,,NCN001,NCS001,NCF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060024-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,250","$23,250","$17,750","$34,250",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,13
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0060024,"Blue Advantage 5500 (broad network, HSA eligible)",11512NC006,,NCN001,NCS001,NCF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060024-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0110024,Blue Select Platinum 500-1,11512NC011,,NCN001,NCS005,NCF021,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0110024-00,Standard Platinum Off Exchange Plan,88.46%,0.87951523065567,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$1,250","$2,500","$1,250","$2,500","$2,500","$5,000","$3,750","$7,500",$500,"$1,000",20%,$500,"$1,000",20%,"$1,000","$2,000","$1,500","$3,000",$0,$0,20%,$0,$0,20%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0110024,Blue Select Platinum 500-1,11512NC011,,NCN001,NCS005,NCF021,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0110024-01,Standard Platinum On Exchange Plan,88.46%,0.87951523065567,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$1,250","$2,500","$1,250","$2,500","$2,500","$5,000","$3,750","$7,500",$500,"$1,000",20%,$500,"$1,000",20%,"$1,000","$2,000","$1,500","$3,000",$0,$0,20%,$0,$0,20%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0060024,"Blue Advantage 5500 (broad network, HSA eligible)",11512NC006,,NCN001,NCS001,NCF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060024-03,Limited Cost Sharing Plan Variation,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,250","$23,250","$17,750","$34,250",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,15
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0060025,Blue Advantage S 0 (broad network),11512NC006,,NCN001,NCS001,NCF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060025-00,Standard Silver Off Exchange Plan,,0.70927506685257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,$250,$750,$250,$750,,,,,,,,,16
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0110039,Blue Select Bronze 4500-1,11512NC011,,NCN001,NCS004,NCF021,New,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0110039-00,Standard Bronze Off Exchange Plan,,0.613904654979706,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400","$19,800","$33,000",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",10%,"$4,500","$9,000",30%,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,16
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0110039,Blue Select Bronze 4500-1,11512NC011,,NCN001,NCS004,NCF021,New,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0110039-01,Standard Bronze On Exchange Plan,,0.613904654979706,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400","$19,800","$33,000",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",10%,"$4,500","$9,000",30%,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,17
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0060025,Blue Advantage S 0 (broad network),11512NC006,,NCN001,NCS001,NCF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060025-01,Standard Silver On Exchange Plan,,0.70927506685257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,$250,$750,$250,$750,,,,,,,,,17
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0060025,Blue Advantage S 0 (broad network),11512NC006,,NCN001,NCS001,NCF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060025-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,18
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0110040,Blue Select Bronze 4500-1,11512NC011,,NCN001,NCS005,NCF021,New,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0110040-00,Standard Bronze Off Exchange Plan,,0.613904654979706,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400","$19,800","$33,000",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",10%,"$4,500","$9,000",30%,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,18
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0110040,Blue Select Bronze 4500-1,11512NC011,,NCN001,NCS005,NCF021,New,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0110040-01,Standard Bronze On Exchange Plan,,0.613904654979706,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400","$19,800","$33,000",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",10%,"$4,500","$9,000",30%,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,19
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0060025,Blue Advantage S 0 (broad network),11512NC006,,NCN001,NCS001,NCF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060025-03,Limited Cost Sharing Plan Variation,,0.70927506685257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,$250,$750,$250,$750,,,,,,,,,19
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0060025,Blue Advantage S 0 (broad network),11512NC006,,NCN001,NCS001,NCF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060025-04,73% AV Level Silver Plan,,0.729394316673279,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,$250,$750,$250,$750,,,,,,,,,20
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0130023,Blue Value Silver 2000-6 (Limited Network),11512NC013,,NCN002,NCS002,NCF018,New,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$200,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0130023-00,Standard Silver Off Exchange Plan,,0.70135110616684,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","$24,000","$48,000","$2,000","$4,000",20%,,,,"$6,000","$12,000","$8,000","$16,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0130023,Blue Value Silver 2000-6 (Limited Network),11512NC013,,NCN002,NCS002,NCF018,New,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$200,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0130023-01,Standard Silver On Exchange Plan,,0.70135110616684,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","$24,000","$48,000","$2,000","$4,000",20%,,,,"$6,000","$12,000","$8,000","$16,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0060025,Blue Advantage S 0 (broad network),11512NC006,,NCN001,NCS001,NCF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060025-05,87% AV Level Silver Plan,,0.866047918796539,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$2,800","$5,600","$4,200","$8,400",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,$250,$750,$250,$750,,,,,,,,,21
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0060025,Blue Advantage S 0 (broad network),11512NC006,,NCN001,NCS001,NCF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060025-06,94% AV Level Silver Plan,,0.93876713514328,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$1,000","$2,000","$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,$250,$750,$250,$750,,,,,,,,,22
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0130024,Blue Value Silver 2000-6 (Limited Network),11512NC013,,NCN002,NCS003,NCF018,New,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$200,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0130024-00,Standard Silver Off Exchange Plan,,0.70135110616684,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","$24,000","$48,000","$2,000","$4,000",20%,,,,"$6,000","$12,000","$8,000","$16,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0130024,Blue Value Silver 2000-6 (Limited Network),11512NC013,,NCN002,NCS003,NCF018,New,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$200,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0130024-01,Standard Silver On Exchange Plan,,0.70135110616684,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","$24,000","$48,000","$2,000","$4,000",20%,,,,"$6,000","$12,000","$8,000","$16,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,23
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100026,Blue Value G 0 (limited network),11512NC010,,NCN002,NCS002,NCF011,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100026-00,Standard Gold Off Exchange Plan,,0.806072235107422,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,$250,$750,$250,$750,,,,,,,,,23
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100026,Blue Value G 0 (limited network),11512NC010,,NCN002,NCS002,NCF011,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100026-01,Standard Gold On Exchange Plan,,0.806072235107422,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,$250,$750,$250,$750,,,,,,,,,24
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0130025,Blue Value Gold 1500-8 (Limited Network),11512NC013,,NCN002,NCS002,NCF021,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0130025-00,Standard Gold Off Exchange Plan,78.46%,0.777095496654511,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000","$1,500","$3,000",20%,,,,"$4,500","$9,000","$6,000","$12,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,24
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0130025,Blue Value Gold 1500-8 (Limited Network),11512NC013,,NCN002,NCS002,NCF021,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0130025-01,Standard Gold On Exchange Plan,78.46%,0.777095496654511,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000","$1,500","$3,000",20%,,,,"$4,500","$9,000","$6,000","$12,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,25
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100026,Blue Value G 0 (limited network),11512NC010,,NCN002,NCS002,NCF011,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100026-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,25
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100026,Blue Value G 0 (limited network),11512NC010,,NCN002,NCS002,NCF011,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100026-03,Limited Cost Sharing Plan Variation,,0.806072235107422,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,$250,$750,$250,$750,,,,,,,,,26
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0130026,Blue Value Gold 1500-8 (Limited Network),11512NC013,,NCN002,NCS003,NCF021,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0130026-00,Standard Gold Off Exchange Plan,78.46%,0.777095496654511,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000","$1,500","$3,000",20%,,,,"$4,500","$9,000","$6,000","$12,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,26
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0130026,Blue Value Gold 1500-8 (Limited Network),11512NC013,,NCN002,NCS003,NCF021,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0130026-01,Standard Gold On Exchange Plan,78.46%,0.777095496654511,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000","$1,500","$3,000",20%,,,,"$4,500","$9,000","$6,000","$12,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,27
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100038,Blue Value G 0 (limited network),11512NC010,,NCN002,NCS003,NCF011,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100038-00,Standard Gold Off Exchange Plan,,0.806072235107422,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,$250,$750,$250,$750,,,,,,,,,27
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100038,Blue Value G 0 (limited network),11512NC010,,NCN002,NCS003,NCF011,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100038-01,Standard Gold On Exchange Plan,,0.806072235107422,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,$250,$750,$250,$750,,,,,,,,,28
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100038,Blue Value G 0 (limited network),11512NC010,,NCN002,NCS003,NCF011,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100038-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,29
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100038,Blue Value G 0 (limited network),11512NC010,,NCN002,NCS003,NCF011,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100038-03,Limited Cost Sharing Plan Variation,,0.806072235107422,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,$250,$750,$250,$750,,,,,,,,,30
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100029,Blue Value S 0 (limited network),11512NC010,,NCN002,NCS002,NCF013,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100029-00,Standard Silver Off Exchange Plan,,0.70927506685257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,$250,$750,$250,$750,,,,,,,,,31
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100029,Blue Value S 0 (limited network),11512NC010,,NCN002,NCS002,NCF013,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100029-01,Standard Silver On Exchange Plan,,0.70927506685257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,$250,$750,$250,$750,,,,,,,,,32
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100029,Blue Value S 0 (limited network),11512NC010,,NCN002,NCS002,NCF013,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100029-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,33
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100029,Blue Value S 0 (limited network),11512NC010,,NCN002,NCS002,NCF013,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100029-03,Limited Cost Sharing Plan Variation,,0.70927506685257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,$250,$750,$250,$750,,,,,,,,,34
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100029,Blue Value S 0 (limited network),11512NC010,,NCN002,NCS002,NCF013,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100029-04,73% AV Level Silver Plan,,0.729394316673279,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,$250,$750,$250,$750,,,,,,,,,35
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100029,Blue Value S 0 (limited network),11512NC010,,NCN002,NCS002,NCF013,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100029-05,87% AV Level Silver Plan,,0.866047918796539,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$2,800","$5,600","$4,200","$8,400",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,$250,$750,$250,$750,,,,,,,,,36
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100029,Blue Value S 0 (limited network),11512NC010,,NCN002,NCS002,NCF013,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100029-06,94% AV Level Silver Plan,,0.93876713514328,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$1,000","$2,000","$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,$250,$750,$250,$750,,,,,,,,,37
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100041,Blue Value S 0 (limited network),11512NC010,,NCN002,NCS003,NCF013,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100041-00,Standard Silver Off Exchange Plan,,0.70927506685257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,$250,$750,$250,$750,,,,,,,,,38
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100041,Blue Value S 0 (limited network),11512NC010,,NCN002,NCS003,NCF013,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100041-01,Standard Silver On Exchange Plan,,0.70927506685257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,$250,$750,$250,$750,,,,,,,,,39
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100041,Blue Value S 0 (limited network),11512NC010,,NCN002,NCS003,NCF013,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100041-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,40
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100041,Blue Value S 0 (limited network),11512NC010,,NCN002,NCS003,NCF013,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100041-03,Limited Cost Sharing Plan Variation,,0.70927506685257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,$250,$750,$250,$750,,,,,,,,,41
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100041,Blue Value S 0 (limited network),11512NC010,,NCN002,NCS003,NCF013,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100041-04,73% AV Level Silver Plan,,0.729394316673279,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,$250,$750,$250,$750,,,,,,,,,42
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100041,Blue Value S 0 (limited network),11512NC010,,NCN002,NCS003,NCF013,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100041-05,87% AV Level Silver Plan,,0.866047918796539,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$2,800","$5,600","$4,200","$8,400",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,$250,$750,$250,$750,,,,,,,,,43
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100041,Blue Value S 0 (limited network),11512NC010,,NCN002,NCS003,NCF013,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100041-06,94% AV Level Silver Plan,,0.93876713514328,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$1,000","$2,000","$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,$250,$750,$250,$750,,,,,,,,,44
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100027,"Blue Value 2700 (limited network, HSA eligible)",11512NC010,,NCN002,NCS002,NCF013,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_2700_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100027-00,Standard Bronze Off Exchange Plan,,0.611337840557098,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",50%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,45
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100027,"Blue Value 2700 (limited network, HSA eligible)",11512NC010,,NCN002,NCS002,NCF013,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_2700_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100027-01,Standard Bronze On Exchange Plan,,0.611337840557098,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",50%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,46
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100027,"Blue Value 2700 (limited network, HSA eligible)",11512NC010,,NCN002,NCS002,NCF013,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_2700_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100027-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,47
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100027,"Blue Value 2700 (limited network, HSA eligible)",11512NC010,,NCN002,NCS002,NCF013,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_2700_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100027-03,Limited Cost Sharing Plan Variation,,0.611337840557098,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",50%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,48
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100039,"Blue Value 2700 (limited network, HSA eligible)",11512NC010,,NCN002,NCS003,NCF013,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_2700_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100039-00,Standard Bronze Off Exchange Plan,,0.611337840557098,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",50%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,49
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100039,"Blue Value 2700 (limited network, HSA eligible)",11512NC010,,NCN002,NCS003,NCF013,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_2700_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100039-01,Standard Bronze On Exchange Plan,,0.611337840557098,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",50%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,50
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100039,"Blue Value 2700 (limited network, HSA eligible)",11512NC010,,NCN002,NCS003,NCF013,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_2700_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100039-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,51
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100039,"Blue Value 2700 (limited network, HSA eligible)",11512NC010,,NCN002,NCS003,NCF013,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_2700_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100039-03,Limited Cost Sharing Plan Variation,,0.611337840557098,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",50%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,52
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100040,"Blue Value 5500 (limited network, HSA eligible)",11512NC010,,NCN002,NCS003,NCF014,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100040-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,250","$23,250","$17,750","$34,250",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,53
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100040,"Blue Value 5500 (limited network, HSA eligible)",11512NC010,,NCN002,NCS003,NCF014,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100040-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,250","$23,250","$17,750","$34,250",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,54
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100040,"Blue Value 5500 (limited network, HSA eligible)",11512NC010,,NCN002,NCS003,NCF014,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100040-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,55
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100040,"Blue Value 5500 (limited network, HSA eligible)",11512NC010,,NCN002,NCS003,NCF014,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100040-03,Limited Cost Sharing Plan Variation,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,250","$23,250","$17,750","$34,250",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,56
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100028,"Blue Value 5500 (limited network, HSA eligible)",11512NC010,,NCN002,NCS002,NCF014,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100028-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,250","$23,250","$17,750","$34,250",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,57
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100028,"Blue Value 5500 (limited network, HSA eligible)",11512NC010,,NCN002,NCS002,NCF014,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100028-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,250","$23,250","$17,750","$34,250",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,58
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100028,"Blue Value 5500 (limited network, HSA eligible)",11512NC010,,NCN002,NCS002,NCF014,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100028-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,59
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0100028,"Blue Value 5500 (limited network, HSA eligible)",11512NC010,,NCN002,NCS002,NCF014,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100028-03,Limited Cost Sharing Plan Variation,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,250","$23,250","$17,750","$34,250",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,60
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0140005,"Blue Local 5500 (local network with Carolinas HealthCare System, HSA eligible)",11512NC014,,NCN003,NCS006,NCF014,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140005-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,250","$23,250","$17,750","$34,250",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,61
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0140005,"Blue Local 5500 (local network with Carolinas HealthCare System, HSA eligible)",11512NC014,,NCN003,NCS006,NCF014,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140005-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,250","$23,250","$17,750","$34,250",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,62
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0140005,"Blue Local 5500 (local network with Carolinas HealthCare System, HSA eligible)",11512NC014,,NCN003,NCS006,NCF014,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,63
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,2,11512,NC,Individual,No,56-0894904,11512NC0140005,"Blue Local 5500 (local network with Carolinas HealthCare System, HSA eligible)",11512NC014,,NCN003,NCS006,NCF014,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_5500_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140005-03,Limited Cost Sharing Plan Variation,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,250","$23,250","$17,750","$34,250",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,64
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,3,11512,NC,Individual,No,56-0894904,11512NC0060026,Blue Advantage B 5000 (broad network),11512NC006,,NCN001,NCS001,NCF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060026-00,Standard Bronze Off Exchange Plan,,0.604631841182709,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,4
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,3,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0040020,Blue Options Silver with HSA 2000-2,11512NC004,,NCN001,NCS001,NCF030,New,PPO,Silver,No,Both,No,No,,,,Yes,Yes,$0.00,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_617_ExchangeEnhancedFormulary4T.pdf,11512NC0040020-00,Standard Silver Off Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,4
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,3,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0040020,Blue Options Silver with HSA 2000-2,11512NC004,,NCN001,NCS001,NCF030,New,PPO,Silver,No,Both,No,No,,,,Yes,Yes,$0.00,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_617_ExchangeEnhancedFormulary4T.pdf,11512NC0040020-01,Standard Silver On Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,5
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,3,11512,NC,Individual,No,56-0894904,11512NC0060026,Blue Advantage B 5000 (broad network),11512NC006,,NCN001,NCS001,NCF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060026-01,Standard Bronze On Exchange Plan,,0.604631841182709,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,5
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,3,11512,NC,Individual,No,56-0894904,11512NC0060026,Blue Advantage B 5000 (broad network),11512NC006,,NCN001,NCS001,NCF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060026-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,3,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0040022,Blue Options Bronze with HSA 2500-1,11512NC004,,NCN001,NCS001,NCF031,New,PPO,Bronze,No,Both,No,No,,,,Yes,Yes,$0.00,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_617_ExchangeEnhancedFormulary4T.pdf,11512NC0040022-00,Standard Bronze Off Exchange Plan,,0.614018678665161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,6
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,3,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0040022,Blue Options Bronze with HSA 2500-1,11512NC004,,NCN001,NCS001,NCF031,New,PPO,Bronze,No,Both,No,No,,,,Yes,Yes,$0.00,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_617_ExchangeEnhancedFormulary4T.pdf,11512NC0040022-01,Standard Bronze On Exchange Plan,,0.614018678665161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,7
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,3,11512,NC,Individual,No,56-0894904,11512NC0060026,Blue Advantage B 5000 (broad network),11512NC006,,NCN001,NCS001,NCF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060026-03,Limited Cost Sharing Plan Variation,,0.604631841182709,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,7
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,3,11512,NC,Individual,No,56-0894904,11512NC0100030,Blue Value B 5000 (limited network),11512NC010,,NCN002,NCS002,NCF015,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100030-00,Standard Bronze Off Exchange Plan,,0.604631841182709,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,8
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,3,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0040023,Blue Options Bronze with HSA 3000-1,11512NC004,,NCN001,NCS001,NCF024,New,PPO,Bronze,No,Both,No,No,,,,Yes,Yes,$0.00,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_617_ExchangeEnhancedFormulary4T.pdf,11512NC0040023-00,Standard Bronze Off Exchange Plan,,0.615474402904511,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",40%,,,,"$6,000","$12,000","$9,000","$18,000",,,,,,,,,8
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,3,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0040023,Blue Options Bronze with HSA 3000-1,11512NC004,,NCN001,NCS001,NCF024,New,PPO,Bronze,No,Both,No,No,,,,Yes,Yes,$0.00,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_617_ExchangeEnhancedFormulary4T.pdf,11512NC0040023-01,Standard Bronze On Exchange Plan,,0.615474402904511,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",40%,,,,"$6,000","$12,000","$9,000","$18,000",,,,,,,,,9
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,3,11512,NC,Individual,No,56-0894904,11512NC0100030,Blue Value B 5000 (limited network),11512NC010,,NCN002,NCS002,NCF015,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100030-01,Standard Bronze On Exchange Plan,,0.604631841182709,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,9
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,3,11512,NC,Individual,No,56-0894904,11512NC0100030,Blue Value B 5000 (limited network),11512NC010,,NCN002,NCS002,NCF015,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100030-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,3,11512,NC,Individual,No,56-0894904,11512NC0100030,Blue Value B 5000 (limited network),11512NC010,,NCN002,NCS002,NCF015,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100030-03,Limited Cost Sharing Plan Variation,,0.604631841182709,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,11
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,3,11512,NC,Individual,No,56-0894904,11512NC0100042,Blue Value B 5000 (limited network),11512NC010,,NCN002,NCS003,NCF015,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100042-00,Standard Bronze Off Exchange Plan,,0.604631841182709,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,12
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,3,11512,NC,Individual,No,56-0894904,11512NC0100042,Blue Value B 5000 (limited network),11512NC010,,NCN002,NCS003,NCF015,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100042-01,Standard Bronze On Exchange Plan,,0.604631841182709,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,13
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,3,11512,NC,Individual,No,56-0894904,11512NC0100042,Blue Value B 5000 (limited network),11512NC010,,NCN002,NCS003,NCF015,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100042-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,3,11512,NC,Individual,No,56-0894904,11512NC0100042,Blue Value B 5000 (limited network),11512NC010,,NCN002,NCS003,NCF015,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100042-03,Limited Cost Sharing Plan Variation,,0.604631841182709,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,15
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,3,11512,NC,Individual,No,56-0894904,11512NC0140006,Blue Local B 5000 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF012,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140006-00,Standard Bronze Off Exchange Plan,,0.604631841182709,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,16
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,3,11512,NC,Individual,No,56-0894904,11512NC0140006,Blue Local B 5000 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF012,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140006-01,Standard Bronze On Exchange Plan,,0.604631841182709,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,17
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,3,11512,NC,Individual,No,56-0894904,11512NC0140006,Blue Local B 5000 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF012,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,18
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,3,11512,NC,Individual,No,56-0894904,11512NC0140006,Blue Local B 5000 (local network with Carolinas HealthCare System),11512NC014,,NCN003,NCS006,NCF012,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_5000_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/blplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0140006-03,Limited Cost Sharing Plan Variation,,0.604631841182709,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,19
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,4,11512,NC,Individual,No,56-0894904,11512NC0060027,Blue Advantage Catastrophic (broad network),11512NC006,,NCN001,NCS001,NCF006,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Catastrophic_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060027-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,450","$27,650","$21,050","$40,850",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400","$19,800","$39,600",,,,,,,,,4
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,4,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0020074,Blue Options Silver 2000-9,11512NC002,,NCN001,NCS001,NCF027,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$200,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_617_ExchangeEnhancedFormulary4T.pdf,11512NC0020074-00,Standard Silver Off Exchange Plan,68.62%,0.671600461006165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,4,11512,NC,SHOP (Small Group),No,56-0894904,11512NC0020074,Blue Options Silver 2000-9,11512NC002,,NCN001,NCS001,NCF027,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$200,0,0,0,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.bcbsnc.com,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_617_ExchangeEnhancedFormulary4T.pdf,11512NC0020074-01,Standard Silver On Exchange Plan,68.62%,0.671600461006165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,4,11512,NC,Individual,No,56-0894904,11512NC0060027,Blue Advantage Catastrophic (broad network),11512NC006,,NCN001,NCS001,NCF006,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Catastrophic_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0060027-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,450","$27,650","$21,050","$40,850",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400","$19,800","$39,600",,,,,,,,,5
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,4,11512,NC,Individual,No,56-0894904,11512NC0100031,Blue Value Catastrophic (limited network),11512NC010,,NCN002,NCS002,NCF014,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Catastrophic_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100031-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,450","$27,650","$21,050","$40,850",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400","$19,800","$39,600",,,,,,,,,6
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,4,11512,NC,Individual,No,56-0894904,11512NC0100031,Blue Value Catastrophic (limited network),11512NC010,,NCN002,NCS002,NCF014,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Catastrophic_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100031-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,450","$27,650","$21,050","$40,850",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400","$19,800","$39,600",,,,,,,,,7
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,4,11512,NC,Individual,No,56-0894904,11512NC0100043,Blue Value Catastrophic (limited network),11512NC010,,NCN002,NCS003,NCF014,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Catastrophic_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100043-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,450","$27,650","$21,050","$40,850",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400","$19,800","$39,600",,,,,,,,,8
2015,NC,11512,HIOS,9,2015-01-16 17:32:32,4,11512,NC,Individual,No,56-0894904,11512NC0100043,Blue Value Catastrophic (limited network),11512NC010,,NCN002,NCS003,NCF014,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Blue Card,Yes,Blue Card,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Catastrophic_2015.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/bvplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_612_ExchangeBasicOpenFormulary5T.pdf,11512NC0100043-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,450","$27,650","$21,050","$40,850",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400","$19,800","$39,600",,,,,,,,,9
2015,NC,12465,HIOS,4,2014-09-05 03:32:16,1,12465,NC,SHOP (Small Group),Yes,81-0170040,12465NC0010001,Assurant Dental ACAFFO High,12465NC001,,NCN001,NCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$44.55,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same coverage as in service area,Yes,,,,,12465NC0010001-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,12465,HIOS,4,2014-09-05 03:32:16,2,12465,NC,SHOP (Small Group),Yes,81-0170040,12465NC0010002,Assurant Dental ACAFFO Low,12465NC001,,NCN001,NCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$37.02,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same coverage as in service area,Yes,,,,,12465NC0010002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,14125,HIOS,4,2014-09-04 03:25:43,1,14125,NC,SHOP (Small Group),Yes,35-0472300,14125NC0010001,Lincoln Dental Connect?,14125NC001,,NCN001,NCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.27,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,14125NC0010001-00,Standard High Off Exchange Plan,85.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,14125,HIOS,4,2014-09-04 03:25:43,1,14125,NC,SHOP (Small Group),Yes,35-0472300,14125NC0010002,Lincoln Dental Connect?,14125NC001,,NCN001,NCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.08,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,14125NC0010002-00,Standard Low Off Exchange Plan,69.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,14125,HIOS,4,2014-09-04 03:25:43,1,14125,NC,SHOP (Small Group),Yes,35-0472300,14125NC0010003,Lincoln Dental Connect?,14125NC001,,NCN001,NCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.96,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,14125NC0010003-00,Standard Low Off Exchange Plan,69.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NC,14125,HIOS,4,2014-09-04 03:25:43,1,14125,NC,SHOP (Small Group),Yes,35-0472300,14125NC0010005,Lincoln Dental Connect?,14125NC001,,NCN001,NCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.01,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,14125NC0010005-00,Standard High Off Exchange Plan,85.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NC,14125,HIOS,4,2014-09-04 03:25:43,1,14125,NC,SHOP (Small Group),Yes,35-0472300,14125NC0010006,Lincoln Dental Connect?,14125NC001,,NCN001,NCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.71,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,14125NC0010006-00,Standard Low Off Exchange Plan,69.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,NC,14125,HIOS,4,2014-09-04 03:25:43,1,14125,NC,SHOP (Small Group),Yes,35-0472300,14125NC0010007,Lincoln Dental Connect?,14125NC001,,NCN001,NCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.25,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,14125NC0010007-00,Standard Low Off Exchange Plan,69.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,NC,14125,HIOS,4,2014-09-04 03:25:43,2,14125,NC,SHOP (Small Group),Yes,35-0472300,14125NC0010004,Lincoln Dental Connect?,14125NC001,,NCN001,NCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.31,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,14125NC0010004-00,Standard High Off Exchange Plan,86.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,14125,HIOS,4,2014-09-04 03:25:43,2,14125,NC,SHOP (Small Group),Yes,35-0472300,14125NC0010008,Lincoln Dental Connect?,14125NC001,,NCN001,NCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$38.49,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,14125NC0010008-00,Standard High Off Exchange Plan,86.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,15220,HIOS,4,2014-09-06 03:39:47,1,15220,NC,SHOP (Small Group),Yes,41-0808596,15220NC0010001,"Plan 1. Passive PPO, $1000 Annual Maximum, no Ortho",15220NC001,,NCN001,NCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,15220NC0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,9,56346,NC,Individual,No,20-0229117,56346NC0060004,Coventry Bronze Ded Only HSA Elig Duke Medicine,56346NC006,,NCN004,NCS004,NCF048,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48389,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060004-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,10,56346,NC,Individual,No,20-0229117,56346NC0050006,Coventry Bronze Deductible Only HSA Eligible,56346NC005,,NCN005,NCS005,NCF028,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48301,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050006-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,10,56346,NC,Individual,No,20-0229117,56346NC0050006,Coventry Bronze Deductible Only HSA Eligible,56346NC005,,NCN005,NCS005,NCF028,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48301,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050006-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,10,56346,NC,Individual,No,20-0229117,56346NC0050006,Coventry Bronze Deductible Only HSA Eligible,56346NC005,,NCN005,NCS005,NCF028,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48301,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,10,56346,NC,Individual,No,20-0229117,56346NC0050006,Coventry Bronze Deductible Only HSA Eligible,56346NC005,,NCN005,NCS005,NCF028,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48301,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050006-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,11,56346,NC,Individual,No,20-0229117,56346NC0050013,Coventry Silver $10 Copay,56346NC005,,NCN005,NCS005,NCF035,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48314,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050013-00,Standard Silver Off Exchange Plan,68.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,11,56346,NC,Individual,No,20-0229117,56346NC0050013,Coventry Silver $10 Copay,56346NC005,,NCN005,NCS005,NCF035,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48314,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050013-01,Standard Silver On Exchange Plan,68.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,11,56346,NC,Individual,No,20-0229117,56346NC0050013,Coventry Silver $10 Copay,56346NC005,,NCN005,NCS005,NCF035,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48314,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050013-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,11,56346,NC,Individual,No,20-0229117,56346NC0050013,Coventry Silver $10 Copay,56346NC005,,NCN005,NCS005,NCF035,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48314,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050013-03,Limited Cost Sharing Plan Variation,68.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,11,56346,NC,Individual,No,20-0229117,56346NC0050013,Coventry Silver $10 Copay,56346NC005,,NCN005,NCS005,NCF035,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48314,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050013-04,73% AV Level Silver Plan,72.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,11,56346,NC,Individual,No,20-0229117,56346NC0050013,Coventry Silver $10 Copay,56346NC005,,NCN005,NCS005,NCF035,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48314,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050013-05,87% AV Level Silver Plan,86.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,11,56346,NC,Individual,No,20-0229117,56346NC0050013,Coventry Silver $10 Copay,56346NC005,,NCN005,NCS005,NCF035,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48314,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050013-06,94% AV Level Silver Plan,93.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,12,56346,NC,Individual,No,20-0229117,56346NC0050014,Coventry Silver $10 Copay Carolinas HealthCare,56346NC005,,NCN008,NCS008,NCF036,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48358,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050014-00,Standard Silver Off Exchange Plan,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,12,56346,NC,Individual,No,20-0229117,56346NC0050014,Coventry Silver $10 Copay Carolinas HealthCare,56346NC005,,NCN008,NCS008,NCF036,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48358,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050014-01,Standard Silver On Exchange Plan,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NC,15220,HIOS,4,2014-09-06 03:39:47,1,15220,NC,SHOP (Small Group),Yes,41-0808596,15220NC0010002,"Plan 2.  Passive PPO, $1000 Annual Maximum, Ortho",15220NC001,,NCN001,NCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,15220NC0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,15220,HIOS,4,2014-09-06 03:39:47,1,15220,NC,SHOP (Small Group),Yes,41-0808596,15220NC0010003,"Plan 3. Passive PPO, $1500 Annual Maximum, no Ortho",15220NC001,,NCN001,NCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,15220NC0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NC,15220,HIOS,4,2014-09-06 03:39:47,1,15220,NC,SHOP (Small Group),Yes,41-0808596,15220NC0010004,"Plan 4.  Passive PPO, $1500 Annual Maximum, Ortho",15220NC001,,NCN001,NCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,15220NC0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NC,15220,HIOS,4,2014-09-06 03:39:47,1,15220,NC,SHOP (Small Group),Yes,41-0808596,15220NC0010005,"Plan 5.  Passive PPO, $2000 Annual Maximum, Ortho",15220NC001,,NCN001,NCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,15220NC0010005-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,NC,15220,HIOS,4,2014-09-06 03:39:47,1,15220,NC,SHOP (Small Group),Yes,41-0808596,15220NC0010006,"Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho",15220NC001,,NCN001,NCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,15220NC0010006-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,NC,15220,HIOS,4,2014-09-06 03:39:47,1,15220,NC,SHOP (Small Group),Yes,41-0808596,15220NC0010007,"Plan 7. Graded Passive PPO, $1500 Annual Maximum, Ortho",15220NC001,,NCN001,NCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,15220NC0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,NC,23521,HIOS,3,2014-08-08 08:53:29,1,23521,NC,SHOP (Small Group),Yes,42-0127290,23521NC0060001,Principal Plan Dental 70,23521NC006,,NCN001,NCS001,,New,PPO,Low,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$29.77,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,23521NC0060001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,23521,HIOS,3,2014-08-08 08:53:29,1,23521,NC,SHOP (Small Group),Yes,42-0127290,23521NC0060002,Principal Plan Dental 80,23521NC006,,NCN001,NCS001,,New,PPO,High,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$31.52,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,23521NC0060002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,24112,HIOS,2,2014-08-07 10:00:19,1,24112,NC,SHOP (Small Group),Yes,47-0098400,24112NC0040002,EHB High PPO,24112NC004,,NCN001,NCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.25,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,24112NC0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,2,54332,NC,Individual,No,56-1461010,54332NC0030001,UnitedHealthcare Platinum Compass 250,54332NC003,,NCN001,NCS001,NCF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030001-00,Standard Platinum Off Exchange Plan,89.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,2,54332,NC,Individual,No,56-1461010,54332NC0030001,UnitedHealthcare Platinum Compass 250,54332NC003,,NCN001,NCS001,NCF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030001-01,Standard Platinum On Exchange Plan,89.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,2,54332,NC,Individual,No,56-1461010,54332NC0030001,UnitedHealthcare Platinum Compass 250,54332NC003,,NCN001,NCS001,NCF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,2,54332,NC,Individual,No,56-1461010,54332NC0030001,UnitedHealthcare Platinum Compass 250,54332NC003,,NCN001,NCS001,NCF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030001-03,Limited Cost Sharing Plan Variation,89.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,3,54332,NC,Individual,No,56-1461010,54332NC0030004,UnitedHealthcare Silver Compass 2000,54332NC003,,NCN001,NCS001,NCF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030004-00,Standard Silver Off Exchange Plan,70.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,3,54332,NC,Individual,No,56-1461010,54332NC0030004,UnitedHealthcare Silver Compass 2000,54332NC003,,NCN001,NCS001,NCF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030004-01,Standard Silver On Exchange Plan,70.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,6,56346,NC,Individual,No,20-0229117,56346NC0060001,Coventry Bronze Ded Only HSA Elig Carolinas HealthCare,56346NC006,,NCN003,NCS003,NCF045,New,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48345,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060001-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,6,56346,NC,Individual,No,20-0229117,56346NC0060001,Coventry Bronze Ded Only HSA Elig Carolinas HealthCare,56346NC006,,NCN003,NCS003,NCF045,New,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48345,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,6,56346,NC,Individual,No,20-0229117,56346NC0060001,Coventry Bronze Ded Only HSA Elig Carolinas HealthCare,56346NC006,,NCN003,NCS003,NCF045,New,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48345,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060001-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,7,56346,NC,Individual,No,20-0229117,56346NC0060002,Coventry Bronze Ded Only HSA Elig CaroMont,56346NC006,,NCN002,NCS002,NCF046,New,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48323,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060002-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,7,56346,NC,Individual,No,20-0229117,56346NC0060002,Coventry Bronze Ded Only HSA Elig CaroMont,56346NC006,,NCN002,NCS002,NCF046,New,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48323,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060002-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,7,56346,NC,Individual,No,20-0229117,56346NC0060002,Coventry Bronze Ded Only HSA Elig CaroMont,56346NC006,,NCN002,NCS002,NCF046,New,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48323,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NC,24112,HIOS,2,2014-08-07 10:00:19,1,24112,NC,SHOP (Small Group),Yes,47-0098400,24112NC0040001,EHB Low PPO,24112NC004,,NCN001,NCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.11,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,24112NC0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,24112,HIOS,2,2014-08-07 10:00:19,1,24112,NC,SHOP (Small Group),Yes,47-0098400,24112NC0030002,EHB High Passive,24112NC003,,NCN001,NCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$46.48,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,24112NC0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NC,24112,HIOS,2,2014-08-07 10:00:19,1,24112,NC,SHOP (Small Group),Yes,47-0098400,24112NC0030001,EHB Low Passive,24112NC003,,NCN001,NCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.21,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,24112NC0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,3,54332,NC,Individual,No,56-1461010,54332NC0030006,UnitedHealthcare Silver Compass 5000,54332NC003,,NCN001,NCS001,NCF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030006-05,87% AV Level Silver Plan,86.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,3,54332,NC,Individual,No,56-1461010,54332NC0030006,UnitedHealthcare Silver Compass 5000,54332NC003,,NCN001,NCS001,NCF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030006-06,94% AV Level Silver Plan,94.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,4,54332,NC,Individual,No,56-1461010,54332NC0030002,UnitedHealthcare Gold Compass 1000,54332NC003,,NCN001,NCS001,NCF001,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030002-00,Standard Gold Off Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,4,54332,NC,Individual,No,56-1461010,54332NC0030002,UnitedHealthcare Gold Compass 1000,54332NC003,,NCN001,NCS001,NCF001,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030002-01,Standard Gold On Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,4,54332,NC,Individual,No,56-1461010,54332NC0030002,UnitedHealthcare Gold Compass 1000,54332NC003,,NCN001,NCS001,NCF001,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,4,54332,NC,Individual,No,56-1461010,54332NC0030002,UnitedHealthcare Gold Compass 1000,54332NC003,,NCN001,NCS001,NCF001,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030002-03,Limited Cost Sharing Plan Variation,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,5,54332,NC,Individual,No,56-1461010,54332NC0030010,UnitedHealthcare Catastrophic Compass 6600,54332NC003,,NCN001,NCS001,NCF003,New,HMO,Catastrophic,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030010-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,5,54332,NC,Individual,No,56-1461010,54332NC0030010,UnitedHealthcare Catastrophic Compass 6600,54332NC003,,NCN001,NCS001,NCF003,New,HMO,Catastrophic,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030010-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,6,54332,NC,Individual,No,56-1461010,54332NC0030007,UnitedHealthcare Bronze Compass 4200,54332NC003,,NCN001,NCS001,NCF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030007-00,Standard Bronze Off Exchange Plan,59.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,6,54332,NC,Individual,No,56-1461010,54332NC0030007,UnitedHealthcare Bronze Compass 4200,54332NC003,,NCN001,NCS001,NCF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030007-01,Standard Bronze On Exchange Plan,59.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,6,54332,NC,Individual,No,56-1461010,54332NC0030007,UnitedHealthcare Bronze Compass 4200,54332NC003,,NCN001,NCS001,NCF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030007-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,6,54332,NC,Individual,No,56-1461010,54332NC0030007,UnitedHealthcare Bronze Compass 4200,54332NC003,,NCN001,NCS001,NCF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030007-03,Limited Cost Sharing Plan Variation,59.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NC,55440,HIOS,8,2014-10-05 17:13:14,1,55440,NC,SHOP (Small Group),Yes,13-5123390,55440NC0150002,Guardian Pediatric Advantage,55440NC015,,NCN001,NCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$22.16,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,55440NC0150002-00,Standard High Off Exchange Plan,84.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,55440,HIOS,8,2014-10-05 17:13:14,1,55440,NC,SHOP (Small Group),Yes,13-5123390,55440NC0160002,Guardian Pediatric Essentials,55440NC016,,NCN001,NCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$15.28,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,55440NC0160002-00,Standard Low Off Exchange Plan,70.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,55440,HIOS,8,2014-10-05 17:13:14,2,55440,NC,SHOP (Small Group),Yes,13-5123390,55440NC0180002,Guardian Family Advantage,55440NC018,,NCN001,NCS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.16,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,55440NC0180002-00,Standard High Off Exchange Plan,84.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,55440,HIOS,8,2014-10-05 17:13:14,2,55440,NC,SHOP (Small Group),Yes,13-5123390,55440NC0180002,Guardian Family Advantage,55440NC018,,NCN001,NCS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.16,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,55440NC0180002-01,Standard High On Exchange Plan,84.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,55440,HIOS,8,2014-10-05 17:13:14,2,55440,NC,SHOP (Small Group),Yes,13-5123390,55440NC0200002,Guardian Family Essentials,55440NC020,,NCN001,NCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$15.28,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,55440NC0200002-00,Standard Low Off Exchange Plan,70.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NC,55440,HIOS,8,2014-10-05 17:13:14,2,55440,NC,SHOP (Small Group),Yes,13-5123390,55440NC0200002,Guardian Family Essentials,55440NC020,,NCN001,NCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$15.28,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,55440NC0200002-01,Standard Low On Exchange Plan,70.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NC,25741,HIOS,4,2014-11-13 10:25:37,1,25741,NC,Individual,Yes,47-0397286,25741NC0010001,"Delta Dental Individual PPO, EHB Certified",25741NC001,,NCN002,NCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.30,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,25741NC0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,25741,HIOS,4,2014-11-13 10:25:37,1,25741,NC,SHOP (Small Group),Yes,47-0397286,25741NC0030001,"Renaissance Group Dental PPO, EHB Certified",25741NC003,,NCN001,NCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.51,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,25741NC0030001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,25741,HIOS,4,2014-11-13 10:25:37,1,25741,NC,SHOP (Small Group),Yes,47-0397286,25741NC0030002,"Renaissance Group Dental PPO, EHB Certified",25741NC003,,NCN001,NCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.07,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,25741NC0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,25741,HIOS,4,2014-11-13 10:25:37,1,25741,NC,Individual,Yes,47-0397286,25741NC0010002,"Delta Dental Individual PPO, EHB Certified",25741NC001,,NCN002,NCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.34,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,25741NC0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,25741,HIOS,4,2014-11-13 10:25:37,1,25741,NC,Individual,Yes,47-0397286,25741NC0020001,"Renaissance Individual Dental PPO, EHB Certified",25741NC002,,NCN001,NCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.40,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,25741NC0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NC,25741,HIOS,4,2014-11-13 10:25:37,1,25741,NC,SHOP (Small Group),Yes,47-0397286,25741NC0050001,"Renaissance Group Dental Indemnity, EHB Certified",25741NC005,,NCN001,NCS001,,Existing,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.51,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,25741NC0050001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NC,25741,HIOS,4,2014-11-13 10:25:37,1,25741,NC,SHOP (Small Group),Yes,47-0397286,25741NC0050002,"Renaissance Group Dental Indemnity, EHB Certified",25741NC005,,NCN001,NCS001,,Existing,Indemnity,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.07,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,25741NC0050002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NC,25741,HIOS,4,2014-11-13 10:25:37,1,25741,NC,Individual,Yes,47-0397286,25741NC0020002,"Renaissance Individual Dental PPO, EHB Certified",25741NC002,,NCN001,NCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.52,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,25741NC0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NC,25741,HIOS,4,2014-11-13 10:25:37,1,25741,NC,Individual,Yes,47-0397286,25741NC0060001,"Delta Dental Individual PPO, EHB Certified (Exchange)",25741NC006,,NCN002,NCS001,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.86,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.deltadentalnc.com/NC_EHB_High,https://psp.toolkitsonline.com/paymentWeb/saml/acs/alias/25741,http://www.deltadentalnc.com/NC_EHB_High,,25741NC0060001-01,Standard High On Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,NC,25741,HIOS,4,2014-11-13 10:25:37,1,25741,NC,Individual,Yes,47-0397286,25741NC0060002,"Delta Dental Individual PPO, EHB Certified (Exchange)",25741NC006,,NCN002,NCS001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.48,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.deltadentalnc.com/NC_EHB_Low,https://psp.toolkitsonline.com/paymentWeb/saml/acs/alias/25741,http://www.deltadentalnc.com/NC_EHB_Low,,25741NC0060002-01,Standard Low On Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,NC,25741,HIOS,4,2014-11-13 10:25:37,2,25741,NC,Individual,Yes,47-0397286,25741NC0070001,"Delta Dental Individual Pediatric-Only PPO, EHB Certified",25741NC007,,NCN002,NCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$36.97,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,25741NC0070001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,25741,HIOS,4,2014-11-13 10:25:37,2,25741,NC,Individual,Yes,47-0397286,25741NC0070002,"Delta Dental Individual Pediatric-Only PPO, EHB Certified",25741NC007,,NCN002,NCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$28.71,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,25741NC0070002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,25741,HIOS,4,2014-11-13 10:25:37,2,25741,NC,Individual,Yes,47-0397286,25741NC0080001,"Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)",25741NC008,,NCN002,NCS001,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$34.78,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.deltadentalnc.com/NC_Ped_High,https://psp.toolkitsonline.com/paymentWeb/saml/acs/alias/25741,http://www.deltadentalnc.com/NC_Ped_High,,25741NC0080001-01,Standard High On Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NC,25741,HIOS,4,2014-11-13 10:25:37,2,25741,NC,Individual,Yes,47-0397286,25741NC0080002,"Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)",25741NC008,,NCN002,NCS001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$27.08,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.deltadentalnc.com/NC_Ped_Low,https://psp.toolkitsonline.com/paymentWeb/saml/acs/alias/25741,http://www.deltadentalnc.com/NC_Ped_Low,,25741NC0080002-01,Standard Low On Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NC,36256,HIOS,5,2014-09-04 03:25:43,1,36256,NC,SHOP (Small Group),Yes,57-0523959,36256NC0010001,Group Pediatric Dental EHB,36256NC001,,NCN001,NCS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$48.29,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximums,Yes,Traditional with inside maximums,Yes,,,,,36256NC0010001-00,Standard High Off Exchange Plan,86.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,36256,HIOS,5,2014-09-04 03:25:43,1,36256,NC,SHOP (Small Group),Yes,57-0523959,36256NC0010002,Group Pediatric Dental EHB,36256NC001,,NCN001,NCS001,,New,Indemnity,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$39.69,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximums,Yes,Traditional with inside maximums,Yes,,,,,36256NC0010002-00,Standard Low Off Exchange Plan,71.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,37576,HIOS,8,2014-11-14 05:23:27,1,37576,NC,Individual,Yes,75-1233841,37576NC0010007,Dentegra Dental PPO Pediatric Basic Plan,37576NC001,,NCN001,NCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$24.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nc/37576nc0010007-15,,37576NC0010007-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,37576,HIOS,8,2014-11-14 05:23:27,1,37576,NC,SHOP (Small Group),Yes,75-1233841,37576NC0020007,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,37576NC002,,NCN001,NCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.40,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/nc/37576nc0020007-15,,37576NC0020007-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,37576,HIOS,8,2014-11-14 05:23:27,1,37576,NC,SHOP (Small Group),Yes,75-1233841,37576NC0020007,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,37576NC002,,NCN001,NCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.40,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/nc/37576nc0020007-15,,37576NC0020007-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,37576,HIOS,8,2014-11-14 05:23:27,1,37576,NC,Individual,Yes,75-1233841,37576NC0010007,Dentegra Dental PPO Pediatric Basic Plan,37576NC001,,NCN001,NCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$24.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nc/37576nc0010007-15,,37576NC0010007-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,37576,HIOS,8,2014-11-14 05:23:27,2,37576,NC,Individual,Yes,75-1233841,37576NC0010009,Dentegra Dental PPO Family Basic Plan,37576NC001,,NCN001,NCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nc/37576nc0010009-15,,37576NC0010009-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,37576,HIOS,8,2014-11-14 05:23:27,2,37576,NC,SHOP (Small Group),Yes,75-1233841,37576NC0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,37576NC002,,NCN001,NCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.40,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/nc/37576nc0020009-15,,37576NC0020009-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,37576,HIOS,8,2014-11-14 05:23:27,2,37576,NC,SHOP (Small Group),Yes,75-1233841,37576NC0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,37576NC002,,NCN001,NCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.40,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/nc/37576nc0020009-15,,37576NC0020009-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,37576,HIOS,8,2014-11-14 05:23:27,2,37576,NC,Individual,Yes,75-1233841,37576NC0010009,Dentegra Dental PPO Family Basic Plan,37576NC001,,NCN001,NCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nc/37576nc0010009-15,,37576NC0010009-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,40411,HIOS,3,2014-08-31 07:07:13,1,40411,NC,Individual,Yes,59-1031071,40411NC0030001,myCigna Dental Pediatric,40411NC003,7730182962,NCN001,NCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$21.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,,,http://www.cigna.com/individuals-families/2015-plans/sob/north-carolina/dental-pediatric,,40411NC0030001-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$150,$300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,40435,HIOS,3,2014-08-28 04:23:13,1,40435,NC,SHOP (Small Group),Yes,13-5581829,40435NC0170001,EHB Basic Dental Plan (Low),40435NC017,,NCN001,NCS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$19.32,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48051,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48050,,40435NC0170001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,40435,HIOS,3,2014-08-28 04:23:13,1,40435,NC,SHOP (Small Group),Yes,13-5581829,40435NC0170001,EHB Basic Dental Plan (Low),40435NC017,,NCN001,NCS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$19.32,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48051,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48050,,40435NC0170001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,40435,HIOS,3,2014-08-28 04:23:13,2,40435,NC,SHOP (Small Group),Yes,13-5581829,40435NC0180001,EHB Enhanced Dental Plan (High),40435NC018,,NCN002,NCS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$24.14,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49096,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49095,,40435NC0180001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,40435,HIOS,3,2014-08-28 04:23:13,2,40435,NC,SHOP (Small Group),Yes,13-5581829,40435NC0180001,EHB Enhanced Dental Plan (High),40435NC018,,NCN002,NCS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$24.14,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49096,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49095,,40435NC0180001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,40435,HIOS,3,2014-08-28 04:23:13,3,40435,NC,SHOP (Small Group),Yes,13-5581829,40435NC0190001,Family Basic Dental Plan (Low),40435NC019,,NCN003,NCS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$19.32,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49098,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49097,,40435NC0190001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,40435,HIOS,3,2014-08-28 04:23:13,3,40435,NC,SHOP (Small Group),Yes,13-5581829,40435NC0190001,Family Basic Dental Plan (Low),40435NC019,,NCN003,NCS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$19.32,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49098,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49097,,40435NC0190001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,40435,HIOS,3,2014-08-28 04:23:13,4,40435,NC,SHOP (Small Group),Yes,13-5581829,40435NC0200001,Family Enhanced Dental Plan (High),40435NC020,,NCN004,NCS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$24.14,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49100,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49099,,40435NC0200001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,40435,HIOS,3,2014-08-28 04:23:13,4,40435,NC,SHOP (Small Group),Yes,13-5581829,40435NC0200001,Family Enhanced Dental Plan (High),40435NC020,,NCN004,NCS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$24.14,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49100,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49099,,40435NC0200001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,1,54332,NC,Individual,No,56-1461010,54332NC0030003,UnitedHealthcare Gold Compass HSA 1300,54332NC003,,NCN001,NCS001,NCF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030003-00,Standard Gold Off Exchange Plan,79.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,1,54332,NC,Individual,No,56-1461010,54332NC0030003,UnitedHealthcare Gold Compass HSA 1300,54332NC003,,NCN001,NCS001,NCF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030003-01,Standard Gold On Exchange Plan,79.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,1,54332,NC,Individual,No,56-1461010,54332NC0030003,UnitedHealthcare Gold Compass HSA 1300,54332NC003,,NCN001,NCS001,NCF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,1,54332,NC,Individual,No,56-1461010,54332NC0030003,UnitedHealthcare Gold Compass HSA 1300,54332NC003,,NCN001,NCS001,NCF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030003-03,Limited Cost Sharing Plan Variation,79.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,1,54332,NC,Individual,No,56-1461010,54332NC0030005,UnitedHealthcare Silver Compass HSA 3600,54332NC003,,NCN001,NCS001,NCF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030005-00,Standard Silver Off Exchange Plan,68.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,1,54332,NC,Individual,No,56-1461010,54332NC0030005,UnitedHealthcare Silver Compass HSA 3600,54332NC003,,NCN001,NCS001,NCF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030005-01,Standard Silver On Exchange Plan,68.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,1,54332,NC,Individual,No,56-1461010,54332NC0030005,UnitedHealthcare Silver Compass HSA 3600,54332NC003,,NCN001,NCS001,NCF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030005-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,1,54332,NC,Individual,No,56-1461010,54332NC0030005,UnitedHealthcare Silver Compass HSA 3600,54332NC003,,NCN001,NCS001,NCF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030005-03,Limited Cost Sharing Plan Variation,68.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,1,54332,NC,Individual,No,56-1461010,54332NC0030005,UnitedHealthcare Silver Compass HSA 3600,54332NC003,,NCN001,NCS001,NCF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030005-04,73% AV Level Silver Plan,72.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,1,54332,NC,Individual,No,56-1461010,54332NC0030005,UnitedHealthcare Silver Compass HSA 3600,54332NC003,,NCN001,NCS001,NCF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030005-05,87% AV Level Silver Plan,86.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,1,54332,NC,Individual,No,56-1461010,54332NC0030005,UnitedHealthcare Silver Compass HSA 3600,54332NC003,,NCN001,NCS001,NCF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030005-06,94% AV Level Silver Plan,93.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,1,54332,NC,Individual,No,56-1461010,54332NC0030008,UnitedHealthcare Bronze Compass HSA 5000,54332NC003,,NCN001,NCS001,NCF004,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030008-00,Standard Bronze Off Exchange Plan,60.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,1,54332,NC,Individual,No,56-1461010,54332NC0030008,UnitedHealthcare Bronze Compass HSA 5000,54332NC003,,NCN001,NCS001,NCF004,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030008-01,Standard Bronze On Exchange Plan,60.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,1,54332,NC,Individual,No,56-1461010,54332NC0030008,UnitedHealthcare Bronze Compass HSA 5000,54332NC003,,NCN001,NCS001,NCF004,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030008-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,17
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,1,54332,NC,Individual,No,56-1461010,54332NC0030008,UnitedHealthcare Bronze Compass HSA 5000,54332NC003,,NCN001,NCS001,NCF004,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030008-03,Limited Cost Sharing Plan Variation,60.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,1,54332,NC,Individual,No,56-1461010,54332NC0030009,UnitedHealthcare Bronze Compass HSA 6275,54332NC003,,NCN001,NCS001,NCF002,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030009-00,Standard Bronze Off Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,275","$12,550",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,1,54332,NC,Individual,No,56-1461010,54332NC0030009,UnitedHealthcare Bronze Compass HSA 6275,54332NC003,,NCN001,NCS001,NCF002,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030009-01,Standard Bronze On Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,275","$12,550",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,1,54332,NC,Individual,No,56-1461010,54332NC0030009,UnitedHealthcare Bronze Compass HSA 6275,54332NC003,,NCN001,NCS001,NCF002,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030009-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,21
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,1,54332,NC,Individual,No,56-1461010,54332NC0030009,UnitedHealthcare Bronze Compass HSA 6275,54332NC003,,NCN001,NCS001,NCF002,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030009-03,Limited Cost Sharing Plan Variation,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,275","$12,550",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,3,54332,NC,Individual,No,56-1461010,54332NC0030004,UnitedHealthcare Silver Compass 2000,54332NC003,,NCN001,NCS001,NCF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030004-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,3,54332,NC,Individual,No,56-1461010,54332NC0030004,UnitedHealthcare Silver Compass 2000,54332NC003,,NCN001,NCS001,NCF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030004-03,Limited Cost Sharing Plan Variation,70.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,3,54332,NC,Individual,No,56-1461010,54332NC0030004,UnitedHealthcare Silver Compass 2000,54332NC003,,NCN001,NCS001,NCF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030004-04,73% AV Level Silver Plan,73.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,600","$3,200",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,3,54332,NC,Individual,No,56-1461010,54332NC0030004,UnitedHealthcare Silver Compass 2000,54332NC003,,NCN001,NCS001,NCF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030004-05,87% AV Level Silver Plan,86.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,3,54332,NC,Individual,No,56-1461010,54332NC0030004,UnitedHealthcare Silver Compass 2000,54332NC003,,NCN001,NCS001,NCF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030004-06,94% AV Level Silver Plan,93.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,3,54332,NC,Individual,No,56-1461010,54332NC0030006,UnitedHealthcare Silver Compass 5000,54332NC003,,NCN001,NCS001,NCF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030006-00,Standard Silver Off Exchange Plan,68.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,3,54332,NC,Individual,No,56-1461010,54332NC0030006,UnitedHealthcare Silver Compass 5000,54332NC003,,NCN001,NCS001,NCF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030006-01,Standard Silver On Exchange Plan,68.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,3,54332,NC,Individual,No,56-1461010,54332NC0030006,UnitedHealthcare Silver Compass 5000,54332NC003,,NCN001,NCS001,NCF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030006-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,3,54332,NC,Individual,No,56-1461010,54332NC0030006,UnitedHealthcare Silver Compass 5000,54332NC003,,NCN001,NCS001,NCF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030006-03,Limited Cost Sharing Plan Variation,68.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,NC,54332,HIOS,9,2014-12-11 04:09:12,3,54332,NC,Individual,No,56-1461010,54332NC0030006,UnitedHealthcare Silver Compass 5000,54332NC003,,NCN001,NCS001,NCF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnc,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnc,54332NC0030006-04,73% AV Level Silver Plan,72.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,600","$7,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,1,56346,NC,Individual,No,20-0229117,56346NC0050001,Coventry Bronze $15 Copay Carolinas HealthCare,56346NC005,,NCN008,NCS008,NCF023,New,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48344,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050001-00,Standard Bronze Off Exchange Plan,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,1,56346,NC,Individual,No,20-0229117,56346NC0050001,Coventry Bronze $15 Copay Carolinas HealthCare,56346NC005,,NCN008,NCS008,NCF023,New,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48344,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050001-01,Standard Bronze On Exchange Plan,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,21,56346,NC,Individual,No,20-0229117,56346NC0050008,Coventry Gold $0 Copay Carolinas HealthCare,56346NC005,,NCN008,NCS008,NCF030,New,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48390,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050008-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,21,56346,NC,Individual,No,20-0229117,56346NC0050008,Coventry Gold $0 Copay Carolinas HealthCare,56346NC005,,NCN008,NCS008,NCF030,New,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48390,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050008-03,Limited Cost Sharing Plan Variation,78.10%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$500,20%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,1,94482,NC,Individual,Yes,95-6042390,94482NC0020001,BESTOne Child Dental Plus,94482NC002,,NCN001,NCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$41.53,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BESTOne_Child_Dental_Plus_Plan.pdf,,94482NC0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,1,94482,NC,SHOP (Small Group),Yes,95-6042390,94482NC0010001,BEST Life Child Dental Plus,94482NC001,,NCN001,NCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$33.22,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BEST_Life_Child_Dental_Plus_Plan.pdf,,94482NC0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,2,94482,NC,SHOP (Small Group),Yes,95-6042390,94482NC0010002,BEST Life Child Dental,94482NC001,,NCN001,NCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.71,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BEST_Life_Child_Dental_Plan.pdf,,94482NC0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,28,56346,NC,Individual,No,20-0229117,56346NC0060006,Coventry Catastrophic 100% HMO CaroMont,56346NC006,,NCN002,NCS002,NCF050,New,HMO,Catastrophic,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48324,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060006-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,28,56346,NC,Individual,No,20-0229117,56346NC0060006,Coventry Catastrophic 100% HMO CaroMont,56346NC006,,NCN002,NCS002,NCF050,New,HMO,Catastrophic,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48324,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060006-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,29,56346,NC,Individual,No,20-0229117,56346NC0060007,Coventry Catastrophic 100% HMO Cornerstone,56346NC006,,NCN001,NCS001,NCF051,New,HMO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48368,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060007-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,29,56346,NC,Individual,No,20-0229117,56346NC0060007,Coventry Catastrophic 100% HMO Cornerstone,56346NC006,,NCN001,NCS001,NCF051,New,HMO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48368,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060007-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,30,56346,NC,Individual,No,20-0229117,56346NC0060008,Coventry Catastrophic 100% HMO Duke Medicine,56346NC006,,NCN004,NCS004,NCF052,New,HMO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48390,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060008-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,30,56346,NC,Individual,No,20-0229117,56346NC0060008,Coventry Catastrophic 100% HMO Duke Medicine,56346NC006,,NCN004,NCS004,NCF052,New,HMO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48390,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060008-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NC,56891,HIOS,3,2014-08-29 03:26:18,1,56891,NC,Individual,Yes,56-1018068,56891NC0030001,"Delta Dental Individual and Family Plans, EHB Certified",56891NC003,,NCN001,NCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.81,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same benefit level,Yes,,,,,56891NC0030001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,$50,$150,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,56891,HIOS,3,2014-08-29 03:26:18,1,56891,NC,SHOP (Small Group),Yes,56-1018068,56891NC0050001,"Delta Dental Group PPO, EHB Certified",56891NC005,,NCN001,NCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.96,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,56891NC0050001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,$50,$150,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,56891,HIOS,3,2014-08-29 03:26:18,1,56891,NC,SHOP (Small Group),Yes,56-1018068,56891NC0050002,"Delta Dental Group PPO, EHB Certified",56891NC005,,NCN001,NCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.87,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,56891NC0050002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,$75,$225,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,56891,HIOS,3,2014-08-29 03:26:18,1,56891,NC,Individual,Yes,56-1018068,56891NC0030002,"Delta Dental Individual and Family Plans, EHB Certified",56891NC003,,NCN001,NCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.46,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same benefit level,Yes,,,,,56891NC0030002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,$75,$225,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,56891,HIOS,3,2014-08-29 03:26:18,1,56891,NC,SHOP (Small Group),Yes,56-1018068,56891NC0050003,"Delta Dental Group PPO, EHB Certified",56891NC005,,NCN001,NCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.96,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,56891NC0050003-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,$50,$150,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NC,56891,HIOS,3,2014-08-29 03:26:18,1,56891,NC,SHOP (Small Group),Yes,56-1018068,56891NC0050004,"Delta Dental Group PPO, EHB Certified",56891NC005,,NCN001,NCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.87,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,56891NC0050004-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,$75,$225,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,13,56346,NC,Individual,No,20-0229117,56346NC0050015,Coventry Silver $10 Copay CaroMont,56346NC005,,NCN007,NCS007,NCF037,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48336,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050015-01,Standard Silver On Exchange Plan,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,13,56346,NC,Individual,No,20-0229117,56346NC0050015,Coventry Silver $10 Copay CaroMont,56346NC005,,NCN007,NCS007,NCF037,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48336,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050015-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,13,56346,NC,Individual,No,20-0229117,56346NC0050015,Coventry Silver $10 Copay CaroMont,56346NC005,,NCN007,NCS007,NCF037,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48336,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050015-03,Limited Cost Sharing Plan Variation,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,13,56346,NC,Individual,No,20-0229117,56346NC0050015,Coventry Silver $10 Copay CaroMont,56346NC005,,NCN007,NCS007,NCF037,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48336,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050015-04,73% AV Level Silver Plan,72.10%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$5,000","$10,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,13,56346,NC,Individual,No,20-0229117,56346NC0050015,Coventry Silver $10 Copay CaroMont,56346NC005,,NCN007,NCS007,NCF037,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48336,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050015-05,87% AV Level Silver Plan,86.50%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,"$1,500","$3,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$0,"$1,000",30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,13,56346,NC,Individual,No,20-0229117,56346NC0050015,Coventry Silver $10 Copay CaroMont,56346NC005,,NCN007,NCS007,NCF037,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48336,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050015-06,94% AV Level Silver Plan,93.20%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,$0,$0,20%,"$11,500","$23,000",Not Applicable,Not Applicable,$0,"$1,000",10%,Not Applicable,Not Applicable,20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,14,56346,NC,Individual,No,20-0229117,56346NC0050016,Coventry Silver $10 Copay Cornerstone,56346NC005,,NCN006,NCS006,NCF038,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48380,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050016-00,Standard Silver Off Exchange Plan,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,14,56346,NC,Individual,No,20-0229117,56346NC0050016,Coventry Silver $10 Copay Cornerstone,56346NC005,,NCN006,NCS006,NCF038,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48380,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050016-01,Standard Silver On Exchange Plan,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,14,56346,NC,Individual,No,20-0229117,56346NC0050016,Coventry Silver $10 Copay Cornerstone,56346NC005,,NCN006,NCS006,NCF038,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48380,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050016-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,14,56346,NC,Individual,No,20-0229117,56346NC0050016,Coventry Silver $10 Copay Cornerstone,56346NC005,,NCN006,NCS006,NCF038,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48380,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050016-03,Limited Cost Sharing Plan Variation,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,14,56346,NC,Individual,No,20-0229117,56346NC0050016,Coventry Silver $10 Copay Cornerstone,56346NC005,,NCN006,NCS006,NCF038,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48380,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050016-04,73% AV Level Silver Plan,72.10%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$5,000","$10,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,14,56346,NC,Individual,No,20-0229117,56346NC0050016,Coventry Silver $10 Copay Cornerstone,56346NC005,,NCN006,NCS006,NCF038,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48380,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050016-05,87% AV Level Silver Plan,86.50%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,"$1,500","$3,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$0,"$1,000",30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,14,56346,NC,Individual,No,20-0229117,56346NC0050016,Coventry Silver $10 Copay Cornerstone,56346NC005,,NCN006,NCS006,NCF038,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48380,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050016-06,94% AV Level Silver Plan,93.20%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,$0,$0,20%,"$11,500","$23,000",Not Applicable,Not Applicable,$0,"$1,000",10%,Not Applicable,Not Applicable,20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,15,56346,NC,Individual,No,20-0229117,56346NC0050017,Coventry Silver $10 Copay Duke Medicine,56346NC005,,NCN009,NCS009,NCF039,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC49002,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050017-00,Standard Silver Off Exchange Plan,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,1,56346,NC,Individual,No,20-0229117,56346NC0050001,Coventry Bronze $15 Copay Carolinas HealthCare,56346NC005,,NCN008,NCS008,NCF023,New,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48344,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,1,56346,NC,Individual,No,20-0229117,56346NC0050001,Coventry Bronze $15 Copay Carolinas HealthCare,56346NC005,,NCN008,NCS008,NCF023,New,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48344,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050001-03,Limited Cost Sharing Plan Variation,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,2,56346,NC,Individual,No,20-0229117,56346NC0050002,Coventry Bronze $15 Copay CaroMont,56346NC005,,NCN007,NCS007,NCF024,New,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48322,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050002-00,Standard Bronze Off Exchange Plan,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,2,56346,NC,Individual,No,20-0229117,56346NC0050002,Coventry Bronze $15 Copay CaroMont,56346NC005,,NCN007,NCS007,NCF024,New,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48322,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050002-01,Standard Bronze On Exchange Plan,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,2,56346,NC,Individual,No,20-0229117,56346NC0050002,Coventry Bronze $15 Copay CaroMont,56346NC005,,NCN007,NCS007,NCF024,New,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48322,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,2,56346,NC,Individual,No,20-0229117,56346NC0050002,Coventry Bronze $15 Copay CaroMont,56346NC005,,NCN007,NCS007,NCF024,New,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48322,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050002-03,Limited Cost Sharing Plan Variation,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,3,56346,NC,Individual,No,20-0229117,56346NC0050003,Coventry Bronze $15 Copay Cornerstone,56346NC005,,NCN006,NCS006,NCF025,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48366,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050003-00,Standard Bronze Off Exchange Plan,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,3,56346,NC,Individual,No,20-0229117,56346NC0050003,Coventry Bronze $15 Copay Cornerstone,56346NC005,,NCN006,NCS006,NCF025,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48366,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050003-01,Standard Bronze On Exchange Plan,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,3,56346,NC,Individual,No,20-0229117,56346NC0050003,Coventry Bronze $15 Copay Cornerstone,56346NC005,,NCN006,NCS006,NCF025,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48366,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,3,56346,NC,Individual,No,20-0229117,56346NC0050003,Coventry Bronze $15 Copay Cornerstone,56346NC005,,NCN006,NCS006,NCF025,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48366,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050003-03,Limited Cost Sharing Plan Variation,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,4,56346,NC,Individual,No,20-0229117,56346NC0050004,Coventry Bronze $15 Copay Duke Medicine,56346NC005,,NCN009,NCS009,NCF026,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48388,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050004-00,Standard Bronze Off Exchange Plan,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,4,56346,NC,Individual,No,20-0229117,56346NC0050004,Coventry Bronze $15 Copay Duke Medicine,56346NC005,,NCN009,NCS009,NCF026,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48388,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050004-01,Standard Bronze On Exchange Plan,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,4,56346,NC,Individual,No,20-0229117,56346NC0050004,Coventry Bronze $15 Copay Duke Medicine,56346NC005,,NCN009,NCS009,NCF026,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48388,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,4,56346,NC,Individual,No,20-0229117,56346NC0050004,Coventry Bronze $15 Copay Duke Medicine,56346NC005,,NCN009,NCS009,NCF026,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48388,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050004-03,Limited Cost Sharing Plan Variation,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,5,56346,NC,Individual,No,20-0229117,56346NC0050005,Coventry Bronze $20 Copay,56346NC005,,NCN005,NCS005,NCF027,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48300,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050005-00,Standard Bronze Off Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,5,56346,NC,Individual,No,20-0229117,56346NC0050005,Coventry Bronze $20 Copay,56346NC005,,NCN005,NCS005,NCF027,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48300,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050005-01,Standard Bronze On Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,5,56346,NC,Individual,No,20-0229117,56346NC0050005,Coventry Bronze $20 Copay,56346NC005,,NCN005,NCS005,NCF027,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48300,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050005-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,5,56346,NC,Individual,No,20-0229117,56346NC0050005,Coventry Bronze $20 Copay,56346NC005,,NCN005,NCS005,NCF027,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48300,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050005-03,Limited Cost Sharing Plan Variation,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,6,56346,NC,Individual,No,20-0229117,56346NC0060001,Coventry Bronze Ded Only HSA Elig Carolinas HealthCare,56346NC006,,NCN003,NCS003,NCF045,New,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48345,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060001-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,7,56346,NC,Individual,No,20-0229117,56346NC0060002,Coventry Bronze Ded Only HSA Elig CaroMont,56346NC006,,NCN002,NCS002,NCF046,New,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48323,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060002-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,8,56346,NC,Individual,No,20-0229117,56346NC0060003,Coventry Bronze Ded Only HSA Elig Cornerstone,56346NC006,,NCN001,NCS001,NCF047,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48367,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060003-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,8,56346,NC,Individual,No,20-0229117,56346NC0060003,Coventry Bronze Ded Only HSA Elig Cornerstone,56346NC006,,NCN001,NCS001,NCF047,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48367,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060003-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,8,56346,NC,Individual,No,20-0229117,56346NC0060003,Coventry Bronze Ded Only HSA Elig Cornerstone,56346NC006,,NCN001,NCS001,NCF047,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48367,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,8,56346,NC,Individual,No,20-0229117,56346NC0060003,Coventry Bronze Ded Only HSA Elig Cornerstone,56346NC006,,NCN001,NCS001,NCF047,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48367,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060003-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,9,56346,NC,Individual,No,20-0229117,56346NC0060004,Coventry Bronze Ded Only HSA Elig Duke Medicine,56346NC006,,NCN004,NCS004,NCF048,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48389,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060004-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,9,56346,NC,Individual,No,20-0229117,56346NC0060004,Coventry Bronze Ded Only HSA Elig Duke Medicine,56346NC006,,NCN004,NCS004,NCF048,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48389,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060004-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,9,56346,NC,Individual,No,20-0229117,56346NC0060004,Coventry Bronze Ded Only HSA Elig Duke Medicine,56346NC006,,NCN004,NCS004,NCF048,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48389,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,12,56346,NC,Individual,No,20-0229117,56346NC0050014,Coventry Silver $10 Copay Carolinas HealthCare,56346NC005,,NCN008,NCS008,NCF036,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48358,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050014-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,12,56346,NC,Individual,No,20-0229117,56346NC0050014,Coventry Silver $10 Copay Carolinas HealthCare,56346NC005,,NCN008,NCS008,NCF036,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48358,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050014-03,Limited Cost Sharing Plan Variation,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,24,56346,NC,Individual,No,20-0229117,56346NC0050011,Coventry Gold $0 Copay Duke Medicine,56346NC005,,NCN009,NCS009,NCF033,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48391,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050011-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,24,56346,NC,Individual,No,20-0229117,56346NC0050011,Coventry Gold $0 Copay Duke Medicine,56346NC005,,NCN009,NCS009,NCF033,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48391,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050011-03,Limited Cost Sharing Plan Variation,78.10%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$500,20%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,25,56346,NC,Individual,No,20-0229117,56346NC0050012,Coventry Gold $5 Copay,56346NC005,,NCN005,NCS005,NCF034,New,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48303,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050012-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,25,56346,NC,Individual,No,20-0229117,56346NC0050012,Coventry Gold $5 Copay,56346NC005,,NCN005,NCS005,NCF034,New,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48303,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050012-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,14,27882,ND,Individual,Yes,41-0952670,27882ND0140001,Pediatric Dental B + Adult E,27882ND014,,NDN001,NDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0140001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,14,27882,ND,SHOP (Small Group),Yes,41-0952670,27882ND0300001,Pediatric Dental B + Adult E,27882ND030,,NDN001,NDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0300001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,14,27882,ND,Individual,Yes,41-0952670,27882ND0140001,Pediatric Dental B + Adult E,27882ND014,,NDN001,NDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0140001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,12,56346,NC,Individual,No,20-0229117,56346NC0050014,Coventry Silver $10 Copay Carolinas HealthCare,56346NC005,,NCN008,NCS008,NCF036,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48358,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050014-04,73% AV Level Silver Plan,72.10%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$5,000","$10,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,12,56346,NC,Individual,No,20-0229117,56346NC0050014,Coventry Silver $10 Copay Carolinas HealthCare,56346NC005,,NCN008,NCS008,NCF036,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48358,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050014-05,87% AV Level Silver Plan,86.50%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,"$1,500","$3,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$0,"$1,000",30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,12,56346,NC,Individual,No,20-0229117,56346NC0050014,Coventry Silver $10 Copay Carolinas HealthCare,56346NC005,,NCN008,NCS008,NCF036,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48358,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050014-06,94% AV Level Silver Plan,93.20%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,$0,$0,20%,"$11,500","$23,000",Not Applicable,Not Applicable,$0,"$1,000",10%,Not Applicable,Not Applicable,20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,13,56346,NC,Individual,No,20-0229117,56346NC0050015,Coventry Silver $10 Copay CaroMont,56346NC005,,NCN007,NCS007,NCF037,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48336,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050015-00,Standard Silver Off Exchange Plan,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,20,56346,NC,Individual,No,20-0229117,56346NC0050022,Coventry Silver $5 Copay 2750 Duke Medicine,56346NC005,,NCN009,NCS009,NCF044,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC49003,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050022-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,20,56346,NC,Individual,No,20-0229117,56346NC0050022,Coventry Silver $5 Copay 2750 Duke Medicine,56346NC005,,NCN009,NCS009,NCF044,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC49003,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050022-04,73% AV Level Silver Plan,72.70%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$4,500","$9,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,20,56346,NC,Individual,No,20-0229117,56346NC0050022,Coventry Silver $5 Copay 2750 Duke Medicine,56346NC005,,NCN009,NCS009,NCF044,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC49003,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050022-05,87% AV Level Silver Plan,86.40%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,"$1,500","$3,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,20,56346,NC,Individual,No,20-0229117,56346NC0050022,Coventry Silver $5 Copay 2750 Duke Medicine,56346NC005,,NCN009,NCS009,NCF044,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC49003,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050022-06,94% AV Level Silver Plan,93.20%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,21,56346,NC,Individual,No,20-0229117,56346NC0050008,Coventry Gold $0 Copay Carolinas HealthCare,56346NC005,,NCN008,NCS008,NCF030,New,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48390,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050008-00,Standard Gold Off Exchange Plan,78.10%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$500,20%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,21,56346,NC,Individual,No,20-0229117,56346NC0050008,Coventry Gold $0 Copay Carolinas HealthCare,56346NC005,,NCN008,NCS008,NCF030,New,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48390,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050008-01,Standard Gold On Exchange Plan,78.10%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$500,20%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,22,56346,NC,Individual,No,20-0229117,56346NC0050009,Coventry Gold $0 Copay CaroMont,56346NC005,,NCN007,NCS007,NCF031,New,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48325,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050009-00,Standard Gold Off Exchange Plan,78.10%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$500,20%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,22,56346,NC,Individual,No,20-0229117,56346NC0050009,Coventry Gold $0 Copay CaroMont,56346NC005,,NCN007,NCS007,NCF031,New,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48325,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050009-01,Standard Gold On Exchange Plan,78.10%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$500,20%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,22,56346,NC,Individual,No,20-0229117,56346NC0050009,Coventry Gold $0 Copay CaroMont,56346NC005,,NCN007,NCS007,NCF031,New,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48325,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050009-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,22,56346,NC,Individual,No,20-0229117,56346NC0050009,Coventry Gold $0 Copay CaroMont,56346NC005,,NCN007,NCS007,NCF031,New,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48325,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050009-03,Limited Cost Sharing Plan Variation,78.10%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$500,20%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,23,56346,NC,Individual,No,20-0229117,56346NC0050010,Coventry Gold $0 Copay Cornerstone,56346NC005,,NCN006,NCS006,NCF032,New,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48369,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050010-00,Standard Gold Off Exchange Plan,78.10%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$500,20%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,23,56346,NC,Individual,No,20-0229117,56346NC0050010,Coventry Gold $0 Copay Cornerstone,56346NC005,,NCN006,NCS006,NCF032,New,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48369,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050010-01,Standard Gold On Exchange Plan,78.10%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$500,20%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NC,82612,HIOS,12,2015-01-16 17:32:32,2,82612,NC,Individual,Yes,36-3757528,82612NC0020001,TruAssure Dental Preferred Plan,82612NC002,,NCN001,NCS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$41.75,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Beneftis,Yes,https://www.truassure.com/plan-information2?state=NC,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=NC,,82612NC0020001-00,Standard High Off Exchange Plan,83.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,82612,HIOS,12,2015-01-16 17:32:32,2,82612,NC,Individual,Yes,36-3757528,82612NC0020001,TruAssure Dental Preferred Plan,82612NC002,,NCN001,NCS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$41.75,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Beneftis,Yes,https://www.truassure.com/plan-information2?state=NC,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=NC,,82612NC0020001-01,Standard High On Exchange Plan,83.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,15,56346,NC,Individual,No,20-0229117,56346NC0050017,Coventry Silver $10 Copay Duke Medicine,56346NC005,,NCN009,NCS009,NCF039,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC49002,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050017-01,Standard Silver On Exchange Plan,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,15,56346,NC,Individual,No,20-0229117,56346NC0050017,Coventry Silver $10 Copay Duke Medicine,56346NC005,,NCN009,NCS009,NCF039,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC49002,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050017-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,15,56346,NC,Individual,No,20-0229117,56346NC0050017,Coventry Silver $10 Copay Duke Medicine,56346NC005,,NCN009,NCS009,NCF039,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC49002,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050017-03,Limited Cost Sharing Plan Variation,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,15,56346,NC,Individual,No,20-0229117,56346NC0050017,Coventry Silver $10 Copay Duke Medicine,56346NC005,,NCN009,NCS009,NCF039,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC49002,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050017-04,73% AV Level Silver Plan,72.10%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$5,000","$10,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,15,56346,NC,Individual,No,20-0229117,56346NC0050017,Coventry Silver $10 Copay Duke Medicine,56346NC005,,NCN009,NCS009,NCF039,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC49002,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050017-05,87% AV Level Silver Plan,86.50%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,"$1,500","$3,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$0,"$1,000",30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,15,56346,NC,Individual,No,20-0229117,56346NC0050017,Coventry Silver $10 Copay Duke Medicine,56346NC005,,NCN009,NCS009,NCF039,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC49002,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050017-06,94% AV Level Silver Plan,93.20%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,$0,$0,20%,"$11,500","$23,000",Not Applicable,Not Applicable,$0,"$1,000",10%,Not Applicable,Not Applicable,20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,16,56346,NC,Individual,No,20-0229117,56346NC0050018,Coventry Silver $5 Copay 2750,56346NC005,,NCN005,NCS005,NCF040,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48315,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050018-00,Standard Silver Off Exchange Plan,68.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,16,56346,NC,Individual,No,20-0229117,56346NC0050018,Coventry Silver $5 Copay 2750,56346NC005,,NCN005,NCS005,NCF040,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48315,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050018-01,Standard Silver On Exchange Plan,68.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,16,56346,NC,Individual,No,20-0229117,56346NC0050018,Coventry Silver $5 Copay 2750,56346NC005,,NCN005,NCS005,NCF040,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48315,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050018-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,16,56346,NC,Individual,No,20-0229117,56346NC0050018,Coventry Silver $5 Copay 2750,56346NC005,,NCN005,NCS005,NCF040,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48315,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050018-03,Limited Cost Sharing Plan Variation,68.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,16,56346,NC,Individual,No,20-0229117,56346NC0050018,Coventry Silver $5 Copay 2750,56346NC005,,NCN005,NCS005,NCF040,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48315,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050018-04,73% AV Level Silver Plan,72.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,16,56346,NC,Individual,No,20-0229117,56346NC0050018,Coventry Silver $5 Copay 2750,56346NC005,,NCN005,NCS005,NCF040,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48315,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050018-05,87% AV Level Silver Plan,86.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,16,56346,NC,Individual,No,20-0229117,56346NC0050018,Coventry Silver $5 Copay 2750,56346NC005,,NCN005,NCS005,NCF040,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48315,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050018-06,94% AV Level Silver Plan,93.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,17,56346,NC,Individual,No,20-0229117,56346NC0050019,Coventry Silver $5 Copay 2750 Carolinas HealthCare,56346NC005,,NCN008,NCS008,NCF041,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48359,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050019-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,17,56346,NC,Individual,No,20-0229117,56346NC0050019,Coventry Silver $5 Copay 2750 Carolinas HealthCare,56346NC005,,NCN008,NCS008,NCF041,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48359,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050019-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,17,56346,NC,Individual,No,20-0229117,56346NC0050019,Coventry Silver $5 Copay 2750 Carolinas HealthCare,56346NC005,,NCN008,NCS008,NCF041,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48359,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050019-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,17,56346,NC,Individual,No,20-0229117,56346NC0050019,Coventry Silver $5 Copay 2750 Carolinas HealthCare,56346NC005,,NCN008,NCS008,NCF041,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48359,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050019-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,17,56346,NC,Individual,No,20-0229117,56346NC0050019,Coventry Silver $5 Copay 2750 Carolinas HealthCare,56346NC005,,NCN008,NCS008,NCF041,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48359,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050019-04,73% AV Level Silver Plan,72.70%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$4,500","$9,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,17,56346,NC,Individual,No,20-0229117,56346NC0050019,Coventry Silver $5 Copay 2750 Carolinas HealthCare,56346NC005,,NCN008,NCS008,NCF041,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48359,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050019-05,87% AV Level Silver Plan,86.40%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,"$1,500","$3,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,17,56346,NC,Individual,No,20-0229117,56346NC0050019,Coventry Silver $5 Copay 2750 Carolinas HealthCare,56346NC005,,NCN008,NCS008,NCF041,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48359,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050019-06,94% AV Level Silver Plan,93.20%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,18,56346,NC,Individual,No,20-0229117,56346NC0050020,Coventry Silver $5 Copay 2750 CaroMont,56346NC005,,NCN007,NCS007,NCF042,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48337,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050020-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,18,56346,NC,Individual,No,20-0229117,56346NC0050020,Coventry Silver $5 Copay 2750 CaroMont,56346NC005,,NCN007,NCS007,NCF042,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48337,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050020-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,18,56346,NC,Individual,No,20-0229117,56346NC0050020,Coventry Silver $5 Copay 2750 CaroMont,56346NC005,,NCN007,NCS007,NCF042,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48337,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050020-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,18,56346,NC,Individual,No,20-0229117,56346NC0050020,Coventry Silver $5 Copay 2750 CaroMont,56346NC005,,NCN007,NCS007,NCF042,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48337,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050020-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,18,56346,NC,Individual,No,20-0229117,56346NC0050020,Coventry Silver $5 Copay 2750 CaroMont,56346NC005,,NCN007,NCS007,NCF042,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48337,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050020-04,73% AV Level Silver Plan,72.70%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$4,500","$9,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,18,56346,NC,Individual,No,20-0229117,56346NC0050020,Coventry Silver $5 Copay 2750 CaroMont,56346NC005,,NCN007,NCS007,NCF042,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48337,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050020-05,87% AV Level Silver Plan,86.40%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,"$1,500","$3,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,18,56346,NC,Individual,No,20-0229117,56346NC0050020,Coventry Silver $5 Copay 2750 CaroMont,56346NC005,,NCN007,NCS007,NCF042,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48337,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CaromontNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050020-06,94% AV Level Silver Plan,93.20%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,19,56346,NC,Individual,No,20-0229117,56346NC0050021,Coventry Silver $5 Copay 2750 Cornerstone,56346NC005,,NCN006,NCS006,NCF043,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48381,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050021-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,19,56346,NC,Individual,No,20-0229117,56346NC0050021,Coventry Silver $5 Copay 2750 Cornerstone,56346NC005,,NCN006,NCS006,NCF043,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48381,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050021-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,19,56346,NC,Individual,No,20-0229117,56346NC0050021,Coventry Silver $5 Copay 2750 Cornerstone,56346NC005,,NCN006,NCS006,NCF043,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48381,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050021-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,19,56346,NC,Individual,No,20-0229117,56346NC0050021,Coventry Silver $5 Copay 2750 Cornerstone,56346NC005,,NCN006,NCS006,NCF043,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48381,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050021-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,19,56346,NC,Individual,No,20-0229117,56346NC0050021,Coventry Silver $5 Copay 2750 Cornerstone,56346NC005,,NCN006,NCS006,NCF043,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48381,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050021-04,73% AV Level Silver Plan,72.70%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$4,500","$9,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,19,56346,NC,Individual,No,20-0229117,56346NC0050021,Coventry Silver $5 Copay 2750 Cornerstone,56346NC005,,NCN006,NCS006,NCF043,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48381,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050021-05,87% AV Level Silver Plan,86.40%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,"$1,500","$3,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,19,56346,NC,Individual,No,20-0229117,56346NC0050021,Coventry Silver $5 Copay 2750 Cornerstone,56346NC005,,NCN006,NCS006,NCF043,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48381,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050021-06,94% AV Level Silver Plan,93.20%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,20,56346,NC,Individual,No,20-0229117,56346NC0050022,Coventry Silver $5 Copay 2750 Duke Medicine,56346NC005,,NCN009,NCS009,NCF044,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC49003,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050022-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,20,56346,NC,Individual,No,20-0229117,56346NC0050022,Coventry Silver $5 Copay 2750 Duke Medicine,56346NC005,,NCN009,NCS009,NCF044,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC49003,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050022-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,20,56346,NC,Individual,No,20-0229117,56346NC0050022,Coventry Silver $5 Copay 2750 Duke Medicine,56346NC005,,NCN009,NCS009,NCF044,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC49003,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050022-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,23,56346,NC,Individual,No,20-0229117,56346NC0050010,Coventry Gold $0 Copay Cornerstone,56346NC005,,NCN006,NCS006,NCF032,New,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48369,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050010-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,23,56346,NC,Individual,No,20-0229117,56346NC0050010,Coventry Gold $0 Copay Cornerstone,56346NC005,,NCN006,NCS006,NCF032,New,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48369,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CornerstoneNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050010-03,Limited Cost Sharing Plan Variation,78.10%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$500,20%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,24,56346,NC,Individual,No,20-0229117,56346NC0050011,Coventry Gold $0 Copay Duke Medicine,56346NC005,,NCN009,NCS009,NCF033,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48391,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050011-00,Standard Gold Off Exchange Plan,78.10%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$500,20%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,24,56346,NC,Individual,No,20-0229117,56346NC0050011,Coventry Gold $0 Copay Duke Medicine,56346NC005,,NCN009,NCS009,NCF033,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48391,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/DukeNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050011-01,Standard Gold On Exchange Plan,78.10%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$500,20%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,25,56346,NC,Individual,No,20-0229117,56346NC0050012,Coventry Gold $5 Copay,56346NC005,,NCN005,NCS005,NCF034,New,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48303,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050012-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,25,56346,NC,Individual,No,20-0229117,56346NC0050012,Coventry Gold $5 Copay,56346NC005,,NCN005,NCS005,NCF034,New,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48303,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050012-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,26,56346,NC,Individual,No,20-0229117,56346NC0050007,Coventry Catastrophic 100%,56346NC005,,NCN005,NCS005,NCF029,New,POS,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48302,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050007-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,26,56346,NC,Individual,No,20-0229117,56346NC0050007,Coventry Catastrophic 100%,56346NC005,,NCN005,NCS005,NCF029,New,POS,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NC48302,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSNC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0050007-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,27,56346,NC,Individual,No,20-0229117,56346NC0060005,Coventry Catastrophic 100% HMO Carolinas HealthCare,56346NC006,,NCN003,NCS003,NCF049,New,HMO,Catastrophic,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48346,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060005-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NC,56346,HIOS,8,2015-01-17 03:15:53,27,56346,NC,Individual,No,20-0229117,56346NC0060005,Coventry Catastrophic 100% HMO Carolinas HealthCare,56346NC006,,NCN003,NCS003,NCF049,New,HMO,Catastrophic,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NC48346,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSHMONC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,56346NC0060005-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NC,56891,HIOS,3,2014-08-29 03:26:18,2,56891,NC,SHOP (Small Group),Yes,56-1018068,56891NC0060001,"Delta Dental Group Pediatric-Only, EHB Certified",56891NC006,,NCN001,NCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$34.96,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,56891NC0060001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,$50,$150,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,56891,HIOS,3,2014-08-29 03:26:18,2,56891,NC,Individual,Yes,56-1018068,56891NC0040001,"Delta Dental Individual Pediatric-Only, EHB Certified",56891NC004,,NCN001,NCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$36.81,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same benefit level,Yes,,,,,56891NC0040001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,$50,$150,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,56891,HIOS,3,2014-08-29 03:26:18,2,56891,NC,Individual,Yes,56-1018068,56891NC0040002,"Delta Dental Individual Pediatric-Only, EHB Certified",56891NC004,,NCN001,NCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$28.46,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same benefit level,Yes,,,,,56891NC0040002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,$75,$225,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,56891,HIOS,3,2014-08-29 03:26:18,2,56891,NC,SHOP (Small Group),Yes,56-1018068,56891NC0060002,"Delta Dental Group Pediatric-Only, EHB Certified",56891NC006,,NCN001,NCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.87,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,56891NC0060002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,$75,$225,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,56891,HIOS,3,2014-08-29 03:26:18,2,56891,NC,SHOP (Small Group),Yes,56-1018068,56891NC0060003,"Delta Dental Group Pediatric-Only, EHB Certified",56891NC006,,NCN001,NCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$34.96,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,56891NC0060003-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,$50,$150,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NC,56891,HIOS,3,2014-08-29 03:26:18,2,56891,NC,SHOP (Small Group),Yes,56-1018068,56891NC0060004,"Delta Dental Group Pediatric-Only, EHB Certified",56891NC006,,NCN001,NCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.87,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,56891NC0060004-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,$75,$225,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,4,94482,NC,SHOP (Small Group),Yes,95-6042390,94482NC0010011,BEST Dental Choice-L,94482NC001,,NCN001,NCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.71,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BESTDental_Choice-L_Plan.pdf,,94482NC0010011-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,4,94482,NC,Individual,Yes,95-6042390,94482NC0020006,BESTOne Dental Basic-Silver,94482NC002,,NCN001,NCS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.15,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BESTOne_Dental_Basic-Silver_Plan.pdf,,94482NC0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,4,94482,NC,Individual,Yes,95-6042390,94482NC0020006,BESTOne Dental Basic-Silver,94482NC002,,NCN001,NCS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.15,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BESTOne_Dental_Basic-Silver_Plan.pdf,,94482NC0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,4,94482,NC,SHOP (Small Group),Yes,95-6042390,94482NC0010011,BEST Dental Choice-L,94482NC001,,NCN001,NCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.71,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BESTDental_Choice-L_Plan.pdf,,94482NC0010011-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,4,94482,NC,SHOP (Small Group),Yes,95-6042390,94482NC0010012,BEST Dental Value,94482NC001,,NCN001,NCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.71,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BESTDental_Value_Plan.pdf,,94482NC0010012-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,4,94482,NC,SHOP (Small Group),Yes,95-6042390,94482NC0010012,BEST Dental Value,94482NC001,,NCN001,NCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.71,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BESTDental_Value_Plan.pdf,,94482NC0010012-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,1,27882,ND,Individual,Yes,41-0952670,27882ND0010001,Pediatric Dental A,27882ND001,,NDN001,NDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0010001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,1,27882,ND,SHOP (Small Group),Yes,41-0952670,27882ND0170001,Pediatric Dental A,27882ND017,,NDN001,NDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0170001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,1,27882,ND,Individual,Yes,41-0952670,27882ND0010001,Pediatric Dental A,27882ND001,,NDN001,NDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0010001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,2,27882,ND,Individual,Yes,41-0952670,27882ND0020001,Pediatric Dental A + Adult A,27882ND002,,NDN001,NDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0020001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,2,27882,ND,SHOP (Small Group),Yes,41-0952670,27882ND0180001,Pediatric Dental A + Adult A,27882ND018,,NDN001,NDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0180001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,2,27882,ND,Individual,Yes,41-0952670,27882ND0020001,Pediatric Dental A + Adult A,27882ND002,,NDN001,NDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0020001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,3,27882,ND,Individual,Yes,41-0952670,27882ND0030001,Pediatric Dental A + Adult B,27882ND003,,NDN001,NDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,3,27882,ND,SHOP (Small Group),Yes,41-0952670,27882ND0190001,Pediatric Dental A + Adult B,27882ND019,,NDN001,NDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0190001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,3,27882,ND,Individual,Yes,41-0952670,27882ND0030001,Pediatric Dental A + Adult B,27882ND003,,NDN001,NDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0030001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,4,27882,ND,Individual,Yes,41-0952670,27882ND0040001,Pediatric Dental A + Adult C,27882ND004,,NDN001,NDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,4,27882,ND,SHOP (Small Group),Yes,41-0952670,27882ND0200001,Pediatric Dental A + Adult C,27882ND020,,NDN001,NDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0200001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,4,27882,ND,Individual,Yes,41-0952670,27882ND0040001,Pediatric Dental A + Adult C,27882ND004,,NDN001,NDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0040001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,56964,HIOS,2,2014-08-07 10:00:19,1,56964,NC,SHOP (Small Group),Yes,93-0242990,56964NC0040002,EHB High PPO,56964NC004,,NCN001,NCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$46.02,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,56964NC0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,56964,HIOS,2,2014-08-07 10:00:19,1,56964,NC,SHOP (Small Group),Yes,93-0242990,56964NC0040001,EHB Low PPO,56964NC004,,NCN001,NCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.52,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,56964NC0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,56964,HIOS,2,2014-08-07 10:00:19,1,56964,NC,SHOP (Small Group),Yes,93-0242990,56964NC0030002,EHB High Passive,56964NC003,,NCN001,NCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$47.27,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,56964NC0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NC,56964,HIOS,2,2014-08-07 10:00:19,1,56964,NC,SHOP (Small Group),Yes,93-0242990,56964NC0030001,EHB Low Passive,56964NC003,,NCN001,NCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.69,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,56964NC0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NC,71499,HIOS,3,2014-08-07 10:00:19,1,71499,NC,SHOP (Small Group),Yes,44-0308260,71499NC0010001,KCL EHB Low R&C,71499NC001,,NCN001,NCS001,,New,Indemnity,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$48.56,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,71499NC0010001-00,Standard Low Off Exchange Plan,71.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,71499,HIOS,3,2014-08-07 10:00:19,1,71499,NC,SHOP (Small Group),Yes,44-0308260,71499NC0010003,KCL EHB Low MAC,71499NC001,,NCN001,NCS001,,New,Indemnity,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$32.19,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,71499NC0010003-00,Standard Low Off Exchange Plan,71.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,71499,HIOS,3,2014-08-07 10:00:19,1,71499,NC,SHOP (Small Group),Yes,44-0308260,71499NC0010005,KCL Fam Low R&C,71499NC001,,NCN001,NCS001,,New,Indemnity,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$48.56,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,71499NC0010005-00,Standard Low Off Exchange Plan,71.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NC,71499,HIOS,3,2014-08-07 10:00:19,1,71499,NC,SHOP (Small Group),Yes,44-0308260,71499NC0010007,KCL Fam Low MAC,71499NC001,,NCN001,NCS001,,New,Indemnity,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$32.19,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,71499NC0010007-00,Standard Low Off Exchange Plan,71.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NC,71499,HIOS,3,2014-08-07 10:00:19,2,71499,NC,SHOP (Small Group),Yes,44-0308260,71499NC0010002,KCL EHB High R&C,71499NC001,,NCN001,NCS001,,New,Indemnity,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$58.45,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,71499NC0010002-00,Standard High Off Exchange Plan,85.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,71499,HIOS,3,2014-08-07 10:00:19,2,71499,NC,SHOP (Small Group),Yes,44-0308260,71499NC0010004,KCL EHB High MAC,71499NC001,,NCN001,NCS001,,New,Indemnity,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$40.13,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,71499NC0010004-00,Standard High Off Exchange Plan,85.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,71499,HIOS,3,2014-08-07 10:00:19,2,71499,NC,SHOP (Small Group),Yes,44-0308260,71499NC0010006,KCL Fam High R&C,71499NC001,,NCN001,NCS001,,New,Indemnity,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$58.45,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,71499NC0010006-00,Standard High Off Exchange Plan,85.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NC,71499,HIOS,3,2014-08-07 10:00:19,2,71499,NC,SHOP (Small Group),Yes,44-0308260,71499NC0010008,KCL Fam High MAC,71499NC001,,NCN001,NCS001,,New,Indemnity,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$40.13,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,71499NC0010008-00,Standard High Off Exchange Plan,85.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NC,72839,HIOS,2,2014-08-08 08:53:29,1,72839,NC,Individual,Yes,72-0977315,72839NC0010001,AlwaysCare All-Star Kids Dental Plan,72839NC001,,NCN001,NCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.26,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,72839NC0010001-00,Standard High Off Exchange Plan,83.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,72839,HIOS,2,2014-08-08 08:53:29,1,72839,NC,SHOP (Small Group),Yes,72-0977315,72839NC0040001,AlwaysCare Small Group - Child,72839NC004,,NCN001,NCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$30.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,72839NC0040001-00,Standard High Off Exchange Plan,83.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,72839,HIOS,2,2014-08-08 08:53:29,1,72839,NC,SHOP (Small Group),Yes,72-0977315,72839NC0040002,AlwaysCare Small Group - Child,72839NC004,,NCN001,NCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.06,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,72839NC0040002-00,Standard Low Off Exchange Plan,68.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410011,BlueDirect 70 4250,37160ND241,,NDN001,NDS001,NDF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$200,14
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410011,BlueDirect 70 4250,37160ND241,,NDN001,NDS001,NDF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410011-03,Limited Cost Sharing Plan Variation,,0.598673403263092,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500",30%,,,,"$8,500","$17,000","$13,020","$25,500","$4,250",$0,$900,$200,"$4,250",$0,$300,$200,15
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440006,BlueDirect 50 4500,37160ND244,,NDN001,NDS001,NDF005,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440006-01,Standard Bronze On Exchange Plan,,0.586178600788116,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",50%,,,,"$9,000","$18,000","$13,500","$27,000","$4,500",$0,"$1,300",$200,"$4,500",$0,$300,$200,15
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440016,BlueDirect 100 5300,37160ND244,,NDN001,NDS001,NDF001,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440016-00,Standard Bronze Off Exchange Plan,,0.617985665798187,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$15,900","$31,800","$21,200","$42,400",,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",0%,,,,"$10,600","$21,200","$15,900","$31,800","$5,300",$0,$0,$200,"$5,110",$0,$0,$200,16
2015,ND,39364,HIOS,7,2014-12-10 11:54:40,2,39364,ND,SHOP (Small Group),No,41-1490988,39364ND0140010,Medica Passport ND 6000-0% HSA Bronze,39364ND014,,NDN001,NDS001,NDF004,New,PPO,Bronze,No,Both,No,Yes,Any member outside the members care system network.,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,39364ND0140010-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$9,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$9,900",0%,,,,"$7,000","$9,900",Not Applicable,Not Applicable,"$4,800",$0,$0,"$1,000","$5,300",$0,$0,$0,13
2015,ND,40479,HIOS,4,2014-09-04 03:25:43,1,40479,ND,SHOP (Small Group),Yes,35-0472300,40479ND0010001,Lincoln Dental Connect?,40479ND001,,NDN001,NDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.17,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,40479ND0010001-00,Standard High Off Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,40479,HIOS,4,2014-09-04 03:25:43,1,40479,ND,SHOP (Small Group),Yes,35-0472300,40479ND0010002,Lincoln Dental Connect?,40479ND001,,NDN001,NDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.49,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,40479ND0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,40479,HIOS,4,2014-09-04 03:25:43,1,40479,ND,SHOP (Small Group),Yes,35-0472300,40479ND0010003,Lincoln Dental Connect?,40479ND001,,NDN001,NDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.02,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,40479ND0010003-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,ND,40479,HIOS,4,2014-09-04 03:25:43,1,40479,ND,SHOP (Small Group),Yes,35-0472300,40479ND0010005,Lincoln Dental Connect?,40479ND001,,NDN001,NDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.04,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,40479ND0010005-00,Standard High Off Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,ND,40479,HIOS,4,2014-09-04 03:25:43,1,40479,ND,SHOP (Small Group),Yes,35-0472300,40479ND0010006,Lincoln Dental Connect?,40479ND001,,NDN001,NDS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.26,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,40479ND0010006-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,ND,40479,HIOS,4,2014-09-04 03:25:43,1,40479,ND,SHOP (Small Group),Yes,35-0472300,40479ND0010007,Lincoln Dental Connect?,40479ND001,,NDN001,NDS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.32,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,40479ND0010007-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,ND,40479,HIOS,4,2014-09-04 03:25:43,2,40479,ND,SHOP (Small Group),Yes,35-0472300,40479ND0010004,Lincoln Dental Connect?,40479ND001,,NDN001,NDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.08,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,40479ND0010004-00,Standard High Off Exchange Plan,86.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,40479,HIOS,4,2014-09-04 03:25:43,2,40479,ND,SHOP (Small Group),Yes,35-0472300,40479ND0010008,Lincoln Dental Connect?,40479ND001,,NDN001,NDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.28,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,40479ND0010008-00,Standard High Off Exchange Plan,86.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,54993,HIOS,2,2014-08-08 08:53:29,1,54993,ND,Individual,Yes,47-0397286,54993ND0010001,"Delta Dental Individual PPO, EHB Certified",54993ND001,,NDN002,NDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.27,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,54993ND0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,54993,HIOS,2,2014-08-08 08:53:29,1,54993,ND,SHOP (Small Group),Yes,47-0397286,54993ND0030001,"Renaissance Group Dental PPO, EHB Certified",54993ND003,,NDN001,NDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.67,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,54993ND0030001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,54993,HIOS,2,2014-08-08 08:53:29,1,54993,ND,SHOP (Small Group),Yes,47-0397286,54993ND0030002,"Renaissance Group Dental PPO, EHB Certified",54993ND003,,NDN001,NDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.59,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,54993ND0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,54993,HIOS,2,2014-08-08 08:53:29,1,54993,ND,Individual,Yes,47-0397286,54993ND0010002,"Delta Dental Individual PPO, EHB Certified",54993ND001,,NDN002,NDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.76,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,54993ND0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,54993,HIOS,2,2014-08-08 08:53:29,1,54993,ND,Individual,Yes,47-0397286,54993ND0020001,"Renaissance Individual Dental PPO, EHB Certified",54993ND002,,NDN001,NDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.66,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,54993ND0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,ND,54993,HIOS,2,2014-08-08 08:53:29,1,54993,ND,Individual,Yes,47-0397286,54993ND0020002,"Renaissance Individual Dental PPO, EHB Certified",54993ND002,,NDN001,NDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.88,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,54993ND0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NC,72839,HIOS,2,2014-08-08 08:53:29,1,72839,NC,Individual,Yes,72-0977315,72839NC0010002,AlwaysCare All-Star Kids Dental Plan,72839NC001,,NCN001,NCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$20.47,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,72839NC0010002-00,Standard Low Off Exchange Plan,68.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,72839,HIOS,2,2014-08-08 08:53:29,2,72839,NC,Individual,Yes,72-0977315,72839NC0020001,AlwaysCare All-Star Family Dental Plan,72839NC002,,NCN001,NCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.26,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,72839NC0020001-00,Standard High Off Exchange Plan,83.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,72839,HIOS,2,2014-08-08 08:53:29,2,72839,NC,SHOP (Small Group),Yes,72-0977315,72839NC0030001,AlwaysCare Small Group Dental - Adults,72839NC003,,NCN001,NCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,72839NC0030001-00,Standard High Off Exchange Plan,83.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,72839,HIOS,2,2014-08-08 08:53:29,2,72839,NC,SHOP (Small Group),Yes,72-0977315,72839NC0030002,AlwaysCare Small Group Dental - Adults,72839NC003,,NCN001,NCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.06,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,72839NC0030002-00,Standard Low Off Exchange Plan,68.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,72839,HIOS,2,2014-08-08 08:53:29,2,72839,NC,Individual,Yes,72-0977315,72839NC0020002,AlwaysCare All-Star Family Dental Plan,72839NC002,,NCN001,NCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.47,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,72839NC0020002-00,Standard Low Off Exchange Plan,68.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,76994,HIOS,2,2014-08-07 10:00:19,1,76994,NC,SHOP (Small Group),Yes,36-0883760,76994NC0040002,EHB High PPO,76994NC004,,NCN001,NCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.88,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,76994NC0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,76994,HIOS,2,2014-08-07 10:00:19,1,76994,NC,SHOP (Small Group),Yes,36-0883760,76994NC0040001,EHB Low PPO,76994NC004,,NCN001,NCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.45,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,76994NC0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,76994,HIOS,2,2014-08-07 10:00:19,1,76994,NC,SHOP (Small Group),Yes,36-0883760,76994NC0030002,EHB High Passive,76994NC003,,NCN001,NCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$47.13,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,76994NC0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NC,76994,HIOS,2,2014-08-07 10:00:19,1,76994,NC,SHOP (Small Group),Yes,36-0883760,76994NC0030001,EHB Low Passive,76994NC003,,NCN001,NCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.60,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,76994NC0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NC,82612,HIOS,12,2015-01-16 17:32:32,1,82612,NC,Individual,Yes,36-3757528,82612NC0010001,TruAssure Dental Basic Plan,82612NC001,,NCN001,NCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.61,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=NC,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=NC,,82612NC0010001-00,Standard Low Off Exchange Plan,68.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$155,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,82612,HIOS,12,2015-01-16 17:32:32,1,82612,NC,SHOP (Small Group),Yes,36-3757528,82612NC0030001,TruAssure Dental Small Group Basic Plan,82612NC003,,NCN001,NCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$47.56,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=NC,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=NC,,82612NC0030001-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,82612,HIOS,12,2015-01-16 17:32:32,1,82612,NC,SHOP (Small Group),Yes,36-3757528,82612NC0040001,TruAssure Dental Small Group Preferred Plan,82612NC004,,NCN001,NCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$47.56,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=NC,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=NC,,82612NC0040001-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,82612,HIOS,12,2015-01-16 17:32:32,1,82612,NC,Individual,Yes,36-3757528,82612NC0010001,TruAssure Dental Basic Plan,82612NC001,,NCN001,NCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.61,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=NC,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=NC,,82612NC0010001-01,Standard Low On Exchange Plan,68.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$155,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,2,94482,NC,Individual,Yes,95-6042390,94482NC0020002,BESTOne Child Dental,94482NC002,,NCN001,NCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$32.15,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BESTOne_Child_Dental_Plan.pdf,,94482NC0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,3,94482,NC,Individual,Yes,95-6042390,94482NC0020003,BESTOne Dental Advantage-Gold,94482NC002,,NCN001,NCS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$41.53,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BESTOne_Dental_Advantage-Gold_Plan.pdf,,94482NC0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,3,94482,NC,SHOP (Small Group),Yes,95-6042390,94482NC0010007,BEST Dental Premium,94482NC001,,NCN001,NCS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.22,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BESTDental_Premium_Plan.pdf,,94482NC0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,3,94482,NC,SHOP (Small Group),Yes,95-6042390,94482NC0010007,BEST Dental Premium,94482NC001,,NCN001,NCS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.22,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BESTDental_Premium_Plan.pdf,,94482NC0010007-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,3,94482,NC,Individual,Yes,95-6042390,94482NC0020003,BESTOne Dental Advantage-Gold,94482NC002,,NCN001,NCS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$41.53,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BESTOne_Dental_Advantage-Gold_Plan.pdf,,94482NC0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,3,94482,NC,Individual,Yes,95-6042390,94482NC0020004,BESTOne Dental Plus-Gold,94482NC002,,NCN001,NCS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$41.53,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BESTOne_Dental_Plus-Gold_Plan.pdf,,94482NC0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,3,94482,NC,SHOP (Small Group),Yes,95-6042390,94482NC0010008,BEST Dental Standard-H,94482NC001,,NCN001,NCS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.22,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BESTDental_Standard-H_Plan.pdf,,94482NC0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,3,94482,NC,SHOP (Small Group),Yes,95-6042390,94482NC0010008,BEST Dental Standard-H,94482NC001,,NCN001,NCS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.22,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BESTDental_Standard-H_Plan.pdf,,94482NC0010008-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,3,94482,NC,Individual,Yes,95-6042390,94482NC0020004,BESTOne Dental Plus-Gold,94482NC002,,NCN001,NCS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$41.53,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BESTOne_Dental_Plus-Gold_Plan.pdf,,94482NC0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,3,94482,NC,SHOP (Small Group),Yes,95-6042390,94482NC0010010,BEST Dental Choice-H,94482NC001,,NCN001,NCS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.22,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BESTDental_Choice-H_Plan.pdf,,94482NC0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,3,94482,NC,SHOP (Small Group),Yes,95-6042390,94482NC0010010,BEST Dental Choice-H,94482NC001,,NCN001,NCS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.22,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BESTDental_Choice-H_Plan.pdf,,94482NC0010010-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,4,94482,NC,SHOP (Small Group),Yes,95-6042390,94482NC0010009,BEST Dental Standard-L,94482NC001,,NCN001,NCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.71,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BESTDental_Standard-L_Plan.pdf,,94482NC0010009-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,4,94482,NC,Individual,Yes,95-6042390,94482NC0020005,BESTOne Dental Plus-Silver,94482NC002,,NCN001,NCS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.15,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BESTOne_Dental_Plus-Silver_Plan.pdf,,94482NC0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,4,94482,NC,Individual,Yes,95-6042390,94482NC0020005,BESTOne Dental Plus-Silver,94482NC002,,NCN001,NCS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.15,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BESTOne_Dental_Plus-Silver_Plan.pdf,,94482NC0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NC,94482,HIOS,6,2014-10-02 12:25:15,4,94482,NC,SHOP (Small Group),Yes,95-6042390,94482NC0010009,BEST Dental Standard-L,94482NC001,,NCN001,NCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.71,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NC/2015/NC_BESTDental_Standard-L_Plan.pdf,,94482NC0010009-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,5,27882,ND,Individual,Yes,41-0952670,27882ND0050001,Pediatric Dental A + Adult D,27882ND005,,NDN001,NDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0050001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,5,27882,ND,SHOP (Small Group),Yes,41-0952670,27882ND0210001,Pediatric Dental A + Adult D,27882ND021,,NDN001,NDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0210001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,5,27882,ND,Individual,Yes,41-0952670,27882ND0050001,Pediatric Dental A + Adult D,27882ND005,,NDN001,NDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0050001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,6,27882,ND,Individual,Yes,41-0952670,27882ND0060001,Pediatric Dental A + Adult E,27882ND006,,NDN001,NDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0060001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,6,27882,ND,SHOP (Small Group),Yes,41-0952670,27882ND0220001,Pediatric Dental A + Adult E,27882ND022,,NDN001,NDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0220001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,6,27882,ND,Individual,Yes,41-0952670,27882ND0060001,Pediatric Dental A + Adult E,27882ND006,,NDN001,NDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0060001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,7,27882,ND,Individual,Yes,41-0952670,27882ND0070001,Pediatric Dental A + Adult F,27882ND007,,NDN001,NDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0070001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,7,27882,ND,SHOP (Small Group),Yes,41-0952670,27882ND0230001,Pediatric Dental A + Adult F,27882ND023,,NDN001,NDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0230001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,7,27882,ND,Individual,Yes,41-0952670,27882ND0070001,Pediatric Dental A + Adult F,27882ND007,,NDN001,NDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0070001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,8,27882,ND,Individual,Yes,41-0952670,27882ND0080001,Pediatric Dental A + Adult G,27882ND008,,NDN001,NDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0080001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,8,27882,ND,SHOP (Small Group),Yes,41-0952670,27882ND0240001,Pediatric Dental A + Adult G,27882ND024,,NDN001,NDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0240001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,8,27882,ND,Individual,Yes,41-0952670,27882ND0080001,Pediatric Dental A + Adult G,27882ND008,,NDN001,NDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0080001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,9,27882,ND,Individual,Yes,41-0952670,27882ND0090001,Pediatric Dental B,27882ND009,,NDN001,NDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0090001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,9,27882,ND,SHOP (Small Group),Yes,41-0952670,27882ND0250001,Pediatric Dental B,27882ND025,,NDN001,NDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0250001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,9,27882,ND,Individual,Yes,41-0952670,27882ND0090001,Pediatric Dental B,27882ND009,,NDN001,NDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0090001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,10,27882,ND,Individual,Yes,41-0952670,27882ND0100001,Pediatric Dental B + Adult A,27882ND010,,NDN001,NDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0100001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,10,27882,ND,SHOP (Small Group),Yes,41-0952670,27882ND0260001,Pediatric Dental B + Adult A,27882ND026,,NDN001,NDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0260001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,10,27882,ND,Individual,Yes,41-0952670,27882ND0100001,Pediatric Dental B + Adult A,27882ND010,,NDN001,NDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0100001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,11,27882,ND,Individual,Yes,41-0952670,27882ND0110001,Pediatric Dental B + Adult B,27882ND011,,NDN001,NDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0110001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,11,27882,ND,SHOP (Small Group),Yes,41-0952670,27882ND0270001,Pediatric Dental B + Adult B,27882ND027,,NDN001,NDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0270001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,11,27882,ND,Individual,Yes,41-0952670,27882ND0110001,Pediatric Dental B + Adult B,27882ND011,,NDN001,NDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0110001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,12,27882,ND,Individual,Yes,41-0952670,27882ND0120001,Pediatric Dental B + Adult C,27882ND012,,NDN001,NDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0120001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,12,27882,ND,SHOP (Small Group),Yes,41-0952670,27882ND0280001,Pediatric Dental B + Adult C,27882ND028,,NDN001,NDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0280001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,12,27882,ND,Individual,Yes,41-0952670,27882ND0120001,Pediatric Dental B + Adult C,27882ND012,,NDN001,NDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0120001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,13,27882,ND,Individual,Yes,41-0952670,27882ND0130001,Pediatric Dental B + Adult D,27882ND013,,NDN001,NDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0130001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,13,27882,ND,SHOP (Small Group),Yes,41-0952670,27882ND0290001,Pediatric Dental B + Adult D,27882ND029,,NDN001,NDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0290001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,13,27882,ND,Individual,Yes,41-0952670,27882ND0130001,Pediatric Dental B + Adult D,27882ND013,,NDN001,NDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0130001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,39364,HIOS,7,2014-12-10 11:54:40,2,39364,ND,SHOP (Small Group),No,41-1490988,39364ND0140005,Medica Passport ND 1300-20% HSA Gold,39364ND014,,NDN001,NDS001,NDF001,Existing,PPO,Gold,No,Both,No,Yes,Any member outside the members care system network.,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,39364ND0140005-01,Standard Gold On Exchange Plan,,0.780426740646362,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$1,300",$0,$700,"$1,000","$1,300",$0,$800,$0,5
2015,ND,39364,HIOS,7,2014-12-10 11:54:40,2,39364,ND,SHOP (Small Group),No,41-1490988,39364ND0140006,Medica Passport ND 1750-25% HSA Silver,39364ND014,,NDN001,NDS001,NDF002,Existing,PPO,Silver,No,Both,No,Yes,Any member outside the members care system network.,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,39364ND0140006-00,Standard Silver Off Exchange Plan,,0.680849492549896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",25%,,,,"$5,000","$9,900",Not Applicable,Not Applicable,"$1,750",$0,$800,"$1,000","$1,750",$0,$900,$0,6
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410002,BlueCare 70 2500,37160ND241,,NDN001,NDS001,NDF009,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410002-05,87% AV Level Silver Plan,,0.863138735294342,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$6,750","$13,500",,,,,,,,,,,,,,,,,,,,,$550,"$1,100",20%,,,,"$1,100","$2,200","$1,650","$3,300",$550,$10,"$1,300",$200,$200,$360,$0,$200,9
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410002,BlueCare 70 2500,37160ND241,,NDN001,NDS001,NDF009,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410002-06,94% AV Level Silver Plan,,0.932118773460388,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,$0,$0,$0,$0,$0,$10,$700,$200,$0,$360,$20,$200,10
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440010,BlueCare 90 1350,37160ND244,,NDN001,NDS001,NDF006,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440010-00,Standard Gold Off Exchange Plan,,0.780312240123749,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",10%,,,,"$2,700","$5,400","$4,050","$8,100","$1,350",$20,$600,$200,$200,$560,$0,$200,10
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440010,BlueCare 90 1350,37160ND244,,NDN001,NDS001,NDF006,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440010-01,Standard Gold On Exchange Plan,,0.780312240123749,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",10%,,,,"$2,700","$5,400","$4,050","$8,100","$1,350",$20,$600,$200,$200,$560,$0,$200,11
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410012,BlueDirect 50 3500,37160ND241,,NDN001,NDS001,NDF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410012-03,Limited Cost Sharing Plan Variation,,0.596491575241089,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",50%,,,,"$7,000","$14,000","$10,500","$21,000","$3,500",$0,"$1,800",$200,"$3,500",$0,$800,$200,19
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410013,BlueDirect 70 1500,37160ND241,,NDN001,NDS001,NDF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410013-00,Standard Silver Off Exchange Plan,,0.681234121322632,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000","$1,500",$0,"$1,700",$200,"$1,500",$0,"$1,100",$200,20
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440012,BlueCare 70 400,37160ND244,,NDN001,NDS001,NDF007,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440012-00,Standard Gold Off Exchange Plan,,0.781254351139069,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,$400,$800,30%,,,,$800,"$1,600","$1,200","$2,400",$400,$20,"$2,000",$200,$200,$560,$0,$200,14
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440012,BlueCare 70 400,37160ND244,,NDN001,NDS001,NDF007,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440012-01,Standard Gold On Exchange Plan,,0.781254351139069,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,$400,$800,30%,,,,$800,"$1,600","$1,200","$2,400",$400,$20,"$2,000",$200,$200,$560,$0,$200,15
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410004,BlueCare 80 2200,37160ND241,,NDN001,NDS001,NDF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410004-04,73% AV Level Silver Plan,,0.737104117870331,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000","$6,000","$12,000","$2,000",$20,"$1,000",$200,$200,$920,$0,$200,15
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410004,BlueCare 80 2200,37160ND241,,NDN001,NDS001,NDF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410004-05,87% AV Level Silver Plan,,0.863138735294342,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$6,750","$13,500",,,,,,,,,,,,,,,,,,,,,$550,"$1,100",20%,,,,"$1,100","$2,200","$1,650","$3,300",$550,$10,"$1,300",$200,$200,$360,$0,$200,16
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440013,BlueCare 70 1000,37160ND244,,NDN001,NDS001,NDF007,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440013-00,Standard Gold Off Exchange Plan,,0.781386315822601,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,350","$8,700",,,"$8,700","$17,400","$13,050","$26,100",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,"$2,000","$4,000","$3,000","$6,000","$1,000",$20,"$1,900",$200,$200,$560,$0,$200,16
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440013,BlueCare 70 1000,37160ND244,,NDN001,NDS001,NDF007,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440013-01,Standard Gold On Exchange Plan,,0.781386315822601,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,350","$8,700",,,"$8,700","$17,400","$13,050","$26,100",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,"$2,000","$4,000","$3,000","$6,000","$1,000",$20,"$1,900",$200,$200,$560,$0,$200,17
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410004,BlueCare 80 2200,37160ND241,,NDN001,NDS001,NDF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410004-00,Standard Silver Off Exchange Plan,,0.680692613124847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600",,,,,,,,,,,,,,,,,,,,,"$2,200","$4,400",20%,,,,"$4,400","$8,800","$6,600","$13,200","$2,200",$20,"$1,000",$200,$200,"$1,000",$0,$200,11
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410004,BlueCare 80 2200,37160ND241,,NDN001,NDS001,NDF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410004-01,Standard Silver On Exchange Plan,,0.680692613124847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600",,,,,,,,,,,,,,,,,,,,,"$2,200","$4,400",20%,,,,"$4,400","$8,800","$6,600","$13,200","$2,200",$20,"$1,000",$200,$200,"$1,000",$0,$200,12
2015,ND,39364,HIOS,7,2014-12-10 11:54:40,2,39364,ND,SHOP (Small Group),No,41-1490988,39364ND0140006,Medica Passport ND 1750-25% HSA Silver,39364ND014,,NDN001,NDS001,NDF002,Existing,PPO,Silver,No,Both,No,Yes,Any member outside the members care system network.,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,39364ND0140006-01,Standard Silver On Exchange Plan,,0.680849492549896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",25%,,,,"$5,000","$9,900",Not Applicable,Not Applicable,"$1,750",$0,$800,"$1,000","$1,750",$0,$900,$0,7
2015,ND,39364,HIOS,7,2014-12-10 11:54:40,2,39364,ND,SHOP (Small Group),No,41-1490988,39364ND0140009,Medica Passport ND 4950-50% HSA Bronze,39364ND014,,NDN001,NDS001,NDF003,Existing,PPO,Bronze,No,Both,No,Yes,Any member outside the members care system network.,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,39364ND0140009-00,Standard Bronze Off Exchange Plan,,0.583925843238831,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,950","$9,900",50%,,,,"$7,500","$9,900",Not Applicable,Not Applicable,"$4,800",$0,$0,"$1,000","$4,950",$0,$200,$0,8
2015,ND,39364,HIOS,7,2014-12-10 11:54:40,2,39364,ND,SHOP (Small Group),No,41-1490988,39364ND0140009,Medica Passport ND 4950-50% HSA Bronze,39364ND014,,NDN001,NDS001,NDF003,Existing,PPO,Bronze,No,Both,No,Yes,Any member outside the members care system network.,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,39364ND0140009-01,Standard Bronze On Exchange Plan,,0.583925843238831,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,950","$9,900",50%,,,,"$7,500","$9,900",Not Applicable,Not Applicable,"$4,800",$0,$0,"$1,000","$4,950",$0,$200,$0,9
2015,ND,39364,HIOS,7,2014-12-10 11:54:40,2,39364,ND,SHOP (Small Group),No,41-1490988,39364ND0140008,Medica Passport ND 3000-0% HSA Silver,39364ND014,,NDN001,NDS001,NDF004,New,PPO,Silver,No,Both,No,Yes,Any member outside the members care system network.,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,39364ND0140008-00,Standard Silver Off Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$3,000",$0,$0,"$1,000","$3,000",$0,$0,$0,10
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,15,27882,ND,Individual,Yes,41-0952670,27882ND0150001,Pediatric Dental B + Adult F,27882ND015,,NDN001,NDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0150001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,15,27882,ND,SHOP (Small Group),Yes,41-0952670,27882ND0310001,Pediatric Dental B + Adult F,27882ND031,,NDN001,NDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0310001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,15,27882,ND,Individual,Yes,41-0952670,27882ND0150001,Pediatric Dental B + Adult F,27882ND015,,NDN001,NDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0150001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,16,27882,ND,Individual,Yes,41-0952670,27882ND0160001,Pediatric Dental B + Adult G,27882ND016,,NDN001,NDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0160001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,16,27882,ND,SHOP (Small Group),Yes,41-0952670,27882ND0320001,Pediatric Dental B + Adult G,27882ND032,,NDN001,NDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0320001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,27882,HIOS,5,2015-01-22 10:35:59,16,27882,ND,Individual,Yes,41-0952670,27882ND0160001,Pediatric Dental B + Adult G,27882ND016,,NDN001,NDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,27882ND0160001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,32120,HIOS,4,2014-09-05 03:32:16,1,32120,ND,SHOP (Small Group),Yes,95-2371728,32120ND0020001,PPO MAC,32120ND002,,NDN001,NDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$34.13,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of ND,Yes,,,,,32120ND0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,32120,HIOS,4,2014-09-05 03:32:16,1,32120,ND,Individual,Yes,95-2371728,32120ND0010001,PPO MAC,32120ND001,,NDN001,NDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$48.22,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of ND,Yes,,,,,32120ND0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,32120,HIOS,4,2014-09-05 03:32:16,1,32120,ND,Individual,Yes,95-2371728,32120ND0010002,PPO MAC,32120ND001,,NDN001,NDS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$40.60,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of ND,Yes,,,,,32120ND0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$100,$300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,32120,HIOS,4,2014-09-05 03:32:16,1,32120,ND,SHOP (Small Group),Yes,95-2371728,32120ND0020002,PPO MAC,32120ND002,,NDN001,NDS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$27.08,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of ND,Yes,,,,,32120ND0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$100,$300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,32120,HIOS,4,2014-09-05 03:32:16,2,32120,ND,SHOP (Small Group),Yes,95-2371728,32120ND0020003,PPO MAC,32120ND002,,NDN001,NDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$35.19,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of ND,Yes,,,,,32120ND0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$200,$600,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,32120,HIOS,4,2014-09-05 03:32:16,2,32120,ND,Individual,Yes,95-2371728,32120ND0010003,PPO MAC,32120ND001,,NDN001,NDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$49.74,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of ND,Yes,,,,,32120ND0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$200,$600,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440001,BlueDirect 100 2100,37160ND244,,NDN001,NDS001,NDF001,Existing,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440001-00,Standard Gold Off Exchange Plan,,0.780541837215424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$6,300","$12,600","$8,400","$16,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400","$6,300","$12,600","$2,100",$0,$0,$200,"$2,100",$0,$0,$200,4
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410009,BlueDirect 100 5300,37160ND241,,NDN001,NDS001,NDF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410009-00,Standard Bronze Off Exchange Plan,,0.617985665798187,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$15,900","$31,800","$21,200","$42,400",,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",0%,,,,"$10,600","$21,200","$15,900","$31,800","$5,300",$0,$0,$200,"$5,110",$0,$0,$200,4
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410018,BlueDirect 100 2100,37160ND241,,NDN001,NDS001,NDF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410018-00,Standard Gold Off Exchange Plan,,0.780541837215424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$6,300","$12,600","$8,400","$16,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400","$6,300","$12,600","$2,100",$0,$0,$200,"$2,100",$0,$0,$200,42
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410018,BlueDirect 100 2100,37160ND241,,NDN001,NDS001,NDF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410018-01,Standard Gold On Exchange Plan,,0.780541837215424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$6,300","$12,600","$8,400","$16,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400","$6,300","$12,600","$2,100",$0,$0,$200,"$2,100",$0,$0,$200,43
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410018,BlueDirect 100 2100,37160ND241,,NDN001,NDS001,NDF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410018-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$200,44
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410018,BlueDirect 100 2100,37160ND241,,NDN001,NDS001,NDF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410018-03,Limited Cost Sharing Plan Variation,,0.780541837215424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$6,300","$12,600","$8,400","$16,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400","$6,300","$12,600","$2,100",$0,$0,$200,"$2,100",$0,$0,$200,45
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410020,BlueDirect 100 6300,37160ND241,,NDN001,NDS001,NDF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410020-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$18,900","$37,800","$25,200","$50,400",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200","$18,900","$37,800","$6,300",$0,$0,$200,"$5,100",$0,$0,$200,46
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410020,BlueDirect 100 6300,37160ND241,,NDN001,NDS001,NDF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410020-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$18,900","$37,800","$25,200","$50,400",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200","$18,900","$37,800","$6,300",$0,$0,$200,"$5,100",$0,$0,$200,47
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410009,BlueDirect 100 5300,37160ND241,,NDN001,NDS001,NDF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410009-01,Standard Bronze On Exchange Plan,,0.617985665798187,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$15,900","$31,800","$21,200","$42,400",,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",0%,,,,"$10,600","$21,200","$15,900","$31,800","$5,300",$0,$0,$200,"$5,110",$0,$0,$200,5
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440001,BlueDirect 100 2100,37160ND244,,NDN001,NDS001,NDF001,Existing,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440001-01,Standard Gold On Exchange Plan,,0.780541837215424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$6,300","$12,600","$8,400","$16,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400","$6,300","$12,600","$2,100",$0,$0,$200,"$2,100",$0,$0,$200,5
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440002,BlueDirect 90 1400,37160ND244,,NDN001,NDS001,NDF002,Existing,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440002-00,Standard Gold Off Exchange Plan,,0.780304431915283,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",10%,,,,"$2,800","$5,600","$4,200","$8,400","$1,400",$0,$600,$200,"$1,400",$0,$400,$200,6
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410009,BlueDirect 100 5300,37160ND241,,NDN001,NDS001,NDF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$200,6
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410009,BlueDirect 100 5300,37160ND241,,NDN001,NDS001,NDF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410009-03,Limited Cost Sharing Plan Variation,,0.617985665798187,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$15,900","$31,800","$21,200","$42,400",,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",0%,,,,"$10,600","$21,200","$15,900","$31,800","$5,300",$0,$0,$200,"$5,110",$0,$0,$200,7
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440002,BlueDirect 90 1400,37160ND244,,NDN001,NDS001,NDF002,Existing,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440002-01,Standard Gold On Exchange Plan,,0.780304431915283,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",10%,,,,"$2,800","$5,600","$4,200","$8,400","$1,400",$0,$600,$200,"$1,400",$0,$400,$200,7
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440003,BlueDirect 80 1400,37160ND244,,NDN001,NDS001,NDF003,Existing,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440003-00,Standard Gold Off Exchange Plan,,0.780071020126343,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600","$4,200","$8,400","$1,400",$0,"$1,100",$200,"$1,400",$0,$600,$200,8
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410010,BlueDirect 90 4900,37160ND241,,NDN001,NDS001,NDF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410010-00,Standard Bronze Off Exchange Plan,,0.603321611881256,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",10%,,,,"$9,800","$19,600","$14,700","$29,400","$4,900",$0,$200,$200,"$4,900",$0,$0,$200,8
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410010,BlueDirect 90 4900,37160ND241,,NDN001,NDS001,NDF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410010-01,Standard Bronze On Exchange Plan,,0.603321611881256,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",10%,,,,"$9,800","$19,600","$14,700","$29,400","$4,900",$0,$200,$200,"$4,900",$0,$0,$200,9
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440003,BlueDirect 80 1400,37160ND244,,NDN001,NDS001,NDF003,Existing,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440003-01,Standard Gold On Exchange Plan,,0.780071020126343,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600","$4,200","$8,400","$1,400",$0,"$1,100",$200,"$1,400",$0,$600,$200,9
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440004,BlueDirect 80 2000,37160ND244,,NDN001,NDS001,NDF003,Existing,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440004-00,Standard Silver Off Exchange Plan,,0.685117065906525,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000","$6,000","$12,000","$2,000",$0,"$1,000",$200,"$2,000",$0,$600,$200,10
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410010,BlueDirect 90 4900,37160ND241,,NDN001,NDS001,NDF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$200,10
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410010,BlueDirect 90 4900,37160ND241,,NDN001,NDS001,NDF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410010-03,Limited Cost Sharing Plan Variation,,0.603321611881256,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",10%,,,,"$9,800","$19,600","$14,700","$29,400","$4,900",$0,$200,$200,"$4,900",$0,$0,$200,11
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440004,BlueDirect 80 2000,37160ND244,,NDN001,NDS001,NDF003,Existing,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440004-01,Standard Silver On Exchange Plan,,0.685117065906525,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000","$6,000","$12,000","$2,000",$0,"$1,000",$200,"$2,000",$0,$600,$200,11
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440005,BlueDirect 70 1500,37160ND244,,NDN001,NDS001,NDF004,Existing,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440005-00,Standard Silver Off Exchange Plan,,0.681907296180725,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000","$1,500",$0,"$1,700",$200,"$1,500",$0,"$1,100",$200,12
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410011,BlueDirect 70 4250,37160ND241,,NDN001,NDS001,NDF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410011-00,Standard Bronze Off Exchange Plan,,0.598673403263092,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500",30%,,,,"$8,500","$17,000","$13,020","$25,500","$4,250",$0,$900,$200,"$4,250",$0,$300,$200,12
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410011,BlueDirect 70 4250,37160ND241,,NDN001,NDS001,NDF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410011-01,Standard Bronze On Exchange Plan,,0.598673403263092,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500",30%,,,,"$8,500","$17,000","$13,020","$25,500","$4,250",$0,$900,$200,"$4,250",$0,$300,$200,13
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440005,BlueDirect 70 1500,37160ND244,,NDN001,NDS001,NDF004,Existing,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440005-01,Standard Silver On Exchange Plan,,0.681907296180725,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000","$1,500",$0,"$1,700",$200,"$1,500",$0,"$1,100",$200,13
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440006,BlueDirect 50 4500,37160ND244,,NDN001,NDS001,NDF005,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440006-00,Standard Bronze Off Exchange Plan,,0.586178600788116,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",50%,,,,"$9,000","$18,000","$13,500","$27,000","$4,500",$0,"$1,300",$200,"$4,500",$0,$300,$200,14
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410012,BlueDirect 50 3500,37160ND241,,NDN001,NDS001,NDF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410012-00,Standard Bronze Off Exchange Plan,,0.596491575241089,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",50%,,,,"$7,000","$14,000","$10,500","$21,000","$3,500",$0,"$1,800",$200,"$3,500",$0,$800,$200,16
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410012,BlueDirect 50 3500,37160ND241,,NDN001,NDS001,NDF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410012-01,Standard Bronze On Exchange Plan,,0.596491575241089,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",50%,,,,"$7,000","$14,000","$10,500","$21,000","$3,500",$0,"$1,800",$200,"$3,500",$0,$800,$200,17
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440016,BlueDirect 100 5300,37160ND244,,NDN001,NDS001,NDF001,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440016-01,Standard Bronze On Exchange Plan,,0.617985665798187,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$15,900","$31,800","$21,200","$42,400",,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",0%,,,,"$10,600","$21,200","$15,900","$31,800","$5,300",$0,$0,$200,"$5,110",$0,$0,$200,17
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410012,BlueDirect 50 3500,37160ND241,,NDN001,NDS001,NDF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$200,18
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410013,BlueDirect 70 1500,37160ND241,,NDN001,NDS001,NDF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410013-01,Standard Silver On Exchange Plan,,0.681234121322632,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000","$1,500",$0,"$1,700",$200,"$1,500",$0,"$1,100",$200,21
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410013,BlueDirect 70 1500,37160ND241,,NDN001,NDS001,NDF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$200,22
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410013,BlueDirect 70 1500,37160ND241,,NDN001,NDS001,NDF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410013-03,Limited Cost Sharing Plan Variation,,0.681234121322632,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000","$1,500",$0,"$1,700",$200,"$1,500",$0,"$1,100",$200,23
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410013,BlueDirect 70 1500,37160ND241,,NDN001,NDS001,NDF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410013-04,73% AV Level Silver Plan,,0.739061772823334,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600","$4,200","$8,400","$1,400",$0,"$1,200",$200,"$1,400",$0,$700,$200,24
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410013,BlueDirect 70 1500,37160ND241,,NDN001,NDS001,NDF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410013-05,87% AV Level Silver Plan,,0.872048735618591,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$6,750","$13,500",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$0,$700,$200,$500,$0,$500,$200,25
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410013,BlueDirect 70 1500,37160ND241,,NDN001,NDS001,NDF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410013-06,94% AV Level Silver Plan,,0.931063115596771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,"$3,800","$7,600","$5,700","$11,400",,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,$0,$0,$0,$0,$0,$0,$700,$200,$0,$0,$500,$200,26
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410014,BlueDirect 80 2300,37160ND241,,NDN001,NDS001,NDF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410014-00,Standard Silver Off Exchange Plan,,0.680602014064789,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$10,600","$21,200","$15,900","$31,800",,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600",20%,,,,"$4,600","$9,200","$6,900","$13,800","$2,300",$0,"$1,000",$200,"$2,300",$0,$600,$200,27
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410014,BlueDirect 80 2300,37160ND241,,NDN001,NDS001,NDF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410014-01,Standard Silver On Exchange Plan,,0.680602014064789,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$10,600","$21,200","$15,900","$31,800",,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600",20%,,,,"$4,600","$9,200","$6,900","$13,800","$2,300",$0,"$1,000",$200,"$2,300",$0,$600,$200,28
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410014,BlueDirect 80 2300,37160ND241,,NDN001,NDS001,NDF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$200,29
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410014,BlueDirect 80 2300,37160ND241,,NDN001,NDS001,NDF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410014-03,Limited Cost Sharing Plan Variation,,0.680602014064789,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$10,600","$21,200","$15,900","$31,800",,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600",20%,,,,"$4,600","$9,200","$6,900","$13,800","$2,300",$0,"$1,000",$200,"$2,300",$0,$600,$200,30
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410014,BlueDirect 80 2300,37160ND241,,NDN001,NDS001,NDF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410014-04,73% AV Level Silver Plan,,0.739061772823334,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600","$4,200","$8,400","$1,400",$0,"$1,200",$200,"$1,400",$0,$700,$200,31
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410014,BlueDirect 80 2300,37160ND241,,NDN001,NDS001,NDF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410014-05,87% AV Level Silver Plan,,0.872048735618591,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$6,750","$13,500",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$0,$700,$200,$500,$0,$500,$200,32
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410014,BlueDirect 80 2300,37160ND241,,NDN001,NDS001,NDF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410014-06,94% AV Level Silver Plan,,0.931063115596771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,"$3,800","$7,600","$5,700","$11,400",,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,$0,$0,$0,$0,$0,$0,$700,$200,$0,$0,$500,$200,33
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410016,BlueDirect 80 1400,37160ND241,,NDN001,NDS001,NDF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410016-00,Standard Gold Off Exchange Plan,,0.780071020126343,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600","$4,200","$8,400","$1,400",$0,"$1,100",$200,"$1,400",$0,$600,$200,34
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410016,BlueDirect 80 1400,37160ND241,,NDN001,NDS001,NDF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410016-01,Standard Gold On Exchange Plan,,0.780071020126343,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600","$4,200","$8,400","$1,400",$0,"$1,100",$200,"$1,400",$0,$600,$200,35
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410016,BlueDirect 80 1400,37160ND241,,NDN001,NDS001,NDF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$200,36
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410016,BlueDirect 80 1400,37160ND241,,NDN001,NDS001,NDF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410016-03,Limited Cost Sharing Plan Variation,,0.780071020126343,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600","$4,200","$8,400","$1,400",$0,"$1,100",$200,"$1,400",$0,$600,$200,37
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410017,BlueDirect 90 1400,37160ND241,,NDN001,NDS001,NDF002,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410017-00,Standard Gold Off Exchange Plan,,0.780304431915283,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",10%,,,,"$2,800","$5,600","$4,200","$8,400","$1,400",$0,$600,$200,"$1,400",$0,$400,$200,38
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410017,BlueDirect 90 1400,37160ND241,,NDN001,NDS001,NDF002,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410017-01,Standard Gold On Exchange Plan,,0.780304431915283,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",10%,,,,"$2,800","$5,600","$4,200","$8,400","$1,400",$0,$600,$200,"$1,400",$0,$400,$200,39
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410017,BlueDirect 90 1400,37160ND241,,NDN001,NDS001,NDF002,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$200,40
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410017,BlueDirect 90 1400,37160ND241,,NDN001,NDS001,NDF002,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410017-03,Limited Cost Sharing Plan Variation,,0.780304431915283,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",10%,,,,"$2,800","$5,600","$4,200","$8,400","$1,400",$0,$600,$200,"$1,400",$0,$400,$200,41
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410020,BlueDirect 100 6300,37160ND241,,NDN001,NDS001,NDF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410020-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$200,48
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,1,37160,ND,Individual,No,45-0173185,37160ND2410020,BlueDirect 100 6300,37160ND241,,NDN001,NDS001,NDF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluedirect,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410020-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$18,900","$37,800","$25,200","$50,400",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200","$18,900","$37,800","$6,300",$0,$0,$200,"$5,110",$0,$0,$200,49
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410002,BlueCare 70 2500,37160ND241,,NDN001,NDS001,NDF009,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410002-00,Standard Silver Off Exchange Plan,,0.680832386016846,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000","$7,500","$15,000","$2,500",$20,"$1,400",$200,$200,"$1,000",$0,$200,4
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440007,BlueCare 90 500,37160ND244,,NDN001,NDS001,NDF010,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440007-00,Standard Platinum Off Exchange Plan,,0.884256303310394,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$20,$700,$200,$200,$520,$0,$200,4
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440007,BlueCare 90 500,37160ND244,,NDN001,NDS001,NDF010,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440007-01,Standard Platinum On Exchange Plan,,0.884256303310394,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$20,$700,$200,$200,$520,$0,$200,5
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410002,BlueCare 70 2500,37160ND241,,NDN001,NDS001,NDF009,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410002-01,Standard Silver On Exchange Plan,,0.680832386016846,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000","$7,500","$15,000","$2,500",$20,"$1,400",$200,$200,"$1,000",$0,$200,5
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410002,BlueCare 70 2500,37160ND241,,NDN001,NDS001,NDF009,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$200,6
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440008,BlueCare 80 0,37160ND244,,NDN001,NDS001,NDF011,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440008-00,Standard Platinum Off Exchange Plan,,0.883267998695374,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$5,200","$10,400","$7,800","$15,600",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,$0,$0,$0,$0,$0,$20,"$1,400",$200,$0,$560,$40,$200,6
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440008,BlueCare 80 0,37160ND244,,NDN001,NDS001,NDF011,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440008-01,Standard Platinum On Exchange Plan,,0.883267998695374,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$5,200","$10,400","$7,800","$15,600",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,$0,$0,$0,$0,$0,$20,"$1,400",$200,$0,$560,$40,$200,7
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410002,BlueCare 70 2500,37160ND241,,NDN001,NDS001,NDF009,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410002-03,Limited Cost Sharing Plan Variation,,0.680832386016846,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000","$7,500","$15,000","$2,500",$20,"$1,400",$200,$200,"$1,000",$0,$200,7
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410002,BlueCare 70 2500,37160ND241,,NDN001,NDS001,NDF009,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410002-04,73% AV Level Silver Plan,,0.737104117870331,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000","$6,000","$12,000","$2,000",$20,"$1,000",$200,$200,$920,$0,$200,8
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440009,BlueCare 80 250,37160ND244,,NDN001,NDS001,NDF011,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440009-00,Standard Platinum Off Exchange Plan,,0.880453526973724,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,$500,"$1,000",$750,"$1,500",$250,$20,"$1,400",$200,$200,$520,$0,$200,8
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440009,BlueCare 80 250,37160ND244,,NDN001,NDS001,NDF011,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440009-01,Standard Platinum On Exchange Plan,,0.880453526973724,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,$500,"$1,000",$750,"$1,500",$250,$20,"$1,400",$200,$200,$520,$0,$200,9
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440011,BlueCare 90 1500,37160ND244,,NDN001,NDS001,NDF006,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440011-00,Standard Gold Off Exchange Plan,,0.780375123023987,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,"$9,400","$18,800","$14,100","$28,200",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$3,000","$6,000","$4,500","$9,000","$1,500",$20,$600,$200,$200,$560,$0,$200,12
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440011,BlueCare 90 1500,37160ND244,,NDN001,NDS001,NDF006,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440011-01,Standard Gold On Exchange Plan,,0.780375123023987,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,"$9,400","$18,800","$14,100","$28,200",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$3,000","$6,000","$4,500","$9,000","$1,500",$20,$600,$200,$200,$560,$0,$200,13
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410004,BlueCare 80 2200,37160ND241,,NDN001,NDS001,NDF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$200,13
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410004,BlueCare 80 2200,37160ND241,,NDN001,NDS001,NDF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410004-03,Limited Cost Sharing Plan Variation,,0.680692613124847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600",,,,,,,,,,,,,,,,,,,,,"$2,200","$4,400",20%,,,,"$4,400","$8,800","$6,600","$13,200","$2,200",$20,"$1,000",$200,$200,"$1,000",$0,$200,14
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410004,BlueCare 80 2200,37160ND241,,NDN001,NDS001,NDF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410004-06,94% AV Level Silver Plan,,0.932118773460388,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,$0,$0,$0,$0,$0,$10,$700,$200,$0,$360,$20,$200,17
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410005,BlueCare 70 400,37160ND241,,NDN001,NDS001,NDF007,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410005-00,Standard Gold Off Exchange Plan,,0.7810178399086,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,200","$26,400","$19,550","$39,600",,,,,,,,,,,,,,,,,,,,,$400,$800,30%,,,,$800,"$1,600","$1,200","$2,400",$400,$20,"$2,000",$200,$200,$560,$0,$200,18
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440014,BlueCare 70 2000,37160ND244,,NDN001,NDS001,NDF009,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440014-00,Standard Silver Off Exchange Plan,,0.680988788604736,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$13,000","$26,000","$18,500","$37,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000","$2,000",$20,"$1,600",$200,$200,"$1,000",$0,$200,18
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440014,BlueCare 70 2000,37160ND244,,NDN001,NDS001,NDF009,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440014-01,Standard Silver On Exchange Plan,,0.680988788604736,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$13,000","$26,000","$18,500","$37,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000","$2,000",$20,"$1,600",$200,$200,"$1,000",$0,$200,19
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410005,BlueCare 70 400,37160ND241,,NDN001,NDS001,NDF007,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410005-01,Standard Gold On Exchange Plan,,0.7810178399086,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,200","$26,400","$19,550","$39,600",,,,,,,,,,,,,,,,,,,,,$400,$800,30%,,,,$800,"$1,600","$1,200","$2,400",$400,$20,"$2,000",$200,$200,$560,$0,$200,19
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410005,BlueCare 70 400,37160ND241,,NDN001,NDS001,NDF007,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$200,20
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440015,BlueCare 60 1500,37160ND244,,NDN001,NDS001,NDF012,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440015-00,Standard Silver Off Exchange Plan,,0.689515888690948,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",40%,,,,"$3,000","$6,000","$4,500","$9,000","$1,500",$20,"$2,300",$200,$200,"$1,000",$0,$200,20
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440015,BlueCare 60 1500,37160ND244,,NDN001,NDS001,NDF012,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440015-01,Standard Silver On Exchange Plan,,0.689515888690948,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",40%,,,,"$3,000","$6,000","$4,500","$9,000","$1,500",$20,"$2,300",$200,$200,"$1,000",$0,$200,21
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410005,BlueCare 70 400,37160ND241,,NDN001,NDS001,NDF007,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410005-03,Limited Cost Sharing Plan Variation,,0.7810178399086,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,200","$26,400","$19,550","$39,600",,,,,,,,,,,,,,,,,,,,,$400,$800,30%,,,,$800,"$1,600","$1,200","$2,400",$400,$20,"$2,000",$200,$200,$560,$0,$200,21
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410006,BlueCare 70 1000,37160ND241,,NDN001,NDS001,NDF007,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410006-00,Standard Gold Off Exchange Plan,,0.780665874481201,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,350","$8,700",,,"$8,700","$17,400","$13,050","$26,100",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,"$2,000","$4,000","$3,000","$6,000","$1,000",$20,"$1,900",$200,$200,$560,$0,$200,22
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440017,BlueCare 80 2500,37160ND244,,NDN001,NDS001,NDF008,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440017-00,Standard Silver Off Exchange Plan,,0.681221663951874,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000","$7,500","$15,000","$2,500",$20,$900,$200,$200,"$1,000",$0,$200,22
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,SHOP (Small Group),No,45-0173185,37160ND2440017,BlueCare 80 2500,37160ND244,,NDN001,NDS001,NDF008,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,,https://www.bcbsnd.com/web/employers/health-insurance-plans/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2440017-01,Standard Silver On Exchange Plan,,0.681221663951874,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000","$7,500","$15,000","$2,500",$20,$900,$200,$200,"$1,000",$0,$200,23
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410006,BlueCare 70 1000,37160ND241,,NDN001,NDS001,NDF007,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410006-01,Standard Gold On Exchange Plan,,0.780665874481201,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,350","$8,700",,,"$8,700","$17,400","$13,050","$26,100",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,"$2,000","$4,000","$3,000","$6,000","$1,000",$20,"$1,900",$200,$200,$560,$0,$200,23
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410006,BlueCare 70 1000,37160ND241,,NDN001,NDS001,NDF007,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$200,24
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410006,BlueCare 70 1000,37160ND241,,NDN001,NDS001,NDF007,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410006-03,Limited Cost Sharing Plan Variation,,0.780665874481201,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,350","$8,700",,,"$8,700","$17,400","$13,050","$26,100",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,"$2,000","$4,000","$3,000","$6,000","$1,000",$20,"$1,900",$200,$200,$560,$0,$200,25
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410007,BlueCare 90 1500,37160ND241,,NDN001,NDS001,NDF006,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410007-00,Standard Gold Off Exchange Plan,,0.780375123023987,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,"$9,400","$18,800","$14,100","$28,200",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$3,000","$6,000","$4,500","$9,000","$1,500",$20,$600,$200,$200,$560,$0,$200,26
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410007,BlueCare 90 1500,37160ND241,,NDN001,NDS001,NDF006,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410007-01,Standard Gold On Exchange Plan,,0.780375123023987,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,"$9,400","$18,800","$14,100","$28,200",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$3,000","$6,000","$4,500","$9,000","$1,500",$20,$600,$200,$200,$560,$0,$200,27
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410007,BlueCare 90 1500,37160ND241,,NDN001,NDS001,NDF006,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$200,28
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410007,BlueCare 90 1500,37160ND241,,NDN001,NDS001,NDF006,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410007-03,Limited Cost Sharing Plan Variation,,0.780375123023987,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,"$9,400","$18,800","$14,100","$28,200",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$3,000","$6,000","$4,500","$9,000","$1,500",$20,$600,$200,$200,$560,$0,$200,29
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410008,BlueCare 90 1350,37160ND241,,NDN001,NDS001,NDF006,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410008-00,Standard Gold Off Exchange Plan,,0.780312240123749,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",10%,,,,"$2,700","$5,400","$4,050","$8,100","$1,350",$20,$600,$200,$200,$560,$0,$200,30
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410008,BlueCare 90 1350,37160ND241,,NDN001,NDS001,NDF006,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410008-01,Standard Gold On Exchange Plan,,0.780312240123749,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",10%,,,,"$2,700","$5,400","$4,050","$8,100","$1,350",$20,$600,$200,$200,$560,$0,$200,31
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410008,BlueCare 90 1350,37160ND241,,NDN001,NDS001,NDF006,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$200,32
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,2,37160,ND,Individual,No,45-0173185,37160ND2410008,BlueCare 90 1350,37160ND241,,NDN001,NDS001,NDF006,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/bluecare,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410008-03,Limited Cost Sharing Plan Variation,,0.780312240123749,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",10%,,,,"$2,700","$5,400","$4,050","$8,100","$1,350",$20,$600,$200,$200,$560,$0,$200,33
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,3,37160,ND,Individual,No,45-0173185,37160ND2410021,BlueEssential 100 6600,37160ND241,,NDN001,NDS001,NDF001,New,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,3,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/blueessential,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410021-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400","$19,800","$39,600","$6,450",$150,$0,$200,"$4,800",$150,$0,$200,4
2015,ND,37160,HIOS,7,2015-06-19 13:25:37,3,37160,ND,Individual,No,45-0173185,37160ND2410021,BlueEssential 100 6600,37160ND241,,NDN001,NDS001,NDF001,New,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,3,2015-01-01,,Yes,The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply,Yes,"Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.",Yes,www.bcbsnd.com/sbc,www.bcbsnd.com/pay,https://www.bcbsnd.com/shop-for-insurance/individuals-and-families/blueessential,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_ND_647_BlueCareBlueDirectBlueEssential.pdf,37160ND2410021-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400","$19,800","$39,600","$6,450",$150,$0,$200,"$4,800",$150,$0,$200,5
2015,ND,39364,HIOS,7,2014-12-10 11:54:40,1,39364,ND,SHOP (Small Group),No,41-1490988,39364ND0140001,Medica Choice Passport ND $250-15-10% Platinum,39364ND014,,NDN001,NDS001,NDF005,New,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,39364ND0140001-00,Standard Platinum Off Exchange Plan,,0.890502095222473,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,$750,"$1,500",Not Applicable,Not Applicable,$250,$20,$500,"$1,000",$250,$600,$100,$0,4
2015,ND,39364,HIOS,7,2014-12-10 11:54:40,1,39364,ND,SHOP (Small Group),No,41-1490988,39364ND0140001,Medica Choice Passport ND $250-15-10% Platinum,39364ND014,,NDN001,NDS001,NDF005,New,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,39364ND0140001-01,Standard Platinum On Exchange Plan,,0.890502095222473,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,$750,"$1,500",Not Applicable,Not Applicable,$250,$20,$500,"$1,000",$250,$600,$100,$0,5
2015,ND,39364,HIOS,7,2014-12-10 11:54:40,1,39364,ND,SHOP (Small Group),No,41-1490988,39364ND0140002,Medica Choice Passport ND $500-20-30% Gold,39364ND014,,NDN001,NDS001,NDF005,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,39364ND0140002-00,Standard Gold Off Exchange Plan,,0.807860136032104,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$20,"$1,300","$1,000",$500,$600,$300,$0,6
2015,ND,39364,HIOS,7,2014-12-10 11:54:40,1,39364,ND,SHOP (Small Group),No,41-1490988,39364ND0140002,Medica Choice Passport ND $500-20-30% Gold,39364ND014,,NDN001,NDS001,NDF005,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,39364ND0140002-01,Standard Gold On Exchange Plan,,0.807860136032104,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$20,"$1,300","$1,000",$500,$600,$300,$0,7
2015,ND,39364,HIOS,7,2014-12-10 11:54:40,1,39364,ND,SHOP (Small Group),No,41-1490988,39364ND0140003,Medica Choice Passport ND $1000-20-30% Gold,39364ND014,,NDN001,NDS001,NDF005,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,39364ND0140003-00,Standard Gold Off Exchange Plan,,0.788811445236206,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$8,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,100","$1,000","$1,000",$600,$100,$0,8
2015,ND,39364,HIOS,7,2014-12-10 11:54:40,1,39364,ND,SHOP (Small Group),No,41-1490988,39364ND0140003,Medica Choice Passport ND $1000-20-30% Gold,39364ND014,,NDN001,NDS001,NDF005,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,39364ND0140003-01,Standard Gold On Exchange Plan,,0.788811445236206,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$8,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,100","$1,000","$1,000",$600,$100,$0,9
2015,ND,39364,HIOS,7,2014-12-10 11:54:40,1,39364,ND,SHOP (Small Group),No,41-1490988,39364ND0140004,Medica Choice Passport ND $1250-20-20% Gold,39364ND014,,NDN001,NDS001,NDF005,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,39364ND0140004-00,Standard Gold Off Exchange Plan,,0.802283525466919,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,"$1,250",$20,$700,"$1,000","$1,250",$600,$40,$0,10
2015,ND,39364,HIOS,7,2014-12-10 11:54:40,1,39364,ND,SHOP (Small Group),No,41-1490988,39364ND0140004,Medica Choice Passport ND $1250-20-20% Gold,39364ND014,,NDN001,NDS001,NDF005,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,39364ND0140004-01,Standard Gold On Exchange Plan,,0.802283525466919,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,"$1,250",$20,$700,"$1,000","$1,250",$600,$40,$0,11
2015,ND,39364,HIOS,7,2014-12-10 11:54:40,1,39364,ND,SHOP (Small Group),No,41-1490988,39364ND0140007,Medica Choice Passport ND $2000-40-30% Silver,39364ND014,,NDN001,NDS001,NDF006,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,39364ND0140007-00,Standard Silver Off Exchange Plan,,0.71827906370163,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,$800,"$1,000","$1,400","$1,000",$0,$0,12
2015,ND,39364,HIOS,7,2014-12-10 11:54:40,1,39364,ND,SHOP (Small Group),No,41-1490988,39364ND0140007,Medica Choice Passport ND $2000-40-30% Silver,39364ND014,,NDN001,NDS001,NDF006,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,39364ND0140007-01,Standard Silver On Exchange Plan,,0.71827906370163,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,$800,"$1,000","$1,400","$1,000",$0,$0,13
2015,ND,39364,HIOS,7,2014-12-10 11:54:40,2,39364,ND,SHOP (Small Group),No,41-1490988,39364ND0140005,Medica Passport ND 1300-20% HSA Gold,39364ND014,,NDN001,NDS001,NDF001,Existing,PPO,Gold,No,Both,No,Yes,Any member outside the members care system network.,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,39364ND0140005-00,Standard Gold Off Exchange Plan,,0.780426740646362,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$1,300",$0,$700,"$1,000","$1,300",$0,$800,$0,4
2015,ND,39364,HIOS,7,2014-12-10 11:54:40,2,39364,ND,SHOP (Small Group),No,41-1490988,39364ND0140008,Medica Passport ND 3000-0% HSA Silver,39364ND014,,NDN001,NDS001,NDF004,New,PPO,Silver,No,Both,No,Yes,Any member outside the members care system network.,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,39364ND0140008-01,Standard Silver On Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$3,000",$0,$0,"$1,000","$3,000",$0,$0,$0,11
2015,ND,39364,HIOS,7,2014-12-10 11:54:40,2,39364,ND,SHOP (Small Group),No,41-1490988,39364ND0140010,Medica Passport ND 6000-0% HSA Bronze,39364ND014,,NDN001,NDS001,NDF004,New,PPO,Bronze,No,Both,No,Yes,Any member outside the members care system network.,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,39364ND0140010-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$9,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$9,900",0%,,,,"$7,000","$9,900",Not Applicable,Not Applicable,"$4,800",$0,$0,"$1,000","$5,300",$0,$0,$0,12
2015,ND,57390,HIOS,2,2014-08-07 10:00:19,1,57390,ND,SHOP (Small Group),Yes,44-0308260,57390ND0010001,KCL EHB Low PPO,57390ND001,,NDN001,NDS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$39.66,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,57390ND0010001-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,57390,HIOS,2,2014-08-07 10:00:19,1,57390,ND,SHOP (Small Group),Yes,44-0308260,57390ND0010003,KCL EHB Low MAC,57390ND001,,NDN001,NDS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$29.76,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,57390ND0010003-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,57390,HIOS,2,2014-08-07 10:00:19,1,57390,ND,SHOP (Small Group),Yes,44-0308260,57390ND0010005,KCL Fam Low PPO,57390ND001,,NDN001,NDS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$39.66,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,57390ND0010005-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,SHOP (Small Group),No,41-1242261,73751ND0090002,Medica Essential ND 1750-25% HSA Silver,73751ND009,,NDN001,NDS001,NDF002,Existing,POS,Silver,No,Both,No,Yes,Any member outside the members care system network.,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPEssentialSBC,,www.medica.com/SHOPEssentialBrochure,www.medica.com/SHOPPharmacy,73751ND0090002-00,Standard Silver Off Exchange Plan,,0.680849492549896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",25%,,,,"$5,000","$9,900",Not Applicable,Not Applicable,"$1,750",$0,$800,"$1,000","$1,750",$0,$900,$0,6
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,Individual,No,41-1242261,73751ND0080007,Medica Applause Gold H S A,73751ND008,,NDN002,NDS002,NDF007,Existing,POS,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseHSA,www.medica.com/IFBPharmacy,73751ND0080007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,Individual,No,41-1242261,73751ND0080007,Medica Applause Gold H S A,73751ND008,,NDN002,NDS002,NDF007,Existing,POS,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseHSA,www.medica.com/IFBPharmacy,73751ND0080007-03,Limited Cost Sharing Plan Variation,,0.781114280223846,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,350","$7,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,SHOP (Small Group),No,41-1242261,73751ND0090002,Medica Essential ND 1750-25% HSA Silver,73751ND009,,NDN001,NDS001,NDF002,Existing,POS,Silver,No,Both,No,Yes,Any member outside the members care system network.,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPEssentialSBC,,www.medica.com/SHOPEssentialBrochure,www.medica.com/SHOPPharmacy,73751ND0090002-01,Standard Silver On Exchange Plan,,0.680849492549896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",25%,,,,"$5,000","$9,900",Not Applicable,Not Applicable,"$1,750",$0,$800,"$1,000","$1,750",$0,$900,$0,7
2015,ND,57390,HIOS,2,2014-08-07 10:00:19,1,57390,ND,SHOP (Small Group),Yes,44-0308260,57390ND0010007,KCL Fam Low MAC,57390ND001,,NDN001,NDS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$29.76,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,57390ND0010007-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,ND,57390,HIOS,2,2014-08-07 10:00:19,2,57390,ND,SHOP (Small Group),Yes,44-0308260,57390ND0010002,KCL EHB High PPO,57390ND001,,NDN001,NDS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$48.53,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,57390ND0010002-00,Standard High Off Exchange Plan,85.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,57390,HIOS,2,2014-08-07 10:00:19,2,57390,ND,SHOP (Small Group),Yes,44-0308260,57390ND0010004,KCL EHB High MAC,57390ND001,,NDN001,NDS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$36.96,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,57390ND0010004-00,Standard High Off Exchange Plan,85.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,57390,HIOS,2,2014-08-07 10:00:19,2,57390,ND,SHOP (Small Group),Yes,44-0308260,57390ND0010006,KCL Fam High PPO,57390ND001,,NDN001,NDS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$48.53,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,57390ND0010006-00,Standard High Off Exchange Plan,85.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,ND,57390,HIOS,2,2014-08-07 10:00:19,2,57390,ND,SHOP (Small Group),Yes,44-0308260,57390ND0010008,KCL Fam High MAC,57390ND001,,NDN001,NDS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$36.96,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,57390ND0010008-00,Standard High Off Exchange Plan,85.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,ND,71860,HIOS,6,2014-10-03 13:54:42,1,71860,ND,SHOP (Small Group),Yes,57-0523959,71860ND0010001,Group Pediatric Dental EHB,71860ND001,,NDN001,NDS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$40.51,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximums,Yes,Traditional with inside maximums,Yes,,,,,71860ND0010001-00,Standard High Off Exchange Plan,85.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,Individual,No,41-1242261,73751ND0080009,Medica Applause Silver H S A,73751ND008,,NDN002,NDS002,NDF008,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseHSA,www.medica.com/IFBPharmacy,73751ND0080009-06,94% AV Level Silver Plan,,0.935520946979523,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$450,5%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,Individual,No,41-1242261,73751ND0080011,Medica Applause Bronze H S A,73751ND008,,NDN002,NDS002,NDF009,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseHSA,www.medica.com/IFBPharmacy,73751ND0080011-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,700",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,Individual,No,41-1242261,73751ND0080011,Medica Applause Bronze H S A,73751ND008,,NDN002,NDS002,NDF009,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseHSA,www.medica.com/IFBPharmacy,73751ND0080011-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,700",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,Individual,No,41-1242261,73751ND0080011,Medica Applause Bronze H S A,73751ND008,,NDN002,NDS002,NDF009,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseHSA,www.medica.com/IFBPharmacy,73751ND0080011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,17
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,Individual,No,41-1242261,73751ND0080011,Medica Applause Bronze H S A,73751ND008,,NDN002,NDS002,NDF009,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseHSA,www.medica.com/IFBPharmacy,73751ND0080011-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,700",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,3,73751,ND,Individual,No,41-1242261,73751ND0080013,Medica Applause Catastrophic,73751ND008,,NDN002,NDS002,NDF009,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseCatastrophic,www.medica.com/IFBPharmacy,73751ND0080013-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,3,73751,ND,Individual,No,41-1242261,73751ND0080013,Medica Applause Catastrophic,73751ND008,,NDN002,NDS002,NDF009,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseCatastrophic,www.medica.com/IFBPharmacy,73751ND0080013-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,1,75329,ND,Individual,Yes,95-6042390,75329ND0020001,BESTOne Child Dental Plus,75329ND002,,NDN001,NDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$36.04,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BESTOne_Child_Dental_Plus_Plan.pdf,,75329ND0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,1,75329,ND,SHOP (Small Group),Yes,95-6042390,75329ND0010001,BEST Life Child Dental Plus,75329ND001,,NDN001,NDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$28.84,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BEST_Life_Child_Dental_Plus_Plan.pdf,,75329ND0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,2,75329,ND,SHOP (Small Group),Yes,95-6042390,75329ND0010002,BEST Life Child Dental,75329ND001,,NDN001,NDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.69,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BEST_Life_Child_Dental_Plan.pdf,,75329ND0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,2,75329,ND,Individual,Yes,95-6042390,75329ND0020002,BESTOne Child Dental,75329ND002,,NDN001,NDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$32.13,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BESTOne_Child_Dental_Plan.pdf,,75329ND0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,3,75329,ND,Individual,Yes,95-6042390,75329ND0020003,BESTOne Dental Advantage-Gold,75329ND002,,NDN001,NDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.04,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BESTOne_Dental_Advantage-Gold_Plan.pdf,,75329ND0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,3,75329,ND,SHOP (Small Group),Yes,95-6042390,75329ND0010007,BEST Dental Premium,75329ND001,,NDN001,NDS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.84,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BESTDental_Premium_Plan.pdf,,75329ND0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,3,75329,ND,SHOP (Small Group),Yes,95-6042390,75329ND0010010,BEST Dental Choice-H,75329ND001,,NDN001,NDS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.84,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BESTDental_Choice-H_Plan.pdf,,75329ND0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,3,75329,ND,SHOP (Small Group),Yes,95-6042390,75329ND0010010,BEST Dental Choice-H,75329ND001,,NDN001,NDS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.84,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BESTDental_Choice-H_Plan.pdf,,75329ND0010010-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,4,75329,ND,SHOP (Small Group),Yes,95-6042390,75329ND0010009,BEST Dental Standard-L,75329ND001,,NDN001,NDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.69,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BESTDental_Standard-L_Plan.pdf,,75329ND0010009-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,4,75329,ND,Individual,Yes,95-6042390,75329ND0020005,BESTOne Dental Plus-Silver,75329ND002,,NDN001,NDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.13,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BESTOne_Dental_Plus-Silver_Plan.pdf,,75329ND0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,4,75329,ND,Individual,Yes,95-6042390,75329ND0020005,BESTOne Dental Plus-Silver,75329ND002,,NDN001,NDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.13,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BESTOne_Dental_Plus-Silver_Plan.pdf,,75329ND0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,4,75329,ND,SHOP (Small Group),Yes,95-6042390,75329ND0010009,BEST Dental Standard-L,75329ND001,,NDN001,NDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.69,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BESTDental_Standard-L_Plan.pdf,,75329ND0010009-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,4,75329,ND,SHOP (Small Group),Yes,95-6042390,75329ND0010011,BEST Dental Choice-L,75329ND001,,NDN001,NDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.69,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BESTDental_Choice-L_Plan.pdf,,75329ND0010011-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,4,75329,ND,Individual,Yes,95-6042390,75329ND0020006,BESTOne Dental Basic-Silver,75329ND002,,NDN001,NDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.13,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BESTOne_Dental_Basic-Silver_Plan.pdf,,75329ND0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,4,75329,ND,Individual,Yes,95-6042390,75329ND0020006,BESTOne Dental Basic-Silver,75329ND002,,NDN001,NDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.13,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BESTOne_Dental_Basic-Silver_Plan.pdf,,75329ND0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,4,75329,ND,SHOP (Small Group),Yes,95-6042390,75329ND0010011,BEST Dental Choice-L,75329ND001,,NDN001,NDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.69,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BESTDental_Choice-L_Plan.pdf,,75329ND0010011-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,4,75329,ND,SHOP (Small Group),Yes,95-6042390,75329ND0010012,BEST Dental Value,75329ND001,,NDN001,NDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.69,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BESTDental_Value_Plan.pdf,,75329ND0010012-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,4,75329,ND,SHOP (Small Group),Yes,95-6042390,75329ND0010012,BEST Dental Value,75329ND001,,NDN001,NDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.69,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BESTDental_Value_Plan.pdf,,75329ND0010012-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,ND,76852,HIOS,5,2014-09-06 03:39:47,1,76852,ND,SHOP (Small Group),Yes,41-0808596,76852ND0010001,"Plan 1. Passive PPO, $1000 Annual Maximum, no Ortho",76852ND001,,NDN001,NDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,76852ND0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,76852,HIOS,5,2014-09-06 03:39:47,1,76852,ND,SHOP (Small Group),Yes,41-0808596,76852ND0010002,"Plan 2.  Passive PPO, $1000 Annual Maximum, Ortho",76852ND001,,NDN001,NDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,76852ND0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,76852,HIOS,5,2014-09-06 03:39:47,1,76852,ND,SHOP (Small Group),Yes,41-0808596,76852ND0010003,"Plan 3. Passive PPO, $1500 Annual Maximum, no Ortho",76852ND001,,NDN001,NDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,76852ND0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,ND,76852,HIOS,5,2014-09-06 03:39:47,1,76852,ND,SHOP (Small Group),Yes,41-0808596,76852ND0010004,"Plan 4.  Passive PPO, $1500 Annual Maximum, Ortho",76852ND001,,NDN001,NDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,76852ND0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,ND,76852,HIOS,5,2014-09-06 03:39:47,1,76852,ND,SHOP (Small Group),Yes,41-0808596,76852ND0010005,"Plan 5.  Passive PPO, $2000 Annual Maximum, Ortho",76852ND001,,NDN001,NDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,76852ND0010005-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,ND,76852,HIOS,5,2014-09-06 03:39:47,1,76852,ND,SHOP (Small Group),Yes,41-0808596,76852ND0010006,"Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho",76852ND001,,NDN001,NDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,76852ND0010006-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,ND,76852,HIOS,5,2014-09-06 03:39:47,1,76852,ND,SHOP (Small Group),Yes,41-0808596,76852ND0010007,"Plan 7. Graded Passive PPO, $1000 Annual Maximum, Ortho",76852ND001,,NDN001,NDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,76852ND0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,ND,76852,HIOS,5,2014-09-06 03:39:47,1,76852,ND,SHOP (Small Group),Yes,41-0808596,76852ND0010008,"Plan 8. MAC PPO, $1000 Annual Maximum, no Ortho",76852ND001,,NDN001,NDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,76852ND0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,ND,76852,HIOS,5,2014-09-06 03:39:47,1,76852,ND,SHOP (Small Group),Yes,41-0808596,76852ND0010009,"Plan 9. MAC PPO, $1500 Annual Maximum, Ortho",76852ND001,,NDN001,NDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,76852ND0010009-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,ND,71860,HIOS,6,2014-10-03 13:54:42,1,71860,ND,SHOP (Small Group),Yes,57-0523959,71860ND0010002,Group Pediatric Dental EHB,71860ND001,,NDN001,NDS001,,New,Indemnity,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$32.63,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximums,Yes,Traditional with inside maximums,Yes,,,,,71860ND0010002-00,Standard Low Off Exchange Plan,68.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,Individual,No,41-1242261,73751ND0080001,Medica Applause Gold Copay,73751ND008,,NDN002,NDS002,NDF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseCopay,www.medica.com/IFBPharmacy,73751ND0080001-00,Standard Gold Off Exchange Plan,,0.785041034221649,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$900,30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,SHOP (Small Group),No,41-1242261,73751ND0090004,Medica Essential ND 250-15-10% Platinum,73751ND009,,NDN001,NDS001,NDF012,New,POS,Platinum,No,Both,No,Yes,Any member outside the members care system network.,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPEssentialSBC,,www.medica.com/SHOPEssentialBrochure,www.medica.com/SHOPPharmacy,73751ND0090004-00,Standard Platinum Off Exchange Plan,,0.890502095222473,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,$750,"$1,500",Not Applicable,Not Applicable,$250,$20,$500,"$1,000",$250,$600,$100,$0,4
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,SHOP (Small Group),No,41-1242261,73751ND0090004,Medica Essential ND 250-15-10% Platinum,73751ND009,,NDN001,NDS001,NDF012,New,POS,Platinum,No,Both,No,Yes,Any member outside the members care system network.,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPEssentialSBC,,www.medica.com/SHOPEssentialBrochure,www.medica.com/SHOPPharmacy,73751ND0090004-01,Standard Platinum On Exchange Plan,,0.890502095222473,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,$750,"$1,500",Not Applicable,Not Applicable,$250,$20,$500,"$1,000",$250,$600,$100,$0,5
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,Individual,No,41-1242261,73751ND0080001,Medica Applause Gold Copay,73751ND008,,NDN002,NDS002,NDF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseCopay,www.medica.com/IFBPharmacy,73751ND0080001-01,Standard Gold On Exchange Plan,,0.785041034221649,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$900,30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,Individual,No,41-1242261,73751ND0080001,Medica Applause Gold Copay,73751ND008,,NDN002,NDS002,NDF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseCopay,www.medica.com/IFBPharmacy,73751ND0080001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,SHOP (Small Group),No,41-1242261,73751ND0090005,Medica Essential ND 500-20-30% Gold,73751ND009,,NDN001,NDS001,NDF012,New,POS,Gold,No,Both,No,Yes,Any member outside the members care system network.,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPEssentialSBC,,www.medica.com/SHOPEssentialBrochure,www.medica.com/SHOPPharmacy,73751ND0090005-00,Standard Gold Off Exchange Plan,,0.807860136032104,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$20,"$1,300","$1,000",$500,$600,$300,$0,6
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,SHOP (Small Group),No,41-1242261,73751ND0090005,Medica Essential ND 500-20-30% Gold,73751ND009,,NDN001,NDS001,NDF012,New,POS,Gold,No,Both,No,Yes,Any member outside the members care system network.,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPEssentialSBC,,www.medica.com/SHOPEssentialBrochure,www.medica.com/SHOPPharmacy,73751ND0090005-01,Standard Gold On Exchange Plan,,0.807860136032104,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$20,"$1,300","$1,000",$500,$600,$300,$0,7
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,Individual,No,41-1242261,73751ND0080001,Medica Applause Gold Copay,73751ND008,,NDN002,NDS002,NDF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseCopay,www.medica.com/IFBPharmacy,73751ND0080001-03,Limited Cost Sharing Plan Variation,,0.785041034221649,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$900,30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,SHOP (Small Group),No,41-1242261,73751ND0090006,Medica Essential ND 1000-20-30% Gold,73751ND009,,NDN001,NDS001,NDF012,New,POS,Gold,No,Both,No,Yes,Any member outside the members care system network.,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPEssentialSBC,,www.medica.com/SHOPEssentialBrochure,www.medica.com/SHOPPharmacy,73751ND0090006-00,Standard Gold Off Exchange Plan,,0.788811445236206,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$8,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,100","$1,000","$1,000",$600,$100,$0,8
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,Individual,No,41-1242261,73751ND0080017,Medica Applause Gold Copay 100,73751ND008,,NDN002,NDS002,NDF010,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseCopay,www.medica.com/IFBPharmacy,73751ND0080017-00,Standard Gold Off Exchange Plan,,0.799562036991119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,400","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,400","$7,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,Individual,No,41-1242261,73751ND0080017,Medica Applause Gold Copay 100,73751ND008,,NDN002,NDS002,NDF010,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseCopay,www.medica.com/IFBPharmacy,73751ND0080017-01,Standard Gold On Exchange Plan,,0.799562036991119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,400","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,400","$7,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,SHOP (Small Group),No,41-1242261,73751ND0090006,Medica Essential ND 1000-20-30% Gold,73751ND009,,NDN001,NDS001,NDF012,New,POS,Gold,No,Both,No,Yes,Any member outside the members care system network.,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPEssentialSBC,,www.medica.com/SHOPEssentialBrochure,www.medica.com/SHOPPharmacy,73751ND0090006-01,Standard Gold On Exchange Plan,,0.788811445236206,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$8,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,100","$1,000","$1,000",$600,$100,$0,9
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,SHOP (Small Group),No,41-1242261,73751ND0090007,Medica Essential ND 1250-20-20% Gold,73751ND009,,NDN001,NDS001,NDF012,New,POS,Gold,No,Both,No,Yes,Any member outside the members care system network.,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPEssentialSBC,,www.medica.com/SHOPEssentialBrochure,www.medica.com/SHOPPharmacy,73751ND0090007-00,Standard Gold Off Exchange Plan,,0.802283525466919,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,"$1,250",$20,$700,"$1,000","$1,250",$600,$40,$0,10
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,Individual,No,41-1242261,73751ND0080017,Medica Applause Gold Copay 100,73751ND008,,NDN002,NDS002,NDF010,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseCopay,www.medica.com/IFBPharmacy,73751ND0080017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,10
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,Individual,No,41-1242261,73751ND0080017,Medica Applause Gold Copay 100,73751ND008,,NDN002,NDS002,NDF010,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseCopay,www.medica.com/IFBPharmacy,73751ND0080017-03,Limited Cost Sharing Plan Variation,,0.799562036991119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,400","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,400","$7,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,SHOP (Small Group),No,41-1242261,73751ND0090007,Medica Essential ND 1250-20-20% Gold,73751ND009,,NDN001,NDS001,NDF012,New,POS,Gold,No,Both,No,Yes,Any member outside the members care system network.,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPEssentialSBC,,www.medica.com/SHOPEssentialBrochure,www.medica.com/SHOPPharmacy,73751ND0090007-01,Standard Gold On Exchange Plan,,0.802283525466919,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,"$1,250",$20,$700,"$1,000","$1,250",$600,$40,$0,11
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,SHOP (Small Group),No,41-1242261,73751ND0090008,Medica Essential ND 2000-40-30% Silver,73751ND009,,NDN001,NDS001,NDF013,New,POS,Silver,No,Both,No,Yes,Any member outside the members care system network.,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPEssentialSBC,,www.medica.com/SHOPEssentialBrochure,www.medica.com/SHOPPharmacy,73751ND0090008-00,Standard Silver Off Exchange Plan,,0.71827906370163,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,$800,"$1,000","$1,400","$1,000",$0,$0,12
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,Individual,No,41-1242261,73751ND0080003,Medica Applause Silver Copay,73751ND008,,NDN002,NDS002,NDF005,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseCopay,www.medica.com/IFBPharmacy,73751ND0080003-00,Standard Silver Off Exchange Plan,,0.680651843547821,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$7,800",40%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,Individual,No,41-1242261,73751ND0080003,Medica Applause Silver Copay,73751ND008,,NDN002,NDS002,NDF005,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseCopay,www.medica.com/IFBPharmacy,73751ND0080003-01,Standard Silver On Exchange Plan,,0.680651843547821,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$7,800",40%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,SHOP (Small Group),No,41-1242261,73751ND0090008,Medica Essential ND 2000-40-30% Silver,73751ND009,,NDN001,NDS001,NDF013,New,POS,Silver,No,Both,No,Yes,Any member outside the members care system network.,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPEssentialSBC,,www.medica.com/SHOPEssentialBrochure,www.medica.com/SHOPPharmacy,73751ND0090008-01,Standard Silver On Exchange Plan,,0.71827906370163,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,$800,"$1,000","$1,400","$1,000",$0,$0,13
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,Individual,No,41-1242261,73751ND0080003,Medica Applause Silver Copay,73751ND008,,NDN002,NDS002,NDF005,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseCopay,www.medica.com/IFBPharmacy,73751ND0080003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,14
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,Individual,No,41-1242261,73751ND0080003,Medica Applause Silver Copay,73751ND008,,NDN002,NDS002,NDF005,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseCopay,www.medica.com/IFBPharmacy,73751ND0080003-03,Limited Cost Sharing Plan Variation,,0.680651843547821,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$7,800",40%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,Individual,No,41-1242261,73751ND0080003,Medica Applause Silver Copay,73751ND008,,NDN002,NDS002,NDF005,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseCopay,www.medica.com/IFBPharmacy,73751ND0080003-04,73% AV Level Silver Plan,,0.735756456851959,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$6,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,Individual,No,41-1242261,73751ND0080003,Medica Applause Silver Copay,73751ND008,,NDN002,NDS002,NDF005,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseCopay,www.medica.com/IFBPharmacy,73751ND0080003-05,87% AV Level Silver Plan,,0.861037850379944,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,"$1,200",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,Individual,No,41-1242261,73751ND0080003,Medica Applause Silver Copay,73751ND008,,NDN002,NDS002,NDF005,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseCopay,www.medica.com/IFBPharmacy,73751ND0080003-06,94% AV Level Silver Plan,,0.931123793125153,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$150,5%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,Individual,No,41-1242261,73751ND0080005,Medica Applause Bronze Copay,73751ND008,,NDN002,NDS002,NDF006,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseCopay,www.medica.com/IFBPharmacy,73751ND0080005-00,Standard Bronze Off Exchange Plan,,0.618459045886993,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,Individual,No,41-1242261,73751ND0080005,Medica Applause Bronze Copay,73751ND008,,NDN002,NDS002,NDF006,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseCopay,www.medica.com/IFBPharmacy,73751ND0080005-01,Standard Bronze On Exchange Plan,,0.618459045886993,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,Individual,No,41-1242261,73751ND0080005,Medica Applause Bronze Copay,73751ND008,,NDN002,NDS002,NDF006,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseCopay,www.medica.com/IFBPharmacy,73751ND0080005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,21
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,1,73751,ND,Individual,No,41-1242261,73751ND0080005,Medica Applause Bronze Copay,73751ND008,,NDN002,NDS002,NDF006,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseCopay,www.medica.com/IFBPharmacy,73751ND0080005-03,Limited Cost Sharing Plan Variation,,0.618459045886993,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,SHOP (Small Group),No,41-1242261,73751ND0090001,Medica Essential ND 1300-20% HSA Gold,73751ND009,,NDN001,NDS001,NDF001,Existing,POS,Gold,No,Both,No,Yes,Any member outside the members care system network.,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPEssentialSBC,,www.medica.com/SHOPEssentialBrochure,www.medica.com/SHOPPharmacy,73751ND0090001-00,Standard Gold Off Exchange Plan,,0.780426740646362,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$1,300",$0,$700,"$1,000","$1,300",$0,$800,$0,4
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,Individual,No,41-1242261,73751ND0080007,Medica Applause Gold H S A,73751ND008,,NDN002,NDS002,NDF007,Existing,POS,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseHSA,www.medica.com/IFBPharmacy,73751ND0080007-00,Standard Gold Off Exchange Plan,,0.781114280223846,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,350","$7,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,Individual,No,41-1242261,73751ND0080007,Medica Applause Gold H S A,73751ND008,,NDN002,NDS002,NDF007,Existing,POS,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseHSA,www.medica.com/IFBPharmacy,73751ND0080007-01,Standard Gold On Exchange Plan,,0.781114280223846,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,350","$7,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,SHOP (Small Group),No,41-1242261,73751ND0090001,Medica Essential ND 1300-20% HSA Gold,73751ND009,,NDN001,NDS001,NDF001,Existing,POS,Gold,No,Both,No,Yes,Any member outside the members care system network.,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPEssentialSBC,,www.medica.com/SHOPEssentialBrochure,www.medica.com/SHOPPharmacy,73751ND0090001-01,Standard Gold On Exchange Plan,,0.780426740646362,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$1,300",$0,$700,"$1,000","$1,300",$0,$800,$0,5
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,SHOP (Small Group),No,41-1242261,73751ND0090003,Medica Essential ND 4950-50% HSA Bronze,73751ND009,,NDN001,NDS001,NDF003,Existing,POS,Bronze,No,Both,No,Yes,Any member outside the members care system network.,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPEssentialSBC,,www.medica.com/SHOPEssentialBrochure,www.medica.com/SHOPPharmacy,73751ND0090003-00,Standard Bronze Off Exchange Plan,,0.583925843238831,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,950","$9,900",50%,,,,"$7,500","$9,900",Not Applicable,Not Applicable,"$4,800",$0,$0,"$1,000","$4,950",$0,$200,$0,8
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,Individual,No,41-1242261,73751ND0080009,Medica Applause Silver H S A,73751ND008,,NDN002,NDS002,NDF008,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseHSA,www.medica.com/IFBPharmacy,73751ND0080009-00,Standard Silver Off Exchange Plan,,0.680960297584534,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,450","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900",40%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,Individual,No,41-1242261,73751ND0080009,Medica Applause Silver H S A,73751ND008,,NDN002,NDS002,NDF008,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseHSA,www.medica.com/IFBPharmacy,73751ND0080009-01,Standard Silver On Exchange Plan,,0.680960297584534,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,450","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900",40%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,SHOP (Small Group),No,41-1242261,73751ND0090003,Medica Essential ND 4950-50% HSA Bronze,73751ND009,,NDN001,NDS001,NDF003,Existing,POS,Bronze,No,Both,No,Yes,Any member outside the members care system network.,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPEssentialSBC,,www.medica.com/SHOPEssentialBrochure,www.medica.com/SHOPPharmacy,73751ND0090003-01,Standard Bronze On Exchange Plan,,0.583925843238831,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,950","$9,900",50%,,,,"$7,500","$9,900",Not Applicable,Not Applicable,"$4,800",$0,$0,"$1,000","$4,950",$0,$200,$0,9
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,SHOP (Small Group),No,41-1242261,73751ND0090009,Medica Essential ND 3000-0% HSA Silver,73751ND009,,NDN001,NDS001,NDF011,New,POS,Silver,No,Both,No,Yes,Any member outside the members care system network.,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPEssentialSBC,,www.medica.com/SHOPEssentialBrochure,www.medica.com/SHOPPharmacy,73751ND0090009-00,Standard Silver Off Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$3,000",$0,$0,"$1,000","$3,000",$0,$0,$0,10
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,Individual,No,41-1242261,73751ND0080009,Medica Applause Silver H S A,73751ND008,,NDN002,NDS002,NDF008,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseHSA,www.medica.com/IFBPharmacy,73751ND0080009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,10
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,Individual,No,41-1242261,73751ND0080009,Medica Applause Silver H S A,73751ND008,,NDN002,NDS002,NDF008,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseHSA,www.medica.com/IFBPharmacy,73751ND0080009-03,Limited Cost Sharing Plan Variation,,0.680960297584534,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,450","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900",40%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,SHOP (Small Group),No,41-1242261,73751ND0090009,Medica Essential ND 3000-0% HSA Silver,73751ND009,,NDN001,NDS001,NDF011,New,POS,Silver,No,Both,No,Yes,Any member outside the members care system network.,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPEssentialSBC,,www.medica.com/SHOPEssentialBrochure,www.medica.com/SHOPPharmacy,73751ND0090009-01,Standard Silver On Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$3,000",$0,$0,"$1,000","$3,000",$0,$0,$0,11
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,SHOP (Small Group),No,41-1242261,73751ND0090010,Medica Essential ND 6000-0% HSA Bronze,73751ND009,,NDN001,NDS001,NDF011,New,POS,Bronze,No,Both,No,Yes,Any member outside the members care system network.,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPEssentialSBC,,www.medica.com/SHOPEssentialBrochure,www.medica.com/SHOPPharmacy,73751ND0090010-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$9,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$9,900",0%,,,,"$7,000","$9,900",Not Applicable,Not Applicable,"$4,800",$0,$0,"$1,000","$5,300",$0,$0,$0,12
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,Individual,No,41-1242261,73751ND0080009,Medica Applause Silver H S A,73751ND008,,NDN002,NDS002,NDF008,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseHSA,www.medica.com/IFBPharmacy,73751ND0080009-04,73% AV Level Silver Plan,,0.721749007701874,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,050","$3,150",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,Individual,No,41-1242261,73751ND0080009,Medica Applause Silver H S A,73751ND008,,NDN002,NDS002,NDF008,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/ND_ApplauseHSA,www.medica.com/IFBPharmacy,73751ND0080009-05,87% AV Level Silver Plan,,0.862255096435547,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$750,20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,ND,73751,HIOS,5,2014-11-15 04:52:41,2,73751,ND,SHOP (Small Group),No,41-1242261,73751ND0090010,Medica Essential ND 6000-0% HSA Bronze,73751ND009,,NDN001,NDS001,NDF011,New,POS,Bronze,No,Both,No,Yes,Any member outside the members care system network.,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency services only,Yes,Out-of-network benefits apply,No,www.medica.com/SHOPEssentialSBC,,www.medica.com/SHOPEssentialBrochure,www.medica.com/SHOPPharmacy,73751ND0090010-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$9,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$9,900",0%,,,,"$7,000","$9,900",Not Applicable,Not Applicable,"$4,800",$0,$0,"$1,000","$5,300",$0,$0,$0,13
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,3,75329,ND,SHOP (Small Group),Yes,95-6042390,75329ND0010007,BEST Dental Premium,75329ND001,,NDN001,NDS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.84,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BESTDental_Premium_Plan.pdf,,75329ND0010007-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,3,75329,ND,Individual,Yes,95-6042390,75329ND0020003,BESTOne Dental Advantage-Gold,75329ND002,,NDN001,NDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.04,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BESTOne_Dental_Advantage-Gold_Plan.pdf,,75329ND0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,3,75329,ND,Individual,Yes,95-6042390,75329ND0020004,BESTOne Dental Plus-Gold,75329ND002,,NDN001,NDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.04,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BESTOne_Dental_Plus-Gold_Plan.pdf,,75329ND0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,3,75329,ND,SHOP (Small Group),Yes,95-6042390,75329ND0010008,BEST Dental Standard-H,75329ND001,,NDN001,NDS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.84,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BESTDental_Standard-H_Plan.pdf,,75329ND0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,3,75329,ND,SHOP (Small Group),Yes,95-6042390,75329ND0010008,BEST Dental Standard-H,75329ND001,,NDN001,NDS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.84,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BESTDental_Standard-H_Plan.pdf,,75329ND0010008-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,ND,75329,HIOS,5,2014-10-02 12:25:15,3,75329,ND,Individual,Yes,95-6042390,75329ND0020004,BESTOne Dental Plus-Gold,75329ND002,,NDN001,NDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.04,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/ND/2015/ND_BESTOne_Dental_Plus-Gold_Plan.pdf,,75329ND0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,ND,76852,HIOS,5,2014-09-06 03:39:47,1,76852,ND,SHOP (Small Group),Yes,41-0808596,76852ND0010010,"Plan 10. Graded MAC PPO, $1000 Annual Maximum, no Ortho",76852ND001,,NDN001,NDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,76852ND0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,13
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,1,89364,ND,Individual,No,91-1842494,89364ND0090004,"Sanford Simplicity-$6,600",89364ND009,,NDN001,NDS001,NDF008,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090004-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$9,000","$18,000","$9,000","$18,000",,,,,,,,,4
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,1,89364,ND,SHOP (Small Group),No,91-1842494,89364ND0100004,"Sanford Simplicity $3,000",89364ND010,,NDN001,NDS001,NDF008,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0100004-00,Standard Bronze Off Exchange Plan,,0.617272973060608,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",40%,,,,"$6,000","$12,000","$6,000","$12,000",,,,,,,,,4
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,1,89364,ND,SHOP (Small Group),No,91-1842494,89364ND0100004,"Sanford Simplicity $3,000",89364ND010,,NDN001,NDS001,NDF008,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0100004-01,Standard Bronze On Exchange Plan,,0.617272973060608,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",40%,,,,"$6,000","$12,000","$6,000","$12,000",,,,,,,,,5
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,1,89364,ND,Individual,No,91-1842494,89364ND0090004,"Sanford Simplicity-$6,600",89364ND009,,NDN001,NDS001,NDF008,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090004-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$9,000","$18,000","$9,000","$18,000",,,,,,,,,5
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,1,89364,ND,Individual,No,91-1842494,89364ND0090003,"Sanford Simplicity-$5,000 HDHP",89364ND009,,NDN001,NDS001,NDF008,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090003-00,Standard Bronze Off Exchange Plan,,0.586283802986145,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$6,000","$12,000","$6,000","$12,000",,,,,,,,,6
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,1,89364,ND,Individual,No,91-1842494,89364ND0090003,"Sanford Simplicity-$5,000 HDHP",89364ND009,,NDN001,NDS001,NDF008,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090003-01,Standard Bronze On Exchange Plan,,0.586283802986145,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$6,000","$12,000","$6,000","$12,000",,,,,,,,,7
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,1,89364,ND,Individual,No,91-1842494,89364ND0090003,"Sanford Simplicity-$5,000 HDHP",89364ND009,,NDN001,NDS001,NDF008,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,1,89364,ND,Individual,No,91-1842494,89364ND0090003,"Sanford Simplicity-$5,000 HDHP",89364ND009,,NDN001,NDS001,NDF008,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090003-03,Limited Cost Sharing Plan Variation,,0.586283802986145,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$6,000","$12,000","$6,000","$12,000",,,,,,,,,9
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,1,89364,ND,Individual,No,91-1842494,89364ND0090009,"Sanford True-$5,000 HDHP Sanford Network",89364ND009,,NDN002,NDS002,NDF008,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090009-00,Standard Bronze Off Exchange Plan,,0.586283802986145,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,1,89364,ND,Individual,No,91-1842494,89364ND0090009,"Sanford True-$5,000 HDHP Sanford Network",89364ND009,,NDN002,NDS002,NDF008,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090009-01,Standard Bronze On Exchange Plan,,0.586283802986145,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,1,89364,ND,Individual,No,91-1842494,89364ND0090009,"Sanford True-$5,000 HDHP Sanford Network",89364ND009,,NDN002,NDS002,NDF008,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,12
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090001,"Sanford Simplicity-$1,500",89364ND009,,NDN001,NDS001,NDF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090001-00,Standard Gold Off Exchange Plan,,0.782246828079224,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000",20%,,,,"$3,000","$6,000","$3,000","$6,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090001,"Sanford Simplicity-$1,500",89364ND009,,NDN001,NDS001,NDF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090001-01,Standard Gold On Exchange Plan,,0.782246828079224,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000",20%,,,,"$3,000","$6,000","$3,000","$6,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090001,"Sanford Simplicity-$1,500",89364ND009,,NDN001,NDS001,NDF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,27
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090001,"Sanford Simplicity-$1,500",89364ND009,,NDN001,NDS001,NDF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090001-03,Limited Cost Sharing Plan Variation,,0.782246828079224,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000",20%,,,,"$3,000","$6,000","$3,000","$6,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,4,89364,ND,SHOP (Small Group),No,91-1842494,89364ND0100007,"Sanford Simplicity $2,500",89364ND010,,NDN001,NDS001,NDF006,New,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0100007-00,Standard Silver Off Exchange Plan,,0.704849600791931,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$18,000","$12,000","$18,000","$2,500","$5,000",30%,,,,"$6,000","$12,000","$6,000","$12,000",$0,$0,40%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,4,89364,ND,SHOP (Small Group),No,91-1842494,89364ND0100007,"Sanford Simplicity $2,500",89364ND010,,NDN001,NDS001,NDF006,New,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0100007-01,Standard Silver On Exchange Plan,,0.704849600791931,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$18,000","$12,000","$18,000","$2,500","$5,000",30%,,,,"$6,000","$12,000","$6,000","$12,000",$0,$0,40%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,5,89364,ND,SHOP (Small Group),No,91-1842494,89364ND0100005,Sanford Simplicity $0,89364ND010,,NDN001,NDS001,NDF001,Existing,HMO,Platinum,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0100005-00,Standard Platinum Off Exchange Plan,,0.885378122329712,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,"$1,500","$3,000","$1,500","$3,000",,,,,,,,,4
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,5,89364,ND,SHOP (Small Group),No,91-1842494,89364ND0100005,Sanford Simplicity $0,89364ND010,,NDN001,NDS001,NDF001,Existing,HMO,Platinum,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0100005-01,Standard Platinum On Exchange Plan,,0.885378122329712,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,"$1,500","$3,000","$1,500","$3,000",,,,,,,,,5
2015,ND,90106,HIOS,8,2014-11-14 05:23:27,1,90106,ND,SHOP (Small Group),Yes,75-1233841,90106ND0020007,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,90106ND002,,NDN001,NDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.73,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/nd/90106nd0020007-15,,90106ND0020007-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,90106,HIOS,8,2014-11-14 05:23:27,1,90106,ND,Individual,Yes,75-1233841,90106ND0010007,Dentegra Dental PPO Pediatric Basic Plan,90106ND001,,NDN001,NDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$23.54,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nd/90106nd0010007-15,,90106ND0010007-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,90106,HIOS,8,2014-11-14 05:23:27,1,90106,ND,Individual,Yes,75-1233841,90106ND0010007,Dentegra Dental PPO Pediatric Basic Plan,90106ND001,,NDN001,NDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$23.54,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nd/90106nd0010007-15,,90106ND0010007-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,90106,HIOS,8,2014-11-14 05:23:27,1,90106,ND,SHOP (Small Group),Yes,75-1233841,90106ND0020007,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,90106ND002,,NDN001,NDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.73,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/nd/90106nd0020007-15,,90106ND0020007-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,90106,HIOS,8,2014-11-14 05:23:27,2,90106,ND,SHOP (Small Group),Yes,75-1233841,90106ND0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,90106ND002,,NDN001,NDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.73,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/nd/90106nd0020009-15,,90106ND0020009-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,90106,HIOS,8,2014-11-14 05:23:27,2,90106,ND,Individual,Yes,75-1233841,90106ND0010009,Dentegra Dental PPO Family Basic Plan,90106ND001,,NDN001,NDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.54,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nd/90106nd0010009-15,,90106ND0010009-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ND,90106,HIOS,8,2014-11-14 05:23:27,2,90106,ND,Individual,Yes,75-1233841,90106ND0010009,Dentegra Dental PPO Family Basic Plan,90106ND001,,NDN001,NDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.54,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nd/90106nd0010009-15,,90106ND0010009-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,90106,HIOS,8,2014-11-14 05:23:27,2,90106,ND,SHOP (Small Group),Yes,75-1233841,90106ND0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,90106ND002,,NDN001,NDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.73,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/nd/90106nd0020009-15,,90106ND0020009-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,1,89364,ND,Individual,No,91-1842494,89364ND0090009,"Sanford True-$5,000 HDHP Sanford Network",89364ND009,,NDN002,NDS002,NDF008,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090009-03,Limited Cost Sharing Plan Variation,,0.586283802986145,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,2,89364,ND,Individual,No,91-1842494,89364ND0090005,"Sanford Simplicity-$5,000",89364ND009,,NDN001,NDS001,NDF007,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090005-00,Standard Bronze Off Exchange Plan,,0.613356590270996,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,000","$20,000","$14,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$13,000","$10,000","$13,000",,,,,,,,,4
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,1,10191,NJ,Individual,No,45-3262003,10191NJ0150001,Health Republic Vital,10191NJ015,,NJN001,NJS001,NJF004,Existing,EPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-catastrophic-off-exchange,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0150001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,1,10191,NJ,Individual,No,45-3262003,10191NJ0150001,Health Republic Vital,10191NJ015,,NJN001,NJS001,NJF004,Existing,EPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-catastrophic-off-exchange,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0150001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0030001,Health Republic Full Access Prime Bronze,10191NJ003,,NJN001,NJS001,NJF002,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-prime-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0030001-00,Standard Bronze Off Exchange Plan,,0.611320734024048,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0030001,Health Republic Full Access Prime Bronze,10191NJ003,,NJN001,NJS001,NJF002,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-prime-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0030001-01,Standard Bronze On Exchange Plan,,0.611320734024048,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,2,89364,ND,SHOP (Small Group),No,91-1842494,89364ND0100008,"Sanford Simplicity $5,000",89364ND010,,NDN001,NDS001,NDF007,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0100008-00,Standard Bronze Off Exchange Plan,,0.613356590270996,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,000","$20,000","$14,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$13,000","$10,000","$13,000",,,,,,,,,4
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,2,89364,ND,SHOP (Small Group),No,91-1842494,89364ND0100008,"Sanford Simplicity $5,000",89364ND010,,NDN001,NDS001,NDF007,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0100008-01,Standard Bronze On Exchange Plan,,0.613356590270996,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,000","$20,000","$14,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$13,000","$10,000","$13,000",,,,,,,,,5
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,2,89364,ND,Individual,No,91-1842494,89364ND0090005,"Sanford Simplicity-$5,000",89364ND009,,NDN001,NDS001,NDF007,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090005-01,Standard Bronze On Exchange Plan,,0.613356590270996,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,000","$20,000","$14,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$13,000","$10,000","$13,000",,,,,,,,,5
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,2,89364,ND,Individual,No,91-1842494,89364ND0090005,"Sanford Simplicity-$5,000",89364ND009,,NDN001,NDS001,NDF007,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,2,89364,ND,Individual,No,91-1842494,89364ND0090005,"Sanford Simplicity-$5,000",89364ND009,,NDN001,NDS001,NDF007,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090005-03,Limited Cost Sharing Plan Variation,,0.613356590270996,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,000","$20,000","$14,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$13,000","$10,000","$13,000",,,,,,,,,7
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,2,89364,ND,Individual,No,91-1842494,89364ND0090007,"Sanford True-$5,000 Sanford Network",89364ND009,,NDN002,NDS002,NDF007,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090007-00,Standard Bronze Off Exchange Plan,,0.613356590270996,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,2,89364,ND,Individual,No,91-1842494,89364ND0090007,"Sanford True-$5,000 Sanford Network",89364ND009,,NDN002,NDS002,NDF007,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090007-01,Standard Bronze On Exchange Plan,,0.613356590270996,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,2,89364,ND,Individual,No,91-1842494,89364ND0090007,"Sanford True-$5,000 Sanford Network",89364ND009,,NDN002,NDS002,NDF007,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,2,89364,ND,Individual,No,91-1842494,89364ND0090007,"Sanford True-$5,000 Sanford Network",89364ND009,,NDN002,NDS002,NDF007,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090007-03,Limited Cost Sharing Plan Variation,,0.613356590270996,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090006,"Sanford Simplicity-$3,500",89364ND009,,NDN001,NDS001,NDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090006-00,Standard Silver Off Exchange Plan,,0.698490560054779,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,000","$20,000","$14,000","$20,000","$3,500","$7,000",30%,,,,"$7,000","$14,000","$7,000","$14,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0030001,Health Republic Full Access Prime Bronze,10191NJ003,,NJN001,NJS001,NJF002,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-prime-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0030001-03,Limited Cost Sharing Plan Variation,,0.611320734024048,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0030002,Health Republic Full Access Prime Silver,10191NJ003,,NJN001,NJS001,NJF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-prime-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0030002-00,Standard Silver Off Exchange Plan,,0.699643313884735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0030002,Health Republic Full Access Prime Silver,10191NJ003,,NJN001,NJS001,NJF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-prime-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0030002-01,Standard Silver On Exchange Plan,,0.699643313884735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0030002,Health Republic Full Access Prime Silver,10191NJ003,,NJN001,NJS001,NJF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-prime-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0030002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0030002,Health Republic Full Access Prime Silver,10191NJ003,,NJN001,NJS001,NJF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-prime-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0030002-03,Limited Cost Sharing Plan Variation,,0.699643313884735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0030002,Health Republic Full Access Prime Silver,10191NJ003,,NJN001,NJS001,NJF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-prime-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0030002-04,73% AV Level Silver Plan,,0.727497100830078,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0030002,Health Republic Full Access Prime Silver,10191NJ003,,NJN001,NJS001,NJF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-prime-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0030002-05,87% AV Level Silver Plan,,0.879265129566193,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0030002,Health Republic Full Access Prime Silver,10191NJ003,,NJN001,NJS001,NJF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-prime-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0030002-06,94% AV Level Silver Plan,,0.947372674942017,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0070001,Health Republic Full Access Solid Bronze,10191NJ007,,NJN001,NJS001,NJF001,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-solid-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0070001-00,Standard Bronze Off Exchange Plan,,0.614018678665161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0070001,Health Republic Full Access Solid Bronze,10191NJ007,,NJN001,NJS001,NJF001,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-solid-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0070001-01,Standard Bronze On Exchange Plan,,0.614018678665161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0070001,Health Republic Full Access Solid Bronze,10191NJ007,,NJN001,NJS001,NJF001,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-solid-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0070001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,17
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0070001,Health Republic Full Access Solid Bronze,10191NJ007,,NJN001,NJS001,NJF001,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-solid-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0070001-03,Limited Cost Sharing Plan Variation,,0.614018678665161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0070002,Health Republic Full Access Solid Silver,10191NJ007,,NJN001,NJS001,NJF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-solid-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0070002-00,Standard Silver Off Exchange Plan,,0.688982665538788,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0070002,Health Republic Full Access Solid Silver,10191NJ007,,NJN001,NJS001,NJF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-solid-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0070002-01,Standard Silver On Exchange Plan,,0.688982665538788,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,SHOP (Small Group),No,91-1842494,89364ND0100003,"Sanford Simplicity $2,000",89364ND010,,NDN001,NDS001,NDF004,Existing,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0100003-00,Standard Silver Off Exchange Plan,,0.705296576023102,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,000","$4,000",40%,,,,"$5,000","$10,000","$5,000","$1,000",$0,$0,40%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,SHOP (Small Group),No,91-1842494,89364ND0100003,"Sanford Simplicity $2,000",89364ND010,,NDN001,NDS001,NDF004,Existing,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0100003-01,Standard Silver On Exchange Plan,,0.705296576023102,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,000","$4,000",40%,,,,"$5,000","$10,000","$5,000","$1,000",$0,$0,40%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090006,"Sanford Simplicity-$3,500",89364ND009,,NDN001,NDS001,NDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090006-01,Standard Silver On Exchange Plan,,0.698490560054779,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,000","$20,000","$14,000","$20,000","$3,500","$7,000",30%,,,,"$7,000","$14,000","$7,000","$14,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090006,"Sanford Simplicity-$3,500",89364ND009,,NDN001,NDS001,NDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,SHOP (Small Group),No,91-1842494,89364ND0100002,"Sanford Simplicity $1,500",89364ND010,,NDN001,NDS001,NDF005,Existing,HMO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0100002-00,Standard Gold Off Exchange Plan,,0.782246828079224,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000",20%,,,,"$3,000","$6,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,SHOP (Small Group),No,91-1842494,89364ND0100002,"Sanford Simplicity $1,500",89364ND010,,NDN001,NDS001,NDF005,Existing,HMO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0100002-01,Standard Gold On Exchange Plan,,0.782246828079224,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000",20%,,,,"$3,000","$6,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090006,"Sanford Simplicity-$3,500",89364ND009,,NDN001,NDS001,NDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090006-03,Limited Cost Sharing Plan Variation,,0.698490560054779,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,000","$20,000","$14,000","$20,000","$3,500","$7,000",30%,,,,"$7,000","$14,000","$7,000","$14,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090006,"Sanford Simplicity-$3,500",89364ND009,,NDN001,NDS001,NDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090006-04,73% AV Level Silver Plan,,0.730322659015656,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,600","$13,200","$6,600","$13,200","$3,000","$6,000",30%,,,,"$5,000","$10,000","$5,000","$10,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,SHOP (Small Group),No,91-1842494,89364ND0100006,"Sanford Simplicity $1,000",89364ND010,,NDN001,NDS001,NDF006,New,HMO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0100006-00,Standard Gold Off Exchange Plan,,0.809297680854797,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$2,000","$4,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,SHOP (Small Group),No,91-1842494,89364ND0100006,"Sanford Simplicity $1,000",89364ND010,,NDN001,NDS001,NDF006,New,HMO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0100006-01,Standard Gold On Exchange Plan,,0.809297680854797,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$2,000","$4,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090006,"Sanford Simplicity-$3,500",89364ND009,,NDN001,NDS001,NDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090006-05,87% AV Level Silver Plan,,0.861830413341522,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,600","$13,200","$6,600","$13,200",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090006,"Sanford Simplicity-$3,500",89364ND009,,NDN001,NDS001,NDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090006-06,94% AV Level Silver Plan,,0.940972089767456,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$6,350","$12,700","$6,350","$12,700",$250,$500,20%,,,,$500,"$1,000",$500,"$1,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,SHOP (Small Group),No,91-1842494,89364ND0100001,Sanford Simplicity $500,89364ND010,,NDN001,NDS001,NDF001,Existing,HMO,Platinum,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0100001-00,Standard Platinum Off Exchange Plan,,0.884950578212738,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$5,000","$10,000","$5,000","$10,000",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,SHOP (Small Group),No,91-1842494,89364ND0100001,Sanford Simplicity $500,89364ND010,,NDN001,NDS001,NDF001,Existing,HMO,Platinum,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0100001-01,Standard Platinum On Exchange Plan,,0.884950578212738,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$5,000","$10,000","$5,000","$10,000",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090008,"Sanford True-$3,500 Sanford Network",89364ND009,,NDN002,NDS002,NDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090008-00,Standard Silver Off Exchange Plan,,0.698490560054779,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090008,"Sanford True-$3,500 Sanford Network",89364ND009,,NDN002,NDS002,NDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090008-01,Standard Silver On Exchange Plan,,0.698490560054779,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090008,"Sanford True-$3,500 Sanford Network",89364ND009,,NDN002,NDS002,NDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090008,"Sanford True-$3,500 Sanford Network",89364ND009,,NDN002,NDS002,NDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090008-03,Limited Cost Sharing Plan Variation,,0.698490560054779,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090008,"Sanford True-$3,500 Sanford Network",89364ND009,,NDN002,NDS002,NDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090008-04,73% AV Level Silver Plan,,0.730322659015656,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090008,"Sanford True-$3,500 Sanford Network",89364ND009,,NDN002,NDS002,NDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090008-05,87% AV Level Silver Plan,,0.861830413341522,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090008,"Sanford True-$3,500 Sanford Network",89364ND009,,NDN002,NDS002,NDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090008-06,94% AV Level Silver Plan,,0.940972089767456,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090002,"Sanford Simplicity-$2,500",89364ND009,,NDN001,NDS001,NDF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090002-00,Standard Silver Off Exchange Plan,,0.699748456478119,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,500","$5,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090002,"Sanford Simplicity-$2,500",89364ND009,,NDN001,NDS001,NDF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090002-01,Standard Silver On Exchange Plan,,0.699748456478119,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,500","$5,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090002,"Sanford Simplicity-$2,500",89364ND009,,NDN001,NDS001,NDF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090002,"Sanford Simplicity-$2,500",89364ND009,,NDN001,NDS001,NDF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090002-03,Limited Cost Sharing Plan Variation,,0.699748456478119,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,500","$5,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090002,"Sanford Simplicity-$2,500",89364ND009,,NDN001,NDS001,NDF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090002-04,73% AV Level Silver Plan,,0.735447406768799,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,350","$12,700","$6,350","$12,700","$1,500","$3,000",20%,,,,"$3,000","$6,000","$3,000","$6,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090002,"Sanford Simplicity-$2,500",89364ND009,,NDN001,NDS001,NDF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090002-05,87% AV Level Silver Plan,,0.871389806270599,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$6,350","$12,700","$6,350","$12,700",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,ND,89364,HIOS,5,2015-01-22 10:35:59,3,89364,ND,Individual,No,91-1842494,89364ND0090002,"Sanford Simplicity-$2,500",89364ND009,,NDN001,NDS001,NDF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,89364ND0090002-06,94% AV Level Silver Plan,,0.940972089767456,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$6,350","$12,700","$6,350","$12,700",$250,$500,20%,,,,$500,"$1,000",$500,"$1,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,7,10191,NJ,Individual,No,45-3262003,10191NJ0290003,Health Republic Full Access Pure Gold,10191NJ029,,NJN001,NJS001,NJF008,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-pure-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0290003-01,Standard Gold On Exchange Plan,79.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,7,10191,NJ,Individual,No,45-3262003,10191NJ0290003,Health Republic Full Access Pure Gold,10191NJ029,,NJN001,NJS001,NJF008,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-pure-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0290003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,7,10191,NJ,Individual,No,45-3262003,10191NJ0290003,Health Republic Full Access Pure Gold,10191NJ029,,NJN001,NJS001,NJF008,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-pure-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0290003-03,Limited Cost Sharing Plan Variation,79.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,8,10191,NJ,Individual,No,45-3262003,10191NJ0290004,Health Republic Full Access Pure Platinum,10191NJ029,,NJN001,NJS001,NJF009,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-pure-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0290004-00,Standard Platinum Off Exchange Plan,89.50%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,8,10191,NJ,Individual,No,45-3262003,10191NJ0290004,Health Republic Full Access Pure Platinum,10191NJ029,,NJN001,NJS001,NJF009,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-pure-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0290004-01,Standard Platinum On Exchange Plan,89.50%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,8,10191,NJ,Individual,No,45-3262003,10191NJ0290004,Health Republic Full Access Pure Platinum,10191NJ029,,NJN001,NJS001,NJF009,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-pure-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0290004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,8,10191,NJ,Individual,No,45-3262003,10191NJ0290004,Health Republic Full Access Pure Platinum,10191NJ029,,NJN001,NJS001,NJF009,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-pure-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0290004-03,Limited Cost Sharing Plan Variation,89.50%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,9,10191,NJ,Individual,No,45-3262003,10191NJ0180001,Health Republic Monmouth County Community Plan Bronze,10191NJ018,,NJN001,NJS003,NJF010,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-monmouth-county-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0180001-00,Standard Bronze Off Exchange Plan,61.62%,0.616167426109314,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",50%,"$2,500","$3,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0030001,Health Republic Full Access Prime Bronze,10191NJ003,,NJN001,NJS001,NJF002,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-prime-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0030001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0070002,Health Republic Full Access Solid Silver,10191NJ007,,NJN001,NJS001,NJF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-solid-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0070002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,21
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0070002,Health Republic Full Access Solid Silver,10191NJ007,,NJN001,NJS001,NJF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-solid-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0070002-03,Limited Cost Sharing Plan Variation,,0.688982665538788,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0070002,Health Republic Full Access Solid Silver,10191NJ007,,NJN001,NJS001,NJF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-solid-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0070002-04,73% AV Level Silver Plan,,0.73824143409729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0070002,Health Republic Full Access Solid Silver,10191NJ007,,NJN001,NJS001,NJF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-solid-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0070002-05,87% AV Level Silver Plan,,0.866633534431458,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,24
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0070002,Health Republic Full Access Solid Silver,10191NJ007,,NJN001,NJS001,NJF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-solid-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0070002-06,94% AV Level Silver Plan,,0.941073060035706,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0290001,Health Republic Full Access Pure Bronze,10191NJ029,,NJN001,NJS001,NJF001,New,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-pure-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0290001-00,Standard Bronze Off Exchange Plan,,0.619205415248871,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550","$13,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,26
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0290001,Health Republic Full Access Pure Bronze,10191NJ029,,NJN001,NJS001,NJF001,New,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-pure-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0290001-01,Standard Bronze On Exchange Plan,,0.619205415248871,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550","$13,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,27
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0290001,Health Republic Full Access Pure Bronze,10191NJ029,,NJN001,NJS001,NJF001,New,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-pure-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0290001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,28
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,2,10191,NJ,Individual,No,45-3262003,10191NJ0290001,Health Republic Full Access Pure Bronze,10191NJ029,,NJN001,NJS001,NJF001,New,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-pure-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0290001-03,Limited Cost Sharing Plan Variation,,0.619205415248871,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550","$13,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,29
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,3,10191,NJ,Individual,No,45-3262003,10191NJ0070003,Health Republic Full Access Solid Gold,10191NJ007,,NJN001,NJS001,NJF003,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-solid-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0070003-00,Standard Gold Off Exchange Plan,,0.800493359565735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,3,10191,NJ,Individual,No,45-3262003,10191NJ0070003,Health Republic Full Access Solid Gold,10191NJ007,,NJN001,NJS001,NJF003,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-solid-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0070003-01,Standard Gold On Exchange Plan,,0.800493359565735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,3,10191,NJ,Individual,No,45-3262003,10191NJ0070003,Health Republic Full Access Solid Gold,10191NJ007,,NJN001,NJS001,NJF003,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-solid-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0070003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,3,10191,NJ,Individual,No,45-3262003,10191NJ0070003,Health Republic Full Access Solid Gold,10191NJ007,,NJN001,NJS001,NJF003,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-solid-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0070003-03,Limited Cost Sharing Plan Variation,,0.800493359565735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,4,10191,NJ,Individual,No,45-3262003,10191NJ0050001,Health Republic Full Access Core Silver,10191NJ005,,NJN001,NJS001,NJF005,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-core-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0050001-00,Standard Silver Off Exchange Plan,,0.713009715080261,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,4,10191,NJ,Individual,No,45-3262003,10191NJ0050001,Health Republic Full Access Core Silver,10191NJ005,,NJN001,NJS001,NJF005,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-core-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0050001-01,Standard Silver On Exchange Plan,,0.713009715080261,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,4,10191,NJ,Individual,No,45-3262003,10191NJ0050001,Health Republic Full Access Core Silver,10191NJ005,,NJN001,NJS001,NJF005,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-core-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0050001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,4,10191,NJ,Individual,No,45-3262003,10191NJ0050001,Health Republic Full Access Core Silver,10191NJ005,,NJN001,NJS001,NJF005,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-core-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0050001-03,Limited Cost Sharing Plan Variation,,0.713009715080261,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,4,10191,NJ,Individual,No,45-3262003,10191NJ0050001,Health Republic Full Access Core Silver,10191NJ005,,NJN001,NJS001,NJF005,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-core-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0050001-04,73% AV Level Silver Plan,,0.734092235565186,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,900","$7,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,4,10191,NJ,Individual,No,45-3262003,10191NJ0050001,Health Republic Full Access Core Silver,10191NJ005,,NJN001,NJS001,NJF005,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-core-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0050001-05,87% AV Level Silver Plan,,0.868922531604767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,4,10191,NJ,Individual,No,45-3262003,10191NJ0050001,Health Republic Full Access Core Silver,10191NJ005,,NJN001,NJS001,NJF005,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-core-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0050001-06,94% AV Level Silver Plan,,0.934897124767303,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,4,10191,NJ,Individual,No,45-3262003,10191NJ0050002,Health Republic Full Access Core Gold,10191NJ005,,NJN001,NJS001,NJF006,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-core-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0050002-00,Standard Gold Off Exchange Plan,,0.784414172172546,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,4,10191,NJ,Individual,No,45-3262003,10191NJ0050002,Health Republic Full Access Core Gold,10191NJ005,,NJN001,NJS001,NJF006,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-core-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0050002-01,Standard Gold On Exchange Plan,,0.784414172172546,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,4,10191,NJ,Individual,No,45-3262003,10191NJ0050002,Health Republic Full Access Core Gold,10191NJ005,,NJN001,NJS001,NJF006,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-core-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0050002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,4,10191,NJ,Individual,No,45-3262003,10191NJ0050002,Health Republic Full Access Core Gold,10191NJ005,,NJN001,NJS001,NJF006,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-core-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0050002-03,Limited Cost Sharing Plan Variation,,0.784414172172546,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,5,10191,NJ,Individual,No,45-3262003,10191NJ0050003,Health Republic Full Access Core Platinum,10191NJ005,,NJN001,NJS001,NJF007,Existing,EPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-core-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0050003-00,Standard Platinum Off Exchange Plan,,0.880226492881775,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,5,10191,NJ,Individual,No,45-3262003,10191NJ0050003,Health Republic Full Access Core Platinum,10191NJ005,,NJN001,NJS001,NJF007,Existing,EPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-core-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0050003-01,Standard Platinum On Exchange Plan,,0.880226492881775,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,5,10191,NJ,Individual,No,45-3262003,10191NJ0050003,Health Republic Full Access Core Platinum,10191NJ005,,NJN001,NJS001,NJF007,Existing,EPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-core-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0050003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,5,10191,NJ,Individual,No,45-3262003,10191NJ0050003,Health Republic Full Access Core Platinum,10191NJ005,,NJN001,NJS001,NJF007,Existing,EPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-core-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0050003-03,Limited Cost Sharing Plan Variation,,0.880226492881775,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,6,10191,NJ,Individual,No,45-3262003,10191NJ0290002,Health Republic Full Access Pure Silver,10191NJ029,,NJN001,NJS001,NJF002,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-pure-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0290002-00,Standard Silver Off Exchange Plan,,0.698090016841888,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,6,10191,NJ,Individual,No,45-3262003,10191NJ0290002,Health Republic Full Access Pure Silver,10191NJ029,,NJN001,NJS001,NJF002,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-pure-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0290002-01,Standard Silver On Exchange Plan,,0.698090016841888,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,6,10191,NJ,Individual,No,45-3262003,10191NJ0290002,Health Republic Full Access Pure Silver,10191NJ029,,NJN001,NJS001,NJF002,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-pure-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0290002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,6,10191,NJ,Individual,No,45-3262003,10191NJ0290002,Health Republic Full Access Pure Silver,10191NJ029,,NJN001,NJS001,NJF002,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-pure-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0290002-03,Limited Cost Sharing Plan Variation,,0.698090016841888,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,6,10191,NJ,Individual,No,45-3262003,10191NJ0290002,Health Republic Full Access Pure Silver,10191NJ029,,NJN001,NJS001,NJF002,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-pure-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0290002-04,73% AV Level Silver Plan,,0.732131958007813,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,6,10191,NJ,Individual,No,45-3262003,10191NJ0290002,Health Republic Full Access Pure Silver,10191NJ029,,NJN001,NJS001,NJF002,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-pure-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0290002-05,87% AV Level Silver Plan,,0.876481056213379,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,6,10191,NJ,Individual,No,45-3262003,10191NJ0290002,Health Republic Full Access Pure Silver,10191NJ029,,NJN001,NJS001,NJF002,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-pure-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0290002-06,94% AV Level Silver Plan,,0.938860416412354,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,7,10191,NJ,Individual,No,45-3262003,10191NJ0290003,Health Republic Full Access Pure Gold,10191NJ029,,NJN001,NJS001,NJF008,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-pure-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0290003-00,Standard Gold Off Exchange Plan,79.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,9,10191,NJ,Individual,No,45-3262003,10191NJ0180001,Health Republic Monmouth County Community Plan Bronze,10191NJ018,,NJN001,NJS003,NJF010,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-monmouth-county-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0180001-01,Standard Bronze On Exchange Plan,61.62%,0.616167426109314,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",50%,"$2,500","$3,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,9,10191,NJ,Individual,No,45-3262003,10191NJ0180001,Health Republic Monmouth County Community Plan Bronze,10191NJ018,,NJN001,NJS003,NJF010,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-monmouth-county-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0180001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,9,10191,NJ,Individual,No,45-3262003,10191NJ0180001,Health Republic Monmouth County Community Plan Bronze,10191NJ018,,NJN001,NJS003,NJF010,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-monmouth-county-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0180001-03,Limited Cost Sharing Plan Variation,61.62%,0.616167426109314,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",50%,"$2,500","$3,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,10,10191,NJ,Individual,No,45-3262003,10191NJ0180002,Health Republic Monmouth County Community Plan Silver,10191NJ018,,NJN001,NJS003,NJF011,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-monmouth-county-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0180002-00,Standard Silver Off Exchange Plan,71.80%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,40%,"$2,500","$5,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,10,10191,NJ,Individual,No,45-3262003,10191NJ0180002,Health Republic Monmouth County Community Plan Silver,10191NJ018,,NJN001,NJS003,NJF011,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-monmouth-county-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0180002-01,Standard Silver On Exchange Plan,71.80%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,40%,"$2,500","$5,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,10,10191,NJ,Individual,No,45-3262003,10191NJ0180002,Health Republic Monmouth County Community Plan Silver,10191NJ018,,NJN001,NJS003,NJF011,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-monmouth-county-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0180002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,10,10191,NJ,Individual,No,45-3262003,10191NJ0180002,Health Republic Monmouth County Community Plan Silver,10191NJ018,,NJN001,NJS003,NJF011,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-monmouth-county-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0180002-03,Limited Cost Sharing Plan Variation,71.80%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,40%,"$2,500","$5,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,10,10191,NJ,Individual,No,45-3262003,10191NJ0180002,Health Republic Monmouth County Community Plan Silver,10191NJ018,,NJN001,NJS003,NJF011,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-monmouth-county-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0180002-04,73% AV Level Silver Plan,73.80%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,40%,"$2,000","$4,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,10,10191,NJ,Individual,No,45-3262003,10191NJ0180002,Health Republic Monmouth County Community Plan Silver,10191NJ018,,NJN001,NJS003,NJF011,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-monmouth-county-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0180002-05,87% AV Level Silver Plan,86.60%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,250","$2,500","$1,250","$2,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,40%,$500,"$1,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,10,10191,NJ,Individual,No,45-3262003,10191NJ0180002,Health Republic Monmouth County Community Plan Silver,10191NJ018,,NJN001,NJS003,NJF011,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-monmouth-county-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0180002-06,94% AV Level Silver Plan,93.50%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$500,"$1,000",$500,"$1,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,40%,$0,$0,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,11,10191,NJ,Individual,No,45-3262003,10191NJ0180003,Health Republic Monmouth County Community Plan Gold,10191NJ018,,NJN001,NJS003,NJF012,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-monmouth-county-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0180003-00,Standard Gold Off Exchange Plan,81.60%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,"$2,500","$5,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,11,10191,NJ,Individual,No,45-3262003,10191NJ0180003,Health Republic Monmouth County Community Plan Gold,10191NJ018,,NJN001,NJS003,NJF012,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-monmouth-county-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0180003-01,Standard Gold On Exchange Plan,81.60%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,"$2,500","$5,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,11,10191,NJ,Individual,No,45-3262003,10191NJ0180003,Health Republic Monmouth County Community Plan Gold,10191NJ018,,NJN001,NJS003,NJF012,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-monmouth-county-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0180003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,11,10191,NJ,Individual,No,45-3262003,10191NJ0180003,Health Republic Monmouth County Community Plan Gold,10191NJ018,,NJN001,NJS003,NJF012,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-monmouth-county-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0180003-03,Limited Cost Sharing Plan Variation,81.60%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,"$2,500","$5,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,12,10191,NJ,Individual,No,45-3262003,10191NJ0180004,Health Republic Monmouth County Community Plan Platinum,10191NJ018,,NJN001,NJS003,NJF013,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-monmouth-county-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0180004-00,Standard Platinum Off Exchange Plan,89.60%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,20%,"$1,500","$3,000",20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,12,10191,NJ,Individual,No,45-3262003,10191NJ0180004,Health Republic Monmouth County Community Plan Platinum,10191NJ018,,NJN001,NJS003,NJF013,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-monmouth-county-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0180004-01,Standard Platinum On Exchange Plan,89.60%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,20%,"$1,500","$3,000",20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,12,10191,NJ,Individual,No,45-3262003,10191NJ0180004,Health Republic Monmouth County Community Plan Platinum,10191NJ018,,NJN001,NJS003,NJF013,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-monmouth-county-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0180004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,12,10191,NJ,Individual,No,45-3262003,10191NJ0180004,Health Republic Monmouth County Community Plan Platinum,10191NJ018,,NJN001,NJS003,NJF013,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-monmouth-county-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0180004-03,Limited Cost Sharing Plan Variation,89.60%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,20%,"$1,500","$3,000",20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,13,10191,NJ,Individual,No,45-3262003,10191NJ0190001,Health Republic Active Access Spotlight Bronze,10191NJ019,,NJN001,NJS004,NJF014,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-spotlight-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0190001-00,Standard Bronze Off Exchange Plan,61.50%,0.628919363021851,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,13,10191,NJ,Individual,No,45-3262003,10191NJ0190001,Health Republic Active Access Spotlight Bronze,10191NJ019,,NJN001,NJS004,NJF014,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-spotlight-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0190001-01,Standard Bronze On Exchange Plan,61.50%,0.628919363021851,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,13,10191,NJ,Individual,No,45-3262003,10191NJ0190001,Health Republic Active Access Spotlight Bronze,10191NJ019,,NJN001,NJS004,NJF014,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-spotlight-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0190001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,13,10191,NJ,Individual,No,45-3262003,10191NJ0190001,Health Republic Active Access Spotlight Bronze,10191NJ019,,NJN001,NJS004,NJF014,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-spotlight-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0190001-03,Limited Cost Sharing Plan Variation,61.50%,0.628919363021851,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,14,10191,NJ,Individual,No,45-3262003,10191NJ0190002,Health Republic Active Access Spotlight Silver,10191NJ019,,NJN001,NJS004,NJF015,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-spotlight-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0190002-00,Standard Silver Off Exchange Plan,70.80%,0,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,"$2,000","$4,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,14,10191,NJ,Individual,No,45-3262003,10191NJ0190002,Health Republic Active Access Spotlight Silver,10191NJ019,,NJN001,NJS004,NJF015,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-spotlight-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0190002-01,Standard Silver On Exchange Plan,70.80%,0,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,"$2,000","$4,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,14,10191,NJ,Individual,No,45-3262003,10191NJ0190002,Health Republic Active Access Spotlight Silver,10191NJ019,,NJN001,NJS004,NJF015,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-spotlight-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0190002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,14,10191,NJ,Individual,No,45-3262003,10191NJ0190002,Health Republic Active Access Spotlight Silver,10191NJ019,,NJN001,NJS004,NJF015,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-spotlight-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0190002-03,Limited Cost Sharing Plan Variation,70.80%,0,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,"$2,000","$4,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,14,10191,NJ,Individual,No,45-3262003,10191NJ0190002,Health Republic Active Access Spotlight Silver,10191NJ019,,NJN001,NJS004,NJF015,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-spotlight-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0190002-04,73% AV Level Silver Plan,72.90%,0,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",40%,"$1,500","$3,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,14,10191,NJ,Individual,No,45-3262003,10191NJ0190002,Health Republic Active Access Spotlight Silver,10191NJ019,,NJN001,NJS004,NJF015,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-spotlight-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0190002-05,87% AV Level Silver Plan,86.80%,0,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,250","$2,500","$1,250","$2,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",40%,$500,"$1,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,14,10191,NJ,Individual,No,45-3262003,10191NJ0190002,Health Republic Active Access Spotlight Silver,10191NJ019,,NJN001,NJS004,NJF015,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-spotlight-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0190002-06,94% AV Level Silver Plan,93.90%,0,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$500,"$1,000",$500,"$1,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,40%,$0,$0,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,15,10191,NJ,Individual,No,45-3262003,10191NJ0190003,Health Republic Active Access Spotlight Gold,10191NJ019,,NJN001,NJS004,NJF016,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-spotlight-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0190003-00,Standard Gold Off Exchange Plan,81.00%,0,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,"$1,500","$3,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,15,10191,NJ,Individual,No,45-3262003,10191NJ0190003,Health Republic Active Access Spotlight Gold,10191NJ019,,NJN001,NJS004,NJF016,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-spotlight-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0190003-01,Standard Gold On Exchange Plan,81.00%,0,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,"$1,500","$3,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,15,10191,NJ,Individual,No,45-3262003,10191NJ0190003,Health Republic Active Access Spotlight Gold,10191NJ019,,NJN001,NJS004,NJF016,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-spotlight-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0190003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,15,10191,NJ,Individual,No,45-3262003,10191NJ0190003,Health Republic Active Access Spotlight Gold,10191NJ019,,NJN001,NJS004,NJF016,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-spotlight-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0190003-03,Limited Cost Sharing Plan Variation,81.00%,0,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,"$1,500","$3,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,16,10191,NJ,Individual,No,45-3262003,10191NJ0190004,Health Republic Active Access Spotlight Platinum,10191NJ019,,NJN001,NJS004,NJF017,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-spotlight-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0190004-00,Standard Platinum Off Exchange Plan,91.80%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,250","$2,500","$1,250","$2,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,20%,$0,$0,20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,16,10191,NJ,Individual,No,45-3262003,10191NJ0190004,Health Republic Active Access Spotlight Platinum,10191NJ019,,NJN001,NJS004,NJF017,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-spotlight-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0190004-01,Standard Platinum On Exchange Plan,91.80%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,250","$2,500","$1,250","$2,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,20%,$0,$0,20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,16,10191,NJ,Individual,No,45-3262003,10191NJ0190004,Health Republic Active Access Spotlight Platinum,10191NJ019,,NJN001,NJS004,NJF017,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-spotlight-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0190004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,10191,HIOS,11,2015-07-22 09:15:52,16,10191,NJ,Individual,No,45-3262003,10191NJ0190004,Health Republic Active Access Spotlight Platinum,10191NJ019,,NJN001,NJS004,NJF017,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://newjersey.healthrepublic.us/sec_docs/nj-individual-spotlight-plan,https://newjersey.healthrepublic.us/make-a-payment/,http://newjersey.healthrepublic.us/sec_docs/hrinj-individual-plan-brochure,https://newjersey.healthrepublic.us/sec_docs/nj-formulary,10191NJ0190004-03,Limited Cost Sharing Plan Variation,91.80%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,250","$2,500","$1,250","$2,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,20%,$0,$0,20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NJ,15720,HIOS,5,2014-11-12 05:24:58,1,15720,NJ,SHOP (Small Group),Yes,47-0397286,15720NJ0030001,"Renaissance Group Dental PPO, EHB Certified",15720NJ003,,NJN001,NJS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$41.63,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,15720NJ0030001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,15720,HIOS,5,2014-11-12 05:24:58,1,15720,NJ,Individual,Yes,47-0397286,15720NJ0010001,"Delta Dental Individual PPO, EHB Certified",15720NJ001,,NJN002,NJS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$40.58,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,15720NJ0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,15720,HIOS,5,2014-11-12 05:24:58,1,15720,NJ,Individual,Yes,47-0397286,15720NJ0010002,"Delta Dental Individual PPO, EHB Certified",15720NJ001,,NJN002,NJS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.01,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,15720NJ0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,15720,HIOS,5,2014-11-12 05:24:58,1,15720,NJ,SHOP (Small Group),Yes,47-0397286,15720NJ0030002,"Renaissance Group Dental PPO, EHB Certified",15720NJ003,,NJN001,NJS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.87,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,15720NJ0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,15720,HIOS,5,2014-11-12 05:24:58,1,15720,NJ,Individual,Yes,47-0397286,15720NJ0020001,"Renaissance Individual Dental PPO, EHB Certified",15720NJ002,,NJN001,NJS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$44.44,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,15720NJ0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NJ,15720,HIOS,5,2014-11-12 05:24:58,1,15720,NJ,Individual,Yes,47-0397286,15720NJ0020002,"Renaissance Individual Dental PPO, EHB Certified",15720NJ002,,NJN001,NJS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.04,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,15720NJ0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NJ,15720,HIOS,5,2014-11-12 05:24:58,1,15720,NJ,Individual,Yes,47-0397286,15720NJ0040001,"Renaissance Individual Dental PPO, EHB Certified (Exchange)",15720NJ004,,NJN001,NJS001,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.49,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/NJ_EHB_High,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/80132,http://www.renaissancedental.com/NJ_EHB_High,,15720NJ0040001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,NJ,15720,HIOS,5,2014-11-12 05:24:58,1,15720,NJ,Individual,Yes,47-0397286,15720NJ0040002,"Renaissance Individual Dental PPO, EHB Certified (Exchange)",15720NJ004,,NJN001,NJS001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.44,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/NJ_EHB_Low,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/80132,http://www.renaissancedental.com/NJ_EHB_Low,,15720NJ0040002-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,NJ,15720,HIOS,5,2014-11-12 05:24:58,2,15720,NJ,Individual,Yes,47-0397286,15720NJ0050001,"Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)",15720NJ005,,NJN001,NJS001,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$48.35,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/NJ_Ped_High,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/80132,http://www.renaissancedental.com/NJ_Ped_High,,15720NJ0050001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,15720,HIOS,5,2014-11-12 05:24:58,2,15720,NJ,Individual,Yes,47-0397286,15720NJ0050002,"Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)",15720NJ005,,NJN001,NJS001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$38.23,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/NJ_Ped_Low,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/80132,http://www.renaissancedental.com/NJ_Ped_Low,,15720NJ0050002-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,15720,HIOS,5,2014-11-12 05:24:58,2,15720,NJ,Individual,Yes,47-0397286,15720NJ0060001,"Renaissance Individual Pediatric-Only Dental PPO, EHB Certified",15720NJ006,,NJN001,NJS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$44.50,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,15720NJ0060001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NJ,15720,HIOS,5,2014-11-12 05:24:58,2,15720,NJ,Individual,Yes,47-0397286,15720NJ0060002,"Renaissance Individual Pediatric-Only Dental PPO, EHB Certified",15720NJ006,,NJN001,NJS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$35.22,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,15720NJ0060002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,2,50221,NJ,Individual,No,47-1142944,50221NJ0020001,Oscar Silver Share,50221NJ002,,NJN001,NJS001,NJF001,New,EPO,Silver,Yes,Both,Yes,No,,,$91.02,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998053925194024,,,0,1,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0020001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0020001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0020001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0020001-06,94% AV Level Silver Plan,94.50%,,Yes,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,$500,"$1,000",$500,"$1,000",Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,,,$0,$0,35%,$0,$0,35%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,10
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,3,50221,NJ,Individual,No,47-1142944,50221NJ0040001,Oscar Silver,50221NJ004,,NJN001,NJS001,NJF002,New,EPO,Silver,Yes,Both,Yes,No,,,$91.02,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99980152753063,,,0,2,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0040001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0040001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0040001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0040001-00,Standard Silver Off Exchange Plan,68.50%,,Yes,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,"$2,000","$4,000",50%,Not Applicable,Not Applicable,"$2,000","$4,000",,,,,,,,,4
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,3,50221,NJ,Individual,No,47-1142944,50221NJ0040001,Oscar Silver,50221NJ004,,NJN001,NJS001,NJF002,New,EPO,Silver,Yes,Both,Yes,No,,,$91.02,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99980152753063,,,0,2,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0040001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0040001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0040001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0040001-01,Standard Silver On Exchange Plan,68.50%,,Yes,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,"$2,000","$4,000",50%,Not Applicable,Not Applicable,"$2,000","$4,000",,,,,,,,,5
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,3,50221,NJ,Individual,No,47-1142944,50221NJ0040001,Oscar Silver,50221NJ004,,NJN001,NJS001,NJF002,New,EPO,Silver,Yes,Both,Yes,No,,,$91.02,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99980152753063,,,0,2,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0040001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0040001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0040001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0040001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,3,50221,NJ,Individual,No,47-1142944,50221NJ0040001,Oscar Silver,50221NJ004,,NJN001,NJS001,NJF002,New,EPO,Silver,Yes,Both,Yes,No,,,$91.02,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99980152753063,,,0,2,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0040001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0040001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0040001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0040001-03,Limited Cost Sharing Plan Variation,68.50%,,Yes,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,"$2,000","$4,000",50%,Not Applicable,Not Applicable,"$2,000","$4,000",,,,,,,,,7
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,3,50221,NJ,Individual,No,47-1142944,50221NJ0040001,Oscar Silver,50221NJ004,,NJN001,NJS001,NJF002,New,EPO,Silver,Yes,Both,Yes,No,,,$91.02,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99980152753063,,,0,2,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0040001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0040001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0040001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0040001-04,73% AV Level Silver Plan,73.70%,,Yes,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,"$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,"$1,000","$2,000",50%,Not Applicable,Not Applicable,"$1,000","$2,000",,,,,,,,,8
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,3,50221,NJ,Individual,No,47-1142944,50221NJ0040001,Oscar Silver,50221NJ004,,NJN001,NJS001,NJF002,New,EPO,Silver,Yes,Both,Yes,No,,,$91.02,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99980152753063,,,0,2,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0040001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0040001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0040001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0040001-05,87% AV Level Silver Plan,87.20%,,Yes,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$1,800","$3,600","$1,800","$3,600",Not Applicable,Not Applicable,"$1,800","$3,600",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,$0,$0,50%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,9
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,3,50221,NJ,Individual,No,47-1142944,50221NJ0040001,Oscar Silver,50221NJ004,,NJN001,NJS001,NJF002,New,EPO,Silver,Yes,Both,Yes,No,,,$91.02,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99980152753063,,,0,2,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0040001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0040001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0040001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0040001-06,94% AV Level Silver Plan,94.60%,,Yes,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,$500,"$1,000",$500,"$1,000",Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,$0,$0,50%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,10
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,3,50221,NJ,Individual,No,47-1142944,50221NJ0050001,Oscar Gold,50221NJ005,,NJN001,NJS001,NJF003,New,EPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999811490572688,,,0,2,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0050001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0050001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0050001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0050001-00,Standard Gold Off Exchange Plan,80.20%,,Yes,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$2,500","$5,000","$2,500","$5,000",Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,"$1,000","$2,000",50%,Not Applicable,Not Applicable,"$1,000","$2,000",,,,,,,,,11
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,3,50221,NJ,Individual,No,47-1142944,50221NJ0050001,Oscar Gold,50221NJ005,,NJN001,NJS001,NJF003,New,EPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999811490572688,,,0,2,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0050001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0050001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0050001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0050001-01,Standard Gold On Exchange Plan,80.20%,,Yes,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$2,500","$5,000","$2,500","$5,000",Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,"$1,000","$2,000",50%,Not Applicable,Not Applicable,"$1,000","$2,000",,,,,,,,,12
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,3,50221,NJ,Individual,No,47-1142944,50221NJ0050001,Oscar Gold,50221NJ005,,NJN001,NJS001,NJF003,New,EPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999811490572688,,,0,2,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0050001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0050001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0050001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0050001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,13
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,3,50221,NJ,Individual,No,47-1142944,50221NJ0050001,Oscar Gold,50221NJ005,,NJN001,NJS001,NJF003,New,EPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999811490572688,,,0,2,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0050001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0050001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0050001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0050001-03,Limited Cost Sharing Plan Variation,80.20%,,Yes,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$2,500","$5,000","$2,500","$5,000",Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,"$1,000","$2,000",50%,Not Applicable,Not Applicable,"$1,000","$2,000",,,,,,,,,14
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,4,50221,NJ,Individual,No,47-1142944,50221NJ0080001,Oscar Secure,50221NJ008,,NJN001,NJS001,NJF004,New,EPO,Catastrophic,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99743490763192,,,0,3,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0080001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0080001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0080001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0080001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,4
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,4,50221,NJ,Individual,No,47-1142944,50221NJ0080001,Oscar Secure,50221NJ008,,NJN001,NJS001,NJF004,New,EPO,Catastrophic,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99743490763192,,,0,3,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0080001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0080001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0080001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0080001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,5
2015,NJ,51152,HIOS,4,2014-09-04 03:25:43,1,51152,NJ,SHOP (Small Group),Yes,35-0472300,51152NJ0010001,Lincoln DentalConnect?,51152NJ001,,NJN001,NJS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.97,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,51152NJ0010001-00,Standard High Off Exchange Plan,84.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,51152,HIOS,4,2014-09-04 03:25:43,1,51152,NJ,SHOP (Small Group),Yes,35-0472300,51152NJ0010002,Lincoln DentalConnect?,51152NJ001,,NJN001,NJS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.46,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,51152NJ0010002-00,Standard Low Off Exchange Plan,70.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,51152,HIOS,4,2014-09-04 03:25:43,1,51152,NJ,SHOP (Small Group),Yes,35-0472300,51152NJ0010003,Lincoln DentalConnect?,51152NJ001,,NJN001,NJS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.42,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,51152NJ0010003-00,Standard Low Off Exchange Plan,70.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NJ,51152,HIOS,4,2014-09-04 03:25:43,1,51152,NJ,SHOP (Small Group),Yes,35-0472300,51152NJ0010005,Lincoln DentalConnect?,51152NJ001,,NJN001,NJS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.05,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,51152NJ0010005-00,Standard High Off Exchange Plan,84.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NJ,51152,HIOS,4,2014-09-04 03:25:43,1,51152,NJ,SHOP (Small Group),Yes,35-0472300,51152NJ0010006,Lincoln DentalConnect?,51152NJ001,,NJN001,NJS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.40,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,51152NJ0010006-00,Standard Low Off Exchange Plan,70.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,NJ,51152,HIOS,4,2014-09-04 03:25:43,1,51152,NJ,SHOP (Small Group),Yes,35-0472300,51152NJ0010007,Lincoln DentalConnect?,51152NJ001,,NJN001,NJS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.54,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,51152NJ0010007-00,Standard Low Off Exchange Plan,70.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,NJ,51152,HIOS,4,2014-09-04 03:25:43,2,51152,NJ,SHOP (Small Group),Yes,35-0472300,51152NJ0010004,Lincoln DentalConnect?,51152NJ001,,NJN001,NJS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.97,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,51152NJ0010004-00,Standard High Off Exchange Plan,86.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,51152,HIOS,4,2014-09-04 03:25:43,2,51152,NJ,SHOP (Small Group),Yes,35-0472300,51152NJ0010008,Lincoln DentalConnect?,51152NJ001,,NJN001,NJS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$40.87,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,51152NJ0010008-00,Standard High Off Exchange Plan,86.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,51791,HIOS,2,2014-08-03 08:59:32,1,51791,NJ,SHOP (Small Group),Yes,93-0242990,51791NJ0040002,EHB High PPO,51791NJ004,,NJN001,NJS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$50.71,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,51791NJ0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,40704,HIOS,2,2014-08-03 08:59:32,1,40704,NJ,SHOP (Small Group),Yes,47-0098400,40704NJ0040002,EHB High PPO,40704NJ004,,NJN001,NJS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$49.86,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,40704NJ0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,1,91661,NJ,Individual,No,22-0999690,91661NJ2260002,Horizon Advance EPO Gold,91661NJ226,,NJN002,NJS001,NJF001,Existing,EPO,Gold,No,Both,No,Yes,Any non-Primary Care Provider,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advance-EPO-Gold,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advance-EPO-Gold,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2260002-01,Standard Gold On Exchange Plan,,0.80037385225296,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$2,500","$5,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,"$2,000","$4,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,$0,$0,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$690,$150,"$1,000",$540,$210,$80,5
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,1,91661,NJ,SHOP (Small Group),No,22-0999690,91661NJ2290002,Horizon Direct Access Gold 100/80/60 BlueCard,91661NJ229,,NJN001,NJS001,NJF007,Existing,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Offers out of network coverage,Yes,http://horizonblue.com/2015/SBC-Advantage-Direct-Access-100-80-60,,,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2290002-01,Standard Gold On Exchange Plan,,0.786255776882172,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,"$1,500",$20,$590,$150,"$1,130",$600,$450,$80,5
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,1,91661,NJ,Individual,No,22-0999690,91661NJ2260002,Horizon Advance EPO Gold,91661NJ226,,NJN002,NJS001,NJF001,Existing,EPO,Gold,No,Both,No,Yes,Any non-Primary Care Provider,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advance-EPO-Gold,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advance-EPO-Gold,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2260002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$690,$150,"$1,000",$540,$210,$80,6
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,1,91661,NJ,Individual,No,22-0999690,91661NJ2260002,Horizon Advance EPO Gold,91661NJ226,,NJN002,NJS001,NJF001,Existing,EPO,Gold,No,Both,No,Yes,Any non-Primary Care Provider,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advance-EPO-Gold,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advance-EPO-Gold,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2260002-03,Limited Cost Sharing Plan Variation,,0.80037385225296,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$2,500","$5,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,"$2,000","$4,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,$0,$0,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$690,$150,"$1,000",$540,$210,$80,7
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,2,91661,NJ,Individual,No,22-0999690,91661NJ2260003,Horizon Advance EPO Silver,91661NJ226,,NJN002,NJS001,NJF002,Existing,EPO,Silver,No,Both,No,Yes,Any non-Primary Care Provider,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advance-EPO-Silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advance-EPO-Silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2260003-00,Standard Silver Off Exchange Plan,,0.697915196418762,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$900,$150,"$1,500",$0,"$1,090",$80,4
2015,NJ,40704,HIOS,2,2014-08-03 08:59:32,1,40704,NJ,SHOP (Small Group),Yes,47-0098400,40704NJ0040001,EHB Low PPO,40704NJ004,,NJN001,NJS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.72,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,40704NJ0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,40704,HIOS,2,2014-08-03 08:59:32,1,40704,NJ,SHOP (Small Group),Yes,47-0098400,40704NJ0030002,EHB High Passive,40704NJ003,,NJN001,NJS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$55.61,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,40704NJ0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NJ,40704,HIOS,2,2014-08-03 08:59:32,1,40704,NJ,SHOP (Small Group),Yes,47-0098400,40704NJ0030001,EHB Low Passive,40704NJ003,,NJN001,NJS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.72,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,40704NJ0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NJ,44811,HIOS,3,2014-08-23 04:11:13,1,44811,NJ,SHOP (Small Group),Yes,22-3849572,44811NJ0020002,Managed DentalGuard NJ Child Essentials 1,44811NJ002,,NJN001,NJS001,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$15.95,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,44811NJ0020002-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,44811,HIOS,3,2014-08-23 04:11:13,2,44811,NJ,SHOP (Small Group),Yes,22-3849572,44811NJ0050002,Managed DentalGuard NJ 10 Family Plan,44811NJ005,,NJN001,NJS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$15.95,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,44811NJ0050002-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,44811,HIOS,3,2014-08-23 04:11:13,2,44811,NJ,SHOP (Small Group),Yes,22-3849572,44811NJ0050002,Managed DentalGuard NJ 10 Family Plan,44811NJ005,,NJN001,NJS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$15.95,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,44811NJ0050002-01,Standard Low On Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,44811,HIOS,3,2014-08-23 04:11:13,2,44811,NJ,SHOP (Small Group),Yes,22-3849572,44811NJ0070002,Managed DentalGuard NJ 20 Family Plan,44811NJ007,,NJN001,NJS001,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$15.95,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,44811NJ0070002-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NJ,44811,HIOS,3,2014-08-23 04:11:13,2,44811,NJ,SHOP (Small Group),Yes,22-3849572,44811NJ0080002,Managed DentalGuard NJ 30 Family Plan,44811NJ008,,NJN001,NJS001,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$15.95,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,44811NJ0080002-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NJ,48608,HIOS,8,2014-11-14 05:23:27,1,48608,NJ,SHOP (Small Group),Yes,75-1233841,48608NJ0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,48608NJ002,,NJN001,NJS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.63,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/nj/48608nj0020001-15,,48608NJ0020001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,48608,HIOS,8,2014-11-14 05:23:27,1,48608,NJ,Individual,Yes,75-1233841,48608NJ0010001,Dentegra Dental PPO Pediatric Basic Plan,48608NJ001,,NJN001,NJS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$23.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nj/48608nj0010001-15,,48608NJ0010001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,48608,HIOS,8,2014-11-14 05:23:27,1,48608,NJ,Individual,Yes,75-1233841,48608NJ0010001,Dentegra Dental PPO Pediatric Basic Plan,48608NJ001,,NJN001,NJS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$23.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nj/48608nj0010001-15,,48608NJ0010001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,48608,HIOS,8,2014-11-14 05:23:27,1,48608,NJ,SHOP (Small Group),Yes,75-1233841,48608NJ0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,48608NJ002,,NJN001,NJS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.63,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/nj/48608nj0020001-15,,48608NJ0020001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,48608,HIOS,8,2014-11-14 05:23:27,2,48608,NJ,SHOP (Small Group),Yes,75-1233841,48608NJ0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,48608NJ002,,NJN001,NJS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.77,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/nj/48608nj0020004-15,,48608NJ0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,48608,HIOS,8,2014-11-14 05:23:27,2,48608,NJ,Individual,Yes,75-1233841,48608NJ0010004,Dentegra Dental PPO Family Preferred Plan,48608NJ001,,NJN001,NJS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.53,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nj/48608nj0010004-15,,48608NJ0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,48608,HIOS,8,2014-11-14 05:23:27,2,48608,NJ,Individual,Yes,75-1233841,48608NJ0010004,Dentegra Dental PPO Family Preferred Plan,48608NJ001,,NJN001,NJS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.53,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nj/48608nj0010004-15,,48608NJ0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,48608,HIOS,8,2014-11-14 05:23:27,2,48608,NJ,SHOP (Small Group),Yes,75-1233841,48608NJ0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,48608NJ002,,NJN001,NJS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.77,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/nj/48608nj0020004-15,,48608NJ0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,48608,HIOS,8,2014-11-14 05:23:27,3,48608,NJ,SHOP (Small Group),Yes,75-1233841,48608NJ0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,48608NJ002,,NJN001,NJS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.48,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/nj/48608nj0020006-15,,48608NJ0020006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,48608,HIOS,8,2014-11-14 05:23:27,3,48608,NJ,Individual,Yes,75-1233841,48608NJ0010006,Dentegra Dental PPO Family Basic Plan,48608NJ001,,NJN001,NJS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nj/48608nj0010006-15,,48608NJ0010006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,48608,HIOS,8,2014-11-14 05:23:27,3,48608,NJ,Individual,Yes,75-1233841,48608NJ0010006,Dentegra Dental PPO Family Basic Plan,48608NJ001,,NJN001,NJS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nj/48608nj0010006-15,,48608NJ0010006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,48608,HIOS,8,2014-11-14 05:23:27,3,48608,NJ,SHOP (Small Group),Yes,75-1233841,48608NJ0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,48608NJ002,,NJN001,NJS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.48,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/nj/48608nj0020006-15,,48608NJ0020006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,1,48834,NJ,Individual,No,22-2745725,48834NJ0080005,Oxford Silver Compass HSA $1500-2,48834NJ008,,NJN006,NJS001,NJF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080005-00,Standard Silver Off Exchange Plan,69.94%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,1,48834,NJ,Individual,No,22-2745725,48834NJ0080005,Oxford Silver Compass HSA $1500-2,48834NJ008,,NJN006,NJS001,NJF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080005-01,Standard Silver On Exchange Plan,69.94%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,1,48834,NJ,Individual,No,22-2745725,48834NJ0080005,Oxford Silver Compass HSA $1500-2,48834NJ008,,NJN006,NJS001,NJF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080005-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,1,48834,NJ,Individual,No,22-2745725,48834NJ0080005,Oxford Silver Compass HSA $1500-2,48834NJ008,,NJN006,NJS001,NJF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080005-03,Limited Cost Sharing Plan Variation,69.94%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,1,48834,NJ,Individual,No,22-2745725,48834NJ0080005,Oxford Silver Compass HSA $1500-2,48834NJ008,,NJN006,NJS001,NJF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080005-04,73% AV Level Silver Plan,72.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,1,48834,NJ,Individual,No,22-2745725,48834NJ0080005,Oxford Silver Compass HSA $1500-2,48834NJ008,,NJN006,NJS001,NJF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080005-05,87% AV Level Silver Plan,87.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,1,48834,NJ,Individual,No,22-2745725,48834NJ0080005,Oxford Silver Compass HSA $1500-2,48834NJ008,,NJN006,NJS001,NJF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080005-06,94% AV Level Silver Plan,93.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,1,48834,NJ,Individual,No,22-2745725,48834NJ0080006,Oxford Bronze Compass HSA $2500,48834NJ008,,NJN006,NJS001,NJF006,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080006-00,Standard Bronze Off Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,1,48834,NJ,Individual,No,22-2745725,48834NJ0080006,Oxford Bronze Compass HSA $2500,48834NJ008,,NJN006,NJS001,NJF006,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080006-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,1,48834,NJ,Individual,No,22-2745725,48834NJ0080006,Oxford Bronze Compass HSA $2500,48834NJ008,,NJN006,NJS001,NJF006,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,1,48834,NJ,Individual,No,22-2745725,48834NJ0080006,Oxford Bronze Compass HSA $2500,48834NJ008,,NJN006,NJS001,NJF006,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080006-03,Limited Cost Sharing Plan Variation,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,2,48834,NJ,Individual,No,22-2745725,48834NJ0080001,Oxford Platinum Compass $200,48834NJ008,,NJN006,NJS001,NJF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080001-00,Standard Platinum Off Exchange Plan,88.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,2,48834,NJ,Individual,No,22-2745725,48834NJ0080001,Oxford Platinum Compass $200,48834NJ008,,NJN006,NJS001,NJF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080001-01,Standard Platinum On Exchange Plan,88.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,2,48834,NJ,Individual,No,22-2745725,48834NJ0080001,Oxford Platinum Compass $200,48834NJ008,,NJN006,NJS001,NJF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,2,48834,NJ,Individual,No,22-2745725,48834NJ0080001,Oxford Platinum Compass $200,48834NJ008,,NJN006,NJS001,NJF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080001-03,Limited Cost Sharing Plan Variation,88.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,3,48834,NJ,Individual,No,22-2745725,48834NJ0080004,Oxford Silver Compass $2500,48834NJ008,,NJN006,NJS001,NJF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080004-00,Standard Silver Off Exchange Plan,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,3,48834,NJ,Individual,No,22-2745725,48834NJ0080004,Oxford Silver Compass $2500,48834NJ008,,NJN006,NJS001,NJF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080004-01,Standard Silver On Exchange Plan,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,3,48834,NJ,Individual,No,22-2745725,48834NJ0080004,Oxford Silver Compass $2500,48834NJ008,,NJN006,NJS001,NJF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080004-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,3,48834,NJ,Individual,No,22-2745725,48834NJ0080004,Oxford Silver Compass $2500,48834NJ008,,NJN006,NJS001,NJF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080004-03,Limited Cost Sharing Plan Variation,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,3,48834,NJ,Individual,No,22-2745725,48834NJ0080004,Oxford Silver Compass $2500,48834NJ008,,NJN006,NJS001,NJF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080004-04,73% AV Level Silver Plan,72.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,3,48834,NJ,Individual,No,22-2745725,48834NJ0080004,Oxford Silver Compass $2500,48834NJ008,,NJN006,NJS001,NJF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080004-05,87% AV Level Silver Plan,86.04%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,3,48834,NJ,Individual,No,22-2745725,48834NJ0080004,Oxford Silver Compass $2500,48834NJ008,,NJN006,NJS001,NJF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080004-06,94% AV Level Silver Plan,93.14%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,4,48834,NJ,Individual,No,22-2745725,48834NJ0080002,Oxford Gold Compass $1000,48834NJ008,,NJN006,NJS001,NJF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080002-00,Standard Gold Off Exchange Plan,81.24%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,4,48834,NJ,Individual,No,22-2745725,48834NJ0080002,Oxford Gold Compass $1000,48834NJ008,,NJN006,NJS001,NJF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080002-01,Standard Gold On Exchange Plan,81.24%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,4,48834,NJ,Individual,No,22-2745725,48834NJ0080002,Oxford Gold Compass $1000,48834NJ008,,NJN006,NJS001,NJF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,4,48834,NJ,Individual,No,22-2745725,48834NJ0080002,Oxford Gold Compass $1000,48834NJ008,,NJN006,NJS001,NJF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080002-03,Limited Cost Sharing Plan Variation,81.24%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,5,48834,NJ,Individual,No,22-2745725,48834NJ0080003,Oxford Gold Compass $500,48834NJ008,,NJN006,NJS001,NJF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080003-00,Standard Gold Off Exchange Plan,78.03%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,5,48834,NJ,Individual,No,22-2745725,48834NJ0080003,Oxford Gold Compass $500,48834NJ008,,NJN006,NJS001,NJF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080003-01,Standard Gold On Exchange Plan,78.03%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,5,48834,NJ,Individual,No,22-2745725,48834NJ0080003,Oxford Gold Compass $500,48834NJ008,,NJN006,NJS001,NJF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080003-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,NJ,48834,HIOS,8,2014-12-10 11:54:40,5,48834,NJ,Individual,No,22-2745725,48834NJ0080003,Oxford Gold Compass $500,48834NJ008,,NJN006,NJS001,NJF004,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xnj,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xnj,48834NJ0080003-03,Limited Cost Sharing Plan Variation,78.03%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,1,50221,NJ,Individual,No,47-1142944,50221NJ0160001,Oscar Bronze,50221NJ016,,NJN001,NJS001,NJF001,New,EPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998000256899034,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0160001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0160001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0160001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0160001-00,Standard Bronze Off Exchange Plan,61.90%,,Yes,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",35%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,4
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,1,50221,NJ,Individual,No,47-1142944,50221NJ0160001,Oscar Bronze,50221NJ016,,NJN001,NJS001,NJF001,New,EPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998000256899034,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0160001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0160001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0160001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0160001-01,Standard Bronze On Exchange Plan,61.90%,,Yes,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",35%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,5
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,1,50221,NJ,Individual,No,47-1142944,50221NJ0160001,Oscar Bronze,50221NJ016,,NJN001,NJS001,NJF001,New,EPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998000256899034,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0160001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0160001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0160001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0160001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,1,50221,NJ,Individual,No,47-1142944,50221NJ0160001,Oscar Bronze,50221NJ016,,NJN001,NJS001,NJF001,New,EPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998000256899034,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0160001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0160001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0160001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0160001-03,Limited Cost Sharing Plan Variation,61.90%,,Yes,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",35%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,7
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,2,50221,NJ,Individual,No,47-1142944,50221NJ0020001,Oscar Silver Share,50221NJ002,,NJN001,NJS001,NJF001,New,EPO,Silver,Yes,Both,Yes,No,,,$91.02,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998053925194024,,,0,1,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0020001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0020001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0020001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0020001-00,Standard Silver Off Exchange Plan,70.70%,,Yes,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,$0,$0,35%,$0,$0,35%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,4
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,2,50221,NJ,Individual,No,47-1142944,50221NJ0020001,Oscar Silver Share,50221NJ002,,NJN001,NJS001,NJF001,New,EPO,Silver,Yes,Both,Yes,No,,,$91.02,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998053925194024,,,0,1,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0020001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0020001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0020001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0020001-01,Standard Silver On Exchange Plan,70.70%,,Yes,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,$0,$0,35%,$0,$0,35%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,5
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,2,50221,NJ,Individual,No,47-1142944,50221NJ0020001,Oscar Silver Share,50221NJ002,,NJN001,NJS001,NJF001,New,EPO,Silver,Yes,Both,Yes,No,,,$91.02,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998053925194024,,,0,1,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0020001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0020001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0020001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0020001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,2,50221,NJ,Individual,No,47-1142944,50221NJ0020001,Oscar Silver Share,50221NJ002,,NJN001,NJS001,NJF001,New,EPO,Silver,Yes,Both,Yes,No,,,$91.02,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998053925194024,,,0,1,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0020001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0020001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0020001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0020001-03,Limited Cost Sharing Plan Variation,70.70%,,Yes,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,$0,$0,35%,$0,$0,35%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,7
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,2,50221,NJ,Individual,No,47-1142944,50221NJ0020001,Oscar Silver Share,50221NJ002,,NJN001,NJS001,NJF001,New,EPO,Silver,Yes,Both,Yes,No,,,$91.02,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998053925194024,,,0,1,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0020001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0020001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0020001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0020001-04,73% AV Level Silver Plan,73.80%,,Yes,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$4,800","$9,600","$4,800","$9,600",Not Applicable,Not Applicable,"$4,800","$9,600",,,,,,,,,,,,,,,,,,,,,$0,$0,35%,$0,$0,35%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,8
2015,NJ,50221,HIOS,14,2015-01-21 09:35:36,2,50221,NJ,Individual,No,47-1142944,50221NJ0020001,Oscar Silver Share,50221NJ002,,NJN001,NJS001,NJF001,New,EPO,Silver,Yes,Both,Yes,No,,,$91.02,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.998053925194024,,,0,1,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,https://www.hioscar.com/njhx/2015/benefits/?plan=50221NJ0020001,https://www.hioscar.com/njhx/2015/enrollment/?plan=50221NJ0020001,https://www.hioscar.com/njhx/2015/products/?plan=50221NJ0020001,https://www.hioscar.com/njhx/2015/pharmacy/,50221NJ0020001-05,87% AV Level Silver Plan,87.00%,,Yes,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000",Not Applicable,Not Applicable,"$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,$0,$0,35%,$0,$0,35%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,9
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,1,91661,NJ,SHOP (Small Group),No,22-0999690,91661NJ2290002,Horizon Direct Access Gold 100/80/60 BlueCard,91661NJ229,,NJN001,NJS001,NJF007,Existing,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Offers out of network coverage,Yes,http://horizonblue.com/2015/SBC-Advantage-Direct-Access-100-80-60,,,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2290002-00,Standard Gold Off Exchange Plan,,0.786255776882172,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,"$1,500",$20,$590,$150,"$1,130",$600,$450,$80,4
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,1,91661,NJ,Individual,Yes,22-0999690,91661NJ2310001,Horizon Young Grins,91661NJ231,,NJN004,NJS002,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$29.78,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,No,,,,,91661NJ2310001-00,Standard High Off Exchange Plan,86.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,1,91661,NJ,Individual,No,22-0999690,91661NJ2260002,Horizon Advance EPO Gold,91661NJ226,,NJN002,NJS001,NJF001,Existing,EPO,Gold,No,Both,No,Yes,Any non-Primary Care Provider,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advance-EPO-Gold,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advance-EPO-Gold,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2260002-00,Standard Gold Off Exchange Plan,,0.80037385225296,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$2,500","$5,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,"$2,000","$4,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,$0,$0,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$690,$150,"$1,000",$540,$210,$80,4
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,1,91661,NJ,SHOP (Small Group),Yes,22-0999690,91661NJ2330001,Horizon Young Grins,91661NJ233,,NJN004,NJS002,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$31.14,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,No,,,,,91661NJ2330001-00,Standard High Off Exchange Plan,86.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,2,91661,NJ,SHOP (Small Group),No,22-0999690,91661NJ2300001,Horizon Advantage EPO Gold 100  $20/$40,91661NJ230,,NJN001,NJS001,NJF007,Existing,EPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,5,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advantage-EPO-100-20-40,,,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2300001-00,Standard Gold Off Exchange Plan,,0.819029688835144,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$320,$0,$150,$0,$800,$640,$80,4
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,2,91661,NJ,SHOP (Small Group),No,22-0999690,91661NJ2300001,Horizon Advantage EPO Gold 100  $20/$40,91661NJ230,,NJN001,NJS001,NJF007,Existing,EPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,5,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advantage-EPO-100-20-40,,,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2300001-01,Standard Gold On Exchange Plan,,0.819029688835144,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$320,$0,$150,$0,$800,$640,$80,5
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,2,91661,NJ,Individual,No,22-0999690,91661NJ2260003,Horizon Advance EPO Silver,91661NJ226,,NJN002,NJS001,NJF002,Existing,EPO,Silver,No,Both,No,Yes,Any non-Primary Care Provider,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advance-EPO-Silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advance-EPO-Silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2260003-01,Standard Silver On Exchange Plan,,0.697915196418762,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$900,$150,"$1,500",$0,"$1,090",$80,5
2015,NJ,51791,HIOS,2,2014-08-03 08:59:32,1,51791,NJ,SHOP (Small Group),Yes,93-0242990,51791NJ0040001,EHB Low PPO,51791NJ004,,NJN001,NJS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.17,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,51791NJ0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,51791,HIOS,2,2014-08-03 08:59:32,1,51791,NJ,SHOP (Small Group),Yes,93-0242990,51791NJ0030002,EHB High Passive,51791NJ003,,NJN001,NJS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$56.56,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,51791NJ0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NJ,51791,HIOS,2,2014-08-03 08:59:32,1,51791,NJ,SHOP (Small Group),Yes,93-0242990,51791NJ0030001,EHB Low Passive,51791NJ003,,NJN001,NJS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.29,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,51791NJ0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,2,91661,NJ,Individual,No,22-0999690,91661NJ2260003,Horizon Advance EPO Silver,91661NJ226,,NJN002,NJS001,NJF002,Existing,EPO,Silver,No,Both,No,Yes,Any non-Primary Care Provider,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advance-EPO-Silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advance-EPO-Silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2260003-04,73% AV Level Silver Plan,,0.735945224761963,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$4,500","$9,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,"$2,000","$4,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$900,$150,"$1,500",$0,"$1,090",$80,8
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,2,91661,NJ,Individual,No,22-0999690,91661NJ2260003,Horizon Advance EPO Silver,91661NJ226,,NJN002,NJS001,NJF002,Existing,EPO,Silver,No,Both,No,Yes,Any non-Primary Care Provider,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advance-EPO-Silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advance-EPO-Silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2260003-05,87% AV Level Silver Plan,,0.87545382976532,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,"$1,000","$2,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$400,$150,$500,$0,$460,$80,9
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,2,91661,NJ,Individual,No,22-0999690,91661NJ2260003,Horizon Advance EPO Silver,91661NJ226,,NJN002,NJS001,NJF002,Existing,EPO,Silver,No,Both,No,Yes,Any non-Primary Care Provider,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advance-EPO-Silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advance-EPO-Silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2260003-06,94% AV Level Silver Plan,,0.945205450057983,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$500,"$1,000","$1,000","$2,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$500,"$1,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$450,$150,$0,$0,$500,$80,10
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,3,91661,NJ,Individual,No,22-0999690,91661NJ2270002,Horizon Advantage EPO Bronze,91661NJ227,,NJN001,NJS001,NJF005,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advantage-EPO-Bronze,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advantage-EPO-Bronze,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2270002-00,Standard Bronze Off Exchange Plan,,0.617939233779907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$0,"$1,000",$150,"$2,500",$0,"$1,320",$80,4
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,3,91661,NJ,SHOP (Small Group),No,22-0999690,91661NJ2300003,Horizon Advantage EPO Gold 100/80,91661NJ230,,NJN001,NJS001,NJF006,Existing,EPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advantage-EPO-100-80,,,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2300003-00,Standard Gold Off Exchange Plan,,0.786284148693085,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$20,$690,$150,$770,$480,$520,$80,4
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,3,91661,NJ,SHOP (Small Group),No,22-0999690,91661NJ2300003,Horizon Advantage EPO Gold 100/80,91661NJ230,,NJN001,NJS001,NJF006,Existing,EPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advantage-EPO-100-80,,,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2300003-01,Standard Gold On Exchange Plan,,0.786284148693085,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$20,$690,$150,$770,$480,$520,$80,5
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,3,91661,NJ,Individual,No,22-0999690,91661NJ2270002,Horizon Advantage EPO Bronze,91661NJ227,,NJN001,NJS001,NJF005,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advantage-EPO-Bronze,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advantage-EPO-Bronze,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2270002-01,Standard Bronze On Exchange Plan,,0.617939233779907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$0,"$1,000",$150,"$2,500",$0,"$1,320",$80,5
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,3,91661,NJ,Individual,No,22-0999690,91661NJ2270002,Horizon Advantage EPO Bronze,91661NJ227,,NJN001,NJS001,NJF005,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advantage-EPO-Bronze,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advantage-EPO-Bronze,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2270002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$0,"$2,040",$150,"$2,500",$0,"$1,320",$80,6
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,3,91661,NJ,Individual,No,22-0999690,91661NJ2270002,Horizon Advantage EPO Bronze,91661NJ227,,NJN001,NJS001,NJF005,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advantage-EPO-Bronze,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advantage-EPO-Bronze,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2270002-03,Limited Cost Sharing Plan Variation,,0.617939233779907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$0,"$2,040",$150,"$2,500",$0,"$1,320",$80,7
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,4,91661,NJ,Individual,No,22-0999690,91661NJ2270001,Horizon Advantage EPO Silver,91661NJ227,,NJN001,NJS001,NJF004,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advantage-EPO-Silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advantage-EPO-Silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2270001-00,Standard Silver Off Exchange Plan,,0.695204973220825,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$990,$150,"$2,000",$620,$350,$80,4
2015,NJ,53877,HIOS,4,2014-11-14 05:23:27,1,53877,NJ,SHOP (Small Group),Yes,13-5581829,53877NJ0230001,EHB Basic Dental Plan (Low),53877NJ023,,NJN001,NJS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$25.55,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48049,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48048,,53877NJ0230001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,53877,HIOS,4,2014-11-14 05:23:27,1,53877,NJ,SHOP (Small Group),Yes,13-5581829,53877NJ0230001,EHB Basic Dental Plan (Low),53877NJ023,,NJN001,NJS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$25.55,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48049,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48048,,53877NJ0230001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,53877,HIOS,4,2014-11-14 05:23:27,2,53877,NJ,SHOP (Small Group),Yes,13-5581829,53877NJ0200001,EHB Enhanced Dental Plan (High),53877NJ020,,NJN002,NJS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$31.81,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49102,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49101,,53877NJ0200001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,7,91661,NJ,Individual,No,22-0999690,91661NJ2270003,Horizon Advantage EPO Gold,91661NJ227,,NJN001,NJS001,NJF001,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-advantage-epo-gold,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/brochure-advantage-epo-gold,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2270003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,000",$20,$690,$150,"$1,000",$540,$210,$80,6
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,7,91661,NJ,Individual,No,22-0999690,91661NJ2270003,Horizon Advantage EPO Gold,91661NJ227,,NJN001,NJS001,NJF001,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-advantage-epo-gold,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/brochure-advantage-epo-gold,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2270003-03,Limited Cost Sharing Plan Variation,,0.784846901893616,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$690,$150,"$1,000",$540,$210,$80,7
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,8,91661,NJ,Individual,No,22-0999690,91661NJ2270004,Patient Centered Advantage EPO Silver 20/30/30%,91661NJ227,,NJN003,NJS001,NJF001,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-pcmh-advantage-silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/brochure-pcmh-advantage-silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2270004-00,Standard Silver Off Exchange Plan,69.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$20,$740,$150,"$2,000",$360,$260,$80,4
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,8,91661,NJ,SHOP (Small Group),No,22-0999690,91661NJ2300018,Horizon Patient Centered Advantage EPO Silver 20/30/70%,91661NJ230,,NJN003,NJS001,NJF009,New,EPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-patient-centered-advantage-epo-silver,,,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2300018-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$20,$740,$150,"$2,000",$400,$440,$80,4
2015,NJ,53877,HIOS,4,2014-11-14 05:23:27,2,53877,NJ,SHOP (Small Group),Yes,13-5581829,53877NJ0200001,EHB Enhanced Dental Plan (High),53877NJ020,,NJN002,NJS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$31.81,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49102,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49101,,53877NJ0200001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,53877,HIOS,4,2014-11-14 05:23:27,3,53877,NJ,SHOP (Small Group),Yes,13-5581829,53877NJ0210001,Family Basic Dental Plan (Low),53877NJ021,,NJN003,NJS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$25.55,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49104,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49103,,53877NJ0210001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,53877,HIOS,4,2014-11-14 05:23:27,3,53877,NJ,SHOP (Small Group),Yes,13-5581829,53877NJ0210001,Family Basic Dental Plan (Low),53877NJ021,,NJN003,NJS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$25.55,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49104,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49103,,53877NJ0210001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,53877,HIOS,4,2014-11-14 05:23:27,4,53877,NJ,SHOP (Small Group),Yes,13-5581829,53877NJ0220001,Family Enhanced Dental Plan (High),53877NJ022,,NJN004,NJS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$31.81,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49106,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49105,,53877NJ0220001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,53877,HIOS,4,2014-11-14 05:23:27,4,53877,NJ,SHOP (Small Group),Yes,13-5581829,53877NJ0220001,Family Enhanced Dental Plan (High),53877NJ022,,NJN004,NJS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$31.81,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49106,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49105,,53877NJ0220001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,67275,HIOS,3,2014-09-05 03:32:16,1,67275,NJ,SHOP (Small Group),Yes,81-0170040,67275NJ0010001,Assurant Dental ACAFFO High,67275NJ001,,NJN001,NJS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$51.81,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same Coverage as in Service Area.,Yes,,,,,67275NJ0010001-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,67275,HIOS,3,2014-09-05 03:32:16,2,67275,NJ,SHOP (Small Group),Yes,81-0170040,67275NJ0010002,Assurant Dental ACAFFO Low,67275NJ001,,NJN001,NJS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$43.28,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same Coverage as in Service Area,Yes,,,,,67275NJ0010002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,72667,HIOS,2,2014-08-05 13:28:44,1,72667,NJ,SHOP (Small Group),Yes,36-0883760,72667NJ0040002,EHB High PPO,72667NJ004,,NJN001,NJS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$50.56,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,72667NJ0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,72667,HIOS,2,2014-08-05 13:28:44,1,72667,NJ,SHOP (Small Group),Yes,36-0883760,72667NJ0040001,EHB Low PPO,72667NJ004,,NJN001,NJS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.09,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,72667NJ0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,72667,HIOS,2,2014-08-05 13:28:44,1,72667,NJ,SHOP (Small Group),Yes,36-0883760,72667NJ0030002,EHB High Passive,72667NJ003,,NJN001,NJS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$56.39,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,72667NJ0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NJ,72667,HIOS,2,2014-08-05 13:28:44,1,72667,NJ,SHOP (Small Group),Yes,36-0883760,72667NJ0030001,EHB Low Passive,72667NJ003,,NJN001,NJS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.19,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,72667NJ0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NJ,77606,HIOS,5,2015-07-22 09:15:52,1,77606,NJ,SHOP (Small Group),No,23-2314460,77606NJ0050001,SEH Silver HMO Local Value $50/$75,77606NJ005,,NJN002,NJS002,NJF001,Existing,HMO,Silver,No,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,No,,,0.9982,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside the service area.,No,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,77606NJ0050001-00,Standard Silver Off Exchange Plan,,0.701933264732361,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",50%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,NJ,77606,HIOS,5,2015-07-22 09:15:52,1,77606,NJ,Individual,No,23-2314460,77606NJ0040001,IHC Silver HMO Local Value $50/$75,77606NJ004,,NJN002,NJS002,NJF001,Existing,HMO,Silver,No,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverHMOLocalValue217_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,77606NJ0040001-00,Standard Silver Off Exchange Plan,,0.697207868099213,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,NJ,77606,HIOS,5,2015-07-22 09:15:52,1,77606,NJ,Individual,No,23-2314460,77606NJ0040001,IHC Silver HMO Local Value $50/$75,77606NJ004,,NJN002,NJS002,NJF001,Existing,HMO,Silver,No,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverHMOLocalValue217_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,77606NJ0040001-01,Standard Silver On Exchange Plan,,0.697207868099213,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,NJ,77606,HIOS,5,2015-07-22 09:15:52,1,77606,NJ,SHOP (Small Group),No,23-2314460,77606NJ0050001,SEH Silver HMO Local Value $50/$75,77606NJ005,,NJN002,NJS002,NJF001,Existing,HMO,Silver,No,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,No,,,0.9982,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside the service area.,No,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,77606NJ0050001-01,Standard Silver On Exchange Plan,,0.701933264732361,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",50%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,NJ,77606,HIOS,5,2015-07-22 09:15:52,1,77606,NJ,Individual,No,23-2314460,77606NJ0040001,IHC Silver HMO Local Value $50/$75,77606NJ004,,NJN002,NJS002,NJF001,Existing,HMO,Silver,No,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverHMOLocalValue217_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,77606NJ0040001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NJ,77606,HIOS,5,2015-07-22 09:15:52,1,77606,NJ,Individual,No,23-2314460,77606NJ0040001,IHC Silver HMO Local Value $50/$75,77606NJ004,,NJN002,NJS002,NJF001,Existing,HMO,Silver,No,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverHMOLocalValue217_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,77606NJ0040001-03,Limited Cost Sharing Plan Variation,,0.697207868099213,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,NJ,77606,HIOS,5,2015-07-22 09:15:52,1,77606,NJ,Individual,No,23-2314460,77606NJ0040001,IHC Silver HMO Local Value $50/$75,77606NJ004,,NJN002,NJS002,NJF001,Existing,HMO,Silver,No,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverHMOLocalValue217_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,77606NJ0040001-04,73% AV Level Silver Plan,,0.722494661808014,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,NJ,77606,HIOS,5,2015-07-22 09:15:52,1,77606,NJ,Individual,No,23-2314460,77606NJ0040001,IHC Silver HMO Local Value $50/$75,77606NJ004,,NJN002,NJS002,NJF001,Existing,HMO,Silver,No,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverHMOLocalValue217_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,77606NJ0040001-05,87% AV Level Silver Plan,,0.860882759094238,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,600","$3,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,50%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,NJ,77606,HIOS,5,2015-07-22 09:15:52,1,77606,NJ,Individual,No,23-2314460,77606NJ0040001,IHC Silver HMO Local Value $50/$75,77606NJ004,,NJN002,NJS002,NJF001,Existing,HMO,Silver,No,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverHMOLocalValue217_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,77606NJ0040001-06,94% AV Level Silver Plan,,0.930625557899475,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$275,$550,50%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,NJ,77606,HIOS,5,2015-07-22 09:15:52,2,77606,NJ,Individual,No,23-2314460,77606NJ0040002,IHC Gold HMO Local Value $15/$30,77606NJ004,,NJN002,NJS002,NJF002,Existing,HMO,Gold,No,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCGoldHMOLocalValue316_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,77606NJ0040002-00,Standard Gold Off Exchange Plan,,0.780353903770447,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,650","$9,300",,,$0,$0,$0,$0,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,NJ,77606,HIOS,5,2015-07-22 09:15:52,2,77606,NJ,SHOP (Small Group),No,23-2314460,77606NJ0050016,SEH Gold HMO Local Value $15/$30,77606NJ005,,NJN002,NJS002,NJF002,Existing,HMO,Gold,No,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,No,,,0.9982,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area.,No,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,77606NJ0050016-00,Standard Gold Off Exchange Plan,,0.780353903770447,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,650","$9,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,NJ,77606,HIOS,5,2015-07-22 09:15:52,2,77606,NJ,SHOP (Small Group),No,23-2314460,77606NJ0050016,SEH Gold HMO Local Value $15/$30,77606NJ005,,NJN002,NJS002,NJF002,Existing,HMO,Gold,No,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,No,,,0.9982,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area.,No,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,77606NJ0050016-01,Standard Gold On Exchange Plan,,0.780353903770447,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,650","$9,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,NJ,77606,HIOS,5,2015-07-22 09:15:52,2,77606,NJ,Individual,No,23-2314460,77606NJ0040002,IHC Gold HMO Local Value $15/$30,77606NJ004,,NJN002,NJS002,NJF002,Existing,HMO,Gold,No,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCGoldHMOLocalValue316_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,77606NJ0040002-01,Standard Gold On Exchange Plan,,0.780353903770447,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,650","$9,300",,,$0,$0,$0,$0,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,NJ,77606,HIOS,5,2015-07-22 09:15:52,2,77606,NJ,Individual,No,23-2314460,77606NJ0040002,IHC Gold HMO Local Value $15/$30,77606NJ004,,NJN002,NJS002,NJF002,Existing,HMO,Gold,No,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCGoldHMOLocalValue316_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,77606NJ0040002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NJ,77606,HIOS,5,2015-07-22 09:15:52,2,77606,NJ,Individual,No,23-2314460,77606NJ0040002,IHC Gold HMO Local Value $15/$30,77606NJ004,,NJN002,NJS002,NJF002,Existing,HMO,Gold,No,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCGoldHMOLocalValue316_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,77606NJ0040002-03,Limited Cost Sharing Plan Variation,,0.780353903770447,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,650","$9,300",,,$0,$0,$0,$0,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,NJ,79370,HIOS,2,2014-08-08 08:53:29,1,79370,NJ,SHOP (Small Group),Yes,42-0127290,79370NJ0040001,Principal Plan Dental 70,79370NJ004,,NJN001,NJS001,,New,PPO,Low,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$35.02,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,79370NJ0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,79370,HIOS,2,2014-08-08 08:53:29,1,79370,NJ,SHOP (Small Group),Yes,42-0127290,79370NJ0040002,Principal Plan Dental 80,79370NJ004,,NJN001,NJS001,,New,PPO,High,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$37.44,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,79370NJ0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,79422,HIOS,4,2014-11-14 05:23:27,1,79422,NJ,SHOP (Small Group),Yes,33-0733552,79422NJ0010001,EHB Basic Dental Plan (Low),79422NJ001,,NJN001,NJS001,,Existing,HMO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$10.99,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.,No,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48047,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48046,,79422NJ0010001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,79422,HIOS,4,2014-11-14 05:23:27,1,79422,NJ,SHOP (Small Group),Yes,33-0733552,79422NJ0010001,EHB Basic Dental Plan (Low),79422NJ001,,NJN001,NJS001,,Existing,HMO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$10.99,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.,No,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48047,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48046,,79422NJ0010001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,79422,HIOS,4,2014-11-14 05:23:27,2,79422,NJ,SHOP (Small Group),Yes,33-0733552,79422NJ0020001,EHB Enhanced Dental Plan (High),79422NJ002,,NJN002,NJS001,,Existing,HMO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$12.60,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.,No,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49108,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49107,,79422NJ0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,79422,HIOS,4,2014-11-14 05:23:27,2,79422,NJ,SHOP (Small Group),Yes,33-0733552,79422NJ0020001,EHB Enhanced Dental Plan (High),79422NJ002,,NJN002,NJS001,,Existing,HMO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$12.60,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.,No,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49108,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49107,,79422NJ0020001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,79422,HIOS,4,2014-11-14 05:23:27,3,79422,NJ,SHOP (Small Group),Yes,33-0733552,79422NJ0030001,Family Basic Dental Plan (Low),79422NJ003,,NJN003,NJS001,,Existing,HMO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$10.99,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.,No,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49110,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49109,,79422NJ0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,79422,HIOS,4,2014-11-14 05:23:27,3,79422,NJ,SHOP (Small Group),Yes,33-0733552,79422NJ0030001,Family Basic Dental Plan (Low),79422NJ003,,NJN003,NJS001,,Existing,HMO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$10.99,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.,No,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49110,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49109,,79422NJ0030001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,79422,HIOS,4,2014-11-14 05:23:27,4,79422,NJ,SHOP (Small Group),Yes,33-0733552,79422NJ0040001,Family Enhanced Dental Plan (High),79422NJ004,,NJN004,NJS001,,Existing,HMO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$12.60,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.,No,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49112,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49111,,79422NJ0040001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,79422,HIOS,4,2014-11-14 05:23:27,4,79422,NJ,SHOP (Small Group),Yes,33-0733552,79422NJ0040001,Family Enhanced Dental Plan (High),79422NJ004,,NJN004,NJS001,,Existing,HMO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$12.60,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.,No,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49112,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49111,,79422NJ0040001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,2,91661,NJ,Individual,No,22-0999690,91661NJ2260003,Horizon Advance EPO Silver,91661NJ226,,NJN002,NJS001,NJF002,Existing,EPO,Silver,No,Both,No,Yes,Any non-Primary Care Provider,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advance-EPO-Silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advance-EPO-Silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2260003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$20,$890,$150,"$1,500",$400,$410,$80,6
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,2,91661,NJ,Individual,No,22-0999690,91661NJ2260003,Horizon Advance EPO Silver,91661NJ226,,NJN002,NJS001,NJF002,Existing,EPO,Silver,No,Both,No,Yes,Any non-Primary Care Provider,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advance-EPO-Silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advance-EPO-Silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2260003-03,Limited Cost Sharing Plan Variation,,0.697915196418762,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$20,$890,$150,"$1,500",$400,$410,$80,7
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,4,91661,NJ,Individual,No,22-0999690,91661NJ2270001,Horizon Advantage EPO Silver,91661NJ227,,NJN001,NJS001,NJF004,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advantage-EPO-Silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advantage-EPO-Silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2270001-01,Standard Silver On Exchange Plan,,0.695204973220825,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$990,$150,"$2,000",$620,$350,$80,5
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,4,91661,NJ,Individual,No,22-0999690,91661NJ2270001,Horizon Advantage EPO Silver,91661NJ227,,NJN001,NJS001,NJF004,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advantage-EPO-Silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advantage-EPO-Silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2270001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$0,"$2,040",$150,"$2,500",$0,"$1,320",$80,6
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,4,91661,NJ,Individual,No,22-0999690,91661NJ2270001,Horizon Advantage EPO Silver,91661NJ227,,NJN001,NJS001,NJF004,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advantage-EPO-Silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advantage-EPO-Silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2270001-03,Limited Cost Sharing Plan Variation,,0.695204973220825,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$0,"$2,040",$150,"$2,500",$0,"$1,320",$80,7
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,4,91661,NJ,Individual,No,22-0999690,91661NJ2270001,Horizon Advantage EPO Silver,91661NJ227,,NJN001,NJS001,NJF004,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advantage-EPO-Silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advantage-EPO-Silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2270001-04,73% AV Level Silver Plan,,0.72064483165741,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$50,"$1,790",$150,"$2,000",$620,$350,$80,8
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,4,91661,NJ,Individual,No,22-0999690,91661NJ2270001,Horizon Advantage EPO Silver,91661NJ227,,NJN001,NJS001,NJF004,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advantage-EPO-Silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advantage-EPO-Silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2270001-05,87% AV Level Silver Plan,,0.862458944320679,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$750,$10,$740,$150,$750,$360,$210,$80,9
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,4,91661,NJ,Individual,No,22-0999690,91661NJ2270001,Horizon Advantage EPO Silver,91661NJ227,,NJN001,NJS001,NJF004,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advantage-EPO-Silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advantage-EPO-Silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2270001-06,94% AV Level Silver Plan,,0.930130481719971,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$40,$450,$150,$0,$400,$130,$80,10
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,5,91661,NJ,SHOP (Small Group),No,22-0999690,91661NJ2300007,Horizon Advantage EPO HSA Bronze 100 Compatible,91661NJ230,,NJN001,NJS001,NJF005,Existing,EPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,5,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advantage-EPO-100-30-50-Bronze,,,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2300007-00,Standard Bronze Off Exchange Plan,,0.615084111690521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$500,$10,$150,"$2,000",$230,"$1,420",$80,4
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,5,91661,NJ,SHOP (Small Group),No,22-0999690,91661NJ2300007,Horizon Advantage EPO HSA Bronze 100 Compatible,91661NJ230,,NJN001,NJS001,NJF005,Existing,EPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,5,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advantage-EPO-100-30-50-Bronze,,,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2300007-01,Standard Bronze On Exchange Plan,,0.615084111690521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$500,$10,$150,"$2,000",$230,"$1,420",$80,5
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,6,91661,NJ,SHOP (Small Group),No,22-0999690,91661NJ2300015,Horizon Advantage EPO HSA Silver 100 Compatible $750 Contrib.,91661NJ230,,NJN001,NJS001,NJF005,Existing,EPO,Silver,No,Both,No,No,,,,Yes,Yes,$750.00,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,5,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advantage-EPO-100-30-50-Silver,,,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2300015-00,Standard Silver Off Exchange Plan,,0.702476322650909,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$500,$10,$150,"$2,000",$230,"$1,420",$80,4
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,6,91661,NJ,Individual,No,22-0999690,91661NJ2260006,Horizon Advance EPO Bronze,91661NJ226,,NJN002,NJS001,NJF005,New,EPO,Bronze,No,Both,No,Yes,Any non-Primary Care Provider,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-horizon-advance-epo-bronze,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/brochure-horizon-advance-epo-bronze,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2260006-00,Standard Bronze Off Exchange Plan,,0.617227435112,Yes,Yes,Yes,71%,29%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",40%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$0,$800,$150,"$2,500",$160,"$1,070",$80,4
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,6,91661,NJ,Individual,No,22-0999690,91661NJ2260006,Horizon Advance EPO Bronze,91661NJ226,,NJN002,NJS001,NJF005,New,EPO,Bronze,No,Both,No,Yes,Any non-Primary Care Provider,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-horizon-advance-epo-bronze,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/brochure-horizon-advance-epo-bronze,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2260006-01,Standard Bronze On Exchange Plan,,0.617227435112,Yes,Yes,Yes,71%,29%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",40%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$0,$800,$150,"$2,500",$160,"$1,070",$80,5
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,6,91661,NJ,SHOP (Small Group),No,22-0999690,91661NJ2300015,Horizon Advantage EPO HSA Silver 100 Compatible $750 Contrib.,91661NJ230,,NJN001,NJS001,NJF005,Existing,EPO,Silver,No,Both,No,No,,,,Yes,Yes,$750.00,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,5,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advantage-EPO-100-30-50-Silver,,,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2300015-01,Standard Silver On Exchange Plan,,0.702476322650909,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$500,$10,$150,"$2,000",$230,"$1,420",$80,5
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,6,91661,NJ,Individual,No,22-0999690,91661NJ2260006,Horizon Advance EPO Bronze,91661NJ226,,NJN002,NJS001,NJF005,New,EPO,Bronze,No,Both,No,Yes,Any non-Primary Care Provider,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-horizon-advance-epo-bronze,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/brochure-horizon-advance-epo-bronze,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2260006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,71%,29%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$0,$800,$150,"$2,500",$160,"$1,070",$80,6
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,6,91661,NJ,Individual,No,22-0999690,91661NJ2260006,Horizon Advance EPO Bronze,91661NJ226,,NJN002,NJS001,NJF005,New,EPO,Bronze,No,Both,No,Yes,Any non-Primary Care Provider,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-horizon-advance-epo-bronze,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/brochure-horizon-advance-epo-bronze,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2260006-03,Limited Cost Sharing Plan Variation,,0.617227435112,Yes,Yes,Yes,71%,29%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",40%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$0,$800,$150,"$2,500",$160,"$1,070",$80,7
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,7,91661,NJ,Individual,No,22-0999690,91661NJ2270003,Horizon Advantage EPO Gold,91661NJ227,,NJN001,NJS001,NJF001,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-advantage-epo-gold,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/brochure-advantage-epo-gold,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2270003-00,Standard Gold Off Exchange Plan,,0.784846901893616,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$690,$150,"$1,000",$540,$210,$80,4
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,7,91661,NJ,SHOP (Small Group),No,22-0999690,91661NJ2300017,Horizon Patient Centered Advantage EPO Bronze 40/50%/50%,91661NJ230,,NJN003,NJS001,NJF008,New,EPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-patient-centered-advantage-epo-bronze,,,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2300017-00,Standard Bronze Off Exchange Plan,61.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$520,$0,$150,"$2,500",$750,$370,$80,4
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,7,91661,NJ,SHOP (Small Group),No,22-0999690,91661NJ2300017,Horizon Patient Centered Advantage EPO Bronze 40/50%/50%,91661NJ230,,NJN003,NJS001,NJF008,New,EPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-patient-centered-advantage-epo-bronze,,,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2300017-01,Standard Bronze On Exchange Plan,61.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$520,$0,$150,"$2,500",$750,$370,$80,5
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,7,91661,NJ,Individual,No,22-0999690,91661NJ2270003,Horizon Advantage EPO Gold,91661NJ227,,NJN001,NJS001,NJF001,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-advantage-epo-gold,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/brochure-advantage-epo-gold,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2270003-01,Standard Gold On Exchange Plan,,0.784846901893616,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$690,$150,"$1,000",$540,$210,$80,5
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,8,91661,NJ,SHOP (Small Group),No,22-0999690,91661NJ2300018,Horizon Patient Centered Advantage EPO Silver 20/30/70%,91661NJ230,,NJN003,NJS001,NJF009,New,EPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-patient-centered-advantage-epo-silver,,,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2300018-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$20,$740,$150,"$2,000",$400,$440,$80,5
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,8,91661,NJ,Individual,No,22-0999690,91661NJ2270004,Patient Centered Advantage EPO Silver 20/30/30%,91661NJ227,,NJN003,NJS001,NJF001,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-pcmh-advantage-silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/brochure-pcmh-advantage-silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2270004-01,Standard Silver On Exchange Plan,69.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$20,$740,$150,"$2,000",$360,$260,$80,5
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,8,91661,NJ,Individual,No,22-0999690,91661NJ2270004,Patient Centered Advantage EPO Silver 20/30/30%,91661NJ227,,NJN003,NJS001,NJF001,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-pcmh-advantage-silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/brochure-pcmh-advantage-silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2270004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$20,$740,$150,"$2,000",$360,$260,$80,6
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,8,91661,NJ,Individual,No,22-0999690,91661NJ2270004,Patient Centered Advantage EPO Silver 20/30/30%,91661NJ227,,NJN003,NJS001,NJF001,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-pcmh-advantage-silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/brochure-pcmh-advantage-silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2270004-03,Limited Cost Sharing Plan Variation,69.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$20,$740,$150,"$2,000",$360,$260,$80,7
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,8,91661,NJ,Individual,No,22-0999690,91661NJ2270004,Patient Centered Advantage EPO Silver 20/30/30%,91661NJ227,,NJN003,NJS001,NJF001,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-pcmh-advantage-silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/brochure-pcmh-advantage-silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2270004-04,73% AV Level Silver Plan,73.59%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$20,$590,$150,"$1,500",$410,$180,$80,8
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,8,91661,NJ,Individual,No,22-0999690,91661NJ2270004,Patient Centered Advantage EPO Silver 20/30/30%,91661NJ227,,NJN003,NJS001,NJF001,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-pcmh-advantage-silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/brochure-pcmh-advantage-silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2270004-05,87% AV Level Silver Plan,86.66%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$10,$400,$150,$500,$290,$100,$80,9
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,8,91661,NJ,Individual,No,22-0999690,91661NJ2270004,Patient Centered Advantage EPO Silver 20/30/30%,91661NJ227,,NJN003,NJS001,NJF001,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-pcmh-advantage-silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/brochure-pcmh-advantage-silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2270004-06,94% AV Level Silver Plan,93.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$10,$450,$150,$0,$300,$130,$80,10
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,9,91661,NJ,Individual,No,22-0999690,91661NJ2260007,Horizon Advance EPO Silver 40/70%,91661NJ226,,NJN002,NJS001,NJF002,New,EPO,Silver,No,Both,No,Yes,Any non-Primary Care Provider,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-horizon-advance-epo-silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/brochure-horizon-advance-epo-silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2260007-00,Standard Silver Off Exchange Plan,,0.681402027606964,Yes,Yes,Yes,73%,27%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$0,$750,$150,"$2,000",$40,$910,$80,4
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,9,91661,NJ,SHOP (Small Group),No,22-0999690,91661NJ2300019,Horizon Patient Centered Advantage EPO Gold 5/20/40,91661NJ230,,NJN003,NJS001,NJF001,New,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-patient-centered-advantage-epo-gold,,,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2300019-00,Standard Gold Off Exchange Plan,78.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$690,$150,"$1,000",$430,$450,$80,4
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,9,91661,NJ,SHOP (Small Group),No,22-0999690,91661NJ2300019,Horizon Patient Centered Advantage EPO Gold 5/20/40,91661NJ230,,NJN003,NJS001,NJF001,New,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-patient-centered-advantage-epo-gold,,,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2300019-01,Standard Gold On Exchange Plan,78.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$690,$150,"$1,000",$430,$450,$80,5
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,9,91661,NJ,Individual,No,22-0999690,91661NJ2260007,Horizon Advance EPO Silver 40/70%,91661NJ226,,NJN002,NJS001,NJF002,New,EPO,Silver,No,Both,No,Yes,Any non-Primary Care Provider,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-horizon-advance-epo-silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/brochure-horizon-advance-epo-silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2260007-01,Standard Silver On Exchange Plan,,0.681402027606964,Yes,Yes,Yes,73%,27%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$0,$750,$150,"$2,000",$40,$910,$80,5
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,9,91661,NJ,Individual,No,22-0999690,91661NJ2260007,Horizon Advance EPO Silver 40/70%,91661NJ226,,NJN002,NJS001,NJF002,New,EPO,Silver,No,Both,No,Yes,Any non-Primary Care Provider,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-horizon-advance-epo-silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/brochure-horizon-advance-epo-silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2260007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,73%,27%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$0,$750,$150,"$2,000",$40,$910,$80,6
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,9,91661,NJ,Individual,No,22-0999690,91661NJ2260007,Horizon Advance EPO Silver 40/70%,91661NJ226,,NJN002,NJS001,NJF002,New,EPO,Silver,No,Both,No,Yes,Any non-Primary Care Provider,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-horizon-advance-epo-silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/brochure-horizon-advance-epo-silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2260007-03,Limited Cost Sharing Plan Variation,,0.681402027606964,Yes,Yes,Yes,73%,27%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$0,$750,$150,"$2,000",$40,$910,$80,7
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,9,91661,NJ,Individual,No,22-0999690,91661NJ2260007,Horizon Advance EPO Silver 40/70%,91661NJ226,,NJN002,NJS001,NJF002,New,EPO,Silver,No,Both,No,Yes,Any non-Primary Care Provider,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-horizon-advance-epo-silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/brochure-horizon-advance-epo-silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2260007-04,73% AV Level Silver Plan,,0.731503367424011,Yes,Yes,Yes,73%,27%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$4,500","$9,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$900,$150,"$1,500",$110,"$1,030",$80,8
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,9,91661,NJ,Individual,No,22-0999690,91661NJ2260007,Horizon Advance EPO Silver 40/70%,91661NJ226,,NJN002,NJS001,NJF002,New,EPO,Silver,No,Both,No,Yes,Any non-Primary Care Provider,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-horizon-advance-epo-silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/brochure-horizon-advance-epo-silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2260007-05,87% AV Level Silver Plan,,0.866917192935944,Yes,Yes,Yes,73%,27%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,"$1,500","$3,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$400,$150,$500,$140,$390,$80,9
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,9,91661,NJ,Individual,No,22-0999690,91661NJ2260007,Horizon Advance EPO Silver 40/70%,91661NJ226,,NJN002,NJS001,NJF002,New,EPO,Silver,No,Both,No,Yes,Any non-Primary Care Provider,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/sbc-horizon-advance-epo-silver,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/brochure-horizon-advance-epo-silver,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2260007-06,94% AV Level Silver Plan,,0.933602035045624,Yes,Yes,Yes,73%,27%,,,,,,,,,,,,,,,,,$500,"$1,000","$1,000","$2,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,$500,$100,30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,$250,$150,$250,$60,$190,$80,10
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,10,91661,NJ,Individual,No,22-0999690,91661NJ2280001,Horizon Advantage EPO Essentials,91661NJ228,,NJN001,NJS001,NJF003,Existing,EPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,3,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advantage-EPO-Catastrophic,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advantage-EPO-Catastrophic,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2280001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,130",$0,$0,$80,4
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,10,91661,NJ,SHOP (Small Group),No,22-0999690,91661NJ2300004,Horizon Advantage EPO Silver 100/70,91661NJ230,,NJN001,NJS001,NJF007,Existing,EPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advantage-EPO-100-70,,,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2300004-00,Standard Silver Off Exchange Plan,,0.714488804340363,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$20,$890,$150,"$1,120",$680,$450,$80,4
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,10,91661,NJ,SHOP (Small Group),No,22-0999690,91661NJ2300004,Horizon Advantage EPO Silver 100/70,91661NJ230,,NJN001,NJS001,NJF007,Existing,EPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advantage-EPO-100-70,,,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2300004-01,Standard Silver On Exchange Plan,,0.714488804340363,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$20,$890,$150,"$1,120",$680,$450,$80,5
2015,NJ,91661,HIOS,7,2014-11-11 04:41:18,10,91661,NJ,Individual,No,22-0999690,91661NJ2280001,Horizon Advantage EPO Essentials,91661NJ228,,NJN001,NJS001,NJF003,Existing,EPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,3,0,2015-01-01,,No,,No,,No,http://horizonblue.com/2015/SBC-Advantage-EPO-Catastrophic,https://secure.horizonblue.com/FedSP/sp/ACS.saml2,http://horizonblue.com/2015/Brochure-Advantage-EPO-Catastrophic,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NJ_HealthInsuranceMarketplaceAdvantageFormulary.pdf,91661NJ2280001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,130",$0,$0,$80,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,1,91762,NJ,Individual,No,22-3338404,91762NJ0070001,IHC Bronze EPO H.S.A Local Value  50%/50%,91762NJ007,,NJN002,NJS002,NJF004,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCBronzeEPOHSA_V_P_N102_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070001-00,Standard Bronze Off Exchange Plan,,0.614018678665161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,1,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0080001,SEH Bronze EPO H.S.A Local Value 50%/50%,91762NJ008,,NJN002,NJS002,NJF004,Existing,EPO,Bronze,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.9982,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside the service area,No,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0080001-00,Standard Bronze Off Exchange Plan,,0.617577314376831,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,1,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0080001,SEH Bronze EPO H.S.A Local Value 50%/50%,91762NJ008,,NJN002,NJS002,NJF004,Existing,EPO,Bronze,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.9982,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside the service area,No,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0080001-01,Standard Bronze On Exchange Plan,,0.617577314376831,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,1,91762,NJ,Individual,No,22-3338404,91762NJ0070001,IHC Bronze EPO H.S.A Local Value  50%/50%,91762NJ007,,NJN002,NJS002,NJF004,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCBronzeEPOHSA_V_P_N102_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070001-01,Standard Bronze On Exchange Plan,,0.614018678665161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,1,91762,NJ,Individual,No,22-3338404,91762NJ0070001,IHC Bronze EPO H.S.A Local Value  50%/50%,91762NJ007,,NJN002,NJS002,NJF004,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCBronzeEPOHSA_V_P_N102_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,1,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0080002,SEH Bronze EPO H.S.A Regional Preferred 50%/50%,91762NJ008,,NJN001,NJS001,NJF004,Existing,EPO,Bronze,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.9982,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside the service area,No,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0080002-00,Standard Bronze Off Exchange Plan,,0.617577314376831,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,1,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0080002,SEH Bronze EPO H.S.A Regional Preferred 50%/50%,91762NJ008,,NJN001,NJS001,NJF004,Existing,EPO,Bronze,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.9982,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside the service area,No,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0080002-01,Standard Bronze On Exchange Plan,,0.617577314376831,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,1,91762,NJ,Individual,No,22-3338404,91762NJ0070001,IHC Bronze EPO H.S.A Local Value  50%/50%,91762NJ007,,NJN002,NJS002,NJF004,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCBronzeEPOHSA_V_P_N102_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070001-03,Limited Cost Sharing Plan Variation,,0.614018678665161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,1,91762,NJ,Individual,No,22-3338404,91762NJ0070002,IHC Bronze EPO H.S.A Regional Preferred 50%/50%,91762NJ007,,NJN001,NJS001,NJF004,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCBronzeEPOHSA_V_P_N102_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070002-00,Standard Bronze Off Exchange Plan,,0.614018678665161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,1,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0080003,SEH Bronze EPO H.S.A National Access 50%/50%,91762NJ008,,NJN003,NJS003,NJF004,Existing,EPO,Bronze,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.9982,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside the service area,Yes,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0080003-00,Standard Bronze Off Exchange Plan,,0.617577314376831,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,1,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0080003,SEH Bronze EPO H.S.A National Access 50%/50%,91762NJ008,,NJN003,NJS003,NJF004,Existing,EPO,Bronze,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.9982,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside the service area,Yes,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0080003-01,Standard Bronze On Exchange Plan,,0.617577314376831,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,6,91762,NJ,Individual,No,22-3338404,91762NJ0070008,IHC Silver EPO Community Advantage  $15/$35,91762NJ007,,NJN002,NJS004,NJF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverEPOCommunityAdvantage265_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070008-01,Standard Silver On Exchange Plan,,0.716189324855804,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",50%,"$2,000","$4,000",50%,Not Applicable,Not Applicable,$0,$0,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,6,91762,NJ,Individual,No,22-3338404,91762NJ0070008,IHC Silver EPO Community Advantage  $15/$35,91762NJ007,,NJN002,NJS004,NJF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverEPOCommunityAdvantage265_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,8,91762,NJ,Individual,No,22-3338404,91762NJ0070012,IHC Gold EPO H.S.A Local Value 80%/80%,91762NJ007,,NJN002,NJS002,NJF004,Existing,EPO,Gold,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency care is covered outside of the service area.,No,www.amerihealth.com/ffm/IHCGoldEPOHSALocalValue305_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070012-01,Standard Gold On Exchange Plan,,0.780205845832825,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,8,91762,NJ,Individual,No,22-3338404,91762NJ0070012,IHC Gold EPO H.S.A Local Value 80%/80%,91762NJ007,,NJN002,NJS002,NJF004,Existing,EPO,Gold,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency care is covered outside of the service area.,No,www.amerihealth.com/ffm/IHCGoldEPOHSALocalValue305_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,8,91762,NJ,Individual,No,22-3338404,91762NJ0070012,IHC Gold EPO H.S.A Local Value 80%/80%,91762NJ007,,NJN002,NJS002,NJF004,Existing,EPO,Gold,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency care is covered outside of the service area.,No,www.amerihealth.com/ffm/IHCGoldEPOHSALocalValue305_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070012-03,Limited Cost Sharing Plan Variation,,0.780205845832825,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,7
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,9,91762,NJ,Individual,No,22-3338404,91762NJ0070082,IHC Gold EPO Community Advantage  $10/$20,91762NJ007,,NJN002,NJS004,NJF002,New,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the Service Area,No,www.amerihealth.com/ffm/IHCGoldEPOCommunityAdvantage365_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070082-00,Standard Gold Off Exchange Plan,,0.818372309207916,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$4,250","$8,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,$500,"$1,000",50%,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,9,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0080053,SEH Gold EPO Community Advantage  $10/$20,91762NJ008,,NJN002,NJS004,NJF004,New,EPO,Gold,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.9982,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area.,No,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0080053-00,Standard Gold Off Exchange Plan,,0.818372309207916,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$4,250","$8,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,$500,"$1,000",50%,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,10,91762,NJ,Individual,No,22-3338404,91762NJ0070014,IHC Local Value Simple Saver,91762NJ007,,NJN002,NJS002,NJF005,Existing,EPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,3,2015-01-01,,No,,Yes,Emergency Care is covered outside of the Service Area,No,www.amerihealth.com/ffm/IHC_V_P_SimpleSaver501_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070014-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,10,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0100002,SEH Platinum POS Plus National Access $10/$25,91762NJ010,,NJN003,NJS003,NJF004,Existing,POS,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.9982,,,5,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,Yes,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0100002-00,Standard Platinum Off Exchange Plan,89.42%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$3,000","$6,000",$0,$0,$0,$0,1%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,10,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0100002,SEH Platinum POS Plus National Access $10/$25,91762NJ010,,NJN003,NJS003,NJF004,Existing,POS,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.9982,,,5,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,Yes,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0100002-01,Standard Platinum On Exchange Plan,89.42%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$3,000","$6,000",$0,$0,$0,$0,1%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,9,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0080053,SEH Gold EPO Community Advantage  $10/$20,91762NJ008,,NJN002,NJS004,NJF004,New,EPO,Gold,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.9982,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area.,No,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0080053-01,Standard Gold On Exchange Plan,,0.818372309207916,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$4,250","$8,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,$500,"$1,000",50%,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,9,91762,NJ,Individual,No,22-3338404,91762NJ0070082,IHC Gold EPO Community Advantage  $10/$20,91762NJ007,,NJN002,NJS004,NJF002,New,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the Service Area,No,www.amerihealth.com/ffm/IHCGoldEPOCommunityAdvantage365_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070082-01,Standard Gold On Exchange Plan,,0.818372309207916,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$4,250","$8,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,$500,"$1,000",50%,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,9,91762,NJ,Individual,No,22-3338404,91762NJ0070082,IHC Gold EPO Community Advantage  $10/$20,91762NJ007,,NJN002,NJS004,NJF002,New,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the Service Area,No,www.amerihealth.com/ffm/IHCGoldEPOCommunityAdvantage365_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070082-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,9,91762,NJ,Individual,No,22-3338404,91762NJ0070082,IHC Gold EPO Community Advantage  $10/$20,91762NJ007,,NJN002,NJS004,NJF002,New,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the Service Area,No,www.amerihealth.com/ffm/IHCGoldEPOCommunityAdvantage365_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070082-03,Limited Cost Sharing Plan Variation,,0.818372309207916,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$4,250","$8,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,$500,"$1,000",50%,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,1,91762,NJ,Individual,No,22-3338404,91762NJ0070002,IHC Bronze EPO H.S.A Regional Preferred 50%/50%,91762NJ007,,NJN001,NJS001,NJF004,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCBronzeEPOHSA_V_P_N102_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070002-01,Standard Bronze On Exchange Plan,,0.614018678665161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,1,91762,NJ,Individual,No,22-3338404,91762NJ0070002,IHC Bronze EPO H.S.A Regional Preferred 50%/50%,91762NJ007,,NJN001,NJS001,NJF004,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCBronzeEPOHSA_V_P_N102_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,1,91762,NJ,Individual,No,22-3338404,91762NJ0070002,IHC Bronze EPO H.S.A Regional Preferred 50%/50%,91762NJ007,,NJN001,NJS001,NJF004,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCBronzeEPOHSA_V_P_N102_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070002-03,Limited Cost Sharing Plan Variation,,0.614018678665161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,1,91762,NJ,Individual,No,22-3338404,91762NJ0070003,IHC Bronze EPO H.S.A National Access 50%/50%,91762NJ007,,NJN003,NJS003,NJF004,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,Yes,www.amerihealth.com/ffm/IHCBronzeEPOHSA_V_P_N102_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070003-00,Standard Bronze Off Exchange Plan,,0.614018678665161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,1,91762,NJ,Individual,No,22-3338404,91762NJ0070003,IHC Bronze EPO H.S.A National Access 50%/50%,91762NJ007,,NJN003,NJS003,NJF004,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,Yes,www.amerihealth.com/ffm/IHCBronzeEPOHSA_V_P_N102_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070003-01,Standard Bronze On Exchange Plan,,0.614018678665161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,1,91762,NJ,Individual,No,22-3338404,91762NJ0070003,IHC Bronze EPO H.S.A National Access 50%/50%,91762NJ007,,NJN003,NJS003,NJF004,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,Yes,www.amerihealth.com/ffm/IHCBronzeEPOHSA_V_P_N102_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,1,91762,NJ,Individual,No,22-3338404,91762NJ0070003,IHC Bronze EPO H.S.A National Access 50%/50%,91762NJ007,,NJN003,NJS003,NJF004,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,Yes,www.amerihealth.com/ffm/IHCBronzeEPOHSA_V_P_N102_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070003-03,Limited Cost Sharing Plan Variation,,0.614018678665161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,2,91762,NJ,Individual,No,22-3338404,91762NJ0070004,IHC Bronze EPO H.S.A Tier 1 Advantage  $50/$75,91762NJ007,,NJN002,NJS002,NJF001,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCBronzeEPOHSATier1Advantage151_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070004-00,Standard Bronze Off Exchange Plan,,0.61904102563858,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,3,29176,OK,Individual,No,39-0658730,29176OK0190006,Assurant Health Bronze Plan 002,29176OK019,,OKN001,OKS002,OKF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190006-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,3,29176,OK,Individual,No,39-0658730,29176OK0190006,Assurant Health Bronze Plan 002,29176OK019,,OKN001,OKS002,OKF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,16
2015,NJ,99708,HIOS,7,2015-01-17 03:15:53,1,99708,NJ,SHOP (Small Group),Yes,22-1896118,99708NJ0140013,Delta Dental -Basic PPO Plus Premier Pediatric Essential Health Benefit Addendum,99708NJ014,,NJN001,NJS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$39.29,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available throughout the United States,Yes,http://www.deltadentalnj.com,http://www.deltadentalnj.com,http://www.deltadentalnj.com,,99708NJ0140013-00,Standard Low Off Exchange Plan,71.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$120,$360,,,,,$120,$360,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NJ,99708,HIOS,7,2015-01-17 03:15:53,1,99708,NJ,SHOP (Small Group),Yes,22-1896118,99708NJ0140014,Delta Dental-Enhanced PPO Plus Premier Pediatric Essential Health Benefit Addendum,99708NJ014,,NJN001,NJS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$44.53,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available throughout the United States,Yes,http://www.deltadentalnj.com,http://www.deltadentalnj.com,http://www.deltadentalnj.com,,99708NJ0140014-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,$75,,,,,$25,$75,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NJ,99708,HIOS,7,2015-01-17 03:15:53,2,99708,NJ,SHOP (Small Group),Yes,22-1896118,99708NJ0130019,Delta Dental - Basic Family PPO Plan I,99708NJ013,,NJN002,NJS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.24,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available throughout the United States,Yes,http://www.deltadentalnj.com,http://www.deltadentalnj.com,http://www.deltadentalnj.com,,99708NJ0130019-00,Standard Low Off Exchange Plan,71.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$120,$360,,,,,$120,$360,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,99708,HIOS,7,2015-01-17 03:15:53,2,99708,NJ,Individual,Yes,22-1896118,99708NJ0120022,Delta Dental Individual - Basic Family PPO Plan I,99708NJ012,,NJN002,NJS001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.58,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available throughout the United States,Yes,http://www.deltadentalnj.com/products/individual_aca_2015_famI.pdf,https://auth.deltadentalcoversme.com/sp/ACS.saml2,https://www.deltadentalcoversme.com/plan-options/nj-plans,,99708NJ0120022-01,Standard Low On Exchange Plan,71.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$120,$360,,,,,$120,$360,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,99708,HIOS,7,2015-01-17 03:15:53,3,99708,NJ,Individual,Yes,22-1896118,99708NJ0120023,Delta Dental Individual - Basic Family PPO Plan II,99708NJ012,,NJN002,NJS001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.43,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available throughout the United States,Yes,http://www.deltadentalnj.com/products/individual_aca_2015_famII.pdf,https://auth.deltadentalcoversme.com/sp/ACS.saml2,https://www.deltadentalcoversme.com/plan-options/nj-plans,,99708NJ0120023-01,Standard Low On Exchange Plan,71.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$120,$360,,,,,$120,$360,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,99708,HIOS,7,2015-01-17 03:15:53,3,99708,NJ,SHOP (Small Group),Yes,22-1896118,99708NJ0130020,Delta Dental  - Basic Family PPO Plan II,99708NJ013,,NJN002,NJS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.18,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available throughout the United States,Yes,http://www.deltadentalnj.com,http://www.deltadentalnj.com,http://www.deltadentalnj.com,,99708NJ0130020-00,Standard Low Off Exchange Plan,71.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$120,$360,,,,,$120,$360,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,99708,HIOS,7,2015-01-17 03:15:53,3,99708,NJ,SHOP (Small Group),Yes,22-1896118,99708NJ0130021,Delta Dental  - Enhanced Family PPO Plan III,99708NJ013,,NJN002,NJS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.33,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available throughout the United States,Yes,http://www.deltadentalnj.com,http://www.deltadentalnj.com,http://www.deltadentalnj.com,,99708NJ0130021-00,Standard High Off Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,$75,,,,,$25,$75,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,99708,HIOS,7,2015-01-17 03:15:53,3,99708,NJ,Individual,Yes,22-1896118,99708NJ0120024,Delta Dental Individual - Enhanced Family PPO Plan III,99708NJ012,,NJN002,NJS001,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$41.31,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available throughout the United States,Yes,http://www.deltadentalnj.com/products/individual_aca_2015_famIII.pdf,https://auth.deltadentalcoversme.com/sp/ACS.saml2,https://www.deltadentalcoversme.com/plan-options/nj-plans,,99708NJ0120024-01,Standard High On Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,$75,,,,,$25,$75,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,12513,HIOS,8,2015-01-16 17:32:32,1,12513,OK,SHOP (Small Group),Yes,36-3757528,12513OK0030001,TruAssure Dental Small Group Basic Plan,12513OK003,,OKN001,OKS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.01,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=OK,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=OK,,12513OK0030001-00,Standard High Off Exchange Plan,83.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,12513,HIOS,8,2015-01-16 17:32:32,1,12513,OK,Individual,Yes,36-3757528,12513OK0010001,TruAssure Dental Basic Plan,12513OK001,,OKN001,OKS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.20,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=OK,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=OK,,12513OK0010001-00,Standard Low Off Exchange Plan,68.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,2,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0080004,SEH Bronze EPO H.S.A Tier 1 Advantage  $50/$75,91762NJ008,,NJN002,NJS002,NJF001,Existing,EPO,Bronze,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.9982,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0080004-00,Standard Bronze Off Exchange Plan,,0.61904102563858,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,2,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0080004,SEH Bronze EPO H.S.A Tier 1 Advantage  $50/$75,91762NJ008,,NJN002,NJS002,NJF001,Existing,EPO,Bronze,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.9982,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0080004-01,Standard Bronze On Exchange Plan,,0.61904102563858,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,2,91762,NJ,Individual,No,22-3338404,91762NJ0070004,IHC Bronze EPO H.S.A Tier 1 Advantage  $50/$75,91762NJ007,,NJN002,NJS002,NJF001,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCBronzeEPOHSATier1Advantage151_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070004-01,Standard Bronze On Exchange Plan,,0.61904102563858,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,2,91762,NJ,Individual,No,22-3338404,91762NJ0070004,IHC Bronze EPO H.S.A Tier 1 Advantage  $50/$75,91762NJ007,,NJN002,NJS002,NJF001,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCBronzeEPOHSATier1Advantage151_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,2,91762,NJ,Individual,No,22-3338404,91762NJ0070004,IHC Bronze EPO H.S.A Tier 1 Advantage  $50/$75,91762NJ007,,NJN002,NJS002,NJF001,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCBronzeEPOHSATier1Advantage151_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070004-03,Limited Cost Sharing Plan Variation,,0.61904102563858,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,3,91762,NJ,Individual,No,22-3338404,91762NJ0070081,IHC Bronze EPO H.S.A Community Advantage  $25/$50,91762NJ007,,NJN002,NJS004,NJF001,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCBronzeEPOHSACommunityAdvantage165_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070081-00,Standard Bronze Off Exchange Plan,,0.619387745857239,Yes,Yes,Yes,45%,55%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,3,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0080052,SEH Bronze EPO H.S.A Community Advantage  $25/$50,91762NJ008,,NJN002,NJS004,NJF001,New,EPO,Bronze,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.9982,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area.,No,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0080052-00,Standard Bronze Off Exchange Plan,,0.619387745857239,Yes,Yes,Yes,45%,55%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,3,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0080052,SEH Bronze EPO H.S.A Community Advantage  $25/$50,91762NJ008,,NJN002,NJS004,NJF001,New,EPO,Bronze,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.9982,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area.,No,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0080052-01,Standard Bronze On Exchange Plan,,0.619387745857239,Yes,Yes,Yes,45%,55%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,3,91762,NJ,Individual,No,22-3338404,91762NJ0070081,IHC Bronze EPO H.S.A Community Advantage  $25/$50,91762NJ007,,NJN002,NJS004,NJF001,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCBronzeEPOHSACommunityAdvantage165_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070081-01,Standard Bronze On Exchange Plan,,0.619387745857239,Yes,Yes,Yes,45%,55%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,3,91762,NJ,Individual,No,22-3338404,91762NJ0070081,IHC Bronze EPO H.S.A Community Advantage  $25/$50,91762NJ007,,NJN002,NJS004,NJF001,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCBronzeEPOHSACommunityAdvantage165_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070081-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,45%,55%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,3,91762,NJ,Individual,No,22-3338404,91762NJ0070081,IHC Bronze EPO H.S.A Community Advantage  $25/$50,91762NJ007,,NJN002,NJS004,NJF001,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCBronzeEPOHSACommunityAdvantage165_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070081-03,Limited Cost Sharing Plan Variation,,0.619387745857239,Yes,Yes,Yes,45%,55%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,4,91762,NJ,Individual,No,22-3338404,91762NJ0070006,IHC Silver EPO H.S.A Local Value $50/$75,91762NJ007,,NJN002,NJS002,NJF001,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,$125,5,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverEPOHSALocalValue220_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070006-00,Standard Silver Off Exchange Plan,,0.689814388751984,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,4,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0080018,SEH Silver EPO H.S.A Tier 1 Advantage  $50/$75,91762NJ008,,NJN002,NJS002,NJF003,Existing,EPO,Silver,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.9982,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0080018-00,Standard Silver Off Exchange Plan,,0.680473387241364,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$5,750","$11,500","$5,750","$11,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",50%,"$1,350","$2,700",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,4,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0080018,SEH Silver EPO H.S.A Tier 1 Advantage  $50/$75,91762NJ008,,NJN002,NJS002,NJF003,Existing,EPO,Silver,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.9982,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0080018-01,Standard Silver On Exchange Plan,,0.680473387241364,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$5,750","$11,500","$5,750","$11,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",50%,"$1,350","$2,700",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,4,91762,NJ,Individual,No,22-3338404,91762NJ0070006,IHC Silver EPO H.S.A Local Value $50/$75,91762NJ007,,NJN002,NJS002,NJF001,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,$125,5,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverEPOHSALocalValue220_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070006-01,Standard Silver On Exchange Plan,,0.689814388751984,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,4,91762,NJ,Individual,No,22-3338404,91762NJ0070006,IHC Silver EPO H.S.A Local Value $50/$75,91762NJ007,,NJN002,NJS002,NJF001,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,$125,5,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverEPOHSALocalValue220_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,4,91762,NJ,Individual,No,22-3338404,91762NJ0070006,IHC Silver EPO H.S.A Local Value $50/$75,91762NJ007,,NJN002,NJS002,NJF001,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,$125,5,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverEPOHSALocalValue220_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070006-03,Limited Cost Sharing Plan Variation,,0.689814388751984,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,4,91762,NJ,Individual,No,22-3338404,91762NJ0070006,IHC Silver EPO H.S.A Local Value $50/$75,91762NJ007,,NJN002,NJS002,NJF001,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,$125,5,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverEPOHSALocalValue220_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070006-04,73% AV Level Silver Plan,,0.727681994438171,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,4,91762,NJ,Individual,No,22-3338404,91762NJ0070006,IHC Silver EPO H.S.A Local Value $50/$75,91762NJ007,,NJN002,NJS002,NJF001,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,$125,5,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverEPOHSALocalValue220_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070006-05,87% AV Level Silver Plan,,0.866135597229004,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,4,91762,NJ,Individual,No,22-3338404,91762NJ0070006,IHC Silver EPO H.S.A Local Value $50/$75,91762NJ007,,NJN002,NJS002,NJF001,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,$125,5,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverEPOHSALocalValue220_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070006-06,94% AV Level Silver Plan,,0.937573373317719,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,5,91762,NJ,Individual,No,22-3338404,91762NJ0070007,IHC Silver EPO H.S.A Tier 1 Advantage  $50/$75,91762NJ007,,NJN002,NJS002,NJF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverEPOHSATier1Advantage251_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070007-00,Standard Silver Off Exchange Plan,,0.680473387241364,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$5,750","$11,500","$5,750","$11,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",50%,"$1,350","$2,700",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,5,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0080019,SEH Silver EPO Community Advantage  $15/$35,91762NJ008,,NJN002,NJS004,NJF003,Existing,EPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.9982,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0080019-00,Standard Silver Off Exchange Plan,,0.716189324855804,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",50%,"$2,000","$4,000",50%,Not Applicable,Not Applicable,$0,$0,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,5,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0080019,SEH Silver EPO Community Advantage  $15/$35,91762NJ008,,NJN002,NJS004,NJF003,Existing,EPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.9982,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0080019-01,Standard Silver On Exchange Plan,,0.716189324855804,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",50%,"$2,000","$4,000",50%,Not Applicable,Not Applicable,$0,$0,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,5,91762,NJ,Individual,No,22-3338404,91762NJ0070007,IHC Silver EPO H.S.A Tier 1 Advantage  $50/$75,91762NJ007,,NJN002,NJS002,NJF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverEPOHSATier1Advantage251_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070007-01,Standard Silver On Exchange Plan,,0.680473387241364,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$5,750","$11,500","$5,750","$11,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",50%,"$1,350","$2,700",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,5,91762,NJ,Individual,No,22-3338404,91762NJ0070007,IHC Silver EPO H.S.A Tier 1 Advantage  $50/$75,91762NJ007,,NJN002,NJS002,NJF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverEPOHSATier1Advantage251_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,5,91762,NJ,Individual,No,22-3338404,91762NJ0070007,IHC Silver EPO H.S.A Tier 1 Advantage  $50/$75,91762NJ007,,NJN002,NJS002,NJF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverEPOHSATier1Advantage251_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070007-03,Limited Cost Sharing Plan Variation,,0.680473387241364,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$5,750","$11,500","$5,750","$11,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",50%,"$1,350","$2,700",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,5,91762,NJ,Individual,No,22-3338404,91762NJ0070007,IHC Silver EPO H.S.A Tier 1 Advantage  $50/$75,91762NJ007,,NJN002,NJS002,NJF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverEPOHSATier1Advantage251_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070007-04,73% AV Level Silver Plan,,0.720654666423798,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$4,200","$8,400","$4,200","$8,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",50%,"$1,300","$2,600",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,5,91762,NJ,Individual,No,22-3338404,91762NJ0070007,IHC Silver EPO H.S.A Tier 1 Advantage  $50/$75,91762NJ007,,NJN002,NJS002,NJF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverEPOHSATier1Advantage251_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070007-05,87% AV Level Silver Plan,,0.862922847270966,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$1,650","$3,300","$1,650","$3,300",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$600,50%,$300,$600,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,5,91762,NJ,Individual,No,22-3338404,91762NJ0070007,IHC Silver EPO H.S.A Tier 1 Advantage  $50/$75,91762NJ007,,NJN002,NJS002,NJF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverEPOHSATier1Advantage251_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070007-06,94% AV Level Silver Plan,,0.931098401546478,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$750,"$1,500",$750,"$1,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,50%,$50,$100,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,6,91762,NJ,Individual,No,22-3338404,91762NJ0070008,IHC Silver EPO Community Advantage  $15/$35,91762NJ007,,NJN002,NJS004,NJF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverEPOCommunityAdvantage265_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070008-00,Standard Silver Off Exchange Plan,,0.716189324855804,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",50%,"$2,000","$4,000",50%,Not Applicable,Not Applicable,$0,$0,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,6,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0080050,SEH Silver EPO H.S.A. Local Value 100%/100%,91762NJ008,,NJN002,NJS002,NJF003,New,EPO,Silver,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.9982,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0080050-00,Standard Silver Off Exchange Plan,71.42%,0.714161396026611,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,6,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0080050,SEH Silver EPO H.S.A. Local Value 100%/100%,91762NJ008,,NJN002,NJS002,NJF003,New,EPO,Silver,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.9982,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0080050-01,Standard Silver On Exchange Plan,71.42%,0.714161396026611,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,6,91762,NJ,Individual,No,22-3338404,91762NJ0070008,IHC Silver EPO Community Advantage  $15/$35,91762NJ007,,NJN002,NJS004,NJF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverEPOCommunityAdvantage265_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070008-03,Limited Cost Sharing Plan Variation,,0.716189324855804,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",50%,"$2,000","$4,000",50%,Not Applicable,Not Applicable,$0,$0,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,6,91762,NJ,Individual,No,22-3338404,91762NJ0070008,IHC Silver EPO Community Advantage  $15/$35,91762NJ007,,NJN002,NJS004,NJF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverEPOCommunityAdvantage265_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070008-04,73% AV Level Silver Plan,,0.738227427005768,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",50%,"$2,000","$4,000",50%,Not Applicable,Not Applicable,$0,$0,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,6,91762,NJ,Individual,No,22-3338404,91762NJ0070008,IHC Silver EPO Community Advantage  $15/$35,91762NJ007,,NJN002,NJS004,NJF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverEPOCommunityAdvantage265_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070008-05,87% AV Level Silver Plan,,0.860055387020111,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$1,750","$3,500","$1,750","$3,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,50%,$300,$600,50%,Not Applicable,Not Applicable,$0,$0,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,6,91762,NJ,Individual,No,22-3338404,91762NJ0070008,IHC Silver EPO Community Advantage  $15/$35,91762NJ007,,NJN002,NJS004,NJF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCSilverEPOCommunityAdvantage265_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070008-06,94% AV Level Silver Plan,,0.933586180210114,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$650,"$1,300",$650,"$1,300",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,50%,$100,$200,50%,Not Applicable,Not Applicable,$0,$0,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,3,29176,OK,Individual,No,39-0658730,29176OK0190005,Assurant Health Bronze Plan 002,29176OK019,,OKN001,OKS001,OKF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190005-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,3,29176,OK,Individual,No,39-0658730,29176OK0190005,Assurant Health Bronze Plan 002,29176OK019,,OKN001,OKS001,OKF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,12
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,5,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020005,Gold Plan 1 with Dental,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9881,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020005-00,Standard Gold Off Exchange Plan,80.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,"$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",100%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$20,$0,$200,"$1,000",$900,$40,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,5,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020005,Gold Plan 1 with Dental,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9881,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020005-01,Standard Gold On Exchange Plan,80.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,"$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",100%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$20,$0,$200,"$1,000",$900,$40,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,5,85408,OK,Individual,No,26-3811422,85408OK0010009,Silver Plan 1 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9895,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010009-01,Standard Silver On Exchange Plan,69.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",100%,,,,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$70,$0,$200,"$1,300","$1,200",$0,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,5,85408,OK,Individual,No,26-3811422,85408OK0010009,Silver Plan 1 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9895,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010009-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,5,85408,OK,Individual,No,26-3811422,85408OK0010009,Silver Plan 1 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9895,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010009-03,Limited Cost Sharing Plan Variation,69.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",100%,,,,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$70,$0,$200,"$1,300","$1,200",$0,$80,7
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,5,85408,OK,Individual,No,26-3811422,85408OK0010009,Silver Plan 1 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9895,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010009-04,73% AV Level Silver Plan,72.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,"$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",100%,,,,Not Applicable,Not Applicable,"$2,000","$4,000","$2,000",$70,$0,$200,"$1,300","$1,200",$0,$80,8
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,5,85408,OK,Individual,No,26-3811422,85408OK0010009,Silver Plan 1 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9895,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010009-05,87% AV Level Silver Plan,86.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,"$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,$750,"$1,500",100%,,,,Not Applicable,Not Applicable,$750,"$1,500",$800,$50,$0,$200,$800,$700,$0,$80,9
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,5,85408,OK,Individual,No,26-3811422,85408OK0010009,Silver Plan 1 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9895,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010009-06,94% AV Level Silver Plan,93.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,$700,"$1,400",,,,,,,,,,,,,,,,,,,,,$250,$500,100%,,,,Not Applicable,Not Applicable,$250,$500,$300,$500,$0,$200,$300,$400,$30,$80,10
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,6,85408,OK,Individual,No,26-3811422,85408OK0010010,Silver Plan 1,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9885,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010010-00,Standard Silver Off Exchange Plan,69.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",100%,,,,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$70,$0,$200,"$1,300","$1,200",$0,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,6,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020006,Gold Plan 1,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9873,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020006-00,Standard Gold Off Exchange Plan,80.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,"$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",100%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$20,$0,$200,"$1,000",$900,$40,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,6,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020006,Gold Plan 1,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9873,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020006-01,Standard Gold On Exchange Plan,80.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,"$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",100%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$20,$0,$200,"$1,000",$900,$40,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,6,85408,OK,Individual,No,26-3811422,85408OK0010010,Silver Plan 1,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9885,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010010-01,Standard Silver On Exchange Plan,69.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",100%,,,,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$70,$0,$200,"$1,300","$1,200",$0,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,6,85408,OK,Individual,No,26-3811422,85408OK0010010,Silver Plan 1,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9885,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010010-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,6,85408,OK,Individual,No,26-3811422,85408OK0010010,Silver Plan 1,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9885,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010010-03,Limited Cost Sharing Plan Variation,69.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",100%,,,,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$70,$0,$200,"$1,300","$1,200",$0,$80,7
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,7,91762,NJ,Individual,No,22-3338404,91762NJ0070010,IHC Gold EPO Regional Preferred $30/$50,91762NJ007,,NJN001,NJS001,NJF002,Existing,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCGoldEPO_P_N304_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070010-00,Standard Gold Off Exchange Plan,,0.781302750110626,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,7,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0080023,SEH Gold EPO Regional Preferred $30/$50,91762NJ008,,NJN001,NJS001,NJF002,Existing,EPO,Gold,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.9982,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0080023-00,Standard Gold Off Exchange Plan,,0.781302750110626,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,7,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0080023,SEH Gold EPO Regional Preferred $30/$50,91762NJ008,,NJN001,NJS001,NJF002,Existing,EPO,Gold,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.9982,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0080023-01,Standard Gold On Exchange Plan,,0.781302750110626,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,7,91762,NJ,Individual,No,22-3338404,91762NJ0070010,IHC Gold EPO Regional Preferred $30/$50,91762NJ007,,NJN001,NJS001,NJF002,Existing,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCGoldEPO_P_N304_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070010-01,Standard Gold On Exchange Plan,,0.781302750110626,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,7,91762,NJ,Individual,No,22-3338404,91762NJ0070010,IHC Gold EPO Regional Preferred $30/$50,91762NJ007,,NJN001,NJS001,NJF002,Existing,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCGoldEPO_P_N304_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,7,91762,NJ,Individual,No,22-3338404,91762NJ0070010,IHC Gold EPO Regional Preferred $30/$50,91762NJ007,,NJN001,NJS001,NJF002,Existing,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCGoldEPO_P_N304_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070010-03,Limited Cost Sharing Plan Variation,,0.781302750110626,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,7,91762,NJ,Individual,No,22-3338404,91762NJ0070080,IHC Gold EPO National Access $30/$50,91762NJ007,,NJN003,NJS003,NJF002,New,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCGoldEPO_P_N304_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070080-00,Standard Gold Off Exchange Plan,,0.781302750110626,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,7,91762,NJ,Individual,No,22-3338404,91762NJ0070080,IHC Gold EPO National Access $30/$50,91762NJ007,,NJN003,NJS003,NJF002,New,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCGoldEPO_P_N304_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070080-01,Standard Gold On Exchange Plan,,0.781302750110626,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,7,91762,NJ,Individual,No,22-3338404,91762NJ0070080,IHC Gold EPO National Access $30/$50,91762NJ007,,NJN003,NJS003,NJF002,New,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCGoldEPO_P_N304_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070080-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,7,91762,NJ,Individual,No,22-3338404,91762NJ0070080,IHC Gold EPO National Access $30/$50,91762NJ007,,NJN003,NJS003,NJF002,New,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area,No,www.amerihealth.com/ffm/IHCGoldEPO_P_N304_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070080-03,Limited Cost Sharing Plan Variation,,0.781302750110626,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,8,91762,NJ,Individual,No,22-3338404,91762NJ0070012,IHC Gold EPO H.S.A Local Value 80%/80%,91762NJ007,,NJN002,NJS002,NJF004,Existing,EPO,Gold,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,No,,Yes,Emergency care is covered outside of the service area.,No,www.amerihealth.com/ffm/IHCGoldEPOHSALocalValue305_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070012-00,Standard Gold Off Exchange Plan,,0.780205845832825,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,4
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,8,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0100001,SEH Gold POS Plus National Access $30/$50,91762NJ010,,NJN003,NJS003,NJF003,Existing,POS,Gold,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.9982,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area.,Yes,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0100001-00,Standard Gold Off Exchange Plan,,0.818338215351105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$3,000","$6,000",$0,$0,$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,8,91762,NJ,SHOP (Small Group),No,22-3338404,91762NJ0100001,SEH Gold POS Plus National Access $30/$50,91762NJ010,,NJN003,NJS003,NJF003,Existing,POS,Gold,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.9982,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the service area.,Yes,www.amerihealth.com/ffm/shop2015,www.amerihealthnj.com/market/SHOP2015,www.amerihealth.com/ffm/shop/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0100001-01,Standard Gold On Exchange Plan,,0.818338215351105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$3,000","$6,000",$0,$0,$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,10,91762,NJ,Individual,No,22-3338404,91762NJ0070014,IHC Local Value Simple Saver,91762NJ007,,NJN002,NJS002,NJF005,Existing,EPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,3,2015-01-01,,No,,Yes,Emergency Care is covered outside of the Service Area,No,www.amerihealth.com/ffm/IHC_V_P_SimpleSaver501_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070014-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,10,91762,NJ,Individual,No,22-3338404,91762NJ0070015,IHC Regional Preferred Simple Saver,91762NJ007,,NJN001,NJS001,NJF005,Existing,EPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,3,2015-01-01,,No,,Yes,Emergency Care is covered outside of the Service Area,No,www.amerihealth.com/ffm/IHC_V_P_SimpleSaver501_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070015-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,1,29176,OK,Individual,No,39-0658730,29176OK0190004,Assurant Health Silver Plan 001,29176OK019,,OKN001,OKS002,OKF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,39
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,1,29176,OK,Individual,No,39-0658730,29176OK0190004,Assurant Health Silver Plan 001,29176OK019,,OKN001,OKS002,OKF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190004-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,1,29176,OK,Individual,No,39-0658730,29176OK0190004,Assurant Health Silver Plan 001,29176OK019,,OKN001,OKS002,OKF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190004-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,1,29176,OK,Individual,No,39-0658730,29176OK0190004,Assurant Health Silver Plan 001,29176OK019,,OKN001,OKS002,OKF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190004-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,42
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,3,29176,OK,Individual,No,39-0658730,29176OK0190005,Assurant Health Bronze Plan 002,29176OK019,,OKN001,OKS001,OKF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190005-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,3,29176,OK,Individual,No,39-0658730,29176OK0190006,Assurant Health Bronze Plan 002,29176OK019,,OKN001,OKS002,OKF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190006-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,OK,12513,HIOS,8,2015-01-16 17:32:32,1,12513,OK,Individual,Yes,36-3757528,12513OK0010001,TruAssure Dental Basic Plan,12513OK001,,OKN001,OKS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.20,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=OK,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=OK,,12513OK0010001-01,Standard Low On Exchange Plan,68.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,12513,HIOS,8,2015-01-16 17:32:32,1,12513,OK,SHOP (Small Group),Yes,36-3757528,12513OK0040001,TruAssure Dental Small Group Preferred Plan,12513OK004,,OKN001,OKS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.01,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=OK,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=OK,,12513OK0040001-00,Standard High Off Exchange Plan,83.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,12513,HIOS,8,2015-01-16 17:32:32,2,12513,OK,Individual,Yes,36-3757528,12513OK0020001,TruAssure Dental Preferred Plan,12513OK002,,OKN001,OKS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.52,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=OK,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=OK,,12513OK0020001-00,Standard High Off Exchange Plan,83.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,12513,HIOS,8,2015-01-16 17:32:32,2,12513,OK,Individual,Yes,36-3757528,12513OK0020001,TruAssure Dental Preferred Plan,12513OK002,,OKN001,OKS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.52,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=OK,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=OK,,12513OK0020001-01,Standard High On Exchange Plan,86.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,12530,HIOS,2,2014-08-08 08:53:29,1,12530,OK,SHOP (Small Group),Yes,42-0127290,12530OK0040001,Principal Plan Dental 70,12530OK004,,OKN001,OKS001,,New,PPO,Low,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$25.83,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,12530OK0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,12530,HIOS,2,2014-08-08 08:53:29,1,12530,OK,SHOP (Small Group),Yes,42-0127290,12530OK0040002,Principal Plan Dental 80,12530OK004,,OKN001,OKS001,,New,PPO,High,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$28.19,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,12530OK0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,13711,HIOS,7,2014-11-13 10:25:37,1,13711,OK,SHOP (Small Group),Yes,47-0397286,13711OK0030001,"Renaissance Group Dental PPO, EHB Certified",13711OK003,,OKN001,OKS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.57,,Estimated Rate,,0,0,0,2014-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,13711OK0030001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,13711,HIOS,7,2014-11-13 10:25:37,1,13711,OK,Individual,Yes,47-0397286,13711OK0010001,"Delta Dental Individual PPO, EHB Certified",13711OK001,,OKN002,OKS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.85,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,13711OK0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,13711,HIOS,7,2014-11-13 10:25:37,1,13711,OK,Individual,Yes,47-0397286,13711OK0010002,"Delta Dental Individual PPO, EHB Certified",13711OK001,,OKN002,OKS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.36,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,13711OK0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,13711,HIOS,7,2014-11-13 10:25:37,1,13711,OK,SHOP (Small Group),Yes,47-0397286,13711OK0030002,"Renaissance Group Dental PPO, EHB Certified",13711OK003,,OKN001,OKS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.72,,Estimated Rate,,0,0,0,2014-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,13711OK0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,13711,HIOS,7,2014-11-13 10:25:37,1,13711,OK,Individual,Yes,47-0397286,13711OK0020001,"Renaissance Individual Dental PPO, EHB Certified",13711OK002,,OKN001,OKS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.63,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,13711OK0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OK,13711,HIOS,7,2014-11-13 10:25:37,1,13711,OK,Individual,Yes,47-0397286,13711OK0020002,"Renaissance Individual Dental PPO, EHB Certified",13711OK002,,OKN001,OKS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.28,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,13711OK0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OK,13711,HIOS,7,2014-11-13 10:25:37,1,13711,OK,Individual,Yes,47-0397286,13711OK0040001,"Renaissance Individual Dental PPO, EHB Certified (Exchange)",13711OK004,,OKN001,OKS001,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.25,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/OK_EHB_High,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/13711,http://www.renaissancedental.com/OK_EHB_High,,13711OK0040001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,OK,13711,HIOS,7,2014-11-13 10:25:37,1,13711,OK,Individual,Yes,47-0397286,13711OK0040002,"Renaissance Individual Dental PPO, EHB Certified (Exchange)",13711OK004,,OKN001,OKS001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.13,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/OK_EHB_Low,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/13711,http://www.renaissancedental.com/OK_EHB_Low,,13711OK0040002-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,OK,13711,HIOS,7,2014-11-13 10:25:37,2,13711,OK,Individual,Yes,47-0397286,13711OK0050001,"Renaissance Individual Pediatric-Only Dental PPO,EHB Certified (Exchange)",13711OK005,,OKN001,OKS001,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$36.72,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/OK_Ped_High,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/13711,http://www.renaissancedental.com/OK_Ped_High,,13711OK0050001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,13711,HIOS,7,2014-11-13 10:25:37,2,13711,OK,Individual,Yes,47-0397286,13711OK0050002,"Renaissance Individual Pediatric-Only Dental PPO,EHB Certified (Exchange)",13711OK005,,OKN001,OKS001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$28.82,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/OK_Ped_Low,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/13711,http://www.renaissancedental.com/OK_Ped_Low,,13711OK0050002-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,13711,HIOS,7,2014-11-13 10:25:37,2,13711,OK,Individual,Yes,47-0397286,13711OK0060001,"Renaissance Individual Pediatric-Only Dental PPO,EHB Certified",13711OK006,,OKN001,OKS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$33.82,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,13711OK0060001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OK,13711,HIOS,7,2014-11-13 10:25:37,2,13711,OK,Individual,Yes,47-0397286,13711OK0060002,"Renaissance Individual Pediatric-Only Dental PPO,EHB Certified",13711OK006,,OKN001,OKS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.57,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,13711OK0060002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OK,17595,HIOS,3,2014-08-05 13:28:44,1,17595,OK,SHOP (Small Group),Yes,57-0523959,17595OK0010001,Group Pediatric Dental EHB Rider,17595OK001,,OKN001,OKS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.38,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,17595OK0010001-00,Standard High Off Exchange Plan,85.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,17595,HIOS,3,2014-08-05 13:28:44,1,17595,OK,SHOP (Small Group),Yes,57-0523959,17595OK0010002,Group Pediatric Dental EHB Rider,17595OK001,,OKN001,OKS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$20.73,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,17595OK0010002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,10,91762,NJ,Individual,No,22-3338404,91762NJ0070015,IHC Regional Preferred Simple Saver,91762NJ007,,NJN001,NJS001,NJF005,Existing,EPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,3,2015-01-01,,No,,Yes,Emergency Care is covered outside of the Service Area,No,www.amerihealth.com/ffm/IHC_V_P_SimpleSaver501_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0070015-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,11,91762,NJ,Individual,No,22-3338404,91762NJ0110001,IHC Platinum POS Plus National Access $15/$25,91762NJ011,,NJN003,NJS003,NJF002,Existing,POS,Platinum,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the Service Area,Yes,www.amerihealth.com/ffm/IHCPlatinumPOSPlusNationalAccess606_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0110001-00,Standard Platinum Off Exchange Plan,88.17%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$3,000","$6,000",$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,3,40254,OK,SHOP (Small Group),Yes,95-6042390,40254OK0010010,BEST Dental Choice-H,40254OK001,,OKN001,OKS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.62,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BESTDental_Choice-H_Plan.pdf,,40254OK0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,3,40254,OK,SHOP (Small Group),Yes,95-6042390,40254OK0010010,BEST Dental Choice-H,40254OK001,,OKN001,OKS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.62,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BESTDental_Choice-H_Plan.pdf,,40254OK0010010-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,4,40254,OK,SHOP (Small Group),Yes,95-6042390,40254OK0010009,BEST Dental Standard-L,40254OK001,,OKN001,OKS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.85,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BESTDental_Standard-L_Plan.pdf,,40254OK0010009-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,4,40254,OK,Individual,Yes,95-6042390,40254OK0020005,BESTOne Dental Plus-Silver,40254OK002,,OKN001,OKS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.07,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BESTOne_Dental_Plus-Silver_Plan.pdf,,40254OK0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,4,40254,OK,Individual,Yes,95-6042390,40254OK0020005,BESTOne Dental Plus-Silver,40254OK002,,OKN001,OKS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.07,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BESTOne_Dental_Plus-Silver_Plan.pdf,,40254OK0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,4,40254,OK,SHOP (Small Group),Yes,95-6042390,40254OK0010009,BEST Dental Standard-L,40254OK001,,OKN001,OKS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.85,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BESTDental_Standard-L_Plan.pdf,,40254OK0010009-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,1,29176,OK,Individual,No,39-0658730,29176OK0190001,Assurant Health Bronze Plan 001,29176OK019,,OKN001,OKS001,OKF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190001-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,1,29176,OK,Individual,No,39-0658730,29176OK0190002,Assurant Health Bronze Plan 001,29176OK019,,OKN001,OKS002,OKF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190002-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,1,29176,OK,Individual,No,39-0658730,29176OK0190002,Assurant Health Bronze Plan 001,29176OK019,,OKN001,OKS002,OKF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190002-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,1,29176,OK,Individual,No,39-0658730,29176OK0190002,Assurant Health Bronze Plan 001,29176OK019,,OKN001,OKS002,OKF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,16
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,1,29176,OK,Individual,No,39-0658730,29176OK0190002,Assurant Health Bronze Plan 001,29176OK019,,OKN001,OKS002,OKF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190002-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,11,91762,NJ,Individual,No,22-3338404,91762NJ0110001,IHC Platinum POS Plus National Access $15/$25,91762NJ011,,NJN003,NJS003,NJF002,Existing,POS,Platinum,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the Service Area,Yes,www.amerihealth.com/ffm/IHCPlatinumPOSPlusNationalAccess606_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0110001-01,Standard Platinum On Exchange Plan,88.17%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$3,000","$6,000",$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,11,91762,NJ,Individual,No,22-3338404,91762NJ0110001,IHC Platinum POS Plus National Access $15/$25,91762NJ011,,NJN003,NJS003,NJF002,Existing,POS,Platinum,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the Service Area,Yes,www.amerihealth.com/ffm/IHCPlatinumPOSPlusNationalAccess606_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0110001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,11,91762,NJ,Individual,No,22-3338404,91762NJ0110001,IHC Platinum POS Plus National Access $15/$25,91762NJ011,,NJN003,NJS003,NJF002,Existing,POS,Platinum,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the Service Area,Yes,www.amerihealth.com/ffm/IHCPlatinumPOSPlusNationalAccess606_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0110001-03,Limited Cost Sharing Plan Variation,88.17%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$3,000","$6,000",$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,12,91762,NJ,Individual,No,22-3338404,91762NJ0110002,IHC Silver POS Plus National Access $40/$50,91762NJ011,,NJN003,NJS003,NJF001,Existing,POS,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the Service Area,Yes,www.amerihealth.com/ffm/IHCSilverPOSPlusNationalAccess618_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0110002-00,Standard Silver Off Exchange Plan,,0.701960563659668,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",$0,$0,$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,12,91762,NJ,Individual,No,22-3338404,91762NJ0110002,IHC Silver POS Plus National Access $40/$50,91762NJ011,,NJN003,NJS003,NJF001,Existing,POS,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the Service Area,Yes,www.amerihealth.com/ffm/IHCSilverPOSPlusNationalAccess618_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0110002-01,Standard Silver On Exchange Plan,,0.701960563659668,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",$0,$0,$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,12,91762,NJ,Individual,No,22-3338404,91762NJ0110002,IHC Silver POS Plus National Access $40/$50,91762NJ011,,NJN003,NJS003,NJF001,Existing,POS,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the Service Area,Yes,www.amerihealth.com/ffm/IHCSilverPOSPlusNationalAccess618_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0110002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,12,91762,NJ,Individual,No,22-3338404,91762NJ0110002,IHC Silver POS Plus National Access $40/$50,91762NJ011,,NJN003,NJS003,NJF001,Existing,POS,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the Service Area,Yes,www.amerihealth.com/ffm/IHCSilverPOSPlusNationalAccess618_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0110002-03,Limited Cost Sharing Plan Variation,,0.701960563659668,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",$0,$0,$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,12,91762,NJ,Individual,No,22-3338404,91762NJ0110002,IHC Silver POS Plus National Access $40/$50,91762NJ011,,NJN003,NJS003,NJF001,Existing,POS,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the Service Area,Yes,www.amerihealth.com/ffm/IHCSilverPOSPlusNationalAccess618_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0110002-04,73% AV Level Silver Plan,,0.728788435459137,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$5,000",30%,,,,"$5,000","$10,000",$0,$0,$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,12,91762,NJ,Individual,No,22-3338404,91762NJ0110002,IHC Silver POS Plus National Access $40/$50,91762NJ011,,NJN003,NJS003,NJF001,Existing,POS,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the Service Area,Yes,www.amerihealth.com/ffm/IHCSilverPOSPlusNationalAccess618_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0110002-05,87% AV Level Silver Plan,,0.864820063114166,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,$200,$400,30%,,,,"$5,000","$10,000",$0,$0,$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,NJ,91762,HIOS,6,2015-07-22 09:15:52,12,91762,NJ,Individual,No,22-3338404,91762NJ0110002,IHC Silver POS Plus National Access $40/$50,91762NJ011,,NJN003,NJS003,NJF001,Existing,POS,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,$125,0,0,0,2015-01-01,,No,,Yes,Emergency Care is covered outside of the Service Area,Yes,www.amerihealth.com/ffm/IHCSilverPOSPlusNationalAccess618_15,www.amerihealthnj.com/market/individual2015,www.amerihealth.com/ffm/brochure2015,www.amerihealth.com/ffm/formulary,91762NJ0110002-06,94% AV Level Silver Plan,,0.9322669506073,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$12,700","$25,400",Not Applicable,Not Applicable,$100,$200,30%,,,,"$5,000","$10,000",$0,$0,$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,NJ,93627,HIOS,4,2014-08-23 04:11:13,1,93627,NJ,SHOP (Small Group),Yes,13-5123390,93627NJ0020002,Guardian Pediatric Advantage,93627NJ002,,NJN001,NJS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$30.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,93627NJ0020002-00,Standard High Off Exchange Plan,86.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,93627,HIOS,4,2014-08-23 04:11:13,1,93627,NJ,SHOP (Small Group),Yes,13-5123390,93627NJ0030002,Guardian Pediatric Essentials,93627NJ003,,NJN001,NJS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$22.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,93627NJ0030002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,93627,HIOS,4,2014-08-23 04:11:13,2,93627,NJ,SHOP (Small Group),Yes,13-5123390,93627NJ0050002,Guardian Family Advantage,93627NJ005,,NJN001,NJS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,93627NJ0050002-00,Standard High Off Exchange Plan,86.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,93627,HIOS,4,2014-08-23 04:11:13,2,93627,NJ,SHOP (Small Group),Yes,13-5123390,93627NJ0050002,Guardian Family Advantage,93627NJ005,,NJN001,NJS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,93627NJ0050002-01,Standard High On Exchange Plan,86.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,93627,HIOS,4,2014-08-23 04:11:13,2,93627,NJ,SHOP (Small Group),Yes,13-5123390,93627NJ0070002,Guardian Family Essentials,93627NJ007,,NJN001,NJS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,93627NJ0070002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NJ,93627,HIOS,4,2014-08-23 04:11:13,2,93627,NJ,SHOP (Small Group),Yes,13-5123390,93627NJ0070002,Guardian Family Essentials,93627NJ007,,NJN001,NJS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,93627NJ0070002-01,Standard Low On Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NJ,97057,HIOS,10,2015-01-16 17:32:32,1,97057,NJ,SHOP (Small Group),Yes,23-1661402,97057NJ0310001,Smile for Health Certified Basic Option Plus (90-50-50),97057NJ031,,NJN001,NJS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$3.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,97057NJ0310001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,97057,HIOS,10,2015-01-16 17:32:32,1,97057,NJ,Individual,Yes,23-1661402,97057NJ0360001,Healthy Chompers Child,97057NJ036,,NJN001,NJS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Child-Only,,,,$35.79,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,97057NJ0360001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,97057,HIOS,10,2015-01-16 17:32:32,2,97057,NJ,Individual,Yes,23-1661402,97057NJ0370001,Healthy Chompers Child with Adult Preventive,97057NJ037,,NJN001,NJS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$35.79,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,97057NJ0370001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,97057,HIOS,10,2015-01-16 17:32:32,2,97057,NJ,SHOP (Small Group),Yes,23-1661402,97057NJ0330001,Smile for Health Certified High Option Plus (100-50-50),97057NJ033,,NJN001,NJS001,,New,PPO,High,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$7.35,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,97057NJ0330001-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,97057,HIOS,10,2015-01-16 17:32:32,3,97057,NJ,SHOP (Small Group),Yes,23-1661402,97057NJ0350001,Smile for Health Certified Low Option Plus (100-100-100),97057NJ035,,NJN001,NJS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$3.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,97057NJ0350001-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,97057,HIOS,10,2015-01-16 17:32:32,4,97057,NJ,SHOP (Small Group),Yes,23-1661402,97057NJ0300001,Smile for Health Certified Basic Option (90-50-50),97057NJ030,,NJN001,NJS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$0.74,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,97057NJ0300001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,97057,HIOS,10,2015-01-16 17:32:32,5,97057,NJ,SHOP (Small Group),Yes,23-1661402,97057NJ0320001,Smile for Health Certified High Option (100-50-50),97057NJ032,,NJN001,NJS001,,New,PPO,High,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$0.74,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,97057NJ0320001-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,97057,HIOS,10,2015-01-16 17:32:32,6,97057,NJ,SHOP (Small Group),Yes,23-1661402,97057NJ0340001,Smile for Health Certified Low Option (100-100-100),97057NJ034,,NJN001,NJS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$0.74,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,97057NJ0340001-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,97057,HIOS,10,2015-01-16 17:32:32,7,97057,NJ,SHOP (Small Group),Yes,23-1661402,97057NJ0260001,Smile for Health Family C80A80,97057NJ026,,NJN001,NJS001,,New,PPO,High,,Both,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$28.30,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,https://www.unitedconcordia.com/docs/hcr/benefits-summary-nj-sfh-family-c80a80-ppo.pdf,,https://www.unitedconcordia.com/docs/hcr/plan-brochure-nj-sfhfamily-premier.pdf,,97057NJ0260001-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,97057,HIOS,10,2015-01-16 17:32:32,7,97057,NJ,SHOP (Small Group),Yes,23-1661402,97057NJ0260001,Smile for Health Family C80A80,97057NJ026,,NJN001,NJS001,,New,PPO,High,,Both,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$28.30,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,https://www.unitedconcordia.com/docs/hcr/benefits-summary-nj-sfh-family-c80a80-ppo.pdf,,https://www.unitedconcordia.com/docs/hcr/plan-brochure-nj-sfhfamily-premier.pdf,,97057NJ0260001-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,97057,HIOS,10,2015-01-16 17:32:32,8,97057,NJ,SHOP (Small Group),Yes,23-1661402,97057NJ0270001,Smile for Health Family C60A60,97057NJ027,,NJN001,NJS001,,New,PPO,Low,,Both,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$23.95,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,https://www.unitedconcordia.com/docs/hcr/benefits-summary-nj-sfh-family-c60a60-ppo.pdf,,https://www.unitedconcordia.com/docs/hcr/plan-brochure-nj-sfhfamily-value.pdf,,97057NJ0270001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,97057,HIOS,10,2015-01-16 17:32:32,8,97057,NJ,SHOP (Small Group),Yes,23-1661402,97057NJ0270001,Smile for Health Family C60A60,97057NJ027,,NJN001,NJS001,,New,PPO,Low,,Both,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$23.95,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,https://www.unitedconcordia.com/docs/hcr/benefits-summary-nj-sfh-family-c60a60-ppo.pdf,,https://www.unitedconcordia.com/docs/hcr/plan-brochure-nj-sfhfamily-value.pdf,,97057NJ0270001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,97057,HIOS,10,2015-01-16 17:32:32,9,97057,NJ,SHOP (Small Group),Yes,23-1661402,97057NJ0280001,Smile for Health Family C60A50,97057NJ028,,NJN001,NJS001,,New,PPO,Low,,Both,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$23.95,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,https://www.unitedconcordia.com/docs/hcr/benefits-summary-nj-sfh-family-c60a50-ppo.pdf,,https://www.unitedconcordia.com/docs/hcr/plan-brochure-nj-sfahfamily-lean.pdf,,97057NJ0280001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,97057,HIOS,10,2015-01-16 17:32:32,9,97057,NJ,SHOP (Small Group),Yes,23-1661402,97057NJ0280001,Smile for Health Family C60A50,97057NJ028,,NJN001,NJS001,,New,PPO,Low,,Both,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$23.95,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,https://www.unitedconcordia.com/docs/hcr/benefits-summary-nj-sfh-family-c60a50-ppo.pdf,,https://www.unitedconcordia.com/docs/hcr/plan-brochure-nj-sfahfamily-lean.pdf,,97057NJ0280001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,97057,HIOS,10,2015-01-16 17:32:32,10,97057,NJ,SHOP (Small Group),Yes,23-1661402,97057NJ0250001,Healthy Chompers Child,97057NJ025,,NJN001,NJS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Child-Only,,,,$26.19,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,97057NJ0250001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,97057,HIOS,10,2015-01-16 17:32:32,11,97057,NJ,SHOP (Small Group),Yes,23-1661402,97057NJ0290001,Healthy Chompers Child with Adult Preventive,97057NJ029,,NJN001,NJS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$26.19,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,97057NJ0290001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,99708,HIOS,7,2015-01-17 03:15:53,1,99708,NJ,SHOP (Small Group),Yes,22-1896118,99708NJ0130017,Delta Dental -Basic PPO Pediatric Essential Health Benefit Addendum,99708NJ013,,NJN002,NJS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$30.56,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available throughout the United States,Yes,http://www.deltadentalnj.com,http://www.deltadentalnj.com,http://www.deltadentalnj.com,,99708NJ0130017-00,Standard Low Off Exchange Plan,71.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$120,$360,,,,,$120,$360,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,99708,HIOS,7,2015-01-17 03:15:53,1,99708,NJ,Individual,Yes,22-1896118,99708NJ0120020,Delta Dental Individual-Basic PPO Pediatric Essential Health Benefit,99708NJ012,,NJN002,NJS001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$34.45,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available throughout the United States,Yes,http://www.deltadentalnj.com/products/individual_aca_2015_pedbasic.pdf,https://auth.deltadentalcoversme.com/sp/ACS.saml2,https://www.deltadentalcoversme.com/plan-options/nj-plans,,99708NJ0120020-01,Standard Low On Exchange Plan,71.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$120,$360,,,,,$120,$360,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NJ,99708,HIOS,7,2015-01-17 03:15:53,1,99708,NJ,Individual,Yes,22-1896118,99708NJ0120021,Delta Dental Individual-Enhanced PPO Pediatric Essential Health Benefit,99708NJ012,,NJN002,NJS001,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$39.68,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available throughout the United States,Yes,http://www.deltadentalnj.com/products/individual_aca_2015_pedenh.pdf,https://auth.deltadentalcoversme.com/sp/ACS.saml2,https://www.deltadentalcoversme.com/plan-options/nj-plans,,99708NJ0120021-01,Standard High On Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,$75,,,,,$25,$75,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NJ,99708,HIOS,7,2015-01-17 03:15:53,1,99708,NJ,SHOP (Small Group),Yes,22-1896118,99708NJ0130018,Delta Dental-Enhanced PPO Pediatric Essential Health Benefit Addendum,99708NJ013,,NJN002,NJS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$35.00,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available throughout the United States,Yes,http://www.deltadentalnj.com,http://www.deltadentalnj.com,http://www.deltadentalnj.com,,99708NJ0130018-00,Standard High Off Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,$75,,,,,$25,$75,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,1,29176,OK,Individual,No,39-0658730,29176OK0190001,Assurant Health Bronze Plan 001,29176OK019,,OKN001,OKS001,OKF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190001-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,1,29176,OK,Individual,No,39-0658730,29176OK0190001,Assurant Health Bronze Plan 001,29176OK019,,OKN001,OKS001,OKF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190001-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,1,29176,OK,Individual,No,39-0658730,29176OK0190001,Assurant Health Bronze Plan 001,29176OK019,,OKN001,OKS001,OKF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,12
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,2,40254,OK,SHOP (Small Group),Yes,95-6042390,40254OK0010002,BEST Life Child Dental,40254OK001,,OKN001,OKS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.85,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BEST_Life_Child_Dental_Plan.pdf,,40254OK0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,3,40254,OK,SHOP (Small Group),Yes,95-6042390,40254OK0010007,BEST Dental Premium,40254OK001,,OKN001,OKS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.62,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BESTDental_Premium_Plan.pdf,,40254OK0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,3,40254,OK,Individual,Yes,95-6042390,40254OK0020003,BESTOne Dental Advantage-Gold,40254OK002,,OKN001,OKS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.53,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BESTOne_Dental_Advantage-Gold_Plan.pdf,,40254OK0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,3,40254,OK,Individual,Yes,95-6042390,40254OK0020003,BESTOne Dental Advantage-Gold,40254OK002,,OKN001,OKS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.53,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BESTOne_Dental_Advantage-Gold_Plan.pdf,,40254OK0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,3,40254,OK,SHOP (Small Group),Yes,95-6042390,40254OK0010007,BEST Dental Premium,40254OK001,,OKN001,OKS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.62,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BESTDental_Premium_Plan.pdf,,40254OK0010007-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,3,40254,OK,SHOP (Small Group),Yes,95-6042390,40254OK0010008,BEST Dental Standard-H,40254OK001,,OKN001,OKS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.62,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BESTDental_Standard-H_Plan.pdf,,40254OK0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,3,40254,OK,Individual,Yes,95-6042390,40254OK0020004,BESTOne Dental Plus-Gold,40254OK002,,OKN001,OKS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.53,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BESTOne_Dental_Plus-Gold_Plan.pdf,,40254OK0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,3,40254,OK,Individual,Yes,95-6042390,40254OK0020004,BESTOne Dental Plus-Gold,40254OK002,,OKN001,OKS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.53,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BESTOne_Dental_Plus-Gold_Plan.pdf,,40254OK0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,3,40254,OK,SHOP (Small Group),Yes,95-6042390,40254OK0010008,BEST Dental Standard-H,40254OK001,,OKN001,OKS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.62,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BESTDental_Standard-H_Plan.pdf,,40254OK0010008-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,1,29176,OK,Individual,No,39-0658730,29176OK0190003,Assurant Health Silver Plan 001,29176OK019,,OKN001,OKS001,OKF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190003-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,1,29176,OK,Individual,No,39-0658730,29176OK0190003,Assurant Health Silver Plan 001,29176OK019,,OKN001,OKS001,OKF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190003-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,1,29176,OK,Individual,No,39-0658730,29176OK0190003,Assurant Health Silver Plan 001,29176OK019,,OKN001,OKS001,OKF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,32
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,1,29176,OK,Individual,No,39-0658730,29176OK0190003,Assurant Health Silver Plan 001,29176OK019,,OKN001,OKS001,OKF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190003-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,1,29176,OK,Individual,No,39-0658730,29176OK0190003,Assurant Health Silver Plan 001,29176OK019,,OKN001,OKS001,OKF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190003-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,1,29176,OK,Individual,No,39-0658730,29176OK0190003,Assurant Health Silver Plan 001,29176OK019,,OKN001,OKS001,OKF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190003-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,1,29176,OK,Individual,No,39-0658730,29176OK0190003,Assurant Health Silver Plan 001,29176OK019,,OKN001,OKS001,OKF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190003-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,1,29176,OK,Individual,No,39-0658730,29176OK0190004,Assurant Health Silver Plan 001,29176OK019,,OKN001,OKS002,OKF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190004-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,1,29176,OK,Individual,No,39-0658730,29176OK0190004,Assurant Health Silver Plan 001,29176OK019,,OKN001,OKS002,OKF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190004-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,1,29176,OK,Individual,No,39-0658730,29176OK0190004,Assurant Health Silver Plan 001,29176OK019,,OKN001,OKS002,OKF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190004-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,43
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190007,Assurant Health Silver Plan 002,29176OK019,,OKN001,OKS001,OKF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190007-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190007,Assurant Health Silver Plan 002,29176OK019,,OKN001,OKS001,OKF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190007-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,1,40254,OK,SHOP (Small Group),Yes,95-6042390,40254OK0010001,BEST Life Child Dental Plus,40254OK001,,OKN001,OKS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$31.62,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BEST_Life_Child_Dental_Plus_Plan.pdf,,40254OK0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,1,40254,OK,Individual,Yes,95-6042390,40254OK0020001,BESTOne Child Dental Plus,40254OK002,,OKN001,OKS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$39.53,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BESTOne_Child_Dental_Plus_Plan.pdf,,40254OK0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,2,40254,OK,Individual,Yes,95-6042390,40254OK0020002,BESTOne Child Dental,40254OK002,,OKN001,OKS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$31.07,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BESTOne_Child_Dental_Plan.pdf,,40254OK0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,45689,HIOS,6,2014-11-14 05:23:27,3,45689,OK,Individual,Yes,75-1233841,45689OK0010006,Dentegra Dental PPO Family Basic Plan,45689OK001,,OKN001,OKS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.73,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ok/45689ok0010006-15,,45689OK0010006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,45689,HIOS,6,2014-11-14 05:23:27,3,45689,OK,Individual,Yes,75-1233841,45689OK0010006,Dentegra Dental PPO Family Basic Plan,45689OK001,,OKN001,OKS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.73,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ok/45689ok0010006-15,,45689OK0010006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,45689,HIOS,6,2014-11-14 05:23:27,3,45689,OK,SHOP (Small Group),Yes,75-1233841,45689OK0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,45689OK002,,OKN001,OKS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.87,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ok/45689ok0020006-15,,45689OK0020006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,50184,HIOS,2,2014-08-07 10:00:19,1,50184,OK,SHOP (Small Group),Yes,44-0308260,50184OK0010001,KCL EHB Low PPO,50184OK001,,OKN001,OKS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$33.88,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,50184OK0010001-00,Standard Low Off Exchange Plan,71.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,50184,HIOS,2,2014-08-07 10:00:19,1,50184,OK,SHOP (Small Group),Yes,44-0308260,50184OK0010003,KCL EHB Low MAC,50184OK001,,OKN001,OKS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$25.50,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,50184OK0010003-00,Standard Low Off Exchange Plan,71.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,50184,HIOS,2,2014-08-07 10:00:19,1,50184,OK,SHOP (Small Group),Yes,44-0308260,50184OK0010005,KCL Fam Low PPO,50184OK001,,OKN001,OKS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$33.88,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,50184OK0010005-00,Standard Low Off Exchange Plan,71.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,3,29176,OK,Individual,No,39-0658730,29176OK0190005,Assurant Health Bronze Plan 002,29176OK019,,OKN001,OKS001,OKF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190005-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,3,29176,OK,Individual,No,39-0658730,29176OK0190006,Assurant Health Bronze Plan 002,29176OK019,,OKN001,OKS002,OKF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29176OK0190006-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190007,Assurant Health Silver Plan 002,29176OK019,,OKN001,OKS001,OKF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190007-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190007,Assurant Health Silver Plan 002,29176OK019,,OKN001,OKS001,OKF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190007-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190007,Assurant Health Silver Plan 002,29176OK019,,OKN001,OKS001,OKF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,12
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190007,Assurant Health Silver Plan 002,29176OK019,,OKN001,OKS001,OKF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190007-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190007,Assurant Health Silver Plan 002,29176OK019,,OKN001,OKS001,OKF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190007-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190008,Assurant Health Silver Plan 002,29176OK019,,OKN001,OKS002,OKF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190008-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190008,Assurant Health Silver Plan 002,29176OK019,,OKN001,OKS002,OKF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190008-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190008,Assurant Health Silver Plan 002,29176OK019,,OKN001,OKS002,OKF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190008-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,19
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190008,Assurant Health Silver Plan 002,29176OK019,,OKN001,OKS002,OKF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190008-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190008,Assurant Health Silver Plan 002,29176OK019,,OKN001,OKS002,OKF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190008-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190008,Assurant Health Silver Plan 002,29176OK019,,OKN001,OKS002,OKF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190008-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190008,Assurant Health Silver Plan 002,29176OK019,,OKN001,OKS002,OKF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190008-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190009,Assurant Health Gold Plan 002,29176OK019,,OKN001,OKS001,OKF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190009-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190009,Assurant Health Gold Plan 002,29176OK019,,OKN001,OKS001,OKF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190009-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190009,Assurant Health Gold Plan 002,29176OK019,,OKN001,OKS001,OKF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,38
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190009,Assurant Health Gold Plan 002,29176OK019,,OKN001,OKS001,OKF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190009-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190010,Assurant Health Gold Plan 002,29176OK019,,OKN001,OKS002,OKF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190010-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190010,Assurant Health Gold Plan 002,29176OK019,,OKN001,OKS002,OKF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190010-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190010,Assurant Health Gold Plan 002,29176OK019,,OKN001,OKS002,OKF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,42
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190010,Assurant Health Gold Plan 002,29176OK019,,OKN001,OKS002,OKF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190010-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,43
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190011,Assurant Health Platinum Plan 002,29176OK019,,OKN001,OKS001,OKF010,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190011-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,50
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190011,Assurant Health Platinum Plan 002,29176OK019,,OKN001,OKS001,OKF010,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190011-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,51
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190011,Assurant Health Platinum Plan 002,29176OK019,,OKN001,OKS001,OKF010,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,52
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190011,Assurant Health Platinum Plan 002,29176OK019,,OKN001,OKS001,OKF010,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190011-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,53
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190012,Assurant Health Platinum Plan 002,29176OK019,,OKN001,OKS002,OKF010,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190012-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,54
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190012,Assurant Health Platinum Plan 002,29176OK019,,OKN001,OKS002,OKF010,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190012-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,55
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190012,Assurant Health Platinum Plan 002,29176OK019,,OKN001,OKS002,OKF010,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,56
2015,OK,29176,HIOS,7,2014-11-11 04:41:18,5,29176,OK,Individual,No,39-0658730,29176OK0190012,Assurant Health Platinum Plan 002,29176OK019,,OKN001,OKS002,OKF010,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OK_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OK.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29176OK0190012-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,57
2015,OK,31125,HIOS,2,2014-08-07 10:00:19,1,31125,OK,SHOP (Small Group),Yes,47-0098400,31125OK0040002,EHB High PPO,31125OK004,,OKN001,OKS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.95,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,31125OK0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,31125,HIOS,2,2014-08-07 10:00:19,1,31125,OK,SHOP (Small Group),Yes,47-0098400,31125OK0040001,EHB Low PPO,31125OK004,,OKN001,OKS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$17.70,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,31125OK0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,31125,HIOS,2,2014-08-07 10:00:19,1,31125,OK,SHOP (Small Group),Yes,47-0098400,31125OK0030002,EHB High Passive,31125OK003,,OKN001,OKS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.85,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,31125OK0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OK,31125,HIOS,2,2014-08-07 10:00:19,1,31125,OK,SHOP (Small Group),Yes,47-0098400,31125OK0030001,EHB Low Passive,31125OK003,,OKN001,OKS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.77,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,31125OK0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OK,36845,HIOS,2,2014-08-07 10:00:19,1,36845,OK,SHOP (Small Group),Yes,36-0083760,36845OK0040002,EHB High PPO,36845OK004,,OKN001,OKS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.43,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,36845OK0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,36845,HIOS,2,2014-08-07 10:00:19,1,36845,OK,SHOP (Small Group),Yes,36-0083760,36845OK0040001,EHB Low PPO,36845OK004,,OKN001,OKS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$17.95,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,36845OK0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,36845,HIOS,2,2014-08-07 10:00:19,1,36845,OK,SHOP (Small Group),Yes,36-0083760,36845OK0030002,EHB High Passive,36845OK003,,OKN001,OKS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$37.37,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,36845OK0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OK,36845,HIOS,2,2014-08-07 10:00:19,1,36845,OK,SHOP (Small Group),Yes,36-0083760,36845OK0030001,EHB Low Passive,36845OK003,,OKN001,OKS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.07,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,36845OK0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,4,40254,OK,SHOP (Small Group),Yes,95-6042390,40254OK0010011,BEST Dental Choice-L,40254OK001,,OKN001,OKS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.85,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BESTDental_Choice-L_Plan.pdf,,40254OK0010011-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,4,40254,OK,Individual,Yes,95-6042390,40254OK0020006,BESTOne Dental Basic-Silver,40254OK002,,OKN001,OKS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.07,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BESTOne_Dental_Basic-Silver_Plan.pdf,,40254OK0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,4,40254,OK,Individual,Yes,95-6042390,40254OK0020006,BESTOne Dental Basic-Silver,40254OK002,,OKN001,OKS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.07,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BESTOne_Dental_Basic-Silver_Plan.pdf,,40254OK0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,4,40254,OK,SHOP (Small Group),Yes,95-6042390,40254OK0010011,BEST Dental Choice-L,40254OK001,,OKN001,OKS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.85,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BESTDental_Choice-L_Plan.pdf,,40254OK0010011-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,4,40254,OK,SHOP (Small Group),Yes,95-6042390,40254OK0010012,BEST Dental Value,40254OK001,,OKN001,OKS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.85,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BESTDental_Value_Plan.pdf,,40254OK0010012-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,OK,40254,HIOS,6,2014-10-02 12:25:15,4,40254,OK,SHOP (Small Group),Yes,95-6042390,40254OK0010012,BEST Dental Value,40254OK001,,OKN001,OKS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.85,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OK/2015/OK_BESTDental_Value_Plan.pdf,,40254OK0010012-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,OK,45689,HIOS,6,2014-11-14 05:23:27,1,45689,OK,SHOP (Small Group),Yes,75-1233841,45689OK0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,45689OK002,,OKN001,OKS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.87,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ok/45689ok0020001-15,,45689OK0020001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,45689,HIOS,6,2014-11-14 05:23:27,1,45689,OK,Individual,Yes,75-1233841,45689OK0010001,Dentegra Dental PPO Pediatric Basic Plan,45689OK001,,OKN001,OKS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$17.73,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ok/45689ok0010001-15,,45689OK0010001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,45689,HIOS,6,2014-11-14 05:23:27,1,45689,OK,Individual,Yes,75-1233841,45689OK0010001,Dentegra Dental PPO Pediatric Basic Plan,45689OK001,,OKN001,OKS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$17.73,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ok/45689ok0010001-15,,45689OK0010001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,45689,HIOS,6,2014-11-14 05:23:27,1,45689,OK,SHOP (Small Group),Yes,75-1233841,45689OK0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,45689OK002,,OKN001,OKS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.87,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ok/45689ok0020001-15,,45689OK0020001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,45689,HIOS,6,2014-11-14 05:23:27,2,45689,OK,SHOP (Small Group),Yes,75-1233841,45689OK0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,45689OK002,,OKN001,OKS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.61,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ok/45689ok0020004-15,,45689OK0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$30,Not Applicable,,,,,$30,Not Applicable,$30,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,45689,HIOS,6,2014-11-14 05:23:27,2,45689,OK,Individual,Yes,75-1233841,45689OK0010004,Dentegra Dental PPO Family Preferred Plan,45689OK001,,OKN001,OKS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.42,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ok/45689ok0010004-15,,45689OK0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$30,Not Applicable,,,,,$30,Not Applicable,$30,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,45689,HIOS,6,2014-11-14 05:23:27,2,45689,OK,Individual,Yes,75-1233841,45689OK0010004,Dentegra Dental PPO Family Preferred Plan,45689OK001,,OKN001,OKS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.42,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ok/45689ok0010004-15,,45689OK0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$30,Not Applicable,,,,,$30,Not Applicable,$30,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,45689,HIOS,6,2014-11-14 05:23:27,2,45689,OK,SHOP (Small Group),Yes,75-1233841,45689OK0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,45689OK002,,OKN001,OKS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.61,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ok/45689ok0020004-15,,45689OK0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$30,Not Applicable,,,,,$30,Not Applicable,$30,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,45689,HIOS,6,2014-11-14 05:23:27,3,45689,OK,SHOP (Small Group),Yes,75-1233841,45689OK0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,45689OK002,,OKN001,OKS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.87,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ok/45689ok0020006-15,,45689OK0020006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,50184,HIOS,2,2014-08-07 10:00:19,1,50184,OK,SHOP (Small Group),Yes,44-0308260,50184OK0010007,KCL Fam Low MAC,50184OK001,,OKN001,OKS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$25.50,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,50184OK0010007-00,Standard Low Off Exchange Plan,71.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OK,50184,HIOS,2,2014-08-07 10:00:19,2,50184,OK,SHOP (Small Group),Yes,44-0308260,50184OK0010002,KCL EHB High PPO,50184OK001,,OKN001,OKS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$40.05,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,50184OK0010002-00,Standard High Off Exchange Plan,83.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,50184,HIOS,2,2014-08-07 10:00:19,2,50184,OK,SHOP (Small Group),Yes,44-0308260,50184OK0010004,KCL EHB High MAC,50184OK001,,OKN001,OKS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$30.61,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,50184OK0010004-00,Standard High Off Exchange Plan,83.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,50184,HIOS,2,2014-08-07 10:00:19,2,50184,OK,SHOP (Small Group),Yes,44-0308260,50184OK0010006,KCL Fam High PPO,50184OK001,,OKN001,OKS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$40.05,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,50184OK0010006-00,Standard High Off Exchange Plan,83.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OK,50184,HIOS,2,2014-08-07 10:00:19,2,50184,OK,SHOP (Small Group),Yes,44-0308260,50184OK0010008,KCL Fam High MAC,50184OK001,,OKN001,OKS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$30.61,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,50184OK0010008-00,Standard High Off Exchange Plan,83.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OK,60283,HIOS,2,2014-08-06 08:27:55,1,60283,OK,SHOP (Small Group),Yes,13-5581829,60283OK0130001,EHB Basic Dental Plan (Low),60283OK013,,OKN001,OKS001,,New,PPO,Low,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$17.38,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,60283OK0130001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,61390,HIOS,4,2014-09-04 03:25:43,1,61390,OK,SHOP (Small Group),Yes,95-2371728,61390OK0020001,PPO MAC,61390OK002,,OKN001,OKS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$27.26,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Oklahoma,Yes,,,,,61390OK0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,61390,HIOS,4,2014-09-04 03:25:43,1,61390,OK,Individual,Yes,95-2371728,61390OK0010001,PPO MAC,61390OK001,,OKN001,OKS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$36.89,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Oklahoma,Yes,,,,,61390OK0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,61390,HIOS,4,2014-09-04 03:25:43,1,61390,OK,Individual,Yes,95-2371728,61390OK0010002,PPO MAC,61390OK001,,OKN001,OKS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$30.41,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Oklahoma,Yes,,,,,61390OK0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,61390,HIOS,4,2014-09-04 03:25:43,1,61390,OK,SHOP (Small Group),Yes,95-2371728,61390OK0020002,PPO MAC,61390OK002,,OKN001,OKS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$21.30,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Oklahoma,Yes,,,,,61390OK0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,61390,HIOS,4,2014-09-04 03:25:43,2,61390,OK,SHOP (Small Group),Yes,95-2371728,61390OK0020003,PPO MAC,61390OK002,,OKN001,OKS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$28.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Oklahoma,Yes,,,,,61390OK0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,61390,HIOS,4,2014-09-04 03:25:43,2,61390,OK,Individual,Yes,95-2371728,61390OK0010003,PPO MAC,61390OK001,,OKN001,OKS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$38.04,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Okalahoma,Yes,,,,,61390OK0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,61858,HIOS,1,2014-08-07 10:00:19,1,61858,OK,SHOP (Small Group),Yes,93-0242990,61858OK0040002,EHB High PPO,61858OK004,,OKN001,OKS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.53,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,61858OK0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,61858,HIOS,1,2014-08-07 10:00:19,1,61858,OK,SHOP (Small Group),Yes,93-0242990,61858OK0040001,EHB Low PPO,61858OK004,,OKN001,OKS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.00,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,61858OK0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,61858,HIOS,1,2014-08-07 10:00:19,1,61858,OK,SHOP (Small Group),Yes,93-0242990,61858OK0030002,EHB High Passive,61858OK003,,OKN001,OKS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$37.48,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,61858OK0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OK,61858,HIOS,1,2014-08-07 10:00:19,1,61858,OK,SHOP (Small Group),Yes,93-0242990,61858OK0030001,EHB Low Passive,61858OK003,,OKN001,OKS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.14,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,61858OK0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,11,85408,OK,Individual,No,26-3811422,85408OK0010015,Bronze Plan 2 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9923,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010015-00,Standard Bronze Off Exchange Plan,58.60%,0.599305033683777,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,"$4,000","$8,000","$4,000",$0,"$1,100",$200,"$4,000",$0,$300,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,11,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020011,Silver Plan 2 with Dental,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9873,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020011-00,Standard Silver Off Exchange Plan,68.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$3,700","$7,400",65%,,,,Not Applicable,Not Applicable,"$3,700","$7,400","$3,700",$0,$700,$200,"$1,300",$400,"$1,000",$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,11,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020011,Silver Plan 2 with Dental,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9873,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020011-01,Standard Silver On Exchange Plan,68.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$3,700","$7,400",65%,,,,Not Applicable,Not Applicable,"$3,700","$7,400","$3,700",$0,$700,$200,"$1,300",$400,"$1,000",$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,11,85408,OK,Individual,No,26-3811422,85408OK0010015,Bronze Plan 2 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9923,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010015-01,Standard Bronze On Exchange Plan,58.60%,0.599305033683777,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,"$4,000","$8,000","$4,000",$0,"$1,100",$200,"$4,000",$0,$300,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,11,85408,OK,Individual,No,26-3811422,85408OK0010015,Bronze Plan 2 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9923,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010015-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,11,85408,OK,Individual,No,26-3811422,85408OK0010015,Bronze Plan 2 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9923,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010015-03,Limited Cost Sharing Plan Variation,58.60%,0.599305033683777,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,"$4,000","$8,000","$4,000",$0,"$1,100",$200,"$4,000",$0,$300,$80,7
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,12,85408,OK,Individual,No,26-3811422,85408OK0010016,Bronze Plan 2,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9914,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010016-00,Standard Bronze Off Exchange Plan,58.60%,0.597958266735077,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,"$4,000","$8,000","$4,000",$0,"$1,100",$200,"$4,000",$0,$300,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,12,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020012,Silver Plan 2,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9862,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020012-00,Standard Silver Off Exchange Plan,68.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$3,700","$7,400",65%,,,,Not Applicable,Not Applicable,"$3,700","$7,400","$3,700",$0,$700,$200,"$1,300",$400,"$1,000",$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,12,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020012,Silver Plan 2,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9862,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020012-01,Standard Silver On Exchange Plan,68.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$3,700","$7,400",65%,,,,Not Applicable,Not Applicable,"$3,700","$7,400","$3,700",$0,$700,$200,"$1,300",$400,"$1,000",$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,12,85408,OK,Individual,No,26-3811422,85408OK0010016,Bronze Plan 2,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9914,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010016-01,Standard Bronze On Exchange Plan,58.60%,0.597958266735077,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,"$4,000","$8,000","$4,000",$0,"$1,100",$200,"$4,000",$0,$300,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,12,85408,OK,Individual,No,26-3811422,85408OK0010016,Bronze Plan 2,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9914,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010016-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,12,85408,OK,Individual,No,26-3811422,85408OK0010016,Bronze Plan 2,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9914,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010016-03,Limited Cost Sharing Plan Variation,58.60%,0.597958266735077,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,"$4,000","$8,000","$4,000",$0,"$1,100",$200,"$4,000",$0,$300,$80,7
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,13,85408,OK,Individual,No,26-3811422,85408OK0010017,Catastropic Plan,85408OK001,,OKN001,OKS001,OKF001,New,HMO,Catastrophic,No,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9796,,,0,0,3,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010017-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,Not Applicable,Not Applicable,"$6,600","$13,200","$6,600",$0,$0,$200,"$4,900",$0,$0,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,13,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020013,Bronze Plan 1 with Dental,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9916,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020013-00,Standard Bronze Off Exchange Plan,59.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",100%,,,,Not Applicable,Not Applicable,"$5,500","$11,000","$5,500",$100,$0,$200,"$4,800",$0,$0,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,13,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020013,Bronze Plan 1 with Dental,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9916,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020013-01,Standard Bronze On Exchange Plan,59.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",100%,,,,Not Applicable,Not Applicable,"$5,500","$11,000","$5,500",$100,$0,$200,"$4,800",$0,$0,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,13,85408,OK,Individual,No,26-3811422,85408OK0010017,Catastropic Plan,85408OK001,,OKN001,OKS001,OKF001,New,HMO,Catastrophic,No,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9796,,,0,0,3,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010017-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,Not Applicable,Not Applicable,"$6,600","$13,200","$6,600",$0,$0,$200,"$4,900",$0,$0,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,2,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020002,Platinum Plan 1,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Platinum,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9874,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020002-01,Standard Platinum On Exchange Plan,88.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,"$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,$0,$0,100%,,,,Not Applicable,Not Applicable,$0,$0,$0,$500,$0,$200,$0,$800,$300,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,2,85408,OK,Individual,No,26-3811422,85408OK0010006,Gold Plan 1,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9883,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010006-01,Standard Gold On Exchange Plan,80.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,"$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",100%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$20,$0,$200,"$1,000",$900,$40,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,2,85408,OK,Individual,No,26-3811422,85408OK0010006,Gold Plan 1,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9883,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,2,85408,OK,Individual,No,26-3811422,85408OK0010006,Gold Plan 1,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9883,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010006-03,Limited Cost Sharing Plan Variation,80.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,"$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",100%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$20,$0,$200,"$1,000",$900,$40,$80,7
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,3,85408,OK,Individual,No,26-3811422,85408OK0010007,Gold Plan 2 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9875,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010007-00,Standard Gold Off Exchange Plan,79.20%,0.812272429466248,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,"$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",75%,,,,Not Applicable,Not Applicable,"$1,500","$3,000","$1,500",$40,$0,$200,"$1,300",$200,$600,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,3,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020003,Platinum Plan 2 with Dental,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Platinum,No,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9873,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020003-00,Standard Platinum Off Exchange Plan,,0.897115230560303,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,"$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",90%,,,,Not Applicable,Not Applicable,$500,"$1,000",$500,$30,$200,$200,$500,$200,$400,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,3,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020003,Platinum Plan 2 with Dental,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Platinum,No,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9873,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020003-01,Standard Platinum On Exchange Plan,,0.897115230560303,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,"$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",90%,,,,Not Applicable,Not Applicable,$500,"$1,000",$500,$30,$200,$200,$500,$200,$400,$80,5
2015,OK,77760,HIOS,4,2014-09-05 03:32:16,1,77760,OK,Individual,Yes,23-7322578,77760OK0010003,Delta Dental PPO Plus Premier - Federally Compliant Plan,77760OK001,,OKN001,OKS001,,New,PPO,High,,Both,,,,For covered persons over the age 18 there is a 6 month wait on Type B services and 12 month wait on Type C services. MOOP only applies to covered persons age 0 through 18.,,,,,Allows Adult and Child-Only,,,,$42.74,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,all benefits that are offered on the plan,Yes,all benefits that are offered on the plan,Yes,www.deltadentalok.org/client/marketplace/SBC/Individual/Combined/High,https://auth.deltadentalcoversme.com/sp/ACS.saml2,www.deltadentalok.org/client/marketplace/Brochure/Individual,,77760OK0010003-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,77760,HIOS,4,2014-09-05 03:32:16,1,77760,OK,SHOP (Small Group),Yes,23-7322578,77760OK0020003,Delta Dental PPO Plus Premier - Federally Compliant Plan,77760OK002,,OKN002,OKS001,,New,PPO,High,,Both,,,,For covered persons over the age 18 there is a 6 month wait on Type B services and 12 month wait on Type C services. MOOP only applies to covered persons age 0 through 18.,,,,,Allows Adult and Child-Only,,,,$36.04,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,all benefits that are offered on the plan,Yes,all benefits that are offered on the plan,Yes,www.deltadentalok.org/client/marketplace/SBC/SHOP/Combined/High,,www.deltadentalok.org/client/marketplace/Brochure/SHOP,,77760OK0020003-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,77760,HIOS,4,2014-09-05 03:32:16,1,77760,OK,SHOP (Small Group),Yes,23-7322578,77760OK0020003,Delta Dental PPO Plus Premier - Federally Compliant Plan,77760OK002,,OKN002,OKS001,,New,PPO,High,,Both,,,,For covered persons over the age 18 there is a 6 month wait on Type B services and 12 month wait on Type C services. MOOP only applies to covered persons age 0 through 18.,,,,,Allows Adult and Child-Only,,,,$36.04,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,all benefits that are offered on the plan,Yes,all benefits that are offered on the plan,Yes,www.deltadentalok.org/client/marketplace/SBC/SHOP/Combined/High,,www.deltadentalok.org/client/marketplace/Brochure/SHOP,,77760OK0020003-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,77760,HIOS,4,2014-09-05 03:32:16,1,77760,OK,Individual,Yes,23-7322578,77760OK0010003,Delta Dental PPO Plus Premier - Federally Compliant Plan,77760OK001,,OKN001,OKS001,,New,PPO,High,,Both,,,,For covered persons over the age 18 there is a 6 month wait on Type B services and 12 month wait on Type C services. MOOP only applies to covered persons age 0 through 18.,,,,,Allows Adult and Child-Only,,,,$42.74,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,all benefits that are offered on the plan,Yes,all benefits that are offered on the plan,Yes,www.deltadentalok.org/client/marketplace/SBC/Individual/Combined/High,https://auth.deltadentalcoversme.com/sp/ACS.saml2,www.deltadentalok.org/client/marketplace/Brochure/Individual,,77760OK0010003-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,77760,HIOS,4,2014-09-05 03:32:16,2,77760,OK,Individual,Yes,23-7322578,77760OK0010004,Delta Dental PPO Plus Premier - Federally Compliant Plan,77760OK001,,OKN001,OKS001,,New,PPO,Low,,Both,,,,For covered persons over the age 18 there is a 6 month wait on Type B services and 12 month wait on Type C services. MOOP only applies to covered persons age 0 through 18.,,,,,Allows Adult and Child-Only,,,,$35.72,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,all benefits that are offered on the plan,Yes,all benefits that are offered on the plan,Yes,www.deltadentalok.org/client/marketplace/SBC/Individual/Combined/Low,https://auth.deltadentalcoversme.com/sp/ACS.saml2,www.deltadentalok.org/client/marketplace/Brochure/Individual,,77760OK0010004-00,Standard Low Off Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,77760,HIOS,4,2014-09-05 03:32:16,2,77760,OK,SHOP (Small Group),Yes,23-7322578,77760OK0020004,Delta Dental PPO Plus Premier - Federally Compliant Plan,77760OK002,,OKN002,OKS001,,New,PPO,Low,,Both,,,,For covered persons over the age 18 there is a 6 month wait on Type B services and 12 month wait on Type C services. MOOP only applies to covered persons age 0 through 18.,,,,,Allows Adult and Child-Only,,,,$30.72,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,all benefits that are offered on the plan,Yes,all benefits that are offered on the plan,Yes,www.deltadentalok.org/client/marketplace/SBC/SHOP/Combined/Low,,www.deltadentalok.org/client/marketplace/Brochure/SHOP,,77760OK0020004-00,Standard Low Off Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,77760,HIOS,4,2014-09-05 03:32:16,2,77760,OK,SHOP (Small Group),Yes,23-7322578,77760OK0020004,Delta Dental PPO Plus Premier - Federally Compliant Plan,77760OK002,,OKN002,OKS001,,New,PPO,Low,,Both,,,,For covered persons over the age 18 there is a 6 month wait on Type B services and 12 month wait on Type C services. MOOP only applies to covered persons age 0 through 18.,,,,,Allows Adult and Child-Only,,,,$30.72,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,all benefits that are offered on the plan,Yes,all benefits that are offered on the plan,Yes,www.deltadentalok.org/client/marketplace/SBC/SHOP/Combined/Low,,www.deltadentalok.org/client/marketplace/Brochure/SHOP,,77760OK0020004-01,Standard Low On Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,77760,HIOS,4,2014-09-05 03:32:16,2,77760,OK,Individual,Yes,23-7322578,77760OK0010004,Delta Dental PPO Plus Premier - Federally Compliant Plan,77760OK001,,OKN001,OKS001,,New,PPO,Low,,Both,,,,For covered persons over the age 18 there is a 6 month wait on Type B services and 12 month wait on Type C services. MOOP only applies to covered persons age 0 through 18.,,,,,Allows Adult and Child-Only,,,,$35.72,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,all benefits that are offered on the plan,Yes,all benefits that are offered on the plan,Yes,www.deltadentalok.org/client/marketplace/SBC/Individual/Combined/Low,https://auth.deltadentalcoversme.com/sp/ACS.saml2,www.deltadentalok.org/client/marketplace/Brochure/Individual,,77760OK0010004-01,Standard Low On Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,77760,HIOS,4,2014-09-05 03:32:16,3,77760,OK,SHOP (Small Group),Yes,23-7322578,77760OK0040003,Delta Dental PPO Plus Premier - Federally Compliant Plan,77760OK004,,OKN002,OKS001,,New,PPO,High,,Off the Exchange,,,,This plan covers children ages 0-18 only.,,,,,Allows Child-Only,,,,$36.04,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,all benefits that are offered on the plan,Yes,all benefits that are offered on the plan,Yes,www.deltadentalok.org/client/marketplace/SBC/SHOP/Pedo/High,,www.deltadentalok.org/client/marketplace/Brochure/SHOP,,77760OK0040003-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,77760,HIOS,4,2014-09-05 03:32:16,4,77760,OK,SHOP (Small Group),Yes,23-7322578,77760OK0040004,Delta Dental PPO Plus Premier - Federally Compliant Plan,77760OK004,,OKN002,OKS001,,New,PPO,Low,,Off the Exchange,,,,This plan covers children ages 0-18 only.,,,,,Allows Child-Only,,,,$30.72,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,all benefits that are offered on the plan,Yes,all benefits that are offered on the plan,Yes,www.deltadentalok.org/client/marketplace/SBC/SHOP/Pedo/Low,,www.deltadentalok.org/client/marketplace/Brochure/SHOP,,77760OK0040004-00,Standard Low Off Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,81457,HIOS,4,2014-08-23 04:11:13,1,81457,OK,SHOP (Small Group),Yes,13-5123390,81457OK0010002,Guardian Pediatric Advantage,81457OK001,,OKN001,OKS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$23.31,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,81457OK0010002-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,81457,HIOS,4,2014-08-23 04:11:13,1,81457,OK,SHOP (Small Group),Yes,13-5123390,81457OK0020002,Guardian Pediatric Essentials,81457OK002,,OKN001,OKS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$17.85,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,81457OK0020002-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,81457,HIOS,4,2014-08-23 04:11:13,2,81457,OK,SHOP (Small Group),Yes,13-5123390,81457OK0040002,Guardian Family Advantage,81457OK004,,OKN001,OKS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.31,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,81457OK0040002-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,81457,HIOS,4,2014-08-23 04:11:13,2,81457,OK,SHOP (Small Group),Yes,13-5123390,81457OK0040002,Guardian Family Advantage,81457OK004,,OKN001,OKS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.31,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,81457OK0040002-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,81457,HIOS,4,2014-08-23 04:11:13,2,81457,OK,SHOP (Small Group),Yes,13-5123390,81457OK0060002,Guardian Family Essentails,81457OK006,,OKN001,OKS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.85,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,81457OK0060002-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OK,81457,HIOS,4,2014-08-23 04:11:13,2,81457,OK,SHOP (Small Group),Yes,13-5123390,81457OK0060002,Guardian Family Essentails,81457OK006,,OKN001,OKS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.85,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,81457OK0060002-01,Standard Low On Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,1,85408,OK,Individual,No,26-3811422,85408OK0010005,Gold Plan 1 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.989,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010005-00,Standard Gold Off Exchange Plan,80.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,"$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",100%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$20,$0,$200,"$1,000",$900,$40,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,1,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020001,Platinum Plan 1 with Dental,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Platinum,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9881,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020001-00,Standard Platinum Off Exchange Plan,88.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,"$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,$0,$0,100%,,,,Not Applicable,Not Applicable,$0,$0,$0,$500,$0,$200,$0,$800,$300,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,1,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020001,Platinum Plan 1 with Dental,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Platinum,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9881,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020001-01,Standard Platinum On Exchange Plan,88.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,"$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,$0,$0,100%,,,,Not Applicable,Not Applicable,$0,$0,$0,$500,$0,$200,$0,$800,$300,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,1,85408,OK,Individual,No,26-3811422,85408OK0010005,Gold Plan 1 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.989,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010005-01,Standard Gold On Exchange Plan,80.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,"$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",100%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$20,$0,$200,"$1,000",$900,$40,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,1,85408,OK,Individual,No,26-3811422,85408OK0010005,Gold Plan 1 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.989,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010005-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,1,85408,OK,Individual,No,26-3811422,85408OK0010005,Gold Plan 1 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.989,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010005-03,Limited Cost Sharing Plan Variation,80.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,"$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",100%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$20,$0,$200,"$1,000",$900,$40,$80,7
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,2,85408,OK,Individual,No,26-3811422,85408OK0010006,Gold Plan 1,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9883,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010006-00,Standard Gold Off Exchange Plan,80.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,"$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",100%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$20,$0,$200,"$1,000",$900,$40,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,2,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020002,Platinum Plan 1,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Platinum,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9874,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020002-00,Standard Platinum Off Exchange Plan,88.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,"$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,$0,$0,100%,,,,Not Applicable,Not Applicable,$0,$0,$0,$500,$0,$200,$0,$800,$300,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,3,85408,OK,Individual,No,26-3811422,85408OK0010007,Gold Plan 2 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9875,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010007-01,Standard Gold On Exchange Plan,79.20%,0.812272429466248,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,"$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",75%,,,,Not Applicable,Not Applicable,"$1,500","$3,000","$1,500",$40,$0,$200,"$1,300",$200,$600,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,3,85408,OK,Individual,No,26-3811422,85408OK0010007,Gold Plan 2 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9875,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,3,85408,OK,Individual,No,26-3811422,85408OK0010007,Gold Plan 2 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9875,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010007-03,Limited Cost Sharing Plan Variation,79.20%,0.812272429466248,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,"$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",75%,,,,Not Applicable,Not Applicable,"$1,500","$3,000","$1,500",$40,$0,$200,"$1,300",$200,$600,$80,7
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,4,85408,OK,Individual,No,26-3811422,85408OK0010008,Gold Plan 2,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9867,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010008-00,Standard Gold Off Exchange Plan,79.20%,0.812272429466248,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,"$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",75%,,,,Not Applicable,Not Applicable,"$1,500","$3,000","$1,500",$40,$0,$200,"$1,300",$200,$600,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,4,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020004,Platinum Plan 2,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Platinum,No,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9866,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020004-00,Standard Platinum Off Exchange Plan,,0.897115230560303,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,"$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",90%,,,,Not Applicable,Not Applicable,$500,"$1,000",$500,$30,$200,$200,$500,$200,$400,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,4,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020004,Platinum Plan 2,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Platinum,No,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9866,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020004-01,Standard Platinum On Exchange Plan,,0.897115230560303,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,"$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",90%,,,,Not Applicable,Not Applicable,$500,"$1,000",$500,$30,$200,$200,$500,$200,$400,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,4,85408,OK,Individual,No,26-3811422,85408OK0010008,Gold Plan 2,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9867,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010008-01,Standard Gold On Exchange Plan,79.20%,0.812272429466248,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,"$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",75%,,,,Not Applicable,Not Applicable,"$1,500","$3,000","$1,500",$40,$0,$200,"$1,300",$200,$600,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,4,85408,OK,Individual,No,26-3811422,85408OK0010008,Gold Plan 2,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9867,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010008-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,4,85408,OK,Individual,No,26-3811422,85408OK0010008,Gold Plan 2,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9867,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010008-03,Limited Cost Sharing Plan Variation,79.20%,0.812272429466248,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,"$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",75%,,,,Not Applicable,Not Applicable,"$1,500","$3,000","$1,500",$40,$0,$200,"$1,300",$200,$600,$80,7
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,5,85408,OK,Individual,No,26-3811422,85408OK0010009,Silver Plan 1 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9895,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010009-00,Standard Silver Off Exchange Plan,69.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",100%,,,,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$70,$0,$200,"$1,300","$1,200",$0,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,6,85408,OK,Individual,No,26-3811422,85408OK0010010,Silver Plan 1,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9885,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010010-04,73% AV Level Silver Plan,72.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,"$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",100%,,,,Not Applicable,Not Applicable,"$2,000","$4,000","$2,000",$70,$0,$200,"$1,300","$1,200",$0,$80,8
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,6,85408,OK,Individual,No,26-3811422,85408OK0010010,Silver Plan 1,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9885,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010010-05,87% AV Level Silver Plan,86.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,"$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,$750,"$1,500",100%,,,,Not Applicable,Not Applicable,$750,"$1,500",$800,$50,$0,$200,$800,$700,$0,$80,9
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,6,85408,OK,Individual,No,26-3811422,85408OK0010010,Silver Plan 1,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9885,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010010-06,94% AV Level Silver Plan,93.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,$700,"$1,400",,,,,,,,,,,,,,,,,,,,,$250,$500,100%,,,,Not Applicable,Not Applicable,$250,$500,$300,$500,$0,$200,$300,$400,$30,$80,10
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,7,85408,OK,Individual,No,26-3811422,85408OK0010011,Silver Plan 2 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9884,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010011-00,Standard Silver Off Exchange Plan,68.90%,0.713768601417542,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$3,700","$7,400",65%,,,,Not Applicable,Not Applicable,"$3,700","$7,400","$3,700",$0,$700,$200,"$1,300",$400,"$1,000",$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,7,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020007,Gold Plan 2 with Dental,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9864,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020007-00,Standard Gold Off Exchange Plan,79.20%,0.802442610263824,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,"$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",75%,,,,Not Applicable,Not Applicable,"$1,500","$3,000","$1,500",$40,$10,$200,"$1,300",$200,$600,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,7,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020007,Gold Plan 2 with Dental,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9864,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020007-01,Standard Gold On Exchange Plan,79.20%,0.802442610263824,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,"$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",75%,,,,Not Applicable,Not Applicable,"$1,500","$3,000","$1,500",$40,$10,$200,"$1,300",$200,$600,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,7,85408,OK,Individual,No,26-3811422,85408OK0010011,Silver Plan 2 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9884,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010011-01,Standard Silver On Exchange Plan,68.90%,0.713768601417542,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$3,700","$7,400",65%,,,,Not Applicable,Not Applicable,"$3,700","$7,400","$3,700",$0,$700,$200,"$1,300",$400,"$1,000",$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,7,85408,OK,Individual,No,26-3811422,85408OK0010011,Silver Plan 2 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9884,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,7,85408,OK,Individual,No,26-3811422,85408OK0010011,Silver Plan 2 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9884,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010011-03,Limited Cost Sharing Plan Variation,68.90%,0.713768601417542,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$3,700","$7,400",65%,,,,Not Applicable,Not Applicable,"$3,700","$7,400","$3,700",$0,$700,$200,"$1,300",$400,"$1,000",$80,7
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,7,85408,OK,Individual,No,26-3811422,85408OK0010011,Silver Plan 2 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9884,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010011-04,73% AV Level Silver Plan,72.20%,0.741886854171753,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",65%,,,,Not Applicable,Not Applicable,"$2,000","$4,000","$2,000",$0,"$1,300",$200,"$1,300",$300,$800,$80,8
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,7,85408,OK,Individual,No,26-3811422,85408OK0010011,Silver Plan 2 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9884,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010011-05,87% AV Level Silver Plan,87.00%,0.879634976387024,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,"$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,$750,"$1,500",65%,,,,Not Applicable,Not Applicable,$750,"$1,500",$800,$0,$800,$200,$800,$100,$600,$80,9
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,7,85408,OK,Individual,No,26-3811422,85408OK0010011,Silver Plan 2 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9884,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010011-06,94% AV Level Silver Plan,93.40%,0.926068782806396,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,$750,"$1,500",,,,,,,,,,,,,,,,,,,,,$0,$0,65%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,"$1,000",$200,$0,$90,$700,$80,10
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,8,85408,OK,Individual,No,26-3811422,85408OK0010012,Silver Plan 2,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9873,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010012-00,Standard Silver Off Exchange Plan,68.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$3,700","$7,400",65%,,,,Not Applicable,Not Applicable,"$3,700","$7,400","$3,700",$0,$700,$200,"$1,300",$400,"$1,000",$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,8,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020008,Gold Plan 2,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9855,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020008-00,Standard Gold Off Exchange Plan,79.20%,0.802442610263824,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,"$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",75%,,,,Not Applicable,Not Applicable,"$1,500","$3,000","$1,500",$40,$10,$200,"$1,300",$200,$600,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,8,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020008,Gold Plan 2,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9855,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020008-01,Standard Gold On Exchange Plan,79.20%,0.802442610263824,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,"$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",75%,,,,Not Applicable,Not Applicable,"$1,500","$3,000","$1,500",$40,$10,$200,"$1,300",$200,$600,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,8,85408,OK,Individual,No,26-3811422,85408OK0010012,Silver Plan 2,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9873,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010012-01,Standard Silver On Exchange Plan,68.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$3,700","$7,400",65%,,,,Not Applicable,Not Applicable,"$3,700","$7,400","$3,700",$0,$700,$200,"$1,300",$400,"$1,000",$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,8,85408,OK,Individual,No,26-3811422,85408OK0010012,Silver Plan 2,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9873,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010012-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,8,85408,OK,Individual,No,26-3811422,85408OK0010012,Silver Plan 2,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9873,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010012-03,Limited Cost Sharing Plan Variation,68.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$3,700","$7,400",65%,,,,Not Applicable,Not Applicable,"$3,700","$7,400","$3,700",$0,$700,$200,"$1,300",$400,"$1,000",$80,7
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,8,85408,OK,Individual,No,26-3811422,85408OK0010012,Silver Plan 2,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9873,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010012-04,73% AV Level Silver Plan,72.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",65%,,,,Not Applicable,Not Applicable,"$2,000","$4,000","$2,000",$0,"$1,300",$200,"$1,300",$300,$800,$80,8
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,8,85408,OK,Individual,No,26-3811422,85408OK0010012,Silver Plan 2,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9873,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010012-05,87% AV Level Silver Plan,87.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,"$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,$750,"$1,500",65%,,,,Not Applicable,Not Applicable,$750,"$1,500",$800,$0,$800,$200,$800,$100,$600,$80,9
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,8,85408,OK,Individual,No,26-3811422,85408OK0010012,Silver Plan 2,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9873,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010012-06,94% AV Level Silver Plan,93.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,$750,"$1,500",,,,,,,,,,,,,,,,,,,,,$0,$0,65%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,"$1,000",$200,$0,$90,$700,$80,10
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,9,85408,OK,Individual,No,26-3811422,85408OK0010013,Bronze Plan 1 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9922,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010013-00,Standard Bronze Off Exchange Plan,59.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",100%,,,,Not Applicable,Not Applicable,"$5,500","$11,000","$5,500",$100,$0,$200,"$4,800",$0,$0,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,9,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020009,Silver Plan 1 with Dental,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9886,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020009-00,Standard Silver Off Exchange Plan,69.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",100%,,,,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$70,$0,$200,"$1,300","$1,200",$0,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,9,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020009,Silver Plan 1 with Dental,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9886,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020009-01,Standard Silver On Exchange Plan,69.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",100%,,,,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$70,$0,$200,"$1,300","$1,200",$0,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,9,85408,OK,Individual,No,26-3811422,85408OK0010013,Bronze Plan 1 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9922,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010013-01,Standard Bronze On Exchange Plan,59.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",100%,,,,Not Applicable,Not Applicable,"$5,500","$11,000","$5,500",$100,$0,$200,"$4,800",$0,$0,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,9,85408,OK,Individual,No,26-3811422,85408OK0010013,Bronze Plan 1 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9922,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010013-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,9,85408,OK,Individual,No,26-3811422,85408OK0010013,Bronze Plan 1 with Dental,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9922,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010013-03,Limited Cost Sharing Plan Variation,59.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",100%,,,,Not Applicable,Not Applicable,"$5,500","$11,000","$5,500",$100,$0,$200,"$4,800",$0,$0,$80,7
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,10,85408,OK,Individual,No,26-3811422,85408OK0010014,Bronze Plan 1,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9913,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010014-00,Standard Bronze Off Exchange Plan,59.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",100%,,,,Not Applicable,Not Applicable,"$5,500","$11,000","$5,500",$100,$0,$200,"$4,800",$0,$0,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,10,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020010,Silver Plan 1,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9876,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020010-00,Standard Silver Off Exchange Plan,69.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",100%,,,,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$70,$0,$200,"$1,300","$1,200",$0,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,10,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020010,Silver Plan 1,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Silver,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9876,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020010-01,Standard Silver On Exchange Plan,69.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",100%,,,,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$70,$0,$200,"$1,300","$1,200",$0,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,10,85408,OK,Individual,No,26-3811422,85408OK0010014,Bronze Plan 1,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9913,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010014-01,Standard Bronze On Exchange Plan,59.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",100%,,,,Not Applicable,Not Applicable,"$5,500","$11,000","$5,500",$100,$0,$200,"$4,800",$0,$0,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,10,85408,OK,Individual,No,26-3811422,85408OK0010014,Bronze Plan 1,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9913,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010014-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,10,85408,OK,Individual,No,26-3811422,85408OK0010014,Bronze Plan 1,85408OK001,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9913,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010014-03,Limited Cost Sharing Plan Variation,59.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",100%,,,,Not Applicable,Not Applicable,"$5,500","$11,000","$5,500",$100,$0,$200,"$4,800",$0,$0,$80,7
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,14,85408,OK,Individual,No,26-3811422,85408OK0010018,Catastropic Plan,85408OK001,,OKN001,OKS001,OKF001,New,HMO,Catastrophic,No,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9786,,,0,0,3,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010018-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,Not Applicable,Not Applicable,"$6,600","$13,200","$6,600",$0,$0,$200,"$4,900",$0,$0,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,14,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020014,Bronze Plan 1,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9907,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020014-00,Standard Bronze Off Exchange Plan,59.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",100%,,,,Not Applicable,Not Applicable,"$5,500","$11,000","$5,500",$100,$0,$200,"$4,800",$0,$0,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,14,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020014,Bronze Plan 1,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9907,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020014-01,Standard Bronze On Exchange Plan,59.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",100%,,,,Not Applicable,Not Applicable,"$5,500","$11,000","$5,500",$100,$0,$200,"$4,800",$0,$0,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,14,85408,OK,Individual,No,26-3811422,85408OK0010018,Catastropic Plan,85408OK001,,OKN001,OKS001,OKF001,New,HMO,Catastrophic,No,Both,Yes,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9786,,,0,0,3,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_ind.aspx,,http://www.globalhealth.com/plans_ffm_ind.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0010018-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,Not Applicable,Not Applicable,"$6,600","$13,200","$6,600",$0,$0,$200,"$4,900",$0,$0,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,15,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020015,Bronze Plan 2 with Dental,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9915,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020015-00,Standard Bronze Off Exchange Plan,58.60%,0.599305033683777,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,"$4,000","$8,000","$4,000",$0,"$1,100",$200,"$4,000",$0,$300,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,15,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020015,Bronze Plan 2 with Dental,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9915,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020015-01,Standard Bronze On Exchange Plan,58.60%,0.599305033683777,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,"$4,000","$8,000","$4,000",$0,"$1,100",$200,"$4,000",$0,$300,$80,5
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,16,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020016,Bronze Plan 2,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9907,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020016-00,Standard Bronze Off Exchange Plan,58.60%,0.597958266735077,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,"$4,000","$8,000","$4,000",$0,"$1,100",$200,"$4,000",$0,$300,$80,4
2015,OK,85408,HIOS,6,2014-12-10 11:54:40,16,85408,OK,SHOP (Small Group),No,26-3811422,85408OK0020016,Bronze Plan 2,85408OK002,,OKN001,OKS001,OKF001,Existing,HMO,Bronze,Yes,Both,Yes,Yes,All Specialists,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9907,,,0,0,0,2015-01-01,,No,,Yes,Urgent and Emergent only,No,http://www.globalhealth.com/plans_ffm_shop.aspx,,http://www.globalhealth.com/plans_ffm_shop.aspx,http://www.globalhealth.com/prescription_formulary.aspx,85408OK0020016-01,Standard Bronze On Exchange Plan,58.60%,0.597958266735077,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,"$4,000","$8,000","$4,000",$0,"$1,100",$200,"$4,000",$0,$300,$80,5
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330001,Blue Preferred Gold PPO? 001,87571OK033,,OKN002,OKS032,OKF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330001-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0290001,Blue Choice Gold PPO? 001,87571OK029,,OKN001,OKS001,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290001-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330016,Blue Preferred Gold PPO? 002,87571OK033,,OKN002,OKS052,OKF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330016-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320011,Blue Preferred Gold PPO? 001,87571OK032,,OKN002,OKS012,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320011-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0300003,Blue Choice Silver PPO? 003,87571OK030,,OKN001,OKS001,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0300003-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320013,Blue Preferred Gold PPO? 001,87571OK032,,OKN002,OKS052,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320013-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,42
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320013,Blue Preferred Gold PPO? 001,87571OK032,,OKN002,OKS052,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320013-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0300003,Blue Choice Silver PPO? 003,87571OK030,,OKN001,OKS001,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0300003-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320014,Blue Preferred Gold PPO? 002,87571OK032,,OKN002,OKS022,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320014-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,69
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330022,Blue Preferred Silver PPO? 004,87571OK033,,OKN002,OKS012,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330022-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,69
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350014,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS043,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350014-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,106
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350014,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS043,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,107
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320004,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS052,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320004-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,192
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320004,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS052,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320004-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,"$5,000","$15,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,193
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0290001,Blue Choice Gold PPO? 001,87571OK029,,OKN001,OKS001,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290001-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0300001,Blue Choice Gold PPO? 001,87571OK030,,OKN001,OKS001,OKF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0300001-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360008,Blue Advantage Gold PPO? 001,87571OK036,,OKN003,OKS033,OKF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360008-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350008,Blue Advantage Gold PPO? 001,87571OK035,,OKN003,OKS043,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350008-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330011,Blue Preferred Gold PPO? 001,87571OK033,,OKN002,OKS042,OKF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330011-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350001,Blue Advantage Gold PPO? 001,87571OK035,,OKN003,OKS033,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350001,Blue Advantage Gold PPO? 001,87571OK035,,OKN003,OKS033,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350001-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330011,Blue Preferred Gold PPO? 001,87571OK033,,OKN002,OKS042,OKF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330011-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360012,Blue Advantage Gold PPO? 002,87571OK036,,OKN003,OKS043,OKF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360012-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320012,Blue Preferred Gold PPO? 001,87571OK032,,OKN002,OKS042,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320012-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,38
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320015,Blue Preferred Gold PPO? 002,87571OK032,,OKN002,OKS032,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320015-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,75
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360004,Blue Advantage Silver PPO? 004,87571OK036,,OKN003,OKS023,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360004-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,75
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360017,Blue Advantage Silver PPO? 004,87571OK036,,OKN003,OKS033,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360017-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,76
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320016,Blue Preferred Gold PPO? 002,87571OK032,,OKN002,OKS042,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320016-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,76
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320016,Blue Preferred Gold PPO? 002,87571OK032,,OKN002,OKS042,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320016-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,77
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360017,Blue Advantage Silver PPO? 004,87571OK036,,OKN003,OKS033,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360017-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,77
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350015,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS053,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350015-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,112
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350015,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS053,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350015-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,113
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350008,Blue Advantage Gold PPO? 001,87571OK035,,OKN003,OKS043,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350008-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360008,Blue Advantage Gold PPO? 001,87571OK036,,OKN003,OKS033,OKF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360008-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330004,Blue Preferred Silver PPO? 004,87571OK033,,OKN002,OKS032,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330004-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,64
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320002,Blue Preferred Gold PPO? 002,87571OK032,,OKN002,OKS052,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320002-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,64
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320018,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS022,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320018-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,128
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320018,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS022,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320018-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,129
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350016,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS023,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350016-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,170
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350016,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS023,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350016-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,171
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360020,Blue Advantage Bronze PPO? 005,87571OK036,,OKN003,OKS033,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360020-00,Standard Bronze Off Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,18
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0350020,Blue Advantage Bronze PPO? 005,87571OK035,,OKN003,OKS043,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350020-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,18
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,4,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360007,Blue Advantage Silver PPO? 007,87571OK036,,OKN003,OKS023,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360007-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,4,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360026,Blue Advantage Silver PPO? 007,87571OK036,,OKN003,OKS033,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360026-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,3,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170047,CommunityCare Platinum Premier Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170047-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170047-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170047-00,Standard Platinum Off Exchange Plan,,0.906196653842926,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$20,$600,$200,$0,$600,$30,$40,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,3,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170047,CommunityCare Platinum Premier Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170047-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170047-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170047-01,Standard Platinum On Exchange Plan,,0.906196653842926,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$20,$600,$200,$0,$600,$30,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,3,98905,OK,Individual,No,73-1433979,98905OK0130016,CommunityCare Gold 1000b Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130016-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130016-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130016-03,Limited Cost Sharing Plan Variation,,0.805282592773438,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$20,$900,$200,$0,$600,$60,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,4,98905,OK,Individual,No,73-1433979,98905OK0130017,CommunityCare Silver 6000 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130017-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130017-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130017-00,Standard Silver Off Exchange Plan,69.00%,0.686589419841766,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,300",$20,$0,$200,$100,$600,$0,$40,4
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,Yes,36-1236610,87571OK0390001,BlueCare Dental? 1A,87571OK039,,OKN004,OKS004,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$42.97,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/dental/,,87571OK0390001-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),Yes,36-1236610,87571OK0400002,BlueCare Dental? 1B,87571OK040,,OKN004,OKS004,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.26,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbsok.com/coverage/individual/on-exchange/dental/,,87571OK0400002-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),Yes,36-1236610,87571OK0400006,BlueCare Dental? 1D,87571OK040,,OKN004,OKS004,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.48,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbsok.com/coverage/individual/on-exchange/dental/,,87571OK0400006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,Yes,36-1236610,87571OK0390001,BlueCare Dental? 1A,87571OK039,,OKN004,OKS004,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$42.97,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/dental/,,87571OK0390001-01,Standard High On Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0300001,Blue Choice Gold PPO? 001,87571OK030,,OKN001,OKS001,OKF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0300001-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0290001,Blue Choice Gold PPO? 001,87571OK029,,OKN001,OKS001,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290001-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0290001,Blue Choice Gold PPO? 001,87571OK029,,OKN001,OKS001,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),Yes,36-1236610,87571OK0400009,BlueCare Dental? 1G,87571OK040,,OKN004,OKS004,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.26,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbsok.com/coverage/individual/on-exchange/dental/,,87571OK0400009-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330001,Blue Preferred Gold PPO? 001,87571OK033,,OKN002,OKS032,OKF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330001-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330010,Blue Preferred Gold PPO? 001,87571OK033,,OKN002,OKS012,OKF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330010-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350001,Blue Advantage Gold PPO? 001,87571OK035,,OKN003,OKS033,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350001-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350001,Blue Advantage Gold PPO? 001,87571OK035,,OKN003,OKS033,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350001-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330010,Blue Preferred Gold PPO? 001,87571OK033,,OKN002,OKS012,OKF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330010-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330012,Blue Preferred Gold PPO? 001,87571OK033,,OKN002,OKS052,OKF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330012-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350007,Blue Advantage Gold PPO? 001,87571OK035,,OKN003,OKS023,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350007-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350007,Blue Advantage Gold PPO? 001,87571OK035,,OKN003,OKS023,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350007-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330012,Blue Preferred Gold PPO? 001,87571OK033,,OKN002,OKS052,OKF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330012-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360001,Blue Advantage Gold PPO? 001,87571OK036,,OKN003,OKS023,OKF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360001-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350007,Blue Advantage Gold PPO? 001,87571OK035,,OKN003,OKS023,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350007,Blue Advantage Gold PPO? 001,87571OK035,,OKN003,OKS023,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350007-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360001,Blue Advantage Gold PPO? 001,87571OK036,,OKN003,OKS023,OKF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360001-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360009,Blue Advantage Gold PPO? 001,87571OK036,,OKN003,OKS043,OKF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360009-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350008,Blue Advantage Gold PPO? 001,87571OK035,,OKN003,OKS043,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350008,Blue Advantage Gold PPO? 001,87571OK035,,OKN003,OKS043,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350008-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360009,Blue Advantage Gold PPO? 001,87571OK036,,OKN003,OKS043,OKF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360009-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360010,Blue Advantage Gold PPO? 001,87571OK036,,OKN003,OKS053,OKF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360010-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350009,Blue Advantage Gold PPO? 001,87571OK035,,OKN003,OKS053,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350009-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350009,Blue Advantage Gold PPO? 001,87571OK035,,OKN003,OKS053,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350009-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360010,Blue Advantage Gold PPO? 001,87571OK036,,OKN003,OKS053,OKF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360010-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0300002,Blue Choice Gold PPO? 002,87571OK030,,OKN001,OKS001,OKF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0300002-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350009,Blue Advantage Gold PPO? 001,87571OK035,,OKN003,OKS053,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350009-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350009,Blue Advantage Gold PPO? 001,87571OK035,,OKN003,OKS053,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350009-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0300002,Blue Choice Gold PPO? 002,87571OK030,,OKN001,OKS001,OKF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0300002-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330002,Blue Preferred Gold PPO? 002,87571OK033,,OKN002,OKS032,OKF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330002-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320001,Blue Preferred Gold PPO? 001,87571OK032,,OKN002,OKS032,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320001-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320001,Blue Preferred Gold PPO? 001,87571OK032,,OKN002,OKS032,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320001-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330002,Blue Preferred Gold PPO? 002,87571OK033,,OKN002,OKS032,OKF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330002-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330013,Blue Preferred Gold PPO? 002,87571OK033,,OKN002,OKS022,OKF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330013-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320001,Blue Preferred Gold PPO? 001,87571OK032,,OKN002,OKS032,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,26
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320001,Blue Preferred Gold PPO? 001,87571OK032,,OKN002,OKS032,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320001-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330013,Blue Preferred Gold PPO? 002,87571OK033,,OKN002,OKS022,OKF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330013-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330014,Blue Preferred Gold PPO? 002,87571OK033,,OKN002,OKS012,OKF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330014-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320010,Blue Preferred Gold PPO? 001,87571OK032,,OKN002,OKS022,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320010-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320010,Blue Preferred Gold PPO? 001,87571OK032,,OKN002,OKS022,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320010-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330014,Blue Preferred Gold PPO? 002,87571OK033,,OKN002,OKS012,OKF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330014-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330015,Blue Preferred Gold PPO? 002,87571OK033,,OKN002,OKS042,OKF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330015-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320010,Blue Preferred Gold PPO? 001,87571OK032,,OKN002,OKS022,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,30
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320010,Blue Preferred Gold PPO? 001,87571OK032,,OKN002,OKS022,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320010-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330015,Blue Preferred Gold PPO? 002,87571OK033,,OKN002,OKS042,OKF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330015-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320011,Blue Preferred Gold PPO? 001,87571OK032,,OKN002,OKS012,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320011-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330016,Blue Preferred Gold PPO? 002,87571OK033,,OKN002,OKS052,OKF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330016-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360002,Blue Advantage Gold PPO? 002,87571OK036,,OKN003,OKS033,OKF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360002-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320011,Blue Preferred Gold PPO? 001,87571OK032,,OKN002,OKS012,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320011-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,34
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320011,Blue Preferred Gold PPO? 001,87571OK032,,OKN002,OKS012,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320011-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360002,Blue Advantage Gold PPO? 002,87571OK036,,OKN003,OKS033,OKF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360002-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330019,Blue Preferred Silver PPO? 003,87571OK033,,OKN002,OKS042,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330019-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,50
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350002,Blue Advantage Gold PPO? 002,87571OK035,,OKN003,OKS033,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,50
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350002,Blue Advantage Gold PPO? 002,87571OK035,,OKN003,OKS033,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350002-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,51
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330019,Blue Preferred Silver PPO? 003,87571OK033,,OKN002,OKS042,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330019-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,51
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330020,Blue Preferred Silver PPO? 003,87571OK033,,OKN002,OKS052,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330020-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,52
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350010,Blue Advantage Gold PPO? 002,87571OK035,,OKN003,OKS023,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350010-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,52
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360018,Blue Advantage Silver PPO? 004,87571OK036,,OKN003,OKS043,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360018-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,78
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320016,Blue Preferred Gold PPO? 002,87571OK032,,OKN002,OKS042,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320016-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,78
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,4,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330039,Blue Preferred Silver PPO? 008,87571OK033,,OKN002,OKS042,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330039-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,4,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330040,Blue Preferred Silver PPO? 008,87571OK033,,OKN002,OKS052,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330040-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320022,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS022,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320022-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,198
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320022,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS022,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320022-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,199
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360011,Blue Advantage Gold PPO? 002,87571OK036,,OKN003,OKS023,OKF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360011-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320012,Blue Preferred Gold PPO? 001,87571OK032,,OKN002,OKS042,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320012-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320012,Blue Preferred Gold PPO? 001,87571OK032,,OKN002,OKS042,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320012-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360011,Blue Advantage Gold PPO? 002,87571OK036,,OKN003,OKS023,OKF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360011-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350011,Blue Advantage Gold PPO? 002,87571OK035,,OKN003,OKS043,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350011-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,59
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360015,Blue Advantage Silver PPO? 003,87571OK036,,OKN003,OKS043,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360015-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,59
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320003,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS052,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320003-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,120
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320003,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS052,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,121
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350004,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS033,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350004-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,164
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350004,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS033,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350004-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,"$5,000","$15,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,165
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360005,Blue Advantage Bronze PPO? 005,87571OK036,,OKN003,OKS023,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360005-00,Standard Bronze Off Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,16
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0350020,Blue Advantage Bronze PPO? 005,87571OK035,,OKN003,OKS043,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350020-00,Standard Bronze Off Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,16
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,4,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330040,Blue Preferred Silver PPO? 008,87571OK033,,OKN002,OKS052,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330040-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,4,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360007,Blue Advantage Silver PPO? 007,87571OK036,,OKN003,OKS023,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360007-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,4,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170028,CommunityCare Gold 2000a Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170028-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170028-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170028-00,Standard Gold Off Exchange Plan,,0.78261810541153,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$20,$700,$200,$0,$600,$60,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,4,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170028,CommunityCare Gold 2000a Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170028-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170028-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170028-01,Standard Gold On Exchange Plan,,0.78261810541153,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$20,$700,$200,$0,$600,$60,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,4,98905,OK,Individual,No,73-1433979,98905OK0130017,CommunityCare Silver 6000 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130017-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130017-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130017-01,Standard Silver On Exchange Plan,69.00%,0.686589419841766,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,300",$20,$0,$200,$100,$600,$0,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,4,98905,OK,Individual,No,73-1433979,98905OK0130017,CommunityCare Silver 6000 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130017-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130017-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130017-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320012,Blue Preferred Gold PPO? 001,87571OK032,,OKN002,OKS042,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320012-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360012,Blue Advantage Gold PPO? 002,87571OK036,,OKN003,OKS043,OKF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360012-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360013,Blue Advantage Gold PPO? 002,87571OK036,,OKN003,OKS053,OKF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360013-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320013,Blue Preferred Gold PPO? 001,87571OK032,,OKN002,OKS052,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320013-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320013,Blue Preferred Gold PPO? 001,87571OK032,,OKN002,OKS052,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320013-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360013,Blue Advantage Gold PPO? 002,87571OK036,,OKN003,OKS053,OKF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360013-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330003,Blue Preferred Silver PPO? 003,87571OK033,,OKN002,OKS032,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330003-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0290002,Blue Choice Gold PPO? 002,87571OK029,,OKN001,OKS001,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290002-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0290002,Blue Choice Gold PPO? 002,87571OK029,,OKN001,OKS001,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290002-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330003,Blue Preferred Silver PPO? 003,87571OK033,,OKN002,OKS032,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330003-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330017,Blue Preferred Silver PPO? 003,87571OK033,,OKN002,OKS022,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330017-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0290002,Blue Choice Gold PPO? 002,87571OK029,,OKN001,OKS001,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,46
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0290002,Blue Choice Gold PPO? 002,87571OK029,,OKN001,OKS001,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290002-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,47
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330017,Blue Preferred Silver PPO? 003,87571OK033,,OKN002,OKS022,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330017-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,47
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330018,Blue Preferred Silver PPO? 003,87571OK033,,OKN002,OKS012,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330018-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350002,Blue Advantage Gold PPO? 002,87571OK035,,OKN003,OKS033,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350002-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350002,Blue Advantage Gold PPO? 002,87571OK035,,OKN003,OKS033,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350002-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,49
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330018,Blue Preferred Silver PPO? 003,87571OK033,,OKN002,OKS012,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330018-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,49
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350010,Blue Advantage Gold PPO? 002,87571OK035,,OKN003,OKS023,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350010-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,53
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330020,Blue Preferred Silver PPO? 003,87571OK033,,OKN002,OKS052,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330020-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,53
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360003,Blue Advantage Silver PPO? 003,87571OK036,,OKN003,OKS023,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360003-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,54
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350010,Blue Advantage Gold PPO? 002,87571OK035,,OKN003,OKS023,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,54
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350010,Blue Advantage Gold PPO? 002,87571OK035,,OKN003,OKS023,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350010-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,55
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360003,Blue Advantage Silver PPO? 003,87571OK036,,OKN003,OKS023,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360003-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,55
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360014,Blue Advantage Silver PPO? 003,87571OK036,,OKN003,OKS033,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360014-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,56
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350011,Blue Advantage Gold PPO? 002,87571OK035,,OKN003,OKS043,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350011-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,56
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350011,Blue Advantage Gold PPO? 002,87571OK035,,OKN003,OKS043,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350011-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,57
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360014,Blue Advantage Silver PPO? 003,87571OK036,,OKN003,OKS033,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360014-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,57
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360015,Blue Advantage Silver PPO? 003,87571OK036,,OKN003,OKS043,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360015-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,58
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350011,Blue Advantage Gold PPO? 002,87571OK035,,OKN003,OKS043,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350011-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,58
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360016,Blue Advantage Silver PPO? 003,87571OK036,,OKN003,OKS053,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360016-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,60
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350012,Blue Advantage Gold PPO? 002,87571OK035,,OKN003,OKS053,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350012-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,60
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350012,Blue Advantage Gold PPO? 002,87571OK035,,OKN003,OKS053,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350012-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,61
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360016,Blue Advantage Silver PPO? 003,87571OK036,,OKN003,OKS053,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360016-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,61
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0300004,Blue Choice Silver PPO? 004,87571OK030,,OKN001,OKS001,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0300004-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,62
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350012,Blue Advantage Gold PPO? 002,87571OK035,,OKN003,OKS053,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350012-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,62
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350012,Blue Advantage Gold PPO? 002,87571OK035,,OKN003,OKS053,OKF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350012-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,63
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0300004,Blue Choice Silver PPO? 004,87571OK030,,OKN001,OKS001,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0300004-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,63
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320002,Blue Preferred Gold PPO? 002,87571OK032,,OKN002,OKS052,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320002-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,65
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330004,Blue Preferred Silver PPO? 004,87571OK033,,OKN002,OKS032,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330004-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,65
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330021,Blue Preferred Silver PPO? 004,87571OK033,,OKN002,OKS022,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330021-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,66
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320002,Blue Preferred Gold PPO? 002,87571OK032,,OKN002,OKS052,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,66
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320002,Blue Preferred Gold PPO? 002,87571OK032,,OKN002,OKS052,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320002-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,67
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330021,Blue Preferred Silver PPO? 004,87571OK033,,OKN002,OKS022,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330021-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,67
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330022,Blue Preferred Silver PPO? 004,87571OK033,,OKN002,OKS012,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330022-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,68
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320014,Blue Preferred Gold PPO? 002,87571OK032,,OKN002,OKS022,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320014-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,68
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330023,Blue Preferred Silver PPO? 004,87571OK033,,OKN002,OKS042,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330023-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,70
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320014,Blue Preferred Gold PPO? 002,87571OK032,,OKN002,OKS022,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,70
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320014,Blue Preferred Gold PPO? 002,87571OK032,,OKN002,OKS022,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320014-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,71
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330023,Blue Preferred Silver PPO? 004,87571OK033,,OKN002,OKS042,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330023-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,71
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330024,Blue Preferred Silver PPO? 004,87571OK033,,OKN002,OKS052,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330024-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,72
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320015,Blue Preferred Gold PPO? 002,87571OK032,,OKN002,OKS032,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320015-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,72
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320015,Blue Preferred Gold PPO? 002,87571OK032,,OKN002,OKS032,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320015-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,73
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330024,Blue Preferred Silver PPO? 004,87571OK033,,OKN002,OKS052,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330024-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,73
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360004,Blue Advantage Silver PPO? 004,87571OK036,,OKN003,OKS023,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360004-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,74
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320015,Blue Preferred Gold PPO? 002,87571OK032,,OKN002,OKS032,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,74
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320016,Blue Preferred Gold PPO? 002,87571OK032,,OKN002,OKS042,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320016-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,79
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360018,Blue Advantage Silver PPO? 004,87571OK036,,OKN003,OKS043,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360018-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,79
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360019,Blue Advantage Silver PPO? 004,87571OK036,,OKN003,OKS053,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360019-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,80
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320017,Blue Preferred Gold PPO? 002,87571OK032,,OKN002,OKS012,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320017-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,80
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320017,Blue Preferred Gold PPO? 002,87571OK032,,OKN002,OKS012,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320017-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,81
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360019,Blue Advantage Silver PPO? 004,87571OK036,,OKN003,OKS053,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360019-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,81
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320017,Blue Preferred Gold PPO? 002,87571OK032,,OKN002,OKS012,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320017-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,82
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320017,Blue Preferred Gold PPO? 002,87571OK032,,OKN002,OKS012,OKF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320017-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,83
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0290003,Blue Choice Silver PPO? 003,87571OK029,,OKN001,OKS001,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290003-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,84
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0290003,Blue Choice Silver PPO? 003,87571OK029,,OKN001,OKS001,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290003-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,85
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0290003,Blue Choice Silver PPO? 003,87571OK029,,OKN001,OKS001,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,86
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0290003,Blue Choice Silver PPO? 003,87571OK029,,OKN001,OKS001,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290003-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,87
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0290003,Blue Choice Silver PPO? 003,87571OK029,,OKN001,OKS001,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290003-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800",Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,"$10,000","$20,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,88
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0290003,Blue Choice Silver PPO? 003,87571OK029,,OKN001,OKS001,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290003-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,89
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0290003,Blue Choice Silver PPO? 003,87571OK029,,OKN001,OKS001,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290003-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$500,"$1,500",0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,90
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350003,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS033,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350003-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,91
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350003,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS033,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350003-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,92
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350003,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS033,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,93
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350003,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS033,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350003-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,94
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350003,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS033,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350003-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800",Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,"$10,000","$20,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,95
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350003,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS033,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350003-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,96
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350003,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS033,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350003-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$500,"$1,500",0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,97
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350013,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS023,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350013-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,98
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350013,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS023,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350013-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,99
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350013,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS023,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350013-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,100
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350013,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS023,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350013-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,101
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350013,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS023,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350013-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800",Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,"$10,000","$20,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,102
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350013,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS023,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350013-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,103
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350013,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS023,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350013-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$500,"$1,500",0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,104
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350014,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS043,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350014-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,105
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350014,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS043,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350014-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,108
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350014,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS043,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350014-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800",Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,"$10,000","$20,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,109
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350014,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS043,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350014-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,110
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350014,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS043,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350014-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$500,"$1,500",0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,111
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350015,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS053,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,114
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350015,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS053,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350015-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,115
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350015,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS053,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350015-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800",Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,"$10,000","$20,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,116
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350015,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS053,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350015-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,117
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350015,Blue Advantage Silver PPO? 003,87571OK035,,OKN003,OKS053,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350015-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$500,"$1,500",0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,118
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320003,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS052,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320003-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,119
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320003,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS052,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320003-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,122
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320003,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS052,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320003-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800",Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,"$10,000","$20,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,123
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320003,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS052,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320003-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,124
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320003,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS052,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320003-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$500,"$1,500",0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,125
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320018,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS022,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320018-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,126
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320018,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS022,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320018-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,127
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320018,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS022,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320018-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800",Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,"$10,000","$20,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,130
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320018,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS022,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320018-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,131
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320018,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS022,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320018-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$500,"$1,500",0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,132
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320019,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS032,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320019-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,133
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320019,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS032,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320019-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,134
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320019,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS032,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320019-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,135
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320019,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS032,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320019-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,136
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320019,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS032,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320019-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800",Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,"$10,000","$20,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,137
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320019,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS032,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320019-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,138
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320019,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS032,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320019-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$500,"$1,500",0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,139
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320020,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS042,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320020-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,140
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320020,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS042,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320020-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,141
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320020,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS042,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320020-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,142
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320020,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS042,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320020-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,143
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320020,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS042,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320020-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800",Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,"$10,000","$20,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,144
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320020,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS042,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320020-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,145
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320020,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS042,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320020-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$500,"$1,500",0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,146
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320021,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS012,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320021-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,147
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320021,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS012,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320021-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,148
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320021,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS012,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320021-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,149
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320021,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS012,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320021-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,150
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320021,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS012,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320021-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800",Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,"$10,000","$20,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,151
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320021,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS012,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320021-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,152
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320021,Blue Preferred Silver PPO? 003,87571OK032,,OKN002,OKS012,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320021-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$500,"$1,500",0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,153
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0290004,Blue Choice Silver PPO? 004,87571OK029,,OKN001,OKS001,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290004-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,154
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0290004,Blue Choice Silver PPO? 004,87571OK029,,OKN001,OKS001,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290004-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,155
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0290004,Blue Choice Silver PPO? 004,87571OK029,,OKN001,OKS001,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,156
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0290004,Blue Choice Silver PPO? 004,87571OK029,,OKN001,OKS001,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290004-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,157
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0290004,Blue Choice Silver PPO? 004,87571OK029,,OKN001,OKS001,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290004-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,"$5,000","$15,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,158
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0290004,Blue Choice Silver PPO? 004,87571OK029,,OKN001,OKS001,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290004-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,159
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330028,Blue Preferred Bronze PPO? 005,87571OK033,,OKN002,OKS052,OKF011,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330028-00,Standard Bronze Off Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,14
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0350019,Blue Advantage Bronze PPO? 005,87571OK035,,OKN003,OKS023,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350019-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,4,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170048,CommunityCare Gold 2000a Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170048-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170048-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170048-00,Standard Gold Off Exchange Plan,,0.78261810541153,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$20,$700,$200,$0,$600,$60,$40,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,4,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170048,CommunityCare Gold 2000a Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170048-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170048-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170048-01,Standard Gold On Exchange Plan,,0.78261810541153,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$20,$700,$200,$0,$600,$60,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,4,98905,OK,Individual,No,73-1433979,98905OK0130017,CommunityCare Silver 6000 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130017-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130017-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130017-03,Limited Cost Sharing Plan Variation,69.00%,0.686589419841766,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,300",$20,$0,$200,$100,$600,$0,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,4,98905,OK,Individual,No,73-1433979,98905OK0130017,CommunityCare Silver 6000 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130017-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130017-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130017-04,73% AV Level Silver Plan,73.90%,0.732050955295563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,200","$6,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,100",$20,$0,$200,$100,$600,$0,$40,8
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,4,98905,OK,Individual,No,73-1433979,98905OK0130017,CommunityCare Silver 6000 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130017-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130017-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130017-05,87% AV Level Silver Plan,87.60%,0.879097700119019,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,200","$4,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$150,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$20,$0,$200,$100,$600,$0,$40,9
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,4,98905,OK,Individual,No,73-1433979,98905OK0130017,CommunityCare Silver 6000 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130017-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130017-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130017-06,94% AV Level Silver Plan,94.50%,0.949052333831787,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$825,"$1,650",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$200,$0,$30,$0,$40,10
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,5,98905,OK,Individual,No,73-1433979,98905OK0130018,CommunityCare Silver 2000 Select,98905OK013,7003819233,OKN001,OKS001,OKF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130018-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130018-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130018-00,Standard Silver Off Exchange Plan,69.30%,0.696230530738831,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$40,"$1,100",$200,$0,"$1,200",$100,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,5,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170029,CommunityCare Gold 1000a Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170029-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170029-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170029-00,Standard Gold Off Exchange Plan,,0.785654425621033,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$20,$900,$200,$0,$600,$60,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,5,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170029,CommunityCare Gold 1000a Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170029-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170029-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170029-01,Standard Gold On Exchange Plan,,0.785654425621033,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$20,$900,$200,$0,$600,$60,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,5,98905,OK,Individual,No,73-1433979,98905OK0130018,CommunityCare Silver 2000 Select,98905OK013,7003819233,OKN001,OKS001,OKF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130018-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130018-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130018-01,Standard Silver On Exchange Plan,69.30%,0.696230530738831,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$40,"$1,100",$200,$0,"$1,200",$100,$40,5
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0290004,Blue Choice Silver PPO? 004,87571OK029,,OKN001,OKS001,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290004-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,160
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350004,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS033,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350004-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,161
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350004,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS033,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350004-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,162
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350004,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS033,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,163
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350004,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS033,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350004-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,166
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350004,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS033,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350004-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,167
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350016,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS023,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350016-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,168
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350016,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS023,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350016-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,169
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350016,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS023,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350016-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,"$5,000","$15,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,172
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350016,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS023,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350016-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,173
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350016,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS023,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350016-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,174
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350017,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS043,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350017-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,175
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350017,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS043,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350017-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,176
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350017,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS043,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350017-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,177
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350017,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS043,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350017-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,178
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350017,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS043,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350017-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,"$5,000","$15,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,179
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350017,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS043,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350017-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,180
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350017,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS043,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350017-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,181
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350018,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS053,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350018-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,182
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350018,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS053,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350018-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,183
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350018,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS053,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350018-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,184
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350018,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS053,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350018-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,185
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350018,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS053,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350018-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,"$5,000","$15,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,186
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350018,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS053,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350018-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,187
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0350018,Blue Advantage Silver PPO? 004,87571OK035,,OKN003,OKS053,OKF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350018-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,188
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320004,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS052,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320004-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,189
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320004,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS052,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320004-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,190
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320004,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS052,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,191
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320004,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS052,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320004-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,194
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320004,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS052,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320004-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,195
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320022,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS022,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320022-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,196
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320022,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS022,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320022-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,197
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320022,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS022,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320022-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,"$5,000","$15,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,200
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320022,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS022,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320022-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,201
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320022,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS022,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320022-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,202
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320023,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS032,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320023-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,203
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320023,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS032,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320023-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,204
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320023,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS032,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320023-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,205
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320023,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS032,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320023-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,206
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320023,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS032,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320023-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,"$5,000","$15,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,207
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320023,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS032,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320023-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,208
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320023,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS032,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320023-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,209
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320024,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS042,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320024-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,210
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320024,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS042,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320024-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,211
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320024,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS042,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320024-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,212
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320024,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS042,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320024-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,213
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320024,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS042,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320024-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,"$5,000","$15,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,214
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320024,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS042,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320024-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,215
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320024,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS042,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320024-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,216
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320025,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS012,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320025-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,217
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320025,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS012,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320025-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,218
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320025,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS012,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320025-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,219
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320025,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS012,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320025-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,220
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320025,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS012,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320025-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,"$5,000","$15,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,221
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320025,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS012,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320025-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,222
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,1,87571,OK,Individual,No,36-1236610,87571OK0320025,Blue Preferred Silver PPO? 004,87571OK032,,OKN002,OKS012,OKF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320025-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,223
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0290005,Blue Choice Bronze PPO? 005,87571OK029,,OKN001,OKS001,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290005-00,Standard Bronze Off Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0300005,Blue Choice Bronze PPO? 005,87571OK030,,OKN001,OKS001,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0300005-00,Standard Bronze Off Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,SHOP (Small Group),Yes,36-1236610,87571OK0400003,BlueCare Dental 4 Kids? 1A,87571OK040,,OKN004,OKS004,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$42.97,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbsok.com/coverage/individual/on-exchange/dental/,,87571OK0400003-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,Yes,36-1236610,87571OK0390003,BlueCare Dental 4 Kids? 1A,87571OK039,,OKN004,OKS004,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$42.97,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/dental/,,87571OK0390003-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,Yes,36-1236610,87571OK0390003,BlueCare Dental 4 Kids? 1A,87571OK039,,OKN004,OKS004,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$42.97,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/dental/,,87571OK0390003-01,Standard High On Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0300005,Blue Choice Bronze PPO? 005,87571OK030,,OKN001,OKS001,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0300005-01,Standard Bronze On Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0290005,Blue Choice Bronze PPO? 005,87571OK029,,OKN001,OKS001,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290005-01,Standard Bronze On Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0290005,Blue Choice Bronze PPO? 005,87571OK029,,OKN001,OKS001,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330005,Blue Preferred Bronze PPO? 005,87571OK033,,OKN002,OKS032,OKF011,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330005-00,Standard Bronze Off Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,6
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330005,Blue Preferred Bronze PPO? 005,87571OK033,,OKN002,OKS032,OKF011,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330005-01,Standard Bronze On Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0290005,Blue Choice Bronze PPO? 005,87571OK029,,OKN001,OKS001,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290005-03,Limited Cost Sharing Plan Variation,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330025,Blue Preferred Bronze PPO? 005,87571OK033,,OKN002,OKS022,OKF011,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330025-00,Standard Bronze Off Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,8
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0350005,Blue Advantage Bronze PPO? 005,87571OK035,,OKN003,OKS033,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350005-00,Standard Bronze Off Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,8
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0350005,Blue Advantage Bronze PPO? 005,87571OK035,,OKN003,OKS033,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350005-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330025,Blue Preferred Bronze PPO? 005,87571OK033,,OKN002,OKS022,OKF011,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330025-01,Standard Bronze On Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330026,Blue Preferred Bronze PPO? 005,87571OK033,,OKN002,OKS012,OKF011,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330026-00,Standard Bronze Off Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,10
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0350005,Blue Advantage Bronze PPO? 005,87571OK035,,OKN003,OKS033,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0350005,Blue Advantage Bronze PPO? 005,87571OK035,,OKN003,OKS033,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350005-03,Limited Cost Sharing Plan Variation,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,11
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330026,Blue Preferred Bronze PPO? 005,87571OK033,,OKN002,OKS012,OKF011,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330026-01,Standard Bronze On Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,11
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330027,Blue Preferred Bronze PPO? 005,87571OK033,,OKN002,OKS042,OKF011,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330027-00,Standard Bronze Off Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,12
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0350019,Blue Advantage Bronze PPO? 005,87571OK035,,OKN003,OKS023,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350019-00,Standard Bronze Off Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,12
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0350019,Blue Advantage Bronze PPO? 005,87571OK035,,OKN003,OKS023,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350019-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,13
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330027,Blue Preferred Bronze PPO? 005,87571OK033,,OKN002,OKS042,OKF011,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330027-01,Standard Bronze On Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,13
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0350019,Blue Advantage Bronze PPO? 005,87571OK035,,OKN003,OKS023,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350019-03,Limited Cost Sharing Plan Variation,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,15
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330028,Blue Preferred Bronze PPO? 005,87571OK033,,OKN002,OKS052,OKF011,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330028-01,Standard Bronze On Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,15
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0350020,Blue Advantage Bronze PPO? 005,87571OK035,,OKN003,OKS043,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350020-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,17
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360005,Blue Advantage Bronze PPO? 005,87571OK036,,OKN003,OKS023,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360005-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,17
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0350020,Blue Advantage Bronze PPO? 005,87571OK035,,OKN003,OKS043,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350020-03,Limited Cost Sharing Plan Variation,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,19
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360020,Blue Advantage Bronze PPO? 005,87571OK036,,OKN003,OKS033,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360020-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,19
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360021,Blue Advantage Bronze PPO? 005,87571OK036,,OKN003,OKS043,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360021-00,Standard Bronze Off Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,20
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0350021,Blue Advantage Bronze PPO? 005,87571OK035,,OKN003,OKS053,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350021-00,Standard Bronze Off Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,20
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0350021,Blue Advantage Bronze PPO? 005,87571OK035,,OKN003,OKS053,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350021-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,21
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360021,Blue Advantage Bronze PPO? 005,87571OK036,,OKN003,OKS043,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360021-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,21
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360022,Blue Advantage Bronze PPO? 005,87571OK036,,OKN003,OKS053,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360022-00,Standard Bronze Off Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,22
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0350021,Blue Advantage Bronze PPO? 005,87571OK035,,OKN003,OKS053,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350021-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,22
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0350021,Blue Advantage Bronze PPO? 005,87571OK035,,OKN003,OKS053,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350021-03,Limited Cost Sharing Plan Variation,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,23
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360022,Blue Advantage Bronze PPO? 005,87571OK036,,OKN003,OKS053,OKF008,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360022-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,23
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0320005,Blue Preferred Bronze PPO? 005,87571OK032,,OKN002,OKS052,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320005-00,Standard Bronze Off Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,24
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0320005,Blue Preferred Bronze PPO? 005,87571OK032,,OKN002,OKS052,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320005-01,Standard Bronze On Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,25
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0320005,Blue Preferred Bronze PPO? 005,87571OK032,,OKN002,OKS052,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,26
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0320005,Blue Preferred Bronze PPO? 005,87571OK032,,OKN002,OKS052,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320005-03,Limited Cost Sharing Plan Variation,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,27
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0320026,Blue Preferred Bronze PPO? 005,87571OK032,,OKN002,OKS022,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320026-00,Standard Bronze Off Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,28
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0320026,Blue Preferred Bronze PPO? 005,87571OK032,,OKN002,OKS022,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320026-01,Standard Bronze On Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,29
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0320026,Blue Preferred Bronze PPO? 005,87571OK032,,OKN002,OKS022,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320026-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,30
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0320026,Blue Preferred Bronze PPO? 005,87571OK032,,OKN002,OKS022,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320026-03,Limited Cost Sharing Plan Variation,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,31
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0320027,Blue Preferred Bronze PPO? 005,87571OK032,,OKN002,OKS032,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320027-00,Standard Bronze Off Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,32
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0320027,Blue Preferred Bronze PPO? 005,87571OK032,,OKN002,OKS032,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320027-01,Standard Bronze On Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,33
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0320027,Blue Preferred Bronze PPO? 005,87571OK032,,OKN002,OKS032,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320027-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,34
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0320027,Blue Preferred Bronze PPO? 005,87571OK032,,OKN002,OKS032,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320027-03,Limited Cost Sharing Plan Variation,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,35
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0320028,Blue Preferred Bronze PPO? 005,87571OK032,,OKN002,OKS042,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320028-00,Standard Bronze Off Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,36
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0320028,Blue Preferred Bronze PPO? 005,87571OK032,,OKN002,OKS042,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320028-01,Standard Bronze On Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,37
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0320028,Blue Preferred Bronze PPO? 005,87571OK032,,OKN002,OKS042,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320028-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,38
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0320028,Blue Preferred Bronze PPO? 005,87571OK032,,OKN002,OKS042,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320028-03,Limited Cost Sharing Plan Variation,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,39
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0320029,Blue Preferred Bronze PPO? 005,87571OK032,,OKN002,OKS012,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320029-00,Standard Bronze Off Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,40
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0320029,Blue Preferred Bronze PPO? 005,87571OK032,,OKN002,OKS012,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320029-01,Standard Bronze On Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,41
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0320029,Blue Preferred Bronze PPO? 005,87571OK032,,OKN002,OKS012,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320029-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,42
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,2,87571,OK,Individual,No,36-1236610,87571OK0320029,Blue Preferred Bronze PPO? 005,87571OK032,,OKN002,OKS012,OKF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320029-03,Limited Cost Sharing Plan Variation,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,43
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0300006,Blue Choice Bronze PPO? 006,87571OK030,,OKN001,OKS001,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0300006-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0350006,Blue Advantage Bronze PPO? 006,87571OK035,,OKN003,OKS033,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350006-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,Yes,36-1236610,87571OK0390002,BlueCare Dental? 1B,87571OK039,,OKN004,OKS004,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.26,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/dental/,,87571OK0390002-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,SHOP (Small Group),Yes,36-1236610,87571OK0400005,BlueCare Dental? 1C,87571OK040,,OKN004,OKS004,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$47.31,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbsok.com/coverage/individual/on-exchange/dental/,,87571OK0400005-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,SHOP (Small Group),Yes,36-1236610,87571OK0400007,BlueCare Dental? 1E,87571OK040,,OKN004,OKS004,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$48.29,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbsok.com/coverage/individual/on-exchange/dental/,,87571OK0400007-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,Yes,36-1236610,87571OK0390002,BlueCare Dental? 1B,87571OK039,,OKN004,OKS004,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.26,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/dental/,,87571OK0390002-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0350006,Blue Advantage Bronze PPO? 006,87571OK035,,OKN003,OKS033,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350006-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0300006,Blue Choice Bronze PPO? 006,87571OK030,,OKN001,OKS001,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0300006-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330006,Blue Preferred Bronze PPO? 006,87571OK033,,OKN002,OKS032,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330006-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,6
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0350006,Blue Advantage Bronze PPO? 006,87571OK035,,OKN003,OKS033,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,SHOP (Small Group),Yes,36-1236610,87571OK0400008,BlueCare Dental? 1F,87571OK040,,OKN004,OKS004,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$43.75,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbsok.com/coverage/individual/on-exchange/dental/,,87571OK0400008-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0350006,Blue Advantage Bronze PPO? 006,87571OK035,,OKN003,OKS033,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350006-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330006,Blue Preferred Bronze PPO? 006,87571OK033,,OKN002,OKS032,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330006-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330029,Blue Preferred Bronze PPO? 006,87571OK033,,OKN002,OKS022,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330029-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,8
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0350022,Blue Advantage Bronze PPO? 006,87571OK035,,OKN003,OKS023,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350022-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,8
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0350022,Blue Advantage Bronze PPO? 006,87571OK035,,OKN003,OKS023,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350022-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330029,Blue Preferred Bronze PPO? 006,87571OK033,,OKN002,OKS022,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330029-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330030,Blue Preferred Bronze PPO? 006,87571OK033,,OKN002,OKS012,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330030-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,10
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0350022,Blue Advantage Bronze PPO? 006,87571OK035,,OKN003,OKS023,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350022-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0350022,Blue Advantage Bronze PPO? 006,87571OK035,,OKN003,OKS023,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350022-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,11
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330030,Blue Preferred Bronze PPO? 006,87571OK033,,OKN002,OKS012,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330030-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,11
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330031,Blue Preferred Bronze PPO? 006,87571OK033,,OKN002,OKS042,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330031-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,12
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0350023,Blue Advantage Bronze PPO? 006,87571OK035,,OKN003,OKS043,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350023-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,12
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0350023,Blue Advantage Bronze PPO? 006,87571OK035,,OKN003,OKS043,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350023-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,13
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330031,Blue Preferred Bronze PPO? 006,87571OK033,,OKN002,OKS042,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330031-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,13
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330032,Blue Preferred Bronze PPO? 006,87571OK033,,OKN002,OKS052,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330032-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,14
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0350023,Blue Advantage Bronze PPO? 006,87571OK035,,OKN003,OKS043,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350023-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0350023,Blue Advantage Bronze PPO? 006,87571OK035,,OKN003,OKS043,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350023-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,15
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330032,Blue Preferred Bronze PPO? 006,87571OK033,,OKN002,OKS052,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330032-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,15
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360006,Blue Advantage Bronze PPO? 006,87571OK036,,OKN003,OKS023,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360006-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,16
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0350024,Blue Advantage Bronze PPO? 006,87571OK035,,OKN003,OKS053,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350024-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,16
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0350024,Blue Advantage Bronze PPO? 006,87571OK035,,OKN003,OKS053,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350024-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,17
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360006,Blue Advantage Bronze PPO? 006,87571OK036,,OKN003,OKS023,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360006-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,17
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360023,Blue Advantage Bronze PPO? 006,87571OK036,,OKN003,OKS033,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360023-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,18
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0350024,Blue Advantage Bronze PPO? 006,87571OK035,,OKN003,OKS053,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350024-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,18
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0350024,Blue Advantage Bronze PPO? 006,87571OK035,,OKN003,OKS053,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0350024-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,19
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360023,Blue Advantage Bronze PPO? 006,87571OK036,,OKN003,OKS033,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360023-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,19
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360024,Blue Advantage Bronze PPO? 006,87571OK036,,OKN003,OKS043,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360024-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,20
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320006,Blue Preferred Bronze PPO? 006,87571OK032,,OKN002,OKS052,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320006-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,20
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320006,Blue Preferred Bronze PPO? 006,87571OK032,,OKN002,OKS052,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320006-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,21
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360024,Blue Advantage Bronze PPO? 006,87571OK036,,OKN003,OKS043,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360024-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,21
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320041,Blue Preferred Security PPO? 008,87571OK032,,OKN002,OKS052,OKF003,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320041-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,50
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320041,Blue Preferred Security PPO? 008,87571OK032,,OKN002,OKS052,OKF003,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320041-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,51
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0290006,Blue Choice Bronze PPO? 006,87571OK029,,OKN001,OKS001,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290006-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,52
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0290006,Blue Choice Bronze PPO? 006,87571OK029,,OKN001,OKS001,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290006-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,53
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,1,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170025,CommunityCare Platinum 250 Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170025-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170025-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170025-00,Standard Platinum Off Exchange Plan,,0.884413778781891,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$200,$0,$200,$0,$600,$0,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,1,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170025,CommunityCare Platinum 250 Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170025-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170025-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170025-01,Standard Platinum On Exchange Plan,,0.884413778781891,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$200,$0,$200,$0,$600,$0,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,1,98905,OK,Individual,No,73-1433979,98905OK0130014,CommnityCare Gold 2000a Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130014-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130014-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130014-01,Standard Gold On Exchange Plan,,0.78261810541153,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$20,$700,$200,$0,$600,$60,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,1,98905,OK,Individual,No,73-1433979,98905OK0130014,CommnityCare Gold 2000a Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130014-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130014-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,1,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170045,CommunityCare Platinum 250 Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170045-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170045-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170045-00,Standard Platinum Off Exchange Plan,,0.884413778781891,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$200,$0,$200,$0,$600,$0,$40,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,1,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170045,CommunityCare Platinum 250 Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170045-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170045-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170045-01,Standard Platinum On Exchange Plan,,0.884413778781891,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$200,$0,$200,$0,$600,$0,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,1,98905,OK,Individual,No,73-1433979,98905OK0130014,CommnityCare Gold 2000a Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130014-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130014-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130014-03,Limited Cost Sharing Plan Variation,,0.78261810541153,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$20,$700,$200,$0,$600,$60,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,2,98905,OK,Individual,No,73-1433979,98905OK0130015,CommunityCare Gold 1500b Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130015-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130015-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130015-00,Standard Gold Off Exchange Plan,,0.803876519203186,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400",$20,$400,$200,$0,$500,$30,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,2,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170026,CommunityCare Platinum 750 Select,98905OK017,7003819233,OKN001,OKS001,OKF002,New,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170026-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170026-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170026-00,Standard Platinum Off Exchange Plan,,0.89422881603241,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$400,$0,$200,$0,$600,$0,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,2,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170026,CommunityCare Platinum 750 Select,98905OK017,7003819233,OKN001,OKS001,OKF002,New,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170026-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170026-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170026-01,Standard Platinum On Exchange Plan,,0.89422881603241,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$400,$0,$200,$0,$600,$0,$40,5
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360025,Blue Advantage Bronze PPO? 006,87571OK036,,OKN003,OKS053,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360025-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,22
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320006,Blue Preferred Bronze PPO? 006,87571OK032,,OKN002,OKS052,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,22
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320006,Blue Preferred Bronze PPO? 006,87571OK032,,OKN002,OKS052,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320006-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,23
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360025,Blue Advantage Bronze PPO? 006,87571OK036,,OKN003,OKS053,OKF007,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360025-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,23
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,4,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330037,Blue Preferred Silver PPO? 008,87571OK033,,OKN002,OKS022,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330037-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,4,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330038,Blue Preferred Silver PPO? 008,87571OK033,,OKN002,OKS012,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330038-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,3,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170027,CommunityCare Platinum Premier Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170027-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170027-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170027-00,Standard Platinum Off Exchange Plan,,0.906196653842926,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$20,$600,$200,$0,$600,$30,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,3,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170027,CommunityCare Platinum Premier Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170027-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170027-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170027-01,Standard Platinum On Exchange Plan,,0.906196653842926,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$20,$600,$200,$0,$600,$30,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,3,98905,OK,Individual,No,73-1433979,98905OK0130016,CommunityCare Gold 1000b Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130016-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130016-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130016-01,Standard Gold On Exchange Plan,,0.805282592773438,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$20,$900,$200,$0,$600,$60,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,3,98905,OK,Individual,No,73-1433979,98905OK0130016,CommunityCare Gold 1000b Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130016-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130016-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,5,98905,OK,Individual,No,73-1433979,98905OK0130018,CommunityCare Silver 2000 Select,98905OK013,7003819233,OKN001,OKS001,OKF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130018-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130018-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130018-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,5,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170049,CommunityCare Gold 1000a Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170049-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170049-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170049-00,Standard Gold Off Exchange Plan,,0.785654425621033,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$20,$900,$200,$0,$600,$60,$40,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,5,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170049,CommunityCare Gold 1000a Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170049-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170049-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170049-01,Standard Gold On Exchange Plan,,0.785654425621033,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$20,$900,$200,$0,$600,$60,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,5,98905,OK,Individual,No,73-1433979,98905OK0130018,CommunityCare Silver 2000 Select,98905OK013,7003819233,OKN001,OKS001,OKF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130018-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130018-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130018-03,Limited Cost Sharing Plan Variation,69.30%,0.696230530738831,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$40,"$1,100",$200,$0,"$1,200",$100,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,5,98905,OK,Individual,No,73-1433979,98905OK0130018,CommunityCare Silver 2000 Select,98905OK013,7003819233,OKN001,OKS001,OKF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130018-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130018-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130018-04,73% AV Level Silver Plan,73.80%,0.741303503513336,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,100","$2,200",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$30,"$1,400",$200,$0,$900,$100,$40,8
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,5,98905,OK,Individual,No,73-1433979,98905OK0130018,CommunityCare Silver 2000 Select,98905OK013,7003819233,OKN001,OKS001,OKF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130018-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130018-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130018-05,87% AV Level Silver Plan,87.90%,0.878646552562714,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$600,$20,"$1,100",$200,$0,$600,$60,$40,9
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,5,98905,OK,Individual,No,73-1433979,98905OK0130018,CommunityCare Silver 2000 Select,98905OK013,7003819233,OKN001,OKS001,OKF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130018-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130018-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130018-06,94% AV Level Silver Plan,95.00%,0.949579298496246,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$600,$200,$0,$30,$30,$40,10
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,6,98905,OK,Individual,No,73-1433979,98905OK0130019,CommunityCare Silver 4500 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130019-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130019-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130019-00,Standard Silver Off Exchange Plan,70.10%,0.69333952665329,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,400",$20,$0,$200,$100,$600,$0,$40,4
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320030,Blue Preferred Bronze PPO? 006,87571OK032,,OKN002,OKS022,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320030-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,24
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320030,Blue Preferred Bronze PPO? 006,87571OK032,,OKN002,OKS022,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320030-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,25
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320030,Blue Preferred Bronze PPO? 006,87571OK032,,OKN002,OKS022,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320030-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,26
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320030,Blue Preferred Bronze PPO? 006,87571OK032,,OKN002,OKS022,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320030-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,27
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320031,Blue Preferred Bronze PPO? 006,87571OK032,,OKN002,OKS032,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320031-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,28
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320031,Blue Preferred Bronze PPO? 006,87571OK032,,OKN002,OKS032,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320031-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,29
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320031,Blue Preferred Bronze PPO? 006,87571OK032,,OKN002,OKS032,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320031-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,30
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320031,Blue Preferred Bronze PPO? 006,87571OK032,,OKN002,OKS032,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320031-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,31
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320032,Blue Preferred Bronze PPO? 006,87571OK032,,OKN002,OKS042,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320032-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,32
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320032,Blue Preferred Bronze PPO? 006,87571OK032,,OKN002,OKS042,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320032-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,33
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320032,Blue Preferred Bronze PPO? 006,87571OK032,,OKN002,OKS042,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320032-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,34
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320032,Blue Preferred Bronze PPO? 006,87571OK032,,OKN002,OKS042,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320032-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,35
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320033,Blue Preferred Bronze PPO? 006,87571OK032,,OKN002,OKS012,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320033-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,36
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320033,Blue Preferred Bronze PPO? 006,87571OK032,,OKN002,OKS012,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320033-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,37
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320033,Blue Preferred Bronze PPO? 006,87571OK032,,OKN002,OKS012,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320033-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,38
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320033,Blue Preferred Bronze PPO? 006,87571OK032,,OKN002,OKS012,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320033-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,39
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0290010,Blue Security Choice PPO? 010,87571OK029,,OKN001,OKS001,OKF003,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290010-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,40
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0290010,Blue Security Choice PPO? 010,87571OK029,,OKN001,OKS001,OKF003,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290010-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,41
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320008,Blue Preferred Security PPO? 008,87571OK032,,OKN002,OKS012,OKF003,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320008-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,42
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320008,Blue Preferred Security PPO? 008,87571OK032,,OKN002,OKS012,OKF003,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320008-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,43
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320038,Blue Preferred Security PPO? 008,87571OK032,,OKN002,OKS022,OKF003,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320038-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,44
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320038,Blue Preferred Security PPO? 008,87571OK032,,OKN002,OKS022,OKF003,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320038-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,45
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320039,Blue Preferred Security PPO? 008,87571OK032,,OKN002,OKS032,OKF003,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320039-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,46
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320039,Blue Preferred Security PPO? 008,87571OK032,,OKN002,OKS032,OKF003,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320039-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,47
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320040,Blue Preferred Security PPO? 008,87571OK032,,OKN002,OKS042,OKF003,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320040-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,48
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0320040,Blue Preferred Security PPO? 008,87571OK032,,OKN002,OKS042,OKF003,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0320040-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,49
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0290006,Blue Choice Bronze PPO? 006,87571OK029,,OKN001,OKS001,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,54
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,3,87571,OK,Individual,No,36-1236610,87571OK0290006,Blue Choice Bronze PPO? 006,87571OK029,,OKN001,OKS001,OKF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0290006-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,55
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,4,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0300016,Blue Choice Silver PPO? 016,87571OK030,,OKN001,OKS001,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0300016-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,4,87571,OK,SHOP (Small Group),Yes,36-1236610,87571OK0400001,BlueCare Dental? 1A,87571OK040,,OKN004,OKS004,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$42.97,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbsok.com/coverage/individual/on-exchange/dental/,,87571OK0400001-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,4,87571,OK,Individual,Yes,36-1236610,87571OK0390004,BlueCare Dental 4 Kids? 1B,87571OK039,,OKN004,OKS004,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$33.26,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/dental/,,87571OK0390004-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,4,87571,OK,Individual,Yes,36-1236610,87571OK0390004,BlueCare Dental 4 Kids? 1B,87571OK039,,OKN004,OKS004,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$33.26,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/dental/,,87571OK0390004-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,4,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0300016,Blue Choice Silver PPO? 016,87571OK030,,OKN001,OKS001,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0300016-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,4,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330008,Blue Preferred Silver PPO? 008,87571OK033,,OKN002,OKS032,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330008-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,4,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330008,Blue Preferred Silver PPO? 008,87571OK033,,OKN002,OKS032,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330008-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,4,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330037,Blue Preferred Silver PPO? 008,87571OK033,,OKN002,OKS022,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330037-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,4,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330038,Blue Preferred Silver PPO? 008,87571OK033,,OKN002,OKS012,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330038-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,4,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0330039,Blue Preferred Silver PPO? 008,87571OK033,,OKN002,OKS042,OKF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0330039-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,4,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360026,Blue Advantage Silver PPO? 007,87571OK036,,OKN003,OKS033,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360026-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,4,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360027,Blue Advantage Silver PPO? 007,87571OK036,,OKN003,OKS043,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360027-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,4,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360027,Blue Advantage Silver PPO? 007,87571OK036,,OKN003,OKS043,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360027-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,4,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360028,Blue Advantage Silver PPO? 007,87571OK036,,OKN003,OKS053,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360028-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,4,87571,OK,SHOP (Small Group),No,36-1236610,87571OK0360028,Blue Advantage Silver PPO? 007,87571OK036,,OKN003,OKS053,OKF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/employer/products/on-exchange/,,http://www.bcbsok.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,87571OK0360028-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,OK,87571,HIOS,11,2015-02-19 06:21:02,5,87571,OK,SHOP (Small Group),Yes,36-1236610,87571OK0400004,BlueCare Dental 4 Kids? 1B,87571OK040,,OKN004,OKS004,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.26,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbsok.com/coverage/individual/on-exchange/dental/,,87571OK0400004-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,1,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090004,CommunityCare PPO Platinum 500 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090004-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090004-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090004-00,Standard Platinum Off Exchange Plan,,0.881763339042664,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,"$1,000",$200,$0,$500,$60,$40,4
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,1,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090004,CommunityCare PPO Platinum 500 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090004-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090004-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090004-01,Standard Platinum On Exchange Plan,,0.881763339042664,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,"$1,000",$200,$0,$500,$60,$40,5
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,2,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090005,CommunityCare PPO Gold 2500 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090005-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090005-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090005-00,Standard Gold Off Exchange Plan,,0.784450769424438,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$3,400",$20,$600,$200,$0,$600,$60,$40,4
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,2,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090005,CommunityCare PPO Gold 2500 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090005-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090005-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090005-01,Standard Gold On Exchange Plan,,0.784450769424438,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$3,400",$20,$600,$200,$0,$600,$60,$40,5
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,3,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090006,CommunityCare PPO Gold 2000 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090006-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090006-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090006-00,Standard Gold Off Exchange Plan,,0.796301662921906,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,900",$20,"$1,100",$200,$0,$600,$100,$40,4
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,3,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090006,CommunityCare PPO Gold 2000 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090006-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090006-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090006-01,Standard Gold On Exchange Plan,,0.796301662921906,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,900",$20,"$1,100",$200,$0,$600,$100,$40,5
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,4,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090007,CommunityCare PPO Gold1500 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090007-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090007-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090007-00,Standard Gold Off Exchange Plan,,0.802147209644318,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$2,400",$20,"$1,300",$200,$0,$500,$100,$40,4
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,4,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090007,CommunityCare PPO Gold1500 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090007-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090007-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090007-01,Standard Gold On Exchange Plan,,0.802147209644318,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$2,400",$20,"$1,300",$200,$0,$500,$100,$40,5
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,5,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090008,CommunityCare PPO Gold 1000 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090008-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090008-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090008-00,Standard Gold Off Exchange Plan,,0.817556083202362,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,900",$20,"$1,400",$200,$0,$600,$100,$40,4
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,5,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090008,CommunityCare PPO Gold 1000 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090008-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090008-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090008-01,Standard Gold On Exchange Plan,,0.817556083202362,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,900",$20,"$1,400",$200,$0,$600,$100,$40,5
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,6,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090009,CommunityCare PPO Gold 900 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090009-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090009-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090009-00,Standard Gold Off Exchange Plan,,0.818424999713898,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$900,"$1,800",25%,,,,"$2,700","$5,400",Not Applicable,Not Applicable,$0,$20,"$1,400",$200,$0,$600,$80,$40,4
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,6,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090009,CommunityCare PPO Gold 900 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090009-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090009-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090009-01,Standard Gold On Exchange Plan,,0.818424999713898,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$900,"$1,800",25%,,,,"$2,700","$5,400",Not Applicable,Not Applicable,$0,$20,"$1,400",$200,$0,$600,$80,$40,5
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,7,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090010,CommunityCare PPO Silver 5000 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090010-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090010-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090010-00,Standard Silver Off Exchange Plan,,0.709163784980774,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",45%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,900",$20,$400,$200,$0,$600,$200,$40,4
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,7,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090010,CommunityCare PPO Silver 5000 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090010-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090010-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090010-01,Standard Silver On Exchange Plan,,0.709163784980774,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",45%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,900",$20,$400,$200,$0,$600,$200,$40,5
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,8,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090011,CommunityCare PPO Silver 4000 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090011-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090011-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090011-00,Standard Silver Off Exchange Plan,,0.714181065559387,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,900",$20,$300,$200,$0,$600,$60,$40,4
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,8,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090011,CommunityCare PPO Silver 4000 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090011-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090011-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090011-01,Standard Silver On Exchange Plan,,0.714181065559387,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,900",$20,$300,$200,$0,$600,$60,$40,5
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,9,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090012,CommunityCare PPO Silver 3500 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,No,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090012-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090012-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090012-00,Standard Silver Off Exchange Plan,,0.71781599521637,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,"$4,400",$20,$700,$200,$0,$600,$100,$40,4
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,9,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090012,CommunityCare PPO Silver 3500 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,No,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090012-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090012-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090012-01,Standard Silver On Exchange Plan,,0.71781599521637,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,"$4,400",$20,$700,$200,$0,$600,$100,$40,5
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,10,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090013,CommunityCare PPO Silver 6000 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090013-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090013-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090013-00,Standard Silver Off Exchange Plan,69.00%,0.719771385192871,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,600",$20,$0,$200,$0,$600,$0,$40,4
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,10,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090013,CommunityCare PPO Silver 6000 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090013-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090013-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090013-01,Standard Silver On Exchange Plan,69.00%,0.719771385192871,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,600",$20,$0,$200,$0,$600,$0,$40,5
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,11,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090014,CommunityCare PPO Bronze 6000 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090014-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090014-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090014-00,Standard Bronze Off Exchange Plan,,0.583025097846985,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,900",$20,$0,$200,"$4,800",$0,$0,$40,4
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,11,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090014,CommunityCare PPO Bronze 6000 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090014-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090014-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090014-01,Standard Bronze On Exchange Plan,,0.583025097846985,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,900",$20,$0,$200,"$4,800",$0,$0,$40,5
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,12,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090015,CommunityCare PPO Bronze 5000 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090015-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090015-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090015-00,Standard Bronze Off Exchange Plan,,0.587134599685669,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,900",$20,$400,$200,"$4,800",$0,$0,$40,4
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,12,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090015,CommunityCare PPO Bronze 5000 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090015-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090015-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090015-01,Standard Bronze On Exchange Plan,,0.587134599685669,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,900",$20,$400,$200,"$4,800",$0,$0,$40,5
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,13,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090016,CommunityCare PPO Bronze 4000 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090016-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090016-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090016-00,Standard Bronze Off Exchange Plan,,0.60355931520462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,900",$20,$700,$200,"$4,000",$100,$20,$40,4
2015,OK,87698,HIOS,4,2014-11-11 04:41:18,13,87698,OK,SHOP (Small Group),No,73-1580741,87698OK0090016,CommunityCare PPO Bronze 4000 Select,87698OK009,7912900140,OKN001,OKS001,OKF001,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,All Covered Services,Yes,All Covered Services,Yes,http://marketplace.ccok.com?plan=201587698OK0090016-01&type=sbc,,http://marketplace.ccok.com?plan=201587698OK0090016-01,http://marketplace.ccok.com?rxFormulary=2,87698OK0090016-01,Standard Bronze On Exchange Plan,,0.60355931520462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,900",$20,$700,$200,"$4,000",$100,$20,$40,5
2015,OK,89953,HIOS,4,2014-10-03 13:54:42,1,89953,OK,SHOP (Small Group),Yes,81-0170040,89953OK0010001,Assurant Dental ACAFFO High,89953OK001,,OKN001,OKS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$38.15,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same Coverage as in Service Area,Yes,,,,,89953OK0010001-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,89953,HIOS,4,2014-10-03 13:54:42,2,89953,OK,SHOP (Small Group),Yes,81-0170040,89953OK0010002,Assurant Dental ACAFFO Low,89953OK001,,OKN001,OKS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.89,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same Coverage as in Service Area,Yes,,,,,89953OK0010002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,91848,HIOS,4,2014-09-04 03:25:43,1,91848,OK,SHOP (Small Group),Yes,35-0472300,91848OK0010001,Lincoln Dental Connect?,91848OK001,,OKN001,OKS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.06,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,91848OK0010001-00,Standard High Off Exchange Plan,84.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,91848,HIOS,4,2014-09-04 03:25:43,1,91848,OK,SHOP (Small Group),Yes,35-0472300,91848OK0010002,Lincoln Dental Connect?,91848OK001,,OKN001,OKS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.49,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,91848OK0010002-00,Standard Low Off Exchange Plan,69.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,91848,HIOS,4,2014-09-04 03:25:43,1,91848,OK,SHOP (Small Group),Yes,35-0472300,91848OK0010003,Lincoln Dental Connect?,91848OK001,,OKN001,OKS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.43,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,91848OK0010003-00,Standard Low Off Exchange Plan,69.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OK,91848,HIOS,4,2014-09-04 03:25:43,1,91848,OK,SHOP (Small Group),Yes,35-0472300,91848OK0010005,Lincoln Dental Connect?,91848OK001,,OKN001,OKS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.64,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,91848OK0010005-00,Standard High Off Exchange Plan,84.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OK,91848,HIOS,4,2014-09-04 03:25:43,1,91848,OK,SHOP (Small Group),Yes,35-0472300,91848OK0010006,Lincoln Dental Connect?,91848OK001,,OKN001,OKS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.89,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,91848OK0010006-00,Standard Low Off Exchange Plan,69.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,OK,91848,HIOS,4,2014-09-04 03:25:43,1,91848,OK,SHOP (Small Group),Yes,35-0472300,91848OK0010007,Lincoln Dental Connect?,91848OK001,,OKN001,OKS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.01,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,91848OK0010007-00,Standard Low Off Exchange Plan,69.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,OK,91848,HIOS,4,2014-09-04 03:25:43,2,91848,OK,SHOP (Small Group),Yes,35-0472300,91848OK0010004,Lincoln Dental Connect?,91848OK001,,OKN001,OKS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.91,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,91848OK0010004-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OK,91848,HIOS,4,2014-09-04 03:25:43,2,91848,OK,SHOP (Small Group),Yes,35-0472300,91848OK0010008,Lincoln Dental Connect?,91848OK001,,OKN001,OKS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.32,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,91848OK0010008-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,1,98905,OK,Individual,No,73-1433979,98905OK0130014,CommnityCare Gold 2000a Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130014-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130014-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130014-00,Standard Gold Off Exchange Plan,,0.78261810541153,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$20,$700,$200,$0,$600,$60,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,2,98905,OK,Individual,No,73-1433979,98905OK0130015,CommunityCare Gold 1500b Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130015-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130015-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130015-01,Standard Gold On Exchange Plan,,0.803876519203186,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400",$20,$400,$200,$0,$500,$30,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,2,98905,OK,Individual,No,73-1433979,98905OK0130015,CommunityCare Gold 1500b Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130015-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130015-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130015-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,2,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170046,CommunityCare Platinum 750 Classic,98905OK017,7003819233,OKN002,OKS002,OKF002,New,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170046-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170046-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170046-00,Standard Platinum Off Exchange Plan,,0.89422881603241,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$400,$0,$200,$0,$600,$0,$40,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,2,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170046,CommunityCare Platinum 750 Classic,98905OK017,7003819233,OKN002,OKS002,OKF002,New,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170046-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170046-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170046-01,Standard Platinum On Exchange Plan,,0.89422881603241,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$400,$0,$200,$0,$600,$0,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,2,98905,OK,Individual,No,73-1433979,98905OK0130015,CommunityCare Gold 1500b Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130015-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130015-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130015-03,Limited Cost Sharing Plan Variation,,0.803876519203186,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400",$20,$400,$200,$0,$500,$30,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,3,98905,OK,Individual,No,73-1433979,98905OK0130016,CommunityCare Gold 1000b Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130016-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130016-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130016-00,Standard Gold Off Exchange Plan,,0.805282592773438,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$20,$900,$200,$0,$600,$60,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,6,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170030,CommunityCare Gold 1500a Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170030-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170030-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170030-00,Standard Gold Off Exchange Plan,,0.789964079856873,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400",$20,$800,$200,$0,$600,$0,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,6,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170030,CommunityCare Gold 1500a Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170030-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170030-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170030-01,Standard Gold On Exchange Plan,,0.789964079856873,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400",$20,$800,$200,$0,$600,$0,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,6,98905,OK,Individual,No,73-1433979,98905OK0130019,CommunityCare Silver 4500 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130019-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130019-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130019-01,Standard Silver On Exchange Plan,70.10%,0.69333952665329,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,400",$20,$0,$200,$100,$600,$0,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,6,98905,OK,Individual,No,73-1433979,98905OK0130019,CommunityCare Silver 4500 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130019-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130019-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130019-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,6,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170050,CommunityCare Gold 1500a Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170050-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170050-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170050-00,Standard Gold Off Exchange Plan,,0.789964079856873,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400",$20,$800,$200,$0,$600,$0,$40,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,6,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170050,CommunityCare Gold 1500a Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170050-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170050-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170050-01,Standard Gold On Exchange Plan,,0.789964079856873,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400",$20,$800,$200,$0,$600,$0,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,6,98905,OK,Individual,No,73-1433979,98905OK0130019,CommunityCare Silver 4500 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130019-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130019-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130019-03,Limited Cost Sharing Plan Variation,70.10%,0.69333952665329,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,400",$20,$0,$200,$100,$600,$0,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,6,98905,OK,Individual,No,73-1433979,98905OK0130019,CommunityCare Silver 4500 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130019-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130019-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130019-04,73% AV Level Silver Plan,73.90%,0.731995403766632,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,050","$6,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,$0,$200,$100,$600,$0,$40,8
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,6,98905,OK,Individual,No,73-1433979,98905OK0130019,CommunityCare Silver 4500 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130019-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130019-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130019-05,87% AV Level Silver Plan,87.60%,0.87736302614212,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$20,$0,$200,$100,$600,$0,$40,9
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,6,98905,OK,Individual,No,73-1433979,98905OK0130019,CommunityCare Silver 4500 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130019-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130019-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130019-06,94% AV Level Silver Plan,94.10%,0.945336163043976,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$850,"$1,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$200,$0,$30,$0,$40,10
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,7,98905,OK,Individual,No,73-1433979,98905OK0130020,CommunityCare Silver 4000 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130020-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130020-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130020-00,Standard Silver Off Exchange Plan,,0.71066278219223,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,900",$20,$300,$200,$0,$600,$60,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,7,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170031,CommunityCare Gold 1500b Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170031-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170031-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170031-00,Standard Gold Off Exchange Plan,,0.803876519203186,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400",$20,$400,$200,$0,$500,$30,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,7,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170031,CommunityCare Gold 1500b Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170031-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170031-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170031-01,Standard Gold On Exchange Plan,,0.803876519203186,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400",$20,$400,$200,$0,$500,$30,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,7,98905,OK,Individual,No,73-1433979,98905OK0130020,CommunityCare Silver 4000 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130020-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130020-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130020-01,Standard Silver On Exchange Plan,,0.71066278219223,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,900",$20,$300,$200,$0,$600,$60,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,7,98905,OK,Individual,No,73-1433979,98905OK0130020,CommunityCare Silver 4000 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130020-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130020-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130020-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,7,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170051,CommunityCare Gold 1500b Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170051-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170051-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170051-00,Standard Gold Off Exchange Plan,,0.803876519203186,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400",$20,$400,$200,$0,$500,$30,$40,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,7,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170051,CommunityCare Gold 1500b Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170051-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170051-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170051-01,Standard Gold On Exchange Plan,,0.803876519203186,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400",$20,$400,$200,$0,$500,$30,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,7,98905,OK,Individual,No,73-1433979,98905OK0130020,CommunityCare Silver 4000 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130020-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130020-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130020-03,Limited Cost Sharing Plan Variation,,0.71066278219223,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,900",$20,$300,$200,$0,$600,$60,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,7,98905,OK,Individual,No,73-1433979,98905OK0130020,CommunityCare Silver 4000 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130020-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130020-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130020-04,73% AV Level Silver Plan,,0.739490270614624,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,200","$6,400",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,100",$20,$500,$200,$0,$600,$60,$40,8
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,7,98905,OK,Individual,No,73-1433979,98905OK0130020,CommunityCare Silver 4000 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130020-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130020-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130020-05,87% AV Level Silver Plan,,0.878929913043976,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$20,"$1,100",$200,$0,$600,$60,$40,9
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,7,98905,OK,Individual,No,73-1433979,98905OK0130020,CommunityCare Silver 4000 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130020-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130020-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130020-06,94% AV Level Silver Plan,,0.949805855751038,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$600,$200,$0,$30,$30,$40,10
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,8,98905,OK,Individual,No,73-1433979,98905OK0130021,CommunityCare Silver 3500 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130021-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130021-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130021-00,Standard Silver Off Exchange Plan,,0.715864360332489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,400",$100,$0,$200,$0,$600,$0,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,8,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170032,CommunityCare Gold 1000b Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170032-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170032-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170032-00,Standard Gold Off Exchange Plan,,0.805282592773438,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$20,$900,$200,$0,$600,$60,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,8,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170032,CommunityCare Gold 1000b Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170032-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170032-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170032-01,Standard Gold On Exchange Plan,,0.805282592773438,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$20,$900,$200,$0,$600,$60,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,8,98905,OK,Individual,No,73-1433979,98905OK0130021,CommunityCare Silver 3500 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130021-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130021-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130021-01,Standard Silver On Exchange Plan,,0.715864360332489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,400",$100,$0,$200,$0,$600,$0,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,8,98905,OK,Individual,No,73-1433979,98905OK0130021,CommunityCare Silver 3500 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130021-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130021-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130021-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,8,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170052,CommunityCare Gold 1000b Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170052-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170052-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170052-00,Standard Gold Off Exchange Plan,,0.805282592773438,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$20,$900,$200,$0,$600,$60,$40,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,8,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170052,CommunityCare Gold 1000b Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170052-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170052-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170052-01,Standard Gold On Exchange Plan,,0.805282592773438,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$20,$900,$200,$0,$600,$60,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,8,98905,OK,Individual,No,73-1433979,98905OK0130021,CommunityCare Silver 3500 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130021-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130021-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130021-03,Limited Cost Sharing Plan Variation,,0.715864360332489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,400",$100,$0,$200,$0,$600,$0,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,8,98905,OK,Individual,No,73-1433979,98905OK0130021,CommunityCare Silver 3500 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130021-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130021-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130021-04,73% AV Level Silver Plan,,0.739304780960083,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$600,$0,$200,$0,$600,$0,$40,8
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,8,98905,OK,Individual,No,73-1433979,98905OK0130021,CommunityCare Silver 3500 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130021-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130021-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130021-05,87% AV Level Silver Plan,,0.878396570682526,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,200","$4,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$800,$400,$0,$200,$0,$300,$0,$40,9
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,8,98905,OK,Individual,No,73-1433979,98905OK0130021,CommunityCare Silver 3500 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130021-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130021-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130021-06,94% AV Level Silver Plan,,0.949718415737152,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$100,$0,$200,$0,$30,$0,$40,10
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,9,98905,OK,Individual,No,73-1433979,98905OK0130022,CommunityCare Bronze 6000 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130022-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130022-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130022-00,Standard Bronze Off Exchange Plan,,0.583025097846985,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900",$20,$0,$200,"$5,000",$0,$0,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,9,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170033,CommunityCare Gold 750 Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170033-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170033-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170033-00,Standard Gold Off Exchange Plan,,0.811419785022736,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$20,"$1,500",$200,$0,$700,$100,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,9,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170033,CommunityCare Gold 750 Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170033-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170033-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170033-01,Standard Gold On Exchange Plan,,0.811419785022736,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$20,"$1,500",$200,$0,$700,$100,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,9,98905,OK,Individual,No,73-1433979,98905OK0130022,CommunityCare Bronze 6000 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130022-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130022-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130022-01,Standard Bronze On Exchange Plan,,0.583025097846985,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900",$20,$0,$200,"$5,000",$0,$0,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,9,98905,OK,Individual,No,73-1433979,98905OK0130022,CommunityCare Bronze 6000 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130022-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130022-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130022-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,9,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170053,CommunityCare Gold 750 Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170053-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170053-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170053-00,Standard Gold Off Exchange Plan,,0.811419785022736,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$20,"$1,500",$200,$0,$700,$100,$40,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,9,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170053,CommunityCare Gold 750 Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170053-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170053-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170053-01,Standard Gold On Exchange Plan,,0.811419785022736,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$20,"$1,500",$200,$0,$700,$100,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,9,98905,OK,Individual,No,73-1433979,98905OK0130022,CommunityCare Bronze 6000 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130022-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130022-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130022-03,Limited Cost Sharing Plan Variation,,0.583025097846985,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900",$20,$0,$200,"$5,000",$0,$0,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,10,98905,OK,Individual,No,73-1433979,98905OK0130023,CommunityCare Bronze 5000 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130023-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130023-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130023-00,Standard Bronze Off Exchange Plan,,0.589809417724609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$70,$400,$200,"$4,800",$0,$0,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,10,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170034,CommunityCare Gold 1000c Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170034-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170034-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170034-00,Standard Gold Off Exchange Plan,,0.812157332897186,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$20,"$1,400",$200,$0,$600,$100,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,10,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170034,CommunityCare Gold 1000c Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170034-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170034-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170034-01,Standard Gold On Exchange Plan,,0.812157332897186,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$20,"$1,400",$200,$0,$600,$100,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,10,98905,OK,Individual,No,73-1433979,98905OK0130023,CommunityCare Bronze 5000 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130023-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130023-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130023-01,Standard Bronze On Exchange Plan,,0.589809417724609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$70,$400,$200,"$4,800",$0,$0,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,10,98905,OK,Individual,No,73-1433979,98905OK0130023,CommunityCare Bronze 5000 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130023-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130023-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130023-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,10,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170054,CommunityCare Gold 1000c Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170054-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170054-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170054-00,Standard Gold Off Exchange Plan,,0.812157332897186,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$20,"$1,400",$200,$0,$600,$100,$40,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,10,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170054,CommunityCare Gold 1000c Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170054-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170054-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170054-01,Standard Gold On Exchange Plan,,0.812157332897186,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$20,"$1,400",$200,$0,$600,$100,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,10,98905,OK,Individual,No,73-1433979,98905OK0130023,CommunityCare Bronze 5000 Select,98905OK013,7003819233,OKN001,OKS001,OKF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130023-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130023-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130023-03,Limited Cost Sharing Plan Variation,,0.589809417724609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$70,$400,$200,"$4,800",$0,$0,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,11,98905,OK,Individual,No,73-1433979,98905OK0130024,CommunityCare Catastrophic 6600 Select,98905OK013,7003819233,OKN001,OKS001,OKF004,New,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130024-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130024-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130024-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$200,"$4,400",$100,$0,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,11,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170035,CommunityCare Gold 2000b Select,98905OK017,7003819233,OKN001,OKS001,OKF002,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,4,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170035-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170035-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170035-00,Standard Gold Off Exchange Plan,,0.818662941455841,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$500,$0,$200,$0,$700,$0,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,11,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170035,CommunityCare Gold 2000b Select,98905OK017,7003819233,OKN001,OKS001,OKF002,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,4,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170035-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170035-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170035-01,Standard Gold On Exchange Plan,,0.818662941455841,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$500,$0,$200,$0,$700,$0,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,11,98905,OK,Individual,No,73-1433979,98905OK0130024,CommunityCare Catastrophic 6600 Select,98905OK013,7003819233,OKN001,OKS001,OKF004,New,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0130024-01&type=sbc,https://ccok.softheon.com/payment,http://marketplace.ccok.com?plan=201598905OK0130024-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0130024-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$200,"$4,400",$100,$0,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,11,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170055,CommunityCare Gold 2000b Classic,98905OK017,7003819233,OKN002,OKS002,OKF002,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,4,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170055-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170055-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170055-00,Standard Gold Off Exchange Plan,,0.818662941455841,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$500,$0,$200,$0,$700,$0,$40,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,11,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170055,CommunityCare Gold 2000b Classic,98905OK017,7003819233,OKN002,OKS002,OKF002,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,4,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170055-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170055-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170055-01,Standard Gold On Exchange Plan,,0.818662941455841,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$500,$0,$200,$0,$700,$0,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,12,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170036,CommunityCare Silver 6000 Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170036-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170036-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170036-00,Standard Silver Off Exchange Plan,69.00%,0.686589419841766,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,300",$20,$0,$200,$100,$600,$0,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,12,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170036,CommunityCare Silver 6000 Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170036-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170036-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170036-01,Standard Silver On Exchange Plan,69.00%,0.686589419841766,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,300",$20,$0,$200,$100,$600,$0,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,12,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170056,CommunityCare Silver 6000 Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170056-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170056-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170056-00,Standard Silver Off Exchange Plan,69.00%,0.686589419841766,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,300",$20,$0,$200,$100,$600,$0,$40,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,12,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170056,CommunityCare Silver 6000 Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170056-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170056-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170056-01,Standard Silver On Exchange Plan,69.00%,0.686589419841766,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,300",$20,$0,$200,$100,$600,$0,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,13,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170037,CommunityCare Silver 2000 Select,98905OK017,7003819233,OKN001,OKS001,OKF003,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170037-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170037-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170037-00,Standard Silver Off Exchange Plan,,0.696230530738831,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$40,"$1,100",$200,$0,"$1,200",$100,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,13,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170037,CommunityCare Silver 2000 Select,98905OK017,7003819233,OKN001,OKS001,OKF003,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170037-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170037-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170037-01,Standard Silver On Exchange Plan,,0.696230530738831,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$40,"$1,100",$200,$0,"$1,200",$100,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,13,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170057,CommunityCare Silver 2000 Classic,98905OK017,7003819233,OKN002,OKS002,OKF003,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170057-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170057-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170057-00,Standard Silver Off Exchange Plan,,0.696230530738831,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$40,"$1,100",$200,$0,"$1,200",$100,$40,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,13,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170057,CommunityCare Silver 2000 Classic,98905OK017,7003819233,OKN002,OKS002,OKF003,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170057-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170057-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170057-01,Standard Silver On Exchange Plan,,0.696230530738831,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$40,"$1,100",$200,$0,"$1,200",$100,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,14,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170038,CommunityCare Silver 4500 Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170038-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170038-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170038-00,Standard Silver Off Exchange Plan,70.10%,0.69333952665329,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,400",$20,$0,$200,$100,$600,$0,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,14,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170038,CommunityCare Silver 4500 Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170038-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170038-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170038-01,Standard Silver On Exchange Plan,70.10%,0.69333952665329,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,400",$20,$0,$200,$100,$600,$0,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,14,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170058,CommunityCare Silver 4500 Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170058-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170058-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170058-00,Standard Silver Off Exchange Plan,70.10%,0.69333952665329,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,400",$20,$0,$200,$100,$600,$0,$40,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,14,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170058,CommunityCare Silver 4500 Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170058-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170058-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170058-01,Standard Silver On Exchange Plan,70.10%,0.69333952665329,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,400",$20,$0,$200,$100,$600,$0,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,15,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170039,CommunityCare Silver 4000 Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170039-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170039-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170039-00,Standard Silver Off Exchange Plan,,0.71066278219223,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,900",$20,$300,$200,$0,$600,$60,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,15,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170039,CommunityCare Silver 4000 Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170039-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170039-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170039-01,Standard Silver On Exchange Plan,,0.71066278219223,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,900",$20,$300,$200,$0,$600,$60,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,15,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170059,CommunityCare Silver 4000 Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170059-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170059-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170059-00,Standard Silver Off Exchange Plan,,0.71066278219223,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,900",$20,$300,$200,$0,$600,$60,$40,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,15,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170059,CommunityCare Silver 4000 Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170059-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170059-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170059-01,Standard Silver On Exchange Plan,,0.71066278219223,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,900",$20,$300,$200,$0,$600,$60,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,16,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170040,CommunityCare Silver 3500 Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170040-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170040-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170040-00,Standard Silver Off Exchange Plan,,0.715864360332489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,400",$100,$0,$200,$0,$600,$0,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,16,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170040,CommunityCare Silver 3500 Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170040-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170040-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170040-01,Standard Silver On Exchange Plan,,0.715864360332489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,400",$100,$0,$200,$0,$600,$0,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,16,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170060,CommunityCare Silver 3500 Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170060-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170060-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170060-00,Standard Silver Off Exchange Plan,,0.715864360332489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,400",$100,$0,$200,$0,$600,$0,$40,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,16,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170060,CommunityCare Silver 3500 Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170060-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170060-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170060-01,Standard Silver On Exchange Plan,,0.715864360332489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,400",$100,$0,$200,$0,$600,$0,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,17,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170042,CommunityCare Bronze 6000 Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170042-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170042-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170042-00,Standard Bronze Off Exchange Plan,,0.583025097846985,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900",$20,$0,$200,"$5,000",$0,$0,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,17,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170042,CommunityCare Bronze 6000 Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170042-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170042-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170042-01,Standard Bronze On Exchange Plan,,0.583025097846985,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900",$20,$0,$200,"$5,000",$0,$0,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,17,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170062,CommunityCare Bronze 6000 Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170062-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170062-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170062-00,Standard Bronze Off Exchange Plan,,0.583025097846985,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900",$20,$0,$200,"$5,000",$0,$0,$40,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,17,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170062,CommunityCare Bronze 6000 Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170062-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170062-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170062-01,Standard Bronze On Exchange Plan,,0.583025097846985,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900",$20,$0,$200,"$5,000",$0,$0,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,18,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170043,CommunityCare Bronze 5000 Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170043-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170043-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170043-00,Standard Bronze Off Exchange Plan,,0.589809417724609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$70,$400,$200,"$4,800",$0,$0,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,18,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170043,CommunityCare Bronze 5000 Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170043-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170043-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170043-01,Standard Bronze On Exchange Plan,,0.589809417724609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$70,$400,$200,"$4,800",$0,$0,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,18,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170063,CommunityCare Bronze 5000 Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170063-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170063-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170063-00,Standard Bronze Off Exchange Plan,,0.589809417724609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$70,$400,$200,"$4,800",$0,$0,$40,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,18,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170063,CommunityCare Bronze 5000 Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170063-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170063-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170063-01,Standard Bronze On Exchange Plan,,0.589809417724609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$70,$400,$200,"$4,800",$0,$0,$40,7
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,19,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170044,CommunityCare Bronze 4000 Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170044-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170044-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170044-00,Standard Bronze Off Exchange Plan,,0.60355931520462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,900",$20,$700,$200,"$4,000",$100,$10,$40,4
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,19,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170044,CommunityCare Bronze 4000 Select,98905OK017,7003819233,OKN001,OKS001,OKF001,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170044-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170044-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170044-01,Standard Bronze On Exchange Plan,,0.60355931520462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,900",$20,$700,$200,"$4,000",$100,$10,$40,5
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,19,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170064,CommunityCare Bronze 4000 Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170064-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170064-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170064-00,Standard Bronze Off Exchange Plan,,0.60355931520462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,900",$20,$700,$200,"$4,000",$100,$10,$40,6
2015,OK,98905,HIOS,5,2014-11-11 04:41:18,19,98905,OK,SHOP (Small Group),No,73-1433979,98905OK0170064,CommunityCare Bronze 4000 Classic,98905OK017,7003819233,OKN002,OKS002,OKF001,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Emergency Services,No,http://marketplace.ccok.com?plan=201598905OK0170064-01&type=sbc,,http://marketplace.ccok.com?plan=201598905OK0170064-01,http://marketplace.ccok.com?rxFormulary=2,98905OK0170064-01,Standard Bronze On Exchange Plan,,0.60355931520462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,900",$20,$700,$200,"$4,000",$100,$10,$40,7
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,2,16322,PA,Individual,No,46-2824626,16322PA0050017,UPMC Advantage Silver $0/$50 - Partner Network,16322PA005,,PAN001,PAS001,PAF018,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050017_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050017_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050017-05,87% AV Level Silver Plan,87.50%,0.874570667743683,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,600",$0,$200,$0,$600,$600,$80,9
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,2,16322,PA,Individual,No,46-2824626,16322PA0050017,UPMC Advantage Silver $0/$50 - Partner Network,16322PA005,,PAN001,PAS001,PAF018,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050017_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050017_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050017-06,94% AV Level Silver Plan,93.20%,0.93240886926651,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$900,$0,$200,$0,$500,$500,$80,10
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,2,16322,PA,Individual,No,46-2824626,16322PA0050009,UPMC Advantage Silver $0/$50 - Partner Network,16322PA005,,PAN005,PAS005,PAF018,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050009_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050009_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050009-01,Standard Silver On Exchange Plan,71.90%,0.718871235847473,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$4,300",$0,$200,$0,"$1,600",$600,$80,12
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,2,16322,PA,Individual,No,46-2824626,16322PA0050009,UPMC Advantage Silver $0/$50 - Partner Network,16322PA005,,PAN005,PAS005,PAF018,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050009_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050009_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,13
2015,PA,15614,HIOS,5,2014-08-07 10:00:19,1,15614,PA,Individual,Yes,54-1808292,15614PA0010001,Select Plan Kids,15614PA001,,PAN001,PAS001,,Existing,HMO,Low,,Both,,,,Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia.,,,,,Allows Child-Only,,,,$12.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/pa14dobiped-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania,,15614PA0010001-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,2,16322,PA,Individual,No,46-2824626,16322PA0050009,UPMC Advantage Silver $0/$50 - Partner Network,16322PA005,,PAN005,PAS005,PAF018,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050009_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050009_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050009-04,73% AV Level Silver Plan,73.90%,0.738796055316925,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$4,300",$0,$200,$0,"$1,400",$600,$80,15
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,2,16322,PA,Individual,No,46-2824626,16322PA0050009,UPMC Advantage Silver $0/$50 - Partner Network,16322PA005,,PAN005,PAS005,PAF018,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050009_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050009_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050009-05,87% AV Level Silver Plan,87.50%,0.874570667743683,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,600",$0,$200,$0,$600,$600,$80,16
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,2,16322,PA,Individual,No,46-2824626,16322PA0050009,UPMC Advantage Silver $0/$50 - Partner Network,16322PA005,,PAN005,PAS005,PAF018,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050009_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050009_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050009-06,94% AV Level Silver Plan,93.20%,0.93240886926651,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$900,$0,$200,$0,$500,$500,$80,17
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060009,UPMC Small Business Advantage Platinum? PPO $10/$25  - Premium Network,16322PA006,,PAN009,PAS006,PAF032,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Platinum_16322PA0060009_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Platinum_16322PA0060009_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060009-00,Standard Platinum Off Exchange Plan,91.50%,0.906211912631989,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$500,$0,$200,$0,$700,$500,$80,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0040007,UPMC Advantage Silver $1750/$30 - Premium Network,16322PA004,,PAN006,PAS006,PAF021,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040007_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040007_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040007-00,Standard Silver Off Exchange Plan,,0.709083139896393,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,750","$3,500",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,800",$10,"$1,100",$200,"$1,800","$1,100",$50,$80,4
2015,PA,15614,HIOS,5,2014-08-07 10:00:19,1,15614,PA,SHOP (Small Group),Yes,54-1808292,15614PA0030001,Select Plan Kids,15614PA003,,PAN001,PAS001,,Existing,HMO,Low,,Off the Exchange,,,,Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.,,,,,Allows Child-Only,,,,$12.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/pa14dobshopped-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania,,15614PA0030001-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,2,16322,PA,Individual,No,46-2824626,16322PA0050009,UPMC Advantage Silver $0/$50 - Partner Network,16322PA005,,PAN005,PAS005,PAF018,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050009_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050009_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050009-00,Standard Silver Off Exchange Plan,71.90%,0.718871235847473,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$4,300",$0,$200,$0,"$1,600",$600,$80,11
2015,PA,15614,HIOS,5,2014-08-07 10:00:19,1,15614,PA,SHOP (Small Group),Yes,54-1808292,15614PA0030001,Select Plan Kids,15614PA003,,PAN001,PAS001,,Existing,HMO,Low,,Off the Exchange,,,,Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.,,,,,Allows Child-Only,,,,$12.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/pa14dobshopped-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania,,15614PA0030001-01,Standard Low On Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,15614,HIOS,5,2014-08-07 10:00:19,1,15614,PA,Individual,Yes,54-1808292,15614PA0010001,Select Plan Kids,15614PA001,,PAN001,PAS001,,Existing,HMO,Low,,Both,,,,Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia.,,,,,Allows Child-Only,,,,$12.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/pa14dobiped-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania,,15614PA0010001-01,Standard Low On Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,15614,HIOS,5,2014-08-07 10:00:19,1,15614,PA,Individual,Yes,54-1808292,15614PA0020001,Access PPO Kids,15614PA002,,PAN002,PAS002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/pa14pcoviped-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania,,15614PA0020001-00,Standard Low Off Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,15614,HIOS,5,2014-08-07 10:00:19,1,15614,PA,SHOP (Small Group),Yes,54-1808292,15614PA0040001,Access PPO Kids,15614PA004,,PAN002,PAS002,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$21.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/pa14pcovshopped-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania,,15614PA0040001-00,Standard Low Off Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,15614,HIOS,5,2014-08-07 10:00:19,1,15614,PA,SHOP (Small Group),Yes,54-1808292,15614PA0040001,Access PPO Kids,15614PA004,,PAN002,PAS002,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$21.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/pa14pcovshopped-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania,,15614PA0040001-01,Standard Low On Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,15614,HIOS,5,2014-08-07 10:00:19,1,15614,PA,Individual,Yes,54-1808292,15614PA0020001,Access PPO Kids,15614PA002,,PAN002,PAS002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/pa14pcoviped-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania,,15614PA0020001-01,Standard Low On Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,15614,HIOS,5,2014-08-07 10:00:19,2,15614,PA,Individual,Yes,54-1808292,15614PA0010002,Select Plan,15614PA001,,PAN001,PAS001,,Existing,HMO,Low,,Both,,,,Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.,,,,,Allows Adult and Child-Only,,,,$12.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/pa14dobifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania,,15614PA0010002-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,15614,HIOS,5,2014-08-07 10:00:19,2,15614,PA,SHOP (Small Group),Yes,54-1808292,15614PA0030002,Select Plan,15614PA003,,PAN001,PAS001,,Existing,HMO,Low,,Both,,,,Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.,,,,,Allows Adult and Child-Only,,,,$12.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/pa14dobshopfam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania,,15614PA0030002-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,15614,HIOS,5,2014-08-07 10:00:19,2,15614,PA,SHOP (Small Group),Yes,54-1808292,15614PA0030002,Select Plan,15614PA003,,PAN001,PAS001,,Existing,HMO,Low,,Both,,,,Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.,,,,,Allows Adult and Child-Only,,,,$12.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/pa14dobshopfam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania,,15614PA0030002-01,Standard Low On Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,15614,HIOS,5,2014-08-07 10:00:19,2,15614,PA,Individual,Yes,54-1808292,15614PA0010002,Select Plan,15614PA001,,PAN001,PAS001,,Existing,HMO,Low,,Both,,,,Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.,,,,,Allows Adult and Child-Only,,,,$12.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/pa14dobifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania,,15614PA0010002-01,Standard Low On Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,15614,HIOS,5,2014-08-07 10:00:19,2,15614,PA,Individual,Yes,54-1808292,15614PA0020002,Access PPO,15614PA002,,PAN002,PAS002,,Existing,PPO,Low,,Both,,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,,,,Allows Adult and Child-Only,,,,$21.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/pa14pcovifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania,,15614PA0020002-00,Standard Low Off Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,15614,HIOS,5,2014-08-07 10:00:19,2,15614,PA,SHOP (Small Group),Yes,54-1808292,15614PA0040002,Access PPO,15614PA004,,PAN002,PAS002,,Existing,PPO,Low,,Both,,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,,,,Allows Adult and Child-Only,,,,$21.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/pa14pcovshopfam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania,,15614PA0040002-00,Standard Low Off Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,15614,HIOS,5,2014-08-07 10:00:19,2,15614,PA,SHOP (Small Group),Yes,54-1808292,15614PA0040002,Access PPO,15614PA004,,PAN002,PAS002,,Existing,PPO,Low,,Both,,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,,,,Allows Adult and Child-Only,,,,$21.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/pa14pcovshopfam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania,,15614PA0040002-01,Standard Low On Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,15614,HIOS,5,2014-08-07 10:00:19,2,15614,PA,Individual,Yes,54-1808292,15614PA0020002,Access PPO,15614PA002,,PAN002,PAS002,,Existing,PPO,Low,,Both,,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,,,,Allows Adult and Child-Only,,,,$21.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/pa14pcovifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania,,15614PA0020002-01,Standard Low On Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,1,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0070002,"UPMC Small Business Advantage Bronze EPO? $5,500 - Premium Network",16322PA007,,PAN008,PAS006,PAF033,New,EPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_EPO_Bronze_16322PA0070002_Serv29_Net31,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_EPO_Bronze_16322PA0070002_Serv29_Net31,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0070002-00,Standard Bronze Off Exchange Plan,58.20%,0.597463726997375,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$10,$0,$200,"$2,134",$740,$0,$80,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,1,16322,PA,Individual,No,46-2824626,16322PA0040006,UPMC Advantage Silver $0/$50 - Premium Network,16322PA004,,PAN006,PAS006,PAF018,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040006_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040006_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040006-00,Standard Silver Off Exchange Plan,71.90%,0.718871235847473,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$4,300",$0,$200,$0,"$1,600",$600,$80,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,1,16322,PA,Individual,No,46-2824626,16322PA0040006,UPMC Advantage Silver $0/$50 - Premium Network,16322PA004,,PAN006,PAS006,PAF018,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040006_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040006_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040006-01,Standard Silver On Exchange Plan,71.90%,0.718871235847473,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$4,300",$0,$200,$0,"$1,600",$600,$80,5
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,1,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0070002,"UPMC Small Business Advantage Bronze EPO? $5,500 - Premium Network",16322PA007,,PAN008,PAS006,PAF033,New,EPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_EPO_Bronze_16322PA0070002_Serv29_Net31,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_EPO_Bronze_16322PA0070002_Serv29_Net31,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0070002-01,Standard Bronze On Exchange Plan,58.20%,0.597463726997375,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$10,$0,$200,"$2,134",$740,$0,$80,5
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,1,16322,PA,Individual,No,46-2824626,16322PA0040006,UPMC Advantage Silver $0/$50 - Premium Network,16322PA004,,PAN006,PAS006,PAF018,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040006_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040006_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040006-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,1,16322,PA,Individual,No,46-2824626,16322PA0040006,UPMC Advantage Silver $0/$50 - Premium Network,16322PA004,,PAN006,PAS006,PAF018,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040006_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040006_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040006-03,Limited Cost Sharing Plan Variation,71.90%,0.718871235847473,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$4,300",$0,$200,$0,"$1,600",$600,$80,7
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,1,16322,PA,Individual,No,46-2824626,16322PA0040006,UPMC Advantage Silver $0/$50 - Premium Network,16322PA004,,PAN006,PAS006,PAF018,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040006_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040006_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040006-04,73% AV Level Silver Plan,73.90%,0.738796055316925,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$4,300",$0,$200,$0,"$1,600",$600,$80,8
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,1,16322,PA,Individual,No,46-2824626,16322PA0040006,UPMC Advantage Silver $0/$50 - Premium Network,16322PA004,,PAN006,PAS006,PAF018,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040006_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040006_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040006-05,87% AV Level Silver Plan,87.50%,0.874570667743683,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,600",$0,$200,$0,$600,$600,$80,9
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,1,16322,PA,Individual,No,46-2824626,16322PA0040006,UPMC Advantage Silver $0/$50 - Premium Network,16322PA004,,PAN006,PAS006,PAF018,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040006_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040006_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040006-06,94% AV Level Silver Plan,93.20%,0.93240886926651,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$900,$0,$200,$0,$500,$500,$80,10
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,1,16322,PA,Individual,No,46-2824626,16322PA0050029,UPMC Advantage Silver $0/$50 - Select Network,16322PA005,,PAN002,PAS002,PAF018,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050029_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050029_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050029-00,Standard Silver Off Exchange Plan,71.90%,0.718871235847473,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$4,300",$0,$200,$0,"$1,600",$600,$80,11
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,1,16322,PA,Individual,No,46-2824626,16322PA0050029,UPMC Advantage Silver $0/$50 - Select Network,16322PA005,,PAN002,PAS002,PAF018,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050029_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050029_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050029-01,Standard Silver On Exchange Plan,71.90%,0.718871235847473,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$4,300",$0,$200,$0,"$1,600",$600,$80,12
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,1,16322,PA,Individual,No,46-2824626,16322PA0050029,UPMC Advantage Silver $0/$50 - Select Network,16322PA005,,PAN002,PAS002,PAF018,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050029_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050029_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050029-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,13
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,1,16322,PA,Individual,No,46-2824626,16322PA0050029,UPMC Advantage Silver $0/$50 - Select Network,16322PA005,,PAN002,PAS002,PAF018,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050029_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050029_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050029-03,Limited Cost Sharing Plan Variation,71.90%,0.718871235847473,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$4,300",$0,$200,$0,"$1,600",$600,$80,14
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,1,16322,PA,Individual,No,46-2824626,16322PA0050029,UPMC Advantage Silver $0/$50 - Select Network,16322PA005,,PAN002,PAS002,PAF018,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050029_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050029_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050029-04,73% AV Level Silver Plan,73.90%,0.738796055316925,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$4,300",$0,$200,$0,"$1,400",$600,$80,15
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,1,16322,PA,Individual,No,46-2824626,16322PA0050029,UPMC Advantage Silver $0/$50 - Select Network,16322PA005,,PAN002,PAS002,PAF018,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050029_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050029_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050029-05,87% AV Level Silver Plan,87.50%,0.874570667743683,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,600",$0,$200,$0,$600,$600,$80,16
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,1,16322,PA,Individual,No,46-2824626,16322PA0050029,UPMC Advantage Silver $0/$50 - Select Network,16322PA005,,PAN002,PAS002,PAF018,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050029_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050029_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050029-06,94% AV Level Silver Plan,93.20%,0.93240886926651,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$900,$0,$200,$0,$500,$500,$80,17
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,2,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060017,"UPMC Consumer Advantage Bronze HSA PPO? $2,750 - Premium Network",16322PA006,,PAN009,PAS006,PAF035,New,PPO,Bronze,Yes,Both,No,No,,,,Yes,Yes,$150.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Bronze_16322PA0060017_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Bronze_16322PA0060017_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060017-00,Standard Bronze Off Exchange Plan,60.80%,0.672537863254547,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$5,500","$11,000",Not Applicable,Not Applicable,"$2,800",$600,$0,$200,"$2,800","$1,000",$0,$80,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,2,16322,PA,Individual,No,46-2824626,16322PA0050017,UPMC Advantage Silver $0/$50 - Partner Network,16322PA005,,PAN001,PAS001,PAF018,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050017_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050017_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050017-00,Standard Silver Off Exchange Plan,71.90%,0.718871235847473,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$4,300",$0,$200,$0,"$1,600",$600,$80,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,2,16322,PA,Individual,No,46-2824626,16322PA0050017,UPMC Advantage Silver $0/$50 - Partner Network,16322PA005,,PAN001,PAS001,PAF018,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050017_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050017_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050017-01,Standard Silver On Exchange Plan,71.90%,0.718871235847473,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$4,300",$0,$200,$0,"$1,600",$600,$80,5
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,2,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060017,"UPMC Consumer Advantage Bronze HSA PPO? $2,750 - Premium Network",16322PA006,,PAN009,PAS006,PAF035,New,PPO,Bronze,Yes,Both,No,No,,,,Yes,Yes,$150.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Bronze_16322PA0060017_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Bronze_16322PA0060017_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060017-01,Standard Bronze On Exchange Plan,60.80%,0.672537863254547,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$5,500","$11,000",Not Applicable,Not Applicable,"$2,800",$600,$0,$200,"$2,800","$1,000",$0,$80,5
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,2,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060020,UPMC Consumer Advantage Silver HSA PPO $2000 - Premium Network,16322PA006,,PAN009,PAS006,PAF035,New,PPO,Silver,Yes,Both,No,No,,,,Yes,Yes,$150.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Silver_16322PA0060020_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Silver_16322PA0060020_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060020-00,Standard Silver Off Exchange Plan,71.00%,0.739671170711517,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$10,$0,$200,"$2,000",$700,$0,$80,6
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,2,16322,PA,Individual,No,46-2824626,16322PA0050017,UPMC Advantage Silver $0/$50 - Partner Network,16322PA005,,PAN001,PAS001,PAF018,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050017_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050017_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050017-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,2,16322,PA,Individual,No,46-2824626,16322PA0050017,UPMC Advantage Silver $0/$50 - Partner Network,16322PA005,,PAN001,PAS001,PAF018,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050017_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050017_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050017-03,Limited Cost Sharing Plan Variation,71.90%,0.718871235847473,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$4,300",$0,$200,$0,"$1,600",$600,$80,7
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,2,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060020,UPMC Consumer Advantage Silver HSA PPO $2000 - Premium Network,16322PA006,,PAN009,PAS006,PAF035,New,PPO,Silver,Yes,Both,No,No,,,,Yes,Yes,$150.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Silver_16322PA0060020_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Silver_16322PA0060020_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060020-01,Standard Silver On Exchange Plan,71.00%,0.739671170711517,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$10,$0,$200,"$2,000",$700,$0,$80,7
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,2,16322,PA,Individual,No,46-2824626,16322PA0050017,UPMC Advantage Silver $0/$50 - Partner Network,16322PA005,,PAN001,PAS001,PAF018,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050017_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050017_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050017-04,73% AV Level Silver Plan,73.90%,0.738796055316925,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$4,300",$0,$200,$0,"$1,400",$600,$80,8
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,2,16322,PA,Individual,No,46-2824626,16322PA0050009,UPMC Advantage Silver $0/$50 - Partner Network,16322PA005,,PAN005,PAS005,PAF018,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050009_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050009_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050009-03,Limited Cost Sharing Plan Variation,71.90%,0.718871235847473,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$4,300",$0,$200,$0,"$1,600",$600,$80,14
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0040007,UPMC Advantage Silver $1750/$30 - Premium Network,16322PA004,,PAN006,PAS006,PAF021,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040007_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040007_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040007-01,Standard Silver On Exchange Plan,,0.709083139896393,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,750","$3,500",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,800",$10,"$1,100",$200,"$1,800","$1,100",$50,$80,5
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060009,UPMC Small Business Advantage Platinum? PPO $10/$25  - Premium Network,16322PA006,,PAN009,PAS006,PAF032,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Platinum_16322PA0060009_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Platinum_16322PA0060009_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060009-01,Standard Platinum On Exchange Plan,91.50%,0.906211912631989,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$500,$0,$200,$0,$700,$500,$80,5
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060029,UPMC Small Business Advantage? Gold PPO $25/$75  - Premium Network,16322PA006,,PAN009,PAS006,PAF032,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060029_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060029_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060029-00,Standard Gold Off Exchange Plan,81.80%,0.724579751491547,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,500",$0,$200,$0,"$1,100",$600,$80,6
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0040007,UPMC Advantage Silver $1750/$30 - Premium Network,16322PA004,,PAN006,PAS006,PAF021,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040007_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040007_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0040007,UPMC Advantage Silver $1750/$30 - Premium Network,16322PA004,,PAN006,PAS006,PAF021,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040007_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040007_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040007-03,Limited Cost Sharing Plan Variation,,0.709083139896393,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,750","$3,500",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,800",$10,"$1,100",$200,"$1,800","$1,100",$50,$80,7
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060029,UPMC Small Business Advantage? Gold PPO $25/$75  - Premium Network,16322PA006,,PAN009,PAS006,PAF032,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060029_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060029_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060029-01,Standard Gold On Exchange Plan,81.80%,0.724579751491547,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,500",$0,$200,$0,"$1,100",$600,$80,7
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0040007,UPMC Advantage Silver $1750/$30 - Premium Network,16322PA004,,PAN006,PAS006,PAF021,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040007_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040007_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040007-04,73% AV Level Silver Plan,,0.729522943496704,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,750","$3,500",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,800",$10,"$1,100",$200,"$1,800","$1,100",$50,$80,8
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0040007,UPMC Advantage Silver $1750/$30 - Premium Network,16322PA004,,PAN006,PAS006,PAF021,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040007_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040007_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040007-05,87% AV Level Silver Plan,,0.864151120185852,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$10,"$1,400",$200,$500,$400,$500,$80,9
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0040007,UPMC Advantage Silver $1750/$30 - Premium Network,16322PA004,,PAN006,PAS006,PAF021,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040007_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040007_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040007-06,94% AV Level Silver Plan,,0.930324018001556,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$75,$150,20%,,,,$150,$300,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$80,$0,$900,$200,$80,$300,$600,$80,10
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0040009,UPMC Advantage Gold $500/$15 - Premium Network,16322PA004,,PAN006,PAS006,PAF021,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Gold_16322PA0040009_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Gold_16322PA0040009_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040009-00,Standard Gold Off Exchange Plan,,0.805168747901917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$10,"$1,400",$200,$500,"$1,000",$500,$80,11
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0040009,UPMC Advantage Gold $500/$15 - Premium Network,16322PA004,,PAN006,PAS006,PAF021,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Gold_16322PA0040009_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Gold_16322PA0040009_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040009-01,Standard Gold On Exchange Plan,,0.805168747901917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$10,"$1,400",$200,$500,"$1,000",$500,$80,12
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0040009,UPMC Advantage Gold $500/$15 - Premium Network,16322PA004,,PAN006,PAS006,PAF021,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Gold_16322PA0040009_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Gold_16322PA0040009_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040009-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,13
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0040009,UPMC Advantage Gold $500/$15 - Premium Network,16322PA004,,PAN006,PAS006,PAF021,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Gold_16322PA0040009_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Gold_16322PA0040009_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040009-03,Limited Cost Sharing Plan Variation,,0.805168747901917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$10,"$1,400",$200,$500,"$1,000",$500,$80,14
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0040010,UPMC Advantage Gold $750/$10 - Premium Network,16322PA004,,PAN006,PAS006,PAF021,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Gold_16322PA0040010_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Gold_16322PA0040010_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040010-00,Standard Gold Off Exchange Plan,,0.803883671760559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$750,"$1,500",10%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$800,$10,$700,$200,$800,"$1,000",$500,$80,15
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0040010,UPMC Advantage Gold $750/$10 - Premium Network,16322PA004,,PAN006,PAS006,PAF021,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Gold_16322PA0040010_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Gold_16322PA0040010_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040010-01,Standard Gold On Exchange Plan,,0.803883671760559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$750,"$1,500",10%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$800,$10,$700,$200,$800,"$1,000",$500,$80,16
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0040010,UPMC Advantage Gold $750/$10 - Premium Network,16322PA004,,PAN006,PAS006,PAF021,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Gold_16322PA0040010_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Gold_16322PA0040010_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,17
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0040010,UPMC Advantage Gold $750/$10 - Premium Network,16322PA004,,PAN006,PAS006,PAF021,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Gold_16322PA0040010_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Gold_16322PA0040010_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040010-03,Limited Cost Sharing Plan Variation,,0.803883671760559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$750,"$1,500",10%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$800,$10,$700,$200,$800,"$1,000",$500,$80,18
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0050030,"UPMC Advantage Silver $1,750/$30 - Select Network",16322PA005,,PAN002,PAS002,PAF007,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050030_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050030_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050030-00,Standard Silver Off Exchange Plan,,0.709083139896393,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,800",$10,"$1,100",$200,"$1,800","$1,100",$50,$80,19
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0050030,"UPMC Advantage Silver $1,750/$30 - Select Network",16322PA005,,PAN002,PAS002,PAF007,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050030_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050030_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050030-01,Standard Silver On Exchange Plan,,0.709083139896393,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,800",$10,"$1,100",$200,"$1,800","$1,100",$50,$80,20
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0050030,"UPMC Advantage Silver $1,750/$30 - Select Network",16322PA005,,PAN002,PAS002,PAF007,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050030_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050030_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050030-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,21
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0050030,"UPMC Advantage Silver $1,750/$30 - Select Network",16322PA005,,PAN002,PAS002,PAF007,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050030_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050030_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050030-03,Limited Cost Sharing Plan Variation,,0.709083139896393,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,800",$10,"$1,100",$200,"$1,800","$1,100",$50,$80,22
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0050030,"UPMC Advantage Silver $1,750/$30 - Select Network",16322PA005,,PAN002,PAS002,PAF007,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050030_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050030_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050030-04,73% AV Level Silver Plan,,0.729522943496704,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,800",$10,"$1,100",$200,"$1,800","$1,100",$50,$80,23
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0050030,"UPMC Advantage Silver $1,750/$30 - Select Network",16322PA005,,PAN002,PAS002,PAF007,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050030_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050030_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050030-05,87% AV Level Silver Plan,,0.864151120185852,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$10,"$1,400",$200,$500,$400,$500,$80,24
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060005,"UPMC Small Business Advantage Gold PPO $2,000 $20/$40 - Premium Network",16322PA006,,PAN009,PAS006,PAF032,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060005_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060005_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060005-00,Standard Gold Off Exchange Plan,78.40%,0.757743000984192,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$400,$0,$200,"$1,000",$0,$80,"$2,880",8
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050018,"UPMC Advantage Silver $1,750/$30 - Partner Network",16322PA005,,PAN001,PAS001,PAF007,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050018_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050018_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050018-04,73% AV Level Silver Plan,,0.729522943496704,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,800",$10,"$1,100",$200,"$1,800","$1,100",$50,$80,8
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050018,"UPMC Advantage Silver $1,750/$30 - Partner Network",16322PA005,,PAN001,PAS001,PAF007,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050018_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050018_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050018-05,87% AV Level Silver Plan,,0.864151120185852,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$10,"$1,400",$200,$500,$400,$500,$80,9
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060005,"UPMC Small Business Advantage Gold PPO $2,000 $20/$40 - Premium Network",16322PA006,,PAN009,PAS006,PAF032,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060005_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060005_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060005-01,Standard Gold On Exchange Plan,78.40%,0.757743000984192,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$400,$0,$200,"$1,000",$0,$80,"$2,880",9
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050018,"UPMC Advantage Silver $1,750/$30 - Partner Network",16322PA005,,PAN001,PAS001,PAF007,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050018_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050018_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050018-06,94% AV Level Silver Plan,,0.930324018001556,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$75,$150,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$80,$0,$900,$200,$80,$300,$600,$80,10
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050020,UPMC Advantage Gold $500/$15 - Partner Network,16322PA005,,PAN001,PAS001,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050020_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050020_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050020-00,Standard Gold Off Exchange Plan,,0.805168747901917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$10,"$1,400",$200,$500,"$1,000",$500,$80,11
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0050030,"UPMC Advantage Silver $1,750/$30 - Select Network",16322PA005,,PAN002,PAS002,PAF007,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050030_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050030_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050030-06,94% AV Level Silver Plan,,0.930324018001556,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$75,$150,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$80,$0,$900,$200,$80,$300,$600,$80,25
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0050032,UPMC Advantage Gold $500/$15 - Select Network,16322PA005,,PAN002,PAS002,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050032_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050032_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050032-00,Standard Gold Off Exchange Plan,,0.805168747901917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$10,"$1,400",$200,$500,"$1,000",$500,$80,26
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0050032,UPMC Advantage Gold $500/$15 - Select Network,16322PA005,,PAN002,PAS002,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050032_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050032_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050032-01,Standard Gold On Exchange Plan,,0.805168747901917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$10,"$1,400",$200,$500,"$1,000",$500,$80,27
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0050032,UPMC Advantage Gold $500/$15 - Select Network,16322PA005,,PAN002,PAS002,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050032_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050032_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050032-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,28
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0050032,UPMC Advantage Gold $500/$15 - Select Network,16322PA005,,PAN002,PAS002,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050032_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050032_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050032-03,Limited Cost Sharing Plan Variation,,0.805168747901917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$10,"$1,400",$200,$500,"$1,000",$500,$80,29
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050010,"UPMC Advantage Silver $1,750/$30 - Partner Network",16322PA005,,PAN005,PAS005,PAF007,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050010_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050010_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050010-00,Standard Silver Off Exchange Plan,,0.709083139896393,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,800",$10,"$1,100",$200,"$1,800","$1,100",$50,$80,19
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0050033,UPMC Advantage Gold $750/$10 - Select Network,16322PA005,,PAN002,PAS002,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050033_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050033_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050033-00,Standard Gold Off Exchange Plan,,0.803883671760559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$800,$10,$700,$200,$800,"$1,000",$500,$80,30
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050012,UPMC Advantage Gold $500/$15 - Partner Network,16322PA005,,PAN005,PAS005,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050012_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050012_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050012-00,Standard Gold Off Exchange Plan,,0.805168747901917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$10,"$1,400",$200,$500,"$1,000",$500,$80,26
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050012,UPMC Advantage Gold $500/$15 - Partner Network,16322PA005,,PAN005,PAS005,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050012_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050012_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050012-01,Standard Gold On Exchange Plan,,0.805168747901917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$10,"$1,400",$200,$500,"$1,000",$500,$80,27
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050012,UPMC Advantage Gold $500/$15 - Partner Network,16322PA005,,PAN005,PAS005,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050012_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050012_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050012-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,28
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050012,UPMC Advantage Gold $500/$15 - Partner Network,16322PA005,,PAN005,PAS005,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050012_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050012_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050012-03,Limited Cost Sharing Plan Variation,,0.805168747901917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$10,"$1,400",$200,$500,"$1,000",$500,$80,29
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050013,UPMC Advantage Gold $750/$10 - Partner Network,16322PA005,,PAN005,PAS005,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050013_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050013_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050013-00,Standard Gold Off Exchange Plan,,0.803883671760559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$800,$10,$700,$200,$800,"$1,000",$500,$80,30
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050013,UPMC Advantage Gold $750/$10 - Partner Network,16322PA005,,PAN005,PAS005,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050013_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050013_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050013-01,Standard Gold On Exchange Plan,,0.803883671760559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$800,$10,$700,$200,$800,"$1,000",$500,$80,31
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050013,UPMC Advantage Gold $750/$10 - Partner Network,16322PA005,,PAN005,PAS005,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050013_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050013_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050013-03,Limited Cost Sharing Plan Variation,,0.803883671760559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$800,$10,$700,$200,$800,"$1,000",$500,$80,33
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,5,16322,PA,Individual,No,46-2824626,16322PA0040008,"UPMC Advantage Silver $3,250/$10 - Premium Network",16322PA004,,PAN006,PAS006,PAF021,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040008_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040008_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040008-00,Standard Silver Off Exchange Plan,71.80%,0.715407490730286,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,250","$6,500",0%,,,,"$6,500","$13,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,300",$700,$0,$200,"$1,300","$1,200",$0,$80,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,5,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060002,UPMC Small Business Advantage? Gold PPO? $1000/10% $25/$50 - Premium Network,16322PA006,,PAN009,PAS006,PAF032,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060002_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060002_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060002-00,Standard Gold Off Exchange Plan,81.40%,0.836222887039185,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$400,$600,$200,"$1,000","$1,100",$60,$80,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,5,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060002,UPMC Small Business Advantage? Gold PPO? $1000/10% $25/$50 - Premium Network,16322PA006,,PAN009,PAS006,PAF032,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060002_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060002_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060002-01,Standard Gold On Exchange Plan,81.40%,0.836222887039185,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$400,$600,$200,"$1,000","$1,100",$60,$80,5
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,5,16322,PA,Individual,No,46-2824626,16322PA0040008,"UPMC Advantage Silver $3,250/$10 - Premium Network",16322PA004,,PAN006,PAS006,PAF021,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040008_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040008_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040008-01,Standard Silver On Exchange Plan,71.80%,0.715407490730286,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,250","$6,500",0%,,,,"$6,500","$13,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,300",$700,$0,$200,"$1,300","$1,200",$0,$80,5
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,5,16322,PA,Individual,No,46-2824626,16322PA0040008,"UPMC Advantage Silver $3,250/$10 - Premium Network",16322PA004,,PAN006,PAS006,PAF021,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040008_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040008_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040008-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,5,16322,PA,Individual,No,46-2824626,16322PA0040008,"UPMC Advantage Silver $3,250/$10 - Premium Network",16322PA004,,PAN006,PAS006,PAF021,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040008_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040008_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040008-03,Limited Cost Sharing Plan Variation,71.80%,0.715407490730286,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,250","$6,500",0%,,,,"$6,500","$13,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,300",$700,$0,$200,"$1,300","$1,200",$0,$80,7
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,5,16322,PA,Individual,No,46-2824626,16322PA0040008,"UPMC Advantage Silver $3,250/$10 - Premium Network",16322PA004,,PAN006,PAS006,PAF021,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040008_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040008_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040008-04,73% AV Level Silver Plan,74.00%,0.735630631446838,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,250","$6,500",0%,,,,"$6,500","$13,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,300",$700,$0,$200,"$1,800","$1,200",$0,$80,8
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0050033,UPMC Advantage Gold $750/$10 - Select Network,16322PA005,,PAN002,PAS002,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050033_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050033_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050033-01,Standard Gold On Exchange Plan,,0.803883671760559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$800,$10,$700,$200,$800,"$1,000",$500,$80,31
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0050033,UPMC Advantage Gold $750/$10 - Select Network,16322PA005,,PAN002,PAS002,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050033_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050033_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050033-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,32
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,3,16322,PA,Individual,No,46-2824626,16322PA0050033,UPMC Advantage Gold $750/$10 - Select Network,16322PA005,,PAN002,PAS002,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050033_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050033_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050033-03,Limited Cost Sharing Plan Variation,,0.803883671760559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$800,$10,$700,$200,$800,"$1,000",$500,$80,33
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060003,"UPMC Small Business Advantage? Gold PPO $1,000 $20/$40 - Premium Network",16322PA006,,PAN009,PAS006,PAF032,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060003_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060003_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060003-00,Standard Gold Off Exchange Plan,79.60%,0.778478801250458,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$400,$0,$200,"$1,000","$1,000",$0,$80,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050018,"UPMC Advantage Silver $1,750/$30 - Partner Network",16322PA005,,PAN001,PAS001,PAF007,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050018_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050018_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050018-00,Standard Silver Off Exchange Plan,,0.709083139896393,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,800",$10,"$1,100",$200,"$1,800","$1,100",$50,$80,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050018,"UPMC Advantage Silver $1,750/$30 - Partner Network",16322PA005,,PAN001,PAS001,PAF007,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050018_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050018_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050018-01,Standard Silver On Exchange Plan,,0.709083139896393,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,800",$10,"$1,100",$200,"$1,800","$1,100",$50,$80,5
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060003,"UPMC Small Business Advantage? Gold PPO $1,000 $20/$40 - Premium Network",16322PA006,,PAN009,PAS006,PAF032,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060003_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060003_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060003-01,Standard Gold On Exchange Plan,79.60%,0.778478801250458,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$400,$0,$200,"$1,000","$1,000",$0,$80,5
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060004,"UPMC Small Business Advantage? Gold PPO $1,500 $10/$40 - Premium Network",16322PA006,,PAN009,PAS006,PAF032,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060004_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060004_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060004-00,Standard Gold Off Exchange Plan,79.40%,0.761127471923828,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$400,$0,$200,"$1,500","$1,000",$0,$80,6
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050018,"UPMC Advantage Silver $1,750/$30 - Partner Network",16322PA005,,PAN001,PAS001,PAF007,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050018_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050018_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050018-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050018,"UPMC Advantage Silver $1,750/$30 - Partner Network",16322PA005,,PAN001,PAS001,PAF007,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050018_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050018_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050018-03,Limited Cost Sharing Plan Variation,,0.709083139896393,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,800",$10,"$1,100",$200,"$1,800","$1,100",$50,$80,7
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060004,"UPMC Small Business Advantage? Gold PPO $1,500 $10/$40 - Premium Network",16322PA006,,PAN009,PAS006,PAF032,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060004_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060004_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060004-01,Standard Gold On Exchange Plan,79.40%,0.761127471923828,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$400,$0,$200,"$1,500","$1,000",$0,$80,7
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050020,UPMC Advantage Gold $500/$15 - Partner Network,16322PA005,,PAN001,PAS001,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050020_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050020_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050020-01,Standard Gold On Exchange Plan,,0.805168747901917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$10,"$1,400",$200,$500,"$1,000",$500,$80,12
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050020,UPMC Advantage Gold $500/$15 - Partner Network,16322PA005,,PAN001,PAS001,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050020_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050020_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050020-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,13
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050020,UPMC Advantage Gold $500/$15 - Partner Network,16322PA005,,PAN001,PAS001,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050020_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050020_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050020-03,Limited Cost Sharing Plan Variation,,0.805168747901917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$10,"$1,400",$200,$500,"$1,000",$500,$80,14
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050021,UPMC Advantage Gold $750/$10 - Partner Network,16322PA005,,PAN001,PAS001,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050021_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050021_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050021-00,Standard Gold Off Exchange Plan,,0.803883671760559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$800,$10,$700,$200,$800,"$1,000",$500,$80,15
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050021,UPMC Advantage Gold $750/$10 - Partner Network,16322PA005,,PAN001,PAS001,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050021_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050021_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050021-01,Standard Gold On Exchange Plan,,0.803883671760559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$800,$10,$700,$200,$800,"$1,000",$500,$80,16
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050021,UPMC Advantage Gold $750/$10 - Partner Network,16322PA005,,PAN001,PAS001,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050021_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050021_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050021-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,17
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050021,UPMC Advantage Gold $750/$10 - Partner Network,16322PA005,,PAN001,PAS001,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050021_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050021_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050021-03,Limited Cost Sharing Plan Variation,,0.803883671760559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$800,$10,$700,$200,$800,"$1,000",$500,$80,18
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050010,"UPMC Advantage Silver $1,750/$30 - Partner Network",16322PA005,,PAN005,PAS005,PAF007,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050010_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050010_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050010-01,Standard Silver On Exchange Plan,,0.709083139896393,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,800",$10,"$1,100",$200,"$1,800","$1,100",$50,$80,20
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050010,"UPMC Advantage Silver $1,750/$30 - Partner Network",16322PA005,,PAN005,PAS005,PAF007,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050010_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050010_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,21
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050010,"UPMC Advantage Silver $1,750/$30 - Partner Network",16322PA005,,PAN005,PAS005,PAF007,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050010_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050010_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050010-03,Limited Cost Sharing Plan Variation,,0.709083139896393,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,800",$10,"$1,100",$200,"$1,800","$1,100",$50,$80,22
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050010,"UPMC Advantage Silver $1,750/$30 - Partner Network",16322PA005,,PAN005,PAS005,PAF007,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050010_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050010_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050010-04,73% AV Level Silver Plan,,0.729522943496704,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,800",$10,"$1,100",$200,"$1,800","$1,100",$50,$80,23
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050010,"UPMC Advantage Silver $1,750/$30 - Partner Network",16322PA005,,PAN005,PAS005,PAF007,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050010_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050010_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050010-05,87% AV Level Silver Plan,,0.864151120185852,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$10,"$1,400",$200,$500,$400,$500,$80,24
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050010,"UPMC Advantage Silver $1,750/$30 - Partner Network",16322PA005,,PAN005,PAS005,PAF007,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050010_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050010_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050010-06,94% AV Level Silver Plan,,0.930324018001556,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$75,$150,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$80,$0,$900,$200,$80,$300,$600,$80,25
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,4,16322,PA,Individual,No,46-2824626,16322PA0050013,UPMC Advantage Gold $750/$10 - Partner Network,16322PA005,,PAN005,PAS005,PAF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050013_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Gold_16322PA0050013_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050013-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,32
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,5,16322,PA,Individual,No,46-2824626,16322PA0040008,"UPMC Advantage Silver $3,250/$10 - Premium Network",16322PA004,,PAN006,PAS006,PAF021,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040008_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040008_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040008-05,87% AV Level Silver Plan,87.50%,0.880695223808289,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$400,$0,$200,$500,$500,$400,$80,9
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,5,16322,PA,Individual,No,46-2824626,16322PA0040008,"UPMC Advantage Silver $3,250/$10 - Premium Network",16322PA004,,PAN006,PAS006,PAF021,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040008_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040008_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040008-06,94% AV Level Silver Plan,93.10%,0.936048209667206,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$100,$200,0%,,,,$200,$400,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$100,$400,$0,$200,$100,$400,$500,$80,10
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,5,16322,PA,Individual,No,46-2824626,16322PA0050031,"UPMC Advantage Silver $3,250/$10 - Select Network",16322PA005,,PAN002,PAS002,PAF007,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050031_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050031_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050031-00,Standard Silver Off Exchange Plan,71.80%,0.715407490730286,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,300",$700,$0,$200,"$1,800","$1,200",$0,$80,11
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,5,16322,PA,Individual,No,46-2824626,16322PA0050031,"UPMC Advantage Silver $3,250/$10 - Select Network",16322PA005,,PAN002,PAS002,PAF007,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050031_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050031_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050031-01,Standard Silver On Exchange Plan,71.80%,0.715407490730286,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,300",$700,$0,$200,"$1,800","$1,200",$0,$80,12
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,5,16322,PA,Individual,No,46-2824626,16322PA0050031,"UPMC Advantage Silver $3,250/$10 - Select Network",16322PA005,,PAN002,PAS002,PAF007,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050031_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050031_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050031-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,13
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,5,16322,PA,Individual,No,46-2824626,16322PA0050031,"UPMC Advantage Silver $3,250/$10 - Select Network",16322PA005,,PAN002,PAS002,PAF007,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050031_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050031_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050031-03,Limited Cost Sharing Plan Variation,71.80%,0.715407490730286,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,300",$700,$0,$200,"$1,800","$1,200",$0,$80,14
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,5,16322,PA,Individual,No,46-2824626,16322PA0050031,"UPMC Advantage Silver $3,250/$10 - Select Network",16322PA005,,PAN002,PAS002,PAF007,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050031_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050031_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050031-04,73% AV Level Silver Plan,74.00%,0.735630631446838,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,300",$700,$0,$200,"$1,800","$1,200",$0,$80,15
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,5,16322,PA,Individual,No,46-2824626,16322PA0050031,"UPMC Advantage Silver $3,250/$10 - Select Network",16322PA005,,PAN002,PAS002,PAF007,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050031_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050031_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050031-05,87% AV Level Silver Plan,87.50%,0.880695223808289,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$400,$0,$200,$500,$500,$500,$80,16
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,5,16322,PA,Individual,No,46-2824626,16322PA0050031,"UPMC Advantage Silver $3,250/$10 - Select Network",16322PA005,,PAN002,PAS002,PAF007,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050031_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050031_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050031-06,94% AV Level Silver Plan,93.10%,0.936048209667206,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$100,$400,$0,$200,$100,$400,$500,$80,17
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,6,16322,PA,Individual,No,46-2824626,16322PA0050019,"UPMC Advantage Silver $3,250/$10 - Partner Network",16322PA005,,PAN001,PAS001,PAF007,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050019_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050019_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050019-00,Standard Silver Off Exchange Plan,71.80%,0.715407490730286,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,300",$700,$0,$200,"$1,800","$1,200",$0,$80,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,6,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060006,UPMC Small Business Advantage Platinum PPO $250 $10/$25 - Premium Network,16322PA006,,PAN009,PAS006,PAF032,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Platinum_16322PA0060006_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Platinum_16322PA0060006_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060006-00,Standard Platinum Off Exchange Plan,90.70%,0.895692825317383,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,$250,$500,0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$300,$500,$0,$200,$300,"$1,000",$0,$80,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,6,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060006,UPMC Small Business Advantage Platinum PPO $250 $10/$25 - Premium Network,16322PA006,,PAN009,PAS006,PAF032,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Platinum_16322PA0060006_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Platinum_16322PA0060006_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060006-01,Standard Platinum On Exchange Plan,90.70%,0.895692825317383,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,$250,$500,0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$300,$500,$0,$200,$300,"$1,000",$0,$80,5
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,6,16322,PA,Individual,No,46-2824626,16322PA0050019,"UPMC Advantage Silver $3,250/$10 - Partner Network",16322PA005,,PAN001,PAS001,PAF007,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050019_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050019_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050019-01,Standard Silver On Exchange Plan,71.80%,0.715407490730286,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,300",$700,$0,$200,"$1,800","$1,200",$0,$80,5
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,6,16322,PA,Individual,No,46-2824626,16322PA0050019,"UPMC Advantage Silver $3,250/$10 - Partner Network",16322PA005,,PAN001,PAS001,PAF007,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050019_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050019_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050019-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,6,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060010,UPMC Small Business Advantage Platinum PPO $500 $20/$40 - Premium Network,16322PA006,,PAN009,PAS006,PAF032,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Platinum_16322PA0060010_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Platinum_16322PA0060010_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060010-00,Standard Platinum Off Exchange Plan,90.90%,0.901799619197845,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$500,$0,$200,$500,$500,$0,$80,6
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,6,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060010,UPMC Small Business Advantage Platinum PPO $500 $20/$40 - Premium Network,16322PA006,,PAN009,PAS006,PAF032,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Platinum_16322PA0060010_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Platinum_16322PA0060010_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060010-01,Standard Platinum On Exchange Plan,90.90%,0.901799619197845,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,6,16322,PA,Individual,No,46-2824626,16322PA0050019,"UPMC Advantage Silver $3,250/$10 - Partner Network",16322PA005,,PAN001,PAS001,PAF007,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050019_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050019_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050019-03,Limited Cost Sharing Plan Variation,71.80%,0.715407490730286,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,300",$700,$0,$200,"$1,800","$1,200",$0,$80,7
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,6,16322,PA,Individual,No,46-2824626,16322PA0050019,"UPMC Advantage Silver $3,250/$10 - Partner Network",16322PA005,,PAN001,PAS001,PAF007,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050019_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050019_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050019-04,73% AV Level Silver Plan,74.00%,0.735630631446838,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,300",$700,$0,$200,"$1,800","$1,200",$0,$80,8
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,6,16322,PA,Individual,No,46-2824626,16322PA0050019,"UPMC Advantage Silver $3,250/$10 - Partner Network",16322PA005,,PAN001,PAS001,PAF007,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050019_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050019_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050019-05,87% AV Level Silver Plan,87.50%,0.880695223808289,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$400,$0,$200,$500,$500,$500,$80,9
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,6,16322,PA,Individual,No,46-2824626,16322PA0050019,"UPMC Advantage Silver $3,250/$10 - Partner Network",16322PA005,,PAN001,PAS001,PAF007,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050019_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050019_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050019-06,94% AV Level Silver Plan,93.10%,0.936048209667206,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$100,$400,$0,$200,$100,$400,$500,$80,10
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,6,16322,PA,Individual,No,46-2824626,16322PA0050011,"UPMC Advantage Silver $3,250/$10 - Partner Network",16322PA005,,PAN005,PAS005,PAF007,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050011_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050011_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050011-00,Standard Silver Off Exchange Plan,71.80%,0.715407490730286,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,300",$700,$0,$200,"$1,800","$1,200",$0,$80,11
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,6,16322,PA,Individual,No,46-2824626,16322PA0050011,"UPMC Advantage Silver $3,250/$10 - Partner Network",16322PA005,,PAN005,PAS005,PAF007,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050011_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050011_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050011-01,Standard Silver On Exchange Plan,71.80%,0.715407490730286,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,300",$700,$0,$200,"$1,800","$1,200",$0,$80,12
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,6,16322,PA,Individual,No,46-2824626,16322PA0050011,"UPMC Advantage Silver $3,250/$10 - Partner Network",16322PA005,,PAN005,PAS005,PAF007,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050011_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050011_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050011-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,13
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,6,16322,PA,Individual,No,46-2824626,16322PA0050011,"UPMC Advantage Silver $3,250/$10 - Partner Network",16322PA005,,PAN005,PAS005,PAF007,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050011_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050011_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050011-03,Limited Cost Sharing Plan Variation,71.80%,0.715407490730286,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,300",$700,$0,$200,"$1,800","$1,200",$0,$80,14
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,6,16322,PA,Individual,No,46-2824626,16322PA0050011,"UPMC Advantage Silver $3,250/$10 - Partner Network",16322PA005,,PAN005,PAS005,PAF007,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050011_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050011_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050011-04,73% AV Level Silver Plan,74.00%,0.735630631446838,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,300",$700,$0,$200,"$1,800","$1,200",$0,$80,15
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,6,16322,PA,Individual,No,46-2824626,16322PA0050011,"UPMC Advantage Silver $3,250/$10 - Partner Network",16322PA005,,PAN005,PAS005,PAF007,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050011_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050011_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050011-05,87% AV Level Silver Plan,87.50%,0.880695223808289,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$400,$0,$200,$500,$500,$500,$80,16
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,6,16322,PA,Individual,No,46-2824626,16322PA0050011,"UPMC Advantage Silver $3,250/$10 - Partner Network",16322PA005,,PAN005,PAS005,PAF007,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050011_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050011_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050011-06,94% AV Level Silver Plan,93.10%,0.936048209667206,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$100,$400,$0,$200,$100,$400,$500,$80,17
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,7,16322,PA,Individual,No,46-2824626,16322PA0040012,UPMC Advantage Platinum $250/$20 - Premium Network,16322PA004,,PAN006,PAS006,PAF029,New,PPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Platinum_16322PA0040012_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Platinum_16322PA0040012_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040012-00,Standard Platinum Off Exchange Plan,88.70%,0.882924139499664,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$250,$500,10%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$300,$10,$700,$200,$300,$800,$500,$80,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,7,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060021,UPMC? Inside Advantage Platinum PPO $250 $20/$40 - Premium Network,16322PA006,,PAN010,PAS008,PAF032,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Platinum_16322PA0060021_Serv10_Net33,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Platinum_16322PA0060021_Serv10_Net33,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060021-00,Standard Platinum Off Exchange Plan,90.30%,0.906414449214935,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000","$10,000","$20,000",Not Applicable,Not Applicable,$250,$500,0%,"$1,000","$2,000",35%,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,"$1,000","$2,000",35%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$300,$400,$0,$200,$300,$800,$0,$80,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,7,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060021,UPMC? Inside Advantage Platinum PPO $250 $20/$40 - Premium Network,16322PA006,,PAN010,PAS008,PAF032,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Platinum_16322PA0060021_Serv10_Net33,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Platinum_16322PA0060021_Serv10_Net33,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060021-01,Standard Platinum On Exchange Plan,90.30%,0.906414449214935,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000","$10,000","$20,000",Not Applicable,Not Applicable,$250,$500,0%,"$1,000","$2,000",35%,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,"$1,000","$2,000",35%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$300,$400,$0,$200,$300,$800,$0,$80,5
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,7,16322,PA,Individual,No,46-2824626,16322PA0040012,UPMC Advantage Platinum $250/$20 - Premium Network,16322PA004,,PAN006,PAS006,PAF029,New,PPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Platinum_16322PA0040012_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Platinum_16322PA0040012_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040012-01,Standard Platinum On Exchange Plan,88.70%,0.882924139499664,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$250,$500,10%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$300,$10,$700,$200,$300,$800,$500,$80,5
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,7,16322,PA,Individual,No,46-2824626,16322PA0040012,UPMC Advantage Platinum $250/$20 - Premium Network,16322PA004,,PAN006,PAS006,PAF029,New,PPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Platinum_16322PA0040012_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Platinum_16322PA0040012_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040012-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,7,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060022,UPMC Inside Advantage Platinum PPO $500 $20/$40 - Premium Network,16322PA006,,PAN010,PAS008,PAF032,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060022_Serv10_Net33,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060022_Serv10_Net33,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060022-00,Standard Platinum Off Exchange Plan,90.40%,0.898107647895813,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000","$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",0%,"$1,000","$2,000",35%,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,"$1,000","$2,000",35%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$400,$0,$200,$500,$500,$0,$80,6
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,7,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060022,UPMC Inside Advantage Platinum PPO $500 $20/$40 - Premium Network,16322PA006,,PAN010,PAS008,PAF032,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060022_Serv10_Net33,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060022_Serv10_Net33,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060022-01,Standard Platinum On Exchange Plan,90.40%,0.898107647895813,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000","$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",0%,"$1,000","$2,000",35%,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,"$1,000","$2,000",35%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$400,$0,$200,$500,$500,$0,$80,7
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,7,16322,PA,Individual,No,46-2824626,16322PA0040012,UPMC Advantage Platinum $250/$20 - Premium Network,16322PA004,,PAN006,PAS006,PAF029,New,PPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Platinum_16322PA0040012_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Platinum_16322PA0040012_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040012-03,Limited Cost Sharing Plan Variation,88.70%,0.882924139499664,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$250,$500,10%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$300,$10,$700,$200,$300,$800,$500,$80,7
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,7,16322,PA,Individual,No,46-2824626,16322PA0050035,UPMC Advantage Platinum $250/$20 - Select Network,16322PA005,,PAN002,PAS002,PAF014,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050035_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050035_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050035-00,Standard Platinum Off Exchange Plan,88.70%,0.882924139499664,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$300,$10,$700,$200,$300,$800,$500,$80,8
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,7,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060023,"UPMC? Inside Advantage Gold PPO $1,250 $20/$40 - Premium Network",16322PA006,,PAN010,PAS008,PAF032,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060023_Serv10_Net33,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060023_Serv10_Net33,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060023-00,Standard Gold Off Exchange Plan,80.70%,0.830275416374207,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$2,500","$5,000","$5,000","$10,000","$10,000","$20,000",Not Applicable,Not Applicable,"$1,250","$2,500",0%,"$2,500","$5,000",35%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,"$2,500","$5,000",35%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$400,$0,$200,"$1,300","$1,000",$0,$80,8
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,7,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060023,"UPMC? Inside Advantage Gold PPO $1,250 $20/$40 - Premium Network",16322PA006,,PAN010,PAS008,PAF032,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060023_Serv10_Net33,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060023_Serv10_Net33,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060023-01,Standard Gold On Exchange Plan,80.70%,0.830275416374207,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$2,500","$5,000","$5,000","$10,000","$10,000","$20,000",Not Applicable,Not Applicable,"$1,250","$2,500",0%,"$2,500","$5,000",35%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,"$2,500","$5,000",35%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$400,$0,$200,"$1,300","$1,000",$0,$80,9
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,7,16322,PA,Individual,No,46-2824626,16322PA0050035,UPMC Advantage Platinum $250/$20 - Select Network,16322PA005,,PAN002,PAS002,PAF014,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050035_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050035_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050035-01,Standard Platinum On Exchange Plan,88.70%,0.882924139499664,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$300,$10,$700,$200,$300,$800,$500,$80,9
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,7,16322,PA,Individual,No,46-2824626,16322PA0050035,UPMC Advantage Platinum $250/$20 - Select Network,16322PA005,,PAN002,PAS002,PAF014,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050035_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050035_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050035-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,10
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,7,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060024,"UPMC? Inside Advantage? Gold PPO $1,500 $20/$40 - Premium Network",16322PA006,,PAN010,PAS008,PAF032,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060024_Serv10_Net33,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060024_Serv10_Net33,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060024-00,Standard Gold Off Exchange Plan,78.80%,0.813796818256378,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,000","$12,000","$10,000","$20,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,"$3,000","$6,000",35%,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,"$3,000","$6,000",35%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$400,$0,$200,"$1,500","$1,000",$0,$80,10
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,7,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060024,"UPMC? Inside Advantage? Gold PPO $1,500 $20/$40 - Premium Network",16322PA006,,PAN010,PAS008,PAF032,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060024_Serv10_Net33,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060024_Serv10_Net33,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060024-01,Standard Gold On Exchange Plan,78.80%,0.813796818256378,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,000","$12,000","$10,000","$20,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,"$3,000","$6,000",35%,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,"$3,000","$6,000",35%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$400,$0,$200,"$1,500","$1,000",$0,$80,11
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,7,16322,PA,Individual,No,46-2824626,16322PA0050035,UPMC Advantage Platinum $250/$20 - Select Network,16322PA005,,PAN002,PAS002,PAF014,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050035_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050035_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050035-03,Limited Cost Sharing Plan Variation,88.70%,0.882924139499664,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$300,$10,$700,$200,$300,$800,$500,$80,11
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,7,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060025,"UPMC? Inside Advantage Gold PPO $2,000 $20/$40 - Premium Network",16322PA006,,PAN010,PAS008,PAF032,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060025_Serv10_Net33,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060025_Serv10_Net33,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060025-00,Standard Gold Off Exchange Plan,78.40%,0.812395989894867,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$5,000","$10,000","$10,000","$20,000",Not Applicable,Not Applicable,"$2,000","$4,000",0%,"$4,000","$8,000",35%,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,"$4,000","$8,000",35%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$400,$0,$200,"$1,800","$1,000",$0,$80,12
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,7,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060025,"UPMC? Inside Advantage Gold PPO $2,000 $20/$40 - Premium Network",16322PA006,,PAN010,PAS008,PAF032,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060025_Serv10_Net33,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060025_Serv10_Net33,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060025-01,Standard Gold On Exchange Plan,78.40%,0.812395989894867,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$5,000","$10,000","$10,000","$20,000",Not Applicable,Not Applicable,"$2,000","$4,000",0%,"$4,000","$8,000",35%,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,"$4,000","$8,000",35%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$400,$0,$200,"$1,800","$1,000",$0,$80,13
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,8,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060001,"UPMC Small Business Advantage Silver PPO? $3,000/20%? $20/$40 - Premium Network",16322PA006,,PAN009,PAS006,PAF032,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Silver_16322PA0060001_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Silver_16322PA0060001_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060001-00,Standard Silver Off Exchange Plan,,0.715319335460663,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$3,000",$400,$800,$200,"$1,800","$1,000",$0,$80,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,8,16322,PA,Individual,No,46-2824626,16322PA0050023,UPMC Advantage Platinum $250/$20 - Partner Network,16322PA005,,PAN001,PAS001,PAF014,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050023_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050023_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050023-00,Standard Platinum Off Exchange Plan,89.00%,0.882924139499664,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$300,$10,$700,$200,$300,$800,$500,$80,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,8,16322,PA,Individual,No,46-2824626,16322PA0050023,UPMC Advantage Platinum $250/$20 - Partner Network,16322PA005,,PAN001,PAS001,PAF014,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050023_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050023_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050023-01,Standard Platinum On Exchange Plan,89.00%,0.882924139499664,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$300,$10,$700,$200,$300,$800,$500,$80,5
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,8,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060001,"UPMC Small Business Advantage Silver PPO? $3,000/20%? $20/$40 - Premium Network",16322PA006,,PAN009,PAS006,PAF032,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Silver_16322PA0060001_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Silver_16322PA0060001_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060001-01,Standard Silver On Exchange Plan,,0.715319335460663,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$3,000",$400,$800,$200,"$1,800","$1,000",$0,$80,5
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,8,16322,PA,Individual,No,46-2824626,16322PA0050023,UPMC Advantage Platinum $250/$20 - Partner Network,16322PA005,,PAN001,PAS001,PAF014,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050023_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050023_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050023-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,8,16322,PA,Individual,No,46-2824626,16322PA0050023,UPMC Advantage Platinum $250/$20 - Partner Network,16322PA005,,PAN001,PAS001,PAF014,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050023_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050023_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050023-03,Limited Cost Sharing Plan Variation,89.00%,0.882924139499664,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$300,$10,$700,$200,$300,$800,$500,$80,7
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,8,16322,PA,Individual,No,46-2824626,16322PA0050015,UPMC Advantage Platinum $250/$20 - Partner Network,16322PA005,,PAN005,PAS005,PAF014,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050015_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050015_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050015-00,Standard Platinum Off Exchange Plan,89.00%,0.882924139499664,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$300,$10,$700,$200,$300,$800,$500,$80,8
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,8,16322,PA,Individual,No,46-2824626,16322PA0050015,UPMC Advantage Platinum $250/$20 - Partner Network,16322PA005,,PAN005,PAS005,PAF014,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050015_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050015_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050015-01,Standard Platinum On Exchange Plan,89.00%,0.882924139499664,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$300,$10,$700,$200,$300,$800,$500,$80,9
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,8,16322,PA,Individual,No,46-2824626,16322PA0050015,UPMC Advantage Platinum $250/$20 - Partner Network,16322PA005,,PAN005,PAS005,PAF014,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050015_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050015_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050015-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,10
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,8,16322,PA,Individual,No,46-2824626,16322PA0050015,UPMC Advantage Platinum $250/$20 - Partner Network,16322PA005,,PAN005,PAS005,PAF014,New,EPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050015_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Platinum_16322PA0050015_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050015-03,Limited Cost Sharing Plan Variation,89.00%,0.882924139499664,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$300,$10,$700,$200,$300,$800,$500,$80,11
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,9,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060026,"UPMC? Inside Advantage Silver PPO $5,000 $20/$40 - Premium Network",16322PA006,,PAN010,PAS008,PAF032,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Silver_16322PA0060026_Serv10_Net33,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Silver_16322PA0060026_Serv10_Net33,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060026-00,Standard Silver Off Exchange Plan,71.10%,0.70829701423645,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$10,000","$20,000",Not Applicable,Not Applicable,"$5,000","$10,000",0%,"$6,000","$12,000",35%,"$6,350","$12,700",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,35%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$5,000",$400,$0,$200,"$1,800","$1,000",$0,$80,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,9,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060026,"UPMC? Inside Advantage Silver PPO $5,000 $20/$40 - Premium Network",16322PA006,,PAN010,PAS008,PAF032,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Silver_16322PA0060026_Serv10_Net33,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Silver_16322PA0060026_Serv10_Net33,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060026-01,Standard Silver On Exchange Plan,71.10%,0.70829701423645,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$10,000","$20,000",Not Applicable,Not Applicable,"$5,000","$10,000",0%,"$6,000","$12,000",35%,"$6,350","$12,700",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,35%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$5,000",$400,$0,$200,"$1,800","$1,000",$0,$80,5
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,10,16322,PA,Individual,No,46-2824626,16322PA0040003,"UPMC Advantage Bronze $5,500/$40 - Premium Network",16322PA004,,PAN006,PAS006,PAF017,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Bronze_16322PA0040003_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Bronze_16322PA0040003_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040003-00,Standard Bronze Off Exchange Plan,60.30%,0.618526339530945,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,500",$10,$500,$200,"$3,600",$300,$40,$80,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,10,16322,PA,Individual,No,46-2824626,16322PA0040003,"UPMC Advantage Bronze $5,500/$40 - Premium Network",16322PA004,,PAN006,PAS006,PAF017,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Bronze_16322PA0040003_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Bronze_16322PA0040003_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040003-01,Standard Bronze On Exchange Plan,60.30%,0.618526339530945,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,500",$10,$500,$200,"$3,600",$300,$40,$80,5
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,10,16322,PA,Individual,No,46-2824626,16322PA0040003,"UPMC Advantage Bronze $5,500/$40 - Premium Network",16322PA004,,PAN006,PAS006,PAF017,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Bronze_16322PA0040003_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Bronze_16322PA0040003_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,10,16322,PA,Individual,No,46-2824626,16322PA0040003,"UPMC Advantage Bronze $5,500/$40 - Premium Network",16322PA004,,PAN006,PAS006,PAF017,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Bronze_16322PA0040003_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Bronze_16322PA0040003_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040003-03,Limited Cost Sharing Plan Variation,60.30%,0.618526339530945,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,500",$10,$500,$200,"$3,600",$300,$40,$80,7
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,10,16322,PA,Individual,No,46-2824626,16322PA0040004,"UPMC Advantage Bronze $6,000/$25 - Premium Network",16322PA004,,PAN006,PAS006,PAF023,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Bronze_16322PA0040004_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Bronze_16322PA0040004_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040004-00,Standard Bronze Off Exchange Plan,59.80%,0.622113823890686,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,000",$20,$0,$200,"$3,600",$500,$40,$80,8
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,10,16322,PA,Individual,No,46-2824626,16322PA0040004,"UPMC Advantage Bronze $6,000/$25 - Premium Network",16322PA004,,PAN006,PAS006,PAF023,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Bronze_16322PA0040004_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Bronze_16322PA0040004_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040004-01,Standard Bronze On Exchange Plan,59.80%,0.622113823890686,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,000",$20,$0,$200,"$3,600",$500,$40,$80,9
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,10,16322,PA,Individual,No,46-2824626,16322PA0040004,"UPMC Advantage Bronze $6,000/$25 - Premium Network",16322PA004,,PAN006,PAS006,PAF023,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Bronze_16322PA0040004_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Bronze_16322PA0040004_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,10
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,10,16322,PA,Individual,No,46-2824626,16322PA0040004,"UPMC Advantage Bronze $6,000/$25 - Premium Network",16322PA004,,PAN006,PAS006,PAF023,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Bronze_16322PA0040004_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Bronze_16322PA0040004_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040004-03,Limited Cost Sharing Plan Variation,59.80%,0.622113823890686,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,000",$20,$0,$200,"$3,600",$500,$40,$80,11
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,10,16322,PA,Individual,No,46-2824626,16322PA0050026,"UPMC Advantage Bronze $5,500/$40 - Select Network",16322PA005,,PAN002,PAS002,PAF001,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050026_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050026_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050026-00,Standard Bronze Off Exchange Plan,60.30%,0.618526339530945,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$20,$500,$200,"$3,600",$600,$40,$80,12
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,10,16322,PA,Individual,No,46-2824626,16322PA0050026,"UPMC Advantage Bronze $5,500/$40 - Select Network",16322PA005,,PAN002,PAS002,PAF001,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050026_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050026_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050026-01,Standard Bronze On Exchange Plan,60.30%,0.618526339530945,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$20,$500,$200,"$3,600",$600,$40,$80,13
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,13,16322,PA,Individual,No,46-2824626,16322PA0050004,"UPMC Advantage Silver HSA $2,000/20% - Partner Network",16322PA005,,PAN001,PAS001,PAF006,New,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050004_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050004_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,13,16322,PA,Individual,No,46-2824626,16322PA0050004,"UPMC Advantage Silver HSA $2,000/20% - Partner Network",16322PA005,,PAN001,PAS001,PAF006,New,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050004_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050004_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050004-03,Limited Cost Sharing Plan Variation,,0.71302330493927,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$10,"$1,100",$200,"$2,000",$800,$300,$80,7
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,13,16322,PA,Individual,No,46-2824626,16322PA0050004,"UPMC Advantage Silver HSA $2,000/20% - Partner Network",16322PA005,,PAN001,PAS001,PAF006,New,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050004_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050004_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050004-04,73% AV Level Silver Plan,,0.734553933143616,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$10,"$1,200",$200,"$1,500",$800,$400,$80,8
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,13,16322,PA,Individual,No,46-2824626,16322PA0050004,"UPMC Advantage Silver HSA $2,000/20% - Partner Network",16322PA005,,PAN001,PAS001,PAF006,New,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050004_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050004_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050004-05,87% AV Level Silver Plan,,0.865670084953308,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$600,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$10,"$1,400",$200,$300,$300,$700,$80,9
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,10,16322,PA,Individual,No,46-2824626,16322PA0050026,"UPMC Advantage Bronze $5,500/$40 - Select Network",16322PA005,,PAN002,PAS002,PAF001,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050026_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050026_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050026-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,14
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,10,16322,PA,Individual,No,46-2824626,16322PA0050026,"UPMC Advantage Bronze $5,500/$40 - Select Network",16322PA005,,PAN002,PAS002,PAF001,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050026_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050026_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050026-03,Limited Cost Sharing Plan Variation,60.30%,0.618526339530945,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$20,$500,$200,"$3,600",$600,$40,$80,15
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,10,16322,PA,Individual,No,46-2824626,16322PA0050027,"UPMC Advantage Bronze $6,000/$25 - Select Network",16322PA005,,PAN002,PAS002,PAF002,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050027_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050027_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050027-00,Standard Bronze Off Exchange Plan,59.80%,0.622113823890686,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$20,$0,$200,"$3,600",$500,$40,$80,16
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,10,16322,PA,Individual,No,46-2824626,16322PA0050027,"UPMC Advantage Bronze $6,000/$25 - Select Network",16322PA005,,PAN002,PAS002,PAF002,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050027_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050027_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050027-01,Standard Bronze On Exchange Plan,59.80%,0.622113823890686,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$20,$0,$200,"$3,600",$500,$40,$80,17
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,10,16322,PA,Individual,No,46-2824626,16322PA0050027,"UPMC Advantage Bronze $6,000/$25 - Select Network",16322PA005,,PAN002,PAS002,PAF002,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050027_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050027_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050027-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,18
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,10,16322,PA,Individual,No,46-2824626,16322PA0050027,"UPMC Advantage Bronze $6,000/$25 - Select Network",16322PA005,,PAN002,PAS002,PAF002,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050027_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050027_Serv5_Net25,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050027-03,Limited Cost Sharing Plan Variation,59.80%,0.622113823890686,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$20,$0,$200,"$3,600",$500,$40,$80,19
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,11,16322,PA,Individual,No,46-2824626,16322PA0050002,"UPMC Advantage Bronze $5,500/$40 - Partner Network",16322PA005,,PAN001,PAS001,PAF001,New,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050002_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050002_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050002-00,Standard Bronze Off Exchange Plan,,0.618526339530945,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$20,$500,$200,"$3,600",$600,$40,$80,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,11,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060019,"UPMC Consumer Advantage Gold HSA PPO $1,350 - Premium Network",16322PA006,,PAN009,PAS006,PAF035,New,PPO,Gold,Yes,Both,No,No,,,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060019_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060019_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060019-00,Standard Gold Off Exchange Plan,78.90%,0.798790693283081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,700","$5,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",0%,,,,"$2,700","$5,400",Not Applicable,Not Applicable,"$1,400",$10,$0,$200,"$1,400",$700,$0,$80,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,11,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060019,"UPMC Consumer Advantage Gold HSA PPO $1,350 - Premium Network",16322PA006,,PAN009,PAS006,PAF035,New,PPO,Gold,Yes,Both,No,No,,,,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060019_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Gold_16322PA0060019_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060019-01,Standard Gold On Exchange Plan,78.90%,0.798790693283081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,700","$5,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",0%,,,,"$2,700","$5,400",Not Applicable,Not Applicable,"$1,400",$10,$0,$200,"$1,400",$700,$0,$80,5
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,11,16322,PA,Individual,No,46-2824626,16322PA0050002,"UPMC Advantage Bronze $5,500/$40 - Partner Network",16322PA005,,PAN001,PAS001,PAF001,New,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050002_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050002_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050002-01,Standard Bronze On Exchange Plan,,0.618526339530945,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$20,$500,$200,"$3,600",$600,$40,$80,5
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,11,16322,PA,Individual,No,46-2824626,16322PA0050002,"UPMC Advantage Bronze $5,500/$40 - Partner Network",16322PA005,,PAN001,PAS001,PAF001,New,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050002_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050002_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,11,16322,PA,Individual,No,46-2824626,16322PA0050002,"UPMC Advantage Bronze $5,500/$40 - Partner Network",16322PA005,,PAN001,PAS001,PAF001,New,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050002_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050002_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050002-03,Limited Cost Sharing Plan Variation,,0.618526339530945,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$20,$500,$200,"$3,600",$600,$40,$80,7
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,11,16322,PA,Individual,No,46-2824626,16322PA0050003,"UPMC Advantage Bronze $6,000/$25 - Partner Network",16322PA005,,PAN001,PAS001,PAF002,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050003_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050003_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050003-00,Standard Bronze Off Exchange Plan,59.80%,0.622113823890686,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$20,$0,$200,"$3,600",$500,$40,$80,8
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,11,16322,PA,Individual,No,46-2824626,16322PA0050003,"UPMC Advantage Bronze $6,000/$25 - Partner Network",16322PA005,,PAN001,PAS001,PAF002,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050003_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050003_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050003-01,Standard Bronze On Exchange Plan,59.80%,0.622113823890686,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$20,$0,$200,"$3,600",$500,$40,$80,9
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,11,16322,PA,Individual,No,46-2824626,16322PA0050003,"UPMC Advantage Bronze $6,000/$25 - Partner Network",16322PA005,,PAN001,PAS001,PAF002,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050003_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050003_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,10
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,11,16322,PA,Individual,No,46-2824626,16322PA0050003,"UPMC Advantage Bronze $6,000/$25 - Partner Network",16322PA005,,PAN001,PAS001,PAF002,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050003_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050003_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050003-03,Limited Cost Sharing Plan Variation,59.80%,0.622113823890686,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$20,$0,$200,"$3,600",$500,$40,$80,11
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,11,16322,PA,Individual,No,46-2824626,16322PA0050006,"UPMC Advantage Bronze $5,500/$40 - Partner Network",16322PA005,,PAN005,PAS005,PAF001,New,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050006_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050006_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050006-00,Standard Bronze Off Exchange Plan,,0.618526339530945,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$20,$500,$200,"$3,600",$600,$40,$80,12
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,11,16322,PA,Individual,No,46-2824626,16322PA0050006,"UPMC Advantage Bronze $5,500/$40 - Partner Network",16322PA005,,PAN005,PAS005,PAF001,New,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050006_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050006_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050006-01,Standard Bronze On Exchange Plan,,0.618526339530945,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$20,$500,$200,"$3,600",$600,$40,$80,13
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,11,16322,PA,Individual,No,46-2824626,16322PA0050006,"UPMC Advantage Bronze $5,500/$40 - Partner Network",16322PA005,,PAN005,PAS005,PAF001,New,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050006_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050006_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,14
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,11,16322,PA,Individual,No,46-2824626,16322PA0050006,"UPMC Advantage Bronze $5,500/$40 - Partner Network",16322PA005,,PAN005,PAS005,PAF001,New,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050006_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050006_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050006-03,Limited Cost Sharing Plan Variation,,0.618526339530945,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$20,$500,$200,"$3,600",$600,$40,$80,15
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,11,16322,PA,Individual,No,46-2824626,16322PA0050007,"UPMC Advantage Bronze $6,000/$25 - Partner Network",16322PA005,,PAN005,PAS005,PAF002,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050007_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050007_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050007-00,Standard Bronze Off Exchange Plan,59.80%,0.622113823890686,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$20,$0,$200,"$3,600",$500,$40,$80,16
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,11,16322,PA,Individual,No,46-2824626,16322PA0050007,"UPMC Advantage Bronze $6,000/$25 - Partner Network",16322PA005,,PAN005,PAS005,PAF002,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050007_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050007_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050007-01,Standard Bronze On Exchange Plan,59.80%,0.622113823890686,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$20,$0,$200,"$3,600",$500,$40,$80,17
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,11,16322,PA,Individual,No,46-2824626,16322PA0050007,"UPMC Advantage Bronze $6,000/$25 - Partner Network",16322PA005,,PAN005,PAS005,PAF002,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050007_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050007_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,18
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,11,16322,PA,Individual,No,46-2824626,16322PA0050007,"UPMC Advantage Bronze $6,000/$25 - Partner Network",16322PA005,,PAN005,PAS005,PAF002,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050007_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Bronze_16322PA0050007_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050007-03,Limited Cost Sharing Plan Variation,59.80%,0.622113823890686,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$20,$0,$200,"$3,600",$500,$40,$80,19
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,12,16322,PA,Individual,No,46-2824626,16322PA0040005,"UPMC Advantage Silver HSA $2,000/20% - Premium Network",16322PA004,,PAN006,PAS006,PAF022,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040005_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040005-00,Standard Silver Off Exchange Plan,,0.71302330493927,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$10,"$1,100",$200,"$2,000",$800,$70,$80,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,12,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060016,UPMC HealthyU? Silver HIA PPO $2500 - Premium Network,16322PA006,,PAN009,PAS006,PAF034,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Silver_16322PA0060016_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Silver_16322PA0060016_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060016-00,Standard Silver Off Exchange Plan,71.30%,0.712400138378143,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$10,$0,$200,"$2,100",$700,$0,$80,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,12,16322,PA,SHOP (Small Group),No,46-2824626,16322PA0060016,UPMC HealthyU? Silver HIA PPO $2500 - Premium Network,16322PA006,,PAN009,PAS006,PAF034,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Silver_16322PA0060016_Serv19_Net32,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_PPO_Silver_16322PA0060016_Serv19_Net32,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0060016-01,Standard Silver On Exchange Plan,71.30%,0.712400138378143,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$10,$0,$200,"$2,100",$700,$0,$80,5
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,12,16322,PA,Individual,No,46-2824626,16322PA0040005,"UPMC Advantage Silver HSA $2,000/20% - Premium Network",16322PA004,,PAN006,PAS006,PAF022,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040005_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040005-01,Standard Silver On Exchange Plan,,0.71302330493927,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$10,"$1,100",$200,"$2,000",$800,$70,$80,5
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,12,16322,PA,Individual,No,46-2824626,16322PA0040005,"UPMC Advantage Silver HSA $2,000/20% - Premium Network",16322PA004,,PAN006,PAS006,PAF022,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040005_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,12,16322,PA,Individual,No,46-2824626,16322PA0040005,"UPMC Advantage Silver HSA $2,000/20% - Premium Network",16322PA004,,PAN006,PAS006,PAF022,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040005_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040005-03,Limited Cost Sharing Plan Variation,,0.71302330493927,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$10,"$1,100",$200,"$2,000",$800,$70,$80,7
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,12,16322,PA,Individual,No,46-2824626,16322PA0040005,"UPMC Advantage Silver HSA $2,000/20% - Premium Network",16322PA004,,PAN006,PAS006,PAF022,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040005_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040005-04,73% AV Level Silver Plan,,0.734553933143616,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,"$1,500",$10,"$1,200",$200,"$1,500",$800,$300,$80,8
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,12,16322,PA,Individual,No,46-2824626,16322PA0040005,"UPMC Advantage Silver HSA $2,000/20% - Premium Network",16322PA004,,PAN006,PAS006,PAF022,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040005_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040005-05,87% AV Level Silver Plan,,0.865670084953308,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$600,20%,,,,$600,"$1,200",Not Applicable,Not Applicable,$300,$10,"$1,400",$200,$300,$300,$700,$80,9
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,12,16322,PA,Individual,No,46-2824626,16322PA0040005,"UPMC Advantage Silver HSA $2,000/20% - Premium Network",16322PA004,,PAN006,PAS006,PAF022,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Silver_16322PA0040005_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040005-06,94% AV Level Silver Plan,,0.931563138961792,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,20%,,,,$200,$400,Not Applicable,Not Applicable,$100,$0,$700,$200,$100,$0,$700,$80,10
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,12,16322,PA,Individual,No,46-2824626,16322PA0050028,"UPMC Advantage Silver HSA $2,000/20% - Select Network",16322PA005,,PAN002,PAS002,PAF006,New,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050028_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050028-00,Standard Silver Off Exchange Plan,,0.71302330493927,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$10,"$1,100",$200,"$2,000",$800,$300,$80,11
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,12,16322,PA,Individual,No,46-2824626,16322PA0050028,"UPMC Advantage Silver HSA $2,000/20% - Select Network",16322PA005,,PAN002,PAS002,PAF006,New,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050028_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050028-01,Standard Silver On Exchange Plan,,0.71302330493927,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$10,"$1,100",$200,"$2,000",$800,$300,$80,12
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,12,16322,PA,Individual,No,46-2824626,16322PA0050028,"UPMC Advantage Silver HSA $2,000/20% - Select Network",16322PA005,,PAN002,PAS002,PAF006,New,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050028_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050028-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,13
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,12,16322,PA,Individual,No,46-2824626,16322PA0050028,"UPMC Advantage Silver HSA $2,000/20% - Select Network",16322PA005,,PAN002,PAS002,PAF006,New,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050028_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050028-03,Limited Cost Sharing Plan Variation,,0.71302330493927,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$10,"$1,100",$200,"$2,000",$800,$300,$80,14
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,12,16322,PA,Individual,No,46-2824626,16322PA0050028,"UPMC Advantage Silver HSA $2,000/20% - Select Network",16322PA005,,PAN002,PAS002,PAF006,New,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050028_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050028-04,73% AV Level Silver Plan,,0.734553933143616,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$10,"$1,200",$200,"$1,500",$800,$400,$80,15
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,12,16322,PA,Individual,No,46-2824626,16322PA0050028,"UPMC Advantage Silver HSA $2,000/20% - Select Network",16322PA005,,PAN002,PAS002,PAF006,New,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050028_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050028-05,87% AV Level Silver Plan,,0.865670084953308,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$600,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$10,"$1,400",$200,$300,$300,$700,$80,16
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,12,16322,PA,Individual,No,46-2824626,16322PA0050028,"UPMC Advantage Silver HSA $2,000/20% - Select Network",16322PA005,,PAN002,PAS002,PAF006,New,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050028_Serv5_Net25,https://www.upmchealthplan.com/marketplace/pay.aspx,,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050028-06,94% AV Level Silver Plan,,0.931563138961792,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$0,$700,$200,$100,$200,$500,$80,17
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,13,16322,PA,Individual,No,46-2824626,16322PA0050004,"UPMC Advantage Silver HSA $2,000/20% - Partner Network",16322PA005,,PAN001,PAS001,PAF006,New,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050004_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050004_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050004-00,Standard Silver Off Exchange Plan,,0.71302330493927,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$10,"$1,100",$200,"$2,000",$800,$300,$80,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,13,16322,PA,Individual,No,46-2824626,16322PA0050004,"UPMC Advantage Silver HSA $2,000/20% - Partner Network",16322PA005,,PAN001,PAS001,PAF006,New,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050004_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050004_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050004-01,Standard Silver On Exchange Plan,,0.71302330493927,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$10,"$1,100",$200,"$2,000",$800,$300,$80,5
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,13,16322,PA,Individual,No,46-2824626,16322PA0050004,"UPMC Advantage Silver HSA $2,000/20% - Partner Network",16322PA005,,PAN001,PAS001,PAF006,New,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050004_Serv1_Net24,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050004_Serv1_Net24,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050004-06,94% AV Level Silver Plan,,0.931563138961792,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$0,$700,$200,$100,$200,$500,$80,10
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,13,16322,PA,Individual,No,46-2824626,16322PA0050008,"UPMC Advantage Silver HSA $2,000/20% - Partner Network",16322PA005,,PAN005,PAS005,PAF006,New,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050008_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050008_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050008-00,Standard Silver Off Exchange Plan,,0.71302330493927,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$10,"$1,100",$200,"$2,000",$800,$300,$80,11
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,13,16322,PA,Individual,No,46-2824626,16322PA0050008,"UPMC Advantage Silver HSA $2,000/20% - Partner Network",16322PA005,,PAN005,PAS005,PAF006,New,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050008_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050008_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050008-01,Standard Silver On Exchange Plan,,0.71302330493927,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$10,"$1,100",$200,"$2,000",$800,$300,$80,12
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,13,16322,PA,Individual,No,46-2824626,16322PA0050008,"UPMC Advantage Silver HSA $2,000/20% - Partner Network",16322PA005,,PAN005,PAS005,PAF006,New,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050008_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050008_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,13
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,13,16322,PA,Individual,No,46-2824626,16322PA0050008,"UPMC Advantage Silver HSA $2,000/20% - Partner Network",16322PA005,,PAN005,PAS005,PAF006,New,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050008_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050008_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050008-03,Limited Cost Sharing Plan Variation,,0.71302330493927,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$10,"$1,100",$200,"$2,000",$800,$300,$80,14
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,13,16322,PA,Individual,No,46-2824626,16322PA0050008,"UPMC Advantage Silver HSA $2,000/20% - Partner Network",16322PA005,,PAN005,PAS005,PAF006,New,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050008_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050008_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050008-04,73% AV Level Silver Plan,,0.734553933143616,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$10,"$1,200",$200,"$1,500",$800,$400,$80,15
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,13,16322,PA,Individual,No,46-2824626,16322PA0050008,"UPMC Advantage Silver HSA $2,000/20% - Partner Network",16322PA005,,PAN005,PAS005,PAF006,New,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050008_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050008_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050008-05,87% AV Level Silver Plan,,0.865670084953308,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$600,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$10,"$1,400",$200,$300,$300,$700,$80,16
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,13,16322,PA,Individual,No,46-2824626,16322PA0050008,"UPMC Advantage Silver HSA $2,000/20% - Partner Network",16322PA005,,PAN005,PAS005,PAF006,New,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050008_Serv1N_Net28,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_EPO_Silver_16322PA0050008_Serv1N_Net28,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0050008-06,94% AV Level Silver Plan,,0.931563138961792,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$0,$700,$200,$100,$200,$500,$80,17
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,17,16322,PA,Individual,No,46-2824626,16322PA0040001,"UPMC Advantage Catastrophic $6,600/$0 - Premium Network",16322PA004,,PAN006,PAS006,PAF025,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Cat_16322PA0040001_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Cat_16322PA0040001_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$3,600",$90,$0,$80,4
2015,PA,16322,HIOS,6,2014-11-09 04:38:15,17,16322,PA,Individual,No,46-2824626,16322PA0040001,"UPMC Advantage Catastrophic $6,600/$0 - Premium Network",16322PA004,,PAN006,PAS006,PAF025,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Medical and Dental Services,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Cat_16322PA0040001_Serv29_Net29,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_IND_PPO_Cat_16322PA0040001_Serv29_Net29,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,16322PA0040001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$3,600",$90,$0,$80,5
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200008,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS001,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200008-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,47
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200008,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS001,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,48
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200010,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS003,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,62
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200010,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS003,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200010-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,63
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200010,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS003,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200010-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,64
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200010,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS003,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200010-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,65
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200009,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS002,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200009-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,53
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200009,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS002,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200009-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,54
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200018,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS004,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200018-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200018,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS004,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200018-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200009,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS002,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,55
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200009,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS002,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200009-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200001,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS001,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200001-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200001,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS001,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200001-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200001,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS001,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,13
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200001,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS001,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200001-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200002,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS002,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200002-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200002,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS002,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200002-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200002,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS002,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,17
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200002,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS002,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200002-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200003,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS003,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200003-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200003,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS003,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200003-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200003,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS003,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,21
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200003,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS003,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200003-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200004,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS004,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200004-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200004,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS004,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200004-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200004,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS004,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,25
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200004,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS004,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200004-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200005,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS005,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200005-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200005,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS005,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200005-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200005,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS005,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,29
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200005,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS005,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200005-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200006,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS006,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200006-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200006,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS006,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200006-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200006,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS006,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,33
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200006,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS006,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200006-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200007,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS007,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200007-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200007,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS007,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200007-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200007,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS007,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,37
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200007,Assurant Health Bronze Plan 001,19068PA020,,PAN001,PAS007,PAF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200007-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200008,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS001,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200008-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,46
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200008,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS001,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200008-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200008,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS001,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200008-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,50
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200008,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS001,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200008-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,51
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200008,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS001,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200008-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,52
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200009,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS002,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200009-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,57
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200009,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS002,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200009-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,58
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200009,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS002,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200009-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,59
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200010,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS003,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200010-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,60
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200010,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS003,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200010-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,61
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200010,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS003,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200010-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,66
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200011,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS004,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200011-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,67
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200040,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS005,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200040-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,127
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040010,Geisinger Health Plan Marketplace POS 25/50/2500,22444PA004,,PAN001,PAS001,PAF003,Existing,POS,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_25_50_2500.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040010-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200025,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS004,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200025-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200025,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS004,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200025-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200026,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS005,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200026-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200026,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS005,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200026-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200026,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS005,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200026-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,41
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200026,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS005,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200026-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,42
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200036,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS001,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200036-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,112
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200037,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS002,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200037-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,113
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,1,22444,PA,Individual,No,23-2311553,22444PA0040008,Geisinger Health Plan Marketplace POS HDHP 20/20/1350,22444PA004,,PAN001,PAS001,PAF001,Existing,POS,Gold,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_20pct_20pct_1350.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040008-03,Limited Cost Sharing Plan Variation,78.20%,0.775048911571503,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,1,22444,PA,Individual,No,23-2311553,22444PA0040018,Geisinger Health Plan Marketplace POS HDHP 0/0/6000,22444PA004,,PAN001,PAS001,PAF002,Existing,POS,Bronze,No,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_0pct_0pct_6000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040018-00,Standard Bronze Off Exchange Plan,,0.586621820926666,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010002,Marketplace Extra 10/50/500,22444PA001,,PAN001,PAS003,PAF003,New,HMO,Gold,No,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_500.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200011,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS004,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200011-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,68
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200011,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS004,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,69
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200011,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS004,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200011-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,70
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200011,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS004,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200011-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,71
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200011,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS004,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200011-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,72
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200011,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS004,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200011-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,73
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200012,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS005,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200012-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,74
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200012,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS005,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200012-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,75
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200012,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS005,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,76
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200012,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS005,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200012-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,77
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200012,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS005,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200012-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,78
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200012,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS005,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200012-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,79
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200012,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS005,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200012-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,80
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200013,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS006,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200013-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,81
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200013,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS006,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200013-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,82
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200013,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS006,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,83
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200013,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS006,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200013-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,84
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200013,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS006,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200013-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,85
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200013,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS006,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200013-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,86
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200013,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS006,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200013-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,87
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200014,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS007,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200014-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,88
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200014,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS007,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200014-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,89
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200014,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS007,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,90
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200014,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS007,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200014-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,91
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200014,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS007,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200014-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,92
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200014,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS007,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200014-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,93
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,1,19068,PA,Individual,No,39-0658730,19068PA0200014,Assurant Health Silver Plan 001,19068PA020,,PAN001,PAS007,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200014-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,94
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200015,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS001,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200015-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200015,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS001,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200015-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200015,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS001,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200015-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,13
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200015,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS001,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200015-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200016,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS002,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200016-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200016,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS002,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200016-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200016,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS002,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200016-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,17
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200016,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS002,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200016-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200017,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS003,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200017-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200017,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS003,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200017-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200017,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS003,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200017-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,21
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200017,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS003,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200017-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200023,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS002,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200023-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200023,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS002,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200023-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200024,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS003,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200024-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200024,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS003,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200024-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200029,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS001,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200029-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,76
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200029,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS001,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200029-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,77
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200040,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS005,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200040-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,126
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040010,Geisinger Health Plan Marketplace POS 25/50/2500,22444PA004,,PAN001,PAS001,PAF003,Existing,POS,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_25_50_2500.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040010-03,Limited Cost Sharing Plan Variation,71.55%,0.739427864551544,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$250,$500,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010004,Marketplace Extra 10/50/3000,22444PA001,,PAN001,PAS003,PAF001,New,HMO,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_3000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010004-03,Limited Cost Sharing Plan Variation,68.53%,0.728779554367065,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,"$3,000","$6,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,$250,$500,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010004,Marketplace Extra 10/50/3000,22444PA001,,PAN001,PAS003,PAF001,New,HMO,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_3000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010004-04,73% AV Level Silver Plan,72.10%,0.758378744125366,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,"$3,000","$6,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,$250,$500,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200018,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS004,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200018-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,25
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200018,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS004,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200018-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200019,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS005,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200019-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200019,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS005,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200019-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200019,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS005,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200019-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,29
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200019,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS005,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200019-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200020,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS006,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200020-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200020,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS006,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200020-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200020,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS006,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200020-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,33
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200020,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS006,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200020-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200021,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS007,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200021-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200021,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS007,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200021-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200021,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS007,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200021-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,37
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,3,19068,PA,Individual,No,39-0658730,19068PA0200021,Assurant Health Bronze Plan 002,19068PA020,,PAN001,PAS007,PAF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19068PA0200021-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200022,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS001,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200022-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200022,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS001,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200022-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200022,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS001,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200022-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,13
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200022,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS001,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200022-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200022,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS001,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200022-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200022,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS001,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200022-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200022,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS001,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200022-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200023,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS002,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200023-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200023,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS002,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200023-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200023,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS002,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200023-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,20
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200023,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS002,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200023-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200023,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS002,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200023-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200024,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS003,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200024-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,27
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200024,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS003,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200024-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200024,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS003,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200024-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200024,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS003,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200024-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200024,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS003,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200024-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200025,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS004,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200025-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200025,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS004,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200025-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200025,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS004,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200025-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,34
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200025,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS004,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200025-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200025,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS004,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200025-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200026,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS005,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200026-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,43
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200026,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS005,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200026-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200026,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS005,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200026-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200027,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS006,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200027-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,46
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200027,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS006,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200027-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,47
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200027,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS006,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200027-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,48
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200027,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS006,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200027-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200027,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS006,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200027-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,50
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200027,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS006,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200027-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,51
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200027,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS006,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200027-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,52
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200028,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS007,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200028-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,53
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200028,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS007,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200028-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,54
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200028,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS007,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200028-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,55
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200028,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS007,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200028-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200028,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS007,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200028-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,57
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200028,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS007,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200028-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,58
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200028,Assurant Health Silver Plan 002,19068PA020,,PAN001,PAS007,PAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200028-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,59
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200029,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS001,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200029-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,74
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200029,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS001,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200029-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,75
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200030,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS002,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200030-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,78
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200030,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS002,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200030-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,79
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200030,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS002,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200030-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,80
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200030,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS002,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200030-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,81
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200031,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS003,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200031-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,82
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200031,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS003,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200031-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,83
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200031,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS003,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200031-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,84
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200031,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS003,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200031-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,85
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200032,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS004,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200032-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,86
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200032,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS004,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200032-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,87
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200032,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS004,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200032-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,88
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200032,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS004,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200032-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,89
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200033,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS005,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200033-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,90
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200033,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS005,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200033-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,91
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200033,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS005,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200033-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,92
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200033,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS005,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200033-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,93
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200034,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS006,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200034-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,94
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200034,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS006,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200034-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,95
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200034,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS006,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200034-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,96
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200034,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS006,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200034-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,97
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200035,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS007,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200035-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,98
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200035,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS007,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200035-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,99
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200035,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS007,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200035-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,100
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200035,Assurant Health Gold Plan 002,19068PA020,,PAN001,PAS007,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200035-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,101
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200036,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS001,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200036-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,109
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200036,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS001,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200036-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,110
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200036,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS001,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200036-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,111
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010002,Marketplace Extra 10/50/500,22444PA001,,PAN001,PAS003,PAF003,New,HMO,Gold,No,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_500.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010002-03,Limited Cost Sharing Plan Variation,,0.808313846588135,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,$500,"$1,000",20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,$250,$500,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010003,Marketplace Extra 10/50/2000,22444PA001,,PAN001,PAS003,PAF003,New,HMO,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_2000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010003-00,Standard Silver Off Exchange Plan,71.40%,0.738892138004303,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,"$2,000","$4,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,$250,$500,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010003,Marketplace Extra 10/50/2000,22444PA001,,PAN001,PAS003,PAF003,New,HMO,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_2000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010003-01,Standard Silver On Exchange Plan,71.40%,0.738892138004303,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,"$2,000","$4,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,$250,$500,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,3,24872,PA,Individual,No,25-1756858,24872PA0010001,UnitedHealthcare Gold Compass  500,24872PA001,,PAN006,PAS001,PAF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,3,24872,PA,Individual,No,25-1756858,24872PA0010001,UnitedHealthcare Gold Compass  500,24872PA001,,PAN006,PAS001,PAF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010001-03,Limited Cost Sharing Plan Variation,78.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200037,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS002,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200037-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,114
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200037,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS002,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200037-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,115
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,1,22444,PA,Individual,No,23-2311553,22444PA0040018,Geisinger Health Plan Marketplace POS HDHP 0/0/6000,22444PA004,,PAN001,PAS001,PAF002,Existing,POS,Bronze,No,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_0pct_0pct_6000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040018-01,Standard Bronze On Exchange Plan,,0.586621820926666,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,1,22444,PA,Individual,No,23-2311553,22444PA0040018,Geisinger Health Plan Marketplace POS HDHP 0/0/6000,22444PA004,,PAN001,PAS001,PAF002,Existing,POS,Bronze,No,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_0pct_0pct_6000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040018-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,1,22444,PA,Individual,No,23-2311553,22444PA0040018,Geisinger Health Plan Marketplace POS HDHP 0/0/6000,22444PA004,,PAN001,PAS001,PAF002,Existing,POS,Bronze,No,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_0pct_0pct_6000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040018-03,Limited Cost Sharing Plan Variation,,0.586621820926666,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,1,22444,PA,Individual,No,23-2311553,22444PA0040019,Marketplace Value,22444PA004,,PAN001,PAS001,PAF001,Existing,POS,Catastrophic,No,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Value.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040019-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,1,31609,PA,Individual,No,23-2184623,31609PA0070001,Personal Choice PPO Platinum,31609PA007,,PAN001,PAS001,PAF013,Existing,PPO,Platinum,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,5,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppoplatinum2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary,31609PA0070001-01,Standard Platinum On Exchange Plan,88.07%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,1,31609,PA,Individual,No,23-2184623,31609PA0070001,Personal Choice PPO Platinum,31609PA007,,PAN001,PAS001,PAF013,Existing,PPO,Platinum,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,5,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppoplatinum2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary,31609PA0070001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,1,31609,PA,Individual,No,23-2184623,31609PA0070001,Personal Choice PPO Platinum,31609PA007,,PAN001,PAS001,PAF013,Existing,PPO,Platinum,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,5,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppoplatinum2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary,31609PA0070001-03,Limited Cost Sharing Plan Variation,88.07%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,2,31609,PA,Individual,No,23-2184623,31609PA0070002,Personal Choice PPO Gold,31609PA007,,PAN001,PAS001,PAF014,Existing,PPO,Gold,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$200,5,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S,Yes,https://www.ibx4you.com/ffm/ppogold2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,31609PA0070002-00,Standard Gold Off Exchange Plan,81.91%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,35%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,2,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150002,Personal Choice PPO Platinum,31609PA015,,PAN001,PAS001,PAF002,Existing,PPO,Platinum,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,5,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150002-00,Standard Platinum Off Exchange Plan,88.88%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,2,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150002,Personal Choice PPO Platinum,31609PA015,,PAN001,PAS001,PAF002,Existing,PPO,Platinum,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,5,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150002-01,Standard Platinum On Exchange Plan,88.88%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,2,31609,PA,Individual,No,23-2184623,31609PA0070002,Personal Choice PPO Gold,31609PA007,,PAN001,PAS001,PAF014,Existing,PPO,Gold,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$200,5,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S,Yes,https://www.ibx4you.com/ffm/ppogold2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,31609PA0070002-01,Standard Gold On Exchange Plan,81.91%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,35%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,2,31609,PA,Individual,No,23-2184623,31609PA0070002,Personal Choice PPO Gold,31609PA007,,PAN001,PAS001,PAF014,Existing,PPO,Gold,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$200,5,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S,Yes,https://www.ibx4you.com/ffm/ppogold2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,31609PA0070002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,8,31609,PA,Individual,No,23-2184623,31609PA0070007,Personal Choice Catastrophic,31609PA007,,PAN001,PAS001,PAF024,Existing,PPO,Catastrophic,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,0,0,3,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppocatastrophic2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary,31609PA0070007-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,8,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150008,Personal Choice PPO Gold HSA,31609PA015,,PAN001,PAS001,PAF005,Existing,PPO,Gold,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150008-00,Standard Gold Off Exchange Plan,79.04%,0.790352404117584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,3,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0460012,Flex PPO $500 Total Health a Community Blue Plan,33709PA046,,PAN001,PAS001,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0460012-00,Standard Gold Off Exchange Plan,81.30%,0.842131376266479,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000",Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,3,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0460012,Flex PPO $500 Total Health a Community Blue Plan,33709PA046,,PAN001,PAS001,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0460012-01,Standard Gold On Exchange Plan,81.30%,0.842131376266479,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000",Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,9,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0490004,FLEX EPO $1650 A Community Blue Plan,33709PA049,,PAN002,PAS005,PAF006,Existing,EPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0490004-00,Standard Silver Off Exchange Plan,,0.690674722194672,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",20%,"$1,650","$3,300",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,9,33709,PA,Individual,No,23-1294723,33709PA0420005,Flex Blue PPO 2650 a Community Blue Plan,33709PA042,,PAN002,PAS004,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420005-06,94% AV Level Silver Plan,,0.932851016521454,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$650,"$1,300",$650,"$1,300","$11,200","$22,400",Not Applicable,Not Applicable,$100,$200,10%,$200,$400,30%,"$10,600","$21,200",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200037,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS002,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200037-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,116
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200038,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS003,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200038-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,117
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200038,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS003,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200038-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,118
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200038,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS003,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200038-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,119
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200038,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS003,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200038-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,120
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200039,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS004,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200039-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,121
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200039,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS004,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200039-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,122
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200039,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS004,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200039-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,123
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200039,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS004,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200039-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,124
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200040,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS005,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200040-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,125
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200040,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS005,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200040-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,128
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200041,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS006,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200041-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,129
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200041,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS006,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200041-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,130
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200041,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS006,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200041-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,131
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200041,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS006,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200041-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,132
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200042,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS007,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200042-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,133
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200042,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS007,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200042-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,134
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200042,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS007,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200042-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,135
2015,PA,19068,HIOS,4,2014-11-09 04:38:15,5,19068,PA,Individual,No,39-0658730,19068PA0200042,Assurant Health Platinum Plan 002,19068PA020,,PAN001,PAS007,PAF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_PA_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-PA.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19068PA0200042-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,136
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,1,22444,PA,Individual,No,23-2311553,22444PA0040008,Geisinger Health Plan Marketplace POS HDHP 20/20/1350,22444PA004,,PAN001,PAS001,PAF001,Existing,POS,Gold,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_20pct_20pct_1350.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040008-00,Standard Gold Off Exchange Plan,78.20%,0.775048911571503,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,1,22444,PA,Individual,No,23-2311553,22444PA0040008,Geisinger Health Plan Marketplace POS HDHP 20/20/1350,22444PA004,,PAN001,PAS001,PAF001,Existing,POS,Gold,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_20pct_20pct_1350.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040008-01,Standard Gold On Exchange Plan,78.20%,0.775048911571503,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,1,22444,PA,Individual,No,23-2311553,22444PA0040008,Geisinger Health Plan Marketplace POS HDHP 20/20/1350,22444PA004,,PAN001,PAS001,PAF001,Existing,POS,Gold,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_20pct_20pct_1350.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040008-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,1,22444,PA,Individual,No,23-2311553,22444PA0040019,Marketplace Value,22444PA004,,PAN001,PAS001,PAF001,Existing,POS,Catastrophic,No,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Value.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040019-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040005,Geisinger Health Plan Marketplace HMO 15/30/0,22444PA004,,PAN001,PAS004,PAF009,Existing,HMO,Platinum,No,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMO_15_30_0.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040005-00,Standard Platinum Off Exchange Plan,,0.891186118125916,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010003,Marketplace Extra 10/50/2000,22444PA001,,PAN001,PAS003,PAF003,New,HMO,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_2000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010003-06,94% AV Level Silver Plan,94.40%,0.946275532245636,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$750,"$1,500",$750,"$1,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,$100,$200,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,10,33709,PA,Individual,No,23-1294723,33709PA0390007,Shared Cost Blue PPO $2100 a Community Blue Flex Plan,33709PA039,,PAN001,PAS002,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0390007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,10,33709,PA,Individual,No,23-1294723,33709PA0390007,Shared Cost Blue PPO $2100 a Community Blue Flex Plan,33709PA039,,PAN001,PAS002,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0390007-03,Limited Cost Sharing Plan Variation,,0.690574884414673,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400",Not Applicable,Not Applicable,"$2,100","$4,200",30%,"$4,200","$8,400",50%,"$8,400","$16,800",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,10,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150010,Personal Choice PPO Silver HSA 25,31609PA015,,PAN001,PAS001,PAF007,Existing,PPO,Silver,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,Yes,Yes,$550.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150010-00,Standard Silver Off Exchange Plan,,0.708137333393097,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,200","$4,400",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,10,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150010,Personal Choice PPO Silver HSA 25,31609PA015,,PAN001,PAS001,PAF007,Existing,PPO,Silver,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,Yes,Yes,$550.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150010-01,Standard Silver On Exchange Plan,,0.708137333393097,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,200","$4,400",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040005,Geisinger Health Plan Marketplace HMO 15/30/0,22444PA004,,PAN001,PAS004,PAF009,Existing,HMO,Platinum,No,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMO_15_30_0.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040005-01,Standard Platinum On Exchange Plan,,0.891186118125916,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040005,Geisinger Health Plan Marketplace HMO 15/30/0,22444PA004,,PAN001,PAS004,PAF009,Existing,HMO,Platinum,No,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMO_15_30_0.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040005,Geisinger Health Plan Marketplace HMO 15/30/0,22444PA004,,PAN001,PAS004,PAF009,Existing,HMO,Platinum,No,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMO_15_30_0.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040005-03,Limited Cost Sharing Plan Variation,,0.891186118125916,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040002,Geisinger Health Plan Marketplace POS 25/50/300,22444PA004,,PAN001,PAS001,PAF003,Existing,POS,Gold,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_25_50_300.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040002-00,Standard Gold Off Exchange Plan,81.37%,0.832447707653046,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$300,$600,20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$250,$500,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040002,Geisinger Health Plan Marketplace POS 25/50/300,22444PA004,,PAN001,PAS001,PAF003,Existing,POS,Gold,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_25_50_300.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040002-01,Standard Gold On Exchange Plan,81.40%,0.832447707653046,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$300,$600,20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$250,$500,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040002,Geisinger Health Plan Marketplace POS 25/50/300,22444PA004,,PAN001,PAS001,PAF003,Existing,POS,Gold,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_25_50_300.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040002,Geisinger Health Plan Marketplace POS 25/50/300,22444PA004,,PAN001,PAS001,PAF003,Existing,POS,Gold,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_25_50_300.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040002-03,Limited Cost Sharing Plan Variation,81.40%,0.832447707653046,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$300,$600,20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$250,$500,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040007,Geisinger Health Plan Marketplace POS 25/50/1000,22444PA004,,PAN001,PAS001,PAF006,Existing,POS,Gold,No,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_25_50_1000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040007-00,Standard Gold Off Exchange Plan,,0.807893037796021,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$125,$250,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040007,Geisinger Health Plan Marketplace POS 25/50/1000,22444PA004,,PAN001,PAS001,PAF006,Existing,POS,Gold,No,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_25_50_1000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040007-01,Standard Gold On Exchange Plan,,0.807893037796021,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$125,$250,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040007,Geisinger Health Plan Marketplace POS 25/50/1000,22444PA004,,PAN001,PAS001,PAF006,Existing,POS,Gold,No,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_25_50_1000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040007,Geisinger Health Plan Marketplace POS 25/50/1000,22444PA004,,PAN001,PAS001,PAF006,Existing,POS,Gold,No,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_25_50_1000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040007-03,Limited Cost Sharing Plan Variation,,0.807893037796021,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$125,$250,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040010,Geisinger Health Plan Marketplace POS 25/50/2500,22444PA004,,PAN001,PAS001,PAF003,Existing,POS,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_25_50_2500.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040010-00,Standard Silver Off Exchange Plan,71.55%,0.739427864551544,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$250,$500,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040010,Geisinger Health Plan Marketplace POS 25/50/2500,22444PA004,,PAN001,PAS001,PAF003,Existing,POS,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_25_50_2500.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040010-01,Standard Silver On Exchange Plan,71.55%,0.739427864551544,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$250,$500,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040010,Geisinger Health Plan Marketplace POS 25/50/2500,22444PA004,,PAN001,PAS001,PAF003,Existing,POS,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_25_50_2500.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040010-04,73% AV Level Silver Plan,73.76%,0.764117062091827,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040010,Geisinger Health Plan Marketplace POS 25/50/2500,22444PA004,,PAN001,PAS001,PAF003,Existing,POS,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_25_50_2500.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040010-05,87% AV Level Silver Plan,88.00%,0.872336566448212,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$15,000","$30,000",Not Applicable,Not Applicable,$175,$350,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040010,Geisinger Health Plan Marketplace POS 25/50/2500,22444PA004,,PAN001,PAS001,PAF003,Existing,POS,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_25_50_2500.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040010-06,94% AV Level Silver Plan,94.72%,0.944721341133118,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$15,000","$30,000",Not Applicable,Not Applicable,$100,$200,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040014,Geisinger Health Plan Marketplace POS 30/50/5000,22444PA004,,PAN001,PAS001,PAF004,Existing,POS,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_30_50_5000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040014-00,Standard Silver Off Exchange Plan,71.88%,0.72442501783371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040014,Geisinger Health Plan Marketplace POS 30/50/5000,22444PA004,,PAN001,PAS001,PAF004,Existing,POS,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_30_50_5000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040014-01,Standard Silver On Exchange Plan,71.88%,0.72442501783371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040014,Geisinger Health Plan Marketplace POS 30/50/5000,22444PA004,,PAN001,PAS001,PAF004,Existing,POS,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_30_50_5000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040014-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,25
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040014,Geisinger Health Plan Marketplace POS 30/50/5000,22444PA004,,PAN001,PAS001,PAF004,Existing,POS,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_30_50_5000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040014-03,Limited Cost Sharing Plan Variation,71.88%,0.72442501783371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040014,Geisinger Health Plan Marketplace POS 30/50/5000,22444PA004,,PAN001,PAS001,PAF004,Existing,POS,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_30_50_5000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040014-04,73% AV Level Silver Plan,73.88%,0.763731837272644,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040014,Geisinger Health Plan Marketplace POS 30/50/5000,22444PA004,,PAN001,PAS001,PAF004,Existing,POS,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_30_50_5000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040014-05,87% AV Level Silver Plan,88.00%,0.872336566448212,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$15,000","$30,000",Not Applicable,Not Applicable,$175,$350,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,3,22444,PA,Individual,No,23-2311553,22444PA0040014,Geisinger Health Plan Marketplace POS 30/50/5000,22444PA004,,PAN001,PAS001,PAF004,Existing,POS,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_HMOPOS_30_50_5000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0040014-06,94% AV Level Silver Plan,94.72%,0.944721341133118,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$15,000","$30,000",Not Applicable,Not Applicable,$100,$200,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010001,Marketplace Extra 10/50/0,22444PA001,,PAN001,PAS003,PAF007,New,HMO,Platinum,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_0.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010001-00,Standard Platinum Off Exchange Plan,88.66%,0.877638459205627,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010001,Marketplace Extra 10/50/0,22444PA001,,PAN001,PAS003,PAF007,New,HMO,Platinum,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_0.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010001-01,Standard Platinum On Exchange Plan,88.66%,0.877638459205627,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010001,Marketplace Extra 10/50/0,22444PA001,,PAN001,PAS003,PAF007,New,HMO,Platinum,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_0.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010001,Marketplace Extra 10/50/0,22444PA001,,PAN001,PAS003,PAF007,New,HMO,Platinum,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_0.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010001-03,Limited Cost Sharing Plan Variation,88.66%,0.877638459205627,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010002,Marketplace Extra 10/50/500,22444PA001,,PAN001,PAS003,PAF003,New,HMO,Gold,No,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_500.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010002-00,Standard Gold Off Exchange Plan,,0.808313846588135,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,$500,"$1,000",20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,$250,$500,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010002,Marketplace Extra 10/50/500,22444PA001,,PAN001,PAS003,PAF003,New,HMO,Gold,No,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_500.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010002-01,Standard Gold On Exchange Plan,,0.808313846588135,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,$500,"$1,000",20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,$250,$500,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010003,Marketplace Extra 10/50/2000,22444PA001,,PAN001,PAS003,PAF003,New,HMO,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_2000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010003-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010003,Marketplace Extra 10/50/2000,22444PA001,,PAN001,PAS003,PAF003,New,HMO,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_2000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010003-03,Limited Cost Sharing Plan Variation,71.40%,0.738892138004303,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,"$2,000","$4,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,$250,$500,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010003,Marketplace Extra 10/50/2000,22444PA001,,PAN001,PAS003,PAF003,New,HMO,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_2000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010003-04,73% AV Level Silver Plan,73.90%,0.757558107376099,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,"$2,000","$4,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,$250,$500,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010003,Marketplace Extra 10/50/2000,22444PA001,,PAN001,PAS003,PAF003,New,HMO,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_2000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010003-05,87% AV Level Silver Plan,86.40%,0.876315653324127,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$175,$350,0%,$175,$350,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,10,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0480002,Comprehensive Care EPO $1500 A Community Blue Plan,33709PA048,,PAN001,PAS002,PAF006,New,EPO,Gold,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0480002-01,Standard Gold On Exchange Plan,,0.782333493232727,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,200","$4,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,10,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0480003,Comprehensive Care EPO $2000 A Community Blue Plan,33709PA048,,PAN001,PAS001,PAF006,New,EPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0480003-00,Standard Silver Off Exchange Plan,,0.683790028095245,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,2,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0460001,Flex PPO $0/$500 a Community Blue Plan,33709PA046,,PAN002,PAS004,PAF013,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$250,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/clients/highmark/commercial.html,33709PA0460001-01,Standard Platinum On Exchange Plan,88.50%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,$500,"$1,000",20%,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,2,33709,PA,Individual,No,23-1294723,33709PA0420011,Flex Blue PPO 1000 a Community Blue Plan,33709PA042,,PAN002,PAS005,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420011-01,Standard Gold On Exchange Plan,,0.785676658153534,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$2,500","$5,000","$8,000","$16,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,"$2,000","$4,000",40%,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,6,33709,PA,Individual,No,23-1294723,33709PA0430001,Health Savings Blue PPO 1700 a Community Blue Plan,33709PA043,,PAN002,PAS004,PAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0430001-06,94% AV Level Silver Plan,,0.949837803840637,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$500,"$1,000",$500,"$1,000","$9,100","$18,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,$100,$200,20%,"$3,400","$6,800",Not Applicable,Not Applicable,,,,,,,,,10
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,6,33709,PA,Individual,No,23-1294723,33709PA0430003,Health Savings Blue PPO 1700 a Community Blue Plan,33709PA043,,PAN002,PAS005,PAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0430003-00,Standard Silver Off Exchange Plan,,0.716458022594452,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$4,550","$9,100","$4,550","$9,100","$9,100","$18,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400",20%,"$1,700","$3,400",30%,"$3,400","$6,800",Not Applicable,Not Applicable,,,,,,,,,11
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,9,33709,PA,Individual,No,23-1294723,33709PA0420005,Flex Blue PPO 2650 a Community Blue Plan,33709PA042,,PAN002,PAS004,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420005-05,87% AV Level Silver Plan,,0.867320120334625,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","$11,200","$22,400",Not Applicable,Not Applicable,$400,$800,20%,$800,"$1,600",40%,"$10,600","$21,200",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,9,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0490003,FLEX EPO $1650 A Community Blue Plan,33709PA049,,PAN002,PAS004,PAF006,Existing,EPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0490003-01,Standard Silver On Exchange Plan,,0.690674722194672,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",20%,"$1,650","$3,300",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010004,Marketplace Extra 10/50/3000,22444PA001,,PAN001,PAS003,PAF001,New,HMO,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_3000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010004-00,Standard Silver Off Exchange Plan,68.53%,0.728779554367065,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,"$3,000","$6,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,$250,$500,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010004,Marketplace Extra 10/50/3000,22444PA001,,PAN001,PAS003,PAF001,New,HMO,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_3000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010004-01,Standard Silver On Exchange Plan,68.53%,0.728779554367065,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,"$3,000","$6,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,$250,$500,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010004,Marketplace Extra 10/50/3000,22444PA001,,PAN001,PAS003,PAF001,New,HMO,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_3000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010004-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010004,Marketplace Extra 10/50/3000,22444PA001,,PAN001,PAS003,PAF001,New,HMO,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_3000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010004-05,87% AV Level Silver Plan,86.40%,0.876315653324127,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$175,$350,0%,$175,$350,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010004,Marketplace Extra 10/50/3000,22444PA001,,PAN001,PAS003,PAF001,New,HMO,Silver,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_3000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010004-06,94% AV Level Silver Plan,94.40%,0.946275532245636,No,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$750,"$1,500",$750,"$1,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,$100,$200,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010005,Marketplace Extra 10/50/6000,22444PA001,,PAN001,PAS003,PAF008,New,HMO,Bronze,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_6000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010005-00,Standard Bronze Off Exchange Plan,61.22%,0.65016371011734,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",30%,"$6,000","$12,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,26
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010005,Marketplace Extra 10/50/6000,22444PA001,,PAN001,PAS003,PAF008,New,HMO,Bronze,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_6000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010005-01,Standard Bronze On Exchange Plan,61.22%,0.65016371011734,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",30%,"$6,000","$12,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,27
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010005,Marketplace Extra 10/50/6000,22444PA001,,PAN001,PAS003,PAF008,New,HMO,Bronze,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_6000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,28
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,4,22444,PA,Individual,No,23-2311553,22444PA0010005,Marketplace Extra 10/50/6000,22444PA001,,PAN001,PAS003,PAF008,New,HMO,Bronze,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care,Yes,Emergent and urgent care.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_Extra_10_50_6000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010005-03,Limited Cost Sharing Plan Variation,61.22%,0.65016371011734,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",30%,"$6,000","$12,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,29
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,5,22444,PA,Individual,No,23-2311553,22444PA0010006,Marketplace HMO 20/40/3000,22444PA001,,PAN001,PAS001,PAF008,New,HMO,Gold,No,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_20_40_3000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010006-00,Standard Gold Off Exchange Plan,,0.796670734882355,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,5,22444,PA,Individual,No,23-2311553,22444PA0010006,Marketplace HMO 20/40/3000,22444PA001,,PAN001,PAS001,PAF008,New,HMO,Gold,No,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_20_40_3000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010006-01,Standard Gold On Exchange Plan,,0.796670734882355,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,5,22444,PA,Individual,No,23-2311553,22444PA0010006,Marketplace HMO 20/40/3000,22444PA001,,PAN001,PAS001,PAF008,New,HMO,Gold,No,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_20_40_3000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,5,22444,PA,Individual,No,23-2311553,22444PA0010006,Marketplace HMO 20/40/3000,22444PA001,,PAN001,PAS001,PAF008,New,HMO,Gold,No,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_20_40_3000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010006-03,Limited Cost Sharing Plan Variation,,0.796670734882355,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,5,22444,PA,Individual,No,23-2311553,22444PA0010007,Marketplace HMO 20/40/4000,22444PA001,,PAN001,PAS001,PAF008,New,HMO,Gold,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_20_40_4000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010007-00,Standard Gold Off Exchange Plan,79.80%,0.776250123977661,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,5,22444,PA,Individual,No,23-2311553,22444PA0010007,Marketplace HMO 20/40/4000,22444PA001,,PAN001,PAS001,PAF008,New,HMO,Gold,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_20_40_4000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010007-01,Standard Gold On Exchange Plan,79.80%,0.776250123977661,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,5,22444,PA,Individual,No,23-2311553,22444PA0010007,Marketplace HMO 20/40/4000,22444PA001,,PAN001,PAS001,PAF008,New,HMO,Gold,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_20_40_4000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010007-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,PA,22444,HIOS,11,2014-11-14 05:23:27,5,22444,PA,Individual,No,23-2311553,22444PA0010007,Marketplace HMO 20/40/4000,22444PA001,,PAN001,PAS001,PAF008,New,HMO,Gold,Yes,Both,No,Yes,"Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Health_Plan_Marketplace_20_40_4000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,22444PA0010007-03,Limited Cost Sharing Plan Variation,79.80%,0.776250123977661,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,1,24872,PA,Individual,No,25-1756858,24872PA0010004,UnitedHealthcare Silver Compass  HSA 1600,24872PA001,,PAN006,PAS001,PAF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010004-00,Standard Silver Off Exchange Plan,68.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,1,24872,PA,Individual,No,25-1756858,24872PA0010004,UnitedHealthcare Silver Compass  HSA 1600,24872PA001,,PAN006,PAS001,PAF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010004-01,Standard Silver On Exchange Plan,68.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,1,24872,PA,Individual,No,25-1756858,24872PA0010004,UnitedHealthcare Silver Compass  HSA 1600,24872PA001,,PAN006,PAS001,PAF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,1,24872,PA,Individual,No,25-1756858,24872PA0010004,UnitedHealthcare Silver Compass  HSA 1600,24872PA001,,PAN006,PAS001,PAF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010004-03,Limited Cost Sharing Plan Variation,68.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,1,24872,PA,Individual,No,25-1756858,24872PA0010004,UnitedHealthcare Silver Compass  HSA 1600,24872PA001,,PAN006,PAS001,PAF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010004-04,73% AV Level Silver Plan,72.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,1,24872,PA,Individual,No,25-1756858,24872PA0010004,UnitedHealthcare Silver Compass  HSA 1600,24872PA001,,PAN006,PAS001,PAF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010004-05,87% AV Level Silver Plan,86.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,1,24872,PA,Individual,No,25-1756858,24872PA0010004,UnitedHealthcare Silver Compass  HSA 1600,24872PA001,,PAN006,PAS001,PAF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010004-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,1,24872,PA,Individual,No,25-1756858,24872PA0010016,UnitedHealthcare Bronze Compass HSA 4900,24872PA001,,PAN006,PAS001,PAF004,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010016-00,Standard Bronze Off Exchange Plan,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,1,24872,PA,Individual,No,25-1756858,24872PA0010016,UnitedHealthcare Bronze Compass HSA 4900,24872PA001,,PAN006,PAS001,PAF004,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010016-01,Standard Bronze On Exchange Plan,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,1,24872,PA,Individual,No,25-1756858,24872PA0010016,UnitedHealthcare Bronze Compass HSA 4900,24872PA001,,PAN006,PAS001,PAF004,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010016-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,1,24872,PA,Individual,No,25-1756858,24872PA0010016,UnitedHealthcare Bronze Compass HSA 4900,24872PA001,,PAN006,PAS001,PAF004,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010016-03,Limited Cost Sharing Plan Variation,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,2,24872,PA,Individual,No,25-1756858,24872PA0010019,UnitedHealthcare Bronze Compass 5500,24872PA001,,PAN006,PAS001,PAF004,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010019-00,Standard Bronze Off Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,2,24872,PA,Individual,No,25-1756858,24872PA0010019,UnitedHealthcare Bronze Compass 5500,24872PA001,,PAN006,PAS001,PAF004,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010019-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,2,24872,PA,Individual,No,25-1756858,24872PA0010019,UnitedHealthcare Bronze Compass 5500,24872PA001,,PAN006,PAS001,PAF004,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010019-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,2,24872,PA,Individual,No,25-1756858,24872PA0010019,UnitedHealthcare Bronze Compass 5500,24872PA001,,PAN006,PAS001,PAF004,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010019-03,Limited Cost Sharing Plan Variation,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,3,24872,PA,Individual,No,25-1756858,24872PA0010001,UnitedHealthcare Gold Compass  500,24872PA001,,PAN006,PAS001,PAF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010001-00,Standard Gold Off Exchange Plan,78.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,3,24872,PA,Individual,No,25-1756858,24872PA0010001,UnitedHealthcare Gold Compass  500,24872PA001,,PAN006,PAS001,PAF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010001-01,Standard Gold On Exchange Plan,78.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,9,33709,PA,Individual,No,23-1294723,33709PA0420005,Flex Blue PPO 2650 a Community Blue Plan,33709PA042,,PAN002,PAS004,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420005-03,Limited Cost Sharing Plan Variation,,0.688801348209381,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$5,600","$11,200","$5,600","$11,200","$11,200","$22,400",Not Applicable,Not Applicable,"$2,650","$5,300",30%,"$5,300","$10,600",50%,"$10,600","$21,200",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,9,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0490002,FLEX EPO $500/$1000 A Community Blue Plan,33709PA049,,PAN002,PAS005,PAF006,Existing,EPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0490002-01,Standard Gold On Exchange Plan,81.99%,0.82002991437912,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$2,200","$4,400","$4,150","$8,300",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,"$1,000","$2,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0560015,Premier Balance PPO $500 A a Community Blue Flex Plan,33709PA056,,PAN001,PAS001,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0560015-01,Standard Gold On Exchange Plan,79.90%,,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$3,400","$6,800","$3,400","$6,800","$10,200","$20,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,"$1,500","$3,000",30%,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0560017,Premier Balance PPO $750 A a Community Blue Flex Plan,33709PA056,,PAN001,PAS001,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0560017-00,Standard Gold Off Exchange Plan,79.40%,,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$3,400","$6,800","$3,400","$6,800","$10,200","$20,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",0%,"$1,500","$3,000",30%,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,PA,38086,HIOS,3,2014-08-05 13:28:44,1,38086,PA,SHOP (Small Group),Yes,47-0397286,38086PA0030001,"Renaissance Group Dental PPO, EHB Certified",38086PA003,,PAN001,PAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.90,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,38086PA0030001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,38086,HIOS,3,2014-08-05 13:28:44,1,38086,PA,SHOP (Small Group),Yes,47-0397286,38086PA0030002,"Renaissance Group Dental PPO, EHB Certified",38086PA003,,PAN001,PAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.64,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,38086PA0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,38086,HIOS,3,2014-08-05 13:28:44,1,38086,PA,Individual,Yes,47-0397286,38086PA0010002,"Delta Dental Individual PPO, EHB Certified",38086PA001,,PAN002,PAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.73,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,38086PA0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,38086,HIOS,3,2014-08-05 13:28:44,1,38086,PA,Individual,Yes,47-0397286,38086PA0020001,"Renaissance Individual Dental PPO, EHB Certified",38086PA002,,PAN001,PAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.14,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,38086PA0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,1,45127,PA,SHOP (Small Group),No,45-5492167,45127PA0010137,Healthy Benefits PPO 1000.0 EX,45127PA001,7588667726,PAN004,PAS002,PAF007,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent & Urgent,Yes,Emergent & Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/45127PA006000200_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0010137-00,Standard Gold Off Exchange Plan,80.80%,0.81167596578598,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,"$1,000","$2,000",0%,"$1,000","$2,000",0%,"$6,000","$12,000",Not Applicable,Not Applicable,$100,$200,0%,$100,$200,0%,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$0,$200,$600,"$2,100",$0,$80,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,1,45127,PA,SHOP (Small Group),No,45-5492167,45127PA0010137,Healthy Benefits PPO 1000.0 EX,45127PA001,7588667726,PAN004,PAS002,PAF007,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent & Urgent,Yes,Emergent & Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/45127PA006000200_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0010137-01,Standard Gold On Exchange Plan,80.80%,0.81167596578598,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,"$1,000","$2,000",0%,"$1,000","$2,000",0%,"$6,000","$12,000",Not Applicable,Not Applicable,$100,$200,0%,$100,$200,0%,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$0,$200,$600,"$2,100",$0,$80,5
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,1,45127,PA,Individual,No,45-5492167,45127PA0020007,Healthy Benefits PPO 5500.50,45127PA002,7588667726,PAN004,PAS002,PAF001,New,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002000701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020007-01,Standard Bronze On Exchange Plan,61.89%,0.618901968002319,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,"$5,500","$11,000",50%,"$5,500","$11,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,1,45127,PA,Individual,Yes,45-5492167,45127PA0030001,Healthy Dental PPO Plan 1,45127PA003,,PAN003,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.19,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Standard PPO Coverage,Yes,Standard PPO Coverage,Yes,,,www.capbluecross.com/pdf/benefits_summary/dental/45127PA0030001_2015.pdf,,45127PA0030001-01,Standard Low On Exchange Plan,71.98%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,1,45127,PA,Individual,No,45-5492167,45127PA0020007,Healthy Benefits PPO 5500.50,45127PA002,7588667726,PAN004,PAS002,PAF001,New,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002000701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,3,24872,PA,Individual,No,25-1756858,24872PA0010010,UnitedHealthcare Silver Compass 5000,24872PA001,,PAN006,PAS001,PAF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010010-00,Standard Silver Off Exchange Plan,69.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,3,24872,PA,Individual,No,25-1756858,24872PA0010010,UnitedHealthcare Silver Compass 5000,24872PA001,,PAN006,PAS001,PAF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010010-01,Standard Silver On Exchange Plan,69.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,3,24872,PA,Individual,No,25-1756858,24872PA0010010,UnitedHealthcare Silver Compass 5000,24872PA001,,PAN006,PAS001,PAF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010010-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,3,24872,PA,Individual,No,25-1756858,24872PA0010010,UnitedHealthcare Silver Compass 5000,24872PA001,,PAN006,PAS001,PAF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010010-03,Limited Cost Sharing Plan Variation,69.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,3,24872,PA,Individual,No,25-1756858,24872PA0010010,UnitedHealthcare Silver Compass 5000,24872PA001,,PAN006,PAS001,PAF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010010-04,73% AV Level Silver Plan,73.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,$750,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,3,24872,PA,Individual,No,25-1756858,24872PA0010010,UnitedHealthcare Silver Compass 5000,24872PA001,,PAN006,PAS001,PAF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010010-05,87% AV Level Silver Plan,86.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,PA,24872,HIOS,9,2014-12-11 04:09:12,3,24872,PA,Individual,No,25-1756858,24872PA0010010,UnitedHealthcare Silver Compass 5000,24872PA001,,PAN006,PAS001,PAF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xpa,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xpa,24872PA0010010-06,94% AV Level Silver Plan,93.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,1,31609,PA,Individual,No,23-2184623,31609PA0070001,Personal Choice PPO Platinum,31609PA007,,PAN001,PAS001,PAF013,Existing,PPO,Platinum,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,5,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppoplatinum2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary,31609PA0070001-00,Standard Platinum Off Exchange Plan,88.07%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,1,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150001,Personal Choice PPO Platinum Premier,31609PA015,,PAN001,PAS001,PAF001,Existing,PPO,Platinum,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150001-00,Standard Platinum Off Exchange Plan,91.16%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,100%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,1,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150001,Personal Choice PPO Platinum Premier,31609PA015,,PAN001,PAS001,PAF001,Existing,PPO,Platinum,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150001-01,Standard Platinum On Exchange Plan,91.16%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,100%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,14,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150014,Personal Choice PPO Platinum HRA 50,31609PA015,,PAN001,PAS001,PAF010,Existing,PPO,Platinum,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,No,Yes,$750.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150014-00,Standard Platinum Off Exchange Plan,88.64%,0.886358737945557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,14,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150014,Personal Choice PPO Platinum HRA 50,31609PA015,,PAN001,PAS001,PAF010,Existing,PPO,Platinum,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,No,Yes,$750.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150014-01,Standard Platinum On Exchange Plan,88.64%,0.886358737945557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0560029,Premier Balance PPO $1400 A a Community Blue Flex Plan,33709PA056,,PAN001,PAS001,PAF008,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0560029-01,Standard Silver On Exchange Plan,71.90%,,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",0%,"$5,000","$10,000",30%,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,12,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0580016,High Deductible PPO $4000 Qualified A a Community Blue Flex Plan,33709PA058,,PAN001,PAS001,PAF006,New,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0580016-00,Standard Bronze Off Exchange Plan,61.00%,0.633822977542877,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$19,350","$38,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,"$4,000","$8,000",30%,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,38086,HIOS,3,2014-08-05 13:28:44,1,38086,PA,SHOP (Small Group),Yes,47-0397286,38086PA0050001,"Renaissance Group Dental Indemnity, EHB Certified",38086PA005,,PAN001,PAS001,,Existing,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.90,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,38086PA0050001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,38086,HIOS,3,2014-08-05 13:28:44,1,38086,PA,SHOP (Small Group),Yes,47-0397286,38086PA0050002,"Renaissance Group Dental Indemnity, EHB Certified",38086PA005,,PAN001,PAS001,,Existing,Indemnity,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.64,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,38086PA0050002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,38086,HIOS,3,2014-08-05 13:28:44,1,38086,PA,Individual,Yes,47-0397286,38086PA0020002,"Renaissance Individual Dental PPO, EHB Certified",38086PA002,,PAN001,PAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.34,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,38086PA0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,38086,HIOS,3,2014-08-05 13:28:44,2,38086,PA,Individual,Yes,47-0397286,38086PA0040001,"Renaissance Individual Dental Indemnity, EHB Certified",38086PA004,,PAN001,PAS001,,Existing,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.82,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefits,Yes,,,,,38086PA0040001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,38086,HIOS,3,2014-08-05 13:28:44,2,38086,PA,Individual,Yes,47-0397286,38086PA0040002,"Renaissance Individual Dental Indemnity, EHB Certified",38086PA004,,PAN001,PAS001,,Existing,Indemnity,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.10,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefits,Yes,,,,,38086PA0040002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,1,45127,PA,Individual,Yes,45-5492167,45127PA0030001,Healthy Dental PPO Plan 1,45127PA003,,PAN003,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.19,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Standard PPO Coverage,Yes,Standard PPO Coverage,Yes,,,www.capbluecross.com/pdf/benefits_summary/dental/45127PA0030001_2015.pdf,,45127PA0030001-00,Standard Low Off Exchange Plan,71.98%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,1,45127,PA,SHOP (Small Group),Yes,45-5492167,45127PA0040001,Healthy Dental PPO Basic,45127PA004,,PAN002,PAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.46,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Standard PPO Coverage,Yes,Standard PPO Coverage,Yes,,,www.capbluecross.com/pdf/benefits_summary/dental/45127PA0040001_2015.pdf,,45127PA0040001-00,Standard Low Off Exchange Plan,71.98%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,1,45127,PA,Individual,No,45-5492167,45127PA0020007,Healthy Benefits PPO 5500.50,45127PA002,7588667726,PAN004,PAS002,PAF001,New,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002000701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020007-00,Standard Bronze Off Exchange Plan,61.89%,0.618901968002319,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,"$5,500","$11,000",50%,"$5,500","$11,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,2,31609,PA,Individual,No,23-2184623,31609PA0070002,Personal Choice PPO Gold,31609PA007,,PAN001,PAS001,PAF014,Existing,PPO,Gold,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$200,5,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S,Yes,https://www.ibx4you.com/ffm/ppogold2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,31609PA0070002-03,Limited Cost Sharing Plan Variation,81.91%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,35%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,3,31609,PA,Individual,No,23-2184623,31609PA0070003,Personal Choice PPO Silver,31609PA007,,PAN001,PAS001,PAF015,Existing,PPO,Silver,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9893,,$200,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S,Yes,https://www.ibx4you.com/ffm/pposilver2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,31609PA0070003-00,Standard Silver Off Exchange Plan,70.93%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,35%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,3,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150003,Personal Choice PPO Gold Premier,31609PA015,,PAN001,PAS001,PAF003,Existing,PPO,Gold,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,5,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150003-00,Standard Gold Off Exchange Plan,81.96%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,3,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150003,Personal Choice PPO Gold Premier,31609PA015,,PAN001,PAS001,PAF003,Existing,PPO,Gold,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,5,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150003-01,Standard Gold On Exchange Plan,81.96%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,3,31609,PA,Individual,No,23-2184623,31609PA0070003,Personal Choice PPO Silver,31609PA007,,PAN001,PAS001,PAF015,Existing,PPO,Silver,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9893,,$200,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S,Yes,https://www.ibx4you.com/ffm/pposilver2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,31609PA0070003-01,Standard Silver On Exchange Plan,70.93%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,35%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,3,31609,PA,Individual,No,23-2184623,31609PA0070003,Personal Choice PPO Silver,31609PA007,,PAN001,PAS001,PAF015,Existing,PPO,Silver,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9893,,$200,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S,Yes,https://www.ibx4you.com/ffm/pposilver2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,31609PA0070003-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,3,31609,PA,Individual,No,23-2184623,31609PA0070003,Personal Choice PPO Silver,31609PA007,,PAN001,PAS001,PAF015,Existing,PPO,Silver,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9893,,$200,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S,Yes,https://www.ibx4you.com/ffm/pposilver2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,31609PA0070003-03,Limited Cost Sharing Plan Variation,70.93%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,35%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,3,31609,PA,Individual,No,23-2184623,31609PA0070003,Personal Choice PPO Silver,31609PA007,,PAN001,PAS001,PAF015,Existing,PPO,Silver,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9893,,$200,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S,Yes,https://www.ibx4you.com/ffm/pposilver2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,31609PA0070003-04,73% AV Level Silver Plan,73.92%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$20,000","$40,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,35%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,3,31609,PA,Individual,No,23-2184623,31609PA0070003,Personal Choice PPO Silver,31609PA007,,PAN001,PAS001,PAF015,Existing,PPO,Silver,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9893,,$200,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S,Yes,https://www.ibx4you.com/ffm/pposilver2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,31609PA0070003-05,87% AV Level Silver Plan,86.64%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$20,000","$40,000",Not Applicable,Not Applicable,$250,$500,10%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,35%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,3,31609,PA,Individual,No,23-2184623,31609PA0070003,Personal Choice PPO Silver,31609PA007,,PAN001,PAS001,PAF015,Existing,PPO,Silver,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9893,,$200,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S,Yes,https://www.ibx4you.com/ffm/pposilver2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,31609PA0070003-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$20,000","$40,000",Not Applicable,Not Applicable,$0,$0,10%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,4,31609,PA,Individual,No,23-2184623,31609PA0070006,Personal Choice PPO Bronze Reserve,31609PA007,,PAN001,PAS001,PAF022,Existing,PPO,Bronze,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppobronzereserve2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary,31609PA0070006-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,4,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150004,Personal Choice PPO Gold,31609PA015,,PAN001,PAS001,PAF003,Existing,PPO,Gold,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150004-00,Standard Gold Off Exchange Plan,78.06%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,4,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150004,Personal Choice PPO Gold,31609PA015,,PAN001,PAS001,PAF003,Existing,PPO,Gold,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150004-01,Standard Gold On Exchange Plan,78.06%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,4,31609,PA,Individual,No,23-2184623,31609PA0070006,Personal Choice PPO Bronze Reserve,31609PA007,,PAN001,PAS001,PAF022,Existing,PPO,Bronze,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppobronzereserve2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary,31609PA0070006-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,4,31609,PA,Individual,No,23-2184623,31609PA0070006,Personal Choice PPO Bronze Reserve,31609PA007,,PAN001,PAS001,PAF022,Existing,PPO,Bronze,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppobronzereserve2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary,31609PA0070006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,4,31609,PA,Individual,No,23-2184623,31609PA0070006,Personal Choice PPO Bronze Reserve,31609PA007,,PAN001,PAS001,PAF022,Existing,PPO,Bronze,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppobronzereserve2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary,31609PA0070006-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,5,31609,PA,Individual,No,23-2184623,31609PA0070009,Personal Choice PPO Platinum Complete,31609PA007,,PAN001,PAS001,PAF025,New,PPO,Platinum,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9501,,,5,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppoplatinumcomplete,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary,31609PA0070009-00,Standard Platinum Off Exchange Plan,89.51%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,5,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150005,Personal Choice PPO Silver,31609PA015,,PAN001,PAS001,PAF004,Existing,PPO,Silver,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,$125,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150005-00,Standard Silver Off Exchange Plan,69.81%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50.00%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,5,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150005,Personal Choice PPO Silver,31609PA015,,PAN001,PAS001,PAF004,Existing,PPO,Silver,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,$125,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150005-01,Standard Silver On Exchange Plan,69.81%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50.00%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,5,31609,PA,Individual,No,23-2184623,31609PA0070009,Personal Choice PPO Platinum Complete,31609PA007,,PAN001,PAS001,PAF025,New,PPO,Platinum,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9501,,,5,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppoplatinumcomplete,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary,31609PA0070009-01,Standard Platinum On Exchange Plan,89.51%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,5,31609,PA,Individual,No,23-2184623,31609PA0070009,Personal Choice PPO Platinum Complete,31609PA007,,PAN001,PAS001,PAF025,New,PPO,Platinum,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9501,,,5,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppoplatinumcomplete,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary,31609PA0070009-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,5,31609,PA,Individual,No,23-2184623,31609PA0070009,Personal Choice PPO Platinum Complete,31609PA007,,PAN001,PAS001,PAF025,New,PPO,Platinum,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9501,,,5,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppoplatinumcomplete,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary,31609PA0070009-03,Limited Cost Sharing Plan Variation,89.51%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,6,31609,PA,Individual,No,23-2184623,31609PA0070004,Personal Choice PPO Bronze,31609PA007,,PAN001,PAS001,PAF016,Existing,PPO,Bronze,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppobronze2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,31609PA0070004-00,Standard Bronze Off Exchange Plan,61.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,6,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150006,Personal Choice PPO Platinum HSA 50,31609PA015,,PAN001,PAS001,PAF005,Existing,PPO,Platinum,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,Yes,Yes,$750.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150006-00,Standard Platinum Off Exchange Plan,88.64%,0.886397302150726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,6,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150006,Personal Choice PPO Platinum HSA 50,31609PA015,,PAN001,PAS001,PAF005,Existing,PPO,Platinum,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,Yes,Yes,$750.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150006-01,Standard Platinum On Exchange Plan,88.64%,0.886397302150726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,6,31609,PA,Individual,No,23-2184623,31609PA0070004,Personal Choice PPO Bronze,31609PA007,,PAN001,PAS001,PAF016,Existing,PPO,Bronze,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppobronze2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,31609PA0070004-01,Standard Bronze On Exchange Plan,61.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,6,31609,PA,Individual,No,23-2184623,31609PA0070004,Personal Choice PPO Bronze,31609PA007,,PAN001,PAS001,PAF016,Existing,PPO,Bronze,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppobronze2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,31609PA0070004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,6,31609,PA,Individual,No,23-2184623,31609PA0070004,Personal Choice PPO Bronze,31609PA007,,PAN001,PAS001,PAF016,Existing,PPO,Bronze,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppobronze2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,31609PA0070004-03,Limited Cost Sharing Plan Variation,61.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,7,31609,PA,Individual,No,23-2184623,31609PA0070010,Personal Choice Bronze Basic,31609PA007,,PAN001,PAS001,PAF024,New,PPO,Bronze,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult/Pediatric), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,0,0,3,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppobronzebasic,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary,31609PA0070010-00,Standard Bronze Off Exchange Plan,,0.591805756092072,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,7,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150007,Personal Choice PPO Gold HSA 25,31609PA015,,PAN001,PAS001,PAF006,Existing,PPO,Gold,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,Yes,Yes,$500.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150007-00,Standard Gold Off Exchange Plan,81.97%,0.819707810878754,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,7,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150007,Personal Choice PPO Gold HSA 25,31609PA015,,PAN001,PAS001,PAF006,Existing,PPO,Gold,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,Yes,Yes,$500.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150007-01,Standard Gold On Exchange Plan,81.97%,0.819707810878754,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,7,31609,PA,Individual,No,23-2184623,31609PA0070010,Personal Choice Bronze Basic,31609PA007,,PAN001,PAS001,PAF024,New,PPO,Bronze,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult/Pediatric), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,0,0,3,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppobronzebasic,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary,31609PA0070010-01,Standard Bronze On Exchange Plan,,0.591805756092072,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,7,31609,PA,Individual,No,23-2184623,31609PA0070010,Personal Choice Bronze Basic,31609PA007,,PAN001,PAS001,PAF024,New,PPO,Bronze,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult/Pediatric), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,0,0,3,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppobronzebasic,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary,31609PA0070010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,7,31609,PA,Individual,No,23-2184623,31609PA0070010,Personal Choice Bronze Basic,31609PA007,,PAN001,PAS001,PAF024,New,PPO,Bronze,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult/Pediatric), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,0,0,3,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppobronzebasic,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary,31609PA0070010-03,Limited Cost Sharing Plan Variation,,0.591805756092072,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,8,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150008,Personal Choice PPO Gold HSA,31609PA015,,PAN001,PAS001,PAF005,Existing,PPO,Gold,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150008-01,Standard Gold On Exchange Plan,79.04%,0.790352404117584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,8,31609,PA,Individual,No,23-2184623,31609PA0070007,Personal Choice Catastrophic,31609PA007,,PAN001,PAS001,PAF024,Existing,PPO,Catastrophic,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,0,0,3,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppocatastrophic2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary,31609PA0070007-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,9,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150009,Personal Choice PPO Gold HSA 50,31609PA015,,PAN001,PAS001,PAF006,Existing,PPO,Gold,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,Yes,Yes,"$1,000.00",Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150009-00,Standard Gold Off Exchange Plan,,0.784781634807587,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,9,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150009,Personal Choice PPO Gold HSA 50,31609PA015,,PAN001,PAS001,PAF006,Existing,PPO,Gold,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,Yes,Yes,"$1,000.00",Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150009-01,Standard Gold On Exchange Plan,,0.784781634807587,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,11,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150011,Personal Choice PPO Silver HSA,31609PA015,,PAN001,PAS001,PAF007,Existing,PPO,Silver,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150011-00,Standard Silver Off Exchange Plan,,0.690182864665985,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,200","$4,400",10%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,11,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150011,Personal Choice PPO Silver HSA,31609PA015,,PAN001,PAS001,PAF007,Existing,PPO,Silver,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150011-01,Standard Silver On Exchange Plan,,0.690182864665985,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,200","$4,400",10%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,12,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150012,Personal Choice PPO Bronze Premier HSA,31609PA015,,PAN001,PAS001,PAF008,Existing,PPO,Bronze,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150012-00,Standard Bronze Off Exchange Plan,,0.600478053092957,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,12,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150012,Personal Choice PPO Bronze Premier HSA,31609PA015,,PAN001,PAS001,PAF008,Existing,PPO,Bronze,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150012-01,Standard Bronze On Exchange Plan,,0.600478053092957,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,10,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0480003,Comprehensive Care EPO $2000 A Community Blue Plan,33709PA048,,PAN001,PAS001,PAF006,New,EPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0480003-01,Standard Silver On Exchange Plan,,0.683790028095245,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,10,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0480004,Comprehensive Care EPO $2000 A Community Blue Plan,33709PA048,,PAN001,PAS002,PAF006,New,EPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0480004-00,Standard Silver Off Exchange Plan,,0.683790028095245,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,10,33709,PA,Individual,No,23-1294723,33709PA0390007,Shared Cost Blue PPO $2100 a Community Blue Flex Plan,33709PA039,,PAN001,PAS002,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0390007-06,94% AV Level Silver Plan,,0.935220718383789,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$500,"$1,000",$500,"$1,000","$12,700","$25,400",Not Applicable,Not Applicable,$150,$300,10%,$300,$600,30%,"$8,400","$16,800",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,10,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0480004,Comprehensive Care EPO $2000 A Community Blue Plan,33709PA048,,PAN001,PAS002,PAF006,New,EPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0480004-01,Standard Silver On Exchange Plan,,0.683790028095245,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,12,33709,PA,Individual,No,23-1294723,33709PA0400001,Health Savings Blue PPO 2750 a Community Blue Flex Plan,33709PA040,,PAN001,PAS001,PAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0400001-05,87% AV Level Silver Plan,,0.871773958206177,Yes,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000","$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,$500,"$1,000",30%,"$5,500","$11,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,12,33709,PA,Individual,No,23-1294723,33709PA0400001,Health Savings Blue PPO 2750 a Community Blue Flex Plan,33709PA040,,PAN001,PAS001,PAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0400001-06,94% AV Level Silver Plan,,0.939523696899414,Yes,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,$750,"$1,500",$750,"$1,500","$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,$100,$200,30%,"$5,500","$11,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,10,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100012,Keystone DPOS Gold Premier,33871PA010,,PAN001,PAS001,PAF010,Existing,HMO,Gold,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100012-01,Standard Gold On Exchange Plan,81.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$15,000","$30,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,11,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100013,Keystone DPOS Gold,33871PA010,,PAN001,PAS001,PAF010,Existing,HMO,Gold,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100013-00,Standard Gold Off Exchange Plan,,0.782004833221436,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,15,33709,PA,Individual,No,23-1294723,33709PA0600001,Balance Blue PPO 1000 a Community Blue Flex Plan,33709PA060,,PAN001,PAS001,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0600001-00,Standard Silver Off Exchange Plan,,0.709764063358307,No,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400",Not Applicable,Not Applicable,"$1,000","$2,000",20%,"$2,500","$5,000",40%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,15,33709,PA,Individual,No,23-1294723,33709PA0600001,Balance Blue PPO 1000 a Community Blue Flex Plan,33709PA060,,PAN001,PAS001,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0600001-01,Standard Silver On Exchange Plan,,0.709764063358307,No,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400",Not Applicable,Not Applicable,"$1,000","$2,000",20%,"$2,500","$5,000",40%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,2,33871,PA,Individual,No,23-2405376,33871PA0040002,Keystone HMO Gold,33871PA004,,PAN001,PAS001,PAF014,Existing,HMO,Gold,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$200,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmogold2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040002-01,Standard Gold On Exchange Plan,82.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,100","$12,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,2,33871,PA,Individual,No,23-2405376,33871PA0040002,Keystone HMO Gold,33871PA004,,PAN001,PAS001,PAF014,Existing,HMO,Gold,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$200,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmogold2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,13,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150013,Personal Choice PPO Bronze HSA,31609PA015,,PAN001,PAS001,PAF009,Existing,PPO,Bronze,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150013-00,Standard Bronze Off Exchange Plan,58.63%,0.586297929286957,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,13,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150013,Personal Choice PPO Bronze HSA,31609PA015,,PAN001,PAS001,PAF009,Existing,PPO,Bronze,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150013-01,Standard Bronze On Exchange Plan,58.63%,0.586297929286957,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,15,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150015,Personal Choice PPO Gold HRA 25,31609PA015,,PAN001,PAS001,PAF011,Existing,PPO,Gold,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,No,Yes,$500.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150015-00,Standard Gold Off Exchange Plan,81.97%,0.819707810878754,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,15,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150015,Personal Choice PPO Gold HRA 25,31609PA015,,PAN001,PAS001,PAF011,Existing,PPO,Gold,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,No,Yes,$500.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150015-01,Standard Gold On Exchange Plan,81.97%,0.819707810878754,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,16,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150017,Personal Choice PPO Gold HRA 50,31609PA015,,PAN001,PAS001,PAF007,Existing,PPO,Gold,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,No,Yes,"$1,000.00",Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150017-00,Standard Gold Off Exchange Plan,,0.784781634807587,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,16,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150017,Personal Choice PPO Gold HRA 50,31609PA015,,PAN001,PAS001,PAF007,Existing,PPO,Gold,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,No,Yes,"$1,000.00",Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150017-01,Standard Gold On Exchange Plan,,0.784781634807587,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,17,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150018,Personal Choice PPO Silver HRA 25,31609PA015,,PAN001,PAS001,PAF011,Existing,PPO,Silver,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,No,Yes,$550.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150018-00,Standard Silver Off Exchange Plan,,0.708137333393097,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,200","$4,400",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,31609,HIOS,7,2015-07-22 09:15:52,17,31609,PA,SHOP (Small Group),No,23-2184623,31609PA0150018,Personal Choice PPO Silver HRA 25,31609PA015,,PAN001,PAS001,PAF011,Existing,PPO,Silver,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,No,Yes,$550.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,31609PA0150018-01,Standard Silver On Exchange Plan,,0.708137333393097,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,200","$4,400",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,32561,HIOS,5,2014-08-28 04:23:13,1,32561,PA,SHOP (Small Group),Yes,13-5123390,32561PA0090002,Guardian Pediatric Advantage,32561PA009,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.76,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,32561PA0090002-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,32561,HIOS,5,2014-08-28 04:23:13,1,32561,PA,SHOP (Small Group),Yes,13-5123390,32561PA0100002,Guardian Pediatric Essentials,32561PA010,,PAN001,PAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$19.27,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,32561PA0100002-00,Standard Low Off Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,32561,HIOS,5,2014-08-28 04:23:13,2,32561,PA,SHOP (Small Group),Yes,13-5123390,32561PA0120002,Guardian Family Advantage,32561PA012,,PAN001,PAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.76,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,32561PA0120002-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,32561,HIOS,5,2014-08-28 04:23:13,2,32561,PA,SHOP (Small Group),Yes,13-5123390,32561PA0120002,Guardian Family Advantage,32561PA012,,PAN001,PAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.76,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,32561PA0120002-01,Standard High On Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,32561,HIOS,5,2014-08-28 04:23:13,2,32561,PA,SHOP (Small Group),Yes,13-5123390,32561PA0140002,Guardian Family Essentials,32561PA014,,PAN001,PAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.27,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,32561PA0140002-00,Standard Low Off Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,32561,HIOS,5,2014-08-28 04:23:13,2,32561,PA,SHOP (Small Group),Yes,13-5123390,32561PA0140002,Guardian Family Essentials,32561PA014,,PAN001,PAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.27,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,32561PA0140002-01,Standard Low On Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,32561,HIOS,5,2014-08-28 04:23:13,3,32561,PA,SHOP (Small Group),Yes,13-5123390,32561PA0110002,Guardian Family Advantage Plus,32561PA011,,PAN001,PAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.76,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,32561PA0110002-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,32561,HIOS,5,2014-08-28 04:23:13,3,32561,PA,SHOP (Small Group),Yes,13-5123390,32561PA0110002,Guardian Family Advantage Plus,32561PA011,,PAN001,PAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.76,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,32561PA0110002-01,Standard High On Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,1,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0460007,Flex PPO $500/$1500 Penn Highlands Region a Community Blue Plan,33709PA046,,PAN001,PAS007,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0460007-00,Standard Gold Off Exchange Plan,80.91%,0.809101223945618,Yes,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,"$1,500","$3,000",30%,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,1,33709,PA,Individual,No,23-1294723,33709PA0380001,Major Events Blue PPO 6600 a Community Blue plan,33709PA038,,PAN001,PAS001,PAF002,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0380001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,1,33709,PA,Individual,No,23-1294723,33709PA0380001,Major Events Blue PPO 6600 a Community Blue plan,33709PA038,,PAN001,PAS001,PAF002,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0380001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,1,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0460007,Flex PPO $500/$1500 Penn Highlands Region a Community Blue Plan,33709PA046,,PAN001,PAS007,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0460007-01,Standard Gold On Exchange Plan,80.91%,0.809101223945618,Yes,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,"$1,500","$3,000",30%,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,1,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0460008,Flex PPO PA Mountains Healthcare Region $500/$1500 a Community Blue Plan,33709PA046,,PAN001,PAS008,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0460008-00,Standard Gold Off Exchange Plan,80.64%,0.806429803371429,Yes,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,"$1,500","$3,000",30%,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,1,33709,PA,Individual,No,23-1294723,33709PA0380002,Major Events Blue PPO 6600 a Community Blue plan,33709PA038,,PAN001,PAS002,PAF002,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0380002-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,1,33709,PA,Individual,No,23-1294723,33709PA0380002,Major Events Blue PPO 6600 a Community Blue plan,33709PA038,,PAN001,PAS002,PAF002,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0380002-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,1,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0460008,Flex PPO PA Mountains Healthcare Region $500/$1500 a Community Blue Plan,33709PA046,,PAN001,PAS008,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0460008-01,Standard Gold On Exchange Plan,80.64%,0.806429803371429,Yes,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,"$1,500","$3,000",30%,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,1,33709,PA,Individual,No,23-1294723,33709PA0410001,Major Events Blue PPO 6600,33709PA041,,PAN002,PAS004,PAF002,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0410001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,1,33709,PA,Individual,No,23-1294723,33709PA0410001,Major Events Blue PPO 6600,33709PA041,,PAN002,PAS004,PAF002,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0410001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,1,33709,PA,Individual,No,23-1294723,33709PA0410002,Major Events Blue PPO 6600,33709PA041,,PAN002,PAS005,PAF002,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0410002-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,10
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,1,33709,PA,Individual,No,23-1294723,33709PA0410002,Major Events Blue PPO 6600,33709PA041,,PAN002,PAS005,PAF002,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0410002-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,11
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,2,33709,PA,Individual,No,23-1294723,33709PA0420011,Flex Blue PPO 1000 a Community Blue Plan,33709PA042,,PAN002,PAS005,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420011-00,Standard Gold Off Exchange Plan,,0.782900631427765,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,"$2,000","$4,000",40%,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,2,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0460001,Flex PPO $0/$500 a Community Blue Plan,33709PA046,,PAN002,PAS004,PAF013,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$250,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/clients/highmark/commercial.html,33709PA0460001-00,Standard Platinum Off Exchange Plan,88.50%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,$500,"$1,000",20%,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,2,33709,PA,Individual,No,23-1294723,33709PA0420011,Flex Blue PPO 1000 a Community Blue Plan,33709PA042,,PAN002,PAS005,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420011-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,2,33709,PA,Individual,No,23-1294723,33709PA0420011,Flex Blue PPO 1000 a Community Blue Plan,33709PA042,,PAN002,PAS005,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420011-03,Limited Cost Sharing Plan Variation,,0.785676658153534,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$2,500","$5,000","$8,000","$16,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,"$2,000","$4,000",40%,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,3,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0460013,Flex PPO $500 Total Health a Community Blue Plan,33709PA046,,PAN001,PAS002,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0460013-00,Standard Gold Off Exchange Plan,81.30%,0.842131376266479,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000",Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,3,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0460013,Flex PPO $500 Total Health a Community Blue Plan,33709PA046,,PAN001,PAS002,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0460013-01,Standard Gold On Exchange Plan,81.30%,0.842131376266479,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000",Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,4,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0460003,Flex PPO $500/$1500 a Community Blue Plan,33709PA046,,PAN002,PAS004,PAF013,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$250,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/clients/highmark/commercial.html,33709PA0460003-00,Standard Gold Off Exchange Plan,,0.809246063232422,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,"$1,500","$3,000",20%,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,4,33709,PA,Individual,No,23-1294723,33709PA0420001,Flex Blue PPO 4000 a Community Blue Plan,33709PA042,,PAN002,PAS004,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0420001-00,Standard Bronze Off Exchange Plan,,0.617553234100342,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,"$4,000","$8,000",60%,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,4,33709,PA,Individual,No,23-1294723,33709PA0420001,Flex Blue PPO 4000 a Community Blue Plan,33709PA042,,PAN002,PAS004,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0420001-01,Standard Bronze On Exchange Plan,,0.617553234100342,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,"$4,000","$8,000",60%,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,4,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0460003,Flex PPO $500/$1500 a Community Blue Plan,33709PA046,,PAN002,PAS004,PAF013,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$250,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/clients/highmark/commercial.html,33709PA0460003-01,Standard Gold On Exchange Plan,,0.809246063232422,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,"$1,500","$3,000",20%,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,4,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0460011,Flex PPO $2000 a Community Blue Plan,33709PA046,,PAN002,PAS004,PAF013,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$250,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/clients/highmark/commercial.html,33709PA0460011-00,Standard Silver Off Exchange Plan,71.90%,0.726178169250488,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$4,000","$8,000",30%,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,4,33709,PA,Individual,No,23-1294723,33709PA0420001,Flex Blue PPO 4000 a Community Blue Plan,33709PA042,,PAN002,PAS004,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0420001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,4,33709,PA,Individual,No,23-1294723,33709PA0420001,Flex Blue PPO 4000 a Community Blue Plan,33709PA042,,PAN002,PAS004,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0420001-03,Limited Cost Sharing Plan Variation,,0.617553234100342,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,"$4,000","$8,000",60%,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,4,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0460011,Flex PPO $2000 a Community Blue Plan,33709PA046,,PAN002,PAS004,PAF013,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$250,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/clients/highmark/commercial.html,33709PA0460011-01,Standard Silver On Exchange Plan,71.90%,0.726178169250488,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$4,000","$8,000",30%,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,4,33709,PA,Individual,No,23-1294723,33709PA0420003,Flex Blue PPO 4000 a Community Blue Plan,33709PA042,,PAN002,PAS005,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0420003-00,Standard Bronze Off Exchange Plan,,0.617553234100342,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,"$4,000","$8,000",60%,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,4,33709,PA,Individual,No,23-1294723,33709PA0420003,Flex Blue PPO 4000 a Community Blue Plan,33709PA042,,PAN002,PAS005,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0420003-01,Standard Bronze On Exchange Plan,,0.617553234100342,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,"$4,000","$8,000",60%,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,4,33709,PA,Individual,No,23-1294723,33709PA0420003,Flex Blue PPO 4000 a Community Blue Plan,33709PA042,,PAN002,PAS005,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0420003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,10
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,4,33709,PA,Individual,No,23-1294723,33709PA0420003,Flex Blue PPO 4000 a Community Blue Plan,33709PA042,,PAN002,PAS005,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0420003-03,Limited Cost Sharing Plan Variation,,0.617553234100342,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,"$4,000","$8,000",60%,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,5,33709,PA,Individual,No,23-1294723,33709PA0390001,Shared Cost Blue PPO 5500 a Community Blue Flex Plan,33709PA039,,PAN001,PAS001,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0390001-00,Standard Bronze Off Exchange Plan,,0.613753080368042,Yes,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,"$5,500","$11,000",60%,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,5,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0470001,Health Savings Flex PPO Q$4000 a Community Blue Plan,33709PA047,,PAN002,PAS004,PAF012,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/clients/highmark/commercial.html,33709PA0470001-00,Standard Bronze Off Exchange Plan,,0.614793479442596,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,"$4,000","$8,000",30%,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,5,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0470001,Health Savings Flex PPO Q$4000 a Community Blue Plan,33709PA047,,PAN002,PAS004,PAF012,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/clients/highmark/commercial.html,33709PA0470001-01,Standard Bronze On Exchange Plan,,0.614793479442596,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,"$4,000","$8,000",30%,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,5,33709,PA,Individual,No,23-1294723,33709PA0390001,Shared Cost Blue PPO 5500 a Community Blue Flex Plan,33709PA039,,PAN001,PAS001,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0390001-01,Standard Bronze On Exchange Plan,,0.613753080368042,Yes,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,"$5,500","$11,000",60%,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,5,33709,PA,Individual,No,23-1294723,33709PA0390001,Shared Cost Blue PPO 5500 a Community Blue Flex Plan,33709PA039,,PAN001,PAS001,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0390001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,5,33709,PA,Individual,No,23-1294723,33709PA0390001,Shared Cost Blue PPO 5500 a Community Blue Flex Plan,33709PA039,,PAN001,PAS001,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0390001-03,Limited Cost Sharing Plan Variation,,0.613753080368042,Yes,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,"$5,500","$11,000",60%,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,5,33709,PA,Individual,No,23-1294723,33709PA0390003,Shared Cost Blue PPO 5500 a Community Blue Flex Plan,33709PA039,,PAN001,PAS002,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0390003-00,Standard Bronze Off Exchange Plan,,0.613829374313354,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,"$5,500","$11,000",60%,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,5,33709,PA,Individual,No,23-1294723,33709PA0390003,Shared Cost Blue PPO 5500 a Community Blue Flex Plan,33709PA039,,PAN001,PAS002,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0390003-01,Standard Bronze On Exchange Plan,,0.613829374313354,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,"$5,500","$11,000",60%,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,5,33709,PA,Individual,No,23-1294723,33709PA0390003,Shared Cost Blue PPO 5500 a Community Blue Flex Plan,33709PA039,,PAN001,PAS002,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0390003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,10
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,5,33709,PA,Individual,No,23-1294723,33709PA0390003,Shared Cost Blue PPO 5500 a Community Blue Flex Plan,33709PA039,,PAN001,PAS002,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0390003-03,Limited Cost Sharing Plan Variation,,0.613829374313354,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,"$5,500","$11,000",60%,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,6,33709,PA,Individual,No,23-1294723,33709PA0430001,Health Savings Blue PPO 1700 a Community Blue Plan,33709PA043,,PAN002,PAS004,PAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0430001-00,Standard Silver Off Exchange Plan,,0.716458022594452,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$4,550","$9,100","$4,550","$9,100","$9,100","$18,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400",20%,"$1,700","$3,400",30%,"$3,400","$6,800",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,6,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0450003,High Deductible PPO $4000 IP Qualified A a Community Blue Flex Plan,33709PA045,,PAN001,PAS002,PAF006,New,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0450003-00,Standard Bronze Off Exchange Plan,60.90%,0.630719482898712,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$19,350","$38,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,"$4,000","$8,000",30%,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,6,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0450003,High Deductible PPO $4000 IP Qualified A a Community Blue Flex Plan,33709PA045,,PAN001,PAS002,PAF006,New,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0450003-01,Standard Bronze On Exchange Plan,60.90%,0.630719482898712,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$19,350","$38,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,"$4,000","$8,000",30%,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,6,33709,PA,Individual,No,23-1294723,33709PA0430001,Health Savings Blue PPO 1700 a Community Blue Plan,33709PA043,,PAN002,PAS004,PAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0430001-01,Standard Silver On Exchange Plan,,0.716458022594452,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$4,550","$9,100","$4,550","$9,100","$9,100","$18,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400",20%,"$1,700","$3,400",30%,"$3,400","$6,800",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,6,33709,PA,Individual,No,23-1294723,33709PA0430001,Health Savings Blue PPO 1700 a Community Blue Plan,33709PA043,,PAN002,PAS004,PAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0430001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,6,33709,PA,Individual,No,23-1294723,33709PA0430001,Health Savings Blue PPO 1700 a Community Blue Plan,33709PA043,,PAN002,PAS004,PAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0430001-03,Limited Cost Sharing Plan Variation,,0.716458022594452,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$4,550","$9,100","$4,550","$9,100","$9,100","$18,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400",20%,"$1,700","$3,400",30%,"$3,400","$6,800",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,6,33709,PA,Individual,No,23-1294723,33709PA0430001,Health Savings Blue PPO 1700 a Community Blue Plan,33709PA043,,PAN002,PAS004,PAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0430001-04,73% AV Level Silver Plan,,0.738389074802399,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$9,100","$18,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,450","$2,900",20%,"$1,450","$2,900",30%,"$3,400","$6,800",Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,6,33709,PA,Individual,No,23-1294723,33709PA0430001,Health Savings Blue PPO 1700 a Community Blue Plan,33709PA043,,PAN002,PAS004,PAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0430001-05,87% AV Level Silver Plan,,0.872968316078186,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$1,750","$3,500","$1,750","$3,500","$9,100","$18,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,$500,"$1,000",20%,"$3,400","$6,800",Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,6,33709,PA,Individual,No,23-1294723,33709PA0430003,Health Savings Blue PPO 1700 a Community Blue Plan,33709PA043,,PAN002,PAS005,PAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0430003-01,Standard Silver On Exchange Plan,,0.716458022594452,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$4,550","$9,100","$4,550","$9,100","$9,100","$18,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400",20%,"$1,700","$3,400",30%,"$3,400","$6,800",Not Applicable,Not Applicable,,,,,,,,,12
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,6,33709,PA,Individual,No,23-1294723,33709PA0430003,Health Savings Blue PPO 1700 a Community Blue Plan,33709PA043,,PAN002,PAS005,PAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0430003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,13
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,6,33709,PA,Individual,No,23-1294723,33709PA0430003,Health Savings Blue PPO 1700 a Community Blue Plan,33709PA043,,PAN002,PAS005,PAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0430003-03,Limited Cost Sharing Plan Variation,,0.716458022594452,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$4,550","$9,100","$4,550","$9,100","$9,100","$18,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400",20%,"$1,700","$3,400",30%,"$3,400","$6,800",Not Applicable,Not Applicable,,,,,,,,,14
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,6,33709,PA,Individual,No,23-1294723,33709PA0430003,Health Savings Blue PPO 1700 a Community Blue Plan,33709PA043,,PAN002,PAS005,PAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0430003-04,73% AV Level Silver Plan,,0.738389074802399,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$9,100","$18,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,450","$2,900",20%,"$1,450","$2,900",30%,"$3,400","$6,800",Not Applicable,Not Applicable,,,,,,,,,15
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,6,33709,PA,Individual,No,23-1294723,33709PA0430003,Health Savings Blue PPO 1700 a Community Blue Plan,33709PA043,,PAN002,PAS005,PAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0430003-05,87% AV Level Silver Plan,,0.872968316078186,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$1,750","$3,500","$1,750","$3,500","$9,100","$18,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,$500,"$1,000",20%,"$3,400","$6,800",Not Applicable,Not Applicable,,,,,,,,,16
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,6,33709,PA,Individual,No,23-1294723,33709PA0430003,Health Savings Blue PPO 1700 a Community Blue Plan,33709PA043,,PAN002,PAS005,PAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0430003-06,94% AV Level Silver Plan,,0.944524705410004,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$750,"$1,500",$500,"$1,000","$9,100","$18,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,$100,$200,20%,"$3,400","$6,800",Not Applicable,Not Applicable,,,,,,,,,17
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,7,33709,PA,Individual,No,23-1294723,33709PA0390011,Shared Cost Blue PPO  1000 a Community Blue Flex Plan,33709PA039,,PAN001,PAS002,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0390011-00,Standard Gold Off Exchange Plan,,0.781804382801056,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$4,250","$8,500","$8,500","$17,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,"$2,500","$5,000",40%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,7,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0440014,Premier Balance PPO $250 IP A a Community Blue Flex Plan,33709PA044,,PAN001,PAS002,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0440014-00,Standard Gold Off Exchange Plan,81.95%,0.819509148597717,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$3,600","$7,200","$3,600","$7,200","$10,800","$21,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,0%,$750,"$1,500",30%,"$2,250","$4,500",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,7,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0440014,Premier Balance PPO $250 IP A a Community Blue Flex Plan,33709PA044,,PAN001,PAS002,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0440014-01,Standard Gold On Exchange Plan,81.95%,0.819509148597717,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$3,600","$7,200","$3,600","$7,200","$10,800","$21,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,0%,$750,"$1,500",30%,"$2,250","$4,500",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,7,33709,PA,Individual,No,23-1294723,33709PA0390011,Shared Cost Blue PPO  1000 a Community Blue Flex Plan,33709PA039,,PAN001,PAS002,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0390011-01,Standard Gold On Exchange Plan,,0.781804382801056,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$4,250","$8,500","$8,500","$17,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,"$2,500","$5,000",40%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,7,33709,PA,Individual,No,23-1294723,33709PA0390011,Shared Cost Blue PPO  1000 a Community Blue Flex Plan,33709PA039,,PAN001,PAS002,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0390011-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,7,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0440009,Premier Balance PPO $750 IP A a Community Blue Flex Plan,33709PA044,,PAN001,PAS002,PAF008,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0440009-00,Standard Gold Off Exchange Plan,,0.789699137210846,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$3,700","$7,400","$3,700","$7,400","$11,100","$22,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",0%,"$1,500","$3,000",30%,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,7,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0440009,Premier Balance PPO $750 IP A a Community Blue Flex Plan,33709PA044,,PAN001,PAS002,PAF008,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0440009-01,Standard Gold On Exchange Plan,,0.789699137210846,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$3,700","$7,400","$3,700","$7,400","$11,100","$22,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",0%,"$1,500","$3,000",30%,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,7,33709,PA,Individual,No,23-1294723,33709PA0390011,Shared Cost Blue PPO  1000 a Community Blue Flex Plan,33709PA039,,PAN001,PAS002,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0390011-03,Limited Cost Sharing Plan Variation,,0.781804382801056,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$4,250","$8,500","$8,500","$17,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,"$2,500","$5,000",40%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,7,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0440013,Premier Balance PPO $1500 IP A a Community Blue Flex Plan,33709PA044,,PAN001,PAS002,PAF009,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0440013-00,Standard Silver Off Exchange Plan,71.80%,0.723937749862671,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,"$4,500","$9,000",30%,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,7,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0440013,Premier Balance PPO $1500 IP A a Community Blue Flex Plan,33709PA044,,PAN001,PAS002,PAF009,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0440013-01,Standard Silver On Exchange Plan,71.80%,0.723937749862671,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,"$4,500","$9,000",30%,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,8,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0570004,Balance PPO $1750 A a Community Blue Flex Plan,33709PA057,,PAN001,PAS001,PAF009,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0570004-00,Standard Silver Off Exchange Plan,,0.693000853061676,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",10%,"$5,250","$10,500",30%,"$15,700","$31,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,8,33709,PA,Individual,No,23-1294723,33709PA0420009,Flex Blue PPO 1200 a Community Blue Plan,33709PA042,,PAN002,PAS004,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420009-00,Standard Gold Off Exchange Plan,,0.788626492023468,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000",Not Applicable,Not Applicable,"$1,200","$2,400",20%,"$2,400","$4,800",40%,"$4,800","$9,600",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,8,33709,PA,Individual,No,23-1294723,33709PA0420009,Flex Blue PPO 1200 a Community Blue Plan,33709PA042,,PAN002,PAS004,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420009-01,Standard Gold On Exchange Plan,,0.788626492023468,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000",Not Applicable,Not Applicable,"$1,200","$2,400",20%,"$2,400","$4,800",40%,"$4,800","$9,600",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,8,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0570004,Balance PPO $1750 A a Community Blue Flex Plan,33709PA057,,PAN001,PAS001,PAF009,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0570004-01,Standard Silver On Exchange Plan,,0.693000853061676,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",10%,"$5,250","$10,500",30%,"$15,700","$31,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,8,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0570006,Balance PPO $2000 A a Community Blue Flex Plan,33709PA057,,PAN001,PAS001,PAF009,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0570006-00,Standard Silver Off Exchange Plan,,0.685679793357849,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,"$6,000","$12,000",30%,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,8,33709,PA,Individual,No,23-1294723,33709PA0420009,Flex Blue PPO 1200 a Community Blue Plan,33709PA042,,PAN002,PAS004,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420009-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,8,33709,PA,Individual,No,23-1294723,33709PA0420009,Flex Blue PPO 1200 a Community Blue Plan,33709PA042,,PAN002,PAS004,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420009-03,Limited Cost Sharing Plan Variation,,0.788626492023468,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000",Not Applicable,Not Applicable,"$1,200","$2,400",20%,"$2,400","$4,800",40%,"$4,800","$9,600",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,8,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0570006,Balance PPO $2000 A a Community Blue Flex Plan,33709PA057,,PAN001,PAS001,PAF009,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0570006-01,Standard Silver On Exchange Plan,,0.685679793357849,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,"$6,000","$12,000",30%,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,9,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0490001,FLEX EPO $500/$1000 A Community Blue Plan,33709PA049,,PAN002,PAS004,PAF006,Existing,EPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0490001-00,Standard Gold Off Exchange Plan,81.99%,0.82002991437912,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$2,200","$4,400","$4,150","$8,300",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,"$1,000","$2,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,9,33709,PA,Individual,No,23-1294723,33709PA0420005,Flex Blue PPO 2650 a Community Blue Plan,33709PA042,,PAN002,PAS004,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420005-00,Standard Silver Off Exchange Plan,,0.688801348209381,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$5,600","$11,200","$5,600","$11,200","$11,200","$22,400",Not Applicable,Not Applicable,"$2,650","$5,300",30%,"$5,300","$10,600",50%,"$10,600","$21,200",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,9,33709,PA,Individual,No,23-1294723,33709PA0420005,Flex Blue PPO 2650 a Community Blue Plan,33709PA042,,PAN002,PAS004,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420005-01,Standard Silver On Exchange Plan,,0.688801348209381,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$5,600","$11,200","$5,600","$11,200","$11,200","$22,400",Not Applicable,Not Applicable,"$2,650","$5,300",30%,"$5,300","$10,600",50%,"$10,600","$21,200",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,9,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0490001,FLEX EPO $500/$1000 A Community Blue Plan,33709PA049,,PAN002,PAS004,PAF006,Existing,EPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0490001-01,Standard Gold On Exchange Plan,81.99%,0.82002991437912,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$2,200","$4,400","$4,150","$8,300",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,"$1,000","$2,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,9,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0490002,FLEX EPO $500/$1000 A Community Blue Plan,33709PA049,,PAN002,PAS005,PAF006,Existing,EPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0490002-00,Standard Gold Off Exchange Plan,81.99%,0.82002991437912,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$2,200","$4,400","$4,150","$8,300",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,"$1,000","$2,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,9,33709,PA,Individual,No,23-1294723,33709PA0420005,Flex Blue PPO 2650 a Community Blue Plan,33709PA042,,PAN002,PAS004,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,9,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0490003,FLEX EPO $1650 A Community Blue Plan,33709PA049,,PAN002,PAS004,PAF006,Existing,EPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0490003-00,Standard Silver Off Exchange Plan,,0.690674722194672,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",20%,"$1,650","$3,300",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,9,33709,PA,Individual,No,23-1294723,33709PA0420005,Flex Blue PPO 2650 a Community Blue Plan,33709PA042,,PAN002,PAS004,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420005-04,73% AV Level Silver Plan,,0.731913506984711,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$11,200","$22,400",Not Applicable,Not Applicable,"$1,500","$3,000",30%,"$3,000","$6,000",50%,"$10,600","$21,200",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,9,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0490004,FLEX EPO $1650 A Community Blue Plan,33709PA049,,PAN002,PAS005,PAF006,Existing,EPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0490004-01,Standard Silver On Exchange Plan,,0.690674722194672,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",20%,"$1,650","$3,300",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,10,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0480001,Comprehensive Care EPO $1500 A Community Blue Plan,33709PA048,,PAN001,PAS001,PAF006,New,EPO,Gold,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0480001-00,Standard Gold Off Exchange Plan,,0.782333493232727,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,200","$4,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,7,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100007,Keystone HMO Bronze,33871PA010,,PAN001,PAS001,PAF005,Existing,HMO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100007-01,Standard Bronze On Exchange Plan,59.81%,0.598058342933655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,8,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100010,Keystone DPOS Platinum Premier,33871PA010,,PAN001,PAS001,PAF008,Existing,HMO,Platinum,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100010-00,Standard Platinum Off Exchange Plan,91.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,8,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100010,Keystone DPOS Platinum Premier,33871PA010,,PAN001,PAS001,PAF008,Existing,HMO,Platinum,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100010-01,Standard Platinum On Exchange Plan,91.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,9,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100011,Keystone DPOS Platinum,33871PA010,,PAN001,PAS001,PAF009,Existing,HMO,Platinum,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100011-00,Standard Platinum Off Exchange Plan,88.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,9,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100011,Keystone DPOS Platinum,33871PA010,,PAN001,PAS001,PAF009,Existing,HMO,Platinum,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100011-01,Standard Platinum On Exchange Plan,88.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,10,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100012,Keystone DPOS Gold Premier,33871PA010,,PAN001,PAS001,PAF010,Existing,HMO,Gold,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100012-00,Standard Gold Off Exchange Plan,81.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$15,000","$30,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,15,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100008,Keystone HMO Gold Proactive,33871PA010,,PAN001,PAS001,PAF006,Existing,HMO,Gold,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,$200,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary2,33871PA0100008-01,Standard Gold On Exchange Plan,78.02%,,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,16,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100009,Keystone HMO Silver Proactive,33871PA010,,PAN001,PAS001,PAF007,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,$400,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary2,33871PA0100009-00,Standard Silver Off Exchange Plan,71.24%,,No,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,"$4,500","$9,000",5%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,Yes,45-5492167,45127PA0030002,Healthy Dental PPO Plan 2,45127PA003,,PAN003,PAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.19,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Standard PPO Coverage,Yes,Yes,Yes,,,www.capbluecross.com/pdf/benefits_summary/dental/45127PA0030002_2015.pdf,,45127PA0030002-00,Standard Low Off Exchange Plan,71.98%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,SHOP (Small Group),Yes,45-5492167,45127PA0040002,Healthy Dental PPO Classic,45127PA004,,PAN002,PAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.46,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Standard PPO Coverage,Yes,Standard PPO Coverage,Yes,,,www.capbluecross.com/pdf/benefits_summary/dental/45127PA0040002_2015.pdf,,45127PA0040002-00,Standard Low Off Exchange Plan,71.98%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,SHOP (Small Group),No,45-5492167,45127PA0010136,Healthy Benefits PPO 6000.0 EX,45127PA001,7588667726,PAN004,PAS002,PAF009,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent & Urgent,Yes,Emergent & Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/45127PA006000100_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0010136-01,Standard Silver On Exchange Plan,69.27%,0.688624501228333,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,"$6,000","$12,000",0%,"$6,000","$12,000",0%,"$6,000","$12,000",Not Applicable,Not Applicable,$300,$600,0%,$300,$600,0%,$300,$600,Not Applicable,Not Applicable,,,,,,,,,,,"$6,000",$0,$0,$200,$700,"$2,300",$0,$80,5
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020008,Healthy Benefits PPO 4500.0,45127PA002,7588667726,PAN004,PAS002,PAF005,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002000801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020008-01,Standard Silver On Exchange Plan,68.09%,0.680857241153717,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,"$4,500","$9,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020008,Healthy Benefits PPO 4500.0,45127PA002,7588667726,PAN004,PAS002,PAF005,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002000801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020008-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020008,Healthy Benefits PPO 4500.0,45127PA002,7588667726,PAN004,PAS002,PAF005,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002000801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020008-03,Limited Cost Sharing Plan Variation,68.09%,0.680857241153717,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,"$4,500","$9,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,10,33709,PA,Individual,No,23-1294723,33709PA0390007,Shared Cost Blue PPO $2100 a Community Blue Flex Plan,33709PA039,,PAN001,PAS002,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0390007-00,Standard Silver Off Exchange Plan,,0.690574884414673,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400",Not Applicable,Not Applicable,"$2,100","$4,200",30%,"$4,200","$8,400",50%,"$8,400","$16,800",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,10,33709,PA,Individual,No,23-1294723,33709PA0390007,Shared Cost Blue PPO $2100 a Community Blue Flex Plan,33709PA039,,PAN001,PAS002,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0390007-01,Standard Silver On Exchange Plan,,0.690574884414673,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400",Not Applicable,Not Applicable,"$2,100","$4,200",30%,"$4,200","$8,400",50%,"$8,400","$16,800",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,10,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0480001,Comprehensive Care EPO $1500 A Community Blue Plan,33709PA048,,PAN001,PAS001,PAF006,New,EPO,Gold,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0480001-01,Standard Gold On Exchange Plan,,0.782333493232727,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,200","$4,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,10,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0480002,Comprehensive Care EPO $1500 A Community Blue Plan,33709PA048,,PAN001,PAS002,PAF006,New,EPO,Gold,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0480002-00,Standard Gold Off Exchange Plan,,0.782333493232727,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,200","$4,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,10,33709,PA,Individual,No,23-1294723,33709PA0390007,Shared Cost Blue PPO $2100 a Community Blue Flex Plan,33709PA039,,PAN001,PAS002,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0390007-04,73% AV Level Silver Plan,,0.723213791847229,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",20%,"$4,000","$8,000",40%,"$8,400","$16,800",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,10,33709,PA,Individual,No,23-1294723,33709PA0390007,Shared Cost Blue PPO $2100 a Community Blue Flex Plan,33709PA039,,PAN001,PAS002,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0390007-05,87% AV Level Silver Plan,,0.866146445274353,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","$12,700","$25,400",Not Applicable,Not Applicable,$400,$800,20%,$800,"$1,600",40%,"$8,400","$16,800",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0560007,Premier Balance PPO $0 Platinum A a Community Blue Flex Plan,33709PA056,,PAN001,PAS001,PAF008,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0560007-00,Standard Platinum Off Exchange Plan,88.60%,,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$1,600","$3,200","$1,600","$3,200","$4,800","$9,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$500,"$1,000",30%,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,Individual,No,23-1294723,33709PA0420007,Flex Blue PPO 2100 a Community Blue Plan,33709PA042,,PAN002,PAS005,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420007-00,Standard Silver Off Exchange Plan,,0.688975691795349,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400",Not Applicable,Not Applicable,"$2,100","$4,200",30%,"$4,200","$8,400",50%,"$8,400","$16,800",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,Individual,No,23-1294723,33709PA0420007,Flex Blue PPO 2100 a Community Blue Plan,33709PA042,,PAN002,PAS005,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420007-01,Standard Silver On Exchange Plan,,0.688975691795349,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400",Not Applicable,Not Applicable,"$2,100","$4,200",30%,"$4,200","$8,400",50%,"$8,400","$16,800",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0560007,Premier Balance PPO $0 Platinum A a Community Blue Flex Plan,33709PA056,,PAN001,PAS001,PAF008,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0560007-01,Standard Platinum On Exchange Plan,88.60%,,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$1,600","$3,200","$1,600","$3,200","$4,800","$9,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$500,"$1,000",30%,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0560009,Premier Balance PPO $250 Platinum A a Community Blue Flex Plan,33709PA056,,PAN001,PAS001,PAF008,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0560009-00,Standard Platinum Off Exchange Plan,88.40%,,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$1,300","$2,600","$1,300","$2,600","$3,900","$7,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,0%,$750,"$1,500",30%,"$2,250","$4,500",Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,Individual,No,23-1294723,33709PA0420007,Flex Blue PPO 2100 a Community Blue Plan,33709PA042,,PAN002,PAS005,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,Individual,No,23-1294723,33709PA0420007,Flex Blue PPO 2100 a Community Blue Plan,33709PA042,,PAN002,PAS005,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420007-03,Limited Cost Sharing Plan Variation,,0.688975691795349,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400",Not Applicable,Not Applicable,"$2,100","$4,200",30%,"$4,200","$8,400",50%,"$8,400","$16,800",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0560009,Premier Balance PPO $250 Platinum A a Community Blue Flex Plan,33709PA056,,PAN001,PAS001,PAF008,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0560009-01,Standard Platinum On Exchange Plan,88.40%,,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$1,300","$2,600","$1,300","$2,600","$3,900","$7,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,0%,$750,"$1,500",30%,"$2,250","$4,500",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0560011,Premier Balance PPO $0 Gold A a Community Blue Flex Plan,33709PA056,,PAN001,PAS001,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0560011-00,Standard Gold Off Exchange Plan,79.30%,,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,"$5,000","$1,000",30%,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,Individual,No,23-1294723,33709PA0420007,Flex Blue PPO 2100 a Community Blue Plan,33709PA042,,PAN002,PAS005,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420007-04,73% AV Level Silver Plan,,0.726758301258087,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$12,700","$25,400",Not Applicable,Not Applicable,"$1,750","$3,500",30%,"$3,500","$7,000",50%,"$8,400","$16,800",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,Individual,No,23-1294723,33709PA0420007,Flex Blue PPO 2100 a Community Blue Plan,33709PA042,,PAN002,PAS005,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420007-05,87% AV Level Silver Plan,,0.863020241260529,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","$12,700","$25,400",Not Applicable,Not Applicable,$500,"$1,000",20%,"$1,000","$2,000",40%,"$8,400","$16,800",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0560011,Premier Balance PPO $0 Gold A a Community Blue Flex Plan,33709PA056,,PAN001,PAS001,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0560011-01,Standard Gold On Exchange Plan,79.30%,,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,"$5,000","$1,000",30%,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0560013,Premier Balance PPO $250 Gold A a Community Blue Flex Plan,33709PA056,,PAN001,PAS001,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,".Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0560013-00,Standard Gold Off Exchange Plan,80.80%,,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$3,400","$6,800","$3,400","$6,800","$10,200","$20,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,0%,$750,"$1,500",30%,"$2,250","$4,500",Not Applicable,Not Applicable,,,,,,,,,10
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,Individual,No,23-1294723,33709PA0420007,Flex Blue PPO 2100 a Community Blue Plan,33709PA042,,PAN002,PAS005,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420007-06,94% AV Level Silver Plan,,0.942163586616516,No,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,$500,"$1,000",$500,"$1,000","$12,700","$25,400",Not Applicable,Not Applicable,$100,$200,10%,$200,$400,30%,"$8,400","$16,800",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0560013,Premier Balance PPO $250 Gold A a Community Blue Flex Plan,33709PA056,,PAN001,PAS001,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,".Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0560013-01,Standard Gold On Exchange Plan,80.80%,,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$3,400","$6,800","$3,400","$6,800","$10,200","$20,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,0%,$750,"$1,500",30%,"$2,250","$4,500",Not Applicable,Not Applicable,,,,,,,,,11
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0560015,Premier Balance PPO $500 A a Community Blue Flex Plan,33709PA056,,PAN001,PAS001,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0560015-00,Standard Gold Off Exchange Plan,79.90%,,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$3,400","$6,800","$3,400","$6,800","$10,200","$20,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,"$1,500","$3,000",30%,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0560017,Premier Balance PPO $750 A a Community Blue Flex Plan,33709PA056,,PAN001,PAS001,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0560017-01,Standard Gold On Exchange Plan,79.40%,,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$3,400","$6,800","$3,400","$6,800","$10,200","$20,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",0%,"$1,500","$3,000",30%,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0560019,Premier Balance PPO $1000 A a Community Blue Flex Plan,33709PA056,,PAN001,PAS001,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0560019-00,Standard Gold Off Exchange Plan,78.60%,,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,"$2,000","$4,000",30%,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0560019,Premier Balance PPO $1000 A a Community Blue Flex Plan,33709PA056,,PAN001,PAS001,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0560019-01,Standard Gold On Exchange Plan,78.60%,,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,"$2,000","$4,000",30%,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0560021,Premier Balance PPO $1250 A a Community Blue Flex Plan,33709PA056,,PAN001,PAS001,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0560021-00,Standard Gold Off Exchange Plan,78.10%,,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",0%,"$2,500","$5,000",30%,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0560021,Premier Balance PPO $1250 A a Community Blue Flex Plan,33709PA056,,PAN001,PAS001,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0560021-01,Standard Gold On Exchange Plan,78.10%,,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",0%,"$2,500","$5,000",30%,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0560023,Premier Balance PPO $1500 A a Community Blue Flex Plan,33709PA056,,PAN001,PAS001,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0560023-00,Standard Gold Off Exchange Plan,78.20%,,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$3,300","$6,600","$3,300","$6,600","$9,900","$19,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,"$3,000","$6,000",30%,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0560023,Premier Balance PPO $1500 A a Community Blue Flex Plan,33709PA056,,PAN001,PAS001,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0560023-01,Standard Gold On Exchange Plan,78.20%,,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$3,300","$6,600","$3,300","$6,600","$9,900","$19,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,"$3,000","$6,000",30%,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0560027,Premier Balance PPO $2000 A a Community Blue Flex Plan,33709PA056,,PAN001,PAS001,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0560027-00,Standard Gold Off Exchange Plan,78.10%,,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$3,200","$6,400","$3,200","$6,400","$9,600","$19,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$3,000","$6,000",30%,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0560027,Premier Balance PPO $2000 A a Community Blue Flex Plan,33709PA056,,PAN001,PAS001,PAF008,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0560027-01,Standard Gold On Exchange Plan,78.10%,,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$3,200","$6,400","$3,200","$6,400","$9,600","$19,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$3,000","$6,000",30%,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,11,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0560029,Premier Balance PPO $1400 A a Community Blue Flex Plan,33709PA056,,PAN001,PAS001,PAF008,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0560029-00,Standard Silver Off Exchange Plan,71.90%,,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",0%,"$5,000","$10,000",30%,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,12,33709,PA,Individual,No,23-1294723,33709PA0400001,Health Savings Blue PPO 2750 a Community Blue Flex Plan,33709PA040,,PAN001,PAS001,PAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0400001-00,Standard Silver Off Exchange Plan,,0.684168100357056,Yes,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",20%,"$2,750","$5,500",40%,"$5,500","$11,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,12,33709,PA,Individual,No,23-1294723,33709PA0400001,Health Savings Blue PPO 2750 a Community Blue Flex Plan,33709PA040,,PAN001,PAS001,PAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0400001-01,Standard Silver On Exchange Plan,,0.684168100357056,Yes,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",20%,"$2,750","$5,500",40%,"$5,500","$11,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,12,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0580016,High Deductible PPO $4000 Qualified A a Community Blue Flex Plan,33709PA058,,PAN001,PAS001,PAF006,New,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0580016-01,Standard Bronze On Exchange Plan,61.00%,0.633822977542877,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$19,350","$38,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,"$4,000","$8,000",30%,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,12,33709,PA,Individual,No,23-1294723,33709PA0400001,Health Savings Blue PPO 2750 a Community Blue Flex Plan,33709PA040,,PAN001,PAS001,PAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0400001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,12,33709,PA,Individual,No,23-1294723,33709PA0400001,Health Savings Blue PPO 2750 a Community Blue Flex Plan,33709PA040,,PAN001,PAS001,PAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0400001-03,Limited Cost Sharing Plan Variation,,0.684168100357056,Yes,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",20%,"$2,750","$5,500",40%,"$5,500","$11,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,12,33709,PA,Individual,No,23-1294723,33709PA0400001,Health Savings Blue PPO 2750 a Community Blue Flex Plan,33709PA040,,PAN001,PAS001,PAF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0400001-04,73% AV Level Silver Plan,,0.722826778888702,Yes,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,"$2,500","$5,000",40%,"$5,500","$11,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,13,33709,PA,Individual,No,23-1294723,33709PA0420013,Flex Blue PPO 1200 PA Mountains Healthcare Region a Community Blue Plan,33709PA042,,PAN002,PAS008,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420013-00,Standard Gold Off Exchange Plan,,0.783652305603027,No,Yes,Yes,69%,31%,,,,,,,,,,,,,,,,,"$3,600","$7,200","$3,600","$7,200","$7,200","$14,400",Not Applicable,Not Applicable,"$1,200","$2,400",20%,"$2,400","$4,800",40%,"$4,800","$9,600",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,13,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0580006,High Deductible PPO $1500 Qualified A a Community Blue Flex Plan,33709PA058,,PAN001,PAS001,PAF008,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0580006-00,Standard Silver Off Exchange Plan,70.88%,0.708835899829865,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,400","$12,800","$6,400","$12,800","$19,200","$38,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,"$1,500","$3,000",30%,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,13,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0580006,High Deductible PPO $1500 Qualified A a Community Blue Flex Plan,33709PA058,,PAN001,PAS001,PAF008,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0580006-01,Standard Silver On Exchange Plan,70.88%,0.708835899829865,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,400","$12,800","$6,400","$12,800","$19,200","$38,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,"$1,500","$3,000",30%,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,13,33709,PA,Individual,No,23-1294723,33709PA0420013,Flex Blue PPO 1200 PA Mountains Healthcare Region a Community Blue Plan,33709PA042,,PAN002,PAS008,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420013-01,Standard Gold On Exchange Plan,,0.783652305603027,No,Yes,Yes,69%,31%,,,,,,,,,,,,,,,,,"$3,600","$7,200","$3,600","$7,200","$7,200","$14,400",Not Applicable,Not Applicable,"$1,200","$2,400",20%,"$2,400","$4,800",40%,"$4,800","$9,600",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,13,33709,PA,Individual,No,23-1294723,33709PA0420013,Flex Blue PPO 1200 PA Mountains Healthcare Region a Community Blue Plan,33709PA042,,PAN002,PAS008,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420013-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,69%,31%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,13,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0580008,High Deductible PPO $1750 Qualified A a Community Blue Flex Plan,33709PA058,,PAN001,PAS001,PAF008,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0580008-00,Standard Silver Off Exchange Plan,69.49%,0.694914042949677,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,400","$12,800","$6,400","$12,800","$19,200","$38,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",0%,"$1,750","$3,500",30%,"$5,250","$10,500",Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,13,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0580008,High Deductible PPO $1750 Qualified A a Community Blue Flex Plan,33709PA058,,PAN001,PAS001,PAF008,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0580008-01,Standard Silver On Exchange Plan,69.49%,0.694914042949677,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,400","$12,800","$6,400","$12,800","$19,200","$38,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",0%,"$1,750","$3,500",30%,"$5,250","$10,500",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,13,33709,PA,Individual,No,23-1294723,33709PA0420013,Flex Blue PPO 1200 PA Mountains Healthcare Region a Community Blue Plan,33709PA042,,PAN002,PAS008,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420013-03,Limited Cost Sharing Plan Variation,,0.783652305603027,No,Yes,Yes,69%,31%,,,,,,,,,,,,,,,,,"$3,600","$7,200","$3,600","$7,200","$7,200","$14,400",Not Applicable,Not Applicable,"$1,200","$2,400",20%,"$2,400","$4,800",40%,"$4,800","$9,600",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,13,33709,PA,Individual,No,23-1294723,33709PA0420014,Flex Blue PPO 1200 Penn Highlands Region a Community Blue Plan,33709PA042,,PAN002,PAS007,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420014-00,Standard Gold Off Exchange Plan,,0.784411191940308,No,Yes,Yes,69%,31%,,,,,,,,,,,,,,,,,"$3,600","$7,200","$3,600","$7,200","$7,200","$14,400",Not Applicable,Not Applicable,"$1,200","$2,400",20%,"$2,400","$4,800",40%,"$4,800","$9,600",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,13,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0580010,High Deductible PPO $2600 Qualified A a Community Blue Flex Plan,33709PA058,,PAN001,PAS001,PAF008,New,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0580010-00,Standard Bronze Off Exchange Plan,61.60%,0.642294943332672,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$19,350","$38,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,"$2,600","$5,200",30%,"$7,800","$15,600",Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,13,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0580010,High Deductible PPO $2600 Qualified A a Community Blue Flex Plan,33709PA058,,PAN001,PAS001,PAF008,New,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0580010-01,Standard Bronze On Exchange Plan,61.60%,0.642294943332672,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$19,350","$38,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,"$2,600","$5,200",30%,"$7,800","$15,600",Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,13,33709,PA,Individual,No,23-1294723,33709PA0420014,Flex Blue PPO 1200 Penn Highlands Region a Community Blue Plan,33709PA042,,PAN002,PAS007,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420014-01,Standard Gold On Exchange Plan,,0.784411191940308,No,Yes,Yes,69%,31%,,,,,,,,,,,,,,,,,"$3,600","$7,200","$3,600","$7,200","$7,200","$14,400",Not Applicable,Not Applicable,"$1,200","$2,400",20%,"$2,400","$4,800",40%,"$4,800","$9,600",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,13,33709,PA,Individual,No,23-1294723,33709PA0420014,Flex Blue PPO 1200 Penn Highlands Region a Community Blue Plan,33709PA042,,PAN002,PAS007,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,69%,31%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,13,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0580012,High Deductible PPO $3000 Qualified A a Community Blue Flex Plan,33709PA058,,PAN001,PAS001,PAF008,New,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0580012-00,Standard Bronze Off Exchange Plan,61.40%,0.637008547782898,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$19,350","$38,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,"$3,000","$6,000",30%,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,13,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0580012,High Deductible PPO $3000 Qualified A a Community Blue Flex Plan,33709PA058,,PAN001,PAS001,PAF008,New,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0580012-01,Standard Bronze On Exchange Plan,61.40%,0.637008547782898,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$19,350","$38,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,"$3,000","$6,000",30%,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,13,33709,PA,Individual,No,23-1294723,33709PA0420014,Flex Blue PPO 1200 Penn Highlands Region a Community Blue Plan,33709PA042,,PAN002,PAS007,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0420014-03,Limited Cost Sharing Plan Variation,,0.784411191940308,No,Yes,Yes,69%,31%,,,,,,,,,,,,,,,,,"$3,600","$7,200","$3,600","$7,200","$7,200","$14,400",Not Applicable,Not Applicable,"$1,200","$2,400",20%,"$2,400","$4,800",40%,"$4,800","$9,600",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,13,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0580014,High Deductible PPO $3500 Qualified A a Community Blue Flex Plan,33709PA058,,PAN001,PAS001,PAF008,New,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0580014-00,Standard Bronze Off Exchange Plan,59.90%,0.622346818447113,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$19,350","$38,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,"$3,500","$7,000",30%,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,13,33709,PA,SHOP (Small Group),No,23-1294723,33709PA0580014,High Deductible PPO $3500 Qualified A a Community Blue Flex Plan,33709PA058,,PAN001,PAS001,PAF008,New,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,33709PA0580014-01,Standard Bronze On Exchange Plan,59.90%,0.622346818447113,Yes,Yes,Yes,86%,14%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$19,350","$38,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,"$3,500","$7,000",30%,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,14,33709,PA,Individual,No,23-1294723,33709PA0590001,Total Health Blue PPO 1200 a Community Blue Plan,33709PA059,,PAN001,PAS001,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0590001-00,Standard Gold Off Exchange Plan,,0.790469765663147,Yes,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400",20%,"$1,200","$2,400",20%,"$2,400","$4,800",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,14,33709,PA,Individual,No,23-1294723,33709PA0590001,Total Health Blue PPO 1200 a Community Blue Plan,33709PA059,,PAN001,PAS001,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0590001-01,Standard Gold On Exchange Plan,,0.790469765663147,Yes,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400",20%,"$1,200","$2,400",20%,"$2,400","$4,800",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,14,33709,PA,Individual,No,23-1294723,33709PA0590001,Total Health Blue PPO 1200 a Community Blue Plan,33709PA059,,PAN001,PAS001,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0590001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,14,33709,PA,Individual,No,23-1294723,33709PA0590001,Total Health Blue PPO 1200 a Community Blue Plan,33709PA059,,PAN001,PAS001,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0590001-03,Limited Cost Sharing Plan Variation,,0.790469765663147,Yes,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400",20%,"$1,200","$2,400",20%,"$2,400","$4,800",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,14,33709,PA,Individual,No,23-1294723,33709PA0590002,Total Health Blue PPO 1200 a Community Blue Plan,33709PA059,,PAN001,PAS002,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0590002-00,Standard Gold Off Exchange Plan,,0.791073381900787,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400",20%,"$1,200","$2,400",20%,"$2,400","$4,800",Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,14,33709,PA,Individual,No,23-1294723,33709PA0590002,Total Health Blue PPO 1200 a Community Blue Plan,33709PA059,,PAN001,PAS002,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0590002-01,Standard Gold On Exchange Plan,,0.791073381900787,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400",20%,"$1,200","$2,400",20%,"$2,400","$4,800",Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,14,33709,PA,Individual,No,23-1294723,33709PA0590002,Total Health Blue PPO 1200 a Community Blue Plan,33709PA059,,PAN001,PAS002,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0590002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,10
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,14,33709,PA,Individual,No,23-1294723,33709PA0590002,Total Health Blue PPO 1200 a Community Blue Plan,33709PA059,,PAN001,PAS002,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0590002-03,Limited Cost Sharing Plan Variation,,0.791073381900787,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400",20%,"$1,200","$2,400",20%,"$2,400","$4,800",Not Applicable,Not Applicable,,,,,,,,,11
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,1,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100001,Keystone HMO Platinum Premier,33871PA010,,PAN001,PAS001,PAF001,Existing,HMO,Platinum,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100001-00,Standard Platinum Off Exchange Plan,91.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,1,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100001,Keystone HMO Platinum Premier,33871PA010,,PAN001,PAS001,PAF001,Existing,HMO,Platinum,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100001-01,Standard Platinum On Exchange Plan,91.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,1,33871,PA,Individual,No,23-2405376,33871PA0040001,Keystone HMO Platinum,33871PA004,,PAN001,PAS001,PAF013,Existing,HMO,Platinum,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmoplatinum2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary,33871PA0040001-01,Standard Platinum On Exchange Plan,88.86%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,1,33871,PA,Individual,No,23-2405376,33871PA0040001,Keystone HMO Platinum,33871PA004,,PAN001,PAS001,PAF013,Existing,HMO,Platinum,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmoplatinum2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary,33871PA0040001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,15,33709,PA,Individual,No,23-1294723,33709PA0600001,Balance Blue PPO 1000 a Community Blue Flex Plan,33709PA060,,PAN001,PAS001,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0600001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,15,33709,PA,Individual,No,23-1294723,33709PA0600001,Balance Blue PPO 1000 a Community Blue Flex Plan,33709PA060,,PAN001,PAS001,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0600001-03,Limited Cost Sharing Plan Variation,,0.709764063358307,No,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400",Not Applicable,Not Applicable,"$1,000","$2,000",20%,"$2,500","$5,000",40%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,15,33709,PA,Individual,No,23-1294723,33709PA0600001,Balance Blue PPO 1000 a Community Blue Flex Plan,33709PA060,,PAN001,PAS001,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0600001-04,73% AV Level Silver Plan,,0.730369865894318,No,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$13,200","$26,400",Not Applicable,Not Applicable,$750,"$1,500",20%,"$2,250","$4,500",40%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,15,33709,PA,Individual,No,23-1294723,33709PA0600001,Balance Blue PPO 1000 a Community Blue Flex Plan,33709PA060,,PAN001,PAS001,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0600001-05,87% AV Level Silver Plan,,0.865462243556976,No,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","$13,200","$26,400",Not Applicable,Not Applicable,$200,$400,10%,$600,"$1,200",30%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,15,33709,PA,Individual,No,23-1294723,33709PA0600001,Balance Blue PPO 1000 a Community Blue Flex Plan,33709PA060,,PAN001,PAS001,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0600001-06,94% AV Level Silver Plan,,0.936545491218567,No,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,$500,"$1,000",$500,"$1,000","$13,200","$26,400",Not Applicable,Not Applicable,$100,$200,10%,$300,$600,30%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,15,33709,PA,Individual,No,23-1294723,33709PA0600002,Balance Blue PPO 1000 a Community Blue Flex Plan,33709PA060,,PAN001,PAS002,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0600002-00,Standard Silver Off Exchange Plan,,0.71478283405304,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400",Not Applicable,Not Applicable,"$1,000","$2,000",20%,"$2,500","$5,000",40%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,15,33709,PA,Individual,No,23-1294723,33709PA0600002,Balance Blue PPO 1000 a Community Blue Flex Plan,33709PA060,,PAN001,PAS002,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0600002-01,Standard Silver On Exchange Plan,,0.71478283405304,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400",Not Applicable,Not Applicable,"$1,000","$2,000",20%,"$2,500","$5,000",40%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,15,33709,PA,Individual,No,23-1294723,33709PA0600002,Balance Blue PPO 1000 a Community Blue Flex Plan,33709PA060,,PAN001,PAS002,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0600002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,15,33709,PA,Individual,No,23-1294723,33709PA0600002,Balance Blue PPO 1000 a Community Blue Flex Plan,33709PA060,,PAN001,PAS002,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0600002-03,Limited Cost Sharing Plan Variation,,0.71478283405304,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400",Not Applicable,Not Applicable,"$1,000","$2,000",20%,"$2,500","$5,000",40%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,15,33709,PA,Individual,No,23-1294723,33709PA0600002,Balance Blue PPO 1000 a Community Blue Flex Plan,33709PA060,,PAN001,PAS002,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0600002-04,73% AV Level Silver Plan,,0.734998106956482,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$13,200","$26,400",Not Applicable,Not Applicable,$750,"$1,500",20%,"$2,250","$4,500",40%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,15,33709,PA,Individual,No,23-1294723,33709PA0600002,Balance Blue PPO 1000 a Community Blue Flex Plan,33709PA060,,PAN001,PAS002,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0600002-05,87% AV Level Silver Plan,,0.866665065288544,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","$13,200","$26,400",Not Applicable,Not Applicable,$200,$400,10%,$600,"$1,200",30%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,15,33709,PA,Individual,No,23-1294723,33709PA0600002,Balance Blue PPO 1000 a Community Blue Flex Plan,33709PA060,,PAN001,PAS002,PAF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0600002-06,94% AV Level Silver Plan,,0.937286615371704,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$500,"$1,000",$500,"$1,000","$13,200","$26,400",Not Applicable,Not Applicable,$100,$200,10%,$300,$600,30%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,16,33709,PA,Individual,No,23-1294723,33709PA0600003,Balance Blue PPO 500 a Community Blue Plan,33709PA060,,PAN001,PAS001,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0600003-00,Standard Gold Off Exchange Plan,,0.803588926792145,Yes,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$2,400","$4,800","$2,400","$4,800","$4,800","$9,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,"$1,250","$2,500",30%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,16,33709,PA,Individual,No,23-1294723,33709PA0600003,Balance Blue PPO 500 a Community Blue Plan,33709PA060,,PAN001,PAS001,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0600003-01,Standard Gold On Exchange Plan,,0.803588926792145,Yes,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$2,400","$4,800","$2,400","$4,800","$4,800","$9,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,"$1,250","$2,500",30%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,16,33709,PA,Individual,No,23-1294723,33709PA0600003,Balance Blue PPO 500 a Community Blue Plan,33709PA060,,PAN001,PAS001,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0600003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,16,33709,PA,Individual,No,23-1294723,33709PA0600003,Balance Blue PPO 500 a Community Blue Plan,33709PA060,,PAN001,PAS001,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0600003-03,Limited Cost Sharing Plan Variation,,0.803588926792145,Yes,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$2,400","$4,800","$2,400","$4,800","$4,800","$9,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,"$1,250","$2,500",30%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,16,33709,PA,Individual,No,23-1294723,33709PA0600004,Balance Blue PPO 500 a Community Blue Plan,33709PA060,,PAN001,PAS002,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0600004-00,Standard Gold Off Exchange Plan,,0.804896771907806,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$2,400","$4,800","$2,400","$4,800","$4,800","$9,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,"$1,250","$2,500",30%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,16,33709,PA,Individual,No,23-1294723,33709PA0600004,Balance Blue PPO 500 a Community Blue Plan,33709PA060,,PAN001,PAS002,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0600004-01,Standard Gold On Exchange Plan,,0.804896771907806,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$2,400","$4,800","$2,400","$4,800","$4,800","$9,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,"$1,250","$2,500",30%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,16,33709,PA,Individual,No,23-1294723,33709PA0600004,Balance Blue PPO 500 a Community Blue Plan,33709PA060,,PAN001,PAS002,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0600004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,10
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,16,33709,PA,Individual,No,23-1294723,33709PA0600004,Balance Blue PPO 500 a Community Blue Plan,33709PA060,,PAN001,PAS002,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0600004-03,Limited Cost Sharing Plan Variation,,0.804896771907806,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$2,400","$4,800","$2,400","$4,800","$4,800","$9,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,"$1,250","$2,500",30%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,17,33709,PA,Individual,No,23-1294723,33709PA0390005,Shared Cost Blue PPO 2650 a Community Blue Flex Plan,33709PA039,,PAN001,PAS001,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0390005-00,Standard Silver Off Exchange Plan,,0.69169807434082,No,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400",Not Applicable,Not Applicable,"$2,650","$5,300",30%,"$5,300","$10,600",50%,"$10,600","$21,200",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,17,33709,PA,Individual,No,23-1294723,33709PA0390005,Shared Cost Blue PPO 2650 a Community Blue Flex Plan,33709PA039,,PAN001,PAS001,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0390005-01,Standard Silver On Exchange Plan,,0.69169807434082,No,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400",Not Applicable,Not Applicable,"$2,650","$5,300",30%,"$5,300","$10,600",50%,"$10,600","$21,200",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,17,33709,PA,Individual,No,23-1294723,33709PA0390005,Shared Cost Blue PPO 2650 a Community Blue Flex Plan,33709PA039,,PAN001,PAS001,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0390005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,17,33709,PA,Individual,No,23-1294723,33709PA0390005,Shared Cost Blue PPO 2650 a Community Blue Flex Plan,33709PA039,,PAN001,PAS001,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0390005-03,Limited Cost Sharing Plan Variation,,0.69169807434082,No,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400",Not Applicable,Not Applicable,"$2,650","$5,300",30%,"$5,300","$10,600",50%,"$10,600","$21,200",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,17,33709,PA,Individual,No,23-1294723,33709PA0390005,Shared Cost Blue PPO 2650 a Community Blue Flex Plan,33709PA039,,PAN001,PAS001,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0390005-04,73% AV Level Silver Plan,,0.724319219589233,No,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,"$4,000","$8,000",50%,"$10,600","$21,200",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,17,33709,PA,Individual,No,23-1294723,33709PA0390005,Shared Cost Blue PPO 2650 a Community Blue Flex Plan,33709PA039,,PAN001,PAS001,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0390005-05,87% AV Level Silver Plan,,0.871948659420013,No,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","$12,700","$25,400",Not Applicable,Not Applicable,$500,"$1,000",20%,"$1,000","$2,000",40%,"$10,600","$21,200",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,17,33709,PA,Individual,No,23-1294723,33709PA0390005,Shared Cost Blue PPO 2650 a Community Blue Flex Plan,33709PA039,,PAN001,PAS001,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0390005-06,94% AV Level Silver Plan,,0.941694617271423,No,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,$500,"$1,000",$500,"$1,000","$12,700","$25,400",Not Applicable,Not Applicable,$100,$200,10%,$250,$500,30%,"$10,600","$21,200",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,17,33709,PA,Individual,No,23-1294723,33709PA0390009,Shared Cost Blue PPO 1200 a Community Blue Flex Plan,33709PA039,,PAN001,PAS001,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0390009-00,Standard Gold Off Exchange Plan,,0.78624039888382,No,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$3,700","$7,400","$3,700","$7,400","$7,400","$14,800",Not Applicable,Not Applicable,"$1,200","$2,400",20%,"$3,000","$6,000",40%,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,17,33709,PA,Individual,No,23-1294723,33709PA0390009,Shared Cost Blue PPO 1200 a Community Blue Flex Plan,33709PA039,,PAN001,PAS001,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0390009-01,Standard Gold On Exchange Plan,,0.78624039888382,No,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$3,700","$7,400","$3,700","$7,400","$7,400","$14,800",Not Applicable,Not Applicable,"$1,200","$2,400",20%,"$3,000","$6,000",40%,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,17,33709,PA,Individual,No,23-1294723,33709PA0390009,Shared Cost Blue PPO 1200 a Community Blue Flex Plan,33709PA039,,PAN001,PAS001,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0390009-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,PA,33709,HIOS,14,2015-06-19 13:25:37,17,33709,PA,Individual,No,23-1294723,33709PA0390009,Shared Cost Blue PPO 1200 a Community Blue Flex Plan,33709PA039,,PAN001,PAS001,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9985,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,33709PA0390009-03,Limited Cost Sharing Plan Variation,,0.78624039888382,No,Yes,Yes,87%,13%,,,,,,,,,,,,,,,,,"$3,700","$7,400","$3,700","$7,400","$7,400","$14,800",Not Applicable,Not Applicable,"$1,200","$2,400",20%,"$3,000","$6,000",40%,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,1,33871,PA,Individual,No,23-2405376,33871PA0040001,Keystone HMO Platinum,33871PA004,,PAN001,PAS001,PAF013,Existing,HMO,Platinum,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmoplatinum2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary,33871PA0040001-00,Standard Platinum Off Exchange Plan,88.86%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,1,33871,PA,Individual,No,23-2405376,33871PA0040001,Keystone HMO Platinum,33871PA004,,PAN001,PAS001,PAF013,Existing,HMO,Platinum,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmoplatinum2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary,33871PA0040001-03,Limited Cost Sharing Plan Variation,88.86%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,2,33871,PA,Individual,No,23-2405376,33871PA0040002,Keystone HMO Gold,33871PA004,,PAN001,PAS001,PAF014,Existing,HMO,Gold,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$200,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmogold2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040002-00,Standard Gold Off Exchange Plan,82.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,100","$12,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,2,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100002,Keystone HMO Platinum,33871PA010,,PAN001,PAS001,PAF002,Existing,HMO,Platinum,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100002-00,Standard Platinum Off Exchange Plan,88.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,2,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100002,Keystone HMO Platinum,33871PA010,,PAN001,PAS001,PAF002,Existing,HMO,Platinum,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100002-01,Standard Platinum On Exchange Plan,88.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,2,33871,PA,Individual,No,23-2405376,33871PA0040002,Keystone HMO Gold,33871PA004,,PAN001,PAS001,PAF014,Existing,HMO,Gold,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$200,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmogold2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040002-03,Limited Cost Sharing Plan Variation,82.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,100","$12,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,3,33871,PA,Individual,No,23-2405376,33871PA0040003,Keystone HMO Silver,33871PA004,,PAN001,PAS001,PAF015,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$300,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmosilver2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040003-00,Standard Silver Off Exchange Plan,,0.700008451938629,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,3,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100003,Keystone HMO Gold Premier,33871PA010,,PAN001,PAS001,PAF003,Existing,HMO,Gold,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100003-00,Standard Gold Off Exchange Plan,81.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,3,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100003,Keystone HMO Gold Premier,33871PA010,,PAN001,PAS001,PAF003,Existing,HMO,Gold,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100003-01,Standard Gold On Exchange Plan,81.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,3,33871,PA,Individual,No,23-2405376,33871PA0040003,Keystone HMO Silver,33871PA004,,PAN001,PAS001,PAF015,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$300,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmosilver2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040003-01,Standard Silver On Exchange Plan,,0.700008451938629,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,3,33871,PA,Individual,No,23-2405376,33871PA0040003,Keystone HMO Silver,33871PA004,,PAN001,PAS001,PAF015,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$300,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmosilver2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,3,33871,PA,Individual,No,23-2405376,33871PA0040003,Keystone HMO Silver,33871PA004,,PAN001,PAS001,PAF015,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$300,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmosilver2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040003-03,Limited Cost Sharing Plan Variation,,0.700008451938629,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,3,33871,PA,Individual,No,23-2405376,33871PA0040003,Keystone HMO Silver,33871PA004,,PAN001,PAS001,PAF015,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$300,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmosilver2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040003-04,73% AV Level Silver Plan,,0.725679099559784,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,3,33871,PA,Individual,No,23-2405376,33871PA0040003,Keystone HMO Silver,33871PA004,,PAN001,PAS001,PAF015,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$300,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmosilver2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040003-05,87% AV Level Silver Plan,,0.865708529949188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,3,33871,PA,Individual,No,23-2405376,33871PA0040003,Keystone HMO Silver,33871PA004,,PAN001,PAS001,PAF015,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$300,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmosilver2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040003-06,94% AV Level Silver Plan,,0.930691301822662,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,4,33871,PA,Individual,No,23-2405376,33871PA0040004,Keystone HMO Bronze,33871PA004,,PAN001,PAS001,PAF016,Existing,HMO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmobronze2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040004-00,Standard Bronze Off Exchange Plan,61.33%,0.613264441490173,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,4,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100004,Keystone HMO Gold,33871PA010,,PAN001,PAS001,PAF003,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100004-00,Standard Gold Off Exchange Plan,,0.782004833221436,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,4,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100004,Keystone HMO Gold,33871PA010,,PAN001,PAS001,PAF003,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100004-01,Standard Gold On Exchange Plan,,0.782004833221436,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,4,33871,PA,Individual,No,23-2405376,33871PA0040004,Keystone HMO Bronze,33871PA004,,PAN001,PAS001,PAF016,Existing,HMO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmobronze2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040004-01,Standard Bronze On Exchange Plan,61.33%,0.613264441490173,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,4,33871,PA,Individual,No,23-2405376,33871PA0040004,Keystone HMO Bronze,33871PA004,,PAN001,PAS001,PAF016,Existing,HMO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmobronze2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,4,33871,PA,Individual,No,23-2405376,33871PA0040004,Keystone HMO Bronze,33871PA004,,PAN001,PAS001,PAF016,Existing,HMO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmobronze2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040004-03,Limited Cost Sharing Plan Variation,61.33%,0.613264441490173,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,5,33871,PA,Individual,No,23-2405376,33871PA0040005,Keystone HMO Gold Proactive,33871PA004,,PAN001,PAS001,PAF021,Existing,HMO,Gold,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$200,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmogoldproactive2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040005-00,Standard Gold Off Exchange Plan,78.02%,,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,5,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100005,Keystone HMO Silver Premier,33871PA010,,PAN001,PAS001,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,$125,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100005-00,Standard Silver Off Exchange Plan,71.32%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,5,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100005,Keystone HMO Silver Premier,33871PA010,,PAN001,PAS001,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,$125,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100005-01,Standard Silver On Exchange Plan,71.32%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,5,33871,PA,Individual,No,23-2405376,33871PA0040005,Keystone HMO Gold Proactive,33871PA004,,PAN001,PAS001,PAF021,Existing,HMO,Gold,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$200,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmogoldproactive2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040005-01,Standard Gold On Exchange Plan,78.02%,,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,5,33871,PA,Individual,No,23-2405376,33871PA0040005,Keystone HMO Gold Proactive,33871PA004,,PAN001,PAS001,PAF021,Existing,HMO,Gold,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$200,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmogoldproactive2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040005-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,5,33871,PA,Individual,No,23-2405376,33871PA0040005,Keystone HMO Gold Proactive,33871PA004,,PAN001,PAS001,PAF021,Existing,HMO,Gold,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$200,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmogoldproactive2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040005-03,Limited Cost Sharing Plan Variation,78.02%,,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,6,33871,PA,Individual,No,23-2405376,33871PA0040006,Keystone HMO Silver Proactive,33871PA004,,PAN001,PAS001,PAF022,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$400,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmosilverproactive2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040006-00,Standard Silver Off Exchange Plan,71.24%,,No,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,"$4,500","$9,000",5%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,6,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100006,Keystone HMO Silver,33871PA010,,PAN001,PAS001,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,$125,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100006-00,Standard Silver Off Exchange Plan,70.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,6,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100006,Keystone HMO Silver,33871PA010,,PAN001,PAS001,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,$125,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100006-01,Standard Silver On Exchange Plan,70.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,6,33871,PA,Individual,No,23-2405376,33871PA0040006,Keystone HMO Silver Proactive,33871PA004,,PAN001,PAS001,PAF022,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$400,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmosilverproactive2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040006-01,Standard Silver On Exchange Plan,71.24%,,No,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,"$4,500","$9,000",5%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,6,33871,PA,Individual,No,23-2405376,33871PA0040006,Keystone HMO Silver Proactive,33871PA004,,PAN001,PAS001,PAF022,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$400,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmosilverproactive2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040006-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,6,33871,PA,Individual,No,23-2405376,33871PA0040006,Keystone HMO Silver Proactive,33871PA004,,PAN001,PAS001,PAF022,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$400,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmosilverproactive2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040006-03,Limited Cost Sharing Plan Variation,71.24%,,No,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,"$4,500","$9,000",5%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,6,33871,PA,Individual,No,23-2405376,33871PA0040006,Keystone HMO Silver Proactive,33871PA004,,PAN001,PAS001,PAF022,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$400,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmosilverproactive2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040006-04,73% AV Level Silver Plan,73.31%,,No,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,"$4,250","$8,500",5%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,6,33871,PA,Individual,No,23-2405376,33871PA0040006,Keystone HMO Silver Proactive,33871PA004,,PAN001,PAS001,PAF022,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$400,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmosilverproactive2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040006-05,87% AV Level Silver Plan,86.14%,,No,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,"$1,000","$2,000",5%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,$0,$0,30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,6,33871,PA,Individual,No,23-2405376,33871PA0040006,Keystone HMO Silver Proactive,33871PA004,,PAN001,PAS001,PAF022,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$400,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx4you.com/ffm/hmosilverproactive2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/brochure,www.ibx.com/ffm/formulary2,33871PA0040006-06,94% AV Level Silver Plan,93.03%,,No,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$100,$200,5%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,$0,$0,10%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,7,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100007,Keystone HMO Bronze,33871PA010,,PAN001,PAS001,PAF005,Existing,HMO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100007-00,Standard Bronze Off Exchange Plan,59.81%,0.598058342933655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,11,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100013,Keystone DPOS Gold,33871PA010,,PAN001,PAS001,PAF010,Existing,HMO,Gold,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100013-01,Standard Gold On Exchange Plan,,0.782004833221436,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,12,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100014,Keystone DPOS Silver Premier,33871PA010,,PAN001,PAS001,PAF011,Existing,HMO,Silver,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,$125,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100014-00,Standard Silver Off Exchange Plan,71.32%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,12,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100014,Keystone DPOS Silver Premier,33871PA010,,PAN001,PAS001,PAF011,Existing,HMO,Silver,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,$125,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100014-01,Standard Silver On Exchange Plan,71.32%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,13,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100015,Keystone DPOS Silver,33871PA010,,PAN001,PAS001,PAF011,Existing,HMO,Silver,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,$125,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100015-00,Standard Silver Off Exchange Plan,70.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$2,500","$5,000",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,13,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100015,Keystone DPOS Silver,33871PA010,,PAN001,PAS001,PAF011,Existing,HMO,Silver,Yes,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,$125,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100015-01,Standard Silver On Exchange Plan,70.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$2,500","$5,000",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,14,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100016,Keystone DPOS Bronze,33871PA010,,PAN001,PAS001,PAF012,Existing,HMO,Bronze,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100016-00,Standard Bronze Off Exchange Plan,,0.598058342933655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$40,000","$80,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0.01%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,14,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100016,Keystone DPOS Bronze,33871PA010,,PAN001,PAS001,PAF012,Existing,HMO,Bronze,No,Both,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100016-01,Standard Bronze On Exchange Plan,,0.598058342933655,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$40,000","$80,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0.01%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,15,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100008,Keystone HMO Gold Proactive,33871PA010,,PAN001,PAS001,PAF006,Existing,HMO,Gold,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,$200,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary2,33871PA0100008-00,Standard Gold Off Exchange Plan,78.02%,,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020011,Healthy Benefits PPO 2500.0,45127PA002,7588667726,PAN004,PAS002,PAF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020011-05,87% AV Level Silver Plan,86.50%,0.864961266517639,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,$500,"$1,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020011,Healthy Benefits PPO 2500.0,45127PA002,7588667726,PAN004,PAS002,PAF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020011-06,94% AV Level Silver Plan,93.39%,0.933910667896271,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,0%,$200,$400,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020012,Healthy Benefits PPO 2000.0,45127PA002,7588667726,PAN004,PAS002,PAF004,New,PPO,Silver,Yes,Both,Yes,No,,,0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020012-00,Standard Silver Off Exchange Plan,70.88%,0.708825469017029,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$2,000","$4,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020012,Healthy Benefits PPO 2000.0,45127PA002,7588667726,PAN004,PAS002,PAF004,New,PPO,Silver,Yes,Both,Yes,No,,,0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020012-01,Standard Silver On Exchange Plan,70.88%,0.708825469017029,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$2,000","$4,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020012,Healthy Benefits PPO 2000.0,45127PA002,7588667726,PAN004,PAS002,PAF004,New,PPO,Silver,Yes,Both,Yes,No,,,0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020012-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,20
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020012,Healthy Benefits PPO 2000.0,45127PA002,7588667726,PAN004,PAS002,PAF004,New,PPO,Silver,Yes,Both,Yes,No,,,0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020012-03,Limited Cost Sharing Plan Variation,70.88%,0.708825469017029,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$2,000","$4,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020012,Healthy Benefits PPO 2000.0,45127PA002,7588667726,PAN004,PAS002,PAF004,New,PPO,Silver,Yes,Both,Yes,No,,,0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020012-04,73% AV Level Silver Plan,73.44%,0.734439194202423,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",0%,"$1,750","$3,500",0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020012,Healthy Benefits PPO 2000.0,45127PA002,7588667726,PAN004,PAS002,PAF004,New,PPO,Silver,Yes,Both,Yes,No,,,0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020012-05,87% AV Level Silver Plan,86.30%,0.862960875034332,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,$500,"$1,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020012,Healthy Benefits PPO 2000.0,45127PA002,7588667726,PAN004,PAS002,PAF004,New,PPO,Silver,Yes,Both,Yes,No,,,0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020012-06,94% AV Level Silver Plan,94.19%,0.94192361831665,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,0%,$100,$200,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020014,Healthy Benefits PPO 500.0,45127PA002,7588667726,PAN004,PAS002,PAF006,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020014-00,Standard Gold Off Exchange Plan,80.39%,0.803941428661346,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,$50,$100,0%,$50,$100,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020014,Healthy Benefits PPO 500.0,45127PA002,7588667726,PAN004,PAS002,PAF006,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020014-01,Standard Gold On Exchange Plan,80.39%,0.803941428661346,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,$50,$100,0%,$50,$100,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020014,Healthy Benefits PPO 500.0,45127PA002,7588667726,PAN004,PAS002,PAF006,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020014-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,27
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020014,Healthy Benefits PPO 500.0,45127PA002,7588667726,PAN004,PAS002,PAF006,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020014-03,Limited Cost Sharing Plan Variation,80.39%,0.803941428661346,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,$50,$100,0%,$50,$100,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020015,Healthy Benefits PPO 0.0,45127PA002,7588667726,PAN004,PAS002,PAF003,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020015-00,Standard Silver Off Exchange Plan,69.15%,0.691467583179474,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,16,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100009,Keystone HMO Silver Proactive,33871PA010,,PAN001,PAS001,PAF007,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,$400,5,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary2,33871PA0100009-01,Standard Silver On Exchange Plan,71.24%,,No,Yes,Yes,55%,45%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,"$4,500","$9,000",5%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,17,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100017,Keystone HMO Bronze Basic,33871PA010,,PAN001,PAS001,PAF027,New,HMO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Routine eye care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100017-00,Standard Bronze Off Exchange Plan,58.03%,0.580297768115997,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33871,HIOS,8,2015-07-22 09:15:52,17,33871,PA,SHOP (Small Group),No,23-2405376,33871PA0100017,Keystone HMO Bronze Basic,33871PA010,,PAN001,PAS001,PAF027,New,HMO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Routine eye care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9912,,,0,0,0,2015-01-01,,Yes,"Emergent, Urgent and Follow-up Care",Yes,"Emergent, Urgent and Follow-up Care",No,https://www.ibx.com/ffm/shop,https://www.ibx.com/market/SHOP,https://www.ibx.com/ffm/shop/brochure,www.ibx.com/ffm/formulary,33871PA0100017-01,Standard Bronze On Exchange Plan,58.03%,0.580297768115997,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,1,33906,PA,Individual,No,06-6033492,33906PA0070010,Aetna Bronze $20 Copay OAMC,33906PA007,,PAN001,PAS001,PAF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070010-00,Standard Bronze Off Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,1,33906,PA,Individual,No,06-6033492,33906PA0070010,Aetna Bronze $20 Copay OAMC,33906PA007,,PAN001,PAS001,PAF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070010-01,Standard Bronze On Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,1,33906,PA,Individual,No,06-6033492,33906PA0070010,Aetna Bronze $20 Copay OAMC,33906PA007,,PAN001,PAS001,PAF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070010-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,1,33906,PA,Individual,No,06-6033492,33906PA0070010,Aetna Bronze $20 Copay OAMC,33906PA007,,PAN001,PAS001,PAF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070010-03,Limited Cost Sharing Plan Variation,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,3,33906,PA,Individual,No,06-6033492,33906PA0070011,Aetna Bronze Deductible Only HSA Eligible OAMC,33906PA007,,PAN001,PAS001,PAF002,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070011-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,3,33906,PA,Individual,No,06-6033492,33906PA0070011,Aetna Bronze Deductible Only HSA Eligible OAMC,33906PA007,,PAN001,PAS001,PAF002,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070011-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,3,33906,PA,Individual,No,06-6033492,33906PA0070011,Aetna Bronze Deductible Only HSA Eligible OAMC,33906PA007,,PAN001,PAS001,PAF002,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070011-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,3,33906,PA,Individual,No,06-6033492,33906PA0070011,Aetna Bronze Deductible Only HSA Eligible OAMC,33906PA007,,PAN001,PAS001,PAF002,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070011-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,7,33906,PA,Individual,No,06-6033492,33906PA0070013,Aetna Silver $10 Copay OAMC,33906PA007,,PAN001,PAS001,PAF004,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070013-00,Standard Silver Off Exchange Plan,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,"$1,000",Not Applicable,$500,$0,,,,,,,,,,,,,,,,,,,4
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,7,33906,PA,Individual,No,06-6033492,33906PA0070013,Aetna Silver $10 Copay OAMC,33906PA007,,PAN001,PAS001,PAF004,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070013-01,Standard Silver On Exchange Plan,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,"$1,000",Not Applicable,$500,$0,,,,,,,,,,,,,,,,,,,5
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,7,33906,PA,Individual,No,06-6033492,33906PA0070013,Aetna Silver $10 Copay OAMC,33906PA007,,PAN001,PAS001,PAF004,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070013-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,7,33906,PA,Individual,No,06-6033492,33906PA0070013,Aetna Silver $10 Copay OAMC,33906PA007,,PAN001,PAS001,PAF004,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070013-03,Limited Cost Sharing Plan Variation,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,"$1,000",Not Applicable,$500,$0,,,,,,,,,,,,,,,,,,,7
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,7,33906,PA,Individual,No,06-6033492,33906PA0070013,Aetna Silver $10 Copay OAMC,33906PA007,,PAN001,PAS001,PAF004,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070013-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,"$1,000",Not Applicable,$500,$0,,,,,,,,,,,,,,,,,,,8
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,7,33906,PA,Individual,No,06-6033492,33906PA0070013,Aetna Silver $10 Copay OAMC,33906PA007,,PAN001,PAS001,PAF004,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070013-05,87% AV Level Silver Plan,86.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,,,,"$1,000",Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,7,33906,PA,Individual,No,06-6033492,33906PA0070013,Aetna Silver $10 Copay OAMC,33906PA007,,PAN001,PAS001,PAF004,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070013-06,94% AV Level Silver Plan,93.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,,,,"$1,000",Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,9,33906,PA,Individual,No,06-6033492,33906PA0070014,Aetna Silver $5 Copay 2750 OAMC,33906PA007,,PAN001,PAS001,PAF005,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070014-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,9,33906,PA,Individual,No,06-6033492,33906PA0070014,Aetna Silver $5 Copay 2750 OAMC,33906PA007,,PAN001,PAS001,PAF005,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070014-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,9,33906,PA,Individual,No,06-6033492,33906PA0070014,Aetna Silver $5 Copay 2750 OAMC,33906PA007,,PAN001,PAS001,PAF005,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070014-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,9,33906,PA,Individual,No,06-6033492,33906PA0070014,Aetna Silver $5 Copay 2750 OAMC,33906PA007,,PAN001,PAS001,PAF005,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070014-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,9,33906,PA,Individual,No,06-6033492,33906PA0070014,Aetna Silver $5 Copay 2750 OAMC,33906PA007,,PAN001,PAS001,PAF005,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070014-04,73% AV Level Silver Plan,72.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,9,33906,PA,Individual,No,06-6033492,33906PA0070014,Aetna Silver $5 Copay 2750 OAMC,33906PA007,,PAN001,PAS001,PAF005,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070014-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,9,33906,PA,Individual,No,06-6033492,33906PA0070014,Aetna Silver $5 Copay 2750 OAMC,33906PA007,,PAN001,PAS001,PAF005,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070014-06,94% AV Level Silver Plan,93.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,12,33906,PA,Individual,No,06-6033492,33906PA0070012,Aetna Gold $5 Copay OAMC,33906PA007,,PAN001,PAS001,PAF003,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070012-00,Standard Gold Off Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,,,,$500,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,12,33906,PA,Individual,No,06-6033492,33906PA0070012,Aetna Gold $5 Copay OAMC,33906PA007,,PAN001,PAS001,PAF003,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070012-01,Standard Gold On Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,,,,$500,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,12,33906,PA,Individual,No,06-6033492,33906PA0070012,Aetna Gold $5 Copay OAMC,33906PA007,,PAN001,PAS001,PAF003,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070012-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,PA,33906,HIOS,9,2014-09-06 03:39:47,12,33906,PA,Individual,No,06-6033492,33906PA0070012,Aetna Gold $5 Copay OAMC,33906PA007,,PAN001,PAS001,PAF003,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998643120412288,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,33906PA0070012-03,Limited Cost Sharing Plan Variation,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,,,,$500,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,38086,HIOS,3,2014-08-05 13:28:44,1,38086,PA,Individual,Yes,47-0397286,38086PA0010001,"Delta Dental Individual PPO, EHB Certified",38086PA001,,PAN002,PAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.89,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,38086PA0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,1,45127,PA,Individual,No,45-5492167,45127PA0020007,Healthy Benefits PPO 5500.50,45127PA002,7588667726,PAN004,PAS002,PAF001,New,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002000701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020007-03,Limited Cost Sharing Plan Variation,61.89%,0.618901968002319,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,"$5,500","$11,000",50%,"$5,500","$11,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020008,Healthy Benefits PPO 4500.0,45127PA002,7588667726,PAN004,PAS002,PAF005,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002000801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020008-00,Standard Silver Off Exchange Plan,68.09%,0.680857241153717,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,"$4,500","$9,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,SHOP (Small Group),No,45-5492167,45127PA0010136,Healthy Benefits PPO 6000.0 EX,45127PA001,7588667726,PAN004,PAS002,PAF009,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent & Urgent,Yes,Emergent & Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/45127PA006000100_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0010136-00,Standard Silver Off Exchange Plan,69.27%,0.688624501228333,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,"$6,000","$12,000",0%,"$6,000","$12,000",0%,"$6,000","$12,000",Not Applicable,Not Applicable,$300,$600,0%,$300,$600,0%,$300,$600,Not Applicable,Not Applicable,,,,,,,,,,,"$6,000",$0,$0,$200,$700,"$2,300",$0,$80,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020008,Healthy Benefits PPO 4500.0,45127PA002,7588667726,PAN004,PAS002,PAF005,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002000801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020008-04,73% AV Level Silver Plan,73.33%,0.733307778835297,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,"$3,000","$6,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020008,Healthy Benefits PPO 4500.0,45127PA002,7588667726,PAN004,PAS002,PAF005,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002000801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020008-05,87% AV Level Silver Plan,86.77%,0.867703020572662,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",0%,$750,"$1,500",0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020008,Healthy Benefits PPO 4500.0,45127PA002,7588667726,PAN004,PAS002,PAF005,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002000801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020008-06,94% AV Level Silver Plan,94.02%,0.940233647823334,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,0%,$250,$500,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020011,Healthy Benefits PPO 2500.0,45127PA002,7588667726,PAN004,PAS002,PAF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020011-00,Standard Silver Off Exchange Plan,70.06%,0.700610637664795,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,"$2,500","$5,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020011,Healthy Benefits PPO 2500.0,45127PA002,7588667726,PAN004,PAS002,PAF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020011-01,Standard Silver On Exchange Plan,70.06%,0.700610637664795,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,"$2,500","$5,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020011,Healthy Benefits PPO 2500.0,45127PA002,7588667726,PAN004,PAS002,PAF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,13
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020011,Healthy Benefits PPO 2500.0,45127PA002,7588667726,PAN004,PAS002,PAF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020011-03,Limited Cost Sharing Plan Variation,70.06%,0.700610637664795,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,"$2,500","$5,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020011,Healthy Benefits PPO 2500.0,45127PA002,7588667726,PAN004,PAS002,PAF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020011-04,73% AV Level Silver Plan,73.79%,0.737852692604065,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$2,000","$4,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020015,Healthy Benefits PPO 0.0,45127PA002,7588667726,PAN004,PAS002,PAF003,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020015-01,Standard Silver On Exchange Plan,69.15%,0.691467583179474,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020015,Healthy Benefits PPO 0.0,45127PA002,7588667726,PAN004,PAS002,PAF003,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020015-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,31
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020015,Healthy Benefits PPO 0.0,45127PA002,7588667726,PAN004,PAS002,PAF003,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020015-03,Limited Cost Sharing Plan Variation,69.15%,0.691467583179474,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020015,Healthy Benefits PPO 0.0,45127PA002,7588667726,PAN004,PAS002,PAF003,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020015-04,73% AV Level Silver Plan,72.78%,0.727825403213501,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020015,Healthy Benefits PPO 0.0,45127PA002,7588667726,PAN004,PAS002,PAF003,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020015-05,87% AV Level Silver Plan,86.85%,0.868488729000092,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020015,Healthy Benefits PPO 0.0,45127PA002,7588667726,PAN004,PAS002,PAF003,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020015-06,94% AV Level Silver Plan,94.48%,0.944750308990479,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020016,Healthy Benefits PPO 0.50,45127PA002,7588667726,PAN004,PAS002,PAF001,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020016-00,Standard Silver Off Exchange Plan,69.27%,0.692744731903076,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020016,Healthy Benefits PPO 0.50,45127PA002,7588667726,PAN004,PAS002,PAF001,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020016-01,Standard Silver On Exchange Plan,69.27%,0.692744731903076,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020016,Healthy Benefits PPO 0.50,45127PA002,7588667726,PAN004,PAS002,PAF001,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020016-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,38
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020016,Healthy Benefits PPO 0.50,45127PA002,7588667726,PAN004,PAS002,PAF001,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020016-03,Limited Cost Sharing Plan Variation,69.27%,0.692744731903076,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020016,Healthy Benefits PPO 0.50,45127PA002,7588667726,PAN004,PAS002,PAF001,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020016-04,73% AV Level Silver Plan,72.20%,0.722045004367828,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,49%,$0,$0,49%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,49%,$0,$0,49%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020016,Healthy Benefits PPO 0.50,45127PA002,7588667726,PAN004,PAS002,PAF001,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020016-05,87% AV Level Silver Plan,86.80%,0.867995798587799,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,25%,$0,$0,25%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,$0,$0,25%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020016,Healthy Benefits PPO 0.50,45127PA002,7588667726,PAN004,PAS002,PAF001,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020016-06,94% AV Level Silver Plan,93.13%,0.931299388408661,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,8%,$0,$0,8%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,8%,$0,$0,8%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020017,Healthy Benefits PPO 0.0.10,45127PA002,7588667726,PAN004,PAS002,PAF008,New,PPO,Platinum,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020017-00,Standard Platinum Off Exchange Plan,88.32%,0.883204638957977,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020017,Healthy Benefits PPO 0.0.10,45127PA002,7588667726,PAN004,PAS002,PAF008,New,PPO,Platinum,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020017-01,Standard Platinum On Exchange Plan,88.32%,0.883204638957977,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020017,Healthy Benefits PPO 0.0.10,45127PA002,7588667726,PAN004,PAS002,PAF008,New,PPO,Platinum,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020017-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,45
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,2,45127,PA,Individual,No,45-5492167,45127PA0020017,Healthy Benefits PPO 0.0.10,45127PA002,7588667726,PAN004,PAS002,PAF008,New,PPO,Platinum,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020017-03,Limited Cost Sharing Plan Variation,88.32%,0.883204638957977,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,3,45127,PA,Individual,No,45-5492167,45127PA0020010,Healthy Benefits PPO 3000.0,45127PA002,7588667726,PAN004,PAS002,PAF007,Existing,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020010-00,Standard Gold Off Exchange Plan,78.18%,0.781755924224854,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$3,000","$6,000",0%,"$3,000","$6,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$400,0%,$200,$400,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,3,45127,PA,SHOP (Small Group),Yes,45-5492167,45127PA0040003,Healthy Dental PPO Classic Plus,45127PA004,,PAN002,PAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.81,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Standard PPO Coverage,Yes,Standard PPO Coverage,Yes,,,www.capbluecross.com/pdf/benefits_summary/dental/45127PA0040003_2015.pdf,,45127PA0040003-00,Standard High Off Exchange Plan,85.06%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,3,45127,PA,Individual,Yes,45-5492167,45127PA0030003,Healthy Dental PPO Plan 3,45127PA003,,PAN003,PAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.19,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Standard PPO Coverage,Yes,Standard PPO Coverage,Yes,,,www.capbluecross.com/pdf/benefits_summary/dental/45127PA0030003_2015.pdf,,45127PA0030003-00,Standard Low Off Exchange Plan,71.98%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,3,45127,PA,Individual,No,45-5492167,45127PA0020010,Healthy Benefits PPO 3000.0,45127PA002,7588667726,PAN004,PAS002,PAF007,Existing,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020010-01,Standard Gold On Exchange Plan,78.18%,0.781755924224854,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$3,000","$6,000",0%,"$3,000","$6,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$400,0%,$200,$400,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,3,45127,PA,Individual,No,45-5492167,45127PA0020010,Healthy Benefits PPO 3000.0,45127PA002,7588667726,PAN004,PAS002,PAF007,Existing,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020010-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,3,45127,PA,Individual,No,45-5492167,45127PA0020010,Healthy Benefits PPO 3000.0,45127PA002,7588667726,PAN004,PAS002,PAF007,Existing,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020010-03,Limited Cost Sharing Plan Variation,78.18%,0.781755924224854,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$3,000","$6,000",0%,"$3,000","$6,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$400,0%,$200,$400,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,3,45127,PA,Individual,No,45-5492167,45127PA0020013,Healthy Benefits PPO 1000.0,45127PA002,7588667726,PAN004,PAS002,PAF007,Existing,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020013-00,Standard Gold Off Exchange Plan,80.80%,0.808037400245667,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,"$1,000","$2,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,$300,$600,0%,$300,$600,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,3,45127,PA,Individual,No,45-5492167,45127PA0020013,Healthy Benefits PPO 1000.0,45127PA002,7588667726,PAN004,PAS002,PAF007,Existing,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020013-01,Standard Gold On Exchange Plan,80.80%,0.808037400245667,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,"$1,000","$2,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,$300,$600,0%,$300,$600,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,3,45127,PA,Individual,No,45-5492167,45127PA0020013,Healthy Benefits PPO 1000.0,45127PA002,7588667726,PAN004,PAS002,PAF007,Existing,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020013-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,3,45127,PA,Individual,No,45-5492167,45127PA0020013,Healthy Benefits PPO 1000.0,45127PA002,7588667726,PAN004,PAS002,PAF007,Existing,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002001301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020013-03,Limited Cost Sharing Plan Variation,80.80%,0.808037400245667,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,"$1,000","$2,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,$300,$600,0%,$300,$600,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,4,45127,PA,Individual,No,45-5492167,45127PA0020009,Healthy Benefits PPO 3500.0,45127PA002,7588667726,PAN004,PAS002,PAF002,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002000901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020009-00,Standard Silver Off Exchange Plan,69.72%,0.697173595428467,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,"$3,500","$7,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,4,45127,PA,Individual,Yes,45-5492167,45127PA0030004,Healthy Dental PPO Pediatric,45127PA003,,PAN003,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$26.19,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Standard PPO Coverage,Yes,Standard PPO Coverage,Yes,,,www.capbluecross.com/pdf/benefits_summary/dental/45127PA0030004_2015.pdf,,45127PA0030004-00,Standard Low Off Exchange Plan,71.98%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,4,45127,PA,SHOP (Small Group),Yes,45-5492167,45127PA0040004,Healthy Dental PPO Classic Enhanced,45127PA004,,PAN002,PAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.81,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Standard PPO Coverage,Yes,Standard PPO Coverage,Yes,,,www.capbluecross.com/pdf/benefits_summary/dental/45127PA0040004_2015.pdf,,45127PA0040004-00,Standard High Off Exchange Plan,85.06%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,4,45127,PA,Individual,Yes,45-5492167,45127PA0030004,Healthy Dental PPO Pediatric,45127PA003,,PAN003,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$26.19,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Standard PPO Coverage,Yes,Standard PPO Coverage,Yes,,,www.capbluecross.com/pdf/benefits_summary/dental/45127PA0030004_2015.pdf,,45127PA0030004-01,Standard Low On Exchange Plan,71.98%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,4,45127,PA,Individual,No,45-5492167,45127PA0020009,Healthy Benefits PPO 3500.0,45127PA002,7588667726,PAN004,PAS002,PAF002,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002000901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020009-01,Standard Silver On Exchange Plan,69.72%,0.697173595428467,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,"$3,500","$7,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,4,45127,PA,Individual,No,45-5492167,45127PA0020009,Healthy Benefits PPO 3500.0,45127PA002,7588667726,PAN004,PAS002,PAF002,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002000901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020009-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,4,45127,PA,Individual,No,45-5492167,45127PA0020009,Healthy Benefits PPO 3500.0,45127PA002,7588667726,PAN004,PAS002,PAF002,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002000901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020009-03,Limited Cost Sharing Plan Variation,69.72%,0.697173595428467,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,"$3,500","$7,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,4,45127,PA,Individual,No,45-5492167,45127PA0020009,Healthy Benefits PPO 3500.0,45127PA002,7588667726,PAN004,PAS002,PAF002,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002000901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020009-04,73% AV Level Silver Plan,72.61%,0.726113379001617,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,"$3,000","$6,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,4,45127,PA,Individual,No,45-5492167,45127PA0020009,Healthy Benefits PPO 3500.0,45127PA002,7588667726,PAN004,PAS002,PAF002,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002000901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020009-05,87% AV Level Silver Plan,86.88%,0.868753612041473,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,"$1,000","$2,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,4,45127,PA,Individual,No,45-5492167,45127PA0020009,Healthy Benefits PPO 3500.0,45127PA002,7588667726,PAN004,PAS002,PAF002,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/45127PA002000901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,45127PA0020009-06,94% AV Level Silver Plan,94.94%,0.949364721775055,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,0%,$250,$500,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,5,45127,PA,Individual,Yes,45-5492167,45127PA0050001,Healthy Dental HMO Basic,45127PA005,,PAN001,PAS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.42,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Emergency,No,,,www.capbluecross.com/pdf/benefits_summary/dental/45127PA0050001_2015.pdf,,45127PA0050001-00,Standard Low Off Exchange Plan,70.52%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,5,45127,PA,SHOP (Small Group),Yes,45-5492167,45127PA0040005,Healthy Dental PPO Value 75,45127PA004,,PAN002,PAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.46,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Standard PPO Coverage,Yes,Standard PPO Coverage,Yes,,,www.capbluecross.com/pdf/benefits_summary/dental/45127PA0040005_2015.pdf,,45127PA0040005-00,Standard Low Off Exchange Plan,71.98%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,5,45127,PA,Individual,Yes,45-5492167,45127PA0050001,Healthy Dental HMO Basic,45127PA005,,PAN001,PAS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.42,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Emergency,No,,,www.capbluecross.com/pdf/benefits_summary/dental/45127PA0050001_2015.pdf,,45127PA0050001-01,Standard Low On Exchange Plan,70.52%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,6,45127,PA,Individual,Yes,45-5492167,45127PA0050002,Healthy Dental HMO Pediatric 702xs,45127PA005,,PAN001,PAS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$20.42,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Emergency,No,,,www.capbluecross.com/pdf/benefits_summary/dental/45127PA0050002_2015.pdf,,45127PA0050002-00,Standard Low Off Exchange Plan,70.52%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,6,45127,PA,SHOP (Small Group),Yes,45-5492167,45127PA0040006,Healthy Dental PPO Pediatric,45127PA004,,PAN002,PAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.46,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Standard PPO Coverage,Yes,Standard PPO Coverage,Yes,,,www.capbluecross.com/pdf/benefits_summary/dental/45127PA0040006_2015.pdf,,45127PA0040006-00,Standard Low Off Exchange Plan,71.98%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,6,45127,PA,Individual,Yes,45-5492167,45127PA0050002,Healthy Dental HMO Pediatric 702xs,45127PA005,,PAN001,PAS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$20.42,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Emergency,No,,,www.capbluecross.com/pdf/benefits_summary/dental/45127PA0050002_2015.pdf,,45127PA0050002-01,Standard Low On Exchange Plan,70.52%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,7,45127,PA,SHOP (Small Group),Yes,45-5492167,45127PA0040007,Healthy Dental PPO Pediatric Plus,45127PA004,,PAN002,PAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$30.81,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Standard PPO Coverage,Yes,Standard PPO Coverage,Yes,,,www.capbluecross.com/pdf/benefits_summary/dental/45127PA0040007_2015.pdf,,45127PA0040007-00,Standard High Off Exchange Plan,85.06%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,8,45127,PA,SHOP (Small Group),Yes,45-5492167,45127PA0060001,Healthy Dental HMO Basic,45127PA006,,PAN001,PAS001,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.82,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Emergency,No,,,www.capbluecross.com/pdf/benefits_summary/dental/45127PA0060001_2015.pdf,,45127PA0060001-00,Standard Low Off Exchange Plan,70.52%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,9,45127,PA,SHOP (Small Group),Yes,45-5492167,45127PA0060002,Healthy Dental HMO Classic,45127PA006,,PAN001,PAS001,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.82,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Emergency,No,,,www.capbluecross.com/pdf/benefits_summary/dental/45127PA0060002_2015.pdf,,45127PA0060002-00,Standard Low Off Exchange Plan,70.52%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,10,45127,PA,SHOP (Small Group),Yes,45-5492167,45127PA0060003,Healthy Dental HMO Pediatric 702xs,45127PA006,,PAN001,PAS001,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$19.82,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency,Yes,Emergency,No,,,www.capbluecross.com/pdf/benefits_summary/dental/45127PA0060003_2015.pdf,,45127PA0060003-00,Standard Low Off Exchange Plan,70.52%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,11,45127,PA,SHOP (Small Group),Yes,45-5492167,45127PA0040008,Healthy Dental PPO Basic Voluntary,45127PA004,,PAN002,PAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.46,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Standard PPO Coverage,Yes,Standard PPO Coverage,Yes,,,www.capbluecross.com/pdf/benefits_summary/dental/45127PA0040001_2015.pdf,,45127PA0040008-00,Standard Low Off Exchange Plan,71.98%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,45127,HIOS,8,2015-06-19 13:25:37,12,45127,PA,SHOP (Small Group),Yes,45-5492167,45127PA0040009,Healthy Dental PPO Classic Voluntary,45127PA004,,PAN002,PAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.46,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Standard PPO Coverage,Yes,Standard PPO Coverage,Yes,,,www.capbluecross.com/pdf/benefits_summary/dental/45127PA0040002_2015.pdf,,45127PA0040009-00,Standard Low Off Exchange Plan,71.98%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,46518,HIOS,11,2014-11-14 05:23:27,1,46518,PA,SHOP (Small Group),Yes,75-1233841,46518PA0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,46518PA002,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.65,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/pa/46518pa0020001-15,,46518PA0020001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,46518,HIOS,11,2014-11-14 05:23:27,1,46518,PA,Individual,Yes,75-1233841,46518PA0010001,Dentegra Dental PPO Pediatric Basic Plan,46518PA001,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$18.44,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/pa/46518pa0010001-15,,46518PA0010001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,46518,HIOS,11,2014-11-14 05:23:27,1,46518,PA,Individual,Yes,75-1233841,46518PA0010001,Dentegra Dental PPO Pediatric Basic Plan,46518PA001,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$18.44,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/pa/46518pa0010001-15,,46518PA0010001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,46518,HIOS,11,2014-11-14 05:23:27,1,46518,PA,SHOP (Small Group),Yes,75-1233841,46518PA0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,46518PA002,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.65,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/pa/46518pa0020001-15,,46518PA0020001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,46518,HIOS,11,2014-11-14 05:23:27,2,46518,PA,SHOP (Small Group),Yes,75-1233841,46518PA0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,46518PA002,,PAN001,PAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.65,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/pa/46518pa0020004-15,,46518PA0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,46518,HIOS,11,2014-11-14 05:23:27,2,46518,PA,Individual,Yes,75-1233841,46518PA0010004,Dentegra Dental PPO Family Preferred Plan,46518PA001,,PAN001,PAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.22,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/pa/46518pa0010004-15,,46518PA0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,46518,HIOS,11,2014-11-14 05:23:27,2,46518,PA,Individual,Yes,75-1233841,46518PA0010004,Dentegra Dental PPO Family Preferred Plan,46518PA001,,PAN001,PAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.22,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/pa/46518pa0010004-15,,46518PA0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,46518,HIOS,11,2014-11-14 05:23:27,2,46518,PA,SHOP (Small Group),Yes,75-1233841,46518PA0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,46518PA002,,PAN001,PAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.65,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/pa/46518pa0020004-15,,46518PA0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,46518,HIOS,11,2014-11-14 05:23:27,3,46518,PA,SHOP (Small Group),Yes,75-1233841,46518PA0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,46518PA002,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.65,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/pa/46518pa0020006-15,,46518PA0020006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,46518,HIOS,11,2014-11-14 05:23:27,3,46518,PA,Individual,Yes,75-1233841,46518PA0010006,Dentegra Dental PPO Family Basic Plan,46518PA001,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.44,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/pa/46518pa0010006-15,,46518PA0010006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,46518,HIOS,11,2014-11-14 05:23:27,3,46518,PA,Individual,Yes,75-1233841,46518PA0010006,Dentegra Dental PPO Family Basic Plan,46518PA001,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.44,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/pa/46518pa0010006-15,,46518PA0010006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,46518,HIOS,11,2014-11-14 05:23:27,3,46518,PA,SHOP (Small Group),Yes,75-1233841,46518PA0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,46518PA002,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.65,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/pa/46518pa0020006-15,,46518PA0020006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,49275,HIOS,7,2015-01-16 17:32:32,1,49275,PA,SHOP (Small Group),Yes,23-1661402,49275PA0310001,Smile for Health Certified Basic Option Plus (90-50-50),49275PA031,,PAN001,PAS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$3.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,49275PA0310001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,53210,HIOS,3,2014-09-04 03:25:43,1,53210,PA,SHOP (Small Group),Yes,41-0808596,53210PA0010008,"Plan 8. MAC PPO, $1000 Annual Maximum, no Ortho",53210PA001,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,53210PA0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,PA,53210,HIOS,3,2014-09-04 03:25:43,1,53210,PA,SHOP (Small Group),Yes,41-0808596,53210PA0010009,"Plan 9. MAC PPO, $1500 Annual Maximum, Ortho",53210PA001,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,53210PA0010009-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,PA,53210,HIOS,3,2014-09-04 03:25:43,1,53210,PA,SHOP (Small Group),Yes,41-0808596,53210PA0010010,"Plan 10. Graded MAC PPO, $1000 Annual Maximum, no Ortho",53210PA001,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,53210PA0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,13
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,Individual,No,23-2399845,53789PA0100008,Healthy Benefits  HMO 5500.50,53789PA010,7205839443,PAN002,PAS002,PAF002,New,HMO,Bronze,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100008-01,Standard Bronze On Exchange Plan,61.89%,0.618891417980194,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,"$5,500","$11,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0070003,Healthy Benefits HMO 500.0 EX,53789PA007,7205839443,PAN002,PAS003,PAF006,Existing,HMO,Gold,Yes,Both,No,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA007000300_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0070003-01,Standard Gold On Exchange Plan,80.70%,0.799481391906738,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$200,$800,"$2,000",$0,$80,5
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0080003,Healthy Benefits Value HMO 500.0 EX,53789PA008,7205839443,PAN001,PAS001,PAF006,Existing,HMO,Gold,Yes,Both,No,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA008000300_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0080003-00,Standard Gold Off Exchange Plan,80.70%,0.799481391906738,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$200,$800,"$2,000",$0,$80,6
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,Individual,No,23-2399845,53789PA0100008,Healthy Benefits  HMO 5500.50,53789PA010,7205839443,PAN002,PAS002,PAF002,New,HMO,Bronze,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100008-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,Individual,No,23-2399845,53789PA0100008,Healthy Benefits  HMO 5500.50,53789PA010,7205839443,PAN002,PAS002,PAF002,New,HMO,Bronze,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100008-03,Limited Cost Sharing Plan Variation,61.89%,0.618891417980194,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,"$5,500","$11,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0080003,Healthy Benefits Value HMO 500.0 EX,53789PA008,7205839443,PAN001,PAS001,PAF006,Existing,HMO,Gold,Yes,Both,No,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA008000300_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0080003-01,Standard Gold On Exchange Plan,80.70%,0.799481391906738,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$200,$800,"$2,000",$0,$80,7
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0070002,Healthy Benefits HMO 0.50 EX,53789PA007,7205839443,PAN002,PAS003,PAF009,Existing,HMO,Silver,Yes,Both,No,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA007000200_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0070002-00,Standard Silver Off Exchange Plan,71.17%,0.71312814950943,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$200,$0,$200,$0,$80,8
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,Individual,No,23-2399845,53789PA0110008,Healthy Benefits Value HMO 5500.50,53789PA011,7205839443,PAN001,PAS001,PAF002,New,HMO,Bronze,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110008-00,Standard Bronze Off Exchange Plan,61.89%,0.618891417980194,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,"$5,500","$11,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0080008,Healthy Benefits Value HMO 0.50 EX,53789PA008,7205839443,PAN001,PAS005,PAF009,Existing,HMO,Silver,Yes,Both,No,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA008000200_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0080008-00,Standard Silver Off Exchange Plan,71.17%,0.71312814950943,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$200,$0,$200,$0,$80,14
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,Individual,No,23-2399845,53789PA0110019,Healthy Benefits Value HMO 5500.50,53789PA011,7205839443,PAN001,PAS004,PAF002,New,HMO,Bronze,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110019-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,14
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,Individual,No,23-2399845,53789PA0110019,Healthy Benefits Value HMO 5500.50,53789PA011,7205839443,PAN001,PAS004,PAF002,New,HMO,Bronze,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110019-03,Limited Cost Sharing Plan Variation,61.89%,0.618891417980194,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,"$5,500","$11,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0080008,Healthy Benefits Value HMO 0.50 EX,53789PA008,7205839443,PAN001,PAS005,PAF009,Existing,HMO,Silver,Yes,Both,No,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA008000200_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0080008-01,Standard Silver On Exchange Plan,71.17%,0.71312814950943,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$200,$0,$200,$0,$80,15
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0070003,Healthy Benefits HMO 500.0 EX,53789PA007,7205839443,PAN002,PAS003,PAF006,Existing,HMO,Gold,Yes,Both,No,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA007000300_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0070003-00,Standard Gold Off Exchange Plan,80.70%,0.799481391906738,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$200,$800,"$2,000",$0,$80,4
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,Individual,No,23-2399845,53789PA0100008,Healthy Benefits  HMO 5500.50,53789PA010,7205839443,PAN002,PAS002,PAF002,New,HMO,Bronze,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100008-00,Standard Bronze Off Exchange Plan,61.89%,0.618891417980194,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,"$5,500","$11,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,Individual,No,23-2399845,53789PA0110008,Healthy Benefits Value HMO 5500.50,53789PA011,7205839443,PAN001,PAS001,PAF002,New,HMO,Bronze,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110008-01,Standard Bronze On Exchange Plan,61.89%,0.618891417980194,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,"$5,500","$11,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0070002,Healthy Benefits HMO 0.50 EX,53789PA007,7205839443,PAN002,PAS003,PAF009,Existing,HMO,Silver,Yes,Both,No,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA007000200_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0070002-01,Standard Silver On Exchange Plan,71.17%,0.71312814950943,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$200,$0,$200,$0,$80,9
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0080002,Healthy Benefits Value HMO 0.50 EX,53789PA008,7205839443,PAN001,PAS001,PAF009,Existing,HMO,Silver,Yes,Both,No,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA008000200_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0080002-00,Standard Silver Off Exchange Plan,71.17%,0.71312814950943,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$200,$0,$200,$0,$80,10
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,Individual,No,23-2399845,53789PA0110008,Healthy Benefits Value HMO 5500.50,53789PA011,7205839443,PAN001,PAS001,PAF002,New,HMO,Bronze,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110008-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,10
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,Individual,No,23-2399845,53789PA0110008,Healthy Benefits Value HMO 5500.50,53789PA011,7205839443,PAN001,PAS001,PAF002,New,HMO,Bronze,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110008-03,Limited Cost Sharing Plan Variation,61.89%,0.618891417980194,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,"$5,500","$11,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0080002,Healthy Benefits Value HMO 0.50 EX,53789PA008,7205839443,PAN001,PAS001,PAF009,Existing,HMO,Silver,Yes,Both,No,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA008000200_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0080002-01,Standard Silver On Exchange Plan,71.17%,0.71312814950943,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$200,$0,$200,$0,$80,11
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0080005,Healthy Benefits Value HMO 0.50 EX,53789PA008,7205839443,PAN001,PAS004,PAF009,Existing,HMO,Silver,Yes,Both,No,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA008000200_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0080005-00,Standard Silver Off Exchange Plan,71.17%,0.71312814950943,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$200,$0,$200,$0,$80,12
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,Individual,No,23-2399845,53789PA0110019,Healthy Benefits Value HMO 5500.50,53789PA011,7205839443,PAN001,PAS004,PAF002,New,HMO,Bronze,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110019-00,Standard Bronze Off Exchange Plan,61.89%,0.618891417980194,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,"$5,500","$11,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,Individual,No,23-2399845,53789PA0110019,Healthy Benefits Value HMO 5500.50,53789PA011,7205839443,PAN001,PAS004,PAF002,New,HMO,Bronze,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110019-01,Standard Bronze On Exchange Plan,61.89%,0.618891417980194,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,"$5,500","$11,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0080005,Healthy Benefits Value HMO 0.50 EX,53789PA008,7205839443,PAN001,PAS004,PAF009,Existing,HMO,Silver,Yes,Both,No,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA008000200_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0080005-01,Standard Silver On Exchange Plan,71.17%,0.71312814950943,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$200,$0,$200,$0,$80,13
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0080006,Healthy Benefits Value HMO 500.0 EX,53789PA008,7205839443,PAN001,PAS004,PAF006,Existing,HMO,Gold,Yes,Both,No,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA008000300_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0080006-00,Standard Gold Off Exchange Plan,80.70%,0.799481391906738,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$200,$800,"$2,000",$0,$80,16
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,Individual,No,23-2399845,53789PA0110020,Healthy Benefits Value HMO 5500.50,53789PA011,7205839443,PAN001,PAS005,PAF002,New,HMO,Bronze,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110020-00,Standard Bronze Off Exchange Plan,61.89%,0.618891417980194,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,"$5,500","$11,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,Individual,No,23-2399845,53789PA0110020,Healthy Benefits Value HMO 5500.50,53789PA011,7205839443,PAN001,PAS005,PAF002,New,HMO,Bronze,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110020-01,Standard Bronze On Exchange Plan,61.89%,0.618891417980194,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,"$5,500","$11,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0080006,Healthy Benefits Value HMO 500.0 EX,53789PA008,7205839443,PAN001,PAS004,PAF006,Existing,HMO,Gold,Yes,Both,No,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA008000300_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0080006-01,Standard Gold On Exchange Plan,80.70%,0.799481391906738,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$200,$800,"$2,000",$0,$80,17
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0080009,Healthy Benefits Value HMO 500.0 EX,53789PA008,7205839443,PAN001,PAS005,PAF006,Existing,HMO,Gold,Yes,Both,Yes,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA008000300_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0080009-00,Standard Gold Off Exchange Plan,80.70%,0.799481391906738,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$200,$800,"$2,000",$0,$80,18
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,Individual,No,23-2399845,53789PA0110020,Healthy Benefits Value HMO 5500.50,53789PA011,7205839443,PAN001,PAS005,PAF002,New,HMO,Bronze,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110020-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,18
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0080001,Healthy Benefits Value HMO 4000.50 EX,53789PA008,7205839442,PAN001,PAS001,PAF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent & Urgent,Yes,Emergent & Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA008000100_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0080001-00,Standard Bronze Off Exchange Plan,61.30%,0.59406191110611,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,"$4,000","$8,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$200,"$4,300",$200,$0,$80,6
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100009,Healthy Benefits HMO 4500.0,53789PA010,7205839443,PAN002,PAS002,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100009-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,,,,,,,,,,6
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100009,Healthy Benefits HMO 4500.0,53789PA010,7205839443,PAN002,PAS002,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100009-03,Limited Cost Sharing Plan Variation,68.09%,0.680857241153717,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,"$4,500","$9,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0080001,Healthy Benefits Value HMO 4000.50 EX,53789PA008,7205839442,PAN001,PAS001,PAF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent & Urgent,Yes,Emergent & Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA008000100_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0080001-01,Standard Bronze On Exchange Plan,61.30%,0.59406191110611,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,"$4,000","$8,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$200,"$4,300",$200,$0,$80,7
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0080004,Healthy Benefits Value HMO 4000.50 EX,53789PA008,7205839442,PAN001,PAS004,PAF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent & Urgent,Yes,Emergent & Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA008000100_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0080004-00,Standard Bronze Off Exchange Plan,61.30%,0.59406191110611,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,"$4,000","$8,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$200,"$4,300",$200,$0,$80,8
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100009,Healthy Benefits HMO 4500.0,53789PA010,7205839443,PAN002,PAS002,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100009-04,73% AV Level Silver Plan,73.33%,0.733307778835297,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100009,Healthy Benefits HMO 4500.0,53789PA010,7205839443,PAN002,PAS002,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100009-05,87% AV Level Silver Plan,86.77%,0.867703020572662,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",0%,$750,"$1,500",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0080004,Healthy Benefits Value HMO 4000.50 EX,53789PA008,7205839442,PAN001,PAS004,PAF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent & Urgent,Yes,Emergent & Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA008000100_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0080004-01,Standard Bronze On Exchange Plan,61.30%,0.59406191110611,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,"$4,000","$8,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$200,"$4,300",$200,$0,$80,9
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,Individual,No,23-2399845,53789PA0110020,Healthy Benefits Value HMO 5500.50,53789PA011,7205839443,PAN001,PAS005,PAF002,New,HMO,Bronze,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110020-03,Limited Cost Sharing Plan Variation,61.89%,0.618891417980194,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,"$5,500","$11,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,1,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0080009,Healthy Benefits Value HMO 500.0 EX,53789PA008,7205839443,PAN001,PAS005,PAF006,Existing,HMO,Gold,Yes,Both,Yes,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA008000300_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0080009-01,Standard Gold On Exchange Plan,80.70%,0.799481391906738,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$200,$800,"$2,000",$0,$80,19
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0070001,Healthy Benefits HMO 4000.50 EX,53789PA007,7205839443,PAN002,PAS003,PAF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent & Urgent,Yes,Emergent & Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA007000100_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0070001-00,Standard Bronze Off Exchange Plan,61.30%,0.59406191110611,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,"$4,000","$8,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$200,"$4,300",$200,$0,$80,4
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100009,Healthy Benefits HMO 4500.0,53789PA010,7205839443,PAN002,PAS002,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100009-00,Standard Silver Off Exchange Plan,68.09%,0.680857241153717,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,"$4,500","$9,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100009,Healthy Benefits HMO 4500.0,53789PA010,7205839443,PAN002,PAS002,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100009-01,Standard Silver On Exchange Plan,68.09%,0.680857241153717,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,"$4,500","$9,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0070001,Healthy Benefits HMO 4000.50 EX,53789PA007,7205839443,PAN002,PAS003,PAF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent & Urgent,Yes,Emergent & Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA007000100_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0070001-01,Standard Bronze On Exchange Plan,61.30%,0.59406191110611,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,"$4,000","$8,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$200,"$4,300",$200,$0,$80,5
2015,PA,49275,HIOS,7,2015-01-16 17:32:32,2,49275,PA,SHOP (Small Group),Yes,23-1661402,49275PA0330001,Smile for Health Certified High Option Plus (100-50-50),49275PA033,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$7.35,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,49275PA0330001-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,49275,HIOS,7,2015-01-16 17:32:32,3,49275,PA,SHOP (Small Group),Yes,23-1661402,49275PA0350001,Smile for Health Certified Low Option Plus (100-100-100),49275PA035,,PAN001,PAS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$3.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,49275PA0350001-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,49275,HIOS,7,2015-01-16 17:32:32,4,49275,PA,SHOP (Small Group),Yes,23-1661402,49275PA0300001,Smile for Health Certified Basic Option (90-50-50),49275PA030,,PAN001,PAS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$0.74,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,49275PA0300001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,49275,HIOS,7,2015-01-16 17:32:32,5,49275,PA,SHOP (Small Group),Yes,23-1661402,49275PA0320001,Smile for Health Certified High Option (100-50-50),49275PA032,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$4.41,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,49275PA0320001-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,49275,HIOS,7,2015-01-16 17:32:32,6,49275,PA,SHOP (Small Group),Yes,23-1661402,49275PA0340001,Smile for Health Certified Low Option (100-100-100),49275PA034,,PAN001,PAS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$0.74,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,49275PA0340001-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,49275,HIOS,7,2015-01-16 17:32:32,7,49275,PA,SHOP (Small Group),Yes,23-1661402,49275PA0250001,Smile for Health Family C80A80,49275PA025,,PAN001,PAS001,,New,PPO,High,,Both,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$21.80,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,https://www.unitedconcordia.com/docs/hcr/benefits-summary-pa-sfh-family-c80a80-ppo.pdf,,https://www.unitedconcordia.com/docs/hcr/plan-brochure-pa-sfhfamily-premier.pdf,,49275PA0250001-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,49275,HIOS,7,2015-01-16 17:32:32,7,49275,PA,SHOP (Small Group),Yes,23-1661402,49275PA0250001,Smile for Health Family C80A80,49275PA025,,PAN001,PAS001,,New,PPO,High,,Both,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$21.80,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,https://www.unitedconcordia.com/docs/hcr/benefits-summary-pa-sfh-family-c80a80-ppo.pdf,,https://www.unitedconcordia.com/docs/hcr/plan-brochure-pa-sfhfamily-premier.pdf,,49275PA0250001-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,49275,HIOS,7,2015-01-16 17:32:32,8,49275,PA,SHOP (Small Group),Yes,23-1661402,49275PA0260001,Smile for Health Family C60A60,49275PA026,,PAN001,PAS001,,New,PPO,Low,,Both,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$18.14,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,https://www.unitedconcordia.com/docs/hcr/benefits-summary-pa-sfh-family-c60a60-ppo.pdf,,https://www.unitedconcordia.com/docs/hcr/plan-brochure-pa-sfhfamily-value.pdf,,49275PA0260001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,49275,HIOS,7,2015-01-16 17:32:32,8,49275,PA,SHOP (Small Group),Yes,23-1661402,49275PA0260001,Smile for Health Family C60A60,49275PA026,,PAN001,PAS001,,New,PPO,Low,,Both,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$18.14,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,https://www.unitedconcordia.com/docs/hcr/benefits-summary-pa-sfh-family-c60a60-ppo.pdf,,https://www.unitedconcordia.com/docs/hcr/plan-brochure-pa-sfhfamily-value.pdf,,49275PA0260001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,49275,HIOS,7,2015-01-16 17:32:32,9,49275,PA,SHOP (Small Group),Yes,23-1661402,49275PA0270001,Smile for Health Family C60A50,49275PA027,,PAN001,PAS001,,New,PPO,Low,,Both,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$18.14,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,https://www.unitedconcordia.com/docs/hcr/benefits-summary-pa-sfh-family-c60a50-ppo.pdf,,https://www.unitedconcordia.com/docs/hcr/plan-brochure-pa-sfhfamily-lean.pdf,,49275PA0270001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,49275,HIOS,7,2015-01-16 17:32:32,9,49275,PA,SHOP (Small Group),Yes,23-1661402,49275PA0270001,Smile for Health Family C60A50,49275PA027,,PAN001,PAS001,,New,PPO,Low,,Both,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$18.14,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,https://www.unitedconcordia.com/docs/hcr/benefits-summary-pa-sfh-family-c60a50-ppo.pdf,,https://www.unitedconcordia.com/docs/hcr/plan-brochure-pa-sfhfamily-lean.pdf,,49275PA0270001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,49275,HIOS,7,2015-01-16 17:32:32,10,49275,PA,SHOP (Small Group),Yes,23-1661402,49275PA0280001,BCNEPA 5 PPO,49275PA028,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$21.28,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,49275PA0280001-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,49275,HIOS,7,2015-01-16 17:32:32,11,49275,PA,SHOP (Small Group),Yes,23-1661402,49275PA0290001,BCNEPA 6 PPO,49275PA029,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$21.28,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,49275PA0290001-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,49275,HIOS,7,2015-01-16 17:32:32,12,49275,PA,SHOP (Small Group),Yes,23-1661402,49275PA0360001,BCNEPA 7 PPO,49275PA036,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$24.09,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,49275PA0360001-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,49275,HIOS,7,2015-01-16 17:32:32,13,49275,PA,SHOP (Small Group),Yes,23-1661402,49275PA0370001,BCNEPA 8,49275PA037,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$24.09,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,49275PA0370001-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,53210,HIOS,3,2014-09-04 03:25:43,1,53210,PA,SHOP (Small Group),Yes,41-0808596,53210PA0010001,"Plan 1. Passive PPO, $1000 Annual Maximum, no Ortho",53210PA001,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,53210PA0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,53210,HIOS,3,2014-09-04 03:25:43,1,53210,PA,SHOP (Small Group),Yes,41-0808596,53210PA0010002,"Plan 2.  Passive PPO, $1000 Annual Maximum, Ortho",53210PA001,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,53210PA0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,53210,HIOS,3,2014-09-04 03:25:43,1,53210,PA,SHOP (Small Group),Yes,41-0808596,53210PA0010003,"Plan 3. Passive PPO, $1500 Annual Maximum, no Ortho",53210PA001,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,53210PA0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,53210,HIOS,3,2014-09-04 03:25:43,1,53210,PA,SHOP (Small Group),Yes,41-0808596,53210PA0010004,"Plan 4.  Passive PPO, $1500 Annual Maximum, Ortho",53210PA001,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,53210PA0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,53210,HIOS,3,2014-09-04 03:25:43,1,53210,PA,SHOP (Small Group),Yes,41-0808596,53210PA0010005,"Plan 5.  Passive PPO, $2000 Annual Maximum, Ortho",53210PA001,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,53210PA0010005-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,PA,53210,HIOS,3,2014-09-04 03:25:43,1,53210,PA,SHOP (Small Group),Yes,41-0808596,53210PA0010006,"Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho",53210PA001,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,53210PA0010006-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,PA,53210,HIOS,3,2014-09-04 03:25:43,1,53210,PA,SHOP (Small Group),Yes,41-0808596,53210PA0010007,"Plan 7. Graded Passive PPO, $1500 Annual Maximum, Ortho",53210PA001,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,53210PA0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0080007,Healthy Benefits Value HMO 4000.50 EX,53789PA008,7205839442,PAN001,PAS005,PAF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent & Urgent,Yes,Emergent & Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA008000100_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0080007-00,Standard Bronze Off Exchange Plan,61.30%,0.59406191110611,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,"$4,000","$8,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$200,"$4,300",$200,$0,$80,10
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100009,Healthy Benefits HMO 4500.0,53789PA010,7205839443,PAN002,PAS002,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100009-06,94% AV Level Silver Plan,94.02%,0.940233647823334,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,0%,$250,$500,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110009,Healthy Benefits Value HMO 4500.0,53789PA011,7205839443,PAN001,PAS001,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110009-00,Standard Silver Off Exchange Plan,68.09%,0.680857241153717,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,"$4,500","$9,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,SHOP (Small Group),No,23-2399845,53789PA0080007,Healthy Benefits Value HMO 4000.50 EX,53789PA008,7205839442,PAN001,PAS005,PAF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All except OBGYN,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent & Urgent,Yes,Emergent & Urgent,Yes,www.capbluecross.com/pdf/benefits_summary/sg/53789PA008000100_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0080007-01,Standard Bronze On Exchange Plan,61.30%,0.59406191110611,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,"$4,000","$8,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$200,"$4,300",$200,$0,$80,11
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110009,Healthy Benefits Value HMO 4500.0,53789PA011,7205839443,PAN001,PAS001,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110009-01,Standard Silver On Exchange Plan,68.09%,0.680857241153717,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,"$4,500","$9,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110009,Healthy Benefits Value HMO 4500.0,53789PA011,7205839443,PAN001,PAS001,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110009-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,,,,,,,,,,13
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110009,Healthy Benefits Value HMO 4500.0,53789PA011,7205839443,PAN001,PAS001,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110009-03,Limited Cost Sharing Plan Variation,68.09%,0.680857241153717,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,"$4,500","$9,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110009,Healthy Benefits Value HMO 4500.0,53789PA011,7205839443,PAN001,PAS001,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110009-04,73% AV Level Silver Plan,73.33%,0.733307778835297,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110009,Healthy Benefits Value HMO 4500.0,53789PA011,7205839443,PAN001,PAS001,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110009-05,87% AV Level Silver Plan,86.77%,0.867703020572662,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",0%,$750,"$1,500",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110009,Healthy Benefits Value HMO 4500.0,53789PA011,7205839443,PAN001,PAS001,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110009-06,94% AV Level Silver Plan,94.02%,0.940233647823334,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,0%,$250,$500,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110021,Healthy Benefits Value HMO 4500.0,53789PA011,7205839443,PAN001,PAS004,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110021-00,Standard Silver Off Exchange Plan,68.09%,0.680857241153717,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,"$4,500","$9,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110021,Healthy Benefits Value HMO 4500.0,53789PA011,7205839443,PAN001,PAS004,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110021-01,Standard Silver On Exchange Plan,68.09%,0.680857241153717,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,"$4,500","$9,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110021,Healthy Benefits Value HMO 4500.0,53789PA011,7205839443,PAN001,PAS004,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110021-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,,,,,,,,,,20
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110021,Healthy Benefits Value HMO 4500.0,53789PA011,7205839443,PAN001,PAS004,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110021-03,Limited Cost Sharing Plan Variation,68.09%,0.680857241153717,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,"$4,500","$9,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110021,Healthy Benefits Value HMO 4500.0,53789PA011,7205839443,PAN001,PAS004,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110021-04,73% AV Level Silver Plan,73.33%,0.733307778835297,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110021,Healthy Benefits Value HMO 4500.0,53789PA011,7205839443,PAN001,PAS004,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110021-05,87% AV Level Silver Plan,86.77%,0.867703020572662,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",0%,$750,"$1,500",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110021,Healthy Benefits Value HMO 4500.0,53789PA011,7205839443,PAN001,PAS004,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110021-06,94% AV Level Silver Plan,94.02%,0.940233647823334,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,0%,$250,$500,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,24
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110022,Healthy Benefits Value HMO 4500.0,53789PA011,7205839443,PAN001,PAS005,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110022-00,Standard Silver Off Exchange Plan,68.09%,0.680857241153717,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,"$4,500","$9,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110022,Healthy Benefits Value HMO 4500.0,53789PA011,7205839443,PAN001,PAS005,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110022-01,Standard Silver On Exchange Plan,68.09%,0.680857241153717,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,"$4,500","$9,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,26
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110022,Healthy Benefits Value HMO 4500.0,53789PA011,7205839443,PAN001,PAS005,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110022-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,,,,,,,,,,27
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110022,Healthy Benefits Value HMO 4500.0,53789PA011,7205839443,PAN001,PAS005,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110022-03,Limited Cost Sharing Plan Variation,68.09%,0.680857241153717,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,"$4,500","$9,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,28
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110022,Healthy Benefits Value HMO 4500.0,53789PA011,7205839443,PAN001,PAS005,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110022-04,73% AV Level Silver Plan,73.33%,0.733307778835297,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,29
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110022,Healthy Benefits Value HMO 4500.0,53789PA011,7205839443,PAN001,PAS005,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110022-05,87% AV Level Silver Plan,86.77%,0.867703020572662,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",0%,$750,"$1,500",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,30
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110022,Healthy Benefits Value HMO 4500.0,53789PA011,7205839443,PAN001,PAS005,PAF005,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110022-06,94% AV Level Silver Plan,94.02%,0.940233647823334,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,0%,$250,$500,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,31
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100006,Healthy Benefits HMO 2500.0,53789PA010,7205839443,PAN002,PAS002,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100006-00,Standard Silver Off Exchange Plan,70.06%,0.700610637664795,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,"$2,500","$5,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,32
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100006,Healthy Benefits HMO 2500.0,53789PA010,7205839443,PAN002,PAS002,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100006-01,Standard Silver On Exchange Plan,70.06%,0.700610637664795,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,"$2,500","$5,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,33
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100006,Healthy Benefits HMO 2500.0,53789PA010,7205839443,PAN002,PAS002,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,,,,,,,,,,34
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100006,Healthy Benefits HMO 2500.0,53789PA010,7205839443,PAN002,PAS002,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100006-03,Limited Cost Sharing Plan Variation,70.06%,0.700610637664795,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,"$2,500","$5,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,35
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100006,Healthy Benefits HMO 2500.0,53789PA010,7205839443,PAN002,PAS002,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100006-04,73% AV Level Silver Plan,73.79%,0.737852692604065,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$2,000","$4,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,36
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100006,Healthy Benefits HMO 2500.0,53789PA010,7205839443,PAN002,PAS002,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100006-05,87% AV Level Silver Plan,86.50%,0.864961266517639,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,37
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100006,Healthy Benefits HMO 2500.0,53789PA010,7205839443,PAN002,PAS002,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100006-06,94% AV Level Silver Plan,93.39%,0.933910667896271,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,0%,$200,$400,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,38
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110006,Healthy Benefits Value HMO 2500.0,53789PA011,7205839443,PAN001,PAS001,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110006-00,Standard Silver Off Exchange Plan,70.06%,0.700610637664795,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,"$2,500","$5,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,39
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110006,Healthy Benefits Value HMO 2500.0,53789PA011,7205839443,PAN001,PAS001,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110006-01,Standard Silver On Exchange Plan,70.06%,0.700610637664795,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,"$2,500","$5,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,40
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110006,Healthy Benefits Value HMO 2500.0,53789PA011,7205839443,PAN001,PAS001,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,,,,,,,,,,41
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110006,Healthy Benefits Value HMO 2500.0,53789PA011,7205839443,PAN001,PAS001,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110006-03,Limited Cost Sharing Plan Variation,70.06%,0.700610637664795,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,"$2,500","$5,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,42
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110006,Healthy Benefits Value HMO 2500.0,53789PA011,7205839443,PAN001,PAS001,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110006-04,73% AV Level Silver Plan,73.79%,0.737852692604065,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$2,000","$4,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,43
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110006,Healthy Benefits Value HMO 2500.0,53789PA011,7205839443,PAN001,PAS001,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110006-05,87% AV Level Silver Plan,86.50%,0.864961266517639,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,44
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110006,Healthy Benefits Value HMO 2500.0,53789PA011,7205839443,PAN001,PAS001,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110006-06,94% AV Level Silver Plan,93.39%,0.933910667896271,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,0%,$200,$400,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,45
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110027,Healthy Benefits Value HMO 2500.0,53789PA011,7205839443,PAN001,PAS004,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110027-00,Standard Silver Off Exchange Plan,70.06%,0.700610637664795,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,"$2,500","$5,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,46
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110027,Healthy Benefits Value HMO 2500.0,53789PA011,7205839443,PAN001,PAS004,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110027-01,Standard Silver On Exchange Plan,70.06%,0.700610637664795,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,"$2,500","$5,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,47
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110027,Healthy Benefits Value HMO 2500.0,53789PA011,7205839443,PAN001,PAS004,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110027-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,,,,,,,,,,48
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110027,Healthy Benefits Value HMO 2500.0,53789PA011,7205839443,PAN001,PAS004,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110027-03,Limited Cost Sharing Plan Variation,70.06%,0.700610637664795,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,"$2,500","$5,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,49
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110027,Healthy Benefits Value HMO 2500.0,53789PA011,7205839443,PAN001,PAS004,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110027-04,73% AV Level Silver Plan,73.79%,0.737852692604065,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$2,000","$4,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,50
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110027,Healthy Benefits Value HMO 2500.0,53789PA011,7205839443,PAN001,PAS004,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110027-05,87% AV Level Silver Plan,86.50%,0.864961266517639,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,51
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110027,Healthy Benefits Value HMO 2500.0,53789PA011,7205839443,PAN001,PAS004,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110027-06,94% AV Level Silver Plan,93.39%,0.933910667896271,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,0%,$200,$400,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,52
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110028,Healthy Benefits Value HMO 2500.0,53789PA011,7205839443,PAN001,PAS005,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110028-00,Standard Silver Off Exchange Plan,70.06%,0.700610637664795,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,"$2,500","$5,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,53
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110028,Healthy Benefits Value HMO 2500.0,53789PA011,7205839443,PAN001,PAS005,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110028-01,Standard Silver On Exchange Plan,70.06%,0.700610637664795,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,"$2,500","$5,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,54
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110028,Healthy Benefits Value HMO 2500.0,53789PA011,7205839443,PAN001,PAS005,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110028-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,,,,,,,,,,55
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110028,Healthy Benefits Value HMO 2500.0,53789PA011,7205839443,PAN001,PAS005,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110028-03,Limited Cost Sharing Plan Variation,70.06%,0.700610637664795,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,"$2,500","$5,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,56
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110028,Healthy Benefits Value HMO 2500.0,53789PA011,7205839443,PAN001,PAS005,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110028-04,73% AV Level Silver Plan,73.79%,0.737852692604065,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$2,000","$4,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,57
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110028,Healthy Benefits Value HMO 2500.0,53789PA011,7205839443,PAN001,PAS005,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110028-05,87% AV Level Silver Plan,86.50%,0.864961266517639,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,58
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110028,Healthy Benefits Value HMO 2500.0,53789PA011,7205839443,PAN001,PAS005,PAF004,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110028-06,94% AV Level Silver Plan,93.39%,0.933910667896271,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,0%,$200,$400,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,59
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100012,Healthy Benefits HMO 2000.0,53789PA010,7205839443,PAN002,PAS002,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100012-00,Standard Silver Off Exchange Plan,70.88%,0.708825469017029,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$2,000","$4,000",0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,60
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100012,Healthy Benefits HMO 2000.0,53789PA010,7205839443,PAN002,PAS002,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100012-01,Standard Silver On Exchange Plan,70.88%,0.708825469017029,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$2,000","$4,000",0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,61
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100012,Healthy Benefits HMO 2000.0,53789PA010,7205839443,PAN002,PAS002,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100012-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,,,,,,,,,,62
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100012,Healthy Benefits HMO 2000.0,53789PA010,7205839443,PAN002,PAS002,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100012-03,Limited Cost Sharing Plan Variation,70.88%,0.708825469017029,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$2,000","$4,000",0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,63
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100012,Healthy Benefits HMO 2000.0,53789PA010,7205839443,PAN002,PAS002,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100012-04,73% AV Level Silver Plan,73.44%,0.734439194202423,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",0%,"$1,750","$3,500",0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,64
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100012,Healthy Benefits HMO 2000.0,53789PA010,7205839443,PAN002,PAS002,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100012-05,87% AV Level Silver Plan,86.30%,0.862960875034332,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,65
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100012,Healthy Benefits HMO 2000.0,53789PA010,7205839443,PAN002,PAS002,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100012-06,94% AV Level Silver Plan,94.19%,0.94192361831665,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,0%,$100,$200,0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,66
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110012,Healthy Benefits Value HMO 2000.0,53789PA011,7205839443,PAN001,PAS001,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110012-00,Standard Silver Off Exchange Plan,70.88%,0.708825469017029,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$2,000","$4,000",0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,67
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110012,Healthy Benefits Value HMO 2000.0,53789PA011,7205839443,PAN001,PAS001,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110012-01,Standard Silver On Exchange Plan,70.88%,0.708825469017029,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$2,000","$4,000",0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,68
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110012,Healthy Benefits Value HMO 2000.0,53789PA011,7205839443,PAN001,PAS001,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110012-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,,,,,,,,,,69
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110012,Healthy Benefits Value HMO 2000.0,53789PA011,7205839443,PAN001,PAS001,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110012-03,Limited Cost Sharing Plan Variation,70.88%,0.708825469017029,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$2,000","$4,000",0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,70
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110012,Healthy Benefits Value HMO 2000.0,53789PA011,7205839443,PAN001,PAS001,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110012-04,73% AV Level Silver Plan,73.44%,0.734439194202423,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",0%,"$1,750","$3,500",0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,71
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110012,Healthy Benefits Value HMO 2000.0,53789PA011,7205839443,PAN001,PAS001,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110012-05,87% AV Level Silver Plan,86.30%,0.862960875034332,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,72
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110012,Healthy Benefits Value HMO 2000.0,53789PA011,7205839443,PAN001,PAS001,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110012-06,94% AV Level Silver Plan,94.19%,0.94192361831665,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,0%,$100,$200,0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,73
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110029,Healthy Benefits Value HMO 2000.0,53789PA011,7205839443,PAN001,PAS004,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110029-00,Standard Silver Off Exchange Plan,70.88%,0.708825469017029,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$2,000","$4,000",0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,74
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110029,Healthy Benefits Value HMO 2000.0,53789PA011,7205839443,PAN001,PAS004,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110029-01,Standard Silver On Exchange Plan,70.88%,0.708825469017029,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$2,000","$4,000",0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,75
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110029,Healthy Benefits Value HMO 2000.0,53789PA011,7205839443,PAN001,PAS004,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110029-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,,,,,,,,,,76
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110029,Healthy Benefits Value HMO 2000.0,53789PA011,7205839443,PAN001,PAS004,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110029-03,Limited Cost Sharing Plan Variation,70.88%,0.708825469017029,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$2,000","$4,000",0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,77
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110029,Healthy Benefits Value HMO 2000.0,53789PA011,7205839443,PAN001,PAS004,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110029-04,73% AV Level Silver Plan,73.44%,0.734439194202423,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",0%,"$1,750","$3,500",0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,78
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110029,Healthy Benefits Value HMO 2000.0,53789PA011,7205839443,PAN001,PAS004,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110029-05,87% AV Level Silver Plan,86.30%,0.862960875034332,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,79
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110029,Healthy Benefits Value HMO 2000.0,53789PA011,7205839443,PAN001,PAS004,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110029-06,94% AV Level Silver Plan,94.19%,0.94192361831665,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,0%,$100,$200,0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,80
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110030,Healthy Benefits Value HMO 2000.0,53789PA011,7205839443,PAN001,PAS005,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110030-00,Standard Silver Off Exchange Plan,70.88%,0.708825469017029,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$2,000","$4,000",0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,81
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110030,Healthy Benefits Value HMO 2000.0,53789PA011,7205839443,PAN001,PAS005,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110030-01,Standard Silver On Exchange Plan,70.88%,0.708825469017029,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$2,000","$4,000",0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,82
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110030,Healthy Benefits Value HMO 2000.0,53789PA011,7205839443,PAN001,PAS005,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110030-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,,,,,,,,,,83
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110030,Healthy Benefits Value HMO 2000.0,53789PA011,7205839443,PAN001,PAS005,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110030-03,Limited Cost Sharing Plan Variation,70.88%,0.708825469017029,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,"$2,000","$4,000",0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,84
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110030,Healthy Benefits Value HMO 2000.0,53789PA011,7205839443,PAN001,PAS005,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110030-04,73% AV Level Silver Plan,73.44%,0.734439194202423,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",0%,"$1,750","$3,500",0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,85
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110030,Healthy Benefits Value HMO 2000.0,53789PA011,7205839443,PAN001,PAS005,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110030-05,87% AV Level Silver Plan,86.30%,0.862960875034332,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,86
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110030,Healthy Benefits Value HMO 2000.0,53789PA011,7205839443,PAN001,PAS005,PAF004,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110030-06,94% AV Level Silver Plan,94.19%,0.94192361831665,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,0%,$100,$200,0%,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,87
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100014,Healthy Benefits HMO 500.0,53789PA010,7205839443,PAN002,PAS002,PAF006,Existing,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100014-00,Standard Gold Off Exchange Plan,80.39%,0.803941428661346,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,0%,$50,$100,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,88
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100014,Healthy Benefits HMO 500.0,53789PA010,7205839443,PAN002,PAS002,PAF006,Existing,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100014-01,Standard Gold On Exchange Plan,80.39%,0.803941428661346,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,0%,$50,$100,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,89
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100014,Healthy Benefits HMO 500.0,53789PA010,7205839443,PAN002,PAS002,PAF006,Existing,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100014-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,90
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100014,Healthy Benefits HMO 500.0,53789PA010,7205839443,PAN002,PAS002,PAF006,Existing,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100014-03,Limited Cost Sharing Plan Variation,80.39%,0.803941428661346,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,0%,$50,$100,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,91
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110014,Healthy Benefits Value HMO 500.0,53789PA011,7205839443,PAN001,PAS001,PAF006,Existing,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110014-00,Standard Gold Off Exchange Plan,80.39%,0.803941428661346,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,0%,$50,$100,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,92
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110014,Healthy Benefits Value HMO 500.0,53789PA011,7205839443,PAN001,PAS001,PAF006,Existing,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110014-01,Standard Gold On Exchange Plan,80.39%,0.803941428661346,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,0%,$50,$100,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,93
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110014,Healthy Benefits Value HMO 500.0,53789PA011,7205839443,PAN001,PAS001,PAF006,Existing,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110014-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,94
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110014,Healthy Benefits Value HMO 500.0,53789PA011,7205839443,PAN001,PAS001,PAF006,Existing,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110014-03,Limited Cost Sharing Plan Variation,80.39%,0.803941428661346,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,0%,$50,$100,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,95
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110033,Healthy Benefits Value HMO 500.0,53789PA011,7205839443,PAN001,PAS004,PAF006,Existing,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110033-00,Standard Gold Off Exchange Plan,80.39%,0.803941428661346,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,0%,$50,$100,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,96
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110033,Healthy Benefits Value HMO 500.0,53789PA011,7205839443,PAN001,PAS004,PAF006,Existing,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110033-01,Standard Gold On Exchange Plan,80.39%,0.803941428661346,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,0%,$50,$100,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,97
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110033,Healthy Benefits Value HMO 500.0,53789PA011,7205839443,PAN001,PAS004,PAF006,Existing,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110033-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,98
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110033,Healthy Benefits Value HMO 500.0,53789PA011,7205839443,PAN001,PAS004,PAF006,Existing,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110033-03,Limited Cost Sharing Plan Variation,80.39%,0.803941428661346,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,0%,$50,$100,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,99
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110034,Healthy Benefits Value HMO 500.0,53789PA011,7205839443,PAN001,PAS005,PAF006,Existing,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110034-00,Standard Gold Off Exchange Plan,80.39%,0.803941428661346,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,0%,$50,$100,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,100
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110034,Healthy Benefits Value HMO 500.0,53789PA011,7205839443,PAN001,PAS005,PAF006,Existing,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110034-01,Standard Gold On Exchange Plan,80.39%,0.803941428661346,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,0%,$50,$100,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,101
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110034,Healthy Benefits Value HMO 500.0,53789PA011,7205839443,PAN001,PAS005,PAF006,Existing,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110034-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,102
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110034,Healthy Benefits Value HMO 500.0,53789PA011,7205839443,PAN001,PAS005,PAF006,Existing,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110034-03,Limited Cost Sharing Plan Variation,80.39%,0.803941428661346,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,0%,$50,$100,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,103
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100015,Healthy Benefits HMO 0.0,53789PA010,7205839443,PAN002,PAS002,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100015-00,Standard Silver Off Exchange Plan,69.15%,0.691467583179474,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,104
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100015,Healthy Benefits HMO 0.0,53789PA010,7205839443,PAN002,PAS002,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100015-01,Standard Silver On Exchange Plan,69.15%,0.691467583179474,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,105
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100015,Healthy Benefits HMO 0.0,53789PA010,7205839443,PAN002,PAS002,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100015-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,,,,,,,,,,106
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100015,Healthy Benefits HMO 0.0,53789PA010,7205839443,PAN002,PAS002,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100015-03,Limited Cost Sharing Plan Variation,69.15%,0.691467583179474,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,107
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100015,Healthy Benefits HMO 0.0,53789PA010,7205839443,PAN002,PAS002,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100015-04,73% AV Level Silver Plan,72.78%,0.727825403213501,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,108
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100015,Healthy Benefits HMO 0.0,53789PA010,7205839443,PAN002,PAS002,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100015-05,87% AV Level Silver Plan,86.85%,0.868488729000092,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,109
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100015,Healthy Benefits HMO 0.0,53789PA010,7205839443,PAN002,PAS002,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100015-06,94% AV Level Silver Plan,94.48%,0.944750308990479,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,110
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110015,Healthy Benefits Value HMO 0.0,53789PA011,7205839443,PAN001,PAS001,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110015-00,Standard Silver Off Exchange Plan,69.15%,0.691467583179474,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,111
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110015,Healthy Benefits Value HMO 0.0,53789PA011,7205839443,PAN001,PAS001,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110015-01,Standard Silver On Exchange Plan,69.15%,0.691467583179474,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,112
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110015,Healthy Benefits Value HMO 0.0,53789PA011,7205839443,PAN001,PAS001,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110015-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,,,,,,,,,,113
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110015,Healthy Benefits Value HMO 0.0,53789PA011,7205839443,PAN001,PAS001,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110015-03,Limited Cost Sharing Plan Variation,69.15%,0.691467583179474,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,114
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110015,Healthy Benefits Value HMO 0.0,53789PA011,7205839443,PAN001,PAS001,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110015-04,73% AV Level Silver Plan,72.78%,0.727825403213501,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,115
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110015,Healthy Benefits Value HMO 0.0,53789PA011,7205839443,PAN001,PAS001,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110015-05,87% AV Level Silver Plan,86.85%,0.868488729000092,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,116
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110015,Healthy Benefits Value HMO 0.0,53789PA011,7205839443,PAN001,PAS001,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110015-06,94% AV Level Silver Plan,94.48%,0.944750308990479,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,117
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110035,Healthy Benefits Value HMO 0.0,53789PA011,7205839443,PAN001,PAS004,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110035-00,Standard Silver Off Exchange Plan,69.15%,0.691467583179474,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,118
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110035,Healthy Benefits Value HMO 0.0,53789PA011,7205839443,PAN001,PAS004,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110035-01,Standard Silver On Exchange Plan,69.15%,0.691467583179474,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,119
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110035,Healthy Benefits Value HMO 0.0,53789PA011,7205839443,PAN001,PAS004,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110035-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,,,,,,,,,,120
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110035,Healthy Benefits Value HMO 0.0,53789PA011,7205839443,PAN001,PAS004,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110035-03,Limited Cost Sharing Plan Variation,69.15%,0.691467583179474,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,121
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110035,Healthy Benefits Value HMO 0.0,53789PA011,7205839443,PAN001,PAS004,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110035-04,73% AV Level Silver Plan,72.78%,0.727825403213501,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,122
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110035,Healthy Benefits Value HMO 0.0,53789PA011,7205839443,PAN001,PAS004,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110035-05,87% AV Level Silver Plan,86.85%,0.868488729000092,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,123
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110035,Healthy Benefits Value HMO 0.0,53789PA011,7205839443,PAN001,PAS004,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110035-06,94% AV Level Silver Plan,94.48%,0.944750308990479,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,124
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110036,Healthy Benefits Value HMO 0.0,53789PA011,7205839443,PAN001,PAS005,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110036-00,Standard Silver Off Exchange Plan,69.15%,0.691467583179474,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,125
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110036,Healthy Benefits Value HMO 0.0,53789PA011,7205839443,PAN001,PAS005,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110036-01,Standard Silver On Exchange Plan,69.15%,0.691467583179474,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,126
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110036,Healthy Benefits Value HMO 0.0,53789PA011,7205839443,PAN001,PAS005,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110036-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,,,,,,,,,,127
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110036,Healthy Benefits Value HMO 0.0,53789PA011,7205839443,PAN001,PAS005,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110036-03,Limited Cost Sharing Plan Variation,69.15%,0.691467583179474,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,128
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110036,Healthy Benefits Value HMO 0.0,53789PA011,7205839443,PAN001,PAS005,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110036-04,73% AV Level Silver Plan,72.78%,0.727825403213501,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,129
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110036,Healthy Benefits Value HMO 0.0,53789PA011,7205839443,PAN001,PAS005,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110036-05,87% AV Level Silver Plan,86.85%,0.868488729000092,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,130
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110036,Healthy Benefits Value HMO 0.0,53789PA011,7205839443,PAN001,PAS005,PAF003,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110036-06,94% AV Level Silver Plan,94.48%,0.944750308990479,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,131
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100005,Healthy Benefits HMO 0.50,53789PA010,7205839443,PAN002,PAS002,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100005-00,Standard Silver Off Exchange Plan,71.11%,0.711068093776703,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,132
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100005,Healthy Benefits HMO 0.50,53789PA010,7205839443,PAN002,PAS002,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100005-01,Standard Silver On Exchange Plan,71.11%,0.711068093776703,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,133
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100005,Healthy Benefits HMO 0.50,53789PA010,7205839443,PAN002,PAS002,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,,,,,,,,,,134
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100005,Healthy Benefits HMO 0.50,53789PA010,7205839443,PAN002,PAS002,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100005-03,Limited Cost Sharing Plan Variation,71.11%,0.711068093776703,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,135
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100005,Healthy Benefits HMO 0.50,53789PA010,7205839443,PAN002,PAS002,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100005-04,73% AV Level Silver Plan,73.60%,0.735958278179169,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,49%,$0,$0,49%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,136
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100005,Healthy Benefits HMO 0.50,53789PA010,7205839443,PAN002,PAS002,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100005-05,87% AV Level Silver Plan,86.80%,0.867995738983154,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,$0,$0,25%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,137
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100005,Healthy Benefits HMO 0.50,53789PA010,7205839443,PAN002,PAS002,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100005-06,94% AV Level Silver Plan,93.13%,0.931299448013306,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,8%,$0,$0,8%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,138
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110005,Healthy Benefits Value HMO 0.50,53789PA011,7205839443,PAN001,PAS001,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110005-00,Standard Silver Off Exchange Plan,71.11%,0.711068093776703,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,139
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110005,Healthy Benefits Value HMO 0.50,53789PA011,7205839443,PAN001,PAS001,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110005-01,Standard Silver On Exchange Plan,71.11%,0.711068093776703,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,140
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110005,Healthy Benefits Value HMO 0.50,53789PA011,7205839443,PAN001,PAS001,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,,,,,,,,,,141
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110005,Healthy Benefits Value HMO 0.50,53789PA011,7205839443,PAN001,PAS001,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110005-03,Limited Cost Sharing Plan Variation,71.11%,0.711068093776703,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,142
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110005,Healthy Benefits Value HMO 0.50,53789PA011,7205839443,PAN001,PAS001,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110005-04,73% AV Level Silver Plan,73.60%,0.735958278179169,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,49%,$0,$0,49%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,143
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110005,Healthy Benefits Value HMO 0.50,53789PA011,7205839443,PAN001,PAS001,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110005-05,87% AV Level Silver Plan,86.80%,0.867995738983154,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,$0,$0,25%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,144
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110005,Healthy Benefits Value HMO 0.50,53789PA011,7205839443,PAN001,PAS001,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000501_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110005-06,94% AV Level Silver Plan,93.13%,0.931299448013306,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,8%,$0,$0,8%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,145
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110037,Healthy Benefits Value HMO 0.50,53789PA011,7205839443,PAN001,PAS004,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110037-00,Standard Silver Off Exchange Plan,71.11%,0.711068093776703,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,146
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110037,Healthy Benefits Value HMO 0.50,53789PA011,7205839443,PAN001,PAS004,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110037-01,Standard Silver On Exchange Plan,71.11%,0.711068093776703,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,147
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110037,Healthy Benefits Value HMO 0.50,53789PA011,7205839443,PAN001,PAS004,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110037-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,,,,,,,,,,148
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110037,Healthy Benefits Value HMO 0.50,53789PA011,7205839443,PAN001,PAS004,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110037-03,Limited Cost Sharing Plan Variation,71.11%,0.711068093776703,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,149
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110037,Healthy Benefits Value HMO 0.50,53789PA011,7205839443,PAN001,PAS004,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110037-04,73% AV Level Silver Plan,73.60%,0.735958278179169,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,49%,$0,$0,49%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,150
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110037,Healthy Benefits Value HMO 0.50,53789PA011,7205839443,PAN001,PAS004,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110037-05,87% AV Level Silver Plan,86.80%,0.867995738983154,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,$0,$0,25%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,151
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110037,Healthy Benefits Value HMO 0.50,53789PA011,7205839443,PAN001,PAS004,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110037-06,94% AV Level Silver Plan,93.13%,0.931299448013306,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,8%,$0,$0,8%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,152
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110038,Healthy Benefits Value HMO 0.50,53789PA011,7205839443,PAN001,PAS005,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110038-00,Standard Silver Off Exchange Plan,71.11%,0.711068093776703,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,153
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110038,Healthy Benefits Value HMO 0.50,53789PA011,7205839443,PAN001,PAS005,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110038-01,Standard Silver On Exchange Plan,71.11%,0.711068093776703,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,154
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110038,Healthy Benefits Value HMO 0.50,53789PA011,7205839443,PAN001,PAS005,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110038-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,,,,,,,,,,155
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110038,Healthy Benefits Value HMO 0.50,53789PA011,7205839443,PAN001,PAS005,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110038-03,Limited Cost Sharing Plan Variation,71.11%,0.711068093776703,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,156
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110038,Healthy Benefits Value HMO 0.50,53789PA011,7205839443,PAN001,PAS005,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110038-04,73% AV Level Silver Plan,73.60%,0.735958278179169,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,49%,$0,$0,49%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,157
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110038,Healthy Benefits Value HMO 0.50,53789PA011,7205839443,PAN001,PAS005,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110038-05,87% AV Level Silver Plan,86.80%,0.867995738983154,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,$0,$0,25%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,158
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110038,Healthy Benefits Value HMO 0.50,53789PA011,7205839443,PAN001,PAS005,PAF009,Existing,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110038-06,94% AV Level Silver Plan,93.13%,0.931299448013306,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,8%,$0,$0,8%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,159
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100016,Healthy Benefits HMO 0.0.10,53789PA010,7205839443,PAN002,PAS002,PAF008,New,HMO,Platinum,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100016-00,Standard Platinum Off Exchange Plan,88.32%,0.883204638957977,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,160
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100016,Healthy Benefits HMO 0.0.10,53789PA010,7205839443,PAN002,PAS002,PAF008,New,HMO,Platinum,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100016-01,Standard Platinum On Exchange Plan,88.32%,0.883204638957977,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,161
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100016,Healthy Benefits HMO 0.0.10,53789PA010,7205839443,PAN002,PAS002,PAF008,New,HMO,Platinum,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100016-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,162
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0100016,Healthy Benefits HMO 0.0.10,53789PA010,7205839443,PAN002,PAS002,PAF008,New,HMO,Platinum,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100016-03,Limited Cost Sharing Plan Variation,88.32%,0.883204638957977,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,163
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110016,Healthy Benefits Value HMO 0.0.10,53789PA011,7205839443,PAN001,PAS001,PAF008,New,HMO,Platinum,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110016-00,Standard Platinum Off Exchange Plan,88.32%,0.883204638957977,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,164
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110016,Healthy Benefits Value HMO 0.0.10,53789PA011,7205839443,PAN001,PAS001,PAF008,New,HMO,Platinum,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110016-01,Standard Platinum On Exchange Plan,88.32%,0.883204638957977,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,165
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110016,Healthy Benefits Value HMO 0.0.10,53789PA011,7205839443,PAN001,PAS001,PAF008,New,HMO,Platinum,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110016-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,166
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110016,Healthy Benefits Value HMO 0.0.10,53789PA011,7205839443,PAN001,PAS001,PAF008,New,HMO,Platinum,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001601_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110016-03,Limited Cost Sharing Plan Variation,88.32%,0.883204638957977,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,167
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110039,Healthy Benefits Value HMO 0.0.10,53789PA011,7205839443,PAN001,PAS004,PAF008,New,HMO,Platinum,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110039-00,Standard Platinum Off Exchange Plan,88.32%,0.883204638957977,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,168
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110039,Healthy Benefits Value HMO 0.0.10,53789PA011,7205839443,PAN001,PAS004,PAF008,New,HMO,Platinum,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110039-01,Standard Platinum On Exchange Plan,88.32%,0.883204638957977,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,169
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110039,Healthy Benefits Value HMO 0.0.10,53789PA011,7205839443,PAN001,PAS004,PAF008,New,HMO,Platinum,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110039-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,170
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110039,Healthy Benefits Value HMO 0.0.10,53789PA011,7205839443,PAN001,PAS004,PAF008,New,HMO,Platinum,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003901_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110039-03,Limited Cost Sharing Plan Variation,88.32%,0.883204638957977,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,171
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110040,Healthy Benefits Value HMO 0.0.10,53789PA011,7205839443,PAN001,PAS005,PAF008,New,HMO,Platinum,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011004001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110040-00,Standard Platinum Off Exchange Plan,88.32%,0.883204638957977,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,172
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110040,Healthy Benefits Value HMO 0.0.10,53789PA011,7205839443,PAN001,PAS005,PAF008,New,HMO,Platinum,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011004001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110040-01,Standard Platinum On Exchange Plan,88.32%,0.883204638957977,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,173
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110040,Healthy Benefits Value HMO 0.0.10,53789PA011,7205839443,PAN001,PAS005,PAF008,New,HMO,Platinum,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011004001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110040-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,174
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,2,53789,PA,Individual,No,23-2399845,53789PA0110040,Healthy Benefits Value HMO 0.0.10,53789PA011,7205839443,PAN001,PAS005,PAF008,New,HMO,Platinum,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011004001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110040-03,Limited Cost Sharing Plan Variation,88.32%,0.883204638957977,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,175
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0100011,Healthy Benefits HMO 3000.0,53789PA010,7205839443,PAN002,PAS002,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA0100011_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100011-00,Standard Gold Off Exchange Plan,78.18%,0.781755924224854,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$3,000","$6,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,$200,$400,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0100011,Healthy Benefits HMO 3000.0,53789PA010,7205839443,PAN002,PAS002,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA0100011_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100011-01,Standard Gold On Exchange Plan,78.18%,0.781755924224854,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$3,000","$6,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,$200,$400,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0100011,Healthy Benefits HMO 3000.0,53789PA010,7205839443,PAN002,PAS002,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA0100011_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100011-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0100011,Healthy Benefits HMO 3000.0,53789PA010,7205839443,PAN002,PAS002,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA0100011_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100011-03,Limited Cost Sharing Plan Variation,78.18%,0.781755924224854,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$3,000","$6,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,$200,$400,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110011,Healthy Benefits Value HMO 3000.0,53789PA011,7205839443,PAN001,PAS001,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA0110011_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110011-00,Standard Gold Off Exchange Plan,78.18%,0.781755924224854,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$3,000","$6,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,$200,$400,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110011,Healthy Benefits Value HMO 3000.0,53789PA011,7205839443,PAN001,PAS001,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA0110011_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110011-01,Standard Gold On Exchange Plan,78.18%,0.781755924224854,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$3,000","$6,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,$200,$400,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110011,Healthy Benefits Value HMO 3000.0,53789PA011,7205839443,PAN001,PAS001,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA0110011_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110011-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110011,Healthy Benefits Value HMO 3000.0,53789PA011,7205839443,PAN001,PAS001,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA0110011_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110011-03,Limited Cost Sharing Plan Variation,78.18%,0.781755924224854,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$3,000","$6,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,$200,$400,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110025,Healthy Benefits Value HMO 3000.0,53789PA011,7205839443,PAN001,PAS004,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA0110025_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110025-00,Standard Gold Off Exchange Plan,78.18%,0.781755924224854,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$3,000","$6,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,$200,$400,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110025,Healthy Benefits Value HMO 3000.0,53789PA011,7205839443,PAN001,PAS004,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA0110025_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110025-01,Standard Gold On Exchange Plan,78.18%,0.781755924224854,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$3,000","$6,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,$200,$400,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110025,Healthy Benefits Value HMO 3000.0,53789PA011,7205839443,PAN001,PAS004,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA0110025_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110025-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110025,Healthy Benefits Value HMO 3000.0,53789PA011,7205839443,PAN001,PAS004,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA0110025_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110025-03,Limited Cost Sharing Plan Variation,78.18%,0.781755924224854,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$3,000","$6,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,$200,$400,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110026,Healthy Benefits Value HMO 3000.0,53789PA011,7205839443,PAN001,PAS005,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA0110026_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110026-00,Standard Gold Off Exchange Plan,78.18%,0.781755924224854,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$3,000","$6,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,$200,$400,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110026,Healthy Benefits Value HMO 3000.0,53789PA011,7205839443,PAN001,PAS005,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA0110026_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110026-01,Standard Gold On Exchange Plan,78.18%,0.781755924224854,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$3,000","$6,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,$200,$400,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110026,Healthy Benefits Value HMO 3000.0,53789PA011,7205839443,PAN001,PAS005,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA0110026_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110026-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110026,Healthy Benefits Value HMO 3000.0,53789PA011,7205839443,PAN001,PAS005,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA0110026_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110026-03,Limited Cost Sharing Plan Variation,78.18%,0.781755924224854,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$3,000","$6,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,$200,$400,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0100013,Healthy Benefits HMO 1000.0,53789PA010,7205839443,PAN002,PAS002,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100013-00,Standard Gold Off Exchange Plan,79.35%,0.793541610240936,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,$300,$600,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0100013,Healthy Benefits HMO 1000.0,53789PA010,7205839443,PAN002,PAS002,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100013-01,Standard Gold On Exchange Plan,79.35%,0.793541610240936,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,$300,$600,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0100013,Healthy Benefits HMO 1000.0,53789PA010,7205839443,PAN002,PAS002,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100013-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0100013,Healthy Benefits HMO 1000.0,53789PA010,7205839443,PAN002,PAS002,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100013-03,Limited Cost Sharing Plan Variation,79.35%,0.793541610240936,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,$300,$600,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110013,Healthy Benefits Value HMO 1000.0,53789PA011,7205839443,PAN001,PAS001,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110013-00,Standard Gold Off Exchange Plan,79.35%,0.793541610240936,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,$300,$600,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110013,Healthy Benefits Value HMO 1000.0,53789PA011,7205839443,PAN001,PAS001,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110013-01,Standard Gold On Exchange Plan,79.35%,0.793541610240936,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,$300,$600,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110013,Healthy Benefits Value HMO 1000.0,53789PA011,7205839443,PAN001,PAS001,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110013-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,26
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110013,Healthy Benefits Value HMO 1000.0,53789PA011,7205839443,PAN001,PAS001,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110013-03,Limited Cost Sharing Plan Variation,79.35%,0.793541610240936,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,$300,$600,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110031,Healthy Benefits Value HMO 1000.0,53789PA011,7205839443,PAN001,PAS004,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110031-00,Standard Gold Off Exchange Plan,79.35%,0.793541610240936,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,$300,$600,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110031,Healthy Benefits Value HMO 1000.0,53789PA011,7205839443,PAN001,PAS004,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110031-01,Standard Gold On Exchange Plan,79.35%,0.793541610240936,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,$300,$600,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110031,Healthy Benefits Value HMO 1000.0,53789PA011,7205839443,PAN001,PAS004,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110031-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,30
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110031,Healthy Benefits Value HMO 1000.0,53789PA011,7205839443,PAN001,PAS004,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110031-03,Limited Cost Sharing Plan Variation,79.35%,0.793541610240936,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,$300,$600,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110032,Healthy Benefits Value HMO 1000.0,53789PA011,7205839443,PAN001,PAS005,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110032-00,Standard Gold Off Exchange Plan,79.35%,0.793541610240936,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,$300,$600,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110032,Healthy Benefits Value HMO 1000.0,53789PA011,7205839443,PAN001,PAS005,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110032-01,Standard Gold On Exchange Plan,79.35%,0.793541610240936,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,$300,$600,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110032,Healthy Benefits Value HMO 1000.0,53789PA011,7205839443,PAN001,PAS005,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110032-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,34
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,3,53789,PA,Individual,No,23-2399845,53789PA0110032,Healthy Benefits Value HMO 1000.0,53789PA011,7205839443,PAN001,PAS005,PAF007,New,HMO,Gold,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011003201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110032-03,Limited Cost Sharing Plan Variation,79.35%,0.793541610240936,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,$300,$600,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0100004,Healthy Benefits HMO 6350.0,53789PA010,7205839443,PAN002,PAS002,PAF001,Existing,HMO,Catastrophic,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100004-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,"$6,350","$12,700",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0100004,Healthy Benefits HMO 6350.0,53789PA010,7205839443,PAN002,PAS002,PAF001,Existing,HMO,Catastrophic,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100004-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,"$6,350","$12,700",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110004,Healthy Benefits Value HMO 6350.0,53789PA011,7205839443,PAN001,PAS001,PAF001,Existing,HMO,Catastrophic,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110004-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,"$6,350","$12,700",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110004,Healthy Benefits Value HMO 6350.0,53789PA011,7205839443,PAN001,PAS001,PAF001,Existing,HMO,Catastrophic,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110004-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,"$6,350","$12,700",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110017,Healthy Benefits Value HMO 6350.0,53789PA011,7205839443,PAN001,PAS004,PAF001,Existing,HMO,Catastrophic,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110017-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,"$6,350","$12,700",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110017,Healthy Benefits Value HMO 6350.0,53789PA011,7205839443,PAN001,PAS004,PAF001,Existing,HMO,Catastrophic,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001701_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110017-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,"$6,350","$12,700",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110018,Healthy Benefits Value HMO 6350.0,53789PA011,7205839443,PAN001,PAS005,PAF001,Existing,HMO,Catastrophic,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110018-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,"$6,350","$12,700",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110018,Healthy Benefits Value HMO 6350.0,53789PA011,7205839443,PAN001,PAS005,PAF001,Existing,HMO,Catastrophic,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001801_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110018-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,"$6,350","$12,700",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0100010,Healthy Benefits  HMO 3500.0,53789PA010,7205839443,PAN002,PAS002,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100010-00,Standard Silver Off Exchange Plan,69.72%,0.697173595428467,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,"$3,500","$7,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0100010,Healthy Benefits  HMO 3500.0,53789PA010,7205839443,PAN002,PAS002,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100010-01,Standard Silver On Exchange Plan,69.72%,0.697173595428467,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,"$3,500","$7,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0100010,Healthy Benefits  HMO 3500.0,53789PA010,7205839443,PAN002,PAS002,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100010-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,14
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0100010,Healthy Benefits  HMO 3500.0,53789PA010,7205839443,PAN002,PAS002,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100010-03,Limited Cost Sharing Plan Variation,69.72%,0.697173595428467,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,"$3,500","$7,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0100010,Healthy Benefits  HMO 3500.0,53789PA010,7205839443,PAN002,PAS002,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100010-04,73% AV Level Silver Plan,72.61%,0.726113379001617,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0100010,Healthy Benefits  HMO 3500.0,53789PA010,7205839443,PAN002,PAS002,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100010-05,87% AV Level Silver Plan,86.88%,0.868753612041473,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,"$1,000","$2,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0100010,Healthy Benefits  HMO 3500.0,53789PA010,7205839443,PAN002,PAS002,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA010001001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0100010-06,94% AV Level Silver Plan,94.94%,0.949364721775055,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,0%,$250,$500,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110010,Healthy Benefits Value HMO 3500.0,53789PA011,7205839443,PAN001,PAS001,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110010-00,Standard Silver Off Exchange Plan,69.72%,0.697173595428467,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,"$3,500","$7,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110010,Healthy Benefits Value HMO 3500.0,53789PA011,7205839443,PAN001,PAS001,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110010-01,Standard Silver On Exchange Plan,69.72%,0.697173595428467,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,"$3,500","$7,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110010,Healthy Benefits Value HMO 3500.0,53789PA011,7205839443,PAN001,PAS001,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110010-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,21
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110010,Healthy Benefits Value HMO 3500.0,53789PA011,7205839443,PAN001,PAS001,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110010-03,Limited Cost Sharing Plan Variation,69.72%,0.697173595428467,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,"$3,500","$7,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110010,Healthy Benefits Value HMO 3500.0,53789PA011,7205839443,PAN001,PAS001,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110010-04,73% AV Level Silver Plan,72.61%,0.726113379001617,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110010,Healthy Benefits Value HMO 3500.0,53789PA011,7205839443,PAN001,PAS001,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110010-05,87% AV Level Silver Plan,86.88%,0.868753612041473,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,"$1,000","$2,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,24
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110010,Healthy Benefits Value HMO 3500.0,53789PA011,7205839443,PAN001,PAS001,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011001001_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110010-06,94% AV Level Silver Plan,94.94%,0.949364721775055,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,0%,$250,$500,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110023,Healthy Benefits Value HMO 3500.0,53789PA011,7205839443,PAN001,PAS004,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110023-00,Standard Silver Off Exchange Plan,69.72%,0.697173595428467,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,"$3,500","$7,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,26
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110023,Healthy Benefits Value HMO 3500.0,53789PA011,7205839443,PAN001,PAS004,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110023-01,Standard Silver On Exchange Plan,69.72%,0.697173595428467,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,"$3,500","$7,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,27
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110023,Healthy Benefits Value HMO 3500.0,53789PA011,7205839443,PAN001,PAS004,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110023-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,28
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110023,Healthy Benefits Value HMO 3500.0,53789PA011,7205839443,PAN001,PAS004,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110023-03,Limited Cost Sharing Plan Variation,69.72%,0.697173595428467,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,"$3,500","$7,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,29
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110023,Healthy Benefits Value HMO 3500.0,53789PA011,7205839443,PAN001,PAS004,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110023-04,73% AV Level Silver Plan,72.61%,0.726113379001617,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,30
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110023,Healthy Benefits Value HMO 3500.0,53789PA011,7205839443,PAN001,PAS004,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110023-05,87% AV Level Silver Plan,86.88%,0.868753612041473,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,"$1,000","$2,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,31
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110023,Healthy Benefits Value HMO 3500.0,53789PA011,7205839443,PAN001,PAS004,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110023-06,94% AV Level Silver Plan,94.94%,0.949364721775055,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,0%,$250,$500,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,32
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110024,Healthy Benefits Value HMO 3500.0,53789PA011,7205839443,PAN001,PAS005,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110024-00,Standard Silver Off Exchange Plan,69.72%,0.697173595428467,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,"$3,500","$7,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,33
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110024,Healthy Benefits Value HMO 3500.0,53789PA011,7205839443,PAN001,PAS005,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110024-01,Standard Silver On Exchange Plan,69.72%,0.697173595428467,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,"$3,500","$7,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,34
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110024,Healthy Benefits Value HMO 3500.0,53789PA011,7205839443,PAN001,PAS005,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110024-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,35
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110024,Healthy Benefits Value HMO 3500.0,53789PA011,7205839443,PAN001,PAS005,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110024-03,Limited Cost Sharing Plan Variation,69.72%,0.697173595428467,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,"$3,500","$7,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,36
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110024,Healthy Benefits Value HMO 3500.0,53789PA011,7205839443,PAN001,PAS005,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110024-04,73% AV Level Silver Plan,72.61%,0.726113379001617,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,"$3,000","$6,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,37
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110024,Healthy Benefits Value HMO 3500.0,53789PA011,7205839443,PAN001,PAS005,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110024-05,87% AV Level Silver Plan,86.88%,0.868753612041473,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,"$1,000","$2,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,38
2015,PA,53789,HIOS,12,2015-06-19 13:25:37,4,53789,PA,Individual,No,23-2399845,53789PA0110024,Healthy Benefits Value HMO 3500.0,53789PA011,7205839443,PAN001,PAS005,PAF001,New,HMO,Silver,Yes,Both,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA011002401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0110024-06,94% AV Level Silver Plan,94.94%,0.949364721775055,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,0%,$250,$500,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,39
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0050001,BlueCare PPO Silver 2,55957PA005,,PAN002,PAS001,PAF001,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2S0000002&rxid=RXRIDERHCR-SC00000007&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/PPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0050001-00,Standard Silver Off Exchange Plan,,0.703730523586273,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$1,250","$2,500",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$150,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,Individual,No,23-2905083,55957PA0160001,"myBlue Choice LP $5,500",55957PA016,,PAN002,PAS001,PAF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9914,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700084000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0160001-00,Standard Bronze Off Exchange Plan,,0.59278017282486,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$5,500",$0,$0,$150,"$2,170",$0,$0,$105,4
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,Individual,No,23-2905083,55957PA0160001,"myBlue Choice LP $5,500",55957PA016,,PAN002,PAS001,PAF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9914,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700084000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0160001-01,Standard Bronze On Exchange Plan,,0.59278017282486,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$5,500",$0,$0,$150,"$2,170",$0,$0,$105,5
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0050001,BlueCare PPO Silver 2,55957PA005,,PAN002,PAS001,PAF001,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2S0000002&rxid=RXRIDERHCR-SC00000007&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/PPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0050001-01,Standard Silver On Exchange Plan,,0.703730523586273,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$1,250","$2,500",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$150,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0050002,BlueCare PPO Gold 13,55957PA005,,PAN002,PAS001,PAF010,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2G0000013&rxid=RXRIDERHCR-SC00000003&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/PPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0050002-00,Standard Gold Off Exchange Plan,,0.811186492443085,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$100,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,Individual,No,23-2905083,55957PA0160001,"myBlue Choice LP $5,500",55957PA016,,PAN002,PAS001,PAF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9914,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700084000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0160001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,Individual,No,23-2905083,55957PA0160001,"myBlue Choice LP $5,500",55957PA016,,PAN002,PAS001,PAF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9914,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700084000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0160001-03,Limited Cost Sharing Plan Variation,,0.59278017282486,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$5,500",$0,$0,$150,"$2,170",$0,$0,$105,7
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0050002,BlueCare PPO Gold 13,55957PA005,,PAN002,PAS001,PAF010,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2G0000013&rxid=RXRIDERHCR-SC00000003&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/PPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0050002-01,Standard Gold On Exchange Plan,,0.811186492443085,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$100,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0050003,BlueCare PPO Platinum 1,55957PA005,,PAN002,PAS001,PAF010,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2P0000001&rxid=RXRIDERHCR-SC00000002&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/PPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0050003-00,Standard Platinum Off Exchange Plan,90.50%,0.90234386920929,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,Individual,No,23-2905083,55957PA0170001,"myBlue Access LP $4,500",55957PA017,,PAN001,PAS001,PAF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9894,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700085000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0170001-00,Standard Bronze Off Exchange Plan,,0.598404586315155,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$4,500",$0,$560,$150,"$2,170",$0,$0,$105,8
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,Individual,No,23-2905083,55957PA0170001,"myBlue Access LP $4,500",55957PA017,,PAN001,PAS001,PAF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9894,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700085000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0170001-01,Standard Bronze On Exchange Plan,,0.598404586315155,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$4,500",$0,$560,$150,"$2,170",$0,$0,$105,9
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0050003,BlueCare PPO Platinum 1,55957PA005,,PAN002,PAS001,PAF010,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2P0000001&rxid=RXRIDERHCR-SC00000002&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/PPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0050003-01,Standard Platinum On Exchange Plan,90.50%,0.90234386920929,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0050018,BlueCare PPO Gold 4,55957PA005,,PAN002,PAS001,PAF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2G0000004&rxid=RXRIDERHCR-SC00000006&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/PPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0050018-00,Standard Gold Off Exchange Plan,,0.809095203876495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$100,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,Individual,No,23-2905083,55957PA0170001,"myBlue Access LP $4,500",55957PA017,,PAN001,PAS001,PAF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9894,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700085000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0170001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,Individual,No,23-2905083,55957PA0170001,"myBlue Access LP $4,500",55957PA017,,PAN001,PAS001,PAF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9894,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700085000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0170001-03,Limited Cost Sharing Plan Variation,,0.598404586315155,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$4,500",$0,$560,$150,"$2,170",$0,$0,$105,11
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0050018,BlueCare PPO Gold 4,55957PA005,,PAN002,PAS001,PAF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2G0000004&rxid=RXRIDERHCR-SC00000006&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/PPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0050018-01,Standard Gold On Exchange Plan,,0.809095203876495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$100,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0050035,BlueCare PPO Gold 22,55957PA005,,PAN002,PAS001,PAF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2G0000022&rxid=RXRIDERHCR-SC00000005&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/PPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0050035-00,Standard Gold Off Exchange Plan,,0.791711270809174,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$6,500","$13,000",Not Applicable,Not Applicable,"$2,000","$4,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,Individual,No,23-2905083,55957PA0170002,"myBlue Access LP $3,000",55957PA017,,PAN001,PAS001,PAF004,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.984,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700086000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0170002-00,Standard Silver Off Exchange Plan,,0.684117615222931,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,Individual,No,23-2905083,55957PA0170002,"myBlue Access LP $3,000",55957PA017,,PAN001,PAS001,PAF004,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.984,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700086000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0170002-01,Standard Silver On Exchange Plan,,0.684117615222931,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0050035,BlueCare PPO Gold 22,55957PA005,,PAN002,PAS001,PAF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2G0000022&rxid=RXRIDERHCR-SC00000005&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/PPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0050035-01,Standard Gold On Exchange Plan,,0.791711270809174,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$6,500","$13,000",Not Applicable,Not Applicable,"$2,000","$4,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0050045,BlueCare PPO Silver 5,55957PA005,,PAN002,PAS001,PAF001,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2S0000005&rxid=RXRIDERHCR-SC00000006&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/PPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0050045-00,Standard Silver Off Exchange Plan,71.10%,0.701851904392242,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$100,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,Individual,No,23-2905083,55957PA0170002,"myBlue Access LP $3,000",55957PA017,,PAN001,PAS001,PAF004,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.984,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700086000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0170002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,Individual,No,23-2905083,55957PA0170002,"myBlue Access LP $3,000",55957PA017,,PAN001,PAS001,PAF004,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.984,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700086000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0170002-03,Limited Cost Sharing Plan Variation,,0.684117615222931,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0050045,BlueCare PPO Silver 5,55957PA005,,PAN002,PAS001,PAF001,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2S0000005&rxid=RXRIDERHCR-SC00000006&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/PPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0050045-01,Standard Silver On Exchange Plan,71.10%,0.701851904392242,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$100,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0050044,BlueCare PPO Gold 26,55957PA005,,PAN002,PAS001,PAF001,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2G0000026&rxid=RXRIDERHCR-SC00000005&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/PPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0050044-00,Standard Gold Off Exchange Plan,78.20%,0.800125539302826,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000",Not Applicable,Not Applicable,$250,$500,0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,Individual,No,23-2905083,55957PA0170002,"myBlue Access LP $3,000",55957PA017,,PAN001,PAS001,PAF004,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.984,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700086000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0170002-04,73% AV Level Silver Plan,,0.729948341846466,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,400","$4,800",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,Individual,No,23-2905083,55957PA0170002,"myBlue Access LP $3,000",55957PA017,,PAN001,PAS001,PAF004,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.984,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700086000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0170002-05,87% AV Level Silver Plan,,0.866610765457153,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$800,"$1,600",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0050044,BlueCare PPO Gold 26,55957PA005,,PAN002,PAS001,PAF001,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2G0000026&rxid=RXRIDERHCR-SC00000005&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/PPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0050044-01,Standard Gold On Exchange Plan,78.20%,0.800125539302826,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000",Not Applicable,Not Applicable,$250,$500,0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0050048,BlueCare PPO Silver 8,55957PA005,,PAN002,PAS001,PAF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2S0000008&rxid=RXRIDERHCR-SC00000006&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/PPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0050048-00,Standard Silver Off Exchange Plan,,0.705432653427124,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$100,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,Individual,No,23-2905083,55957PA0170002,"myBlue Access LP $3,000",55957PA017,,PAN001,PAS001,PAF004,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.984,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700086000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0170002-06,94% AV Level Silver Plan,,0.940287828445435,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,Individual,No,23-2905083,55957PA0170003,"myBlue Access LP $1,500",55957PA017,,PAN001,PAS001,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9864,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700088000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0170003-00,Standard Gold Off Exchange Plan,,0.799982726573944,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0050048,BlueCare PPO Silver 8,55957PA005,,PAN002,PAS001,PAF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2S0000008&rxid=RXRIDERHCR-SC00000006&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/PPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0050048-01,Standard Silver On Exchange Plan,,0.705432653427124,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$100,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0050049,BlueCare PPO Silver 9,55957PA005,,PAN002,PAS001,PAF001,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2S0000009&rxid=RXRIDERHCR-SC00000005&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/PPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0050049-00,Standard Silver Off Exchange Plan,71.70%,0.707274198532104,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,Individual,No,23-2905083,55957PA0170003,"myBlue Access LP $1,500",55957PA017,,PAN001,PAS001,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9864,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700088000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0170003-01,Standard Gold On Exchange Plan,,0.799982726573944,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,Individual,No,23-2905083,55957PA0170003,"myBlue Access LP $1,500",55957PA017,,PAN001,PAS001,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9864,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700088000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0170003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,21
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0050049,BlueCare PPO Silver 9,55957PA005,,PAN002,PAS001,PAF001,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2S0000009&rxid=RXRIDERHCR-SC00000005&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/PPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0050049-01,Standard Silver On Exchange Plan,71.70%,0.707274198532104,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0050043,BlueCare PPO Platinum 12,55957PA005,,PAN002,PAS001,PAF010,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2P0000012&rxid=RXRIDERHCR-SC00000002&effectivedate=2015-01-01,,,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0050043-00,Standard Platinum Off Exchange Plan,88.00%,0.900219976902008,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$3,500","$7,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,Individual,No,23-2905083,55957PA0170003,"myBlue Access LP $1,500",55957PA017,,PAN001,PAS001,PAF006,New,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9864,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700088000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0170003-03,Limited Cost Sharing Plan Variation,,0.799982726573944,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,1,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0050043,BlueCare PPO Platinum 12,55957PA005,,PAN002,PAS001,PAF010,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2P0000012&rxid=RXRIDERHCR-SC00000002&effectivedate=2015-01-01,,,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0050043-01,Standard Platinum On Exchange Plan,88.00%,0.900219976902008,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$3,500","$7,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,Individual,No,23-2905083,55957PA0190005,"myBlue Access $2,500",55957PA019,,PAN001,PAS001,PAF002,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9545,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700087000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0190005-00,Standard Bronze Off Exchange Plan,,0.615068376064301,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$0,"$1,440",$150,"$2,170",$0,$0,$105,4
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0080038,BlueCare Custom PPO Silver 2,55957PA008,,PAN001,PAS001,PAF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=EPOHCR-S2S0000002&rxid=RXRIDERHCR-SC00000007&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0080038-00,Standard Silver Off Exchange Plan,,0.703730642795563,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$1,250","$2,500",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$150,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0080038,BlueCare Custom PPO Silver 2,55957PA008,,PAN001,PAS001,PAF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=EPOHCR-S2S0000002&rxid=RXRIDERHCR-SC00000007&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0080038-01,Standard Silver On Exchange Plan,,0.703730642795563,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$1,250","$2,500",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$150,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,Individual,No,23-2905083,55957PA0190005,"myBlue Access $2,500",55957PA019,,PAN001,PAS001,PAF002,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9545,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700087000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0190005-01,Standard Bronze On Exchange Plan,,0.615068376064301,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$0,"$1,440",$150,"$2,170",$0,$0,$105,5
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,Individual,No,23-2905083,55957PA0190005,"myBlue Access $2,500",55957PA019,,PAN001,PAS001,PAF002,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9545,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700087000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0190005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0080025,BlueCare Custom PPO Gold 13,55957PA008,,PAN001,PAS001,PAF010,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=EPOHCR-S2G0000013&rxid=RXRIDERHCR-SC00000003&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0080025-00,Standard Gold Off Exchange Plan,,0.811186492443085,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$100,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0080025,BlueCare Custom PPO Gold 13,55957PA008,,PAN001,PAS001,PAF010,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=EPOHCR-S2G0000013&rxid=RXRIDERHCR-SC00000003&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0080025-01,Standard Gold On Exchange Plan,,0.811186492443085,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$100,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,Individual,No,23-2905083,55957PA0190005,"myBlue Access $2,500",55957PA019,,PAN001,PAS001,PAF002,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9545,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700087000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0190005-03,Limited Cost Sharing Plan Variation,,0.615068376064301,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$0,"$1,440",$150,"$2,170",$0,$0,$105,7
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0080001,BlueCare Custom PPO Platinum 1,55957PA008,,PAN001,PAS001,PAF010,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=EPOHCR-S2P0000001&rxid=RXRIDERHCR-SC00000002&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0080001-00,Standard Platinum Off Exchange Plan,90.50%,0.904339253902435,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0080001,BlueCare Custom PPO Platinum 1,55957PA008,,PAN001,PAS001,PAF010,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=EPOHCR-S2P0000001&rxid=RXRIDERHCR-SC00000002&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0080001-01,Standard Platinum On Exchange Plan,90.50%,0.904339253902435,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0080016,BlueCare Custom PPO Gold 4,55957PA008,,PAN001,PAS001,PAF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=EPOHCR-S2G0000004&rxid=RXRIDERHCR-SC00000006&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0080016-00,Standard Gold Off Exchange Plan,,0.808509767055511,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0080016,BlueCare Custom PPO Gold 4,55957PA008,,PAN001,PAS001,PAF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=EPOHCR-S2G0000004&rxid=RXRIDERHCR-SC00000006&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0080016-01,Standard Gold On Exchange Plan,,0.80909526348114,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$100,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0080034,BlueCare Custom PPO Gold 22,55957PA008,,PAN001,PAS001,PAF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=EPOHCR-S2G0000022&rxid=RXRIDERHCR-SC00000005&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0080034-00,Standard Gold Off Exchange Plan,,0.791711270809174,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$6,500","$13,000",Not Applicable,Not Applicable,"$2,000","$4,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0080034,BlueCare Custom PPO Gold 22,55957PA008,,PAN001,PAS001,PAF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=EPOHCR-S2G0000022&rxid=RXRIDERHCR-SC00000005&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0080034-01,Standard Gold On Exchange Plan,,0.791711270809174,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$6,500","$13,000",Not Applicable,Not Applicable,"$2,000","$4,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0080045,BlueCare Custom PPO Silver 5,55957PA008,,PAN001,PAS001,PAF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=EPOHCR-S2S0000005&rxid=RXRIDERHCR-SC00000006&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0080045-00,Standard Silver Off Exchange Plan,,0.700461506843567,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$100,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0080045,BlueCare Custom PPO Silver 5,55957PA008,,PAN001,PAS001,PAF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=EPOHCR-S2S0000005&rxid=RXRIDERHCR-SC00000006&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0080045-01,Standard Silver On Exchange Plan,,0.700461506843567,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$100,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0080044,BlueCare Custom PPO Gold 26,55957PA008,,PAN001,PAS001,PAF001,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=EPOHCR-S2G0000026&rxid=RXRIDERHCR-SC00000005&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0080044-00,Standard Gold Off Exchange Plan,78.20%,0.814994931221008,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000",Not Applicable,Not Applicable,$250,$500,0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0080044,BlueCare Custom PPO Gold 26,55957PA008,,PAN001,PAS001,PAF001,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=EPOHCR-S2G0000026&rxid=RXRIDERHCR-SC00000005&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0080044-01,Standard Gold On Exchange Plan,78.20%,0.814994931221008,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000",Not Applicable,Not Applicable,$250,$500,0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0080048,BlueCare Custom PPO Silver 8,55957PA008,,PAN001,PAS001,PAF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=EPOHCR-S2S0000008&rxid=RXRIDERHCR-SC00000006&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0080048-00,Standard Silver Off Exchange Plan,,0.705432713031769,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$100,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0080048,BlueCare Custom PPO Silver 8,55957PA008,,PAN001,PAS001,PAF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=EPOHCR-S2S0000008&rxid=RXRIDERHCR-SC00000006&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0080048-01,Standard Silver On Exchange Plan,,0.705432713031769,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$100,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0080049,BlueCare Custom PPO Silver 9,55957PA008,,PAN001,PAS001,PAF001,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=EPOHCR-S2S0000009&rxid=RXRIDERHCR-SC00000005&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0080049-00,Standard Silver Off Exchange Plan,71.70%,0.707274198532104,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0080049,BlueCare Custom PPO Silver 9,55957PA008,,PAN001,PAS001,PAF001,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=EPOHCR-S2S0000009&rxid=RXRIDERHCR-SC00000005&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0080049-01,Standard Silver On Exchange Plan,71.70%,0.707274198532104,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0080043,BlueCare Custom PPO Platinum 12,55957PA008,,PAN001,PAS001,PAF010,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=EPOHCR-S2P0000012&rxid=RXRIDERHCR-SC00000002&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0080043-00,Standard Platinum Off Exchange Plan,88.00%,0.900219976902008,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,"$2,000",0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,2,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0080043,BlueCare Custom PPO Platinum 12,55957PA008,,PAN001,PAS001,PAF010,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=EPOHCR-S2P0000012&rxid=RXRIDERHCR-SC00000002&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0080043-01,Standard Platinum On Exchange Plan,88.00%,0.900219976902008,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,"$2,000",0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,3,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0070009,BlueCare QHD PPO Bronze 4,55957PA007,,PAN002,PAS001,PAF001,New,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=QHDPPOHCR-S2B0000004&rxid=&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/QHDPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0070009-00,Standard Bronze Off Exchange Plan,58.40%,0.615818381309509,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",10%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,3,55957,PA,Individual,No,23-2905083,55957PA0180001,"myBlue Choice $2,500",55957PA018,,PAN002,PAS001,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9924,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,http://test.api.bcnepa.com/sbc/download.pdf?group=700064000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0180001-00,Standard Silver Off Exchange Plan,,0.704418182373047,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$0,$960,$150,"$1,440",$200,$0,$105,4
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,3,55957,PA,Individual,No,23-2905083,55957PA0180001,"myBlue Choice $2,500",55957PA018,,PAN002,PAS001,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9924,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,http://test.api.bcnepa.com/sbc/download.pdf?group=700064000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0180001-01,Standard Silver On Exchange Plan,,0.704418182373047,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$0,$960,$150,"$1,440",$200,$0,$105,5
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,3,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0070009,BlueCare QHD PPO Bronze 4,55957PA007,,PAN002,PAS001,PAF001,New,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=QHDPPOHCR-S2B0000004&rxid=&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/QHDPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0070009-01,Standard Bronze On Exchange Plan,58.40%,0.615818381309509,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",10%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,3,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0070011,BlueCare QHD PPO Silver 5,55957PA007,,PAN002,PAS001,PAF001,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=QHDPPOHCR-S2S0000005&rxid=&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/QHDPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0070011-00,Standard Silver Off Exchange Plan,68.10%,0.717693746089935,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,3,55957,PA,Individual,No,23-2905083,55957PA0180001,"myBlue Choice $2,500",55957PA018,,PAN002,PAS001,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9924,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,http://test.api.bcnepa.com/sbc/download.pdf?group=700064000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0180001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,3,55957,PA,Individual,No,23-2905083,55957PA0180001,"myBlue Choice $2,500",55957PA018,,PAN002,PAS001,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9924,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,http://test.api.bcnepa.com/sbc/download.pdf?group=700064000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0180001-03,Limited Cost Sharing Plan Variation,,0.704418182373047,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$0,$960,$150,"$1,440",$200,$0,$105,7
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,3,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0070011,BlueCare QHD PPO Silver 5,55957PA007,,PAN002,PAS001,PAF001,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=QHDPPOHCR-S2S0000005&rxid=&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/QHDPPO.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0070011-01,Standard Silver On Exchange Plan,68.10%,0.717693746089935,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,3,55957,PA,Individual,No,23-2905083,55957PA0180001,"myBlue Choice $2,500",55957PA018,,PAN002,PAS001,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9924,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,http://test.api.bcnepa.com/sbc/download.pdf?group=700064000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0180001-04,73% AV Level Silver Plan,,0.729937434196472,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,3,55957,PA,Individual,No,23-2905083,55957PA0180001,"myBlue Choice $2,500",55957PA018,,PAN002,PAS001,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9924,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,http://test.api.bcnepa.com/sbc/download.pdf?group=700064000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0180001-05,87% AV Level Silver Plan,,0.860823512077332,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$10,000","$20,000",Not Applicable,Not Applicable,$250,$500,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,3,55957,PA,Individual,No,23-2905083,55957PA0180001,"myBlue Choice $2,500",55957PA018,,PAN002,PAS001,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9924,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,http://test.api.bcnepa.com/sbc/download.pdf?group=700064000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0180001-06,94% AV Level Silver Plan,,0.932590425014496,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$450,$900,,,"$10,000","$20,000",Not Applicable,Not Applicable,$100,$200,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,4,55957,PA,Individual,No,23-2905083,55957PA0260001,myBlue Care - Silver,55957PA026,,PAN001,PAS001,PAF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9933,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700066000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0260001-00,Standard Silver Off Exchange Plan,,0.699937641620636,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",10%,"$3,000","$6,000",30%,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,100%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$630,$150,"$1,000",$140,$44,$105,4
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,4,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0110001,AffordaBlue Platinum 1,55957PA011,,PAN001,PAS001,PAF010,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=AFFORDABLUEHCR-S2P0000001&rxid=RXRIDERHCR-SC00000002&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/AffordaBlue.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0110001-00,Standard Platinum Off Exchange Plan,89.60%,0.894941747188568,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$5,000","$10,000","$12,000","$24,000",Not Applicable,Not Applicable,$250,$500,0%,$750,"$1,500",30%,"$4,000","$8,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,$0,Not Applicable,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,4,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0110001,AffordaBlue Platinum 1,55957PA011,,PAN001,PAS001,PAF010,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=AFFORDABLUEHCR-S2P0000001&rxid=RXRIDERHCR-SC00000002&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/AffordaBlue.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0110001-01,Standard Platinum On Exchange Plan,89.60%,0.894941747188568,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$5,000","$10,000","$12,000","$24,000",Not Applicable,Not Applicable,$250,$500,0%,$750,"$1,500",30%,"$4,000","$8,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,$0,Not Applicable,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,4,55957,PA,Individual,No,23-2905083,55957PA0260001,myBlue Care - Silver,55957PA026,,PAN001,PAS001,PAF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9933,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700066000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0260001-01,Standard Silver On Exchange Plan,,0.699937641620636,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",10%,"$3,000","$6,000",30%,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,100%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$630,$150,"$1,000",$140,$44,$105,5
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,4,55957,PA,Individual,No,23-2905083,55957PA0260001,myBlue Care - Silver,55957PA026,,PAN001,PAS001,PAF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9933,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700066000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0260001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,4,55957,PA,Individual,No,23-2905083,55957PA0260001,myBlue Care - Silver,55957PA026,,PAN001,PAS001,PAF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9933,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700066000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0260001-03,Limited Cost Sharing Plan Variation,,0.699937641620636,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",10%,"$3,000","$6,000",30%,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,100%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$630,$150,"$1,000",$140,$44,$105,7
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,4,55957,PA,Individual,No,23-2905083,55957PA0260001,myBlue Care - Silver,55957PA026,,PAN001,PAS001,PAF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9933,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700066000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0260001-04,73% AV Level Silver Plan,,0.72627204656601,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$5,200","$10,400","$10,000","$20,000",Not Applicable,Not Applicable,$700,"$1,400",10%,"$3,000","$6,000",30%,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,100%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,4,55957,PA,Individual,No,23-2905083,55957PA0260001,myBlue Care - Silver,55957PA026,,PAN001,PAS001,PAF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9933,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700066000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0260001-05,87% AV Level Silver Plan,,0.863165080547333,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$500,"$1,000","$1,000","$2,000","$10,000","$20,000",Not Applicable,Not Applicable,$400,$800,10%,$500,"$1,000",30%,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,100%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,4,55957,PA,Individual,No,23-2905083,55957PA0260001,myBlue Care - Silver,55957PA026,,PAN001,PAS001,PAF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9933,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700066000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0260001-06,94% AV Level Silver Plan,,0.943251967430115,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$150,$300,$450,$900,"$10,000","$20,000",Not Applicable,Not Applicable,$100,$200,10%,$200,$400,30%,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,100%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,5,55957,PA,Individual,No,23-2905083,55957PA0260002,myBlue Care - Platinum,55957PA026,,PAN001,PAS001,PAF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9676,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700090000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0260002-00,Standard Platinum Off Exchange Plan,,0.902274429798126,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$500,"$1,000","$6,000","$12,000","$10,000","$20,000",Not Applicable,Not Applicable,$100,$200,0%,"$2,500","$5,000",20%,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,5,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0110005,AffordaBlue Gold 4,55957PA011,,PAN001,PAS001,PAF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=AFFORDABLUEHCR-S2G0000004&rxid=RXRIDERHCR-SC00000005&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/AffordaBlue.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0110005-00,Standard Gold Off Exchange Plan,,0.806098520755768,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,500","$7,000","$12,000","$24,000",Not Applicable,Not Applicable,$500,"$1,000",10%,"$2,000","$4,000",30%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,$0,Not Applicable,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,5,55957,PA,SHOP (Small Group),No,23-2905083,55957PA0110005,AffordaBlue Gold 4,55957PA011,,PAN001,PAS001,PAF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9954,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?healthproductid=AFFORDABLUEHCR-S2G0000004&rxid=RXRIDERHCR-SC00000005&effectivedate=2015-01-01,,https://www.bcnepa.com/Products/Group/AffordaBlue.aspx,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0110005-01,Standard Gold On Exchange Plan,,0.806098520755768,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,500","$7,000","$12,000","$24,000",Not Applicable,Not Applicable,$500,"$1,000",10%,"$2,000","$4,000",30%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,Not Applicable,0%,$0,Not Applicable,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,5,55957,PA,Individual,No,23-2905083,55957PA0260002,myBlue Care - Platinum,55957PA026,,PAN001,PAS001,PAF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9676,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700090000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0260002-01,Standard Platinum On Exchange Plan,,0.902274429798126,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$500,"$1,000","$6,000","$12,000","$10,000","$20,000",Not Applicable,Not Applicable,$100,$200,0%,"$2,500","$5,000",20%,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,5,55957,PA,Individual,No,23-2905083,55957PA0260002,myBlue Care - Platinum,55957PA026,,PAN001,PAS001,PAF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9676,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700090000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0260002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,5,55957,PA,Individual,No,23-2905083,55957PA0260002,myBlue Care - Platinum,55957PA026,,PAN001,PAS001,PAF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9676,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700090000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0260002-03,Limited Cost Sharing Plan Variation,,0.902274429798126,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$500,"$1,000","$6,000","$12,000","$10,000","$20,000",Not Applicable,Not Applicable,$100,$200,0%,"$2,500","$5,000",20%,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,6,55957,PA,Individual,No,23-2905083,55957PA0180002,"myBlue Choice $1,000",55957PA018,,PAN002,PAS001,PAF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9933,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700068000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0180002-00,Standard Gold Off Exchange Plan,,0.810705423355103,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,"$1,260",$150,"$1,000",$160,$88,$105,4
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,6,55957,PA,Individual,No,23-2905083,55957PA0180002,"myBlue Choice $1,000",55957PA018,,PAN002,PAS001,PAF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9933,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700068000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0180002-01,Standard Gold On Exchange Plan,,0.810705423355103,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,"$1,260",$150,"$1,000",$160,$88,$105,5
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,6,55957,PA,Individual,No,23-2905083,55957PA0180002,"myBlue Choice $1,000",55957PA018,,PAN002,PAS001,PAF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9933,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700068000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0180002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,6,55957,PA,Individual,No,23-2905083,55957PA0180002,"myBlue Choice $1,000",55957PA018,,PAN002,PAS001,PAF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9933,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700068000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0180002-03,Limited Cost Sharing Plan Variation,,0.810705423355103,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,"$1,260",$150,"$1,000",$160,$88,$105,7
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,7,55957,PA,Individual,No,23-2905083,55957PA0190002,myBlue Access $750,55957PA019,,PAN001,PAS001,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9922,,,1,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700069000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0190002-00,Standard Gold Off Exchange Plan,,0.819668173789978,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$750,"$1,500",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$0,$655,$150,$750,$160,$69,$105,4
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,7,55957,PA,Individual,No,23-2905083,55957PA0190002,myBlue Access $750,55957PA019,,PAN001,PAS001,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9922,,,1,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700069000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0190002-01,Standard Gold On Exchange Plan,,0.819668173789978,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$750,"$1,500",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$0,$655,$150,$750,$160,$69,$105,5
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,7,55957,PA,Individual,No,23-2905083,55957PA0190002,myBlue Access $750,55957PA019,,PAN001,PAS001,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9922,,,1,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700069000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0190002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,7,55957,PA,Individual,No,23-2905083,55957PA0190002,myBlue Access $750,55957PA019,,PAN001,PAS001,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9922,,,1,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700069000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0190002-03,Limited Cost Sharing Plan Variation,,0.819668173789978,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$750,"$1,500",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$0,$655,$150,$750,$160,$69,$105,7
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,8,55957,PA,Individual,No,23-2905083,55957PA0260003,myBlue Care - Gold,55957PA026,,PAN001,PAS001,PAF007,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.966,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700089000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0260003-00,Standard Gold Off Exchange Plan,,0.810844004154205,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$5,500","$11,000","$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",10%,"$3,500","$7,000",30%,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,8,55957,PA,Individual,No,23-2905083,55957PA0260003,myBlue Care - Gold,55957PA026,,PAN001,PAS001,PAF007,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.966,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700089000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0260003-01,Standard Gold On Exchange Plan,,0.810844004154205,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$5,500","$11,000","$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",10%,"$3,500","$7,000",30%,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,8,55957,PA,Individual,No,23-2905083,55957PA0260003,myBlue Care - Gold,55957PA026,,PAN001,PAS001,PAF007,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.966,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700089000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0260003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,8,55957,PA,Individual,No,23-2905083,55957PA0260003,myBlue Care - Gold,55957PA026,,PAN001,PAS001,PAF007,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.966,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700089000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0260003-03,Limited Cost Sharing Plan Variation,,0.810844004154205,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$5,500","$11,000","$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",10%,"$3,500","$7,000",30%,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,9,55957,PA,Individual,No,23-2905083,55957PA0180003,myBlue Choice $250,55957PA018,,PAN002,PAS001,PAF008,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9938,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700071000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0180003-00,Standard Platinum Off Exchange Plan,,0.906325101852417,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$6,000","$12,000",Not Applicable,Not Applicable,$250,$500,10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$250,$0,$705,$150,$250,$0,$192,$105,4
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,9,55957,PA,Individual,No,23-2905083,55957PA0180003,myBlue Choice $250,55957PA018,,PAN002,PAS001,PAF008,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9938,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700071000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0180003-01,Standard Platinum On Exchange Plan,,0.906325101852417,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$6,000","$12,000",Not Applicable,Not Applicable,$250,$500,10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$250,$0,$705,$150,$250,$0,$192,$105,5
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,9,55957,PA,Individual,No,23-2905083,55957PA0180003,myBlue Choice $250,55957PA018,,PAN002,PAS001,PAF008,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9938,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700071000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0180003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,9,55957,PA,Individual,No,23-2905083,55957PA0180003,myBlue Choice $250,55957PA018,,PAN002,PAS001,PAF008,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9938,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700071000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0180003-03,Limited Cost Sharing Plan Variation,,0.906325101852417,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$6,000","$12,000",Not Applicable,Not Applicable,$250,$500,10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$250,$0,$705,$150,$250,$0,$192,$105,7
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,10,55957,PA,Individual,No,23-2905083,55957PA0190003,myBlue Access $500,55957PA019,,PAN001,PAS001,PAF008,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9932,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700072000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0190003-00,Standard Platinum Off Exchange Plan,,0.890036284923553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$0,$0,$150,$500,$0,$0,$105,4
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,10,55957,PA,Individual,No,23-2905083,55957PA0190003,myBlue Access $500,55957PA019,,PAN001,PAS001,PAF008,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9932,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700072000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0190003-01,Standard Platinum On Exchange Plan,,0.890036284923553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$0,$0,$150,$500,$0,$0,$105,5
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,10,55957,PA,Individual,No,23-2905083,55957PA0190003,myBlue Access $500,55957PA019,,PAN001,PAS001,PAF008,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9932,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700072000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0190003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,10,55957,PA,Individual,No,23-2905083,55957PA0190003,myBlue Access $500,55957PA019,,PAN001,PAS001,PAF008,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9932,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700072000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0190003-03,Limited Cost Sharing Plan Variation,,0.890036284923553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$0,$0,$150,$500,$0,$0,$105,7
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,11,55957,PA,Individual,No,23-2905083,55957PA0190004,"myBlue Access $6,350",55957PA019,,PAN001,PAS001,PAF011,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9762,,,0,0,3,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700073000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0190004-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$6,350",$0,$0,$150,"$2,170",$0,$0,$105,4
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,11,55957,PA,Individual,No,23-2905083,55957PA0190004,"myBlue Access $6,350",55957PA019,,PAN001,PAS001,PAF011,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9762,,,0,0,3,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700073000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0190004-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$6,350",$0,$0,$150,"$2,170",$0,$0,$105,5
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,12,55957,PA,Individual,No,23-2905083,55957PA0190001,"myBlue Access $1,500",55957PA019,,PAN001,PAS001,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9917,,,1,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700065000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0190001-00,Standard Silver Off Exchange Plan,,0.698050737380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,12,55957,PA,Individual,No,23-2905083,55957PA0190001,"myBlue Access $1,500",55957PA019,,PAN001,PAS001,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9917,,,1,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700065000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0190001-01,Standard Silver On Exchange Plan,,0.698050737380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,12,55957,PA,Individual,No,23-2905083,55957PA0190001,"myBlue Access $1,500",55957PA019,,PAN001,PAS001,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9917,,,1,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700065000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0190001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,12,55957,PA,Individual,No,23-2905083,55957PA0190001,"myBlue Access $1,500",55957PA019,,PAN001,PAS001,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9917,,,1,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700065000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0190001-03,Limited Cost Sharing Plan Variation,,0.698050737380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,12,55957,PA,Individual,No,23-2905083,55957PA0190001,"myBlue Access $1,500",55957PA019,,PAN001,PAS001,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9917,,,1,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700065000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0190001-04,73% AV Level Silver Plan,,0.72497832775116,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,12,55957,PA,Individual,No,23-2905083,55957PA0190001,"myBlue Access $1,500",55957PA019,,PAN001,PAS001,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9917,,,1,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700065000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0190001-05,87% AV Level Silver Plan,,0.860685646533966,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$250,$500,20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,55957,HIOS,7,2015-02-14 07:15:27,12,55957,PA,Individual,No,23-2905083,55957PA0190001,"myBlue Access $1,500",55957PA019,,PAN001,PAS001,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9917,,,1,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700065000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,https://d1tpfj3hind0fx.cloudfront.net/Media/Documents/Reform/RxFormulary.pdf,55957PA0190001-06,94% AV Level Silver Plan,,0.940525114536285,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$250,$500,,,"$10,000","$20,000",Not Applicable,Not Applicable,$100,$200,20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,PA,59933,HIOS,2,2014-08-08 08:53:29,1,59933,PA,SHOP (Small Group),Yes,42-0127290,59933PA0040001,Principal Plan Dental 70,59933PA004,,PAN001,PAS001,,New,PPO,Low,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$26.16,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,59933PA0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,59933,HIOS,2,2014-08-08 08:53:29,1,59933,PA,SHOP (Small Group),Yes,42-0127290,59933PA0040002,Principal Plan Dental 80,59933PA004,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$27.70,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,59933PA0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,61775,HIOS,3,2014-08-05 13:28:44,1,61775,PA,SHOP (Small Group),Yes,57-0523959,61775PA0010001,Group Pediatric Dental EHB Rider,61775PA001,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$30.79,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,61775PA0010001-00,Standard High Off Exchange Plan,84.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,61775,HIOS,3,2014-08-05 13:28:44,1,61775,PA,SHOP (Small Group),Yes,57-0523959,61775PA0010002,Group Pediatric Dental EHB Rider,61775PA001,,PAN001,PAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.05,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,61775PA0010002-00,Standard Low Off Exchange Plan,68.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,1,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020010,"UPMC Small Business Advantage Silver HMO $3,000 $10/$25 - Partner Network",62560PA002,,PAN006,PAS001,PAF016,New,HMO,Silver,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Silver_62560PA0020010_Serv1_Net19,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Silver_62560PA0020010_Serv1_Net19,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020010-00,Standard Silver Off Exchange Plan,70.60%,0.706780254840851,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$400,$0,$200,"$1,900","$1,000",$0,$80,4
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,1,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020010,"UPMC Small Business Advantage Silver HMO $3,000 $10/$25 - Partner Network",62560PA002,,PAN006,PAS001,PAF016,New,HMO,Silver,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Silver_62560PA0020010_Serv1_Net19,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Silver_62560PA0020010_Serv1_Net19,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020010-01,Standard Silver On Exchange Plan,70.60%,0.706780254840851,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$400,$0,$200,"$1,900","$1,000",$0,$80,5
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,1,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020022,"UPMC Small Business Advantage Silver HMO $3,000 $10/$25 - Standard Network",62560PA002,,PAN008,PAS003,PAF016,New,HMO,Silver,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Silver_62560PA0020022_Serv28_Net21,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Silver_62560PA0020022_Serv28_Net21,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020022-00,Standard Silver Off Exchange Plan,70.60%,0.706780254840851,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$400,$0,$200,"$1,900","$1,000",$0,$80,6
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,2,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020035,"UPMC Small Business Advantage Gold HMO $1,000 $10/$25 - Partner Network",62560PA002,,PAN010,PAS005,PAF015,New,HMO,Gold,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020035_Serv1N_Net23,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020035_Serv1N_Net23,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020035-01,Standard Gold On Exchange Plan,81.50%,0.832422196865082,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$400,$0,$200,"$1,000","$1,000",$0,$80,9
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,3,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020012,UPMC Small Business Advantage Platinum HMO $20/$40 - Partner Network,62560PA002,,PAN006,PAS001,PAF015,New,HMO,Platinum,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020012_Serv1_Net19,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020012_Serv1_Net19,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020012-00,Standard Platinum Off Exchange Plan,88.20%,0.844815611839294,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,500",$0,$200,$0,$900,$600,$80,4
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,2,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020035,"UPMC Small Business Advantage Gold HMO $1,000 $10/$25 - Partner Network",62560PA002,,PAN010,PAS005,PAF015,New,HMO,Gold,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020035_Serv1N_Net23,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020035_Serv1N_Net23,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020035-00,Standard Gold Off Exchange Plan,81.50%,0.832422196865082,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$400,$0,$200,"$1,000","$1,000",$0,$80,8
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,3,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020015,UPMC Small Business Advantage Gold HMO $30/$50 - Partner Network,62560PA002,,PAN006,PAS001,PAF015,New,HMO,Gold,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020015_Serv1_Net19,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020015_Serv1_Net19,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020015-00,Standard Gold Off Exchange Plan,81.50%,0.723928272724152,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$2,100",$0,$200,$0,"$1,100",$600,$80,8
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,1,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020022,"UPMC Small Business Advantage Silver HMO $3,000 $10/$25 - Standard Network",62560PA002,,PAN008,PAS003,PAF016,New,HMO,Silver,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Silver_62560PA0020022_Serv28_Net21,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Silver_62560PA0020022_Serv28_Net21,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020022-01,Standard Silver On Exchange Plan,70.60%,0.706780254840851,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$400,$0,$200,"$1,900","$1,000",$0,$80,7
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,1,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020034,"UPMC Small Business Advantage Silver HMO $3,000 $10/$25 - Partner Network",62560PA002,,PAN010,PAS005,PAF016,New,HMO,Silver,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Silver_62560PA0020034_Serv1N_Net23,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Silver_62560PA0020034_Serv1N_Net23,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020034-00,Standard Silver Off Exchange Plan,70.60%,0.706780254840851,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$400,$0,$200,"$1,900","$1,000",$0,$80,8
2015,PA,68711,HIOS,12,2015-02-12 14:27:33,1,68711,PA,Individual,Yes,59-0397210,68711PA0030001,DentaQuest EPO Pediatric High,68711PA003,,PAN002,PAS001,,New,EPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$36.74,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/,https://paydirect.dentaquest.com,http://www.dentaquest.com/marketplace/,,68711PA0030001-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,68711,HIOS,12,2015-02-12 14:27:33,1,68711,PA,SHOP (Small Group),Yes,59-0397210,68711PA0020003,DentaQuest EPO Family High,68711PA002,,PAN002,PAS001,,New,EPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.62,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/,,http://www.dentaquest.com/marketplace/,,68711PA0020003-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,68711,HIOS,12,2015-02-12 14:27:33,1,68711,PA,SHOP (Small Group),Yes,59-0397210,68711PA0020004,DentaQuest EPO Family Low,68711PA002,,PAN002,PAS001,,New,EPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.91,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/,,http://www.dentaquest.com/marketplace/,,68711PA0020004-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,68711,HIOS,12,2015-02-12 14:27:33,1,68711,PA,Individual,Yes,59-0397210,68711PA0030002,DentaQuest EPO Pediatric Low,68711PA003,,PAN002,PAS001,,New,EPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$25.23,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/,https://paydirect.dentaquest.com,http://www.dentaquest.com/marketplace/,,68711PA0030002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,68711,HIOS,12,2015-02-12 14:27:33,1,68711,PA,Individual,Yes,59-0397210,68711PA0030002,DentaQuest EPO Pediatric Low,68711PA003,,PAN002,PAS001,,New,EPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$25.23,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/,https://paydirect.dentaquest.com,http://www.dentaquest.com/marketplace/,,68711PA0030002-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,68711,HIOS,12,2015-02-12 14:27:33,1,68711,PA,SHOP (Small Group),Yes,59-0397210,68711PA0020004,DentaQuest EPO Family Low,68711PA002,,PAN002,PAS001,,New,EPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.91,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/,,http://www.dentaquest.com/marketplace/,,68711PA0020004-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,68711,HIOS,12,2015-02-12 14:27:33,2,68711,PA,Individual,Yes,59-0397210,68711PA0030003,DentaQuest EPO Family High,68711PA003,,PAN002,PAS001,,New,EPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.74,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/,https://paydirect.dentaquest.com,http://www.dentaquest.com/marketplace/,,68711PA0030003-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,68711,HIOS,12,2015-02-12 14:27:33,2,68711,PA,Individual,Yes,59-0397210,68711PA0030003,DentaQuest EPO Family High,68711PA003,,PAN002,PAS001,,New,EPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.74,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/,https://paydirect.dentaquest.com,http://www.dentaquest.com/marketplace/,,68711PA0030003-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,68711,HIOS,12,2015-02-12 14:27:33,2,68711,PA,Individual,Yes,59-0397210,68711PA0030004,DentaQuest EPO Family Low,68711PA003,,PAN002,PAS001,,New,EPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.23,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/,https://paydirect.dentaquest.com,http://www.dentaquest.com/marketplace/,,68711PA0030004-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,68711,HIOS,12,2015-02-12 14:27:33,2,68711,PA,Individual,Yes,59-0397210,68711PA0030004,DentaQuest EPO Family Low,68711PA003,,PAN002,PAS001,,New,EPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.23,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/,https://paydirect.dentaquest.com,http://www.dentaquest.com/marketplace/,,68711PA0030004-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,1,70194,PA,SHOP (Small Group),No,54-1637426,70194PA0200002,Comprehensive Care EPO $2000 70% A Community Blue Plan,70194PA020,,PAN001,PAS001,PAF006,Existing,EPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0200002-00,Standard Silver Off Exchange Plan,,0.683790028095245,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,1,70194,PA,Individual,No,54-1637426,70194PA0140001,Shared Cost Blue PPO 5500,70194PA014,,PAN001,PAS003,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0140001-00,Standard Bronze Off Exchange Plan,,0.61387699842453,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,1,70194,PA,Individual,No,54-1637426,70194PA0140001,Shared Cost Blue PPO 5500,70194PA014,,PAN001,PAS003,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0140001-01,Standard Bronze On Exchange Plan,,0.61387699842453,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,1,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020034,"UPMC Small Business Advantage Silver HMO $3,000 $10/$25 - Partner Network",62560PA002,,PAN010,PAS005,PAF016,New,HMO,Silver,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Silver_62560PA0020034_Serv1N_Net23,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Silver_62560PA0020034_Serv1N_Net23,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020034-01,Standard Silver On Exchange Plan,70.60%,0.706780254840851,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$400,$0,$200,"$1,900","$1,000",$0,$80,9
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,3,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020014,UPMC Small Business Advantage Platinum HMO $5/$35 - Partner Network,62560PA002,,PAN006,PAS001,PAF015,New,HMO,Platinum,No,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020014_Serv1_Net19,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020014_Serv1_Net19,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020014-00,Standard Platinum Off Exchange Plan,,0.88195812702179,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,000",$0,$200,$0,$700,$300,$80,6
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,2,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020011,"UPMC Small Business Advantage Gold HMO $1,000 $10/$25 - Partner Network",62560PA002,,PAN006,PAS001,PAF015,New,HMO,Gold,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020011_Serv1_Net19,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020011_Serv1_Net19,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020011-00,Standard Gold Off Exchange Plan,81.50%,0.832422196865082,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$400,$0,$200,"$1,000","$1,000",$0,$80,4
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,2,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020011,"UPMC Small Business Advantage Gold HMO $1,000 $10/$25 - Partner Network",62560PA002,,PAN006,PAS001,PAF015,New,HMO,Gold,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020011_Serv1_Net19,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020011_Serv1_Net19,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020011-01,Standard Gold On Exchange Plan,81.50%,0.832422196865082,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$400,$0,$200,"$1,000","$1,000",$0,$80,5
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,2,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020023,"UPMC Small Business Advantage Gold HMO $1,000 $10/$25 - Standard Network",62560PA002,,PAN008,PAS003,PAF015,New,HMO,Gold,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020023_Serv28_Net21,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020023_Serv28_Net21,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020023-00,Standard Gold Off Exchange Plan,81.50%,0.832422196865082,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$400,$0,$200,"$1,000","$1,000",$0,$80,6
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,2,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020023,"UPMC Small Business Advantage Gold HMO $1,000 $10/$25 - Standard Network",62560PA002,,PAN008,PAS003,PAF015,New,HMO,Gold,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020023_Serv28_Net21,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020023_Serv28_Net21,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020023-01,Standard Gold On Exchange Plan,81.50%,0.832422196865082,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$400,$0,$200,"$1,000","$1,000",$0,$80,7
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,3,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020014,UPMC Small Business Advantage Platinum HMO $5/$35 - Partner Network,62560PA002,,PAN006,PAS001,PAF015,New,HMO,Platinum,No,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020014_Serv1_Net19,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020014_Serv1_Net19,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020014-01,Standard Platinum On Exchange Plan,,0.88195812702179,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,000",$0,$200,$0,$700,$300,$80,7
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,3,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020015,UPMC Small Business Advantage Gold HMO $30/$50 - Partner Network,62560PA002,,PAN006,PAS001,PAF015,New,HMO,Gold,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020015_Serv1_Net19,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020015_Serv1_Net19,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020015-01,Standard Gold On Exchange Plan,81.50%,0.723928272724152,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$2,100",$0,$200,$0,"$1,100",$600,$80,9
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,3,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020024,UPMC Small Business Advantage Platinum HMO $20/$40 - Standard Network,62560PA002,,PAN008,PAS003,PAF015,New,HMO,Platinum,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020024_Serv28_Net21,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020024_Serv28_Net21,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020024-00,Standard Platinum Off Exchange Plan,88.20%,0.844815611839294,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,500",$0,$200,$0,$900,$600,$80,10
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,3,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020012,UPMC Small Business Advantage Platinum HMO $20/$40 - Partner Network,62560PA002,,PAN006,PAS001,PAF015,New,HMO,Platinum,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020012_Serv1_Net19,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020012_Serv1_Net19,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020012-01,Standard Platinum On Exchange Plan,88.20%,0.844815611839294,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,500",$0,$200,$0,$900,$600,$80,5
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,3,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020024,UPMC Small Business Advantage Platinum HMO $20/$40 - Standard Network,62560PA002,,PAN008,PAS003,PAF015,New,HMO,Platinum,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020024_Serv28_Net21,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020024_Serv28_Net21,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020024-01,Standard Platinum On Exchange Plan,88.20%,0.844815611839294,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,500",$0,$200,$0,$900,$600,$80,11
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,3,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020026,UPMC Small Business Advantage Platinum HMO $5/$35 - Standard Network,62560PA002,,PAN008,PAS003,PAF015,New,HMO,Platinum,No,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020026_Serv28_Net21,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020026_Serv28_Net21,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020026-00,Standard Platinum Off Exchange Plan,,0.88195812702179,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,000",$0,$200,$0,$700,$300,$80,12
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,3,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020026,UPMC Small Business Advantage Platinum HMO $5/$35 - Standard Network,62560PA002,,PAN008,PAS003,PAF015,New,HMO,Platinum,No,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020026_Serv28_Net21,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020026_Serv28_Net21,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020026-01,Standard Platinum On Exchange Plan,,0.88195812702179,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,000",$0,$200,$0,$700,$300,$80,13
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,3,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020027,UPMC Small Business Advantage Gold HMO $30/$50 - Standard Network,62560PA002,,PAN008,PAS003,PAF015,New,HMO,Gold,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020027_Serv28_Net21,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020027_Serv28_Net21,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020027-00,Standard Gold Off Exchange Plan,81.50%,0.723928272724152,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$2,100",$0,$200,$0,"$1,100",$600,$80,14
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,3,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020027,UPMC Small Business Advantage Gold HMO $30/$50 - Standard Network,62560PA002,,PAN008,PAS003,PAF015,New,HMO,Gold,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020027_Serv28_Net21,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020027_Serv28_Net21,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020027-01,Standard Gold On Exchange Plan,81.50%,0.723928272724152,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$2,100",$0,$200,$0,"$1,100",$600,$80,15
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,3,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020036,UPMC Small Business Advantage Platinum HMO $20/$40 - Partner Network,62560PA002,,PAN010,PAS005,PAF015,New,HMO,Platinum,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020036_Serv1N_Net23,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020036_Serv1N_Net23,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020036-00,Standard Platinum Off Exchange Plan,88.20%,0.844815611839294,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,500",$0,$200,$0,$900,$600,$80,16
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,3,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020036,UPMC Small Business Advantage Platinum HMO $20/$40 - Partner Network,62560PA002,,PAN010,PAS005,PAF015,New,HMO,Platinum,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020036_Serv1N_Net23,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020036_Serv1N_Net23,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020036-01,Standard Platinum On Exchange Plan,88.20%,0.844815611839294,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,500",$0,$200,$0,$900,$600,$80,17
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,3,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020038,UPMC Small Business Advantage Platinum HMO $5/$35 - Partner Network,62560PA002,,PAN010,PAS005,PAF015,New,HMO,Platinum,No,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020038_Serv1N_Net23,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020038_Serv1N_Net23,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020038-00,Standard Platinum Off Exchange Plan,,0.88195812702179,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,000",$0,$200,$0,$700,$300,$80,18
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,3,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020038,UPMC Small Business Advantage Platinum HMO $5/$35 - Partner Network,62560PA002,,PAN010,PAS005,PAF015,New,HMO,Platinum,No,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020038_Serv1N_Net23,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Platinum_62560PA0020038_Serv1N_Net23,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020038-01,Standard Platinum On Exchange Plan,,0.88195812702179,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,000",$0,$200,$0,$700,$300,$80,19
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,3,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020039,UPMC Small Business Advantage Gold HMO $30/$50 - Partner Network,62560PA002,,PAN010,PAS005,PAF015,New,HMO,Gold,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020039_Serv1N_Net23,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020039_Serv1N_Net23,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020039-00,Standard Gold Off Exchange Plan,81.50%,0.723928272724152,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$2,100",$0,$200,$0,"$1,100",$600,$80,20
2015,PA,62560,HIOS,7,2014-12-12 09:23:47,3,62560,PA,SHOP (Small Group),No,46-2824537,62560PA0020039,UPMC Small Business Advantage Gold HMO $30/$50 - Partner Network,62560PA002,,PAN010,PAS005,PAF015,New,HMO,Gold,Yes,Both,No,Yes,"A PCP is required for specialists and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Dental Services and Emergency Medical Services Only,No,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020039_Serv1N_Net23,https://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_HMO_Gold_62560PA0020039_Serv1N_Net23,http://www.upmchealthplan.com/marketplace/2015_rxlist.aspx,62560PA0020039-01,Standard Gold On Exchange Plan,81.50%,0.723928272724152,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$2,100",$0,$200,$0,"$1,100",$600,$80,21
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,11,64844,PA,Individual,No,23-2169745,64844PA0050017,Aetna Silver $5 Copay 2500 HMO Savings Plus,64844PA005,,PAN002,PAS002,PAF008,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050017-05,87% AV Level Silver Plan,86.40%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,"$1,500","$3,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,11,64844,PA,Individual,No,23-2169745,64844PA0050017,Aetna Silver $5 Copay 2500 HMO Savings Plus,64844PA005,,PAN002,PAS002,PAF008,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050017-06,94% AV Level Silver Plan,93.20%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,17,64844,PA,Individual,No,23-2169745,64844PA0050014,Aetna Gold $5 Copay HMO,64844PA005,,PAN001,PAS001,PAF005,Existing,HMO,Gold,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050014-00,Standard Gold Off Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,17,64844,PA,Individual,No,23-2169745,64844PA0050014,Aetna Gold $5 Copay HMO,64844PA005,,PAN001,PAS001,PAF005,Existing,HMO,Gold,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050014-01,Standard Gold On Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,17,64844,PA,Individual,No,23-2169745,64844PA0050014,Aetna Gold $5 Copay HMO,64844PA005,,PAN001,PAS001,PAF005,Existing,HMO,Gold,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050014-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,9,64844,PA,Individual,No,23-2169745,64844PA0050016,Aetna Silver $10 Copay HMO Savings Plus,64844PA005,,PAN002,PAS002,PAF007,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050016-05,87% AV Level Silver Plan,86.50%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,"$1,500","$3,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,9,64844,PA,Individual,No,23-2169745,64844PA0050016,Aetna Silver $10 Copay HMO Savings Plus,64844PA005,,PAN002,PAS002,PAF007,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050016-06,94% AV Level Silver Plan,93.20%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,$0,$0,20%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,Not Applicable,Not Applicable,20%,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,11,64844,PA,Individual,No,23-2169745,64844PA0050017,Aetna Silver $5 Copay 2500 HMO Savings Plus,64844PA005,,PAN002,PAS002,PAF008,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050017-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$5,500","$11,000","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$5,750","$11,500",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,11,64844,PA,Individual,No,23-2169745,64844PA0050017,Aetna Silver $5 Copay 2500 HMO Savings Plus,64844PA005,,PAN002,PAS002,PAF008,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050017-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$5,500","$11,000","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$5,750","$11,500",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,11,64844,PA,Individual,No,23-2169745,64844PA0050017,Aetna Silver $5 Copay 2500 HMO Savings Plus,64844PA005,,PAN002,PAS002,PAF008,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050017-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,11,64844,PA,Individual,No,23-2169745,64844PA0050017,Aetna Silver $5 Copay 2500 HMO Savings Plus,64844PA005,,PAN002,PAS002,PAF008,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050017-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$5,500","$11,000","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$5,750","$11,500",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,11,64844,PA,Individual,No,23-2169745,64844PA0050017,Aetna Silver $5 Copay 2500 HMO Savings Plus,64844PA005,,PAN002,PAS002,PAF008,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050017-04,73% AV Level Silver Plan,72.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$4,500","$9,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,2,70194,PA,Individual,No,54-1637426,70194PA0160001,Comprehensive Care Blue PPO 1500,70194PA016,,PAN001,PAS003,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0160001-06,94% AV Level Silver Plan,,0.940365195274353,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,$100,$200,10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,2,70194,PA,SHOP (Small Group),No,54-1637426,70194PA0210004,Flex EPO $1650 80%/70% a Community Blue Plan,70194PA021,,PAN002,PAS005,PAF006,Existing,EPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0210004-00,Standard Silver Off Exchange Plan,,0.690674722194672,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",20%,"$1,650","$3,300",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,1,64844,PA,Individual,No,23-2169745,64844PA0050010,Aetna Bronze $15 Copay HMO Savings Plus,64844PA005,,PAN002,PAS002,PAF001,New,HMO,Bronze,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050010-00,Standard Bronze Off Exchange Plan,60.70%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,1,64844,PA,Individual,No,23-2169745,64844PA0050010,Aetna Bronze $15 Copay HMO Savings Plus,64844PA005,,PAN002,PAS002,PAF001,New,HMO,Bronze,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050010-01,Standard Bronze On Exchange Plan,60.70%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,1,64844,PA,Individual,No,23-2169745,64844PA0050010,Aetna Bronze $15 Copay HMO Savings Plus,64844PA005,,PAN002,PAS002,PAF001,New,HMO,Bronze,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050010-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,1,64844,PA,Individual,No,23-2169745,64844PA0050010,Aetna Bronze $15 Copay HMO Savings Plus,64844PA005,,PAN002,PAS002,PAF001,New,HMO,Bronze,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050010-03,Limited Cost Sharing Plan Variation,60.70%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,3,64844,PA,Individual,No,23-2169745,64844PA0050011,Aetna Bronze $20 Copay HMO,64844PA005,,PAN001,PAS001,PAF002,Existing,HMO,Bronze,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050011-00,Standard Bronze Off Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,3,64844,PA,Individual,No,23-2169745,64844PA0050011,Aetna Bronze $20 Copay HMO,64844PA005,,PAN001,PAS001,PAF002,Existing,HMO,Bronze,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050011-01,Standard Bronze On Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,3,64844,PA,Individual,No,23-2169745,64844PA0050011,Aetna Bronze $20 Copay HMO,64844PA005,,PAN001,PAS001,PAF002,Existing,HMO,Bronze,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050011-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,3,64844,PA,Individual,No,23-2169745,64844PA0050011,Aetna Bronze $20 Copay HMO,64844PA005,,PAN001,PAS001,PAF002,Existing,HMO,Bronze,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050011-03,Limited Cost Sharing Plan Variation,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,5,64844,PA,Individual,No,23-2169745,64844PA0050012,Aetna Bronze Deductible Only HSA Eligible HMO,64844PA005,,PAN001,PAS001,PAF003,Existing,HMO,Bronze,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050012-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,5,64844,PA,Individual,No,23-2169745,64844PA0050012,Aetna Bronze Deductible Only HSA Eligible HMO,64844PA005,,PAN001,PAS001,PAF003,Existing,HMO,Bronze,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050012-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,5,64844,PA,Individual,No,23-2169745,64844PA0050012,Aetna Bronze Deductible Only HSA Eligible HMO,64844PA005,,PAN001,PAS001,PAF003,Existing,HMO,Bronze,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050012-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,5,64844,PA,Individual,No,23-2169745,64844PA0050012,Aetna Bronze Deductible Only HSA Eligible HMO,64844PA005,,PAN001,PAS001,PAF003,Existing,HMO,Bronze,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050012-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,7,64844,PA,Individual,No,23-2169745,64844PA0050015,Aetna Silver $10 Copay HMO,64844PA005,,PAN001,PAS001,PAF006,Existing,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050015-00,Standard Silver Off Exchange Plan,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,$500,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,7,64844,PA,Individual,No,23-2169745,64844PA0050015,Aetna Silver $10 Copay HMO,64844PA005,,PAN001,PAS001,PAF006,Existing,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050015-01,Standard Silver On Exchange Plan,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,$500,$0,,,,,,,,,,,,,,,,,,,5
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,7,64844,PA,Individual,No,23-2169745,64844PA0050015,Aetna Silver $10 Copay HMO,64844PA005,,PAN001,PAS001,PAF006,Existing,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050015-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,7,64844,PA,Individual,No,23-2169745,64844PA0050015,Aetna Silver $10 Copay HMO,64844PA005,,PAN001,PAS001,PAF006,Existing,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050015-03,Limited Cost Sharing Plan Variation,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,$500,$0,,,,,,,,,,,,,,,,,,,7
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,7,64844,PA,Individual,No,23-2169745,64844PA0050015,Aetna Silver $10 Copay HMO,64844PA005,,PAN001,PAS001,PAF006,Existing,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050015-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,$500,$0,,,,,,,,,,,,,,,,,,,8
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,7,64844,PA,Individual,No,23-2169745,64844PA0050015,Aetna Silver $10 Copay HMO,64844PA005,,PAN001,PAS001,PAF006,Existing,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050015-05,87% AV Level Silver Plan,86.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,7,64844,PA,Individual,No,23-2169745,64844PA0050015,Aetna Silver $10 Copay HMO,64844PA005,,PAN001,PAS001,PAF006,Existing,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050015-06,94% AV Level Silver Plan,93.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,9,64844,PA,Individual,No,23-2169745,64844PA0050016,Aetna Silver $10 Copay HMO Savings Plus,64844PA005,,PAN002,PAS002,PAF007,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050016-00,Standard Silver Off Exchange Plan,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,9,64844,PA,Individual,No,23-2169745,64844PA0050016,Aetna Silver $10 Copay HMO Savings Plus,64844PA005,,PAN002,PAS002,PAF007,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050016-01,Standard Silver On Exchange Plan,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,9,64844,PA,Individual,No,23-2169745,64844PA0050016,Aetna Silver $10 Copay HMO Savings Plus,64844PA005,,PAN002,PAS002,PAF007,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050016-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,9,64844,PA,Individual,No,23-2169745,64844PA0050016,Aetna Silver $10 Copay HMO Savings Plus,64844PA005,,PAN002,PAS002,PAF007,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050016-03,Limited Cost Sharing Plan Variation,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,9,64844,PA,Individual,No,23-2169745,64844PA0050016,Aetna Silver $10 Copay HMO Savings Plus,64844PA005,,PAN002,PAS002,PAF007,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050016-04,73% AV Level Silver Plan,72.30%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$5,000","$10,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,2,70194,PA,Individual,No,54-1637426,70194PA0160001,Comprehensive Care Blue PPO 1500,70194PA016,,PAN001,PAS003,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0160001-00,Standard Silver Off Exchange Plan,,0.690294206142426,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,2,70194,PA,SHOP (Small Group),No,54-1637426,70194PA0210001,Flex EPO $500/$1000 80%/70% a Community Blue Plan,70194PA021,,PAN002,PAS004,PAF006,Existing,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0210001-00,Standard Gold Off Exchange Plan,81.99%,0.82002991437912,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$2,200","$4,400","$4,150","$8,300",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,"$1,000","$2,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,13,64844,PA,Individual,No,23-2169745,64844PA0050018,Aetna Silver $5 Copay 2750 HMO,64844PA005,,PAN001,PAS001,PAF009,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050018-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,13,64844,PA,Individual,No,23-2169745,64844PA0050018,Aetna Silver $5 Copay 2750 HMO,64844PA005,,PAN001,PAS001,PAF009,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050018-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,13,64844,PA,Individual,No,23-2169745,64844PA0050018,Aetna Silver $5 Copay 2750 HMO,64844PA005,,PAN001,PAS001,PAF009,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050018-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,13,64844,PA,Individual,No,23-2169745,64844PA0050018,Aetna Silver $5 Copay 2750 HMO,64844PA005,,PAN001,PAS001,PAF009,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050018-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,13,64844,PA,Individual,No,23-2169745,64844PA0050018,Aetna Silver $5 Copay 2750 HMO,64844PA005,,PAN001,PAS001,PAF009,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050018-04,73% AV Level Silver Plan,72.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,13,64844,PA,Individual,No,23-2169745,64844PA0050018,Aetna Silver $5 Copay 2750 HMO,64844PA005,,PAN001,PAS001,PAF009,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050018-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,13,64844,PA,Individual,No,23-2169745,64844PA0050018,Aetna Silver $5 Copay 2750 HMO,64844PA005,,PAN001,PAS001,PAF009,New,HMO,Silver,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050018-06,94% AV Level Silver Plan,93.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,15,64844,PA,Individual,No,23-2169745,64844PA0050013,Aetna Gold $0 Copay HMO Savings Plus,64844PA005,,PAN002,PAS002,PAF004,New,HMO,Gold,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050013-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,15,64844,PA,Individual,No,23-2169745,64844PA0050013,Aetna Gold $0 Copay HMO Savings Plus,64844PA005,,PAN002,PAS002,PAF004,New,HMO,Gold,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050013-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,15,64844,PA,Individual,No,23-2169745,64844PA0050013,Aetna Gold $0 Copay HMO Savings Plus,64844PA005,,PAN002,PAS002,PAF004,New,HMO,Gold,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050013-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,15,64844,PA,Individual,No,23-2169745,64844PA0050013,Aetna Gold $0 Copay HMO Savings Plus,64844PA005,,PAN002,PAS002,PAF004,New,HMO,Gold,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050013-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,64844,HIOS,7,2014-09-06 03:39:47,17,64844,PA,Individual,No,23-2169745,64844PA0050014,Aetna Gold $5 Copay HMO,64844PA005,,PAN001,PAS001,PAF005,Existing,HMO,Gold,Yes,Both,No,Yes,"Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998538501173655,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/pennsylvania-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1620794006,64844PA0050014-03,Limited Cost Sharing Plan Variation,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,67430,HIOS,6,2014-11-09 04:38:15,1,67430,PA,SHOP (Small Group),Yes,25-1844144,67430PA0040001,UPMC Dental Advantage Basic Plan,67430PA004,,PAN001,PAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$0.00,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is through contracted wrap network.,Yes,,http://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_DAP_Basic_67430PA0040001_Serv29_Net36,,67430PA0040001-00,Standard Low Off Exchange Plan,69.20%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,67430,HIOS,6,2014-11-09 04:38:15,1,67430,PA,SHOP (Small Group),Yes,25-1844144,67430PA0040001,UPMC Dental Advantage Basic Plan,67430PA004,,PAN001,PAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$0.00,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is through contracted wrap network.,Yes,,http://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_DAP_Basic_67430PA0040001_Serv29_Net36,,67430PA0040001-01,Standard Low On Exchange Plan,69.20%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,67430,HIOS,6,2014-11-09 04:38:15,2,67430,PA,SHOP (Small Group),Yes,25-1844144,67430PA0040002,UPMC Dental Advantage Standard Plan,67430PA004,,PAN001,PAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$0.00,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is through contracted wrap network.,Yes,,http://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_DAP_Standard_67430PA0040002_Serv29_Net36,,67430PA0040002-00,Standard Low Off Exchange Plan,69.20%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,67430,HIOS,6,2014-11-09 04:38:15,2,67430,PA,SHOP (Small Group),Yes,25-1844144,67430PA0040002,UPMC Dental Advantage Standard Plan,67430PA004,,PAN001,PAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$0.00,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is through contracted wrap network.,Yes,,http://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_DAP_Standard_67430PA0040002_Serv29_Net36,,67430PA0040002-01,Standard Low On Exchange Plan,69.20%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,67430,HIOS,6,2014-11-09 04:38:15,2,67430,PA,SHOP (Small Group),Yes,25-1844144,67430PA0040003,UPMC Dental Advantage Premium Plan,67430PA004,,PAN001,PAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$0.00,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is through contracted wrap network.,Yes,,http://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_DAP_Premium_67430PA0040003_Serv29_Net36,,67430PA0040003-00,Standard Low Off Exchange Plan,69.20%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,67430,HIOS,6,2014-11-09 04:38:15,2,67430,PA,SHOP (Small Group),Yes,25-1844144,67430PA0040003,UPMC Dental Advantage Premium Plan,67430PA004,,PAN001,PAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$0.00,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is through contracted wrap network.,Yes,,http://www.upmchealthplan.com/marketplace/pay.aspx,http://www.upmchealthplan.com/marketplace/details.aspx?plan=2015_SHOP_DAP_Premium_67430PA0040003_Serv29_Net36,,67430PA0040003-01,Standard Low On Exchange Plan,69.20%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,67499,HIOS,14,2015-01-16 17:32:32,1,67499,PA,Individual,Yes,39-1263473,67499PA0010001,Humana Dental Smart Choice,67499PA001,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.60,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541357,,67499PA0010001-00,Standard Low Off Exchange Plan,72.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,67499,HIOS,14,2015-01-16 17:32:32,1,67499,PA,Individual,Yes,39-1263473,67499PA0010001,Humana Dental Smart Choice,67499PA001,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.60,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541357,,67499PA0010001-01,Standard Low On Exchange Plan,72.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,68711,HIOS,12,2015-02-12 14:27:33,1,68711,PA,SHOP (Small Group),Yes,59-0397210,68711PA0020003,DentaQuest EPO Family High,68711PA002,,PAN002,PAS001,,New,EPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.62,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/,,http://www.dentaquest.com/marketplace/,,68711PA0020003-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,68711,HIOS,12,2015-02-12 14:27:33,1,68711,PA,Individual,Yes,59-0397210,68711PA0030001,DentaQuest EPO Pediatric High,68711PA003,,PAN002,PAS001,,New,EPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$36.74,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/,https://paydirect.dentaquest.com,http://www.dentaquest.com/marketplace/,,68711PA0030001-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,1,70194,PA,SHOP (Small Group),No,54-1637426,70194PA0200002,Comprehensive Care EPO $2000 70% A Community Blue Plan,70194PA020,,PAN001,PAS001,PAF006,Existing,EPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0200002-01,Standard Silver On Exchange Plan,,0.683790028095245,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,1,70194,PA,SHOP (Small Group),No,54-1637426,70194PA0200004,Comprehensive Care EPO $2000 70% A Community Blue Plan,70194PA020,,PAN001,PAS002,PAF006,Existing,EPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0200004-00,Standard Silver Off Exchange Plan,,0.683790028095245,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,1,70194,PA,Individual,No,54-1637426,70194PA0140001,Shared Cost Blue PPO 5500,70194PA014,,PAN001,PAS003,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0140001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,1,70194,PA,Individual,No,54-1637426,70194PA0140001,Shared Cost Blue PPO 5500,70194PA014,,PAN001,PAS003,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0140001-03,Limited Cost Sharing Plan Variation,,0.61387699842453,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,1,70194,PA,SHOP (Small Group),No,54-1637426,70194PA0200004,Comprehensive Care EPO $2000 70% A Community Blue Plan,70194PA020,,PAN001,PAS002,PAF006,Existing,EPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0200004-01,Standard Silver On Exchange Plan,,0.683790028095245,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,1,70194,PA,Individual,No,54-1637426,70194PA0170001,Shared Cost Blue PPO 5500,70194PA017,,PAN002,PAS006,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0170001-00,Standard Bronze Off Exchange Plan,,0.61387699842453,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,1,70194,PA,Individual,No,54-1637426,70194PA0170001,Shared Cost Blue PPO 5500,70194PA017,,PAN002,PAS006,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0170001-01,Standard Bronze On Exchange Plan,,0.61387699842453,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,1,70194,PA,Individual,No,54-1637426,70194PA0170001,Shared Cost Blue PPO 5500,70194PA017,,PAN002,PAS006,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0170001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,1,70194,PA,Individual,No,54-1637426,70194PA0170001,Shared Cost Blue PPO 5500,70194PA017,,PAN002,PAS006,PAF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0170001-03,Limited Cost Sharing Plan Variation,,0.61387699842453,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,2,70194,PA,SHOP (Small Group),No,54-1637426,70194PA0210001,Flex EPO $500/$1000 80%/70% a Community Blue Plan,70194PA021,,PAN002,PAS004,PAF006,Existing,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0210001-01,Standard Gold On Exchange Plan,81.99%,0.82002991437912,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$2,200","$4,400","$4,150","$8,300",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,"$1,000","$2,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,2,70194,PA,Individual,No,54-1637426,70194PA0160001,Comprehensive Care Blue PPO 1500,70194PA016,,PAN001,PAS003,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0160001-01,Standard Silver On Exchange Plan,,0.690294206142426,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,Individual,No,54-1637426,70194PA0140003,Shared Cost Blue PPO 3200,70194PA014,,PAN001,PAS003,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0140003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,Individual,No,54-1637426,70194PA0140003,Shared Cost Blue PPO 3200,70194PA014,,PAN001,PAS003,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0140003-03,Limited Cost Sharing Plan Variation,,0.691314995288849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,200","$6,400",20%,,,,"$6,400","$12,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,2,82110,PA,SHOP (Small Group),Yes,23-1667011,82110PA0020004,Delta Dental PPO Preferred Plan for Families for Small Businesses,82110PA002,,PAN001,PAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$15.32,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/pa/82110pa0020004-15,,82110PA0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,2,82110,PA,Individual,Yes,23-1667011,82110PA0010004,Delta Dental PPO Preferred Plan for Families,82110PA001,,PAN001,PAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.11,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/pa/82110pa0010004-15,,82110PA0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,3,82110,PA,Individual,Yes,23-1667011,82110PA0010006,Delta Dental PPO Basic Plan for Families,82110PA001,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$12.96,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/pa/82110pa0010006-15,,82110PA0010006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,3,82110,PA,SHOP (Small Group),Yes,23-1667011,82110PA0020006,Delta Dental PPO Basic Plan for Families for Small Businesses,82110PA002,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$12.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/pa/82110pa0020006-15,,82110PA0020006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,3,82110,PA,SHOP (Small Group),Yes,23-1667011,82110PA0020006,Delta Dental PPO Basic Plan for Families for Small Businesses,82110PA002,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$12.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/pa/82110pa0020006-15,,82110PA0020006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,3,82110,PA,Individual,Yes,23-1667011,82110PA0010006,Delta Dental PPO Basic Plan for Families,82110PA001,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$12.96,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/pa/82110pa0010006-15,,82110PA0010006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,4,82110,PA,Individual,Yes,23-1667011,82110PA0030002,DeltaCare USA Pediatric Preferred Plan,82110PA003,,PAN002,PAS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Child-Only,,,,$18.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/pa/82110pa0030002-15,,82110PA0030002-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,4,82110,PA,SHOP (Small Group),Yes,23-1667011,82110PA0040002,DeltaCare USA Pediatric Preferred Plan for Small Businesses,82110PA004,,PAN002,PAS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,,deltadentalins.com/hcx/pa/82110pa0040002-15,,82110PA0040002-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,4,82110,PA,SHOP (Small Group),Yes,23-1667011,82110PA0040002,DeltaCare USA Pediatric Preferred Plan for Small Businesses,82110PA004,,PAN002,PAS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,,deltadentalins.com/hcx/pa/82110pa0040002-15,,82110PA0040002-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,4,82110,PA,Individual,Yes,23-1667011,82110PA0030002,DeltaCare USA Pediatric Preferred Plan,82110PA003,,PAN002,PAS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Child-Only,,,,$18.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/pa/82110pa0030002-15,,82110PA0030002-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,4,82110,PA,Individual,Yes,23-1667011,82110PA0030001,DeltaCare USA Pediatric Basic Plan,82110PA003,,PAN002,PAS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$16.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/pa/82110pa0030001-15,,82110PA0030001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,4,82110,PA,SHOP (Small Group),Yes,23-1667011,82110PA0040001,DeltaCare USA Pediatric Basic Plan for Small Businesses,82110PA004,,PAN002,PAS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,,deltadentalins.com/hcx/pa/82110pa0040001-15,,82110PA0040001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,4,82110,PA,SHOP (Small Group),Yes,23-1667011,82110PA0040001,DeltaCare USA Pediatric Basic Plan for Small Businesses,82110PA004,,PAN002,PAS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,,deltadentalins.com/hcx/pa/82110pa0040001-15,,82110PA0040001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,4,82110,PA,Individual,Yes,23-1667011,82110PA0030001,DeltaCare USA Pediatric Basic Plan,82110PA003,,PAN002,PAS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$16.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/pa/82110pa0030001-15,,82110PA0030001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,5,82110,PA,Individual,Yes,23-1667011,82110PA0030004,DeltaCare USA Preferred Plan for Families,82110PA003,,PAN002,PAS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.99,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/pa/82110pa0030004-15,,82110PA0030004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,5,82110,PA,SHOP (Small Group),Yes,23-1667011,82110PA0040004,DeltaCare USA Preferred Plan for Families for Small Businesses,82110PA004,,PAN002,PAS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,,deltadentalins.com/hcx/pa/82110pa0040004-15,,82110PA0040004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,5,82110,PA,SHOP (Small Group),Yes,23-1667011,82110PA0040004,DeltaCare USA Preferred Plan for Families for Small Businesses,82110PA004,,PAN002,PAS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,,deltadentalins.com/hcx/pa/82110pa0040004-15,,82110PA0040004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,5,82110,PA,Individual,Yes,23-1667011,82110PA0030004,DeltaCare USA Preferred Plan for Families,82110PA003,,PAN002,PAS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.99,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/pa/82110pa0030004-15,,82110PA0030004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,2,70194,PA,Individual,No,54-1637426,70194PA0160001,Comprehensive Care Blue PPO 1500,70194PA016,,PAN001,PAS003,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0160001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,2,70194,PA,SHOP (Small Group),No,54-1637426,70194PA0210003,Flex EPO $500/$1000 80%/70% a Community Blue Plan,70194PA021,,PAN002,PAS005,PAF006,Existing,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0210003-00,Standard Gold Off Exchange Plan,81.99%,0.82002991437912,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$2,200","$4,400","$4,150","$8,300",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,"$1,000","$2,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,2,70194,PA,SHOP (Small Group),No,54-1637426,70194PA0210003,Flex EPO $500/$1000 80%/70% a Community Blue Plan,70194PA021,,PAN002,PAS005,PAF006,Existing,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0210003-01,Standard Gold On Exchange Plan,81.99%,0.82002991437912,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$2,200","$4,400","$4,150","$8,300",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,"$1,000","$2,000",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,2,70194,PA,Individual,No,54-1637426,70194PA0160001,Comprehensive Care Blue PPO 1500,70194PA016,,PAN001,PAS003,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0160001-03,Limited Cost Sharing Plan Variation,,0.690294206142426,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,Individual,No,54-1637426,70194PA0170005,Shared Cost Blue PPO 1500,70194PA017,,PAN002,PAS006,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0170005-01,Standard Gold On Exchange Plan,,0.783825159072876,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,Individual,No,54-1637426,70194PA0170005,Shared Cost Blue PPO 1500,70194PA017,,PAN002,PAS006,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0170005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,Individual,No,54-1637426,70194PA0170005,Shared Cost Blue PPO 1500,70194PA017,,PAN002,PAS006,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0170005-03,Limited Cost Sharing Plan Variation,,0.783825159072876,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,Individual,No,54-1637426,70194PA0170003,Shared Cost Blue PPO 3200,70194PA017,,PAN002,PAS006,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0170003-00,Standard Silver Off Exchange Plan,,0.691314995288849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,200","$6,400",20%,,,,"$6,400","$12,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,19
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,1,71933,PA,SHOP (Small Group),Yes,95-6042390,71933PA0010001,BEST Life Child Dental Plus,71933PA001,,PAN001,PAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$32.83,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BEST_Life_Child_Dental_Plus_Plan.pdf,,71933PA0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,2,71933,PA,SHOP (Small Group),Yes,95-6042390,71933PA0010002,BEST Life Child Dental,71933PA001,,PAN001,PAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.41,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BEST_Life_Child_Dental_Plan.pdf,,71933PA0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,2,71933,PA,Individual,Yes,95-6042390,71933PA0020002,BESTOne Child Dental,71933PA002,,PAN001,PAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$31.76,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BESTOne_Child_Dental_Plan.pdf,,71933PA0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,3,71933,PA,Individual,Yes,95-6042390,71933PA0020003,BESTOne Dental Advantage-Gold,71933PA002,,PAN001,PAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$41.03,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BESTOne_Dental_Advantage-Gold_Plan.pdf,,71933PA0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,3,71933,PA,SHOP (Small Group),Yes,95-6042390,71933PA0010037,BEST Dental Premium,71933PA001,,PAN001,PAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.83,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BESTDental_Premium_Plan.pdf,,71933PA0010037-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,3,71933,PA,SHOP (Small Group),Yes,95-6042390,71933PA0010037,BEST Dental Premium,71933PA001,,PAN001,PAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.83,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BESTDental_Premium_Plan.pdf,,71933PA0010037-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,3,71933,PA,Individual,Yes,95-6042390,71933PA0020003,BESTOne Dental Advantage-Gold,71933PA002,,PAN001,PAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$41.03,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BESTOne_Dental_Advantage-Gold_Plan.pdf,,71933PA0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,3,71933,PA,Individual,Yes,95-6042390,71933PA0020004,BESTOne Dental Plus-Gold,71933PA002,,PAN001,PAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$41.03,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BESTOne_Dental_Plus-Gold_Plan.pdf,,71933PA0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,3,71933,PA,SHOP (Small Group),Yes,95-6042390,71933PA0010038,BEST Dental Standard-H,71933PA001,,PAN001,PAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.83,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BESTDental_Standard-H_Plan.pdf,,71933PA0010038-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,3,71933,PA,SHOP (Small Group),Yes,95-6042390,71933PA0010038,BEST Dental Standard-H,71933PA001,,PAN001,PAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.83,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BESTDental_Standard-H_Plan.pdf,,71933PA0010038-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,3,71933,PA,Individual,Yes,95-6042390,71933PA0020004,BESTOne Dental Plus-Gold,71933PA002,,PAN001,PAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$41.03,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BESTOne_Dental_Plus-Gold_Plan.pdf,,71933PA0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,3,71933,PA,SHOP (Small Group),Yes,95-6042390,71933PA0010040,BEST Dental Choice-H,71933PA001,,PAN001,PAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.83,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BESTDental_Choice-H_Plan.pdf,,71933PA0010040-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,4,71933,PA,Individual,Yes,95-6042390,71933PA0020005,BESTOne Dental Plus-Silver,71933PA002,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.76,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BESTOne_Dental_Plus-Silver_Plan.pdf,,71933PA0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,4,71933,PA,SHOP (Small Group),Yes,95-6042390,71933PA0010039,BEST Dental Standard-L,71933PA001,,PAN001,PAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.41,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BESTDental_Standard-L_Plan.pdf,,71933PA0010039-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,4,71933,PA,SHOP (Small Group),Yes,95-6042390,71933PA0010041,BEST Dental Choice-L,71933PA001,,PAN001,PAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.41,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BESTDental_Choice-L_Plan.pdf,,71933PA0010041-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,2,70194,PA,Individual,No,54-1637426,70194PA0160001,Comprehensive Care Blue PPO 1500,70194PA016,,PAN001,PAS003,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0160001-04,73% AV Level Silver Plan,,0.733900666236877,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,2,70194,PA,SHOP (Small Group),No,54-1637426,70194PA0210002,Flex EPO $1650 80%/70% a Community Blue Plan,70194PA021,,PAN002,PAS004,PAF006,Existing,EPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0210002-00,Standard Silver Off Exchange Plan,,0.690674722194672,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",20%,"$1,650","$3,300",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,2,70194,PA,SHOP (Small Group),No,54-1637426,70194PA0210002,Flex EPO $1650 80%/70% a Community Blue Plan,70194PA021,,PAN002,PAS004,PAF006,Existing,EPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0210002-01,Standard Silver On Exchange Plan,,0.690674722194672,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",20%,"$1,650","$3,300",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,2,70194,PA,Individual,No,54-1637426,70194PA0160001,Comprehensive Care Blue PPO 1500,70194PA016,,PAN001,PAS003,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0160001-05,87% AV Level Silver Plan,,0.878387570381165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,7,91303,PA,Individual,No,25-1264318,91303PA0020006,Coventry Silver $5 Copay 2750 HMO,91303PA002,,PAN001,PAS001,PAF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51001,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020006-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,7,91303,PA,Individual,No,25-1264318,91303PA0020006,Coventry Silver $5 Copay 2750 HMO,91303PA002,,PAN001,PAS001,PAF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51001,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,98060,HIOS,3,2014-08-28 04:23:13,3,98060,PA,SHOP (Small Group),Yes,13-5581829,98060PA0190001,Family Basic Dental Plan (Low),98060PA019,,PAN003,PAS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$21.10,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49122,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49121,,98060PA0190001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,5,26065,SC,Individual,No,57-0287419,26065SC0380004,BlueEssentials Silver 3,26065SC038,,SCN001,SCS001,SCF004,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380004-03,Limited Cost Sharing Plan Variation,,0.70070868730545,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$9,850",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$5,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,5,26065,SC,Individual,No,57-0287419,26065SC0380004,BlueEssentials Silver 3,26065SC038,,SCN001,SCS001,SCF004,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380004-04,73% AV Level Silver Plan,,0.721383571624756,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$9,850",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,600","$3,050",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,5,26065,SC,Individual,No,57-0287419,26065SC0380004,BlueEssentials Silver 3,26065SC038,,SCN001,SCS001,SCF004,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380004-05,87% AV Level Silver Plan,,0.869142651557922,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,5,26065,SC,Individual,No,57-0287419,26065SC0380004,BlueEssentials Silver 3,26065SC038,,SCN001,SCS001,SCF004,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380004-06,94% AV Level Silver Plan,,0.930735349655151,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$3,250",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,6,26065,SC,Individual,No,57-0287419,26065SC0380005,BlueEssentials Bronze 1,26065SC038,,SCN001,SCS001,SCF005,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,4,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380005-00,Standard Bronze Off Exchange Plan,,0.613533794879913,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$9,050",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,6,26065,SC,Individual,No,57-0287419,26065SC0380005,BlueEssentials Bronze 1,26065SC038,,SCN001,SCS001,SCF005,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,4,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380005-01,Standard Bronze On Exchange Plan,,0.613533794879913,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$9,050",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,6,26065,SC,Individual,No,57-0287419,26065SC0380005,BlueEssentials Bronze 1,26065SC038,,SCN001,SCS001,SCF005,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,4,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,6,26065,SC,Individual,No,57-0287419,26065SC0380005,BlueEssentials Bronze 1,26065SC038,,SCN001,SCS001,SCF005,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,4,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380005-03,Limited Cost Sharing Plan Variation,,0.613533794879913,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$9,050",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,7,26065,SC,Individual,No,57-0287419,26065SC0390001,BlueEssentials Catastrophic 1,26065SC039,,SCN001,SCS001,SCF006,Existing,EPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0390001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,7,26065,SC,Individual,No,57-0287419,26065SC0390001,BlueEssentials Catastrophic 1,26065SC039,,SCN001,SCS001,SCF006,Existing,EPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0390001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,2,70194,PA,SHOP (Small Group),No,54-1637426,70194PA0210004,Flex EPO $1650 80%/70% a Community Blue Plan,70194PA021,,PAN002,PAS005,PAF006,Existing,EPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0210004-01,Standard Silver On Exchange Plan,,0.690674722194672,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",20%,"$1,650","$3,300",30%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,2,70194,PA,Individual,No,54-1637426,70194PA0190001,Comprehensive Care Blue PPO 1500,70194PA019,,PAN002,PAS006,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0190001-00,Standard Silver Off Exchange Plan,,0.690294206142426,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,PA,72299,HIOS,9,2015-01-16 17:32:32,1,72299,PA,Individual,Yes,36-3757528,72299PA0010001,TruAssure Dental Basic Plan,72299PA001,,PAN001,PAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.48,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=PA,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=PA,,72299PA0010001-01,Standard Low On Exchange Plan,68.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$120,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,72299,HIOS,9,2015-01-16 17:32:32,2,72299,PA,Individual,Yes,36-3757528,72299PA0020001,TruAssure Dental Preferred Plan,72299PA002,,PAN001,PAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.76,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=PA,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=PA,,72299PA0020001-00,Standard High Off Exchange Plan,83.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,72299,HIOS,9,2015-01-16 17:32:32,2,72299,PA,Individual,Yes,36-3757528,72299PA0020001,TruAssure Dental Preferred Plan,72299PA002,,PAN001,PAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.76,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=PA,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=PA,,72299PA0020001-01,Standard High On Exchange Plan,83.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,75729,HIOS,8,2014-11-14 05:23:27,1,75729,PA,Individual,No,20-4275139,75729PA0012596,Marketplace PPO 25/50/1000,75729PA001,,PAN001,PAS001,PAF006,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Choice_Marketplace_PPO_25_50_1000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,75729PA0012596-00,Standard Gold Off Exchange Plan,,0.802350342273712,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$125,$250,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,75729,HIOS,8,2014-11-14 05:23:27,1,75729,PA,Individual,No,20-4275139,75729PA0012596,Marketplace PPO 25/50/1000,75729PA001,,PAN001,PAS001,PAF006,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Choice_Marketplace_PPO_25_50_1000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,75729PA0012596-01,Standard Gold On Exchange Plan,,0.802350342273712,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$125,$250,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,75729,HIOS,8,2014-11-14 05:23:27,1,75729,PA,Individual,No,20-4275139,75729PA0012596,Marketplace PPO 25/50/1000,75729PA001,,PAN001,PAS001,PAF006,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Choice_Marketplace_PPO_25_50_1000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,75729PA0012596-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,75729,HIOS,8,2014-11-14 05:23:27,1,75729,PA,Individual,No,20-4275139,75729PA0012596,Marketplace PPO 25/50/1000,75729PA001,,PAN001,PAS001,PAF006,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Choice_Marketplace_PPO_25_50_1000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,75729PA0012596-03,Limited Cost Sharing Plan Variation,,0.802350342273712,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$125,$250,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,75729,HIOS,8,2014-11-14 05:23:27,1,75729,PA,Individual,No,20-4275139,75729PA0012603,Marketplace PPO 30/50/5000,75729PA001,,PAN001,PAS001,PAF004,Existing,PPO,Silver,Yes,Both,No,No,,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Choice_Marketplace_PPO_30_50_5000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,75729PA0012603-00,Standard Silver Off Exchange Plan,69.00%,0.707965135574341,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,5,91303,PA,Individual,No,25-1264318,91303PA0020002,Coventry Silver $10 Copay HMO,91303PA002,,PAN001,PAS001,PAF002,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51002,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020002-00,Standard Silver Off Exchange Plan,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,$500,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,2,70194,PA,Individual,No,54-1637426,70194PA0190001,Comprehensive Care Blue PPO 1500,70194PA019,,PAN002,PAS006,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0190001-01,Standard Silver On Exchange Plan,,0.690294206142426,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,2,70194,PA,Individual,No,54-1637426,70194PA0190001,Comprehensive Care Blue PPO 1500,70194PA019,,PAN002,PAS006,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0190001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,2,70194,PA,Individual,No,54-1637426,70194PA0190001,Comprehensive Care Blue PPO 1500,70194PA019,,PAN002,PAS006,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0190001-03,Limited Cost Sharing Plan Variation,,0.690294206142426,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,2,70194,PA,Individual,No,54-1637426,70194PA0190001,Comprehensive Care Blue PPO 1500,70194PA019,,PAN002,PAS006,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0190001-04,73% AV Level Silver Plan,,0.733900666236877,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,2,70194,PA,Individual,No,54-1637426,70194PA0190001,Comprehensive Care Blue PPO 1500,70194PA019,,PAN002,PAS006,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0190001-05,87% AV Level Silver Plan,,0.878387570381165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,2,70194,PA,Individual,No,54-1637426,70194PA0190001,Comprehensive Care Blue PPO 1500,70194PA019,,PAN002,PAS006,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0190001-06,94% AV Level Silver Plan,,0.940365195274353,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,$100,$200,10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,Individual,No,54-1637426,70194PA0140005,Shared Cost Blue PPO 1500,70194PA014,,PAN001,PAS003,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0140005-00,Standard Gold Off Exchange Plan,,0.783825159072876,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,SHOP (Small Group),No,54-1637426,70194PA0230002,Health Savings PPO Q$4000,70194PA023,,PAN001,PAS003,PAF006,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0230002-00,Standard Bronze Off Exchange Plan,,0.605742812156677,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,SHOP (Small Group),No,54-1637426,70194PA0230002,Health Savings PPO Q$4000,70194PA023,,PAN001,PAS003,PAF006,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0230002-01,Standard Bronze On Exchange Plan,,0.605742812156677,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,Individual,No,54-1637426,70194PA0140005,Shared Cost Blue PPO 1500,70194PA014,,PAN001,PAS003,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0140005-01,Standard Gold On Exchange Plan,,0.783825159072876,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,Individual,No,54-1637426,70194PA0140005,Shared Cost Blue PPO 1500,70194PA014,,PAN001,PAS003,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0140005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,SHOP (Small Group),No,54-1637426,70194PA0250002,Health Savings PPO Q$4000,70194PA025,,PAN002,PAS006,PAF006,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0250002-00,Standard Bronze Off Exchange Plan,,0.605742812156677,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,SHOP (Small Group),No,54-1637426,70194PA0250002,Health Savings PPO Q$4000,70194PA025,,PAN002,PAS006,PAF006,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0250002-01,Standard Bronze On Exchange Plan,,0.605742812156677,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,Individual,No,54-1637426,70194PA0140005,Shared Cost Blue PPO 1500,70194PA014,,PAN001,PAS003,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0140005-03,Limited Cost Sharing Plan Variation,,0.783825159072876,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,Individual,No,54-1637426,70194PA0140003,Shared Cost Blue PPO 3200,70194PA014,,PAN001,PAS003,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0140003-00,Standard Silver Off Exchange Plan,,0.691314995288849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,200","$6,400",20%,,,,"$6,400","$12,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,Individual,No,54-1637426,70194PA0140003,Shared Cost Blue PPO 3200,70194PA014,,PAN001,PAS003,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0140003-01,Standard Silver On Exchange Plan,,0.691314995288849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,200","$6,400",20%,,,,"$6,400","$12,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,Individual,No,54-1637426,70194PA0140003,Shared Cost Blue PPO 3200,70194PA014,,PAN001,PAS003,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0140003-04,73% AV Level Silver Plan,,0.722588956356049,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,200","$6,400",20%,,,,"$6,400","$12,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,Individual,No,54-1637426,70194PA0140003,Shared Cost Blue PPO 3200,70194PA014,,PAN001,PAS003,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0140003-05,87% AV Level Silver Plan,,0.874915480613709,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$12,700","$25,400",Not Applicable,Not Applicable,$650,"$1,300",10%,,,,"$6,400","$12,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,Individual,No,54-1637426,70194PA0140003,Shared Cost Blue PPO 3200,70194PA014,,PAN001,PAS003,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0140003-06,94% AV Level Silver Plan,,0.941447615623474,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,$100,$200,10%,,,,"$6,400","$12,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,Individual,No,54-1637426,70194PA0170005,Shared Cost Blue PPO 1500,70194PA017,,PAN002,PAS006,PAF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0170005-00,Standard Gold Off Exchange Plan,,0.783825159072876,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,Individual,No,54-1637426,70194PA0170003,Shared Cost Blue PPO 3200,70194PA017,,PAN002,PAS006,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0170003-01,Standard Silver On Exchange Plan,,0.691314995288849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,200","$6,400",20%,,,,"$6,400","$12,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,Individual,No,54-1637426,70194PA0170003,Shared Cost Blue PPO 3200,70194PA017,,PAN002,PAS006,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0170003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,Individual,No,54-1637426,70194PA0170003,Shared Cost Blue PPO 3200,70194PA017,,PAN002,PAS006,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0170003-03,Limited Cost Sharing Plan Variation,,0.691314995288849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,200","$6,400",20%,,,,"$6,400","$12,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,Individual,No,54-1637426,70194PA0170003,Shared Cost Blue PPO 3200,70194PA017,,PAN002,PAS006,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0170003-04,73% AV Level Silver Plan,,0.722588956356049,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,200","$6,400",20%,,,,"$6,400","$12,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,23
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,Individual,No,54-1637426,70194PA0170003,Shared Cost Blue PPO 3200,70194PA017,,PAN002,PAS006,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0170003-05,87% AV Level Silver Plan,,0.874915480613709,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$12,700","$25,400",Not Applicable,Not Applicable,$650,"$1,300",10%,,,,"$6,400","$12,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,24
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,3,70194,PA,Individual,No,54-1637426,70194PA0170003,Shared Cost Blue PPO 3200,70194PA017,,PAN002,PAS006,PAF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0170003-06,94% AV Level Silver Plan,,0.941447615623474,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,$100,$200,10%,,,,"$6,400","$12,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,25
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,SHOP (Small Group),No,54-1637426,70194PA0220006,Shared Cost PPO $1500,70194PA022,,PAN001,PAS003,PAF010,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0220006-00,Standard Gold Off Exchange Plan,,0.780548751354218,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0180001,Health Savings Blue PPO 3400,70194PA018,,PAN002,PAS006,PAF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0180001-00,Standard Bronze Off Exchange Plan,,0.618958473205566,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",30%,,,,"$6,800","$13,600",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0180001,Health Savings Blue PPO 3400,70194PA018,,PAN002,PAS006,PAF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0180001-01,Standard Bronze On Exchange Plan,,0.618958473205566,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",30%,,,,"$6,800","$13,600",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,SHOP (Small Group),No,54-1637426,70194PA0220006,Shared Cost PPO $1500,70194PA022,,PAN001,PAS003,PAF010,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0220006-01,Standard Gold On Exchange Plan,,0.780548751354218,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,SHOP (Small Group),No,54-1637426,70194PA0240006,Shared Cost PPO $1500,70194PA024,,PAN002,PAS006,PAF010,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0240006-00,Standard Gold Off Exchange Plan,,0.780548751354218,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0180001,Health Savings Blue PPO 3400,70194PA018,,PAN002,PAS006,PAF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0180001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0180001,Health Savings Blue PPO 3400,70194PA018,,PAN002,PAS006,PAF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0180001-03,Limited Cost Sharing Plan Variation,,0.618958473205566,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",30%,,,,"$6,800","$13,600",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,SHOP (Small Group),No,54-1637426,70194PA0240006,Shared Cost PPO $1500,70194PA024,,PAN002,PAS006,PAF010,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0240006-01,Standard Gold On Exchange Plan,,0.780548751354218,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0180003,Health Savings Blue PPO 2500,70194PA018,,PAN002,PAS006,PAF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/clients/highmark/commercial.html,70194PA0180003-00,Standard Silver Off Exchange Plan,,0.716210186481476,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$5,000",$10,Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0180003,Health Savings Blue PPO 2500,70194PA018,,PAN002,PAS006,PAF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/clients/highmark/commercial.html,70194PA0180003-01,Standard Silver On Exchange Plan,,0.716210186481476,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0180003,Health Savings Blue PPO 2500,70194PA018,,PAN002,PAS006,PAF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/clients/highmark/commercial.html,70194PA0180003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0180003,Health Savings Blue PPO 2500,70194PA018,,PAN002,PAS006,PAF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/clients/highmark/commercial.html,70194PA0180003-03,Limited Cost Sharing Plan Variation,,0.716210186481476,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0180003,Health Savings Blue PPO 2500,70194PA018,,PAN002,PAS006,PAF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/clients/highmark/commercial.html,70194PA0180003-04,73% AV Level Silver Plan,,0.73978066444397,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0180003,Health Savings Blue PPO 2500,70194PA018,,PAN002,PAS006,PAF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/clients/highmark/commercial.html,70194PA0180003-05,87% AV Level Silver Plan,,0.874960958957672,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0180003,Health Savings Blue PPO 2500,70194PA018,,PAN002,PAS006,PAF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/clients/highmark/commercial.html,70194PA0180003-06,94% AV Level Silver Plan,,0.936530709266663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0180005,Health Savings Blue PPO 1300,70194PA018,,PAN002,PAS006,PAF011,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/clients/highmark/commercial.html,70194PA0180005-00,Standard Gold Off Exchange Plan,,0.806593358516693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,300","$4,600",,,"$4,600","$9,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,,,,,,,,,15
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0180005,Health Savings Blue PPO 1300,70194PA018,,PAN002,PAS006,PAF011,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/clients/highmark/commercial.html,70194PA0180005-01,Standard Gold On Exchange Plan,,0.806593358516693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,300","$4,600",,,"$4,600","$9,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,,,,,,,,,16
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0180005,Health Savings Blue PPO 1300,70194PA018,,PAN002,PAS006,PAF011,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/clients/highmark/commercial.html,70194PA0180005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,17
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0180005,Health Savings Blue PPO 1300,70194PA018,,PAN002,PAS006,PAF011,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/clients/highmark/commercial.html,70194PA0180005-03,Limited Cost Sharing Plan Variation,,0.806593358516693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,300","$4,600",,,"$4,600","$9,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,,,,,,,,,18
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0150001,Health Savings Blue PPO 3400,70194PA015,,PAN001,PAS003,PAF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0150001-00,Standard Bronze Off Exchange Plan,,0.618958473205566,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",30%,,,,"$6,800","$13,600",Not Applicable,Not Applicable,,,,,,,,,19
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0150001,Health Savings Blue PPO 3400,70194PA015,,PAN001,PAS003,PAF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0150001-01,Standard Bronze On Exchange Plan,,0.618958473205566,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",30%,,,,"$6,800","$13,600",Not Applicable,Not Applicable,,,,,,,,,20
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0150001,Health Savings Blue PPO 3400,70194PA015,,PAN001,PAS003,PAF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0150001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,21
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0150001,Health Savings Blue PPO 3400,70194PA015,,PAN001,PAS003,PAF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0150001-03,Limited Cost Sharing Plan Variation,,0.618958473205566,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",30%,,,,"$6,800","$13,600",Not Applicable,Not Applicable,,,,,,,,,22
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0150003,Health Savings Blue PPO 2500,70194PA015,,PAN001,PAS003,PAF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/clients/highmark/commercial.html,70194PA0150003-00,Standard Silver Off Exchange Plan,,0.716210186481476,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$5,000",$10,Not Applicable,Not Applicable,,,,,,,,,23
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0150003,Health Savings Blue PPO 2500,70194PA015,,PAN001,PAS003,PAF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/clients/highmark/commercial.html,70194PA0150003-01,Standard Silver On Exchange Plan,,0.716210186481476,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0150003,Health Savings Blue PPO 2500,70194PA015,,PAN001,PAS003,PAF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/clients/highmark/commercial.html,70194PA0150003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,25
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0150003,Health Savings Blue PPO 2500,70194PA015,,PAN001,PAS003,PAF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/clients/highmark/commercial.html,70194PA0150003-03,Limited Cost Sharing Plan Variation,,0.716210186481476,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0150003,Health Savings Blue PPO 2500,70194PA015,,PAN001,PAS003,PAF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/clients/highmark/commercial.html,70194PA0150003-04,73% AV Level Silver Plan,,0.73978066444397,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,PA,70533,HIOS,3,2014-09-04 03:25:43,2,70533,PA,SHOP (Small Group),Yes,35-0472300,70533PA0010004,Lincoln DentalConnect?,70533PA001,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.26,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,70533PA0010004-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,70533,HIOS,3,2014-09-04 03:25:43,2,70533,PA,SHOP (Small Group),Yes,35-0472300,70533PA0010008,Lincoln DentalConnect?,70533PA001,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.12,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,70533PA0010008-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,1,71933,PA,Individual,Yes,95-6042390,71933PA0020001,BESTOne Child Dental Plus,71933PA002,,PAN001,PAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$41.03,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BESTOne_Child_Dental_Plus_Plan.pdf,,71933PA0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0150003,Health Savings Blue PPO 2500,70194PA015,,PAN001,PAS003,PAF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/clients/highmark/commercial.html,70194PA0150003-05,87% AV Level Silver Plan,,0.874960958957672,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0150003,Health Savings Blue PPO 2500,70194PA015,,PAN001,PAS003,PAF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/clients/highmark/commercial.html,70194PA0150003-06,94% AV Level Silver Plan,,0.936530709266663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0150005,Health Savings Blue PPO 1300,70194PA015,,PAN001,PAS003,PAF011,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/clients/highmark/commercial.html,70194PA0150005-00,Standard Gold Off Exchange Plan,,0.806593358516693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,300","$4,600",,,"$4,600","$9,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,,,,,,,,,30
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0150005,Health Savings Blue PPO 1300,70194PA015,,PAN001,PAS003,PAF011,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/clients/highmark/commercial.html,70194PA0150005-01,Standard Gold On Exchange Plan,,0.806593358516693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,300","$4,600",,,"$4,600","$9,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,,,,,,,,,31
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0150005,Health Savings Blue PPO 1300,70194PA015,,PAN001,PAS003,PAF011,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/clients/highmark/commercial.html,70194PA0150005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,32
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,4,70194,PA,Individual,No,54-1637426,70194PA0150005,Health Savings Blue PPO 1300,70194PA015,,PAN001,PAS003,PAF011,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/clients/highmark/commercial.html,70194PA0150005-03,Limited Cost Sharing Plan Variation,,0.806593358516693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,300","$4,600",,,"$4,600","$9,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,,,,,,,,,33
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,5,70194,PA,Individual,No,54-1637426,70194PA0190003,Comprehensive Care Blue PPO 500,70194PA019,,PAN002,PAS006,PAF007,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0190003-00,Standard Platinum Off Exchange Plan,,0.8981654047966,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,650","$3,300",,,"$3,300","$6,600",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,5,70194,PA,Individual,No,54-1637426,70194PA0190003,Comprehensive Care Blue PPO 500,70194PA019,,PAN002,PAS006,PAF007,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0190003-01,Standard Platinum On Exchange Plan,,0.8981654047966,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,650","$3,300",,,"$3,300","$6,600",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,5,70194,PA,Individual,No,54-1637426,70194PA0190003,Comprehensive Care Blue PPO 500,70194PA019,,PAN002,PAS006,PAF007,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0190003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,5,70194,PA,Individual,No,54-1637426,70194PA0190003,Comprehensive Care Blue PPO 500,70194PA019,,PAN002,PAS006,PAF007,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0190003-03,Limited Cost Sharing Plan Variation,,0.8981654047966,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,650","$3,300",,,"$3,300","$6,600",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,5,70194,PA,Individual,No,54-1637426,70194PA0160003,Comprehensive Care Blue PPO 500,70194PA016,,PAN001,PAS003,PAF007,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0160003-00,Standard Platinum Off Exchange Plan,,0.8981654047966,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,650","$3,300",,,"$3,300","$6,600",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,5,70194,PA,Individual,No,54-1637426,70194PA0160003,Comprehensive Care Blue PPO 500,70194PA016,,PAN001,PAS003,PAF007,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0160003-01,Standard Platinum On Exchange Plan,,0.8981654047966,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,650","$3,300",,,"$3,300","$6,600",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,5,70194,PA,Individual,No,54-1637426,70194PA0160003,Comprehensive Care Blue PPO 500,70194PA016,,PAN001,PAS003,PAF007,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0160003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,5,70194,PA,Individual,No,54-1637426,70194PA0160003,Comprehensive Care Blue PPO 500,70194PA016,,PAN001,PAS003,PAF007,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20,70194PA0160003-03,Limited Cost Sharing Plan Variation,,0.8981654047966,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,650","$3,300",,,"$3,300","$6,600",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,6,70194,PA,Individual,No,54-1637426,70194PA0460001,Balance Blue PPO 500,70194PA046,,PAN002,PAS006,PAF001,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0460001-00,Standard Gold Off Exchange Plan,78.10%,0.776750802993774,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,6,70194,PA,Individual,No,54-1637426,70194PA0460001,Balance Blue PPO 500,70194PA046,,PAN002,PAS006,PAF001,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0460001-01,Standard Gold On Exchange Plan,78.10%,0.776750802993774,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,6,70194,PA,Individual,No,54-1637426,70194PA0460001,Balance Blue PPO 500,70194PA046,,PAN002,PAS006,PAF001,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0460001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,6,70194,PA,Individual,No,54-1637426,70194PA0460001,Balance Blue PPO 500,70194PA046,,PAN002,PAS006,PAF001,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0460001-03,Limited Cost Sharing Plan Variation,78.10%,0.776750802993774,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,6,70194,PA,Individual,No,54-1637426,70194PA0460002,Balance Blue PPO 2000,70194PA046,,PAN002,PAS006,PAF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0460002-00,Standard Silver Off Exchange Plan,68.33%,0.683317422866821,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,6,70194,PA,Individual,No,54-1637426,70194PA0460002,Balance Blue PPO 2000,70194PA046,,PAN002,PAS006,PAF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0460002-01,Standard Silver On Exchange Plan,68.33%,0.683317422866821,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,6,70194,PA,Individual,No,54-1637426,70194PA0460002,Balance Blue PPO 2000,70194PA046,,PAN002,PAS006,PAF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0460002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,6,70194,PA,Individual,No,54-1637426,70194PA0460002,Balance Blue PPO 2000,70194PA046,,PAN002,PAS006,PAF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0460002-03,Limited Cost Sharing Plan Variation,68.33%,0.683317422866821,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,6,70194,PA,Individual,No,54-1637426,70194PA0460002,Balance Blue PPO 2000,70194PA046,,PAN002,PAS006,PAF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0460002-04,73% AV Level Silver Plan,72.00%,0.709445536136627,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,6,70194,PA,Individual,No,54-1637426,70194PA0460002,Balance Blue PPO 2000,70194PA046,,PAN002,PAS006,PAF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0460002-05,87% AV Level Silver Plan,87.27%,0.872702300548553,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,6,70194,PA,Individual,No,54-1637426,70194PA0460002,Balance Blue PPO 2000,70194PA046,,PAN002,PAS006,PAF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0460002-06,94% AV Level Silver Plan,93.70%,0.936997950077057,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,7,70194,PA,Individual,No,54-1637426,70194PA0470001,Total Health Blue PPO 1200,70194PA047,,PAN002,PAS006,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0470001-00,Standard Gold Off Exchange Plan,,0.786266505718231,Yes,Yes,Yes,98%,2%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400",20%,"$1,200","$2,400",20%,"$2,400","$4,800",Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,7,70194,PA,Individual,No,54-1637426,70194PA0470001,Total Health Blue PPO 1200,70194PA047,,PAN002,PAS006,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0470001-01,Standard Gold On Exchange Plan,,0.786266505718231,Yes,Yes,Yes,98%,2%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400",20%,"$1,200","$2,400",20%,"$2,400","$4,800",Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,7,70194,PA,Individual,No,54-1637426,70194PA0470001,Total Health Blue PPO 1200,70194PA047,,PAN002,PAS006,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0470001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,98%,2%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,PA,70194,HIOS,11,2015-01-17 03:15:53,7,70194,PA,Individual,No,54-1637426,70194PA0470001,Total Health Blue PPO 1200,70194PA047,,PAN002,PAS006,PAF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0470001-03,Limited Cost Sharing Plan Variation,,0.786266505718231,Yes,Yes,Yes,98%,2%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400",20%,"$1,200","$2,400",20%,"$2,400","$4,800",Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,70406,HIOS,2,2014-08-05 13:28:44,1,70406,PA,SHOP (Small Group),Yes,36-0883760,70406PA0040002,EHB High PPO,70406PA004,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.63,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,70406PA0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,70406,HIOS,2,2014-08-05 13:28:44,1,70406,PA,SHOP (Small Group),Yes,36-0883760,70406PA0040001,EHB Low PPO,70406PA004,,PAN001,PAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.72,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,70406PA0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,70406,HIOS,2,2014-08-05 13:28:44,1,70406,PA,SHOP (Small Group),Yes,36-0883760,70406PA0030002,EHB High Passive,70406PA003,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$42.74,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,70406PA0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,70406,HIOS,2,2014-08-05 13:28:44,1,70406,PA,SHOP (Small Group),Yes,36-0883760,70406PA0030001,EHB Low Passive,70406PA003,,PAN001,PAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.19,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,70406PA0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,70533,HIOS,3,2014-09-04 03:25:43,1,70533,PA,SHOP (Small Group),Yes,35-0472300,70533PA0010001,Lincoln DentalConnect?,70533PA001,,PAN001,PAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.45,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,70533PA0010001-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,70533,HIOS,3,2014-09-04 03:25:43,1,70533,PA,SHOP (Small Group),Yes,35-0472300,70533PA0010002,Lincoln DentalConnect?,70533PA001,,PAN001,PAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.33,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,70533PA0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,70533,HIOS,3,2014-09-04 03:25:43,1,70533,PA,SHOP (Small Group),Yes,35-0472300,70533PA0010003,Lincoln DentalConnect?,70533PA001,,PAN001,PAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.16,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,70533PA0010003-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,70533,HIOS,3,2014-09-04 03:25:43,1,70533,PA,SHOP (Small Group),Yes,35-0472300,70533PA0010005,Lincoln DentalConnect?,70533PA001,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.50,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,70533PA0010005-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,70533,HIOS,3,2014-09-04 03:25:43,1,70533,PA,SHOP (Small Group),Yes,35-0472300,70533PA0010006,Lincoln DentalConnect?,70533PA001,,PAN001,PAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.95,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,70533PA0010006-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,PA,70533,HIOS,3,2014-09-04 03:25:43,1,70533,PA,SHOP (Small Group),Yes,35-0472300,70533PA0010007,Lincoln DentalConnect?,70533PA001,,PAN001,PAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.48,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,70533PA0010007-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,3,71933,PA,SHOP (Small Group),Yes,95-6042390,71933PA0010040,BEST Dental Choice-H,71933PA001,,PAN001,PAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.83,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BESTDental_Choice-H_Plan.pdf,,71933PA0010040-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,4,71933,PA,SHOP (Small Group),Yes,95-6042390,71933PA0010039,BEST Dental Standard-L,71933PA001,,PAN001,PAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.41,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BESTDental_Standard-L_Plan.pdf,,71933PA0010039-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,4,71933,PA,Individual,Yes,95-6042390,71933PA0020005,BESTOne Dental Plus-Silver,71933PA002,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.76,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BESTOne_Dental_Plus-Silver_Plan.pdf,,71933PA0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,4,71933,PA,Individual,Yes,95-6042390,71933PA0020006,BESTOne Dental Basic-Silver,71933PA002,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.76,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BESTOne_Dental_Basic-Silver_Plan.pdf,,71933PA0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,4,71933,PA,Individual,Yes,95-6042390,71933PA0020006,BESTOne Dental Basic-Silver,71933PA002,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.76,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BESTOne_Dental_Basic-Silver_Plan.pdf,,71933PA0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,4,71933,PA,SHOP (Small Group),Yes,95-6042390,71933PA0010041,BEST Dental Choice-L,71933PA001,,PAN001,PAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.41,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BESTDental_Choice-L_Plan.pdf,,71933PA0010041-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,4,71933,PA,SHOP (Small Group),Yes,95-6042390,71933PA0010042,BEST Dental Value,71933PA001,,PAN001,PAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.41,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BESTDental_Value_Plan.pdf,,71933PA0010042-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,PA,71933,HIOS,4,2014-09-03 04:28:59,4,71933,PA,SHOP (Small Group),Yes,95-6042390,71933PA0010042,BEST Dental Value,71933PA001,,PAN001,PAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.41,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/PA/2015/PA_BESTDental_Value_Plan.pdf,,71933PA0010042-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,PA,72299,HIOS,9,2015-01-16 17:32:32,1,72299,PA,Individual,Yes,36-3757528,72299PA0010001,TruAssure Dental Basic Plan,72299PA001,,PAN001,PAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.48,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=PA,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=PA,,72299PA0010001-00,Standard Low Off Exchange Plan,68.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$120,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,72299,HIOS,9,2015-01-16 17:32:32,1,72299,PA,SHOP (Small Group),Yes,36-3757528,72299PA0030001,TruAssure Dental Small Group Basic Plan,72299PA003,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.29,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=PA,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=PA,,72299PA0030001-00,Standard High Off Exchange Plan,83.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,72299,HIOS,9,2015-01-16 17:32:32,1,72299,PA,SHOP (Small Group),Yes,36-3757528,72299PA0040001,TruAssure Dental Small Group Preferred Plan,72299PA004,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.29,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=PA,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=PA,,72299PA0040001-00,Standard High Off Exchange Plan,83.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,7,91303,PA,Individual,No,25-1264318,91303PA0020006,Coventry Silver $5 Copay 2750 HMO,91303PA002,,PAN001,PAS001,PAF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51001,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020006-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,7,91303,PA,Individual,No,25-1264318,91303PA0020006,Coventry Silver $5 Copay 2750 HMO,91303PA002,,PAN001,PAS001,PAF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51001,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020006-06,94% AV Level Silver Plan,93.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,9,91303,PA,Individual,No,25-1264318,91303PA0020001,Coventry Gold $5 Copay HMO,91303PA002,,PAN001,PAS001,PAF001,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020001-00,Standard Gold Off Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,9,91303,PA,Individual,No,25-1264318,91303PA0020001,Coventry Gold $5 Copay HMO,91303PA002,,PAN001,PAS001,PAF001,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020001-01,Standard Gold On Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,9,91303,PA,Individual,No,25-1264318,91303PA0020001,Coventry Gold $5 Copay HMO,91303PA002,,PAN001,PAS001,PAF001,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,9,91303,PA,Individual,No,25-1264318,91303PA0020001,Coventry Gold $5 Copay HMO,91303PA002,,PAN001,PAS001,PAF001,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020001-03,Limited Cost Sharing Plan Variation,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,94118,HIOS,2,2014-08-03 08:59:32,1,94118,PA,SHOP (Small Group),Yes,47-0098400,94118PA0040002,EHB High PPO,94118PA004,,PAN001,PAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.08,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,94118PA0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,94118,HIOS,2,2014-08-03 08:59:32,1,94118,PA,SHOP (Small Group),Yes,47-0098400,94118PA0040001,EHB Low PPO,94118PA004,,PAN001,PAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.45,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,94118PA0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,98060,HIOS,3,2014-08-28 04:23:13,4,98060,PA,SHOP (Small Group),Yes,13-5581829,98060PA0200001,Family Enhanced Dental Plan (High),98060PA020,,PAN004,PAS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$25.96,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49124,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49123,,98060PA0200001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,98060,HIOS,3,2014-08-28 04:23:13,4,98060,PA,SHOP (Small Group),Yes,13-5581829,98060PA0200001,Family Enhanced Dental Plan (High),98060PA020,,PAN004,PAS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$25.96,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49124,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49123,,98060PA0200001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,75729,HIOS,8,2014-11-14 05:23:27,1,75729,PA,Individual,No,20-4275139,75729PA0012603,Marketplace PPO 30/50/5000,75729PA001,,PAN001,PAS001,PAF004,Existing,PPO,Silver,Yes,Both,No,No,,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Choice_Marketplace_PPO_30_50_5000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,75729PA0012603-01,Standard Silver On Exchange Plan,69.00%,0.707965135574341,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,75729,HIOS,8,2014-11-14 05:23:27,1,75729,PA,Individual,No,20-4275139,75729PA0012603,Marketplace PPO 30/50/5000,75729PA001,,PAN001,PAS001,PAF004,Existing,PPO,Silver,Yes,Both,No,No,,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Choice_Marketplace_PPO_30_50_5000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,75729PA0012603-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,PA,75729,HIOS,8,2014-11-14 05:23:27,1,75729,PA,Individual,No,20-4275139,75729PA0012603,Marketplace PPO 30/50/5000,75729PA001,,PAN001,PAS001,PAF004,Existing,PPO,Silver,Yes,Both,No,No,,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Choice_Marketplace_PPO_30_50_5000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,75729PA0012603-03,Limited Cost Sharing Plan Variation,69.00%,0.707965135574341,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,PA,75729,HIOS,8,2014-11-14 05:23:27,1,75729,PA,Individual,No,20-4275139,75729PA0012603,Marketplace PPO 30/50/5000,75729PA001,,PAN001,PAS001,PAF004,Existing,PPO,Silver,Yes,Both,No,No,,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Choice_Marketplace_PPO_30_50_5000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,75729PA0012603-04,73% AV Level Silver Plan,73.00%,0.751993238925934,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,PA,75729,HIOS,8,2014-11-14 05:23:27,1,75729,PA,Individual,No,20-4275139,75729PA0012603,Marketplace PPO 30/50/5000,75729PA001,,PAN001,PAS001,PAF004,Existing,PPO,Silver,Yes,Both,No,No,,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Choice_Marketplace_PPO_30_50_5000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,75729PA0012603-05,87% AV Level Silver Plan,87.23%,0.871982336044312,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$15,000","$30,000",Not Applicable,Not Applicable,$175,$350,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,PA,75729,HIOS,8,2014-11-14 05:23:27,1,75729,PA,Individual,No,20-4275139,75729PA0012603,Marketplace PPO 30/50/5000,75729PA001,,PAN001,PAS001,PAF004,Existing,PPO,Silver,Yes,Both,No,No,,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and urgent care.,Yes,Emergent and urgent care covered. Other services covered with a referral.,No,https://www.thehealthplan.com/Reform/marketplace/Documents/SBC/2015/Geisinger_Choice_Marketplace_PPO_30_50_5000.pdf,https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST,http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf,http://www.thehealthplan.com/pharmacy/pharmacy.aspx,75729PA0012603-06,94% AV Level Silver Plan,94.47%,0.94463038444519,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$15,000","$30,000",Not Applicable,Not Applicable,$100,$200,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,PA,79570,HIOS,2,2014-08-07 10:00:19,1,79570,PA,SHOP (Small Group),Yes,44-0308260,79570PA0010001,KCL EHB Low PPO,79570PA001,,PAN001,PAS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$39.88,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,79570PA0010001-00,Standard Low Off Exchange Plan,70.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,79570,HIOS,2,2014-08-07 10:00:19,1,79570,PA,SHOP (Small Group),Yes,44-0308260,79570PA0010003,KCL EHB Low MAC,79570PA001,,PAN001,PAS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$29.81,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,79570PA0010003-00,Standard Low Off Exchange Plan,70.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,79570,HIOS,2,2014-08-07 10:00:19,1,79570,PA,SHOP (Small Group),Yes,44-0308260,79570PA0010005,KCL Fam Low PPO,79570PA001,,PAN001,PAS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$39.88,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,79570PA0010005-00,Standard Low Off Exchange Plan,70.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,79570,HIOS,2,2014-08-07 10:00:19,1,79570,PA,SHOP (Small Group),Yes,44-0308260,79570PA0010007,KCL Fam Low MAC,79570PA001,,PAN001,PAS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$29.81,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,79570PA0010007-00,Standard Low Off Exchange Plan,70.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,79570,HIOS,2,2014-08-07 10:00:19,2,79570,PA,SHOP (Small Group),Yes,44-0308260,79570PA0010002,KCL EHB High PPO,79570PA001,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$48.50,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,79570PA0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,79570,HIOS,2,2014-08-07 10:00:19,2,79570,PA,SHOP (Small Group),Yes,44-0308260,79570PA0010004,KCL EHB High MAC,79570PA001,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$37.22,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,79570PA0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,79570,HIOS,2,2014-08-07 10:00:19,2,79570,PA,SHOP (Small Group),Yes,44-0308260,79570PA0010006,KCL Fam High PPO,79570PA001,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$48.50,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,79570PA0010006-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,79570,HIOS,2,2014-08-07 10:00:19,2,79570,PA,SHOP (Small Group),Yes,44-0308260,79570PA0010008,KCL Fam High MAC,79570PA001,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$37.22,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,79570PA0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,1,82110,PA,SHOP (Small Group),Yes,23-1667011,82110PA0020002,Delta Dental PPO Pediatric Preferred Plan for Small Businesses,82110PA002,,PAN001,PAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$15.32,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/pa/82110pa0020002-15,,82110PA0020002-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,1,82110,PA,Individual,Yes,23-1667011,82110PA0010002,Delta Dental PPO Pediatric Preferred Plan,82110PA001,,PAN001,PAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$16.11,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/pa/82110pa0010001-15,,82110PA0010002-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,1,82110,PA,Individual,Yes,23-1667011,82110PA0010002,Delta Dental PPO Pediatric Preferred Plan,82110PA001,,PAN001,PAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$16.11,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/pa/82110pa0010001-15,,82110PA0010002-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,1,82110,PA,SHOP (Small Group),Yes,23-1667011,82110PA0020002,Delta Dental PPO Pediatric Preferred Plan for Small Businesses,82110PA002,,PAN001,PAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$15.32,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/pa/82110pa0020002-15,,82110PA0020002-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,1,82110,PA,SHOP (Small Group),Yes,23-1667011,82110PA0020001,Delta Dental PPO Pediatric Basic Plan for Small Businesses,82110PA002,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$12.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/pa/82110pa0020001-15,,82110PA0020001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,1,82110,PA,Individual,Yes,23-1667011,82110PA0010001,Delta Dental PPO Pediatric Basic Plan,82110PA001,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$12.18,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/pa/82110pa0010002-15,,82110PA0010001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,1,82110,PA,Individual,Yes,23-1667011,82110PA0010001,Delta Dental PPO Pediatric Basic Plan,82110PA001,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$12.18,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/pa/82110pa0010002-15,,82110PA0010001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,1,82110,PA,SHOP (Small Group),Yes,23-1667011,82110PA0020001,Delta Dental PPO Pediatric Basic Plan for Small Businesses,82110PA002,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$12.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/pa/82110pa0020001-15,,82110PA0020001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,2,82110,PA,Individual,Yes,23-1667011,82110PA0010004,Delta Dental PPO Preferred Plan for Families,82110PA001,,PAN001,PAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.11,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/pa/82110pa0010004-15,,82110PA0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,2,82110,PA,SHOP (Small Group),Yes,23-1667011,82110PA0020004,Delta Dental PPO Preferred Plan for Families for Small Businesses,82110PA002,,PAN001,PAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$15.32,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/pa/82110pa0020004-15,,82110PA0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,6,82110,PA,Individual,Yes,23-1667011,82110PA0030006,DeltaCare USA Basic Plan for Families,82110PA003,,PAN002,PAS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$15.99,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/pa/82110pa0030006-15,,82110PA0030006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,6,82110,PA,SHOP (Small Group),Yes,23-1667011,82110PA0040006,DeltaCare USA Basic Plan for Families for Small Businesses,82110PA004,,PAN002,PAS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,,deltadentalins.com/hcx/pa/82110pa0040006-15,,82110PA0040006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,6,82110,PA,SHOP (Small Group),Yes,23-1667011,82110PA0040006,DeltaCare USA Basic Plan for Families for Small Businesses,82110PA004,,PAN002,PAS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,,deltadentalins.com/hcx/pa/82110pa0040006-15,,82110PA0040006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,82110,HIOS,8,2014-11-14 05:23:27,6,82110,PA,Individual,Yes,23-1667011,82110PA0030006,DeltaCare USA Basic Plan for Families,82110PA003,,PAN002,PAS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$15.99,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/pa/82110pa0030006-15,,82110PA0030006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,84496,HIOS,2,2014-08-07 10:00:19,1,84496,PA,SHOP (Small Group),Yes,93-0242990,84496PA0040002,EHB High PPO,84496PA004,,PAN001,PAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.74,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,84496PA0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,84496,HIOS,2,2014-08-07 10:00:19,1,84496,PA,SHOP (Small Group),Yes,93-0242990,84496PA0040001,EHB Low PPO,84496PA004,,PAN001,PAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.78,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,84496PA0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380013,BlueEssentials HD Bronze 4,26065SC038,,SCN001,SCS001,SCF017,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,32
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380013,BlueEssentials HD Bronze 4,26065SC038,,SCN001,SCS001,SCF017,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380013-03,Limited Cost Sharing Plan Variation,,0.583911716938019,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$11,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,200","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,33
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380014,BlueEssentials HD Bronze 5,26065SC038,,SCN001,SCS001,SCF006,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380014-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$10,950",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$10,950",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,34
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380014,BlueEssentials HD Bronze 5,26065SC038,,SCN001,SCS001,SCF006,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380014-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$10,950",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$10,950",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,35
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380014,BlueEssentials HD Bronze 5,26065SC038,,SCN001,SCS001,SCF006,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,36
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380014,BlueEssentials HD Bronze 5,26065SC038,,SCN001,SCS001,SCF006,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380014-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$10,950",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$10,950",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,37
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,2,26065,SC,Individual,No,57-0287419,26065SC0380001,BlueEssentials Gold 1,26065SC038,,SCN001,SCS001,SCF001,Existing,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380001-00,Standard Gold Off Exchange Plan,,0.789704382419586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,250",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,350",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,2,26065,SC,Individual,No,57-0287419,26065SC0380001,BlueEssentials Gold 1,26065SC038,,SCN001,SCS001,SCF001,Existing,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380001-01,Standard Gold On Exchange Plan,,0.789704382419586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,250",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,350",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,2,26065,SC,Individual,No,57-0287419,26065SC0380001,BlueEssentials Gold 1,26065SC038,,SCN001,SCS001,SCF001,Existing,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,2,26065,SC,Individual,No,57-0287419,26065SC0380001,BlueEssentials Gold 1,26065SC038,,SCN001,SCS001,SCF001,Existing,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380001-03,Limited Cost Sharing Plan Variation,,0.789704382419586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,250",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,350",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,2,26065,SC,Individual,No,57-0287419,26065SC0380007,BlueEssentials Gold 2,26065SC038,,SCN001,SCS001,SCF015,New,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380007-00,Standard Gold Off Exchange Plan,,0.798534572124481,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$7,450",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,450",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,2,26065,SC,Individual,No,57-0287419,26065SC0380007,BlueEssentials Gold 2,26065SC038,,SCN001,SCS001,SCF015,New,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380007-01,Standard Gold On Exchange Plan,,0.798534572124481,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$7,450",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,450",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,84496,HIOS,2,2014-08-07 10:00:19,1,84496,PA,SHOP (Small Group),Yes,93-0242990,84496PA0030002,EHB High Passive,84496PA003,,PAN001,PAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$42.87,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,84496PA0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,PA,84496,HIOS,2,2014-08-07 10:00:19,1,84496,PA,SHOP (Small Group),Yes,93-0242990,84496PA0030001,EHB Low Passive,84496PA003,,PAN001,PAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.27,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,84496PA0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,1,91303,PA,Individual,No,25-1264318,91303PA0020003,Coventry Bronze $20 Copay HMO,91303PA002,,PAN001,PAS001,PAF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51019,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020003-00,Standard Bronze Off Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,1,91303,PA,Individual,No,25-1264318,91303PA0020003,Coventry Bronze $20 Copay HMO,91303PA002,,PAN001,PAS001,PAF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51019,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020003-01,Standard Bronze On Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,1,91303,PA,Individual,No,25-1264318,91303PA0020003,Coventry Bronze $20 Copay HMO,91303PA002,,PAN001,PAS001,PAF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51019,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,1,91303,PA,Individual,No,25-1264318,91303PA0020003,Coventry Bronze $20 Copay HMO,91303PA002,,PAN001,PAS001,PAF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51019,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020003-03,Limited Cost Sharing Plan Variation,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,3,91303,PA,Individual,No,25-1264318,91303PA0020004,Coventry Bronze Deductible Only HSA Eligible HMO,91303PA002,,PAN001,PAS001,PAF004,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51013,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020004-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,3,91303,PA,Individual,No,25-1264318,91303PA0020004,Coventry Bronze Deductible Only HSA Eligible HMO,91303PA002,,PAN001,PAS001,PAF004,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51013,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020004-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,3,91303,PA,Individual,No,25-1264318,91303PA0020004,Coventry Bronze Deductible Only HSA Eligible HMO,91303PA002,,PAN001,PAS001,PAF004,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51013,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,3,91303,PA,Individual,No,25-1264318,91303PA0020004,Coventry Bronze Deductible Only HSA Eligible HMO,91303PA002,,PAN001,PAS001,PAF004,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51013,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020004-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,5,91303,PA,Individual,No,25-1264318,91303PA0020002,Coventry Silver $10 Copay HMO,91303PA002,,PAN001,PAS001,PAF002,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51002,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020002-01,Standard Silver On Exchange Plan,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,$500,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,5,91303,PA,Individual,No,25-1264318,91303PA0020002,Coventry Silver $10 Copay HMO,91303PA002,,PAN001,PAS001,PAF002,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51002,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,5,91303,PA,Individual,No,25-1264318,91303PA0020002,Coventry Silver $10 Copay HMO,91303PA002,,PAN001,PAS001,PAF002,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51002,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020002-03,Limited Cost Sharing Plan Variation,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,$500,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,5,91303,PA,Individual,No,25-1264318,91303PA0020002,Coventry Silver $10 Copay HMO,91303PA002,,PAN001,PAS001,PAF002,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51002,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020002-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,$500,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,5,91303,PA,Individual,No,25-1264318,91303PA0020002,Coventry Silver $10 Copay HMO,91303PA002,,PAN001,PAS001,PAF002,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51002,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020002-05,87% AV Level Silver Plan,86.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,5,91303,PA,Individual,No,25-1264318,91303PA0020002,Coventry Silver $10 Copay HMO,91303PA002,,PAN001,PAS001,PAF002,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51002,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020002-06,94% AV Level Silver Plan,93.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,7,91303,PA,Individual,No,25-1264318,91303PA0020006,Coventry Silver $5 Copay 2750 HMO,91303PA002,,PAN001,PAS001,PAF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51001,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020006-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,7,91303,PA,Individual,No,25-1264318,91303PA0020006,Coventry Silver $5 Copay 2750 HMO,91303PA002,,PAN001,PAS001,PAF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51001,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020006-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,PA,91303,HIOS,6,2014-09-06 03:39:47,7,91303,PA,Individual,No,25-1264318,91303PA0020006,Coventry Silver $5 Copay 2750 HMO,91303PA002,,PAN001,PAS001,PAF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.997656605215344,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/PA51001,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOPA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,91303PA0020006-04,73% AV Level Silver Plan,72.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,PA,94118,HIOS,2,2014-08-03 08:59:32,1,94118,PA,SHOP (Small Group),Yes,47-0098400,94118PA0030002,EHB High Passive,94118PA003,,PAN001,PAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$42.15,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,94118PA0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,5,26065,SC,Individual,No,57-0287419,26065SC0380004,BlueEssentials Silver 3,26065SC038,,SCN001,SCS001,SCF004,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380004-01,Standard Silver On Exchange Plan,,0.70070868730545,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$9,850",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$5,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,5,26065,SC,Individual,No,57-0287419,26065SC0380004,BlueEssentials Silver 3,26065SC038,,SCN001,SCS001,SCF004,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,8,26065,SC,Individual,No,57-0287419,26065SC0380015,BlueEssentials Silver 7,26065SC038,,SCN001,SCS001,SCF015,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380015-00,Standard Silver Off Exchange Plan,,0.680732071399689,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$11,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$11,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,8,26065,SC,Individual,No,57-0287419,26065SC0380015,BlueEssentials Silver 7,26065SC038,,SCN001,SCS001,SCF015,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380015-01,Standard Silver On Exchange Plan,,0.680732071399689,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$11,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$11,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,PA,94118,HIOS,2,2014-08-03 08:59:32,1,94118,PA,SHOP (Small Group),Yes,47-0098400,94118PA0030001,EHB Low Passive,94118PA003,,PAN001,PAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.86,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,94118PA0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,PA,94365,HIOS,3,2014-09-05 03:32:16,1,94365,PA,SHOP (Small Group),Yes,81-0170040,94365PA0010001,Assurant Dental ACAFFO High,94365PA001,,PAN001,PAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$37.94,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same coverage as in service area,Yes,,,,,94365PA0010001-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,94365,HIOS,3,2014-09-05 03:32:16,2,94365,PA,SHOP (Small Group),Yes,81-0170040,94365PA0010002,Assurant Dental ACAFFO Low,94365PA001,,PAN001,PAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.69,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same coverage as in service area,Yes,,,,,94365PA0010002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,98060,HIOS,3,2014-08-28 04:23:13,1,98060,PA,SHOP (Small Group),Yes,13-5581829,98060PA0170001,EHB Basic Dental Plan (Low),98060PA017,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$21.10,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48055,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48054,,98060PA0170001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,PA,98060,HIOS,3,2014-08-28 04:23:13,1,98060,PA,SHOP (Small Group),Yes,13-5581829,98060PA0170001,EHB Basic Dental Plan (Low),98060PA017,,PAN001,PAS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$21.10,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48055,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48054,,98060PA0170001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,98060,HIOS,3,2014-08-28 04:23:13,2,98060,PA,SHOP (Small Group),Yes,13-5581829,98060PA0180001,EHB Enhanced Dental Plan (High),98060PA018,,PAN002,PAS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$25.96,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49120,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49119,,98060PA0180001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,8,26065,SC,Individual,No,57-0287419,26065SC0380015,BlueEssentials Silver 7,26065SC038,,SCN001,SCS001,SCF015,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380015-04,73% AV Level Silver Plan,,0.732057511806488,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,550",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,8,26065,SC,Individual,No,57-0287419,26065SC0380015,BlueEssentials Silver 7,26065SC038,,SCN001,SCS001,SCF015,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380015-05,87% AV Level Silver Plan,,0.861879408359528,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,150",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,8,26065,SC,Individual,No,57-0287419,26065SC0380015,BlueEssentials Silver 7,26065SC038,,SCN001,SCS001,SCF015,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380015-06,94% AV Level Silver Plan,,0.934555649757385,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$450,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,SC,32899,HIOS,2,2014-08-05 13:28:44,1,32899,SC,SHOP (Small Group),Yes,36-0883760,32899SC0040002,EHB High PPO,32899SC004,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$37.90,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,32899SC0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220034,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS004,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220034-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,13,41614,SC,Individual,No,20-0229117,41614SC0020037,Coventry Silver $10 Copay,41614SC002,,SCN005,SCS005,SCF006,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48210,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020037-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,13,41614,SC,Individual,No,20-0229117,41614SC0020037,Coventry Silver $10 Copay,41614SC002,,SCN005,SCS005,SCF006,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48210,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020037-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,13,41614,SC,Individual,No,20-0229117,41614SC0020037,Coventry Silver $10 Copay,41614SC002,,SCN005,SCS005,SCF006,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48210,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020037-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,8
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,13,41614,SC,Individual,No,20-0229117,41614SC0020037,Coventry Silver $10 Copay,41614SC002,,SCN005,SCS005,SCF006,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48210,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020037-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220013,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS001,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220013-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,PA,98060,HIOS,3,2014-08-28 04:23:13,2,98060,PA,SHOP (Small Group),Yes,13-5581829,98060PA0180001,EHB Enhanced Dental Plan (High),98060PA018,,PAN002,PAS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$25.96,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49120,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49119,,98060PA0180001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,PA,98060,HIOS,3,2014-08-28 04:23:13,3,98060,PA,SHOP (Small Group),Yes,13-5581829,98060PA0190001,Family Basic Dental Plan (Low),98060PA019,,PAN003,PAS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$21.10,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49122,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49121,,98060PA0190001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,SHOP (Small Group),No,57-0287419,26065SC0360001,Business BlueEssentials PPO Gold 1,26065SC036,,SCN002,SCS001,SCF007,Existing,PPO,Gold,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/shop/SBC_2015,https://www.southcarolinablues.com/links/shop/pay,http://www.SouthCarolinaBlues.com/links/metallic/BusinessBlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0360001-00,Standard Gold Off Exchange Plan,,0.789840877056122,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,250",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,350",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380006,BlueEssentials HD Bronze 2,26065SC038,,SCN001,SCS001,SCF014,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380006-00,Standard Bronze Off Exchange Plan,,0.584032356739044,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$8,650",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380006,BlueEssentials HD Bronze 2,26065SC038,,SCN001,SCS001,SCF014,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380006-01,Standard Bronze On Exchange Plan,,0.584032356739044,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$8,650",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,SHOP (Small Group),No,57-0287419,26065SC0360001,Business BlueEssentials PPO Gold 1,26065SC036,,SCN002,SCS001,SCF007,Existing,PPO,Gold,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/shop/SBC_2015,https://www.southcarolinablues.com/links/shop/pay,http://www.SouthCarolinaBlues.com/links/metallic/BusinessBlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0360001-01,Standard Gold On Exchange Plan,,0.789840877056122,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,250",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,350",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,SHOP (Small Group),No,57-0287419,26065SC0360002,Business BlueEssentials PPO Silver 1,26065SC036,,SCN002,SCS001,SCF008,Existing,PPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/shop/SBC_2015,https://www.southcarolinablues.com/links/shop/pay,http://www.SouthCarolinaBlues.com/links/metallic/BusinessBlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0360002-00,Standard Silver Off Exchange Plan,,0.719961881637573,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$3,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380006,BlueEssentials HD Bronze 2,26065SC038,,SCN001,SCS001,SCF014,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380006,BlueEssentials HD Bronze 2,26065SC038,,SCN001,SCS001,SCF014,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380006-03,Limited Cost Sharing Plan Variation,,0.584032356739044,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$8,650",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,SHOP (Small Group),No,57-0287419,26065SC0360002,Business BlueEssentials PPO Silver 1,26065SC036,,SCN002,SCS001,SCF008,Existing,PPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/shop/SBC_2015,https://www.southcarolinablues.com/links/shop/pay,http://www.SouthCarolinaBlues.com/links/metallic/BusinessBlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0360002-01,Standard Silver On Exchange Plan,,0.719961881637573,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$3,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380008,BlueEssentials HD Gold 3,26065SC038,,SCN001,SCS001,SCF006,New,EPO,Gold,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380008-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,250",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,250",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380008,BlueEssentials HD Gold 3,26065SC038,,SCN001,SCS001,SCF006,New,EPO,Gold,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380008-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,250",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,250",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380008,BlueEssentials HD Gold 3,26065SC038,,SCN001,SCS001,SCF006,New,EPO,Gold,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380008,BlueEssentials HD Gold 3,26065SC038,,SCN001,SCS001,SCF006,New,EPO,Gold,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380008-03,Limited Cost Sharing Plan Variation,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,250",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,250",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380010,BlueEssentials HD Silver 5,26065SC038,,SCN001,SCS001,SCF016,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380010-00,Standard Silver Off Exchange Plan,,0.68402636051178,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$9,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,300","$4,300",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380010,BlueEssentials HD Silver 5,26065SC038,,SCN001,SCS001,SCF016,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380010-01,Standard Silver On Exchange Plan,,0.68402636051178,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$9,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,300","$4,300",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380010,BlueEssentials HD Silver 5,26065SC038,,SCN001,SCS001,SCF016,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380010,BlueEssentials HD Silver 5,26065SC038,,SCN001,SCS001,SCF016,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380010-03,Limited Cost Sharing Plan Variation,,0.68402636051178,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$9,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,300","$4,300",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380010,BlueEssentials HD Silver 5,26065SC038,,SCN001,SCS001,SCF016,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380010-04,73% AV Level Silver Plan,,0.721108496189117,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$9,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,050",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380010,BlueEssentials HD Silver 5,26065SC038,,SCN001,SCS001,SCF016,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380010-05,87% AV Level Silver Plan,,0.862293839454651,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,150",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$450,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380010,BlueEssentials HD Silver 5,26065SC038,,SCN001,SCS001,SCF016,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380010-06,94% AV Level Silver Plan,,0.931547224521637,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,150",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380011,BlueEssentials HD Silver 6,26065SC038,,SCN001,SCS001,SCF006,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380011-00,Standard Silver Off Exchange Plan,,0.683036506175995,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$6,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$6,900",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380011,BlueEssentials HD Silver 6,26065SC038,,SCN001,SCS001,SCF006,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380011-01,Standard Silver On Exchange Plan,,0.683036506175995,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$6,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$6,900",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380011,BlueEssentials HD Silver 6,26065SC038,,SCN001,SCS001,SCF006,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,21
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380011,BlueEssentials HD Silver 6,26065SC038,,SCN001,SCS001,SCF006,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380011-03,Limited Cost Sharing Plan Variation,,0.683036506175995,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$6,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$6,900",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380011,BlueEssentials HD Silver 6,26065SC038,,SCN001,SCS001,SCF006,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380011-04,73% AV Level Silver Plan,,0.723027527332306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,900","$5,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380011,BlueEssentials HD Silver 6,26065SC038,,SCN001,SCS001,SCF006,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380011-05,87% AV Level Silver Plan,,0.861683309078217,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150","$2,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,150","$2,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,24
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380011,BlueEssentials HD Silver 6,26065SC038,,SCN001,SCS001,SCF006,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380011-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,250",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,250",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380012,BlueEssentials HD Bronze 3,26065SC038,,SCN001,SCS001,SCF016,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380012-00,Standard Bronze Off Exchange Plan,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$7,100",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,26
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380012,BlueEssentials HD Bronze 3,26065SC038,,SCN001,SCS001,SCF016,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380012-01,Standard Bronze On Exchange Plan,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$7,100",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,27
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380012,BlueEssentials HD Bronze 3,26065SC038,,SCN001,SCS001,SCF016,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,28
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380012,BlueEssentials HD Bronze 3,26065SC038,,SCN001,SCS001,SCF016,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380012-03,Limited Cost Sharing Plan Variation,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$7,100",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,29
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380013,BlueEssentials HD Bronze 4,26065SC038,,SCN001,SCS001,SCF017,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380013-00,Standard Bronze Off Exchange Plan,,0.583911716938019,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$11,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,200","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,30
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,1,26065,SC,Individual,No,57-0287419,26065SC0380013,BlueEssentials HD Bronze 4,26065SC038,,SCN001,SCS001,SCF017,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380013-01,Standard Bronze On Exchange Plan,,0.583911716938019,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$11,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,200","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,31
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,2,26065,SC,Individual,No,57-0287419,26065SC0380007,BlueEssentials Gold 2,26065SC038,,SCN001,SCS001,SCF015,New,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,2,26065,SC,Individual,No,57-0287419,26065SC0380007,BlueEssentials Gold 2,26065SC038,,SCN001,SCS001,SCF015,New,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380007-03,Limited Cost Sharing Plan Variation,,0.798534572124481,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$7,450",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,450",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,2,26065,SC,Individual,No,57-0287419,26065SC0380009,BlueEssentials Silver 4,26065SC038,,SCN001,SCS001,SCF004,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380009-00,Standard Silver Off Exchange Plan,,0.7159423828125,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$12,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900","$3,450",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,2,26065,SC,Individual,No,57-0287419,26065SC0380009,BlueEssentials Silver 4,26065SC038,,SCN001,SCS001,SCF004,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380009-01,Standard Silver On Exchange Plan,,0.7159423828125,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$12,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900","$3,450",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,2,26065,SC,Individual,No,57-0287419,26065SC0380009,BlueEssentials Silver 4,26065SC038,,SCN001,SCS001,SCF004,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380009-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,2,26065,SC,Individual,No,57-0287419,26065SC0380009,BlueEssentials Silver 4,26065SC038,,SCN001,SCS001,SCF004,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380009-03,Limited Cost Sharing Plan Variation,,0.7159423828125,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$12,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900","$3,450",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,2,26065,SC,Individual,No,57-0287419,26065SC0380009,BlueEssentials Silver 4,26065SC038,,SCN001,SCS001,SCF004,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380009-04,73% AV Level Silver Plan,,0.736901462078094,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$9,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900","$3,450",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,2,26065,SC,Individual,No,57-0287419,26065SC0380009,BlueEssentials Silver 4,26065SC038,,SCN001,SCS001,SCF004,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380009-05,87% AV Level Silver Plan,,0.864354431629181,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$3,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$50,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,2,26065,SC,Individual,No,57-0287419,26065SC0380009,BlueEssentials Silver 4,26065SC038,,SCN001,SCS001,SCF004,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380009-06,94% AV Level Silver Plan,,0.930770576000214,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$3,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,3,26065,SC,Individual,No,57-0287419,26065SC0380002,BlueEssentials Silver 1,26065SC038,,SCN001,SCS001,SCF002,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380002-00,Standard Silver Off Exchange Plan,,0.713919937610626,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,3,26065,SC,Individual,No,57-0287419,26065SC0380002,BlueEssentials Silver 1,26065SC038,,SCN001,SCS001,SCF002,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380002-01,Standard Silver On Exchange Plan,,0.713919937610626,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,3,26065,SC,Individual,No,57-0287419,26065SC0380002,BlueEssentials Silver 1,26065SC038,,SCN001,SCS001,SCF002,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,3,26065,SC,Individual,No,57-0287419,26065SC0380002,BlueEssentials Silver 1,26065SC038,,SCN001,SCS001,SCF002,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380002-03,Limited Cost Sharing Plan Variation,,0.713919937610626,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,3,26065,SC,Individual,No,57-0287419,26065SC0380002,BlueEssentials Silver 1,26065SC038,,SCN001,SCS001,SCF002,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380002-04,73% AV Level Silver Plan,,0.734579563140869,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$8,150",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,3,26065,SC,Individual,No,57-0287419,26065SC0380002,BlueEssentials Silver 1,26065SC038,,SCN001,SCS001,SCF002,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380002-05,87% AV Level Silver Plan,,0.864248514175415,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,3,26065,SC,Individual,No,57-0287419,26065SC0380002,BlueEssentials Silver 1,26065SC038,,SCN001,SCS001,SCF002,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380002-06,94% AV Level Silver Plan,,0.930526256561279,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$3,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,4,26065,SC,Individual,No,57-0287419,26065SC0380003,BlueEssentials Silver 2,26065SC038,,SCN001,SCS001,SCF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380003-00,Standard Silver Off Exchange Plan,,0.681290745735168,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$3,650",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,4,26065,SC,Individual,No,57-0287419,26065SC0380003,BlueEssentials Silver 2,26065SC038,,SCN001,SCS001,SCF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380003-01,Standard Silver On Exchange Plan,,0.681290745735168,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$3,650",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,4,26065,SC,Individual,No,57-0287419,26065SC0380003,BlueEssentials Silver 2,26065SC038,,SCN001,SCS001,SCF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,4,26065,SC,Individual,No,57-0287419,26065SC0380003,BlueEssentials Silver 2,26065SC038,,SCN001,SCS001,SCF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380003-03,Limited Cost Sharing Plan Variation,,0.681290745735168,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$3,650",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,4,26065,SC,Individual,No,57-0287419,26065SC0380003,BlueEssentials Silver 2,26065SC038,,SCN001,SCS001,SCF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380003-04,73% AV Level Silver Plan,,0.720782101154327,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$9,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,400",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,4,26065,SC,Individual,No,57-0287419,26065SC0380003,BlueEssentials Silver 2,26065SC038,,SCN001,SCS001,SCF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380003-05,87% AV Level Silver Plan,,0.862378120422363,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$350,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,4,26065,SC,Individual,No,57-0287419,26065SC0380003,BlueEssentials Silver 2,26065SC038,,SCN001,SCS001,SCF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380003-06,94% AV Level Silver Plan,,0.930801510810852,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$2,950",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,5,26065,SC,Individual,No,57-0287419,26065SC0380004,BlueEssentials Silver 3,26065SC038,,SCN001,SCS001,SCF004,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380004-00,Standard Silver Off Exchange Plan,,0.70070868730545,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$9,850",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$5,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,8,26065,SC,Individual,No,57-0287419,26065SC0380015,BlueEssentials Silver 7,26065SC038,,SCN001,SCS001,SCF015,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SC,26065,HIOS,10,2014-10-05 17:13:14,8,26065,SC,Individual,No,57-0287419,26065SC0380015,BlueEssentials Silver 7,26065SC038,,SCN001,SCS001,SCF015,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0380015-03,Limited Cost Sharing Plan Variation,,0.680732071399689,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$11,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$11,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220005,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS005,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220005-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220005,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS005,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,34
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220004,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS004,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220004-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220005,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS005,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220005-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220006,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS006,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220006-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220006,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS006,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,38
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220012,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS006,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220012-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,93
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220010,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS004,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220010-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,79
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220011,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS005,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220011-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,80
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220005,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS005,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220005-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220006,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS006,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220006-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220006,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS006,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220006-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220012,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS006,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220012-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,91
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220012,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS006,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220012-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,92
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220007,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS001,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,54
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220007,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS001,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220007-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,55
2015,SC,32899,HIOS,2,2014-08-05 13:28:44,1,32899,SC,SHOP (Small Group),Yes,36-0883760,32899SC0040001,EHB Low PPO,32899SC004,,SCN001,SCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.47,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,32899SC0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,32899,HIOS,2,2014-08-05 13:28:44,1,32899,SC,SHOP (Small Group),Yes,36-0883760,32899SC0030002,EHB High Passive,32899SC003,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.60,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,32899SC0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SC,32899,HIOS,2,2014-08-05 13:28:44,1,32899,SC,SHOP (Small Group),Yes,36-0883760,32899SC0030001,EHB Low Passive,32899SC003,,SCN001,SCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.67,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,32899SC0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220001,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS001,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220001-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220001,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS001,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220001-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220001,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS001,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,18
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220001,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS001,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220001-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220002,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS002,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220002-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220002,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS002,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220002-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220002,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS002,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,22
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220002,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS002,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220002-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220003,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS003,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220003-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220003,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS003,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220003-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220003,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS003,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,26
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220003,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS003,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220003-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220004,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS004,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220004-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220004,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS004,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220004-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220004,Assurant Health Bronze Plan 001,39996SC022,,SCN001,SCS004,SCF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,30
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220017,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS005,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220017-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220018,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS006,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220018-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220015,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS003,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220015-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220015,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS003,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220015-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,26
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220015,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS003,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220015-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220016,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS004,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220016-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220016,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS004,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220016-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220016,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS004,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220016-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,30
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220016,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS004,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220016-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220017,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS005,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220017-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220007,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS001,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220007-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,52
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220007,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS001,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220007-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,53
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220007,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS001,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220007-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220007,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS001,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220007-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,57
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220007,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS001,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220007-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,58
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220008,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS002,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220008-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,59
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220008,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS002,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220008-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,60
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220008,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS002,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,61
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220008,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS002,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220008-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,62
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220008,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS002,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220008-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,63
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220008,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS002,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220008-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,64
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220008,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS002,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220008-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,65
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220009,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS003,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220009-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,66
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220009,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS003,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220009-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,67
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220009,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS003,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,68
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220009,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS003,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220009-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,69
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220009,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS003,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220009-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,70
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220009,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS003,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220009-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,71
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220009,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS003,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220009-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,72
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220010,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS004,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220010-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,73
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220010,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS004,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220010-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,74
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220010,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS004,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,75
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220010,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS004,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220010-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,76
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220010,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS004,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220010-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,77
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220010,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS004,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220010-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,78
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220011,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS005,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220011-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,81
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220011,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS005,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,82
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220011,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS005,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220011-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,83
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220011,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS005,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220011-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,84
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220011,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS005,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220011-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,85
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220011,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS005,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220011-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,86
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220012,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS006,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220012-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,87
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220012,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS006,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220012-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,88
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220012,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS006,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,89
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,1,39996,SC,Individual,No,39-0658730,39996SC0220012,Assurant Health Silver Plan 001,39996SC022,,SCN001,SCS006,SCF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220012-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,90
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220018,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS006,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220018-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220018,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS006,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220018-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,38
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220018,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS006,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220018-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220022,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS004,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220022-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220027,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS003,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220027-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,92
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220036,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS006,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220036-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,1,41614,SC,Individual,No,20-0229117,41614SC0020082,Coventry Bronze $15 Copay Carolinas HealthCare,41614SC002,,SCN011,SCS011,SCF026,New,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48222,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020082-00,Standard Bronze Off Exchange Plan,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,1,41614,SC,Individual,No,20-0229117,41614SC0020082,Coventry Bronze $15 Copay Carolinas HealthCare,41614SC002,,SCN011,SCS011,SCF026,New,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48222,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020082-01,Standard Bronze On Exchange Plan,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,1,41614,SC,Individual,No,20-0229117,41614SC0020082,Coventry Bronze $15 Copay Carolinas HealthCare,41614SC002,,SCN011,SCS011,SCF026,New,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48222,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020082-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220014,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS002,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220014-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220014,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS002,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220014-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,22
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220014,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS002,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220014-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220015,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS003,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220015-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220033,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS003,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220033-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220013,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS001,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220013-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220013,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS001,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220013-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,18
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220013,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS001,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220013-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220014,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS002,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220014-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220029,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS005,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220029-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,98
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220029,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS005,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220029-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,99
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220029,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS005,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220029-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,100
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220029,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS005,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220029-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,101
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,3,41614,SC,Individual,No,20-0229117,41614SC0020043,Coventry Bronze $15 Copay Regional HealthPlus,41614SC002,,SCN007,SCS007,SCF012,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48266,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020043-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,3,41614,SC,Individual,No,20-0229117,41614SC0020043,Coventry Bronze $15 Copay Regional HealthPlus,41614SC002,,SCN007,SCS007,SCF012,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48266,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020043-03,Limited Cost Sharing Plan Variation,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,15,41614,SC,Individual,No,20-0229117,41614SC0020040,Coventry Silver $10 Copay Midlands,41614SC002,,SCN010,SCS010,SCF009,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48254,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020040-01,Standard Silver On Exchange Plan,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,15,41614,SC,Individual,No,20-0229117,41614SC0020040,Coventry Silver $10 Copay Midlands,41614SC002,,SCN010,SCS010,SCF009,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48254,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020040-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220022,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS004,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220022-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,42
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220022,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS004,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220022-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,43
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220023,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS005,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220023-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220023,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS005,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220023-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220017,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS005,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220017-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,4,39996,SC,Individual,No,39-0658730,39996SC0220017,Assurant Health Bronze Plan 002,39996SC022,,SCN001,SCS005,SCF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,39996SC0220017-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,34
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220019,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS001,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220019-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220019,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS001,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220019-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220019,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS001,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220019-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,18
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220019,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS001,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220019-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220019,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS001,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220019-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220019,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS001,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220019-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220019,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS001,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220019-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220020,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS002,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220020-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220020,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS002,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220020-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220020,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS002,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220020-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,25
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220020,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS002,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220020-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220020,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS002,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220020-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220020,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS002,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220020-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220020,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS002,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220020-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220021,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS003,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220021-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220021,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS003,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220021-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220021,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS003,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220021-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,32
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220021,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS003,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220021-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220021,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS003,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220021-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220021,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS003,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220021-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220021,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS003,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220021-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220022,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS004,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220022-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220022,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS004,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220022-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220022,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS004,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220022-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,39
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220022,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS004,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220022-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,1,41614,SC,Individual,No,20-0229117,41614SC0020082,Coventry Bronze $15 Copay Carolinas HealthCare,41614SC002,,SCN011,SCS011,SCF026,New,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48222,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020082-03,Limited Cost Sharing Plan Variation,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,2,41614,SC,Individual,No,20-0229117,41614SC0020045,Coventry Bronze $15 Copay Midlands,41614SC002,,SCN010,SCS010,SCF014,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48244,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020045-00,Standard Bronze Off Exchange Plan,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,2,41614,SC,Individual,No,20-0229117,41614SC0020045,Coventry Bronze $15 Copay Midlands,41614SC002,,SCN010,SCS010,SCF014,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48244,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020045-01,Standard Bronze On Exchange Plan,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,2,41614,SC,Individual,No,20-0229117,41614SC0020045,Coventry Bronze $15 Copay Midlands,41614SC002,,SCN010,SCS010,SCF014,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48244,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020045-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,2,41614,SC,Individual,No,20-0229117,41614SC0020045,Coventry Bronze $15 Copay Midlands,41614SC002,,SCN010,SCS010,SCF014,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48244,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020045-03,Limited Cost Sharing Plan Variation,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,3,41614,SC,Individual,No,20-0229117,41614SC0020043,Coventry Bronze $15 Copay Regional HealthPlus,41614SC002,,SCN007,SCS007,SCF012,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48266,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020043-00,Standard Bronze Off Exchange Plan,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,3,41614,SC,Individual,No,20-0229117,41614SC0020043,Coventry Bronze $15 Copay Regional HealthPlus,41614SC002,,SCN007,SCS007,SCF012,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48266,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020043-01,Standard Bronze On Exchange Plan,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,4,41614,SC,Individual,No,20-0229117,41614SC0020044,Coventry Bronze $15 Copay Roper St. Francis,41614SC002,,SCN008,SCS008,SCF013,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48288,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020044-00,Standard Bronze Off Exchange Plan,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,14,41614,SC,Individual,No,20-0229117,41614SC0020086,Coventry Silver $10 Copay Carolinas HealthCare,41614SC002,,SCN011,SCS011,SCF030,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48232,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020086-05,87% AV Level Silver Plan,86.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,"$1,500","$3,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,14,41614,SC,Individual,No,20-0229117,41614SC0020086,Coventry Silver $10 Copay Carolinas HealthCare,41614SC002,,SCN011,SCS011,SCF030,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48232,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020086-06,94% AV Level Silver Plan,93.10%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,$0,$0,20%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,Not Applicable,Not Applicable,20%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,15,41614,SC,Individual,No,20-0229117,41614SC0020040,Coventry Silver $10 Copay Midlands,41614SC002,,SCN010,SCS010,SCF009,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48254,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020040-00,Standard Silver Off Exchange Plan,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,15,41614,SC,Individual,No,20-0229117,41614SC0020040,Coventry Silver $10 Copay Midlands,41614SC002,,SCN010,SCS010,SCF009,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48254,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020040-03,Limited Cost Sharing Plan Variation,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,15,41614,SC,Individual,No,20-0229117,41614SC0020040,Coventry Silver $10 Copay Midlands,41614SC002,,SCN010,SCS010,SCF009,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48254,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020040-04,73% AV Level Silver Plan,72.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$5,000","$10,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,8
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,15,41614,SC,Individual,No,20-0229117,41614SC0020040,Coventry Silver $10 Copay Midlands,41614SC002,,SCN010,SCS010,SCF009,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48254,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020040-05,87% AV Level Silver Plan,86.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,"$1,500","$3,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220027,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS003,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220027-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,93
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220028,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS004,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220028-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,94
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220028,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS004,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220028-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,95
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220028,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS004,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220028-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,96
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220028,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS004,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220028-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,97
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220023,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS005,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220023-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,46
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220023,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS005,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220023-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,47
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220023,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS005,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220023-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220023,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS005,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220023-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220023,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS005,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220023-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,50
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220024,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS006,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220024-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,51
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220024,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS006,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220024-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,52
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220024,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS006,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220024-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,53
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220024,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS006,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220024-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,54
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220024,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS006,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220024-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,55
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220024,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS006,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220024-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220024,Assurant Health Silver Plan 002,39996SC022,,SCN001,SCS006,SCF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220024-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,57
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220025,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS001,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220025-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,82
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220025,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS001,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220025-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,83
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220025,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS001,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220025-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,84
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220025,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS001,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220025-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,85
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220026,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS002,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220026-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,86
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220026,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS002,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220026-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,87
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220026,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS002,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220026-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,88
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220026,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS002,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220026-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,89
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220027,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS003,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220027-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,90
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220027,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS003,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220027-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,91
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220030,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS006,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220030-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,102
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220030,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS006,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220030-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,103
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220030,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS006,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220030-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,104
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,6,39996,SC,Individual,No,39-0658730,39996SC0220030,Assurant Health Gold Plan 002,39996SC022,,SCN001,SCS006,SCF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220030-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,105
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220031,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS001,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220031-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220031,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS001,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220031-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220031,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS001,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220031-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,18
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220031,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS001,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220031-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220032,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS002,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220032-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220032,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS002,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220032-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220032,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS002,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220032-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,22
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220032,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS002,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220032-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220033,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS003,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220033-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220033,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS003,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220033-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220033,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS003,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220033-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,26
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220034,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS004,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220034-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220034,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS004,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220034-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,30
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220034,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS004,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220034-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220035,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS005,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220035-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220035,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS005,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220035-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220035,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS005,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220035-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,34
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220035,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS005,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220035-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220036,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS006,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220036-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220036,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS006,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220036-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,SC,39996,HIOS,5,2014-11-13 10:25:37,7,39996,SC,Individual,No,39-0658730,39996SC0220036,Assurant Health Platinum Plan 002,39996SC022,,SCN001,SCS006,SCF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_SC_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-SC.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,39996SC0220036-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,38
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,16,41614,SC,Individual,No,20-0229117,41614SC0020038,Coventry Silver $10 Copay Regional HealthPlus,41614SC002,,SCN007,SCS007,SCF007,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48276,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020038-03,Limited Cost Sharing Plan Variation,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,24,41614,SC,Individual,No,20-0229117,41614SC0020092,Coventry Silver $5 Copay 2750 Upstate,41614SC002,,SCN009,SCS009,SCF036,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48826,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020092-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,23,41614,SC,Individual,No,20-0229117,41614SC0020091,Coventry Silver $5 Copay 2750 Roper St. Francis,41614SC002,,SCN008,SCS008,SCF035,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48806,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020091-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,23,41614,SC,Individual,No,20-0229117,41614SC0020091,Coventry Silver $5 Copay 2750 Roper St. Francis,41614SC002,,SCN008,SCS008,SCF035,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48806,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020091-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$4,500","$9,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,23,41614,SC,Individual,No,20-0229117,41614SC0020091,Coventry Silver $5 Copay 2750 Roper St. Francis,41614SC002,,SCN008,SCS008,SCF035,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48806,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020091-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,"$1,500","$3,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,23,41614,SC,Individual,No,20-0229117,41614SC0020091,Coventry Silver $5 Copay 2750 Roper St. Francis,41614SC002,,SCN008,SCS008,SCF035,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48806,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020091-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,24,41614,SC,Individual,No,20-0229117,41614SC0020092,Coventry Silver $5 Copay 2750 Upstate,41614SC002,,SCN009,SCS009,SCF036,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48826,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020092-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,15,41614,SC,Individual,No,20-0229117,41614SC0020040,Coventry Silver $10 Copay Midlands,41614SC002,,SCN010,SCS010,SCF009,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48254,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020040-06,94% AV Level Silver Plan,93.10%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,$0,$0,20%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,Not Applicable,Not Applicable,20%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,16,41614,SC,Individual,No,20-0229117,41614SC0020038,Coventry Silver $10 Copay Regional HealthPlus,41614SC002,,SCN007,SCS007,SCF007,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48276,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020038-00,Standard Silver Off Exchange Plan,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,23,41614,SC,Individual,No,20-0229117,41614SC0020091,Coventry Silver $5 Copay 2750 Roper St. Francis,41614SC002,,SCN008,SCS008,SCF035,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48806,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020091-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,23,41614,SC,Individual,No,20-0229117,41614SC0020091,Coventry Silver $5 Copay 2750 Roper St. Francis,41614SC002,,SCN008,SCS008,SCF035,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48806,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020091-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,24,41614,SC,Individual,No,20-0229117,41614SC0020092,Coventry Silver $5 Copay 2750 Upstate,41614SC002,,SCN009,SCS009,SCF036,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48826,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020092-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,2,49532,SC,Individual,No,57-0768835,49532SC0380003,Blue Option Bronze 6350,49532SC038,,SCN001,SCS001,SCF003,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9952,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380003-03,Limited Cost Sharing Plan Variation,,0.6043940782547,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$10,950",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$10,950",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,2,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370005,Business Advantage Silver 1750 HD,49532SC037,,SCN002,SCS001,SCF003,Existing,PPO,Silver,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Silver1750HD,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370005-00,Standard Silver Off Exchange Plan,,0.68342000246048,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,150",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,2,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370005,Business Advantage Silver 1750 HD,49532SC037,,SCN002,SCS001,SCF003,Existing,PPO,Silver,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Silver1750HD,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370005-01,Standard Silver On Exchange Plan,,0.68342000246048,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,150",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,2,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370013,Business Advantage Silver 3500 HD,49532SC037,,SCN002,SCS001,SCF003,New,PPO,Silver,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9963,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Silver3500HD,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370013-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$6,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$6,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,24,41614,SC,Individual,No,20-0229117,41614SC0020092,Coventry Silver $5 Copay 2750 Upstate,41614SC002,,SCN009,SCS009,SCF036,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48826,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020092-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,4,41614,SC,Individual,No,20-0229117,41614SC0020044,Coventry Bronze $15 Copay Roper St. Francis,41614SC002,,SCN008,SCS008,SCF013,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48288,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020044-01,Standard Bronze On Exchange Plan,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,4,41614,SC,Individual,No,20-0229117,41614SC0020044,Coventry Bronze $15 Copay Roper St. Francis,41614SC002,,SCN008,SCS008,SCF013,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48288,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020044-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,4,41614,SC,Individual,No,20-0229117,41614SC0020044,Coventry Bronze $15 Copay Roper St. Francis,41614SC002,,SCN008,SCS008,SCF013,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48288,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020044-03,Limited Cost Sharing Plan Variation,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,5,41614,SC,Individual,No,20-0229117,41614SC0020046,Coventry Bronze $15 Copay Upstate,41614SC002,,SCN009,SCS009,SCF015,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48810,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020046-00,Standard Bronze Off Exchange Plan,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,5,41614,SC,Individual,No,20-0229117,41614SC0020046,Coventry Bronze $15 Copay Upstate,41614SC002,,SCN009,SCS009,SCF015,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48810,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020046-01,Standard Bronze On Exchange Plan,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,5,41614,SC,Individual,No,20-0229117,41614SC0020046,Coventry Bronze $15 Copay Upstate,41614SC002,,SCN009,SCS009,SCF015,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48810,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020046-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,5,41614,SC,Individual,No,20-0229117,41614SC0020046,Coventry Bronze $15 Copay Upstate,41614SC002,,SCN009,SCS009,SCF015,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48810,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020046-03,Limited Cost Sharing Plan Variation,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,6,41614,SC,Individual,No,20-0229117,41614SC0020042,Coventry Bronze $20 Copay,41614SC002,,SCN005,SCS005,SCF011,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48200,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020042-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,6,41614,SC,Individual,No,20-0229117,41614SC0020042,Coventry Bronze $20 Copay,41614SC002,,SCN005,SCS005,SCF011,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48200,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020042-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,6,41614,SC,Individual,No,20-0229117,41614SC0020042,Coventry Bronze $20 Copay,41614SC002,,SCN005,SCS005,SCF011,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48200,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020042-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,6,41614,SC,Individual,No,20-0229117,41614SC0020042,Coventry Bronze $20 Copay,41614SC002,,SCN005,SCS005,SCF011,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48200,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020042-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,7,41614,SC,Individual,No,20-0229117,41614SC0020083,Coventry Bronze Ded Only HSA Elig Carolinas Healt,41614SC002,,SCN006,SCS006,SCF027,New,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48225,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020083-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,7,41614,SC,Individual,No,20-0229117,41614SC0020083,Coventry Bronze Ded Only HSA Elig Carolinas Healt,41614SC002,,SCN006,SCS006,SCF027,New,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48225,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020083-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,7,41614,SC,Individual,No,20-0229117,41614SC0020083,Coventry Bronze Ded Only HSA Elig Carolinas Healt,41614SC002,,SCN006,SCS006,SCF027,New,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48225,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020083-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,7,41614,SC,Individual,No,20-0229117,41614SC0020083,Coventry Bronze Ded Only HSA Elig Carolinas Healt,41614SC002,,SCN006,SCS006,SCF027,New,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48225,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020083-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,8,41614,SC,Individual,No,20-0229117,41614SC0020048,Coventry Bronze Ded Only HSA Elig Regional HealthPlus,41614SC002,,SCN001,SCS001,SCF017,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48269,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020048-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,8,41614,SC,Individual,No,20-0229117,41614SC0020048,Coventry Bronze Ded Only HSA Elig Regional HealthPlus,41614SC002,,SCN001,SCS001,SCF017,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48269,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020048-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,8,41614,SC,Individual,No,20-0229117,41614SC0020048,Coventry Bronze Ded Only HSA Elig Regional HealthPlus,41614SC002,,SCN001,SCS001,SCF017,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48269,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020048-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,8,41614,SC,Individual,No,20-0229117,41614SC0020048,Coventry Bronze Ded Only HSA Elig Regional HealthPlus,41614SC002,,SCN001,SCS001,SCF017,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48269,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020048-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,9,41614,SC,Individual,No,20-0229117,41614SC0020050,Coventry Bronze Ded Only HSA Eligible Midlands,41614SC002,,SCN004,SCS004,SCF019,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48247,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020050-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,9,41614,SC,Individual,No,20-0229117,41614SC0020050,Coventry Bronze Ded Only HSA Eligible Midlands,41614SC002,,SCN004,SCS004,SCF019,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48247,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020050-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,9,41614,SC,Individual,No,20-0229117,41614SC0020050,Coventry Bronze Ded Only HSA Eligible Midlands,41614SC002,,SCN004,SCS004,SCF019,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48247,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020050-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,9,41614,SC,Individual,No,20-0229117,41614SC0020050,Coventry Bronze Ded Only HSA Eligible Midlands,41614SC002,,SCN004,SCS004,SCF019,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48247,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020050-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,10,41614,SC,Individual,No,20-0229117,41614SC0020049,Coventry Bronze Ded Only HSA Eligible Roper St. Francis,41614SC002,,SCN002,SCS002,SCF018,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48291,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020049-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,10,41614,SC,Individual,No,20-0229117,41614SC0020049,Coventry Bronze Ded Only HSA Eligible Roper St. Francis,41614SC002,,SCN002,SCS002,SCF018,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48291,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020049-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,10,41614,SC,Individual,No,20-0229117,41614SC0020049,Coventry Bronze Ded Only HSA Eligible Roper St. Francis,41614SC002,,SCN002,SCS002,SCF018,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48291,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020049-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,10,41614,SC,Individual,No,20-0229117,41614SC0020049,Coventry Bronze Ded Only HSA Eligible Roper St. Francis,41614SC002,,SCN002,SCS002,SCF018,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48291,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020049-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,11,41614,SC,Individual,No,20-0229117,41614SC0020051,Coventry Bronze Ded Only HSA Eligible Upstate,41614SC002,,SCN003,SCS003,SCF020,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48813,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020051-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,11,41614,SC,Individual,No,20-0229117,41614SC0020051,Coventry Bronze Ded Only HSA Eligible Upstate,41614SC002,,SCN003,SCS003,SCF020,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48813,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020051-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,11,41614,SC,Individual,No,20-0229117,41614SC0020051,Coventry Bronze Ded Only HSA Eligible Upstate,41614SC002,,SCN003,SCS003,SCF020,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48813,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020051-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,11,41614,SC,Individual,No,20-0229117,41614SC0020051,Coventry Bronze Ded Only HSA Eligible Upstate,41614SC002,,SCN003,SCS003,SCF020,Existing,HMO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48813,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020051-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,12,41614,SC,Individual,No,20-0229117,41614SC0020047,Coventry Bronze Deductible Only HSA Eligible,41614SC002,,SCN005,SCS005,SCF016,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48203,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020047-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,12,41614,SC,Individual,No,20-0229117,41614SC0020047,Coventry Bronze Deductible Only HSA Eligible,41614SC002,,SCN005,SCS005,SCF016,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48203,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020047-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,12,41614,SC,Individual,No,20-0229117,41614SC0020047,Coventry Bronze Deductible Only HSA Eligible,41614SC002,,SCN005,SCS005,SCF016,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48203,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020047-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,12,41614,SC,Individual,No,20-0229117,41614SC0020047,Coventry Bronze Deductible Only HSA Eligible,41614SC002,,SCN005,SCS005,SCF016,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48203,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020047-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,13,41614,SC,Individual,No,20-0229117,41614SC0020037,Coventry Silver $10 Copay,41614SC002,,SCN005,SCS005,SCF006,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48210,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020037-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,13,41614,SC,Individual,No,20-0229117,41614SC0020037,Coventry Silver $10 Copay,41614SC002,,SCN005,SCS005,SCF006,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48210,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020037-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,13,41614,SC,Individual,No,20-0229117,41614SC0020037,Coventry Silver $10 Copay,41614SC002,,SCN005,SCS005,SCF006,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48210,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020037-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,14,41614,SC,Individual,No,20-0229117,41614SC0020086,Coventry Silver $10 Copay Carolinas HealthCare,41614SC002,,SCN011,SCS011,SCF030,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48232,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020086-00,Standard Silver Off Exchange Plan,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,14,41614,SC,Individual,No,20-0229117,41614SC0020086,Coventry Silver $10 Copay Carolinas HealthCare,41614SC002,,SCN011,SCS011,SCF030,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48232,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020086-01,Standard Silver On Exchange Plan,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,14,41614,SC,Individual,No,20-0229117,41614SC0020086,Coventry Silver $10 Copay Carolinas HealthCare,41614SC002,,SCN011,SCS011,SCF030,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48232,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020086-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,21,41614,SC,Individual,No,20-0229117,41614SC0020089,Coventry Silver $5 Copay 2750 Midlands,41614SC002,,SCN010,SCS010,SCF033,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48260,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020089-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,21,41614,SC,Individual,No,20-0229117,41614SC0020089,Coventry Silver $5 Copay 2750 Midlands,41614SC002,,SCN010,SCS010,SCF033,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48260,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020089-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,21,41614,SC,Individual,No,20-0229117,41614SC0020089,Coventry Silver $5 Copay 2750 Midlands,41614SC002,,SCN010,SCS010,SCF033,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48260,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020089-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,21,41614,SC,Individual,No,20-0229117,41614SC0020089,Coventry Silver $5 Copay 2750 Midlands,41614SC002,,SCN010,SCS010,SCF033,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48260,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020089-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$4,500","$9,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,21,41614,SC,Individual,No,20-0229117,41614SC0020089,Coventry Silver $5 Copay 2750 Midlands,41614SC002,,SCN010,SCS010,SCF033,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48260,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020089-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,"$1,500","$3,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,21,41614,SC,Individual,No,20-0229117,41614SC0020089,Coventry Silver $5 Copay 2750 Midlands,41614SC002,,SCN010,SCS010,SCF033,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48260,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020089-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,22,41614,SC,Individual,No,20-0229117,41614SC0020090,Coventry Silver $5 Copay 2750 Regional HealthPlus,41614SC002,,SCN007,SCS007,SCF034,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48284,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020090-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,22,41614,SC,Individual,No,20-0229117,41614SC0020090,Coventry Silver $5 Copay 2750 Regional HealthPlus,41614SC002,,SCN007,SCS007,SCF034,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48284,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020090-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,22,41614,SC,Individual,No,20-0229117,41614SC0020090,Coventry Silver $5 Copay 2750 Regional HealthPlus,41614SC002,,SCN007,SCS007,SCF034,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48284,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020090-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,22,41614,SC,Individual,No,20-0229117,41614SC0020090,Coventry Silver $5 Copay 2750 Regional HealthPlus,41614SC002,,SCN007,SCS007,SCF034,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48284,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020090-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,34,41614,SC,Individual,No,20-0229117,41614SC0020053,Coventry Catastrophic 100% Regional HealthPlus,41614SC002,,SCN001,SCS001,SCF022,Existing,HMO,Catastrophic,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48272,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020053-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,34,41614,SC,Individual,No,20-0229117,41614SC0020053,Coventry Catastrophic 100% Regional HealthPlus,41614SC002,,SCN001,SCS001,SCF022,Existing,HMO,Catastrophic,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48272,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020053-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,14,41614,SC,Individual,No,20-0229117,41614SC0020086,Coventry Silver $10 Copay Carolinas HealthCare,41614SC002,,SCN011,SCS011,SCF030,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48232,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020086-03,Limited Cost Sharing Plan Variation,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,14,41614,SC,Individual,No,20-0229117,41614SC0020086,Coventry Silver $10 Copay Carolinas HealthCare,41614SC002,,SCN011,SCS011,SCF030,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48232,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020086-04,73% AV Level Silver Plan,72.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$5,000","$10,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,8
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,16,41614,SC,Individual,No,20-0229117,41614SC0020038,Coventry Silver $10 Copay Regional HealthPlus,41614SC002,,SCN007,SCS007,SCF007,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48276,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020038-01,Standard Silver On Exchange Plan,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,16,41614,SC,Individual,No,20-0229117,41614SC0020038,Coventry Silver $10 Copay Regional HealthPlus,41614SC002,,SCN007,SCS007,SCF007,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48276,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020038-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,24,41614,SC,Individual,No,20-0229117,41614SC0020092,Coventry Silver $5 Copay 2750 Upstate,41614SC002,,SCN009,SCS009,SCF036,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48826,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020092-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$4,500","$9,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,24,41614,SC,Individual,No,20-0229117,41614SC0020092,Coventry Silver $5 Copay 2750 Upstate,41614SC002,,SCN009,SCS009,SCF036,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48826,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020092-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,"$1,500","$3,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,24,41614,SC,Individual,No,20-0229117,41614SC0020092,Coventry Silver $5 Copay 2750 Upstate,41614SC002,,SCN009,SCS009,SCF036,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48826,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020092-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,25,41614,SC,Individual,No,20-0229117,41614SC0020085,Coventry Gold $0 Copay Carolinas HealthCare,41614SC002,,SCN011,SCS011,SCF029,New,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48229,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020085-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$0,20%,$0,$0,40%,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,4
2015,SC,47973,HIOS,4,2014-09-04 03:25:43,1,47973,SC,SHOP (Small Group),Yes,57-0523959,47973SC0020002,Group Pediatric EHB Rider,47973SC002,,SCN001,SCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$28.83,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximums,Yes,Traditional with inside maximums,No,,,,,47973SC0020002-00,Standard Low Off Exchange Plan,70.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,47973,HIOS,4,2014-09-04 03:25:43,1,47973,SC,Individual,Yes,57-0523959,47973SC0040002,Group Pediatric EHB Rider,47973SC004,,SCN001,SCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$28.83,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximums,Yes,Traditional with inside maximums,No,,,,,47973SC0040002-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,47973,HIOS,4,2014-09-04 03:25:43,2,47973,SC,SHOP (Small Group),Yes,57-0523959,47973SC0030001,Group Child Only EHB Policy,47973SC003,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$37.35,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximums,Yes,Traditional with inside maximums,No,,,,,47973SC0030001-00,Standard High Off Exchange Plan,85.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,47973,HIOS,4,2014-09-04 03:25:43,2,47973,SC,SHOP (Small Group),Yes,57-0523959,47973SC0030002,Group Child Only EHB Policy,47973SC003,,SCN001,SCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$30.12,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximums,Yes,Traditional with inside maximums,No,,,,,47973SC0030002-00,Standard Low Off Exchange Plan,70.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370001,Business Advantage Bronze 3800,49532SC037,,SCN002,SCS001,SCF018,Existing,PPO,Bronze,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9956,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/bronze3800,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370001-00,Standard Bronze Off Exchange Plan,,0.619742929935455,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,800","$6,750",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,3,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370004,Business Advantage Silver 2001,49532SC037,,SCN002,SCS001,SCF020,Existing,PPO,Silver,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Silver2001,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370004-01,Standard Silver On Exchange Plan,,0.71983402967453,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,900","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$3,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,3,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370012,Business Advantage Silver 2500,49532SC037,,SCN002,SCS001,SCF021,New,PPO,Silver,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Silver2500,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370012-00,Standard Silver Off Exchange Plan,,0.715049207210541,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$11,150",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$4,650",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,Individual,No,57-0768835,49532SC0380018,Blue Option Gold 800,49532SC038,,SCN001,SCS001,SCF016,New,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9966,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380018-03,Limited Cost Sharing Plan Variation,,0.792466819286346,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$6,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$800,"$1,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,6,49532,SC,Individual,No,57-0768835,49532SC0380016,Blue Option Silver 6000,49532SC038,,SCN001,SCS001,SCF013,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9956,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380016-00,Standard Silver Off Exchange Plan,,0.680205464363098,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$11,100",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,25,41614,SC,Individual,No,20-0229117,41614SC0020085,Coventry Gold $0 Copay Carolinas HealthCare,41614SC002,,SCN011,SCS011,SCF029,New,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48229,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020085-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$0,20%,$0,$0,40%,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,25,41614,SC,Individual,No,20-0229117,41614SC0020085,Coventry Gold $0 Copay Carolinas HealthCare,41614SC002,,SCN011,SCS011,SCF029,New,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48229,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020085-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,25,41614,SC,Individual,No,20-0229117,41614SC0020085,Coventry Gold $0 Copay Carolinas HealthCare,41614SC002,,SCN011,SCS011,SCF029,New,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48229,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020085-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$0,20%,$0,$0,40%,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,16,41614,SC,Individual,No,20-0229117,41614SC0020038,Coventry Silver $10 Copay Regional HealthPlus,41614SC002,,SCN007,SCS007,SCF007,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48276,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020038-04,73% AV Level Silver Plan,72.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$5,000","$10,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,8
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,16,41614,SC,Individual,No,20-0229117,41614SC0020038,Coventry Silver $10 Copay Regional HealthPlus,41614SC002,,SCN007,SCS007,SCF007,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48276,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020038-05,87% AV Level Silver Plan,86.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,"$1,500","$3,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,16,41614,SC,Individual,No,20-0229117,41614SC0020038,Coventry Silver $10 Copay Regional HealthPlus,41614SC002,,SCN007,SCS007,SCF007,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48276,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020038-06,94% AV Level Silver Plan,93.10%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,$0,$0,20%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,Not Applicable,Not Applicable,20%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,17,41614,SC,Individual,No,20-0229117,41614SC0020039,Coventry Silver $10 Copay Roper St. Francis,41614SC002,,SCN008,SCS008,SCF008,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48298,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020039-00,Standard Silver Off Exchange Plan,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,17,41614,SC,Individual,No,20-0229117,41614SC0020039,Coventry Silver $10 Copay Roper St. Francis,41614SC002,,SCN008,SCS008,SCF008,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48298,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020039-01,Standard Silver On Exchange Plan,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,17,41614,SC,Individual,No,20-0229117,41614SC0020039,Coventry Silver $10 Copay Roper St. Francis,41614SC002,,SCN008,SCS008,SCF008,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48298,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020039-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,17,41614,SC,Individual,No,20-0229117,41614SC0020039,Coventry Silver $10 Copay Roper St. Francis,41614SC002,,SCN008,SCS008,SCF008,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48298,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020039-03,Limited Cost Sharing Plan Variation,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,17,41614,SC,Individual,No,20-0229117,41614SC0020039,Coventry Silver $10 Copay Roper St. Francis,41614SC002,,SCN008,SCS008,SCF008,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48298,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020039-04,73% AV Level Silver Plan,72.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$5,000","$10,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,8
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,17,41614,SC,Individual,No,20-0229117,41614SC0020039,Coventry Silver $10 Copay Roper St. Francis,41614SC002,,SCN008,SCS008,SCF008,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48298,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020039-05,87% AV Level Silver Plan,86.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,"$1,500","$3,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,17,41614,SC,Individual,No,20-0229117,41614SC0020039,Coventry Silver $10 Copay Roper St. Francis,41614SC002,,SCN008,SCS008,SCF008,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48298,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020039-06,94% AV Level Silver Plan,93.10%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,$0,$0,20%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,Not Applicable,Not Applicable,20%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,18,41614,SC,Individual,No,20-0229117,41614SC0020041,Coventry Silver $10 Copay Upstate,41614SC002,,SCN009,SCS009,SCF010,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48820,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020041-00,Standard Silver Off Exchange Plan,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,18,41614,SC,Individual,No,20-0229117,41614SC0020041,Coventry Silver $10 Copay Upstate,41614SC002,,SCN009,SCS009,SCF010,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48820,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020041-01,Standard Silver On Exchange Plan,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,18,41614,SC,Individual,No,20-0229117,41614SC0020041,Coventry Silver $10 Copay Upstate,41614SC002,,SCN009,SCS009,SCF010,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48820,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020041-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,18,41614,SC,Individual,No,20-0229117,41614SC0020041,Coventry Silver $10 Copay Upstate,41614SC002,,SCN009,SCS009,SCF010,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48820,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020041-03,Limited Cost Sharing Plan Variation,68.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,18,41614,SC,Individual,No,20-0229117,41614SC0020041,Coventry Silver $10 Copay Upstate,41614SC002,,SCN009,SCS009,SCF010,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48820,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020041-04,73% AV Level Silver Plan,72.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$5,000","$10,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,8
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,18,41614,SC,Individual,No,20-0229117,41614SC0020041,Coventry Silver $10 Copay Upstate,41614SC002,,SCN009,SCS009,SCF010,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48820,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020041-05,87% AV Level Silver Plan,86.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,"$1,500","$3,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,18,41614,SC,Individual,No,20-0229117,41614SC0020041,Coventry Silver $10 Copay Upstate,41614SC002,,SCN009,SCS009,SCF010,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48820,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020041-06,94% AV Level Silver Plan,93.10%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,$0,$0,20%,"$11,500","$23,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,Not Applicable,Not Applicable,20%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,19,41614,SC,Individual,No,20-0229117,41614SC0020087,Coventry Silver $5 Copay 2750,41614SC002,,SCN005,SCS005,SCF031,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48216,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020087-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,19,41614,SC,Individual,No,20-0229117,41614SC0020087,Coventry Silver $5 Copay 2750,41614SC002,,SCN005,SCS005,SCF031,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48216,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020087-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,19,41614,SC,Individual,No,20-0229117,41614SC0020087,Coventry Silver $5 Copay 2750,41614SC002,,SCN005,SCS005,SCF031,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48216,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020087-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,19,41614,SC,Individual,No,20-0229117,41614SC0020087,Coventry Silver $5 Copay 2750,41614SC002,,SCN005,SCS005,SCF031,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48216,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020087-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,19,41614,SC,Individual,No,20-0229117,41614SC0020087,Coventry Silver $5 Copay 2750,41614SC002,,SCN005,SCS005,SCF031,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48216,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020087-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,19,41614,SC,Individual,No,20-0229117,41614SC0020087,Coventry Silver $5 Copay 2750,41614SC002,,SCN005,SCS005,SCF031,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48216,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020087-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,19,41614,SC,Individual,No,20-0229117,41614SC0020087,Coventry Silver $5 Copay 2750,41614SC002,,SCN005,SCS005,SCF031,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48216,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020087-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,20,41614,SC,Individual,No,20-0229117,41614SC0020088,Coventry Silver $5 Copay 2750 Carolinas HealthCare,41614SC002,,SCN011,SCS011,SCF032,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48240,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020088-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,20,41614,SC,Individual,No,20-0229117,41614SC0020088,Coventry Silver $5 Copay 2750 Carolinas HealthCare,41614SC002,,SCN011,SCS011,SCF032,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48240,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020088-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,20,41614,SC,Individual,No,20-0229117,41614SC0020088,Coventry Silver $5 Copay 2750 Carolinas HealthCare,41614SC002,,SCN011,SCS011,SCF032,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48240,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020088-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,20,41614,SC,Individual,No,20-0229117,41614SC0020088,Coventry Silver $5 Copay 2750 Carolinas HealthCare,41614SC002,,SCN011,SCS011,SCF032,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48240,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020088-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,20,41614,SC,Individual,No,20-0229117,41614SC0020088,Coventry Silver $5 Copay 2750 Carolinas HealthCare,41614SC002,,SCN011,SCS011,SCF032,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48240,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020088-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$4,500","$9,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,20,41614,SC,Individual,No,20-0229117,41614SC0020088,Coventry Silver $5 Copay 2750 Carolinas HealthCare,41614SC002,,SCN011,SCS011,SCF032,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48240,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020088-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,"$1,500","$3,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,20,41614,SC,Individual,No,20-0229117,41614SC0020088,Coventry Silver $5 Copay 2750 Carolinas HealthCare,41614SC002,,SCN011,SCS011,SCF032,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48240,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020088-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,21,41614,SC,Individual,No,20-0229117,41614SC0020089,Coventry Silver $5 Copay 2750 Midlands,41614SC002,,SCN010,SCS010,SCF033,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48260,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020089-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,22,41614,SC,Individual,No,20-0229117,41614SC0020090,Coventry Silver $5 Copay 2750 Regional HealthPlus,41614SC002,,SCN007,SCS007,SCF034,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48284,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020090-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$4,500","$9,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,22,41614,SC,Individual,No,20-0229117,41614SC0020090,Coventry Silver $5 Copay 2750 Regional HealthPlus,41614SC002,,SCN007,SCS007,SCF034,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48284,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020090-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,"$1,500","$3,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,22,41614,SC,Individual,No,20-0229117,41614SC0020090,Coventry Silver $5 Copay 2750 Regional HealthPlus,41614SC002,,SCN007,SCS007,SCF034,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48284,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/RHPSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020090-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,23,41614,SC,Individual,No,20-0229117,41614SC0020091,Coventry Silver $5 Copay 2750 Roper St. Francis,41614SC002,,SCN008,SCS008,SCF035,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48806,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020091-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,26,41614,SC,Individual,No,20-0229117,41614SC0020035,Coventry Gold $0 Copay Midlands,41614SC002,,SCN010,SCS010,SCF004,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48251,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020035-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$0,20%,$0,$0,40%,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,26,41614,SC,Individual,No,20-0229117,41614SC0020035,Coventry Gold $0 Copay Midlands,41614SC002,,SCN010,SCS010,SCF004,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48251,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020035-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$0,20%,$0,$0,40%,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,26,41614,SC,Individual,No,20-0229117,41614SC0020035,Coventry Gold $0 Copay Midlands,41614SC002,,SCN010,SCS010,SCF004,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48251,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020035-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,26,41614,SC,Individual,No,20-0229117,41614SC0020035,Coventry Gold $0 Copay Midlands,41614SC002,,SCN010,SCS010,SCF004,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48251,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020035-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$0,20%,$0,$0,40%,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,27,41614,SC,Individual,No,20-0229117,41614SC0020033,Coventry Gold $0 Copay Regional HealthPlus,41614SC002,,SCN007,SCS007,SCF002,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48273,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HPNSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020033-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$0,20%,$0,$0,40%,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,27,41614,SC,Individual,No,20-0229117,41614SC0020033,Coventry Gold $0 Copay Regional HealthPlus,41614SC002,,SCN007,SCS007,SCF002,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48273,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HPNSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020033-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$0,20%,$0,$0,40%,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,5
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,7,49532,SC,Individual,No,57-0768835,49532SC0380005,Blue Option Silver 400,49532SC038,,SCN001,SCS001,SCF001,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380005-00,Standard Silver Off Exchange Plan,,0.683563947677612,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$650,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,Individual,No,57-0768835,49532SC0380024,Blue Option Silver 3250 HD,49532SC038,,SCN001,SCS001,SCF003,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9961,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380024-01,Standard Silver On Exchange Plan,,0.702368676662445,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,350",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,250","$6,350",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,Individual,No,57-0768835,49532SC0380024,Blue Option Silver 3250 HD,49532SC038,,SCN001,SCS001,SCF003,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9961,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380024-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,3,49532,SC,Individual,No,57-0768835,49532SC0380022,Blue Option Bronze 6500,49532SC038,,SCN001,SCS001,SCF005,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9952,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380022-00,Standard Bronze Off Exchange Plan,,0.60860276222229,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$11,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$11,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,3,49532,SC,Individual,No,57-0768835,49532SC0380022,Blue Option Bronze 6500,49532SC038,,SCN001,SCS001,SCF005,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9952,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380022-01,Standard Bronze On Exchange Plan,,0.60860276222229,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$11,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$11,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,6,49532,SC,Individual,No,57-0768835,49532SC0380016,Blue Option Silver 6000,49532SC038,,SCN001,SCS001,SCF013,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9956,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380016-01,Standard Silver On Exchange Plan,,0.680205464363098,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$11,100",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,6,49532,SC,Individual,No,57-0768835,49532SC0380016,Blue Option Silver 6000,49532SC038,,SCN001,SCS001,SCF013,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9956,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,9,49532,SC,Individual,No,57-0768835,49532SC0380009,Blue Option Silver 1500,49532SC038,,SCN001,SCS001,SCF008,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380009-04,73% AV Level Silver Plan,,0.720630526542664,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$9,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,300",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,9,49532,SC,Individual,No,57-0768835,49532SC0380009,Blue Option Silver 1500,49532SC038,,SCN001,SCS001,SCF008,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380009-05,87% AV Level Silver Plan,,0.862309575080872,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$450,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,7,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370015,Business Advantage Silver 4000,49532SC037,,SCN002,SCS001,SCF023,New,PPO,Silver,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9963,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Silver4000,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370015-00,Standard Silver Off Exchange Plan,,0.702966630458832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$7,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$7,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,9,49532,SC,Individual,No,57-0768835,49532SC0380009,Blue Option Silver 1500,49532SC038,,SCN001,SCS001,SCF008,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380009-06,94% AV Level Silver Plan,,0.932368457317352,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,10,49532,SC,Individual,No,57-0768835,49532SC0380001,Blue Option Bronze 5001 HD,49532SC038,,SCN001,SCS001,SCF001,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9952,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380001-00,Standard Bronze Off Exchange Plan,,0.584032356739044,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$8,650",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,10,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370007,Business Advantage Silver 3000,49532SC037,,SCN002,SCS001,SCF021,Existing,PPO,Silver,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Silver3000,,,http://www.BlueOptionSC.com/pharmacy,49532SC0370007-00,Standard Silver Off Exchange Plan,,0.709403097629547,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$5,450",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,10,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370007,Business Advantage Silver 3000,49532SC037,,SCN002,SCS001,SCF021,Existing,PPO,Silver,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Silver3000,,,http://www.BlueOptionSC.com/pharmacy,49532SC0370007-01,Standard Silver On Exchange Plan,,0.709403097629547,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$5,450",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,5,65122,SC,Individual,No,45-3124969,65122SC0010025,Consumers' Choice Silver 11,65122SC001,,SCN001,SCS001,SCF022,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010025,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010025,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010025-04,73% AV Level Silver Plan,,0.729394316673279,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,"$3,640",$150,$0,$0,"$2,640",$80,8
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,5,65122,SC,Individual,No,45-3124969,65122SC0010025,Consumers' Choice Silver 11,65122SC001,,SCN001,SCS001,SCF022,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010025,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010025,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010025-05,87% AV Level Silver Plan,,0.875955283641815,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,"$1,250",$150,$0,$0,"$1,250",$80,9
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,5,65122,SC,Individual,No,45-3124969,65122SC0010025,Consumers' Choice Silver 11,65122SC001,,SCN001,SCS001,SCF022,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010025,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010025,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010025-06,94% AV Level Silver Plan,,0.93876713514328,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$500,$150,$0,$0,$500,$80,10
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,6,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020029,CCHP SHOP S10,65122SC002,,SCN001,SCS001,SCF029,New,EPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020029,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020029,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020029-00,Standard Silver Off Exchange Plan,71.86%,0.726703107357025,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$40,"$1,520",$150,"$2,000",$420,$280,$80,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,27,41614,SC,Individual,No,20-0229117,41614SC0020033,Coventry Gold $0 Copay Regional HealthPlus,41614SC002,,SCN007,SCS007,SCF002,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48273,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HPNSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020033-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,27,41614,SC,Individual,No,20-0229117,41614SC0020033,Coventry Gold $0 Copay Regional HealthPlus,41614SC002,,SCN007,SCS007,SCF002,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48273,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HPNSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020033-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$0,20%,$0,$0,40%,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,28,41614,SC,Individual,No,20-0229117,41614SC0020034,Coventry Gold $0 Copay Roper St. Francis,41614SC002,,SCN008,SCS008,SCF003,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48295,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020034-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$0,20%,$0,$0,40%,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,28,41614,SC,Individual,No,20-0229117,41614SC0020034,Coventry Gold $0 Copay Roper St. Francis,41614SC002,,SCN008,SCS008,SCF003,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48295,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020034-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$0,20%,$0,$0,40%,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,28,41614,SC,Individual,No,20-0229117,41614SC0020034,Coventry Gold $0 Copay Roper St. Francis,41614SC002,,SCN008,SCS008,SCF003,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48295,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020034-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,28,41614,SC,Individual,No,20-0229117,41614SC0020034,Coventry Gold $0 Copay Roper St. Francis,41614SC002,,SCN008,SCS008,SCF003,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48295,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020034-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$0,20%,$0,$0,40%,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,29,41614,SC,Individual,No,20-0229117,41614SC0020036,Coventry Gold $0 Copay Upstate,41614SC002,,SCN009,SCS009,SCF005,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48817,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020036-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$0,20%,$0,$0,40%,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,29,41614,SC,Individual,No,20-0229117,41614SC0020036,Coventry Gold $0 Copay Upstate,41614SC002,,SCN009,SCS009,SCF005,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48817,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020036-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$0,20%,$0,$0,40%,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,29,41614,SC,Individual,No,20-0229117,41614SC0020036,Coventry Gold $0 Copay Upstate,41614SC002,,SCN009,SCS009,SCF005,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48817,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020036-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,29,41614,SC,Individual,No,20-0229117,41614SC0020036,Coventry Gold $0 Copay Upstate,41614SC002,,SCN009,SCS009,SCF005,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48817,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020036-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$0,20%,$0,$0,40%,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,30,41614,SC,Individual,No,20-0229117,41614SC0020032,Coventry Gold $5 Copay,41614SC002,,SCN005,SCS005,SCF001,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48207,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020032-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,$250,$500,,,,,,,,,,,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,30,41614,SC,Individual,No,20-0229117,41614SC0020032,Coventry Gold $5 Copay,41614SC002,,SCN005,SCS005,SCF001,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48207,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020032-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,$250,$500,,,,,,,,,,,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,30,41614,SC,Individual,No,20-0229117,41614SC0020032,Coventry Gold $5 Copay,41614SC002,,SCN005,SCS005,SCF001,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48207,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020032-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,30,41614,SC,Individual,No,20-0229117,41614SC0020032,Coventry Gold $5 Copay,41614SC002,,SCN005,SCS005,SCF001,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48207,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020032-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,$250,$500,,,,,,,,,,,,,,,,,,,7
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,31,41614,SC,Individual,No,20-0229117,41614SC0020052,Coventry Catastrophic 100%,41614SC002,,SCN005,SCS005,SCF021,Existing,POS,Catastrophic,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48206,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020052-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,31,41614,SC,Individual,No,20-0229117,41614SC0020052,Coventry Catastrophic 100%,41614SC002,,SCN005,SCS005,SCF021,Existing,POS,Catastrophic,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/SC48206,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020052-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,32,41614,SC,Individual,No,20-0229117,41614SC0020084,Coventry Catastrophic 100% Carolinas HealthCare,41614SC002,,SCN006,SCS006,SCF028,New,HMO,Catastrophic,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48228,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020084-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,32,41614,SC,Individual,No,20-0229117,41614SC0020084,Coventry Catastrophic 100% Carolinas HealthCare,41614SC002,,SCN006,SCS006,SCF028,New,HMO,Catastrophic,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48228,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CHSSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020084-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,33,41614,SC,Individual,No,20-0229117,41614SC0020055,Coventry Catastrophic 100% Midlands,41614SC002,,SCN004,SCS004,SCF024,Existing,HMO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48250,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020055-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,33,41614,SC,Individual,No,20-0229117,41614SC0020055,Coventry Catastrophic 100% Midlands,41614SC002,,SCN004,SCS004,SCF024,Existing,HMO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48250,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/MidlandsSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020055-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,35,41614,SC,Individual,No,20-0229117,41614SC0020054,Coventry Catastrophic 100% Roper St. Francis,41614SC002,,SCN002,SCS002,SCF023,Existing,HMO,Catastrophic,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48294,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020054-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,35,41614,SC,Individual,No,20-0229117,41614SC0020054,Coventry Catastrophic 100% Roper St. Francis,41614SC002,,SCN002,SCS002,SCF023,Existing,HMO,Catastrophic,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48294,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/StFrancisSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020054-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,36,41614,SC,Individual,No,20-0229117,41614SC0020056,Coventry Catastrophic 100% Upstate,41614SC002,,SCN003,SCS003,SCF025,Existing,HMO,Catastrophic,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48816,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020056-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,41614,HIOS,8,2014-12-12 09:23:47,36,41614,SC,Individual,No,20-0229117,41614SC0020056,Coventry Catastrophic 100% Upstate,41614SC002,,SCN003,SCS003,SCF025,Existing,HMO,Catastrophic,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/SC48816,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UpstateSC2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,41614SC0020056-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,45445,HIOS,2,2014-08-03 08:59:32,1,45445,SC,SHOP (Small Group),Yes,47-0098400,45445SC0040002,EHB High PPO,45445SC004,,SCN001,SCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$37.38,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,45445SC0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,45445,HIOS,2,2014-08-03 08:59:32,1,45445,SC,SHOP (Small Group),Yes,47-0098400,45445SC0040001,EHB Low PPO,45445SC004,,SCN001,SCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.20,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,45445SC0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,45445,HIOS,2,2014-08-03 08:59:32,1,45445,SC,SHOP (Small Group),Yes,47-0098400,45445SC0030002,EHB High Passive,45445SC003,,SCN001,SCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.05,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,45445SC0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,2,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370020,Business Advantage Gold 2100 HD,49532SC037,,SCN002,SCS001,SCF003,New,PPO,Gold,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9969,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/gold2100HD,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370020-01,Standard Gold On Exchange Plan,,0.780541837215424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,100","$4,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,3,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370004,Business Advantage Silver 2001,49532SC037,,SCN002,SCS001,SCF020,Existing,PPO,Silver,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Silver2001,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370004-00,Standard Silver Off Exchange Plan,,0.71983402967453,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,900","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$3,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,3,49532,SC,Individual,No,57-0768835,49532SC0380020,Blue Option Bronze 4500,49532SC038,,SCN001,SCS001,SCF004,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9952,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380020-00,Standard Bronze Off Exchange Plan,,0.609690546989441,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$11,550",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,3,49532,SC,Individual,No,57-0768835,49532SC0380020,Blue Option Bronze 4500,49532SC038,,SCN001,SCS001,SCF004,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9952,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380020-01,Standard Bronze On Exchange Plan,,0.609690546989441,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$11,550",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,6,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370010,Business Advantage Bronze 5500,49532SC037,,SCN002,SCS001,SCF027,New,PPO,Bronze,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9956,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/bronze5500,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370010-00,Standard Bronze Off Exchange Plan,,0.611961305141449,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$11,450",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$9,700",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,6,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370010,Business Advantage Bronze 5500,49532SC037,,SCN002,SCS001,SCF027,New,PPO,Bronze,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9956,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/bronze5500,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370010-01,Standard Bronze On Exchange Plan,,0.611961305141449,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$11,450",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$9,700",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,6,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020029,CCHP SHOP S10,65122SC002,,SCN001,SCS001,SCF029,New,EPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020029,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020029,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020029-01,Standard Silver On Exchange Plan,71.86%,0.726703107357025,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$40,"$1,520",$150,"$2,000",$420,$280,$80,5
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,7,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020004,CCHP SHOP HDP G1,65122SC002,,SCN001,SCS001,SCF024,Existing,EPO,Gold,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020004,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020004,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020004-00,Standard Gold Off Exchange Plan,78.40%,0.78892058134079,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400",$0,$510,$150,"$1,400",$0,$340,$80,4
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,7,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020004,CCHP SHOP HDP G1,65122SC002,,SCN001,SCS001,SCF024,Existing,EPO,Gold,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020004,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020004,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020004-01,Standard Gold On Exchange Plan,78.40%,0.78892058134079,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400",$0,$510,$150,"$1,400",$0,$340,$80,5
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,7,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020007,CCHP SHOP HDP S2,65122SC002,,SCN001,SCS001,SCF019,Existing,EPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020007,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020007,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020007-00,Standard Silver Off Exchange Plan,70.41%,0.709602534770966,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750",$0,"$1,020",$150,"$1,750",$0,$610,$80,6
2015,SC,45445,HIOS,2,2014-08-03 08:59:32,1,45445,SC,SHOP (Small Group),Yes,47-0098400,45445SC0030001,EHB Low Passive,45445SC003,,SCN001,SCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.34,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,45445SC0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SC,47973,HIOS,4,2014-09-04 03:25:43,1,47973,SC,Individual,Yes,57-0523959,47973SC0040001,Group Pediatric EHB Rider,47973SC004,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$34.97,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximums,Yes,Traditional with inside maximums,No,,,,,47973SC0040001-00,Standard High Off Exchange Plan,86.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,47973,HIOS,4,2014-09-04 03:25:43,1,47973,SC,SHOP (Small Group),Yes,57-0523959,47973SC0020001,Group Pediatric EHB Rider,47973SC002,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$34.97,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximums,Yes,Traditional with inside maximums,No,,,,,47973SC0020001-00,Standard High Off Exchange Plan,85.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,Individual,No,57-0768835,49532SC0380021,Blue Option Bronze 6250 HD,49532SC038,,SCN001,SCS001,SCF003,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9952,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380021-00,Standard Bronze Off Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$10,850",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$10,850",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,Individual,No,57-0768835,49532SC0380021,Blue Option Bronze 6250 HD,49532SC038,,SCN001,SCS001,SCF003,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9952,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380021-01,Standard Bronze On Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$10,850",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$10,850",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370001,Business Advantage Bronze 3800,49532SC037,,SCN002,SCS001,SCF018,Existing,PPO,Bronze,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9956,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/bronze3800,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370001-01,Standard Bronze On Exchange Plan,,0.619742929935455,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,800","$6,750",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,Individual,No,57-0768835,49532SC0380021,Blue Option Bronze 6250 HD,49532SC038,,SCN001,SCS001,SCF003,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9952,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380021-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,Individual,No,57-0768835,49532SC0380021,Blue Option Bronze 6250 HD,49532SC038,,SCN001,SCS001,SCF003,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9952,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380021-03,Limited Cost Sharing Plan Variation,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$10,850",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$10,850",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,Individual,No,57-0768835,49532SC0380024,Blue Option Silver 3250 HD,49532SC038,,SCN001,SCS001,SCF003,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9961,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380024-00,Standard Silver Off Exchange Plan,,0.702368676662445,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,350",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,250","$6,350",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,Individual,No,57-0768835,49532SC0380024,Blue Option Silver 3250 HD,49532SC038,,SCN001,SCS001,SCF003,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9961,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380024-03,Limited Cost Sharing Plan Variation,,0.702368676662445,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,350",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,250","$6,350",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,Individual,No,57-0768835,49532SC0380024,Blue Option Silver 3250 HD,49532SC038,,SCN001,SCS001,SCF003,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9961,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380024-04,73% AV Level Silver Plan,,0.723027527332306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,900","$5,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,Individual,No,57-0768835,49532SC0380024,Blue Option Silver 3250 HD,49532SC038,,SCN001,SCS001,SCF003,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9961,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380024-05,87% AV Level Silver Plan,,0.861683309078217,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150","$2,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,150","$2,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,Individual,No,57-0768835,49532SC0380024,Blue Option Silver 3250 HD,49532SC038,,SCN001,SCS001,SCF003,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9961,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380024-06,94% AV Level Silver Plan,,0.944938838481903,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,Individual,No,57-0768835,49532SC0380025,Blue Option Silver 3650 HD,49532SC038,,SCN001,SCS001,SCF003,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380025-00,Standard Silver Off Exchange Plan,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,Individual,No,57-0768835,49532SC0380025,Blue Option Silver 3650 HD,49532SC038,,SCN001,SCS001,SCF003,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380025-01,Standard Silver On Exchange Plan,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,Individual,No,57-0768835,49532SC0380025,Blue Option Silver 3650 HD,49532SC038,,SCN001,SCS001,SCF003,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380025-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,17
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,Individual,No,57-0768835,49532SC0380025,Blue Option Silver 3650 HD,49532SC038,,SCN001,SCS001,SCF003,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380025-03,Limited Cost Sharing Plan Variation,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,Individual,No,57-0768835,49532SC0380025,Blue Option Silver 3650 HD,49532SC038,,SCN001,SCS001,SCF003,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380025-04,73% AV Level Silver Plan,,0.723027527332306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,900","$5,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,Individual,No,57-0768835,49532SC0380025,Blue Option Silver 3650 HD,49532SC038,,SCN001,SCS001,SCF003,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380025-05,87% AV Level Silver Plan,,0.861683309078217,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150","$2,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,150","$2,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,Individual,No,57-0768835,49532SC0380025,Blue Option Silver 3650 HD,49532SC038,,SCN001,SCS001,SCF003,New,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380025-06,94% AV Level Silver Plan,,0.944938838481903,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,Individual,No,57-0768835,49532SC0380019,Blue Option Gold 2000 HD,49532SC038,,SCN001,SCS001,SCF003,New,EPO,Gold,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9966,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380019-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,250",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,250",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,Individual,No,57-0768835,49532SC0380019,Blue Option Gold 2000 HD,49532SC038,,SCN001,SCS001,SCF003,New,EPO,Gold,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9966,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380019-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,250",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,250",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,Individual,No,57-0768835,49532SC0380019,Blue Option Gold 2000 HD,49532SC038,,SCN001,SCS001,SCF003,New,EPO,Gold,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9966,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380019-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,24
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,1,49532,SC,Individual,No,57-0768835,49532SC0380019,Blue Option Gold 2000 HD,49532SC038,,SCN001,SCS001,SCF003,New,EPO,Gold,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9966,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380019-03,Limited Cost Sharing Plan Variation,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,250",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,250",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,2,49532,SC,Individual,No,57-0768835,49532SC0380003,Blue Option Bronze 6350,49532SC038,,SCN001,SCS001,SCF003,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9952,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380003-00,Standard Bronze Off Exchange Plan,,0.6043940782547,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$10,950",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$10,950",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,2,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370002,Business Advantage Bronze 6000 HD,49532SC037,,SCN002,SCS001,SCF003,Existing,PPO,Bronze,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9956,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/bronze6000HD,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370002-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$10,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,2,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370002,Business Advantage Bronze 6000 HD,49532SC037,,SCN002,SCS001,SCF003,Existing,PPO,Bronze,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9956,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/bronze6000HD,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370002-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$10,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,2,49532,SC,Individual,No,57-0768835,49532SC0380003,Blue Option Bronze 6350,49532SC038,,SCN001,SCS001,SCF003,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9952,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380003-01,Standard Bronze On Exchange Plan,,0.6043940782547,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$10,950",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$10,950",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,2,49532,SC,Individual,No,57-0768835,49532SC0380003,Blue Option Bronze 6350,49532SC038,,SCN001,SCS001,SCF003,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9952,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,2,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370011,Business Advantage Bronze 6300 HD,49532SC037,,SCN002,SCS001,SCF003,New,PPO,Bronze,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9955,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/bronze6300HD,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370011-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$10,950",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$10,950",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,2,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370011,Business Advantage Bronze 6300 HD,49532SC037,,SCN002,SCS001,SCF003,New,PPO,Bronze,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9955,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/bronze6300HD,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370011-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$10,950",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$10,950",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,2,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370013,Business Advantage Silver 3500 HD,49532SC037,,SCN002,SCS001,SCF003,New,PPO,Silver,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9963,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Silver3500HD,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370013-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$6,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$6,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,2,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370019,Business Advantage Gold 1750 HD,49532SC037,,SCN002,SCS001,SCF003,New,PPO,Gold,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9969,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Gold1750HD,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370019-00,Standard Gold Off Exchange Plan,,0.808071136474609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,2,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370019,Business Advantage Gold 1750 HD,49532SC037,,SCN002,SCS001,SCF003,New,PPO,Gold,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9969,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Gold1750HD,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370019-01,Standard Gold On Exchange Plan,,0.808071136474609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,2,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370020,Business Advantage Gold 2100 HD,49532SC037,,SCN002,SCS001,SCF003,New,PPO,Gold,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9969,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/gold2100HD,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370020-00,Standard Gold Off Exchange Plan,,0.780541837215424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,100","$4,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,3,49532,SC,Individual,No,57-0768835,49532SC0380020,Blue Option Bronze 4500,49532SC038,,SCN001,SCS001,SCF004,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9952,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380020-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,3,49532,SC,Individual,No,57-0768835,49532SC0380020,Blue Option Bronze 4500,49532SC038,,SCN001,SCS001,SCF004,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9952,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380020-03,Limited Cost Sharing Plan Variation,,0.609690546989441,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$11,550",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,3,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370012,Business Advantage Silver 2500,49532SC037,,SCN002,SCS001,SCF021,New,PPO,Silver,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Silver2500,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370012-01,Standard Silver On Exchange Plan,,0.715049207210541,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$11,150",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$4,650",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,3,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370021,Business Advantage Gold 1003,49532SC037,,SCN002,SCS001,SCF025,New,PPO,Gold,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9968,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Gold1003,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370021-00,Standard Gold Off Exchange Plan,,0.792771518230438,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$9,650",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$1,900",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,3,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370021,Business Advantage Gold 1003,49532SC037,,SCN002,SCS001,SCF025,New,PPO,Gold,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9968,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Gold1003,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370021-01,Standard Gold On Exchange Plan,,0.792771518230438,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$9,650",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$1,900",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,3,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370022,Business Advantage Gold 1502,49532SC037,,SCN002,SCS001,SCF026,New,PPO,Gold,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9968,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/gold1502,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370022-00,Standard Gold Off Exchange Plan,,0.791090726852417,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,750","$7,650",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,050",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,3,49532,SC,Individual,No,57-0768835,49532SC0380022,Blue Option Bronze 6500,49532SC038,,SCN001,SCS001,SCF005,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9952,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380022-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,3,49532,SC,Individual,No,57-0768835,49532SC0380022,Blue Option Bronze 6500,49532SC038,,SCN001,SCS001,SCF005,New,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9952,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380022-03,Limited Cost Sharing Plan Variation,,0.60860276222229,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$11,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$11,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,3,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370022,Business Advantage Gold 1502,49532SC037,,SCN002,SCS001,SCF026,New,PPO,Gold,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9968,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/gold1502,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370022-01,Standard Gold On Exchange Plan,,0.791090726852417,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,750","$7,650",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,050",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,3,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370023,Business Advantage Gold 2000,49532SC037,,SCN002,SCS001,SCF026,New,PPO,Gold,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9968,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Gold2000,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370023-00,Standard Gold Off Exchange Plan,,0.788711845874786,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,050",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,3,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370023,Business Advantage Gold 2000,49532SC037,,SCN002,SCS001,SCF026,New,PPO,Gold,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9968,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Gold2000,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370023-01,Standard Gold On Exchange Plan,,0.788711845874786,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,050",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,4,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370003,Business Advantage Bronze 5000,49532SC037,,SCN002,SCS001,SCF017,Existing,PPO,Bronze,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9957,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/bronze5000,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370003-00,Standard Bronze Off Exchange Plan,,0.612638294696808,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$11,250",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$8,650",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,4,49532,SC,Individual,No,57-0768835,49532SC0380004,Blue Option Catastrophic,49532SC038,,SCN001,SCS001,SCF003,Existing,EPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9946,,,0,0,3,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380004-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,4,49532,SC,Individual,No,57-0768835,49532SC0380004,Blue Option Catastrophic,49532SC038,,SCN001,SCS001,SCF003,Existing,EPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9946,,,0,0,3,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380004-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,4,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370003,Business Advantage Bronze 5000,49532SC037,,SCN002,SCS001,SCF017,Existing,PPO,Bronze,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9957,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/bronze5000,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370003-01,Standard Bronze On Exchange Plan,,0.612638294696808,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$11,250",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$8,650",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,4,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370006,Business Advantage Silver 2000,49532SC037,,SCN002,SCS001,SCF007,Existing,PPO,Silver,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Silver2000,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370006-00,Standard Silver Off Exchange Plan,,0.68558394908905,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$3,650",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,4,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370006,Business Advantage Silver 2000,49532SC037,,SCN002,SCS001,SCF007,Existing,PPO,Silver,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Silver2000,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370006-01,Standard Silver On Exchange Plan,,0.68558394908905,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$3,650",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370009,Business Advantage Bronze 3500,49532SC037,,SCN002,SCS001,SCF001,New,PPO,Bronze,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9956,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/bronze3500,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370009-00,Standard Bronze Off Exchange Plan,,0.616795122623444,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$11,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$6,300",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,Individual,No,57-0768835,49532SC0380013,Blue Option Silver 3000,49532SC038,,SCN001,SCS001,SCF010,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380013-00,Standard Silver Off Exchange Plan,,0.695320308208466,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$9,950",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$5,400",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,Individual,No,57-0768835,49532SC0380013,Blue Option Silver 3000,49532SC038,,SCN001,SCS001,SCF010,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380013-01,Standard Silver On Exchange Plan,,0.695320308208466,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$9,950",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$5,400",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370009,Business Advantage Bronze 3500,49532SC037,,SCN002,SCS001,SCF001,New,PPO,Bronze,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9956,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/bronze3500,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370009-01,Standard Bronze On Exchange Plan,,0.616795122623444,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$11,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$6,300",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,Individual,No,57-0768835,49532SC0380013,Blue Option Silver 3000,49532SC038,,SCN001,SCS001,SCF010,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,Individual,No,57-0768835,49532SC0380013,Blue Option Silver 3000,49532SC038,,SCN001,SCS001,SCF010,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380013-03,Limited Cost Sharing Plan Variation,,0.695320308208466,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$9,950",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$5,400",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,Individual,No,57-0768835,49532SC0380013,Blue Option Silver 3000,49532SC038,,SCN001,SCS001,SCF010,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380013-04,73% AV Level Silver Plan,,0.731351852416992,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$9,450",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$5,400",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,Individual,No,57-0768835,49532SC0380013,Blue Option Silver 3000,49532SC038,,SCN001,SCS001,SCF010,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380013-05,87% AV Level Silver Plan,,0.867832005023956,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,650",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,Individual,No,57-0768835,49532SC0380013,Blue Option Silver 3000,49532SC038,,SCN001,SCS001,SCF010,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380013-06,94% AV Level Silver Plan,,0.931235373020172,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$700,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,Individual,No,57-0768835,49532SC0380015,Blue Option Silver 4000,49532SC038,,SCN001,SCS001,SCF012,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380015-00,Standard Silver Off Exchange Plan,,0.696206569671631,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$9,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,Individual,No,57-0768835,49532SC0380015,Blue Option Silver 4000,49532SC038,,SCN001,SCS001,SCF012,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380015-01,Standard Silver On Exchange Plan,,0.696206569671631,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$9,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,Individual,No,57-0768835,49532SC0380015,Blue Option Silver 4000,49532SC038,,SCN001,SCS001,SCF012,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380015-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,Individual,No,57-0768835,49532SC0380015,Blue Option Silver 4000,49532SC038,,SCN001,SCS001,SCF012,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380015-03,Limited Cost Sharing Plan Variation,,0.696206569671631,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$9,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,Individual,No,57-0768835,49532SC0380015,Blue Option Silver 4000,49532SC038,,SCN001,SCS001,SCF012,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380015-04,73% AV Level Silver Plan,,0.72128689289093,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$9,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,Individual,No,57-0768835,49532SC0380015,Blue Option Silver 4000,49532SC038,,SCN001,SCS001,SCF012,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380015-05,87% AV Level Silver Plan,,0.86587655544281,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,850",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,200",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,Individual,No,57-0768835,49532SC0380015,Blue Option Silver 4000,49532SC038,,SCN001,SCS001,SCF012,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380015-06,94% AV Level Silver Plan,,0.940787792205811,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,450",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$700,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,Individual,No,57-0768835,49532SC0380017,Blue Option Gold 1100,49532SC038,,SCN001,SCS001,SCF015,New,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9966,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380017-00,Standard Gold Off Exchange Plan,,0.784847438335419,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,150",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,250",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,Individual,No,57-0768835,49532SC0380017,Blue Option Gold 1100,49532SC038,,SCN001,SCS001,SCF015,New,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9966,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380017-01,Standard Gold On Exchange Plan,,0.784847438335419,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,150",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,250",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,Individual,No,57-0768835,49532SC0380017,Blue Option Gold 1100,49532SC038,,SCN001,SCS001,SCF015,New,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9966,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,Individual,No,57-0768835,49532SC0380017,Blue Option Gold 1100,49532SC038,,SCN001,SCS001,SCF015,New,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9966,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380017-03,Limited Cost Sharing Plan Variation,,0.784847438335419,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,150",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,250",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,Individual,No,57-0768835,49532SC0380018,Blue Option Gold 800,49532SC038,,SCN001,SCS001,SCF016,New,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9966,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380018-00,Standard Gold Off Exchange Plan,,0.792466819286346,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$6,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$800,"$1,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,9,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370008,Business Advantage Gold 1000,49532SC037,,SCN002,SCS001,SCF024,Existing,PPO,Gold,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9968,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Gold1000,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370008-01,Standard Gold On Exchange Plan,,0.786852478981018,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,100",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,9,49532,SC,Individual,No,57-0768835,49532SC0380009,Blue Option Silver 1500,49532SC038,,SCN001,SCS001,SCF008,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380009-01,Standard Silver On Exchange Plan,,0.683107376098633,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$2,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,9,49532,SC,Individual,No,57-0768835,49532SC0380009,Blue Option Silver 1500,49532SC038,,SCN001,SCS001,SCF008,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380009-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,9,49532,SC,Individual,No,57-0768835,49532SC0380009,Blue Option Silver 1500,49532SC038,,SCN001,SCS001,SCF008,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380009-03,Limited Cost Sharing Plan Variation,,0.683107376098633,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$2,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,7,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020007,CCHP SHOP HDP S2,65122SC002,,SCN001,SCS001,SCF019,Existing,EPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020007,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020007,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020007-01,Standard Silver On Exchange Plan,70.41%,0.709602534770966,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750",$0,"$1,020",$150,"$1,750",$0,$610,$80,7
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,7,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020030,CCHP SHOP HDP S3,65122SC002,,SCN001,SCS001,SCF018,New,EPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020030,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020030,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020030-00,Standard Silver Off Exchange Plan,70.35%,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$0,$0,$150,"$3,000",$0,$0,$80,8
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,7,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020030,CCHP SHOP HDP S3,65122SC002,,SCN001,SCS001,SCF018,New,EPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020030,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020030,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020030-01,Standard Silver On Exchange Plan,70.35%,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$0,$0,$150,"$3,000",$0,$0,$80,9
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,7,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020031,CCHP SHOP HDP B4,65122SC002,,SCN001,SCS001,SCF018,New,EPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020031,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020031,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020031-00,Standard Bronze Off Exchange Plan,58.38%,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$0,$0,$150,"$5,270",$0,$0,$80,10
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,7,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020031,CCHP SHOP HDP B4,65122SC002,,SCN001,SCS001,SCF018,New,EPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020031,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020031,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020031-01,Standard Bronze On Exchange Plan,58.38%,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$0,$0,$150,"$5,270",$0,$0,$80,11
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,8,65122,SC,Individual,No,45-3124969,65122SC0010026,Consumers' Choice Bronze 10,65122SC001,,SCN001,SCS001,SCF017,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010026,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010026,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010026-00,Standard Bronze Off Exchange Plan,61.82%,0.626958250999451,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$20,$190,$150,"$5,270",$0,$0,$80,4
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,8,65122,SC,Individual,No,45-3124969,65122SC0010026,Consumers' Choice Bronze 10,65122SC001,,SCN001,SCS001,SCF017,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010026,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010026,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010026-01,Standard Bronze On Exchange Plan,61.82%,0.626958250999451,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$20,$190,$150,"$5,270",$0,$0,$80,5
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,8,65122,SC,Individual,No,45-3124969,65122SC0010026,Consumers' Choice Bronze 10,65122SC001,,SCN001,SCS001,SCF017,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010026,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010026,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010026-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,8,65122,SC,Individual,No,45-3124969,65122SC0010026,Consumers' Choice Bronze 10,65122SC001,,SCN001,SCS001,SCF017,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010026,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010026,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010026-03,Limited Cost Sharing Plan Variation,61.82%,0.626958250999451,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$20,$190,$150,"$5,270",$0,$0,$80,7
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,9,65122,SC,Individual,No,45-3124969,65122SC0010008,Consumers' Choice Value Plan,65122SC001,,SCN001,SCS001,SCF018,Existing,EPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010008,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010008,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010008-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,Individual,No,57-0768835,49532SC0380018,Blue Option Gold 800,49532SC038,,SCN001,SCS001,SCF016,New,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9966,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380018-01,Standard Gold On Exchange Plan,,0.792466819286346,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$6,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$800,"$1,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,5,49532,SC,Individual,No,57-0768835,49532SC0380018,Blue Option Gold 800,49532SC038,,SCN001,SCS001,SCF016,New,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9966,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380018-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,24
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,6,49532,SC,Individual,No,57-0768835,49532SC0380016,Blue Option Silver 6000,49532SC038,,SCN001,SCS001,SCF013,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9956,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380016-03,Limited Cost Sharing Plan Variation,,0.680205464363098,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$11,100",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,6,49532,SC,Individual,No,57-0768835,49532SC0380016,Blue Option Silver 6000,49532SC038,,SCN001,SCS001,SCF013,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9956,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380016-04,73% AV Level Silver Plan,,0.734034538269043,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$9,650",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,6,49532,SC,Individual,No,57-0768835,49532SC0380016,Blue Option Silver 6000,49532SC038,,SCN001,SCS001,SCF013,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9956,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380016-05,87% AV Level Silver Plan,,0.864837050437927,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,250",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,6,49532,SC,Individual,No,57-0768835,49532SC0380016,Blue Option Silver 6000,49532SC038,,SCN001,SCS001,SCF013,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9956,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380016-06,94% AV Level Silver Plan,,0.942567646503448,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,450",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$700,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,7,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370015,Business Advantage Silver 4000,49532SC037,,SCN002,SCS001,SCF023,New,PPO,Silver,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9963,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Silver4000,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370015-01,Standard Silver On Exchange Plan,,0.702966630458832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$7,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$7,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,7,49532,SC,Individual,No,57-0768835,49532SC0380005,Blue Option Silver 400,49532SC038,,SCN001,SCS001,SCF001,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380005-01,Standard Silver On Exchange Plan,,0.683563947677612,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$650,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,7,49532,SC,Individual,No,57-0768835,49532SC0380005,Blue Option Silver 400,49532SC038,,SCN001,SCS001,SCF001,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,7,49532,SC,Individual,No,57-0768835,49532SC0380005,Blue Option Silver 400,49532SC038,,SCN001,SCS001,SCF001,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380005-03,Limited Cost Sharing Plan Variation,,0.683563947677612,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$650,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,7,49532,SC,Individual,No,57-0768835,49532SC0380005,Blue Option Silver 400,49532SC038,,SCN001,SCS001,SCF001,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380005-04,73% AV Level Silver Plan,,0.723980605602264,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$8,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$150,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,7,49532,SC,Individual,No,57-0768835,49532SC0380005,Blue Option Silver 400,49532SC038,,SCN001,SCS001,SCF001,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380005-05,87% AV Level Silver Plan,,0.864971578121185,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$3,850",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$75,$100,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,7,49532,SC,Individual,No,57-0768835,49532SC0380005,Blue Option Silver 400,49532SC038,,SCN001,SCS001,SCF001,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380005-06,94% AV Level Silver Plan,,0.930382549762726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$850,"$1,650",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$75,$100,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,7,49532,SC,Individual,No,57-0768835,49532SC0380006,Blue Option Silver 2501 HD,49532SC038,,SCN001,SCS001,SCF006,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9959,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380006-00,Standard Silver Off Exchange Plan,,0.680481553077698,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$10,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$4,700",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,7,49532,SC,Individual,No,57-0768835,49532SC0380006,Blue Option Silver 2501 HD,49532SC038,,SCN001,SCS001,SCF006,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9959,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380006-01,Standard Silver On Exchange Plan,,0.680481553077698,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$10,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$4,700",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,7,49532,SC,Individual,No,57-0768835,49532SC0380006,Blue Option Silver 2501 HD,49532SC038,,SCN001,SCS001,SCF006,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9959,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,7,49532,SC,Individual,No,57-0768835,49532SC0380006,Blue Option Silver 2501 HD,49532SC038,,SCN001,SCS001,SCF006,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9959,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380006-03,Limited Cost Sharing Plan Variation,,0.680481553077698,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$10,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$4,700",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,7,49532,SC,Individual,No,57-0768835,49532SC0380006,Blue Option Silver 2501 HD,49532SC038,,SCN001,SCS001,SCF006,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9959,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380006-04,73% AV Level Silver Plan,,0.720474004745483,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,150","$10,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,850","$3,600",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,7,49532,SC,Individual,No,57-0768835,49532SC0380006,Blue Option Silver 2501 HD,49532SC038,,SCN001,SCS001,SCF006,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9959,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380006-05,87% AV Level Silver Plan,,0.863398253917694,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,250",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,7,49532,SC,Individual,No,57-0768835,49532SC0380006,Blue Option Silver 2501 HD,49532SC038,,SCN001,SCS001,SCF006,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9959,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380006-06,94% AV Level Silver Plan,,0.93122661113739,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$675,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$550,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,8,49532,SC,Individual,No,57-0768835,49532SC0380007,Blue Option Silver 2500,49532SC038,,SCN001,SCS001,SCF007,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380007-00,Standard Silver Off Exchange Plan,,0.686743795871735,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$4,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,8,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370016,Business Advantage Silver 5000,49532SC037,,SCN002,SCS001,SCF023,New,PPO,Silver,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9961,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Silver5000,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370016-00,Standard Silver Off Exchange Plan,,0.693469703197479,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$8,850",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$8,850",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,8,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370016,Business Advantage Silver 5000,49532SC037,,SCN002,SCS001,SCF023,New,PPO,Silver,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9961,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Silver5000,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370016-01,Standard Silver On Exchange Plan,,0.693469703197479,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$8,850",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$8,850",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,8,49532,SC,Individual,No,57-0768835,49532SC0380007,Blue Option Silver 2500,49532SC038,,SCN001,SCS001,SCF007,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380007-01,Standard Silver On Exchange Plan,,0.686743795871735,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$4,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,8,49532,SC,Individual,No,57-0768835,49532SC0380007,Blue Option Silver 2500,49532SC038,,SCN001,SCS001,SCF007,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,8,49532,SC,Individual,No,57-0768835,49532SC0380007,Blue Option Silver 2500,49532SC038,,SCN001,SCS001,SCF007,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380007-03,Limited Cost Sharing Plan Variation,,0.686743795871735,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$4,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,8,49532,SC,Individual,No,57-0768835,49532SC0380007,Blue Option Silver 2500,49532SC038,,SCN001,SCS001,SCF007,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380007-04,73% AV Level Silver Plan,,0.724437415599823,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$9,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$2,750",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,8,49532,SC,Individual,No,57-0768835,49532SC0380007,Blue Option Silver 2500,49532SC038,,SCN001,SCS001,SCF007,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380007-05,87% AV Level Silver Plan,,0.863001465797424,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,150",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$450,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,15%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,8,49532,SC,Individual,No,57-0768835,49532SC0380007,Blue Option Silver 2500,49532SC038,,SCN001,SCS001,SCF007,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380007-06,94% AV Level Silver Plan,,0.930843889713287,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$450,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,8,49532,SC,Individual,No,57-0768835,49532SC0380008,Blue Option Silver 1750,49532SC038,,SCN001,SCS001,SCF007,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9959,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380008-00,Standard Silver Off Exchange Plan,,0.680733859539032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,450",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,150",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,8,49532,SC,Individual,No,57-0768835,49532SC0380008,Blue Option Silver 1750,49532SC038,,SCN001,SCS001,SCF007,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9959,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380008-01,Standard Silver On Exchange Plan,,0.680733859539032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,450",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,150",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,8,49532,SC,Individual,No,57-0768835,49532SC0380008,Blue Option Silver 1750,49532SC038,,SCN001,SCS001,SCF007,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9959,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,8,49532,SC,Individual,No,57-0768835,49532SC0380008,Blue Option Silver 1750,49532SC038,,SCN001,SCS001,SCF007,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9959,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380008-03,Limited Cost Sharing Plan Variation,,0.680733859539032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,450",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,150",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,8,49532,SC,Individual,No,57-0768835,49532SC0380008,Blue Option Silver 1750,49532SC038,,SCN001,SCS001,SCF007,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9959,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380008-04,73% AV Level Silver Plan,,0.721798181533813,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$9,850",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$2,850",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,8,49532,SC,Individual,No,57-0768835,49532SC0380008,Blue Option Silver 1750,49532SC038,,SCN001,SCS001,SCF007,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9959,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380008-05,87% AV Level Silver Plan,,0.862481832504272,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$450,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,8,49532,SC,Individual,No,57-0768835,49532SC0380008,Blue Option Silver 1750,49532SC038,,SCN001,SCS001,SCF007,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9959,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380008-06,94% AV Level Silver Plan,,0.930489659309387,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$450,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,9,49532,SC,Individual,No,57-0768835,49532SC0380009,Blue Option Silver 1500,49532SC038,,SCN001,SCS001,SCF008,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9958,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380009-00,Standard Silver Off Exchange Plan,,0.683107376098633,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$2,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,9,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370008,Business Advantage Gold 1000,49532SC037,,SCN002,SCS001,SCF024,Existing,PPO,Gold,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9968,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Gold1000,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370008-00,Standard Gold Off Exchange Plan,,0.786852478981018,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,100",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,10,49532,SC,Individual,No,57-0768835,49532SC0380001,Blue Option Bronze 5001 HD,49532SC038,,SCN001,SCS001,SCF001,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9952,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380001-01,Standard Bronze On Exchange Plan,,0.584032356739044,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$8,650",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,10,49532,SC,Individual,No,57-0768835,49532SC0380001,Blue Option Bronze 5001 HD,49532SC038,,SCN001,SCS001,SCF001,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9952,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,Individual,No,45-3124969,65122SC0010001,Consumers' Choice Gold 1,65122SC001,,SCN001,SCS001,SCF005,Existing,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010001,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010001,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020003,CCHP SHOP G3,65122SC002,,SCN001,SCS001,SCF026,Existing,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020003,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020003,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020003-00,Standard Gold Off Exchange Plan,79.05%,0.796014368534088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250",$40,"$1,010",$150,"$1,250",$460,$220,$80,6
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020003,CCHP SHOP G3,65122SC002,,SCN001,SCS001,SCF026,Existing,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020003,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020003,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020003-01,Standard Gold On Exchange Plan,79.05%,0.796014368534088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250",$40,"$1,010",$150,"$1,250",$460,$220,$80,7
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,Individual,No,45-3124969,65122SC0010001,Consumers' Choice Gold 1,65122SC001,,SCN001,SCS001,SCF005,Existing,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010001,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010001,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010001-03,Limited Cost Sharing Plan Variation,81.59%,0.820558071136475,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,$40,"$1,010",$150,$600,$560,$230,$80,7
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,10,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370014,Business Advantage Silver 2501,49532SC037,,SCN002,SCS001,SCF022,New,PPO,Silver,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Silver2501,,,http://www.BlueOptionSC.com/pharmacy,49532SC0370014-00,Standard Silver Off Exchange Plan,,0.719205677509308,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$4,450",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,35%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,10,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370014,Business Advantage Silver 2501,49532SC037,,SCN002,SCS001,SCF022,New,PPO,Silver,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Silver2501,,,http://www.BlueOptionSC.com/pharmacy,49532SC0370014-01,Standard Silver On Exchange Plan,,0.719205677509308,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$4,450",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,35%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,10,49532,SC,Individual,No,57-0768835,49532SC0380001,Blue Option Bronze 5001 HD,49532SC038,,SCN001,SCS001,SCF001,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9952,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380001-03,Limited Cost Sharing Plan Variation,,0.584032356739044,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$8,650",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,10,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370017,Business Advantage Gold 1001,49532SC037,,SCN002,SCS001,SCF025,New,PPO,Gold,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9969,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Gold1001,,,http://www.BlueOptionSC.com/pharmacy,49532SC0370017-00,Standard Gold Off Exchange Plan,,0.815264761447906,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$6,950",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$1,950",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,10,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370017,Business Advantage Gold 1001,49532SC037,,SCN002,SCS001,SCF025,New,PPO,Gold,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9969,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Gold1001,,,http://www.BlueOptionSC.com/pharmacy,49532SC0370017-01,Standard Gold On Exchange Plan,,0.815264761447906,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$6,950",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$1,950",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,10,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370018,Business Advantage Gold 1002,49532SC037,,SCN002,SCS001,SCF025,New,PPO,Gold,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9969,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Gold1002,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370018-00,Standard Gold Off Exchange Plan,,0.80769956111908,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$7,850",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$1,950",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,10,49532,SC,SHOP (Small Group),No,57-0768835,49532SC0370018,Business Advantage Gold 1002,49532SC037,,SCN002,SCS001,SCF025,New,PPO,Gold,No,Both,Yes,Yes,A Physician who is not a Primary Care Physician,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9969,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://bluechoicesc.com/Gold1002,,http://www.BlueChoiceSC.com/BABrochure,http://www.BlueOptionSC.com/pharmacy,49532SC0370018-01,Standard Gold On Exchange Plan,,0.80769956111908,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$7,850",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$1,950",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,11,49532,SC,Individual,No,57-0768835,49532SC0380002,Blue Option Bronze 5002,49532SC038,,SCN001,SCS001,SCF002,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9955,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380002-00,Standard Bronze Off Exchange Plan,,0.581771969795227,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$11,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$8,900",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,11,49532,SC,Individual,No,57-0768835,49532SC0380002,Blue Option Bronze 5002,49532SC038,,SCN001,SCS001,SCF002,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9955,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380002-01,Standard Bronze On Exchange Plan,,0.581771969795227,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$11,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$8,900",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,11,49532,SC,Individual,No,57-0768835,49532SC0380002,Blue Option Bronze 5002,49532SC038,,SCN001,SCS001,SCF002,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9955,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,11,49532,SC,Individual,No,57-0768835,49532SC0380002,Blue Option Bronze 5002,49532SC038,,SCN001,SCS001,SCF002,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9955,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380002-03,Limited Cost Sharing Plan Variation,,0.581771969795227,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$11,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$8,900",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,12,49532,SC,Individual,No,57-0768835,49532SC0380023,Blue Option Silver 2000,49532SC038,,SCN001,SCS001,SCF009,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380023-00,Standard Silver Off Exchange Plan,,0.719770193099976,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$8,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$3,750",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,12,49532,SC,Individual,No,57-0768835,49532SC0380023,Blue Option Silver 2000,49532SC038,,SCN001,SCS001,SCF009,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380023-01,Standard Silver On Exchange Plan,,0.719770193099976,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$8,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$3,750",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,12,49532,SC,Individual,No,57-0768835,49532SC0380023,Blue Option Silver 2000,49532SC038,,SCN001,SCS001,SCF009,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380023-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,12,49532,SC,Individual,No,57-0768835,49532SC0380023,Blue Option Silver 2000,49532SC038,,SCN001,SCS001,SCF009,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380023-03,Limited Cost Sharing Plan Variation,,0.719770193099976,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$8,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$3,750",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,12,49532,SC,Individual,No,57-0768835,49532SC0380023,Blue Option Silver 2000,49532SC038,,SCN001,SCS001,SCF009,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380023-04,73% AV Level Silver Plan,,0.739867091178894,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$7,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,350",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,12,49532,SC,Individual,No,57-0768835,49532SC0380023,Blue Option Silver 2000,49532SC038,,SCN001,SCS001,SCF009,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380023-05,87% AV Level Silver Plan,,0.867913007736206,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,250",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,050",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,12,49532,SC,Individual,No,57-0768835,49532SC0380023,Blue Option Silver 2000,49532SC038,,SCN001,SCS001,SCF009,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380023-06,94% AV Level Silver Plan,,0.93641209602356,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,450",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$600,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,12,49532,SC,Individual,No,57-0768835,49532SC0380014,Blue Option Silver 3500,49532SC038,,SCN001,SCS001,SCF011,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9959,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380014-00,Standard Silver Off Exchange Plan,,0.705666959285736,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$8,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$6,850",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,12,49532,SC,Individual,No,57-0768835,49532SC0380014,Blue Option Silver 3500,49532SC038,,SCN001,SCS001,SCF011,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9959,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380014-01,Standard Silver On Exchange Plan,,0.705666959285736,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$8,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$6,850",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,12,49532,SC,Individual,No,57-0768835,49532SC0380014,Blue Option Silver 3500,49532SC038,,SCN001,SCS001,SCF011,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9959,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,12,49532,SC,Individual,No,57-0768835,49532SC0380014,Blue Option Silver 3500,49532SC038,,SCN001,SCS001,SCF011,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9959,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380014-03,Limited Cost Sharing Plan Variation,,0.705666959285736,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$8,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$6,850",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,12,49532,SC,Individual,No,57-0768835,49532SC0380014,Blue Option Silver 3500,49532SC038,,SCN001,SCS001,SCF011,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9959,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380014-04,73% AV Level Silver Plan,,0.73225861787796,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,750","$7,450",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$6,850",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,12,49532,SC,Individual,No,57-0768835,49532SC0380014,Blue Option Silver 3500,49532SC038,,SCN001,SCS001,SCF011,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9959,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380014-05,87% AV Level Silver Plan,,0.86397796869278,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,450",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,300",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,12,49532,SC,Individual,No,57-0768835,49532SC0380014,Blue Option Silver 3500,49532SC038,,SCN001,SCS001,SCF011,New,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9959,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380014-06,94% AV Level Silver Plan,,0.937458038330078,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$550,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,13,49532,SC,Individual,No,57-0768835,49532SC0380011,Blue Option Gold 1000,49532SC038,,SCN001,SCS001,SCF014,Existing,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9966,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380011-00,Standard Gold Off Exchange Plan,,0.786852478981018,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,400",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,13,49532,SC,Individual,No,57-0768835,49532SC0380011,Blue Option Gold 1000,49532SC038,,SCN001,SCS001,SCF014,Existing,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9966,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380011-01,Standard Gold On Exchange Plan,,0.786852478981018,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,400",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,13,49532,SC,Individual,No,57-0768835,49532SC0380011,Blue Option Gold 1000,49532SC038,,SCN001,SCS001,SCF014,Existing,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9966,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380011-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SC,49532,HIOS,20,2015-01-16 17:32:32,13,49532,SC,Individual,No,57-0768835,49532SC0380011,Blue Option Gold 1000,49532SC038,,SCN001,SCS001,SCF014,Existing,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9966,,,0,0,0,2015-01-01,,Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,"Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").",Yes,http://www.BlueOptionSC.com/SBC,,http://www.blueoptionsc.com/brochure,http://www.BlueOptionSC.com/pharmacy,49532SC0380011-03,Limited Cost Sharing Plan Variation,,0.786852478981018,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,400",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,SC,54362,HIOS,3,2014-08-31 07:07:13,1,54362,SC,Individual,Yes,59-1031071,54362SC0030001,myCigna Dental Pediatric,54362SC003,7730182962,SCN001,SCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,,,http://www.cigna.com/individuals-families/2015-plans/sob/south-carolina/dental-pediatric,,54362SC0030001-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$150,$300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,56571,HIOS,2,2014-08-08 08:53:29,1,56571,SC,SHOP (Small Group),Yes,72-0977315,56571SC0040001,AlwaysCare Small Group - Child,56571SC004,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$28.96,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,56571SC0040001-00,Standard High Off Exchange Plan,84.12%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,56571,HIOS,2,2014-08-08 08:53:29,1,56571,SC,Individual,Yes,72-0977315,56571SC0010001,AlwaysCare All-Star Kids Dental Plan,56571SC001,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.85,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,56571SC0010001-00,Standard High Off Exchange Plan,84.21%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,56571,HIOS,2,2014-08-08 08:53:29,1,56571,SC,Individual,Yes,72-0977315,56571SC0010002,AlwaysCare All-Star Kids Dental Plan,56571SC001,,SCN001,SCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$20.18,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,56571SC0010002-00,Standard Low Off Exchange Plan,68.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,56571,HIOS,2,2014-08-08 08:53:29,1,56571,SC,SHOP (Small Group),Yes,72-0977315,56571SC0040002,AlwaysCare Small Group - Child,56571SC004,,SCN001,SCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$23.73,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,56571SC0040002-00,Standard Low Off Exchange Plan,68.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,56571,HIOS,2,2014-08-08 08:53:29,2,56571,SC,SHOP (Small Group),Yes,72-0977315,56571SC0030001,AlwaysCare Small Group Dental - Adults,56571SC003,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.96,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,56571SC0030001-00,Standard High Off Exchange Plan,84.12%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,56571,HIOS,2,2014-08-08 08:53:29,2,56571,SC,Individual,Yes,72-0977315,56571SC0020001,AlwaysCare All-Star Family Dental Plan,56571SC002,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.85,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,56571SC0020001-00,Standard High Off Exchange Plan,84.21%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,56571,HIOS,2,2014-08-08 08:53:29,2,56571,SC,Individual,Yes,72-0977315,56571SC0020002,AlwaysCare All-Star Family Dental Plan,56571SC002,,SCN001,SCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,56571SC0020002-00,Standard Low Off Exchange Plan,68.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,56571,HIOS,2,2014-08-08 08:53:29,2,56571,SC,SHOP (Small Group),Yes,72-0977315,56571SC0030002,AlwaysCare Small Group Dental - Adults,56571SC003,,SCN001,SCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.73,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,56571SC0030002-00,Standard Low Off Exchange Plan,68.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190107,BlueCross SG Platinum 03S,14002TN019,,TNN002,TNS007,TNF001,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Platinum-03S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190107-01,Standard Platinum On Exchange Plan,88.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","$8,000","$16,000",$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190108,BlueCross SG Platinum 03S,14002TN019,,TNN002,TNS008,TNF001,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Platinum-03S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190108-00,Standard Platinum Off Exchange Plan,88.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","$8,000","$16,000",$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190108,BlueCross SG Platinum 03S,14002TN019,,TNN002,TNS008,TNF001,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Platinum-03S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190108-01,Standard Platinum On Exchange Plan,88.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","$8,000","$16,000",$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,19
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190109,BlueCross SG Platinum 03P,14002TN019,,TNN001,TNS010,TNF001,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Platinum-03P,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190109-00,Standard Platinum Off Exchange Plan,88.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","$8,000","$16,000",$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190109,BlueCross SG Platinum 03P,14002TN019,,TNN001,TNS010,TNF001,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Platinum-03P,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190109-01,Standard Platinum On Exchange Plan,88.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","$8,000","$16,000",$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190083,BlueCross SG Gold 18S,14002TN019,,TNN002,TNS001,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-18S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190083-00,Standard Gold Off Exchange Plan,,0.818502187728882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,Individual,No,62-0427913,14002TN0320002,BlueCross Bronze B02S,14002TN032,,TNN002,TNS010,TNF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320002-00,Standard Bronze Off Exchange Plan,,0.593126475811005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,Individual,No,62-0427913,14002TN0320002,BlueCross Bronze B02S,14002TN032,,TNN002,TNS010,TNF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320002-01,Standard Bronze On Exchange Plan,,0.593126475811005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,5
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,4,89281,SC,SHOP (Small Group),Yes,95-6042390,89281SC0010011,BEST Dental Choice-L,89281SC001,,SCN001,SCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.09,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BESTDental_Choice-L_Plan.pdf,,89281SC0010011-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,4,89281,SC,SHOP (Small Group),Yes,95-6042390,89281SC0010012,BEST Dental Value,89281SC001,,SCN001,SCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.09,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BESTDental_Value_Plan.pdf,,89281SC0010012-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,4,89281,SC,SHOP (Small Group),Yes,95-6042390,89281SC0010012,BEST Dental Value,89281SC001,,SCN001,SCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.09,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BESTDental_Value_Plan.pdf,,89281SC0010012-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,SC,92498,HIOS,8,2014-11-15 04:52:41,1,92498,SC,Individual,Yes,75-1233841,92498SC0010007,Dentegra Dental PPO Pediatric Basic Plan,92498SC001,,SCN001,SCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/sc/92498sc0010007-15,,92498SC0010007-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,92498,HIOS,8,2014-11-15 04:52:41,1,92498,SC,SHOP (Small Group),Yes,75-1233841,92498SC0020007,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,92498SC002,,SCN001,SCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.85,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/sc/92498sc0020007-15,,92498SC0020007-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,92498,HIOS,8,2014-11-15 04:52:41,1,92498,SC,SHOP (Small Group),Yes,75-1233841,92498SC0020007,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,92498SC002,,SCN001,SCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.85,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/sc/92498sc0020007-15,,92498SC0020007-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,92498,HIOS,8,2014-11-15 04:52:41,1,92498,SC,Individual,Yes,75-1233841,92498SC0010007,Dentegra Dental PPO Pediatric Basic Plan,92498SC001,,SCN001,SCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/sc/92498sc0010007-15,,92498SC0010007-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,92498,HIOS,8,2014-11-15 04:52:41,2,92498,SC,Individual,Yes,75-1233841,92498SC0010009,Dentegra Dental PPO Family Basic Plan,92498SC001,,SCN001,SCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/sc/92498sc0010009-15,,92498SC0010009-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,92498,HIOS,8,2014-11-15 04:52:41,2,92498,SC,SHOP (Small Group),Yes,75-1233841,92498SC0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,92498SC002,,SCN001,SCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.85,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/sc/92498sc0020009-15,,92498SC0020009-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,92498,HIOS,8,2014-11-15 04:52:41,2,92498,SC,SHOP (Small Group),Yes,75-1233841,92498SC0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,92498SC002,,SCN001,SCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.85,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/sc/92498sc0020009-15,,92498SC0020009-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,92498,HIOS,8,2014-11-15 04:52:41,2,92498,SC,Individual,Yes,75-1233841,92498SC0010009,Dentegra Dental PPO Family Basic Plan,92498SC001,,SCN001,SCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/sc/92498sc0010009-15,,92498SC0010009-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,94996,HIOS,2,2014-08-05 13:28:44,1,94996,SC,SHOP (Small Group),Yes,44-0308260,94996SC0010001,KCL EHB Low PPO,94996SC001,,SCN001,SCS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$44.56,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,94996SC0010001-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,3,89281,SC,SHOP (Small Group),Yes,95-6042390,89281SC0010010,BEST Dental Choice-H,89281SC001,,SCN001,SCS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.11,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BESTDental_Choice-H_Plan.pdf,,89281SC0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,Individual,No,45-3124969,65122SC0010001,Consumers' Choice Gold 1,65122SC001,,SCN001,SCS001,SCF005,Existing,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010001,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010001,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010001-00,Standard Gold Off Exchange Plan,81.59%,0.820558071136475,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,$40,"$1,010",$150,$600,$560,$230,$80,4
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020002,CCHP SHOP G2,65122SC002,,SCN001,SCS001,SCF026,Existing,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020002,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020002,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020002-00,Standard Gold Off Exchange Plan,81.42%,0.81914234161377,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$40,"$1,010",$150,$500,$630,$240,$80,4
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020002,CCHP SHOP G2,65122SC002,,SCN001,SCS001,SCF026,Existing,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020002,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020002,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020002-01,Standard Gold On Exchange Plan,81.42%,0.81914234161377,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$40,"$1,010",$150,$500,$630,$240,$80,5
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,Individual,No,45-3124969,65122SC0010001,Consumers' Choice Gold 1,65122SC001,,SCN001,SCS001,SCF005,Existing,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010001,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010001,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010001-01,Standard Gold On Exchange Plan,81.59%,0.820558071136475,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,$40,"$1,010",$150,$600,$560,$230,$80,5
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,Individual,No,45-3124969,65122SC0010002,Consumers' Choice Gold 2,65122SC001,,SCN001,SCS001,SCF006,Existing,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010002,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010002,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010002-00,Standard Gold Off Exchange Plan,79.38%,0.79938417673111,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$40,"$1,520",$150,"$1,000",$500,$320,$80,8
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,Individual,No,45-3124969,65122SC0010002,Consumers' Choice Gold 2,65122SC001,,SCN001,SCS001,SCF006,Existing,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010002,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010002,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010002-01,Standard Gold On Exchange Plan,79.38%,0.79938417673111,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$40,"$1,520",$150,"$1,000",$500,$320,$80,9
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,Individual,No,45-3124969,65122SC0010002,Consumers' Choice Gold 2,65122SC001,,SCN001,SCS001,SCF006,Existing,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010002,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010002,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,Individual,No,45-3124969,65122SC0010002,Consumers' Choice Gold 2,65122SC001,,SCN001,SCS001,SCF006,Existing,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010002,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010002,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010002-03,Limited Cost Sharing Plan Variation,79.38%,0.79938417673111,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$40,"$1,520",$150,"$1,000",$500,$320,$80,11
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,Individual,No,45-3124969,65122SC0010003,Consumers' Choice Silver 1,65122SC001,,SCN001,SCS001,SCF012,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010003,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010003,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010003-00,Standard Silver Off Exchange Plan,71.39%,0.721283674240112,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$50,"$1,520",$150,"$2,000",$440,$280,$80,12
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,Individual,No,45-3124969,65122SC0010003,Consumers' Choice Silver 1,65122SC001,,SCN001,SCS001,SCF012,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010003,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010003,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010003-01,Standard Silver On Exchange Plan,71.39%,0.721283674240112,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$50,"$1,520",$150,"$2,000",$440,$280,$80,13
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,Individual,No,45-3124969,65122SC0010003,Consumers' Choice Silver 1,65122SC001,,SCN001,SCS001,SCF012,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010003,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010003,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,Individual,No,45-3124969,65122SC0010003,Consumers' Choice Silver 1,65122SC001,,SCN001,SCS001,SCF012,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010003,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010003,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010003-03,Limited Cost Sharing Plan Variation,71.39%,0.721283674240112,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$50,"$1,520",$150,"$2,000",$440,$280,$80,15
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,Individual,No,45-3124969,65122SC0010003,Consumers' Choice Silver 1,65122SC001,,SCN001,SCS001,SCF012,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010003,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010003,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010003-04,73% AV Level Silver Plan,73.70%,0.743900060653687,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$40,"$1,520",$150,"$2,000",$420,$280,$80,16
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,Individual,No,45-3124969,65122SC0010003,Consumers' Choice Silver 1,65122SC001,,SCN001,SCS001,SCF012,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010003,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010003,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010003-05,87% AV Level Silver Plan,87.05%,0.873508453369141,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$30,"$1,010",$150,$250,$500,$240,$80,17
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,Individual,No,45-3124969,65122SC0010003,Consumers' Choice Silver 1,65122SC001,,SCN001,SCS001,SCF012,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010003,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010003,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010003-06,94% AV Level Silver Plan,93.95%,0.940868675708771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$75,$150,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$70,$10,$510,$150,$80,$210,$130,$80,18
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,Individual,No,45-3124969,65122SC0010004,Consumers' Choice Silver 2,65122SC001,,SCN001,SCS001,SCF010,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010004,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010004,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010004-00,Standard Silver Off Exchange Plan,69.84%,0.706492245197296,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$20,"$1,130",$150,"$3,500",$200,$160,$80,19
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,Individual,No,45-3124969,65122SC0010004,Consumers' Choice Silver 2,65122SC001,,SCN001,SCS001,SCF010,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010004,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010004,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010004-01,Standard Silver On Exchange Plan,69.84%,0.706492245197296,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$20,"$1,130",$150,"$3,500",$200,$160,$80,20
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,Individual,No,45-3124969,65122SC0010004,Consumers' Choice Silver 2,65122SC001,,SCN001,SCS001,SCF010,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010004,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010004,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,21
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,Individual,No,45-3124969,65122SC0010004,Consumers' Choice Silver 2,65122SC001,,SCN001,SCS001,SCF010,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010004,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010004,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010004-03,Limited Cost Sharing Plan Variation,69.84%,0.706492245197296,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$20,"$1,130",$150,"$3,500",$200,$160,$80,22
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,Individual,No,45-3124969,65122SC0010004,Consumers' Choice Silver 2,65122SC001,,SCN001,SCS001,SCF010,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010004,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010004,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010004-04,73% AV Level Silver Plan,73.07%,0.737858831882477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750",$20,"$1,350",$150,"$2,750",$310,$190,$80,23
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,Individual,No,45-3124969,65122SC0010004,Consumers' Choice Silver 2,65122SC001,,SCN001,SCS001,SCF010,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010004,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010004,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010004-05,87% AV Level Silver Plan,86.06%,0.863628685474396,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$30,"$1,010",$150,$400,$490,$240,$80,24
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,1,65122,SC,Individual,No,45-3124969,65122SC0010004,Consumers' Choice Silver 2,65122SC001,,SCN001,SCS001,SCF010,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010004,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010004,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010004-06,94% AV Level Silver Plan,93.09%,0.932184219360352,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$10,$510,$150,$150,$210,$130,$80,25
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,2,65122,SC,Individual,No,45-3124969,65122SC0010006,Consumers' Choice Bronze 1,65122SC001,,SCN001,SCS001,SCF021,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010006,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010006,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010006-00,Standard Bronze Off Exchange Plan,,0.612426102161407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,400","$8,800",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,"$1,150",$190,"$4,400",$0,$350,$220,4
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,2,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020005,CCHP SHOP S4,65122SC002,,SCN001,SCS001,SCF028,Existing,EPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020005,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020005,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020005-00,Standard Silver Off Exchange Plan,71.38%,0.722023904323578,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,200","$4,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,200",$20,"$1,520",$150,"$2,200",$390,$260,$80,4
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,2,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020005,CCHP SHOP S4,65122SC002,,SCN001,SCS001,SCF028,Existing,EPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020005,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020005,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020005-01,Standard Silver On Exchange Plan,71.38%,0.722023904323578,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,200","$4,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,200",$20,"$1,520",$150,"$2,200",$390,$260,$80,5
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,2,65122,SC,Individual,No,45-3124969,65122SC0010006,Consumers' Choice Bronze 1,65122SC001,,SCN001,SCS001,SCF021,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010006,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010006,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010006-01,Standard Bronze On Exchange Plan,,0.612426102161407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,400","$8,800",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,"$1,150",$190,"$4,400",$0,$350,$220,5
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,2,65122,SC,Individual,No,45-3124969,65122SC0010006,Consumers' Choice Bronze 1,65122SC001,,SCN001,SCS001,SCF021,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010006,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010006,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$190,$0,$0,$0,$220,6
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,2,65122,SC,Individual,No,45-3124969,65122SC0010006,Consumers' Choice Bronze 1,65122SC001,,SCN001,SCS001,SCF021,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010006,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010006,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010006-03,Limited Cost Sharing Plan Variation,,0.612426102161407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,400","$8,800",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,"$1,150",$190,"$4,400",$0,$350,$220,7
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,3,65122,SC,Individual,No,45-3124969,65122SC0010024,Consumers' Choice Silver 10,65122SC001,,SCN001,SCS001,SCF016,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010024,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010024,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010024-00,Standard Silver Off Exchange Plan,,0.680555939674377,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,$650,$190,"$4,000",$140,$60,$220,4
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,3,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020006,CCHP SHOP S5,65122SC002,,SCN001,SCS001,SCF031,Existing,EPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020006,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020006,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020006-00,Standard Silver Off Exchange Plan,,0.697947561740875,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$50,"$2,030",$150,"$2,000",$460,$370,$80,4
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,3,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020006,CCHP SHOP S5,65122SC002,,SCN001,SCS001,SCF031,Existing,EPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020006,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020006,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020006-01,Standard Silver On Exchange Plan,,0.697947561740875,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$50,"$2,030",$150,"$2,000",$460,$370,$80,5
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,3,65122,SC,Individual,No,45-3124969,65122SC0010024,Consumers' Choice Silver 10,65122SC001,,SCN001,SCS001,SCF016,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010024,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010024,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010024-01,Standard Silver On Exchange Plan,,0.680555939674377,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,$650,$190,"$4,000",$140,$60,$220,5
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,3,65122,SC,Individual,No,45-3124969,65122SC0010024,Consumers' Choice Silver 10,65122SC001,,SCN001,SCS001,SCF016,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010024,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010024,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010024-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$190,$0,$0,$0,$220,6
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,3,65122,SC,Individual,No,45-3124969,65122SC0010024,Consumers' Choice Silver 10,65122SC001,,SCN001,SCS001,SCF016,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010024,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010024,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010024-03,Limited Cost Sharing Plan Variation,,0.680555939674377,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,$650,$190,"$4,000",$140,$60,$220,7
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,3,65122,SC,Individual,No,45-3124969,65122SC0010024,Consumers' Choice Silver 10,65122SC001,,SCN001,SCS001,SCF016,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010024,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010024,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010024-04,73% AV Level Silver Plan,,0.72628128528595,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,250",$20,"$1,000",$190,"$2,250",$310,$160,$220,8
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,3,65122,SC,Individual,No,45-3124969,65122SC0010024,Consumers' Choice Silver 10,65122SC001,,SCN001,SCS001,SCF016,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010024,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010024,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010024-05,87% AV Level Silver Plan,,0.875527143478394,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$10,$990,$190,$500,$480,$240,$220,9
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,3,65122,SC,Individual,No,45-3124969,65122SC0010024,Consumers' Choice Silver 10,65122SC001,,SCN001,SCS001,SCF016,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010024,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010024,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010024-06,94% AV Level Silver Plan,,0.944840252399445,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$10,$240,$190,$250,$130,$120,$220,10
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,4,65122,SC,Individual,No,45-3124969,65122SC0010005,Consumers' Choice Silver HDP 1,65122SC001,,SCN001,SCS001,SCF018,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010005,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010005,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010005-00,Standard Silver Off Exchange Plan,71.03%,0.723027527332306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,900","$5,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$0,$190,"$2,900",$0,$0,$220,4
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,4,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020008,CCHP SHOP B6,65122SC002,,SCN001,SCS001,SCF021,Existing,EPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020008,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020008,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020008-00,Standard Bronze Off Exchange Plan,,0.615464687347412,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,250",$0,"$1,210",$150,"$4,250",$30,$370,$80,4
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,4,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020008,CCHP SHOP B6,65122SC002,,SCN001,SCS001,SCF021,Existing,EPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020008,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020008,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020008-01,Standard Bronze On Exchange Plan,,0.615464687347412,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,250",$0,"$1,210",$150,"$4,250",$30,$370,$80,5
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,4,65122,SC,Individual,No,45-3124969,65122SC0010005,Consumers' Choice Silver HDP 1,65122SC001,,SCN001,SCS001,SCF018,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010005,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010005,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010005-01,Standard Silver On Exchange Plan,71.03%,0.723027527332306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,900","$5,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$0,$190,"$2,900",$0,$0,$220,5
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,4,65122,SC,Individual,No,45-3124969,65122SC0010005,Consumers' Choice Silver HDP 1,65122SC001,,SCN001,SCS001,SCF018,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010005,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010005,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$190,$0,$0,$0,$220,6
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,4,65122,SC,Individual,No,45-3124969,65122SC0010005,Consumers' Choice Silver HDP 1,65122SC001,,SCN001,SCS001,SCF018,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010005,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010005,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010005-03,Limited Cost Sharing Plan Variation,71.03%,0.723027527332306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,900","$5,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$0,$190,"$2,900",$0,$0,$220,7
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,4,65122,SC,Individual,No,45-3124969,65122SC0010005,Consumers' Choice Silver HDP 1,65122SC001,,SCN001,SCS001,SCF018,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010005,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010005,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010005-04,73% AV Level Silver Plan,73.80%,0.74889475107193,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$0,$0,$190,"$2,500",$0,$0,$220,8
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,4,65122,SC,Individual,No,45-3124969,65122SC0010005,Consumers' Choice Silver HDP 1,65122SC001,,SCN001,SCS001,SCF018,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010005,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010005,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010005-05,87% AV Level Silver Plan,87.29%,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$190,"$1,000",$0,$0,$220,9
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,4,65122,SC,Individual,No,45-3124969,65122SC0010005,Consumers' Choice Silver HDP 1,65122SC001,,SCN001,SCS001,SCF018,Existing,EPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010005,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010005,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010005-06,94% AV Level Silver Plan,94.40%,0.944938838481903,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$0,$0,$150,$400,$0,$0,$80,10
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,4,65122,SC,Individual,No,45-3124969,65122SC0010007,Consumers' Choice Bronze HDP 1,65122SC001,,SCN001,SCS001,SCF018,Existing,EPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010007,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010007,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010007-00,Standard Bronze Off Exchange Plan,58.45%,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$0,$0,$150,"$5,270",$0,$0,$80,11
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,4,65122,SC,Individual,No,45-3124969,65122SC0010007,Consumers' Choice Bronze HDP 1,65122SC001,,SCN001,SCS001,SCF018,Existing,EPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010007,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010007,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010007-01,Standard Bronze On Exchange Plan,58.45%,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$0,$0,$150,"$5,270",$0,$0,$80,12
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,4,65122,SC,Individual,No,45-3124969,65122SC0010007,Consumers' Choice Bronze HDP 1,65122SC001,,SCN001,SCS001,SCF018,Existing,EPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010007,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010007,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$190,$0,$0,$0,$220,13
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,4,65122,SC,Individual,No,45-3124969,65122SC0010007,Consumers' Choice Bronze HDP 1,65122SC001,,SCN001,SCS001,SCF018,Existing,EPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010007,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010007,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010007-03,Limited Cost Sharing Plan Variation,58.45%,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500",$0,$0,$150,"$5,270",$0,$0,$80,14
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,5,65122,SC,Individual,No,45-3124969,65122SC0010025,Consumers' Choice Silver 11,65122SC001,,SCN001,SCS001,SCF022,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010025,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010025,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010025-00,Standard Silver Off Exchange Plan,,0.704901278018951,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,"$3,640",$150,$0,$0,"$2,640",$80,4
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,5,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020027,CCHP SHOP G7,65122SC002,,SCN001,SCS001,SCF023,New,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020027,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020027,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020027-00,Standard Gold Off Exchange Plan,78.16%,0.786996126174927,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$0,$0,$150,"$3,500",$0,$0,$80,4
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,5,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020027,CCHP SHOP G7,65122SC002,,SCN001,SCS001,SCF023,New,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020027,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020027,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020027-01,Standard Gold On Exchange Plan,78.16%,0.786996126174927,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$0,$0,$150,"$3,500",$0,$0,$80,5
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,5,65122,SC,Individual,No,45-3124969,65122SC0010025,Consumers' Choice Silver 11,65122SC001,,SCN001,SCS001,SCF022,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010025,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010025,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010025-01,Standard Silver On Exchange Plan,,0.704901278018951,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,"$3,640",$150,$0,$0,"$2,640",$80,5
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,5,65122,SC,Individual,No,45-3124969,65122SC0010025,Consumers' Choice Silver 11,65122SC001,,SCN001,SCS001,SCF022,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010025,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010025,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010025-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,5,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020028,CCHP SHOP S8,65122SC002,,SCN001,SCS001,SCF032,New,EPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020028,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020028,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020028-00,Standard Silver Off Exchange Plan,71.31%,0.722319543361664,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$0,"$1,500",$150,"$3,500",$190,$270,$80,6
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,5,65122,SC,SHOP (Small Group),No,45-3124969,65122SC0020028,CCHP SHOP S8,65122SC002,,SCN001,SCS001,SCF032,New,EPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,Yes,http://www.cchpsc.org/members/plans/2015/65122sc0020028,http://www.cchpsc.org/members/payments/,http://www.cchpsc.org/members/plans/2015/65122sc0020028,http://www.cchpsc.org/media/Formulary.pdf,65122SC0020028-01,Standard Silver On Exchange Plan,71.31%,0.722319543361664,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$0,"$1,500",$150,"$3,500",$190,$270,$80,7
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,5,65122,SC,Individual,No,45-3124969,65122SC0010025,Consumers' Choice Silver 11,65122SC001,,SCN001,SCS001,SCF022,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010025,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010025,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010025-03,Limited Cost Sharing Plan Variation,,0.704901278018951,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,"$3,640",$150,$0,$0,"$2,640",$80,7
2015,SC,65122,HIOS,5,2014-11-15 04:52:41,9,65122,SC,Individual,No,45-3124969,65122SC0010008,Consumers' Choice Value Plan,65122SC001,,SCN001,SCS001,SCF018,Existing,EPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010008,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010008,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010008-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,5
2015,SC,72408,HIOS,3,2014-09-05 03:32:16,1,72408,SC,SHOP (Small Group),Yes,81-0170040,72408SC0010001,Assurant Dental ACAFFO High,72408SC001,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$38.75,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same Coverage as in Service Area,Yes,,,,,72408SC0010001-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,72408,HIOS,3,2014-09-05 03:32:16,2,72408,SC,SHOP (Small Group),Yes,81-0170040,72408SC0010002,Assurant Dental ACAFFO Low,72408SC001,,SCN001,SCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.25,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same Coverage as in Service Area,Yes,,,,,72408SC0010002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,77305,HIOS,3,2014-08-28 04:23:13,1,77305,SC,Individual,Yes,43-0908349,77305SC0190001,Delta Dental Individual and Family - Standard,77305SC019,7497758624,SCN002,SCS001,,New,PPO,Low,,Off the Exchange,,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,Allows Adult and Child-Only,,,,$32.21,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same as in USA,Yes,Same as in service area,Yes,,,,,77305SC0190001-00,Standard Low Off Exchange Plan,71.44%,,,,Yes,52%,48%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,$100,Not Applicable,,$100,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,77305,HIOS,3,2014-08-28 04:23:13,1,77305,SC,SHOP (Small Group),Yes,43-0908349,77305SC0240001,Delta Dental - PPO Choice,77305SC024,7497758624,SCN002,SCS001,,New,PPO,Low,,Off the Exchange,,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,Allows Adult and Child-Only,,,,$21.24,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same as in USA,Yes,Same as in service area,Yes,,,,,77305SC0240001-00,Standard Low Off Exchange Plan,69.30%,,,,Yes,28%,72%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,$100,Not Applicable,,$100,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,3,89281,SC,SHOP (Small Group),Yes,95-6042390,89281SC0010010,BEST Dental Choice-H,89281SC001,,SCN001,SCS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.11,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BESTDental_Choice-H_Plan.pdf,,89281SC0010010-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,4,89281,SC,SHOP (Small Group),Yes,95-6042390,89281SC0010009,BEST Dental Standard-L,89281SC001,,SCN001,SCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.09,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BESTDental_Standard-L_Plan.pdf,,89281SC0010009-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,4,89281,SC,Individual,Yes,95-6042390,89281SC0020005,BESTOne Dental Plus-Silver,89281SC002,,SCN001,SCS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.11,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BESTOne_Dental_Plus-Silver_Plan.pdf,,89281SC0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,4,89281,SC,Individual,Yes,95-6042390,89281SC0020005,BESTOne Dental Plus-Silver,89281SC002,,SCN001,SCS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.11,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BESTOne_Dental_Plus-Silver_Plan.pdf,,89281SC0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,4,89281,SC,SHOP (Small Group),Yes,95-6042390,89281SC0010009,BEST Dental Standard-L,89281SC001,,SCN001,SCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.09,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BESTDental_Standard-L_Plan.pdf,,89281SC0010009-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,94996,HIOS,2,2014-08-05 13:28:44,1,94996,SC,SHOP (Small Group),Yes,44-0308260,94996SC0010003,KCL EHB Low MAC,94996SC001,,SCN001,SCS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$28.70,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,94996SC0010003-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,94996,HIOS,2,2014-08-05 13:28:44,1,94996,SC,SHOP (Small Group),Yes,44-0308260,94996SC0010005,KCL Fam Low PPO,94996SC001,,SCN001,SCS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$44.56,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,94996SC0010005-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SC,94996,HIOS,2,2014-08-05 13:28:44,1,94996,SC,SHOP (Small Group),Yes,44-0308260,94996SC0010007,KCL Fam Low MAC,94996SC001,,SCN001,SCS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$28.70,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,94996SC0010007-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190097,BlueCross SG Gold 19S,14002TN019,,TNN002,TNS006,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-19S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190097-01,Standard Gold On Exchange Plan,,0.787335395812988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190065,BlueCross SG Silver 13S,14002TN019,,TNN002,TNS001,TNF014,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-13S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190065-00,Standard Silver Off Exchange Plan,68.80%,0.666971623897552,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",20%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,Individual,No,62-0427913,14002TN0320004,BlueCross Bronze B04S,14002TN032,,TNN002,TNS010,TNF013,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320004-00,Standard Bronze Off Exchange Plan,,0.617985665798187,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$15,900","$31,800","$21,200","$42,400",,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",0%,,,,"$10,600","$21,200","$15,900","$31,800",,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,Individual,No,62-0427913,14002TN0320004,BlueCross Bronze B04S,14002TN032,,TNN002,TNS010,TNF013,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320004-01,Standard Bronze On Exchange Plan,,0.617985665798187,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$15,900","$31,800","$21,200","$42,400",,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",0%,,,,"$10,600","$21,200","$15,900","$31,800",,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190065,BlueCross SG Silver 13S,14002TN019,,TNN002,TNS001,TNF014,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-13S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190065-01,Standard Silver On Exchange Plan,68.80%,0.666971623897552,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",20%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190066,BlueCross SG Silver 13S,14002TN019,,TNN002,TNS002,TNF014,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-13S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190066-00,Standard Silver Off Exchange Plan,68.80%,0.666971623897552,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",20%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,Individual,No,62-0427913,14002TN0320004,BlueCross Bronze B04S,14002TN032,,TNN002,TNS010,TNF013,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,Individual,No,62-0427913,14002TN0320004,BlueCross Bronze B04S,14002TN032,,TNN002,TNS010,TNF013,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320004-03,Limited Cost Sharing Plan Variation,,0.617985665798187,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$15,900","$31,800","$21,200","$42,400",,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",0%,,,,"$10,600","$21,200","$15,900","$31,800",,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190066,BlueCross SG Silver 13S,14002TN019,,TNN002,TNS002,TNF014,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-13S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190066-01,Standard Silver On Exchange Plan,68.80%,0.666971623897552,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",20%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190067,BlueCross SG Silver 13S,14002TN019,,TNN002,TNS003,TNF014,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-13S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190067-00,Standard Silver Off Exchange Plan,68.80%,0.666971623897552,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",20%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,Individual,No,62-0427913,14002TN0320008,BlueCross Bronze B04E,14002TN032,,TNN003,TNS009,TNF013,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320008-00,Standard Bronze Off Exchange Plan,,0.617985665798187,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$15,900","$31,800","$21,200","$42,400",,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",0%,,,,"$10,600","$21,200","$15,900","$31,800",,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,Individual,No,62-0427913,14002TN0320008,BlueCross Bronze B04E,14002TN032,,TNN003,TNS009,TNF013,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320008-01,Standard Bronze On Exchange Plan,,0.617985665798187,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$15,900","$31,800","$21,200","$42,400",,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",0%,,,,"$10,600","$21,200","$15,900","$31,800",,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190067,BlueCross SG Silver 13S,14002TN019,,TNN002,TNS003,TNF014,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-13S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190067-01,Standard Silver On Exchange Plan,68.80%,0.666971623897552,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",20%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190068,BlueCross SG Silver 13S,14002TN019,,TNN002,TNS004,TNF014,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-13S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190068-00,Standard Silver Off Exchange Plan,68.80%,0.666971623897552,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",20%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190098,BlueCross SG Gold 19S,14002TN019,,TNN002,TNS007,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-19S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190098-00,Standard Gold Off Exchange Plan,,0.787335395812988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190098,BlueCross SG Gold 19S,14002TN019,,TNN002,TNS007,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-19S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190098-01,Standard Gold On Exchange Plan,,0.787335395812988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190099,BlueCross SG Gold 19S,14002TN019,,TNN002,TNS008,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-19S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190099-00,Standard Gold Off Exchange Plan,,0.787335395812988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190099,BlueCross SG Gold 19S,14002TN019,,TNN002,TNS008,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-19S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190099-01,Standard Gold On Exchange Plan,,0.787335395812988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,19
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190100,BlueCross SG Gold 19P,14002TN019,,TNN001,TNS010,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-19P,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190100-00,Standard Gold Off Exchange Plan,,0.787335395812988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,SC,94996,HIOS,2,2014-08-05 13:28:44,2,94996,SC,SHOP (Small Group),Yes,44-0308260,94996SC0010002,KCL EHB High PPO,94996SC001,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$54.01,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,94996SC0010002-00,Standard High Off Exchange Plan,84.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,94996,HIOS,2,2014-08-05 13:28:44,2,94996,SC,SHOP (Small Group),Yes,44-0308260,94996SC0010004,KCL EHB High MAC,94996SC001,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$36.22,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,94996SC0010004-00,Standard High Off Exchange Plan,84.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,94996,HIOS,2,2014-08-05 13:28:44,2,94996,SC,SHOP (Small Group),Yes,44-0308260,94996SC0010006,KCL Fam High PPO,94996SC001,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$54.01,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,94996SC0010006-00,Standard High Off Exchange Plan,84.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,Individual,No,62-0427913,14002TN0320003,BlueCross Bronze B03S,14002TN032,,TNN002,TNS010,TNF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,Individual,No,62-0427913,14002TN0320003,BlueCross Bronze B03S,14002TN032,,TNN002,TNS010,TNF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320003-03,Limited Cost Sharing Plan Variation,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190093,BlueCross SG Gold 19S,14002TN019,,TNN002,TNS002,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-19S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190093-01,Standard Gold On Exchange Plan,,0.787335395812988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190094,BlueCross SG Gold 19S,14002TN019,,TNN002,TNS003,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-19S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190094-00,Standard Gold Off Exchange Plan,,0.787335395812988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,Individual,No,62-0427913,14002TN0320007,BlueCross Bronze B03E,14002TN032,,TNN003,TNS009,TNF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320007-00,Standard Bronze Off Exchange Plan,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,Individual,No,62-0427913,14002TN0320007,BlueCross Bronze B03E,14002TN032,,TNN003,TNS009,TNF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320007-01,Standard Bronze On Exchange Plan,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190094,BlueCross SG Gold 19S,14002TN019,,TNN002,TNS003,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-19S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190094-01,Standard Gold On Exchange Plan,,0.787335395812988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190095,BlueCross SG Gold 19S,14002TN019,,TNN002,TNS004,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-19S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190095-00,Standard Gold Off Exchange Plan,,0.787335395812988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,Individual,No,62-0427913,14002TN0320007,BlueCross Bronze B03E,14002TN032,,TNN003,TNS009,TNF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,Individual,No,62-0427913,14002TN0320007,BlueCross Bronze B03E,14002TN032,,TNN003,TNS009,TNF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320007-03,Limited Cost Sharing Plan Variation,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190095,BlueCross SG Gold 19S,14002TN019,,TNN002,TNS004,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-19S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190095-01,Standard Gold On Exchange Plan,,0.787335395812988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190096,BlueCross SG Gold 19S,14002TN019,,TNN002,TNS005,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-19S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190096-00,Standard Gold Off Exchange Plan,,0.787335395812988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,Individual,No,62-0427913,14002TN0320011,BlueCross Bronze B03E,14002TN032,,TNN003,TNS004,TNF011,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320011-00,Standard Bronze Off Exchange Plan,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,Individual,No,62-0427913,14002TN0320011,BlueCross Bronze B03E,14002TN032,,TNN003,TNS004,TNF011,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320011-01,Standard Bronze On Exchange Plan,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190096,BlueCross SG Gold 19S,14002TN019,,TNN002,TNS005,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-19S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190096-01,Standard Gold On Exchange Plan,,0.787335395812988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190097,BlueCross SG Gold 19S,14002TN019,,TNN002,TNS006,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-19S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190097-00,Standard Gold Off Exchange Plan,,0.787335395812988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,Individual,No,62-0427913,14002TN0320011,BlueCross Bronze B03E,14002TN032,,TNN003,TNS004,TNF011,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,Individual,No,62-0427913,14002TN0320011,BlueCross Bronze B03E,14002TN032,,TNN003,TNS004,TNF011,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320011-03,Limited Cost Sharing Plan Variation,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,15
2015,SC,77305,HIOS,3,2014-08-28 04:23:13,1,77305,SC,Individual,Yes,43-0908349,77305SC0200001,Delta Dental Individual and Family - Standard Plus,77305SC020,7497758624,SCN002,SCS001,,New,PPO,High,,Off the Exchange,,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,Allows Adult and Child-Only,,,,$38.44,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same as in USA,Yes,Same as in service area,Yes,,,,,77305SC0200001-00,Standard High Off Exchange Plan,84.27%,,,,Yes,52%,48%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,$0,Not Applicable,,$0,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,77305,HIOS,3,2014-08-28 04:23:13,2,77305,SC,Individual,Yes,43-0908349,77305SC0210001,Delta Dental Individual and Family - FFM Basic,77305SC021,7497758624,SCN002,SCS001,,New,PPO,Low,,On the Exchange,,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,Allows Adult and Child-Only,,,,$36.53,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same as in USA,Yes,Same as in service area,Yes,https://Individual.deltadentalsc.com/benefits/FFMBasic,https://Individual.deltadentalsc.com/marketplace/FFMBasic,https://Individual.deltadentalsc.com/brochure/FFMBasic,,77305SC0210001-01,Standard Low On Exchange Plan,71.57%,,,,Yes,35%,65%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,$50,Not Applicable,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,77305,HIOS,3,2014-08-28 04:23:13,2,77305,SC,SHOP (Small Group),Yes,43-0908349,77305SC0250001,Delta Dental - PPO Choice Plus,77305SC025,7497758624,SCN002,SCS001,,New,PPO,High,,Off the Exchange,,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,Allows Adult and Child-Only,,,,$28.01,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same as in USA,Yes,Same as in service area,Yes,,,,,77305SC0250001-00,Standard High Off Exchange Plan,86.47%,,,,Yes,28%,72%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,$100,Not Applicable,,$100,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,77305,HIOS,3,2014-08-28 04:23:13,3,77305,SC,SHOP (Small Group),Yes,43-0908349,77305SC0260001,Delta Dental - FFM Exclusive,77305SC026,7497758624,SCN002,SCS001,,New,EPO,Low,,On the Exchange,,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,Allows Adult and Child-Only,,,,$18.64,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same as in USA,Yes,Same as in service area,Yes,http://www.deltadentalsc.com/FFMExclusive/Benefits,http://www.deltadentalsc.com/FFMExclusive/MarketPlace,http://www.deltadentalsc.com/FFMExclusive/Brochure,,77305SC0260001-01,Standard Low On Exchange Plan,70.17%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,77305,HIOS,3,2014-08-28 04:23:13,3,77305,SC,Individual,Yes,43-0908349,77305SC0220001,Delta Dental Individual and Family - FFM Preferred,77305SC022,7497758624,SCN002,SCS001,,New,PPO,Low,,On the Exchange,,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,Allows Adult and Child-Only,,,,$36.53,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same as in USA,Yes,Same as in service area,Yes,https://Individual.deltadentalsc.com/benefits/FFMPreferred,https://Individual.deltadentalsc.com/marketplace/FFMPreferred,https://Individual.deltadentalsc.com/brochure/FFMPreferred,,77305SC0220001-01,Standard Low On Exchange Plan,71.57%,,,,Yes,35%,65%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,$50,Not Applicable,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,77305,HIOS,3,2014-08-28 04:23:13,4,77305,SC,Individual,Yes,43-0908349,77305SC0230001,Delta Dental Individual and Family - FFM Choice,77305SC023,7497758624,SCN002,SCS001,,New,PPO,High,,On the Exchange,,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,Allows Adult and Child-Only,,,,$42.36,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same as in USA,Yes,Same as in service area,Yes,https://Individual.deltadentalsc.com/benefits/FFMChoice,https://Individual.deltadentalsc.com/marketplace/FFMChoice,https://Individual.deltadentalsc.com/brochure/FFMChoice,,77305SC0230001-01,Standard High On Exchange Plan,85.59%,,,,Yes,35%,65%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,$75,Not Applicable,,$75,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,77305,HIOS,3,2014-08-28 04:23:13,4,77305,SC,SHOP (Small Group),Yes,43-0908349,77305SC0270001,Delta Dental - FFM Premier,77305SC027,7497758624,SCN001,SCS001,,New,PPO,High,,On the Exchange,,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,Allows Adult and Child-Only,,,,$30.53,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same as in USA,Yes,Same as in service area,Yes,http://www.deltadentalsc.com/FFMPremier/Benefits,http://www.deltadentalsc.com/FFMPremier/MarketPlace,http://www.deltadentalsc.com/FFMPremier/Brochure,,77305SC0270001-01,Standard High On Exchange Plan,85.89%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,$150,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,83876,HIOS,3,2014-09-04 03:25:43,1,83876,SC,SHOP (Small Group),Yes,41-0808596,83876SC0010001,"Plan 1. Passive PPO, $1000 Annual Maximum, no Ortho",83876SC001,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,83876SC0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,83876,HIOS,3,2014-09-04 03:25:43,1,83876,SC,SHOP (Small Group),Yes,41-0808596,83876SC0010002,"Plan 2.  Passive PPO, $1000 Annual Maximum, Ortho",83876SC001,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,83876SC0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,83876,HIOS,3,2014-09-04 03:25:43,1,83876,SC,SHOP (Small Group),Yes,41-0808596,83876SC0010003,"Plan 3. Passive PPO, $1500 Annual Maximum, no Ortho",83876SC001,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,83876SC0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SC,83876,HIOS,3,2014-09-04 03:25:43,1,83876,SC,SHOP (Small Group),Yes,41-0808596,83876SC0010004,"Plan 4.  Passive PPO, $1500 Annual Maximum, Ortho",83876SC001,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,83876SC0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SC,83876,HIOS,3,2014-09-04 03:25:43,1,83876,SC,SHOP (Small Group),Yes,41-0808596,83876SC0010005,"Plan 5.  Passive PPO, $2000 Annual Maximum, Ortho",83876SC001,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,83876SC0010005-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,SC,83876,HIOS,3,2014-09-04 03:25:43,1,83876,SC,SHOP (Small Group),Yes,41-0808596,83876SC0010006,"Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho",83876SC001,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,83876SC0010006-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,SC,83876,HIOS,3,2014-09-04 03:25:43,1,83876,SC,SHOP (Small Group),Yes,41-0808596,83876SC0010007,"Plan 7. Graded Passive PPO, $1500 Annual Maximum, Ortho",83876SC001,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,83876SC0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,SC,83876,HIOS,3,2014-09-04 03:25:43,1,83876,SC,SHOP (Small Group),Yes,41-0808596,83876SC0010008,"Plan 8. MAC PPO, $1000 Annual Maximum, no Ortho",83876SC001,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,83876SC0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,SC,83876,HIOS,3,2014-09-04 03:25:43,1,83876,SC,SHOP (Small Group),Yes,41-0808596,83876SC0010009,"Plan 9. MAC PPO, $1500 Annual Maximum, Ortho",83876SC001,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,83876SC0010009-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,SC,83876,HIOS,3,2014-09-04 03:25:43,1,83876,SC,SHOP (Small Group),Yes,41-0808596,83876SC0010010,"Plan 10. Graded MAC PPO, $1000 Annual Maximum, no Ortho",83876SC001,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,83876SC0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,13
2015,SC,84589,HIOS,3,2014-09-04 03:25:43,1,84589,SC,SHOP (Small Group),Yes,35-0472300,84589SC0010001,Lincoln DentalConnect?,84589SC001,,SCN001,SCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.21,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,84589SC0010001-00,Standard High Off Exchange Plan,85.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,84589,HIOS,3,2014-09-04 03:25:43,1,84589,SC,SHOP (Small Group),Yes,35-0472300,84589SC0010002,Lincoln DentalConnect?,84589SC001,,SCN001,SCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.87,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,84589SC0010002-00,Standard Low Off Exchange Plan,70.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,84589,HIOS,3,2014-09-04 03:25:43,1,84589,SC,SHOP (Small Group),Yes,35-0472300,84589SC0010003,Lincoln DentalConnect?,84589SC001,,SCN001,SCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.33,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,84589SC0010003-00,Standard Low Off Exchange Plan,70.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SC,84589,HIOS,3,2014-09-04 03:25:43,1,84589,SC,SHOP (Small Group),Yes,35-0472300,84589SC0010005,Lincoln DentalConnect?,84589SC001,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.38,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,84589SC0010005-00,Standard High Off Exchange Plan,85.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SC,84589,HIOS,3,2014-09-04 03:25:43,1,84589,SC,SHOP (Small Group),Yes,35-0472300,84589SC0010006,Lincoln DentalConnect?,84589SC001,,SCN001,SCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.99,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,84589SC0010006-00,Standard Low Off Exchange Plan,70.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,SC,84589,HIOS,3,2014-09-04 03:25:43,1,84589,SC,SHOP (Small Group),Yes,35-0472300,84589SC0010007,Lincoln DentalConnect?,84589SC001,,SCN001,SCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.95,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,84589SC0010007-00,Standard Low Off Exchange Plan,70.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,SC,84589,HIOS,3,2014-09-04 03:25:43,2,84589,SC,SHOP (Small Group),Yes,35-0472300,84589SC0010004,Lincoln DentalConnect?,84589SC001,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.45,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,84589SC0010004-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,84589,HIOS,3,2014-09-04 03:25:43,2,84589,SC,SHOP (Small Group),Yes,35-0472300,84589SC0010008,Lincoln DentalConnect?,84589SC001,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.18,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,84589SC0010008-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,84939,HIOS,4,2014-08-23 04:11:13,1,84939,SC,SHOP (Small Group),Yes,13-5123390,84939SC0110002,Guardian Pediatric Advantage,84939SC011,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$22.63,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,84939SC0110002-00,Standard High Off Exchange Plan,84.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,84939,HIOS,4,2014-08-23 04:11:13,1,84939,SC,SHOP (Small Group),Yes,13-5123390,84939SC0120002,Guardian Pediatric Essentials,84939SC012,,SCN001,SCS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$16.95,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,84939SC0120002-00,Standard Low Off Exchange Plan,70.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,84939,HIOS,4,2014-08-23 04:11:13,2,84939,SC,SHOP (Small Group),Yes,13-5123390,84939SC0140002,Guardian Family Advantage,84939SC014,,SCN001,SCS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.63,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,84939SC0140002-00,Standard High Off Exchange Plan,84.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,84939,HIOS,4,2014-08-23 04:11:13,2,84939,SC,SHOP (Small Group),Yes,13-5123390,84939SC0140002,Guardian Family Advantage,84939SC014,,SCN001,SCS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.63,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,84939SC0140002-01,Standard High On Exchange Plan,84.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,84939,HIOS,4,2014-08-23 04:11:13,2,84939,SC,SHOP (Small Group),Yes,13-5123390,84939SC0160002,Guardian Family Essentials,84939SC016,,SCN001,SCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.95,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,84939SC0160002-00,Standard Low Off Exchange Plan,70.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SC,84939,HIOS,4,2014-08-23 04:11:13,2,84939,SC,SHOP (Small Group),Yes,13-5123390,84939SC0160002,Guardian Family Essentials,84939SC016,,SCN001,SCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.95,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,84939SC0160002-01,Standard Low On Exchange Plan,70.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SC,84966,HIOS,2,2014-08-05 13:28:44,1,84966,SC,SHOP (Small Group),Yes,13-5581829,84966SC0120001,EHB Basic Dental Plan (Low),84966SC012,,SCN001,SCS001,,Existing,PPO,Low,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$17.37,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,84966SC0120001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,84966,HIOS,2,2014-08-05 13:28:44,2,84966,SC,SHOP (Small Group),Yes,13-5581829,84966SC0130001,EHB Enhanced Dental Plan (High),84966SC013,,SCN002,SCS001,,Existing,PPO,High,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$21.49,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,84966SC0130001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,84966,HIOS,2,2014-08-05 13:28:44,3,84966,SC,SHOP (Small Group),Yes,13-5581829,84966SC0140001,Family Basic Dental Plan (Low),84966SC014,,SCN003,SCS001,,Existing,PPO,Low,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$17.37,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,84966SC0140001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,84966,HIOS,2,2014-08-05 13:28:44,4,84966,SC,SHOP (Small Group),Yes,13-5581829,84966SC0150001,Family Enhanced Dental Plan (High),84966SC015,,SCN004,SCS001,,Existing,PPO,High,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$21.49,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,84966SC0150001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,88250,HIOS,2,2014-08-03 08:59:32,1,88250,SC,SHOP (Small Group),Yes,93-0242990,88250SC0040002,EHB High PPO,88250SC004,,SCN001,SCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$38.02,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,88250SC0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,88250,HIOS,2,2014-08-03 08:59:32,1,88250,SC,SHOP (Small Group),Yes,93-0242990,88250SC0040001,EHB Low PPO,88250SC004,,SCN001,SCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.53,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,88250SC0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,88250,HIOS,2,2014-08-03 08:59:32,1,88250,SC,SHOP (Small Group),Yes,93-0242990,88250SC0030002,EHB High Passive,88250SC003,,SCN001,SCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.71,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,88250SC0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SC,88250,HIOS,2,2014-08-03 08:59:32,1,88250,SC,SHOP (Small Group),Yes,93-0242990,88250SC0030001,EHB Low Passive,88250SC003,,SCN001,SCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.74,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,88250SC0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,1,89281,SC,Individual,Yes,95-6042390,89281SC0020001,BESTOne Child Dental Plus,89281SC002,,SCN001,SCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$38.89,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BESTOne_Child_Dental_Plus_Plan.pdf,,89281SC0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,1,89281,SC,SHOP (Small Group),Yes,95-6042390,89281SC0010001,BEST Life Child Dental Plus,89281SC001,,SCN001,SCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$31.11,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BEST_Life_Child_Dental_Plus_Plan.pdf,,89281SC0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,2,89281,SC,SHOP (Small Group),Yes,95-6042390,89281SC0010002,BEST Life Child Dental,89281SC001,,SCN001,SCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.09,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BEST_Life_Child_Dental_Plan.pdf,,89281SC0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,2,89281,SC,Individual,Yes,95-6042390,89281SC0020002,BESTOne Child Dental,89281SC002,,SCN001,SCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$30.11,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BESTOne_Child_Dental_Plan.pdf,,89281SC0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,3,89281,SC,Individual,Yes,95-6042390,89281SC0020003,BESTOne Dental Advantage-Gold,89281SC002,,SCN001,SCS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.89,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BESTOne_Dental_Advantage-Gold_Plan.pdf,,89281SC0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,3,89281,SC,SHOP (Small Group),Yes,95-6042390,89281SC0010007,BEST Dental Premium,89281SC001,,SCN001,SCS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.11,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BESTDental_Premium_Plan.pdf,,89281SC0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,3,89281,SC,SHOP (Small Group),Yes,95-6042390,89281SC0010007,BEST Dental Premium,89281SC001,,SCN001,SCS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.11,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BESTDental_Premium_Plan.pdf,,89281SC0010007-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,3,89281,SC,Individual,Yes,95-6042390,89281SC0020003,BESTOne Dental Advantage-Gold,89281SC002,,SCN001,SCS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.89,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BESTOne_Dental_Advantage-Gold_Plan.pdf,,89281SC0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,3,89281,SC,Individual,Yes,95-6042390,89281SC0020004,BESTOne Dental Plus-Gold,89281SC002,,SCN001,SCS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.89,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BESTOne_Dental_Plus-Gold_Plan.pdf,,89281SC0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,3,89281,SC,SHOP (Small Group),Yes,95-6042390,89281SC0010008,BEST Dental Standard-H,89281SC001,,SCN001,SCS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.11,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BESTDental_Standard-H_Plan.pdf,,89281SC0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,3,89281,SC,SHOP (Small Group),Yes,95-6042390,89281SC0010008,BEST Dental Standard-H,89281SC001,,SCN001,SCS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.11,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BESTDental_Standard-H_Plan.pdf,,89281SC0010008-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,3,89281,SC,Individual,Yes,95-6042390,89281SC0020004,BESTOne Dental Plus-Gold,89281SC002,,SCN001,SCS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.89,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BESTOne_Dental_Plus-Gold_Plan.pdf,,89281SC0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,4,89281,SC,SHOP (Small Group),Yes,95-6042390,89281SC0010011,BEST Dental Choice-L,89281SC001,,SCN001,SCS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.09,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BESTDental_Choice-L_Plan.pdf,,89281SC0010011-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,4,89281,SC,Individual,Yes,95-6042390,89281SC0020006,BESTOne Dental Basic-Silver,89281SC002,,SCN001,SCS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.11,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BESTOne_Dental_Basic-Silver_Plan.pdf,,89281SC0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SC,89281,HIOS,5,2014-10-02 12:25:15,4,89281,SC,Individual,Yes,95-6042390,89281SC0020006,BESTOne Dental Basic-Silver,89281SC002,,SCN001,SCS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.11,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SC/2015/SC_BESTOne_Dental_Basic-Silver_Plan.pdf,,89281SC0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190100,BlueCross SG Gold 19P,14002TN019,,TNN001,TNS010,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-19P,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190100-01,Standard Gold On Exchange Plan,,0.787335395812988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,Individual,No,62-0427913,14002TN0320008,BlueCross Bronze B04E,14002TN032,,TNN003,TNS009,TNF013,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,Individual,No,62-0427913,14002TN0320008,BlueCross Bronze B04E,14002TN032,,TNN003,TNS009,TNF013,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320008-03,Limited Cost Sharing Plan Variation,,0.617985665798187,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$15,900","$31,800","$21,200","$42,400",,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",0%,,,,"$10,600","$21,200","$15,900","$31,800",,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190068,BlueCross SG Silver 13S,14002TN019,,TNN002,TNS004,TNF014,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-13S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190068-01,Standard Silver On Exchange Plan,68.80%,0.666971623897552,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",20%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190069,BlueCross SG Silver 13S,14002TN019,,TNN002,TNS005,TNF014,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-13S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190069-00,Standard Silver Off Exchange Plan,68.80%,0.666971623897552,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",20%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,Individual,No,62-0427913,14002TN0320012,BlueCross Bronze B04E,14002TN032,,TNN003,TNS004,TNF013,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320012-00,Standard Bronze Off Exchange Plan,,0.617985665798187,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$15,900","$31,800","$21,200","$42,400",,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",0%,,,,"$10,600","$21,200","$15,900","$31,800",,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,Individual,No,62-0427913,14002TN0320012,BlueCross Bronze B04E,14002TN032,,TNN003,TNS004,TNF013,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320012-01,Standard Bronze On Exchange Plan,,0.617985665798187,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$15,900","$31,800","$21,200","$42,400",,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",0%,,,,"$10,600","$21,200","$15,900","$31,800",,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190069,BlueCross SG Silver 13S,14002TN019,,TNN002,TNS005,TNF014,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-13S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190069-01,Standard Silver On Exchange Plan,68.80%,0.666971623897552,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",20%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,13
2015,SC,94996,HIOS,2,2014-08-05 13:28:44,2,94996,SC,SHOP (Small Group),Yes,44-0308260,94996SC0010008,KCL Fam High MAC,94996SC001,,SCN001,SCS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$36.22,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,94996SC0010008-00,Standard High Off Exchange Plan,84.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SC,97325,HIOS,7,2014-11-12 05:24:58,1,97325,SC,Individual,Yes,47-0397286,97325SC0010001,"Delta Dental Individual PPO, EHB Certified",97325SC001,,SCN002,SCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.90,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,97325SC0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,$0,$0,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,97325,HIOS,7,2014-11-12 05:24:58,1,97325,SC,SHOP (Small Group),Yes,47-0397286,97325SC0030001,"Renaissance Group Dental PPO, EHB Certified",97325SC003,,SCN001,SCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.59,,Estimated Rate,,0,0,0,2005-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,97325SC0030001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,97325,HIOS,7,2014-11-12 05:24:58,1,97325,SC,SHOP (Small Group),Yes,47-0397286,97325SC0030002,"Renaissance Group Dental PPO, EHB Certified",97325SC003,,SCN001,SCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.52,,Estimated Rate,,0,0,0,2005-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,97325SC0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,97325,HIOS,7,2014-11-12 05:24:58,1,97325,SC,Individual,Yes,47-0397286,97325SC0010002,"Delta Dental Individual PPO, EHB Certified",97325SC001,,SCN002,SCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.51,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,97325SC0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,$0,$0,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,97325,HIOS,7,2014-11-12 05:24:58,1,97325,SC,Individual,Yes,47-0397286,97325SC0020001,"Renaissance Individual Dental PPO, EHB Certified",97325SC002,,SCN001,SCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.07,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,97325SC0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SC,97325,HIOS,7,2014-11-12 05:24:58,1,97325,SC,SHOP (Small Group),Yes,47-0397286,97325SC0080001,"Renaissance Group Dental PPO, EHB Certified (Exchange)",97325SC008,,SCN001,SCS001,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$13.45,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/SC_EHB_Group_High_2015,,http://www.renaissancedental.com/SC_EHB_Group_High_2015,,97325SC0080001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SC,97325,HIOS,7,2014-11-12 05:24:58,1,97325,SC,SHOP (Small Group),Yes,47-0397286,97325SC0080002,"Renaissance Group Dental PPO, EHB Certified (Exchange)",97325SC008,,SCN001,SCS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$13.45,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/SC_EHB_Group_Low_2015,,http://www.renaissancedental.com/SC_EHB_Group_Low_2015,,97325SC0080002-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SC,97325,HIOS,7,2014-11-12 05:24:58,1,97325,SC,Individual,Yes,47-0397286,97325SC0020002,"Renaissance Individual Dental PPO, EHB Certified",97325SC002,,SCN001,SCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.39,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,97325SC0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SC,97325,HIOS,7,2014-11-12 05:24:58,1,97325,SC,Individual,Yes,47-0397286,97325SC0060001,"Renaissance Individual Dental PPO, EHB Certified (Exchange)",97325SC006,,SCN001,SCS001,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.47,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/SC_EHB_High_2015,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/97325,http://www.renaissancedental.com/SC_EHB_High_2015,,97325SC0060001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,SC,97325,HIOS,7,2014-11-12 05:24:58,1,97325,SC,SHOP (Small Group),Yes,47-0397286,97325SC0080003,"Renaissance Group Dental PPO, EHB Certified (Exchange)",97325SC008,,SCN001,SCS001,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$13.45,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/SC_50_50_High_2015,,http://www.renaissancedental.com/SC_50_50_High_2015,,97325SC0080003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,SC,97325,HIOS,7,2014-11-12 05:24:58,1,97325,SC,SHOP (Small Group),Yes,47-0397286,97325SC0080004,"Renaissance Group Dental PPO, EHB Certified (Exchange)",97325SC008,,SCN001,SCS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$13.45,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/SC_50_50_Low_2015,,http://www.renaissancedental.com/SC_50_50_Low_2015,,97325SC0080004-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,SC,97325,HIOS,7,2014-11-12 05:24:58,1,97325,SC,Individual,Yes,47-0397286,97325SC0060002,"Renaissance Individual Dental PPO, EHB Certified (Exchange)",97325SC006,,SCN001,SCS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$17.74,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/SC_EHB_Low_2015,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/97325,http://www.renaissancedental.com/SC_EHB_Low_2015,,97325SC0060002-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,SC,97325,HIOS,7,2014-11-12 05:24:58,2,97325,SC,Individual,Yes,47-0397286,97325SC0050001,"Renaissance Individual Dental Pediatric-Only, EHB Certified",97325SC005,,SCN001,SCS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$32.69,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,97325SC0050001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SC,97325,HIOS,7,2014-11-12 05:24:58,2,97325,SC,Individual,Yes,47-0397286,97325SC0050002,"Renaissance Individual Dental Pediatric-Only, EHB Certified",97325SC005,,SCN001,SCS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.68,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,97325SC0050002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SC,97325,HIOS,7,2014-11-12 05:24:58,2,97325,SC,Individual,Yes,47-0397286,97325SC0070001,"Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)",97325SC007,,SCN001,SCS001,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$35.51,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/SC_Ped_High_2015,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/97325,http://www.renaissancedental.com/SC_Ped_High_2015,,97325SC0070001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SC,97325,HIOS,7,2014-11-12 05:24:58,2,97325,SC,Individual,Yes,47-0397286,97325SC0070002,"Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)",97325SC007,,SCN001,SCS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$27.93,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/SC_Ped_Low_2015,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/97325,http://www.renaissancedental.com/SC_Ped_Low_2015,,97325SC0070002-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,Individual,No,62-0427913,14002TN0320001,BlueCross Bronze B01S,14002TN032,,TNN002,TNS010,TNF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320001-00,Standard Bronze Off Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190101,BlueCross SG Platinum 03S,14002TN019,,TNN002,TNS001,TNF001,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Platinum-03S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190101-00,Standard Platinum Off Exchange Plan,88.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","$8,000","$16,000",$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190101,BlueCross SG Platinum 03S,14002TN019,,TNN002,TNS001,TNF001,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Platinum-03S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190101-01,Standard Platinum On Exchange Plan,88.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","$8,000","$16,000",$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,Individual,No,62-0427913,14002TN0320001,BlueCross Bronze B01S,14002TN032,,TNN002,TNS010,TNF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320001-01,Standard Bronze On Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,Individual,No,62-0427913,14002TN0320001,BlueCross Bronze B01S,14002TN032,,TNN002,TNS010,TNF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190102,BlueCross SG Platinum 03S,14002TN019,,TNN002,TNS002,TNF001,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Platinum-03S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190102-00,Standard Platinum Off Exchange Plan,88.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","$8,000","$16,000",$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190102,BlueCross SG Platinum 03S,14002TN019,,TNN002,TNS002,TNF001,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Platinum-03S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190102-01,Standard Platinum On Exchange Plan,88.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","$8,000","$16,000",$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,Individual,No,62-0427913,14002TN0320001,BlueCross Bronze B01S,14002TN032,,TNN002,TNS010,TNF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320001-03,Limited Cost Sharing Plan Variation,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,Individual,No,62-0427913,14002TN0320005,BlueCross Bronze B01E,14002TN032,,TNN003,TNS009,TNF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320005-00,Standard Bronze Off Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190103,BlueCross SG Platinum 03S,14002TN019,,TNN002,TNS003,TNF001,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Platinum-03S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190103-00,Standard Platinum Off Exchange Plan,88.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","$8,000","$16,000",$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190103,BlueCross SG Platinum 03S,14002TN019,,TNN002,TNS003,TNF001,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Platinum-03S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190103-01,Standard Platinum On Exchange Plan,88.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","$8,000","$16,000",$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,Individual,No,62-0427913,14002TN0320005,BlueCross Bronze B01E,14002TN032,,TNN003,TNS009,TNF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320005-01,Standard Bronze On Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,Individual,No,62-0427913,14002TN0320005,BlueCross Bronze B01E,14002TN032,,TNN003,TNS009,TNF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190104,BlueCross SG Platinum 03S,14002TN019,,TNN002,TNS004,TNF001,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Platinum-03S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190104-00,Standard Platinum Off Exchange Plan,88.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","$8,000","$16,000",$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190104,BlueCross SG Platinum 03S,14002TN019,,TNN002,TNS004,TNF001,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Platinum-03S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190104-01,Standard Platinum On Exchange Plan,88.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","$8,000","$16,000",$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,Individual,No,62-0427913,14002TN0320005,BlueCross Bronze B01E,14002TN032,,TNN003,TNS009,TNF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320005-03,Limited Cost Sharing Plan Variation,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,Individual,No,62-0427913,14002TN0320009,BlueCross Bronze B01E,14002TN032,,TNN003,TNS004,TNF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320009-00,Standard Bronze Off Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190105,BlueCross SG Platinum 03S,14002TN019,,TNN002,TNS005,TNF001,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Platinum-03S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190105-00,Standard Platinum Off Exchange Plan,88.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","$8,000","$16,000",$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190105,BlueCross SG Platinum 03S,14002TN019,,TNN002,TNS005,TNF001,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Platinum-03S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190105-01,Standard Platinum On Exchange Plan,88.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","$8,000","$16,000",$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,Individual,No,62-0427913,14002TN0320009,BlueCross Bronze B01E,14002TN032,,TNN003,TNS004,TNF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320009-01,Standard Bronze On Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,Individual,No,62-0427913,14002TN0320009,BlueCross Bronze B01E,14002TN032,,TNN003,TNS004,TNF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190106,BlueCross SG Platinum 03S,14002TN019,,TNN002,TNS006,TNF001,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Platinum-03S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190106-00,Standard Platinum Off Exchange Plan,88.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","$8,000","$16,000",$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190106,BlueCross SG Platinum 03S,14002TN019,,TNN002,TNS006,TNF001,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Platinum-03S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190106-01,Standard Platinum On Exchange Plan,88.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","$8,000","$16,000",$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,Individual,No,62-0427913,14002TN0320009,BlueCross Bronze B01E,14002TN032,,TNN003,TNS004,TNF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320009-03,Limited Cost Sharing Plan Variation,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,1,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190107,BlueCross SG Platinum 03S,14002TN019,,TNN002,TNS007,TNF001,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Platinum-03S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190107-00,Standard Platinum Off Exchange Plan,88.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","$8,000","$16,000",$0,$0,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190083,BlueCross SG Gold 18S,14002TN019,,TNN002,TNS001,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-18S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190083-01,Standard Gold On Exchange Plan,,0.818502187728882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190084,BlueCross SG Gold 18S,14002TN019,,TNN002,TNS002,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-18S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190084-00,Standard Gold Off Exchange Plan,,0.818502187728882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,Individual,No,62-0427913,14002TN0320002,BlueCross Bronze B02S,14002TN032,,TNN002,TNS010,TNF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,Individual,No,62-0427913,14002TN0320002,BlueCross Bronze B02S,14002TN032,,TNN002,TNS010,TNF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320002-03,Limited Cost Sharing Plan Variation,,0.593126475811005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190084,BlueCross SG Gold 18S,14002TN019,,TNN002,TNS002,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-18S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190084-01,Standard Gold On Exchange Plan,,0.818502187728882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190085,BlueCross SG Gold 18S,14002TN019,,TNN002,TNS003,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-18S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190085-00,Standard Gold Off Exchange Plan,,0.818502187728882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,Individual,No,62-0427913,14002TN0320006,BlueCross Bronze B02E,14002TN032,,TNN003,TNS009,TNF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320006-00,Standard Bronze Off Exchange Plan,,0.593126475811005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,Individual,No,62-0427913,14002TN0320006,BlueCross Bronze B02E,14002TN032,,TNN003,TNS009,TNF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320006-01,Standard Bronze On Exchange Plan,,0.593126475811005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190085,BlueCross SG Gold 18S,14002TN019,,TNN002,TNS003,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-18S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190085-01,Standard Gold On Exchange Plan,,0.818502187728882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190086,BlueCross SG Gold 18S,14002TN019,,TNN002,TNS004,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-18S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190086-00,Standard Gold Off Exchange Plan,,0.818502187728882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,Individual,No,62-0427913,14002TN0320006,BlueCross Bronze B02E,14002TN032,,TNN003,TNS009,TNF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,Individual,No,62-0427913,14002TN0320006,BlueCross Bronze B02E,14002TN032,,TNN003,TNS009,TNF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320006-03,Limited Cost Sharing Plan Variation,,0.593126475811005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190086,BlueCross SG Gold 18S,14002TN019,,TNN002,TNS004,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-18S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190086-01,Standard Gold On Exchange Plan,,0.818502187728882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190087,BlueCross SG Gold 18S,14002TN019,,TNN002,TNS005,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-18S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190087-00,Standard Gold Off Exchange Plan,,0.818502187728882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,Individual,No,62-0427913,14002TN0320010,BlueCross Bronze B02E,14002TN032,,TNN003,TNS004,TNF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320010-00,Standard Bronze Off Exchange Plan,,0.593126475811005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,10,14002,TN,Individual,No,62-0427913,14002TN0330005,BlueCross Silver S08S,14002TN033,,TNN002,TNS010,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330005-03,Limited Cost Sharing Plan Variation,,0.698870837688446,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,10,14002,TN,Individual,No,62-0427913,14002TN0330005,BlueCross Silver S08S,14002TN033,,TNN002,TNS010,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330005-04,73% AV Level Silver Plan,,0.720056891441345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$15,000","$30,000","$18,650","$37,300",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,10,14002,TN,Individual,No,62-0427913,14002TN0330005,BlueCross Silver S08S,14002TN033,,TNN002,TNS010,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330005-05,87% AV Level Silver Plan,,0.864041566848755,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$15,000","$30,000","$17,000","$34,000",,,,,,,,,,,,,,,,,,,,,$300,$600,20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,9,14002,TN,Individual,No,62-0427913,14002TN0330024,BlueCross Silver S07E,14002TN033,,TNN003,TNS004,TNF009,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330024-00,Standard Silver Off Exchange Plan,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,9,14002,TN,Individual,No,62-0427913,14002TN0330014,BlueCross Silver S07E,14002TN033,,TNN003,TNS009,TNF009,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330014-03,Limited Cost Sharing Plan Variation,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,9,14002,TN,Individual,No,62-0427913,14002TN0330014,BlueCross Silver S07E,14002TN033,,TNN003,TNS009,TNF009,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330014-04,73% AV Level Silver Plan,,0.720305323600769,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,950","$7,900",,,"$19,050","$38,100","$23,000","$46,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,10,14002,TN,Individual,No,62-0427913,14002TN0330015,BlueCross Silver S08E,14002TN033,,TNN003,TNS009,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330015-06,94% AV Level Silver Plan,,0.93165785074234,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$800,"$1,600",,,"$15,000","$30,000","$15,800","$31,600",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,13,14002,TN,Individual,No,62-0427913,14002TN0330018,BlueCross Silver S12E,14002TN033,,TNN003,TNS009,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330018-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,13,14002,TN,Individual,No,62-0427913,14002TN0330018,BlueCross Silver S12E,14002TN033,,TNN003,TNS009,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330018-03,Limited Cost Sharing Plan Variation,,0.689522922039032,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,13,14002,TN,Individual,No,62-0427913,14002TN0330018,BlueCross Silver S12E,14002TN033,,TNN003,TNS009,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330018-04,73% AV Level Silver Plan,,0.720732450485229,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$16,500","$33,000","$21,500","$43,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,13,14002,TN,Individual,No,62-0427913,14002TN0330018,BlueCross Silver S12E,14002TN033,,TNN003,TNS009,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330018-05,87% AV Level Silver Plan,,0.861333131790161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$16,500","$33,000","$18,500","$37,000",,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,13,14002,TN,Individual,No,62-0427913,14002TN0330028,BlueCross Silver S12E,14002TN033,,TNN003,TNS004,TNF011,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330028-04,73% AV Level Silver Plan,,0.720732450485229,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$16,500","$33,000","$21,500","$43,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,13,14002,TN,Individual,No,62-0427913,14002TN0330008,BlueCross Silver S12S,14002TN033,,TNN002,TNS010,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330008-06,94% AV Level Silver Plan,,0.930114090442657,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$16,500","$33,000","$17,600","$35,200",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,13,14002,TN,Individual,No,62-0427913,14002TN0330018,BlueCross Silver S12E,14002TN033,,TNN003,TNS009,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330018-00,Standard Silver Off Exchange Plan,,0.689522922039032,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,13,14002,TN,Individual,No,62-0427913,14002TN0330028,BlueCross Silver S12E,14002TN033,,TNN003,TNS004,TNF011,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330028-05,87% AV Level Silver Plan,,0.861333131790161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$16,500","$33,000","$18,500","$37,000",,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,13,14002,TN,Individual,No,62-0427913,14002TN0330028,BlueCross Silver S12E,14002TN033,,TNN003,TNS004,TNF011,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330028-06,94% AV Level Silver Plan,,0.930114090442657,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$16,500","$33,000","$17,600","$35,200",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,14,14002,TN,Individual,No,62-0427913,14002TN0330009,BlueCross Silver S14S,14002TN033,,TNN002,TNS010,TNF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330009-00,Standard Silver Off Exchange Plan,,0.719600379467011,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800","$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,9,14002,TN,Individual,No,62-0427913,14002TN0330024,BlueCross Silver S07E,14002TN033,,TNN003,TNS004,TNF009,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330024-01,Standard Silver On Exchange Plan,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,9,14002,TN,Individual,No,62-0427913,14002TN0330024,BlueCross Silver S07E,14002TN033,,TNN003,TNS004,TNF009,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330024-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,20
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,9,14002,TN,Individual,No,62-0427913,14002TN0330024,BlueCross Silver S07E,14002TN033,,TNN003,TNS004,TNF009,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330024-03,Limited Cost Sharing Plan Variation,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,Individual,No,62-0427913,14002TN0320010,BlueCross Bronze B02E,14002TN032,,TNN003,TNS004,TNF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320010-01,Standard Bronze On Exchange Plan,,0.593126475811005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190087,BlueCross SG Gold 18S,14002TN019,,TNN002,TNS005,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-18S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190087-01,Standard Gold On Exchange Plan,,0.818502187728882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190088,BlueCross SG Gold 18S,14002TN019,,TNN002,TNS006,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-18S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190088-00,Standard Gold Off Exchange Plan,,0.818502187728882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,Individual,No,62-0427913,14002TN0320010,BlueCross Bronze B02E,14002TN032,,TNN003,TNS004,TNF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,Individual,No,62-0427913,14002TN0320010,BlueCross Bronze B02E,14002TN032,,TNN003,TNS004,TNF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320010-03,Limited Cost Sharing Plan Variation,,0.593126475811005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190088,BlueCross SG Gold 18S,14002TN019,,TNN002,TNS006,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-18S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190088-01,Standard Gold On Exchange Plan,,0.818502187728882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190089,BlueCross SG Gold 18S,14002TN019,,TNN002,TNS007,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-18S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190089-00,Standard Gold Off Exchange Plan,,0.818502187728882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190089,BlueCross SG Gold 18S,14002TN019,,TNN002,TNS007,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-18S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190089-01,Standard Gold On Exchange Plan,,0.818502187728882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190090,BlueCross SG Gold 18S,14002TN019,,TNN002,TNS008,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-18S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190090-00,Standard Gold Off Exchange Plan,,0.818502187728882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190090,BlueCross SG Gold 18S,14002TN019,,TNN002,TNS008,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-18S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190090-01,Standard Gold On Exchange Plan,,0.818502187728882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,19
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190091,BlueCross SG Gold 18P,14002TN019,,TNN001,TNS010,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-18P,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190091-00,Standard Gold Off Exchange Plan,,0.818502187728882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,2,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190091,BlueCross SG Gold 18P,14002TN019,,TNN001,TNS010,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-18P,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190091-01,Standard Gold On Exchange Plan,,0.818502187728882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190092,BlueCross SG Gold 19S,14002TN019,,TNN002,TNS001,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-19S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190092-00,Standard Gold Off Exchange Plan,,0.787335395812988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,Individual,No,62-0427913,14002TN0320003,BlueCross Bronze B03S,14002TN032,,TNN002,TNS010,TNF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320003-00,Standard Bronze Off Exchange Plan,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,Individual,No,62-0427913,14002TN0320003,BlueCross Bronze B03S,14002TN032,,TNN002,TNS010,TNF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320003-01,Standard Bronze On Exchange Plan,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190092,BlueCross SG Gold 19S,14002TN019,,TNN002,TNS001,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-19S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190092-01,Standard Gold On Exchange Plan,,0.787335395812988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,3,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190093,BlueCross SG Gold 19S,14002TN019,,TNN002,TNS002,TNF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Gold-19S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190093-00,Standard Gold Off Exchange Plan,,0.787335395812988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190070,BlueCross SG Silver 13S,14002TN019,,TNN002,TNS006,TNF014,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-13S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190070-00,Standard Silver Off Exchange Plan,68.80%,0.666971623897552,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",20%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,Individual,No,62-0427913,14002TN0320012,BlueCross Bronze B04E,14002TN032,,TNN003,TNS004,TNF013,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,Individual,No,62-0427913,14002TN0320012,BlueCross Bronze B04E,14002TN032,,TNN003,TNS004,TNF013,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320012-03,Limited Cost Sharing Plan Variation,,0.617985665798187,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$15,900","$31,800","$21,200","$42,400",,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",0%,,,,"$10,600","$21,200","$15,900","$31,800",,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190070,BlueCross SG Silver 13S,14002TN019,,TNN002,TNS006,TNF014,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-13S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190070-01,Standard Silver On Exchange Plan,68.80%,0.666971623897552,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",20%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190071,BlueCross SG Silver 13S,14002TN019,,TNN002,TNS007,TNF014,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-13S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190071-00,Standard Silver Off Exchange Plan,68.80%,0.666971623897552,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",20%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,16
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190071,BlueCross SG Silver 13S,14002TN019,,TNN002,TNS007,TNF014,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-13S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190071-01,Standard Silver On Exchange Plan,68.80%,0.666971623897552,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",20%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,17
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190072,BlueCross SG Silver 13S,14002TN019,,TNN002,TNS008,TNF014,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-13S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190072-00,Standard Silver Off Exchange Plan,68.80%,0.666971623897552,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",20%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,18
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190072,BlueCross SG Silver 13S,14002TN019,,TNN002,TNS008,TNF014,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-13S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190072-01,Standard Silver On Exchange Plan,68.80%,0.666971623897552,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",20%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,19
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190073,BlueCross SG Silver 13P,14002TN019,,TNN001,TNS010,TNF014,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-13P,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190073-00,Standard Silver Off Exchange Plan,68.80%,0.666971623897552,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",20%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,20
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,4,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190073,BlueCross SG Silver 13P,14002TN019,,TNN001,TNS010,TNF014,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-13P,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190073-01,Standard Silver On Exchange Plan,68.80%,0.666971623897552,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",20%,,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,21
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190074,BlueCross SG Silver 17S,14002TN019,,TNN002,TNS001,TNF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-17S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190074-00,Standard Silver Off Exchange Plan,,0.715431869029999,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$19,500","$39,000","$26,000","$52,000","$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,Individual,No,62-0427913,14002TN0320015,BlueCross Bronze B07S,14002TN032,,TNN002,TNS010,TNF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320015-00,Standard Bronze Off Exchange Plan,,0.58128023147583,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,"$19,200","$38,400","$25,600","$51,200",,,,,,,,,,,,,,,,,,,,,"$5,200","$10,400",50%,,,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,Individual,No,62-0427913,14002TN0320015,BlueCross Bronze B07S,14002TN032,,TNN002,TNS010,TNF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320015-01,Standard Bronze On Exchange Plan,,0.58128023147583,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,"$19,200","$38,400","$25,600","$51,200",,,,,,,,,,,,,,,,,,,,,"$5,200","$10,400",50%,,,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190074,BlueCross SG Silver 17S,14002TN019,,TNN002,TNS001,TNF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-17S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190074-01,Standard Silver On Exchange Plan,,0.715431869029999,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$19,500","$39,000","$26,000","$52,000","$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190075,BlueCross SG Silver 17S,14002TN019,,TNN002,TNS002,TNF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-17S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190075-00,Standard Silver Off Exchange Plan,,0.715431869029999,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$19,500","$39,000","$26,000","$52,000","$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,Individual,No,62-0427913,14002TN0320015,BlueCross Bronze B07S,14002TN032,,TNN002,TNS010,TNF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320015-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,Individual,No,62-0427913,14002TN0320015,BlueCross Bronze B07S,14002TN032,,TNN002,TNS010,TNF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320015-03,Limited Cost Sharing Plan Variation,,0.58128023147583,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,"$19,200","$38,400","$25,600","$51,200",,,,,,,,,,,,,,,,,,,,,"$5,200","$10,400",50%,,,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190075,BlueCross SG Silver 17S,14002TN019,,TNN002,TNS002,TNF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-17S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190075-01,Standard Silver On Exchange Plan,,0.715431869029999,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$19,500","$39,000","$26,000","$52,000","$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190076,BlueCross SG Silver 17S,14002TN019,,TNN002,TNS003,TNF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-17S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190076-00,Standard Silver Off Exchange Plan,,0.715431869029999,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$19,500","$39,000","$26,000","$52,000","$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,Individual,No,62-0427913,14002TN0320013,BlueCross Bronze B07E,14002TN032,,TNN003,TNS009,TNF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320013-00,Standard Bronze Off Exchange Plan,,0.58128023147583,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,"$19,200","$38,400","$25,600","$51,200",,,,,,,,,,,,,,,,,,,,,"$5,200","$10,400",50%,,,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,Individual,No,62-0427913,14002TN0320013,BlueCross Bronze B07E,14002TN032,,TNN003,TNS009,TNF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320013-01,Standard Bronze On Exchange Plan,,0.58128023147583,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,"$19,200","$38,400","$25,600","$51,200",,,,,,,,,,,,,,,,,,,,,"$5,200","$10,400",50%,,,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190076,BlueCross SG Silver 17S,14002TN019,,TNN002,TNS003,TNF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-17S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190076-01,Standard Silver On Exchange Plan,,0.715431869029999,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$19,500","$39,000","$26,000","$52,000","$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190077,BlueCross SG Silver 17S,14002TN019,,TNN002,TNS004,TNF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-17S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190077-00,Standard Silver Off Exchange Plan,,0.715431869029999,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$19,500","$39,000","$26,000","$52,000","$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,Individual,No,62-0427913,14002TN0320013,BlueCross Bronze B07E,14002TN032,,TNN003,TNS009,TNF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,Individual,No,62-0427913,14002TN0320013,BlueCross Bronze B07E,14002TN032,,TNN003,TNS009,TNF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320013-03,Limited Cost Sharing Plan Variation,,0.58128023147583,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,"$19,200","$38,400","$25,600","$51,200",,,,,,,,,,,,,,,,,,,,,"$5,200","$10,400",50%,,,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190077,BlueCross SG Silver 17S,14002TN019,,TNN002,TNS004,TNF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-17S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190077-01,Standard Silver On Exchange Plan,,0.715431869029999,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$19,500","$39,000","$26,000","$52,000","$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190078,BlueCross SG Silver 17S,14002TN019,,TNN002,TNS005,TNF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-17S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190078-00,Standard Silver Off Exchange Plan,,0.715431869029999,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$19,500","$39,000","$26,000","$52,000","$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,Individual,No,62-0427913,14002TN0320014,BlueCross Bronze B07E,14002TN032,,TNN003,TNS004,TNF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320014-00,Standard Bronze Off Exchange Plan,,0.58128023147583,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,"$19,200","$38,400","$25,600","$51,200",,,,,,,,,,,,,,,,,,,,,"$5,200","$10,400",50%,,,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,Individual,No,62-0427913,14002TN0320014,BlueCross Bronze B07E,14002TN032,,TNN003,TNS004,TNF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320014-01,Standard Bronze On Exchange Plan,,0.58128023147583,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,"$19,200","$38,400","$25,600","$51,200",,,,,,,,,,,,,,,,,,,,,"$5,200","$10,400",50%,,,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190078,BlueCross SG Silver 17S,14002TN019,,TNN002,TNS005,TNF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-17S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190078-01,Standard Silver On Exchange Plan,,0.715431869029999,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$19,500","$39,000","$26,000","$52,000","$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190079,BlueCross SG Silver 17S,14002TN019,,TNN002,TNS006,TNF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-17S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190079-00,Standard Silver Off Exchange Plan,,0.715431869029999,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$19,500","$39,000","$26,000","$52,000","$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,Individual,No,62-0427913,14002TN0320014,BlueCross Bronze B07E,14002TN032,,TNN003,TNS004,TNF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,Individual,No,62-0427913,14002TN0320014,BlueCross Bronze B07E,14002TN032,,TNN003,TNS004,TNF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0320014-03,Limited Cost Sharing Plan Variation,,0.58128023147583,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,"$19,200","$38,400","$25,600","$51,200",,,,,,,,,,,,,,,,,,,,,"$5,200","$10,400",50%,,,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190079,BlueCross SG Silver 17S,14002TN019,,TNN002,TNS006,TNF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-17S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190079-01,Standard Silver On Exchange Plan,,0.715431869029999,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$19,500","$39,000","$26,000","$52,000","$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190080,BlueCross SG Silver 17S,14002TN019,,TNN002,TNS007,TNF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-17S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190080-00,Standard Silver Off Exchange Plan,,0.715431869029999,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$19,500","$39,000","$26,000","$52,000","$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190080,BlueCross SG Silver 17S,14002TN019,,TNN002,TNS007,TNF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-17S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190080-01,Standard Silver On Exchange Plan,,0.715431869029999,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$19,500","$39,000","$26,000","$52,000","$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190081,BlueCross SG Silver 17S,14002TN019,,TNN002,TNS008,TNF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-17S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190081-00,Standard Silver Off Exchange Plan,,0.715431869029999,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$19,500","$39,000","$26,000","$52,000","$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190081,BlueCross SG Silver 17S,14002TN019,,TNN002,TNS008,TNF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-17S,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190081-01,Standard Silver On Exchange Plan,,0.715431869029999,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$19,500","$39,000","$26,000","$52,000","$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,19
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190082,BlueCross SG Silver 17P,14002TN019,,TNN001,TNS010,TNF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-17P,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190082-00,Standard Silver Off Exchange Plan,,0.715431869029999,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$19,500","$39,000","$26,000","$52,000","$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,5,14002,TN,SHOP (Small Group),No,62-0427913,14002TN0190082,BlueCross SG Silver 17P,14002TN019,,TNN001,TNS010,TNF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc/2015/Grp-Silver-17P,,http://www.bcbst.com/SHOPbrochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0190082-01,Standard Silver On Exchange Plan,,0.715431869029999,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$19,500","$39,000","$26,000","$52,000","$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,6,14002,TN,Individual,No,62-0427913,14002TN0330001,BlueCross Silver S01S,14002TN033,,TNN002,TNS010,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330001-00,Standard Silver Off Exchange Plan,,0.70927506685257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,6,14002,TN,Individual,No,62-0427913,14002TN0330001,BlueCross Silver S01S,14002TN033,,TNN002,TNS010,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330001-01,Standard Silver On Exchange Plan,,0.70927506685257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,6,14002,TN,Individual,No,62-0427913,14002TN0330001,BlueCross Silver S01S,14002TN033,,TNN002,TNS010,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,6,14002,TN,Individual,No,62-0427913,14002TN0330001,BlueCross Silver S01S,14002TN033,,TNN002,TNS010,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330001-03,Limited Cost Sharing Plan Variation,,0.70927506685257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,6,14002,TN,Individual,No,62-0427913,14002TN0330001,BlueCross Silver S01S,14002TN033,,TNN002,TNS010,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330001-04,73% AV Level Silver Plan,,0.729394316673279,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$19,050","$38,100","$24,250","$48,500",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,6,14002,TN,Individual,No,62-0427913,14002TN0330001,BlueCross Silver S01S,14002TN033,,TNN002,TNS010,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330001-05,87% AV Level Silver Plan,,0.862899124622345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$19,050","$38,100","$20,500","$41,000",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,6,14002,TN,Individual,No,62-0427913,14002TN0330001,BlueCross Silver S01S,14002TN033,,TNN002,TNS010,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330001-06,94% AV Level Silver Plan,,0.933690011501312,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,"$19,050","$38,100","$19,600","$39,200",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,6,14002,TN,Individual,No,62-0427913,14002TN0330011,BlueCross Silver S01E,14002TN033,,TNN003,TNS009,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330011-00,Standard Silver Off Exchange Plan,,0.70927506685257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,6,14002,TN,Individual,No,62-0427913,14002TN0330011,BlueCross Silver S01E,14002TN033,,TNN003,TNS009,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330011-01,Standard Silver On Exchange Plan,,0.70927506685257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,6,14002,TN,Individual,No,62-0427913,14002TN0330011,BlueCross Silver S01E,14002TN033,,TNN003,TNS009,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,6,14002,TN,Individual,No,62-0427913,14002TN0330011,BlueCross Silver S01E,14002TN033,,TNN003,TNS009,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330011-03,Limited Cost Sharing Plan Variation,,0.70927506685257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,9,14002,TN,Individual,No,62-0427913,14002TN0330014,BlueCross Silver S07E,14002TN033,,TNN003,TNS009,TNF009,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330014-05,87% AV Level Silver Plan,,0.86647492647171,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$19,050","$38,100","$21,050","$42,100",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,9,14002,TN,Individual,No,62-0427913,14002TN0330014,BlueCross Silver S07E,14002TN033,,TNN003,TNS009,TNF009,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330014-06,94% AV Level Silver Plan,,0.932236790657043,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,"$19,050","$38,100","$19,700","$39,400",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,9,14002,TN,Individual,No,62-0427913,14002TN0330004,BlueCross Silver S07S,14002TN033,,TNN002,TNS010,TNF009,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330004-04,73% AV Level Silver Plan,,0.720305323600769,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,950","$7,900",,,"$19,050","$38,100","$23,000","$46,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,9,14002,TN,Individual,No,62-0427913,14002TN0330004,BlueCross Silver S07S,14002TN033,,TNN002,TNS010,TNF009,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330004-05,87% AV Level Silver Plan,,0.86647492647171,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$19,050","$38,100","$21,050","$42,100",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,9,14002,TN,Individual,No,62-0427913,14002TN0330004,BlueCross Silver S07S,14002TN033,,TNN002,TNS010,TNF009,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330004-06,94% AV Level Silver Plan,,0.932236790657043,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,"$19,050","$38,100","$19,700","$39,400",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,9,14002,TN,Individual,No,62-0427913,14002TN0330014,BlueCross Silver S07E,14002TN033,,TNN003,TNS009,TNF009,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330014-00,Standard Silver Off Exchange Plan,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,9,14002,TN,Individual,No,62-0427913,14002TN0330014,BlueCross Silver S07E,14002TN033,,TNN003,TNS009,TNF009,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330014-01,Standard Silver On Exchange Plan,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,9,14002,TN,Individual,No,62-0427913,14002TN0330014,BlueCross Silver S07E,14002TN033,,TNN003,TNS009,TNF009,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,8,14002,TN,Individual,No,62-0427913,14002TN0330023,BlueCross Silver S04E,14002TN033,,TNN003,TNS004,TNF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330023-05,87% AV Level Silver Plan,,0.862899124622345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$12,000","$24,000","$13,450","$26,900",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,8,14002,TN,Individual,No,62-0427913,14002TN0330023,BlueCross Silver S04E,14002TN033,,TNN003,TNS004,TNF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330023-06,94% AV Level Silver Plan,,0.933690011501312,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,"$12,000","$24,000","$12,550","$25,100",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,9,14002,TN,Individual,No,62-0427913,14002TN0330004,BlueCross Silver S07S,14002TN033,,TNN002,TNS010,TNF009,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330004-00,Standard Silver Off Exchange Plan,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,9,14002,TN,Individual,No,62-0427913,14002TN0330004,BlueCross Silver S07S,14002TN033,,TNN002,TNS010,TNF009,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330004-01,Standard Silver On Exchange Plan,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,10,14002,TN,Individual,No,62-0427913,14002TN0330005,BlueCross Silver S08S,14002TN033,,TNN002,TNS010,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,9,14002,TN,Individual,No,62-0427913,14002TN0330024,BlueCross Silver S07E,14002TN033,,TNN003,TNS004,TNF009,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330024-04,73% AV Level Silver Plan,,0.720305323600769,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,950","$7,900",,,"$19,050","$38,100","$23,000","$46,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,9,14002,TN,Individual,No,62-0427913,14002TN0330024,BlueCross Silver S07E,14002TN033,,TNN003,TNS004,TNF009,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330024-05,87% AV Level Silver Plan,,0.86647492647171,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$19,050","$38,100","$21,050","$42,100",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,9,14002,TN,Individual,No,62-0427913,14002TN0330024,BlueCross Silver S07E,14002TN033,,TNN003,TNS004,TNF009,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330024-06,94% AV Level Silver Plan,,0.932236790657043,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,"$19,050","$38,100","$19,700","$39,400",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,10,14002,TN,Individual,No,62-0427913,14002TN0330005,BlueCross Silver S08S,14002TN033,,TNN002,TNS010,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330005-00,Standard Silver Off Exchange Plan,,0.698870837688446,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,10,14002,TN,Individual,No,62-0427913,14002TN0330005,BlueCross Silver S08S,14002TN033,,TNN002,TNS010,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330005-01,Standard Silver On Exchange Plan,,0.698870837688446,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,6,14002,TN,Individual,No,62-0427913,14002TN0330011,BlueCross Silver S01E,14002TN033,,TNN003,TNS009,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330011-04,73% AV Level Silver Plan,,0.729394316673279,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$19,050","$38,100","$24,250","$48,500",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,6,14002,TN,Individual,No,62-0427913,14002TN0330011,BlueCross Silver S01E,14002TN033,,TNN003,TNS009,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330011-05,87% AV Level Silver Plan,,0.862899124622345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$19,050","$38,100","$20,500","$41,000",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,6,14002,TN,Individual,No,62-0427913,14002TN0330011,BlueCross Silver S01E,14002TN033,,TNN003,TNS009,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330011-06,94% AV Level Silver Plan,,0.933690011501312,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,"$19,050","$38,100","$19,600","$39,200",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,6,14002,TN,Individual,No,62-0427913,14002TN0330021,BlueCross Silver S01E,14002TN033,,TNN003,TNS004,TNF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330021-00,Standard Silver Off Exchange Plan,,0.70927506685257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,6,14002,TN,Individual,No,62-0427913,14002TN0330021,BlueCross Silver S01E,14002TN033,,TNN003,TNS004,TNF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330021-01,Standard Silver On Exchange Plan,,0.70927506685257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,6,14002,TN,Individual,No,62-0427913,14002TN0330021,BlueCross Silver S01E,14002TN033,,TNN003,TNS004,TNF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330021-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,6,14002,TN,Individual,No,62-0427913,14002TN0330021,BlueCross Silver S01E,14002TN033,,TNN003,TNS004,TNF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330021-03,Limited Cost Sharing Plan Variation,,0.70927506685257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,6,14002,TN,Individual,No,62-0427913,14002TN0330021,BlueCross Silver S01E,14002TN033,,TNN003,TNS004,TNF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330021-04,73% AV Level Silver Plan,,0.729394316673279,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$19,050","$38,100","$24,250","$48,500",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,6,14002,TN,Individual,No,62-0427913,14002TN0330021,BlueCross Silver S01E,14002TN033,,TNN003,TNS004,TNF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330021-05,87% AV Level Silver Plan,,0.862899124622345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$19,050","$38,100","$20,500","$41,000",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,6,14002,TN,Individual,No,62-0427913,14002TN0330021,BlueCross Silver S01E,14002TN033,,TNN003,TNS004,TNF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330021-06,94% AV Level Silver Plan,,0.933690011501312,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,"$19,050","$38,100","$19,600","$39,200",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,7,14002,TN,Individual,No,62-0427913,14002TN0330002,BlueCross Silver S02S,14002TN033,,TNN002,TNS010,TNF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330002-00,Standard Silver Off Exchange Plan,,0.680950701236725,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,7,14002,TN,Individual,No,62-0427913,14002TN0330002,BlueCross Silver S02S,14002TN033,,TNN002,TNS010,TNF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330002-01,Standard Silver On Exchange Plan,,0.680950701236725,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,7,14002,TN,Individual,No,62-0427913,14002TN0330002,BlueCross Silver S02S,14002TN033,,TNN002,TNS010,TNF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,7,14002,TN,Individual,No,62-0427913,14002TN0330002,BlueCross Silver S02S,14002TN033,,TNN002,TNS010,TNF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330002-03,Limited Cost Sharing Plan Variation,,0.680950701236725,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,7,14002,TN,Individual,No,62-0427913,14002TN0330002,BlueCross Silver S02S,14002TN033,,TNN002,TNS010,TNF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330002-04,73% AV Level Silver Plan,,0.721290111541748,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,"$18,750","$37,500","$23,150","$46,300",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,7,14002,TN,Individual,No,62-0427913,14002TN0330002,BlueCross Silver S02S,14002TN033,,TNN002,TNS010,TNF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330002-05,87% AV Level Silver Plan,,0.866972923278809,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$18,750","$37,500","$20,250","$40,500",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,7,14002,TN,Individual,No,62-0427913,14002TN0330002,BlueCross Silver S02S,14002TN033,,TNN002,TNS010,TNF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330002-06,94% AV Level Silver Plan,,0.931876420974731,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$18,750","$37,500","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,7,14002,TN,Individual,No,62-0427913,14002TN0330012,BlueCross Silver S02E,14002TN033,,TNN003,TNS009,TNF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330012-00,Standard Silver Off Exchange Plan,,0.680950701236725,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,7,14002,TN,Individual,No,62-0427913,14002TN0330012,BlueCross Silver S02E,14002TN033,,TNN003,TNS009,TNF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330012-01,Standard Silver On Exchange Plan,,0.680950701236725,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,7,14002,TN,Individual,No,62-0427913,14002TN0330012,BlueCross Silver S02E,14002TN033,,TNN003,TNS009,TNF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,7,14002,TN,Individual,No,62-0427913,14002TN0330012,BlueCross Silver S02E,14002TN033,,TNN003,TNS009,TNF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330012-03,Limited Cost Sharing Plan Variation,,0.680950701236725,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,7,14002,TN,Individual,No,62-0427913,14002TN0330012,BlueCross Silver S02E,14002TN033,,TNN003,TNS009,TNF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330012-04,73% AV Level Silver Plan,,0.721290111541748,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,"$18,750","$37,500","$23,150","$46,300",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,7,14002,TN,Individual,No,62-0427913,14002TN0330012,BlueCross Silver S02E,14002TN033,,TNN003,TNS009,TNF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330012-05,87% AV Level Silver Plan,,0.866972923278809,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$18,750","$37,500","$20,250","$40,500",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,7,14002,TN,Individual,No,62-0427913,14002TN0330012,BlueCross Silver S02E,14002TN033,,TNN003,TNS009,TNF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330012-06,94% AV Level Silver Plan,,0.931876420974731,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$18,750","$37,500","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,7,14002,TN,Individual,No,62-0427913,14002TN0330022,BlueCross Silver S02E,14002TN033,,TNN003,TNS004,TNF005,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330022-00,Standard Silver Off Exchange Plan,,0.680950701236725,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,7,14002,TN,Individual,No,62-0427913,14002TN0330022,BlueCross Silver S02E,14002TN033,,TNN003,TNS004,TNF005,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330022-01,Standard Silver On Exchange Plan,,0.680950701236725,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,7,14002,TN,Individual,No,62-0427913,14002TN0330022,BlueCross Silver S02E,14002TN033,,TNN003,TNS004,TNF005,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330022-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,20
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,7,14002,TN,Individual,No,62-0427913,14002TN0330022,BlueCross Silver S02E,14002TN033,,TNN003,TNS004,TNF005,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330022-03,Limited Cost Sharing Plan Variation,,0.680950701236725,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,7,14002,TN,Individual,No,62-0427913,14002TN0330022,BlueCross Silver S02E,14002TN033,,TNN003,TNS004,TNF005,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330022-04,73% AV Level Silver Plan,,0.721290111541748,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,"$18,750","$37,500","$23,150","$46,300",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,7,14002,TN,Individual,No,62-0427913,14002TN0330022,BlueCross Silver S02E,14002TN033,,TNN003,TNS004,TNF005,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330022-05,87% AV Level Silver Plan,,0.866972923278809,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$18,750","$37,500","$20,250","$40,500",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,7,14002,TN,Individual,No,62-0427913,14002TN0330022,BlueCross Silver S02E,14002TN033,,TNN003,TNS004,TNF005,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330022-06,94% AV Level Silver Plan,,0.931876420974731,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$18,750","$37,500","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,8,14002,TN,Individual,No,62-0427913,14002TN0330003,BlueCross Silver S04S,14002TN033,,TNN002,TNS010,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330003-00,Standard Silver Off Exchange Plan,,0.681622445583344,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,8,14002,TN,Individual,No,62-0427913,14002TN0330003,BlueCross Silver S04S,14002TN033,,TNN002,TNS010,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330003-01,Standard Silver On Exchange Plan,,0.681622445583344,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,8,14002,TN,Individual,No,62-0427913,14002TN0330003,BlueCross Silver S04S,14002TN033,,TNN002,TNS010,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,8,14002,TN,Individual,No,62-0427913,14002TN0330003,BlueCross Silver S04S,14002TN033,,TNN002,TNS010,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330003-03,Limited Cost Sharing Plan Variation,,0.681622445583344,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,8,14002,TN,Individual,No,62-0427913,14002TN0330003,BlueCross Silver S04S,14002TN033,,TNN002,TNS010,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330003-04,73% AV Level Silver Plan,,0.72050142288208,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$12,000","$24,000","$15,650","$31,300",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,8,14002,TN,Individual,No,62-0427913,14002TN0330003,BlueCross Silver S04S,14002TN033,,TNN002,TNS010,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330003-05,87% AV Level Silver Plan,,0.862899124622345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$12,000","$24,000","$13,450","$26,900",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,8,14002,TN,Individual,No,62-0427913,14002TN0330003,BlueCross Silver S04S,14002TN033,,TNN002,TNS010,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330003-06,94% AV Level Silver Plan,,0.933690011501312,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,"$12,000","$24,000","$12,550","$25,100",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,8,14002,TN,Individual,No,62-0427913,14002TN0330013,BlueCross Silver S04E,14002TN033,,TNN003,TNS009,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330013-00,Standard Silver Off Exchange Plan,,0.681622445583344,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,8,14002,TN,Individual,No,62-0427913,14002TN0330013,BlueCross Silver S04E,14002TN033,,TNN003,TNS009,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330013-01,Standard Silver On Exchange Plan,,0.681622445583344,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,8,14002,TN,Individual,No,62-0427913,14002TN0330013,BlueCross Silver S04E,14002TN033,,TNN003,TNS009,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,8,14002,TN,Individual,No,62-0427913,14002TN0330013,BlueCross Silver S04E,14002TN033,,TNN003,TNS009,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330013-03,Limited Cost Sharing Plan Variation,,0.681622445583344,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,8,14002,TN,Individual,No,62-0427913,14002TN0330013,BlueCross Silver S04E,14002TN033,,TNN003,TNS009,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330013-04,73% AV Level Silver Plan,,0.72050142288208,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$12,000","$24,000","$15,650","$31,300",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,8,14002,TN,Individual,No,62-0427913,14002TN0330013,BlueCross Silver S04E,14002TN033,,TNN003,TNS009,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330013-05,87% AV Level Silver Plan,,0.862899124622345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$12,000","$24,000","$13,450","$26,900",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,8,14002,TN,Individual,No,62-0427913,14002TN0330013,BlueCross Silver S04E,14002TN033,,TNN003,TNS009,TNF007,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330013-06,94% AV Level Silver Plan,,0.933690011501312,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,"$12,000","$24,000","$12,550","$25,100",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,8,14002,TN,Individual,No,62-0427913,14002TN0330023,BlueCross Silver S04E,14002TN033,,TNN003,TNS004,TNF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330023-00,Standard Silver Off Exchange Plan,,0.681622445583344,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,8,14002,TN,Individual,No,62-0427913,14002TN0330023,BlueCross Silver S04E,14002TN033,,TNN003,TNS004,TNF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330023-01,Standard Silver On Exchange Plan,,0.681622445583344,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,8,14002,TN,Individual,No,62-0427913,14002TN0330023,BlueCross Silver S04E,14002TN033,,TNN003,TNS004,TNF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330023-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,20
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,8,14002,TN,Individual,No,62-0427913,14002TN0330023,BlueCross Silver S04E,14002TN033,,TNN003,TNS004,TNF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330023-03,Limited Cost Sharing Plan Variation,,0.681622445583344,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,8,14002,TN,Individual,No,62-0427913,14002TN0330023,BlueCross Silver S04E,14002TN033,,TNN003,TNS004,TNF007,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330023-04,73% AV Level Silver Plan,,0.72050142288208,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$12,000","$24,000","$15,650","$31,300",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,9,14002,TN,Individual,No,62-0427913,14002TN0330004,BlueCross Silver S07S,14002TN033,,TNN002,TNS010,TNF009,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,9,14002,TN,Individual,No,62-0427913,14002TN0330004,BlueCross Silver S07S,14002TN033,,TNN002,TNS010,TNF009,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330004-03,Limited Cost Sharing Plan Variation,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,10,14002,TN,Individual,No,62-0427913,14002TN0330005,BlueCross Silver S08S,14002TN033,,TNN002,TNS010,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330005-06,94% AV Level Silver Plan,,0.93165785074234,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$800,"$1,600",,,"$15,000","$30,000","$15,800","$31,600",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,10,14002,TN,Individual,No,62-0427913,14002TN0330015,BlueCross Silver S08E,14002TN033,,TNN003,TNS009,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330015-00,Standard Silver Off Exchange Plan,,0.698870837688446,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,10,14002,TN,Individual,No,62-0427913,14002TN0330015,BlueCross Silver S08E,14002TN033,,TNN003,TNS009,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330015-01,Standard Silver On Exchange Plan,,0.698870837688446,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,10,14002,TN,Individual,No,62-0427913,14002TN0330015,BlueCross Silver S08E,14002TN033,,TNN003,TNS009,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330015-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,10,14002,TN,Individual,No,62-0427913,14002TN0330015,BlueCross Silver S08E,14002TN033,,TNN003,TNS009,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330015-03,Limited Cost Sharing Plan Variation,,0.698870837688446,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,10,14002,TN,Individual,No,62-0427913,14002TN0330015,BlueCross Silver S08E,14002TN033,,TNN003,TNS009,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330015-04,73% AV Level Silver Plan,,0.720056891441345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$15,000","$30,000","$18,650","$37,300",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,10,14002,TN,Individual,No,62-0427913,14002TN0330015,BlueCross Silver S08E,14002TN033,,TNN003,TNS009,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330015-05,87% AV Level Silver Plan,,0.864041566848755,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$15,000","$30,000","$17,000","$34,000",,,,,,,,,,,,,,,,,,,,,$300,$600,20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,13,14002,TN,Individual,No,62-0427913,14002TN0330018,BlueCross Silver S12E,14002TN033,,TNN003,TNS009,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330018-06,94% AV Level Silver Plan,,0.930114090442657,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$16,500","$33,000","$17,600","$35,200",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,13,14002,TN,Individual,No,62-0427913,14002TN0330028,BlueCross Silver S12E,14002TN033,,TNN003,TNS004,TNF011,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330028-00,Standard Silver Off Exchange Plan,,0.689522922039032,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,13,14002,TN,Individual,No,62-0427913,14002TN0330028,BlueCross Silver S12E,14002TN033,,TNN003,TNS004,TNF011,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330028-01,Standard Silver On Exchange Plan,,0.689522922039032,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,13,14002,TN,Individual,No,62-0427913,14002TN0330028,BlueCross Silver S12E,14002TN033,,TNN003,TNS004,TNF011,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330028-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,20
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,14,14002,TN,Individual,No,62-0427913,14002TN0330009,BlueCross Silver S14S,14002TN033,,TNN002,TNS010,TNF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330009-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,14,14002,TN,Individual,No,62-0427913,14002TN0330009,BlueCross Silver S14S,14002TN033,,TNN002,TNS010,TNF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330009-03,Limited Cost Sharing Plan Variation,,0.719600379467011,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800","$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,14,14002,TN,Individual,No,62-0427913,14002TN0330009,BlueCross Silver S14S,14002TN033,,TNN002,TNS010,TNF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330009-04,73% AV Level Silver Plan,,0.73997163772583,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$19,050","$38,100","$24,250","$48,500","$4,500","$9,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,14,14002,TN,Individual,No,62-0427913,14002TN0330009,BlueCross Silver S14S,14002TN033,,TNN002,TNS010,TNF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330009-05,87% AV Level Silver Plan,,0.86304372549057,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$19,050","$38,100","$21,050","$42,100",$750,"$1,500",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,14,14002,TN,Individual,No,62-0427913,14002TN0330019,BlueCross Silver S14E,14002TN033,,TNN003,TNS009,TNF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330019-03,Limited Cost Sharing Plan Variation,,0.719600379467011,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800","$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,14,14002,TN,Individual,No,62-0427913,14002TN0330019,BlueCross Silver S14E,14002TN033,,TNN003,TNS009,TNF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330019-04,73% AV Level Silver Plan,,0.73997163772583,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$19,050","$38,100","$24,250","$48,500","$4,500","$9,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,14,14002,TN,Individual,No,62-0427913,14002TN0330019,BlueCross Silver S14E,14002TN033,,TNN003,TNS009,TNF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330019-05,87% AV Level Silver Plan,,0.86304372549057,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$19,050","$38,100","$21,050","$42,100",$750,"$1,500",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,14,14002,TN,Individual,No,62-0427913,14002TN0330019,BlueCross Silver S14E,14002TN033,,TNN003,TNS009,TNF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330019-06,94% AV Level Silver Plan,,0.930751979351044,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$850,"$1,700",,,"$19,050","$38,100","$19,900","$39,800",$0,$0,20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,14,14002,TN,Individual,No,62-0427913,14002TN0330029,BlueCross Silver S14E,14002TN033,,TNN003,TNS004,TNF003,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330029-00,Standard Silver Off Exchange Plan,,0.719600379467011,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800","$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,19,14002,TN,Individual,No,62-0427913,14002TN0340003,BlueCross Gold G04S,14002TN034,,TNN002,TNS010,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340003-01,Standard Gold On Exchange Plan,,0.811477065086365,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,19,14002,TN,Individual,No,62-0427913,14002TN0340003,BlueCross Gold G04S,14002TN034,,TNN002,TNS010,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,19,14002,TN,Individual,No,62-0427913,14002TN0340003,BlueCross Gold G04S,14002TN034,,TNN002,TNS010,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340003-03,Limited Cost Sharing Plan Variation,,0.811477065086365,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,19,14002,TN,Individual,No,62-0427913,14002TN0340011,BlueCross Gold G04E,14002TN034,,TNN003,TNS009,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340011-00,Standard Gold Off Exchange Plan,,0.811477065086365,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,14,14002,TN,Individual,No,62-0427913,14002TN0330009,BlueCross Silver S14S,14002TN033,,TNN002,TNS010,TNF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330009-06,94% AV Level Silver Plan,,0.930751979351044,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$850,"$1,700",,,"$19,050","$38,100","$19,900","$39,800",$0,$0,20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,14,14002,TN,Individual,No,62-0427913,14002TN0330019,BlueCross Silver S14E,14002TN033,,TNN003,TNS009,TNF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330019-00,Standard Silver Off Exchange Plan,,0.719600379467011,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800","$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,14,14002,TN,Individual,No,62-0427913,14002TN0330019,BlueCross Silver S14E,14002TN033,,TNN003,TNS009,TNF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330019-01,Standard Silver On Exchange Plan,,0.719600379467011,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800","$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,14,14002,TN,Individual,No,62-0427913,14002TN0330019,BlueCross Silver S14E,14002TN033,,TNN003,TNS009,TNF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330019-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,13,14002,TN,Individual,No,62-0427913,14002TN0330028,BlueCross Silver S12E,14002TN033,,TNN003,TNS004,TNF011,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330028-03,Limited Cost Sharing Plan Variation,,0.689522922039032,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,10,14002,TN,Individual,No,62-0427913,14002TN0330025,BlueCross Silver S08E,14002TN033,,TNN003,TNS004,TNF011,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330025-00,Standard Silver Off Exchange Plan,,0.698870837688446,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,10,14002,TN,Individual,No,62-0427913,14002TN0330025,BlueCross Silver S08E,14002TN033,,TNN003,TNS004,TNF011,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330025-01,Standard Silver On Exchange Plan,,0.698870837688446,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,10,14002,TN,Individual,No,62-0427913,14002TN0330025,BlueCross Silver S08E,14002TN033,,TNN003,TNS004,TNF011,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330025-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,20
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,10,14002,TN,Individual,No,62-0427913,14002TN0330025,BlueCross Silver S08E,14002TN033,,TNN003,TNS004,TNF011,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330025-03,Limited Cost Sharing Plan Variation,,0.698870837688446,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,10,14002,TN,Individual,No,62-0427913,14002TN0330025,BlueCross Silver S08E,14002TN033,,TNN003,TNS004,TNF011,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330025-04,73% AV Level Silver Plan,,0.720056891441345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$15,000","$30,000","$18,650","$37,300",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,10,14002,TN,Individual,No,62-0427913,14002TN0330025,BlueCross Silver S08E,14002TN033,,TNN003,TNS004,TNF011,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330025-05,87% AV Level Silver Plan,,0.864041566848755,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$15,000","$30,000","$17,000","$34,000",,,,,,,,,,,,,,,,,,,,,$300,$600,20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,10,14002,TN,Individual,No,62-0427913,14002TN0330025,BlueCross Silver S08E,14002TN033,,TNN003,TNS004,TNF011,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330025-06,94% AV Level Silver Plan,,0.93165785074234,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$800,"$1,600",,,"$15,000","$30,000","$15,800","$31,600",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,11,14002,TN,Individual,No,62-0427913,14002TN0330006,BlueCross Silver S09S,14002TN033,,TNN002,TNS010,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330006-00,Standard Silver Off Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,11,14002,TN,Individual,No,62-0427913,14002TN0330006,BlueCross Silver S09S,14002TN033,,TNN002,TNS010,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330006-01,Standard Silver On Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,11,14002,TN,Individual,No,62-0427913,14002TN0330006,BlueCross Silver S09S,14002TN033,,TNN002,TNS010,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,11,14002,TN,Individual,No,62-0427913,14002TN0330006,BlueCross Silver S09S,14002TN033,,TNN002,TNS010,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330006-03,Limited Cost Sharing Plan Variation,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,11,14002,TN,Individual,No,62-0427913,14002TN0330006,BlueCross Silver S09S,14002TN033,,TNN002,TNS010,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330006-04,73% AV Level Silver Plan,,0.720056891441345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$13,500","$27,000","$17,150","$34,300",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,11,14002,TN,Individual,No,62-0427913,14002TN0330006,BlueCross Silver S09S,14002TN033,,TNN002,TNS010,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330006-05,87% AV Level Silver Plan,,0.864041566848755,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$13,500","$27,000","$15,500","$31,000",,,,,,,,,,,,,,,,,,,,,$300,$600,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,11,14002,TN,Individual,No,62-0427913,14002TN0330006,BlueCross Silver S09S,14002TN033,,TNN002,TNS010,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330006-06,94% AV Level Silver Plan,,0.93165785074234,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$800,"$1,600",,,"$13,500","$27,000","$14,300","$28,600",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,11,14002,TN,Individual,No,62-0427913,14002TN0330016,BlueCross Silver S09E,14002TN033,,TNN003,TNS009,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330016-00,Standard Silver Off Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,11,14002,TN,Individual,No,62-0427913,14002TN0330016,BlueCross Silver S09E,14002TN033,,TNN003,TNS009,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330016-01,Standard Silver On Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,11,14002,TN,Individual,No,62-0427913,14002TN0330016,BlueCross Silver S09E,14002TN033,,TNN003,TNS009,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,11,14002,TN,Individual,No,62-0427913,14002TN0330016,BlueCross Silver S09E,14002TN033,,TNN003,TNS009,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330016-03,Limited Cost Sharing Plan Variation,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,11,14002,TN,Individual,No,62-0427913,14002TN0330016,BlueCross Silver S09E,14002TN033,,TNN003,TNS009,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330016-04,73% AV Level Silver Plan,,0.720056891441345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$13,500","$27,000","$17,150","$34,300",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,11,14002,TN,Individual,No,62-0427913,14002TN0330016,BlueCross Silver S09E,14002TN033,,TNN003,TNS009,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330016-05,87% AV Level Silver Plan,,0.864041566848755,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$13,500","$27,000","$15,500","$31,000",,,,,,,,,,,,,,,,,,,,,$300,$600,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,11,14002,TN,Individual,No,62-0427913,14002TN0330016,BlueCross Silver S09E,14002TN033,,TNN003,TNS009,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330016-06,94% AV Level Silver Plan,,0.93165785074234,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$800,"$1,600",,,"$13,500","$27,000","$14,300","$28,600",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,11,14002,TN,Individual,No,62-0427913,14002TN0330026,BlueCross Silver S09E,14002TN033,,TNN003,TNS004,TNF011,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330026-00,Standard Silver Off Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,11,14002,TN,Individual,No,62-0427913,14002TN0330026,BlueCross Silver S09E,14002TN033,,TNN003,TNS004,TNF011,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330026-01,Standard Silver On Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,11,14002,TN,Individual,No,62-0427913,14002TN0330026,BlueCross Silver S09E,14002TN033,,TNN003,TNS004,TNF011,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330026-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,20
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,11,14002,TN,Individual,No,62-0427913,14002TN0330026,BlueCross Silver S09E,14002TN033,,TNN003,TNS004,TNF011,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330026-03,Limited Cost Sharing Plan Variation,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,11,14002,TN,Individual,No,62-0427913,14002TN0330026,BlueCross Silver S09E,14002TN033,,TNN003,TNS004,TNF011,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330026-04,73% AV Level Silver Plan,,0.720056891441345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$13,500","$27,000","$17,150","$34,300",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,11,14002,TN,Individual,No,62-0427913,14002TN0330026,BlueCross Silver S09E,14002TN033,,TNN003,TNS004,TNF011,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330026-05,87% AV Level Silver Plan,,0.864041566848755,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$13,500","$27,000","$15,500","$31,000",,,,,,,,,,,,,,,,,,,,,$300,$600,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,11,14002,TN,Individual,No,62-0427913,14002TN0330026,BlueCross Silver S09E,14002TN033,,TNN003,TNS004,TNF011,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330026-06,94% AV Level Silver Plan,,0.93165785074234,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$800,"$1,600",,,"$13,500","$27,000","$14,300","$28,600",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,12,14002,TN,Individual,No,62-0427913,14002TN0330007,BlueCross Silver S11S,14002TN033,,TNN002,TNS010,TNF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330007-00,Standard Silver Off Exchange Plan,,0.702820777893066,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000","$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,12,14002,TN,Individual,No,62-0427913,14002TN0330007,BlueCross Silver S11S,14002TN033,,TNN002,TNS010,TNF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330007-01,Standard Silver On Exchange Plan,,0.702820777893066,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000","$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,12,14002,TN,Individual,No,62-0427913,14002TN0330007,BlueCross Silver S11S,14002TN033,,TNN002,TNS010,TNF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,12,14002,TN,Individual,No,62-0427913,14002TN0330007,BlueCross Silver S11S,14002TN033,,TNN002,TNS010,TNF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330007-03,Limited Cost Sharing Plan Variation,,0.702820777893066,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000","$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,12,14002,TN,Individual,No,62-0427913,14002TN0330007,BlueCross Silver S11S,14002TN033,,TNN002,TNS010,TNF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330007-04,73% AV Level Silver Plan,,0.72333550453186,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,150","$8,300",,,"$16,500","$33,000","$20,650","$41,300","$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,12,14002,TN,Individual,No,62-0427913,14002TN0330007,BlueCross Silver S11S,14002TN033,,TNN002,TNS010,TNF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330007-05,87% AV Level Silver Plan,,0.863325655460358,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$16,500","$33,000","$18,000","$36,000",$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,12,14002,TN,Individual,No,62-0427913,14002TN0330007,BlueCross Silver S11S,14002TN033,,TNN002,TNS010,TNF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330007-06,94% AV Level Silver Plan,,0.930253565311432,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$16,500","$33,000","$17,250","$34,500",$0,$0,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,12,14002,TN,Individual,No,62-0427913,14002TN0330017,BlueCross Silver S11E,14002TN033,,TNN003,TNS009,TNF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330017-00,Standard Silver Off Exchange Plan,,0.702820777893066,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000","$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,12,14002,TN,Individual,No,62-0427913,14002TN0330017,BlueCross Silver S11E,14002TN033,,TNN003,TNS009,TNF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330017-01,Standard Silver On Exchange Plan,,0.702820777893066,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000","$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,12,14002,TN,Individual,No,62-0427913,14002TN0330017,BlueCross Silver S11E,14002TN033,,TNN003,TNS009,TNF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330017-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,12,14002,TN,Individual,No,62-0427913,14002TN0330017,BlueCross Silver S11E,14002TN033,,TNN003,TNS009,TNF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330017-03,Limited Cost Sharing Plan Variation,,0.702820777893066,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000","$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,12,14002,TN,Individual,No,62-0427913,14002TN0330017,BlueCross Silver S11E,14002TN033,,TNN003,TNS009,TNF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330017-04,73% AV Level Silver Plan,,0.72333550453186,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,150","$8,300",,,"$16,500","$33,000","$20,650","$41,300","$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,12,14002,TN,Individual,No,62-0427913,14002TN0330017,BlueCross Silver S11E,14002TN033,,TNN003,TNS009,TNF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330017-05,87% AV Level Silver Plan,,0.863325655460358,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$16,500","$33,000","$18,000","$36,000",$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,12,14002,TN,Individual,No,62-0427913,14002TN0330017,BlueCross Silver S11E,14002TN033,,TNN003,TNS009,TNF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330017-06,94% AV Level Silver Plan,,0.930253565311432,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$16,500","$33,000","$17,250","$34,500",$0,$0,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,12,14002,TN,Individual,No,62-0427913,14002TN0330027,BlueCross Silver S11E,14002TN033,,TNN003,TNS004,TNF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330027-00,Standard Silver Off Exchange Plan,,0.702820777893066,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000","$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,12,14002,TN,Individual,No,62-0427913,14002TN0330027,BlueCross Silver S11E,14002TN033,,TNN003,TNS004,TNF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330027-01,Standard Silver On Exchange Plan,,0.702820777893066,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000","$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,19
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,12,14002,TN,Individual,No,62-0427913,14002TN0330027,BlueCross Silver S11E,14002TN033,,TNN003,TNS004,TNF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330027-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,12,14002,TN,Individual,No,62-0427913,14002TN0330027,BlueCross Silver S11E,14002TN033,,TNN003,TNS004,TNF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330027-03,Limited Cost Sharing Plan Variation,,0.702820777893066,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000","$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,12,14002,TN,Individual,No,62-0427913,14002TN0330027,BlueCross Silver S11E,14002TN033,,TNN003,TNS004,TNF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330027-04,73% AV Level Silver Plan,,0.72333550453186,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,150","$8,300",,,"$16,500","$33,000","$20,650","$41,300","$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,12,14002,TN,Individual,No,62-0427913,14002TN0330027,BlueCross Silver S11E,14002TN033,,TNN003,TNS004,TNF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330027-05,87% AV Level Silver Plan,,0.863325655460358,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$16,500","$33,000","$18,000","$36,000",$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,23
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,12,14002,TN,Individual,No,62-0427913,14002TN0330027,BlueCross Silver S11E,14002TN033,,TNN003,TNS004,TNF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330027-06,94% AV Level Silver Plan,,0.930253565311432,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$16,500","$33,000","$17,250","$34,500",$0,$0,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,24
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,13,14002,TN,Individual,No,62-0427913,14002TN0330008,BlueCross Silver S12S,14002TN033,,TNN002,TNS010,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330008-00,Standard Silver Off Exchange Plan,,0.689522922039032,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,13,14002,TN,Individual,No,62-0427913,14002TN0330008,BlueCross Silver S12S,14002TN033,,TNN002,TNS010,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330008-01,Standard Silver On Exchange Plan,,0.689522922039032,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,13,14002,TN,Individual,No,62-0427913,14002TN0330008,BlueCross Silver S12S,14002TN033,,TNN002,TNS010,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,13,14002,TN,Individual,No,62-0427913,14002TN0330008,BlueCross Silver S12S,14002TN033,,TNN002,TNS010,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330008-03,Limited Cost Sharing Plan Variation,,0.689522922039032,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,13,14002,TN,Individual,No,62-0427913,14002TN0330008,BlueCross Silver S12S,14002TN033,,TNN002,TNS010,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330008-04,73% AV Level Silver Plan,,0.720732450485229,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$16,500","$33,000","$21,500","$43,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,13,14002,TN,Individual,No,62-0427913,14002TN0330008,BlueCross Silver S12S,14002TN033,,TNN002,TNS010,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330008-05,87% AV Level Silver Plan,,0.861333131790161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$16,500","$33,000","$18,500","$37,000",,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,13,14002,TN,Individual,No,62-0427913,14002TN0330018,BlueCross Silver S12E,14002TN033,,TNN003,TNS009,TNF011,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330018-01,Standard Silver On Exchange Plan,,0.689522922039032,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,14,14002,TN,Individual,No,62-0427913,14002TN0330009,BlueCross Silver S14S,14002TN033,,TNN002,TNS010,TNF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330009-01,Standard Silver On Exchange Plan,,0.719600379467011,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800","$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,19,14002,TN,Individual,No,62-0427913,14002TN0340011,BlueCross Gold G04E,14002TN034,,TNN003,TNS009,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340011-01,Standard Gold On Exchange Plan,,0.811477065086365,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,19,14002,TN,Individual,No,62-0427913,14002TN0340011,BlueCross Gold G04E,14002TN034,,TNN003,TNS009,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340011-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,18,14002,TN,Individual,No,62-0427913,14002TN0340002,BlueCross Gold G02S,14002TN034,,TNN002,TNS010,TNF010,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340002-00,Standard Gold Off Exchange Plan,,0.817800939083099,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,18,14002,TN,Individual,No,62-0427913,14002TN0340002,BlueCross Gold G02S,14002TN034,,TNN002,TNS010,TNF010,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340002-01,Standard Gold On Exchange Plan,,0.817800939083099,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,18,14002,TN,Individual,No,62-0427913,14002TN0340002,BlueCross Gold G02S,14002TN034,,TNN002,TNS010,TNF010,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,18,14002,TN,Individual,No,62-0427913,14002TN0340002,BlueCross Gold G02S,14002TN034,,TNN002,TNS010,TNF010,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340002-03,Limited Cost Sharing Plan Variation,,0.817800939083099,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,18,14002,TN,Individual,No,62-0427913,14002TN0340010,BlueCross Gold G02E,14002TN034,,TNN003,TNS009,TNF010,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340010-00,Standard Gold Off Exchange Plan,,0.817800939083099,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,18,14002,TN,Individual,No,62-0427913,14002TN0340010,BlueCross Gold G02E,14002TN034,,TNN003,TNS009,TNF010,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340010-01,Standard Gold On Exchange Plan,,0.817800939083099,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,18,14002,TN,Individual,No,62-0427913,14002TN0340010,BlueCross Gold G02E,14002TN034,,TNN003,TNS009,TNF010,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,16,14002,TN,Individual,No,62-0427913,14002TN0330032,BlueCross Silver S19E,14002TN033,,TNN003,TNS004,TNF012,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330032-06,94% AV Level Silver Plan,,0.930477440357208,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,950","$3,900",,,"$12,750","$25,500","$14,700","$29,400",,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,17,14002,TN,Individual,No,62-0427913,14002TN0340001,BlueCross Gold G01S,14002TN034,,TNN002,TNS010,TNF008,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340001-00,Standard Gold Off Exchange Plan,,0.780546188354492,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$15,750","$31,500","$21,000","$42,000",,,,,,,,,,,,,,,,,,,,,$0,$0,35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,17,14002,TN,Individual,No,62-0427913,14002TN0340001,BlueCross Gold G01S,14002TN034,,TNN002,TNS010,TNF008,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340001-01,Standard Gold On Exchange Plan,,0.780546188354492,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$15,750","$31,500","$21,000","$42,000",,,,,,,,,,,,,,,,,,,,,$0,$0,35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,17,14002,TN,Individual,No,62-0427913,14002TN0340001,BlueCross Gold G01S,14002TN034,,TNN002,TNS010,TNF008,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,17,14002,TN,Individual,No,62-0427913,14002TN0340001,BlueCross Gold G01S,14002TN034,,TNN002,TNS010,TNF008,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340001-03,Limited Cost Sharing Plan Variation,,0.780546188354492,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$15,750","$31,500","$21,000","$42,000",,,,,,,,,,,,,,,,,,,,,$0,$0,35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,17,14002,TN,Individual,No,62-0427913,14002TN0340009,BlueCross Gold G01E,14002TN034,,TNN003,TNS009,TNF008,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340009-00,Standard Gold Off Exchange Plan,,0.780546188354492,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$15,750","$31,500","$21,000","$42,000",,,,,,,,,,,,,,,,,,,,,$0,$0,35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,17,14002,TN,Individual,No,62-0427913,14002TN0340009,BlueCross Gold G01E,14002TN034,,TNN003,TNS009,TNF008,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340009-01,Standard Gold On Exchange Plan,,0.780546188354492,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$15,750","$31,500","$21,000","$42,000",,,,,,,,,,,,,,,,,,,,,$0,$0,35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,17,14002,TN,Individual,No,62-0427913,14002TN0340009,BlueCross Gold G01E,14002TN034,,TNN003,TNS009,TNF008,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,26,14002,TN,Individual,No,62-0427913,14002TN0350003,BlueCross Platinum P03S,14002TN035,,TNN002,TNS010,TNF002,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,26,14002,TN,Individual,No,62-0427913,14002TN0350003,BlueCross Platinum P03S,14002TN035,,TNN002,TNS010,TNF002,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350003-03,Limited Cost Sharing Plan Variation,,0.882617235183716,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000",$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,18,14002,TN,Individual,No,62-0427913,14002TN0340010,BlueCross Gold G02E,14002TN034,,TNN003,TNS009,TNF010,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340010-03,Limited Cost Sharing Plan Variation,,0.817800939083099,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,18,14002,TN,Individual,No,62-0427913,14002TN0340018,BlueCross Gold G02E,14002TN034,,TNN003,TNS004,TNF010,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340018-00,Standard Gold Off Exchange Plan,,0.817800939083099,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,17,14002,TN,Individual,No,62-0427913,14002TN0340017,BlueCross Gold G01E,14002TN034,,TNN003,TNS004,TNF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340017-01,Standard Gold On Exchange Plan,,0.780546188354492,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$15,750","$31,500","$21,000","$42,000",,,,,,,,,,,,,,,,,,,,,$0,$0,35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,17,14002,TN,Individual,No,62-0427913,14002TN0340017,BlueCross Gold G01E,14002TN034,,TNN003,TNS004,TNF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,17,14002,TN,Individual,No,62-0427913,14002TN0340017,BlueCross Gold G01E,14002TN034,,TNN003,TNS004,TNF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340017-03,Limited Cost Sharing Plan Variation,,0.780546188354492,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$15,750","$31,500","$21,000","$42,000",,,,,,,,,,,,,,,,,,,,,$0,$0,35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,TN,55044,HIOS,2,2014-08-05 13:28:44,1,55044,TN,SHOP (Small Group),Yes,44-0308260,55044TN0010005,KCL Fam Low PPO,55044TN001,,TNN001,TNS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$35.09,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,55044TN0010005-00,Standard Low Off Exchange Plan,68.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TN,55044,HIOS,2,2014-08-05 13:28:44,1,55044,TN,SHOP (Small Group),Yes,44-0308260,55044TN0010007,KCL Fam Low MAC,55044TN001,,TNN001,TNS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$25.42,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,55044TN0010007-00,Standard Low Off Exchange Plan,68.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TN,55044,HIOS,2,2014-08-05 13:28:44,2,55044,TN,SHOP (Small Group),Yes,44-0308260,55044TN0010002,KCL EHB High PPO,55044TN001,,TNN001,TNS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$43.18,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,55044TN0010002-00,Standard High Off Exchange Plan,83.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,55044,HIOS,2,2014-08-05 13:28:44,2,55044,TN,SHOP (Small Group),Yes,44-0308260,55044TN0010004,KCL EHB High MAC,55044TN001,,TNN001,TNS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$32.33,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,55044TN0010004-00,Standard High Off Exchange Plan,83.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,55044,HIOS,2,2014-08-05 13:28:44,2,55044,TN,SHOP (Small Group),Yes,44-0308260,55044TN0010006,KCL Fam High PPO,55044TN001,,TNN001,TNS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$43.18,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,55044TN0010006-00,Standard High Off Exchange Plan,83.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TN,55044,HIOS,2,2014-08-05 13:28:44,2,55044,TN,SHOP (Small Group),Yes,44-0308260,55044TN0010008,KCL Fam High MAC,55044TN001,,TNN001,TNS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$32.33,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,55044TN0010008-00,Standard High Off Exchange Plan,83.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210008,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS003,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210008-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,61
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210008,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS003,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210008-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,62
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,18,14002,TN,Individual,No,62-0427913,14002TN0340018,BlueCross Gold G02E,14002TN034,,TNN003,TNS004,TNF010,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340018-01,Standard Gold On Exchange Plan,,0.817800939083099,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,18,14002,TN,Individual,No,62-0427913,14002TN0340018,BlueCross Gold G02E,14002TN034,,TNN003,TNS004,TNF010,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340018-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,26,14002,TN,Individual,No,62-0427913,14002TN0350006,BlueCross Platinum P03E,14002TN035,,TNN003,TNS009,TNF002,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,26,14002,TN,Individual,No,62-0427913,14002TN0350006,BlueCross Platinum P03E,14002TN035,,TNN003,TNS009,TNF002,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350006-03,Limited Cost Sharing Plan Variation,,0.882617235183716,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000",$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,26,14002,TN,Individual,No,62-0427913,14002TN0350009,BlueCross Platinum P03E,14002TN035,,TNN003,TNS004,TNF002,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350009-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,26,14002,TN,Individual,No,62-0427913,14002TN0350009,BlueCross Platinum P03E,14002TN035,,TNN003,TNS004,TNF002,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350009-03,Limited Cost Sharing Plan Variation,,0.882617235183716,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000",$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,TN,21535,HIOS,2,2014-08-05 13:28:44,1,21535,TN,SHOP (Small Group),Yes,13-5581829,21535TN0120001,EHB Basic Dental Plan (Low),21535TN012,,TNN001,TNS001,,New,PPO,Low,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$18.86,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,21535TN0120001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,22384,HIOS,6,2014-12-09 03:57:54,1,22384,TN,Individual,Yes,62-0812197,22384TN0010001,Delta Dental FFM Individual Product,22384TN001,,TNN002,TNS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$30.47,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Benefits allowed as 'Non Participating,Yes,Benefits allowed as Delta Dental PPO or Non Participating,Yes,www.deltadentaltn.com/acamarketplace/individualpediatricplan,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/22384,,,22384TN0010001-01,Standard Low On Exchange Plan,70.71%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,22384,HIOS,6,2014-12-09 03:57:54,1,22384,TN,SHOP (Small Group),Yes,62-0812197,22384TN0040001,Delta Dental Small Group Product,22384TN004,,TNN001,TNS001,,Existing,POS,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.85,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Benefits allowed as 'Non Participating',Yes,Benefits allowed as Delta Dental PPO or Non Participating,Yes,,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/delta,,,22384TN0040001-00,Standard Low Off Exchange Plan,71.81%,,,,Yes,60%,40%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210004,Assurant Health Bronze Plan 001,60299TN021,,TNN001,TNS004,TNF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210004-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,19,14002,TN,Individual,No,62-0427913,14002TN0340011,BlueCross Gold G04E,14002TN034,,TNN003,TNS009,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340011-03,Limited Cost Sharing Plan Variation,,0.811477065086365,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,19,14002,TN,Individual,No,62-0427913,14002TN0340019,BlueCross Gold G04E,14002TN034,,TNN003,TNS004,TNF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340019-00,Standard Gold Off Exchange Plan,,0.811477065086365,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,19,14002,TN,Individual,No,62-0427913,14002TN0340019,BlueCross Gold G04E,14002TN034,,TNN003,TNS004,TNF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340019-01,Standard Gold On Exchange Plan,,0.811477065086365,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,19,14002,TN,Individual,No,62-0427913,14002TN0340019,BlueCross Gold G04E,14002TN034,,TNN003,TNS004,TNF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340019-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,19,14002,TN,Individual,No,62-0427913,14002TN0340019,BlueCross Gold G04E,14002TN034,,TNN003,TNS004,TNF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340019-03,Limited Cost Sharing Plan Variation,,0.811477065086365,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,20,14002,TN,Individual,No,62-0427913,14002TN0340004,BlueCross Gold G06S,14002TN034,,TNN002,TNS010,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340004-00,Standard Gold Off Exchange Plan,,0.791000127792358,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000","$1,500","$3,000",20%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,20,14002,TN,Individual,No,62-0427913,14002TN0340004,BlueCross Gold G06S,14002TN034,,TNN002,TNS010,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340004-01,Standard Gold On Exchange Plan,,0.791000127792358,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000","$1,500","$3,000",20%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,20,14002,TN,Individual,No,62-0427913,14002TN0340004,BlueCross Gold G06S,14002TN034,,TNN002,TNS010,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,20,14002,TN,Individual,No,62-0427913,14002TN0340004,BlueCross Gold G06S,14002TN034,,TNN002,TNS010,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340004-03,Limited Cost Sharing Plan Variation,,0.791000127792358,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000","$1,500","$3,000",20%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,20,14002,TN,Individual,No,62-0427913,14002TN0340012,BlueCross Gold G06E,14002TN034,,TNN003,TNS009,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340012-00,Standard Gold Off Exchange Plan,,0.791000127792358,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000","$1,500","$3,000",20%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,26,14002,TN,Individual,No,62-0427913,14002TN0350009,BlueCross Platinum P03E,14002TN035,,TNN003,TNS004,TNF002,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350009-00,Standard Platinum Off Exchange Plan,,0.882617235183716,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000",$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,26,14002,TN,Individual,No,62-0427913,14002TN0350009,BlueCross Platinum P03E,14002TN035,,TNN003,TNS004,TNF002,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350009-01,Standard Platinum On Exchange Plan,,0.882617235183716,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000",$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,14,14002,TN,Individual,No,62-0427913,14002TN0330029,BlueCross Silver S14E,14002TN033,,TNN003,TNS004,TNF003,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330029-01,Standard Silver On Exchange Plan,,0.719600379467011,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800","$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,19
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,14,14002,TN,Individual,No,62-0427913,14002TN0330029,BlueCross Silver S14E,14002TN033,,TNN003,TNS004,TNF003,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330029-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,14,14002,TN,Individual,No,62-0427913,14002TN0330029,BlueCross Silver S14E,14002TN033,,TNN003,TNS004,TNF003,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330029-03,Limited Cost Sharing Plan Variation,,0.719600379467011,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800","$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,14,14002,TN,Individual,No,62-0427913,14002TN0330029,BlueCross Silver S14E,14002TN033,,TNN003,TNS004,TNF003,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330029-04,73% AV Level Silver Plan,,0.73997163772583,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$19,050","$38,100","$24,250","$48,500","$4,500","$9,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,14,14002,TN,Individual,No,62-0427913,14002TN0330029,BlueCross Silver S14E,14002TN033,,TNN003,TNS004,TNF003,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330029-05,87% AV Level Silver Plan,,0.86304372549057,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$19,050","$38,100","$21,050","$42,100",$750,"$1,500",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,23
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,14,14002,TN,Individual,No,62-0427913,14002TN0330029,BlueCross Silver S14E,14002TN033,,TNN003,TNS004,TNF003,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330029-06,94% AV Level Silver Plan,,0.930751979351044,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$850,"$1,700",,,"$19,050","$38,100","$19,900","$39,800",$0,$0,20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,24
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,15,14002,TN,Individual,No,62-0427913,14002TN0330010,BlueCross Silver S16S,14002TN033,,TNN002,TNS010,TNF013,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330010-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,15,14002,TN,Individual,No,62-0427913,14002TN0330010,BlueCross Silver S16S,14002TN033,,TNN002,TNS010,TNF013,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330010-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,15,14002,TN,Individual,No,62-0427913,14002TN0330010,BlueCross Silver S16S,14002TN033,,TNN002,TNS010,TNF013,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,15,14002,TN,Individual,No,62-0427913,14002TN0330010,BlueCross Silver S16S,14002TN033,,TNN002,TNS010,TNF013,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330010-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,15,14002,TN,Individual,No,62-0427913,14002TN0330010,BlueCross Silver S16S,14002TN033,,TNN002,TNS010,TNF013,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330010-04,73% AV Level Silver Plan,,0.720003962516785,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,950","$5,900",,,"$10,500","$21,000","$13,450","$26,900",,,,,,,,,,,,,,,,,,,,,"$2,950","$5,900",0%,,,,"$7,000","$14,000","$9,950","$19,900",,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,15,14002,TN,Individual,No,62-0427913,14002TN0330010,BlueCross Silver S16S,14002TN033,,TNN002,TNS010,TNF013,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330010-05,87% AV Level Silver Plan,,0.861683309078217,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"$10,500","$21,000","$11,650","$23,300",,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300",0%,,,,"$7,000","$14,000","$8,150","$16,300",,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,15,14002,TN,Individual,No,62-0427913,14002TN0330010,BlueCross Silver S16S,14002TN033,,TNN002,TNS010,TNF013,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330010-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000","$11,000","$22,000",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$7,000","$14,000","$7,500","$15,000",,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,15,14002,TN,Individual,No,62-0427913,14002TN0330020,BlueCross Silver S16E,14002TN033,,TNN003,TNS009,TNF013,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330020-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,15,14002,TN,Individual,No,62-0427913,14002TN0330020,BlueCross Silver S16E,14002TN033,,TNN003,TNS009,TNF013,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330020-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,15,14002,TN,Individual,No,62-0427913,14002TN0330020,BlueCross Silver S16E,14002TN033,,TNN003,TNS009,TNF013,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330020-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,15,14002,TN,Individual,No,62-0427913,14002TN0330020,BlueCross Silver S16E,14002TN033,,TNN003,TNS009,TNF013,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330020-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,15,14002,TN,Individual,No,62-0427913,14002TN0330020,BlueCross Silver S16E,14002TN033,,TNN003,TNS009,TNF013,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330020-04,73% AV Level Silver Plan,,0.720003962516785,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,950","$5,900",,,"$10,500","$21,000","$13,450","$26,900",,,,,,,,,,,,,,,,,,,,,"$2,950","$5,900",0%,,,,"$7,000","$14,000","$9,950","$19,900",,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,15,14002,TN,Individual,No,62-0427913,14002TN0330020,BlueCross Silver S16E,14002TN033,,TNN003,TNS009,TNF013,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330020-05,87% AV Level Silver Plan,,0.861683309078217,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"$10,500","$21,000","$11,650","$23,300",,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300",0%,,,,"$7,000","$14,000","$8,150","$16,300",,,,,,,,,16
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,15,14002,TN,Individual,No,62-0427913,14002TN0330020,BlueCross Silver S16E,14002TN033,,TNN003,TNS009,TNF013,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330020-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000","$11,000","$22,000",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$7,000","$14,000","$7,500","$15,000",,,,,,,,,17
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,15,14002,TN,Individual,No,62-0427913,14002TN0330030,BlueCross Silver S16E,14002TN033,,TNN003,TNS004,TNF013,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330030-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,18
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,15,14002,TN,Individual,No,62-0427913,14002TN0330030,BlueCross Silver S16E,14002TN033,,TNN003,TNS004,TNF013,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330030-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,19
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,15,14002,TN,Individual,No,62-0427913,14002TN0330030,BlueCross Silver S16E,14002TN033,,TNN003,TNS004,TNF013,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330030-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,15,14002,TN,Individual,No,62-0427913,14002TN0330030,BlueCross Silver S16E,14002TN033,,TNN003,TNS004,TNF013,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330030-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,21
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,15,14002,TN,Individual,No,62-0427913,14002TN0330030,BlueCross Silver S16E,14002TN033,,TNN003,TNS004,TNF013,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330030-04,73% AV Level Silver Plan,,0.720003962516785,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,950","$5,900",,,"$10,500","$21,000","$13,450","$26,900",,,,,,,,,,,,,,,,,,,,,"$2,950","$5,900",0%,,,,"$7,000","$14,000","$9,950","$19,900",,,,,,,,,22
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,15,14002,TN,Individual,No,62-0427913,14002TN0330030,BlueCross Silver S16E,14002TN033,,TNN003,TNS004,TNF013,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330030-05,87% AV Level Silver Plan,,0.861683309078217,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"$10,500","$21,000","$11,650","$23,300",,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300",0%,,,,"$7,000","$14,000","$8,150","$16,300",,,,,,,,,23
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,15,14002,TN,Individual,No,62-0427913,14002TN0330030,BlueCross Silver S16E,14002TN033,,TNN003,TNS004,TNF013,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330030-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000","$11,000","$22,000",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$7,000","$14,000","$7,500","$15,000",,,,,,,,,24
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,16,14002,TN,Individual,No,62-0427913,14002TN0330033,BlueCross Silver S19S,14002TN033,,TNN002,TNS010,TNF012,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330033-00,Standard Silver Off Exchange Plan,,0.682542681694031,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$12,750","$25,500","$17,000","$34,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,16,14002,TN,Individual,No,62-0427913,14002TN0330033,BlueCross Silver S19S,14002TN033,,TNN002,TNS010,TNF012,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330033-01,Standard Silver On Exchange Plan,,0.682542681694031,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$12,750","$25,500","$17,000","$34,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,16,14002,TN,Individual,No,62-0427913,14002TN0330033,BlueCross Silver S19S,14002TN033,,TNN002,TNS010,TNF012,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330033-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,16,14002,TN,Individual,No,62-0427913,14002TN0330033,BlueCross Silver S19S,14002TN033,,TNN002,TNS010,TNF012,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330033-03,Limited Cost Sharing Plan Variation,,0.682542681694031,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$12,750","$25,500","$17,000","$34,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,16,14002,TN,Individual,No,62-0427913,14002TN0330033,BlueCross Silver S19S,14002TN033,,TNN002,TNS010,TNF012,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330033-04,73% AV Level Silver Plan,,0.722818732261658,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$12,750","$25,500","$17,000","$34,000",,,,,,,,,,,,,,,,,,,,,"$2,200","$4,400",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,16,14002,TN,Individual,No,62-0427913,14002TN0330033,BlueCross Silver S19S,14002TN033,,TNN002,TNS010,TNF012,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330033-05,87% AV Level Silver Plan,,0.872048735618591,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,750","$25,500","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,16,14002,TN,Individual,No,62-0427913,14002TN0330033,BlueCross Silver S19S,14002TN033,,TNN002,TNS010,TNF012,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330033-06,94% AV Level Silver Plan,,0.930477440357208,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,950","$3,900",,,"$12,750","$25,500","$14,700","$29,400",,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,16,14002,TN,Individual,No,62-0427913,14002TN0330031,BlueCross Silver S19E,14002TN033,,TNN003,TNS009,TNF012,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330031-00,Standard Silver Off Exchange Plan,,0.682542681694031,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$12,750","$25,500","$17,000","$34,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,16,14002,TN,Individual,No,62-0427913,14002TN0330031,BlueCross Silver S19E,14002TN033,,TNN003,TNS009,TNF012,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330031-01,Standard Silver On Exchange Plan,,0.682542681694031,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$12,750","$25,500","$17,000","$34,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,16,14002,TN,Individual,No,62-0427913,14002TN0330031,BlueCross Silver S19E,14002TN033,,TNN003,TNS009,TNF012,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330031-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,16,14002,TN,Individual,No,62-0427913,14002TN0330031,BlueCross Silver S19E,14002TN033,,TNN003,TNS009,TNF012,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330031-03,Limited Cost Sharing Plan Variation,,0.682542681694031,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$12,750","$25,500","$17,000","$34,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,16,14002,TN,Individual,No,62-0427913,14002TN0330031,BlueCross Silver S19E,14002TN033,,TNN003,TNS009,TNF012,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330031-04,73% AV Level Silver Plan,,0.722818732261658,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$12,750","$25,500","$17,000","$34,000",,,,,,,,,,,,,,,,,,,,,"$2,200","$4,400",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,25,14002,TN,Individual,No,62-0427913,14002TN0350002,BlueCross Platinum P02S,14002TN035,,TNN002,TNS010,TNF010,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350002-03,Limited Cost Sharing Plan Variation,,0.892159700393677,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,25,14002,TN,Individual,No,62-0427913,14002TN0350005,BlueCross Platinum P02E,14002TN035,,TNN003,TNS009,TNF010,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350005-00,Standard Platinum Off Exchange Plan,,0.892159700393677,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,25,14002,TN,Individual,No,62-0427913,14002TN0350005,BlueCross Platinum P02E,14002TN035,,TNN003,TNS009,TNF010,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350005-01,Standard Platinum On Exchange Plan,,0.892159700393677,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,25,14002,TN,Individual,No,62-0427913,14002TN0350005,BlueCross Platinum P02E,14002TN035,,TNN003,TNS009,TNF010,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,25,14002,TN,Individual,No,62-0427913,14002TN0350005,BlueCross Platinum P02E,14002TN035,,TNN003,TNS009,TNF010,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350005-03,Limited Cost Sharing Plan Variation,,0.892159700393677,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,25,14002,TN,Individual,No,62-0427913,14002TN0350008,BlueCross Platinum P02E,14002TN035,,TNN003,TNS004,TNF010,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350008-00,Standard Platinum Off Exchange Plan,,0.892159700393677,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,25,14002,TN,Individual,No,62-0427913,14002TN0350008,BlueCross Platinum P02E,14002TN035,,TNN003,TNS004,TNF010,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350008-01,Standard Platinum On Exchange Plan,,0.892159700393677,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,25,14002,TN,Individual,No,62-0427913,14002TN0350008,BlueCross Platinum P02E,14002TN035,,TNN003,TNS004,TNF010,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,25,14002,TN,Individual,No,62-0427913,14002TN0350008,BlueCross Platinum P02E,14002TN035,,TNN003,TNS004,TNF010,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350008-03,Limited Cost Sharing Plan Variation,,0.892159700393677,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,26,14002,TN,Individual,No,62-0427913,14002TN0350003,BlueCross Platinum P03S,14002TN035,,TNN002,TNS010,TNF002,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350003-00,Standard Platinum Off Exchange Plan,,0.882617235183716,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000",$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,26,14002,TN,Individual,No,62-0427913,14002TN0350003,BlueCross Platinum P03S,14002TN035,,TNN002,TNS010,TNF002,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350003-01,Standard Platinum On Exchange Plan,,0.882617235183716,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000",$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,26,14002,TN,Individual,No,62-0427913,14002TN0350006,BlueCross Platinum P03E,14002TN035,,TNN003,TNS009,TNF002,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350006-00,Standard Platinum Off Exchange Plan,,0.882617235183716,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000",$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,4,60299,TN,Individual,No,39-0658730,60299TN0210011,Assurant Health Bronze Plan 002,60299TN021,,TNN001,TNS001,TNF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210011-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,4,60299,TN,Individual,No,39-0658730,60299TN0210012,Assurant Health Bronze Plan 002,60299TN021,,TNN001,TNS002,TNF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210012-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,16,14002,TN,Individual,No,62-0427913,14002TN0330031,BlueCross Silver S19E,14002TN033,,TNN003,TNS009,TNF012,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330031-05,87% AV Level Silver Plan,,0.872048735618591,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,750","$25,500","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,16,14002,TN,Individual,No,62-0427913,14002TN0330031,BlueCross Silver S19E,14002TN033,,TNN003,TNS009,TNF012,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330031-06,94% AV Level Silver Plan,,0.930477440357208,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,950","$3,900",,,"$12,750","$25,500","$14,700","$29,400",,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,16,14002,TN,Individual,No,62-0427913,14002TN0330032,BlueCross Silver S19E,14002TN033,,TNN003,TNS004,TNF012,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330032-00,Standard Silver Off Exchange Plan,,0.682542681694031,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$12,750","$25,500","$17,000","$34,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,16,14002,TN,Individual,No,62-0427913,14002TN0330032,BlueCross Silver S19E,14002TN033,,TNN003,TNS004,TNF012,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330032-01,Standard Silver On Exchange Plan,,0.682542681694031,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$12,750","$25,500","$17,000","$34,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,16,14002,TN,Individual,No,62-0427913,14002TN0330032,BlueCross Silver S19E,14002TN033,,TNN003,TNS004,TNF012,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330032-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,20
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,16,14002,TN,Individual,No,62-0427913,14002TN0330032,BlueCross Silver S19E,14002TN033,,TNN003,TNS004,TNF012,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330032-03,Limited Cost Sharing Plan Variation,,0.682542681694031,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$12,750","$25,500","$17,000","$34,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,16,14002,TN,Individual,No,62-0427913,14002TN0330032,BlueCross Silver S19E,14002TN033,,TNN003,TNS004,TNF012,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330032-04,73% AV Level Silver Plan,,0.722818732261658,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$12,750","$25,500","$17,000","$34,000",,,,,,,,,,,,,,,,,,,,,"$2,200","$4,400",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,16,14002,TN,Individual,No,62-0427913,14002TN0330032,BlueCross Silver S19E,14002TN033,,TNN003,TNS004,TNF012,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0330032-05,87% AV Level Silver Plan,,0.872048735618591,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,750","$25,500","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,17,14002,TN,Individual,No,62-0427913,14002TN0340009,BlueCross Gold G01E,14002TN034,,TNN003,TNS009,TNF008,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340009-03,Limited Cost Sharing Plan Variation,,0.780546188354492,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$15,750","$31,500","$21,000","$42,000",,,,,,,,,,,,,,,,,,,,,$0,$0,35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,17,14002,TN,Individual,No,62-0427913,14002TN0340017,BlueCross Gold G01E,14002TN034,,TNN003,TNS004,TNF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340017-00,Standard Gold Off Exchange Plan,,0.780546188354492,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$15,750","$31,500","$21,000","$42,000",,,,,,,,,,,,,,,,,,,,,$0,$0,35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,18,14002,TN,Individual,No,62-0427913,14002TN0340018,BlueCross Gold G02E,14002TN034,,TNN003,TNS004,TNF010,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340018-03,Limited Cost Sharing Plan Variation,,0.817800939083099,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,19,14002,TN,Individual,No,62-0427913,14002TN0340003,BlueCross Gold G04S,14002TN034,,TNN002,TNS010,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340003-00,Standard Gold Off Exchange Plan,,0.811477065086365,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,20,14002,TN,Individual,No,62-0427913,14002TN0340012,BlueCross Gold G06E,14002TN034,,TNN003,TNS009,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340012-01,Standard Gold On Exchange Plan,,0.791000127792358,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000","$1,500","$3,000",20%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,20,14002,TN,Individual,No,62-0427913,14002TN0340012,BlueCross Gold G06E,14002TN034,,TNN003,TNS009,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340012-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,20,14002,TN,Individual,No,62-0427913,14002TN0340012,BlueCross Gold G06E,14002TN034,,TNN003,TNS009,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340012-03,Limited Cost Sharing Plan Variation,,0.791000127792358,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000","$1,500","$3,000",20%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,20,14002,TN,Individual,No,62-0427913,14002TN0340020,BlueCross Gold G06E,14002TN034,,TNN003,TNS004,TNF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340020-00,Standard Gold Off Exchange Plan,,0.791000127792358,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000","$1,500","$3,000",20%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,20,14002,TN,Individual,No,62-0427913,14002TN0340020,BlueCross Gold G06E,14002TN034,,TNN003,TNS004,TNF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340020-01,Standard Gold On Exchange Plan,,0.791000127792358,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000","$1,500","$3,000",20%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,20,14002,TN,Individual,No,62-0427913,14002TN0340020,BlueCross Gold G06E,14002TN034,,TNN003,TNS004,TNF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340020-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,20,14002,TN,Individual,No,62-0427913,14002TN0340020,BlueCross Gold G06E,14002TN034,,TNN003,TNS004,TNF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340020-03,Limited Cost Sharing Plan Variation,,0.791000127792358,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000","$1,500","$3,000",20%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,21,14002,TN,Individual,No,62-0427913,14002TN0340005,BlueCross Gold G08S,14002TN034,,TNN002,TNS010,TNF013,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340005-00,Standard Gold Off Exchange Plan,,0.780541837215424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$6,300","$12,600","$8,400","$16,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400","$6,300","$12,600",,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,21,14002,TN,Individual,No,62-0427913,14002TN0340005,BlueCross Gold G08S,14002TN034,,TNN002,TNS010,TNF013,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340005-01,Standard Gold On Exchange Plan,,0.780541837215424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$6,300","$12,600","$8,400","$16,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400","$6,300","$12,600",,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,21,14002,TN,Individual,No,62-0427913,14002TN0340005,BlueCross Gold G08S,14002TN034,,TNN002,TNS010,TNF013,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,21,14002,TN,Individual,No,62-0427913,14002TN0340005,BlueCross Gold G08S,14002TN034,,TNN002,TNS010,TNF013,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340005-03,Limited Cost Sharing Plan Variation,,0.780541837215424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$6,300","$12,600","$8,400","$16,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400","$6,300","$12,600",,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,21,14002,TN,Individual,No,62-0427913,14002TN0340013,BlueCross Gold G08E,14002TN034,,TNN003,TNS009,TNF013,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340013-00,Standard Gold Off Exchange Plan,,0.780541837215424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$6,300","$12,600","$8,400","$16,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400","$6,300","$12,600",,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,21,14002,TN,Individual,No,62-0427913,14002TN0340013,BlueCross Gold G08E,14002TN034,,TNN003,TNS009,TNF013,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340013-01,Standard Gold On Exchange Plan,,0.780541837215424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$6,300","$12,600","$8,400","$16,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400","$6,300","$12,600",,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,21,14002,TN,Individual,No,62-0427913,14002TN0340013,BlueCross Gold G08E,14002TN034,,TNN003,TNS009,TNF013,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,21,14002,TN,Individual,No,62-0427913,14002TN0340013,BlueCross Gold G08E,14002TN034,,TNN003,TNS009,TNF013,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340013-03,Limited Cost Sharing Plan Variation,,0.780541837215424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$6,300","$12,600","$8,400","$16,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400","$6,300","$12,600",,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,21,14002,TN,Individual,No,62-0427913,14002TN0340021,BlueCross Gold G08E,14002TN034,,TNN003,TNS004,TNF013,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340021-00,Standard Gold Off Exchange Plan,,0.780541837215424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$6,300","$12,600","$8,400","$16,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400","$6,300","$12,600",,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,21,14002,TN,Individual,No,62-0427913,14002TN0340021,BlueCross Gold G08E,14002TN034,,TNN003,TNS004,TNF013,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340021-01,Standard Gold On Exchange Plan,,0.780541837215424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$6,300","$12,600","$8,400","$16,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400","$6,300","$12,600",,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,21,14002,TN,Individual,No,62-0427913,14002TN0340021,BlueCross Gold G08E,14002TN034,,TNN003,TNS004,TNF013,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340021-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,21,14002,TN,Individual,No,62-0427913,14002TN0340021,BlueCross Gold G08E,14002TN034,,TNN003,TNS004,TNF013,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340021-03,Limited Cost Sharing Plan Variation,,0.780541837215424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$6,300","$12,600","$8,400","$16,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400","$6,300","$12,600",,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,22,14002,TN,Individual,No,62-0427913,14002TN0340007,BlueCross Gold G10S,14002TN034,,TNN002,TNS010,TNF006,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340007-00,Standard Gold Off Exchange Plan,,0.78556501865387,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,22,14002,TN,Individual,No,62-0427913,14002TN0340007,BlueCross Gold G10S,14002TN034,,TNN002,TNS010,TNF006,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340007-01,Standard Gold On Exchange Plan,,0.78556501865387,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,22,14002,TN,Individual,No,62-0427913,14002TN0340007,BlueCross Gold G10S,14002TN034,,TNN002,TNS010,TNF006,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,22,14002,TN,Individual,No,62-0427913,14002TN0340007,BlueCross Gold G10S,14002TN034,,TNN002,TNS010,TNF006,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340007-03,Limited Cost Sharing Plan Variation,,0.78556501865387,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,22,14002,TN,Individual,No,62-0427913,14002TN0340015,BlueCross Gold G10E,14002TN034,,TNN003,TNS009,TNF006,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340015-00,Standard Gold Off Exchange Plan,,0.78556501865387,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,22,14002,TN,Individual,No,62-0427913,14002TN0340015,BlueCross Gold G10E,14002TN034,,TNN003,TNS009,TNF006,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340015-01,Standard Gold On Exchange Plan,,0.78556501865387,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,22,14002,TN,Individual,No,62-0427913,14002TN0340015,BlueCross Gold G10E,14002TN034,,TNN003,TNS009,TNF006,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,22,14002,TN,Individual,No,62-0427913,14002TN0340015,BlueCross Gold G10E,14002TN034,,TNN003,TNS009,TNF006,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340015-03,Limited Cost Sharing Plan Variation,,0.78556501865387,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,22,14002,TN,Individual,No,62-0427913,14002TN0340022,BlueCross Gold G10E,14002TN034,,TNN003,TNS004,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340022-00,Standard Gold Off Exchange Plan,,0.78556501865387,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,22,14002,TN,Individual,No,62-0427913,14002TN0340022,BlueCross Gold G10E,14002TN034,,TNN003,TNS004,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340022-01,Standard Gold On Exchange Plan,,0.78556501865387,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,22,14002,TN,Individual,No,62-0427913,14002TN0340022,BlueCross Gold G10E,14002TN034,,TNN003,TNS004,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340022-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,22,14002,TN,Individual,No,62-0427913,14002TN0340022,BlueCross Gold G10E,14002TN034,,TNN003,TNS004,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340022-03,Limited Cost Sharing Plan Variation,,0.78556501865387,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,23,14002,TN,Individual,No,62-0427913,14002TN0340008,BlueCross Gold G11S,14002TN034,,TNN002,TNS010,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340008-00,Standard Gold Off Exchange Plan,,0.796816885471344,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,23,14002,TN,Individual,No,62-0427913,14002TN0340008,BlueCross Gold G11S,14002TN034,,TNN002,TNS010,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340008-01,Standard Gold On Exchange Plan,,0.796816885471344,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,23,14002,TN,Individual,No,62-0427913,14002TN0340008,BlueCross Gold G11S,14002TN034,,TNN002,TNS010,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,23,14002,TN,Individual,No,62-0427913,14002TN0340008,BlueCross Gold G11S,14002TN034,,TNN002,TNS010,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340008-03,Limited Cost Sharing Plan Variation,,0.796816885471344,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,23,14002,TN,Individual,No,62-0427913,14002TN0340016,BlueCross Gold G11E,14002TN034,,TNN003,TNS009,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340016-00,Standard Gold Off Exchange Plan,,0.796816885471344,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,23,14002,TN,Individual,No,62-0427913,14002TN0340016,BlueCross Gold G11E,14002TN034,,TNN003,TNS009,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340016-01,Standard Gold On Exchange Plan,,0.796816885471344,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,23,14002,TN,Individual,No,62-0427913,14002TN0340016,BlueCross Gold G11E,14002TN034,,TNN003,TNS009,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340016-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,23,14002,TN,Individual,No,62-0427913,14002TN0340016,BlueCross Gold G11E,14002TN034,,TNN003,TNS009,TNF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340016-03,Limited Cost Sharing Plan Variation,,0.796816885471344,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,23,14002,TN,Individual,No,62-0427913,14002TN0340023,BlueCross Gold G11E,14002TN034,,TNN003,TNS004,TNF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340023-00,Standard Gold Off Exchange Plan,,0.796816885471344,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,23,14002,TN,Individual,No,62-0427913,14002TN0340023,BlueCross Gold G11E,14002TN034,,TNN003,TNS004,TNF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340023-01,Standard Gold On Exchange Plan,,0.796816885471344,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,23,14002,TN,Individual,No,62-0427913,14002TN0340023,BlueCross Gold G11E,14002TN034,,TNN003,TNS004,TNF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340023-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,23,14002,TN,Individual,No,62-0427913,14002TN0340023,BlueCross Gold G11E,14002TN034,,TNN003,TNS004,TNF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0340023-03,Limited Cost Sharing Plan Variation,,0.796816885471344,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,24,14002,TN,Individual,No,62-0427913,14002TN0350001,BlueCross Platinum P01S,14002TN035,,TNN002,TNS010,TNF002,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350001-00,Standard Platinum Off Exchange Plan,,0.882483839988709,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"$5,400","$10,800","$7,200","$14,400",$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,24,14002,TN,Individual,No,62-0427913,14002TN0350001,BlueCross Platinum P01S,14002TN035,,TNN002,TNS010,TNF002,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350001-01,Standard Platinum On Exchange Plan,,0.882483839988709,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"$5,400","$10,800","$7,200","$14,400",$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,24,14002,TN,Individual,No,62-0427913,14002TN0350001,BlueCross Platinum P01S,14002TN035,,TNN002,TNS010,TNF002,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,24,14002,TN,Individual,No,62-0427913,14002TN0350001,BlueCross Platinum P01S,14002TN035,,TNN002,TNS010,TNF002,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350001-03,Limited Cost Sharing Plan Variation,,0.882483839988709,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"$5,400","$10,800","$7,200","$14,400",$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,24,14002,TN,Individual,No,62-0427913,14002TN0350004,BlueCross Platinum P01E,14002TN035,,TNN003,TNS009,TNF002,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350004-00,Standard Platinum Off Exchange Plan,,0.882483839988709,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"$5,400","$10,800","$7,200","$14,400",$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,24,14002,TN,Individual,No,62-0427913,14002TN0350004,BlueCross Platinum P01E,14002TN035,,TNN003,TNS009,TNF002,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350004-01,Standard Platinum On Exchange Plan,,0.882483839988709,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"$5,400","$10,800","$7,200","$14,400",$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,24,14002,TN,Individual,No,62-0427913,14002TN0350004,BlueCross Platinum P01E,14002TN035,,TNN003,TNS009,TNF002,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,24,14002,TN,Individual,No,62-0427913,14002TN0350004,BlueCross Platinum P01E,14002TN035,,TNN003,TNS009,TNF002,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350004-03,Limited Cost Sharing Plan Variation,,0.882483839988709,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"$5,400","$10,800","$7,200","$14,400",$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,24,14002,TN,Individual,No,62-0427913,14002TN0350007,BlueCross Platinum P01E,14002TN035,,TNN003,TNS004,TNF002,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350007-00,Standard Platinum Off Exchange Plan,,0.882483839988709,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"$5,400","$10,800","$7,200","$14,400",$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,24,14002,TN,Individual,No,62-0427913,14002TN0350007,BlueCross Platinum P01E,14002TN035,,TNN003,TNS004,TNF002,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350007-01,Standard Platinum On Exchange Plan,,0.882483839988709,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"$5,400","$10,800","$7,200","$14,400",$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,24,14002,TN,Individual,No,62-0427913,14002TN0350007,BlueCross Platinum P01E,14002TN035,,TNN003,TNS004,TNF002,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,24,14002,TN,Individual,No,62-0427913,14002TN0350007,BlueCross Platinum P01E,14002TN035,,TNN003,TNS004,TNF002,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350007-03,Limited Cost Sharing Plan Variation,,0.882483839988709,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"$5,400","$10,800","$7,200","$14,400",$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,25,14002,TN,Individual,No,62-0427913,14002TN0350002,BlueCross Platinum P02S,14002TN035,,TNN002,TNS010,TNF010,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350002-00,Standard Platinum Off Exchange Plan,,0.892159700393677,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,25,14002,TN,Individual,No,62-0427913,14002TN0350002,BlueCross Platinum P02S,14002TN035,,TNN002,TNS010,TNF010,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350002-01,Standard Platinum On Exchange Plan,,0.892159700393677,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,25,14002,TN,Individual,No,62-0427913,14002TN0350002,BlueCross Platinum P02S,14002TN035,,TNN002,TNS010,TNF010,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TN,14002,HIOS,3,2014-09-04 03:25:43,26,14002,TN,Individual,No,62-0427913,14002TN0350006,BlueCross Platinum P03E,14002TN035,,TNN003,TNS009,TNF002,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,"Out of State is BlueCard PPO, In State is Out of Network Benefits",Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0350006-01,Standard Platinum On Exchange Plan,,0.882617235183716,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000",$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210018,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS003,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210018-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210019,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS004,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210019-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210019,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS004,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210019-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210019,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS004,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210019-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,37
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210019,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS004,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210019-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210019,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS004,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210019-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210004,Assurant Health Bronze Plan 001,60299TN021,,TNN001,TNS004,TNF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,28
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210004,Assurant Health Bronze Plan 001,60299TN021,,TNN001,TNS004,TNF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210004-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210005,Assurant Health Bronze Plan 001,60299TN021,,TNN001,TNS005,TNF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210005-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210005,Assurant Health Bronze Plan 001,60299TN021,,TNN001,TNS005,TNF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210005-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210005,Assurant Health Bronze Plan 001,60299TN021,,TNN001,TNS005,TNF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,32
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210020,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS005,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210020-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,7,60299,TN,Individual,No,39-0658730,60299TN0210026,Assurant Health Platinum Plan 002,60299TN021,,TNN001,TNS001,TNF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210026-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,7,60299,TN,Individual,No,39-0658730,60299TN0210027,Assurant Health Platinum Plan 002,60299TN021,,TNN001,TNS002,TNF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210027-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,TN,22384,HIOS,6,2014-12-09 03:57:54,1,22384,TN,SHOP (Small Group),Yes,62-0812197,22384TN0040002,Delta Dental Small Group Product,22384TN004,,TNN001,TNS001,,Existing,POS,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$32.59,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Benefits allowed as 'Non Participating',Yes,Benefits allowed as Delta Dental PPO or Non Participating,Yes,,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/delta,,,22384TN0040002-00,Standard High Off Exchange Plan,86.18%,,,,Yes,60%,40%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,22384,HIOS,6,2014-12-09 03:57:54,1,22384,TN,Individual,Yes,62-0812197,22384TN0010002,Delta Dental FFM Individual Product,22384TN001,,TNN002,TNS001,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$36.82,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Benefits allowed as 'Non Participating,Yes,Benefits allowed as Delta Dental PPO or Non Participating,Yes,www.deltadentaltn.com/acamarketplace/individualpediatricplan,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/22384,,,22384TN0010002-01,Standard High On Exchange Plan,84.86%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,22384,HIOS,6,2014-12-09 03:57:54,1,22384,TN,Individual,Yes,62-0812197,22384TN0030001,Delta Dental Individual Plan,22384TN003,,TNN002,TNS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$28.01,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Benefits allowed as 'Non Participating,Yes,Benefits allowed as Delta Dental PPO or Non Participating,Yes,,,,,22384TN0030001-00,Standard Low Off Exchange Plan,70.71%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TN,22384,HIOS,6,2014-12-09 03:57:54,1,22384,TN,Individual,Yes,62-0812197,22384TN0030002,Delta Dental Individual Plan,22384TN003,,TNN002,TNS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$33.89,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Benefits allowed as 'Non Participating,Yes,Benefits allowed as Delta Dental PPO or Non Participating,Yes,,,,,22384TN0030002-00,Standard High Off Exchange Plan,84.86%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TN,22384,HIOS,6,2014-12-09 03:57:54,2,22384,TN,Individual,Yes,62-0812197,22384TN0010003,Delta Dental FFM Individual Product,22384TN001,,TNN002,TNS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.47,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Benefits allowed as Delta Dental PPO or Non Participating,Yes,Benefits allowed as Delta Dental PPO or Non Participating,Yes,www.deltadentaltn.com/acamarketplace/individualpediatricplan,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/22384,,,22384TN0010003-01,Standard Low On Exchange Plan,70.71%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,22384,HIOS,6,2014-12-09 03:57:54,2,22384,TN,Individual,Yes,62-0812197,22384TN0010004,Delta Dental FFM Individual Product,22384TN001,,TNN002,TNS001,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.82,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Benefits allowed as Delta Dental PPO or Non Participating,Yes,Benefits allowed as Delta Dental PPO or Non Participating,Yes,www.deltadentaltn.com/acamarketplace/individualpediatricplan,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/22384,,,22384TN0010004-01,Standard High On Exchange Plan,84.86%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,1,24601,TN,Individual,Yes,95-6042390,24601TN0020001,BESTOne Child Dental Plus,24601TN002,,TNN001,TNS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$29.57,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BESTOne_Child_Dental_Plus_Plan.pdf,,24601TN0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,1,24601,TN,SHOP (Small Group),Yes,95-6042390,24601TN0010001,BEST Life Child Dental Plus,24601TN001,,TNN001,TNS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$23.65,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BEST_Life_Child_Dental_Plus_Plan.pdf,,24601TN0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,2,24601,TN,SHOP (Small Group),Yes,95-6042390,24601TN0010002,BEST Life Child Dental,24601TN001,,TNN001,TNS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$18.31,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BEST_Life_Child_Dental_Plan.pdf,,24601TN0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,2,24601,TN,Individual,Yes,95-6042390,24601TN0020002,BESTOne Child Dental,24601TN002,,TNN001,TNS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$22.88,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BESTOne_Child_Dental_Plan.pdf,,24601TN0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,3,24601,TN,Individual,Yes,95-6042390,24601TN0020003,BESTOne Dental Advantage-Gold,24601TN002,,TNN001,TNS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.57,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BESTOne_Dental_Advantage-Gold_Plan.pdf,,24601TN0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,3,24601,TN,SHOP (Small Group),Yes,95-6042390,24601TN0010007,BEST Dental Premium,24601TN001,,TNN001,TNS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BESTDental_Premium_Plan.pdf,,24601TN0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,3,24601,TN,SHOP (Small Group),Yes,95-6042390,24601TN0010007,BEST Dental Premium,24601TN001,,TNN001,TNS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BESTDental_Premium_Plan.pdf,,24601TN0010007-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,3,24601,TN,Individual,Yes,95-6042390,24601TN0020003,BESTOne Dental Advantage-Gold,24601TN002,,TNN001,TNS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.57,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BESTOne_Dental_Advantage-Gold_Plan.pdf,,24601TN0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,3,24601,TN,Individual,Yes,95-6042390,24601TN0020004,BESTOne Dental Plus-Gold,24601TN002,,TNN001,TNS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.57,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BESTOne_Dental_Plus-Gold_Plan.pdf,,24601TN0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,3,24601,TN,SHOP (Small Group),Yes,95-6042390,24601TN0010008,BEST Dental Standard-H,24601TN001,,TNN001,TNS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BESTDental_Standard-H_Plan.pdf,,24601TN0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,3,24601,TN,SHOP (Small Group),Yes,95-6042390,24601TN0010008,BEST Dental Standard-H,24601TN001,,TNN001,TNS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BESTDental_Standard-H_Plan.pdf,,24601TN0010008-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,3,24601,TN,Individual,Yes,95-6042390,24601TN0020004,BESTOne Dental Plus-Gold,24601TN002,,TNN001,TNS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.57,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BESTOne_Dental_Plus-Gold_Plan.pdf,,24601TN0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,3,24601,TN,SHOP (Small Group),Yes,95-6042390,24601TN0010010,BEST Dental Choice-H,24601TN001,,TNN001,TNS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BESTDental_Choice-H_Plan.pdf,,24601TN0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,3,24601,TN,SHOP (Small Group),Yes,95-6042390,24601TN0010010,BEST Dental Choice-H,24601TN001,,TNN001,TNS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BESTDental_Choice-H_Plan.pdf,,24601TN0010010-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,4,24601,TN,SHOP (Small Group),Yes,95-6042390,24601TN0010009,BEST Dental Standard-L,24601TN001,,TNN001,TNS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.31,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BESTDental_Standard-L_Plan.pdf,,24601TN0010009-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,4,24601,TN,Individual,Yes,95-6042390,24601TN0020005,BESTOne Dental Plus-Silver,24601TN002,,TNN001,TNS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.88,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BESTOne_Dental_Plus-Silver_Plan.pdf,,24601TN0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,4,24601,TN,Individual,Yes,95-6042390,24601TN0020005,BESTOne Dental Plus-Silver,24601TN002,,TNN001,TNS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.88,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BESTOne_Dental_Plus-Silver_Plan.pdf,,24601TN0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,4,24601,TN,SHOP (Small Group),Yes,95-6042390,24601TN0010009,BEST Dental Standard-L,24601TN001,,TNN001,TNS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.31,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BESTDental_Standard-L_Plan.pdf,,24601TN0010009-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,4,24601,TN,SHOP (Small Group),Yes,95-6042390,24601TN0010011,BEST Dental Choice-L,24601TN001,,TNN001,TNS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.31,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BESTDental_Choice-L_Plan.pdf,,24601TN0010011-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,4,24601,TN,Individual,Yes,95-6042390,24601TN0020006,BESTOne Dental Basic-Silver,24601TN002,,TNN001,TNS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.88,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BESTOne_Dental_Basic-Silver_Plan.pdf,,24601TN0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,4,24601,TN,Individual,Yes,95-6042390,24601TN0020006,BESTOne Dental Basic-Silver,24601TN002,,TNN001,TNS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.88,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BESTOne_Dental_Basic-Silver_Plan.pdf,,24601TN0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,4,24601,TN,SHOP (Small Group),Yes,95-6042390,24601TN0010011,BEST Dental Choice-L,24601TN001,,TNN001,TNS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.31,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BESTDental_Choice-L_Plan.pdf,,24601TN0010011-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,4,24601,TN,SHOP (Small Group),Yes,95-6042390,24601TN0010012,BEST Dental Value,24601TN001,,TNN001,TNS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.31,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BESTDental_Value_Plan.pdf,,24601TN0010012-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,TN,24601,HIOS,4,2014-09-03 04:28:59,4,24601,TN,SHOP (Small Group),Yes,95-6042390,24601TN0010012,BEST Dental Value,24601TN001,,TNN001,TNS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.31,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TN/2015/TN_BESTDental_Value_Plan.pdf,,24601TN0010012-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,TN,28398,HIOS,8,2015-01-16 17:32:32,1,28398,TN,SHOP (Small Group),Yes,36-3757528,28398TN0030001,TruAssure Dental Small Group Basic Plan,28398TN003,,TNN001,TNS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.99,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=TN,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=TN,,28398TN0030001-00,Standard High Off Exchange Plan,83.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,28398,HIOS,8,2015-01-16 17:32:32,1,28398,TN,Individual,Yes,36-3757528,28398TN0010001,TruAssure Dental Basic Plan,28398TN001,,TNN001,TNS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.65,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=TN,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=TN,,28398TN0010001-00,Standard Low Off Exchange Plan,68.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,28398,HIOS,8,2015-01-16 17:32:32,1,28398,TN,Individual,Yes,36-3757528,28398TN0010001,TruAssure Dental Basic Plan,28398TN001,,TNN001,TNS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.65,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=TN,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=TN,,28398TN0010001-01,Standard Low On Exchange Plan,68.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,28398,HIOS,8,2015-01-16 17:32:32,1,28398,TN,SHOP (Small Group),Yes,36-3757528,28398TN0040001,TruAssure Dental Small Group Preferred Plan,28398TN004,,TNN001,TNS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.99,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=TN,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=TN,,28398TN0040001-00,Standard High Off Exchange Plan,83.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,28398,HIOS,8,2015-01-16 17:32:32,2,28398,TN,Individual,Yes,36-3757528,28398TN0020001,TruAssure Dental Preferred Plan,28398TN002,,TNN001,TNS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.93,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=TN,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=TN,,28398TN0020001-00,Standard High Off Exchange Plan,83.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$30,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,28398,HIOS,8,2015-01-16 17:32:32,2,28398,TN,Individual,Yes,36-3757528,28398TN0020001,TruAssure Dental Preferred Plan,28398TN002,,TNN001,TNS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.93,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=TN,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=TN,,28398TN0020001-01,Standard High On Exchange Plan,83.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$30,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,55044,HIOS,2,2014-08-05 13:28:44,1,55044,TN,SHOP (Small Group),Yes,44-0308260,55044TN0010001,KCL EHB Low PPO,55044TN001,,TNN001,TNS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$35.09,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,55044TN0010001-00,Standard Low Off Exchange Plan,68.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,55044,HIOS,2,2014-08-05 13:28:44,1,55044,TN,SHOP (Small Group),Yes,44-0308260,55044TN0010003,KCL EHB Low MAC,55044TN001,,TNN001,TNS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$25.42,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,55044TN0010003-00,Standard Low Off Exchange Plan,68.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210001,Assurant Health Bronze Plan 001,60299TN021,,TNN001,TNS001,TNF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210001-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210001,Assurant Health Bronze Plan 001,60299TN021,,TNN001,TNS001,TNF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210001-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210001,Assurant Health Bronze Plan 001,60299TN021,,TNN001,TNS001,TNF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,16
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210001,Assurant Health Bronze Plan 001,60299TN021,,TNN001,TNS001,TNF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210001-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210002,Assurant Health Bronze Plan 001,60299TN021,,TNN001,TNS002,TNF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210002-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210002,Assurant Health Bronze Plan 001,60299TN021,,TNN001,TNS002,TNF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210002-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210002,Assurant Health Bronze Plan 001,60299TN021,,TNN001,TNS002,TNF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,20
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210002,Assurant Health Bronze Plan 001,60299TN021,,TNN001,TNS002,TNF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210002-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210003,Assurant Health Bronze Plan 001,60299TN021,,TNN001,TNS003,TNF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210003-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210003,Assurant Health Bronze Plan 001,60299TN021,,TNN001,TNS003,TNF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210003-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210003,Assurant Health Bronze Plan 001,60299TN021,,TNN001,TNS003,TNF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,24
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210003,Assurant Health Bronze Plan 001,60299TN021,,TNN001,TNS003,TNF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210003-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210004,Assurant Health Bronze Plan 001,60299TN021,,TNN001,TNS004,TNF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210004-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210005,Assurant Health Bronze Plan 001,60299TN021,,TNN001,TNS005,TNF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210005-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210006,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS001,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210006-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210006,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS001,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210006-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210006,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS001,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,46
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210006,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS001,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210006-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,47
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210006,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS001,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210006-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210006,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS001,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210006-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210006,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS001,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210006-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,50
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210007,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS002,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210007-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,51
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210007,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS002,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210007-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,52
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210007,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS002,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,53
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210007,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS002,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210007-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,54
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210007,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS002,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210007-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,55
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210007,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS002,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210007-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210007,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS002,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210007-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,57
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210008,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS003,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210008-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,58
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210008,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS003,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210008-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,59
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210008,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS003,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,60
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210008,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS003,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210008-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,63
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210008,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS003,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210008-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,64
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210009,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS004,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210009-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,65
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210009,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS004,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210009-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,66
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210009,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS004,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,67
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210009,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS004,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210009-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,68
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210009,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS004,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210009-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,69
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210009,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS004,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210009-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,70
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210009,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS004,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210009-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,71
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210010,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS005,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210010-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,72
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,7,60299,TN,Individual,No,39-0658730,60299TN0210026,Assurant Health Platinum Plan 002,60299TN021,,TNN001,TNS001,TNF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210026-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,7,60299,TN,Individual,No,39-0658730,60299TN0210026,Assurant Health Platinum Plan 002,60299TN021,,TNN001,TNS001,TNF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210026-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,7,60299,TN,Individual,No,39-0658730,60299TN0210026,Assurant Health Platinum Plan 002,60299TN021,,TNN001,TNS001,TNF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210026-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,16
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,7,60299,TN,Individual,No,39-0658730,60299TN0210027,Assurant Health Platinum Plan 002,60299TN021,,TNN001,TNS002,TNF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210027-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,7,60299,TN,Individual,No,39-0658730,60299TN0210027,Assurant Health Platinum Plan 002,60299TN021,,TNN001,TNS002,TNF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210027-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,20
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210010,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS005,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210010-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,73
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210010,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS005,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,74
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210010,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS005,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210010-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,75
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210010,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS005,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210010-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,76
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210010,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS005,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210010-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,77
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,1,60299,TN,Individual,No,39-0658730,60299TN0210010,Assurant Health Silver Plan 001,60299TN021,,TNN001,TNS005,TNF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210010-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,78
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,4,60299,TN,Individual,No,39-0658730,60299TN0210011,Assurant Health Bronze Plan 002,60299TN021,,TNN001,TNS001,TNF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210011-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,4,60299,TN,Individual,No,39-0658730,60299TN0210011,Assurant Health Bronze Plan 002,60299TN021,,TNN001,TNS001,TNF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210011-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,4,60299,TN,Individual,No,39-0658730,60299TN0210011,Assurant Health Bronze Plan 002,60299TN021,,TNN001,TNS001,TNF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,16
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,4,60299,TN,Individual,No,39-0658730,60299TN0210012,Assurant Health Bronze Plan 002,60299TN021,,TNN001,TNS002,TNF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210012-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,4,60299,TN,Individual,No,39-0658730,60299TN0210012,Assurant Health Bronze Plan 002,60299TN021,,TNN001,TNS002,TNF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210012-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,20
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,4,60299,TN,Individual,No,39-0658730,60299TN0210012,Assurant Health Bronze Plan 002,60299TN021,,TNN001,TNS002,TNF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210012-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,4,60299,TN,Individual,No,39-0658730,60299TN0210013,Assurant Health Bronze Plan 002,60299TN021,,TNN001,TNS003,TNF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210013-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,4,60299,TN,Individual,No,39-0658730,60299TN0210013,Assurant Health Bronze Plan 002,60299TN021,,TNN001,TNS003,TNF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210013-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,4,60299,TN,Individual,No,39-0658730,60299TN0210013,Assurant Health Bronze Plan 002,60299TN021,,TNN001,TNS003,TNF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210013-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,24
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,4,60299,TN,Individual,No,39-0658730,60299TN0210013,Assurant Health Bronze Plan 002,60299TN021,,TNN001,TNS003,TNF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210013-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,4,60299,TN,Individual,No,39-0658730,60299TN0210014,Assurant Health Bronze Plan 002,60299TN021,,TNN001,TNS004,TNF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210014-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,4,60299,TN,Individual,No,39-0658730,60299TN0210014,Assurant Health Bronze Plan 002,60299TN021,,TNN001,TNS004,TNF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210014-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,4,60299,TN,Individual,No,39-0658730,60299TN0210014,Assurant Health Bronze Plan 002,60299TN021,,TNN001,TNS004,TNF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210014-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,28
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,4,60299,TN,Individual,No,39-0658730,60299TN0210014,Assurant Health Bronze Plan 002,60299TN021,,TNN001,TNS004,TNF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210014-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,4,60299,TN,Individual,No,39-0658730,60299TN0210015,Assurant Health Bronze Plan 002,60299TN021,,TNN001,TNS005,TNF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210015-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,4,60299,TN,Individual,No,39-0658730,60299TN0210015,Assurant Health Bronze Plan 002,60299TN021,,TNN001,TNS005,TNF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210015-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210018,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS003,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210018-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210018,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS003,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210018-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210019,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS004,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210019-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210019,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS004,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210019-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,7,60299,TN,Individual,No,39-0658730,60299TN0210027,Assurant Health Platinum Plan 002,60299TN021,,TNN001,TNS002,TNF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210027-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,7,60299,TN,Individual,No,39-0658730,60299TN0210028,Assurant Health Platinum Plan 002,60299TN021,,TNN001,TNS003,TNF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210028-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,7,60299,TN,Individual,No,39-0658730,60299TN0210028,Assurant Health Platinum Plan 002,60299TN021,,TNN001,TNS003,TNF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210028-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,7,60299,TN,Individual,No,39-0658730,60299TN0210028,Assurant Health Platinum Plan 002,60299TN021,,TNN001,TNS003,TNF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210028-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,24
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,4,60299,TN,Individual,No,39-0658730,60299TN0210015,Assurant Health Bronze Plan 002,60299TN021,,TNN001,TNS005,TNF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210015-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,32
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,4,60299,TN,Individual,No,39-0658730,60299TN0210015,Assurant Health Bronze Plan 002,60299TN021,,TNN001,TNS005,TNF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,60299TN0210015-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210016,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS001,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210016-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210016,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS001,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210016-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210016,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS001,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210016-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,16
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210016,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS001,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210016-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210016,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS001,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210016-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210016,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS001,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210016-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210016,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS001,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210016-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210017,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS002,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210017-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210017,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS002,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210017-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210017,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS002,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210017-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,23
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210017,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS002,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210017-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210017,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS002,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210017-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210017,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS002,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210017-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210017,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS002,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210017-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210018,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS003,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210018-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210018,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS003,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210018-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210018,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS003,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210018-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,30
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210018,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS003,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210018-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210020,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS005,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210020-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,42
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210020,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS005,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210020-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,43
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210020,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS005,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210020-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,44
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210020,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS005,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210020-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210020,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS005,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210020-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,46
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210020,Assurant Health Silver Plan 002,60299TN021,,TNN001,TNS005,TNF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210020-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,47
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210021,Assurant Health Gold Plan 002,60299TN021,,TNN001,TNS001,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210021-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,69
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210021,Assurant Health Gold Plan 002,60299TN021,,TNN001,TNS001,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210021-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,70
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210021,Assurant Health Gold Plan 002,60299TN021,,TNN001,TNS001,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210021-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,71
2015,TX,22012,HIOS,4,2014-09-06 03:39:47,1,22012,TX,SHOP (Small Group),Yes,41-0808596,22012TX0010002,"Plan 2. MAC PPO, $1500 Annual Maximum, Ortho",22012TX001,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,22012TX0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,23749,HIOS,8,2014-11-15 04:52:41,1,23749,TX,Individual,Yes,75-1233841,23749TX0010001,Dentegra Dental PPO Pediatric Basic Plan,23749TX001,,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$19.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/tx/23749tx0010001-15,,23749TX0010001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,23749,HIOS,8,2014-11-15 04:52:41,1,23749,TX,Individual,Yes,75-1233841,23749TX0010001,Dentegra Dental PPO Pediatric Basic Plan,23749TX001,,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$19.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/tx/23749tx0010001-15,,23749TX0010001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,23749,HIOS,8,2014-11-15 04:52:41,2,23749,TX,Individual,Yes,75-1233841,23749TX0010004,Dentegra Dental PPO Family Preferred Plan,23749TX001,,TXN001,TXS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.60,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/tx/23749tx0010004-15,,23749TX0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,23749,HIOS,8,2014-11-15 04:52:41,2,23749,TX,SHOP (Small Group),Yes,75-1233841,23749TX0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,23749TX002,,TXN001,TXS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.35,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/tx/23749tx0020004-15,,23749TX0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,23749,HIOS,8,2014-11-15 04:52:41,2,23749,TX,SHOP (Small Group),Yes,75-1233841,23749TX0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,23749TX002,,TXN001,TXS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.35,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/tx/23749tx0020004-15,,23749TX0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,23749,HIOS,8,2014-11-15 04:52:41,2,23749,TX,Individual,Yes,75-1233841,23749TX0010004,Dentegra Dental PPO Family Preferred Plan,23749TX001,,TXN001,TXS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.60,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/tx/23749tx0010004-15,,23749TX0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,23749,HIOS,8,2014-11-15 04:52:41,3,23749,TX,Individual,Yes,75-1233841,23749TX0010006,Dentegra Dental PPO Family Basic Plan,23749TX001,,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/tx/23749tx0010006-15,,23749TX0010006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600023,HumanaSilver 4600/Memphis PPOx,82120TN060,,TNN002,TNS002,TNF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342730,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334449,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600023-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$25,200","$50,400",Not Applicable,Not Applicable,$900,"$1,800",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600023,HumanaSilver 4600/Memphis PPOx,82120TN060,,TNN002,TNS002,TNF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342730,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334449,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600023-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$25,200","$50,400",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,$250,$500,50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600023,HumanaSilver 4600/Memphis PPOx,82120TN060,,TNN002,TNS002,TNF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342730,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334449,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600023-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600024,Humana Gold 2500/Memphis PPOx,82120TN060,,TNN002,TNS002,TNF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342509,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334501,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600024-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,28
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,2,82120,TN,Individual,No,39-1263473,82120TN0600022,Humana Bronze 6300/Memphis PPOx,82120TN060,,TNN002,TNS002,TNF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342457,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334436,http://apps.humana.com/marketing/documents.asp?file=2323880,82120TN0600022-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,15
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,2,82120,TN,Individual,No,39-1263473,82120TN0600031,Humana Basic 6600/Nashville PPOx,82120TN060,,TNN003,TNS003,TNF001,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343159,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334540,http://apps.humana.com/marketing/documents.asp?file=2323880,82120TN0600031-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,16
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210021,Assurant Health Gold Plan 002,60299TN021,,TNN001,TNS001,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210021-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,72
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210022,Assurant Health Gold Plan 002,60299TN021,,TNN001,TNS002,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210022-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,73
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210022,Assurant Health Gold Plan 002,60299TN021,,TNN001,TNS002,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210022-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,74
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210022,Assurant Health Gold Plan 002,60299TN021,,TNN001,TNS002,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210022-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,75
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210022,Assurant Health Gold Plan 002,60299TN021,,TNN001,TNS002,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210022-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,76
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210023,Assurant Health Gold Plan 002,60299TN021,,TNN001,TNS003,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210023-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,77
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210023,Assurant Health Gold Plan 002,60299TN021,,TNN001,TNS003,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210023-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,78
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210023,Assurant Health Gold Plan 002,60299TN021,,TNN001,TNS003,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210023-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,79
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210023,Assurant Health Gold Plan 002,60299TN021,,TNN001,TNS003,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210023-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,80
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210024,Assurant Health Gold Plan 002,60299TN021,,TNN001,TNS004,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210024-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,81
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210024,Assurant Health Gold Plan 002,60299TN021,,TNN001,TNS004,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210024-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,82
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210024,Assurant Health Gold Plan 002,60299TN021,,TNN001,TNS004,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210024-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,83
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210024,Assurant Health Gold Plan 002,60299TN021,,TNN001,TNS004,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210024-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,84
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210025,Assurant Health Gold Plan 002,60299TN021,,TNN001,TNS005,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210025-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,85
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210025,Assurant Health Gold Plan 002,60299TN021,,TNN001,TNS005,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210025-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,86
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210025,Assurant Health Gold Plan 002,60299TN021,,TNN001,TNS005,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210025-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,87
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,6,60299,TN,Individual,No,39-0658730,60299TN0210025,Assurant Health Gold Plan 002,60299TN021,,TNN001,TNS005,TNF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210025-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,88
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,7,60299,TN,Individual,No,39-0658730,60299TN0210028,Assurant Health Platinum Plan 002,60299TN021,,TNN001,TNS003,TNF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210028-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,7,60299,TN,Individual,No,39-0658730,60299TN0210029,Assurant Health Platinum Plan 002,60299TN021,,TNN001,TNS004,TNF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210029-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,7,60299,TN,Individual,No,39-0658730,60299TN0210029,Assurant Health Platinum Plan 002,60299TN021,,TNN001,TNS004,TNF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210029-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,7,60299,TN,Individual,No,39-0658730,60299TN0210029,Assurant Health Platinum Plan 002,60299TN021,,TNN001,TNS004,TNF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210029-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,28
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,7,60299,TN,Individual,No,39-0658730,60299TN0210029,Assurant Health Platinum Plan 002,60299TN021,,TNN001,TNS004,TNF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210029-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,7,60299,TN,Individual,No,39-0658730,60299TN0210030,Assurant Health Platinum Plan 002,60299TN021,,TNN001,TNS005,TNF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210030-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,7,60299,TN,Individual,No,39-0658730,60299TN0210030,Assurant Health Platinum Plan 002,60299TN021,,TNN001,TNS005,TNF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210030-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,7,60299,TN,Individual,No,39-0658730,60299TN0210030,Assurant Health Platinum Plan 002,60299TN021,,TNN001,TNS005,TNF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210030-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,32
2015,TN,60299,HIOS,6,2014-11-09 04:38:15,7,60299,TN,Individual,No,39-0658730,60299TN0210030,Assurant Health Platinum Plan 002,60299TN021,,TNN001,TNS005,TNF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TN_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TN.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,60299TN0210030-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,TN,71781,HIOS,4,2014-09-05 03:32:16,1,71781,TN,SHOP (Small Group),Yes,41-0808596,71781TN0010001,"Plan 1. Passive PPO, $1000 Annual Maximum, no Ortho",71781TN001,,TNN001,TNS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,71781TN0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600015,Humana Platinum 1000/Knoxville PPOx,82120TN060,,TNN001,TNS001,TNF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343250,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334410,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600015-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600015,Humana Platinum 1000/Knoxville PPOx,82120TN060,,TNN001,TNS001,TNF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343250,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334410,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600013,Humana Silver 4600/Knoxville PPOx,82120TN060,,TNN001,TNS001,TNF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343328,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334345,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600013-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,Yes,39-1263473,82120TN0630001,Humana Dental Smart Choice,82120TN063,,TNN005,TNS005,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.60,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541370,,82120TN0630001-00,Standard Low Off Exchange Plan,71.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,Yes,39-1263473,82120TN0630001,Humana Dental Smart Choice,82120TN063,,TNN005,TNS005,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.60,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541370,,82120TN0630001-01,Standard Low On Exchange Plan,71.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600013,Humana Silver 4600/Knoxville PPOx,82120TN060,,TNN001,TNS001,TNF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343328,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334345,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600013-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,2,82120,TN,Individual,No,39-1263473,82120TN0600012,Humana Bronze 6300/Knoxville PPOx,82120TN060,,TNN001,TNS001,TNF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343172,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334332,http://apps.humana.com/marketing/documents.asp?file=2323880,82120TN0600012-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,2,82120,TN,Individual,No,39-1263473,82120TN0600012,Humana Bronze 6300/Knoxville PPOx,82120TN060,,TNN001,TNS001,TNF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343172,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334332,http://apps.humana.com/marketing/documents.asp?file=2323880,82120TN0600012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,TX,12350,HIOS,2,2014-08-07 10:00:19,1,12350,TX,SHOP (Small Group),Yes,44-0308260,12350TX0010005,KCL Fam Low PPO,12350TX001,,TXN001,TXS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$39.95,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,12350TX0010005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TX,12350,HIOS,2,2014-08-07 10:00:19,1,12350,TX,SHOP (Small Group),Yes,44-0308260,12350TX0010007,KCL Fam Low MAC,12350TX001,,TXN001,TXS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$30.77,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,12350TX0010007-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TX,12350,HIOS,2,2014-08-07 10:00:19,2,12350,TX,SHOP (Small Group),Yes,44-0308260,12350TX0010002,KCL EHB High PPO,12350TX001,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$47.30,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,12350TX0010002-00,Standard High Off Exchange Plan,84.90%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,12350,HIOS,2,2014-08-07 10:00:19,2,12350,TX,SHOP (Small Group),Yes,44-0308260,12350TX0010004,KCL EHB High MAC,12350TX001,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$37.33,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,12350TX0010004-00,Standard High Off Exchange Plan,84.90%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,12350,HIOS,2,2014-08-07 10:00:19,2,12350,TX,SHOP (Small Group),Yes,44-0308260,12350TX0010006,KCL Fam High PPO,12350TX001,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$47.30,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,12350TX0010006-00,Standard High Off Exchange Plan,84.90%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TX,12350,HIOS,2,2014-08-07 10:00:19,2,12350,TX,SHOP (Small Group),Yes,44-0308260,12350TX0010008,KCL Fam High MAC,12350TX001,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$37.33,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,12350TX0010008-00,Standard High Off Exchange Plan,84.90%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TX,12846,HIOS,6,2014-08-27 03:27:11,1,12846,TX,SHOP (Small Group),Yes,13-5123390,12846TX0200002,Guardian Pediatric Advantage,12846TX020,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.04,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,12846TX0200002-00,Standard High Off Exchange Plan,84.70%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,12846,HIOS,6,2014-08-27 03:27:11,1,12846,TX,SHOP (Small Group),Yes,13-5123390,12846TX0210002,Guardian Pediatric Essentials,12846TX021,,TXN001,TXS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$18.94,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,12846TX0210002-00,Standard Low Off Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,12846,HIOS,6,2014-08-27 03:27:11,2,12846,TX,SHOP (Small Group),Yes,13-5123390,12846TX0230002,Guardian Family Advantage,12846TX023,,TXN001,TXS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.04,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,12846TX0230002-00,Standard High Off Exchange Plan,84.70%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,12846,HIOS,6,2014-08-27 03:27:11,2,12846,TX,SHOP (Small Group),Yes,13-5123390,12846TX0230002,Guardian Family Advantage,12846TX023,,TXN001,TXS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.04,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,12846TX0230002-01,Standard High On Exchange Plan,84.70%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,12846,HIOS,6,2014-08-27 03:27:11,2,12846,TX,SHOP (Small Group),Yes,13-5123390,12846TX0250002,Guardian Family Essentials,12846TX025,,TXN001,TXS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.94,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,12846TX0250002-00,Standard Low Off Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TX,12846,HIOS,6,2014-08-27 03:27:11,2,12846,TX,SHOP (Small Group),Yes,13-5123390,12846TX0250002,Guardian Family Essentials,12846TX025,,TXN001,TXS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.94,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,12846TX0250002-01,Standard Low On Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TX,19312,HIOS,4,2014-09-05 03:32:16,1,19312,TX,SHOP (Small Group),Yes,91-1857813,19312TX0020001,Smile for Kids EHB - PPO,19312TX002,,TXN001,TXS001,,Existing,PPO,Low,,Off the Exchange,,,,Please see Schedule of Benefits for limitations and exclusions,,,,,Allows Child-Only,,,,$21.88,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.",Yes,www.premierlife.com/txhealthreform,www.premierlife.com/payment,www.premierlife.com/txhealthreform,,19312TX0020001-00,Standard Low Off Exchange Plan,69.36%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$200,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,19312,HIOS,4,2014-09-05 03:32:16,1,19312,TX,Individual,Yes,91-1857813,19312TX0010001,Smile for Kids EHB - PPO,19312TX001,,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,Please see Schedule of Benefits for limitations and exclusions,,,,,Allows Child-Only,,,,$24.75,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.",Yes,www.premierlife.com/txhealthreform,www.premierlife.com/payment,www.premierlife.com/txhealthreform,,19312TX0010001-01,Standard Low On Exchange Plan,70.65%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$200,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,19312,HIOS,4,2014-09-05 03:32:16,2,19312,TX,Individual,Yes,91-1857813,19312TX0010003,PLUS Family Plan with EHB PLUS,19312TX001,,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,Please see the Schedule of Benefits for limitations and exclusions,,,,,Allows Adult and Child-Only,,,,$24.75,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule agreed to by participating providers.",Yes,www.premierlife.com/txhealthreform,www.premierlife.com/payment,www.premierlife.com/txhealthreform,,19312TX0010003-00,Standard Low Off Exchange Plan,70.65%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$200,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,19312,HIOS,4,2014-09-05 03:32:16,2,19312,TX,Individual,Yes,91-1857813,19312TX0010003,PLUS Family Plan with EHB PLUS,19312TX001,,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,Please see the Schedule of Benefits for limitations and exclusions,,,,,Allows Adult and Child-Only,,,,$24.75,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule agreed to by participating providers.",Yes,www.premierlife.com/txhealthreform,www.premierlife.com/payment,www.premierlife.com/txhealthreform,,19312TX0010003-01,Standard Low On Exchange Plan,70.65%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$200,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,22012,HIOS,4,2014-09-06 03:39:47,1,22012,TX,SHOP (Small Group),Yes,41-0808596,22012TX0010001,"Plan 1. MAC PPO, $1000 Annual Maximum, no Ortho",22012TX001,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,22012TX0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600024,Humana Gold 2500/Memphis PPOx,82120TN060,,TNN002,TNS002,TNF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342509,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334501,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600024-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600024,Humana Gold 2500/Memphis PPOx,82120TN060,,TNN002,TNS002,TNF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342509,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334501,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600024-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,TN,90303,HIOS,1,2014-06-25 03:28:48,1,90303,TN,Individual,Yes,47-0397286,90303TN0020001,"Renaissance Individual Dental PPO, EHB Certified",90303TN002,,TNN001,TNS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.18,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,90303TN0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TN,90303,HIOS,1,2014-06-25 03:28:48,1,90303,TN,Individual,Yes,47-0397286,90303TN0020002,"Renaissance Individual Dental PPO, EHB Certified",90303TN002,,TNN001,TNS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.54,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,90303TN0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TN,90303,HIOS,1,2014-06-25 03:28:48,2,90303,TN,SHOP (Small Group),Yes,47-0397286,90303TN0060001,"Renaissance Group Dental GBA PPO, EHB Certified",90303TN006,,TNN001,TNS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.11,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,90303TN0060001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,90303,HIOS,1,2014-06-25 03:28:48,2,90303,TN,SHOP (Small Group),Yes,47-0397286,90303TN0060002,"Renaissance Group Dental GBA PPO, EHB Certified",90303TN006,,TNN001,TNS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.32,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,90303TN0060002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,90303,HIOS,1,2014-06-25 03:28:48,2,90303,TN,SHOP (Small Group),Yes,47-0397286,90303TN0070001,"Renaissance Group Dental EPO, EHB Certified",90303TN007,,TNN001,TNS001,,Existing,EPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.11,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,90303TN0070001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TN,90303,HIOS,1,2014-06-25 03:28:48,2,90303,TN,SHOP (Small Group),Yes,47-0397286,90303TN0070002,"Renaissance Group Dental EPO, EHB Certified",90303TN007,,TNN001,TNS001,,Existing,EPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.32,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,90303TN0070002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TN,90402,HIOS,4,2014-08-27 03:27:11,1,90402,TN,SHOP (Small Group),Yes,13-5123390,90402TN0010002,Guardian Pediatric Advantage,90402TN001,,TNN001,TNS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$22.54,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,90402TN0010002-00,Standard High Off Exchange Plan,84.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,90402,HIOS,4,2014-08-27 03:27:11,1,90402,TN,SHOP (Small Group),Yes,13-5123390,90402TN0020002,Guardian Pediatric Essentials,90402TN002,,TNN001,TNS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$17.13,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,90402TN0020002-00,Standard Low Off Exchange Plan,70.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,90402,HIOS,4,2014-08-27 03:27:11,2,90402,TN,SHOP (Small Group),Yes,13-5123390,90402TN0040002,Guardian Family Advantage,90402TN004,,TNN001,TNS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.54,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,90402TN0040002-00,Standard High Off Exchange Plan,84.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,90402,HIOS,4,2014-08-27 03:27:11,2,90402,TN,SHOP (Small Group),Yes,13-5123390,90402TN0040002,Guardian Family Advantage,90402TN004,,TNN001,TNS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.54,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,90402TN0040002-01,Standard High On Exchange Plan,84.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,90402,HIOS,4,2014-08-27 03:27:11,2,90402,TN,SHOP (Small Group),Yes,13-5123390,90402TN0060002,Guardian Family Essentials,90402TN006,,TNN001,TNS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.13,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,90402TN0060002-00,Standard Low Off Exchange Plan,70.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TN,90402,HIOS,4,2014-08-27 03:27:11,2,90402,TN,SHOP (Small Group),Yes,13-5123390,90402TN0060002,Guardian Family Essentials,90402TN006,,TNN001,TNS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.13,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,90402TN0060002-01,Standard Low On Exchange Plan,70.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TN,71781,HIOS,4,2014-09-05 03:32:16,1,71781,TN,SHOP (Small Group),Yes,41-0808596,71781TN0010002,"Plan 2.  Passive PPO, $1000 Annual Maximum, Ortho",71781TN001,,TNN001,TNS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,71781TN0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,71781,HIOS,4,2014-09-05 03:32:16,1,71781,TN,SHOP (Small Group),Yes,41-0808596,71781TN0010003,"Plan 3. Passive PPO, $1500 Annual Maximum, no Ortho",71781TN001,,TNN001,TNS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,71781TN0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TN,71781,HIOS,4,2014-09-05 03:32:16,1,71781,TN,SHOP (Small Group),Yes,41-0808596,71781TN0010004,"Plan 4.  Passive PPO, $1500 Annual Maximum, Ortho",71781TN001,,TNN001,TNS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,71781TN0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TN,71781,HIOS,4,2014-09-05 03:32:16,1,71781,TN,SHOP (Small Group),Yes,41-0808596,71781TN0010005,"Plan 5.  Passive PPO, $2000 Annual Maximum, Ortho",71781TN001,,TNN001,TNS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,71781TN0010005-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,TN,71781,HIOS,4,2014-09-05 03:32:16,1,71781,TN,SHOP (Small Group),Yes,41-0808596,71781TN0010006,"Plan 6. MAC PPO, $1000 Annual Maximum, no Ortho",71781TN001,,TNN001,TNS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,71781TN0010006-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,TN,71781,HIOS,4,2014-09-05 03:32:16,1,71781,TN,SHOP (Small Group),Yes,41-0808596,71781TN0010007,"Plan 7. MAC PPO, $1500 Annual Maximum, Ortho",71781TN001,,TNN001,TNS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,71781TN0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,TN,72254,HIOS,2,2014-08-05 13:28:44,1,72254,TN,SHOP (Small Group),Yes,36-0883760,72254TN0040002,EHB High PPO,72254TN004,,TNN001,TNS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.36,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,72254TN0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,72254,HIOS,2,2014-08-05 13:28:44,1,72254,TN,SHOP (Small Group),Yes,36-0883760,72254TN0040001,EHB Low PPO,72254TN004,,TNN001,TNS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$16.64,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,72254TN0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,72254,HIOS,2,2014-08-05 13:28:44,1,72254,TN,SHOP (Small Group),Yes,36-0883760,72254TN0030002,EHB High Passive,72254TN003,,TNN001,TNS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$37.24,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,72254TN0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TN,72254,HIOS,2,2014-08-05 13:28:44,1,72254,TN,SHOP (Small Group),Yes,36-0883760,72254TN0030001,EHB Low Passive,72254TN003,,TNN001,TNS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.99,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,72254TN0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TN,73043,HIOS,2,2014-08-03 08:59:32,1,73043,TN,SHOP (Small Group),Yes,47-0098400,73043TN0040002,EHB High PPO,73043TN004,,TNN001,TNS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.89,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,73043TN0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,73043,HIOS,2,2014-08-03 08:59:32,1,73043,TN,SHOP (Small Group),Yes,47-0098400,73043TN0040001,EHB Low PPO,73043TN004,,TNN001,TNS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$16.41,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,73043TN0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,73043,HIOS,2,2014-08-03 08:59:32,1,73043,TN,SHOP (Small Group),Yes,47-0098400,73043TN0030002,EHB High Passive,73043TN003,,TNN001,TNS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.73,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,73043TN0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TN,73043,HIOS,2,2014-08-03 08:59:32,1,73043,TN,SHOP (Small Group),Yes,47-0098400,73043TN0030001,EHB Low Passive,73043TN003,,TNN001,TNS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.70,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,73043TN0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TN,75832,HIOS,3,2014-09-05 03:32:16,1,75832,TN,SHOP (Small Group),Yes,81-0170040,75832TN0010001,Assurant Dental ACAFFO High,75832TN001,,TNN001,TNS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.21,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same Coverage as in Service Area,Yes,,,,,75832TN0010001-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,75832,HIOS,3,2014-09-05 03:32:16,2,75832,TN,SHOP (Small Group),Yes,81-0170040,75832TN0010002,Assurant Dental ACAFFO Low,75832TN001,,TNN001,TNS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.70,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same Coverage as in Service Area,Yes,,,,,75832TN0010002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,77432,HIOS,3,2014-09-04 03:25:43,1,77432,TN,SHOP (Small Group),Yes,35-0472300,77432TN0010002,Lincoln DentalConnect?,77432TN001,,TNN001,TNS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.28,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,77432TN0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,77432,HIOS,3,2014-09-04 03:25:43,1,77432,TN,SHOP (Small Group),Yes,35-0472300,77432TN0010003,Lincoln DentalConnect?,77432TN001,,TNN001,TNS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.58,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,77432TN0010003-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,77432,HIOS,3,2014-09-04 03:25:43,1,77432,TN,SHOP (Small Group),Yes,35-0472300,77432TN0010005,Lincoln DentalConnect?,77432TN001,,TNN001,TNS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.77,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,77432TN0010005-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TN,77432,HIOS,3,2014-09-04 03:25:43,1,77432,TN,SHOP (Small Group),Yes,35-0472300,77432TN0010006,Lincoln DentalConnect?,77432TN001,,TNN001,TNS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.97,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,77432TN0010006-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TN,77432,HIOS,3,2014-09-04 03:25:43,2,77432,TN,SHOP (Small Group),Yes,35-0472300,77432TN0010001,Lincoln DentalConnect?,77432TN001,,TNN001,TNS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.67,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,77432TN0010001-00,Standard High Off Exchange Plan,86.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,77432,HIOS,3,2014-09-04 03:25:43,2,77432,TN,SHOP (Small Group),Yes,35-0472300,77432TN0010004,Lincoln DentalConnect?,77432TN001,,TNN001,TNS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.75,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,77432TN0010004-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,78859,HIOS,3,2014-08-05 13:28:44,1,78859,TN,SHOP (Small Group),Yes,57-0523959,78859TN0010001,Group Pediatric Dental EHB Rider,78859TN001,,TNN001,TNS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$27.53,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,78859TN0010001-00,Standard High Off Exchange Plan,86.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,78859,HIOS,3,2014-08-05 13:28:44,1,78859,TN,SHOP (Small Group),Yes,57-0523959,78859TN0010002,Group Pediatric Dental EHB Rider,78859TN001,,TNN001,TNS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$22.66,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,78859TN0010002-00,Standard Low Off Exchange Plan,70.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,79913,HIOS,7,2014-11-15 04:52:41,1,79913,TN,Individual,Yes,75-1233841,79913TN0010007,Dentegra Dental PPO Pediatric Basic Plan,79913TN001,,TNN001,TNS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.85,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/tn/79913tn0010007-15,,79913TN0010007-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,79913,HIOS,7,2014-11-15 04:52:41,1,79913,TN,SHOP (Small Group),Yes,75-1233841,79913TN0020007,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,79913TN002,,TNN001,TNS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.02,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/tn/79913tn0020007-15,,79913TN0020007-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,79913,HIOS,7,2014-11-15 04:52:41,1,79913,TN,SHOP (Small Group),Yes,75-1233841,79913TN0020007,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,79913TN002,,TNN001,TNS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.02,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/tn/79913tn0020007-15,,79913TN0020007-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,79913,HIOS,7,2014-11-15 04:52:41,1,79913,TN,Individual,Yes,75-1233841,79913TN0010007,Dentegra Dental PPO Pediatric Basic Plan,79913TN001,,TNN001,TNS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.85,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/tn/79913tn0010007-15,,79913TN0010007-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,79913,HIOS,7,2014-11-15 04:52:41,2,79913,TN,Individual,Yes,75-1233841,79913TN0010009,Dentegra Dental PPO Family Basic Plan,79913TN001,,TNN001,TNS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.85,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/tn/79913tn0010009-15,,79913TN0010009-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,79913,HIOS,7,2014-11-15 04:52:41,2,79913,TN,SHOP (Small Group),Yes,75-1233841,79913TN0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,79913TN002,,TNN001,TNS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.02,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/tn/79913tn0020009-15,,79913TN0020009-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,79913,HIOS,7,2014-11-15 04:52:41,2,79913,TN,SHOP (Small Group),Yes,75-1233841,79913TN0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,79913TN002,,TNN001,TNS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.02,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/tn/79913tn0020009-15,,79913TN0020009-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,79913,HIOS,7,2014-11-15 04:52:41,2,79913,TN,Individual,Yes,75-1233841,79913TN0010009,Dentegra Dental PPO Family Basic Plan,79913TN001,,TNN001,TNS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.85,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/tn/79913tn0010009-15,,79913TN0010009-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600013,Humana Silver 4600/Knoxville PPOx,82120TN060,,TNN001,TNS001,TNF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343328,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334345,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600013-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600013,Humana Silver 4600/Knoxville PPOx,82120TN060,,TNN001,TNS001,TNF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343328,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334345,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600013-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600013,Humana Silver 4600/Knoxville PPOx,82120TN060,,TNN001,TNS001,TNF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343328,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334345,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600013-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600013,Humana Silver 4600/Knoxville PPOx,82120TN060,,TNN001,TNS001,TNF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343328,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334345,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600013-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$25,200","$50,400",Not Applicable,Not Applicable,$900,"$1,800",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600013,Humana Silver 4600/Knoxville PPOx,82120TN060,,TNN001,TNS001,TNF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343328,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334345,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600013-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$25,200","$50,400",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,$250,$500,50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600014,Humana Gold 2500/Knoxville PPOx,82120TN060,,TNN001,TNS001,TNF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343211,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334397,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600014-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600014,Humana Gold 2500/Knoxville PPOx,82120TN060,,TNN001,TNS001,TNF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343211,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334397,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600014-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600014,Humana Gold 2500/Knoxville PPOx,82120TN060,,TNN001,TNS001,TNF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343211,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334397,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600014,Humana Gold 2500/Knoxville PPOx,82120TN060,,TNN001,TNS001,TNF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343211,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334397,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600014-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600015,Humana Platinum 1000/Knoxville PPOx,82120TN060,,TNN001,TNS001,TNF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343250,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334410,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600015-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600015,Humana Platinum 1000/Knoxville PPOx,82120TN060,,TNN001,TNS001,TNF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343250,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334410,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600015-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600023,HumanaSilver 4600/Memphis PPOx,82120TN060,,TNN002,TNS002,TNF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342730,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334449,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600023-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600023,HumanaSilver 4600/Memphis PPOx,82120TN060,,TNN002,TNS002,TNF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342730,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334449,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600023-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600023,HumanaSilver 4600/Memphis PPOx,82120TN060,,TNN002,TNS002,TNF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342730,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334449,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600023-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600023,HumanaSilver 4600/Memphis PPOx,82120TN060,,TNN002,TNS002,TNF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342730,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334449,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600023-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600024,Humana Gold 2500/Memphis PPOx,82120TN060,,TNN002,TNS002,TNF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342509,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334501,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600024-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600025,Humana Platinum 1000/Memphis PPOx,82120TN060,,TNN002,TNS002,TNF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342548,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334514,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600025-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600025,Humana Platinum 1000/Memphis PPOx,82120TN060,,TNN002,TNS002,TNF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342548,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334514,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600025-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600025,Humana Platinum 1000/Memphis PPOx,82120TN060,,TNN002,TNS002,TNF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342548,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334514,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600025-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,32
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600025,Humana Platinum 1000/Memphis PPOx,82120TN060,,TNN002,TNS002,TNF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342548,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334514,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600025-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600033,Humana Silver 4600/Nashville PPOx,82120TN060,,TNN003,TNS003,TNF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343354,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334566,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600033-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600033,Humana Silver 4600/Nashville PPOx,82120TN060,,TNN003,TNS003,TNF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343354,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334566,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600033-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600033,Humana Silver 4600/Nashville PPOx,82120TN060,,TNN003,TNS003,TNF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343354,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334566,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600033-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,36
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600033,Humana Silver 4600/Nashville PPOx,82120TN060,,TNN003,TNS003,TNF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343354,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334566,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600033-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600033,Humana Silver 4600/Nashville PPOx,82120TN060,,TNN003,TNS003,TNF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343354,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334566,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600033-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$25,200","$50,400",Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600033,Humana Silver 4600/Nashville PPOx,82120TN060,,TNN003,TNS003,TNF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343354,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334566,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600033-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$25,200","$50,400",Not Applicable,Not Applicable,$900,"$1,800",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600033,Humana Silver 4600/Nashville PPOx,82120TN060,,TNN003,TNS003,TNF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343354,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334566,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600033-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$25,200","$50,400",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$9,200","$18,400",Not Applicable,Not Applicable,$250,$500,50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600034,Humana Gold 2500/Nashville PPOx,82120TN060,,TNN003,TNS003,TNF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343237,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334618,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600034-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600034,Humana Gold 2500/Nashville PPOx,82120TN060,,TNN003,TNS003,TNF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343237,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334618,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600034-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600034,Humana Gold 2500/Nashville PPOx,82120TN060,,TNN003,TNS003,TNF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343237,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334618,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600034-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,43
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600034,Humana Gold 2500/Nashville PPOx,82120TN060,,TNN003,TNS003,TNF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343237,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334618,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600034-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600035,Humana Platinum 1000/Nashville PPOx,82120TN060,,TNN003,TNS003,TNF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343276,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334631,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600035-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600035,Humana Platinum 1000/Nashville PPOx,82120TN060,,TNN003,TNS003,TNF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343276,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334631,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600035-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600035,Humana Platinum 1000/Nashville PPOx,82120TN060,,TNN003,TNS003,TNF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343276,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334631,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600035-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,47
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,1,82120,TN,Individual,No,39-1263473,82120TN0600035,Humana Platinum 1000/Nashville PPOx,82120TN060,,TNN003,TNS003,TNF003,Existing,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343276,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334631,http://apps.humana.com/marketing/documents.asp?file=2323815,82120TN0600035-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,2,82120,TN,Individual,No,39-1263473,82120TN0600011,Humana Basic 6600/Knoxville PPOx,82120TN060,,TNN001,TNS001,TNF001,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343133,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334319,http://apps.humana.com/marketing/documents.asp?file=2323880,82120TN0600011-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,2,82120,TN,Individual,No,39-1263473,82120TN0600011,Humana Basic 6600/Knoxville PPOx,82120TN060,,TNN001,TNS001,TNF001,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343133,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334319,http://apps.humana.com/marketing/documents.asp?file=2323880,82120TN0600011-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,2,82120,TN,Individual,No,39-1263473,82120TN0600012,Humana Bronze 6300/Knoxville PPOx,82120TN060,,TNN001,TNS001,TNF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343172,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334332,http://apps.humana.com/marketing/documents.asp?file=2323880,82120TN0600012-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,6
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,2,82120,TN,Individual,No,39-1263473,82120TN0600012,Humana Bronze 6300/Knoxville PPOx,82120TN060,,TNN001,TNS001,TNF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343172,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334332,http://apps.humana.com/marketing/documents.asp?file=2323880,82120TN0600012-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,9
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,2,82120,TN,Individual,No,39-1263473,82120TN0600021,Humana Basic 6600/Memphis PPOx,82120TN060,,TNN002,TNS002,TNF001,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342379,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334423,http://apps.humana.com/marketing/documents.asp?file=2323880,82120TN0600021-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,10
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,4,99248,TN,Individual,No,59-1031071,99248TN0020004,myCigna Health Flex 1500,99248TN002,7730182962,TNN001,TNS001,TNF003,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,2,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-flex-1500,http://www.cigna.com/ifp-drug-list,99248TN0020004-06,94% AV Level Silver Plan,93.40%,0.936385273933411,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$575,"$1,150",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,TX,12350,HIOS,2,2014-08-07 10:00:19,1,12350,TX,SHOP (Small Group),Yes,44-0308260,12350TX0010001,KCL EHB Low PPO,12350TX001,,TXN001,TXS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$39.95,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,12350TX0010001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,12350,HIOS,2,2014-08-07 10:00:19,1,12350,TX,SHOP (Small Group),Yes,44-0308260,12350TX0010003,KCL EHB Low MAC,12350TX001,,TXN001,TXS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$30.77,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,12350TX0010003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,1,26539,TX,Individual,No,75-2569094,26539TX0140001,Gold - Coinsurance,26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_GoldPlanCoinsurance_SBC_26539TX0140001-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_GoldPlanCoinsurance_BenefitsSummary_26539TX0140001-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140001-01,Standard Gold On Exchange Plan,,0.798102974891663,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$20,"$1,310",$150,$0,"$1,620",,$80,5
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,1,26539,TX,SHOP (Small Group),No,75-2569094,26539TX0130001,Gold - Coinsurance,26539TX013,,TXN001,TXS001,TXF001,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-1_MarketplaceSHOP_GoldPlanCoinsurance_SBC_26539TX0130001-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-1_MarketplaceSHOP_GoldPlanCoinsurance_BenefitsSummary_26539TX0130001-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0130001-01,Standard Gold On Exchange Plan,,0.798102974891663,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$20,"$1,310",$150,$0,"$1,620",,$80,5
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,1,26539,TX,SHOP (Small Group),No,75-2569094,26539TX0130002,Gold - Copay,26539TX013,,TXN001,TXS001,TXF001,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,5,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-1_MarketplaceSHOP_GoldPlanCopay_SBC_26539TX0130002-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-1_MarketplaceSHOP_GoldPlanCopay_BenefitsSummary_26539TX0130002-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0130002-00,Standard Gold Off Exchange Plan,,0.782505035400391,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,850",$0,$150,$0,"$1,620",,$80,6
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,1,26539,TX,Individual,No,75-2569094,26539TX0140001,Gold - Coinsurance,26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_GoldPlanCoinsurance_SBC_26539TX0140001-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_GoldPlanCoinsurance_BenefitsSummary_26539TX0140001-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,,$80,6
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,1,26539,TX,Individual,No,75-2569094,26539TX0140001,Gold - Coinsurance,26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_GoldPlanCoinsurance_SBC_26539TX0140001-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_GoldPlanCoinsurance_BenefitsSummary_26539TX0140001-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140001-03,Limited Cost Sharing Plan Variation,,0.798102974891663,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$20,"$1,310",$150,$0,"$1,620",,$80,7
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,1,26539,TX,SHOP (Small Group),No,75-2569094,26539TX0130002,Gold - Copay,26539TX013,,TXN001,TXS001,TXF001,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,5,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-1_MarketplaceSHOP_GoldPlanCopay_SBC_26539TX0130002-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-1_MarketplaceSHOP_GoldPlanCopay_BenefitsSummary_26539TX0130002-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0130002-01,Standard Gold On Exchange Plan,,0.782505035400391,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,850",$0,$150,$0,"$1,620",,$80,7
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,1,26539,TX,Individual,No,75-2569094,26539TX0140002,Gold - Copay,26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,5,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_GoldPlanCopay_SBC_26539TX0140002-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_GoldPlanCopay_BenefitsSummary_26539TX0140002-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140002-00,Standard Gold Off Exchange Plan,,0.782505035400391,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,850",$0,$150,$0,"$1,620",,$80,8
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,1,26539,TX,Individual,No,75-2569094,26539TX0140002,Gold - Copay,26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,5,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_GoldPlanCopay_SBC_26539TX0140002-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_GoldPlanCopay_BenefitsSummary_26539TX0140002-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140002-01,Standard Gold On Exchange Plan,,0.782505035400391,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,850",$0,$150,$0,"$1,620",,$80,9
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330028,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS008,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330028-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,78
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330028,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS008,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330028-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,79
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330028,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS008,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330028-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,80
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330028,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS008,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330028-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,81
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,2,82120,TN,Individual,No,39-1263473,82120TN0600021,Humana Basic 6600/Memphis PPOx,82120TN060,,TNN002,TNS002,TNF001,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342379,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334423,http://apps.humana.com/marketing/documents.asp?file=2323880,82120TN0600021-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,11
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,2,82120,TN,Individual,No,39-1263473,82120TN0600022,Humana Bronze 6300/Memphis PPOx,82120TN060,,TNN002,TNS002,TNF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342457,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334436,http://apps.humana.com/marketing/documents.asp?file=2323880,82120TN0600022-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,12
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,2,82120,TN,Individual,No,39-1263473,82120TN0600022,Humana Bronze 6300/Memphis PPOx,82120TN060,,TNN002,TNS002,TNF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342457,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334436,http://apps.humana.com/marketing/documents.asp?file=2323880,82120TN0600022-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,13
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,2,82120,TN,Individual,No,39-1263473,82120TN0600022,Humana Bronze 6300/Memphis PPOx,82120TN060,,TNN002,TNS002,TNF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2342457,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334436,http://apps.humana.com/marketing/documents.asp?file=2323880,82120TN0600022-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,2,82120,TN,Individual,No,39-1263473,82120TN0600031,Humana Basic 6600/Nashville PPOx,82120TN060,,TNN003,TNS003,TNF001,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343159,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334540,http://apps.humana.com/marketing/documents.asp?file=2323880,82120TN0600031-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,17
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,2,82120,TN,Individual,No,39-1263473,82120TN0600032,Humana Bronze 6300/Nashville PPOx,82120TN060,,TNN003,TNS003,TNF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343198,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334553,http://apps.humana.com/marketing/documents.asp?file=2323880,82120TN0600032-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,18
2015,TX,24349,HIOS,9,2014-11-15 04:52:41,1,24349,TX,Individual,Yes,94-2761537,24349TX0010002,Delta Dental PPO Pediatric Preferred Plan,24349TX001,,TXN001,TXS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$24.60,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/tx/24349tx0010002-15,,24349TX0010002-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,24349,HIOS,9,2014-11-15 04:52:41,1,24349,TX,Individual,Yes,94-2761537,24349TX0010002,Delta Dental PPO Pediatric Preferred Plan,24349TX001,,TXN001,TXS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$24.60,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/tx/24349tx0010002-15,,24349TX0010002-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,24349,HIOS,9,2014-11-15 04:52:41,1,24349,TX,Individual,Yes,94-2761537,24349TX0010001,Delta Dental PPO Pediatric Basic Plan,24349TX001,,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$19.60,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/tx/24349tx0010001-15,,24349TX0010001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TX,24349,HIOS,9,2014-11-15 04:52:41,1,24349,TX,Individual,Yes,94-2761537,24349TX0010001,Delta Dental PPO Pediatric Basic Plan,24349TX001,,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$19.60,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/tx/24349tx0010001-15,,24349TX0010001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TX,24349,HIOS,9,2014-11-15 04:52:41,2,24349,TX,SHOP (Small Group),Yes,94-2761537,24349TX0020004,Delta Dental PPO Preferred Plan for Families for Small Businesses,24349TX002,,TXN001,TXS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.60,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/tx/24349tx0020004-15,,24349TX0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,24349,HIOS,9,2014-11-15 04:52:41,2,24349,TX,Individual,Yes,94-2761537,24349TX0010004,Delta Dental PPO Preferred Plan for Families,24349TX001,,TXN001,TXS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.60,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/tx/24349tx0010004-15,,24349TX0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,24349,HIOS,9,2014-11-15 04:52:41,2,24349,TX,Individual,Yes,94-2761537,24349TX0010004,Delta Dental PPO Preferred Plan for Families,24349TX001,,TXN001,TXS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.60,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/tx/24349tx0010004-15,,24349TX0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,24349,HIOS,9,2014-11-15 04:52:41,2,24349,TX,SHOP (Small Group),Yes,94-2761537,24349TX0020004,Delta Dental PPO Preferred Plan for Families for Small Businesses,24349TX002,,TXN001,TXS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.60,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/tx/24349tx0020004-15,,24349TX0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,24349,HIOS,9,2014-11-15 04:52:41,3,24349,TX,SHOP (Small Group),Yes,94-2761537,24349TX0020006,Delta Dental PPO Basic Plan for Families for Small Businesses,24349TX002,,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.68,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/tx/24349tx0020006-15,,24349TX0020006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,24349,HIOS,9,2014-11-15 04:52:41,3,24349,TX,Individual,Yes,94-2761537,24349TX0010006,Delta Dental PPO Basic Plan for Families,24349TX001,,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/tx/24349tx0010006-15,,24349TX0010006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,24349,HIOS,9,2014-11-15 04:52:41,3,24349,TX,Individual,Yes,94-2761537,24349TX0010006,Delta Dental PPO Basic Plan for Families,24349TX001,,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/tx/24349tx0010006-15,,24349TX0010006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,24349,HIOS,9,2014-11-15 04:52:41,3,24349,TX,SHOP (Small Group),Yes,94-2761537,24349TX0020006,Delta Dental PPO Basic Plan for Families for Small Businesses,24349TX002,,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.68,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/tx/24349tx0020006-15,,24349TX0020006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,26250,HIOS,6,2015-01-16 17:32:32,1,26250,TX,Individual,Yes,75-2698702,26250TX0060001,Managed DentalGuard TX Essentials 1,26250TX006,,TXN001,TXS001,,New,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$8.17,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,https://mydental.guardianlife.com/exchange/texas,,https://mydental.guardianlife.com/exchange/texas,,26250TX0060001-00,Standard Low Off Exchange Plan,71.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,26250,HIOS,6,2015-01-16 17:32:32,1,26250,TX,SHOP (Small Group),Yes,75-2698702,26250TX0020002,Managed DentalGuard TX Child Essentials 1,26250TX002,,TXN001,TXS001,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$8.17,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,26250TX0020002-00,Standard Low Off Exchange Plan,71.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,26250,HIOS,6,2015-01-16 17:32:32,1,26250,TX,Individual,Yes,75-2698702,26250TX0060001,Managed DentalGuard TX Essentials 1,26250TX006,,TXN001,TXS001,,New,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$8.17,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,https://mydental.guardianlife.com/exchange/texas,,https://mydental.guardianlife.com/exchange/texas,,26250TX0060001-01,Standard Low On Exchange Plan,71.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,26250,HIOS,6,2015-01-16 17:32:32,2,26250,TX,SHOP (Small Group),Yes,75-2698702,26250TX0030002,Managed DentalGuard TX 10 Family Plan,26250TX003,,TXN001,TXS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$8.17,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,26250TX0030002-00,Standard Low Off Exchange Plan,71.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,26250,HIOS,6,2015-01-16 17:32:32,2,26250,TX,SHOP (Small Group),Yes,75-2698702,26250TX0030002,Managed DentalGuard TX 10 Family Plan,26250TX003,,TXN001,TXS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$8.17,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,26250TX0030002-01,Standard Low On Exchange Plan,71.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,26250,HIOS,6,2015-01-16 17:32:32,2,26250,TX,SHOP (Small Group),Yes,75-2698702,26250TX0040002,Managed DentalGuard TX 30 Family Plan,26250TX004,,TXN001,TXS001,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$8.17,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,26250TX0040002-00,Standard Low Off Exchange Plan,71.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TX,26250,HIOS,6,2015-01-16 17:32:32,2,26250,TX,SHOP (Small Group),Yes,75-2698702,26250TX0050002,Managed DentalGuard TX 40 Family Plan,26250TX005,,TXN001,TXS001,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$8.17,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,26250TX0050002-00,Standard Low Off Exchange Plan,71.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,1,26539,TX,SHOP (Small Group),No,75-2569094,26539TX0130001,Gold - Coinsurance,26539TX013,,TXN001,TXS001,TXF001,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-1_MarketplaceSHOP_GoldPlanCoinsurance_SBC_26539TX0130001-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-1_MarketplaceSHOP_GoldPlanCoinsurance_BenefitsSummary_26539TX0130001-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0130001-00,Standard Gold Off Exchange Plan,,0.798102974891663,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$20,"$1,310",$150,$0,"$1,620",,$80,4
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,2,82120,TN,Individual,No,39-1263473,82120TN0600032,Humana Bronze 6300/Nashville PPOx,82120TN060,,TNN003,TNS003,TNF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343198,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334553,http://apps.humana.com/marketing/documents.asp?file=2323880,82120TN0600032-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,19
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,2,82120,TN,Individual,No,39-1263473,82120TN0600032,Humana Bronze 6300/Nashville PPOx,82120TN060,,TNN003,TNS003,TNF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343198,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334553,http://apps.humana.com/marketing/documents.asp?file=2323880,82120TN0600032-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,TN,82120,HIOS,19,2015-01-16 17:32:32,2,82120,TN,Individual,No,39-1263473,82120TN0600032,Humana Bronze 6300/Nashville PPOx,82120TN060,,TNN003,TNS003,TNF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",No,http://apps.humana.com/marketing/documents.asp?file=2343198,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334553,http://apps.humana.com/marketing/documents.asp?file=2323880,82120TN0600032-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,21
2015,TN,90303,HIOS,1,2014-06-25 03:28:48,1,90303,TN,Individual,Yes,47-0397286,90303TN0010001,"Delta Dental Individual PPO, EHB Certified",90303TN001,,TNN002,TNS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.01,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,90303TN0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,90303,HIOS,1,2014-06-25 03:28:48,1,90303,TN,SHOP (Small Group),Yes,47-0397286,90303TN0030001,"Renaissance Group Dental PPO, EHB Certified",90303TN003,,TNN001,TNS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.11,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,90303TN0030001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,90303,HIOS,1,2014-06-25 03:28:48,1,90303,TN,SHOP (Small Group),Yes,47-0397286,90303TN0030002,"Renaissance Group Dental PPO, EHB Certified",90303TN003,,TNN001,TNS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.32,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,90303TN0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,90303,HIOS,1,2014-06-25 03:28:48,1,90303,TN,Individual,Yes,47-0397286,90303TN0010002,"Delta Dental Individual PPO, EHB Certified",90303TN001,,TNN002,TNS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.88,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,90303TN0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,97957,HIOS,2,2014-08-03 08:59:32,1,97957,TN,SHOP (Small Group),Yes,93-0242990,97957TN0040002,EHB High PPO,97957TN004,,TNN001,TNS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.47,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,97957TN0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,97957,HIOS,2,2014-08-03 08:59:32,1,97957,TN,SHOP (Small Group),Yes,93-0242990,97957TN0040001,EHB Low PPO,97957TN004,,TNN001,TNS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$16.69,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,97957TN0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,97957,HIOS,2,2014-08-03 08:59:32,1,97957,TN,SHOP (Small Group),Yes,93-0242990,97957TN0030002,EHB High Passive,97957TN003,,TNN001,TNS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$37.35,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,97957TN0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TN,97957,HIOS,2,2014-08-03 08:59:32,1,97957,TN,SHOP (Small Group),Yes,93-0242990,97957TN0030001,EHB Low Passive,97957TN003,,TNN001,TNS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.05,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,97957TN0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,1,99248,TN,Individual,No,59-1031071,99248TN0020001,myCigna Health Savings 6100,99248TN002,7730182962,TNN001,TNS001,TNF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-savings-6100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-savings-6100,http://www.cigna.com/ifp-drug-list,99248TN0020001-00,Standard Bronze Off Exchange Plan,58.20%,0.5818812251091,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,1,99248,TN,Individual,Yes,59-1031071,99248TN0030001,myCigna Dental Pediatric,99248TN003,7730182962,TNN002,TNS002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$23.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,All Services,Yes,,,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/dental-pediatric,,99248TN0030001-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$150,$300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,1,99248,TN,Individual,Yes,59-1031071,99248TN0030001,myCigna Dental Pediatric,99248TN003,7730182962,TNN002,TNS002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$23.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,All Services,Yes,,,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/dental-pediatric,,99248TN0030001-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$150,$300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,1,99248,TN,Individual,No,59-1031071,99248TN0020001,myCigna Health Savings 6100,99248TN002,7730182962,TNN001,TNS001,TNF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-savings-6100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-savings-6100,http://www.cigna.com/ifp-drug-list,99248TN0020001-01,Standard Bronze On Exchange Plan,58.20%,0.5818812251091,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,1,99248,TN,Individual,No,59-1031071,99248TN0020001,myCigna Health Savings 6100,99248TN002,7730182962,TNN001,TNS001,TNF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-savings-6100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-savings-6100,http://www.cigna.com/ifp-drug-list,99248TN0020001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,1,99248,TN,Individual,No,59-1031071,99248TN0020001,myCigna Health Savings 6100,99248TN002,7730182962,TNN001,TNS001,TNF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-savings-6100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-savings-6100,http://www.cigna.com/ifp-drug-list,99248TN0020001-03,Limited Cost Sharing Plan Variation,58.20%,0.5818812251091,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,1,99248,TN,Individual,No,59-1031071,99248TN0020003,myCigna Health Savings 3400,99248TN002,7730182962,TNN001,TNS001,TNF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-savings-3400,http://www.cigna.com/ifp-drug-list,99248TN0020003-00,Standard Silver Off Exchange Plan,68.40%,0.684268593788147,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,1,99248,TN,Individual,No,59-1031071,99248TN0020003,myCigna Health Savings 3400,99248TN002,7730182962,TNN001,TNS001,TNF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-savings-3400,http://www.cigna.com/ifp-drug-list,99248TN0020003-01,Standard Silver On Exchange Plan,68.40%,0.684268593788147,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,1,99248,TN,Individual,No,59-1031071,99248TN0020003,myCigna Health Savings 3400,99248TN002,7730182962,TNN001,TNS001,TNF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-savings-3400,http://www.cigna.com/ifp-drug-list,99248TN0020003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,1,99248,TN,Individual,No,59-1031071,99248TN0020003,myCigna Health Savings 3400,99248TN002,7730182962,TNN001,TNS001,TNF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-savings-3400,http://www.cigna.com/ifp-drug-list,99248TN0020003-03,Limited Cost Sharing Plan Variation,68.40%,0.684268593788147,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,1,99248,TN,Individual,No,59-1031071,99248TN0020003,myCigna Health Savings 3400,99248TN002,7730182962,TNN001,TNS001,TNF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-savings-3400,http://www.cigna.com/ifp-drug-list,99248TN0020003-04,73% AV Level Silver Plan,73.20%,0.731574892997742,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,1,99248,TN,Individual,No,59-1031071,99248TN0020003,myCigna Health Savings 3400,99248TN002,7730182962,TNN001,TNS001,TNF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-savings-3400,http://www.cigna.com/ifp-drug-list,99248TN0020003-05,87% AV Level Silver Plan,86.30%,0.865731179714203,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,1,99248,TN,Individual,No,59-1031071,99248TN0020003,myCigna Health Savings 3400,99248TN002,7730182962,TNN001,TNS001,TNF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-savings-3400,http://www.cigna.com/ifp-drug-list,99248TN0020003-06,94% AV Level Silver Plan,94.30%,0.942874848842621,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$350,$700,0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,2,99248,TN,Individual,No,59-1031071,99248TN0020005,myCigna Health Flex 5000,99248TN002,7730182962,TNN001,TNS001,TNF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-flex-5000,http://www.cigna.com/ifp-drug-list,99248TN0020005-00,Standard Silver Off Exchange Plan,69.40%,0.70461243391037,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,2,99248,TN,Individual,Yes,59-1031071,99248TN0030002,myCigna Dental Family + Pediatric,99248TN003,7730182962,TNN002,TNS002,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,All Services,Yes,,,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/dental-family-ped,,99248TN0030002-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$150,$300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,2,99248,TN,Individual,No,59-1031071,99248TN0020005,myCigna Health Flex 5000,99248TN002,7730182962,TNN001,TNS001,TNF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-flex-5000,http://www.cigna.com/ifp-drug-list,99248TN0020005-01,Standard Silver On Exchange Plan,69.40%,0.70461243391037,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,2,99248,TN,Individual,No,59-1031071,99248TN0020005,myCigna Health Flex 5000,99248TN002,7730182962,TNN001,TNS001,TNF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-flex-5000,http://www.cigna.com/ifp-drug-list,99248TN0020005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,2,99248,TN,Individual,No,59-1031071,99248TN0020005,myCigna Health Flex 5000,99248TN002,7730182962,TNN001,TNS001,TNF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-flex-5000,http://www.cigna.com/ifp-drug-list,99248TN0020005-03,Limited Cost Sharing Plan Variation,69.40%,0.70461243391037,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,2,99248,TN,Individual,No,59-1031071,99248TN0020005,myCigna Health Flex 5000,99248TN002,7730182962,TNN001,TNS001,TNF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-flex-5000,http://www.cigna.com/ifp-drug-list,99248TN0020005-04,73% AV Level Silver Plan,72.00%,0.73010665178299,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,2,99248,TN,Individual,No,59-1031071,99248TN0020005,myCigna Health Flex 5000,99248TN002,7730182962,TNN001,TNS001,TNF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-flex-5000,http://www.cigna.com/ifp-drug-list,99248TN0020005-05,87% AV Level Silver Plan,86.20%,0.866659820079803,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,450","$2,900",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,2,99248,TN,Individual,No,59-1031071,99248TN0020005,myCigna Health Flex 5000,99248TN002,7730182962,TNN001,TNS001,TNF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-flex-5000,http://www.cigna.com/ifp-drug-list,99248TN0020005-06,94% AV Level Silver Plan,93.40%,0.93491131067276,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,2,99248,TN,Individual,No,59-1031071,99248TN0020007,myCigna Health Flex 1250,99248TN002,7730182962,TNN001,TNS001,TNF005,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-flex-1250,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-flex-1250,http://www.cigna.com/ifp-drug-list,99248TN0020007-00,Standard Gold Off Exchange Plan,80.60%,0.811365246772766,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,2,99248,TN,Individual,No,59-1031071,99248TN0020007,myCigna Health Flex 1250,99248TN002,7730182962,TNN001,TNS001,TNF005,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-flex-1250,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-flex-1250,http://www.cigna.com/ifp-drug-list,99248TN0020007-01,Standard Gold On Exchange Plan,80.60%,0.811365246772766,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,2,99248,TN,Individual,No,59-1031071,99248TN0020007,myCigna Health Flex 1250,99248TN002,7730182962,TNN001,TNS001,TNF005,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-flex-1250,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-flex-1250,http://www.cigna.com/ifp-drug-list,99248TN0020007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,2,99248,TN,Individual,No,59-1031071,99248TN0020007,myCigna Health Flex 1250,99248TN002,7730182962,TNN001,TNS001,TNF005,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-flex-1250,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-flex-1250,http://www.cigna.com/ifp-drug-list,99248TN0020007-03,Limited Cost Sharing Plan Variation,80.60%,0.811365246772766,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,3,99248,TN,Individual,No,59-1031071,99248TN0020002,myCigna Health Flex 5500,99248TN002,7730182962,TNN001,TNS001,TNF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,2,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-flex-5500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-flex-5500,http://www.cigna.com/ifp-drug-list,99248TN0020002-00,Standard Bronze Off Exchange Plan,60.30%,0.629223048686981,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,3,99248,TN,Individual,No,59-1031071,99248TN0020002,myCigna Health Flex 5500,99248TN002,7730182962,TNN001,TNS001,TNF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,2,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-flex-5500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-flex-5500,http://www.cigna.com/ifp-drug-list,99248TN0020002-01,Standard Bronze On Exchange Plan,60.30%,0.629223048686981,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,3,99248,TN,Individual,No,59-1031071,99248TN0020002,myCigna Health Flex 5500,99248TN002,7730182962,TNN001,TNS001,TNF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,2,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-flex-5500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-flex-5500,http://www.cigna.com/ifp-drug-list,99248TN0020002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,3,99248,TN,Individual,No,59-1031071,99248TN0020002,myCigna Health Flex 5500,99248TN002,7730182962,TNN001,TNS001,TNF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,2,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-flex-5500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-flex-5500,http://www.cigna.com/ifp-drug-list,99248TN0020002-03,Limited Cost Sharing Plan Variation,60.30%,0.629223048686981,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,4,99248,TN,Individual,No,59-1031071,99248TN0020004,myCigna Health Flex 1500,99248TN002,7730182962,TNN001,TNS001,TNF003,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,2,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-flex-1500,http://www.cigna.com/ifp-drug-list,99248TN0020004-00,Standard Silver Off Exchange Plan,69.10%,0.704952836036682,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,4,99248,TN,Individual,No,59-1031071,99248TN0020004,myCigna Health Flex 1500,99248TN002,7730182962,TNN001,TNS001,TNF003,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,2,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-flex-1500,http://www.cigna.com/ifp-drug-list,99248TN0020004-01,Standard Silver On Exchange Plan,69.10%,0.704952836036682,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,4,99248,TN,Individual,No,59-1031071,99248TN0020004,myCigna Health Flex 1500,99248TN002,7730182962,TNN001,TNS001,TNF003,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,2,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-flex-1500,http://www.cigna.com/ifp-drug-list,99248TN0020004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,4,99248,TN,Individual,No,59-1031071,99248TN0020004,myCigna Health Flex 1500,99248TN002,7730182962,TNN001,TNS001,TNF003,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,2,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-flex-1500,http://www.cigna.com/ifp-drug-list,99248TN0020004-03,Limited Cost Sharing Plan Variation,69.10%,0.704952836036682,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,4,99248,TN,Individual,No,59-1031071,99248TN0020004,myCigna Health Flex 1500,99248TN002,7730182962,TNN001,TNS001,TNF003,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,2,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-flex-1500,http://www.cigna.com/ifp-drug-list,99248TN0020004-04,73% AV Level Silver Plan,72.50%,0.738160490989685,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TN,99248,HIOS,7,2015-01-16 17:32:32,4,99248,TN,Individual,No,59-1031071,99248TN0020004,myCigna Health Flex 1500,99248TN002,7730182962,TNN001,TNS001,TNF003,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,2,2015-01-01,,Yes,All services except exclusions listed in Benefits Package.,Yes,Some services excluded. See plan documents.,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/tennessee/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/tennessee/health-flex-1500,http://www.cigna.com/ifp-drug-list,99248TN0020004-05,87% AV Level Silver Plan,86.30%,0.867470383644104,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$725,"$1,450",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,12846,HIOS,6,2014-08-27 03:27:11,3,12846,TX,SHOP (Small Group),Yes,13-5123390,12846TX0220002,Guardian Family Advantage Plus,12846TX022,,TXN001,TXS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.04,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,12846TX0220002-00,Standard High Off Exchange Plan,84.70%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,12846,HIOS,6,2014-08-27 03:27:11,3,12846,TX,SHOP (Small Group),Yes,13-5123390,12846TX0220002,Guardian Family Advantage Plus,12846TX022,,TXN001,TXS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.04,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,12846TX0220002-01,Standard High On Exchange Plan,84.70%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,19312,HIOS,4,2014-09-05 03:32:16,1,19312,TX,Individual,Yes,91-1857813,19312TX0010001,Smile for Kids EHB - PPO,19312TX001,,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,Please see Schedule of Benefits for limitations and exclusions,,,,,Allows Child-Only,,,,$24.75,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.",Yes,www.premierlife.com/txhealthreform,www.premierlife.com/payment,www.premierlife.com/txhealthreform,,19312TX0010001-00,Standard Low Off Exchange Plan,70.65%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$200,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,23749,HIOS,8,2014-11-15 04:52:41,3,23749,TX,SHOP (Small Group),Yes,75-1233841,23749TX0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,23749TX002,,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.93,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/tx/23749tx0020006-15,,23749TX0020006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,23749,HIOS,8,2014-11-15 04:52:41,3,23749,TX,SHOP (Small Group),Yes,75-1233841,23749TX0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,23749TX002,,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.93,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/tx/23749tx0020006-15,,23749TX0020006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,23749,HIOS,8,2014-11-15 04:52:41,3,23749,TX,Individual,Yes,75-1233841,23749TX0010006,Dentegra Dental PPO Family Basic Plan,23749TX001,,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/tx/23749tx0010006-15,,23749TX0010006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,23891,HIOS,10,2014-11-15 04:52:41,1,23891,TX,Individual,Yes,94-2761537,23891TX0010002,DeltaCare USA Pediatric Preferred Plan,23891TX001,,TXN001,TXS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Child-Only,,,,$15.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/tx/23891tx0010002-15,,23891TX0010002-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,23891,HIOS,10,2014-11-15 04:52:41,1,23891,TX,Individual,Yes,94-2761537,23891TX0010002,DeltaCare USA Pediatric Preferred Plan,23891TX001,,TXN001,TXS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Child-Only,,,,$15.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/tx/23891tx0010002-15,,23891TX0010002-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,23891,HIOS,10,2014-11-15 04:52:41,1,23891,TX,Individual,Yes,94-2761537,23891TX0010001,DeltaCare USA Pediatric Basic Plan,23891TX001,,TXN001,TXS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$13.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/tx/23891tx0010001-15,,23891TX0010001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TX,23891,HIOS,10,2014-11-15 04:52:41,1,23891,TX,Individual,Yes,94-2761537,23891TX0010001,DeltaCare USA Pediatric Basic Plan,23891TX001,,TXN001,TXS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$13.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/tx/23891tx0010001-15,,23891TX0010001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TX,23891,HIOS,10,2014-11-15 04:52:41,2,23891,TX,Individual,Yes,94-2761537,23891TX0010004,DeltaCare USA Preferred Plan for Families,23891TX001,,TXN001,TXS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$15.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/tx/23891tx0010004-15,,23891TX0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,23891,HIOS,10,2014-11-15 04:52:41,2,23891,TX,SHOP (Small Group),Yes,94-2761537,23891TX0020004,DeltaCare USA Preferred Plan for Families for Small Businesses,23891TX002,,TXN001,TXS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$15.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,no,,,deltadentalins.com/hcx/tx/23891tx0020004-15,,23891TX0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,23891,HIOS,10,2014-11-15 04:52:41,2,23891,TX,SHOP (Small Group),Yes,94-2761537,23891TX0020004,DeltaCare USA Preferred Plan for Families for Small Businesses,23891TX002,,TXN001,TXS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$15.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,no,,,deltadentalins.com/hcx/tx/23891tx0020004-15,,23891TX0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,23891,HIOS,10,2014-11-15 04:52:41,2,23891,TX,Individual,Yes,94-2761537,23891TX0010004,DeltaCare USA Preferred Plan for Families,23891TX001,,TXN001,TXS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$15.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/tx/23891tx0010004-15,,23891TX0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,23891,HIOS,10,2014-11-15 04:52:41,3,23891,TX,Individual,Yes,94-2761537,23891TX0010006,DeltaCare USA Basic Plan for Families,23891TX001,,TXN001,TXS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$13.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/tx/23891tx0010006-15,,23891TX0010006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,23891,HIOS,10,2014-11-15 04:52:41,3,23891,TX,SHOP (Small Group),Yes,94-2761537,23891TX0020006,DeltaCare USA Basic Plan for Families for Small Businesses,23891TX002,,TXN001,TXS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$13.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,no,,,deltadentalins.com/hcx/tx/23891tx0020006-15,,23891TX0020006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,23891,HIOS,10,2014-11-15 04:52:41,3,23891,TX,SHOP (Small Group),Yes,94-2761537,23891TX0020006,DeltaCare USA Basic Plan for Families for Small Businesses,23891TX002,,TXN001,TXS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$13.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,no,,,deltadentalins.com/hcx/tx/23891tx0020006-15,,23891TX0020006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,23891,HIOS,10,2014-11-15 04:52:41,3,23891,TX,Individual,Yes,94-2761537,23891TX0010006,DeltaCare USA Basic Plan for Families,23891TX001,,TXN001,TXS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$13.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/tx/23891tx0010006-15,,23891TX0010006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,1,26539,TX,Individual,No,75-2569094,26539TX0140001,Gold - Coinsurance,26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_GoldPlanCoinsurance_SBC_26539TX0140001-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_GoldPlanCoinsurance_BenefitsSummary_26539TX0140001-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140001-00,Standard Gold Off Exchange Plan,,0.798102974891663,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$20,"$1,310",$150,$0,"$1,620",,$80,4
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,3,27248,TX,Individual,No,76-0495152,27248TX0010004,Community Health Choice HMO Silver Deductible,27248TX001,7932102164,TXN001,TXS001,TXF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,3,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010004-04,73% AV Level Silver Plan,,0.721721887588501,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,"$5,200","$10,400","$1,250","$2,500",0%,,,,Not Applicable,Not Applicable,"$1,250","$2,500",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,"$1,250",$820,$0,$150,"$1,250","$1,150",$0,$80,8
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,3,27248,TX,Individual,No,76-0495152,27248TX0010004,Community Health Choice HMO Silver Deductible,27248TX001,7932102164,TXN001,TXS001,TXF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,3,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010004-05,87% AV Level Silver Plan,,0.868944823741913,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,"$2,250","$4,500",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$610,$0,$150,$0,"$1,090",$0,$80,9
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,3,27248,TX,Individual,No,76-0495152,27248TX0010004,Community Health Choice HMO Silver Deductible,27248TX001,7932102164,TXN001,TXS001,TXF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,3,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010004-06,94% AV Level Silver Plan,,0.933283984661102,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,"$1,000","$2,000",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$450,$0,$150,$0,$840,$0,$80,10
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,3,27248,TX,Individual,No,76-0495152,27248TX0010005,Community Health Choice HMO Gold Deductible,27248TX001,7932102164,TXN001,TXS001,TXF005,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,3,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010005-00,Standard Gold Off Exchange Plan,,0.788609027862549,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",$500,"$1,000",0%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$500,$620,$0,$150,$500,"$1,270",$0,$80,11
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,3,27248,TX,Individual,No,76-0495152,27248TX0010005,Community Health Choice HMO Gold Deductible,27248TX001,7932102164,TXN001,TXS001,TXF005,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,3,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010005-01,Standard Gold On Exchange Plan,,0.788609027862549,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",$500,"$1,000",0%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$500,$620,$0,$150,$500,"$1,270",$0,$80,12
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,3,27248,TX,Individual,No,76-0495152,27248TX0010005,Community Health Choice HMO Gold Deductible,27248TX001,7932102164,TXN001,TXS001,TXF005,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,3,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,13
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,3,27248,TX,Individual,No,76-0495152,27248TX0010005,Community Health Choice HMO Gold Deductible,27248TX001,7932102164,TXN001,TXS001,TXF005,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,3,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010005-03,Limited Cost Sharing Plan Variation,,0.788609027862549,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",$500,"$1,000",0%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$500,$620,$0,$150,$500,"$1,270",$0,$80,14
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,2,27248,TX,Individual,No,76-0495152,27248TX0010003,Community Health Choice HMO Bronze Deductible,27248TX001,7932102164,TXN001,TXS001,TXF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,3,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,2,27248,TX,Individual,No,76-0495152,27248TX0010003,Community Health Choice HMO Bronze Deductible,27248TX001,7932102164,TXN001,TXS001,TXF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,3,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010003-03,Limited Cost Sharing Plan Variation,,0.611144304275513,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,"$4,000","$8,000",$200,$400,0%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,"$4,000",$420,$0,$150,"$4,000",$580,$0,$80,7
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,3,27248,TX,Individual,No,76-0495152,27248TX0010004,Community Health Choice HMO Silver Deductible,27248TX001,7932102164,TXN001,TXS001,TXF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,3,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010004-00,Standard Silver Off Exchange Plan,,0.699897289276123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,"$1,500","$3,000",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,"$1,500",$820,$0,$150,"$1,500","$1,100",$0,$80,4
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,3,27248,TX,Individual,No,76-0495152,27248TX0010004,Community Health Choice HMO Silver Deductible,27248TX001,7932102164,TXN001,TXS001,TXF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,3,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010004-01,Standard Silver On Exchange Plan,,0.699897289276123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,"$1,500","$3,000",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,"$1,500",$820,$0,$150,"$1,500","$1,100",$0,$80,5
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,3,27248,TX,Individual,No,76-0495152,27248TX0010004,Community Health Choice HMO Silver Deductible,27248TX001,7932102164,TXN001,TXS001,TXF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,3,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,3,27248,TX,Individual,No,76-0495152,27248TX0010004,Community Health Choice HMO Silver Deductible,27248TX001,7932102164,TXN001,TXS001,TXF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,3,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010004-03,Limited Cost Sharing Plan Variation,,0.699897289276123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,"$1,500","$3,000",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,"$1,500",$820,$0,$150,"$1,500","$1,100",$0,$80,7
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,1,27248,TX,Individual,No,76-0495152,27248TX0010002,Community Health Choice HMO Silver Copay,27248TX001,7932102164,TXN001,TXS001,TXF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010002-03,Limited Cost Sharing Plan Variation,,0.712013781070709,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$990,$0,$150,$0,"$2,500",$0,$80,11
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,1,27248,TX,Individual,No,76-0495152,27248TX0010002,Community Health Choice HMO Silver Copay,27248TX001,7932102164,TXN001,TXS001,TXF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010002-04,73% AV Level Silver Plan,,0.735604166984558,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,"$5,200","$10,400",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$990,$0,$150,$0,"$2,300",$0,$80,12
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330022,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS002,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330022-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330022,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS002,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330022-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330007,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS007,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330007-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330008,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS008,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330008-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,57
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330008,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS008,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330008-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,58
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330008,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS008,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,59
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,1,26539,TX,Individual,No,75-2569094,26539TX0140002,Gold - Copay,26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,5,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_GoldPlanCopay_SBC_26539TX0140002-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_GoldPlanCopay_BenefitsSummary_26539TX0140002-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,,,$0,,,,10
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,1,26539,TX,Individual,No,75-2569094,26539TX0140002,Gold - Copay,26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,5,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_GoldPlanCopay_SBC_26539TX0140002-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_GoldPlanCopay_BenefitsSummary_26539TX0140002-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140002-03,Limited Cost Sharing Plan Variation,,0.782505035400391,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,"$1,850",$0,$150,$0,"$1,620",,$80,11
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330003,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS003,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330003-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330003,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS003,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330003-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340001,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS001,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340001-05,87% AV Level Silver Plan,86.29%,0.862909555435181,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340001,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS001,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340001-06,94% AV Level Silver Plan,94.28%,0.942808330059052,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340002,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS002,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340002-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340002,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS002,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340002-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340002,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS002,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,38
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330030,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS010,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330030-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,96
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,2,26539,TX,Individual,No,75-2569094,26539TX0140003,Silver,26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_SilverPlan_SBC_26539TX0140003-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_SilverPlan_BenefitsSummary_26539TX0140003-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140003-00,Standard Silver Off Exchange Plan,,0.69314056634903,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$70,$890,$150,$0,"$1,660",$0,$80,4
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,2,26539,TX,SHOP (Small Group),No,75-2569094,26539TX0130003,Silver - Coinsurance,26539TX013,,TXN001,TXS001,TXF001,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-2_MarketplaceSHOP_SilverPlan_SBC_26539TX0130003-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-2_MarketplaceSHOP_SilverPlan_BenefitsSummary_26539TX0130003-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0130003-00,Standard Silver Off Exchange Plan,,0.69314056634903,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$70,$890,$150,$0,$1660,$0,$80,4
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,2,26539,TX,SHOP (Small Group),No,75-2569094,26539TX0130003,Silver - Coinsurance,26539TX013,,TXN001,TXS001,TXF001,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-2_MarketplaceSHOP_SilverPlan_SBC_26539TX0130003-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-2_MarketplaceSHOP_SilverPlan_BenefitsSummary_26539TX0130003-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0130003-01,Standard Silver On Exchange Plan,,0.69314056634903,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$70,$890,$150,$0,$1660,$0,$80,5
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,2,26539,TX,Individual,No,75-2569094,26539TX0140003,Silver,26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_SilverPlan_SBC_26539TX0140003-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_SilverPlan_BenefitsSummary_26539TX0140003-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140003-01,Standard Silver On Exchange Plan,,0.69314056634903,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$70,$890,$150,$0,"$1,660",$0,$80,5
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,2,26539,TX,Individual,No,75-2569094,26539TX0140003,Silver,26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_SilverPlan_SBC_26539TX0140003-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_SilverPlan_BenefitsSummary_26539TX0140003-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,2,26539,TX,SHOP (Small Group),No,75-2569094,26539TX0130006,Silver - Copay,26539TX013,,TXN001,TXS001,TXF001,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,5,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-2_MarketplaceSHOP_SilverPlan_SBC_26539TX0130006-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-2_MarketplaceSHOP_SilverPlan_BenefitsSummary_26539TX0130006-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0130006-00,Standard Silver Off Exchange Plan,,0.692508518695831,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000","$1,880",$0,$150,$0,"$1,580",$0,$80,6
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,2,26539,TX,SHOP (Small Group),No,75-2569094,26539TX0130006,Silver - Copay,26539TX013,,TXN001,TXS001,TXF001,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,5,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-2_MarketplaceSHOP_SilverPlan_SBC_26539TX0130006-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-2_MarketplaceSHOP_SilverPlan_BenefitsSummary_26539TX0130006-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0130006-01,Standard Silver On Exchange Plan,,0.692508518695831,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000","$1,880",$0,$150,$0,"$1,580",$0,$80,7
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,2,26539,TX,Individual,No,75-2569094,26539TX0140003,Silver,26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_SilverPlan_SBC_26539TX0140003-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_SilverPlan_BenefitsSummary_26539TX0140003-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140003-03,Limited Cost Sharing Plan Variation,,0.69314056634903,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$70,$890,$150,$0,"$1,660",$0,$80,7
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,2,26539,TX,Individual,No,75-2569094,26539TX0140003,Silver,26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_SilverPlan_SBC_26539TX0140003-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_SilverPlan_BenefitsSummary_26539TX0140003-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140003-04,73% AV Level Silver Plan,,0.731631994247437,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,750",$60,$890,$150,$0,"$1,660",$0,$80,8
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,2,26539,TX,Individual,No,75-2569094,26539TX0140003,Silver,26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_SilverPlan_SBC_26539TX0140003-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_SilverPlan_BenefitsSummary_26539TX0140003-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140003-05,87% AV Level Silver Plan,,0.879721105098724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$30,$890,$150,$0,$550,$0,$80,9
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,2,26539,TX,Individual,No,75-2569094,26539TX0140003,Silver,26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_SilverPlan_SBC_26539TX0140003-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_SilverPlan_BenefitsSummary_26539TX0140003-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140003-06,94% AV Level Silver Plan,,0.948557078838348,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$10,$450,$150,$0,$250,$0,$80,10
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,3,26539,TX,Individual,No,75-2569094,26539TX0140004,Bronze - Coinsurance,26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,3,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanCoinsurance_SBC_26539TX0140004-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanCoinsurance_BenefitsSummary_26539TX0140004-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140004-00,Standard Bronze Off Exchange Plan,,0.604889154434204,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$520,$150,"$5,000",$70,$0,$80,4
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,3,26539,TX,SHOP (Small Group),No,75-2569094,26539TX0130004,Bronze,26539TX013,,TXN001,TXS001,TXF001,Existing,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,3,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-3_MarketplaceSHOP_BronzePlanCoinsurance_SBC_26539TX0130004-01.pdf,https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-3_MarketplaceSHOP_BronzePlanCoinsurance_BenefitsSummary_26539TX0130004-01_1.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0130004-00,Standard Bronze Off Exchange Plan,,0.604913175106049,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$520,$150,"$5,000",$70,$0,$80,4
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,3,26539,TX,SHOP (Small Group),No,75-2569094,26539TX0130004,Bronze,26539TX013,,TXN001,TXS001,TXF001,Existing,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,3,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-3_MarketplaceSHOP_BronzePlanCoinsurance_SBC_26539TX0130004-01.pdf,https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-3_MarketplaceSHOP_BronzePlanCoinsurance_BenefitsSummary_26539TX0130004-01_1.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0130004-01,Standard Bronze On Exchange Plan,,0.604913175106049,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$520,$150,"$5,000",$70,$0,$80,5
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,3,26539,TX,Individual,No,75-2569094,26539TX0140004,Bronze - Coinsurance,26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,3,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanCoinsurance_SBC_26539TX0140004-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanCoinsurance_BenefitsSummary_26539TX0140004-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140004-01,Standard Bronze On Exchange Plan,,0.604889154434204,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350.00","$12,700.00",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$520,$150,"$5,000",$70,$0,$80,5
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,3,26539,TX,Individual,No,75-2569094,26539TX0140004,Bronze - Coinsurance,26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,3,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanCoinsurance_SBC_26539TX0140004-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanCoinsurance_BenefitsSummary_26539TX0140004-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,3,26539,TX,Individual,No,75-2569094,26539TX0140004,Bronze - Coinsurance,26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,3,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanCoinsurance_SBC_26539TX0140004-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanCoinsurance_BenefitsSummary_26539TX0140004-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140004-03,Limited Cost Sharing Plan Variation,,0.604889154434204,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350.00","$12,700.00",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$520,$150,"$5,000",$70,$0,$80,7
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,4,26539,TX,Individual,No,75-2569094,26539TX0140005,Bronze - H S A (60%),26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanHSAeligible_SBC_26539TX0140005-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanHSAeligible_BenefitsSummary_26539TX0140005-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140005-00,Standard Bronze Off Exchange Plan,,0.591230452060699,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$0,"$1,100",$150,"$4,500",$0,$310,$80,4
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,4,26539,TX,SHOP (Small Group),No,75-2569094,26539TX0130005,Bronze - H S A (60%),26539TX013,,TXN001,TXS001,TXF001,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-3_MarketplaceSHOP_BronzePlanHSAEligible_SBC_26539TX0130005-01.pdf,https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-3_MarketplaceSHOP_BronzePlanHSAEligible_BenefitsSummary_26539TX0130005-01_1.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0130005-00,Standard Bronze Off Exchange Plan,,0.591230452060699,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$0,"$1,100",$150,"$4,500",$0,$310,$80,4
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,4,26539,TX,SHOP (Small Group),No,75-2569094,26539TX0130005,Bronze - H S A (60%),26539TX013,,TXN001,TXS001,TXF001,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-3_MarketplaceSHOP_BronzePlanHSAEligible_SBC_26539TX0130005-01.pdf,https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-3_MarketplaceSHOP_BronzePlanHSAEligible_BenefitsSummary_26539TX0130005-01_1.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0130005-01,Standard Bronze On Exchange Plan,,0.591230452060699,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$0,"$1,100",$150,"$4,500",$0,$310,$80,5
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,4,26539,TX,Individual,No,75-2569094,26539TX0140005,Bronze - H S A (60%),26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanHSAeligible_SBC_26539TX0140005-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanHSAeligible_BenefitsSummary_26539TX0140005-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140005-01,Standard Bronze On Exchange Plan,,0.591230452060699,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$0,"$1,100",$150,"$4,500",$0,$310,$80,5
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,4,26539,TX,Individual,No,75-2569094,26539TX0140005,Bronze - H S A (60%),26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanHSAeligible_SBC_26539TX0140005-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanHSAeligible_BenefitsSummary_26539TX0140005-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,4,26539,TX,SHOP (Small Group),No,75-2569094,26539TX0130007,Bronze - H S A (100%),26539TX013,,TXN001,TXS001,TXF001,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-3_MarketplaceSHOP_BronzePlanHSAEligible_SBC_26539TX0130007-01.pdf,https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-3_MarketplaceSHOP_BronzePlanHSAEligible_BenefitsSummary_26539TX0130007-01_1.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0130007-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,270",$0,$0,$80,6
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,4,26539,TX,SHOP (Small Group),No,75-2569094,26539TX0130007,Bronze - H S A (100%),26539TX013,,TXN001,TXS001,TXF001,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-3_MarketplaceSHOP_BronzePlanHSAEligible_SBC_26539TX0130007-01.pdf,https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/3-2-3_MarketplaceSHOP_BronzePlanHSAEligible_BenefitsSummary_26539TX0130007-01_1.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0130007-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,270",$0,$0,$80,7
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,4,26539,TX,Individual,No,75-2569094,26539TX0140005,Bronze - H S A (60%),26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanHSAeligible_SBC_26539TX0140005-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanHSAeligible_BenefitsSummary_26539TX0140005-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140005-03,Limited Cost Sharing Plan Variation,,0.591230452060699,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500",$0,"$1,100",$150,"$4,500",$0,$310,$80,7
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,5,26539,TX,Individual,No,75-2569094,26539TX0140006,Bronze - H S A (100%),26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanHSAeligible_SBC_26539TX0140006-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanHSAeligible_BenefitsSummary_26539TX0140006-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140006-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,270",$0,$0,$80,4
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,5,26539,TX,Individual,No,75-2569094,26539TX0140006,Bronze - H S A (100%),26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanHSAeligible_SBC_26539TX0140006-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanHSAeligible_BenefitsSummary_26539TX0140006-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140006-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,270",$0,$0,$80,5
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,5,26539,TX,Individual,No,75-2569094,26539TX0140006,Bronze - H S A (100%),26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanHSAeligible_SBC_26539TX0140006-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanHSAeligible_BenefitsSummary_26539TX0140006-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,TX,26539,HIOS,16,2014-12-06 05:18:25,5,26539,TX,Individual,No,75-2569094,26539TX0140006,Bronze - H S A (100%),26539TX014,,TXN001,TXS001,TXF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.95,,,0,0,0,2015-01-01,,Yes,Covered for emergency care.  See Plan documents for details on how to access care.,Yes,Covered for emergency care and urgent care.  See Plan documents for details on how to access care.,Yes,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanHSAeligible_SBC_26539TX0140006-01.pdf,https://FirstCare.softheon.com/payment,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/FirstCare_Marketplace_BronzePlanHSAeligible_BenefitsSummary_26539TX0140006-01.pdf,http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2015_MarketPlace_Firstcare_Formulary.pdf,26539TX0140006-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,270",$0,$0,$80,7
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,1,27248,TX,Individual,No,76-0495152,27248TX0010001,Community Health Choice HMO Gold Copay,27248TX001,7932102164,TXN001,TXS001,TXF003,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010001-00,Standard Gold Off Exchange Plan,,0.807158648967743,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$780,$0,$150,$0,"$1,610",$0,$80,4
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,1,27248,TX,Individual,No,76-0495152,27248TX0010001,Community Health Choice HMO Gold Copay,27248TX001,7932102164,TXN001,TXS001,TXF003,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010001-01,Standard Gold On Exchange Plan,,0.807158648967743,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$780,$0,$150,$0,"$1,610",$0,$80,5
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,1,27248,TX,Individual,No,76-0495152,27248TX0010001,Community Health Choice HMO Gold Copay,27248TX001,7932102164,TXN001,TXS001,TXF003,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,1,27248,TX,Individual,No,76-0495152,27248TX0010001,Community Health Choice HMO Gold Copay,27248TX001,7932102164,TXN001,TXS001,TXF003,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010001-03,Limited Cost Sharing Plan Variation,,0.807158648967743,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$780,$0,$150,$0,"$1,610",$0,$80,7
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,1,27248,TX,Individual,No,76-0495152,27248TX0010002,Community Health Choice HMO Silver Copay,27248TX001,7932102164,TXN001,TXS001,TXF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010002-00,Standard Silver Off Exchange Plan,,0.712013781070709,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$990,$0,$150,$0,"$2,500",$0,$80,8
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,1,27248,TX,Individual,No,76-0495152,27248TX0010002,Community Health Choice HMO Silver Copay,27248TX001,7932102164,TXN001,TXS001,TXF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010002-01,Standard Silver On Exchange Plan,,0.712013781070709,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$990,$0,$150,$0,"$2,500",$0,$80,9
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,1,27248,TX,Individual,No,76-0495152,27248TX0010002,Community Health Choice HMO Silver Copay,27248TX001,7932102164,TXN001,TXS001,TXF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,1,27248,TX,Individual,No,76-0495152,27248TX0010002,Community Health Choice HMO Silver Copay,27248TX001,7932102164,TXN001,TXS001,TXF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010002-05,87% AV Level Silver Plan,,0.869212508201599,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,"$2,250","$4,500",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$610,$0,$150,$0,"$1,090",$0,$80,13
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,1,27248,TX,Individual,No,76-0495152,27248TX0010002,Community Health Choice HMO Silver Copay,27248TX001,7932102164,TXN001,TXS001,TXF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010002-06,94% AV Level Silver Plan,,0.933725595474243,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,"$1,000","$2,000",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$450,$0,$150,$0,$840,$0,$80,14
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,2,27248,TX,Individual,No,76-0495152,27248TX0010003,Community Health Choice HMO Bronze Deductible,27248TX001,7932102164,TXN001,TXS001,TXF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,3,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010003-00,Standard Bronze Off Exchange Plan,,0.611144304275513,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,"$4,000","$8,000",$200,$400,0%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,"$4,000",$420,$0,$150,"$4,000",$580,$0,$80,4
2015,TX,27248,HIOS,6,2014-11-15 04:52:41,2,27248,TX,Individual,No,76-0495152,27248TX0010003,Community Health Choice HMO Bronze Deductible,27248TX001,7932102164,TXN001,TXS001,TXF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,5,0,3,2015-01-01,2015-12-31,No,,Yes,For emergency only,No,http://www.communitycares.com/en-us/hmo,,http://www.communitycares.com/en-us/Plans-Benefits/Health-Insurance-Marketplace,http://www.communitycares.com/Portals/0/Downloads/HIM/Community-Health-Choice-Formulary-501.pdf,27248TX0010003-01,Standard Bronze On Exchange Plan,,0.611144304275513,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,"$4,000","$8,000",$200,$400,0%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,"$4,000",$420,$0,$150,"$4,000",$580,$0,$80,5
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330028,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS008,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330028-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,84
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330029,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS009,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330029-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,85
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330029,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS009,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330029-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,86
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330029,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS009,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330029-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,87
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330029,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS009,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330029-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,88
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330029,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS009,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330029-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,89
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330001,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS001,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330001-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330001,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS001,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330001-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330001,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS001,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,31
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330001,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS001,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330001-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330002,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS002,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330002-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330002,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS002,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330002-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330002,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS002,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,35
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330002,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS002,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330002-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330003,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS003,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,39
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330003,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS003,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330003-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330004,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS004,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330004-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330004,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS004,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330004-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,42
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330004,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS004,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,43
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330004,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS004,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330004-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330005,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS005,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330005-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330005,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS005,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330005-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,46
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330005,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS005,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,47
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330005,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS005,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330005-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330006,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS006,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330006-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330006,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS006,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330006-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,50
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330006,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS006,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,51
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330006,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS006,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330006-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,52
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330007,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS007,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330007-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,53
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330007,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS007,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330007-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,54
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330007,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS007,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,55
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330008,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS008,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330008-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,60
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330009,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS009,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330009-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,61
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330019,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS009,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330019-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,63
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330019,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS009,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330019-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,64
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330020,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS010,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330020-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,65
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330020,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS010,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330020-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,66
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330009,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS009,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330009-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,62
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330009,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS009,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,63
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330009,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS009,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330009-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,64
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330010,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS010,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330010-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,65
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330010,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS010,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330010-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,66
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330010,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS010,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,67
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,1,28020,TX,Individual,No,39-0658730,28020TX0330010,Assurant Health Bronze Plan 001,28020TX033,,TXN001,TXS010,TXF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330010-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,68
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330021,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS001,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330021-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330021,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS001,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330021-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330021,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS001,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330021-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,31
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330021,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS001,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330021-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330021,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS001,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330021-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330021,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS001,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330021-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330021,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS001,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330021-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330022,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS002,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330022-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,38
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330022,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS002,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330022-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330029,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS009,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330029-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,90
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330029,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS009,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330029-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,91
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330030,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS010,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330030-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,92
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330030,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS010,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330030-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,93
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330022,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS002,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330022-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330022,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS002,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330022-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330022,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS002,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330022-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,42
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330023,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS003,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330023-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,43
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330023,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS003,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330023-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330023,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS003,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330023-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,45
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330023,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS003,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330023-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,46
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330023,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS003,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330023-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,47
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330023,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS003,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330023-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330023,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS003,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330023-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330024,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS004,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330024-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,50
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330024,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS004,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330024-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,51
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330024,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS004,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330024-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,52
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330024,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS004,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330024-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,53
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330024,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS004,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330024-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,54
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330024,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS004,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330024-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,55
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330024,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS004,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330024-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330025,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS005,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330025-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,57
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330025,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS005,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330025-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,58
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330025,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS005,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330025-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,59
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330025,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS005,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330025-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,60
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330025,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS005,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330025-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,61
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330025,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS005,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330025-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,62
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330025,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS005,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330025-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,63
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330026,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS006,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330026-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,64
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330026,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS006,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330026-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,65
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330026,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS006,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330026-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,66
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330026,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS006,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330026-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,67
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330026,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS006,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330026-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,68
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330026,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS006,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330026-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,69
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330026,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS006,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330026-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,70
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330027,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS007,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330027-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,71
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330027,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS007,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330027-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,72
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330027,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS007,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330027-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,73
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330027,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS007,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330027-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,74
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330027,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS007,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330027-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,75
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330027,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS007,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330027-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,76
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330027,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS007,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330027-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,77
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330028,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS008,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330028-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,82
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330028,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS008,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330028-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,83
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330030,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS010,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330030-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,94
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330030,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS010,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330030-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,95
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330018,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS008,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330018-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,57
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330018,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS008,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330018-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,58
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330018,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS008,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330018-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,59
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330018,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS008,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330018-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,60
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340001,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS001,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340001-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330030,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS010,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330030-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,97
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,2,28020,TX,Individual,No,39-0658730,28020TX0330030,Assurant Health Silver Plan 001,28020TX033,,TXN001,TXS010,TXF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330030-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,98
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330017,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS007,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330017-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,53
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330017,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS007,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330017-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,54
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340009,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS009,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340009-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,85
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340009,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS009,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340009-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,86
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330039,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS009,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330039-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,61
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330039,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS009,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330039-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,62
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330047,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS007,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330047-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,55
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330047,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS007,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330047-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640016,Humana Silver 4600/Waco HMOx,32673TX064,,TXN004,TXS002,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344316,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334917,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640016-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640016,Humana Silver 4600/Waco HMOx,32673TX064,,TXN004,TXS002,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344316,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334917,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640016-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640052,Humana Gold 2500/Corpus Christi HMOx,32673TX064,,TXN006,TXS007,TXF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343809,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335307,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640052-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,66
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640052,Humana Gold 2500/Corpus Christi HMOx,32673TX064,,TXN006,TXS007,TXF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343809,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335307,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640052-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,67
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0640042,Humana Platinum 0/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343965,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335216,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640042-00,Standard Platinum Off Exchange Plan,,0.902322471141815,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0640042,Humana Platinum 0/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343965,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335216,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640042-01,Standard Platinum On Exchange Plan,,0.902322471141815,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330017,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS007,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330017-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,55
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330017,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS007,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330017-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340004,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS004,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340004-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,55
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340004,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS004,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340004-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340005,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS005,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340005-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,57
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340005,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS005,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340005-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,58
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340004,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS004,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340004-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,51
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340004,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS004,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,52
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330036,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS006,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330036-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,50
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330036,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS006,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330036-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,51
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640004,Humana Silver 4600/Austin HMOx,32673TX064,,TXN002,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344238,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334800,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640004-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640004,Humana Silver 4600/Austin HMOx,32673TX064,,TXN002,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344238,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334800,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640004-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0640006,Humana Platinum 0/Austin HMOx,32673TX064,,TXN002,TXS001,TXF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343900,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334865,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640006-00,Standard Platinum Off Exchange Plan,,0.902322471141815,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0640006,Humana Platinum 0/Austin HMOx,32673TX064,,TXN002,TXS001,TXF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343900,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334865,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640006-01,Standard Platinum On Exchange Plan,,0.902322471141815,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330011,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS001,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330011-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330011,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS001,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330011-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330011,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS001,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,31
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330011,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS001,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330011-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330012,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS002,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330012-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330012,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS002,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330012-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330012,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS002,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330012-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,35
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330012,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS002,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330012-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330013,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS003,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330013-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330013,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS003,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330013-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330013,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS003,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330013-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,39
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330013,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS003,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330013-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330014,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS004,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330014-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330014,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS004,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330014-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,42
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330014,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS004,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330014-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,43
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330014,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS004,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330014-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330015,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS005,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330015-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330015,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS005,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330015-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,46
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330015,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS005,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330015-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,47
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330015,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS005,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330015-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330016,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS006,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330016-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330016,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS006,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330016-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,50
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330016,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS006,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330016-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,51
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330016,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS006,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330016-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,52
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330019,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS009,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330019-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,61
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330019,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS009,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330019-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,62
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330020,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS010,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330020-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,67
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,7,28020,TX,Individual,No,39-0658730,28020TX0330020,Assurant Health Bronze Plan 002,28020TX033,,TXN001,TXS010,TXF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,28020TX0330020-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,68
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340005,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS005,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,59
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340005,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS005,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340005-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,60
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340003,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS003,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340003-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340004,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS004,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340004-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,50
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340004,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS004,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340004-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,53
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340004,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS004,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340004-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,54
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340005,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS005,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340005-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,63
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340006,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS006,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340006-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,64
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340006,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS006,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340006-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,65
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340006,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS006,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,66
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460020,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS112,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460020-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460020,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS112,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460020-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,47
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460021,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS122,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460021-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460021,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS122,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460021-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,49
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460033,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS242,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460033-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,98
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460033,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS242,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460033-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,99
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340005,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS005,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340005-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,61
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340005,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS005,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340005-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,62
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340001,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS001,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340001-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340001,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS001,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340001-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340001,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS001,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,31
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340001,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS001,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340001-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340002,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS002,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340002-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340002,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS002,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340002-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340002,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS002,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340002-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340002,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS002,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340002-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,42
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340003,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS003,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340003-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,43
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340003,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS003,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340003-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340003,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS003,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,45
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340003,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS003,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340003-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,46
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340003,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS003,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340003-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,47
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340003,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS003,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340003-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340006,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS006,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340006-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,67
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340006,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS006,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340006-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,68
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340006,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS006,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340006-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,69
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340006,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS006,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340006-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,70
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340007,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS007,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340007-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,71
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340007,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS007,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340007-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,72
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340007,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS007,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,73
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340007,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS007,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340007-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,74
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340007,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS007,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340007-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,75
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340007,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS007,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340007-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,76
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340007,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS007,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340007-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,77
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340008,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS008,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340008-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,78
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340008,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS008,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340008-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,79
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340008,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS008,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340008-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,80
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340008,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS008,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340008-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,81
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340008,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS008,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340008-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,82
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340008,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS008,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340008-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,83
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340008,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS008,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340008-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,84
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340009,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS009,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340009-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,87
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340009,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS009,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340009-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,88
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340009,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS009,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340009-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,89
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340009,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS009,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340009-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,90
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340009,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS009,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340009-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,91
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340010,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS010,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340010-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,92
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340010,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS010,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340010-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,93
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340010,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS010,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340010-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,94
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340010,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS010,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340010-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,95
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340010,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS010,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340010-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,96
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340010,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS010,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340010-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,97
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,9,28020,TX,Individual,No,39-0658730,28020TX0340010,Assurant Health Silver Plan 002,28020TX034,,TXN001,TXS010,TXF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0340010-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,98
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330031,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS001,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330031-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330031,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS001,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330031-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330031,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS001,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330031-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,31
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330031,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS001,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330031-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330032,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS002,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330032-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330032,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS002,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330032-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330032,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS002,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330032-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,35
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330032,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS002,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330032-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330033,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS003,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330033-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330033,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS003,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330033-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330033,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS003,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330033-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,39
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330033,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS003,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330033-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330034,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS004,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330034-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330034,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS004,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330034-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,42
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330034,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS004,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330034-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,43
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330034,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS004,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330034-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330035,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS005,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330035-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330035,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS005,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330035-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,46
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330035,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS005,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330035-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,47
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330035,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS005,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330035-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330036,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS006,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330036-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,3,33602,TX,Individual,Yes,36-1236610,33602TX0500005,BlueCare Dental? 2A,33602TX050,,TXN003,TXS003,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.41,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/dental/,,33602TX0500005-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,3,33602,TX,Individual,Yes,36-1236610,33602TX0500005,BlueCare Dental? 2A,33602TX050,,TXN003,TXS003,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.41,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/dental/,,33602TX0500005-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460020,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS112,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460020-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460020,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS112,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460020-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330036,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS006,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330036-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,52
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330037,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS007,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330037-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,53
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330037,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS007,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330037-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,54
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330037,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS007,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330037-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,55
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330037,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS007,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330037-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330038,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS008,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330038-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,57
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330038,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS008,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330038-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,58
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330038,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS008,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330038-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,59
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330038,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS008,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330038-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,60
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330039,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS009,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330039-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,63
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330039,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS009,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330039-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,64
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330040,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS010,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330040-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,65
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330040,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS010,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330040-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,66
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330040,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS010,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330040-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,67
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,11,28020,TX,Individual,No,39-0658730,28020TX0330040,Assurant Health Gold Plan 002,28020TX033,,TXN001,TXS010,TXF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330040-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,68
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330041,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS001,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330041-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330041,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS001,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330041-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330041,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS001,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330041-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,31
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330041,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS001,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330041-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330042,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS002,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330042-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330042,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS002,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330042-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330042,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS002,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330042-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,35
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330042,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS002,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330042-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330043,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS003,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330043-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330043,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS003,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330043-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330043,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS003,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330043-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,39
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330043,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS003,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330043-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330044,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS004,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330044-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,5,32673,TX,Individual,No,61-0994632,32673TX0650012,Humana Silver 3650/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF005,New,POS,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2344199,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335710,http://apps.humana.com/marketing/documents.asp?file=2323841,32673TX0650012-00,Standard Silver Off Exchange Plan,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,10
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,5,32673,TX,Individual,No,61-0994632,32673TX0650012,Humana Silver 3650/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF005,New,POS,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2344199,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335710,http://apps.humana.com/marketing/documents.asp?file=2323841,32673TX0650012-01,Standard Silver On Exchange Plan,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,11
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640041,Humana Gold 2500/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343874,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335203,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640041-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,56
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640041,Humana Gold 2500/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343874,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335203,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640041-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,57
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640051,Humana Silver 4600/Corpus Christi HMOx,32673TX064,,TXN006,TXS007,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344251,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335255,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640051-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,62
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640051,Humana Silver 4600/Corpus Christi HMOx,32673TX064,,TXN006,TXS007,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344251,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335255,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640051-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,63
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0640018,Humana Platinum 0/Waco HMOx,32673TX064,,TXN004,TXS002,TXF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343978,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334982,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640018-00,Standard Platinum Off Exchange Plan,,0.902322471141815,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0640018,Humana Platinum 0/Waco HMOx,32673TX064,,TXN004,TXS002,TXF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343978,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334982,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640018-01,Standard Platinum On Exchange Plan,,0.902322471141815,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,5,32673,TX,Individual,No,61-0994632,32673TX0650012,Humana Silver 3650/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF005,New,POS,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2344199,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335710,http://apps.humana.com/marketing/documents.asp?file=2323841,32673TX0650012-06,94% AV Level Silver Plan,,0.935785233974457,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$475,$950,,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$475,$950,0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,16
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,6,32673,TX,Individual,No,61-0994632,32673TX0650011,Humana Silver 4250/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF007,New,POS,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2344225,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335658,http://apps.humana.com/marketing/documents.asp?file=2323776,32673TX0650011-00,Standard Silver Off Exchange Plan,,0.695273876190186,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$4,250","$8,500",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,6,32673,TX,Individual,No,61-0994632,32673TX0650011,Humana Silver 4250/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF007,New,POS,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2344225,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335658,http://apps.humana.com/marketing/documents.asp?file=2323776,32673TX0650011-01,Standard Silver On Exchange Plan,,0.695273876190186,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$4,250","$8,500",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,6,32673,TX,Individual,No,61-0994632,32673TX0650011,Humana Silver 4250/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF007,New,POS,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2344225,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335658,http://apps.humana.com/marketing/documents.asp?file=2323776,32673TX0650011-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,6,32673,TX,Individual,No,61-0994632,32673TX0650011,Humana Silver 4250/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF007,New,POS,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2344225,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335658,http://apps.humana.com/marketing/documents.asp?file=2323776,32673TX0650011-03,Limited Cost Sharing Plan Variation,,0.695273876190186,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$4,250","$8,500",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,6,32673,TX,Individual,No,61-0994632,32673TX0650011,Humana Silver 4250/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF007,New,POS,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2344225,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335658,http://apps.humana.com/marketing/documents.asp?file=2323776,32673TX0650011-04,73% AV Level Silver Plan,,0.735092222690582,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330044,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS004,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330044-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,42
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330044,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS004,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330044-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,43
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330044,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS004,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330044-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330045,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS005,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330045-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330045,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS005,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330045-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,46
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330045,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS005,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330045-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,47
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330045,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS005,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330045-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330046,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS006,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330046-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330046,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS006,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330046-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,50
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330046,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS006,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330046-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,51
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330046,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS006,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330046-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,52
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330047,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS007,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330047-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,53
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330047,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS007,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330047-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,54
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330048,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS008,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330048-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,57
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330048,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS008,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330048-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,58
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330048,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS008,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330048-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,59
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330048,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS008,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330048-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,60
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330049,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS009,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330049-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,61
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330049,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS009,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330049-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,62
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330049,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS009,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330049-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,63
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330049,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS009,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330049-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,64
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330050,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS010,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330050-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,65
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330050,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS010,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330050-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,66
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330050,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS010,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330050-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,67
2015,TX,28020,HIOS,6,2014-11-11 04:41:18,12,28020,TX,Individual,No,39-0658730,28020TX0330050,Assurant Health Platinum Plan 002,28020TX033,,TXN001,TXS010,TXF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_TX_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-TX.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,28020TX0330050-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,68
2015,TX,29817,HIOS,9,2014-10-03 13:54:42,1,29817,TX,SHOP (Small Group),Yes,57-0523959,29817TX0010001,Group Pediatric Dental EHB Rider,29817TX001,,TXN001,TXS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$42.71,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,29817TX0010001-00,Standard High Off Exchange Plan,85.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,29817,HIOS,9,2014-10-03 13:54:42,1,29817,TX,SHOP (Small Group),Yes,57-0523959,29817TX0010002,Group Pediatric Dental EHB Rider,29817TX001,,TXN001,TXS001,,New,Indemnity,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$34.73,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,29817TX0010002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0630004,Humana Silver 4600/HMO Premier,32673TX063,,TXN001,TXS003,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2344264,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334683,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0630004-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0630004,Humana Silver 4600/HMO Premier,32673TX063,,TXN001,TXS003,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2344264,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334683,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0630004-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0630004,Humana Silver 4600/HMO Premier,32673TX063,,TXN001,TXS003,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2344264,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334683,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0630004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0630004,Humana Silver 4600/HMO Premier,32673TX063,,TXN001,TXS003,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2344264,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334683,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0630004-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0630004,Humana Silver 4600/HMO Premier,32673TX063,,TXN001,TXS003,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2344264,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334683,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0630004-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0630004,Humana Silver 4600/HMO Premier,32673TX063,,TXN001,TXS003,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2344264,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334683,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0630004-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0630004,Humana Silver 4600/HMO Premier,32673TX063,,TXN001,TXS003,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2344264,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334683,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0630004-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0630005,Humana Gold 2500/HMO Premier,32673TX063,,TXN001,TXS003,TXF004,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343822,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334735,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0630005-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640041,Humana Gold 2500/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343874,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335203,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640041-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,58
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640051,Humana Silver 4600/Corpus Christi HMOx,32673TX064,,TXN006,TXS007,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344251,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335255,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640051-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,59
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640051,Humana Silver 4600/Corpus Christi HMOx,32673TX064,,TXN006,TXS007,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344251,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335255,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640051-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,60
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640051,Humana Silver 4600/Corpus Christi HMOx,32673TX064,,TXN006,TXS007,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344251,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335255,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640051-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,61
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640050,Humana Bronze 6300/Corpus Christi HMOx,32673TX064,,TXN006,TXS007,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343692,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335242,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640050-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,38
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640050,Humana Bronze 6300/Corpus Christi HMOx,32673TX064,,TXN006,TXS007,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343692,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335242,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640050-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,39
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0630006,Humana Platinum 0/HMO Premier,32673TX063,,TXN001,TXS003,TXF004,Existing,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343926,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334748,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0630006-00,Standard Platinum Off Exchange Plan,,0.902322471141815,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0630006,Humana Platinum 0/HMO Premier,32673TX063,,TXN001,TXS003,TXF004,Existing,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343926,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334748,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0630006-01,Standard Platinum On Exchange Plan,,0.902322471141815,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0630006,Humana Platinum 0/HMO Premier,32673TX063,,TXN001,TXS003,TXF004,Existing,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343926,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334748,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0630006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0630006,Humana Platinum 0/HMO Premier,32673TX063,,TXN001,TXS003,TXF004,Existing,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343926,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334748,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0630006-03,Limited Cost Sharing Plan Variation,,0.902322471141815,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460022,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS132,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460022-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,52
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460022,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS132,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460022-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,53
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0630005,Humana Gold 2500/HMO Premier,32673TX063,,TXN001,TXS003,TXF004,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343822,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334735,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0630005-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0630005,Humana Gold 2500/HMO Premier,32673TX063,,TXN001,TXS003,TXF004,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343822,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334735,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0630005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0630005,Humana Gold 2500/HMO Premier,32673TX063,,TXN001,TXS003,TXF004,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343822,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334735,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0630005-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640004,Humana Silver 4600/Austin HMOx,32673TX064,,TXN002,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344238,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334800,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640004-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640004,Humana Silver 4600/Austin HMOx,32673TX064,,TXN002,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344238,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334800,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640004-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640004,Humana Silver 4600/Austin HMOx,32673TX064,,TXN002,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344238,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334800,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640004,Humana Silver 4600/Austin HMOx,32673TX064,,TXN002,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344238,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334800,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640004-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640004,Humana Silver 4600/Austin HMOx,32673TX064,,TXN002,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344238,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334800,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640004-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640005,Humana Gold 2500/Austin HMOx,32673TX064,,TXN002,TXS001,TXF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343783,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334852,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640005-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640005,Humana Gold 2500/Austin HMOx,32673TX064,,TXN002,TXS001,TXF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343783,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334852,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640005-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640005,Humana Gold 2500/Austin HMOx,32673TX064,,TXN002,TXS001,TXF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343783,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334852,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,24
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640005,Humana Gold 2500/Austin HMOx,32673TX064,,TXN002,TXS001,TXF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343783,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334852,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640005-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640016,Humana Silver 4600/Waco HMOx,32673TX064,,TXN004,TXS002,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344316,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334917,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640016-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,28
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640016,Humana Silver 4600/Waco HMOx,32673TX064,,TXN004,TXS002,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344316,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334917,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640016-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640016,Humana Silver 4600/Waco HMOx,32673TX064,,TXN004,TXS002,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344316,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334917,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640016-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640016,Humana Silver 4600/Waco HMOx,32673TX064,,TXN004,TXS002,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344316,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334917,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640016-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640016,Humana Silver 4600/Waco HMOx,32673TX064,,TXN004,TXS002,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344316,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334917,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640016-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640017,Humana Gold 2500/Waco HMOx,32673TX064,,TXN004,TXS002,TXF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343887,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334969,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640017-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640017,Humana Gold 2500/Waco HMOx,32673TX064,,TXN004,TXS002,TXF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343887,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334969,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640017-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640017,Humana Gold 2500/Waco HMOx,32673TX064,,TXN004,TXS002,TXF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343887,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334969,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640017-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,35
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640017,Humana Gold 2500/Waco HMOx,32673TX064,,TXN004,TXS002,TXF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343887,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334969,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640017-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640028,Humana Silver 4600/Houston HMOx,32673TX064,,TXN003,TXS004,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344277,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335034,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640028-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640025,Humana Basic 6600/Houston HMOx,32673TX064,,TXN003,TXS004,TXF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343497,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334995,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640025-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640025,Humana Basic 6600/Houston HMOx,32673TX064,,TXN003,TXS004,TXF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343497,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334995,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640025-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,4,32673,TX,Individual,No,61-0994632,32673TX0640027,Humana Bronze 4850/Houston HMOx,32673TX064,,TXN003,TXS004,TXF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343601,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335021,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640027-00,Standard Bronze Off Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,4,32673,TX,Individual,No,61-0994632,32673TX0640027,Humana Bronze 4850/Houston HMOx,32673TX064,,TXN003,TXS004,TXF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343601,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335021,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640027-01,Standard Bronze On Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,4,32673,TX,Individual,No,61-0994632,32673TX0640027,Humana Bronze 4850/Houston HMOx,32673TX064,,TXN003,TXS004,TXF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343601,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335021,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640027-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,4,32673,TX,Individual,No,61-0994632,32673TX0640027,Humana Bronze 4850/Houston HMOx,32673TX064,,TXN003,TXS004,TXF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343601,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335021,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640027-03,Limited Cost Sharing Plan Variation,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,4,32673,TX,Individual,No,61-0994632,32673TX0640039,Humana Bronze 4850/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343640,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335138,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640039-00,Standard Bronze Off Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,4,32673,TX,Individual,No,61-0994632,32673TX0640039,Humana Bronze 4850/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343640,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335138,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640039-01,Standard Bronze On Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,4,32673,TX,Individual,No,61-0994632,32673TX0640039,Humana Bronze 4850/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343640,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335138,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640039-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,4,32673,TX,Individual,No,61-0994632,32673TX0640039,Humana Bronze 4850/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343640,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335138,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640039-03,Limited Cost Sharing Plan Variation,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,5,32673,TX,Individual,No,61-0994632,32673TX0650008,Humana Basic 6600/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF005,New,POS,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343510,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335619,http://apps.humana.com/marketing/documents.asp?file=2323841,32673TX0650008-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,5,32673,TX,Individual,No,61-0994632,32673TX0650008,Humana Basic 6600/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF005,New,POS,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343510,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335619,http://apps.humana.com/marketing/documents.asp?file=2323841,32673TX0650008-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460017,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS012,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460017-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460017,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS012,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460017-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640028,Humana Silver 4600/Houston HMOx,32673TX064,,TXN003,TXS004,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344277,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335034,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640028-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640028,Humana Silver 4600/Houston HMOx,32673TX064,,TXN003,TXS004,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344277,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335034,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640028-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,39
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640028,Humana Silver 4600/Houston HMOx,32673TX064,,TXN003,TXS004,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344277,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335034,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640028-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640028,Humana Silver 4600/Houston HMOx,32673TX064,,TXN003,TXS004,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344277,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335034,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640028-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640028,Humana Silver 4600/Houston HMOx,32673TX064,,TXN003,TXS004,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344277,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335034,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640028-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640028,Humana Silver 4600/Houston HMOx,32673TX064,,TXN003,TXS004,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344277,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335034,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640028-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640029,Humana Gold 2500/Houston HMOx,32673TX064,,TXN003,TXS004,TXF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343835,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335086,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640029-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640029,Humana Gold 2500/Houston HMOx,32673TX064,,TXN003,TXS004,TXF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343835,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335086,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640029-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640029,Humana Gold 2500/Houston HMOx,32673TX064,,TXN003,TXS004,TXF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343835,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335086,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640029-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,46
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640029,Humana Gold 2500/Houston HMOx,32673TX064,,TXN003,TXS004,TXF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343835,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335086,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640029-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,47
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640040,Humana Silver 4600/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344303,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335151,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640040-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640040,Humana Silver 4600/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344303,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335151,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640040-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,49
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640040,Humana Silver 4600/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344303,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335151,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640040-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,50
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640040,Humana Silver 4600/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344303,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335151,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640040-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,51
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640040,Humana Silver 4600/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344303,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335151,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640040-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,52
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640040,Humana Silver 4600/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344303,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335151,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640040-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,53
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640040,Humana Silver 4600/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344303,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335151,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640040-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,54
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640041,Humana Gold 2500/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343874,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335203,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640041-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,55
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640051,Humana Silver 4600/Corpus Christi HMOx,32673TX064,,TXN006,TXS007,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344251,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335255,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640051-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,64
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640051,Humana Silver 4600/Corpus Christi HMOx,32673TX064,,TXN006,TXS007,TXF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344251,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335255,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640051-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,65
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640052,Humana Gold 2500/Corpus Christi HMOx,32673TX064,,TXN006,TXS007,TXF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343809,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335307,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640052-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,68
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,1,32673,TX,Individual,No,61-0994632,32673TX0640052,Humana Gold 2500/Corpus Christi HMOx,32673TX064,,TXN006,TXS007,TXF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343809,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335307,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640052-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,69
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0630001,Humana Basic 6600/HMO Premier,32673TX063,,TXN001,TXS003,TXF001,Existing,HMO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343484,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334644,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0630001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0630001,Humana Basic 6600/HMO Premier,32673TX063,,TXN001,TXS003,TXF001,Existing,HMO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343484,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334644,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0630001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0630002,Humana Bronze 6300/HMO Premier,32673TX063,,TXN001,TXS003,TXF001,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343705,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334657,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0630002-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0630002,Humana Bronze 6300/HMO Premier,32673TX063,,TXN001,TXS003,TXF001,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343705,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334657,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0630002-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0630002,Humana Bronze 6300/HMO Premier,32673TX063,,TXN001,TXS003,TXF001,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343705,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334657,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0630002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0630002,Humana Bronze 6300/HMO Premier,32673TX063,,TXN001,TXS003,TXF001,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343705,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334657,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0630002-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640001,Humana Basic 6600/Austin HMOx,32673TX064,,TXN002,TXS001,TXF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343445,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334761,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640001,Humana Basic 6600/Austin HMOx,32673TX064,,TXN002,TXS001,TXF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343445,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334761,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640002,Humana Bronze 6300/Austin HMOx,32673TX064,,TXN002,TXS001,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343666,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334774,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640002-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640002,Humana Bronze 6300/Austin HMOx,32673TX064,,TXN002,TXS001,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343666,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334774,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640002-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640002,Humana Bronze 6300/Austin HMOx,32673TX064,,TXN002,TXS001,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343666,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334774,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640002,Humana Bronze 6300/Austin HMOx,32673TX064,,TXN002,TXS001,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343666,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334774,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640002-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640013,Humana Basic 6600/Waco HMOx,32673TX064,,TXN004,TXS002,TXF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343549,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334878,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640013-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640013,Humana Basic 6600/Waco HMOx,32673TX064,,TXN004,TXS002,TXF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343549,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334878,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640013-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640014,Humana Bronze 6300/Waco HMOx,32673TX064,,TXN004,TXS002,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343770,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334891,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640014-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640014,Humana Bronze 6300/Waco HMOx,32673TX064,,TXN004,TXS002,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343770,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334891,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640014-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640014,Humana Bronze 6300/Waco HMOx,32673TX064,,TXN004,TXS002,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343770,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334891,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640014,Humana Bronze 6300/Waco HMOx,32673TX064,,TXN004,TXS002,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343770,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334891,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640014-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640026,Humana Bronze 6300/Houston HMOx,32673TX064,,TXN003,TXS004,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343718,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335008,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640026-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,24
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640026,Humana Bronze 6300/Houston HMOx,32673TX064,,TXN003,TXS004,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343718,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335008,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640026-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640026,Humana Bronze 6300/Houston HMOx,32673TX064,,TXN003,TXS004,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343718,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335008,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640026-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,26
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640026,Humana Bronze 6300/Houston HMOx,32673TX064,,TXN003,TXS004,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343718,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335008,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640026-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,27
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640037,Humana Basic 6600/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343536,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335112,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640037-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,28
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640037,Humana Basic 6600/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343536,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335112,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640037-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,29
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640038,Humana Bronze 6300/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343757,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335125,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640038-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,30
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640038,Humana Bronze 6300/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343757,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335125,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640038-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,31
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640038,Humana Bronze 6300/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343757,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335125,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640038-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,32
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640038,Humana Bronze 6300/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343757,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335125,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640038-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,33
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640049,Humana Basic 6600/Corpus Christi HMOx,32673TX064,,TXN006,TXS007,TXF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343471,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335229,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640049-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,34
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640049,Humana Basic 6600/Corpus Christi HMOx,32673TX064,,TXN006,TXS007,TXF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343471,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335229,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640049-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,35
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640050,Humana Bronze 6300/Corpus Christi HMOx,32673TX064,,TXN006,TXS007,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343692,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335242,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640050-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,36
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,2,32673,TX,Individual,No,61-0994632,32673TX0640050,Humana Bronze 6300/Corpus Christi HMOx,32673TX064,,TXN006,TXS007,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343692,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335242,http://apps.humana.com/marketing/documents.asp?file=2323828,32673TX0640050-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,37
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0640006,Humana Platinum 0/Austin HMOx,32673TX064,,TXN002,TXS001,TXF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343900,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334865,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0640006,Humana Platinum 0/Austin HMOx,32673TX064,,TXN002,TXS001,TXF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343900,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334865,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640006-03,Limited Cost Sharing Plan Variation,,0.902322471141815,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0640018,Humana Platinum 0/Waco HMOx,32673TX064,,TXN004,TXS002,TXF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343978,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334982,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640018-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0640018,Humana Platinum 0/Waco HMOx,32673TX064,,TXN004,TXS002,TXF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343978,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334982,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640018-03,Limited Cost Sharing Plan Variation,,0.902322471141815,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0640030,Humana Platinum 0/Houston HMOx,32673TX064,,TXN003,TXS004,TXF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343939,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335099,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640030-00,Standard Platinum Off Exchange Plan,,0.902322471141815,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0640030,Humana Platinum 0/Houston HMOx,32673TX064,,TXN003,TXS004,TXF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343939,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335099,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640030-01,Standard Platinum On Exchange Plan,,0.902322471141815,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0640030,Humana Platinum 0/Houston HMOx,32673TX064,,TXN003,TXS004,TXF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343939,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335099,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640030-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0640030,Humana Platinum 0/Houston HMOx,32673TX064,,TXN003,TXS004,TXF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343939,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335099,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640030-03,Limited Cost Sharing Plan Variation,,0.902322471141815,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0640042,Humana Platinum 0/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343965,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335216,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640042-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0640042,Humana Platinum 0/San Antonio HMOx,32673TX064,,TXN005,TXS005,TXF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343965,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335216,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640042-03,Limited Cost Sharing Plan Variation,,0.902322471141815,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,No,36-1236610,33602TX0420004,Blue Choice Silver PPO? 004,33602TX042,,TXN001,TXS001,TXF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420004-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,No,36-1236610,33602TX0420004,Blue Choice Silver PPO? 004,33602TX042,,TXN001,TXS001,TXF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420004-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,No,36-1236610,33602TX0420004,Blue Choice Silver PPO? 004,33602TX042,,TXN001,TXS001,TXF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,No,36-1236610,33602TX0420004,Blue Choice Silver PPO? 004,33602TX042,,TXN001,TXS001,TXF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420004-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460013,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS042,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460013-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460013,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS042,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460013-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460014,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS052,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460014-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460014,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS052,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460014-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460014,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS052,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460014,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS052,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460014-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460031,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS222,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460031-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,88
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460031,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS222,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460031-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,89
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460031,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS222,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460031-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,90
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460031,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS222,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460031-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,91
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0640053,Humana Platinum 0/Corpus Christi HMOx,32673TX064,,TXN006,TXS007,TXF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343913,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335320,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640053-00,Standard Platinum Off Exchange Plan,,0.902322471141815,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0640053,Humana Platinum 0/Corpus Christi HMOx,32673TX064,,TXN006,TXS007,TXF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343913,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335320,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640053-01,Standard Platinum On Exchange Plan,,0.902322471141815,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0640053,Humana Platinum 0/Corpus Christi HMOx,32673TX064,,TXN006,TXS007,TXF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343913,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335320,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640053-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,26
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,3,32673,TX,Individual,No,61-0994632,32673TX0640053,Humana Platinum 0/Corpus Christi HMOx,32673TX064,,TXN006,TXS007,TXF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343913,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335320,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640053-03,Limited Cost Sharing Plan Variation,,0.902322471141815,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,4,32673,TX,Individual,No,61-0994632,32673TX0630003,Humana Bronze 4850/HMO Premier,32673TX063,,TXN001,TXS003,TXF002,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343588,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334670,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0630003-00,Standard Bronze Off Exchange Plan,,0.619466245174408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",80%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,4,32673,TX,Individual,No,61-0994632,32673TX0630003,Humana Bronze 4850/HMO Premier,32673TX063,,TXN001,TXS003,TXF002,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343588,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334670,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0630003-01,Standard Bronze On Exchange Plan,,0.619466245174408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",80%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,4,32673,TX,Individual,No,61-0994632,32673TX0630003,Humana Bronze 4850/HMO Premier,32673TX063,,TXN001,TXS003,TXF002,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343588,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334670,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0630003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,4,32673,TX,Individual,No,61-0994632,32673TX0630003,Humana Bronze 4850/HMO Premier,32673TX063,,TXN001,TXS003,TXF002,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343588,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334670,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0630003-03,Limited Cost Sharing Plan Variation,,0.619466245174408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",80%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,4,32673,TX,Individual,No,61-0994632,32673TX0640003,Humana Bronze 4850/Austin HMOx,32673TX064,,TXN002,TXS001,TXF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343562,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334787,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640003-00,Standard Bronze Off Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,4,32673,TX,Individual,No,61-0994632,32673TX0640003,Humana Bronze 4850/Austin HMOx,32673TX064,,TXN002,TXS001,TXF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343562,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334787,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640003-01,Standard Bronze On Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,4,32673,TX,Individual,No,61-0994632,32673TX0640003,Humana Bronze 4850/Austin HMOx,32673TX064,,TXN002,TXS001,TXF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343562,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334787,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,4,32673,TX,Individual,No,61-0994632,32673TX0640003,Humana Bronze 4850/Austin HMOx,32673TX064,,TXN002,TXS001,TXF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343562,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334787,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640003-03,Limited Cost Sharing Plan Variation,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,4,32673,TX,Individual,No,61-0994632,32673TX0640015,Humana Bronze 4850/Waco HMOx,32673TX064,,TXN004,TXS002,TXF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343653,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334904,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640015-00,Standard Bronze Off Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,4,32673,TX,Individual,No,61-0994632,32673TX0640015,Humana Bronze 4850/Waco HMOx,32673TX064,,TXN004,TXS002,TXF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343653,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334904,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640015-01,Standard Bronze On Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,4,32673,TX,Individual,No,61-0994632,32673TX0640015,Humana Bronze 4850/Waco HMOx,32673TX064,,TXN004,TXS002,TXF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343653,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334904,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,4,32673,TX,Individual,No,61-0994632,32673TX0640015,Humana Bronze 4850/Waco HMOx,32673TX064,,TXN004,TXS002,TXF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343653,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334904,http://apps.humana.com/marketing/documents.asp?file=2323763,32673TX0640015-03,Limited Cost Sharing Plan Variation,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,5,32673,TX,Individual,No,61-0994632,32673TX0650009,Humana Bronze 6300/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF005,New,POS,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343731,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335632,http://apps.humana.com/marketing/documents.asp?file=2323841,32673TX0650009-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,6
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,5,32673,TX,Individual,No,61-0994632,32673TX0650009,Humana Bronze 6300/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF005,New,POS,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343731,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335632,http://apps.humana.com/marketing/documents.asp?file=2323841,32673TX0650009-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,5,32673,TX,Individual,No,61-0994632,32673TX0650009,Humana Bronze 6300/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF005,New,POS,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343731,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335632,http://apps.humana.com/marketing/documents.asp?file=2323841,32673TX0650009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,5,32673,TX,Individual,No,61-0994632,32673TX0650009,Humana Bronze 6300/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF005,New,POS,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343731,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335632,http://apps.humana.com/marketing/documents.asp?file=2323841,32673TX0650009-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,5,32673,TX,Individual,No,61-0994632,32673TX0650012,Humana Silver 3650/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF005,New,POS,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2344199,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335710,http://apps.humana.com/marketing/documents.asp?file=2323841,32673TX0650012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,12
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,5,32673,TX,Individual,No,61-0994632,32673TX0650012,Humana Silver 3650/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF005,New,POS,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2344199,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335710,http://apps.humana.com/marketing/documents.asp?file=2323841,32673TX0650012-03,Limited Cost Sharing Plan Variation,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,13
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,5,32673,TX,Individual,No,61-0994632,32673TX0650012,Humana Silver 3650/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF005,New,POS,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2344199,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335710,http://apps.humana.com/marketing/documents.asp?file=2323841,32673TX0650012-04,73% AV Level Silver Plan,,0.721818149089813,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,920","$5,840",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,920","$5,840",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,14
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,5,32673,TX,Individual,No,61-0994632,32673TX0650012,Humana Silver 3650/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF005,New,POS,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2344199,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335710,http://apps.humana.com/marketing/documents.asp?file=2323841,32673TX0650012-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,15
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,6,32673,TX,Individual,No,61-0994632,32673TX0650011,Humana Silver 4250/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF007,New,POS,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2344225,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335658,http://apps.humana.com/marketing/documents.asp?file=2323776,32673TX0650011-05,87% AV Level Silver Plan,,0.867647707462311,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,6,32673,TX,Individual,No,61-0994632,32673TX0650011,Humana Silver 4250/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF007,New,POS,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2344225,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335658,http://apps.humana.com/marketing/documents.asp?file=2323776,32673TX0650011-06,94% AV Level Silver Plan,,0.93690437078476,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,$250,$500,50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460025,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS162,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460025-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,66
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460025,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS162,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460025-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,67
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460026,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS172,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460026-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,68
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460026,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS172,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460026-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,69
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460026,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS172,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460026-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,70
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460026,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS172,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460026-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,71
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470058,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS112,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470058-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470058,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS112,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470058-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460063,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS042,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460063-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460063,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS042,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460063-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460035,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS262,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460035-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,104
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460035,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS262,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460035-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,105
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470036,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS142,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470036-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470036,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS142,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470036-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,6,32673,TX,Individual,No,61-0994632,32673TX0650013,Humana Gold 2500/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF008,New,POS,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343848,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335775,http://apps.humana.com/marketing/documents.asp?file=2323776,32673TX0650013-00,Standard Gold Off Exchange Plan,,0.78094208240509,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,6,32673,TX,Individual,No,61-0994632,32673TX0650013,Humana Gold 2500/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF008,New,POS,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343848,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335775,http://apps.humana.com/marketing/documents.asp?file=2323776,32673TX0650013-01,Standard Gold On Exchange Plan,,0.78094208240509,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,6,32673,TX,Individual,No,61-0994632,32673TX0650013,Humana Gold 2500/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF008,New,POS,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343848,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335775,http://apps.humana.com/marketing/documents.asp?file=2323776,32673TX0650013-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,6,32673,TX,Individual,No,61-0994632,32673TX0650013,Humana Gold 2500/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF008,New,POS,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343848,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335775,http://apps.humana.com/marketing/documents.asp?file=2323776,32673TX0650013-03,Limited Cost Sharing Plan Variation,,0.78094208240509,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,7,32673,TX,Individual,No,61-0994632,32673TX0650014,Humana Platinum 0/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF008,New,POS,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343952,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335788,http://apps.humana.com/marketing/documents.asp?file=2323776,32673TX0650014-00,Standard Platinum Off Exchange Plan,,0.911060273647308,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,7,32673,TX,Individual,No,61-0994632,32673TX0650014,Humana Platinum 0/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF008,New,POS,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343952,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335788,http://apps.humana.com/marketing/documents.asp?file=2323776,32673TX0650014-01,Standard Platinum On Exchange Plan,,0.911060273647308,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,7,32673,TX,Individual,No,61-0994632,32673TX0650014,Humana Platinum 0/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF008,New,POS,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343952,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335788,http://apps.humana.com/marketing/documents.asp?file=2323776,32673TX0650014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,7,32673,TX,Individual,No,61-0994632,32673TX0650014,Humana Platinum 0/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF008,New,POS,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343952,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335788,http://apps.humana.com/marketing/documents.asp?file=2323776,32673TX0650014-03,Limited Cost Sharing Plan Variation,,0.911060273647308,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,8,32673,TX,Individual,No,61-0994632,32673TX0650010,Humana Bronze 4850/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF006,New,POS,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343614,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335645,http://apps.humana.com/marketing/documents.asp?file=2323776,32673TX0650010-00,Standard Bronze Off Exchange Plan,,0.616929411888123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800",Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,"$9,700","$19,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,8,32673,TX,Individual,No,61-0994632,32673TX0650010,Humana Bronze 4850/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF006,New,POS,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343614,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335645,http://apps.humana.com/marketing/documents.asp?file=2323776,32673TX0650010-01,Standard Bronze On Exchange Plan,,0.616929411888123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800",Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,"$9,700","$19,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,8,32673,TX,Individual,No,61-0994632,32673TX0650010,Humana Bronze 4850/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF006,New,POS,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343614,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335645,http://apps.humana.com/marketing/documents.asp?file=2323776,32673TX0650010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,32673,HIOS,12,2014-12-09 03:57:54,8,32673,TX,Individual,No,61-0994632,32673TX0650010,Humana Bronze 4850/National POS - Open Access,32673TX065,,TXN007,TXS006,TXF006,New,POS,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,Yes,http://apps.humana.com/marketing/documents.asp?file=2343614,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335645,http://apps.humana.com/marketing/documents.asp?file=2323776,32673TX0650010-03,Limited Cost Sharing Plan Variation,,0.616929411888123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800",Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,"$9,700","$19,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,33348,HIOS,2,2014-08-08 08:53:29,1,33348,TX,Individual,Yes,72-0977315,33348TX0050001,AlwaysCare All-Star Kids Dental Plan 2015,33348TX005,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$43.51,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,33348TX0050001-00,Standard High Off Exchange Plan,85.21%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,33348,HIOS,2,2014-08-08 08:53:29,1,33348,TX,SHOP (Small Group),Yes,72-0977315,33348TX0080001,AlwaysCare Small Group - Child,33348TX008,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$38.33,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,33348TX0080001-00,Standard High Off Exchange Plan,85.21%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,33348,HIOS,2,2014-08-08 08:53:29,1,33348,TX,SHOP (Small Group),Yes,72-0977315,33348TX0080002,AlwaysCare Small Group - Child,33348TX008,,TXN001,TXS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$31.24,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,33348TX0080002-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,33348,HIOS,2,2014-08-08 08:53:29,1,33348,TX,Individual,Yes,72-0977315,33348TX0050002,AlwaysCare All-Star Kids Dental Plan 2015,33348TX005,,TXN001,TXS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$35.46,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,33348TX0050002-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,33348,HIOS,2,2014-08-08 08:53:29,2,33348,TX,Individual,Yes,72-0977315,33348TX0060001,AlwaysCare All-Star Family Dental Plan 2015,33348TX006,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$43.51,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,33348TX0060001-00,Standard High Off Exchange Plan,85.21%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,33348,HIOS,2,2014-08-08 08:53:29,2,33348,TX,SHOP (Small Group),Yes,72-0977315,33348TX0070001,AlwaysCare Small Group Dental - Adults,33348TX007,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$38.33,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,33348TX0070001-00,Standard High Off Exchange Plan,85.21%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,33348,HIOS,2,2014-08-08 08:53:29,2,33348,TX,SHOP (Small Group),Yes,72-0977315,33348TX0070002,AlwaysCare Small Group Dental - Adults,33348TX007,,TXN001,TXS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.24,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,33348TX0070002-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,33348,HIOS,2,2014-08-08 08:53:29,2,33348,TX,Individual,Yes,72-0977315,33348TX0060002,AlwaysCare All-Star Family Dental Plan 2015,33348TX006,,TXN001,TXS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.46,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,33348TX0060002-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,No,36-1236610,33602TX0420001,Blue Choice Gold PPO? 001,33602TX042,,TXN001,TXS001,TXF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420001-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,SHOP (Small Group),Yes,36-1236610,33602TX0600002,BlueCare Dental? 1B,33602TX060,,TXN003,TXS003,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.41,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbstx.com/coverage/individual/on-exchange/dental/,,33602TX0600002-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,Yes,36-1236610,33602TX0500001,BlueCare Dental? 1A,33602TX050,,TXN003,TXS003,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.96,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/dental/,,33602TX0500001-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0430001,Blue Choice Gold PPO? 001,33602TX043,,TXN001,TXS001,TXF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0430001-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0430001,Blue Choice Gold PPO? 001,33602TX043,,TXN001,TXS001,TXF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0430001-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,Yes,36-1236610,33602TX0500001,BlueCare Dental? 1A,33602TX050,,TXN003,TXS003,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.96,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/dental/,,33602TX0500001-01,Standard High On Exchange Plan,86.90%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,SHOP (Small Group),Yes,36-1236610,33602TX0600008,BlueCare Dental? 1F,33602TX060,,TXN003,TXS003,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.41,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbstx.com/coverage/individual/on-exchange/dental/,,33602TX0600008-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,No,36-1236610,33602TX0420001,Blue Choice Gold PPO? 001,33602TX042,,TXN001,TXS001,TXF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420001-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,No,36-1236610,33602TX0420001,Blue Choice Gold PPO? 001,33602TX042,,TXN001,TXS001,TXF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,SHOP (Small Group),Yes,36-1236610,33602TX0600006,BlueCare Dental? 1D,33602TX060,,TXN003,TXS003,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.60,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbstx.com/coverage/individual/on-exchange/dental/,,33602TX0600006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0430002,Blue Choice Gold PPO? 002,33602TX043,,TXN001,TXS001,TXF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0430002-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0430002,Blue Choice Gold PPO? 002,33602TX043,,TXN001,TXS001,TXF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0430002-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,No,36-1236610,33602TX0420001,Blue Choice Gold PPO? 001,33602TX042,,TXN001,TXS001,TXF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420001-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,No,36-1236610,33602TX0420002,Blue Choice Gold PPO? 002,33602TX042,,TXN001,TXS001,TXF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420002-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0430003,Blue Choice Silver PPO? 003,33602TX043,,TXN001,TXS001,TXF003,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0430003-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0430003,Blue Choice Silver PPO? 003,33602TX043,,TXN001,TXS001,TXF003,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0430003-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,No,36-1236610,33602TX0420002,Blue Choice Gold PPO? 002,33602TX042,,TXN001,TXS001,TXF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420002-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,No,36-1236610,33602TX0420002,Blue Choice Gold PPO? 002,33602TX042,,TXN001,TXS001,TXF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0430004,Blue Choice Silver PPO? 004,33602TX043,,TXN001,TXS001,TXF003,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0430004-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0430004,Blue Choice Silver PPO? 004,33602TX043,,TXN001,TXS001,TXF003,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0430004-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,No,36-1236610,33602TX0420002,Blue Choice Gold PPO? 002,33602TX042,,TXN001,TXS001,TXF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420002-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,No,36-1236610,33602TX0420003,Blue Choice Silver PPO? 003,33602TX042,,TXN001,TXS001,TXF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420003-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,No,36-1236610,33602TX0420003,Blue Choice Silver PPO? 003,33602TX042,,TXN001,TXS001,TXF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420003-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,No,36-1236610,33602TX0420003,Blue Choice Silver PPO? 003,33602TX042,,TXN001,TXS001,TXF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,No,36-1236610,33602TX0420003,Blue Choice Silver PPO? 003,33602TX042,,TXN001,TXS001,TXF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420003-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,No,36-1236610,33602TX0420003,Blue Choice Silver PPO? 003,33602TX042,,TXN001,TXS001,TXF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420003-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800",Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,"$10,000","$20,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,No,36-1236610,33602TX0420003,Blue Choice Silver PPO? 003,33602TX042,,TXN001,TXS001,TXF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420003-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,No,36-1236610,33602TX0420003,Blue Choice Silver PPO? 003,33602TX042,,TXN001,TXS001,TXF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420003-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$500,"$1,500",0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,No,36-1236610,33602TX0420004,Blue Choice Silver PPO? 004,33602TX042,,TXN001,TXS001,TXF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420004-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,"$5,000","$15,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,No,36-1236610,33602TX0420004,Blue Choice Silver PPO? 004,33602TX042,,TXN001,TXS001,TXF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420004-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,1,33602,TX,Individual,No,36-1236610,33602TX0420004,Blue Choice Silver PPO? 004,33602TX042,,TXN001,TXS001,TXF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420004-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,2,33602,TX,Individual,No,36-1236610,33602TX0420005,Blue Choice Bronze PPO? 005,33602TX042,,TXN001,TXS001,TXF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420005-00,Standard Bronze Off Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,2,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0430005,Blue Choice Bronze PPO? 005,33602TX043,,TXN001,TXS001,TXF002,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0430005-00,Standard Bronze Off Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,2,33602,TX,Individual,Yes,36-1236610,33602TX0500003,BlueCare Dental 4 Kids? 1A,33602TX050,,TXN003,TXS003,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$31.96,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/dental/,,33602TX0500003-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,2,33602,TX,SHOP (Small Group),Yes,36-1236610,33602TX0600003,BlueCare Dental 4 Kids? 1A,33602TX060,,TXN003,TXS003,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.96,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbstx.com/coverage/individual/on-exchange/dental/,,33602TX0600003-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,2,33602,TX,Individual,Yes,36-1236610,33602TX0500003,BlueCare Dental 4 Kids? 1A,33602TX050,,TXN003,TXS003,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$31.96,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/dental/,,33602TX0500003-01,Standard High On Exchange Plan,86.90%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,2,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0430005,Blue Choice Bronze PPO? 005,33602TX043,,TXN001,TXS001,TXF002,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0430005-01,Standard Bronze On Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,2,33602,TX,Individual,No,36-1236610,33602TX0420005,Blue Choice Bronze PPO? 005,33602TX042,,TXN001,TXS001,TXF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420005-01,Standard Bronze On Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,2,33602,TX,Individual,No,36-1236610,33602TX0420005,Blue Choice Bronze PPO? 005,33602TX042,,TXN001,TXS001,TXF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,2,33602,TX,Individual,No,36-1236610,33602TX0420005,Blue Choice Bronze PPO? 005,33602TX042,,TXN001,TXS001,TXF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420005-03,Limited Cost Sharing Plan Variation,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,3,33602,TX,Individual,No,36-1236610,33602TX0420006,Blue Choice Bronze PPO? 006,33602TX042,,TXN001,TXS001,TXF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420006-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,3,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0430006,Blue Choice Bronze PPO? 006,33602TX043,,TXN001,TXS001,TXF004,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0430006-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,3,33602,TX,Individual,Yes,36-1236610,33602TX0500002,BlueCare Dental? 1B,33602TX050,,TXN003,TXS003,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.41,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/dental/,,33602TX0500002-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,3,33602,TX,SHOP (Small Group),Yes,36-1236610,33602TX0600005,BlueCare Dental? 1C,33602TX060,,TXN003,TXS003,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$48.22,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbstx.com/coverage/individual/on-exchange/dental/,,33602TX0600005-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,3,33602,TX,SHOP (Small Group),Yes,36-1236610,33602TX0600007,BlueCare Dental? 1E,33602TX060,,TXN003,TXS003,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$46.08,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbstx.com/coverage/individual/on-exchange/dental/,,33602TX0600007-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,3,33602,TX,Individual,Yes,36-1236610,33602TX0500002,BlueCare Dental? 1B,33602TX050,,TXN003,TXS003,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.41,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/dental/,,33602TX0500002-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,3,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0430006,Blue Choice Bronze PPO? 006,33602TX043,,TXN001,TXS001,TXF004,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0430006-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,3,33602,TX,Individual,No,36-1236610,33602TX0420006,Blue Choice Bronze PPO? 006,33602TX042,,TXN001,TXS001,TXF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420006-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,3,33602,TX,Individual,No,36-1236610,33602TX0420006,Blue Choice Bronze PPO? 006,33602TX042,,TXN001,TXS001,TXF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,3,33602,TX,Individual,No,36-1236610,33602TX0420006,Blue Choice Bronze PPO? 006,33602TX042,,TXN001,TXS001,TXF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420006-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,3,33602,TX,Individual,No,36-1236610,33602TX0420010,Blue Security Choice PPO? 010,33602TX042,,TXN001,TXS001,TXF004,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420010-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,8
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,3,33602,TX,Individual,No,36-1236610,33602TX0420010,Blue Security Choice PPO? 010,33602TX042,,TXN001,TXS001,TXF004,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0420010-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460001,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS082,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460001-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,Yes,36-1236610,33602TX0500004,BlueCare Dental 4 Kids? 1B,33602TX050,,TXN003,TXS003,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$22.41,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/dental/,,33602TX0500004-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0430027,Blue Choice Silver PPO? 027,33602TX043,,TXN001,TXS001,TXF003,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0430027-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,SHOP (Small Group),Yes,36-1236610,33602TX0600001,BlueCare Dental? 1A,33602TX060,,TXN003,TXS003,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.96,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbstx.com/coverage/individual/on-exchange/dental/,,33602TX0600001-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0430027,Blue Choice Silver PPO? 027,33602TX043,,TXN001,TXS001,TXF003,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0430027-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,Yes,36-1236610,33602TX0500004,BlueCare Dental 4 Kids? 1B,33602TX050,,TXN003,TXS003,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$22.41,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/dental/,,33602TX0500004-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460001,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS082,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460001-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460001,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS082,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460001,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS082,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460001-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460011,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS022,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460011-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460011,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS022,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460011-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460011,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS022,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460011-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460011,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS022,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460011-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460012,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS032,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460012-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460012,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS032,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460012-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460012,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS032,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460012-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460012,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS032,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460012-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460013,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS042,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460013-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460013,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS042,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460013-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460015,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS062,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460015-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460015,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS062,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460015-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460015,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS062,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460015,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS062,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460015-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460016,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS072,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460016-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460016,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS072,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460016-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460016,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS072,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460016-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460016,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS072,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460016-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460017,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS012,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460017-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460017,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS012,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460017-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460018,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS092,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460018-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460018,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS092,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460018-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460018,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS092,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460018-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460018,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS092,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460018-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460019,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS102,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460019-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460019,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS102,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460019-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460019,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS102,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460019-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460019,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS102,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460019-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460021,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS122,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460021-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,50
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460021,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS122,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460021-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,51
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460022,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS132,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460022-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,54
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460022,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS132,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460022-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,55
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460023,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS142,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460023-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,56
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460023,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS142,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460023-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,57
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460023,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS142,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460023-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,58
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460023,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS142,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460023-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,59
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460024,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS152,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460024-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,60
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460024,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS152,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460024-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,61
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460024,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS152,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460024-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,62
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460024,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS152,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460024-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,63
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460025,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS162,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460025-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,64
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460025,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS162,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460025-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,65
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460027,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS182,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460027-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,72
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460027,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS182,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460027-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,73
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460027,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS182,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460027-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,74
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460027,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS182,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460027-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,75
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460028,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS192,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460028-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,76
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460028,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS192,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460028-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,77
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460028,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS192,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460028-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,78
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460028,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS192,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460028-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,79
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460029,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS202,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460029-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,80
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460029,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS202,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460029-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,81
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460029,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS202,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460029-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,82
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460029,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS202,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460029-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,83
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460030,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS212,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460030-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,84
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460030,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS212,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460030-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,85
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460030,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS212,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460030-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,86
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460030,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS212,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460030-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,87
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460032,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS232,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460032-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,92
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460032,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS232,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460032-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,93
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460002,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS082,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460002-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460002,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS082,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470024,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS022,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470024-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470024,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS022,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470024-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460002,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS082,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460002-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460036,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS022,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460036-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470025,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS032,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470025-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470025,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS032,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470025-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470050,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS032,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470050-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470050,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS032,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470050-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460042,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS012,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460042-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460042,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS012,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460042-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470038,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS162,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470038-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470038,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS162,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470038-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460032,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS232,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460032-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,94
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460032,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS232,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460032-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,95
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460033,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS242,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460033-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,96
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460033,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS242,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460033-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,97
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460034,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS252,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460034-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,100
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460034,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS252,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460034-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,101
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460034,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS252,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460034-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,102
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460034,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS252,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460034-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,103
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460052,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS182,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460052-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,75
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460053,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS192,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460053-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,76
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460053,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS192,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460053-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,77
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460053,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS192,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460053-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,78
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460053,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS192,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460053-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,79
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460054,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS202,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460054-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,80
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470056,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS092,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470056-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470056,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS092,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470056-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460062,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS032,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460062-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460062,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS032,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460062-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470069,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS222,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470069-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470069,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS222,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470069-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,47
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460066,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS072,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460066-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,47
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460066,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS072,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460066-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460040,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS062,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460040-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460040,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS062,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460040-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470046,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS242,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470046-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,50
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470046,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS242,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470046-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,51
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460046,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS122,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460046-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,51
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460047,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS132,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460047-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,52
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470032,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS012,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470032-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470032,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS012,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470032-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460039,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS052,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460039-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460040,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS062,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460040-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470033,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS112,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470033-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470033,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS112,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470033-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470047,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS252,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470047-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,52
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470047,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS252,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470047-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,53
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460047,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS132,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460047-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,53
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460047,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS132,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460047-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,54
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460062,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS032,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460062-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460062,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS032,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460062-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460035,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS262,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460035-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,106
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,4,33602,TX,Individual,No,36-1236610,33602TX0460035,Blue Advantage Gold HMO? 001,33602TX046,,TXN002,TXS262,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460035-03,Limited Cost Sharing Plan Variation,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,107
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460002,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS082,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460002-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470001,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS102,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470001-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),Yes,36-1236610,33602TX0600004,BlueCare Dental 4 Kids? 1B,33602TX060,,TXN003,TXS003,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.41,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbstx.com/coverage/individual/on-exchange/dental/,,33602TX0600004-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470001,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS102,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470001-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460036,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS022,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460036-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460036,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS022,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460036-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470026,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS042,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470026-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470026,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS042,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470026-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460036,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS022,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460036-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460037,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS032,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460037-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470027,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS052,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470027-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470027,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS052,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470027-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460037,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS032,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460037-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460037,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS032,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460037-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470028,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS062,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470028-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470028,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS062,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470028-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460037,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS032,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460037-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460038,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS042,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460038-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470029,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS072,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470029-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470029,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS072,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470029-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460038,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS042,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460038-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460038,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS042,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460038-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470030,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS082,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470030-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470030,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS082,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470030-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460038,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS042,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460038-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460039,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS052,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460039-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470031,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS092,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470031-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470031,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS092,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470031-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460039,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS052,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460039-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460039,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS052,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460039-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470034,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS122,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470034-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470034,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS122,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470034-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460040,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS062,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460040-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460041,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS072,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460041-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470035,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS132,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470035-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470035,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS132,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470035-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460041,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS072,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460041-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460041,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS072,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460041-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460041,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS072,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460041-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460042,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS012,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460042-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470037,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS152,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470037-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470037,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS152,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470037-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470072,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS252,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470072-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,52
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470072,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS252,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470072-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,53
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460047,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS132,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460047-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,55
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460048,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS142,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460048-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,56
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460048,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS142,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460048-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,57
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460048,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS142,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460048-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,58
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470049,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS022,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470049-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470049,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS022,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470049-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460003,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS082,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460003-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460003,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS082,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460003-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460042,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS012,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460042-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460043,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS092,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460043-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470039,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS172,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470039-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470039,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS172,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470039-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460043,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS092,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460043-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460043,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS092,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460043-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470040,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS182,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470040-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470040,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS182,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470040-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460043,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS092,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460043-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460044,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS102,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460044-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470041,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS192,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470041-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470041,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS192,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470041-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460044,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS102,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460044-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460044,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS102,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460044-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470042,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS202,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470042-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470042,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS202,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470042-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460044,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS102,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460044-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460045,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS112,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460045-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470043,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS212,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470043-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470043,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS212,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470043-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460045,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS112,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460045-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460045,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS112,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460045-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470044,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS222,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470044-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470044,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS222,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470044-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,47
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460045,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS112,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460045-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,47
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460046,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS122,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460046-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470045,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS232,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470045-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470045,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS232,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470045-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,49
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460046,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS122,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460046-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,49
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460046,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS122,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460046-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,50
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470048,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS262,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470048-00,Standard Gold Off Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,54
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470048,Blue Advantage Gold HMO? 001,33602TX047,,TXN002,TXS262,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470048-01,Standard Gold On Exchange Plan,,0.792829096317291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,55
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460059,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS252,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460059-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,103
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460060,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS262,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460060-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,104
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460060,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS262,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460060-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,105
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460060,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS262,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460060-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,106
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460060,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS262,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460060-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,107
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460003,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS082,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460003-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460063,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS042,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460063-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460064,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS052,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460064-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470062,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS152,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470062-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470062,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS152,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470062-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460064,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS052,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460064-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460064,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS052,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460064-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460048,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS142,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460048-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,59
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460049,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS152,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460049-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,60
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460049,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS152,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460049-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,61
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460049,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS152,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460049-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,62
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460049,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS152,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460049-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,63
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460050,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS162,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460050-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,64
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460050,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS162,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460050-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,65
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460050,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS162,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460050-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,66
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460050,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS162,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460050-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,67
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460051,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS172,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460051-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,68
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460061,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS022,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460061-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460062,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS032,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460062-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470055,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS082,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470055-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470055,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS082,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470055-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460062,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS032,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460062-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460062,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS032,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460062-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470070,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS232,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470070-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470070,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS232,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470070-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,49
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460066,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS072,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460066-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,49
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460066,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS072,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460066-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,50
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460051,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS172,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460051-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,69
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460051,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS172,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460051-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,70
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460051,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS172,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460051-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,71
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460052,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS182,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460052-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,72
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460052,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS182,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460052-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,73
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460052,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS182,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460052-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,74
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460054,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS202,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460054-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,81
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460054,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS202,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460054-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,82
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460054,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS202,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460054-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,83
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460055,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS212,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460055-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,84
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460055,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS212,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460055-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,85
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460055,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS212,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460055-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,86
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460055,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS212,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460055-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,87
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460056,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS222,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460056-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,88
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460056,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS222,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460056-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,89
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460056,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS222,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460056-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,90
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460056,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS222,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460056-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,91
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460057,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS232,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460057-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,92
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460057,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS232,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460057-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,93
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460057,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS232,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460057-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,94
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460057,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS232,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460057-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,95
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460058,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS242,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460058-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,96
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460058,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS242,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460058-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,97
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460058,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS242,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460058-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,98
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460058,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS242,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460058-03,Limited Cost Sharing Plan Variation,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,99
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460059,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS252,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460059-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,100
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460059,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS252,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460059-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,101
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,5,33602,TX,Individual,No,36-1236610,33602TX0460059,Blue Advantage Gold HMO? 002,33602TX046,,TXN002,TXS252,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460059-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,102
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470002,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS102,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470002-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470002,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS102,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470002-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460003,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS082,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460003-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460003,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS082,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460003,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS082,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460003-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460003,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS082,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460003-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470051,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS042,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470051-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470051,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS042,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470051-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460061,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS022,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460061-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460061,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS022,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460061-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470052,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS052,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470052-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470052,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS052,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470052-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460061,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS022,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460061-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460061,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS022,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460061-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470053,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS062,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470053-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470053,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS062,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470053-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460061,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS022,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460061-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460061,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS022,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460061-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470054,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS072,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470054-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470054,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS072,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470054-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470057,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS012,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470057-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470057,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS012,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470057-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470059,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS122,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470059-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470059,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS122,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470059-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460063,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS042,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460063-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460063,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS042,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460063-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470060,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS132,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470060-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470060,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS132,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470060-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460063,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS042,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460063-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460063,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS042,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460063-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470061,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS142,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470061-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470061,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS142,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470061-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470063,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS162,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470063-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470063,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS162,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470063-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460064,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS052,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460064-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460064,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS052,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460064-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470064,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS172,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470064-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470064,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS172,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470064-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460064,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS052,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460064-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460064,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS052,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460064-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470065,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS182,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470065-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470065,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS182,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470065-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460065,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS062,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460065-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460065,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS062,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460065-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470066,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS192,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470066-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470066,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS192,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470066-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460083,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS242,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460083-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,165
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460083,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS242,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460083-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,166
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460067,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS012,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460067-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,55
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460067,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS012,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460067-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,56
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460083,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS242,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460083-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,171
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460084,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS252,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460084-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,172
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460084,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS252,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460084-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,173
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460084,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS252,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460084-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,174
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460084,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS252,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460084-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,175
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460084,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS252,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460084-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,176
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460096,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS122,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460096-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,85
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460096,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS122,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460096-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,86
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460065,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS062,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460065-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460065,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS062,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460065-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470067,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS202,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470067-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470067,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS202,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470067-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460065,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS062,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460065-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460065,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS062,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460065-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470068,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS212,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470068-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470068,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS212,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470068-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460065,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS062,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460065-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460066,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS072,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460066-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470071,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS242,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470071-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,50
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470071,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS242,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470071-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,51
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460066,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS072,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460066-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,51
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460066,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS072,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460066-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,52
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460073,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS142,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460073-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,97
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460073,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS142,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460073-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,98
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460073,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS142,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460073-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,99
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460073,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS142,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460073-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,100
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470076,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS042,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470076-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470076,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS042,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470076-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460086,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS022,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460086-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460086,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS022,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460086-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470077,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS052,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470077-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470077,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS052,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470077-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460089,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS052,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460089-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460089,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS052,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460089-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460067,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS012,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460067-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,53
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460067,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS012,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460067-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,54
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470073,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS262,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470073-00,Standard Gold Off Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,54
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470073,Blue Advantage Gold HMO? 002,33602TX047,,TXN002,TXS262,TXF005,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470073-01,Standard Gold On Exchange Plan,,0.796903312206268,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,55
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460074,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS152,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460074-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,107
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460074,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS152,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460074-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,108
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460075,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS162,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460075-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,109
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460075,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS162,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460075-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,110
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460075,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS162,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460075-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,111
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460075,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS162,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460075-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,112
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460082,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS232,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460082-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,161
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460082,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS232,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460082-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,162
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460082,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS232,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460082-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,163
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460082,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS232,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460082-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,164
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460067,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS012,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460067-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,57
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460067,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS012,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460067-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,58
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460067,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS012,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460067-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,59
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460068,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS092,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460068-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,60
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460068,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS092,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460068-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,61
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460068,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS092,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460068-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,62
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460068,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS092,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460068-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,63
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460068,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS092,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460068-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,64
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460068,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS092,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460068-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,65
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460068,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS092,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460068-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,66
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460069,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS102,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460069-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,67
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460069,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS102,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460069-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,68
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460069,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS102,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460069-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,69
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460069,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS102,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460069-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,70
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460069,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS102,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460069-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,71
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460069,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS102,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460069-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,72
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460069,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS102,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460069-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,73
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460070,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS112,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460070-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,74
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460070,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS112,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460070-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,75
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460070,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS112,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460070-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,76
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460070,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS112,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460070-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,77
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460070,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS112,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460070-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,78
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460004,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS082,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460004-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460004,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS082,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470074,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS022,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470074-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470074,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS022,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470074-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460004,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS082,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460004-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460004,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS082,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460004-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470084,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS122,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470084-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470084,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS122,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470084-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460088,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS042,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460088-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460088,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS042,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460088-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460106,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS222,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460106-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,153
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460106,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS222,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460106-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,154
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460070,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS112,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460070-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,79
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460070,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS112,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460070-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,80
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460071,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS122,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460071-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,81
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460071,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS122,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460071-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,82
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460071,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS122,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460071-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,83
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460071,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS122,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460071-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,84
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460071,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS122,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460071-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,85
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460071,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS122,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460071-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,86
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460071,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS122,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460071-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,87
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460072,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS132,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460072-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,88
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460072,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS132,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460072-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,89
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460072,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS132,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460072-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,90
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460072,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS132,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460072-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,91
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460072,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS132,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460072-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,92
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460072,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS132,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460072-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,93
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460072,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS132,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460072-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,94
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460073,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS142,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460073-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,95
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460073,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS142,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460073-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,96
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460073,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS142,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460073-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,101
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460074,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS152,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460074-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,102
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460074,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS152,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460074-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,103
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460074,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS152,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460074-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,104
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460074,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS152,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460074-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,105
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460074,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS152,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460074-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,106
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460075,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS162,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460075-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,113
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460075,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS162,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460075-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,114
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460075,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS162,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460075-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,115
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460076,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS172,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460076-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,116
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460076,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS172,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460076-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,117
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460076,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS172,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460076-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,118
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460076,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS172,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460076-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,119
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460076,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS172,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460076-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,120
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460076,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS172,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460076-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,121
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460076,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS172,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460076-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,122
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460077,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS182,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460077-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,123
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460077,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS182,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460077-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,124
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460077,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS182,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460077-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,125
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460077,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS182,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460077-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,126
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460077,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS182,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460077-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,127
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460077,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS182,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460077-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,128
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460077,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS182,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460077-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,129
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460078,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS192,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460078-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,130
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460078,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS192,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460078-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,131
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460078,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS192,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460078-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,132
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460078,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS192,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460078-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,133
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460078,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS192,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460078-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,134
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460078,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS192,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460078-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,135
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460078,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS192,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460078-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,136
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460004,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS082,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460004-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460004,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS082,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460004-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460086,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS022,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460086-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460086,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS022,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460086-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460088,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS042,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460088-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460088,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS042,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460088-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470085,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS132,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470085-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470085,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS132,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470085-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460091,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS072,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460091-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,51
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460091,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS072,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460091-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,52
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460079,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS202,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460079-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,137
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460079,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS202,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460079-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,138
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460079,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS202,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460079-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,139
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460079,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS202,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460079-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,140
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460079,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS202,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460079-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,141
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460079,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS202,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460079-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,142
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460079,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS202,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460079-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,143
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460080,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS212,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460080-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,144
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460080,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS212,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460080-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,145
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460080,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS212,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460080-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,146
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460080,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS212,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460080-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,147
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460080,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS212,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460080-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,148
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460080,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS212,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460080-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,149
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460080,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS212,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460080-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,150
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460081,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS222,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460081-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,151
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460081,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS222,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460081-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,152
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460081,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS222,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460081-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,153
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460081,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS222,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460081-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,154
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460081,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS222,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460081-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,155
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460081,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS222,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460081-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,156
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460081,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS222,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460081-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,157
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460082,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS232,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460082-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,158
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460082,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS232,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460082-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,159
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460082,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS232,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460082-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,160
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460083,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS242,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460083-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,167
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460083,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS242,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460083-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,168
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460083,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS242,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460083-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,169
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460083,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS242,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460083-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,170
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460084,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS252,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460084-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,177
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460084,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS252,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460084-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,178
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460085,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS262,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460085-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,179
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460085,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS262,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460085-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,180
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460085,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS262,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460085-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,181
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460085,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS262,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460085-03,Limited Cost Sharing Plan Variation,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,182
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460085,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS262,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460085-04,73% AV Level Silver Plan,,0.735160112380981,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,183
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460085,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS262,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460085-05,87% AV Level Silver Plan,,0.875936031341553,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,184
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,6,33602,TX,Individual,No,36-1236610,33602TX0460085,Blue Advantage Silver HMO? 003,33602TX046,,TXN002,TXS262,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460085-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,185
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460004,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS082,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460004-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470003,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS082,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470003-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470003,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS082,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470003-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470075,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS032,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470075-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470075,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS032,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470075-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470078,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS062,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470078-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470078,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS062,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470078-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460086,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS022,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460086-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460086,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS022,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460086-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470079,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS072,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470079-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470079,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS072,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470079-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460086,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS022,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460086-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460087,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS032,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460087-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470080,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS012,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470080-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470080,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS012,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470080-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460087,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS032,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460087-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460087,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS032,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460087-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470081,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS092,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470081-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470081,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS092,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470081-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460087,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS032,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460087-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460087,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS032,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460087-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470082,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS102,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470082-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470082,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS102,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470082-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460087,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS032,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460087-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460087,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS032,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460087-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470092,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS202,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470092-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470092,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS202,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470092-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460090,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS062,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460090-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460090,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS062,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460090-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460096,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS122,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460096-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,87
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460097,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS132,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460097-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,88
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460090,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS062,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460090-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460090,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS062,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460090-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470093,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS212,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470093-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470093,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS212,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470093-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460097,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS132,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460097-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,91
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460097,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS132,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460097-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,92
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460097,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS132,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460097-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,93
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460097,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS132,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460097-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,94
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460110,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS262,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460110-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,185
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460005,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS082,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460005-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470004,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS102,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470004-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470004,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS102,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470004-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460005,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS082,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460005-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460005,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS082,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460104,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS202,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460104-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,141
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460104,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS202,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460104-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,142
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470083,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS112,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470083-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470083,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS112,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470083-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460088,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS042,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460088-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460088,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS042,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460088-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470086,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS142,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470086-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470086,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS142,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470086-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460088,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS042,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460088-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460089,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS052,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460089-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470087,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS152,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470087-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470087,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS152,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470087-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460089,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS052,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460089-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460089,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS052,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460089-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470088,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS162,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470088-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470088,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS162,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470088-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460089,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS052,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460089-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460089,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS052,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460089-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470089,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS172,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470089-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470089,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS172,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470089-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470090,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS182,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470090-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470090,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS182,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470090-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460094,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS102,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460094-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,71
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460094,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS102,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460094-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,72
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460094,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS102,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460094-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,73
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460095,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS112,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460095-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,74
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460102,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS182,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460102-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,123
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460102,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS182,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460102-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,124
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460102,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS182,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460102-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,125
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460102,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS182,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460102-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,126
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460114,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS052,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460114-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460115,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS062,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460115-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,24
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470108,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS112,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470108-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470108,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS112,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470108-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460115,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS062,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460115-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460115,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS062,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460115-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,26
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460090,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS062,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460090-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460090,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS062,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460090-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470091,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS192,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470091-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470091,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS192,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470091-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460090,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS062,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460090-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460091,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS072,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460091-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470094,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS222,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470094-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470094,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS222,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470094-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,47
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460091,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS072,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460091-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,47
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460091,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS072,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460091-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470095,Blue Advantage Silver HMO?003,33602TX047,,TXN002,TXS232,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470095-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470095,Blue Advantage Silver HMO?003,33602TX047,,TXN002,TXS232,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470095-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,49
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460091,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS072,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460091-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,49
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460091,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS072,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460091-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,50
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470096,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS242,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470096-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,50
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470096,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS242,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470096-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,51
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470097,Blue Advantage Silver HMO 003,33602TX047,,TXN002,TXS252,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470097-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,52
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470097,Blue Advantage Silver HMO 003,33602TX047,,TXN002,TXS252,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470097-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,53
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460106,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS222,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460106-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,155
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460106,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS222,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460106-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,156
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460098,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS142,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460098-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,101
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460099,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS152,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460099-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,102
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460099,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS152,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460099-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,103
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460099,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS152,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460099-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,104
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470103,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS062,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470103-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470103,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS062,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470103-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460112,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS032,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460112-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460113,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS042,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460113-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470104,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS072,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470104-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470104,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS072,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470104-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460120,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS112,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460120-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,45
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460120,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS112,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460120-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,46
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470119,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS222,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470119-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470119,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS222,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470119-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,47
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460106,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS222,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460106-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,157
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460107,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS232,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460107-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,158
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460113,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS042,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460113-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460113,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS042,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460113-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470105,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS082,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470105-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470105,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS082,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470105-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460119,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS102,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460119-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,43
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460120,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS112,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460120-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,44
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470118,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS212,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470118-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470118,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS212,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470118-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460092,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS012,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460092-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,53
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460092,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS012,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460092-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,54
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470098,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS262,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470098-00,Standard Silver Off Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,54
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470098,Blue Advantage Silver HMO? 003,33602TX047,,TXN002,TXS262,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470098-01,Standard Silver On Exchange Plan,,0.707263290882111,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,55
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460092,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS012,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460092-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,55
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460092,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS012,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460092-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,56
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460092,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS012,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460092-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,57
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460092,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS012,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460092-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,58
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460092,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS012,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460092-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,59
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460093,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS092,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460093-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,60
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460093,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS092,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460093-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,61
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460093,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS092,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460093-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,62
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460093,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS092,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460093-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,63
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460093,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS092,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460093-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,64
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460093,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS092,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460093-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,65
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460093,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS092,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460093-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,66
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460094,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS102,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460094-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,67
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460094,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS102,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460094-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,68
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460094,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS102,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460094-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,69
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460094,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS102,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460094-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,70
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460095,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS112,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460095-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,75
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460095,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS112,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460095-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,76
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460095,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS112,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460095-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,77
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460095,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS112,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460095-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,78
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460095,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS112,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460095-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,79
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460095,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS112,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460095-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,80
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460096,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS122,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460096-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,81
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460096,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS122,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460096-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,82
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460096,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS122,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460096-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,83
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460096,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS122,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460096-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,84
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460097,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS132,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460097-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,89
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460097,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS132,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460097-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,90
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460098,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS142,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460098-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,95
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460098,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS142,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460098-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,96
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460098,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS142,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460098-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,97
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460098,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS142,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460098-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,98
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460098,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS142,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460098-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,99
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460098,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS142,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460098-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,100
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460099,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS152,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460099-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,105
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460099,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS152,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460099-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,106
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460099,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS152,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460099-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,107
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460099,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS152,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460099-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,108
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460100,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS162,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460100-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,109
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460100,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS162,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460100-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,110
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460100,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS162,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460100-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,111
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460100,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS162,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460100-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,112
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460100,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS162,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460100-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,113
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460100,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS162,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460100-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,114
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460100,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS162,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460100-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,115
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460101,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS172,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460101-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,116
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460101,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS172,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460101-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,117
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460101,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS172,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460101-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,118
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460101,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS172,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460101-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,119
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460101,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS172,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460101-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,120
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460101,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS172,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460101-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,121
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460101,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS172,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460101-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,122
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460102,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS182,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460102-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,127
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460102,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS182,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460102-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,128
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460102,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS182,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460102-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,129
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460103,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS192,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460103-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,130
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460103,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS192,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460103-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,131
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460103,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS192,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460103-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,132
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460103,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS192,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460103-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,133
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460103,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS192,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460103-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,134
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460103,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS192,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460103-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,135
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460103,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS192,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460103-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,136
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460104,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS202,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460104-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,137
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460104,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS202,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460104-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,138
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460104,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS202,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460104-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,139
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460104,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS202,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460104-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,140
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460104,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS202,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460104-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,143
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460105,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS212,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460105-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,144
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460117,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS012,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460117-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,35
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460118,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS092,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460118-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,36
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470114,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS172,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470114-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470114,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS172,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470114-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460118,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS092,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460118-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,37
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460118,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS092,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460118-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,38
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460123,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS142,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460123-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,57
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460123,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS142,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460123-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,58
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460123,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS142,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460123-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,59
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460124,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS152,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460124-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,60
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470124,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS022,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470124-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470124,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS022,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470124-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460006,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS082,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460006-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460136,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS022,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460136-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460105,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS212,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460105-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,145
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460105,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS212,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460105-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,146
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460105,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS212,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460105-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,147
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460105,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS212,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460105-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,148
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460105,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS212,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460105-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,149
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460105,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS212,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460105-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,150
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460106,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS222,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460106-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,151
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460106,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS222,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460106-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,152
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460107,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS232,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460107-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,159
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460107,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS232,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460107-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,160
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460107,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS232,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460107-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,161
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460107,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS232,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460107-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,162
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460107,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS232,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460107-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,163
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460107,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS232,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460107-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,164
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460108,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS242,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460108-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,165
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460108,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS242,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460108-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,166
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460108,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS242,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460108-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,167
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460108,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS242,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460108-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,168
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460108,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS242,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460108-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,169
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460108,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS242,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460108-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,170
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460108,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS242,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460108-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,171
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460109,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS252,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460109-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,172
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460109,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS252,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460109-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,173
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460109,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS252,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460109-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,174
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460109,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS252,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460109-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,175
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460109,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS252,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460109-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,176
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460109,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS252,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460109-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,177
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460109,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS252,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460109-06,94% AV Level Silver Plan,,0.946654319763184,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,178
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460110,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS262,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460110-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,179
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460110,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS262,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460110-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,180
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460110,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS262,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460110-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,181
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460110,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS262,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460110-03,Limited Cost Sharing Plan Variation,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,182
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460110,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS262,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460110-04,73% AV Level Silver Plan,,0.735981404781342,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,183
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,7,33602,TX,Individual,No,36-1236610,33602TX0460110,Blue Advantage Silver HMO? 004,33602TX046,,TXN002,TXS262,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460110-05,87% AV Level Silver Plan,,0.873121440410614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,184
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470099,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS022,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470099-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470099,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS022,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470099-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460005,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS082,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460005-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460111,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS022,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460111-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470100,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS032,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470100-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470100,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS032,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470100-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460111,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS022,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460111-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460111,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS022,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460111-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470101,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS042,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470101-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470101,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS042,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470101-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460111,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS022,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460111-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460112,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS032,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460112-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470102,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS052,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470102-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470102,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS052,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470102-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460112,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS032,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460112-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460112,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS032,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460112-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460113,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS042,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460113-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460114,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS052,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460114-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470106,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS092,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470106-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470106,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS092,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470106-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460114,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS052,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460114-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460114,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS052,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460114-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470107,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS012,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470107-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470107,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS012,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470107-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470109,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS122,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470109-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470109,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS122,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470109-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460115,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS062,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460115-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,27
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460116,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS072,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460116-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,28
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470110,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS132,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470110-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470110,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS132,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470110-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460116,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS072,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460116-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,29
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460116,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS072,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460116-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,30
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470111,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS142,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470111-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470111,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS142,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470111-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460116,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS072,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460116-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,31
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460117,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS012,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460117-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,32
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470112,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS152,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470112-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470112,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS152,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470112-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460117,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS012,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460117-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,33
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460117,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS012,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460117-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,34
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470113,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS162,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470113-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470113,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS162,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470113-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460124,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS152,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460124-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,61
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460124,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS152,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460124-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,62
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460124,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS152,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460124-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,63
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460125,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS162,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460125-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,64
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460142,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS012,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460142-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,35
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460143,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS092,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460143-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,36
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470139,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS172,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470139-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,36
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470139,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS172,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470139-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,37
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460143,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS092,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460143-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,37
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460143,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS092,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460143-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,38
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470400,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS032,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470400-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470401,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS042,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470401-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470115,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS182,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470115-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470115,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS182,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470115-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460118,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS092,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460118-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,39
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460119,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS102,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460119-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,40
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470116,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS192,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470116-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470116,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS192,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470116-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460119,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS102,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460119-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,41
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460119,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS102,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460119-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,42
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470117,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS202,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470117-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470117,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS202,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470117-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460120,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS112,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460120-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,47
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460121,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS122,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460121-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,48
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470120,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS232,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470120-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470120,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS232,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470120-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,49
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460121,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS122,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460121-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,49
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460121,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS122,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460121-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,50
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470121,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS242,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470121-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,50
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470121,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS242,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470121-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,51
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460121,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS122,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460121-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,51
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460122,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS132,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460122-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,52
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460133,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS242,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460133-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,97
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460133,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS242,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460133-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,98
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460133,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS242,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460133-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,99
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460134,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS252,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460134-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,100
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460146,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS122,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460146-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,49
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460146,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS122,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460146-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,50
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470146,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS242,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470146-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,50
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470146,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS242,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470146-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,51
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460146,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS122,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460146-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,51
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460147,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS132,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460147-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,52
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460158,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS242,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460158-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,97
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460158,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS242,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460158-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,98
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470122,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS252,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470122-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,52
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470122,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS252,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470122-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,53
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460122,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS132,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460122-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,53
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460122,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS132,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460122-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,54
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470123,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS262,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470123-00,Standard Silver Off Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,54
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470123,Blue Advantage Silver HMO? 004,33602TX047,,TXN002,TXS262,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470123-01,Standard Silver On Exchange Plan,,0.710773587226868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,55
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460122,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS132,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460122-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,55
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460123,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS142,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460123-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,56
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460125,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS162,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460125-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,65
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460125,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS162,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460125-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,66
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460125,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS162,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460125-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,67
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460126,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS172,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460126-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,68
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460126,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS172,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460126-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,69
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460126,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS172,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460126-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,70
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460126,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS172,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460126-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,71
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460127,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS182,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460127-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,72
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460127,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS182,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460127-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,73
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460127,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS182,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460127-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,74
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460127,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS182,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460127-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,75
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460128,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS192,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460128-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,76
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460128,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS192,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460128-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,77
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460128,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS192,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460128-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,78
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460128,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS192,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460128-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,79
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460129,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS202,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460129-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,80
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460129,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS202,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460129-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,81
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460129,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS202,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460129-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,82
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460129,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS202,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460129-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,83
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460130,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS212,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460130-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,84
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460130,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS212,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460130-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,85
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460130,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS212,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460130-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,86
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470143,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS212,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470143-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,44
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470143,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS212,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470143-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,45
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460145,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS112,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460145-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,45
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460145,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS112,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460145-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,46
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470144,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS222,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470144-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,46
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470144,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS222,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470144-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,47
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470155,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS082,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470155-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470156,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS092,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470156-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470414,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS172,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470414-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470415,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS182,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470415-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470415,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS182,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470415-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470416,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS192,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470416-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460130,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS212,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460130-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,87
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460131,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS222,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460131-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,88
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460131,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS222,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460131-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,89
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460131,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS222,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460131-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,90
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460131,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS222,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460131-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,91
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460132,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS232,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460132-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,92
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460132,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS232,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460132-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,93
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460132,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS232,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460132-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,94
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460132,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS232,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460132-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,95
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460133,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS242,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460133-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,96
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460134,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS252,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460134-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,101
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460134,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS252,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460134-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,102
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460134,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS252,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460134-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,103
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460135,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS262,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460135-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,104
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460135,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS262,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460135-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,105
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460135,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS262,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460135-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,106
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,8,33602,TX,Individual,No,36-1236610,33602TX0460135,Blue Advantage Bronze HMO? 005,33602TX046,,TXN002,TXS262,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460135-03,Limited Cost Sharing Plan Variation,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,107
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460006,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS082,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460006-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470005,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS102,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470005-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470005,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS102,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470005-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460006,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS082,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460006-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460006,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS082,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470125,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS032,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470125-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470125,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS032,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470125-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460136,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS022,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460136-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460136,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS022,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460136-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470126,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS042,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470126-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470126,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS042,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470126-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460136,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS022,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460136-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460137,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS032,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460137-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470127,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS052,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470127-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470127,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS052,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470127-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460137,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS032,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460137-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460137,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS032,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460137-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470128,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS062,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470128-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470128,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS062,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470128-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460137,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS032,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460137-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460138,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS042,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460138-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470129,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS072,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470129-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470129,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS072,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470129-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460138,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS042,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460138-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460138,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS042,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460138-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470130,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS082,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470130-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470130,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS082,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470130-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460138,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS042,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460138-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460139,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS052,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460139-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470131,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS092,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470131-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470131,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS092,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470131-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470145,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS232,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470145-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,48
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470145,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS232,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470145-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,49
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470147,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS252,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470147-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,52
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470147,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS252,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470147-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,53
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460154,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS202,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460154-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,83
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460155,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS212,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460155-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,84
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470156,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS092,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470156-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470157,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS012,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470157-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470413,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS162,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470413-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470414,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS172,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470414-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460139,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS052,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460139-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460139,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS052,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460139-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470132,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS012,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470132-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470132,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS012,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470132-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460139,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS052,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460139-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460140,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS062,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460140-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,24
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470133,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS112,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470133-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,24
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470133,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS112,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470133-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460140,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS062,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460140-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460140,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS062,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460140-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,26
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470134,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS122,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470134-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,26
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470134,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS122,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470134-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,27
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460140,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS062,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460140-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,27
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460141,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS072,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460141-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,28
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470135,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS132,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470135-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,28
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470135,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS132,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470135-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,29
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460141,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS072,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460141-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,29
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460141,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS072,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460141-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,30
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470136,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS142,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470136-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,30
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470136,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS142,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470136-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,31
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460141,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS072,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460141-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,31
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460142,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS012,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460142-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,32
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470137,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS152,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470137-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,32
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470137,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS152,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470137-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,33
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460142,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS012,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460142-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,33
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460142,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS012,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460142-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,34
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470138,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS162,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470138-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,34
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470138,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS162,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470138-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,35
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470140,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS182,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470140-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,38
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470140,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS182,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470140-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,39
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460143,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS092,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460143-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,39
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460144,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS102,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460144-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,40
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470141,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS192,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470141-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,40
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470141,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS192,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470141-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,41
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460144,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS102,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460144-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,41
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460144,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS102,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460144-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,42
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470142,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS202,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470142-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,42
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470142,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS202,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470142-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,43
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460144,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS102,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460144-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,43
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460145,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS112,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460145-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,44
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460145,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS112,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460145-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,47
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460146,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS122,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460146-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,48
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460147,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS132,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460147-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,53
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460147,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS132,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460147-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,54
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470148,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS262,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470148-00,Standard Bronze Off Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,54
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470148,Blue Advantage Bronze HMO? 005,33602TX047,,TXN002,TXS262,TXF008,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470148-01,Standard Bronze On Exchange Plan,,0.618286550045013,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,55
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460147,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS132,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460147-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,55
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460148,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS142,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460148-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,56
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460148,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS142,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460148-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,57
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460148,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS142,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460148-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,58
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460148,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS142,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460148-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,59
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460149,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS152,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460149-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,60
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460149,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS152,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460149-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,61
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460149,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS152,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460149-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,62
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460149,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS152,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460149-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,63
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460150,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS162,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460150-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,64
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460150,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS162,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460150-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,65
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460150,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS162,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460150-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,66
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460150,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS162,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460150-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,67
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460151,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS172,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460151-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,68
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460151,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS172,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460151-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,69
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460151,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS172,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460151-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,70
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470020,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS102,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470020-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470399,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS022,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470399-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470399,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS022,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470399-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470400,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS032,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470400-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,40540,HIOS,4,2014-11-12 05:24:58,1,40540,TX,SHOP (Small Group),Yes,47-0397286,40540TX0080004,"Renaissance Group Dental PPO, EHB Certified (Exchange)",40540TX008,,TXN001,TXS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$13.46,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/TX_50_50_Low_2015,,http://www.renaissancedental.com/TX_50_50_Low_2015,,40540TX0080004-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,TX,40540,HIOS,4,2014-11-12 05:24:58,2,40540,TX,Individual,Yes,47-0397286,40540TX0050001,"Renaissance Individual Dental Pediatric-Only, EHB Certified",40540TX005,,TXN001,TXS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$32.50,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,40540TX0050001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,40540,HIOS,4,2014-11-12 05:24:58,2,40540,TX,Individual,Yes,47-0397286,40540TX0050002,"Renaissance Individual Dental Pediatric-Only, EHB Certified",40540TX005,,TXN001,TXS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$27.93,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,40540TX0050002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,40540,HIOS,4,2014-11-12 05:24:58,2,40540,TX,Individual,Yes,47-0397286,40540TX0070001,"Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)",40540TX007,,TXN001,TXS001,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$35.32,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/TX_Ped_High_2015,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/40540,http://www.renaissancedental.com/TX_Ped_High_2015,,40540TX0070001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TX,40540,HIOS,4,2014-11-12 05:24:58,2,40540,TX,Individual,Yes,47-0397286,40540TX0070002,"Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)",40540TX007,,TXN001,TXS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$30.38,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/TX_Ped_Low_2015,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/40540,http://www.renaissancedental.com/TX_Ped_Low_2015,,40540TX0070002-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460151,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS172,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460151-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,71
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460152,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS182,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460152-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,72
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470149,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS022,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470149-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470150,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS032,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470150-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470403,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS062,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470403-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470404,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS072,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470404-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470404,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS072,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470404-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470405,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS082,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470405-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470405,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS082,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470405-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470406,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS092,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470406-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,1,45786,TX,Individual,No,20-1494502,45786TX0010001,Molina Marketplace Gold Plan,45786TX001,,TXN001,TXS001,TXF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.996595327418336,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/marketplace/tx/plans/gold/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/gold/Pages/gold.aspx,45786TX0010001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,1,45786,TX,Individual,No,20-1494502,45786TX0010001,Molina Marketplace Gold Plan,45786TX001,,TXN001,TXS001,TXF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.996595327418336,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/marketplace/tx/plans/gold/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/gold/Pages/gold.aspx,45786TX0010001-03,Limited Cost Sharing Plan Variation,,0.796361267566681,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460152,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS182,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460152-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,73
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460152,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS182,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460152-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,74
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460152,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS182,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460152-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,75
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460153,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS192,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460153-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,76
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460153,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS192,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460153-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,77
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460153,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS192,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460153-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,78
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460153,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS192,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460153-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,79
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460154,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS202,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460154-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,80
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460154,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS202,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460154-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,81
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460154,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS202,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460154-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,82
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460155,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS212,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460155-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,85
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460155,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS212,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460155-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,86
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460155,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS212,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460155-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,87
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460156,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS222,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460156-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,88
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460156,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS222,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460156-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,89
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460156,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS222,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460156-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,90
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460156,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS222,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460156-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,91
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460157,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS232,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460157-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,92
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460157,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS232,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460157-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,93
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460157,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS232,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460157-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,94
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460157,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS232,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460157-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,95
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460158,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS242,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460158-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,96
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460158,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS242,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460158-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,99
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460159,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS252,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460159-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,100
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470168,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS212,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470168-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,45
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470169,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS222,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470169-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,46
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470169,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS222,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470169-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,47
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470170,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS232,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470170-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,48
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470418,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS212,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470418-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470419,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS222,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470419-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470419,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS222,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470419-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,47
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470420,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS232,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470420-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,TX,46224,HIOS,3,2014-11-14 05:23:27,1,46224,TX,Individual,No,74-2723334,46224TX0010001,CommunityFirstPlus,46224TX001,,TXN001,TXS001,TXF014,Existing,HMO,Silver,No,Both,No,No,,Refer to plan's certificate of coverage.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.cfhp.com/SBCS/HealthInsuranceExchange.asp,https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx,http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf,http://www.cfhp.com/Members/Commercial/ffmpreferreddrugs.pdf,46224TX0010001-06,94% AV Level Silver Plan,,0.948848783969879,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$200,$15,$734,$500,$200,$50,$450,"$1,000",10
2015,TX,46224,HIOS,3,2014-11-14 05:23:27,1,46224,TX,Individual,No,74-2723334,46224TX0010002,CommunityFirst Premier,46224TX001,,TXN001,TXS001,TXF007,Existing,HMO,Gold,No,Both,No,No,,Refer to plan's certificate of coverage.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.cfhp.com/SBCS/HealthInsuranceExchange.asp,https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx,http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf,http://www.cfhp.com/Members/Commercial/ffmpreferreddrugs.pdf,46224TX0010002-00,Standard Gold Off Exchange Plan,,0.792152762413025,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$50,$906,"$3,000","$1,500",$200,$480,"$3,000",11
2015,TX,46224,HIOS,3,2014-11-14 05:23:27,1,46224,TX,Individual,No,74-2723334,46224TX0010002,CommunityFirst Premier,46224TX001,,TXN001,TXS001,TXF007,Existing,HMO,Gold,No,Both,No,No,,Refer to plan's certificate of coverage.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.cfhp.com/SBCS/HealthInsuranceExchange.asp,https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx,http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf,http://www.cfhp.com/Members/Commercial/ffmpreferreddrugs.pdf,46224TX0010002-01,Standard Gold On Exchange Plan,,0.792152762413025,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$50,$906,"$3,000","$1,500",$200,$480,"$3,000",12
2015,TX,46224,HIOS,3,2014-11-14 05:23:27,1,46224,TX,Individual,No,74-2723334,46224TX0010002,CommunityFirst Premier,46224TX001,,TXN001,TXS001,TXF007,Existing,HMO,Gold,No,Both,No,No,,Refer to plan's certificate of coverage.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.cfhp.com/SBCS/HealthInsuranceExchange.asp,https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx,http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf,http://www.cfhp.com/Members/Commercial/ffmpreferreddrugs.pdf,46224TX0010002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,$0,$0,$0,,$0,$0,$0,13
2015,TX,46224,HIOS,3,2014-11-14 05:23:27,1,46224,TX,Individual,No,74-2723334,46224TX0010002,CommunityFirst Premier,46224TX001,,TXN001,TXS001,TXF007,Existing,HMO,Gold,No,Both,No,No,,Refer to plan's certificate of coverage.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.cfhp.com/SBCS/HealthInsuranceExchange.asp,https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx,http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf,http://www.cfhp.com/Members/Commercial/ffmpreferreddrugs.pdf,46224TX0010002-03,Limited Cost Sharing Plan Variation,,0.792152762413025,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$50,$906,"$3,000","$1,500",$200,$480,"$3,000",14
2015,TX,46224,HIOS,3,2014-11-14 05:23:27,2,46224,TX,Individual,No,74-2723334,46224TX0010003,CommunityFirst Value,46224TX001,,TXN001,TXS001,TXF002,Existing,HMO,Bronze,No,Both,No,No,,Refer to plan's certificate of coverage.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.cfhp.com/SBCS/HealthInsuranceExchange.asp,https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx,http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf,http://www.cfhp.com/Members/Commercial/ffmpreferreddrugs.pdf,46224TX0010003-00,Standard Bronze Off Exchange Plan,,0.611952126026154,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,250","$10,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,250",$0,$916,"$6,600","$5,250",$0,"$1,150","$6,600",4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460159,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS252,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460159-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,101
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460159,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS252,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460159-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,102
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460159,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS252,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460159-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,103
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460160,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS262,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460160-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,104
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460160,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS262,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460160-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,105
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460160,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS262,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460160-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,106
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,9,33602,TX,Individual,No,36-1236610,33602TX0460160,Blue Advantage Bronze HMO? 006,33602TX046,,TXN002,TXS262,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0460160-03,Limited Cost Sharing Plan Variation,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,107
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470006,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS102,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470006-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470006,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS102,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470006-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470149,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS022,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470149-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470150,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS032,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470150-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470151,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS042,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470151-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470151,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS042,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470151-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470152,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS052,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470152-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470152,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS052,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470152-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470153,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS062,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470153-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470153,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS062,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470153-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470154,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS072,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470154-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470154,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS072,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470154-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470155,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS082,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470155-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470157,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS012,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470157-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470158,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS112,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470158-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,24
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470158,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS112,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470158-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470159,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS122,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470159-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,26
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470159,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS122,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470159-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,27
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470160,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS132,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470160-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,28
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470160,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS132,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470160-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,29
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470161,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS142,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470161-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,30
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470161,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS142,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470161-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,31
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470162,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS152,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470162-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,32
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470162,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS152,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470162-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,33
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470163,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS162,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470163-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,34
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470163,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS162,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470163-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,35
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470164,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS172,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470164-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,36
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470164,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS172,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470164-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,37
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470165,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS182,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470165-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,38
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470165,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS182,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470165-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,39
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470166,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS192,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470166-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,40
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470166,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS192,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470166-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,41
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470167,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS202,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470167-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,42
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470167,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS202,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470167-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,43
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470168,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS212,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470168-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,44
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470170,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS232,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470170-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,49
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470171,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS242,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470171-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,50
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470171,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS242,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470171-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,51
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470172,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS252,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470172-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,52
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470172,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS252,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470172-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,53
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470173,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS262,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470173-00,Standard Bronze Off Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,54
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,10,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470173,Blue Advantage Bronze HMO? 006,33602TX047,,TXN002,TXS262,TXF007,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470173-01,Standard Bronze On Exchange Plan,,0.597155630588531,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,55
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470020,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS102,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470020-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470401,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS042,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470401-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470402,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS052,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470402-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470402,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS052,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470402-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470403,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS062,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470403-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470406,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS092,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470406-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470407,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS012,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470407-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470407,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS012,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470407-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470408,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS112,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470408-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470408,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS112,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470408-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470409,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS122,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470409-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470409,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS122,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470409-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470410,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS132,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470410-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470410,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS132,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470410-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470411,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS142,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470411-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470411,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS142,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470411-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470412,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS152,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470412-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470412,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS152,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470412-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470413,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS162,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470413-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,3,40788,TX,Individual,No,74-2052197,40788TX0170002,Scott and White Health Plan Bronze 5000 H.S.A.,40788TX017,,TXN001,TXS001,TXF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0170002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,3,40788,TX,Individual,No,74-2052197,40788TX0170002,Scott and White Health Plan Bronze 5000 H.S.A.,40788TX017,,TXN001,TXS001,TXF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0170002-03,Limited Cost Sharing Plan Variation,59.50%,0.591570556163788,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,46224,HIOS,3,2014-11-14 05:23:27,3,46224,TX,Individual,No,74-2723334,46224TX0030001,CommunityFirst Advantage,46224TX003,,TXN001,TXS001,TXF009,New,HMO,Silver,No,Both,No,No,,Refer to plan's certificate of coverage.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.cfhp.com/SBCS/HealthInsuranceExchange.asp,https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx,http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf,http://www.cfhp.com/Members/Commercial/ffmpreferreddrugs.pdf,46224TX0030001-01,Standard Silver On Exchange Plan,,0.717505276203156,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$75,$0,"$6,600",$0,,$0,"$6,600",5
2015,TX,46224,HIOS,3,2014-11-14 05:23:27,3,46224,TX,Individual,No,74-2723334,46224TX0030001,CommunityFirst Advantage,46224TX003,,TXN001,TXS001,TXF009,New,HMO,Silver,No,Both,No,No,,Refer to plan's certificate of coverage.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.cfhp.com/SBCS/HealthInsuranceExchange.asp,https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx,http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf,http://www.cfhp.com/Members/Commercial/ffmpreferreddrugs.pdf,46224TX0030001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,,$0,,$0,,6
2015,TX,46224,HIOS,3,2014-11-14 05:23:27,3,46224,TX,Individual,No,74-2723334,46224TX0030001,CommunityFirst Advantage,46224TX003,,TXN001,TXS001,TXF009,New,HMO,Silver,No,Both,No,No,,Refer to plan's certificate of coverage.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.cfhp.com/SBCS/HealthInsuranceExchange.asp,https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx,http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf,http://www.cfhp.com/Members/Commercial/ffmpreferreddrugs.pdf,46224TX0030001-03,Limited Cost Sharing Plan Variation,,0.717505276203156,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$75,$0,"$6,600",$0,,$0,"$6,600",7
2015,TX,46224,HIOS,3,2014-11-14 05:23:27,3,46224,TX,Individual,No,74-2723334,46224TX0030001,CommunityFirst Advantage,46224TX003,,TXN001,TXS001,TXF009,New,HMO,Silver,No,Both,No,No,,Refer to plan's certificate of coverage.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.cfhp.com/SBCS/HealthInsuranceExchange.asp,https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx,http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf,http://www.cfhp.com/Members/Commercial/ffmpreferreddrugs.pdf,46224TX0030001-04,73% AV Level Silver Plan,,0.738633036613464,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$75,$0,"$5,000",$0,,$0,"$5,000",8
2015,TX,46224,HIOS,3,2014-11-14 05:23:27,3,46224,TX,Individual,No,74-2723334,46224TX0030001,CommunityFirst Advantage,46224TX003,,TXN001,TXS001,TXF009,New,HMO,Silver,No,Both,No,No,,Refer to plan's certificate of coverage.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.cfhp.com/SBCS/HealthInsuranceExchange.asp,https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx,http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf,http://www.cfhp.com/Members/Commercial/ffmpreferreddrugs.pdf,46224TX0030001-05,87% AV Level Silver Plan,,0.875776827335358,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$0,"$2,250",$0,,$0,"$2,250",9
2015,TX,46224,HIOS,3,2014-11-14 05:23:27,3,46224,TX,Individual,No,74-2723334,46224TX0030001,CommunityFirst Advantage,46224TX003,,TXN001,TXS001,TXF009,New,HMO,Silver,No,Both,No,No,,Refer to plan's certificate of coverage.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.cfhp.com/SBCS/HealthInsuranceExchange.asp,https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx,http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf,http://www.cfhp.com/Members/Commercial/ffmpreferreddrugs.pdf,46224TX0030001-06,94% AV Level Silver Plan,,0.935316205024719,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$20,$0,"$1,000",$0,,$0,"$1,000",10
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,1,47665,TX,Individual,Yes,95-6042390,47665TX0020001,BESTOne Child Dental Plus,47665TX002,,TXN001,TXS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$33.41,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BESTOne_Child_Dental_Plus_Plan.pdf,,47665TX0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,1,47665,TX,SHOP (Small Group),Yes,95-6042390,47665TX0010001,BEST Life Child Dental Plus,47665TX001,,TXN001,TXS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.73,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BEST_Life_Child_Dental_Plus_Plan.pdf,,47665TX0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,2,47665,TX,SHOP (Small Group),Yes,95-6042390,47665TX0010002,BEST Life Child Dental,47665TX001,,TXN001,TXS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$22.46,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BEST_Life_Child_Dental_Plan.pdf,,47665TX0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,2,47665,TX,Individual,Yes,95-6042390,47665TX0020002,BESTOne Child Dental,47665TX002,,TXN001,TXS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$28.10,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BESTOne_Child_Dental_Plan.pdf,,47665TX0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,3,47665,TX,Individual,Yes,95-6042390,47665TX0020003,BESTOne Dental Advantage-Gold,47665TX002,,TXN001,TXS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.41,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BESTOne_Dental_Advantage-Gold_Plan.pdf,,47665TX0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,3,47665,TX,SHOP (Small Group),Yes,95-6042390,47665TX0010007,BEST Dental Premium,47665TX001,,TXN001,TXS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.73,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BESTDental_Premium_Plan.pdf,,47665TX0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,3,47665,TX,SHOP (Small Group),Yes,95-6042390,47665TX0010007,BEST Dental Premium,47665TX001,,TXN001,TXS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.73,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BESTDental_Premium_Plan.pdf,,47665TX0010007-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,3,47665,TX,Individual,Yes,95-6042390,47665TX0020003,BESTOne Dental Advantage-Gold,47665TX002,,TXN001,TXS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.41,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BESTOne_Dental_Advantage-Gold_Plan.pdf,,47665TX0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,3,47665,TX,Individual,Yes,95-6042390,47665TX0020004,BESTOne Dental Plus-Gold,47665TX002,,TXN001,TXS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.41,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BESTOne_Dental_Plus-Gold_Plan.pdf,,47665TX0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,3,47665,TX,SHOP (Small Group),Yes,95-6042390,47665TX0010008,BEST Dental Standard-H,47665TX001,,TXN001,TXS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.73,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BESTDental_Standard-H_Plan.pdf,,47665TX0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,3,47665,TX,SHOP (Small Group),Yes,95-6042390,47665TX0010008,BEST Dental Standard-H,47665TX001,,TXN001,TXS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.73,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BESTDental_Standard-H_Plan.pdf,,47665TX0010008-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,3,47665,TX,Individual,Yes,95-6042390,47665TX0020004,BESTOne Dental Plus-Gold,47665TX002,,TXN001,TXS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.41,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BESTOne_Dental_Plus-Gold_Plan.pdf,,47665TX0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470416,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS192,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470416-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470417,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS202,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470417-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470417,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS202,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470417-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470418,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS212,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470418-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470420,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS232,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470420-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,49
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470421,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS242,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470421-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,50
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470421,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS242,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470421-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,51
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470422,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS252,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470422-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,52
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470422,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS252,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470422-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,53
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470423,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS262,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470423-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,54
2015,TX,33602,HIOS,7,2015-02-19 06:21:02,11,33602,TX,SHOP (Small Group),No,36-1236610,33602TX0470423,Blue Advantage Silver HMO? 020,33602TX047,,TXN002,TXS262,TXF006,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbstx.com/employer/products/on-exchange/,,http://www.bcbstx.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierGenericsPlusDrugList.pdf,33602TX0470423-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,55
2015,TX,40540,HIOS,4,2014-11-12 05:24:58,1,40540,TX,SHOP (Small Group),Yes,47-0397286,40540TX0030001,"Renaissance Group Dental PPO, EHB Certified",40540TX003,,TXN001,TXS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,40540TX0030001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,40540,HIOS,4,2014-11-12 05:24:58,1,40540,TX,Individual,Yes,47-0397286,40540TX0010001,"Delta Dental Individual PPO, EHB Certified",40540TX001,,TXN002,TXS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.86,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,40540TX0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,40540,HIOS,4,2014-11-12 05:24:58,1,40540,TX,Individual,Yes,47-0397286,40540TX0010002,"Delta Dental Individual PPO, EHB Certified",40540TX001,,TXN002,TXS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.66,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,40540TX0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,40540,HIOS,4,2014-11-12 05:24:58,1,40540,TX,SHOP (Small Group),Yes,47-0397286,40540TX0030002,"Renaissance Group Dental PPO, EHB Certified",40540TX003,,TXN001,TXS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.12,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,40540TX0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,40540,HIOS,4,2014-11-12 05:24:58,1,40540,TX,SHOP (Small Group),Yes,47-0397286,40540TX0080001,"Renaissance Group Dental PPO, EHB Certified (Exchange)",40540TX008,,TXN001,TXS001,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$13.46,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/TX_EHB_Group_High_2015,,http://www.renaissancedental.com/TX_EHB_Group_High_2015,,40540TX0080001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TX,40540,HIOS,4,2014-11-12 05:24:58,1,40540,TX,Individual,Yes,47-0397286,40540TX0020001,"Renaissance Individual Dental PPO, EHB Certified",40540TX002,,TXN001,TXS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.50,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,40540TX0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TX,40540,HIOS,4,2014-11-12 05:24:58,1,40540,TX,Individual,Yes,47-0397286,40540TX0020002,"Renaissance Individual Dental PPO, EHB Certified",40540TX002,,TXN001,TXS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.93,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,40540TX0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TX,40540,HIOS,4,2014-11-12 05:24:58,1,40540,TX,SHOP (Small Group),Yes,47-0397286,40540TX0080002,"Renaissance Group Dental PPO, EHB Certified (Exchange)",40540TX008,,TXN001,TXS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$13.46,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/TX_EHB_Group_Low_2015,,http://www.renaissancedental.com/TX_EHB_Group_Low_2015,,40540TX0080002-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TX,40540,HIOS,4,2014-11-12 05:24:58,1,40540,TX,SHOP (Small Group),Yes,47-0397286,40540TX0080003,"Renaissance Group Dental PPO, EHB Certified (Exchange)",40540TX008,,TXN001,TXS001,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$13.46,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/TX_50_50_High_2015,,http://www.renaissancedental.com/TX_50_50_High_2015,,40540TX0080003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,TX,40540,HIOS,4,2014-11-12 05:24:58,1,40540,TX,Individual,Yes,47-0397286,40540TX0060001,"Renaissance Individual Dental PPO, EHB Certified (Exchange)",40540TX006,,TXN001,TXS001,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.03,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/TX_EHB_High_2015,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/40540,http://www.renaissancedental.com/TX_EHB_High_2015,,40540TX0060001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,TX,40540,HIOS,4,2014-11-12 05:24:58,1,40540,TX,Individual,Yes,47-0397286,40540TX0060002,"Renaissance Individual Dental PPO, EHB Certified (Exchange)",40540TX006,,TXN001,TXS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.76,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/TX_EHB_Low_2015,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/40540,http://www.renaissancedental.com/TX_EHB_Low_2015,,40540TX0060002-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,1,40788,TX,Individual,No,74-2052197,40788TX0160001,Scott and White Health Plan Catastrophic 6350,40788TX016,,TXN001,TXS001,TXF001,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,3,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0160001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,1,40788,TX,Individual,No,74-2052197,40788TX0160001,Scott and White Health Plan Catastrophic 6350,40788TX016,,TXN001,TXS001,TXF001,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,3,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0160001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,2,40788,TX,Individual,No,74-2052197,40788TX0180001,Scott and White Health Plan Silver 3000,40788TX018,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180001-00,Standard Silver Off Exchange Plan,68.10%,0.672454535961151,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,2,40788,TX,Individual,No,74-2052197,40788TX0180001,Scott and White Health Plan Silver 3000,40788TX018,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180001-01,Standard Silver On Exchange Plan,68.10%,0.672454535961151,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,2,40788,TX,Individual,No,74-2052197,40788TX0180001,Scott and White Health Plan Silver 3000,40788TX018,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,2,40788,TX,Individual,No,74-2052197,40788TX0180001,Scott and White Health Plan Silver 3000,40788TX018,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180001-03,Limited Cost Sharing Plan Variation,68.10%,0.672454535961151,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,2,40788,TX,Individual,No,74-2052197,40788TX0180001,Scott and White Health Plan Silver 3000,40788TX018,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180001-04,73% AV Level Silver Plan,72.20%,0.711905837059021,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,2,40788,TX,Individual,No,74-2052197,40788TX0180001,Scott and White Health Plan Silver 3000,40788TX018,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180001-05,87% AV Level Silver Plan,87.40%,0.860200107097626,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,1,45786,TX,Individual,No,20-1494502,45786TX0010001,Molina Marketplace Gold Plan,45786TX001,,TXN001,TXS001,TXF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.996595327418336,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/marketplace/tx/plans/gold/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/gold/Pages/gold.aspx,45786TX0010001-00,Standard Gold Off Exchange Plan,,0.796361267566681,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,1,45786,TX,Individual,No,20-1494502,45786TX0010001,Molina Marketplace Gold Plan,45786TX001,,TXN001,TXS001,TXF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.996595327418336,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/marketplace/tx/plans/gold/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/gold/Pages/gold.aspx,45786TX0010001-01,Standard Gold On Exchange Plan,,0.796361267566681,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,2,45786,TX,Individual,No,20-1494502,45786TX0010002,Molina Marketplace Silver Plan,45786TX001,,TXN001,TXS001,TXF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.987841353111539,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/marketplace/tx/plans/silver/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/silver/Pages/silver.aspx,45786TX0010002-00,Standard Silver Off Exchange Plan,,0.709303736686707,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$0,$0,40%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,40%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,2,45786,TX,Individual,No,20-1494502,45786TX0010002,Molina Marketplace Silver Plan,45786TX001,,TXN001,TXS001,TXF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.987841353111539,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/marketplace/tx/plans/silver/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/silver/Pages/silver.aspx,45786TX0010002-01,Standard Silver On Exchange Plan,,0.709303736686707,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$0,$0,40%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,40%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,2,45786,TX,Individual,No,20-1494502,45786TX0010002,Molina Marketplace Silver Plan,45786TX001,,TXN001,TXS001,TXF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.987841353111539,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/marketplace/tx/plans/silver/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/silver/Pages/silver.aspx,45786TX0010002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,2,45786,TX,Individual,No,20-1494502,45786TX0010002,Molina Marketplace Silver Plan,45786TX001,,TXN001,TXS001,TXF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.987841353111539,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/marketplace/tx/plans/silver/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/silver/Pages/silver.aspx,45786TX0010002-03,Limited Cost Sharing Plan Variation,,0.709303736686707,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$0,$0,40%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,40%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,2,40788,TX,Individual,No,74-2052197,40788TX0180001,Scott and White Health Plan Silver 3000,40788TX018,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180001-06,94% AV Level Silver Plan,93.30%,0.897824168205261,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,2,40788,TX,Individual,No,74-2052197,40788TX0190001,Scott and White Health Plan Gold 1000,40788TX019,,TXN001,TXS001,TXF007,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0190001-00,Standard Gold Off Exchange Plan,78.40%,0.772826731204987,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,2,40788,TX,Individual,No,74-2052197,40788TX0190001,Scott and White Health Plan Gold 1000,40788TX019,,TXN001,TXS001,TXF007,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0190001-01,Standard Gold On Exchange Plan,78.40%,0.772826731204987,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,2,40788,TX,Individual,No,74-2052197,40788TX0190001,Scott and White Health Plan Gold 1000,40788TX019,,TXN001,TXS001,TXF007,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0190001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,9,40788,TX,Individual,No,74-2052197,40788TX0180006,Scott and White Health Plan Silver 2500/30OV,40788TX018,,TXN001,TXS001,TXF013,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180006-05,87% AV Level Silver Plan,86.20%,0.873332262039185,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,9,40788,TX,Individual,No,74-2052197,40788TX0180006,Scott and White Health Plan Silver 2500/30OV,40788TX018,,TXN001,TXS001,TXF013,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180006-06,94% AV Level Silver Plan,94.40%,0.943444430828094,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,2,45786,TX,Individual,No,20-1494502,45786TX0010002,Molina Marketplace Silver Plan,45786TX001,,TXN001,TXS001,TXF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.987841353111539,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/marketplace/tx/plans/silver/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/silver/Pages/silver.aspx,45786TX0010002-04,73% AV Level Silver Plan,,0.739768922328949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,"$5,200","$10,400",$0,$0,35%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,35%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,2,45786,TX,Individual,No,20-1494502,45786TX0010002,Molina Marketplace Silver Plan,45786TX001,,TXN001,TXS001,TXF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.987841353111539,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/marketplace/tx/plans/silver/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/silver/Pages/silver.aspx,45786TX0010002-05,87% AV Level Silver Plan,,0.876791298389435,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,"$2,250","$4,500",$0,$0,25%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,25%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,2,45786,TX,Individual,No,20-1494502,45786TX0010002,Molina Marketplace Silver Plan,45786TX001,,TXN001,TXS001,TXF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.987841353111539,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/marketplace/tx/plans/silver/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/silver/Pages/silver.aspx,45786TX0010002-06,94% AV Level Silver Plan,,0.943551361560822,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,"$2,250","$4,500",$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,3,45786,TX,Individual,No,20-1494502,45786TX0020001,Molina Marketplace Choice Gold Plan,45786TX002,,TXN001,TXS001,TXF001,New,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.996553040933116,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/goldhttp://www.molinahealthcare.com/marketplace/tx/plans/gold-cc/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/gold/Pages/gold.aspx,45786TX0020001-00,Standard Gold Off Exchange Plan,,0.797688841819763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,3,45786,TX,Individual,No,20-1494502,45786TX0020001,Molina Marketplace Choice Gold Plan,45786TX002,,TXN001,TXS001,TXF001,New,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.996553040933116,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/goldhttp://www.molinahealthcare.com/marketplace/tx/plans/gold-cc/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/gold/Pages/gold.aspx,45786TX0020001-01,Standard Gold On Exchange Plan,,0.797688841819763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,3,45786,TX,Individual,No,20-1494502,45786TX0020001,Molina Marketplace Choice Gold Plan,45786TX002,,TXN001,TXS001,TXF001,New,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.996553040933116,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/goldhttp://www.molinahealthcare.com/marketplace/tx/plans/gold-cc/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/gold/Pages/gold.aspx,45786TX0020001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,2,40788,TX,Individual,No,74-2052197,40788TX0190001,Scott and White Health Plan Gold 1000,40788TX019,,TXN001,TXS001,TXF007,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0190001-03,Limited Cost Sharing Plan Variation,78.40%,0.772826731204987,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,2,40788,TX,Individual,No,74-2052197,40788TX0180005,Scott and White Health Plan Silver 2500/OV35,40788TX018,,TXN001,TXS001,TXF012,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180005-00,Standard Silver Off Exchange Plan,68.10%,0.67042201757431,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,2,40788,TX,Individual,No,74-2052197,40788TX0180005,Scott and White Health Plan Silver 2500/OV35,40788TX018,,TXN001,TXS001,TXF012,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180005-01,Standard Silver On Exchange Plan,68.10%,0.67042201757431,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,2,40788,TX,Individual,No,74-2052197,40788TX0180005,Scott and White Health Plan Silver 2500/OV35,40788TX018,,TXN001,TXS001,TXF012,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,17
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,2,40788,TX,Individual,No,74-2052197,40788TX0180005,Scott and White Health Plan Silver 2500/OV35,40788TX018,,TXN001,TXS001,TXF012,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180005-03,Limited Cost Sharing Plan Variation,68.10%,0.67042201757431,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,2,40788,TX,Individual,No,74-2052197,40788TX0180005,Scott and White Health Plan Silver 2500/OV35,40788TX018,,TXN001,TXS001,TXF012,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180005-04,73% AV Level Silver Plan,72.20%,0.732352554798126,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,2,40788,TX,Individual,No,74-2052197,40788TX0180005,Scott and White Health Plan Silver 2500/OV35,40788TX018,,TXN001,TXS001,TXF012,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180005-05,87% AV Level Silver Plan,87.00%,0.861422657966614,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,2,40788,TX,Individual,No,74-2052197,40788TX0180005,Scott and White Health Plan Silver 2500/OV35,40788TX018,,TXN001,TXS001,TXF012,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180005-06,94% AV Level Silver Plan,93.10%,0.930801928043365,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,3,40788,TX,Individual,No,74-2052197,40788TX0170002,Scott and White Health Plan Bronze 5000 H.S.A.,40788TX017,,TXN001,TXS001,TXF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0170002-00,Standard Bronze Off Exchange Plan,59.50%,0.591570556163788,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,3,40788,TX,Individual,No,74-2052197,40788TX0170002,Scott and White Health Plan Bronze 5000 H.S.A.,40788TX017,,TXN001,TXS001,TXF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0170002-01,Standard Bronze On Exchange Plan,59.50%,0.591570556163788,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,3,40788,TX,Individual,No,74-2052197,40788TX0180003,Scott and White Health Plan Silver 2750 H.S.A.,40788TX018,,TXN001,TXS001,TXF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180003-00,Standard Silver Off Exchange Plan,68.70%,0.64389032125473,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,3,40788,TX,Individual,No,74-2052197,40788TX0180003,Scott and White Health Plan Silver 2750 H.S.A.,40788TX018,,TXN001,TXS001,TXF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180003-01,Standard Silver On Exchange Plan,68.70%,0.64389032125473,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,3,40788,TX,Individual,No,74-2052197,40788TX0180003,Scott and White Health Plan Silver 2750 H.S.A.,40788TX018,,TXN001,TXS001,TXF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,3,40788,TX,Individual,No,74-2052197,40788TX0180003,Scott and White Health Plan Silver 2750 H.S.A.,40788TX018,,TXN001,TXS001,TXF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180003-03,Limited Cost Sharing Plan Variation,68.70%,0.64389032125473,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,3,40788,TX,Individual,No,74-2052197,40788TX0180003,Scott and White Health Plan Silver 2750 H.S.A.,40788TX018,,TXN001,TXS001,TXF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180003-04,73% AV Level Silver Plan,73.50%,0.728263378143311,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,3,40788,TX,Individual,No,74-2052197,40788TX0180003,Scott and White Health Plan Silver 2750 H.S.A.,40788TX018,,TXN001,TXS001,TXF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180003-05,87% AV Level Silver Plan,86.80%,0.857962965965271,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$550,"$1,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,3,40788,TX,Individual,No,74-2052197,40788TX0180003,Scott and White Health Plan Silver 2750 H.S.A.,40788TX018,,TXN001,TXS001,TXF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180003-06,94% AV Level Silver Plan,94.40%,0.931664168834686,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,3,40788,TX,Individual,No,74-2052197,40788TX0190002,Scott and White Health Plan Gold 1400 H.S.A.,40788TX019,,TXN001,TXS001,TXF008,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0190002-00,Standard Gold Off Exchange Plan,78.80%,0.761456727981567,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,3,40788,TX,Individual,No,74-2052197,40788TX0190002,Scott and White Health Plan Gold 1400 H.S.A.,40788TX019,,TXN001,TXS001,TXF008,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0190002-01,Standard Gold On Exchange Plan,78.80%,0.761456727981567,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,3,40788,TX,Individual,No,74-2052197,40788TX0190002,Scott and White Health Plan Gold 1400 H.S.A.,40788TX019,,TXN001,TXS001,TXF008,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0190002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,3,40788,TX,Individual,No,74-2052197,40788TX0190002,Scott and White Health Plan Gold 1400 H.S.A.,40788TX019,,TXN001,TXS001,TXF008,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0190002-03,Limited Cost Sharing Plan Variation,78.80%,0.761456727981567,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,4,40788,TX,Individual,No,74-2052197,40788TX0190003,Scott and White Health Plan Gold HMO 30,40788TX019,,TXN001,TXS001,TXF005,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0190003-00,Standard Gold Off Exchange Plan,78.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,4,40788,TX,Individual,No,74-2052197,40788TX0190003,Scott and White Health Plan Gold HMO 30,40788TX019,,TXN001,TXS001,TXF005,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0190003-01,Standard Gold On Exchange Plan,78.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,4,40788,TX,Individual,No,74-2052197,40788TX0190003,Scott and White Health Plan Gold HMO 30,40788TX019,,TXN001,TXS001,TXF005,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0190003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,4,40788,TX,Individual,No,74-2052197,40788TX0190003,Scott and White Health Plan Gold HMO 30,40788TX019,,TXN001,TXS001,TXF005,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0190003-03,Limited Cost Sharing Plan Variation,78.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,5,40788,TX,Individual,No,74-2052197,40788TX0170001,Scott and White Health Plan Bronze 6000/50Ov,40788TX017,,TXN001,TXS001,TXF002,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,3,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0170001-00,Standard Bronze Off Exchange Plan,,0.594311892986298,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,5,40788,TX,Individual,No,74-2052197,40788TX0170001,Scott and White Health Plan Bronze 6000/50Ov,40788TX017,,TXN001,TXS001,TXF002,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,3,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0170001-01,Standard Bronze On Exchange Plan,,0.594311892986298,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,5,40788,TX,Individual,No,74-2052197,40788TX0170001,Scott and White Health Plan Bronze 6000/50Ov,40788TX017,,TXN001,TXS001,TXF002,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,3,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0170001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,5,40788,TX,Individual,No,74-2052197,40788TX0170001,Scott and White Health Plan Bronze 6000/50Ov,40788TX017,,TXN001,TXS001,TXF002,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,3,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0170001-03,Limited Cost Sharing Plan Variation,,0.594311892986298,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,6,40788,TX,Individual,No,74-2052197,40788TX0170003,Scott and White Health Plan Bronze 6600,40788TX017,,TXN001,TXS001,TXF009,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,3,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0170003-00,Standard Bronze Off Exchange Plan,,0.606021761894226,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,6,40788,TX,Individual,No,74-2052197,40788TX0170003,Scott and White Health Plan Bronze 6600,40788TX017,,TXN001,TXS001,TXF009,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,3,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0170003-01,Standard Bronze On Exchange Plan,,0.606021761894226,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,6,40788,TX,Individual,No,74-2052197,40788TX0170003,Scott and White Health Plan Bronze 6600,40788TX017,,TXN001,TXS001,TXF009,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,3,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0170003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,6,40788,TX,Individual,No,74-2052197,40788TX0170003,Scott and White Health Plan Bronze 6600,40788TX017,,TXN001,TXS001,TXF009,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,3,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0170003-03,Limited Cost Sharing Plan Variation,,0.606021761894226,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,7,40788,TX,Individual,No,74-2052197,40788TX0170004,Scott and White Health Plan Bronze 6000/35OV,40788TX017,,TXN001,TXS001,TXF010,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,3,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0170004-00,Standard Bronze Off Exchange Plan,58.10%,0.63050103187561,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,"$1,200",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,7,40788,TX,Individual,No,74-2052197,40788TX0170004,Scott and White Health Plan Bronze 6000/35OV,40788TX017,,TXN001,TXS001,TXF010,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,3,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0170004-01,Standard Bronze On Exchange Plan,58.10%,0.63050103187561,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,"$1,200",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,7,40788,TX,Individual,No,74-2052197,40788TX0170004,Scott and White Health Plan Bronze 6000/35OV,40788TX017,,TXN001,TXS001,TXF010,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,3,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0170004-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,7,40788,TX,Individual,No,74-2052197,40788TX0170004,Scott and White Health Plan Bronze 6000/35OV,40788TX017,,TXN001,TXS001,TXF010,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,3,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0170004-03,Limited Cost Sharing Plan Variation,58.10%,0.63050103187561,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,"$1,200",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,8,40788,TX,Individual,No,74-2052197,40788TX0170005,Scott and White Health Plan Bronze 6600/60OV,40788TX017,,TXN001,TXS001,TXF011,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,3,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0170005-00,Standard Bronze Off Exchange Plan,,0.587739706039429,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,8,40788,TX,Individual,No,74-2052197,40788TX0170005,Scott and White Health Plan Bronze 6600/60OV,40788TX017,,TXN001,TXS001,TXF011,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,3,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0170005-01,Standard Bronze On Exchange Plan,,0.587739706039429,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,8,40788,TX,Individual,No,74-2052197,40788TX0170005,Scott and White Health Plan Bronze 6600/60OV,40788TX017,,TXN001,TXS001,TXF011,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,3,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0170005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,8,40788,TX,Individual,No,74-2052197,40788TX0170005,Scott and White Health Plan Bronze 6600/60OV,40788TX017,,TXN001,TXS001,TXF011,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,3,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0170005-03,Limited Cost Sharing Plan Variation,,0.587739706039429,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,9,40788,TX,Individual,No,74-2052197,40788TX0180006,Scott and White Health Plan Silver 2500/30OV,40788TX018,,TXN001,TXS001,TXF013,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180006-00,Standard Silver Off Exchange Plan,68.00%,0.674485325813293,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,9,40788,TX,Individual,No,74-2052197,40788TX0180006,Scott and White Health Plan Silver 2500/30OV,40788TX018,,TXN001,TXS001,TXF013,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180006-01,Standard Silver On Exchange Plan,68.00%,0.674485325813293,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,9,40788,TX,Individual,No,74-2052197,40788TX0180006,Scott and White Health Plan Silver 2500/30OV,40788TX018,,TXN001,TXS001,TXF013,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180006-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,9,40788,TX,Individual,No,74-2052197,40788TX0180006,Scott and White Health Plan Silver 2500/30OV,40788TX018,,TXN001,TXS001,TXF013,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180006-03,Limited Cost Sharing Plan Variation,68.00%,0.674485325813293,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,40788,HIOS,6,2014-11-13 10:25:37,9,40788,TX,Individual,No,74-2052197,40788TX0180006,Scott and White Health Plan Silver 2500/30OV,40788TX018,,TXN001,TXS001,TXF013,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,Yes,For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.,No,https://swhp.org/plandoc,,https://swhp.org/plandoc,https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information,40788TX0180006-04,73% AV Level Silver Plan,72.50%,0.735775828361511,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,3,45786,TX,Individual,No,20-1494502,45786TX0020001,Molina Marketplace Choice Gold Plan,45786TX002,,TXN001,TXS001,TXF001,New,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.996553040933116,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/goldhttp://www.molinahealthcare.com/marketplace/tx/plans/gold-cc/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/gold/Pages/gold.aspx,45786TX0020001-03,Limited Cost Sharing Plan Variation,,0.797688841819763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,4,45786,TX,Individual,No,20-1494502,45786TX0020002,Molina Marketplace Choice Silver Plan,45786TX002,,TXN001,TXS001,TXF001,New,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.987689801810946,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/marketplace/tx/plans/silver-cc/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/gold/Pages/gold.aspx,45786TX0020002-00,Standard Silver Off Exchange Plan,,0.706084549427032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$200,$400,30%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,4
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,4,45786,TX,Individual,No,20-1494502,45786TX0020002,Molina Marketplace Choice Silver Plan,45786TX002,,TXN001,TXS001,TXF001,New,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.987689801810946,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/marketplace/tx/plans/silver-cc/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/gold/Pages/gold.aspx,45786TX0020002-01,Standard Silver On Exchange Plan,,0.706084549427032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$200,$400,30%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,5
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,4,45786,TX,Individual,No,20-1494502,45786TX0020002,Molina Marketplace Choice Silver Plan,45786TX002,,TXN001,TXS001,TXF001,New,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.987689801810946,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/marketplace/tx/plans/silver-cc/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/gold/Pages/gold.aspx,45786TX0020002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,4,45786,TX,Individual,No,20-1494502,45786TX0020002,Molina Marketplace Choice Silver Plan,45786TX002,,TXN001,TXS001,TXF001,New,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.987689801810946,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/marketplace/tx/plans/silver-cc/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/gold/Pages/gold.aspx,45786TX0020002-03,Limited Cost Sharing Plan Variation,,0.706084549427032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$200,$400,30%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,7
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,4,45786,TX,Individual,No,20-1494502,45786TX0020002,Molina Marketplace Choice Silver Plan,45786TX002,,TXN001,TXS001,TXF001,New,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.987689801810946,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/marketplace/tx/plans/silver-cc/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/gold/Pages/gold.aspx,45786TX0020002-04,73% AV Level Silver Plan,,0.739861905574799,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,"$5,200","$10,400","$1,700","$3,400",30%,,,,Not Applicable,Not Applicable,"$1,700","$3,400",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,4,45786,TX,Individual,No,20-1494502,45786TX0020002,Molina Marketplace Choice Silver Plan,45786TX002,,TXN001,TXS001,TXF001,New,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.987689801810946,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/marketplace/tx/plans/silver-cc/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/gold/Pages/gold.aspx,45786TX0020002-05,87% AV Level Silver Plan,,0.87469470500946,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,"$2,250","$4,500",$250,$500,20%,,,,Not Applicable,Not Applicable,$250,$500,$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,4,45786,TX,Individual,No,20-1494502,45786TX0020002,Molina Marketplace Choice Silver Plan,45786TX002,,TXN001,TXS001,TXF001,New,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.987689801810946,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/marketplace/tx/plans/silver-cc/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/gold/Pages/gold.aspx,45786TX0020002-06,94% AV Level Silver Plan,,0.943551361560822,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,"$2,250","$4,500",$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,5,45786,TX,Individual,No,20-1494502,45786TX0020003,Molina Marketplace Choice Bronze Plan,45786TX002,,TXN001,TXS001,TXF001,New,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.995128322689499,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/marketplace/tx/plans/bronze-cc/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/gold/Pages/gold.aspx,45786TX0020003-00,Standard Bronze Off Exchange Plan,,0.61972439289093,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,4
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,5,45786,TX,Individual,No,20-1494502,45786TX0020003,Molina Marketplace Choice Bronze Plan,45786TX002,,TXN001,TXS001,TXF001,New,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.995128322689499,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/marketplace/tx/plans/bronze-cc/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/gold/Pages/gold.aspx,45786TX0020003-01,Standard Bronze On Exchange Plan,,0.61972439289093,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,5
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,5,45786,TX,Individual,No,20-1494502,45786TX0020003,Molina Marketplace Choice Bronze Plan,45786TX002,,TXN001,TXS001,TXF001,New,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.995128322689499,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/marketplace/tx/plans/bronze-cc/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/gold/Pages/gold.aspx,45786TX0020003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TX,45786,HIOS,16,2015-01-16 17:32:32,5,45786,TX,Individual,No,20-1494502,45786TX0020003,Molina Marketplace Choice Bronze Plan,45786TX002,,TXN001,TXS001,TXF001,New,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.995128322689499,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/marketplace/tx/plans/bronze-cc/2015/SBC,www.molinahealthcare.com/paymenttx,www.molinahealthcare.com/marketplace/tx/2015/brochure,http://www.molinahealthcare.com/members/tx/en-US/hp/marketplace/plans/standard/gold/Pages/gold.aspx,45786TX0020003-03,Limited Cost Sharing Plan Variation,,0.61972439289093,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,7
2015,TX,46224,HIOS,3,2014-11-14 05:23:27,1,46224,TX,Individual,No,74-2723334,46224TX0010001,CommunityFirstPlus,46224TX001,,TXN001,TXS001,TXF014,Existing,HMO,Silver,No,Both,No,No,,Refer to plan's certificate of coverage.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.cfhp.com/SBCS/HealthInsuranceExchange.asp,https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx,http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf,http://www.cfhp.com/Members/Commercial/ffmpreferreddrugs.pdf,46224TX0010001-00,Standard Silver Off Exchange Plan,,0.685167670249939,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$60,$808,"$6,000","$3,500",$260,$240,"$6,000",4
2015,TX,46224,HIOS,3,2014-11-14 05:23:27,1,46224,TX,Individual,No,74-2723334,46224TX0010001,CommunityFirstPlus,46224TX001,,TXN001,TXS001,TXF014,Existing,HMO,Silver,No,Both,No,No,,Refer to plan's certificate of coverage.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.cfhp.com/SBCS/HealthInsuranceExchange.asp,https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx,http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf,http://www.cfhp.com/Members/Commercial/ffmpreferreddrugs.pdf,46224TX0010001-01,Standard Silver On Exchange Plan,,0.685167670249939,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$60,$808,"$6,000","$3,500",$260,$240,"$6,000",5
2015,TX,46224,HIOS,3,2014-11-14 05:23:27,1,46224,TX,Individual,No,74-2723334,46224TX0010001,CommunityFirstPlus,46224TX001,,TXN001,TXS001,TXF014,Existing,HMO,Silver,No,Both,No,No,,Refer to plan's certificate of coverage.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.cfhp.com/SBCS/HealthInsuranceExchange.asp,https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx,http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf,http://www.cfhp.com/Members/Commercial/ffmpreferreddrugs.pdf,46224TX0010001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,TX,46224,HIOS,3,2014-11-14 05:23:27,1,46224,TX,Individual,No,74-2723334,46224TX0010001,CommunityFirstPlus,46224TX001,,TXN001,TXS001,TXF014,Existing,HMO,Silver,No,Both,No,No,,Refer to plan's certificate of coverage.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.cfhp.com/SBCS/HealthInsuranceExchange.asp,https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx,http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf,http://www.cfhp.com/Members/Commercial/ffmpreferreddrugs.pdf,46224TX0010001-03,Limited Cost Sharing Plan Variation,,0.685167670249939,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$60,$808,"$6,000","$3,500",$260,$240,"$6,000",7
2015,TX,46224,HIOS,3,2014-11-14 05:23:27,1,46224,TX,Individual,No,74-2723334,46224TX0010001,CommunityFirstPlus,46224TX001,,TXN001,TXS001,TXF014,Existing,HMO,Silver,No,Both,No,No,,Refer to plan's certificate of coverage.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.cfhp.com/SBCS/HealthInsuranceExchange.asp,https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx,http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf,http://www.cfhp.com/Members/Commercial/ffmpreferreddrugs.pdf,46224TX0010001-04,73% AV Level Silver Plan,,0.732713282108307,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$60,$908,"$4,000","$3,000",$240,$340,"$4,000",8
2015,TX,46224,HIOS,3,2014-11-14 05:23:27,1,46224,TX,Individual,No,74-2723334,46224TX0010001,CommunityFirstPlus,46224TX001,,TXN001,TXS001,TXF014,Existing,HMO,Silver,No,Both,No,No,,Refer to plan's certificate of coverage.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.cfhp.com/SBCS/HealthInsuranceExchange.asp,https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx,http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf,http://www.cfhp.com/Members/Commercial/ffmpreferreddrugs.pdf,46224TX0010001-05,87% AV Level Silver Plan,,0.876001060009003,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$700,"$1,400",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$700,$50,$500,"$1,250",$700,$200,$350,"$1,250",9
2015,TX,46224,HIOS,3,2014-11-14 05:23:27,2,46224,TX,Individual,No,74-2723334,46224TX0010003,CommunityFirst Value,46224TX001,,TXN001,TXS001,TXF002,Existing,HMO,Bronze,No,Both,No,No,,Refer to plan's certificate of coverage.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.cfhp.com/SBCS/HealthInsuranceExchange.asp,https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx,http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf,http://www.cfhp.com/Members/Commercial/ffmpreferreddrugs.pdf,46224TX0010003-01,Standard Bronze On Exchange Plan,,0.611952126026154,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,250","$10,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,250",$0,$916,"$6,600","$5,250",$0,"$1,150","$6,600",5
2015,TX,46224,HIOS,3,2014-11-14 05:23:27,2,46224,TX,Individual,No,74-2723334,46224TX0010003,CommunityFirst Value,46224TX001,,TXN001,TXS001,TXF002,Existing,HMO,Bronze,No,Both,No,No,,Refer to plan's certificate of coverage.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.cfhp.com/SBCS/HealthInsuranceExchange.asp,https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx,http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf,http://www.cfhp.com/Members/Commercial/ffmpreferreddrugs.pdf,46224TX0010003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,TX,46224,HIOS,3,2014-11-14 05:23:27,2,46224,TX,Individual,No,74-2723334,46224TX0010003,CommunityFirst Value,46224TX001,,TXN001,TXS001,TXF002,Existing,HMO,Bronze,No,Both,No,No,,Refer to plan's certificate of coverage.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.cfhp.com/SBCS/HealthInsuranceExchange.asp,https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx,http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf,http://www.cfhp.com/Members/Commercial/ffmpreferreddrugs.pdf,46224TX0010003-03,Limited Cost Sharing Plan Variation,,0.611952126026154,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,250","$10,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,250",$0,$916,"$6,600","$5,250",$0,"$1,150","$6,600",7
2015,TX,46224,HIOS,3,2014-11-14 05:23:27,3,46224,TX,Individual,No,74-2723334,46224TX0030001,CommunityFirst Advantage,46224TX003,,TXN001,TXS001,TXF009,New,HMO,Silver,No,Both,No,No,,Refer to plan's certificate of coverage.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.cfhp.com/SBCS/HealthInsuranceExchange.asp,https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx,http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf,http://www.cfhp.com/Members/Commercial/ffmpreferreddrugs.pdf,46224TX0030001-00,Standard Silver Off Exchange Plan,,0.717505276203156,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$75,$0,"$6,600",$0,,$0,"$6,600",4
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,3,47665,TX,SHOP (Small Group),Yes,95-6042390,47665TX0010010,BEST Dental Choice-H,47665TX001,,TXN001,TXS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.73,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BESTDental_Choice-H_Plan.pdf,,47665TX0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,3,47665,TX,SHOP (Small Group),Yes,95-6042390,47665TX0010010,BEST Dental Choice-H,47665TX001,,TXN001,TXS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.73,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BESTDental_Choice-H_Plan.pdf,,47665TX0010010-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,4,47665,TX,SHOP (Small Group),Yes,95-6042390,47665TX0010009,BEST Dental Standard-L,47665TX001,,TXN001,TXS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.46,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BESTDental_Standard-L_Plan.pdf,,47665TX0010009-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,4,47665,TX,Individual,Yes,95-6042390,47665TX0020005,BESTOne Dental Plus-Silver,47665TX002,,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.10,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BESTOne_Dental_Plus-Silver_Plan.pdf,,47665TX0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,4,47665,TX,Individual,Yes,95-6042390,47665TX0020005,BESTOne Dental Plus-Silver,47665TX002,,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.10,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BESTOne_Dental_Plus-Silver_Plan.pdf,,47665TX0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,4,47665,TX,SHOP (Small Group),Yes,95-6042390,47665TX0010009,BEST Dental Standard-L,47665TX001,,TXN001,TXS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.46,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BESTDental_Standard-L_Plan.pdf,,47665TX0010009-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,4,47665,TX,SHOP (Small Group),Yes,95-6042390,47665TX0010011,BEST Dental Choice-L,47665TX001,,TXN001,TXS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.46,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BESTDental_Choice-L_Plan.pdf,,47665TX0010011-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,4,47665,TX,Individual,Yes,95-6042390,47665TX0020006,BESTOne Dental Basic-Silver,47665TX002,,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.10,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BESTOne_Dental_Basic-Silver_Plan.pdf,,47665TX0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,4,47665,TX,Individual,Yes,95-6042390,47665TX0020006,BESTOne Dental Basic-Silver,47665TX002,,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.10,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BESTOne_Dental_Basic-Silver_Plan.pdf,,47665TX0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,4,47665,TX,SHOP (Small Group),Yes,95-6042390,47665TX0010011,BEST Dental Choice-L,47665TX001,,TXN001,TXS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.46,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BESTDental_Choice-L_Plan.pdf,,47665TX0010011-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,4,47665,TX,SHOP (Small Group),Yes,95-6042390,47665TX0010012,BEST Dental Value,47665TX001,,TXN001,TXS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.46,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BESTDental_Value_Plan.pdf,,47665TX0010012-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,TX,47665,HIOS,5,2014-10-02 12:25:15,4,47665,TX,SHOP (Small Group),Yes,95-6042390,47665TX0010012,BEST Dental Value,47665TX001,,TXN001,TXS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.46,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/TX/2015/TX_BESTDental_Value_Plan.pdf,,47665TX0010012-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,5,55409,TX,Individual,No,59-1031071,55409TX0020011,myCigna Copay Assure Gold,55409TX002,7730182962,TXN001,TXS001,TXF004,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/copay-assure-gold,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/copay-assure-gold,http://www.cigna.com/ifp-drug-list,55409TX0020011-00,Standard Gold Off Exchange Plan,78.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,5,55409,TX,Individual,No,59-1031071,55409TX0020011,myCigna Copay Assure Gold,55409TX002,7730182962,TXN001,TXS001,TXF004,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/copay-assure-gold,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/copay-assure-gold,http://www.cigna.com/ifp-drug-list,55409TX0020011-01,Standard Gold On Exchange Plan,78.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,5,55409,TX,Individual,No,59-1031071,55409TX0020011,myCigna Copay Assure Gold,55409TX002,7730182962,TXN001,TXS001,TXF004,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/copay-assure-gold,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/copay-assure-gold,http://www.cigna.com/ifp-drug-list,55409TX0020011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,5,55409,TX,Individual,No,59-1031071,55409TX0020011,myCigna Copay Assure Gold,55409TX002,7730182962,TXN001,TXS001,TXF004,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/copay-assure-gold,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/copay-assure-gold,http://www.cigna.com/ifp-drug-list,55409TX0020011-03,Limited Cost Sharing Plan Variation,78.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,6,55409,TX,Individual,No,59-1031071,55409TX0020012,myCigna Health Flex 5100,55409TX002,7730182962,TXN001,TXS002,TXF009,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,No,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-5100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-5100,http://www.cigna.com/ifp-drug-list,55409TX0020012-00,Standard Bronze Off Exchange Plan,60.90%,0.619452893733978,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,100","$10,200",40%,"$5,100","$10,200",40%,"$12,500","$50,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,6,55409,TX,Individual,No,59-1031071,55409TX0020012,myCigna Health Flex 5100,55409TX002,7730182962,TXN001,TXS002,TXF009,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,No,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-5100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-5100,http://www.cigna.com/ifp-drug-list,55409TX0020012-01,Standard Bronze On Exchange Plan,60.90%,0.619452893733978,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,100","$10,200",40%,"$5,100","$10,200",40%,"$12,500","$50,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,6,55409,TX,Individual,No,59-1031071,55409TX0020012,myCigna Health Flex 5100,55409TX002,7730182962,TXN001,TXS002,TXF009,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,No,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-5100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-5100,http://www.cigna.com/ifp-drug-list,55409TX0020012-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,6,55409,TX,Individual,No,59-1031071,55409TX0020012,myCigna Health Flex 5100,55409TX002,7730182962,TXN001,TXS002,TXF009,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,No,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-5100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-5100,http://www.cigna.com/ifp-drug-list,55409TX0020012-03,Limited Cost Sharing Plan Variation,60.90%,0.619452893733978,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,100","$10,200",40%,"$5,100","$10,200",40%,"$12,500","$50,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,6,55409,TX,Individual,No,59-1031071,55409TX0020022,myCigna Health Flex 3000,55409TX002,7730182962,TXN001,TXS002,TXF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,No,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-3000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-3000,http://www.cigna.com/ifp-drug-list,55409TX0020022-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,10
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,6,55409,TX,Individual,No,59-1031071,55409TX0020022,myCigna Health Flex 3000,55409TX002,7730182962,TXN001,TXS002,TXF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,No,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-3000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-3000,http://www.cigna.com/ifp-drug-list,55409TX0020022-03,Limited Cost Sharing Plan Variation,68.60%,0.677498042583466,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,"$3,000","$6,000",20%,"$12,500","$50,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,6,55409,TX,Individual,No,59-1031071,55409TX0020022,myCigna Health Flex 3000,55409TX002,7730182962,TXN001,TXS002,TXF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,No,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-3000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-3000,http://www.cigna.com/ifp-drug-list,55409TX0020022-04,73% AV Level Silver Plan,72.80%,0.726306974887848,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,"$2,000","$4,000",20%,"$12,500","$50,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,6,55409,TX,Individual,No,59-1031071,55409TX0020022,myCigna Health Flex 3000,55409TX002,7730182962,TXN001,TXS002,TXF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,No,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-3000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-3000,http://www.cigna.com/ifp-drug-list,55409TX0020022-05,87% AV Level Silver Plan,87.00%,0.874924600124359,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$1,250","$2,500","$1,250","$2,500","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,$500,"$1,000",20%,"$12,500","$50,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,6,55409,TX,Individual,No,59-1031071,55409TX0020022,myCigna Health Flex 3000,55409TX002,7730182962,TXN001,TXS002,TXF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,No,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-3000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-3000,http://www.cigna.com/ifp-drug-list,55409TX0020022-06,94% AV Level Silver Plan,93.20%,0.936883985996246,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,$500,"$1,000",$500,"$1,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,$250,$500,20%,"$12,500","$50,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,7,55409,TX,Individual,No,59-1031071,55409TX0020013,myCigna Health Flex 2750,55409TX002,7730182962,TXN001,TXS002,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-2750,http://www.cigna.com/ifp-drug-list,55409TX0020013-00,Standard Silver Off Exchange Plan,68.00%,0.673387467861176,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",20%,"$2,750","$5,500",20%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,48364,HIOS,4,2014-11-14 05:23:27,1,48364,TX,SHOP (Small Group),Yes,75-2046497,48364TX0030001,Family Basic Dental Plan (Low),48364TX003,,TXN003,TXS001,,Existing,HMO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$10.27,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.,No,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48057,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48056,,48364TX0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,48364,HIOS,4,2014-11-14 05:23:27,1,48364,TX,SHOP (Small Group),Yes,75-2046497,48364TX0030001,Family Basic Dental Plan (Low),48364TX003,,TXN003,TXS001,,Existing,HMO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$10.27,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.,No,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48057,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48056,,48364TX0030001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,48364,HIOS,4,2014-11-14 05:23:27,2,48364,TX,SHOP (Small Group),Yes,75-2046497,48364TX0040001,Family Enhanced Dental Plan (High),48364TX004,,TXN004,TXS001,,Existing,HMO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$12.96,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.,No,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49128,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49127,,48364TX0040001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,48364,HIOS,4,2014-11-14 05:23:27,2,48364,TX,SHOP (Small Group),Yes,75-2046497,48364TX0040001,Family Enhanced Dental Plan (High),48364TX004,,TXN004,TXS001,,Existing,HMO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$12.96,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.,No,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49128,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49127,,48364TX0040001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,53108,HIOS,2,2014-08-07 10:00:19,1,53108,TX,SHOP (Small Group),Yes,47-0098400,53108TX0030002,EHB High PPO,53108TX003,,TXN001,TXS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$38.14,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,53108TX0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,6,55409,TX,Individual,No,59-1031071,55409TX0020022,myCigna Health Flex 3000,55409TX002,7730182962,TXN001,TXS002,TXF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,No,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-3000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-3000,http://www.cigna.com/ifp-drug-list,55409TX0020022-00,Standard Silver Off Exchange Plan,68.60%,0.677498042583466,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,"$3,000","$6,000",20%,"$12,500","$50,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,6,55409,TX,Individual,No,59-1031071,55409TX0020022,myCigna Health Flex 3000,55409TX002,7730182962,TXN001,TXS002,TXF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,No,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-3000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-3000,http://www.cigna.com/ifp-drug-list,55409TX0020022-01,Standard Silver On Exchange Plan,68.60%,0.677498042583466,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,"$3,000","$6,000",20%,"$12,500","$50,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,53108,HIOS,2,2014-08-07 10:00:19,1,53108,TX,Individual,Yes,47-0098400,53108TX0010002,EHB High Passive,53108TX001,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$48.17,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,53108TX0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,53108,HIOS,2,2014-08-07 10:00:19,1,53108,TX,SHOP (Small Group),Yes,47-0098400,53108TX0030001,EHB Low PPO,53108TX003,,TXN001,TXS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.69,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,53108TX0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,53108,HIOS,2,2014-08-07 10:00:19,1,53108,TX,Individual,Yes,47-0098400,53108TX0010001,EHB Low Passive,53108TX001,,TXN001,TXS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.30,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,53108TX0010001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,1,55409,TX,Individual,Yes,59-1031071,55409TX0030001,myCigna Dental Pediatric,55409TX003,7730182962,TXN002,TXS003,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$19.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,,,http://www.cigna.com/individuals-families/2015-plans/sob/texas/dental-pediatric,,55409TX0030001-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$150,$300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,1,55409,TX,Individual,No,59-1031071,55409TX0020001,myCigna Health Savings 6100,55409TX002,7730182962,TXN001,TXS001,TXF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-savings-6100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-savings-6100,http://www.cigna.com/ifp-drug-list,55409TX0020001-00,Standard Bronze Off Exchange Plan,58.20%,0.5818812251091,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,1,55409,TX,Individual,No,59-1031071,55409TX0020001,myCigna Health Savings 6100,55409TX002,7730182962,TXN001,TXS001,TXF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-savings-6100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-savings-6100,http://www.cigna.com/ifp-drug-list,55409TX0020001-01,Standard Bronze On Exchange Plan,58.20%,0.5818812251091,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,1,55409,TX,Individual,Yes,59-1031071,55409TX0030001,myCigna Dental Pediatric,55409TX003,7730182962,TXN002,TXS003,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$19.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,,,http://www.cigna.com/individuals-families/2015-plans/sob/texas/dental-pediatric,,55409TX0030001-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$150,$300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,1,55409,TX,Individual,No,59-1031071,55409TX0020001,myCigna Health Savings 6100,55409TX002,7730182962,TXN001,TXS001,TXF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-savings-6100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-savings-6100,http://www.cigna.com/ifp-drug-list,55409TX0020001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,1,55409,TX,Individual,No,59-1031071,55409TX0020001,myCigna Health Savings 6100,55409TX002,7730182962,TXN001,TXS001,TXF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-savings-6100,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-savings-6100,http://www.cigna.com/ifp-drug-list,55409TX0020001-03,Limited Cost Sharing Plan Variation,58.20%,0.5818812251091,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,1,55409,TX,Individual,No,59-1031071,55409TX0020004,myCigna Health Savings 3400,55409TX002,7730182962,TXN001,TXS001,TXF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-savings-3400,http://www.cigna.com/ifp-drug-list,55409TX0020004-00,Standard Silver Off Exchange Plan,68.40%,0.684268593788147,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,1,55409,TX,Individual,No,59-1031071,55409TX0020004,myCigna Health Savings 3400,55409TX002,7730182962,TXN001,TXS001,TXF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-savings-3400,http://www.cigna.com/ifp-drug-list,55409TX0020004-01,Standard Silver On Exchange Plan,68.40%,0.684268593788147,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,1,55409,TX,Individual,No,59-1031071,55409TX0020004,myCigna Health Savings 3400,55409TX002,7730182962,TXN001,TXS001,TXF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-savings-3400,http://www.cigna.com/ifp-drug-list,55409TX0020004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,1,55409,TX,Individual,No,59-1031071,55409TX0020004,myCigna Health Savings 3400,55409TX002,7730182962,TXN001,TXS001,TXF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-savings-3400,http://www.cigna.com/ifp-drug-list,55409TX0020004-03,Limited Cost Sharing Plan Variation,68.40%,0.684268593788147,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,1,55409,TX,Individual,No,59-1031071,55409TX0020004,myCigna Health Savings 3400,55409TX002,7730182962,TXN001,TXS001,TXF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-savings-3400,http://www.cigna.com/ifp-drug-list,55409TX0020004-04,73% AV Level Silver Plan,73.20%,0.731574892997742,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,1,55409,TX,Individual,No,59-1031071,55409TX0020004,myCigna Health Savings 3400,55409TX002,7730182962,TXN001,TXS001,TXF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-savings-3400,http://www.cigna.com/ifp-drug-list,55409TX0020004-05,87% AV Level Silver Plan,86.60%,0.865731179714203,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,1,55409,TX,Individual,No,59-1031071,55409TX0020004,myCigna Health Savings 3400,55409TX002,7730182962,TXN001,TXS001,TXF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-savings-3400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-savings-3400,http://www.cigna.com/ifp-drug-list,55409TX0020004-06,94% AV Level Silver Plan,94.30%,0.942874848842621,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$350,$700,0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,2,55409,TX,Individual,No,59-1031071,55409TX0020021,myCignaHealth Flex 5000 Bronze,55409TX002,7730182962,TXN001,TXS001,TXF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-5000-bronze,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-5000-bronze,http://www.cigna.com/ifp-drug-list,55409TX0020021-00,Standard Bronze Off Exchange Plan,61.60%,0.632702648639679,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,2,55409,TX,Individual,Yes,59-1031071,55409TX0030002,myCigna Dental Family + Pediatric,55409TX003,7730182962,TXN002,TXS003,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,,,http://www.cigna.com/individuals-families/2015-plans/sob/texas/dental-family-ped,,55409TX0030002-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$150,$300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,2,55409,TX,Individual,No,59-1031071,55409TX0020021,myCignaHealth Flex 5000 Bronze,55409TX002,7730182962,TXN001,TXS001,TXF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-5000-bronze,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-5000-bronze,http://www.cigna.com/ifp-drug-list,55409TX0020021-01,Standard Bronze On Exchange Plan,61.60%,0.632702648639679,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,2,55409,TX,Individual,No,59-1031071,55409TX0020021,myCignaHealth Flex 5000 Bronze,55409TX002,7730182962,TXN001,TXS001,TXF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-5000-bronze,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-5000-bronze,http://www.cigna.com/ifp-drug-list,55409TX0020021-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,2,55409,TX,Individual,No,59-1031071,55409TX0020021,myCignaHealth Flex 5000 Bronze,55409TX002,7730182962,TXN001,TXS001,TXF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-5000-bronze,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-5000-bronze,http://www.cigna.com/ifp-drug-list,55409TX0020021-03,Limited Cost Sharing Plan Variation,61.60%,0.632702648639679,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,3,55409,TX,Individual,No,59-1031071,55409TX0020005,myCigna Health Flex 1500,55409TX002,7730182962,TXN001,TXS001,TXF003,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-1500,http://www.cigna.com/ifp-drug-list,55409TX0020005-00,Standard Silver Off Exchange Plan,69.10%,0.709242641925812,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,3,55409,TX,Individual,No,59-1031071,55409TX0020005,myCigna Health Flex 1500,55409TX002,7730182962,TXN001,TXS001,TXF003,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-1500,http://www.cigna.com/ifp-drug-list,55409TX0020005-01,Standard Silver On Exchange Plan,69.10%,0.709242641925812,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,3,55409,TX,Individual,No,59-1031071,55409TX0020005,myCigna Health Flex 1500,55409TX002,7730182962,TXN001,TXS001,TXF003,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-1500,http://www.cigna.com/ifp-drug-list,55409TX0020005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,3,55409,TX,Individual,No,59-1031071,55409TX0020005,myCigna Health Flex 1500,55409TX002,7730182962,TXN001,TXS001,TXF003,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-1500,http://www.cigna.com/ifp-drug-list,55409TX0020005-03,Limited Cost Sharing Plan Variation,69.10%,0.709242641925812,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,3,55409,TX,Individual,No,59-1031071,55409TX0020005,myCigna Health Flex 1500,55409TX002,7730182962,TXN001,TXS001,TXF003,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-1500,http://www.cigna.com/ifp-drug-list,55409TX0020005-04,73% AV Level Silver Plan,72.60%,0.742465913295746,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,3,55409,TX,Individual,No,59-1031071,55409TX0020005,myCigna Health Flex 1500,55409TX002,7730182962,TXN001,TXS001,TXF003,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-1500,http://www.cigna.com/ifp-drug-list,55409TX0020005-05,87% AV Level Silver Plan,86.30%,0.867775917053223,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$725,"$1,450",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,3,55409,TX,Individual,No,59-1031071,55409TX0020005,myCigna Health Flex 1500,55409TX002,7730182962,TXN001,TXS001,TXF003,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-1500,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-1500,http://www.cigna.com/ifp-drug-list,55409TX0020005-06,94% AV Level Silver Plan,93.40%,0.93521922826767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$575,"$1,150",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,4,55409,TX,Individual,No,59-1031071,55409TX0020006,myCigna Health Flex 2750,55409TX002,7730182962,TXN001,TXS001,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-2750,http://www.cigna.com/ifp-drug-list,55409TX0020006-00,Standard Silver Off Exchange Plan,68.50%,0.693712592124939,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,4,55409,TX,Individual,No,59-1031071,55409TX0020006,myCigna Health Flex 2750,55409TX002,7730182962,TXN001,TXS001,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-2750,http://www.cigna.com/ifp-drug-list,55409TX0020006-01,Standard Silver On Exchange Plan,68.50%,0.693712592124939,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,4,55409,TX,Individual,No,59-1031071,55409TX0020006,myCigna Health Flex 2750,55409TX002,7730182962,TXN001,TXS001,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-2750,http://www.cigna.com/ifp-drug-list,55409TX0020006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,4,55409,TX,Individual,No,59-1031071,55409TX0020006,myCigna Health Flex 2750,55409TX002,7730182962,TXN001,TXS001,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-2750,http://www.cigna.com/ifp-drug-list,55409TX0020006-03,Limited Cost Sharing Plan Variation,68.50%,0.693712592124939,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,4,55409,TX,Individual,No,59-1031071,55409TX0020006,myCigna Health Flex 2750,55409TX002,7730182962,TXN001,TXS001,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-2750,http://www.cigna.com/ifp-drug-list,55409TX0020006-04,73% AV Level Silver Plan,72.40%,0.73218709230423,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$5,500",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,4,55409,TX,Individual,No,59-1031071,55409TX0020006,myCigna Health Flex 2750,55409TX002,7730182962,TXN001,TXS001,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-2750,http://www.cigna.com/ifp-drug-list,55409TX0020006-05,87% AV Level Silver Plan,86.00%,0.865245342254639,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,4,55409,TX,Individual,No,59-1031071,55409TX0020006,myCigna Health Flex 2750,55409TX002,7730182962,TXN001,TXS001,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-2750,http://www.cigna.com/ifp-drug-list,55409TX0020006-06,94% AV Level Silver Plan,93.10%,0.933359861373901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$575,"$1,150",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,4,55409,TX,Individual,No,59-1031071,55409TX0020007,myCigna Health Flex 5000,55409TX002,7730182962,TXN001,TXS001,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-5000,http://www.cigna.com/ifp-drug-list,55409TX0020007-00,Standard Silver Off Exchange Plan,69.40%,0.70461243391037,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,4,55409,TX,Individual,No,59-1031071,55409TX0020007,myCigna Health Flex 5000,55409TX002,7730182962,TXN001,TXS001,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-5000,http://www.cigna.com/ifp-drug-list,55409TX0020007-01,Standard Silver On Exchange Plan,69.40%,0.70461243391037,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,4,55409,TX,Individual,No,59-1031071,55409TX0020007,myCigna Health Flex 5000,55409TX002,7730182962,TXN001,TXS001,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-5000,http://www.cigna.com/ifp-drug-list,55409TX0020007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,4,55409,TX,Individual,No,59-1031071,55409TX0020007,myCigna Health Flex 5000,55409TX002,7730182962,TXN001,TXS001,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-5000,http://www.cigna.com/ifp-drug-list,55409TX0020007-03,Limited Cost Sharing Plan Variation,69.40%,0.70461243391037,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,4,55409,TX,Individual,No,59-1031071,55409TX0020007,myCigna Health Flex 5000,55409TX002,7730182962,TXN001,TXS001,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-5000,http://www.cigna.com/ifp-drug-list,55409TX0020007-04,73% AV Level Silver Plan,72.20%,0.731884956359863,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,4,55409,TX,Individual,No,59-1031071,55409TX0020007,myCigna Health Flex 5000,55409TX002,7730182962,TXN001,TXS001,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-5000,http://www.cigna.com/ifp-drug-list,55409TX0020007-05,87% AV Level Silver Plan,86.20%,0.866659820079803,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,450","$2,900",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,4,55409,TX,Individual,No,59-1031071,55409TX0020007,myCigna Health Flex 5000,55409TX002,7730182962,TXN001,TXS001,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-5000,http://www.cigna.com/ifp-drug-list,55409TX0020007-06,94% AV Level Silver Plan,93.40%,0.93491131067276,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,4,55409,TX,Individual,No,59-1031071,55409TX0020010,myCigna Health Flex 1250,55409TX002,7730182962,TXN001,TXS001,TXF010,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-1250,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-1250,http://www.cigna.com/ifp-drug-list,55409TX0020010-00,Standard Gold Off Exchange Plan,78.10%,0.784661948680878,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,4,55409,TX,Individual,No,59-1031071,55409TX0020010,myCigna Health Flex 1250,55409TX002,7730182962,TXN001,TXS001,TXF010,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-1250,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-1250,http://www.cigna.com/ifp-drug-list,55409TX0020010-01,Standard Gold On Exchange Plan,78.10%,0.784661948680878,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,4,55409,TX,Individual,No,59-1031071,55409TX0020010,myCigna Health Flex 1250,55409TX002,7730182962,TXN001,TXS001,TXF010,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-1250,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-1250,http://www.cigna.com/ifp-drug-list,55409TX0020010-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,4,55409,TX,Individual,No,59-1031071,55409TX0020010,myCigna Health Flex 1250,55409TX002,7730182962,TXN001,TXS001,TXF010,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/health-flex-1250,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/health-flex-1250,http://www.cigna.com/ifp-drug-list,55409TX0020010-03,Limited Cost Sharing Plan Variation,78.10%,0.784661948680878,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,5,55409,TX,Individual,No,59-1031071,55409TX0020008,myCigna Copay Assure Silver,55409TX002,7730182962,TXN001,TXS001,TXF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/copay-assure-silver,http://www.cigna.com/ifp-drug-list,55409TX0020008-00,Standard Silver Off Exchange Plan,71.80%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,5,55409,TX,Individual,No,59-1031071,55409TX0020008,myCigna Copay Assure Silver,55409TX002,7730182962,TXN001,TXS001,TXF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/copay-assure-silver,http://www.cigna.com/ifp-drug-list,55409TX0020008-01,Standard Silver On Exchange Plan,71.80%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,5,55409,TX,Individual,No,59-1031071,55409TX0020008,myCigna Copay Assure Silver,55409TX002,7730182962,TXN001,TXS001,TXF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/copay-assure-silver,http://www.cigna.com/ifp-drug-list,55409TX0020008-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,5,55409,TX,Individual,No,59-1031071,55409TX0020008,myCigna Copay Assure Silver,55409TX002,7730182962,TXN001,TXS001,TXF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/copay-assure-silver,http://www.cigna.com/ifp-drug-list,55409TX0020008-03,Limited Cost Sharing Plan Variation,71.80%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,5,55409,TX,Individual,No,59-1031071,55409TX0020008,myCigna Copay Assure Silver,55409TX002,7730182962,TXN001,TXS001,TXF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/copay-assure-silver,http://www.cigna.com/ifp-drug-list,55409TX0020008-04,73% AV Level Silver Plan,73.90%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,5,55409,TX,Individual,No,59-1031071,55409TX0020008,myCigna Copay Assure Silver,55409TX002,7730182962,TXN001,TXS001,TXF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/copay-assure-silver,http://www.cigna.com/ifp-drug-list,55409TX0020008-05,87% AV Level Silver Plan,87.20%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,5,55409,TX,Individual,No,59-1031071,55409TX0020008,myCigna Copay Assure Silver,55409TX002,7730182962,TXN001,TXS001,TXF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-dallas-austin/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-dallas-austin/copay-assure-silver,http://www.cigna.com/ifp-drug-list,55409TX0020008-06,94% AV Level Silver Plan,93.90%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,7,55409,TX,Individual,No,59-1031071,55409TX0020013,myCigna Health Flex 2750,55409TX002,7730182962,TXN001,TXS002,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-2750,http://www.cigna.com/ifp-drug-list,55409TX0020013-01,Standard Silver On Exchange Plan,68.00%,0.673387467861176,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",20%,"$2,750","$5,500",20%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,7,55409,TX,Individual,No,59-1031071,55409TX0020013,myCigna Health Flex 2750,55409TX002,7730182962,TXN001,TXS002,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-2750,http://www.cigna.com/ifp-drug-list,55409TX0020013-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,7,55409,TX,Individual,No,59-1031071,55409TX0020013,myCigna Health Flex 2750,55409TX002,7730182962,TXN001,TXS002,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-2750,http://www.cigna.com/ifp-drug-list,55409TX0020013-03,Limited Cost Sharing Plan Variation,68.00%,0.673387467861176,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",20%,"$2,750","$5,500",20%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,7,55409,TX,Individual,No,59-1031071,55409TX0020013,myCigna Health Flex 2750,55409TX002,7730182962,TXN001,TXS002,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-2750,http://www.cigna.com/ifp-drug-list,55409TX0020013-04,73% AV Level Silver Plan,72.10%,0.71707946062088,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$4,450","$8,900","$4,450","$8,900","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",20%,"$2,250","$4,500",20%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,7,55409,TX,Individual,No,59-1031071,55409TX0020013,myCigna Health Flex 2750,55409TX002,7730182962,TXN001,TXS002,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-2750,http://www.cigna.com/ifp-drug-list,55409TX0020013-05,87% AV Level Silver Plan,86.10%,0.8697469830513,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$1,150","$2,300","$1,150","$2,300","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,$750,"$1,500",20%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,7,55409,TX,Individual,No,59-1031071,55409TX0020013,myCigna Health Flex 2750,55409TX002,7730182962,TXN001,TXS002,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-2750,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-2750,http://www.cigna.com/ifp-drug-list,55409TX0020013-06,94% AV Level Silver Plan,93.00%,0.930103003978729,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,$500,"$1,000",$500,"$1,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,$200,$400,20%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,7,55409,TX,Individual,No,59-1031071,55409TX0020014,myCigna Health Flex 5000,55409TX002,7730182962,TXN001,TXS002,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-5000,http://www.cigna.com/ifp-drug-list,55409TX0020014-00,Standard Silver Off Exchange Plan,69.00%,0.67004805803299,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$5,000","$10,000",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,7,55409,TX,Individual,No,59-1031071,55409TX0020014,myCigna Health Flex 5000,55409TX002,7730182962,TXN001,TXS002,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-5000,http://www.cigna.com/ifp-drug-list,55409TX0020014-01,Standard Silver On Exchange Plan,69.00%,0.67004805803299,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$5,000","$10,000",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,7,55409,TX,Individual,No,59-1031071,55409TX0020014,myCigna Health Flex 5000,55409TX002,7730182962,TXN001,TXS002,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-5000,http://www.cigna.com/ifp-drug-list,55409TX0020014-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,13
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,7,55409,TX,Individual,No,59-1031071,55409TX0020014,myCigna Health Flex 5000,55409TX002,7730182962,TXN001,TXS002,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-5000,http://www.cigna.com/ifp-drug-list,55409TX0020014-03,Limited Cost Sharing Plan Variation,69.00%,0.67004805803299,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$5,000","$10,000",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,7,55409,TX,Individual,No,59-1031071,55409TX0020014,myCigna Health Flex 5000,55409TX002,7730182962,TXN001,TXS002,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-5000,http://www.cigna.com/ifp-drug-list,55409TX0020014-04,73% AV Level Silver Plan,72.20%,0.706443786621094,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$4,100","$8,200","$4,100","$8,200","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,100","$8,200",0%,"$4,100","$8,200",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,7,55409,TX,Individual,No,59-1031071,55409TX0020014,myCigna Health Flex 5000,55409TX002,7730182962,TXN001,TXS002,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-5000,http://www.cigna.com/ifp-drug-list,55409TX0020014-05,87% AV Level Silver Plan,86.40%,0.861970782279968,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$1,400","$2,800","$1,400","$2,800","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",0%,"$1,400","$2,800",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,7,55409,TX,Individual,No,59-1031071,55409TX0020014,myCigna Health Flex 5000,55409TX002,7730182962,TXN001,TXS002,TXF004,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-5000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-5000,http://www.cigna.com/ifp-drug-list,55409TX0020014-06,94% AV Level Silver Plan,93.30%,0.931980431079865,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,$600,"$1,200",$600,"$1,200","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",0%,$600,"$1,200",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,8,55409,TX,Individual,No,59-1031071,55409TX0020015,myCigna Copay Assure Silver,55409TX002,7730182962,TXN001,TXS002,TXF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/copay-assure-silver,http://www.cigna.com/ifp-drug-list,55409TX0020015-00,Standard Silver Off Exchange Plan,71.30%,0,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,$0,$0,30%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,8,55409,TX,Individual,No,59-1031071,55409TX0020015,myCigna Copay Assure Silver,55409TX002,7730182962,TXN001,TXS002,TXF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/copay-assure-silver,http://www.cigna.com/ifp-drug-list,55409TX0020015-01,Standard Silver On Exchange Plan,71.30%,0,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,$0,$0,30%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,8,55409,TX,Individual,No,59-1031071,55409TX0020015,myCigna Copay Assure Silver,55409TX002,7730182962,TXN001,TXS002,TXF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/copay-assure-silver,http://www.cigna.com/ifp-drug-list,55409TX0020015-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,8,55409,TX,Individual,No,59-1031071,55409TX0020015,myCigna Copay Assure Silver,55409TX002,7730182962,TXN001,TXS002,TXF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/copay-assure-silver,http://www.cigna.com/ifp-drug-list,55409TX0020015-03,Limited Cost Sharing Plan Variation,71.30%,0,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,$0,$0,30%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,8,55409,TX,Individual,No,59-1031071,55409TX0020015,myCigna Copay Assure Silver,55409TX002,7730182962,TXN001,TXS002,TXF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/copay-assure-silver,http://www.cigna.com/ifp-drug-list,55409TX0020015-04,73% AV Level Silver Plan,73.50%,0,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,$0,$0,30%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,8,55409,TX,Individual,No,59-1031071,55409TX0020015,myCigna Copay Assure Silver,55409TX002,7730182962,TXN001,TXS002,TXF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/copay-assure-silver,http://www.cigna.com/ifp-drug-list,55409TX0020015-05,87% AV Level Silver Plan,86.80%,0,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$1,200","$2,400","$1,200","$2,400","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,$0,$0,30%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,8,55409,TX,Individual,No,59-1031071,55409TX0020015,myCigna Copay Assure Silver,55409TX002,7730182962,TXN001,TXS002,TXF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/copay-assure-silver,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/copay-assure-silver,http://www.cigna.com/ifp-drug-list,55409TX0020015-06,94% AV Level Silver Plan,93.60%,0,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,$500,"$1,000",$500,"$1,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,$0,$0,30%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,8,55409,TX,Individual,No,59-1031071,55409TX0020017,myCigna Copay Assure Gold,55409TX002,7730182962,TXN001,TXS002,TXF004,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/copay-assure-gold,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/copay-assure-gold,http://www.cigna.com/ifp-drug-list,55409TX0020017-00,Standard Gold Off Exchange Plan,78.80%,0,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,$0,$0,30%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,8,55409,TX,Individual,No,59-1031071,55409TX0020017,myCigna Copay Assure Gold,55409TX002,7730182962,TXN001,TXS002,TXF004,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/copay-assure-gold,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/copay-assure-gold,http://www.cigna.com/ifp-drug-list,55409TX0020017-01,Standard Gold On Exchange Plan,78.80%,0,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,$0,$0,30%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,8,55409,TX,Individual,No,59-1031071,55409TX0020017,myCigna Copay Assure Gold,55409TX002,7730182962,TXN001,TXS002,TXF004,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/copay-assure-gold,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/copay-assure-gold,http://www.cigna.com/ifp-drug-list,55409TX0020017-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,13
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,8,55409,TX,Individual,No,59-1031071,55409TX0020017,myCigna Copay Assure Gold,55409TX002,7730182962,TXN001,TXS002,TXF004,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/copay-assure-gold,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/copay-assure-gold,http://www.cigna.com/ifp-drug-list,55409TX0020017-03,Limited Cost Sharing Plan Variation,78.80%,0,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,$0,$0,30%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,9,55409,TX,Individual,No,59-1031071,55409TX0020016,myCigna Health Flex 1000,55409TX002,7730182962,TXN001,TXS002,TXF010,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-1000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-1000,http://www.cigna.com/ifp-drug-list,55409TX0020016-00,Standard Gold Off Exchange Plan,78.30%,0.786973178386688,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,"$1,000","$2,000",20%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,9,55409,TX,Individual,No,59-1031071,55409TX0020016,myCigna Health Flex 1000,55409TX002,7730182962,TXN001,TXS002,TXF010,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-1000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-1000,http://www.cigna.com/ifp-drug-list,55409TX0020016-01,Standard Gold On Exchange Plan,78.30%,0.786973178386688,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,"$1,000","$2,000",20%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,9,55409,TX,Individual,No,59-1031071,55409TX0020016,myCigna Health Flex 1000,55409TX002,7730182962,TXN001,TXS002,TXF010,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-1000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-1000,http://www.cigna.com/ifp-drug-list,55409TX0020016-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,TX,55409,HIOS,14,2015-01-16 17:32:32,9,55409,TX,Individual,No,59-1031071,55409TX0020016,myCigna Health Flex 1000,55409TX002,7730182962,TXN001,TXS002,TXF010,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,Diabetes,,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,All Services,Yes,http://www.cigna.com/individuals-families/2015-plans/sbc/texas-houston/health-flex-1000,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.cigna.com/individuals-families/2015-plans/sob/texas-houston/health-flex-1000,http://www.cigna.com/ifp-drug-list,55409TX0020016-03,Limited Cost Sharing Plan Variation,78.30%,0.786973178386688,Yes,Yes,Yes,35%,65%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,"$1,000","$2,000",20%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,58609,HIOS,7,2014-09-03 04:28:59,1,58609,TX,Individual,Yes,20-2970185,58609TX0010001,DentaQuest PPO  Pediatric High,58609TX001,7083617218,TXN001,TXS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$32.99,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/tx/,http://www.dentaquest.com/marketplace/tx/,http://www.dentaquest.com/marketplace/tx/,,58609TX0010001-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,58609,HIOS,7,2014-09-03 04:28:59,1,58609,TX,SHOP (Small Group),Yes,20-2970185,58609TX0020003,DentaQuest PPO Family High,58609TX002,7083617218,TXN001,TXS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.90,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/tx/,,http://www.dentaquest.com/marketplace/tx/,,58609TX0020003-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,58609,HIOS,7,2014-09-03 04:28:59,1,58609,TX,SHOP (Small Group),Yes,20-2970185,58609TX0020003,DentaQuest PPO Family High,58609TX002,7083617218,TXN001,TXS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.90,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/tx/,,http://www.dentaquest.com/marketplace/tx/,,58609TX0020003-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,58609,HIOS,7,2014-09-03 04:28:59,1,58609,TX,Individual,Yes,20-2970185,58609TX0010001,DentaQuest PPO  Pediatric High,58609TX001,7083617218,TXN001,TXS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$32.99,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/tx/,http://www.dentaquest.com/marketplace/tx/,http://www.dentaquest.com/marketplace/tx/,,58609TX0010001-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,58609,HIOS,7,2014-09-03 04:28:59,1,58609,TX,Individual,Yes,20-2970185,58609TX0010002,DentaQuest PPO Pediatric Low,58609TX001,7083617218,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$24.69,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/tx/,http://www.dentaquest.com/marketplace/tx/,http://www.dentaquest.com/marketplace/tx/,,58609TX0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TX,58609,HIOS,7,2014-09-03 04:28:59,1,58609,TX,SHOP (Small Group),Yes,20-2970185,58609TX0020004,DentaQuest PPO Family Low,58609TX002,7083617218,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.14,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/tx/,,http://www.dentaquest.com/marketplace/tx/,,58609TX0020004-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TX,58609,HIOS,7,2014-09-03 04:28:59,1,58609,TX,SHOP (Small Group),Yes,20-2970185,58609TX0020004,DentaQuest PPO Family Low,58609TX002,7083617218,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.14,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/tx/,,http://www.dentaquest.com/marketplace/tx/,,58609TX0020004-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TX,58609,HIOS,7,2014-09-03 04:28:59,1,58609,TX,Individual,Yes,20-2970185,58609TX0010002,DentaQuest PPO Pediatric Low,58609TX001,7083617218,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$24.69,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/tx/,http://www.dentaquest.com/marketplace/tx/,http://www.dentaquest.com/marketplace/tx/,,58609TX0010002-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TX,58609,HIOS,7,2014-09-03 04:28:59,2,58609,TX,Individual,Yes,20-2970185,58609TX0010003,DentaQuest PPO Family High,58609TX001,7083617218,TXN001,TXS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.99,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/tx/,www.dentaquest.com,http://www.dentaquest.com/marketplace/tx/,,58609TX0010003-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,2,63141,TX,Individual,No,39-1263473,63141TX0740001,Humana Basic 6600/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF001,Existing,EPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343523,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335333,http://apps.humana.com/marketing/documents.asp?file=2323828,63141TX0740001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,2,63141,TX,Individual,No,39-1263473,63141TX0740002,Humana Bronze 6300/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF001,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343744,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335346,http://apps.humana.com/marketing/documents.asp?file=2323828,63141TX0740002-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,3,63141,TX,Individual,No,39-1263473,63141TX0740003,Humana Bronze 4850/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF002,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343627,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335359,http://apps.humana.com/marketing/documents.asp?file=2323763,63141TX0740003-03,Limited Cost Sharing Plan Variation,,0.611254394054413,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,4,63141,TX,Individual,No,39-1263473,63141TX0750008,Humana Basic 6600/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF005,New,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343458,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335450,http://apps.humana.com/marketing/documents.asp?file=2323841,63141TX0750008-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,4,63141,TX,Individual,No,39-1263473,63141TX0750009,Humana Bronze 6300/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF005,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343679,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335463,http://apps.humana.com/marketing/documents.asp?file=2323841,63141TX0750009-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,4,63141,TX,Individual,No,39-1263473,63141TX0750012,Humana Silver 3650/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF005,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344186,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335541,http://apps.humana.com/marketing/documents.asp?file=2323841,63141TX0750012-00,Standard Silver Off Exchange Plan,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,10
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,2,63141,TX,Individual,No,39-1263473,63141TX0740002,Humana Bronze 6300/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF001,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343744,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335346,http://apps.humana.com/marketing/documents.asp?file=2323828,63141TX0740002-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,2,63141,TX,Individual,No,39-1263473,63141TX0740002,Humana Bronze 6300/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF001,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343744,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335346,http://apps.humana.com/marketing/documents.asp?file=2323828,63141TX0740002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,4,63141,TX,Individual,No,39-1263473,63141TX0750012,Humana Silver 3650/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF005,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344186,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335541,http://apps.humana.com/marketing/documents.asp?file=2323841,63141TX0750012-03,Limited Cost Sharing Plan Variation,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,13
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,4,63141,TX,Individual,No,39-1263473,63141TX0750012,Humana Silver 3650/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF005,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344186,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335541,http://apps.humana.com/marketing/documents.asp?file=2323841,63141TX0750012-04,73% AV Level Silver Plan,,0.721818149089813,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,920","$5,840",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,920","$5,840",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,14
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,4,63141,TX,Individual,No,39-1263473,63141TX0750012,Humana Silver 3650/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF005,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344186,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335541,http://apps.humana.com/marketing/documents.asp?file=2323841,63141TX0750012-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,15
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,4,63141,TX,Individual,No,39-1263473,63141TX0750012,Humana Silver 3650/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF005,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344186,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335541,http://apps.humana.com/marketing/documents.asp?file=2323841,63141TX0750012-06,94% AV Level Silver Plan,,0.935785233974457,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$475,$950,,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$475,$950,0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,16
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,5,63141,TX,Individual,No,39-1263473,63141TX0750011,Humana Silver 4250/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF007,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344212,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335489,http://apps.humana.com/marketing/documents.asp?file=2323776,63141TX0750011-00,Standard Silver Off Exchange Plan,,0.695273876190186,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$4,250","$8,500",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,5,63141,TX,Individual,No,39-1263473,63141TX0750011,Humana Silver 4250/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF007,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344212,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335489,http://apps.humana.com/marketing/documents.asp?file=2323776,63141TX0750011-01,Standard Silver On Exchange Plan,,0.695273876190186,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$4,250","$8,500",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,5,63141,TX,Individual,No,39-1263473,63141TX0750011,Humana Silver 4250/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF007,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344212,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335489,http://apps.humana.com/marketing/documents.asp?file=2323776,63141TX0750011-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,5,63141,TX,Individual,No,39-1263473,63141TX0750011,Humana Silver 4250/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF007,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344212,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335489,http://apps.humana.com/marketing/documents.asp?file=2323776,63141TX0750011-03,Limited Cost Sharing Plan Variation,,0.695273876190186,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$4,250","$8,500",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,58609,HIOS,7,2014-09-03 04:28:59,2,58609,TX,Individual,Yes,20-2970185,58609TX0010003,DentaQuest PPO Family High,58609TX001,7083617218,TXN001,TXS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.99,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/tx/,www.dentaquest.com,http://www.dentaquest.com/marketplace/tx/,,58609TX0010003-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,58609,HIOS,7,2014-09-03 04:28:59,2,58609,TX,Individual,Yes,20-2970185,58609TX0010004,DentaQuest PPO Family Low,58609TX001,7083617218,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.69,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/tx/,www.dentaquest.com,http://www.dentaquest.com/marketplace/tx/,,58609TX0010004-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TX,58609,HIOS,7,2014-09-03 04:28:59,2,58609,TX,Individual,Yes,20-2970185,58609TX0010004,DentaQuest PPO Family Low,58609TX001,7083617218,TXN001,TXS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.69,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/tx/,www.dentaquest.com,http://www.dentaquest.com/marketplace/tx/,,58609TX0010004-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,5,63141,TX,Individual,No,39-1263473,63141TX0750011,Humana Silver 4250/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF007,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344212,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335489,http://apps.humana.com/marketing/documents.asp?file=2323776,63141TX0750011-04,73% AV Level Silver Plan,,0.735092222690582,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,5,63141,TX,Individual,No,39-1263473,63141TX0750011,Humana Silver 4250/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF007,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344212,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335489,http://apps.humana.com/marketing/documents.asp?file=2323776,63141TX0750011-05,87% AV Level Silver Plan,,0.867647707462311,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,5,63141,TX,Individual,No,39-1263473,63141TX0750011,Humana Silver 4250/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF007,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344212,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335489,http://apps.humana.com/marketing/documents.asp?file=2323776,63141TX0750011-06,94% AV Level Silver Plan,,0.93690437078476,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,$250,$500,50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,5,63141,TX,Individual,No,39-1263473,63141TX0750013,Humana Gold 2500/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF008,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343796,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335593,http://apps.humana.com/marketing/documents.asp?file=2323776,63141TX0750013-00,Standard Gold Off Exchange Plan,,0.780732274055481,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,5,63141,TX,Individual,No,39-1263473,63141TX0750013,Humana Gold 2500/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF008,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343796,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335593,http://apps.humana.com/marketing/documents.asp?file=2323776,63141TX0750013-01,Standard Gold On Exchange Plan,,0.780732274055481,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,5,63141,TX,Individual,No,39-1263473,63141TX0750013,Humana Gold 2500/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF008,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343796,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335593,http://apps.humana.com/marketing/documents.asp?file=2323776,63141TX0750013-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,TX,59246,HIOS,5,2014-11-09 04:38:15,1,59246,TX,SHOP (Small Group),Yes,95-2371728,59246TX0020001,PPO MAC,59246TX002,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$28.39,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Texas,Yes,,,,,59246TX0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,59246,HIOS,5,2014-11-09 04:38:15,1,59246,TX,Individual,Yes,95-2371728,59246TX0010001,PPO MAC,59246TX001,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$38.47,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Texas,Yes,,,,,59246TX0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,59246,HIOS,5,2014-11-09 04:38:15,1,59246,TX,Individual,Yes,95-2371728,59246TX0010002,PPO MAC,59246TX001,,TXN001,TXS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$31.39,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Texas,Yes,,,,,59246TX0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,59246,HIOS,5,2014-11-09 04:38:15,1,59246,TX,SHOP (Small Group),Yes,95-2371728,59246TX0020002,PPO MAC,59246TX002,,TXN001,TXS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$21.95,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Texas,Yes,,,,,59246TX0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,59246,HIOS,5,2014-11-09 04:38:15,2,59246,TX,SHOP (Small Group),Yes,95-2371728,59246TX0020003,PPO MAC,59246TX002,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$29.27,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Texas,Yes,,,,,59246TX0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,59246,HIOS,5,2014-11-09 04:38:15,2,59246,TX,Individual,Yes,95-2371728,59246TX0010003,PPO MAC,59246TX001,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$39.67,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Texas,Yes,,,,,59246TX0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,61315,HIOS,10,2015-01-16 17:32:32,1,61315,TX,Individual,Yes,36-3757528,61315TX0010001,TruAssure Dental Basic Plan,61315TX001,,TXN001,TXS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.90,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=TX,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=TX,,61315TX0010001-00,Standard Low Off Exchange Plan,68.30%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,61315,HIOS,10,2015-01-16 17:32:32,1,61315,TX,SHOP (Small Group),Yes,36-3757528,61315TX0030001,TruAssure Dental Small Group Basic Plan,61315TX003,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$44.80,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=TX,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=TX,,61315TX0030001-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,61315,HIOS,10,2015-01-16 17:32:32,1,61315,TX,SHOP (Small Group),Yes,36-3757528,61315TX0040001,TruAssure Dental Small Group Preferred Plan,61315TX004,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$44.80,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=TX,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=TX,,61315TX0040001-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,61315,HIOS,10,2015-01-16 17:32:32,1,61315,TX,Individual,Yes,36-3757528,61315TX0010001,TruAssure Dental Basic Plan,61315TX001,,TXN001,TXS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.90,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=TX,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=TX,,61315TX0010001-01,Standard Low On Exchange Plan,68.30%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,61315,HIOS,10,2015-01-16 17:32:32,2,61315,TX,Individual,Yes,36-3757528,61315TX0020001,TruAssure Dental Preferred Plan,61315TX002,,TXN001,TXS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.08,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=TX,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=TX,,61315TX0020001-00,Standard High Off Exchange Plan,83.30%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$30,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,61315,HIOS,10,2015-01-16 17:32:32,2,61315,TX,Individual,Yes,36-3757528,61315TX0020001,TruAssure Dental Preferred Plan,61315TX002,,TXN001,TXS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.08,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=TX,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=TX,,61315TX0020001-01,Standard High On Exchange Plan,83.30%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$30,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,1,63141,TX,Individual,Yes,39-1263473,63141TX0760001,Humana Dental Smart Choice,63141TX076,,TXN002,TXS002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.60,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541383,,63141TX0760001-00,Standard Low Off Exchange Plan,71.80%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$80,Not Applicable,,,,,$80,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,1,63141,TX,Individual,No,39-1263473,63141TX0740004,Humana Silver 4600/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344290,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335372,http://apps.humana.com/marketing/documents.asp?file=2323763,63141TX0740004-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,1,63141,TX,Individual,No,39-1263473,63141TX0740004,Humana Silver 4600/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344290,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335372,http://apps.humana.com/marketing/documents.asp?file=2323763,63141TX0740004-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,1,63141,TX,Individual,Yes,39-1263473,63141TX0760001,Humana Dental Smart Choice,63141TX076,,TXN002,TXS002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.60,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541383,,63141TX0760001-01,Standard Low On Exchange Plan,71.80%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$80,Not Applicable,,,,,$80,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,1,63141,TX,Individual,No,39-1263473,63141TX0740004,Humana Silver 4600/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344290,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335372,http://apps.humana.com/marketing/documents.asp?file=2323763,63141TX0740004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,1,63141,TX,Individual,No,39-1263473,63141TX0740004,Humana Silver 4600/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344290,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335372,http://apps.humana.com/marketing/documents.asp?file=2323763,63141TX0740004-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,1,63141,TX,Individual,No,39-1263473,63141TX0740004,Humana Silver 4600/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344290,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335372,http://apps.humana.com/marketing/documents.asp?file=2323763,63141TX0740004-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,1,63141,TX,Individual,No,39-1263473,63141TX0740004,Humana Silver 4600/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344290,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335372,http://apps.humana.com/marketing/documents.asp?file=2323763,63141TX0740004-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,1,63141,TX,Individual,No,39-1263473,63141TX0740004,Humana Silver 4600/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF003,Existing,EPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344290,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335372,http://apps.humana.com/marketing/documents.asp?file=2323763,63141TX0740004-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,1,63141,TX,Individual,No,39-1263473,63141TX0740005,Humana Gold 2500/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF004,Existing,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343861,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335424,http://apps.humana.com/marketing/documents.asp?file=2323763,63141TX0740005-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,1,63141,TX,Individual,No,39-1263473,63141TX0740005,Humana Gold 2500/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF004,Existing,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343861,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335424,http://apps.humana.com/marketing/documents.asp?file=2323763,63141TX0740005-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,1,63141,TX,Individual,No,39-1263473,63141TX0740005,Humana Gold 2500/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF004,Existing,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343861,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335424,http://apps.humana.com/marketing/documents.asp?file=2323763,63141TX0740005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,1,63141,TX,Individual,No,39-1263473,63141TX0740005,Humana Gold 2500/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF004,Existing,EPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343861,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335424,http://apps.humana.com/marketing/documents.asp?file=2323763,63141TX0740005-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,1,63141,TX,Individual,No,39-1263473,63141TX0740006,Humana Platinum 1000/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF004,Existing,EPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344004,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335437,http://apps.humana.com/marketing/documents.asp?file=2323763,63141TX0740006-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,1,63141,TX,Individual,No,39-1263473,63141TX0740006,Humana Platinum 1000/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF004,Existing,EPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344004,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335437,http://apps.humana.com/marketing/documents.asp?file=2323763,63141TX0740006-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,1,63141,TX,Individual,No,39-1263473,63141TX0740006,Humana Platinum 1000/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF004,Existing,EPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344004,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335437,http://apps.humana.com/marketing/documents.asp?file=2323763,63141TX0740006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,1,63141,TX,Individual,No,39-1263473,63141TX0740006,Humana Platinum 1000/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF004,Existing,EPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344004,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335437,http://apps.humana.com/marketing/documents.asp?file=2323763,63141TX0740006-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,2,63141,TX,Individual,No,39-1263473,63141TX0740001,Humana Basic 6600/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF001,Existing,EPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343523,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335333,http://apps.humana.com/marketing/documents.asp?file=2323828,63141TX0740001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,2,63141,TX,Individual,No,39-1263473,63141TX0740002,Humana Bronze 6300/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF001,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343744,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335346,http://apps.humana.com/marketing/documents.asp?file=2323828,63141TX0740002-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,3,63141,TX,Individual,No,39-1263473,63141TX0740003,Humana Bronze 4850/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF002,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343627,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335359,http://apps.humana.com/marketing/documents.asp?file=2323763,63141TX0740003-00,Standard Bronze Off Exchange Plan,,0.611254394054413,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,3,63141,TX,Individual,No,39-1263473,63141TX0740003,Humana Bronze 4850/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF002,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343627,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335359,http://apps.humana.com/marketing/documents.asp?file=2323763,63141TX0740003-01,Standard Bronze On Exchange Plan,,0.611254394054413,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,3,63141,TX,Individual,No,39-1263473,63141TX0740003,Humana Bronze 4850/Rio Grande EPOx,63141TX074,,TXN001,TXS001,TXF002,Existing,EPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343627,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335359,http://apps.humana.com/marketing/documents.asp?file=2323763,63141TX0740003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,4,63141,TX,Individual,No,39-1263473,63141TX0750008,Humana Basic 6600/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF005,New,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343458,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335450,http://apps.humana.com/marketing/documents.asp?file=2323841,63141TX0750008-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,4,63141,TX,Individual,No,39-1263473,63141TX0750009,Humana Bronze 6300/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF005,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343679,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335463,http://apps.humana.com/marketing/documents.asp?file=2323841,63141TX0750009-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,6
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,4,63141,TX,Individual,No,39-1263473,63141TX0750009,Humana Bronze 6300/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF005,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343679,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335463,http://apps.humana.com/marketing/documents.asp?file=2323841,63141TX0750009-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,4,63141,TX,Individual,No,39-1263473,63141TX0750009,Humana Bronze 6300/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF005,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343679,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335463,http://apps.humana.com/marketing/documents.asp?file=2323841,63141TX0750009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,4,63141,TX,Individual,No,39-1263473,63141TX0750012,Humana Silver 3650/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF005,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344186,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335541,http://apps.humana.com/marketing/documents.asp?file=2323841,63141TX0750012-01,Standard Silver On Exchange Plan,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,11
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,4,63141,TX,Individual,No,39-1263473,63141TX0750012,Humana Silver 3650/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF005,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2344186,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335541,http://apps.humana.com/marketing/documents.asp?file=2323841,63141TX0750012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,12
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,5,63141,TX,Individual,No,39-1263473,63141TX0750013,Humana Gold 2500/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF008,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343796,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335593,http://apps.humana.com/marketing/documents.asp?file=2323776,63141TX0750013-03,Limited Cost Sharing Plan Variation,,0.780732274055481,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,5,63141,TX,Individual,No,39-1263473,63141TX0750014,Humana Platinum 1000/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF008,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343991,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335606,http://apps.humana.com/marketing/documents.asp?file=2323776,63141TX0750014-00,Standard Platinum Off Exchange Plan,,0.908816576004028,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,5,63141,TX,Individual,No,39-1263473,63141TX0750014,Humana Platinum 1000/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF008,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343991,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335606,http://apps.humana.com/marketing/documents.asp?file=2323776,63141TX0750014-01,Standard Platinum On Exchange Plan,,0.908816576004028,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,5,63141,TX,Individual,No,39-1263473,63141TX0750014,Humana Platinum 1000/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF008,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343991,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335606,http://apps.humana.com/marketing/documents.asp?file=2323776,63141TX0750014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,5,63141,TX,Individual,No,39-1263473,63141TX0750014,Humana Platinum 1000/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF008,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343991,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335606,http://apps.humana.com/marketing/documents.asp?file=2323776,63141TX0750014-03,Limited Cost Sharing Plan Variation,,0.908816576004028,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",35%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,6,63141,TX,Individual,No,39-1263473,63141TX0750010,Humana Bronze 4850/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF006,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343575,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335476,http://apps.humana.com/marketing/documents.asp?file=2323776,63141TX0750010-00,Standard Bronze Off Exchange Plan,,0.600789666175842,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800",Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,"$9,700","$19,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,2,85947,TX,Individual,No,35-1665915,85947TX0010001,UnitedHealthcare Platinum Compass 250,85947TX001,,TXN006,TXS001,TXF004,New,EPO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010001-00,Standard Platinum Off Exchange Plan,88.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,2,85947,TX,SHOP (Small Group),No,35-1665915,85947TX0020002,UnitedHealthcare Gold Choice HSA 1500 - 1,85947TX002,,TXN002,TXS002,TXF001,New,EPO,Gold,Yes,Both,No,No,,,,Yes,Yes,$150.00,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shoptx,,,www.uhc.com/xtx,85947TX0020002-00,Standard Gold Off Exchange Plan,81.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,2,85947,TX,SHOP (Small Group),No,35-1665915,85947TX0020002,UnitedHealthcare Gold Choice HSA 1500 - 1,85947TX002,,TXN002,TXS002,TXF001,New,EPO,Gold,Yes,Both,No,No,,,,Yes,Yes,$150.00,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shoptx,,,www.uhc.com/xtx,85947TX0020002-01,Standard Gold On Exchange Plan,81.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,2,85947,TX,Individual,No,35-1665915,85947TX0010001,UnitedHealthcare Platinum Compass 250,85947TX001,,TXN006,TXS001,TXF004,New,EPO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010001-01,Standard Platinum On Exchange Plan,88.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,69758,HIOS,2,2014-08-07 10:00:19,1,69758,TX,SHOP (Small Group),Yes,36-0883760,69758TX0030001,EHB Low Passive,69758TX003,,TXN001,TXS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.99,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,69758TX0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010006,UnitedHealthcare Silver Compass 2000,85947TX001,,TXN006,TXS001,TXF009,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010006-01,Standard Silver On Exchange Plan,69.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,$500,$500,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010006,UnitedHealthcare Silver Compass 2000,85947TX001,,TXN006,TXS001,TXF009,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010006-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010006,UnitedHealthcare Silver Compass 2000,85947TX001,,TXN006,TXS001,TXF009,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010006-03,Limited Cost Sharing Plan Variation,69.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,$500,$500,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010006,UnitedHealthcare Silver Compass 2000,85947TX001,,TXN006,TXS001,TXF009,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010006-04,73% AV Level Silver Plan,73.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,$500,$500,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,6,63141,TX,Individual,No,39-1263473,63141TX0750010,Humana Bronze 4850/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF006,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343575,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335476,http://apps.humana.com/marketing/documents.asp?file=2323776,63141TX0750010-01,Standard Bronze On Exchange Plan,,0.600789666175842,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800",Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,"$9,700","$19,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,6,63141,TX,Individual,No,39-1263473,63141TX0750010,Humana Bronze 4850/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF006,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343575,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335476,http://apps.humana.com/marketing/documents.asp?file=2323776,63141TX0750010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,63141,HIOS,18,2015-01-16 17:32:32,6,63141,TX,Individual,No,39-1263473,63141TX0750010,Humana Bronze 4850/ChoiceCare PPO,63141TX075,,TXN003,TXS003,TXF006,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.,No,http://apps.humana.com/marketing/documents.asp?file=2343575,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335476,http://apps.humana.com/marketing/documents.asp?file=2323776,63141TX0750010-03,Limited Cost Sharing Plan Variation,,0.600789666175842,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800",Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,"$9,700","$19,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,1,63509,TX,Individual,No,20-3870730,63509TX0070005,Allegian Choice Bronze,63509TX007,,TXN001,TXS001,TXF001,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,No,,No,Emergency Only,No,http://www.allegianchoice.com/HMOBronze,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0070005-00,Standard Bronze Off Exchange Plan,,0.592655181884766,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,1,63509,TX,Individual,No,20-3870730,63509TX0070005,Allegian Choice Bronze,63509TX007,,TXN001,TXS001,TXF001,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,No,,No,Emergency Only,No,http://www.allegianchoice.com/HMOBronze,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0070005-01,Standard Bronze On Exchange Plan,,0.592655181884766,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,1,63509,TX,Individual,No,20-3870730,63509TX0070005,Allegian Choice Bronze,63509TX007,,TXN001,TXS001,TXF001,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,No,,No,Emergency Only,No,http://www.allegianchoice.com/HMOBronze,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0070005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,1,63509,TX,Individual,No,20-3870730,63509TX0070005,Allegian Choice Bronze,63509TX007,,TXN001,TXS001,TXF001,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,No,,No,Emergency Only,No,http://www.allegianchoice.com/HMOBronze,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0070005-03,Limited Cost Sharing Plan Variation,,0.592655181884766,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,2,63509,TX,Individual,No,20-3870730,63509TX0070006,Allegian Choice Silver,63509TX007,,TXN001,TXS001,TXF001,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.allegianchoice.com/HMOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0070006-00,Standard Silver Off Exchange Plan,,0.680851757526398,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,600","$13,200","$5,000","$10,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,2,63509,TX,Individual,No,20-3870730,63509TX0070006,Allegian Choice Silver,63509TX007,,TXN001,TXS001,TXF001,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.allegianchoice.com/HMOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0070006-01,Standard Silver On Exchange Plan,,0.680851757526398,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,600","$13,200","$5,000","$10,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,2,63509,TX,Individual,No,20-3870730,63509TX0070006,Allegian Choice Silver,63509TX007,,TXN001,TXS001,TXF001,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.allegianchoice.com/HMOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0070006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,2,63509,TX,Individual,No,20-3870730,63509TX0070006,Allegian Choice Silver,63509TX007,,TXN001,TXS001,TXF001,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.allegianchoice.com/HMOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0070006-03,Limited Cost Sharing Plan Variation,,0.680851757526398,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,600","$13,200","$5,000","$10,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,2,63509,TX,Individual,No,20-3870730,63509TX0070006,Allegian Choice Silver,63509TX007,,TXN001,TXS001,TXF001,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.allegianchoice.com/HMOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0070006-04,73% AV Level Silver Plan,,0.734743297100067,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$5,000","$10,000","$2,750","$5,500",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,2,63509,TX,Individual,No,20-3870730,63509TX0070006,Allegian Choice Silver,63509TX007,,TXN001,TXS001,TXF001,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.allegianchoice.com/HMOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0070006-05,87% AV Level Silver Plan,,0.868489563465118,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$1,500","$3,000",$750,"$1,500",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,2,63509,TX,Individual,No,20-3870730,63509TX0070006,Allegian Choice Silver,63509TX007,,TXN001,TXS001,TXF001,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.allegianchoice.com/HMOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0070006-06,94% AV Level Silver Plan,,0.948472738265991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$500,"$1,000",$200,$400,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,3,63509,TX,Individual,No,20-3870730,63509TX0070007,Allegian Choice Gold,63509TX007,,TXN001,TXS001,TXF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.allegianchoice.com/HMOGold,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0070007-00,Standard Gold Off Exchange Plan,,0.794914901256561,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$4,500","$9,000","$1,500","$3,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,3,63509,TX,Individual,No,20-3870730,63509TX0070007,Allegian Choice Gold,63509TX007,,TXN001,TXS001,TXF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.allegianchoice.com/HMOGold,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0070007-01,Standard Gold On Exchange Plan,,0.794914901256561,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$4,500","$9,000","$1,500","$3,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,3,63509,TX,Individual,No,20-3870730,63509TX0070007,Allegian Choice Gold,63509TX007,,TXN001,TXS001,TXF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.allegianchoice.com/HMOGold,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0070007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,3,63509,TX,Individual,No,20-3870730,63509TX0070007,Allegian Choice Gold,63509TX007,,TXN001,TXS001,TXF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.allegianchoice.com/HMOGold,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0070007-03,Limited Cost Sharing Plan Variation,,0.794914901256561,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$4,500","$9,000","$1,500","$3,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,4,63509,TX,Individual,No,20-3870730,63509TX0140001,Allegian Choice Bronze,63509TX014,,TXN001,TXS002,TXF001,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,,No,,Yes,Plan allows for out-of-network coverage,No,http://www.allegianchoice.com/PPOBronze,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0140001-00,Standard Bronze Off Exchange Plan,,0.593721210956573,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,4,63509,TX,Individual,No,20-3870730,63509TX0140001,Allegian Choice Bronze,63509TX014,,TXN001,TXS002,TXF001,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,,No,,Yes,Plan allows for out-of-network coverage,No,http://www.allegianchoice.com/PPOBronze,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0140001-01,Standard Bronze On Exchange Plan,,0.593721210956573,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,4,63509,TX,Individual,No,20-3870730,63509TX0140001,Allegian Choice Bronze,63509TX014,,TXN001,TXS002,TXF001,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,,No,,Yes,Plan allows for out-of-network coverage,No,http://www.allegianchoice.com/PPOBronze,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0140001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,4,63509,TX,Individual,No,20-3870730,63509TX0140001,Allegian Choice Bronze,63509TX014,,TXN001,TXS002,TXF001,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,,No,,Yes,Plan allows for out-of-network coverage,No,http://www.allegianchoice.com/PPOBronze,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0140001-03,Limited Cost Sharing Plan Variation,,0.593721210956573,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,5,63509,TX,Individual,No,20-3870730,63509TX0140003,Allegian Choice Silver $3500,63509TX014,,TXN001,TXS002,TXF001,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,$500,0,0,0,2015-01-01,,No,,Yes,Plan allows for out-of-network coverage,No,http://www.allegianchoice.com/PPOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0140003-00,Standard Silver Off Exchange Plan,,0.690090000629425,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,5,63509,TX,Individual,No,20-3870730,63509TX0140003,Allegian Choice Silver $3500,63509TX014,,TXN001,TXS002,TXF001,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,$500,0,0,0,2015-01-01,,No,,Yes,Plan allows for out-of-network coverage,No,http://www.allegianchoice.com/PPOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0140003-01,Standard Silver On Exchange Plan,,0.690090000629425,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,5,63509,TX,Individual,No,20-3870730,63509TX0140003,Allegian Choice Silver $3500,63509TX014,,TXN001,TXS002,TXF001,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,$500,0,0,0,2015-01-01,,No,,Yes,Plan allows for out-of-network coverage,No,http://www.allegianchoice.com/PPOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0140003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,5,63509,TX,Individual,No,20-3870730,63509TX0140003,Allegian Choice Silver $3500,63509TX014,,TXN001,TXS002,TXF001,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,$500,0,0,0,2015-01-01,,No,,Yes,Plan allows for out-of-network coverage,No,http://www.allegianchoice.com/PPOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0140003-03,Limited Cost Sharing Plan Variation,,0.690090000629425,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,5,63509,TX,Individual,No,20-3870730,63509TX0140003,Allegian Choice Silver $3500,63509TX014,,TXN001,TXS002,TXF001,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,$500,0,0,0,2015-01-01,,No,,Yes,Plan allows for out-of-network coverage,No,http://www.allegianchoice.com/PPOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0140003-04,73% AV Level Silver Plan,,0.724327564239502,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,5,63509,TX,Individual,No,20-3870730,63509TX0140003,Allegian Choice Silver $3500,63509TX014,,TXN001,TXS002,TXF001,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,$500,0,0,0,2015-01-01,,No,,Yes,Plan allows for out-of-network coverage,No,http://www.allegianchoice.com/PPOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0140003-05,87% AV Level Silver Plan,,0.86550372838974,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,5,63509,TX,Individual,No,20-3870730,63509TX0140003,Allegian Choice Silver $3500,63509TX014,,TXN001,TXS002,TXF001,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,$500,0,0,0,2015-01-01,,No,,Yes,Plan allows for out-of-network coverage,No,http://www.allegianchoice.com/PPOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0140003-06,94% AV Level Silver Plan,,0.935280680656433,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,6,63509,TX,Individual,No,20-3870730,63509TX0140002,Allegian Choice Silver $5000,63509TX014,,TXN001,TXS002,TXF001,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,$500,0,0,0,2015-01-01,,No,,Yes,Plan allows for out-of-network coverage,No,http://www.allegianchoice.com/PPOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0140002-00,Standard Silver Off Exchange Plan,,0.684351325035095,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,6,63509,TX,Individual,No,20-3870730,63509TX0140002,Allegian Choice Silver $5000,63509TX014,,TXN001,TXS002,TXF001,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,$500,0,0,0,2015-01-01,,No,,Yes,Plan allows for out-of-network coverage,No,http://www.allegianchoice.com/PPOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0140002-01,Standard Silver On Exchange Plan,,0.684351325035095,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,6,63509,TX,Individual,No,20-3870730,63509TX0140002,Allegian Choice Silver $5000,63509TX014,,TXN001,TXS002,TXF001,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,$500,0,0,0,2015-01-01,,No,,Yes,Plan allows for out-of-network coverage,No,http://www.allegianchoice.com/PPOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0140002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,6,63509,TX,Individual,No,20-3870730,63509TX0140002,Allegian Choice Silver $5000,63509TX014,,TXN001,TXS002,TXF001,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,$500,0,0,0,2015-01-01,,No,,Yes,Plan allows for out-of-network coverage,No,http://www.allegianchoice.com/PPOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0140002-03,Limited Cost Sharing Plan Variation,,0.684351325035095,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,6,63509,TX,Individual,No,20-3870730,63509TX0140002,Allegian Choice Silver $5000,63509TX014,,TXN001,TXS002,TXF001,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,$500,0,0,0,2015-01-01,,No,,Yes,Plan allows for out-of-network coverage,No,http://www.allegianchoice.com/PPOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0140002-04,73% AV Level Silver Plan,,0.735273122787476,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,6,63509,TX,Individual,No,20-3870730,63509TX0140002,Allegian Choice Silver $5000,63509TX014,,TXN001,TXS002,TXF001,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,$500,0,0,0,2015-01-01,,No,,Yes,Plan allows for out-of-network coverage,No,http://www.allegianchoice.com/PPOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0140002-05,87% AV Level Silver Plan,,0.874786376953125,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,6,63509,TX,Individual,No,20-3870730,63509TX0140002,Allegian Choice Silver $5000,63509TX014,,TXN001,TXS002,TXF001,New,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,$500,0,0,0,2015-01-01,,No,,Yes,Plan allows for out-of-network coverage,No,http://www.allegianchoice.com/PPOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0140002-06,94% AV Level Silver Plan,,0.931415021419525,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,7,63509,TX,Individual,No,20-3870730,63509TX0140004,Allegian Choice Gold,63509TX014,,TXN001,TXS002,TXF001,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,$500,0,0,0,2015-01-01,,No,,Yes,Plan allows for out-of-network coverage,No,http://www.allegianchoice.com/PPOGold,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0140004-00,Standard Gold Off Exchange Plan,,0.781434953212738,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,7,63509,TX,Individual,No,20-3870730,63509TX0140004,Allegian Choice Gold,63509TX014,,TXN001,TXS002,TXF001,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,$500,0,0,0,2015-01-01,,No,,Yes,Plan allows for out-of-network coverage,No,http://www.allegianchoice.com/PPOGold,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0140004-01,Standard Gold On Exchange Plan,,0.781434953212738,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,7,63509,TX,Individual,No,20-3870730,63509TX0140004,Allegian Choice Gold,63509TX014,,TXN001,TXS002,TXF001,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,$500,0,0,0,2015-01-01,,No,,Yes,Plan allows for out-of-network coverage,No,http://www.allegianchoice.com/PPOGold,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0140004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,63509,HIOS,12,2015-01-16 17:32:32,7,63509,TX,Individual,No,20-3870730,63509TX0140004,Allegian Choice Gold,63509TX014,,TXN001,TXS002,TXF001,New,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,$500,0,0,0,2015-01-01,,No,,Yes,Plan allows for out-of-network coverage,No,http://www.allegianchoice.com/PPOGold,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=TX,,http://www.allegianchoice.com/Formulary,63509TX0140004-03,Limited Cost Sharing Plan Variation,,0.781434953212738,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,69758,HIOS,2,2014-08-07 10:00:19,1,69758,TX,SHOP (Small Group),Yes,36-0883760,69758TX0030002,EHB High Passive,69758TX003,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$38.67,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,69758TX0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,SHOP (Small Group),No,35-1665915,85947TX0020003,UnitedHealthcare Silver Choice HSA 3000,85947TX002,,TXN002,TXS002,TXF001,New,EPO,Silver,Yes,Both,No,No,,,,Yes,Yes,$250.00,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shoptx,,,www.uhc.com/xtx,85947TX0020003-00,Standard Silver Off Exchange Plan,71.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,Individual,No,35-1665915,85947TX0010004,UnitedHealthcare Silver Compass HSA 2600,85947TX001,,TXN006,TXS001,TXF003,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,Individual,No,35-1665915,85947TX0010004,UnitedHealthcare Silver Compass HSA 2600,85947TX001,,TXN006,TXS001,TXF003,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010004-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,SHOP (Small Group),No,35-1665915,85947TX0020003,UnitedHealthcare Silver Choice HSA 3000,85947TX002,,TXN002,TXS002,TXF001,New,EPO,Silver,Yes,Both,No,No,,,,Yes,Yes,$250.00,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shoptx,,,www.uhc.com/xtx,85947TX0020003-01,Standard Silver On Exchange Plan,71.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,SHOP (Small Group),No,35-1665915,85947TX0020005,UnitedHealthcare Bronze Choice HSA 5000,85947TX002,,TXN002,TXS002,TXF001,New,EPO,Bronze,Yes,Both,No,No,,,,Yes,Yes,$25.00,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shoptx,,,www.uhc.com/xtx,85947TX0020005-00,Standard Bronze Off Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,Individual,No,35-1665915,85947TX0010004,UnitedHealthcare Silver Compass HSA 2600,85947TX001,,TXN006,TXS001,TXF003,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010004-04,73% AV Level Silver Plan,72.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,1,87226,TX,Individual,No,74-2770542,87226TX0010009,Ambetter Balanced Care 5,87226TX001,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010009-04,73% AV Level Silver Plan,73.24%,0.732411444187164,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$2,920",$350,$0,$80,8
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,1,87226,TX,Individual,No,74-2770542,87226TX0010009,Ambetter Balanced Care 5,87226TX001,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010009-05,87% AV Level Silver Plan,87.97%,0.879661500453949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$410,$0,$150,$600,$520,$0,$80,9
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,1,87226,TX,Individual,No,74-2770542,87226TX0010009,Ambetter Balanced Care 5,87226TX001,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010009-06,94% AV Level Silver Plan,93.34%,0.933413624763489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$120,$0,$150,$0,$450,$0,$80,10
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,1,87226,TX,Individual,No,74-2770542,87226TX0010007,Ambetter Balanced Care 3,87226TX001,,TXN001,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010007-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,11
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,1,87226,TX,Individual,No,74-2770542,87226TX0010007,Ambetter Balanced Care 3,87226TX001,,TXN001,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010007-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,12
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,1,87226,TX,Individual,No,74-2770542,87226TX0010007,Ambetter Balanced Care 3,87226TX001,,TXN001,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,1,87226,TX,Individual,No,74-2770542,87226TX0010007,Ambetter Balanced Care 3,87226TX001,,TXN001,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010007-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,14
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,1,87226,TX,Individual,No,74-2770542,87226TX0010007,Ambetter Balanced Care 3,87226TX001,,TXN001,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010007-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,15
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,1,87226,TX,Individual,No,74-2770542,87226TX0010007,Ambetter Balanced Care 3,87226TX001,,TXN001,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010007-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,16
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,1,87226,TX,Individual,No,74-2770542,87226TX0010007,Ambetter Balanced Care 3,87226TX001,,TXN001,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010007-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,17
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,Individual,No,35-1665915,85947TX0010004,UnitedHealthcare Silver Compass HSA 2600,85947TX001,,TXN006,TXS001,TXF003,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010004-05,87% AV Level Silver Plan,86.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$550,"$1,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,SHOP (Small Group),No,35-1665915,85947TX0020005,UnitedHealthcare Bronze Choice HSA 5000,85947TX002,,TXN002,TXS002,TXF001,New,EPO,Bronze,Yes,Both,No,No,,,,Yes,Yes,$25.00,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shoptx,,,www.uhc.com/xtx,85947TX0020005-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,Individual,No,35-1665915,85947TX0010004,UnitedHealthcare Silver Compass HSA 2600,85947TX001,,TXN006,TXS001,TXF003,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010004-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$75,$150,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,Individual,No,35-1665915,85947TX0010005,UnitedHealthcare Silver Compass HSA 1600,85947TX001,,TXN006,TXS001,TXF009,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010005-00,Standard Silver Off Exchange Plan,68.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,Individual,No,35-1665915,85947TX0010005,UnitedHealthcare Silver Compass HSA 1600,85947TX001,,TXN006,TXS001,TXF009,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010005-01,Standard Silver On Exchange Plan,68.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,Individual,No,35-1665915,85947TX0010005,UnitedHealthcare Silver Compass HSA 1600,85947TX001,,TXN006,TXS001,TXF009,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010005-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,Individual,No,35-1665915,85947TX0010005,UnitedHealthcare Silver Compass HSA 1600,85947TX001,,TXN006,TXS001,TXF009,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010005-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,Individual,No,35-1665915,85947TX0010009,UnitedHealthcare Bronze Compass HSA 4900,85947TX001,,TXN006,TXS001,TXF008,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010009-00,Standard Bronze Off Exchange Plan,58.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,Individual,No,35-1665915,85947TX0010009,UnitedHealthcare Bronze Compass HSA 4900,85947TX001,,TXN006,TXS001,TXF008,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010009-01,Standard Bronze On Exchange Plan,58.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,Individual,No,35-1665915,85947TX0010009,UnitedHealthcare Bronze Compass HSA 4900,85947TX001,,TXN006,TXS001,TXF008,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010009-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,Individual,No,35-1665915,85947TX0010009,UnitedHealthcare Bronze Compass HSA 4900,85947TX001,,TXN006,TXS001,TXF008,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010009-03,Limited Cost Sharing Plan Variation,58.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,TX,71837,HIOS,9,2015-01-22 10:35:59,1,71837,TX,Individual,No,27-5219887,71837TX0010001,IdealCare Complete,71837TX001,7386647516,TXN001,TXS001,TXF001,Existing,HMO,Silver,No,Both,Yes,Yes,"Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ?Allergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women?s Health), ?Neurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ?Family Practice (General Family Medical Care), ?Endocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,www.senderohealth.com/idealcarebenefits/,www.senderohealth.com/idealcareenroll/??,www.senderohealth.com/idealcareplandetails/,www.senderohealth.com\idealcareformulary,71837TX0010001-00,Standard Silver Off Exchange Plan,,0.681189358234406,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200",20%,,,,Not Applicable,Not Applicable,"$6,100","$12,200","$2,790",$260,$0,$150,"$1,150",$200,$250,$80,4
2015,TX,71837,HIOS,9,2015-01-22 10:35:59,1,71837,TX,Individual,No,27-5219887,71837TX0010001,IdealCare Complete,71837TX001,7386647516,TXN001,TXS001,TXF001,Existing,HMO,Silver,No,Both,Yes,Yes,"Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ?Allergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women?s Health), ?Neurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ?Family Practice (General Family Medical Care), ?Endocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,www.senderohealth.com/idealcarebenefits/,www.senderohealth.com/idealcareenroll/??,www.senderohealth.com/idealcareplandetails/,www.senderohealth.com\idealcareformulary,71837TX0010001-01,Standard Silver On Exchange Plan,,0.681189358234406,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200",20%,,,,Not Applicable,Not Applicable,"$6,100","$12,200","$2,790",$260,$0,$150,"$1,150",$200,$250,$80,5
2015,TX,71837,HIOS,9,2015-01-22 10:35:59,1,71837,TX,Individual,No,27-5219887,71837TX0010001,IdealCare Complete,71837TX001,7386647516,TXN001,TXS001,TXF001,Existing,HMO,Silver,No,Both,Yes,Yes,"Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ?Allergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women?s Health), ?Neurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ?Family Practice (General Family Medical Care), ?Endocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,www.senderohealth.com/idealcarebenefits/,www.senderohealth.com/idealcareenroll/??,www.senderohealth.com/idealcareplandetails/,www.senderohealth.com\idealcareformulary,71837TX0010001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,TX,71837,HIOS,9,2015-01-22 10:35:59,1,71837,TX,Individual,No,27-5219887,71837TX0010001,IdealCare Complete,71837TX001,7386647516,TXN001,TXS001,TXF001,Existing,HMO,Silver,No,Both,Yes,Yes,"Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ?Allergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women?s Health), ?Neurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ?Family Practice (General Family Medical Care), ?Endocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,www.senderohealth.com/idealcarebenefits/,www.senderohealth.com/idealcareenroll/??,www.senderohealth.com/idealcareplandetails/,www.senderohealth.com\idealcareformulary,71837TX0010001-03,Limited Cost Sharing Plan Variation,,0.681189358234406,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200",20%,,,,Not Applicable,Not Applicable,"$6,100","$12,200","$2,790",$260,$0,$150,"$1,150",$200,$250,$80,7
2015,TX,71837,HIOS,9,2015-01-22 10:35:59,1,71837,TX,Individual,No,27-5219887,71837TX0010001,IdealCare Complete,71837TX001,7386647516,TXN001,TXS001,TXF001,Existing,HMO,Silver,No,Both,Yes,Yes,"Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ?Allergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women?s Health), ?Neurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ?Family Practice (General Family Medical Care), ?Endocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,www.senderohealth.com/idealcarebenefits/,www.senderohealth.com/idealcareenroll/??,www.senderohealth.com/idealcareplandetails/,www.senderohealth.com\idealcareformulary,71837TX0010001-04,73% AV Level Silver Plan,,0.734429717063904,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,"$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",15%,,,,Not Applicable,Not Applicable,"$4,200","$8,400","$2,790",$260,$0,$150,"$1,150",$200,$190,$80,8
2015,TX,71837,HIOS,9,2015-01-22 10:35:59,1,71837,TX,Individual,No,27-5219887,71837TX0010001,IdealCare Complete,71837TX001,7386647516,TXN001,TXS001,TXF001,Existing,HMO,Silver,No,Both,Yes,Yes,"Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ?Allergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women?s Health), ?Neurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ?Family Practice (General Family Medical Care), ?Endocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,www.senderohealth.com/idealcarebenefits/,www.senderohealth.com/idealcareenroll/??,www.senderohealth.com/idealcareplandetails/,www.senderohealth.com\idealcareformulary,71837TX0010001-05,87% AV Level Silver Plan,,0.879331827163696,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,"$2,250","$4,500",,,,,,,,,,,,,,,,,,,,,$400,$800,10%,,,,Not Applicable,Not Applicable,$400,$800,$400,$270,$60,$150,$400,$300,$120,$80,9
2015,TX,71837,HIOS,9,2015-01-22 10:35:59,1,71837,TX,Individual,No,27-5219887,71837TX0010001,IdealCare Complete,71837TX001,7386647516,TXN001,TXS001,TXF001,Existing,HMO,Silver,No,Both,Yes,Yes,"Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ?Allergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women?s Health), ?Neurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ?Family Practice (General Family Medical Care), ?Endocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,www.senderohealth.com/idealcarebenefits/,www.senderohealth.com/idealcareenroll/??,www.senderohealth.com/idealcareplandetails/,www.senderohealth.com\idealcareformulary,71837TX0010001-06,94% AV Level Silver Plan,,0.949710547924042,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$850,"$1,700",,,Not Applicable,Not Applicable,$850,"$1,700",,,,,,,,,,,,,,,,,,,,,$0,$0,5%,,,,Not Applicable,Not Applicable,$0,$0,$0,$120,$40,$150,$0,$250,$70,$80,10
2015,TX,71837,HIOS,9,2015-01-22 10:35:59,1,71837,TX,Individual,No,27-5219887,71837TX0010002,IdealCare Total,71837TX001,7386647516,TXN001,TXS001,TXF001,Existing,HMO,Gold,No,Both,Yes,Yes,"Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ?Allergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women?s Health), ?Neurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ?Family Practice (General Family Medical Care), ?Endocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,www.senderohealth.com/idealcarebenefits/,www.senderohealth.com/idealcareenroll/??,www.senderohealth.com/idealcareplandetails/,www.senderohealth.com\idealcareformulary,71837TX0010002-00,Standard Gold Off Exchange Plan,,0.790173828601837,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,Not Applicable,Not Applicable,$0,$0,$0,$270,$350,$150,$0,$400,$700,$80,11
2015,TX,71837,HIOS,9,2015-01-22 10:35:59,1,71837,TX,Individual,No,27-5219887,71837TX0010002,IdealCare Total,71837TX001,7386647516,TXN001,TXS001,TXF001,Existing,HMO,Gold,No,Both,Yes,Yes,"Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ?Allergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women?s Health), ?Neurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ?Family Practice (General Family Medical Care), ?Endocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,www.senderohealth.com/idealcarebenefits/,www.senderohealth.com/idealcareenroll/??,www.senderohealth.com/idealcareplandetails/,www.senderohealth.com\idealcareformulary,71837TX0010002-01,Standard Gold On Exchange Plan,,0.790173828601837,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,Not Applicable,Not Applicable,$0,$0,$0,$270,$350,$150,$0,$400,$700,$80,12
2015,TX,71837,HIOS,9,2015-01-22 10:35:59,1,71837,TX,Individual,No,27-5219887,71837TX0010002,IdealCare Total,71837TX001,7386647516,TXN001,TXS001,TXF001,Existing,HMO,Gold,No,Both,Yes,Yes,"Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ?Allergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women?s Health), ?Neurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ?Family Practice (General Family Medical Care), ?Endocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,www.senderohealth.com/idealcarebenefits/,www.senderohealth.com/idealcareenroll/??,www.senderohealth.com/idealcareplandetails/,www.senderohealth.com\idealcareformulary,71837TX0010002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,TX,71837,HIOS,9,2015-01-22 10:35:59,1,71837,TX,Individual,No,27-5219887,71837TX0010002,IdealCare Total,71837TX001,7386647516,TXN001,TXS001,TXF001,Existing,HMO,Gold,No,Both,Yes,Yes,"Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ?Allergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women?s Health), ?Neurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ?Family Practice (General Family Medical Care), ?Endocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,www.senderohealth.com/idealcarebenefits/,www.senderohealth.com/idealcareenroll/??,www.senderohealth.com/idealcareplandetails/,www.senderohealth.com\idealcareformulary,71837TX0010002-03,Limited Cost Sharing Plan Variation,,0.790173828601837,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,Not Applicable,Not Applicable,$0,$0,$0,$270,$350,$150,$0,$400,$700,$80,14
2015,TX,71837,HIOS,9,2015-01-22 10:35:59,2,71837,TX,Individual,No,27-5219887,71837TX0010003,IdealCare Essential,71837TX001,7386647516,TXN001,TXS001,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ?Allergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women?s Health), ?Neurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ?Family Practice (General Family Medical Care), ?Endocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,www.senderohealth.com/idealcarebenefits/,www.senderohealth.com/idealcareenroll/??,www.senderohealth.com/idealcareplandetails/,www.senderohealth.com\idealcareformulary,71837TX0010003-00,Standard Bronze Off Exchange Plan,,0.609028875827789,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",20%,,,,Not Applicable,Not Applicable,"$6,350","$12,700","$6,350",$0,$0,$150,"$5,270",$0,$0,$80,4
2015,TX,71837,HIOS,9,2015-01-22 10:35:59,2,71837,TX,Individual,No,27-5219887,71837TX0010003,IdealCare Essential,71837TX001,7386647516,TXN001,TXS001,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ?Allergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women?s Health), ?Neurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ?Family Practice (General Family Medical Care), ?Endocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,www.senderohealth.com/idealcarebenefits/,www.senderohealth.com/idealcareenroll/??,www.senderohealth.com/idealcareplandetails/,www.senderohealth.com\idealcareformulary,71837TX0010003-01,Standard Bronze On Exchange Plan,,0.609028875827789,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",20%,,,,Not Applicable,Not Applicable,"$6,350","$12,700","$6,350",$0,$0,$150,"$5,270",$0,$0,$80,5
2015,TX,71837,HIOS,9,2015-01-22 10:35:59,2,71837,TX,Individual,No,27-5219887,71837TX0010003,IdealCare Essential,71837TX001,7386647516,TXN001,TXS001,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ?Allergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women?s Health), ?Neurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ?Family Practice (General Family Medical Care), ?Endocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,www.senderohealth.com/idealcarebenefits/,www.senderohealth.com/idealcareenroll/??,www.senderohealth.com/idealcareplandetails/,www.senderohealth.com\idealcareformulary,71837TX0010003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,TX,71837,HIOS,9,2015-01-22 10:35:59,2,71837,TX,Individual,No,27-5219887,71837TX0010003,IdealCare Essential,71837TX001,7386647516,TXN001,TXS001,TXF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ?Allergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women?s Health), ?Neurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ?Family Practice (General Family Medical Care), ?Endocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,www.senderohealth.com/idealcarebenefits/,www.senderohealth.com/idealcareenroll/??,www.senderohealth.com/idealcareplandetails/,www.senderohealth.com\idealcareformulary,71837TX0010003-03,Limited Cost Sharing Plan Variation,,0.609028875827789,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",20%,,,,Not Applicable,Not Applicable,"$6,350","$12,700","$6,350",$0,$0,$150,"$5,270",$0,$0,$80,7
2015,TX,72166,HIOS,3,2014-09-04 03:25:43,1,72166,TX,SHOP (Small Group),Yes,35-0472300,72166TX0010001,Lincoln DentalConnect?,72166TX001,,TXN001,TXS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$38.24,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,72166TX0010001-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,72166,HIOS,3,2014-09-04 03:25:43,1,72166,TX,SHOP (Small Group),Yes,35-0472300,72166TX0010002,Lincoln DentalConnect?,72166TX001,,TXN001,TXS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.19,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,72166TX0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,72166,HIOS,3,2014-09-04 03:25:43,1,72166,TX,SHOP (Small Group),Yes,35-0472300,72166TX0010003,Lincoln DentalConnect?,72166TX001,,TXN001,TXS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.02,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,72166TX0010003-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TX,72166,HIOS,3,2014-09-04 03:25:43,2,72166,TX,SHOP (Small Group),Yes,35-0472300,72166TX0010004,Lincoln DentalConnect?,72166TX001,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$37.73,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,72166TX0010004-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,SHOP (Small Group),No,35-1665915,85947TX0020001,UnitedHealthcare Gold Choice HSA 1500,85947TX002,,TXN002,TXS002,TXF001,New,EPO,Gold,Yes,Both,No,No,,,,Yes,Yes,$150.00,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shoptx,,,www.uhc.com/xtx,85947TX0020001-00,Standard Gold Off Exchange Plan,81.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,Individual,No,35-1665915,85947TX0010004,UnitedHealthcare Silver Compass HSA 2600,85947TX001,,TXN006,TXS001,TXF003,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010004-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,Individual,No,35-1665915,85947TX0010004,UnitedHealthcare Silver Compass HSA 2600,85947TX001,,TXN006,TXS001,TXF003,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010004-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,SHOP (Small Group),No,35-1665915,85947TX0020001,UnitedHealthcare Gold Choice HSA 1500,85947TX002,,TXN002,TXS002,TXF001,New,EPO,Gold,Yes,Both,No,No,,,,Yes,Yes,$150.00,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shoptx,,,www.uhc.com/xtx,85947TX0020001-01,Standard Gold On Exchange Plan,81.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,Individual,No,35-1665915,85947TX0010005,UnitedHealthcare Silver Compass HSA 1600,85947TX001,,TXN006,TXS001,TXF009,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010005-03,Limited Cost Sharing Plan Variation,68.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,Individual,No,35-1665915,85947TX0010005,UnitedHealthcare Silver Compass HSA 1600,85947TX001,,TXN006,TXS001,TXF009,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010005-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,1,85947,TX,Individual,No,35-1665915,85947TX0010005,UnitedHealthcare Silver Compass HSA 1600,85947TX001,,TXN006,TXS001,TXF009,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010005-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,2,85947,TX,Individual,No,35-1665915,85947TX0010001,UnitedHealthcare Platinum Compass 250,85947TX001,,TXN006,TXS001,TXF004,New,EPO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,2,85947,TX,SHOP (Small Group),No,35-1665915,85947TX0020004,UnitedHealthcare Silver Choice HSA 3000 - 1,85947TX002,,TXN002,TXS002,TXF001,New,EPO,Silver,Yes,Both,No,No,,,,Yes,Yes,$250.00,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shoptx,,,www.uhc.com/xtx,85947TX0020004-00,Standard Silver Off Exchange Plan,71.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,2,85947,TX,SHOP (Small Group),No,35-1665915,85947TX0020004,UnitedHealthcare Silver Choice HSA 3000 - 1,85947TX002,,TXN002,TXS002,TXF001,New,EPO,Silver,Yes,Both,No,No,,,,Yes,Yes,$250.00,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shoptx,,,www.uhc.com/xtx,85947TX0020004-01,Standard Silver On Exchange Plan,71.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,2,85947,TX,Individual,No,35-1665915,85947TX0010001,UnitedHealthcare Platinum Compass 250,85947TX001,,TXN006,TXS001,TXF004,New,EPO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010001-03,Limited Cost Sharing Plan Variation,88.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,2,85947,TX,SHOP (Small Group),No,35-1665915,85947TX0020006,UnitedHealthcare Bronze Choice HSA 5000 - 1,85947TX002,,TXN002,TXS002,TXF001,New,EPO,Bronze,Yes,Both,No,No,,,,Yes,Yes,$25.00,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shoptx,,,www.uhc.com/xtx,85947TX0020006-00,Standard Bronze Off Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,2,85947,TX,SHOP (Small Group),No,35-1665915,85947TX0020006,UnitedHealthcare Bronze Choice HSA 5000 - 1,85947TX002,,TXN002,TXS002,TXF001,New,EPO,Bronze,Yes,Both,No,No,,,,Yes,Yes,$25.00,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shoptx,,,www.uhc.com/xtx,85947TX0020006-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010002,UnitedHealthcare Gold Compass 1250,85947TX001,,TXN006,TXS001,TXF005,New,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010002-00,Standard Gold Off Exchange Plan,79.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,$500,$500,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010002,UnitedHealthcare Gold Compass 1250,85947TX001,,TXN006,TXS001,TXF005,New,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010002-01,Standard Gold On Exchange Plan,79.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,$500,$500,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010002,UnitedHealthcare Gold Compass 1250,85947TX001,,TXN006,TXS001,TXF005,New,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010002,UnitedHealthcare Gold Compass 1250,85947TX001,,TXN006,TXS001,TXF005,New,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010002-03,Limited Cost Sharing Plan Variation,79.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,$500,$500,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010003,UnitedHealthcare Gold Compass 500,85947TX001,,TXN006,TXS001,TXF005,New,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010003-00,Standard Gold Off Exchange Plan,78.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,$250,$250,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010003,UnitedHealthcare Gold Compass 500,85947TX001,,TXN006,TXS001,TXF005,New,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010003-01,Standard Gold On Exchange Plan,78.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,$250,$250,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010003,UnitedHealthcare Gold Compass 500,85947TX001,,TXN006,TXS001,TXF005,New,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010003-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010003,UnitedHealthcare Gold Compass 500,85947TX001,,TXN006,TXS001,TXF005,New,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010003-03,Limited Cost Sharing Plan Variation,78.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,$250,$250,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010006,UnitedHealthcare Silver Compass 2000,85947TX001,,TXN006,TXS001,TXF009,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010006-00,Standard Silver Off Exchange Plan,69.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,$500,$500,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010006,UnitedHealthcare Silver Compass 2000,85947TX001,,TXN006,TXS001,TXF009,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010006-05,87% AV Level Silver Plan,86.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,$250,$250,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010006,UnitedHealthcare Silver Compass 2000,85947TX001,,TXN006,TXS001,TXF009,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010006-06,94% AV Level Silver Plan,93.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,0%,,,,$100,$100,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010007,UnitedHealthcare Silver Compass 3500-1,85947TX001,,TXN006,TXS001,TXF006,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010007-00,Standard Silver Off Exchange Plan,70.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,$1000,$1000,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010007,UnitedHealthcare Silver Compass 3500-1,85947TX001,,TXN006,TXS001,TXF006,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010007-01,Standard Silver On Exchange Plan,70.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,$1000,$1000,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,3,87226,TX,Individual,No,74-2770542,87226TX0010008,Ambetter Balanced Care 4,87226TX001,,TXN001,TXS001,TXF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,3,87226,TX,Individual,No,74-2770542,87226TX0010008,Ambetter Balanced Care 4,87226TX001,,TXN001,TXS001,TXF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010008-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,7
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,3,87226,TX,Individual,No,74-2770542,87226TX0010008,Ambetter Balanced Care 4,87226TX001,,TXN001,TXS001,TXF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010008-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,8
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,3,87226,TX,Individual,No,74-2770542,87226TX0010008,Ambetter Balanced Care 4,87226TX001,,TXN001,TXS001,TXF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010008-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,9
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,3,87226,TX,Individual,No,74-2770542,87226TX0010008,Ambetter Balanced Care 4,87226TX001,,TXN001,TXS001,TXF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010008-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,10
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,4,87226,TX,Individual,No,74-2770542,87226TX0010014,Ambetter Balanced Care 2,87226TX001,,TXN001,TXS001,TXF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010014-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,4
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,4,87226,TX,Individual,No,74-2770542,87226TX0010014,Ambetter Balanced Care 2,87226TX001,,TXN001,TXS001,TXF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010014-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,5
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,4,87226,TX,Individual,No,74-2770542,87226TX0010014,Ambetter Balanced Care 2,87226TX001,,TXN001,TXS001,TXF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,5,87226,TX,Individual,No,74-2770542,87226TX0010015,Ambetter Balanced Care 1,87226TX001,,TXN001,TXS001,TXF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,5,87226,TX,Individual,No,74-2770542,87226TX0010015,Ambetter Balanced Care 1,87226TX001,,TXN001,TXS001,TXF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010015-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,7
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,5,87226,TX,Individual,No,74-2770542,87226TX0010015,Ambetter Balanced Care 1,87226TX001,,TXN001,TXS001,TXF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010015-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,8
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,5,87226,TX,Individual,No,74-2770542,87226TX0010015,Ambetter Balanced Care 1,87226TX001,,TXN001,TXS001,TXF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010015-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,9
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,5,87226,TX,Individual,No,74-2770542,87226TX0010015,Ambetter Balanced Care 1,87226TX001,,TXN001,TXS001,TXF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010015-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,10
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,6,87226,TX,Individual,No,74-2770542,87226TX0020009,Ambetter Balanced Care 5 + Vision,87226TX002,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977149956579029,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020009-00,Standard Silver Off Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,4
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010007,UnitedHealthcare Silver Compass 3500-1,85947TX001,,TXN006,TXS001,TXF006,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010007-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010007,UnitedHealthcare Silver Compass 3500-1,85947TX001,,TXN006,TXS001,TXF006,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010007-03,Limited Cost Sharing Plan Variation,70.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,$1000,$1000,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010007,UnitedHealthcare Silver Compass 3500-1,85947TX001,,TXN006,TXS001,TXF006,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010007-04,73% AV Level Silver Plan,73.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,$500,$500,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,4,87226,TX,Individual,No,74-2770542,87226TX0010014,Ambetter Balanced Care 2,87226TX001,,TXN001,TXS001,TXF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010014-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,7
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,4,87226,TX,Individual,No,74-2770542,87226TX0010014,Ambetter Balanced Care 2,87226TX001,,TXN001,TXS001,TXF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010014-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,8
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,4,87226,TX,Individual,No,74-2770542,87226TX0010014,Ambetter Balanced Care 2,87226TX001,,TXN001,TXS001,TXF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010014-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,9
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,4,87226,TX,Individual,No,74-2770542,87226TX0010014,Ambetter Balanced Care 2,87226TX001,,TXN001,TXS001,TXF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010014-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,10
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,5,87226,TX,Individual,No,74-2770542,87226TX0010015,Ambetter Balanced Care 1,87226TX001,,TXN001,TXS001,TXF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010015-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,4
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,5,87226,TX,Individual,No,74-2770542,87226TX0010015,Ambetter Balanced Care 1,87226TX001,,TXN001,TXS001,TXF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010015-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,5
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010007,UnitedHealthcare Silver Compass 3500-1,85947TX001,,TXN006,TXS001,TXF006,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010007-05,87% AV Level Silver Plan,86.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,$250,$250,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010007,UnitedHealthcare Silver Compass 3500-1,85947TX001,,TXN006,TXS001,TXF006,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010007-06,94% AV Level Silver Plan,93.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,0%,,,,$100,$100,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010008,UnitedHealthcare Silver Compass 5000,85947TX001,,TXN006,TXS001,TXF007,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010008-00,Standard Silver Off Exchange Plan,69.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,$1000,$1000,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010008,UnitedHealthcare Silver Compass 5000,85947TX001,,TXN006,TXS001,TXF007,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010008-01,Standard Silver On Exchange Plan,69.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,$1000,$1000,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010008,UnitedHealthcare Silver Compass 5000,85947TX001,,TXN006,TXS001,TXF007,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010008-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,28
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010008,UnitedHealthcare Silver Compass 5000,85947TX001,,TXN006,TXS001,TXF007,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010008-03,Limited Cost Sharing Plan Variation,69.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,$1000,$1000,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010008,UnitedHealthcare Silver Compass 5000,85947TX001,,TXN006,TXS001,TXF007,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010008-04,73% AV Level Silver Plan,73.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,$750,0%,,,,$750,$750,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010008,UnitedHealthcare Silver Compass 5000,85947TX001,,TXN006,TXS001,TXF007,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010008-05,87% AV Level Silver Plan,86.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,$250,$250,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,3,85947,TX,Individual,No,35-1665915,85947TX0010008,UnitedHealthcare Silver Compass 5000,85947TX001,,TXN006,TXS001,TXF007,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010008-06,94% AV Level Silver Plan,93.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,0%,,,,$100,$100,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,4,85947,TX,Individual,No,35-1665915,85947TX0010010,UnitedHealthcare Bronze Compass 5500,85947TX001,,TXN006,TXS001,TXF009,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010010-00,Standard Bronze Off Exchange Plan,60.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,4,85947,TX,Individual,No,35-1665915,85947TX0010010,UnitedHealthcare Bronze Compass 5500,85947TX001,,TXN006,TXS001,TXF009,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010010-01,Standard Bronze On Exchange Plan,60.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,4,85947,TX,Individual,No,35-1665915,85947TX0010010,UnitedHealthcare Bronze Compass 5500,85947TX001,,TXN006,TXS001,TXF009,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010010-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,7,87226,TX,Individual,No,74-2770542,87226TX0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,87226TX002,,TXN001,TXS001,TXF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976092262370766,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020013-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,7,87226,TX,Individual,No,74-2770542,87226TX0020016,Ambetter Essential Care 2 + Vision,87226TX002,,TXN001,TXS001,TXF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976092504757717,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020016-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,7,87226,TX,Individual,No,74-2770542,87226TX0020016,Ambetter Essential Care 2 + Vision,87226TX002,,TXN001,TXS001,TXF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976092504757717,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020016-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,7,87226,TX,Individual,No,74-2770542,87226TX0020016,Ambetter Essential Care 2 + Vision,87226TX002,,TXN001,TXS001,TXF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976092504757717,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,7,87226,TX,Individual,No,74-2770542,87226TX0020016,Ambetter Essential Care 2 + Vision,87226TX002,,TXN001,TXS001,TXF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976092504757717,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020016-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,7,87226,TX,Individual,No,74-2770542,87226TX0020017,Ambetter Essential Care 1 + Vision,87226TX002,,TXN001,TXS001,TXF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976092413886607,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020017-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,7,87226,TX,Individual,No,74-2770542,87226TX0020017,Ambetter Essential Care 1 + Vision,87226TX002,,TXN001,TXS001,TXF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976092413886607,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020017-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,7,87226,TX,Individual,No,74-2770542,87226TX0020017,Ambetter Essential Care 1 + Vision,87226TX002,,TXN001,TXS001,TXF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976092413886607,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,7,87226,TX,Individual,No,74-2770542,87226TX0020017,Ambetter Essential Care 1 + Vision,87226TX002,,TXN001,TXS001,TXF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976092413886607,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020017-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,8,87226,TX,Individual,No,74-2770542,87226TX0020008,Ambetter Balanced Care 4 + Vision,87226TX002,,TXN001,TXS001,TXF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976523093633116,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020008-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,4
2015,TX,85947,HIOS,9,2014-12-11 04:09:12,4,85947,TX,Individual,No,35-1665915,85947TX0010010,UnitedHealthcare Bronze Compass 5500,85947TX001,,TXN006,TXS001,TXF009,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xtx,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xtx,85947TX0010010-03,Limited Cost Sharing Plan Variation,60.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,86889,HIOS,4,2014-09-05 03:32:16,1,86889,TX,SHOP (Small Group),Yes,47-0322111,86889TX0010001,Certified Dental Plan Policy 1,86889TX001,,TXN001,TXS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$16.41,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,86889TX0010001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,86889,HIOS,4,2014-09-05 03:32:16,1,86889,TX,SHOP (Small Group),Yes,47-0322111,86889TX0010002,Certified Dental Plan Policy 2,86889TX001,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.73,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,86889TX0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,86889,HIOS,4,2014-09-05 03:32:16,1,86889,TX,SHOP (Small Group),Yes,47-0322111,86889TX0010003,Certified Dental Plan Policy 3,86889TX001,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.74,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,86889TX0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,TX,86889,HIOS,4,2014-09-05 03:32:16,1,86889,TX,SHOP (Small Group),Yes,47-0322111,86889TX0010004,Certified Dental Plan Policy 4,86889TX001,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.05,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,86889TX0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,1,87226,TX,Individual,No,74-2770542,87226TX0010009,Ambetter Balanced Care 5,87226TX001,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010009-00,Standard Silver Off Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,4
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,1,87226,TX,Individual,No,74-2770542,87226TX0010009,Ambetter Balanced Care 5,87226TX001,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010009-01,Standard Silver On Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,5
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,1,87226,TX,Individual,No,74-2770542,87226TX0010009,Ambetter Balanced Care 5,87226TX001,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,1,87226,TX,Individual,No,74-2770542,87226TX0010009,Ambetter Balanced Care 5,87226TX001,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010009-03,Limited Cost Sharing Plan Variation,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,7
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,1,87226,TX,Individual,No,74-2770542,87226TX0010002,Ambetter Secure Care 2,87226TX001,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,18
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,1,87226,TX,Individual,No,74-2770542,87226TX0010002,Ambetter Secure Care 2,87226TX001,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,19
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,1,87226,TX,Individual,No,74-2770542,87226TX0010002,Ambetter Secure Care 2,87226TX001,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,20
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,1,87226,TX,Individual,No,74-2770542,87226TX0010002,Ambetter Secure Care 2,87226TX001,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,21
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,2,87226,TX,Individual,No,74-2770542,87226TX0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,87226TX001,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010004-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,2,87226,TX,Individual,No,74-2770542,87226TX0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,87226TX001,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010004-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,2,87226,TX,Individual,No,74-2770542,87226TX0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,87226TX001,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,2,87226,TX,Individual,No,74-2770542,87226TX0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,87226TX001,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010004-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,2,87226,TX,Individual,No,74-2770542,87226TX0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,87226TX001,,TXN001,TXS001,TXF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010012-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,2,87226,TX,Individual,No,74-2770542,87226TX0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,87226TX001,,TXN001,TXS001,TXF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010012-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,2,87226,TX,Individual,No,74-2770542,87226TX0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,87226TX001,,TXN001,TXS001,TXF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,2,87226,TX,Individual,No,74-2770542,87226TX0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,87226TX001,,TXN001,TXS001,TXF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010012-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,2,87226,TX,Individual,No,74-2770542,87226TX0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,87226TX001,,TXN001,TXS001,TXF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010013-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,2,87226,TX,Individual,No,74-2770542,87226TX0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,87226TX001,,TXN001,TXS001,TXF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010013-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,2,87226,TX,Individual,No,74-2770542,87226TX0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,87226TX001,,TXN001,TXS001,TXF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,2,87226,TX,Individual,No,74-2770542,87226TX0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,87226TX001,,TXN001,TXS001,TXF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010013-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,2,87226,TX,Individual,No,74-2770542,87226TX0010016,Ambetter Essential Care 2,87226TX001,,TXN001,TXS001,TXF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010016-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,2,87226,TX,Individual,No,74-2770542,87226TX0010016,Ambetter Essential Care 2,87226TX001,,TXN001,TXS001,TXF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010016-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,2,87226,TX,Individual,No,74-2770542,87226TX0010016,Ambetter Essential Care 2,87226TX001,,TXN001,TXS001,TXF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,2,87226,TX,Individual,No,74-2770542,87226TX0010016,Ambetter Essential Care 2,87226TX001,,TXN001,TXS001,TXF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010016-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,2,87226,TX,Individual,No,74-2770542,87226TX0010017,Ambetter Essential Care 1,87226TX001,,TXN001,TXS001,TXF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010017-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,2,87226,TX,Individual,No,74-2770542,87226TX0010017,Ambetter Essential Care 1,87226TX001,,TXN001,TXS001,TXF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010017-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,2,87226,TX,Individual,No,74-2770542,87226TX0010017,Ambetter Essential Care 1,87226TX001,,TXN001,TXS001,TXF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,2,87226,TX,Individual,No,74-2770542,87226TX0010017,Ambetter Essential Care 1,87226TX001,,TXN001,TXS001,TXF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010017-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,3,87226,TX,Individual,No,74-2770542,87226TX0010008,Ambetter Balanced Care 4,87226TX001,,TXN001,TXS001,TXF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010008-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,4
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,3,87226,TX,Individual,No,74-2770542,87226TX0010008,Ambetter Balanced Care 4,87226TX001,,TXN001,TXS001,TXF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0010008-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,5
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,6,87226,TX,Individual,No,74-2770542,87226TX0020009,Ambetter Balanced Care 5 + Vision,87226TX002,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977149956579029,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020009-01,Standard Silver On Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,5
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,6,87226,TX,Individual,No,74-2770542,87226TX0020009,Ambetter Balanced Care 5 + Vision,87226TX002,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977149956579029,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,6,87226,TX,Individual,No,74-2770542,87226TX0020009,Ambetter Balanced Care 5 + Vision,87226TX002,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977149956579029,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020009-03,Limited Cost Sharing Plan Variation,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,7
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,6,87226,TX,Individual,No,74-2770542,87226TX0020009,Ambetter Balanced Care 5 + Vision,87226TX002,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977149956579029,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020009-04,73% AV Level Silver Plan,73.24%,0.732411444187164,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$2,920",$350,$0,$80,8
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,6,87226,TX,Individual,No,74-2770542,87226TX0020009,Ambetter Balanced Care 5 + Vision,87226TX002,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977149956579029,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020009-05,87% AV Level Silver Plan,87.97%,0.879661500453949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$410,$0,$150,$600,$520,$0,$80,9
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,6,87226,TX,Individual,No,74-2770542,87226TX0020009,Ambetter Balanced Care 5 + Vision,87226TX002,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977149956579029,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020009-06,94% AV Level Silver Plan,93.34%,0.933413624763489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$120,$0,$150,$0,$450,$0,$80,10
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,6,87226,TX,Individual,No,74-2770542,87226TX0020007,Ambetter Balanced Care 3 + Vision,87226TX002,,TXN001,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977149871285178,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020007-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,11
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,6,87226,TX,Individual,No,74-2770542,87226TX0020007,Ambetter Balanced Care 3 + Vision,87226TX002,,TXN001,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977149871285178,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020007-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,12
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,6,87226,TX,Individual,No,74-2770542,87226TX0020007,Ambetter Balanced Care 3 + Vision,87226TX002,,TXN001,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977149871285178,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,6,87226,TX,Individual,No,74-2770542,87226TX0020007,Ambetter Balanced Care 3 + Vision,87226TX002,,TXN001,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977149871285178,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020007-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,14
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,6,87226,TX,Individual,No,74-2770542,87226TX0020007,Ambetter Balanced Care 3 + Vision,87226TX002,,TXN001,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977149871285178,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020007-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,15
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,6,87226,TX,Individual,No,74-2770542,87226TX0020007,Ambetter Balanced Care 3 + Vision,87226TX002,,TXN001,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977149871285178,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020007-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,16
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,6,87226,TX,Individual,No,74-2770542,87226TX0020007,Ambetter Balanced Care 3 + Vision,87226TX002,,TXN001,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977149871285178,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020007-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,17
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,6,87226,TX,Individual,No,74-2770542,87226TX0020002,Ambetter Secure Care 2 + Vision,87226TX002,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974657418227043,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,18
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,6,87226,TX,Individual,No,74-2770542,87226TX0020002,Ambetter Secure Care 2 + Vision,87226TX002,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974657418227043,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,19
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,6,87226,TX,Individual,No,74-2770542,87226TX0020002,Ambetter Secure Care 2 + Vision,87226TX002,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974657418227043,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,20
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,6,87226,TX,Individual,No,74-2770542,87226TX0020002,Ambetter Secure Care 2 + Vision,87226TX002,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974657418227043,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,21
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,7,87226,TX,Individual,No,74-2770542,87226TX0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,87226TX002,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974657015737898,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020004-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,7,87226,TX,Individual,No,74-2770542,87226TX0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,87226TX002,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974657015737898,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020004-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,7,87226,TX,Individual,No,74-2770542,87226TX0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,87226TX002,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974657015737898,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,7,87226,TX,Individual,No,74-2770542,87226TX0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,87226TX002,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.974657015737898,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020004-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,7,87226,TX,Individual,No,74-2770542,87226TX0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,87226TX002,,TXN001,TXS001,TXF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976092504757717,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020012-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,7,87226,TX,Individual,No,74-2770542,87226TX0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,87226TX002,,TXN001,TXS001,TXF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976092504757717,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020012-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,7,87226,TX,Individual,No,74-2770542,87226TX0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,87226TX002,,TXN001,TXS001,TXF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976092504757717,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,7,87226,TX,Individual,No,74-2770542,87226TX0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,87226TX002,,TXN001,TXS001,TXF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976092504757717,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020012-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,7,87226,TX,Individual,No,74-2770542,87226TX0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,87226TX002,,TXN001,TXS001,TXF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976092262370766,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020013-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,7,87226,TX,Individual,No,74-2770542,87226TX0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,87226TX002,,TXN001,TXS001,TXF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976092262370766,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020013-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,7,87226,TX,Individual,No,74-2770542,87226TX0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,87226TX002,,TXN001,TXS001,TXF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976092262370766,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,8,87226,TX,Individual,No,74-2770542,87226TX0020008,Ambetter Balanced Care 4 + Vision,87226TX002,,TXN001,TXS001,TXF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976523093633116,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020008-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,5
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,8,87226,TX,Individual,No,74-2770542,87226TX0020008,Ambetter Balanced Care 4 + Vision,87226TX002,,TXN001,TXS001,TXF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976523093633116,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,8,87226,TX,Individual,No,74-2770542,87226TX0020008,Ambetter Balanced Care 4 + Vision,87226TX002,,TXN001,TXS001,TXF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976523093633116,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020008-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,7
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,8,87226,TX,Individual,No,74-2770542,87226TX0020008,Ambetter Balanced Care 4 + Vision,87226TX002,,TXN001,TXS001,TXF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976523093633116,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020008-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,8
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,8,87226,TX,Individual,No,74-2770542,87226TX0020008,Ambetter Balanced Care 4 + Vision,87226TX002,,TXN001,TXS001,TXF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976523093633116,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020008-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,9
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,8,87226,TX,Individual,No,74-2770542,87226TX0020008,Ambetter Balanced Care 4 + Vision,87226TX002,,TXN001,TXS001,TXF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.976523093633116,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020008-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,10
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,9,87226,TX,Individual,No,74-2770542,87226TX0020014,Ambetter Balanced Care 2 + Vision,87226TX002,,TXN001,TXS001,TXF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977236947089604,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020014-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,4
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,9,87226,TX,Individual,No,74-2770542,87226TX0020014,Ambetter Balanced Care 2 + Vision,87226TX002,,TXN001,TXS001,TXF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977236947089604,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020014-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,5
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,9,87226,TX,Individual,No,74-2770542,87226TX0020014,Ambetter Balanced Care 2 + Vision,87226TX002,,TXN001,TXS001,TXF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977236947089604,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,9,87226,TX,Individual,No,74-2770542,87226TX0020014,Ambetter Balanced Care 2 + Vision,87226TX002,,TXN001,TXS001,TXF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977236947089604,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020014-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,7
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,9,87226,TX,Individual,No,74-2770542,87226TX0020014,Ambetter Balanced Care 2 + Vision,87226TX002,,TXN001,TXS001,TXF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977236947089604,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020014-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,8
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,9,87226,TX,Individual,No,74-2770542,87226TX0020014,Ambetter Balanced Care 2 + Vision,87226TX002,,TXN001,TXS001,TXF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977236947089604,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020014-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,9
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,9,87226,TX,Individual,No,74-2770542,87226TX0020014,Ambetter Balanced Care 2 + Vision,87226TX002,,TXN001,TXS001,TXF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977236947089604,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020014-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,10
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,10,87226,TX,Individual,No,74-2770542,87226TX0020015,Ambetter Balanced Care 1 + Vision,87226TX002,,TXN001,TXS001,TXF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977370297408313,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020015-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,4
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,10,87226,TX,Individual,No,74-2770542,87226TX0020015,Ambetter Balanced Care 1 + Vision,87226TX002,,TXN001,TXS001,TXF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977370297408313,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020015-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,5
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,10,87226,TX,Individual,No,74-2770542,87226TX0020015,Ambetter Balanced Care 1 + Vision,87226TX002,,TXN001,TXS001,TXF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977370297408313,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,10,87226,TX,Individual,No,74-2770542,87226TX0020015,Ambetter Balanced Care 1 + Vision,87226TX002,,TXN001,TXS001,TXF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977370297408313,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020015-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,7
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,10,87226,TX,Individual,No,74-2770542,87226TX0020015,Ambetter Balanced Care 1 + Vision,87226TX002,,TXN001,TXS001,TXF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977370297408313,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020015-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,8
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,10,87226,TX,Individual,No,74-2770542,87226TX0020015,Ambetter Balanced Care 1 + Vision,87226TX002,,TXN001,TXS001,TXF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977370297408313,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020015-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,9
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,10,87226,TX,Individual,No,74-2770542,87226TX0020015,Ambetter Balanced Care 1 + Vision,87226TX002,,TXN001,TXS001,TXF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.977370297408313,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0020015-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,10
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,11,87226,TX,Individual,No,74-2770542,87226TX0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.92248525039194,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030009-00,Standard Silver Off Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,4
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,11,87226,TX,Individual,No,74-2770542,87226TX0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.92248525039194,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030009-01,Standard Silver On Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,5
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,11,87226,TX,Individual,No,74-2770542,87226TX0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.92248525039194,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,11,87226,TX,Individual,No,74-2770542,87226TX0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.92248525039194,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030009-03,Limited Cost Sharing Plan Variation,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,7
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,11,87226,TX,Individual,No,74-2770542,87226TX0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.92248525039194,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030009-04,73% AV Level Silver Plan,73.24%,0.732411444187164,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$2,920",$350,$0,$80,8
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,11,87226,TX,Individual,No,74-2770542,87226TX0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.92248525039194,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030009-05,87% AV Level Silver Plan,87.97%,0.879661500453949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$410,$0,$150,$600,$520,$0,$80,9
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,11,87226,TX,Individual,No,74-2770542,87226TX0030009,Ambetter Balanced Care 5 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF004,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.92248525039194,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030009-06,94% AV Level Silver Plan,93.34%,0.933413624763489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$120,$0,$150,$0,$450,$0,$80,10
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,11,87226,TX,Individual,No,74-2770542,87226TX0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.922484694555932,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030007-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,11
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,11,87226,TX,Individual,No,74-2770542,87226TX0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.922484694555932,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030007-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,12
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,11,87226,TX,Individual,No,74-2770542,87226TX0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.922484694555932,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,11,87226,TX,Individual,No,74-2770542,87226TX0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.922484694555932,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030007-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,14
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,11,87226,TX,Individual,No,74-2770542,87226TX0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.922484694555932,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030007-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,15
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,11,87226,TX,Individual,No,74-2770542,87226TX0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.922484694555932,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030007-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,16
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,11,87226,TX,Individual,No,74-2770542,87226TX0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF003,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.922484694555932,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030007-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,17
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,11,87226,TX,Individual,No,74-2770542,87226TX0030002,Ambetter Secure Care 2 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.914528434994849,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,18
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,11,87226,TX,Individual,No,74-2770542,87226TX0030002,Ambetter Secure Care 2 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.914528434994849,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,19
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,11,87226,TX,Individual,No,74-2770542,87226TX0030002,Ambetter Secure Care 2 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.914528434994849,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,20
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,11,87226,TX,Individual,No,74-2770542,87226TX0030002,Ambetter Secure Care 2 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.914528434994849,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,21
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,12,87226,TX,Individual,No,74-2770542,87226TX0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.914527907344124,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030004-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,12,87226,TX,Individual,No,74-2770542,87226TX0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.914527907344124,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030004-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,12,87226,TX,Individual,No,74-2770542,87226TX0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.914527907344124,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,12,87226,TX,Individual,No,74-2770542,87226TX0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.914527907344124,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030004-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,12,87226,TX,Individual,No,74-2770542,87226TX0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.919110369698856,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030012-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,12,87226,TX,Individual,No,74-2770542,87226TX0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.919110369698856,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030012-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,12,87226,TX,Individual,No,74-2770542,87226TX0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.919110369698856,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,12,87226,TX,Individual,No,74-2770542,87226TX0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF008,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.919110369698856,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030012-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,12,87226,TX,Individual,No,74-2770542,87226TX0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.919109608853223,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030013-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,12,87226,TX,Individual,No,74-2770542,87226TX0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.919109608853223,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030013-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,12,87226,TX,Individual,No,74-2770542,87226TX0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.919109608853223,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,12,87226,TX,Individual,No,74-2770542,87226TX0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF009,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.919109608853223,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030013-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,12,87226,TX,Individual,No,74-2770542,87226TX0030016,Ambetter Essential Care 2 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.919110369698856,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030016-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,12,87226,TX,Individual,No,74-2770542,87226TX0030016,Ambetter Essential Care 2 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.919110369698856,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030016-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,12,87226,TX,Individual,No,74-2770542,87226TX0030016,Ambetter Essential Care 2 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.919110369698856,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,12,87226,TX,Individual,No,74-2770542,87226TX0030016,Ambetter Essential Care 2 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.919110369698856,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030016-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,12,87226,TX,Individual,No,74-2770542,87226TX0030017,Ambetter Essential Care 1 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.919110084458799,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030017-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,12,87226,TX,Individual,No,74-2770542,87226TX0030017,Ambetter Essential Care 1 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.919110084458799,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030017-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,12,87226,TX,Individual,No,74-2770542,87226TX0030017,Ambetter Essential Care 1 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.919110084458799,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,12,87226,TX,Individual,No,74-2770542,87226TX0030017,Ambetter Essential Care 1 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.919110084458799,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030017-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,13,87226,TX,Individual,No,74-2770542,87226TX0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.920483567487044,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030008-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,4
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,13,87226,TX,Individual,No,74-2770542,87226TX0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.920483567487044,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030008-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,5
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,13,87226,TX,Individual,No,74-2770542,87226TX0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.920483567487044,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,13,87226,TX,Individual,No,74-2770542,87226TX0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.920483567487044,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030008-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,7
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,13,87226,TX,Individual,No,74-2770542,87226TX0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.920483567487044,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030008-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,8
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,13,87226,TX,Individual,No,74-2770542,87226TX0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.920483567487044,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030008-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,9
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,13,87226,TX,Individual,No,74-2770542,87226TX0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF004,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.920483567487044,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030008-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,10
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,14,87226,TX,Individual,No,74-2770542,87226TX0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.922763246932473,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030014-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,4
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,14,87226,TX,Individual,No,74-2770542,87226TX0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.922763246932473,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030014-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,5
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,14,87226,TX,Individual,No,74-2770542,87226TX0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.922763246932473,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,14,87226,TX,Individual,No,74-2770542,87226TX0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.922763246932473,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030014-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,7
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,14,87226,TX,Individual,No,74-2770542,87226TX0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.922763246932473,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030014-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,8
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,14,87226,TX,Individual,No,74-2770542,87226TX0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.922763246932473,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030014-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,9
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,14,87226,TX,Individual,No,74-2770542,87226TX0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.922763246932473,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030014-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,10
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,15,87226,TX,Individual,No,74-2770542,87226TX0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.923188654081868,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030015-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,4
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,15,87226,TX,Individual,No,74-2770542,87226TX0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.923188654081868,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030015-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,5
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,15,87226,TX,Individual,No,74-2770542,87226TX0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.923188654081868,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,15,87226,TX,Individual,No,74-2770542,87226TX0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.923188654081868,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030015-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,7
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,15,87226,TX,Individual,No,74-2770542,87226TX0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.923188654081868,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030015-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,8
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,15,87226,TX,Individual,No,74-2770542,87226TX0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.923188654081868,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030015-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,9
2015,TX,87226,HIOS,6,2015-02-20 06:27:36,15,87226,TX,Individual,No,74-2770542,87226TX0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,87226TX003,,TXN001,TXS001,TXF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.923188654081868,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.superiorhealthplan.com/benefits,http://ambetter.superiorhealthplan.com/payments,http://ambetter.superiorhealthplan.com/ourplans,http://ambetter.superiorhealthplan.com/formulary,87226TX0030015-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,10
2015,TX,90453,HIOS,2,2014-08-08 08:53:29,1,90453,TX,SHOP (Small Group),Yes,42-0127290,90453TX0050001,Principal Plan Dental 70,90453TX005,,TXN001,TXS001,,New,PPO,Low,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$27.08,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,90453TX0050001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,90453,HIOS,2,2014-08-08 08:53:29,1,90453,TX,SHOP (Small Group),Yes,42-0127290,90453TX0050002,Principal Plan Dental 80,90453TX005,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$28.29,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,90453TX0050002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,1,91716,TX,Individual,No,06-6033492,91716TX0080002,Aetna Bronze $20 Copay,91716TX008,,TXN001,TXS001,TXF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080002-00,Standard Bronze Off Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,1,91716,TX,Individual,No,06-6033492,91716TX0080002,Aetna Bronze $20 Copay,91716TX008,,TXN001,TXS001,TXF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080002-01,Standard Bronze On Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,1,91716,TX,Individual,No,06-6033492,91716TX0080002,Aetna Bronze $20 Copay,91716TX008,,TXN001,TXS001,TXF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,1,91716,TX,Individual,No,06-6033492,91716TX0080002,Aetna Bronze $20 Copay,91716TX008,,TXN001,TXS001,TXF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080002-03,Limited Cost Sharing Plan Variation,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,2,91716,TX,Individual,No,06-6033492,91716TX0080011,Aetna Bronze $20 Copay Austin Community Plan,91716TX008,,TXN002,TXS002,TXF005,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080011-00,Standard Bronze Off Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,2,91716,TX,Individual,No,06-6033492,91716TX0080011,Aetna Bronze $20 Copay Austin Community Plan,91716TX008,,TXN002,TXS002,TXF005,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080011-01,Standard Bronze On Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,2,91716,TX,Individual,No,06-6033492,91716TX0080011,Aetna Bronze $20 Copay Austin Community Plan,91716TX008,,TXN002,TXS002,TXF005,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080011-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,2,91716,TX,Individual,No,06-6033492,91716TX0080011,Aetna Bronze $20 Copay Austin Community Plan,91716TX008,,TXN002,TXS002,TXF005,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080011-03,Limited Cost Sharing Plan Variation,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,4,91716,TX,Individual,No,06-6033492,91716TX0080012,Aetna Bronze $20 Copay San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF006,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080012-00,Standard Bronze Off Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,4,91716,TX,Individual,No,06-6033492,91716TX0080012,Aetna Bronze $20 Copay San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF006,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080012-01,Standard Bronze On Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,4,91716,TX,Individual,No,06-6033492,91716TX0080012,Aetna Bronze $20 Copay San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF006,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080012-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,4,91716,TX,Individual,No,06-6033492,91716TX0080012,Aetna Bronze $20 Copay San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF006,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080012-03,Limited Cost Sharing Plan Variation,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,5,91716,TX,Individual,No,06-6033492,91716TX0080004,Aetna Bronze HSA Eligible,91716TX008,,TXN001,TXS001,TXF002,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080004-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,5,91716,TX,Individual,No,06-6033492,91716TX0080004,Aetna Bronze HSA Eligible,91716TX008,,TXN001,TXS001,TXF002,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080004-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,5,91716,TX,Individual,No,06-6033492,91716TX0080004,Aetna Bronze HSA Eligible,91716TX008,,TXN001,TXS001,TXF002,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,5,91716,TX,Individual,No,06-6033492,91716TX0080004,Aetna Bronze HSA Eligible,91716TX008,,TXN001,TXS001,TXF002,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080004-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,6,91716,TX,Individual,No,06-6033492,91716TX0080013,Aetna Bronze HSA Eligible Austin Community Plan,91716TX008,,TXN002,TXS002,TXF007,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080013-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,6,91716,TX,Individual,No,06-6033492,91716TX0080013,Aetna Bronze HSA Eligible Austin Community Plan,91716TX008,,TXN002,TXS002,TXF007,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080013-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,6,91716,TX,Individual,No,06-6033492,91716TX0080013,Aetna Bronze HSA Eligible Austin Community Plan,91716TX008,,TXN002,TXS002,TXF007,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080013-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,6,91716,TX,Individual,No,06-6033492,91716TX0080013,Aetna Bronze HSA Eligible Austin Community Plan,91716TX008,,TXN002,TXS002,TXF007,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080013-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,8,91716,TX,Individual,No,06-6033492,91716TX0080014,Aetna Bronze HSA Eligible San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF008,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080014-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,8,91716,TX,Individual,No,06-6033492,91716TX0080014,Aetna Bronze HSA Eligible San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF008,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080014-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,8,91716,TX,Individual,No,06-6033492,91716TX0080014,Aetna Bronze HSA Eligible San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF008,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080014-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,8,91716,TX,Individual,No,06-6033492,91716TX0080014,Aetna Bronze HSA Eligible San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF008,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080014-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,13,91716,TX,Individual,No,06-6033492,91716TX0080017,Aetna Memorial Hermann Bronze $20 Copay,91716TX008,,TXN004,TXS004,TXF011,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080017-00,Standard Bronze Off Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,13,91716,TX,Individual,No,06-6033492,91716TX0080017,Aetna Memorial Hermann Bronze $20 Copay,91716TX008,,TXN004,TXS004,TXF011,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080017-01,Standard Bronze On Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,13,91716,TX,Individual,No,06-6033492,91716TX0080017,Aetna Memorial Hermann Bronze $20 Copay,91716TX008,,TXN004,TXS004,TXF011,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080017-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,13,91716,TX,Individual,No,06-6033492,91716TX0080017,Aetna Memorial Hermann Bronze $20 Copay,91716TX008,,TXN004,TXS004,TXF011,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080017-03,Limited Cost Sharing Plan Variation,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,15,91716,TX,Individual,No,06-6033492,91716TX0080018,Aetna Memorial Hermann Bronze HSA Eligible,91716TX008,,TXN004,TXS004,TXF012,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080018-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,15,91716,TX,Individual,No,06-6033492,91716TX0080018,Aetna Memorial Hermann Bronze HSA Eligible,91716TX008,,TXN004,TXS004,TXF012,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080018-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,15,91716,TX,Individual,No,06-6033492,91716TX0080018,Aetna Memorial Hermann Bronze HSA Eligible,91716TX008,,TXN004,TXS004,TXF012,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080018-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,15,91716,TX,Individual,No,06-6033492,91716TX0080018,Aetna Memorial Hermann Bronze HSA Eligible,91716TX008,,TXN004,TXS004,TXF012,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080018-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,19,91716,TX,Individual,No,06-6033492,91716TX0080020,Aetna Memorial Hermann Silver $10 Copay,91716TX008,,TXN004,TXS004,TXF014,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080020-00,Standard Silver Off Exchange Plan,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,19,91716,TX,Individual,No,06-6033492,91716TX0080020,Aetna Memorial Hermann Silver $10 Copay,91716TX008,,TXN004,TXS004,TXF014,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080020-01,Standard Silver On Exchange Plan,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,19,91716,TX,Individual,No,06-6033492,91716TX0080020,Aetna Memorial Hermann Silver $10 Copay,91716TX008,,TXN004,TXS004,TXF014,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080020-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,19,91716,TX,Individual,No,06-6033492,91716TX0080020,Aetna Memorial Hermann Silver $10 Copay,91716TX008,,TXN004,TXS004,TXF014,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080020-03,Limited Cost Sharing Plan Variation,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,19,91716,TX,Individual,No,06-6033492,91716TX0080020,Aetna Memorial Hermann Silver $10 Copay,91716TX008,,TXN004,TXS004,TXF014,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080020-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,19,91716,TX,Individual,No,06-6033492,91716TX0080020,Aetna Memorial Hermann Silver $10 Copay,91716TX008,,TXN004,TXS004,TXF014,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080020-05,87% AV Level Silver Plan,86.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,19,91716,TX,Individual,No,06-6033492,91716TX0080020,Aetna Memorial Hermann Silver $10 Copay,91716TX008,,TXN004,TXS004,TXF014,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080020-06,94% AV Level Silver Plan,93.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,21,91716,TX,Individual,No,06-6033492,91716TX0080021,Aetna Memorial Hermann Silver $5 Copay 2750,91716TX008,,TXN004,TXS004,TXF015,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080021-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,21,91716,TX,Individual,No,06-6033492,91716TX0080021,Aetna Memorial Hermann Silver $5 Copay 2750,91716TX008,,TXN004,TXS004,TXF015,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080021-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,21,91716,TX,Individual,No,06-6033492,91716TX0080021,Aetna Memorial Hermann Silver $5 Copay 2750,91716TX008,,TXN004,TXS004,TXF015,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080021-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,21,91716,TX,Individual,No,06-6033492,91716TX0080021,Aetna Memorial Hermann Silver $5 Copay 2750,91716TX008,,TXN004,TXS004,TXF015,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080021-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,21,91716,TX,Individual,No,06-6033492,91716TX0080021,Aetna Memorial Hermann Silver $5 Copay 2750,91716TX008,,TXN004,TXS004,TXF015,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080021-04,73% AV Level Silver Plan,72.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,21,91716,TX,Individual,No,06-6033492,91716TX0080021,Aetna Memorial Hermann Silver $5 Copay 2750,91716TX008,,TXN004,TXS004,TXF015,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080021-05,87% AV Level Silver Plan,86.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,21,91716,TX,Individual,No,06-6033492,91716TX0080021,Aetna Memorial Hermann Silver $5 Copay 2750,91716TX008,,TXN004,TXS004,TXF015,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080021-06,94% AV Level Silver Plan,93.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,23,91716,TX,Individual,No,06-6033492,91716TX0080009,Aetna Silver $10 Copay,91716TX008,,TXN001,TXS001,TXF004,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080009-00,Standard Silver Off Exchange Plan,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,23,91716,TX,Individual,No,06-6033492,91716TX0080009,Aetna Silver $10 Copay,91716TX008,,TXN001,TXS001,TXF004,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080009-01,Standard Silver On Exchange Plan,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,23,91716,TX,Individual,No,06-6033492,91716TX0080009,Aetna Silver $10 Copay,91716TX008,,TXN001,TXS001,TXF004,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080009-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,23,91716,TX,Individual,No,06-6033492,91716TX0080009,Aetna Silver $10 Copay,91716TX008,,TXN001,TXS001,TXF004,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080009-03,Limited Cost Sharing Plan Variation,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,23,91716,TX,Individual,No,06-6033492,91716TX0080009,Aetna Silver $10 Copay,91716TX008,,TXN001,TXS001,TXF004,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080009-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,23,91716,TX,Individual,No,06-6033492,91716TX0080009,Aetna Silver $10 Copay,91716TX008,,TXN001,TXS001,TXF004,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080009-05,87% AV Level Silver Plan,86.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,23,91716,TX,Individual,No,06-6033492,91716TX0080009,Aetna Silver $10 Copay,91716TX008,,TXN001,TXS001,TXF004,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080009-06,94% AV Level Silver Plan,93.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,24,91716,TX,Individual,No,06-6033492,91716TX0080022,Aetna Silver $10 Copay Austin Community Plan,91716TX008,,TXN002,TXS002,TXF016,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080022-00,Standard Silver Off Exchange Plan,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,24,91716,TX,Individual,No,06-6033492,91716TX0080022,Aetna Silver $10 Copay Austin Community Plan,91716TX008,,TXN002,TXS002,TXF016,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080022-01,Standard Silver On Exchange Plan,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,24,91716,TX,Individual,No,06-6033492,91716TX0080022,Aetna Silver $10 Copay Austin Community Plan,91716TX008,,TXN002,TXS002,TXF016,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080022-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,24,91716,TX,Individual,No,06-6033492,91716TX0080022,Aetna Silver $10 Copay Austin Community Plan,91716TX008,,TXN002,TXS002,TXF016,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080022-03,Limited Cost Sharing Plan Variation,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,24,91716,TX,Individual,No,06-6033492,91716TX0080022,Aetna Silver $10 Copay Austin Community Plan,91716TX008,,TXN002,TXS002,TXF016,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080022-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,24,91716,TX,Individual,No,06-6033492,91716TX0080022,Aetna Silver $10 Copay Austin Community Plan,91716TX008,,TXN002,TXS002,TXF016,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080022-05,87% AV Level Silver Plan,86.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,24,91716,TX,Individual,No,06-6033492,91716TX0080022,Aetna Silver $10 Copay Austin Community Plan,91716TX008,,TXN002,TXS002,TXF016,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080022-06,94% AV Level Silver Plan,93.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,27,91716,TX,Individual,No,06-6033492,91716TX0080023,Aetna Silver $10 Copay San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF017,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080023-00,Standard Silver Off Exchange Plan,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,27,91716,TX,Individual,No,06-6033492,91716TX0080023,Aetna Silver $10 Copay San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF017,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080023-01,Standard Silver On Exchange Plan,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,27,91716,TX,Individual,No,06-6033492,91716TX0080023,Aetna Silver $10 Copay San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF017,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080023-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,27,91716,TX,Individual,No,06-6033492,91716TX0080023,Aetna Silver $10 Copay San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF017,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080023-03,Limited Cost Sharing Plan Variation,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,27,91716,TX,Individual,No,06-6033492,91716TX0080023,Aetna Silver $10 Copay San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF017,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080023-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,27,91716,TX,Individual,No,06-6033492,91716TX0080023,Aetna Silver $10 Copay San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF017,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080023-05,87% AV Level Silver Plan,86.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,27,91716,TX,Individual,No,06-6033492,91716TX0080023,Aetna Silver $10 Copay San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF017,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080023-06,94% AV Level Silver Plan,93.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,29,91716,TX,Individual,No,06-6033492,91716TX0080024,Aetna Silver $5 Copay 2750,91716TX008,,TXN001,TXS001,TXF018,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080024-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,29,91716,TX,Individual,No,06-6033492,91716TX0080024,Aetna Silver $5 Copay 2750,91716TX008,,TXN001,TXS001,TXF018,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080024-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,29,91716,TX,Individual,No,06-6033492,91716TX0080024,Aetna Silver $5 Copay 2750,91716TX008,,TXN001,TXS001,TXF018,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080024-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,29,91716,TX,Individual,No,06-6033492,91716TX0080024,Aetna Silver $5 Copay 2750,91716TX008,,TXN001,TXS001,TXF018,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080024-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,29,91716,TX,Individual,No,06-6033492,91716TX0080024,Aetna Silver $5 Copay 2750,91716TX008,,TXN001,TXS001,TXF018,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080024-04,73% AV Level Silver Plan,72.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,29,91716,TX,Individual,No,06-6033492,91716TX0080024,Aetna Silver $5 Copay 2750,91716TX008,,TXN001,TXS001,TXF018,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080024-05,87% AV Level Silver Plan,86.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,29,91716,TX,Individual,No,06-6033492,91716TX0080024,Aetna Silver $5 Copay 2750,91716TX008,,TXN001,TXS001,TXF018,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080024-06,94% AV Level Silver Plan,93.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,30,91716,TX,Individual,No,06-6033492,91716TX0080025,Aetna Silver $5 Copay 2750 Austin Community Plan,91716TX008,,TXN002,TXS002,TXF019,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080025-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,30,91716,TX,Individual,No,06-6033492,91716TX0080025,Aetna Silver $5 Copay 2750 Austin Community Plan,91716TX008,,TXN002,TXS002,TXF019,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080025-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,30,91716,TX,Individual,No,06-6033492,91716TX0080025,Aetna Silver $5 Copay 2750 Austin Community Plan,91716TX008,,TXN002,TXS002,TXF019,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080025-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,30,91716,TX,Individual,No,06-6033492,91716TX0080025,Aetna Silver $5 Copay 2750 Austin Community Plan,91716TX008,,TXN002,TXS002,TXF019,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080025-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,30,91716,TX,Individual,No,06-6033492,91716TX0080025,Aetna Silver $5 Copay 2750 Austin Community Plan,91716TX008,,TXN002,TXS002,TXF019,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080025-04,73% AV Level Silver Plan,72.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,30,91716,TX,Individual,No,06-6033492,91716TX0080025,Aetna Silver $5 Copay 2750 Austin Community Plan,91716TX008,,TXN002,TXS002,TXF019,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080025-05,87% AV Level Silver Plan,86.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,30,91716,TX,Individual,No,06-6033492,91716TX0080025,Aetna Silver $5 Copay 2750 Austin Community Plan,91716TX008,,TXN002,TXS002,TXF019,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080025-06,94% AV Level Silver Plan,93.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,33,91716,TX,Individual,No,06-6033492,91716TX0080026,Aetna Silver $5 Copay 2750 San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF020,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080026-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,33,91716,TX,Individual,No,06-6033492,91716TX0080026,Aetna Silver $5 Copay 2750 San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF020,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080026-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,33,91716,TX,Individual,No,06-6033492,91716TX0080026,Aetna Silver $5 Copay 2750 San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF020,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080026-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,33,91716,TX,Individual,No,06-6033492,91716TX0080026,Aetna Silver $5 Copay 2750 San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF020,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080026-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,33,91716,TX,Individual,No,06-6033492,91716TX0080026,Aetna Silver $5 Copay 2750 San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF020,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080026-04,73% AV Level Silver Plan,72.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,33,91716,TX,Individual,No,06-6033492,91716TX0080026,Aetna Silver $5 Copay 2750 San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF020,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080026-05,87% AV Level Silver Plan,86.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,33,91716,TX,Individual,No,06-6033492,91716TX0080026,Aetna Silver $5 Copay 2750 San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF020,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080026-06,94% AV Level Silver Plan,93.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,36,91716,TX,Individual,No,06-6033492,91716TX0080007,Aetna Gold $5 Copay,91716TX008,,TXN001,TXS001,TXF003,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080007-00,Standard Gold Off Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,36,91716,TX,Individual,No,06-6033492,91716TX0080007,Aetna Gold $5 Copay,91716TX008,,TXN001,TXS001,TXF003,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080007-01,Standard Gold On Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,36,91716,TX,Individual,No,06-6033492,91716TX0080007,Aetna Gold $5 Copay,91716TX008,,TXN001,TXS001,TXF003,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080007-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,36,91716,TX,Individual,No,06-6033492,91716TX0080007,Aetna Gold $5 Copay,91716TX008,,TXN001,TXS001,TXF003,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080007-03,Limited Cost Sharing Plan Variation,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,37,91716,TX,Individual,No,06-6033492,91716TX0080015,Aetna Gold $5 Copay Austin Community Plan,91716TX008,,TXN002,TXS002,TXF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080015-00,Standard Gold Off Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,37,91716,TX,Individual,No,06-6033492,91716TX0080015,Aetna Gold $5 Copay Austin Community Plan,91716TX008,,TXN002,TXS002,TXF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080015-01,Standard Gold On Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,37,91716,TX,Individual,No,06-6033492,91716TX0080015,Aetna Gold $5 Copay Austin Community Plan,91716TX008,,TXN002,TXS002,TXF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080015-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,37,91716,TX,Individual,No,06-6033492,91716TX0080015,Aetna Gold $5 Copay Austin Community Plan,91716TX008,,TXN002,TXS002,TXF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080015-03,Limited Cost Sharing Plan Variation,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,40,91716,TX,Individual,No,06-6033492,91716TX0080016,Aetna Gold $5 San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF010,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080016-00,Standard Gold Off Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,40,91716,TX,Individual,No,06-6033492,91716TX0080016,Aetna Gold $5 San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF010,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080016-01,Standard Gold On Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,40,91716,TX,Individual,No,06-6033492,91716TX0080016,Aetna Gold $5 San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF010,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080016-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,40,91716,TX,Individual,No,06-6033492,91716TX0080016,Aetna Gold $5 San Antonio Community Plan,91716TX008,,TXN003,TXS003,TXF010,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080016-03,Limited Cost Sharing Plan Variation,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,42,91716,TX,Individual,No,06-6033492,91716TX0080019,Aetna Memorial Hermann Gold $5 Copay,91716TX008,,TXN004,TXS004,TXF013,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080019-00,Standard Gold Off Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,42,91716,TX,Individual,No,06-6033492,91716TX0080019,Aetna Memorial Hermann Gold $5 Copay,91716TX008,,TXN004,TXS004,TXF013,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080019-01,Standard Gold On Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,42,91716,TX,Individual,No,06-6033492,91716TX0080019,Aetna Memorial Hermann Gold $5 Copay,91716TX008,,TXN004,TXS004,TXF013,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080019-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,TX,91716,HIOS,9,2014-09-06 03:39:47,42,91716,TX,Individual,No,06-6033492,91716TX0080019,Aetna Memorial Hermann Gold $5 Copay,91716TX008,,TXN004,TXS004,TXF013,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/texas-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1633091767,91716TX0080019-03,Limited Cost Sharing Plan Variation,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,92388,HIOS,4,2014-11-14 05:23:27,1,92388,TX,SHOP (Small Group),Yes,13-5581829,92388TX0190001,Family Basic Dental Plan (Low),92388TX019,,TXN003,TXS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$15.65,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48059,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48058,,92388TX0190001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,92388,HIOS,4,2014-11-14 05:23:27,1,92388,TX,SHOP (Small Group),Yes,13-5581829,92388TX0190001,Family Basic Dental Plan (Low),92388TX019,,TXN003,TXS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$15.65,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48059,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48058,,92388TX0190001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,92388,HIOS,4,2014-11-14 05:23:27,2,92388,TX,SHOP (Small Group),Yes,13-5581829,92388TX0200001,Family Enhanced Dental Plan (High),92388TX020,,TXN004,TXS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$20.46,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49126,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49125,,92388TX0200001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,92388,HIOS,4,2014-11-14 05:23:27,2,92388,TX,SHOP (Small Group),Yes,13-5581829,92388TX0200001,Family Enhanced Dental Plan (High),92388TX020,,TXN004,TXS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$20.46,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49126,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49125,,92388TX0200001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,TX,95819,HIOS,3,2014-09-05 03:32:16,1,95819,TX,SHOP (Small Group),Yes,81-0170040,95819TX0010001,Assurant Dental ACAFFO High,95819TX001,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$37.74,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same coverage as in service area,Yes,,,,,95819TX0010001-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,95819,HIOS,3,2014-09-05 03:32:16,2,95819,TX,SHOP (Small Group),Yes,81-0170040,95819TX0010002,Assurant Dental ACAFFO Low,95819TX001,,TXN001,TXS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.63,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same coverage as in service area,Yes,,,,,95819TX0010002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,97937,HIOS,2,2014-09-05 03:32:16,1,97937,TX,SHOP (Small Group),Yes,86-0307623,97937TX0220001,Smile for Health Certified Basic Option Plus (90-50-50),97937TX022,,TXN001,TXS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$3.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,97937TX0220001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,2,32754,WI,Individual,No,39-1678579,32754WI0010008,Ambetter Essential Care 3 with 3 Free PCP Visits,32754WI001,,WIN001,WIS001,WIF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0010008-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,2,32754,WI,Individual,No,39-1678579,32754WI0010008,Ambetter Essential Care 3 with 3 Free PCP Visits,32754WI001,,WIN001,WIS001,WIF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0010008-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,2,32754,WI,Individual,No,39-1678579,32754WI0010009,Ambetter Essential Care 4 with 3 Free PCP Visits,32754WI001,,WIN001,WIS001,WIF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/formulary,32754WI0010009-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,2,32754,WI,Individual,No,39-1678579,32754WI0010009,Ambetter Essential Care 4 with 3 Free PCP Visits,32754WI001,,WIN001,WIS001,WIF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/formulary,32754WI0010009-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,2,32754,WI,Individual,No,39-1678579,32754WI0010009,Ambetter Essential Care 4 with 3 Free PCP Visits,32754WI001,,WIN001,WIS001,WIF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/formulary,32754WI0010009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,2,32754,WI,Individual,No,39-1678579,32754WI0010009,Ambetter Essential Care 4 with 3 Free PCP Visits,32754WI001,,WIN001,WIS001,WIF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/formulary,32754WI0010009-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,2,32754,WI,Individual,No,39-1678579,32754WI0010011,Ambetter Essential Care 1,32754WI001,,WIN001,WIS001,WIF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/formulary,32754WI0010011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,2,32754,WI,Individual,No,39-1678579,32754WI0010011,Ambetter Essential Care 1,32754WI001,,WIN001,WIS001,WIF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/formulary,32754WI0010011-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,3,32754,WI,Individual,No,39-1678579,32754WI0010004,Ambetter Balanced Care 4,32754WI001,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/formulary,32754WI0010004-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,4
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,3,32754,WI,Individual,No,39-1678579,32754WI0010004,Ambetter Balanced Care 4,32754WI001,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/formulary,32754WI0010004-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,5
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,3,32754,WI,Individual,No,39-1678579,32754WI0010004,Ambetter Balanced Care 4,32754WI001,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/formulary,32754WI0010004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,3,32754,WI,Individual,No,39-1678579,32754WI0010004,Ambetter Balanced Care 4,32754WI001,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/formulary,32754WI0010004-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,7
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,2,32754,WI,Individual,No,39-1678579,32754WI0010008,Ambetter Essential Care 3 with 3 Free PCP Visits,32754WI001,,WIN001,WIS001,WIF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0010008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,2,32754,WI,Individual,No,39-1678579,32754WI0010008,Ambetter Essential Care 3 with 3 Free PCP Visits,32754WI001,,WIN001,WIS001,WIF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0010008-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,2,32754,WI,Individual,No,39-1678579,32754WI0010010,Ambetter Essential Care 2,32754WI001,,WIN001,WIS001,WIF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/formulary,32754WI0010010-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,2,32754,WI,Individual,No,39-1678579,32754WI0010010,Ambetter Essential Care 2,32754WI001,,WIN001,WIS001,WIF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/formulary,32754WI0010010-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,2,32754,WI,Individual,No,39-1678579,32754WI0010010,Ambetter Essential Care 2,32754WI001,,WIN001,WIS001,WIF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/formulary,32754WI0010010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,2,32754,WI,Individual,No,39-1678579,32754WI0010010,Ambetter Essential Care 2,32754WI001,,WIN001,WIS001,WIF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/formulary,32754WI0010010-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,2,32754,WI,Individual,No,39-1678579,32754WI0010011,Ambetter Essential Care 1,32754WI001,,WIN001,WIS001,WIF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/formulary,32754WI0010011-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,2,32754,WI,Individual,No,39-1678579,32754WI0010011,Ambetter Essential Care 1,32754WI001,,WIN001,WIS001,WIF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/formulary,32754WI0010011-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,5,32754,WI,Individual,No,39-1678579,32754WI0010007,Ambetter Balanced Care 1,32754WI001,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/formulary,32754WI0010007-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,4
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,5,32754,WI,Individual,No,39-1678579,32754WI0010007,Ambetter Balanced Care 1,32754WI001,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/formulary,32754WI0010007-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,5
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,5,32754,WI,Individual,No,39-1678579,32754WI0010007,Ambetter Balanced Care 1,32754WI001,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/formulary,32754WI0010007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,5,32754,WI,Individual,No,39-1678579,32754WI0010007,Ambetter Balanced Care 1,32754WI001,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/formulary,32754WI0010007-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,7
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,5,32754,WI,Individual,No,39-1678579,32754WI0010007,Ambetter Balanced Care 1,32754WI001,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/formulary,32754WI0010007-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,8
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,5,32754,WI,Individual,No,39-1678579,32754WI0010007,Ambetter Balanced Care 1,32754WI001,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/formulary,32754WI0010007-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,9
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,5,32754,WI,Individual,No,39-1678579,32754WI0010007,Ambetter Balanced Care 1,32754WI001,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/formulary,32754WI0010007-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,10
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,6,32754,WI,Individual,No,39-1678579,32754WI0020005,Ambetter Balanced Care 5 + Vision,32754WI002,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.99244901155982,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/formulary,32754WI0020005-00,Standard Silver Off Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,4
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,6,32754,WI,Individual,No,39-1678579,32754WI0020005,Ambetter Balanced Care 5 + Vision,32754WI002,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.99244901155982,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/formulary,32754WI0020005-01,Standard Silver On Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,5
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,6,32754,WI,Individual,No,39-1678579,32754WI0020005,Ambetter Balanced Care 5 + Vision,32754WI002,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.99244901155982,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/formulary,32754WI0020005-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,6,32754,WI,Individual,No,39-1678579,32754WI0020005,Ambetter Balanced Care 5 + Vision,32754WI002,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.99244901155982,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/formulary,32754WI0020005-03,Limited Cost Sharing Plan Variation,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,7
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,6,32754,WI,Individual,No,39-1678579,32754WI0020005,Ambetter Balanced Care 5 + Vision,32754WI002,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.99244901155982,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/formulary,32754WI0020005-04,73% AV Level Silver Plan,73.39%,0.733918905258179,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$2,920",$350,$0,$80,8
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,6,32754,WI,Individual,No,39-1678579,32754WI0020005,Ambetter Balanced Care 5 + Vision,32754WI002,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.99244901155982,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/formulary,32754WI0020005-05,87% AV Level Silver Plan,87.97%,0.879661500453949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$410,$0,$150,$600,$520,$0,$80,9
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,6,32754,WI,Individual,No,39-1678579,32754WI0020005,Ambetter Balanced Care 5 + Vision,32754WI002,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.99244901155982,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/formulary,32754WI0020005-06,94% AV Level Silver Plan,93.34%,0.933413624763489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$120,$0,$150,$0,$450,$0,$80,10
2015,TX,97937,HIOS,2,2014-09-05 03:32:16,2,97937,TX,SHOP (Small Group),Yes,86-0307623,97937TX0240001,Smile for Health Certified High Option Plus (100-50-50),97937TX024,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$7.35,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,97937TX0240001-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,97937,HIOS,2,2014-09-05 03:32:16,3,97937,TX,SHOP (Small Group),Yes,86-0307623,97937TX0260001,Smile for Health Certified Low Option Plus (100-100-100),97937TX026,,TXN001,TXS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$3.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,97937TX0260001-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,97937,HIOS,2,2014-09-05 03:32:16,4,97937,TX,SHOP (Small Group),Yes,86-0307623,97937TX0210001,Smile for Health Certified Basic Option (90-50-50),97937TX021,,TXN001,TXS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$0.74,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,97937TX0210001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,97937,HIOS,2,2014-09-05 03:32:16,5,97937,TX,SHOP (Small Group),Yes,86-0307623,97937TX0230001,Smile for Health Certified High Option (100-50-50),97937TX023,,TXN001,TXS001,,New,PPO,High,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$4.41,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,97937TX0230001-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,97937,HIOS,2,2014-09-05 03:32:16,6,97937,TX,SHOP (Small Group),Yes,86-0307623,97937TX0250001,Smile for Health Certified Low Option (100-100-100),97937TX025,,TXN001,TXS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$0.74,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,97937TX0250001-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,98899,HIOS,2,2014-08-07 10:00:19,1,98899,TX,SHOP (Small Group),Yes,93-0242990,98899TX0030002,EHB High Passive,98899TX003,,TXN001,TXS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$38.79,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,98899TX0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,TX,98899,HIOS,2,2014-08-07 10:00:19,1,98899,TX,SHOP (Small Group),Yes,93-0242990,98899TX0030001,EHB Low Passive,98899TX003,,TXN001,TXS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.06,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,98899TX0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,11503,HIOS,2,2014-08-07 10:00:19,1,11503,WI,SHOP (Small Group),Yes,44-0308260,11503WI0010001,KCL EHB Low PPO,11503WI001,,WIN001,WIS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$49.66,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,11503WI0010001-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,11503,HIOS,2,2014-08-07 10:00:19,1,11503,WI,SHOP (Small Group),Yes,44-0308260,11503WI0010003,KCL EHB Low MAC,11503WI001,,WIN001,WIS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$36.02,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,11503WI0010003-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,11503,HIOS,2,2014-08-07 10:00:19,1,11503,WI,SHOP (Small Group),Yes,44-0308260,11503WI0010005,KCL Fam Low PPO,11503WI001,,WIN001,WIS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$49.66,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,11503WI0010005-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WI,11503,HIOS,2,2014-08-07 10:00:19,1,11503,WI,SHOP (Small Group),Yes,44-0308260,11503WI0010007,KCL Fam Low MAC,11503WI001,,WIN001,WIS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$36.02,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,11503WI0010007-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WI,11503,HIOS,2,2014-08-07 10:00:19,2,11503,WI,SHOP (Small Group),Yes,44-0308260,11503WI0010002,KCL EHB High PPO,11503WI001,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$61.43,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,11503WI0010002-00,Standard High Off Exchange Plan,86.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,11503,HIOS,2,2014-08-07 10:00:19,2,11503,WI,SHOP (Small Group),Yes,44-0308260,11503WI0010004,KCL EHB High MAC,11503WI001,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$46.15,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,11503WI0010004-00,Standard High Off Exchange Plan,86.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,11503,HIOS,2,2014-08-07 10:00:19,2,11503,WI,SHOP (Small Group),Yes,44-0308260,11503WI0010006,KCL Fam High PPO,11503WI001,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$61.43,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,11503WI0010006-00,Standard High Off Exchange Plan,86.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WI,11503,HIOS,2,2014-08-07 10:00:19,2,11503,WI,SHOP (Small Group),Yes,44-0308260,11503WI0010008,KCL Fam High MAC,11503WI001,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$46.15,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,11503WI0010008-00,Standard High Off Exchange Plan,86.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WI,16837,HIOS,7,2014-11-15 04:52:41,1,16837,WI,SHOP (Small Group),Yes,75-1233841,16837WI0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,16837WI002,,WIN001,WIS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.07,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/wi/16837wi0020001-15,,16837WI0020001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,16837,HIOS,7,2014-11-15 04:52:41,1,16837,WI,Individual,Yes,75-1233841,16837WI0010001,Dentegra Dental PPO Pediatric Basic Plan,16837WI001,,WIN001,WIS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$24.88,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/wi/16837wi0010001-15,,16837WI0010001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,16837,HIOS,7,2014-11-15 04:52:41,1,16837,WI,Individual,Yes,75-1233841,16837WI0010001,Dentegra Dental PPO Pediatric Basic Plan,16837WI001,,WIN001,WIS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$24.88,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/wi/16837wi0010001-15,,16837WI0010001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,16837,HIOS,7,2014-11-15 04:52:41,1,16837,WI,SHOP (Small Group),Yes,75-1233841,16837WI0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,16837WI002,,WIN001,WIS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.07,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/wi/16837wi0020001-15,,16837WI0020001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,16837,HIOS,7,2014-11-15 04:52:41,2,16837,WI,SHOP (Small Group),Yes,75-1233841,16837WI0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,16837WI002,,WIN001,WIS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.52,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/wi/16837wi0020004-15,,16837WI0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,16837,HIOS,7,2014-11-15 04:52:41,2,16837,WI,Individual,Yes,75-1233841,16837WI0010004,Dentegra Dental PPO Family Preferred Plan,16837WI001,,WIN001,WIS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.27,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/wi/16837wi0010004-15,,16837WI0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,16837,HIOS,7,2014-11-15 04:52:41,2,16837,WI,Individual,Yes,75-1233841,16837WI0010004,Dentegra Dental PPO Family Preferred Plan,16837WI001,,WIN001,WIS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.27,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/wi/16837wi0010004-15,,16837WI0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,16837,HIOS,7,2014-11-15 04:52:41,2,16837,WI,SHOP (Small Group),Yes,75-1233841,16837WI0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,16837WI002,,WIN001,WIS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.52,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/wi/16837wi0020004-15,,16837WI0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,16837,HIOS,7,2014-11-15 04:52:41,3,16837,WI,SHOP (Small Group),Yes,75-1233841,16837WI0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,16837WI002,,WIN001,WIS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.07,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/wi/16837wi0020006-15,,16837WI0020006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,16837,HIOS,7,2014-11-15 04:52:41,3,16837,WI,Individual,Yes,75-1233841,16837WI0010006,Dentegra Dental PPO Family Basic Plan,16837WI001,,WIN001,WIS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.88,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/wi/16837wi0010006-15,,16837WI0010006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,16837,HIOS,7,2014-11-15 04:52:41,3,16837,WI,Individual,Yes,75-1233841,16837WI0010006,Dentegra Dental PPO Family Basic Plan,16837WI001,,WIN001,WIS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.88,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/wi/16837wi0010006-15,,16837WI0010006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,16837,HIOS,7,2014-11-15 04:52:41,3,16837,WI,SHOP (Small Group),Yes,75-1233841,16837WI0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,16837WI002,,WIN001,WIS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.07,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/wi/16837wi0020006-15,,16837WI0020006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,31248,HIOS,9,2015-01-16 17:32:32,1,31248,WI,SHOP (Small Group),Yes,36-3757528,31248WI0030001,TruAssure Dental Small Group Basic Plan,31248WI003,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.46,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=WI,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=WI,,31248WI0030001-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$80,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,31248,HIOS,9,2015-01-16 17:32:32,1,31248,WI,Individual,Yes,36-3757528,31248WI0010001,TruAssure Dental Basic Plan,31248WI001,,WIN001,WIS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.71,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=WI,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=WI,,31248WI0010001-00,Standard Low Off Exchange Plan,68.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$145,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,31248,HIOS,9,2015-01-16 17:32:32,1,31248,WI,Individual,Yes,36-3757528,31248WI0010001,TruAssure Dental Basic Plan,31248WI001,,WIN001,WIS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.71,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=WI,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=WI,,31248WI0010001-01,Standard Low On Exchange Plan,68.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$145,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,31248,HIOS,9,2015-01-16 17:32:32,1,31248,WI,SHOP (Small Group),Yes,36-3757528,31248WI0040001,TruAssure Dental Small Group Preferred Plan,31248WI004,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.46,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=WI,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=WI,,31248WI0040001-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$80,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,31248,HIOS,9,2015-01-16 17:32:32,2,31248,WI,Individual,Yes,36-3757528,31248WI0020001,TruAssure Dental Preferred Plan,31248WI002,,WIN001,WIS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.72,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=WI,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=WI,,31248WI0020001-00,Standard High Off Exchange Plan,83.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,31248,HIOS,9,2015-01-16 17:32:32,2,31248,WI,Individual,Yes,36-3757528,31248WI0020001,TruAssure Dental Preferred Plan,31248WI002,,WIN001,WIS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.72,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=WI,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=WI,,31248WI0020001-01,Standard High On Exchange Plan,83.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,1,32754,WI,Individual,No,39-1678579,32754WI0010005,Ambetter Balanced Care 5,32754WI001,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/formulary,32754WI0010005-00,Standard Silver Off Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,4
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,1,32754,WI,Individual,No,39-1678579,32754WI0010005,Ambetter Balanced Care 5,32754WI001,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/formulary,32754WI0010005-01,Standard Silver On Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,5
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,1,32754,WI,Individual,No,39-1678579,32754WI0010005,Ambetter Balanced Care 5,32754WI001,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/formulary,32754WI0010005-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,1,32754,WI,Individual,No,39-1678579,32754WI0010005,Ambetter Balanced Care 5,32754WI001,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/formulary,32754WI0010005-03,Limited Cost Sharing Plan Variation,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,7
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,1,32754,WI,Individual,No,39-1678579,32754WI0010005,Ambetter Balanced Care 5,32754WI001,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/formulary,32754WI0010005-04,73% AV Level Silver Plan,73.39%,0.733918905258179,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$2,920",$350,$0,$80,8
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,1,32754,WI,Individual,No,39-1678579,32754WI0010005,Ambetter Balanced Care 5,32754WI001,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/formulary,32754WI0010005-05,87% AV Level Silver Plan,87.97%,0.879661500453949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$410,$0,$150,$600,$520,$0,$80,9
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,1,32754,WI,Individual,No,39-1678579,32754WI0010005,Ambetter Balanced Care 5,32754WI001,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/formulary,32754WI0010005-06,94% AV Level Silver Plan,93.34%,0.933413624763489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$120,$0,$150,$0,$450,$0,$80,10
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,1,32754,WI,Individual,No,39-1678579,32754WI0010003,Ambetter Balanced Care 3,32754WI001,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0010003-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,11
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,1,32754,WI,Individual,No,39-1678579,32754WI0010003,Ambetter Balanced Care 3,32754WI001,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0010003-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,12
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,1,32754,WI,Individual,No,39-1678579,32754WI0010003,Ambetter Balanced Care 3,32754WI001,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0010003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,1,32754,WI,Individual,No,39-1678579,32754WI0010003,Ambetter Balanced Care 3,32754WI001,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0010003-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,14
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,1,32754,WI,Individual,No,39-1678579,32754WI0010003,Ambetter Balanced Care 3,32754WI001,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0010003-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,15
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,1,32754,WI,Individual,No,39-1678579,32754WI0010003,Ambetter Balanced Care 3,32754WI001,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0010003-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,16
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,1,32754,WI,Individual,No,39-1678579,32754WI0010003,Ambetter Balanced Care 3,32754WI001,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0010003-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,17
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,1,32754,WI,Individual,No,39-1678579,32754WI0010001,Ambetter Secure Care 2,32754WI001,,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/formulary,32754WI0010001-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,18
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,1,32754,WI,Individual,No,39-1678579,32754WI0010001,Ambetter Secure Care 2,32754WI001,,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/formulary,32754WI0010001-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,19
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,1,32754,WI,Individual,No,39-1678579,32754WI0010001,Ambetter Secure Care 2,32754WI001,,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/formulary,32754WI0010001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,20
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,1,32754,WI,Individual,No,39-1678579,32754WI0010001,Ambetter Secure Care 2,32754WI001,,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/formulary,32754WI0010001-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,21
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,2,32754,WI,Individual,No,39-1678579,32754WI0010002,Ambetter Secure Care 1 with 3 Free PCP Visits,32754WI001,,WIN001,WIS001,WIF002,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/formulary,32754WI0010002-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,2,32754,WI,Individual,No,39-1678579,32754WI0010002,Ambetter Secure Care 1 with 3 Free PCP Visits,32754WI001,,WIN001,WIS001,WIF002,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/formulary,32754WI0010002-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,2,32754,WI,Individual,No,39-1678579,32754WI0010002,Ambetter Secure Care 1 with 3 Free PCP Visits,32754WI001,,WIN001,WIS001,WIF002,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/formulary,32754WI0010002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,2,32754,WI,Individual,No,39-1678579,32754WI0010002,Ambetter Secure Care 1 with 3 Free PCP Visits,32754WI001,,WIN001,WIS001,WIF002,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/formulary,32754WI0010002-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,3,32754,WI,Individual,No,39-1678579,32754WI0010004,Ambetter Balanced Care 4,32754WI001,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/formulary,32754WI0010004-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,8
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,3,32754,WI,Individual,No,39-1678579,32754WI0010004,Ambetter Balanced Care 4,32754WI001,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/formulary,32754WI0010004-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,9
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,3,32754,WI,Individual,No,39-1678579,32754WI0010004,Ambetter Balanced Care 4,32754WI001,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/formulary,32754WI0010004-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,10
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,4,32754,WI,Individual,No,39-1678579,32754WI0010006,Ambetter Balanced Care 2,32754WI001,,WIN001,WIS001,WIF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/formulary,32754WI0010006-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,4
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,4,32754,WI,Individual,No,39-1678579,32754WI0010006,Ambetter Balanced Care 2,32754WI001,,WIN001,WIS001,WIF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/formulary,32754WI0010006-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,5
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,4,32754,WI,Individual,No,39-1678579,32754WI0010006,Ambetter Balanced Care 2,32754WI001,,WIN001,WIS001,WIF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/formulary,32754WI0010006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,4,32754,WI,Individual,No,39-1678579,32754WI0010006,Ambetter Balanced Care 2,32754WI001,,WIN001,WIS001,WIF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/formulary,32754WI0010006-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,7
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,4,32754,WI,Individual,No,39-1678579,32754WI0010006,Ambetter Balanced Care 2,32754WI001,,WIN001,WIS001,WIF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/formulary,32754WI0010006-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,8
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,4,32754,WI,Individual,No,39-1678579,32754WI0010006,Ambetter Balanced Care 2,32754WI001,,WIN001,WIS001,WIF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/formulary,32754WI0010006-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,9
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,4,32754,WI,Individual,No,39-1678579,32754WI0010006,Ambetter Balanced Care 2,32754WI001,,WIN001,WIS001,WIF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/formulary,32754WI0010006-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,10
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,6,32754,WI,Individual,No,39-1678579,32754WI0020003,Ambetter Balanced Care 3 + Vision,32754WI002,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992449062583979,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0020003-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,11
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,6,32754,WI,Individual,No,39-1678579,32754WI0020003,Ambetter Balanced Care 3 + Vision,32754WI002,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992449062583979,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0020003-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,12
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,6,32754,WI,Individual,No,39-1678579,32754WI0020003,Ambetter Balanced Care 3 + Vision,32754WI002,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992449062583979,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0020003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,6,32754,WI,Individual,No,39-1678579,32754WI0020003,Ambetter Balanced Care 3 + Vision,32754WI002,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992449062583979,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0020003-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,14
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,6,32754,WI,Individual,No,39-1678579,32754WI0020003,Ambetter Balanced Care 3 + Vision,32754WI002,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992449062583979,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0020003-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,15
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,6,32754,WI,Individual,No,39-1678579,32754WI0020003,Ambetter Balanced Care 3 + Vision,32754WI002,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992449062583979,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0020003-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,16
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,6,32754,WI,Individual,No,39-1678579,32754WI0020003,Ambetter Balanced Care 3 + Vision,32754WI002,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992449062583979,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0020003-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,17
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,6,32754,WI,Individual,No,39-1678579,32754WI0020001,Ambetter Secure Care 2 + Vision,32754WI002,,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992020341254233,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/formulary,32754WI0020001-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,18
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,6,32754,WI,Individual,No,39-1678579,32754WI0020001,Ambetter Secure Care 2 + Vision,32754WI002,,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992020341254233,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/formulary,32754WI0020001-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,19
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,6,32754,WI,Individual,No,39-1678579,32754WI0020001,Ambetter Secure Care 2 + Vision,32754WI002,,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992020341254233,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/formulary,32754WI0020001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,20
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,6,32754,WI,Individual,No,39-1678579,32754WI0020001,Ambetter Secure Care 2 + Vision,32754WI002,,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992020341254233,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/formulary,32754WI0020001-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,21
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,7,32754,WI,Individual,No,39-1678579,32754WI0020002,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,32754WI002,,WIN001,WIS001,WIF002,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992020918086442,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/formulary,32754WI0020002-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,7,32754,WI,Individual,No,39-1678579,32754WI0020002,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,32754WI002,,WIN001,WIS001,WIF002,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992020918086442,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/formulary,32754WI0020002-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,7,32754,WI,Individual,No,39-1678579,32754WI0020002,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,32754WI002,,WIN001,WIS001,WIF002,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992020918086442,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/formulary,32754WI0020002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,7,32754,WI,Individual,No,39-1678579,32754WI0020002,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,32754WI002,,WIN001,WIS001,WIF002,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992020918086442,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/formulary,32754WI0020002-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,7,32754,WI,Individual,No,39-1678579,32754WI0020008,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,32754WI002,,WIN001,WIS001,WIF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992245610530637,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0020008-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,7,32754,WI,Individual,No,39-1678579,32754WI0020008,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,32754WI002,,WIN001,WIS001,WIF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992245610530637,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0020008-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,7,32754,WI,Individual,No,39-1678579,32754WI0020008,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,32754WI002,,WIN001,WIS001,WIF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992245610530637,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0020008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,7,32754,WI,Individual,No,39-1678579,32754WI0020008,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,32754WI002,,WIN001,WIS001,WIF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992245610530637,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0020008-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,7,32754,WI,Individual,No,39-1678579,32754WI0020009,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,32754WI002,,WIN001,WIS001,WIF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992245527800138,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/formulary,32754WI0020009-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,7,32754,WI,Individual,No,39-1678579,32754WI0020009,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,32754WI002,,WIN001,WIS001,WIF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992245527800138,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/formulary,32754WI0020009-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,7,32754,WI,Individual,No,39-1678579,32754WI0020009,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,32754WI002,,WIN001,WIS001,WIF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992245527800138,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/formulary,32754WI0020009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,7,32754,WI,Individual,No,39-1678579,32754WI0020009,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,32754WI002,,WIN001,WIS001,WIF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992245527800138,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/formulary,32754WI0020009-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,7,32754,WI,Individual,No,39-1678579,32754WI0020010,Ambetter Essential Care 2 + Vision,32754WI002,,WIN001,WIS001,WIF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992245610530637,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/formulary,32754WI0020010-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,7,32754,WI,Individual,No,39-1678579,32754WI0020010,Ambetter Essential Care 2 + Vision,32754WI002,,WIN001,WIS001,WIF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992245610530637,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/formulary,32754WI0020010-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,7,32754,WI,Individual,No,39-1678579,32754WI0020010,Ambetter Essential Care 2 + Vision,32754WI002,,WIN001,WIS001,WIF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992245610530637,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/formulary,32754WI0020010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,7,32754,WI,Individual,No,39-1678579,32754WI0020010,Ambetter Essential Care 2 + Vision,32754WI002,,WIN001,WIS001,WIF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992245610530637,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/formulary,32754WI0020010-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,7,32754,WI,Individual,No,39-1678579,32754WI0020011,Ambetter Essential Care 1 + Vision,32754WI002,,WIN001,WIS001,WIF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992245716886964,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/formulary,32754WI0020011-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,7,32754,WI,Individual,No,39-1678579,32754WI0020011,Ambetter Essential Care 1 + Vision,32754WI002,,WIN001,WIS001,WIF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992245716886964,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/formulary,32754WI0020011-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,7,32754,WI,Individual,No,39-1678579,32754WI0020011,Ambetter Essential Care 1 + Vision,32754WI002,,WIN001,WIS001,WIF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992245716886964,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/formulary,32754WI0020011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,7,32754,WI,Individual,No,39-1678579,32754WI0020011,Ambetter Essential Care 1 + Vision,32754WI002,,WIN001,WIS001,WIF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992245716886964,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/formulary,32754WI0020011-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,8,32754,WI,Individual,No,39-1678579,32754WI0020004,Ambetter Balanced Care 4 + Vision,32754WI002,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992340440961588,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/formulary,32754WI0020004-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,4
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,8,32754,WI,Individual,No,39-1678579,32754WI0020004,Ambetter Balanced Care 4 + Vision,32754WI002,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992340440961588,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/formulary,32754WI0020004-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,5
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,8,32754,WI,Individual,No,39-1678579,32754WI0020004,Ambetter Balanced Care 4 + Vision,32754WI002,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992340440961588,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/formulary,32754WI0020004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,8,32754,WI,Individual,No,39-1678579,32754WI0020004,Ambetter Balanced Care 4 + Vision,32754WI002,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992340440961588,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/formulary,32754WI0020004-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,7
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,8,32754,WI,Individual,No,39-1678579,32754WI0020004,Ambetter Balanced Care 4 + Vision,32754WI002,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992340440961588,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/formulary,32754WI0020004-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,8
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,8,32754,WI,Individual,No,39-1678579,32754WI0020004,Ambetter Balanced Care 4 + Vision,32754WI002,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992340440961588,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/formulary,32754WI0020004-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,9
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,8,32754,WI,Individual,No,39-1678579,32754WI0020004,Ambetter Balanced Care 4 + Vision,32754WI002,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992340440961588,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/formulary,32754WI0020004-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,10
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,9,32754,WI,Individual,No,39-1678579,32754WI0020006,Ambetter Balanced Care 2 + Vision,32754WI002,,WIN001,WIS001,WIF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992463720385809,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/formulary,32754WI0020006-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,4
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,9,32754,WI,Individual,No,39-1678579,32754WI0020006,Ambetter Balanced Care 2 + Vision,32754WI002,,WIN001,WIS001,WIF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992463720385809,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/formulary,32754WI0020006-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,5
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,9,32754,WI,Individual,No,39-1678579,32754WI0020006,Ambetter Balanced Care 2 + Vision,32754WI002,,WIN001,WIS001,WIF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992463720385809,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/formulary,32754WI0020006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,9,32754,WI,Individual,No,39-1678579,32754WI0020006,Ambetter Balanced Care 2 + Vision,32754WI002,,WIN001,WIS001,WIF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992463720385809,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/formulary,32754WI0020006-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,7
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,9,32754,WI,Individual,No,39-1678579,32754WI0020006,Ambetter Balanced Care 2 + Vision,32754WI002,,WIN001,WIS001,WIF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992463720385809,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/formulary,32754WI0020006-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,8
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,9,32754,WI,Individual,No,39-1678579,32754WI0020006,Ambetter Balanced Care 2 + Vision,32754WI002,,WIN001,WIS001,WIF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992463720385809,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/formulary,32754WI0020006-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,9
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,9,32754,WI,Individual,No,39-1678579,32754WI0020006,Ambetter Balanced Care 2 + Vision,32754WI002,,WIN001,WIS001,WIF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992463720385809,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/formulary,32754WI0020006-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,10
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,10,32754,WI,Individual,No,39-1678579,32754WI0020007,Ambetter Balanced Care 1 + Vision,32754WI002,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992495127268302,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/formulary,32754WI0020007-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,4
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,10,32754,WI,Individual,No,39-1678579,32754WI0020007,Ambetter Balanced Care 1 + Vision,32754WI002,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992495127268302,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/formulary,32754WI0020007-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,5
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,10,32754,WI,Individual,No,39-1678579,32754WI0020007,Ambetter Balanced Care 1 + Vision,32754WI002,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992495127268302,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/formulary,32754WI0020007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,10,32754,WI,Individual,No,39-1678579,32754WI0020007,Ambetter Balanced Care 1 + Vision,32754WI002,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992495127268302,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/formulary,32754WI0020007-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,7
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,10,32754,WI,Individual,No,39-1678579,32754WI0020007,Ambetter Balanced Care 1 + Vision,32754WI002,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992495127268302,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/formulary,32754WI0020007-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,8
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,10,32754,WI,Individual,No,39-1678579,32754WI0020007,Ambetter Balanced Care 1 + Vision,32754WI002,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992495127268302,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/formulary,32754WI0020007-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,9
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,10,32754,WI,Individual,No,39-1678579,32754WI0020007,Ambetter Balanced Care 1 + Vision,32754WI002,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.992495127268302,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/formulary,32754WI0020007-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,10
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,11,32754,WI,Individual,No,39-1678579,32754WI0030005,Ambetter Balanced Care 5 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960844331310535,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/formulary,32754WI0030005-00,Standard Silver Off Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,4
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,11,32754,WI,Individual,No,39-1678579,32754WI0030005,Ambetter Balanced Care 5 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960844331310535,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/formulary,32754WI0030005-01,Standard Silver On Exchange Plan,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,5
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,11,32754,WI,Individual,No,39-1678579,32754WI0030005,Ambetter Balanced Care 5 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960844331310535,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/formulary,32754WI0030005-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,11,32754,WI,Individual,No,39-1678579,32754WI0030005,Ambetter Balanced Care 5 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960844331310535,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/formulary,32754WI0030005-03,Limited Cost Sharing Plan Variation,68.13%,0.681264340877533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,7
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,11,32754,WI,Individual,No,39-1678579,32754WI0030005,Ambetter Balanced Care 5 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960844331310535,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/formulary,32754WI0030005-04,73% AV Level Silver Plan,73.39%,0.733918905258179,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$2,920",$350,$0,$80,8
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,11,32754,WI,Individual,No,39-1678579,32754WI0030005,Ambetter Balanced Care 5 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960844331310535,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/formulary,32754WI0030005-05,87% AV Level Silver Plan,87.97%,0.879661500453949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$410,$0,$150,$600,$520,$0,$80,9
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,11,32754,WI,Individual,No,39-1678579,32754WI0030005,Ambetter Balanced Care 5 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960844331310535,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare5,http://ambetter.mhswi.com/formulary,32754WI0030005-06,94% AV Level Silver Plan,93.34%,0.933413624763489,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$120,$0,$150,$0,$450,$0,$80,10
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,11,32754,WI,Individual,No,39-1678579,32754WI0030003,Ambetter Balanced Care 3 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960843767262497,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0030003-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,11
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,11,32754,WI,Individual,No,39-1678579,32754WI0030003,Ambetter Balanced Care 3 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960843767262497,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0030003-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,12
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,11,32754,WI,Individual,No,39-1678579,32754WI0030003,Ambetter Balanced Care 3 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960843767262497,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0030003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,11,32754,WI,Individual,No,39-1678579,32754WI0030003,Ambetter Balanced Care 3 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960843767262497,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0030003-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,14
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,11,32754,WI,Individual,No,39-1678579,32754WI0030003,Ambetter Balanced Care 3 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960843767262497,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0030003-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,15
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,11,32754,WI,Individual,No,39-1678579,32754WI0030003,Ambetter Balanced Care 3 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960843767262497,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0030003-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,16
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,11,32754,WI,Individual,No,39-1678579,32754WI0030003,Ambetter Balanced Care 3 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960843767262497,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0030003-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,17
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,11,32754,WI,Individual,No,39-1678579,32754WI0030001,Ambetter Secure Care 2 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.958677625670063,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/formulary,32754WI0030001-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,18
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,11,32754,WI,Individual,No,39-1678579,32754WI0030001,Ambetter Secure Care 2 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.958677625670063,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/formulary,32754WI0030001-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,19
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,11,32754,WI,Individual,No,39-1678579,32754WI0030001,Ambetter Secure Care 2 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.958677625670063,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/formulary,32754WI0030001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,20
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,11,32754,WI,Individual,No,39-1678579,32754WI0030001,Ambetter Secure Care 2 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.958677625670063,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare2,http://ambetter.mhswi.com/formulary,32754WI0030001-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,21
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,12,32754,WI,Individual,No,39-1678579,32754WI0030002,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF002,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.958680600149855,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/formulary,32754WI0030002-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,12,32754,WI,Individual,No,39-1678579,32754WI0030002,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF002,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.958680600149855,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/formulary,32754WI0030002-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,12,32754,WI,Individual,No,39-1678579,32754WI0030002,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF002,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.958680600149855,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/formulary,32754WI0030002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,12,32754,WI,Individual,No,39-1678579,32754WI0030002,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF002,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.958680600149855,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=SecureCare1,http://ambetter.mhswi.com/formulary,32754WI0030002-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,12,32754,WI,Individual,No,39-1678579,32754WI0030008,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.959824660823262,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0030008-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,12,32754,WI,Individual,No,39-1678579,32754WI0030008,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.959824660823262,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0030008-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,12,32754,WI,Individual,No,39-1678579,32754WI0030008,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.959824660823262,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0030008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,12,32754,WI,Individual,No,39-1678579,32754WI0030008,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.959824660823262,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare3,http://ambetter.mhswi.com/formulary,32754WI0030008-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,12,32754,WI,Individual,No,39-1678579,32754WI0030009,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.959824284953085,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/formulary,32754WI0030009-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,12,32754,WI,Individual,No,39-1678579,32754WI0030009,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.959824284953085,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/formulary,32754WI0030009-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,12,32754,WI,Individual,No,39-1678579,32754WI0030009,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.959824284953085,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/formulary,32754WI0030009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,12,32754,WI,Individual,No,39-1678579,32754WI0030009,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.959824284953085,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare4,http://ambetter.mhswi.com/formulary,32754WI0030009-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,12,32754,WI,Individual,No,39-1678579,32754WI0030010,Ambetter Essential Care 2 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.959824660823262,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/formulary,32754WI0030010-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,12,32754,WI,Individual,No,39-1678579,32754WI0030010,Ambetter Essential Care 2 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.959824660823262,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/formulary,32754WI0030010-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,12,32754,WI,Individual,No,39-1678579,32754WI0030010,Ambetter Essential Care 2 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.959824660823262,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/formulary,32754WI0030010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,12,32754,WI,Individual,No,39-1678579,32754WI0030010,Ambetter Essential Care 2 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF010,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.959824660823262,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare2,http://ambetter.mhswi.com/formulary,32754WI0030010-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,12,32754,WI,Individual,No,39-1678579,32754WI0030011,Ambetter Essential Care 1 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.959825205260154,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/formulary,32754WI0030011-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,12,32754,WI,Individual,No,39-1678579,32754WI0030011,Ambetter Essential Care 1 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.959825205260154,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/formulary,32754WI0030011-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,12,32754,WI,Individual,No,39-1678579,32754WI0030011,Ambetter Essential Care 1 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.959825205260154,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/formulary,32754WI0030011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,12,32754,WI,Individual,No,39-1678579,32754WI0030011,Ambetter Essential Care 1 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF011,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.959825205260154,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=EssentialCare1,http://ambetter.mhswi.com/formulary,32754WI0030011-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,13,32754,WI,Individual,No,39-1678579,32754WI0030004,Ambetter Balanced Care 4 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960303462423766,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/formulary,32754WI0030004-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,4
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,13,32754,WI,Individual,No,39-1678579,32754WI0030004,Ambetter Balanced Care 4 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960303462423766,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/formulary,32754WI0030004-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,5
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,13,32754,WI,Individual,No,39-1678579,32754WI0030004,Ambetter Balanced Care 4 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960303462423766,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/formulary,32754WI0030004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,13,32754,WI,Individual,No,39-1678579,32754WI0030004,Ambetter Balanced Care 4 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960303462423766,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/formulary,32754WI0030004-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,7
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,13,32754,WI,Individual,No,39-1678579,32754WI0030004,Ambetter Balanced Care 4 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960303462423766,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/formulary,32754WI0030004-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,8
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,13,32754,WI,Individual,No,39-1678579,32754WI0030004,Ambetter Balanced Care 4 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960303462423766,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/formulary,32754WI0030004-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,9
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,13,32754,WI,Individual,No,39-1678579,32754WI0030004,Ambetter Balanced Care 4 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960303462423766,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare4,http://ambetter.mhswi.com/formulary,32754WI0030004-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,10
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,14,32754,WI,Individual,No,39-1678579,32754WI0030006,Ambetter Balanced Care 2 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960916511564931,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/formulary,32754WI0030006-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,4
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,14,32754,WI,Individual,No,39-1678579,32754WI0030006,Ambetter Balanced Care 2 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960916511564931,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/formulary,32754WI0030006-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,5
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,14,32754,WI,Individual,No,39-1678579,32754WI0030006,Ambetter Balanced Care 2 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960916511564931,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/formulary,32754WI0030006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,14,32754,WI,Individual,No,39-1678579,32754WI0030006,Ambetter Balanced Care 2 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960916511564931,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/formulary,32754WI0030006-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,7
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,14,32754,WI,Individual,No,39-1678579,32754WI0030006,Ambetter Balanced Care 2 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960916511564931,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/formulary,32754WI0030006-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,8
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,14,32754,WI,Individual,No,39-1678579,32754WI0030006,Ambetter Balanced Care 2 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960916511564931,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/formulary,32754WI0030006-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,9
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,14,32754,WI,Individual,No,39-1678579,32754WI0030006,Ambetter Balanced Care 2 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF007,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.960916511564931,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare2,http://ambetter.mhswi.com/formulary,32754WI0030006-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,10
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,15,32754,WI,Individual,No,39-1678579,32754WI0030007,Ambetter Balanced Care 1 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.961072505798107,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/formulary,32754WI0030007-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,4
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,15,32754,WI,Individual,No,39-1678579,32754WI0030007,Ambetter Balanced Care 1 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.961072505798107,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/formulary,32754WI0030007-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,5
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,15,32754,WI,Individual,No,39-1678579,32754WI0030007,Ambetter Balanced Care 1 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.961072505798107,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/formulary,32754WI0030007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,15,32754,WI,Individual,No,39-1678579,32754WI0030007,Ambetter Balanced Care 1 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.961072505798107,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/formulary,32754WI0030007-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,7
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,15,32754,WI,Individual,No,39-1678579,32754WI0030007,Ambetter Balanced Care 1 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.961072505798107,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/formulary,32754WI0030007-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,8
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,15,32754,WI,Individual,No,39-1678579,32754WI0030007,Ambetter Balanced Care 1 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.961072505798107,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/formulary,32754WI0030007-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,9
2015,WI,32754,HIOS,8,2015-04-22 11:06:15,15,32754,WI,Individual,No,39-1678579,32754WI0030007,Ambetter Balanced Care 1 + Vision + Adult Dental,32754WI003,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.961072505798107,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/payments,http://ambetter.mhswi.com/brochures/?plan=BalancedCare1,http://ambetter.mhswi.com/formulary,32754WI0030007-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,10
2015,WI,34210,HIOS,1,2014-06-25 03:28:48,1,34210,WI,SHOP (Small Group),Yes,47-0397286,34210WI0030001,"Renaissance Group Dental PPO, EHB Certified",34210WI003,,WIN001,WIS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.48,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34210WI0030001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,34210,HIOS,1,2014-06-25 03:28:48,1,34210,WI,Individual,Yes,47-0397286,34210WI0010001,"Delta Dental Individual PPO, EHB Certified",34210WI001,,WIN002,WIS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.10,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34210WI0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,34210,HIOS,1,2014-06-25 03:28:48,1,34210,WI,Individual,Yes,47-0397286,34210WI0010002,"Delta Dental Individual PPO, EHB Certified",34210WI001,,WIN002,WIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.99,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34210WI0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,34210,HIOS,1,2014-06-25 03:28:48,1,34210,WI,SHOP (Small Group),Yes,47-0397286,34210WI0030002,"Renaissance Group Dental PPO, EHB Certified",34210WI003,,WIN001,WIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.11,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34210WI0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,34210,HIOS,1,2014-06-25 03:28:48,1,34210,WI,Individual,Yes,47-0397286,34210WI0020001,"Renaissance Individual Dental PPO, EHB Certified",34210WI002,,WIN001,WIS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.77,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34210WI0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WI,34210,HIOS,1,2014-06-25 03:28:48,1,34210,WI,Individual,Yes,47-0397286,34210WI0020002,"Renaissance Individual Dental PPO, EHB Certified",34210WI002,,WIN001,WIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.85,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34210WI0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010003,MercyCare PPO CO 90-70 $0 Deductible; $17/$40/$60 Rx,35334WI001,,WIN001,WIS001,WIF004,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010003-00,Standard Platinum Off Exchange Plan,91.20%,0.914201557636261,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,10%,,,,$750,"$1,500",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510019,Unity Elite Silver 40/90,37833WI051,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510019-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,97
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510019,Unity Elite Silver 40/90,37833WI051,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510019-03,Limited Cost Sharing Plan Variation,,0.680200815200806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,98
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140001,Tradition $500 - 10%,38166WI014,,WIN001,WIS001,WIF007,Existing,HMO,Platinum,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140001-01,Standard Platinum On Exchange Plan,,0.896489024162292,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0170001,"Classic $1,000 - 20%",38166WI017,,WIN001,WIS001,WIF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170001-01,Standard Gold On Exchange Plan,80.70%,0.797870516777039,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160008,"Reliance $2,000 - 10% HDHP",38166WI016,,WIN002,WIS002,WIF003,Existing,EPO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160008-01,Standard Silver On Exchange Plan,,0.691667020320892,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0180002,"Select $3,000 HDHP",38166WI018,,WIN002,WIS002,WIF006,Existing,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180002-04,73% AV Level Silver Plan,73.73%,0.737290322780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,675","$5,350",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,675","$5,350",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0180002,"Select $3,000 HDHP",38166WI018,,WIN002,WIS002,WIF006,Existing,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180002-05,87% AV Level Silver Plan,87.65%,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,24
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160009,"Reliance $4,000 - 20% HDHP",38166WI016,,WIN002,WIS002,WIF003,Existing,EPO,Bronze,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160009-00,Standard Bronze Off Exchange Plan,,0.614021420478821,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,24
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380012,Unity Prime Silver 25/85 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS1FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380012-04,73% AV Level Silver Plan,,0.739934623241425,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300","$4,600",45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380012,Unity Prime Silver 25/85 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS1FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380012-05,87% AV Level Silver Plan,,0.878882467746735,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380026,Unity Elite Silver 20/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380026-01,Standard Silver On Exchange Plan,,0.707099437713623,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,108
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380026,Unity Elite Silver 20/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380026-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,109
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010003,MercyCare PPO CO 90-70 $0 Deductible; $17/$40/$60 Rx,35334WI001,,WIN001,WIS001,WIF004,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010003-01,Standard Platinum On Exchange Plan,91.20%,0.914201557636261,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,10%,,,,$750,"$1,500",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010004,MercyCare PPO CO 90-70 $0 Deductible; $10/$25/$50 Rx,35334WI001,,WIN001,WIS001,WIF001,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010004-00,Standard Platinum Off Exchange Plan,91.80%,0.918204963207245,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,10%,,,,$750,"$1,500",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010004,MercyCare PPO CO 90-70 $0 Deductible; $10/$25/$50 Rx,35334WI001,,WIN001,WIS001,WIF001,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010004-01,Standard Platinum On Exchange Plan,91.80%,0.918204963207245,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,10%,,,,$750,"$1,500",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010005,MercyCare PPO CO 80-60 $0 Deductible; $17/$40/$60 Rx,35334WI001,,WIN001,WIS001,WIF004,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010005-00,Standard Platinum Off Exchange Plan,91.10%,0.913043081760406,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$750,"$1,500",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010005,MercyCare PPO CO 80-60 $0 Deductible; $17/$40/$60 Rx,35334WI001,,WIN001,WIS001,WIF004,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010005-01,Standard Platinum On Exchange Plan,91.10%,0.913043081760406,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$750,"$1,500",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010006,MercyCare PPO CO 80-60 $0 Deductible; $10/$25/$50 Rx,35334WI001,,WIN001,WIS001,WIF001,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010006-00,Standard Platinum Off Exchange Plan,90.70%,0.906812191009521,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$750,"$1,500",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010006,MercyCare PPO CO 80-60 $0 Deductible; $10/$25/$50 Rx,35334WI001,,WIN001,WIS001,WIF001,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010006-01,Standard Platinum On Exchange Plan,90.70%,0.906812191009521,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$750,"$1,500",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010007,MercyCare PPO CO 90-70 $500 Deductible; $17/$40/$60 Rx,35334WI001,,WIN001,WIS001,WIF004,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010007-00,Standard Platinum Off Exchange Plan,89.10%,0.893075942993164,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010007,MercyCare PPO CO 90-70 $500 Deductible; $17/$40/$60 Rx,35334WI001,,WIN001,WIS001,WIF004,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010007-01,Standard Platinum On Exchange Plan,89.10%,0.893075942993164,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010008,MercyCare PPO CO 90-70 $500 Deductible; $10/$25/$50 Rx,35334WI001,,WIN001,WIS001,WIF001,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010008-00,Standard Platinum Off Exchange Plan,88.60%,0.88584566116333,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010008,MercyCare PPO CO 90-70 $500 Deductible; $10/$25/$50 Rx,35334WI001,,WIN001,WIS001,WIF001,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010008-01,Standard Platinum On Exchange Plan,88.60%,0.88584566116333,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010009,MercyCare PPO CO 80-60 $500 Deductible; $17/$40/$60 Rx,35334WI001,,WIN001,WIS001,WIF004,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010009-00,Standard Platinum Off Exchange Plan,89.50%,0.897381067276001,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010009,MercyCare PPO CO 80-60 $500 Deductible; $17/$40/$60 Rx,35334WI001,,WIN001,WIS001,WIF004,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010009-01,Standard Platinum On Exchange Plan,89.50%,0.897381067276001,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010010,MercyCare PPO CO 80-60 $500 Deductible; $10/$25/$50 Rx,35334WI001,,WIN001,WIS001,WIF001,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010010-00,Standard Platinum Off Exchange Plan,88.30%,0.883324682712555,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010010,MercyCare PPO CO 80-60 $500 Deductible; $10/$25/$50 Rx,35334WI001,,WIN001,WIS001,WIF001,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010010-01,Standard Platinum On Exchange Plan,88.30%,0.883324682712555,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010011,MercyCare PPO CO 80-60 $1250 Deductible; $20/$40/$60 Rx,35334WI001,,WIN001,WIS001,WIF002,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010011-00,Standard Gold Off Exchange Plan,82.00%,0.819660723209381,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,250","$2,500",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010011,MercyCare PPO CO 80-60 $1250 Deductible; $20/$40/$60 Rx,35334WI001,,WIN001,WIS001,WIF002,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010011-01,Standard Gold On Exchange Plan,82.00%,0.819660723209381,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,250","$2,500",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010012,MercyCare PPO CO 80-60 $1250 Deductible; $10/$25/$50 Rx,35334WI001,,WIN001,WIS001,WIF001,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010012-00,Standard Gold Off Exchange Plan,82.00%,0.819542109966278,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$6,500","$13,000",Not Applicable,Not Applicable,"$1,250","$2,500",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010012,MercyCare PPO CO 80-60 $1250 Deductible; $10/$25/$50 Rx,35334WI001,,WIN001,WIS001,WIF001,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010012-01,Standard Gold On Exchange Plan,82.00%,0.819542109966278,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$6,500","$13,000",Not Applicable,Not Applicable,"$1,250","$2,500",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010013,MercyCare PPO CO 80-60 $2000 Deductible; $20/$40/$60 Rx,35334WI001,,WIN001,WIS001,WIF002,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010013-00,Standard Gold Off Exchange Plan,78.10%,0.780282735824585,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$8,750","$17,500",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010013,MercyCare PPO CO 80-60 $2000 Deductible; $20/$40/$60 Rx,35334WI001,,WIN001,WIS001,WIF002,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010013-01,Standard Gold On Exchange Plan,78.10%,0.780282735824585,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$8,750","$17,500",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010014,MercyCare PPO CO 80-60 $2000 Deductible; $10/$25/$50 Rx,35334WI001,,WIN001,WIS001,WIF001,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010014-00,Standard Gold Off Exchange Plan,79.00%,0.788441300392151,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,750","$17,500",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370013,Unity Prime Silver 35/110 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS3CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370013-03,Limited Cost Sharing Plan Variation,,0.69202595949173,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,300","$8,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370013,Unity Prime Silver 35/110 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS3CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370013-04,73% AV Level Silver Plan,,0.734951317310333,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,800","$5,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370014,Unity Prime Silver 20/65 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS2CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370014,Unity Prime Silver 20/65 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS2CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370014-03,Limited Cost Sharing Plan Variation,,0.709311366081238,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370014,Unity Prime Silver 20/65 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS2CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370014-06,94% AV Level Silver Plan,,0.94780308008194,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370013,Unity Prime Silver 35/110 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS3CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370013-00,Standard Silver Off Exchange Plan,,0.69202595949173,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,300","$8,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380025,Unity Elite Silver 30/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380025-04,73% AV Level Silver Plan,,0.739827036857605,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,104
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380025,Unity Elite Silver 30/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380025-05,87% AV Level Silver Plan,,0.879024684429169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,105
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380029,Unity Elite Silver 40/90 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380029-00,Standard Silver Off Exchange Plan,,0.680200815200806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,128
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380029,Unity Elite Silver 40/90 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380029-01,Standard Silver On Exchange Plan,,0.680200815200806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,129
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510015,Unity Elite Silver 30/60,37833WI051,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510015-00,Standard Silver Off Exchange Plan,,0.718933463096619,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,67
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510015,Unity Elite Silver 30/60,37833WI051,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510015-01,Standard Silver On Exchange Plan,,0.718933463096619,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,68
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0170004,"Classic $2,000 - 30%",38166WI017,,WIN001,WIS001,WIF002,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170004-03,Limited Cost Sharing Plan Variation,69.50%,0.691363513469696,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160004,"Reliance $1,500 - 30%",38166WI016,,WIN002,WIS002,WIF003,Existing,EPO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160004-00,Standard Silver Off Exchange Plan,,0.700253307819366,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370014,Unity Prime Silver 20/65 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS2CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370014-04,73% AV Level Silver Plan,,0.739199876785278,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,700","$9,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370014,Unity Prime Silver 20/65 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS2CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370014-05,87% AV Level Silver Plan,,0.878224551677704,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,600","$3,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370013,Unity Prime Silver 35/110 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS3CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370013-05,87% AV Level Silver Plan,,0.877517640590668,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370013,Unity Prime Silver 35/110 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS3CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370013-06,94% AV Level Silver Plan,,0.948969841003418,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380003,Unity Prime Platinum 15/50 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF001,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP2FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380003-00,Standard Platinum Off Exchange Plan,,0.880020797252655,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,600","$3,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380003,Unity Prime Platinum 15/50 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF001,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP2FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380003-01,Standard Platinum On Exchange Plan,,0.880020797252655,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,600","$3,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380016,Unity Prime Silver 20/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380016-00,Standard Silver Off Exchange Plan,,0.707099437713623,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,56
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380016,Unity Prime Silver 20/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380016-01,Standard Silver On Exchange Plan,,0.707099437713623,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,57
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010014,MercyCare PPO CO 80-60 $2000 Deductible; $10/$25/$50 Rx,35334WI001,,WIN001,WIS001,WIF001,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010014-01,Standard Gold On Exchange Plan,79.00%,0.788441300392151,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,750","$17,500",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010015,MercyCare PPO CO 60-40 $2000 Deductible; $20/$40/$60 Rx,35334WI001,,WIN001,WIS001,WIF002,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010015-00,Standard Silver Off Exchange Plan,71.90%,0.718986630439758,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000",Not Applicable,Not Applicable,"$2,000","$4,000",40%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010015,MercyCare PPO CO 60-40 $2000 Deductible; $20/$40/$60 Rx,35334WI001,,WIN001,WIS001,WIF002,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010015-01,Standard Silver On Exchange Plan,71.90%,0.718986630439758,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000",Not Applicable,Not Applicable,"$2,000","$4,000",40%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010016,MercyCare PPO CO 70-50 $2500 Deductible; $20/$40/$60 Rx,35334WI001,,WIN001,WIS001,WIF002,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010016-00,Standard Silver Off Exchange Plan,71.60%,0.715973556041718,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380012,Unity Prime Silver 25/85 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS1FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380012-00,Standard Silver Off Exchange Plan,,0.715900540351868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550","$13,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300","$4,600",45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380012,Unity Prime Silver 25/85 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS1FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380012-01,Standard Silver On Exchange Plan,,0.715900540351868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550","$13,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300","$4,600",45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380012,Unity Prime Silver 25/85 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS1FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380012-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380012,Unity Prime Silver 25/85 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS1FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380012-03,Limited Cost Sharing Plan Variation,,0.715900540351868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550","$13,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300","$4,600",45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160009,"Reliance $4,000 - 20% HDHP",38166WI016,,WIN002,WIS002,WIF003,Existing,EPO,Bronze,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160009-01,Standard Bronze On Exchange Plan,,0.614021420478821,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0180002,"Select $3,000 HDHP",38166WI018,,WIN002,WIS002,WIF006,Existing,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180002-06,94% AV Level Silver Plan,94.49%,0.944938838481903,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,WI,35334,HIOS,3,2014-09-04 03:25:43,1,35334,WI,SHOP (Small Group),No,39-1768192,35334WI0010016,MercyCare PPO CO 70-50 $2500 Deductible; $20/$40/$60 Rx,35334WI001,,WIN001,WIS001,WIF002,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,Yes,"Providers in HealthEOS, Multiplan or PHCS PPO networks",Yes,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,35334WI0010016-01,Standard Silver On Exchange Plan,71.60%,0.715973556041718,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370004,Unity Prime Platinum 15/50 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF001,Existing,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP2CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370004-00,Standard Platinum Off Exchange Plan,,0.880020797252655,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,600","$3,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370004,Unity Prime Platinum 15/50 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF001,Existing,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP2CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370004-01,Standard Platinum On Exchange Plan,,0.880020797252655,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,600","$3,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370004,Unity Prime Platinum 15/50 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF001,Existing,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP2CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370004,Unity Prime Platinum 15/50 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF001,Existing,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP2CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370004-03,Limited Cost Sharing Plan Variation,,0.880020797252655,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,600","$3,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370011,Unity Prime Gold 15/55 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG1CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370011-00,Standard Gold Off Exchange Plan,,0.818845570087433,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370011,Unity Prime Gold 15/55 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG1CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370011-01,Standard Gold On Exchange Plan,,0.818845570087433,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370011,Unity Prime Gold 15/55 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG1CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370011-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370011,Unity Prime Gold 15/55 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG1CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370011-03,Limited Cost Sharing Plan Variation,,0.818845570087433,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370009,Unity Prime Gold 20/70 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG2CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370009-00,Standard Gold Off Exchange Plan,,0.780307173728943,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370009,Unity Prime Gold 20/70 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG2CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370009-01,Standard Gold On Exchange Plan,,0.780307173728943,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370009,Unity Prime Gold 20/70 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG2CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370009-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370009,Unity Prime Gold 20/70 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG2CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370009-03,Limited Cost Sharing Plan Variation,,0.780307173728943,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370015,Unity Prime Silver 25/85 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS1CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370015-00,Standard Silver Off Exchange Plan,,0.715900540351868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550","$13,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300","$4,600",45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370015,Unity Prime Silver 25/85 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS1CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370015-01,Standard Silver On Exchange Plan,,0.715900540351868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550","$13,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300","$4,600",45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370015,Unity Prime Silver 25/85 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS1CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370015,Unity Prime Silver 25/85 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS1CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370015-03,Limited Cost Sharing Plan Variation,,0.715900540351868,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550","$13,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300","$4,600",45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370015,Unity Prime Silver 25/85 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS1CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370015-04,73% AV Level Silver Plan,,0.739934623241425,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300","$4,600",45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370015,Unity Prime Silver 25/85 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS1CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370015-05,87% AV Level Silver Plan,,0.878882467746735,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370015,Unity Prime Silver 25/85 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS1CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370015-06,94% AV Level Silver Plan,,0.949481785297394,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370014,Unity Prime Silver 20/65 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS2CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370014-00,Standard Silver Off Exchange Plan,,0.709311366081238,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370014,Unity Prime Silver 20/65 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS2CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370014-01,Standard Silver On Exchange Plan,,0.709311366081238,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380031,Beloit One Platinum 15/30 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380031-01,Standard Platinum On Exchange Plan,,0.883316993713379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,140
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380031,Beloit One Platinum 15/30 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380031-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,141
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510006,Unity Prime Silver 20/60,37833WI051,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510006-04,73% AV Level Silver Plan,,0.739884376525879,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510006,Unity Prime Silver 20/60,37833WI051,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510006-05,87% AV Level Silver Plan,,0.878708362579346,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380045,Unity Elite Silver Maintenance 30/70 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380045-06,94% AV Level Silver Plan,,0.94986492395401,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$675,"$1,350",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510030,Unity Prime Silver Maintenance 20/60,37833WI051,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510030-00,Standard Silver Off Exchange Plan,,0.714370906352997,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$925,"$1,850",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0170007,"Classic $5,500 HDHP",38166WI017,,WIN001,WIS001,WIF003,Existing,HMO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170007-03,Limited Cost Sharing Plan Variation,59.46%,0.594647645950317,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160006,"Reliance $1,500 - 20% HDHP",38166WI016,,WIN002,WIS002,WIF004,Existing,EPO,Gold,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160006-00,Standard Gold Off Exchange Plan,,0.797334671020508,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160006,"Reliance $1,500 - 20% HDHP",38166WI016,,WIN002,WIS002,WIF004,Existing,EPO,Gold,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160006-01,Standard Gold On Exchange Plan,,0.797334671020508,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0180002,"Select $3,000 HDHP",38166WI018,,WIN002,WIS002,WIF006,Existing,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180002-00,Standard Silver Off Exchange Plan,71.70%,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0180002,"Select $3,000 HDHP",38166WI018,,WIN002,WIS002,WIF006,Existing,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180002-01,Standard Silver On Exchange Plan,71.70%,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160007,"Reliance $1,750 - 20% HDHP",38166WI016,,WIN002,WIS002,WIF003,Existing,EPO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160007-00,Standard Silver Off Exchange Plan,,0.686293601989746,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370013,Unity Prime Silver 35/110 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS3CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370013-01,Standard Silver On Exchange Plan,,0.69202595949173,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,300","$8,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,1,37833,WI,Individual,No,39-1450766,37833WI0370013,Unity Prime Silver 35/110 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS3CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370013-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380003,Unity Prime Platinum 15/50 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF001,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP2FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380003,Unity Prime Platinum 15/50 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF001,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP2FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380003-03,Limited Cost Sharing Plan Variation,,0.880020797252655,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,600","$3,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380007,Unity Prime Gold 15/55 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG1FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380007-00,Standard Gold Off Exchange Plan,,0.818845570087433,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380007,Unity Prime Gold 15/55 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG1FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380007-01,Standard Gold On Exchange Plan,,0.818845570087433,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380007,Unity Prime Gold 15/55 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG1FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380007,Unity Prime Gold 15/55 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG1FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380007-03,Limited Cost Sharing Plan Variation,,0.818845570087433,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380008,Unity Prime Gold 20/70 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG2FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380008-00,Standard Gold Off Exchange Plan,,0.780307173728943,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380008,Unity Prime Gold 20/70 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG2FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380008-01,Standard Gold On Exchange Plan,,0.780307173728943,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380008,Unity Prime Gold 20/70 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG2FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380008,Unity Prime Gold 20/70 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG2FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380008-03,Limited Cost Sharing Plan Variation,,0.780307173728943,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380012,Unity Prime Silver 25/85 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS1FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380012-06,94% AV Level Silver Plan,,0.949481785297394,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380013,Unity Prime Silver 20/65 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS2FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380013-00,Standard Silver Off Exchange Plan,,0.709311366081238,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380013,Unity Prime Silver 20/65 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS2FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380013-01,Standard Silver On Exchange Plan,,0.709311366081238,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380013,Unity Prime Silver 20/65 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS2FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380013-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380013,Unity Prime Silver 20/65 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS2FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380013-03,Limited Cost Sharing Plan Variation,,0.709311366081238,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380013,Unity Prime Silver 20/65 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS2FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380013-04,73% AV Level Silver Plan,,0.739199876785278,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,700","$9,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380013,Unity Prime Silver 20/65 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS2FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380013-05,87% AV Level Silver Plan,,0.878224551677704,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,600","$3,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380013,Unity Prime Silver 20/65 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS2FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380013-06,94% AV Level Silver Plan,,0.94780308008194,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380014,Unity Prime Silver 35/110 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS3FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380014-00,Standard Silver Off Exchange Plan,,0.69202595949173,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,300","$8,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380014,Unity Prime Silver 35/110 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS3FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380014-01,Standard Silver On Exchange Plan,,0.69202595949173,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,300","$8,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380014,Unity Prime Silver 35/110 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS3FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380014,Unity Prime Silver 35/110 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS3FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380014-03,Limited Cost Sharing Plan Variation,,0.69202595949173,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,300","$8,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380014,Unity Prime Silver 35/110 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS3FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380014-04,73% AV Level Silver Plan,,0.734951317310333,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,800","$5,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380014,Unity Prime Silver 35/110 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS3FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380014-05,87% AV Level Silver Plan,,0.877517640590668,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380014,Unity Prime Silver 35/110 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS3FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380014-06,94% AV Level Silver Plan,,0.948969841003418,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380005,Unity Prime Platinum 15/30 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380005-00,Standard Platinum Off Exchange Plan,,0.883316993713379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380005,Unity Prime Platinum 15/30 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380005-01,Standard Platinum On Exchange Plan,,0.883316993713379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380005,Unity Prime Platinum 15/30 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380005,Unity Prime Platinum 15/30 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380005-03,Limited Cost Sharing Plan Variation,,0.883316993713379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380009,Unity Prime Gold 30/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380009-00,Standard Gold Off Exchange Plan,,0.798056602478027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380009,Unity Prime Gold 30/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380009-01,Standard Gold On Exchange Plan,,0.798056602478027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380009,Unity Prime Gold 30/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380009-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380009,Unity Prime Gold 30/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380009-03,Limited Cost Sharing Plan Variation,,0.798056602478027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380010,Unity Prime Gold 20/40 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380010-00,Standard Gold Off Exchange Plan,,0.78011167049408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380010,Unity Prime Gold 20/40 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380010-01,Standard Gold On Exchange Plan,,0.78011167049408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380010,Unity Prime Gold 20/40 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,47
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380010,Unity Prime Gold 20/40 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380010-03,Limited Cost Sharing Plan Variation,,0.78011167049408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380015,Unity Prime Silver 30/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380015-00,Standard Silver Off Exchange Plan,,0.718933463096619,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,49
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380015,Unity Prime Silver 30/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380015-01,Standard Silver On Exchange Plan,,0.718933463096619,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,50
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380015,Unity Prime Silver 30/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,51
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380015,Unity Prime Silver 30/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380015-03,Limited Cost Sharing Plan Variation,,0.718933463096619,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,52
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380015,Unity Prime Silver 30/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380015-04,73% AV Level Silver Plan,,0.739827036857605,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,53
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380015,Unity Prime Silver 30/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380015-05,87% AV Level Silver Plan,,0.879024684429169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,54
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380015,Unity Prime Silver 30/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380015-06,94% AV Level Silver Plan,,0.948155105113983,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,55
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380016,Unity Prime Silver 20/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380016-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,58
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380016,Unity Prime Silver 20/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380016-03,Limited Cost Sharing Plan Variation,,0.707099437713623,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,59
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380016,Unity Prime Silver 20/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380016-04,73% AV Level Silver Plan,,0.739884376525879,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,60
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380016,Unity Prime Silver 20/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380016-05,87% AV Level Silver Plan,,0.878708362579346,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,61
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380016,Unity Prime Silver 20/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380016-06,94% AV Level Silver Plan,,0.949733018875122,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$525,"$1,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,62
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380017,Unity Prime Silver 40/75 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380017-00,Standard Silver Off Exchange Plan,,0.696292221546173,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,300","$8,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,63
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380017,Unity Prime Silver 40/75 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380017-01,Standard Silver On Exchange Plan,,0.696292221546173,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,300","$8,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,64
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380017,Unity Prime Silver 40/75 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380017-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,65
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380017,Unity Prime Silver 40/75 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380017-03,Limited Cost Sharing Plan Variation,,0.696292221546173,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,300","$8,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,66
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380017,Unity Prime Silver 40/75 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380017-04,73% AV Level Silver Plan,,0.7389315366745,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,67
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380017,Unity Prime Silver 40/75 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380017-05,87% AV Level Silver Plan,,0.878599882125854,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$700,"$1,400",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,68
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380017,Unity Prime Silver 40/75 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380017-06,94% AV Level Silver Plan,,0.949953615665436,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$525,"$1,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,69
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380018,Unity Prime Silver 25/50 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380018-00,Standard Silver Off Exchange Plan,,0.712002038955688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,70
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380018,Unity Prime Silver 25/50 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380018-01,Standard Silver On Exchange Plan,,0.712002038955688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,71
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380018,Unity Prime Silver 25/50 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380018-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,72
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380018,Unity Prime Silver 25/50 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380018-03,Limited Cost Sharing Plan Variation,,0.712002038955688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,73
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380018,Unity Prime Silver 25/50 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380018-04,73% AV Level Silver Plan,,0.739226698875427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,600","$5,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,74
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380018,Unity Prime Silver 25/50 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380018-05,87% AV Level Silver Plan,,0.879670321941376,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,75
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380018,Unity Prime Silver 25/50 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380018-06,94% AV Level Silver Plan,,0.94948011636734,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,76
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380019,Unity Prime Silver 40/90 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380019-00,Standard Silver Off Exchange Plan,,0.680200815200806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,77
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380019,Unity Prime Silver 40/90 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380019-01,Standard Silver On Exchange Plan,,0.680200815200806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,78
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380019,Unity Prime Silver 40/90 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380019-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,79
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380019,Unity Prime Silver 40/90 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380019-03,Limited Cost Sharing Plan Variation,,0.680200815200806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,80
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380019,Unity Prime Silver 40/90 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380019-04,73% AV Level Silver Plan,,0.739249706268311,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,81
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380019,Unity Prime Silver 40/90 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380019-05,87% AV Level Silver Plan,,0.879130303859711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,82
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380019,Unity Prime Silver 40/90 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380019-06,94% AV Level Silver Plan,,0.949833750724792,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,83
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380020,Unity Prime Bronze 55/150 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380020-00,Standard Bronze Off Exchange Plan,,0.619748115539551,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,600","$11,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,84
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380020,Unity Prime Bronze 55/150 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380020-01,Standard Bronze On Exchange Plan,,0.619748115539551,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,600","$11,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,85
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380020,Unity Prime Bronze 55/150 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380020-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,86
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380020,Unity Prime Bronze 55/150 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380020-03,Limited Cost Sharing Plan Variation,,0.619748115539551,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,600","$11,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,87
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380021,Unity Elite Platinum 15/30 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380021-00,Standard Platinum Off Exchange Plan,,0.883316993713379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,88
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380021,Unity Elite Platinum 15/30 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380021-01,Standard Platinum On Exchange Plan,,0.883316993713379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,89
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380021,Unity Elite Platinum 15/30 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380021-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,90
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380021,Unity Elite Platinum 15/30 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380021-03,Limited Cost Sharing Plan Variation,,0.883316993713379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,91
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380023,Unity Elite Gold 30/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380023-00,Standard Gold Off Exchange Plan,,0.798056602478027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,92
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380023,Unity Elite Gold 30/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380023-01,Standard Gold On Exchange Plan,,0.798056602478027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,93
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380023,Unity Elite Gold 30/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380023-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,94
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380023,Unity Elite Gold 30/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380023-03,Limited Cost Sharing Plan Variation,,0.798056602478027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,95
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380024,Unity Elite Gold 20/40 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380024-00,Standard Gold Off Exchange Plan,,0.78011167049408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,96
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380024,Unity Elite Gold 20/40 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380024-01,Standard Gold On Exchange Plan,,0.78011167049408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,97
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380024,Unity Elite Gold 20/40 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380024-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,98
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380024,Unity Elite Gold 20/40 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380024-03,Limited Cost Sharing Plan Variation,,0.78011167049408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,99
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380025,Unity Elite Silver 30/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380025-00,Standard Silver Off Exchange Plan,,0.718933463096619,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,100
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380025,Unity Elite Silver 30/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380025-01,Standard Silver On Exchange Plan,,0.718933463096619,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,101
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380025,Unity Elite Silver 30/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380025-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,102
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380025,Unity Elite Silver 30/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380025-03,Limited Cost Sharing Plan Variation,,0.718933463096619,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,103
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,4,37833,WI,Individual,No,39-1450766,37833WI0520002,Unity Prime Silver Deductible Child Dental,37833WI052,7114920342,WIN001,WIS001,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0520002-01,Standard Silver On Exchange Plan,,0.680290997028351,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,4,37833,WI,Individual,No,39-1450766,37833WI0520002,Unity Prime Silver Deductible Child Dental,37833WI052,7114920342,WIN001,WIS001,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0520002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150003,"Independence - $1,000 - 40%",38166WI015,,WIN001,WIS001,WIF003,Existing,POS,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150003-01,Standard Silver On Exchange Plan,,0.702124893665314,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$7,750","$15,500","$13,750","$27,500","$1,000","$2,000",40%,,,,"$1,500","$3,000","$2,500","$5,000",$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0180001,"Select $1,000 - 20%",38166WI018,,WIN002,WIS002,WIF001,Existing,EPO,Gold,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180001-03,Limited Cost Sharing Plan Variation,80.70%,0.797870516777039,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0180003,"Select $1,800 - 20%",38166WI018,,WIN002,WIS002,WIF002,Existing,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180003-00,Standard Silver Off Exchange Plan,71.50%,0.713086247444153,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,800","$3,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150004,"Independence - $1,500 - 30%",38166WI015,,WIN001,WIS001,WIF003,Existing,POS,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150004-00,Standard Silver Off Exchange Plan,,0.700253307819366,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,250","$20,500","$16,250","$32,500","$1,500","$3,000",30%,,,,"$2,250","$4,500","$3,750","$7,500",$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150004,"Independence - $1,500 - 30%",38166WI015,,WIN001,WIS001,WIF003,Existing,POS,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150004-01,Standard Silver On Exchange Plan,,0.700253307819366,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,250","$20,500","$16,250","$32,500","$1,500","$3,000",30%,,,,"$2,250","$4,500","$3,750","$7,500",$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0180003,"Select $1,800 - 20%",38166WI018,,WIN002,WIS002,WIF002,Existing,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180003-01,Standard Silver On Exchange Plan,71.50%,0.713086247444153,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,800","$3,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0180002,"Select $3,000 HDHP",38166WI018,,WIN002,WIS002,WIF006,Existing,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180002-03,Limited Cost Sharing Plan Variation,71.70%,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160008,"Reliance $2,000 - 10% HDHP",38166WI016,,WIN002,WIS002,WIF003,Existing,EPO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160008-00,Standard Silver Off Exchange Plan,,0.691667020320892,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0180005,"Select $5,000 HDHP",38166WI018,,WIN002,WIS002,WIF003,Existing,EPO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180005-00,Standard Bronze Off Exchange Plan,60.48%,0.604778349399567,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,26
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160010,"Reliance $3,350 - 40% HDHP",38166WI016,,WIN002,WIS002,WIF003,Existing,EPO,Bronze,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160010-00,Standard Bronze Off Exchange Plan,,0.613374412059784,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,350","$6,700",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,26
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160010,"Reliance $3,350 - 40% HDHP",38166WI016,,WIN002,WIS002,WIF003,Existing,EPO,Bronze,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160010-01,Standard Bronze On Exchange Plan,,0.613374412059784,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,350","$6,700",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,27
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0180005,"Select $5,000 HDHP",38166WI018,,WIN002,WIS002,WIF003,Existing,EPO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180005-01,Standard Bronze On Exchange Plan,60.48%,0.604778349399567,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,27
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380025,Unity Elite Silver 30/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380025-06,94% AV Level Silver Plan,,0.948155105113983,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,106
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380026,Unity Elite Silver 20/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380026-00,Standard Silver Off Exchange Plan,,0.707099437713623,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,107
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380026,Unity Elite Silver 20/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380026-03,Limited Cost Sharing Plan Variation,,0.707099437713623,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,110
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380026,Unity Elite Silver 20/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380026-04,73% AV Level Silver Plan,,0.739884376525879,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,111
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380026,Unity Elite Silver 20/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380026-05,87% AV Level Silver Plan,,0.878708362579346,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,112
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380026,Unity Elite Silver 20/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380026-06,94% AV Level Silver Plan,,0.949733018875122,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$525,"$1,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,113
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380027,Unity Elite Silver 40/75 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380027-00,Standard Silver Off Exchange Plan,,0.696292221546173,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,300","$8,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,114
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380027,Unity Elite Silver 40/75 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380027-01,Standard Silver On Exchange Plan,,0.696292221546173,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,300","$8,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,115
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380027,Unity Elite Silver 40/75 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380027-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,116
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380027,Unity Elite Silver 40/75 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380027-03,Limited Cost Sharing Plan Variation,,0.696292221546173,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,300","$8,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,117
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380027,Unity Elite Silver 40/75 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380027-04,73% AV Level Silver Plan,,0.7389315366745,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,118
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380027,Unity Elite Silver 40/75 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380027-05,87% AV Level Silver Plan,,0.878599882125854,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$700,"$1,400",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,119
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380027,Unity Elite Silver 40/75 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380027-06,94% AV Level Silver Plan,,0.949953615665436,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$525,"$1,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,120
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380028,Unity Elite Silver 25/50 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380028-00,Standard Silver Off Exchange Plan,,0.712002038955688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,121
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380028,Unity Elite Silver 25/50 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380028-01,Standard Silver On Exchange Plan,,0.712002038955688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,122
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380028,Unity Elite Silver 25/50 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380028-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,123
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380028,Unity Elite Silver 25/50 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380028-03,Limited Cost Sharing Plan Variation,,0.712002038955688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,124
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380028,Unity Elite Silver 25/50 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380028-04,73% AV Level Silver Plan,,0.739226698875427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,600","$5,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,125
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380028,Unity Elite Silver 25/50 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380028-05,87% AV Level Silver Plan,,0.879670321941376,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,126
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380028,Unity Elite Silver 25/50 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380028-06,94% AV Level Silver Plan,,0.94948011636734,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,127
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380029,Unity Elite Silver 40/90 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380029-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,130
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380029,Unity Elite Silver 40/90 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380029-03,Limited Cost Sharing Plan Variation,,0.680200815200806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,131
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380029,Unity Elite Silver 40/90 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380029-04,73% AV Level Silver Plan,,0.739249706268311,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,132
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380029,Unity Elite Silver 40/90 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380029-05,87% AV Level Silver Plan,,0.879130303859711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,133
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380029,Unity Elite Silver 40/90 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380029-06,94% AV Level Silver Plan,,0.949833750724792,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,134
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380030,Unity Elite Bronze 55/150 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380030-00,Standard Bronze Off Exchange Plan,,0.619748115539551,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,600","$11,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,135
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380030,Unity Elite Bronze 55/150 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380030-01,Standard Bronze On Exchange Plan,,0.619748115539551,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,600","$11,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,136
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380030,Unity Elite Bronze 55/150 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380030-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,137
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380030,Unity Elite Bronze 55/150 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380030-03,Limited Cost Sharing Plan Variation,,0.619748115539551,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,600","$11,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,138
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380031,Beloit One Platinum 15/30 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380031-00,Standard Platinum Off Exchange Plan,,0.883316993713379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,139
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380031,Beloit One Platinum 15/30 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380031-03,Limited Cost Sharing Plan Variation,,0.883316993713379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,142
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380032,Beloit One Gold 30/60 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380032-00,Standard Gold Off Exchange Plan,,0.798056602478027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,143
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380032,Beloit One Gold 30/60 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380032-01,Standard Gold On Exchange Plan,,0.798056602478027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,144
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380032,Beloit One Gold 30/60 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380032-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,145
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380032,Beloit One Gold 30/60 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380032-03,Limited Cost Sharing Plan Variation,,0.798056602478027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,146
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380033,Beloit One Silver 20/60 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380033-00,Standard Silver Off Exchange Plan,,0.707099437713623,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,147
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380033,Beloit One Silver 20/60 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380033-01,Standard Silver On Exchange Plan,,0.707099437713623,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,148
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380033,Beloit One Silver 20/60 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380033-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,149
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380033,Beloit One Silver 20/60 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380033-03,Limited Cost Sharing Plan Variation,,0.707099437713623,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,150
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380033,Beloit One Silver 20/60 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380033-04,73% AV Level Silver Plan,,0.739884376525879,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,151
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380033,Beloit One Silver 20/60 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380033-05,87% AV Level Silver Plan,,0.878708362579346,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,152
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380033,Beloit One Silver 20/60 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380033-06,94% AV Level Silver Plan,,0.949733018875122,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$525,"$1,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,153
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380035,Beloit One Silver 40/90 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380035-00,Standard Silver Off Exchange Plan,,0.680200815200806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,154
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380035,Beloit One Silver 40/90 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380035-01,Standard Silver On Exchange Plan,,0.680200815200806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,155
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380035,Beloit One Silver 40/90 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380035-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,156
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380035,Beloit One Silver 40/90 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380035-03,Limited Cost Sharing Plan Variation,,0.680200815200806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,157
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380035,Beloit One Silver 40/90 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380035-04,73% AV Level Silver Plan,,0.739249706268311,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,158
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380035,Beloit One Silver 40/90 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380035-05,87% AV Level Silver Plan,,0.879130303859711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,159
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380035,Beloit One Silver 40/90 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380035-06,94% AV Level Silver Plan,,0.949833750724792,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,160
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380036,Beloit One Bronze 55/150 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380036-00,Standard Bronze Off Exchange Plan,,0.619748115539551,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,600","$11,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,161
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510033,Unity Elite Silver Maintenance 30/70,37833WI051,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510033-04,73% AV Level Silver Plan,,0.73957097530365,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510033,Unity Elite Silver Maintenance 30/70,37833WI051,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510033-05,87% AV Level Silver Plan,,0.879691183567047,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0170003,"Classic $1,800 - 20%",38166WI017,,WIN001,WIS001,WIF002,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170003-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140007,"Tradition $1,500 - 30%",38166WI014,,WIN001,WIS001,WIF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140007-00,Standard Silver Off Exchange Plan,,0.700253307819366,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140007,"Tradition $1,500 - 30%",38166WI014,,WIN001,WIS001,WIF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140007-01,Standard Silver On Exchange Plan,,0.700253307819366,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0170003,"Classic $1,800 - 20%",38166WI017,,WIN001,WIS001,WIF002,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170003-03,Limited Cost Sharing Plan Variation,71.50%,0.713086247444153,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,800","$3,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0170003,"Classic $1,800 - 20%",38166WI017,,WIN001,WIS001,WIF002,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170003-04,73% AV Level Silver Plan,73.92%,0.73924720287323,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160001,Reliance $500 - 10%,38166WI016,,WIN002,WIS002,WIF007,Existing,EPO,Platinum,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160001-00,Standard Platinum Off Exchange Plan,,0.896489024162292,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0180004,"Select $2,000 - 30%",38166WI018,,WIN002,WIS002,WIF002,Existing,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180004-05,87% AV Level Silver Plan,87.88%,0.878813982009888,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0180004,"Select $2,000 - 30%",38166WI018,,WIN002,WIS002,WIF002,Existing,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180004-06,94% AV Level Silver Plan,93.32%,0.933220684528351,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0170002,"Classic $3,000 HDHP",38166WI017,,WIN001,WIS001,WIF006,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170002-00,Standard Silver Off Exchange Plan,71.70%,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140002,"Tradition $2,000 - HDHP",38166WI014,,WIN001,WIS001,WIF006,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140002-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140002,"Tradition $2,000 - HDHP",38166WI014,,WIN001,WIS001,WIF006,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140002-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0170002,"Classic $3,000 HDHP",38166WI017,,WIN001,WIS001,WIF006,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170002-01,Standard Silver On Exchange Plan,71.70%,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380036,Beloit One Bronze 55/150 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380036-01,Standard Bronze On Exchange Plan,,0.619748115539551,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,600","$11,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,162
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380036,Beloit One Bronze 55/150 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380036-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,163
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,2,37833,WI,Individual,No,39-1450766,37833WI0380036,Beloit One Bronze 55/150 Family Dental,37833WI038,7114920342,WIN003,WIS003,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2D,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0380036-03,Limited Cost Sharing Plan Variation,,0.619748115539551,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,600","$11,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,164
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510001,Unity Prime Platinum 15/30,37833WI051,7114920342,WIN001,WIS001,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510001-00,Standard Platinum Off Exchange Plan,,0.883316993713379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510001,Unity Prime Platinum 15/30,37833WI051,7114920342,WIN001,WIS001,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510001-01,Standard Platinum On Exchange Plan,,0.883316993713379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510001,Unity Prime Platinum 15/30,37833WI051,7114920342,WIN001,WIS001,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510001,Unity Prime Platinum 15/30,37833WI051,7114920342,WIN001,WIS001,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510001-03,Limited Cost Sharing Plan Variation,,0.883316993713379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510003,Unity Prime Gold 30/60,37833WI051,7114920342,WIN001,WIS001,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510003-00,Standard Gold Off Exchange Plan,,0.798056602478027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510003,Unity Prime Gold 30/60,37833WI051,7114920342,WIN001,WIS001,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510003-01,Standard Gold On Exchange Plan,,0.798056602478027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510003,Unity Prime Gold 30/60,37833WI051,7114920342,WIN001,WIS001,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510003,Unity Prime Gold 30/60,37833WI051,7114920342,WIN001,WIS001,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510003-03,Limited Cost Sharing Plan Variation,,0.798056602478027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510004,Unity Prime Gold 20/40,37833WI051,7114920342,WIN001,WIS001,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510004-00,Standard Gold Off Exchange Plan,,0.78011167049408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510004,Unity Prime Gold 20/40,37833WI051,7114920342,WIN001,WIS001,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510004-01,Standard Gold On Exchange Plan,,0.78011167049408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510004,Unity Prime Gold 20/40,37833WI051,7114920342,WIN001,WIS001,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510004,Unity Prime Gold 20/40,37833WI051,7114920342,WIN001,WIS001,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510004-03,Limited Cost Sharing Plan Variation,,0.78011167049408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510005,Unity Prime Silver 30/60,37833WI051,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510005-00,Standard Silver Off Exchange Plan,,0.718933463096619,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510005,Unity Prime Silver 30/60,37833WI051,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510005-01,Standard Silver On Exchange Plan,,0.718933463096619,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510005,Unity Prime Silver 30/60,37833WI051,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510005,Unity Prime Silver 30/60,37833WI051,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510005-03,Limited Cost Sharing Plan Variation,,0.718933463096619,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510005,Unity Prime Silver 30/60,37833WI051,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510005-04,73% AV Level Silver Plan,,0.739827036857605,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510005,Unity Prime Silver 30/60,37833WI051,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510005-05,87% AV Level Silver Plan,,0.879024684429169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510005,Unity Prime Silver 30/60,37833WI051,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510005-06,94% AV Level Silver Plan,,0.948155105113983,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510006,Unity Prime Silver 20/60,37833WI051,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510006-00,Standard Silver Off Exchange Plan,,0.707099437713623,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510006,Unity Prime Silver 20/60,37833WI051,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510006-01,Standard Silver On Exchange Plan,,0.707099437713623,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510006,Unity Prime Silver 20/60,37833WI051,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510006,Unity Prime Silver 20/60,37833WI051,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510006-03,Limited Cost Sharing Plan Variation,,0.707099437713623,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510006,Unity Prime Silver 20/60,37833WI051,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510006-06,94% AV Level Silver Plan,,0.949733018875122,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$525,"$1,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510007,Unity Prime Silver 40/75,37833WI051,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510007-00,Standard Silver Off Exchange Plan,,0.696292221546173,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,300","$8,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510007,Unity Prime Silver 40/75,37833WI051,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510007-01,Standard Silver On Exchange Plan,,0.696292221546173,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,300","$8,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510007,Unity Prime Silver 40/75,37833WI051,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510007,Unity Prime Silver 40/75,37833WI051,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510007-03,Limited Cost Sharing Plan Variation,,0.696292221546173,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,300","$8,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510007,Unity Prime Silver 40/75,37833WI051,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510007-04,73% AV Level Silver Plan,,0.7389315366745,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510007,Unity Prime Silver 40/75,37833WI051,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510007-05,87% AV Level Silver Plan,,0.878599882125854,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$700,"$1,400",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510007,Unity Prime Silver 40/75,37833WI051,7114920342,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510007-06,94% AV Level Silver Plan,,0.949953615665436,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$525,"$1,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510008,Unity Prime Silver 25/50,37833WI051,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510008-00,Standard Silver Off Exchange Plan,,0.712002038955688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510008,Unity Prime Silver 25/50,37833WI051,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510008-01,Standard Silver On Exchange Plan,,0.712002038955688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510008,Unity Prime Silver 25/50,37833WI051,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510008,Unity Prime Silver 25/50,37833WI051,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510008-03,Limited Cost Sharing Plan Variation,,0.712002038955688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510008,Unity Prime Silver 25/50,37833WI051,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510008-04,73% AV Level Silver Plan,,0.739226698875427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,600","$5,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510008,Unity Prime Silver 25/50,37833WI051,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510008-05,87% AV Level Silver Plan,,0.879670321941376,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510008,Unity Prime Silver 25/50,37833WI051,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510008-06,94% AV Level Silver Plan,,0.94948011636734,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510009,Unity Prime Silver 40/90,37833WI051,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510009-00,Standard Silver Off Exchange Plan,,0.680200815200806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510009,Unity Prime Silver 40/90,37833WI051,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510009-01,Standard Silver On Exchange Plan,,0.680200815200806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510009,Unity Prime Silver 40/90,37833WI051,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510009-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510009,Unity Prime Silver 40/90,37833WI051,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510009-03,Limited Cost Sharing Plan Variation,,0.680200815200806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,47
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510009,Unity Prime Silver 40/90,37833WI051,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510009-04,73% AV Level Silver Plan,,0.739249706268311,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510009,Unity Prime Silver 40/90,37833WI051,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510009-05,87% AV Level Silver Plan,,0.879130303859711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,49
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510009,Unity Prime Silver 40/90,37833WI051,7114920342,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510009-06,94% AV Level Silver Plan,,0.949833750724792,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,50
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510010,Unity Prime Bronze 55/150,37833WI051,7114920342,WIN001,WIS001,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510010-00,Standard Bronze Off Exchange Plan,,0.619748115539551,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,600","$11,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,51
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510010,Unity Prime Bronze 55/150,37833WI051,7114920342,WIN001,WIS001,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510010-01,Standard Bronze On Exchange Plan,,0.619748115539551,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,600","$11,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,52
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510010,Unity Prime Bronze 55/150,37833WI051,7114920342,WIN001,WIS001,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,53
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510010,Unity Prime Bronze 55/150,37833WI051,7114920342,WIN001,WIS001,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510010-03,Limited Cost Sharing Plan Variation,,0.619748115539551,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,600","$11,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,54
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510011,Unity Elite Platinum 15/30,37833WI051,7114920342,WIN002,WIS002,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510011-00,Standard Platinum Off Exchange Plan,,0.883316993713379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,55
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510011,Unity Elite Platinum 15/30,37833WI051,7114920342,WIN002,WIS002,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510011-01,Standard Platinum On Exchange Plan,,0.883316993713379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,56
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510011,Unity Elite Platinum 15/30,37833WI051,7114920342,WIN002,WIS002,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510011-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,57
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510011,Unity Elite Platinum 15/30,37833WI051,7114920342,WIN002,WIS002,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510011-03,Limited Cost Sharing Plan Variation,,0.883316993713379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,58
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510013,Unity Elite Gold 30/60,37833WI051,7114920342,WIN002,WIS002,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510013-00,Standard Gold Off Exchange Plan,,0.798056602478027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,59
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510013,Unity Elite Gold 30/60,37833WI051,7114920342,WIN002,WIS002,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510013-01,Standard Gold On Exchange Plan,,0.798056602478027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,60
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510013,Unity Elite Gold 30/60,37833WI051,7114920342,WIN002,WIS002,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510013-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,61
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510013,Unity Elite Gold 30/60,37833WI051,7114920342,WIN002,WIS002,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510013-03,Limited Cost Sharing Plan Variation,,0.798056602478027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,62
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510014,Unity Elite Gold 20/40,37833WI051,7114920342,WIN002,WIS002,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510014-00,Standard Gold Off Exchange Plan,,0.78011167049408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,63
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510014,Unity Elite Gold 20/40,37833WI051,7114920342,WIN002,WIS002,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510014-01,Standard Gold On Exchange Plan,,0.78011167049408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,64
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510014,Unity Elite Gold 20/40,37833WI051,7114920342,WIN002,WIS002,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,65
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510014,Unity Elite Gold 20/40,37833WI051,7114920342,WIN002,WIS002,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510014-03,Limited Cost Sharing Plan Variation,,0.78011167049408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,66
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510015,Unity Elite Silver 30/60,37833WI051,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,69
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510015,Unity Elite Silver 30/60,37833WI051,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510015-03,Limited Cost Sharing Plan Variation,,0.718933463096619,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,70
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510015,Unity Elite Silver 30/60,37833WI051,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510015-04,73% AV Level Silver Plan,,0.739827036857605,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,71
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510015,Unity Elite Silver 30/60,37833WI051,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510015-05,87% AV Level Silver Plan,,0.879024684429169,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,72
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510015,Unity Elite Silver 30/60,37833WI051,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS7,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510015-06,94% AV Level Silver Plan,,0.948155105113983,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,73
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510016,Unity Elite Silver 20/60,37833WI051,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510016-00,Standard Silver Off Exchange Plan,,0.707099437713623,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,74
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510016,Unity Elite Silver 20/60,37833WI051,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510016-01,Standard Silver On Exchange Plan,,0.707099437713623,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,75
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510016,Unity Elite Silver 20/60,37833WI051,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510016-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,76
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510016,Unity Elite Silver 20/60,37833WI051,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510016-03,Limited Cost Sharing Plan Variation,,0.707099437713623,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,77
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510016,Unity Elite Silver 20/60,37833WI051,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510016-04,73% AV Level Silver Plan,,0.739884376525879,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,78
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510016,Unity Elite Silver 20/60,37833WI051,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510016-05,87% AV Level Silver Plan,,0.878708362579346,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,79
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510016,Unity Elite Silver 20/60,37833WI051,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510016-06,94% AV Level Silver Plan,,0.949733018875122,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$525,"$1,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,80
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510017,Unity Elite Silver 40/75,37833WI051,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510017-00,Standard Silver Off Exchange Plan,,0.696292221546173,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,300","$8,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,81
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510017,Unity Elite Silver 40/75,37833WI051,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510017-01,Standard Silver On Exchange Plan,,0.696292221546173,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,300","$8,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,82
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510017,Unity Elite Silver 40/75,37833WI051,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510017-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,83
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510017,Unity Elite Silver 40/75,37833WI051,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510017-03,Limited Cost Sharing Plan Variation,,0.696292221546173,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,300","$8,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,84
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510017,Unity Elite Silver 40/75,37833WI051,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510017-04,73% AV Level Silver Plan,,0.7389315366745,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,85
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510017,Unity Elite Silver 40/75,37833WI051,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510017-05,87% AV Level Silver Plan,,0.878599882125854,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$700,"$1,400",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,86
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510017,Unity Elite Silver 40/75,37833WI051,7114920342,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS9,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510017-06,94% AV Level Silver Plan,,0.949953615665436,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$525,"$1,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,87
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510018,Unity Elite Silver 25/50,37833WI051,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510018-00,Standard Silver Off Exchange Plan,,0.712002038955688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,88
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510018,Unity Elite Silver 25/50,37833WI051,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510018-01,Standard Silver On Exchange Plan,,0.712002038955688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,89
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510018,Unity Elite Silver 25/50,37833WI051,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510018-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,90
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510018,Unity Elite Silver 25/50,37833WI051,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510018-03,Limited Cost Sharing Plan Variation,,0.712002038955688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,91
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510018,Unity Elite Silver 25/50,37833WI051,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510018-04,73% AV Level Silver Plan,,0.739226698875427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,600","$5,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,92
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510018,Unity Elite Silver 25/50,37833WI051,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510018-05,87% AV Level Silver Plan,,0.879670321941376,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,93
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510018,Unity Elite Silver 25/50,37833WI051,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS10,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510018-06,94% AV Level Silver Plan,,0.94948011636734,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,94
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510019,Unity Elite Silver 40/90,37833WI051,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510019-00,Standard Silver Off Exchange Plan,,0.680200815200806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,95
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510019,Unity Elite Silver 40/90,37833WI051,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510019-01,Standard Silver On Exchange Plan,,0.680200815200806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,96
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510019,Unity Elite Silver 40/90,37833WI051,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510019-04,73% AV Level Silver Plan,,0.739249706268311,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,99
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510019,Unity Elite Silver 40/90,37833WI051,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510019-05,87% AV Level Silver Plan,,0.879130303859711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,100
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510019,Unity Elite Silver 40/90,37833WI051,7114920342,WIN002,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510019-06,94% AV Level Silver Plan,,0.949833750724792,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,101
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510020,Unity Elite Bronze 55/150,37833WI051,7114920342,WIN002,WIS002,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510020-00,Standard Bronze Off Exchange Plan,,0.619748115539551,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,600","$11,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,102
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510020,Unity Elite Bronze 55/150,37833WI051,7114920342,WIN002,WIS002,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510020-01,Standard Bronze On Exchange Plan,,0.619748115539551,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,600","$11,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,103
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510020,Unity Elite Bronze 55/150,37833WI051,7114920342,WIN002,WIS002,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510020-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,104
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510020,Unity Elite Bronze 55/150,37833WI051,7114920342,WIN002,WIS002,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510020-03,Limited Cost Sharing Plan Variation,,0.619748115539551,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,600","$11,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,105
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510021,Beloit One Platinum 15/30,37833WI051,7114920342,WIN003,WIS003,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510021-00,Standard Platinum Off Exchange Plan,,0.883316993713379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,106
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510021,Beloit One Platinum 15/30,37833WI051,7114920342,WIN003,WIS003,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510021-01,Standard Platinum On Exchange Plan,,0.883316993713379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,107
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510021,Beloit One Platinum 15/30,37833WI051,7114920342,WIN003,WIS003,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510021-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,108
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510021,Beloit One Platinum 15/30,37833WI051,7114920342,WIN003,WIS003,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP4,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510021-03,Limited Cost Sharing Plan Variation,,0.883316993713379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,109
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510022,Beloit One Gold 30/60,37833WI051,7114920342,WIN003,WIS003,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510022-00,Standard Gold Off Exchange Plan,,0.798056602478027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,110
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510022,Beloit One Gold 30/60,37833WI051,7114920342,WIN003,WIS003,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510022-01,Standard Gold On Exchange Plan,,0.798056602478027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,111
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510022,Beloit One Gold 30/60,37833WI051,7114920342,WIN003,WIS003,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510022-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,112
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510022,Beloit One Gold 30/60,37833WI051,7114920342,WIN003,WIS003,WIF003,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG4,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510022-03,Limited Cost Sharing Plan Variation,,0.798056602478027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,113
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510023,Beloit One Silver 20/60,37833WI051,7114920342,WIN003,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510023-00,Standard Silver Off Exchange Plan,,0.707099437713623,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,114
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510023,Beloit One Silver 20/60,37833WI051,7114920342,WIN003,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510023-01,Standard Silver On Exchange Plan,,0.707099437713623,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,115
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510023,Beloit One Silver 20/60,37833WI051,7114920342,WIN003,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510023-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,116
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510023,Beloit One Silver 20/60,37833WI051,7114920342,WIN003,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510023-03,Limited Cost Sharing Plan Variation,,0.707099437713623,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,117
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510023,Beloit One Silver 20/60,37833WI051,7114920342,WIN003,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510023-04,73% AV Level Silver Plan,,0.739884376525879,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,118
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510023,Beloit One Silver 20/60,37833WI051,7114920342,WIN003,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510023-05,87% AV Level Silver Plan,,0.878708362579346,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,119
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510023,Beloit One Silver 20/60,37833WI051,7114920342,WIN003,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS8,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510023-06,94% AV Level Silver Plan,,0.949733018875122,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$525,"$1,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,120
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510024,Beloit One Silver 40/90,37833WI051,7114920342,WIN003,WIS003,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510024-00,Standard Silver Off Exchange Plan,,0.680200815200806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,121
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510024,Beloit One Silver 40/90,37833WI051,7114920342,WIN003,WIS003,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510024-01,Standard Silver On Exchange Plan,,0.680200815200806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,122
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510024,Beloit One Silver 40/90,37833WI051,7114920342,WIN003,WIS003,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510024-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,123
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510024,Beloit One Silver 40/90,37833WI051,7114920342,WIN003,WIS003,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510024-03,Limited Cost Sharing Plan Variation,,0.680200815200806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,124
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510024,Beloit One Silver 40/90,37833WI051,7114920342,WIN003,WIS003,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510024-04,73% AV Level Silver Plan,,0.739249706268311,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,125
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510024,Beloit One Silver 40/90,37833WI051,7114920342,WIN003,WIS003,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510024-05,87% AV Level Silver Plan,,0.879130303859711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,126
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510024,Beloit One Silver 40/90,37833WI051,7114920342,WIN003,WIS003,WIF005,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS11,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510024-06,94% AV Level Silver Plan,,0.949833750724792,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,127
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510025,Beloit One Bronze 55/150,37833WI051,7114920342,WIN003,WIS003,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510025-00,Standard Bronze Off Exchange Plan,,0.619748115539551,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,600","$11,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,128
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510025,Beloit One Bronze 55/150,37833WI051,7114920342,WIN003,WIS003,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510025-01,Standard Bronze On Exchange Plan,,0.619748115539551,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,600","$11,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,129
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510025,Beloit One Bronze 55/150,37833WI051,7114920342,WIN003,WIS003,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510025-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,130
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,3,37833,WI,Individual,No,39-1450766,37833WI0510025,Beloit One Bronze 55/150,37833WI051,7114920342,WIN003,WIS003,WIF006,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB2,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0510025-03,Limited Cost Sharing Plan Variation,,0.619748115539551,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,600","$11,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,131
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,4,37833,WI,Individual,No,39-1450766,37833WI0520001,Unity Prime Gold Deductible Child Dental,37833WI052,7114920342,WIN001,WIS001,WIF008,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG3D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0520001-00,Standard Gold Off Exchange Plan,,0.780651926994324,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,4,37833,WI,Individual,No,39-1450766,37833WI0520001,Unity Prime Gold Deductible Child Dental,37833WI052,7114920342,WIN001,WIS001,WIF008,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG3D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0520001-01,Standard Gold On Exchange Plan,,0.780651926994324,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,4,37833,WI,Individual,No,39-1450766,37833WI0520001,Unity Prime Gold Deductible Child Dental,37833WI052,7114920342,WIN001,WIS001,WIF008,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG3D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0520001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,4,37833,WI,Individual,No,39-1450766,37833WI0520001,Unity Prime Gold Deductible Child Dental,37833WI052,7114920342,WIN001,WIS001,WIF008,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG3D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0520001-03,Limited Cost Sharing Plan Variation,,0.780651926994324,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,4,37833,WI,Individual,No,39-1450766,37833WI0520002,Unity Prime Silver Deductible Child Dental,37833WI052,7114920342,WIN001,WIS001,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0520002-00,Standard Silver Off Exchange Plan,,0.680290997028351,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,4,37833,WI,Individual,No,39-1450766,37833WI0520002,Unity Prime Silver Deductible Child Dental,37833WI052,7114920342,WIN001,WIS001,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0520002-03,Limited Cost Sharing Plan Variation,,0.680290997028351,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,4,37833,WI,Individual,No,39-1450766,37833WI0520002,Unity Prime Silver Deductible Child Dental,37833WI052,7114920342,WIN001,WIS001,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0520002-04,73% AV Level Silver Plan,,0.738487541675568,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,4,37833,WI,Individual,No,39-1450766,37833WI0520002,Unity Prime Silver Deductible Child Dental,37833WI052,7114920342,WIN001,WIS001,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0520002-05,87% AV Level Silver Plan,,0.877934813499451,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,4,37833,WI,Individual,No,39-1450766,37833WI0520002,Unity Prime Silver Deductible Child Dental,37833WI052,7114920342,WIN001,WIS001,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0520002-06,94% AV Level Silver Plan,,0.948312282562256,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,4,37833,WI,Individual,No,39-1450766,37833WI0520003,Unity Prime Bronze HSA Child Dental,37833WI052,7114920342,WIN001,WIS001,WIF010,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB1D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0520003-00,Standard Bronze Off Exchange Plan,,0.580270707607269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,400","$10,800",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,4,37833,WI,Individual,No,39-1450766,37833WI0520003,Unity Prime Bronze HSA Child Dental,37833WI052,7114920342,WIN001,WIS001,WIF010,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB1D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0520003-01,Standard Bronze On Exchange Plan,,0.580270707607269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,400","$10,800",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,4,37833,WI,Individual,No,39-1450766,37833WI0520003,Unity Prime Bronze HSA Child Dental,37833WI052,7114920342,WIN001,WIS001,WIF010,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB1D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0520003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,4,37833,WI,Individual,No,39-1450766,37833WI0520003,Unity Prime Bronze HSA Child Dental,37833WI052,7114920342,WIN001,WIS001,WIF010,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB1D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0520003-03,Limited Cost Sharing Plan Variation,,0.580270707607269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,400","$10,800",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,4,37833,WI,Individual,No,39-1450766,37833WI0520004,Unity Prime Catastrophic Child Dental,37833WI052,7114920342,WIN001,WIS001,WIF007,New,HMO,Catastrophic,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",excludes child-only enrollment,$0.00,No,,,Allows Adult-Only,37833WI0520003,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDC1D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0520004-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,4,37833,WI,Individual,No,39-1450766,37833WI0520004,Unity Prime Catastrophic Child Dental,37833WI052,7114920342,WIN001,WIS001,WIF007,New,HMO,Catastrophic,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",excludes child-only enrollment,$0.00,No,,,Allows Adult-Only,37833WI0520003,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDC1D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0520004-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540001,Unity Prime Gold Deductible,37833WI054,7114920342,WIN001,WIS001,WIF008,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG3,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0540001-00,Standard Gold Off Exchange Plan,,0.780651926994324,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540001,Unity Prime Gold Deductible,37833WI054,7114920342,WIN001,WIS001,WIF008,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG3,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0540001-01,Standard Gold On Exchange Plan,,0.780651926994324,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540001,Unity Prime Gold Deductible,37833WI054,7114920342,WIN001,WIS001,WIF008,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG3,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0540001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540001,Unity Prime Gold Deductible,37833WI054,7114920342,WIN001,WIS001,WIF008,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG3,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0540001-03,Limited Cost Sharing Plan Variation,,0.780651926994324,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540002,Unity Prime Silver Deductible,37833WI054,7114920342,WIN001,WIS001,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0540002-00,Standard Silver Off Exchange Plan,,0.680290997028351,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540002,Unity Prime Silver Deductible,37833WI054,7114920342,WIN001,WIS001,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0540002-01,Standard Silver On Exchange Plan,,0.680290997028351,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540002,Unity Prime Silver Deductible,37833WI054,7114920342,WIN001,WIS001,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0540002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540002,Unity Prime Silver Deductible,37833WI054,7114920342,WIN001,WIS001,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0540002-03,Limited Cost Sharing Plan Variation,,0.680290997028351,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540002,Unity Prime Silver Deductible,37833WI054,7114920342,WIN001,WIS001,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0540002-04,73% AV Level Silver Plan,,0.738487541675568,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540002,Unity Prime Silver Deductible,37833WI054,7114920342,WIN001,WIS001,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0540002-05,87% AV Level Silver Plan,,0.877934813499451,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540002,Unity Prime Silver Deductible,37833WI054,7114920342,WIN001,WIS001,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0540002-06,94% AV Level Silver Plan,,0.948312282562256,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540003,Unity Prime Bronze HSA,37833WI054,7114920342,WIN001,WIS001,WIF010,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB1,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0540003-00,Standard Bronze Off Exchange Plan,,0.580270707607269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,400","$10,800",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540003,Unity Prime Bronze HSA,37833WI054,7114920342,WIN001,WIS001,WIF010,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB1,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0540003-01,Standard Bronze On Exchange Plan,,0.580270707607269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,400","$10,800",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540003,Unity Prime Bronze HSA,37833WI054,7114920342,WIN001,WIS001,WIF010,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB1,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0540003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540003,Unity Prime Bronze HSA,37833WI054,7114920342,WIN001,WIS001,WIF010,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB1,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0540003-03,Limited Cost Sharing Plan Variation,,0.580270707607269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,400","$10,800",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540004,Unity Prime Catastrophic,37833WI054,7114920342,WIN001,WIS001,WIF007,New,HMO,Catastrophic,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",excludes child-only enrollment,$0.00,No,,,Allows Adult-Only,37833WI0540003,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDC1,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0540004-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540004,Unity Prime Catastrophic,37833WI054,7114920342,WIN001,WIS001,WIF007,New,HMO,Catastrophic,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",excludes child-only enrollment,$0.00,No,,,Allows Adult-Only,37833WI0540003,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDC1,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0540004-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540005,Unity Elite Gold Deductible,37833WI054,7114920342,WIN002,WIS002,WIF008,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG3,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0540005-00,Standard Gold Off Exchange Plan,,0.780651926994324,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540005,Unity Elite Gold Deductible,37833WI054,7114920342,WIN002,WIS002,WIF008,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG3,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0540005-01,Standard Gold On Exchange Plan,,0.780651926994324,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540005,Unity Elite Gold Deductible,37833WI054,7114920342,WIN002,WIS002,WIF008,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG3,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0540005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540005,Unity Elite Gold Deductible,37833WI054,7114920342,WIN002,WIS002,WIF008,New,HMO,Gold,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDG3,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0540005-03,Limited Cost Sharing Plan Variation,,0.780651926994324,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,24
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540006,Unity Elite Silver Deductible,37833WI054,7114920342,WIN002,WIS002,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0540006-00,Standard Silver Off Exchange Plan,,0.680290997028351,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540006,Unity Elite Silver Deductible,37833WI054,7114920342,WIN002,WIS002,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0540006-01,Standard Silver On Exchange Plan,,0.680290997028351,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,26
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540006,Unity Elite Silver Deductible,37833WI054,7114920342,WIN002,WIS002,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0540006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,27
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540006,Unity Elite Silver Deductible,37833WI054,7114920342,WIN002,WIS002,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0540006-03,Limited Cost Sharing Plan Variation,,0.680290997028351,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,28
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540006,Unity Elite Silver Deductible,37833WI054,7114920342,WIN002,WIS002,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0540006-04,73% AV Level Silver Plan,,0.738487541675568,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,29
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540006,Unity Elite Silver Deductible,37833WI054,7114920342,WIN002,WIS002,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0540006-05,87% AV Level Silver Plan,,0.877934813499451,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,30
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540006,Unity Elite Silver Deductible,37833WI054,7114920342,WIN002,WIS002,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0540006-06,94% AV Level Silver Plan,,0.948312282562256,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,31
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540007,Unity Elite Bronze HSA,37833WI054,7114920342,WIN002,WIS002,WIF010,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB1,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0540007-00,Standard Bronze Off Exchange Plan,,0.580270707607269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,400","$10,800",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,32
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540007,Unity Elite Bronze HSA,37833WI054,7114920342,WIN002,WIS002,WIF010,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB1,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0540007-01,Standard Bronze On Exchange Plan,,0.580270707607269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,400","$10,800",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,33
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540007,Unity Elite Bronze HSA,37833WI054,7114920342,WIN002,WIS002,WIF010,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB1,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0540007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,34
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540007,Unity Elite Bronze HSA,37833WI054,7114920342,WIN002,WIS002,WIF010,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB1,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0540007-03,Limited Cost Sharing Plan Variation,,0.580270707607269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,400","$10,800",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,35
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540008,Unity Elite Catastrophic,37833WI054,7114920342,WIN002,WIS002,WIF007,New,HMO,Catastrophic,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",excludes child-only enrollment,$0.00,No,,,Allows Adult-Only,37833WI0540007,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDC1,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0540008-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,36
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540008,Unity Elite Catastrophic,37833WI054,7114920342,WIN002,WIS002,WIF007,New,HMO,Catastrophic,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",excludes child-only enrollment,$0.00,No,,,Allows Adult-Only,37833WI0540007,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDC1,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0540008-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,37
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540009,Beloit One Silver Deductible,37833WI054,7114920342,WIN003,WIS003,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0540009-00,Standard Silver Off Exchange Plan,,0.680290997028351,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,38
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540009,Beloit One Silver Deductible,37833WI054,7114920342,WIN003,WIS003,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0540009-01,Standard Silver On Exchange Plan,,0.680290997028351,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,39
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540009,Beloit One Silver Deductible,37833WI054,7114920342,WIN003,WIS003,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0540009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,40
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540009,Beloit One Silver Deductible,37833WI054,7114920342,WIN003,WIS003,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0540009-03,Limited Cost Sharing Plan Variation,,0.680290997028351,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,41
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540009,Beloit One Silver Deductible,37833WI054,7114920342,WIN003,WIS003,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0540009-04,73% AV Level Silver Plan,,0.738487541675568,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,42
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540009,Beloit One Silver Deductible,37833WI054,7114920342,WIN003,WIS003,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0540009-05,87% AV Level Silver Plan,,0.877934813499451,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,43
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540009,Beloit One Silver Deductible,37833WI054,7114920342,WIN003,WIS003,WIF009,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS4,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0540009-06,94% AV Level Silver Plan,,0.948312282562256,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,44
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540010,Beloit One Bronze HSA,37833WI054,7114920342,WIN003,WIS003,WIF010,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB1,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0540010-00,Standard Bronze Off Exchange Plan,,0.580270707607269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,400","$10,800",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,45
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540010,Beloit One Bronze HSA,37833WI054,7114920342,WIN003,WIS003,WIF010,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB1,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0540010-01,Standard Bronze On Exchange Plan,,0.580270707607269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,400","$10,800",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,46
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540010,Beloit One Bronze HSA,37833WI054,7114920342,WIN003,WIS003,WIF010,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB1,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0540010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,47
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540010,Beloit One Bronze HSA,37833WI054,7114920342,WIN003,WIS003,WIF010,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB1,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0540010-03,Limited Cost Sharing Plan Variation,,0.580270707607269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,400","$10,800",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,48
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540011,Beloit One Catastrophic,37833WI054,7114920342,WIN003,WIS003,WIF007,New,HMO,Catastrophic,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",excludes child-only enrollment,$0.00,No,,,Allows Adult-Only,37833WI0540010,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDC1,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0540011-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,49
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,5,37833,WI,Individual,No,39-1450766,37833WI0540011,Beloit One Catastrophic,37833WI054,7114920342,WIN003,WIS003,WIF007,New,HMO,Catastrophic,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",excludes child-only enrollment,$0.00,No,,,Allows Adult-Only,37833WI0540010,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDC1,https://hixenroll.unityhealth.com,https://unityhealth.com/BeloitOnePlans,http://www.unityhealth.com/Formulary,37833WI0540011-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,50
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,6,37833,WI,Individual,No,39-1450766,37833WI0380037,Unity Prime Bronze 40/100 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB3D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380037-00,Standard Bronze Off Exchange Plan,,0.619103908538818,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,550","$13,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,6,37833,WI,Individual,No,39-1450766,37833WI0380037,Unity Prime Bronze 40/100 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB3D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380037-01,Standard Bronze On Exchange Plan,,0.619103908538818,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,550","$13,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,6,37833,WI,Individual,No,39-1450766,37833WI0380037,Unity Prime Bronze 40/100 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB3D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380037-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,6,37833,WI,Individual,No,39-1450766,37833WI0380037,Unity Prime Bronze 40/100 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB3D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380037-03,Limited Cost Sharing Plan Variation,,0.619103908538818,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,550","$13,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,6,37833,WI,Individual,No,39-1450766,37833WI0380038,Unity Elite Bronze 40/100 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB3D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380038-00,Standard Bronze Off Exchange Plan,,0.619103908538818,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,550","$13,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,6,37833,WI,Individual,No,39-1450766,37833WI0380038,Unity Elite Bronze 40/100 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB3D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380038-01,Standard Bronze On Exchange Plan,,0.619103908538818,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,550","$13,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,6,37833,WI,Individual,No,39-1450766,37833WI0380038,Unity Elite Bronze 40/100 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB3D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380038-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,6,37833,WI,Individual,No,39-1450766,37833WI0380038,Unity Elite Bronze 40/100 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB3D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380038-03,Limited Cost Sharing Plan Variation,,0.619103908538818,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,550","$13,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,7,37833,WI,Individual,No,39-1450766,37833WI0510026,Unity Prime Bronze 40/100,37833WI051,7114920342,WIN001,WIS001,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB3,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510026-00,Standard Bronze Off Exchange Plan,,0.619103908538818,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,550","$13,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,7,37833,WI,Individual,No,39-1450766,37833WI0510026,Unity Prime Bronze 40/100,37833WI051,7114920342,WIN001,WIS001,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB3,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510026-01,Standard Bronze On Exchange Plan,,0.619103908538818,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,550","$13,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,7,37833,WI,Individual,No,39-1450766,37833WI0510026,Unity Prime Bronze 40/100,37833WI051,7114920342,WIN001,WIS001,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB3,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510026-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,7,37833,WI,Individual,No,39-1450766,37833WI0510026,Unity Prime Bronze 40/100,37833WI051,7114920342,WIN001,WIS001,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB3,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510026-03,Limited Cost Sharing Plan Variation,,0.619103908538818,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,550","$13,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,7,37833,WI,Individual,No,39-1450766,37833WI0510027,Unity Elite Bronze 40/100,37833WI051,7114920342,WIN002,WIS002,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB3,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510027-00,Standard Bronze Off Exchange Plan,,0.619103908538818,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,550","$13,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,7,37833,WI,Individual,No,39-1450766,37833WI0510027,Unity Elite Bronze 40/100,37833WI051,7114920342,WIN002,WIS002,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB3,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510027-01,Standard Bronze On Exchange Plan,,0.619103908538818,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,550","$13,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,7,37833,WI,Individual,No,39-1450766,37833WI0510027,Unity Elite Bronze 40/100,37833WI051,7114920342,WIN002,WIS002,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB3,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510027-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,7,37833,WI,Individual,No,39-1450766,37833WI0510027,Unity Elite Bronze 40/100,37833WI051,7114920342,WIN002,WIS002,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB3,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510027-03,Limited Cost Sharing Plan Variation,,0.619103908538818,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,550","$13,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,8,37833,WI,Individual,No,39-1450766,37833WI0530001,Unity Prime Bronze Deductible Family Dental,37833WI053,7114920342,WIN001,WIS001,WIF005,New,HMO,Bronze,Yes,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0530001-00,Standard Bronze Off Exchange Plan,60.54%,0.605404019355774,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,8,37833,WI,Individual,No,39-1450766,37833WI0530001,Unity Prime Bronze Deductible Family Dental,37833WI053,7114920342,WIN001,WIS001,WIF005,New,HMO,Bronze,Yes,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0530001-01,Standard Bronze On Exchange Plan,60.54%,0.605404019355774,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,8,37833,WI,Individual,No,39-1450766,37833WI0530001,Unity Prime Bronze Deductible Family Dental,37833WI053,7114920342,WIN001,WIS001,WIF005,New,HMO,Bronze,Yes,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0530001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,8,37833,WI,Individual,No,39-1450766,37833WI0530001,Unity Prime Bronze Deductible Family Dental,37833WI053,7114920342,WIN001,WIS001,WIF005,New,HMO,Bronze,Yes,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0530001-03,Limited Cost Sharing Plan Variation,60.54%,0.605404019355774,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,8,37833,WI,Individual,No,39-1450766,37833WI0530002,Unity Elite Bronze Deductible Family Dental,37833WI053,7114920342,WIN002,WIS002,WIF005,New,HMO,Bronze,Yes,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0530002-00,Standard Bronze Off Exchange Plan,60.54%,0.605404019355774,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,8,37833,WI,Individual,No,39-1450766,37833WI0530002,Unity Elite Bronze Deductible Family Dental,37833WI053,7114920342,WIN002,WIS002,WIF005,New,HMO,Bronze,Yes,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0530002-01,Standard Bronze On Exchange Plan,60.54%,0.605404019355774,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,8,37833,WI,Individual,No,39-1450766,37833WI0530002,Unity Elite Bronze Deductible Family Dental,37833WI053,7114920342,WIN002,WIS002,WIF005,New,HMO,Bronze,Yes,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0530002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,8,37833,WI,Individual,No,39-1450766,37833WI0530002,Unity Elite Bronze Deductible Family Dental,37833WI053,7114920342,WIN002,WIS002,WIF005,New,HMO,Bronze,Yes,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB4D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0530002-03,Limited Cost Sharing Plan Variation,60.54%,0.605404019355774,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,9,37833,WI,Individual,No,39-1450766,37833WI0540012,Unity Prime Bronze Deductible,37833WI054,7114920342,WIN001,WIS001,WIF005,New,HMO,Bronze,Yes,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0540012-00,Standard Bronze Off Exchange Plan,60.54%,0.605404019355774,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,9,37833,WI,Individual,No,39-1450766,37833WI0540012,Unity Prime Bronze Deductible,37833WI054,7114920342,WIN001,WIS001,WIF005,New,HMO,Bronze,Yes,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0540012-01,Standard Bronze On Exchange Plan,60.54%,0.605404019355774,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,9,37833,WI,Individual,No,39-1450766,37833WI0540012,Unity Prime Bronze Deductible,37833WI054,7114920342,WIN001,WIS001,WIF005,New,HMO,Bronze,Yes,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0540012-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,9,37833,WI,Individual,No,39-1450766,37833WI0540012,Unity Prime Bronze Deductible,37833WI054,7114920342,WIN001,WIS001,WIF005,New,HMO,Bronze,Yes,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0540012-03,Limited Cost Sharing Plan Variation,60.54%,0.605404019355774,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,9,37833,WI,Individual,No,39-1450766,37833WI0540013,Unity Elite Bronze Deductible,37833WI054,7114920342,WIN002,WIS002,WIF005,New,HMO,Bronze,Yes,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0540013-00,Standard Bronze Off Exchange Plan,60.54%,0.605404019355774,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,9,37833,WI,Individual,No,39-1450766,37833WI0540013,Unity Elite Bronze Deductible,37833WI054,7114920342,WIN002,WIS002,WIF005,New,HMO,Bronze,Yes,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0540013-01,Standard Bronze On Exchange Plan,60.54%,0.605404019355774,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,9,37833,WI,Individual,No,39-1450766,37833WI0540013,Unity Elite Bronze Deductible,37833WI054,7114920342,WIN002,WIS002,WIF005,New,HMO,Bronze,Yes,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0540013-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,9,37833,WI,Individual,No,39-1450766,37833WI0540013,Unity Elite Bronze Deductible,37833WI054,7114920342,WIN002,WIS002,WIF005,New,HMO,Bronze,Yes,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB4,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0540013-03,Limited Cost Sharing Plan Variation,60.54%,0.605404019355774,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,10,37833,WI,Individual,No,39-1450766,37833WI0380040,Unity Prime Bronze 30/Deductible Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380040-00,Standard Bronze Off Exchange Plan,,0.600355088710785,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,10,37833,WI,Individual,No,39-1450766,37833WI0380040,Unity Prime Bronze 30/Deductible Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380040-01,Standard Bronze On Exchange Plan,,0.600355088710785,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,10,37833,WI,Individual,No,39-1450766,37833WI0380040,Unity Prime Bronze 30/Deductible Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380040-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,10,37833,WI,Individual,No,39-1450766,37833WI0380040,Unity Prime Bronze 30/Deductible Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380040-03,Limited Cost Sharing Plan Variation,,0.600355088710785,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,10,37833,WI,Individual,No,39-1450766,37833WI0380041,Unity Elite Bronze 30/Deductible Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380041-00,Standard Bronze Off Exchange Plan,,0.600355088710785,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,10,37833,WI,Individual,No,39-1450766,37833WI0380041,Unity Elite Bronze 30/Deductible Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380041-01,Standard Bronze On Exchange Plan,,0.600355088710785,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,10,37833,WI,Individual,No,39-1450766,37833WI0380041,Unity Elite Bronze 30/Deductible Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380041-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,10,37833,WI,Individual,No,39-1450766,37833WI0380041,Unity Elite Bronze 30/Deductible Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380041-03,Limited Cost Sharing Plan Variation,,0.600355088710785,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,11,37833,WI,Individual,No,39-1450766,37833WI0510028,Unity Prime Bronze 30/Deductible,37833WI051,7114920342,WIN001,WIS001,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510028-00,Standard Bronze Off Exchange Plan,,0.600355088710785,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,11,37833,WI,Individual,No,39-1450766,37833WI0510028,Unity Prime Bronze 30/Deductible,37833WI051,7114920342,WIN001,WIS001,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510028-01,Standard Bronze On Exchange Plan,,0.600355088710785,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,11,37833,WI,Individual,No,39-1450766,37833WI0510028,Unity Prime Bronze 30/Deductible,37833WI051,7114920342,WIN001,WIS001,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510028-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,11,37833,WI,Individual,No,39-1450766,37833WI0510028,Unity Prime Bronze 30/Deductible,37833WI051,7114920342,WIN001,WIS001,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510028-03,Limited Cost Sharing Plan Variation,,0.600355088710785,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,11,37833,WI,Individual,No,39-1450766,37833WI0510029,Unity Elite Bronze 30/Deductible,37833WI051,7114920342,WIN002,WIS002,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510029-00,Standard Bronze Off Exchange Plan,,0.600355088710785,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,11,37833,WI,Individual,No,39-1450766,37833WI0510029,Unity Elite Bronze 30/Deductible,37833WI051,7114920342,WIN002,WIS002,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510029-01,Standard Bronze On Exchange Plan,,0.600355088710785,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,11,37833,WI,Individual,No,39-1450766,37833WI0510029,Unity Elite Bronze 30/Deductible,37833WI051,7114920342,WIN002,WIS002,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510029-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,11,37833,WI,Individual,No,39-1450766,37833WI0510029,Unity Elite Bronze 30/Deductible,37833WI051,7114920342,WIN002,WIS002,WIF007,New,HMO,Bronze,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDB5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510029-03,Limited Cost Sharing Plan Variation,,0.600355088710785,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380042,Unity Prime Silver Maintenance 20/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380042-00,Standard Silver Off Exchange Plan,,0.714370906352997,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$925,"$1,850",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380042,Unity Prime Silver Maintenance 20/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380042-01,Standard Silver On Exchange Plan,,0.714370906352997,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$925,"$1,850",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380042,Unity Prime Silver Maintenance 20/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380042-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380042,Unity Prime Silver Maintenance 20/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380042-03,Limited Cost Sharing Plan Variation,,0.714370906352997,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$925,"$1,850",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380042,Unity Prime Silver Maintenance 20/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380042-04,73% AV Level Silver Plan,,0.739795327186584,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$925,"$1,850",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380042,Unity Prime Silver Maintenance 20/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380042-05,87% AV Level Silver Plan,,0.878787994384766,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380042,Unity Prime Silver Maintenance 20/60 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380042-06,94% AV Level Silver Plan,,0.949921131134033,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380043,Unity Prime Silver Maintenance 30/70 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380043-00,Standard Silver Off Exchange Plan,,0.680236756801605,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,200","$6,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380043,Unity Prime Silver Maintenance 30/70 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380043-01,Standard Silver On Exchange Plan,,0.680236756801605,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,200","$6,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380043,Unity Prime Silver Maintenance 30/70 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380043-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380043,Unity Prime Silver Maintenance 30/70 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380043-03,Limited Cost Sharing Plan Variation,,0.680236756801605,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,200","$6,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380043,Unity Prime Silver Maintenance 30/70 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380043-04,73% AV Level Silver Plan,,0.73957097530365,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380043,Unity Prime Silver Maintenance 30/70 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380043-05,87% AV Level Silver Plan,,0.879691183567047,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380043,Unity Prime Silver Maintenance 30/70 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380043-06,94% AV Level Silver Plan,,0.94986492395401,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$675,"$1,350",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380044,Unity Elite Silver Maintenance 20/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380044-00,Standard Silver Off Exchange Plan,,0.714370906352997,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$925,"$1,850",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380044,Unity Elite Silver Maintenance 20/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380044-01,Standard Silver On Exchange Plan,,0.714370906352997,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$925,"$1,850",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380044,Unity Elite Silver Maintenance 20/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380044-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380044,Unity Elite Silver Maintenance 20/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380044-03,Limited Cost Sharing Plan Variation,,0.714370906352997,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$925,"$1,850",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380044,Unity Elite Silver Maintenance 20/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380044-04,73% AV Level Silver Plan,,0.739795327186584,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$925,"$1,850",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380044,Unity Elite Silver Maintenance 20/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380044-05,87% AV Level Silver Plan,,0.878787994384766,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380044,Unity Elite Silver Maintenance 20/60 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380044-06,94% AV Level Silver Plan,,0.949921131134033,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380045,Unity Elite Silver Maintenance 30/70 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380045-00,Standard Silver Off Exchange Plan,,0.680236756801605,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,200","$6,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380045,Unity Elite Silver Maintenance 30/70 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380045-01,Standard Silver On Exchange Plan,,0.680236756801605,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,200","$6,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380045,Unity Elite Silver Maintenance 30/70 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380045-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380045,Unity Elite Silver Maintenance 30/70 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380045-03,Limited Cost Sharing Plan Variation,,0.680236756801605,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,200","$6,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380045,Unity Elite Silver Maintenance 30/70 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380045-04,73% AV Level Silver Plan,,0.73957097530365,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,12,37833,WI,Individual,No,39-1450766,37833WI0380045,Unity Elite Silver Maintenance 30/70 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380045-05,87% AV Level Silver Plan,,0.879691183567047,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510030,Unity Prime Silver Maintenance 20/60,37833WI051,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510030-01,Standard Silver On Exchange Plan,,0.714370906352997,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$925,"$1,850",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510030,Unity Prime Silver Maintenance 20/60,37833WI051,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510030-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510030,Unity Prime Silver Maintenance 20/60,37833WI051,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510030-03,Limited Cost Sharing Plan Variation,,0.714370906352997,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$925,"$1,850",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510030,Unity Prime Silver Maintenance 20/60,37833WI051,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510030-04,73% AV Level Silver Plan,,0.739795327186584,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$925,"$1,850",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510030,Unity Prime Silver Maintenance 20/60,37833WI051,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510030-05,87% AV Level Silver Plan,,0.878787994384766,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510030,Unity Prime Silver Maintenance 20/60,37833WI051,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510030-06,94% AV Level Silver Plan,,0.949921131134033,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510031,Unity Prime Silver Maintenance 30/70,37833WI051,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510031-00,Standard Silver Off Exchange Plan,,0.680236756801605,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,200","$6,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510031,Unity Prime Silver Maintenance 30/70,37833WI051,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510031-01,Standard Silver On Exchange Plan,,0.680236756801605,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,200","$6,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510031,Unity Prime Silver Maintenance 30/70,37833WI051,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510031-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510031,Unity Prime Silver Maintenance 30/70,37833WI051,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510031-03,Limited Cost Sharing Plan Variation,,0.680236756801605,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,200","$6,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510031,Unity Prime Silver Maintenance 30/70,37833WI051,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510031-04,73% AV Level Silver Plan,,0.73957097530365,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510031,Unity Prime Silver Maintenance 30/70,37833WI051,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510031-05,87% AV Level Silver Plan,,0.879691183567047,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510031,Unity Prime Silver Maintenance 30/70,37833WI051,7114920342,WIN001,WIS001,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510031-06,94% AV Level Silver Plan,,0.94986492395401,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$675,"$1,350",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510032,Unity Elite Silver Maintenance 20/60,37833WI051,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510032-00,Standard Silver Off Exchange Plan,,0.714370906352997,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$925,"$1,850",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510032,Unity Elite Silver Maintenance 20/60,37833WI051,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510032-01,Standard Silver On Exchange Plan,,0.714370906352997,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$925,"$1,850",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510032,Unity Elite Silver Maintenance 20/60,37833WI051,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510032-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510032,Unity Elite Silver Maintenance 20/60,37833WI051,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510032-03,Limited Cost Sharing Plan Variation,,0.714370906352997,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$925,"$1,850",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510032,Unity Elite Silver Maintenance 20/60,37833WI051,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510032-04,73% AV Level Silver Plan,,0.739795327186584,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$925,"$1,850",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510032,Unity Elite Silver Maintenance 20/60,37833WI051,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510032-05,87% AV Level Silver Plan,,0.878787994384766,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510032,Unity Elite Silver Maintenance 20/60,37833WI051,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510032-06,94% AV Level Silver Plan,,0.949921131134033,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510033,Unity Elite Silver Maintenance 30/70,37833WI051,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510033-00,Standard Silver Off Exchange Plan,,0.680236756801605,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,200","$6,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510033,Unity Elite Silver Maintenance 30/70,37833WI051,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510033-01,Standard Silver On Exchange Plan,,0.680236756801605,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,200","$6,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510033,Unity Elite Silver Maintenance 30/70,37833WI051,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510033-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510033,Unity Elite Silver Maintenance 30/70,37833WI051,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510033-03,Limited Cost Sharing Plan Variation,,0.680236756801605,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,200","$6,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,13,37833,WI,Individual,No,39-1450766,37833WI0510033,Unity Elite Silver Maintenance 30/70,37833WI051,7114920342,WIN002,WIS002,WIF002,New,HMO,Silver,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDS6,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510033-06,94% AV Level Silver Plan,,0.94986492395401,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$675,"$1,350",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,14,37833,WI,Individual,No,39-1450766,37833WI0370001,Unity Prime Platinum 20/70 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF001,Existing,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP3CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370001-00,Standard Platinum Off Exchange Plan,,0.880531847476959,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,14,37833,WI,Individual,No,39-1450766,37833WI0370001,Unity Prime Platinum 20/70 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF001,Existing,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP3CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370001-01,Standard Platinum On Exchange Plan,,0.880531847476959,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,14,37833,WI,Individual,No,39-1450766,37833WI0370001,Unity Prime Platinum 20/70 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF001,Existing,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP3CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,14,37833,WI,Individual,No,39-1450766,37833WI0370001,Unity Prime Platinum 20/70 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF001,Existing,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP3CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370001-03,Limited Cost Sharing Plan Variation,,0.880531847476959,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,14,37833,WI,Individual,No,39-1450766,37833WI0370005,Unity Prime Platinum 10/50 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF001,Existing,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP1CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370005-00,Standard Platinum Off Exchange Plan,,0.904826879501343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,14,37833,WI,Individual,No,39-1450766,37833WI0370005,Unity Prime Platinum 10/50 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF001,Existing,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP1CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370005-01,Standard Platinum On Exchange Plan,,0.904826879501343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,14,37833,WI,Individual,No,39-1450766,37833WI0370005,Unity Prime Platinum 10/50 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF001,Existing,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP1CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,14,37833,WI,Individual,No,39-1450766,37833WI0370005,Unity Prime Platinum 10/50 Child Dental,37833WI037,7114920342,WIN001,WIS001,WIF001,Existing,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP1CD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0370005-03,Limited Cost Sharing Plan Variation,,0.904826879501343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,15,37833,WI,Individual,No,39-1450766,37833WI0380002,Unity Prime Platinum 20/70 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF001,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP3FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380002-00,Standard Platinum Off Exchange Plan,,0.880531847476959,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,15,37833,WI,Individual,No,39-1450766,37833WI0380002,Unity Prime Platinum 20/70 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF001,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP3FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380002-01,Standard Platinum On Exchange Plan,,0.880531847476959,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,15,37833,WI,Individual,No,39-1450766,37833WI0380002,Unity Prime Platinum 20/70 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF001,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP3FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,15,37833,WI,Individual,No,39-1450766,37833WI0380002,Unity Prime Platinum 20/70 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF001,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP3FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380002-03,Limited Cost Sharing Plan Variation,,0.880531847476959,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,15,37833,WI,Individual,No,39-1450766,37833WI0380004,Unity Prime Platinum 10/50 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF001,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP1FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380004-00,Standard Platinum Off Exchange Plan,,0.904826879501343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,15,37833,WI,Individual,No,39-1450766,37833WI0380004,Unity Prime Platinum 10/50 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF001,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP1FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380004-01,Standard Platinum On Exchange Plan,,0.904826879501343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,15,37833,WI,Individual,No,39-1450766,37833WI0380004,Unity Prime Platinum 10/50 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF001,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP1FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,15,37833,WI,Individual,No,39-1450766,37833WI0380004,Unity Prime Platinum 10/50 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF001,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP1FD,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380004-03,Limited Cost Sharing Plan Variation,,0.904826879501343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,15,37833,WI,Individual,No,39-1450766,37833WI0380006,Unity Prime Platinum 10/30 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380006-00,Standard Platinum Off Exchange Plan,,0.885420799255371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,15,37833,WI,Individual,No,39-1450766,37833WI0380006,Unity Prime Platinum 10/30 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380006-01,Standard Platinum On Exchange Plan,,0.885420799255371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,15,37833,WI,Individual,No,39-1450766,37833WI0380006,Unity Prime Platinum 10/30 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,15,37833,WI,Individual,No,39-1450766,37833WI0380006,Unity Prime Platinum 10/30 Family Dental,37833WI038,7114920342,WIN001,WIS001,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0380006-03,Limited Cost Sharing Plan Variation,,0.885420799255371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,15,37833,WI,Individual,No,39-1450766,37833WI0380022,Unity Elite Platinum 10/30 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380022-00,Standard Platinum Off Exchange Plan,,0.885420799255371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,15,37833,WI,Individual,No,39-1450766,37833WI0380022,Unity Elite Platinum 10/30 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380022-01,Standard Platinum On Exchange Plan,,0.885420799255371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,15,37833,WI,Individual,No,39-1450766,37833WI0380022,Unity Elite Platinum 10/30 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380022-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,15,37833,WI,Individual,No,39-1450766,37833WI0380022,Unity Elite Platinum 10/30 Family Dental,37833WI038,7114920342,WIN002,WIS002,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.950119492029719,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP5D,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0380022-03,Limited Cost Sharing Plan Variation,,0.885420799255371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,16,37833,WI,Individual,No,39-1450766,37833WI0510002,Unity Prime Platinum 10/30,37833WI051,7114920342,WIN001,WIS001,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510002-00,Standard Platinum Off Exchange Plan,,0.885420799255371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,16,37833,WI,Individual,No,39-1450766,37833WI0510002,Unity Prime Platinum 10/30,37833WI051,7114920342,WIN001,WIS001,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510002-01,Standard Platinum On Exchange Plan,,0.885420799255371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,16,37833,WI,Individual,No,39-1450766,37833WI0510002,Unity Prime Platinum 10/30,37833WI051,7114920342,WIN001,WIS001,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,16,37833,WI,Individual,No,39-1450766,37833WI0510002,Unity Prime Platinum 10/30,37833WI051,7114920342,WIN001,WIS001,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityPrimePlans,http://www.unityhealth.com/Formulary,37833WI0510002-03,Limited Cost Sharing Plan Variation,,0.885420799255371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,16,37833,WI,Individual,No,39-1450766,37833WI0510012,Unity Elite Platinum 10/30,37833WI051,7114920342,WIN002,WIS002,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510012-00,Standard Platinum Off Exchange Plan,,0.885420799255371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,16,37833,WI,Individual,No,39-1450766,37833WI0510012,Unity Elite Platinum 10/30,37833WI051,7114920342,WIN002,WIS002,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510012-01,Standard Platinum On Exchange Plan,,0.885420799255371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,16,37833,WI,Individual,No,39-1450766,37833WI0510012,Unity Elite Platinum 10/30,37833WI051,7114920342,WIN002,WIS002,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510012-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WI,37833,HIOS,7,2014-11-09 04:38:15,16,37833,WI,Individual,No,39-1450766,37833WI0510012,Unity Elite Platinum 10/30,37833WI051,7114920342,WIN002,WIS002,WIF003,New,HMO,Platinum,No,Both,No,Yes,"As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency room,Yes,"Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization",No,https://unityhealth.com/HIM-2015-SBC/INDP5,https://hixenroll.unityhealth.com,https://unityhealth.com/UnityElitePlans,http://www.unityhealth.com/Formulary,37833WI0510012-03,Limited Cost Sharing Plan Variation,,0.885420799255371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WI,38152,HIOS,3,2014-09-04 03:25:43,1,38152,WI,SHOP (Small Group),Yes,35-0472300,38152WI0010001,Lincoln DentalConnect?,38152WI001,,WIN001,WIS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$38.79,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,38152WI0010001-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,38152,HIOS,3,2014-09-04 03:25:43,1,38152,WI,SHOP (Small Group),Yes,35-0472300,38152WI0010002,Lincoln DentalConnect?,38152WI001,,WIN001,WIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.35,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,38152WI0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,38152,HIOS,3,2014-09-04 03:25:43,1,38152,WI,SHOP (Small Group),Yes,35-0472300,38152WI0010003,Lincoln DentalConnect?,38152WI001,,WIN001,WIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.54,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,38152WI0010003-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WI,38152,HIOS,3,2014-09-04 03:25:43,1,38152,WI,SHOP (Small Group),Yes,35-0472300,38152WI0010005,Lincoln DentalConnect?,38152WI001,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.60,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,38152WI0010005-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WI,38152,HIOS,3,2014-09-04 03:25:43,1,38152,WI,SHOP (Small Group),Yes,35-0472300,38152WI0010006,Lincoln DentalConnect?,38152WI001,,WIN001,WIS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.06,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,38152WI0010006-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,WI,38152,HIOS,3,2014-09-04 03:25:43,2,38152,WI,SHOP (Small Group),Yes,35-0472300,38152WI0010004,Lincoln DentalConnect?,38152WI001,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.83,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,38152WI0010004-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,38152,HIOS,3,2014-09-04 03:25:43,2,38152,WI,SHOP (Small Group),Yes,35-0472300,38152WI0010007,Lincoln DentalConnect?,38152WI001,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$37.92,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,38152WI0010007-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0170001,"Classic $1,000 - 20%",38166WI017,,WIN001,WIS001,WIF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170001-00,Standard Gold Off Exchange Plan,80.70%,0.797870516777039,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140001,Tradition $500 - 10%,38166WI014,,WIN001,WIS001,WIF007,Existing,HMO,Platinum,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140001-00,Standard Platinum Off Exchange Plan,,0.896489024162292,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0170001,"Classic $1,000 - 20%",38166WI017,,WIN001,WIS001,WIF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140004,"Tradition $1,000 - 20%",38166WI014,,WIN001,WIS001,WIF005,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140004-00,Standard Gold Off Exchange Plan,,0.786382079124451,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140004,"Tradition $1,000 - 20%",38166WI014,,WIN001,WIS001,WIF005,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140004-01,Standard Gold On Exchange Plan,,0.786382079124451,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0170001,"Classic $1,000 - 20%",38166WI017,,WIN001,WIS001,WIF001,Existing,HMO,Gold,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170001-03,Limited Cost Sharing Plan Variation,80.70%,0.797870516777039,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0170003,"Classic $1,800 - 20%",38166WI017,,WIN001,WIS001,WIF002,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170003-00,Standard Silver Off Exchange Plan,71.50%,0.713086247444153,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,800","$3,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140006,"Tradition $1,000 - 40%",38166WI014,,WIN001,WIS001,WIF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140006-00,Standard Silver Off Exchange Plan,,0.702124893665314,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140006,"Tradition $1,000 - 40%",38166WI014,,WIN001,WIS001,WIF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140006-01,Standard Silver On Exchange Plan,,0.702124893665314,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0170003,"Classic $1,800 - 20%",38166WI017,,WIN001,WIS001,WIF002,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170003-01,Standard Silver On Exchange Plan,71.50%,0.713086247444153,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,800","$3,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160001,Reliance $500 - 10%,38166WI016,,WIN002,WIS002,WIF007,Existing,EPO,Platinum,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160001-01,Standard Platinum On Exchange Plan,,0.896489024162292,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0170003,"Classic $1,800 - 20%",38166WI017,,WIN001,WIS001,WIF002,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170003-05,87% AV Level Silver Plan,87.29%,0.872929096221924,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0170003,"Classic $1,800 - 20%",38166WI017,,WIN001,WIS001,WIF002,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170003-06,94% AV Level Silver Plan,93.32%,0.933220684528351,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160002,"Reliance $1,000 - 20%",38166WI016,,WIN002,WIS002,WIF005,Existing,EPO,Gold,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160002-00,Standard Gold Off Exchange Plan,,0.786382079124451,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160002,"Reliance $1,000 - 20%",38166WI016,,WIN002,WIS002,WIF005,Existing,EPO,Gold,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160002-01,Standard Gold On Exchange Plan,,0.786382079124451,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0170004,"Classic $2,000 - 30%",38166WI017,,WIN001,WIS001,WIF002,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170004-00,Standard Silver Off Exchange Plan,69.50%,0.691363513469696,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0170004,"Classic $2,000 - 30%",38166WI017,,WIN001,WIS001,WIF002,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170004-01,Standard Silver On Exchange Plan,69.50%,0.691363513469696,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160003,"Reliance $1,000 - 40%",38166WI016,,WIN002,WIS002,WIF003,Existing,EPO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160003-00,Standard Silver Off Exchange Plan,,0.702124893665314,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160003,"Reliance $1,000 - 40%",38166WI016,,WIN002,WIS002,WIF003,Existing,EPO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160003-01,Standard Silver On Exchange Plan,,0.702124893665314,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0170004,"Classic $2,000 - 30%",38166WI017,,WIN001,WIS001,WIF002,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170004-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160004,"Reliance $1,500 - 30%",38166WI016,,WIN002,WIS002,WIF003,Existing,EPO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160004-01,Standard Silver On Exchange Plan,,0.700253307819366,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0170004,"Classic $2,000 - 30%",38166WI017,,WIN001,WIS001,WIF002,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170004-04,73% AV Level Silver Plan,73.28%,0.732791364192963,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0170007,"Classic $5,500 HDHP",38166WI017,,WIN001,WIS001,WIF003,Existing,HMO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170007-01,Standard Bronze On Exchange Plan,59.46%,0.594647645950317,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160005,"Reliance $2,000 - HDHP",38166WI016,,WIN002,WIS002,WIF006,Existing,EPO,Gold,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160005-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160005,"Reliance $2,000 - HDHP",38166WI016,,WIN002,WIS002,WIF006,Existing,EPO,Gold,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160005-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0170007,"Classic $5,500 HDHP",38166WI017,,WIN001,WIS001,WIF003,Existing,HMO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0170008,"Classic $6,600",38166WI017,,WIN001,WIS001,WIF006,Existing,HMO,Catastrophic,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170008-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,42
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0170008,"Classic $6,600",38166WI017,,WIN001,WIS001,WIF006,Existing,HMO,Catastrophic,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170008-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,43
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0180008,"Select $6,600",38166WI018,,WIN002,WIS002,WIF006,Existing,EPO,Catastrophic,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180008-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,44
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0180008,"Select $6,600",38166WI018,,WIN002,WIS002,WIF006,Existing,EPO,Catastrophic,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180008-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,45
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0010097,Dean Classic 3000X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010097-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0010097,Dean Classic 3000X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010097-03,Limited Cost Sharing Plan Variation,,0.681259632110596,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0010097,Dean Classic 3000X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010097-04,73% AV Level Silver Plan,,0.739331245422363,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0010097,Dean Classic 3000X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010097-05,87% AV Level Silver Plan,,0.876643180847168,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0010097,Dean Classic 3000X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010097-06,94% AV Level Silver Plan,,0.939289629459381,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$175,$350,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0010098,Dean Classic 4500X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010098-00,Standard Silver Off Exchange Plan,,0.695580661296844,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0170004,"Classic $2,000 - 30%",38166WI017,,WIN001,WIS001,WIF002,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170004-05,87% AV Level Silver Plan,87.88%,0.878813982009888,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150001,Independence $500  - 10%,38166WI015,,WIN001,WIS001,WIF007,Existing,POS,Platinum,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150001-00,Standard Platinum Off Exchange Plan,,0.896489024162292,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$1,750","$3,500","$2,750","$5,500",$500,"$1,000",10%,,,,$750,"$1,500","$1,250","$2,500",$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150001,Independence $500  - 10%,38166WI015,,WIN001,WIS001,WIF007,Existing,POS,Platinum,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150001-01,Standard Platinum On Exchange Plan,,0.896489024162292,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$1,750","$3,500","$2,750","$5,500",$500,"$1,000",10%,,,,$750,"$1,500","$1,250","$2,500",$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0170004,"Classic $2,000 - 30%",38166WI017,,WIN001,WIS001,WIF002,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170004-06,94% AV Level Silver Plan,93.32%,0.933220684528351,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0180001,"Select $1,000 - 20%",38166WI018,,WIN002,WIS002,WIF001,Existing,EPO,Gold,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180001-00,Standard Gold Off Exchange Plan,80.70%,0.797870516777039,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150002,"Independence $1,000 - 20%",38166WI015,,WIN001,WIS001,WIF005,Existing,POS,Gold,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150002-00,Standard Gold Off Exchange Plan,,0.786382079124451,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$7,500","$15,000","$12,500","$25,000","$1,000","$2,000",20%,,,,"$1,500","$3,000","$2,500","$5,000",$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150002,"Independence $1,000 - 20%",38166WI015,,WIN001,WIS001,WIF005,Existing,POS,Gold,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150002-01,Standard Gold On Exchange Plan,,0.786382079124451,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$7,500","$15,000","$12,500","$25,000","$1,000","$2,000",20%,,,,"$1,500","$3,000","$2,500","$5,000",$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0180001,"Select $1,000 - 20%",38166WI018,,WIN002,WIS002,WIF001,Existing,EPO,Gold,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180001-01,Standard Gold On Exchange Plan,80.70%,0.797870516777039,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0180001,"Select $1,000 - 20%",38166WI018,,WIN002,WIS002,WIF001,Existing,EPO,Gold,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150003,"Independence - $1,000 - 40%",38166WI015,,WIN001,WIS001,WIF003,Existing,POS,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150003-00,Standard Silver Off Exchange Plan,,0.702124893665314,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$7,750","$15,500","$13,750","$27,500","$1,000","$2,000",40%,,,,"$1,500","$3,000","$2,500","$5,000",$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0180003,"Select $1,800 - 20%",38166WI018,,WIN002,WIS002,WIF002,Existing,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180003-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0180003,"Select $1,800 - 20%",38166WI018,,WIN002,WIS002,WIF002,Existing,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180003-03,Limited Cost Sharing Plan Variation,71.50%,0.713086247444153,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,800","$3,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0180003,"Select $1,800 - 20%",38166WI018,,WIN002,WIS002,WIF002,Existing,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180003-04,73% AV Level Silver Plan,73.92%,0.73924720287323,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0180003,"Select $1,800 - 20%",38166WI018,,WIN002,WIS002,WIF002,Existing,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180003-05,87% AV Level Silver Plan,87.29%,0.872929096221924,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0180003,"Select $1,800 - 20%",38166WI018,,WIN002,WIS002,WIF002,Existing,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180003-06,94% AV Level Silver Plan,93.32%,0.933220684528351,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0180004,"Select $2,000 - 30%",38166WI018,,WIN002,WIS002,WIF002,Existing,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180004-00,Standard Silver Off Exchange Plan,69.50%,0.691363513469696,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0180004,"Select $2,000 - 30%",38166WI018,,WIN002,WIS002,WIF002,Existing,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180004-01,Standard Silver On Exchange Plan,69.50%,0.691363513469696,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0180004,"Select $2,000 - 30%",38166WI018,,WIN002,WIS002,WIF002,Existing,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180004-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0180004,"Select $2,000 - 30%",38166WI018,,WIN002,WIS002,WIF002,Existing,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180004-03,Limited Cost Sharing Plan Variation,69.50%,0.691363513469696,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,1,38166,WI,Individual,No,39-1572880,38166WI0180004,"Select $2,000 - 30%",38166WI018,,WIN002,WIS002,WIF002,Existing,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180004-04,73% AV Level Silver Plan,73.28%,0.732791364192963,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0170002,"Classic $3,000 HDHP",38166WI017,,WIN001,WIS001,WIF006,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140003,"Tradition $1,500 - 20% HDHP",38166WI014,,WIN001,WIS001,WIF004,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140003-00,Standard Gold Off Exchange Plan,,0.797334671020508,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140003,"Tradition $1,500 - 20% HDHP",38166WI014,,WIN001,WIS001,WIF004,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140003-01,Standard Gold On Exchange Plan,,0.797334671020508,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0170002,"Classic $3,000 HDHP",38166WI017,,WIN001,WIS001,WIF006,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170002-03,Limited Cost Sharing Plan Variation,71.70%,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0170002,"Classic $3,000 HDHP",38166WI017,,WIN001,WIS001,WIF006,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170002-04,73% AV Level Silver Plan,73.73%,0.737290322780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,675","$5,350",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,675","$5,350",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140005,"Tradition $1,750 - 20% HDHP",38166WI014,,WIN001,WIS001,WIF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140005-00,Standard Silver Off Exchange Plan,,0.686293601989746,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140005,"Tradition $1,750 - 20% HDHP",38166WI014,,WIN001,WIS001,WIF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140005-01,Standard Silver On Exchange Plan,,0.686293601989746,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0170002,"Classic $3,000 HDHP",38166WI017,,WIN001,WIS001,WIF006,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170002-05,87% AV Level Silver Plan,87.65%,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0170002,"Classic $3,000 HDHP",38166WI017,,WIN001,WIS001,WIF006,Existing,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170002-06,94% AV Level Silver Plan,94.49%,0.944938838481903,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140008,"Tradition $2,000 - 10% HDHP",38166WI014,,WIN001,WIS001,WIF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140008-00,Standard Silver Off Exchange Plan,,0.691667020320892,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140008,"Tradition $2,000 - 10% HDHP",38166WI014,,WIN001,WIS001,WIF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140008-01,Standard Silver On Exchange Plan,,0.691667020320892,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0170005,"Classic $5,000 HDHP",38166WI017,,WIN001,WIS001,WIF003,Existing,HMO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170005-00,Standard Bronze Off Exchange Plan,60.48%,0.604778349399567,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0170005,"Classic $5,000 HDHP",38166WI017,,WIN001,WIS001,WIF003,Existing,HMO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170005-01,Standard Bronze On Exchange Plan,60.48%,0.604778349399567,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140009,"Tradition $4,000 - 20% HDHP",38166WI014,,WIN001,WIS001,WIF003,Existing,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140009-00,Standard Bronze Off Exchange Plan,,0.614021420478821,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140009,"Tradition $4,000 - 20% HDHP",38166WI014,,WIN001,WIS001,WIF003,Existing,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140009-01,Standard Bronze On Exchange Plan,,0.614021420478821,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0170005,"Classic $5,000 HDHP",38166WI017,,WIN001,WIS001,WIF003,Existing,HMO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0170005,"Classic $5,000 HDHP",38166WI017,,WIN001,WIS001,WIF003,Existing,HMO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170005-03,Limited Cost Sharing Plan Variation,60.48%,0.604778349399567,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140010,"Tradition $3,350 - 40% HDHP",38166WI014,,WIN001,WIS001,WIF003,Existing,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140010-00,Standard Bronze Off Exchange Plan,,0.613374412059784,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,350","$6,700",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140010,"Tradition $3,350 - 40% HDHP",38166WI014,,WIN001,WIS001,WIF003,Existing,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140010-01,Standard Bronze On Exchange Plan,,0.613374412059784,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,350","$6,700",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0170007,"Classic $5,500 HDHP",38166WI017,,WIN001,WIS001,WIF003,Existing,HMO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170007-00,Standard Bronze Off Exchange Plan,59.46%,0.594647645950317,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160007,"Reliance $1,750 - 20% HDHP",38166WI016,,WIN002,WIS002,WIF003,Existing,EPO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160007-01,Standard Silver On Exchange Plan,,0.686293601989746,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0180002,"Select $3,000 HDHP",38166WI018,,WIN002,WIS002,WIF006,Existing,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,3,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150011,"Independence $2,500 - 20%",38166WI015,,WIN001,WIS001,WIF003,New,POS,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150011-01,Standard Silver On Exchange Plan,,0.710424304008484,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,750","$19,500","$16,100","$32,200","$2,500","$5,000",20%,,,,"$3,750","$7,500","$6,250","$12,500",$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,3,38166,WI,Individual,No,39-1572880,38166WI0170009,"Classic $4,500 - 30%",38166WI017,,WIN001,WIS001,WIF008,New,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170009-05,87% AV Level Silver Plan,86.77%,0.867691099643707,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,3,38166,WI,Individual,No,39-1572880,38166WI0170009,"Classic $4,500 - 30%",38166WI017,,WIN001,WIS001,WIF008,New,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170009-06,94% AV Level Silver Plan,94.65%,0.946492075920105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,3,38166,WI,Individual,No,39-1572880,38166WI0180009,"Select  $4,500 - 30%",38166WI018,,WIN002,WIS002,WIF008,New,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180009-00,Standard Silver Off Exchange Plan,68.01%,0.680108964443207,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,3,38166,WI,Individual,No,39-1572880,38166WI0180009,"Select  $4,500 - 30%",38166WI018,,WIN002,WIS002,WIF008,New,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180009-01,Standard Silver On Exchange Plan,68.01%,0.680108964443207,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,3,38166,WI,Individual,No,39-1572880,38166WI0180009,"Select  $4,500 - 30%",38166WI018,,WIN002,WIS002,WIF008,New,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,3,38166,WI,Individual,No,39-1572880,38166WI0180009,"Select  $4,500 - 30%",38166WI018,,WIN002,WIS002,WIF008,New,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180009-03,Limited Cost Sharing Plan Variation,68.01%,0.680108964443207,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,3,38166,WI,Individual,No,39-1572880,38166WI0180009,"Select  $4,500 - 30%",38166WI018,,WIN002,WIS002,WIF008,New,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180009-04,73% AV Level Silver Plan,72.66%,0.726611316204071,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,3,38166,WI,Individual,No,39-1572880,38166WI0180009,"Select  $4,500 - 30%",38166WI018,,WIN002,WIS002,WIF008,New,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180009-05,87% AV Level Silver Plan,86.77%,0.867691099643707,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,3,38166,WI,Individual,No,39-1572880,38166WI0180009,"Select  $4,500 - 30%",38166WI018,,WIN002,WIS002,WIF008,New,EPO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180009-06,94% AV Level Silver Plan,94.65%,0.946492075920105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0060047,Prevea360 Classic 3000X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060047-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0060047,Prevea360 Classic 3000X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060047-03,Limited Cost Sharing Plan Variation,,0.681259632110596,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0060048,Prevea360 Classic 4500X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060048-05,87% AV Level Silver Plan,,0.876970589160919,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,100","$2,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0060048,Prevea360 Classic 4500X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060048-06,94% AV Level Silver Plan,,0.946281552314758,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,4,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140012,"Tradition $3,000 - HDHP",38166WI014,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140012-00,Standard Silver Off Exchange Plan,,0.708089172840118,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,4,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140012,"Tradition $3,000 - HDHP",38166WI014,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140012-01,Standard Silver On Exchange Plan,,0.708089172840118,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,4,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140013,"Tradition $5,000 - HDHP",38166WI014,,WIN001,WIS001,WIF003,New,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140013-00,Standard Bronze Off Exchange Plan,,0.608729362487793,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,4,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140013,"Tradition $5,000 - HDHP",38166WI014,,WIN001,WIS001,WIF003,New,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140013-01,Standard Bronze On Exchange Plan,,0.608729362487793,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0060047,Prevea360 Classic 3000X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060047-04,73% AV Level Silver Plan,,0.739331245422363,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0060047,Prevea360 Classic 3000X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060047-05,87% AV Level Silver Plan,,0.876643180847168,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0060047,Prevea360 Classic 3000X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060047-06,94% AV Level Silver Plan,,0.939289629459381,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$175,$350,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0060048,Prevea360 Classic 4500X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060048-00,Standard Silver Off Exchange Plan,,0.695580661296844,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0060048,Prevea360 Classic 4500X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060048-01,Standard Silver On Exchange Plan,,0.695580661296844,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0060048,Prevea360 Classic 4500X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060048-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,27
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0060048,Prevea360 Classic 4500X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060048-03,Limited Cost Sharing Plan Variation,,0.695580661296844,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0060048,Prevea360 Classic 4500X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060048-04,73% AV Level Silver Plan,,0.735028386116028,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0180005,"Select $5,000 HDHP",38166WI018,,WIN002,WIS002,WIF003,Existing,EPO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,28
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150005,"Independence $2,000 - HDHP",38166WI015,,WIN001,WIS001,WIF006,Existing,POS,Gold,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150005-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$3,000","$6,000","$5,000","$10,000",,,,,,,,,28
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150005,"Independence $2,000 - HDHP",38166WI015,,WIN001,WIS001,WIF006,Existing,POS,Gold,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150005-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$3,000","$6,000","$5,000","$10,000",,,,,,,,,29
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0180005,"Select $5,000 HDHP",38166WI018,,WIN002,WIS002,WIF003,Existing,EPO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180005-03,Limited Cost Sharing Plan Variation,60.48%,0.604778349399567,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,29
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150006,"Independence $1,500 -20% HDHP",38166WI015,,WIN001,WIS001,WIF004,Existing,POS,Gold,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150006-00,Standard Gold Off Exchange Plan,,0.797334671020508,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$3,000","$6,000","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$2,250","$4,500","$3,750","$7,500",,,,,,,,,30
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0180007,"Select $5,500 HDHP",38166WI018,,WIN002,WIS002,WIF003,Existing,EPO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180007-00,Standard Bronze Off Exchange Plan,59.46%,0.594647645950317,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,30
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0180007,"Select $5,500 HDHP",38166WI018,,WIN002,WIS002,WIF003,Existing,EPO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180007-01,Standard Bronze On Exchange Plan,59.46%,0.594647645950317,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,31
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150006,"Independence $1,500 -20% HDHP",38166WI015,,WIN001,WIS001,WIF004,Existing,POS,Gold,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150006-01,Standard Gold On Exchange Plan,,0.797334671020508,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$3,000","$6,000","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$2,250","$4,500","$3,750","$7,500",,,,,,,,,31
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0060044,Prevea360 Copay Plus 1000X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Gold,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060044-00,Standard Gold Off Exchange Plan,,0.802473604679108,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0060044,Prevea360 Copay Plus 1000X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Gold,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060044-01,Standard Gold On Exchange Plan,,0.802473604679108,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0060044,Prevea360 Copay Plus 1000X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Gold,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060044-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,24
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0060044,Prevea360 Copay Plus 1000X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Gold,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060044-03,Limited Cost Sharing Plan Variation,,0.802473604679108,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0060045,Prevea360 Copay Plus 2000X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060045-00,Standard Silver Off Exchange Plan,,0.715749859809875,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0060045,Prevea360 Copay Plus 2000X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060045-01,Standard Silver On Exchange Plan,,0.715749859809875,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0060045,Prevea360 Copay Plus 2000X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060045-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,28
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0060045,Prevea360 Copay Plus 2000X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060045-03,Limited Cost Sharing Plan Variation,,0.715749859809875,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0060045,Prevea360 Copay Plus 2000X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060045-04,73% AV Level Silver Plan,,0.737549364566803,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0060045,Prevea360 Copay Plus 2000X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060045-05,87% AV Level Silver Plan,,0.877905964851379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0060045,Prevea360 Copay Plus 2000X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060045-06,94% AV Level Silver Plan,,0.946377992630005,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$200,$400,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0060046,Prevea360 Copay Plus 3500X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060046-00,Standard Silver Off Exchange Plan,,0.70142388343811,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0060046,Prevea360 Copay Plus 3500X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060046-01,Standard Silver On Exchange Plan,,0.70142388343811,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0060046,Prevea360 Copay Plus 3500X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060046-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,35
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150007,"Independence $1,750 - 20% HDHP",38166WI015,,WIN001,WIS001,WIF003,Existing,POS,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150007-00,Standard Silver Off Exchange Plan,,0.686293601989746,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,"$8,625","$17,250","$14,375","$28,750",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",20%,,,,"$2,625","$5,250","$4,375","$8,750",,,,,,,,,32
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0180007,"Select $5,500 HDHP",38166WI018,,WIN002,WIS002,WIF003,Existing,EPO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,32
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0180007,"Select $5,500 HDHP",38166WI018,,WIN002,WIS002,WIF003,Existing,EPO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180007-03,Limited Cost Sharing Plan Variation,59.46%,0.594647645950317,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,33
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150007,"Independence $1,750 - 20% HDHP",38166WI015,,WIN001,WIS001,WIF003,Existing,POS,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150007-01,Standard Silver On Exchange Plan,,0.686293601989746,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,"$8,625","$17,250","$14,375","$28,750",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",20%,,,,"$2,625","$5,250","$4,375","$8,750",,,,,,,,,33
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150008,"Independence $2,000 - 10% HDHP",38166WI015,,WIN001,WIS001,WIF003,Existing,POS,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150008-00,Standard Silver Off Exchange Plan,,0.691667020320892,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$11,000","$22,000","$17,000","$34,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,,,,"$3,000","$6,000","$5,000","$10,000",,,,,,,,,34
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0180006,"Select $6,000 HDHP",38166WI018,,WIN002,WIS002,WIF003,Existing,EPO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180006-00,Standard Bronze Off Exchange Plan,58.27%,0.582668662071228,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,34
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0180006,"Select $6,000 HDHP",38166WI018,,WIN002,WIS002,WIF003,Existing,EPO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180006-01,Standard Bronze On Exchange Plan,58.27%,0.582668662071228,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,35
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150008,"Independence $2,000 - 10% HDHP",38166WI015,,WIN001,WIS001,WIF003,Existing,POS,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150008-01,Standard Silver On Exchange Plan,,0.691667020320892,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$11,000","$22,000","$17,000","$34,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,,,,"$3,000","$6,000","$5,000","$10,000",,,,,,,,,35
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150009,"Independence $4,000 - 20% HDHP",38166WI015,,WIN001,WIS001,WIF003,Existing,POS,Bronze,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150009-00,Standard Bronze Off Exchange Plan,,0.614021420478821,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$9,000","$18,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$6,000","$12,000","$10,000","$20,000",,,,,,,,,36
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0180006,"Select $6,000 HDHP",38166WI018,,WIN002,WIS002,WIF003,Existing,EPO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,36
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0180006,"Select $6,000 HDHP",38166WI018,,WIN002,WIS002,WIF003,Existing,EPO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0180006-03,Limited Cost Sharing Plan Variation,58.27%,0.582668662071228,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,37
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150009,"Independence $4,000 - 20% HDHP",38166WI015,,WIN001,WIS001,WIF003,Existing,POS,Bronze,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150009-01,Standard Bronze On Exchange Plan,,0.614021420478821,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$9,000","$18,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$6,000","$12,000","$10,000","$20,000",,,,,,,,,37
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150010,"Independence $3,350 - 40% HDHP",38166WI015,,WIN001,WIS001,WIF003,Existing,POS,Bronze,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150010-00,Standard Bronze Off Exchange Plan,,0.613374412059784,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,775","$17,550","$15,125","$30,250",,,,,,,,,,,,,,,,,,,,,"$3,350","$6,700",40%,,,,"$5,025","$10,050","$8,375","$16,750",,,,,,,,,38
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0170006,"Classic $6,000 HDHP",38166WI017,,WIN001,WIS001,WIF003,Existing,HMO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170006-00,Standard Bronze Off Exchange Plan,58.27%,0.582668662071228,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,38
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0170006,"Classic $6,000 HDHP",38166WI017,,WIN001,WIS001,WIF003,Existing,HMO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170006-01,Standard Bronze On Exchange Plan,58.27%,0.582668662071228,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,39
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150010,"Independence $3,350 - 40% HDHP",38166WI015,,WIN001,WIS001,WIF003,Existing,POS,Bronze,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150010-01,Standard Bronze On Exchange Plan,,0.613374412059784,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,775","$17,550","$15,125","$30,250",,,,,,,,,,,,,,,,,,,,,"$3,350","$6,700",40%,,,,"$5,025","$10,050","$8,375","$16,750",,,,,,,,,39
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0170006,"Classic $6,000 HDHP",38166WI017,,WIN001,WIS001,WIF003,Existing,HMO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,40
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,2,38166,WI,Individual,No,39-1572880,38166WI0170006,"Classic $6,000 HDHP",38166WI017,,WIN001,WIS001,WIF003,Existing,HMO,Bronze,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170006-03,Limited Cost Sharing Plan Variation,58.27%,0.582668662071228,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,41
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,3,38166,WI,Individual,No,39-1572880,38166WI0170009,"Classic $4,500 - 30%",38166WI017,,WIN001,WIS001,WIF008,New,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170009-00,Standard Silver Off Exchange Plan,68.01%,0.680108964443207,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,3,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140011,Tradition $2500 - 20%,38166WI014,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140011-00,Standard Silver Off Exchange Plan,,0.710424304008484,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,3,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0140011,Tradition $2500 - 20%,38166WI014,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0140011-01,Standard Silver On Exchange Plan,,0.710424304008484,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,3,38166,WI,Individual,No,39-1572880,38166WI0170009,"Classic $4,500 - 30%",38166WI017,,WIN001,WIS001,WIF008,New,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170009-01,Standard Silver On Exchange Plan,68.01%,0.680108964443207,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,3,38166,WI,Individual,No,39-1572880,38166WI0170009,"Classic $4,500 - 30%",38166WI017,,WIN001,WIS001,WIF008,New,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,3,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160011,Reliance $2500 - 20%,38166WI016,,WIN002,WIS002,WIF003,New,EPO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160011-00,Standard Silver Off Exchange Plan,,0.710424304008484,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,3,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160011,Reliance $2500 - 20%,38166WI016,,WIN002,WIS002,WIF003,New,EPO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160011-01,Standard Silver On Exchange Plan,,0.710424304008484,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,3,38166,WI,Individual,No,39-1572880,38166WI0170009,"Classic $4,500 - 30%",38166WI017,,WIN001,WIS001,WIF008,New,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170009-03,Limited Cost Sharing Plan Variation,68.01%,0.680108964443207,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,3,38166,WI,Individual,No,39-1572880,38166WI0170009,"Classic $4,500 - 30%",38166WI017,,WIN001,WIS001,WIF008,New,HMO,Silver,Yes,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://securityhealth.healthinsurance-asp.com/shp/shopping/anonymous.html#welcome,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/individual-and-family,http://securityhealth.org/formulary,38166WI0170009-04,73% AV Level Silver Plan,72.66%,0.726611316204071,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,3,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150011,"Independence $2,500 - 20%",38166WI015,,WIN001,WIS001,WIF003,New,POS,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150011-00,Standard Silver Off Exchange Plan,,0.710424304008484,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,750","$19,500","$16,100","$32,200","$2,500","$5,000",20%,,,,"$3,750","$7,500","$6,250","$12,500",$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,4,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160012,"Reliance $3,000 - HDHP",38166WI016,,WIN002,WIS002,WIF003,New,EPO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160012-00,Standard Silver Off Exchange Plan,,0.708089172840118,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,4,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160012,"Reliance $3,000 - HDHP",38166WI016,,WIN002,WIS002,WIF003,New,EPO,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160012-01,Standard Silver On Exchange Plan,,0.708089172840118,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,4,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160013,"Reliance $5,000 - HDHP",38166WI016,,WIN002,WIS002,WIF003,New,EPO,Bronze,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160013-00,Standard Bronze Off Exchange Plan,,0.608729362487793,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,4,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0160013,"Reliance $5,000 - HDHP",38166WI016,,WIN002,WIS002,WIF003,New,EPO,Bronze,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,Urgent and Emergent Care Only,No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0160013-01,Standard Bronze On Exchange Plan,,0.608729362487793,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,4,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150012,"Independence $3,000 - HDHP",38166WI015,,WIN001,WIS001,WIF006,New,POS,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150012-00,Standard Silver Off Exchange Plan,,0.708089172840118,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$5,000","$10,000","$8,000","$16,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$4,500","$9,000","$7,500","$15,000",,,,,,,,,12
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,4,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150012,"Independence $3,000 - HDHP",38166WI015,,WIN001,WIS001,WIF006,New,POS,Silver,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150012-01,Standard Silver On Exchange Plan,,0.708089172840118,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$5,000","$10,000","$8,000","$16,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$4,500","$9,000","$7,500","$15,000",,,,,,,,,13
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,4,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150013,"Independence $5,000 - HDHP",38166WI015,,WIN001,WIS001,WIF003,New,POS,Bronze,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150013-00,Standard Bronze Off Exchange Plan,,0.608729362487793,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,350","$16,700","$14,700","$29,400",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,"$7,500","$15,000","$12,500","$25,000",,,,,,,,,14
2015,WI,38166,HIOS,6,2014-11-11 04:41:18,4,38166,WI,SHOP (Small Group),No,39-1572880,38166WI0150013,"Independence $5,000 - HDHP",38166WI015,,WIN001,WIS001,WIF003,New,POS,Bronze,No,Both,Yes,Yes,"Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergent Care Only,Yes,"Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care",No,https://www.securityhealth.org/find-your-plan/employer-groups/2015-small-group/sbc,www.securityhealth.org/onlinepayment,https://www.securityhealth.org/find-your-plan/employer-groups/small-group,http://securityhealth.org/formulary,38166WI0150013-01,Standard Bronze On Exchange Plan,,0.608729362487793,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,350","$16,700","$14,700","$29,400",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,"$7,500","$15,000","$12,500","$25,000",,,,,,,,,15
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0010094,Dean Copay Plus 1000X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010094-00,Standard Gold Off Exchange Plan,,0.802473604679108,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0010094,Dean Copay Plus 1000X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010094-01,Standard Gold On Exchange Plan,,0.802473604679108,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0010094,Dean Copay Plus 1000X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010094-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0010094,Dean Copay Plus 1000X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Gold,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010094-03,Limited Cost Sharing Plan Variation,,0.802473604679108,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0010095,Dean Copay Plus 2000X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010095-00,Standard Silver Off Exchange Plan,,0.715749859809875,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0010095,Dean Copay Plus 2000X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010095-01,Standard Silver On Exchange Plan,,0.715749859809875,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0010095,Dean Copay Plus 2000X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010095-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0010095,Dean Copay Plus 2000X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010095-03,Limited Cost Sharing Plan Variation,,0.715749859809875,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0010095,Dean Copay Plus 2000X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010095-04,73% AV Level Silver Plan,,0.737549364566803,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0010095,Dean Copay Plus 2000X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010095-05,87% AV Level Silver Plan,,0.877905964851379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0010095,Dean Copay Plus 2000X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010095-06,94% AV Level Silver Plan,,0.946377992630005,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$200,$400,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0010096,Dean Copay Plus 3500X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010096-00,Standard Silver Off Exchange Plan,,0.70142388343811,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0010096,Dean Copay Plus 3500X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010096-01,Standard Silver On Exchange Plan,,0.70142388343811,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0010096,Dean Copay Plus 3500X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010096-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0010096,Dean Copay Plus 3500X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010096-03,Limited Cost Sharing Plan Variation,,0.70142388343811,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0010096,Dean Copay Plus 3500X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010096-04,73% AV Level Silver Plan,,0.737001180648804,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0010096,Dean Copay Plus 3500X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010096-05,87% AV Level Silver Plan,,0.877905964851379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0010096,Dean Copay Plus 3500X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010096-06,94% AV Level Silver Plan,,0.946377992630005,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$200,$400,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0060046,Prevea360 Copay Plus 3500X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060046-03,Limited Cost Sharing Plan Variation,,0.70142388343811,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0060046,Prevea360 Copay Plus 3500X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060046-04,73% AV Level Silver Plan,,0.737001180648804,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0060046,Prevea360 Copay Plus 3500X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060046-05,87% AV Level Silver Plan,,0.877905964851379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,1,38345,WI,Individual,No,39-1535024,38345WI0060046,Prevea360 Copay Plus 3500X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060046-06,94% AV Level Silver Plan,,0.946377992630005,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$200,$400,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0010097,Dean Classic 3000X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010097-00,Standard Silver Off Exchange Plan,,0.681259632110596,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0010097,Dean Classic 3000X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010097-01,Standard Silver On Exchange Plan,,0.681259632110596,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0010098,Dean Classic 4500X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010098-01,Standard Silver On Exchange Plan,,0.695580661296844,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0010098,Dean Classic 4500X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010098-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0010098,Dean Classic 4500X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010098-03,Limited Cost Sharing Plan Variation,,0.695580661296844,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0010098,Dean Classic 4500X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010098-04,73% AV Level Silver Plan,,0.735028386116028,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0010098,Dean Classic 4500X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010098-05,87% AV Level Silver Plan,,0.876970589160919,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,100","$2,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0010098,Dean Classic 4500X,38345WI001,,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010098-06,94% AV Level Silver Plan,,0.946281552314758,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0060047,Prevea360 Classic 3000X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060047-00,Standard Silver Off Exchange Plan,,0.681259632110596,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,2,38345,WI,Individual,No,39-1535024,38345WI0060047,Prevea360 Classic 3000X,38345WI006,,WIN003,WIS004,WIF005,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060047-01,Standard Silver On Exchange Plan,,0.681259632110596,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0010099,Dean Value 5250X,38345WI001,,WIN001,WIS003,WIF003,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010099-00,Standard Silver Off Exchange Plan,,0.685750246047974,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,250","$10,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0010099,Dean Value 5250X,38345WI001,,WIN001,WIS003,WIF003,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010099-01,Standard Silver On Exchange Plan,,0.685750246047974,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,250","$10,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0010099,Dean Value 5250X,38345WI001,,WIN001,WIS003,WIF003,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010099-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0010099,Dean Value 5250X,38345WI001,,WIN001,WIS003,WIF003,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010099-03,Limited Cost Sharing Plan Variation,,0.685750246047974,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,250","$10,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0010099,Dean Value 5250X,38345WI001,,WIN001,WIS003,WIF003,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010099-04,73% AV Level Silver Plan,,0.737922608852386,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,900","$7,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900","$7,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0010099,Dean Value 5250X,38345WI001,,WIN001,WIS003,WIF003,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010099-05,87% AV Level Silver Plan,,0.878001689910889,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300","$2,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0010099,Dean Value 5250X,38345WI001,,WIN001,WIS003,WIF003,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010099-06,94% AV Level Silver Plan,,0.945298612117767,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0010100,Dean Value 5000X,38345WI001,,WIN001,WIS003,WIF004,New,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010100-00,Standard Bronze Off Exchange Plan,,0.617459774017334,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0010100,Dean Value 5000X,38345WI001,,WIN001,WIS003,WIF004,New,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010100-01,Standard Bronze On Exchange Plan,,0.617459774017334,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0010100,Dean Value 5000X,38345WI001,,WIN001,WIS003,WIF004,New,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010100-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0010100,Dean Value 5000X,38345WI001,,WIN001,WIS003,WIF004,New,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010100-03,Limited Cost Sharing Plan Variation,,0.617459774017334,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0010101,Dean Value 6600X,38345WI001,,WIN001,WIS003,WIF004,New,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010101-00,Standard Bronze Off Exchange Plan,,0.618175208568573,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0010101,Dean Value 6600X,38345WI001,,WIN001,WIS003,WIF004,New,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010101-01,Standard Bronze On Exchange Plan,,0.618175208568573,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0010101,Dean Value 6600X,38345WI001,,WIN001,WIS003,WIF004,New,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010101-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0010101,Dean Value 6600X,38345WI001,,WIN001,WIS003,WIF004,New,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010101-03,Limited Cost Sharing Plan Variation,,0.618175208568573,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0080018,Dean Value Focus 5250X,38345WI008,,WIN002,WIS002,WIF003,New,EPO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0080018-00,Standard Silver Off Exchange Plan,,0.685750246047974,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,250","$10,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0080018,Dean Value Focus 5250X,38345WI008,,WIN002,WIS002,WIF003,New,EPO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0080018-01,Standard Silver On Exchange Plan,,0.685750246047974,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,250","$10,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0080018,Dean Value Focus 5250X,38345WI008,,WIN002,WIS002,WIF003,New,EPO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0080018-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0080018,Dean Value Focus 5250X,38345WI008,,WIN002,WIS002,WIF003,New,EPO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0080018-03,Limited Cost Sharing Plan Variation,,0.685750246047974,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,250","$10,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0080018,Dean Value Focus 5250X,38345WI008,,WIN002,WIS002,WIF003,New,EPO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0080018-04,73% AV Level Silver Plan,,0.737922608852386,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,900","$7,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900","$7,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0080018,Dean Value Focus 5250X,38345WI008,,WIN002,WIS002,WIF003,New,EPO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0080018-05,87% AV Level Silver Plan,,0.878001689910889,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300","$2,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0080018,Dean Value Focus 5250X,38345WI008,,WIN002,WIS002,WIF003,New,EPO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0080018-06,94% AV Level Silver Plan,,0.945298612117767,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0080019,Dean Value Focus 5000X,38345WI008,,WIN002,WIS002,WIF004,New,EPO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0080019-00,Standard Bronze Off Exchange Plan,,0.617459774017334,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0080019,Dean Value Focus 5000X,38345WI008,,WIN002,WIS002,WIF004,New,EPO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0080019-01,Standard Bronze On Exchange Plan,,0.617459774017334,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0080019,Dean Value Focus 5000X,38345WI008,,WIN002,WIS002,WIF004,New,EPO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0080019-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,28
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0080019,Dean Value Focus 5000X,38345WI008,,WIN002,WIS002,WIF004,New,EPO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0080019-03,Limited Cost Sharing Plan Variation,,0.617459774017334,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030003,UnitedHealthcare Gold Compass 500,39924WI003,,WIN006,WIS001,WIF003,New,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030003-01,Standard Gold On Exchange Plan,78.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030003,UnitedHealthcare Gold Compass 500,39924WI003,,WIN006,WIS001,WIF003,New,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030003-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030003,UnitedHealthcare Gold Compass 500,39924WI003,,WIN006,WIS001,WIF003,New,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030003-03,Limited Cost Sharing Plan Variation,78.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030006,UnitedHealthcare Silver Compass 2000,39924WI003,,WIN006,WIS001,WIF006,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030006-00,Standard Silver Off Exchange Plan,69.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0080020,Dean Value Focus 6600X,38345WI008,,WIN002,WIS002,WIF004,New,EPO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0080020-00,Standard Bronze Off Exchange Plan,,0.618175208568573,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0080020,Dean Value Focus 6600X,38345WI008,,WIN002,WIS002,WIF004,New,EPO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0080020-01,Standard Bronze On Exchange Plan,,0.618175208568573,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,1,39924,WI,Individual,No,35-1665915,39924WI0030005,UnitedHealthcare Silver Compass HSA 1600,39924WI003,,WIN006,WIS001,WIF006,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030005-04,73% AV Level Silver Plan,72.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,1,39924,WI,Individual,No,35-1665915,39924WI0030005,UnitedHealthcare Silver Compass HSA 1600,39924WI003,,WIN006,WIS001,WIF006,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030005-05,87% AV Level Silver Plan,86.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,1,39924,WI,Individual,No,35-1665915,39924WI0030005,UnitedHealthcare Silver Compass HSA 1600,39924WI003,,WIN006,WIS001,WIF006,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030005-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,1,39924,WI,Individual,No,35-1665915,39924WI0030009,UnitedHealthcare Bronze Compass HSA 4900,39924WI003,,WIN006,WIS001,WIF006,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030009-00,Standard Bronze Off Exchange Plan,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,1,39924,WI,Individual,No,35-1665915,39924WI0030009,UnitedHealthcare Bronze Compass HSA 4900,39924WI003,,WIN006,WIS001,WIF006,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030009-01,Standard Bronze On Exchange Plan,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,1,39924,WI,Individual,No,35-1665915,39924WI0030009,UnitedHealthcare Bronze Compass HSA 4900,39924WI003,,WIN006,WIS001,WIF006,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030009-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,1,39924,WI,Individual,No,35-1665915,39924WI0030009,UnitedHealthcare Bronze Compass HSA 4900,39924WI003,,WIN006,WIS001,WIF006,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030009-03,Limited Cost Sharing Plan Variation,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030002,UnitedHealthcare Gold Compass 1250,39924WI003,,WIN006,WIS001,WIF003,New,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030002-00,Standard Gold Off Exchange Plan,79.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,SHOP (Small Group),No,35-1665915,39924WI0040001,UnitedHealthcare Gold Navigate_1000,39924WI004,,WIN005,WIS001,WIF001,New,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,No,No,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shopwi,,,www.uhc.com/shopwi,39924WI0040001-00,Standard Gold Off Exchange Plan,78.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,SHOP (Small Group),No,35-1665915,39924WI0040001,UnitedHealthcare Gold Navigate_1000,39924WI004,,WIN005,WIS001,WIF001,New,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,No,No,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shopwi,,,www.uhc.com/shopwi,39924WI0040001-01,Standard Gold On Exchange Plan,78.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0080020,Dean Value Focus 6600X,38345WI008,,WIN002,WIS002,WIF004,New,EPO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0080020-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,32
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0080020,Dean Value Focus 6600X,38345WI008,,WIN002,WIS002,WIF004,New,EPO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0080020-03,Limited Cost Sharing Plan Variation,,0.618175208568573,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030007,UnitedHealthcare Silver Compass 3500,39924WI003,,WIN006,WIS001,WIF004,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030007-00,Standard Silver Off Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030007,UnitedHealthcare Silver Compass 3500,39924WI003,,WIN006,WIS001,WIF004,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030007-01,Standard Silver On Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030007,UnitedHealthcare Silver Compass 3500,39924WI003,,WIN006,WIS001,WIF004,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030007-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030007,UnitedHealthcare Silver Compass 3500,39924WI003,,WIN006,WIS001,WIF004,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030007-03,Limited Cost Sharing Plan Variation,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030007,UnitedHealthcare Silver Compass 3500,39924WI003,,WIN006,WIS001,WIF004,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030007-04,73% AV Level Silver Plan,73.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030007,UnitedHealthcare Silver Compass 3500,39924WI003,,WIN006,WIS001,WIF004,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030007-05,87% AV Level Silver Plan,86.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030007,UnitedHealthcare Silver Compass 3500,39924WI003,,WIN006,WIS001,WIF004,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030007-06,94% AV Level Silver Plan,93.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030008,UnitedHealthcare Silver Compass 5000,39924WI003,,WIN006,WIS001,WIF005,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030008-00,Standard Silver Off Exchange Plan,69.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050032,Silver 2000/80,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050032-04,73% AV Level Silver Plan,,0.738161027431488,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$150,$880,$0,"$2,000",$435,$280,$0,31
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050032,Silver 2000/80,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050032-05,87% AV Level Silver Plan,,0.863753616809845,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,600",$100,$320,$0,$800,$400,$0,$0,32
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030008,UnitedHealthcare Silver Compass 5000,39924WI003,,WIN006,WIS001,WIF005,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030008-01,Standard Silver On Exchange Plan,69.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030008,UnitedHealthcare Silver Compass 5000,39924WI003,,WIN006,WIS001,WIF005,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030008-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,28
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030008,UnitedHealthcare Silver Compass 5000,39924WI003,,WIN006,WIS001,WIF005,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030008-03,Limited Cost Sharing Plan Variation,69.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030008,UnitedHealthcare Silver Compass 5000,39924WI003,,WIN006,WIS001,WIF005,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030008-04,73% AV Level Silver Plan,73.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,$750,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0060049,Prevea360 Value 5250X,38345WI006,,WIN003,WIS004,WIF007,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060049-00,Standard Silver Off Exchange Plan,,0.685750246047974,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,250","$10,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0060049,Prevea360 Value 5250X,38345WI006,,WIN003,WIS004,WIF007,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060049-01,Standard Silver On Exchange Plan,,0.685750246047974,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,250","$10,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0060049,Prevea360 Value 5250X,38345WI006,,WIN003,WIS004,WIF007,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060049-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,36
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0060049,Prevea360 Value 5250X,38345WI006,,WIN003,WIS004,WIF007,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060049-03,Limited Cost Sharing Plan Variation,,0.685750246047974,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,250","$10,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0060049,Prevea360 Value 5250X,38345WI006,,WIN003,WIS004,WIF007,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060049-04,73% AV Level Silver Plan,,0.737922608852386,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,900","$7,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900","$7,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0060049,Prevea360 Value 5250X,38345WI006,,WIN003,WIS004,WIF007,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060049-05,87% AV Level Silver Plan,,0.878001689910889,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300","$2,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0060049,Prevea360 Value 5250X,38345WI006,,WIN003,WIS004,WIF007,New,HMO,Silver,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060049-06,94% AV Level Silver Plan,,0.945298612117767,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0060050,Prevea360 Value 5000X,38345WI006,,WIN003,WIS004,WIF008,New,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060050-00,Standard Bronze Off Exchange Plan,,0.617459774017334,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0060050,Prevea360 Value 5000X,38345WI006,,WIN003,WIS004,WIF008,New,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060050-01,Standard Bronze On Exchange Plan,,0.617459774017334,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0060050,Prevea360 Value 5000X,38345WI006,,WIN003,WIS004,WIF008,New,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060050-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,43
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0060050,Prevea360 Value 5000X,38345WI006,,WIN003,WIS004,WIF008,New,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060050-03,Limited Cost Sharing Plan Variation,,0.617459774017334,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0060051,Prevea360 Value 6600X,38345WI006,,WIN003,WIS004,WIF008,New,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060051-00,Standard Bronze Off Exchange Plan,,0.618175208568573,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0060051,Prevea360 Value 6600X,38345WI006,,WIN003,WIS004,WIF008,New,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060051-01,Standard Bronze On Exchange Plan,,0.618175208568573,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0060051,Prevea360 Value 6600X,38345WI006,,WIN003,WIS004,WIF008,New,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060051-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,47
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,3,38345,WI,Individual,No,39-1535024,38345WI0060051,Prevea360 Value 6600X,38345WI006,,WIN003,WIS004,WIF008,New,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060051-03,Limited Cost Sharing Plan Variation,,0.618175208568573,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,4,38345,WI,Individual,No,39-1535024,38345WI0010060,Dean HSA 6250X,38345WI001,,WIN001,WIS003,WIF002,Existing,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010060-00,Standard Bronze Off Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,4,38345,WI,Individual,No,39-1535024,38345WI0010060,Dean HSA 6250X,38345WI001,,WIN001,WIS003,WIF002,Existing,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010060-01,Standard Bronze On Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,4,38345,WI,Individual,No,39-1535024,38345WI0010060,Dean HSA 6250X,38345WI001,,WIN001,WIS003,WIF002,Existing,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010060-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,4,38345,WI,Individual,No,39-1535024,38345WI0010060,Dean HSA 6250X,38345WI001,,WIN001,WIS003,WIF002,Existing,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010060-03,Limited Cost Sharing Plan Variation,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,4,38345,WI,Individual,No,39-1535024,38345WI0080002,Dean HSA Focus 6250X,38345WI008,,WIN002,WIS002,WIF002,Existing,EPO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0080002-00,Standard Bronze Off Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,4,38345,WI,Individual,No,39-1535024,38345WI0080002,Dean HSA Focus 6250X,38345WI008,,WIN002,WIS002,WIF002,Existing,EPO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0080002-01,Standard Bronze On Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,4,38345,WI,Individual,No,39-1535024,38345WI0080002,Dean HSA Focus 6250X,38345WI008,,WIN002,WIS002,WIF002,Existing,EPO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0080002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,4,38345,WI,Individual,No,39-1535024,38345WI0080002,Dean HSA Focus 6250X,38345WI008,,WIN002,WIS002,WIF002,Existing,EPO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0080002-03,Limited Cost Sharing Plan Variation,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,4,38345,WI,Individual,No,39-1535024,38345WI0060010,Prevea360 HSA 6250X,38345WI006,,WIN003,WIS004,WIF006,Existing,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060010-00,Standard Bronze Off Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,4,38345,WI,Individual,No,39-1535024,38345WI0060010,Prevea360 HSA 6250X,38345WI006,,WIN003,WIS004,WIF006,Existing,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060010-01,Standard Bronze On Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,4,38345,WI,Individual,No,39-1535024,38345WI0060010,Prevea360 HSA 6250X,38345WI006,,WIN003,WIS004,WIF006,Existing,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,4,38345,WI,Individual,No,39-1535024,38345WI0060010,Prevea360 HSA 6250X,38345WI006,,WIN003,WIS004,WIF006,Existing,HMO,Bronze,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060010-03,Limited Cost Sharing Plan Variation,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,5,38345,WI,Individual,No,39-1535024,38345WI0010063,Dean Safety Net,38345WI001,,WIN001,WIS001,WIF002,Existing,HMO,Catastrophic,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010063-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,5,38345,WI,Individual,No,39-1535024,38345WI0010063,Dean Safety Net,38345WI001,,WIN001,WIS001,WIF002,Existing,HMO,Catastrophic,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.deancare.com/sbc/Individual.aspx,https://payment.deanhealthplan.com/payment.php,http://www.deancare.com/insurance/find-plan/individual-family/,http://www.deancare.com/insurance/members/drug-formulary/,38345WI0010063-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,5,38345,WI,Individual,No,39-1535024,38345WI0060013,Prevea360 Safety Net,38345WI006,,WIN003,WIS004,WIF006,Existing,HMO,Catastrophic,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060013-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,WI,38345,HIOS,4,2014-09-04 03:25:43,5,38345,WI,Individual,No,39-1535024,38345WI0060013,Prevea360 Safety Net,38345WI006,,WIN003,WIS004,WIF006,Existing,HMO,Catastrophic,No,Both,No,No,,See policy or plan document for additional excluded services.,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,https://app.prevea360.com/sbc/Individual.aspx,https://payment.prevea360.com/payment.php,http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx,http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx,38345WI0060013-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,1,39924,WI,Individual,No,35-1665915,39924WI0030004,UnitedHealthcare Silver Compass HSA 2600,39924WI003,,WIN006,WIS001,WIF003,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030004-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,1,39924,WI,SHOP (Small Group),No,35-1665915,39924WI0040003,UnitedHealthcare Silver Navigate HSA_2500,39924WI004,,WIN005,WIS001,WIF001,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,Yes,Yes,$450.00,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shopwi,,,www.uhc.com/shopwi,39924WI0040003-00,Standard Silver Off Exchange Plan,71.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,1,39924,WI,SHOP (Small Group),No,35-1665915,39924WI0040003,UnitedHealthcare Silver Navigate HSA_2500,39924WI004,,WIN005,WIS001,WIF001,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,Yes,Yes,$450.00,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shopwi,,,www.uhc.com/shopwi,39924WI0040003-01,Standard Silver On Exchange Plan,71.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,1,39924,WI,Individual,No,35-1665915,39924WI0030004,UnitedHealthcare Silver Compass HSA 2600,39924WI003,,WIN006,WIS001,WIF003,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030004-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,1,39924,WI,Individual,No,35-1665915,39924WI0030004,UnitedHealthcare Silver Compass HSA 2600,39924WI003,,WIN006,WIS001,WIF003,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,1,39924,WI,SHOP (Small Group),No,35-1665915,39924WI0040004,UnitedHealthcare Bronze Navigate HSA_5000,39924WI004,,WIN005,WIS001,WIF001,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,Yes,No,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shopwi,,,www.uhc.com/shopwi,39924WI0040004-00,Standard Bronze Off Exchange Plan,61.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,1,39924,WI,SHOP (Small Group),No,35-1665915,39924WI0040004,UnitedHealthcare Bronze Navigate HSA_5000,39924WI004,,WIN005,WIS001,WIF001,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,Yes,No,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shopwi,,,www.uhc.com/shopwi,39924WI0040004-01,Standard Bronze On Exchange Plan,61.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050003,Gold 1000/80,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050003-00,Standard Gold Off Exchange Plan,,0.786036670207977,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$70,"$1,080",$0,"$1,000",$435,$280,$0,4
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050003,Gold 1000/80,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050003-01,Standard Gold On Exchange Plan,,0.786036670207977,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$70,"$1,080",$0,"$1,000",$435,$280,$0,5
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060005,Gold 1000/80,47342WI006,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-groups,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060005-01,Standard Gold On Exchange Plan,,0.804280996322632,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$70,"$1,080",$0,"$1,000",$435,$280,$0,5
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060006,Gold 1000/80,47342WI006,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-groups,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060006-00,Standard Gold Off Exchange Plan,,0.804280996322632,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$70,"$1,080",$0,"$1,000",$435,$280,$0,6
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050003,Gold 1000/80,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050003,Gold 1000/80,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050003-03,Limited Cost Sharing Plan Variation,,0.786036670207977,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$70,"$1,080",$0,"$1,000",$435,$280,$0,7
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,1,39924,WI,Individual,No,35-1665915,39924WI0030004,UnitedHealthcare Silver Compass HSA 2600,39924WI003,,WIN006,WIS001,WIF003,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030004-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,1,39924,WI,Individual,No,35-1665915,39924WI0030004,UnitedHealthcare Silver Compass HSA 2600,39924WI003,,WIN006,WIS001,WIF003,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030004-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,1,39924,WI,Individual,No,35-1665915,39924WI0030004,UnitedHealthcare Silver Compass HSA 2600,39924WI003,,WIN006,WIS001,WIF003,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030004-05,87% AV Level Silver Plan,86.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$550,"$1,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,1,39924,WI,Individual,No,35-1665915,39924WI0030004,UnitedHealthcare Silver Compass HSA 2600,39924WI003,,WIN006,WIS001,WIF003,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030004-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$75,$150,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,1,39924,WI,Individual,No,35-1665915,39924WI0030005,UnitedHealthcare Silver Compass HSA 1600,39924WI003,,WIN006,WIS001,WIF006,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030005-00,Standard Silver Off Exchange Plan,68.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,1,39924,WI,Individual,No,35-1665915,39924WI0030005,UnitedHealthcare Silver Compass HSA 1600,39924WI003,,WIN006,WIS001,WIF006,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030005-01,Standard Silver On Exchange Plan,68.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,1,39924,WI,Individual,No,35-1665915,39924WI0030005,UnitedHealthcare Silver Compass HSA 1600,39924WI003,,WIN006,WIS001,WIF006,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030005-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,1,39924,WI,Individual,No,35-1665915,39924WI0030005,UnitedHealthcare Silver Compass HSA 1600,39924WI003,,WIN006,WIS001,WIF006,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030005-03,Limited Cost Sharing Plan Variation,68.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030002,UnitedHealthcare Gold Compass 1250,39924WI003,,WIN006,WIS001,WIF003,New,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030002-01,Standard Gold On Exchange Plan,79.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030002,UnitedHealthcare Gold Compass 1250,39924WI003,,WIN006,WIS001,WIF003,New,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030002,UnitedHealthcare Gold Compass 1250,39924WI003,,WIN006,WIS001,WIF003,New,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030002-03,Limited Cost Sharing Plan Variation,79.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030003,UnitedHealthcare Gold Compass 500,39924WI003,,WIN006,WIS001,WIF003,New,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030003-00,Standard Gold Off Exchange Plan,78.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030006,UnitedHealthcare Silver Compass 2000,39924WI003,,WIN006,WIS001,WIF006,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030006-01,Standard Silver On Exchange Plan,69.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030006,UnitedHealthcare Silver Compass 2000,39924WI003,,WIN006,WIS001,WIF006,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030006-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030006,UnitedHealthcare Silver Compass 2000,39924WI003,,WIN006,WIS001,WIF006,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030006-03,Limited Cost Sharing Plan Variation,69.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030006,UnitedHealthcare Silver Compass 2000,39924WI003,,WIN006,WIS001,WIF006,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030006-04,73% AV Level Silver Plan,73.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030006,UnitedHealthcare Silver Compass 2000,39924WI003,,WIN006,WIS001,WIF006,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030006-05,87% AV Level Silver Plan,86.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030006,UnitedHealthcare Silver Compass 2000,39924WI003,,WIN006,WIS001,WIF006,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030006-06,94% AV Level Silver Plan,93.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030008,UnitedHealthcare Silver Compass 5000,39924WI003,,WIN006,WIS001,WIF005,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030008-05,87% AV Level Silver Plan,86.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,2,39924,WI,Individual,No,35-1665915,39924WI0030008,UnitedHealthcare Silver Compass 5000,39924WI003,,WIN006,WIS001,WIF005,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030008-06,94% AV Level Silver Plan,93.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,3,39924,WI,Individual,No,35-1665915,39924WI0030001,UnitedHealthcare Platinum Compass 250,39924WI003,,WIN006,WIS001,WIF002,New,EPO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030001-00,Standard Platinum Off Exchange Plan,88.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,3,39924,WI,SHOP (Small Group),No,35-1665915,39924WI0040002,UnitedHealthcare Silver Navigate_2000,39924WI004,,WIN005,WIS001,WIF001,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,No,No,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shopwi,,,www.uhc.com/shopwi,39924WI0040002-00,Standard Silver Off Exchange Plan,71.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,2,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060004,Gold 1000/80 w/copay,47342WI006,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060004-01,Standard Gold On Exchange Plan,,0.816229283809662,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$70,"$1,080",$0,"$1,000",$560,$140,$0,11
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,2,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060013,Silver 2500/80 w/copay,47342WI006,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060013-00,Standard Silver Off Exchange Plan,,0.719456493854523,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$70,"$1,170",$0,"$1,700",$560,$0,$0,12
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,2,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060013,Silver 2500/80 w/copay,47342WI006,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060013-01,Standard Silver On Exchange Plan,,0.719456493854523,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$70,"$1,170",$0,"$1,700",$560,$0,$0,13
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,2,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060014,Silver 2500/80 w/copay,47342WI006,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060014-00,Standard Silver Off Exchange Plan,,0.719456493854523,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$70,"$1,170",$0,"$1,700",$560,$0,$0,14
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,2,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060014,Silver 2500/80 w/copay,47342WI006,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060014-01,Standard Silver On Exchange Plan,,0.719456493854523,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$70,"$1,170",$0,"$1,700",$560,$0,$0,15
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,2,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060035,Silver 1500/70 w/copay,47342WI006,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060035-00,Standard Silver Off Exchange Plan,,0.686019718647003,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$150,"$1,470",$0,"$1,500","$1,455",$60,$0,16
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,2,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060035,Silver 1500/70 w/copay,47342WI006,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060035-01,Standard Silver On Exchange Plan,,0.686019718647003,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$150,"$1,470",$0,"$1,500","$1,455",$60,$0,17
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,2,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060034,Silver 1500/70 w/copay,47342WI006,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060034-00,Standard Silver Off Exchange Plan,,0.686019718647003,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$150,"$1,470",$0,"$1,500","$1,455",$60,$0,18
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,2,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060034,Silver 1500/70 w/copay,47342WI006,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060034-01,Standard Silver On Exchange Plan,,0.686019718647003,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$150,"$1,470",$0,"$1,500","$1,455",$60,$0,19
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050001,Gold HDHP 100,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050001-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$0,"$2,000",$0,$0,$0,4
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060007,Gold HDHP 100,47342WI006,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060007-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$0,"$2,000",$0,$0,$0,4
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060007,Gold HDHP 100,47342WI006,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060007-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$0,"$2,000",$0,$0,$0,5
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,3,39924,WI,SHOP (Small Group),No,35-1665915,39924WI0040002,UnitedHealthcare Silver Navigate_2000,39924WI004,,WIN005,WIS001,WIF001,New,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,No,No,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shopwi,,,www.uhc.com/shopwi,39924WI0040002-01,Standard Silver On Exchange Plan,71.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,3,39924,WI,Individual,No,35-1665915,39924WI0030001,UnitedHealthcare Platinum Compass 250,39924WI003,,WIN006,WIS001,WIF002,New,EPO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030001-01,Standard Platinum On Exchange Plan,88.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,3,39924,WI,Individual,No,35-1665915,39924WI0030001,UnitedHealthcare Platinum Compass 250,39924WI003,,WIN006,WIS001,WIF002,New,EPO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060008,Gold HDHP 100,47342WI006,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060008-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$0,"$2,000",$0,$0,$0,6
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060008,Gold HDHP 100,47342WI006,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060008-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$0,"$2,000",$0,$0,$0,7
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050001,Gold HDHP 100,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050001-03,Limited Cost Sharing Plan Variation,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$0,"$2,000",$0,$0,$0,7
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050002,Gold HDHP 100,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050002-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$0,"$2,000",$0,$0,$0,8
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060015,Silver HDHP 80,47342WI006,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060015-00,Standard Silver Off Exchange Plan,,0.682228088378906,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$700,$0,"$2,000",$0,$660,$0,8
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060015,Silver HDHP 80,47342WI006,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060015-01,Standard Silver On Exchange Plan,,0.682228088378906,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$700,$0,"$2,000",$0,$660,$0,9
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050002,Gold HDHP 100,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050002-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$0,"$2,000",$0,$0,$0,9
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050002,Gold HDHP 100,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060016,Silver HDHP 80,47342WI006,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060016-00,Standard Silver Off Exchange Plan,,0.682228088378906,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$700,$0,"$2,000",$0,$660,$0,10
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060016,Silver HDHP 80,47342WI006,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060016-01,Standard Silver On Exchange Plan,,0.682228088378906,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$700,$0,"$2,000",$0,$660,$0,11
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050002,Gold HDHP 100,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050002-03,Limited Cost Sharing Plan Variation,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$0,"$2,000",$0,$0,$0,11
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050037,Silver HDHP 85,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050037-00,Standard Silver Off Exchange Plan,,0.680381238460541,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$225,$0,"$3,000",$0,$345,$0,12
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060017,Silver HDHP 90,47342WI006,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060017-00,Standard Silver Off Exchange Plan,,0.680117845535278,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$150,$0,"$3,000",$0,$230,$0,12
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060017,Silver HDHP 90,47342WI006,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060017-01,Standard Silver On Exchange Plan,,0.680117845535278,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$150,$0,"$3,000",$0,$230,$0,13
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,3,39924,WI,Individual,No,35-1665915,39924WI0030001,UnitedHealthcare Platinum Compass 250,39924WI003,,WIN006,WIS001,WIF002,New,EPO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030001-03,Limited Cost Sharing Plan Variation,88.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,4,39924,WI,Individual,No,35-1665915,39924WI0030010,UnitedHealthcare Bronze Compass 5500,39924WI003,,WIN006,WIS001,WIF003,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030010-00,Standard Bronze Off Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,4,39924,WI,Individual,No,35-1665915,39924WI0030010,UnitedHealthcare Bronze Compass 5500,39924WI003,,WIN006,WIS001,WIF003,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030010-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,4,39924,WI,Individual,No,35-1665915,39924WI0030010,UnitedHealthcare Bronze Compass 5500,39924WI003,,WIN006,WIS001,WIF003,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030010-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WI,39924,HIOS,9,2014-12-11 04:09:12,4,39924,WI,Individual,No,35-1665915,39924WI0030010,UnitedHealthcare Bronze Compass 5500,39924WI003,,WIN006,WIS001,WIF003,New,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xwi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xwi,39924WI0030010-03,Limited Cost Sharing Plan Variation,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,41436,HIOS,3,2014-09-04 03:25:43,1,41436,WI,SHOP (Small Group),Yes,41-0808596,41436WI0010001,"Plan 1. Passive PPO, $1000 Annual Maximum, no Ortho",41436WI001,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,41436WI0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,41436,HIOS,3,2014-09-04 03:25:43,1,41436,WI,SHOP (Small Group),Yes,41-0808596,41436WI0010002,"Plan 2.  Passive PPO, $1000 Annual Maximum, Ortho",41436WI001,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,41436WI0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,41436,HIOS,3,2014-09-04 03:25:43,1,41436,WI,SHOP (Small Group),Yes,41-0808596,41436WI0010003,"Plan 3. Passive PPO, $1500 Annual Maximum, no Ortho",41436WI001,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,41436WI0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WI,41436,HIOS,3,2014-09-04 03:25:43,1,41436,WI,SHOP (Small Group),Yes,41-0808596,41436WI0010004,"Plan 4.  Passive PPO, $1500 Annual Maximum, Ortho",41436WI001,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,41436WI0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WI,41436,HIOS,3,2014-09-04 03:25:43,1,41436,WI,SHOP (Small Group),Yes,41-0808596,41436WI0010005,"Plan 5.  Passive PPO, $2000 Annual Maximum, Ortho",41436WI001,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,41436WI0010005-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,WI,41436,HIOS,3,2014-09-04 03:25:43,1,41436,WI,SHOP (Small Group),Yes,41-0808596,41436WI0010006,"Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho",41436WI001,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,41436WI0010006-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,WI,41436,HIOS,3,2014-09-04 03:25:43,1,41436,WI,SHOP (Small Group),Yes,41-0808596,41436WI0010007,"Plan 7. Graded Passive PPO, $1500 Annual Maximum, Ortho",41436WI001,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,41436WI0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,WI,41436,HIOS,3,2014-09-04 03:25:43,1,41436,WI,SHOP (Small Group),Yes,41-0808596,41436WI0010008,"Plan 8. MAC PPO, $1000 Annual Maximum, no Ortho",41436WI001,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,41436WI0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,WI,41436,HIOS,3,2014-09-04 03:25:43,1,41436,WI,SHOP (Small Group),Yes,41-0808596,41436WI0010009,"Plan 9. MAC PPO, $1500 Annual Maximum, Ortho",41436WI001,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,41436WI0010009-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,WI,41436,HIOS,3,2014-09-04 03:25:43,1,41436,WI,SHOP (Small Group),Yes,41-0808596,41436WI0010010,"Plan 10. Graded MAC PPO, $1000 Annual Maximum, no Ortho",41436WI001,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,41436WI0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,13
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060005,Gold 1000/80,47342WI006,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-groups,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060005-00,Standard Gold Off Exchange Plan,,0.804280996322632,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$70,"$1,080",$0,"$1,000",$435,$280,$0,4
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060006,Gold 1000/80,47342WI006,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-groups,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060006-01,Standard Gold On Exchange Plan,,0.804280996322632,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$70,"$1,080",$0,"$1,000",$435,$280,$0,7
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060009,Silver 2000/70,47342WI006,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-groups,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060009-00,Standard Silver Off Exchange Plan,,0.692387819290161,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$70,"$1,320",$0,"$2,000",$435,$120,$0,8
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050004,Gold 1000/80,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050004-00,Standard Gold Off Exchange Plan,,0.786036670207977,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$70,"$1,080",$0,"$1,000",$435,$280,$0,8
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050004,Gold 1000/80,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050004-01,Standard Gold On Exchange Plan,,0.786036670207977,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$70,"$1,080",$0,"$1,000",$435,$280,$0,9
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060009,Silver 2000/70,47342WI006,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-groups,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060009-01,Standard Silver On Exchange Plan,,0.692387819290161,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$70,"$1,320",$0,"$2,000",$435,$120,$0,9
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060010,Silver 2000/70,47342WI006,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-groups,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060010-00,Standard Silver Off Exchange Plan,,0.692387819290161,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$70,"$1,320",$0,"$2,000",$435,$120,$0,10
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050004,Gold 1000/80,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050004,Gold 1000/80,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050004-03,Limited Cost Sharing Plan Variation,,0.786036670207977,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$70,"$1,080",$0,"$1,000",$435,$280,$0,11
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060010,Silver 2000/70,47342WI006,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-groups,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060010-01,Standard Silver On Exchange Plan,,0.692387819290161,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$70,"$1,320",$0,"$2,000",$435,$120,$0,11
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060021,Bronze 6000/80,47342WI006,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-groups,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060021-00,Standard Bronze Off Exchange Plan,,0.595147490501404,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,900",$120,$80,$0,"$2,400",$435,$0,$0,12
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050015,Bronze 6000/80,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050015-00,Standard Bronze Off Exchange Plan,,0.595393300056458,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,900",$70,$80,$0,"$2,400",$435,$0,$0,12
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050015,Bronze 6000/80,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050015-01,Standard Bronze On Exchange Plan,,0.595393300056458,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,900",$70,$80,$0,"$2,400",$435,$0,$0,13
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060021,Bronze 6000/80,47342WI006,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-groups,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060021-01,Standard Bronze On Exchange Plan,,0.595147490501404,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,900",$120,$80,$0,"$2,400",$435,$0,$0,13
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060022,Bronze 6000/80,47342WI006,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-groups,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060022-00,Standard Bronze Off Exchange Plan,,0.595147490501404,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,900",$120,$80,$0,"$2,400",$435,$0,$0,14
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050015,Bronze 6000/80,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050015,Bronze 6000/80,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050015-03,Limited Cost Sharing Plan Variation,,0.595393300056458,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,900",$70,$80,$0,"$2,400",$435,$0,$0,15
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060022,Bronze 6000/80,47342WI006,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-groups,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060022-01,Standard Bronze On Exchange Plan,,0.595147490501404,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,900",$120,$80,$0,"$2,400",$435,$0,$0,15
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050016,Bronze 6000/80,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050016-00,Standard Bronze Off Exchange Plan,,0.595393300056458,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,900",$70,$80,$0,"$2,400",$435,$0,$0,16
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050016,Bronze 6000/80,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050016-01,Standard Bronze On Exchange Plan,,0.595393300056458,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,900",$70,$80,$0,"$2,400",$435,$0,$0,17
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050016,Bronze 6000/80,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050016-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050016,Bronze 6000/80,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050016-03,Limited Cost Sharing Plan Variation,,0.595393300056458,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,900",$70,$80,$0,"$2,400",$435,$0,$0,19
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050031,Silver 2000/80,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050031-00,Standard Silver Off Exchange Plan,,0.68997997045517,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$150,"$1,080",$0,"$2,000",$435,$280,$0,20
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050031,Silver 2000/80,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050031-01,Standard Silver On Exchange Plan,,0.68997997045517,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$150,"$1,080",$0,"$2,000",$435,$280,$0,21
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050031,Silver 2000/80,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050031-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050031,Silver 2000/80,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050031-03,Limited Cost Sharing Plan Variation,,0.68997997045517,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$150,"$1,080",$0,"$2,000",$435,$280,$0,23
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050031,Silver 2000/80,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050031-04,73% AV Level Silver Plan,,0.738161027431488,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$150,$880,$0,"$2,000",$435,$280,$0,24
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050031,Silver 2000/80,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050031-05,87% AV Level Silver Plan,,0.863753616809845,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,"$1,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,600",$100,$320,$0,$800,$400,$0,$0,25
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050031,Silver 2000/80,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050031-06,94% AV Level Silver Plan,,0.932871043682098,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$360,$0,$250,$300,$0,$0,26
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050032,Silver 2000/80,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050032-00,Standard Silver Off Exchange Plan,,0.68997997045517,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$150,"$1,080",$0,"$2,000",$435,$280,$0,27
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050032,Silver 2000/80,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050032-01,Standard Silver On Exchange Plan,,0.68997997045517,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$150,"$1,080",$0,"$2,000",$435,$280,$0,28
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050032,Silver 2000/80,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050032-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,29
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050032,Silver 2000/80,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050032-03,Limited Cost Sharing Plan Variation,,0.68997997045517,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$150,"$1,080",$0,"$2,000",$435,$280,$0,30
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,1,47342,WI,Individual,No,39-1545987,47342WI0050032,Silver 2000/80,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050032-06,94% AV Level Silver Plan,,0.932871043682098,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$360,$0,$250,$300,$0,$0,33
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,2,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060001,Platinum 1000,47342WI006,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060001-00,Standard Platinum Off Exchange Plan,,0.905760228633881,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$0,$0,$0,"$1,000",$0,$0,$0,4
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,2,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060001,Platinum 1000,47342WI006,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060001-01,Standard Platinum On Exchange Plan,,0.905760228633881,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$0,$0,$0,"$1,000",$0,$0,$0,5
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,2,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060002,Platinum 1000,47342WI006,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060002-00,Standard Platinum Off Exchange Plan,,0.905760228633881,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$0,$0,$0,"$1,000",$0,$0,$0,6
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,2,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060002,Platinum 1000,47342WI006,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060002-01,Standard Platinum On Exchange Plan,,0.905760228633881,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$0,$0,$0,"$1,000",$0,$0,$0,7
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,2,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060003,Gold 1000/80 w/copay,47342WI006,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060003-00,Standard Gold Off Exchange Plan,,0.816229283809662,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$70,"$1,080",$0,"$1,000",$560,$140,$0,8
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,2,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060003,Gold 1000/80 w/copay,47342WI006,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060003-01,Standard Gold On Exchange Plan,,0.816229283809662,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$70,"$1,080",$0,"$1,000",$560,$140,$0,9
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,2,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060004,Gold 1000/80 w/copay,47342WI006,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060004-00,Standard Gold Off Exchange Plan,,0.816229283809662,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$70,"$1,080",$0,"$1,000",$560,$140,$0,10
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050001,Gold HDHP 100,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050001-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$0,"$2,000",$0,$0,$0,5
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050001,Gold HDHP 100,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050037,Silver HDHP 85,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050037-01,Standard Silver On Exchange Plan,,0.680381238460541,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$225,$0,"$3,000",$0,$345,$0,13
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050037,Silver HDHP 85,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050037-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060018,Silver HDHP 90,47342WI006,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060018-00,Standard Silver Off Exchange Plan,,0.680117845535278,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$150,$0,"$3,000",$0,$230,$0,14
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060018,Silver HDHP 90,47342WI006,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060018-01,Standard Silver On Exchange Plan,,0.680117845535278,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$150,$0,"$3,000",$0,$230,$0,15
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050037,Silver HDHP 85,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050037-03,Limited Cost Sharing Plan Variation,,0.680381238460541,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$225,$0,"$3,000",$0,$345,$0,15
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050037,Silver HDHP 85,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050037-04,73% AV Level Silver Plan,,0.722721517086029,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$525,$0,"$2,000",$0,$495,$0,16
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060019,Bronze HDHP 80,47342WI006,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060019-00,Standard Bronze Off Exchange Plan,,0.601567029953003,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$4,500",$0,$160,$0,16
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060019,Bronze HDHP 80,47342WI006,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060019-01,Standard Bronze On Exchange Plan,,0.601567029953003,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$4,500",$0,$160,$0,17
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050037,Silver HDHP 85,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050037-05,87% AV Level Silver Plan,,0.860263049602509,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$900,"$1,800",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,800",$0,$700,$0,$900,$0,$350,$0,17
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050037,Silver HDHP 85,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050037-06,94% AV Level Silver Plan,,0.932660579681396,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$700,$0,$250,$0,$350,$0,18
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060020,Bronze HDHP 80,47342WI006,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060020-00,Standard Bronze Off Exchange Plan,,0.601567029953003,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$4,500",$0,$160,$0,18
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060020,Bronze HDHP 80,47342WI006,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060020-01,Standard Bronze On Exchange Plan,,0.601567029953003,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$4,500",$0,$160,$0,19
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050038,Silver HDHP 85,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050038-00,Standard Silver Off Exchange Plan,,0.680381238460541,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$225,$0,"$3,000",$0,$345,$0,19
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050038,Silver HDHP 85,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050038-01,Standard Silver On Exchange Plan,,0.680381238460541,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$225,$0,"$3,000",$0,$345,$0,20
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060011,Bronze HDHP 60,47342WI006,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060011-00,Standard Bronze Off Exchange Plan,,0.595898628234863,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$4,000",$0,$520,$0,20
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060011,Bronze HDHP 60,47342WI006,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060011-01,Standard Bronze On Exchange Plan,,0.595898628234863,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$4,000",$0,$520,$0,21
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050038,Silver HDHP 85,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050038-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,21
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050038,Silver HDHP 85,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050038-03,Limited Cost Sharing Plan Variation,,0.680381238460541,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$225,$0,"$3,000",$0,$345,$0,22
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060012,Bronze HDHP 60,47342WI006,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060012-00,Standard Bronze Off Exchange Plan,,0.595898628234863,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$4,000",$0,$520,$0,22
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060012,Bronze HDHP 60,47342WI006,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060012-01,Standard Bronze On Exchange Plan,,0.595898628234863,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$4,000",$0,$520,$0,23
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050038,Silver HDHP 85,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050038-04,73% AV Level Silver Plan,,0.722721517086029,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$525,$0,"$2,000",$0,$495,$0,23
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050038,Silver HDHP 85,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050038-05,87% AV Level Silver Plan,,0.860263049602509,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$900,"$1,800",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,800",$0,$700,$0,$900,$0,$350,$0,24
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060037,Bronze HDHP 50,47342WI006,7720081950,WIN001,WIS001,WIF001,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060037-00,Standard Bronze Off Exchange Plan,,0.606329083442688,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$750,$0,"$3,000",$0,$690,$0,24
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060037,Bronze HDHP 50,47342WI006,7720081950,WIN001,WIS001,WIF001,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060037-01,Standard Bronze On Exchange Plan,,0.606329083442688,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$750,$0,"$3,000",$0,$690,$0,25
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050038,Silver HDHP 85,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050038-06,94% AV Level Silver Plan,,0.932660579681396,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$700,$0,$250,$0,$350,$0,25
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050013,Bronze HDHP 100 Low,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050013-00,Standard Bronze Off Exchange Plan,,0.619937121868134,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$5,250",$0,$0,$0,26
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060038,Bronze HDHP 50,47342WI006,7720081950,WIN001,WIS002,WIF001,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060038-00,Standard Bronze Off Exchange Plan,,0.606329083442688,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$750,$0,"$3,000",$0,$690,$0,26
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,SHOP (Small Group),No,39-1545987,47342WI0060038,Bronze HDHP 50,47342WI006,7720081950,WIN001,WIS002,WIF001,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,http://www.healthtradition.com/coverage-summary-for-groups,,http://www.healthtradition.com/brochures-for-group,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0060038-01,Standard Bronze On Exchange Plan,,0.606329083442688,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$750,$0,"$3,000",$0,$690,$0,27
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050013,Bronze HDHP 100 Low,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050013-01,Standard Bronze On Exchange Plan,,0.619937121868134,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$5,250",$0,$0,$0,27
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050013,Bronze HDHP 100 Low,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,28
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050013,Bronze HDHP 100 Low,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050013-03,Limited Cost Sharing Plan Variation,,0.619937121868134,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$5,250",$0,$0,$0,29
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050014,Bronze HDHP 100 Low,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050014-00,Standard Bronze Off Exchange Plan,,0.619937121868134,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$5,250",$0,$0,$0,30
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050014,Bronze HDHP 100 Low,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050014-01,Standard Bronze On Exchange Plan,,0.619937121868134,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$5,250",$0,$0,$0,31
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050014,Bronze HDHP 100 Low,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,32
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050014,Bronze HDHP 100 Low,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050014-03,Limited Cost Sharing Plan Variation,,0.619937121868134,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$5,250",$0,$0,$0,33
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050017,Bronze HDHP 100 High,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050017-00,Standard Bronze Off Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$5,300",$0,$0,$0,34
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050017,Bronze HDHP 100 High,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050017-01,Standard Bronze On Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$5,300",$0,$0,$0,35
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050017,Bronze HDHP 100 High,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,36
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050017,Bronze HDHP 100 High,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050017-03,Limited Cost Sharing Plan Variation,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$5,300",$0,$0,$0,37
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050018,Bronze HDHP 100 High,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050018-00,Standard Bronze Off Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$5,300",$0,$0,$0,38
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050018,Bronze HDHP 100 High,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050018-01,Standard Bronze On Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$5,300",$0,$0,$0,39
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050018,Bronze HDHP 100 High,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050018-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,40
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050018,Bronze HDHP 100 High,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050018-03,Limited Cost Sharing Plan Variation,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$5,300",$0,$0,$0,41
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050019,Essential HDHP,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050019-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$5,300",$0,$0,$0,42
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050019,Essential HDHP,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050019-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$5,300",$0,$0,$0,43
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050020,Essential HDHP,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050020-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$5,300",$0,$0,$0,44
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,3,47342,WI,Individual,No,39-1545987,47342WI0050020,Essential HDHP,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050020-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,500",$0,$0,$0,"$5,300",$0,$0,$0,45
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050005,Gold 2000/80 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050005-00,Standard Gold Off Exchange Plan,,0.781772255897522,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$70,$880,$0,"$1,700",$560,$0,$0,4
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050005,Gold 2000/80 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050005-01,Standard Gold On Exchange Plan,,0.781772255897522,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$70,$880,$0,"$1,700",$560,$0,$0,5
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050005,Gold 2000/80 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050005,Gold 2000/80 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050005-03,Limited Cost Sharing Plan Variation,,0.781772255897522,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$70,$880,$0,"$1,700",$560,$0,$0,7
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050006,Gold 2000/80 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050006-00,Standard Gold Off Exchange Plan,,0.781772255897522,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$70,$880,$0,"$1,700",$560,$0,$0,8
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050006,Gold 2000/80 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050006-01,Standard Gold On Exchange Plan,,0.781772255897522,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$70,$880,$0,"$1,700",$560,$0,$0,9
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050006,Gold 2000/80 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050006,Gold 2000/80 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050006-03,Limited Cost Sharing Plan Variation,,0.781772255897522,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$70,$880,$0,"$1,700",$560,$0,$0,11
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050034,Silver 4000/80 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050034-00,Standard Silver Off Exchange Plan,,0.683347940444946,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$100,$480,$0,"$1,700",$645,$0,$0,12
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050034,Silver 4000/80 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050034-01,Standard Silver On Exchange Plan,,0.683347940444946,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$100,$480,$0,"$1,700",$645,$0,$0,13
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050034,Silver 4000/80 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050034-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050034,Silver 4000/80 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050034-03,Limited Cost Sharing Plan Variation,,0.683347940444946,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$100,$480,$0,"$1,700",$645,$0,$0,15
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050034,Silver 4000/80 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050034-04,73% AV Level Silver Plan,,0.733389496803284,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,150",$100,$630,$0,"$1,700",$645,$0,$0,16
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050034,Silver 4000/80 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050034-05,87% AV Level Silver Plan,,0.864430367946625,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$70,$430,$0,"$1,000",$500,$0,$0,17
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050034,Silver 4000/80 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050034-06,94% AV Level Silver Plan,,0.931923449039459,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$600,$40,$800,$0,$300,$400,$0,$0,18
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050035,Silver 4000/80 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050035-00,Standard Silver Off Exchange Plan,,0.683347940444946,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$100,$480,$0,"$1,700",$645,$0,$0,19
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050035,Silver 4000/80 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050035-01,Standard Silver On Exchange Plan,,0.683347940444946,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$100,$480,$0,"$1,700",$645,$0,$0,20
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050035,Silver 4000/80 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050035-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050035,Silver 4000/80 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050035-03,Limited Cost Sharing Plan Variation,,0.683347940444946,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$100,$480,$0,"$1,700",$645,$0,$0,22
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050035,Silver 4000/80 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050035-04,73% AV Level Silver Plan,,0.733389496803284,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,150",$100,$630,$0,"$1,700",$645,$0,$0,23
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050035,Silver 4000/80 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050035-05,87% AV Level Silver Plan,,0.864430367946625,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$70,$430,$0,"$1,000",$500,$0,$0,24
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050035,Silver 4000/80 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050035-06,94% AV Level Silver Plan,,0.931923449039459,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$600,$40,$800,$0,$300,$400,$0,$0,25
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050040,Silver 3000/70 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050040-00,Standard Silver Off Exchange Plan,,0.682186245918274,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,400","$10,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$120,"$1,020",$0,"$1,700",$765,$0,$0,26
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050040,Silver 3000/70 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050040-01,Standard Silver On Exchange Plan,,0.682186245918274,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,400","$10,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$120,"$1,020",$0,"$1,700",$765,$0,$0,27
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050040,Silver 3000/70 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050040-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,28
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050040,Silver 3000/70 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050040-03,Limited Cost Sharing Plan Variation,,0.682186245918274,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,400","$10,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$120,"$1,020",$0,"$1,700",$765,$0,$0,29
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050040,Silver 3000/70 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050040-04,73% AV Level Silver Plan,,0.728947162628174,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$120,"$1,320",$0,"$1,700",$765,$0,$0,30
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050040,Silver 3000/70 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050040-05,87% AV Level Silver Plan,,0.860416293144226,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$80,$670,$0,"$1,000",$545,$205,$0,31
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050040,Silver 3000/70 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050040-06,94% AV Level Silver Plan,,0.93161940574646,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$70,$330,$0,$500,$200,$0,$0,32
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050041,Silver 3000/70 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050041-00,Standard Silver Off Exchange Plan,,0.682186245918274,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,400","$10,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$120,"$1,020",$0,"$1,700",$765,$0,$0,33
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050041,Silver 3000/70 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050041-01,Standard Silver On Exchange Plan,,0.682186245918274,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,400","$10,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$120,"$1,020",$0,"$1,700",$765,$0,$0,34
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050041,Silver 3000/70 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050041-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,35
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050041,Silver 3000/70 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050041-03,Limited Cost Sharing Plan Variation,,0.682186245918274,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,400","$10,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$120,"$1,020",$0,"$1,700",$765,$0,$0,36
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050041,Silver 3000/70 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050041-04,73% AV Level Silver Plan,,0.728947162628174,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$120,"$1,320",$0,"$1,700",$765,$0,$0,37
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050041,Silver 3000/70 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050041-05,87% AV Level Silver Plan,,0.860416293144226,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$80,$670,$0,"$1,000",$545,$205,$0,38
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050041,Silver 3000/70 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050041-06,94% AV Level Silver Plan,,0.93161940574646,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$70,$330,$0,$500,$200,$0,$0,39
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050043,Bronze 3000/60 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050043-00,Standard Bronze Off Exchange Plan,,0.610428512096405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$200,"$1,360",$0,"$1,700","$1,455",$0,$0,40
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050043,Bronze 3000/60 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050043-01,Standard Bronze On Exchange Plan,,0.610428512096405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$200,"$1,360",$0,"$1,700","$1,455",$0,$0,41
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050043,Bronze 3000/60 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050043-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,42
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050043,Bronze 3000/60 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050043-03,Limited Cost Sharing Plan Variation,,0.610428512096405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$200,"$1,360",$0,"$1,700","$1,455",$0,$0,43
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050044,Bronze 3000/60 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050044-00,Standard Bronze Off Exchange Plan,,0.610428512096405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$200,"$1,360",$0,"$1,700","$1,455",$0,$0,44
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050044,Bronze 3000/60 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050044-01,Standard Bronze On Exchange Plan,,0.610428512096405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$200,"$1,360",$0,"$1,700","$1,455",$0,$0,45
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050044,Bronze 3000/60 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050044-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,46
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050044,Bronze 3000/60 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050044-03,Limited Cost Sharing Plan Variation,,0.610428512096405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$200,"$1,360",$0,"$1,700","$1,455",$0,$0,47
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050046,Bronze 5500/80 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050046-00,Standard Bronze Off Exchange Plan,,0.59688663482666,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,400",$200,$180,$0,"$1,700","$1,305",$0,$0,48
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050046,Bronze 5500/80 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050046-01,Standard Bronze On Exchange Plan,,0.59688663482666,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,400",$200,$180,$0,"$1,700","$1,305",$0,$0,49
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050046,Bronze 5500/80 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050046-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,50
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050046,Bronze 5500/80 w/copay,47342WI005,7720081950,WIN001,WIS001,WIF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050046-03,Limited Cost Sharing Plan Variation,,0.59688663482666,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,400",$200,$180,$0,"$1,700","$1,305",$0,$0,51
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050047,Bronze 5500/80 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050047-00,Standard Bronze Off Exchange Plan,,0.59688663482666,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,400",$200,$180,$0,"$1,700","$1,305",$0,$0,52
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050047,Bronze 5500/80 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050047-01,Standard Bronze On Exchange Plan,,0.59688663482666,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,400",$200,$180,$0,"$1,700","$1,305",$0,$0,53
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050047,Bronze 5500/80 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050047-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,54
2015,WI,47342,HIOS,7,2015-01-20 13:44:26,4,47342,WI,Individual,No,39-1545987,47342WI0050047,Bronze 5500/80 w/copay,47342WI005,7720081950,WIN001,WIS002,WIF001,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Urgent Care and Emergency Only,Yes,Urgent Care and Emergency Only,No,www.healthtradition.com/coverage-summary-for-individuals,www.HealthTradition.com/go/paynow,www.healthtradition.com/brochures-for-individuals,http://www.healthtradition.com/go/members/drugs-pharmacy,47342WI0050047-03,Limited Cost Sharing Plan Variation,,0.59688663482666,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,400",$200,$180,$0,"$1,700","$1,305",$0,$0,55
2015,WI,52697,HIOS,8,2014-09-05 03:32:16,1,52697,WI,Individual,No,20-0813104,52697WI0010001,Molina Marketplace  Gold Plan,52697WI001,,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.997099594388224,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/wi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/wi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,http://www.molinahealthcare.com/members/wi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,52697WI0010001-00,Standard Gold Off Exchange Plan,,0.797688901424408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,WI,52697,HIOS,8,2014-09-05 03:32:16,1,52697,WI,Individual,No,20-0813104,52697WI0010001,Molina Marketplace  Gold Plan,52697WI001,,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.997099594388224,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/wi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/wi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,http://www.molinahealthcare.com/members/wi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,52697WI0010001-01,Standard Gold On Exchange Plan,,0.797688901424408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,WI,52697,HIOS,8,2014-09-05 03:32:16,1,52697,WI,Individual,No,20-0813104,52697WI0010001,Molina Marketplace  Gold Plan,52697WI001,,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.997099594388224,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/wi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/wi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,http://www.molinahealthcare.com/members/wi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,52697WI0010001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WI,52697,HIOS,8,2014-09-05 03:32:16,1,52697,WI,Individual,No,20-0813104,52697WI0010001,Molina Marketplace  Gold Plan,52697WI001,,WIN001,WIS001,WIF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.997099594388224,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/wi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/wi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,http://www.molinahealthcare.com/members/wi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,52697WI0010001-03,Limited Cost Sharing Plan Variation,,0.797688901424408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,WI,52697,HIOS,8,2014-09-05 03:32:16,2,52697,WI,Individual,No,20-0813104,52697WI0010002,Molina Marketplace  Silver Plan,52697WI001,,WIN001,WIS001,WIF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.989197081603913,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,52697WI0010002-00,Standard Silver Off Exchange Plan,,0.706084549427032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$200,$400,30%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,4
2015,WI,52697,HIOS,8,2014-09-05 03:32:16,2,52697,WI,Individual,No,20-0813104,52697WI0010002,Molina Marketplace  Silver Plan,52697WI001,,WIN001,WIS001,WIF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.989197081603913,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,52697WI0010002-01,Standard Silver On Exchange Plan,,0.706084549427032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$200,$400,30%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,5
2015,WI,52697,HIOS,8,2014-09-05 03:32:16,2,52697,WI,Individual,No,20-0813104,52697WI0010002,Molina Marketplace  Silver Plan,52697WI001,,WIN001,WIS001,WIF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.989197081603913,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,52697WI0010002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WI,52697,HIOS,8,2014-09-05 03:32:16,2,52697,WI,Individual,No,20-0813104,52697WI0010002,Molina Marketplace  Silver Plan,52697WI001,,WIN001,WIS001,WIF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.989197081603913,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,52697WI0010002-03,Limited Cost Sharing Plan Variation,,0.706084549427032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$200,$400,30%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,7
2015,WI,52697,HIOS,8,2014-09-05 03:32:16,2,52697,WI,Individual,No,20-0813104,52697WI0010002,Molina Marketplace  Silver Plan,52697WI001,,WIN001,WIS001,WIF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.989197081603913,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,52697WI0010002-04,73% AV Level Silver Plan,,0.739861905574799,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,"$5,200","$10,400","$1,700","$3,400",30%,,,,Not Applicable,Not Applicable,"$1,700","$3,400",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,WI,52697,HIOS,8,2014-09-05 03:32:16,2,52697,WI,Individual,No,20-0813104,52697WI0010002,Molina Marketplace  Silver Plan,52697WI001,,WIN001,WIS001,WIF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.989197081603913,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,52697WI0010002-05,87% AV Level Silver Plan,,0.874694764614105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,"$2,250","$4,500",$250,$500,20%,,,,Not Applicable,Not Applicable,$250,$500,$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,WI,52697,HIOS,8,2014-09-05 03:32:16,2,52697,WI,Individual,No,20-0813104,52697WI0010002,Molina Marketplace  Silver Plan,52697WI001,,WIN001,WIS001,WIF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.989197081603913,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,52697WI0010002-06,94% AV Level Silver Plan,,0.943551361560822,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,"$2,250","$4,500",$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,WI,52697,HIOS,8,2014-09-05 03:32:16,3,52697,WI,Individual,No,20-0813104,52697WI0010003,Molina Marketplace  Bronze Plan,52697WI001,,WIN001,WIS001,WIF003,New,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.995835886863035,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,52697WI0010003-00,Standard Bronze Off Exchange Plan,,0.619724571704865,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,4
2015,WI,52697,HIOS,8,2014-09-05 03:32:16,3,52697,WI,Individual,No,20-0813104,52697WI0010003,Molina Marketplace  Bronze Plan,52697WI001,,WIN001,WIS001,WIF003,New,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.995835886863035,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,52697WI0010003-01,Standard Bronze On Exchange Plan,,0.619724571704865,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,5
2015,WI,52697,HIOS,8,2014-09-05 03:32:16,3,52697,WI,Individual,No,20-0813104,52697WI0010003,Molina Marketplace  Bronze Plan,52697WI001,,WIN001,WIS001,WIF003,New,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.995835886863035,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,52697WI0010003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,6
2015,WI,52697,HIOS,8,2014-09-05 03:32:16,3,52697,WI,Individual,No,20-0813104,52697WI0010003,Molina Marketplace  Bronze Plan,52697WI001,,WIN001,WIS001,WIF003,New,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.995835886863035,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,52697WI0010003-03,Limited Cost Sharing Plan Variation,,0.619724571704865,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,7
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,3,57845,WI,Individual,No,41-1843804,57845WI0010013,Medica Applause Catastrophic,57845WI001,,WIN001,WIS001,WIF006,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseCatastrophic,www.medica.com/IFBPharmacy,57845WI0010013-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090001,MercyCare HMO Gold Option A,58326WI009,,WIN001,WIS001,WIF005,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090001-00,Standard Gold Off Exchange Plan,78.10%,0.781372904777527,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060007,MercyCare HMO Full Pay $0 Deductible; $10/$25/$50 Rx,58326WI006,,WIN001,WIS001,WIF001,Existing,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060007-00,Standard Platinum Off Exchange Plan,91.10%,0.911261379718781,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060007,MercyCare HMO Full Pay $0 Deductible; $10/$25/$50 Rx,58326WI006,,WIN001,WIS001,WIF001,Existing,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060007-01,Standard Platinum On Exchange Plan,91.10%,0.911261379718781,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090001,MercyCare HMO Gold Option A,58326WI009,,WIN001,WIS001,WIF005,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090001-01,Standard Gold On Exchange Plan,78.10%,0.781372904777527,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090001,MercyCare HMO Gold Option A,58326WI009,,WIN001,WIS001,WIF005,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060009,MercyCare HMO CO-90 $0 Deductible; $10/$25/$50 Rx,58326WI006,,WIN001,WIS001,WIF001,Existing,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060009-00,Standard Platinum Off Exchange Plan,91.80%,0.918205797672272,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060009,MercyCare HMO CO-90 $0 Deductible; $10/$25/$50 Rx,58326WI006,,WIN001,WIS001,WIF001,Existing,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060009-01,Standard Platinum On Exchange Plan,91.80%,0.918205797672272,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090001,MercyCare HMO Gold Option A,58326WI009,,WIN001,WIS001,WIF005,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090001-03,Limited Cost Sharing Plan Variation,78.10%,0.781372904777527,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090012,MercyCare HMO Gold Option B,58326WI009,,WIN001,WIS001,WIF005,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090012-00,Standard Gold Off Exchange Plan,78.20%,0.781829297542572,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060011,MercyCare HMO CO-80 $0 Deductible; $10/$25/$50 Rx,58326WI006,,WIN001,WIS001,WIF001,Existing,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060011-00,Standard Platinum Off Exchange Plan,90.70%,0.906812846660614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060011,MercyCare HMO CO-80 $0 Deductible; $10/$25/$50 Rx,58326WI006,,WIN001,WIS001,WIF001,Existing,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060011-01,Standard Platinum On Exchange Plan,90.70%,0.906812846660614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090012,MercyCare HMO Gold Option B,58326WI009,,WIN001,WIS001,WIF005,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090012-01,Standard Gold On Exchange Plan,78.20%,0.781829297542572,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090012,MercyCare HMO Gold Option B,58326WI009,,WIN001,WIS001,WIF005,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090012-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,WI,57369,HIOS,2,2014-08-08 08:53:29,1,57369,WI,SHOP (Small Group),Yes,42-0127290,57369WI0040001,Principal Plan Dental 70,57369WI004,,WIN001,WIS001,,New,PPO,Low,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$32.24,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,57369WI0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,57369,HIOS,2,2014-08-08 08:53:29,1,57369,WI,SHOP (Small Group),Yes,42-0127290,57369WI0040002,Principal Plan Dental 80,57369WI004,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$34.15,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,57369WI0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,1,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070001,Medica Choice Passport WI 1300-20% HSA Gold,57637WI007,,WIN001,WIS001,WIF001,Existing,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070001-00,Standard Gold Off Exchange Plan,,0.780426740646362,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$1,300",$0,$700,"$1,000","$1,300",$0,$800,$0,4
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,1,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070001,Medica Choice Passport WI 1300-20% HSA Gold,57637WI007,,WIN001,WIS001,WIF001,Existing,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070001-01,Standard Gold On Exchange Plan,,0.780426740646362,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$1,300",$0,$700,"$1,000","$1,300",$0,$800,$0,5
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,1,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070002,Medica Choice Passport WI 1750-25% HSA Silver,57637WI007,,WIN001,WIS001,WIF002,Existing,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070002-00,Standard Silver Off Exchange Plan,,0.680849492549896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",25%,,,,"$5,000","$9,900",Not Applicable,Not Applicable,"$1,750",$0,$800,"$1,000","$1,750",$0,$900,$0,6
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,1,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070002,Medica Choice Passport WI 1750-25% HSA Silver,57637WI007,,WIN001,WIS001,WIF002,Existing,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070002-01,Standard Silver On Exchange Plan,,0.680849492549896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",25%,,,,"$5,000","$9,900",Not Applicable,Not Applicable,"$1,750",$0,$800,"$1,000","$1,750",$0,$900,$0,7
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,1,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070003,Medica Choice Passport WI 4950-50% HSA Bronze,57637WI007,,WIN001,WIS001,WIF003,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070003-00,Standard Bronze Off Exchange Plan,,0.583925843238831,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,950","$9,900",50%,,,,"$7,500","$9,900",Not Applicable,Not Applicable,"$4,800",$0,$0,"$1,000","$4,950",$0,$200,$0,8
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,1,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070003,Medica Choice Passport WI 4950-50% HSA Bronze,57637WI007,,WIN001,WIS001,WIF003,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070003-01,Standard Bronze On Exchange Plan,,0.583925843238831,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,950","$9,900",50%,,,,"$7,500","$9,900",Not Applicable,Not Applicable,"$4,800",$0,$0,"$1,000","$4,950",$0,$200,$0,9
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,1,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070009,Medica Choice Passport WI 1650-0% HSA Gold,57637WI007,,WIN001,WIS001,WIF004,New,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070009-00,Standard Gold Off Exchange Plan,,0.816413819789886,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,650","$3,300",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$1,650",$0,$0,"$1,000","$1,650",$0,$10,$0,10
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,1,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070009,Medica Choice Passport WI 1650-0% HSA Gold,57637WI007,,WIN001,WIS001,WIF004,New,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070009-01,Standard Gold On Exchange Plan,,0.816413819789886,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,650","$3,300",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$1,650",$0,$0,"$1,000","$1,650",$0,$10,$0,11
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,1,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070010,Medica Choice Passport WI 2000-0% HSA Gold,57637WI007,,WIN001,WIS001,WIF004,New,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070010-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$5,000","$9,900",Not Applicable,Not Applicable,"$2,000",$0,$0,"$1,000","$2,000",$0,$0,$0,12
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,1,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070010,Medica Choice Passport WI 2000-0% HSA Gold,57637WI007,,WIN001,WIS001,WIF004,New,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070010-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$5,000","$9,900",Not Applicable,Not Applicable,"$2,000",$0,$0,"$1,000","$2,000",$0,$0,$0,13
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,1,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070014,Medica Choice Passport WI 3000-0% HSA Silver,57637WI007,,WIN001,WIS001,WIF004,New,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070014-00,Standard Silver Off Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,500","$9,900",Not Applicable,Not Applicable,"$3,000",$0,$0,"$1,000","$3,000",$0,$0,$0,14
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,1,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070014,Medica Choice Passport WI 3000-0% HSA Silver,57637WI007,,WIN001,WIS001,WIF004,New,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070014-01,Standard Silver On Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,500","$9,900",Not Applicable,Not Applicable,"$3,000",$0,$0,"$1,000","$3,000",$0,$0,$0,15
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,1,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070015,Medica Choice Passport WI 3500-0% HSA Silver,57637WI007,,WIN001,WIS001,WIF004,New,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070015-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$9,900",Not Applicable,Not Applicable,"$3,500",$0,$0,"$1,000","$3,500",$0,$0,$0,16
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,1,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070015,Medica Choice Passport WI 3500-0% HSA Silver,57637WI007,,WIN001,WIS001,WIF004,New,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070015-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$9,900",Not Applicable,Not Applicable,"$3,500",$0,$0,"$1,000","$3,500",$0,$0,$0,17
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,1,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070016,Medica Choice Passport WI 4000-30% HSA Bronze,57637WI007,,WIN001,WIS001,WIF004,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070016-00,Standard Bronze Off Exchange Plan,,0.604342997074127,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,"$7,000","$9,900",Not Applicable,Not Applicable,"$4,000",$0,$400,"$1,000","$4,000",$0,$600,$0,18
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,1,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070016,Medica Choice Passport WI 4000-30% HSA Bronze,57637WI007,,WIN001,WIS001,WIF004,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070016-01,Standard Bronze On Exchange Plan,,0.604342997074127,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,"$7,000","$9,900",Not Applicable,Not Applicable,"$4,000",$0,$400,"$1,000","$4,000",$0,$600,$0,19
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,1,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070017,Medica Choice Passport WI 6000-30% HSA Bronze,57637WI007,,WIN001,WIS001,WIF004,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070017-00,Standard Bronze Off Exchange Plan,,0.580388724803925,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$9,000",30%,,,,"$7,500","$9,900",Not Applicable,Not Applicable,"$4,800",$0,$0,"$1,000","$5,300",$0,$0,$0,20
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,1,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070017,Medica Choice Passport WI 6000-30% HSA Bronze,57637WI007,,WIN001,WIS001,WIF004,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070017-01,Standard Bronze On Exchange Plan,,0.580388724803925,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$9,000",30%,,,,"$7,500","$9,900",Not Applicable,Not Applicable,"$4,800",$0,$0,"$1,000","$5,300",$0,$0,$0,21
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,2,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070004,Medica Choice Passport WI 10%-25 Platinum,57637WI007,,WIN001,WIS001,WIF007,New,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070004-00,Standard Platinum Off Exchange Plan,,0.881775438785553,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$9,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$20,$500,"$1,000",$0,$700,$100,$0,4
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,2,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070004,Medica Choice Passport WI 10%-25 Platinum,57637WI007,,WIN001,WIS001,WIF007,New,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070004-01,Standard Platinum On Exchange Plan,,0.881775438785553,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$9,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$20,$500,"$1,000",$0,$700,$100,$0,5
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,3,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070005,Medica Choice Passport WI 500-25-25% Platinum,57637WI007,,WIN001,WIS001,WIF007,New,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070005-00,Standard Platinum Off Exchange Plan,,0.892797768115997,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$9,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,500",25%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$500,$0,$500,"$1,000",$500,$500,$50,$0,4
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,3,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070005,Medica Choice Passport WI 500-25-25% Platinum,57637WI007,,WIN001,WIS001,WIF007,New,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070005-01,Standard Platinum On Exchange Plan,,0.892797768115997,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$9,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,500",25%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$500,$0,$500,"$1,000",$500,$500,$50,$0,5
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,3,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070006,Medica Choice Passport WI 500-40-25% Gold,57637WI007,,WIN001,WIS001,WIF005,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070006-00,Standard Gold Off Exchange Plan,,0.793329536914825,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$9,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,500",25%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$500,$20,"$1,100","$1,000",$500,$900,$200,$0,6
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,3,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070006,Medica Choice Passport WI 500-40-25% Gold,57637WI007,,WIN001,WIS001,WIF005,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070006-01,Standard Gold On Exchange Plan,,0.793329536914825,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$9,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,500",25%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$500,$20,"$1,100","$1,000",$500,$900,$200,$0,7
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,3,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070007,Medica Choice Passport WI 750-40-25% Gold,57637WI007,,WIN001,WIS001,WIF005,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070007-00,Standard Gold Off Exchange Plan,,0.784385561943054,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$9,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$2,250",25%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$750,$20,"$1,000","$1,000",$750,$900,$100,$0,8
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,3,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070007,Medica Choice Passport WI 750-40-25% Gold,57637WI007,,WIN001,WIS001,WIF005,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070007-01,Standard Gold On Exchange Plan,,0.784385561943054,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$9,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$2,250",25%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$750,$20,"$1,000","$1,000",$750,$900,$100,$0,9
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,3,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070008,Medica Choice Passport WI 1000-40-25% Gold,57637WI007,,WIN001,WIS001,WIF005,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070008-00,Standard Gold Off Exchange Plan,78.50%,0.776599705219269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$9,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$3,000",25%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,000",$20,$900,"$1,000","$1,000",$900,$80,$0,10
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,3,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070008,Medica Choice Passport WI 1000-40-25% Gold,57637WI007,,WIN001,WIS001,WIF005,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070008-01,Standard Gold On Exchange Plan,78.50%,0.776599705219269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$9,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$3,000",25%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,000",$20,$900,"$1,000","$1,000",$900,$80,$0,11
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,3,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070011,Medica Choice Passport WI 1500-50-30% Silver,57637WI007,,WIN001,WIS001,WIF005,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070011-00,Standard Silver Off Exchange Plan,,0.707387924194336,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,000","$1,000","$1,300","$1,000",$0,$0,12
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,3,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070011,Medica Choice Passport WI 1500-50-30% Silver,57637WI007,,WIN001,WIS001,WIF005,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070011-01,Standard Silver On Exchange Plan,,0.707387924194336,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,000","$1,000","$1,300","$1,000",$0,$0,13
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,3,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070012,Medica Choice Passport WI 2500-50-30% Silver,57637WI007,,WIN001,WIS001,WIF005,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070012-00,Standard Silver Off Exchange Plan,,0.687993884086609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$3,750","$9,900",Not Applicable,Not Applicable,"$2,500",$20,$700,"$1,000","$1,300","$1,000",$0,$0,14
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,3,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070012,Medica Choice Passport WI 2500-50-30% Silver,57637WI007,,WIN001,WIS001,WIF005,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070012-01,Standard Silver On Exchange Plan,,0.687993884086609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$3,750","$9,900",Not Applicable,Not Applicable,"$2,500",$20,$700,"$1,000","$1,300","$1,000",$0,$0,15
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,3,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070013,Medica Choice Passport WI 3000-50-30% Silver,57637WI007,,WIN001,WIS001,WIF005,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070013-00,Standard Silver Off Exchange Plan,,0.682978689670563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",30%,,,,"$5,250","$9,900",Not Applicable,Not Applicable,"$3,000",$20,$500,"$1,000","$1,300","$1,000",$0,$0,16
2015,WI,57637,HIOS,6,2015-04-22 11:06:15,3,57637,WI,SHOP (Small Group),No,41-1490988,57637WI0070013,Medica Choice Passport WI 3000-50-30% Silver,57637WI007,,WIN001,WIS001,WIF005,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$200,0,0,0,2015-01-01,,Yes,Emergency Services,Yes,Out-of-network benefits.,Yes,www.medica.com/SHOPPassportChoicePlusSBC,,www.medica.com/SHOPPassportChoicePlusBrochure,www.medica.com/SHOPPharmacy,57637WI0070013-01,Standard Silver On Exchange Plan,,0.682978689670563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",30%,,,,"$5,250","$9,900",Not Applicable,Not Applicable,"$3,000",$20,$500,"$1,000","$1,300","$1,000",$0,$0,17
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,1,57845,WI,Individual,No,41-1843804,57845WI0010001,Medica Applause Gold Copay,57845WI001,,WIN001,WIS001,WIF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseCopay,www.medica.com/IFBPharmacy,57845WI0010001-00,Standard Gold Off Exchange Plan,,0.785041034221649,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$900,30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,1,57845,WI,Individual,No,41-1843804,57845WI0010001,Medica Applause Gold Copay,57845WI001,,WIN001,WIS001,WIF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseCopay,www.medica.com/IFBPharmacy,57845WI0010001-01,Standard Gold On Exchange Plan,,0.785041034221649,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$900,30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,1,57845,WI,Individual,No,41-1843804,57845WI0010001,Medica Applause Gold Copay,57845WI001,,WIN001,WIS001,WIF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseCopay,www.medica.com/IFBPharmacy,57845WI0010001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,1,57845,WI,Individual,No,41-1843804,57845WI0010001,Medica Applause Gold Copay,57845WI001,,WIN001,WIS001,WIF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseCopay,www.medica.com/IFBPharmacy,57845WI0010001-03,Limited Cost Sharing Plan Variation,,0.785041034221649,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$900,30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,1,57845,WI,Individual,No,41-1843804,57845WI0010003,Medica Applause Silver Copay,57845WI001,,WIN001,WIS001,WIF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseCopay,www.medica.com/IFBPharmacy,57845WI0010003-00,Standard Silver Off Exchange Plan,,0.680651843547821,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$7,800",40%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,1,57845,WI,Individual,No,41-1843804,57845WI0010003,Medica Applause Silver Copay,57845WI001,,WIN001,WIS001,WIF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseCopay,www.medica.com/IFBPharmacy,57845WI0010003-01,Standard Silver On Exchange Plan,,0.680651843547821,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$7,800",40%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,1,57845,WI,Individual,No,41-1843804,57845WI0010003,Medica Applause Silver Copay,57845WI001,,WIN001,WIS001,WIF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseCopay,www.medica.com/IFBPharmacy,57845WI0010003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,10
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,1,57845,WI,Individual,No,41-1843804,57845WI0010003,Medica Applause Silver Copay,57845WI001,,WIN001,WIS001,WIF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseCopay,www.medica.com/IFBPharmacy,57845WI0010003-03,Limited Cost Sharing Plan Variation,,0.680651843547821,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$7,800",40%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,1,57845,WI,Individual,No,41-1843804,57845WI0010003,Medica Applause Silver Copay,57845WI001,,WIN001,WIS001,WIF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseCopay,www.medica.com/IFBPharmacy,57845WI0010003-04,73% AV Level Silver Plan,,0.735756456851959,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$6,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,1,57845,WI,Individual,No,41-1843804,57845WI0010003,Medica Applause Silver Copay,57845WI001,,WIN001,WIS001,WIF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseCopay,www.medica.com/IFBPharmacy,57845WI0010003-05,87% AV Level Silver Plan,,0.861037850379944,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,"$1,200",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,1,57845,WI,Individual,No,41-1843804,57845WI0010003,Medica Applause Silver Copay,57845WI001,,WIN001,WIS001,WIF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseCopay,www.medica.com/IFBPharmacy,57845WI0010003-06,94% AV Level Silver Plan,,0.931123793125153,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$150,5%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,1,57845,WI,Individual,No,41-1843804,57845WI0010005,Medica Applause Bronze Copay,57845WI001,,WIN001,WIS001,WIF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseCopay,www.medica.com/IFBPharmacy,57845WI0010005-00,Standard Bronze Off Exchange Plan,,0.618459045886993,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,1,57845,WI,Individual,No,41-1843804,57845WI0010005,Medica Applause Bronze Copay,57845WI001,,WIN001,WIS001,WIF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseCopay,www.medica.com/IFBPharmacy,57845WI0010005-01,Standard Bronze On Exchange Plan,,0.618459045886993,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,1,57845,WI,Individual,No,41-1843804,57845WI0010005,Medica Applause Bronze Copay,57845WI001,,WIN001,WIS001,WIF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseCopay,www.medica.com/IFBPharmacy,57845WI0010005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,17
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,1,57845,WI,Individual,No,41-1843804,57845WI0010005,Medica Applause Bronze Copay,57845WI001,,WIN001,WIS001,WIF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseCopay,www.medica.com/IFBPharmacy,57845WI0010005-03,Limited Cost Sharing Plan Variation,,0.618459045886993,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,1,57845,WI,Individual,No,41-1843804,57845WI0010017,Medica Applause Gold Copay 100,57845WI001,,WIN001,WIS001,WIF007,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseCopay,www.medica.com/IFBPharmacy,57845WI0010017-00,Standard Gold Off Exchange Plan,,0.799562036991119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,400","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,400","$7,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,1,57845,WI,Individual,No,41-1843804,57845WI0010017,Medica Applause Gold Copay 100,57845WI001,,WIN001,WIS001,WIF007,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseCopay,www.medica.com/IFBPharmacy,57845WI0010017-01,Standard Gold On Exchange Plan,,0.799562036991119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,400","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,400","$7,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,1,57845,WI,Individual,No,41-1843804,57845WI0010017,Medica Applause Gold Copay 100,57845WI001,,WIN001,WIS001,WIF007,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseCopay,www.medica.com/IFBPharmacy,57845WI0010017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,21
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,1,57845,WI,Individual,No,41-1843804,57845WI0010017,Medica Applause Gold Copay 100,57845WI001,,WIN001,WIS001,WIF007,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseCopay,www.medica.com/IFBPharmacy,57845WI0010017-03,Limited Cost Sharing Plan Variation,,0.799562036991119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,400","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,400","$7,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,2,57845,WI,Individual,No,41-1843804,57845WI0010007,Medica Applause Gold H S A,57845WI001,,WIN001,WIS001,WIF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseHSA,www.medica.com/IFBPharmacy,57845WI0010007-00,Standard Gold Off Exchange Plan,,0.781114280223846,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,350","$7,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,2,57845,WI,Individual,No,41-1843804,57845WI0010007,Medica Applause Gold H S A,57845WI001,,WIN001,WIS001,WIF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseHSA,www.medica.com/IFBPharmacy,57845WI0010007-01,Standard Gold On Exchange Plan,,0.781114280223846,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,350","$7,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,2,57845,WI,Individual,No,41-1843804,57845WI0010007,Medica Applause Gold H S A,57845WI001,,WIN001,WIS001,WIF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseHSA,www.medica.com/IFBPharmacy,57845WI0010007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,2,57845,WI,Individual,No,41-1843804,57845WI0010007,Medica Applause Gold H S A,57845WI001,,WIN001,WIS001,WIF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseHSA,www.medica.com/IFBPharmacy,57845WI0010007-03,Limited Cost Sharing Plan Variation,,0.781114280223846,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,350","$7,050",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,2,57845,WI,Individual,No,41-1843804,57845WI0010009,Medica Applause Silver H S A,57845WI001,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseHSA,www.medica.com/IFBPharmacy,57845WI0010009-00,Standard Silver Off Exchange Plan,,0.680960297584534,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,450","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900",40%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,2,57845,WI,Individual,No,41-1843804,57845WI0010009,Medica Applause Silver H S A,57845WI001,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseHSA,www.medica.com/IFBPharmacy,57845WI0010009-01,Standard Silver On Exchange Plan,,0.680960297584534,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,450","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900",40%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,2,57845,WI,Individual,No,41-1843804,57845WI0010009,Medica Applause Silver H S A,57845WI001,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseHSA,www.medica.com/IFBPharmacy,57845WI0010009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,10
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,2,57845,WI,Individual,No,41-1843804,57845WI0010009,Medica Applause Silver H S A,57845WI001,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseHSA,www.medica.com/IFBPharmacy,57845WI0010009-03,Limited Cost Sharing Plan Variation,,0.680960297584534,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,450","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900",40%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,2,57845,WI,Individual,No,41-1843804,57845WI0010009,Medica Applause Silver H S A,57845WI001,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseHSA,www.medica.com/IFBPharmacy,57845WI0010009-04,73% AV Level Silver Plan,,0.721749007701874,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,050","$3,150",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,2,57845,WI,Individual,No,41-1843804,57845WI0010009,Medica Applause Silver H S A,57845WI001,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseHSA,www.medica.com/IFBPharmacy,57845WI0010009-05,87% AV Level Silver Plan,,0.862255096435547,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$750,20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,2,57845,WI,Individual,No,41-1843804,57845WI0010009,Medica Applause Silver H S A,57845WI001,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseHSA,www.medica.com/IFBPharmacy,57845WI0010009-06,94% AV Level Silver Plan,,0.935520946979523,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$450,5%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,2,57845,WI,Individual,No,41-1843804,57845WI0010011,Medica Applause Bronze H S A,57845WI001,,WIN001,WIS001,WIF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseHSA,www.medica.com/IFBPharmacy,57845WI0010011-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,700",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,2,57845,WI,Individual,No,41-1843804,57845WI0010011,Medica Applause Bronze H S A,57845WI001,,WIN001,WIS001,WIF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseHSA,www.medica.com/IFBPharmacy,57845WI0010011-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,700",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,2,57845,WI,Individual,No,41-1843804,57845WI0010011,Medica Applause Bronze H S A,57845WI001,,WIN001,WIS001,WIF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseHSA,www.medica.com/IFBPharmacy,57845WI0010011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,17
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,2,57845,WI,Individual,No,41-1843804,57845WI0010011,Medica Applause Bronze H S A,57845WI001,,WIN001,WIS001,WIF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseHSA,www.medica.com/IFBPharmacy,57845WI0010011-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,700",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,WI,57845,HIOS,3,2014-08-08 08:53:29,3,57845,WI,Individual,No,41-1843804,57845WI0010013,Medica Applause Catastrophic,57845WI001,,WIN001,WIS001,WIF006,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,Out of Network Benefits,No,www.medica.com/sbc,www.medica.com/firstmonthpayment,www.medica.com/WI_ApplauseCatastrophic,www.medica.com/IFBPharmacy,57845WI0010013-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060013,MercyCare HMO CO-90 $500 Deductible; $10/$25/$50 Rx,58326WI006,,WIN001,WIS001,WIF001,Existing,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060013-00,Standard Platinum Off Exchange Plan,88.60%,0.885846078395844,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060013,MercyCare HMO CO-90 $500 Deductible; $10/$25/$50 Rx,58326WI006,,WIN001,WIS001,WIF001,Existing,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060013-01,Standard Platinum On Exchange Plan,88.60%,0.885846078395844,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090012,MercyCare HMO Gold Option B,58326WI009,,WIN001,WIS001,WIF005,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090012-03,Limited Cost Sharing Plan Variation,78.20%,0.781829297542572,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090013,MercyCare HMO Gold Option C,58326WI009,,WIN001,WIS001,WIF004,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090013-00,Standard Gold Off Exchange Plan,81.60%,0.81584757566452,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060015,MercyCare HMO CO-80 $500 Deductible; $10/$25/$50 Rx,58326WI006,,WIN001,WIS001,WIF001,Existing,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060015-00,Standard Platinum Off Exchange Plan,88.30%,0.883324921131134,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,10,79475,WI,Individual,No,39-1462554,79475WI0340023,Anthem Silver Blue Priority X WI 1850 20,79475WI034,,WIN002,WIS001,WIF008,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GNK,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340023-00,Standard Silver Off Exchange Plan,70.80%,0.713846921920776,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,850","$3,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,10,79475,WI,Individual,No,39-1462554,79475WI0340023,Anthem Silver Blue Priority X WI 1850 20,79475WI034,,WIN002,WIS001,WIF008,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GNK,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340023-01,Standard Silver On Exchange Plan,70.80%,0.713846921920776,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,850","$3,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,10,79475,WI,Individual,No,39-1462554,79475WI0340023,Anthem Silver Blue Priority X WI 1850 20,79475WI034,,WIN002,WIS001,WIF008,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GNK,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340023-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,10,79475,WI,Individual,No,39-1462554,79475WI0340023,Anthem Silver Blue Priority X WI 1850 20,79475WI034,,WIN002,WIS001,WIF008,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GNK,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340023-03,Limited Cost Sharing Plan Variation,70.80%,0.713846921920776,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,850","$3,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060015,MercyCare HMO CO-80 $500 Deductible; $10/$25/$50 Rx,58326WI006,,WIN001,WIS001,WIF001,Existing,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060015-01,Standard Platinum On Exchange Plan,88.30%,0.883324921131134,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070005,MercyCare EPO CO-80 $0 Deductible; $10/$25/$50 Rx,58326WI007,,WIN002,WIS001,WIF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070005-01,Standard Platinum On Exchange Plan,90.70%,0.906812846660614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070007,MercyCare EPO CO-90 $500 Deductible; $10/$25/$50 Rx,58326WI007,,WIN002,WIS001,WIF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070007-00,Standard Platinum Off Exchange Plan,88.60%,0.885846078395844,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070007,MercyCare EPO CO-90 $500 Deductible; $10/$25/$50 Rx,58326WI007,,WIN002,WIS001,WIF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070007-01,Standard Platinum On Exchange Plan,88.60%,0.885846078395844,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070009,MercyCare EPO CO-80 $500 Deductible; $10/$25/$50 Rx,58326WI007,,WIN002,WIS001,WIF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070009-00,Standard Platinum Off Exchange Plan,88.30%,0.883324921131134,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070009,MercyCare EPO CO-80 $500 Deductible; $10/$25/$50 Rx,58326WI007,,WIN002,WIS001,WIF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070009-01,Standard Platinum On Exchange Plan,88.30%,0.883324921131134,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070011,"MercyCare EPO CO-80 $1,250 Deductible; $10/$25/$50 Rx",58326WI007,,WIN002,WIS001,WIF001,Existing,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070011-00,Standard Gold Off Exchange Plan,82.00%,0.819543838500977,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090013,MercyCare HMO Gold Option C,58326WI009,,WIN001,WIS001,WIF004,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090013-01,Standard Gold On Exchange Plan,81.60%,0.81584757566452,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090013,MercyCare HMO Gold Option C,58326WI009,,WIN001,WIS001,WIF004,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090013-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060017,"MercyCare HMO CO-80 $1,250 Deductible; $10/$25/$50 Rx",58326WI006,,WIN001,WIS001,WIF001,Existing,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060017-00,Standard Gold Off Exchange Plan,82.00%,0.819543838500977,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060017,"MercyCare HMO CO-80 $1,250 Deductible; $10/$25/$50 Rx",58326WI006,,WIN001,WIS001,WIF001,Existing,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060017-01,Standard Gold On Exchange Plan,82.00%,0.819543838500977,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090013,MercyCare HMO Gold Option C,58326WI009,,WIN001,WIS001,WIF004,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090013-03,Limited Cost Sharing Plan Variation,81.60%,0.81584757566452,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090002,MercyCare HMO Silver Option A,58326WI009,,WIN001,WIS001,WIF005,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090002-00,Standard Silver Off Exchange Plan,70.00%,0.699542224407196,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070012,"MercyCare EPO CO-80 $2,000 Deductible; $20/$40/$60 Rx",58326WI007,,WIN002,WIS001,WIF002,Existing,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070012-01,Standard Gold On Exchange Plan,78.10%,0.781417906284332,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,59
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070014,"MercyCare EPO CO-60 $2,000 Deductible; $20/$40/$60 Rx",58326WI007,,WIN002,WIS001,WIF002,Existing,EPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070014-00,Standard Silver Off Exchange Plan,71.90%,0.718991279602051,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,60
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060019,"MercyCare HMO CO-80 $2,000 Deductible; $10/$25/$50 Rx",58326WI006,,WIN001,WIS001,WIF001,Existing,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060019-00,Standard Gold Off Exchange Plan,79.00%,0.789688766002655,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060019,"MercyCare HMO CO-80 $2,000 Deductible; $10/$25/$50 Rx",58326WI006,,WIN001,WIS001,WIF001,Existing,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060019-01,Standard Gold On Exchange Plan,79.00%,0.789688766002655,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090002,MercyCare HMO Silver Option A,58326WI009,,WIN001,WIS001,WIF005,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090002-01,Standard Silver On Exchange Plan,70.00%,0.699542224407196,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090002,MercyCare HMO Silver Option A,58326WI009,,WIN001,WIS001,WIF005,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060008,MercyCare HMO CO-90 $0 Deductible; $17/$40/$60 Rx,58326WI006,,WIN001,WIS001,WIF008,Existing,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060008-00,Standard Platinum Off Exchange Plan,91.20%,0.914202272891998,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060008,MercyCare HMO CO-90 $0 Deductible; $17/$40/$60 Rx,58326WI006,,WIN001,WIS001,WIF008,Existing,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060008-01,Standard Platinum On Exchange Plan,91.20%,0.914202272891998,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090002,MercyCare HMO Silver Option A,58326WI009,,WIN001,WIS001,WIF005,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090002-03,Limited Cost Sharing Plan Variation,70.00%,0.699542224407196,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090002,MercyCare HMO Silver Option A,58326WI009,,WIN001,WIS001,WIF005,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090002-04,73% AV Level Silver Plan,73.80%,0.73792439699173,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,2,58326,WI,Individual,No,20-1482553,58326WI0090016,MercyCare HMO Silver Option C,58326WI009,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090016-03,Limited Cost Sharing Plan Variation,68.00%,0.680308699607849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,2,58326,WI,Individual,No,20-1482553,58326WI0090016,MercyCare HMO Silver Option C,58326WI009,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090016-04,73% AV Level Silver Plan,73.00%,0.729625403881073,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060010,MercyCare HMO CO-80 $0 Deductible; $17/$40/$60 Rx,58326WI006,,WIN001,WIS001,WIF008,Existing,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060010-00,Standard Platinum Off Exchange Plan,91.10%,0.913043737411499,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060010,MercyCare HMO CO-80 $0 Deductible; $17/$40/$60 Rx,58326WI006,,WIN001,WIS001,WIF008,Existing,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060010-01,Standard Platinum On Exchange Plan,91.10%,0.913043737411499,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090002,MercyCare HMO Silver Option A,58326WI009,,WIN001,WIS001,WIF005,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090002-05,87% AV Level Silver Plan,86.50%,0.86500346660614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090002,MercyCare HMO Silver Option A,58326WI009,,WIN001,WIS001,WIF005,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090002-06,94% AV Level Silver Plan,94.50%,0.94464236497879,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060012,MercyCare HMO CO-90 $500 Deductible; $17/$40/$60 Rx,58326WI006,,WIN001,WIS001,WIF008,Existing,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060012-00,Standard Platinum Off Exchange Plan,89.10%,0.893076121807098,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060012,MercyCare HMO CO-90 $500 Deductible; $17/$40/$60 Rx,58326WI006,,WIN001,WIS001,WIF008,Existing,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060012-01,Standard Platinum On Exchange Plan,89.10%,0.893076121807098,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090015,MercyCare HMO Silver Option B,58326WI009,,WIN001,WIS001,WIF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090015-00,Standard Silver Off Exchange Plan,71.50%,0.715148746967316,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090015,MercyCare HMO Silver Option B,58326WI009,,WIN001,WIS001,WIF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090015-01,Standard Silver On Exchange Plan,71.50%,0.715148746967316,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060014,MercyCare HMO CO-80 $500 Deductible; $17/$40/$60 Rx,58326WI006,,WIN001,WIS001,WIF008,Existing,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060014-00,Standard Platinum Off Exchange Plan,89.50%,0.897381186485291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060014,MercyCare HMO CO-80 $500 Deductible; $17/$40/$60 Rx,58326WI006,,WIN001,WIS001,WIF008,Existing,HMO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060014-01,Standard Platinum On Exchange Plan,89.50%,0.897381186485291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090015,MercyCare HMO Silver Option B,58326WI009,,WIN001,WIS001,WIF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090015-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,25
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090015,MercyCare HMO Silver Option B,58326WI009,,WIN001,WIS001,WIF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090015-03,Limited Cost Sharing Plan Variation,71.50%,0.715148746967316,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060016,"MercyCare HMO CO-80 $1,250 Deductible; $20/$40/$60 Rx",58326WI006,,WIN001,WIS001,WIF002,Existing,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060016-00,Standard Gold Off Exchange Plan,82.00%,0.819661915302277,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060016,"MercyCare HMO CO-80 $1,250 Deductible; $20/$40/$60 Rx",58326WI006,,WIN001,WIS001,WIF002,Existing,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060016-01,Standard Gold On Exchange Plan,82.00%,0.819661915302277,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090015,MercyCare HMO Silver Option B,58326WI009,,WIN001,WIS001,WIF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090015-04,73% AV Level Silver Plan,74.00%,0.738465905189514,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090015,MercyCare HMO Silver Option B,58326WI009,,WIN001,WIS001,WIF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090015-05,87% AV Level Silver Plan,86.10%,0.861207842826843,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060018,"MercyCare HMO CO-80 $2,000 Deductible; $20/$40/$60 Rx",58326WI006,,WIN001,WIS001,WIF002,Existing,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060018-00,Standard Gold Off Exchange Plan,78.10%,0.781417906284332,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060018,"MercyCare HMO CO-80 $2,000 Deductible; $20/$40/$60 Rx",58326WI006,,WIN001,WIS001,WIF002,Existing,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060018-01,Standard Gold On Exchange Plan,78.10%,0.781417906284332,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,Individual,No,20-1482553,58326WI0090015,MercyCare HMO Silver Option B,58326WI009,,WIN001,WIS001,WIF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090015-06,94% AV Level Silver Plan,93.20%,0.932052195072174,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060021,"MercyCare HMO CO-60 $2,000 Deductible; $20/$40/$60 Rx",58326WI006,,WIN001,WIS001,WIF002,Existing,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060021-00,Standard Silver Off Exchange Plan,71.90%,0.718991279602051,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060021,"MercyCare HMO CO-60 $2,000 Deductible; $20/$40/$60 Rx",58326WI006,,WIN001,WIS001,WIF002,Existing,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060021-01,Standard Silver On Exchange Plan,71.90%,0.718991279602051,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060022,"MercyCare HMO CO-70 $2,500 Deductible; $20/$40/$60 Rx",58326WI006,,WIN001,WIS001,WIF002,Existing,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060022-00,Standard Silver Off Exchange Plan,71.60%,0.715985298156738,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060022,"MercyCare HMO CO-70 $2,500 Deductible; $20/$40/$60 Rx",58326WI006,,WIN001,WIS001,WIF002,Existing,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060022-01,Standard Silver On Exchange Plan,71.60%,0.715985298156738,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070001,MercyCare EPO Full Pay $0 Deductible; $10/$25/$50 Rx,58326WI007,,WIN002,WIS001,WIF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070001-00,Standard Platinum Off Exchange Plan,91.10%,0.911261379718781,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070001,MercyCare EPO Full Pay $0 Deductible; $10/$25/$50 Rx,58326WI007,,WIN002,WIS001,WIF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070001-01,Standard Platinum On Exchange Plan,91.10%,0.911261379718781,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070003,MercyCare EPO CO-90 $0 Deductible; $10/$25/$50 Rx,58326WI007,,WIN002,WIS001,WIF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070003-00,Standard Platinum Off Exchange Plan,91.80%,0.918205797672272,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070003,MercyCare EPO CO-90 $0 Deductible; $10/$25/$50 Rx,58326WI007,,WIN002,WIS001,WIF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070003-01,Standard Platinum On Exchange Plan,91.80%,0.918205797672272,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070005,MercyCare EPO CO-80 $0 Deductible; $10/$25/$50 Rx,58326WI007,,WIN002,WIS001,WIF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070005-00,Standard Platinum Off Exchange Plan,90.70%,0.906812846660614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070011,"MercyCare EPO CO-80 $1,250 Deductible; $10/$25/$50 Rx",58326WI007,,WIN002,WIS001,WIF001,Existing,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070011-01,Standard Gold On Exchange Plan,82.00%,0.819543838500977,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070013,"MercyCare EPO CO-80 $2,000 Deductible; $10/$25/$50 Rx",58326WI007,,WIN002,WIS001,WIF001,Existing,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070013-00,Standard Gold Off Exchange Plan,79.00%,0.789688766002655,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070013,"MercyCare EPO CO-80 $2,000 Deductible; $10/$25/$50 Rx",58326WI007,,WIN002,WIS001,WIF001,Existing,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070013-01,Standard Gold On Exchange Plan,79.00%,0.789688766002655,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,47
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070002,MercyCare EPO CO-90 $0 Deductible; $17/$40/$60 Rx,58326WI007,,WIN002,WIS001,WIF008,Existing,EPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070002-00,Standard Platinum Off Exchange Plan,91.20%,0.914202272891998,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070002,MercyCare EPO CO-90 $0 Deductible; $17/$40/$60 Rx,58326WI007,,WIN002,WIS001,WIF008,Existing,EPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070002-01,Standard Platinum On Exchange Plan,91.20%,0.914202272891998,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,49
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070004,MercyCare EPO CO-80 $0 Deductible; $17/$40/$60 Rx,58326WI007,,WIN002,WIS001,WIF008,Existing,EPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070004-00,Standard Platinum Off Exchange Plan,91.10%,0.913043737411499,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,50
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070004,MercyCare EPO CO-80 $0 Deductible; $17/$40/$60 Rx,58326WI007,,WIN002,WIS001,WIF008,Existing,EPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070004-01,Standard Platinum On Exchange Plan,91.10%,0.913043737411499,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,51
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070006,MercyCare EPO CO-90 $500 Deductible; $17/$40/$60 Rx,58326WI007,,WIN002,WIS001,WIF008,Existing,EPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070006-00,Standard Platinum Off Exchange Plan,89.10%,0.893076121807098,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,52
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070006,MercyCare EPO CO-90 $500 Deductible; $17/$40/$60 Rx,58326WI007,,WIN002,WIS001,WIF008,Existing,EPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070006-01,Standard Platinum On Exchange Plan,89.10%,0.893076121807098,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,53
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070008,MercyCare EPO CO-80 $500 Deductible; $17/$40/$60 Rx,58326WI007,,WIN002,WIS001,WIF008,Existing,EPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070008-00,Standard Platinum Off Exchange Plan,89.50%,0.897381186485291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,54
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070008,MercyCare EPO CO-80 $500 Deductible; $17/$40/$60 Rx,58326WI007,,WIN002,WIS001,WIF008,Existing,EPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070008-01,Standard Platinum On Exchange Plan,89.50%,0.897381186485291,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,55
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070010,"MercyCare EPO CO-80 $1,250 Deductible; $20/$40/$60 Rx",58326WI007,,WIN002,WIS001,WIF002,Existing,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070010-00,Standard Gold Off Exchange Plan,82.00%,0.819661915302277,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,56
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070010,"MercyCare EPO CO-80 $1,250 Deductible; $20/$40/$60 Rx",58326WI007,,WIN002,WIS001,WIF002,Existing,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070010-01,Standard Gold On Exchange Plan,82.00%,0.819661915302277,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,57
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070012,"MercyCare EPO CO-80 $2,000 Deductible; $20/$40/$60 Rx",58326WI007,,WIN002,WIS001,WIF002,Existing,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070012-00,Standard Gold Off Exchange Plan,78.10%,0.781417906284332,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,58
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070014,"MercyCare EPO CO-60 $2,000 Deductible; $20/$40/$60 Rx",58326WI007,,WIN002,WIS001,WIF002,Existing,EPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070014-01,Standard Silver On Exchange Plan,71.90%,0.718991279602051,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,61
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070015,"MercyCare EPO CO-70 $2,500 Deductible; $20/$40/$60 Rx",58326WI007,,WIN002,WIS001,WIF002,Existing,EPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070015-00,Standard Silver Off Exchange Plan,71.60%,0.715985298156738,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,62
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0070015,"MercyCare EPO CO-70 $2,500 Deductible; $20/$40/$60 Rx",58326WI007,,WIN002,WIS001,WIF002,Existing,EPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0070015-01,Standard Silver On Exchange Plan,71.60%,0.715985298156738,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,63
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060050,"MercyCare HMO CO-70 $5,000 Deductible; $20/$40/$60 Rx",58326WI006,,WIN001,WIS001,WIF002,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060050-00,Standard Silver Off Exchange Plan,69.20%,0.691554725170136,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,64
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,1,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060050,"MercyCare HMO CO-70 $5,000 Deductible; $20/$40/$60 Rx",58326WI006,,WIN001,WIS001,WIF002,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060050-01,Standard Silver On Exchange Plan,69.20%,0.691554725170136,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,65
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,2,58326,WI,Individual,No,20-1482553,58326WI0090016,MercyCare HMO Silver Option C,58326WI009,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090016-00,Standard Silver Off Exchange Plan,68.00%,0.680308699607849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,2,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060024,MercyCare HMO CO-60 HDHP $3200 Deductible,58326WI006,,WIN001,WIS001,WIF002,Existing,HMO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060024-00,Standard Bronze Off Exchange Plan,61.70%,0.616851806640625,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,200","$6,400",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,2,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060024,MercyCare HMO CO-60 HDHP $3200 Deductible,58326WI006,,WIN001,WIS001,WIF002,Existing,HMO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060024-01,Standard Bronze On Exchange Plan,61.70%,0.616851806640625,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,200","$6,400",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,2,58326,WI,Individual,No,20-1482553,58326WI0090016,MercyCare HMO Silver Option C,58326WI009,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090016-01,Standard Silver On Exchange Plan,68.00%,0.680308699607849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,2,58326,WI,Individual,No,20-1482553,58326WI0090016,MercyCare HMO Silver Option C,58326WI009,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090016-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,2,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060020,"MercyCare HMO H.S.A. $1,800 Deductible",58326WI006,,WIN001,WIS001,WIF003,Existing,HMO,Gold,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060020-00,Standard Gold Off Exchange Plan,80.40%,0.803948640823364,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,2,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060020,"MercyCare HMO H.S.A. $1,800 Deductible",58326WI006,,WIN001,WIS001,WIF003,Existing,HMO,Gold,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060020-01,Standard Gold On Exchange Plan,80.40%,0.803948640823364,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,2,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060049,"MercyCare HMO H.S.A. $3,600 Deductible",58326WI006,,WIN001,WIS001,WIF003,New,HMO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060049-00,Standard Silver Off Exchange Plan,68.30%,0.683036506175995,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,2,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060049,"MercyCare HMO H.S.A. $3,600 Deductible",58326WI006,,WIN001,WIS001,WIF003,New,HMO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060049-01,Standard Silver On Exchange Plan,68.30%,0.683036506175995,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,2,58326,WI,Individual,No,20-1482553,58326WI0090016,MercyCare HMO Silver Option C,58326WI009,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090016-05,87% AV Level Silver Plan,86.50%,0.865049004554749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,2,58326,WI,Individual,No,20-1482553,58326WI0090016,MercyCare HMO Silver Option C,58326WI009,,WIN001,WIS001,WIF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090016-06,94% AV Level Silver Plan,93.30%,0.932900547981262,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,2,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060051,"MercyCare HMO H.S.A. $5,500 Deductible",58326WI006,,WIN001,WIS001,WIF003,New,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060051-00,Standard Bronze Off Exchange Plan,61.00%,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,2,58326,WI,SHOP (Small Group),No,20-1482553,58326WI0060051,"MercyCare HMO H.S.A. $5,500 Deductible",58326WI006,,WIN001,WIS001,WIF003,New,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Out of Country Coverage for Emergency Services Only,No,Out of Service Area Coverage for Emergency Services Only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0060051-01,Standard Bronze On Exchange Plan,61.00%,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,3,58326,WI,Individual,No,20-1482553,58326WI0090006,MercyCare HMO Bronze Option A,58326WI009,,WIN001,WIS001,WIF005,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090006-00,Standard Bronze Off Exchange Plan,59.10%,0.590844571590424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,3,58326,WI,Individual,No,20-1482553,58326WI0090006,MercyCare HMO Bronze Option A,58326WI009,,WIN001,WIS001,WIF005,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090006-01,Standard Bronze On Exchange Plan,59.10%,0.590844571590424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,77525,HIOS,2,2014-08-08 08:53:29,2,77525,WI,SHOP (Small Group),Yes,72-0977315,77525WI0030001,AlwaysCare Small Group Dental - Adults,77525WI003,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.89,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,77525WI0030001-00,Standard High Off Exchange Plan,84.63%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,77525,HIOS,2,2014-08-08 08:53:29,2,77525,WI,SHOP (Small Group),Yes,72-0977315,77525WI0030002,AlwaysCare Small Group Dental - Adults,77525WI003,,WIN001,WIS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,77525WI0030002-00,Standard Low Off Exchange Plan,69.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,77525,HIOS,2,2014-08-08 08:53:29,2,77525,WI,Individual,Yes,72-0977315,77525WI0020002,AlwaysCare All-Star Family Dental Plan,77525WI002,,WIN001,WIS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$17.73,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,77525WI0020002-00,Standard Low Off Exchange Plan,69.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,79597,HIOS,2,2014-08-27 03:27:11,2,79597,WI,SHOP (Small Group),Yes,39-6094742,79597WI0040002,Delta Dental PPO Plus Premier Family Plan Low Option,79597WI004,,WIN002,WIS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.12,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.,Yes,http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2015/SG_FamilyLowPlan.pdf,https://auth.deltadentalwi.com/sp/ACS.saml2,http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2015/SG_FamilyLowPlan.pdf,,79597WI0040002-01,Standard Low On Exchange Plan,69.90%,,,,Yes,55%,45%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,$75,$225,,$75,$225,$75,$225,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,79597,HIOS,2,2014-08-27 03:27:11,2,79597,WI,Individual,Yes,39-6094742,79597WI0030002,Delta Dental Individual and Family Low Plan Major,79597WI003,,WIN001,WIS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.88,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.,Yes,www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_Low_Plan_Major.pdf,https://auth.deltadentalcoversme.com/sp/ACS.saml2,www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_Low_Plan_Major.pdf,,79597WI0030002-01,Standard Low On Exchange Plan,69.90%,,,,Yes,55%,45%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,$75,$225,,$75,$225,$75,$225,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,79597,HIOS,2,2014-08-27 03:27:11,3,79597,WI,Individual,Yes,39-6094742,79597WI0030003,Delta Dental Individual and Family Low Plan,79597WI003,,WIN001,WIS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.88,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.,Yes,www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_Low_Plan.pdf,https://auth.deltadentalcoversme.com/sp/ACS.saml2,www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_Low_Plan.pdf,,79597WI0030003-00,Standard Low Off Exchange Plan,69.90%,,,,Yes,55%,45%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,$75,$225,,$75,$225,$75,$225,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,79597,HIOS,2,2014-08-27 03:27:11,3,79597,WI,SHOP (Small Group),Yes,39-6094742,79597WI0040003,Delta Dental PPO Plus Premier Family Plan High Option Orthodontics,79597WI004,,WIN002,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.71,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.,Yes,,,,,79597WI0040003-00,Standard High Off Exchange Plan,84.30%,,,,Yes,55%,45%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,$75,,$25,$75,,$25,$75,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,79597,HIOS,2,2014-08-27 03:27:11,3,79597,WI,Individual,Yes,39-6094742,79597WI0030003,Delta Dental Individual and Family Low Plan,79597WI003,,WIN001,WIS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.88,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.,Yes,www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_Low_Plan.pdf,https://auth.deltadentalcoversme.com/sp/ACS.saml2,www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_Low_Plan.pdf,,79597WI0030003-01,Standard Low On Exchange Plan,69.90%,,,,Yes,55%,45%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,$75,$225,,$75,$225,$75,$225,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,81335,HIOS,3,2014-08-28 04:23:13,1,81335,WI,SHOP (Small Group),Yes,13-5581829,81335WI0120001,EHB Basic Dental Plan (Low),81335WI012,,WIN001,WIS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$18.82,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48063,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48062,,81335WI0120001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,81335,HIOS,3,2014-08-28 04:23:13,1,81335,WI,SHOP (Small Group),Yes,13-5581829,81335WI0120001,EHB Basic Dental Plan (Low),81335WI012,,WIN001,WIS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$18.82,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48063,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48062,,81335WI0120001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,81335,HIOS,3,2014-08-28 04:23:13,2,81335,WI,SHOP (Small Group),Yes,13-5581829,81335WI0130001,EHB Enhanced Dental Plan (High),81335WI013,,WIN002,WIS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$23.23,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49136,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49135,,81335WI0130001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,3,58326,WI,Individual,No,20-1482553,58326WI0090006,MercyCare HMO Bronze Option A,58326WI009,,WIN001,WIS001,WIF005,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,3,58326,WI,Individual,No,20-1482553,58326WI0090006,MercyCare HMO Bronze Option A,58326WI009,,WIN001,WIS001,WIF005,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090006-03,Limited Cost Sharing Plan Variation,59.10%,0.590844571590424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,3,58326,WI,Individual,No,20-1482553,58326WI0090018,MercyCare HMO Bronze Option B,58326WI009,,WIN001,WIS001,WIF006,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090018-00,Standard Bronze Off Exchange Plan,61.20%,0.61217737197876,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,3,58326,WI,Individual,No,20-1482553,58326WI0090018,MercyCare HMO Bronze Option B,58326WI009,,WIN001,WIS001,WIF006,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090018-01,Standard Bronze On Exchange Plan,61.20%,0.61217737197876,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,3,58326,WI,Individual,No,20-1482553,58326WI0090018,MercyCare HMO Bronze Option B,58326WI009,,WIN001,WIS001,WIF006,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090018-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,3,58326,WI,Individual,No,20-1482553,58326WI0090018,MercyCare HMO Bronze Option B,58326WI009,,WIN001,WIS001,WIF006,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090018-03,Limited Cost Sharing Plan Variation,61.20%,0.61217737197876,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,3,58326,WI,Individual,No,20-1482553,58326WI0090019,MercyCare HMO Bronze Option C,58326WI009,,WIN001,WIS001,WIF007,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090019-00,Standard Bronze Off Exchange Plan,58.30%,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,3,58326,WI,Individual,No,20-1482553,58326WI0090019,MercyCare HMO Bronze Option C,58326WI009,,WIN001,WIS001,WIF007,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090019-01,Standard Bronze On Exchange Plan,58.30%,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,3,58326,WI,Individual,No,20-1482553,58326WI0090019,MercyCare HMO Bronze Option C,58326WI009,,WIN001,WIS001,WIF007,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090019-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,WI,58326,HIOS,5,2014-09-06 03:39:47,3,58326,WI,Individual,No,20-1482553,58326WI0090019,MercyCare HMO Bronze Option C,58326WI009,,WIN001,WIS001,WIF007,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,No,Limited to emergency services only,No,Limited to emergency services only,No,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/pay,http://www.mercycarehealthplans.com,http://www.mercycarehealthplans.com/index.asp?menuID=146&firstlevelmenuID=137&siteID=1,58326WI0090019-03,Limited Cost Sharing Plan Variation,58.30%,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,9,79475,WI,Individual,No,39-1462554,79475WI0340022,Anthem Silver Blue Priority X WI 10 for HSA,79475WI034,,WIN002,WIS001,WIF013,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GND,https://shop.anthem.com/sales/eox/payment/landing/wi,https://shop.anthem.com/sales/eox/payment/landing/wi,anthem.com/WISelectdrugtier4,79475WI0340022-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,9,79475,WI,Individual,No,39-1462554,79475WI0340022,Anthem Silver Blue Priority X WI 10 for HSA,79475WI034,,WIN002,WIS001,WIF013,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GND,https://shop.anthem.com/sales/eox/payment/landing/wi,https://shop.anthem.com/sales/eox/payment/landing/wi,anthem.com/WISelectdrugtier4,79475WI0340022-03,Limited Cost Sharing Plan Variation,68.45%,0.688326954841614,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,900","$7,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,9,79475,WI,Individual,No,39-1462554,79475WI0340022,Anthem Silver Blue Priority X WI 10 for HSA,79475WI034,,WIN002,WIS001,WIF013,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GND,https://shop.anthem.com/sales/eox/payment/landing/wi,https://shop.anthem.com/sales/eox/payment/landing/wi,anthem.com/WISelectdrugtier4,79475WI0340022-04,73% AV Level Silver Plan,72.21%,0.727197229862213,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,550","$7,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,9,79475,WI,Individual,No,39-1462554,79475WI0340022,Anthem Silver Blue Priority X WI 10 for HSA,79475WI034,,WIN002,WIS001,WIF013,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GND,https://shop.anthem.com/sales/eox/payment/landing/wi,https://shop.anthem.com/sales/eox/payment/landing/wi,anthem.com/WISelectdrugtier4,79475WI0340022-05,87% AV Level Silver Plan,86.17%,0.861683309078217,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,9,79475,WI,Individual,No,39-1462554,79475WI0340022,Anthem Silver Blue Priority X WI 10 for HSA,79475WI034,,WIN002,WIS001,WIF013,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GND,https://shop.anthem.com/sales/eox/payment/landing/wi,https://shop.anthem.com/sales/eox/payment/landing/wi,anthem.com/WISelectdrugtier4,79475WI0340022-06,94% AV Level Silver Plan,93.27%,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,10,79475,WI,Individual,No,39-1462554,79475WI0340023,Anthem Silver Blue Priority X WI 1850 20,79475WI034,,WIN002,WIS001,WIF008,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GNK,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340023-04,73% AV Level Silver Plan,72.89%,0.733917713165283,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,2,58564,WI,Individual,No,39-1565691,58564WI0370008,Dane Choice Simple Gold Plan,58564WI037,7477556600,WIN003,WIS001,WIF001,New,HMO,Gold,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,"$2,400",0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceSimpleG.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-simple-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370008-00,Standard Gold Off Exchange Plan,,0.784829497337341,No,No,No,100%,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400","$4,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,800","$3,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,2,58564,WI,Individual,No,39-1565691,58564WI0370008,Dane Choice Simple Gold Plan,58564WI037,7477556600,WIN003,WIS001,WIF001,New,HMO,Gold,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,"$2,400",0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceSimpleG.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-simple-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370008-01,Standard Gold On Exchange Plan,,0.784829497337341,No,No,No,100%,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400","$4,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,800","$3,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,2,58564,WI,Individual,No,39-1565691,58564WI0370008,Dane Choice Simple Gold Plan,58564WI037,7477556600,WIN003,WIS001,WIF001,New,HMO,Gold,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,"$2,400",0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceSimpleG.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-simple-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370008-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,$0,$0,$0,$0,,,$0,$0,$0,$0,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,27
2015,WI,69589,HIOS,4,2014-08-23 04:11:13,2,69589,WI,SHOP (Small Group),Yes,13-5123390,69589WI0060002,Guardian Family Essentials,69589WI006,,WIN001,WIS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.00,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,69589WI0060002-00,Standard Low Off Exchange Plan,68.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WI,69589,HIOS,4,2014-08-23 04:11:13,2,69589,WI,SHOP (Small Group),Yes,13-5123390,69589WI0060002,Guardian Family Essentials,69589WI006,,WIN001,WIS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.00,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,69589WI0060002-01,Standard Low On Exchange Plan,68.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WI,69883,HIOS,3,2014-09-05 03:32:16,1,69883,WI,SHOP (Small Group),Yes,81-0170040,69883WI0010001,Assurant Dental ACAFFO High,69883WI001,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$49.75,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same Coverage as in Service Area,Yes,,,,,69883WI0010001-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,69883,HIOS,3,2014-09-05 03:32:16,2,69883,WI,SHOP (Small Group),Yes,81-0170040,69883WI0010002,Assurant Dental ACAFFO Low,69883WI001,,WIN001,WIS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$41.42,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same Coverage as in Service Area,Yes,,,,,69883WI0010002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,77525,HIOS,2,2014-08-08 08:53:29,1,77525,WI,Individual,Yes,72-0977315,77525WI0010001,AlwaysCare All-Star Kids Dental Plan,77525WI001,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$21.80,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,77525WI0010001-00,Standard High Off Exchange Plan,84.63%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,77525,HIOS,2,2014-08-08 08:53:29,1,77525,WI,SHOP (Small Group),Yes,72-0977315,77525WI0040001,AlwaysCare Small Group - Child,77525WI004,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.89,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,77525WI0040001-00,Standard High Off Exchange Plan,84.63%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250014,Arise Silver HMO 2000-80 to 6600,84670WI125,,WIN001,WIS001,WIF003,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125001401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250014.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250014-05,87% AV Level Silver Plan,86.60%,0.883187234401703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$110,$0,$30,$140,"$1,360",$0,$0,28
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330049,Arise Metro Platinum HMO 250,84670WI133,,WIN001,WIS003,WIF001,New,HMO,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133004901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330049.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330049-00,Standard Platinum Off Exchange Plan,88.90%,0.906141638755798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,28
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330049,Arise Metro Platinum HMO 250,84670WI133,,WIN001,WIS003,WIF001,New,HMO,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133004901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330049.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330049-01,Standard Platinum On Exchange Plan,88.90%,0.906141638755798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,29
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250014,Arise Silver HMO 2000-80 to 6600,84670WI125,,WIN001,WIS001,WIF003,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125001401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250014.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250014-06,94% AV Level Silver Plan,93.70%,0.949354588985443,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$110,$0,$30,$140,$360,$0,$0,29
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250015,Arise Silver HMO 4000,84670WI125,,WIN001,WIS001,WIF003,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125001501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250015.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250015-00,Standard Silver Off Exchange Plan,68.00%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,30
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330050,Arise Metro Gold HMO 2000,84670WI133,,WIN001,WIS003,WIF002,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133005001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330050.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330050-00,Standard Gold Off Exchange Plan,79.20%,0.808325171470642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$90,$0,$30,$140,"$1,610",$0,$0,30
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,2,79475,WI,Individual,No,39-1462554,79475WI0340015,Anthem Bronze Blue Priority X WI 5750 20,79475WI034,,WIN002,WIS001,WIF015,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GMK,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340015-00,Standard Bronze Off Exchange Plan,61.29%,0.614510357379913,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,2,79475,WI,Individual,No,39-1462554,79475WI0340015,Anthem Bronze Blue Priority X WI 5750 20,79475WI034,,WIN002,WIS001,WIF015,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GMK,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340015-01,Standard Bronze On Exchange Plan,61.29%,0.614510357379913,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,79597,HIOS,2,2014-08-27 03:27:11,1,79597,WI,SHOP (Small Group),Yes,39-6094742,79597WI0040001,Delta Dental PPO Plus Premier Family Plan High Option,79597WI004,,WIN002,WIS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.71,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.,Yes,http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2015/SG_FamilyHighPlan.pdf,https://auth.deltadentalwi.com/sp/ACS.saml2,http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2015/SG_FamilyHighPlan.pdf,,79597WI0040001-01,Standard High On Exchange Plan,84.30%,,,,Yes,55%,45%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,$75,,$25,$75,,$25,$75,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,79597,HIOS,2,2014-08-27 03:27:11,1,79597,WI,Individual,Yes,39-6094742,79597WI0030001,Delta Dental Individual and Family High Plan,79597WI003,,WIN001,WIS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$37.24,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.,Yes,www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_High_Plan.pdf,https://auth.deltadentalcoversme.com/sp/ACS.saml2,www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_High_Plan.pdf,,79597WI0030001-01,Standard High On Exchange Plan,84.30%,,,,Yes,55%,45%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,$75,,$25,$75,,$25,$75,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,2,58564,WI,Individual,No,39-1565691,58564WI0370008,Dane Choice Simple Gold Plan,58564WI037,7477556600,WIN003,WIS001,WIF001,New,HMO,Gold,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,"$2,400",0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceSimpleG.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-simple-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370008-03,Limited Cost Sharing Plan Variation,,0.784829497337341,No,No,No,100%,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400","$4,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,800","$3,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,2,58564,WI,Individual,No,39-1565691,58564WI0370009,Dane Choice Simple Silver Plan,58564WI037,7477556600,WIN003,WIS001,WIF001,New,HMO,Silver,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,"$2,400",0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceSimpleS.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-simple-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370009-00,Standard Silver Off Exchange Plan,,0.695968627929688,No,No,No,100%,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400","$4,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,2,58564,WI,Individual,No,39-1565691,58564WI0370009,Dane Choice Simple Silver Plan,58564WI037,7477556600,WIN003,WIS001,WIF001,New,HMO,Silver,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,"$2,400",0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceSimpleS.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-simple-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370009-01,Standard Silver On Exchange Plan,,0.695968627929688,No,No,No,100%,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400","$4,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,2,58564,WI,Individual,No,39-1565691,58564WI0370009,Dane Choice Simple Silver Plan,58564WI037,7477556600,WIN003,WIS001,WIF001,New,HMO,Silver,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,"$2,400",0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceSimpleS.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-simple-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370009-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,$0,$0,$0,$0,,,$0,$0,$0,$0,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,31
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,2,58564,WI,Individual,No,39-1565691,58564WI0370009,Dane Choice Simple Silver Plan,58564WI037,7477556600,WIN003,WIS001,WIF001,New,HMO,Silver,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,"$2,400",0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceSimpleS.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-simple-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370009-03,Limited Cost Sharing Plan Variation,,0.695968627929688,No,No,No,100%,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400","$4,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,2,58564,WI,Individual,No,39-1565691,58564WI0370009,Dane Choice Simple Silver Plan,58564WI037,7477556600,WIN003,WIS001,WIF001,New,HMO,Silver,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,"$2,400",0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceSimpleS.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-simple-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370009-04,73% AV Level Silver Plan,,0.72691011428833,No,No,No,100%,,"$2,800","$5,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400","$4,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$2,800","$5,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,2,58564,WI,Individual,No,39-1565691,58564WI0370009,Dane Choice Simple Silver Plan,58564WI037,7477556600,WIN003,WIS001,WIF001,New,HMO,Silver,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,"$2,400",0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceSimpleS.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-simple-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370009-05,87% AV Level Silver Plan,,0.877111434936523,No,No,No,100%,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,350","$2,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$750,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,2,58564,WI,Individual,No,39-1565691,58564WI0370009,Dane Choice Simple Silver Plan,58564WI037,7477556600,WIN003,WIS001,WIF001,New,HMO,Silver,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,"$2,400",0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceSimpleS.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-simple-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370009-06,94% AV Level Silver Plan,,0.939551413059235,No,No,No,100%,,$200,$400,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,350","$2,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$200,$400,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,2,58564,WI,Individual,No,39-1565691,58564WI0370010,Dane Choice Simple Bronze  Plan,58564WI037,7477556600,WIN003,WIS001,WIF002,New,HMO,Bronze,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,"$1,350",0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceSimpleB.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-simple-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370010-00,Standard Bronze Off Exchange Plan,,0.595934331417084,No,No,No,100%,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,350","$2,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,2,58564,WI,Individual,No,39-1565691,58564WI0370010,Dane Choice Simple Bronze  Plan,58564WI037,7477556600,WIN003,WIS001,WIF002,New,HMO,Bronze,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,"$1,350",0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceSimpleB.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-simple-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370010-01,Standard Bronze On Exchange Plan,,0.595934331417084,No,No,No,100%,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,350","$2,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,2,58564,WI,Individual,No,39-1565691,58564WI0370010,Dane Choice Simple Bronze  Plan,58564WI037,7477556600,WIN003,WIS001,WIF002,New,HMO,Bronze,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,"$1,350",0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceSimpleB.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-simple-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370010-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,$0,$0,$0,$0,,,$0,$0,$0,$0,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,38
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,2,58564,WI,Individual,No,39-1565691,58564WI0370010,Dane Choice Simple Bronze  Plan,58564WI037,7477556600,WIN003,WIS001,WIF002,New,HMO,Bronze,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,"$1,350",0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceSimpleB.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-simple-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370010-03,Limited Cost Sharing Plan Variation,,0.595934331417084,No,No,No,100%,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,350","$2,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,3,58564,WI,Individual,No,39-1565691,58564WI0370012,Dane Choice Deductible Silver,58564WI037,7477556600,WIN003,WIS001,WIF003,Existing,HMO,Silver,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceDeductibleS.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-deductible-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370012-00,Standard Silver Off Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,3,58564,WI,Individual,No,39-1565691,58564WI0370012,Dane Choice Deductible Silver,58564WI037,7477556600,WIN003,WIS001,WIF003,Existing,HMO,Silver,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceDeductibleS.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-deductible-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370012-01,Standard Silver On Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,3,58564,WI,Individual,No,39-1565691,58564WI0370012,Dane Choice Deductible Silver,58564WI037,7477556600,WIN003,WIS001,WIF003,Existing,HMO,Silver,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceDeductibleS.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-deductible-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,22
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,3,58564,WI,Individual,No,39-1565691,58564WI0370012,Dane Choice Deductible Silver,58564WI037,7477556600,WIN003,WIS001,WIF003,Existing,HMO,Silver,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceDeductibleS.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-deductible-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370012-03,Limited Cost Sharing Plan Variation,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,3,58564,WI,Individual,No,39-1565691,58564WI0370012,Dane Choice Deductible Silver,58564WI037,7477556600,WIN003,WIS001,WIF003,Existing,HMO,Silver,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceDeductibleS.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-deductible-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370012-04,73% AV Level Silver Plan,,0.738942980766296,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,650","$5,300",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,24
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,3,58564,WI,Individual,No,39-1565691,58564WI0370012,Dane Choice Deductible Silver,58564WI037,7477556600,WIN003,WIS001,WIF003,Existing,HMO,Silver,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceDeductibleS.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-deductible-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370012-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,3,58564,WI,Individual,No,39-1565691,58564WI0370012,Dane Choice Deductible Silver,58564WI037,7477556600,WIN003,WIS001,WIF003,Existing,HMO,Silver,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceDeductibleS.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-deductible-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370012-06,94% AV Level Silver Plan,,0.944938838481903,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,26
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,3,58564,WI,Individual,No,39-1565691,58564WI0370014,Dane Choice Basic Plan,58564WI037,7477556600,WIN003,WIS001,WIF003,New,HMO,Catastrophic,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceBP.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-deductible-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370014-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,28
2015,WI,58564,HIOS,7,2015-07-22 09:15:52,3,58564,WI,Individual,No,39-1565691,58564WI0370014,Dane Choice Basic Plan,58564WI037,7477556600,WIN003,WIS001,WIF003,New,HMO,Catastrophic,No,Both,No,Yes,"All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies thtat are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Highly specialized or tertiary care with prior authorization of the plan.  Emergency care until the patient is stabilized for transport to a facility in the Service Area.,No,http://www.pplusic.com/documents/upload/DaneChoiceBP.pdf,,http://www.pplusic.com/home/buying-insurance/individual-plans/dane-choice-deductible-plans,http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf,58564WI0370014-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,29
2015,WI,62011,HIOS,2,2014-08-03 08:59:32,1,62011,WI,SHOP (Small Group),Yes,93-0242990,62011WI0040002,EHB High PPO,62011WI004,,WIN001,WIS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$48.72,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,62011WI0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,62011,HIOS,2,2014-08-03 08:59:32,1,62011,WI,SHOP (Small Group),Yes,93-0242990,62011WI0040001,EHB Low PPO,62011WI004,,WIN001,WIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.06,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,62011WI0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,62011,HIOS,2,2014-08-03 08:59:32,1,62011,WI,SHOP (Small Group),Yes,93-0242990,62011WI0030002,EHB High Passive,62011WI003,,WIN001,WIS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$50.96,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,62011WI0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WI,62011,HIOS,2,2014-08-03 08:59:32,1,62011,WI,SHOP (Small Group),Yes,93-0242990,62011WI0030001,EHB Low Passive,62011WI003,,WIN001,WIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.42,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,62011WI0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WI,66115,HIOS,2,2014-08-03 08:59:32,1,66115,WI,SHOP (Small Group),Yes,47-0098400,66115WI0040002,EHB High PPO,66115WI004,,WIN001,WIS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$47.91,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,66115WI0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,66115,HIOS,2,2014-08-03 08:59:32,1,66115,WI,SHOP (Small Group),Yes,47-0098400,66115WI0040001,EHB Low PPO,66115WI004,,WIN001,WIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.62,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,66115WI0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,66115,HIOS,2,2014-08-03 08:59:32,1,66115,WI,SHOP (Small Group),Yes,47-0098400,66115WI0030002,EHB High Passive,66115WI003,,WIN001,WIS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$50.11,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,66115WI0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WI,66115,HIOS,2,2014-08-03 08:59:32,1,66115,WI,SHOP (Small Group),Yes,47-0098400,66115WI0030001,EHB Low Passive,66115WI003,,WIN001,WIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.91,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,66115WI0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WI,69380,HIOS,3,2014-08-05 13:28:44,1,69380,WI,SHOP (Small Group),Yes,57-0523959,69380WI0010001,Group Pediatric Dental EHB Rider,69380WI001,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$34.31,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,69380WI0010001-00,Standard High Off Exchange Plan,85.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,69380,HIOS,3,2014-08-05 13:28:44,1,69380,WI,SHOP (Small Group),Yes,57-0523959,69380WI0010002,Group Pediatric Dental EHB Rider,69380WI001,,WIN001,WIS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$28.25,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,69380WI0010002-00,Standard Low Off Exchange Plan,70.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,69380,HIOS,3,2014-08-05 13:28:44,2,69380,WI,SHOP (Small Group),Yes,57-0523959,69380WI0020001,Group Pediatric Dental EHB Policy,69380WI002,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$40.21,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,69380WI0020001-00,Standard High Off Exchange Plan,84.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,69380,HIOS,3,2014-08-05 13:28:44,2,69380,WI,SHOP (Small Group),Yes,57-0523959,69380WI0020002,Group Pediatric Dental EHB Policy,69380WI002,,WIN001,WIS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$32.70,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,69380WI0020002-00,Standard Low Off Exchange Plan,69.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,69589,HIOS,4,2014-08-23 04:11:13,1,69589,WI,SHOP (Small Group),Yes,13-5123390,69589WI0010002,Guardian Pediatric Advantage,69589WI001,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$27.52,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,69589WI0010002-00,Standard High Off Exchange Plan,85.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,69589,HIOS,4,2014-08-23 04:11:13,1,69589,WI,SHOP (Small Group),Yes,13-5123390,69589WI0020002,Guardian Pediatric Essentials,69589WI002,,WIN001,WIS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$20.00,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,69589WI0020002-00,Standard Low Off Exchange Plan,68.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,69589,HIOS,4,2014-08-23 04:11:13,2,69589,WI,SHOP (Small Group),Yes,13-5123390,69589WI0040002,Guardian Family Advantge,69589WI004,,WIN001,WIS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.52,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,69589WI0040002-00,Standard High Off Exchange Plan,85.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,69589,HIOS,4,2014-08-23 04:11:13,2,69589,WI,SHOP (Small Group),Yes,13-5123390,69589WI0040002,Guardian Family Advantge,69589WI004,,WIN001,WIS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.52,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,69589WI0040002-01,Standard High On Exchange Plan,85.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,77525,HIOS,2,2014-08-08 08:53:29,1,77525,WI,SHOP (Small Group),Yes,72-0977315,77525WI0040002,AlwaysCare Small Group - Child,77525WI004,,WIN001,WIS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$22.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,77525WI0040002-00,Standard Low Off Exchange Plan,69.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,77525,HIOS,2,2014-08-08 08:53:29,1,77525,WI,Individual,Yes,72-0977315,77525WI0010002,AlwaysCare All-Star Kids Dental Plan,77525WI001,,WIN001,WIS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$17.73,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,77525WI0010002-00,Standard Low Off Exchange Plan,69.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,77525,HIOS,2,2014-08-08 08:53:29,2,77525,WI,Individual,Yes,72-0977315,77525WI0020001,AlwaysCare All-Star Family Dental Plan,77525WI002,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.80,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,77525WI0020001-00,Standard High Off Exchange Plan,84.63%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,1,79475,WI,Individual,No,39-1462554,79475WI0340014,Anthem Catastrophic Blue Priority X WI 6600 0,79475WI034,,WIN002,WIS001,WIF003,Existing,POS,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GMH,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340014-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,1,79475,WI,Individual,No,39-1462554,79475WI0340014,Anthem Catastrophic Blue Priority X WI 6600 0,79475WI034,,WIN002,WIS001,WIF003,Existing,POS,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GMH,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340014-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,2,79475,WI,Individual,No,39-1462554,79475WI0340015,Anthem Bronze Blue Priority X WI 5750 20,79475WI034,,WIN002,WIS001,WIF015,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GMK,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340015-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,2,79475,WI,Individual,No,39-1462554,79475WI0340015,Anthem Bronze Blue Priority X WI 5750 20,79475WI034,,WIN002,WIS001,WIF015,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GMK,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340015-03,Limited Cost Sharing Plan Variation,61.29%,0.614510357379913,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,3,79475,WI,Individual,No,39-1462554,79475WI0340016,Anthem Bronze Blue Priority X WI 6050 25,79475WI034,,WIN002,WIS001,WIF002,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GMN,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340016-00,Standard Bronze Off Exchange Plan,59.08%,0.61033433675766,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,050","$12,100",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,3,79475,WI,Individual,No,39-1462554,79475WI0340016,Anthem Bronze Blue Priority X WI 6050 25,79475WI034,,WIN002,WIS001,WIF002,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GMN,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340016-01,Standard Bronze On Exchange Plan,59.08%,0.61033433675766,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,050","$12,100",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,3,79475,WI,Individual,No,39-1462554,79475WI0340016,Anthem Bronze Blue Priority X WI 6050 25,79475WI034,,WIN002,WIS001,WIF002,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GMN,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340016-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,3,79475,WI,Individual,No,39-1462554,79475WI0340016,Anthem Bronze Blue Priority X WI 6050 25,79475WI034,,WIN002,WIS001,WIF002,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GMN,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340016-03,Limited Cost Sharing Plan Variation,59.08%,0.61033433675766,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,050","$12,100",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,4,79475,WI,Individual,No,39-1462554,79475WI0340017,Anthem Bronze Blue Priority X WI 0 for HSA,79475WI034,,WIN002,WIS001,WIF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GMR,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340017-00,Standard Bronze Off Exchange Plan,58.16%,0.576829433441162,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,4,79475,WI,Individual,No,39-1462554,79475WI0340017,Anthem Bronze Blue Priority X WI 0 for HSA,79475WI034,,WIN002,WIS001,WIF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GMR,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340017-01,Standard Bronze On Exchange Plan,58.16%,0.576829433441162,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,4,79475,WI,Individual,No,39-1462554,79475WI0340017,Anthem Bronze Blue Priority X WI 0 for HSA,79475WI034,,WIN002,WIS001,WIF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GMR,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340017-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,4,79475,WI,Individual,No,39-1462554,79475WI0340017,Anthem Bronze Blue Priority X WI 0 for HSA,79475WI034,,WIN002,WIS001,WIF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GMR,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340017-03,Limited Cost Sharing Plan Variation,58.16%,0.576829433441162,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,5,79475,WI,Individual,No,39-1462554,79475WI0340018,Anthem Bronze Blue Priority X WI 20 for HSA,79475WI034,,WIN002,WIS001,WIF004,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GMV,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340018-00,Standard Bronze Off Exchange Plan,61.00%,0.613896250724792,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,5,79475,WI,Individual,No,39-1462554,79475WI0340018,Anthem Bronze Blue Priority X WI 20 for HSA,79475WI034,,WIN002,WIS001,WIF004,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GMV,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340018-01,Standard Bronze On Exchange Plan,61.00%,0.613896250724792,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,5,79475,WI,Individual,No,39-1462554,79475WI0340018,Anthem Bronze Blue Priority X WI 20 for HSA,79475WI034,,WIN002,WIS001,WIF004,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GMV,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340018-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,5,79475,WI,Individual,No,39-1462554,79475WI0340018,Anthem Bronze Blue Priority X WI 20 for HSA,79475WI034,,WIN002,WIS001,WIF004,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GMV,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340018-03,Limited Cost Sharing Plan Variation,61.00%,0.613896250724792,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,6,79475,WI,Individual,No,39-1462554,79475WI0340019,Anthem Bronze Blue Priority X WI 4300 20,79475WI034,,WIN002,WIS001,WIF004,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GMY,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340019-00,Standard Bronze Off Exchange Plan,61.56%,0.619325935840607,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,6,79475,WI,Individual,No,39-1462554,79475WI0340019,Anthem Bronze Blue Priority X WI 4300 20,79475WI034,,WIN002,WIS001,WIF004,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GMY,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340019-01,Standard Bronze On Exchange Plan,61.56%,0.619325935840607,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,6,79475,WI,Individual,No,39-1462554,79475WI0340019,Anthem Bronze Blue Priority X WI 4300 20,79475WI034,,WIN002,WIS001,WIF004,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GMY,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340019-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,6,79475,WI,Individual,No,39-1462554,79475WI0340019,Anthem Bronze Blue Priority X WI 4300 20,79475WI034,,WIN002,WIS001,WIF004,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GMY,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340019-03,Limited Cost Sharing Plan Variation,61.56%,0.619325935840607,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,7,79475,WI,Individual,No,39-1462554,79475WI0340020,Anthem Silver Blue Priority X WI 3500 0,79475WI034,,WIN002,WIS001,WIF005,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GN1,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340020-00,Standard Silver Off Exchange Plan,70.30%,0.703458368778229,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,7,79475,WI,Individual,No,39-1462554,79475WI0340020,Anthem Silver Blue Priority X WI 3500 0,79475WI034,,WIN002,WIS001,WIF005,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GN1,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340020-01,Standard Silver On Exchange Plan,70.30%,0.703458368778229,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,7,79475,WI,Individual,No,39-1462554,79475WI0340020,Anthem Silver Blue Priority X WI 3500 0,79475WI034,,WIN002,WIS001,WIF005,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GN1,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340020-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,7,79475,WI,Individual,No,39-1462554,79475WI0340020,Anthem Silver Blue Priority X WI 3500 0,79475WI034,,WIN002,WIS001,WIF005,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GN1,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340020-03,Limited Cost Sharing Plan Variation,70.30%,0.703458368778229,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,7,79475,WI,Individual,No,39-1462554,79475WI0340020,Anthem Silver Blue Priority X WI 3500 0,79475WI034,,WIN002,WIS001,WIF005,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GN1,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340020-04,73% AV Level Silver Plan,72.33%,0.713923513889313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,7,79475,WI,Individual,No,39-1462554,79475WI0340020,Anthem Silver Blue Priority X WI 3500 0,79475WI034,,WIN002,WIS001,WIF005,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GN1,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340020-05,87% AV Level Silver Plan,86.09%,0.858777821063995,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$800,"$1,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,7,79475,WI,Individual,No,39-1462554,79475WI0340020,Anthem Silver Blue Priority X WI 3500 0,79475WI034,,WIN002,WIS001,WIF005,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GN1,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340020-06,94% AV Level Silver Plan,93.26%,0.930816173553467,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,8,79475,WI,Individual,No,39-1462554,79475WI0340021,Anthem Silver Blue Priority X WI 2500 10,79475WI034,,WIN002,WIS001,WIF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GN7,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340021-00,Standard Silver Off Exchange Plan,70.25%,0.710120856761932,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,8,79475,WI,Individual,No,39-1462554,79475WI0340021,Anthem Silver Blue Priority X WI 2500 10,79475WI034,,WIN002,WIS001,WIF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GN7,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340021-01,Standard Silver On Exchange Plan,70.25%,0.710120856761932,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,8,79475,WI,Individual,No,39-1462554,79475WI0340021,Anthem Silver Blue Priority X WI 2500 10,79475WI034,,WIN002,WIS001,WIF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GN7,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340021-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,8,79475,WI,Individual,No,39-1462554,79475WI0340021,Anthem Silver Blue Priority X WI 2500 10,79475WI034,,WIN002,WIS001,WIF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GN7,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340021-03,Limited Cost Sharing Plan Variation,70.25%,0.710120856761932,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,8,79475,WI,Individual,No,39-1462554,79475WI0340021,Anthem Silver Blue Priority X WI 2500 10,79475WI034,,WIN002,WIS001,WIF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GN7,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340021-04,73% AV Level Silver Plan,72.29%,0.729553401470184,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,450","$4,900",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,8,79475,WI,Individual,No,39-1462554,79475WI0340021,Anthem Silver Blue Priority X WI 2500 10,79475WI034,,WIN002,WIS001,WIF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GN7,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340021-05,87% AV Level Silver Plan,86.32%,0.865337550640106,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,8,79475,WI,Individual,No,39-1462554,79475WI0340021,Anthem Silver Blue Priority X WI 2500 10,79475WI034,,WIN002,WIS001,WIF001,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GN7,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340021-06,94% AV Level Silver Plan,93.23%,0.933515608310699,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,9,79475,WI,Individual,No,39-1462554,79475WI0340022,Anthem Silver Blue Priority X WI 10 for HSA,79475WI034,,WIN002,WIS001,WIF013,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GND,https://shop.anthem.com/sales/eox/payment/landing/wi,https://shop.anthem.com/sales/eox/payment/landing/wi,anthem.com/WISelectdrugtier4,79475WI0340022-00,Standard Silver Off Exchange Plan,68.45%,0.688326954841614,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,900","$7,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,9,79475,WI,Individual,No,39-1462554,79475WI0340022,Anthem Silver Blue Priority X WI 10 for HSA,79475WI034,,WIN002,WIS001,WIF013,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GND,https://shop.anthem.com/sales/eox/payment/landing/wi,https://shop.anthem.com/sales/eox/payment/landing/wi,anthem.com/WISelectdrugtier4,79475WI0340022-01,Standard Silver On Exchange Plan,68.45%,0.688326954841614,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,900","$7,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,10,79475,WI,Individual,No,39-1462554,79475WI0340023,Anthem Silver Blue Priority X WI 1850 20,79475WI034,,WIN002,WIS001,WIF008,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GNK,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340023-05,87% AV Level Silver Plan,86.13%,0.862643301486969,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,10,79475,WI,Individual,No,39-1462554,79475WI0340023,Anthem Silver Blue Priority X WI 1850 20,79475WI034,,WIN002,WIS001,WIF008,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GNK,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340023-06,94% AV Level Silver Plan,93.08%,0.931563556194305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$175,$350,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,11,79475,WI,Individual,No,39-1462554,79475WI0340024,Anthem Gold Blue Priority X WI 1100 10,79475WI034,,WIN002,WIS001,WIF001,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GP0,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340024-00,Standard Gold Off Exchange Plan,78.01%,0.779826045036316,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,600","$11,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,11,79475,WI,Individual,No,39-1462554,79475WI0340024,Anthem Gold Blue Priority X WI 1100 10,79475WI034,,WIN002,WIS001,WIF001,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GP0,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340024-01,Standard Gold On Exchange Plan,78.01%,0.779826045036316,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,600","$11,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,11,79475,WI,Individual,No,39-1462554,79475WI0340024,Anthem Gold Blue Priority X WI 1100 10,79475WI034,,WIN002,WIS001,WIF001,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GP0,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340024-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WI,79475,HIOS,18,2015-02-18 06:26:47,11,79475,WI,Individual,No,39-1462554,79475WI0340024,Anthem Gold Blue Priority X WI 1100 10,79475WI034,,WIN002,WIS001,WIF001,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GP0,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0340024-03,Limited Cost Sharing Plan Variation,78.01%,0.779826045036316,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,600","$11,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,79597,HIOS,2,2014-08-27 03:27:11,1,79597,WI,Individual,Yes,39-6094742,79597WI0030001,Delta Dental Individual and Family High Plan,79597WI003,,WIN001,WIS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$37.24,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.,Yes,www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_High_Plan.pdf,https://auth.deltadentalcoversme.com/sp/ACS.saml2,www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_High_Plan.pdf,,79597WI0030001-00,Standard High Off Exchange Plan,84.30%,,,,Yes,55%,45%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,$75,,$25,$75,,$25,$75,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,79597,HIOS,2,2014-08-27 03:27:11,1,79597,WI,SHOP (Small Group),Yes,39-6094742,79597WI0040001,Delta Dental PPO Plus Premier Family Plan High Option,79597WI004,,WIN002,WIS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.71,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.,Yes,http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2015/SG_FamilyHighPlan.pdf,https://auth.deltadentalwi.com/sp/ACS.saml2,http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2015/SG_FamilyHighPlan.pdf,,79597WI0040001-00,Standard High Off Exchange Plan,84.30%,,,,Yes,55%,45%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,$75,,$25,$75,,$25,$75,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,79597,HIOS,2,2014-08-27 03:27:11,2,79597,WI,Individual,Yes,39-6094742,79597WI0030002,Delta Dental Individual and Family Low Plan Major,79597WI003,,WIN001,WIS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.88,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.,Yes,www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_Low_Plan_Major.pdf,https://auth.deltadentalcoversme.com/sp/ACS.saml2,www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_Low_Plan_Major.pdf,,79597WI0030002-00,Standard Low Off Exchange Plan,69.90%,,,,Yes,55%,45%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,$75,$225,,$75,$225,$75,$225,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,79597,HIOS,2,2014-08-27 03:27:11,2,79597,WI,SHOP (Small Group),Yes,39-6094742,79597WI0040002,Delta Dental PPO Plus Premier Family Plan Low Option,79597WI004,,WIN002,WIS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.12,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.,Yes,http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2015/SG_FamilyLowPlan.pdf,https://auth.deltadentalwi.com/sp/ACS.saml2,http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2015/SG_FamilyLowPlan.pdf,,79597WI0040002-00,Standard Low Off Exchange Plan,69.90%,,,,Yes,55%,45%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,$75,$225,,$75,$225,$75,$225,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250014,Arise Silver HMO 2000-80 to 6600,84670WI125,,WIN001,WIS001,WIF003,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125001401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250014.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250014-01,Standard Silver On Exchange Plan,71.30%,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,24
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330047,Aspirus Arise Silver HMO 2000-80 to 6600,84670WI133,,WIN001,WIS002,WIF003,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133004701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330047.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330047-00,Standard Silver Off Exchange Plan,,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,24
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330047,Aspirus Arise Silver HMO 2000-80 to 6600,84670WI133,,WIN001,WIS002,WIF003,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133004701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330047.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330047-01,Standard Silver On Exchange Plan,,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,25
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250014,Arise Silver HMO 2000-80 to 6600,84670WI125,,WIN001,WIS001,WIF003,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125001401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250014.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250014-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,25
2015,WI,81335,HIOS,3,2014-08-28 04:23:13,2,81335,WI,SHOP (Small Group),Yes,13-5581829,81335WI0130001,EHB Enhanced Dental Plan (High),81335WI013,,WIN002,WIS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$23.23,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49136,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49135,,81335WI0130001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,81335,HIOS,3,2014-08-28 04:23:13,3,81335,WI,SHOP (Small Group),Yes,13-5581829,81335WI0140001,Family Basic Dental Plan (Low),81335WI014,,WIN003,WIS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$18.82,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49139,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49138,,81335WI0140001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,81335,HIOS,3,2014-08-28 04:23:13,3,81335,WI,SHOP (Small Group),Yes,13-5581829,81335WI0140001,Family Basic Dental Plan (Low),81335WI014,,WIN003,WIS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$18.82,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49139,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49138,,81335WI0140001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330052,Arise Metro Silver HMO 3000,84670WI133,,WIN001,WIS003,WIF003,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133005201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330052.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330052-01,Standard Silver On Exchange Plan,,0.697050273418427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$110,$380,$30,$140,"$1,950",$10,$0,35
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250015,Arise Silver HMO 4000,84670WI125,,WIN001,WIS001,WIF003,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125001501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250015.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250015-05,87% AV Level Silver Plan,86.60%,0.883187234401703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$90,$0,$30,$140,"$1,360",$0,$0,35
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250015,Arise Silver HMO 4000,84670WI125,,WIN001,WIS001,WIF003,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125001501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250015.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250015-06,94% AV Level Silver Plan,93.70%,0.949354588985443,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,$360,$0,$0,36
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330053,Arise Metro Silver HMO 2000-80 to 6600,84670WI133,,WIN001,WIS003,WIF003,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133005301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330053.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330053-00,Standard Silver Off Exchange Plan,,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,36
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330053,Arise Metro Silver HMO 2000-80 to 6600,84670WI133,,WIN001,WIS003,WIF003,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133005301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330053.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330053-01,Standard Silver On Exchange Plan,,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,37
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250043,Aspirus Arise Platinum HMO 250,84670WI125,,WIN001,WIS002,WIF001,New,HMO,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250043.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250043-00,Standard Platinum Off Exchange Plan,88.90%,0.906141638755798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,37
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250043,Aspirus Arise Platinum HMO 250,84670WI125,,WIN001,WIS002,WIF001,New,HMO,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250043.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250043-01,Standard Platinum On Exchange Plan,88.90%,0.906141638755798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,38
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330054,Arise Metro Silver HMO 4000,84670WI133,,WIN001,WIS003,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133005401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330054.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330054-00,Standard Silver Off Exchange Plan,68.00%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,38
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330054,Arise Metro Silver HMO 4000,84670WI133,,WIN001,WIS003,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133005401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330054.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330054-01,Standard Silver On Exchange Plan,68.00%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,39
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250043,Aspirus Arise Platinum HMO 250,84670WI125,,WIN001,WIS002,WIF001,New,HMO,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250043.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250043-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,39
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250043,Aspirus Arise Platinum HMO 250,84670WI125,,WIN001,WIS002,WIF001,New,HMO,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250043.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250043-03,Limited Cost Sharing Plan Variation,88.90%,0.906141638755798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,40
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250044,Aspirus Arise Gold HMO 2000,84670WI125,,WIN001,WIS002,WIF002,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250044.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250044-00,Standard Gold Off Exchange Plan,79.20%,0.808325171470642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$90,$0,$30,$140,"$1,610",$0,$0,41
2015,WI,81335,HIOS,3,2014-08-28 04:23:13,4,81335,WI,SHOP (Small Group),Yes,13-5581829,81335WI0150001,Family Enhanced Dental Plan (High),81335WI015,,WIN004,WIS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$23.23,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49141,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49140,,81335WI0150001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,81335,HIOS,3,2014-08-28 04:23:13,4,81335,WI,SHOP (Small Group),Yes,13-5581829,81335WI0150001,Family Enhanced Dental Plan (High),81335WI015,,WIN004,WIS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$23.23,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49141,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49140,,81335WI0150001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250001,Arise Platinum HMO 250,84670WI125,,WIN001,WIS001,WIF001,Existing,HMO,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125000101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250001.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250001-00,Standard Platinum Off Exchange Plan,88.90%,0.906141638755798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,4
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330001,Arise Platinum HMO 250,84670WI133,,WIN001,WIS001,WIF001,Existing,HMO,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133000101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330001.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330001-00,Standard Platinum Off Exchange Plan,88.90%,0.906141638755798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,4
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350005,Arise Gold POS 2000,84670WI135,,WIN001,WIS001,WIF002,Existing,POS,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135000501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350005.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350005-00,Standard Gold Off Exchange Plan,79.20%,0.808325171470642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$90,$0,$30,$140,"$1,610",$0,$0,6
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350005,Arise Gold POS 2000,84670WI135,,WIN001,WIS001,WIF002,Existing,POS,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135000501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350005.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350005-01,Standard Gold On Exchange Plan,79.20%,0.808325171470642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$90,$0,$30,$140,"$1,610",$0,$0,7
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270001,Arise Platinum POS 250,84670WI127,,WIN001,WIS001,WIF001,Existing,POS,Platinum,No,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127000101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270001.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270001-03,Limited Cost Sharing Plan Variation,,0.905437052249908,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,$250,$500,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,7
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270007,Arise Gold POS 1000,84670WI127,,WIN001,WIS001,WIF002,Existing,POS,Gold,No,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127000701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270007.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270007-00,Standard Gold Off Exchange Plan,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,8
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330001,Arise Platinum HMO 250,84670WI133,,WIN001,WIS001,WIF001,Existing,HMO,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133000101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330001.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330001-01,Standard Platinum On Exchange Plan,88.90%,0.906141638755798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,5
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250001,Arise Platinum HMO 250,84670WI125,,WIN001,WIS001,WIF001,Existing,HMO,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125000101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250001.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250001-01,Standard Platinum On Exchange Plan,88.90%,0.906141638755798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,5
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250001,Arise Platinum HMO 250,84670WI125,,WIN001,WIS001,WIF001,Existing,HMO,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125000101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250001.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330005,Arise Gold HMO 2000,84670WI133,,WIN001,WIS001,WIF002,Existing,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133000501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330005.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330005-00,Standard Gold Off Exchange Plan,79.20%,0.808325171470642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$90,$0,$30,$140,"$1,610",$0,$0,6
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330005,Arise Gold HMO 2000,84670WI133,,WIN001,WIS001,WIF002,Existing,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133000501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330005.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330005-01,Standard Gold On Exchange Plan,79.20%,0.808325171470642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$90,$0,$30,$140,"$1,610",$0,$0,7
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250001,Arise Platinum HMO 250,84670WI125,,WIN001,WIS001,WIF001,Existing,HMO,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125000101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250001.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250001-03,Limited Cost Sharing Plan Variation,88.90%,0.906141638755798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,7
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250005,Arise Gold HMO 2000,84670WI125,,WIN001,WIS001,WIF002,Existing,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125000501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250005.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250005-00,Standard Gold Off Exchange Plan,79.20%,0.808325171470642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$90,$0,$30,$140,"$1,610",$0,$0,8
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330007,Arise Gold HMO 1000,84670WI133,,WIN001,WIS001,WIF002,Existing,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133000701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330007.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330007-00,Standard Gold Off Exchange Plan,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,8
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330007,Arise Gold HMO 1000,84670WI133,,WIN001,WIS001,WIF002,Existing,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133000701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330007.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330007-01,Standard Gold On Exchange Plan,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,9
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250005,Arise Gold HMO 2000,84670WI125,,WIN001,WIS001,WIF002,Existing,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125000501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250005.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250005-01,Standard Gold On Exchange Plan,79.20%,0.808325171470642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$90,$0,$30,$140,"$1,610",$0,$0,9
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250005,Arise Gold HMO 2000,84670WI125,,WIN001,WIS001,WIF002,Existing,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125000501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250005.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250005-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330093,Arise Silver HMO 3000,84670WI133,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133009301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330093.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330093-00,Standard Silver Off Exchange Plan,,0.697050273418427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$110,$380,$30,$140,"$1,950",$10,$0,10
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330093,Arise Silver HMO 3000,84670WI133,,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133009301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330093.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330093-01,Standard Silver On Exchange Plan,,0.697050273418427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$110,$380,$30,$140,"$1,950",$10,$0,11
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250005,Arise Gold HMO 2000,84670WI125,,WIN001,WIS001,WIF002,Existing,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125000501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250005.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250005-03,Limited Cost Sharing Plan Variation,79.20%,0.808325171470642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$90,$0,$30,$140,"$1,610",$0,$0,11
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250007,Arise Gold HMO 1000,84670WI125,,WIN001,WIS001,WIF002,Existing,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125000701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250007.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250007-00,Standard Gold Off Exchange Plan,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,12
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330011,Arise Silver HMO 2000-80 to 6600,84670WI133,,WIN001,WIS001,WIF003,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133001101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330011.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330011-00,Standard Silver Off Exchange Plan,,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,12
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330011,Arise Silver HMO 2000-80 to 6600,84670WI133,,WIN001,WIS001,WIF003,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133001101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330011.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330011-01,Standard Silver On Exchange Plan,,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,13
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250007,Arise Gold HMO 1000,84670WI125,,WIN001,WIS001,WIF002,Existing,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125000701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250007.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250007-01,Standard Gold On Exchange Plan,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,13
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250007,Arise Gold HMO 1000,84670WI125,,WIN001,WIS001,WIF002,Existing,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125000701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250007.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330021,Arise Silver HMO 4000,84670WI133,,WIN001,WIS001,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133002101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330021.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330021-00,Standard Silver Off Exchange Plan,68.00%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,14
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330021,Arise Silver HMO 4000,84670WI133,,WIN001,WIS001,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133002101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330021.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330021-01,Standard Silver On Exchange Plan,68.00%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,15
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250007,Arise Gold HMO 1000,84670WI125,,WIN001,WIS001,WIF002,Existing,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125000701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250007.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250007-03,Limited Cost Sharing Plan Variation,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,15
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250012,Arise Silver HMO 3000,84670WI125,,WIN001,WIS001,WIF003,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125001201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250012.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250012-00,Standard Silver Off Exchange Plan,70.00%,0.697050273418427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$110,$380,$30,$140,"$1,950",$10,$0,16
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330043,Aspirus Arise Platinum HMO 250,84670WI133,,WIN001,WIS002,WIF001,New,HMO,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133004301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330043.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330043-00,Standard Platinum Off Exchange Plan,88.90%,0.906141638755798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,16
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330043,Aspirus Arise Platinum HMO 250,84670WI133,,WIN001,WIS002,WIF001,New,HMO,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133004301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330043.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330043-01,Standard Platinum On Exchange Plan,88.90%,0.906141638755798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,17
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250012,Arise Silver HMO 3000,84670WI125,,WIN001,WIS001,WIF003,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125001201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250012.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250012-01,Standard Silver On Exchange Plan,70.00%,0.697050273418427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$110,$380,$30,$140,"$1,950",$10,$0,17
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250012,Arise Silver HMO 3000,84670WI125,,WIN001,WIS001,WIF003,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125001201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250012.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250012-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330044,Aspirus Arise Gold HMO 2000,84670WI133,,WIN001,WIS002,WIF002,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133004401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330044.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330044-00,Standard Gold Off Exchange Plan,79.20%,0.808325171470642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$90,$0,$30,$140,"$1,610",$0,$0,18
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330044,Aspirus Arise Gold HMO 2000,84670WI133,,WIN001,WIS002,WIF002,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133004401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330044.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330044-01,Standard Gold On Exchange Plan,79.20%,0.808325171470642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$90,$0,$30,$140,"$1,610",$0,$0,19
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250012,Arise Silver HMO 3000,84670WI125,,WIN001,WIS001,WIF003,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125001201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250012.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250012-03,Limited Cost Sharing Plan Variation,70.00%,0.697050273418427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$110,$380,$30,$140,"$1,950",$10,$0,19
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250012,Arise Silver HMO 3000,84670WI125,,WIN001,WIS001,WIF003,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125001201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250012.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250012-04,73% AV Level Silver Plan,73.40%,0.770442008972168,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$110,$0,$30,$140,"$1,950",$0,$0,20
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330045,Aspirus Arise Gold HMO 1000,84670WI133,,WIN001,WIS002,WIF002,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133004501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330045.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330045-00,Standard Gold Off Exchange Plan,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,20
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330045,Aspirus Arise Gold HMO 1000,84670WI133,,WIN001,WIS002,WIF002,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133004501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330045.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330045-01,Standard Gold On Exchange Plan,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,21
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250012,Arise Silver HMO 3000,84670WI125,,WIN001,WIS001,WIF003,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125001201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250012.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250012-05,87% AV Level Silver Plan,86.60%,0.883187234401703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$110,$0,$30,$140,"$1,360",$0,$0,21
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250012,Arise Silver HMO 3000,84670WI125,,WIN001,WIS001,WIF003,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125001201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250012.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250012-06,94% AV Level Silver Plan,93.70%,0.949354588985443,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$110,$0,$30,$140,$360,$0,$0,22
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330046,Aspirus Arise Silver HMO 3000,84670WI133,,WIN001,WIS002,WIF003,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133004601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330046.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330046-00,Standard Silver Off Exchange Plan,,0.697050273418427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$110,$380,$30,$140,"$1,950",$10,$0,22
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330046,Aspirus Arise Silver HMO 3000,84670WI133,,WIN001,WIS002,WIF003,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133004601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330046.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330046-01,Standard Silver On Exchange Plan,,0.697050273418427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$110,$380,$30,$140,"$1,950",$10,$0,23
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250014,Arise Silver HMO 2000-80 to 6600,84670WI125,,WIN001,WIS001,WIF003,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125001401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250014.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250014-00,Standard Silver Off Exchange Plan,71.30%,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,23
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250014,Arise Silver HMO 2000-80 to 6600,84670WI125,,WIN001,WIS001,WIF003,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125001401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250014.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250014-03,Limited Cost Sharing Plan Variation,71.30%,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,26
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330048,Aspirus Arise Silver HMO 4000,84670WI133,,WIN001,WIS002,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133004801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330048.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330048-00,Standard Silver Off Exchange Plan,68.00%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,26
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330048,Aspirus Arise Silver HMO 4000,84670WI133,,WIN001,WIS002,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133004801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330048.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330048-01,Standard Silver On Exchange Plan,68.00%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,27
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250014,Arise Silver HMO 2000-80 to 6600,84670WI125,,WIN001,WIS001,WIF003,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125001401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250014.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250014-04,73% AV Level Silver Plan,73.40%,0.770442008972168,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$110,$0,$30,$140,"$1,950",$0,$0,27
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330050,Arise Metro Gold HMO 2000,84670WI133,,WIN001,WIS003,WIF002,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133005001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330050.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330050-01,Standard Gold On Exchange Plan,79.20%,0.808325171470642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$90,$0,$30,$140,"$1,610",$0,$0,31
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250015,Arise Silver HMO 4000,84670WI125,,WIN001,WIS001,WIF003,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125001501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250015.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250015-01,Standard Silver On Exchange Plan,68.00%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,31
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250015,Arise Silver HMO 4000,84670WI125,,WIN001,WIS001,WIF003,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125001501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250015.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250015-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,32
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330051,Arise Metro Gold HMO 1000,84670WI133,,WIN001,WIS003,WIF002,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133005101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330051.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330051-00,Standard Gold Off Exchange Plan,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,32
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330051,Arise Metro Gold HMO 1000,84670WI133,,WIN001,WIS003,WIF002,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133005101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330051.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330051-01,Standard Gold On Exchange Plan,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,33
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250015,Arise Silver HMO 4000,84670WI125,,WIN001,WIS001,WIF003,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125001501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250015.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250015-03,Limited Cost Sharing Plan Variation,68.00%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,33
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250052,Arise Metro Silver HMO 3000,84670WI125,,WIN001,WIS003,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250052.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250052-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,84
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250052,Arise Metro Silver HMO 3000,84670WI125,,WIN001,WIS003,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250052.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250052-03,Limited Cost Sharing Plan Variation,70.00%,0.697050273418427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$110,$380,$30,$140,"$1,950",$10,$0,85
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250052,Arise Metro Silver HMO 3000,84670WI125,,WIN001,WIS003,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250052.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250052-04,73% AV Level Silver Plan,73.40%,0.770442008972168,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$110,$0,$30,$140,"$1,950",$0,$0,86
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250052,Arise Metro Silver HMO 3000,84670WI125,,WIN001,WIS003,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250052.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250052-05,87% AV Level Silver Plan,86.60%,0.883187234401703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$110,$0,$30,$140,"$1,360",$0,$0,87
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250052,Arise Metro Silver HMO 3000,84670WI125,,WIN001,WIS003,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250052.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250052-06,94% AV Level Silver Plan,93.70%,0.949354588985443,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$110,$0,$30,$140,$360,$0,$0,88
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250053,Arise Metro Silver HMO 2000-80 to 6600,84670WI125,,WIN001,WIS003,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250053.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250053-00,Standard Silver Off Exchange Plan,71.30%,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,89
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250015,Arise Silver HMO 4000,84670WI125,,WIN001,WIS001,WIF003,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125001501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250015.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250015-04,73% AV Level Silver Plan,73.40%,0.770442008972168,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$110,$0,$30,$140,"$1,950",$0,$0,34
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330052,Arise Metro Silver HMO 3000,84670WI133,,WIN001,WIS003,WIF003,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133005201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330052.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330052-00,Standard Silver Off Exchange Plan,,0.697050273418427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$110,$380,$30,$140,"$1,950",$10,$0,34
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250044,Aspirus Arise Gold HMO 2000,84670WI125,,WIN001,WIS002,WIF002,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250044.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250044-01,Standard Gold On Exchange Plan,79.20%,0.808325171470642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$90,$0,$30,$140,"$1,610",$0,$0,42
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250044,Aspirus Arise Gold HMO 2000,84670WI125,,WIN001,WIS002,WIF002,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250044.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250044-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,43
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350001,Arise Platinum POS 250,84670WI135,,WIN001,WIS001,WIF001,Existing,POS,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135000101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350001.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350001-00,Standard Platinum Off Exchange Plan,88.90%,0.906141638755798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,$250,$500,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,4
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350001,Arise Platinum POS 250,84670WI135,,WIN001,WIS001,WIF001,Existing,POS,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135000101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350001.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350001-01,Standard Platinum On Exchange Plan,88.90%,0.906141638755798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,$250,$500,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,5
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270001,Arise Platinum POS 250,84670WI127,,WIN001,WIS001,WIF001,Existing,POS,Platinum,No,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127000101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270001.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270001-01,Standard Platinum On Exchange Plan,,0.905437052249908,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,$250,$500,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,5
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270001,Arise Platinum POS 250,84670WI127,,WIN001,WIS001,WIF001,Existing,POS,Platinum,No,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127000101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270001.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270047,Aspirus Arise Silver POS 2000,84670WI127,,WIN001,WIS002,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270047.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270047-03,Limited Cost Sharing Plan Variation,71.30%,0.727031648159027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,37
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270047,Aspirus Arise Silver POS 2000,84670WI127,,WIN001,WIS002,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270047.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270047-04,73% AV Level Silver Plan,73.40%,0.774271309375763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$110,$0,$30,$140,"$1,950",$0,$0,38
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250044,Aspirus Arise Gold HMO 2000,84670WI125,,WIN001,WIS002,WIF002,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250044.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250044-03,Limited Cost Sharing Plan Variation,79.20%,0.808325171470642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$90,$0,$30,$140,"$1,610",$0,$0,44
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250045,Aspirus Arise Gold HMO 1000,84670WI125,,WIN001,WIS002,WIF002,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250045.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250045-00,Standard Gold Off Exchange Plan,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,45
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270007,Arise Gold POS 1000,84670WI127,,WIN001,WIS001,WIF002,Existing,POS,Gold,No,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127000701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270007.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270007-01,Standard Gold On Exchange Plan,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,9
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270007,Arise Gold POS 1000,84670WI127,,WIN001,WIS001,WIF002,Existing,POS,Gold,No,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127000701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270007.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250045,Aspirus Arise Gold HMO 1000,84670WI125,,WIN001,WIS002,WIF002,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250045.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250045-01,Standard Gold On Exchange Plan,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,46
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250045,Aspirus Arise Gold HMO 1000,84670WI125,,WIN001,WIS002,WIF002,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250045.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250045-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,47
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350093,Arise Silver POS 3000,84670WI135,,WIN001,WIS001,WIF003,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135009301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350093.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350093-00,Standard Silver Off Exchange Plan,,0.697050273418427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$110,$380,$30,$140,"$1,950",$10,$0,10
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350093,Arise Silver POS 3000,84670WI135,,WIN001,WIS001,WIF003,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135009301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350093.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350093-01,Standard Silver On Exchange Plan,,0.697050273418427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$110,$380,$30,$140,"$1,950",$10,$0,11
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270007,Arise Gold POS 1000,84670WI127,,WIN001,WIS001,WIF002,Existing,POS,Gold,No,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127000701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270007.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270007-03,Limited Cost Sharing Plan Variation,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,11
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270014,Arise Silver POS 2000,84670WI127,,WIN001,WIS001,WIF003,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127001401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270014.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270014-00,Standard Silver Off Exchange Plan,71.30%,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,12
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270048,Aspirus Arise Silver POS 4000,84670WI127,,WIN001,WIS002,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270048.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270048-04,73% AV Level Silver Plan,73.40%,0.774271309375763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$110,$0,$30,$140,"$1,950",$0,$0,45
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270048,Aspirus Arise Silver POS 4000,84670WI127,,WIN001,WIS002,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270048.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270048-05,87% AV Level Silver Plan,86.60%,0.88813054561615,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$90,$0,$30,$140,"$1,360",$0,$0,46
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270048,Aspirus Arise Silver POS 4000,84670WI127,,WIN001,WIS002,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270048.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270048-06,94% AV Level Silver Plan,93.70%,0.951277196407318,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,$250,$500,0%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,$360,$0,$0,47
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270049,Arise Metro Platinum POS 250,84670WI127,,WIN001,WIS003,WIF001,New,POS,Platinum,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270049.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270049-00,Standard Platinum Off Exchange Plan,88.90%,0.907695114612579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,$250,$500,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,48
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250045,Aspirus Arise Gold HMO 1000,84670WI125,,WIN001,WIS002,WIF002,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250045.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250045-03,Limited Cost Sharing Plan Variation,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,48
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250046,Aspirus Arise Silver HMO 3000,84670WI125,,WIN001,WIS002,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250046.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250046-00,Standard Silver Off Exchange Plan,70.00%,0.697050273418427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$110,$380,$30,$140,"$1,950",$10,$0,49
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250046,Aspirus Arise Silver HMO 3000,84670WI125,,WIN001,WIS002,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250046.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250046-01,Standard Silver On Exchange Plan,70.00%,0.697050273418427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$110,$380,$30,$140,"$1,950",$10,$0,50
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250046,Aspirus Arise Silver HMO 3000,84670WI125,,WIN001,WIS002,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250046.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250046-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,51
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250046,Aspirus Arise Silver HMO 3000,84670WI125,,WIN001,WIS002,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250046.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250046-03,Limited Cost Sharing Plan Variation,70.00%,0.697050273418427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$110,$380,$30,$140,"$1,950",$10,$0,52
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250046,Aspirus Arise Silver HMO 3000,84670WI125,,WIN001,WIS002,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250046.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250046-04,73% AV Level Silver Plan,73.40%,0.770442008972168,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$110,$0,$30,$140,"$1,950",$0,$0,53
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250046,Aspirus Arise Silver HMO 3000,84670WI125,,WIN001,WIS002,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250046.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250046-05,87% AV Level Silver Plan,86.60%,0.883187234401703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$110,$0,$30,$140,"$1,360",$0,$0,54
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250046,Aspirus Arise Silver HMO 3000,84670WI125,,WIN001,WIS002,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250046.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250046-06,94% AV Level Silver Plan,93.70%,0.949354588985443,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$110,$0,$30,$140,$360,$0,$0,55
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250047,Aspirus Arise Silver HMO 2000-80 to 6600,84670WI125,,WIN001,WIS002,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250047.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250047-00,Standard Silver Off Exchange Plan,71.30%,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,56
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250047,Aspirus Arise Silver HMO 2000-80 to 6600,84670WI125,,WIN001,WIS002,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250047.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250047-01,Standard Silver On Exchange Plan,71.30%,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,57
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250047,Aspirus Arise Silver HMO 2000-80 to 6600,84670WI125,,WIN001,WIS002,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250047.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250047-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,58
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250047,Aspirus Arise Silver HMO 2000-80 to 6600,84670WI125,,WIN001,WIS002,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250047.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250047-03,Limited Cost Sharing Plan Variation,71.30%,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,59
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250047,Aspirus Arise Silver HMO 2000-80 to 6600,84670WI125,,WIN001,WIS002,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250047.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250047-04,73% AV Level Silver Plan,73.40%,0.770442008972168,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$110,$0,$30,$140,"$1,950",$0,$0,60
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250047,Aspirus Arise Silver HMO 2000-80 to 6600,84670WI125,,WIN001,WIS002,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250047.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250047-05,87% AV Level Silver Plan,86.60%,0.883187234401703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$110,$0,$30,$140,"$1,360",$0,$0,61
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250047,Aspirus Arise Silver HMO 2000-80 to 6600,84670WI125,,WIN001,WIS002,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250047.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250047-06,94% AV Level Silver Plan,93.70%,0.949354588985443,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$110,$0,$30,$140,$360,$0,$0,62
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250048,Aspirus Arise Silver HMO 4000,84670WI125,,WIN001,WIS002,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250048.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250048-00,Standard Silver Off Exchange Plan,68.00%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,63
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250048,Aspirus Arise Silver HMO 4000,84670WI125,,WIN001,WIS002,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250048.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250048-01,Standard Silver On Exchange Plan,68.00%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,64
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250048,Aspirus Arise Silver HMO 4000,84670WI125,,WIN001,WIS002,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250048.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250048-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,65
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250048,Aspirus Arise Silver HMO 4000,84670WI125,,WIN001,WIS002,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250048.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250048-03,Limited Cost Sharing Plan Variation,68.00%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,66
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250048,Aspirus Arise Silver HMO 4000,84670WI125,,WIN001,WIS002,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250048.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250048-04,73% AV Level Silver Plan,73.40%,0.770442008972168,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$110,$0,$30,$140,"$1,950",$0,$0,67
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250048,Aspirus Arise Silver HMO 4000,84670WI125,,WIN001,WIS002,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250048.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250048-05,87% AV Level Silver Plan,86.60%,0.883187234401703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$90,$0,$30,$140,"$1,360",$0,$0,68
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250048,Aspirus Arise Silver HMO 4000,84670WI125,,WIN001,WIS002,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250048.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250048-06,94% AV Level Silver Plan,93.70%,0.949354588985443,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,$360,$0,$0,69
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250049,Arise Metro Platinum HMO 250,84670WI125,,WIN001,WIS003,WIF001,New,HMO,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250049.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250049-00,Standard Platinum Off Exchange Plan,88.90%,0.906141638755798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,70
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250049,Arise Metro Platinum HMO 250,84670WI125,,WIN001,WIS003,WIF001,New,HMO,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250049.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250049-01,Standard Platinum On Exchange Plan,88.90%,0.906141638755798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,71
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250049,Arise Metro Platinum HMO 250,84670WI125,,WIN001,WIS003,WIF001,New,HMO,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250049.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250049-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,72
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250049,Arise Metro Platinum HMO 250,84670WI125,,WIN001,WIS003,WIF001,New,HMO,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250049.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250049-03,Limited Cost Sharing Plan Variation,88.90%,0.906141638755798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,73
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250050,Arise Metro Gold HMO 2000,84670WI125,,WIN001,WIS003,WIF002,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250050.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250050-00,Standard Gold Off Exchange Plan,79.20%,0.808325171470642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$90,$0,$30,$140,"$1,610",$0,$0,74
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250050,Arise Metro Gold HMO 2000,84670WI125,,WIN001,WIS003,WIF002,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250050.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250050-01,Standard Gold On Exchange Plan,79.20%,0.808325171470642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$90,$0,$30,$140,"$1,610",$0,$0,75
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250050,Arise Metro Gold HMO 2000,84670WI125,,WIN001,WIS003,WIF002,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250050.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250050-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,76
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250050,Arise Metro Gold HMO 2000,84670WI125,,WIN001,WIS003,WIF002,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250050.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250050-03,Limited Cost Sharing Plan Variation,79.20%,0.808325171470642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$90,$0,$30,$140,"$1,610",$0,$0,77
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250051,Arise Metro Gold HMO 1000,84670WI125,,WIN001,WIS003,WIF002,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250051.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250051-00,Standard Gold Off Exchange Plan,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,78
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250051,Arise Metro Gold HMO 1000,84670WI125,,WIN001,WIS003,WIF002,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250051.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250051-01,Standard Gold On Exchange Plan,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,79
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250051,Arise Metro Gold HMO 1000,84670WI125,,WIN001,WIS003,WIF002,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250051.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250051-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,80
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250051,Arise Metro Gold HMO 1000,84670WI125,,WIN001,WIS003,WIF002,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250051.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250051-03,Limited Cost Sharing Plan Variation,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,81
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250052,Arise Metro Silver HMO 3000,84670WI125,,WIN001,WIS003,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250052.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250052-00,Standard Silver Off Exchange Plan,70.00%,0.697050273418427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$110,$380,$30,$140,"$1,950",$10,$0,82
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250052,Arise Metro Silver HMO 3000,84670WI125,,WIN001,WIS003,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250052.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250052-01,Standard Silver On Exchange Plan,70.00%,0.697050273418427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$110,$380,$30,$140,"$1,950",$10,$0,83
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250053,Arise Metro Silver HMO 2000-80 to 6600,84670WI125,,WIN001,WIS003,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250053.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250053-01,Standard Silver On Exchange Plan,71.30%,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,90
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250053,Arise Metro Silver HMO 2000-80 to 6600,84670WI125,,WIN001,WIS003,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250053.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250053-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,91
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250053,Arise Metro Silver HMO 2000-80 to 6600,84670WI125,,WIN001,WIS003,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250053.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250053-03,Limited Cost Sharing Plan Variation,71.30%,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,92
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250053,Arise Metro Silver HMO 2000-80 to 6600,84670WI125,,WIN001,WIS003,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250053.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250053-04,73% AV Level Silver Plan,73.40%,0.770442008972168,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$110,$0,$30,$140,"$1,950",$0,$0,93
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250053,Arise Metro Silver HMO 2000-80 to 6600,84670WI125,,WIN001,WIS003,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250053.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250053-05,87% AV Level Silver Plan,86.60%,0.883187234401703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$110,$0,$30,$140,"$1,360",$0,$0,94
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250053,Arise Metro Silver HMO 2000-80 to 6600,84670WI125,,WIN001,WIS003,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250053.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250053-06,94% AV Level Silver Plan,93.70%,0.949354588985443,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$110,$0,$30,$140,$360,$0,$0,95
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250054,Arise Metro Silver HMO 4000,84670WI125,,WIN001,WIS003,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250054.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250054-00,Standard Silver Off Exchange Plan,68.00%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,96
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250054,Arise Metro Silver HMO 4000,84670WI125,,WIN001,WIS003,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250054.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250054-01,Standard Silver On Exchange Plan,68.00%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,97
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250054,Arise Metro Silver HMO 4000,84670WI125,,WIN001,WIS003,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250054.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250054-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,98
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250054,Arise Metro Silver HMO 4000,84670WI125,,WIN001,WIS003,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250054.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250054-03,Limited Cost Sharing Plan Variation,68.00%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,99
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350049,Arise Metro Platinum POS 250,84670WI135,,WIN001,WIS003,WIF001,New,POS,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135004901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350049.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350049-00,Standard Platinum Off Exchange Plan,88.90%,0.906141638755798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,$250,$500,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,28
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350049,Arise Metro Platinum POS 250,84670WI135,,WIN001,WIS003,WIF001,New,POS,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135004901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350049.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350049-01,Standard Platinum On Exchange Plan,88.90%,0.906141638755798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,$250,$500,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,29
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330014,Arise Silver HMO 1500,84670WI133,,WIN001,WIS001,WIF007,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133001401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330014.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330014-01,Standard Silver On Exchange Plan,,0.700263202190399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,"$1,460",$30,"$1,150","$1,710",$0,$0,13
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330022,Arise Silver HMO 2500,84670WI133,,WIN001,WIS001,WIF007,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133002201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330022.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330022-00,Standard Silver Off Exchange Plan,,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,14
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250008,Arise Gold HMO 1500,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125000801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250008.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250008-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250008,Arise Gold HMO 1500,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125000801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250008.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250008-03,Limited Cost Sharing Plan Variation,79.80%,0.82320111989975,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,350",$0,$0,15
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250054,Arise Metro Silver HMO 4000,84670WI125,,WIN001,WIS003,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250054.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250054-04,73% AV Level Silver Plan,73.40%,0.770442008972168,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$110,$0,$30,$140,"$1,950",$0,$0,100
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250054,Arise Metro Silver HMO 4000,84670WI125,,WIN001,WIS003,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250054.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250054-05,87% AV Level Silver Plan,86.60%,0.883187234401703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$90,$0,$30,$140,"$1,360",$0,$0,101
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,1,84670,WI,Individual,No,20-2660193,84670WI1250054,Arise Metro Silver HMO 4000,84670WI125,,WIN001,WIS003,WIF003,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250054.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250054-06,94% AV Level Silver Plan,93.70%,0.949354588985443,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,$360,$0,$0,102
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270001,Arise Platinum POS 250,84670WI127,,WIN001,WIS001,WIF001,Existing,POS,Platinum,No,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127000101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270001.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270001-00,Standard Platinum Off Exchange Plan,,0.905437052249908,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,$250,$500,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,4
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350007,Arise Gold POS 1000,84670WI135,,WIN001,WIS001,WIF002,Existing,POS,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135000701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350007.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350007-00,Standard Gold Off Exchange Plan,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,8
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350007,Arise Gold POS 1000,84670WI135,,WIN001,WIS001,WIF002,Existing,POS,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135000701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350007.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350007-01,Standard Gold On Exchange Plan,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,9
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250020,Arise Silver HMO 2000-80 to 5000,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250020.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250020-04,73% AV Level Silver Plan,73.70%,0.774895846843719,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,410",$0,$0,20
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250020,Arise Silver HMO 2000-80 to 5000,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250020.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250020-05,87% AV Level Silver Plan,86.20%,0.887905538082123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$70,$0,$30,$500,"$1,000",$0,$0,21
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330058,Aspirus Arise Silver HMO 2000,84670WI133,,WIN001,WIS002,WIF007,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133005801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330058.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330058-01,Standard Silver On Exchange Plan,,0.717462003231049,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$80,$870,$30,"$1,150","$1,710",$0,$0,21
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330059,Aspirus Arise Silver HMO 1500,84670WI133,,WIN001,WIS002,WIF007,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133005901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330059.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330059-00,Standard Silver Off Exchange Plan,,0.700263202190399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,"$1,460",$30,"$1,150","$1,710",$0,$0,22
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270048,Aspirus Arise Silver POS 4000,84670WI127,,WIN001,WIS002,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270048.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270048-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,43
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270048,Aspirus Arise Silver POS 4000,84670WI127,,WIN001,WIS002,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270048.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270048-03,Limited Cost Sharing Plan Variation,68.20%,0.692034184932709,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,44
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270049,Arise Metro Platinum POS 250,84670WI127,,WIN001,WIS003,WIF001,New,POS,Platinum,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270049.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270049-01,Standard Platinum On Exchange Plan,88.90%,0.907695114612579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,$250,$500,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,49
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270049,Arise Metro Platinum POS 250,84670WI127,,WIN001,WIS003,WIF001,New,POS,Platinum,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270049.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270049-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,50
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270049,Arise Metro Platinum POS 250,84670WI127,,WIN001,WIS003,WIF001,New,POS,Platinum,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270049.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270049-03,Limited Cost Sharing Plan Variation,88.90%,0.907695114612579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,$250,$500,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,51
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270051,Arise Metro Gold POS 1000,84670WI127,,WIN001,WIS003,WIF002,New,POS,Gold,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127005101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270051.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270051-00,Standard Gold Off Exchange Plan,81.70%,0.827668309211731,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,52
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250021,Arise Silver HMO 1500,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250021.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250021-05,87% AV Level Silver Plan,86.20%,0.887905538082123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$70,$0,$30,$500,"$1,000",$0,$0,28
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250021,Arise Silver HMO 1500,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250021.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250021-06,94% AV Level Silver Plan,94.20%,0.950752198696136,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$50,$0,$30,$250,$750,$0,$0,29
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330062,Arise Metro Platinum HMO Zero,84670WI133,,WIN001,WIS003,WIF005,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133006201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330062.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330062-01,Standard Platinum On Exchange Plan,,0.884471535682678,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$850,$30,$0,"$1,360",$110,$0,29
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330063,Arise Metro Gold HMO 1500,84670WI133,,WIN001,WIS003,WIF004,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133006301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330063.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330063-00,Standard Gold Off Exchange Plan,79.80%,0.825080037117004,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,350",$0,$0,30
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250022,Arise Silver HMO 2500,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250022.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250022-00,Standard Silver Off Exchange Plan,70.00%,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,30
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250022,Arise Silver HMO 2500,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250022.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250022-01,Standard Silver On Exchange Plan,70.00%,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,31
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250020,Arise Silver HMO 2000-80 to 5000,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250020.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250020-06,94% AV Level Silver Plan,94.20%,0.950752198696136,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$50,$0,$30,$250,$750,$0,$0,22
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250021,Arise Silver HMO 1500,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250021.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250021-00,Standard Silver Off Exchange Plan,70.00%,0.700263202190399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,"$1,460",$30,"$1,150","$1,710",$0,$0,23
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330059,Aspirus Arise Silver HMO 1500,84670WI133,,WIN001,WIS002,WIF007,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133005901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330059.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330059-01,Standard Silver On Exchange Plan,,0.700263202190399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,"$1,460",$30,"$1,150","$1,710",$0,$0,23
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330060,Aspirus Arise Silver HMO 2500,84670WI133,,WIN001,WIS002,WIF007,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133006001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330060.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330060-00,Standard Silver Off Exchange Plan,,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,24
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350011,Arise Silver POS 2000-80 to 6600,84670WI135,,WIN001,WIS001,WIF003,Existing,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135001101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350011.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350011-00,Standard Silver Off Exchange Plan,,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,12
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350011,Arise Silver POS 2000-80 to 6600,84670WI135,,WIN001,WIS001,WIF003,Existing,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135001101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350011.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350011-01,Standard Silver On Exchange Plan,,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,13
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270014,Arise Silver POS 2000,84670WI127,,WIN001,WIS001,WIF003,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127001401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270014.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270014-01,Standard Silver On Exchange Plan,71.30%,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,13
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270014,Arise Silver POS 2000,84670WI127,,WIN001,WIS001,WIF003,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127001401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270014.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270014-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350021,Arise Silver POS 4000,84670WI135,,WIN001,WIS001,WIF003,New,POS,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135002101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350021.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350021-00,Standard Silver Off Exchange Plan,68.00%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,14
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350021,Arise Silver POS 4000,84670WI135,,WIN001,WIS001,WIF003,New,POS,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135002101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350021.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350021-01,Standard Silver On Exchange Plan,68.00%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,15
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270014,Arise Silver POS 2000,84670WI127,,WIN001,WIS001,WIF003,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127001401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270014.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270014-03,Limited Cost Sharing Plan Variation,71.30%,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,15
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270014,Arise Silver POS 2000,84670WI127,,WIN001,WIS001,WIF003,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127001401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270014.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270014-04,73% AV Level Silver Plan,73.40%,0.765812873840332,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$110,$0,$30,$140,"$1,950",$0,$0,16
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350043,Aspirus Arise Platinum POS 250,84670WI135,,WIN001,WIS002,WIF001,New,POS,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135004301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350043.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350043-00,Standard Platinum Off Exchange Plan,88.90%,0.906141638755798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,$250,$500,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,16
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350043,Aspirus Arise Platinum POS 250,84670WI135,,WIN001,WIS002,WIF001,New,POS,Platinum,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135004301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350043.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350043-01,Standard Platinum On Exchange Plan,88.90%,0.906141638755798,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,$250,$500,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,17
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270014,Arise Silver POS 2000,84670WI127,,WIN001,WIS001,WIF003,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127001401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270014.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270014-05,87% AV Level Silver Plan,86.60%,0.884285390377045,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$110,$0,$30,$140,"$1,360",$0,$0,17
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270014,Arise Silver POS 2000,84670WI127,,WIN001,WIS001,WIF003,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127001401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270014.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270014-06,94% AV Level Silver Plan,93.70%,0.950154721736908,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$250,$500,0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$110,$0,$30,$140,$360,$0,$0,18
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350044,Aspirus Arise Gold POS 2000,84670WI135,,WIN001,WIS002,WIF002,New,POS,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135004401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350044.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350044-00,Standard Gold Off Exchange Plan,79.20%,0.808325171470642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$90,$0,$30,$140,"$1,610",$0,$0,18
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350044,Aspirus Arise Gold POS 2000,84670WI135,,WIN001,WIS002,WIF002,New,POS,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135004401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350044.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350044-01,Standard Gold On Exchange Plan,79.20%,0.808325171470642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$90,$0,$30,$140,"$1,610",$0,$0,19
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270015,Arise Silver POS 4000,84670WI127,,WIN001,WIS001,WIF003,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127001501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270015.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270015-00,Standard Silver Off Exchange Plan,68.20%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,19
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270015,Arise Silver POS 4000,84670WI127,,WIN001,WIS001,WIF003,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127001501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270015.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270015-01,Standard Silver On Exchange Plan,68.20%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,20
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350045,Aspirus Arise Gold POS 1000,84670WI135,,WIN001,WIS002,WIF002,New,POS,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135004501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350045.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350045-00,Standard Gold Off Exchange Plan,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,20
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350045,Aspirus Arise Gold POS 1000,84670WI135,,WIN001,WIS002,WIF002,New,POS,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135004501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350045.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350045-01,Standard Gold On Exchange Plan,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,21
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270015,Arise Silver POS 4000,84670WI127,,WIN001,WIS001,WIF003,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127001501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270015.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270015-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,21
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270015,Arise Silver POS 4000,84670WI127,,WIN001,WIS001,WIF003,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127001501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270015.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270015-03,Limited Cost Sharing Plan Variation,68.20%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,22
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350046,Aspirus Arise Silver POS 3000,84670WI135,,WIN001,WIS002,WIF003,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135004601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350046.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350046-00,Standard Silver Off Exchange Plan,,0.697050273418427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$110,$380,$30,$140,"$1,950",$10,$0,22
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350046,Aspirus Arise Silver POS 3000,84670WI135,,WIN001,WIS002,WIF003,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135004601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350046.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350046-01,Standard Silver On Exchange Plan,,0.697050273418427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$110,$380,$30,$140,"$1,950",$10,$0,23
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270015,Arise Silver POS 4000,84670WI127,,WIN001,WIS001,WIF003,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127001501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270015.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270015-04,73% AV Level Silver Plan,73.40%,0.765812873840332,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$110,$0,$30,$140,"$1,950",$0,$0,23
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270015,Arise Silver POS 4000,84670WI127,,WIN001,WIS001,WIF003,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127001501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270015.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270015-05,87% AV Level Silver Plan,86.60%,0.884285390377045,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$90,$0,$30,$140,"$1,360",$0,$0,24
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350047,Aspirus Arise Silver POS 2000-80 to 6600,84670WI135,,WIN001,WIS002,WIF003,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135004701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350047.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350047-00,Standard Silver Off Exchange Plan,,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,24
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350047,Aspirus Arise Silver POS 2000-80 to 6600,84670WI135,,WIN001,WIS002,WIF003,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135004701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350047.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350047-01,Standard Silver On Exchange Plan,,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,25
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270015,Arise Silver POS 4000,84670WI127,,WIN001,WIS001,WIF003,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127001501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270015.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270015-06,94% AV Level Silver Plan,93.70%,0.950154721736908,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,$250,$500,0%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,$360,$0,$0,25
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270043,Aspirus Arise Platinum POS 250,84670WI127,,WIN001,WIS002,WIF001,New,POS,Platinum,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270043.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270043-00,Standard Platinum Off Exchange Plan,88.90%,0.907695114612579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,$250,$500,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,26
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350048,Aspirus Arise Silver POS 4000,84670WI135,,WIN001,WIS002,WIF003,New,POS,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135004801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350048.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350048-00,Standard Silver Off Exchange Plan,68.00%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,26
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350048,Aspirus Arise Silver POS 4000,84670WI135,,WIN001,WIS002,WIF003,New,POS,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135004801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350048.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350048-01,Standard Silver On Exchange Plan,68.00%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,27
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270043,Aspirus Arise Platinum POS 250,84670WI127,,WIN001,WIS002,WIF001,New,POS,Platinum,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270043.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270043-01,Standard Platinum On Exchange Plan,88.90%,0.907695114612579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,$250,$500,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,27
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270043,Aspirus Arise Platinum POS 250,84670WI127,,WIN001,WIS002,WIF001,New,POS,Platinum,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270043.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270043-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,28
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270043,Aspirus Arise Platinum POS 250,84670WI127,,WIN001,WIS002,WIF001,New,POS,Platinum,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270043.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270043-03,Limited Cost Sharing Plan Variation,88.90%,0.907695114612579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$4,500","$9,000",Not Applicable,Not Applicable,$250,$500,0%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,"$1,110",$0,$0,29
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270045,Aspirus Arise Gold POS 1000,84670WI127,,WIN001,WIS002,WIF002,New,POS,Gold,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270045.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270045-00,Standard Gold Off Exchange Plan,81.70%,0.827668309211731,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,30
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350050,Arise Metro Gold POS 2000,84670WI135,,WIN001,WIS003,WIF002,New,POS,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135005001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350050.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350050-00,Standard Gold Off Exchange Plan,79.20%,0.808325171470642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$90,$0,$30,$140,"$1,610",$0,$0,30
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350050,Arise Metro Gold POS 2000,84670WI135,,WIN001,WIS003,WIF002,New,POS,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135005001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350050.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350050-01,Standard Gold On Exchange Plan,79.20%,0.808325171470642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$90,$0,$30,$140,"$1,610",$0,$0,31
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270045,Aspirus Arise Gold POS 1000,84670WI127,,WIN001,WIS002,WIF002,New,POS,Gold,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270045.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270045-01,Standard Gold On Exchange Plan,81.70%,0.827668309211731,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,31
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270045,Aspirus Arise Gold POS 1000,84670WI127,,WIN001,WIS002,WIF002,New,POS,Gold,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270045.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270045-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,32
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350051,Arise Metro Gold POS 1000,84670WI135,,WIN001,WIS003,WIF002,New,POS,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135005101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350051.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350051-00,Standard Gold Off Exchange Plan,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,32
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350051,Arise Metro Gold POS 1000,84670WI135,,WIN001,WIS003,WIF002,New,POS,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135005101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350051.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350051-01,Standard Gold On Exchange Plan,,0.816162467002869,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,33
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270045,Aspirus Arise Gold POS 1000,84670WI127,,WIN001,WIS002,WIF002,New,POS,Gold,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270045.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270045-03,Limited Cost Sharing Plan Variation,81.70%,0.827668309211731,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,33
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270047,Aspirus Arise Silver POS 2000,84670WI127,,WIN001,WIS002,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270047.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270047-00,Standard Silver Off Exchange Plan,71.30%,0.727031648159027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,34
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350052,Arise Metro Silver POS 3000,84670WI135,,WIN001,WIS003,WIF003,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135005201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350052.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350052-00,Standard Silver Off Exchange Plan,,0.697050273418427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$110,$380,$30,$140,"$1,950",$10,$0,34
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350052,Arise Metro Silver POS 3000,84670WI135,,WIN001,WIS003,WIF003,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135005201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350052.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350052-01,Standard Silver On Exchange Plan,,0.697050273418427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,900",$110,$380,$30,$140,"$1,950",$10,$0,35
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270047,Aspirus Arise Silver POS 2000,84670WI127,,WIN001,WIS002,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270047.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270047-01,Standard Silver On Exchange Plan,71.30%,0.727031648159027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,35
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270047,Aspirus Arise Silver POS 2000,84670WI127,,WIN001,WIS002,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270047.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270047-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,36
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350053,Arise Metro Silver POS 2000-80 to 6600,84670WI135,,WIN001,WIS003,WIF003,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135005301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350053.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350053-00,Standard Silver Off Exchange Plan,,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,36
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350053,Arise Metro Silver POS 2000-80 to 6600,84670WI135,,WIN001,WIS003,WIF003,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135005301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350053.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350053-01,Standard Silver On Exchange Plan,,0.710203945636749,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,37
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350054,Arise Metro Silver POS 4000,84670WI135,,WIN001,WIS003,WIF003,New,POS,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135005401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350054.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350054-00,Standard Silver Off Exchange Plan,68.00%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,38
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350054,Arise Metro Silver POS 4000,84670WI135,,WIN001,WIS003,WIF003,New,POS,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135005401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350054.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350054-01,Standard Silver On Exchange Plan,68.00%,0.678543746471405,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,39
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270047,Aspirus Arise Silver POS 2000,84670WI127,,WIN001,WIS002,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270047.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270047-05,87% AV Level Silver Plan,86.60%,0.88813054561615,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$110,$0,$30,$140,"$1,360",$0,$0,39
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270047,Aspirus Arise Silver POS 2000,84670WI127,,WIN001,WIS002,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270047.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270047-06,94% AV Level Silver Plan,93.70%,0.951277196407318,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$250,$500,0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$110,$0,$30,$140,$360,$0,$0,40
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270048,Aspirus Arise Silver POS 4000,84670WI127,,WIN001,WIS002,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270048.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270048-00,Standard Silver Off Exchange Plan,68.20%,0.692034184932709,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,41
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270048,Aspirus Arise Silver POS 4000,84670WI127,,WIN001,WIS002,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127004801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270048.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270048-01,Standard Silver On Exchange Plan,68.20%,0.692034184932709,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,42
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270051,Arise Metro Gold POS 1000,84670WI127,,WIN001,WIS003,WIF002,New,POS,Gold,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127005101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270051.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270051-01,Standard Gold On Exchange Plan,81.70%,0.827668309211731,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,53
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270051,Arise Metro Gold POS 1000,84670WI127,,WIN001,WIS003,WIF002,New,POS,Gold,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127005101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270051.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270051-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,54
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270051,Arise Metro Gold POS 1000,84670WI127,,WIN001,WIS003,WIF002,New,POS,Gold,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127005101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270051.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270051-03,Limited Cost Sharing Plan Variation,81.70%,0.827668309211731,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$1,100",$30,$140,"$1,610",$30,$0,55
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270053,Arise Metro Silver POS 2000,84670WI127,,WIN001,WIS003,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127005301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270053.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270053-00,Standard Silver Off Exchange Plan,71.10%,0.727031648159027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,56
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270053,Arise Metro Silver POS 2000,84670WI127,,WIN001,WIS003,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127005301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270053.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270053-01,Standard Silver On Exchange Plan,71.10%,0.727031648159027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,57
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270053,Arise Metro Silver POS 2000,84670WI127,,WIN001,WIS003,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127005301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270053.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270053-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,58
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270053,Arise Metro Silver POS 2000,84670WI127,,WIN001,WIS003,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127005301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270053.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270053-03,Limited Cost Sharing Plan Variation,71.10%,0.727031648159027,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$110,$960,$30,$140,"$1,950",$30,$0,59
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270053,Arise Metro Silver POS 2000,84670WI127,,WIN001,WIS003,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127005301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270053.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270053-04,73% AV Level Silver Plan,73.40%,0.774271309375763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$110,$0,$30,$140,"$1,950",$0,$0,60
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270053,Arise Metro Silver POS 2000,84670WI127,,WIN001,WIS003,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127005301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270053.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270053-05,87% AV Level Silver Plan,86.60%,0.88813054561615,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$110,$0,$30,$140,"$1,360",$0,$0,61
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270053,Arise Metro Silver POS 2000,84670WI127,,WIN001,WIS003,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127005301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270053.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270053-06,94% AV Level Silver Plan,93.70%,0.951277196407318,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$250,$500,0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$110,$0,$30,$140,$360,$0,$0,62
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270054,Arise Metro Silver POS 4000,84670WI127,,WIN001,WIS003,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127005401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270054.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270054-00,Standard Silver Off Exchange Plan,68.20%,0.692034184932709,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,63
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270054,Arise Metro Silver POS 4000,84670WI127,,WIN001,WIS003,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127005401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270054.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270054-01,Standard Silver On Exchange Plan,68.20%,0.692034184932709,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,64
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270054,Arise Metro Silver POS 4000,84670WI127,,WIN001,WIS003,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127005401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270054.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270054-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,65
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270054,Arise Metro Silver POS 4000,84670WI127,,WIN001,WIS003,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127005401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270054.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270054-03,Limited Cost Sharing Plan Variation,68.20%,0.692034184932709,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,900",$110,$840,$30,$140,"$1,950",$40,$0,66
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270054,Arise Metro Silver POS 4000,84670WI127,,WIN001,WIS003,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127005401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270054.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270054-04,73% AV Level Silver Plan,73.40%,0.774271309375763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$110,$0,$30,$140,"$1,950",$0,$0,67
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270054,Arise Metro Silver POS 4000,84670WI127,,WIN001,WIS003,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127005401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270054.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270054-05,87% AV Level Silver Plan,86.60%,0.88813054561615,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$90,$0,$30,$140,"$1,360",$0,$0,68
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,2,84670,WI,Individual,No,20-2660193,84670WI1270054,Arise Metro Silver POS 4000,84670WI127,,WIN001,WIS003,WIF003,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127005401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270054.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270054-06,94% AV Level Silver Plan,93.70%,0.951277196407318,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,$250,$500,0%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$70,$0,$30,$140,$360,$0,$0,69
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250004,Arise Platinum HMO 500,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125000401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250004.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250004-00,Standard Platinum Off Exchange Plan,,0.881754577159882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$750,$30,$500,$620,$130,$0,4
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330004,Arise Platinum HMO 500,84670WI133,,WIN001,WIS001,WIF006,Existing,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133000401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330004.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330004-00,Standard Platinum Off Exchange Plan,,0.881754577159882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$750,$30,$500,$620,$130,$0,4
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330004,Arise Platinum HMO 500,84670WI133,,WIN001,WIS001,WIF006,Existing,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133000401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330004.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330004-01,Standard Platinum On Exchange Plan,,0.881754577159882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$750,$30,$500,$620,$130,$0,5
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250004,Arise Platinum HMO 500,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125000401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250004.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250004-01,Standard Platinum On Exchange Plan,,0.881754577159882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$750,$30,$500,$620,$130,$0,5
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250004,Arise Platinum HMO 500,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125000401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250004.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330041,Arise Platinum HMO Zero,84670WI133,,WIN001,WIS001,WIF005,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133004101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330041.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330041-00,Standard Platinum Off Exchange Plan,,0.884471535682678,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$850,$30,$0,"$1,360",$110,$0,6
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330041,Arise Platinum HMO Zero,84670WI133,,WIN001,WIS001,WIF005,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133004101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330041.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330041-01,Standard Platinum On Exchange Plan,,0.884471535682678,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$850,$30,$0,"$1,360",$110,$0,7
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250004,Arise Platinum HMO 500,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125000401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250004.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250004-03,Limited Cost Sharing Plan Variation,,0.881754577159882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$750,$30,$500,$620,$130,$0,7
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330008,Arise Gold HMO 1500,84670WI133,,WIN001,WIS001,WIF004,Existing,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133000801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330008.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330008-00,Standard Gold Off Exchange Plan,79.80%,0.825080037117004,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,350",$0,$0,8
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250041,Arise Platinum HMO Zero,84670WI125,,WIN001,WIS001,WIF005,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250041.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250041-00,Standard Platinum Off Exchange Plan,,0.884471535682678,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$850,$30,$0,"$1,360",$110,$0,8
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250041,Arise Platinum HMO Zero,84670WI125,,WIN001,WIS001,WIF005,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250041.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250041-01,Standard Platinum On Exchange Plan,,0.884471535682678,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$850,$30,$0,"$1,360",$110,$0,9
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330008,Arise Gold HMO 1500,84670WI133,,WIN001,WIS001,WIF004,Existing,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133000801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330008.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330008-01,Standard Gold On Exchange Plan,79.80%,0.825080037117004,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,350",$0,$0,9
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330013,Arise Silver HMO 2000,84670WI133,,WIN001,WIS001,WIF007,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133001301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330013.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330013-00,Standard Silver Off Exchange Plan,,0.717462003231049,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$80,$870,$30,"$1,150","$1,710",$0,$0,10
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250041,Arise Platinum HMO Zero,84670WI125,,WIN001,WIS001,WIF005,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250041.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250041-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250041,Arise Platinum HMO Zero,84670WI125,,WIN001,WIS001,WIF005,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250041.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250041-03,Limited Cost Sharing Plan Variation,,0.884471535682678,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$850,$30,$0,"$1,360",$110,$0,11
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330013,Arise Silver HMO 2000,84670WI133,,WIN001,WIS001,WIF007,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133001301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330013.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330013-01,Standard Silver On Exchange Plan,,0.717462003231049,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$80,$870,$30,"$1,150","$1,710",$0,$0,11
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330014,Arise Silver HMO 1500,84670WI133,,WIN001,WIS001,WIF007,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133001401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330014.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330014-00,Standard Silver Off Exchange Plan,,0.700263202190399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,"$1,460",$30,"$1,150","$1,710",$0,$0,12
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250008,Arise Gold HMO 1500,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125000801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250008.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250008-00,Standard Gold Off Exchange Plan,79.80%,0.82320111989975,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,350",$0,$0,12
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250008,Arise Gold HMO 1500,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125000801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250008.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250008-01,Standard Gold On Exchange Plan,79.80%,0.82320111989975,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,350",$0,$0,13
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330022,Arise Silver HMO 2500,84670WI133,,WIN001,WIS001,WIF007,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133002201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330022.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330022-01,Standard Silver On Exchange Plan,,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,15
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330055,Aspirus Arise Platinum HMO 500,84670WI133,,WIN001,WIS002,WIF006,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133005501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330055.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330055-00,Standard Platinum Off Exchange Plan,,0.881754577159882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$750,$30,$500,$620,$130,$0,16
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250020,Arise Silver HMO 2000-80 to 5000,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250020.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250020-00,Standard Silver Off Exchange Plan,71.70%,0.717462003231049,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$80,$870,$30,"$1,150","$1,710",$0,$0,16
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250020,Arise Silver HMO 2000-80 to 5000,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250020.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250020-01,Standard Silver On Exchange Plan,71.70%,0.717462003231049,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$80,$870,$30,"$1,150","$1,710",$0,$0,17
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330055,Aspirus Arise Platinum HMO 500,84670WI133,,WIN001,WIS002,WIF006,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133005501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330055.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330055-01,Standard Platinum On Exchange Plan,,0.881754577159882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$750,$30,$500,$620,$130,$0,17
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330056,Aspirus Arise Platinum HMO Zero,84670WI133,,WIN001,WIS002,WIF005,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133005601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330056.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330056-00,Standard Platinum Off Exchange Plan,,0.884471535682678,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$850,$30,$0,"$1,360",$110,$0,18
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250020,Arise Silver HMO 2000-80 to 5000,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250020.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250020-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250020,Arise Silver HMO 2000-80 to 5000,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250020.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250020-03,Limited Cost Sharing Plan Variation,71.70%,0.717462003231049,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$80,$870,$30,"$1,150","$1,710",$0,$0,19
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330056,Aspirus Arise Platinum HMO Zero,84670WI133,,WIN001,WIS002,WIF005,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133005601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330056.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330056-01,Standard Platinum On Exchange Plan,,0.884471535682678,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$850,$30,$0,"$1,360",$110,$0,19
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330058,Aspirus Arise Silver HMO 2000,84670WI133,,WIN001,WIS002,WIF007,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133005801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330058.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330058-00,Standard Silver Off Exchange Plan,,0.717462003231049,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$80,$870,$30,"$1,150","$1,710",$0,$0,20
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250021,Arise Silver HMO 1500,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250021.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250021-01,Standard Silver On Exchange Plan,70.00%,0.700263202190399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,"$1,460",$30,"$1,150","$1,710",$0,$0,24
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250021,Arise Silver HMO 1500,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250021.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250021-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,25
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330060,Aspirus Arise Silver HMO 2500,84670WI133,,WIN001,WIS002,WIF007,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133006001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330060.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330060-01,Standard Silver On Exchange Plan,,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,25
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330061,Arise Metro Platinum HMO 500,84670WI133,,WIN001,WIS003,WIF006,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133006101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330061.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330061-00,Standard Platinum Off Exchange Plan,,0.881754577159882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$750,$30,$500,$620,$130,$0,26
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250021,Arise Silver HMO 1500,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250021.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250021-03,Limited Cost Sharing Plan Variation,70.00%,0.700263202190399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,"$1,460",$30,"$1,150","$1,710",$0,$0,26
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250021,Arise Silver HMO 1500,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250021.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250021-04,73% AV Level Silver Plan,73.30%,0.775132656097412,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,410",$0,$0,27
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330061,Arise Metro Platinum HMO 500,84670WI133,,WIN001,WIS003,WIF006,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133006101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330061.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330061-01,Standard Platinum On Exchange Plan,,0.881754577159882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$750,$30,$500,$620,$130,$0,27
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330062,Arise Metro Platinum HMO Zero,84670WI133,,WIN001,WIS003,WIF005,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133006201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330062.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330062-00,Standard Platinum Off Exchange Plan,,0.884471535682678,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$850,$30,$0,"$1,360",$110,$0,28
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330063,Arise Metro Gold HMO 1500,84670WI133,,WIN001,WIS003,WIF004,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133006301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330063.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330063-01,Standard Gold On Exchange Plan,79.80%,0.825080037117004,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,350",$0,$0,31
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330064,Arise Metro Silver HMO 2000,84670WI133,,WIN001,WIS003,WIF007,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133006401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330064.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330064-00,Standard Silver Off Exchange Plan,,0.717462003231049,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$80,$870,$30,"$1,150","$1,710",$0,$0,32
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250022,Arise Silver HMO 2500,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250022.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250022-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,32
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250022,Arise Silver HMO 2500,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250022.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250022-03,Limited Cost Sharing Plan Variation,70.00%,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,33
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330064,Arise Metro Silver HMO 2000,84670WI133,,WIN001,WIS003,WIF007,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133006401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330064.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330064-01,Standard Silver On Exchange Plan,,0.717462003231049,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$80,$870,$30,"$1,150","$1,710",$0,$0,33
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330065,Arise Metro Silver HMO 1500,84670WI133,,WIN001,WIS003,WIF007,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133006501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330065.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330065-00,Standard Silver Off Exchange Plan,,0.700263202190399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,"$1,460",$30,"$1,150","$1,710",$0,$0,34
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250022,Arise Silver HMO 2500,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250022.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250022-04,73% AV Level Silver Plan,72.10%,0.765756666660309,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,410",$0,$0,34
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250022,Arise Silver HMO 2500,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250022.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250022-05,87% AV Level Silver Plan,86.20%,0.887905538082123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$70,$0,$30,$500,"$1,000",$0,$0,35
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250059,Aspirus Arise Silver HMO 1500,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250059.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250059-03,Limited Cost Sharing Plan Variation,70.00%,0.700263202190399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,"$1,460",$30,"$1,150","$1,710",$0,$0,59
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250059,Aspirus Arise Silver HMO 1500,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250059.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250059-04,73% AV Level Silver Plan,73.30%,0.775132656097412,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,410",$0,$0,60
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250059,Aspirus Arise Silver HMO 1500,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250059.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250059-05,87% AV Level Silver Plan,86.20%,0.887905538082123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$70,$0,$30,$500,"$1,000",$0,$0,61
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250059,Aspirus Arise Silver HMO 1500,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250059.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250059-06,94% AV Level Silver Plan,94.20%,0.950752198696136,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$50,$0,$30,$250,$750,$0,$0,62
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350057,Aspirus Arise Gold POS 1500,84670WI135,,WIN001,WIS002,WIF004,New,POS,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135005701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350057.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350057-01,Standard Gold On Exchange Plan,79.80%,0.825080037117004,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,350",$0,$0,21
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,Individual,No,20-2660193,84670WI1270066,Arise Metro Silver POS 2500,84670WI127,,WIN001,WIS003,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127006601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270066.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270066-03,Limited Cost Sharing Plan Variation,70.00%,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,21
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330065,Arise Metro Silver HMO 1500,84670WI133,,WIN001,WIS003,WIF007,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133006501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330065.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330065-01,Standard Silver On Exchange Plan,,0.700263202190399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,"$1,460",$30,"$1,150","$1,710",$0,$0,35
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330066,Arise Metro Silver HMO 2500,84670WI133,,WIN001,WIS003,WIF007,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133006601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330066.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330066-00,Standard Silver Off Exchange Plan,,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,36
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250065,Arise Metro Silver HMO 1500,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250065.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250065-04,73% AV Level Silver Plan,73.30%,0.775132656097412,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,410",$0,$0,93
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250065,Arise Metro Silver HMO 1500,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250065.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250065-05,87% AV Level Silver Plan,86.20%,0.887905538082123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$70,$0,$30,$500,"$1,000",$0,$0,94
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250065,Arise Metro Silver HMO 1500,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250065.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250065-06,94% AV Level Silver Plan,94.20%,0.950752198696136,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$50,$0,$30,$250,$750,$0,$0,95
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250066,Arise Metro Silver HMO 2500,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250066.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250066-00,Standard Silver Off Exchange Plan,70.00%,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,96
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250065,Arise Metro Silver HMO 1500,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250065.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250065-00,Standard Silver Off Exchange Plan,70.00%,0.700263202190399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,"$1,460",$30,"$1,150","$1,710",$0,$0,89
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250065,Arise Metro Silver HMO 1500,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250065.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250065-01,Standard Silver On Exchange Plan,70.00%,0.700263202190399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,"$1,460",$30,"$1,150","$1,710",$0,$0,90
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250064,Arise Metro Silver HMO 2000-80 to 5000,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250064.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250064-05,87% AV Level Silver Plan,86.20%,0.887905538082123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$70,$0,$30,$500,"$1,000",$0,$0,87
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250064,Arise Metro Silver HMO 2000-80 to 5000,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250064.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250064-06,94% AV Level Silver Plan,94.20%,0.950752198696136,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$50,$0,$30,$250,$750,$0,$0,88
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250064,Arise Metro Silver HMO 2000-80 to 5000,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250064.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250064-01,Standard Silver On Exchange Plan,71.70%,0.717462003231049,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$80,$870,$30,"$1,150","$1,710",$0,$0,83
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250064,Arise Metro Silver HMO 2000-80 to 5000,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250064.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250064-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,84
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250064,Arise Metro Silver HMO 2000-80 to 5000,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250064.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250064-03,Limited Cost Sharing Plan Variation,71.70%,0.717462003231049,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$80,$870,$30,"$1,150","$1,710",$0,$0,85
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250064,Arise Metro Silver HMO 2000-80 to 5000,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250064.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250064-04,73% AV Level Silver Plan,73.70%,0.774895846843719,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,410",$0,$0,86
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250024,Arise Bronze HMO 6600,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250024.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250024-00,Standard Bronze Off Exchange Plan,,0.597552061080933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,4
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250024,Arise Bronze HMO 6600,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250024.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250024-01,Standard Bronze On Exchange Plan,,0.597552061080933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,5
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330024,Arise Bronze HMO 6600,84670WI133,,WIN001,WIS001,WIF004,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133002401,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330024.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330024-01,Standard Bronze On Exchange Plan,,0.597552061080933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,5
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330015,Arise Bronze HMO 5000,84670WI133,,WIN001,WIS001,WIF006,Existing,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133015601,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330015.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330015-00,Standard Bronze Off Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,6
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250024,Arise Bronze HMO 6600,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250024.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250024-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250024,Arise Bronze HMO 6600,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250024.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250024-03,Limited Cost Sharing Plan Variation,,0.597552061080933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,7
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330015,Arise Bronze HMO 5000,84670WI133,,WIN001,WIS001,WIF006,Existing,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133015601,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330015.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330015-01,Standard Bronze On Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,7
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330027,Arise Bronze HMO 4500,84670WI133,,WIN001,WIS001,WIF007,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133002701,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330027.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330027-00,Standard Bronze Off Exchange Plan,,0.615317523479462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,400",$0,$560,$30,"$4,500",$0,$150,$0,8
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250026,Arise Bronze HMO 5000,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250026.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250026-00,Standard Bronze Off Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,8
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250026,Arise Bronze HMO 5000,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250026.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250026-01,Standard Bronze On Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,9
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250066,Arise Metro Silver HMO 2500,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250066.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250066-01,Standard Silver On Exchange Plan,70.00%,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,97
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250066,Arise Metro Silver HMO 2500,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250066.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250066-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,98
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350066,Arise Metro Silver POS 2500,84670WI135,,WIN001,WIS003,WIF007,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135006601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350066.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350066-01,Standard Silver On Exchange Plan,,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,39
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330024,Arise Bronze HMO 6600,84670WI133,,WIN001,WIS001,WIF004,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133002401,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330024.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330024-00,Standard Bronze Off Exchange Plan,,0.597552061080933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,4
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250065,Arise Metro Silver HMO 1500,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250065.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250065-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,91
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250065,Arise Metro Silver HMO 1500,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250065.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250065-03,Limited Cost Sharing Plan Variation,70.00%,0.700263202190399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,"$1,460",$30,"$1,150","$1,710",$0,$0,92
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350063,Arise Metro Gold POS 1500,84670WI135,,WIN001,WIS003,WIF004,New,POS,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135006301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350063.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350063-01,Standard Gold On Exchange Plan,79.80%,0.825080037117004,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,350",$0,$0,33
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350064,Arise Metro Silver POS 2000,84670WI135,,WIN001,WIS003,WIF007,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135006401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350064.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350064-00,Standard Silver Off Exchange Plan,,0.717462003231049,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$80,$870,$30,"$1,150","$1,710",$0,$0,34
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350064,Arise Metro Silver POS 2000,84670WI135,,WIN001,WIS003,WIF007,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135006401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350064.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350064-01,Standard Silver On Exchange Plan,,0.717462003231049,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$80,$870,$30,"$1,150","$1,710",$0,$0,35
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350065,Arise Metro Silver POS 1500,84670WI135,,WIN001,WIS003,WIF007,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135006501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350065.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350065-00,Standard Silver Off Exchange Plan,,0.700263202190399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,000","$26,000",Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,"$1,460",$30,"$1,150","$1,710",$0,$0,36
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250022,Arise Silver HMO 2500,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250022.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250022-06,94% AV Level Silver Plan,94.20%,0.950752198696136,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$50,$0,$30,$250,$750,$0,$0,36
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330066,Arise Metro Silver HMO 2500,84670WI133,,WIN001,WIS003,WIF007,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133006601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330066.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330066-01,Standard Silver On Exchange Plan,,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,37
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250055,Aspirus Arise Platinum HMO 500,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250055.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250055-00,Standard Platinum Off Exchange Plan,,0.881754577159882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$750,$30,$500,$620,$130,$0,37
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250055,Aspirus Arise Platinum HMO 500,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250055.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250055-01,Standard Platinum On Exchange Plan,,0.881754577159882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$750,$30,$500,$620,$130,$0,38
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330057,Aspirus Arise Gold HMO 1500,84670WI133,,WIN001,WIS002,WIF004,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133005701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330057.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330057-00,Standard Gold Off Exchange Plan,79.80%,0.819301784038544,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,350",$0,$0,38
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330057,Aspirus Arise Gold HMO 1500,84670WI133,,WIN001,WIS002,WIF004,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133005701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330057.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330057-01,Standard Gold On Exchange Plan,79.80%,0.819301784038544,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,350",$0,$0,39
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250055,Aspirus Arise Platinum HMO 500,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250055.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250055-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,39
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250055,Aspirus Arise Platinum HMO 500,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250055.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250055-03,Limited Cost Sharing Plan Variation,,0.881754577159882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$750,$30,$500,$620,$130,$0,40
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250056,Aspirus Arise Platinum HMO Zero,84670WI125,,WIN001,WIS002,WIF005,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250056.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250056-00,Standard Platinum Off Exchange Plan,,0.884471535682678,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$850,$30,$0,"$1,360",$110,$0,41
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250056,Aspirus Arise Platinum HMO Zero,84670WI125,,WIN001,WIS002,WIF005,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250056.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250056-01,Standard Platinum On Exchange Plan,,0.884471535682678,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$850,$30,$0,"$1,360",$110,$0,42
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250056,Aspirus Arise Platinum HMO Zero,84670WI125,,WIN001,WIS002,WIF005,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250056.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250056-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,43
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250056,Aspirus Arise Platinum HMO Zero,84670WI125,,WIN001,WIS002,WIF005,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250056.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250056-03,Limited Cost Sharing Plan Variation,,0.884471535682678,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$850,$30,$0,"$1,360",$110,$0,44
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250057,Aspirus Arise Gold HMO 1500,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250057.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250057-00,Standard Gold Off Exchange Plan,79.80%,0.82320111989975,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,350",$0,$0,45
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250057,Aspirus Arise Gold HMO 1500,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250057.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250057-01,Standard Gold On Exchange Plan,79.80%,0.82320111989975,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,350",$0,$0,46
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250057,Aspirus Arise Gold HMO 1500,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250057.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250057-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,47
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250057,Aspirus Arise Gold HMO 1500,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250057.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250057-03,Limited Cost Sharing Plan Variation,79.80%,0.82320111989975,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,350",$0,$0,48
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250058,Aspirus Arise Silver HMO 2000-80 to 5000,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250058.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250058-00,Standard Silver Off Exchange Plan,71.70%,0.717462003231049,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$80,$870,$30,"$1,150","$1,710",$0,$0,49
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250058,Aspirus Arise Silver HMO 2000-80 to 5000,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250058.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250058-01,Standard Silver On Exchange Plan,71.70%,0.717462003231049,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$80,$870,$30,"$1,150","$1,710",$0,$0,50
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250058,Aspirus Arise Silver HMO 2000-80 to 5000,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250058.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250058-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,51
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250058,Aspirus Arise Silver HMO 2000-80 to 5000,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250058.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250058-03,Limited Cost Sharing Plan Variation,71.70%,0.717462003231049,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$80,$870,$30,"$1,150","$1,710",$0,$0,52
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250058,Aspirus Arise Silver HMO 2000-80 to 5000,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250058.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250058-04,73% AV Level Silver Plan,73.70%,0.774895846843719,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,410",$0,$0,53
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250058,Aspirus Arise Silver HMO 2000-80 to 5000,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250058.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250058-05,87% AV Level Silver Plan,86.20%,0.887905538082123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$70,$0,$30,$500,"$1,000",$0,$0,54
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250058,Aspirus Arise Silver HMO 2000-80 to 5000,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250058.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250058-06,94% AV Level Silver Plan,94.20%,0.950752198696136,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$50,$0,$30,$250,$750,$0,$0,55
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250059,Aspirus Arise Silver HMO 1500,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250059.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250059-00,Standard Silver Off Exchange Plan,70.00%,0.700263202190399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,"$1,460",$30,"$1,150","$1,710",$0,$0,56
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250059,Aspirus Arise Silver HMO 1500,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250059.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250059-01,Standard Silver On Exchange Plan,70.00%,0.700263202190399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,"$1,460",$30,"$1,150","$1,710",$0,$0,57
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250059,Aspirus Arise Silver HMO 1500,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125005901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250059.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250059-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,58
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250060,Aspirus Arise Silver HMO 2500,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250060.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250060-00,Standard Silver Off Exchange Plan,70.00%,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,63
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250060,Aspirus Arise Silver HMO 2500,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250060.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250060-01,Standard Silver On Exchange Plan,70.00%,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,64
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250060,Aspirus Arise Silver HMO 2500,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250060.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250060-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,65
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250060,Aspirus Arise Silver HMO 2500,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250060.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250060-03,Limited Cost Sharing Plan Variation,70.00%,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,66
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250060,Aspirus Arise Silver HMO 2500,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250060.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250060-04,73% AV Level Silver Plan,72.10%,0.765756666660309,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,410",$0,$0,67
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250060,Aspirus Arise Silver HMO 2500,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250060.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250060-05,87% AV Level Silver Plan,86.20%,0.887905538082123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$70,$0,$30,$500,"$1,000",$0,$0,68
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250060,Aspirus Arise Silver HMO 2500,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250060.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250060-06,94% AV Level Silver Plan,94.20%,0.950752198696136,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$50,$0,$30,$250,$750,$0,$0,69
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250061,Arise Metro Platinum HMO 500,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250061.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250061-00,Standard Platinum Off Exchange Plan,,0.881754577159882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$750,$30,$500,$620,$130,$0,70
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250061,Arise Metro Platinum HMO 500,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250061.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250061-01,Standard Platinum On Exchange Plan,,0.881754577159882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$750,$30,$500,$620,$130,$0,71
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250061,Arise Metro Platinum HMO 500,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250061.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250061-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,72
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250061,Arise Metro Platinum HMO 500,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250061.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250061-03,Limited Cost Sharing Plan Variation,,0.881754577159882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$750,$30,$500,$620,$130,$0,73
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250062,Arise Metro Platinum HMO Zero,84670WI125,,WIN001,WIS003,WIF005,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250062.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250062-00,Standard Platinum Off Exchange Plan,,0.884471535682678,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$850,$30,$0,"$1,360",$110,$0,74
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250062,Arise Metro Platinum HMO Zero,84670WI125,,WIN001,WIS003,WIF005,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250062.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250062-01,Standard Platinum On Exchange Plan,,0.884471535682678,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$850,$30,$0,"$1,360",$110,$0,75
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250062,Arise Metro Platinum HMO Zero,84670WI125,,WIN001,WIS003,WIF005,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250062.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250062-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,76
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250062,Arise Metro Platinum HMO Zero,84670WI125,,WIN001,WIS003,WIF005,New,HMO,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250062.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250062-03,Limited Cost Sharing Plan Variation,,0.884471535682678,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$850,$30,$0,"$1,360",$110,$0,77
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250063,Arise Metro Gold HMO 1500,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250063.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250063-00,Standard Gold Off Exchange Plan,79.80%,0.82320111989975,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,350",$0,$0,78
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250063,Arise Metro Gold HMO 1500,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250063.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250063-01,Standard Gold On Exchange Plan,79.80%,0.82320111989975,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,350",$0,$0,79
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250063,Arise Metro Gold HMO 1500,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250063.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250063-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,80
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250063,Arise Metro Gold HMO 1500,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250063.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250063-03,Limited Cost Sharing Plan Variation,79.80%,0.82320111989975,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,350",$0,$0,81
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250064,Arise Metro Silver HMO 2000-80 to 5000,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250064.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250064-00,Standard Silver Off Exchange Plan,71.70%,0.717462003231049,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$80,$870,$30,"$1,150","$1,710",$0,$0,82
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250066,Arise Metro Silver HMO 2500,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250066.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250066-03,Limited Cost Sharing Plan Variation,70.00%,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,99
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250066,Arise Metro Silver HMO 2500,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250066.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250066-04,73% AV Level Silver Plan,72.10%,0.765756666660309,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,410",$0,$0,100
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250066,Arise Metro Silver HMO 2500,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250066.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250066-05,87% AV Level Silver Plan,86.20%,0.887905538082123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$70,$0,$30,$500,"$1,000",$0,$0,101
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,3,84670,WI,Individual,No,20-2660193,84670WI1250066,Arise Metro Silver HMO 2500,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250066.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250066-06,94% AV Level Silver Plan,94.20%,0.950752198696136,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$50,$0,$30,$250,$750,$0,$0,102
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,Individual,No,20-2660193,84670WI1270022,Arise Silver POS 2500,84670WI127,,WIN001,WIS001,WIF007,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127002201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270022.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270022-00,Standard Silver Off Exchange Plan,70.00%,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,4
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350004,Arise Platinum POS 500,84670WI135,,WIN001,WIS001,WIF006,Existing,POS,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135000401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350004.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350004-00,Standard Platinum Off Exchange Plan,,0.881754577159882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$9,000","$18,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$750,$30,$500,$620,$130,$0,4
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350004,Arise Platinum POS 500,84670WI135,,WIN001,WIS001,WIF006,Existing,POS,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135000401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350004.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350004-01,Standard Platinum On Exchange Plan,,0.881754577159882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$9,000","$18,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$750,$30,$500,$620,$130,$0,5
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,Individual,No,20-2660193,84670WI1270022,Arise Silver POS 2500,84670WI127,,WIN001,WIS001,WIF007,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127002201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270022.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270022-01,Standard Silver On Exchange Plan,70.00%,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,5
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,Individual,No,20-2660193,84670WI1270022,Arise Silver POS 2500,84670WI127,,WIN001,WIS001,WIF007,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127002201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270022.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270022-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350041,Arise Platinum POS Zero,84670WI135,,WIN001,WIS001,WIF005,New,POS,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135004101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350041.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350041-00,Standard Platinum Off Exchange Plan,,0.884471535682678,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$7,000","$14,000",Not Applicable,Not Applicable,$0,$0,10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$850,$30,$0,"$1,360",$110,$0,6
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350041,Arise Platinum POS Zero,84670WI135,,WIN001,WIS001,WIF005,New,POS,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135004101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350041.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350041-01,Standard Platinum On Exchange Plan,,0.884471535682678,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$7,000","$14,000",Not Applicable,Not Applicable,$0,$0,10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$850,$30,$0,"$1,360",$110,$0,7
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,Individual,No,20-2660193,84670WI1270022,Arise Silver POS 2500,84670WI127,,WIN001,WIS001,WIF007,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127002201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270022.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270022-03,Limited Cost Sharing Plan Variation,70.00%,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,7
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,Individual,No,20-2660193,84670WI1270022,Arise Silver POS 2500,84670WI127,,WIN001,WIS001,WIF007,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127002201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270022.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270022-04,73% AV Level Silver Plan,72.10%,0.765756666660309,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,$0,$30,"$1,150","$1,710",$0,$0,8
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350008,Arise Gold POS 1500,84670WI135,,WIN001,WIS001,WIF004,Existing,POS,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135000801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350008.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350008-00,Standard Gold Off Exchange Plan,79.80%,0.825080037117004,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,350",$0,$0,8
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350008,Arise Gold POS 1500,84670WI135,,WIN001,WIS001,WIF004,Existing,POS,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135000801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350008.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350008-01,Standard Gold On Exchange Plan,79.80%,0.825080037117004,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,350",$0,$0,9
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,Individual,No,20-2660193,84670WI1270022,Arise Silver POS 2500,84670WI127,,WIN001,WIS001,WIF007,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127002201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270022.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270022-05,87% AV Level Silver Plan,86.20%,0.887905538082123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$70,$0,$30,$500,"$1,000",$0,$0,9
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,Individual,No,20-2660193,84670WI1270022,Arise Silver POS 2500,84670WI127,,WIN001,WIS001,WIF007,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127002201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270022.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270022-06,94% AV Level Silver Plan,94.20%,0.950752198696136,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,$250,$500,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$50,$0,$30,$250,$750,$0,$0,10
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350013,Arise Silver POS 2000,84670WI135,,WIN001,WIS001,WIF007,Existing,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135001301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350013.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350013-00,Standard Silver Off Exchange Plan,,0.717462003231049,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$80,$870,$30,"$1,150","$1,710",$0,$0,10
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350013,Arise Silver POS 2000,84670WI135,,WIN001,WIS001,WIF007,Existing,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135001301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350013.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350013-01,Standard Silver On Exchange Plan,,0.717462003231049,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$80,$870,$30,"$1,150","$1,710",$0,$0,11
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,Individual,No,20-2660193,84670WI1270060,Aspirus Arise Silver POS 2500,84670WI127,,WIN001,WIS002,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127006001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270060.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270060-00,Standard Silver Off Exchange Plan,70.00%,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,11
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,Individual,No,20-2660193,84670WI1270060,Aspirus Arise Silver POS 2500,84670WI127,,WIN001,WIS002,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127006001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270060.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270060-01,Standard Silver On Exchange Plan,70.00%,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,12
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350014,Arise Silver POS 1500,84670WI135,,WIN001,WIS001,WIF007,Existing,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135001401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350014.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350014-00,Standard Silver Off Exchange Plan,,0.700263202190399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,000","$26,000",Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,"$1,460",$30,"$1,150","$1,710",$0,$0,12
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350014,Arise Silver POS 1500,84670WI135,,WIN001,WIS001,WIF007,Existing,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135001401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350014.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350014-01,Standard Silver On Exchange Plan,,0.700263202190399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,000","$26,000",Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,"$1,460",$30,"$1,150","$1,710",$0,$0,13
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,Individual,No,20-2660193,84670WI1270060,Aspirus Arise Silver POS 2500,84670WI127,,WIN001,WIS002,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127006001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270060.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270060-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,Individual,No,20-2660193,84670WI1270060,Aspirus Arise Silver POS 2500,84670WI127,,WIN001,WIS002,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127006001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270060.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270060-03,Limited Cost Sharing Plan Variation,70.00%,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,14
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350022,Arise Silver POS 2500,84670WI135,,WIN001,WIS001,WIF007,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135002201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350022.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350022-00,Standard Silver Off Exchange Plan,,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,14
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350022,Arise Silver POS 2500,84670WI135,,WIN001,WIS001,WIF007,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135002201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350022.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350022-01,Standard Silver On Exchange Plan,,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,15
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,Individual,No,20-2660193,84670WI1270060,Aspirus Arise Silver POS 2500,84670WI127,,WIN001,WIS002,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127006001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270060.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270060-04,73% AV Level Silver Plan,72.10%,0.765756666660309,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,$0,$30,"$1,150","$1,710",$0,$0,15
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,Individual,No,20-2660193,84670WI1270060,Aspirus Arise Silver POS 2500,84670WI127,,WIN001,WIS002,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127006001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270060.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270060-05,87% AV Level Silver Plan,86.20%,0.887905538082123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$70,$0,$30,$500,"$1,000",$0,$0,16
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350055,Aspirus Arise Platinum POS 500,84670WI135,,WIN001,WIS002,WIF006,New,POS,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135005501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350055.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350055-00,Standard Platinum Off Exchange Plan,,0.881754577159882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$9,000","$18,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$750,$30,$500,$620,$130,$0,16
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350055,Aspirus Arise Platinum POS 500,84670WI135,,WIN001,WIS002,WIF006,New,POS,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135005501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350055.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350055-01,Standard Platinum On Exchange Plan,,0.881754577159882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$9,000","$18,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$750,$30,$500,$620,$130,$0,17
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,Individual,No,20-2660193,84670WI1270060,Aspirus Arise Silver POS 2500,84670WI127,,WIN001,WIS002,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127006001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270060.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270060-06,94% AV Level Silver Plan,94.20%,0.950752198696136,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,$250,$500,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$50,$0,$30,$250,$750,$0,$0,17
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,Individual,No,20-2660193,84670WI1270066,Arise Metro Silver POS 2500,84670WI127,,WIN001,WIS003,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127006601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270066.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270066-00,Standard Silver Off Exchange Plan,70.00%,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,18
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350056,Aspirus Arise Platinum POS Zero,84670WI135,,WIN001,WIS002,WIF005,New,POS,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135005601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350056.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350056-00,Standard Platinum Off Exchange Plan,,0.884471535682678,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$7,000","$14,000",Not Applicable,Not Applicable,$0,$0,10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$850,$30,$0,"$1,360",$110,$0,18
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350056,Aspirus Arise Platinum POS Zero,84670WI135,,WIN001,WIS002,WIF005,New,POS,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135005601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350056.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350056-01,Standard Platinum On Exchange Plan,,0.884471535682678,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$7,000","$14,000",Not Applicable,Not Applicable,$0,$0,10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$850,$30,$0,"$1,360",$110,$0,19
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,Individual,No,20-2660193,84670WI1270066,Arise Metro Silver POS 2500,84670WI127,,WIN001,WIS003,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127006601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270066.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270066-01,Standard Silver On Exchange Plan,70.00%,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,19
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,Individual,No,20-2660193,84670WI1270066,Arise Metro Silver POS 2500,84670WI127,,WIN001,WIS003,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127006601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270066.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270066-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,20
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350057,Aspirus Arise Gold POS 1500,84670WI135,,WIN001,WIS002,WIF004,New,POS,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135005701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350057.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350057-00,Standard Gold Off Exchange Plan,79.80%,0.825080037117004,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,350",$0,$0,20
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,Individual,No,20-2660193,84670WI1270066,Arise Metro Silver POS 2500,84670WI127,,WIN001,WIS003,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127006601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270066.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270066-04,73% AV Level Silver Plan,72.10%,0.765756666660309,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,$0,$30,"$1,150","$1,710",$0,$0,22
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350058,Aspirus Arise Silver POS 2000,84670WI135,,WIN001,WIS002,WIF007,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135005801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350058.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350058-00,Standard Silver Off Exchange Plan,,0.717462003231049,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$80,$870,$30,"$1,150","$1,710",$0,$0,22
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350058,Aspirus Arise Silver POS 2000,84670WI135,,WIN001,WIS002,WIF007,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135005801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350058.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350058-01,Standard Silver On Exchange Plan,,0.717462003231049,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,900",$80,$870,$30,"$1,150","$1,710",$0,$0,23
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,Individual,No,20-2660193,84670WI1270066,Arise Metro Silver POS 2500,84670WI127,,WIN001,WIS003,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127006601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270066.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270066-05,87% AV Level Silver Plan,86.20%,0.887905538082123,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$70,$0,$30,$500,"$1,000",$0,$0,23
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,Individual,No,20-2660193,84670WI1270066,Arise Metro Silver POS 2500,84670WI127,,WIN001,WIS003,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127006601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270066.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270066-06,94% AV Level Silver Plan,94.20%,0.950752198696136,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,$250,$500,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$50,$0,$30,$250,$750,$0,$0,24
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350059,Aspirus Arise Silver POS 1500,84670WI135,,WIN001,WIS002,WIF007,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135005901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350059.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350059-00,Standard Silver Off Exchange Plan,,0.700263202190399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,000","$26,000",Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,"$1,460",$30,"$1,150","$1,710",$0,$0,24
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350059,Aspirus Arise Silver POS 1500,84670WI135,,WIN001,WIS002,WIF007,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135005901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350059.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350059-01,Standard Silver On Exchange Plan,,0.700263202190399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,000","$26,000",Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,"$1,460",$30,"$1,150","$1,710",$0,$0,25
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350060,Aspirus Arise Silver POS 2500,84670WI135,,WIN001,WIS002,WIF007,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135006001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350060.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350060-00,Standard Silver Off Exchange Plan,,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,26
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350060,Aspirus Arise Silver POS 2500,84670WI135,,WIN001,WIS002,WIF007,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135006001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350060.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350060-01,Standard Silver On Exchange Plan,,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,27
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350061,Arise Metro Platinum POS 500,84670WI135,,WIN001,WIS003,WIF006,New,POS,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135006101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350061.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350061-00,Standard Platinum Off Exchange Plan,,0.881754577159882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$9,000","$18,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$750,$30,$500,$620,$130,$0,28
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350061,Arise Metro Platinum POS 500,84670WI135,,WIN001,WIS003,WIF006,New,POS,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135006101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350061.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350061-01,Standard Platinum On Exchange Plan,,0.881754577159882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$9,000","$18,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$750,$30,$500,$620,$130,$0,29
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350062,Arise Metro Platinum POS Zero,84670WI135,,WIN001,WIS003,WIF005,New,POS,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135006201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350062.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350062-00,Standard Platinum Off Exchange Plan,,0.884471535682678,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$7,000","$14,000",Not Applicable,Not Applicable,$0,$0,10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$850,$30,$0,"$1,360",$110,$0,30
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350062,Arise Metro Platinum POS Zero,84670WI135,,WIN001,WIS003,WIF005,New,POS,Platinum,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135006201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350062.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350062-01,Standard Platinum On Exchange Plan,,0.884471535682678,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$7,000","$14,000",Not Applicable,Not Applicable,$0,$0,10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$850,$30,$0,"$1,360",$110,$0,31
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350063,Arise Metro Gold POS 1500,84670WI135,,WIN001,WIS003,WIF004,New,POS,Gold,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135006301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350063.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350063-00,Standard Gold Off Exchange Plan,79.80%,0.825080037117004,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$70,$0,$30,"$1,150","$1,350",$0,$0,32
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350065,Arise Metro Silver POS 1500,84670WI135,,WIN001,WIS003,WIF007,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135006501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350065.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350065-01,Standard Silver On Exchange Plan,,0.700263202190399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,000","$26,000",Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$80,"$1,460",$30,"$1,150","$1,710",$0,$0,37
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,4,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350066,Arise Metro Silver POS 2500,84670WI135,,WIN001,WIS003,WIF007,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,$500,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135006601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350066.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350066-00,Standard Silver Off Exchange Plan,,0.699841439723969,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,400",$80,"$1,150",$30,"$1,150","$1,710",$0,$0,38
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330027,Arise Bronze HMO 4500,84670WI133,,WIN001,WIS001,WIF007,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133002701,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330027.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330027-01,Standard Bronze On Exchange Plan,,0.615317523479462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,400",$0,$560,$30,"$4,500",$0,$150,$0,9
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330067,Aspirus Arise Bronze HMO 6600,84670WI133,,WIN001,WIS002,WIF004,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133006701,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330067.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330067-00,Standard Bronze Off Exchange Plan,,0.597552061080933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,10
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250026,Arise Bronze HMO 5000,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250026.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250026-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250026,Arise Bronze HMO 5000,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250026.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250026-03,Limited Cost Sharing Plan Variation,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,11
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330067,Aspirus Arise Bronze HMO 6600,84670WI133,,WIN001,WIS002,WIF004,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133006701,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330067.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330067-01,Standard Bronze On Exchange Plan,,0.597552061080933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,11
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330068,Aspirus Arise Bronze HMO 5000,84670WI133,,WIN001,WIS002,WIF006,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133006801,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330068.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330068-00,Standard Bronze Off Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,12
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250027,Arise Bronze HMO 4500,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250027.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250027-00,Standard Bronze Off Exchange Plan,,0.615317523479462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,400",$0,$560,$30,"$4,500",$0,$150,$0,12
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250027,Arise Bronze HMO 4500,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250027.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250027-01,Standard Bronze On Exchange Plan,,0.615317523479462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,400",$0,$560,$30,"$4,500",$0,$150,$0,13
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330068,Aspirus Arise Bronze HMO 5000,84670WI133,,WIN001,WIS002,WIF006,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133006801,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330068.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330068-01,Standard Bronze On Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,13
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330069,Aspirus Arise Bronze HMO 4500,84670WI133,,WIN001,WIS002,WIF007,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133006901,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330069.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330069-00,Standard Bronze Off Exchange Plan,,0.615317523479462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,400",$0,$560,$30,"$4,500",$0,$150,$0,14
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250072,Arise Metro Bronze HMO 4500,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250072.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250072-01,Standard Bronze On Exchange Plan,,0.615317523479462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,400",$0,$560,$30,"$4,500",$0,$150,$0,37
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250072,Arise Metro Bronze HMO 4500,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250072.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250072-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,38
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250072,Arise Metro Bronze HMO 4500,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250072.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250072-03,Limited Cost Sharing Plan Variation,,0.615317523479462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,400",$0,$560,$30,"$4,500",$0,$150,$0,39
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,Individual,No,20-2660193,84670WI1270026,Arise Bronze POS 5000,84670WI127,,WIN001,WIS001,WIF006,Existing,POS,Bronze,No,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127002601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270026.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270026-00,Standard Bronze Off Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,4
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350024,Arise Bronze POS 6600,84670WI135,,WIN001,WIS001,WIF004,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135002401,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350024.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350024-00,Standard Bronze Off Exchange Plan,,0.597552061080933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$17,200","$34,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,4
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350024,Arise Bronze POS 6600,84670WI135,,WIN001,WIS001,WIF004,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135002401,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350024.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350024-01,Standard Bronze On Exchange Plan,,0.597552061080933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$17,200","$34,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,5
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330076,Aspirus Arise Silver HMO 3000-90 HSA,84670WI133,,WIN001,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133007601,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330076.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330076-01,Standard Silver On Exchange Plan,,0.686612367630005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$340,$30,"$3,000",$0,$220,$0,31
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330077,Aspirus Arise Silver HMO 2500 HSA,84670WI133,,WIN001,WIS002,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133007701,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330077.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330077-00,Standard Silver Off Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,32
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250032,Arise Silver HMO 2500 HSA,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250032.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250032-03,Limited Cost Sharing Plan Variation,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,32
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250032,Arise Silver HMO 2500 HSA,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250032.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250032-04,73% AV Level Silver Plan,,0.736850261688232,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,33
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330077,Aspirus Arise Silver HMO 2500 HSA,84670WI133,,WIN001,WIS002,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133007701,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330077.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330077-01,Standard Silver On Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,33
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330078,Aspirus Arise Silver HMO 1400 HSA,84670WI133,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133007801,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330078.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330078-00,Standard Silver Off Exchange Plan,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,34
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350070,Arise Metro Bronze POS 6600,84670WI135,,WIN001,WIS003,WIF004,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135007001,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350070.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350070-01,Standard Bronze On Exchange Plan,,0.597552061080933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$17,200","$34,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,17
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350071,Arise Metro Bronze POS 5000,84670WI135,,WIN001,WIS003,WIF006,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135007101,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350071.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350071-00,Standard Bronze Off Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,18
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350069,Aspirus Arise Bronze POS 4500,84670WI135,,WIN001,WIS002,WIF007,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135006901,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350069.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350069-00,Standard Bronze Off Exchange Plan,,0.615317523479462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,"$5,400",$0,$560,$30,"$4,500",$0,$150,$0,14
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350069,Aspirus Arise Bronze POS 4500,84670WI135,,WIN001,WIS002,WIF007,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135006901,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350069.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350069-01,Standard Bronze On Exchange Plan,,0.615317523479462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,"$5,400",$0,$560,$30,"$4,500",$0,$150,$0,15
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,Individual,No,20-2660193,84670WI1270071,Arise Metro Bronze POS 5000,84670WI127,,WIN001,WIS003,WIF006,New,POS,Bronze,No,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127007101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270071.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270071-03,Limited Cost Sharing Plan Variation,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,15
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350070,Arise Metro Bronze POS 6600,84670WI135,,WIN001,WIS003,WIF004,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135007001,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350070.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350070-00,Standard Bronze Off Exchange Plan,,0.597552061080933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$17,200","$34,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,16
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250028,Arise Gold HMO 2000 HSA,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250028.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250028-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,4
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250028,Arise Gold HMO 2000 HSA,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250028.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250028-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,5
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330016,Arise Gold HMO 2000 HSA,84670WI133,,WIN001,WIS001,WIF004,Existing,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133001601,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330016.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330016-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,5
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330029,Arise Silver HMO 3500 HSA,84670WI133,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133002901,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330029.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330029-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$0,$30,"$3,500",$0,$0,$0,6
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250028,Arise Gold HMO 2000 HSA,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250028.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250028-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250028,Arise Gold HMO 2000 HSA,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250028.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250028-03,Limited Cost Sharing Plan Variation,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,7
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330029,Arise Silver HMO 3500 HSA,84670WI133,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133002901,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330029.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330029-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$0,$30,"$3,500",$0,$0,$0,7
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330030,Arise Silver HMO 3000-100 HSA,84670WI133,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133003001,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330030.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330030-00,Standard Silver Off Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$0,$30,"$3,000",$0,$0,$0,8
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250029,Arise Silver HMO 3500 HSA,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250029.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250029-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$0,$30,"$3,500",$0,$0,$0,8
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250029,Arise Silver HMO 3500 HSA,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250029.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250029-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$0,$30,"$3,500",$0,$0,$0,9
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350071,Arise Metro Bronze POS 5000,84670WI135,,WIN001,WIS003,WIF006,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135007101,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350071.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350071-01,Standard Bronze On Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,19
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350072,Arise Metro Bronze POS 4500,84670WI135,,WIN001,WIS003,WIF007,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135007201,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350072.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350072-00,Standard Bronze Off Exchange Plan,,0.615317523479462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,"$5,400",$0,$560,$30,"$4,500",$0,$150,$0,20
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350072,Arise Metro Bronze POS 4500,84670WI135,,WIN001,WIS003,WIF007,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135007201,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350072.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350072-01,Standard Bronze On Exchange Plan,,0.615317523479462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,"$5,400",$0,$560,$30,"$4,500",$0,$150,$0,21
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330016,Arise Gold HMO 2000 HSA,84670WI133,,WIN001,WIS001,WIF004,Existing,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133001601,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330016.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330016-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,4
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250032,Arise Silver HMO 2500 HSA,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250032.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250032-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,34
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250032,Arise Silver HMO 2500 HSA,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250032.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250032-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,35
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250027,Arise Bronze HMO 4500,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250027.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250027-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250027,Arise Bronze HMO 4500,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250027.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250027-03,Limited Cost Sharing Plan Variation,,0.615317523479462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,400",$0,$560,$30,"$4,500",$0,$150,$0,15
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330069,Aspirus Arise Bronze HMO 4500,84670WI133,,WIN001,WIS002,WIF007,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133006901,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330069.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330069-01,Standard Bronze On Exchange Plan,,0.615317523479462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,400",$0,$560,$30,"$4,500",$0,$150,$0,15
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330070,Arise Metro Bronze HMO 6600,84670WI133,,WIN001,WIS003,WIF004,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133007001,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330070.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330070-00,Standard Bronze Off Exchange Plan,,0.597552061080933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,16
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250067,Aspirus Arise Bronze HMO 6600,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250067.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250067-00,Standard Bronze Off Exchange Plan,,0.597552061080933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,16
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250067,Aspirus Arise Bronze HMO 6600,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250067.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250067-01,Standard Bronze On Exchange Plan,,0.597552061080933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,17
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330070,Arise Metro Bronze HMO 6600,84670WI133,,WIN001,WIS003,WIF004,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133007001,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330070.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330070-01,Standard Bronze On Exchange Plan,,0.597552061080933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,17
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330071,Arise Metro Bronze HMO 5000,84670WI133,,WIN001,WIS003,WIF006,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133007101,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330071.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330071-00,Standard Bronze Off Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,18
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250067,Aspirus Arise Bronze HMO 6600,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250067.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250067-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250067,Aspirus Arise Bronze HMO 6600,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250067.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250067-03,Limited Cost Sharing Plan Variation,,0.597552061080933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,19
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330071,Arise Metro Bronze HMO 5000,84670WI133,,WIN001,WIS003,WIF006,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133007101,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330071.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330071-01,Standard Bronze On Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,19
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330072,Arise Metro Bronze HMO 4500,84670WI133,,WIN001,WIS003,WIF007,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133007201,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330072.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330072-00,Standard Bronze Off Exchange Plan,,0.615317523479462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,400",$0,$560,$30,"$4,500",$0,$150,$0,20
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250068,Aspirus Arise Bronze HMO 5000,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250068.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250068-00,Standard Bronze Off Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,20
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250068,Aspirus Arise Bronze HMO 5000,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250068.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250068-01,Standard Bronze On Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,21
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330072,Arise Metro Bronze HMO 4500,84670WI133,,WIN001,WIS003,WIF007,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133007201,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330072.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330072-01,Standard Bronze On Exchange Plan,,0.615317523479462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,400",$0,$560,$30,"$4,500",$0,$150,$0,21
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250068,Aspirus Arise Bronze HMO 5000,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250068.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250068-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250068,Aspirus Arise Bronze HMO 5000,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250068.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250068-03,Limited Cost Sharing Plan Variation,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,23
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250069,Aspirus Arise Bronze HMO 4500,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250069.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250069-00,Standard Bronze Off Exchange Plan,,0.615317523479462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,400",$0,$560,$30,"$4,500",$0,$150,$0,24
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250069,Aspirus Arise Bronze HMO 4500,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250069.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250069-01,Standard Bronze On Exchange Plan,,0.615317523479462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,400",$0,$560,$30,"$4,500",$0,$150,$0,25
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250069,Aspirus Arise Bronze HMO 4500,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250069.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250069-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,26
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250069,Aspirus Arise Bronze HMO 4500,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250069.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250069-03,Limited Cost Sharing Plan Variation,,0.615317523479462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,400",$0,$560,$30,"$4,500",$0,$150,$0,27
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250070,Arise Metro Bronze HMO 6600,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250070.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250070-00,Standard Bronze Off Exchange Plan,,0.597552061080933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,28
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250070,Arise Metro Bronze HMO 6600,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250070.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250070-01,Standard Bronze On Exchange Plan,,0.597552061080933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,29
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250070,Arise Metro Bronze HMO 6600,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250070.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250070-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,30
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250070,Arise Metro Bronze HMO 6600,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250070.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250070-03,Limited Cost Sharing Plan Variation,,0.597552061080933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,31
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250071,Arise Metro Bronze HMO 5000,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250071.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250071-00,Standard Bronze Off Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,32
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250071,Arise Metro Bronze HMO 5000,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250071.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250071-01,Standard Bronze On Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,33
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250071,Arise Metro Bronze HMO 5000,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250071.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250071-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,34
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250071,Arise Metro Bronze HMO 5000,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250071.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250071-03,Limited Cost Sharing Plan Variation,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,35
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,5,84670,WI,Individual,No,20-2660193,84670WI1250072,Arise Metro Bronze HMO 4500,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250072.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250072-00,Standard Bronze Off Exchange Plan,,0.615317523479462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,400",$0,$560,$30,"$4,500",$0,$150,$0,36
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,Individual,No,20-2660193,84670WI1270026,Arise Bronze POS 5000,84670WI127,,WIN001,WIS001,WIF006,Existing,POS,Bronze,No,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127002601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270026.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270026-01,Standard Bronze On Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,5
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,Individual,No,20-2660193,84670WI1270026,Arise Bronze POS 5000,84670WI127,,WIN001,WIS001,WIF006,Existing,POS,Bronze,No,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127002601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270026.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270026-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350015,Arise Bronze POS 5000,84670WI135,,WIN001,WIS001,WIF006,Existing,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135011501,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350015.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350015-00,Standard Bronze Off Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,6
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350015,Arise Bronze POS 5000,84670WI135,,WIN001,WIS001,WIF006,Existing,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135011501,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350015.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350015-01,Standard Bronze On Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,7
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330019,Arise Bronze HMO 3500 HSA,84670WI133,,WIN001,WIS001,WIF007,Existing,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133001901,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330019.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330019-01,Standard Bronze On Exchange Plan,61.50%,0.612004160881042,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$860,$30,"$3,500",$0,$480,$0,23
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330073,Aspirus Arise Gold HMO 2000 HSA,84670WI133,,WIN001,WIS002,WIF004,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133007301,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330073.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330073-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,24
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250031,Arise Silver HMO 3000-90 HSA,84670WI125,,WIN001,WIS001,WIF005,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250031.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250031-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,24
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250031,Arise Silver HMO 3000-90 HSA,84670WI125,,WIN001,WIS001,WIF005,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250031.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250031-03,Limited Cost Sharing Plan Variation,,0.686612367630005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$340,$30,"$3,000",$0,$220,$0,25
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330073,Aspirus Arise Gold HMO 2000 HSA,84670WI133,,WIN001,WIS002,WIF004,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133007301,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330073.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330073-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,25
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330074,Aspirus Arise Silver HMO 3500 HSA,84670WI133,,WIN001,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133007401,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330074.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330074-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$0,$30,"$3,500",$0,$0,$0,26
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250031,Arise Silver HMO 3000-90 HSA,84670WI125,,WIN001,WIS001,WIF005,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250031.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250031-04,73% AV Level Silver Plan,,0.729270815849304,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,700",$0,$0,$30,"$2,800",$0,$0,$0,26
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250031,Arise Silver HMO 3000-90 HSA,84670WI125,,WIN001,WIS001,WIF005,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250031.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250031-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,27
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330074,Aspirus Arise Silver HMO 3500 HSA,84670WI133,,WIN001,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133007401,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330074.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330074-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$0,$30,"$3,500",$0,$0,$0,27
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330075,Aspirus Arise Silver HMO 3000-100 HSA,84670WI133,,WIN001,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133007501,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330075.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330075-00,Standard Silver Off Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$0,$30,"$3,000",$0,$0,$0,28
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250031,Arise Silver HMO 3000-90 HSA,84670WI125,,WIN001,WIS001,WIF005,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250031.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250031-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,28
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250032,Arise Silver HMO 2500 HSA,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250032.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250032-00,Standard Silver Off Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,29
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,Individual,No,20-2660193,84670WI1270026,Arise Bronze POS 5000,84670WI127,,WIN001,WIS001,WIF006,Existing,POS,Bronze,No,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127002601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270026.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270026-03,Limited Cost Sharing Plan Variation,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,7
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,Individual,No,20-2660193,84670WI1270068,Aspirus Arise Bronze POS 5000,84670WI127,,WIN001,WIS002,WIF006,New,POS,Bronze,No,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127006801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270068.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270068-00,Standard Bronze Off Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,8
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350027,Arise Bronze POS 4500,84670WI135,,WIN001,WIS001,WIF007,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135002701,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350027.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350027-00,Standard Bronze Off Exchange Plan,,0.615317523479462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,"$5,400",$0,$560,$30,"$4,500",$0,$150,$0,8
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350027,Arise Bronze POS 4500,84670WI135,,WIN001,WIS001,WIF007,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135002701,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350027.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350027-01,Standard Bronze On Exchange Plan,,0.615317523479462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,"$5,400",$0,$560,$30,"$4,500",$0,$150,$0,9
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,Individual,No,20-2660193,84670WI1270068,Aspirus Arise Bronze POS 5000,84670WI127,,WIN001,WIS002,WIF006,New,POS,Bronze,No,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127006801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270068.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270068-01,Standard Bronze On Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,9
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,Individual,No,20-2660193,84670WI1270068,Aspirus Arise Bronze POS 5000,84670WI127,,WIN001,WIS002,WIF006,New,POS,Bronze,No,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127006801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270068.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270068-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350067,Aspirus Arise Bronze POS 6600,84670WI135,,WIN001,WIS002,WIF004,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135006701,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350067.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350067-00,Standard Bronze Off Exchange Plan,,0.597552061080933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$17,200","$34,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,10
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350067,Aspirus Arise Bronze POS 6600,84670WI135,,WIN001,WIS002,WIF004,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135006701,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350067.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350067-01,Standard Bronze On Exchange Plan,,0.597552061080933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$17,200","$34,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,11
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,Individual,No,20-2660193,84670WI1270068,Aspirus Arise Bronze POS 5000,84670WI127,,WIN001,WIS002,WIF006,New,POS,Bronze,No,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127006801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270068.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270068-03,Limited Cost Sharing Plan Variation,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,11
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,Individual,No,20-2660193,84670WI1270071,Arise Metro Bronze POS 5000,84670WI127,,WIN001,WIS003,WIF006,New,POS,Bronze,No,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127007101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270071.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270071-00,Standard Bronze Off Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,12
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350068,Aspirus Arise Bronze POS 5000,84670WI135,,WIN001,WIS002,WIF006,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135006801,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350068.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350068-00,Standard Bronze Off Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,12
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350068,Aspirus Arise Bronze POS 5000,84670WI135,,WIN001,WIS002,WIF006,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135006801,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350068.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350068-01,Standard Bronze On Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,13
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,Individual,No,20-2660193,84670WI1270071,Arise Metro Bronze POS 5000,84670WI127,,WIN001,WIS003,WIF006,New,POS,Bronze,No,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127007101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270071.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270071-01,Standard Bronze On Exchange Plan,,0.612878799438477,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,900",$0,$270,$30,"$4,900",$0,$0,$0,13
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,6,84670,WI,Individual,No,20-2660193,84670WI1270071,Arise Metro Bronze POS 5000,84670WI127,,WIN001,WIS003,WIF006,New,POS,Bronze,No,Both,No,Yes,Tertiary care specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127007101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270071.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270071-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330030,Arise Silver HMO 3000-100 HSA,84670WI133,,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133003001,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330030.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330030-01,Standard Silver On Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$0,$30,"$3,000",$0,$0,$0,9
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330031,Arise Silver HMO 3000-90 HSA,84670WI133,,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133003101,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330031.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330031-00,Standard Silver Off Exchange Plan,,0.686612367630005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$340,$30,"$3,000",$0,$220,$0,10
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250076,Aspirus Arise Silver HMO 3000-90 HSA,84670WI125,,WIN001,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250076.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250076-01,Standard Silver On Exchange Plan,,0.686612367630005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$340,$30,"$3,000",$0,$220,$0,81
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250076,Aspirus Arise Silver HMO 3000-90 HSA,84670WI125,,WIN001,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250076.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250076-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,82
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250033,Arise Silver HMO 1400 HSA,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250033.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250033-06,94% AV Level Silver Plan,93.30%,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,42
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250042,Arise Silver HMO 2000 HSA,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250042.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250042-00,Standard Silver Off Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,43
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250075,Aspirus Arise Silver HMO 3000-100 HSA,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250075.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250075-00,Standard Silver Off Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$0,$30,"$3,000",$0,$0,$0,73
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250075,Aspirus Arise Silver HMO 3000-100 HSA,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250075.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250075-01,Standard Silver On Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$0,$30,"$3,000",$0,$0,$0,74
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250075,Aspirus Arise Silver HMO 3000-100 HSA,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250075.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250075-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,75
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250075,Aspirus Arise Silver HMO 3000-100 HSA,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250075.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250075-03,Limited Cost Sharing Plan Variation,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$0,$30,"$3,000",$0,$0,$0,76
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250075,Aspirus Arise Silver HMO 3000-100 HSA,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250075.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250075-04,73% AV Level Silver Plan,,0.738942980766296,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,650","$5,300",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,550",$0,$0,$30,"$2,650",$0,$0,$0,77
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250075,Aspirus Arise Silver HMO 3000-100 HSA,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250075.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250075-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,78
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250082,Aspirus Arise Bronze HMO 3500 HSA,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250082.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250082-03,Limited Cost Sharing Plan Variation,61.50%,0.612004160881042,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$860,$30,"$3,500",$0,$480,$0,119
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250083,Arise  Metro Gold HMO 2000 HSA,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250083.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250083-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,120
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250083,Arise  Metro Gold HMO 2000 HSA,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250083.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250083-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,121
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250083,Arise  Metro Gold HMO 2000 HSA,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250083.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250083-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,122
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330082,Aspirus Arise Bronze HMO 3500 HSA,84670WI133,,WIN001,WIS002,WIF007,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133008201,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330082.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330082-01,Standard Bronze On Exchange Plan,61.50%,0.612004160881042,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$860,$30,"$3,500",$0,$480,$0,43
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330083,Arise  Metro Gold HMO 2000 HSA,84670WI133,,WIN001,WIS003,WIF004,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133008301,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330083.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330083-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,44
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250087,Arise Metro Silver HMO 2500 HSA,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250087.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250087-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,147
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250087,Arise Metro Silver HMO 2500 HSA,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250087.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250087-03,Limited Cost Sharing Plan Variation,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,148
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250029,Arise Silver HMO 3500 HSA,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250029.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250029-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250029,Arise Silver HMO 3500 HSA,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250029.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250029-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$0,$30,"$3,500",$0,$0,$0,11
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330031,Arise Silver HMO 3000-90 HSA,84670WI133,,WIN001,WIS001,WIF005,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133003101,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330031.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330031-01,Standard Silver On Exchange Plan,,0.686612367630005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$340,$30,"$3,000",$0,$220,$0,11
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330032,Arise Silver HMO 2500 HSA,84670WI133,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133003201,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330032.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330032-00,Standard Silver Off Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,12
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250029,Arise Silver HMO 3500 HSA,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250029.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250029-04,73% AV Level Silver Plan,,0.729270815849304,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,700",$0,$0,$30,"$2,800",$0,$0,$0,12
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250029,Arise Silver HMO 3500 HSA,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250029.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250029-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,13
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330032,Arise Silver HMO 2500 HSA,84670WI133,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133003201,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330032.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330032-01,Standard Silver On Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,13
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330017,Arise Silver HMO 1400 HSA,84670WI133,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133001701,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330017.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330017-00,Standard Silver Off Exchange Plan,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,14
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250029,Arise Silver HMO 3500 HSA,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125002901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250029.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250029-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,14
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250030,Arise Silver HMO 3000-100 HSA,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250030.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250030-00,Standard Silver Off Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$0,$30,"$3,000",$0,$0,$0,15
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330017,Arise Silver HMO 1400 HSA,84670WI133,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133001701,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330017.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330017-01,Standard Silver On Exchange Plan,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,15
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330042,Arise Silver HMO 2000 HSA,84670WI133,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133004201,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330042.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330042-00,Standard Silver Off Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,16
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250030,Arise Silver HMO 3000-100 HSA,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250030.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250030-01,Standard Silver On Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$0,$30,"$3,000",$0,$0,$0,16
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250030,Arise Silver HMO 3000-100 HSA,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250030.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250030-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,17
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330042,Arise Silver HMO 2000 HSA,84670WI133,,WIN001,WIS001,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133004201,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330042.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330042-01,Standard Silver On Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,17
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330034,Arise Bronze HMO 6000 HSA,84670WI133,,WIN001,WIS001,WIF001,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133003401,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330034.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330034-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900",$0,$0,$30,"$4,900",$0,$0,$0,18
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250030,Arise Silver HMO 3000-100 HSA,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250030.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250030-03,Limited Cost Sharing Plan Variation,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$0,$30,"$3,000",$0,$0,$0,18
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250030,Arise Silver HMO 3000-100 HSA,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250030.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250030-04,73% AV Level Silver Plan,,0.738942980766296,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,650","$5,300",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,550",$0,$0,$30,"$2,650",$0,$0,$0,19
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330034,Arise Bronze HMO 6000 HSA,84670WI133,,WIN001,WIS001,WIF001,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133003401,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330034.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330034-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900",$0,$0,$30,"$4,900",$0,$0,$0,19
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330018,Arise Bronze HMO 5500 HSA,84670WI133,,WIN001,WIS001,WIF006,Existing,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133001801,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330018.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330018-00,Standard Bronze Off Exchange Plan,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,20
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250030,Arise Silver HMO 3000-100 HSA,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250030.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250030-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,20
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250030,Arise Silver HMO 3000-100 HSA,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250030.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250030-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,21
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330018,Arise Bronze HMO 5500 HSA,84670WI133,,WIN001,WIS001,WIF006,Existing,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133001801,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330018.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330018-01,Standard Bronze On Exchange Plan,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,21
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330019,Arise Bronze HMO 3500 HSA,84670WI133,,WIN001,WIS001,WIF007,Existing,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133001901,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1330019.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330019-00,Standard Bronze Off Exchange Plan,61.50%,0.612004160881042,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$860,$30,"$3,500",$0,$480,$0,22
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250031,Arise Silver HMO 3000-90 HSA,84670WI125,,WIN001,WIS001,WIF005,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250031.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250031-00,Standard Silver Off Exchange Plan,,0.686612367630005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$340,$30,"$3,000",$0,$220,$0,22
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250031,Arise Silver HMO 3000-90 HSA,84670WI125,,WIN001,WIS001,WIF005,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250031.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250031-01,Standard Silver On Exchange Plan,,0.686612367630005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$340,$30,"$3,000",$0,$220,$0,23
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330075,Aspirus Arise Silver HMO 3000-100 HSA,84670WI133,,WIN001,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133007501,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330075.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330075-01,Standard Silver On Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$0,$30,"$3,000",$0,$0,$0,29
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330076,Aspirus Arise Silver HMO 3000-90 HSA,84670WI133,,WIN001,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133007601,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330076.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330076-00,Standard Silver Off Exchange Plan,,0.686612367630005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$340,$30,"$3,000",$0,$220,$0,30
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250032,Arise Silver HMO 2500 HSA,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250032.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250032-01,Standard Silver On Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,30
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250032,Arise Silver HMO 2500 HSA,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250032.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250032-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,31
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330078,Aspirus Arise Silver HMO 1400 HSA,84670WI133,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133007801,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330078.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330078-01,Standard Silver On Exchange Plan,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,35
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330079,Aspirus Arise Silver HMO 2000 HSA,84670WI133,,WIN001,WIS002,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133007901,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330079.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330079-00,Standard Silver Off Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,36
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250033,Arise Silver HMO 1400 HSA,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250033.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250033-00,Standard Silver Off Exchange Plan,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,36
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250033,Arise Silver HMO 1400 HSA,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250033.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250033-01,Standard Silver On Exchange Plan,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,37
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330079,Aspirus Arise Silver HMO 2000 HSA,84670WI133,,WIN001,WIS002,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133007901,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330079.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330079-01,Standard Silver On Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,37
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330080,Aspirus Arise Bronze HMO 6000 HSA,84670WI133,,WIN001,WIS002,WIF001,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133008001,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330080.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330080-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900",$0,$0,$30,"$4,900",$0,$0,$0,38
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250033,Arise Silver HMO 1400 HSA,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250033.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250033-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,38
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250033,Arise Silver HMO 1400 HSA,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250033.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250033-03,Limited Cost Sharing Plan Variation,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,39
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330080,Aspirus Arise Bronze HMO 6000 HSA,84670WI133,,WIN001,WIS002,WIF001,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133008001,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330080.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330080-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900",$0,$0,$30,"$4,900",$0,$0,$0,39
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330081,Aspirus Arise Bronze HMO 5500 HSA,84670WI133,,WIN001,WIS002,WIF006,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133008101,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330081.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330081-00,Standard Bronze Off Exchange Plan,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,40
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250033,Arise Silver HMO 1400 HSA,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250033.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250033-04,73% AV Level Silver Plan,73.90%,0.739061772823334,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300",$0,"$1,020",$30,"$1,400",$0,$790,$0,40
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250033,Arise Silver HMO 1400 HSA,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250033.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250033-05,87% AV Level Silver Plan,87.70%,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,41
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330081,Aspirus Arise Bronze HMO 5500 HSA,84670WI133,,WIN001,WIS002,WIF006,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133008101,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330081.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330081-01,Standard Bronze On Exchange Plan,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,41
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330082,Aspirus Arise Bronze HMO 3500 HSA,84670WI133,,WIN001,WIS002,WIF007,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133008201,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1330082.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330082-00,Standard Bronze Off Exchange Plan,61.50%,0.612004160881042,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$860,$30,"$3,500",$0,$480,$0,42
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350085,Arise Metro Silver POS 3000-100 HSA,84670WI135,,WIN001,WIS003,WIF004,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135008501,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350085.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350085-00,Standard Silver Off Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,900",$0,$0,$30,"$3,000",$0,$0,$0,48
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350085,Arise Metro Silver POS 3000-100 HSA,84670WI135,,WIN001,WIS003,WIF004,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135008501,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350085.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350085-01,Standard Silver On Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,900",$0,$0,$30,"$3,000",$0,$0,$0,49
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250085,Arise Metro Silver HMO 3000-100 HSA,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250085.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250085-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,137
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250086,Arise Metro Silver HMO 3000-90 HSA,84670WI125,,WIN001,WIS003,WIF005,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250086.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250086-00,Standard Silver Off Exchange Plan,,0.686612367630005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$340,$30,"$3,000",$0,$220,$0,138
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250086,Arise Metro Silver HMO 3000-90 HSA,84670WI125,,WIN001,WIS003,WIF005,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250086.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250086-01,Standard Silver On Exchange Plan,,0.686612367630005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$340,$30,"$3,000",$0,$220,$0,139
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250086,Arise Metro Silver HMO 3000-90 HSA,84670WI125,,WIN001,WIS003,WIF005,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250086.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250086-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,140
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250086,Arise Metro Silver HMO 3000-90 HSA,84670WI125,,WIN001,WIS003,WIF005,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250086.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250086-03,Limited Cost Sharing Plan Variation,,0.686612367630005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$340,$30,"$3,000",$0,$220,$0,141
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250086,Arise Metro Silver HMO 3000-90 HSA,84670WI125,,WIN001,WIS003,WIF005,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250086.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250086-04,73% AV Level Silver Plan,,0.729270815849304,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,700",$0,$0,$30,"$2,800",$0,$0,$0,142
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250086,Arise Metro Silver HMO 3000-90 HSA,84670WI125,,WIN001,WIS003,WIF005,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250086.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250086-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,143
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250086,Arise Metro Silver HMO 3000-90 HSA,84670WI125,,WIN001,WIS003,WIF005,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250086.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250086-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,144
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250042,Arise Silver HMO 2000 HSA,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250042.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250042-01,Standard Silver On Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,44
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250042,Arise Silver HMO 2000 HSA,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250042.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250042-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,45
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330083,Arise  Metro Gold HMO 2000 HSA,84670WI133,,WIN001,WIS003,WIF004,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133008301,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330083.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330083-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,45
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330084,Arise Metro Silver HMO 3500 HSA,84670WI133,,WIN001,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133008401,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330084.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330084-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$0,$30,"$3,500",$0,$0,$0,46
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250042,Arise Silver HMO 2000 HSA,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250042.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250042-03,Limited Cost Sharing Plan Variation,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,46
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250042,Arise Silver HMO 2000 HSA,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250042.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250042-04,73% AV Level Silver Plan,,0.736850261688232,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,47
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330084,Arise Metro Silver HMO 3500 HSA,84670WI133,,WIN001,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133008401,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330084.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330084-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$0,$30,"$3,500",$0,$0,$0,47
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330085,Arise Metro Silver HMO 3000-100 HSA,84670WI133,,WIN001,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133008501,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330085.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330085-00,Standard Silver Off Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$0,$30,"$3,000",$0,$0,$0,48
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250042,Arise Silver HMO 2000 HSA,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250042.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250042-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,48
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250042,Arise Silver HMO 2000 HSA,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125004201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250042.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250042-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,49
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330085,Arise Metro Silver HMO 3000-100 HSA,84670WI133,,WIN001,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133008501,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330085.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330085-01,Standard Silver On Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$0,$30,"$3,000",$0,$0,$0,49
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330086,Arise Metro Silver HMO 3000-90 HSA,84670WI133,,WIN001,WIS003,WIF005,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133008601,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330086.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330086-00,Standard Silver Off Exchange Plan,,0.686612367630005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$340,$30,"$3,000",$0,$220,$0,50
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250034,Arise Bronze HMO 6000 HSA,84670WI125,,WIN001,WIS001,WIF001,Existing,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250034.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250034-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900",$0,$0,$30,"$4,900",$0,$0,$0,50
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250034,Arise Bronze HMO 6000 HSA,84670WI125,,WIN001,WIS001,WIF001,Existing,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250034.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250034-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900",$0,$0,$30,"$4,900",$0,$0,$0,51
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330086,Arise Metro Silver HMO 3000-90 HSA,84670WI133,,WIN001,WIS003,WIF005,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133008601,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330086.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330086-01,Standard Silver On Exchange Plan,,0.686612367630005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$340,$30,"$3,000",$0,$220,$0,51
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330087,Arise Metro Silver HMO 2500 HSA,84670WI133,,WIN001,WIS003,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133008701,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330087.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330087-00,Standard Silver Off Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,52
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250034,Arise Bronze HMO 6000 HSA,84670WI125,,WIN001,WIS001,WIF001,Existing,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250034.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250034-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,52
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250034,Arise Bronze HMO 6000 HSA,84670WI125,,WIN001,WIS001,WIF001,Existing,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250034.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250034-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900",$0,$0,$30,"$4,900",$0,$0,$0,53
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330087,Arise Metro Silver HMO 2500 HSA,84670WI133,,WIN001,WIS003,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133008701,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330087.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330087-01,Standard Silver On Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,53
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330088,Arise Metro Silver HMO 1400 HSA,84670WI133,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133008801,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330088.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330088-00,Standard Silver Off Exchange Plan,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,54
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250036,Arise Bronze HMO 5500 HSA,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250036.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250036-00,Standard Bronze Off Exchange Plan,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,54
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250036,Arise Bronze HMO 5500 HSA,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250036.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250036-01,Standard Bronze On Exchange Plan,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,55
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330088,Arise Metro Silver HMO 1400 HSA,84670WI133,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133008801,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330088.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330088-01,Standard Silver On Exchange Plan,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,55
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330089,Arise Metro Silver HMO 2000 HSA,84670WI133,,WIN001,WIS003,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133008901,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330089.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330089-00,Standard Silver Off Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,56
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250036,Arise Bronze HMO 5500 HSA,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250036.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250036-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,56
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250036,Arise Bronze HMO 5500 HSA,84670WI125,,WIN001,WIS001,WIF006,Existing,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250036.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250036-03,Limited Cost Sharing Plan Variation,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,57
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330089,Arise Metro Silver HMO 2000 HSA,84670WI133,,WIN001,WIS003,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133008901,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330089.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330089-01,Standard Silver On Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,57
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330090,Arise Metro Bronze HMO 6000 HSA,84670WI133,,WIN001,WIS003,WIF001,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133009001,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330090.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330090-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900",$0,$0,$30,"$4,900",$0,$0,$0,58
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250037,Arise Bronze HMO 3500 HSA,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250037.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250037-00,Standard Bronze Off Exchange Plan,61.50%,0.612004160881042,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$860,$30,"$3,500",$0,$480,$0,58
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250037,Arise Bronze HMO 3500 HSA,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250037.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250037-01,Standard Bronze On Exchange Plan,61.50%,0.612004160881042,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$860,$30,"$3,500",$0,$480,$0,59
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330090,Arise Metro Bronze HMO 6000 HSA,84670WI133,,WIN001,WIS003,WIF001,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133009001,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330090.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330090-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900",$0,$0,$30,"$4,900",$0,$0,$0,59
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330091,Arise Metro Bronze HMO 5500 HSA,84670WI133,,WIN001,WIS003,WIF006,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133009101,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330091.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330091-00,Standard Bronze Off Exchange Plan,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,60
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250037,Arise Bronze HMO 3500 HSA,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250037.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250037-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,60
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250037,Arise Bronze HMO 3500 HSA,84670WI125,,WIN001,WIS001,WIF007,Existing,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125003701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250037.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250037-03,Limited Cost Sharing Plan Variation,61.50%,0.612004160881042,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$860,$30,"$3,500",$0,$480,$0,61
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330091,Arise Metro Bronze HMO 5500 HSA,84670WI133,,WIN001,WIS003,WIF006,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133009101,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330091.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330091-01,Standard Bronze On Exchange Plan,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,61
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330092,Arise Metro Bronze HMO 3500 HSA,84670WI133,,WIN001,WIS003,WIF007,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133009201,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330092.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330092-00,Standard Bronze Off Exchange Plan,61.50%,0.612004160881042,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$860,$30,"$3,500",$0,$480,$0,62
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250079,Aspirus Arise Silver HMO 2000 HSA,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250079.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250079-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,107
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250080,Aspirus Arise Bronze HMO 6000 HSA,84670WI125,,WIN001,WIS002,WIF001,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250080.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250080-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900",$0,$0,$30,"$4,900",$0,$0,$0,108
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250080,Aspirus Arise Bronze HMO 6000 HSA,84670WI125,,WIN001,WIS002,WIF001,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250080.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250080-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900",$0,$0,$30,"$4,900",$0,$0,$0,109
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250080,Aspirus Arise Bronze HMO 6000 HSA,84670WI125,,WIN001,WIS002,WIF001,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250080.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250080-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,110
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250080,Aspirus Arise Bronze HMO 6000 HSA,84670WI125,,WIN001,WIS002,WIF001,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250080.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250080-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900",$0,$0,$30,"$4,900",$0,$0,$0,111
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250081,Aspirus Arise Bronze HMO 5500 HSA,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250081.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250081-00,Standard Bronze Off Exchange Plan,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,112
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250081,Aspirus Arise Bronze HMO 5500 HSA,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250081.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250081-01,Standard Bronze On Exchange Plan,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,113
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250081,Aspirus Arise Bronze HMO 5500 HSA,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250081.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250081-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,114
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250081,Aspirus Arise Bronze HMO 5500 HSA,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250081.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250081-03,Limited Cost Sharing Plan Variation,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,115
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250082,Aspirus Arise Bronze HMO 3500 HSA,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250082.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250082-00,Standard Bronze Off Exchange Plan,61.50%,0.612004160881042,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$860,$30,"$3,500",$0,$480,$0,116
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350031,Arise Silver POS 3000-90 HSA,84670WI135,,WIN001,WIS001,WIF005,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135003101,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350031.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350031-00,Standard Silver Off Exchange Plan,,0.686612367630005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,900",$0,$340,$30,"$3,000",$0,$220,$0,10
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350031,Arise Silver POS 3000-90 HSA,84670WI135,,WIN001,WIS001,WIF005,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135003101,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350031.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350031-01,Standard Silver On Exchange Plan,,0.686612367630005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,900",$0,$340,$30,"$3,000",$0,$220,$0,11
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250073,Aspirus Arise Gold HMO 2000 HSA,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250073.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250073-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,62
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250073,Aspirus Arise Gold HMO 2000 HSA,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250073.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250073-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,63
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1330092,Arise Metro Bronze HMO 3500 HSA,84670WI133,,WIN001,WIS003,WIF007,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/133009201,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1330092.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1330092-01,Standard Bronze On Exchange Plan,61.50%,0.612004160881042,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$860,$30,"$3,500",$0,$480,$0,63
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250073,Aspirus Arise Gold HMO 2000 HSA,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250073.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250073-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,64
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250073,Aspirus Arise Gold HMO 2000 HSA,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250073.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250073-03,Limited Cost Sharing Plan Variation,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,65
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250074,Aspirus Arise Silver HMO 3500 HSA,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250074.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250074-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$0,$30,"$3,500",$0,$0,$0,66
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250074,Aspirus Arise Silver HMO 3500 HSA,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250074.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250074-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$0,$30,"$3,500",$0,$0,$0,67
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250074,Aspirus Arise Silver HMO 3500 HSA,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250074.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250074-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,68
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250074,Aspirus Arise Silver HMO 3500 HSA,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250074.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250074-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$0,$30,"$3,500",$0,$0,$0,69
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250074,Aspirus Arise Silver HMO 3500 HSA,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250074.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250074-04,73% AV Level Silver Plan,,0.729270815849304,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,700",$0,$0,$30,"$2,800",$0,$0,$0,70
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250074,Aspirus Arise Silver HMO 3500 HSA,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250074.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250074-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,71
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250074,Aspirus Arise Silver HMO 3500 HSA,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250074.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250074-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,72
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250084,Arise Metro Silver HMO 3500 HSA,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250084.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250084-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,129
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250084,Arise Metro Silver HMO 3500 HSA,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250084.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250084-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,130
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250085,Arise Metro Silver HMO 3000-100 HSA,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250085.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250085-00,Standard Silver Off Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$0,$30,"$3,000",$0,$0,$0,131
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250085,Arise Metro Silver HMO 3000-100 HSA,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250085.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250085-01,Standard Silver On Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$0,$30,"$3,000",$0,$0,$0,132
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250085,Arise Metro Silver HMO 3000-100 HSA,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250085.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250085-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,133
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250085,Arise Metro Silver HMO 3000-100 HSA,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250085.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250085-03,Limited Cost Sharing Plan Variation,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$0,$30,"$3,000",$0,$0,$0,134
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250085,Arise Metro Silver HMO 3000-100 HSA,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250085.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250085-04,73% AV Level Silver Plan,,0.738942980766296,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,650","$5,300",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,550",$0,$0,$30,"$2,650",$0,$0,$0,135
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250085,Arise Metro Silver HMO 3000-100 HSA,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250085.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250085-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,136
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250087,Arise Metro Silver HMO 2500 HSA,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250087.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250087-04,73% AV Level Silver Plan,,0.736850261688232,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,149
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250087,Arise Metro Silver HMO 2500 HSA,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250087.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250087-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,150
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270033,Arise Silver POS 1400 HSA,84670WI127,,WIN001,WIS001,WIF007,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127003301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270033.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270033-04,73% AV Level Silver Plan,73.90%,0.739061772823334,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$2,300",$0,"$1,020",$30,"$1,400",$0,$790,$0,19
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270033,Arise Silver POS 1400 HSA,84670WI127,,WIN001,WIS001,WIF007,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127003301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270033.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270033-05,87% AV Level Silver Plan,87.70%,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,20
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250075,Aspirus Arise Silver HMO 3000-100 HSA,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007501,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250075.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250075-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,79
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250076,Aspirus Arise Silver HMO 3000-90 HSA,84670WI125,,WIN001,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250076.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250076-00,Standard Silver Off Exchange Plan,,0.686612367630005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$340,$30,"$3,000",$0,$220,$0,80
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250076,Aspirus Arise Silver HMO 3000-90 HSA,84670WI125,,WIN001,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250076.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250076-03,Limited Cost Sharing Plan Variation,,0.686612367630005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$340,$30,"$3,000",$0,$220,$0,83
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250076,Aspirus Arise Silver HMO 3000-90 HSA,84670WI125,,WIN001,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250076.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250076-04,73% AV Level Silver Plan,,0.729270815849304,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,700",$0,$0,$30,"$2,800",$0,$0,$0,84
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250087,Arise Metro Silver HMO 2500 HSA,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250087.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250087-00,Standard Silver Off Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,145
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250087,Arise Metro Silver HMO 2500 HSA,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250087.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250087-01,Standard Silver On Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,146
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270083,Arise Metro Gold POS 2000 HSA,84670WI127,,WIN001,WIS003,WIF004,New,POS,Gold,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127008301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270083.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270083-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,49
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270083,Arise Metro Gold POS 2000 HSA,84670WI127,,WIN001,WIS003,WIF004,New,POS,Gold,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127008301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270083.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270083-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,50
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350086,Arise Metro Silver POS 3000-90 HSA,84670WI135,,WIN001,WIS003,WIF005,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135008601,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350086.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350086-00,Standard Silver Off Exchange Plan,,0.686612367630005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,900",$0,$340,$30,"$3,000",$0,$220,$0,50
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350086,Arise Metro Silver POS 3000-90 HSA,84670WI135,,WIN001,WIS003,WIF005,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135008601,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350086.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350086-01,Standard Silver On Exchange Plan,,0.686612367630005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,900",$0,$340,$30,"$3,000",$0,$220,$0,51
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270083,Arise Metro Gold POS 2000 HSA,84670WI127,,WIN001,WIS003,WIF004,New,POS,Gold,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127008301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270083.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270083-03,Limited Cost Sharing Plan Variation,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,51
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270087,Arise Metro Silver POS 2500 HSA,84670WI127,,WIN001,WIS003,WIF006,New,POS,Silver,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127008701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270087.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270087-00,Standard Silver Off Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,52
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350087,Arise Metro Silver POS 2500 HSA,84670WI135,,WIN001,WIS003,WIF006,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135008701,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350087.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350087-00,Standard Silver Off Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,52
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350087,Arise Metro Silver POS 2500 HSA,84670WI135,,WIN001,WIS003,WIF006,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135008701,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350087.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350087-01,Standard Silver On Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,53
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250076,Aspirus Arise Silver HMO 3000-90 HSA,84670WI125,,WIN001,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250076.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250076-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,85
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250076,Aspirus Arise Silver HMO 3000-90 HSA,84670WI125,,WIN001,WIS002,WIF005,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250076.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250076-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,86
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250077,Aspirus Arise Silver HMO 2500 HSA,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250077.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250077-00,Standard Silver Off Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,87
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250077,Aspirus Arise Silver HMO 2500 HSA,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250077.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250077-01,Standard Silver On Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,88
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250077,Aspirus Arise Silver HMO 2500 HSA,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250077.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250077-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,89
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250077,Aspirus Arise Silver HMO 2500 HSA,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250077.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250077-03,Limited Cost Sharing Plan Variation,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,90
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250077,Aspirus Arise Silver HMO 2500 HSA,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250077.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250077-04,73% AV Level Silver Plan,,0.736850261688232,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,91
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250077,Aspirus Arise Silver HMO 2500 HSA,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250077.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250077-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,92
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250077,Aspirus Arise Silver HMO 2500 HSA,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250077.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250077-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,93
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250078,Aspirus Arise Silver HMO 1400 HSA,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250078.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250078-00,Standard Silver Off Exchange Plan,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,94
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250078,Aspirus Arise Silver HMO 1400 HSA,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250078.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250078-01,Standard Silver On Exchange Plan,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,95
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250078,Aspirus Arise Silver HMO 1400 HSA,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250078.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250078-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,96
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250078,Aspirus Arise Silver HMO 1400 HSA,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250078.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250078-03,Limited Cost Sharing Plan Variation,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,97
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250078,Aspirus Arise Silver HMO 1400 HSA,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250078.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250078-04,73% AV Level Silver Plan,73.90%,0.739061772823334,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300",$0,"$1,020",$30,"$1,400",$0,$790,$0,98
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250078,Aspirus Arise Silver HMO 1400 HSA,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250078.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250078-05,87% AV Level Silver Plan,87.70%,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,99
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250078,Aspirus Arise Silver HMO 1400 HSA,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250078.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250078-06,94% AV Level Silver Plan,93.30%,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,100
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250079,Aspirus Arise Silver HMO 2000 HSA,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250079.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250079-00,Standard Silver Off Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,101
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250079,Aspirus Arise Silver HMO 2000 HSA,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250079.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250079-01,Standard Silver On Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,102
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250079,Aspirus Arise Silver HMO 2000 HSA,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250079.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250079-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,103
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250079,Aspirus Arise Silver HMO 2000 HSA,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250079.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250079-03,Limited Cost Sharing Plan Variation,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,104
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250079,Aspirus Arise Silver HMO 2000 HSA,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250079.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250079-04,73% AV Level Silver Plan,,0.736850261688232,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,105
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250079,Aspirus Arise Silver HMO 2000 HSA,84670WI125,,WIN001,WIS002,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125007901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250079.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250079-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,106
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250082,Aspirus Arise Bronze HMO 3500 HSA,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250082.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250082-01,Standard Bronze On Exchange Plan,61.50%,0.612004160881042,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$860,$30,"$3,500",$0,$480,$0,117
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250082,Aspirus Arise Bronze HMO 3500 HSA,84670WI125,,WIN001,WIS002,WIF007,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250082.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250082-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,118
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250083,Arise  Metro Gold HMO 2000 HSA,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250083.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250083-03,Limited Cost Sharing Plan Variation,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,123
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250084,Arise Metro Silver HMO 3500 HSA,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250084.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250084-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$0,$30,"$3,500",$0,$0,$0,124
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250084,Arise Metro Silver HMO 3500 HSA,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250084.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250084-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$0,$30,"$3,500",$0,$0,$0,125
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250084,Arise Metro Silver HMO 3500 HSA,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250084.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250084-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,126
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250084,Arise Metro Silver HMO 3500 HSA,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250084.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250084-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$0,$30,"$3,500",$0,$0,$0,127
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250084,Arise Metro Silver HMO 3500 HSA,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250084.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250084-04,73% AV Level Silver Plan,,0.729270815849304,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,700",$0,$0,$30,"$2,800",$0,$0,$0,128
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350018,Arise Bronze POS 5500 HSA,84670WI135,,WIN001,WIS001,WIF006,Existing,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135001801,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350018.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350018-00,Standard Bronze Off Exchange Plan,,0.583189904689789,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,20
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350018,Arise Bronze POS 5500 HSA,84670WI135,,WIN001,WIS001,WIF006,Existing,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135001801,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350018.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350018-01,Standard Bronze On Exchange Plan,,0.583189904689789,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,21
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270033,Arise Silver POS 1400 HSA,84670WI127,,WIN001,WIS001,WIF007,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127003301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270033.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270033-06,94% AV Level Silver Plan,93.30%,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,21
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270036,Arise Bronze POS 5500 HSA,84670WI127,,WIN001,WIS001,WIF006,Existing,POS,Bronze,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127003601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270036.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270036-00,Standard Bronze Off Exchange Plan,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,22
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350019,Arise Bronze POS 3500 HSA,84670WI135,,WIN001,WIS001,WIF007,Existing,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135001901,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350019.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350019-00,Standard Bronze Off Exchange Plan,,0.614702045917511,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,"$4,400",$0,$860,$30,"$3,500",$0,$480,$0,22
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350019,Arise Bronze POS 3500 HSA,84670WI135,,WIN001,WIS001,WIF007,Existing,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135001901,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350019.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350019-01,Standard Bronze On Exchange Plan,,0.614702045917511,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,"$4,400",$0,$860,$30,"$3,500",$0,$480,$0,23
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270036,Arise Bronze POS 5500 HSA,84670WI127,,WIN001,WIS001,WIF006,Existing,POS,Bronze,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127003601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270036.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270036-01,Standard Bronze On Exchange Plan,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,23
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270036,Arise Bronze POS 5500 HSA,84670WI127,,WIN001,WIS001,WIF006,Existing,POS,Bronze,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127003601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270036.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270036-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,24
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350073,Aspirus Arise Gold POS 2000 HSA,84670WI135,,WIN001,WIS002,WIF004,New,POS,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135007301,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350073.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350073-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,24
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350073,Aspirus Arise Gold POS 2000 HSA,84670WI135,,WIN001,WIS002,WIF004,New,POS,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135007301,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350073.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350073-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,25
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250087,Arise Metro Silver HMO 2500 HSA,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250087.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250087-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,151
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250088,Arise Metro Silver HMO 1400 HSA,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250088.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250088-00,Standard Silver Off Exchange Plan,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,152
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250088,Arise Metro Silver HMO 1400 HSA,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250088.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250088-01,Standard Silver On Exchange Plan,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,153
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250088,Arise Metro Silver HMO 1400 HSA,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250088.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250088-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,154
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250088,Arise Metro Silver HMO 1400 HSA,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250088.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250088-03,Limited Cost Sharing Plan Variation,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,155
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250088,Arise Metro Silver HMO 1400 HSA,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250088.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250088-04,73% AV Level Silver Plan,73.90%,0.739061772823334,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,300",$0,"$1,020",$30,"$1,400",$0,$790,$0,156
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250088,Arise Metro Silver HMO 1400 HSA,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250088.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250088-05,87% AV Level Silver Plan,87.70%,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,157
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250088,Arise Metro Silver HMO 1400 HSA,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Silver,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250088.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250088-06,94% AV Level Silver Plan,93.30%,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,158
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250089,Arise Metro Silver HMO 2000 HSA,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250089.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250089-00,Standard Silver Off Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,159
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250089,Arise Metro Silver HMO 2000 HSA,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250089.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250089-01,Standard Silver On Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,160
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250089,Arise Metro Silver HMO 2000 HSA,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250089.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250089-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,161
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250089,Arise Metro Silver HMO 2000 HSA,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250089.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250089-03,Limited Cost Sharing Plan Variation,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,162
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250089,Arise Metro Silver HMO 2000 HSA,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250089.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250089-04,73% AV Level Silver Plan,,0.736850261688232,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,163
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250089,Arise Metro Silver HMO 2000 HSA,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250089.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250089-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,164
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250089,Arise Metro Silver HMO 2000 HSA,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125008901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250089.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250089-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,165
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250090,Arise Metro Bronze HMO 6000 HSA,84670WI125,,WIN001,WIS003,WIF001,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125009001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250090.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250090-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900",$0,$0,$30,"$4,900",$0,$0,$0,166
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250090,Arise Metro Bronze HMO 6000 HSA,84670WI125,,WIN001,WIS003,WIF001,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125009001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250090.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250090-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900",$0,$0,$30,"$4,900",$0,$0,$0,167
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250090,Arise Metro Bronze HMO 6000 HSA,84670WI125,,WIN001,WIS003,WIF001,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125009001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250090.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250090-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,168
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250090,Arise Metro Bronze HMO 6000 HSA,84670WI125,,WIN001,WIS003,WIF001,New,HMO,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125009001,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250090.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250090-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900",$0,$0,$30,"$4,900",$0,$0,$0,169
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250091,Arise Metro Bronze HMO 5500 HSA,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125009101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250091.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250091-00,Standard Bronze Off Exchange Plan,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,170
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250091,Arise Metro Bronze HMO 5500 HSA,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125009101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250091.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250091-01,Standard Bronze On Exchange Plan,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,171
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250091,Arise Metro Bronze HMO 5500 HSA,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125009101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250091.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250091-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,172
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250091,Arise Metro Bronze HMO 5500 HSA,84670WI125,,WIN001,WIS003,WIF006,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125009101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250091.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250091-03,Limited Cost Sharing Plan Variation,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,173
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250092,Arise Metro Bronze HMO 3500 HSA,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125009201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250092.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250092-00,Standard Bronze Off Exchange Plan,61.50%,0.612004160881042,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$860,$30,"$3,500",$0,$480,$0,174
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250092,Arise Metro Bronze HMO 3500 HSA,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125009201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250092.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250092-01,Standard Bronze On Exchange Plan,61.50%,0.612004160881042,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$860,$30,"$3,500",$0,$480,$0,175
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250092,Arise Metro Bronze HMO 3500 HSA,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125009201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250092.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250092-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,176
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,7,84670,WI,Individual,No,20-2660193,84670WI1250092,Arise Metro Bronze HMO 3500 HSA,84670WI125,,WIN001,WIS003,WIF007,New,HMO,Bronze,Yes,Both,No,Yes,Non-participating specialists and tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125009201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250092.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250092-03,Limited Cost Sharing Plan Variation,61.50%,0.612004160881042,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,400",$0,$860,$30,"$3,500",$0,$480,$0,177
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270028,Arise Gold POS 2000 HSA,84670WI127,,WIN001,WIS001,WIF004,Existing,POS,Gold,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127002801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270028.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270028-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,4
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350016,Arise Gold POS 2000 HSA,84670WI135,,WIN001,WIS001,WIF004,Existing,POS,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135001601,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350016.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350016-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,4
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350016,Arise Gold POS 2000 HSA,84670WI135,,WIN001,WIS001,WIF004,Existing,POS,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135001601,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350016.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350016-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,5
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270028,Arise Gold POS 2000 HSA,84670WI127,,WIN001,WIS001,WIF004,Existing,POS,Gold,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127002801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270028.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270028-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,5
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270028,Arise Gold POS 2000 HSA,84670WI127,,WIN001,WIS001,WIF004,Existing,POS,Gold,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127002801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270028.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270028-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350029,Arise Silver POS 3500 HSA,84670WI135,,WIN001,WIS001,WIF004,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135002901,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350029.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350029-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,"$4,400",$0,$0,$30,"$3,500",$0,$0,$0,6
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350029,Arise Silver POS 3500 HSA,84670WI135,,WIN001,WIS001,WIF004,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135002901,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350029.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350029-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,"$4,400",$0,$0,$30,"$3,500",$0,$0,$0,7
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270028,Arise Gold POS 2000 HSA,84670WI127,,WIN001,WIS001,WIF004,Existing,POS,Gold,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127002801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270028.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270028-03,Limited Cost Sharing Plan Variation,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,7
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270032,Arise Silver POS 2500 HSA,84670WI127,,WIN001,WIS001,WIF006,Existing,POS,Silver,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127003201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270032.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270032-00,Standard Silver Off Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,8
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350030,Arise Silver POS 3000-100 HSA,84670WI135,,WIN001,WIS001,WIF004,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135003001,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350030.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350030-00,Standard Silver Off Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,900",$0,$0,$30,"$3,000",$0,$0,$0,8
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350030,Arise Silver POS 3000-100 HSA,84670WI135,,WIN001,WIS001,WIF004,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135003001,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350030.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350030-01,Standard Silver On Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,900",$0,$0,$30,"$3,000",$0,$0,$0,9
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270032,Arise Silver POS 2500 HSA,84670WI127,,WIN001,WIS001,WIF006,Existing,POS,Silver,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127003201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270032.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270032-01,Standard Silver On Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,9
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270032,Arise Silver POS 2500 HSA,84670WI127,,WIN001,WIS001,WIF006,Existing,POS,Silver,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127003201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270032.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270032-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270032,Arise Silver POS 2500 HSA,84670WI127,,WIN001,WIS001,WIF006,Existing,POS,Silver,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127003201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270032.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270032-03,Limited Cost Sharing Plan Variation,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,11
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270032,Arise Silver POS 2500 HSA,84670WI127,,WIN001,WIS001,WIF006,Existing,POS,Silver,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127003201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270032.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270032-04,73% AV Level Silver Plan,,0.736850261688232,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,12
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350032,Arise Silver POS 2500 HSA,84670WI135,,WIN001,WIS001,WIF006,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135003201,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350032.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350032-00,Standard Silver Off Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,12
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350032,Arise Silver POS 2500 HSA,84670WI135,,WIN001,WIS001,WIF006,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135003201,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350032.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350032-01,Standard Silver On Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,13
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270032,Arise Silver POS 2500 HSA,84670WI127,,WIN001,WIS001,WIF006,Existing,POS,Silver,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127003201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270032.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270032-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,13
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270032,Arise Silver POS 2500 HSA,84670WI127,,WIN001,WIS001,WIF006,Existing,POS,Silver,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127003201,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270032.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270032-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,14
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350017,Arise Silver POS 1400 HSA,84670WI135,,WIN001,WIS001,WIF007,Existing,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135001701,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350017.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350017-00,Standard Silver Off Exchange Plan,,0.686691343784332,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,14
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350017,Arise Silver POS 1400 HSA,84670WI135,,WIN001,WIS001,WIF007,Existing,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135001701,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1350017.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350017-01,Standard Silver On Exchange Plan,,0.686691343784332,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,15
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270033,Arise Silver POS 1400 HSA,84670WI127,,WIN001,WIS001,WIF007,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127003301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270033.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270033-00,Standard Silver Off Exchange Plan,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,15
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270033,Arise Silver POS 1400 HSA,84670WI127,,WIN001,WIS001,WIF007,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127003301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270033.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270033-01,Standard Silver On Exchange Plan,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,16
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350042,Arise Silver POS 2000 HSA,84670WI135,,WIN001,WIS001,WIF006,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135004201,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350042.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350042-00,Standard Silver Off Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,16
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350042,Arise Silver POS 2000 HSA,84670WI135,,WIN001,WIS001,WIF006,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135004201,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350042.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350042-01,Standard Silver On Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,17
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270078,Aspirus Arise Silver POS 1400 HSA,84670WI127,,WIN001,WIS002,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127007801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270078.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270078-06,94% AV Level Silver Plan,93.30%,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,43
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270081,Aspirus Arise Bronze POS 5500 HSA,84670WI127,,WIN001,WIS002,WIF006,New,POS,Bronze,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127008101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270081.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270081-00,Standard Bronze Off Exchange Plan,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,44
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350083,Arise  Metro Gold POS 2000 HSA,84670WI135,,WIN001,WIS003,WIF004,New,POS,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135008301,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350083.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350083-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,44
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350083,Arise  Metro Gold POS 2000 HSA,84670WI135,,WIN001,WIS003,WIF004,New,POS,Gold,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135008301,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350083.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350083-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,45
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270033,Arise Silver POS 1400 HSA,84670WI127,,WIN001,WIS001,WIF007,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127003301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270033.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270033-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,17
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270033,Arise Silver POS 1400 HSA,84670WI127,,WIN001,WIS001,WIF007,Existing,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127003301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270033.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270033-03,Limited Cost Sharing Plan Variation,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,18
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350034,Arise Bronze POS 6000 HSA,84670WI135,,WIN001,WIS001,WIF001,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135003401,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350034.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350034-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$16,000","$32,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,900",$0,$0,$30,"$4,900",$0,$0,$0,18
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350034,Arise Bronze POS 6000 HSA,84670WI135,,WIN001,WIS001,WIF001,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135003401,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350034.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350034-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$16,000","$32,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,900",$0,$0,$30,"$4,900",$0,$0,$0,19
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270036,Arise Bronze POS 5500 HSA,84670WI127,,WIN001,WIS001,WIF006,Existing,POS,Bronze,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127003601,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270036.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270036-03,Limited Cost Sharing Plan Variation,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,25
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270073,Aspirus Arise Gold POS 2000 HSA,84670WI127,,WIN001,WIS002,WIF004,New,POS,Gold,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127007301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270073.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270073-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,26
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350074,Aspirus Arise Silver POS 3500 HSA,84670WI135,,WIN001,WIS002,WIF004,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135007401,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350074.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350074-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,"$4,400",$0,$0,$30,"$3,500",$0,$0,$0,26
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350074,Aspirus Arise Silver POS 3500 HSA,84670WI135,,WIN001,WIS002,WIF004,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135007401,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350074.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350074-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,"$4,400",$0,$0,$30,"$3,500",$0,$0,$0,27
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270073,Aspirus Arise Gold POS 2000 HSA,84670WI127,,WIN001,WIS002,WIF004,New,POS,Gold,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127007301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270073.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270073-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,27
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270073,Aspirus Arise Gold POS 2000 HSA,84670WI127,,WIN001,WIS002,WIF004,New,POS,Gold,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127007301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270073.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270073-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,28
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350075,Aspirus Arise Silver POS 3000-100 HSA,84670WI135,,WIN001,WIS002,WIF004,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135007501,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350075.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350075-00,Standard Silver Off Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,900",$0,$0,$30,"$3,000",$0,$0,$0,28
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350075,Aspirus Arise Silver POS 3000-100 HSA,84670WI135,,WIN001,WIS002,WIF004,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135007501,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350075.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350075-01,Standard Silver On Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,900",$0,$0,$30,"$3,000",$0,$0,$0,29
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270073,Aspirus Arise Gold POS 2000 HSA,84670WI127,,WIN001,WIS002,WIF004,New,POS,Gold,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127007301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270073.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270073-03,Limited Cost Sharing Plan Variation,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,29
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270077,Aspirus Arise Silver POS 2500 HSA,84670WI127,,WIN001,WIS002,WIF006,New,POS,Silver,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127007701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270077.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270077-00,Standard Silver Off Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,30
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350076,Aspirus Arise Silver POS 3000-90 HSA,84670WI135,,WIN001,WIS002,WIF005,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135007601,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350076.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350076-00,Standard Silver Off Exchange Plan,,0.686612367630005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,900",$0,$340,$30,"$3,000",$0,$220,$0,30
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350076,Aspirus Arise Silver POS 3000-90 HSA,84670WI135,,WIN001,WIS002,WIF005,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135007601,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350076.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350076-01,Standard Silver On Exchange Plan,,0.686612367630005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,900",$0,$340,$30,"$3,000",$0,$220,$0,31
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270077,Aspirus Arise Silver POS 2500 HSA,84670WI127,,WIN001,WIS002,WIF006,New,POS,Silver,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127007701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270077.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270077-01,Standard Silver On Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,31
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270077,Aspirus Arise Silver POS 2500 HSA,84670WI127,,WIN001,WIS002,WIF006,New,POS,Silver,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127007701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270077.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270077-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,32
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270088,Arise Metro Silver POS 1400 HSA,84670WI127,,WIN001,WIS003,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127008801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270088.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270088-00,Standard Silver Off Exchange Plan,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,59
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270088,Arise Metro Silver POS 1400 HSA,84670WI127,,WIN001,WIS003,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127008801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270088.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270088-01,Standard Silver On Exchange Plan,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,60
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350091,Arise Metro Bronze POS 5500 HSA,84670WI135,,WIN001,WIS003,WIF006,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135009101,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350091.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350091-00,Standard Bronze Off Exchange Plan,,0.583189904689789,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,60
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350091,Arise Metro Bronze POS 5500 HSA,84670WI135,,WIN001,WIS003,WIF006,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135009101,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350091.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350091-01,Standard Bronze On Exchange Plan,,0.583189904689789,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,61
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270088,Arise Metro Silver POS 1400 HSA,84670WI127,,WIN001,WIS003,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127008801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270088.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270088-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,61
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270088,Arise Metro Silver POS 1400 HSA,84670WI127,,WIN001,WIS003,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127008801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270088.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270088-03,Limited Cost Sharing Plan Variation,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,62
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350092,Arise Metro Bronze POS 3500 HSA,84670WI135,,WIN001,WIS003,WIF007,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135009201,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350092.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350092-00,Standard Bronze Off Exchange Plan,,0.614702045917511,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,"$4,400",$0,$860,$30,"$3,500",$0,$480,$0,62
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350092,Arise Metro Bronze POS 3500 HSA,84670WI135,,WIN001,WIS003,WIF007,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135009201,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350092.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350092-01,Standard Bronze On Exchange Plan,,0.614702045917511,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,"$4,400",$0,$860,$30,"$3,500",$0,$480,$0,63
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270088,Arise Metro Silver POS 1400 HSA,84670WI127,,WIN001,WIS003,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127008801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270088.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270088-04,73% AV Level Silver Plan,73.90%,0.739061772823334,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$2,300",$0,"$1,020",$30,"$1,400",$0,$790,$0,63
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270088,Arise Metro Silver POS 1400 HSA,84670WI127,,WIN001,WIS003,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127008801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270088.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270088-05,87% AV Level Silver Plan,87.70%,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,64
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270088,Arise Metro Silver POS 1400 HSA,84670WI127,,WIN001,WIS003,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127008801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270088.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270088-06,94% AV Level Silver Plan,93.30%,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,65
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270091,Arise Metro Bronze POS 5500 HSA,84670WI127,,WIN001,WIS003,WIF006,New,POS,Bronze,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127009101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270091.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270091-00,Standard Bronze Off Exchange Plan,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,66
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270091,Arise Metro Bronze POS 5500 HSA,84670WI127,,WIN001,WIS003,WIF006,New,POS,Bronze,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127009101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270091.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270091-01,Standard Bronze On Exchange Plan,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,67
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270091,Arise Metro Bronze POS 5500 HSA,84670WI127,,WIN001,WIS003,WIF006,New,POS,Bronze,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127009101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270091.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270091-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,68
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270091,Arise Metro Bronze POS 5500 HSA,84670WI127,,WIN001,WIS003,WIF006,New,POS,Bronze,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127009101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270091.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270091-03,Limited Cost Sharing Plan Variation,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,69
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,9,84670,WI,Individual,No,20-2660193,84670WI1250039,Arise Catastrophic HMO 6600,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Catastrophic,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,Child only does not apply,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250039.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250039-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,4
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,9,84670,WI,Individual,No,20-2660193,84670WI1250039,Arise Catastrophic HMO 6600,84670WI125,,WIN001,WIS001,WIF004,Existing,HMO,Catastrophic,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,Child only does not apply,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125006901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1250039.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250039-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,5
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,9,84670,WI,Individual,No,20-2660193,84670WI1250093,Aspirus Arise Catastrophic HMO 6600,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Catastrophic,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,Child only does not apply,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125009301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250093.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250093-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,6
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350077,Aspirus Arise Silver POS 2500 HSA,84670WI135,,WIN001,WIS002,WIF006,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135007701,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350077.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350077-00,Standard Silver Off Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,32
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350077,Aspirus Arise Silver POS 2500 HSA,84670WI135,,WIN001,WIS002,WIF006,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135007701,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350077.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350077-01,Standard Silver On Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,33
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270077,Aspirus Arise Silver POS 2500 HSA,84670WI127,,WIN001,WIS002,WIF006,New,POS,Silver,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127007701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270077.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270077-03,Limited Cost Sharing Plan Variation,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,33
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270077,Aspirus Arise Silver POS 2500 HSA,84670WI127,,WIN001,WIS002,WIF006,New,POS,Silver,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127007701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270077.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270077-04,73% AV Level Silver Plan,,0.736850261688232,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,34
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350078,Aspirus Arise Silver POS 1400 HSA,84670WI135,,WIN001,WIS002,WIF007,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135007801,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350078.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350078-00,Standard Silver Off Exchange Plan,,0.686691343784332,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,34
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350078,Aspirus Arise Silver POS 1400 HSA,84670WI135,,WIN001,WIS002,WIF007,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135007801,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350078.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350078-01,Standard Silver On Exchange Plan,,0.686691343784332,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,35
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270077,Aspirus Arise Silver POS 2500 HSA,84670WI127,,WIN001,WIS002,WIF006,New,POS,Silver,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127007701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270077.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270077-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,35
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270077,Aspirus Arise Silver POS 2500 HSA,84670WI127,,WIN001,WIS002,WIF006,New,POS,Silver,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127007701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270077.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270077-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,36
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350079,Aspirus Arise Silver POS 2000 HSA,84670WI135,,WIN001,WIS002,WIF006,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135007901,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350079.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350079-00,Standard Silver Off Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,36
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350079,Aspirus Arise Silver POS 2000 HSA,84670WI135,,WIN001,WIS002,WIF006,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135007901,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350079.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350079-01,Standard Silver On Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,37
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270078,Aspirus Arise Silver POS 1400 HSA,84670WI127,,WIN001,WIS002,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127007801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270078.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270078-00,Standard Silver Off Exchange Plan,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,37
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270078,Aspirus Arise Silver POS 1400 HSA,84670WI127,,WIN001,WIS002,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127007801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270078.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270078-01,Standard Silver On Exchange Plan,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,38
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350080,Aspirus Arise Bronze POS 6000 HSA,84670WI135,,WIN001,WIS002,WIF001,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135008001,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350080.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350080-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$16,000","$32,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,900",$0,$0,$30,"$4,900",$0,$0,$0,38
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350080,Aspirus Arise Bronze POS 6000 HSA,84670WI135,,WIN001,WIS002,WIF001,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135008001,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350080.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350080-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$16,000","$32,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,900",$0,$0,$30,"$4,900",$0,$0,$0,39
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270078,Aspirus Arise Silver POS 1400 HSA,84670WI127,,WIN001,WIS002,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127007801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270078.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270078-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,39
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270078,Aspirus Arise Silver POS 1400 HSA,84670WI127,,WIN001,WIS002,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127007801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270078.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270078-03,Limited Cost Sharing Plan Variation,68.70%,0.684979200363159,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,40
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350081,Aspirus Arise Bronze POS 5500 HSA,84670WI135,,WIN001,WIS002,WIF006,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135008101,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350081.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350081-00,Standard Bronze Off Exchange Plan,,0.583189904689789,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,40
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350081,Aspirus Arise Bronze POS 5500 HSA,84670WI135,,WIN001,WIS002,WIF006,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135008101,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350081.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350081-01,Standard Bronze On Exchange Plan,,0.583189904689789,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,41
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270078,Aspirus Arise Silver POS 1400 HSA,84670WI127,,WIN001,WIS002,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127007801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270078.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270078-04,73% AV Level Silver Plan,73.90%,0.739061772823334,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$2,300",$0,"$1,020",$30,"$1,400",$0,$790,$0,41
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270078,Aspirus Arise Silver POS 1400 HSA,84670WI127,,WIN001,WIS002,WIF007,New,POS,Silver,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127007801,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270078.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270078-05,87% AV Level Silver Plan,87.70%,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,42
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350082,Aspirus Arise Bronze POS 3500 HSA,84670WI135,,WIN001,WIS002,WIF007,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135008201,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350082.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350082-00,Standard Bronze Off Exchange Plan,,0.614702045917511,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,"$4,400",$0,$860,$30,"$3,500",$0,$480,$0,42
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350082,Aspirus Arise Bronze POS 3500 HSA,84670WI135,,WIN001,WIS002,WIF007,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135008201,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1350082.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350082-01,Standard Bronze On Exchange Plan,,0.614702045917511,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,"$4,400",$0,$860,$30,"$3,500",$0,$480,$0,43
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270081,Aspirus Arise Bronze POS 5500 HSA,84670WI127,,WIN001,WIS002,WIF006,New,POS,Bronze,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127008101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270081.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270081-01,Standard Bronze On Exchange Plan,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,45
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270081,Aspirus Arise Bronze POS 5500 HSA,84670WI127,,WIN001,WIS002,WIF006,New,POS,Bronze,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127008101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270081.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270081-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,46
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350084,Arise Metro Silver POS 3500 HSA,84670WI135,,WIN001,WIS003,WIF004,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135008401,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350084.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350084-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,"$4,400",$0,$0,$30,"$3,500",$0,$0,$0,46
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350084,Arise Metro Silver POS 3500 HSA,84670WI135,,WIN001,WIS003,WIF004,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135008401,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350084.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350084-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,"$4,400",$0,$0,$30,"$3,500",$0,$0,$0,47
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270081,Aspirus Arise Bronze POS 5500 HSA,84670WI127,,WIN001,WIS002,WIF006,New,POS,Bronze,Yes,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127008101,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270081.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270081-03,Limited Cost Sharing Plan Variation,58.30%,0.580491960048676,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,"$6,400",$0,$170,$30,"$4,900",$0,$0,$0,47
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270083,Arise Metro Gold POS 2000 HSA,84670WI127,,WIN001,WIS003,WIF004,New,POS,Gold,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127008301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270083.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270083-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,900",$0,$0,$30,"$2,000",$0,$0,$0,48
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270087,Arise Metro Silver POS 2500 HSA,84670WI127,,WIN001,WIS003,WIF006,New,POS,Silver,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127008701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270087.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270087-01,Standard Silver On Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,53
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270087,Arise Metro Silver POS 2500 HSA,84670WI127,,WIN001,WIS003,WIF006,New,POS,Silver,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127008701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270087.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270087-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,54
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020015,Envision Aurora Network - Gold 500/80,87416WI002,,WIN002,WIS001,WIF004,Existing,PPO,Gold,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionGold500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionGold500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020015-00,Standard Gold Off Exchange Plan,,0.784706950187683,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$50,"$1,010",$150,$500,$680,$240,$80,10
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010011,Empower Open Network - Gold 500/90,87416WI001,,WIN001,WIS001,WIF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerGold500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerGold500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020019,Envision Aurora Network - Silver 1500/80,87416WI002,,WIN002,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionSilver1500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionSilver1500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020019-01,Standard Silver On Exchange Plan,,0.715797424316406,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,000","$6,000","$4,500","$9,000","$1,500",$0,"$1,160",$150,"$1,500",$0,$750,$80,11
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010015,Empower Open Network - Silver 1500/80,87416WI001,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver1500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver1500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010015-00,Standard Silver Off Exchange Plan,,0.715797424316406,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,160",$150,"$1,500",$0,$750,$80,11
2015,WI,85005,HIOS,9,2015-02-18 06:26:47,1,85005,WI,SHOP (Small Group),Yes,27-2407349,85005WI0080001,Group Dental Only Low,85005WI008,,WIN001,WIS001,,New,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.21,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,85005WI0080001-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,$105,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WI,85005,HIOS,9,2015-02-18 06:26:47,1,85005,WI,SHOP (Small Group),Yes,27-2407349,85005WI0080001,Group Dental Only Low,85005WI008,,WIN001,WIS001,,New,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.21,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,85005WI0080001-01,Standard Low On Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,$105,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WI,85005,HIOS,9,2015-02-18 06:26:47,1,85005,WI,Individual,Yes,27-2407349,85005WI0040001,Individual Dental Only Low,85005WI004,,WIN001,WIS001,,New,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.21,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,85005WI0040001-01,Standard Low On Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$90,$270,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WI,85005,HIOS,9,2015-02-18 06:26:47,2,85005,WI,Individual,Yes,27-2407349,85005WI0010001,Individual Pediatric Dental Only High,85005WI001,,WIN001,WIS001,,New,HMO,High,,Both,,,,,,,,,Allows Child-Only,,,,$43.86,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,85005WI0010001-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,$105,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,85005,HIOS,9,2015-02-18 06:26:47,2,85005,WI,Individual,Yes,27-2407349,85005WI0010001,Individual Pediatric Dental Only High,85005WI001,,WIN001,WIS001,,New,HMO,High,,Both,,,,,,,,,Allows Child-Only,,,,$43.86,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,85005WI0010001-01,Standard High On Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,$105,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,85005,HIOS,9,2015-02-18 06:26:47,2,85005,WI,Individual,Yes,27-2407349,85005WI0020001,Individual Pediatric Dental Only Low,85005WI002,,WIN001,WIS001,,New,HMO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$33.21,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,85005WI0020001-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$90,$270,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010015,Empower Open Network - Silver 1500/80,87416WI001,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver1500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver1500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010015-01,Standard Silver On Exchange Plan,,0.715797424316406,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,160",$150,"$1,500",$0,$750,$80,12
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020030,Empower Open Network - HSA Gold 2000/100,87416WI002,,WIN001,WIS001,WIF006,New,PPO,Gold,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerGoldHSA2000-100.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerGoldHSA2000-100.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020030-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,12
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020030,Empower Open Network - HSA Gold 2000/100,87416WI002,,WIN001,WIS001,WIF006,New,PPO,Gold,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerGoldHSA2000-100.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerGoldHSA2000-100.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020030-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,13
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010015,Empower Open Network - Silver 1500/80,87416WI001,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver1500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver1500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010015-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,13
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010015,Empower Open Network - Silver 1500/80,87416WI001,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver1500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver1500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010015-03,Limited Cost Sharing Plan Variation,,0.715797424316406,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,160",$150,"$1,500",$0,$750,$80,14
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020031,Empower Open Network - HSA Silver 2500/80,87416WI002,,WIN001,WIS001,WIF005,New,PPO,Silver,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerSilverHSA2500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerSilverHSA2500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020031-00,Standard Silver Off Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,14
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020031,Empower Open Network - HSA Silver 2500/80,87416WI002,,WIN001,WIS001,WIF005,New,PPO,Silver,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerSilverHSA2500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerSilverHSA2500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020031-01,Standard Silver On Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,15
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010015,Empower Open Network - Silver 1500/80,87416WI001,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver1500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver1500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010015-04,73% AV Level Silver Plan,,0.739799737930298,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,,,,,,,,,15
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010015,Empower Open Network - Silver 1500/80,87416WI001,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver1500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver1500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010015-05,87% AV Level Silver Plan,,0.879795908927917,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$4,500","$9,000","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,$100,$200,20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020032,Empower Open Network - HSA Bronze 4500/90,87416WI002,,WIN001,WIS001,WIF007,New,PPO,Bronze,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerBronzeHSA4500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerBronzeHSA4500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020032-00,Standard Bronze Off Exchange Plan,,0.616446435451508,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",10%,,,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,16
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350088,Arise Metro Silver POS 1400 HSA,84670WI135,,WIN001,WIS003,WIF007,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135008801,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350088.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350088-00,Standard Silver Off Exchange Plan,,0.686691343784332,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,54
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350088,Arise Metro Silver POS 1400 HSA,84670WI135,,WIN001,WIS003,WIF007,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135008801,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350088.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350088-01,Standard Silver On Exchange Plan,,0.686691343784332,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$2,300",$0,"$1,530",$30,"$1,400",$0,"$1,180",$0,55
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270087,Arise Metro Silver POS 2500 HSA,84670WI127,,WIN001,WIS003,WIF006,New,POS,Silver,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127008701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270087.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270087-03,Limited Cost Sharing Plan Variation,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$3,400",$0,$770,$30,"$2,500",$0,$480,$0,55
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270087,Arise Metro Silver POS 2500 HSA,84670WI127,,WIN001,WIS003,WIF006,New,POS,Silver,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127008701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270087.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270087-04,73% AV Level Silver Plan,,0.736850261688232,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,56
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350089,Arise Metro Silver POS 2000 HSA,84670WI135,,WIN001,WIS003,WIF006,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135008901,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350089.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350089-00,Standard Silver Off Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,56
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350089,Arise Metro Silver POS 2000 HSA,84670WI135,,WIN001,WIS003,WIF006,New,POS,Silver,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135008901,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350089.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350089-01,Standard Silver On Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,900",$0,$870,$30,"$2,000",$0,$590,$0,57
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270087,Arise Metro Silver POS 2500 HSA,84670WI127,,WIN001,WIS003,WIF006,New,POS,Silver,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127008701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270087.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270087-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,900",$0,$0,$30,"$1,000",$0,$0,$0,57
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,Individual,No,20-2660193,84670WI1270087,Arise Metro Silver POS 2500 HSA,84670WI127,,WIN001,WIS003,WIF006,New,POS,Silver,No,Both,No,Yes,Tertiary care specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127008701,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270087.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270087-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$13,000","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,000",$0,$0,$30,$500,$0,$0,$0,58
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350090,Arise Metro Bronze POS 6000 HSA,84670WI135,,WIN001,WIS003,WIF001,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135009001,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350090.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350090-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$16,000","$32,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,900",$0,$0,$30,"$4,900",$0,$0,$0,58
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,8,84670,WI,SHOP (Small Group),No,20-2660193,84670WI1350090,Arise Metro Bronze POS 6000 HSA,84670WI135,,WIN001,WIS003,WIF001,New,POS,Bronze,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/135009001,,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1350090.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1350090-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$16,000","$32,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,900",$0,$0,$30,"$4,900",$0,$0,$0,59
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,9,84670,WI,Individual,No,20-2660193,84670WI1250093,Aspirus Arise Catastrophic HMO 6600,84670WI125,,WIN001,WIS002,WIF004,New,HMO,Catastrophic,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,Child only does not apply,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125009301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1250093.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250093-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,7
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,9,84670,WI,Individual,No,20-2660193,84670WI1250094,Arise Metro Catastrophic HMO 6600,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Catastrophic,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,Child only does not apply,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125009401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250094.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250094-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,8
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,9,84670,WI,Individual,No,20-2660193,84670WI1250094,Arise Metro Catastrophic HMO 6600,84670WI125,,WIN001,WIS003,WIF004,New,HMO,Catastrophic,No,Both,No,Yes,Non-participating specialists and tertiary care specialists,Child only does not apply,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Limited to emergency care only,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/125009401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1250094.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1250094-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,9
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,10,84670,WI,Individual,No,20-2660193,84670WI1270039,Arise Catastrophic POS 6600,84670WI127,,WIN001,WIS001,WIF004,Existing,POS,Catastrophic,No,Both,No,Yes,Tertiary care specialists,Child only does not apply,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127003901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270039.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270039-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$17,200","$34,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,4
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010020,Envision Aurora Network - Gold 500/90,87416WI001,,WIN002,WIS001,WIF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionGold500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionGold500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010020-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,32
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010020,Envision Aurora Network - Gold 500/90,87416WI001,,WIN002,WIS001,WIF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionGold500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionGold500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010020-03,Limited Cost Sharing Plan Variation,,0.815297067165375,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$50,$510,$150,$500,$680,$120,$80,33
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010021,Envision Aurora Network - Silver 3000/80,87416WI001,,WIN002,WIS001,WIF001,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver3000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver3000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010021-00,Standard Silver Off Exchange Plan,,0.683428943157196,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,$850,$150,"$3,000",$620,$120,$80,34
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010021,Envision Aurora Network - Silver 3000/80,87416WI001,,WIN002,WIS001,WIF001,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver3000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver3000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010021-01,Standard Silver On Exchange Plan,,0.683428943157196,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,$850,$150,"$3,000",$620,$120,$80,35
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010021,Envision Aurora Network - Silver 3000/80,87416WI001,,WIN002,WIS001,WIF001,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver3000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver3000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010021-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,36
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010021,Envision Aurora Network - Silver 3000/80,87416WI001,,WIN002,WIS001,WIF001,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver3000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver3000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010021-03,Limited Cost Sharing Plan Variation,,0.683428943157196,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,$850,$150,"$3,000",$620,$120,$80,37
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020053,Envision Aurora Network - Silver 3000/80,87416WI002,,WIN002,WIS001,WIF001,New,PPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionSilver3000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionSilver3000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020053-00,Standard Silver Off Exchange Plan,,0.683428943157196,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000","$9,000","$18,000","$3,000",$20,$850,$150,"$3,000",$620,$120,$80,18
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010012,Empower Open Network - Silver 3000/80,87416WI001,,WIN001,WIS001,WIF001,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver3000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver3000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010012-06,94% AV Level Silver Plan,,0.930528700351715,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$4,500","$9,000","$5,700","$11,400",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$20,"$1,030",$150,$0,$250,$280,$80,18
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010013,Empower Open Network - Silver 2000/80/Copay30,87416WI001,,WIN001,WIS001,WIF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80-Copay30.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80-Copay30.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010013-00,Standard Silver Off Exchange Plan,,0.718460619449615,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$50,"$1,010",$150,"$2,000",$440,$190,$80,19
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020053,Envision Aurora Network - Silver 3000/80,87416WI002,,WIN002,WIS001,WIF001,New,PPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionSilver3000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionSilver3000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020053-01,Standard Silver On Exchange Plan,,0.683428943157196,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000","$9,000","$18,000","$3,000",$20,$850,$150,"$3,000",$620,$120,$80,19
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010013,Empower Open Network - Silver 2000/80/Copay30,87416WI001,,WIN001,WIS001,WIF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80-Copay30.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80-Copay30.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010013-01,Standard Silver On Exchange Plan,,0.718460619449615,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$50,"$1,010",$150,"$2,000",$440,$190,$80,20
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010013,Empower Open Network - Silver 2000/80/Copay30,87416WI001,,WIN001,WIS001,WIF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80-Copay30.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80-Copay30.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,21
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010030,Empower Open Network - HSA Silver 2500/80 Low Premium,87416WI001,,WIN001,WIS001,WIF005,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilverHSA2500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilverHSA2500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010030-04,73% AV Level Silver Plan,,0.721001505851746,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400",20%,,,,"$3,400","$6,800","$5,100","$10,200",,,,,,,,,36
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010030,Empower Open Network - HSA Silver 2500/80 Low Premium,87416WI001,,WIN001,WIS001,WIF005,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilverHSA2500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilverHSA2500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010030-05,87% AV Level Silver Plan,,0.862293839454651,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$6,750","$13,500",,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,$500,"$1,000",$750,"$1,500",,,,,,,,,37
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010030,Empower Open Network - HSA Silver 2500/80 Low Premium,87416WI001,,WIN001,WIS001,WIF005,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilverHSA2500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilverHSA2500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010030-06,94% AV Level Silver Plan,,0.930051743984222,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$760,"$1,520",,,"$1,520","$3,040","$2,280","$4,560",,,,,,,,,,,,,,,,,,,,,$50,$100,20%,,,,$100,$200,$150,$300,,,,,,,,,38
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010031,Empower Open Network - HSA Bronze 4500/90 Low Premium,87416WI001,,WIN001,WIS001,WIF007,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerBronzeHSA4500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerBronzeHSA4500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010031-00,Standard Bronze Off Exchange Plan,,0.616446435451508,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",10%,,,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,39
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010020,Envision Aurora Network - Gold 500/90,87416WI001,,WIN002,WIS001,WIF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionGold500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionGold500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010020-00,Standard Gold Off Exchange Plan,,0.815297067165375,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$50,$510,$150,$500,$680,$120,$80,30
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010020,Envision Aurora Network - Gold 500/90,87416WI001,,WIN002,WIS001,WIF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionGold500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionGold500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010020-01,Standard Gold On Exchange Plan,,0.815297067165375,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$50,$510,$150,$500,$680,$120,$80,31
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010021,Envision Aurora Network - Silver 3000/80,87416WI001,,WIN002,WIS001,WIF001,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver3000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver3000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010021-04,73% AV Level Silver Plan,,0.739448189735413,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$50,"$1,010",$150,"$2,000",$440,$190,$80,38
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010021,Envision Aurora Network - Silver 3000/80,87416WI001,,WIN002,WIS001,WIF001,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver3000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver3000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010021-05,87% AV Level Silver Plan,,0.874741733074188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$6,750","$13,500",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$40,"$1,030",$150,$0,$500,$280,$860,39
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010050,Envision Aurora Network - HSA Silver 2500/80 Low Premium,87416WI001,,WIN002,WIS001,WIF005,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilverHSA2500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilverHSA2500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010050-03,Limited Cost Sharing Plan Variation,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,46
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010050,Envision Aurora Network - HSA Silver 2500/80 Low Premium,87416WI001,,WIN002,WIS001,WIF005,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilverHSA2500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilverHSA2500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010050-04,73% AV Level Silver Plan,,0.721001505851746,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400",20%,,,,"$3,400","$6,800","$5,100","$10,200",,,,,,,,,47
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010050,Envision Aurora Network - HSA Silver 2500/80 Low Premium,87416WI001,,WIN002,WIS001,WIF005,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilverHSA2500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilverHSA2500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010050-05,87% AV Level Silver Plan,,0.862293839454651,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$6,750","$13,500",,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,$500,"$1,000",$750,"$1,500",,,,,,,,,48
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010050,Envision Aurora Network - HSA Silver 2500/80 Low Premium,87416WI001,,WIN002,WIS001,WIF005,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilverHSA2500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilverHSA2500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010050-06,94% AV Level Silver Plan,,0.930051743984222,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$760,"$1,520",,,"$1,520","$3,040","$2,280","$4,560",,,,,,,,,,,,,,,,,,,,,$50,$100,20%,,,,$100,$200,$150,$300,,,,,,,,,49
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010031,Empower Open Network - HSA Bronze 4500/90 Low Premium,87416WI001,,WIN001,WIS001,WIF007,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerBronzeHSA4500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerBronzeHSA4500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010031-01,Standard Bronze On Exchange Plan,,0.616446435451508,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",10%,,,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,40
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010031,Empower Open Network - HSA Bronze 4500/90 Low Premium,87416WI001,,WIN001,WIS001,WIF007,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerBronzeHSA4500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerBronzeHSA4500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010031-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,41
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010031,Empower Open Network - HSA Bronze 4500/90 Low Premium,87416WI001,,WIN001,WIS001,WIF007,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerBronzeHSA4500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerBronzeHSA4500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010031-03,Limited Cost Sharing Plan Variation,,0.616446435451508,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",10%,,,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,42
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010050,Envision Aurora Network - HSA Silver 2500/80 Low Premium,87416WI001,,WIN002,WIS001,WIF005,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilverHSA2500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilverHSA2500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010050-00,Standard Silver Off Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,43
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,10,84670,WI,Individual,No,20-2660193,84670WI1270039,Arise Catastrophic POS 6600,84670WI127,,WIN001,WIS001,WIF004,Existing,POS,Catastrophic,No,Both,No,Yes,Tertiary care specialists,Child only does not apply,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127003901,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2015/84670WI1270039.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270039-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$17,200","$34,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,5
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,10,84670,WI,Individual,No,20-2660193,84670WI1270093,Aspirus Arise Catastrophic POS 6600,84670WI127,,WIN001,WIS002,WIF004,New,POS,Catastrophic,No,Both,No,Yes,Tertiary care specialists,Child only does not apply,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127009301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270093.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270093-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$17,200","$34,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,6
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,10,84670,WI,Individual,No,20-2660193,84670WI1270093,Aspirus Arise Catastrophic POS 6600,84670WI127,,WIN001,WIS002,WIF004,New,POS,Catastrophic,No,Both,No,Yes,Tertiary care specialists,Child only does not apply,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127009301,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/aspirus/84670WI1270093.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270093-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$17,200","$34,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,7
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,10,84670,WI,Individual,No,20-2660193,84670WI1270094,Arise Metro Catastrophic POS 6600,84670WI127,,WIN001,WIS003,WIF004,New,POS,Catastrophic,No,Both,No,Yes,Tertiary care specialists,Child only does not apply,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127009401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270094.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270094-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$17,200","$34,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,8
2015,WI,84670,HIOS,8,2015-04-22 11:06:15,10,84670,WI,Individual,No,20-2660193,84670WI1270094,Arise Metro Catastrophic POS 6600,84670WI127,,WIN001,WIS003,WIF004,New,POS,Catastrophic,No,Both,No,Yes,Tertiary care specialists,Child only does not apply,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Low Back Pain",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Limited to emergency care only,Yes,Services paid at the non-participating provider level.,No,https://secure.wecareforwisconsin.com/visitors/find_sbc/127009401,http://www.wecareforwisconsin.com/payment,http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/metro/84670WI1270094.pdf,http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary,84670WI1270094-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$17,200","$34,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$7,260",$0,$0,$30,"$4,900",$0,$0,$0,9
2015,WI,85005,HIOS,9,2015-02-18 06:26:47,1,85005,WI,Individual,Yes,27-2407349,85005WI0030001,Individual Dental Only High,85005WI003,,WIN001,WIS001,,New,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$43.86,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,85005WI0030001-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,$105,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,85005,HIOS,9,2015-02-18 06:26:47,1,85005,WI,SHOP (Small Group),Yes,27-2407349,85005WI0070001,Group Dental Only High,85005WI007,,WIN001,WIS001,,New,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$43.86,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,85005WI0070001-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,$105,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,85005,HIOS,9,2015-02-18 06:26:47,1,85005,WI,SHOP (Small Group),Yes,27-2407349,85005WI0070001,Group Dental Only High,85005WI007,,WIN001,WIS001,,New,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$43.86,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,85005WI0070001-01,Standard High On Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,$105,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,85005,HIOS,9,2015-02-18 06:26:47,1,85005,WI,Individual,Yes,27-2407349,85005WI0030001,Individual Dental Only High,85005WI003,,WIN001,WIS001,,New,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$43.86,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,85005WI0030001-01,Standard High On Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,$105,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,85005,HIOS,9,2015-02-18 06:26:47,1,85005,WI,Individual,Yes,27-2407349,85005WI0040001,Individual Dental Only Low,85005WI004,,WIN001,WIS001,,New,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.21,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,85005WI0040001-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$90,$270,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WI,85005,HIOS,9,2015-02-18 06:26:47,2,85005,WI,Individual,Yes,27-2407349,85005WI0020001,Individual Pediatric Dental Only Low,85005WI002,,WIN001,WIS001,,New,HMO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$33.21,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,85005WI0020001-01,Standard Low On Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$90,$270,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WI,86572,HIOS,2,2014-08-05 13:28:44,1,86572,WI,SHOP (Small Group),Yes,36-0883760,86572WI0040002,EHB High PPO,86572WI004,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$48.58,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,86572WI0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,86572,HIOS,2,2014-08-05 13:28:44,1,86572,WI,SHOP (Small Group),Yes,36-0883760,86572WI0040001,EHB Low PPO,86572WI004,,WIN001,WIS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.98,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,86572WI0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020032,Empower Open Network - HSA Bronze 4500/90,87416WI002,,WIN001,WIS001,WIF007,New,PPO,Bronze,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerBronzeHSA4500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerBronzeHSA4500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020032-01,Standard Bronze On Exchange Plan,,0.616446435451508,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",10%,,,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,17
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010015,Empower Open Network - Silver 1500/80,87416WI001,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver1500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver1500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010015-06,94% AV Level Silver Plan,,0.937170624732971,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,"$4,500","$9,000","$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010023,Envision Aurora Network - Silver 2000/80,87416WI001,,WIN002,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010023-00,Standard Silver Off Exchange Plan,,0.685929417610168,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$650,$80,18
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020050,Envision Aurora Network - HSA Gold 2000/100,87416WI002,,WIN002,WIS001,WIF006,New,PPO,Gold,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionrGoldHSA2000-100.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionGoldHSA2000-100.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020050-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,18
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020050,Envision Aurora Network - HSA Gold 2000/100,87416WI002,,WIN002,WIS001,WIF006,New,PPO,Gold,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionrGoldHSA2000-100.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionGoldHSA2000-100.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020050-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,19
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010023,Envision Aurora Network - Silver 2000/80,87416WI001,,WIN002,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010023-01,Standard Silver On Exchange Plan,,0.685929417610168,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$650,$80,19
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010023,Envision Aurora Network - Silver 2000/80,87416WI001,,WIN002,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010023-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,20
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020051,Envision Aurora Network - HSA Silver 2500/80,87416WI002,,WIN002,WIS001,WIF005,New,PPO,Silver,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionSilverHSA2500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionSilverHSA2500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020051-00,Standard Silver Off Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,20
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020051,Envision Aurora Network - HSA Silver 2500/80,87416WI002,,WIN002,WIS001,WIF005,New,PPO,Silver,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionSilverHSA2500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionSilverHSA2500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020051-01,Standard Silver On Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,21
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010023,Envision Aurora Network - Silver 2000/80,87416WI001,,WIN002,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010023-03,Limited Cost Sharing Plan Variation,,0.685929417610168,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$650,$80,21
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010023,Envision Aurora Network - Silver 2000/80,87416WI001,,WIN002,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010023-04,73% AV Level Silver Plan,,0.738043427467346,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,"$1,300",$0,"$1,200",$150,"$1,300",$0,$790,$80,22
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020052,Envision Aurora Network - HSA Bronze 4500/90,87416WI002,,WIN002,WIS001,WIF007,New,PPO,Bronze,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionBronzeHSA4500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionBronzeHSA4500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020052-00,Standard Bronze Off Exchange Plan,,0.616446435451508,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",10%,,,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,22
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020052,Envision Aurora Network - HSA Bronze 4500/90,87416WI002,,WIN002,WIS001,WIF007,New,PPO,Bronze,No,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionBronzeHSA4500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionBronzeHSA4500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020052-01,Standard Bronze On Exchange Plan,,0.616446435451508,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",10%,,,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,23
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010023,Envision Aurora Network - Silver 2000/80,87416WI001,,WIN002,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010023-05,87% AV Level Silver Plan,,0.877109706401825,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$6,750","$13,500",,,,,,,,,,,,,,,,,,,,,$100,$200,20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$100,$0,"$1,440",$150,$100,$0,"$1,030",$80,23
2015,WI,86572,HIOS,2,2014-08-05 13:28:44,1,86572,WI,SHOP (Small Group),Yes,36-0883760,86572WI0030002,EHB High Passive,86572WI003,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$50.81,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,86572WI0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WI,86572,HIOS,2,2014-08-05 13:28:44,1,86572,WI,SHOP (Small Group),Yes,36-0883760,86572WI0030001,EHB Low Passive,86572WI003,,WIN001,WIS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.33,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,86572WI0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020008,Empower Open Network - Gold 500/80,87416WI002,,WIN001,WIS001,WIF004,Existing,PPO,Gold,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerGold500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerGold500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020008-00,Standard Gold Off Exchange Plan,,0.784706950187683,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$50,"$1,010",$150,$500,$680,$240,$80,4
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010010,Empower Open Network - Gold 500/80,87416WI001,,WIN001,WIS001,WIF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerGold500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerGold500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010010-00,Standard Gold Off Exchange Plan,,0.784706950187683,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$50,"$1,010",$150,$500,$680,$240,$80,4
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010010,Empower Open Network - Gold 500/80,87416WI001,,WIN001,WIS001,WIF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerGold500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerGold500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010010-01,Standard Gold On Exchange Plan,,0.784706950187683,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$50,"$1,010",$150,$500,$680,$240,$80,5
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020008,Empower Open Network - Gold 500/80,87416WI002,,WIN001,WIS001,WIF004,Existing,PPO,Gold,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerGold500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerGold500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020008-01,Standard Gold On Exchange Plan,,0.784706950187683,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$50,"$1,010",$150,$500,$680,$240,$80,5
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020009,Empower Open Network - Gold 500/90,87416WI002,,WIN001,WIS001,WIF003,Existing,PPO,Gold,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerGold500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerGold500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020009-00,Standard Gold Off Exchange Plan,,0.815297067165375,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$50,$510,$150,$500,$680,$120,$80,6
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010010,Empower Open Network - Gold 500/80,87416WI001,,WIN001,WIS001,WIF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerGold500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerGold500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010010,Empower Open Network - Gold 500/80,87416WI001,,WIN001,WIS001,WIF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerGold500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerGold500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010010-03,Limited Cost Sharing Plan Variation,,0.784706950187683,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$50,"$1,010",$150,$500,$680,$240,$80,7
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020009,Empower Open Network - Gold 500/90,87416WI002,,WIN001,WIS001,WIF003,Existing,PPO,Gold,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerGold500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerGold500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020009-01,Standard Gold On Exchange Plan,,0.815297067165375,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$50,$510,$150,$500,$680,$120,$80,7
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020010,Empower Open Network - Silver 2000/80/Copay30,87416WI002,,WIN001,WIS001,WIF002,Existing,PPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerSilver2000-80-Copay30.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerSilver2000-80-Copay30.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020010-00,Standard Silver Off Exchange Plan,,0.718460619449615,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000","$6,000","$12,000","$2,000",$50,"$1,010",$150,"$2,000",$440,$190,$80,8
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010011,Empower Open Network - Gold 500/90,87416WI001,,WIN001,WIS001,WIF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerGold500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerGold500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010011-00,Standard Gold Off Exchange Plan,,0.815297067165375,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$50,$510,$150,$500,$680,$120,$80,8
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010011,Empower Open Network - Gold 500/90,87416WI001,,WIN001,WIS001,WIF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerGold500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerGold500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010011-01,Standard Gold On Exchange Plan,,0.815297067165375,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$50,$510,$150,$500,$680,$120,$80,9
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020010,Empower Open Network - Silver 2000/80/Copay30,87416WI002,,WIN001,WIS001,WIF002,Existing,PPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerSilver2000-80-Copay30.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerSilver2000-80-Copay30.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020010-01,Standard Silver On Exchange Plan,,0.718460619449615,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000","$6,000","$12,000","$2,000",$50,"$1,010",$150,"$2,000",$440,$190,$80,9
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010011,Empower Open Network - Gold 500/90,87416WI001,,WIN001,WIS001,WIF003,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerGold500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerGold500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010011-03,Limited Cost Sharing Plan Variation,,0.815297067165375,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$50,$510,$150,$500,$680,$120,$80,11
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020015,Envision Aurora Network - Gold 500/80,87416WI002,,WIN002,WIS001,WIF004,Existing,PPO,Gold,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionGold500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionGold500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020015-01,Standard Gold On Exchange Plan,,0.784706950187683,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$50,"$1,010",$150,$500,$680,$240,$80,11
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020016,Envision Aurora Network - Gold 500/90,87416WI002,,WIN002,WIS001,WIF003,Existing,PPO,Gold,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionGold500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionGold500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020016-00,Standard Gold Off Exchange Plan,,0.815297067165375,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$50,$510,$150,$500,$680,$120,$80,12
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010012,Empower Open Network - Silver 3000/80,87416WI001,,WIN001,WIS001,WIF001,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver3000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver3000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010012-00,Standard Silver Off Exchange Plan,,0.683428943157196,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,$850,$150,"$3,000",$620,$120,$80,12
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010012,Empower Open Network - Silver 3000/80,87416WI001,,WIN001,WIS001,WIF001,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver3000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver3000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010012-01,Standard Silver On Exchange Plan,,0.683428943157196,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,$850,$150,"$3,000",$620,$120,$80,13
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020016,Envision Aurora Network - Gold 500/90,87416WI002,,WIN002,WIS001,WIF003,Existing,PPO,Gold,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionGold500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionGold500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020016-01,Standard Gold On Exchange Plan,,0.815297067165375,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$50,$510,$150,$500,$680,$120,$80,13
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020017,Envision Aurora Network - Silver 2000/80/Copay30,87416WI002,,WIN002,WIS001,WIF002,Existing,PPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionSilver2000-80-Copay30.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionSilver2000-80-Copay30.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020017-00,Standard Silver Off Exchange Plan,,0.718460619449615,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000","$6,000","$12,000","$2,000",$50,"$1,010",$150,"$2,000",$440,$190,$80,14
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010012,Empower Open Network - Silver 3000/80,87416WI001,,WIN001,WIS001,WIF001,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver3000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver3000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,14
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010012,Empower Open Network - Silver 3000/80,87416WI001,,WIN001,WIS001,WIF001,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver3000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver3000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010012-03,Limited Cost Sharing Plan Variation,,0.683428943157196,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,$850,$150,"$3,000",$620,$120,$80,15
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020017,Envision Aurora Network - Silver 2000/80/Copay30,87416WI002,,WIN002,WIS001,WIF002,Existing,PPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionSilver2000-80-Copay30.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionSilver2000-80-Copay30.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020017-01,Standard Silver On Exchange Plan,,0.718460619449615,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000","$6,000","$12,000","$2,000",$50,"$1,010",$150,"$2,000",$440,$190,$80,15
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020033,Empower Open Network - Silver 3000/80,87416WI002,,WIN001,WIS001,WIF001,New,PPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerSilver3000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerSilver3000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020033-00,Standard Silver Off Exchange Plan,,0.683428943157196,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000","$9,000","$18,000","$3,000",$20,$850,$150,"$3,000",$620,$120,$80,16
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010012,Empower Open Network - Silver 3000/80,87416WI001,,WIN001,WIS001,WIF001,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver3000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver3000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010012-04,73% AV Level Silver Plan,,0.739448189735413,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$50,"$1,010",$150,"$2,000",$440,$190,$80,16
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010012,Empower Open Network - Silver 3000/80,87416WI001,,WIN001,WIS001,WIF001,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver3000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver3000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010012-05,87% AV Level Silver Plan,,0.874741733074188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$6,750","$13,500",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$40,"$1,030",$150,$0,$500,$280,$860,17
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020033,Empower Open Network - Silver 3000/80,87416WI002,,WIN001,WIS001,WIF001,New,PPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerSilver3000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerSilver3000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020033-01,Standard Silver On Exchange Plan,,0.683428943157196,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000","$9,000","$18,000","$3,000",$20,$850,$150,"$3,000",$620,$120,$80,17
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010013,Empower Open Network - Silver 2000/80/Copay30,87416WI001,,WIN001,WIS001,WIF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80-Copay30.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80-Copay30.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010013-03,Limited Cost Sharing Plan Variation,,0.718460619449615,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$50,"$1,010",$150,"$2,000",$440,$190,$80,22
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010013,Empower Open Network - Silver 2000/80/Copay30,87416WI001,,WIN001,WIS001,WIF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80-Copay30.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80-Copay30.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010013-04,73% AV Level Silver Plan,,0.739930272102356,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010013,Empower Open Network - Silver 2000/80/Copay30,87416WI001,,WIN001,WIS001,WIF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80-Copay30.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80-Copay30.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010013-05,87% AV Level Silver Plan,,0.879296720027924,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$6,750","$13,500",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010013,Empower Open Network - Silver 2000/80/Copay30,87416WI001,,WIN001,WIS001,WIF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80-Copay30.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80-Copay30.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010013-06,94% AV Level Silver Plan,,0.936828851699829,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$4,500","$9,000","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010019,Envision Aurora Network - Gold 500/80,87416WI001,,WIN002,WIS001,WIF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionGold500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionGold500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010019-00,Standard Gold Off Exchange Plan,,0.784706950187683,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$50,"$1,010",$150,$500,$680,$240,$80,26
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010019,Envision Aurora Network - Gold 500/80,87416WI001,,WIN002,WIS001,WIF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionGold500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionGold500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010019-01,Standard Gold On Exchange Plan,,0.784706950187683,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$50,"$1,010",$150,$500,$680,$240,$80,27
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010019,Envision Aurora Network - Gold 500/80,87416WI001,,WIN002,WIS001,WIF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionGold500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionGold500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010019-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,28
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010019,Envision Aurora Network - Gold 500/80,87416WI001,,WIN002,WIS001,WIF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionGold500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionGold500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010019-03,Limited Cost Sharing Plan Variation,,0.784706950187683,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$50,"$1,010",$150,$500,$680,$240,$80,29
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010021,Envision Aurora Network - Silver 3000/80,87416WI001,,WIN002,WIS001,WIF001,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver3000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver3000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010021-06,94% AV Level Silver Plan,,0.930528700351715,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$4,500","$9,000","$5,700","$11,400",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$20,"$1,030",$150,$0,$250,$280,$80,40
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010022,Envision Aurora Network - Silver 2000/80/Copay30,87416WI001,,WIN002,WIS001,WIF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80-Copay30.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80-Copay30.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010022-00,Standard Silver Off Exchange Plan,,0.718460619449615,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$50,"$1,010",$150,"$2,000",$440,$190,$80,41
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010022,Envision Aurora Network - Silver 2000/80/Copay30,87416WI001,,WIN002,WIS001,WIF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80-Copay30.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80-Copay30.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010022-01,Standard Silver On Exchange Plan,,0.718460619449615,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$50,"$1,010",$150,"$2,000",$440,$190,$80,42
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010022,Envision Aurora Network - Silver 2000/80/Copay30,87416WI001,,WIN002,WIS001,WIF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80-Copay30.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80-Copay30.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010022-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,43
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010022,Envision Aurora Network - Silver 2000/80/Copay30,87416WI001,,WIN002,WIS001,WIF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80-Copay30.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80-Copay30.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010022-03,Limited Cost Sharing Plan Variation,,0.718460619449615,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$50,"$1,010",$150,"$2,000",$440,$190,$80,44
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010022,Envision Aurora Network - Silver 2000/80/Copay30,87416WI001,,WIN002,WIS001,WIF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80-Copay30.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80-Copay30.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010022-04,73% AV Level Silver Plan,,0.739930272102356,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010022,Envision Aurora Network - Silver 2000/80/Copay30,87416WI001,,WIN002,WIS001,WIF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80-Copay30.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80-Copay30.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010022-05,87% AV Level Silver Plan,,0.879296720027924,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$6,750","$13,500",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,46
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,1,87416,WI,Individual,No,45-3309488,87416WI0010022,Envision Aurora Network - Silver 2000/80/Copay30,87416WI001,,WIN002,WIS001,WIF002,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80-Copay30.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80-Copay30.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010022-06,94% AV Level Silver Plan,,0.936828851699829,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$4,500","$9,000","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,47
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010014,Empower Open Network - Silver 2000/80,87416WI001,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010014-00,Standard Silver Off Exchange Plan,,0.685929417610168,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$650,$80,4
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020011,Empower Open Network - Silver 2000/80,87416WI002,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerSilver2000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerSilver2000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020011-00,Standard Silver Off Exchange Plan,,0.685929417610168,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000","$6,000","$12,000","$2,000",$0,"$1,060",$150,"$2,000",$0,$650,$80,4
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020011,Empower Open Network - Silver 2000/80,87416WI002,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerSilver2000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerSilver2000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020011-01,Standard Silver On Exchange Plan,,0.685929417610168,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000","$6,000","$12,000","$2,000",$0,"$1,060",$150,"$2,000",$0,$650,$80,5
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010014,Empower Open Network - Silver 2000/80,87416WI001,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010014-01,Standard Silver On Exchange Plan,,0.685929417610168,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$650,$80,5
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010014,Empower Open Network - Silver 2000/80,87416WI001,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020012,Empower Open Network - Silver 1500/80,87416WI002,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerSilver1500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerSilver1500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020012-00,Standard Silver Off Exchange Plan,,0.715797424316406,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,000","$6,000","$4,500","$9,000","$1,500",$0,"$1,160",$150,"$1,500",$0,$750,$80,6
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020012,Empower Open Network - Silver 1500/80,87416WI002,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerSilver1500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerSilver1500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020012-01,Standard Silver On Exchange Plan,,0.715797424316406,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,000","$6,000","$4,500","$9,000","$1,500",$0,"$1,160",$150,"$1,500",$0,$750,$80,7
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010014,Empower Open Network - Silver 2000/80,87416WI001,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010014-03,Limited Cost Sharing Plan Variation,,0.685929417610168,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$650,$80,7
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010014,Empower Open Network - Silver 2000/80,87416WI001,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010014-04,73% AV Level Silver Plan,,0.738043427467346,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,"$1,300",$0,"$1,200",$150,"$1,300",$0,$790,$80,8
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020018,Envision Aurora Network - Silver 2000/80,87416WI002,,WIN002,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionSilver2000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionSilver2000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020018-00,Standard Silver Off Exchange Plan,,0.685929417610168,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000","$6,000","$12,000","$2,000",$0,"$1,060",$150,"$2,000",$0,$650,$80,8
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020018,Envision Aurora Network - Silver 2000/80,87416WI002,,WIN002,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionSilver2000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionSilver2000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020018-01,Standard Silver On Exchange Plan,,0.685929417610168,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000","$6,000","$12,000","$2,000",$0,"$1,060",$150,"$2,000",$0,$650,$80,9
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010014,Empower Open Network - Silver 2000/80,87416WI001,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010014-05,87% AV Level Silver Plan,,0.877109706401825,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$6,750","$13,500",,,,,,,,,,,,,,,,,,,,,$100,$200,20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$100,$0,"$1,440",$150,$100,$0,"$1,030",$80,9
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010014,Empower Open Network - Silver 2000/80,87416WI001,,WIN001,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010014-06,94% AV Level Silver Plan,,0.930102705955505,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$830,"$1,660",,,"$4,500","$9,000","$5,330","$10,660",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,$830,$150,$0,$0,$830,$80,10
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020019,Envision Aurora Network - Silver 1500/80,87416WI002,,WIN002,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionSilver1500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionSilver1500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020019-00,Standard Silver Off Exchange Plan,,0.715797424316406,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,000","$6,000","$4,500","$9,000","$1,500",$0,"$1,160",$150,"$1,500",$0,$750,$80,10
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010023,Envision Aurora Network - Silver 2000/80,87416WI001,,WIN002,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010023-06,94% AV Level Silver Plan,,0.930102705955505,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$830,"$1,660",,,"$4,500","$9,000","$5,330","$10,660",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,$830,$150,$0,$0,$830,$80,24
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010024,Envision Aurora Network - Silver 1500/80,87416WI001,,WIN002,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver1500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver1500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010024-00,Standard Silver Off Exchange Plan,,0.715797424316406,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,160",$150,"$1,500",$0,$750,$80,25
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010024,Envision Aurora Network - Silver 1500/80,87416WI001,,WIN002,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver1500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver1500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010024-01,Standard Silver On Exchange Plan,,0.715797424316406,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,160",$150,"$1,500",$0,$750,$80,26
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010024,Envision Aurora Network - Silver 1500/80,87416WI001,,WIN002,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver1500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver1500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010024-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,27
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010024,Envision Aurora Network - Silver 1500/80,87416WI001,,WIN002,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver1500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver1500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010024-03,Limited Cost Sharing Plan Variation,,0.715797424316406,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,160",$150,"$1,500",$0,$750,$80,28
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010024,Envision Aurora Network - Silver 1500/80,87416WI001,,WIN002,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver1500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver1500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010024-04,73% AV Level Silver Plan,,0.739799737930298,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,,,,,,,,,29
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010024,Envision Aurora Network - Silver 1500/80,87416WI001,,WIN002,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver1500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver1500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010024-05,87% AV Level Silver Plan,,0.879795908927917,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$4,500","$9,000","$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,$100,$200,20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010024,Envision Aurora Network - Silver 1500/80,87416WI001,,WIN002,WIS001,WIF005,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver1500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver1500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010024-06,94% AV Level Silver Plan,,0.937170624732971,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,"$4,500","$9,000","$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050003,Gold $1500 - 30%,91058WI005,,WIN003,WIS001,WIF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050003-00,Standard Gold Off Exchange Plan,,0.80832302570343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,45%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050003,Gold $1500 - 30%,91058WI005,,WIN003,WIS001,WIF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050003-01,Standard Gold On Exchange Plan,,0.80832302570343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,45%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050003,Gold $1500 - 30%,91058WI005,,WIN003,WIS001,WIF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050003,Gold $1500 - 30%,91058WI005,,WIN003,WIS001,WIF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050003-03,Limited Cost Sharing Plan Variation,,0.80832302570343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,45%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050004,Gold $3500 - 0%,91058WI005,,WIN003,WIS001,WIF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050004-00,Standard Gold Off Exchange Plan,,0.785882353782654,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$3,500","$7,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,45%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010030,Empower Open Network - HSA Silver 2500/80 Low Premium,87416WI001,,WIN001,WIS001,WIF005,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilverHSA2500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilverHSA2500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010030-00,Standard Silver Off Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,32
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050006,Silver $2500 - 50%,91058WI005,,WIN003,WIS001,WIF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050006-00,Standard Silver Off Exchange Plan,,0.690641224384308,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050006,Silver $2500 - 50%,91058WI005,,WIN003,WIS001,WIF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050006-01,Standard Silver On Exchange Plan,,0.690641224384308,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010030,Empower Open Network - HSA Silver 2500/80 Low Premium,87416WI001,,WIN001,WIS001,WIF005,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilverHSA2500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilverHSA2500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010030-01,Standard Silver On Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,33
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010030,Empower Open Network - HSA Silver 2500/80 Low Premium,87416WI001,,WIN001,WIS001,WIF005,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilverHSA2500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilverHSA2500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010030-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,34
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010030,Empower Open Network - HSA Silver 2500/80 Low Premium,87416WI001,,WIN001,WIS001,WIF005,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilverHSA2500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilverHSA2500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010030-03,Limited Cost Sharing Plan Variation,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,35
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010050,Envision Aurora Network - HSA Silver 2500/80 Low Premium,87416WI001,,WIN002,WIS001,WIF005,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilverHSA2500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilverHSA2500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010050-01,Standard Silver On Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,44
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010050,Envision Aurora Network - HSA Silver 2500/80 Low Premium,87416WI001,,WIN002,WIS001,WIF005,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilverHSA2500-80.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilverHSA2500-80.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010050-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,45
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010051,Envision Aurora Network - HSA Bronze 4500/90 Low Premium,87416WI001,,WIN002,WIS001,WIF007,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionBronzeHSA4500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionBronzeHSA4500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010051-00,Standard Bronze Off Exchange Plan,,0.616446435451508,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",10%,,,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,50
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010051,Envision Aurora Network - HSA Bronze 4500/90 Low Premium,87416WI001,,WIN002,WIS001,WIF007,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionBronzeHSA4500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionBronzeHSA4500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010051-01,Standard Bronze On Exchange Plan,,0.616446435451508,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",10%,,,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,51
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010051,Envision Aurora Network - HSA Bronze 4500/90 Low Premium,87416WI001,,WIN002,WIS001,WIF007,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionBronzeHSA4500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionBronzeHSA4500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010051-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,52
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,2,87416,WI,Individual,No,45-3309488,87416WI0010051,Envision Aurora Network - HSA Bronze 4500/90 Low Premium,87416WI001,,WIN002,WIS001,WIF007,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionBronzeHSA4500-90.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionBronzeHSA4500-90.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010051-03,Limited Cost Sharing Plan Variation,,0.616446435451508,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",10%,,,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,53
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,3,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020014,Empower Open Network - Bronze 5800/100,87416WI002,,WIN001,WIS001,WIF006,Existing,PPO,Bronze,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerBronze5800-100.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerBronze5800-100.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020014-00,Standard Bronze Off Exchange Plan,,0.619809925556183,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"$23,200","$46,400","$29,000","$58,000",,,,,,,,,,,,,,,,,,,,,"$5,800","$11,600",0%,,,,"$11,600","$23,200","$17,400","$34,800","$5,800",$0,$0,$150,"$5,270",$0,$0,$80,4
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,3,87416,WI,Individual,No,45-3309488,87416WI0010018,Empower Open Network - Bronze 5800/100,87416WI001,,WIN001,WIS001,WIF006,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerBronze5800-100.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerBronze5800-100.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010018-00,Standard Bronze Off Exchange Plan,,0.619809925556183,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"$23,200","$46,400","$29,000","$58,000",,,,,,,,,,,,,,,,,,,,,"$5,800","$11,600",0%,,,,"$11,600","$23,200","$17,400","$34,800","$5,800",$0,$0,$150,"$5,270",$0,$0,$80,4
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,3,87416,WI,Individual,No,45-3309488,87416WI0010018,Empower Open Network - Bronze 5800/100,87416WI001,,WIN001,WIS001,WIF006,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerBronze5800-100.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerBronze5800-100.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010018-01,Standard Bronze On Exchange Plan,,0.619809925556183,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"$23,200","$46,400","$29,000","$58,000",,,,,,,,,,,,,,,,,,,,,"$5,800","$11,600",0%,,,,"$11,600","$23,200","$17,400","$34,800","$5,800",$0,$0,$150,"$5,270",$0,$0,$80,5
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,3,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020014,Empower Open Network - Bronze 5800/100,87416WI002,,WIN001,WIS001,WIF006,Existing,PPO,Bronze,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerBronze5800-100.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerBronze5800-100.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020014-01,Standard Bronze On Exchange Plan,,0.619809925556183,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"$23,200","$46,400","$29,000","$58,000",,,,,,,,,,,,,,,,,,,,,"$5,800","$11,600",0%,,,,"$11,600","$23,200","$17,400","$34,800","$5,800",$0,$0,$150,"$5,270",$0,$0,$80,5
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,3,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020021,Envision Aurora Network - Bronze 5800/100,87416WI002,,WIN002,WIS001,WIF006,Existing,PPO,Bronze,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionBronze5800-100.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionBronze5800-100.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020021-00,Standard Bronze Off Exchange Plan,,0.619809925556183,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"$23,200","$46,400","$29,000","$58,000",,,,,,,,,,,,,,,,,,,,,"$5,800","$11,600",0%,,,,"$11,600","$23,200","$17,400","$34,800","$5,800",$0,$0,$150,"$5,270",$0,$0,$80,6
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,3,87416,WI,Individual,No,45-3309488,87416WI0010018,Empower Open Network - Bronze 5800/100,87416WI001,,WIN001,WIS001,WIF006,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerBronze5800-100.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerBronze5800-100.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010018-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,3,87416,WI,Individual,No,45-3309488,87416WI0010018,Empower Open Network - Bronze 5800/100,87416WI001,,WIN001,WIS001,WIF006,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerBronze5800-100.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerBronze5800-100.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010018-03,Limited Cost Sharing Plan Variation,,0.619809925556183,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"$23,200","$46,400","$29,000","$58,000",,,,,,,,,,,,,,,,,,,,,"$5,800","$11,600",0%,,,,"$11,600","$23,200","$17,400","$34,800","$5,800",$0,$0,$150,"$5,270",$0,$0,$80,7
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,3,87416,WI,SHOP (Small Group),No,45-3309488,87416WI0020021,Envision Aurora Network - Bronze 5800/100,87416WI002,,WIN002,WIS001,WIF006,Existing,PPO,Bronze,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionBronze5800-100.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionBronze5800-100.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0020021-01,Standard Bronze On Exchange Plan,,0.619809925556183,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"$23,200","$46,400","$29,000","$58,000",,,,,,,,,,,,,,,,,,,,,"$5,800","$11,600",0%,,,,"$11,600","$23,200","$17,400","$34,800","$5,800",$0,$0,$150,"$5,270",$0,$0,$80,7
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,3,87416,WI,Individual,No,45-3309488,87416WI0010027,Envision Aurora Network - Bronze 5800/100,87416WI001,,WIN002,WIS001,WIF006,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionBronze5800-100.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionBronze5800-100.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010027-00,Standard Bronze Off Exchange Plan,,0.619809925556183,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"$23,200","$46,400","$29,000","$58,000",,,,,,,,,,,,,,,,,,,,,"$5,800","$11,600",0%,,,,"$11,600","$23,200","$17,400","$34,800","$5,800",$0,$0,$150,"$5,270",$0,$0,$80,8
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,3,87416,WI,Individual,No,45-3309488,87416WI0010027,Envision Aurora Network - Bronze 5800/100,87416WI001,,WIN002,WIS001,WIF006,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionBronze5800-100.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionBronze5800-100.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010027-01,Standard Bronze On Exchange Plan,,0.619809925556183,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"$23,200","$46,400","$29,000","$58,000",,,,,,,,,,,,,,,,,,,,,"$5,800","$11,600",0%,,,,"$11,600","$23,200","$17,400","$34,800","$5,800",$0,$0,$150,"$5,270",$0,$0,$80,9
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,3,87416,WI,Individual,No,45-3309488,87416WI0010027,Envision Aurora Network - Bronze 5800/100,87416WI001,,WIN002,WIS001,WIF006,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionBronze5800-100.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionBronze5800-100.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010027-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,3,87416,WI,Individual,No,45-3309488,87416WI0010027,Envision Aurora Network - Bronze 5800/100,87416WI001,,WIN002,WIS001,WIF006,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionBronze5800-100.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionBronze5800-100.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010027-03,Limited Cost Sharing Plan Variation,,0.619809925556183,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"$23,200","$46,400","$29,000","$58,000",,,,,,,,,,,,,,,,,,,,,"$5,800","$11,600",0%,,,,"$11,600","$23,200","$17,400","$34,800","$5,800",$0,$0,$150,"$5,270",$0,$0,$80,11
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,3,87416,WI,Individual,No,45-3309488,87416WI0010026,Envision Aurora Network - Catastrophic 6600/100,87416WI001,,WIN002,WIS001,WIF006,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,3,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionCatastrophic6350-100.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionCatastrophic6350-100.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010026-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800","$33,000","$66,000",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400","$19,800","$39,600",,,,,,,,,12
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,3,87416,WI,Individual,No,45-3309488,87416WI0010026,Envision Aurora Network - Catastrophic 6600/100,87416WI001,,WIN002,WIS001,WIF006,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,3,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionCatastrophic6350-100.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionCatastrophic6350-100.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010026-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800","$33,000","$66,000",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400","$19,800","$39,600",,,,,,,,,13
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,3,87416,WI,Individual,No,45-3309488,87416WI0010017,Empower Open Network - Catastrophic 6600/100,87416WI001,,WIN001,WIS001,WIF006,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,3,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerCatastrophic6350-100.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerCatastrophic6350-100.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010017-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800","$33,000","$66,000",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400","$19,800","$39,600",,,,,,,,,14
2015,WI,87416,HIOS,8,2014-11-14 05:23:27,3,87416,WI,Individual,No,45-3309488,87416WI0010017,Empower Open Network - Catastrophic 6600/100,87416WI001,,WIN001,WIS001,WIF006,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,3,0,2015-01-01,,Yes,Emergency Services Only,Yes,May be subject to Out of Network Benefit,Yes,http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerCatastrophic6350-100.pdf,https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs,http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerCatastrophic6350-100.pdf,http://commongroundhealthcare.org/assets/pdf/formulary.pdf,87416WI0010017-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800","$33,000","$66,000",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400","$19,800","$39,600",,,,,,,,,15
2015,WI,90028,HIOS,4,2014-11-09 04:38:15,1,90028,WI,Individual,Yes,39-0138065,90028WI0400003,Anthem Dental Pediatric,90028WI040,,WIN001,WIS001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$24.75,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/wi/f0/s0/t0/pw_e214663.pdf,,www.anthem.com/agent/wi/f0/s0/t0/pw_e215734.pdf,,90028WI0400003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,90028,HIOS,4,2014-11-09 04:38:15,1,90028,WI,Individual,Yes,39-0138065,90028WI0460003,Anthem Dental Pediatric,90028WI046,,WIN001,WIS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.75,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/wi/f0/s0/t0/pw_e214663.pdf,,www.anthem.com/agent/wi/f0/s0/t0/pw_e215734.pdf,,90028WI0460003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,90028,HIOS,4,2014-11-09 04:38:15,2,90028,WI,Individual,Yes,39-0138065,90028WI0420003,Anthem Dental Family,90028WI042,,WIN001,WIS001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.20,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/wi/f0/s0/t0/pw_e214661.pdf,,www.anthem.com/agent/wi/f0/s0/t0/pw_e215732.pdf,,90028WI0420003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060002,Silver HSA $2000 - 50%,91058WI006,,WIN003,WIS001,WIF006,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060002-04,73% AV Level Silver Plan,,0.723856747150421,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060002,Silver HSA $2000 - 50%,91058WI006,,WIN003,WIS001,WIF006,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060002-05,87% AV Level Silver Plan,,0.864543795585632,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,WI,90028,HIOS,4,2014-11-09 04:38:15,2,90028,WI,Individual,Yes,39-0138065,90028WI0480003,Anthem Dental Family,90028WI048,,WIN001,WIS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.20,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/wi/f0/s0/t0/pw_e214661.pdf,,www.anthem.com/agent/wi/f0/s0/t0/pw_e215732.pdf,,90028WI0480003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,90028,HIOS,4,2014-11-09 04:38:15,2,90028,WI,Individual,Yes,39-0138065,90028WI0420004,Anthem Dental Family Enhanced,90028WI042,,WIN001,WIS001,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.30,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/wi/f0/s0/t0/pw_e214662.pdf,,www.anthem.com/agent/wi/f0/s0/t0/pw_e215733.pdf,,90028WI0420004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WI,90028,HIOS,4,2014-11-09 04:38:15,2,90028,WI,Individual,Yes,39-0138065,90028WI0480004,Anthem Dental Family Enhanced,90028WI048,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.30,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/wi/f0/s0/t0/pw_e214662.pdf,,www.anthem.com/agent/wi/f0/s0/t0/pw_e215733.pdf,,90028WI0480004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060003,Bronze HSA $2500 - 50%,91058WI006,,WIN003,WIS001,WIF006,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060003-00,Standard Bronze Off Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060003,Bronze HSA $2500 - 50%,91058WI006,,WIN003,WIS001,WIF006,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060003-01,Standard Bronze On Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0070001,Platinum $1000 - 0% $30 OV,91058WI007,,WIN001,WIS001,WIF001,Existing,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8A&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0070001-00,Standard Platinum Off Exchange Plan,,0.911718785762787,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050001,Platinum $1000 - 0%,91058WI005,,WIN003,WIS001,WIF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050001-00,Standard Platinum Off Exchange Plan,,0.907304048538208,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,45%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050001,Platinum $1000 - 0%,91058WI005,,WIN003,WIS001,WIF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050001-01,Standard Platinum On Exchange Plan,,0.907304048538208,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,45%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0070001,Platinum $1000 - 0% $30 OV,91058WI007,,WIN001,WIS001,WIF001,Existing,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8A&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0070001-01,Standard Platinum On Exchange Plan,,0.911718785762787,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0070002,Platinum $500 - 20% $15 OV,91058WI007,,WIN001,WIS001,WIF001,Existing,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8B&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0070002-00,Standard Platinum Off Exchange Plan,,0.882930278778076,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050001,Platinum $1000 - 0%,91058WI005,,WIN003,WIS001,WIF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050001,Platinum $1000 - 0%,91058WI005,,WIN003,WIS001,WIF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050001-03,Limited Cost Sharing Plan Variation,,0.907304048538208,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,45%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0070002,Platinum $500 - 20% $15 OV,91058WI007,,WIN001,WIS001,WIF001,Existing,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8B&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0070002-01,Standard Platinum On Exchange Plan,,0.882930278778076,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0070004,Gold $1000 - 20% $40 OV,91058WI007,,WIN001,WIS001,WIF002,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8D&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0070004-00,Standard Gold Off Exchange Plan,,0.799402117729187,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050002,Platinum $500 - 20%,91058WI005,,WIN003,WIS001,WIF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050002-00,Standard Platinum Off Exchange Plan,,0.903732120990753,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,45%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050002,Platinum $500 - 20%,91058WI005,,WIN003,WIS001,WIF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050002-01,Standard Platinum On Exchange Plan,,0.903732120990753,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,45%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0070004,Gold $1000 - 20% $40 OV,91058WI007,,WIN001,WIS001,WIF002,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8D&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0070004-01,Standard Gold On Exchange Plan,,0.799402117729187,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0070006,Silver $2000 - 20% $40 OV,91058WI007,,WIN001,WIS001,WIF003,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8F&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0070006-00,Standard Silver Off Exchange Plan,,0.711495935916901,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050002,Platinum $500 - 20%,91058WI005,,WIN003,WIS001,WIF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050002,Platinum $500 - 20%,91058WI005,,WIN003,WIS001,WIF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050002-03,Limited Cost Sharing Plan Variation,,0.903732120990753,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,45%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0070006,Silver $2000 - 20% $40 OV,91058WI007,,WIN001,WIS001,WIF003,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8F&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0070006-01,Standard Silver On Exchange Plan,,0.711495935916901,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050004,Gold $3500 - 0%,91058WI005,,WIN003,WIS001,WIF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050004-01,Standard Gold On Exchange Plan,,0.785882353782654,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$3,500","$7,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,45%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050004,Gold $3500 - 0%,91058WI005,,WIN003,WIS001,WIF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050004,Gold $3500 - 0%,91058WI005,,WIN003,WIS001,WIF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050004-03,Limited Cost Sharing Plan Variation,,0.785882353782654,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$3,500","$7,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,45%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050005,Silver $3500 - 20%,91058WI005,,WIN003,WIS001,WIF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050005-00,Standard Silver Off Exchange Plan,,0.701671302318573,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$17,500","$35,000",Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050005,Silver $3500 - 20%,91058WI005,,WIN003,WIS001,WIF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050005-01,Standard Silver On Exchange Plan,,0.701671302318573,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$17,500","$35,000",Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050005,Silver $3500 - 20%,91058WI005,,WIN003,WIS001,WIF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050005,Silver $3500 - 20%,91058WI005,,WIN003,WIS001,WIF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050005-03,Limited Cost Sharing Plan Variation,,0.701671302318573,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$17,500","$35,000",Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050005,Silver $3500 - 20%,91058WI005,,WIN003,WIS001,WIF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050005-04,73% AV Level Silver Plan,,0.728078246116638,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050005,Silver $3500 - 20%,91058WI005,,WIN003,WIS001,WIF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050005-05,87% AV Level Silver Plan,,0.87049925327301,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050005,Silver $3500 - 20%,91058WI005,,WIN003,WIS001,WIF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050005-06,94% AV Level Silver Plan,,0.935769379138947,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,$250,$500,10%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050006,Silver $2500 - 50%,91058WI005,,WIN003,WIS001,WIF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,29
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050006,Silver $2500 - 50%,91058WI005,,WIN003,WIS001,WIF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050006-03,Limited Cost Sharing Plan Variation,,0.690641224384308,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050006,Silver $2500 - 50%,91058WI005,,WIN003,WIS001,WIF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050006-04,73% AV Level Silver Plan,,0.730945885181427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",40%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050006,Silver $2500 - 50%,91058WI005,,WIN003,WIS001,WIF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050006-05,87% AV Level Silver Plan,,0.872846245765686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,1,91058,WI,Individual,No,39-1807071,91058WI0050006,Silver $2500 - 50%,91058WI005,,WIN003,WIS001,WIF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050006-06,94% AV Level Silver Plan,,0.935769379138947,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,$250,$500,10%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060001,Silver HSA $3500 - 0%,91058WI006,,WIN003,WIS001,WIF008,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060001-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$17,500","$35,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0080001,Silver HSA $2000 - 20%,91058WI008,,WIN001,WIS001,WIF005,Existing,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=A8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0080001-00,Standard Silver Off Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0080001,Silver HSA $2000 - 20%,91058WI008,,WIN001,WIS001,WIF005,Existing,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=A8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0080001-01,Standard Silver On Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060001,Silver HSA $3500 - 0%,91058WI006,,WIN003,WIS001,WIF008,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060001-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$17,500","$35,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060001,Silver HSA $3500 - 0%,91058WI006,,WIN003,WIS001,WIF008,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0080002,Bronze HSA $2500 - 50%,91058WI008,,WIN001,WIS001,WIF006,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=B8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0080002-00,Standard Bronze Off Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0080002,Bronze HSA $2500 - 50%,91058WI008,,WIN001,WIS001,WIF006,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=B8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0080002-01,Standard Bronze On Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060001,Silver HSA $3500 - 0%,91058WI006,,WIN003,WIS001,WIF008,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060001-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$17,500","$35,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060001,Silver HSA $3500 - 0%,91058WI006,,WIN003,WIS001,WIF008,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060001-04,73% AV Level Silver Plan,,0.732454240322113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0080003,Bronze HSA $5000 - 30%,91058WI008,,WIN001,WIS001,WIF007,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=D8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0080003-00,Standard Bronze Off Exchange Plan,,0.588535189628601,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0080003,Bronze HSA $5000 - 30%,91058WI008,,WIN001,WIS001,WIF007,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=D8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0080003-01,Standard Bronze On Exchange Plan,,0.588535189628601,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060001,Silver HSA $3500 - 0%,91058WI006,,WIN003,WIS001,WIF008,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060001-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060001,Silver HSA $3500 - 0%,91058WI006,,WIN003,WIS001,WIF008,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060001-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0080004,Bronze HSA $6300 - 0%,91058WI008,,WIN001,WIS001,WIF008,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=E8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0080004-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0080004,Bronze HSA $6300 - 0%,91058WI008,,WIN001,WIS001,WIF008,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=E8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0080004-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060002,Silver HSA $2000 - 50%,91058WI006,,WIN003,WIS001,WIF006,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060002-00,Standard Silver Off Exchange Plan,,0.682069897651672,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060002,Silver HSA $2000 - 50%,91058WI006,,WIN003,WIS001,WIF006,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060002-01,Standard Silver On Exchange Plan,,0.682069897651672,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060002,Silver HSA $2000 - 50%,91058WI006,,WIN003,WIS001,WIF006,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060002,Silver HSA $2000 - 50%,91058WI006,,WIN003,WIS001,WIF006,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060002-03,Limited Cost Sharing Plan Variation,,0.682069897651672,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060002,Silver HSA $2000 - 50%,91058WI006,,WIN003,WIS001,WIF006,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060002-06,94% AV Level Silver Plan,,0.941158354282379,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060003,Bronze HSA $2500 - 50%,91058WI006,,WIN003,WIS001,WIF006,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060003,Bronze HSA $2500 - 50%,91058WI006,,WIN003,WIS001,WIF006,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060003-03,Limited Cost Sharing Plan Variation,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060004,Bronze HSA $5500 - 0%,91058WI006,,WIN003,WIS001,WIF008,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060004-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060004,Bronze HSA $5500 - 0%,91058WI006,,WIN003,WIS001,WIF008,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060004-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060004,Bronze HSA $5500 - 0%,91058WI006,,WIN003,WIS001,WIF008,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,24
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060004,Bronze HSA $5500 - 0%,91058WI006,,WIN003,WIS001,WIF008,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060004-03,Limited Cost Sharing Plan Variation,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060005,Bronze HSA $4500 - 20%,91058WI006,,WIN003,WIS001,WIF005,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060005-00,Standard Bronze Off Exchange Plan,,0.60315477848053,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060005,Bronze HSA $4500 - 20%,91058WI006,,WIN003,WIS001,WIF005,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060005-01,Standard Bronze On Exchange Plan,,0.60315477848053,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060005,Bronze HSA $4500 - 20%,91058WI006,,WIN003,WIS001,WIF005,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,28
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,2,91058,WI,Individual,No,39-1807071,91058WI0060005,Bronze HSA $4500 - 20%,91058WI006,,WIN003,WIS001,WIF005,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0060005-03,Limited Cost Sharing Plan Variation,,0.60315477848053,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,3,91058,WI,Individual,No,39-1807071,91058WI0050007,Silver $2500 - 20%,91058WI005,,WIN003,WIS001,WIF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050007-00,Standard Silver Off Exchange Plan,,0.689048707485199,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,3,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0070003,Gold $2000 - 0%,91058WI007,,WIN001,WIS001,WIF002,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8C&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0070003-00,Standard Gold Off Exchange Plan,,0.818400382995605,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,3,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0070003,Gold $2000 - 0%,91058WI007,,WIN001,WIS001,WIF002,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8C&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0070003-01,Standard Gold On Exchange Plan,,0.818400382995605,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,3,91058,WI,Individual,No,39-1807071,91058WI0050007,Silver $2500 - 20%,91058WI005,,WIN003,WIS001,WIF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050007-01,Standard Silver On Exchange Plan,,0.689048707485199,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,3,91058,WI,Individual,No,39-1807071,91058WI0050007,Silver $2500 - 20%,91058WI005,,WIN003,WIS001,WIF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,3,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0070005,Silver $2000 - 20%,91058WI007,,WIN001,WIS001,WIF003,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8E&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0070005-00,Standard Silver Off Exchange Plan,,0.719587922096252,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,3,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0070005,Silver $2000 - 20%,91058WI007,,WIN001,WIS001,WIF003,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8E&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0070005-01,Standard Silver On Exchange Plan,,0.719587922096252,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,3,91058,WI,Individual,No,39-1807071,91058WI0050007,Silver $2500 - 20%,91058WI005,,WIN003,WIS001,WIF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050007-03,Limited Cost Sharing Plan Variation,,0.689048707485199,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210017,Platinum 500 Deductible,94529WI021,7558364783,WIN001,WIS001,WIF001,New,HMO,Platinum,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6000,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210017.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210017-00,Standard Platinum Off Exchange Plan,,0.908414244651794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$0,"$1,150","$1,000",$0,$0,"$1,080",4
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210017,Platinum 500 Deductible,94529WI021,7558364783,WIN001,WIS001,WIF001,New,HMO,Platinum,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6000,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210017.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210017-01,Standard Platinum On Exchange Plan,,0.908414244651794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$0,"$1,150","$1,000",$0,$0,"$1,080",5
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210033,Select Silver 30 Copay,94529WI021,7558364783,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6055,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210033.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210033-00,Standard Silver Off Exchange Plan,,0.717596411705017,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$410,$60,"$4,550",31
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210033,Select Silver 30 Copay,94529WI021,7558364783,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6055,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210033.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210033-01,Standard Silver On Exchange Plan,,0.717596411705017,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$410,$60,"$4,550",32
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,Individual,No,39-1199466,94529WI0210031,"Select Gold 2,000 Deductible Benefit Arch",94529WI021,7558364783,WIN002,WIS002,WIF002,New,HMO,Gold,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6049,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210031.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210031-03,Limited Cost Sharing Plan Variation,81.60%,0.739685416221619,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$580,$260,"$2,920",19
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,3,94529,WI,Individual,No,39-1199466,94529WI0210021,"Gold 2,000 Deductible HSA",94529WI021,7558364783,WIN001,WIS001,WIF003,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6012,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210021.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210021-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,3,91058,WI,Individual,No,39-1807071,91058WI0050007,Silver $2500 - 20%,91058WI005,,WIN003,WIS001,WIF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050007-04,73% AV Level Silver Plan,,0.733032584190369,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,3,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0070008,Silver $2000 - 0%,91058WI007,,WIN001,WIS001,WIF003,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8H&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0070008-00,Standard Silver Off Exchange Plan,,0.685942351818085,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,3,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0070008,Silver $2000 - 0%,91058WI007,,WIN001,WIS001,WIF003,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8H&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0070008-01,Standard Silver On Exchange Plan,,0.685942351818085,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,3,91058,WI,Individual,No,39-1807071,91058WI0050007,Silver $2500 - 20%,91058WI005,,WIN003,WIS001,WIF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050007-05,87% AV Level Silver Plan,,0.864616453647614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210036,"Select Bronze 4,000 Deductible",94529WI021,7558364783,WIN002,WIS002,WIF006,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6073,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210036.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210036-03,Limited Cost Sharing Plan Variation,,0.617190957069397,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",41
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,Individual,No,39-1199466,94529WI0210018,"Platinum 1,000 Deductible Benefit Arch",94529WI021,7558364783,WIN001,WIS001,WIF001,New,HMO,Platinum,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6003,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210018.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210018-00,Standard Platinum Off Exchange Plan,88.00%,0.820158958435059,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,$500,"$2,650","$2,000",$270,$230,"$2,580",4
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,3,94529,WI,Individual,No,39-1199466,94529WI0210021,"Gold 2,000 Deductible HSA",94529WI021,7558364783,WIN001,WIS001,WIF003,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6012,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210021.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210021-03,Limited Cost Sharing Plan Variation,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,3,94529,WI,Individual,No,39-1199466,94529WI0210032,"Select Gold 2,000 Deductible HSA",94529WI021,7558364783,WIN002,WIS002,WIF003,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6052,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210032.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210032-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,5,94529,WI,Individual,No,39-1199466,94529WI0210023,"Silver 2,000 Deductible",94529WI021,7558364783,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6021,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210023.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210023-05,87% AV Level Silver Plan,,0.86662346124649,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,5,94529,WI,Individual,No,39-1199466,94529WI0210023,"Silver 2,000 Deductible",94529WI021,7558364783,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6021,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210023.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210023-06,94% AV Level Silver Plan,,0.931361377239227,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,8,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0110010,"Gold 2,000 Deductible HSA PPO",94529WI011,7558364783,WIN003,WIS003,WIF003,New,PPO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"GHC-SCW issues employer contracts to employer groups located in service area of Dane, Columbia, Iowa, and Sauk County.  Employer groups may have locations outside of Dane, Columbia, Iowa, and Sauk County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount for out of network services.",Yes,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6182,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0110010.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0110010-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,$0,"$2,150","$2,000",$0,$80,"$2,080",5
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,8,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0110012,"Silver 3,500 Deductible HSA PPO",94529WI011,7558364783,WIN003,WIS003,WIF003,New,PPO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"GHC-SCW issues employer contracts to employer groups located in service area of Dane, Columbia, Iowa, and Sauk County.  Employer groups may have locations outside of Dane, Columbia, Iowa, and Sauk County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount for out of network services.",Yes,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6184,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0110012.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0110012-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,"$3,500",$0,$0,"$3,650","$3,500",$0,$0,"$3,580",6
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,3,47731,WY,SHOP (Small Group),Yes,95-6042390,47731WY0010007,BEST Dental Premium,47731WY001,,WYN001,WYS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.25,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BESTDental_Premium_Plan.pdf,,47731WY0010007-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,3,47731,WY,Individual,Yes,95-6042390,47731WY0020003,BESTOne Dental Advantage-Gold,47731WY002,,WYN001,WYS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$47.81,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BESTOne_Dental_Advantage-Gold_Plan.pdf,,47731WY0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,3,47731,WY,Individual,Yes,95-6042390,47731WY0020004,BESTOne Dental Plus-Gold,47731WY002,,WYN001,WYS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$47.81,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BESTOne_Dental_Plus-Gold_Plan.pdf,,47731WY0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,3,91058,WI,Individual,No,39-1807071,91058WI0050007,Silver $2500 - 20%,91058WI005,,WIN003,WIS001,WIF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050007-06,94% AV Level Silver Plan,,0.938193678855896,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$250,$500,10%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,4,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0070009,Bronze $3500 - 30%,91058WI007,,WIN001,WIS001,WIF004,Existing,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8I&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0070009-00,Standard Bronze Off Exchange Plan,,0.608460307121277,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,4,91058,WI,Individual,No,39-1807071,91058WI0050008,Bronze $2500 - 50%,91058WI005,,WIN003,WIS001,WIF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050008-00,Standard Bronze Off Exchange Plan,,0.615333676338196,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,4,91058,WI,Individual,No,39-1807071,91058WI0050008,Bronze $2500 - 50%,91058WI005,,WIN003,WIS001,WIF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050008-01,Standard Bronze On Exchange Plan,,0.615333676338196,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,4,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0070009,Bronze $3500 - 30%,91058WI007,,WIN001,WIS001,WIF004,Existing,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8I&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0070009-01,Standard Bronze On Exchange Plan,,0.608460307121277,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,4,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0070010,Bronze $6350 - 0%,91058WI007,,WIN001,WIS001,WIF004,Existing,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8J&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0070010-00,Standard Bronze Off Exchange Plan,,0.606137454509735,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,350","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,4,91058,WI,Individual,No,39-1807071,91058WI0050008,Bronze $2500 - 50%,91058WI005,,WIN003,WIS001,WIF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,4,91058,WI,Individual,No,39-1807071,91058WI0050008,Bronze $2500 - 50%,91058WI005,,WIN003,WIS001,WIF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050008-03,Limited Cost Sharing Plan Variation,,0.615333676338196,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,4,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0070010,Bronze $6350 - 0%,91058WI007,,WIN001,WIS001,WIF004,Existing,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8J&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0070010-01,Standard Bronze On Exchange Plan,,0.606137454509735,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,350","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,4,91058,WI,Individual,No,39-1807071,91058WI0050009,Bronze $3500 - 30%,91058WI005,,WIN003,WIS001,WIF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050009-00,Standard Bronze Off Exchange Plan,,0.611142992973328,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000",Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,4,91058,WI,Individual,No,39-1807071,91058WI0050009,Bronze $3500 - 30%,91058WI005,,WIN003,WIS001,WIF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050009-01,Standard Bronze On Exchange Plan,,0.611142992973328,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000",Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,4,91058,WI,Individual,No,39-1807071,91058WI0050009,Bronze $3500 - 30%,91058WI005,,WIN003,WIS001,WIF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050009-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,4,91058,WI,Individual,No,39-1807071,91058WI0050009,Bronze $3500 - 30%,91058WI005,,WIN003,WIS001,WIF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050009-03,Limited Cost Sharing Plan Variation,,0.611142992973328,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000",Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,5,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0070007,Silver - 50%,91058WI007,,WIN001,WIS001,WIF003,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8G&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0070007-00,Standard Silver Off Exchange Plan,,0.713833391666412,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,5,91058,WI,Individual,No,39-1807071,91058WI0050010,Bronze $5500 - 20%,91058WI005,,WIN003,WIS001,WIF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050010-00,Standard Bronze Off Exchange Plan,,0.600705564022064,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,"$5,500","$11,000",20%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,5,91058,WI,Individual,No,39-1807071,91058WI0050010,Bronze $5500 - 20%,91058WI005,,WIN003,WIS001,WIF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050010-01,Standard Bronze On Exchange Plan,,0.600705564022064,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,"$5,500","$11,000",20%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,5,91058,WI,SHOP (Small Group),No,39-1807071,91058WI0070007,Silver - 50%,91058WI007,,WIN001,WIS001,WIF003,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8G&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0070007-01,Standard Silver On Exchange Plan,,0.713833391666412,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,5,91058,WI,Individual,No,39-1807071,91058WI0050010,Bronze $5500 - 20%,91058WI005,,WIN003,WIS001,WIF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,5,91058,WI,Individual,No,39-1807071,91058WI0050010,Bronze $5500 - 20%,91058WI005,,WIN003,WIS001,WIF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050010-03,Limited Cost Sharing Plan Variation,,0.600705564022064,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,"$5,500","$11,000",20%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,6,91058,WI,Individual,No,39-1807071,91058WI0050014,"Catastrophic $6,600 - 0%",91058WI005,,WIN003,WIS001,WIF008,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,3,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=CT&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050014-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,91058,HIOS,2,2014-08-06 08:27:55,6,91058,WI,Individual,No,39-1807071,91058WI0050014,"Catastrophic $6,600 - 0%",91058WI005,,WIN003,WIS001,WIF008,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,3,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=CT&eff_date=01/01/2015&state=WI,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,91058WI0050014-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,91604,HIOS,14,2015-01-16 17:32:32,1,91604,WI,Individual,Yes,39-1263473,91604WI0490001,Humana Dental Smart Choice,91604WI049,,WIN001,WIS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.90,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541409,,91604WI0490001-00,Standard Low Off Exchange Plan,71.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$85,Not Applicable,,,,,$85,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,91604,HIOS,14,2015-01-16 17:32:32,1,91604,WI,Individual,Yes,39-1263473,91604WI0490001,Humana Dental Smart Choice,91604WI049,,WIN001,WIS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.90,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541409,,91604WI0490001-01,Standard Low On Exchange Plan,71.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$85,Not Applicable,,,,,$85,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220016,Platinum 500 Deductible,94529WI022,7558364783,WIN001,WIS003,WIF001,New,HMO,Platinum,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6100,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220016.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220016-00,Standard Platinum Off Exchange Plan,,0.908414244651794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$0,"$1,150","$1,000",$0,$0,"$1,080",4
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,3,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220023,"Silver 3,500 Deductible HSA",94529WI022,7558364783,WIN001,WIS003,WIF003,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6127,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220023.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220023-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$0,$0,"$3,650","$3,500",$0,$0,"$3,580",6
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,3,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220023,"Silver 3,500 Deductible HSA",94529WI022,7558364783,WIN001,WIS003,WIF003,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6127,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220023.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220023-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$0,$0,"$3,650","$3,500",$0,$0,"$3,580",7
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,3,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220030,"Select Gold 2,000 Deductible HSA",94529WI022,7558364783,WIN002,WIS004,WIF003,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6112,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220020.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220030-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$0,$0,"$2,150","$2,000",$0,$80,"$2,080",8
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,3,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220030,"Select Gold 2,000 Deductible HSA",94529WI022,7558364783,WIN002,WIS004,WIF003,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6112,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220020.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220030-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$0,$0,"$2,150","$2,000",$0,$80,"$2,080",9
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220016,Platinum 500 Deductible,94529WI022,7558364783,WIN001,WIS003,WIF001,New,HMO,Platinum,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6100,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220016.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220016-01,Standard Platinum On Exchange Plan,,0.908414244651794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$0,"$1,150","$1,000",$0,$0,"$1,080",5
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220018,"Gold 1,000 Deductible",94529WI022,7558364783,WIN001,WIS003,WIF002,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6106,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220018.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220018-00,Standard Gold Off Exchange Plan,,0.814249455928802,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$730,$190,"$3,000",6
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210017,Platinum 500 Deductible,94529WI021,7558364783,WIN001,WIS001,WIF001,New,HMO,Platinum,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6000,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210017.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210017-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$0,"$1,150","$1,000",$0,$0,"$1,080",6
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210017,Platinum 500 Deductible,94529WI021,7558364783,WIN001,WIS001,WIF001,New,HMO,Platinum,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6000,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210017.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210017-03,Limited Cost Sharing Plan Variation,,0.908414244651794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$0,"$1,150","$1,000",$0,$0,"$1,080",7
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220018,"Gold 1,000 Deductible",94529WI022,7558364783,WIN001,WIS003,WIF002,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6106,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220018.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220018-01,Standard Gold On Exchange Plan,,0.814249455928802,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$730,$190,"$3,000",7
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220021,Silver 30 Copay,94529WI022,7558364783,WIN001,WIS003,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6115,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220021.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220021-00,Standard Silver Off Exchange Plan,,0.717596411705017,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$410,$60,"$4,550",8
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210019,"Gold 1,000 Deductible",94529WI021,7558364783,WIN001,WIS001,WIF002,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6006,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210019.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210019-00,Standard Gold Off Exchange Plan,,0.814249455928802,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$730,$190,"$3,000",8
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210019,"Gold 1,000 Deductible",94529WI021,7558364783,WIN001,WIS001,WIF002,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6006,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210019.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210019-01,Standard Gold On Exchange Plan,,0.814249455928802,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$730,$190,"$3,000",9
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220021,Silver 30 Copay,94529WI022,7558364783,WIN001,WIS003,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6115,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220021.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220021-01,Standard Silver On Exchange Plan,,0.717596411705017,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$410,$60,"$4,550",9
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220026,Select Platinum 500 Deductible,94529WI022,7558364783,WIN002,WIS004,WIF001,New,HMO,Platinum,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6100,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220016.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220026-00,Standard Platinum Off Exchange Plan,,0.908414244651794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$0,"$1,150","$1,000",$0,$0,"$1,080",10
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210019,"Gold 1,000 Deductible",94529WI021,7558364783,WIN001,WIS001,WIF002,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6006,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210019.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210019-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$730,$190,"$3,000",10
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210019,"Gold 1,000 Deductible",94529WI021,7558364783,WIN001,WIS001,WIF002,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6006,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210019.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210019-03,Limited Cost Sharing Plan Variation,,0.814249455928802,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$730,$190,"$3,000",11
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220026,Select Platinum 500 Deductible,94529WI022,7558364783,WIN002,WIS004,WIF001,New,HMO,Platinum,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6100,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220016.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220026-01,Standard Platinum On Exchange Plan,,0.908414244651794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$0,"$1,150","$1,000",$0,$0,"$1,080",11
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220028,"Select Gold 1,000 Deductible",94529WI022,7558364783,WIN002,WIS004,WIF002,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6106,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220018.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220028-00,Standard Gold Off Exchange Plan,,0.814249455928802,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$730,$190,"$3,000",12
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210022,Silver 30 Copay,94529WI021,7558364783,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6015,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210022.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210022-00,Standard Silver Off Exchange Plan,,0.717596411705017,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$410,$60,"$4,550",12
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210022,Silver 30 Copay,94529WI021,7558364783,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6015,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210022.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210022-01,Standard Silver On Exchange Plan,,0.717596411705017,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$410,$60,"$4,550",13
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220028,"Select Gold 1,000 Deductible",94529WI022,7558364783,WIN002,WIS004,WIF002,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6106,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220018.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220028-01,Standard Gold On Exchange Plan,,0.814249455928802,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$730,$190,"$3,000",13
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220031,Select Silver 30 Copay,94529WI022,7558364783,WIN002,WIS004,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6115,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220021.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220031-00,Standard Silver Off Exchange Plan,,0.717596411705017,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$410,$60,"$4,550",14
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210022,Silver 30 Copay,94529WI021,7558364783,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6015,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210022.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210022-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$410,$60,"$4,550",14
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210022,Silver 30 Copay,94529WI021,7558364783,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6015,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210022.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210022-03,Limited Cost Sharing Plan Variation,,0.717596411705017,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$410,$60,"$4,550",15
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220031,Select Silver 30 Copay,94529WI022,7558364783,WIN002,WIS004,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6115,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220021.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220031-01,Standard Silver On Exchange Plan,,0.717596411705017,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$410,$60,"$4,550",15
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210022,Silver 30 Copay,94529WI021,7558364783,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6015,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210022.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210022-04,73% AV Level Silver Plan,,0.73856920003891,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210022,Silver 30 Copay,94529WI021,7558364783,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6015,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210022.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210022-05,87% AV Level Silver Plan,,0.874475121498108,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210022,Silver 30 Copay,94529WI021,7558364783,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6015,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210022.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210022-06,94% AV Level Silver Plan,,0.939438223838806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210025,"Bronze 4,000 Deductible",94529WI021,7558364783,WIN001,WIS001,WIF006,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6033,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210025.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210025-00,Standard Bronze Off Exchange Plan,,0.617190957069397,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",19
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210025,"Bronze 4,000 Deductible",94529WI021,7558364783,WIN001,WIS001,WIF006,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6033,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210025.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210025-01,Standard Bronze On Exchange Plan,,0.617190957069397,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",20
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210025,"Bronze 4,000 Deductible",94529WI021,7558364783,WIN001,WIS001,WIF006,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6033,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210025.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210025-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",21
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210025,"Bronze 4,000 Deductible",94529WI021,7558364783,WIN001,WIS001,WIF006,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6033,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210025.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210025-03,Limited Cost Sharing Plan Variation,,0.617190957069397,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",22
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,4,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220022,"Silver 2,000 Deductible",94529WI022,7558364783,WIN001,WIS003,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6121,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220022.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220022-00,Standard Silver Off Exchange Plan,,0.680544078350067,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$380,$90,"$4,550",4
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,4,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220022,"Silver 2,000 Deductible",94529WI022,7558364783,WIN001,WIS003,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6121,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220022.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220022-01,Standard Silver On Exchange Plan,,0.680544078350067,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$380,$90,"$4,550",5
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,5,94529,WI,Individual,No,39-1199466,94529WI0210034,"Select Silver 2,000 Deductible",94529WI021,7558364783,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6061,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210034.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210034-04,73% AV Level Silver Plan,,0.72787469625473,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,5,94529,WI,Individual,No,39-1199466,94529WI0210034,"Select Silver 2,000 Deductible",94529WI021,7558364783,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6061,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210034.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210034-05,87% AV Level Silver Plan,,0.86662346124649,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,8,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0110012,"Silver 3,500 Deductible HSA PPO",94529WI011,7558364783,WIN003,WIS003,WIF003,New,PPO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"GHC-SCW issues employer contracts to employer groups located in service area of Dane, Columbia, Iowa, and Sauk County.  Employer groups may have locations outside of Dane, Columbia, Iowa, and Sauk County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount for out of network services.",Yes,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6184,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0110012.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0110012-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,"$3,500",$0,$0,"$3,650","$3,500",$0,$0,"$3,580",7
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,9,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0110014,"Bronze 5,000 Deductible HSA PPO",94529WI011,7558364783,WIN003,WIS003,WIF005,New,PPO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"GHC-SCW issues employer contracts to employer groups located in service area of Dane, Columbia, Iowa, and Sauk County.  Employer groups may have locations outside of Dane, Columbia, Iowa, and Sauk County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount for out of network services.",Yes,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6186,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0110014.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0110014-00,Standard Bronze Off Exchange Plan,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,Individual,No,83-0231011,11269WY0070020,BlueSelect Bronze Classic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF015,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070020-03,Limited Cost Sharing Plan Variation,61.04%,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$9,550","$19,100","$15,050","$30,100",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$8,000","$13,500","$13,500","$24,500",,,,,,,,,22
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,3,11269,WY,Individual,No,83-0231011,11269WY0070005,BlueSelect Catastrophic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF005,Existing,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0070005-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",50%,,,,"$8,850","$17,700","$15,200","$30,400",,,,,,,,,4
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,3,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220033,Select Silver 3500 Ded HSA,94529WI022,7558364783,WIN002,WIS004,WIF003,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6127,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220023.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220033-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$0,$0,"$3,650","$3,500",$0,$0,"$3,580",10
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,3,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220033,Select Silver 3500 Ded HSA,94529WI022,7558364783,WIN002,WIS004,WIF003,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6127,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220023.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220033-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$0,$0,"$3,650","$3,500",$0,$0,"$3,580",11
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,5,94529,WI,Individual,No,39-1199466,94529WI0210034,"Select Silver 2,000 Deductible",94529WI021,7558364783,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6061,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210034.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210034-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,5,94529,WI,Individual,No,39-1199466,94529WI0210034,"Select Silver 2,000 Deductible",94529WI021,7558364783,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6061,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210034.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210034-03,Limited Cost Sharing Plan Variation,,0.680544078350067,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$380,$90,"$4,550",14
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,9,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0110014,"Bronze 5,000 Deductible HSA PPO",94529WI011,7558364783,WIN003,WIS003,WIF005,New,PPO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"GHC-SCW issues employer contracts to employer groups located in service area of Dane, Columbia, Iowa, and Sauk County.  Employer groups may have locations outside of Dane, Columbia, Iowa, and Sauk County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount for out of network services.",Yes,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6186,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0110014.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0110014-01,Standard Bronze On Exchange Plan,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",5
2015,WI,96723,HIOS,5,2014-09-04 03:25:43,1,96723,WI,SHOP (Small Group),Yes,95-2371728,96723WI0020001,PPO MAC,96723WI002,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$41.05,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Wisconsin,Yes,,,,,96723WI0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,96723,HIOS,5,2014-09-04 03:25:43,1,96723,WI,Individual,Yes,95-2371728,96723WI0010001,PPO MAC,96723WI001,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$55.70,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Wisconsin,Yes,,,,,96723WI0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,96723,HIOS,5,2014-09-04 03:25:43,1,96723,WI,Individual,Yes,95-2371728,96723WI0010002,PPO MAC,96723WI001,,WIN001,WIS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$45.85,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Wisconsin,Yes,,,,,96723WI0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,96723,HIOS,5,2014-09-04 03:25:43,1,96723,WI,SHOP (Small Group),Yes,95-2371728,96723WI0020002,PPO MAC,96723WI002,,WIN001,WIS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$31.98,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Wisconsin,Yes,,,,,96723WI0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WI,96723,HIOS,5,2014-09-04 03:25:43,2,96723,WI,SHOP (Small Group),Yes,95-2371728,96723WI0020003,PPO MAC,96723WI002,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$42.33,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Wisconsin,Yes,,,,,96723WI0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WI,96723,HIOS,5,2014-09-04 03:25:43,2,96723,WI,Individual,Yes,95-2371728,96723WI0010003,PPO MAC,96723WI001,,WIN001,WIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$57.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Wisconsin,Yes,,,,,96723WI0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,1,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080001,BlueSelect Gold Basic Plus Dental,11269WY008,,WYN001,WYS001,WYF001,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0080001-00,Standard Gold Off Exchange Plan,78.01%,0.780111849308014,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$3,500","$7,000","$4,500","$9,000",,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,1,11269,WY,Individual,No,83-0231011,11269WY0070001,BlueSelect Gold Basic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0070001-00,Standard Gold Off Exchange Plan,78.05%,0.780469596385956,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$3,500","$7,000","$4,500","$9,000",,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,10,11269,WY,Individual,No,83-0231011,11269WY0070018,BlueSelect Silver ValueTwo Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF013,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070018-04,73% AV Level Silver Plan,73.10%,0.757708370685577,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$13,200","$26,400","$16,950","$33,900","$3,000","$6,000",0%,,,,"$6,000","$12,000","$9,000","$18,000",$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,10,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190004,BlueSelect Bronze HSATwo,11269WY019,,WYN001,WYS001,WYF015,New,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0190004-00,Standard Bronze Off Exchange Plan,59.21%,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,500","$21,000","$16,500","$33,000",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$8,500","$14,500","$14,500","$26,500",,,,,,,,,8
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,9,11269,WY,Individual,No,83-0231011,11269WY0070021,BlueSelect Silver ValueOne Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF012,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070021-05,87% AV Level Silver Plan,87.20%,0.872128009796143,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000","$11,500","$23,000","$1,000","$2,000",20%,,,,"$7,000","$14,000","$8,000","$16,000",$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,9,11269,WY,Individual,No,83-0231011,11269WY0070021,BlueSelect Silver ValueOne Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF012,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070021-06,94% AV Level Silver Plan,94.30%,0.943031549453735,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000","$10,500","$21,000",$250,$500,20%,,,,"$7,000","$14,000","$7,250","$14,500",$50,$100,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,13,11269,WY,Individual,No,83-0231011,11269WY0170004,BlueSelect Silver HSA,11269WY017,7154324389,WYN001,WYS001,WYF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170004-05,87% AV Level Silver Plan,86.70%,0.867013514041901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$9,700","$19,400","$11,950","$23,900",,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,"$4,500","$6,500","$4,700","$6,900",,,,,,,,,13
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,13,11269,WY,Individual,No,83-0231011,11269WY0170004,BlueSelect Silver HSA,11269WY017,7154324389,WYN001,WYS001,WYF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170004-06,94% AV Level Silver Plan,93.66%,0.936563849449158,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$9,700","$19,400","$10,300","$20,600",,,,,,,,,,,,,,,,,,,,,$100,$200,20%,,,,"$4,500","$6,500","$4,600","$6,700",,,,,,,,,14
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,13,11269,WY,Individual,No,83-0231011,11269WY0170005,BlueSelect Bronze Classic,11269WY017,7154324389,WYN001,WYS001,WYF015,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170005-00,Standard Bronze Off Exchange Plan,61.04%,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$9,550","$19,100","$15,050","$30,100",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$8,000","$13,500","$13,500","$24,500",,,,,,,,,15
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210028,Select Platinum 500 Deductible,94529WI021,7558364783,WIN002,WIS002,WIF001,New,HMO,Platinum,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6040,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210028.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210028-00,Standard Platinum Off Exchange Plan,,0.908414244651794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$0,"$1,150","$1,000",$0,$0,"$1,080",23
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210028,Select Platinum 500 Deductible,94529WI021,7558364783,WIN002,WIS002,WIF001,New,HMO,Platinum,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6040,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210028.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210028-01,Standard Platinum On Exchange Plan,,0.908414244651794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$0,"$1,150","$1,000",$0,$0,"$1,080",24
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210028,Select Platinum 500 Deductible,94529WI021,7558364783,WIN002,WIS002,WIF001,New,HMO,Platinum,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6040,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210028.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210028-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$0,"$1,150","$1,000",$0,$0,"$1,080",25
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210028,Select Platinum 500 Deductible,94529WI021,7558364783,WIN002,WIS002,WIF001,New,HMO,Platinum,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6040,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210028.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210028-03,Limited Cost Sharing Plan Variation,,0.908414244651794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$0,"$1,150","$1,000",$0,$0,"$1,080",26
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210030,"Select Gold 1,000 Deductible",94529WI021,7558364783,WIN002,WIS002,WIF002,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6046,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210030.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210030-00,Standard Gold Off Exchange Plan,,0.814249455928802,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$730,$190,"$3,000",27
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210030,"Select Gold 1,000 Deductible",94529WI021,7558364783,WIN002,WIS002,WIF002,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6046,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210030.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210030-01,Standard Gold On Exchange Plan,,0.814249455928802,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$730,$190,"$3,000",28
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210030,"Select Gold 1,000 Deductible",94529WI021,7558364783,WIN002,WIS002,WIF002,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6046,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210030.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210030-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$730,$190,"$3,000",29
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210030,"Select Gold 1,000 Deductible",94529WI021,7558364783,WIN002,WIS002,WIF002,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6046,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210030.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210030-03,Limited Cost Sharing Plan Variation,,0.814249455928802,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$730,$190,"$3,000",30
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210033,Select Silver 30 Copay,94529WI021,7558364783,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6055,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210033.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210033-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$410,$60,"$4,550",33
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210033,Select Silver 30 Copay,94529WI021,7558364783,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6055,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210033.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210033-03,Limited Cost Sharing Plan Variation,,0.717596411705017,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$410,$60,"$4,550",34
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210033,Select Silver 30 Copay,94529WI021,7558364783,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6055,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210033.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210033-04,73% AV Level Silver Plan,,0.73856920003891,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210033,Select Silver 30 Copay,94529WI021,7558364783,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6055,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210033.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210033-05,87% AV Level Silver Plan,,0.874475121498108,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210033,Select Silver 30 Copay,94529WI021,7558364783,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6055,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210033.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210033-06,94% AV Level Silver Plan,,0.939438223838806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210036,"Select Bronze 4,000 Deductible",94529WI021,7558364783,WIN002,WIS002,WIF006,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6073,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210036.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210036-00,Standard Bronze Off Exchange Plan,,0.617190957069397,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",38
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210036,"Select Bronze 4,000 Deductible",94529WI021,7558364783,WIN002,WIS002,WIF006,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6073,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210036.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210036-01,Standard Bronze On Exchange Plan,,0.617190957069397,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",39
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,1,94529,WI,Individual,No,39-1199466,94529WI0210036,"Select Bronze 4,000 Deductible",94529WI021,7558364783,WIN002,WIS002,WIF006,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6073,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210036.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210036-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",40
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220017,"Platinum 1,000 Deductible Benefit Arch",94529WI022,7558364783,WIN001,WIS003,WIF001,New,HMO,Platinum,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6103,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220017.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220017-00,Standard Platinum Off Exchange Plan,88.00%,0.820158958435059,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,$500,"$2,650","$2,000",$270,$230,"$2,580",4
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220017,"Platinum 1,000 Deductible Benefit Arch",94529WI022,7558364783,WIN001,WIS003,WIF001,New,HMO,Platinum,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6103,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220017.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220017-01,Standard Platinum On Exchange Plan,88.00%,0.820158958435059,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,$500,"$2,650","$2,000",$270,$230,"$2,580",5
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,Individual,No,39-1199466,94529WI0210018,"Platinum 1,000 Deductible Benefit Arch",94529WI021,7558364783,WIN001,WIS001,WIF001,New,HMO,Platinum,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6003,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210018.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210018-01,Standard Platinum On Exchange Plan,88.00%,0.820158958435059,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,$500,"$2,650","$2,000",$270,$230,"$2,580",5
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,Individual,No,39-1199466,94529WI0210018,"Platinum 1,000 Deductible Benefit Arch",94529WI021,7558364783,WIN001,WIS001,WIF001,New,HMO,Platinum,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6003,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210018.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210018-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,$500,"$2,650","$2,000",$270,$230,"$2,580",6
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220019,"Gold 2,000 Deductible Benefit Arch",94529WI022,7558364783,WIN001,WIS003,WIF002,New,HMO,Gold,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6109,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220019.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220019-00,Standard Gold Off Exchange Plan,81.60%,0.739685416221619,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$580,$260,"$2,920",6
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220019,"Gold 2,000 Deductible Benefit Arch",94529WI022,7558364783,WIN001,WIS003,WIF002,New,HMO,Gold,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6109,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220019.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220019-01,Standard Gold On Exchange Plan,81.60%,0.739685416221619,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$580,$260,"$2,920",7
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,Individual,No,39-1199466,94529WI0210018,"Platinum 1,000 Deductible Benefit Arch",94529WI021,7558364783,WIN001,WIS001,WIF001,New,HMO,Platinum,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6003,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210018.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210018-03,Limited Cost Sharing Plan Variation,88.00%,0.820158958435059,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,$500,"$2,650","$2,000",$270,$230,"$2,580",7
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,Individual,No,39-1199466,94529WI0210020,"Gold 2,000 Deductible Benefit Arch",94529WI021,7558364783,WIN001,WIS001,WIF002,New,HMO,Gold,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6009,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210020.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210020-00,Standard Gold Off Exchange Plan,81.60%,0.739685416221619,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$580,$260,"$2,920",8
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220027,"Select Platinum 1,000 Deductible Benefit Arch",94529WI022,7558364783,WIN002,WIS004,WIF001,New,HMO,Platinum,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6103,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220017.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220027-00,Standard Platinum Off Exchange Plan,88.00%,0.820158958435059,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,$500,"$2,650","$2,000",$270,$230,"$2,580",8
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220027,"Select Platinum 1,000 Deductible Benefit Arch",94529WI022,7558364783,WIN002,WIS004,WIF001,New,HMO,Platinum,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6103,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220017.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220027-01,Standard Platinum On Exchange Plan,88.00%,0.820158958435059,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,$500,"$2,650","$2,000",$270,$230,"$2,580",9
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,Individual,No,39-1199466,94529WI0210020,"Gold 2,000 Deductible Benefit Arch",94529WI021,7558364783,WIN001,WIS001,WIF002,New,HMO,Gold,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6009,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210020.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210020-01,Standard Gold On Exchange Plan,81.60%,0.739685416221619,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$580,$260,"$2,920",9
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,Individual,No,39-1199466,94529WI0210020,"Gold 2,000 Deductible Benefit Arch",94529WI021,7558364783,WIN001,WIS001,WIF002,New,HMO,Gold,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6009,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210020.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210020-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$580,$260,"$2,920",10
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220029,"Select Gold 2,000 Deductible Benefit Arch",94529WI022,7558364783,WIN002,WIS004,WIF002,New,HMO,Gold,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6109,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220019.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220029-00,Standard Gold Off Exchange Plan,81.60%,0.739685416221619,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$580,$260,"$2,920",10
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220029,"Select Gold 2,000 Deductible Benefit Arch",94529WI022,7558364783,WIN002,WIS004,WIF002,New,HMO,Gold,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6109,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220019.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220029-01,Standard Gold On Exchange Plan,81.60%,0.739685416221619,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$580,$260,"$2,920",11
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,Individual,No,39-1199466,94529WI0210020,"Gold 2,000 Deductible Benefit Arch",94529WI021,7558364783,WIN001,WIS001,WIF002,New,HMO,Gold,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6009,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210020.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210020-03,Limited Cost Sharing Plan Variation,81.60%,0.739685416221619,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$580,$260,"$2,920",11
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,Individual,No,39-1199466,94529WI0210029,"Select Platinum 1,000 Deductible Benefit Arch",94529WI021,7558364783,WIN002,WIS002,WIF001,New,HMO,Platinum,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6043,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210029.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210029-00,Standard Platinum Off Exchange Plan,88.00%,0.820158958435059,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,$500,"$2,650","$2,000",$270,$230,"$2,580",12
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,Individual,No,39-1199466,94529WI0210029,"Select Platinum 1,000 Deductible Benefit Arch",94529WI021,7558364783,WIN002,WIS002,WIF001,New,HMO,Platinum,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6043,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210029.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210029-01,Standard Platinum On Exchange Plan,88.00%,0.820158958435059,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,$500,"$2,650","$2,000",$270,$230,"$2,580",13
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,Individual,No,39-1199466,94529WI0210029,"Select Platinum 1,000 Deductible Benefit Arch",94529WI021,7558364783,WIN002,WIS002,WIF001,New,HMO,Platinum,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6043,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210029.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210029-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,$500,"$2,650","$2,000",$270,$230,"$2,580",14
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,Individual,No,39-1199466,94529WI0210029,"Select Platinum 1,000 Deductible Benefit Arch",94529WI021,7558364783,WIN002,WIS002,WIF001,New,HMO,Platinum,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6043,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210029.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210029-03,Limited Cost Sharing Plan Variation,88.00%,0.820158958435059,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,$500,"$2,650","$2,000",$270,$230,"$2,580",15
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,Individual,No,39-1199466,94529WI0210031,"Select Gold 2,000 Deductible Benefit Arch",94529WI021,7558364783,WIN002,WIS002,WIF002,New,HMO,Gold,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6049,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210031.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210031-00,Standard Gold Off Exchange Plan,81.60%,0.739685416221619,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$580,$260,"$2,920",16
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,Individual,No,39-1199466,94529WI0210031,"Select Gold 2,000 Deductible Benefit Arch",94529WI021,7558364783,WIN002,WIS002,WIF002,New,HMO,Gold,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6049,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210031.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210031-01,Standard Gold On Exchange Plan,81.60%,0.739685416221619,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$580,$260,"$2,920",17
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,2,94529,WI,Individual,No,39-1199466,94529WI0210031,"Select Gold 2,000 Deductible Benefit Arch",94529WI021,7558364783,WIN002,WIS002,WIF002,New,HMO,Gold,Yes,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6049,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210031.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210031-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$580,$260,"$2,920",18
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,3,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220020,"Gold 2,000 Deductible HSA",94529WI022,7558364783,WIN001,WIS003,WIF003,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6112,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220020.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220020-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$0,$0,"$2,150","$2,000",$0,$80,"$2,080",4
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,3,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220020,"Gold 2,000 Deductible HSA",94529WI022,7558364783,WIN001,WIS003,WIF003,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6112,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220020.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220020-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$0,$0,"$2,150","$2,000",$0,$80,"$2,080",5
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,3,94529,WI,Individual,No,39-1199466,94529WI0210021,"Gold 2,000 Deductible HSA",94529WI021,7558364783,WIN001,WIS001,WIF003,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6012,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210021.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210021-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,3,94529,WI,Individual,No,39-1199466,94529WI0210021,"Gold 2,000 Deductible HSA",94529WI021,7558364783,WIN001,WIS001,WIF003,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6012,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210021.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210021-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,3,94529,WI,Individual,No,39-1199466,94529WI0210032,"Select Gold 2,000 Deductible HSA",94529WI021,7558364783,WIN002,WIS002,WIF003,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6052,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210032.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210032-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,3,94529,WI,Individual,No,39-1199466,94529WI0210032,"Select Gold 2,000 Deductible HSA",94529WI021,7558364783,WIN002,WIS002,WIF003,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6052,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210032.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210032-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,3,94529,WI,Individual,No,39-1199466,94529WI0210032,"Select Gold 2,000 Deductible HSA",94529WI021,7558364783,WIN002,WIS002,WIF003,New,HMO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6052,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210032.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210032-03,Limited Cost Sharing Plan Variation,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,4,94529,WI,Individual,No,39-1199466,94529WI0210024,"Silver 3,500 Deductible HSA",94529WI021,7558364783,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6027,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210024.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210024-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$0,$0,"$3,650","$3,500",$0,$0,"$3,580",4
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,4,94529,WI,Individual,No,39-1199466,94529WI0210024,"Silver 3,500 Deductible HSA",94529WI021,7558364783,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6027,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210024.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210024-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$0,$0,"$3,650","$3,500",$0,$0,"$3,580",5
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,4,94529,WI,Individual,No,39-1199466,94529WI0210024,"Silver 3,500 Deductible HSA",94529WI021,7558364783,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6027,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210024.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210024-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,"$3,500",$0,$0,"$3,650","$3,500",$0,$0,"$3,580",6
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,4,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220032,"Select Silver 2,000 Deductible",94529WI022,7558364783,WIN002,WIS004,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6121,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220022.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220032-00,Standard Silver Off Exchange Plan,,0.680544078350067,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$380,$90,"$4,550",6
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,4,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220032,"Select Silver 2,000 Deductible",94529WI022,7558364783,WIN002,WIS004,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6121,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220022.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220032-01,Standard Silver On Exchange Plan,,0.680544078350067,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$380,$90,"$4,550",7
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,4,94529,WI,Individual,No,39-1199466,94529WI0210024,"Silver 3,500 Deductible HSA",94529WI021,7558364783,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6027,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210024.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210024-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$0,$0,"$3,650","$3,500",$0,$0,"$3,580",7
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,4,94529,WI,Individual,No,39-1199466,94529WI0210024,"Silver 3,500 Deductible HSA",94529WI021,7558364783,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6027,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210024.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210024-04,73% AV Level Silver Plan,,0.732454240322113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,4,94529,WI,Individual,No,39-1199466,94529WI0210024,"Silver 3,500 Deductible HSA",94529WI021,7558364783,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6027,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210024.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210024-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,4,94529,WI,Individual,No,39-1199466,94529WI0210024,"Silver 3,500 Deductible HSA",94529WI021,7558364783,WIN001,WIS001,WIF003,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6027,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210024.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210024-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,4,94529,WI,Individual,No,39-1199466,94529WI0210035,"Select Silver 3,500 Deductible HSA",94529WI021,7558364783,WIN002,WIS002,WIF003,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6067,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210035.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210035-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$0,$0,"$3,650","$3,500",$0,$0,"$3,580",11
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,4,94529,WI,Individual,No,39-1199466,94529WI0210035,"Select Silver 3,500 Deductible HSA",94529WI021,7558364783,WIN002,WIS002,WIF003,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6067,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210035.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210035-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$0,$0,"$3,650","$3,500",$0,$0,"$3,580",12
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,4,94529,WI,Individual,No,39-1199466,94529WI0210035,"Select Silver 3,500 Deductible HSA",94529WI021,7558364783,WIN002,WIS002,WIF003,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6067,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210035.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210035-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,"$3,500",$0,$0,"$3,650","$3,500",$0,$0,"$3,580",13
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,4,94529,WI,Individual,No,39-1199466,94529WI0210035,"Select Silver 3,500 Deductible HSA",94529WI021,7558364783,WIN002,WIS002,WIF003,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6067,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210035.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210035-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$0,$0,"$3,650","$3,500",$0,$0,"$3,580",14
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,4,94529,WI,Individual,No,39-1199466,94529WI0210035,"Select Silver 3,500 Deductible HSA",94529WI021,7558364783,WIN002,WIS002,WIF003,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6067,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210035.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210035-04,73% AV Level Silver Plan,,0.732454240322113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,4,94529,WI,Individual,No,39-1199466,94529WI0210035,"Select Silver 3,500 Deductible HSA",94529WI021,7558364783,WIN002,WIS002,WIF003,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6067,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210035.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210035-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,4,94529,WI,Individual,No,39-1199466,94529WI0210035,"Select Silver 3,500 Deductible HSA",94529WI021,7558364783,WIN002,WIS002,WIF003,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6067,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210035.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210035-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,5,94529,WI,Individual,No,39-1199466,94529WI0210023,"Silver 2,000 Deductible",94529WI021,7558364783,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6021,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210023.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210023-00,Standard Silver Off Exchange Plan,,0.680544078350067,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$380,$90,"$4,550",4
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,5,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220024,"Bronze 4,000 Deductible",94529WI022,7558364783,WIN001,WIS003,WIF006,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6133,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220024.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220024-00,Standard Bronze Off Exchange Plan,,0.617190957069397,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",4
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,5,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220024,"Bronze 4,000 Deductible",94529WI022,7558364783,WIN001,WIS003,WIF006,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6133,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220024.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220024-01,Standard Bronze On Exchange Plan,,0.617190957069397,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",5
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,5,94529,WI,Individual,No,39-1199466,94529WI0210023,"Silver 2,000 Deductible",94529WI021,7558364783,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6021,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210023.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210023-01,Standard Silver On Exchange Plan,,0.680544078350067,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$380,$90,"$4,550",5
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,5,94529,WI,Individual,No,39-1199466,94529WI0210023,"Silver 2,000 Deductible",94529WI021,7558364783,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6021,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210023.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210023-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,3,11269,WY,Individual,No,83-0231011,11269WY0070005,BlueSelect Catastrophic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF005,Existing,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0070005-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",50%,,,,"$8,850","$17,700","$15,200","$30,400",,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,10,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190004,BlueSelect Bronze HSATwo,11269WY019,,WYN001,WYS001,WYF015,New,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0190004-01,Standard Bronze On Exchange Plan,59.21%,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,500","$21,000","$16,500","$33,000",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$8,500","$14,500","$14,500","$26,500",,,,,,,,,9
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,10,11269,WY,Individual,No,83-0231011,11269WY0070018,BlueSelect Silver ValueTwo Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF013,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070018-05,87% AV Level Silver Plan,86.20%,0.859497308731079,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$13,200","$26,400","$14,700","$29,400","$1,250","$2,500",0%,,,,"$6,000","$12,000","$7,250","$14,500",$150,$300,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,3,47731,WY,SHOP (Small Group),Yes,95-6042390,47731WY0010007,BEST Dental Premium,47731WY001,,WYN001,WYS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.25,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BESTDental_Premium_Plan.pdf,,47731WY0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,3,47731,WY,SHOP (Small Group),Yes,95-6042390,47731WY0010008,BEST Dental Standard-H,47731WY001,,WYN001,WYS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.25,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BESTDental_Standard-H_Plan.pdf,,47731WY0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,3,47731,WY,SHOP (Small Group),Yes,95-6042390,47731WY0010008,BEST Dental Standard-H,47731WY001,,WYN001,WYS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.25,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BESTDental_Standard-H_Plan.pdf,,47731WY0010008-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,3,47731,WY,Individual,Yes,95-6042390,47731WY0020004,BESTOne Dental Plus-Gold,47731WY002,,WYN001,WYS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$47.81,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BESTOne_Dental_Plus-Gold_Plan.pdf,,47731WY0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,3,47731,WY,SHOP (Small Group),Yes,95-6042390,47731WY0010010,BEST Dental Choice-H,47731WY001,,WYN001,WYS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.25,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BESTDental_Choice-H_Plan.pdf,,47731WY0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,3,47731,WY,SHOP (Small Group),Yes,95-6042390,47731WY0010010,BEST Dental Choice-H,47731WY001,,WYN001,WYS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.25,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BESTDental_Choice-H_Plan.pdf,,47731WY0010010-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,4,47731,WY,SHOP (Small Group),Yes,95-6042390,47731WY0010009,BEST Dental Standard-L,47731WY001,,WYN001,WYS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.61,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BESTDental_Standard-L_Plan.pdf,,47731WY0010009-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,4,47731,WY,Individual,Yes,95-6042390,47731WY0020005,BESTOne Dental Plus-Silver,47731WY002,,WYN001,WYS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$37.00,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BESTOne_Dental_Plus-Silver_Plan.pdf,,47731WY0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,4,47731,WY,Individual,Yes,95-6042390,47731WY0020005,BESTOne Dental Plus-Silver,47731WY002,,WYN001,WYS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$37.00,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BESTOne_Dental_Plus-Silver_Plan.pdf,,47731WY0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,4,47731,WY,SHOP (Small Group),Yes,95-6042390,47731WY0010009,BEST Dental Standard-L,47731WY001,,WYN001,WYS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.61,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BESTDental_Standard-L_Plan.pdf,,47731WY0010009-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,4,47731,WY,SHOP (Small Group),Yes,95-6042390,47731WY0010011,BEST Dental Choice-L,47731WY001,,WYN001,WYS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.61,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BESTDental_Choice-L_Plan.pdf,,47731WY0010011-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,4,47731,WY,Individual,Yes,95-6042390,47731WY0020006,BESTOne Dental Basic-Silver,47731WY002,,WYN001,WYS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$37.00,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BESTOne_Dental_Basic-Silver_Plan.pdf,,47731WY0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,4,47731,WY,Individual,Yes,95-6042390,47731WY0020006,BESTOne Dental Basic-Silver,47731WY002,,WYN001,WYS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$37.00,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BESTOne_Dental_Basic-Silver_Plan.pdf,,47731WY0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,5,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220034,"Select Bronze 4,000 Deductible",94529WI022,7558364783,WIN002,WIS004,WIF006,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6133,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220024.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220034-00,Standard Bronze Off Exchange Plan,,0.617190957069397,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",6
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,14,11269,WY,Individual,No,83-0231011,11269WY0170008,BlueSelect Silver HealthPlus,11269WY017,7154324389,WYN001,WYS001,WYF011,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170008-00,Standard Silver Off Exchange Plan,69.40%,0.68479710817337,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$9,900","$19,800","$16,500","$33,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",25%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,8
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,14,11269,WY,Individual,No,83-0231011,11269WY0170008,BlueSelect Silver HealthPlus,11269WY017,7154324389,WYN001,WYS001,WYF011,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170008-01,Standard Silver On Exchange Plan,69.40%,0.68479710817337,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$9,900","$19,800","$16,500","$33,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",25%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,9
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,14,11269,WY,Individual,No,83-0231011,11269WY0170008,BlueSelect Silver HealthPlus,11269WY017,7154324389,WYN001,WYS001,WYF011,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170008-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,8,53189,WY,Individual,No,83-0309681,53189WY0070006,WINhealth Gold,53189WY007,,WYN001,WYS003,WYF005,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,8,53189,WY,Individual,No,83-0309681,53189WY0070006,WINhealth Gold,53189WY007,,WYN001,WYS003,WYF005,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070006-03,Limited Cost Sharing Plan Variation,,0.78597092628479,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,000",$650,$400,$0,"$1,000",$380,$60,$0,7
2015,WY,44450,HIOS,7,2014-11-15 04:52:41,2,44450,WY,SHOP (Small Group),Yes,75-1233841,44450WY0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,44450WY002,,WYN001,WYS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.40,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/wy/44450wy0020009-15,,44450WY0020009-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,46998,HIOS,4,2014-09-05 03:32:16,1,46998,WY,Individual,Yes,95-2371728,46998WY0010001,PPO MAC,46998WY001,,WYN001,WYS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$45.55,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Wyoming,Yes,,,,,46998WY0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,46998,HIOS,4,2014-09-05 03:32:16,1,46998,WY,SHOP (Small Group),Yes,95-2371728,46998WY0020001,PPO MAC,46998WY002,,WYN001,WYS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$33.61,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Wyoming,Yes,,,,,46998WY0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,46998,HIOS,4,2014-09-05 03:32:16,1,46998,WY,SHOP (Small Group),Yes,95-2371728,46998WY0020002,PPO MAC,46998WY002,,WYN001,WYS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.22,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Wyoming,Yes,,,,,46998WY0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,46998,HIOS,4,2014-09-05 03:32:16,1,46998,WY,Individual,Yes,95-2371728,46998WY0010002,PPO MAC,46998WY001,,WYN001,WYS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$37.52,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Wyoming,Yes,,,,,46998WY0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,46998,HIOS,4,2014-09-05 03:32:16,2,46998,WY,Individual,Yes,95-2371728,46998WY0010003,PPO MAC,46998WY001,,WYN001,WYS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$46.98,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Wyoming,Yes,,,,,46998WY0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,14,11269,WY,Individual,No,83-0231011,11269WY0170008,BlueSelect Silver HealthPlus,11269WY017,7154324389,WYN001,WYS001,WYF011,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170008-03,Limited Cost Sharing Plan Variation,69.40%,0.68479710817337,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$9,900","$19,800","$16,500","$33,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",25%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,11
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,14,11269,WY,Individual,No,83-0231011,11269WY0170008,BlueSelect Silver HealthPlus,11269WY017,7154324389,WYN001,WYS001,WYF011,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170008-04,73% AV Level Silver Plan,72.50%,0.715461373329163,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$9,900","$19,800","$15,100","$30,200",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",25%,,,,"$5,000","$10,000","$7,100","$14,200",,,,,,,,,12
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,14,11269,WY,Individual,No,83-0231011,11269WY0170008,BlueSelect Silver HealthPlus,11269WY017,7154324389,WYN001,WYS001,WYF011,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170008-05,87% AV Level Silver Plan,86.50%,0.863705217838287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$9,900","$19,800","$11,900","$23,800",,,,,,,,,,,,,,,,,,,,,$400,$800,25%,,,,"$5,000","$10,000","$5,400","$10,800",,,,,,,,,13
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,15,11269,WY,Individual,No,83-0231011,11269WY0170015,BlueSelect Silver ValueOne,11269WY017,7154324389,WYN001,WYS001,WYF012,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170015-05,87% AV Level Silver Plan,87.20%,0.872128009796143,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000","$11,500","$23,000","$1,000","$2,000",20%,,,,"$7,000","$14,000","$8,000","$16,000",$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,15,11269,WY,Individual,No,83-0231011,11269WY0170015,BlueSelect Silver ValueOne,11269WY017,7154324389,WYN001,WYS001,WYF012,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170015-06,94% AV Level Silver Plan,94.30%,0.943031549453735,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000","$10,500","$21,000",$250,$500,20%,,,,"$7,000","$14,000","$7,250","$14,500",$50,$100,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,16,11269,WY,Individual,No,83-0231011,11269WY0170009,BlueSelect Silver ValueTwo,11269WY017,7154324389,WYN001,WYS001,WYF013,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170009-00,Standard Silver Off Exchange Plan,68.52%,0.683096170425415,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$3,000","$6,000",20%,,,,"$6,000","$12,000","$9,000","$18,000",$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,16,11269,WY,Individual,No,83-0231011,11269WY0170009,BlueSelect Silver ValueTwo,11269WY017,7154324389,WYN001,WYS001,WYF013,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170009-01,Standard Silver On Exchange Plan,68.52%,0.683096170425415,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$3,000","$6,000",20%,,,,"$6,000","$12,000","$9,000","$18,000",$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,16,11269,WY,Individual,No,83-0231011,11269WY0170009,BlueSelect Silver ValueTwo,11269WY017,7154324389,WYN001,WYS001,WYF013,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,5,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220034,"Select Bronze 4,000 Deductible",94529WI022,7558364783,WIN002,WIS004,WIF006,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6133,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220024.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220034-01,Standard Bronze On Exchange Plan,,0.617190957069397,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",7
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,5,94529,WI,Individual,No,39-1199466,94529WI0210023,"Silver 2,000 Deductible",94529WI021,7558364783,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6021,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210023.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210023-03,Limited Cost Sharing Plan Variation,,0.680544078350067,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$380,$90,"$4,550",7
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,5,94529,WI,Individual,No,39-1199466,94529WI0210023,"Silver 2,000 Deductible",94529WI021,7558364783,WIN001,WIS001,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6021,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210023.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210023-04,73% AV Level Silver Plan,,0.72787469625473,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,5,94529,WI,Individual,No,39-1199466,94529WI0210034,"Select Silver 2,000 Deductible",94529WI021,7558364783,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6061,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210034.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210034-00,Standard Silver Off Exchange Plan,,0.680544078350067,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$380,$90,"$4,550",11
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,5,94529,WI,Individual,No,39-1199466,94529WI0210034,"Select Silver 2,000 Deductible",94529WI021,7558364783,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6061,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210034.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210034-01,Standard Silver On Exchange Plan,,0.680544078350067,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$380,$90,"$4,550",12
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,5,94529,WI,Individual,No,39-1199466,94529WI0210034,"Select Silver 2,000 Deductible",94529WI021,7558364783,WIN002,WIS002,WIF004,New,HMO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6061,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210034.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210034-06,94% AV Level Silver Plan,,0.931361377239227,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,6,94529,WI,Individual,No,39-1199466,94529WI0210026,"Bronze 5,000 Deductible HSA",94529WI021,7558364783,WIN001,WIS001,WIF006,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6036,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210026.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210026-00,Standard Bronze Off Exchange Plan,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",4
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,6,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220025,"Bronze 5,000 Deductible HSA",94529WI022,7558364783,WIN001,WIS003,WIF005,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6136,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220025.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220025-00,Standard Bronze Off Exchange Plan,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",4
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,6,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220025,"Bronze 5,000 Deductible HSA",94529WI022,7558364783,WIN001,WIS003,WIF005,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6136,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220025.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220025-01,Standard Bronze On Exchange Plan,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",5
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,6,94529,WI,Individual,No,39-1199466,94529WI0210026,"Bronze 5,000 Deductible HSA",94529WI021,7558364783,WIN001,WIS001,WIF006,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6036,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210026.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210026-01,Standard Bronze On Exchange Plan,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",5
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,6,94529,WI,Individual,No,39-1199466,94529WI0210026,"Bronze 5,000 Deductible HSA",94529WI021,7558364783,WIN001,WIS001,WIF006,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6036,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210026.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210026-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",6
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,6,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220035,"Select Bronze 5,000 Deductible HSA",94529WI022,7558364783,WIN002,WIS004,WIF005,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6136,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220025.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220035-00,Standard Bronze Off Exchange Plan,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",6
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,6,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0220035,"Select Bronze 5,000 Deductible HSA",94529WI022,7558364783,WIN002,WIS004,WIF005,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6136,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0220025.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0220035-01,Standard Bronze On Exchange Plan,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",7
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,6,94529,WI,Individual,No,39-1199466,94529WI0210026,"Bronze 5,000 Deductible HSA",94529WI021,7558364783,WIN001,WIS001,WIF006,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6036,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210026.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210026-03,Limited Cost Sharing Plan Variation,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",7
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,6,94529,WI,Individual,No,39-1199466,94529WI0210037,"Select Bronze 5,000 Deductible HSA",94529WI021,7558364783,WIN002,WIS002,WIF006,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6076,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210037.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210037-00,Standard Bronze Off Exchange Plan,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",8
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,6,94529,WI,Individual,No,39-1199466,94529WI0210037,"Select Bronze 5,000 Deductible HSA",94529WI021,7558364783,WIN002,WIS002,WIF006,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6076,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210037.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210037-01,Standard Bronze On Exchange Plan,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",9
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,6,94529,WI,Individual,No,39-1199466,94529WI0210037,"Select Bronze 5,000 Deductible HSA",94529WI021,7558364783,WIN002,WIS002,WIF006,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6076,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210037.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210037-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",10
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,6,94529,WI,Individual,No,39-1199466,94529WI0210037,"Select Bronze 5,000 Deductible HSA",94529WI021,7558364783,WIN002,WIS002,WIF006,New,HMO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6076,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210037.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210037-03,Limited Cost Sharing Plan Variation,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",11
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,7,94529,WI,Individual,No,39-1199466,94529WI0210027,"Catastrophic 6,600 Deductible",94529WI021,7558364783,WIN001,WIS001,WIF003,New,HMO,Catastrophic,Yes,Both,No,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,3,3,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6039,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210027.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210027-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,7,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0110008,Platinum 500 Deductible PPO,94529WI011,7558364783,WIN003,WIS003,WIF001,New,PPO,Platinum,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"GHC-SCW issues employer contracts to employer groups located in service area of Dane, Columbia, Iowa, and Sauk County.  Employer groups may have locations outside of Dane, Columbia, Iowa, and Sauk County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount for out of network services.",Yes,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6180,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0110008.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0110008-00,Standard Platinum Off Exchange Plan,,0.908414244651794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$0,"$1,150","$1,000",$0,$0,"$1,080",4
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,7,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0110008,Platinum 500 Deductible PPO,94529WI011,7558364783,WIN003,WIS003,WIF001,New,PPO,Platinum,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"GHC-SCW issues employer contracts to employer groups located in service area of Dane, Columbia, Iowa, and Sauk County.  Employer groups may have locations outside of Dane, Columbia, Iowa, and Sauk County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount for out of network services.",Yes,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6180,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0110008.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0110008-01,Standard Platinum On Exchange Plan,,0.908414244651794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,$0,"$1,150","$1,000",$0,$0,"$1,080",5
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,7,94529,WI,Individual,No,39-1199466,94529WI0210027,"Catastrophic 6,600 Deductible",94529WI021,7558364783,WIN001,WIS001,WIF003,New,HMO,Catastrophic,Yes,Both,No,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,3,3,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6039,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210027.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210027-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,7,94529,WI,Individual,No,39-1199466,94529WI0210038,"Select Catastrophic 6,600 Deductible",94529WI021,7558364783,WIN002,WIS002,WIF003,New,HMO,Catastrophic,Yes,Both,No,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,3,3,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6079,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210038.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210038-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,7,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0110009,"Gold 1,000 Deductible PPO",94529WI011,7558364783,WIN003,WIS003,WIF002,New,PPO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"GHC-SCW issues employer contracts to employer groups located in service area of Dane, Columbia, Iowa, and Sauk County.  Employer groups may have locations outside of Dane, Columbia, Iowa, and Sauk County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount for out of network services.",Yes,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6181,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0110009.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0110009-00,Standard Gold Off Exchange Plan,,0.814249455928802,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$730,$190,"$3,000",6
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,7,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0110009,"Gold 1,000 Deductible PPO",94529WI011,7558364783,WIN003,WIS003,WIF002,New,PPO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"GHC-SCW issues employer contracts to employer groups located in service area of Dane, Columbia, Iowa, and Sauk County.  Employer groups may have locations outside of Dane, Columbia, Iowa, and Sauk County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount for out of network services.",Yes,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6181,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0110009.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0110009-01,Standard Gold On Exchange Plan,,0.814249455928802,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,"$2,800","$2,000",$730,$190,"$3,000",7
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,7,94529,WI,Individual,No,39-1199466,94529WI0210038,"Select Catastrophic 6,600 Deductible",94529WI021,7558364783,WIN002,WIS002,WIF003,New,HMO,Catastrophic,Yes,Both,No,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,3,3,2015-01-01,2015-12-31,No,,No,,No,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6079,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0210038.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0210038-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,7,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0110011,"Silver 2,000 Deductible PPO",94529WI011,7558364783,WIN003,WIS003,WIF004,New,PPO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"GHC-SCW issues employer contracts to employer groups located in service area of Dane, Columbia, Iowa, and Sauk County.  Employer groups may have locations outside of Dane, Columbia, Iowa, and Sauk County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount for out of network services.",Yes,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6183,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0110011.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0110011-00,Standard Silver Off Exchange Plan,,0.717596411705017,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$410,$60,"$4,550",8
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,7,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0110011,"Silver 2,000 Deductible PPO",94529WI011,7558364783,WIN003,WIS003,WIF004,New,PPO,Silver,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"GHC-SCW issues employer contracts to employer groups located in service area of Dane, Columbia, Iowa, and Sauk County.  Employer groups may have locations outside of Dane, Columbia, Iowa, and Sauk County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount for out of network services.",Yes,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6183,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0110011.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0110011-01,Standard Silver On Exchange Plan,,0.717596411705017,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$350,"$4,520","$4,000",$410,$60,"$4,550",9
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,7,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0110013,"Bronze 4,000 Deductible PPO",94529WI011,7558364783,WIN003,WIS003,WIF006,New,PPO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"GHC-SCW issues employer contracts to employer groups located in service area of Dane, Columbia, Iowa, and Sauk County.  Employer groups may have locations outside of Dane, Columbia, Iowa, and Sauk County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount for out of network services.",Yes,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6185,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0110013.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0110013-00,Standard Bronze Off Exchange Plan,,0.617190957069397,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",10
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,7,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0110013,"Bronze 4,000 Deductible PPO",94529WI011,7558364783,WIN003,WIS003,WIF006,New,PPO,Bronze,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"GHC-SCW issues employer contracts to employer groups located in service area of Dane, Columbia, Iowa, and Sauk County.  Employer groups may have locations outside of Dane, Columbia, Iowa, and Sauk County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount for out of network services.",Yes,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6185,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0110013.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0110013-01,Standard Bronze On Exchange Plan,,0.617190957069397,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,200",$0,$0,"$5,350","$5,270",$0,$0,"$5,350",11
2015,WI,94529,HIOS,6,2014-11-09 04:38:15,8,94529,WI,SHOP (Small Group),No,39-1199466,94529WI0110010,"Gold 2,000 Deductible HSA PPO",94529WI011,7558364783,WIN003,WIS003,WIF003,New,PPO,Gold,No,Both,Yes,Yes,"Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"GHC-SCW issues employer contracts to employer groups located in service area of Dane, Columbia, Iowa, and Sauk County.  Employer groups may have locations outside of Dane, Columbia, Iowa, and Sauk County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount for out of network services.",Yes,https://benefitsummary.ghcscw.com/Plans/PreviewPdf/6182,https://ghcscw.com/welcome,https://ghcscw.com/SiteCollectionDocuments/Plan_Brochures/94529WI0110010.pdf,https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf,94529WI0110010-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,$0,"$2,150","$2,000",$0,$80,"$2,080",4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,1,11269,WY,Individual,No,83-0231011,11269WY0070001,BlueSelect Gold Basic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0070001-01,Standard Gold On Exchange Plan,78.05%,0.780469596385956,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$3,500","$7,000","$4,500","$9,000",,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,1,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080001,BlueSelect Gold Basic Plus Dental,11269WY008,,WYN001,WYS001,WYF001,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0080001-01,Standard Gold On Exchange Plan,78.01%,0.780111849308014,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$3,500","$7,000","$4,500","$9,000",,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,1,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080002,BlueSelect Silver Basic Plus Dental,11269WY008,,WYN001,WYS001,WYF002,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0080002-00,Standard Silver Off Exchange Plan,70.03%,0.700286328792572,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",25%,,,,"$4,500","$9,000","$6,500","$13,000",,,,,,,,,6
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,1,11269,WY,Individual,No,83-0231011,11269WY0070001,BlueSelect Gold Basic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0070001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,1,11269,WY,Individual,No,83-0231011,11269WY0070001,BlueSelect Gold Basic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0070001-03,Limited Cost Sharing Plan Variation,78.05%,0.780469596385956,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$3,500","$7,000","$4,500","$9,000",,,,,,,,,7
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,1,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080002,BlueSelect Silver Basic Plus Dental,11269WY008,,WYN001,WYS001,WYF002,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0080002-01,Standard Silver On Exchange Plan,70.03%,0.700286328792572,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",25%,,,,"$4,500","$9,000","$6,500","$13,000",,,,,,,,,7
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,1,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080003,BlueSelect Bronze Basic Plus Dental,11269WY008,,WYN001,WYS001,WYF003,Existing,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0080003-00,Standard Bronze Off Exchange Plan,61.68%,0.616817772388458,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$6,500","$13,000","$10,500","$11,000",,,,,,,,,8
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,1,11269,WY,Individual,No,83-0231011,11269WY0070002,BlueSelect Silver Basic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0070002-00,Standard Silver Off Exchange Plan,68.64%,0.6863973736763,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",25%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,8
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,1,11269,WY,Individual,No,83-0231011,11269WY0070002,BlueSelect Silver Basic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0070002-01,Standard Silver On Exchange Plan,68.64%,0.6863973736763,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",25%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,9
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,1,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080003,BlueSelect Bronze Basic Plus Dental,11269WY008,,WYN001,WYS001,WYF003,Existing,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0080003-01,Standard Bronze On Exchange Plan,61.68%,0.616817772388458,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$6,500","$13,000","$10,500","$11,000",,,,,,,,,9
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,1,11269,WY,Individual,No,83-0231011,11269WY0070002,BlueSelect Silver Basic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0070002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,1,11269,WY,Individual,No,83-0231011,11269WY0070002,BlueSelect Silver Basic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0070002-03,Limited Cost Sharing Plan Variation,68.64%,0.6863973736763,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",25%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,11
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,1,11269,WY,Individual,No,83-0231011,11269WY0070002,BlueSelect Silver Basic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0070002-04,73% AV Level Silver Plan,72.33%,0.723316311836243,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400","$17,900","$35,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",25%,,,,"$5,000","$10,000","$7,100","$14,200",,,,,,,,,12
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,1,11269,WY,Individual,No,83-0231011,11269WY0070002,BlueSelect Silver Basic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0070002-05,87% AV Level Silver Plan,86.63%,0.866335332393646,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,700","$25,400","$14,950","$29,900",,,,,,,,,,,,,,,,,,,,,$400,$800,25%,,,,"$5,000","$10,000","$5,400","$10,800",,,,,,,,,13
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,1,11269,WY,Individual,No,83-0231011,11269WY0070002,BlueSelect Silver Basic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0070002-06,94% AV Level Silver Plan,93.66%,0.936602890491486,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$850,"$1,700",,,"$12,700","$25,400","$13,550","$27,100",,,,,,,,,,,,,,,,,,,,,$100,$200,25%,,,,"$5,000","$10,000","$5,100","$10,200",,,,,,,,,14
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,1,11269,WY,Individual,No,83-0231011,11269WY0070003,BlueSelect Bronze Basic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0070003-00,Standard Bronze Off Exchange Plan,61.90%,0.619034111499786,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$8,000","$15,000","$13,500","$26,000",,,,,,,,,15
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,1,11269,WY,Individual,No,83-0231011,11269WY0070003,BlueSelect Bronze Basic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0070003-01,Standard Bronze On Exchange Plan,61.90%,0.619034111499786,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$8,000","$15,000","$13,500","$26,000",,,,,,,,,16
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,1,11269,WY,Individual,No,83-0231011,11269WY0070003,BlueSelect Bronze Basic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0070003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,17
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,1,11269,WY,Individual,No,83-0231011,11269WY0070003,BlueSelect Bronze Basic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0070003-03,Limited Cost Sharing Plan Variation,61.90%,0.619034111499786,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$8,000","$15,000","$13,500","$26,000",,,,,,,,,18
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,Individual,No,83-0231011,11269WY0070004,BlueSelect Bronze HSA Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0070004-00,Standard Bronze Off Exchange Plan,59.91%,0.599059820175171,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$6,000",50%,,,,"$6,000","$12,000","$9,500","$18,000",,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080004,BlueSelect Bronze HSAOne Plus Dental,11269WY008,,WYN001,WYS001,WYF004,Existing,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0080004-00,Standard Bronze Off Exchange Plan,59.91%,0.599059820175171,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$6,000",50%,,,,"$6,000","$12,000","$9,500","$18,000",,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080004,BlueSelect Bronze HSAOne Plus Dental,11269WY008,,WYN001,WYS001,WYF004,Existing,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0080004-01,Standard Bronze On Exchange Plan,59.91%,0.599059820175171,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$6,000",50%,,,,"$6,000","$12,000","$9,500","$18,000",,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,Individual,No,83-0231011,11269WY0070004,BlueSelect Bronze HSA Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0070004-01,Standard Bronze On Exchange Plan,59.91%,0.599059820175171,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$6,000",50%,,,,"$6,000","$12,000","$9,500","$18,000",,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,Individual,No,83-0231011,11269WY0070004,BlueSelect Bronze HSA Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0070004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080013,BlueSelect Gold HSA Plus Dental,11269WY008,,WYN001,WYS001,WYF007,New,PPO,Gold,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0080013-00,Standard Gold Off Exchange Plan,79.29%,0.792936325073242,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$8,550","$17,100","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",5%,,,,"$4,000","$5,500","$5,500","$8,500",,,,,,,,,6
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080013,BlueSelect Gold HSA Plus Dental,11269WY008,,WYN001,WYS001,WYF007,New,PPO,Gold,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0080013-01,Standard Gold On Exchange Plan,79.29%,0.792936325073242,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$8,550","$17,100","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",5%,,,,"$4,000","$5,500","$5,500","$8,500",,,,,,,,,7
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,Individual,No,83-0231011,11269WY0070004,BlueSelect Bronze HSA Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0070004-03,Limited Cost Sharing Plan Variation,59.91%,0.599059820175171,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$6,000",50%,,,,"$6,000","$12,000","$9,500","$18,000",,,,,,,,,7
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,Individual,No,83-0231011,11269WY0070012,BlueSelect Gold HSA Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF007,New,PPO,Gold,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070012-00,Standard Gold Off Exchange Plan,81.00%,0.810047090053558,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$8,550","$17,100","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",5%,,,,"$3,800","$5,100","$5,100","$7,700",,,,,,,,,8
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080014,BlueSelect Silver HSA Plus Dental,11269WY008,,WYN001,WYS001,WYF018,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0080014-00,Standard Silver Off Exchange Plan,69.70%,0.696969985961914,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$9,700","$19,400","$16,150","$32,300",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",25%,,,,"$4,000","$5,500","$5,500","$8,500",,,,,,,,,8
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080014,BlueSelect Silver HSA Plus Dental,11269WY008,,WYN001,WYS001,WYF018,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0080014-01,Standard Silver On Exchange Plan,69.70%,0.696969985961914,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$9,700","$19,400","$16,150","$32,300",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",25%,,,,"$4,000","$5,500","$5,500","$8,500",,,,,,,,,9
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,Individual,No,83-0231011,11269WY0070012,BlueSelect Gold HSA Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF007,New,PPO,Gold,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070012-01,Standard Gold On Exchange Plan,81.00%,0.810047090053558,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$8,550","$17,100","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",5%,,,,"$3,800","$5,100","$5,100","$7,700",,,,,,,,,9
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,Individual,No,83-0231011,11269WY0070012,BlueSelect Gold HSA Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF007,New,PPO,Gold,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070012-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080015,BlueSelect Bronze HSATwo with Dental,11269WY008,,WYN001,WYS001,WYF015,New,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0080015-00,Standard Bronze Off Exchange Plan,59.21%,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,500","$21,000","$16,500","$33,000",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$8,500","$14,500","$14,500","$26,500",,,,,,,,,10
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080015,BlueSelect Bronze HSATwo with Dental,11269WY008,,WYN001,WYS001,WYF015,New,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0080015-01,Standard Bronze On Exchange Plan,59.21%,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,500","$21,000","$16,500","$33,000",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$8,500","$14,500","$14,500","$26,500",,,,,,,,,11
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,Individual,No,83-0231011,11269WY0070012,BlueSelect Gold HSA Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF007,New,PPO,Gold,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070012-03,Limited Cost Sharing Plan Variation,81.00%,0.810047090053558,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$8,550","$17,100","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",5%,,,,"$3,800","$5,100","$5,100","$7,700",,,,,,,,,11
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,Individual,No,83-0231011,11269WY0070015,BlueSelect Silver HSA Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070015-00,Standard Silver Off Exchange Plan,68.51%,0.685117065906525,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$9,700","$19,400","$16,150","$32,300",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,500","$6,500","$6,500","$10,500",,,,,,,,,12
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,Individual,No,83-0231011,11269WY0070015,BlueSelect Silver HSA Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070015-01,Standard Silver On Exchange Plan,68.51%,0.685117065906525,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$9,700","$19,400","$16,150","$32,300",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,500","$6,500","$6,500","$10,500",,,,,,,,,13
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,Individual,No,83-0231011,11269WY0070015,BlueSelect Silver HSA Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070015-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,Individual,No,83-0231011,11269WY0070015,BlueSelect Silver HSA Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070015-03,Limited Cost Sharing Plan Variation,68.51%,0.685117065906525,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$9,700","$19,400","$16,150","$32,300",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,500","$6,500","$6,500","$10,500",,,,,,,,,15
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,Individual,No,83-0231011,11269WY0070015,BlueSelect Silver HSA Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070015-04,73% AV Level Silver Plan,72.48%,0.724834859371185,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$9,700","$19,400","$14,900","$29,800",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$4,500","$6,500","$6,000","$9,500",,,,,,,,,16
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,Individual,No,83-0231011,11269WY0070015,BlueSelect Silver HSA Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070015-05,87% AV Level Silver Plan,86.70%,0.867013514041901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$9,700","$19,400","$11,950","$23,900",,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,"$4,500","$6,500","$4,700","$6,900",,,,,,,,,17
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,Individual,No,83-0231011,11269WY0070015,BlueSelect Silver HSA Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070015-06,94% AV Level Silver Plan,93.66%,0.936563849449158,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$9,700","$19,400","$10,300","$20,600",,,,,,,,,,,,,,,,,,,,,$100,$200,20%,,,,"$4,500","$6,500","$4,600","$6,700",,,,,,,,,18
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,Individual,No,83-0231011,11269WY0070020,BlueSelect Bronze Classic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF015,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070020-00,Standard Bronze Off Exchange Plan,61.04%,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$9,550","$19,100","$15,050","$30,100",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$8,000","$13,500","$13,500","$24,500",,,,,,,,,19
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,Individual,No,83-0231011,11269WY0070020,BlueSelect Bronze Classic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF015,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070020-01,Standard Bronze On Exchange Plan,61.04%,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$9,550","$19,100","$15,050","$30,100",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$8,000","$13,500","$13,500","$24,500",,,,,,,,,20
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,2,11269,WY,Individual,No,83-0231011,11269WY0070020,BlueSelect Bronze Classic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF015,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070020-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,21
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,5,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080016,BlueSelect Gold Classic Plus Dental,11269WY008,,WYN001,WYS001,WYF016,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0080016-00,Standard Gold Off Exchange Plan,79.26%,0.792572379112244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$8,800","$17,600","$15,400","$28,600",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",25%,,,,"$3,000","$3,500","$3,500","$4,500",,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,5,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080016,BlueSelect Gold Classic Plus Dental,11269WY008,,WYN001,WYS001,WYF016,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0080016-01,Standard Gold On Exchange Plan,79.26%,0.792572379112244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$8,800","$17,600","$15,400","$28,600",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",25%,,,,"$3,000","$3,500","$3,500","$4,500",,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,6,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080010,BlueSelect Silver HealthPlus with Dental,11269WY008,,WYN001,WYS001,WYF011,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0080010-00,Standard Silver Off Exchange Plan,70.90%,0.697564482688904,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$9,900","$19,800","$16,500","$33,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",25%,,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,6,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080010,BlueSelect Silver HealthPlus with Dental,11269WY008,,WYN001,WYS001,WYF011,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0080010-01,Standard Silver On Exchange Plan,70.90%,0.697564482688904,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$9,900","$19,800","$16,500","$33,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",25%,,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,6,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080017,BlueSelect Gold HealthPlus with Dental,11269WY008,,WYN001,WYS001,WYF006,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0080017-00,Standard Gold Off Exchange Plan,78.60%,0.78067535161972,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$8,250","$16,700","$14,500","$29,200",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$3,500","$7,000","$4,500","$9,000",,,,,,,,,6
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,6,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080017,BlueSelect Gold HealthPlus with Dental,11269WY008,,WYN001,WYS001,WYF006,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0080017-01,Standard Gold On Exchange Plan,78.60%,0.78067535161972,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$8,250","$16,700","$14,500","$29,200",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$3,500","$7,000","$4,500","$9,000",,,,,,,,,7
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,7,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080011,BlueSelect Silver Classic Plus Dental,11269WY008,,WYN001,WYS001,WYF017,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0080011-00,Standard Silver Off Exchange Plan,69.94%,0.699410796165466,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$9,900","$19,800","$16,500","$33,000",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$3,900","$5,300","$3,300","$8,100",,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,7,11269,WY,Individual,No,83-0231011,11269WY0070011,BlueSelect Gold Classic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF006,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070011-00,Standard Gold Off Exchange Plan,79.31%,0.793082475662231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$8,800","$17,600","$15,400","$30,800",,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$3,250","$4,000","$4,000","$5,500",,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,7,11269,WY,Individual,No,83-0231011,11269WY0070011,BlueSelect Gold Classic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF006,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070011-01,Standard Gold On Exchange Plan,79.31%,0.793082475662231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$8,800","$17,600","$15,400","$30,800",,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$3,250","$4,000","$4,000","$5,500",,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,7,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080011,BlueSelect Silver Classic Plus Dental,11269WY008,,WYN001,WYS001,WYF017,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0080011-01,Standard Silver On Exchange Plan,69.94%,0.699410796165466,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$9,900","$19,800","$16,500","$33,000",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$3,900","$5,300","$3,300","$8,100",,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,7,11269,WY,Individual,No,83-0231011,11269WY0070011,BlueSelect Gold Classic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF006,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,7,11269,WY,Individual,No,83-0231011,11269WY0070011,BlueSelect Gold Classic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF006,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070011-03,Limited Cost Sharing Plan Variation,79.31%,0.793082475662231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$8,800","$17,600","$15,400","$30,800",,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$3,250","$4,000","$4,000","$5,500",,,,,,,,,7
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,7,11269,WY,Individual,No,83-0231011,11269WY0070014,BlueSelect Silver Classic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070014-00,Standard Silver Off Exchange Plan,69.09%,0.690910041332245,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$8,750","$17,500","$14,750","$29,500",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",35%,,,,"$4,500","$6,500","$6,500","$10,500",,,,,,,,,8
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,7,11269,WY,Individual,No,83-0231011,11269WY0070014,BlueSelect Silver Classic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070014-01,Standard Silver On Exchange Plan,69.09%,0.690910041332245,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$8,750","$17,500","$14,750","$29,500",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",35%,,,,"$4,500","$6,500","$6,500","$10,500",,,,,,,,,9
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,7,11269,WY,Individual,No,83-0231011,11269WY0070014,BlueSelect Silver Classic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070014-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,7,11269,WY,Individual,No,83-0231011,11269WY0070014,BlueSelect Silver Classic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070014-03,Limited Cost Sharing Plan Variation,69.09%,0.690910041332245,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$8,750","$17,500","$14,750","$29,500",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",35%,,,,"$4,500","$6,500","$6,500","$10,500",,,,,,,,,11
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,7,11269,WY,Individual,No,83-0231011,11269WY0070014,BlueSelect Silver Classic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070014-04,73% AV Level Silver Plan,72.40%,0.723968625068665,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$8,750","$17,500","$13,950","$27,900",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",35%,,,,"$4,500","$6,500","$6,100","$9,700",,,,,,,,,12
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,7,11269,WY,Individual,No,83-0231011,11269WY0070014,BlueSelect Silver Classic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070014-05,87% AV Level Silver Plan,87.15%,0.871481001377106,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$8,750","$17,500","$11,000","$22,000",,,,,,,,,,,,,,,,,,,,,$100,$200,35%,,,,"$4,500","$6,500","$4,600","$6,700",,,,,,,,,13
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,7,11269,WY,Individual,No,83-0231011,11269WY0070014,BlueSelect Silver Classic Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070014-06,94% AV Level Silver Plan,93.83%,0.938290417194366,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$8,750","$17,500","$9,500","$19,000",,,,,,,,,,,,,,,,,,,,,$50,$100,35%,,,,"$4,500","$6,500","$4,550","$6,600",,,,,,,,,14
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,8,11269,WY,Individual,No,83-0231011,11269WY0070013,BlueSelect Gold HealthPlus with Dental,11269WY007,7154324389,WYN001,WYS001,WYF008,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070013-00,Standard Gold Off Exchange Plan,80.30%,0.795480728149414,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$8,800","$17,600","$15,400","$30,800",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",15%,,,,"$3,500","$7,000","$4,500","$9,000",,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,8,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080012,BlueSelect Bronze Value Plus Dental,11269WY008,,WYN001,WYS001,WYF019,New,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0080012-00,Standard Bronze Off Exchange Plan,58.87%,0.588734745979309,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",50%,,,,"$10,000","$20,000","$15,000","$30,000","$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,8,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0080012,BlueSelect Bronze Value Plus Dental,11269WY008,,WYN001,WYS001,WYF019,New,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0080012-01,Standard Bronze On Exchange Plan,58.87%,0.588734745979309,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",50%,,,,"$10,000","$20,000","$15,000","$30,000","$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,8,11269,WY,Individual,No,83-0231011,11269WY0070013,BlueSelect Gold HealthPlus with Dental,11269WY007,7154324389,WYN001,WYS001,WYF008,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070013-01,Standard Gold On Exchange Plan,80.30%,0.795480728149414,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$8,800","$17,600","$15,400","$30,800",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",15%,,,,"$3,500","$7,000","$4,500","$9,000",,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,8,11269,WY,Individual,No,83-0231011,11269WY0070013,BlueSelect Gold HealthPlus with Dental,11269WY007,7154324389,WYN001,WYS001,WYF008,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070013-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,8,11269,WY,Individual,No,83-0231011,11269WY0070013,BlueSelect Gold HealthPlus with Dental,11269WY007,7154324389,WYN001,WYS001,WYF008,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070013-03,Limited Cost Sharing Plan Variation,80.30%,0.795480728149414,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$8,800","$17,600","$15,400","$30,800",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",15%,,,,"$3,500","$7,000","$4,500","$9,000",,,,,,,,,7
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,8,11269,WY,Individual,No,83-0231011,11269WY0070016,BlueSelect Silver HealthPlus with Dental,11269WY007,7154324389,WYN001,WYS001,WYF011,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070016-00,Standard Silver Off Exchange Plan,69.40%,0.682893872261047,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$9,900","$19,800","$16,500","$33,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",25%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,8
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,8,11269,WY,Individual,No,83-0231011,11269WY0070016,BlueSelect Silver HealthPlus with Dental,11269WY007,7154324389,WYN001,WYS001,WYF011,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070016-01,Standard Silver On Exchange Plan,69.40%,0.682893872261047,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$9,900","$19,800","$16,500","$33,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",25%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,9
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,8,11269,WY,Individual,No,83-0231011,11269WY0070016,BlueSelect Silver HealthPlus with Dental,11269WY007,7154324389,WYN001,WYS001,WYF011,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070016-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,8,11269,WY,Individual,No,83-0231011,11269WY0070016,BlueSelect Silver HealthPlus with Dental,11269WY007,7154324389,WYN001,WYS001,WYF011,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070016-03,Limited Cost Sharing Plan Variation,69.40%,0.682893872261047,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$9,900","$19,800","$16,500","$33,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",25%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,11
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,8,11269,WY,Individual,No,83-0231011,11269WY0070016,BlueSelect Silver HealthPlus with Dental,11269WY007,7154324389,WYN001,WYS001,WYF011,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070016-04,73% AV Level Silver Plan,72.50%,0.715461373329163,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$9,900","$19,800","$15,100","$30,200",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",25%,,,,"$5,000","$10,000","$7,100","$14,200",,,,,,,,,12
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,8,11269,WY,Individual,No,83-0231011,11269WY0070016,BlueSelect Silver HealthPlus with Dental,11269WY007,7154324389,WYN001,WYS001,WYF011,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070016-05,87% AV Level Silver Plan,86.50%,0.863705217838287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$9,900","$19,800","$11,900","$23,800",,,,,,,,,,,,,,,,,,,,,$400,$800,25%,,,,"$5,000","$10,000","$5,400","$10,800",,,,,,,,,13
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,8,11269,WY,Individual,No,83-0231011,11269WY0070016,BlueSelect Silver HealthPlus with Dental,11269WY007,7154324389,WYN001,WYS001,WYF011,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070016-06,94% AV Level Silver Plan,93.40%,0.937383472919464,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$9,900","$19,800","$10,650","$21,300",,,,,,,,,,,,,,,,,,,,,$100,$200,25%,,,,"$5,000","$10,000","$5,100","$10,200",,,,,,,,,14
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,9,11269,WY,Individual,No,83-0231011,11269WY0070021,BlueSelect Silver ValueOne Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF012,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070021-00,Standard Silver Off Exchange Plan,68.90%,0.674259424209595,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$3,500","$7,000",50%,,,,"$7,000","$14,000","$10,500","$21,000",$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,9,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190001,BlueSelect Gold Classic,11269WY019,,WYN001,WYS001,WYF016,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0190001-00,Standard Gold Off Exchange Plan,79.26%,0.792572379112244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$8,800","$17,600","$15,400","$28,600",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",25%,,,,"$3,000","$3,500","$3,500","$4,500",,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,9,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190001,BlueSelect Gold Classic,11269WY019,,WYN001,WYS001,WYF016,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0190001-01,Standard Gold On Exchange Plan,79.26%,0.792572379112244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$8,800","$17,600","$15,400","$28,600",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",25%,,,,"$3,000","$3,500","$3,500","$4,500",,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,9,11269,WY,Individual,No,83-0231011,11269WY0070021,BlueSelect Silver ValueOne Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF012,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070021-01,Standard Silver On Exchange Plan,68.90%,0.674259424209595,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$3,500","$7,000",50%,,,,"$7,000","$14,000","$10,500","$21,000",$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,9,11269,WY,Individual,No,83-0231011,11269WY0070021,BlueSelect Silver ValueOne Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF012,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070021-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,9,11269,WY,Individual,No,83-0231011,11269WY0070021,BlueSelect Silver ValueOne Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF012,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070021-03,Limited Cost Sharing Plan Variation,68.90%,0.674259424209595,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$3,500","$7,000",50%,,,,"$7,000","$14,000","$10,500","$21,000",$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,9,11269,WY,Individual,No,83-0231011,11269WY0070021,BlueSelect Silver ValueOne Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF012,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070021-04,73% AV Level Silver Plan,72.20%,0.721754431724548,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$10,000","$20,000","$14,000","$28,000","$3,000","$6,000",50%,,,,"$7,000","$14,000","$10,000","$20,000",$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,10,11269,WY,Individual,No,83-0231011,11269WY0070018,BlueSelect Silver ValueTwo Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF013,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070018-00,Standard Silver Off Exchange Plan,68.52%,0.683096170425415,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$3,000","$6,000",20%,,,,"$6,000","$12,000","$9,000","$18,000",$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,10,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190002,BlueSelect Gold HSA,11269WY019,,WYN001,WYS001,WYF007,New,PPO,Gold,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0190002-00,Standard Gold Off Exchange Plan,79.29%,0.792936325073242,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$8,550","$17,100","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",5%,,,,"$4,000","$5,500","$5,500","$8,500",,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,10,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190002,BlueSelect Gold HSA,11269WY019,,WYN001,WYS001,WYF007,New,PPO,Gold,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0190002-01,Standard Gold On Exchange Plan,79.29%,0.792936325073242,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$8,550","$17,100","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",5%,,,,"$4,000","$5,500","$5,500","$8,500",,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,10,11269,WY,Individual,No,83-0231011,11269WY0070018,BlueSelect Silver ValueTwo Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF013,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070018-01,Standard Silver On Exchange Plan,68.52%,0.683096170425415,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$3,000","$6,000",20%,,,,"$6,000","$12,000","$9,000","$18,000",$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,10,11269,WY,Individual,No,83-0231011,11269WY0070018,BlueSelect Silver ValueTwo Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF013,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070018-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,10,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190003,BlueSelect Silver HSA,11269WY019,,WYN001,WYS001,WYF018,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0190003-00,Standard Silver Off Exchange Plan,69.70%,0.696969985961914,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$9,700","$19,400","$16,150","$32,300",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",25%,,,,"$4,000","$5,500","$5,500","$8,500",,,,,,,,,6
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,10,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190003,BlueSelect Silver HSA,11269WY019,,WYN001,WYS001,WYF018,New,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0190003-01,Standard Silver On Exchange Plan,69.70%,0.696969985961914,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$9,700","$19,400","$16,150","$32,300",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",25%,,,,"$4,000","$5,500","$5,500","$8,500",,,,,,,,,7
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,10,11269,WY,Individual,No,83-0231011,11269WY0070018,BlueSelect Silver ValueTwo Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF013,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070018-03,Limited Cost Sharing Plan Variation,68.52%,0.683096170425415,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$3,000","$6,000",20%,,,,"$6,000","$12,000","$9,000","$18,000",$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,4,47731,WY,SHOP (Small Group),Yes,95-6042390,47731WY0010011,BEST Dental Choice-L,47731WY001,,WYN001,WYS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.61,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BESTDental_Choice-L_Plan.pdf,,47731WY0010011-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,4,47731,WY,SHOP (Small Group),Yes,95-6042390,47731WY0010012,BEST Dental Value,47731WY001,,WYN001,WYS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.61,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BESTDental_Value_Plan.pdf,,47731WY0010012-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,4,47731,WY,SHOP (Small Group),Yes,95-6042390,47731WY0010012,BEST Dental Value,47731WY001,,WYN001,WYS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.61,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BESTDental_Value_Plan.pdf,,47731WY0010012-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,WY,48887,HIOS,2,2014-08-07 10:00:19,1,48887,WY,SHOP (Small Group),Yes,44-0308260,48887WY0010001,KCL EHB Low PPO,48887WY001,,WYN001,WYS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$37.83,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,48887WY0010001-00,Standard Low Off Exchange Plan,70.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,48887,HIOS,2,2014-08-07 10:00:19,1,48887,WY,SHOP (Small Group),Yes,44-0308260,48887WY0010003,KCL EHB Low MAC,48887WY001,,WYN001,WYS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$28.80,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,48887WY0010003-00,Standard Low Off Exchange Plan,70.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,10,11269,WY,Individual,No,83-0231011,11269WY0070018,BlueSelect Silver ValueTwo Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF013,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070018-06,94% AV Level Silver Plan,93.30%,0.945738434791565,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,"$13,200","$26,400","$13,900","$27,800",$150,$300,0%,,,,"$6,000","$12,000","$6,150","$12,300",$50,$100,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,14,11269,WY,Individual,No,83-0231011,11269WY0170007,BlueSelect Gold HealthPlus,11269WY017,7154324389,WYN001,WYS001,WYF008,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170007-01,Standard Gold On Exchange Plan,80.30%,0.795480728149414,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$8,800","$17,600","$15,400","$30,800",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",15%,,,,"$3,500","$7,000","$4,500","$9,000",,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,14,11269,WY,Individual,No,83-0231011,11269WY0170007,BlueSelect Gold HealthPlus,11269WY017,7154324389,WYN001,WYS001,WYF008,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,14,11269,WY,Individual,No,83-0231011,11269WY0170007,BlueSelect Gold HealthPlus,11269WY017,7154324389,WYN001,WYS001,WYF008,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170007-03,Limited Cost Sharing Plan Variation,80.30%,0.795480728149414,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$8,800","$17,600","$15,400","$30,800",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",15%,,,,"$3,500","$7,000","$4,500","$9,000",,,,,,,,,7
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,14,11269,WY,Individual,No,83-0231011,11269WY0170008,BlueSelect Silver HealthPlus,11269WY017,7154324389,WYN001,WYS001,WYF011,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170008-06,94% AV Level Silver Plan,93.40%,0.937383472919464,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$9,900","$19,800","$10,650","$21,300",,,,,,,,,,,,,,,,,,,,,$100,$200,25%,,,,"$5,000","$10,000","$5,100","$10,200",,,,,,,,,14
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,15,11269,WY,Individual,No,83-0231011,11269WY0170015,BlueSelect Silver ValueOne,11269WY017,7154324389,WYN001,WYS001,WYF012,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170015-00,Standard Silver Off Exchange Plan,68.90%,0.674259424209595,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$3,500","$7,000",50%,,,,"$7,000","$14,000","$10,500","$21,000",$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,10,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190005,BlueSelect Bronze HSAOne,11269WY019,,WYN001,WYS001,WYF004,New,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0190005-00,Standard Bronze Off Exchange Plan,59.91%,0.599059820175171,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$6,000",50%,,,,"$6,000","$12,000","$9,500","$18,000",,,,,,,,,10
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,10,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190005,BlueSelect Bronze HSAOne,11269WY019,,WYN001,WYS001,WYF004,New,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0190005-01,Standard Bronze On Exchange Plan,59.91%,0.599059820175171,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$6,000",50%,,,,"$6,000","$12,000","$9,500","$18,000",,,,,,,,,11
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,11,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190006,BlueSelect Gold HealthPlus,11269WY019,,WYN001,WYS001,WYF006,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0190006-00,Standard Gold Off Exchange Plan,78.60%,0.78067535161972,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$8,250","$16,700","$14,500","$29,200",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$3,500","$7,000","$4,500","$9,000",,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,11,11269,WY,Individual,No,83-0231011,11269WY0070019,BlueSelect Bronze Value Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF014,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070019-00,Standard Bronze Off Exchange Plan,61.52%,0.615162312984467,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$13,000","$26,000","$19,500","$39,000","$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000","$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,11,11269,WY,Individual,No,83-0231011,11269WY0070019,BlueSelect Bronze Value Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF014,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070019-01,Standard Bronze On Exchange Plan,61.52%,0.615162312984467,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$13,000","$26,000","$19,500","$39,000","$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000","$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,11,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190006,BlueSelect Gold HealthPlus,11269WY019,,WYN001,WYS001,WYF006,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0190006-01,Standard Gold On Exchange Plan,78.60%,0.78067535161972,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$8,250","$16,700","$14,500","$29,200",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$3,500","$7,000","$4,500","$9,000",,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,11,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190007,BlueSelect Silver HealthPlus,11269WY019,,WYN001,WYS001,WYF011,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0190007-00,Standard Silver Off Exchange Plan,70.90%,0.697564482688904,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$9,900","$19,800","$16,500","$33,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",25%,,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,6
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,11,11269,WY,Individual,No,83-0231011,11269WY0070019,BlueSelect Bronze Value Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF014,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070019-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,11,11269,WY,Individual,No,83-0231011,11269WY0070019,BlueSelect Bronze Value Plus Dental,11269WY007,7154324389,WYN001,WYS001,WYF014,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0070019-03,Limited Cost Sharing Plan Variation,61.52%,0.615162312984467,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$13,000","$26,000","$19,500","$39,000","$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000","$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,11,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190007,BlueSelect Silver HealthPlus,11269WY019,,WYN001,WYS001,WYF011,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0190007-01,Standard Silver On Exchange Plan,70.90%,0.697564482688904,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$9,900","$19,800","$16,500","$33,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",25%,,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,7
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,12,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190008,BlueSelect Silver Classic,11269WY019,,WYN001,WYS001,WYF017,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0190008-00,Standard Silver Off Exchange Plan,69.94%,0.699410796165466,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$9,900","$19,800","$16,500","$33,000",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$3,900","$5,300","$3,300","$8,100",,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,12,11269,WY,Individual,No,83-0231011,11269WY0170001,BlueSelect Gold Classic,11269WY017,7154324389,WYN001,WYS001,WYF006,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170001-00,Standard Gold Off Exchange Plan,79.31%,0.793082475662231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$8,800","$17,600","$15,400","$30,800",,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$3,250","$4,000","$4,000","$5,500",,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,12,11269,WY,Individual,No,83-0231011,11269WY0170001,BlueSelect Gold Classic,11269WY017,7154324389,WYN001,WYS001,WYF006,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170001-01,Standard Gold On Exchange Plan,79.31%,0.793082475662231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$8,800","$17,600","$15,400","$30,800",,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$3,250","$4,000","$4,000","$5,500",,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,12,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190008,BlueSelect Silver Classic,11269WY019,,WYN001,WYS001,WYF017,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0190008-01,Standard Silver On Exchange Plan,69.94%,0.699410796165466,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$9,900","$19,800","$16,500","$33,000",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$3,900","$5,300","$3,300","$8,100",,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,12,11269,WY,Individual,No,83-0231011,11269WY0170001,BlueSelect Gold Classic,11269WY017,7154324389,WYN001,WYS001,WYF006,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,12,11269,WY,Individual,No,83-0231011,11269WY0170001,BlueSelect Gold Classic,11269WY017,7154324389,WYN001,WYS001,WYF006,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170001-03,Limited Cost Sharing Plan Variation,79.31%,0.793082475662231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$8,800","$17,600","$15,400","$30,800",,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$3,250","$4,000","$4,000","$5,500",,,,,,,,,7
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,12,11269,WY,Individual,No,83-0231011,11269WY0170002,BlueSelect Silver Classic,11269WY017,7154324389,WYN001,WYS001,WYF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170002-00,Standard Silver Off Exchange Plan,69.09%,0.690910041332245,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$8,750","$17,500","$14,750","$29,500",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",35%,,,,"$4,500","$6,500","$6,500","$10,500",,,,,,,,,8
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,12,11269,WY,Individual,No,83-0231011,11269WY0170002,BlueSelect Silver Classic,11269WY017,7154324389,WYN001,WYS001,WYF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170002-01,Standard Silver On Exchange Plan,69.09%,0.690910041332245,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$8,750","$17,500","$14,750","$29,500",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",35%,,,,"$4,500","$6,500","$6,500","$10,500",,,,,,,,,9
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,12,11269,WY,Individual,No,83-0231011,11269WY0170002,BlueSelect Silver Classic,11269WY017,7154324389,WYN001,WYS001,WYF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,12,11269,WY,Individual,No,83-0231011,11269WY0170002,BlueSelect Silver Classic,11269WY017,7154324389,WYN001,WYS001,WYF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170002-03,Limited Cost Sharing Plan Variation,69.09%,0.690910041332245,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$8,750","$17,500","$14,750","$29,500",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",35%,,,,"$4,500","$6,500","$6,500","$10,500",,,,,,,,,11
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,12,11269,WY,Individual,No,83-0231011,11269WY0170002,BlueSelect Silver Classic,11269WY017,7154324389,WYN001,WYS001,WYF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170002-04,73% AV Level Silver Plan,72.40%,0.723968625068665,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$8,750","$17,500","$13,950","$27,900",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",35%,,,,"$4,500","$6,500","$6,100","$9,700",,,,,,,,,12
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,12,11269,WY,Individual,No,83-0231011,11269WY0170002,BlueSelect Silver Classic,11269WY017,7154324389,WYN001,WYS001,WYF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170002-05,87% AV Level Silver Plan,87.15%,0.871481001377106,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$8,750","$17,500","$11,000","$22,000",,,,,,,,,,,,,,,,,,,,,$100,$200,35%,,,,"$4,500","$6,500","$4,600","$6,700",,,,,,,,,13
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,12,11269,WY,Individual,No,83-0231011,11269WY0170002,BlueSelect Silver Classic,11269WY017,7154324389,WYN001,WYS001,WYF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,2,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170002-06,94% AV Level Silver Plan,93.83%,0.938290417194366,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$8,750","$17,500","$9,500","$19,000",,,,,,,,,,,,,,,,,,,,,$50,$100,35%,,,,"$4,500","$6,500","$4,550","$6,600",,,,,,,,,14
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,13,11269,WY,Individual,No,83-0231011,11269WY0170003,BlueSelect Gold HSA,11269WY017,7154324389,WYN001,WYS001,WYF007,New,PPO,Gold,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170003-00,Standard Gold Off Exchange Plan,81.00%,0.810047090053558,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$8,550","$17,100","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",5%,,,,"$3,800","$5,100","$5,100","$7,700",,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,13,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190009,BlueSelect Bronze Value,11269WY019,,WYN001,WYS001,WYF019,New,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0190009-00,Standard Bronze Off Exchange Plan,58.87%,0.588734745979309,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",50%,,,,"$10,000","$20,000","$15,000","$30,000","$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,13,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190009,BlueSelect Bronze Value,11269WY019,,WYN001,WYS001,WYF019,New,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0190009-01,Standard Bronze On Exchange Plan,58.87%,0.588734745979309,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$5,000","$10,000",50%,,,,"$10,000","$20,000","$15,000","$30,000","$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,13,11269,WY,Individual,No,83-0231011,11269WY0170003,BlueSelect Gold HSA,11269WY017,7154324389,WYN001,WYS001,WYF007,New,PPO,Gold,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170003-01,Standard Gold On Exchange Plan,81.00%,0.810047090053558,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$8,550","$17,100","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",5%,,,,"$3,800","$5,100","$5,100","$7,700",,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,13,11269,WY,Individual,No,83-0231011,11269WY0170003,BlueSelect Gold HSA,11269WY017,7154324389,WYN001,WYS001,WYF007,New,PPO,Gold,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,13,11269,WY,Individual,No,83-0231011,11269WY0170003,BlueSelect Gold HSA,11269WY017,7154324389,WYN001,WYS001,WYF007,New,PPO,Gold,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170003-03,Limited Cost Sharing Plan Variation,81.00%,0.810047090053558,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$8,550","$17,100","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",5%,,,,"$3,800","$5,100","$5,100","$7,700",,,,,,,,,7
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,13,11269,WY,Individual,No,83-0231011,11269WY0170004,BlueSelect Silver HSA,11269WY017,7154324389,WYN001,WYS001,WYF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170004-00,Standard Silver Off Exchange Plan,68.51%,0.685117065906525,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$9,700","$19,400","$16,150","$32,300",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,500","$6,500","$6,500","$10,500",,,,,,,,,8
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,13,11269,WY,Individual,No,83-0231011,11269WY0170004,BlueSelect Silver HSA,11269WY017,7154324389,WYN001,WYS001,WYF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170004-01,Standard Silver On Exchange Plan,68.51%,0.685117065906525,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$9,700","$19,400","$16,150","$32,300",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,500","$6,500","$6,500","$10,500",,,,,,,,,9
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,13,11269,WY,Individual,No,83-0231011,11269WY0170004,BlueSelect Silver HSA,11269WY017,7154324389,WYN001,WYS001,WYF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,13,11269,WY,Individual,No,83-0231011,11269WY0170004,BlueSelect Silver HSA,11269WY017,7154324389,WYN001,WYS001,WYF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170004-03,Limited Cost Sharing Plan Variation,68.51%,0.685117065906525,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$9,700","$19,400","$16,150","$32,300",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,500","$6,500","$6,500","$10,500",,,,,,,,,11
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,13,11269,WY,Individual,No,83-0231011,11269WY0170004,BlueSelect Silver HSA,11269WY017,7154324389,WYN001,WYS001,WYF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170004-04,73% AV Level Silver Plan,72.48%,0.724834859371185,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$9,700","$19,400","$14,900","$29,800",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$4,500","$6,500","$6,000","$9,500",,,,,,,,,12
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,13,11269,WY,Individual,No,83-0231011,11269WY0170005,BlueSelect Bronze Classic,11269WY017,7154324389,WYN001,WYS001,WYF015,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170005-01,Standard Bronze On Exchange Plan,61.04%,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$9,550","$19,100","$15,050","$30,100",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$8,000","$13,500","$13,500","$24,500",,,,,,,,,16
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,13,11269,WY,Individual,No,83-0231011,11269WY0170005,BlueSelect Bronze Classic,11269WY017,7154324389,WYN001,WYS001,WYF015,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,17
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,13,11269,WY,Individual,No,83-0231011,11269WY0170005,BlueSelect Bronze Classic,11269WY017,7154324389,WYN001,WYS001,WYF015,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170005-03,Limited Cost Sharing Plan Variation,61.04%,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$9,550","$19,100","$15,050","$30,100",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$8,000","$13,500","$13,500","$24,500",,,,,,,,,18
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,13,11269,WY,Individual,No,83-0231011,11269WY0170006,BlueSelect Bronze HSA,11269WY017,7154324389,WYN001,WYS001,WYF004,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0170006-00,Standard Bronze Off Exchange Plan,59.91%,0.599059820175171,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$6,000",50%,,,,"$6,000","$12,000","$9,500","$18,000",,,,,,,,,19
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,13,11269,WY,Individual,No,83-0231011,11269WY0170006,BlueSelect Bronze HSA,11269WY017,7154324389,WYN001,WYS001,WYF004,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0170006-01,Standard Bronze On Exchange Plan,59.91%,0.599059820175171,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$6,000",50%,,,,"$6,000","$12,000","$9,500","$18,000",,,,,,,,,20
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,13,11269,WY,Individual,No,83-0231011,11269WY0170006,BlueSelect Bronze HSA,11269WY017,7154324389,WYN001,WYS001,WYF004,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0170006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,21
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,13,11269,WY,Individual,No,83-0231011,11269WY0170006,BlueSelect Bronze HSA,11269WY017,7154324389,WYN001,WYS001,WYF004,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0170006-03,Limited Cost Sharing Plan Variation,59.91%,0.599059820175171,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$6,000",50%,,,,"$6,000","$12,000","$9,500","$18,000",,,,,,,,,22
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,14,11269,WY,Individual,No,83-0231011,11269WY0170007,BlueSelect Gold HealthPlus,11269WY017,7154324389,WYN001,WYS001,WYF008,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170007-00,Standard Gold Off Exchange Plan,80.30%,0.795480728149414,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$8,800","$17,600","$15,400","$30,800",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",15%,,,,"$3,500","$7,000","$4,500","$9,000",,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,15,11269,WY,Individual,No,83-0231011,11269WY0170015,BlueSelect Silver ValueOne,11269WY017,7154324389,WYN001,WYS001,WYF012,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170015-01,Standard Silver On Exchange Plan,68.90%,0.674259424209595,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$3,500","$7,000",50%,,,,"$7,000","$14,000","$10,500","$21,000",$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,15,11269,WY,Individual,No,83-0231011,11269WY0170015,BlueSelect Silver ValueOne,11269WY017,7154324389,WYN001,WYS001,WYF012,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170015-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,15,11269,WY,Individual,No,83-0231011,11269WY0170015,BlueSelect Silver ValueOne,11269WY017,7154324389,WYN001,WYS001,WYF012,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170015-03,Limited Cost Sharing Plan Variation,68.90%,0.674259424209595,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$3,500","$7,000",50%,,,,"$7,000","$14,000","$10,500","$21,000",$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,15,11269,WY,Individual,No,83-0231011,11269WY0170015,BlueSelect Silver ValueOne,11269WY017,7154324389,WYN001,WYS001,WYF012,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170015-04,73% AV Level Silver Plan,72.20%,0.721754431724548,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$10,000","$20,000","$14,000","$28,000","$3,000","$6,000",50%,,,,"$7,000","$14,000","$10,000","$20,000",$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,16,11269,WY,Individual,No,83-0231011,11269WY0170009,BlueSelect Silver ValueTwo,11269WY017,7154324389,WYN001,WYS001,WYF013,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170009-03,Limited Cost Sharing Plan Variation,68.52%,0.683096170425415,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600","$3,000","$6,000",20%,,,,"$6,000","$12,000","$9,000","$18,000",$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,16,11269,WY,Individual,No,83-0231011,11269WY0170009,BlueSelect Silver ValueTwo,11269WY017,7154324389,WYN001,WYS001,WYF013,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170009-04,73% AV Level Silver Plan,73.10%,0.757708370685577,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$13,200","$26,400","$16,950","$33,900","$3,000","$6,000",0%,,,,"$6,000","$12,000","$9,000","$18,000",$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,16,11269,WY,Individual,No,83-0231011,11269WY0170009,BlueSelect Silver ValueTwo,11269WY017,7154324389,WYN001,WYS001,WYF013,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170009-05,87% AV Level Silver Plan,86.20%,0.859497308731079,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$13,200","$26,400","$14,700","$29,400","$1,250","$2,500",0%,,,,"$6,000","$12,000","$7,250","$14,500",$150,$300,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,16,11269,WY,Individual,No,83-0231011,11269WY0170009,BlueSelect Silver ValueTwo,11269WY017,7154324389,WYN001,WYS001,WYF013,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170009-06,94% AV Level Silver Plan,93.30%,0.945738434791565,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,"$13,200","$26,400","$13,900","$27,800",$150,$300,0%,,,,"$6,000","$12,000","$6,150","$12,300",$50,$100,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,17,11269,WY,Individual,No,83-0231011,11269WY0170010,BlueSelect Bronze Value,11269WY017,7154324389,WYN001,WYS001,WYF014,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170010-00,Standard Bronze Off Exchange Plan,61.52%,0.615162312984467,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$13,000","$26,000","$19,500","$39,000","$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000","$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,17,11269,WY,Individual,No,83-0231011,11269WY0170010,BlueSelect Bronze Value,11269WY017,7154324389,WYN001,WYS001,WYF014,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170010-01,Standard Bronze On Exchange Plan,61.52%,0.615162312984467,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$13,000","$26,000","$19,500","$39,000","$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000","$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,17,11269,WY,Individual,No,83-0231011,11269WY0170010,BlueSelect Bronze Value,11269WY017,7154324389,WYN001,WYS001,WYF014,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170010-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,17,11269,WY,Individual,No,83-0231011,11269WY0170010,BlueSelect Bronze Value,11269WY017,7154324389,WYN001,WYS001,WYF014,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect4TierPrescriptionDrugList.pdf,11269WY0170010-03,Limited Cost Sharing Plan Variation,61.52%,0.615162312984467,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$13,000","$26,000","$19,500","$39,000","$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000","$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,23,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190010,BlueSelect Gold Basic,11269WY019,,WYN001,WYS001,WYF001,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0190010-00,Standard Gold Off Exchange Plan,78.01%,0.780111849308014,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$3,500","$7,000","$4,500","$9,000",,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,23,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190010,BlueSelect Gold Basic,11269WY019,,WYN001,WYS001,WYF001,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0190010-01,Standard Gold On Exchange Plan,78.01%,0.780111849308014,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$3,500","$7,000","$4,500","$9,000",,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,23,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190011,BlueSelect Silver Basic,11269WY019,,WYN001,WYS001,WYF002,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0190011-00,Standard Silver Off Exchange Plan,70.03%,0.700286328792572,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",25%,,,,"$4,500","$9,000","$6,500","$13,000",,,,,,,,,6
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,23,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190011,BlueSelect Silver Basic,11269WY019,,WYN001,WYS001,WYF002,New,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0190011-01,Standard Silver On Exchange Plan,70.03%,0.700286328792572,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",25%,,,,"$4,500","$9,000","$6,500","$13,000",,,,,,,,,7
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,23,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190012,BlueSelect Bronze Basic,11269WY019,,WYN001,WYS001,WYF003,New,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0190012-00,Standard Bronze Off Exchange Plan,61.68%,0.616817772388458,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$6,500","$13,000","$10,500","$11,000",,,,,,,,,8
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,23,11269,WY,SHOP (Small Group),No,83-0231011,11269WY0190012,BlueSelect Bronze Basic,11269WY019,,WYN001,WYS001,WYF003,New,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,http://www.bcbswy.com/pay,https://www.bcbswy.com/employers/plans_services/blueselect_smallgroup/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0190012-01,Standard Bronze On Exchange Plan,61.68%,0.616817772388458,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$6,500","$13,000","$10,500","$11,000",,,,,,,,,9
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,9,53189,WY,Individual,No,83-0309681,53189WY0070013,WINhealth Gold with Child Dental,53189WY007,,WYN001,WYS003,WYF005,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070013-00,Standard Gold Off Exchange Plan,,0.78597092628479,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,000",$450,$600,$0,"$1,000",$400,$60,$0,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,9,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080011,WINhealth Gold with Child Dental  -SG,53189WY008,,WYN001,WYS003,WYF005,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080011-00,Standard Gold Off Exchange Plan,,0.78597092628479,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,000",$450,$600,$0,"$1,000",$400,$60,$0,4
2015,WY,83964,HIOS,5,2015-01-21 09:35:36,1,83964,WY,SHOP (Small Group),Yes,83-0209667,83964WY0020003,Delta Dental Small Group Low Plan,83964WY002,,WYN001,WYS001,,Existing,Indemnity,Low,,Both,,,,EHB Pediatric Coverage is not available for anyone over the age of 18,,,,,Allows Adult and Child-Only,,,,$28.62,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.   Through the Delta Dental Plan Association there is a nationwide Premier network presence,Yes,www.deltadentalwy.org/subscribers/subscribersdocuments/d119899.aspx,https://secure.deltadentalwy.org/wyffm/default.aspx,www.deltadentalwy.org/healthcarereform/,,83964WY0020003-00,Standard Low Off Exchange Plan,70.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,$125,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,83964,HIOS,5,2015-01-21 09:35:36,1,83964,WY,SHOP (Small Group),Yes,83-0209667,83964WY0020003,Delta Dental Small Group Low Plan,83964WY002,,WYN001,WYS001,,Existing,Indemnity,Low,,Both,,,,EHB Pediatric Coverage is not available for anyone over the age of 18,,,,,Allows Adult and Child-Only,,,,$28.62,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.   Through the Delta Dental Plan Association there is a nationwide Premier network presence,Yes,www.deltadentalwy.org/subscribers/subscribersdocuments/d119899.aspx,https://secure.deltadentalwy.org/wyffm/default.aspx,www.deltadentalwy.org/healthcarereform/,,83964WY0020003-01,Standard Low On Exchange Plan,70.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,$125,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,83964,HIOS,5,2015-01-21 09:35:36,1,83964,WY,Individual,Yes,83-0209667,83964WY0010003,Delta Dental Individual & Family Low Plan,83964WY001,,WYN001,WYS001,,Existing,Indemnity,Low,,Both,,,,EHB Pediatric Coverage is not available for anyone over the age of 18,,,,,Allows Adult and Child-Only,,,,$37.40,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.   Through the Delta Dental Plan Association there is a nationwide Premier network presence,Yes,www.deltadentalwy.org/subscribers/subscribersdocuments/d119896.aspx,https://secure.deltadentalwy.org/wyffm/default.aspx,www.deltadentalwy.org/healthcarereform/,,83964WY0010003-01,Standard Low On Exchange Plan,70.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,$125,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,83964,HIOS,5,2015-01-21 09:35:36,2,83964,WY,Individual,Yes,83-0209667,83964WY0010004,Delta Dental Individual & Family High Plan,83964WY001,,WYN001,WYS001,,Existing,Indemnity,High,,Both,,,,EHB Pediatric coverage not available for anyone over the age of 18.,,,,,Allows Adult and Child-Only,,,,$44.25,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.,Yes,www.deltadentalwy.org/subscribers/subscribersdocuments/d119897.aspx,https://secure.deltadentalwy.org/wyffm/default.aspx,www.deltadentalwy.org/healthcarereform,,83964WY0010004-00,Standard High Off Exchange Plan,85.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,7,53189,WY,Individual,No,83-0309681,53189WY0070010,WINhealth Silver HSA with Child Dental,53189WY007,,WYN001,WYS003,WYF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,7,53189,WY,Individual,No,83-0309681,53189WY0070010,WINhealth Silver HSA with Child Dental,53189WY007,,WYN001,WYS003,WYF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070010-03,Limited Cost Sharing Plan Variation,,0.700544476509094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,500",$0,$500,$0,"$2,500",$0,$280,$0,7
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,7,53189,WY,Individual,No,83-0309681,53189WY0070010,WINhealth Silver HSA with Child Dental,53189WY007,,WYN001,WYS003,WYF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070010-04,73% AV Level Silver Plan,,0.730297029018402,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000",$0,$550,$0,"$2,000",$0,$330,$0,8
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,10,53189,WY,Individual,No,83-0309681,53189WY0070005,WINhealth Gold-HSA,53189WY007,,WYN001,WYS003,WYF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070005-00,Standard Gold Off Exchange Plan,,0.781938672065735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500",$0,$600,$0,"$1,500",$0,$380,$0,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,10,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080004,WINhealth Gold HSA -SG,53189WY008,,WYN001,WYS003,WYF002,Existing,HMO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080004-00,Standard Gold Off Exchange Plan,,0.781938672065735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500",$0,$600,$0,"$1,500",$0,$380,$0,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,1,38344,AK,Individual,No,91-0499247,38344AK0600003,"Blue Cross Blue Shield Select 1500, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF202,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028264_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0600003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,30,11269,WY,Individual,No,83-0231011,11269WY0170011,BlueSelect Gold Basic,11269WY017,7154324389,WYN001,WYS001,WYF001,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0170011-00,Standard Gold Off Exchange Plan,78.01%,0.780111849308014,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$3,500","$7,000","$4,500","$9,000",,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,30,11269,WY,Individual,No,83-0231011,11269WY0170011,BlueSelect Gold Basic,11269WY017,7154324389,WYN001,WYS001,WYF001,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0170011-01,Standard Gold On Exchange Plan,78.01%,0.780111849308014,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$3,500","$7,000","$4,500","$9,000",,,,,,,,,5
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,30,11269,WY,Individual,No,83-0231011,11269WY0170011,BlueSelect Gold Basic,11269WY017,7154324389,WYN001,WYS001,WYF001,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0170011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,30,11269,WY,Individual,No,83-0231011,11269WY0170011,BlueSelect Gold Basic,11269WY017,7154324389,WYN001,WYS001,WYF001,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0170011-03,Limited Cost Sharing Plan Variation,78.01%,0.780111849308014,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$3,500","$7,000","$4,500","$9,000",,,,,,,,,7
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,30,11269,WY,Individual,No,83-0231011,11269WY0170012,BlueSelect Silver Basic,11269WY017,7154324389,WYN001,WYS001,WYF002,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0170012-00,Standard Silver Off Exchange Plan,68.58%,0.685770511627197,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",25%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,8
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,30,11269,WY,Individual,No,83-0231011,11269WY0170012,BlueSelect Silver Basic,11269WY017,7154324389,WYN001,WYS001,WYF002,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0170012-01,Standard Silver On Exchange Plan,68.58%,0.685770511627197,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",25%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,9
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,30,11269,WY,Individual,No,83-0231011,11269WY0170012,BlueSelect Silver Basic,11269WY017,7154324389,WYN001,WYS001,WYF002,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0170012-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,30,11269,WY,Individual,No,83-0231011,11269WY0170012,BlueSelect Silver Basic,11269WY017,7154324389,WYN001,WYS001,WYF002,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0170012-03,Limited Cost Sharing Plan Variation,68.58%,0.685770511627197,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",25%,,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,11
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,30,11269,WY,Individual,No,83-0231011,11269WY0170012,BlueSelect Silver Basic,11269WY017,7154324389,WYN001,WYS001,WYF002,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0170012-04,73% AV Level Silver Plan,72.26%,0.722632050514221,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400","$17,900","$35,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",25%,,,,"$5,000","$10,000","$7,100","$14,200",,,,,,,,,12
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,30,11269,WY,Individual,No,83-0231011,11269WY0170012,BlueSelect Silver Basic,11269WY017,7154324389,WYN001,WYS001,WYF002,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0170012-05,87% AV Level Silver Plan,86.62%,0.866226613521576,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,700","$25,400","$14,950","$29,900",,,,,,,,,,,,,,,,,,,,,$400,$800,25%,,,,"$5,000","$10,000","$5,400","$10,800",,,,,,,,,13
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,30,11269,WY,Individual,No,83-0231011,11269WY0170012,BlueSelect Silver Basic,11269WY017,7154324389,WYN001,WYS001,WYF002,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0170012-06,94% AV Level Silver Plan,93.66%,0.936602771282196,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$850,"$1,700",,,"$12,700","$25,400","$13,550","$27,100",,,,,,,,,,,,,,,,,,,,,$100,$200,25%,,,,"$5,000","$10,000","$5,100","$10,200",,,,,,,,,14
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,30,11269,WY,Individual,No,83-0231011,11269WY0170013,BlueSelect Bronze Basic,11269WY017,7154324389,WYN001,WYS001,WYF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0170013-00,Standard Bronze Off Exchange Plan,61.85%,0.618507981300354,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$8,000","$15,000","$13,500","$26,000",,,,,,,,,15
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,30,11269,WY,Individual,No,83-0231011,11269WY0170013,BlueSelect Bronze Basic,11269WY017,7154324389,WYN001,WYS001,WYF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0170013-01,Standard Bronze On Exchange Plan,61.85%,0.618507981300354,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$8,000","$15,000","$13,500","$26,000",,,,,,,,,16
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,30,11269,WY,Individual,No,83-0231011,11269WY0170013,BlueSelect Bronze Basic,11269WY017,7154324389,WYN001,WYS001,WYF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0170013-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,17
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,30,11269,WY,Individual,No,83-0231011,11269WY0170013,BlueSelect Bronze Basic,11269WY017,7154324389,WYN001,WYS001,WYF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,6,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0170013-03,Limited Cost Sharing Plan Variation,61.85%,0.618507981300354,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$8,000","$15,000","$13,500","$26,000",,,,,,,,,18
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,31,11269,WY,Individual,No,83-0231011,11269WY0170014,BlueSelect Catastrophic,11269WY017,7154324389,WYN001,WYS001,WYF005,New,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0170014-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",50%,,,,"$8,850","$17,700","$15,200","$30,400",,,,,,,,,4
2015,WY,11269,HIOS,6,2014-12-10 11:54:40,31,11269,WY,Individual,No,83-0231011,11269WY0170014,BlueSelect Catastrophic,11269WY017,7154324389,WYN001,WYS001,WYF005,New,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,3,2015-01-01,,Yes,"BlueCard? Worldwide Program ? Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard? Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.",Yes,"BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.",Yes,http://www.WyomingBlueSBC.com/marketplace,https://shop.bcbswy.com/pay,http://www.bcbswy.com/shopping,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_WY_BlueSelect3TierPrescriptionDrugList.pdf,11269WY0170014-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",50%,,,,"$8,850","$17,700","$15,200","$30,400",,,,,,,,,5
2015,WY,14609,HIOS,4,2014-09-04 03:25:43,1,14609,WY,SHOP (Small Group),Yes,57-0523959,14609WY0010001,Group Pediatric EHB,14609WY001,,WYN001,WYS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$38.06,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,traditional with inside maximums,Yes,traditional with inside maximums,No,,,,,14609WY0010001-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,14609,HIOS,4,2014-09-04 03:25:43,1,14609,WY,SHOP (Small Group),Yes,57-0523959,14609WY0010002,Group Pediatric EHB,14609WY001,,WYN001,WYS001,,New,Indemnity,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$30.59,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,traditional with inside maximums,Yes,traditional with inside maximums,No,,,,,14609WY0010002-00,Standard Low Off Exchange Plan,68.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,37378,HIOS,3,2014-09-04 03:25:43,1,37378,WY,SHOP (Small Group),Yes,35-0472300,37378WY0010001,Lincoln DentalConnect?,37378WY001,,WYN001,WYS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.92,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,37378WY0010001-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,37378,HIOS,3,2014-09-04 03:25:43,1,37378,WY,SHOP (Small Group),Yes,35-0472300,37378WY0010002,Lincoln DentalConnect?,37378WY001,,WYN001,WYS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.78,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,37378WY0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,37378,HIOS,3,2014-09-04 03:25:43,1,37378,WY,SHOP (Small Group),Yes,35-0472300,37378WY0010003,Lincoln DentalConnect?,37378WY001,,WYN001,WYS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.22,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,37378WY0010003-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WY,37378,HIOS,3,2014-09-04 03:25:43,1,37378,WY,SHOP (Small Group),Yes,35-0472300,37378WY0010005,Lincoln DentalConnect?,37378WY001,,WYN001,WYS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.47,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,37378WY0010005-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WY,37378,HIOS,3,2014-09-04 03:25:43,1,37378,WY,SHOP (Small Group),Yes,35-0472300,37378WY0010006,Lincoln DentalConnect?,37378WY001,,WYN001,WYS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.36,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,37378WY0010006-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,WY,37378,HIOS,3,2014-09-04 03:25:43,1,37378,WY,SHOP (Small Group),Yes,35-0472300,37378WY0010007,Lincoln DentalConnect?,37378WY001,,WYN001,WYS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.58,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,37378WY0010007-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,WY,37378,HIOS,3,2014-09-04 03:25:43,2,37378,WY,SHOP (Small Group),Yes,35-0472300,37378WY0010004,Lincoln DentalConnect?,37378WY001,,WYN001,WYS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.37,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,37378WY0010004-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,37378,HIOS,3,2014-09-04 03:25:43,2,37378,WY,SHOP (Small Group),Yes,35-0472300,37378WY0010008,Lincoln DentalConnect?,37378WY001,,WYN001,WYS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.76,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,37378WY0010008-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,44450,HIOS,7,2014-11-15 04:52:41,1,44450,WY,SHOP (Small Group),Yes,75-1233841,44450WY0020007,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,44450WY002,,WYN001,WYS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.40,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/wy/44450wy0020007-15,,44450WY0020007-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,44450,HIOS,7,2014-11-15 04:52:41,1,44450,WY,Individual,Yes,75-1233841,44450WY0010007,Dentegra Dental PPO Pediatric Basic Plan,44450WY001,,WYN001,WYS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$22.22,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/wy/44450wy0010007-15,,44450WY0010007-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,44450,HIOS,7,2014-11-15 04:52:41,1,44450,WY,Individual,Yes,75-1233841,44450WY0010007,Dentegra Dental PPO Pediatric Basic Plan,44450WY001,,WYN001,WYS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$22.22,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/wy/44450wy0010007-15,,44450WY0010007-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,44450,HIOS,7,2014-11-15 04:52:41,1,44450,WY,SHOP (Small Group),Yes,75-1233841,44450WY0020007,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,44450WY002,,WYN001,WYS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.40,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/wy/44450wy0020007-15,,44450WY0020007-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,44450,HIOS,7,2014-11-15 04:52:41,2,44450,WY,SHOP (Small Group),Yes,75-1233841,44450WY0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,44450WY002,,WYN001,WYS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.40,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/wy/44450wy0020009-15,,44450WY0020009-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,44450,HIOS,7,2014-11-15 04:52:41,2,44450,WY,Individual,Yes,75-1233841,44450WY0010009,Dentegra Dental PPO Family Basic Plan,44450WY001,,WYN001,WYS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.22,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/wy/44450wy0010009-15,,44450WY0010009-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,44450,HIOS,7,2014-11-15 04:52:41,2,44450,WY,Individual,Yes,75-1233841,44450WY0010009,Dentegra Dental PPO Family Basic Plan,44450WY001,,WYN001,WYS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.22,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/wy/44450wy0010009-15,,44450WY0010009-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,46998,HIOS,4,2014-09-05 03:32:16,2,46998,WY,SHOP (Small Group),Yes,95-2371728,46998WY0020003,PPO MAC,46998WY002,,WYN001,WYS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$34.65,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Wyoming,Yes,,,,,46998WY0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,1,47731,WY,Individual,Yes,95-6042390,47731WY0020001,BESTOne Child Dental Plus,47731WY002,,WYN001,WYS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$47.81,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BESTOne_Child_Dental_Plus_Plan.pdf,,47731WY0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,1,47731,WY,SHOP (Small Group),Yes,95-6042390,47731WY0010001,BEST Life Child Dental Plus,47731WY001,,WYN001,WYS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$38.25,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BEST_Life_Child_Dental_Plus_Plan.pdf,,47731WY0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,2,47731,WY,SHOP (Small Group),Yes,95-6042390,47731WY0010002,BEST Life Child Dental,47731WY001,,WYN001,WYS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$29.61,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BEST_Life_Child_Dental_Plan.pdf,,47731WY0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,2,47731,WY,Individual,Yes,95-6042390,47731WY0020002,BESTOne Child Dental,47731WY002,,WYN001,WYS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$37.00,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BESTOne_Child_Dental_Plan.pdf,,47731WY0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,47731,HIOS,4,2014-09-03 04:28:59,3,47731,WY,Individual,Yes,95-6042390,47731WY0020003,BESTOne Dental Advantage-Gold,47731WY002,,WYN001,WYS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$47.81,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/WY/2015/WY_BESTOne_Dental_Advantage-Gold_Plan.pdf,,47731WY0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,7,53189,WY,Individual,No,83-0309681,53189WY0070010,WINhealth Silver HSA with Child Dental,53189WY007,,WYN001,WYS003,WYF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070010-05,87% AV Level Silver Plan,,0.879124939441681,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$500,$0,$700,$0,$500,$0,$480,$0,9
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,7,53189,WY,Individual,No,83-0309681,53189WY0070010,WINhealth Silver HSA with Child Dental,53189WY007,,WYN001,WYS003,WYF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070010-06,94% AV Level Silver Plan,,0.933893859386444,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$100,$0,$740,$0,$100,$0,$520,$0,10
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,8,53189,WY,Individual,No,83-0309681,53189WY0070006,WINhealth Gold,53189WY007,,WYN001,WYS003,WYF005,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070006-00,Standard Gold Off Exchange Plan,,0.78597092628479,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,000",$450,$600,$0,"$1,000",$400,$60,$0,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,8,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080005,WINhealth Gold SG,53189WY008,,WYN001,WYS003,WYF005,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080005-00,Standard Gold Off Exchange Plan,,0.78597092628479,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,000",$450,$600,$0,"$1,000",$400,$60,$0,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,8,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080005,WINhealth Gold SG,53189WY008,,WYN001,WYS003,WYF005,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080005-01,Standard Gold On Exchange Plan,,0.78597092628479,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,000",$450,$600,$0,"$1,000",$400,$60,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,8,53189,WY,Individual,No,83-0309681,53189WY0070006,WINhealth Gold,53189WY007,,WYN001,WYS003,WYF005,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070006-01,Standard Gold On Exchange Plan,,0.78597092628479,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,000",$450,$600,$0,"$1,000",$400,$60,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,9,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080011,WINhealth Gold with Child Dental  -SG,53189WY008,,WYN001,WYS003,WYF005,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080011-01,Standard Gold On Exchange Plan,,0.78597092628479,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,000",$450,$600,$0,"$1,000",$400,$60,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,9,53189,WY,Individual,No,83-0309681,53189WY0070013,WINhealth Gold with Child Dental,53189WY007,,WYN001,WYS003,WYF005,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070013-01,Standard Gold On Exchange Plan,,0.78597092628479,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,000",$450,$600,$0,"$1,000",$400,$60,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,9,53189,WY,Individual,No,83-0309681,53189WY0070013,WINhealth Gold with Child Dental,53189WY007,,WYN001,WYS003,WYF005,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,9,53189,WY,Individual,No,83-0309681,53189WY0070013,WINhealth Gold with Child Dental,53189WY007,,WYN001,WYS003,WYF005,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070013-03,Limited Cost Sharing Plan Variation,,0.78597092628479,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,000",$650,$400,$0,"$1,000",$380,$60,$0,7
2015,WY,48887,HIOS,2,2014-08-07 10:00:19,1,48887,WY,SHOP (Small Group),Yes,44-0308260,48887WY0010005,KCL Fam Low PPO,48887WY001,,WYN001,WYS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$37.83,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,48887WY0010005-00,Standard Low Off Exchange Plan,70.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WY,48887,HIOS,2,2014-08-07 10:00:19,1,48887,WY,SHOP (Small Group),Yes,44-0308260,48887WY0010007,KCL Fam Low MAC,48887WY001,,WYN001,WYS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$28.80,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,48887WY0010007-00,Standard Low Off Exchange Plan,70.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WY,48887,HIOS,2,2014-08-07 10:00:19,2,48887,WY,SHOP (Small Group),Yes,44-0308260,48887WY0010002,KCL EHB High PPO,48887WY001,,WYN001,WYS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$46.38,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,48887WY0010002-00,Standard High Off Exchange Plan,85.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,48887,HIOS,2,2014-08-07 10:00:19,2,48887,WY,SHOP (Small Group),Yes,44-0308260,48887WY0010004,KCL EHB High MAC,48887WY001,,WYN001,WYS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$35.85,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,48887WY0010004-00,Standard High Off Exchange Plan,85.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,48887,HIOS,2,2014-08-07 10:00:19,2,48887,WY,SHOP (Small Group),Yes,44-0308260,48887WY0010006,KCL Fam High PPO,48887WY001,,WYN001,WYS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$46.38,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,48887WY0010006-00,Standard High Off Exchange Plan,85.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WY,48887,HIOS,2,2014-08-07 10:00:19,2,48887,WY,SHOP (Small Group),Yes,44-0308260,48887WY0010008,KCL Fam High MAC,48887WY001,,WYN001,WYS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$35.85,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,48887WY0010008-00,Standard High Off Exchange Plan,85.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,1,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080012,WINhealth Platinum with Child Dental -SG,53189WY008,,WYN001,WYS003,WYF005,Existing,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080012-00,Standard Platinum Off Exchange Plan,,0.882263779640198,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$750,$400,$350,$0,$750,$330,$110,$0,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,7,53189,WY,Individual,No,83-0309681,53189WY0070010,WINhealth Silver HSA with Child Dental,53189WY007,,WYN001,WYS003,WYF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070010-00,Standard Silver Off Exchange Plan,,0.700544476509094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,500",$0,$500,$0,"$2,500",$0,$280,$0,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,7,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080008,WINhealth Silver HSA with Child Dental -SG,53189WY008,,WYN001,WYS003,WYF002,Existing,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080008-00,Standard Silver Off Exchange Plan,,0.700544476509094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,500",$0,$500,$0,"$2,500",$0,$280,$0,4
2015,WY,80132,HIOS,5,2014-11-12 05:24:58,1,80132,WY,Individual,Yes,47-0397286,80132WY0010001,"Delta Dental Individual PPO, EHB Certified",80132WY001,,WYN002,WYS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.86,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,80132WY0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,80132,HIOS,5,2014-11-12 05:24:58,1,80132,WY,Individual,Yes,47-0397286,80132WY0010002,"Delta Dental Individual PPO, EHB Certified",80132WY001,,WYN002,WYS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,80132WY0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,80132,HIOS,5,2014-11-12 05:24:58,1,80132,WY,SHOP (Small Group),Yes,47-0397286,80132WY0030002,"Renaissance Group Dental PPO, EHB Certified",80132WY003,,WYN001,WYS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.53,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,80132WY0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,80132,HIOS,5,2014-11-12 05:24:58,1,80132,WY,Individual,Yes,47-0397286,80132WY0020001,"Renaissance Individual Dental PPO, EHB Certified",80132WY002,,WYN001,WYS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.67,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,80132WY0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WY,80132,HIOS,5,2014-11-12 05:24:58,1,80132,WY,Individual,Yes,47-0397286,80132WY0020002,"Renaissance Individual Dental PPO, EHB Certified",80132WY002,,WYN001,WYS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.15,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,80132WY0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WY,80132,HIOS,5,2014-11-12 05:24:58,1,80132,WY,Individual,Yes,47-0397286,80132WY0040001,"Renaissance Individual Dental PPO, EHB Certified (Exchange)",80132WY004,,WYN001,WYS001,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.62,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/WY_EHB_High,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/80132,http://www.renaissancedental.com/WY_EHB_High,,80132WY0040001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,WY,80132,HIOS,5,2014-11-12 05:24:58,1,80132,WY,Individual,Yes,47-0397286,80132WY0040002,"Renaissance Individual Dental PPO, EHB Certified (Exchange)",80132WY004,,WYN001,WYS001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$17.91,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/WY_EHB_Low,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/80132,http://www.renaissancedental.com/WY_EHB_Low,,80132WY0040002-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,WY,80132,HIOS,5,2014-11-12 05:24:58,2,80132,WY,Individual,Yes,47-0397286,80132WY0050001,"Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)",80132WY005,,WYN001,WYS001,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$37.84,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/WY_Ped_High,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/80132,http://www.renaissancedental.com/WY_Ped_High,,80132WY0050001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,80132,HIOS,5,2014-11-12 05:24:58,2,80132,WY,Individual,Yes,47-0397286,80132WY0050002,"Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)",80132WY005,,WYN001,WYS001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$29.73,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.renaissancedental.com/WY_Ped_Low,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/80132,http://www.renaissancedental.com/WY_Ped_Low,,80132WY0050002-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,83964,HIOS,5,2015-01-21 09:35:36,2,83964,WY,SHOP (Small Group),Yes,83-0209667,83964WY0020004,Delta Dental Small Group High Plan,83964WY002,,WYN001,WYS001,,Existing,Indemnity,High,,Both,,,,EHB Pediatric coverage not available for anyone over the age of 18.,,,,,Allows Adult and Child-Only,,,,$33.86,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.,Yes,www.deltadentalwy.org/subscribers/subscribersdocuments/d119898.aspx,https://secure.deltadentalwy.org/wyffm/default.aspx,www.deltadentalwy.org/healthcarereform,,83964WY0020004-00,Standard High Off Exchange Plan,85.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,8,38344,AK,Individual,No,91-0499247,38344AK0620006,"Blue Cross Blue Shield Plus 3000, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF210,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028245_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0620006-01,Standard Silver On Exchange Plan,70.54%,0.70536082983017,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,AK,38344,OPM,10,2014-12-12 12:37:36,8,38344,AK,Individual,No,91-0499247,38344AK0620006,"Blue Cross Blue Shield Plus 3000, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF210,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028245_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0620006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,11
2015,IN,17575,OPM,5,2014-12-12 12:37:36,1,17575,IN,Individual,No,35-0781558,17575IN0930005,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",17575IN093,,INN201,INS201,INF202,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GFA,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0930005-05,87% AV Level Silver Plan,86.13%,0.862643301486969,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,IN,17575,OPM,5,2014-12-12 12:37:36,1,17575,IN,Individual,No,35-0781558,17575IN0930005,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",17575IN093,,INN201,INS201,INF202,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GFA,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0930005-06,94% AV Level Silver Plan,93.37%,0.934376955032349,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,IN,17575,OPM,5,2014-12-12 12:37:36,2,17575,IN,Individual,No,35-0781558,17575IN0930006,"Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan",17575IN093,,INN201,INS201,INF201,Existing,HMO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GFE,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0930006-01,Standard Gold On Exchange Plan,78.52%,0.794258236885071,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IN,17575,OPM,5,2014-12-12 12:37:36,2,17575,IN,Individual,No,35-0781558,17575IN0930006,"Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan",17575IN093,,INN201,INS201,INF201,Existing,HMO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GFE,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0930006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,AK,38344,OPM,10,2014-12-12 12:37:36,8,38344,AK,SHOP (Small Group),No,91-0499247,38344AK0980011,"Blue Cross Blue Shield Plus 5500, a Multi-State Plan",38344AK098,,AKN201,AKS201,AKF208,Existing,PPO,Bronze,No,On the Exchange,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you?re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028490_2015.pdf,,https://www.premera.com/documents/031125.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0980011-01,Standard Bronze On Exchange Plan,,0.615731298923492,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,8,38344,AK,Individual,No,91-0499247,38344AK0620004,"Blue Cross Blue Shield Plus 2000, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF209,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028235_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0620004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,AK,38344,OPM,10,2014-12-12 12:37:36,8,38344,AK,Individual,No,91-0499247,38344AK0620004,"Blue Cross Blue Shield Plus 2000, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF209,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028235_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0620004-03,Limited Cost Sharing Plan Variation,,0.719489276409149,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,AK,38344,OPM,10,2014-12-12 12:37:36,8,38344,AK,Individual,No,91-0499247,38344AK0620004,"Blue Cross Blue Shield Plus 2000, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF209,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028235_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0620004-04,73% AV Level Silver Plan,,0.739825904369354,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,AK,38344,OPM,10,2014-12-12 12:37:36,1,38344,AK,SHOP (Small Group),No,91-0499247,38344AK0930003,"Blue Cross Blue Shield Select 1000, a Multi-State Plan",38344AK093,,AKN201,AKS201,AKF201,Existing,PPO,Gold,No,On the Exchange,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you?re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028524_2015.pdf,,https://www.premera.com/documents/031125.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0930003-01,Standard Gold On Exchange Plan,,0.794752836227417,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000",Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,20%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,1,38344,AK,Individual,No,91-0499247,38344AK0600002,"Blue Cross Blue Shield Select 1000, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF201,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028262_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0600002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,MO,32753,OPM,7,2014-12-12 12:37:36,1,32753,MO,Individual,No,86-0257201,32753MO0930004,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",32753MO093,,MON201,MOS201,MOF208,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GK2,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0930004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,MO,32753,OPM,7,2014-12-12 12:37:36,1,32753,MO,Individual,No,86-0257201,32753MO0930004,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",32753MO093,,MON201,MOS201,MOF208,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GK2,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0930004-03,Limited Cost Sharing Plan Variation,71.01%,0.716200590133667,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,1,53189,WY,Individual,No,83-0309681,53189WY0070001,WINhealth Catastrophic,53189WY007,,WYN001,WYS003,WYF001,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$6,350",$0,$0,$0,"$5,300",$0,$0,$0,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,1,53189,WY,Individual,No,83-0309681,53189WY0070001,WINhealth Catastrophic,53189WY007,,WYN001,WYS003,WYF001,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$6,350",$0,$0,$0,"$5,300",$0,$0,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,1,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080012,WINhealth Platinum with Child Dental -SG,53189WY008,,WYN001,WYS003,WYF005,Existing,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080012-01,Standard Platinum On Exchange Plan,,0.882263779640198,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$750,$400,$350,$0,$750,$330,$110,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,2,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080001,WINhealth Bronze-SG,53189WY008,,WYN001,WYS003,WYF004,Existing,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"emergent care without preauth, non emergent care requires preauth",Yes,only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080001-00,Standard Bronze Off Exchange Plan,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,$595,$0,"$4,000",$0,$260,$0,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,2,53189,WY,Individual,No,83-0309681,53189WY0070002,WINhealth Bronze,53189WY007,,WYN001,WYS003,WYF004,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"emergent care without preauth, non emergent care requires preauth",Yes,only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070002-00,Standard Bronze Off Exchange Plan,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,$595,$0,"$4,000",$0,$260,$0,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,2,53189,WY,Individual,No,83-0309681,53189WY0070002,WINhealth Bronze,53189WY007,,WYN001,WYS003,WYF004,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"emergent care without preauth, non emergent care requires preauth",Yes,only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070002-01,Standard Bronze On Exchange Plan,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,$595,$0,"$4,000",$0,$260,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,2,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080001,WINhealth Bronze-SG,53189WY008,,WYN001,WYS003,WYF004,Existing,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"emergent care without preauth, non emergent care requires preauth",Yes,only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080001-01,Standard Bronze On Exchange Plan,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,$595,$0,"$4,000",$0,$260,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,2,53189,WY,Individual,No,83-0309681,53189WY0070002,WINhealth Bronze,53189WY007,,WYN001,WYS003,WYF004,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"emergent care without preauth, non emergent care requires preauth",Yes,only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,2,53189,WY,Individual,No,83-0309681,53189WY0070002,WINhealth Bronze,53189WY007,,WYN001,WYS003,WYF004,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"emergent care without preauth, non emergent care requires preauth",Yes,only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070002-03,Limited Cost Sharing Plan Variation,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,$700,$0,"$4,000",$0,$460,$0,7
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,3,53189,WY,Individual,No,83-0309681,53189WY0070009,WINhealth Bronze with Child Dental,53189WY007,,WYN001,WYS003,WYF004,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070009-00,Standard Bronze Off Exchange Plan,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,$595,$0,"$4,000",$0,$260,$0,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,3,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080007,WINhealth Bronze with Child Dental -SG,53189WY008,,WYN001,WYS003,WYF004,Existing,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080007-00,Standard Bronze Off Exchange Plan,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,$595,$0,"$4,000",$0,$260,$0,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,3,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080007,WINhealth Bronze with Child Dental -SG,53189WY008,,WYN001,WYS003,WYF004,Existing,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080007-01,Standard Bronze On Exchange Plan,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,$595,$0,"$4,000",$0,$260,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,3,53189,WY,Individual,No,83-0309681,53189WY0070009,WINhealth Bronze with Child Dental,53189WY007,,WYN001,WYS003,WYF004,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070009-01,Standard Bronze On Exchange Plan,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,$595,$0,"$4,000",$0,$260,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,3,53189,WY,Individual,No,83-0309681,53189WY0070009,WINhealth Bronze with Child Dental,53189WY007,,WYN001,WYS003,WYF004,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,3,53189,WY,Individual,No,83-0309681,53189WY0070009,WINhealth Bronze with Child Dental,53189WY007,,WYN001,WYS003,WYF004,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070009-03,Limited Cost Sharing Plan Variation,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,$700,$0,"$4,000",$0,$460,$0,7
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,4,53189,WY,Individual,No,83-0309681,53189WY0070004,WINhealth Silver,53189WY007,,WYN001,WYS003,WYF003,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070004-00,Standard Silver Off Exchange Plan,,0.705477714538574,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$1,080",$600,$0,"$1,300",$690,$0,$0,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,4,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080003,WINhealth Silver SG,53189WY008,,WYN001,WYS003,WYF003,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080003-00,Standard Silver Off Exchange Plan,,0.705477714538574,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$1,080",$600,$0,"$1,300",$690,$0,$0,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,4,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080003,WINhealth Silver SG,53189WY008,,WYN001,WYS003,WYF003,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080003-01,Standard Silver On Exchange Plan,,0.705477714538574,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$1,080",$600,$0,"$1,300",$690,$0,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,4,53189,WY,Individual,No,83-0309681,53189WY0070004,WINhealth Silver,53189WY007,,WYN001,WYS003,WYF003,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070004-01,Standard Silver On Exchange Plan,,0.705477714538574,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$1,080",$600,$0,"$1,300",$690,$0,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,4,53189,WY,Individual,No,83-0309681,53189WY0070004,WINhealth Silver,53189WY007,,WYN001,WYS003,WYF003,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,4,53189,WY,Individual,No,83-0309681,53189WY0070004,WINhealth Silver,53189WY007,,WYN001,WYS003,WYF003,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070004-03,Limited Cost Sharing Plan Variation,,0.705477714538574,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$1,080",$600,$0,"$1,300",$660,$0,$0,7
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,4,53189,WY,Individual,No,83-0309681,53189WY0070004,WINhealth Silver,53189WY007,,WYN001,WYS003,WYF003,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070004-04,73% AV Level Silver Plan,,0.727786481380463,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$1,080",$600,$0,"$2,000",$690,$0,$0,8
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,4,53189,WY,Individual,No,83-0309681,53189WY0070004,WINhealth Silver,53189WY007,,WYN001,WYS003,WYF003,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070004-05,87% AV Level Silver Plan,,0.86363297700882,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$500,$600,$400,$0,$500,$400,$160,$0,9
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,4,53189,WY,Individual,No,83-0309681,53189WY0070004,WINhealth Silver,53189WY007,,WYN001,WYS003,WYF003,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070004-06,94% AV Level Silver Plan,,0.93087500333786,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$800,"$1,600",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$100,$400,$500,$0,$100,$235,$240,$0,10
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,5,53189,WY,Individual,No,83-0309681,53189WY0070011,WINhealth Silver with Child Dental,53189WY007,,WYN001,WYS003,WYF003,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070011-00,Standard Silver Off Exchange Plan,,0.705477714538574,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$1,080",$600,$0,"$1,300",$690,$0,$0,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,5,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080009,WINhealth Silver with Child Dental -SG,53189WY008,,WYN001,WYS003,WYF003,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080009-00,Standard Silver Off Exchange Plan,,0.705477714538574,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$1,080",$600,$0,"$1,300",$690,$0,$0,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,5,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080009,WINhealth Silver with Child Dental -SG,53189WY008,,WYN001,WYS003,WYF003,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080009-01,Standard Silver On Exchange Plan,,0.705477714538574,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$1,080",$600,$0,"$1,300",$690,$0,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,5,53189,WY,Individual,No,83-0309681,53189WY0070011,WINhealth Silver with Child Dental,53189WY007,,WYN001,WYS003,WYF003,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070011-01,Standard Silver On Exchange Plan,,0.705477714538574,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$1,080",$600,$0,"$1,300",$690,$0,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,5,53189,WY,Individual,No,83-0309681,53189WY0070011,WINhealth Silver with Child Dental,53189WY007,,WYN001,WYS003,WYF003,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,5,53189,WY,Individual,No,83-0309681,53189WY0070011,WINhealth Silver with Child Dental,53189WY007,,WYN001,WYS003,WYF003,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070011-03,Limited Cost Sharing Plan Variation,,0.705477714538574,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$1,080",$600,$0,"$1,300",$660,$0,$0,7
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,5,53189,WY,Individual,No,83-0309681,53189WY0070011,WINhealth Silver with Child Dental,53189WY007,,WYN001,WYS003,WYF003,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070011-04,73% AV Level Silver Plan,,0.727786481380463,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$1,080",$600,$0,"$2,000",$690,$0,$0,8
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,5,53189,WY,Individual,No,83-0309681,53189WY0070011,WINhealth Silver with Child Dental,53189WY007,,WYN001,WYS003,WYF003,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070011-05,87% AV Level Silver Plan,,0.86363297700882,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$500,$600,$400,$0,$500,$400,$160,$0,9
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,5,53189,WY,Individual,No,83-0309681,53189WY0070011,WINhealth Silver with Child Dental,53189WY007,,WYN001,WYS003,WYF003,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070011-06,94% AV Level Silver Plan,,0.93087500333786,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$800,"$1,600",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$100,$400,$500,$0,$100,$235,$240,$0,10
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,6,53189,WY,Individual,No,83-0309681,53189WY0070003,WINhealth Silver-HSA,53189WY007,,WYN001,WYS003,WYF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070003-00,Standard Silver Off Exchange Plan,,0.700544476509094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,500",$0,$500,$0,"$2,500",$0,$280,$0,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,6,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080002,WINhealth Silver HSA -SG,53189WY008,,WYN001,WYS003,WYF002,Existing,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080002-00,Standard Silver Off Exchange Plan,,0.700544476509094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,500",$0,$500,$0,"$2,500",$0,$280,$0,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,6,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080002,WINhealth Silver HSA -SG,53189WY008,,WYN001,WYS003,WYF002,Existing,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080002-01,Standard Silver On Exchange Plan,,0.700544476509094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,500",$0,$500,$0,"$2,500",$0,$280,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,6,53189,WY,Individual,No,83-0309681,53189WY0070003,WINhealth Silver-HSA,53189WY007,,WYN001,WYS003,WYF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070003-01,Standard Silver On Exchange Plan,,0.700544476509094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,500",$0,$500,$0,"$2,500",$0,$280,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,6,53189,WY,Individual,No,83-0309681,53189WY0070003,WINhealth Silver-HSA,53189WY007,,WYN001,WYS003,WYF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,6,53189,WY,Individual,No,83-0309681,53189WY0070003,WINhealth Silver-HSA,53189WY007,,WYN001,WYS003,WYF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070003-03,Limited Cost Sharing Plan Variation,,0.700544476509094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,500",$0,$500,$0,"$2,500",$0,$280,$0,7
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,6,53189,WY,Individual,No,83-0309681,53189WY0070003,WINhealth Silver-HSA,53189WY007,,WYN001,WYS003,WYF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070003-04,73% AV Level Silver Plan,,0.730297029018402,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000",$0,$550,$0,"$2,000",$0,$330,$0,8
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,6,53189,WY,Individual,No,83-0309681,53189WY0070003,WINhealth Silver-HSA,53189WY007,,WYN001,WYS003,WYF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070003-05,87% AV Level Silver Plan,,0.879124939441681,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$500,$0,$700,$0,$500,$0,$480,$0,9
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,6,53189,WY,Individual,No,83-0309681,53189WY0070003,WINhealth Silver-HSA,53189WY007,,WYN001,WYS003,WYF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070003-06,94% AV Level Silver Plan,,0.933893859386444,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$100,$0,$740,$0,$100,$0,$520,$0,10
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,7,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080008,WINhealth Silver HSA with Child Dental -SG,53189WY008,,WYN001,WYS003,WYF002,Existing,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080008-01,Standard Silver On Exchange Plan,,0.700544476509094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,500",$0,$500,$0,"$2,500",$0,$280,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,7,53189,WY,Individual,No,83-0309681,53189WY0070010,WINhealth Silver HSA with Child Dental,53189WY007,,WYN001,WYS003,WYF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070010-01,Standard Silver On Exchange Plan,,0.700544476509094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,500",$0,$500,$0,"$2,500",$0,$280,$0,5
2015,WY,80132,HIOS,5,2014-11-12 05:24:58,2,80132,WY,Individual,Yes,47-0397286,80132WY0060001,"Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)",80132WY006,,WYN001,WYS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$34.85,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,80132WY0060001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WY,80132,HIOS,5,2014-11-12 05:24:58,2,80132,WY,Individual,Yes,47-0397286,80132WY0060002,"Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)",80132WY006,,WYN001,WYS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$27.42,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,80132WY0060002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WY,83964,HIOS,5,2015-01-21 09:35:36,1,83964,WY,Individual,Yes,83-0209667,83964WY0010003,Delta Dental Individual & Family Low Plan,83964WY001,,WYN001,WYS001,,Existing,Indemnity,Low,,Both,,,,EHB Pediatric Coverage is not available for anyone over the age of 18,,,,,Allows Adult and Child-Only,,,,$37.40,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.   Through the Delta Dental Plan Association there is a nationwide Premier network presence,Yes,www.deltadentalwy.org/subscribers/subscribersdocuments/d119896.aspx,https://secure.deltadentalwy.org/wyffm/default.aspx,www.deltadentalwy.org/healthcarereform/,,83964WY0010003-00,Standard Low Off Exchange Plan,70.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,$125,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,1,38344,AK,Individual,No,91-0499247,38344AK0600003,"Blue Cross Blue Shield Select 1500, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF202,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028264_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0600003-03,Limited Cost Sharing Plan Variation,,0.783508956432343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000",Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,AK,38344,OPM,10,2014-12-12 12:37:36,2,38344,AK,Individual,No,91-0499247,38344AK0610001,"Blue Cross Blue Shield Select 5250 HSA, a Multi-State Plan",38344AK061,,AKN201,AKS201,AKF206,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028279_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0610001-01,Standard Bronze On Exchange Plan,,0.619937121868134,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,2,38344,AK,SHOP (Small Group),No,91-0499247,38344AK0930004,"Blue Cross Blue Shield Select 1500, a Multi-State Plan",38344AK093,,AKN201,AKS201,AKF201,Existing,PPO,Gold,No,On the Exchange,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you?re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028525_2015.pdf,,https://www.premera.com/documents/031125.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0930004-01,Standard Gold On Exchange Plan,,0.789163172245026,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000",Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,20%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,2,38344,AK,Individual,No,91-0499247,38344AK0610001,"Blue Cross Blue Shield Select 5250 HSA, a Multi-State Plan",38344AK061,,AKN201,AKS201,AKF206,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028279_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0610001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,AK,38344,OPM,10,2014-12-12 12:37:36,8,38344,AK,Individual,No,91-0499247,38344AK0620004,"Blue Cross Blue Shield Plus 2000, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF209,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028235_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0620004-05,87% AV Level Silver Plan,,0.868941366672516,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,AK,38344,OPM,10,2014-12-12 12:37:36,8,38344,AK,Individual,No,91-0499247,38344AK0620004,"Blue Cross Blue Shield Plus 2000, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF209,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028235_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0620004-06,94% AV Level Silver Plan,,0.941989898681641,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,$400,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,WY,90776,HIOS,2,2014-08-07 10:00:19,1,90776,WY,SHOP (Small Group),Yes,93-0242990,90776WY0030002,EHB High Passive,90776WY003,,WYN001,WYS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$46.67,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,90776WY0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WY,90776,HIOS,2,2014-08-07 10:00:19,1,90776,WY,SHOP (Small Group),Yes,93-0242990,90776WY0030001,EHB Low Passive,90776WY003,,WYN001,WYS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.24,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,90776WY0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AK,38344,OPM,10,2014-12-12 12:37:36,1,38344,AK,Individual,No,91-0499247,38344AK0600002,"Blue Cross Blue Shield Select 1000, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF201,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028262_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0600002-01,Standard Gold On Exchange Plan,,0.791462600231171,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000",Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,8,38344,AK,Individual,No,91-0499247,38344AK0620006,"Blue Cross Blue Shield Plus 3000, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF210,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028245_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0620006-05,87% AV Level Silver Plan,86.05%,0.857541263103485,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,AK,38344,OPM,10,2014-12-12 12:37:36,8,38344,AK,Individual,No,91-0499247,38344AK0620006,"Blue Cross Blue Shield Plus 3000, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF210,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028245_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0620006-06,94% AV Level Silver Plan,93.10%,0.930977761745453,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$600,20%,,,,$600,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,AK,38344,OPM,10,2014-12-12 12:37:36,2,38344,AK,Individual,No,91-0499247,38344AK0610001,"Blue Cross Blue Shield Select 5250 HSA, a Multi-State Plan",38344AK061,,AKN201,AKS201,AKF206,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028279_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0610001-03,Limited Cost Sharing Plan Variation,,0.619937121868134,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,AK,38344,OPM,10,2014-12-12 12:37:36,2,38344,AK,Individual,No,91-0499247,38344AK0610002,"Blue Cross Blue Shield Select 2500 HSA, a Multi-State Plan",38344AK061,,AKN201,AKS201,AKF207,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028273_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0610002-01,Standard Silver On Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AK,38344,OPM,10,2014-12-12 12:37:36,2,38344,AK,Individual,No,91-0499247,38344AK0610002,"Blue Cross Blue Shield Select 2500 HSA, a Multi-State Plan",38344AK061,,AKN201,AKS201,AKF207,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028273_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0610002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,GA,49046,OPM,7,2015-01-26 08:44:00,1,49046,GA,Individual,No,58-1638390,49046GA0610003,"Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess, a Multi-State Plan",49046GA061,,GAN201,GAS201,GAF202,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G64,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0610003-04,73% AV Level Silver Plan,73.13%,0.735201418399811,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,GA,49046,OPM,7,2015-01-26 08:44:00,1,49046,GA,Individual,No,58-1638390,49046GA0610003,"Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess, a Multi-State Plan",49046GA061,,GAN201,GAS201,GAF202,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G64,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0610003-05,87% AV Level Silver Plan,86.10%,0.86240416765213,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$725,"$1,450",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,GA,49046,OPM,7,2015-01-26 08:44:00,1,49046,GA,Individual,No,58-1638390,49046GA0610003,"Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess, a Multi-State Plan",49046GA061,,GAN201,GAS201,GAF202,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G64,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0610003-06,94% AV Level Silver Plan,93.07%,0.93149346113205,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,GA,49046,OPM,7,2015-01-26 08:44:00,2,49046,GA,Individual,No,58-1638390,49046GA0610004,"Blue Cross and Blue Shield Healthcare Plan of Georgia Gold DirectAccess, a Multi-State Plan",49046GA061,,GAN201,GAS201,GAF203,Existing,HMO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6A,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0610004-01,Standard Gold On Exchange Plan,78.01%,0.78846937417984,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,GA,49046,OPM,7,2015-01-26 08:44:00,2,49046,GA,Individual,No,58-1638390,49046GA0610004,"Blue Cross and Blue Shield Healthcare Plan of Georgia Gold DirectAccess, a Multi-State Plan",49046GA061,,GAN201,GAS201,GAF203,Existing,HMO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6A,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0610004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,GA,49046,OPM,7,2015-01-26 08:44:00,2,49046,GA,Individual,No,58-1638390,49046GA0610004,"Blue Cross and Blue Shield Healthcare Plan of Georgia Gold DirectAccess, a Multi-State Plan",49046GA061,,GAN201,GAS201,GAF203,Existing,HMO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G6A,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0610004-03,Limited Cost Sharing Plan Variation,78.01%,0.78846937417984,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,10,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080004,WINhealth Gold HSA -SG,53189WY008,,WYN001,WYS003,WYF002,Existing,HMO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080004-01,Standard Gold On Exchange Plan,,0.781938672065735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500",$0,$600,$0,"$1,500",$0,$380,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,10,53189,WY,Individual,No,83-0309681,53189WY0070005,WINhealth Gold-HSA,53189WY007,,WYN001,WYS003,WYF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070005-01,Standard Gold On Exchange Plan,,0.781938672065735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500",$0,$600,$0,"$1,500",$0,$380,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,10,53189,WY,Individual,No,83-0309681,53189WY0070005,WINhealth Gold-HSA,53189WY007,,WYN001,WYS003,WYF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,10,53189,WY,Individual,No,83-0309681,53189WY0070005,WINhealth Gold-HSA,53189WY007,,WYN001,WYS003,WYF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070005-03,Limited Cost Sharing Plan Variation,,0.781938672065735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500",$0,$600,$0,"$1,500",$0,$380,$0,7
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,11,53189,WY,Individual,No,83-0309681,53189WY0070012,WINhealth Gold HSA with Child Dental,53189WY007,,WYN001,WYS003,WYF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070012-00,Standard Gold Off Exchange Plan,,0.781938672065735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500",$0,$600,$0,"$1,500",$0,$380,$0,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,11,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080010,WINhealth Gold HSA with Child Dental -SG,53189WY008,,WYN001,WYS003,WYF002,Existing,HMO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080010-00,Standard Gold Off Exchange Plan,,0.781938672065735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500",$0,$600,$0,"$1,500",$0,$380,$0,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,11,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080010,WINhealth Gold HSA with Child Dental -SG,53189WY008,,WYN001,WYS003,WYF002,Existing,HMO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080010-01,Standard Gold On Exchange Plan,,0.781938672065735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500",$0,$600,$0,"$1,500",$0,$380,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,11,53189,WY,Individual,No,83-0309681,53189WY0070012,WINhealth Gold HSA with Child Dental,53189WY007,,WYN001,WYS003,WYF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070012-01,Standard Gold On Exchange Plan,,0.781938672065735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500",$0,$600,$0,"$1,500",$0,$380,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,11,53189,WY,Individual,No,83-0309681,53189WY0070012,WINhealth Gold HSA with Child Dental,53189WY007,,WYN001,WYS003,WYF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,11,53189,WY,Individual,No,83-0309681,53189WY0070012,WINhealth Gold HSA with Child Dental,53189WY007,,WYN001,WYS003,WYF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070012-03,Limited Cost Sharing Plan Variation,,0.781938672065735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500",$0,$600,$0,"$1,500",$0,$380,$0,7
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,12,53189,WY,Individual,No,83-0309681,53189WY0070007,WINhealth Platinum,53189WY007,,WYN001,WYS003,WYF005,Existing,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070007-00,Standard Platinum Off Exchange Plan,,0.882263779640198,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$750,$400,$350,$0,$750,$330,$110,$0,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,12,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080006,WINhealth Platinum -SG,53189WY008,,WYN001,WYS003,WYF005,Existing,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080006-00,Standard Platinum Off Exchange Plan,,0.882263779640198,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$750,$400,$350,$0,$750,$330,$110,$0,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,12,53189,WY,SHOP (Small Group),No,83-0309681,53189WY0080006,WINhealth Platinum -SG,53189WY008,,WYN001,WYS003,WYF005,Existing,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0080006-01,Standard Platinum On Exchange Plan,,0.882263779640198,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$750,$400,$350,$0,$750,$330,$110,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,12,53189,WY,Individual,No,83-0309681,53189WY0070007,WINhealth Platinum,53189WY007,,WYN001,WYS003,WYF005,Existing,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070007-01,Standard Platinum On Exchange Plan,,0.882263779640198,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$750,$400,$350,$0,$750,$330,$110,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,12,53189,WY,Individual,No,83-0309681,53189WY0070007,WINhealth Platinum,53189WY007,,WYN001,WYS003,WYF005,Existing,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,12,53189,WY,Individual,No,83-0309681,53189WY0070007,WINhealth Platinum,53189WY007,,WYN001,WYS003,WYF005,Existing,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070007-03,Limited Cost Sharing Plan Variation,,0.882263779640198,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$750,$400,$350,$0,$750,$330,$110,$0,7
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,13,53189,WY,Individual,No,83-0309681,53189WY0070014,WINhealth Platinum with Child Dental,53189WY007,,WYN001,WYS003,WYF005,Existing,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070014-00,Standard Platinum Off Exchange Plan,,0.882263779640198,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$750,$400,$350,$0,$750,$330,$110,$0,4
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,13,53189,WY,Individual,No,83-0309681,53189WY0070014,WINhealth Platinum with Child Dental,53189WY007,,WYN001,WYS003,WYF005,Existing,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070014-01,Standard Platinum On Exchange Plan,,0.882263779640198,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$750,$400,$350,$0,$750,$330,$110,$0,5
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,13,53189,WY,Individual,No,83-0309681,53189WY0070014,WINhealth Platinum with Child Dental,53189WY007,,WYN001,WYS003,WYF005,Existing,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,WY,53189,HIOS,13,2015-01-16 17:32:32,13,53189,WY,Individual,No,83-0309681,53189WY0070014,WINhealth Platinum with Child Dental,53189WY007,,WYN001,WYS003,WYF005,Existing,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergent care without preauth, non emergent care requires preauth",Yes,Only sole source coverage at tier 1,No,http://winhealthplans.com/members/individualSBC,https://winhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx,,http://www.winhealthplans.com/media/2014-formulary.pdf,53189WY0070014-03,Limited Cost Sharing Plan Variation,,0.882263779640198,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$750,$400,$350,$0,$750,$330,$110,$0,7
2015,WY,54763,HIOS,2,2014-08-07 10:00:19,1,54763,WY,SHOP (Small Group),Yes,47-0098400,54763WY0040002,EHB High PPO,54763WY004,,WYN001,WYS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$42.56,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,54763WY0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,54763,HIOS,2,2014-08-07 10:00:19,1,54763,WY,SHOP (Small Group),Yes,47-0098400,54763WY0040001,EHB Low PPO,54763WY004,,WYN001,WYS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.18,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,54763WY0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,54763,HIOS,2,2014-08-07 10:00:19,1,54763,WY,SHOP (Small Group),Yes,47-0098400,54763WY0030002,EHB High Passive,54763WY003,,WYN001,WYS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.89,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,54763WY0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WY,54763,HIOS,2,2014-08-07 10:00:19,1,54763,WY,SHOP (Small Group),Yes,47-0098400,54763WY0030001,EHB Low Passive,54763WY003,,WYN001,WYS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.78,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,54763WY0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WY,76197,HIOS,2,2014-08-07 10:00:19,1,76197,WY,SHOP (Small Group),Yes,36-0883760,76197WY0040002,EHB High PPO,76197WY004,,WYN001,WYS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$43.16,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,76197WY0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,76197,HIOS,2,2014-08-07 10:00:19,1,76197,WY,SHOP (Small Group),Yes,36-0883760,76197WY0040001,EHB Low PPO,76197WY004,,WYN001,WYS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.48,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,76197WY0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,76197,HIOS,2,2014-08-07 10:00:19,1,76197,WY,SHOP (Small Group),Yes,36-0883760,76197WY0030002,EHB High Passive,76197WY003,,WYN001,WYS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$46.53,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,76197WY0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WY,76197,HIOS,2,2014-08-07 10:00:19,1,76197,WY,SHOP (Small Group),Yes,36-0883760,76197WY0030001,EHB Low Passive,76197WY003,,WYN001,WYS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.15,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,76197WY0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WY,80132,HIOS,5,2014-11-12 05:24:58,1,80132,WY,SHOP (Small Group),Yes,47-0397286,80132WY0030001,"Renaissance Group Dental PPO, EHB Certified",80132WY003,,WYN001,WYS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.53,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,80132WY0030001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,83964,HIOS,5,2015-01-21 09:35:36,2,83964,WY,SHOP (Small Group),Yes,83-0209667,83964WY0020004,Delta Dental Small Group High Plan,83964WY002,,WYN001,WYS001,,Existing,Indemnity,High,,Both,,,,EHB Pediatric coverage not available for anyone over the age of 18.,,,,,Allows Adult and Child-Only,,,,$33.86,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.,Yes,www.deltadentalwy.org/subscribers/subscribersdocuments/d119898.aspx,https://secure.deltadentalwy.org/wyffm/default.aspx,www.deltadentalwy.org/healthcarereform,,83964WY0020004-01,Standard High On Exchange Plan,85.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,83964,HIOS,5,2015-01-21 09:35:36,2,83964,WY,Individual,Yes,83-0209667,83964WY0010004,Delta Dental Individual & Family High Plan,83964WY001,,WYN001,WYS001,,Existing,Indemnity,High,,Both,,,,EHB Pediatric coverage not available for anyone over the age of 18.,,,,,Allows Adult and Child-Only,,,,$44.25,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.,Yes,www.deltadentalwy.org/subscribers/subscribersdocuments/d119897.aspx,https://secure.deltadentalwy.org/wyffm/default.aspx,www.deltadentalwy.org/healthcarereform,,83964WY0010004-01,Standard High On Exchange Plan,85.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WY,90776,HIOS,2,2014-08-07 10:00:19,1,90776,WY,SHOP (Small Group),Yes,93-0242990,90776WY0040002,EHB High PPO,90776WY004,,WYN001,WYS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$43.28,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,90776WY0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WY,90776,HIOS,2,2014-08-07 10:00:19,1,90776,WY,SHOP (Small Group),Yes,93-0242990,90776WY0040001,EHB Low PPO,90776WY004,,WYN001,WYS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.54,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,90776WY0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,LA,97176,OPM,6,2015-01-23 12:43:55,1,97176,LA,Individual,No,23-7384555,97176LA0330002,"Blue Cross and Blue Shield of Louisiana $2000, a Multi-State Plan",97176LA033,,LAN201,LAS201,LAF201,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0330002,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-mspp-brochure2015,http://www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0330002-04,73% AV Level Silver Plan,72.91%,0.729070127010345,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,700","$25,400","$17,700","$35,400","$2,000","$6,000",30%,,,,"$4,000","$12,000","$6,000","$18,000",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,000",$20,"$1,578",$150,"$1,272","$1,000",$0,$79,10
2015,LA,97176,OPM,6,2015-01-23 12:43:55,1,97176,LA,Individual,No,23-7384555,97176LA0330002,"Blue Cross and Blue Shield of Louisiana $2000, a Multi-State Plan",97176LA033,,LAN201,LAS201,LAF201,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0330002,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-mspp-brochure2015,http://www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0330002-05,87% AV Level Silver Plan,86.08%,0.860804855823517,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,700","$25,400","$14,850","$29,700",$400,"$1,200",20%,,,,"$4,000","$12,000","$4,400","$13,200",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$400,$12,"$1,372",$150,$400,$480,$174,$79,11
2015,MO,32753,OPM,7,2014-12-12 12:37:36,1,32753,MO,Individual,No,86-0257201,32753MO0930004,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",32753MO093,,MON201,MOS201,MOF208,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GK2,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0930004-04,73% AV Level Silver Plan,73.01%,0.735092580318451,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MO,32753,OPM,7,2014-12-12 12:37:36,1,32753,MO,Individual,No,86-0257201,32753MO0930004,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",32753MO093,,MON201,MOS201,MOF208,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GK2,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0930004-05,87% AV Level Silver Plan,86.13%,0.862643301486969,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,MO,32753,OPM,7,2014-12-12 12:37:36,1,32753,MO,Individual,No,86-0257201,32753MO0930004,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",32753MO093,,MON201,MOS201,MOF208,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GK2,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0930004-06,94% AV Level Silver Plan,93.08%,0.931563556194305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$175,$350,20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,MO,32753,OPM,7,2014-12-12 12:37:36,2,32753,MO,Individual,No,86-0257201,32753MO0930006,"Anthem Blue Cross and Blue Shield Gold Direct Access, a Multi-State Plan",32753MO093,,MON201,MOS201,MOF201,Existing,PPO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GK8,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0930006-01,Standard Gold On Exchange Plan,78.52%,0.794258236885071,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,36096,OPM,6,2015-02-20 08:57:57,1,36096,IL,Individual,No,36-1236610,36096IL0780001,"Blue Cross Blue Shield Premier 1, a Multi-State Plan?",36096IL078,,ILN201,ILS201,ILF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0780001-03,Limited Cost Sharing Plan Variation,,0.817188739776611,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$8,250",,,"$5,500","$16,500",Not Applicable,Not Applicable,"$1,000","$3,000",20%,,,,"$2,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IL,36096,OPM,6,2015-02-20 08:57:57,1,36096,IL,Individual,No,36-1236610,36096IL0780002,"Blue Cross Blue Shield Premier 2, a Multi-State Plan?",36096IL078,,ILN201,ILS201,ILF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0780002-01,Standard Gold On Exchange Plan,,0.80812656879425,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$12,000",,,"$8,000","$24,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,DE,76168,OPM,4,2014-11-24 15:19:06,2,76168,DE,Individual,No,51-0020405,76168DE0390002,"Blue Cross Blue Shield Health Savings 1800, a Multi-State Plan",76168DE039,,DEN201,DES201,DEF201,Existing,EPO,Gold,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0390002-01,Standard Gold On Exchange Plan,,0.803948640823364,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,DE,76168,OPM,4,2014-11-24 15:19:06,2,76168,DE,Individual,No,51-0020405,76168DE0390002,"Blue Cross Blue Shield Health Savings 1800, a Multi-State Plan",76168DE039,,DEN201,DES201,DEF201,Existing,EPO,Gold,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0390002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,DE,76168,OPM,4,2014-11-24 15:19:06,2,76168,DE,Individual,No,51-0020405,76168DE0390002,"Blue Cross Blue Shield Health Savings 1800, a Multi-State Plan",76168DE039,,DEN201,DES201,DEF201,Existing,EPO,Gold,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0390002-03,Limited Cost Sharing Plan Variation,,0.803948640823364,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,GA,49046,OPM,7,2015-01-26 08:44:00,1,49046,GA,Individual,No,58-1638390,49046GA0610003,"Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess, a Multi-State Plan",49046GA061,,GAN201,GAS201,GAF202,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G64,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0610003-01,Standard Silver On Exchange Plan,71.04%,0.715576171875,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,1,38344,AK,Individual,No,91-0499247,38344AK0600002,"Blue Cross Blue Shield Select 1000, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF201,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028262_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0600002-03,Limited Cost Sharing Plan Variation,,0.791462600231171,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000",Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AK,38344,OPM,10,2014-12-12 12:37:36,1,38344,AK,Individual,No,91-0499247,38344AK0600003,"Blue Cross Blue Shield Select 1500, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF202,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028264_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0600003-01,Standard Gold On Exchange Plan,,0.783508956432343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000",Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AK,38344,OPM,10,2014-12-12 12:37:36,2,38344,AK,Individual,No,91-0499247,38344AK0610002,"Blue Cross Blue Shield Select 2500 HSA, a Multi-State Plan",38344AK061,,AKN201,AKS201,AKF207,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028273_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0610002-03,Limited Cost Sharing Plan Variation,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,AK,38344,OPM,10,2014-12-12 12:37:36,2,38344,AK,Individual,No,91-0499247,38344AK0610002,"Blue Cross Blue Shield Select 2500 HSA, a Multi-State Plan",38344AK061,,AKN201,AKS201,AKF207,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028273_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0610002-04,73% AV Level Silver Plan,,0.723487317562103,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,AK,38344,OPM,10,2014-12-12 12:37:36,2,38344,AK,Individual,No,91-0499247,38344AK0610002,"Blue Cross Blue Shield Select 2500 HSA, a Multi-State Plan",38344AK061,,AKN201,AKS201,AKF207,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028273_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0610002-05,87% AV Level Silver Plan,,0.863225042819977,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,AK,38344,OPM,10,2014-12-12 12:37:36,2,38344,AK,Individual,No,91-0499247,38344AK0610002,"Blue Cross Blue Shield Select 2500 HSA, a Multi-State Plan",38344AK061,,AKN201,AKS201,AKF207,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028273_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0610002-06,94% AV Level Silver Plan,,0.937364161014557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,AK,38344,OPM,10,2014-12-12 12:37:36,3,38344,AK,Individual,No,91-0499247,38344AK0620002,"Blue Cross Blue Shield Plus 1000, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF208,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028228_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0620002-01,Standard Gold On Exchange Plan,,0.787347435951233,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,3,38344,AK,SHOP (Small Group),No,91-0499247,38344AK0930005,"Blue Cross Blue Shield Select 2000, a Multi-State Plan",38344AK093,,AKN201,AKS201,AKF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you?re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028526_2015.pdf,,https://www.premera.com/documents/031125.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0930005-01,Standard Silver On Exchange Plan,,0.719565331935883,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,3,38344,AK,Individual,No,91-0499247,38344AK0620002,"Blue Cross Blue Shield Plus 1000, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF208,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028228_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0620002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,AK,38344,OPM,10,2014-12-12 12:37:36,3,38344,AK,Individual,No,91-0499247,38344AK0620002,"Blue Cross Blue Shield Plus 1000, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF208,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028228_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0620002-03,Limited Cost Sharing Plan Variation,,0.787347435951233,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,AK,38344,OPM,10,2014-12-12 12:37:36,4,38344,AK,Individual,No,91-0499247,38344AK0630001,"Blue Cross Blue Shield Plus 5250 HSA, a Multi-State Plan",38344AK063,,AKN201,AKS201,AKF206,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028247_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0630001-01,Standard Bronze On Exchange Plan,,0.619937121868134,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,4,38344,AK,SHOP (Small Group),No,91-0499247,38344AK0950001,"Blue Cross Blue Shield Select 1500 HSA, a Multi-State Plan",38344AK095,,AKN201,AKS201,AKF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you?re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028489_2015.pdf,,https://www.premera.com/documents/031125.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0950001-01,Standard Silver On Exchange Plan,,0.715797424316406,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,4,38344,AK,SHOP (Small Group),No,91-0499247,38344AK0950003,"Blue Cross Blue Shield Select 3850 HSA, a Multi-State Plan",38344AK095,,AKN201,AKS201,AKF203,Existing,PPO,Bronze,No,On the Exchange,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you?re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028488_2015.pdf,,https://www.premera.com/documents/031125.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0950003-01,Standard Bronze On Exchange Plan,,0.619450092315674,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,850","$7,700",20%,,,,"$7,700","$15,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,AK,38344,OPM,10,2014-12-12 12:37:36,4,38344,AK,Individual,No,91-0499247,38344AK0630001,"Blue Cross Blue Shield Plus 5250 HSA, a Multi-State Plan",38344AK063,,AKN201,AKS201,AKF206,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028247_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0630001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,AK,38344,OPM,10,2014-12-12 12:37:36,4,38344,AK,Individual,No,91-0499247,38344AK0630001,"Blue Cross Blue Shield Plus 5250 HSA, a Multi-State Plan",38344AK063,,AKN201,AKS201,AKF206,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028247_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0630001-03,Limited Cost Sharing Plan Variation,,0.619937121868134,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,AK,38344,OPM,10,2014-12-12 12:37:36,4,38344,AK,Individual,No,91-0499247,38344AK0630002,"Blue Cross Blue Shield Plus 2500 HSA, a Multi-State Plan",38344AK063,,AKN201,AKS201,AKF207,Existing,PPO,Silver,No,On the Exchange,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028240_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0630002-01,Standard Silver On Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AK,38344,OPM,10,2014-12-12 12:37:36,4,38344,AK,Individual,No,91-0499247,38344AK0630002,"Blue Cross Blue Shield Plus 2500 HSA, a Multi-State Plan",38344AK063,,AKN201,AKS201,AKF207,Existing,PPO,Silver,No,On the Exchange,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028240_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0630002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,AK,38344,OPM,10,2014-12-12 12:37:36,4,38344,AK,Individual,No,91-0499247,38344AK0630002,"Blue Cross Blue Shield Plus 2500 HSA, a Multi-State Plan",38344AK063,,AKN201,AKS201,AKF207,Existing,PPO,Silver,No,On the Exchange,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028240_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0630002-03,Limited Cost Sharing Plan Variation,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,AK,38344,OPM,10,2014-12-12 12:37:36,4,38344,AK,Individual,No,91-0499247,38344AK0630002,"Blue Cross Blue Shield Plus 2500 HSA, a Multi-State Plan",38344AK063,,AKN201,AKS201,AKF207,Existing,PPO,Silver,No,On the Exchange,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028240_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0630002-04,73% AV Level Silver Plan,,0.723487317562103,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,AK,38344,OPM,10,2014-12-12 12:37:36,4,38344,AK,Individual,No,91-0499247,38344AK0630002,"Blue Cross Blue Shield Plus 2500 HSA, a Multi-State Plan",38344AK063,,AKN201,AKS201,AKF207,Existing,PPO,Silver,No,On the Exchange,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028240_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0630002-05,87% AV Level Silver Plan,,0.863225042819977,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,AK,38344,OPM,10,2014-12-12 12:37:36,4,38344,AK,Individual,No,91-0499247,38344AK0630002,"Blue Cross Blue Shield Plus 2500 HSA, a Multi-State Plan",38344AK063,,AKN201,AKS201,AKF207,Existing,PPO,Silver,No,On the Exchange,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028240_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0630002-06,94% AV Level Silver Plan,,0.937364161014557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,AK,38344,OPM,10,2014-12-12 12:37:36,5,38344,AK,Individual,No,91-0499247,38344AK0620003,"Blue Cross Blue Shield Plus 1500, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF208,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028230_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0620003-01,Standard Gold On Exchange Plan,,0.783990740776062,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000",Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,5,38344,AK,SHOP (Small Group),No,91-0499247,38344AK0980003,"Blue Cross Blue Shield Plus 1000, a Multi-State Plan",38344AK098,,AKN201,AKS201,AKF204,Existing,PPO,Gold,No,On the Exchange,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you?re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028492_2015.pdf,,https://www.premera.com/documents/031125.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0980003-01,Standard Gold On Exchange Plan,,0.791901886463165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000",Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,20%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,5,38344,AK,SHOP (Small Group),No,91-0499247,38344AK0980004,"Blue Cross Blue Shield Plus 1500, a Multi-State Plan",38344AK098,,AKN201,AKS201,AKF205,Existing,PPO,Gold,No,On the Exchange,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you?re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028493_2015.pdf,,https://www.premera.com/documents/031125.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0980004-01,Standard Gold On Exchange Plan,,0.786754369735718,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000",Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,20%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,AK,38344,OPM,10,2014-12-12 12:37:36,5,38344,AK,Individual,No,91-0499247,38344AK0620003,"Blue Cross Blue Shield Plus 1500, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF208,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028230_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0620003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,AK,38344,OPM,10,2014-12-12 12:37:36,5,38344,AK,Individual,No,91-0499247,38344AK0620003,"Blue Cross Blue Shield Plus 1500, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF208,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028230_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0620003-03,Limited Cost Sharing Plan Variation,,0.783990740776062,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000",Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AK,38344,OPM,10,2014-12-12 12:37:36,6,38344,AK,Individual,No,91-0499247,38344AK0600004,"Blue Cross Blue Shield Select 2000, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028269_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0600004-01,Standard Silver On Exchange Plan,,0.719565331935883,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,6,38344,AK,SHOP (Small Group),No,91-0499247,38344AK0980005,"Blue Cross Blue Shield Plus 1700, a Multi-State Plan",38344AK098,,AKN201,AKS201,AKF206,Existing,PPO,Silver,No,On the Exchange,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you?re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028494_2015.pdf,,https://www.premera.com/documents/031125.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0980005-01,Standard Silver On Exchange Plan,,0.718562126159668,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400",20%,,,,"$3,400",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,6,38344,AK,Individual,No,91-0499247,38344AK0600004,"Blue Cross Blue Shield Select 2000, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028269_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0600004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,AK,38344,OPM,10,2014-12-12 12:37:36,6,38344,AK,Individual,No,91-0499247,38344AK0600004,"Blue Cross Blue Shield Select 2000, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028269_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0600004-03,Limited Cost Sharing Plan Variation,,0.719565331935883,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,AK,38344,OPM,10,2014-12-12 12:37:36,6,38344,AK,Individual,No,91-0499247,38344AK0600004,"Blue Cross Blue Shield Select 2000, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028269_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0600004-04,73% AV Level Silver Plan,,0.739607691764832,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,050","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,AK,38344,OPM,10,2014-12-12 12:37:36,6,38344,AK,Individual,No,91-0499247,38344AK0600004,"Blue Cross Blue Shield Select 2000, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028269_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0600004-05,87% AV Level Silver Plan,,0.86902642250061,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,AK,38344,OPM,10,2014-12-12 12:37:36,6,38344,AK,Individual,No,91-0499247,38344AK0600004,"Blue Cross Blue Shield Select 2000, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028269_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0600004-06,94% AV Level Silver Plan,,0.942213594913483,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,$400,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,AK,38344,OPM,10,2014-12-12 12:37:36,6,38344,AK,Individual,No,91-0499247,38344AK0600006,"Blue Cross Blue Shield Select 3000, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF204,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028278_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0600006-01,Standard Silver On Exchange Plan,70.08%,0.700752556324005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,AK,38344,OPM,10,2014-12-12 12:37:36,6,38344,AK,Individual,No,91-0499247,38344AK0600006,"Blue Cross Blue Shield Select 3000, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF204,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028278_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0600006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,11
2015,AK,38344,OPM,10,2014-12-12 12:37:36,6,38344,AK,Individual,No,91-0499247,38344AK0600006,"Blue Cross Blue Shield Select 3000, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF204,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028278_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0600006-03,Limited Cost Sharing Plan Variation,70.08%,0.700752556324005,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,AK,38344,OPM,10,2014-12-12 12:37:36,6,38344,AK,Individual,No,91-0499247,38344AK0600006,"Blue Cross Blue Shield Select 3000, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF204,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028278_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0600006-04,73% AV Level Silver Plan,72.77%,0.727713763713837,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,AK,38344,OPM,10,2014-12-12 12:37:36,6,38344,AK,Individual,No,91-0499247,38344AK0600006,"Blue Cross Blue Shield Select 3000, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF204,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028278_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0600006-05,87% AV Level Silver Plan,86.22%,0.859749317169189,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,AK,38344,OPM,10,2014-12-12 12:37:36,6,38344,AK,Individual,No,91-0499247,38344AK0600006,"Blue Cross Blue Shield Select 3000, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF204,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028278_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0600006-06,94% AV Level Silver Plan,93.08%,0.930837154388428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$600,20%,,,,$600,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,AK,38344,OPM,10,2014-12-12 12:37:36,7,38344,AK,Individual,No,91-0499247,38344AK0600007,"Blue Cross Blue Shield Select 5500, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF205,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028281_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0600007-01,Standard Bronze On Exchange Plan,,0.613848924636841,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,7,38344,AK,SHOP (Small Group),No,91-0499247,38344AK0980006,"Blue Cross Blue Shield Plus 2000, a Multi-State Plan",38344AK098,,AKN201,AKS201,AKF207,Existing,PPO,Silver,No,On the Exchange,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you?re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028495_2015.pdf,,https://www.premera.com/documents/031125.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0980006-01,Standard Silver On Exchange Plan,,0.71899402141571,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,7,38344,AK,Individual,No,91-0499247,38344AK0600007,"Blue Cross Blue Shield Select 5500, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF205,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028281_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0600007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,AK,38344,OPM,10,2014-12-12 12:37:36,7,38344,AK,Individual,No,91-0499247,38344AK0600007,"Blue Cross Blue Shield Select 5500, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF205,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028281_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0600007-03,Limited Cost Sharing Plan Variation,,0.613848924636841,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,AK,38344,OPM,10,2014-12-12 12:37:36,8,38344,AK,Individual,No,91-0499247,38344AK0620004,"Blue Cross Blue Shield Plus 2000, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF209,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028235_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0620004-01,Standard Silver On Exchange Plan,,0.719489276409149,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,8,38344,AK,Individual,No,91-0499247,38344AK0620006,"Blue Cross Blue Shield Plus 3000, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF210,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028245_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0620006-03,Limited Cost Sharing Plan Variation,70.54%,0.70536082983017,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,AK,38344,OPM,10,2014-12-12 12:37:36,8,38344,AK,Individual,No,91-0499247,38344AK0620006,"Blue Cross Blue Shield Plus 3000, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF210,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028245_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0620006-04,73% AV Level Silver Plan,72.65%,0.726522505283356,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,AK,38344,OPM,10,2014-12-12 12:37:36,9,38344,AK,Individual,No,91-0499247,38344AK0620007,"Blue Cross Blue Shield Plus 5500, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF205,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028249_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0620007-01,Standard Bronze On Exchange Plan,,0.616936385631561,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,9,38344,AK,SHOP (Small Group),No,91-0499247,38344AK0980012,"Blue Cross Blue Shield Plus 6350, a Multi-State Plan",38344AK098,,AKN201,AKS201,AKF209,Existing,PPO,Bronze,No,On the Exchange,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you?re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028491_2015.pdf,,https://www.premera.com/documents/031125.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0980012-01,Standard Bronze On Exchange Plan,,0.618990540504456,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$12,700",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,LA,97176,OPM,6,2015-01-23 12:43:55,1,97176,LA,Individual,No,23-7384555,97176LA0330001,"Blue Cross and Blue Shield of Louisiana $1500, a Multi-State Plan",97176LA033,,LAN201,LAS201,LAF202,Existing,PPO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0330001,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-mspp-brochure2015,http://www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0330001-01,Standard Gold On Exchange Plan,78.64%,0.786351084709167,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$1,500","$4,500",20%,,,,"$3,000","$9,000","$4,500","$13,500",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,500",$12,"$1,152",$150,"$1,272",$330,$0,$79,4
2015,LA,97176,OPM,6,2015-01-23 12:43:55,1,97176,LA,Individual,No,23-7384555,97176LA0330001,"Blue Cross and Blue Shield of Louisiana $1500, a Multi-State Plan",97176LA033,,LAN201,LAS201,LAF202,Existing,PPO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0330001,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-mspp-brochure2015,http://www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0330001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$79,5
2015,LA,97176,OPM,6,2015-01-23 12:43:55,1,97176,LA,Individual,No,23-7384555,97176LA0330001,"Blue Cross and Blue Shield of Louisiana $1500, a Multi-State Plan",97176LA033,,LAN201,LAS201,LAF202,Existing,PPO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0330001,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-mspp-brochure2015,http://www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0330001-03,Limited Cost Sharing Plan Variation,78.64%,0.786351084709167,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$1,500","$4,500",20%,,,,"$3,000","$9,000","$4,500","$13,500",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,500",$12,"$1,152",$150,"$1,272",$330,$0,$79,6
2015,LA,97176,OPM,6,2015-01-23 12:43:55,1,97176,LA,Individual,No,23-7384555,97176LA0330002,"Blue Cross and Blue Shield of Louisiana $2000, a Multi-State Plan",97176LA033,,LAN201,LAS201,LAF201,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0330002,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-mspp-brochure2015,http://www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0330002-01,Standard Silver On Exchange Plan,70.84%,0.708419740200043,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$6,000",30%,,,,"$4,000","$12,000","$6,000","$18,000",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,000",$20,"$1,578",$150,"$1,272","$1,000",$0,$79,7
2015,LA,97176,OPM,6,2015-01-23 12:43:55,1,97176,LA,Individual,No,23-7384555,97176LA0330002,"Blue Cross and Blue Shield of Louisiana $2000, a Multi-State Plan",97176LA033,,LAN201,LAS201,LAF201,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0330002,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-mspp-brochure2015,http://www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0330002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$79,8
2015,LA,97176,OPM,6,2015-01-23 12:43:55,1,97176,LA,Individual,No,23-7384555,97176LA0330002,"Blue Cross and Blue Shield of Louisiana $2000, a Multi-State Plan",97176LA033,,LAN201,LAS201,LAF201,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0330002,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-mspp-brochure2015,http://www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0330002-03,Limited Cost Sharing Plan Variation,70.84%,0.708419740200043,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$6,000",30%,,,,"$4,000","$12,000","$6,000","$18,000",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,000",$20,"$1,578",$150,"$1,272","$1,000",$0,$79,9
2015,ME,48396,OPM,7,2015-01-30 09:51:15,1,48396,ME,Individual,No,31-1705652,48396ME0940003,"Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan",48396ME094,,MEN202,MES202,MEF205,Existing,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3P,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,them.com/MESelectdrugtier4,48396ME0940003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,ME,48396,OPM,7,2015-01-30 09:51:15,1,48396,ME,Individual,No,31-1705652,48396ME0940003,"Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan",48396ME094,,MEN202,MES202,MEF205,Existing,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3P,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,them.com/MESelectdrugtier4,48396ME0940003-03,Limited Cost Sharing Plan Variation,71.28%,0.703481376171112,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,ME,48396,OPM,7,2015-01-30 09:51:15,1,48396,ME,Individual,No,31-1705652,48396ME0940003,"Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan",48396ME094,,MEN202,MES202,MEF205,Existing,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3P,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,them.com/MESelectdrugtier4,48396ME0940003-04,73% AV Level Silver Plan,73.33%,0.725252687931061,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,OPM,7,2015-01-30 09:51:15,1,48396,ME,Individual,No,31-1705652,48396ME0940003,"Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan",48396ME094,,MEN202,MES202,MEF205,Existing,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3P,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,them.com/MESelectdrugtier4,48396ME0940003-05,87% AV Level Silver Plan,86.13%,0.853124976158142,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,KS,18558,OPM,1,2014-08-15 09:47:40,1,18558,KS,Individual,No,48-0952857,18558KS0380002,"Blue Cross and Blue Shield Freedom, a Multi-State Plan",18558KS038,,KSN201,KSS201,KSF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0380002,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0380002&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0380002-03,Limited Cost Sharing Plan Variation,,0.682029366493225,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$100,$200,50%,,,,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$0,$900,$200,$400,$400,"$2,000",$40,9
2015,KS,18558,OPM,1,2014-08-15 09:47:40,1,18558,KS,Individual,No,48-0952857,18558KS0380002,"Blue Cross and Blue Shield Freedom, a Multi-State Plan",18558KS038,,KSN201,KSS201,KSF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0380002,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0380002&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0380002-04,73% AV Level Silver Plan,,0.723213791847229,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$100,$200,50%,,,,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,000",$200,$400,$400,"$2,000",$40,10
2015,KS,18558,OPM,1,2014-08-15 09:47:40,1,18558,KS,Individual,No,48-0952857,18558KS0380002,"Blue Cross and Blue Shield Freedom, a Multi-State Plan",18558KS038,,KSN201,KSS201,KSF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0380002,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0380002&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0380002-05,87% AV Level Silver Plan,,0.864288926124573,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$50,$100,20%,,,,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,$800,$0,$800,$200,$400,$300,$800,$40,11
2015,KS,18558,OPM,1,2014-08-15 09:47:40,1,18558,KS,Individual,No,48-0952857,18558KS0380002,"Blue Cross and Blue Shield Freedom, a Multi-State Plan",18558KS038,,KSN201,KSS201,KSF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0380002,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0380002&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0380002-06,94% AV Level Silver Plan,,0.931155264377594,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$250,$500,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$25,$50,20%,,,,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,$300,$0,$300,$200,$200,$200,$200,$40,12
2015,AK,38344,OPM,10,2014-12-12 12:37:36,9,38344,AK,Individual,No,91-0499247,38344AK0620007,"Blue Cross Blue Shield Plus 5500, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF205,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028249_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0620007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,AK,38344,OPM,10,2014-12-12 12:37:36,9,38344,AK,Individual,No,91-0499247,38344AK0620007,"Blue Cross Blue Shield Plus 5500, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF205,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028249_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,38344AK0620007-03,Limited Cost Sharing Plan Variation,,0.616936385631561,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,AK,38344,OPM,10,2014-12-12 12:37:36,10,38344,AK,Individual,No,91-0499247,38344AK0620008,"Blue Cross Blue Shield Plus 6350, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF206,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028252_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0620008-01,Standard Bronze On Exchange Plan,,0.618990540504456,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$12,700",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,10,38344,AK,SHOP (Small Group),No,91-0499247,38344AK1000003,"Blue Cross Blue Shield Plus 3850 HSA, a Multi-State Plan",38344AK100,,AKN201,AKS201,AKF203,Existing,PPO,Bronze,No,On the Exchange,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you?re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028496_2015.pdf,,https://www.premera.com/documents/031125.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK1000003-01,Standard Bronze On Exchange Plan,,0.619450092315674,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,850","$7,700",20%,,,,"$7,700","$15,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,10,38344,AK,Individual,No,91-0499247,38344AK0620008,"Blue Cross Blue Shield Plus 6350, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF206,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028252_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0620008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,AK,38344,OPM,10,2014-12-12 12:37:36,10,38344,AK,Individual,No,91-0499247,38344AK0620008,"Blue Cross Blue Shield Plus 6350, a Multi-State Plan",38344AK062,,AKN201,AKS201,AKF206,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028252_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0620008-03,Limited Cost Sharing Plan Variation,,0.618990540504456,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$12,700",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,AK,38344,OPM,10,2014-12-12 12:37:36,11,38344,AK,Individual,No,91-0499247,38344AK0600008,"Blue Cross Blue Shield Select 6350, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF206,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028283_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0600008-01,Standard Bronze On Exchange Plan,,0.619306743144989,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$12,700",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,11,38344,AK,Individual,No,91-0499247,38344AK0600008,"Blue Cross Blue Shield Select 6350, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF206,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028283_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0600008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,AK,38344,OPM,10,2014-12-12 12:37:36,11,38344,AK,Individual,No,91-0499247,38344AK0600008,"Blue Cross Blue Shield Select 6350, a Multi-State Plan",38344AK060,,AKN201,AKS201,AKF206,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028283_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0600008-03,Limited Cost Sharing Plan Variation,,0.619306743144989,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$12,700",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,AK,38344,OPM,10,2014-12-12 12:37:36,12,38344,AK,Individual,No,91-0499247,38344AK0570001,"Blue Cross Blue Shield Plus 5250 HSA High, a Multi-State Plan",38344AK057,,AKN201,AKS201,AKF206,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028246_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0570001-01,Standard Bronze On Exchange Plan,,0.619937121868134,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AK,38344,OPM,10,2014-12-12 12:37:36,12,38344,AK,Individual,No,91-0499247,38344AK0570001,"Blue Cross Blue Shield Plus 5250 HSA High, a Multi-State Plan",38344AK057,,AKN201,AKS201,AKF206,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028246_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0570001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,AK,38344,OPM,10,2014-12-12 12:37:36,12,38344,AK,Individual,No,91-0499247,38344AK0570001,"Blue Cross Blue Shield Plus 5250 HSA High, a Multi-State Plan",38344AK057,,AKN201,AKS201,AKF206,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028246_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0570001-03,Limited Cost Sharing Plan Variation,,0.619937121868134,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,AK,38344,OPM,10,2014-12-12 12:37:36,12,38344,AK,Individual,No,91-0499247,38344AK0570002,"Blue Cross Blue Shield Plus 2500 HSA High, a Multi-State Plan",38344AK057,,AKN201,AKS201,AKF207,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028239_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0570002-01,Standard Silver On Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AK,38344,OPM,10,2014-12-12 12:37:36,12,38344,AK,Individual,No,91-0499247,38344AK0570002,"Blue Cross Blue Shield Plus 2500 HSA High, a Multi-State Plan",38344AK057,,AKN201,AKS201,AKF207,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028239_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0570002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,AK,38344,OPM,10,2014-12-12 12:37:36,12,38344,AK,Individual,No,91-0499247,38344AK0570002,"Blue Cross Blue Shield Plus 2500 HSA High, a Multi-State Plan",38344AK057,,AKN201,AKS201,AKF207,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028239_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0570002-03,Limited Cost Sharing Plan Variation,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,AK,38344,OPM,10,2014-12-12 12:37:36,12,38344,AK,Individual,No,91-0499247,38344AK0570002,"Blue Cross Blue Shield Plus 2500 HSA High, a Multi-State Plan",38344AK057,,AKN201,AKS201,AKF207,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028239_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0570002-04,73% AV Level Silver Plan,,0.723487317562103,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,AK,38344,OPM,10,2014-12-12 12:37:36,12,38344,AK,Individual,No,91-0499247,38344AK0570002,"Blue Cross Blue Shield Plus 2500 HSA High, a Multi-State Plan",38344AK057,,AKN201,AKS201,AKF207,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028239_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0570002-05,87% AV Level Silver Plan,,0.863225042819977,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,AK,38344,OPM,10,2014-12-12 12:37:36,12,38344,AK,Individual,No,91-0499247,38344AK0570002,"Blue Cross Blue Shield Plus 2500 HSA High, a Multi-State Plan",38344AK057,,AKN201,AKS201,AKF207,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,Yes,"Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands",Yes,"If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.",Yes,https://www.premera.com/documents/028239_2015.pdf,,https://www.premera.com/documents/031112.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,38344AK0570002-06,94% AV Level Silver Plan,,0.937364161014557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,AR,75293,OPM,4,2015-01-26 08:44:00,1,75293,AR,Individual,No,71-0226428,75293AR0330001,"Blue Cross Blue Shield 500, a Multi-State Plan",75293AR033,7427051652,ARN201,ARS201,ARF204,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Coinsurance reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=28002,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0330001-01,Standard Gold On Exchange Plan,,0.816178262233734,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AR,75293,OPM,4,2015-01-26 08:44:00,1,75293,AR,Individual,No,71-0226428,75293AR0330001,"Blue Cross Blue Shield 500, a Multi-State Plan",75293AR033,7427051652,ARN201,ARS201,ARF204,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Coinsurance reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=28002,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0330001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,AR,75293,OPM,4,2015-01-26 08:44:00,1,75293,AR,Individual,No,71-0226428,75293AR0330001,"Blue Cross Blue Shield 500, a Multi-State Plan",75293AR033,7427051652,ARN201,ARS201,ARF204,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Coinsurance reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=28002,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0330001-03,Limited Cost Sharing Plan Variation,,0.816178262233734,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,AR,75293,OPM,4,2015-01-26 08:44:00,2,75293,AR,Individual,No,71-0226428,75293AR0290001,"Blue Cross Blue Shield 5000, a Multi-State Plan",75293AR029,7427051652,ARN201,ARS201,ARF240,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Coinsurance reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0290001-01,Standard Bronze On Exchange Plan,,0.619454145431519,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AR,75293,OPM,4,2015-01-26 08:44:00,2,75293,AR,Individual,No,71-0226428,75293AR0290001,"Blue Cross Blue Shield 5000, a Multi-State Plan",75293AR029,7427051652,ARN201,ARS201,ARF240,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Coinsurance reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0290001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,AR,75293,OPM,4,2015-01-26 08:44:00,2,75293,AR,Individual,No,71-0226428,75293AR0290001,"Blue Cross Blue Shield 5000, a Multi-State Plan",75293AR029,7427051652,ARN201,ARS201,ARF240,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Coinsurance reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0290001-03,Limited Cost Sharing Plan Variation,,0.619454145431519,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,AR,75293,OPM,4,2015-01-26 08:44:00,3,75293,AR,Individual,No,71-0226428,75293AR0350001,"Blue Cross Blue Shield 2000, a Multi-State Plan",75293AR035,7427051652,ARN201,ARS201,ARF216,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9983,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Coinsurance reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32013,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0350001-01,Standard Silver On Exchange Plan,,0.719472289085388,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AR,75293,OPM,4,2015-01-26 08:44:00,3,75293,AR,Individual,No,71-0226428,75293AR0350001,"Blue Cross Blue Shield 2000, a Multi-State Plan",75293AR035,7427051652,ARN201,ARS201,ARF216,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9983,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Coinsurance reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32013,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0350001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,AR,75293,OPM,4,2015-01-26 08:44:00,3,75293,AR,Individual,No,71-0226428,75293AR0350001,"Blue Cross Blue Shield 2000, a Multi-State Plan",75293AR035,7427051652,ARN201,ARS201,ARF216,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9983,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Coinsurance reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32013,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0350001-03,Limited Cost Sharing Plan Variation,,0.719472289085388,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,AR,75293,OPM,4,2015-01-26 08:44:00,3,75293,AR,Individual,No,71-0226428,75293AR0350001,"Blue Cross Blue Shield 2000, a Multi-State Plan",75293AR035,7427051652,ARN201,ARS201,ARF216,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9983,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Coinsurance reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32013,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0350001-04,73% AV Level Silver Plan,,0.73962539434433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,"$12,600","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AR,75293,OPM,4,2015-01-26 08:44:00,3,75293,AR,Individual,No,71-0226428,75293AR0350001,"Blue Cross Blue Shield 2000, a Multi-State Plan",75293AR035,7427051652,ARN201,ARS201,ARF216,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9983,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Coinsurance reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32013,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0350001-05,87% AV Level Silver Plan,,0.875786900520325,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$12,600","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,AR,75293,OPM,4,2015-01-26 08:44:00,3,75293,AR,Individual,No,71-0226428,75293AR0350001,"Blue Cross Blue Shield 2000, a Multi-State Plan",75293AR035,7427051652,ARN201,ARS201,ARF216,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9983,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Coinsurance reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32013,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0350001-06,94% AV Level Silver Plan,,0.94826328754425,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$754,"$1,508",,,"$12,600","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,DE,76168,OPM,4,2014-11-24 15:19:06,1,76168,DE,Individual,No,51-0020405,76168DE0390001,"Blue Cross Blue Shield Shared Cost 3000, a Multi-State Plan",76168DE039,,DEN201,DES201,DEF202,Existing,EPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0390001-01,Standard Silver On Exchange Plan,,0.699627578258514,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,DE,76168,OPM,4,2014-11-24 15:19:06,1,76168,DE,Individual,No,51-0020405,76168DE0390001,"Blue Cross Blue Shield Shared Cost 3000, a Multi-State Plan",76168DE039,,DEN201,DES201,DEF202,Existing,EPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0390001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,DE,76168,OPM,4,2014-11-24 15:19:06,1,76168,DE,Individual,No,51-0020405,76168DE0390001,"Blue Cross Blue Shield Shared Cost 3000, a Multi-State Plan",76168DE039,,DEN201,DES201,DEF202,Existing,EPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0390001-03,Limited Cost Sharing Plan Variation,,0.699627578258514,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,DE,76168,OPM,4,2014-11-24 15:19:06,1,76168,DE,Individual,No,51-0020405,76168DE0390001,"Blue Cross Blue Shield Shared Cost 3000, a Multi-State Plan",76168DE039,,DEN201,DES201,DEF202,Existing,EPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0390001-04,73% AV Level Silver Plan,,0.731760799884796,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,DE,76168,OPM,4,2014-11-24 15:19:06,1,76168,DE,Individual,No,51-0020405,76168DE0390001,"Blue Cross Blue Shield Shared Cost 3000, a Multi-State Plan",76168DE039,,DEN201,DES201,DEF202,Existing,EPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0390001-05,87% AV Level Silver Plan,,0.871685922145844,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,DE,76168,OPM,4,2014-11-24 15:19:06,1,76168,DE,Individual,No,51-0020405,76168DE0390001,"Blue Cross Blue Shield Shared Cost 3000, a Multi-State Plan",76168DE039,,DEN201,DES201,DEF202,Existing,EPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0390001-06,94% AV Level Silver Plan,,0.933216869831085,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,GA,49046,OPM,7,2015-01-26 08:44:00,1,49046,GA,Individual,No,58-1638390,49046GA0610003,"Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess, a Multi-State Plan",49046GA061,,GAN201,GAS201,GAF202,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G64,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0610003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,GA,49046,OPM,7,2015-01-26 08:44:00,1,49046,GA,Individual,No,58-1638390,49046GA0610003,"Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess, a Multi-State Plan",49046GA061,,GAN201,GAS201,GAF202,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G64,https://shop.bcbsga.com/sales/eox/payment/landing/ga,http://file.bcbsga.com/03269GAMENHPG.pdf,www.bcbsga.com/GASelectdrugtier4,49046GA0610003-03,Limited Cost Sharing Plan Variation,71.04%,0.715576171875,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,MT,30751,OPM,7,2015-02-20 08:57:57,1,30751,MT,Individual,No,36-1236610,30751MT0570001,"Blue Cross Blue Shield Premier 1, a Multi-State Plan?",30751MT057,,MTN201,MTS201,MTF202,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0570001-01,Standard Gold On Exchange Plan,,0.817188739776611,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$5,500","$11,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,MT,30751,OPM,7,2015-02-20 08:57:57,1,30751,MT,Individual,No,36-1236610,30751MT0570001,"Blue Cross Blue Shield Premier 1, a Multi-State Plan?",30751MT057,,MTN201,MTS201,MTF202,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0570001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,LA,97176,OPM,6,2015-01-23 12:43:55,1,97176,LA,Individual,No,23-7384555,97176LA0330002,"Blue Cross and Blue Shield of Louisiana $2000, a Multi-State Plan",97176LA033,,LAN201,LAS201,LAF201,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.,Yes,Coverage available for covered benefits,Yes,http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0330002,https://www.bcbsla.com/marketplacepayment,www.bcbsla.com/individual-mspp-brochure2015,http://www.bcbsla.com/pharmacy-4tier-formulary2015,97176LA0330002-06,94% AV Level Silver Plan,93.74%,0.937390029430389,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,700","$25,400","$14,850","$29,700",$100,$300,0%,,,,"$4,000","$12,000","$4,100","$12,300",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$100,$12,$0,$150,$100,$480,$0,$79,12
2015,ME,48396,OPM,7,2015-01-30 09:51:15,1,48396,ME,Individual,No,31-1705652,48396ME0940003,"Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan",48396ME094,,MEN202,MES202,MEF205,Existing,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3P,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,them.com/MESelectdrugtier4,48396ME0940003-01,Standard Silver On Exchange Plan,71.28%,0.703481376171112,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,OPM,7,2015-01-30 09:51:15,1,48396,ME,Individual,No,31-1705652,48396ME0940003,"Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan",48396ME094,,MEN202,MES202,MEF205,Existing,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3P,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,them.com/MESelectdrugtier4,48396ME0940003-06,94% AV Level Silver Plan,93.38%,0.927381932735443,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,ME,48396,OPM,7,2015-01-30 09:51:15,1,48396,ME,Individual,No,31-1705652,48396ME0940005,"Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan",48396ME094,,MEN202,MES203,MEF205,Existing,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3P,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,them.com/MESelectdrugtier4,48396ME0940005-01,Standard Silver On Exchange Plan,71.28%,0.703481376171112,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,ME,48396,OPM,7,2015-01-30 09:51:15,1,48396,ME,Individual,No,31-1705652,48396ME0940005,"Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan",48396ME094,,MEN202,MES203,MEF205,Existing,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3P,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,them.com/MESelectdrugtier4,48396ME0940005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,11
2015,ME,48396,OPM,7,2015-01-30 09:51:15,1,48396,ME,Individual,No,31-1705652,48396ME0940005,"Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan",48396ME094,,MEN202,MES203,MEF205,Existing,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3P,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,them.com/MESelectdrugtier4,48396ME0940005-03,Limited Cost Sharing Plan Variation,71.28%,0.703481376171112,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,ME,48396,OPM,7,2015-01-30 09:51:15,1,48396,ME,Individual,No,31-1705652,48396ME0940005,"Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan",48396ME094,,MEN202,MES203,MEF205,Existing,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3P,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,them.com/MESelectdrugtier4,48396ME0940005-04,73% AV Level Silver Plan,73.33%,0.725252687931061,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,ME,48396,OPM,7,2015-01-30 09:51:15,1,48396,ME,Individual,No,31-1705652,48396ME0940005,"Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan",48396ME094,,MEN202,MES203,MEF205,Existing,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3P,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,them.com/MESelectdrugtier4,48396ME0940005-05,87% AV Level Silver Plan,86.13%,0.853124976158142,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,ME,48396,OPM,7,2015-01-30 09:51:15,1,48396,ME,Individual,No,31-1705652,48396ME0940005,"Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan",48396ME094,,MEN202,MES203,MEF205,Existing,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3P,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,them.com/MESelectdrugtier4,48396ME0940005-06,94% AV Level Silver Plan,93.38%,0.927381932735443,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,ME,48396,OPM,7,2015-01-30 09:51:15,2,48396,ME,Individual,No,31-1705652,48396ME0940004,"Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan",48396ME094,,MEN202,MES202,MEF202,Existing,POS,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care only,Yes,Emergency/Urgent Care only,No,http://www.sbc.anthem.com/dps/CCD1J3Z,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0940004-01,Standard Gold On Exchange Plan,79.97%,0.78450083732605,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",5%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,OPM,7,2015-01-30 09:51:15,2,48396,ME,Individual,No,31-1705652,48396ME0940004,"Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan",48396ME094,,MEN202,MES202,MEF202,Existing,POS,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care only,Yes,Emergency/Urgent Care only,No,http://www.sbc.anthem.com/dps/CCD1J3Z,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0940004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,ME,48396,OPM,7,2015-01-30 09:51:15,2,48396,ME,Individual,No,31-1705652,48396ME0940004,"Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan",48396ME094,,MEN202,MES202,MEF202,Existing,POS,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care only,Yes,Emergency/Urgent Care only,No,http://www.sbc.anthem.com/dps/CCD1J3Z,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0940004-03,Limited Cost Sharing Plan Variation,79.97%,0.78450083732605,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",5%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,36096,OPM,6,2015-02-20 08:57:57,1,36096,IL,Individual,No,36-1236610,36096IL0780001,"Blue Cross Blue Shield Premier 1, a Multi-State Plan?",36096IL078,,ILN201,ILS201,ILF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0780001-01,Standard Gold On Exchange Plan,,0.817188739776611,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$8,250",,,"$5,500","$16,500",Not Applicable,Not Applicable,"$1,000","$3,000",20%,,,,"$2,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,36096,OPM,6,2015-02-20 08:57:57,1,36096,IL,Individual,No,36-1236610,36096IL0780001,"Blue Cross Blue Shield Premier 1, a Multi-State Plan?",36096IL078,,ILN201,ILS201,ILF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0780001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,IL,36096,OPM,6,2015-02-20 08:57:57,1,36096,IL,Individual,No,36-1236610,36096IL0780002,"Blue Cross Blue Shield Premier 2, a Multi-State Plan?",36096IL078,,ILN201,ILS201,ILF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0780002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,IL,36096,OPM,6,2015-02-20 08:57:57,1,36096,IL,Individual,No,36-1236610,36096IL0780002,"Blue Cross Blue Shield Premier 2, a Multi-State Plan?",36096IL078,,ILN201,ILS201,ILF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0780002-03,Limited Cost Sharing Plan Variation,,0.80812656879425,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$12,000",,,"$8,000","$24,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IL,36096,OPM,6,2015-02-20 08:57:57,1,36096,IL,Individual,No,36-1236610,36096IL0780003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",36096IL078,,ILN201,ILS201,ILF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0780003-01,Standard Silver On Exchange Plan,,0.703163325786591,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,500","$12,700",20%,,,,"$9,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IL,36096,OPM,6,2015-02-20 08:57:57,1,36096,IL,Individual,No,36-1236610,36096IL0780003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",36096IL078,,ILN201,ILS201,ILF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0780003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,IL,36096,OPM,6,2015-02-20 08:57:57,1,36096,IL,Individual,No,36-1236610,36096IL0780003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",36096IL078,,ILN201,ILS201,ILF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0780003-03,Limited Cost Sharing Plan Variation,,0.703163325786591,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,500","$12,700",20%,,,,"$9,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,IL,36096,OPM,6,2015-02-20 08:57:57,1,36096,IL,Individual,No,36-1236610,36096IL0780003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",36096IL078,,ILN201,ILS201,ILF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0780003-04,73% AV Level Silver Plan,,0.739054918289185,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,IL,36096,OPM,6,2015-02-20 08:57:57,1,36096,IL,Individual,No,36-1236610,36096IL0780003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",36096IL078,,ILN201,ILS201,ILF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0780003-05,87% AV Level Silver Plan,,0.868183553218842,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,500",,,"$4,000","$9,000",Not Applicable,Not Applicable,$250,$750,20%,,,,$500,"$1,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,IL,36096,OPM,6,2015-02-20 08:57:57,1,36096,IL,Individual,No,36-1236610,36096IL0780003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",36096IL078,,ILN201,ILS201,ILF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0780003-06,94% AV Level Silver Plan,,0.946778774261475,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,IL,36096,OPM,6,2015-02-20 08:57:57,1,36096,IL,Individual,No,36-1236610,36096IL0780004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",36096IL078,,ILN201,ILS201,ILF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0780004-01,Standard Silver On Exchange Plan,,0.686640679836273,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400",Not Applicable,Not Applicable,"$6,250","$12,700",0%,,,,"$12,500","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,IL,36096,OPM,6,2015-02-20 08:57:57,1,36096,IL,Individual,No,36-1236610,36096IL0780004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",36096IL078,,ILN201,ILS201,ILF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0780004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,IL,36096,OPM,6,2015-02-20 08:57:57,1,36096,IL,Individual,No,36-1236610,36096IL0780004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",36096IL078,,ILN201,ILS201,ILF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0780004-03,Limited Cost Sharing Plan Variation,,0.686640679836273,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400",Not Applicable,Not Applicable,"$6,250","$12,700",0%,,,,"$12,500","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,IL,36096,OPM,6,2015-02-20 08:57:57,1,36096,IL,Individual,No,36-1236610,36096IL0780004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",36096IL078,,ILN201,ILS201,ILF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0780004-04,73% AV Level Silver Plan,,0.730801701545715,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$10,400",,,"$9,500","$20,800",Not Applicable,Not Applicable,"$4,750","$10,400",0%,,,,"$9,500","$20,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,IL,36096,OPM,6,2015-02-20 08:57:57,1,36096,IL,Individual,No,36-1236610,36096IL0780004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",36096IL078,,ILN201,ILS201,ILF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0780004-05,87% AV Level Silver Plan,,0.871323525905609,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,IL,36096,OPM,6,2015-02-20 08:57:57,1,36096,IL,Individual,No,36-1236610,36096IL0780004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",36096IL078,,ILN201,ILS201,ILF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0780004-06,94% AV Level Silver Plan,,0.94565761089325,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$500,"$1,500",0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,IL,36096,OPM,6,2015-02-20 08:57:57,2,36096,IL,Individual,No,36-1236610,36096IL0780005,"Blue Cross Blue Shield Basic 5, a Multi-State Plan?",36096IL078,,ILN201,ILS201,ILF202,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0780005-01,Standard Bronze On Exchange Plan,,0.611617028713226,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$11,250",30%,,,,"$7,500","$22,500",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,36096,OPM,6,2015-02-20 08:57:57,2,36096,IL,Individual,No,36-1236610,36096IL0780005,"Blue Cross Blue Shield Basic 5, a Multi-State Plan?",36096IL078,,ILN201,ILS201,ILF202,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0780005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,IL,36096,OPM,6,2015-02-20 08:57:57,2,36096,IL,Individual,No,36-1236610,36096IL0780005,"Blue Cross Blue Shield Basic 5, a Multi-State Plan?",36096IL078,,ILN201,ILS201,ILF202,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0780005-03,Limited Cost Sharing Plan Variation,,0.611617028713226,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$11,250",30%,,,,"$7,500","$22,500",Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,79763,OPM,6,2014-10-28 20:25:58,1,79763,IL,Individual,No,90-0962741,79763IL0680001,"CO-OPtions Land of Lincoln National Elite Gold, a Multi-State Plan",79763IL068,,ILN201,ILS201,ILF001,New,PPO,Gold,Yes,On the Exchange,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-068G-SBC-Elite.pdf,landoflincolnhealth.org/member/make-a-payment,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0680001-01,Standard Gold On Exchange Plan,78.09%,0.765416026115417,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,350","$6,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",25%,,,,"$5,000","$10,000","$5,500","$11,000",,,,,,,,,4
2015,IL,79763,OPM,6,2014-10-28 20:25:58,1,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0710001,"CO-OPtions Land of Lincoln National Elite Gold, a Multi-State Plan",79763IL071,,ILN201,ILS201,ILF001,New,PPO,Gold,Yes,On the Exchange,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $5000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-071G-SBC-Elite.pdf,www.landoflincolnhealth.org/employer/make-a-payment,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0710001-01,Standard Gold On Exchange Plan,78.09%,0.765416026115417,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,350","$6,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",25%,,,,"$5,000","$10,000","$5,500","$11,000",,,,,,,,,4
2015,IL,79763,OPM,6,2014-10-28 20:25:58,1,79763,IL,Individual,No,90-0962741,79763IL0680001,"CO-OPtions Land of Lincoln National Elite Gold, a Multi-State Plan",79763IL068,,ILN201,ILS201,ILF001,New,PPO,Gold,Yes,On the Exchange,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-068G-SBC-Elite.pdf,landoflincolnhealth.org/member/make-a-payment,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0680001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,IL,79763,OPM,6,2014-10-28 20:25:58,1,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0710002,"CO-OPtions Land of Lincoln National Elite Silver, a Multi-State Plan",79763IL071,,ILN201,ILS201,ILF002,New,PPO,Silver,Yes,On the Exchange,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $8000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-071S-SBC-Elite.pdf,www.landoflincolnhealth.org/employer/make-a-payment,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0710002-01,Standard Silver On Exchange Plan,68.20%,0.620908260345459,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$8,000","$16,000","$10,500","$21,000",,,,,,,,,5
2015,IL,79763,OPM,6,2014-10-28 20:25:58,1,79763,IL,Individual,No,90-0962741,79763IL0680001,"CO-OPtions Land of Lincoln National Elite Gold, a Multi-State Plan",79763IL068,,ILN201,ILS201,ILF001,New,PPO,Gold,Yes,On the Exchange,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-068G-SBC-Elite.pdf,landoflincolnhealth.org/member/make-a-payment,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0680001-03,Limited Cost Sharing Plan Variation,78.09%,0.765416026115417,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,350","$6,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",25%,,,,"$5,000","$10,000","$5,500","$11,000",,,,,,,,,6
2015,IL,79763,OPM,6,2014-10-28 20:25:58,1,79763,IL,Individual,No,90-0962741,79763IL0680002,"CO-OPtions Land of Lincoln National Elite Silver, a Multi-State Plan",79763IL068,,ILN201,ILS201,ILF002,New,PPO,Silver,Yes,On the Exchange,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $8000 deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-068S-SBC-Elite.pdf,landoflincolnhealth.org/member/make-a-payment,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0680002-01,Standard Silver On Exchange Plan,68.02%,0.599533975124359,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500",30%,,,,"$8,000","$16,000","$11,750","$23,500",,,,,,,,,7
2015,IL,79763,OPM,6,2014-10-28 20:25:58,1,79763,IL,Individual,No,90-0962741,79763IL0680002,"CO-OPtions Land of Lincoln National Elite Silver, a Multi-State Plan",79763IL068,,ILN201,ILS201,ILF002,New,PPO,Silver,Yes,On the Exchange,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $8000 deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-068S-SBC-Elite.pdf,landoflincolnhealth.org/member/make-a-payment,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0680002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,IL,79763,OPM,6,2014-10-28 20:25:58,1,79763,IL,Individual,No,90-0962741,79763IL0680002,"CO-OPtions Land of Lincoln National Elite Silver, a Multi-State Plan",79763IL068,,ILN201,ILS201,ILF002,New,PPO,Silver,Yes,On the Exchange,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $8000 deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-068S-SBC-Elite.pdf,landoflincolnhealth.org/member/make-a-payment,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0680002-03,Limited Cost Sharing Plan Variation,68.02%,0.599533975124359,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500",30%,,,,"$8,000","$16,000","$11,750","$23,500",,,,,,,,,9
2015,IL,79763,OPM,6,2014-10-28 20:25:58,1,79763,IL,Individual,No,90-0962741,79763IL0680002,"CO-OPtions Land of Lincoln National Elite Silver, a Multi-State Plan",79763IL068,,ILN201,ILS201,ILF002,New,PPO,Silver,Yes,On the Exchange,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $8000 deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-068S-SBC-Elite.pdf,landoflincolnhealth.org/member/make-a-payment,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0680002-04,73% AV Level Silver Plan,73.85%,0.712815046310425,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",30%,,,,"$8,000","$16,000","$8,750","$17,500",,,,,,,,,10
2015,IL,79763,OPM,6,2014-10-28 20:25:58,1,79763,IL,Individual,No,90-0962741,79763IL0680002,"CO-OPtions Land of Lincoln National Elite Silver, a Multi-State Plan",79763IL068,,ILN201,ILS201,ILF002,New,PPO,Silver,Yes,On the Exchange,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $8000 deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-068S-SBC-Elite.pdf,landoflincolnhealth.org/member/make-a-payment,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0680002-05,87% AV Level Silver Plan,87.87%,0.87828516960144,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$8,000","$16,000",$0,$0,,,,,,,,,11
2015,IL,79763,OPM,6,2014-10-28 20:25:58,1,79763,IL,Individual,No,90-0962741,79763IL0680002,"CO-OPtions Land of Lincoln National Elite Silver, a Multi-State Plan",79763IL068,,ILN201,ILS201,ILF002,New,PPO,Silver,Yes,On the Exchange,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $8000 deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-068S-SBC-Elite.pdf,landoflincolnhealth.org/member/make-a-payment,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0680002-06,94% AV Level Silver Plan,93.97%,0.939527750015259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$8,000","$16,000",$0,$0,,,,,,,,,12
2015,IN,17575,OPM,5,2014-12-12 12:37:36,1,17575,IN,Individual,No,35-0781558,17575IN0930005,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",17575IN093,,INN201,INS201,INF202,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GFA,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0930005-01,Standard Silver On Exchange Plan,70.00%,0.705859959125519,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IN,17575,OPM,5,2014-12-12 12:37:36,1,17575,IN,Individual,No,35-0781558,17575IN0930005,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",17575IN093,,INN201,INS201,INF202,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GFA,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0930005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,IN,17575,OPM,5,2014-12-12 12:37:36,1,17575,IN,Individual,No,35-0781558,17575IN0930005,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",17575IN093,,INN201,INS201,INF202,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GFA,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0930005-03,Limited Cost Sharing Plan Variation,70.00%,0.705859959125519,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,IN,17575,OPM,5,2014-12-12 12:37:36,1,17575,IN,Individual,No,35-0781558,17575IN0930005,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",17575IN093,,INN201,INS201,INF202,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GFA,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0930005-04,73% AV Level Silver Plan,72.92%,0.733173727989197,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IN,17575,OPM,5,2014-12-12 12:37:36,2,17575,IN,Individual,No,35-0781558,17575IN0930006,"Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan",17575IN093,,INN201,INS201,INF201,Existing,HMO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency/Urgent Care Only,No,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GFE,https://shop.anthem.com/sales/eox/payment/landing/in,http://file.anthem.com/03259INMENABS.pdf,anthem.com/INSelectdrugtier4,17575IN0930006-03,Limited Cost Sharing Plan Variation,78.52%,0.794258236885071,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,KS,18558,OPM,1,2014-08-15 09:47:40,1,18558,KS,Individual,No,48-0952857,18558KS0380001,"Blue Cross and Blue Shield FreedomPlus, a Multi-State Plan",18558KS038,,KSN201,KSS201,KSF201,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0380001,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0380001&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0380001-01,Standard Gold On Exchange Plan,,0.785770952701569,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$100,$200,50%,,,,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,"$1,200",$200,$400,$400,"$1,700",$40,4
2015,KS,18558,OPM,1,2014-08-15 09:47:40,1,18558,KS,Individual,No,48-0952857,18558KS0380001,"Blue Cross and Blue Shield FreedomPlus, a Multi-State Plan",18558KS038,,KSN201,KSS201,KSF201,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0380001,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0380001&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0380001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$40,5
2015,KS,18558,OPM,1,2014-08-15 09:47:40,1,18558,KS,Individual,No,48-0952857,18558KS0380001,"Blue Cross and Blue Shield FreedomPlus, a Multi-State Plan",18558KS038,,KSN201,KSS201,KSF201,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0380001,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0380001&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0380001-03,Limited Cost Sharing Plan Variation,,0.785770952701569,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$100,$200,50%,,,,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,"$1,200",$200,$400,$400,"$1,700",$40,6
2015,KS,18558,OPM,1,2014-08-15 09:47:40,1,18558,KS,Individual,No,48-0952857,18558KS0380002,"Blue Cross and Blue Shield Freedom, a Multi-State Plan",18558KS038,,KSN201,KSS201,KSF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0380002,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0380002&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0380002-01,Standard Silver On Exchange Plan,,0.682029366493225,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$100,$200,50%,,,,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$0,$900,$200,$400,$400,"$2,000",$40,7
2015,KS,18558,OPM,1,2014-08-15 09:47:40,1,18558,KS,Individual,No,48-0952857,18558KS0380002,"Blue Cross and Blue Shield Freedom, a Multi-State Plan",18558KS038,,KSN201,KSS201,KSF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0380002,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0380002&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0380002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,MI,41895,OPM,6,2015-01-23 12:43:55,1,41895,MI,Individual,No,45-3758112,41895MI0010058,"CO-Options? Choice Silver, a Multi-State Plan",41895MI001,,MIN201,MIS201,MIF201,New,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010058-05,87% AV Level Silver Plan,86.29%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,MI,41895,OPM,6,2015-01-23 12:43:55,1,41895,MI,Individual,No,45-3758112,41895MI0010058,"CO-Options? Choice Silver, a Multi-State Plan",41895MI001,,MIN201,MIS201,MIF201,New,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010058-06,94% AV Level Silver Plan,93.09%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,MI,41895,OPM,6,2015-01-23 12:43:55,1,41895,MI,Individual,No,45-3758112,41895MI0010059,"CO-Options? Basic Bronze, a Multi-State Plan",41895MI001,,MIN201,MIS201,MIF202,New,PPO,Bronze,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010059-01,Standard Bronze On Exchange Plan,58.93%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",60%,"$2,000","$4,000",70%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,MI,41895,OPM,6,2015-01-23 12:43:55,1,41895,MI,Individual,No,45-3758112,41895MI0010059,"CO-Options? Basic Bronze, a Multi-State Plan",41895MI001,,MIN201,MIS201,MIF202,New,PPO,Bronze,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010059-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,14
2015,MI,41895,OPM,6,2015-01-23 12:43:55,1,41895,MI,Individual,No,45-3758112,41895MI0010059,"CO-Options? Basic Bronze, a Multi-State Plan",41895MI001,,MIN201,MIS201,MIF202,New,PPO,Bronze,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010059-03,Limited Cost Sharing Plan Variation,58.93%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",60%,"$2,000","$4,000",70%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,MO,32753,OPM,7,2014-12-12 12:37:36,1,32753,MO,Individual,No,86-0257201,32753MO0930004,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",32753MO093,,MON201,MOS201,MOF208,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GK2,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0930004-01,Standard Silver On Exchange Plan,71.01%,0.716200590133667,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MO,32753,OPM,7,2014-12-12 12:37:36,2,32753,MO,Individual,No,86-0257201,32753MO0930006,"Anthem Blue Cross and Blue Shield Gold Direct Access, a Multi-State Plan",32753MO093,,MON201,MOS201,MOF201,Existing,PPO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GK8,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0930006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,MO,32753,OPM,7,2014-12-12 12:37:36,2,32753,MO,Individual,No,86-0257201,32753MO0930006,"Anthem Blue Cross and Blue Shield Gold Direct Access, a Multi-State Plan",32753MO093,,MON201,MOS201,MOF201,Existing,PPO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GK8,https://shop.anthem.com/sales/eox/payment/landing/mo,http://file.anthem.com/03261MOMENABS.pdf,anthem.com/MOSelectdrugtier4,32753MO0930006-03,Limited Cost Sharing Plan Variation,78.52%,0.794258236885071,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,ME,48396,OPM,7,2015-01-30 09:51:15,2,48396,ME,Individual,No,31-1705652,48396ME0940006,"Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan",48396ME094,,MEN202,MES203,MEF202,Existing,POS,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care only,Yes,Emergency/Urgent Care only,No,http://www.sbc.anthem.com/dps/CCD1J3Z,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0940006-01,Standard Gold On Exchange Plan,79.97%,0.78450083732605,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",5%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,OPM,7,2015-01-30 09:51:15,2,48396,ME,Individual,No,31-1705652,48396ME0940006,"Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan",48396ME094,,MEN202,MES203,MEF202,Existing,POS,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care only,Yes,Emergency/Urgent Care only,No,http://www.sbc.anthem.com/dps/CCD1J3Z,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0940006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,ME,48396,OPM,7,2015-01-30 09:51:15,2,48396,ME,Individual,No,31-1705652,48396ME0940006,"Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan",48396ME094,,MEN202,MES203,MEF202,Existing,POS,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care only,Yes,Emergency/Urgent Care only,No,http://www.sbc.anthem.com/dps/CCD1J3Z,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0940006-03,Limited Cost Sharing Plan Variation,79.97%,0.78450083732605,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",5%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,ME,48396,OPM,7,2015-01-30 09:51:15,3,48396,ME,Individual,No,31-1705652,48396ME0930003,"Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan",48396ME093,,MEN201,MES201,MEF203,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4K,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0930003-01,Standard Silver On Exchange Plan,70.90%,0.700181782245636,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,OPM,7,2015-01-30 09:51:15,3,48396,ME,Individual,No,31-1705652,48396ME0930003,"Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan",48396ME093,,MEN201,MES201,MEF203,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4K,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0930003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,ME,48396,OPM,7,2015-01-30 09:51:15,3,48396,ME,Individual,No,31-1705652,48396ME0930003,"Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan",48396ME093,,MEN201,MES201,MEF203,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4K,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0930003-03,Limited Cost Sharing Plan Variation,70.90%,0.700181782245636,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,ME,48396,OPM,7,2015-01-30 09:51:15,3,48396,ME,Individual,No,31-1705652,48396ME0930003,"Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan",48396ME093,,MEN201,MES201,MEF203,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4K,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0930003-04,73% AV Level Silver Plan,73.20%,0.721496284008026,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,400","$4,800",5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,OPM,7,2015-01-30 09:51:15,3,48396,ME,Individual,No,31-1705652,48396ME0930003,"Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan",48396ME093,,MEN201,MES201,MEF203,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4K,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0930003-05,87% AV Level Silver Plan,86.54%,0.85183048248291,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,ME,48396,OPM,7,2015-01-30 09:51:15,3,48396,ME,Individual,No,31-1705652,48396ME0930003,"Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan",48396ME093,,MEN201,MES201,MEF203,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4K,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0930003-06,94% AV Level Silver Plan,93.41%,0.918961703777313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,ME,48396,OPM,7,2015-01-30 09:51:15,4,48396,ME,Individual,No,31-1705652,48396ME0930004,"Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan",48396ME093,,MEN201,MES201,MEF204,Existing,HMO,Gold,Yes,On the Exchange,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J57,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0930004-01,Standard Gold On Exchange Plan,78.59%,0.772568047046661,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,OPM,7,2015-01-30 09:51:15,4,48396,ME,Individual,No,31-1705652,48396ME0930004,"Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan",48396ME093,,MEN201,MES201,MEF204,Existing,HMO,Gold,Yes,On the Exchange,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J57,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0930004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,ME,48396,OPM,7,2015-01-30 09:51:15,4,48396,ME,Individual,No,31-1705652,48396ME0930004,"Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan",48396ME093,,MEN201,MES201,MEF204,Existing,HMO,Gold,Yes,On the Exchange,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J57,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0930004-03,Limited Cost Sharing Plan Variation,78.59%,0.772568047046661,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,MI,15560,OPM,3,2014-10-28 20:25:58,1,15560,MI,Individual,No,38-2069753,15560MI0410001,"Blue Cross? Silver with Dental and Vision, a Multi-State Plan",15560MI041,7538162760,MIN003,MIS001,MIF052,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.912,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0410001-01,Standard Silver On Exchange Plan,68.90%,0.699648082256317,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,400",$500,$850,$150,"$1,400",$90,$725,$40,4
2015,MI,15560,OPM,3,2014-10-28 20:25:58,1,15560,MI,Individual,No,38-2069753,15560MI0410001,"Blue Cross? Silver with Dental and Vision, a Multi-State Plan",15560MI041,7538162760,MIN003,MIS001,MIF052,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.912,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0410001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$40,5
2015,MI,15560,OPM,3,2014-10-28 20:25:58,1,15560,MI,Individual,No,38-2069753,15560MI0410001,"Blue Cross? Silver with Dental and Vision, a Multi-State Plan",15560MI041,7538162760,MIN003,MIS001,MIF052,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.912,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0410001-03,Limited Cost Sharing Plan Variation,68.90%,0.699648082256317,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,400",$500,$850,$150,"$1,400",$90,$725,$40,6
2015,MI,15560,OPM,3,2014-10-28 20:25:58,1,15560,MI,Individual,No,38-2069753,15560MI0410001,"Blue Cross? Silver with Dental and Vision, a Multi-State Plan",15560MI041,7538162760,MIN003,MIS001,MIF052,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.912,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0410001-04,73% AV Level Silver Plan,73.00%,0.740858197212219,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$500,$930,$150,"$1,000",$150,$740,$40,7
2015,MI,15560,OPM,3,2014-10-28 20:25:58,1,15560,MI,Individual,No,38-2069753,15560MI0410001,"Blue Cross? Silver with Dental and Vision, a Multi-State Plan",15560MI041,7538162760,MIN003,MIS001,MIF052,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.912,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0410001-05,87% AV Level Silver Plan,86.50%,0.864163339138031,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$2,800","$5,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$600,10%,,,,$600,"$1,200",Not Applicable,Not Applicable,$300,$500,$540,$150,$300,$180,$430,$40,8
2015,MI,15560,OPM,3,2014-10-28 20:25:58,1,15560,MI,Individual,No,38-2069753,15560MI0410001,"Blue Cross? Silver with Dental and Vision, a Multi-State Plan",15560MI041,7538162760,MIN003,MIS001,MIF052,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.912,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0410001-06,94% AV Level Silver Plan,93.00%,0.931599736213684,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$175,$350,10%,,,,$350,$700,Not Applicable,Not Applicable,$175,$0,$325,$150,$175,$180,$145,$40,9
2015,MI,15560,OPM,3,2014-10-28 20:25:58,1,15560,MI,Individual,No,38-2069753,15560MI0410002,"Blue Cross? Gold with Dental and Vision, a Multi-State Plan",15560MI041,7538162760,MIN003,MIS001,MIF052,Existing,PPO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9158,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0410002-01,Standard Gold On Exchange Plan,79.40%,0.808510422706604,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"$10,200","$20,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,20%,,,,$300,$600,Not Applicable,Not Applicable,$150,$500,"$1,100",$150,$150,$180,$890,$40,10
2015,MI,15560,OPM,3,2014-10-28 20:25:58,1,15560,MI,Individual,No,38-2069753,15560MI0410002,"Blue Cross? Gold with Dental and Vision, a Multi-State Plan",15560MI041,7538162760,MIN003,MIS001,MIF052,Existing,PPO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9158,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0410002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$40,11
2015,MI,15560,OPM,3,2014-10-28 20:25:58,1,15560,MI,Individual,No,38-2069753,15560MI0410002,"Blue Cross? Gold with Dental and Vision, a Multi-State Plan",15560MI041,7538162760,MIN003,MIS001,MIF052,Existing,PPO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9158,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0410002-03,Limited Cost Sharing Plan Variation,79.40%,0.808510422706604,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"$10,200","$20,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,20%,,,,$300,$600,Not Applicable,Not Applicable,$150,$500,"$1,100",$150,$150,$180,$890,$40,12
2015,MI,15560,OPM,3,2014-10-28 20:25:58,2,15560,MI,Individual,No,38-2069753,15560MI0880001,"Blue Cross? Silver Extra with Dental and Vision, a Multi-State Plan",15560MI088,7538162760,MIN003,MIS001,MIF053,New,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9111,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0880001-01,Standard Silver On Exchange Plan,70.20%,0.704515039920807,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,$800,$150,"$2,000",$300,$440,$40,4
2015,MI,15560,OPM,3,2014-10-28 20:25:58,2,15560,MI,Individual,No,38-2069753,15560MI0880001,"Blue Cross? Silver Extra with Dental and Vision, a Multi-State Plan",15560MI088,7538162760,MIN003,MIS001,MIF053,New,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9111,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0880001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$40,5
2015,MI,15560,OPM,3,2014-10-28 20:25:58,2,15560,MI,Individual,No,38-2069753,15560MI0880001,"Blue Cross? Silver Extra with Dental and Vision, a Multi-State Plan",15560MI088,7538162760,MIN003,MIS001,MIF053,New,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9111,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0880001-03,Limited Cost Sharing Plan Variation,70.20%,0.704515039920807,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,$800,$150,"$2,000",$300,$440,$40,6
2015,MI,15560,OPM,3,2014-10-28 20:25:58,2,15560,MI,Individual,No,38-2069753,15560MI0880001,"Blue Cross? Silver Extra with Dental and Vision, a Multi-State Plan",15560MI088,7538162760,MIN003,MIS001,MIF053,New,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9111,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0880001-04,73% AV Level Silver Plan,72.60%,0.732052087783813,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$0,$900,$150,"$1,500",$300,$560,$40,7
2015,MI,15560,OPM,3,2014-10-28 20:25:58,2,15560,MI,Individual,No,38-2069753,15560MI0880001,"Blue Cross? Silver Extra with Dental and Vision, a Multi-State Plan",15560MI088,7538162760,MIN003,MIS001,MIF053,New,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9111,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0880001-05,87% AV Level Silver Plan,86.40%,0.871445834636688,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$2,800","$5,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$600,10%,,,,$600,"$1,200",Not Applicable,Not Applicable,$300,$0,$570,$150,$300,$300,$460,$40,8
2015,MI,15560,OPM,3,2014-10-28 20:25:58,2,15560,MI,Individual,No,38-2069753,15560MI0880001,"Blue Cross? Silver Extra with Dental and Vision, a Multi-State Plan",15560MI088,7538162760,MIN003,MIS001,MIF053,New,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9111,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0880001-06,94% AV Level Silver Plan,93.00%,0.933878242969513,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,10%,,,,$300,$600,Not Applicable,Not Applicable,$150,$0,$590,$150,$150,$300,$50,$40,9
2015,MI,15560,OPM,3,2014-10-28 20:25:58,2,15560,MI,Individual,No,38-2069753,15560MI0880002,"Blue Cross? Gold Extra with Dental and Vision, a Multi-State Plan",15560MI088,7538162760,MIN003,MIS001,MIF053,New,PPO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.916,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0880002-01,Standard Gold On Exchange Plan,81.80%,0.825072824954987,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$0,"$1,100",$150,$500,$300,$880,$40,10
2015,MI,15560,OPM,3,2014-10-28 20:25:58,2,15560,MI,Individual,No,38-2069753,15560MI0880002,"Blue Cross? Gold Extra with Dental and Vision, a Multi-State Plan",15560MI088,7538162760,MIN003,MIS001,MIF053,New,PPO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.916,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0880002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$40,11
2015,MI,15560,OPM,3,2014-10-28 20:25:58,2,15560,MI,Individual,No,38-2069753,15560MI0880002,"Blue Cross? Gold Extra with Dental and Vision, a Multi-State Plan",15560MI088,7538162760,MIN003,MIS001,MIF053,New,PPO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.916,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0880002-03,Limited Cost Sharing Plan Variation,81.80%,0.825072824954987,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$0,"$1,100",$150,$500,$300,$880,$40,12
2015,MI,41895,OPM,6,2015-01-23 12:43:55,1,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0020057,"CO-Options? Premier Gold, a Multi-State Plan",41895MI002,,MIN201,MIS201,MIF201,New,PPO,Gold,Yes,On the Exchange,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0020057-01,Standard Gold On Exchange Plan,78.04%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,"$1,000","$2,000",20%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MI,41895,OPM,6,2015-01-23 12:43:55,1,41895,MI,Individual,No,45-3758112,41895MI0010057,"CO-Options? Premier Gold, a Multi-State Plan",41895MI001,,MIN201,MIS201,MIF201,New,PPO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010057-01,Standard Gold On Exchange Plan,78.04%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,"$1,000","$2,000",20%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MI,41895,OPM,6,2015-01-23 12:43:55,1,41895,MI,Individual,No,45-3758112,41895MI0010057,"CO-Options? Premier Gold, a Multi-State Plan",41895MI001,,MIN201,MIS201,MIF201,New,PPO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010057-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,5
2015,MI,41895,OPM,6,2015-01-23 12:43:55,1,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0020058,"CO-Options? Choice Silver, a Multi-State Plan",41895MI002,,MIN201,MIS201,MIF201,New,PPO,Silver,Yes,On the Exchange,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0020058-01,Standard Silver On Exchange Plan,68.04%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,"$1,000","$2,000",30%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MI,41895,OPM,6,2015-01-23 12:43:55,1,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0020060,"CO-Options? Basic Bronze, a Multi-State Plan",41895MI002,,MIN201,MIS201,MIF202,New,PPO,Bronze,Yes,On the Exchange,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0020060-01,Standard Bronze On Exchange Plan,58.93%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",60%,"$2,000","$4,000",70%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,MI,41895,OPM,6,2015-01-23 12:43:55,1,41895,MI,Individual,No,45-3758112,41895MI0010057,"CO-Options? Premier Gold, a Multi-State Plan",41895MI001,,MIN201,MIS201,MIF201,New,PPO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010057-03,Limited Cost Sharing Plan Variation,78.04%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,"$1,000","$2,000",20%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,MI,41895,OPM,6,2015-01-23 12:43:55,1,41895,MI,Individual,No,45-3758112,41895MI0010058,"CO-Options? Choice Silver, a Multi-State Plan",41895MI001,,MIN201,MIS201,MIF201,New,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010058-01,Standard Silver On Exchange Plan,68.04%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,"$1,000","$2,000",30%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MI,41895,OPM,6,2015-01-23 12:43:55,1,41895,MI,Individual,No,45-3758112,41895MI0010058,"CO-Options? Choice Silver, a Multi-State Plan",41895MI001,,MIN201,MIS201,MIF201,New,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010058-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,8
2015,MI,41895,OPM,6,2015-01-23 12:43:55,1,41895,MI,Individual,No,45-3758112,41895MI0010058,"CO-Options? Choice Silver, a Multi-State Plan",41895MI001,,MIN201,MIS201,MIF201,New,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010058-03,Limited Cost Sharing Plan Variation,68.04%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,"$1,000","$2,000",30%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,MI,41895,OPM,6,2015-01-23 12:43:55,1,41895,MI,Individual,No,45-3758112,41895MI0010058,"CO-Options? Choice Silver, a Multi-State Plan",41895MI001,,MIN201,MIS201,MIF201,New,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010058-04,73% AV Level Silver Plan,72.03%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,"$1,000","$2,000",30%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,OK,87571,OPM,6,2015-02-20 08:57:57,1,87571,OK,Individual,No,36-1236610,87571OK0310004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",87571OK031,,OKN201,OKS201,OKF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0310004-03,Limited Cost Sharing Plan Variation,,0.686640679836273,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400",Not Applicable,Not Applicable,"$6,250","$12,700",0%,,,,"$12,500","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,OK,87571,OPM,6,2015-02-20 08:57:57,1,87571,OK,Individual,No,36-1236610,87571OK0310004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",87571OK031,,OKN201,OKS201,OKF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0310004-04,73% AV Level Silver Plan,,0.730801701545715,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$10,400",,,"$9,500","$20,800",Not Applicable,Not Applicable,"$4,750","$10,400",0%,,,,"$9,500","$20,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,NH,96751,OPM,7,2015-01-26 08:44:00,1,96751,NH,Individual,No,02-0494919,96751NH0330005,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",96751NH033,,NHN201,NHS201,NHF207,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPQ,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0330005-05,87% AV Level Silver Plan,86.32%,0.864060521125793,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NH,96751,OPM,7,2015-01-26 08:44:00,1,96751,NH,Individual,No,02-0494919,96751NH0330005,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",96751NH033,,NHN201,NHS201,NHF207,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPQ,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0330005-06,94% AV Level Silver Plan,93.43%,0.934767663478851,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$175,$350,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NH,96751,OPM,7,2015-01-26 08:44:00,2,96751,NH,Individual,No,02-0494919,96751NH0330006,"Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan",96751NH033,,NHN201,NHS201,NHF204,Existing,HMO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GP4,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0330006-01,Standard Gold On Exchange Plan,79.82%,0.805724143981934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,96751,OPM,7,2015-01-26 08:44:00,2,96751,NH,Individual,No,02-0494919,96751NH0330006,"Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan",96751NH033,,NHN201,NHS201,NHF204,Existing,HMO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GP4,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0330006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,NH,96751,OPM,7,2015-01-26 08:44:00,2,96751,NH,Individual,No,02-0494919,96751NH0330006,"Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan",96751NH033,,NHN201,NHS201,NHF204,Existing,HMO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GP4,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0330006-03,Limited Cost Sharing Plan Variation,79.82%,0.805724143981934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NM,75605,OPM,6,2015-02-20 08:57:57,1,75605,NM,Individual,No,36-1236610,75605NM0350001,"Blue Cross Blue Shield Premier 1, a Multi-State Plan?",75605NM035,,NMN201,NMS201,NMF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0350001-01,Standard Gold On Exchange Plan,,0.817188739776611,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$8,250",,,"$5,500","$16,500",Not Applicable,Not Applicable,"$1,000","$3,000",20%,,,,"$2,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NM,75605,OPM,6,2015-02-20 08:57:57,1,75605,NM,Individual,No,36-1236610,75605NM0350001,"Blue Cross Blue Shield Premier 1, a Multi-State Plan?",75605NM035,,NMN201,NMS201,NMF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0350001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,NM,75605,OPM,6,2015-02-20 08:57:57,1,75605,NM,Individual,No,36-1236610,75605NM0350001,"Blue Cross Blue Shield Premier 1, a Multi-State Plan?",75605NM035,,NMN201,NMS201,NMF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0350001-03,Limited Cost Sharing Plan Variation,,0.817188739776611,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$8,250",,,"$5,500","$16,500",Not Applicable,Not Applicable,"$1,000","$3,000",20%,,,,"$2,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,NM,75605,OPM,6,2015-02-20 08:57:57,1,75605,NM,Individual,No,36-1236610,75605NM0350002,"Blue Cross Blue Shield Premier 2, a Multi-State Plan?",75605NM035,,NMN201,NMS201,NMF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0350002-01,Standard Gold On Exchange Plan,,0.80812656879425,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$12,000",,,"$8,000","$24,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NM,75605,OPM,6,2015-02-20 08:57:57,1,75605,NM,Individual,No,36-1236610,75605NM0350002,"Blue Cross Blue Shield Premier 2, a Multi-State Plan?",75605NM035,,NMN201,NMS201,NMF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0350002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,OK,87571,OPM,6,2015-02-20 08:57:57,1,87571,OK,Individual,No,36-1236610,87571OK0310001,"Blue Cross Blue Shield Premier 1, a Multi-State Plan?",87571OK031,,OKN201,OKS201,OKF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0310001-01,Standard Gold On Exchange Plan,,0.817188739776611,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$8,250",,,"$5,500","$16,500",Not Applicable,Not Applicable,"$1,000","$3,000",20%,,,,"$2,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,OK,87571,OPM,6,2015-02-20 08:57:57,1,87571,OK,Individual,No,36-1236610,87571OK0310001,"Blue Cross Blue Shield Premier 1, a Multi-State Plan?",87571OK031,,OKN201,OKS201,OKF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0310001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,OK,87571,OPM,6,2015-02-20 08:57:57,1,87571,OK,Individual,No,36-1236610,87571OK0310004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",87571OK031,,OKN201,OKS201,OKF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0310004-05,87% AV Level Silver Plan,,0.871323525905609,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,OK,87571,OPM,6,2015-02-20 08:57:57,1,87571,OK,Individual,No,36-1236610,87571OK0310004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",87571OK031,,OKN201,OKS201,OKF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0310004-06,94% AV Level Silver Plan,,0.94565761089325,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$500,"$1,500",0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,OK,87571,OPM,6,2015-02-20 08:57:57,2,87571,OK,Individual,No,36-1236610,87571OK0310005,"Blue Cross Blue Shield Basic 5, a Multi-State Plan?",87571OK031,,OKN201,OKS201,OKF202,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0310005-01,Standard Bronze On Exchange Plan,,0.611617028713226,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$11,250",30%,,,,"$7,500","$22,500",Not Applicable,Not Applicable,,,,,,,,,4
2015,OK,87571,OPM,6,2015-02-20 08:57:57,2,87571,OK,Individual,No,36-1236610,87571OK0310005,"Blue Cross Blue Shield Basic 5, a Multi-State Plan?",87571OK031,,OKN201,OKS201,OKF202,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0310005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,PA,55957,OPM,3,2015-07-24 22:33:25,1,55957,PA,Individual,No,23-2905083,55957PA0140001,"my Blue Cross $2500, a Multi-State Plan",55957PA014,,PAN201,PAS201,PAF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.993,,,0,0,0,2015-01-01,,Yes,BlueCare Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700067000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,www.bcnepa.com,55957PA0140001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,,$0,$0,$0,,5
2015,PA,55957,OPM,3,2015-07-24 22:33:25,1,55957,PA,Individual,No,23-2905083,55957PA0140001,"my Blue Cross $2500, a Multi-State Plan",55957PA014,,PAN201,PAS201,PAF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.993,,,0,0,0,2015-01-01,,Yes,BlueCare Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700067000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,www.bcnepa.com,55957PA0140001-03,Limited Cost Sharing Plan Variation,,0.687548816204071,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,500","$5,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$0,$0,$150,"$2,500",$0,$0,$150,6
2015,PA,55957,OPM,3,2015-07-24 22:33:25,1,55957,PA,Individual,No,23-2905083,55957PA0140001,"my Blue Cross $2500, a Multi-State Plan",55957PA014,,PAN201,PAS201,PAF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.993,,,0,0,0,2015-01-01,,Yes,BlueCare Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700067000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,www.bcnepa.com,55957PA0140001-04,73% AV Level Silver Plan,,0.726332068443298,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,$0,,"$2,000",$0,$0,,7
2015,PA,55957,OPM,3,2015-07-24 22:33:25,1,55957,PA,Individual,No,23-2905083,55957PA0140001,"my Blue Cross $2500, a Multi-State Plan",55957PA014,,PAN201,PAS201,PAF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.993,,,0,0,0,2015-01-01,,Yes,BlueCare Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700067000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,www.bcnepa.com,55957PA0140001-05,87% AV Level Silver Plan,,0.876445293426514,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$0,$0,,"$1,500",$0,$0,,8
2015,PA,55957,OPM,3,2015-07-24 22:33:25,1,55957,PA,Individual,No,23-2905083,55957PA0140001,"my Blue Cross $2500, a Multi-State Plan",55957PA014,,PAN201,PAS201,PAF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.993,,,0,0,0,2015-01-01,,Yes,BlueCare Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700067000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,www.bcnepa.com,55957PA0140001-06,94% AV Level Silver Plan,,0.940792679786682,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$1,200","$2,400",Not Applicable,Not Applicable,$100,$200,0%,,,,$200,$400,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$100,$0,$0,,$100,$0,$0,,9
2015,PA,55957,OPM,3,2015-07-24 22:33:25,1,55957,PA,Individual,No,23-2905083,55957PA0140002,"my Blue Cross $2000, a Multi-State Plan",55957PA014,,PAN201,PAS201,PAF202,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9917,,,0,0,0,2015-01-01,,Yes,BlueCare Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700070000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,www.bcnepa.com,55957PA0140002-01,Standard Gold On Exchange Plan,,0.78177398443222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000","$4,000",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$100,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,$10,$150,"$2,000",$0,$0,$150,10
2015,MT,30751,OPM,7,2015-02-20 08:57:57,1,30751,MT,Individual,No,36-1236610,30751MT0570001,"Blue Cross Blue Shield Premier 1, a Multi-State Plan?",30751MT057,,MTN201,MTS201,MTF202,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0570001-03,Limited Cost Sharing Plan Variation,,0.817188739776611,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$5,500","$11,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,MT,30751,OPM,7,2015-02-20 08:57:57,1,30751,MT,Individual,No,36-1236610,30751MT0570002,"Blue Cross Blue Shield Premier 2, a Multi-State Plan?",30751MT057,,MTN201,MTS201,MTF202,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0570002-01,Standard Gold On Exchange Plan,,0.80812656879425,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,MT,30751,OPM,7,2015-02-20 08:57:57,1,30751,MT,Individual,No,36-1236610,30751MT0570002,"Blue Cross Blue Shield Premier 2, a Multi-State Plan?",30751MT057,,MTN201,MTS201,MTF202,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0570002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,MT,30751,OPM,7,2015-02-20 08:57:57,1,30751,MT,Individual,No,36-1236610,30751MT0570002,"Blue Cross Blue Shield Premier 2, a Multi-State Plan?",30751MT057,,MTN201,MTS201,MTF202,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0570002-03,Limited Cost Sharing Plan Variation,,0.80812656879425,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,MT,30751,OPM,7,2015-02-20 08:57:57,1,30751,MT,Individual,No,36-1236610,30751MT0570003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",30751MT057,,MTN201,MTS201,MTF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0570003-01,Standard Silver On Exchange Plan,,0.703163325786591,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,500","$9,000",20%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,MT,30751,OPM,7,2015-02-20 08:57:57,1,30751,MT,Individual,No,36-1236610,30751MT0570003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",30751MT057,,MTN201,MTS201,MTF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0570003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,MT,30751,OPM,7,2015-02-20 08:57:57,1,30751,MT,Individual,No,36-1236610,30751MT0570003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",30751MT057,,MTN201,MTS201,MTF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0570003-03,Limited Cost Sharing Plan Variation,,0.703163325786591,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,500","$9,000",20%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,MT,30751,OPM,7,2015-02-20 08:57:57,1,30751,MT,Individual,No,36-1236610,30751MT0570003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",30751MT057,,MTN201,MTS201,MTF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0570003-04,73% AV Level Silver Plan,,0.739054918289185,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,MT,30751,OPM,7,2015-02-20 08:57:57,1,30751,MT,Individual,No,36-1236610,30751MT0570003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",30751MT057,,MTN201,MTS201,MTF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0570003-05,87% AV Level Silver Plan,,0.868183553218842,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,$250,$500,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,MT,30751,OPM,7,2015-02-20 08:57:57,1,30751,MT,Individual,No,36-1236610,30751MT0570003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",30751MT057,,MTN201,MTS201,MTF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0570003-06,94% AV Level Silver Plan,,0.946778774261475,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,MT,30751,OPM,7,2015-02-20 08:57:57,1,30751,MT,Individual,No,36-1236610,30751MT0570004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",30751MT057,,MTN201,MTS201,MTF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0570004-01,Standard Silver On Exchange Plan,,0.686640679836273,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,"$6,250","$12,500",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,MT,30751,OPM,7,2015-02-20 08:57:57,1,30751,MT,Individual,No,36-1236610,30751MT0570004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",30751MT057,,MTN201,MTS201,MTF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0570004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,MT,30751,OPM,7,2015-02-20 08:57:57,1,30751,MT,Individual,No,36-1236610,30751MT0570004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",30751MT057,,MTN201,MTS201,MTF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0570004-03,Limited Cost Sharing Plan Variation,,0.686640679836273,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,"$6,250","$12,500",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,MT,30751,OPM,7,2015-02-20 08:57:57,1,30751,MT,Individual,No,36-1236610,30751MT0570004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",30751MT057,,MTN201,MTS201,MTF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0570004-04,73% AV Level Silver Plan,,0.730801701545715,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000",Not Applicable,Not Applicable,"$4,750","$9,500",0%,,,,"$9,500","$19,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,MT,30751,OPM,7,2015-02-20 08:57:57,1,30751,MT,Individual,No,36-1236610,30751MT0570004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",30751MT057,,MTN201,MTS201,MTF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0570004-05,87% AV Level Silver Plan,,0.871323525905609,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,MT,30751,OPM,7,2015-02-20 08:57:57,1,30751,MT,Individual,No,36-1236610,30751MT0570004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",30751MT057,,MTN201,MTS201,MTF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0570004-06,94% AV Level Silver Plan,,0.94565761089325,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,MT,30751,OPM,7,2015-02-20 08:57:57,2,30751,MT,Individual,No,36-1236610,30751MT0570005,"Blue Cross Blue Shield Basic 5, a Multi-State Plan?",30751MT057,,MTN201,MTS201,MTF203,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0570005-01,Standard Bronze On Exchange Plan,,0.611617028713226,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MT,30751,OPM,7,2015-02-20 08:57:57,2,30751,MT,Individual,No,36-1236610,30751MT0570005,"Blue Cross Blue Shield Basic 5, a Multi-State Plan?",30751MT057,,MTN201,MTS201,MTF203,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0570005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,MT,30751,OPM,7,2015-02-20 08:57:57,2,30751,MT,Individual,No,36-1236610,30751MT0570005,"Blue Cross Blue Shield Basic 5, a Multi-State Plan?",30751MT057,,MTN201,MTS201,MTF203,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0570005-03,Limited Cost Sharing Plan Variation,,0.611617028713226,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,NC,11512,OPM,7,2015-01-23 12:43:55,2,11512,NC,Individual,No,56-0894904,11512NC0150001,"Blue Cross Blue Shield 100, a Multi-State Plan",11512NC015,,NCN201,NCS201,NCF201,New,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,BlueCard,Yes,BlueCard,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_MSP_Gold_100.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0150001-01,Standard Gold On Exchange Plan,,0.796079933643341,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,$100,$200,30%,,,,$200,$400,$300,$600,,,,,,,,,4
2015,NC,11512,OPM,7,2015-01-23 12:43:55,2,11512,NC,Individual,No,56-0894904,11512NC0150001,"Blue Cross Blue Shield 100, a Multi-State Plan",11512NC015,,NCN201,NCS201,NCF201,New,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,BlueCard,Yes,BlueCard,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_MSP_Gold_100.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0150001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,NC,11512,OPM,7,2015-01-23 12:43:55,2,11512,NC,Individual,No,56-0894904,11512NC0150001,"Blue Cross Blue Shield 100, a Multi-State Plan",11512NC015,,NCN201,NCS201,NCF201,New,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,BlueCard,Yes,BlueCard,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_MSP_Gold_100.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0150001-03,Limited Cost Sharing Plan Variation,,0.796079933643341,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,$100,$200,30%,,,,$200,$400,$300,$600,,,,,,,,,6
2015,NC,11512,OPM,7,2015-01-23 12:43:55,2,11512,NC,Individual,No,56-0894904,11512NC0150002,"Blue Cross Blue Shield 200, a Multi-State Plan",11512NC015,,NCN201,NCS201,NCF202,New,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,BlueCard,Yes,BlueCard,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_MSP_Silver_200.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0150002-01,Standard Silver On Exchange Plan,,0.695513784885406,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$200,$400,50%,,,,$400,$800,$600,"$1,200",,,,,,,,,7
2015,NC,11512,OPM,7,2015-01-23 12:43:55,2,11512,NC,Individual,No,56-0894904,11512NC0150002,"Blue Cross Blue Shield 200, a Multi-State Plan",11512NC015,,NCN201,NCS201,NCF202,New,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,BlueCard,Yes,BlueCard,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_MSP_Silver_200.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0150002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,NC,11512,OPM,7,2015-01-23 12:43:55,2,11512,NC,Individual,No,56-0894904,11512NC0150002,"Blue Cross Blue Shield 200, a Multi-State Plan",11512NC015,,NCN201,NCS201,NCF202,New,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,BlueCard,Yes,BlueCard,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_MSP_Silver_200.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0150002-03,Limited Cost Sharing Plan Variation,,0.695513784885406,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,$200,$400,50%,,,,$400,$800,$600,"$1,200",,,,,,,,,9
2015,NC,11512,OPM,7,2015-01-23 12:43:55,2,11512,NC,Individual,No,56-0894904,11512NC0150002,"Blue Cross Blue Shield 200, a Multi-State Plan",11512NC015,,NCN201,NCS201,NCF202,New,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,BlueCard,Yes,BlueCard,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_MSP_Silver_200.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0150002-04,73% AV Level Silver Plan,,0.722231090068817,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,$100,$200,50%,,,,$200,$400,$300,$600,,,,,,,,,10
2015,NC,11512,OPM,7,2015-01-23 12:43:55,2,11512,NC,Individual,No,56-0894904,11512NC0150002,"Blue Cross Blue Shield 200, a Multi-State Plan",11512NC015,,NCN201,NCS201,NCF202,New,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,BlueCard,Yes,BlueCard,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_MSP_Silver_200.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0150002-05,87% AV Level Silver Plan,,0.861556828022003,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$2,800","$5,400","$4,200","$8,400",,,,,,,,,,,,,,,,,,,,,$100,$200,50%,,,,$200,$400,$300,$600,,,,,,,,,11
2015,NC,11512,OPM,7,2015-01-23 12:43:55,2,11512,NC,Individual,No,56-0894904,11512NC0150002,"Blue Cross Blue Shield 200, a Multi-State Plan",11512NC015,,NCN201,NCS201,NCF202,New,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,BlueCard,Yes,BlueCard,Yes,http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_MSP_Silver_200.pdf,https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login,www.bcbsnc.com/baplanbrochure,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NC_611_ExchangeEnhancedFormulary5T.pdf,11512NC0150002-06,94% AV Level Silver Plan,,0.936513185501099,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$1,000","$2,000","$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,$100,$200,50%,,,,$200,$400,$300,$600,,,,,,,,,12
2015,NH,96751,OPM,7,2015-01-26 08:44:00,1,96751,NH,Individual,No,02-0494919,96751NH0330005,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",96751NH033,,NHN201,NHS201,NHF207,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPQ,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0330005-01,Standard Silver On Exchange Plan,70.55%,0.70981377363205,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,96751,OPM,7,2015-01-26 08:44:00,1,96751,NH,Individual,No,02-0494919,96751NH0330005,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",96751NH033,,NHN201,NHS201,NHF207,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPQ,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0330005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,NH,96751,OPM,7,2015-01-26 08:44:00,1,96751,NH,Individual,No,02-0494919,96751NH0330005,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",96751NH033,,NHN201,NHS201,NHF207,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPQ,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0330005-03,Limited Cost Sharing Plan Variation,70.55%,0.70981377363205,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NH,96751,OPM,7,2015-01-26 08:44:00,1,96751,NH,Individual,No,02-0494919,96751NH0330005,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",96751NH033,,NHN201,NHS201,NHF207,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPQ,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0330005-04,73% AV Level Silver Plan,72.61%,0.729691684246063,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,OK,87571,OPM,6,2015-02-20 08:57:57,1,87571,OK,Individual,No,36-1236610,87571OK0310003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",87571OK031,,OKN201,OKS201,OKF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0310003-03,Limited Cost Sharing Plan Variation,,0.703163325786591,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,500","$12,700",20%,,,,"$9,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,OK,87571,OPM,6,2015-02-20 08:57:57,1,87571,OK,Individual,No,36-1236610,87571OK0310003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",87571OK031,,OKN201,OKS201,OKF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0310003-04,73% AV Level Silver Plan,,0.739054918289185,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,OK,87571,OPM,6,2015-02-20 08:57:57,1,87571,OK,Individual,No,36-1236610,87571OK0310002,"Blue Cross Blue Shield Premier 2, a Multi-State Plan?",87571OK031,,OKN201,OKS201,OKF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0310002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,OK,87571,OPM,6,2015-02-20 08:57:57,1,87571,OK,Individual,No,36-1236610,87571OK0310002,"Blue Cross Blue Shield Premier 2, a Multi-State Plan?",87571OK031,,OKN201,OKS201,OKF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0310002-03,Limited Cost Sharing Plan Variation,,0.80812656879425,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$12,000",,,"$8,000","$24,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,OK,87571,OPM,6,2015-02-20 08:57:57,1,87571,OK,Individual,No,36-1236610,87571OK0310003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",87571OK031,,OKN201,OKS201,OKF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0310003-05,87% AV Level Silver Plan,,0.868183553218842,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,500",,,"$4,000","$9,000",Not Applicable,Not Applicable,$250,$750,20%,,,,$500,"$1,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,OK,87571,OPM,6,2015-02-20 08:57:57,1,87571,OK,Individual,No,36-1236610,87571OK0310003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",87571OK031,,OKN201,OKS201,OKF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0310003-06,94% AV Level Silver Plan,,0.946778774261475,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,OK,87571,OPM,6,2015-02-20 08:57:57,1,87571,OK,Individual,No,36-1236610,87571OK0310004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",87571OK031,,OKN201,OKS201,OKF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0310004-01,Standard Silver On Exchange Plan,,0.686640679836273,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400",Not Applicable,Not Applicable,"$6,250","$12,700",0%,,,,"$12,500","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,OK,87571,OPM,6,2015-02-20 08:57:57,1,87571,OK,Individual,No,36-1236610,87571OK0310004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",87571OK031,,OKN201,OKS201,OKF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0310004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,PA,55957,OPM,3,2015-07-24 22:33:25,1,55957,PA,Individual,No,23-2905083,55957PA0140002,"my Blue Cross $2000, a Multi-State Plan",55957PA014,,PAN201,PAS201,PAF202,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9917,,,0,0,0,2015-01-01,,Yes,BlueCare Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700070000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,www.bcnepa.com,55957PA0140002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,,$0,$0,$0,,11
2015,PA,55957,OPM,3,2015-07-24 22:33:25,1,55957,PA,Individual,No,23-2905083,55957PA0140002,"my Blue Cross $2000, a Multi-State Plan",55957PA014,,PAN201,PAS201,PAF202,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9917,,,0,0,0,2015-01-01,,Yes,BlueCare Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700070000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,www.bcnepa.com,55957PA0140002-03,Limited Cost Sharing Plan Variation,,0.78177398443222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000","$4,000",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$100,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,$10,$150,"$2,000",$0,$0,$150,12
2015,PA,70194,OPM,6,2015-01-23 12:43:55,1,70194,PA,Individual,No,54-1637426,70194PA0130001,"Blue Cross Blue Shield Shared Cost 3200, a Multi-State Plan",70194PA013,,PAN201,PAS201,PAF201,New,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0130001-01,Standard Silver On Exchange Plan,,0.691457331180573,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,200","$6,400",20%,,,,"$6,400","$12,800","$9,600","$19,200",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,PA,70194,OPM,6,2015-01-23 12:43:55,1,70194,PA,Individual,No,54-1637426,70194PA0130001,"Blue Cross Blue Shield Shared Cost 3200, a Multi-State Plan",70194PA013,,PAN201,PAS201,PAF201,New,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0130001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,NM,75605,OPM,6,2015-02-20 08:57:57,1,75605,NM,Individual,No,36-1236610,75605NM0350002,"Blue Cross Blue Shield Premier 2, a Multi-State Plan?",75605NM035,,NMN201,NMS201,NMF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0350002-03,Limited Cost Sharing Plan Variation,,0.80812656879425,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$12,000",,,"$8,000","$24,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,NM,75605,OPM,6,2015-02-20 08:57:57,1,75605,NM,Individual,No,36-1236610,75605NM0350003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",75605NM035,,NMN201,NMS201,NMF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0350003-01,Standard Silver On Exchange Plan,,0.703163325786591,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,500","$12,700",20%,,,,"$9,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,NM,75605,OPM,6,2015-02-20 08:57:57,1,75605,NM,Individual,No,36-1236610,75605NM0350003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",75605NM035,,NMN201,NMS201,NMF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0350003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,NM,75605,OPM,6,2015-02-20 08:57:57,1,75605,NM,Individual,No,36-1236610,75605NM0350003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",75605NM035,,NMN201,NMS201,NMF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0350003-03,Limited Cost Sharing Plan Variation,,0.703163325786591,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,500","$12,700",20%,,,,"$9,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,NM,75605,OPM,6,2015-02-20 08:57:57,1,75605,NM,Individual,No,36-1236610,75605NM0350003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",75605NM035,,NMN201,NMS201,NMF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0350003-04,73% AV Level Silver Plan,,0.739054918289185,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,NM,75605,OPM,6,2015-02-20 08:57:57,1,75605,NM,Individual,No,36-1236610,75605NM0350003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",75605NM035,,NMN201,NMS201,NMF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0350003-05,87% AV Level Silver Plan,,0.868183553218842,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,500",,,"$4,000","$9,000",Not Applicable,Not Applicable,$250,$750,20%,,,,$500,"$1,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,NM,75605,OPM,6,2015-02-20 08:57:57,1,75605,NM,Individual,No,36-1236610,75605NM0350003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",75605NM035,,NMN201,NMS201,NMF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0350003-06,94% AV Level Silver Plan,,0.946778774261475,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,NM,75605,OPM,6,2015-02-20 08:57:57,1,75605,NM,Individual,No,36-1236610,75605NM0350004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",75605NM035,,NMN201,NMS201,NMF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0350004-01,Standard Silver On Exchange Plan,,0.686640679836273,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400",Not Applicable,Not Applicable,"$6,250","$12,700",0%,,,,"$12,500","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,NM,75605,OPM,6,2015-02-20 08:57:57,1,75605,NM,Individual,No,36-1236610,75605NM0350004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",75605NM035,,NMN201,NMS201,NMF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0350004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,NM,75605,OPM,6,2015-02-20 08:57:57,1,75605,NM,Individual,No,36-1236610,75605NM0350004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",75605NM035,,NMN201,NMS201,NMF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0350004-03,Limited Cost Sharing Plan Variation,,0.686640679836273,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400",Not Applicable,Not Applicable,"$6,250","$12,700",0%,,,,"$12,500","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,NM,75605,OPM,6,2015-02-20 08:57:57,1,75605,NM,Individual,No,36-1236610,75605NM0350004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",75605NM035,,NMN201,NMS201,NMF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0350004-04,73% AV Level Silver Plan,,0.730801701545715,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$10,400",,,"$9,500","$20,800",Not Applicable,Not Applicable,"$4,750","$10,400",0%,,,,"$9,500","$20,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,NM,75605,OPM,6,2015-02-20 08:57:57,1,75605,NM,Individual,No,36-1236610,75605NM0350004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",75605NM035,,NMN201,NMS201,NMF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0350004-05,87% AV Level Silver Plan,,0.871323525905609,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,NM,75605,OPM,6,2015-02-20 08:57:57,1,75605,NM,Individual,No,36-1236610,75605NM0350004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",75605NM035,,NMN201,NMS201,NMF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0350004-06,94% AV Level Silver Plan,,0.94565761089325,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$500,"$1,500",0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,NM,75605,OPM,6,2015-02-20 08:57:57,2,75605,NM,Individual,No,36-1236610,75605NM0350005,"Blue Cross Blue Shield Basic 5, a Multi-State Plan?",75605NM035,,NMN201,NMS201,NMF202,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0350005-01,Standard Bronze On Exchange Plan,,0.611617028713226,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$11,250",30%,,,,"$7,500","$22,500",Not Applicable,Not Applicable,,,,,,,,,4
2015,NM,75605,OPM,6,2015-02-20 08:57:57,2,75605,NM,Individual,No,36-1236610,75605NM0350005,"Blue Cross Blue Shield Basic 5, a Multi-State Plan?",75605NM035,,NMN201,NMS201,NMF202,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0350005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,NM,75605,OPM,6,2015-02-20 08:57:57,2,75605,NM,Individual,No,36-1236610,75605NM0350005,"Blue Cross Blue Shield Basic 5, a Multi-State Plan?",75605NM035,,NMN201,NMS201,NMF202,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0350005-03,Limited Cost Sharing Plan Variation,,0.611617028713226,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$11,250",30%,,,,"$7,500","$22,500",Not Applicable,Not Applicable,,,,,,,,,6
2015,NM,93091,OPM,5,2014-11-24 15:19:06,1,93091,NM,Individual,No,45-1294709,93091NM0190001,"CO-OPTIONSSM Choice Connect Gold $1,000 PPO, a Multi-State Plan",93091NM019,,NMN201,NMS206,NMF201,New,PPO,Gold,Yes,On the Exchange,No,No,,,$45.78,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Within USA,Yes,http://mynmhc.org/msp-choice-connect-gold-$1000-ppo-2015.pdf,http://enroll.mynmhc.org/hixcheckout,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0190001-01,Standard Gold On Exchange Plan,81.62%,0.801748275756836,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$9,000",,,"$6,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$3,000",20%,,,,"$2,000","$6,000",Not Applicable,Not Applicable,"$1,000",$50,$0,$150,"$1,000",$0,$0,$80,4
2015,NM,93091,OPM,5,2014-11-24 15:19:06,1,93091,NM,Individual,No,45-1294709,93091NM0190001,"CO-OPTIONSSM Choice Connect Gold $1,000 PPO, a Multi-State Plan",93091NM019,,NMN201,NMS206,NMF201,New,PPO,Gold,Yes,On the Exchange,No,No,,,$45.78,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Within USA,Yes,http://mynmhc.org/msp-choice-connect-gold-$1000-ppo-2015.pdf,http://enroll.mynmhc.org/hixcheckout,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0190001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,5
2015,NM,93091,OPM,5,2014-11-24 15:19:06,1,93091,NM,Individual,No,45-1294709,93091NM0190001,"CO-OPTIONSSM Choice Connect Gold $1,000 PPO, a Multi-State Plan",93091NM019,,NMN201,NMS206,NMF201,New,PPO,Gold,Yes,On the Exchange,No,No,,,$45.78,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Within USA,Yes,http://mynmhc.org/msp-choice-connect-gold-$1000-ppo-2015.pdf,http://enroll.mynmhc.org/hixcheckout,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0190001-03,Limited Cost Sharing Plan Variation,81.62%,0.801748275756836,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$9,000",,,"$6,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$3,000",20%,,,,"$2,000","$6,000",Not Applicable,Not Applicable,"$1,000",$50,$0,$150,"$1,000",$0,$0,$80,6
2015,NM,93091,OPM,5,2014-11-24 15:19:06,2,93091,NM,Individual,No,45-1294709,93091NM0190002,"CO-OPTIONSSM Choice Connect Silver $4,500 PPO, a Multi-State Plan",93091NM019,,NMN201,NMS206,NMF202,New,PPO,Silver,Yes,On the Exchange,No,No,,,$64.44,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Emergency only,Yes,Within USA,Yes,http://mynmhc.org/msp-choice-connect-silver-$4-500-ppo-2015.pdf,http://enroll.mynmhc.org/hixcheckout,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0190002-01,Standard Silver On Exchange Plan,71.26%,0.707345426082611,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$12,700",20%,,,,"$9,000","$25,400",Not Applicable,Not Applicable,"$4,500",$20,$550,$150,"$4,500",$90,$30,$80,4
2015,NM,93091,OPM,5,2014-11-24 15:19:06,2,93091,NM,Individual,No,45-1294709,93091NM0190002,"CO-OPTIONSSM Choice Connect Silver $4,500 PPO, a Multi-State Plan",93091NM019,,NMN201,NMS206,NMF202,New,PPO,Silver,Yes,On the Exchange,No,No,,,$64.44,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Emergency only,Yes,Within USA,Yes,http://mynmhc.org/msp-choice-connect-silver-$4-500-ppo-2015.pdf,http://enroll.mynmhc.org/hixcheckout,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0190002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,5
2015,NM,93091,OPM,5,2014-11-24 15:19:06,2,93091,NM,Individual,No,45-1294709,93091NM0190002,"CO-OPTIONSSM Choice Connect Silver $4,500 PPO, a Multi-State Plan",93091NM019,,NMN201,NMS206,NMF202,New,PPO,Silver,Yes,On the Exchange,No,No,,,$64.44,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Emergency only,Yes,Within USA,Yes,http://mynmhc.org/msp-choice-connect-silver-$4-500-ppo-2015.pdf,http://enroll.mynmhc.org/hixcheckout,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0190002-03,Limited Cost Sharing Plan Variation,71.26%,0.707345426082611,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$12,700",20%,,,,"$9,000","$25,400",Not Applicable,Not Applicable,"$4,500",$20,$550,$150,"$4,500",$90,$30,$80,6
2015,NM,93091,OPM,5,2014-11-24 15:19:06,2,93091,NM,Individual,No,45-1294709,93091NM0190002,"CO-OPTIONSSM Choice Connect Silver $4,500 PPO, a Multi-State Plan",93091NM019,,NMN201,NMS206,NMF202,New,PPO,Silver,Yes,On the Exchange,No,No,,,$64.44,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Emergency only,Yes,Within USA,Yes,http://mynmhc.org/msp-choice-connect-silver-$4-500-ppo-2015.pdf,http://enroll.mynmhc.org/hixcheckout,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0190002-04,73% AV Level Silver Plan,73.61%,0.726304709911346,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$20,$650,$150,"$4,000",$160,$60,$80,7
2015,NM,93091,OPM,5,2014-11-24 15:19:06,2,93091,NM,Individual,No,45-1294709,93091NM0190002,"CO-OPTIONSSM Choice Connect Silver $4,500 PPO, a Multi-State Plan",93091NM019,,NMN201,NMS206,NMF202,New,PPO,Silver,Yes,On the Exchange,No,No,,,$64.44,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Emergency only,Yes,Within USA,Yes,http://mynmhc.org/msp-choice-connect-silver-$4-500-ppo-2015.pdf,http://enroll.mynmhc.org/hixcheckout,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0190002-05,87% AV Level Silver Plan,86.61%,0.859987497329712,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,$980,$150,"$1,000",$290,$220,$80,8
2015,NM,93091,OPM,5,2014-11-24 15:19:06,2,93091,NM,Individual,No,45-1294709,93091NM0190002,"CO-OPTIONSSM Choice Connect Silver $4,500 PPO, a Multi-State Plan",93091NM019,,NMN201,NMS206,NMF202,New,PPO,Silver,Yes,On the Exchange,No,No,,,$64.44,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Emergency only,Yes,Within USA,Yes,http://mynmhc.org/msp-choice-connect-silver-$4-500-ppo-2015.pdf,http://enroll.mynmhc.org/hixcheckout,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0190002-06,94% AV Level Silver Plan,93.29%,0.929228663444519,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$800,"$1,600",,,"$1,600","$3,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,10%,,,,$800,"$1,600",Not Applicable,Not Applicable,$400,$10,$390,$150,$400,$290,$120,$80,9
2015,NV,34996,OPM,3,2014-11-24 15:19:06,1,34996,NV,Individual,No,90-0917673,34996NV0250001,"Co-Options Simple Gold, a Multi-State Plan",34996NV025,,NVN201,NVS201,NVF001,New,POS,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9983,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/members/benefits-glance/,,http://nevadahealthcoop.org/plans/choose-plan/,http://qa.nevadahealthcoop.org/wp-content/uploads/2014/01/Prescription-Drug-List_Catamaran_050914.pdf,34996NV0250001-01,Standard Gold On Exchange Plan,79.35%,0.769230544567108,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,,,,$6500,$13000,$6500,$13000,$500,$25,$860,$0,$500,$622,$29,$0,4
2015,NV,34996,OPM,3,2014-11-24 15:19:06,1,34996,NV,Individual,No,90-0917673,34996NV0250001,"Co-Options Simple Gold, a Multi-State Plan",34996NV025,,NVN201,NVS201,NVF001,New,POS,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9983,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/members/benefits-glance/,,http://nevadahealthcoop.org/plans/choose-plan/,http://qa.nevadahealthcoop.org/wp-content/uploads/2014/01/Prescription-Drug-List_Catamaran_050914.pdf,34996NV0250001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,5
2015,NV,34996,OPM,3,2014-11-24 15:19:06,1,34996,NV,Individual,No,90-0917673,34996NV0250001,"Co-Options Simple Gold, a Multi-State Plan",34996NV025,,NVN201,NVS201,NVF001,New,POS,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9983,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/members/benefits-glance/,,http://nevadahealthcoop.org/plans/choose-plan/,http://qa.nevadahealthcoop.org/wp-content/uploads/2014/01/Prescription-Drug-List_Catamaran_050914.pdf,34996NV0250001-03,Limited Cost Sharing Plan Variation,79.35%,0.769230544567108,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,,,,$6500,$13000,$6500,$13000,$500,$25,$860,$0,$500,$622,$29,$0,6
2015,NV,34996,OPM,3,2014-11-24 15:19:06,1,34996,NV,Individual,No,90-0917673,34996NV0250002,"Co-Options Simple Silver, a Multi-State Plan",34996NV025,,NVN201,NVS201,NVF002,New,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9981,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/members/benefits-glance/,,http://nevadahealthcoop.org/plans/choose-plan/,http://qa.nevadahealthcoop.org/wp-content/uploads/2014/01/Prescription-Drug-List_Catamaran_050914.pdf,34996NV0250002-01,Standard Silver On Exchange Plan,68.30%,0.613840520381927,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$3000,$6000,30%,,,,$6500,$13000,$6500,$13000,"$3,000",$25,$540,$0,"$1,426",$0,$0,$0,7
2015,NV,34996,OPM,3,2014-11-24 15:19:06,1,34996,NV,Individual,No,90-0917673,34996NV0250002,"Co-Options Simple Silver, a Multi-State Plan",34996NV025,,NVN201,NVS201,NVF002,New,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9981,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/members/benefits-glance/,,http://nevadahealthcoop.org/plans/choose-plan/,http://qa.nevadahealthcoop.org/wp-content/uploads/2014/01/Prescription-Drug-List_Catamaran_050914.pdf,34996NV0250002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,8
2015,NV,34996,OPM,3,2014-11-24 15:19:06,1,34996,NV,Individual,No,90-0917673,34996NV0250002,"Co-Options Simple Silver, a Multi-State Plan",34996NV025,,NVN201,NVS201,NVF002,New,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9981,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/members/benefits-glance/,,http://nevadahealthcoop.org/plans/choose-plan/,http://qa.nevadahealthcoop.org/wp-content/uploads/2014/01/Prescription-Drug-List_Catamaran_050914.pdf,34996NV0250002-03,Limited Cost Sharing Plan Variation,68.30%,0.613840520381927,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$3000,$6000,30%,,,,$6500,$13000,$6500,$13000,"$3,000",$25,$540,$0,"$1,426",$0,$0,$0,9
2015,NV,34996,OPM,3,2014-11-24 15:19:06,1,34996,NV,Individual,No,90-0917673,34996NV0250002,"Co-Options Simple Silver, a Multi-State Plan",34996NV025,,NVN201,NVS201,NVF002,New,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9981,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/members/benefits-glance/,,http://nevadahealthcoop.org/plans/choose-plan/,http://qa.nevadahealthcoop.org/wp-content/uploads/2014/01/Prescription-Drug-List_Catamaran_050914.pdf,34996NV0250002-04,73% AV Level Silver Plan,72.60%,0.689823687076569,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$5200,$10400,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$1000,$2000,30%,,,,$6500,$13000,$6500,$13000,"$1,000",$25,"$1,140",$0,"$1,000",$415,$9,$0,10
2015,NV,34996,OPM,3,2014-11-24 15:19:06,1,34996,NV,Individual,No,90-0917673,34996NV0250002,"Co-Options Simple Silver, a Multi-State Plan",34996NV025,,NVN201,NVS201,NVF002,New,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9981,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/members/benefits-glance/,,http://nevadahealthcoop.org/plans/choose-plan/,http://qa.nevadahealthcoop.org/wp-content/uploads/2014/01/Prescription-Drug-List_Catamaran_050914.pdf,34996NV0250002-05,87% AV Level Silver Plan,87.70%,0.861581802368164,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$2100,$4200,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$300,$600,15%,,,,$6500,$13000,$6500,$13000,$300,$12,$675,$0,$300,$359,$22,$0,11
2015,NV,34996,OPM,3,2014-11-24 15:19:06,1,34996,NV,Individual,No,90-0917673,34996NV0250002,"Co-Options Simple Silver, a Multi-State Plan",34996NV025,,NVN201,NVS201,NVF002,New,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9981,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/members/benefits-glance/,,http://nevadahealthcoop.org/plans/choose-plan/,http://qa.nevadahealthcoop.org/wp-content/uploads/2014/01/Prescription-Drug-List_Catamaran_050914.pdf,34996NV0250002-06,94% AV Level Silver Plan,94.30%,0.934890806674957,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$850,$1700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$0,$0,5%,,,,$6500,$13000,$6500,$13000,$0,$12,$240,$0,$0,$436,$14,$0,12
2015,NV,60156,OPM,6,2014-12-12 12:37:36,1,60156,NV,Individual,No,84-1017384,60156NV0390003,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",60156NV039,,NVN201,NVS201,NVF205,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G2H,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0390003-01,Standard Silver On Exchange Plan,71.27%,0.716442286968231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750",$20,"$1,100",$150,"$1,750",$470,$280,$80,4
2015,NV,60156,OPM,6,2014-12-12 12:37:36,1,60156,NV,Individual,No,84-1017384,60156NV0390003,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",60156NV039,,NVN201,NVS201,NVF205,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G2H,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0390003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,5
2015,NV,60156,OPM,6,2014-12-12 12:37:36,1,60156,NV,Individual,No,84-1017384,60156NV0390003,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",60156NV039,,NVN201,NVS201,NVF205,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G2H,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0390003-03,Limited Cost Sharing Plan Variation,71.27%,0.716442286968231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750",$20,"$1,100",$150,"$1,750",$470,$280,$80,6
2015,NV,60156,OPM,6,2014-12-12 12:37:36,1,60156,NV,Individual,No,84-1017384,60156NV0390003,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",60156NV039,,NVN201,NVS201,NVF205,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G2H,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0390003-04,73% AV Level Silver Plan,73.47%,0.738028883934021,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,700",$20,"$1,100",$150,"$1,700",$500,$280,$80,7
2015,NV,60156,OPM,6,2014-12-12 12:37:36,1,60156,NV,Individual,No,84-1017384,60156NV0390003,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",60156NV039,,NVN201,NVS201,NVF205,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G2H,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0390003-05,87% AV Level Silver Plan,86.13%,0.863917052745819,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$700,$0,$800,$150,$700,$360,$420,$80,8
2015,NV,60156,OPM,6,2014-12-12 12:37:36,1,60156,NV,Individual,No,84-1017384,60156NV0390003,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",60156NV039,,NVN201,NVS201,NVF205,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G2H,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0390003-06,94% AV Level Silver Plan,93.01%,0.931060791015625,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$0,$450,$150,$200,$200,$250,$80,9
2015,NV,60156,OPM,6,2014-12-12 12:37:36,2,60156,NV,Individual,No,84-1017384,60156NV0390004,"Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan",60156NV039,,NVN201,NVS201,NVF208,Existing,HMO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G3B,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0390004-01,Standard Gold On Exchange Plan,78.04%,0.789279103279114,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,100",$520,$170,$150,"$1,100",$540,$170,$80,4
2015,NV,60156,OPM,6,2014-12-12 12:37:36,2,60156,NV,Individual,No,84-1017384,60156NV0390004,"Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan",60156NV039,,NVN201,NVS201,NVF208,Existing,HMO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G3B,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0390004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,5
2015,NV,60156,OPM,6,2014-12-12 12:37:36,2,60156,NV,Individual,No,84-1017384,60156NV0390004,"Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan",60156NV039,,NVN201,NVS201,NVF208,Existing,HMO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G3B,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0390004-03,Limited Cost Sharing Plan Variation,78.04%,0.789279103279114,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,100",$520,$170,$150,"$1,100",$540,$170,$80,6
2015,OK,87571,OPM,6,2015-02-20 08:57:57,1,87571,OK,Individual,No,36-1236610,87571OK0310001,"Blue Cross Blue Shield Premier 1, a Multi-State Plan?",87571OK031,,OKN201,OKS201,OKF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0310001-03,Limited Cost Sharing Plan Variation,,0.817188739776611,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$8,250",,,"$5,500","$16,500",Not Applicable,Not Applicable,"$1,000","$3,000",20%,,,,"$2,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,OK,87571,OPM,6,2015-02-20 08:57:57,1,87571,OK,Individual,No,36-1236610,87571OK0310002,"Blue Cross Blue Shield Premier 2, a Multi-State Plan?",87571OK031,,OKN201,OKS201,OKF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0310002-01,Standard Gold On Exchange Plan,,0.80812656879425,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$12,000",,,"$8,000","$24,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TN,14002,OPM,3,2014-09-12 09:45:59,3,14002,TN,Individual,No,62-0427913,14002TN0230002,"BlueCross S11P, a Multi-State Plan",14002TN023,,TNN201,TNS201,TNF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0230002-04,73% AV Level Silver Plan,,0.72333550453186,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,150","$8,300",,,"$16,500","$33,000","$20,650","$41,300","$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,TN,14002,OPM,3,2014-09-12 09:45:59,3,14002,TN,Individual,No,62-0427913,14002TN0230002,"BlueCross S11P, a Multi-State Plan",14002TN023,,TNN201,TNS201,TNF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0230002-05,87% AV Level Silver Plan,,0.863325655460358,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$16,500","$33,000","$18,000","$36,000",$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,TN,14002,OPM,3,2014-09-12 09:45:59,3,14002,TN,Individual,No,62-0427913,14002TN0230002,"BlueCross S11P, a Multi-State Plan",14002TN023,,TNN201,TNS201,TNF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0230002-06,94% AV Level Silver Plan,,0.930253565311432,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$16,500","$33,000","$17,250","$34,500",$0,$0,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,TN,14002,OPM,3,2014-09-12 09:45:59,4,14002,TN,Individual,No,62-0427913,14002TN0230003,"BlueCross S12P, a Multi-State Plan",14002TN023,,TNN201,TNS201,TNF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0230003-01,Standard Silver On Exchange Plan,,0.689522922039032,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TN,14002,OPM,3,2014-09-12 09:45:59,4,14002,TN,Individual,No,62-0427913,14002TN0230003,"BlueCross S12P, a Multi-State Plan",14002TN023,,TNN201,TNS201,TNF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0230003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,5
2015,TN,14002,OPM,3,2014-09-12 09:45:59,4,14002,TN,Individual,No,62-0427913,14002TN0230003,"BlueCross S12P, a Multi-State Plan",14002TN023,,TNN201,TNS201,TNF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0230003-03,Limited Cost Sharing Plan Variation,,0.689522922039032,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,VA,40308,OPM,4,2014-09-11 12:10:19,1,40308,VA,Individual,No,53-0078070,40308VA0220001,"BlueCross BlueShield Preferred 500, A Multi-State Plan",40308VA022,,VAN200,VAS200,VAF202,Existing,PPO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99743536943784,,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,Yes,http://content.carefirst.com/sbc/BPPVBN7NRXMVBN7CN012015.pdf,,,www.carefirst.com/acarx,40308VA0220001-01,Standard Gold On Exchange Plan,78.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$0,$940,$150,$500,$300,$750,$80,4
2015,VA,40308,OPM,4,2014-09-11 12:10:19,1,40308,VA,Individual,No,53-0078070,40308VA0220001,"BlueCross BlueShield Preferred 500, A Multi-State Plan",40308VA022,,VAN200,VAS200,VAF202,Existing,PPO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99743536943784,,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,Yes,http://content.carefirst.com/sbc/BPPVBN7NRXMVBN7CN012015.pdf,,,www.carefirst.com/acarx,40308VA0220001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,5
2015,VA,40308,OPM,4,2014-09-11 12:10:19,1,40308,VA,SHOP (Small Group),No,53-0078070,40308VA0230001,"BlueCross BlueShield Preferred 1000, A Multi-State Plan",40308VA023,,VAN200,VAS200,VAF201,Existing,PPO,Gold,Yes,On the Exchange,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996116981182913,,,0,0,0,2015-01-01,,Yes,All covered services,Yes,All covered services,Yes,http://content.carefirst.com/sbc/BPHVB57BRXMVBA7CN012015.pdf,,,www.carefirst.com/acarx,40308VA0230001-01,Standard Gold On Exchange Plan,79.88%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,$510,$150,"$1,000",$360,$180,$80,5
2015,VA,40308,OPM,4,2014-09-11 12:10:19,1,40308,VA,Individual,No,53-0078070,40308VA0220001,"BlueCross BlueShield Preferred 500, A Multi-State Plan",40308VA022,,VAN200,VAS200,VAF202,Existing,PPO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99743536943784,,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,Yes,http://content.carefirst.com/sbc/BPPVBN7NRXMVBN7CN012015.pdf,,,www.carefirst.com/acarx,40308VA0220001-03,Limited Cost Sharing Plan Variation,78.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$0,$940,$150,$500,$300,$750,$80,6
2015,OK,87571,OPM,6,2015-02-20 08:57:57,1,87571,OK,Individual,No,36-1236610,87571OK0310003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",87571OK031,,OKN201,OKS201,OKF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0310003-01,Standard Silver On Exchange Plan,,0.703163325786591,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,500","$12,700",20%,,,,"$9,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,OK,87571,OPM,6,2015-02-20 08:57:57,1,87571,OK,Individual,No,36-1236610,87571OK0310003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",87571OK031,,OKN201,OKS201,OKF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0310003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,OK,87571,OPM,6,2015-02-20 08:57:57,2,87571,OK,Individual,No,36-1236610,87571OK0310005,"Blue Cross Blue Shield Basic 5, a Multi-State Plan?",87571OK031,,OKN201,OKS201,OKF202,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsok.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred,http://www.bcbsok.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_OK_HealthInsMarketplace5TierStandardDrugList.pdf,87571OK0310005-03,Limited Cost Sharing Plan Variation,,0.611617028713226,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$11,250",30%,,,,"$7,500","$22,500",Not Applicable,Not Applicable,,,,,,,,,6
2015,OR,99389,OPM,6,2014-10-28 20:25:58,1,99389,OR,Individual,No,45-3321455,99389OR0490001,"CO-Options SiMPLE Gold, a Multi-State Plan",99389OR049,,ORN001,ORS001,ORF005,New,PPO,Gold,Yes,On the Exchange,No,No,,voluntary abortion excluded,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.997,,"$6,600",1,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,http://www.ohcoop.org/find-a-plan/individual-family-plans,http://www.ohcoop.org/billing,http://www.ohcoop.org/find-a-plan/individual-family-plans,www.ohcoop.org/providers/rx-for-providers,99389OR0490001-01,Standard Gold On Exchange Plan,78.19%,0.759842216968536,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$3,380",$0,$150,$0,"$1,500",$0,$80,4
2015,OR,99389,OPM,6,2014-10-28 20:25:58,1,99389,OR,Individual,No,45-3321455,99389OR0490001,"CO-Options SiMPLE Gold, a Multi-State Plan",99389OR049,,ORN001,ORS001,ORF005,New,PPO,Gold,Yes,On the Exchange,No,No,,voluntary abortion excluded,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.997,,"$6,600",1,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,http://www.ohcoop.org/find-a-plan/individual-family-plans,http://www.ohcoop.org/billing,http://www.ohcoop.org/find-a-plan/individual-family-plans,www.ohcoop.org/providers/rx-for-providers,99389OR0490001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,5
2015,OR,99389,OPM,6,2014-10-28 20:25:58,1,99389,OR,Individual,No,45-3321455,99389OR0490001,"CO-Options SiMPLE Gold, a Multi-State Plan",99389OR049,,ORN001,ORS001,ORF005,New,PPO,Gold,Yes,On the Exchange,No,No,,voluntary abortion excluded,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.997,,"$6,600",1,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,http://www.ohcoop.org/find-a-plan/individual-family-plans,http://www.ohcoop.org/billing,http://www.ohcoop.org/find-a-plan/individual-family-plans,www.ohcoop.org/providers/rx-for-providers,99389OR0490001-03,Limited Cost Sharing Plan Variation,78.19%,0.759842216968536,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$3,380",$0,$150,$0,"$1,500",$0,$80,6
2015,OR,99389,OPM,6,2014-10-28 20:25:58,1,99389,OR,Individual,No,45-3321455,99389OR0480001,"CO-Options SiMPLE Silver, a Multi-State Plan",99389OR048,,ORN001,ORS001,ORF007,New,PPO,Silver,Yes,On the Exchange,No,No,,voluntary abortion excluded,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9969,,"$6,000",1,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,http://www.ohcoop.org/find-a-plan/individual-family-plans,http://www.ohcoop.org/billing,http://www.ohcoop.org/find-a-plan/individual-family-plans,www.ohcoop.org/providers/rx-for-providers,99389OR0480001-01,Standard Silver On Exchange Plan,70.14%,0.711547434329987,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$4,980",$0,$150,$0,"$1,930",$0,$80,7
2015,OR,99389,OPM,6,2014-10-28 20:25:58,1,99389,OR,Individual,No,45-3321455,99389OR0480001,"CO-Options SiMPLE Silver, a Multi-State Plan",99389OR048,,ORN001,ORS001,ORF007,New,PPO,Silver,Yes,On the Exchange,No,No,,voluntary abortion excluded,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9969,,"$6,000",1,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,http://www.ohcoop.org/find-a-plan/individual-family-plans,http://www.ohcoop.org/billing,http://www.ohcoop.org/find-a-plan/individual-family-plans,www.ohcoop.org/providers/rx-for-providers,99389OR0480001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,8
2015,OR,99389,OPM,6,2014-10-28 20:25:58,1,99389,OR,Individual,No,45-3321455,99389OR0480001,"CO-Options SiMPLE Silver, a Multi-State Plan",99389OR048,,ORN001,ORS001,ORF007,New,PPO,Silver,Yes,On the Exchange,No,No,,voluntary abortion excluded,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9969,,"$6,000",1,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,http://www.ohcoop.org/find-a-plan/individual-family-plans,http://www.ohcoop.org/billing,http://www.ohcoop.org/find-a-plan/individual-family-plans,www.ohcoop.org/providers/rx-for-providers,99389OR0480001-03,Limited Cost Sharing Plan Variation,70.14%,0.711547434329987,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$4,980",$0,$150,$0,"$1,930",$0,$80,9
2015,OR,99389,OPM,6,2014-10-28 20:25:58,1,99389,OR,Individual,No,45-3321455,99389OR0480001,"CO-Options SiMPLE Silver, a Multi-State Plan",99389OR048,,ORN001,ORS001,ORF007,New,PPO,Silver,Yes,On the Exchange,No,No,,voluntary abortion excluded,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9969,,"$6,000",1,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,http://www.ohcoop.org/find-a-plan/individual-family-plans,http://www.ohcoop.org/billing,http://www.ohcoop.org/find-a-plan/individual-family-plans,www.ohcoop.org/providers/rx-for-providers,99389OR0480001-04,73% AV Level Silver Plan,73.87%,0.744931161403656,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$4,510",$0,$150,$0,"$1,400",$0,$80,10
2015,OR,99389,OPM,6,2014-10-28 20:25:58,1,99389,OR,Individual,No,45-3321455,99389OR0480001,"CO-Options SiMPLE Silver, a Multi-State Plan",99389OR048,,ORN001,ORS001,ORF007,New,PPO,Silver,Yes,On the Exchange,No,No,,voluntary abortion excluded,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9969,,"$6,000",1,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,http://www.ohcoop.org/find-a-plan/individual-family-plans,http://www.ohcoop.org/billing,http://www.ohcoop.org/find-a-plan/individual-family-plans,www.ohcoop.org/providers/rx-for-providers,99389OR0480001-05,87% AV Level Silver Plan,87.81%,0.874668300151825,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000","$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$2,000",$0,$150,$0,"$1,270",$0,$80,11
2015,OR,99389,OPM,6,2014-10-28 20:25:58,1,99389,OR,Individual,No,45-3321455,99389OR0480001,"CO-Options SiMPLE Silver, a Multi-State Plan",99389OR048,,ORN001,ORS001,ORF007,New,PPO,Silver,Yes,On the Exchange,No,No,,voluntary abortion excluded,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9969,,"$6,000",1,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,http://www.ohcoop.org/find-a-plan/individual-family-plans,http://www.ohcoop.org/billing,http://www.ohcoop.org/find-a-plan/individual-family-plans,www.ohcoop.org/providers/rx-for-providers,99389OR0480001-06,94% AV Level Silver Plan,94.73%,0.945932030677795,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,$600,"$1,200",$600,"$1,200","$1,200","$2,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,$520,$0,$150,$0,$600,$0,$80,12
2015,PA,31609,OPM,4,2014-09-11 12:10:19,1,31609,PA,Individual,No,23-2184623,31609PA0140001,"Blue Cross Gold, a Multi-State Plan",31609PA014,,PAN201,PAS201,PAF201,Existing,PPO,Gold,Yes,On the Exchange,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$125,5,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppogoldnational2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/ppogoldnational2015,www.ibx.com/ffm/formulary5,31609PA0140001-01,Standard Gold On Exchange Plan,81.97%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,31609,OPM,4,2014-09-11 12:10:19,1,31609,PA,Individual,No,23-2184623,31609PA0140001,"Blue Cross Gold, a Multi-State Plan",31609PA014,,PAN201,PAS201,PAF201,Existing,PPO,Gold,Yes,On the Exchange,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$125,5,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppogoldnational2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/ppogoldnational2015,www.ibx.com/ffm/formulary5,31609PA0140001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,PA,31609,OPM,4,2014-09-11 12:10:19,1,31609,PA,Individual,No,23-2184623,31609PA0140001,"Blue Cross Gold, a Multi-State Plan",31609PA014,,PAN201,PAS201,PAF201,Existing,PPO,Gold,Yes,On the Exchange,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9985,,$125,5,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/ppogoldnational2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/ppogoldnational2015,www.ibx.com/ffm/formulary5,31609PA0140001-03,Limited Cost Sharing Plan Variation,81.97%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,PA,31609,OPM,4,2014-09-11 12:10:19,2,31609,PA,Individual,No,23-2184623,31609PA0140002,"Blue Cross Silver, a Multi-State Plan",31609PA014,,PAN201,PAS201,PAF203,Existing,PPO,Silver,Yes,On the Exchange,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9893,,$200,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/pposilvernational2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/pposilvernational2015,www.ibx.com/ffm/formulary5,31609PA0140002-01,Standard Silver On Exchange Plan,71.93%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,"$20,000","$40,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,31609,OPM,4,2014-09-11 12:10:19,2,31609,PA,Individual,No,23-2184623,31609PA0140002,"Blue Cross Silver, a Multi-State Plan",31609PA014,,PAN201,PAS201,PAF203,Existing,PPO,Silver,Yes,On the Exchange,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9893,,$200,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/pposilvernational2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/pposilvernational2015,www.ibx.com/ffm/formulary5,31609PA0140002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,PA,31609,OPM,4,2014-09-11 12:10:19,2,31609,PA,Individual,No,23-2184623,31609PA0140002,"Blue Cross Silver, a Multi-State Plan",31609PA014,,PAN201,PAS201,PAF203,Existing,PPO,Silver,Yes,On the Exchange,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9893,,$200,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/pposilvernational2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/pposilvernational2015,www.ibx.com/ffm/formulary5,31609PA0140002-03,Limited Cost Sharing Plan Variation,71.93%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,"$20,000","$40,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,PA,31609,OPM,4,2014-09-11 12:10:19,2,31609,PA,Individual,No,23-2184623,31609PA0140002,"Blue Cross Silver, a Multi-State Plan",31609PA014,,PAN201,PAS201,PAF203,Existing,PPO,Silver,Yes,On the Exchange,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9893,,$200,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/pposilvernational2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/pposilvernational2015,www.ibx.com/ffm/formulary5,31609PA0140002-04,73% AV Level Silver Plan,73.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,150","$10,300",,,"$20,000","$40,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,35%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,31609,OPM,4,2014-09-11 12:10:19,2,31609,PA,Individual,No,23-2184623,31609PA0140002,"Blue Cross Silver, a Multi-State Plan",31609PA014,,PAN201,PAS201,PAF203,Existing,PPO,Silver,Yes,On the Exchange,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9893,,$200,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/pposilvernational2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/pposilvernational2015,www.ibx.com/ffm/formulary5,31609PA0140002-05,87% AV Level Silver Plan,86.64%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$20,000","$40,000",Not Applicable,Not Applicable,$250,$500,10%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,35%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,PA,31609,OPM,4,2014-09-11 12:10:19,2,31609,PA,Individual,No,23-2184623,31609PA0140002,"Blue Cross Silver, a Multi-State Plan",31609PA014,,PAN201,PAS201,PAF203,Existing,PPO,Silver,Yes,On the Exchange,Yes,No,,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9893,,$200,0,0,0,2015-01-01,,Yes,Coverage is provided for benefits received while outside of the U.S.,Yes,Coverage is provided for benefits received anywhere in the U.S.,Yes,https://www.ibx4you.com/ffm/pposilvernational2015,https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action,https://www.ibx4you.com/ffm/pposilvernational2015,www.ibx.com/ffm/formulary5,31609PA0140002-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$20,000","$40,000",Not Applicable,Not Applicable,$0,$0,10%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0050002,"BlueCross 500.0, a Multi-State Plan",53789PA005,7205839443,PAN202,PAS202,PAF202,Existing,HMO,Gold,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA005000201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0050002-01,Standard Gold On Exchange Plan,80.39%,0.803941428661346,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,0%,$50,$100,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0050002,"BlueCross 500.0, a Multi-State Plan",53789PA005,7205839443,PAN202,PAS202,PAF202,Existing,HMO,Gold,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA005000201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0050002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0050002,"BlueCross 500.0, a Multi-State Plan",53789PA005,7205839443,PAN202,PAS202,PAF202,Existing,HMO,Gold,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA005000201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0050002-03,Limited Cost Sharing Plan Variation,80.39%,0.803941428661346,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,0%,$50,$100,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0030002,"BlueCross Value 500.0, a Multi-State Plan",53789PA003,7205839443,PAN201,PAS201,PAF202,Existing,HMO,Gold,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA003000201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0030002-01,Standard Gold On Exchange Plan,80.39%,0.803941428661346,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,0%,$50,$100,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0030002,"BlueCross Value 500.0, a Multi-State Plan",53789PA003,7205839443,PAN201,PAS201,PAF202,Existing,HMO,Gold,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA003000201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0030002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0030002,"BlueCross Value 500.0, a Multi-State Plan",53789PA003,7205839443,PAN201,PAS201,PAF202,Existing,HMO,Gold,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA003000201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0030002-03,Limited Cost Sharing Plan Variation,80.39%,0.803941428661346,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,0%,$50,$100,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0030003,"BlueCross Value 500.0, a Multi-State Plan",53789PA003,7205839443,PAN201,PAS203,PAF202,Existing,HMO,Gold,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA003000301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0030003-01,Standard Gold On Exchange Plan,80.39%,0.803941428661346,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,0%,$50,$100,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0030003,"BlueCross Value 500.0, a Multi-State Plan",53789PA003,7205839443,PAN201,PAS203,PAF202,Existing,HMO,Gold,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA003000301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0030003-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0030003,"BlueCross Value 500.0, a Multi-State Plan",53789PA003,7205839443,PAN201,PAS203,PAF202,Existing,HMO,Gold,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA003000301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0030003-03,Limited Cost Sharing Plan Variation,80.39%,0.803941428661346,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,0%,$50,$100,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0030004,"BlueCross Value 500.0, a Multi-State Plan",53789PA003,7205839443,PAN201,PAS200,PAF202,Existing,HMO,Gold,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA003000401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0030004-01,Standard Gold On Exchange Plan,80.39%,0.803941428661346,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,0%,$50,$100,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0030004,"BlueCross Value 500.0, a Multi-State Plan",53789PA003,7205839443,PAN201,PAS200,PAF202,Existing,HMO,Gold,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA003000401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0030004-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0030004,"BlueCross Value 500.0, a Multi-State Plan",53789PA003,7205839443,PAN201,PAS200,PAF202,Existing,HMO,Gold,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA003000401_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0030004-03,Limited Cost Sharing Plan Variation,80.39%,0.803941428661346,No,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,0%,$50,$100,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0060001,"BlueCross 0.50, a Multi-State Plan",53789PA006,7205839443,PAN202,PAS202,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA006000101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0060001-01,Standard Silver On Exchange Plan,71.11%,0.711068093776703,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0060001,"BlueCross 0.50, a Multi-State Plan",53789PA006,7205839443,PAN202,PAS202,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA006000101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0060001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,17
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0060001,"BlueCross 0.50, a Multi-State Plan",53789PA006,7205839443,PAN202,PAS202,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA006000101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0060001-03,Limited Cost Sharing Plan Variation,71.11%,0.711068093776703,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0060001,"BlueCross 0.50, a Multi-State Plan",53789PA006,7205839443,PAN202,PAS202,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA006000101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0060001-04,73% AV Level Silver Plan,73.60%,0.735958278179169,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,49%,$0,$0,49%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0060001,"BlueCross 0.50, a Multi-State Plan",53789PA006,7205839443,PAN202,PAS202,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA006000101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0060001-05,87% AV Level Silver Plan,86.80%,0.867995738983154,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,$0,$0,25%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0060001,"BlueCross 0.50, a Multi-State Plan",53789PA006,7205839443,PAN202,PAS202,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA006000101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0060001-06,94% AV Level Silver Plan,93.13%,0.931299448013306,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,8%,$0,$0,8%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0040001,"BlueCross Value 0.50, a Multi-State Plan",53789PA004,7205839443,PAN201,PAS201,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0040001-01,Standard Silver On Exchange Plan,71.11%,0.711068093776703,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0040001,"BlueCross Value 0.50, a Multi-State Plan",53789PA004,7205839443,PAN201,PAS201,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0040001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,23
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0040001,"BlueCross Value 0.50, a Multi-State Plan",53789PA004,7205839443,PAN201,PAS201,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0040001-03,Limited Cost Sharing Plan Variation,71.11%,0.711068093776703,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,24
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0040001,"BlueCross Value 0.50, a Multi-State Plan",53789PA004,7205839443,PAN201,PAS201,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0040001-04,73% AV Level Silver Plan,73.60%,0.735958278179169,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,49%,$0,$0,49%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0040001,"BlueCross Value 0.50, a Multi-State Plan",53789PA004,7205839443,PAN201,PAS201,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0040001-05,87% AV Level Silver Plan,86.80%,0.867995738983154,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,$0,$0,25%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,26
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0040001,"BlueCross Value 0.50, a Multi-State Plan",53789PA004,7205839443,PAN201,PAS201,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000101_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0040001-06,94% AV Level Silver Plan,93.13%,0.931299448013306,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,8%,$0,$0,8%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,27
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0040002,"BlueCross Value 0.50, a Multi-State Plan",53789PA004,7205839443,PAN201,PAS203,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0040002-01,Standard Silver On Exchange Plan,71.11%,0.711068093776703,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,28
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0040002,"BlueCross Value 0.50, a Multi-State Plan",53789PA004,7205839443,PAN201,PAS203,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0040002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,29
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0040002,"BlueCross Value 0.50, a Multi-State Plan",53789PA004,7205839443,PAN201,PAS203,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0040002-03,Limited Cost Sharing Plan Variation,71.11%,0.711068093776703,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,30
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0040002,"BlueCross Value 0.50, a Multi-State Plan",53789PA004,7205839443,PAN201,PAS203,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0040002-04,73% AV Level Silver Plan,73.60%,0.735958278179169,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,49%,$0,$0,49%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,31
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0040002,"BlueCross Value 0.50, a Multi-State Plan",53789PA004,7205839443,PAN201,PAS203,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0040002-05,87% AV Level Silver Plan,86.80%,0.867995738983154,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,$0,$0,25%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,32
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0040002,"BlueCross Value 0.50, a Multi-State Plan",53789PA004,7205839443,PAN201,PAS203,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000201_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0040002-06,94% AV Level Silver Plan,93.13%,0.931299448013306,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,8%,$0,$0,8%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,33
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0040003,"BlueCross Value 0.50, a Multi-State Plan",53789PA004,7205839443,PAN201,PAS200,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0040003-01,Standard Silver On Exchange Plan,71.11%,0.711068093776703,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,34
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0040003,"BlueCross Value 0.50, a Multi-State Plan",53789PA004,7205839443,PAN201,PAS200,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0040003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,35
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0040003,"BlueCross Value 0.50, a Multi-State Plan",53789PA004,7205839443,PAN201,PAS200,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0040003-03,Limited Cost Sharing Plan Variation,71.11%,0.711068093776703,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,$0,$0,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,36
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0040003,"BlueCross Value 0.50, a Multi-State Plan",53789PA004,7205839443,PAN201,PAS200,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0040003-04,73% AV Level Silver Plan,73.60%,0.735958278179169,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,49%,$0,$0,49%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,37
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0040003,"BlueCross Value 0.50, a Multi-State Plan",53789PA004,7205839443,PAN201,PAS200,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0040003-05,87% AV Level Silver Plan,86.80%,0.867995738983154,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,$0,$0,25%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,38
2015,PA,53789,OPM,8,2015-01-23 12:43:55,1,53789,PA,Individual,No,23-2399845,53789PA0040003,"BlueCross Value 0.50, a Multi-State Plan",53789PA004,7205839443,PAN201,PAS200,PAF201,Existing,HMO,Silver,Yes,On the Exchange,Yes,Yes,all except OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergent and Urgent,Yes,Emergent and Urgent,Yes,https://www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000301_2015.pdf,https://w2.capbluecross.com/sp/ACS.saml2,,https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed,53789PA0040003-06,94% AV Level Silver Plan,93.13%,0.931299448013306,Yes,Yes,Yes,40%,60%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,8%,$0,$0,8%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,39
2015,PA,55957,OPM,3,2015-07-24 22:33:25,1,55957,PA,Individual,No,23-2905083,55957PA0140001,"my Blue Cross $2500, a Multi-State Plan",55957PA014,,PAN201,PAS201,PAF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.993,,,0,0,0,2015-01-01,,Yes,BlueCare Worldwide,Yes,BlueCard PPO,Yes,https://api.bcnepa.com/sbc/download.pdf?group=700067000&effectivedate=2015-01-01,,https://store.bcnepa.com/individual/products/,www.bcnepa.com,55957PA0140001-01,Standard Silver On Exchange Plan,,0.687548816204071,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,500","$5,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$0,$0,$150,"$2,500",$0,$0,$150,4
2015,PA,70194,OPM,6,2015-01-23 12:43:55,1,70194,PA,Individual,No,54-1637426,70194PA0130001,"Blue Cross Blue Shield Shared Cost 3200, a Multi-State Plan",70194PA013,,PAN201,PAS201,PAF201,New,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0130001-03,Limited Cost Sharing Plan Variation,,0.691457331180573,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,200","$6,400",20%,,,,"$6,400","$12,800","$9,600","$19,200",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,PA,70194,OPM,6,2015-01-23 12:43:55,1,70194,PA,Individual,No,54-1637426,70194PA0130001,"Blue Cross Blue Shield Shared Cost 3200, a Multi-State Plan",70194PA013,,PAN201,PAS201,PAF201,New,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0130001-04,73% AV Level Silver Plan,,0.722597599029541,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,200","$6,400",20%,,,,"$6,400","$12,800","$9,600","$19,200",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,PA,70194,OPM,6,2015-01-23 12:43:55,1,70194,PA,Individual,No,54-1637426,70194PA0130001,"Blue Cross Blue Shield Shared Cost 3200, a Multi-State Plan",70194PA013,,PAN201,PAS201,PAF201,New,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0130001-05,87% AV Level Silver Plan,,0.874879121780396,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$12,700","$25,400",Not Applicable,Not Applicable,$650,"$1,300",10%,,,,"$6,400","$12,800","$7,050","$14,100",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,PA,70194,OPM,6,2015-01-23 12:43:55,1,70194,PA,Individual,No,54-1637426,70194PA0130001,"Blue Cross Blue Shield Shared Cost 3200, a Multi-State Plan",70194PA013,,PAN201,PAS201,PAF201,New,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0130001-06,94% AV Level Silver Plan,,0.941418409347534,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,$100,$200,10%,,,,"$6,400","$12,800","$6,500","$13,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,PA,70194,OPM,6,2015-01-23 12:43:55,1,70194,PA,Individual,No,54-1637426,70194PA0130003,"Blue Shield Shared Cost 3200, a Multi-State Plan",70194PA013,,PAN202,PAS202,PAF201,New,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0130003-01,Standard Silver On Exchange Plan,,0.691457331180573,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,200","$6,400",20%,,,,"$6,400","$12,800","$9,600","$19,200",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,PA,70194,OPM,6,2015-01-23 12:43:55,1,70194,PA,Individual,No,54-1637426,70194PA0130003,"Blue Shield Shared Cost 3200, a Multi-State Plan",70194PA013,,PAN202,PAS202,PAF201,New,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0130003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,VA,40308,OPM,4,2014-09-11 12:10:19,1,40308,VA,Individual,No,53-0078070,40308VA0280001,"BlueCross BlueShield Preferred 1500, A Multi-State Plan",40308VA028,,VAN200,VAS200,VAF202,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99743536943784,,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,Yes,http://content.carefirst.com/sbc/BPHVBN6NRXMVBN6FN012015.pdf,,,www.carefirst.com/acarx,40308VA0280001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,8
2015,VA,40308,OPM,4,2014-09-11 12:10:19,1,40308,VA,Individual,No,53-0078070,40308VA0280001,"BlueCross BlueShield Preferred 1500, A Multi-State Plan",40308VA028,,VAN200,VAS200,VAF202,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99743536943784,,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,Yes,http://content.carefirst.com/sbc/BPHVBN6NRXMVBN6FN012015.pdf,,,www.carefirst.com/acarx,40308VA0280001-03,Limited Cost Sharing Plan Variation,68.42%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,110",$150,"$1,500",$150,$770,$80,9
2015,PA,70194,OPM,6,2015-01-23 12:43:55,1,70194,PA,Individual,No,54-1637426,70194PA0130003,"Blue Shield Shared Cost 3200, a Multi-State Plan",70194PA013,,PAN202,PAS202,PAF201,New,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0130003-03,Limited Cost Sharing Plan Variation,,0.691457331180573,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,200","$6,400",20%,,,,"$6,400","$12,800","$9,600","$19,200",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,PA,70194,OPM,6,2015-01-23 12:43:55,1,70194,PA,Individual,No,54-1637426,70194PA0130003,"Blue Shield Shared Cost 3200, a Multi-State Plan",70194PA013,,PAN202,PAS202,PAF201,New,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0130003-04,73% AV Level Silver Plan,,0.722597599029541,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,200","$6,400",20%,,,,"$6,400","$12,800","$9,600","$19,200",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,PA,70194,OPM,6,2015-01-23 12:43:55,1,70194,PA,Individual,No,54-1637426,70194PA0130003,"Blue Shield Shared Cost 3200, a Multi-State Plan",70194PA013,,PAN202,PAS202,PAF201,New,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0130003-05,87% AV Level Silver Plan,,0.874879121780396,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$12,700","$25,400",Not Applicable,Not Applicable,$650,"$1,300",10%,,,,"$6,400","$12,800","$7,050","$14,100",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,PA,70194,OPM,6,2015-01-23 12:43:55,1,70194,PA,Individual,No,54-1637426,70194PA0130003,"Blue Shield Shared Cost 3200, a Multi-State Plan",70194PA013,,PAN202,PAS202,PAF201,New,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0130003-06,94% AV Level Silver Plan,,0.941418409347534,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,$100,$200,10%,,,,"$6,400","$12,800","$6,500","$13,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,PA,70194,OPM,6,2015-01-23 12:43:55,1,70194,PA,Individual,No,54-1637426,70194PA0130004,"Blue Shield Shared Cost 1500, a Multi-State Plan",70194PA013,,PAN202,PAS202,PAF201,New,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0130004-01,Standard Gold On Exchange Plan,,0.784273862838745,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,PA,70194,OPM,6,2015-01-23 12:43:55,1,70194,PA,Individual,No,54-1637426,70194PA0130004,"Blue Shield Shared Cost 1500, a Multi-State Plan",70194PA013,,PAN202,PAS202,PAF201,New,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0130004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,PA,70194,OPM,6,2015-01-23 12:43:55,1,70194,PA,Individual,No,54-1637426,70194PA0130004,"Blue Shield Shared Cost 1500, a Multi-State Plan",70194PA013,,PAN202,PAS202,PAF201,New,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,https://www.highmarkblueshield.com/sbc/bs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/centralpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0130004-03,Limited Cost Sharing Plan Variation,,0.784273862838745,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,PA,70194,OPM,6,2015-01-23 12:43:55,1,70194,PA,Individual,No,54-1637426,70194PA0130002,"Blue Cross Blue Shield Shared Cost 1500, a Multi-State Plan",70194PA013,,PAN201,PAS201,PAF201,New,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0130002-01,Standard Gold On Exchange Plan,,0.784273862838745,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,19
2015,PA,70194,OPM,6,2015-01-23 12:43:55,1,70194,PA,Individual,No,54-1637426,70194PA0130002,"Blue Cross Blue Shield Shared Cost 1500, a Multi-State Plan",70194PA013,,PAN201,PAS201,PAF201,New,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0130002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,PA,70194,OPM,6,2015-01-23 12:43:55,1,70194,PA,Individual,No,54-1637426,70194PA0130002,"Blue Cross Blue Shield Shared Cost 1500, a Multi-State Plan",70194PA013,,PAN201,PAS201,PAF201,New,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9989,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.",Yes,https://www.highmarkbcbs.com/sbc/bcbs.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westernpa,http://client.formularynavigator.com/Search.aspx?siteCode=1791332925,70194PA0130002-03,Limited Cost Sharing Plan Variation,,0.784273862838745,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,"$3,000","$6,000","$4,500","$9,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,SC,26065,OPM,5,2014-09-13 04:19:20,1,26065,SC,Individual,No,57-0287419,26065SC0400001,"Blue Cross Blue Shield Gold 1, a Multi-State Plan",26065SC040,,SCN201,SCS201,SCF204,Existing,EPO,Gold,No,On the Exchange,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0400001-01,Standard Gold On Exchange Plan,,0.787705361843109,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$1,900",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,SC,26065,OPM,5,2014-09-13 04:19:20,1,26065,SC,Individual,No,57-0287419,26065SC0400001,"Blue Cross Blue Shield Gold 1, a Multi-State Plan",26065SC040,,SCN201,SCS201,SCF204,Existing,EPO,Gold,No,On the Exchange,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0400001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,SC,26065,OPM,5,2014-09-13 04:19:20,1,26065,SC,Individual,No,57-0287419,26065SC0400001,"Blue Cross Blue Shield Gold 1, a Multi-State Plan",26065SC040,,SCN201,SCS201,SCF204,Existing,EPO,Gold,No,On the Exchange,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0400001-03,Limited Cost Sharing Plan Variation,,0.787705361843109,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$1,900",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,SC,26065,OPM,5,2014-09-13 04:19:20,1,26065,SC,Individual,No,57-0287419,26065SC0400002,"Blue Cross Blue Shield Silver 1, a Multi-State Plan",26065SC040,,SCN201,SCS201,SCF201,Existing,EPO,Silver,No,On the Exchange,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0400002-01,Standard Silver On Exchange Plan,,0.696509778499603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$4,550",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,SC,26065,OPM,5,2014-09-13 04:19:20,1,26065,SC,Individual,No,57-0287419,26065SC0400002,"Blue Cross Blue Shield Silver 1, a Multi-State Plan",26065SC040,,SCN201,SCS201,SCF201,Existing,EPO,Silver,No,On the Exchange,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0400002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,SC,26065,OPM,5,2014-09-13 04:19:20,1,26065,SC,Individual,No,57-0287419,26065SC0400002,"Blue Cross Blue Shield Silver 1, a Multi-State Plan",26065SC040,,SCN201,SCS201,SCF201,Existing,EPO,Silver,No,On the Exchange,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0400002-03,Limited Cost Sharing Plan Variation,,0.696509778499603,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$4,550",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,SC,26065,OPM,5,2014-09-13 04:19:20,1,26065,SC,Individual,No,57-0287419,26065SC0400002,"Blue Cross Blue Shield Silver 1, a Multi-State Plan",26065SC040,,SCN201,SCS201,SCF201,Existing,EPO,Silver,No,On the Exchange,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0400002-04,73% AV Level Silver Plan,,0.733879029750824,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$9,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300","$2,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,SC,26065,OPM,5,2014-09-13 04:19:20,1,26065,SC,Individual,No,57-0287419,26065SC0400002,"Blue Cross Blue Shield Silver 1, a Multi-State Plan",26065SC040,,SCN201,SCS201,SCF201,Existing,EPO,Silver,No,On the Exchange,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0400002-05,87% AV Level Silver Plan,,0.864447712898254,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$3,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$150,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,SC,26065,OPM,5,2014-09-13 04:19:20,1,26065,SC,Individual,No,57-0287419,26065SC0400002,"Blue Cross Blue Shield Silver 1, a Multi-State Plan",26065SC040,,SCN201,SCS201,SCF201,Existing,EPO,Silver,No,On the Exchange,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard,Yes,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pay,https://www.southcarolinablues.com/links/metallic/SBC_2015,https://www.southcarolinablues.com/links/metallic/pharmacy,26065SC0400002-06,94% AV Level Silver Plan,,0.933865785598755,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$3,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,SC,65122,OPM,4,2014-11-24 15:19:06,1,65122,SC,Individual,No,45-3124969,65122SC0010027,"CO-OPtions Consumers' Choice Silver 12, A Multistate Plan",65122SC001,,SCN201,SCS201,SCF205,New,EPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010027,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010027,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010027-01,Standard Silver On Exchange Plan,71.57%,0.723403692245483,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SC,65122,OPM,4,2014-11-24 15:19:06,1,65122,SC,Individual,No,45-3124969,65122SC0010027,"CO-OPtions Consumers' Choice Silver 12, A Multistate Plan",65122SC001,,SCN201,SCS201,SCF205,New,EPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010027,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010027,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010027-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,SC,65122,OPM,4,2014-11-24 15:19:06,1,65122,SC,Individual,No,45-3124969,65122SC0010027,"CO-OPtions Consumers' Choice Silver 12, A Multistate Plan",65122SC001,,SCN201,SCS201,SCF205,New,EPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010027,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010027,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010027-03,Limited Cost Sharing Plan Variation,71.57%,0.723403692245483,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,SC,65122,OPM,4,2014-11-24 15:19:06,1,65122,SC,Individual,No,45-3124969,65122SC0010027,"CO-OPtions Consumers' Choice Silver 12, A Multistate Plan",65122SC001,,SCN201,SCS201,SCF205,New,EPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010027,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010027,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010027-04,73% AV Level Silver Plan,73.70%,0.743915140628815,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,SC,65122,OPM,4,2014-11-24 15:19:06,1,65122,SC,Individual,No,45-3124969,65122SC0010027,"CO-OPtions Consumers' Choice Silver 12, A Multistate Plan",65122SC001,,SCN201,SCS201,SCF205,New,EPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010027,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010027,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010027-05,87% AV Level Silver Plan,86.70%,0.870104432106018,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,SC,65122,OPM,4,2014-11-24 15:19:06,1,65122,SC,Individual,No,45-3124969,65122SC0010027,"CO-OPtions Consumers' Choice Silver 12, A Multistate Plan",65122SC001,,SCN201,SCS201,SCF205,New,EPO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010027,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010027,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010027-06,94% AV Level Silver Plan,93.49%,0.936293542385101,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,SC,65122,OPM,4,2014-11-24 15:19:06,1,65122,SC,Individual,No,45-3124969,65122SC0010028,"CO-OPtions Consumers Choice' Gold 4, A Multistate Plan",65122SC001,,SCN201,SCS201,SCF204,New,EPO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010028,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010028,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010028-01,Standard Gold On Exchange Plan,79.09%,0.795510053634644,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,SC,65122,OPM,4,2014-11-24 15:19:06,1,65122,SC,Individual,No,45-3124969,65122SC0010028,"CO-OPtions Consumers Choice' Gold 4, A Multistate Plan",65122SC001,,SCN201,SCS201,SCF204,New,EPO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010028,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010028,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010028-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,11
2015,SC,65122,OPM,4,2014-11-24 15:19:06,1,65122,SC,Individual,No,45-3124969,65122SC0010028,"CO-OPtions Consumers Choice' Gold 4, A Multistate Plan",65122SC001,,SCN201,SCS201,SCF204,New,EPO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.cchpsc.org/members/plans/2015/65122sc0010028,https://cchpsc.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.cchpsc.org/members/plans/2015/65122sc0010028,http://www.cchpsc.org/media/Formulary.pdf,65122SC0010028-03,Limited Cost Sharing Plan Variation,79.09%,0.795510053634644,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,TN,14002,OPM,3,2014-09-12 09:45:59,1,14002,TN,Individual,No,62-0427913,14002TN0220001,"BlueCross B04P, a Multi-State Plan",14002TN022,,TNN201,TNS201,TNF201,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0220001-01,Standard Bronze On Exchange Plan,,0.617985665798187,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$15,900","$31,800","$21,200","$42,400",,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",0%,,,,"$10,600","$21,200","$15,900","$31,800",,,,,,,,,4
2015,TN,14002,OPM,3,2014-09-12 09:45:59,1,14002,TN,Individual,No,62-0427913,14002TN0220001,"BlueCross B04P, a Multi-State Plan",14002TN022,,TNN201,TNS201,TNF201,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0220001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,TN,14002,OPM,3,2014-09-12 09:45:59,1,14002,TN,Individual,No,62-0427913,14002TN0220001,"BlueCross B04P, a Multi-State Plan",14002TN022,,TNN201,TNS201,TNF201,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0220001-03,Limited Cost Sharing Plan Variation,,0.617985665798187,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$15,900","$31,800","$21,200","$42,400",,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600",0%,,,,"$10,600","$21,200","$15,900","$31,800",,,,,,,,,6
2015,TN,14002,OPM,3,2014-09-12 09:45:59,2,14002,TN,Individual,No,62-0427913,14002TN0230001,"BlueCross S09P, a Multi-State Plan",14002TN023,,TNN201,TNS201,TNF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard WorldWide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0230001-01,Standard Silver On Exchange Plan,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,TN,14002,OPM,3,2014-09-12 09:45:59,2,14002,TN,Individual,No,62-0427913,14002TN0230001,"BlueCross S09P, a Multi-State Plan",14002TN023,,TNN201,TNS201,TNF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard WorldWide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0230001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,5
2015,TN,14002,OPM,3,2014-09-12 09:45:59,2,14002,TN,Individual,No,62-0427913,14002TN0230001,"BlueCross S09P, a Multi-State Plan",14002TN023,,TNN201,TNS201,TNF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard WorldWide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0230001-03,Limited Cost Sharing Plan Variation,,0.683525621891022,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,TN,14002,OPM,3,2014-09-12 09:45:59,2,14002,TN,Individual,No,62-0427913,14002TN0230001,"BlueCross S09P, a Multi-State Plan",14002TN023,,TNN201,TNS201,TNF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard WorldWide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0230001-04,73% AV Level Silver Plan,,0.720056891441345,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$13,500","$27,000","$17,150","$34,300",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TN,14002,OPM,3,2014-09-12 09:45:59,2,14002,TN,Individual,No,62-0427913,14002TN0230001,"BlueCross S09P, a Multi-State Plan",14002TN023,,TNN201,TNS201,TNF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard WorldWide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0230001-05,87% AV Level Silver Plan,,0.864041566848755,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$13,500","$27,000","$15,500","$31,000",,,,,,,,,,,,,,,,,,,,,$300,$600,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TN,14002,OPM,3,2014-09-12 09:45:59,2,14002,TN,Individual,No,62-0427913,14002TN0230001,"BlueCross S09P, a Multi-State Plan",14002TN023,,TNN201,TNS201,TNF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard WorldWide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0230001-06,94% AV Level Silver Plan,,0.93165785074234,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$800,"$1,600",,,"$13,500","$27,000","$14,300","$28,600",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TN,14002,OPM,3,2014-09-12 09:45:59,3,14002,TN,Individual,No,62-0427913,14002TN0230002,"BlueCross S11P, a Multi-State Plan",14002TN023,,TNN201,TNS201,TNF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0230002-01,Standard Silver On Exchange Plan,,0.702820777893066,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000","$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,$0,,,4
2015,TN,14002,OPM,3,2014-09-12 09:45:59,3,14002,TN,Individual,No,62-0427913,14002TN0230002,"BlueCross S11P, a Multi-State Plan",14002TN023,,TNN201,TNS201,TNF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0230002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,TN,14002,OPM,3,2014-09-12 09:45:59,3,14002,TN,Individual,No,62-0427913,14002TN0230002,"BlueCross S11P, a Multi-State Plan",14002TN023,,TNN201,TNS201,TNF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0230002-03,Limited Cost Sharing Plan Variation,,0.702820777893066,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000","$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,$0,,,6
2015,TN,14002,OPM,3,2014-09-12 09:45:59,4,14002,TN,Individual,No,62-0427913,14002TN0230003,"BlueCross S12P, a Multi-State Plan",14002TN023,,TNN201,TNS201,TNF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0230003-04,73% AV Level Silver Plan,,0.720732450485229,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$16,500","$33,000","$21,500","$43,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,TN,14002,OPM,3,2014-09-12 09:45:59,4,14002,TN,Individual,No,62-0427913,14002TN0230003,"BlueCross S12P, a Multi-State Plan",14002TN023,,TNN201,TNS201,TNF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0230003-05,87% AV Level Silver Plan,,0.861333131790161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$16,500","$33,000","$18,500","$37,000",,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,TN,14002,OPM,3,2014-09-12 09:45:59,4,14002,TN,Individual,No,62-0427913,14002TN0230003,"BlueCross S12P, a Multi-State Plan",14002TN023,,TNN201,TNS201,TNF202,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0230003-06,94% AV Level Silver Plan,,0.930114090442657,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$16,500","$33,000","$17,600","$35,200",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,TN,14002,OPM,3,2014-09-12 09:45:59,5,14002,TN,Individual,No,62-0427913,14002TN0300001,"BlueCross G08P, a Multi-State Plan",14002TN030,,TNN201,TNS201,TNF201,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0300001-01,Standard Gold On Exchange Plan,,0.780541837215424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$6,300","$12,600","$8,400","$16,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400","$6,300","$12,600",,,,,,,,,4
2015,TN,14002,OPM,3,2014-09-12 09:45:59,5,14002,TN,Individual,No,62-0427913,14002TN0300001,"BlueCross G08P, a Multi-State Plan",14002TN030,,TNN201,TNS201,TNF201,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0300001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,TN,14002,OPM,3,2014-09-12 09:45:59,5,14002,TN,Individual,No,62-0427913,14002TN0300001,"BlueCross G08P, a Multi-State Plan",14002TN030,,TNN201,TNS201,TNF201,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0300001-03,Limited Cost Sharing Plan Variation,,0.780541837215424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$6,300","$12,600","$8,400","$16,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400","$6,300","$12,600",,,,,,,,,6
2015,TN,14002,OPM,3,2014-09-12 09:45:59,6,14002,TN,Individual,No,62-0427913,14002TN0300002,"BlueCross G11P, a Multi-State Plan",14002TN030,,TNN201,TNS201,TNF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0300002-01,Standard Gold On Exchange Plan,,0.796816885471344,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,TN,14002,OPM,3,2014-09-12 09:45:59,6,14002,TN,Individual,No,62-0427913,14002TN0300002,"BlueCross G11P, a Multi-State Plan",14002TN030,,TNN201,TNS201,TNF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0300002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,TN,14002,OPM,3,2014-09-12 09:45:59,6,14002,TN,Individual,No,62-0427913,14002TN0300002,"BlueCross G11P, a Multi-State Plan",14002TN030,,TNN201,TNS201,TNF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,BlueCard Worldwide,Yes,BlueCard PPO,Yes,http://www.bcbst.com/sbc,https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action,www.bcbst.com/brochures,http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2015/index.page,14002TN0300002-03,Limited Cost Sharing Plan Variation,,0.796816885471344,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000",0%,,,,"$7,000","$14,000","$10,500","$21,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,VA,40308,OPM,4,2014-09-11 12:10:19,1,40308,VA,Individual,No,53-0078070,40308VA0280001,"BlueCross BlueShield Preferred 1500, A Multi-State Plan",40308VA028,,VAN200,VAS200,VAF202,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99743536943784,,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,Yes,http://content.carefirst.com/sbc/BPHVBN6NRXMVBN6FN012015.pdf,,,www.carefirst.com/acarx,40308VA0280001-04,73% AV Level Silver Plan,73.66%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,VA,40308,OPM,4,2014-09-11 12:10:19,1,40308,VA,Individual,No,53-0078070,40308VA0280001,"BlueCross BlueShield Preferred 1500, A Multi-State Plan",40308VA028,,VAN200,VAS200,VAF202,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99743536943784,,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,Yes,http://content.carefirst.com/sbc/BPHVBN6NRXMVBN6FN012015.pdf,,,www.carefirst.com/acarx,40308VA0280001-05,87% AV Level Silver Plan,87.64%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,11
2015,VA,40308,OPM,4,2014-09-11 12:10:19,1,40308,VA,SHOP (Small Group),No,53-0078070,40308VA0290001,"BlueCross BlueShield Preferred 2000, A Multi-State Plan",40308VA029,,VAN200,VAS200,VAF201,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996117002947396,,,0,0,0,2015-01-01,,Yes,All covered services,Yes,All covered services,Yes,http://content.carefirst.com/sbc/BPHVB56CRXMVBA6CN012015.pdf,,,www.carefirst.com/acarx,40308VA0290001-01,Standard Silver On Exchange Plan,70.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,010",$150,"$2,000",$290,$260,$80,4
2015,VA,40308,OPM,4,2014-09-11 12:10:19,1,40308,VA,Individual,No,53-0078070,40308VA0280001,"BlueCross BlueShield Preferred 1500, A Multi-State Plan",40308VA028,,VAN200,VAS200,VAF202,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99743536943784,,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,Yes,http://content.carefirst.com/sbc/BPHVBN6NRXMVBN6FN012015.pdf,,,www.carefirst.com/acarx,40308VA0280001-01,Standard Silver On Exchange Plan,68.42%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,110",$150,"$1,500",$150,$770,$80,7
2015,VA,40308,OPM,4,2014-09-11 12:10:19,1,40308,VA,Individual,No,53-0078070,40308VA0280001,"BlueCross BlueShield Preferred 1500, A Multi-State Plan",40308VA028,,VAN200,VAS200,VAF202,Existing,PPO,Silver,Yes,On the Exchange,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99743536943784,,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,Yes,http://content.carefirst.com/sbc/BPHVBN6NRXMVBN6FN012015.pdf,,,www.carefirst.com/acarx,40308VA0280001-06,94% AV Level Silver Plan,93.22%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,12
2015,VA,88380,OPM,7,2014-12-12 12:37:36,1,88380,VA,Individual,No,54-1356687,88380VA0880005,"Anthem Blue Cross and Blue Shield HealthKeepers Silver Direct Access, a Multi-State Plan",88380VA088,,VAN201,VAS201,VAF202,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GAV,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0880005-01,Standard Silver On Exchange Plan,71.04%,0.71509200334549,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,500","$11,000","$5,500","$11,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,"$1,500","$3,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,88380,OPM,7,2014-12-12 12:37:36,1,88380,VA,Individual,No,54-1356687,88380VA0880005,"Anthem Blue Cross and Blue Shield HealthKeepers Silver Direct Access, a Multi-State Plan",88380VA088,,VAN201,VAS201,VAF202,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GAV,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0880005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,5
2015,VA,88380,OPM,7,2014-12-12 12:37:36,1,88380,VA,Individual,No,54-1356687,88380VA0880005,"Anthem Blue Cross and Blue Shield HealthKeepers Silver Direct Access, a Multi-State Plan",88380VA088,,VAN201,VAS201,VAF202,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GAV,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0880005-03,Limited Cost Sharing Plan Variation,71.04%,0.71509200334549,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,500","$11,000","$5,500","$11,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,"$1,500","$3,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,VA,88380,OPM,7,2014-12-12 12:37:36,1,88380,VA,Individual,No,54-1356687,88380VA0880005,"Anthem Blue Cross and Blue Shield HealthKeepers Silver Direct Access, a Multi-State Plan",88380VA088,,VAN201,VAS201,VAF202,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GAV,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0880005-04,73% AV Level Silver Plan,73.50%,0.739178836345673,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$4,250","$8,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,"$1,500","$3,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,88380,OPM,7,2014-12-12 12:37:36,1,88380,VA,Individual,No,54-1356687,88380VA0880005,"Anthem Blue Cross and Blue Shield HealthKeepers Silver Direct Access, a Multi-State Plan",88380VA088,,VAN201,VAS201,VAF202,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GAV,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0880005-05,87% AV Level Silver Plan,86.24%,0.864681005477905,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,450","$2,900","$1,450","$2,900",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$725,"$1,450",30%,$725,"$1,450",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,VA,88380,OPM,7,2014-12-12 12:37:36,1,88380,VA,Individual,No,54-1356687,88380VA0880005,"Anthem Blue Cross and Blue Shield HealthKeepers Silver Direct Access, a Multi-State Plan",88380VA088,,VAN201,VAS201,VAF202,Existing,HMO,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GAV,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0880005-06,94% AV Level Silver Plan,93.35%,0.93507981300354,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$600,"$1,200",$600,"$1,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$175,$350,30%,$175,$350,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,VA,88380,OPM,7,2014-12-12 12:37:36,2,88380,VA,Individual,No,54-1356687,88380VA0880006,"Anthem Blue Cross and Blue Shield HealthKeepers Gold Direct Access, a Multi-State Plan",88380VA088,,VAN201,VAS201,VAF201,Existing,HMO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GB4,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0880006-01,Standard Gold On Exchange Plan,78.91%,0.794866383075714,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,$750,"$1,500",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,33602,OPM,7,2015-02-20 08:57:57,1,33602,TX,Individual,No,36-1236610,33602TX0440001,"Blue Cross Blue Shield Premier 1, a Multi-State Plan?",33602TX044,,TXN201,TXS201,TXF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0440001-01,Standard Gold On Exchange Plan,,0.817188739776611,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$8,250",,,"$5,500","$16,500",Not Applicable,Not Applicable,"$1,000","$3,000",20%,,,,"$2,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,AR,28348,SERFF,5,2014-11-13 16:11:17,3,28348,AR,Individual,Yes,71-0561140,28348AR0100001,Delta Dental Family Silver Plan,28348AR010,,ARN001,ARS001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.08,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address,Yes,Claims will be paid based on In Network fee level and out of network benefit levels.,Yes,http://deltadentalar.com/Shop/aca-individual-and-family-plans,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348,http://deltadentalar.com/Shop/aca-individual-and-family-plans,,28348AR0100001-01,Standard Low On Exchange Plan,70.00%,,,,Yes,30%,70%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$50,,$50,$50,,$50,$50,$50,$50,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,4,62141,AR,Individual,No,06-0641618,62141AR0090003,Ambetter Balanced Care 1 + Vision,62141AR009,,ARN001,ARS001,ARF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.980650698139116,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,4,62141,AR,Individual,No,06-0641618,62141AR0090003,Ambetter Balanced Care 1 + Vision,62141AR009,,ARN001,ARS001,ARF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.980650698139116,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090003-03,Limited Cost Sharing Plan Variation,,0.682594239711761,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$500,"$1,000",0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,020","$1,430",$0,$150,"$2,500",$730,$100,$80,7
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,3,62141,AR,Individual,No,06-0641618,62141AR0090002,Ambetter Secure Care 2 with 3 Free PCP Visits + Vision,62141AR009,,ARN001,ARS001,ARF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982930316596711,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,3,62141,AR,Individual,No,06-0641618,62141AR0090002,Ambetter Secure Care 2 with 3 Free PCP Visits + Vision,62141AR009,,ARN001,ARS001,ARF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982930316596711,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090002-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$500,"$1,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,11
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,3,62141,AR,Individual,No,06-0641618,62141AR0090005,Ambetter Essential Care 1 + Vision,62141AR009,,ARN001,ARS001,ARF009,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.983241660268527,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090005-00,Standard Bronze Off Exchange Plan,,0.603424847126007,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$5,000","$10,000",40%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$5,020",$0,$900,$150,"$2,920",$860,$0,$80,12
2015,TX,33602,OPM,7,2015-02-20 08:57:57,1,33602,TX,Individual,No,36-1236610,33602TX0440001,"Blue Cross Blue Shield Premier 1, a Multi-State Plan?",33602TX044,,TXN201,TXS201,TXF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0440001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,WI,79475,OPM,6,2015-02-20 08:57:57,1,79475,WI,Individual,No,39-1462554,79475WI0500003,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",79475WI050,,WIN201,WIS201,WIF208,Existing,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GNR,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0500003-03,Limited Cost Sharing Plan Variation,71.01%,0.698062241077423,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,WI,79475,OPM,6,2015-02-20 08:57:57,1,79475,WI,Individual,No,39-1462554,79475WI0500003,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",79475WI050,,WIN201,WIS201,WIF208,Existing,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GNR,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0500003-04,73% AV Level Silver Plan,73.01%,0.71789962053299,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,WI,79475,OPM,6,2015-02-20 08:57:57,1,79475,WI,Individual,No,39-1462554,79475WI0500003,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",79475WI050,,WIN201,WIS201,WIF208,Existing,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GNR,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0500003-05,87% AV Level Silver Plan,86.13%,0.857210278511047,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,WI,79475,OPM,6,2015-02-20 08:57:57,1,79475,WI,Individual,No,39-1462554,79475WI0500003,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",79475WI050,,WIN201,WIS201,WIF208,Existing,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GNR,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0500003-06,94% AV Level Silver Plan,93.08%,0.930851757526398,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$175,$350,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,WI,79475,OPM,6,2015-02-20 08:57:57,2,79475,WI,Individual,No,39-1462554,79475WI0500004,"Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan",79475WI050,,WIN201,WIS201,WIF201,Existing,POS,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GNX,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0500004-01,Standard Gold On Exchange Plan,78.52%,0.786124408245087,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,79475,OPM,6,2015-02-20 08:57:57,2,79475,WI,Individual,No,39-1462554,79475WI0500004,"Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan",79475WI050,,WIN201,WIS201,WIF201,Existing,POS,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GNX,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0500004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,WI,79475,OPM,6,2015-02-20 08:57:57,2,79475,WI,Individual,No,39-1462554,79475WI0500004,"Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan",79475WI050,,WIN201,WIS201,WIF201,Existing,POS,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GNX,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0500004-03,Limited Cost Sharing Plan Variation,78.52%,0.786124408245087,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070001,Silver,37903AR007,,ARN001,ARS001,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070001-05,87% AV Level Silver Plan,,0.860203385353088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,$600,$400,$200,$500,$900,$100,$80,9
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070001,Silver,37903AR007,,ARN001,ARS001,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070001-06,94% AV Level Silver Plan,,0.94902229309082,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$754,"$1,508",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$300,$300,$200,$200,$500,$80,$80,10
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070002,Silver,37903AR007,,ARN001,ARS002,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070002-00,Standard Silver Off Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,11
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070002,Silver,37903AR007,,ARN001,ARS002,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070002-01,Standard Silver On Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,12
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070002,Silver,37903AR007,,ARN001,ARS002,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,13
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070002,Silver,37903AR007,,ARN001,ARS002,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070002-03,Limited Cost Sharing Plan Variation,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,14
2015,TX,33602,OPM,7,2015-02-20 08:57:57,1,33602,TX,Individual,No,36-1236610,33602TX0440001,"Blue Cross Blue Shield Premier 1, a Multi-State Plan?",33602TX044,,TXN201,TXS201,TXF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0440001-03,Limited Cost Sharing Plan Variation,,0.817188739776611,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$8,250",,,"$5,500","$16,500",Not Applicable,Not Applicable,"$1,000","$3,000",20%,,,,"$2,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,TX,33602,OPM,7,2015-02-20 08:57:57,1,33602,TX,Individual,No,36-1236610,33602TX0440002,"Blue Cross Blue Shield Premier 2, a Multi-State Plan?",33602TX044,,TXN201,TXS201,TXF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0440002-01,Standard Gold On Exchange Plan,,0.80812656879425,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$12,000",,,"$8,000","$24,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,TX,33602,OPM,7,2015-02-20 08:57:57,1,33602,TX,Individual,No,36-1236610,33602TX0440002,"Blue Cross Blue Shield Premier 2, a Multi-State Plan?",33602TX044,,TXN201,TXS201,TXF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0440002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,TX,33602,OPM,7,2015-02-20 08:57:57,1,33602,TX,Individual,No,36-1236610,33602TX0440002,"Blue Cross Blue Shield Premier 2, a Multi-State Plan?",33602TX044,,TXN201,TXS201,TXF203,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0440002-03,Limited Cost Sharing Plan Variation,,0.80812656879425,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$12,000",,,"$8,000","$24,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,TX,33602,OPM,7,2015-02-20 08:57:57,1,33602,TX,Individual,No,36-1236610,33602TX0440003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",33602TX044,,TXN201,TXS201,TXF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0440003-01,Standard Silver On Exchange Plan,,0.703163325786591,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,500","$12,700",20%,,,,"$9,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,TX,33602,OPM,7,2015-02-20 08:57:57,1,33602,TX,Individual,No,36-1236610,33602TX0440003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",33602TX044,,TXN201,TXS201,TXF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0440003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,TX,33602,OPM,7,2015-02-20 08:57:57,1,33602,TX,Individual,No,36-1236610,33602TX0440003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",33602TX044,,TXN201,TXS201,TXF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0440003-03,Limited Cost Sharing Plan Variation,,0.703163325786591,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,500","$12,700",20%,,,,"$9,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,TX,33602,OPM,7,2015-02-20 08:57:57,1,33602,TX,Individual,No,36-1236610,33602TX0440003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",33602TX044,,TXN201,TXS201,TXF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0440003-04,73% AV Level Silver Plan,,0.739054918289185,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,TX,33602,OPM,7,2015-02-20 08:57:57,1,33602,TX,Individual,No,36-1236610,33602TX0440003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",33602TX044,,TXN201,TXS201,TXF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0440003-05,87% AV Level Silver Plan,,0.868183553218842,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,500",,,"$4,000","$9,000",Not Applicable,Not Applicable,$250,$750,20%,,,,$500,"$1,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,TX,33602,OPM,7,2015-02-20 08:57:57,1,33602,TX,Individual,No,36-1236610,33602TX0440003,"Blue Cross Blue Shield Solution 3, a Multi-State Plan?",33602TX044,,TXN201,TXS201,TXF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0440003-06,94% AV Level Silver Plan,,0.946778774261475,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,TX,33602,OPM,7,2015-02-20 08:57:57,1,33602,TX,Individual,No,36-1236610,33602TX0440004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",33602TX044,,TXN201,TXS201,TXF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0440004-01,Standard Silver On Exchange Plan,,0.686640679836273,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400",Not Applicable,Not Applicable,"$6,250","$12,700",0%,,,,"$12,500","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,TX,33602,OPM,7,2015-02-20 08:57:57,1,33602,TX,Individual,No,36-1236610,33602TX0440004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",33602TX044,,TXN201,TXS201,TXF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0440004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,TX,33602,OPM,7,2015-02-20 08:57:57,1,33602,TX,Individual,No,36-1236610,33602TX0440004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",33602TX044,,TXN201,TXS201,TXF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0440004-03,Limited Cost Sharing Plan Variation,,0.686640679836273,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400",Not Applicable,Not Applicable,"$6,250","$12,700",0%,,,,"$12,500","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,TX,33602,OPM,7,2015-02-20 08:57:57,1,33602,TX,Individual,No,36-1236610,33602TX0440004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",33602TX044,,TXN201,TXS201,TXF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0440004-04,73% AV Level Silver Plan,,0.730801701545715,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$10,400",,,"$9,500","$20,800",Not Applicable,Not Applicable,"$4,750","$10,400",0%,,,,"$9,500","$20,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,TX,33602,OPM,7,2015-02-20 08:57:57,1,33602,TX,Individual,No,36-1236610,33602TX0440004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",33602TX044,,TXN201,TXS201,TXF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0440004-05,87% AV Level Silver Plan,,0.871323525905609,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,TX,33602,OPM,7,2015-02-20 08:57:57,1,33602,TX,Individual,No,36-1236610,33602TX0440004,"Blue Cross Blue Shield Solution 4, a Multi-State Plan?",33602TX044,,TXN201,TXS201,TXF203,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0440004-06,94% AV Level Silver Plan,,0.94565761089325,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$500,"$1,500",0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,TX,33602,OPM,7,2015-02-20 08:57:57,2,33602,TX,Individual,No,36-1236610,33602TX0440005,"Blue Cross Blue Shield Basic 5, a Multi-State Plan?",33602TX044,,TXN201,TXS201,TXF202,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0440005-01,Standard Bronze On Exchange Plan,,0.611617028713226,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$11,250",30%,,,,"$7,500","$22,500",Not Applicable,Not Applicable,,,,,,,,,4
2015,TX,33602,OPM,7,2015-02-20 08:57:57,2,33602,TX,Individual,No,36-1236610,33602TX0440005,"Blue Cross Blue Shield Basic 5, a Multi-State Plan?",33602TX044,,TXN201,TXS201,TXF202,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0440005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,TX,33602,OPM,7,2015-02-20 08:57:57,2,33602,TX,Individual,No,36-1236610,33602TX0440005,"Blue Cross Blue Shield Basic 5, a Multi-State Plan?",33602TX044,,TXN201,TXS201,TXF202,Existing,PPO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbstx.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred,http://www.bcbstx.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_TX_Marketplace5TierStandardDrugList.pdf,33602TX0440005-03,Limited Cost Sharing Plan Variation,,0.611617028713226,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$11,250",30%,,,,"$7,500","$22,500",Not Applicable,Not Applicable,,,,,,,,,6
2015,UT,27619,OPM,4,2014-11-04 20:29:03,1,27619,UT,Individual,No,45-3174628,27619UT0010025,"CO-OPtions Arches Gold, A Multi-State Plan",27619UT001,,UTN201,UTS201,UTF203,New,HMO,Gold,Yes,On the Exchange,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9913,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10025.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10025.pdf,www.archeshealth.org/pharmacy,27619UT0010025-01,Standard Gold On Exchange Plan,81.36%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,Not Applicable,Not Applicable,$250,$500,$250,$20,"$1,400",$150,$250,$600,$230,$80,4
2015,UT,27619,OPM,4,2014-11-04 20:29:03,1,27619,UT,Individual,No,45-3174628,27619UT0010025,"CO-OPtions Arches Gold, A Multi-State Plan",27619UT001,,UTN201,UTS201,UTF203,New,HMO,Gold,Yes,On the Exchange,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9913,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10025.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10025.pdf,www.archeshealth.org/pharmacy,27619UT0010025-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,5
2015,UT,27619,OPM,4,2014-11-04 20:29:03,1,27619,UT,Individual,No,45-3174628,27619UT0010025,"CO-OPtions Arches Gold, A Multi-State Plan",27619UT001,,UTN201,UTS201,UTF203,New,HMO,Gold,Yes,On the Exchange,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9913,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10025.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10025.pdf,www.archeshealth.org/pharmacy,27619UT0010025-03,Limited Cost Sharing Plan Variation,81.36%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,Not Applicable,Not Applicable,$250,$500,$250,$20,"$1,400",$150,$250,$600,$230,$80,6
2015,UT,27619,OPM,4,2014-11-04 20:29:03,2,27619,UT,Individual,No,45-3174628,27619UT0010026,"CO-OPtions Arches Silver, A Multi-State Plan",27619UT001,,UTN202,UTS202,UTF207,New,HMO,Silver,Yes,On the Exchange,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,Yes,www.archeshealth.org/SBC/10026.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10026.pdf,www.archeshealth.org/pharmacy,27619UT0010026-01,Standard Silver On Exchange Plan,70.63%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",40%,"$3,500","$7,000",40%,Not Applicable,Not Applicable,"$3,500","$7,000","$3,500",$10,"$1,500",$150,"$2,420",$200,$0,$80,4
2015,UT,27619,OPM,4,2014-11-04 20:29:03,2,27619,UT,Individual,No,45-3174628,27619UT0010026,"CO-OPtions Arches Silver, A Multi-State Plan",27619UT001,,UTN202,UTS202,UTF207,New,HMO,Silver,Yes,On the Exchange,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,Yes,www.archeshealth.org/SBC/10026.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10026.pdf,www.archeshealth.org/pharmacy,27619UT0010026-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,5
2015,UT,27619,OPM,4,2014-11-04 20:29:03,2,27619,UT,Individual,No,45-3174628,27619UT0010026,"CO-OPtions Arches Silver, A Multi-State Plan",27619UT001,,UTN202,UTS202,UTF207,New,HMO,Silver,Yes,On the Exchange,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,Yes,www.archeshealth.org/SBC/10026.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10026.pdf,www.archeshealth.org/pharmacy,27619UT0010026-03,Limited Cost Sharing Plan Variation,70.63%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",40%,"$3,500","$7,000",40%,Not Applicable,Not Applicable,"$3,500","$7,000","$3,500",$10,"$1,500",$150,"$2,420",$200,$0,$80,6
2015,UT,27619,OPM,4,2014-11-04 20:29:03,2,27619,UT,Individual,No,45-3174628,27619UT0010026,"CO-OPtions Arches Silver, A Multi-State Plan",27619UT001,,UTN202,UTS202,UTF207,New,HMO,Silver,Yes,On the Exchange,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,Yes,www.archeshealth.org/SBC/10026.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10026.pdf,www.archeshealth.org/pharmacy,27619UT0010026-04,73% AV Level Silver Plan,73.30%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,"$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",40%,"$2,600","$5,200",40%,Not Applicable,Not Applicable,"$2,600","$5,200","$2,000","$1,100",$240,$150,"$2,000",$170,$370,$80,7
2015,UT,27619,OPM,4,2014-11-04 20:29:03,2,27619,UT,Individual,No,45-3174628,27619UT0010026,"CO-OPtions Arches Silver, A Multi-State Plan",27619UT001,,UTN202,UTS202,UTF207,New,HMO,Silver,Yes,On the Exchange,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,Yes,www.archeshealth.org/SBC/10026.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10026.pdf,www.archeshealth.org/pharmacy,27619UT0010026-05,87% AV Level Silver Plan,87.80%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000",Not Applicable,Not Applicable,"$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,$0,$0,40%,$0,$0,40%,Not Applicable,Not Applicable,$0,$0,$0,"$1,720",$280,$150,$0,$250,$560,$80,8
2015,UT,27619,OPM,4,2014-11-04 20:29:03,2,27619,UT,Individual,No,45-3174628,27619UT0010026,"CO-OPtions Arches Silver, A Multi-State Plan",27619UT001,,UTN202,UTS202,UTF207,New,HMO,Silver,Yes,On the Exchange,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,Yes,www.archeshealth.org/SBC/10026.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10026.pdf,www.archeshealth.org/pharmacy,27619UT0010026-06,94% AV Level Silver Plan,94.50%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$600,"$1,200",$600,"$1,200",Not Applicable,Not Applicable,$600,"$1,200",,,,,,,,,,,,,,,,,,,,,$0,$0,40%,$0,$0,40%,Not Applicable,Not Applicable,$0,$0,$0,$560,$40,$150,$0,$180,$420,$80,9
2015,VA,88380,OPM,7,2014-12-12 12:37:36,2,88380,VA,Individual,No,54-1356687,88380VA0880006,"Anthem Blue Cross and Blue Shield HealthKeepers Gold Direct Access, a Multi-State Plan",88380VA088,,VAN201,VAS201,VAF201,Existing,HMO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GB4,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0880006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,5
2015,VA,88380,OPM,7,2014-12-12 12:37:36,2,88380,VA,Individual,No,54-1356687,88380VA0880006,"Anthem Blue Cross and Blue Shield HealthKeepers Gold Direct Access, a Multi-State Plan",88380VA088,,VAN201,VAS201,VAF201,Existing,HMO,Gold,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GB4,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0880006-03,Limited Cost Sharing Plan Variation,78.91%,0.794866383075714,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,$750,"$1,500",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,WI,79475,OPM,6,2015-02-20 08:57:57,1,79475,WI,Individual,No,39-1462554,79475WI0500003,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",79475WI050,,WIN201,WIS201,WIF208,Existing,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GNR,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0500003-01,Standard Silver On Exchange Plan,71.01%,0.698062241077423,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,WI,79475,OPM,6,2015-02-20 08:57:57,1,79475,WI,Individual,No,39-1462554,79475WI0500003,"Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan",79475WI050,,WIN201,WIS201,WIF208,Existing,POS,Silver,Yes,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GNR,https://shop.anthem.com/sales/eox/payment/landing/wi,http://file.anthem.com/03262WIMENABS.pdf,anthem.com/WISelectdrugtier4,79475WI0500003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,5
2015,WV,31274,OPM,5,2014-11-24 15:19:06,1,31274,WV,Individual,No,55-0624615,31274WV0310002,"Blue Cross Blue Shield Shared Cost 4750, a Multi-State Plan",31274WV031,,WVN201,WVS201,WVF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbswv.com/sbc/bcbswv.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westvirginia,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0310002-01,Standard Silver On Exchange Plan,,0.699447989463806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,750","$9,500",20%,,,,"$9,500","$19,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WV,31274,OPM,5,2014-11-24 15:19:06,1,31274,WV,Individual,No,55-0624615,31274WV0310002,"Blue Cross Blue Shield Shared Cost 4750, a Multi-State Plan",31274WV031,,WVN201,WVS201,WVF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbswv.com/sbc/bcbswv.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westvirginia,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0310002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,WV,31274,OPM,5,2014-11-24 15:19:06,1,31274,WV,Individual,No,55-0624615,31274WV0310002,"Blue Cross Blue Shield Shared Cost 4750, a Multi-State Plan",31274WV031,,WVN201,WVS201,WVF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbswv.com/sbc/bcbswv.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westvirginia,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0310002-03,Limited Cost Sharing Plan Variation,,0.699447989463806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,750","$9,500",20%,,,,"$9,500","$19,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,AR,28348,SERFF,5,2014-11-13 16:11:17,2,28348,AR,SHOP (Small Group),Yes,71-0561140,28348AR0140002,Delta Dental Pediatric Gold Plan,28348AR014,,ARN002,ARS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.73,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address,Yes,Claims will be paid based on In Network fee level and out of network benefit levels.,Yes,,,,,28348AR0140002-00,Standard High Off Exchange Plan,85.00%,,,,Yes,30%,70%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,3,62141,AR,Individual,No,06-0641618,62141AR0090005,Ambetter Essential Care 1 + Vision,62141AR009,,ARN001,ARS001,ARF009,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.983241660268527,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090005-01,Standard Bronze On Exchange Plan,,0.603424847126007,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$5,000","$10,000",40%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$5,020",$0,$900,$150,"$2,920",$860,$0,$80,13
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070002,Silver,37903AR007,,ARN001,ARS002,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070002-04,73% AV Level Silver Plan,,0.725960195064545,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$600,$900,$200,"$1,400","$1,300",$0,$80,15
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070002,Silver,37903AR007,,ARN001,ARS002,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070002-05,87% AV Level Silver Plan,,0.860203385353088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,$600,$400,$200,$500,$900,$100,$80,16
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070002,Silver,37903AR007,,ARN001,ARS002,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070002-06,94% AV Level Silver Plan,,0.94902229309082,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$754,"$1,508",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$300,$300,$200,$200,$500,$80,$80,17
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070003,Silver,37903AR007,,ARN001,ARS003,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070003-00,Standard Silver Off Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,18
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070003,Silver,37903AR007,,ARN001,ARS003,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070003-01,Standard Silver On Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,19
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070003,Silver,37903AR007,,ARN001,ARS003,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,20
2015,WV,31274,OPM,5,2014-11-24 15:19:06,1,31274,WV,Individual,No,55-0624615,31274WV0310002,"Blue Cross Blue Shield Shared Cost 4750, a Multi-State Plan",31274WV031,,WVN201,WVS201,WVF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbswv.com/sbc/bcbswv.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westvirginia,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0310002-04,73% AV Level Silver Plan,,0.722866296768188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,"$9,500","$19,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,AR,28448,SERFF,2,2014-09-09 16:12:42,2,28448,AR,SHOP (Small Group),Yes,57-0523959,28448AR0020002,Group Pediatric Dental EHB Policy,28448AR002,,ARN001,ARS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$21.78,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,28448AR0020002-00,Standard Low Off Exchange Plan,68.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070001,Silver,37903AR007,,ARN001,ARS001,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070001-00,Standard Silver Off Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,4
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070001,Silver,37903AR007,,ARN001,ARS001,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070001-01,Standard Silver On Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,5
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070001,Silver,37903AR007,,ARN001,ARS001,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070001,Silver,37903AR007,,ARN001,ARS001,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070001-03,Limited Cost Sharing Plan Variation,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,7
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070001,Silver,37903AR007,,ARN001,ARS001,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070001-04,73% AV Level Silver Plan,,0.725960195064545,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$600,$900,$200,"$1,400","$1,300",$0,$80,8
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070003,Silver,37903AR007,,ARN001,ARS003,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070003-03,Limited Cost Sharing Plan Variation,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,21
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070003,Silver,37903AR007,,ARN001,ARS003,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070003-04,73% AV Level Silver Plan,,0.725960195064545,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$600,$900,$200,"$1,400","$1,300",$0,$80,22
2015,WV,31274,OPM,5,2014-11-24 15:19:06,1,31274,WV,Individual,No,55-0624615,31274WV0310002,"Blue Cross Blue Shield Shared Cost 4750, a Multi-State Plan",31274WV031,,WVN201,WVS201,WVF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbswv.com/sbc/bcbswv.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westvirginia,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0310002-05,87% AV Level Silver Plan,,0.868642091751099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$9,500","$19,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070004,Silver,37903AR007,,ARN001,ARS004,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070004-00,Standard Silver Off Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,25
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070004,Silver,37903AR007,,ARN001,ARS004,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070004-01,Standard Silver On Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,26
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070004,Silver,37903AR007,,ARN001,ARS004,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,27
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070004,Silver,37903AR007,,ARN001,ARS004,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070004-03,Limited Cost Sharing Plan Variation,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,28
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070004,Silver,37903AR007,,ARN001,ARS004,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070004-04,73% AV Level Silver Plan,,0.725960195064545,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$600,$900,$200,"$1,400","$1,300",$0,$80,29
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070004,Silver,37903AR007,,ARN001,ARS004,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070004-05,87% AV Level Silver Plan,,0.860203385353088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,$600,$400,$200,$500,$900,$100,$80,30
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070004,Silver,37903AR007,,ARN001,ARS004,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070004-06,94% AV Level Silver Plan,,0.94902229309082,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$754,"$1,508",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$300,$300,$200,$200,$500,$80,$80,31
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070005,Silver,37903AR007,,ARN001,ARS005,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070005-00,Standard Silver Off Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,32
2015,WV,31274,OPM,5,2014-11-24 15:19:06,1,31274,WV,Individual,No,55-0624615,31274WV0310002,"Blue Cross Blue Shield Shared Cost 4750, a Multi-State Plan",31274WV031,,WVN201,WVS201,WVF201,Existing,PPO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbswv.com/sbc/bcbswv.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westvirginia,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0310002-06,94% AV Level Silver Plan,,0.933111906051636,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,$100,$200,10%,,,,"$9,500","$19,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WV,31274,OPM,5,2014-11-24 15:19:06,1,31274,WV,Individual,No,55-0624615,31274WV0310001,"Blue Cross Blue Shield Shared Cost 1500, a Multi-State Plan",31274WV031,,WVN201,WVS201,WVF201,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbswv.com/sbc/bcbswv.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westvirginia,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0310001-01,Standard Gold On Exchange Plan,,0.78404176235199,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WV,31274,OPM,5,2014-11-24 15:19:06,1,31274,WV,Individual,No,55-0624615,31274WV0310001,"Blue Cross Blue Shield Shared Cost 1500, a Multi-State Plan",31274WV031,,WVN201,WVS201,WVF201,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbswv.com/sbc/bcbswv.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westvirginia,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0310001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,WV,31274,OPM,5,2014-11-24 15:19:06,1,31274,WV,Individual,No,55-0624615,31274WV0310001,"Blue Cross Blue Shield Shared Cost 1500, a Multi-State Plan",31274WV031,,WVN201,WVS201,WVF201,Existing,PPO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbswv.com/sbc/bcbswv.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/westvirginia,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0310001-03,Limited Cost Sharing Plan Variation,,0.78404176235199,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,AR,13285,SERFF,2,2014-09-09 16:12:42,1,13285,AR,SHOP (Small Group),Yes,36-0883760,13285AR0040002,EHB High PPO,13285AR004,,ARN001,ARS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.66,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,13285AR0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,13285,SERFF,2,2014-09-09 16:12:42,1,13285,AR,SHOP (Small Group),Yes,36-0883760,13285AR0040001,EHB Low PPO,13285AR004,,ARN001,ARS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$8.83,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,13285AR0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AR,13285,SERFF,2,2014-09-09 16:12:42,1,13285,AR,SHOP (Small Group),Yes,36-0883760,13285AR0030002,EHB High Passive,13285AR003,,ARN001,ARS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.25,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,13285AR0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AR,13285,SERFF,2,2014-09-09 16:12:42,1,13285,AR,SHOP (Small Group),Yes,36-0883760,13285AR0030001,EHB Low Passive,13285AR003,,ARN001,ARS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$10.79,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,13285AR0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AR,15995,SERFF,3,2014-11-13 16:11:17,1,15995,AR,Individual,Yes,47-0397286,15995AR0040001,"Delta Dental Individual, EHB Certified",15995AR004,,ARN001,ARS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.55,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,15995AR0040001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,15995,SERFF,3,2014-11-13 16:11:17,1,15995,AR,Individual,Yes,47-0397286,15995AR0040002,"Delta Dental Individual, EHB Certified",15995AR004,,ARN001,ARS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.31,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,15995AR0040002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AR,25093,SERFF,2,2014-09-09 16:12:42,1,25093,AR,SHOP (Small Group),Yes,44-0308260,25093AR0010001,KCL EHB Low PPO,25093AR001,,ARN001,ARS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$33.67,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,25093AR0010001-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,25093,SERFF,2,2014-09-09 16:12:42,1,25093,AR,SHOP (Small Group),Yes,44-0308260,25093AR0010003,KCL EHB Low MAC,25093AR001,,ARN001,ARS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$25.35,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,25093AR0010003-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AR,25093,SERFF,2,2014-09-09 16:12:42,1,25093,AR,SHOP (Small Group),Yes,44-0308260,25093AR0010005,KCL Fam Low PPO,25093AR001,,ARN001,ARS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$33.67,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,25093AR0010005-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AR,25093,SERFF,2,2014-09-09 16:12:42,1,25093,AR,SHOP (Small Group),Yes,44-0308260,25093AR0010007,KCL Fam Low MAC,25093AR001,,ARN001,ARS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$25.35,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,25093AR0010007-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AR,25093,SERFF,2,2014-09-09 16:12:42,2,25093,AR,SHOP (Small Group),Yes,44-0308260,25093AR0010002,KCL EHB High PPO,25093AR001,,ARN001,ARS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$39.82,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,25093AR0010002-00,Standard High Off Exchange Plan,83.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,25093,SERFF,2,2014-09-09 16:12:42,2,25093,AR,SHOP (Small Group),Yes,44-0308260,25093AR0010004,KCL EHB High MAC,25093AR001,,ARN001,ARS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$30.44,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,25093AR0010004-00,Standard High Off Exchange Plan,83.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AR,25093,SERFF,2,2014-09-09 16:12:42,2,25093,AR,SHOP (Small Group),Yes,44-0308260,25093AR0010006,KCL Fam High PPO,25093AR001,,ARN001,ARS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$39.82,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,25093AR0010006-00,Standard High Off Exchange Plan,83.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AR,25093,SERFF,2,2014-09-09 16:12:42,2,25093,AR,SHOP (Small Group),Yes,44-0308260,25093AR0010008,KCL Fam High MAC,25093AR001,,ARN001,ARS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$30.44,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,25093AR0010008-00,Standard High Off Exchange Plan,83.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,1,26904,AR,Individual,Yes,95-6042390,26904AR0020001,BESTOne Child Dental Plus,26904AR002,,ARN001,ARS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$34.93,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BESTOne_Child_Dental_Plus_Plan.pdf,,26904AR0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,1,26904,AR,SHOP (Small Group),Yes,95-6042390,26904AR0010001,BEST Life Child Dental Plus,26904AR001,,ARN001,ARS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$27.95,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BEST_Life_Child_Dental_Plus_Plan.pdf,,26904AR0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,2,26904,AR,SHOP (Small Group),Yes,95-6042390,26904AR0010002,BEST Life Child Dental,26904AR001,,ARN001,ARS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$23.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BEST_Life_Child_Dental_Plan.pdf,,26904AR0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,2,26904,AR,Individual,Yes,95-6042390,26904AR0020002,BESTOne Child Dental,26904AR002,,ARN001,ARS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$29.57,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BESTOne_Child_Dental_Plan.pdf,,26904AR0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,3,26904,AR,Individual,Yes,95-6042390,26904AR0020003,BESTOne Dental Advantage-Gold,26904AR002,,ARN001,ARS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.93,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BESTOne_Dental_Advantage-Gold_Plan.pdf,,26904AR0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,3,26904,AR,SHOP (Small Group),Yes,95-6042390,26904AR0010007,BEST Dental Premium,26904AR001,,ARN001,ARS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.95,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BESTDental_Premium_Plan.pdf,,26904AR0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,3,26904,AR,SHOP (Small Group),Yes,95-6042390,26904AR0010007,BEST Dental Premium,26904AR001,,ARN001,ARS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.95,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BESTDental_Premium_Plan.pdf,,26904AR0010007-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,3,26904,AR,Individual,Yes,95-6042390,26904AR0020003,BESTOne Dental Advantage-Gold,26904AR002,,ARN001,ARS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.93,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BESTOne_Dental_Advantage-Gold_Plan.pdf,,26904AR0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,3,26904,AR,Individual,Yes,95-6042390,26904AR0020004,BESTOne Dental Plus-Gold,26904AR002,,ARN001,ARS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.93,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BESTOne_Dental_Plus-Gold_Plan.pdf,,26904AR0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,3,26904,AR,SHOP (Small Group),Yes,95-6042390,26904AR0010008,BEST Dental Standard-H,26904AR001,,ARN001,ARS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.95,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BESTDental_Standard-H_Plan.pdf,,26904AR0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,3,26904,AR,SHOP (Small Group),Yes,95-6042390,26904AR0010008,BEST Dental Standard-H,26904AR001,,ARN001,ARS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.95,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BESTDental_Standard-H_Plan.pdf,,26904AR0010008-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,3,26904,AR,Individual,Yes,95-6042390,26904AR0020004,BESTOne Dental Plus-Gold,26904AR002,,ARN001,ARS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.93,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BESTOne_Dental_Plus-Gold_Plan.pdf,,26904AR0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,3,26904,AR,SHOP (Small Group),Yes,95-6042390,26904AR0010010,BEST Dental Choice-H,26904AR001,,ARN001,ARS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.95,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BESTDental_Choice-H_Plan.pdf,,26904AR0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,3,26904,AR,SHOP (Small Group),Yes,95-6042390,26904AR0010010,BEST Dental Choice-H,26904AR001,,ARN001,ARS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.95,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BESTDental_Choice-H_Plan.pdf,,26904AR0010010-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,4,26904,AR,Individual,Yes,95-6042390,26904AR0020005,BESTOne Dental Plus-Silver,26904AR002,,ARN001,ARS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.57,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BESTOne_Dental_Plus-Silver_Plan.pdf,,26904AR0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,4,26904,AR,SHOP (Small Group),Yes,95-6042390,26904AR0010009,BEST Dental Standard-L,26904AR001,,ARN001,ARS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BESTDental_Standard-L_Plan.pdf,,26904AR0010009-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,4,26904,AR,SHOP (Small Group),Yes,95-6042390,26904AR0010009,BEST Dental Standard-L,26904AR001,,ARN001,ARS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BESTDental_Standard-L_Plan.pdf,,26904AR0010009-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,4,26904,AR,Individual,Yes,95-6042390,26904AR0020005,BESTOne Dental Plus-Silver,26904AR002,,ARN001,ARS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.57,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BESTOne_Dental_Plus-Silver_Plan.pdf,,26904AR0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,4,26904,AR,Individual,Yes,95-6042390,26904AR0020006,BESTOne Dental Basic-Silver,26904AR002,,ARN001,ARS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.57,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BESTOne_Dental_Basic-Silver_Plan.pdf,,26904AR0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,4,26904,AR,SHOP (Small Group),Yes,95-6042390,26904AR0010011,BEST Dental Choice-L,26904AR001,,ARN001,ARS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BESTDental_Choice-L_Plan.pdf,,26904AR0010011-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,4,26904,AR,SHOP (Small Group),Yes,95-6042390,26904AR0010011,BEST Dental Choice-L,26904AR001,,ARN001,ARS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BESTDental_Choice-L_Plan.pdf,,26904AR0010011-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,4,26904,AR,Individual,Yes,95-6042390,26904AR0020006,BESTOne Dental Basic-Silver,26904AR002,,ARN001,ARS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.57,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BESTOne_Dental_Basic-Silver_Plan.pdf,,26904AR0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,4,26904,AR,SHOP (Small Group),Yes,95-6042390,26904AR0010012,BEST Dental Value,26904AR001,,ARN001,ARS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BESTDental_Value_Plan.pdf,,26904AR0010012-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,AR,26904,SERFF,3,2014-09-09 16:12:42,4,26904,AR,SHOP (Small Group),Yes,95-6042390,26904AR0010012,BEST Dental Value,26904AR001,,ARN001,ARS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/AR/2015/AR_BESTDental_Value_Plan.pdf,,26904AR0010012-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,AR,28348,SERFF,5,2014-11-13 16:11:17,1,28348,AR,Individual,Yes,71-0561140,28348AR0090001,Delta Dental Pediatric Silver Plan,28348AR009,,ARN001,ARS001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$18.08,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address,Yes,Claims will be paid based on In Network fee level and out of network benefit levels.,Yes,http://deltadentalar.com/Shop/aca-individual-and-family-plans,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348,http://deltadentalar.com/Shop/aca-individual-and-family-plans,,28348AR0090001-01,Standard Low On Exchange Plan,70.00%,,,,Yes,30%,70%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$50,,$50,$50,,$50,$50,$50,$50,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,28348,SERFF,5,2014-11-13 16:11:17,1,28348,AR,SHOP (Small Group),Yes,71-0561140,28348AR0150001,Delta Dental Pediatric Silver Plan,28348AR015,,ARN001,ARS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$21.02,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address,Yes,Claims will be paid based on In Network fee level and out of network benefit levels.,Yes,,,,,28348AR0150001-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,30%,70%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$50,,$50,$50,,$50,$50,$50,$50,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,28348,SERFF,5,2014-11-13 16:11:17,1,28348,AR,SHOP (Small Group),Yes,71-0561140,28348AR0140001,Delta Dental Pediatric Silver Plan,28348AR014,,ARN002,ARS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$21.76,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address,Yes,Claims will be paid based on In Network fee level and out of network benefit levels.,Yes,,,,,28348AR0140001-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,30%,70%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$50,,$50,$50,,$50,$50,$50,$50,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AR,28348,SERFF,5,2014-11-13 16:11:17,1,28348,AR,Individual,Yes,71-0561140,28348AR0110001,Delta Dental Pediatric Silver Plan,28348AR011,,ARN001,ARS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$21.21,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address,Yes,Claims will be paid based on In Network fee level and out of network benefit levels.,Yes,http://deltadentalar.com/Shop/aca-individual-and-family-plans,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348,http://deltadentalar.com/Shop/aca-individual-and-family-plans,,28348AR0110001-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,30%,70%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$50,,$50,$50,,$50,$50,$50,$50,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AR,28348,SERFF,5,2014-11-13 16:11:17,1,28348,AR,SHOP (Small Group),Yes,71-0561140,28348AR0150019,Delta Dental Pediatric Silver Plan,28348AR015,,ARN001,ARS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$0.00,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address,Yes,Claims will be paid based on In Network fee level and out of network benefit levels.,Yes,,,,,28348AR0150019-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,30%,70%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$50,,$50,$50,,$50,$50,$50,$50,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AR,28348,SERFF,5,2014-11-13 16:11:17,1,28348,AR,SHOP (Small Group),Yes,71-0561140,28348AR0140019,Delta Dental Pediatric Silver Plan,28348AR014,,ARN002,ARS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$0.00,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address,Yes,Claims will be paid based on In Network fee level and out of network benefit levels.,Yes,,,,,28348AR0140019-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,30%,70%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$50,,$50,$50,,$50,$50,$50,$50,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AR,28348,SERFF,5,2014-11-13 16:11:17,2,28348,AR,SHOP (Small Group),Yes,71-0561140,28348AR0150002,Delta Dental Pediatric Gold Plan,28348AR015,,ARN001,ARS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.98,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address,Yes,Claims will be paid based on In Network fee level and out of network benefit levels.,Yes,,,,,28348AR0150002-00,Standard High Off Exchange Plan,85.00%,,,,Yes,30%,70%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,28348,SERFF,5,2014-11-13 16:11:17,2,28348,AR,Individual,Yes,71-0561140,28348AR0090002,Delta Dental Pediatric Gold Plan,28348AR009,,ARN001,ARS001,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$21.15,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address,Yes,Claims will be paid based on In Network fee level and out of network benefit levels.,Yes,http://deltadentalar.com/Shop/aca-individual-and-family-plans,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348,http://deltadentalar.com/Shop/aca-individual-and-family-plans,,28348AR0090002-01,Standard High On Exchange Plan,85.00%,,,,Yes,30%,70%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,28348,SERFF,5,2014-11-13 16:11:17,2,28348,AR,Individual,Yes,71-0561140,28348AR0110002,Delta Dental Pediatric Gold Plan,28348AR011,,ARN001,ARS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.00,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address,Yes,Claims will be paid based on In Network fee level and out of network benefit levels.,Yes,http://deltadentalar.com/Shop/aca-individual-and-family-plans,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348,http://deltadentalar.com/Shop/aca-individual-and-family-plans,,28348AR0110002-00,Standard High Off Exchange Plan,85.00%,,,,Yes,30%,70%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AR,28348,SERFF,5,2014-11-13 16:11:17,3,28348,AR,Individual,Yes,71-0561140,28348AR0120001,Delta Dental Family Silver Plan,28348AR012,,ARN001,ARS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.21,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address,Yes,Claims will be paid based on In Network fee level and out of network benefit levels.,Yes,http://deltadentalar.com/Shop/aca-individual-and-family-plans,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348,http://deltadentalar.com/Shop/aca-individual-and-family-plans,,28348AR0120001-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,30%,70%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$50,,$50,$50,,$50,$50,$50,$50,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AR,28348,SERFF,5,2014-11-13 16:11:17,4,28348,AR,Individual,Yes,71-0561140,28348AR0100002,Delta Dental Family Gold Plan,28348AR010,,ARN001,ARS001,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.15,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address,Yes,Claims will be paid based on In Network fee level and out of network benefit levels.,Yes,http://deltadentalar.com/Shop/aca-individual-and-family-plans,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348,http://deltadentalar.com/Shop/aca-individual-and-family-plans,,28348AR0100002-01,Standard High On Exchange Plan,85.00%,,,,Yes,30%,70%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,28348,SERFF,5,2014-11-13 16:11:17,4,28348,AR,Individual,Yes,71-0561140,28348AR0120002,Delta Dental Family Gold Plan,28348AR012,,ARN001,ARS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.00,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address,Yes,Claims will be paid based on In Network fee level and out of network benefit levels.,Yes,http://deltadentalar.com/Shop/aca-individual-and-family-plans,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348,http://deltadentalar.com/Shop/aca-individual-and-family-plans,,28348AR0120002-00,Standard High Off Exchange Plan,85.00%,,,,Yes,30%,70%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AR,28448,SERFF,2,2014-09-09 16:12:42,1,28448,AR,SHOP (Small Group),Yes,57-0523959,28448AR0010001,Group Pediatric Dental EHB Rider,28448AR001,,ARN001,ARS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$23.99,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,28448AR0010001-00,Standard High Off Exchange Plan,83.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,28448,SERFF,2,2014-09-09 16:12:42,1,28448,AR,SHOP (Small Group),Yes,57-0523959,28448AR0010002,Group Pediatric Dental EHB Rider,28448AR001,,ARN001,ARS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$19.65,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,28448AR0010002-00,Standard Low Off Exchange Plan,68.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AR,28448,SERFF,2,2014-09-09 16:12:42,2,28448,AR,SHOP (Small Group),Yes,57-0523959,28448AR0020001,Group Pediatric Dental EHB Policy,28448AR002,,ARN001,ARS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$27.16,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,28448AR0020001-00,Standard High Off Exchange Plan,83.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070003,Silver,37903AR007,,ARN001,ARS003,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070003-05,87% AV Level Silver Plan,,0.860203385353088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,$600,$400,$200,$500,$900,$100,$80,23
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070003,Silver,37903AR007,,ARN001,ARS003,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070003-06,94% AV Level Silver Plan,,0.94902229309082,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$754,"$1,508",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$300,$300,$200,$200,$500,$80,$80,24
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070005,Silver,37903AR007,,ARN001,ARS005,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070005-01,Standard Silver On Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,33
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070005,Silver,37903AR007,,ARN001,ARS005,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,34
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070005,Silver,37903AR007,,ARN001,ARS005,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070005-03,Limited Cost Sharing Plan Variation,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,35
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070005,Silver,37903AR007,,ARN001,ARS005,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070005-04,73% AV Level Silver Plan,,0.725960195064545,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$600,$900,$200,"$1,400","$1,300",$0,$80,36
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070005,Silver,37903AR007,,ARN001,ARS005,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070005-05,87% AV Level Silver Plan,,0.860203385353088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,$600,$400,$200,$500,$900,$100,$80,37
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070005,Silver,37903AR007,,ARN001,ARS005,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070005-06,94% AV Level Silver Plan,,0.94902229309082,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$754,"$1,508",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$300,$300,$200,$200,$500,$80,$80,38
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070006,Silver,37903AR007,,ARN001,ARS006,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070006-00,Standard Silver Off Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,39
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070006,Silver,37903AR007,,ARN001,ARS006,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070006-01,Standard Silver On Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,40
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070006,Silver,37903AR007,,ARN001,ARS006,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,41
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070006,Silver,37903AR007,,ARN001,ARS006,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070006-03,Limited Cost Sharing Plan Variation,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,42
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070006,Silver,37903AR007,,ARN001,ARS006,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070006-04,73% AV Level Silver Plan,,0.725960195064545,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$600,$900,$200,"$1,400","$1,300",$0,$80,43
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070006,Silver,37903AR007,,ARN001,ARS006,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070006-05,87% AV Level Silver Plan,,0.860203385353088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,$600,$400,$200,$500,$900,$100,$80,44
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070006,Silver,37903AR007,,ARN001,ARS006,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070006-06,94% AV Level Silver Plan,,0.94902229309082,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$754,"$1,508",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$300,$300,$200,$200,$500,$80,$80,45
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070007,Silver,37903AR007,,ARN001,ARS007,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070007-00,Standard Silver Off Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,46
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070007,Silver,37903AR007,,ARN001,ARS007,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070007-01,Standard Silver On Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,47
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070007,Silver,37903AR007,,ARN001,ARS007,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,48
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070007,Silver,37903AR007,,ARN001,ARS007,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070007-03,Limited Cost Sharing Plan Variation,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,49
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070007,Silver,37903AR007,,ARN001,ARS007,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070007-04,73% AV Level Silver Plan,,0.725960195064545,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$600,$900,$200,"$1,400","$1,300",$0,$80,50
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070007,Silver,37903AR007,,ARN001,ARS007,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070007-05,87% AV Level Silver Plan,,0.860203385353088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,$600,$400,$200,$500,$900,$100,$80,51
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,1,37903,AR,Individual,No,71-0386640,37903AR0070007,Silver,37903AR007,,ARN001,ARS007,ARF001,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070007-06,94% AV Level Silver Plan,,0.94902229309082,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$754,"$1,508",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$300,$300,$200,$200,$500,$80,$80,52
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070008,Gold 2000,37903AR007,,ARN001,ARS001,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070008-00,Standard Gold Off Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,4
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070008,Gold 2000,37903AR007,,ARN001,ARS001,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070008-01,Standard Gold On Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,5
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070008,Gold 2000,37903AR007,,ARN001,ARS001,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070008,Gold 2000,37903AR007,,ARN001,ARS001,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070008-03,Limited Cost Sharing Plan Variation,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,7
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070009,Gold 2000,37903AR007,,ARN001,ARS002,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070009-00,Standard Gold Off Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,8
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070009,Gold 2000,37903AR007,,ARN001,ARS002,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070009-01,Standard Gold On Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,9
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070009,Gold 2000,37903AR007,,ARN001,ARS002,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070009-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,10
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070009,Gold 2000,37903AR007,,ARN001,ARS002,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070009-03,Limited Cost Sharing Plan Variation,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,11
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070010,Gold 2000,37903AR007,,ARN001,ARS003,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070010-00,Standard Gold Off Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,12
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070010,Gold 2000,37903AR007,,ARN001,ARS003,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070010-01,Standard Gold On Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,13
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070010,Gold 2000,37903AR007,,ARN001,ARS003,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,14
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070010,Gold 2000,37903AR007,,ARN001,ARS003,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070010-03,Limited Cost Sharing Plan Variation,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,15
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070011,Gold 2000,37903AR007,,ARN001,ARS004,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070011-00,Standard Gold Off Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,16
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070011,Gold 2000,37903AR007,,ARN001,ARS004,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070011-01,Standard Gold On Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,17
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070011,Gold 2000,37903AR007,,ARN001,ARS004,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070011-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,18
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070011,Gold 2000,37903AR007,,ARN001,ARS004,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070011-03,Limited Cost Sharing Plan Variation,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,19
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070012,Gold 2000,37903AR007,,ARN001,ARS005,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070012-00,Standard Gold Off Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,20
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070012,Gold 2000,37903AR007,,ARN001,ARS005,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070012-01,Standard Gold On Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,21
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070012,Gold 2000,37903AR007,,ARN001,ARS005,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070012-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,22
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070012,Gold 2000,37903AR007,,ARN001,ARS005,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070012-03,Limited Cost Sharing Plan Variation,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,23
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070013,Gold 2000,37903AR007,,ARN001,ARS006,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070013-00,Standard Gold Off Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,24
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070013,Gold 2000,37903AR007,,ARN001,ARS006,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070013-01,Standard Gold On Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,25
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070013,Gold 2000,37903AR007,,ARN001,ARS006,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070013-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,26
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070013,Gold 2000,37903AR007,,ARN001,ARS006,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070013-03,Limited Cost Sharing Plan Variation,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,27
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070014,Gold 2000,37903AR007,,ARN001,ARS007,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070014-00,Standard Gold Off Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,28
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070014,Gold 2000,37903AR007,,ARN001,ARS007,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070014-01,Standard Gold On Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,29
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070014,Gold 2000,37903AR007,,ARN001,ARS007,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,30
2015,AR,37903,SERFF,7,2014-11-15 10:06:04,2,37903,AR,Individual,No,71-0386640,37903AR0070014,Gold 2000,37903AR007,,ARN001,ARS007,ARF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QC-Life-Health-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,37903AR0070014-03,Limited Cost Sharing Plan Variation,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,31
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,4,62141,AR,Individual,No,06-0641618,62141AR0090003,Ambetter Balanced Care 1 + Vision,62141AR009,,ARN001,ARS001,ARF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.980650698139116,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090003-04,73% AV Level Silver Plan,,0.739648163318634,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,500","$25,000","$18,850","$37,700","$1,750","$3,500",20%,,,,"$4,000","$8,000","$6,000","$12,000",$250,$500,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,770","$1,320",$0,$150,"$2,000",$610,$110,$80,8
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,4,62141,AR,Individual,No,06-0641618,62141AR0090003,Ambetter Balanced Care 1 + Vision,62141AR009,,ARN001,ARS001,ARF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.980650698139116,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090003-05,87% AV Level Silver Plan,,0.879927635192871,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,500","$25,000","$18,850","$37,700",$250,$500,10%,,,,"$4,000","$8,000","$6,000","$12,000",$50,$100,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$270,$410,$0,$150,$300,$590,$100,$80,9
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,4,62141,AR,Individual,No,06-0641618,62141AR0090003,Ambetter Balanced Care 1 + Vision,62141AR009,,ARN001,ARS001,ARF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.980650698139116,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090003-06,94% AV Level Silver Plan,,0.949261546134949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$754,"$1,508",,,"$12,500","$25,000","$18,850","$37,700",$150,$300,0%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$150,$160,$0,$150,$150,$240,$0,$80,10
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,4,62141,AR,Individual,No,06-0641618,62141AR0090004,Ambetter Balanced Care 2 + Vision,62141AR009,,ARN001,ARS001,ARF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.980650648339799,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090004-00,Standard Silver Off Exchange Plan,,0.684876263141632,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$3,000","$6,000",20%,,,,"$6,000","$12,000","$9,000","$18,000","$1,000","$2,000",0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,11
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,4,62141,AR,Individual,No,06-0641618,62141AR0090004,Ambetter Balanced Care 2 + Vision,62141AR009,,ARN001,ARS001,ARF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.980650648339799,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090004-03,Limited Cost Sharing Plan Variation,,0.684876263141632,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$3,000","$6,000",20%,,,,"$6,000","$12,000","$9,000","$18,000","$1,000","$2,000",0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,14
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,4,62141,AR,Individual,No,06-0641618,62141AR0090004,Ambetter Balanced Care 2 + Vision,62141AR009,,ARN001,ARS001,ARF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.980650648339799,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090004-04,73% AV Level Silver Plan,,0.738831877708435,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,500","$25,000","$18,850","$37,700","$2,500","$5,000",10%,,,,"$6,000","$12,000","$7,500","$15,000",$250,$500,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,520","$1,120",$0,$150,"$2,670",$390,$0,$80,15
2015,AR,48168,SERFF,2,2014-09-09 16:12:42,1,48168,AR,SHOP (Small Group),Yes,47-0098400,48168AR0040002,EHB High PPO,48168AR004,,ARN001,ARS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.33,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,48168AR0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,48168,SERFF,2,2014-09-09 16:12:42,1,48168,AR,SHOP (Small Group),Yes,47-0098400,48168AR0040001,EHB Low PPO,48168AR004,,ARN001,ARS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$8.71,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,48168AR0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AR,48168,SERFF,2,2014-09-09 16:12:42,1,48168,AR,SHOP (Small Group),Yes,47-0098400,48168AR0030002,EHB High Passive,48168AR003,,ARN001,ARS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.92,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,48168AR0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,1,70525,AR,Individual,No,71-0794605,70525AR0070214,Catastrophic,70525AR007,,ARN001,ARS006,ARF001,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,70525AR0070036,No,"Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Catastrophic.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070214-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,300",$0,$0,$80,15
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,1,70525,AR,Individual,No,71-0794605,70525AR0070030,Catastrophic,70525AR007,,ARN001,ARS007,ARF001,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,70525AR0070036,No,"Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Catastrophic.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070030-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,300",$0,$0,$80,16
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,1,70525,AR,Individual,No,71-0794605,70525AR0070030,Catastrophic,70525AR007,,ARN001,ARS007,ARF001,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,70525AR0070036,No,"Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Catastrophic.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070030-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,300",$0,$0,$80,17
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070124,Classic Bronze 6000,70525AR007,,ARN001,ARS001,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070124-00,Standard Bronze Off Exchange Plan,,0.613058567047119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$600,$200,"$3,100",$800,$0,$80,4
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070124,Classic Bronze 6000,70525AR007,,ARN001,ARS001,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070124-01,Standard Bronze On Exchange Plan,,0.613058567047119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$600,$200,"$3,100",$800,$0,$80,5
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070124,Classic Bronze 6000,70525AR007,,ARN001,ARS001,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070124-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,5,62141,AR,Individual,No,06-0641618,62141AR0100001,Ambetter Secure Care 1 + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.942921808378015,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100001-00,Standard Gold Off Exchange Plan,,0.780103087425232,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,500","$3,000",10%,,,,"$3,000","$6,000","$4,500","$9,000","$1,000","$2,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,520",$0,$580,$150,"$2,500",$270,$90,$80,4
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,5,62141,AR,Individual,No,06-0641618,62141AR0100001,Ambetter Secure Care 1 + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.942921808378015,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100001-01,Standard Gold On Exchange Plan,,0.780103087425232,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,500","$3,000",10%,,,,"$3,000","$6,000","$4,500","$9,000","$1,000","$2,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,520",$0,$580,$150,"$2,500",$270,$90,$80,5
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070126,Classic Bronze 6000,70525AR007,,ARN001,ARS003,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070126-03,Limited Cost Sharing Plan Variation,,0.613058567047119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$600,$200,"$3,100",$800,$0,$80,15
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070127,Classic Bronze 6000,70525AR007,,ARN001,ARS004,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070127-00,Standard Bronze Off Exchange Plan,,0.613058567047119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$600,$200,"$3,100",$800,$0,$80,16
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070127,Classic Bronze 6000,70525AR007,,ARN001,ARS004,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070127-01,Standard Bronze On Exchange Plan,,0.613058567047119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$600,$200,"$3,100",$800,$0,$80,17
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070127,Classic Bronze 6000,70525AR007,,ARN001,ARS004,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070127-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,18
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,4,62141,AR,Individual,No,06-0641618,62141AR0090004,Ambetter Balanced Care 2 + Vision,62141AR009,,ARN001,ARS001,ARF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.980650648339799,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090004-01,Standard Silver On Exchange Plan,,0.684876263141632,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$3,000","$6,000",20%,,,,"$6,000","$12,000","$9,000","$18,000","$1,000","$2,000",0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,12
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,4,62141,AR,Individual,No,06-0641618,62141AR0090004,Ambetter Balanced Care 2 + Vision,62141AR009,,ARN001,ARS001,ARF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.980650648339799,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,AR,48168,SERFF,2,2014-09-09 16:12:42,1,48168,AR,SHOP (Small Group),Yes,47-0098400,48168AR0030001,EHB Low Passive,48168AR003,,ARN001,ARS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$10.64,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,48168AR0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AR,53741,SERFF,2,2014-09-09 16:12:42,1,53741,AR,SHOP (Small Group),Yes,93-0242990,53741AR0040002,EHB High PPO,53741AR004,,ARN001,ARS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.73,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,53741AR0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,53741,SERFF,2,2014-09-09 16:12:42,1,53741,AR,SHOP (Small Group),Yes,93-0242990,53741AR0040001,EHB Low PPO,53741AR004,,ARN001,ARS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$8.86,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,53741AR0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AR,53741,SERFF,2,2014-09-09 16:12:42,1,53741,AR,SHOP (Small Group),Yes,93-0242990,53741AR0030002,EHB High Passive,53741AR003,,ARN001,ARS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.33,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,53741AR0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AR,53741,SERFF,2,2014-09-09 16:12:42,1,53741,AR,SHOP (Small Group),Yes,93-0242990,53741AR0030001,EHB Low Passive,53741AR003,,ARN001,ARS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$10.82,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,53741AR0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,1,62141,AR,Individual,No,06-0641618,62141AR0080001,Ambetter Secure Care 1,62141AR008,,ARN001,ARS001,ARF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080001-00,Standard Gold Off Exchange Plan,,0.780103087425232,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,500","$3,000",10%,,,,"$3,000","$6,000","$4,500","$9,000","$1,000","$2,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,520",$0,$580,$150,"$2,500",$270,$90,$80,4
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,1,62141,AR,Individual,No,06-0641618,62141AR0080001,Ambetter Secure Care 1,62141AR008,,ARN001,ARS001,ARF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080001-01,Standard Gold On Exchange Plan,,0.780103087425232,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,500","$3,000",10%,,,,"$3,000","$6,000","$4,500","$9,000","$1,000","$2,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,520",$0,$580,$150,"$2,500",$270,$90,$80,5
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,1,62141,AR,Individual,No,06-0641618,62141AR0080001,Ambetter Secure Care 1,62141AR008,,ARN001,ARS001,ARF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,1,62141,AR,Individual,No,06-0641618,62141AR0080001,Ambetter Secure Care 1,62141AR008,,ARN001,ARS001,ARF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080001-03,Limited Cost Sharing Plan Variation,,0.780103087425232,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,500","$3,000",10%,,,,"$3,000","$6,000","$4,500","$9,000","$1,000","$2,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,520",$0,$580,$150,"$2,500",$270,$90,$80,7
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,1,62141,AR,Individual,No,06-0641618,62141AR0080002,Ambetter Secure Care 2 with 3 Free PCP Visits,62141AR008,,ARN001,ARS001,ARF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080002-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$500,"$1,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,8
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,1,62141,AR,Individual,No,06-0641618,62141AR0080002,Ambetter Secure Care 2 with 3 Free PCP Visits,62141AR008,,ARN001,ARS001,ARF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080002-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$500,"$1,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,9
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,1,62141,AR,Individual,No,06-0641618,62141AR0080002,Ambetter Secure Care 2 with 3 Free PCP Visits,62141AR008,,ARN001,ARS001,ARF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,1,62141,AR,Individual,No,06-0641618,62141AR0080002,Ambetter Secure Care 2 with 3 Free PCP Visits,62141AR008,,ARN001,ARS001,ARF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080002-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$500,"$1,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,11
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,1,62141,AR,Individual,No,06-0641618,62141AR0080005,Ambetter Essential Care 1,62141AR008,,ARN001,ARS001,ARF009,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080005-00,Standard Bronze Off Exchange Plan,,0.603424847126007,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$5,000","$10,000",40%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$5,020",$0,$900,$150,"$2,920",$860,$0,$80,12
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,1,62141,AR,Individual,No,06-0641618,62141AR0080005,Ambetter Essential Care 1,62141AR008,,ARN001,ARS001,ARF009,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080005-01,Standard Bronze On Exchange Plan,,0.603424847126007,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$5,000","$10,000",40%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$5,020",$0,$900,$150,"$2,920",$860,$0,$80,13
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,1,62141,AR,Individual,No,06-0641618,62141AR0080005,Ambetter Essential Care 1,62141AR008,,ARN001,ARS001,ARF009,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,1,62141,AR,Individual,No,06-0641618,62141AR0080005,Ambetter Essential Care 1,62141AR008,,ARN001,ARS001,ARF009,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080005-03,Limited Cost Sharing Plan Variation,,0.603424847126007,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$5,000","$10,000",40%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$5,020",$0,$900,$150,"$2,920",$860,$0,$80,15
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,1,62141,AR,Individual,No,06-0641618,62141AR0080006,Ambetter Essential Care 2 with 3 Free PCP Visits,62141AR008,,ARN001,ARS001,ARF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080006-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,16
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,1,62141,AR,Individual,No,06-0641618,62141AR0080006,Ambetter Essential Care 2 with 3 Free PCP Visits,62141AR008,,ARN001,ARS001,ARF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080006-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,17
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,1,62141,AR,Individual,No,06-0641618,62141AR0080006,Ambetter Essential Care 2 with 3 Free PCP Visits,62141AR008,,ARN001,ARS001,ARF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,1,62141,AR,Individual,No,06-0641618,62141AR0080006,Ambetter Essential Care 2 with 3 Free PCP Visits,62141AR008,,ARN001,ARS001,ARF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080006-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,19
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,2,62141,AR,Individual,No,06-0641618,62141AR0080003,Ambetter Balanced Care 1,62141AR008,,ARN001,ARS001,ARF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080003-00,Standard Silver Off Exchange Plan,,0.682594239711761,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$500,"$1,000",0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,020","$1,430",$0,$150,"$2,500",$730,$100,$80,4
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,2,62141,AR,Individual,No,06-0641618,62141AR0080003,Ambetter Balanced Care 1,62141AR008,,ARN001,ARS001,ARF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080003-01,Standard Silver On Exchange Plan,,0.682594239711761,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$500,"$1,000",0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,020","$1,430",$0,$150,"$2,500",$730,$100,$80,5
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,2,62141,AR,Individual,No,06-0641618,62141AR0080003,Ambetter Balanced Care 1,62141AR008,,ARN001,ARS001,ARF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,2,62141,AR,Individual,No,06-0641618,62141AR0080003,Ambetter Balanced Care 1,62141AR008,,ARN001,ARS001,ARF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080003-03,Limited Cost Sharing Plan Variation,,0.682594239711761,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$500,"$1,000",0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,020","$1,430",$0,$150,"$2,500",$730,$100,$80,7
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,2,62141,AR,Individual,No,06-0641618,62141AR0080003,Ambetter Balanced Care 1,62141AR008,,ARN001,ARS001,ARF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080003-04,73% AV Level Silver Plan,,0.739648163318634,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,500","$25,000","$18,850","$37,700","$1,750","$3,500",20%,,,,"$4,000","$8,000","$6,000","$12,000",$250,$500,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,770","$1,320",$0,$150,"$2,000",$610,$110,$80,8
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,2,62141,AR,Individual,No,06-0641618,62141AR0080003,Ambetter Balanced Care 1,62141AR008,,ARN001,ARS001,ARF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080003-05,87% AV Level Silver Plan,,0.879927635192871,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,500","$25,000","$18,850","$37,700",$250,$500,10%,,,,"$4,000","$8,000","$6,000","$12,000",$50,$100,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$270,$410,$0,$150,$300,$590,$100,$80,9
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,2,62141,AR,Individual,No,06-0641618,62141AR0080003,Ambetter Balanced Care 1,62141AR008,,ARN001,ARS001,ARF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080003-06,94% AV Level Silver Plan,,0.949261546134949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$754,"$1,508",,,"$12,500","$25,000","$18,850","$37,700",$150,$300,0%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$150,$160,$0,$150,$150,$240,$0,$80,10
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,2,62141,AR,Individual,No,06-0641618,62141AR0080004,Ambetter Balanced Care 2,62141AR008,,ARN001,ARS001,ARF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080004-00,Standard Silver Off Exchange Plan,,0.684876263141632,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$3,000","$6,000",20%,,,,"$6,000","$12,000","$9,000","$18,000","$1,000","$2,000",0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,11
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,2,62141,AR,Individual,No,06-0641618,62141AR0080004,Ambetter Balanced Care 2,62141AR008,,ARN001,ARS001,ARF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080004-01,Standard Silver On Exchange Plan,,0.684876263141632,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$3,000","$6,000",20%,,,,"$6,000","$12,000","$9,000","$18,000","$1,000","$2,000",0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,12
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,2,62141,AR,Individual,No,06-0641618,62141AR0080004,Ambetter Balanced Care 2,62141AR008,,ARN001,ARS001,ARF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,2,62141,AR,Individual,No,06-0641618,62141AR0080004,Ambetter Balanced Care 2,62141AR008,,ARN001,ARS001,ARF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080004-03,Limited Cost Sharing Plan Variation,,0.684876263141632,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$3,000","$6,000",20%,,,,"$6,000","$12,000","$9,000","$18,000","$1,000","$2,000",0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,14
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,2,62141,AR,Individual,No,06-0641618,62141AR0080004,Ambetter Balanced Care 2,62141AR008,,ARN001,ARS001,ARF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080004-04,73% AV Level Silver Plan,,0.738831877708435,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,500","$25,000","$18,850","$37,700","$2,500","$5,000",10%,,,,"$6,000","$12,000","$7,500","$15,000",$250,$500,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,520","$1,120",$0,$150,"$2,670",$390,$0,$80,15
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,2,62141,AR,Individual,No,06-0641618,62141AR0080004,Ambetter Balanced Care 2,62141AR008,,ARN001,ARS001,ARF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080004-05,87% AV Level Silver Plan,,0.877011597156525,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,500","$25,000","$18,850","$37,700",$500,"$1,000",5%,,,,"$6,000","$12,000","$1,500","$3,000",$100,$200,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$520,$410,$0,$150,$600,$520,$50,$80,16
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,2,62141,AR,Individual,No,06-0641618,62141AR0080004,Ambetter Balanced Care 2,62141AR008,,ARN001,ARS001,ARF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.999871545758153,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0080004-06,94% AV Level Silver Plan,,0.949261546134949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$754,"$1,508",,,"$12,500","$25,000","$18,850","$37,700",$150,$300,0%,,,,"$6,000","$12,000",$450,$900,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$150,$160,$0,$150,$150,$240,$0,$80,17
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,3,62141,AR,Individual,No,06-0641618,62141AR0090001,Ambetter Secure Care 1 + Vision,62141AR009,,ARN001,ARS001,ARF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982930316596711,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090001-00,Standard Gold Off Exchange Plan,,0.780103087425232,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,500","$3,000",10%,,,,"$3,000","$6,000","$4,500","$9,000","$1,000","$2,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,520",$0,$580,$150,"$2,500",$270,$90,$80,4
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,3,62141,AR,Individual,No,06-0641618,62141AR0090001,Ambetter Secure Care 1 + Vision,62141AR009,,ARN001,ARS001,ARF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982930316596711,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090001-01,Standard Gold On Exchange Plan,,0.780103087425232,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,500","$3,000",10%,,,,"$3,000","$6,000","$4,500","$9,000","$1,000","$2,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,520",$0,$580,$150,"$2,500",$270,$90,$80,5
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,3,62141,AR,Individual,No,06-0641618,62141AR0090001,Ambetter Secure Care 1 + Vision,62141AR009,,ARN001,ARS001,ARF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982930316596711,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,3,62141,AR,Individual,No,06-0641618,62141AR0090001,Ambetter Secure Care 1 + Vision,62141AR009,,ARN001,ARS001,ARF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982930316596711,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090001-03,Limited Cost Sharing Plan Variation,,0.780103087425232,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,500","$3,000",10%,,,,"$3,000","$6,000","$4,500","$9,000","$1,000","$2,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,520",$0,$580,$150,"$2,500",$270,$90,$80,7
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,3,62141,AR,Individual,No,06-0641618,62141AR0090002,Ambetter Secure Care 2 with 3 Free PCP Visits + Vision,62141AR009,,ARN001,ARS001,ARF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982930316596711,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090002-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$500,"$1,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,8
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,3,62141,AR,Individual,No,06-0641618,62141AR0090002,Ambetter Secure Care 2 with 3 Free PCP Visits + Vision,62141AR009,,ARN001,ARS001,ARF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.982930316596711,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090002-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$500,"$1,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,9
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,3,62141,AR,Individual,No,06-0641618,62141AR0090005,Ambetter Essential Care 1 + Vision,62141AR009,,ARN001,ARS001,ARF009,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.983241660268527,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,3,62141,AR,Individual,No,06-0641618,62141AR0090005,Ambetter Essential Care 1 + Vision,62141AR009,,ARN001,ARS001,ARF009,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.983241660268527,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090005-03,Limited Cost Sharing Plan Variation,,0.603424847126007,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$5,000","$10,000",40%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$5,020",$0,$900,$150,"$2,920",$860,$0,$80,15
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,3,62141,AR,Individual,No,06-0641618,62141AR0090006,Ambetter Essential Care 2 with 3 Free PCP Visits + Vision,62141AR009,,ARN001,ARS001,ARF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.983241660268527,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090006-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,16
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,3,62141,AR,Individual,No,06-0641618,62141AR0090006,Ambetter Essential Care 2 with 3 Free PCP Visits + Vision,62141AR009,,ARN001,ARS001,ARF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.983241660268527,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090006-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,17
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,3,62141,AR,Individual,No,06-0641618,62141AR0090006,Ambetter Essential Care 2 with 3 Free PCP Visits + Vision,62141AR009,,ARN001,ARS001,ARF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.983241660268527,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,3,62141,AR,Individual,No,06-0641618,62141AR0090006,Ambetter Essential Care 2 with 3 Free PCP Visits + Vision,62141AR009,,ARN001,ARS001,ARF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.983241660268527,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090006-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,19
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,4,62141,AR,Individual,No,06-0641618,62141AR0090003,Ambetter Balanced Care 1 + Vision,62141AR009,,ARN001,ARS001,ARF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.980650698139116,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090003-00,Standard Silver Off Exchange Plan,,0.682594239711761,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$500,"$1,000",0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,020","$1,430",$0,$150,"$2,500",$730,$100,$80,4
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,4,62141,AR,Individual,No,06-0641618,62141AR0090003,Ambetter Balanced Care 1 + Vision,62141AR009,,ARN001,ARS001,ARF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.980650698139116,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090003-01,Standard Silver On Exchange Plan,,0.682594239711761,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$500,"$1,000",0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,020","$1,430",$0,$150,"$2,500",$730,$100,$80,5
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,1,70525,AR,Individual,No,71-0794605,70525AR0070209,Catastrophic,70525AR007,,ARN001,ARS005,ARF001,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,70525AR0070036,No,"Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Catastrophic.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070209-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,300",$0,$0,$80,13
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,1,70525,AR,Individual,No,71-0794605,70525AR0070214,Catastrophic,70525AR007,,ARN001,ARS006,ARF001,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,70525AR0070036,No,"Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Catastrophic.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070214-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,300",$0,$0,$80,14
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,4,62141,AR,Individual,No,06-0641618,62141AR0090004,Ambetter Balanced Care 2 + Vision,62141AR009,,ARN001,ARS001,ARF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.980650648339799,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090004-05,87% AV Level Silver Plan,,0.877011597156525,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,500","$25,000","$18,850","$37,700",$500,"$1,000",5%,,,,"$6,000","$12,000","$1,500","$3,000",$100,$200,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$520,$410,$0,$150,$600,$520,$50,$80,16
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,4,62141,AR,Individual,No,06-0641618,62141AR0090004,Ambetter Balanced Care 2 + Vision,62141AR009,,ARN001,ARS001,ARF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.980650648339799,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0090004-06,94% AV Level Silver Plan,,0.949261546134949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$754,"$1,508",,,"$12,500","$25,000","$18,850","$37,700",$150,$300,0%,,,,"$6,000","$12,000",$450,$900,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$150,$160,$0,$150,$150,$240,$0,$80,17
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070127,Classic Bronze 6000,70525AR007,,ARN001,ARS004,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070127-03,Limited Cost Sharing Plan Variation,,0.613058567047119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$600,$200,"$3,100",$800,$0,$80,19
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070128,Classic Bronze 6000,70525AR007,,ARN001,ARS005,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070128-00,Standard Bronze Off Exchange Plan,,0.613058567047119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$600,$200,"$3,100",$800,$0,$80,20
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070128,Classic Bronze 6000,70525AR007,,ARN001,ARS005,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070128-01,Standard Bronze On Exchange Plan,,0.613058567047119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$600,$200,"$3,100",$800,$0,$80,21
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070128,Classic Bronze 6000,70525AR007,,ARN001,ARS005,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070128-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,22
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070128,Classic Bronze 6000,70525AR007,,ARN001,ARS005,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070128-03,Limited Cost Sharing Plan Variation,,0.613058567047119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$600,$200,"$3,100",$800,$0,$80,23
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070129,Classic Bronze 6000,70525AR007,,ARN001,ARS006,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070129-00,Standard Bronze Off Exchange Plan,,0.613058567047119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$600,$200,"$3,100",$800,$0,$80,24
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070130,Classic Bronze 6000,70525AR007,,ARN001,ARS007,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070130-01,Standard Bronze On Exchange Plan,,0.613058567047119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$600,$200,"$3,100",$800,$0,$80,29
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070130,Classic Bronze 6000,70525AR007,,ARN001,ARS007,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070130-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,30
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,5,62141,AR,Individual,No,06-0641618,62141AR0100001,Ambetter Secure Care 1 + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.942921808378015,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,5,62141,AR,Individual,No,06-0641618,62141AR0100001,Ambetter Secure Care 1 + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.942921808378015,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100001-03,Limited Cost Sharing Plan Variation,,0.780103087425232,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,500","$3,000",10%,,,,"$3,000","$6,000","$4,500","$9,000","$1,000","$2,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,520",$0,$580,$150,"$2,500",$270,$90,$80,7
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,5,62141,AR,Individual,No,06-0641618,62141AR0100002,Ambetter Secure Care 2 with 3 Free PCP Visits + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.942921808378015,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100002-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$500,"$1,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,8
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,5,62141,AR,Individual,No,06-0641618,62141AR0100002,Ambetter Secure Care 2 with 3 Free PCP Visits + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.942921808378015,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100002-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$500,"$1,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,9
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,5,62141,AR,Individual,No,06-0641618,62141AR0100002,Ambetter Secure Care 2 with 3 Free PCP Visits + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.942921808378015,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,5,62141,AR,Individual,No,06-0641618,62141AR0100002,Ambetter Secure Care 2 with 3 Free PCP Visits + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.942921808378015,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100002-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$500,"$1,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,11
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070129,Classic Bronze 6000,70525AR007,,ARN001,ARS006,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070129-01,Standard Bronze On Exchange Plan,,0.613058567047119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$600,$200,"$3,100",$800,$0,$80,25
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070129,Classic Bronze 6000,70525AR007,,ARN001,ARS006,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070129-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,26
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070129,Classic Bronze 6000,70525AR007,,ARN001,ARS006,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070129-03,Limited Cost Sharing Plan Variation,,0.613058567047119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$600,$200,"$3,100",$800,$0,$80,27
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070130,Classic Bronze 6000,70525AR007,,ARN001,ARS007,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070130-00,Standard Bronze Off Exchange Plan,,0.613058567047119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$600,$200,"$3,100",$800,$0,$80,28
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,5,62141,AR,Individual,No,06-0641618,62141AR0100005,Ambetter Essential Care 1 + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF009,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94394470941586,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100005-00,Standard Bronze Off Exchange Plan,,0.603424847126007,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$5,000","$10,000",40%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$5,020",$0,$900,$150,"$2,920",$860,$0,$80,12
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,5,62141,AR,Individual,No,06-0641618,62141AR0100005,Ambetter Essential Care 1 + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF009,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94394470941586,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100005-01,Standard Bronze On Exchange Plan,,0.603424847126007,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$5,000","$10,000",40%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$5,020",$0,$900,$150,"$2,920",$860,$0,$80,13
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,5,62141,AR,Individual,No,06-0641618,62141AR0100005,Ambetter Essential Care 1 + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF009,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94394470941586,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,5,62141,AR,Individual,No,06-0641618,62141AR0100005,Ambetter Essential Care 1 + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF009,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94394470941586,,$350,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100005-03,Limited Cost Sharing Plan Variation,,0.603424847126007,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$5,000","$10,000",40%,,,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,000",30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$5,020",$0,$900,$150,"$2,920",$860,$0,$80,15
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,5,62141,AR,Individual,No,06-0641618,62141AR0100006,Ambetter Essential Care 2 with 3 Free PCP Visits + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94394470941586,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100006-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,16
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,5,62141,AR,Individual,No,06-0641618,62141AR0100006,Ambetter Essential Care 2 with 3 Free PCP Visits + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94394470941586,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100006-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,17
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,5,62141,AR,Individual,No,06-0641618,62141AR0100006,Ambetter Essential Care 2 with 3 Free PCP Visits + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94394470941586,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,5,62141,AR,Individual,No,06-0641618,62141AR0100006,Ambetter Essential Care 2 with 3 Free PCP Visits + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF011,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94394470941586,,$350,0,3,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100006-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,19
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070015,Classic Silver,70525AR007,,ARN001,ARS003,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070015-03,Limited Cost Sharing Plan Variation,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,21
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070015,Classic Silver,70525AR007,,ARN001,ARS003,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070015-04,73% AV Level Silver Plan,,0.725960195064545,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$600,$900,$200,"$1,400","$1,300",$0,$80,22
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070015,Classic Silver,70525AR007,,ARN001,ARS003,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070015-05,87% AV Level Silver Plan,,0.860203385353088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,$600,$400,$200,$500,$900,$100,$80,23
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070015,Classic Silver,70525AR007,,ARN001,ARS003,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070015-06,94% AV Level Silver Plan,,0.94902229309082,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$754,"$1,508",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$300,$300,$200,$200,$500,$80,$80,24
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070021,Classic Silver,70525AR007,,ARN001,ARS004,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070021-00,Standard Silver Off Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,25
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070021,Classic Silver,70525AR007,,ARN001,ARS004,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070021-01,Standard Silver On Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,26
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,6,62141,AR,Individual,No,06-0641618,62141AR0100003,Ambetter Balanced Care 1 + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935635292218774,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100003-00,Standard Silver Off Exchange Plan,,0.682594239711761,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$500,"$1,000",0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,020","$1,430",$0,$150,"$2,500",$730,$100,$80,4
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,6,62141,AR,Individual,No,06-0641618,62141AR0100003,Ambetter Balanced Care 1 + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935635292218774,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100003-01,Standard Silver On Exchange Plan,,0.682594239711761,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$500,"$1,000",0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,020","$1,430",$0,$150,"$2,500",$730,$100,$80,5
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,6,62141,AR,Individual,No,06-0641618,62141AR0100003,Ambetter Balanced Care 1 + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935635292218774,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,6,62141,AR,Individual,No,06-0641618,62141AR0100003,Ambetter Balanced Care 1 + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935635292218774,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100003-03,Limited Cost Sharing Plan Variation,,0.682594239711761,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$500,"$1,000",0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,020","$1,430",$0,$150,"$2,500",$730,$100,$80,7
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,6,62141,AR,Individual,No,06-0641618,62141AR0100003,Ambetter Balanced Care 1 + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935635292218774,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100003-04,73% AV Level Silver Plan,,0.739648163318634,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,500","$25,000","$18,850","$37,700","$1,750","$3,500",20%,,,,"$4,000","$8,000","$6,000","$12,000",$250,$500,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,770","$1,320",$0,$150,"$2,000",$610,$110,$80,8
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,6,62141,AR,Individual,No,06-0641618,62141AR0100003,Ambetter Balanced Care 1 + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935635292218774,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100003-05,87% AV Level Silver Plan,,0.879927635192871,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,500","$25,000","$18,850","$37,700",$250,$500,10%,,,,"$4,000","$8,000","$6,000","$12,000",$50,$100,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$270,$410,$0,$150,$300,$590,$100,$80,9
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,6,62141,AR,Individual,No,06-0641618,62141AR0100003,Ambetter Balanced Care 1 + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935635292218774,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100003-06,94% AV Level Silver Plan,,0.949261546134949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$754,"$1,508",,,"$12,500","$25,000","$18,850","$37,700",$150,$300,0%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$150,$160,$0,$150,$150,$240,$0,$80,10
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,6,62141,AR,Individual,No,06-0641618,62141AR0100004,Ambetter Balanced Care 2 + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935635244154845,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100004-00,Standard Silver Off Exchange Plan,,0.684876263141632,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$3,000","$6,000",20%,,,,"$6,000","$12,000","$9,000","$18,000","$1,000","$2,000",0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,11
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,6,62141,AR,Individual,No,06-0641618,62141AR0100004,Ambetter Balanced Care 2 + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935635244154845,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100004-01,Standard Silver On Exchange Plan,,0.684876263141632,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$3,000","$6,000",20%,,,,"$6,000","$12,000","$9,000","$18,000","$1,000","$2,000",0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,12
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,6,62141,AR,Individual,No,06-0641618,62141AR0100004,Ambetter Balanced Care 2 + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935635244154845,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,6,62141,AR,Individual,No,06-0641618,62141AR0100004,Ambetter Balanced Care 2 + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935635244154845,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100004-03,Limited Cost Sharing Plan Variation,,0.684876263141632,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$3,000","$6,000",20%,,,,"$6,000","$12,000","$9,000","$18,000","$1,000","$2,000",0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$3,020","$1,000",$0,$150,"$3,420",$270,$0,$80,14
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,6,62141,AR,Individual,No,06-0641618,62141AR0100004,Ambetter Balanced Care 2 + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935635244154845,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100004-04,73% AV Level Silver Plan,,0.738831877708435,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,500","$25,000","$18,850","$37,700","$2,500","$5,000",10%,,,,"$6,000","$12,000","$7,500","$15,000",$250,$500,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,520","$1,120",$0,$150,"$2,670",$390,$0,$80,15
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070027,Classic Silver,70525AR007,,ARN001,ARS007,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070027-01,Standard Silver On Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,47
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070027,Classic Silver,70525AR007,,ARN001,ARS007,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070027-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,48
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,6,62141,AR,Individual,No,06-0641618,62141AR0100004,Ambetter Balanced Care 2 + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935635244154845,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100004-05,87% AV Level Silver Plan,,0.877011597156525,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,500","$25,000","$18,850","$37,700",$500,"$1,000",5%,,,,"$6,000","$12,000","$1,500","$3,000",$100,$200,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$520,$410,$0,$150,$600,$520,$50,$80,16
2015,AR,62141,SERFF,4,2015-02-22 21:18:17,6,62141,AR,Individual,No,06-0641618,62141AR0100004,Ambetter Balanced Care 2 + Vision + Adult Dental,62141AR010,,ARN001,ARS001,ARF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.935635244154845,,,0,0,0,2015-01-01,,No,,Yes,PPO Plan - out of network limitations apply,No,http://ambetter.ambetterofarkansas.com/benefits,http://ambetter.ambetterofarkansas.com/payments,http://ambetter.ambetterofarkansas.com/ourplans,http://ambetter.ambetterofarkansas.com/formulary,62141AR0100004-06,94% AV Level Silver Plan,,0.949261546134949,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$754,"$1,508",,,"$12,500","$25,000","$18,850","$37,700",$150,$300,0%,,,,"$6,000","$12,000",$450,$900,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$150,$160,$0,$150,$150,$240,$0,$80,17
2015,AR,67635,SERFF,2,2014-09-09 16:12:42,1,67635,AR,SHOP (Small Group),Yes,35-0472300,67635AR0010001,Lincoln Dental Connect?,67635AR001,,ARN001,ARS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.48,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,67635AR0010001-00,Standard High Off Exchange Plan,83.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,67635,SERFF,2,2014-09-09 16:12:42,1,67635,AR,SHOP (Small Group),Yes,35-0472300,67635AR0010002,Lincoln Dental Connect?,67635AR001,,ARN001,ARS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.89,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,67635AR0010002-00,Standard Low Off Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AR,67635,SERFF,2,2014-09-09 16:12:42,1,67635,AR,SHOP (Small Group),Yes,35-0472300,67635AR0010003,Lincoln Dental Connect?,67635AR001,,ARN001,ARS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.33,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,67635AR0010003-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AR,67635,SERFF,2,2014-09-09 16:12:42,1,67635,AR,SHOP (Small Group),Yes,35-0472300,67635AR0010005,Lincoln Dental Connect?,67635AR001,,ARN001,ARS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.24,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,67635AR0010005-00,Standard High Off Exchange Plan,83.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AR,67635,SERFF,2,2014-09-09 16:12:42,1,67635,AR,SHOP (Small Group),Yes,35-0472300,67635AR0010006,Lincoln Dental Connect?,67635AR001,,ARN001,ARS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.26,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,67635AR0010006-00,Standard Low Off Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,AR,67635,SERFF,2,2014-09-09 16:12:42,1,67635,AR,SHOP (Small Group),Yes,35-0472300,67635AR0010007,Lincoln Dental Connect?,67635AR001,,ARN001,ARS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.92,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,67635AR0010007-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,AR,67635,SERFF,2,2014-09-09 16:12:42,2,67635,AR,SHOP (Small Group),Yes,35-0472300,67635AR0010004,Lincoln Dental Connect?,67635AR001,,ARN001,ARS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.10,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,67635AR0010004-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,67635,SERFF,2,2014-09-09 16:12:42,2,67635,AR,SHOP (Small Group),Yes,35-0472300,67635AR0010008,Lincoln Dental Connect?,67635AR001,,ARN001,ARS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.25,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,67635AR0010008-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,1,70525,AR,Individual,No,71-0794605,70525AR0070006,Catastrophic,70525AR007,,ARN001,ARS001,ARF001,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,70525AR0070042,No,"Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Catastrophic.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070006-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,300",$0,$0,$80,4
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,1,70525,AR,Individual,No,71-0794605,70525AR0070006,Catastrophic,70525AR007,,ARN001,ARS001,ARF001,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,70525AR0070042,No,"Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Catastrophic.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070006-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,300",$0,$0,$80,5
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,1,70525,AR,Individual,No,71-0794605,70525AR0070012,Catastrophic,70525AR007,,ARN001,ARS002,ARF001,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,70525AR0070036,No,"Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Catastrophic.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070012-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,300",$0,$0,$80,6
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,1,70525,AR,Individual,No,71-0794605,70525AR0070012,Catastrophic,70525AR007,,ARN001,ARS002,ARF001,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,70525AR0070036,No,"Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Catastrophic.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070012-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,300",$0,$0,$80,7
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,1,70525,AR,Individual,No,71-0794605,70525AR0070018,Catastrophic,70525AR007,,ARN001,ARS003,ARF001,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,70525AR0070036,No,"Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Catastrophic.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070018-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,300",$0,$0,$80,8
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,1,70525,AR,Individual,No,71-0794605,70525AR0070018,Catastrophic,70525AR007,,ARN001,ARS003,ARF001,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,70525AR0070036,No,"Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Catastrophic.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070018-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,300",$0,$0,$80,9
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,1,70525,AR,Individual,No,71-0794605,70525AR0070024,Catastrophic,70525AR007,,ARN001,ARS004,ARF001,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,70525AR0070036,No,"Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Catastrophic.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070024-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,300",$0,$0,$80,10
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,1,70525,AR,Individual,No,71-0794605,70525AR0070024,Catastrophic,70525AR007,,ARN001,ARS004,ARF001,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,70525AR0070036,No,"Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Catastrophic.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070024-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,300",$0,$0,$80,11
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,1,70525,AR,Individual,No,71-0794605,70525AR0070209,Catastrophic,70525AR007,,ARN001,ARS005,ARF001,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,70525AR0070036,No,"Diabetes, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Catastrophic.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070209-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,300",$0,$0,$80,12
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070124,Classic Bronze 6000,70525AR007,,ARN001,ARS001,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070124-03,Limited Cost Sharing Plan Variation,,0.613058567047119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$600,$200,"$3,100",$800,$0,$80,7
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070125,Classic Bronze 6000,70525AR007,,ARN001,ARS002,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070125-00,Standard Bronze Off Exchange Plan,,0.613058567047119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$600,$200,"$3,100",$800,$0,$80,8
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070125,Classic Bronze 6000,70525AR007,,ARN001,ARS002,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070125-01,Standard Bronze On Exchange Plan,,0.613058567047119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$600,$200,"$3,100",$800,$0,$80,9
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070125,Classic Bronze 6000,70525AR007,,ARN001,ARS002,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070125-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,10
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070125,Classic Bronze 6000,70525AR007,,ARN001,ARS002,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070125-03,Limited Cost Sharing Plan Variation,,0.613058567047119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$600,$200,"$3,100",$800,$0,$80,11
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070126,Classic Bronze 6000,70525AR007,,ARN001,ARS003,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070126-00,Standard Bronze Off Exchange Plan,,0.613058567047119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$600,$200,"$3,100",$800,$0,$80,12
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070126,Classic Bronze 6000,70525AR007,,ARN001,ARS003,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070126-01,Standard Bronze On Exchange Plan,,0.613058567047119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$600,$200,"$3,100",$800,$0,$80,13
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070126,Classic Bronze 6000,70525AR007,,ARN001,ARS003,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070126-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,14
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,2,70525,AR,Individual,No,71-0794605,70525AR0070130,Classic Bronze 6000,70525AR007,,ARN001,ARS007,ARF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Bronze-6000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070130-03,Limited Cost Sharing Plan Variation,,0.613058567047119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",50%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$600,$200,"$3,100",$800,$0,$80,31
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070003,Classic Silver,70525AR007,,ARN001,ARS001,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070003-00,Standard Silver Off Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,4
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070003,Classic Silver,70525AR007,,ARN001,ARS001,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070003-01,Standard Silver On Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,5
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070003,Classic Silver,70525AR007,,ARN001,ARS001,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070003,Classic Silver,70525AR007,,ARN001,ARS001,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070003-03,Limited Cost Sharing Plan Variation,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,7
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070003,Classic Silver,70525AR007,,ARN001,ARS001,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070003-04,73% AV Level Silver Plan,,0.725960195064545,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$600,$900,$200,"$1,400","$1,300",$0,$80,8
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070003,Classic Silver,70525AR007,,ARN001,ARS001,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070003-05,87% AV Level Silver Plan,,0.860203385353088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,$600,$400,$200,$500,$900,$100,$80,9
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070003,Classic Silver,70525AR007,,ARN001,ARS001,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070003-06,94% AV Level Silver Plan,,0.94902229309082,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$754,"$1,508",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$300,$300,$200,$200,$500,$80,$80,10
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070009,Classic Silver,70525AR007,,ARN001,ARS002,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070009-00,Standard Silver Off Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,11
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070009,Classic Silver,70525AR007,,ARN001,ARS002,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070009-01,Standard Silver On Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,12
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070009,Classic Silver,70525AR007,,ARN001,ARS002,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,13
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070009,Classic Silver,70525AR007,,ARN001,ARS002,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070009-03,Limited Cost Sharing Plan Variation,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,14
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070009,Classic Silver,70525AR007,,ARN001,ARS002,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070009-04,73% AV Level Silver Plan,,0.725960195064545,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$600,$900,$200,"$1,400","$1,300",$0,$80,15
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070009,Classic Silver,70525AR007,,ARN001,ARS002,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070009-05,87% AV Level Silver Plan,,0.860203385353088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,$600,$400,$200,$500,$900,$100,$80,16
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070009,Classic Silver,70525AR007,,ARN001,ARS002,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070009-06,94% AV Level Silver Plan,,0.94902229309082,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$754,"$1,508",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$300,$300,$200,$200,$500,$80,$80,17
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070015,Classic Silver,70525AR007,,ARN001,ARS003,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070015-00,Standard Silver Off Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,18
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070015,Classic Silver,70525AR007,,ARN001,ARS003,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070015-01,Standard Silver On Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,19
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070015,Classic Silver,70525AR007,,ARN001,ARS003,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070015-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,20
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070021,Classic Silver,70525AR007,,ARN001,ARS004,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070021-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,27
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070021,Classic Silver,70525AR007,,ARN001,ARS004,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070021-03,Limited Cost Sharing Plan Variation,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,28
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070021,Classic Silver,70525AR007,,ARN001,ARS004,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070021-04,73% AV Level Silver Plan,,0.725960195064545,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$600,$900,$200,"$1,400","$1,300",$0,$80,29
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070021,Classic Silver,70525AR007,,ARN001,ARS004,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070021-05,87% AV Level Silver Plan,,0.860203385353088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,$600,$400,$200,$500,$900,$100,$80,30
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070021,Classic Silver,70525AR007,,ARN001,ARS004,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070021-06,94% AV Level Silver Plan,,0.94902229309082,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$754,"$1,508",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$300,$300,$200,$200,$500,$80,$80,31
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070160,Classic Silver,70525AR007,,ARN001,ARS005,ARF003,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070160-00,Standard Silver Off Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,32
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070160,Classic Silver,70525AR007,,ARN001,ARS005,ARF003,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070160-01,Standard Silver On Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,33
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070160,Classic Silver,70525AR007,,ARN001,ARS005,ARF003,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070160-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,34
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070160,Classic Silver,70525AR007,,ARN001,ARS005,ARF003,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070160-03,Limited Cost Sharing Plan Variation,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,35
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070160,Classic Silver,70525AR007,,ARN001,ARS005,ARF003,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070160-04,73% AV Level Silver Plan,,0.725960195064545,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$600,$900,$200,"$1,400","$1,300",$0,$80,36
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070160,Classic Silver,70525AR007,,ARN001,ARS005,ARF003,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070160-05,87% AV Level Silver Plan,,0.860203385353088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,$600,$400,$200,$500,$900,$100,$80,37
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070160,Classic Silver,70525AR007,,ARN001,ARS005,ARF003,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070160-06,94% AV Level Silver Plan,,0.94902229309082,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$754,"$1,508",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$300,$300,$200,$200,$500,$80,$80,38
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070161,Classic Silver,70525AR007,,ARN001,ARS006,ARF003,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070161-00,Standard Silver Off Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,39
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070161,Classic Silver,70525AR007,,ARN001,ARS006,ARF003,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070161-01,Standard Silver On Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,40
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070161,Classic Silver,70525AR007,,ARN001,ARS006,ARF003,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070161-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,41
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070161,Classic Silver,70525AR007,,ARN001,ARS006,ARF003,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070161-03,Limited Cost Sharing Plan Variation,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,42
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070161,Classic Silver,70525AR007,,ARN001,ARS006,ARF003,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070161-04,73% AV Level Silver Plan,,0.725960195064545,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$600,$900,$200,"$1,400","$1,300",$0,$80,43
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070161,Classic Silver,70525AR007,,ARN001,ARS006,ARF003,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070161-05,87% AV Level Silver Plan,,0.860203385353088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,$600,$400,$200,$500,$900,$100,$80,44
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070161,Classic Silver,70525AR007,,ARN001,ARS006,ARF003,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070161-06,94% AV Level Silver Plan,,0.94902229309082,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$754,"$1,508",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$300,$300,$200,$200,$500,$80,$80,45
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070027,Classic Silver,70525AR007,,ARN001,ARS007,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070027-00,Standard Silver Off Exchange Plan,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,46
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070027,Classic Silver,70525AR007,,ARN001,ARS007,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070027-03,Limited Cost Sharing Plan Variation,,0.695800125598907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$600,"$1,200",$200,"$1,400","$1,300",$0,$80,49
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070027,Classic Silver,70525AR007,,ARN001,ARS007,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070027-04,73% AV Level Silver Plan,,0.725960195064545,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$600,$900,$200,"$1,400","$1,300",$0,$80,50
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070027,Classic Silver,70525AR007,,ARN001,ARS007,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070027-05,87% AV Level Silver Plan,,0.860203385353088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,$600,$400,$200,$500,$900,$100,$80,51
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,3,70525,AR,Individual,No,71-0794605,70525AR0070027,Classic Silver,70525AR007,,ARN001,ARS007,ARF003,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Silver.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070027-06,94% AV Level Silver Plan,,0.94902229309082,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$754,"$1,508",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$300,$300,$200,$200,$500,$80,$80,52
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070050,Classic Gold 2000,70525AR007,,ARN001,ARS001,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070050-00,Standard Gold Off Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,4
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070050,Classic Gold 2000,70525AR007,,ARN001,ARS001,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070050-01,Standard Gold On Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,5
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070050,Classic Gold 2000,70525AR007,,ARN001,ARS001,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070050-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070050,Classic Gold 2000,70525AR007,,ARN001,ARS001,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070050-03,Limited Cost Sharing Plan Variation,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,7
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070059,Classic Gold 2000,70525AR007,,ARN001,ARS002,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070059-00,Standard Gold Off Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,8
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070059,Classic Gold 2000,70525AR007,,ARN001,ARS002,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070059-01,Standard Gold On Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,9
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070059,Classic Gold 2000,70525AR007,,ARN001,ARS002,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070059-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,10
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070059,Classic Gold 2000,70525AR007,,ARN001,ARS002,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070059-03,Limited Cost Sharing Plan Variation,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,11
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070068,Classic Gold 2000,70525AR007,,ARN001,ARS003,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070068-00,Standard Gold Off Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,12
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070068,Classic Gold 2000,70525AR007,,ARN001,ARS003,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070068-01,Standard Gold On Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,13
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070068,Classic Gold 2000,70525AR007,,ARN001,ARS003,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070068-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,14
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070068,Classic Gold 2000,70525AR007,,ARN001,ARS003,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070068-03,Limited Cost Sharing Plan Variation,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,15
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070077,Classic Gold 2000,70525AR007,,ARN001,ARS004,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070077-00,Standard Gold Off Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,16
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070077,Classic Gold 2000,70525AR007,,ARN001,ARS004,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070077-01,Standard Gold On Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,17
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070077,Classic Gold 2000,70525AR007,,ARN001,ARS004,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070077-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,18
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070077,Classic Gold 2000,70525AR007,,ARN001,ARS004,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070077-03,Limited Cost Sharing Plan Variation,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,19
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070086,Classic Gold 2000,70525AR007,,ARN001,ARS005,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070086-00,Standard Gold Off Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,20
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070086,Classic Gold 2000,70525AR007,,ARN001,ARS005,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070086-01,Standard Gold On Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,21
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070086,Classic Gold 2000,70525AR007,,ARN001,ARS005,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070086-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,22
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070086,Classic Gold 2000,70525AR007,,ARN001,ARS005,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070086-03,Limited Cost Sharing Plan Variation,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,23
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070095,Classic Gold 2000,70525AR007,,ARN001,ARS006,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070095-00,Standard Gold Off Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,24
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070095,Classic Gold 2000,70525AR007,,ARN001,ARS006,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070095-01,Standard Gold On Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,25
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070095,Classic Gold 2000,70525AR007,,ARN001,ARS006,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070095-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,26
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070095,Classic Gold 2000,70525AR007,,ARN001,ARS006,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070095-03,Limited Cost Sharing Plan Variation,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,27
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070104,Classic Gold 2000,70525AR007,,ARN001,ARS007,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070104-00,Standard Gold Off Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,28
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070104,Classic Gold 2000,70525AR007,,ARN001,ARS007,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070104-01,Standard Gold On Exchange Plan,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,29
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070104,Classic Gold 2000,70525AR007,,ARN001,ARS007,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070104-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,30
2015,AR,70525,SERFF,3,2014-11-15 10:06:04,4,70525,AR,Individual,No,71-0794605,70525AR0070104,Classic Gold 2000,70525AR007,,ARN001,ARS007,ARF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.qualchoice.com/!userfiles/pdfs/Indv-2015-Plans/Classic-Gold-2000.pdf,,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/2015-QualChoice-Marketplace-Plans.pdf,https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary_2015.pdf,70525AR0070104-03,Limited Cost Sharing Plan Variation,,0.780182182788849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$0,"$1,500",$200,"$1,400","$1,000",$0,$80,31
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,1,75293,AR,Individual,No,71-0226428,75293AR0260001,Gold 1000,75293AR026,7427051652,ARN001,ARS001,ARF007,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=30001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0260001-00,Standard Gold Off Exchange Plan,,0.783204436302185,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,1,75293,AR,SHOP (Small Group),No,71-0226428,75293AR0510001,SHOP Bronze 3000,75293AR051,7427051652,ARN001,ARS001,ARF001,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.996738729606493,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefits reduction for medical care,Yes,https://secure.arkansasbluecross.com/employers/sbc.aspx,https://secure.arkansasbluecross.com/exchange/payment/group.aspx,http://www.arkansasbluecross.com/lookingforinsurance/smallgroupplans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0510001-00,Standard Bronze Off Exchange Plan,,0.617272973060608,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",40%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,1,75293,AR,Individual,Yes,71-0226428,75293AR0400001,Pediatric Dental,75293AR040,7427051652,ARN002,ARS002,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$28.07,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefit reduction for dental care,Yes,,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D,,75293AR0400001-00,Standard High Off Exchange Plan,85.90%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$20,$40,,,,,$20,$40,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,1,75293,AR,SHOP (Small Group),Yes,71-0226428,75293AR0940001,SHOP Dental-Pediatric,75293AR094,7427051652,ARN001,ARS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$18.53,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefit reduction for dental care,Yes,,https://secure.arkansasbluecross.com/exchange/payment/group.aspx,,,75293AR0940001-01,Standard Low On Exchange Plan,70.60%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$100,,,,,$50,$100,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,1,75293,AR,Individual,Yes,71-0226428,75293AR0400001,Pediatric Dental,75293AR040,7427051652,ARN002,ARS002,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$28.07,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefit reduction for dental care,Yes,,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D,,75293AR0400001-01,Standard High On Exchange Plan,85.90%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$20,$40,,,,,$20,$40,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,1,75293,AR,SHOP (Small Group),No,71-0226428,75293AR0510001,SHOP Bronze 3000,75293AR051,7427051652,ARN001,ARS001,ARF001,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.996738729606493,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefits reduction for medical care,Yes,https://secure.arkansasbluecross.com/employers/sbc.aspx,https://secure.arkansasbluecross.com/exchange/payment/group.aspx,http://www.arkansasbluecross.com/lookingforinsurance/smallgroupplans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0510001-01,Standard Bronze On Exchange Plan,,0.617272973060608,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",40%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,1,75293,AR,Individual,No,71-0226428,75293AR0260001,Gold 1000,75293AR026,7427051652,ARN001,ARS001,ARF007,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=30001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0260001-01,Standard Gold On Exchange Plan,,0.783204436302185,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,1,75293,AR,Individual,No,71-0226428,75293AR0260001,Gold 1000,75293AR026,7427051652,ARN001,ARS001,ARF007,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=30001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0260001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,1,75293,AR,Individual,No,71-0226428,75293AR0260001,Gold 1000,75293AR026,7427051652,ARN001,ARS001,ARF007,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=30001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0260001-03,Limited Cost Sharing Plan Variation,,0.783204436302185,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,2,75293,AR,Individual,No,71-0226428,75293AR0250001,Gold 500,75293AR025,7427051652,ARN001,ARS001,ARF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=28001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0250001-00,Standard Gold Off Exchange Plan,,0.818483948707581,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$7,600","$15,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,2,75293,AR,SHOP (Small Group),No,71-0226428,75293AR0500001,SHOP Silver 2000-1,75293AR050,7427051652,ARN001,ARS001,ARF001,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.996738729606493,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefits reduction for medical care,Yes,https://secure.arkansasbluecross.com/employers/sbc.aspx,https://secure.arkansasbluecross.com/exchange/payment/group.aspx,http://www.arkansasbluecross.com/lookingforinsurance/smallgroupplans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0500001-00,Standard Silver Off Exchange Plan,,0.706937372684479,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,2,75293,AR,SHOP (Small Group),Yes,71-0226428,75293AR0970001,Small Group Dental-Pediatric,75293AR097,7427051652,ARN002,ARS002,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$3.91,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefit Reduction for dental care,Yes,,https://secure.arkansasbluecross.com/exchange/payment/group.aspx,,,75293AR0970001-00,Standard Low Off Exchange Plan,70.60%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$100,,,,,$50,$100,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,2,75293,AR,Individual,Yes,71-0226428,75293AR0410001,Dental Gold,75293AR041,7427051652,ARN002,ARS002,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.07,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefit reduction for dental care,Yes,,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D,,75293AR0410001-00,Standard High Off Exchange Plan,85.90%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$20,$40,,,,,$20,$40,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,2,75293,AR,Individual,Yes,71-0226428,75293AR0410001,Dental Gold,75293AR041,7427051652,ARN002,ARS002,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.07,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefit reduction for dental care,Yes,,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D,,75293AR0410001-01,Standard High On Exchange Plan,85.90%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$20,$40,,,,,$20,$40,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,2,75293,AR,SHOP (Small Group),No,71-0226428,75293AR0500001,SHOP Silver 2000-1,75293AR050,7427051652,ARN001,ARS001,ARF001,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.996738729606493,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefits reduction for medical care,Yes,https://secure.arkansasbluecross.com/employers/sbc.aspx,https://secure.arkansasbluecross.com/exchange/payment/group.aspx,http://www.arkansasbluecross.com/lookingforinsurance/smallgroupplans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0500001-01,Standard Silver On Exchange Plan,,0.706937372684479,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,2,75293,AR,Individual,No,71-0226428,75293AR0250001,Gold 500,75293AR025,7427051652,ARN001,ARS001,ARF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=28001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0250001-01,Standard Gold On Exchange Plan,,0.818483948707581,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$7,600","$15,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,2,75293,AR,Individual,No,71-0226428,75293AR0250001,Gold 500,75293AR025,7427051652,ARN001,ARS001,ARF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=28001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0250001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,2,75293,AR,Individual,Yes,71-0226428,75293AR0420001,Dental Gold Plus Vision,75293AR042,7427051652,ARN002,ARS002,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.07,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefit reduction for dental care,Yes,,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D,,75293AR0420001-00,Standard High Off Exchange Plan,85.90%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$20,$40,,,,,$20,$40,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,2,75293,AR,Individual,Yes,71-0226428,75293AR0420001,Dental Gold Plus Vision,75293AR042,7427051652,ARN002,ARS002,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.07,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefit reduction for dental care,Yes,,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D,,75293AR0420001-01,Standard High On Exchange Plan,85.90%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$20,$40,,,,,$20,$40,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,2,75293,AR,Individual,No,71-0226428,75293AR0250001,Gold 500,75293AR025,7427051652,ARN001,ARS001,ARF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=28001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0250001-03,Limited Cost Sharing Plan Variation,,0.818483948707581,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$7,600","$15,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,3,75293,AR,Individual,No,71-0226428,75293AR0320001,Catastrophic,75293AR032,7427051652,ARN001,ARS001,ARF052,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=27001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0320001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,7,75293,AR,Individual,No,71-0226428,75293AR1180001,Silver 1500,75293AR118,7427051652,ARN001,ARS001,ARF010,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32019?,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR1180001-04,73% AV Level Silver Plan,,0.739061534404755,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",25%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,7,75293,AR,Individual,No,71-0226428,75293AR1180001,Silver 1500,75293AR118,7427051652,ARN001,ARS001,ARF010,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32019?,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR1180001-05,87% AV Level Silver Plan,,0.867011308670044,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",25%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,7,75293,AR,Individual,No,71-0226428,75293AR1180001,Silver 1500,75293AR118,7427051652,ARN001,ARS001,ARF010,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32019?,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR1180001-06,94% AV Level Silver Plan,,0.936518430709839,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,8,75293,AR,Individual,No,71-0226428,75293AR0270001,Silver 2500,75293AR027,7427051652,ARN001,ARS001,ARF024,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9983,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0270001-00,Standard Silver Off Exchange Plan,,0.718243658542633,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,8,75293,AR,Individual,No,71-0226428,75293AR0270001,Silver 2500,75293AR027,7427051652,ARN001,ARS001,ARF024,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9983,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0270001-01,Standard Silver On Exchange Plan,,0.718243658542633,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,8,75293,AR,Individual,No,71-0226428,75293AR0270001,Silver 2500,75293AR027,7427051652,ARN001,ARS001,ARF024,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9983,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0270001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,8,75293,AR,Individual,No,71-0226428,75293AR0270001,Silver 2500,75293AR027,7427051652,ARN001,ARS001,ARF024,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9983,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0270001-03,Limited Cost Sharing Plan Variation,,0.718243658542633,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,8,75293,AR,Individual,No,71-0226428,75293AR0270001,Silver 2500,75293AR027,7427051652,ARN001,ARS001,ARF024,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9983,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0270001-04,73% AV Level Silver Plan,,0.739495098590851,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,600","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,8,75293,AR,Individual,No,71-0226428,75293AR0270001,Silver 2500,75293AR027,7427051652,ARN001,ARS001,ARF024,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9983,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0270001-05,87% AV Level Silver Plan,,0.875786900520325,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$12,600","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,8,75293,AR,Individual,No,71-0226428,75293AR0270001,Silver 2500,75293AR027,7427051652,ARN001,ARS001,ARF024,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9983,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0270001-06,94% AV Level Silver Plan,,0.94826328754425,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$754,"$1,508",,,"$12,600","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,8,75293,AR,Individual,No,71-0226428,75293AR0280001,Silver 3500,75293AR028,7427051652,ARN001,ARS001,ARF032,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9983,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32007,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0280001-06,94% AV Level Silver Plan,,0.94826328754425,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$754,"$1,508",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,DE,19005,SERFF,4,2014-10-06 10:59:03,1,19005,DE,SHOP (Small Group),Yes,93-0242990,19005DE0040002,EHB High PPO,19005DE004,,DEN001,DES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$50.09,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,19005DE0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,19005,SERFF,4,2014-10-06 10:59:03,1,19005,DE,SHOP (Small Group),Yes,93-0242990,19005DE0040001,EHB Low PPO,19005DE004,,DEN001,DES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.51,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,19005DE0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,1,67190,DE,Individual,No,23-2169745,67190DE0080001,Aetna Bronze $20 Copay HNOnly,67190DE008,,DEN001,DES001,DEF001,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080001-00,Standard Bronze Off Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,1,67190,DE,Individual,No,23-2169745,67190DE0080001,Aetna Bronze $20 Copay HNOnly,67190DE008,,DEN001,DES001,DEF001,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080001-01,Standard Bronze On Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,1,67190,DE,Individual,No,23-2169745,67190DE0080001,Aetna Bronze $20 Copay HNOnly,67190DE008,,DEN001,DES001,DEF001,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,1,67190,DE,Individual,No,23-2169745,67190DE0080001,Aetna Bronze $20 Copay HNOnly,67190DE008,,DEN001,DES001,DEF001,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080001-03,Limited Cost Sharing Plan Variation,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,2,67190,DE,SHOP (Small Group),No,23-2169745,67190DE0070001,DE Bronze HNOnly 5700 100% HSA,67190DE007,,DEN001,DES001,DEF030,New,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998518563306999,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1549988715,67190DE0070001-00,Standard Bronze Off Exchange Plan,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,700","$11,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,700","$11,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,2,67190,DE,SHOP (Small Group),No,23-2169745,67190DE0070001,DE Bronze HNOnly 5700 100% HSA,67190DE007,,DEN001,DES001,DEF030,New,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998518563306999,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1549988715,67190DE0070001-01,Standard Bronze On Exchange Plan,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,700","$11,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,700","$11,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,3,75293,AR,SHOP (Small Group),No,71-0226428,75293AR0450001,SHOP Gold 1500,75293AR045,7427051652,ARN001,ARS001,ARF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.996738729606493,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Coinsurance reduction for medical care,Yes,https://secure.arkansasbluecross.com/employers/sbc.aspx,https://secure.arkansasbluecross.com/exchange/payment/group.aspx,http://www.arkansasbluecross.com/lookingforinsurance/smallgroupplans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0450001-00,Standard Gold Off Exchange Plan,,0.783279776573181,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,3,75293,AR,Individual,Yes,71-0226428,75293AR0430001,Dental Silver,75293AR043,7427051652,ARN002,ARS002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.23,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefit reduction for dental care,Yes,,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D,,75293AR0430001-00,Standard Low Off Exchange Plan,70.60%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$100,,,,,$50,$100,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,3,75293,AR,Individual,Yes,71-0226428,75293AR0430001,Dental Silver,75293AR043,7427051652,ARN002,ARS002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.23,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefit reduction for dental care,Yes,,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D,,75293AR0430001-01,Standard Low On Exchange Plan,70.60%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$100,,,,,$50,$100,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,3,75293,AR,SHOP (Small Group),No,71-0226428,75293AR0450001,SHOP Gold 1500,75293AR045,7427051652,ARN001,ARS001,ARF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.996738729606493,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Coinsurance reduction for medical care,Yes,https://secure.arkansasbluecross.com/employers/sbc.aspx,https://secure.arkansasbluecross.com/exchange/payment/group.aspx,http://www.arkansasbluecross.com/lookingforinsurance/smallgroupplans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0450001-01,Standard Gold On Exchange Plan,,0.783279776573181,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,3,75293,AR,Individual,No,71-0226428,75293AR0320001,Catastrophic,75293AR032,7427051652,ARN001,ARS001,ARF052,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=27001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0320001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,4,75293,AR,Individual,No,71-0226428,75293AR0370001,Bronze 5500,75293AR037,7427051652,ARN001,ARS001,ARF046,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23002,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0370001-00,Standard Bronze Off Exchange Plan,,0.618733704090118,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,8,75293,AR,Individual,No,71-0226428,75293AR0280001,Silver 3500,75293AR028,7427051652,ARN001,ARS001,ARF032,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9983,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32007,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0280001-00,Standard Silver Off Exchange Plan,,0.70938903093338,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,8,75293,AR,Individual,No,71-0226428,75293AR0280001,Silver 3500,75293AR028,7427051652,ARN001,ARS001,ARF032,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9983,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32007,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0280001-01,Standard Silver On Exchange Plan,,0.70938903093338,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,8,75293,AR,Individual,No,71-0226428,75293AR0280001,Silver 3500,75293AR028,7427051652,ARN001,ARS001,ARF032,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9983,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32007,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0280001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,8,75293,AR,Individual,No,71-0226428,75293AR0280001,Silver 3500,75293AR028,7427051652,ARN001,ARS001,ARF032,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9983,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32007,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0280001-03,Limited Cost Sharing Plan Variation,,0.70938903093338,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,8,75293,AR,Individual,No,71-0226428,75293AR0280001,Silver 3500,75293AR028,7427051652,ARN001,ARS001,ARF032,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9983,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32007,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0280001-04,73% AV Level Silver Plan,,0.735491275787354,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,8,75293,AR,Individual,No,71-0226428,75293AR0280001,Silver 3500,75293AR028,7427051652,ARN001,ARS001,ARF032,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9983,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32007,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0280001-05,87% AV Level Silver Plan,,0.875786900520325,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,4,75293,AR,Individual,No,71-0226428,75293AR0370001,Bronze 5500,75293AR037,7427051652,ARN001,ARS001,ARF046,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23002,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0370001-01,Standard Bronze On Exchange Plan,,0.618733704090118,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,4,75293,AR,Individual,No,71-0226428,75293AR0370001,Bronze 5500,75293AR037,7427051652,ARN001,ARS001,ARF046,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23002,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0370001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,4,75293,AR,Individual,No,71-0226428,75293AR0370001,Bronze 5500,75293AR037,7427051652,ARN001,ARS001,ARF046,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23002,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0370001-03,Limited Cost Sharing Plan Variation,,0.618733704090118,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",50%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,5,75293,AR,Individual,No,71-0226428,75293AR0310001,Bronze 6300,75293AR031,7427051652,ARN001,ARS001,ARF049,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=25001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0310001-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,5,75293,AR,Individual,No,71-0226428,75293AR0310001,Bronze 6300,75293AR031,7427051652,ARN001,ARS001,ARF049,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=25001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0310001-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,5,75293,AR,Individual,No,71-0226428,75293AR0310001,Bronze 6300,75293AR031,7427051652,ARN001,ARS001,ARF049,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=25001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0310001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,5,75293,AR,Individual,No,71-0226428,75293AR0310001,Bronze 6300,75293AR031,7427051652,ARN001,ARS001,ARF049,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=25001,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0310001-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,6,75293,AR,Individual,No,71-0226428,75293AR0300001,Bronze 6200,75293AR030,7427051652,ARN001,ARS001,ARF043,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23003,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0300001-00,Standard Bronze Off Exchange Plan,,0.619811832904816,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,200","$12,400",30%,,,,"$12,400","$24,800",Not Applicable,Not Applicable,,,,,,,,,4
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,6,75293,AR,Individual,No,71-0226428,75293AR0300001,Bronze 6200,75293AR030,7427051652,ARN001,ARS001,ARF043,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23003,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0300001-01,Standard Bronze On Exchange Plan,,0.619811832904816,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,200","$12,400",30%,,,,"$12,400","$24,800",Not Applicable,Not Applicable,,,,,,,,,5
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,6,75293,AR,Individual,No,71-0226428,75293AR0300001,Bronze 6200,75293AR030,7427051652,ARN001,ARS001,ARF043,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23003,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0300001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,6,75293,AR,Individual,No,71-0226428,75293AR0300001,Bronze 6200,75293AR030,7427051652,ARN001,ARS001,ARF043,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23003,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR0300001-03,Limited Cost Sharing Plan Variation,,0.619811832904816,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,200","$12,400",30%,,,,"$12,400","$24,800",Not Applicable,Not Applicable,,,,,,,,,7
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,7,75293,AR,Individual,No,71-0226428,75293AR1180001,Silver 1500,75293AR118,7427051652,ARN001,ARS001,ARF010,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32019?,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR1180001-00,Standard Silver Off Exchange Plan,,0.719009518623352,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",25%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,7,75293,AR,Individual,No,71-0226428,75293AR1180001,Silver 1500,75293AR118,7427051652,ARN001,ARS001,ARF010,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32019?,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR1180001-01,Standard Silver On Exchange Plan,,0.719009518623352,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",25%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,7,75293,AR,Individual,No,71-0226428,75293AR1180001,Silver 1500,75293AR118,7427051652,ARN001,ARS001,ARF010,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32019?,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR1180001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,AR,75293,SERFF,12,2015-07-22 12:46:44,7,75293,AR,Individual,No,71-0226428,75293AR1180001,Silver 1500,75293AR118,7427051652,ARN001,ARS001,ARF010,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.996268636632684,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care,Yes,Benefit reduction for medical care,Yes,https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32019?,https://secure.arkansasbluecross.com/exchange/payment/individual.aspx,http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx,http://www.arkansasbluecross.com/pd_list/exchange/2015/metallicdruglist.aspx,75293AR1180001-03,Limited Cost Sharing Plan Variation,,0.719009518623352,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",25%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,3,67190,DE,Individual,No,23-2169745,67190DE0080002,Aetna Bronze Deductible Only HSA Eligible HNOnly,67190DE008,,DEN001,DES001,DEF002,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080002-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,3,67190,DE,Individual,No,23-2169745,67190DE0080002,Aetna Bronze Deductible Only HSA Eligible HNOnly,67190DE008,,DEN001,DES001,DEF002,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080002-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,3,67190,DE,Individual,No,23-2169745,67190DE0080002,Aetna Bronze Deductible Only HSA Eligible HNOnly,67190DE008,,DEN001,DES001,DEF002,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,3,67190,DE,Individual,No,23-2169745,67190DE0080002,Aetna Bronze Deductible Only HSA Eligible HNOnly,67190DE008,,DEN001,DES001,DEF002,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080002-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,DE,19005,SERFF,4,2014-10-06 10:59:03,1,19005,DE,SHOP (Small Group),Yes,93-0242990,19005DE0030002,EHB High Passive,19005DE003,,DEN001,DES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$52.16,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,19005DE0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,5,67190,DE,Individual,No,23-2169745,67190DE0080004,Aetna Silver $10 Copay HNOnly,67190DE008,,DEN001,DES001,DEF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080004-00,Standard Silver Off Exchange Plan,68.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,5,67190,DE,Individual,No,23-2169745,67190DE0080004,Aetna Silver $10 Copay HNOnly,67190DE008,,DEN001,DES001,DEF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080004-01,Standard Silver On Exchange Plan,68.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,DE,19005,SERFF,4,2014-10-06 10:59:03,1,19005,DE,SHOP (Small Group),Yes,93-0242990,19005DE0030001,EHB Low Passive,19005DE003,,DEN001,DES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.99,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,19005DE0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,DE,26018,SERFF,5,2014-11-14 14:52:18,1,26018,DE,SHOP (Small Group),Yes,51-0228088,26018DE0020002,Delta Dental PPO Pediatric Preferred Plan for Small Businesses,26018DE002,,DEN001,DES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.80,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/de/26018de0020002-15,,26018DE0020002-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,26018,SERFF,5,2014-11-14 14:52:18,1,26018,DE,Individual,Yes,51-0228088,26018DE0010002,Delta Dental PPO Pediatric Preferred Plan,26018DE001,,DEN001,DES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$29.57,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/de/26018de0010002-15,,26018DE0010002-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,26018,SERFF,5,2014-11-14 14:52:18,1,26018,DE,Individual,Yes,51-0228088,26018DE0010002,Delta Dental PPO Pediatric Preferred Plan,26018DE001,,DEN001,DES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$29.57,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/de/26018de0010002-15,,26018DE0010002-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,DE,26018,SERFF,5,2014-11-14 14:52:18,1,26018,DE,SHOP (Small Group),Yes,51-0228088,26018DE0020002,Delta Dental PPO Pediatric Preferred Plan for Small Businesses,26018DE002,,DEN001,DES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.80,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/de/26018de0020002-15,,26018DE0020002-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,DE,26018,SERFF,5,2014-11-14 14:52:18,1,26018,DE,SHOP (Small Group),Yes,51-0228088,26018DE0020001,Delta Dental PPO Pediatric Basic Plan for Small Businesses,26018DE002,,DEN001,DES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/de/26018de0020001-15,,26018DE0020001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,DE,26018,SERFF,5,2014-11-14 14:52:18,1,26018,DE,Individual,Yes,51-0228088,26018DE0010001,Delta Dental PPO Pediatric Basic Plan,26018DE001,,DEN001,DES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$23.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/de/26018de0010001-15,,26018DE0010001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,DE,26018,SERFF,5,2014-11-14 14:52:18,1,26018,DE,Individual,Yes,51-0228088,26018DE0010001,Delta Dental PPO Pediatric Basic Plan,26018DE001,,DEN001,DES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$23.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/de/26018de0010001-15,,26018DE0010001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,DE,26018,SERFF,5,2014-11-14 14:52:18,1,26018,DE,SHOP (Small Group),Yes,51-0228088,26018DE0020001,Delta Dental PPO Pediatric Basic Plan for Small Businesses,26018DE002,,DEN001,DES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/de/26018de0020001-15,,26018DE0020001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,DE,26018,SERFF,5,2014-11-14 14:52:18,2,26018,DE,SHOP (Small Group),Yes,51-0228088,26018DE0020004,Delta Dental PPO Preferred Plan for Families for Small Businesses,26018DE002,,DEN001,DES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.80,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/de/26018de0020004-15,,26018DE0020004-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,26018,SERFF,5,2014-11-14 14:52:18,2,26018,DE,Individual,Yes,51-0228088,26018DE0010004,Family Delta Dental PPO Preferred Plan for Families,26018DE001,,DEN001,DES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.57,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/de/26018de0010004-15,,26018DE0010004-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,26018,SERFF,5,2014-11-14 14:52:18,2,26018,DE,Individual,Yes,51-0228088,26018DE0010004,Family Delta Dental PPO Preferred Plan for Families,26018DE001,,DEN001,DES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.57,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/de/26018de0010004-15,,26018DE0010004-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,DE,26018,SERFF,5,2014-11-14 14:52:18,2,26018,DE,SHOP (Small Group),Yes,51-0228088,26018DE0020004,Delta Dental PPO Preferred Plan for Families for Small Businesses,26018DE002,,DEN001,DES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.80,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/de/26018de0020004-15,,26018DE0020004-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,DE,26018,SERFF,5,2014-11-14 14:52:18,3,26018,DE,SHOP (Small Group),Yes,51-0228088,26018DE0020006,Delta Dental PPO Basic Plan for Families for Small Businesses,26018DE002,,DEN001,DES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/de/26018de0020006-15,,26018DE0020006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,26018,SERFF,5,2014-11-14 14:52:18,3,26018,DE,Individual,Yes,51-0228088,26018DE0010006,Delta Dental PPO Basic Plan for Families,26018DE001,,DEN001,DES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/de/26018de0010006-15,,26018DE0010006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,26018,SERFF,5,2014-11-14 14:52:18,3,26018,DE,Individual,Yes,51-0228088,26018DE0010006,Delta Dental PPO Basic Plan for Families,26018DE001,,DEN001,DES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/de/26018de0010006-15,,26018DE0010006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,DE,26018,SERFF,5,2014-11-14 14:52:18,3,26018,DE,SHOP (Small Group),Yes,51-0228088,26018DE0020006,Delta Dental PPO Basic Plan for Families for Small Businesses,26018DE002,,DEN001,DES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/de/26018de0020006-15,,26018DE0020006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,1,29497,DE,Individual,No,06-6033492,29497DE0090001,Aetna Bronze $20 Copay PPO,29497DE009,,DEN001,DES001,DEF001,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090001-00,Standard Bronze Off Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,1,29497,DE,Individual,No,06-6033492,29497DE0090001,Aetna Bronze $20 Copay PPO,29497DE009,,DEN001,DES001,DEF001,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090001-01,Standard Bronze On Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,1,29497,DE,Individual,No,06-6033492,29497DE0090001,Aetna Bronze $20 Copay PPO,29497DE009,,DEN001,DES001,DEF001,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,1,29497,DE,Individual,No,06-6033492,29497DE0090001,Aetna Bronze $20 Copay PPO,29497DE009,,DEN001,DES001,DEF001,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090001-03,Limited Cost Sharing Plan Variation,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,3,29497,DE,Individual,No,06-6033492,29497DE0090002,Aetna Bronze Deductible Only HSA Eligible PPO,29497DE009,,DEN001,DES001,DEF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090002-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,3,29497,DE,Individual,No,06-6033492,29497DE0090002,Aetna Bronze Deductible Only HSA Eligible PPO,29497DE009,,DEN001,DES001,DEF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090002-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,3,29497,DE,Individual,No,06-6033492,29497DE0090002,Aetna Bronze Deductible Only HSA Eligible PPO,29497DE009,,DEN001,DES001,DEF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,3,29497,DE,Individual,No,06-6033492,29497DE0090002,Aetna Bronze Deductible Only HSA Eligible PPO,29497DE009,,DEN001,DES001,DEF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090002-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,5,29497,DE,Individual,No,06-6033492,29497DE0090004,Aetna Silver $10 Copay PPO,29497DE009,,DEN001,DES001,DEF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090004-00,Standard Silver Off Exchange Plan,68.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,5,29497,DE,Individual,No,06-6033492,29497DE0090004,Aetna Silver $10 Copay PPO,29497DE009,,DEN001,DES001,DEF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090004-01,Standard Silver On Exchange Plan,68.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,5,29497,DE,Individual,No,06-6033492,29497DE0090004,Aetna Silver $10 Copay PPO,29497DE009,,DEN001,DES001,DEF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090004-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,5,29497,DE,Individual,No,06-6033492,29497DE0090004,Aetna Silver $10 Copay PPO,29497DE009,,DEN001,DES001,DEF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090004-03,Limited Cost Sharing Plan Variation,68.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,5,29497,DE,Individual,No,06-6033492,29497DE0090004,Aetna Silver $10 Copay PPO,29497DE009,,DEN001,DES001,DEF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090004-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,5,29497,DE,Individual,No,06-6033492,29497DE0090004,Aetna Silver $10 Copay PPO,29497DE009,,DEN001,DES001,DEF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090004-05,87% AV Level Silver Plan,86.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,5,29497,DE,Individual,No,06-6033492,29497DE0090004,Aetna Silver $10 Copay PPO,29497DE009,,DEN001,DES001,DEF004,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090004-06,94% AV Level Silver Plan,93.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,7,29497,DE,Individual,No,06-6033492,29497DE0090005,Aetna Silver $5 Copay 2750 PPO,29497DE009,,DEN001,DES001,DEF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090005-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,7,29497,DE,Individual,No,06-6033492,29497DE0090005,Aetna Silver $5 Copay 2750 PPO,29497DE009,,DEN001,DES001,DEF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090005-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,7,29497,DE,Individual,No,06-6033492,29497DE0090005,Aetna Silver $5 Copay 2750 PPO,29497DE009,,DEN001,DES001,DEF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090005-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,7,29497,DE,Individual,No,06-6033492,29497DE0090005,Aetna Silver $5 Copay 2750 PPO,29497DE009,,DEN001,DES001,DEF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090005-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,7,29497,DE,Individual,No,06-6033492,29497DE0090005,Aetna Silver $5 Copay 2750 PPO,29497DE009,,DEN001,DES001,DEF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090005-04,73% AV Level Silver Plan,72.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,7,29497,DE,Individual,No,06-6033492,29497DE0090005,Aetna Silver $5 Copay 2750 PPO,29497DE009,,DEN001,DES001,DEF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090005-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,7,29497,DE,Individual,No,06-6033492,29497DE0090005,Aetna Silver $5 Copay 2750 PPO,29497DE009,,DEN001,DES001,DEF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090005-06,94% AV Level Silver Plan,93.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,9,29497,DE,Individual,No,06-6033492,29497DE0090003,Aetna Gold $5 Copay PPO,29497DE009,,DEN001,DES001,DEF003,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090003-00,Standard Gold Off Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,9,29497,DE,Individual,No,06-6033492,29497DE0090003,Aetna Gold $5 Copay PPO,29497DE009,,DEN001,DES001,DEF003,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090003-01,Standard Gold On Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,9,29497,DE,Individual,No,06-6033492,29497DE0090003,Aetna Gold $5 Copay PPO,29497DE009,,DEN001,DES001,DEF003,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090003-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,DE,29497,SERFF,9,2015-02-22 21:18:17,9,29497,DE,Individual,No,06-6033492,29497DE0090003,Aetna Gold $5 Copay PPO,29497DE009,,DEN001,DES001,DEF003,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999081697572007,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,29497DE0090003-03,Limited Cost Sharing Plan Variation,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,4,76168,DE,Individual,No,51-0020405,76168DE0410008,Shared Cost Blue EPO 3000,76168DE041,,DEN001,DES001,DEF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410008-00,Standard Silver Off Exchange Plan,,0.698856353759766,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,4,76168,DE,SHOP (Small Group),No,51-0020405,76168DE0440001,Health Savings PPO HSA $2000/80,76168DE044,,DEN001,DES001,DEF007,Existing,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9979,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0440001-00,Standard Silver Off Exchange Plan,,0.698870837688446,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,2,76168,DE,Individual,No,51-0020405,76168DE0400001,Major Events Blue EPO 6600,76168DE040,,DEN001,DES001,DEF001,Existing,EPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0400001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,2,76168,DE,SHOP (Small Group),No,51-0020405,76168DE0430002,Shared Cost EPO Basic $2000/75,76168DE043,,DEN001,DES001,DEF006,Existing,EPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9979,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0430002-00,Standard Silver Off Exchange Plan,,0.694727122783661,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,2,76168,DE,SHOP (Small Group),No,51-0020405,76168DE0430002,Shared Cost EPO Basic $2000/75,76168DE043,,DEN001,DES001,DEF006,Existing,EPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9979,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0430002-01,Standard Silver On Exchange Plan,,0.694727122783661,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,2,76168,DE,Individual,No,51-0020405,76168DE0400001,Major Events Blue EPO 6600,76168DE040,,DEN001,DES001,DEF001,Existing,EPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0400001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,8,76168,DE,Individual,No,51-0020405,76168DE0410002,Shared Cost Blue EPO 0,76168DE041,,DEN001,DES001,DEF004,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410002-03,Limited Cost Sharing Plan Variation,,0.809682786464691,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,9,76168,DE,Individual,No,51-0020405,76168DE0410004,Shared Cost Blue EPO 300,76168DE041,,DEN001,DES001,DEF004,Existing,EPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410004-00,Standard Platinum Off Exchange Plan,,0.891458928585052,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,2,18973,IA,Individual,No,42-1244752,18973IA0220017,Coventry Gold $5 Copay UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF028,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51504,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220017-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,2,18973,IA,Individual,No,42-1244752,18973IA0220017,Coventry Gold $5 Copay UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF028,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51504,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220017-03,Limited Cost Sharing Plan Variation,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,3,18973,IA,Individual,No,42-1244752,18973IA0210013,Coventry Gold $5 Copay UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF021,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51476,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210013-00,Standard Gold Off Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0250002,Coventry Silver $10 Copay,18973IA025,,IAN001,IAS001,IAF042,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51415,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250002-00,Standard Silver Off Exchange Plan,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0250002,Coventry Silver $10 Copay,18973IA025,,IAN001,IAS001,IAF042,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51415,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250002-01,Standard Silver On Exchange Plan,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0250002,Coventry Silver $10 Copay,18973IA025,,IAN001,IAS001,IAF042,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51415,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,DE,41726,SERFF,6,2014-10-06 10:59:03,1,41726,DE,SHOP (Small Group),Yes,44-0308260,41726DE0010001,KCL EHB Low PPO,41726DE001,,DEN001,DES001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$61.38,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,41726DE0010001-00,Standard Low Off Exchange Plan,71.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,41726,SERFF,6,2014-10-06 10:59:03,1,41726,DE,SHOP (Small Group),Yes,44-0308260,41726DE0010003,KCL EHB Low MAC,41726DE001,,DEN001,DES001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$44.51,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,41726DE0010003-00,Standard Low Off Exchange Plan,71.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,DE,41726,SERFF,6,2014-10-06 10:59:03,1,41726,DE,SHOP (Small Group),Yes,44-0308260,41726DE0010005,KCL Fam Low PPO,41726DE001,,DEN001,DES001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$61.38,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,41726DE0010005-00,Standard Low Off Exchange Plan,71.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,DE,41726,SERFF,6,2014-10-06 10:59:03,1,41726,DE,SHOP (Small Group),Yes,44-0308260,41726DE0010007,KCL Fam Low MAC,41726DE001,,DEN001,DES001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$44.51,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,41726DE0010007-00,Standard Low Off Exchange Plan,71.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,DE,41726,SERFF,6,2014-10-06 10:59:03,2,41726,DE,SHOP (Small Group),Yes,44-0308260,41726DE0010002,KCL EHB High PPO,41726DE001,,DEN001,DES001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$74.71,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,41726DE0010002-00,Standard High Off Exchange Plan,85.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,41726,SERFF,6,2014-10-06 10:59:03,2,41726,DE,SHOP (Small Group),Yes,44-0308260,41726DE0010004,KCL EHB High MAC,41726DE001,,DEN001,DES001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$55.47,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,41726DE0010004-00,Standard High Off Exchange Plan,85.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,DE,41726,SERFF,6,2014-10-06 10:59:03,2,41726,DE,SHOP (Small Group),Yes,44-0308260,41726DE0010006,KCL Fam High PPO,41726DE001,,DEN001,DES001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$74.71,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,41726DE0010006-00,Standard High Off Exchange Plan,85.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,DE,41726,SERFF,6,2014-10-06 10:59:03,2,41726,DE,SHOP (Small Group),Yes,44-0308260,41726DE0010008,KCL Fam High MAC,41726DE001,,DEN001,DES001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$55.47,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,41726DE0010008-00,Standard High Off Exchange Plan,85.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,DE,48664,SERFF,5,2014-11-14 14:52:18,1,48664,DE,SHOP (Small Group),Yes,75-1233841,48664DE0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,48664DE002,,DEN001,DES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.63,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/de/48664de0020001-15,,48664DE0020001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$80,Not Applicable,,,,,$80,Not Applicable,$80,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,48664,SERFF,5,2014-11-14 14:52:18,1,48664,DE,Individual,Yes,75-1233841,48664DE0010001,Dentegra Dental PPO Pediatric Basic Plan,48664DE001,,DEN001,DES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$29.40,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/de/48664de0010001-15,,48664DE0010001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$80,Not Applicable,,,,,$80,Not Applicable,$80,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,48664,SERFF,5,2014-11-14 14:52:18,1,48664,DE,Individual,Yes,75-1233841,48664DE0010001,Dentegra Dental PPO Pediatric Basic Plan,48664DE001,,DEN001,DES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$29.40,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/de/48664de0010001-15,,48664DE0010001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$80,Not Applicable,,,,,$80,Not Applicable,$80,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,DE,48664,SERFF,5,2014-11-14 14:52:18,1,48664,DE,SHOP (Small Group),Yes,75-1233841,48664DE0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,48664DE002,,DEN001,DES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.63,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/de/48664de0020001-15,,48664DE0020001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$80,Not Applicable,,,,,$80,Not Applicable,$80,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,DE,48664,SERFF,5,2014-11-14 14:52:18,2,48664,DE,SHOP (Small Group),Yes,75-1233841,48664DE0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,48664DE002,,DEN001,DES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$37.93,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/de/48664de0020004-15,,48664DE0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$80,Not Applicable,,,,,$80,Not Applicable,$80,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,48664,SERFF,5,2014-11-14 14:52:18,2,48664,DE,Individual,Yes,75-1233841,48664DE0010004,Dentegra Dental PPO Family Preferred Plan,48664DE001,,DEN001,DES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$37.63,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/de/48664de0010004-15,,48664DE0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$80,Not Applicable,,,,,$80,Not Applicable,$80,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,48664,SERFF,5,2014-11-14 14:52:18,2,48664,DE,Individual,Yes,75-1233841,48664DE0010004,Dentegra Dental PPO Family Preferred Plan,48664DE001,,DEN001,DES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$37.63,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/de/48664de0010004-15,,48664DE0010004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$80,Not Applicable,,,,,$80,Not Applicable,$80,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,DE,48664,SERFF,5,2014-11-14 14:52:18,2,48664,DE,SHOP (Small Group),Yes,75-1233841,48664DE0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,48664DE002,,DEN001,DES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$37.93,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/de/48664de0020004-15,,48664DE0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$80,Not Applicable,,,,,$80,Not Applicable,$80,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,DE,48664,SERFF,5,2014-11-14 14:52:18,3,48664,DE,SHOP (Small Group),Yes,75-1233841,48664DE0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,48664DE002,,DEN001,DES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.63,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/de/48664de0020006-15,,48664DE0020006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$80,Not Applicable,,,,,$80,Not Applicable,$80,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,48664,SERFF,5,2014-11-14 14:52:18,3,48664,DE,Individual,Yes,75-1233841,48664DE0010006,Dentegra Dental PPO Family Basic Plan,48664DE001,,DEN001,DES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.40,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/de/48664de0010006-15,,48664DE0010006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$80,Not Applicable,,,,,$80,Not Applicable,$80,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,48664,SERFF,5,2014-11-14 14:52:18,3,48664,DE,Individual,Yes,75-1233841,48664DE0010006,Dentegra Dental PPO Family Basic Plan,48664DE001,,DEN001,DES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.40,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/de/48664de0010006-15,,48664DE0010006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$80,Not Applicable,,,,,$80,Not Applicable,$80,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,DE,48664,SERFF,5,2014-11-14 14:52:18,3,48664,DE,SHOP (Small Group),Yes,75-1233841,48664DE0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,48664DE002,,DEN001,DES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.63,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/de/48664de0020006-15,,48664DE0020006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$80,Not Applicable,,,,,$80,Not Applicable,$80,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,DE,60359,SERFF,1,2014-11-14 14:52:18,1,60359,DE,SHOP (Small Group),Yes,13-5581829,60359DE0090001,EHB Basic Dental Plan (Low),60359DE009,,DEN001,DES001,,New,PPO,Low,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$22.24,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,www.metlife.com/reform,,www.metlife.com/reform,,60359DE0090001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,61298,SERFF,4,2014-10-06 10:59:03,1,61298,DE,SHOP (Small Group),Yes,47-0098400,61298DE0040002,EHB High PPO,61298DE004,,DEN001,DES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$49.25,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,61298DE0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,61298,SERFF,4,2014-10-06 10:59:03,1,61298,DE,SHOP (Small Group),Yes,47-0098400,61298DE0040001,EHB Low PPO,61298DE004,,DEN001,DES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.03,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,61298DE0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,DE,61298,SERFF,4,2014-10-06 10:59:03,1,61298,DE,SHOP (Small Group),Yes,47-0098400,61298DE0030002,EHB High Passive,61298DE003,,DEN001,DES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$51.29,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,61298DE0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,DE,61298,SERFF,4,2014-10-06 10:59:03,1,61298,DE,SHOP (Small Group),Yes,47-0098400,61298DE0030001,EHB Low Passive,61298DE003,,DEN001,DES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.42,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,61298DE0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,5,67190,DE,Individual,No,23-2169745,67190DE0080004,Aetna Silver $10 Copay HNOnly,67190DE008,,DEN001,DES001,DEF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080004-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,5,67190,DE,Individual,No,23-2169745,67190DE0080004,Aetna Silver $10 Copay HNOnly,67190DE008,,DEN001,DES001,DEF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080004-03,Limited Cost Sharing Plan Variation,68.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,5,67190,DE,Individual,No,23-2169745,67190DE0080004,Aetna Silver $10 Copay HNOnly,67190DE008,,DEN001,DES001,DEF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080004-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,5,67190,DE,Individual,No,23-2169745,67190DE0080004,Aetna Silver $10 Copay HNOnly,67190DE008,,DEN001,DES001,DEF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080004-05,87% AV Level Silver Plan,86.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,5,67190,DE,Individual,No,23-2169745,67190DE0080004,Aetna Silver $10 Copay HNOnly,67190DE008,,DEN001,DES001,DEF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080004-06,94% AV Level Silver Plan,93.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,6,67190,DE,SHOP (Small Group),No,23-2169745,67190DE0060001,DE Bronze HNOption 5700 100/50 HSA,67190DE006,,DEN002,DES002,DEF027,New,POS,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998518563306999,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1549988715,67190DE0060001-00,Standard Bronze Off Exchange Plan,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,700","$11,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,700","$11,400",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,6,67190,DE,SHOP (Small Group),No,23-2169745,67190DE0060001,DE Bronze HNOption 5700 100/50 HSA,67190DE006,,DEN002,DES002,DEF027,New,POS,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998518563306999,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1549988715,67190DE0060001-01,Standard Bronze On Exchange Plan,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,700","$11,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,700","$11,400",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,7,67190,DE,Individual,No,23-2169745,67190DE0080005,Aetna Silver $5 Copay 2750 HNOnly,67190DE008,,DEN001,DES001,DEF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080005-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,7,67190,DE,Individual,No,23-2169745,67190DE0080005,Aetna Silver $5 Copay 2750 HNOnly,67190DE008,,DEN001,DES001,DEF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080005-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,7,67190,DE,Individual,No,23-2169745,67190DE0080005,Aetna Silver $5 Copay 2750 HNOnly,67190DE008,,DEN001,DES001,DEF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080005-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,7,67190,DE,Individual,No,23-2169745,67190DE0080005,Aetna Silver $5 Copay 2750 HNOnly,67190DE008,,DEN001,DES001,DEF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080005-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,7,67190,DE,Individual,No,23-2169745,67190DE0080005,Aetna Silver $5 Copay 2750 HNOnly,67190DE008,,DEN001,DES001,DEF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080005-04,73% AV Level Silver Plan,72.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,7,67190,DE,Individual,No,23-2169745,67190DE0080005,Aetna Silver $5 Copay 2750 HNOnly,67190DE008,,DEN001,DES001,DEF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080005-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,7,67190,DE,Individual,No,23-2169745,67190DE0080005,Aetna Silver $5 Copay 2750 HNOnly,67190DE008,,DEN001,DES001,DEF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080005-06,94% AV Level Silver Plan,93.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,9,67190,DE,Individual,No,23-2169745,67190DE0080003,Aetna Gold $5 Copay HNOnly,67190DE008,,DEN001,DES001,DEF003,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080003-00,Standard Gold Off Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,9,67190,DE,Individual,No,23-2169745,67190DE0080003,Aetna Gold $5 Copay HNOnly,67190DE008,,DEN001,DES001,DEF003,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080003-01,Standard Gold On Exchange Plan,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,9,67190,DE,Individual,No,23-2169745,67190DE0080003,Aetna Gold $5 Copay HNOnly,67190DE008,,DEN001,DES001,DEF003,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080003-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,9,67190,DE,Individual,No,23-2169745,67190DE0080003,Aetna Gold $5 Copay HNOnly,67190DE008,,DEN001,DES001,DEF003,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999079281781913,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,,http://www.aetna.com/individuals-families/health-insurance-exchange/delaware-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1552411001,67190DE0080003-03,Limited Cost Sharing Plan Variation,78.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,11,67190,DE,SHOP (Small Group),No,23-2169745,67190DE0070003,DE Silver HNOnly 2000 70% $30,67190DE007,,DEN001,DES001,DEF032,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998518563306999,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1549988715,67190DE0070003-00,Standard Silver Off Exchange Plan,71.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,11,67190,DE,SHOP (Small Group),No,23-2169745,67190DE0070003,DE Silver HNOnly 2000 70% $30,67190DE007,,DEN001,DES001,DEF032,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998518563306999,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1549988715,67190DE0070003-01,Standard Silver On Exchange Plan,71.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,17,67190,DE,SHOP (Small Group),No,23-2169745,67190DE0060003,DE Silver HNOption 2000 70/50 $30,67190DE006,,DEN002,DES002,DEF029,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998518563306999,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1549988715,67190DE0060003-00,Standard Silver Off Exchange Plan,71.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,17,67190,DE,SHOP (Small Group),No,23-2169745,67190DE0060003,DE Silver HNOption 2000 70/50 $30,67190DE006,,DEN002,DES002,DEF029,New,POS,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998518563306999,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1549988715,67190DE0060003-01,Standard Silver On Exchange Plan,71.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,23,67190,DE,SHOP (Small Group),No,23-2169745,67190DE0070002,DE Gold HNOnly 1000 80% $25,67190DE007,,DEN001,DES001,DEF031,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998518563306999,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1549988715,67190DE0070002-00,Standard Gold Off Exchange Plan,78.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,23,67190,DE,SHOP (Small Group),No,23-2169745,67190DE0070002,DE Gold HNOnly 1000 80% $25,67190DE007,,DEN001,DES001,DEF031,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998518563306999,,,0,0,0,2015-01-01,,No,,No,,No,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1549988715,67190DE0070002-01,Standard Gold On Exchange Plan,78.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,29,67190,DE,SHOP (Small Group),No,23-2169745,67190DE0060002,DE Gold HNOption 1000 80/50 $25,67190DE006,,DEN002,DES002,DEF028,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998518563306999,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1549988715,67190DE0060002-00,Standard Gold Off Exchange Plan,78.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,DE,67190,SERFF,10,2015-05-22 14:18:43,29,67190,DE,SHOP (Small Group),No,23-2169745,67190DE0060002,DE Gold HNOption 1000 80/50 $25,67190DE006,,DEN002,DES002,DEF028,New,POS,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.998518563306999,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,,http://www.aetna.com/employers-organizations/small-business-plans-by-state/DE-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1549988715,67190DE0060002-01,Standard Gold On Exchange Plan,78.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,DE,67775,SERFF,9,2015-06-19 18:30:37,1,67775,DE,Individual,Yes,54-1808292,67775DE0010001,Select Plan Kids,67775DE001,,DEN001,DES001,,Existing,HMO,Low,,Both,,,,Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia.,,,,,Allows Child-Only,,,,$22.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/de14dobifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware,,67775DE0010001-00,Standard Low Off Exchange Plan,71.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,3,76168,DE,SHOP (Small Group),No,51-0020405,76168DE0430003,Shared Cost EPO Basic $5250/90,76168DE043,,DEN001,DES001,DEF003,Existing,EPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9979,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0430003-01,Standard Bronze On Exchange Plan,,0.603456914424896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,3,76168,DE,Individual,No,51-0020405,76168DE0410010,Shared Cost Blue EPO 5250,76168DE041,,DEN001,DES001,DEF003,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410010-01,Standard Bronze On Exchange Plan,,0.600610435009003,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,2,18973,IA,Individual,No,42-1244752,18973IA0160001,Coventry Gold $5 Copay Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF001,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51300,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160001-03,Limited Cost Sharing Plan Variation,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,7
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,2,18973,IA,Individual,No,42-1244752,18973IA0170001,Coventry Gold $5 Copay MIPPA,18973IA017,,IAN002,IAS002,IAF006,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51356,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170001-00,Standard Gold Off Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,2,18973,IA,Individual,No,42-1244752,18973IA0170001,Coventry Gold $5 Copay MIPPA,18973IA017,,IAN002,IAS002,IAF006,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51356,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170001-01,Standard Gold On Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,2,18973,IA,Individual,No,42-1244752,18973IA0170001,Coventry Gold $5 Copay MIPPA,18973IA017,,IAN002,IAS002,IAF006,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51356,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,DE,67775,SERFF,9,2015-06-19 18:30:37,1,67775,DE,SHOP (Small Group),Yes,54-1808292,67775DE0030001,Select Plan Kids,67775DE003,,DEN001,DES001,,Existing,HMO,Low,,Off the Exchange,,,,Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.,,,,,Allows Child-Only,,,,$22.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/de14dobifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware,,67775DE0030001-00,Standard Low Off Exchange Plan,71.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,67775,SERFF,9,2015-06-19 18:30:37,1,67775,DE,SHOP (Small Group),Yes,54-1808292,67775DE0030001,Select Plan Kids,67775DE003,,DEN001,DES001,,Existing,HMO,Low,,Off the Exchange,,,,Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.,,,,,Allows Child-Only,,,,$22.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/de14dobifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware,,67775DE0030001-01,Standard Low On Exchange Plan,71.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,10,76168,DE,Individual,No,51-0020405,76168DE0420002,Health Savings Blue EPO 1800,76168DE042,,DEN001,DES001,DEF001,Existing,EPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0420002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,10,76168,DE,Individual,No,51-0020405,76168DE0420002,Health Savings Blue EPO 1800,76168DE042,,DEN001,DES001,DEF001,Existing,EPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0420002-03,Limited Cost Sharing Plan Variation,,0.803948640823364,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,9,76168,DE,Individual,No,51-0020405,76168DE0410004,Shared Cost Blue EPO 300,76168DE041,,DEN001,DES001,DEF004,Existing,EPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410004-03,Limited Cost Sharing Plan Variation,,0.891458928585052,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,10,76168,DE,Individual,No,51-0020405,76168DE0420004,Health Savings Blue EPO 3000,76168DE042,,DEN001,DES001,DEF001,Existing,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0420004-00,Standard Silver Off Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,3,18973,IA,Individual,No,42-1244752,18973IA0210013,Coventry Gold $5 Copay UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF021,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51476,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210013-01,Standard Gold On Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,3,18973,IA,Individual,No,42-1244752,18973IA0210013,Coventry Gold $5 Copay UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF021,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51476,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210013-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,3,18973,IA,Individual,No,42-1244752,18973IA0210013,Coventry Gold $5 Copay UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF021,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51476,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210013-03,Limited Cost Sharing Plan Variation,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,3,18973,IA,Individual,No,42-1244752,18973IA0220018,Coventry Gold $5 Copay UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF026,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51532,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220018-00,Standard Gold Off Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,3,18973,IA,Individual,No,42-1244752,18973IA0220018,Coventry Gold $5 Copay UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF026,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51532,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220018-01,Standard Gold On Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,3,18973,IA,Individual,No,42-1244752,18973IA0220018,Coventry Gold $5 Copay UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF026,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51532,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220018-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0250014,Coventry Marketplace Choice Plan,18973IA025,,IAN009,IAS009,IAF048,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51440,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250014-01,Standard Silver On Exchange Plan,68.20%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,900","$5,800",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0250014,Coventry Marketplace Choice Plan,18973IA025,,IAN009,IAS009,IAF048,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51440,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250014-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0250014,Coventry Marketplace Choice Plan,18973IA025,,IAN009,IAS009,IAF048,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51440,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250014-03,Limited Cost Sharing Plan Variation,68.20%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,900","$5,800",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0250014,Coventry Marketplace Choice Plan,18973IA025,,IAN009,IAS009,IAF048,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51440,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250014-04,73% AV Level Silver Plan,72.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,900","$5,800",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0250014,Coventry Marketplace Choice Plan,18973IA025,,IAN009,IAS009,IAF048,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51440,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250014-05,87% AV Level Silver Plan,86.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0250014,Coventry Marketplace Choice Plan,18973IA025,,IAN009,IAS009,IAF048,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51440,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250014-06,94% AV Level Silver Plan,93.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,3,18973,IA,Individual,No,42-1244752,18973IA0220018,Coventry Gold $5 Copay UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF026,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51532,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220018-03,Limited Cost Sharing Plan Variation,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,3,18973,IA,Individual,No,42-1244752,18973IA0220019,Coventry Gold $5 Copay UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF027,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51560,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220019-00,Standard Gold Off Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,3,18973,IA,Individual,No,42-1244752,18973IA0220019,Coventry Gold $5 Copay UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF027,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51560,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220019-01,Standard Gold On Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,3,18973,IA,Individual,No,42-1244752,18973IA0220019,Coventry Gold $5 Copay UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF027,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51560,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220019-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,3,18973,IA,Individual,No,42-1244752,18973IA0220019,Coventry Gold $5 Copay UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF027,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51560,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220019-03,Limited Cost Sharing Plan Variation,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0250014,Coventry Marketplace Choice Plan,18973IA025,,IAN009,IAS009,IAF048,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51440,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250014-00,Standard Silver Off Exchange Plan,68.20%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,900","$5,800",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,DE,67775,SERFF,9,2015-06-19 18:30:37,1,67775,DE,Individual,Yes,54-1808292,67775DE0010001,Select Plan Kids,67775DE001,,DEN001,DES001,,Existing,HMO,Low,,Both,,,,Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia.,,,,,Allows Child-Only,,,,$22.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/de14dobifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware,,67775DE0010001-01,Standard Low On Exchange Plan,71.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,DE,67775,SERFF,9,2015-06-19 18:30:37,1,67775,DE,Individual,Yes,54-1808292,67775DE0020001,Access PPO Kids,67775DE002,,DEN002,DES002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$26.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/de14pcovifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware,,67775DE0020001-00,Standard Low Off Exchange Plan,70.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,DE,67775,SERFF,9,2015-06-19 18:30:37,1,67775,DE,SHOP (Small Group),Yes,54-1808292,67775DE0040001,Access PPO Kids,67775DE004,,DEN002,DES002,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/de14pcovifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware,,67775DE0040001-00,Standard Low Off Exchange Plan,70.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,DE,67775,SERFF,9,2015-06-19 18:30:37,1,67775,DE,SHOP (Small Group),Yes,54-1808292,67775DE0040001,Access PPO Kids,67775DE004,,DEN002,DES002,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/de14pcovifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware,,67775DE0040001-01,Standard Low On Exchange Plan,70.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,DE,67775,SERFF,9,2015-06-19 18:30:37,1,67775,DE,Individual,Yes,54-1808292,67775DE0020001,Access PPO Kids,67775DE002,,DEN002,DES002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$26.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/de14pcovifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware,,67775DE0020001-01,Standard Low On Exchange Plan,70.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,DE,67775,SERFF,9,2015-06-19 18:30:37,2,67775,DE,Individual,Yes,54-1808292,67775DE0010002,Select Plan,67775DE001,,DEN001,DES001,,Existing,HMO,Low,,Both,,,,Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia.,,,,,Allows Adult and Child-Only,,,,$22.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/de14dobifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware,,67775DE0010002-00,Standard Low Off Exchange Plan,71.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,11,76168,DE,Individual,No,51-0020405,76168DE0420001,Health Savings Blue EPO 6300 Rewards,76168DE042,,DEN001,DES001,DEF001,New,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0420001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,11,76168,DE,Individual,No,51-0020405,76168DE0420001,Health Savings Blue EPO 6300 Rewards,76168DE042,,DEN001,DES001,DEF001,New,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0420001-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0250002,Coventry Silver $10 Copay,18973IA025,,IAN001,IAS001,IAF042,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51415,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250002-04,73% AV Level Silver Plan,72.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0250002,Coventry Silver $10 Copay,18973IA025,,IAN001,IAS001,IAF042,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51415,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250002-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0250002,Coventry Silver $10 Copay,18973IA025,,IAN001,IAS001,IAF042,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51415,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250002-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0360004,Coventry Silver $10 Copay Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF111,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51387,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360004-00,Standard Silver Off Exchange Plan,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0360004,Coventry Silver $10 Copay Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF111,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51387,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360004-01,Standard Silver On Exchange Plan,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0360004,Coventry Silver $10 Copay Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF111,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51387,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360004-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0360004,Coventry Silver $10 Copay Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF111,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51387,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360004-03,Limited Cost Sharing Plan Variation,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0360004,Coventry Silver $10 Copay Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF111,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51387,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360004-04,73% AV Level Silver Plan,72.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0360004,Coventry Silver $10 Copay Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF111,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51387,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360004-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0360004,Coventry Silver $10 Copay Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF111,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51387,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360004-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0180002,Coventry Silver $10 Copay Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF012,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51331,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180002-00,Standard Silver Off Exchange Plan,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0180002,Coventry Silver $10 Copay Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF012,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51331,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180002-01,Standard Silver On Exchange Plan,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,DE,67775,SERFF,9,2015-06-19 18:30:37,2,67775,DE,SHOP (Small Group),Yes,54-1808292,67775DE0030002,Select Plan,67775DE003,,DEN001,DES001,,Existing,HMO,Low,,Both,,,,Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.,,,,,Allows Adult and Child-Only,,,,$22.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/de14dobifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware,,67775DE0030002-00,Standard Low Off Exchange Plan,71.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,67775,SERFF,9,2015-06-19 18:30:37,2,67775,DE,SHOP (Small Group),Yes,54-1808292,67775DE0030002,Select Plan,67775DE003,,DEN001,DES001,,Existing,HMO,Low,,Both,,,,Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.,,,,,Allows Adult and Child-Only,,,,$22.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/de14dobifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware,,67775DE0030002-01,Standard Low On Exchange Plan,71.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,DE,67775,SERFF,9,2015-06-19 18:30:37,2,67775,DE,Individual,Yes,54-1808292,67775DE0010002,Select Plan,67775DE001,,DEN001,DES001,,Existing,HMO,Low,,Both,,,,Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia.,,,,,Allows Adult and Child-Only,,,,$22.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/de14dobifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware,,67775DE0010002-01,Standard Low On Exchange Plan,71.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,DE,67775,SERFF,9,2015-06-19 18:30:37,2,67775,DE,SHOP (Small Group),Yes,54-1808292,67775DE0040002,Access PPO,67775DE004,,DEN002,DES002,,Existing,PPO,Low,,Both,,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,,,,Allows Adult and Child-Only,,,,$26.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/de14pcovifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware,,67775DE0040002-00,Standard Low Off Exchange Plan,70.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,DE,67775,SERFF,9,2015-06-19 18:30:37,2,67775,DE,Individual,Yes,54-1808292,67775DE0020002,Access PPO,67775DE002,,DEN002,DES002,,Existing,PPO,Low,,Both,,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,,,,Allows Adult and Child-Only,,,,$26.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/de14pcovifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware,,67775DE0020002-00,Standard Low Off Exchange Plan,70.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,DE,67775,SERFF,9,2015-06-19 18:30:37,2,67775,DE,Individual,Yes,54-1808292,67775DE0020002,Access PPO,67775DE002,,DEN002,DES002,,Existing,PPO,Low,,Both,,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,,,,Allows Adult and Child-Only,,,,$26.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/de14pcovifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware,,67775DE0020002-01,Standard Low On Exchange Plan,70.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,DE,67775,SERFF,9,2015-06-19 18:30:37,2,67775,DE,SHOP (Small Group),Yes,54-1808292,67775DE0040002,Access PPO,67775DE004,,DEN002,DES002,,Existing,PPO,Low,,Both,,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,,,,Allows Adult and Child-Only,,,,$26.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/de14pcovifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware,,67775DE0040002-01,Standard Low On Exchange Plan,70.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,DE,68245,SERFF,4,2014-10-06 10:59:03,1,68245,DE,SHOP (Small Group),Yes,36-0883760,68245DE0040002,EHB High PPO,68245DE004,,DEN001,DES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$49.94,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,68245DE0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,68245,SERFF,4,2014-10-06 10:59:03,1,68245,DE,SHOP (Small Group),Yes,36-0883760,68245DE0040001,EHB Low PPO,68245DE004,,DEN001,DES001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.42,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,68245DE0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,DE,68245,SERFF,4,2014-10-06 10:59:03,1,68245,DE,SHOP (Small Group),Yes,36-0883760,68245DE0030002,EHB High Passive,68245DE003,,DEN001,DES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$52.01,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,68245DE0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,DE,68245,SERFF,4,2014-10-06 10:59:03,1,68245,DE,SHOP (Small Group),Yes,36-0883760,68245DE0030001,EHB Low Passive,68245DE003,,DEN001,DES001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.89,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,68245DE0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,1,76168,DE,Individual,No,51-0020405,76168DE0560002,Shared Cost Blue PPO 1800 Rewards,76168DE056,,DEN001,DES001,DEF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0560002-00,Standard Gold Off Exchange Plan,,0.790886580944061,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",40%,,,,"$3,600","$7,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,1,76168,DE,SHOP (Small Group),No,51-0020405,76168DE0430001,Shared Cost EPO Basic $1000/75,76168DE043,,DEN001,DES001,DEF005,Existing,EPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9979,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0430001-00,Standard Gold Off Exchange Plan,,0.805035412311554,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,1,76168,DE,SHOP (Small Group),No,51-0020405,76168DE0430001,Shared Cost EPO Basic $1000/75,76168DE043,,DEN001,DES001,DEF005,Existing,EPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9979,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0430001-01,Standard Gold On Exchange Plan,,0.805035412311554,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,1,76168,DE,Individual,No,51-0020405,76168DE0560002,Shared Cost Blue PPO 1800 Rewards,76168DE056,,DEN001,DES001,DEF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0560002-01,Standard Gold On Exchange Plan,,0.790886580944061,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",40%,,,,"$3,600","$7,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,1,76168,DE,Individual,No,51-0020405,76168DE0560002,Shared Cost Blue PPO 1800 Rewards,76168DE056,,DEN001,DES001,DEF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0560002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,1,76168,DE,Individual,No,51-0020405,76168DE0560002,Shared Cost Blue PPO 1800 Rewards,76168DE056,,DEN001,DES001,DEF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0560002-03,Limited Cost Sharing Plan Variation,,0.790886580944061,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",40%,,,,"$3,600","$7,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,3,76168,DE,Individual,No,51-0020405,76168DE0410010,Shared Cost Blue EPO 5250,76168DE041,,DEN001,DES001,DEF003,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410010-00,Standard Bronze Off Exchange Plan,,0.600610435009003,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,3,76168,DE,SHOP (Small Group),No,51-0020405,76168DE0430003,Shared Cost EPO Basic $5250/90,76168DE043,,DEN001,DES001,DEF003,Existing,EPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9979,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0430003-00,Standard Bronze Off Exchange Plan,,0.603456914424896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,3,76168,DE,Individual,No,51-0020405,76168DE0410010,Shared Cost Blue EPO 5250,76168DE041,,DEN001,DES001,DEF003,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,3,76168,DE,Individual,No,51-0020405,76168DE0410010,Shared Cost Blue EPO 5250,76168DE041,,DEN001,DES001,DEF003,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410010-03,Limited Cost Sharing Plan Variation,,0.600610435009003,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,4,76168,DE,SHOP (Small Group),No,51-0020405,76168DE0440001,Health Savings PPO HSA $2000/80,76168DE044,,DEN001,DES001,DEF007,Existing,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9979,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0440001-01,Standard Silver On Exchange Plan,,0.698870837688446,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,4,76168,DE,Individual,No,51-0020405,76168DE0410008,Shared Cost Blue EPO 3000,76168DE041,,DEN001,DES001,DEF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410008-01,Standard Silver On Exchange Plan,,0.698856353759766,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,4,76168,DE,Individual,No,51-0020405,76168DE0410008,Shared Cost Blue EPO 3000,76168DE041,,DEN001,DES001,DEF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,4,76168,DE,SHOP (Small Group),No,51-0020405,76168DE0450001,Health Savings EPO HSA $3500/90,76168DE045,,DEN001,DES001,DEF003,Existing,EPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9979,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0450001-00,Standard Bronze Off Exchange Plan,,0.615489542484283,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,4,76168,DE,SHOP (Small Group),No,51-0020405,76168DE0450001,Health Savings EPO HSA $3500/90,76168DE045,,DEN001,DES001,DEF003,Existing,EPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9979,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0450001-01,Standard Bronze On Exchange Plan,,0.615489542484283,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,4,76168,DE,Individual,No,51-0020405,76168DE0410008,Shared Cost Blue EPO 3000,76168DE041,,DEN001,DES001,DEF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410008-03,Limited Cost Sharing Plan Variation,,0.698856353759766,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,4,76168,DE,Individual,No,51-0020405,76168DE0410008,Shared Cost Blue EPO 3000,76168DE041,,DEN001,DES001,DEF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410008-04,73% AV Level Silver Plan,,0.731100738048553,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,4,76168,DE,SHOP (Small Group),No,51-0020405,76168DE0450002,Health Savings EPO HSA $6000/100,76168DE045,,DEN001,DES001,DEF001,New,EPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9979,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0450002-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,4,76168,DE,SHOP (Small Group),No,51-0020405,76168DE0450002,Health Savings EPO HSA $6000/100,76168DE045,,DEN001,DES001,DEF001,New,EPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9979,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0450002-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,4,76168,DE,Individual,No,51-0020405,76168DE0410008,Shared Cost Blue EPO 3000,76168DE041,,DEN001,DES001,DEF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410008-05,87% AV Level Silver Plan,,0.871234178543091,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,4,76168,DE,Individual,No,51-0020405,76168DE0410008,Shared Cost Blue EPO 3000,76168DE041,,DEN001,DES001,DEF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410008-06,94% AV Level Silver Plan,,0.933149755001068,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,4,76168,DE,SHOP (Small Group),No,51-0020405,76168DE0510004,Health Savings EPO HSA  $1800/100,76168DE051,,DEN001,DES001,DEF001,New,EPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9979,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0510004-00,Standard Gold Off Exchange Plan,,0.803948640823364,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,4,76168,DE,SHOP (Small Group),No,51-0020405,76168DE0510004,Health Savings EPO HSA  $1800/100,76168DE051,,DEN001,DES001,DEF001,New,EPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9979,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0510004-01,Standard Gold On Exchange Plan,,0.803948640823364,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,5,76168,DE,SHOP (Small Group),No,51-0020405,76168DE0490012,Shared Cost EPO $2500/100,76168DE049,,DEN001,DES001,DEF005,New,EPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9979,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0490012-00,Standard Silver Off Exchange Plan,71.80%,0.729773163795471,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,5,76168,DE,SHOP (Small Group),No,51-0020405,76168DE0490012,Shared Cost EPO $2500/100,76168DE049,,DEN001,DES001,DEF005,New,EPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9979,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0490012-01,Standard Silver On Exchange Plan,71.80%,0.729773163795471,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,5,76168,DE,SHOP (Small Group),No,51-0020405,76168DE0490004,Shared Cost EPO  $1500/100,76168DE049,,DEN001,DES001,DEF005,New,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9979,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0490004-00,Standard Gold Off Exchange Plan,79.75%,0.797520339488983,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,5,76168,DE,SHOP (Small Group),No,51-0020405,76168DE0490004,Shared Cost EPO  $1500/100,76168DE049,,DEN001,DES001,DEF005,New,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9979,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0490004-01,Standard Gold On Exchange Plan,79.75%,0.797520339488983,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,6,76168,DE,SHOP (Small Group),No,51-0020405,76168DE0490006,Shared Cost EPO  $750/100,76168DE049,,DEN001,DES001,DEF005,New,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9979,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0490006-00,Standard Gold Off Exchange Plan,80.78%,0.807763159275055,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,6,76168,DE,Individual,No,51-0020405,76168DE0410012,Shared Cost Blue EPO 750,76168DE041,,DEN001,DES001,DEF004,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410012-00,Standard Gold Off Exchange Plan,,0.81830769777298,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,6,76168,DE,Individual,No,51-0020405,76168DE0410012,Shared Cost Blue EPO 750,76168DE041,,DEN001,DES001,DEF004,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410012-01,Standard Gold On Exchange Plan,,0.81830769777298,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,6,76168,DE,SHOP (Small Group),No,51-0020405,76168DE0490006,Shared Cost EPO  $750/100,76168DE049,,DEN001,DES001,DEF005,New,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,,,0.9979,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services are not covered.",Yes,https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do,https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment,http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0490006-01,Standard Gold On Exchange Plan,80.78%,0.807763159275055,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,6,76168,DE,Individual,No,51-0020405,76168DE0410012,Shared Cost Blue EPO 750,76168DE041,,DEN001,DES001,DEF004,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410012-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,6,76168,DE,Individual,No,51-0020405,76168DE0410012,Shared Cost Blue EPO 750,76168DE041,,DEN001,DES001,DEF004,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410012-03,Limited Cost Sharing Plan Variation,,0.81830769777298,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,6,76168,DE,Individual,No,51-0020405,76168DE0560001,Shared Cost Blue PPO 1500,76168DE056,,DEN001,DES001,DEF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0560001-00,Standard Gold Off Exchange Plan,,0.811323583126068,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,6,76168,DE,Individual,No,51-0020405,76168DE0560001,Shared Cost Blue PPO 1500,76168DE056,,DEN001,DES001,DEF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0560001-01,Standard Gold On Exchange Plan,,0.811323583126068,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,6,76168,DE,Individual,No,51-0020405,76168DE0560001,Shared Cost Blue PPO 1500,76168DE056,,DEN001,DES001,DEF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0560001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,6,76168,DE,Individual,No,51-0020405,76168DE0560001,Shared Cost Blue PPO 1500,76168DE056,,DEN001,DES001,DEF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0560001-03,Limited Cost Sharing Plan Variation,,0.811323583126068,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,7,76168,DE,Individual,No,51-0020405,76168DE0410006,Shared Cost Blue EPO 1000,76168DE041,,DEN001,DES001,DEF009,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410006-00,Standard Gold Off Exchange Plan,,0.787660360336304,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,7,76168,DE,Individual,No,51-0020405,76168DE0410006,Shared Cost Blue EPO 1000,76168DE041,,DEN001,DES001,DEF009,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410006-01,Standard Gold On Exchange Plan,,0.787660360336304,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,7,76168,DE,Individual,No,51-0020405,76168DE0410006,Shared Cost Blue EPO 1000,76168DE041,,DEN001,DES001,DEF009,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,7,76168,DE,Individual,No,51-0020405,76168DE0410006,Shared Cost Blue EPO 1000,76168DE041,,DEN001,DES001,DEF009,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410006-03,Limited Cost Sharing Plan Variation,,0.787660360336304,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,8,76168,DE,Individual,No,51-0020405,76168DE0410002,Shared Cost Blue EPO 0,76168DE041,,DEN001,DES001,DEF004,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410002-00,Standard Gold Off Exchange Plan,,0.809682786464691,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,8,76168,DE,Individual,No,51-0020405,76168DE0410002,Shared Cost Blue EPO 0,76168DE041,,DEN001,DES001,DEF004,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410002-01,Standard Gold On Exchange Plan,,0.809682786464691,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,8,76168,DE,Individual,No,51-0020405,76168DE0410002,Shared Cost Blue EPO 0,76168DE041,,DEN001,DES001,DEF004,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,,,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,9,76168,DE,Individual,No,51-0020405,76168DE0410004,Shared Cost Blue EPO 300,76168DE041,,DEN001,DES001,DEF004,Existing,EPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410004-01,Standard Platinum On Exchange Plan,,0.891458928585052,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,9,76168,DE,Individual,No,51-0020405,76168DE0410004,Shared Cost Blue EPO 300,76168DE041,,DEN001,DES001,DEF004,Existing,EPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,10,76168,DE,Individual,No,51-0020405,76168DE0420004,Health Savings Blue EPO 3000,76168DE042,,DEN001,DES001,DEF001,Existing,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0420004-01,Standard Silver On Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,10,76168,DE,Individual,No,51-0020405,76168DE0420004,Health Savings Blue EPO 3000,76168DE042,,DEN001,DES001,DEF001,Existing,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0420004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,10,76168,DE,Individual,No,51-0020405,76168DE0420004,Health Savings Blue EPO 3000,76168DE042,,DEN001,DES001,DEF001,Existing,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0420004-03,Limited Cost Sharing Plan Variation,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,10,76168,DE,Individual,No,51-0020405,76168DE0420004,Health Savings Blue EPO 3000,76168DE042,,DEN001,DES001,DEF001,Existing,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0420004-04,73% AV Level Silver Plan,,0.738942980766296,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,650","$5,300",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,10,76168,DE,Individual,No,51-0020405,76168DE0420004,Health Savings Blue EPO 3000,76168DE042,,DEN001,DES001,DEF001,Existing,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0420004-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,10,76168,DE,Individual,No,51-0020405,76168DE0420004,Health Savings Blue EPO 3000,76168DE042,,DEN001,DES001,DEF001,Existing,EPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0420004-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,10,76168,DE,Individual,No,51-0020405,76168DE0420002,Health Savings Blue EPO 1800,76168DE042,,DEN001,DES001,DEF001,Existing,EPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0420002-00,Standard Gold Off Exchange Plan,,0.803948640823364,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,10,76168,DE,Individual,No,51-0020405,76168DE0420002,Health Savings Blue EPO 1800,76168DE042,,DEN001,DES001,DEF001,Existing,EPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0420002-01,Standard Gold On Exchange Plan,,0.803948640823364,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,11,76168,DE,Individual,No,51-0020405,76168DE0420001,Health Savings Blue EPO 6300 Rewards,76168DE042,,DEN001,DES001,DEF001,New,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0420001-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,11,76168,DE,Individual,No,51-0020405,76168DE0420001,Health Savings Blue EPO 6300 Rewards,76168DE042,,DEN001,DES001,DEF001,New,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0420001-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,12,76168,DE,Individual,No,51-0020405,76168DE0410011,Shared Cost Blue EPO 1350,76168DE041,,DEN001,DES001,DEF004,Existing,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410011-00,Standard Gold Off Exchange Plan,81.87%,0.81870311498642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,350","$2,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,12,76168,DE,Individual,No,51-0020405,76168DE0410011,Shared Cost Blue EPO 1350,76168DE041,,DEN001,DES001,DEF004,Existing,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410011-01,Standard Gold On Exchange Plan,81.87%,0.81870311498642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,350","$2,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,12,76168,DE,Individual,No,51-0020405,76168DE0410011,Shared Cost Blue EPO 1350,76168DE041,,DEN001,DES001,DEF004,Existing,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410011-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,DE,76168,SERFF,9,2015-02-22 21:18:17,12,76168,DE,Individual,No,51-0020405,76168DE0410011,Shared Cost Blue EPO 1350,76168DE041,,DEN001,DES001,DEF004,Existing,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9987,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmarkbcbsde.com/sbc/bcbsde.html,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/insurance/product-information/delaware,https://client.formularynavigator.com/Search.aspx?siteCode=1546534148,76168DE0410011-03,Limited Cost Sharing Plan Variation,81.87%,0.81870311498642,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,350","$2,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,DE,90955,SERFF,5,2014-10-28 20:25:58,1,90955,DE,SHOP (Small Group),Yes,13-5123390,90955DE0090002,Guardian Pediatric Advantage,90955DE009,,DEN001,DES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$29.70,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,90955DE0090002-00,Standard High Off Exchange Plan,85.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,90955,SERFF,5,2014-10-28 20:25:58,1,90955,DE,SHOP (Small Group),Yes,13-5123390,90955DE0100002,Guardian Pediatric Essentials,90955DE010,,DEN001,DES001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$22.39,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,90955DE0100002-00,Standard Low Off Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,DE,90955,SERFF,5,2014-10-28 20:25:58,2,90955,DE,SHOP (Small Group),Yes,13-5123390,90955DE0060002,Guardian Family Advantage,90955DE006,,DEN001,DES001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.70,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,90955DE0060002-00,Standard High Off Exchange Plan,85.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,DE,90955,SERFF,5,2014-10-28 20:25:58,2,90955,DE,SHOP (Small Group),Yes,13-5123390,90955DE0060002,Guardian Family Advantage,90955DE006,,DEN001,DES001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$29.70,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,90955DE0060002-01,Standard High On Exchange Plan,85.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,DE,90955,SERFF,5,2014-10-28 20:25:58,2,90955,DE,SHOP (Small Group),Yes,13-5123390,90955DE0080002,Guardian Family Essentials,90955DE008,,DEN001,DES001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.39,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,90955DE0080002-00,Standard Low Off Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,DE,90955,SERFF,5,2014-10-28 20:25:58,2,90955,DE,SHOP (Small Group),Yes,13-5123390,90955DE0080002,Guardian Family Essentials,90955DE008,,DEN001,DES001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.39,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,90955DE0080002-01,Standard Low On Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IA,11474,SERFF,2,2014-09-07 12:14:41,1,11474,IA,SHOP (Small Group),Yes,47-0397286,11474IA0030001,"Renaissance Group Dental PPO, EHB Certified",11474IA003,,IAN001,IAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.92,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,11474IA0030001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,11474,SERFF,2,2014-09-07 12:14:41,1,11474,IA,Individual,Yes,47-0397286,11474IA0010001,"Delta Dental Individual PPO, EHB Certified",11474IA001,,IAN002,IAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.71,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,11474IA0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,11474,SERFF,2,2014-09-07 12:14:41,1,11474,IA,SHOP (Small Group),Yes,47-0397286,11474IA0030002,"Renaissance Group Dental PPO, EHB Certified",11474IA003,,IAN001,IAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.22,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,11474IA0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,11474,SERFF,2,2014-09-07 12:14:41,1,11474,IA,Individual,Yes,47-0397286,11474IA0010002,"Delta Dental Individual PPO, EHB Certified",11474IA001,,IAN002,IAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.47,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,11474IA0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,11474,SERFF,2,2014-09-07 12:14:41,1,11474,IA,Individual,Yes,47-0397286,11474IA0020001,"Renaissance Individual Dental PPO, EHB Certified",11474IA002,,IAN001,IAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.93,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,11474IA0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IA,11474,SERFF,2,2014-09-07 12:14:41,1,11474,IA,Individual,Yes,47-0397286,11474IA0020002,"Renaissance Individual Dental PPO, EHB Certified",11474IA002,,IAN001,IAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.74,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,11474IA0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,1,18973,IA,Individual,No,42-1244752,18973IA0250001,Coventry Gold $5 Copay,18973IA025,,IAN001,IAS001,IAF041,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51412,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250001-00,Standard Gold Off Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,1,18973,IA,Individual,No,42-1244752,18973IA0250001,Coventry Gold $5 Copay,18973IA025,,IAN001,IAS001,IAF041,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51412,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250001-01,Standard Gold On Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,1,18973,IA,Individual,No,42-1244752,18973IA0250001,Coventry Gold $5 Copay,18973IA025,,IAN001,IAS001,IAF041,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51412,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,1,18973,IA,Individual,No,42-1244752,18973IA0250001,Coventry Gold $5 Copay,18973IA025,,IAN001,IAS001,IAF041,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51412,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250001-03,Limited Cost Sharing Plan Variation,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,1,18973,IA,Individual,No,42-1244752,18973IA0360003,Coventry Gold $5 Copay Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF110,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51384,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360003-00,Standard Gold Off Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,1,18973,IA,Individual,No,42-1244752,18973IA0360003,Coventry Gold $5 Copay Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF110,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51384,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360003-01,Standard Gold On Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,1,18973,IA,Individual,No,42-1244752,18973IA0360003,Coventry Gold $5 Copay Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF110,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51384,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360003-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,1,18973,IA,Individual,No,42-1244752,18973IA0360003,Coventry Gold $5 Copay Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF110,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51384,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360003-03,Limited Cost Sharing Plan Variation,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,1,18973,IA,Individual,No,42-1244752,18973IA0180001,Coventry Gold $5 Copay Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF011,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51328,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180001-00,Standard Gold Off Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,1,18973,IA,Individual,No,42-1244752,18973IA0180001,Coventry Gold $5 Copay Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF011,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51328,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180001-01,Standard Gold On Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,1,18973,IA,Individual,No,42-1244752,18973IA0180001,Coventry Gold $5 Copay Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF011,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51328,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,1,18973,IA,Individual,No,42-1244752,18973IA0180001,Coventry Gold $5 Copay Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF011,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51328,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180001-03,Limited Cost Sharing Plan Variation,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,1,18973,IA,Individual,No,42-1244752,18973IA0250013,Coventry Gold $5 Copay Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF047,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51588,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250013-00,Standard Gold Off Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,1,18973,IA,Individual,No,42-1244752,18973IA0250013,Coventry Gold $5 Copay Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF047,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51588,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250013-01,Standard Gold On Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,1,18973,IA,Individual,No,42-1244752,18973IA0250013,Coventry Gold $5 Copay Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF047,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51588,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250013-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,1,18973,IA,Individual,No,42-1244752,18973IA0250013,Coventry Gold $5 Copay Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF047,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51588,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250013-03,Limited Cost Sharing Plan Variation,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,2,18973,IA,Individual,No,42-1244752,18973IA0160001,Coventry Gold $5 Copay Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF001,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51300,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160001-00,Standard Gold Off Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,4
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,2,18973,IA,Individual,No,42-1244752,18973IA0160001,Coventry Gold $5 Copay Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF001,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51300,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160001-01,Standard Gold On Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,5
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,2,18973,IA,Individual,No,42-1244752,18973IA0160001,Coventry Gold $5 Copay Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF001,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51300,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,6
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,2,18973,IA,Individual,No,42-1244752,18973IA0170001,Coventry Gold $5 Copay MIPPA,18973IA017,,IAN002,IAS002,IAF006,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51356,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170001-03,Limited Cost Sharing Plan Variation,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,2,18973,IA,Individual,No,42-1244752,18973IA0190001,Coventry Gold $5 Copay Patient Preferred,18973IA019,,IAN003,IAS003,IAF016,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51448,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190001-00,Standard Gold Off Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,2,18973,IA,Individual,No,42-1244752,18973IA0190001,Coventry Gold $5 Copay Patient Preferred,18973IA019,,IAN003,IAS003,IAF016,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51448,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190001-01,Standard Gold On Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,2,18973,IA,Individual,No,42-1244752,18973IA0190001,Coventry Gold $5 Copay Patient Preferred,18973IA019,,IAN003,IAS003,IAF016,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51448,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,2,18973,IA,Individual,No,42-1244752,18973IA0190001,Coventry Gold $5 Copay Patient Preferred,18973IA019,,IAN003,IAS003,IAF016,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51448,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190001-03,Limited Cost Sharing Plan Variation,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,2,18973,IA,Individual,No,42-1244752,18973IA0220017,Coventry Gold $5 Copay UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF028,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51504,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220017-00,Standard Gold Off Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,2,18973,IA,Individual,No,42-1244752,18973IA0220017,Coventry Gold $5 Copay UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF028,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51504,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220017-01,Standard Gold On Exchange Plan,78.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0250002,Coventry Silver $10 Copay,18973IA025,,IAN001,IAS001,IAF042,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51415,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250002-03,Limited Cost Sharing Plan Variation,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0180002,Coventry Silver $10 Copay Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF012,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51331,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0180002,Coventry Silver $10 Copay Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF012,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51331,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180002-03,Limited Cost Sharing Plan Variation,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0180002,Coventry Silver $10 Copay Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF012,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51331,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180002-04,73% AV Level Silver Plan,72.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0180002,Coventry Silver $10 Copay Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF012,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51331,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180002-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,4,18973,IA,Individual,No,42-1244752,18973IA0180002,Coventry Silver $10 Copay Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF012,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51331,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180002-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0250015,Coventry Silver $10 Copay Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF049,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51591,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250015-00,Standard Silver Off Exchange Plan,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0250015,Coventry Silver $10 Copay Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF049,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51591,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250015-01,Standard Silver On Exchange Plan,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0250015,Coventry Silver $10 Copay Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF049,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51591,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250015-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0250015,Coventry Silver $10 Copay Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF049,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51591,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250015-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0250015,Coventry Silver $10 Copay Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF049,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51591,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250015-04,73% AV Level Silver Plan,72.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0250015,Coventry Silver $10 Copay Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF049,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51591,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250015-05,87% AV Level Silver Plan,86.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0250015,Coventry Silver $10 Copay Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF049,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51591,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250015-06,94% AV Level Silver Plan,93.10%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0160002,Coventry Silver $10 Copay Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF002,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51303,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160002-00,Standard Silver Off Exchange Plan,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0160002,Coventry Silver $10 Copay Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF002,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51303,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160002-01,Standard Silver On Exchange Plan,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0160002,Coventry Silver $10 Copay Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF002,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51303,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0160002,Coventry Silver $10 Copay Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF002,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51303,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160002-03,Limited Cost Sharing Plan Variation,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0160002,Coventry Silver $10 Copay Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF002,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51303,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160002-04,73% AV Level Silver Plan,72.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0160002,Coventry Silver $10 Copay Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF002,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51303,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160002-05,87% AV Level Silver Plan,86.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0160002,Coventry Silver $10 Copay Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF002,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51303,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160002-06,94% AV Level Silver Plan,93.10%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0170002,Coventry Silver $10 Copay MIPPA,18973IA017,,IAN002,IAS002,IAF007,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51359,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170002-00,Standard Silver Off Exchange Plan,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0170002,Coventry Silver $10 Copay MIPPA,18973IA017,,IAN002,IAS002,IAF007,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51359,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170002-01,Standard Silver On Exchange Plan,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0170002,Coventry Silver $10 Copay MIPPA,18973IA017,,IAN002,IAS002,IAF007,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51359,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0170002,Coventry Silver $10 Copay MIPPA,18973IA017,,IAN002,IAS002,IAF007,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51359,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170002-03,Limited Cost Sharing Plan Variation,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0170002,Coventry Silver $10 Copay MIPPA,18973IA017,,IAN002,IAS002,IAF007,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51359,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170002-04,73% AV Level Silver Plan,72.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0170002,Coventry Silver $10 Copay MIPPA,18973IA017,,IAN002,IAS002,IAF007,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51359,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170002-05,87% AV Level Silver Plan,86.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0170002,Coventry Silver $10 Copay MIPPA,18973IA017,,IAN002,IAS002,IAF007,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51359,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170002-06,94% AV Level Silver Plan,93.10%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0190002,Coventry Silver $10 Copay Patient Preferred,18973IA019,,IAN003,IAS003,IAF017,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51451,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190002-00,Standard Silver Off Exchange Plan,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0190002,Coventry Silver $10 Copay Patient Preferred,18973IA019,,IAN003,IAS003,IAF017,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51451,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190002-01,Standard Silver On Exchange Plan,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0190002,Coventry Silver $10 Copay Patient Preferred,18973IA019,,IAN003,IAS003,IAF017,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51451,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0190002,Coventry Silver $10 Copay Patient Preferred,18973IA019,,IAN003,IAS003,IAF017,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51451,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190002-03,Limited Cost Sharing Plan Variation,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0190002,Coventry Silver $10 Copay Patient Preferred,18973IA019,,IAN003,IAS003,IAF017,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51451,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190002-04,73% AV Level Silver Plan,72.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0190002,Coventry Silver $10 Copay Patient Preferred,18973IA019,,IAN003,IAS003,IAF017,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51451,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190002-05,87% AV Level Silver Plan,86.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,5,18973,IA,Individual,No,42-1244752,18973IA0190002,Coventry Silver $10 Copay Patient Preferred,18973IA019,,IAN003,IAS003,IAF017,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51451,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190002-06,94% AV Level Silver Plan,93.10%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0220020,Coventry Silver $10 Copay UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF031,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51507,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220020-00,Standard Silver Off Exchange Plan,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0220020,Coventry Silver $10 Copay UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF031,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51507,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220020-01,Standard Silver On Exchange Plan,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0220020,Coventry Silver $10 Copay UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF031,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51507,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220020-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0220020,Coventry Silver $10 Copay UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF031,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51507,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220020-03,Limited Cost Sharing Plan Variation,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0220020,Coventry Silver $10 Copay UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF031,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51507,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220020-04,73% AV Level Silver Plan,72.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0220020,Coventry Silver $10 Copay UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF031,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51507,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220020-05,87% AV Level Silver Plan,86.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0220020,Coventry Silver $10 Copay UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF031,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51507,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220020-06,94% AV Level Silver Plan,93.10%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0210014,Coventry Silver $10 Copay UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF022,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51479,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210014-00,Standard Silver Off Exchange Plan,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0210014,Coventry Silver $10 Copay UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF022,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51479,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210014-01,Standard Silver On Exchange Plan,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0210014,Coventry Silver $10 Copay UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF022,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51479,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210014-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0210014,Coventry Silver $10 Copay UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF022,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51479,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210014-03,Limited Cost Sharing Plan Variation,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0210014,Coventry Silver $10 Copay UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF022,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51479,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210014-04,73% AV Level Silver Plan,72.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0210014,Coventry Silver $10 Copay UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF022,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51479,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210014-05,87% AV Level Silver Plan,86.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0210014,Coventry Silver $10 Copay UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF022,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51479,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210014-06,94% AV Level Silver Plan,93.10%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0220021,Coventry Silver $10 Copay UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF030,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51535,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220021-00,Standard Silver Off Exchange Plan,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0220021,Coventry Silver $10 Copay UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF030,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51535,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220021-01,Standard Silver On Exchange Plan,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0220021,Coventry Silver $10 Copay UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF030,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51535,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220021-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0220021,Coventry Silver $10 Copay UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF030,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51535,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220021-03,Limited Cost Sharing Plan Variation,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0220021,Coventry Silver $10 Copay UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF030,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51535,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220021-04,73% AV Level Silver Plan,72.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0220021,Coventry Silver $10 Copay UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF030,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51535,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220021-05,87% AV Level Silver Plan,86.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0220021,Coventry Silver $10 Copay UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF030,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51535,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220021-06,94% AV Level Silver Plan,93.10%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0220022,Coventry Silver $10 Copay UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF029,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51563,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220022-00,Standard Silver Off Exchange Plan,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0220022,Coventry Silver $10 Copay UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF029,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51563,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220022-01,Standard Silver On Exchange Plan,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0220022,Coventry Silver $10 Copay UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF029,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51563,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220022-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0220022,Coventry Silver $10 Copay UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF029,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51563,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220022-03,Limited Cost Sharing Plan Variation,68.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0220022,Coventry Silver $10 Copay UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF029,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51563,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220022-04,73% AV Level Silver Plan,72.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0220022,Coventry Silver $10 Copay UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF029,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51563,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220022-05,87% AV Level Silver Plan,86.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,6,18973,IA,Individual,No,42-1244752,18973IA0220022,Coventry Silver $10 Copay UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF029,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51563,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220022-06,94% AV Level Silver Plan,93.10%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0250016,Coventry Silver $5 Copay 2750,18973IA025,,IAN001,IAS001,IAF050,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51421,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250016-00,Standard Silver Off Exchange Plan,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0250016,Coventry Silver $5 Copay 2750,18973IA025,,IAN001,IAS001,IAF050,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51421,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250016-01,Standard Silver On Exchange Plan,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0250016,Coventry Silver $5 Copay 2750,18973IA025,,IAN001,IAS001,IAF050,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51421,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250016-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0250016,Coventry Silver $5 Copay 2750,18973IA025,,IAN001,IAS001,IAF050,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51421,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250016-03,Limited Cost Sharing Plan Variation,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0250016,Coventry Silver $5 Copay 2750,18973IA025,,IAN001,IAS001,IAF050,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51421,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250016-04,73% AV Level Silver Plan,72.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0250016,Coventry Silver $5 Copay 2750,18973IA025,,IAN001,IAS001,IAF050,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51421,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250016-05,87% AV Level Silver Plan,86.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0250016,Coventry Silver $5 Copay 2750,18973IA025,,IAN001,IAS001,IAF050,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51421,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250016-06,94% AV Level Silver Plan,93.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0360005,Coventry Silver $5 Copay 2750 Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF112,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51393,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360005-00,Standard Silver Off Exchange Plan,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0360005,Coventry Silver $5 Copay 2750 Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF112,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51393,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360005-01,Standard Silver On Exchange Plan,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0360005,Coventry Silver $5 Copay 2750 Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF112,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51393,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0360005,Coventry Silver $5 Copay 2750 Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF112,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51393,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360005-03,Limited Cost Sharing Plan Variation,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0360005,Coventry Silver $5 Copay 2750 Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF112,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51393,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360005-04,73% AV Level Silver Plan,72.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0360005,Coventry Silver $5 Copay 2750 Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF112,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51393,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360005-05,87% AV Level Silver Plan,86.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0360005,Coventry Silver $5 Copay 2750 Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF112,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51393,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360005-06,94% AV Level Silver Plan,93.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0180011,Coventry Silver $5 Copay 2750 Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF015,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51337,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180011-00,Standard Silver Off Exchange Plan,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0180011,Coventry Silver $5 Copay 2750 Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF015,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51337,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180011-01,Standard Silver On Exchange Plan,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0180011,Coventry Silver $5 Copay 2750 Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF015,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51337,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0180011,Coventry Silver $5 Copay 2750 Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF015,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51337,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180011-03,Limited Cost Sharing Plan Variation,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0180011,Coventry Silver $5 Copay 2750 Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF015,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51337,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180011-04,73% AV Level Silver Plan,72.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0180011,Coventry Silver $5 Copay 2750 Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF015,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51337,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180011-05,87% AV Level Silver Plan,86.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0180011,Coventry Silver $5 Copay 2750 Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF015,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51337,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180011-06,94% AV Level Silver Plan,93.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,24
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0250017,Coventry Silver $5 Copay 2750 Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF051,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51597,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250017-00,Standard Silver Off Exchange Plan,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0250017,Coventry Silver $5 Copay 2750 Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF051,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51597,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250017-01,Standard Silver On Exchange Plan,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0250017,Coventry Silver $5 Copay 2750 Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF051,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51597,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250017-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,27
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0250017,Coventry Silver $5 Copay 2750 Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF051,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51597,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250017-03,Limited Cost Sharing Plan Variation,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0250017,Coventry Silver $5 Copay 2750 Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF051,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51597,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250017-04,73% AV Level Silver Plan,72.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0250017,Coventry Silver $5 Copay 2750 Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF051,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51597,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250017-05,87% AV Level Silver Plan,86.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,7,18973,IA,Individual,No,42-1244752,18973IA0250017,Coventry Silver $5 Copay 2750 Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF051,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51597,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250017-06,94% AV Level Silver Plan,93.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0160011,Coventry Silver $5 Copay 2750 Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51309,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160011-00,Standard Silver Off Exchange Plan,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0160011,Coventry Silver $5 Copay 2750 Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51309,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160011-01,Standard Silver On Exchange Plan,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0160011,Coventry Silver $5 Copay 2750 Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51309,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0160011,Coventry Silver $5 Copay 2750 Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51309,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160011-03,Limited Cost Sharing Plan Variation,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0160011,Coventry Silver $5 Copay 2750 Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51309,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160011-04,73% AV Level Silver Plan,72.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0160011,Coventry Silver $5 Copay 2750 Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51309,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160011-05,87% AV Level Silver Plan,86.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0160011,Coventry Silver $5 Copay 2750 Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51309,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160011-06,94% AV Level Silver Plan,93.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0170011,Coventry Silver $5 Copay 2750 MIPPA,18973IA017,,IAN002,IAS002,IAF010,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51365,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170011-00,Standard Silver Off Exchange Plan,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0170011,Coventry Silver $5 Copay 2750 MIPPA,18973IA017,,IAN002,IAS002,IAF010,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51365,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170011-01,Standard Silver On Exchange Plan,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0170011,Coventry Silver $5 Copay 2750 MIPPA,18973IA017,,IAN002,IAS002,IAF010,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51365,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,13
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0170011,Coventry Silver $5 Copay 2750 MIPPA,18973IA017,,IAN002,IAS002,IAF010,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51365,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170011-03,Limited Cost Sharing Plan Variation,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0170011,Coventry Silver $5 Copay 2750 MIPPA,18973IA017,,IAN002,IAS002,IAF010,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51365,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170011-04,73% AV Level Silver Plan,72.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0170011,Coventry Silver $5 Copay 2750 MIPPA,18973IA017,,IAN002,IAS002,IAF010,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51365,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170011-05,87% AV Level Silver Plan,86.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0170011,Coventry Silver $5 Copay 2750 MIPPA,18973IA017,,IAN002,IAS002,IAF010,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51365,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170011-06,94% AV Level Silver Plan,93.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0190011,Coventry Silver $5 Copay 2750 Patient Preferred,18973IA019,,IAN003,IAS003,IAF020,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51457,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190011-00,Standard Silver Off Exchange Plan,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0190011,Coventry Silver $5 Copay 2750 Patient Preferred,18973IA019,,IAN003,IAS003,IAF020,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51457,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190011-01,Standard Silver On Exchange Plan,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0190011,Coventry Silver $5 Copay 2750 Patient Preferred,18973IA019,,IAN003,IAS003,IAF020,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51457,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,20
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0190011,Coventry Silver $5 Copay 2750 Patient Preferred,18973IA019,,IAN003,IAS003,IAF020,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51457,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190011-03,Limited Cost Sharing Plan Variation,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0190011,Coventry Silver $5 Copay 2750 Patient Preferred,18973IA019,,IAN003,IAS003,IAF020,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51457,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190011-04,73% AV Level Silver Plan,72.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0190011,Coventry Silver $5 Copay 2750 Patient Preferred,18973IA019,,IAN003,IAS003,IAF020,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51457,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190011-05,87% AV Level Silver Plan,86.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0190011,Coventry Silver $5 Copay 2750 Patient Preferred,18973IA019,,IAN003,IAS003,IAF020,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51457,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190011-06,94% AV Level Silver Plan,93.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0220023,Coventry Silver $5 Copay 2750 UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF038,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51513,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220023-00,Standard Silver Off Exchange Plan,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0220023,Coventry Silver $5 Copay 2750 UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF038,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51513,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220023-01,Standard Silver On Exchange Plan,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0220023,Coventry Silver $5 Copay 2750 UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF038,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51513,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220023-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,27
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0220023,Coventry Silver $5 Copay 2750 UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF038,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51513,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220023-03,Limited Cost Sharing Plan Variation,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0220023,Coventry Silver $5 Copay 2750 UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF038,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51513,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220023-04,73% AV Level Silver Plan,72.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0220023,Coventry Silver $5 Copay 2750 UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF038,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51513,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220023-05,87% AV Level Silver Plan,86.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,8,18973,IA,Individual,No,42-1244752,18973IA0220023,Coventry Silver $5 Copay 2750 UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF038,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51513,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220023-06,94% AV Level Silver Plan,93.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,9,18973,IA,Individual,No,42-1244752,18973IA0210015,Coventry Silver $5 Copay 2750 UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF025,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51485,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210015-00,Standard Silver Off Exchange Plan,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,9,18973,IA,Individual,No,42-1244752,18973IA0210015,Coventry Silver $5 Copay 2750 UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF025,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51485,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210015-01,Standard Silver On Exchange Plan,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,9,18973,IA,Individual,No,42-1244752,18973IA0210015,Coventry Silver $5 Copay 2750 UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF025,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51485,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210015-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,9,18973,IA,Individual,No,42-1244752,18973IA0210015,Coventry Silver $5 Copay 2750 UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF025,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51485,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210015-03,Limited Cost Sharing Plan Variation,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,9,18973,IA,Individual,No,42-1244752,18973IA0210015,Coventry Silver $5 Copay 2750 UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF025,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51485,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210015-04,73% AV Level Silver Plan,72.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,9,18973,IA,Individual,No,42-1244752,18973IA0210015,Coventry Silver $5 Copay 2750 UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF025,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51485,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210015-05,87% AV Level Silver Plan,86.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,9,18973,IA,Individual,No,42-1244752,18973IA0210015,Coventry Silver $5 Copay 2750 UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF025,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51485,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210015-06,94% AV Level Silver Plan,93.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,9,18973,IA,Individual,No,42-1244752,18973IA0220024,Coventry Silver $5 Copay 2750 UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF039,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51541,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220024-00,Standard Silver Off Exchange Plan,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,9,18973,IA,Individual,No,42-1244752,18973IA0220024,Coventry Silver $5 Copay 2750 UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF039,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51541,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220024-01,Standard Silver On Exchange Plan,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,9,18973,IA,Individual,No,42-1244752,18973IA0220024,Coventry Silver $5 Copay 2750 UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF039,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51541,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220024-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,13
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,9,18973,IA,Individual,No,42-1244752,18973IA0220024,Coventry Silver $5 Copay 2750 UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF039,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51541,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220024-03,Limited Cost Sharing Plan Variation,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,9,18973,IA,Individual,No,42-1244752,18973IA0220024,Coventry Silver $5 Copay 2750 UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF039,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51541,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220024-04,73% AV Level Silver Plan,72.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,9,18973,IA,Individual,No,42-1244752,18973IA0220024,Coventry Silver $5 Copay 2750 UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF039,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51541,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220024-05,87% AV Level Silver Plan,86.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,9,18973,IA,Individual,No,42-1244752,18973IA0220024,Coventry Silver $5 Copay 2750 UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF039,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51541,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220024-06,94% AV Level Silver Plan,93.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,9,18973,IA,Individual,No,42-1244752,18973IA0220025,Coventry Silver $5 Copay 2750 UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF040,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51569,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220025-00,Standard Silver Off Exchange Plan,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,9,18973,IA,Individual,No,42-1244752,18973IA0220025,Coventry Silver $5 Copay 2750 UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF040,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51569,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220025-01,Standard Silver On Exchange Plan,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,9,18973,IA,Individual,No,42-1244752,18973IA0220025,Coventry Silver $5 Copay 2750 UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF040,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51569,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220025-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,20
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,9,18973,IA,Individual,No,42-1244752,18973IA0220025,Coventry Silver $5 Copay 2750 UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF040,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51569,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220025-03,Limited Cost Sharing Plan Variation,68.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,9,18973,IA,Individual,No,42-1244752,18973IA0220025,Coventry Silver $5 Copay 2750 UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF040,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51569,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220025-04,73% AV Level Silver Plan,72.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,9,18973,IA,Individual,No,42-1244752,18973IA0220025,Coventry Silver $5 Copay 2750 UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF040,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51569,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220025-05,87% AV Level Silver Plan,86.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,9,18973,IA,Individual,No,42-1244752,18973IA0220025,Coventry Silver $5 Copay 2750 UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF040,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51569,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220025-06,94% AV Level Silver Plan,93.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,10,18973,IA,Individual,No,42-1244752,18973IA0250003,Coventry Bronze $20 Copay,18973IA025,,IAN001,IAS001,IAF043,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51427,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250003-00,Standard Bronze Off Exchange Plan,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,10,18973,IA,Individual,No,42-1244752,18973IA0250003,Coventry Bronze $20 Copay,18973IA025,,IAN001,IAS001,IAF043,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51427,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250003-01,Standard Bronze On Exchange Plan,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,10,18973,IA,Individual,No,42-1244752,18973IA0250003,Coventry Bronze $20 Copay,18973IA025,,IAN001,IAS001,IAF043,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51427,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,10,18973,IA,Individual,No,42-1244752,18973IA0250003,Coventry Bronze $20 Copay,18973IA025,,IAN001,IAS001,IAF043,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51427,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250003-03,Limited Cost Sharing Plan Variation,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,10,18973,IA,Individual,No,42-1244752,18973IA0360001,Coventry Bronze $20 Copay Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF108,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51399,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360001-00,Standard Bronze Off Exchange Plan,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,10,18973,IA,Individual,No,42-1244752,18973IA0360001,Coventry Bronze $20 Copay Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF108,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51399,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360001-01,Standard Bronze On Exchange Plan,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,10,18973,IA,Individual,No,42-1244752,18973IA0360001,Coventry Bronze $20 Copay Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF108,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51399,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,10,18973,IA,Individual,No,42-1244752,18973IA0360001,Coventry Bronze $20 Copay Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF108,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51399,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360001-03,Limited Cost Sharing Plan Variation,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,10,18973,IA,Individual,No,42-1244752,18973IA0180003,Coventry Bronze $20 Copay Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF013,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51343,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180003-00,Standard Bronze Off Exchange Plan,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,10,18973,IA,Individual,No,42-1244752,18973IA0180003,Coventry Bronze $20 Copay Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF013,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51343,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180003-01,Standard Bronze On Exchange Plan,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,10,18973,IA,Individual,No,42-1244752,18973IA0180003,Coventry Bronze $20 Copay Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF013,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51343,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,10,18973,IA,Individual,No,42-1244752,18973IA0180003,Coventry Bronze $20 Copay Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF013,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51343,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180003-03,Limited Cost Sharing Plan Variation,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,10,18973,IA,Individual,No,42-1244752,18973IA0250011,Coventry Bronze $20 Copay Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF045,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA73510,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250011-00,Standard Bronze Off Exchange Plan,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,10,18973,IA,Individual,No,42-1244752,18973IA0250011,Coventry Bronze $20 Copay Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF045,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA73510,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250011-01,Standard Bronze On Exchange Plan,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,10,18973,IA,Individual,No,42-1244752,18973IA0250011,Coventry Bronze $20 Copay Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF045,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA73510,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,18
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,10,18973,IA,Individual,No,42-1244752,18973IA0250011,Coventry Bronze $20 Copay Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF045,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA73510,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250011-03,Limited Cost Sharing Plan Variation,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,11,18973,IA,Individual,No,42-1244752,18973IA0160003,Coventry Bronze $20 Copay Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51315,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160003-00,Standard Bronze Off Exchange Plan,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,11,18973,IA,Individual,No,42-1244752,18973IA0160003,Coventry Bronze $20 Copay Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51315,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160003-01,Standard Bronze On Exchange Plan,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,11,18973,IA,Individual,No,42-1244752,18973IA0160003,Coventry Bronze $20 Copay Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51315,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,11,18973,IA,Individual,No,42-1244752,18973IA0160003,Coventry Bronze $20 Copay Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51315,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160003-03,Limited Cost Sharing Plan Variation,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,11,18973,IA,Individual,No,42-1244752,18973IA0170003,Coventry Bronze $20 Copay MIPPA,18973IA017,,IAN002,IAS002,IAF008,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51371,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170003-00,Standard Bronze Off Exchange Plan,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,11,18973,IA,Individual,No,42-1244752,18973IA0170003,Coventry Bronze $20 Copay MIPPA,18973IA017,,IAN002,IAS002,IAF008,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51371,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170003-01,Standard Bronze On Exchange Plan,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,11,18973,IA,Individual,No,42-1244752,18973IA0170003,Coventry Bronze $20 Copay MIPPA,18973IA017,,IAN002,IAS002,IAF008,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51371,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,10
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,11,18973,IA,Individual,No,42-1244752,18973IA0170003,Coventry Bronze $20 Copay MIPPA,18973IA017,,IAN002,IAS002,IAF008,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51371,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170003-03,Limited Cost Sharing Plan Variation,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,11,18973,IA,Individual,No,42-1244752,18973IA0190003,Coventry Bronze $20 Copay Patient Preferred,18973IA019,,IAN003,IAS003,IAF018,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51463,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190003-00,Standard Bronze Off Exchange Plan,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,11,18973,IA,Individual,No,42-1244752,18973IA0190003,Coventry Bronze $20 Copay Patient Preferred,18973IA019,,IAN003,IAS003,IAF018,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51463,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190003-01,Standard Bronze On Exchange Plan,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,11,18973,IA,Individual,No,42-1244752,18973IA0190003,Coventry Bronze $20 Copay Patient Preferred,18973IA019,,IAN003,IAS003,IAF018,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51463,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,14
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,11,18973,IA,Individual,No,42-1244752,18973IA0190003,Coventry Bronze $20 Copay Patient Preferred,18973IA019,,IAN003,IAS003,IAF018,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51463,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190003-03,Limited Cost Sharing Plan Variation,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,11,18973,IA,Individual,No,42-1244752,18973IA0220011,Coventry Bronze $20 Copay UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF032,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51519,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220011-00,Standard Bronze Off Exchange Plan,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,11,18973,IA,Individual,No,42-1244752,18973IA0220011,Coventry Bronze $20 Copay UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF032,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51519,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220011-01,Standard Bronze On Exchange Plan,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,11,18973,IA,Individual,No,42-1244752,18973IA0220011,Coventry Bronze $20 Copay UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF032,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51519,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,18
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,11,18973,IA,Individual,No,42-1244752,18973IA0220011,Coventry Bronze $20 Copay UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF032,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51519,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220011-03,Limited Cost Sharing Plan Variation,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,12,18973,IA,Individual,No,42-1244752,18973IA0210011,Coventry Bronze $20 Copay UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF023,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51491,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210011-00,Standard Bronze Off Exchange Plan,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,12,18973,IA,Individual,No,42-1244752,18973IA0210011,Coventry Bronze $20 Copay UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF023,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51491,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210011-01,Standard Bronze On Exchange Plan,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,12,18973,IA,Individual,No,42-1244752,18973IA0210011,Coventry Bronze $20 Copay UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF023,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51491,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,12,18973,IA,Individual,No,42-1244752,18973IA0210011,Coventry Bronze $20 Copay UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF023,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51491,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210011-03,Limited Cost Sharing Plan Variation,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,12,18973,IA,Individual,No,42-1244752,18973IA0220012,Coventry Bronze $20 Copay UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF033,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51547,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220012-00,Standard Bronze Off Exchange Plan,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,12,18973,IA,Individual,No,42-1244752,18973IA0220012,Coventry Bronze $20 Copay UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF033,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51547,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220012-01,Standard Bronze On Exchange Plan,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,12,18973,IA,Individual,No,42-1244752,18973IA0220012,Coventry Bronze $20 Copay UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF033,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51547,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220012-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,10
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,12,18973,IA,Individual,No,42-1244752,18973IA0220012,Coventry Bronze $20 Copay UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF033,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51547,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220012-03,Limited Cost Sharing Plan Variation,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,12,18973,IA,Individual,No,42-1244752,18973IA0220013,Coventry Bronze $20 Copay UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF034,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51575,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220013-00,Standard Bronze Off Exchange Plan,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,12,18973,IA,Individual,No,42-1244752,18973IA0220013,Coventry Bronze $20 Copay UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF034,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51575,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220013-01,Standard Bronze On Exchange Plan,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,12,18973,IA,Individual,No,42-1244752,18973IA0220013,Coventry Bronze $20 Copay UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF034,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51575,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220013-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,14
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,12,18973,IA,Individual,No,42-1244752,18973IA0220013,Coventry Bronze $20 Copay UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF034,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51575,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220013-03,Limited Cost Sharing Plan Variation,61.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,13,18973,IA,Individual,No,42-1244752,18973IA0250005,Coventry Bronze Deductible Only HSA Eligible,18973IA025,,IAN001,IAS001,IAF044,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51430,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250005-00,Standard Bronze Off Exchange Plan,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,13,18973,IA,Individual,No,42-1244752,18973IA0250005,Coventry Bronze Deductible Only HSA Eligible,18973IA025,,IAN001,IAS001,IAF044,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51430,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250005-01,Standard Bronze On Exchange Plan,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,13,18973,IA,Individual,No,42-1244752,18973IA0250005,Coventry Bronze Deductible Only HSA Eligible,18973IA025,,IAN001,IAS001,IAF044,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51430,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,13,18973,IA,Individual,No,42-1244752,18973IA0250005,Coventry Bronze Deductible Only HSA Eligible,18973IA025,,IAN001,IAS001,IAF044,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51430,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250005-03,Limited Cost Sharing Plan Variation,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,13,18973,IA,Individual,No,42-1244752,18973IA0360002,Coventry Bronze Deductible Only HSA Eligible Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF109,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51402,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360002-00,Standard Bronze Off Exchange Plan,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,13,18973,IA,Individual,No,42-1244752,18973IA0360002,Coventry Bronze Deductible Only HSA Eligible Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF109,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51402,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360002-01,Standard Bronze On Exchange Plan,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,13,18973,IA,Individual,No,42-1244752,18973IA0360002,Coventry Bronze Deductible Only HSA Eligible Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF109,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51402,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,13,18973,IA,Individual,No,42-1244752,18973IA0360002,Coventry Bronze Deductible Only HSA Eligible Accountable Care Alliance,18973IA036,,IAN012,IAS012,IAF109,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51402,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0360002-03,Limited Cost Sharing Plan Variation,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,13,18973,IA,Individual,No,42-1244752,18973IA0180005,Coventry Bronze Deductible Only HSA Eligible Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF014,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51346,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180005-00,Standard Bronze Off Exchange Plan,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,13,18973,IA,Individual,No,42-1244752,18973IA0180005,Coventry Bronze Deductible Only HSA Eligible Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF014,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51346,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180005-01,Standard Bronze On Exchange Plan,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,13,18973,IA,Individual,No,42-1244752,18973IA0180005,Coventry Bronze Deductible Only HSA Eligible Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF014,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51346,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,13,18973,IA,Individual,No,42-1244752,18973IA0180005,Coventry Bronze Deductible Only HSA Eligible Alegent Creighton Health,18973IA018,,IAN010,IAS010,IAF014,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51346,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0180005-03,Limited Cost Sharing Plan Variation,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,13,18973,IA,Individual,No,42-1244752,18973IA0250012,Coventry Bronze Deductible Only HSA Eligible Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF046,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA73513,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250012-00,Standard Bronze Off Exchange Plan,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,16
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,13,18973,IA,Individual,No,42-1244752,18973IA0250012,Coventry Bronze Deductible Only HSA Eligible Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF046,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA73513,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250012-01,Standard Bronze On Exchange Plan,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,17
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,13,18973,IA,Individual,No,42-1244752,18973IA0250012,Coventry Bronze Deductible Only HSA Eligible Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF046,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA73513,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250012-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,18
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,13,18973,IA,Individual,No,42-1244752,18973IA0250012,Coventry Bronze Deductible Only HSA Eligible Mercy Des Moines,18973IA025,,IAN008,IAS008,IAF046,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA73513,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0250012-03,Limited Cost Sharing Plan Variation,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,19
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,14,18973,IA,Individual,No,42-1244752,18973IA0160005,Coventry Bronze Deductible Only HSA Eligible Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF004,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51318,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160005-00,Standard Bronze Off Exchange Plan,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,14,18973,IA,Individual,No,42-1244752,18973IA0160005,Coventry Bronze Deductible Only HSA Eligible Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF004,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51318,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160005-01,Standard Bronze On Exchange Plan,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,14,18973,IA,Individual,No,42-1244752,18973IA0160005,Coventry Bronze Deductible Only HSA Eligible Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF004,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51318,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,14,18973,IA,Individual,No,42-1244752,18973IA0160005,Coventry Bronze Deductible Only HSA Eligible Methodist Health Partners,18973IA016,,IAN011,IAS011,IAF004,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/IA51318,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0160005-03,Limited Cost Sharing Plan Variation,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,14,18973,IA,Individual,No,42-1244752,18973IA0170005,Coventry Bronze Deductible Only HSA Eligible MIPPA,18973IA017,,IAN002,IAS002,IAF009,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51374,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170005-00,Standard Bronze Off Exchange Plan,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,8
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,14,18973,IA,Individual,No,42-1244752,18973IA0170005,Coventry Bronze Deductible Only HSA Eligible MIPPA,18973IA017,,IAN002,IAS002,IAF009,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51374,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170005-01,Standard Bronze On Exchange Plan,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,9
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,14,18973,IA,Individual,No,42-1244752,18973IA0170005,Coventry Bronze Deductible Only HSA Eligible MIPPA,18973IA017,,IAN002,IAS002,IAF009,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51374,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,10
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,14,18973,IA,Individual,No,42-1244752,18973IA0170005,Coventry Bronze Deductible Only HSA Eligible MIPPA,18973IA017,,IAN002,IAS002,IAF009,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51374,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0170005-03,Limited Cost Sharing Plan Variation,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,11
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,14,18973,IA,Individual,No,42-1244752,18973IA0190005,Coventry Bronze Deductible Only HSA Eligible Patient Preferred,18973IA019,,IAN003,IAS003,IAF019,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51466,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190005-00,Standard Bronze Off Exchange Plan,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,12
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,14,18973,IA,Individual,No,42-1244752,18973IA0190005,Coventry Bronze Deductible Only HSA Eligible Patient Preferred,18973IA019,,IAN003,IAS003,IAF019,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51466,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190005-01,Standard Bronze On Exchange Plan,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,13
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,14,18973,IA,Individual,No,42-1244752,18973IA0190005,Coventry Bronze Deductible Only HSA Eligible Patient Preferred,18973IA019,,IAN003,IAS003,IAF019,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51466,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,14
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,14,18973,IA,Individual,No,42-1244752,18973IA0190005,Coventry Bronze Deductible Only HSA Eligible Patient Preferred,18973IA019,,IAN003,IAS003,IAF019,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51466,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0190005-03,Limited Cost Sharing Plan Variation,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,15
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,14,18973,IA,Individual,No,42-1244752,18973IA0220014,Coventry Bronze Deductible Only HSA Eligible UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF037,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51522,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220014-00,Standard Bronze Off Exchange Plan,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,16
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,14,18973,IA,Individual,No,42-1244752,18973IA0220014,Coventry Bronze Deductible Only HSA Eligible UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF037,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51522,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220014-01,Standard Bronze On Exchange Plan,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,17
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,14,18973,IA,Individual,No,42-1244752,18973IA0220014,Coventry Bronze Deductible Only HSA Eligible UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF037,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51522,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220014-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,18
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,14,18973,IA,Individual,No,42-1244752,18973IA0220014,Coventry Bronze Deductible Only HSA Eligible UnityPoint Health Cedar Rapids,18973IA022,,IAN006,IAS006,IAF037,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51522,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220014-03,Limited Cost Sharing Plan Variation,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,19
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,15,18973,IA,Individual,No,42-1244752,18973IA0210012,Coventry Bronze Deductible Only HSA Eligible UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF024,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51494,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210012-00,Standard Bronze Off Exchange Plan,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,15,18973,IA,Individual,No,42-1244752,18973IA0210012,Coventry Bronze Deductible Only HSA Eligible UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF024,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51494,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210012-01,Standard Bronze On Exchange Plan,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,15,18973,IA,Individual,No,42-1244752,18973IA0210012,Coventry Bronze Deductible Only HSA Eligible UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF024,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51494,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210012-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,15,18973,IA,Individual,No,42-1244752,18973IA0210012,Coventry Bronze Deductible Only HSA Eligible UnityPoint Health Des Moines,18973IA021,,IAN004,IAS004,IAF024,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51494,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0210012-03,Limited Cost Sharing Plan Variation,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,15,18973,IA,Individual,No,42-1244752,18973IA0220015,Coventry Bronze Deductible Only HSA Eligible UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF036,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51550,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220015-00,Standard Bronze Off Exchange Plan,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,8
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,15,18973,IA,Individual,No,42-1244752,18973IA0220015,Coventry Bronze Deductible Only HSA Eligible UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF036,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51550,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220015-01,Standard Bronze On Exchange Plan,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,9
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,15,18973,IA,Individual,No,42-1244752,18973IA0220015,Coventry Bronze Deductible Only HSA Eligible UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF036,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51550,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220015-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,10
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,15,18973,IA,Individual,No,42-1244752,18973IA0220015,Coventry Bronze Deductible Only HSA Eligible UnityPoint Health Quad Cities Muscatine,18973IA022,,IAN005,IAS005,IAF036,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51550,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220015-03,Limited Cost Sharing Plan Variation,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,11
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,15,18973,IA,Individual,No,42-1244752,18973IA0220016,Coventry Bronze Deductible Only HSA Eligible UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF035,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51578,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220016-00,Standard Bronze Off Exchange Plan,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,12
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,15,18973,IA,Individual,No,42-1244752,18973IA0220016,Coventry Bronze Deductible Only HSA Eligible UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF035,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51578,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220016-01,Standard Bronze On Exchange Plan,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,13
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,15,18973,IA,Individual,No,42-1244752,18973IA0220016,Coventry Bronze Deductible Only HSA Eligible UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF035,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51578,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220016-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,14
2015,IA,18973,SERFF,8,2014-11-13 16:11:17,15,18973,IA,Individual,No,42-1244752,18973IA0220016,Coventry Bronze Deductible Only HSA Eligible UnityPoint Health Waterloo,18973IA022,,IAN007,IAS007,IAF035,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.999989278450555,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IA51578,https://ssoprod.healthplan.com/sp/ACS.saml2,,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,18973IA0220016-03,Limited Cost Sharing Plan Variation,58.40%,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,15
2015,IA,23499,SERFF,2,2014-08-12 09:41:38,1,23499,IA,SHOP (Small Group),Yes,41-0808596,23499IA0010001,"Plan 1. Passive PPO, $1000 Annual Maximum, no Ortho",23499IA001,,IAN001,IAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,23499IA0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,23499,SERFF,2,2014-08-12 09:41:38,1,23499,IA,SHOP (Small Group),Yes,41-0808596,23499IA0010002,"Plan 2.  Passive PPO, $1000 Annual Maximum, Ortho",23499IA001,,IAN001,IAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,23499IA0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,23499,SERFF,2,2014-08-12 09:41:38,1,23499,IA,SHOP (Small Group),Yes,41-0808596,23499IA0010003,"Plan 3. Passive PPO, $1500 Annual Maximum, no Ortho",23499IA001,,IAN001,IAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,23499IA0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IA,23499,SERFF,2,2014-08-12 09:41:38,1,23499,IA,SHOP (Small Group),Yes,41-0808596,23499IA0010004,"Plan 4.  Passive PPO, $1500 Annual Maximum, Ortho",23499IA001,,IAN001,IAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,23499IA0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IA,23499,SERFF,2,2014-08-12 09:41:38,1,23499,IA,SHOP (Small Group),Yes,41-0808596,23499IA0010005,"Plan 5.  Passive PPO, $2000 Annual Maximum, Ortho",23499IA001,,IAN001,IAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,23499IA0010005-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,IA,23499,SERFF,2,2014-08-12 09:41:38,1,23499,IA,SHOP (Small Group),Yes,41-0808596,23499IA0010006,"Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho",23499IA001,,IAN001,IAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,23499IA0010006-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,3,27651,IA,Individual,No,39-1807071,27651IA0050007,Silver $2500 - 20%,27651IA005,,IAN003,IAS001,IAF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,3,27651,IA,Individual,No,39-1807071,27651IA0050007,Silver $2500 - 20%,27651IA005,,IAN003,IAS001,IAF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050007-03,Limited Cost Sharing Plan Variation,,0.688570082187653,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,3,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0070005,Silver $2000 - 20%,27651IA007,,IAN001,IAS001,IAF003,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8E&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0070005-01,Standard Silver On Exchange Plan,,0.719719231128693,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,3,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0070008,Silver $2000 - 0%,27651IA007,,IAN001,IAS001,IAF003,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8H&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0070008-00,Standard Silver Off Exchange Plan,,0.686079859733582,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IA,23499,SERFF,2,2014-08-12 09:41:38,1,23499,IA,SHOP (Small Group),Yes,41-0808596,23499IA0010007,"Plan 7. Graded Passive PPO, $1500 Annual Maximum, Ortho",23499IA001,,IAN001,IAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,23499IA0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,IA,23499,SERFF,2,2014-08-12 09:41:38,1,23499,IA,SHOP (Small Group),Yes,41-0808596,23499IA0010008,"Plan 8. MAC PPO, $1000 Annual Maximum, no Ortho",23499IA001,,IAN001,IAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,23499IA0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,IA,23499,SERFF,2,2014-08-12 09:41:38,1,23499,IA,SHOP (Small Group),Yes,41-0808596,23499IA0010009,"Plan 9. MAC PPO, $1500 Annual Maximum, Ortho",23499IA001,,IAN001,IAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,23499IA0010009-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,IA,23499,SERFF,2,2014-08-12 09:41:38,1,23499,IA,SHOP (Small Group),Yes,41-0808596,23499IA0010010,"Plan 10. Graded MAC PPO, $1000 Annual Maximum, no Ortho",23499IA001,,IAN001,IAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,23499IA0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,13
2015,IA,25440,SERFF,1,2014-08-11 09:11:26,1,25440,IA,SHOP (Small Group),Yes,93-0242990,25440IA0040002,EHB High PPO,25440IA004,,IAN001,IAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$40.09,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,25440IA0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,25440,SERFF,1,2014-08-11 09:11:26,1,25440,IA,SHOP (Small Group),Yes,93-0242990,25440IA0040001,EHB Low PPO,25440IA004,,IAN001,IAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.72,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,25440IA0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0080002,Bronze HSA $2500 - 50%,27651IA008,,IAN001,IAS001,IAF006,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=B8&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0080002-01,Standard Bronze On Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060001,Silver HSA $3500 - 0%,27651IA006,,IAN003,IAS001,IAF008,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060001-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$17,500","$35,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060001,Silver HSA $3500 - 0%,27651IA006,,IAN003,IAS001,IAF008,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060001-04,73% AV Level Silver Plan,,0.732454240322113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0080003,Bronze HSA $5000 - 30%,27651IA008,,IAN001,IAS001,IAF007,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=D8&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0080003-00,Standard Bronze Off Exchange Plan,,0.588535189628601,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0080004,Bronze HSA $6300 - 0%,27651IA008,,IAN001,IAS001,IAF008,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=E8&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0080004-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060002,Silver HSA $2000 - 50%,27651IA006,,IAN003,IAS001,IAF006,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060002-00,Standard Silver Off Exchange Plan,,0.682383358478546,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060002,Silver HSA $2000 - 50%,27651IA006,,IAN003,IAS001,IAF006,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060002-01,Standard Silver On Exchange Plan,,0.682383358478546,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0080003,Bronze HSA $5000 - 30%,27651IA008,,IAN001,IAS001,IAF007,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=D8&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0080003-01,Standard Bronze On Exchange Plan,,0.588535189628601,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060001,Silver HSA $3500 - 0%,27651IA006,,IAN003,IAS001,IAF008,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060001-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060001,Silver HSA $3500 - 0%,27651IA006,,IAN003,IAS001,IAF008,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060001-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0080004,Bronze HSA $6300 - 0%,27651IA008,,IAN001,IAS001,IAF008,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=E8&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0080004-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,IA,63366,SERFF,8,2014-11-04 20:29:03,2,63366,IA,Individual,Yes,42-0959302,63366IA0020002,Delta Dental PPO Plus Premier? Individual Choice - Preventive Plus,63366IA002,7790788922,IAN002,IAS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.24,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Claims can be submitted for reimbursement,Yes,Claims can be submitted for reimbursement if an in-network is not selected,Yes,www.deltadentalia.com/mp/individual/prevent15,https://saml.deltadentalia.com/sp/ACS.saml2,www.deltadentalia.com/mp/individual/brochure15,,63366IA0020002-01,Standard Low On Exchange Plan,69.10%,,,,Yes,33%,67%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,$75,Not Applicable,,$225,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,63366,SERFF,8,2014-11-04 20:29:03,2,63366,IA,Individual,Yes,42-0959302,63366IA0020004,Delta Dental PPO Plus Premier? Individual Choice - Preventive Plus,63366IA002,7790788922,IAN002,IAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.24,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Claims can be submitted for reimbursement,Yes,Claims can be submitted for reimbursement if an in-network is not selected,Yes,,,,,63366IA0020004-00,Standard Low Off Exchange Plan,69.10%,,,,Yes,33%,67%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,$75,Not Applicable,,$225,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,63366,SERFF,8,2014-11-04 20:29:03,2,63366,IA,SHOP (Small Group),Yes,42-0959302,63366IA0010009,Delta Dental Premier? Plan B Plus - HC,63366IA001,7790788922,IAN001,IAS001,,Existing,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.40,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Claims can be submitted for reimbursement,Yes,Claims can be submitted for reimbursement if an in-network dentist is not selected,Yes,,,,,63366IA0010009-00,Standard High Off Exchange Plan,83.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$225,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,63366,SERFF,8,2014-11-04 20:29:03,2,63366,IA,SHOP (Small Group),Yes,42-0959302,63366IA0010010,Delta Dental Premier? Plan C Plus - HC,63366IA001,7790788922,IAN001,IAS001,,Existing,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.40,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Claims can be submitted for reimbursement,Yes,Claims can be submitted for reimbursement if an in-network dentist is not selected,Yes,,,,,63366IA0010010-00,Standard High Off Exchange Plan,83.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$225,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IA,63366,SERFF,8,2014-11-04 20:29:03,3,63366,IA,Individual,Yes,42-0959302,63366IA0020005,Delta Dental PPO Plus Premier? Individual Comprehensive Plus,63366IA002,7790788922,IAN002,IAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.65,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Claims can be submitted for reimbursement,Yes,Claims can be submitted for reimbursement if an in-network is not selected,Yes,,,,,63366IA0020005-00,Standard High Off Exchange Plan,85.40%,,,,Yes,52%,48%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,$25,Not Applicable,,$225,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,63366,SERFF,8,2014-11-04 20:29:03,3,63366,IA,SHOP (Small Group),Yes,42-0959302,63366IA0010012,Delta Dental PPO Plus Premier? Plan A  Plus - L,63366IA001,7790788922,IAN002,IAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Claims can be submitted for reimbursement,Yes,Claims can be submitted for reimbusement if an in-network detntist is not selected,Yes,,,,,63366IA0010012-00,Standard Low Off Exchange Plan,69.10%,,,,Yes,50%,50%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,$75,Not Applicable,,$225,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,63366,SERFF,8,2014-11-04 20:29:03,3,63366,IA,SHOP (Small Group),Yes,42-0959302,63366IA0010013,Delta Dental PPO Plus Premier? Plan B Plus - H,63366IA001,7790788922,IAN002,IAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.40,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Claims can be submitted for reimbursement,Yes,Claims can be submitted for reimbusement if an in-network detntist is not selected,Yes,,,,,63366IA0010013-00,Standard High Off Exchange Plan,85.40%,,,,Yes,60%,40%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,$25,Not Applicable,,$225,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,63366,SERFF,8,2014-11-04 20:29:03,3,63366,IA,SHOP (Small Group),Yes,42-0959302,63366IA0010014,Delta Dental PPO Plus Premier? Plan C  Plus - H,63366IA001,7790788922,IAN002,IAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.40,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Claims can be submitted for reimbursement,Yes,Claims can be submitted for reimbusement if an in-network detntist is not selected,Yes,,,,,63366IA0010014-00,Standard High Off Exchange Plan,85.40%,,,,Yes,54%,46%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,$25,Not Applicable,,$225,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IA,63366,SERFF,8,2014-11-04 20:29:03,4,63366,IA,Individual,Yes,42-0959302,63366IA0020006,Delta Dental PPO Plus Premier? Individual Choice - Platinum Plus,63366IA002,7790788922,IAN002,IAS001,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.65,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Claims can be submitted for reimbursement,Yes,Claims can be submitted for reimbursement if an in-network is not selected,Yes,www.deltadentalia.com/mp/individual/plat15,https://saml.deltadentalia.com/sp/ACS.saml2,www.deltadentalia.com/mp/individual/brochure15,,63366IA0020006-01,Standard High On Exchange Plan,85.40%,,,,Yes,42%,58%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,$25,Not Applicable,,$225,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,63366,SERFF,8,2014-11-04 20:29:03,4,63366,IA,SHOP (Small Group),Yes,42-0959302,63366IA0010016,Delta Dental PPO Plus Premier? Plan A Plus - LC,63366IA001,7790788922,IAN002,IAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Claims can be submitted for reimbursement,Yes,Claims can be submitted for reimbusement if an in-network detntist is not selected,Yes,,,,,63366IA0010016-00,Standard Low Off Exchange Plan,69.10%,,,,Yes,54%,46%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,$75,Not Applicable,,$225,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,63366,SERFF,8,2014-11-04 20:29:03,4,63366,IA,Individual,Yes,42-0959302,63366IA0020007,Delta Dental PPO Plus Premier? Individual Choice - Platinum Plus,63366IA002,7790788922,IAN002,IAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.65,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Claims can be submitted for reimbursement,Yes,Claims can be submitted for reimbursement if an in-network is not selected,Yes,,,,,63366IA0020007-00,Standard High Off Exchange Plan,85.40%,,,,Yes,42%,58%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,$25,Not Applicable,,$225,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,63366,SERFF,8,2014-11-04 20:29:03,4,63366,IA,SHOP (Small Group),Yes,42-0959302,63366IA0010017,Delta Dental PPO Plus Premier? Plan B Plus - HC,63366IA001,7790788922,IAN002,IAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.40,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Claims can be submitted for reimbursement,Yes,Claims can be submitted for reimbusement if an in-network detntist is not selected,Yes,,,,,63366IA0010017-00,Standard High Off Exchange Plan,85.40%,,,,Yes,50%,50%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,$25,Not Applicable,,$225,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,25440,SERFF,1,2014-08-11 09:11:26,1,25440,IA,SHOP (Small Group),Yes,93-0242990,25440IA0030002,EHB High Passive,25440IA003,,IAN001,IAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$43.74,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,25440IA0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IA,25440,SERFF,1,2014-08-11 09:11:26,1,25440,IA,SHOP (Small Group),Yes,93-0242990,25440IA0030001,EHB Low Passive,25440IA003,,IAN001,IAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.69,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,25440IA0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050001,Platinum $1000 - 0%,27651IA005,,IAN003,IAS001,IAF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050001-00,Standard Platinum Off Exchange Plan,,0.907075166702271,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0070001,Platinum $1000 - 0% $30 OV,27651IA007,,IAN001,IAS001,IAF001,Existing,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8A&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0070001-00,Standard Platinum Off Exchange Plan,,0.911718785762787,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0070001,Platinum $1000 - 0% $30 OV,27651IA007,,IAN001,IAS001,IAF001,Existing,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8A&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0070001-01,Standard Platinum On Exchange Plan,,0.911718785762787,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050001,Platinum $1000 - 0%,27651IA005,,IAN003,IAS001,IAF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050001-01,Standard Platinum On Exchange Plan,,0.907075166702271,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050001,Platinum $1000 - 0%,27651IA005,,IAN003,IAS001,IAF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0070002,Platinum $500 - 20% $15 OV,27651IA007,,IAN001,IAS001,IAF001,Existing,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8B&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0070002-00,Standard Platinum Off Exchange Plan,,0.882930278778076,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0070002,Platinum $500 - 20% $15 OV,27651IA007,,IAN001,IAS001,IAF001,Existing,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8B&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0070002-01,Standard Platinum On Exchange Plan,,0.882930278778076,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050001,Platinum $1000 - 0%,27651IA005,,IAN003,IAS001,IAF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050001-03,Limited Cost Sharing Plan Variation,,0.907075166702271,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0070004,Gold $1000 - 20% $40 OV,27651IA007,,IAN001,IAS001,IAF002,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8D&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0070004-00,Standard Gold Off Exchange Plan,,0.799402117729187,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050002,Platinum $500 - 20%,27651IA005,,IAN003,IAS001,IAF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050002-00,Standard Platinum Off Exchange Plan,,0.903730511665344,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050002,Platinum $500 - 20%,27651IA005,,IAN003,IAS001,IAF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050002-01,Standard Platinum On Exchange Plan,,0.903730511665344,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0070004,Gold $1000 - 20% $40 OV,27651IA007,,IAN001,IAS001,IAF002,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8D&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0070004-01,Standard Gold On Exchange Plan,,0.799402117729187,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0070006,Silver $2000 - 20% $40 OV,27651IA007,,IAN001,IAS001,IAF003,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8F&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0070006-00,Standard Silver Off Exchange Plan,,0.711667835712433,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050002,Platinum $500 - 20%,27651IA005,,IAN003,IAS001,IAF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050002,Platinum $500 - 20%,27651IA005,,IAN003,IAS001,IAF009,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050002-03,Limited Cost Sharing Plan Variation,,0.903730511665344,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0070006,Silver $2000 - 20% $40 OV,27651IA007,,IAN001,IAS001,IAF003,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8F&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0070006-01,Standard Silver On Exchange Plan,,0.711667835712433,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050003,Gold $1500 - 30%,27651IA005,,IAN003,IAS001,IAF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050003-00,Standard Gold Off Exchange Plan,,0.808317065238953,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050003,Gold $1500 - 30%,27651IA005,,IAN003,IAS001,IAF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050003-01,Standard Gold On Exchange Plan,,0.808317065238953,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050003,Gold $1500 - 30%,27651IA005,,IAN003,IAS001,IAF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050003,Gold $1500 - 30%,27651IA005,,IAN003,IAS001,IAF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050003-03,Limited Cost Sharing Plan Variation,,0.808317065238953,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050004,Gold $3500 - 0%,27651IA005,,IAN003,IAS001,IAF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050004-00,Standard Gold Off Exchange Plan,,0.785880863666534,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$3,500","$7,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050004,Gold $3500 - 0%,27651IA005,,IAN003,IAS001,IAF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050004-01,Standard Gold On Exchange Plan,,0.785880863666534,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$3,500","$7,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050004,Gold $3500 - 0%,27651IA005,,IAN003,IAS001,IAF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050004,Gold $3500 - 0%,27651IA005,,IAN003,IAS001,IAF010,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050004-03,Limited Cost Sharing Plan Variation,,0.785880863666534,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$3,500","$7,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050005,Silver $3500 - 20%,27651IA005,,IAN003,IAS001,IAF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050005-00,Standard Silver Off Exchange Plan,,0.701237916946411,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$17,500","$35,000",Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050005,Silver $3500 - 20%,27651IA005,,IAN003,IAS001,IAF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050005-01,Standard Silver On Exchange Plan,,0.701237916946411,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$17,500","$35,000",Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050005,Silver $3500 - 20%,27651IA005,,IAN003,IAS001,IAF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050005,Silver $3500 - 20%,27651IA005,,IAN003,IAS001,IAF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050005-03,Limited Cost Sharing Plan Variation,,0.701237916946411,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$17,500","$35,000",Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050005,Silver $3500 - 20%,27651IA005,,IAN003,IAS001,IAF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050005-04,73% AV Level Silver Plan,,0.727602303028107,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050005,Silver $3500 - 20%,27651IA005,,IAN003,IAS001,IAF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050005-05,87% AV Level Silver Plan,,0.87049925327301,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050005,Silver $3500 - 20%,27651IA005,,IAN003,IAS001,IAF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050005-06,94% AV Level Silver Plan,,0.935769379138947,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,$250,$500,10%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050006,Silver $2500 - 50%,27651IA005,,IAN003,IAS001,IAF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050006-00,Standard Silver Off Exchange Plan,,0.689670622348785,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050006,Silver $2500 - 50%,27651IA005,,IAN003,IAS001,IAF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050006-01,Standard Silver On Exchange Plan,,0.689670622348785,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050006,Silver $2500 - 50%,27651IA005,,IAN003,IAS001,IAF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,29
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050006,Silver $2500 - 50%,27651IA005,,IAN003,IAS001,IAF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050006-03,Limited Cost Sharing Plan Variation,,0.689670622348785,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050006,Silver $2500 - 50%,27651IA005,,IAN003,IAS001,IAF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050006-04,73% AV Level Silver Plan,,0.730540812015533,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",40%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050006,Silver $2500 - 50%,27651IA005,,IAN003,IAS001,IAF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050006-05,87% AV Level Silver Plan,,0.872846245765686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,1,27651,IA,Individual,No,39-1807071,27651IA0050006,Silver $2500 - 50%,27651IA005,,IAN003,IAS001,IAF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050006-06,94% AV Level Silver Plan,,0.935769379138947,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,$250,$500,10%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060001,Silver HSA $3500 - 0%,27651IA006,,IAN003,IAS001,IAF008,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060001-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$17,500","$35,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0080001,Silver HSA $2000 - 20%,27651IA008,,IAN001,IAS001,IAF005,Existing,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=A8&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0080001-00,Standard Silver Off Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0080001,Silver HSA $2000 - 20%,27651IA008,,IAN001,IAS001,IAF005,Existing,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=A8&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0080001-01,Standard Silver On Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060001,Silver HSA $3500 - 0%,27651IA006,,IAN003,IAS001,IAF008,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060001-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$17,500","$35,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060001,Silver HSA $3500 - 0%,27651IA006,,IAN003,IAS001,IAF008,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0080002,Bronze HSA $2500 - 50%,27651IA008,,IAN001,IAS001,IAF006,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=B8&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0080002-00,Standard Bronze Off Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060002,Silver HSA $2000 - 50%,27651IA006,,IAN003,IAS001,IAF006,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060002,Silver HSA $2000 - 50%,27651IA006,,IAN003,IAS001,IAF006,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060002-03,Limited Cost Sharing Plan Variation,,0.682383358478546,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060002,Silver HSA $2000 - 50%,27651IA006,,IAN003,IAS001,IAF006,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060002-04,73% AV Level Silver Plan,,0.724044322967529,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060002,Silver HSA $2000 - 50%,27651IA006,,IAN003,IAS001,IAF006,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060002-05,87% AV Level Silver Plan,,0.864543795585632,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060002,Silver HSA $2000 - 50%,27651IA006,,IAN003,IAS001,IAF006,Existing,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060002-06,94% AV Level Silver Plan,,0.941158354282379,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060003,Bronze HSA $2500 - 50%,27651IA006,,IAN003,IAS001,IAF006,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060003-00,Standard Bronze Off Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060003,Bronze HSA $2500 - 50%,27651IA006,,IAN003,IAS001,IAF006,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060003-01,Standard Bronze On Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060003,Bronze HSA $2500 - 50%,27651IA006,,IAN003,IAS001,IAF006,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060003,Bronze HSA $2500 - 50%,27651IA006,,IAN003,IAS001,IAF006,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060003-03,Limited Cost Sharing Plan Variation,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,5,27651,IA,Individual,No,39-1807071,27651IA0050010,Bronze $5500 - 20%,27651IA005,,IAN003,IAS001,IAF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,5,27651,IA,Individual,No,39-1807071,27651IA0050010,Bronze $5500 - 20%,27651IA005,,IAN003,IAS001,IAF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050010-03,Limited Cost Sharing Plan Variation,,0.600705564022064,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,"$5,500","$11,000",20%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060004,Bronze HSA $5500 - 0%,27651IA006,,IAN003,IAS001,IAF008,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060004-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060004,Bronze HSA $5500 - 0%,27651IA006,,IAN003,IAS001,IAF008,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060004-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,IA,50730,SERFF,2,2014-09-10 06:01:28,2,50730,IA,SHOP (Small Group),Yes,13-5123390,50730IA0060002,Guardian Family Essentials,50730IA006,,IAN001,IAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.24,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,50730IA0060002-01,Standard Low On Exchange Plan,71.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IA,52391,SERFF,1,2014-08-11 09:11:26,1,52391,IA,SHOP (Small Group),Yes,47-0098400,52391IA0040002,EHB High PPO,52391IA004,,IAN001,IAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.42,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,52391IA0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,52391,SERFF,1,2014-08-11 09:11:26,1,52391,IA,SHOP (Small Group),Yes,47-0098400,52391IA0040001,EHB Low PPO,52391IA004,,IAN001,IAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.39,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,52391IA0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,52391,SERFF,1,2014-08-11 09:11:26,1,52391,IA,SHOP (Small Group),Yes,47-0098400,52391IA0030002,EHB High Passive,52391IA003,,IAN001,IAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$43.01,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,52391IA0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IA,52391,SERFF,1,2014-08-11 09:11:26,1,52391,IA,SHOP (Small Group),Yes,47-0098400,52391IA0030001,EHB Low Passive,52391IA003,,IAN001,IAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.26,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,52391IA0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IA,57646,SERFF,1,2014-08-11 09:11:26,1,57646,IA,SHOP (Small Group),Yes,35-0472300,57646IA0010001,Lincoln Dental Connect?,57646IA001,,IAN001,IAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.95,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,57646IA0010001-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060004,Bronze HSA $5500 - 0%,27651IA006,,IAN003,IAS001,IAF008,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,24
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060004,Bronze HSA $5500 - 0%,27651IA006,,IAN003,IAS001,IAF008,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060004-03,Limited Cost Sharing Plan Variation,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060005,Bronze HSA $4500 - 20%,27651IA006,,IAN003,IAS001,IAF005,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060005-00,Standard Bronze Off Exchange Plan,,0.60315477848053,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060005,Bronze HSA $4500 - 20%,27651IA006,,IAN003,IAS001,IAF005,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060005-01,Standard Bronze On Exchange Plan,,0.60315477848053,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060005,Bronze HSA $4500 - 20%,27651IA006,,IAN003,IAS001,IAF005,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,28
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,2,27651,IA,Individual,No,39-1807071,27651IA0060005,Bronze HSA $4500 - 20%,27651IA006,,IAN003,IAS001,IAF005,Existing,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0060005-03,Limited Cost Sharing Plan Variation,,0.60315477848053,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,IA,57646,SERFF,1,2014-08-11 09:11:26,2,57646,IA,SHOP (Small Group),Yes,35-0472300,57646IA0010004,Lincoln Dental Connect?,57646IA001,,IAN001,IAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.64,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,57646IA0010004-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,61284,SERFF,6,2014-11-14 14:52:18,1,61284,IA,Individual,Yes,75-1233841,61284IA0010007,Dentegra Dental PPO Pediatric Basic Plan,61284IA001,,IAN001,IAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.31,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ia/61284ia0010007-15,,61284IA0010007-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,61284,SERFF,6,2014-11-14 14:52:18,1,61284,IA,SHOP (Small Group),Yes,75-1233841,61284IA0020007,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,61284IA002,,IAN001,IAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.48,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ia/61284ia0020007-15,,61284IA0020007-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,61284,SERFF,6,2014-11-14 14:52:18,1,61284,IA,SHOP (Small Group),Yes,75-1233841,61284IA0020007,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,61284IA002,,IAN001,IAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.48,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ia/61284ia0020007-15,,61284IA0020007-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,61284,SERFF,6,2014-11-14 14:52:18,1,61284,IA,Individual,Yes,75-1233841,61284IA0010007,Dentegra Dental PPO Pediatric Basic Plan,61284IA001,,IAN001,IAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.31,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ia/61284ia0010007-15,,61284IA0010007-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,3,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0070003,Gold $2000 - 0%,27651IA007,,IAN001,IAS001,IAF002,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8C&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0070003-00,Standard Gold Off Exchange Plan,,0.818400382995605,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,3,27651,IA,Individual,No,39-1807071,27651IA0050007,Silver $2500 - 20%,27651IA005,,IAN003,IAS001,IAF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050007-00,Standard Silver Off Exchange Plan,,0.688570082187653,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,3,27651,IA,Individual,No,39-1807071,27651IA0050007,Silver $2500 - 20%,27651IA005,,IAN003,IAS001,IAF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050007-01,Standard Silver On Exchange Plan,,0.688570082187653,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,3,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0070003,Gold $2000 - 0%,27651IA007,,IAN001,IAS001,IAF002,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8C&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0070003-01,Standard Gold On Exchange Plan,,0.818400382995605,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,3,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0070005,Silver $2000 - 20%,27651IA007,,IAN001,IAS001,IAF003,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8E&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0070005-00,Standard Silver Off Exchange Plan,,0.719719231128693,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,3,27651,IA,Individual,No,39-1807071,27651IA0050007,Silver $2500 - 20%,27651IA005,,IAN003,IAS001,IAF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050007-04,73% AV Level Silver Plan,,0.732563555240631,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,3,27651,IA,Individual,No,39-1807071,27651IA0050007,Silver $2500 - 20%,27651IA005,,IAN003,IAS001,IAF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050007-05,87% AV Level Silver Plan,,0.864616453647614,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,3,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0070008,Silver $2000 - 0%,27651IA007,,IAN001,IAS001,IAF003,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8H&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0070008-01,Standard Silver On Exchange Plan,,0.686079859733582,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,3,27651,IA,Individual,No,39-1807071,27651IA0050007,Silver $2500 - 20%,27651IA005,,IAN003,IAS001,IAF011,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050007-06,94% AV Level Silver Plan,,0.938193678855896,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$250,$500,10%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,4,27651,IA,Individual,No,39-1807071,27651IA0050008,Bronze $2500 - 50%,27651IA005,,IAN003,IAS001,IAF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050008-00,Standard Bronze Off Exchange Plan,,0.615333676338196,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,4,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0070009,Bronze $3500 - 30%,27651IA007,,IAN001,IAS001,IAF004,Existing,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8I&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0070009-00,Standard Bronze Off Exchange Plan,,0.608460307121277,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,4,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0070009,Bronze $3500 - 30%,27651IA007,,IAN001,IAS001,IAF004,Existing,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8I&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0070009-01,Standard Bronze On Exchange Plan,,0.608460307121277,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,4,27651,IA,Individual,No,39-1807071,27651IA0050008,Bronze $2500 - 50%,27651IA005,,IAN003,IAS001,IAF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050008-01,Standard Bronze On Exchange Plan,,0.615333676338196,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,4,27651,IA,Individual,No,39-1807071,27651IA0050008,Bronze $2500 - 50%,27651IA005,,IAN003,IAS001,IAF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,4,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0070010,Bronze $6350 - 0%,27651IA007,,IAN001,IAS001,IAF004,Existing,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8J&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0070010-00,Standard Bronze Off Exchange Plan,,0.606137454509735,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,350","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,4,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0070010,Bronze $6350 - 0%,27651IA007,,IAN001,IAS001,IAF004,Existing,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8J&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0070010-01,Standard Bronze On Exchange Plan,,0.606137454509735,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,350","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,4,27651,IA,Individual,No,39-1807071,27651IA0050008,Bronze $2500 - 50%,27651IA005,,IAN003,IAS001,IAF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050008-03,Limited Cost Sharing Plan Variation,,0.615333676338196,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,4,27651,IA,Individual,No,39-1807071,27651IA0050009,Bronze $3500 - 30%,27651IA005,,IAN003,IAS001,IAF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050009-00,Standard Bronze Off Exchange Plan,,0.611142992973328,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000",Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,4,27651,IA,Individual,No,39-1807071,27651IA0050009,Bronze $3500 - 30%,27651IA005,,IAN003,IAS001,IAF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050009-01,Standard Bronze On Exchange Plan,,0.611142992973328,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000",Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,4,27651,IA,Individual,No,39-1807071,27651IA0050009,Bronze $3500 - 30%,27651IA005,,IAN003,IAS001,IAF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050009-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,4,27651,IA,Individual,No,39-1807071,27651IA0050009,Bronze $3500 - 30%,27651IA005,,IAN003,IAS001,IAF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050009-03,Limited Cost Sharing Plan Variation,,0.611142992973328,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000",Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,5,27651,IA,Individual,No,39-1807071,27651IA0050010,Bronze $5500 - 20%,27651IA005,,IAN003,IAS001,IAF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050010-00,Standard Bronze Off Exchange Plan,,0.600705564022064,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,"$5,500","$11,000",20%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,5,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0070007,Silver - 50%,27651IA007,,IAN001,IAS001,IAF003,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8G&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0070007-00,Standard Silver Off Exchange Plan,,0.714789986610413,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,5,27651,IA,SHOP (Small Group),No,39-1807071,27651IA0070007,Silver - 50%,27651IA007,,IAN001,IAS001,IAF003,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,Urgent/Emergent,No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8G&eff_date=01/01/2015&state=IA,,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0070007-01,Standard Silver On Exchange Plan,,0.714789986610413,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,33%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,5,27651,IA,Individual,No,39-1807071,27651IA0050010,Bronze $5500 - 20%,27651IA005,,IAN003,IAS001,IAF012,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050010-01,Standard Bronze On Exchange Plan,,0.600705564022064,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,"$5,500","$11,000",20%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,6,27651,IA,Individual,No,39-1807071,27651IA0050014,"Catastrophic $6,600 - 0%",27651IA005,,IAN003,IAS001,IAF008,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,3,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=CT&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050014-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IA,27651,SERFF,7,2015-02-22 21:18:17,6,27651,IA,Individual,No,39-1807071,27651IA0050014,"Catastrophic $6,600 - 0%",27651IA005,,IAN003,IAS001,IAF008,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes",,1,,,0,0,3,2015-01-01,,Yes,Urgent/Emergent,Yes,"Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON",No,http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=CT&eff_date=01/01/2015&state=IA,https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx,,https://www.gundersenhealthplan.org/ForMembers/PharmacyBenefits/EmployerGroupPlans/DrugFormulary.aspx,27651IA0050014-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IA,41482,SERFF,2,2014-11-13 16:11:17,1,41482,IA,SHOP (Small Group),Yes,13-5581829,41482IA0070001,EHB Basic Dental Plan (Low),41482IA007,,IAN001,IAS001,,Existing,PPO,Low,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$13.37,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,41482IA0070001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,41482,SERFF,2,2014-11-13 16:11:17,2,41482,IA,SHOP (Small Group),Yes,13-5581829,41482IA0080001,EHB Enhanced Dental Plan (High),41482IA008,,IAN002,IAS001,,Existing,PPO,High,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$17.16,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,41482IA0080001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,41482,SERFF,2,2014-11-13 16:11:17,3,41482,IA,SHOP (Small Group),Yes,13-5581829,41482IA0090001,Family Basic Dental Plan (Low),41482IA009,,IAN003,IAS001,,Existing,PPO,Low,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$13.37,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,41482IA0090001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,41482,SERFF,2,2014-11-13 16:11:17,4,41482,IA,SHOP (Small Group),Yes,13-5581829,41482IA0100001,Family Enhanced Dental Plan (High),41482IA010,,IAN004,IAS001,,Existing,PPO,High,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$17.16,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,41482IA0100001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,50730,SERFF,2,2014-09-10 06:01:28,1,50730,IA,SHOP (Small Group),Yes,13-5123390,50730IA0010002,Guardian Pediatric Advantage,50730IA001,,IAN001,IAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.19,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,50730IA0010002-00,Standard High Off Exchange Plan,84.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,50730,SERFF,2,2014-09-10 06:01:28,1,50730,IA,SHOP (Small Group),Yes,13-5123390,50730IA0020002,Guardian Pediatric Essentials,50730IA002,,IAN001,IAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$18.24,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,50730IA0020002-00,Standard Low Off Exchange Plan,71.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,50730,SERFF,2,2014-09-10 06:01:28,2,50730,IA,SHOP (Small Group),Yes,13-5123390,50730IA0040002,Guardian Family Advantage,50730IA004,,IAN001,IAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.19,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,50730IA0040002-00,Standard High Off Exchange Plan,84.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,50730,SERFF,2,2014-09-10 06:01:28,2,50730,IA,SHOP (Small Group),Yes,13-5123390,50730IA0040002,Guardian Family Advantage,50730IA004,,IAN001,IAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.19,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,50730IA0040002-01,Standard High On Exchange Plan,84.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,50730,SERFF,2,2014-09-10 06:01:28,2,50730,IA,SHOP (Small Group),Yes,13-5123390,50730IA0060002,Guardian Family Essentials,50730IA006,,IAN001,IAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.24,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,50730IA0060002-00,Standard Low Off Exchange Plan,71.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IA,57646,SERFF,1,2014-08-11 09:11:26,1,57646,IA,SHOP (Small Group),Yes,35-0472300,57646IA0010002,Lincoln Dental Connect?,57646IA001,,IAN001,IAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.87,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,57646IA0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,57646,SERFF,1,2014-08-11 09:11:26,1,57646,IA,SHOP (Small Group),Yes,35-0472300,57646IA0010003,Lincoln Dental Connect?,57646IA001,,IAN001,IAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.81,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,57646IA0010003-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IA,57646,SERFF,1,2014-08-11 09:11:26,1,57646,IA,SHOP (Small Group),Yes,35-0472300,57646IA0010005,Lincoln Dental Connect?,57646IA001,,IAN001,IAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.40,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,57646IA0010005-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IA,57646,SERFF,1,2014-08-11 09:11:26,1,57646,IA,SHOP (Small Group),Yes,35-0472300,57646IA0010006,Lincoln Dental Connect?,57646IA001,,IAN001,IAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.22,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,57646IA0010006-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,IA,61284,SERFF,6,2014-11-14 14:52:18,2,61284,IA,Individual,Yes,75-1233841,61284IA0010009,Dentegra Dental PPO Family Basic Plan,61284IA001,,IAN001,IAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.31,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ia/61284ia0010009-15,,61284IA0010009-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,61284,SERFF,6,2014-11-14 14:52:18,2,61284,IA,SHOP (Small Group),Yes,75-1233841,61284IA0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,61284IA002,,IAN001,IAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.48,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ia/61284ia0020009-15,,61284IA0020009-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,61284,SERFF,6,2014-11-14 14:52:18,2,61284,IA,SHOP (Small Group),Yes,75-1233841,61284IA0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,61284IA002,,IAN001,IAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.48,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ia/61284ia0020009-15,,61284IA0020009-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,61284,SERFF,6,2014-11-14 14:52:18,2,61284,IA,Individual,Yes,75-1233841,61284IA0010009,Dentegra Dental PPO Family Basic Plan,61284IA001,,IAN001,IAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.31,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ia/61284ia0010009-15,,61284IA0010009-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,63366,SERFF,8,2014-11-04 20:29:03,1,63366,IA,Individual,Yes,42-0959302,63366IA0020001,Delta Dental PPO Plus Premier? Individual Choice - Preferred Plus,63366IA002,7790788922,IAN002,IAS001,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.65,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Claims can be submitted for reimbursement,Yes,Claims can be submitted for reimbursement if an in-network is not selected,Yes,www.deltadentalia.com/mp/individual/preferred15,https://saml.deltadentalia.com/sp/ACS.saml2,www.deltadentalia.com/mp/individual/brochure15,,63366IA0020001-01,Standard High On Exchange Plan,85.40%,,,,Yes,42%,58%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,$25,Not Applicable,,$225,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,63366,SERFF,8,2014-11-04 20:29:03,1,63366,IA,SHOP (Small Group),Yes,42-0959302,63366IA0010003,Delta Dental Premier? Plan A Plus - L,63366IA001,7790788922,IAN001,IAS001,,Existing,Indemnity,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Claims can be submitted for reimbursement,Yes,Claims can be submitted for reimbursement if an in-network dentist is not selected,Yes,,,,,63366IA0010003-00,Standard Low Off Exchange Plan,69.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$225,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,63366,SERFF,8,2014-11-04 20:29:03,1,63366,IA,Individual,Yes,42-0959302,63366IA0020003,Delta Dental PPO Plus Premier? Individual Choice - Preferred Plus,63366IA002,7790788922,IAN002,IAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.65,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Claims can be submitted for reimbursement,Yes,Claims can be submitted for reimbursement if an in-network is not selected,Yes,,,,,63366IA0020003-00,Standard High Off Exchange Plan,85.40%,,,,Yes,42%,58%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,$25,Not Applicable,,$225,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,63366,SERFF,8,2014-11-04 20:29:03,1,63366,IA,SHOP (Small Group),Yes,42-0959302,63366IA0010004,Delta Dental Premier? Plan B Plus - H,63366IA001,7790788922,IAN001,IAS001,,Existing,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.40,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Claims can be submitted for reimbursement,Yes,Claims can be submitted for reimbursement if an in-network dentist is not selected,Yes,,,,,63366IA0010004-00,Standard High Off Exchange Plan,83.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$225,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,63366,SERFF,8,2014-11-04 20:29:03,1,63366,IA,SHOP (Small Group),Yes,42-0959302,63366IA0010005,Delta Dental Premier? Plan C Plus - H,63366IA001,7790788922,IAN001,IAS001,,Existing,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.40,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Claims can be submitted for reimbursement,Yes,Claims can be submitted for reimbursement if an in-network dentist is not selected,Yes,,,,,63366IA0010005-00,Standard High Off Exchange Plan,83.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$225,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IA,63366,SERFF,8,2014-11-04 20:29:03,2,63366,IA,SHOP (Small Group),Yes,42-0959302,63366IA0010008,Delta Dental Premier? Plan A Plus - LC,63366IA001,7790788922,IAN001,IAS001,,Existing,Indemnity,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Claims can be submitted for reimbursement,Yes,Claims can be submitted for reimbursement if an in-network dentist is not selected,Yes,,,,,63366IA0010008-00,Standard Low Off Exchange Plan,69.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$225,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,63366,SERFF,8,2014-11-04 20:29:03,4,63366,IA,SHOP (Small Group),Yes,42-0959302,63366IA0010018,Delta Dental PPO Plus Premier? PlanC Plus - HC,63366IA001,7790788922,IAN002,IAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.40,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Claims can be submitted for reimbursement,Yes,Claims can be submitted for reimbusement if an in-network detntist is not selected,Yes,,,,,63366IA0010018-00,Standard High Off Exchange Plan,85.40%,,,,Yes,67%,33%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,$25,Not Applicable,,$225,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IA,63366,SERFF,8,2014-11-04 20:29:03,5,63366,IA,SHOP (Small Group),Yes,42-0959302,63366IA0010022,Delta Dental PPO Plus Premier? Employee Choice - Preferred Plus,63366IA001,7790788922,IAN002,IAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.40,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Claims can be submitted for reimbursement,Yes,Claims can be submitted for reimbusement if an in-network detntist is not selected,Yes,,,,,63366IA0010022-00,Standard High Off Exchange Plan,85.40%,,,,Yes,42%,58%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,$25,Not Applicable,,$225,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,63366,SERFF,8,2014-11-04 20:29:03,6,63366,IA,SHOP (Small Group),Yes,42-0959302,63366IA0010020,Delta Dental PPO Plus Premier? Individual Choice - Preventive Plus,63366IA001,7790788922,IAN002,IAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Claims can be submitted for reimbursement,Yes,Claims can be submitted for reimbusement if an in-network detntist is not selected,Yes,,,,,63366IA0010020-00,Standard Low Off Exchange Plan,69.10%,,,,Yes,29%,71%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,$75,Not Applicable,,$225,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,63366,SERFF,8,2014-11-04 20:29:03,7,63366,IA,SHOP (Small Group),Yes,42-0959302,63366IA0010023,Delta Dental PPO Plus Premier? Individual Choice - Platinum Plus,63366IA001,7790788922,IAN002,IAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.40,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Claims can be submitted for reimbursement,Yes,Claims can be submitted for reimbusement if an in-network detntist is not selected,Yes,,,,,63366IA0010023-00,Standard High Off Exchange Plan,85.40%,,,,Yes,29%,71%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,$25,Not Applicable,,$225,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,1,71051,IA,Individual,Yes,95-6042390,71051IA0020001,BESTOne Child Dental Plus,71051IA002,,IAN001,IAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$39.82,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BESTOne_Child_Dental_Plus_Plan.pdf,,71051IA0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,1,71051,IA,SHOP (Small Group),Yes,95-6042390,71051IA0010001,BEST Life Child Dental Plus,71051IA001,,IAN001,IAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$31.84,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BEST_Life_Child_Dental_Plus_Plan.pdf,,71051IA0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,2,71051,IA,SHOP (Small Group),Yes,95-6042390,71051IA0010002,BEST Life Child Dental,71051IA001,,IAN001,IAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BEST_Life_Child_Dental_Plan.pdf,,71051IA0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,2,71051,IA,Individual,Yes,95-6042390,71051IA0020002,BESTOne Child Dental,71051IA002,,IAN001,IAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$30.81,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BESTOne_Child_Dental_Plan.pdf,,71051IA0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,3,71051,IA,Individual,Yes,95-6042390,71051IA0020003,BESTOne Dental Advantage-Gold,71051IA002,,IAN001,IAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.82,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Advantage-Gold_Plan.pdf,,71051IA0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,3,71051,IA,SHOP (Small Group),Yes,95-6042390,71051IA0010007,BEST Dental Premium,71051IA001,,IAN001,IAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.84,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BESTDental_Premium_Plan.pdf,,71051IA0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,3,71051,IA,SHOP (Small Group),Yes,95-6042390,71051IA0010007,BEST Dental Premium,71051IA001,,IAN001,IAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.84,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BESTDental_Premium_Plan.pdf,,71051IA0010007-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,3,71051,IA,Individual,Yes,95-6042390,71051IA0020003,BESTOne Dental Advantage-Gold,71051IA002,,IAN001,IAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.82,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Advantage-Gold_Plan.pdf,,71051IA0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,3,71051,IA,Individual,Yes,95-6042390,71051IA0020004,BESTOne Dental Plus-Gold,71051IA002,,IAN001,IAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.82,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Plus-Gold_Plan.pdf,,71051IA0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,3,71051,IA,SHOP (Small Group),Yes,95-6042390,71051IA0010008,BEST Dental Standard-H,71051IA001,,IAN001,IAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.84,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BESTDental_Standard-H_Plan.pdf,,71051IA0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,3,71051,IA,SHOP (Small Group),Yes,95-6042390,71051IA0010008,BEST Dental Standard-H,71051IA001,,IAN001,IAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.84,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BESTDental_Standard-H_Plan.pdf,,71051IA0010008-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,3,71051,IA,Individual,Yes,95-6042390,71051IA0020004,BESTOne Dental Plus-Gold,71051IA002,,IAN001,IAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.82,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Plus-Gold_Plan.pdf,,71051IA0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,3,71051,IA,SHOP (Small Group),Yes,95-6042390,71051IA0010010,BEST Dental Choice-H,71051IA001,,IAN001,IAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.84,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BESTDental_Choice-H_Plan.pdf,,71051IA0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,3,71051,IA,SHOP (Small Group),Yes,95-6042390,71051IA0010010,BEST Dental Choice-H,71051IA001,,IAN001,IAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.84,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BESTDental_Choice-H_Plan.pdf,,71051IA0010010-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,4,71051,IA,SHOP (Small Group),Yes,95-6042390,71051IA0010009,BEST Dental Standard-L,71051IA001,,IAN001,IAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BESTDental_Standard-L_Plan.pdf,,71051IA0010009-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,4,71051,IA,Individual,Yes,95-6042390,71051IA0020005,BESTOne Dental Plus-Silver,71051IA002,,IAN001,IAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.81,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Plus-Silver_Plan.pdf,,71051IA0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,4,71051,IA,Individual,Yes,95-6042390,71051IA0020005,BESTOne Dental Plus-Silver,71051IA002,,IAN001,IAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.81,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Plus-Silver_Plan.pdf,,71051IA0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,4,71051,IA,SHOP (Small Group),Yes,95-6042390,71051IA0010009,BEST Dental Standard-L,71051IA001,,IAN001,IAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BESTDental_Standard-L_Plan.pdf,,71051IA0010009-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,4,71051,IA,SHOP (Small Group),Yes,95-6042390,71051IA0010011,BEST Dental Choice-L,71051IA001,,IAN001,IAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BESTDental_Choice-L_Plan.pdf,,71051IA0010011-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,4,71051,IA,Individual,Yes,95-6042390,71051IA0020006,BESTOne Dental Basic-Silver,71051IA002,,IAN001,IAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.81,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Basic-Silver_Plan.pdf,,71051IA0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,4,71051,IA,Individual,Yes,95-6042390,71051IA0020006,BESTOne Dental Basic-Silver,71051IA002,,IAN001,IAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.81,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Basic-Silver_Plan.pdf,,71051IA0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,4,71051,IA,SHOP (Small Group),Yes,95-6042390,71051IA0010011,BEST Dental Choice-L,71051IA001,,IAN001,IAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BESTDental_Choice-L_Plan.pdf,,71051IA0010011-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,4,71051,IA,SHOP (Small Group),Yes,95-6042390,71051IA0010012,BEST Dental Value,71051IA001,,IAN001,IAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BESTDental_Value_Plan.pdf,,71051IA0010012-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,IA,71051,SERFF,2,2014-09-04 06:14:21,4,71051,IA,SHOP (Small Group),Yes,95-6042390,71051IA0010012,BEST Dental Value,71051IA001,,IAN001,IAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.65,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IA/2015/IA_BESTDental_Value_Plan.pdf,,71051IA0010012-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,1,74980,IA,Individual,No,46-0451539,74980IA0020001,"Avera MyPlan $1,500 / 20% Coinsurance",74980IA002,7942203176,IAN001,IAS001,IAF008,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14615/2015-IA-Avera-MyPlan-1500-20-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020001-01,Standard Gold On Exchange Plan,,0.788982570171356,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,1,74980,IA,SHOP (Small Group),No,46-0451539,74980IA0010010,Avera $250 / 10% Coinsurance,74980IA001,7942203176,IAN001,IAS001,IAF001,Existing,PPO,Platinum,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14603/2015-IA-Avera-250-10-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0010010-01,Standard Platinum On Exchange Plan,,0.880899608135223,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$250,$500,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,3,74980,IA,Individual,No,46-0451539,74980IA0020006,"Avera MyPlan $3,500",74980IA002,7942203176,IAN001,IAS001,IAF012,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14623/2015-IA-Avera-MyPlan-3500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020006-04,73% AV Level Silver Plan,,0.732454240322113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,3,74980,IA,Individual,No,46-0451539,74980IA0020006,"Avera MyPlan $3,500",74980IA002,7942203176,IAN001,IAS001,IAF012,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14623/2015-IA-Avera-MyPlan-3500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020006-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,3,74980,IA,Individual,No,46-0451539,74980IA0020006,"Avera MyPlan $3,500",74980IA002,7942203176,IAN001,IAS001,IAF012,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14623/2015-IA-Avera-MyPlan-3500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020006-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,3,74980,IA,Individual,No,46-0451539,74980IA0020019,"Avera MyPlan $6,200",74980IA002,7942203176,IAN001,IAS001,IAF012,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14626/2015-IA-Avera-MyPlan-6200.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020019-00,Standard Bronze Off Exchange Plan,,0.585070788860321,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,200","$12,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,200","$12,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,9,74980,IA,Individual,No,46-0451539,74980IA0020013,"Avera MyPlan $6,600",74980IA002,7942203176,IAN001,IAS001,IAF012,Existing,PPO,Catastrophic,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14627/2015-IA-Avera-MyPlan-6600.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020013-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,9,74980,IA,Individual,No,46-0451539,74980IA0020013,"Avera MyPlan $6,600",74980IA002,7942203176,IAN001,IAS001,IAF012,Existing,PPO,Catastrophic,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14627/2015-IA-Avera-MyPlan-6600.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020013-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,2,74980,IA,Individual,No,46-0451539,74980IA0020009,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14617/2015-IA-Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020009-01,Standard Silver On Exchange Plan,,0.711994588375092,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,2,74980,IA,Individual,No,46-0451539,74980IA0020009,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14617/2015-IA-Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020009-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,7,74980,IA,Individual,No,46-0451539,74980IA0020016,"Avera MyPlan $3,000 / 30% Coinsurance",74980IA002,7942203176,IAN001,IAS001,IAF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14622/2015-IA-Avera-MyPlan-3000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020016-06,94% AV Level Silver Plan,,0.946691811084747,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,8,74980,IA,Individual,No,46-0451539,74980IA0020017,"Avera MyPlan $3,000 / 30% Coinsurance, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14621/2015-IA-Avera-MyPlan-3000-30-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020017-00,Standard Silver Off Exchange Plan,,0.683893144130707,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,8,74980,IA,Individual,No,46-0451539,74980IA0020017,"Avera MyPlan $3,000 / 30% Coinsurance, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14621/2015-IA-Avera-MyPlan-3000-30-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020017-01,Standard Silver On Exchange Plan,,0.683893144130707,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,8,74980,IA,Individual,No,46-0451539,74980IA0020017,"Avera MyPlan $3,000 / 30% Coinsurance, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14621/2015-IA-Avera-MyPlan-3000-30-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020017-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,IA,77847,SERFF,1,2014-08-11 09:11:26,1,77847,IA,SHOP (Small Group),Yes,57-0523959,77847IA0010001,Group Pediatric Dental EHB Rider,77847IA001,,IAN001,IAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$32.15,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,77847IA0010001-00,Standard High Off Exchange Plan,84.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,77847,SERFF,1,2014-08-11 09:11:26,1,77847,IA,SHOP (Small Group),Yes,57-0523959,77847IA0010002,Group Pediatric Dental EHB Rider,77847IA001,,IAN001,IAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.25,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,77847IA0010002-00,Standard Low Off Exchange Plan,69.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,85930,SERFF,6,2015-01-23 12:43:55,1,85930,IA,SHOP (Small Group),No,91-1842494,85930IA0060005,"Sanford Simplicity-$5,000",85930IA006,,IAN001,IAS001,IAF003,New,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,85930IA0060005-00,Standard Bronze Off Exchange Plan,,0.613356590270996,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,000","$20,000","$14,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$13,000","$10,000","$13,000",,,,,,,,,4
2015,IA,85930,SERFF,6,2015-01-23 12:43:55,1,85930,IA,SHOP (Small Group),No,91-1842494,85930IA0060005,"Sanford Simplicity-$5,000",85930IA006,,IAN001,IAS001,IAF003,New,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,85930IA0060005-01,Standard Bronze On Exchange Plan,,0.613356590270996,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,000","$20,000","$14,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$13,000","$10,000","$13,000",,,,,,,,,5
2015,IA,85930,SERFF,6,2015-01-23 12:43:55,2,85930,IA,SHOP (Small Group),No,91-1842494,85930IA0060004,"Sanford Simplicity-$3,000",85930IA006,,IAN001,IAS001,IAF004,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,85930IA0060004-00,Standard Bronze Off Exchange Plan,,0.617272973060608,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",40%,,,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,4
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,8,74980,IA,Individual,No,46-0451539,74980IA0020017,"Avera MyPlan $3,000 / 30% Coinsurance, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14621/2015-IA-Avera-MyPlan-3000-30-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020017-03,Limited Cost Sharing Plan Variation,,0.683893144130707,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,8,74980,IA,Individual,No,46-0451539,74980IA0020017,"Avera MyPlan $3,000 / 30% Coinsurance, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14621/2015-IA-Avera-MyPlan-3000-30-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020017-04,73% AV Level Silver Plan,,0.738397479057312,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,850","$5,700",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,8,74980,IA,Individual,No,46-0451539,74980IA0020017,"Avera MyPlan $3,000 / 30% Coinsurance, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14621/2015-IA-Avera-MyPlan-3000-30-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020017-05,87% AV Level Silver Plan,,0.86927729845047,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,8,74980,IA,Individual,No,46-0451539,74980IA0020017,"Avera MyPlan $3,000 / 30% Coinsurance, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14621/2015-IA-Avera-MyPlan-3000-30-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020017-06,94% AV Level Silver Plan,,0.946691811084747,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,1,74980,IA,SHOP (Small Group),No,46-0451539,74980IA0010010,Avera $250 / 10% Coinsurance,74980IA001,7942203176,IAN001,IAS001,IAF001,Existing,PPO,Platinum,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14603/2015-IA-Avera-250-10-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0010010-00,Standard Platinum Off Exchange Plan,,0.880899608135223,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$250,$500,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,1,74980,IA,Individual,No,46-0451539,74980IA0020001,"Avera MyPlan $1,500 / 20% Coinsurance",74980IA002,7942203176,IAN001,IAS001,IAF008,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14615/2015-IA-Avera-MyPlan-1500-20-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020001-00,Standard Gold Off Exchange Plan,,0.788982570171356,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,3,74980,IA,Individual,No,46-0451539,74980IA0020019,"Avera MyPlan $6,200",74980IA002,7942203176,IAN001,IAS001,IAF012,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14626/2015-IA-Avera-MyPlan-6200.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020019-01,Standard Bronze On Exchange Plan,,0.585070788860321,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,200","$12,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,200","$12,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,3,74980,IA,Individual,No,46-0451539,74980IA0020019,"Avera MyPlan $6,200",74980IA002,7942203176,IAN001,IAS001,IAF012,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14626/2015-IA-Avera-MyPlan-6200.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020019-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,IA,85930,SERFF,6,2015-01-23 12:43:55,3,85930,IA,SHOP (Small Group),No,91-1842494,85930IA0060002,"Sanford Simplicity-$1,500",85930IA006,,IAN001,IAS001,IAF001,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,85930IA0060002-01,Standard Gold On Exchange Plan,,0.782246828079224,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000",20%,,,,"$3,000","$6,000","$3,000","$6,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IA,85930,SERFF,6,2015-01-23 12:43:55,3,85930,IA,SHOP (Small Group),No,91-1842494,85930IA0060003,"Sanford Simplicity-$2,000",85930IA006,,IAN001,IAS001,IAF002,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,85930IA0060003-00,Standard Silver Off Exchange Plan,,0.705296576023102,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,000","$4,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IA,85930,SERFF,6,2015-01-23 12:43:55,3,85930,IA,SHOP (Small Group),No,91-1842494,85930IA0060003,"Sanford Simplicity-$2,000",85930IA006,,IAN001,IAS001,IAF002,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,85930IA0060003-01,Standard Silver On Exchange Plan,,0.705296576023102,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,000","$4,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IA,85930,SERFF,6,2015-01-23 12:43:55,3,85930,IA,SHOP (Small Group),No,91-1842494,85930IA0060007,"Sanford Simplicity-$1,000",85930IA006,,IAN001,IAS001,IAF005,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,85930IA0060007-00,Standard Gold Off Exchange Plan,,0.809297680854797,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$2,000","$4,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IA,85930,SERFF,6,2015-01-23 12:43:55,3,85930,IA,SHOP (Small Group),No,91-1842494,85930IA0060007,"Sanford Simplicity-$1,000",85930IA006,,IAN001,IAS001,IAF005,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,85930IA0060007-01,Standard Gold On Exchange Plan,,0.809297680854797,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$2,000","$4,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,IA,85930,SERFF,6,2015-01-23 12:43:55,4,85930,IA,SHOP (Small Group),No,91-1842494,85930IA0060006,"Simplicity-$2,500",85930IA006,,IAN001,IAS001,IAF005,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,85930IA0060006-00,Standard Silver Off Exchange Plan,,0.704835176467896,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$18,000","$12,000","$18,000","$2,500","$5,000",30%,,,,"$6,000","$12,000","$6,000","$12,000",$0,$0,40%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,IA,85930,SERFF,6,2015-01-23 12:43:55,4,85930,IA,SHOP (Small Group),No,91-1842494,85930IA0060006,"Simplicity-$2,500",85930IA006,,IAN001,IAS001,IAF005,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,85930IA0060006-01,Standard Silver On Exchange Plan,,0.704835176467896,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$18,000","$12,000","$18,000","$2,500","$5,000",30%,,,,"$6,000","$12,000","$6,000","$12,000",$0,$0,40%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,IA,86010,SERFF,1,2014-08-11 09:11:26,1,86010,IA,SHOP (Small Group),Yes,36-0883760,86010IA0040002,EHB High PPO,86010IA004,,IAN001,IAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.97,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,86010IA0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,1,74980,IA,SHOP (Small Group),No,46-0451539,74980IA0010018,"Avera $6,000 / 40% Coinsurance",74980IA001,7942203176,IAN001,IAS001,IAF004,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14602/2015-IA-Avera-6000-40-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0010018-00,Standard Bronze Off Exchange Plan,,0.610579550266266,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,000","$12,000",40%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,1,74980,IA,Individual,No,46-0451539,74980IA0020001,"Avera MyPlan $1,500 / 20% Coinsurance",74980IA002,7942203176,IAN001,IAS001,IAF008,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14615/2015-IA-Avera-MyPlan-1500-20-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,1,74980,IA,Individual,No,46-0451539,74980IA0020001,"Avera MyPlan $1,500 / 20% Coinsurance",74980IA002,7942203176,IAN001,IAS001,IAF008,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14615/2015-IA-Avera-MyPlan-1500-20-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020001-03,Limited Cost Sharing Plan Variation,,0.788982570171356,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,14,20129,IL,Individual,No,37-1260731,20129IL0370009,Health Alliance PPO 2000 Gold,20129IL037,7740283974,ILN001,ILS001,ILF014,New,PPO,Gold,Yes,Both,No,No,,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_PPO_2000_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_PPO_2000_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0370009-03,Limited Cost Sharing Plan Variation,78.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$24,000","$12,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,"$4,000","$12,000","$6,000","$16,000","$2,000",$10,$600,$200,$700,$600,$0,$80,7
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,15,20129,IL,Individual,No,37-1260731,20129IL0300013,Health Alliance POS HSA 2100a Gold,20129IL030,7740283974,ILN001,ILS001,ILF002,New,POS,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_HSA_2100a_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_HSA_2100a_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300013-00,Standard Gold Off Exchange Plan,78.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$8,400","$16,800","$10,500","$21,000",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400","$6,300","$12,600","$2,100",$0,$0,$200,"$2,100",$6,$0,$80,4
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,1,16724,IL,Individual,No,43-1361841,16724IL0010002,UnitedHealthcare Bronze Compass HSA 4900,16724IL001,,ILN006,ILS001,ILF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010002-00,Standard Bronze Off Exchange Plan,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,1,16724,IL,Individual,No,43-1361841,16724IL0010002,UnitedHealthcare Bronze Compass HSA 4900,16724IL001,,ILN006,ILS001,ILF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010002-01,Standard Bronze On Exchange Plan,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,1,16724,IL,Individual,No,43-1361841,16724IL0010002,UnitedHealthcare Bronze Compass HSA 4900,16724IL001,,ILN006,ILS001,ILF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,1,20129,IL,Individual,No,37-1260731,20129IL0330018,Health Alliance HMO 2750 Gold,20129IL033,7740283974,ILN001,ILS001,ILF010,New,HMO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_2750_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_2750_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330018-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,1,20129,IL,Individual,No,37-1260731,20129IL0330018,Health Alliance HMO 2750 Gold,20129IL033,7740283974,ILN001,ILS001,ILF010,New,HMO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_2750_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_2750_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330018-03,Limited Cost Sharing Plan Variation,78.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750",$10,$300,$200,$700,$500,$0,$80,7
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,6,35670,IL,Individual,No,75-1296086,35670IL0070007,Coventry Bronze Deductible Only HSA Eligible FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF011,New,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48247,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070007-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,6,35670,IL,Individual,No,75-1296086,35670IL0070007,Coventry Bronze Deductible Only HSA Eligible FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF011,New,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48247,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070007-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,2,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0280011,Health Alliance POS HSA 2000 Gold,20129IL028,7740283974,ILN001,ILS001,ILF002,New,POS,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_HSA_2000_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_HSA_2000_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0280011-00,Standard Gold Off Exchange Plan,78.80%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000","$2,000",$0,$0,$200,"$2,000",$0,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,2,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0280011,Health Alliance POS HSA 2000 Gold,20129IL028,7740283974,ILN001,ILS001,ILF002,New,POS,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_HSA_2000_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_HSA_2000_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0280011-01,Standard Gold On Exchange Plan,78.80%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000","$2,000",$0,$0,$200,"$2,000",$0,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,3,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0280014,Health Alliance POS HSA 2100a Gold,20129IL028,7740283974,ILN001,ILS001,ILF002,New,POS,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_HSA_2100a_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_HSA_2100a_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0280014-00,Standard Gold Off Exchange Plan,78.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$8,400","$16,800","$10,500","$21,000",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400","$6,300","$12,600","$2,100",$0,$0,$200,"$2,100",$0,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,3,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0280014,Health Alliance POS HSA 2100a Gold,20129IL028,7740283974,ILN001,ILS001,ILF002,New,POS,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_HSA_2100a_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_HSA_2100a_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0280014-01,Standard Gold On Exchange Plan,78.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$8,400","$16,800","$10,500","$21,000",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400","$6,300","$12,600","$2,100",$0,$0,$200,"$2,100",$0,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,16,20129,IL,Individual,No,37-1260731,20129IL0300014,Health Alliance POS HSA 3750a Bronze,20129IL030,7740283974,ILN001,ILS001,ILF004,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_HSA_3750a_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_HSA_3750a_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300014-03,Limited Cost Sharing Plan Variation,61.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,700","$38,100","$18,950","$50,800",,,,,,,,,,,,,,,,,,,,,"$3,750","$11,250",30%,,,,"$11,250","$22,500","$15,000","$33,750","$3,750",$0,$700,$200,"$3,750",$0,$400,$80,7
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,17,20129,IL,Individual,No,37-1260731,20129IL0300015,Health Alliance POS 4000a Bronze,20129IL030,7740283974,ILN001,ILS001,ILF005,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_4000a_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_4000a_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300015-00,Standard Bronze Off Exchange Plan,58.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$39,600","$19,800","$52,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$24,000","$12,000","$32,000","$4,000",$0,$0,$200,"$4,000",$500,$0,$80,4
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,1,74980,IA,SHOP (Small Group),No,46-0451539,74980IA0010018,"Avera $6,000 / 40% Coinsurance",74980IA001,7942203176,IAN001,IAS001,IAF004,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14602/2015-IA-Avera-6000-40-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0010018-01,Standard Bronze On Exchange Plan,,0.610579550266266,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,000","$12,000",40%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,1,74980,IA,Individual,No,46-0451539,74980IA0020004,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket",74980IA002,7942203176,IAN001,IAS001,IAF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14620/2015-IA-Avera-MyPlan-2500-6350-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020004-00,Standard Silver Off Exchange Plan,,0.683463633060455,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,1,74980,IA,Individual,No,46-0451539,74980IA0020004,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket",74980IA002,7942203176,IAN001,IAS001,IAF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14620/2015-IA-Avera-MyPlan-2500-6350-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020004-01,Standard Silver On Exchange Plan,,0.683463633060455,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,1,74980,IA,Individual,No,46-0451539,74980IA0020004,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket",74980IA002,7942203176,IAN001,IAS001,IAF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14620/2015-IA-Avera-MyPlan-2500-6350-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,1,74980,IA,Individual,No,46-0451539,74980IA0020004,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket",74980IA002,7942203176,IAN001,IAS001,IAF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14620/2015-IA-Avera-MyPlan-2500-6350-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020004-03,Limited Cost Sharing Plan Variation,,0.683463633060455,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,1,74980,IA,Individual,No,46-0451539,74980IA0020004,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket",74980IA002,7942203176,IAN001,IAS001,IAF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14620/2015-IA-Avera-MyPlan-2500-6350-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020004-04,73% AV Level Silver Plan,,0.728156566619873,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,1,74980,IA,Individual,No,46-0451539,74980IA0020004,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket",74980IA002,7942203176,IAN001,IAS001,IAF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14620/2015-IA-Avera-MyPlan-2500-6350-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020004-05,87% AV Level Silver Plan,,0.862476468086243,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,1,74980,IA,Individual,No,46-0451539,74980IA0020004,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket",74980IA002,7942203176,IAN001,IAS001,IAF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14620/2015-IA-Avera-MyPlan-2500-6350-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020004-06,94% AV Level Silver Plan,,0.938910305500031,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,1,74980,IA,Individual,No,46-0451539,74980IA0020008,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket",74980IA002,7942203176,IAN001,IAS001,IAF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14618/2015-IA-Avera-MyPlan-2500--5500-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020008-00,Standard Silver Off Exchange Plan,,0.711994588375092,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,1,74980,IA,Individual,No,46-0451539,74980IA0020008,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket",74980IA002,7942203176,IAN001,IAS001,IAF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14618/2015-IA-Avera-MyPlan-2500--5500-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020008-01,Standard Silver On Exchange Plan,,0.711994588375092,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,1,74980,IA,Individual,No,46-0451539,74980IA0020008,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket",74980IA002,7942203176,IAN001,IAS001,IAF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14618/2015-IA-Avera-MyPlan-2500--5500-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,1,74980,IA,Individual,No,46-0451539,74980IA0020008,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket",74980IA002,7942203176,IAN001,IAS001,IAF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14618/2015-IA-Avera-MyPlan-2500--5500-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020008-03,Limited Cost Sharing Plan Variation,,0.711994588375092,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,1,74980,IA,Individual,No,46-0451539,74980IA0020008,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket",74980IA002,7942203176,IAN001,IAS001,IAF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14618/2015-IA-Avera-MyPlan-2500--5500-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020008-04,73% AV Level Silver Plan,,0.732257664203644,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,180","$10,360",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,250","$4,500",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,1,74980,IA,Individual,No,46-0451539,74980IA0020008,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket",74980IA002,7942203176,IAN001,IAS001,IAF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14618/2015-IA-Avera-MyPlan-2500--5500-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020008-05,87% AV Level Silver Plan,,0.865615248680115,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,1,74980,IA,Individual,No,46-0451539,74980IA0020008,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket",74980IA002,7942203176,IAN001,IAS001,IAF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14618/2015-IA-Avera-MyPlan-2500--5500-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020008-06,94% AV Level Silver Plan,,0.938384711742401,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,2,74980,IA,Individual,No,46-0451539,74980IA0020002,"Avera MyPlan $1,500 / 20% Coinsurance, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF008,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14614/2015-IA-Avera-MyPlan-1500-20-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020002-00,Standard Gold Off Exchange Plan,,0.788982570171356,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,2,74980,IA,SHOP (Small Group),No,46-0451539,74980IA0010003,"Avera $1,000 / 20% Coinsurance",74980IA001,7942203176,IAN001,IAS001,IAF002,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14611/2015-IA-Avera-1000-20-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0010003-00,Standard Gold Off Exchange Plan,,0.789279103279114,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,2,74980,IA,SHOP (Small Group),No,46-0451539,74980IA0010003,"Avera $1,000 / 20% Coinsurance",74980IA001,7942203176,IAN001,IAS001,IAF002,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14611/2015-IA-Avera-1000-20-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0010003-01,Standard Gold On Exchange Plan,,0.789279103279114,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,2,74980,IA,Individual,No,46-0451539,74980IA0020002,"Avera MyPlan $1,500 / 20% Coinsurance, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF008,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14614/2015-IA-Avera-MyPlan-1500-20-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020002-01,Standard Gold On Exchange Plan,,0.788982570171356,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,2,74980,IA,Individual,No,46-0451539,74980IA0020002,"Avera MyPlan $1,500 / 20% Coinsurance, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF008,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14614/2015-IA-Avera-MyPlan-1500-20-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,2,74980,IA,SHOP (Small Group),No,46-0451539,74980IA0010012,"Avera $2,500 / 10% Coinsurance",74980IA001,7942203176,IAN001,IAS001,IAF003,New,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14606/2015-IA-Avera-2500-10-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0010012-00,Standard Gold Off Exchange Plan,,0.780976831912994,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,2,74980,IA,SHOP (Small Group),No,46-0451539,74980IA0010012,"Avera $2,500 / 10% Coinsurance",74980IA001,7942203176,IAN001,IAS001,IAF003,New,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14606/2015-IA-Avera-2500-10-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0010012-01,Standard Gold On Exchange Plan,,0.780976831912994,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,2,74980,IA,Individual,No,46-0451539,74980IA0020002,"Avera MyPlan $1,500 / 20% Coinsurance, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF008,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14614/2015-IA-Avera-MyPlan-1500-20-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020002-03,Limited Cost Sharing Plan Variation,,0.788982570171356,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,2,74980,IA,Individual,No,46-0451539,74980IA0020005,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14619/2015-IA-Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020005-00,Standard Silver Off Exchange Plan,,0.683463633060455,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,2,74980,IA,Individual,No,46-0451539,74980IA0020005,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14619/2015-IA-Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020005-01,Standard Silver On Exchange Plan,,0.683463633060455,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,2,74980,IA,Individual,No,46-0451539,74980IA0020005,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14619/2015-IA-Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,2,74980,IA,Individual,No,46-0451539,74980IA0020005,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14619/2015-IA-Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020005-03,Limited Cost Sharing Plan Variation,,0.683463633060455,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,2,74980,IA,Individual,No,46-0451539,74980IA0020005,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14619/2015-IA-Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020005-04,73% AV Level Silver Plan,,0.728156566619873,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,2,74980,IA,Individual,No,46-0451539,74980IA0020005,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14619/2015-IA-Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020005-05,87% AV Level Silver Plan,,0.862476468086243,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,2,74980,IA,Individual,No,46-0451539,74980IA0020005,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14619/2015-IA-Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020005-06,94% AV Level Silver Plan,,0.938910305500031,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,2,74980,IA,Individual,No,46-0451539,74980IA0020009,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14617/2015-IA-Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020009-00,Standard Silver Off Exchange Plan,,0.711994588375092,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,2,74980,IA,Individual,No,46-0451539,74980IA0020009,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14617/2015-IA-Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020009-03,Limited Cost Sharing Plan Variation,,0.711994588375092,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,2,74980,IA,Individual,No,46-0451539,74980IA0020009,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14617/2015-IA-Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020009-04,73% AV Level Silver Plan,,0.732257664203644,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,180","$10,360",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,250","$4,500",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,2,74980,IA,Individual,No,46-0451539,74980IA0020009,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14617/2015-IA-Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020009-05,87% AV Level Silver Plan,,0.865615248680115,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,2,74980,IA,Individual,No,46-0451539,74980IA0020009,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14617/2015-IA-Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020009-06,94% AV Level Silver Plan,,0.938384711742401,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,3,74980,IA,Individual,No,46-0451539,74980IA0020006,"Avera MyPlan $3,500",74980IA002,7942203176,IAN001,IAS001,IAF012,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14623/2015-IA-Avera-MyPlan-3500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020006-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,3,74980,IA,SHOP (Small Group),No,46-0451539,74980IA0010011,"Avera $1,500 / 10% Coinsurance",74980IA001,7942203176,IAN001,IAS001,IAF003,New,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14610/2015-IA-Avera-1500-10-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0010011-00,Standard Gold Off Exchange Plan,,0.787112951278687,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,3,74980,IA,SHOP (Small Group),No,46-0451539,74980IA0010011,"Avera $1,500 / 10% Coinsurance",74980IA001,7942203176,IAN001,IAS001,IAF003,New,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14610/2015-IA-Avera-1500-10-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0010011-01,Standard Gold On Exchange Plan,,0.787112951278687,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,3,74980,IA,Individual,No,46-0451539,74980IA0020006,"Avera MyPlan $3,500",74980IA002,7942203176,IAN001,IAS001,IAF012,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14623/2015-IA-Avera-MyPlan-3500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020006-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,3,74980,IA,Individual,No,46-0451539,74980IA0020006,"Avera MyPlan $3,500",74980IA002,7942203176,IAN001,IAS001,IAF012,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14623/2015-IA-Avera-MyPlan-3500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,3,74980,IA,SHOP (Small Group),No,46-0451539,74980IA0010014,"Avera $1,500 / 40% Coinsurance",74980IA001,7942203176,IAN001,IAS001,IAF006,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14609/2015-IA-Avera-1500-40-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0010014-00,Standard Silver Off Exchange Plan,,0.698360085487366,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,500","$3,000",40%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,3,74980,IA,SHOP (Small Group),No,46-0451539,74980IA0010014,"Avera $1,500 / 40% Coinsurance",74980IA001,7942203176,IAN001,IAS001,IAF006,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14609/2015-IA-Avera-1500-40-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0010014-01,Standard Silver On Exchange Plan,,0.698360085487366,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,500","$3,000",40%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,3,74980,IA,Individual,No,46-0451539,74980IA0020006,"Avera MyPlan $3,500",74980IA002,7942203176,IAN001,IAS001,IAF012,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14623/2015-IA-Avera-MyPlan-3500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020006-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,3,74980,IA,Individual,No,46-0451539,74980IA0020019,"Avera MyPlan $6,200",74980IA002,7942203176,IAN001,IAS001,IAF012,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14626/2015-IA-Avera-MyPlan-6200.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020019-03,Limited Cost Sharing Plan Variation,,0.585070788860321,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,200","$12,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,200","$12,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,4,74980,IA,SHOP (Small Group),No,46-0451539,74980IA0010017,"Avera $4,500",74980IA001,7942203176,IAN001,IAS001,IAF007,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14604/2015-IA-Avera-4500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0010017-00,Standard Bronze Off Exchange Plan,,0.585586369037628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,4,74980,IA,Individual,No,46-0451539,74980IA0020012,Avera MyPlan $250 / 10% Coinsurance,74980IA002,7942203176,IAN001,IAS001,IAF001,Existing,PPO,Platinum,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14628/2015-IA-Avera-MyPlan-250-10-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020012-00,Standard Platinum Off Exchange Plan,,0.880899608135223,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,4,74980,IA,Individual,No,46-0451539,74980IA0020012,Avera MyPlan $250 / 10% Coinsurance,74980IA002,7942203176,IAN001,IAS001,IAF001,Existing,PPO,Platinum,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14628/2015-IA-Avera-MyPlan-250-10-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020012-01,Standard Platinum On Exchange Plan,,0.880899608135223,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,4,74980,IA,SHOP (Small Group),No,46-0451539,74980IA0010017,"Avera $4,500",74980IA001,7942203176,IAN001,IAS001,IAF007,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14604/2015-IA-Avera-4500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0010017-01,Standard Bronze On Exchange Plan,,0.585586369037628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,4,74980,IA,Individual,No,46-0451539,74980IA0020012,Avera MyPlan $250 / 10% Coinsurance,74980IA002,7942203176,IAN001,IAS001,IAF001,Existing,PPO,Platinum,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14628/2015-IA-Avera-MyPlan-250-10-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020012-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,4,74980,IA,Individual,No,46-0451539,74980IA0020012,Avera MyPlan $250 / 10% Coinsurance,74980IA002,7942203176,IAN001,IAS001,IAF001,Existing,PPO,Platinum,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14628/2015-IA-Avera-MyPlan-250-10-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020012-03,Limited Cost Sharing Plan Variation,,0.880899608135223,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,5,74980,IA,Individual,No,46-0451539,74980IA0020007,"Avera MyPlan $5,000 / 30% Coinsurance",74980IA002,7942203176,IAN001,IAS001,IAF013,Existing,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14625/2015-IA-Avera-MyPlan-5000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020007-00,Standard Bronze Off Exchange Plan,,0.619278430938721,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,5,74980,IA,SHOP (Small Group),No,46-0451539,74980IA0010015,"Avera $3,000 / 40% Coinsurance",74980IA001,7942203176,IAN001,IAS001,IAF004,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14605/2015-IA-Avera-3000-40-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0010015-00,Standard Silver Off Exchange Plan,,0.683652639389038,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,000","$6,000",40%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,5,74980,IA,SHOP (Small Group),No,46-0451539,74980IA0010015,"Avera $3,000 / 40% Coinsurance",74980IA001,7942203176,IAN001,IAS001,IAF004,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14605/2015-IA-Avera-3000-40-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0010015-01,Standard Silver On Exchange Plan,,0.683652639389038,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,000","$6,000",40%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,5,74980,IA,Individual,No,46-0451539,74980IA0020007,"Avera MyPlan $5,000 / 30% Coinsurance",74980IA002,7942203176,IAN001,IAS001,IAF013,Existing,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14625/2015-IA-Avera-MyPlan-5000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020007-01,Standard Bronze On Exchange Plan,,0.619278430938721,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,5,74980,IA,Individual,No,46-0451539,74980IA0020007,"Avera MyPlan $5,000 / 30% Coinsurance",74980IA002,7942203176,IAN001,IAS001,IAF013,Existing,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14625/2015-IA-Avera-MyPlan-5000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,5,74980,IA,Individual,No,46-0451539,74980IA0020007,"Avera MyPlan $5,000 / 30% Coinsurance",74980IA002,7942203176,IAN001,IAS001,IAF013,Existing,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14625/2015-IA-Avera-MyPlan-5000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020007-03,Limited Cost Sharing Plan Variation,,0.619278430938721,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,6,74980,IA,Individual,No,46-0451539,74980IA0020018,"Avera MyPlan $5,000 /30% Coinsurance, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF013,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14624/2015-IA-Avera-MyPlan-5000-30-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020018-00,Standard Bronze Off Exchange Plan,,0.619278430938721,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,6,74980,IA,SHOP (Small Group),No,46-0451539,74980IA0010013,"Avera $2,000 / 20% Coinsurance",74980IA001,7942203176,IAN001,IAS001,IAF004,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14613/2015-IA-Avera-2000-20-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0010013-00,Standard Silver Off Exchange Plan,,0.693703711032867,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,6,74980,IA,SHOP (Small Group),No,46-0451539,74980IA0010013,"Avera $2,000 / 20% Coinsurance",74980IA001,7942203176,IAN001,IAS001,IAF004,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14613/2015-IA-Avera-2000-20-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0010013-01,Standard Silver On Exchange Plan,,0.693703711032867,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,6,74980,IA,Individual,No,46-0451539,74980IA0020018,"Avera MyPlan $5,000 /30% Coinsurance, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF013,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14624/2015-IA-Avera-MyPlan-5000-30-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020018-01,Standard Bronze On Exchange Plan,,0.619278430938721,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,6,74980,IA,Individual,No,46-0451539,74980IA0020018,"Avera MyPlan $5,000 /30% Coinsurance, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF013,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14624/2015-IA-Avera-MyPlan-5000-30-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020018-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,6,74980,IA,Individual,No,46-0451539,74980IA0020018,"Avera MyPlan $5,000 /30% Coinsurance, Pediatric Dental",74980IA002,7942203176,IAN001,IAS001,IAF013,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14624/2015-IA-Avera-MyPlan-5000-30-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020018-03,Limited Cost Sharing Plan Variation,,0.619278430938721,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,7,74980,IA,SHOP (Small Group),No,46-0451539,74980IA0010006,"Avera $2,000 / 30% Coinsurance",74980IA001,7942203176,IAN001,IAS001,IAF005,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14633/2015-IA-Avera-2000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0010006-00,Standard Silver Off Exchange Plan,,0.70047664642334,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,7,74980,IA,Individual,No,46-0451539,74980IA0020014,"Avera MyPlan $2,000 / 30% Coinsurance",74980IA002,7942203176,IAN001,IAS001,IAF009,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14616/2015-IA-Avera-MyPlan-2000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020014-00,Standard Silver Off Exchange Plan,,0.719203412532806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,7,74980,IA,Individual,No,46-0451539,74980IA0020014,"Avera MyPlan $2,000 / 30% Coinsurance",74980IA002,7942203176,IAN001,IAS001,IAF009,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14616/2015-IA-Avera-MyPlan-2000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020014-01,Standard Silver On Exchange Plan,,0.719203412532806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,7,74980,IA,SHOP (Small Group),No,46-0451539,74980IA0010006,"Avera $2,000 / 30% Coinsurance",74980IA001,7942203176,IAN001,IAS001,IAF005,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14633/2015-IA-Avera-2000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0010006-01,Standard Silver On Exchange Plan,,0.70047664642334,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,7,74980,IA,Individual,No,46-0451539,74980IA0020014,"Avera MyPlan $2,000 / 30% Coinsurance",74980IA002,7942203176,IAN001,IAS001,IAF009,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14616/2015-IA-Avera-MyPlan-2000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,7,74980,IA,Individual,No,46-0451539,74980IA0020014,"Avera MyPlan $2,000 / 30% Coinsurance",74980IA002,7942203176,IAN001,IAS001,IAF009,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14616/2015-IA-Avera-MyPlan-2000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020014-03,Limited Cost Sharing Plan Variation,,0.719203412532806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,7,74980,IA,Individual,No,46-0451539,74980IA0020014,"Avera MyPlan $2,000 / 30% Coinsurance",74980IA002,7942203176,IAN001,IAS001,IAF009,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14616/2015-IA-Avera-MyPlan-2000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020014-04,73% AV Level Silver Plan,,0.739821970462799,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,600","$3,200",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,7,74980,IA,Individual,No,46-0451539,74980IA0020014,"Avera MyPlan $2,000 / 30% Coinsurance",74980IA002,7942203176,IAN001,IAS001,IAF009,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14616/2015-IA-Avera-MyPlan-2000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020014-05,87% AV Level Silver Plan,,0.86927729845047,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,7,74980,IA,Individual,No,46-0451539,74980IA0020014,"Avera MyPlan $2,000 / 30% Coinsurance",74980IA002,7942203176,IAN001,IAS001,IAF009,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14616/2015-IA-Avera-MyPlan-2000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020014-06,94% AV Level Silver Plan,,0.946691811084747,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,7,74980,IA,Individual,No,46-0451539,74980IA0020016,"Avera MyPlan $3,000 / 30% Coinsurance",74980IA002,7942203176,IAN001,IAS001,IAF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14622/2015-IA-Avera-MyPlan-3000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020016-00,Standard Silver Off Exchange Plan,,0.683893144130707,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,7,74980,IA,Individual,No,46-0451539,74980IA0020016,"Avera MyPlan $3,000 / 30% Coinsurance",74980IA002,7942203176,IAN001,IAS001,IAF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14622/2015-IA-Avera-MyPlan-3000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020016-01,Standard Silver On Exchange Plan,,0.683893144130707,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,7,74980,IA,Individual,No,46-0451539,74980IA0020016,"Avera MyPlan $3,000 / 30% Coinsurance",74980IA002,7942203176,IAN001,IAS001,IAF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14622/2015-IA-Avera-MyPlan-3000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020016-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,7,74980,IA,Individual,No,46-0451539,74980IA0020016,"Avera MyPlan $3,000 / 30% Coinsurance",74980IA002,7942203176,IAN001,IAS001,IAF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14622/2015-IA-Avera-MyPlan-3000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020016-03,Limited Cost Sharing Plan Variation,,0.683893144130707,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,7,74980,IA,Individual,No,46-0451539,74980IA0020016,"Avera MyPlan $3,000 / 30% Coinsurance",74980IA002,7942203176,IAN001,IAS001,IAF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14622/2015-IA-Avera-MyPlan-3000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020016-04,73% AV Level Silver Plan,,0.738397479057312,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,850","$5,700",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,IA,74980,SERFF,3,2014-10-06 10:59:03,7,74980,IA,Individual,No,46-0451539,74980IA0020016,"Avera MyPlan $3,000 / 30% Coinsurance",74980IA002,7942203176,IAN001,IAS001,IAF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14622/2015-IA-Avera-MyPlan-3000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,74980IA0020016-05,87% AV Level Silver Plan,,0.86927729845047,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,IA,85930,SERFF,6,2015-01-23 12:43:55,2,85930,IA,SHOP (Small Group),No,91-1842494,85930IA0060004,"Sanford Simplicity-$3,000",85930IA006,,IAN001,IAS001,IAF004,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,85930IA0060004-01,Standard Bronze On Exchange Plan,,0.617272973060608,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",40%,,,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,5
2015,IA,85930,SERFF,6,2015-01-23 12:43:55,3,85930,IA,SHOP (Small Group),No,91-1842494,85930IA0060001,Sanford Simplicity-$500,85930IA006,,IAN001,IAS001,IAF006,Existing,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,85930IA0060001-00,Standard Platinum Off Exchange Plan,,0.884950578212738,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$5,000","$10,000","$5,000","$10,000",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IA,85930,SERFF,6,2015-01-23 12:43:55,3,85930,IA,SHOP (Small Group),No,91-1842494,85930IA0060001,Sanford Simplicity-$500,85930IA006,,IAN001,IAS001,IAF006,Existing,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,85930IA0060001-01,Standard Platinum On Exchange Plan,,0.884950578212738,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$5,000","$10,000","$5,000","$10,000",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IA,85930,SERFF,6,2015-01-23 12:43:55,3,85930,IA,SHOP (Small Group),No,91-1842494,85930IA0060002,"Sanford Simplicity-$1,500",85930IA006,,IAN001,IAS001,IAF001,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/business/smallemployerinsurance/simplicityplans/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,85930IA0060002-00,Standard Gold Off Exchange Plan,,0.782246828079224,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000",20%,,,,"$3,000","$6,000","$3,000","$6,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IA,86010,SERFF,1,2014-08-11 09:11:26,1,86010,IA,SHOP (Small Group),Yes,36-0883760,86010IA0040001,EHB Low PPO,86010IA004,,IAN001,IAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.66,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,86010IA0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IA,86010,SERFF,1,2014-08-11 09:11:26,1,86010,IA,SHOP (Small Group),Yes,36-0883760,86010IA0030001,EHB Low Passive,86010IA003,,IAN001,IAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.61,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,86010IA0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IA,89617,SERFF,1,2014-08-11 09:11:26,1,89617,IA,SHOP (Small Group),Yes,42-0127290,89617IA0040001,Principal Plan Dental 70,89617IA004,,IAN001,IAS001,,New,PPO,Low,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$26.86,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,89617IA0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IA,89617,SERFF,1,2014-08-11 09:11:26,1,89617,IA,SHOP (Small Group),Yes,42-0127290,89617IA0040002,Principal Plan Dental 80,89617IA004,,IAN001,IAS001,,New,PPO,High,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$28.45,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,89617IA0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010007,UnitedHealthcare Silver Compass 2000,16724IL001,,ILN006,ILS001,ILF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010007-04,73% AV Level Silver Plan,73.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010007,UnitedHealthcare Silver Compass 2000,16724IL001,,ILN006,ILS001,ILF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010007-05,87% AV Level Silver Plan,86.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010007,UnitedHealthcare Silver Compass 2000,16724IL001,,ILN006,ILS001,ILF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010007-06,94% AV Level Silver Plan,93.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010010,UnitedHealthcare Silver Compass 3500,16724IL001,,ILN006,ILS001,ILF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010010-00,Standard Silver Off Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010010,UnitedHealthcare Silver Compass 3500,16724IL001,,ILN006,ILS001,ILF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010010-05,87% AV Level Silver Plan,86.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010010,UnitedHealthcare Silver Compass 3500,16724IL001,,ILN006,ILS001,ILF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010010-06,94% AV Level Silver Plan,93.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010010,UnitedHealthcare Silver Compass 3500,16724IL001,,ILN006,ILS001,ILF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010010-01,Standard Silver On Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010010,UnitedHealthcare Silver Compass 3500,16724IL001,,ILN006,ILS001,ILF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010010-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,32
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010010,UnitedHealthcare Silver Compass 3500,16724IL001,,ILN006,ILS001,ILF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010010-03,Limited Cost Sharing Plan Variation,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010010,UnitedHealthcare Silver Compass 3500,16724IL001,,ILN006,ILS001,ILF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010010-04,73% AV Level Silver Plan,73.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,14,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0320011,Health Alliance HMO 3500b Silver,20129IL032,7740283974,ILN001,ILS001,ILF003,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_3500b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_3500b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0320011-00,Standard Silver Off Exchange Plan,68.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$6,750",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$20,$500,$200,$700,$900,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,14,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0320011,Health Alliance HMO 3500b Silver,20129IL032,7740283974,ILN001,ILS001,ILF003,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_3500b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_3500b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0320011-01,Standard Silver On Exchange Plan,68.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$6,750",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500",$20,$500,$200,$700,$900,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,14,20129,IL,Individual,No,37-1260731,20129IL0370009,Health Alliance PPO 2000 Gold,20129IL037,7740283974,ILN001,ILS001,ILF014,New,PPO,Gold,Yes,Both,No,No,,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_PPO_2000_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_PPO_2000_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0370009-01,Standard Gold On Exchange Plan,78.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$24,000","$12,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,"$4,000","$12,000","$6,000","$16,000","$2,000",$10,$600,$200,$700,$600,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,14,20129,IL,Individual,No,37-1260731,20129IL0370009,Health Alliance PPO 2000 Gold,20129IL037,7740283974,ILN001,ILS001,ILF014,New,PPO,Gold,Yes,Both,No,No,,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_PPO_2000_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_PPO_2000_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0370009-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,1,16724,IL,Individual,No,43-1361841,16724IL0010002,UnitedHealthcare Bronze Compass HSA 4900,16724IL001,,ILN006,ILS001,ILF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010002-03,Limited Cost Sharing Plan Variation,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,1,16724,IL,Individual,No,43-1361841,16724IL0010008,UnitedHealthcare Silver Compass HSA 2600,16724IL001,,ILN006,ILS001,ILF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010008-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,IL,18715,SERFF,3,2014-10-06 10:59:03,3,18715,IL,SHOP (Small Group),Yes,75-1233841,18715IL0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,18715IL002,,ILN001,ILS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.58,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/il/18715il0020009-15,,18715IL0020009-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,18715,SERFF,3,2014-10-06 10:59:03,3,18715,IL,Individual,Yes,75-1233841,18715IL0010009,Dentegra Dental PPO Family Basic Plan,18715IL001,,ILN001,ILS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.41,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/il/18715il0010009-15,,18715IL0010009-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,1,20129,IL,Individual,No,37-1260731,20129IL0330018,Health Alliance HMO 2750 Gold,20129IL033,7740283974,ILN001,ILS001,ILF010,New,HMO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_2750_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_2750_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330018-00,Standard Gold Off Exchange Plan,78.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750",$10,$300,$200,$700,$500,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,1,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0270012,Health Alliance HMO HSA 2250a Silver,20129IL027,7740283974,ILN001,ILS001,ILF001,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_HSA_2250a_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_HSA_2250a_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0270012-00,Standard Silver Off Exchange Plan,68.80%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,250",$10,$800,$200,"$2,250",$400,$100,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,1,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0270012,Health Alliance HMO HSA 2250a Silver,20129IL027,7740283974,ILN001,ILS001,ILF001,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_HSA_2250a_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_HSA_2250a_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0270012-01,Standard Silver On Exchange Plan,68.80%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,250",$10,$800,$200,"$2,250",$400,$100,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,1,20129,IL,Individual,No,37-1260731,20129IL0330018,Health Alliance HMO 2750 Gold,20129IL033,7740283974,ILN001,ILS001,ILF010,New,HMO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_2750_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_2750_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330018-01,Standard Gold On Exchange Plan,78.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750",$10,$300,$200,$700,$500,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,16,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0310013,Health Alliance POS 3750a Silver,20129IL031,7740283974,ILN001,ILS001,ILF009,New,POS,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_3750a_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_3750a_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0310013-00,Standard Silver Off Exchange Plan,70.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,"$12,800","$38,400","$19,200","$51,200",,,,,,,,,,,,,,,,,,,,,"$3,750","$6,750",20%,,,,"$6,750","$20,250","$10,500","$27,000","$3,750",$10,$500,$200,$700,$700,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,16,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0310013,Health Alliance POS 3750a Silver,20129IL031,7740283974,ILN001,ILS001,ILF009,New,POS,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_3750a_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_3750a_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0310013-01,Standard Silver On Exchange Plan,70.10%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,"$12,800","$38,400","$19,200","$51,200",,,,,,,,,,,,,,,,,,,,,"$3,750","$6,750",20%,,,,"$6,750","$20,250","$10,500","$27,000","$3,750",$10,$500,$200,$700,$700,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,16,20129,IL,Individual,No,37-1260731,20129IL0300014,Health Alliance POS HSA 3750a Bronze,20129IL030,7740283974,ILN001,ILS001,ILF004,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_HSA_3750a_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_HSA_3750a_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300014-01,Standard Bronze On Exchange Plan,61.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,700","$38,100","$18,950","$50,800",,,,,,,,,,,,,,,,,,,,,"$3,750","$11,250",30%,,,,"$11,250","$22,500","$15,000","$33,750","$3,750",$0,$700,$200,"$3,750",$0,$400,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,16,20129,IL,Individual,No,37-1260731,20129IL0300014,Health Alliance POS HSA 3750a Bronze,20129IL030,7740283974,ILN001,ILS001,ILF004,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_HSA_3750a_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_HSA_3750a_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300014-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,6
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,1,16724,IL,Individual,No,43-1361841,16724IL0010008,UnitedHealthcare Silver Compass HSA 2600,16724IL001,,ILN006,ILS001,ILF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010008-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,1,16724,IL,Individual,No,43-1361841,16724IL0010008,UnitedHealthcare Silver Compass HSA 2600,16724IL001,,ILN006,ILS001,ILF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010008-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,1,16724,IL,Individual,No,43-1361841,16724IL0010008,UnitedHealthcare Silver Compass HSA 2600,16724IL001,,ILN006,ILS001,ILF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010008-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,1,16724,IL,Individual,No,43-1361841,16724IL0010008,UnitedHealthcare Silver Compass HSA 2600,16724IL001,,ILN006,ILS001,ILF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010008-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,1,16724,IL,Individual,No,43-1361841,16724IL0010008,UnitedHealthcare Silver Compass HSA 2600,16724IL001,,ILN006,ILS001,ILF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010008-05,87% AV Level Silver Plan,86.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$550,"$1,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,1,16724,IL,Individual,No,43-1361841,16724IL0010008,UnitedHealthcare Silver Compass HSA 2600,16724IL001,,ILN006,ILS001,ILF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010008-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$75,$150,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,1,16724,IL,Individual,No,43-1361841,16724IL0010011,UnitedHealthcare Silver Compass HSA 1600,16724IL001,,ILN006,ILS001,ILF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010011-00,Standard Silver Off Exchange Plan,68.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,1,16724,IL,Individual,No,43-1361841,16724IL0010011,UnitedHealthcare Silver Compass HSA 1600,16724IL001,,ILN006,ILS001,ILF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010011-01,Standard Silver On Exchange Plan,68.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,1,16724,IL,Individual,No,43-1361841,16724IL0010011,UnitedHealthcare Silver Compass HSA 1600,16724IL001,,ILN006,ILS001,ILF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010011-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,17
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,1,16724,IL,Individual,No,43-1361841,16724IL0010011,UnitedHealthcare Silver Compass HSA 1600,16724IL001,,ILN006,ILS001,ILF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010011-03,Limited Cost Sharing Plan Variation,68.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,1,16724,IL,Individual,No,43-1361841,16724IL0010011,UnitedHealthcare Silver Compass HSA 1600,16724IL001,,ILN006,ILS001,ILF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010011-04,73% AV Level Silver Plan,72.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,1,16724,IL,Individual,No,43-1361841,16724IL0010011,UnitedHealthcare Silver Compass HSA 1600,16724IL001,,ILN006,ILS001,ILF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010011-05,87% AV Level Silver Plan,86.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,1,16724,IL,Individual,No,43-1361841,16724IL0010011,UnitedHealthcare Silver Compass HSA 1600,16724IL001,,ILN006,ILS001,ILF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010011-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010003,UnitedHealthcare Gold Compass 1250,16724IL001,,ILN006,ILS001,ILF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010003-00,Standard Gold Off Exchange Plan,79.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010003,UnitedHealthcare Gold Compass 1250,16724IL001,,ILN006,ILS001,ILF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010003-01,Standard Gold On Exchange Plan,79.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010003,UnitedHealthcare Gold Compass 1250,16724IL001,,ILN006,ILS001,ILF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010003-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010003,UnitedHealthcare Gold Compass 1250,16724IL001,,ILN006,ILS001,ILF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010003-03,Limited Cost Sharing Plan Variation,79.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010004,UnitedHealthcare Gold Compass 500,16724IL001,,ILN006,ILS001,ILF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010004-00,Standard Gold Off Exchange Plan,78.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010004,UnitedHealthcare Gold Compass 500,16724IL001,,ILN006,ILS001,ILF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010004-01,Standard Gold On Exchange Plan,78.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010004,UnitedHealthcare Gold Compass 500,16724IL001,,ILN006,ILS001,ILF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010004-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010004,UnitedHealthcare Gold Compass 500,16724IL001,,ILN006,ILS001,ILF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010004-03,Limited Cost Sharing Plan Variation,78.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010005,UnitedHealthcare Platinum Compass 250,16724IL001,,ILN006,ILS001,ILF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010005-00,Standard Platinum Off Exchange Plan,88.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010005,UnitedHealthcare Platinum Compass 250,16724IL001,,ILN006,ILS001,ILF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010005-01,Standard Platinum On Exchange Plan,88.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010005,UnitedHealthcare Platinum Compass 250,16724IL001,,ILN006,ILS001,ILF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010005-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010005,UnitedHealthcare Platinum Compass 250,16724IL001,,ILN006,ILS001,ILF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010005-03,Limited Cost Sharing Plan Variation,88.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010006,UnitedHealthcare Silver Compass 5000,16724IL001,,ILN006,ILS001,ILF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010006-00,Standard Silver Off Exchange Plan,69.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010006,UnitedHealthcare Silver Compass 5000,16724IL001,,ILN006,ILS001,ILF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010006-01,Standard Silver On Exchange Plan,69.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010006,UnitedHealthcare Silver Compass 5000,16724IL001,,ILN006,ILS001,ILF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010006-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010006,UnitedHealthcare Silver Compass 5000,16724IL001,,ILN006,ILS001,ILF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010006-03,Limited Cost Sharing Plan Variation,69.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010006,UnitedHealthcare Silver Compass 5000,16724IL001,,ILN006,ILS001,ILF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010006-04,73% AV Level Silver Plan,73.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,$750,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010006,UnitedHealthcare Silver Compass 5000,16724IL001,,ILN006,ILS001,ILF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010006-05,87% AV Level Silver Plan,86.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010006,UnitedHealthcare Silver Compass 5000,16724IL001,,ILN006,ILS001,ILF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010006-06,94% AV Level Silver Plan,93.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,11,20129,IL,Individual,No,37-1260731,20129IL0290011,Health Alliance HMO 4000d Bronze,20129IL029,7740283974,ILN001,ILS001,ILF013,New,HMO,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_4000d_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_4000d_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0290011-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,11,20129,IL,Individual,No,37-1260731,20129IL0290011,Health Alliance HMO 4000d Bronze,20129IL029,7740283974,ILN001,ILS001,ILF013,New,HMO,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_4000d_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_4000d_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0290011-03,Limited Cost Sharing Plan Variation,58.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$200,"$4,000",$0,$500,$80,7
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,12,20129,IL,Individual,No,37-1260731,20129IL0290013,Health Alliance HMO HSA 3000 Bronze,20129IL029,7740283974,ILN001,ILS001,ILF015,New,HMO,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_HSA_3000_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_HSA_3000_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0290013-00,Standard Bronze Off Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$0,"$1,400",$200,"$3,000",$0,$900,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,12,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0280032,Health Alliance POS 5000a Bronze,20129IL028,7740283974,ILN001,ILS001,ILF007,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_5000a_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_5000a_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0280032-00,Standard Bronze Off Exchange Plan,59.50%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$13,200",,,"$15,500","$31,000","$21,750","$56,400",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$12,700","$25,400","$17,700","$38,100","$4,000",$0,$0,$200,"$5,000",$0,$20,$80,4
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010007,UnitedHealthcare Silver Compass 2000,16724IL001,,ILN006,ILS001,ILF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010007-00,Standard Silver Off Exchange Plan,69.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010007,UnitedHealthcare Silver Compass 2000,16724IL001,,ILN006,ILS001,ILF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010007-01,Standard Silver On Exchange Plan,69.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010007,UnitedHealthcare Silver Compass 2000,16724IL001,,ILN006,ILS001,ILF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010007-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,25
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,2,16724,IL,Individual,No,43-1361841,16724IL0010007,UnitedHealthcare Silver Compass 2000,16724IL001,,ILN006,ILS001,ILF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010007-03,Limited Cost Sharing Plan Variation,69.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,3,16724,IL,Individual,No,43-1361841,16724IL0010001,UnitedHealthcare Bronze Compass 5500,16724IL001,,ILN006,ILS001,ILF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010001-00,Standard Bronze Off Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,3,16724,IL,Individual,No,43-1361841,16724IL0010001,UnitedHealthcare Bronze Compass 5500,16724IL001,,ILN006,ILS001,ILF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010001-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,3,16724,IL,Individual,No,43-1361841,16724IL0010001,UnitedHealthcare Bronze Compass 5500,16724IL001,,ILN006,ILS001,ILF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,IL,16724,SERFF,5,2015-02-22 21:18:17,3,16724,IL,Individual,No,43-1361841,16724IL0010001,UnitedHealthcare Bronze Compass 5500,16724IL001,,ILN006,ILS001,ILF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.999,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xil,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.comxil,16724IL0010001-03,Limited Cost Sharing Plan Variation,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,17522,SERFF,2,2014-09-09 16:12:42,1,17522,IL,SHOP (Small Group),Yes,47-0322111,17522IL0010001,Certfied Dental Plan 1,17522IL001,,ILN001,ILS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$19.69,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,17522IL0010001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,17522,SERFF,2,2014-09-09 16:12:42,1,17522,IL,SHOP (Small Group),Yes,47-0322111,17522IL0010002,Certfied Dental Plan 2,17522IL001,,ILN001,ILS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$27.13,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,17522IL0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,17522,SERFF,2,2014-09-09 16:12:42,1,17522,IL,SHOP (Small Group),Yes,47-0322111,17522IL0010003,Certfied Dental Plan 3,17522IL001,,ILN001,ILS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$31.03,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,17522IL0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IL,17522,SERFF,2,2014-09-09 16:12:42,1,17522,IL,SHOP (Small Group),Yes,47-0322111,17522IL0010004,Certfied Dental Plan 4,17522IL001,,ILN001,ILS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$30.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,17522IL0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IL,18715,SERFF,3,2014-10-06 10:59:03,1,18715,IL,Individual,Yes,75-1233841,18715IL0010001,Dentegra Dental PPO Pediatric Basic Plan,18715IL001,,ILN001,ILS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.41,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/il/18715il0010001-15,,18715IL0010001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,18715,SERFF,3,2014-10-06 10:59:03,1,18715,IL,SHOP (Small Group),Yes,75-1233841,18715IL0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,18715IL002,,ILN001,ILS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.58,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/il/18715il0020001-15,,18715IL0020001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,18715,SERFF,3,2014-10-06 10:59:03,1,18715,IL,SHOP (Small Group),Yes,75-1233841,18715IL0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,18715IL002,,ILN001,ILS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.58,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/il/18715il0020001-15,,18715IL0020001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,18715,SERFF,3,2014-10-06 10:59:03,1,18715,IL,Individual,Yes,75-1233841,18715IL0010001,Dentegra Dental PPO Pediatric Basic Plan,18715IL001,,ILN001,ILS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.41,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/il/18715il0010001-15,,18715IL0010001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,18715,SERFF,3,2014-10-06 10:59:03,2,18715,IL,Individual,Yes,75-1233841,18715IL0010004,Dentegra Dental PPO Family Preferred Plan,18715IL001,,ILN001,ILS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.87,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/il/18715il0010004-15,,18715IL0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,$70,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,18715,SERFF,3,2014-10-06 10:59:03,2,18715,IL,SHOP (Small Group),Yes,75-1233841,18715IL0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,18715IL002,,ILN001,ILS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.09,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/il/18715il0020004-15,,18715IL0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,$70,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,18715,SERFF,3,2014-10-06 10:59:03,2,18715,IL,SHOP (Small Group),Yes,75-1233841,18715IL0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,18715IL002,,ILN001,ILS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.09,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/il/18715il0020004-15,,18715IL0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,$70,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,18715,SERFF,3,2014-10-06 10:59:03,2,18715,IL,Individual,Yes,75-1233841,18715IL0010004,Dentegra Dental PPO Family Preferred Plan,18715IL001,,ILN001,ILS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.87,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/il/18715il0010004-15,,18715IL0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,$70,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,18715,SERFF,3,2014-10-06 10:59:03,3,18715,IL,Individual,Yes,75-1233841,18715IL0010009,Dentegra Dental PPO Family Basic Plan,18715IL001,,ILN001,ILS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.41,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/il/18715il0010009-15,,18715IL0010009-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,18715,SERFF,3,2014-10-06 10:59:03,3,18715,IL,SHOP (Small Group),Yes,75-1233841,18715IL0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,18715IL002,,ILN001,ILS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.58,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/il/18715il0020009-15,,18715IL0020009-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,4,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0360002,Health Alliance PPO HSA 3750 Bronze,20129IL036,7740283974,ILN001,ILS001,ILF004,New,PPO,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_PPO_HSA_3750_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_PPO_HSA_3750_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0360002-00,Standard Bronze Off Exchange Plan,61.30%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,700","$38,100","$18,950","$50,800",,,,,,,,,,,,,,,,,,,,,"$3,750","$11,250",30%,,,,"$11,250","$33,750","$15,000","$45,000","$3,750",$0,$700,$200,"$3,750",$0,$400,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,4,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0360002,Health Alliance PPO HSA 3750 Bronze,20129IL036,7740283974,ILN001,ILS001,ILF004,New,PPO,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_PPO_HSA_3750_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_PPO_HSA_3750_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0360002-01,Standard Bronze On Exchange Plan,61.30%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,700","$38,100","$18,950","$50,800",,,,,,,,,,,,,,,,,,,,,"$3,750","$11,250",30%,,,,"$11,250","$33,750","$15,000","$45,000","$3,750",$0,$700,$200,"$3,750",$0,$400,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,5,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0270018,Health Alliance HMO HSA 3750 Bronze,20129IL027,7740283974,ILN001,ILS001,ILF012,New,HMO,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_HSA_3750_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_HSA_3750_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0270018-00,Standard Bronze Off Exchange Plan,61.30%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$11,250",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750",$0,$700,$200,"$3,750",$0,$400,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,5,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0270018,Health Alliance HMO HSA 3750 Bronze,20129IL027,7740283974,ILN001,ILS001,ILF012,New,HMO,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_HSA_3750_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_HSA_3750_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0270018-01,Standard Bronze On Exchange Plan,61.30%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$11,250",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750",$0,$700,$200,"$3,750",$0,$400,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,6,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0270015,Health Alliance HMO HSA 3150 Bronze,20129IL027,7740283974,ILN001,ILS001,ILF003,New,HMO,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_HSA_3150_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_HSA_3150_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0270015-00,Standard Bronze Off Exchange Plan,62.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,150","$6,300",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,150",$0,"$1,200",$200,"$3,150",$0,$800,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,6,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0270015,Health Alliance HMO HSA 3150 Bronze,20129IL027,7740283974,ILN001,ILS001,ILF003,New,HMO,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_HSA_3150_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_HSA_3150_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0270015-01,Standard Bronze On Exchange Plan,62.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,150","$6,300",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,150",$0,"$1,200",$200,"$3,150",$0,$800,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,7,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0270032,Health Alliance HMO HSA 3000 Bronze,20129IL027,7740283974,ILN001,ILS001,ILF003,New,HMO,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_HSA_3000_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_HSA_3000_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0270032-00,Standard Bronze Off Exchange Plan,62.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$200,"$5,100",$0,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,7,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0270032,Health Alliance HMO HSA 3000 Bronze,20129IL027,7740283974,ILN001,ILS001,ILF003,New,HMO,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_HSA_3000_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_HSA_3000_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0270032-01,Standard Bronze On Exchange Plan,62.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$200,"$5,100",$0,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,8,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0280023,Health Alliance POS HSA 3750b Bronze,20129IL028,7740283974,ILN001,ILS001,ILF005,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_HSA_3750b_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_HSA_3750b_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0280023-00,Standard Bronze Off Exchange Plan,59.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$38,100","$19,050","$50,800",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500",50%,,,,"$7,500","$15,000","$11,250","$22,500","$3,750",$0,"$1,100",$200,"$3,750",$20,$600,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,8,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0280023,Health Alliance POS HSA 3750b Bronze,20129IL028,7740283974,ILN001,ILS001,ILF005,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_HSA_3750b_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_HSA_3750b_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0280023-01,Standard Bronze On Exchange Plan,59.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$38,100","$19,050","$50,800",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500",50%,,,,"$7,500","$15,000","$11,250","$22,500","$3,750",$0,"$1,100",$200,"$3,750",$20,$600,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,9,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0280035,Health Alliance POS HSA 3750c Bronze,20129IL028,7740283974,ILN001,ILS001,ILF006,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_HSA_3750c_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_HSA_3750c_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0280035-00,Standard Bronze Off Exchange Plan,59.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$38,700","$19,350","$51,600",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500",45%,,,,"$7,500","$15,000","$11,250","$22,500","$3,750",$0,"$1,000",$200,"$3,750",$20,$500,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,9,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0280035,Health Alliance POS HSA 3750c Bronze,20129IL028,7740283974,ILN001,ILS001,ILF006,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_HSA_3750c_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_HSA_3750c_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0280035-01,Standard Bronze On Exchange Plan,59.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$38,700","$19,350","$51,600",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500",45%,,,,"$7,500","$15,000","$11,250","$22,500","$3,750",$0,"$1,000",$200,"$3,750",$20,$500,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,10,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0270021,Health Alliance HMO  4000d Bronze,20129IL027,7740283974,ILN001,ILS001,ILF013,New,HMO,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_4000d_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_4000d_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0270021-00,Standard Bronze Off Exchange Plan,58.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$200,"$4,000",$0,$500,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,10,20129,IL,Individual,No,37-1260731,20129IL0330020,Health Alliance HMO 6600 Catastrophic,20129IL033,7740283974,ILN001,ILS001,ILF011,New,HMO,Catastrophic,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_6600_Catastrophic.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_6600_Catastrophic.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330020-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$200,"$5,100",$0,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,10,20129,IL,Individual,No,37-1260731,20129IL0330020,Health Alliance HMO 6600 Catastrophic,20129IL033,7740283974,ILN001,ILS001,ILF011,New,HMO,Catastrophic,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_6600_Catastrophic.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_6600_Catastrophic.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330020-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$200,"$5,100",$0,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,10,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0270021,Health Alliance HMO  4000d Bronze,20129IL027,7740283974,ILN001,ILS001,ILF013,New,HMO,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_4000d_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_4000d_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0270021-01,Standard Bronze On Exchange Plan,58.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$200,"$4,000",$0,$500,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,11,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0280026,Health Alliance POS 4000a Bronze,20129IL028,7740283974,ILN001,ILS001,ILF005,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_4000a_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_4000a_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0280026-00,Standard Bronze Off Exchange Plan,58.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$39,600","$19,800","$52,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$24,000","$12,000","$32,000","$4,000",$0,$0,$200,"$4,000",$0,$500,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,11,20129,IL,Individual,No,37-1260731,20129IL0290011,Health Alliance HMO 4000d Bronze,20129IL029,7740283974,ILN001,ILS001,ILF013,New,HMO,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_4000d_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_4000d_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0290011-00,Standard Bronze Off Exchange Plan,58.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$200,"$4,000",$0,$500,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,11,20129,IL,Individual,No,37-1260731,20129IL0290011,Health Alliance HMO 4000d Bronze,20129IL029,7740283974,ILN001,ILS001,ILF013,New,HMO,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_4000d_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_4000d_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0290011-01,Standard Bronze On Exchange Plan,58.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$200,"$4,000",$0,$500,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,11,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0280026,Health Alliance POS 4000a Bronze,20129IL028,7740283974,ILN001,ILS001,ILF005,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_4000a_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_4000a_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0280026-01,Standard Bronze On Exchange Plan,58.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$39,600","$19,800","$52,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$24,000","$12,000","$32,000","$4,000",$0,$0,$200,"$4,000",$0,$500,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,12,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0280032,Health Alliance POS 5000a Bronze,20129IL028,7740283974,ILN001,ILS001,ILF007,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_5000a_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_5000a_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0280032-01,Standard Bronze On Exchange Plan,59.50%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$13,200",,,"$15,500","$31,000","$21,750","$56,400",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$12,700","$25,400","$17,700","$38,100","$4,000",$0,$0,$200,"$5,000",$0,$20,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,12,20129,IL,Individual,No,37-1260731,20129IL0290013,Health Alliance HMO HSA 3000 Bronze,20129IL029,7740283974,ILN001,ILS001,ILF015,New,HMO,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_HSA_3000_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_HSA_3000_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0290013-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$0,"$1,400",$200,"$3,000",$0,$900,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,12,20129,IL,Individual,No,37-1260731,20129IL0290013,Health Alliance HMO HSA 3000 Bronze,20129IL029,7740283974,ILN001,ILS001,ILF015,New,HMO,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_HSA_3000_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_HSA_3000_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0290013-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,12,20129,IL,Individual,No,37-1260731,20129IL0290013,Health Alliance HMO HSA 3000 Bronze,20129IL029,7740283974,ILN001,ILS001,ILF015,New,HMO,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_HSA_3000_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_HSA_3000_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0290013-03,Limited Cost Sharing Plan Variation,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",45%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$0,"$1,400",$200,"$3,000",$0,$900,$80,7
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,13,20129,IL,Individual,No,37-1260731,20129IL0370007,Health Alliance PPO 4000 Silver,20129IL037,7740283974,ILN001,ILS001,ILF009,New,PPO,Silver,Yes,Both,No,No,,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_PPO_4000_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_PPO_4000_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0370007-00,Standard Silver Off Exchange Plan,69.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$37,500","$18,750","$50,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000","$12,000","$24,000","$3,900",$10,$0,$200,$700,$700,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,13,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0310007,Health Alliance POS 3000a Silver,20129IL031,7740283974,ILN001,ILS001,ILF008,New,POS,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_3000a_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_3000a_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0310007-00,Standard Silver Off Exchange Plan,69.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,"$12,800","$38,400","$19,200","$51,200",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$18,000","$9,000","$24,000","$3,000",$20,$600,$200,$700,$900,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,13,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0310007,Health Alliance POS 3000a Silver,20129IL031,7740283974,ILN001,ILS001,ILF008,New,POS,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_3000a_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_3000a_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0310007-01,Standard Silver On Exchange Plan,69.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,"$12,800","$38,400","$19,200","$51,200",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$18,000","$9,000","$24,000","$3,000",$20,$600,$200,$700,$900,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,13,20129,IL,Individual,No,37-1260731,20129IL0370007,Health Alliance PPO 4000 Silver,20129IL037,7740283974,ILN001,ILS001,ILF009,New,PPO,Silver,Yes,Both,No,No,,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_PPO_4000_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_PPO_4000_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0370007-01,Standard Silver On Exchange Plan,69.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$37,500","$18,750","$50,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000","$12,000","$24,000","$3,900",$10,$0,$200,$700,$700,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,13,20129,IL,Individual,No,37-1260731,20129IL0370007,Health Alliance PPO 4000 Silver,20129IL037,7740283974,ILN001,ILS001,ILF009,New,PPO,Silver,Yes,Both,No,No,,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_PPO_4000_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_PPO_4000_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0370007-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,13,20129,IL,Individual,No,37-1260731,20129IL0370007,Health Alliance PPO 4000 Silver,20129IL037,7740283974,ILN001,ILS001,ILF009,New,PPO,Silver,Yes,Both,No,No,,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_PPO_4000_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_PPO_4000_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0370007-03,Limited Cost Sharing Plan Variation,69.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$37,500","$18,750","$50,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000","$12,000","$24,000","$3,900",$10,$0,$200,$700,$700,$0,$80,7
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,13,20129,IL,Individual,No,37-1260731,20129IL0370007,Health Alliance PPO 4000 Silver,20129IL037,7740283974,ILN001,ILS001,ILF009,New,PPO,Silver,Yes,Both,No,No,,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_PPO_4000_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_PPO_4000_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0370007-04,73% AV Level Silver Plan,72.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$27,000","$13,500","$36,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000","$12,000","$24,000","$3,900","$1,515",$0,$200,$700,$700,$0,$80,8
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,13,20129,IL,Individual,No,37-1260731,20129IL0370007,Health Alliance PPO 4000 Silver,20129IL037,7740283974,ILN001,ILS001,ILF009,New,PPO,Silver,Yes,Both,No,No,,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_PPO_4000_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_PPO_4000_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0370007-05,87% AV Level Silver Plan,86.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$9,000","$27,000","$11,000","$31,000",,,,,,,,,,,,,,,,,,,,,$250,$500,5%,,,,"$8,000","$16,000","$8,250","$16,500",$250,$10,$300,$200,$250,$70,$10,$80,9
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,23,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0320023,Health Alliance HMO 1500a Gold,20129IL032,7740283974,ILN001,ILS001,ILF010,New,HMO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_1500a_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_1500a_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0320023-01,Standard Gold On Exchange Plan,78.50%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$200,$900,$200,$700,$500,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,23,20129,IL,Individual,No,37-1260731,20129IL0340012,Health Alliance POS 6000b Silver,20129IL034,7740283974,ILN001,ILS001,ILF009,New,POS,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_6000b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_6000b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0340012-01,Standard Silver On Exchange Plan,68.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$39,600","$19,800","$52,800",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$36,000","$18,000","$48,000","$1,200",$500,$0,$200,$700,$700,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,23,20129,IL,Individual,No,37-1260731,20129IL0340012,Health Alliance POS 6000b Silver,20129IL034,7740283974,ILN001,ILS001,ILF009,New,POS,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_6000b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_6000b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0340012-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,23,20129,IL,Individual,No,37-1260731,20129IL0340012,Health Alliance POS 6000b Silver,20129IL034,7740283974,ILN001,ILS001,ILF009,New,POS,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_6000b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_6000b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0340012-03,Limited Cost Sharing Plan Variation,68.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$39,600","$19,800","$52,800",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$36,000","$18,000","$48,000","$1,200",$500,$0,$200,$700,$700,$0,$80,7
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,13,20129,IL,Individual,No,37-1260731,20129IL0370007,Health Alliance PPO 4000 Silver,20129IL037,7740283974,ILN001,ILS001,ILF009,New,PPO,Silver,Yes,Both,No,No,,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_PPO_4000_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_PPO_4000_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0370007-06,94% AV Level Silver Plan,94.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$12,000","$6,000","$10,000",,,,,,,,,,,,,,,,,,,,,$0,$0,2%,,,,$500,"$1,000",$500,"$1,000",$0,$10,$100,$200,$0,$10,$600,$80,10
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,14,20129,IL,Individual,No,37-1260731,20129IL0370009,Health Alliance PPO 2000 Gold,20129IL037,7740283974,ILN001,ILS001,ILF014,New,PPO,Gold,Yes,Both,No,No,,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_PPO_2000_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_PPO_2000_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0370009-00,Standard Gold Off Exchange Plan,78.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$24,000","$12,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,"$4,000","$12,000","$6,000","$16,000","$2,000",$10,$600,$200,$700,$600,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,15,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0350009,Health Alliance PPO 3750 Silver,20129IL035,7740283974,ILN001,ILS001,ILF009,New,PPO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_PPO_3750_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_PPO_3750_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0350009-00,Standard Silver Off Exchange Plan,69.90%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$39,600","$19,800","$52,800",,,,,,,,,,,,,,,,,,,,,"$3,750","$6,750",20%,,,,"$6,750","$20,250","$10,500","$27,000","$3,750",$10,$500,$200,$700,$700,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,15,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0350009,Health Alliance PPO 3750 Silver,20129IL035,7740283974,ILN001,ILS001,ILF009,New,PPO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_PPO_3750_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_PPO_3750_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0350009-01,Standard Silver On Exchange Plan,69.90%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$39,600","$19,800","$52,800",,,,,,,,,,,,,,,,,,,,,"$3,750","$6,750",20%,,,,"$6,750","$20,250","$10,500","$27,000","$3,750",$10,$500,$200,$700,$700,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,23,20129,IL,Individual,No,37-1260731,20129IL0340012,Health Alliance POS 6000b Silver,20129IL034,7740283974,ILN001,ILS001,ILF009,New,POS,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_6000b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_6000b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0340012-04,73% AV Level Silver Plan,73.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$13,200","$39,600","$18,400","$50,000",,,,,,,,,,,,,,,,,,,,,"$5,200","$10,400",0%,,,,"$12,000","$36,000","$17,200","$46,400","$1,200",$500,$0,$200,$700,$700,$0,$80,8
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,23,20129,IL,Individual,No,37-1260731,20129IL0340012,Health Alliance POS 6000b Silver,20129IL034,7740283974,ILN001,ILS001,ILF009,New,POS,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_6000b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_6000b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0340012-05,87% AV Level Silver Plan,86.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$12,000","$6,000","$16,000",,,,,,,,,,,,,,,,,,,,,$250,$500,0%,,,,"$2,000","$6,000","$2,250","$6,500",$250,$200,$0,$200,$250,$700,$0,$80,9
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,23,20129,IL,Individual,No,37-1260731,20129IL0340012,Health Alliance POS 6000b Silver,20129IL034,7740283974,ILN001,ILS001,ILF009,New,POS,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_6000b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_6000b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0340012-06,94% AV Level Silver Plan,93.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$1,500","$4,500","$2,250","$6,000",,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$500,"$1,500",$500,"$1,500",$0,$200,$0,$200,$0,$600,$0,$80,10
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,24,20129,IL,Individual,No,37-1260731,20129IL0330017,Health Alliance HMO 1500a Gold,20129IL033,7740283974,ILN001,ILS001,ILF010,New,HMO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_1500a_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_1500a_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330017-00,Standard Gold Off Exchange Plan,78.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200",$200,$500,$200,$700,$500,$0,$80,4
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,4,35670,IL,Individual,No,75-1296086,35670IL0060004,Coventry Bronze Deductible Only HSA Eligible,35670IL006,,ILN001,ILS001,ILF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48203,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060004-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,4,35670,IL,Individual,No,75-1296086,35670IL0060004,Coventry Bronze Deductible Only HSA Eligible,35670IL006,,ILN001,ILS001,ILF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48203,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,4,35670,IL,Individual,No,75-1296086,35670IL0060004,Coventry Bronze Deductible Only HSA Eligible,35670IL006,,ILN001,ILS001,ILF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48203,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060004-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,5,35670,IL,Individual,No,75-1296086,35670IL0070004,Coventry Bronze Deductible Only HSA Eligible Carelink,35670IL007,,ILN002,ILS002,ILF009,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48225,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070004-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,5,35670,IL,Individual,No,75-1296086,35670IL0070004,Coventry Bronze Deductible Only HSA Eligible Carelink,35670IL007,,ILN002,ILS002,ILF009,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48225,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070004-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,5,35670,IL,Individual,No,75-1296086,35670IL0070004,Coventry Bronze Deductible Only HSA Eligible Carelink,35670IL007,,ILN002,ILS002,ILF009,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48225,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,5,35670,IL,Individual,No,75-1296086,35670IL0070004,Coventry Bronze Deductible Only HSA Eligible Carelink,35670IL007,,ILN002,ILS002,ILF009,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48225,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070004-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,6,35670,IL,Individual,No,75-1296086,35670IL0070007,Coventry Bronze Deductible Only HSA Eligible FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF011,New,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48247,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070007-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,15,20129,IL,Individual,No,37-1260731,20129IL0300013,Health Alliance POS HSA 2100a Gold,20129IL030,7740283974,ILN001,ILS001,ILF002,New,POS,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_HSA_2100a_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_HSA_2100a_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300013-01,Standard Gold On Exchange Plan,78.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$8,400","$16,800","$10,500","$21,000",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400","$6,300","$12,600","$2,100",$0,$0,$200,"$2,100",$6,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,15,20129,IL,Individual,No,37-1260731,20129IL0300013,Health Alliance POS HSA 2100a Gold,20129IL030,7740283974,ILN001,ILS001,ILF002,New,POS,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_HSA_2100a_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_HSA_2100a_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300013-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,15,20129,IL,Individual,No,37-1260731,20129IL0300013,Health Alliance POS HSA 2100a Gold,20129IL030,7740283974,ILN001,ILS001,ILF002,New,POS,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_HSA_2100a_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_HSA_2100a_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300013-03,Limited Cost Sharing Plan Variation,78.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$8,400","$16,800","$10,500","$21,000",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400","$6,300","$12,600","$2,100",$0,$0,$200,"$2,100",$6,$0,$80,7
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,16,20129,IL,Individual,No,37-1260731,20129IL0300014,Health Alliance POS HSA 3750a Bronze,20129IL030,7740283974,ILN001,ILS001,ILF004,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_HSA_3750a_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_HSA_3750a_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300014-00,Standard Bronze Off Exchange Plan,61.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,700","$38,100","$18,950","$50,800",,,,,,,,,,,,,,,,,,,,,"$3,750","$11,250",30%,,,,"$11,250","$22,500","$15,000","$33,750","$3,750",$0,$700,$200,"$3,750",$0,$400,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,27,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0320026,Health Alliance HMO 2000 Gold,20129IL032,7740283974,ILN001,ILS001,ILF003,New,HMO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_2000_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_2000_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0320026-00,Standard Gold Off Exchange Plan,78.40%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$20,$400,$200,$700,$800,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,27,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0320026,Health Alliance HMO 2000 Gold,20129IL032,7740283974,ILN001,ILS001,ILF003,New,HMO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_2000_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_2000_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0320026-01,Standard Gold On Exchange Plan,78.40%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$20,$400,$200,$700,$800,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,27,20129,IL,Individual,No,37-1260731,20129IL0330014,Health Alliance HMO 4000b Silver,20129IL033,7740283974,ILN001,ILS001,ILF010,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_4000b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_4000b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330014-01,Standard Silver On Exchange Plan,71.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,700","$1,700",$200,$600,$700,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,27,20129,IL,Individual,No,37-1260731,20129IL0330014,Health Alliance HMO 4000b Silver,20129IL033,7740283974,ILN001,ILS001,ILF010,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_4000b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_4000b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330014-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,27,20129,IL,Individual,No,37-1260731,20129IL0330014,Health Alliance HMO 4000b Silver,20129IL033,7740283974,ILN001,ILS001,ILF010,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_4000b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_4000b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330014-03,Limited Cost Sharing Plan Variation,71.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,700","$1,700",$200,$600,$700,$0,$80,7
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,27,20129,IL,Individual,No,37-1260731,20129IL0330014,Health Alliance HMO 4000b Silver,20129IL033,7740283974,ILN001,ILS001,ILF010,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_4000b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_4000b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330014-04,73% AV Level Silver Plan,73.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,700","$1,700",$200,$600,$700,$0,$80,8
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,7,35670,IL,Individual,No,75-1296086,35670IL0060006,Coventry Silver $10 Copay 2750,35670IL006,,ILN001,ILS001,ILF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48210,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060006-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,8,35670,IL,Individual,No,75-1296086,35670IL0070009,Coventry Silver $10 Copay 2750 FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF013,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48254,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070009-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,26,20129,IL,Individual,No,37-1260731,20129IL0300018,Health Alliance POS HSA 3750c Bronze,20129IL030,7740283974,ILN001,ILS001,ILF006,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_HSA_3750c_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_HSA_3750c_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300018-01,Standard Bronze On Exchange Plan,59.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$38,700","$19,350","$51,600",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500",45%,,,,"$7,500","$15,000","$11,250","$22,500","$3,750",$0,"$1,000",$200,"$3,750",$0,$600,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,26,20129,IL,Individual,No,37-1260731,20129IL0300018,Health Alliance POS HSA 3750c Bronze,20129IL030,7740283974,ILN001,ILS001,ILF006,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_HSA_3750c_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_HSA_3750c_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300018-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,8,35670,IL,Individual,No,75-1296086,35670IL0070009,Coventry Silver $10 Copay 2750 FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF013,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48254,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070009-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,8,35670,IL,Individual,No,75-1296086,35670IL0070009,Coventry Silver $10 Copay 2750 FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF013,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48254,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070009-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,8,35670,IL,Individual,No,75-1296086,35670IL0070009,Coventry Silver $10 Copay 2750 FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF013,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48254,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070009-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,8,35670,IL,Individual,No,75-1296086,35670IL0070009,Coventry Silver $10 Copay 2750 FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF013,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48254,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070009-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,950","$9,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,8,35670,IL,Individual,No,75-1296086,35670IL0070009,Coventry Silver $10 Copay 2750 FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF013,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48254,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070009-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,8,35670,IL,Individual,No,75-1296086,35670IL0070009,Coventry Silver $10 Copay 2750 FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF013,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48254,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070009-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,17,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0320014,Health Alliance HMO 4000a Silver,20129IL032,7740283974,ILN001,ILS001,ILF010,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_4000a_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_4000a_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0320014-00,Standard Silver Off Exchange Plan,71.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,200","$12,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$800,$0,$200,$700,$600,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,17,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0320014,Health Alliance HMO 4000a Silver,20129IL032,7740283974,ILN001,ILS001,ILF010,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_4000a_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_4000a_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0320014-01,Standard Silver On Exchange Plan,71.60%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,200","$12,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$800,$0,$200,$700,$600,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,17,20129,IL,Individual,No,37-1260731,20129IL0300015,Health Alliance POS 4000a Bronze,20129IL030,7740283974,ILN001,ILS001,ILF005,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_4000a_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_4000a_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300015-01,Standard Bronze On Exchange Plan,58.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$39,600","$19,800","$52,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$24,000","$12,000","$32,000","$4,000",$0,$0,$200,"$4,000",$500,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,17,20129,IL,Individual,No,37-1260731,20129IL0300015,Health Alliance POS 4000a Bronze,20129IL030,7740283974,ILN001,ILS001,ILF005,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_4000a_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_4000a_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300015-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,17,20129,IL,Individual,No,37-1260731,20129IL0300015,Health Alliance POS 4000a Bronze,20129IL030,7740283974,ILN001,ILS001,ILF005,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_4000a_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_4000a_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300015-03,Limited Cost Sharing Plan Variation,58.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$39,600","$19,800","$52,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$24,000","$12,000","$32,000","$4,000",$0,$0,$200,"$4,000",$500,$0,$80,7
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,18,20129,IL,Individual,No,37-1260731,20129IL0300016,Health Alliance POS 5000a Bronze,20129IL030,7740283974,ILN001,ILS001,ILF007,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_5000a_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_5000a_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300016-00,Standard Bronze Off Exchange Plan,59.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$13,200",,,"$15,500","$31,000","$21,750","$56,400",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$12,700","$25,400","$17,700","$38,100","$4,000",$0,$0,$200,"$5,000",$0,$20,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,18,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0320020,Health Alliance HMO 5000b Silver,20129IL032,7740283974,ILN001,ILS001,ILF003,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_5000b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_5000b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0320020-00,Standard Silver Off Exchange Plan,69.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$15,$0,$200,$700,$800,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,18,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0320020,Health Alliance HMO 5000b Silver,20129IL032,7740283974,ILN001,ILS001,ILF003,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_5000b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_5000b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0320020-01,Standard Silver On Exchange Plan,69.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$15,$0,$200,$700,$800,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,18,20129,IL,Individual,No,37-1260731,20129IL0300016,Health Alliance POS 5000a Bronze,20129IL030,7740283974,ILN001,ILS001,ILF007,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_5000a_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_5000a_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300016-01,Standard Bronze On Exchange Plan,59.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$13,200",,,"$15,500","$31,000","$21,750","$56,400",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$12,700","$25,400","$17,700","$38,100","$4,000",$0,$0,$200,"$5,000",$0,$20,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,18,20129,IL,Individual,No,37-1260731,20129IL0300016,Health Alliance POS 5000a Bronze,20129IL030,7740283974,ILN001,ILS001,ILF007,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_5000a_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_5000a_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300016-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,18,20129,IL,Individual,No,37-1260731,20129IL0300016,Health Alliance POS 5000a Bronze,20129IL030,7740283974,ILN001,ILS001,ILF007,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_5000a_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_5000a_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300016-03,Limited Cost Sharing Plan Variation,59.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$13,200",,,"$15,500","$31,000","$21,750","$56,400",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$12,700","$25,400","$17,700","$38,100","$4,000",$0,$0,$200,"$5,000",$0,$20,$80,7
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,19,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0320017,Health Alliance HMO 4000c Silver,20129IL032,7740283974,ILN001,ILS001,ILF001,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_4000c_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_4000c_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0320017-00,Standard Silver Off Exchange Plan,69.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$10,$0,$10,$700,$700,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,19,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0320017,Health Alliance HMO 4000c Silver,20129IL032,7740283974,ILN001,ILS001,ILF001,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_4000c_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_4000c_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0320017-01,Standard Silver On Exchange Plan,69.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$10,$0,$10,$700,$700,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,20,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0350012,Health Alliance PPO 4500a Silver,20129IL035,7740283974,ILN001,ILS001,ILF008,New,PPO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_PPO_4500a_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_PPO_4500a_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0350012-00,Standard Silver Off Exchange Plan,70.30%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,100","$13,200",,,"$15,000","$45,000","$21,100","$58,300",,,,,,,,,,,,,,,,,,,,,"$4,500","$12,700",20%,,,,"$12,700","$38,100","$17,200","$50,800","$3,900",$300,$400,$200,$700,$900,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,20,20129,IL,Individual,No,37-1260731,20129IL0300012,Health Alliance POS HSA 2000 Gold,20129IL030,7740283974,ILN001,ILS001,ILF002,New,POS,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_HSA_2000_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_HSA_2000_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300012-00,Standard Gold Off Exchange Plan,78.81%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000","$2,000",$0,$0,$200,"$2,000",$0,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,20,20129,IL,Individual,No,37-1260731,20129IL0300012,Health Alliance POS HSA 2000 Gold,20129IL030,7740283974,ILN001,ILS001,ILF002,New,POS,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_HSA_2000_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_HSA_2000_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300012-01,Standard Gold On Exchange Plan,78.81%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000","$2,000",$0,$0,$200,"$2,000",$0,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,20,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0350012,Health Alliance PPO 4500a Silver,20129IL035,7740283974,ILN001,ILS001,ILF008,New,PPO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_PPO_4500a_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_PPO_4500a_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0350012-01,Standard Silver On Exchange Plan,70.30%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,100","$13,200",,,"$15,000","$45,000","$21,100","$58,300",,,,,,,,,,,,,,,,,,,,,"$4,500","$12,700",20%,,,,"$12,700","$38,100","$17,200","$50,800","$3,900",$300,$400,$200,$700,$900,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,20,20129,IL,Individual,No,37-1260731,20129IL0300012,Health Alliance POS HSA 2000 Gold,20129IL030,7740283974,ILN001,ILS001,ILF002,New,POS,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_HSA_2000_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_HSA_2000_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300012-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,20,20129,IL,Individual,No,37-1260731,20129IL0300012,Health Alliance POS HSA 2000 Gold,20129IL030,7740283974,ILN001,ILS001,ILF002,New,POS,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_HSA_2000_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_HSA_2000_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300012-03,Limited Cost Sharing Plan Variation,78.81%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000","$2,000",$0,$0,$200,"$2,000",$0,$0,$80,7
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,21,20129,IL,Individual,No,37-1260731,20129IL0370008,Health Alliance PPO 4500b Silver,20129IL037,7740283974,ILN001,ILS001,ILF008,New,PPO,Silver,Yes,Both,No,No,,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_PPO_4500b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_PPO_4500b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0370008-00,Standard Silver Off Exchange Plan,69.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$38,100","$19,050","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,"$9,000","$27,000","$13,500","$36,000","$1,200",$500,$700,$200,$700,$900,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,21,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0310016,Health Alliance POS 4500a Silver,20129IL031,7740283974,ILN001,ILS001,ILF008,New,POS,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_4500a_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_4500a_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0310016-00,Standard Silver Off Exchange Plan,70.30%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,100","$12,200",,,"$12,200","$36,600","$18,300","$48,800",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,"$9,000","$18,000","$13,500","$27,000","$2,900",$300,$400,$200,$700,$900,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,21,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0310016,Health Alliance POS 4500a Silver,20129IL031,7740283974,ILN001,ILS001,ILF008,New,POS,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_4500a_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_4500a_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0310016-01,Standard Silver On Exchange Plan,70.30%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,100","$12,200",,,"$12,200","$36,600","$18,300","$48,800",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,"$9,000","$18,000","$13,500","$27,000","$2,900",$300,$400,$200,$700,$900,$0,$80,5
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,1,35670,IL,Individual,No,75-1296086,35670IL0070003,Coventry Bronze $20 Copay Carelink,35670IL007,,ILN002,ILS002,ILF008,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48222,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070003-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,1,35670,IL,Individual,No,75-1296086,35670IL0070003,Coventry Bronze $20 Copay Carelink,35670IL007,,ILN002,ILS002,ILF008,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48222,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,1,35670,IL,Individual,No,75-1296086,35670IL0070003,Coventry Bronze $20 Copay Carelink,35670IL007,,ILN002,ILS002,ILF008,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48222,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070003-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,2,35670,IL,Individual,No,75-1296086,35670IL0060003,Coventry Bronze $25 Copay,35670IL006,,ILN001,ILS001,ILF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48200,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060003-00,Standard Bronze Off Exchange Plan,61.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,2,35670,IL,Individual,No,75-1296086,35670IL0060003,Coventry Bronze $25 Copay,35670IL006,,ILN001,ILS001,ILF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48200,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060003-01,Standard Bronze On Exchange Plan,61.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,2,35670,IL,Individual,No,75-1296086,35670IL0060003,Coventry Bronze $25 Copay,35670IL006,,ILN001,ILS001,ILF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48200,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,2,35670,IL,Individual,No,75-1296086,35670IL0060003,Coventry Bronze $25 Copay,35670IL006,,ILN001,ILS001,ILF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48200,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060003-03,Limited Cost Sharing Plan Variation,61.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,3,35670,IL,Individual,No,75-1296086,35670IL0070006,Coventry Bronze $25 Copay FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF010,New,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48244,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070006-00,Standard Bronze Off Exchange Plan,61.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,3,35670,IL,Individual,No,75-1296086,35670IL0070006,Coventry Bronze $25 Copay FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF010,New,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48244,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070006-01,Standard Bronze On Exchange Plan,61.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,3,35670,IL,Individual,No,75-1296086,35670IL0070006,Coventry Bronze $25 Copay FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF010,New,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48244,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,21,20129,IL,Individual,No,37-1260731,20129IL0370008,Health Alliance PPO 4500b Silver,20129IL037,7740283974,ILN001,ILS001,ILF008,New,PPO,Silver,Yes,Both,No,No,,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_PPO_4500b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_PPO_4500b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0370008-01,Standard Silver On Exchange Plan,69.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$38,100","$19,050","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,"$9,000","$27,000","$13,500","$36,000","$1,200",$500,$700,$200,$700,$900,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,21,20129,IL,Individual,No,37-1260731,20129IL0370008,Health Alliance PPO 4500b Silver,20129IL037,7740283974,ILN001,ILS001,ILF008,New,PPO,Silver,Yes,Both,No,No,,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_PPO_4500b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_PPO_4500b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0370008-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,21,20129,IL,Individual,No,37-1260731,20129IL0370008,Health Alliance PPO 4500b Silver,20129IL037,7740283974,ILN001,ILS001,ILF008,New,PPO,Silver,Yes,Both,No,No,,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_PPO_4500b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_PPO_4500b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0370008-03,Limited Cost Sharing Plan Variation,69.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$38,100","$19,050","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,,,,"$9,000","$27,000","$13,500","$36,000","$1,200",$500,$700,$200,$700,$900,$0,$80,7
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,21,20129,IL,Individual,No,37-1260731,20129IL0370008,Health Alliance PPO 4500b Silver,20129IL037,7740283974,ILN001,ILS001,ILF008,New,PPO,Silver,Yes,Both,No,No,,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_PPO_4500b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_PPO_4500b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0370008-04,73% AV Level Silver Plan,72.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$12,700","$38,100","$17,200","$47,100",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$9,000","$27,000","$13,000","$36,000","$1,200",$500,$686,$200,$700,$900,$0,$80,8
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,21,20129,IL,Individual,No,37-1260731,20129IL0370008,Health Alliance PPO 4500b Silver,20129IL037,7740283974,ILN001,ILS001,ILF008,New,PPO,Silver,Yes,Both,No,No,,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_PPO_4500b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_PPO_4500b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0370008-05,87% AV Level Silver Plan,87.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,000","$36,000","$14,000","$40,000",,,,,,,,,,,,,,,,,,,,,$250,$500,5%,,,,"$8,000","$24,000","$8,250","$24,500",$250,$500,$300,$200,$250,$900,$10,$80,9
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,21,20129,IL,Individual,No,37-1260731,20129IL0370008,Health Alliance PPO 4500b Silver,20129IL037,7740283974,ILN001,ILS001,ILF008,New,PPO,Silver,Yes,Both,No,No,,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_PPO_4500b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_PPO_4500b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0370008-06,94% AV Level Silver Plan,93.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$12,000","$6,000","$16,000",,,,,,,,,,,,,,,,,,,,,$0,$0,2%,,,,$500,"$1,500",$500,"$1,500",$0,$200,$100,$200,$0,$800,$10,$80,10
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,22,20129,IL,Individual,No,37-1260731,20129IL0370010,Health Alliance PPO 3250b Gold,20129IL037,7740283974,ILN001,ILS001,ILF009,New,PPO,Gold,Yes,Both,No,No,,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_PPO_3250b_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_PPO_3250b_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0370010-00,Standard Gold Off Exchange Plan,79.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$12,000","$24,000","$9,750","$30,500",,,,,,,,,,,,,,,,,,,,,"$3,250","$6,500",0%,,,,"$6,500","$19,500","$9,750","$26,000","$3,250",$0,$0,$200,$700,$700,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,22,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0310022,Health Alliance POS 6000a Silver,20129IL031,7740283974,ILN001,ILS001,ILF009,New,POS,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_6000a_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_6000a_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0310022-00,Standard Silver Off Exchange Plan,69.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,"$12,800","$38,400","$19,200","$51,200",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$36,000","$18,000","$48,000","$3,900",$300,$0,$200,$700,$700,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,22,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0310022,Health Alliance POS 6000a Silver,20129IL031,7740283974,ILN001,ILS001,ILF009,New,POS,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_6000a_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_6000a_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0310022-01,Standard Silver On Exchange Plan,69.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,"$12,800","$38,400","$19,200","$51,200",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$36,000","$18,000","$48,000","$3,900",$300,$0,$200,$700,$700,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,22,20129,IL,Individual,No,37-1260731,20129IL0370010,Health Alliance PPO 3250b Gold,20129IL037,7740283974,ILN001,ILS001,ILF009,New,PPO,Gold,Yes,Both,No,No,,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_PPO_3250b_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_PPO_3250b_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0370010-01,Standard Gold On Exchange Plan,79.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$12,000","$24,000","$9,750","$30,500",,,,,,,,,,,,,,,,,,,,,"$3,250","$6,500",0%,,,,"$6,500","$19,500","$9,750","$26,000","$3,250",$0,$0,$200,$700,$700,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,22,20129,IL,Individual,No,37-1260731,20129IL0370010,Health Alliance PPO 3250b Gold,20129IL037,7740283974,ILN001,ILS001,ILF009,New,PPO,Gold,Yes,Both,No,No,,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_PPO_3250b_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_PPO_3250b_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0370010-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,22,20129,IL,Individual,No,37-1260731,20129IL0370010,Health Alliance PPO 3250b Gold,20129IL037,7740283974,ILN001,ILS001,ILF009,New,PPO,Gold,Yes,Both,No,No,,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_PPO_3250b_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_PPO_3250b_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0370010-03,Limited Cost Sharing Plan Variation,79.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$12,000","$24,000","$9,750","$30,500",,,,,,,,,,,,,,,,,,,,,"$3,250","$6,500",0%,,,,"$6,500","$19,500","$9,750","$26,000","$3,250",$0,$0,$200,$700,$700,$0,$80,7
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,23,20129,IL,Individual,No,37-1260731,20129IL0340012,Health Alliance POS 6000b Silver,20129IL034,7740283974,ILN001,ILS001,ILF009,New,POS,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_6000b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_6000b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0340012-00,Standard Silver Off Exchange Plan,68.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$39,600","$19,800","$52,800",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$36,000","$18,000","$48,000","$1,200",$500,$0,$200,$700,$700,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,23,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0320023,Health Alliance HMO 1500a Gold,20129IL032,7740283974,ILN001,ILS001,ILF010,New,HMO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_1500a_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_1500a_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0320023-00,Standard Gold Off Exchange Plan,78.50%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$200,$900,$200,$700,$500,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,24,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0310031,Health Alliance POS 1500 Gold,20129IL031,7740283974,ILN001,ILS001,ILF009,New,POS,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_1500_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_1500_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0310031-00,Standard Gold Off Exchange Plan,78.40%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$21,000","$10,500","$28,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",15%,,,,"$3,000","$9,000","$4,500","$12,000","$1,500",$10,$700,$200,$700,$700,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,24,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0310031,Health Alliance POS 1500 Gold,20129IL031,7740283974,ILN001,ILS001,ILF009,New,POS,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_1500_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_1500_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0310031-01,Standard Gold On Exchange Plan,78.40%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$21,000","$10,500","$28,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",15%,,,,"$3,000","$9,000","$4,500","$12,000","$1,500",$10,$700,$200,$700,$700,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,24,20129,IL,Individual,No,37-1260731,20129IL0330017,Health Alliance HMO 1500a Gold,20129IL033,7740283974,ILN001,ILS001,ILF010,New,HMO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_1500a_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_1500a_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330017-01,Standard Gold On Exchange Plan,78.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200",$200,$500,$200,$700,$500,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,24,20129,IL,Individual,No,37-1260731,20129IL0330017,Health Alliance HMO 1500a Gold,20129IL033,7740283974,ILN001,ILS001,ILF010,New,HMO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_1500a_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_1500a_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330017-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,24,20129,IL,Individual,No,37-1260731,20129IL0330017,Health Alliance HMO 1500a Gold,20129IL033,7740283974,ILN001,ILS001,ILF010,New,HMO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_1500a_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_1500a_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330017-03,Limited Cost Sharing Plan Variation,78.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200",$200,$500,$200,$700,$500,$0,$80,7
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,25,20129,IL,Individual,No,37-1260731,20129IL0330021,Health Alliance HMO 1500b Gold,20129IL033,7740283974,ILN001,ILS001,ILF010,New,HMO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_1500b_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_1500b_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330021-00,Standard Gold Off Exchange Plan,78.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200",$200,$0,$200,$700,$500,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,25,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0310034,Health Alliance POS 2000 Gold,20129IL031,7740283974,ILN001,ILS001,ILF014,New,POS,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_2000_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_2000_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0310034-00,Standard Gold Off Exchange Plan,78.30%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$24,000","$12,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,"$4,000","$12,000","$6,000","$16,000","$2,000",$10,$600,$200,$700,$600,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,25,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0310034,Health Alliance POS 2000 Gold,20129IL031,7740283974,ILN001,ILS001,ILF014,New,POS,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_2000_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_2000_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0310034-01,Standard Gold On Exchange Plan,78.30%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$24,000","$12,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,"$4,000","$12,000","$6,000","$16,000","$2,000",$10,$600,$200,$700,$600,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,25,20129,IL,Individual,No,37-1260731,20129IL0330021,Health Alliance HMO 1500b Gold,20129IL033,7740283974,ILN001,ILS001,ILF010,New,HMO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_1500b_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_1500b_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330021-01,Standard Gold On Exchange Plan,78.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200",$200,$0,$200,$700,$500,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,25,20129,IL,Individual,No,37-1260731,20129IL0330021,Health Alliance HMO 1500b Gold,20129IL033,7740283974,ILN001,ILS001,ILF010,New,HMO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_1500b_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_1500b_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330021-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,25,20129,IL,Individual,No,37-1260731,20129IL0330021,Health Alliance HMO 1500b Gold,20129IL033,7740283974,ILN001,ILS001,ILF010,New,HMO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_1500b_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_1500b_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330021-03,Limited Cost Sharing Plan Variation,78.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200",$200,$0,$200,$700,$500,$0,$80,7
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,26,20129,IL,Individual,No,37-1260731,20129IL0300018,Health Alliance POS HSA 3750c Bronze,20129IL030,7740283974,ILN001,ILS001,ILF006,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_HSA_3750c_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_HSA_3750c_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300018-00,Standard Bronze Off Exchange Plan,59.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$38,700","$19,350","$51,600",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500",45%,,,,"$7,500","$15,000","$11,250","$22,500","$3,750",$0,"$1,000",$200,"$3,750",$0,$600,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,26,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0350015,Health Alliance PPO 2000 Gold,20129IL035,7740283974,ILN001,ILS001,ILF014,New,PPO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_PPO_2000_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_PPO_2000_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0350015-00,Standard Gold Off Exchange Plan,78.30%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$24,000","$12,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,"$4,000","$12,000","$6,000","$16,000","$2,000",$10,$600,$200,$700,$600,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,26,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0350015,Health Alliance PPO 2000 Gold,20129IL035,7740283974,ILN001,ILS001,ILF014,New,PPO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_PPO_2000_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_PPO_2000_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0350015-01,Standard Gold On Exchange Plan,78.30%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$24,000","$12,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,,,,"$4,000","$12,000","$6,000","$16,000","$2,000",$10,$600,$200,$700,$600,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,26,20129,IL,Individual,No,37-1260731,20129IL0300018,Health Alliance POS HSA 3750c Bronze,20129IL030,7740283974,ILN001,ILS001,ILF006,New,POS,Bronze,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage Available,Yes,Out of Network Coverage Available,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_POS_HSA_3750c_Bronze.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_POS_HSA_3750c_Bronze.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0300018-03,Limited Cost Sharing Plan Variation,59.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$38,700","$19,350","$51,600",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500",45%,,,,"$7,500","$15,000","$11,250","$22,500","$3,750",$0,"$1,000",$200,"$3,750",$0,$600,$80,7
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,27,20129,IL,Individual,No,37-1260731,20129IL0330014,Health Alliance HMO 4000b Silver,20129IL033,7740283974,ILN001,ILS001,ILF010,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_4000b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_4000b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330014-00,Standard Silver Off Exchange Plan,71.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,700","$1,700",$200,$600,$700,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,27,20129,IL,Individual,No,37-1260731,20129IL0330014,Health Alliance HMO 4000b Silver,20129IL033,7740283974,ILN001,ILS001,ILF010,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_4000b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_4000b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330014-05,87% AV Level Silver Plan,87.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,2%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$800,$100,$200,$0,$700,$10,$80,9
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,27,20129,IL,Individual,No,37-1260731,20129IL0330014,Health Alliance HMO 4000b Silver,20129IL033,7740283974,ILN001,ILS001,ILF010,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_4000b_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_4000b_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330014-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,2%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$200,$100,$200,$0,$600,$10,$80,10
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,28,20129,IL,Individual,No,37-1260731,20129IL0330015,Health Alliance HMO 5000c Silver,20129IL033,7740283974,ILN001,ILS001,ILF003,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_5000c_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_5000c_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330015-00,Standard Silver Off Exchange Plan,69.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$300,$200,$400,$800,$90,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,28,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0320029,Health Alliance HMO 2250 Gold,20129IL032,7740283974,ILN001,ILS001,ILF010,New,HMO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_2250_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_2250_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0320029-00,Standard Gold Off Exchange Plan,78.30%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$5,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,250",$10,$400,$200,$700,$600,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,28,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0320029,Health Alliance HMO 2250 Gold,20129IL032,7740283974,ILN001,ILS001,ILF010,New,HMO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_2250_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_2250_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0320029-01,Standard Gold On Exchange Plan,78.30%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$5,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,250",$10,$400,$200,$700,$600,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,28,20129,IL,Individual,No,37-1260731,20129IL0330015,Health Alliance HMO 5000c Silver,20129IL033,7740283974,ILN001,ILS001,ILF003,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_5000c_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_5000c_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330015-01,Standard Silver On Exchange Plan,69.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$300,$200,$400,$800,$90,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,28,20129,IL,Individual,No,37-1260731,20129IL0330015,Health Alliance HMO 5000c Silver,20129IL033,7740283974,ILN001,ILS001,ILF003,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_5000c_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_5000c_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330015-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,28,20129,IL,Individual,No,37-1260731,20129IL0330015,Health Alliance HMO 5000c Silver,20129IL033,7740283974,ILN001,ILS001,ILF003,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_5000c_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_5000c_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330015-03,Limited Cost Sharing Plan Variation,69.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$300,$200,$400,$800,$90,$80,7
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,28,20129,IL,Individual,No,37-1260731,20129IL0330015,Health Alliance HMO 5000c Silver,20129IL033,7740283974,ILN001,ILS001,ILF003,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_5000c_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_5000c_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330015-04,73% AV Level Silver Plan,73.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$300,$200,$400,$800,$90,$80,8
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,28,20129,IL,Individual,No,37-1260731,20129IL0330015,Health Alliance HMO 5000c Silver,20129IL033,7740283974,ILN001,ILS001,ILF003,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_5000c_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_5000c_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330015-05,87% AV Level Silver Plan,86.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,$200,$200,$400,$800,$30,$80,9
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,28,20129,IL,Individual,No,37-1260731,20129IL0330015,Health Alliance HMO 5000c Silver,20129IL033,7740283974,ILN001,ILS001,ILF003,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SBC_HealthAlliance_HMO_5000c_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_IND_PUB_SOB_HealthAlliance_HMO_5000c_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0330015-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,2%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$20,$100,$200,$250,$800,$10,$80,10
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,29,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0310037,Health Alliance POS 2750 Gold,20129IL031,7740283974,ILN001,ILS001,ILF014,New,POS,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_2750_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_2750_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0310037-00,Standard Gold Off Exchange Plan,78.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$33,000","$16,500","$44,000",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",10%,,,,"$5,500","$16,500","$8,250","$22,000","$2,750",$10,$300,$200,$700,$500,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,29,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0310037,Health Alliance POS 2750 Gold,20129IL031,7740283974,ILN001,ILS001,ILF014,New,POS,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_POS_2750_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_POS_2750_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0310037-01,Standard Gold On Exchange Plan,78.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$33,000","$16,500","$44,000",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",10%,,,,"$5,500","$16,500","$8,250","$22,000","$2,750",$10,$300,$200,$700,$500,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,30,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0350018,Health Alliance PPO 3250a Gold,20129IL035,7740283974,ILN001,ILS001,ILF014,New,PPO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_PPO_3250a_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_PPO_3250a_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0350018-00,Standard Gold Off Exchange Plan,79.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$13,000","$26,000","$16,250","$32,500",,,,,,,,,,,,,,,,,,,,,"$3,250","$6,500",0%,,,,"$6,500","$19,500","$9,750","$26,000","$3,250",$0,$0,$200,$700,$600,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,30,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0350018,Health Alliance PPO 3250a Gold,20129IL035,7740283974,ILN001,ILS001,ILF014,New,PPO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_PPO_3250a_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_PPO_3250a_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0350018-01,Standard Gold On Exchange Plan,79.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$13,000","$26,000","$16,250","$32,500",,,,,,,,,,,,,,,,,,,,,"$3,250","$6,500",0%,,,,"$6,500","$19,500","$9,750","$26,000","$3,250",$0,$0,$200,$700,$600,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,31,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0350021,Health Alliance PPO 3250b Gold,20129IL035,7740283974,ILN001,ILS001,ILF009,New,PPO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_PPO_3250B_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_PPO_3250B_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0350021-00,Standard Gold Off Exchange Plan,79.50%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$12,000","$24,000","$15,250","$30,500",,,,,,,,,,,,,,,,,,,,,"$3,250","$6,500",0%,,,,"$6,500","$19,500","$9,750","$26,000","$3,250",$0,$0,$200,$700,$700,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,31,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0350021,Health Alliance PPO 3250b Gold,20129IL035,7740283974,ILN001,ILS001,ILF009,New,PPO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Network Coverage available,Yes,Out of Network Coverage available,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_PPO_3250B_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_PPO_3250B_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0350021-01,Standard Gold On Exchange Plan,79.50%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$12,000","$24,000","$15,250","$30,500",,,,,,,,,,,,,,,,,,,,,"$3,250","$6,500",0%,,,,"$6,500","$19,500","$9,750","$26,000","$3,250",$0,$0,$200,$700,$700,$0,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,32,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0270029,Health Alliance HMO HSA 2250b Silver,20129IL027,7740283974,ILN001,ILS001,ILF001,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_HSA_2250B_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_HSA_2250B_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0270029-00,Standard Silver Off Exchange Plan,68.50%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,250",$10,$900,$200,"$2,250",$400,$100,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,32,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0270029,Health Alliance HMO HSA 2250b Silver,20129IL027,7740283974,ILN001,ILS001,ILF001,New,HMO,Silver,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,Yes,Yes,$0.00,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_HSA_2250B_Silver.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_HSA_2250B_Silver.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0270029-01,Standard Silver On Exchange Plan,68.50%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,250",$10,$900,$200,"$2,250",$400,$100,$80,5
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,33,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0320032,Health Alliance HMO 1500b Gold,20129IL032,7740283974,ILN001,ILS001,ILF010,New,HMO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_1500B_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_1500B_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0320032-00,Standard Gold Off Exchange Plan,78.50%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$10,$900,$200,$700,$500,$0,$80,4
2015,IL,20129,SERFF,9,2015-07-24 22:33:25,33,20129,IL,SHOP (Small Group),No,37-1260731,20129IL0320032,Health Alliance HMO 1500b Gold,20129IL032,7740283974,ILN001,ILS001,ILF010,New,HMO,Gold,Yes,Both,No,Yes,All specialists (IN) may require a referral except OB-GYN and Optometrists,"Acupunture, Custodial Care, Weight Loss Programs",,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Emergency Coverage Only,No,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SBC_HealthAlliance_HMO_1500B_Gold.pdf,https://shop.healthalliancemarket.org/payment?source=ffe,https://www.healthalliance.org/docs/2015_IL_GRP_PUB_SOB_HealthAlliance_HMO_1500B_Gold.pdf,https://www.healthalliance.org/content/pharmacy#formulary,20129IL0320032-01,Standard Gold On Exchange Plan,78.50%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$10,$900,$200,$700,$500,$0,$80,5
2015,IL,20545,SERFF,1,2014-08-12 09:41:38,1,20545,IL,SHOP (Small Group),Yes,57-0523959,20545IL0010001,Group Pediatric Dental EHB Rider,20545IL001,,ILN001,ILS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$28.60,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,20545IL0010001-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,20545,SERFF,1,2014-08-12 09:41:38,1,20545,IL,SHOP (Small Group),Yes,57-0523959,20545IL0010002,Group Pediatric Dental EHB Rider,20545IL001,,ILN001,ILS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$23.06,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,20545IL0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,30680,SERFF,1,2014-08-09 13:12:30,1,30680,IL,SHOP (Small Group),Yes,93-0242990,30680IL0040002,EHB High PPO,30680IL004,,ILN001,ILS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.76,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,30680IL0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,30680,SERFF,1,2014-08-09 13:12:30,1,30680,IL,SHOP (Small Group),Yes,93-0242990,30680IL0040001,EHB Low PPO,30680IL004,,ILN001,ILS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.85,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,30680IL0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,30680,SERFF,1,2014-08-09 13:12:30,1,30680,IL,SHOP (Small Group),Yes,93-0242990,30680IL0030002,EHB High Passive,30680IL003,,ILN001,ILS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$44.21,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,30680IL0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IL,30680,SERFF,1,2014-08-09 13:12:30,1,30680,IL,SHOP (Small Group),Yes,93-0242990,30680IL0030001,EHB Low Passive,30680IL003,,ILN001,ILS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.43,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,30680IL0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,1,35670,IL,Individual,No,75-1296086,35670IL0070003,Coventry Bronze $20 Copay Carelink,35670IL007,,ILN002,ILS002,ILF008,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48222,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070003-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,3,35670,IL,Individual,No,75-1296086,35670IL0070006,Coventry Bronze $25 Copay FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF010,New,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48244,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070006-03,Limited Cost Sharing Plan Variation,61.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,4,35670,IL,Individual,No,75-1296086,35670IL0060004,Coventry Bronze Deductible Only HSA Eligible,35670IL006,,ILN001,ILS001,ILF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48203,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060004-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,6,35670,IL,Individual,No,75-1296086,35670IL0070007,Coventry Bronze Deductible Only HSA Eligible FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF011,New,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48247,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070007-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,7,35670,IL,Individual,No,75-1296086,35670IL0060006,Coventry Silver $10 Copay 2750,35670IL006,,ILN001,ILS001,ILF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48210,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060006-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,7,35670,IL,Individual,No,75-1296086,35670IL0060006,Coventry Silver $10 Copay 2750,35670IL006,,ILN001,ILS001,ILF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48210,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060006-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,7,35670,IL,Individual,No,75-1296086,35670IL0060006,Coventry Silver $10 Copay 2750,35670IL006,,ILN001,ILS001,ILF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48210,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,7,35670,IL,Individual,No,75-1296086,35670IL0060006,Coventry Silver $10 Copay 2750,35670IL006,,ILN001,ILS001,ILF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48210,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060006-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,7,35670,IL,Individual,No,75-1296086,35670IL0060006,Coventry Silver $10 Copay 2750,35670IL006,,ILN001,ILS001,ILF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48210,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060006-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,950","$9,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,7,35670,IL,Individual,No,75-1296086,35670IL0060006,Coventry Silver $10 Copay 2750,35670IL006,,ILN001,ILS001,ILF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48210,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060006-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,9,35670,IL,Individual,No,75-1296086,35670IL0070002,Coventry Silver $10 Copay Carelink,35670IL007,,ILN002,ILS002,ILF007,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48232,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070002-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,9,35670,IL,Individual,No,75-1296086,35670IL0070002,Coventry Silver $10 Copay Carelink,35670IL007,,ILN002,ILS002,ILF007,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48232,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070002-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,9,35670,IL,Individual,No,75-1296086,35670IL0070002,Coventry Silver $10 Copay Carelink,35670IL007,,ILN002,ILS002,ILF007,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48232,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,9,35670,IL,Individual,No,75-1296086,35670IL0070002,Coventry Silver $10 Copay Carelink,35670IL007,,ILN002,ILS002,ILF007,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48232,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070002-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,9,35670,IL,Individual,No,75-1296086,35670IL0070002,Coventry Silver $10 Copay Carelink,35670IL007,,ILN002,ILS002,ILF007,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48232,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070002-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,9,35670,IL,Individual,No,75-1296086,35670IL0070002,Coventry Silver $10 Copay Carelink,35670IL007,,ILN002,ILS002,ILF007,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48232,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070002-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,9,35670,IL,Individual,No,75-1296086,35670IL0070002,Coventry Silver $10 Copay Carelink,35670IL007,,ILN002,ILS002,ILF007,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48232,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070002-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,10,35670,IL,Individual,No,75-1296086,35670IL0060002,Coventry Silver $15 Copay,35670IL006,,ILN001,ILS001,ILF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48216,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060002-00,Standard Silver Off Exchange Plan,68.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,10,35670,IL,Individual,No,75-1296086,35670IL0060002,Coventry Silver $15 Copay,35670IL006,,ILN001,ILS001,ILF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48216,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060002-01,Standard Silver On Exchange Plan,68.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,10,35670,IL,Individual,No,75-1296086,35670IL0060002,Coventry Silver $15 Copay,35670IL006,,ILN001,ILS001,ILF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48216,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,10,35670,IL,Individual,No,75-1296086,35670IL0060002,Coventry Silver $15 Copay,35670IL006,,ILN001,ILS001,ILF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48216,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060002-03,Limited Cost Sharing Plan Variation,68.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,10,35670,IL,Individual,No,75-1296086,35670IL0060002,Coventry Silver $15 Copay,35670IL006,,ILN001,ILS001,ILF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48216,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060002-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,10,35670,IL,Individual,No,75-1296086,35670IL0060002,Coventry Silver $15 Copay,35670IL006,,ILN001,ILS001,ILF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48216,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060002-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,050","$4,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,10,35670,IL,Individual,No,75-1296086,35670IL0060002,Coventry Silver $15 Copay,35670IL006,,ILN001,ILS001,ILF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48216,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060002-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,11,35670,IL,Individual,No,75-1296086,35670IL0070010,Coventry Silver $15 Copay FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF014,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48260,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070010-00,Standard Silver Off Exchange Plan,68.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,11,35670,IL,Individual,No,75-1296086,35670IL0070010,Coventry Silver $15 Copay FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF014,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48260,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070010-01,Standard Silver On Exchange Plan,68.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,11,35670,IL,Individual,No,75-1296086,35670IL0070010,Coventry Silver $15 Copay FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF014,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48260,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070010-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,11,35670,IL,Individual,No,75-1296086,35670IL0070010,Coventry Silver $15 Copay FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF014,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48260,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070010-03,Limited Cost Sharing Plan Variation,68.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,11,35670,IL,Individual,No,75-1296086,35670IL0070010,Coventry Silver $15 Copay FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF014,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48260,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070010-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,11,35670,IL,Individual,No,75-1296086,35670IL0070010,Coventry Silver $15 Copay FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF014,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48260,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070010-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,050","$4,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,11,35670,IL,Individual,No,75-1296086,35670IL0070010,Coventry Silver $15 Copay FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF014,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48260,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070010-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,15,35670,IL,Individual,No,75-1296086,35670IL0070001,Coventry Gold $5 Copay Carelink,35670IL007,,ILN002,ILS002,ILF006,Existing,PPO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48229,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070001-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0760001,Blue PPO Gold? 001,36096IL076,,ILN001,ILS001,ILF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760001-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,12,35670,IL,Individual,No,75-1296086,35670IL0070011,Coventry Silver $5 Copay 2750 Carelink,35670IL007,,ILN002,ILS002,ILF015,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48238,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070011-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,12,35670,IL,Individual,No,75-1296086,35670IL0070011,Coventry Silver $5 Copay 2750 Carelink,35670IL007,,ILN002,ILS002,ILF015,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48238,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070011-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,12,35670,IL,Individual,No,75-1296086,35670IL0070011,Coventry Silver $5 Copay 2750 Carelink,35670IL007,,ILN002,ILS002,ILF015,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48238,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070011-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,12,35670,IL,Individual,No,75-1296086,35670IL0070011,Coventry Silver $5 Copay 2750 Carelink,35670IL007,,ILN002,ILS002,ILF015,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48238,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070011-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,12,35670,IL,Individual,No,75-1296086,35670IL0070011,Coventry Silver $5 Copay 2750 Carelink,35670IL007,,ILN002,ILS002,ILF015,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48238,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070011-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,12,35670,IL,Individual,No,75-1296086,35670IL0070011,Coventry Silver $5 Copay 2750 Carelink,35670IL007,,ILN002,ILS002,ILF015,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48238,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070011-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,12,35670,IL,Individual,No,75-1296086,35670IL0070011,Coventry Silver $5 Copay 2750 Carelink,35670IL007,,ILN002,ILS002,ILF015,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48238,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070011-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0760001,Blue PPO Gold? 001,36096IL076,,ILN001,ILS001,ILF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760001-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0760001,Blue PPO Gold? 001,36096IL076,,ILN001,ILS001,ILF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),Yes,36-1236610,36096IL0840006,BlueCare Dental? 1D,36096IL084,,ILN005,ILS005,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.49,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbsil.com/employer/products/on-exchange/dental/,,36096IL0840006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800001,Blue Choice Gold PPO? 001,36096IL080,,ILN003,ILS033,ILF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800001-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800017,Blue Choice Gold PPO? 002,36096IL080,,ILN003,ILS023,ILF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800017-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790011,Blue Choice Gold PPO? 001,36096IL079,,ILN003,ILS043,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790011-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790011,Blue Choice Gold PPO? 001,36096IL079,,ILN003,ILS043,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790011-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800018,Blue Choice Gold PPO? 002,36096IL080,,ILN003,ILS033,ILF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800018-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790012,Blue Choice Gold PPO? 001,36096IL079,,ILN003,ILS063,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790012-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800019,Blue Choice Gold PPO? 002,36096IL080,,ILN003,ILS043,ILF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800019-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790016,Blue Choice Gold PPO? 002,36096IL079,,ILN003,ILS063,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790016-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800027,Blue Choice Silver PPO? 004,36096IL080,,ILN003,ILS043,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800027-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,13,35670,IL,Individual,No,75-1296086,35670IL0060001,Coventry Gold $10 Copay,35670IL006,,ILN004,ILS004,ILF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48207,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060001-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,13,35670,IL,Individual,No,75-1296086,35670IL0060001,Coventry Gold $10 Copay,35670IL006,,ILN004,ILS004,ILF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48207,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060001-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,13,35670,IL,Individual,No,75-1296086,35670IL0060001,Coventry Gold $10 Copay,35670IL006,,ILN004,ILS004,ILF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48207,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,13,35670,IL,Individual,No,75-1296086,35670IL0060001,Coventry Gold $10 Copay,35670IL006,,ILN004,ILS004,ILF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48207,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0060001-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,14,35670,IL,Individual,No,75-1296086,35670IL0070008,Coventry Gold $10 Copay FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF012,New,PPO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48251,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070008-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,14,35670,IL,Individual,No,75-1296086,35670IL0070008,Coventry Gold $10 Copay FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF012,New,PPO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48251,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070008-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,14,35670,IL,Individual,No,75-1296086,35670IL0070008,Coventry Gold $10 Copay FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF012,New,PPO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48251,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070008-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,14,35670,IL,Individual,No,75-1296086,35670IL0070008,Coventry Gold $10 Copay FocusedCare HPN,35670IL007,,ILN003,ILS003,ILF012,New,PPO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48251,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/FocusedCareIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070008-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,15,35670,IL,Individual,No,75-1296086,35670IL0070001,Coventry Gold $5 Copay Carelink,35670IL007,,ILN002,ILS002,ILF006,Existing,PPO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48229,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070001-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,15,35670,IL,Individual,No,75-1296086,35670IL0070001,Coventry Gold $5 Copay Carelink,35670IL007,,ILN002,ILS002,ILF006,Existing,PPO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48229,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070001-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790014,Blue Choice Gold PPO? 002,36096IL079,,ILN003,ILS033,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,42
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800004,Blue Choice Silver PPO? 004,36096IL080,,ILN003,ILS013,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800004-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790018,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS033,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790018-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,74
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790018,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS033,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790018-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,75
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790029,Blue Choice Bronze PPO? 006,36096IL079,,ILN003,ILS023,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790029-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800036,Blue Choice Bronze PPO? 006,36096IL080,,ILN003,ILS063,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800036-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,14
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810014,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS044,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810014-05,87% AV Level Silver Plan,,0.868057608604431,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$3,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,54
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810014,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS044,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810014-06,94% AV Level Silver Plan,,0.938782095909119,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,55
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810015,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS054,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810015-00,Standard Silver Off Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,56
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810015,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS054,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810015-01,Standard Silver On Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,57
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810015,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS054,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,58
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810015,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS054,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810015-03,Limited Cost Sharing Plan Variation,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,59
2015,IL,60600,SERFF,2,2015-01-22 16:02:51,2,60600,IL,Individual,Yes,36-2612058,60600IL0010004,Delta Dental Individual Basic Plan,60600IL001,,ILN001,ILS001,,Existing,EPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.99,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Benefits; Must see Delta Dental PPO Provider,Yes,www.deltadentalilexchange.com/dental-plans,https://www.deltadentalil.me/payment,www.deltadentalilexchange.com/dental-plans,,60600IL0010004-01,Standard Low On Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$120,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,60600,SERFF,2,2015-01-22 16:02:51,2,60600,IL,Individual,Yes,36-2612058,60600IL0010003,Delta Dental Individual Preferred Plan,60600IL001,,ILN001,ILS001,,Existing,EPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.99,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Benefits; Must see Delta Dental PPO Provider,Yes,www.deltadentalilexchange.com/dental-plans,https://www.deltadentalil.me/payment,www.deltadentalilexchange.com/dental-plans,,60600IL0010003-00,Standard High Off Exchange Plan,84.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IL,35670,SERFF,3,2014-10-28 20:25:58,15,35670,IL,Individual,No,75-1296086,35670IL0070001,Coventry Gold $5 Copay Carelink,35670IL007,,ILN002,ILS002,ILF006,Existing,PPO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48229,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,35670IL0070001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0770001,Blue PPO Gold? 001,36096IL077,,ILN001,ILS001,ILF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0770001-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800018,Blue Choice Gold PPO? 002,36096IL080,,ILN003,ILS033,ILF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800018-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790011,Blue Choice Gold PPO? 001,36096IL079,,ILN003,ILS043,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790011-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800025,Blue Choice Silver PPO? 004,36096IL080,,ILN003,ILS023,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800025-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810016,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS074,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810016-00,Standard Silver Off Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,63
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800016,Blue Choice Gold PPO? 001,36096IL080,,ILN003,ILS063,ILF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800016-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790009,Blue Choice Gold PPO? 001,36096IL079,,ILN003,ILS023,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790009-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790010,Blue Choice Gold PPO? 001,36096IL079,,ILN003,ILS033,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790010-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790014,Blue Choice Gold PPO? 002,36096IL079,,ILN003,ILS033,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790014-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800004,Blue Choice Silver PPO? 004,36096IL080,,ILN003,ILS013,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800004-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790019,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS043,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790019-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,81
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790019,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS043,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790019-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,82
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0790025,Blue Choice Bronze PPO? 005,36096IL079,,ILN003,ILS023,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790025-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,13
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800031,Blue Choice Bronze PPO? 005,36096IL080,,ILN003,ILS043,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800031-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,13
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800032,Blue Choice Bronze PPO? 005,36096IL080,,ILN003,ILS063,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800032-00,Standard Bronze Off Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,14
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0790025,Blue Choice Bronze PPO? 005,36096IL079,,ILN003,ILS023,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790025-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790015,Blue Choice Gold PPO? 002,36096IL079,,ILN003,ILS043,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790015-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790023,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS043,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790023-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,124
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790023,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS043,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790023-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,125
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810009,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS044,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810009-00,Standard Gold Off Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810009,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS044,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810009-01,Standard Gold On Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),Yes,36-1236610,36096IL0840004,BlueCare Dental 4 Kids? 1B,36096IL084,,ILN005,ILS005,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.75,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbsil.com/employer/products/on-exchange/dental/,,36096IL0840004-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820001,Blue Precision Gold HMO? 001,36096IL082,,ILN004,ILS034,ILF012,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820001-01,Standard Gold On Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,6,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820016,Blue Precision Bronze HMO? 003,36096IL082,,ILN004,ILS024,ILF014,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820016-01,Standard Bronze On Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,6,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820017,Blue Precision Bronze HMO? 003,36096IL082,,ILN004,ILS034,ILF014,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820017-00,Standard Bronze Off Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,6,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820017,Blue Precision Bronze HMO? 003,36096IL082,,ILN004,ILS034,ILF014,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820017-01,Standard Bronze On Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,6,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820018,Blue Precision Bronze HMO? 003,36096IL082,,ILN004,ILS044,ILF014,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820018-00,Standard Bronze Off Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,Yes,36-1236610,36096IL0830001,BlueCare Dental? 1A,36096IL083,,ILN005,ILS005,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.11,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/dental/,,36096IL0830001-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),Yes,36-1236610,36096IL0840002,BlueCare Dental? 1B,36096IL084,,ILN005,ILS005,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.75,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbsil.com/employer/products/on-exchange/dental/,,36096IL0840002-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,Yes,36-1236610,36096IL0830001,BlueCare Dental? 1A,36096IL083,,ILN005,ILS005,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.11,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/dental/,,36096IL0830001-01,Standard High On Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),Yes,36-1236610,36096IL0840009,BlueCare Dental? 1G,36096IL084,,ILN005,ILS005,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.75,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbsil.com/employer/products/on-exchange/dental/,,36096IL0840009-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0770001,Blue PPO Gold? 001,36096IL077,,ILN001,ILS001,ILF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0770001-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800001,Blue Choice Gold PPO? 001,36096IL080,,ILN003,ILS033,ILF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800001-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0760001,Blue PPO Gold? 001,36096IL076,,ILN001,ILS001,ILF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760001-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790001,Blue Choice Gold PPO? 001,36096IL079,,ILN003,ILS013,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790001-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800013,Blue Choice Gold PPO? 001,36096IL080,,ILN003,ILS023,ILF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800013-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800013,Blue Choice Gold PPO? 001,36096IL080,,ILN003,ILS023,ILF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800013-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790001,Blue Choice Gold PPO? 001,36096IL079,,ILN003,ILS013,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790001-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790001,Blue Choice Gold PPO? 001,36096IL079,,ILN003,ILS013,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800014,Blue Choice Gold PPO? 001,36096IL080,,ILN003,ILS013,ILF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800014-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800014,Blue Choice Gold PPO? 001,36096IL080,,ILN003,ILS013,ILF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800014-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790001,Blue Choice Gold PPO? 001,36096IL079,,ILN003,ILS013,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790001-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790009,Blue Choice Gold PPO? 001,36096IL079,,ILN003,ILS023,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790009-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800015,Blue Choice Gold PPO? 001,36096IL080,,ILN003,ILS043,ILF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800015-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800015,Blue Choice Gold PPO? 001,36096IL080,,ILN003,ILS043,ILF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800015-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790009,Blue Choice Gold PPO? 001,36096IL079,,ILN003,ILS023,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790009-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790009,Blue Choice Gold PPO? 001,36096IL079,,ILN003,ILS023,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790009-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800016,Blue Choice Gold PPO? 001,36096IL080,,ILN003,ILS063,ILF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800016-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790013,Blue Choice Gold PPO? 002,36096IL079,,ILN003,ILS023,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790013-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800023,Blue Choice Silver PPO? 003,36096IL080,,ILN003,ILS043,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800023-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790021,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS023,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790021-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,110
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790021,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS023,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790021-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,111
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800041,Blue Choice Silver PPO? 008,36096IL080,,ILN003,ILS023,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800041-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810007,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS024,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810007-01,Standard Gold On Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810007,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS024,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800042,Blue Choice Silver PPO? 008,36096IL080,,ILN003,ILS033,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800042-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810015,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS054,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810015-04,73% AV Level Silver Plan,,0.72942328453064,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$10,400",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,60
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810015,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS054,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810015-05,87% AV Level Silver Plan,,0.868057608604431,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$3,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,61
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810015,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS054,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810015-06,94% AV Level Silver Plan,,0.938782095909119,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,62
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0770002,Blue PPO Gold? 002,36096IL077,,ILN001,ILS001,ILF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0770002-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0770002,Blue PPO Gold? 002,36096IL077,,ILN001,ILS001,ILF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0770002-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790010,Blue Choice Gold PPO? 001,36096IL079,,ILN003,ILS033,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790010-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790010,Blue Choice Gold PPO? 001,36096IL079,,ILN003,ILS033,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800002,Blue Choice Gold PPO? 002,36096IL080,,ILN003,ILS013,ILF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800002-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800002,Blue Choice Gold PPO? 002,36096IL080,,ILN003,ILS013,ILF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800002-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790010,Blue Choice Gold PPO? 001,36096IL079,,ILN003,ILS033,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790010-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790011,Blue Choice Gold PPO? 001,36096IL079,,ILN003,ILS043,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790011-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800017,Blue Choice Gold PPO? 002,36096IL080,,ILN003,ILS023,ILF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800017-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800019,Blue Choice Gold PPO? 002,36096IL080,,ILN003,ILS043,ILF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800019-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790012,Blue Choice Gold PPO? 001,36096IL079,,ILN003,ILS063,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790012-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790012,Blue Choice Gold PPO? 001,36096IL079,,ILN003,ILS063,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790012-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,26
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800020,Blue Choice Gold PPO? 002,36096IL080,,ILN003,ILS063,ILF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800020-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800020,Blue Choice Gold PPO? 002,36096IL080,,ILN003,ILS063,ILF005,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800020-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,000",20%,,,,"$3,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790012,Blue Choice Gold PPO? 001,36096IL079,,ILN003,ILS063,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790012-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0760002,Blue PPO Gold? 002,36096IL076,,ILN001,ILS001,ILF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760002-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0770003,Blue PPO Silver? 003,36096IL077,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0770003-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0770003,Blue PPO Silver? 003,36096IL077,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0770003-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0760002,Blue PPO Gold? 002,36096IL076,,ILN001,ILS001,ILF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760002-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0760002,Blue PPO Gold? 002,36096IL076,,ILN001,ILS001,ILF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,30
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800003,Blue Choice Silver PPO? 003,36096IL080,,ILN003,ILS013,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800003-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800003,Blue Choice Silver PPO? 003,36096IL080,,ILN003,ILS013,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800003-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0760002,Blue PPO Gold? 002,36096IL076,,ILN001,ILS001,ILF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760002-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790002,Blue Choice Gold PPO? 002,36096IL079,,ILN003,ILS013,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790002-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800021,Blue Choice Silver PPO? 003,36096IL080,,ILN003,ILS023,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800021-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800021,Blue Choice Silver PPO? 003,36096IL080,,ILN003,ILS023,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800021-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790002,Blue Choice Gold PPO? 002,36096IL079,,ILN003,ILS013,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790002-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790002,Blue Choice Gold PPO? 002,36096IL079,,ILN003,ILS013,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,34
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800022,Blue Choice Silver PPO? 003,36096IL080,,ILN003,ILS033,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800022-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800022,Blue Choice Silver PPO? 003,36096IL080,,ILN003,ILS033,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800022-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790002,Blue Choice Gold PPO? 002,36096IL079,,ILN003,ILS013,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790002-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800023,Blue Choice Silver PPO? 003,36096IL080,,ILN003,ILS043,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800023-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790013,Blue Choice Gold PPO? 002,36096IL079,,ILN003,ILS023,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790013-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790013,Blue Choice Gold PPO? 002,36096IL079,,ILN003,ILS023,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790013-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,38
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800024,Blue Choice Silver PPO? 003,36096IL080,,ILN003,ILS063,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800024-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800024,Blue Choice Silver PPO? 003,36096IL080,,ILN003,ILS063,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800024-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790013,Blue Choice Gold PPO? 002,36096IL079,,ILN003,ILS023,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790013-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790014,Blue Choice Gold PPO? 002,36096IL079,,ILN003,ILS033,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790014-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0770004,Blue PPO Silver? 004,36096IL077,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0770004-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0770004,Blue PPO Silver? 004,36096IL077,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0770004-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790014,Blue Choice Gold PPO? 002,36096IL079,,ILN003,ILS033,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790014-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790015,Blue Choice Gold PPO? 002,36096IL079,,ILN003,ILS043,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790015-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800025,Blue Choice Silver PPO? 004,36096IL080,,ILN003,ILS023,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800025-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790015,Blue Choice Gold PPO? 002,36096IL079,,ILN003,ILS043,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,46
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800026,Blue Choice Silver PPO? 004,36096IL080,,ILN003,ILS033,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800026-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800026,Blue Choice Silver PPO? 004,36096IL080,,ILN003,ILS033,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800026-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,47
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790015,Blue Choice Gold PPO? 002,36096IL079,,ILN003,ILS043,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790015-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,47
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800027,Blue Choice Silver PPO? 004,36096IL080,,ILN003,ILS043,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800027-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,49
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790016,Blue Choice Gold PPO? 002,36096IL079,,ILN003,ILS063,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790016-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,49
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790016,Blue Choice Gold PPO? 002,36096IL079,,ILN003,ILS063,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790016-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,50
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800028,Blue Choice Silver PPO? 004,36096IL080,,ILN003,ILS063,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800028-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,50
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800028,Blue Choice Silver PPO? 004,36096IL080,,ILN003,ILS063,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800028-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,51
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790016,Blue Choice Gold PPO? 002,36096IL079,,ILN003,ILS063,ILF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790016-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,51
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0760003,Blue PPO Silver? 003,36096IL076,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760003-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,52
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0760003,Blue PPO Silver? 003,36096IL076,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760003-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,53
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0760003,Blue PPO Silver? 003,36096IL076,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,54
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0760003,Blue PPO Silver? 003,36096IL076,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760003-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,55
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0760003,Blue PPO Silver? 003,36096IL076,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760003-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800",Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,"$10,000","$20,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,56
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0760003,Blue PPO Silver? 003,36096IL076,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760003-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,57
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0760003,Blue PPO Silver? 003,36096IL076,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760003-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$500,"$1,500",0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,58
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790003,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS013,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790003-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,59
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790003,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS013,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790003-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,60
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790003,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS013,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,61
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790003,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS013,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790003-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,62
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790003,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS013,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790003-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800",Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,"$10,000","$20,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,63
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790003,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS013,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790003-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,64
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790003,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS013,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790003-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$500,"$1,500",0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,65
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790017,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS023,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790017-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,66
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790017,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS023,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790017-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,67
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790017,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS023,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790017-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,68
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790017,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS023,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790017-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,69
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790017,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS023,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790017-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800",Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,"$10,000","$20,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,70
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790017,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS023,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790017-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,71
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790017,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS023,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790017-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$500,"$1,500",0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,72
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790018,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS033,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790018-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,73
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790018,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS033,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790018-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,76
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790018,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS033,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790018-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800",Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,"$10,000","$20,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,77
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790018,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS033,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790018-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,78
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790018,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS033,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790018-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$500,"$1,500",0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,79
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790019,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS043,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790019-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,80
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790019,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS043,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790019-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,83
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790019,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS043,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790019-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800",Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,"$10,000","$20,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,84
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790019,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS043,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790019-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,85
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790019,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS043,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790019-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$500,"$1,500",0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,86
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790020,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS063,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790020-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,87
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790020,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS063,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790020-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,88
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790020,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS063,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790020-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,89
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790020,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS063,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790020-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,90
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790020,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS063,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790020-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800",Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,"$10,000","$20,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,91
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790020,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS063,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790020-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,92
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790020,Blue Choice Silver PPO? 003,36096IL079,,ILN003,ILS063,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790020-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$500,"$1,500",0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,93
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0760004,Blue PPO Silver? 004,36096IL076,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760004-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,94
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0760004,Blue PPO Silver? 004,36096IL076,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760004-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,95
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0760004,Blue PPO Silver? 004,36096IL076,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,96
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0760004,Blue PPO Silver? 004,36096IL076,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760004-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,97
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0760004,Blue PPO Silver? 004,36096IL076,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760004-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,"$5,000","$15,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,98
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0760004,Blue PPO Silver? 004,36096IL076,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760004-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,99
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0760004,Blue PPO Silver? 004,36096IL076,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760004-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,100
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790004,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS013,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790004-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,101
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790004,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS013,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790004-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,102
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790004,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS013,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,103
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790004,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS013,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790004-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,104
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790004,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS013,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790004-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,"$5,000","$15,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,105
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790004,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS013,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790004-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,106
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790004,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS013,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790004-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,107
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790021,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS023,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790021-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,108
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790021,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS023,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790021-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,109
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790021,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS023,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790021-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,"$5,000","$15,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,112
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790021,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS023,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790021-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,113
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790021,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS023,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790021-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,114
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790022,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS033,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790022-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,115
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790022,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS033,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790022-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,116
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790022,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS033,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790022-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,117
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790022,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS033,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790022-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,118
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790022,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS033,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790022-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,"$5,000","$15,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,119
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790022,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS033,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790022-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,120
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790022,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS033,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790022-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,121
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790023,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS043,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790023-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,122
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790023,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS043,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790023-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,123
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790023,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS043,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790023-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,"$5,000","$15,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,126
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790023,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS043,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790023-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,127
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790023,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS043,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790023-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,128
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790024,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS063,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790024-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,129
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790024,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS063,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790024-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,130
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790024,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS063,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790024-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,131
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790024,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS063,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790024-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,132
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790024,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS063,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790024-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,"$5,000","$15,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,133
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790024,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS063,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790024-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,134
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,1,36096,IL,Individual,No,36-1236610,36096IL0790024,Blue Choice Silver PPO? 004,36096IL079,,ILN003,ILS063,ILF006,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790024-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,135
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,Yes,36-1236610,36096IL0830002,BlueCare Dental? 1B,36096IL083,,ILN005,ILS005,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.75,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/dental/,,36096IL0830002-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,SHOP (Small Group),Yes,36-1236610,36096IL0840005,BlueCare Dental? 1C,36096IL084,,ILN005,ILS005,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.64,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbsil.com/employer/products/on-exchange/dental/,,36096IL0840005-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,SHOP (Small Group),Yes,36-1236610,36096IL0840007,BlueCare Dental? 1E,36096IL084,,ILN005,ILS005,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$46.43,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbsil.com/employer/products/on-exchange/dental/,,36096IL0840007-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810002,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS014,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810002-06,94% AV Level Silver Plan,,0.938782095909119,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810012,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS024,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810012-00,Standard Silver Off Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810012,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS024,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810012-01,Standard Silver On Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810012,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS024,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810012-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,37
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810012,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS024,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810012-03,Limited Cost Sharing Plan Variation,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810012,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS024,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810012-04,73% AV Level Silver Plan,,0.72942328453064,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$10,400",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810012,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS024,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810012-05,87% AV Level Silver Plan,,0.868057608604431,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$3,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810012,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS024,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810012-06,94% AV Level Silver Plan,,0.938782095909119,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380016,Humana Silver 4600/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341014,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332187,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380016-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380016,Humana Silver 4600/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341014,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332187,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380016-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0770005,Blue PPO Bronze? 005,36096IL077,,ILN001,ILS001,ILF002,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0770005-00,Standard Bronze Off Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,SHOP (Small Group),Yes,36-1236610,36096IL0840003,BlueCare Dental 4 Kids? 1A,36096IL084,,ILN005,ILS005,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.11,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbsil.com/employer/products/on-exchange/dental/,,36096IL0840003-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,Yes,36-1236610,36096IL0830003,BlueCare Dental 4 Kids? 1A,36096IL083,,ILN005,ILS005,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$34.11,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/dental/,,36096IL0830003-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0760005,Blue PPO Bronze? 005,36096IL076,,ILN001,ILS001,ILF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760005-00,Standard Bronze Off Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0760005,Blue PPO Bronze? 005,36096IL076,,ILN001,ILS001,ILF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760005-01,Standard Bronze On Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,Yes,36-1236610,36096IL0830003,BlueCare Dental 4 Kids? 1A,36096IL083,,ILN005,ILS005,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$34.11,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/dental/,,36096IL0830003-01,Standard High On Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0770005,Blue PPO Bronze? 005,36096IL077,,ILN001,ILS001,ILF002,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0770005-01,Standard Bronze On Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800005,Blue Choice Bronze PPO? 005,36096IL080,,ILN003,ILS013,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800005-00,Standard Bronze Off Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0760005,Blue PPO Bronze? 005,36096IL076,,ILN001,ILS001,ILF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0760005,Blue PPO Bronze? 005,36096IL076,,ILN001,ILS001,ILF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760005-03,Limited Cost Sharing Plan Variation,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800005,Blue Choice Bronze PPO? 005,36096IL080,,ILN003,ILS013,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800005-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800029,Blue Choice Bronze PPO? 005,36096IL080,,ILN003,ILS023,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800029-00,Standard Bronze Off Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,8
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0790005,Blue Choice Bronze PPO? 005,36096IL079,,ILN003,ILS013,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790005-00,Standard Bronze Off Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,8
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0790005,Blue Choice Bronze PPO? 005,36096IL079,,ILN003,ILS013,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790005-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800029,Blue Choice Bronze PPO? 005,36096IL080,,ILN003,ILS023,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800029-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800030,Blue Choice Bronze PPO? 005,36096IL080,,ILN003,ILS033,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800030-00,Standard Bronze Off Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,10
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0790005,Blue Choice Bronze PPO? 005,36096IL079,,ILN003,ILS013,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0790005,Blue Choice Bronze PPO? 005,36096IL079,,ILN003,ILS013,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790005-03,Limited Cost Sharing Plan Variation,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,11
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800030,Blue Choice Bronze PPO? 005,36096IL080,,ILN003,ILS033,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800030-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,11
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800031,Blue Choice Bronze PPO? 005,36096IL080,,ILN003,ILS043,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800031-00,Standard Bronze Off Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,12
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0790025,Blue Choice Bronze PPO? 005,36096IL079,,ILN003,ILS023,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790025-00,Standard Bronze Off Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,12
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0790025,Blue Choice Bronze PPO? 005,36096IL079,,ILN003,ILS023,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790025-03,Limited Cost Sharing Plan Variation,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,15
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800032,Blue Choice Bronze PPO? 005,36096IL080,,ILN003,ILS063,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800032-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,15
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790031,Blue Choice Bronze PPO? 006,36096IL079,,ILN003,ILS043,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790031-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,20
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790031,Blue Choice Bronze PPO? 006,36096IL079,,ILN003,ILS043,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790031-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,21
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810010,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS054,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810010-00,Standard Gold Off Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810010,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS054,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810010-01,Standard Gold On Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810010,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS054,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810010,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS054,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810010-03,Limited Cost Sharing Plan Variation,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810011,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS074,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810011-00,Standard Gold Off Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810011,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS074,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810011-01,Standard Gold On Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380016,Humana Silver 4600/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341014,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332187,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380016-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380017,Humana Gold 2500/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340767,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332239,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380017-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",32%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280018,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS003,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280018-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,20
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280018,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS003,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280018-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280018,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS003,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280018-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280018,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS003,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280018-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0790026,Blue Choice Bronze PPO? 005,36096IL079,,ILN003,ILS033,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790026-00,Standard Bronze Off Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,16
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0790026,Blue Choice Bronze PPO? 005,36096IL079,,ILN003,ILS033,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790026-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,17
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0790026,Blue Choice Bronze PPO? 005,36096IL079,,ILN003,ILS033,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790026-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,18
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0790026,Blue Choice Bronze PPO? 005,36096IL079,,ILN003,ILS033,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790026-03,Limited Cost Sharing Plan Variation,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,19
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0790027,Blue Choice Bronze PPO? 005,36096IL079,,ILN003,ILS043,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790027-00,Standard Bronze Off Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,20
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0790027,Blue Choice Bronze PPO? 005,36096IL079,,ILN003,ILS043,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790027-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,21
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0790027,Blue Choice Bronze PPO? 005,36096IL079,,ILN003,ILS043,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790027-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,22
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0790027,Blue Choice Bronze PPO? 005,36096IL079,,ILN003,ILS043,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790027-03,Limited Cost Sharing Plan Variation,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,23
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0790028,Blue Choice Bronze PPO? 005,36096IL079,,ILN003,ILS063,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790028-00,Standard Bronze Off Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,24
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0790028,Blue Choice Bronze PPO? 005,36096IL079,,ILN003,ILS063,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790028-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,25
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0790028,Blue Choice Bronze PPO? 005,36096IL079,,ILN003,ILS063,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790028-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,26
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,2,36096,IL,Individual,No,36-1236610,36096IL0790028,Blue Choice Bronze PPO? 005,36096IL079,,ILN003,ILS063,ILF008,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790028-03,Limited Cost Sharing Plan Variation,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,27
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0760006,Blue PPO Bronze? 006,36096IL076,,ILN001,ILS001,ILF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760006-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0770006,Blue PPO Bronze? 006,36096IL077,,ILN001,ILS001,ILF004,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0770006-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,Yes,36-1236610,36096IL0830002,BlueCare Dental? 1B,36096IL083,,ILN005,ILS005,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.75,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/dental/,,36096IL0830002-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0770006,Blue PPO Bronze? 006,36096IL077,,ILN001,ILS001,ILF004,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0770006-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0760006,Blue PPO Bronze? 006,36096IL076,,ILN001,ILS001,ILF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760006-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0760006,Blue PPO Bronze? 006,36096IL076,,ILN001,ILS001,ILF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800006,Blue Choice Bronze PPO? 006,36096IL080,,ILN003,ILS013,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800006-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,SHOP (Small Group),Yes,36-1236610,36096IL0840008,BlueCare Dental? 1F,36096IL084,,ILN005,ILS005,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$40.05,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbsil.com/employer/products/on-exchange/dental/,,36096IL0840008-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800006,Blue Choice Bronze PPO? 006,36096IL080,,ILN003,ILS013,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800006-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0760006,Blue PPO Bronze? 006,36096IL076,,ILN001,ILS001,ILF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760006-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790006,Blue Choice Bronze PPO? 006,36096IL079,,ILN003,ILS013,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790006-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,8
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800033,Blue Choice Bronze PPO? 006,36096IL080,,ILN003,ILS023,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800033-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,8
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800033,Blue Choice Bronze PPO? 006,36096IL080,,ILN003,ILS023,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800033-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790006,Blue Choice Bronze PPO? 006,36096IL079,,ILN003,ILS013,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790006-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790006,Blue Choice Bronze PPO? 006,36096IL079,,ILN003,ILS013,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800034,Blue Choice Bronze PPO? 006,36096IL080,,ILN003,ILS033,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800034-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,10
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800034,Blue Choice Bronze PPO? 006,36096IL080,,ILN003,ILS033,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800034-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,11
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790006,Blue Choice Bronze PPO? 006,36096IL079,,ILN003,ILS013,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790006-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,11
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790029,Blue Choice Bronze PPO? 006,36096IL079,,ILN003,ILS023,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790029-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,12
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800035,Blue Choice Bronze PPO? 006,36096IL080,,ILN003,ILS043,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800035-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,12
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800035,Blue Choice Bronze PPO? 006,36096IL080,,ILN003,ILS043,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800035-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,13
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790029,Blue Choice Bronze PPO? 006,36096IL079,,ILN003,ILS023,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790029-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,13
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800036,Blue Choice Bronze PPO? 006,36096IL080,,ILN003,ILS063,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800036-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,15
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790029,Blue Choice Bronze PPO? 006,36096IL079,,ILN003,ILS023,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790029-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,15
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790030,Blue Choice Bronze PPO? 006,36096IL079,,ILN003,ILS033,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790030-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,16
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790030,Blue Choice Bronze PPO? 006,36096IL079,,ILN003,ILS033,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790030-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,17
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790030,Blue Choice Bronze PPO? 006,36096IL079,,ILN003,ILS033,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790030-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,18
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790030,Blue Choice Bronze PPO? 006,36096IL079,,ILN003,ILS033,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790030-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,19
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790031,Blue Choice Bronze PPO? 006,36096IL079,,ILN003,ILS043,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790031-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,22
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790031,Blue Choice Bronze PPO? 006,36096IL079,,ILN003,ILS043,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790031-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,23
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790032,Blue Choice Bronze PPO? 006,36096IL079,,ILN003,ILS063,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790032-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,24
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790032,Blue Choice Bronze PPO? 006,36096IL079,,ILN003,ILS063,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790032-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,25
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790032,Blue Choice Bronze PPO? 006,36096IL079,,ILN003,ILS063,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790032-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,26
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790032,Blue Choice Bronze PPO? 006,36096IL079,,ILN003,ILS063,ILF007,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790032-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,27
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0760010,Blue Security PPO? 010,36096IL076,,ILN001,ILS001,ILF004,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760010-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,28
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0760010,Blue Security PPO? 010,36096IL076,,ILN001,ILS001,ILF004,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0760010-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,29
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790008,Blue Choice Security PPO? 008,36096IL079,,ILN003,ILS013,ILF007,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790008-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,30
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790008,Blue Choice Security PPO? 008,36096IL079,,ILN003,ILS013,ILF007,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790008-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,31
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790037,Blue Choice Security PPO? 008,36096IL079,,ILN003,ILS023,ILF007,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790037-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,32
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790037,Blue Choice Security PPO? 008,36096IL079,,ILN003,ILS023,ILF007,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790037-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,33
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790038,Blue Choice Security PPO? 008,36096IL079,,ILN003,ILS033,ILF007,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790038-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,34
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790038,Blue Choice Security PPO? 008,36096IL079,,ILN003,ILS033,ILF007,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790038-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,35
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790039,Blue Choice Security PPO? 008,36096IL079,,ILN003,ILS043,ILF007,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790039-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,36
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790039,Blue Choice Security PPO? 008,36096IL079,,ILN003,ILS043,ILF007,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790039-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,37
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790040,Blue Choice Security PPO? 008,36096IL079,,ILN003,ILS063,ILF007,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790040-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,38
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,3,36096,IL,Individual,No,36-1236610,36096IL0790040,Blue Choice Security PPO? 008,36096IL079,,ILN003,ILS063,ILF007,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0790040-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,39
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810001,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS014,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810001-00,Standard Gold Off Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0770020,Blue PPO Silver? 020,36096IL077,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0770020-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,SHOP (Small Group),Yes,36-1236610,36096IL0840001,BlueCare Dental? 1A,36096IL084,,ILN005,ILS005,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.11,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,,http://www.bcbsil.com/employer/products/on-exchange/dental/,,36096IL0840001-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,Yes,36-1236610,36096IL0830004,BlueCare Dental 4 Kids? 1B,36096IL083,,ILN005,ILS005,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$26.75,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/dental/,,36096IL0830004-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,Yes,36-1236610,36096IL0830004,BlueCare Dental 4 Kids? 1B,36096IL083,,ILN005,ILS005,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$26.75,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/dental/,,36096IL0830004-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0770020,Blue PPO Silver? 020,36096IL077,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierStandardDrugList.pdf,36096IL0770020-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810001,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS014,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810001-01,Standard Gold On Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810001,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS014,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800008,Blue Choice Silver PPO? 008,36096IL080,,ILN003,ILS013,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800008-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800008,Blue Choice Silver PPO? 008,36096IL080,,ILN003,ILS013,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800008-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810001,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS014,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810001-03,Limited Cost Sharing Plan Variation,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810007,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS024,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810007-00,Standard Gold Off Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800041,Blue Choice Silver PPO? 008,36096IL080,,ILN003,ILS023,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800041-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800042,Blue Choice Silver PPO? 008,36096IL080,,ILN003,ILS033,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800042-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810007,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS024,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810007-03,Limited Cost Sharing Plan Variation,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810008,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS034,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810008-00,Standard Gold Off Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800043,Blue Choice Silver PPO? 008,36096IL080,,ILN003,ILS043,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800043-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800043,Blue Choice Silver PPO? 008,36096IL080,,ILN003,ILS043,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800043-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810008,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS034,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810008-01,Standard Gold On Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810008,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS034,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800044,Blue Choice Silver PPO? 008,36096IL080,,ILN003,ILS063,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800044-00,Standard Silver Off Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0800044,Blue Choice Silver PPO? 008,36096IL080,,ILN003,ILS063,ILF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0800044-01,Standard Silver On Exchange Plan,,0.715575575828552,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810008,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS034,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810008-03,Limited Cost Sharing Plan Variation,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810009,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS044,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810009-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810009,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS044,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810009-03,Limited Cost Sharing Plan Variation,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810011,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS074,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810011-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,26
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810011,Blue Precision Gold HMO? 001,36096IL081,,ILN004,ILS074,ILF009,Existing,HMO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810011-03,Limited Cost Sharing Plan Variation,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810002,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS014,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810002-00,Standard Silver Off Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810002,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS014,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810002-01,Standard Silver On Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810002,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS014,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,30
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810002,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS014,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810002-03,Limited Cost Sharing Plan Variation,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810002,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS014,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810002-04,73% AV Level Silver Plan,,0.72942328453064,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$10,400",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810002,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS014,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810002-05,87% AV Level Silver Plan,,0.868057608604431,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$3,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810013,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS034,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810013-00,Standard Silver Off Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810013,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS034,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810013-01,Standard Silver On Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810013,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS034,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810013-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,44
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810013,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS034,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810013-03,Limited Cost Sharing Plan Variation,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810013,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS034,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810013-04,73% AV Level Silver Plan,,0.72942328453064,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$10,400",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810013,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS034,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810013-05,87% AV Level Silver Plan,,0.868057608604431,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$3,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,47
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810013,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS034,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810013-06,94% AV Level Silver Plan,,0.938782095909119,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810014,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS044,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810014-00,Standard Silver Off Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,49
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810014,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS044,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810014-01,Standard Silver On Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,50
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810014,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS044,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,51
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810014,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS044,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810014-03,Limited Cost Sharing Plan Variation,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,52
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810014,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS044,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810014-04,73% AV Level Silver Plan,,0.72942328453064,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$10,400",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,53
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810016,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS074,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810016-01,Standard Silver On Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,64
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810016,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS074,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810016-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,65
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810016,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS074,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810016-03,Limited Cost Sharing Plan Variation,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,66
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810016,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS074,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810016-04,73% AV Level Silver Plan,,0.72942328453064,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$10,400",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,67
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810021,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS074,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810021-03,Limited Cost Sharing Plan Variation,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,27
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,6,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820003,Blue Precision Bronze HMO? 003,36096IL082,,ILN004,ILS014,ILF014,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820003-00,Standard Bronze Off Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,6,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820003,Blue Precision Bronze HMO? 003,36096IL082,,ILN004,ILS014,ILF014,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820003-01,Standard Bronze On Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,6,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820016,Blue Precision Bronze HMO? 003,36096IL082,,ILN004,ILS024,ILF014,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820016-00,Standard Bronze Off Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,6,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820018,Blue Precision Bronze HMO? 003,36096IL082,,ILN004,ILS044,ILF014,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820018-01,Standard Bronze On Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,6,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820019,Blue Precision Bronze HMO? 003,36096IL082,,ILN004,ILS054,ILF014,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820019-00,Standard Bronze Off Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280008,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS003,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280008-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280008,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS003,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,40
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0040012,Ambetter Essential Care 1 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0040012-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,43
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,3,68432,IL,Individual,No,27-2186150,68432IL0010005,Ambetter Balanced Care 4 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0010005-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,4
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,3,68432,IL,Individual,No,27-2186150,68432IL0010005,Ambetter Balanced Care 4 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0010005-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,5
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,3,68432,IL,Individual,No,27-2186150,68432IL0010005,Ambetter Balanced Care 4 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0010005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810016,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS074,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810016-05,87% AV Level Silver Plan,,0.868057608604431,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$3,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,68
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,4,36096,IL,Individual,No,36-1236610,36096IL0810016,Blue Precision Silver HMO? 002,36096IL081,,ILN004,ILS074,ILF009,Existing,HMO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810016-06,94% AV Level Silver Plan,,0.938782095909119,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,69
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810003,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS014,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810003-00,Standard Bronze Off Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820001,Blue Precision Gold HMO? 001,36096IL082,,ILN004,ILS034,ILF012,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820001-00,Standard Gold Off Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810003,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS014,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810003-01,Standard Bronze On Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810003,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS014,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820006,Blue Precision Gold HMO? 001,36096IL082,,ILN004,ILS024,ILF012,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820006-00,Standard Gold Off Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820006,Blue Precision Gold HMO? 001,36096IL082,,ILN004,ILS024,ILF012,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820006-01,Standard Gold On Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810003,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS014,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810003-03,Limited Cost Sharing Plan Variation,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810017,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS024,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810017-00,Standard Bronze Off Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820007,Blue Precision Gold HMO? 001,36096IL082,,ILN004,ILS014,ILF012,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820007-00,Standard Gold Off Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820007,Blue Precision Gold HMO? 001,36096IL082,,ILN004,ILS014,ILF012,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820007-01,Standard Gold On Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810017,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS024,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810017-01,Standard Bronze On Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810017,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS024,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820008,Blue Precision Gold HMO? 001,36096IL082,,ILN004,ILS044,ILF012,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820008-00,Standard Gold Off Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820008,Blue Precision Gold HMO? 001,36096IL082,,ILN004,ILS044,ILF012,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820008-01,Standard Gold On Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810017,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS024,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810017-03,Limited Cost Sharing Plan Variation,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810018,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS034,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810018-00,Standard Bronze Off Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820009,Blue Precision Gold HMO? 001,36096IL082,,ILN004,ILS054,ILF012,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820009-00,Standard Gold Off Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820009,Blue Precision Gold HMO? 001,36096IL082,,ILN004,ILS054,ILF012,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820009-01,Standard Gold On Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810018,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS034,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810018-01,Standard Bronze On Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810018,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS034,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810018-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820010,Blue Precision Gold HMO? 001,36096IL082,,ILN004,ILS074,ILF012,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820010-00,Standard Gold Off Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820010,Blue Precision Gold HMO? 001,36096IL082,,ILN004,ILS074,ILF012,Existing,HMO,Gold,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820010-01,Standard Gold On Exchange Plan,,0.807351887226105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810018,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS034,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810018-03,Limited Cost Sharing Plan Variation,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810019,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS044,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810019-00,Standard Bronze Off Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820002,Blue Precision Silver HMO? 002,36096IL082,,ILN004,ILS014,ILF012,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820002-00,Standard Silver Off Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820002,Blue Precision Silver HMO? 002,36096IL082,,ILN004,ILS014,ILF012,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820002-01,Standard Silver On Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810019,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS044,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810019-01,Standard Bronze On Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810019,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS044,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810019-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820011,Blue Precision Silver HMO? 002,36096IL082,,ILN004,ILS024,ILF012,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820011-00,Standard Silver Off Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820011,Blue Precision Silver HMO? 002,36096IL082,,ILN004,ILS024,ILF012,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820011-01,Standard Silver On Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810019,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS044,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810019-03,Limited Cost Sharing Plan Variation,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810020,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS054,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810020-00,Standard Bronze Off Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820012,Blue Precision Silver HMO? 002,36096IL082,,ILN004,ILS034,ILF012,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820012-00,Standard Silver Off Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820012,Blue Precision Silver HMO? 002,36096IL082,,ILN004,ILS034,ILF012,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820012-01,Standard Silver On Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810020,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS054,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810020-01,Standard Bronze On Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810020,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS054,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810020-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820013,Blue Precision Silver HMO? 002,36096IL082,,ILN004,ILS044,ILF012,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820013-00,Standard Silver Off Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820013,Blue Precision Silver HMO? 002,36096IL082,,ILN004,ILS044,ILF012,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820013-01,Standard Silver On Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810020,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS054,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810020-03,Limited Cost Sharing Plan Variation,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810021,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS074,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810021-00,Standard Bronze Off Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,24
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820014,Blue Precision Silver HMO? 002,36096IL082,,ILN004,ILS054,ILF012,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820014-00,Standard Silver Off Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820014,Blue Precision Silver HMO? 002,36096IL082,,ILN004,ILS054,ILF012,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820014-01,Standard Silver On Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810021,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS074,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810021-01,Standard Bronze On Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,Individual,No,36-1236610,36096IL0810021,Blue Precision Bronze HMO? 003,36096IL081,,ILN004,ILS074,ILF011,Existing,HMO,Bronze,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred,http://www.bcbsil.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0810021-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,26
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820015,Blue Precision Silver HMO? 002,36096IL082,,ILN004,ILS074,ILF012,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820015-00,Standard Silver Off Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,5,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820015,Blue Precision Silver HMO? 002,36096IL082,,ILN004,ILS074,ILF012,Existing,HMO,Silver,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820015-01,Standard Silver On Exchange Plan,,0.705312609672546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,6,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820019,Blue Precision Bronze HMO? 003,36096IL082,,ILN004,ILS054,ILF014,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820019-01,Standard Bronze On Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,6,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820020,Blue Precision Bronze HMO? 003,36096IL082,,ILN004,ILS074,ILF014,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820020-00,Standard Bronze Off Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,IL,36096,SERFF,10,2015-02-22 21:18:17,6,36096,IL,SHOP (Small Group),No,36-1236610,36096IL0820020,Blue Precision Bronze HMO? 003,36096IL082,,ILN004,ILS074,ILF014,Existing,HMO,Bronze,No,Both,No,Yes,All,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsil.com/employer/products/on-exchange/,,http://www.bcbsil.com/employer/products/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_IL_HealthInsMarketplace5TierGenericsPlusDrugList.pdf,36096IL0820020-01,Standard Bronze On Exchange Plan,,0.615997314453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,IL,39096,SERFF,2,2014-09-09 16:12:42,1,39096,IL,SHOP (Small Group),Yes,44-0308260,39096IL0010001,KCL Fam Low PPO,39096IL001,,ILN001,ILS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$50.88,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,39096IL0010001-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,39096,SERFF,2,2014-09-09 16:12:42,1,39096,IL,SHOP (Small Group),Yes,44-0308260,39096IL0010003,KCL Fam Low MAC,39096IL001,,ILN001,ILS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$36.64,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,39096IL0010003-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,39096,SERFF,2,2014-09-09 16:12:42,2,39096,IL,SHOP (Small Group),Yes,44-0308260,39096IL0010002,KCL Fam High PPO,39096IL001,,ILN001,ILS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$62.66,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,39096IL0010002-00,Standard High Off Exchange Plan,86.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,39096,SERFF,2,2014-09-09 16:12:42,2,39096,IL,SHOP (Small Group),Yes,44-0308260,39096IL0010004,KCL Fam High MAC,39096IL001,,ILN001,ILS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$46.74,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,39096IL0010004-00,Standard High Off Exchange Plan,86.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,40653,SERFF,3,2014-09-09 16:12:42,1,40653,IL,SHOP (Small Group),Yes,42-0127290,40653IL0050001,Principal Plan Dental 70,40653IL005,,ILN001,ILS001,,New,PPO,Low,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$33.86,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,40653IL0050001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,40653,SERFF,3,2014-09-09 16:12:42,1,40653,IL,SHOP (Small Group),Yes,42-0127290,40653IL0050002,Principal Plan Dental 80,40653IL005,,ILN001,ILS001,,New,PPO,High,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$36.28,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,40653IL0050002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,46552,SERFF,2,2014-09-09 16:12:42,1,46552,IL,Individual,Yes,47-0397286,46552IL0010001,"Delta Dental Individual PPO, EHB Certified",46552IL001,,ILN002,ILS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.47,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,46552IL0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,46552,SERFF,2,2014-09-09 16:12:42,1,46552,IL,Individual,Yes,47-0397286,46552IL0010002,"Delta Dental Individual PPO, EHB Certified",46552IL001,,ILN002,ILS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.35,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,46552IL0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,46552,SERFF,2,2014-09-09 16:12:42,1,46552,IL,Individual,Yes,47-0397286,46552IL0020001,"Renaissance Individual Dental PPO, EHB Certified",46552IL002,,ILN001,ILS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.69,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,46552IL0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IL,46552,SERFF,2,2014-09-09 16:12:42,1,46552,IL,Individual,Yes,47-0397286,46552IL0020002,"Renaissance Individual Dental PPO, EHB Certified",46552IL002,,ILN001,ILS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.16,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,46552IL0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IL,53554,SERFF,3,2014-09-11 12:10:19,1,53554,IL,SHOP (Small Group),Yes,81-0170040,53554IL0010001,Assurant Dental ACAFFO High,53554IL001,,ILN001,ILS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$44.08,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same Coverage as in Service Area,Yes,,,,,53554IL0010001-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,53554,SERFF,3,2014-09-11 12:10:19,1,53554,IL,SHOP (Small Group),Yes,81-0170040,53554IL0010003,Assurant Dental ACAFFO High Cosmetic,53554IL001,,ILN001,ILS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$44.08,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same Coverage as in Service Area,Yes,,,,,53554IL0010003-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,53554,SERFF,3,2014-09-11 12:10:19,2,53554,IL,SHOP (Small Group),Yes,81-0170040,53554IL0010004,Assurant Dental ACAFFO Low Cosmetic,53554IL001,,ILN001,ILS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.72,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same Coverage as in Service Area,Yes,,,,,53554IL0010004-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,53554,SERFF,3,2014-09-11 12:10:19,2,53554,IL,SHOP (Small Group),Yes,81-0170040,53554IL0010002,Assurant Dental ACAFFO Low,53554IL001,,ILN001,ILS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.72,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same Coverage as in Service Area,Yes,,,,,53554IL0010002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380016,Humana Silver 4600/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341014,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332187,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380016-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380016,Humana Silver 4600/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341014,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332187,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380016-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380016,Humana Silver 4600/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341014,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332187,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380016-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380016,Humana Silver 4600/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341014,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332187,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380016-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380017,Humana Gold 2500/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340767,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332239,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380017-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",32%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380017,Humana Gold 2500/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340767,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332239,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380017-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380017,Humana Gold 2500/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340767,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332239,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380017-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",32%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380018,Humana Platinum 1000/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340832,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332252,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380018-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",32%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380018,Humana Platinum 1000/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340832,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332252,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380018-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",32%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380018,Humana Platinum 1000/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340832,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332252,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380018-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380018,Humana Platinum 1000/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340832,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332252,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380018-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",32%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380040,Humana Silver 4600/Springfield IL HMOx,58288IL038,,ILN003,ILS004,ILF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340559,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332447,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380040-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380040,Humana Silver 4600/Springfield IL HMOx,58288IL038,,ILN003,ILS004,ILF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340559,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332447,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380040-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380040,Humana Silver 4600/Springfield IL HMOx,58288IL038,,ILN003,ILS004,ILF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340559,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332447,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380040-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380040,Humana Silver 4600/Springfield IL HMOx,58288IL038,,ILN003,ILS004,ILF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340559,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332447,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380040-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380040,Humana Silver 4600/Springfield IL HMOx,58288IL038,,ILN003,ILS004,ILF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340559,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332447,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380040-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380040,Humana Silver 4600/Springfield IL HMOx,58288IL038,,ILN003,ILS004,ILF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340559,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332447,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380040-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,3,58288,IL,Individual,No,61-1013183,58288IL0380013,Humana Basic 6600/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340572,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332148,http://apps.humana.com/marketing/documents.asp?file=2323880,58288IL0380013-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,3,58288,IL,Individual,No,61-1013183,58288IL0380014,Humana Bronze 6300/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340702,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332161,http://apps.humana.com/marketing/documents.asp?file=2323880,58288IL0380014-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280002,Assurant Health Bronze Plan 001,67807IL028,,ILN001,ILS002,ILF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280002-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280002,Assurant Health Bronze Plan 001,67807IL028,,ILN001,ILS002,ILF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,10
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280010,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS005,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280010-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,57
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280010,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS005,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280010-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,58
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,2,67807,IL,Individual,No,39-0658730,67807IL0280011,Assurant Health Bronze Plan 002,67807IL028,,ILN001,ILS001,ILF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280011-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,2,67807,IL,Individual,No,39-0658730,67807IL0280011,Assurant Health Bronze Plan 002,67807IL028,,ILN001,ILS001,ILF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280011-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280021,Assurant Health Gold Plan 002,67807IL028,,ILN001,ILS001,ILF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280021-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280021,Assurant Health Gold Plan 002,67807IL028,,ILN001,ILS001,ILF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280021-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,41
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280021,Assurant Health Gold Plan 002,67807IL028,,ILN001,ILS001,ILF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280021-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,42
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280022,Assurant Health Gold Plan 002,67807IL028,,ILN001,ILS002,ILF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280022-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,43
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380040,Humana Silver 4600/Springfield IL HMOx,58288IL038,,ILN003,ILS004,ILF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340559,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332447,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380040-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380041,Humana Gold 2500/Springfield IL HMOx,58288IL038,,ILN003,ILS004,ILF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340819,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332499,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380041-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",32%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380041,Humana Gold 2500/Springfield IL HMOx,58288IL038,,ILN003,ILS004,ILF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340819,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332499,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380041-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",32%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380041,Humana Gold 2500/Springfield IL HMOx,58288IL038,,ILN003,ILS004,ILF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340819,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332499,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380041-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,28
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380041,Humana Gold 2500/Springfield IL HMOx,58288IL038,,ILN003,ILS004,ILF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340819,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332499,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380041-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",32%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380042,Humana Platinum 1000/Springfield IL HMOx,58288IL038,,ILN003,ILS004,ILF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340884,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332512,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380042-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",32%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380042,Humana Platinum 1000/Springfield IL HMOx,58288IL038,,ILN003,ILS004,ILF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340884,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332512,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380042-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",32%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380042,Humana Platinum 1000/Springfield IL HMOx,58288IL038,,ILN003,ILS004,ILF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340884,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332512,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380042-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,32
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380042,Humana Platinum 1000/Springfield IL HMOx,58288IL038,,ILN003,ILS004,ILF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340884,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332512,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380042-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",32%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380028,Humana Silver 4600/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341040,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332304,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380028-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380028,Humana Silver 4600/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341040,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332304,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380028-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380028,Humana Silver 4600/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341040,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332304,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380028-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,36
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380028,Humana Silver 4600/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341040,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332304,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380028-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380028,Humana Silver 4600/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341040,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332304,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380028-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380028,Humana Silver 4600/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341040,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332304,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380028-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380028,Humana Silver 4600/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341040,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332304,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380028-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,3,58288,IL,Individual,No,61-1013183,58288IL0380026,Humana Bronze 6300/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340741,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332278,http://apps.humana.com/marketing/documents.asp?file=2323880,58288IL0380026-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,3,58288,IL,Individual,No,61-1013183,58288IL0380026,Humana Bronze 6300/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340741,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332278,http://apps.humana.com/marketing/documents.asp?file=2323880,58288IL0380026-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,3,58288,IL,Individual,No,61-1013183,58288IL0380026,Humana Bronze 6300/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340741,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332278,http://apps.humana.com/marketing/documents.asp?file=2323880,58288IL0380026-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,3,58288,IL,Individual,No,61-1013183,58288IL0380026,Humana Bronze 6300/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340741,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332278,http://apps.humana.com/marketing/documents.asp?file=2323880,58288IL0380026-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,IL,59928,SERFF,1,2014-08-09 13:12:30,1,59928,IL,SHOP (Small Group),Yes,36-0883760,59928IL0040002,EHB High PPO,59928IL004,,ILN001,ILS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.65,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,59928IL0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,59928,SERFF,1,2014-08-09 13:12:30,1,59928,IL,SHOP (Small Group),Yes,36-0883760,59928IL0040001,EHB Low PPO,59928IL004,,ILN001,ILS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.79,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,59928IL0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,59928,SERFF,1,2014-08-09 13:12:30,1,59928,IL,SHOP (Small Group),Yes,36-0883760,59928IL0030002,EHB High Passive,59928IL003,,ILN001,ILS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$44.08,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,59928IL0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280007,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS002,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280007-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280007,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS002,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280007-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280007,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS002,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,33
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280007,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS002,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280007-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380029,Humana Gold 2500/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340806,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332382,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380029-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",32%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380029,Humana Gold 2500/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340806,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332382,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380029-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",32%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380029,Humana Gold 2500/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340806,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332382,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380029-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,43
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380029,Humana Gold 2500/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340806,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332382,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380029-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",32%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380030,Humana Platinum 1000/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340871,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332395,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380030-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",32%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380030,Humana Platinum 1000/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340871,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332395,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380030-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",32%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380030,Humana Platinum 1000/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340871,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332395,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380030-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,47
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,1,58288,IL,Individual,No,61-1013183,58288IL0380030,Humana Platinum 1000/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340871,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332395,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380030-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",32%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,2,58288,IL,Individual,No,61-1013183,58288IL0380015,Humana Bronze 4850/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340637,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332174,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380015-00,Standard Bronze Off Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,2,58288,IL,Individual,No,61-1013183,58288IL0380015,Humana Bronze 4850/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340637,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332174,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380015-01,Standard Bronze On Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,2,58288,IL,Individual,No,61-1013183,58288IL0380015,Humana Bronze 4850/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340637,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332174,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,2,58288,IL,Individual,No,61-1013183,58288IL0380015,Humana Bronze 4850/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340637,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332174,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380015-03,Limited Cost Sharing Plan Variation,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,2,58288,IL,Individual,No,61-1013183,58288IL0380039,Humana Bronze 4850/Springfield IL HMOx,58288IL038,,ILN003,ILS004,ILF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340689,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332434,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380039-00,Standard Bronze Off Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,2,58288,IL,Individual,No,61-1013183,58288IL0380039,Humana Bronze 4850/Springfield IL HMOx,58288IL038,,ILN003,ILS004,ILF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340689,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332434,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380039-01,Standard Bronze On Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,2,58288,IL,Individual,No,61-1013183,58288IL0380039,Humana Bronze 4850/Springfield IL HMOx,58288IL038,,ILN003,ILS004,ILF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340689,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332434,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380039-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,2,58288,IL,Individual,No,61-1013183,58288IL0380039,Humana Bronze 4850/Springfield IL HMOx,58288IL038,,ILN003,ILS004,ILF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340689,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332434,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380039-03,Limited Cost Sharing Plan Variation,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,2,58288,IL,Individual,No,61-1013183,58288IL0380027,Humana Bronze 4850/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340676,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332291,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380027-00,Standard Bronze Off Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,2,58288,IL,Individual,No,61-1013183,58288IL0380027,Humana Bronze 4850/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340676,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332291,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380027-01,Standard Bronze On Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,2,58288,IL,Individual,No,61-1013183,58288IL0380027,Humana Bronze 4850/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340676,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332291,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380027-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,2,58288,IL,Individual,No,61-1013183,58288IL0380027,Humana Bronze 4850/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340676,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332291,http://apps.humana.com/marketing/documents.asp?file=2323815,58288IL0380027-03,Limited Cost Sharing Plan Variation,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,3,58288,IL,Individual,No,61-1013183,58288IL0380013,Humana Basic 6600/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340572,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332148,http://apps.humana.com/marketing/documents.asp?file=2323880,58288IL0380013-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,3,58288,IL,Individual,No,61-1013183,58288IL0380014,Humana Bronze 6300/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340702,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332161,http://apps.humana.com/marketing/documents.asp?file=2323880,58288IL0380014-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,3,58288,IL,Individual,No,61-1013183,58288IL0380014,Humana Bronze 6300/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340702,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332161,http://apps.humana.com/marketing/documents.asp?file=2323880,58288IL0380014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,3,58288,IL,Individual,No,61-1013183,58288IL0380014,Humana Bronze 6300/Chicago HMOx,58288IL038,,ILN002,ILS002,ILF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340702,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332161,http://apps.humana.com/marketing/documents.asp?file=2323880,58288IL0380014-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,3,58288,IL,Individual,No,61-1013183,58288IL0380037,Humana Basic 6600/Springfield HMOx,58288IL038,,ILN003,ILS004,ILF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340624,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332408,http://apps.humana.com/marketing/documents.asp?file=2323880,58288IL0380037-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,3,58288,IL,Individual,No,61-1013183,58288IL0380037,Humana Basic 6600/Springfield HMOx,58288IL038,,ILN003,ILS004,ILF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340624,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332408,http://apps.humana.com/marketing/documents.asp?file=2323880,58288IL0380037-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,3,58288,IL,Individual,No,61-1013183,58288IL0380038,Humana Bronze 6300/Springfield HMOx,58288IL038,,ILN003,ILS004,ILF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340754,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332421,http://apps.humana.com/marketing/documents.asp?file=2323880,58288IL0380038-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,3,58288,IL,Individual,No,61-1013183,58288IL0380038,Humana Bronze 6300/Springfield HMOx,58288IL038,,ILN003,ILS004,ILF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340754,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332421,http://apps.humana.com/marketing/documents.asp?file=2323880,58288IL0380038-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,3,58288,IL,Individual,No,61-1013183,58288IL0380038,Humana Bronze 6300/Springfield HMOx,58288IL038,,ILN003,ILS004,ILF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340754,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332421,http://apps.humana.com/marketing/documents.asp?file=2323880,58288IL0380038-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,3,58288,IL,Individual,No,61-1013183,58288IL0380038,Humana Bronze 6300/Springfield HMOx,58288IL038,,ILN003,ILS004,ILF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340754,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332421,http://apps.humana.com/marketing/documents.asp?file=2323880,58288IL0380038-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,3,58288,IL,Individual,No,61-1013183,58288IL0380025,Humana Basic 6600/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340611,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332265,http://apps.humana.com/marketing/documents.asp?file=2323880,58288IL0380025-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,IL,58288,SERFF,4,2014-10-06 10:59:03,3,58288,IL,Individual,No,61-1013183,58288IL0380025,Humana Basic 6600/Rockford-Peoria HMOx,58288IL038,,ILN004,ILS003,ILF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2340611,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332265,http://apps.humana.com/marketing/documents.asp?file=2323880,58288IL0380025-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,IL,59928,SERFF,1,2014-08-09 13:12:30,1,59928,IL,SHOP (Small Group),Yes,36-0883760,59928IL0030001,EHB Low Passive,59928IL003,,ILN001,ILS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.35,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,59928IL0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IL,60600,SERFF,2,2015-01-22 16:02:51,1,60600,IL,Individual,Yes,36-2612058,60600IL0010002,Delta Dental Individual Kids Basic Plan,60600IL001,,ILN001,ILS001,,Existing,EPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$24.99,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Benefits; Must see Delta Dental PPO Provider,Yes,www.deltadentalilexchange.com/dental-plans,https://www.deltadentalil.me/payment,www.deltadentalilexchange.com/dental-plans,,60600IL0010002-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$120,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,60600,SERFF,2,2015-01-22 16:02:51,1,60600,IL,SHOP (Small Group),Yes,36-2612058,60600IL0030002,Delta Dental Individual Kids Preferred Plan,60600IL003,,ILN001,ILS001,,Existing,EPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.99,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Benefits; Must see a Delta Dental PPO Provider,Yes,www.deltadentalilshop.com/dental-plans,https://www.deltadentalil.me/payment,www.deltadentalilshop.com/dental-plans,,60600IL0030002-00,Standard High Off Exchange Plan,84.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,60600,SERFF,2,2015-01-22 16:02:51,1,60600,IL,Individual,Yes,36-2612058,60600IL0010002,Delta Dental Individual Kids Basic Plan,60600IL001,,ILN001,ILS001,,Existing,EPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$24.99,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Benefits; Must see Delta Dental PPO Provider,Yes,www.deltadentalilexchange.com/dental-plans,https://www.deltadentalil.me/payment,www.deltadentalilexchange.com/dental-plans,,60600IL0010002-01,Standard Low On Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$120,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,60600,SERFF,2,2015-01-22 16:02:51,1,60600,IL,Individual,Yes,36-2612058,60600IL0010001,Delta Dental Individual Kids Preferred Plan,60600IL001,,ILN001,ILS001,,Existing,EPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$28.99,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Benefits; Must see Delta Dental PPO Provider,Yes,www.deltadentalilexchange.com/dental-plans,https://www.deltadentalil.me/payment,www.deltadentalilexchange.com/dental-plans,,60600IL0010001-00,Standard High Off Exchange Plan,84.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IL,60600,SERFF,2,2015-01-22 16:02:51,1,60600,IL,Individual,Yes,36-2612058,60600IL0010001,Delta Dental Individual Kids Preferred Plan,60600IL001,,ILN001,ILS001,,Existing,EPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$28.99,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Benefits; Must see Delta Dental PPO Provider,Yes,www.deltadentalilexchange.com/dental-plans,https://www.deltadentalil.me/payment,www.deltadentalilexchange.com/dental-plans,,60600IL0010001-01,Standard High On Exchange Plan,84.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IL,60600,SERFF,2,2015-01-22 16:02:51,2,60600,IL,Individual,Yes,36-2612058,60600IL0010004,Delta Dental Individual Basic Plan,60600IL001,,ILN001,ILS001,,Existing,EPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.99,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Benefits; Must see Delta Dental PPO Provider,Yes,www.deltadentalilexchange.com/dental-plans,https://www.deltadentalil.me/payment,www.deltadentalilexchange.com/dental-plans,,60600IL0010004-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$120,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,60600,SERFF,2,2015-01-22 16:02:51,2,60600,IL,Individual,Yes,36-2612058,60600IL0010003,Delta Dental Individual Preferred Plan,60600IL001,,ILN001,ILS001,,Existing,EPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.99,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Benefits; Must see Delta Dental PPO Provider,Yes,www.deltadentalilexchange.com/dental-plans,https://www.deltadentalil.me/payment,www.deltadentalilexchange.com/dental-plans,,60600IL0010003-01,Standard High On Exchange Plan,84.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280001,Assurant Health Bronze Plan 001,67807IL028,,ILN001,ILS001,ILF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280001-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280018,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS003,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280018-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280019,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS004,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280019-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280019,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS004,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280019-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280019,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS004,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280019-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,27
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280019,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS004,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280019-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280019,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS004,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280019-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,1,68432,IL,Individual,No,27-2186150,68432IL0010004,Ambetter Balanced Care 3 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0010004-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,11
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,1,68432,IL,Individual,No,27-2186150,68432IL0010004,Ambetter Balanced Care 3 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0010004-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,12
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280001,Assurant Health Bronze Plan 001,67807IL028,,ILN001,ILS001,ILF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280001-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280001,Assurant Health Bronze Plan 001,67807IL028,,ILN001,ILS001,ILF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280001,Assurant Health Bronze Plan 001,67807IL028,,ILN001,ILS001,ILF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280001-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280002,Assurant Health Bronze Plan 001,67807IL028,,ILN001,ILS002,ILF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280002-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280002,Assurant Health Bronze Plan 001,67807IL028,,ILN001,ILS002,ILF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280002-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280003,Assurant Health Bronze Plan 001,67807IL028,,ILN001,ILS003,ILF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280003-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280003,Assurant Health Bronze Plan 001,67807IL028,,ILN001,ILS003,ILF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280003-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280003,Assurant Health Bronze Plan 001,67807IL028,,ILN001,ILS003,ILF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,14
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280003,Assurant Health Bronze Plan 001,67807IL028,,ILN001,ILS003,ILF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280003-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280004,Assurant Health Bronze Plan 001,67807IL028,,ILN001,ILS004,ILF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280004-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280004,Assurant Health Bronze Plan 001,67807IL028,,ILN001,ILS004,ILF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280004-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280004,Assurant Health Bronze Plan 001,67807IL028,,ILN001,ILS004,ILF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,18
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280004,Assurant Health Bronze Plan 001,67807IL028,,ILN001,ILS004,ILF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280004-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280005,Assurant Health Bronze Plan 001,67807IL028,,ILN001,ILS005,ILF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280005-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280005,Assurant Health Bronze Plan 001,67807IL028,,ILN001,ILS005,ILF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280005-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280005,Assurant Health Bronze Plan 001,67807IL028,,ILN001,ILS005,ILF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,22
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280005,Assurant Health Bronze Plan 001,67807IL028,,ILN001,ILS005,ILF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280005-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280006,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS001,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280006-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280006,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS001,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280006-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280006,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS001,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,26
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280006,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS001,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280006-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280006,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS001,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280006-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280006,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS001,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280006-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280006,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS001,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280006-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280007,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS002,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280007-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280007,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS002,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280007-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280007,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS002,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280007-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280008,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS003,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280008-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280027,Assurant Health Platinum Plan 002,67807IL028,,ILN001,ILS002,ILF004,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280027-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,64
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280027,Assurant Health Platinum Plan 002,67807IL028,,ILN001,ILS002,ILF004,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280027-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,65
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280027,Assurant Health Platinum Plan 002,67807IL028,,ILN001,ILS002,ILF004,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280027-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,66
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280028,Assurant Health Platinum Plan 002,67807IL028,,ILN001,ILS003,ILF004,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280028-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,67
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280028,Assurant Health Platinum Plan 002,67807IL028,,ILN001,ILS003,ILF004,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280028-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,68
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280028,Assurant Health Platinum Plan 002,67807IL028,,ILN001,ILS003,ILF004,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280028-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,69
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,3,68303,IL,Individual,No,39-1263473,68303IL0680003,Humana Bronze 4850/Choice POS,68303IL068,,ILN001,ILS001,ILF002,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340650,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332564,http://apps.humana.com/marketing/documents.asp?file=2323815,68303IL0680003-03,Limited Cost Sharing Plan Variation,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800",Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,"$9,700","$19,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280008,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS003,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280008-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280008,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS003,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280008-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,42
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280008,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS003,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280008-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,43
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280008,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS003,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280008-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280009,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS004,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280009-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280009,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS004,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280009-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,46
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280009,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS004,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,47
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280019,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS004,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280019-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280020,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS005,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280020-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280020,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS005,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280020-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280020,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS005,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280020-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,34
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280020,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS005,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280020-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280020,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS005,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280020-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280020,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS005,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280020-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280020,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS005,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280020-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0040003,Ambetter Secure Care 1 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0040003-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,25
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0040003,Ambetter Secure Care 1 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0040003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,26
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0040003,Ambetter Secure Care 1 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0040003-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,27
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0040009,Ambetter Essential Care 3 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0040009-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,28
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280009,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS004,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280009-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280009,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS004,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280009-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280009,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS004,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280009-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,50
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280009,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS004,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280009-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,51
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280010,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS005,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280010-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,52
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280010,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS005,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280010-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,53
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280010,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS005,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,54
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280010,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS005,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280010-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,55
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,1,67807,IL,Individual,No,39-0658730,67807IL0280010,Assurant Health Silver Plan 001,67807IL028,,ILN001,ILS005,ILF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280010-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,2,67807,IL,Individual,No,39-0658730,67807IL0280011,Assurant Health Bronze Plan 002,67807IL028,,ILN001,ILS001,ILF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,2,67807,IL,Individual,No,39-0658730,67807IL0280011,Assurant Health Bronze Plan 002,67807IL028,,ILN001,ILS001,ILF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280011-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,2,67807,IL,Individual,No,39-0658730,67807IL0280012,Assurant Health Bronze Plan 002,67807IL028,,ILN001,ILS002,ILF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280012-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,2,67807,IL,Individual,No,39-0658730,67807IL0280012,Assurant Health Bronze Plan 002,67807IL028,,ILN001,ILS002,ILF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280012-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,2,67807,IL,Individual,No,39-0658730,67807IL0280012,Assurant Health Bronze Plan 002,67807IL028,,ILN001,ILS002,ILF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280012-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,10
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,2,67807,IL,Individual,No,39-0658730,67807IL0280012,Assurant Health Bronze Plan 002,67807IL028,,ILN001,ILS002,ILF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280012-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,2,67807,IL,Individual,No,39-0658730,67807IL0280013,Assurant Health Bronze Plan 002,67807IL028,,ILN001,ILS003,ILF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280013-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,2,67807,IL,Individual,No,39-0658730,67807IL0280013,Assurant Health Bronze Plan 002,67807IL028,,ILN001,ILS003,ILF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280013-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,2,67807,IL,Individual,No,39-0658730,67807IL0280013,Assurant Health Bronze Plan 002,67807IL028,,ILN001,ILS003,ILF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280013-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,14
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,2,67807,IL,Individual,No,39-0658730,67807IL0280013,Assurant Health Bronze Plan 002,67807IL028,,ILN001,ILS003,ILF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280013-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,2,67807,IL,Individual,No,39-0658730,67807IL0280014,Assurant Health Bronze Plan 002,67807IL028,,ILN001,ILS004,ILF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280014-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,2,67807,IL,Individual,No,39-0658730,67807IL0280014,Assurant Health Bronze Plan 002,67807IL028,,ILN001,ILS004,ILF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280014-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,2,67807,IL,Individual,No,39-0658730,67807IL0280014,Assurant Health Bronze Plan 002,67807IL028,,ILN001,ILS004,ILF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280014-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,18
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,2,67807,IL,Individual,No,39-0658730,67807IL0280014,Assurant Health Bronze Plan 002,67807IL028,,ILN001,ILS004,ILF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280014-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,2,67807,IL,Individual,No,39-0658730,67807IL0280015,Assurant Health Bronze Plan 002,67807IL028,,ILN001,ILS005,ILF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280015-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,2,67807,IL,Individual,No,39-0658730,67807IL0280015,Assurant Health Bronze Plan 002,67807IL028,,ILN001,ILS005,ILF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280015-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,2,67807,IL,Individual,No,39-0658730,67807IL0280015,Assurant Health Bronze Plan 002,67807IL028,,ILN001,ILS005,ILF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280015-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,22
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,2,67807,IL,Individual,No,39-0658730,67807IL0280015,Assurant Health Bronze Plan 002,67807IL028,,ILN001,ILS005,ILF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,67807IL0280015-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280016,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS001,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280016-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280016,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS001,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280016-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280016,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS001,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280016-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280016,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS001,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280016-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280016,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS001,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280016-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280016,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS001,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280016-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280016,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS001,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280016-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280017,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS002,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280017-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280017,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS002,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280017-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280017,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS002,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280017-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,13
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280017,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS002,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280017-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280017,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS002,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280017-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280017,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS002,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280017-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280017,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS002,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280017-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280018,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS003,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280018-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280018,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS003,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280018-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280019,Assurant Health Silver Plan 002,67807IL028,,ILN001,ILS004,ILF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280019-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280021,Assurant Health Gold Plan 002,67807IL028,,ILN001,ILS001,ILF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280021-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280022,Assurant Health Gold Plan 002,67807IL028,,ILN001,ILS002,ILF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280022-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280022,Assurant Health Gold Plan 002,67807IL028,,ILN001,ILS002,ILF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280022-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,45
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,1,68303,IL,Individual,No,39-1263473,68303IL0680006,Humana Gold 2500/Choice POS,68303IL068,,ILN001,ILS001,ILF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340780,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332681,http://apps.humana.com/marketing/documents.asp?file=2323815,68303IL0680006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,1,68303,IL,Individual,No,39-1263473,68303IL0680006,Humana Gold 2500/Choice POS,68303IL068,,ILN001,ILS001,ILF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340780,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332681,http://apps.humana.com/marketing/documents.asp?file=2323815,68303IL0680006-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",32%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,1,68432,IL,Individual,No,27-2186150,68432IL0040002,Ambetter Secure Care 2 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0040002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,37
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,1,68432,IL,Individual,No,27-2186150,68432IL0040002,Ambetter Secure Care 2 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0040002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,38
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,1,68432,IL,Individual,No,27-2186150,68432IL0040002,Ambetter Secure Care 2 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0040002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,39
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0010003,Ambetter Secure Care 1 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0010003-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0010003,Ambetter Secure Care 1 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0010003-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0010003,Ambetter Secure Care 1 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0010003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0010003,Ambetter Secure Care 1 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0010003-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0010009,Ambetter Essential Care 3 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0010009-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0010009,Ambetter Essential Care 3 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0010009-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0010009,Ambetter Essential Care 3 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0010009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0010009,Ambetter Essential Care 3 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0010009-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0010010,Ambetter Essential Care 4 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0010010-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280022,Assurant Health Gold Plan 002,67807IL028,,ILN001,ILS002,ILF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280022-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,46
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280023,Assurant Health Gold Plan 002,67807IL028,,ILN001,ILS003,ILF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280023-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,47
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280023,Assurant Health Gold Plan 002,67807IL028,,ILN001,ILS003,ILF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280023-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280023,Assurant Health Gold Plan 002,67807IL028,,ILN001,ILS003,ILF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280023-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,49
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280023,Assurant Health Gold Plan 002,67807IL028,,ILN001,ILS003,ILF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280023-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,50
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280024,Assurant Health Gold Plan 002,67807IL028,,ILN001,ILS004,ILF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280024-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,51
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280024,Assurant Health Gold Plan 002,67807IL028,,ILN001,ILS004,ILF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280024-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,52
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280024,Assurant Health Gold Plan 002,67807IL028,,ILN001,ILS004,ILF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280024-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,53
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280024,Assurant Health Gold Plan 002,67807IL028,,ILN001,ILS004,ILF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280024-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,54
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280025,Assurant Health Gold Plan 002,67807IL028,,ILN001,ILS005,ILF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280025-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,55
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280025,Assurant Health Gold Plan 002,67807IL028,,ILN001,ILS005,ILF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280025-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280025,Assurant Health Gold Plan 002,67807IL028,,ILN001,ILS005,ILF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280025-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,57
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280025,Assurant Health Gold Plan 002,67807IL028,,ILN001,ILS005,ILF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280025-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,58
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280026,Assurant Health Platinum Plan 002,67807IL028,,ILN001,ILS001,ILF004,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280026-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,59
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280026,Assurant Health Platinum Plan 002,67807IL028,,ILN001,ILS001,ILF004,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280026-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,60
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280026,Assurant Health Platinum Plan 002,67807IL028,,ILN001,ILS001,ILF004,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280026-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,61
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280026,Assurant Health Platinum Plan 002,67807IL028,,ILN001,ILS001,ILF004,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280026-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,62
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280027,Assurant Health Platinum Plan 002,67807IL028,,ILN001,ILS002,ILF004,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280027-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,63
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280028,Assurant Health Platinum Plan 002,67807IL028,,ILN001,ILS003,ILF004,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280028-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,70
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280029,Assurant Health Platinum Plan 002,67807IL028,,ILN001,ILS004,ILF004,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280029-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,71
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280029,Assurant Health Platinum Plan 002,67807IL028,,ILN001,ILS004,ILF004,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280029-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,72
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280029,Assurant Health Platinum Plan 002,67807IL028,,ILN001,ILS004,ILF004,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280029-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,73
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280029,Assurant Health Platinum Plan 002,67807IL028,,ILN001,ILS004,ILF004,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280029-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,74
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280030,Assurant Health Platinum Plan 002,67807IL028,,ILN001,ILS005,ILF004,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280030-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,75
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280030,Assurant Health Platinum Plan 002,67807IL028,,ILN001,ILS005,ILF004,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280030-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,76
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280030,Assurant Health Platinum Plan 002,67807IL028,,ILN001,ILS005,ILF004,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280030-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,77
2015,IL,67807,SERFF,3,2014-11-15 10:06:04,3,67807,IL,Individual,No,39-0658730,67807IL0280030,Assurant Health Platinum Plan 002,67807IL028,,ILN001,ILS005,ILF004,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_IL_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-IL.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,67807IL0280030-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,78
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,1,68303,IL,Individual,No,39-1263473,68303IL0680004,Humana Silver 4250/Choice POS,68303IL068,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341001,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332577,http://apps.humana.com/marketing/documents.asp?file=2323815,68303IL0680004-00,Standard Silver Off Exchange Plan,,0.681853055953979,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$4,250","$8,500",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,1,68303,IL,Individual,Yes,39-1263473,68303IL0690001,Humana Dental Smart Choice,68303IL069,,ILN002,ILS002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.30,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541227,,68303IL0690001-00,Standard Low Off Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,1,68303,IL,Individual,Yes,39-1263473,68303IL0690001,Humana Dental Smart Choice,68303IL069,,ILN002,ILS002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.30,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541227,,68303IL0690001-01,Standard Low On Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,1,68303,IL,Individual,No,39-1263473,68303IL0680004,Humana Silver 4250/Choice POS,68303IL068,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341001,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332577,http://apps.humana.com/marketing/documents.asp?file=2323815,68303IL0680004-01,Standard Silver On Exchange Plan,,0.681853055953979,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$4,250","$8,500",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,1,68303,IL,Individual,No,39-1263473,68303IL0680004,Humana Silver 4250/Choice POS,68303IL068,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341001,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332577,http://apps.humana.com/marketing/documents.asp?file=2323815,68303IL0680004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,1,68303,IL,Individual,No,39-1263473,68303IL0680004,Humana Silver 4250/Choice POS,68303IL068,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341001,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332577,http://apps.humana.com/marketing/documents.asp?file=2323815,68303IL0680004-03,Limited Cost Sharing Plan Variation,,0.681853055953979,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$4,250","$8,500",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,1,68303,IL,Individual,No,39-1263473,68303IL0680004,Humana Silver 4250/Choice POS,68303IL068,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341001,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332577,http://apps.humana.com/marketing/documents.asp?file=2323815,68303IL0680004-04,73% AV Level Silver Plan,,0.725123465061188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,1,68303,IL,Individual,No,39-1263473,68303IL0680004,Humana Silver 4250/Choice POS,68303IL068,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341001,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332577,http://apps.humana.com/marketing/documents.asp?file=2323815,68303IL0680004-05,87% AV Level Silver Plan,,0.863307356834412,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$25,000","$50,000",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,$500,"$1,000",50%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,1,68303,IL,Individual,No,39-1263473,68303IL0680004,Humana Silver 4250/Choice POS,68303IL068,,ILN001,ILS001,ILF003,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2341001,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332577,http://apps.humana.com/marketing/documents.asp?file=2323815,68303IL0680004-06,94% AV Level Silver Plan,,0.937241017818451,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,$250,$500,50%,,,,$750,"$1,500",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,1,68303,IL,Individual,No,39-1263473,68303IL0680006,Humana Gold 2500/Choice POS,68303IL068,,ILN001,ILS001,ILF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340780,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332681,http://apps.humana.com/marketing/documents.asp?file=2323815,68303IL0680006-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",32%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,1,68303,IL,Individual,No,39-1263473,68303IL0680006,Humana Gold 2500/Choice POS,68303IL068,,ILN001,ILS001,ILF004,Existing,PPO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340780,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332681,http://apps.humana.com/marketing/documents.asp?file=2323815,68303IL0680006-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,"$1,000",32%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,2,68303,IL,Individual,No,39-1263473,68303IL0680001,Humana Basic 6600/Choice POS,68303IL068,,ILN001,ILS001,ILF001,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340585,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332538,http://apps.humana.com/marketing/documents.asp?file=2323880,68303IL0680001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,2,68303,IL,Individual,No,39-1263473,68303IL0680001,Humana Basic 6600/Choice POS,68303IL068,,ILN001,ILS001,ILF001,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340585,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332538,http://apps.humana.com/marketing/documents.asp?file=2323880,68303IL0680001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,2,68303,IL,Individual,No,39-1263473,68303IL0680002,Humana Bronze 6300/Choice POS,68303IL068,,ILN001,ILS001,ILF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340715,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332551,http://apps.humana.com/marketing/documents.asp?file=2323880,68303IL0680002-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,2,68303,IL,Individual,No,39-1263473,68303IL0680002,Humana Bronze 6300/Choice POS,68303IL068,,ILN001,ILS001,ILF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340715,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332551,http://apps.humana.com/marketing/documents.asp?file=2323880,68303IL0680002-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,2,68303,IL,Individual,No,39-1263473,68303IL0680002,Humana Bronze 6300/Choice POS,68303IL068,,ILN001,ILS001,ILF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340715,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332551,http://apps.humana.com/marketing/documents.asp?file=2323880,68303IL0680002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,2,68303,IL,Individual,No,39-1263473,68303IL0680002,Humana Bronze 6300/Choice POS,68303IL068,,ILN001,ILS001,ILF001,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340715,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332551,http://apps.humana.com/marketing/documents.asp?file=2323880,68303IL0680002-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,9
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,2,68303,IL,Individual,No,39-1263473,68303IL0680005,Humana Silver 3650/Choice POS,68303IL068,,ILN001,ILS001,ILF001,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340988,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332629,http://apps.humana.com/marketing/documents.asp?file=2323880,68303IL0680005-00,Standard Silver Off Exchange Plan,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,10
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,2,68303,IL,Individual,No,39-1263473,68303IL0680005,Humana Silver 3650/Choice POS,68303IL068,,ILN001,ILS001,ILF001,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340988,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332629,http://apps.humana.com/marketing/documents.asp?file=2323880,68303IL0680005-01,Standard Silver On Exchange Plan,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,11
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,2,68303,IL,Individual,No,39-1263473,68303IL0680005,Humana Silver 3650/Choice POS,68303IL068,,ILN001,ILS001,ILF001,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340988,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332629,http://apps.humana.com/marketing/documents.asp?file=2323880,68303IL0680005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,12
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,2,68303,IL,Individual,No,39-1263473,68303IL0680005,Humana Silver 3650/Choice POS,68303IL068,,ILN001,ILS001,ILF001,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340988,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332629,http://apps.humana.com/marketing/documents.asp?file=2323880,68303IL0680005-03,Limited Cost Sharing Plan Variation,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,13
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,2,68303,IL,Individual,No,39-1263473,68303IL0680005,Humana Silver 3650/Choice POS,68303IL068,,ILN001,ILS001,ILF001,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340988,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332629,http://apps.humana.com/marketing/documents.asp?file=2323880,68303IL0680005-04,73% AV Level Silver Plan,,0.721818149089813,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,920","$5,840",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,920","$5,840",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,14
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,2,68303,IL,Individual,No,39-1263473,68303IL0680005,Humana Silver 3650/Choice POS,68303IL068,,ILN001,ILS001,ILF001,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340988,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332629,http://apps.humana.com/marketing/documents.asp?file=2323880,68303IL0680005-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,15
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,2,68303,IL,Individual,No,39-1263473,68303IL0680005,Humana Silver 3650/Choice POS,68303IL068,,ILN001,ILS001,ILF001,Existing,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340988,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332629,http://apps.humana.com/marketing/documents.asp?file=2323880,68303IL0680005-06,94% AV Level Silver Plan,,0.935785233974457,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$475,$950,,,"$14,600","$29,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$475,$950,0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,16
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,3,68303,IL,Individual,No,39-1263473,68303IL0680003,Humana Bronze 4850/Choice POS,68303IL068,,ILN001,ILS001,ILF002,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340650,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332564,http://apps.humana.com/marketing/documents.asp?file=2323815,68303IL0680003-00,Standard Bronze Off Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800",Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,"$9,700","$19,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,3,68303,IL,Individual,No,39-1263473,68303IL0680003,Humana Bronze 4850/Choice POS,68303IL068,,ILN001,ILS001,ILF002,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340650,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332564,http://apps.humana.com/marketing/documents.asp?file=2323815,68303IL0680003-01,Standard Bronze On Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800",Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,"$9,700","$19,400",Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,68303,SERFF,6,2015-01-31 17:35:53,3,68303,IL,Individual,No,39-1263473,68303IL0680003,Humana Bronze 4850/Choice POS,68303IL068,,ILN001,ILS001,ILF002,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,http://apps.humana.com/marketing/documents.asp?file=2340650,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2332564,http://apps.humana.com/marketing/documents.asp?file=2323815,68303IL0680003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,1,68432,IL,Individual,No,27-2186150,68432IL0010004,Ambetter Balanced Care 3 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0010004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,1,68432,IL,Individual,No,27-2186150,68432IL0010004,Ambetter Balanced Care 3 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0010004-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,14
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,1,68432,IL,Individual,No,27-2186150,68432IL0010004,Ambetter Balanced Care 3 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0010004-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,15
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,1,68432,IL,Individual,No,27-2186150,68432IL0010004,Ambetter Balanced Care 3 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0010004-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,16
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,1,68432,IL,Individual,No,27-2186150,68432IL0010004,Ambetter Balanced Care 3 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0010004-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,17
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,1,68432,IL,Individual,No,27-2186150,68432IL0010002,Ambetter Secure Care 2 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0010002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,18
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,1,68432,IL,Individual,No,27-2186150,68432IL0010002,Ambetter Secure Care 2 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0010002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,19
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,1,68432,IL,Individual,No,27-2186150,68432IL0010002,Ambetter Secure Care 2 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0010002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,20
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,1,68432,IL,Individual,No,27-2186150,68432IL0010002,Ambetter Secure Care 2 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0010002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,21
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,1,68432,IL,Individual,No,27-2186150,68432IL0040004,Ambetter Balanced Care 3 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0040004-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,29
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,1,68432,IL,Individual,No,27-2186150,68432IL0040004,Ambetter Balanced Care 3 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0040004-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,30
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,1,68432,IL,Individual,No,27-2186150,68432IL0040004,Ambetter Balanced Care 3 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0040004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,31
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,1,68432,IL,Individual,No,27-2186150,68432IL0040004,Ambetter Balanced Care 3 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0040004-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,32
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,1,68432,IL,Individual,No,27-2186150,68432IL0040004,Ambetter Balanced Care 3 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0040004-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,33
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,1,68432,IL,Individual,No,27-2186150,68432IL0040004,Ambetter Balanced Care 3 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0040004-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,34
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,1,68432,IL,Individual,No,27-2186150,68432IL0040004,Ambetter Balanced Care 3 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0040004-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,35
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,1,68432,IL,Individual,No,27-2186150,68432IL0040002,Ambetter Secure Care 2 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0040002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,36
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0010010,Ambetter Essential Care 4 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0010010-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0010010,Ambetter Essential Care 4 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0010010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0010010,Ambetter Essential Care 4 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0010010-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0010011,Ambetter Essential Care 2 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0010011-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0010011,Ambetter Essential Care 2 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0010011-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0010011,Ambetter Essential Care 2 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0010011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0010011,Ambetter Essential Care 2 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0010011-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0010012,Ambetter Essential Care 1 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0010012-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0010012,Ambetter Essential Care 1 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0010012-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0010012,Ambetter Essential Care 1 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0010012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0010012,Ambetter Essential Care 1 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0010012-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0040003,Ambetter Secure Care 1 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0040003-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,24
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0040009,Ambetter Essential Care 3 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0040009-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,29
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0040009,Ambetter Essential Care 3 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0040009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,30
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0040009,Ambetter Essential Care 3 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0040009-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,31
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0040010,Ambetter Essential Care 4 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0040010-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,32
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0040010,Ambetter Essential Care 4 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0040010-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,33
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0040010,Ambetter Essential Care 4 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0040010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,34
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0040010,Ambetter Essential Care 4 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0040010-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,35
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0040011,Ambetter Essential Care 2 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0040011-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,36
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0040011,Ambetter Essential Care 2 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0040011-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,37
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0040011,Ambetter Essential Care 2 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0040011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,38
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0040011,Ambetter Essential Care 2 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0040011-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,39
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0040012,Ambetter Essential Care 1 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0040012-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,40
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0040012,Ambetter Essential Care 1 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0040012-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,41
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,2,68432,IL,Individual,No,27-2186150,68432IL0040012,Ambetter Essential Care 1 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0040012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,42
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,3,68432,IL,Individual,No,27-2186150,68432IL0010005,Ambetter Balanced Care 4 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0010005-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,7
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,3,68432,IL,Individual,No,27-2186150,68432IL0010005,Ambetter Balanced Care 4 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0010005-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,8
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,3,68432,IL,Individual,No,27-2186150,68432IL0010005,Ambetter Balanced Care 4 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0010005-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,9
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,3,68432,IL,Individual,No,27-2186150,68432IL0010005,Ambetter Balanced Care 4 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0010005-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,10
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,3,68432,IL,Individual,No,27-2186150,68432IL0040005,Ambetter Balanced Care 4 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0040005-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,11
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,3,68432,IL,Individual,No,27-2186150,68432IL0040005,Ambetter Balanced Care 4 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0040005-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,12
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,3,68432,IL,Individual,No,27-2186150,68432IL0040005,Ambetter Balanced Care 4 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0040005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,3,68432,IL,Individual,No,27-2186150,68432IL0040005,Ambetter Balanced Care 4 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0040005-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,14
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,3,68432,IL,Individual,No,27-2186150,68432IL0040005,Ambetter Balanced Care 4 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0040005-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,15
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,3,68432,IL,Individual,No,27-2186150,68432IL0040005,Ambetter Balanced Care 4 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0040005-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,16
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,3,68432,IL,Individual,No,27-2186150,68432IL0040005,Ambetter Balanced Care 4 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0040005-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,17
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,4,68432,IL,Individual,No,27-2186150,68432IL0010007,Ambetter Balanced Care 2 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0010007-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,4
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,4,68432,IL,Individual,No,27-2186150,68432IL0010007,Ambetter Balanced Care 2 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0010007-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,5
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,4,68432,IL,Individual,No,27-2186150,68432IL0010007,Ambetter Balanced Care 2 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0010007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,4,68432,IL,Individual,No,27-2186150,68432IL0010007,Ambetter Balanced Care 2 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0010007-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,7
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,4,68432,IL,Individual,No,27-2186150,68432IL0010007,Ambetter Balanced Care 2 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0010007-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,8
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,4,68432,IL,Individual,No,27-2186150,68432IL0010007,Ambetter Balanced Care 2 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0010007-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,9
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,4,68432,IL,Individual,No,27-2186150,68432IL0010007,Ambetter Balanced Care 2 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0010007-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,10
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,4,68432,IL,Individual,No,27-2186150,68432IL0040007,Ambetter Balanced Care 2 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0040007-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,11
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,4,68432,IL,Individual,No,27-2186150,68432IL0040007,Ambetter Balanced Care 2 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0040007-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,12
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,4,68432,IL,Individual,No,27-2186150,68432IL0040007,Ambetter Balanced Care 2 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0040007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,4,68432,IL,Individual,No,27-2186150,68432IL0040007,Ambetter Balanced Care 2 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0040007-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,14
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,4,68432,IL,Individual,No,27-2186150,68432IL0040007,Ambetter Balanced Care 2 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0040007-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,15
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,4,68432,IL,Individual,No,27-2186150,68432IL0040007,Ambetter Balanced Care 2 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0040007-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,16
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,4,68432,IL,Individual,No,27-2186150,68432IL0040007,Ambetter Balanced Care 2 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0040007-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,17
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,5,68432,IL,Individual,No,27-2186150,68432IL0010008,Ambetter Balanced Care 1 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0010008-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,4
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,5,68432,IL,Individual,No,27-2186150,68432IL0010008,Ambetter Balanced Care 1 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0010008-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,5
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,5,68432,IL,Individual,No,27-2186150,68432IL0010008,Ambetter Balanced Care 1 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0010008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,5,68432,IL,Individual,No,27-2186150,68432IL0010008,Ambetter Balanced Care 1 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0010008-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,7
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,5,68432,IL,Individual,No,27-2186150,68432IL0010008,Ambetter Balanced Care 1 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0010008-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,8
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,5,68432,IL,Individual,No,27-2186150,68432IL0010008,Ambetter Balanced Care 1 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0010008-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,9
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,5,68432,IL,Individual,No,27-2186150,68432IL0010008,Ambetter Balanced Care 1 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0010008-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,10
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,5,68432,IL,Individual,No,27-2186150,68432IL0010001,Ambetter Platinum Care 1 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0010001-00,Standard Platinum Off Exchange Plan,,0.88078773021698,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$120,$10,"$1,010",$150,$350,$90,$260,$80,11
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,5,68432,IL,Individual,No,27-2186150,68432IL0010001,Ambetter Platinum Care 1 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0010001-01,Standard Platinum On Exchange Plan,,0.88078773021698,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$120,$10,"$1,010",$150,$350,$90,$260,$80,12
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,5,68432,IL,Individual,No,27-2186150,68432IL0010001,Ambetter Platinum Care 1 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0010001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,5,68432,IL,Individual,No,27-2186150,68432IL0010001,Ambetter Platinum Care 1 Sinai Health Select Network,68432IL001,,ILN001,ILS001,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0010001-03,Limited Cost Sharing Plan Variation,,0.88078773021698,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$120,$10,"$1,010",$150,$350,$90,$260,$80,14
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,5,68432,IL,Individual,No,27-2186150,68432IL0040008,Ambetter Balanced Care 1 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0040008-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,15
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,5,68432,IL,Individual,No,27-2186150,68432IL0040008,Ambetter Balanced Care 1 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0040008-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,16
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,5,68432,IL,Individual,No,27-2186150,68432IL0040008,Ambetter Balanced Care 1 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0040008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,17
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,5,68432,IL,Individual,No,27-2186150,68432IL0040008,Ambetter Balanced Care 1 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0040008-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,18
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,5,68432,IL,Individual,No,27-2186150,68432IL0040008,Ambetter Balanced Care 1 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0040008-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,19
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,5,68432,IL,Individual,No,27-2186150,68432IL0040008,Ambetter Balanced Care 1 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0040008-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,20
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,5,68432,IL,Individual,No,27-2186150,68432IL0040008,Ambetter Balanced Care 1 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0040008-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,21
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,5,68432,IL,Individual,No,27-2186150,68432IL0040001,Ambetter Platinum Care 1 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0040001-00,Standard Platinum Off Exchange Plan,,0.88078773021698,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$120,$10,"$1,010",$150,$350,$90,$260,$80,22
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,5,68432,IL,Individual,No,27-2186150,68432IL0040001,Ambetter Platinum Care 1 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0040001-01,Standard Platinum On Exchange Plan,,0.88078773021698,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$120,$10,"$1,010",$150,$350,$90,$260,$80,23
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,5,68432,IL,Individual,No,27-2186150,68432IL0040001,Ambetter Platinum Care 1 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0040001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,24
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,5,68432,IL,Individual,No,27-2186150,68432IL0040001,Ambetter Platinum Care 1 Swedish Covenant Select Network,68432IL004,,ILN002,ILS002,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.999258282883552,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0040001-03,Limited Cost Sharing Plan Variation,,0.88078773021698,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$120,$10,"$1,010",$150,$350,$90,$260,$80,25
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,6,68432,IL,Individual,No,27-2186150,68432IL0020004,Ambetter Balanced Care 3 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.97507001403083,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0020004-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,11
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,6,68432,IL,Individual,No,27-2186150,68432IL0020004,Ambetter Balanced Care 3 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.97507001403083,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0020004-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,12
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,6,68432,IL,Individual,No,27-2186150,68432IL0020004,Ambetter Balanced Care 3 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.97507001403083,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0020004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,6,68432,IL,Individual,No,27-2186150,68432IL0020004,Ambetter Balanced Care 3 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.97507001403083,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0020004-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,14
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,6,68432,IL,Individual,No,27-2186150,68432IL0020004,Ambetter Balanced Care 3 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.97507001403083,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0020004-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,15
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,6,68432,IL,Individual,No,27-2186150,68432IL0020004,Ambetter Balanced Care 3 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.97507001403083,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0020004-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,16
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,6,68432,IL,Individual,No,27-2186150,68432IL0020004,Ambetter Balanced Care 3 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.97507001403083,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0020004-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,17
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,6,68432,IL,Individual,No,27-2186150,68432IL0020002,Ambetter Secure Care 2 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973659353123269,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0020002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,18
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,6,68432,IL,Individual,No,27-2186150,68432IL0020002,Ambetter Secure Care 2 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973659353123269,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0020002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,19
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,6,68432,IL,Individual,No,27-2186150,68432IL0020002,Ambetter Secure Care 2 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973659353123269,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0020002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,20
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,6,68432,IL,Individual,No,27-2186150,68432IL0020002,Ambetter Secure Care 2 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973659353123269,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0020002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,21
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,6,68432,IL,Individual,No,27-2186150,68432IL0050004,Ambetter Balanced Care 3 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.97507001403083,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0050004-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,29
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,6,68432,IL,Individual,No,27-2186150,68432IL0050004,Ambetter Balanced Care 3 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.97507001403083,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0050004-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,30
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,6,68432,IL,Individual,No,27-2186150,68432IL0050004,Ambetter Balanced Care 3 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.97507001403083,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0050004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,31
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,6,68432,IL,Individual,No,27-2186150,68432IL0050004,Ambetter Balanced Care 3 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.97507001403083,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0050004-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,32
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,6,68432,IL,Individual,No,27-2186150,68432IL0050004,Ambetter Balanced Care 3 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.97507001403083,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0050004-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,33
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,6,68432,IL,Individual,No,27-2186150,68432IL0050004,Ambetter Balanced Care 3 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.97507001403083,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0050004-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,34
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,6,68432,IL,Individual,No,27-2186150,68432IL0050004,Ambetter Balanced Care 3 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.97507001403083,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0050004-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,35
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,6,68432,IL,Individual,No,27-2186150,68432IL0050002,Ambetter Secure Care 2 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973659353123269,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0050002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,36
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,6,68432,IL,Individual,No,27-2186150,68432IL0050002,Ambetter Secure Care 2 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973659353123269,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0050002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,37
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,6,68432,IL,Individual,No,27-2186150,68432IL0050002,Ambetter Secure Care 2 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973659353123269,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0050002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,38
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,6,68432,IL,Individual,No,27-2186150,68432IL0050002,Ambetter Secure Care 2 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973659353123269,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0050002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,39
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0020003,Ambetter Secure Care 1 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973659403236287,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0020003-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0020003,Ambetter Secure Care 1 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973659403236287,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0020003-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0020003,Ambetter Secure Care 1 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973659403236287,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0020003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0020003,Ambetter Secure Care 1 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973659403236287,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0020003-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0020009,Ambetter Essential Care 3 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342370437208,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0020009-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0020009,Ambetter Essential Care 3 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342370437208,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0020009-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0020009,Ambetter Essential Care 3 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342370437208,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0020009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0020009,Ambetter Essential Care 3 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342370437208,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0020009-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0020010,Ambetter Essential Care 4 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342027447755,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0020010-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0020010,Ambetter Essential Care 4 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342027447755,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0020010-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0020010,Ambetter Essential Care 4 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342027447755,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0020010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0020010,Ambetter Essential Care 4 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342027447755,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0020010-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0020011,Ambetter Essential Care 2 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342370437208,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0020011-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0020011,Ambetter Essential Care 2 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342370437208,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0020011-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0020011,Ambetter Essential Care 2 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342370437208,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0020011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0020011,Ambetter Essential Care 2 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342370437208,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0020011-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0020012,Ambetter Essential Care 1 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342313261469,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0020012-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0020012,Ambetter Essential Care 1 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342313261469,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0020012-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0020012,Ambetter Essential Care 1 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342313261469,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0020012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0020012,Ambetter Essential Care 1 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342313261469,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0020012-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0050003,Ambetter Secure Care 1 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973659403236287,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0050003-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,24
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0050003,Ambetter Secure Care 1 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973659403236287,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0050003-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,25
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0050003,Ambetter Secure Care 1 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973659403236287,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0050003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,26
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0050003,Ambetter Secure Care 1 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973659403236287,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0050003-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,27
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0050009,Ambetter Essential Care 3 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342370437208,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0050009-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,28
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0050009,Ambetter Essential Care 3 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342370437208,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0050009-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,29
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0050009,Ambetter Essential Care 3 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342370437208,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0050009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,30
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0050009,Ambetter Essential Care 3 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342370437208,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0050009-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,31
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0050010,Ambetter Essential Care 4 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342027447755,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0050010-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,32
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0050010,Ambetter Essential Care 4 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342027447755,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0050010-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,33
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0050010,Ambetter Essential Care 4 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342027447755,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0050010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,34
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0050010,Ambetter Essential Care 4 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342027447755,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0050010-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,35
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0050011,Ambetter Essential Care 2 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342370437208,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0050011-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,36
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0050011,Ambetter Essential Care 2 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342370437208,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0050011-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,37
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0050011,Ambetter Essential Care 2 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342370437208,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0050011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,38
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0050011,Ambetter Essential Care 2 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342370437208,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0050011-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,39
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0050012,Ambetter Essential Care 1 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342313261469,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0050012-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,40
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0050012,Ambetter Essential Care 1 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342313261469,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0050012-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,41
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0050012,Ambetter Essential Care 1 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342313261469,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0050012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,42
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,7,68432,IL,Individual,No,27-2186150,68432IL0050012,Ambetter Essential Care 1 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974342313261469,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0050012-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,43
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,8,68432,IL,Individual,No,27-2186150,68432IL0020005,Ambetter Balanced Care 4 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974757294203507,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0020005-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,4
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,8,68432,IL,Individual,No,27-2186150,68432IL0020005,Ambetter Balanced Care 4 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974757294203507,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0020005-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,5
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,8,68432,IL,Individual,No,27-2186150,68432IL0020005,Ambetter Balanced Care 4 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974757294203507,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0020005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,8,68432,IL,Individual,No,27-2186150,68432IL0020005,Ambetter Balanced Care 4 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974757294203507,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0020005-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,7
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,8,68432,IL,Individual,No,27-2186150,68432IL0020005,Ambetter Balanced Care 4 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974757294203507,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0020005-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,8
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,8,68432,IL,Individual,No,27-2186150,68432IL0020005,Ambetter Balanced Care 4 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974757294203507,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0020005-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,9
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,8,68432,IL,Individual,No,27-2186150,68432IL0020005,Ambetter Balanced Care 4 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974757294203507,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0020005-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,10
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,8,68432,IL,Individual,No,27-2186150,68432IL0050005,Ambetter Balanced Care 4 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974757294203507,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0050005-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,11
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,8,68432,IL,Individual,No,27-2186150,68432IL0050005,Ambetter Balanced Care 4 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974757294203507,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0050005-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,12
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,8,68432,IL,Individual,No,27-2186150,68432IL0050005,Ambetter Balanced Care 4 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974757294203507,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0050005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,8,68432,IL,Individual,No,27-2186150,68432IL0050005,Ambetter Balanced Care 4 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974757294203507,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0050005-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,14
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,8,68432,IL,Individual,No,27-2186150,68432IL0050005,Ambetter Balanced Care 4 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974757294203507,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0050005-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,15
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,8,68432,IL,Individual,No,27-2186150,68432IL0050005,Ambetter Balanced Care 4 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974757294203507,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0050005-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,16
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,8,68432,IL,Individual,No,27-2186150,68432IL0050005,Ambetter Balanced Care 4 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.974757294203507,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0050005-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,17
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,9,68432,IL,Individual,No,27-2186150,68432IL0020007,Ambetter Balanced Care 2 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975083197356707,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0020007-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,4
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,9,68432,IL,Individual,No,27-2186150,68432IL0020007,Ambetter Balanced Care 2 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975083197356707,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0020007-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,5
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,9,68432,IL,Individual,No,27-2186150,68432IL0020007,Ambetter Balanced Care 2 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975083197356707,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0020007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,9,68432,IL,Individual,No,27-2186150,68432IL0020007,Ambetter Balanced Care 2 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975083197356707,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0020007-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,7
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,9,68432,IL,Individual,No,27-2186150,68432IL0020007,Ambetter Balanced Care 2 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975083197356707,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0020007-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,8
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,9,68432,IL,Individual,No,27-2186150,68432IL0020007,Ambetter Balanced Care 2 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975083197356707,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0020007-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,9
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,9,68432,IL,Individual,No,27-2186150,68432IL0020007,Ambetter Balanced Care 2 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975083197356707,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0020007-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,10
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,9,68432,IL,Individual,No,27-2186150,68432IL0050007,Ambetter Balanced Care 2 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975083197356707,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0050007-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,11
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,9,68432,IL,Individual,No,27-2186150,68432IL0050007,Ambetter Balanced Care 2 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975083197356707,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0050007-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,12
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,9,68432,IL,Individual,No,27-2186150,68432IL0050007,Ambetter Balanced Care 2 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975083197356707,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0050007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,9,68432,IL,Individual,No,27-2186150,68432IL0050007,Ambetter Balanced Care 2 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975083197356707,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0050007-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,14
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,9,68432,IL,Individual,No,27-2186150,68432IL0050007,Ambetter Balanced Care 2 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975083197356707,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0050007-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,15
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,9,68432,IL,Individual,No,27-2186150,68432IL0050007,Ambetter Balanced Care 2 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975083197356707,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0050007-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,16
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,9,68432,IL,Individual,No,27-2186150,68432IL0050007,Ambetter Balanced Care 2 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975083197356707,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0050007-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,17
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,10,68432,IL,Individual,No,27-2186150,68432IL0020008,Ambetter Balanced Care 1 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975333332383526,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0020008-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,4
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,10,68432,IL,Individual,No,27-2186150,68432IL0020008,Ambetter Balanced Care 1 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975333332383526,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0020008-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,5
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,10,68432,IL,Individual,No,27-2186150,68432IL0020008,Ambetter Balanced Care 1 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975333332383526,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0020008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,10,68432,IL,Individual,No,27-2186150,68432IL0020008,Ambetter Balanced Care 1 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975333332383526,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0020008-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,7
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,10,68432,IL,Individual,No,27-2186150,68432IL0020008,Ambetter Balanced Care 1 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975333332383526,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0020008-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,8
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,10,68432,IL,Individual,No,27-2186150,68432IL0020008,Ambetter Balanced Care 1 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975333332383526,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0020008-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,9
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,10,68432,IL,Individual,No,27-2186150,68432IL0020008,Ambetter Balanced Care 1 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975333332383526,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0020008-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,10
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,10,68432,IL,Individual,No,27-2186150,68432IL0020001,Ambetter Platinum Care 1 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973651709614338,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0020001-00,Standard Platinum Off Exchange Plan,,0.88078773021698,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$120,$10,"$1,010",$150,$350,$90,$260,$80,11
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,10,68432,IL,Individual,No,27-2186150,68432IL0020001,Ambetter Platinum Care 1 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973651709614338,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0020001-01,Standard Platinum On Exchange Plan,,0.88078773021698,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$120,$10,"$1,010",$150,$350,$90,$260,$80,12
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,10,68432,IL,Individual,No,27-2186150,68432IL0020001,Ambetter Platinum Care 1 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973651709614338,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0020001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,10,68432,IL,Individual,No,27-2186150,68432IL0020001,Ambetter Platinum Care 1 Sinai Health Select Network + Vision,68432IL002,,ILN001,ILS001,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973651709614338,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0020001-03,Limited Cost Sharing Plan Variation,,0.88078773021698,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$120,$10,"$1,010",$150,$350,$90,$260,$80,14
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,10,68432,IL,Individual,No,27-2186150,68432IL0050008,Ambetter Balanced Care 1 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975333332383526,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0050008-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,15
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,10,68432,IL,Individual,No,27-2186150,68432IL0050008,Ambetter Balanced Care 1 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975333332383526,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0050008-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,16
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,10,68432,IL,Individual,No,27-2186150,68432IL0050008,Ambetter Balanced Care 1 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975333332383526,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0050008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,17
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,10,68432,IL,Individual,No,27-2186150,68432IL0050008,Ambetter Balanced Care 1 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975333332383526,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0050008-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,18
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,10,68432,IL,Individual,No,27-2186150,68432IL0050008,Ambetter Balanced Care 1 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975333332383526,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0050008-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,19
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,10,68432,IL,Individual,No,27-2186150,68432IL0050008,Ambetter Balanced Care 1 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975333332383526,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0050008-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,20
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,10,68432,IL,Individual,No,27-2186150,68432IL0050008,Ambetter Balanced Care 1 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.975333332383526,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0050008-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,21
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,10,68432,IL,Individual,No,27-2186150,68432IL0050001,Ambetter Platinum Care 1 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973651709614338,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0050001-00,Standard Platinum Off Exchange Plan,,0.88078773021698,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$120,$10,"$1,010",$150,$350,$90,$260,$80,22
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,10,68432,IL,Individual,No,27-2186150,68432IL0050001,Ambetter Platinum Care 1 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973651709614338,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0050001-01,Standard Platinum On Exchange Plan,,0.88078773021698,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$120,$10,"$1,010",$150,$350,$90,$260,$80,23
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,10,68432,IL,Individual,No,27-2186150,68432IL0050001,Ambetter Platinum Care 1 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973651709614338,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0050001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,24
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,10,68432,IL,Individual,No,27-2186150,68432IL0050001,Ambetter Platinum Care 1 Swedish Covenant Select Network + Vision,68432IL005,,ILN002,ILS002,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.973651709614338,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0050001-03,Limited Cost Sharing Plan Variation,,0.88078773021698,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$120,$10,"$1,010",$150,$350,$90,$260,$80,25
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,11,68432,IL,Individual,No,27-2186150,68432IL0030004,Ambetter Balanced Care 3 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939034914365024,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0030004-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,11
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,11,68432,IL,Individual,No,27-2186150,68432IL0030004,Ambetter Balanced Care 3 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939034914365024,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0030004-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,12
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,11,68432,IL,Individual,No,27-2186150,68432IL0030004,Ambetter Balanced Care 3 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939034914365024,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0030004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,11,68432,IL,Individual,No,27-2186150,68432IL0030004,Ambetter Balanced Care 3 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939034914365024,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0030004-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,14
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,11,68432,IL,Individual,No,27-2186150,68432IL0030004,Ambetter Balanced Care 3 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939034914365024,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0030004-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,15
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,11,68432,IL,Individual,No,27-2186150,68432IL0030004,Ambetter Balanced Care 3 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939034914365024,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0030004-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,16
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,11,68432,IL,Individual,No,27-2186150,68432IL0030004,Ambetter Balanced Care 3 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939034914365024,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0030004-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,17
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,11,68432,IL,Individual,No,27-2186150,68432IL0030002,Ambetter Secure Care 2 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935637640217882,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0030002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,18
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,11,68432,IL,Individual,No,27-2186150,68432IL0030002,Ambetter Secure Care 2 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935637640217882,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0030002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,19
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,11,68432,IL,Individual,No,27-2186150,68432IL0030002,Ambetter Secure Care 2 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935637640217882,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0030002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,20
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,11,68432,IL,Individual,No,27-2186150,68432IL0030002,Ambetter Secure Care 2 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935637640217882,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0030002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,21
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,11,68432,IL,Individual,No,27-2186150,68432IL0060004,Ambetter Balanced Care 3 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939034914365024,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0060004-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,29
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,11,68432,IL,Individual,No,27-2186150,68432IL0060004,Ambetter Balanced Care 3 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939034914365024,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0060004-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,30
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,11,68432,IL,Individual,No,27-2186150,68432IL0060004,Ambetter Balanced Care 3 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939034914365024,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0060004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,31
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,11,68432,IL,Individual,No,27-2186150,68432IL0060004,Ambetter Balanced Care 3 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939034914365024,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0060004-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,32
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,11,68432,IL,Individual,No,27-2186150,68432IL0060004,Ambetter Balanced Care 3 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939034914365024,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0060004-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,33
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,11,68432,IL,Individual,No,27-2186150,68432IL0060004,Ambetter Balanced Care 3 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939034914365024,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0060004-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,34
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,11,68432,IL,Individual,No,27-2186150,68432IL0060004,Ambetter Balanced Care 3 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939034914365024,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0060004-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,35
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,11,68432,IL,Individual,No,27-2186150,68432IL0060002,Ambetter Secure Care 2 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935637640217882,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0060002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,36
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,11,68432,IL,Individual,No,27-2186150,68432IL0060002,Ambetter Secure Care 2 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935637640217882,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0060002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,37
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,11,68432,IL,Individual,No,27-2186150,68432IL0060002,Ambetter Secure Care 2 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935637640217882,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0060002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,38
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,11,68432,IL,Individual,No,27-2186150,68432IL0060002,Ambetter Secure Care 2 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF003,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935637640217882,,$350,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0060002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,39
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0030003,Ambetter Secure Care 1 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935637686492016,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0030003-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0030003,Ambetter Secure Care 1 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935637686492016,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0030003-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0030003,Ambetter Secure Care 1 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935637686492016,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0030003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0030003,Ambetter Secure Care 1 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935637686492016,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=SecureCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0030003-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0030009,Ambetter Essential Care 3 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288940373134,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0030009-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0030009,Ambetter Essential Care 3 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288940373134,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0030009-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0030009,Ambetter Essential Care 3 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288940373134,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0030009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0030009,Ambetter Essential Care 3 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288940373134,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare3Sinai,http://marketplace.illinicare.com/formulary,68432IL0030009-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0030010,Ambetter Essential Care 4 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288119752307,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0030010-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0030010,Ambetter Essential Care 4 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288119752307,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0030010-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0030010,Ambetter Essential Care 4 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288119752307,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0030010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0030010,Ambetter Essential Care 4 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288119752307,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0030010-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0030011,Ambetter Essential Care 2 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288940373134,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0030011-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0030011,Ambetter Essential Care 2 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288940373134,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0030011-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0030011,Ambetter Essential Care 2 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288940373134,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0030011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0030011,Ambetter Essential Care 2 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288940373134,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0030011-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0030012,Ambetter Essential Care 1 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288803577025,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0030012-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0030012,Ambetter Essential Care 1 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288803577025,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0030012-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0030012,Ambetter Essential Care 1 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288803577025,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0030012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0030012,Ambetter Essential Care 1 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288803577025,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=EssentialCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0030012-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0060003,Ambetter Secure Care 1 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935637686492016,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0060003-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,24
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0060003,Ambetter Secure Care 1 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935637686492016,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0060003-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,25
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0060003,Ambetter Secure Care 1 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935637686492016,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0060003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,26
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0060003,Ambetter Secure Care 1 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF004,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935637686492016,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=SecureCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0060003-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,27
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0060009,Ambetter Essential Care 3 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288940373134,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0060009-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,28
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0060009,Ambetter Essential Care 3 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288940373134,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0060009-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,29
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0060009,Ambetter Essential Care 3 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288940373134,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0060009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,30
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0060009,Ambetter Essential Care 3 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288940373134,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare3Swedish,http://marketplace.illinicare.com/formulary,68432IL0060009-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,31
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0060010,Ambetter Essential Care 4 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288119752307,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0060010-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,32
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0060010,Ambetter Essential Care 4 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288119752307,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0060010-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,33
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0060010,Ambetter Essential Care 4 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288119752307,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0060010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,34
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0060010,Ambetter Essential Care 4 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF006,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288119752307,,$350,0,3,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0060010-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,35
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0060011,Ambetter Essential Care 2 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288940373134,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0060011-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,36
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0060011,Ambetter Essential Care 2 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288940373134,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0060011-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,37
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0060011,Ambetter Essential Care 2 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288940373134,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0060011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,38
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0060011,Ambetter Essential Care 2 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF007,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288940373134,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare2Swedish,http://marketplace.illinicare.com/formulary,68432IL0060011-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,39
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0060012,Ambetter Essential Care 1 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288803577025,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0060012-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,40
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0060012,Ambetter Essential Care 1 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288803577025,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0060012-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,41
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0060012,Ambetter Essential Care 1 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288803577025,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0060012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,42
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,12,68432,IL,Individual,No,27-2186150,68432IL0060012,Ambetter Essential Care 1 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF008,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.937288803577025,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=EssentialCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0060012-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,43
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,13,68432,IL,Individual,No,27-2186150,68432IL0030005,Ambetter Balanced Care 4 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.938288438563073,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0030005-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,4
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,13,68432,IL,Individual,No,27-2186150,68432IL0030005,Ambetter Balanced Care 4 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.938288438563073,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0030005-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,5
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,13,68432,IL,Individual,No,27-2186150,68432IL0030005,Ambetter Balanced Care 4 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.938288438563073,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0030005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,13,68432,IL,Individual,No,27-2186150,68432IL0030005,Ambetter Balanced Care 4 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.938288438563073,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0030005-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,7
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,13,68432,IL,Individual,No,27-2186150,68432IL0030005,Ambetter Balanced Care 4 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.938288438563073,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0030005-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,8
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,13,68432,IL,Individual,No,27-2186150,68432IL0030005,Ambetter Balanced Care 4 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.938288438563073,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0030005-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,9
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,13,68432,IL,Individual,No,27-2186150,68432IL0030005,Ambetter Balanced Care 4 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.938288438563073,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare4Sinai,http://marketplace.illinicare.com/formulary,68432IL0030005-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,10
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,13,68432,IL,Individual,No,27-2186150,68432IL0060005,Ambetter Balanced Care 4 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.938288438563073,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0060005-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,11
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,13,68432,IL,Individual,No,27-2186150,68432IL0060005,Ambetter Balanced Care 4 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.938288438563073,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0060005-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,12
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,13,68432,IL,Individual,No,27-2186150,68432IL0060005,Ambetter Balanced Care 4 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.938288438563073,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0060005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,13,68432,IL,Individual,No,27-2186150,68432IL0060005,Ambetter Balanced Care 4 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.938288438563073,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0060005-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,14
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,13,68432,IL,Individual,No,27-2186150,68432IL0060005,Ambetter Balanced Care 4 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.938288438563073,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0060005-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,15
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,13,68432,IL,Individual,No,27-2186150,68432IL0060005,Ambetter Balanced Care 4 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.938288438563073,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0060005-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,16
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,13,68432,IL,Individual,No,27-2186150,68432IL0060005,Ambetter Balanced Care 4 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF009,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.938288438563073,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare4Swedish,http://marketplace.illinicare.com/formulary,68432IL0060005-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,17
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,14,68432,IL,Individual,No,27-2186150,68432IL0030007,Ambetter Balanced Care 2 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939065937059043,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0030007-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,4
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,14,68432,IL,Individual,No,27-2186150,68432IL0030007,Ambetter Balanced Care 2 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939065937059043,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0030007-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,5
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,14,68432,IL,Individual,No,27-2186150,68432IL0030007,Ambetter Balanced Care 2 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939065937059043,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0030007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,14,68432,IL,Individual,No,27-2186150,68432IL0030007,Ambetter Balanced Care 2 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939065937059043,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0030007-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,7
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,14,68432,IL,Individual,No,27-2186150,68432IL0030007,Ambetter Balanced Care 2 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939065937059043,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0030007-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,8
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,14,68432,IL,Individual,No,27-2186150,68432IL0030007,Ambetter Balanced Care 2 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939065937059043,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0030007-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,9
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,14,68432,IL,Individual,No,27-2186150,68432IL0030007,Ambetter Balanced Care 2 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939065937059043,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare2Sinai,http://marketplace.illinicare.com/formulary,68432IL0030007-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,10
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,14,68432,IL,Individual,No,27-2186150,68432IL0060007,Ambetter Balanced Care 2 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939065937059043,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare5Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare5Swedish,http://marketplace.illinicare.com/formulary,68432IL0060007-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,11
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,14,68432,IL,Individual,No,27-2186150,68432IL0060007,Ambetter Balanced Care 2 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939065937059043,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare5Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare5Swedish,http://marketplace.illinicare.com/formulary,68432IL0060007-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,12
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,14,68432,IL,Individual,No,27-2186150,68432IL0060007,Ambetter Balanced Care 2 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939065937059043,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare5Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare5Swedish,http://marketplace.illinicare.com/formulary,68432IL0060007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,14,68432,IL,Individual,No,27-2186150,68432IL0060007,Ambetter Balanced Care 2 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939065937059043,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare5Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare5Swedish,http://marketplace.illinicare.com/formulary,68432IL0060007-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,14
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,14,68432,IL,Individual,No,27-2186150,68432IL0060007,Ambetter Balanced Care 2 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939065937059043,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare5Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare5Swedish,http://marketplace.illinicare.com/formulary,68432IL0060007-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,15
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,14,68432,IL,Individual,No,27-2186150,68432IL0060007,Ambetter Balanced Care 2 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939065937059043,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare5Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare5Swedish,http://marketplace.illinicare.com/formulary,68432IL0060007-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,16
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,14,68432,IL,Individual,No,27-2186150,68432IL0060007,Ambetter Balanced Care 2 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF010,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939065937059043,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare5Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare5Swedish,http://marketplace.illinicare.com/formulary,68432IL0060007-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,17
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,15,68432,IL,Individual,No,27-2186150,68432IL0030008,Ambetter Balanced Care 1 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939662630411842,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0030008-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,4
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,15,68432,IL,Individual,No,27-2186150,68432IL0030008,Ambetter Balanced Care 1 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939662630411842,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0030008-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,5
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,15,68432,IL,Individual,No,27-2186150,68432IL0030008,Ambetter Balanced Care 1 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939662630411842,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0030008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,15,68432,IL,Individual,No,27-2186150,68432IL0030008,Ambetter Balanced Care 1 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939662630411842,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0030008-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,7
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,15,68432,IL,Individual,No,27-2186150,68432IL0030008,Ambetter Balanced Care 1 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939662630411842,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0030008-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,8
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,15,68432,IL,Individual,No,27-2186150,68432IL0030008,Ambetter Balanced Care 1 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939662630411842,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0030008-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,9
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,15,68432,IL,Individual,No,27-2186150,68432IL0030008,Ambetter Balanced Care 1 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939662630411842,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=BalancedCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0030008-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,10
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,15,68432,IL,Individual,No,27-2186150,68432IL0030001,Ambetter Platinum Care 1 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935612573882728,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0030001-00,Standard Platinum Off Exchange Plan,,0.88078773021698,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$120,$10,"$1,010",$150,$350,$90,$260,$80,11
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,15,68432,IL,Individual,No,27-2186150,68432IL0030001,Ambetter Platinum Care 1 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935612573882728,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0030001-01,Standard Platinum On Exchange Plan,,0.88078773021698,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$120,$10,"$1,010",$150,$350,$90,$260,$80,12
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,15,68432,IL,Individual,No,27-2186150,68432IL0030001,Ambetter Platinum Care 1 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935612573882728,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0030001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,15,68432,IL,Individual,No,27-2186150,68432IL0030001,Ambetter Platinum Care 1 Sinai Health Select Network + Vision + Adult Dental,68432IL003,,ILN001,ILS001,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935612573882728,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-sinai/?plan=PlatinumCare1Sinai,http://marketplace.illinicare.com/formulary,68432IL0030001-03,Limited Cost Sharing Plan Variation,,0.88078773021698,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$120,$10,"$1,010",$150,$350,$90,$260,$80,14
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,15,68432,IL,Individual,No,27-2186150,68432IL0060008,Ambetter Balanced Care 1 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939662630411842,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0060008-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,15
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,15,68432,IL,Individual,No,27-2186150,68432IL0060008,Ambetter Balanced Care 1 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939662630411842,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0060008-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,16
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,15,68432,IL,Individual,No,27-2186150,68432IL0060008,Ambetter Balanced Care 1 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939662630411842,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0060008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,17
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,15,68432,IL,Individual,No,27-2186150,68432IL0060008,Ambetter Balanced Care 1 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939662630411842,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0060008-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,18
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,15,68432,IL,Individual,No,27-2186150,68432IL0060008,Ambetter Balanced Care 1 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939662630411842,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0060008-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,19
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,15,68432,IL,Individual,No,27-2186150,68432IL0060008,Ambetter Balanced Care 1 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939662630411842,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0060008-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,20
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,15,68432,IL,Individual,No,27-2186150,68432IL0060008,Ambetter Balanced Care 1 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF011,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.939662630411842,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=BalancedCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0060008-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,21
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,15,68432,IL,Individual,No,27-2186150,68432IL0060001,Ambetter Platinum Care 1 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935612573882728,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0060001-00,Standard Platinum Off Exchange Plan,,0.88078773021698,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$120,$10,"$1,010",$150,$350,$90,$260,$80,22
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,15,68432,IL,Individual,No,27-2186150,68432IL0060001,Ambetter Platinum Care 1 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935612573882728,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0060001-01,Standard Platinum On Exchange Plan,,0.88078773021698,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$120,$10,"$1,010",$150,$350,$90,$260,$80,23
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,15,68432,IL,Individual,No,27-2186150,68432IL0060001,Ambetter Platinum Care 1 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935612573882728,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0060001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,24
2015,IL,68432,SERFF,6,2015-02-22 21:18:17,15,68432,IL,Individual,No,27-2186150,68432IL0060001,Ambetter Platinum Care 1 Swedish Covenant Select Network + Vision + Adult Dental,68432IL006,,ILN002,ILS002,ILF012,New,HMO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,0.935612573882728,,,0,0,0,2015-01-01,,No,,No,,No,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/payments,http://marketplace.illinicare.com/brochures-swedish/?plan=PlatinumCare1Swedish,http://marketplace.illinicare.com/formulary,68432IL0060001-03,Limited Cost Sharing Plan Variation,,0.88078773021698,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$120,$10,"$1,010",$150,$350,$90,$260,$80,25
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,2,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0720001,Land of Lincoln  Freedom PPO Gold,79763IL072,,ILN002,ILS003,ILF002,New,PPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $6000 deductible; MOOP is unlmited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-072G-SBC-Freedom.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0720001-01,Standard Gold On Exchange Plan,78.13%,0.764799892902374,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",25%,$500,"$1,000",25%,"$6,000","$12,000","$6,500","$13,000",,,,,,,,,5
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,2,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0720002,Land of Lincoln Freedom PPO Silver,79763IL072,,ILN002,ILS003,ILF014,New,PPO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $10000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-072S-SBC-Freedom.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0720002-00,Standard Silver Off Exchange Plan,68.17%,0.621329843997955,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$2,500","$5,000",30%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,6
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,2,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0720002,Land of Lincoln Freedom PPO Silver,79763IL072,,ILN002,ILS003,ILF014,New,PPO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $10000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-072S-SBC-Freedom.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0720002-01,Standard Silver On Exchange Plan,68.17%,0.621329843997955,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$2,500","$5,000",30%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,7
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,3,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0720003,Land of Lincoln  Freedom PPO Bronze,79763IL072,,ILN002,ILS003,ILF004,New,PPO,Bronze,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $15000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-072B-SBC-Freedom.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0720003-00,Standard Bronze Off Exchange Plan,,0.599202156066895,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,500","$13,000","$6,500","$13,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,"$5,500","$11,000",50%,"$15,000","$30,000","$20,500","$41,000",,,,,,,,,4
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,3,79763,IL,Individual,No,90-0962741,79763IL0690001,Land of Lincoln Freedom PPO Gold,79763IL069,,ILN002,ILS003,ILF002,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-069G-SBC-Freedom.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0690001-00,Standard Gold Off Exchange Plan,78.13%,0.76572197675705,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",25%,$500,"$1,000",25%,"$6,000","$12,000","$6,500","$13,000",,,,,,,,,4
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,3,79763,IL,Individual,No,90-0962741,79763IL0690001,Land of Lincoln Freedom PPO Gold,79763IL069,,ILN002,ILS003,ILF002,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-069G-SBC-Freedom.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0690001-01,Standard Gold On Exchange Plan,78.13%,0.76572197675705,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",25%,$500,"$1,000",25%,"$6,000","$12,000","$6,500","$13,000",,,,,,,,,5
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,3,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0720003,Land of Lincoln  Freedom PPO Bronze,79763IL072,,ILN002,ILS003,ILF004,New,PPO,Bronze,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $15000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-072B-SBC-Freedom.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0720003-01,Standard Bronze On Exchange Plan,,0.599202156066895,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,500","$13,000","$6,500","$13,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,"$5,500","$11,000",50%,"$15,000","$30,000","$20,500","$41,000",,,,,,,,,5
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,3,79763,IL,Individual,No,90-0962741,79763IL0690001,Land of Lincoln Freedom PPO Gold,79763IL069,,ILN002,ILS003,ILF002,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-069G-SBC-Freedom.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0690001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,3,79763,IL,Individual,No,90-0962741,79763IL0690001,Land of Lincoln Freedom PPO Gold,79763IL069,,ILN002,ILS003,ILF002,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-069G-SBC-Freedom.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0690001-03,Limited Cost Sharing Plan Variation,78.13%,0.76572197675705,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",25%,$500,"$1,000",25%,"$6,000","$12,000","$6,500","$13,000",,,,,,,,,7
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,3,79763,IL,Individual,No,90-0962741,79763IL0690002,Land of Lincoln Freedom PPO Silver,79763IL069,,ILN002,ILS003,ILF014,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-069S-SBC-Freedom.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0690002-00,Standard Silver Off Exchange Plan,68.03%,0.599788963794708,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,200","$12,400","$6,200","$12,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500",30%,"$4,250","$8,500",30%,"$10,000","$20,000","$14,250","$28,500",,,,,,,,,8
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,3,79763,IL,Individual,No,90-0962741,79763IL0690002,Land of Lincoln Freedom PPO Silver,79763IL069,,ILN002,ILS003,ILF014,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-069S-SBC-Freedom.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0690002-01,Standard Silver On Exchange Plan,68.03%,0.599788963794708,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,200","$12,400","$6,200","$12,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500",30%,"$4,250","$8,500",30%,"$10,000","$20,000","$14,250","$28,500",,,,,,,,,9
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,3,79763,IL,Individual,No,90-0962741,79763IL0690002,Land of Lincoln Freedom PPO Silver,79763IL069,,ILN002,ILS003,ILF014,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-069S-SBC-Freedom.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0690002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,10
2015,IL,75159,SERFF,1,2014-08-09 13:12:30,1,75159,IL,SHOP (Small Group),Yes,47-0098400,75159IL0040002,EHB High PPO,75159IL004,,ILN001,ILS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.10,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,75159IL0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,75159,SERFF,1,2014-08-09 13:12:30,1,75159,IL,SHOP (Small Group),Yes,47-0098400,75159IL0040001,EHB Low PPO,75159IL004,,ILN001,ILS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.50,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,75159IL0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,75159,SERFF,1,2014-08-09 13:12:30,1,75159,IL,SHOP (Small Group),Yes,47-0098400,75159IL0030002,EHB High Passive,75159IL003,,ILN001,ILS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$43.47,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,75159IL0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,5,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0420001,SBAC Land of Lincoln Gold 2000 HSA,79763IL042,,ILN001,ILS001,ILF001,New,PPO,Gold,No,Both,Yes,No,,,,Yes,Yes,"$1,000.00",Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $6000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-042G-SBC-SBAC2000HSA.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-SBAC.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0420001-00,Standard Gold Off Exchange Plan,,0.809960782527924,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,4
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,5,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0420001,SBAC Land of Lincoln Gold 2000 HSA,79763IL042,,ILN001,ILS001,ILF001,New,PPO,Gold,No,Both,Yes,No,,,,Yes,Yes,"$1,000.00",Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $6000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-042G-SBC-SBAC2000HSA.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-SBAC.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0420001-01,Standard Gold On Exchange Plan,,0.809960782527924,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,5
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,5,79763,IL,Individual,No,90-0962741,79763IL0430004,Swedish Covenant Land of Lincoln Platinum,79763IL043,,ILN005,ILS002,ILF011,New,PPO,Platinum,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-043P-SBC-Swedish.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Swedish.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0430004-01,Standard Platinum On Exchange Plan,88.39%,0.883317410945892,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,40%,"$5,000","$10,000",$0,$0,,,,,,,,,5
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,5,79763,IL,Individual,No,90-0962741,79763IL0430004,Swedish Covenant Land of Lincoln Platinum,79763IL043,,ILN005,ILS002,ILF011,New,PPO,Platinum,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-043P-SBC-Swedish.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Swedish.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0430004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,5,79763,IL,Individual,No,90-0962741,79763IL0430004,Swedish Covenant Land of Lincoln Platinum,79763IL043,,ILN005,ILS002,ILF011,New,PPO,Platinum,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-043P-SBC-Swedish.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Swedish.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0430004-03,Limited Cost Sharing Plan Variation,88.39%,0.883317410945892,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,40%,"$5,000","$10,000",$0,$0,,,,,,,,,7
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,5,79763,IL,Individual,No,90-0962741,79763IL0430001,Swedish Covenant Land of Lincoln Gold,79763IL043,,ILN005,ILS002,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-043G-SBC-Swedish.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Swedish.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0430001-00,Standard Gold Off Exchange Plan,78.48%,0.771818518638611,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,20%,$400,$800,40%,"$6,000","$12,000","$6,400","$12,800",,,,,,,,,8
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,5,79763,IL,Individual,No,90-0962741,79763IL0430001,Swedish Covenant Land of Lincoln Gold,79763IL043,,ILN005,ILS002,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-043G-SBC-Swedish.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Swedish.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0430001-01,Standard Gold On Exchange Plan,78.48%,0.771818518638611,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,20%,$400,$800,40%,"$6,000","$12,000","$6,400","$12,800",,,,,,,,,9
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,5,79763,IL,Individual,No,90-0962741,79763IL0430001,Swedish Covenant Land of Lincoln Gold,79763IL043,,ILN005,ILS002,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-043G-SBC-Swedish.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Swedish.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0430001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,10
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,5,79763,IL,Individual,No,90-0962741,79763IL0430001,Swedish Covenant Land of Lincoln Gold,79763IL043,,ILN005,ILS002,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-043G-SBC-Swedish.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Swedish.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0430001-03,Limited Cost Sharing Plan Variation,78.48%,0.771818518638611,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,20%,$400,$800,40%,"$6,000","$12,000","$6,400","$12,800",,,,,,,,,11
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,5,79763,IL,Individual,No,90-0962741,79763IL0430002,Swedish Covenant Land of Lincoln Silver,79763IL043,,ILN005,ILS002,ILF010,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-043S-SBC-Swedish.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Swedish.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0430002-00,Standard Silver Off Exchange Plan,68.73%,0.625396847724915,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,"$2,500","$5,000",45%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,12
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,8,79763,IL,Individual,No,90-0962741,79763IL0460002,Presence Health Land of Lincoln Silver PPO,79763IL046,,ILN010,ILS004,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-046S-SBC-Presence.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Presence.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0460002-01,Standard Silver On Exchange Plan,68.67%,0.613909184932709,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,"$3,000","$6,000",45%,"$10,000","$20,000","$13,000","$26,000",,,,,,,,,13
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,8,79763,IL,Individual,No,90-0962741,79763IL0460002,Presence Health Land of Lincoln Silver PPO,79763IL046,,ILN010,ILS004,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-046S-SBC-Presence.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Presence.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0460002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,14
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,8,79763,IL,Individual,No,90-0962741,79763IL0460002,Presence Health Land of Lincoln Silver PPO,79763IL046,,ILN010,ILS004,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-046S-SBC-Presence.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Presence.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0460002-03,Limited Cost Sharing Plan Variation,68.67%,0.613909184932709,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,"$3,000","$6,000",45%,"$10,000","$20,000","$13,000","$26,000",,,,,,,,,15
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,8,79763,IL,Individual,No,90-0962741,79763IL0460002,Presence Health Land of Lincoln Silver PPO,79763IL046,,ILN010,ILS004,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-046S-SBC-Presence.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Presence.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0460002-04,73% AV Level Silver Plan,73.81%,0.700685143470764,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300",20%,"$1,150","$2,300",45%,"$10,000","$20,000","$11,150","$22,300",,,,,,,,,16
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,5,79763,IL,Individual,No,90-0962741,79763IL0430002,Swedish Covenant Land of Lincoln Silver,79763IL043,,ILN005,ILS002,ILF010,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-043S-SBC-Swedish.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Swedish.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0430002-05,87% AV Level Silver Plan,87.06%,0.869890809059143,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,$100,$200,40%,"$10,000","$20,000","$10,100","$20,200",,,,,,,,,17
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,5,79763,IL,Individual,No,90-0962741,79763IL0430002,Swedish Covenant Land of Lincoln Silver,79763IL043,,ILN005,ILS002,ILF010,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-043S-SBC-Swedish.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Swedish.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0430002-06,94% AV Level Silver Plan,93.77%,0.937750101089478,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$700,"$1,400",$700,"$1,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,40%,"$10,000","$20,000",$0,$0,,,,,,,,,18
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,9,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0580001,Presence Health Land of Lincoln Gold PPO,79763IL058,,ILN010,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $6000 deductible; MOOP in unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-058G-SBC-Presence.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Presence.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0580001-01,Standard Gold On Exchange Plan,78.46%,0.771402299404144,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,20%,$400,$800,40%,"$6,000","$12,000","$6,400","$12,800",,,,,,,,,7
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,9,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0580002,Presence Health Land of Lincoln Silver PPO,79763IL058,,ILN010,ILS004,ILF016,New,PPO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $10000 deductible; MOOP in unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-058S-SBC-Presence.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Presence.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0580002-00,Standard Silver Off Exchange Plan,68.79%,0.627526938915253,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",25%,"$2,500","$5,000",50%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,8
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,9,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0580002,Presence Health Land of Lincoln Silver PPO,79763IL058,,ILN010,ILS004,ILF016,New,PPO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $10000 deductible; MOOP in unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-058S-SBC-Presence.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Presence.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0580002-01,Standard Silver On Exchange Plan,68.79%,0.627526938915253,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",25%,"$2,500","$5,000",50%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,9
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,10,79763,IL,Individual,No,90-0962741,79763IL0480004,Centegra Land of Lincoln Health Plan - Platinum,79763IL048,,ILN008,ILS007,ILF012,New,PPO,Platinum,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-048P-SBC-Centegra.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Centegra.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0480004-00,Standard Platinum Off Exchange Plan,88.28%,0.87568998336792,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,500","$5,000","$2,500","$5,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,$250,$500,30%,"$5,000","$10,000","$5,250","$10,500",,,,,,,,,4
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,10,79763,IL,Individual,No,90-0962741,79763IL0480004,Centegra Land of Lincoln Health Plan - Platinum,79763IL048,,ILN008,ILS007,ILF012,New,PPO,Platinum,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-048P-SBC-Centegra.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Centegra.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0480004-01,Standard Platinum On Exchange Plan,88.28%,0.87568998336792,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,500","$5,000","$2,500","$5,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,$250,$500,30%,"$5,000","$10,000","$5,250","$10,500",,,,,,,,,5
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,6,79763,IL,Individual,No,90-0962741,79763IL0440004,Land of Lincoln Champion PPO Platinum,79763IL044,,ILN006,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-044P-SBC-Champion.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Champion.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0440004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,6,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0550001,Swedish Covenant Land of Lincoln Gold,79763IL055,,ILN005,ILS002,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $6000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-055G-SBC-Swedish.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Swedish.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0550001-00,Standard Gold Off Exchange Plan,78.48%,0.771818518638611,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,20%,$400,$800,40%,"$6,000","$12,000","$6,400","$12,800",,,,,,,,,6
2015,IL,75159,SERFF,1,2014-08-09 13:12:30,1,75159,IL,SHOP (Small Group),Yes,47-0098400,75159IL0030001,EHB Low Passive,75159IL003,,ILN001,ILS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.97,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,75159IL0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IL,77956,SERFF,2,2014-09-09 16:12:42,1,77956,IL,SHOP (Small Group),Yes,41-0808596,77956IL0010001,"Plan 1. Passive PPO, $1000 Annual Maximum, Ortho",77956IL001,,ILN001,ILS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,77956IL0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,77956,SERFF,2,2014-09-09 16:12:42,1,77956,IL,SHOP (Small Group),Yes,41-0808596,77956IL0010002,"Plan 2.  Passive PPO Graded Plan, $1500 Annual Maximum, Ortho",77956IL001,,ILN001,ILS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,77956IL0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,77956,SERFF,2,2014-09-09 16:12:42,1,77956,IL,SHOP (Small Group),Yes,41-0808596,77956IL0010003,"Plan 3. MAC PPO, $1000 Annual Maximum, No Ortho",77956IL001,,ILN001,ILS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,77956IL0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,1,79763,IL,Individual,No,90-0962741,79763IL0670001,Land of Lincoln Preferred PPO Gold,79763IL067,,ILN001,ILS001,ILF001,New,PPO,Gold,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-067G-SBC-Preferred.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0670001-00,Standard Gold Off Exchange Plan,,0.78083473443985,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,550","$5,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",20%,,,,"$5,000","$10,000","$6,350","$12,700",,,,,,,,,4
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,1,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0700001,Land of Lincoln Preferred PPO Gold,79763IL070,,ILN001,ILS001,ILF001,New,PPO,Gold,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-070G-SBC-Preferred.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0700001-00,Standard Gold Off Exchange Plan,,0.78083473443985,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,550","$5,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",20%,,,,"$5,000","$10,000","$6,350","$12,700",,,,,,,,,4
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,1,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0700001,Land of Lincoln Preferred PPO Gold,79763IL070,,ILN001,ILS001,ILF001,New,PPO,Gold,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-070G-SBC-Preferred.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0700001-01,Standard Gold On Exchange Plan,,0.78083473443985,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,550","$5,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",20%,,,,"$5,000","$10,000","$6,350","$12,700",,,,,,,,,5
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,1,79763,IL,Individual,No,90-0962741,79763IL0670001,Land of Lincoln Preferred PPO Gold,79763IL067,,ILN001,ILS001,ILF001,New,PPO,Gold,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-067G-SBC-Preferred.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0670001-01,Standard Gold On Exchange Plan,,0.78083473443985,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,550","$5,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",20%,,,,"$5,000","$10,000","$6,350","$12,700",,,,,,,,,5
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,1,79763,IL,Individual,No,90-0962741,79763IL0670001,Land of Lincoln Preferred PPO Gold,79763IL067,,ILN001,ILS001,ILF001,New,PPO,Gold,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-067G-SBC-Preferred.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0670001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,1,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0700002,Land of Lincoln  Preferred PPO Silver,79763IL070,,ILN001,ILS001,ILF003,New,PPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $8000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-070S-SBC-Preferred.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0700002-00,Standard Silver Off Exchange Plan,,0.681234121322632,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$8,000","$16,000","$9,500","$19,000",,,,,,,,,6
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,1,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0700002,Land of Lincoln  Preferred PPO Silver,79763IL070,,ILN001,ILS001,ILF003,New,PPO,Silver,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $8000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-070S-SBC-Preferred.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0700002-01,Standard Silver On Exchange Plan,,0.681234121322632,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$8,000","$16,000","$9,500","$19,000",,,,,,,,,7
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,1,79763,IL,Individual,No,90-0962741,79763IL0670001,Land of Lincoln Preferred PPO Gold,79763IL067,,ILN001,ILS001,ILF001,New,PPO,Gold,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-067G-SBC-Preferred.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0670001-03,Limited Cost Sharing Plan Variation,,0.78083473443985,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,550","$5,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700",20%,,,,"$5,000","$10,000","$6,350","$12,700",,,,,,,,,7
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,1,79763,IL,Individual,No,90-0962741,79763IL0670002,Land of Lincoln Preferred PPO Silver,79763IL067,,ILN001,ILS001,ILF003,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $8000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-067S-SBC-Preferred.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0670002-00,Standard Silver Off Exchange Plan,,0.681234121322632,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$8,000","$16,000","$9,500","$19,000",,,,,,,,,8
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,1,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0700003,Land of Lincoln Preferred PPO Bronze,79763IL070,,ILN001,ILS001,ILF021,New,PPO,Bronze,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $12000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-070B-SBC-Preferred.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0700003-00,Standard Bronze Off Exchange Plan,,0.590558171272278,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,8
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,1,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0700003,Land of Lincoln Preferred PPO Bronze,79763IL070,,ILN001,ILS001,ILF021,New,PPO,Bronze,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $12000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-070B-SBC-Preferred.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0700003-01,Standard Bronze On Exchange Plan,,0.590558171272278,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,9
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,7,79763,IL,Individual,No,90-0962741,79763IL0450004,Illinois Health Partners Land of Lincoln Platinum,79763IL045,,ILN004,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-045P-SBC-IHP.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-IHP.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0450004-00,Standard Platinum Off Exchange Plan,,0.884297609329224,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,40%,"$5,000","$10,000",$0,$0,,,,,,,,,4
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,7,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0560004,Land of Lincoln  Champion PPO Platinum,79763IL056,,ILN006,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $5000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-056P-SBC-Champion.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Champion.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0560004-00,Standard Platinum Off Exchange Plan,,0.883790910243988,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,40%,"$5,000","$10,000",$0,$0,,,,,,,,,4
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,7,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0560004,Land of Lincoln  Champion PPO Platinum,79763IL056,,ILN006,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $5000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-056P-SBC-Champion.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Champion.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0560004-01,Standard Platinum On Exchange Plan,,0.883790910243988,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,40%,"$5,000","$10,000",$0,$0,,,,,,,,,5
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,7,79763,IL,Individual,No,90-0962741,79763IL0450004,Illinois Health Partners Land of Lincoln Platinum,79763IL045,,ILN004,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-045P-SBC-IHP.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-IHP.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0450004-01,Standard Platinum On Exchange Plan,,0.884297609329224,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,40%,"$5,000","$10,000",$0,$0,,,,,,,,,5
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,7,79763,IL,Individual,No,90-0962741,79763IL0450004,Illinois Health Partners Land of Lincoln Platinum,79763IL045,,ILN004,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-045P-SBC-IHP.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-IHP.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0450004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,7,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0560001,Land of Lincoln Champion PPO Gold,79763IL056,,ILN006,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $6000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-056G-SBC-Champion.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Champion.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0560001-00,Standard Gold Off Exchange Plan,78.46%,0.771381437778473,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,800","$9,600","$4,800","$9,600",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,20%,$400,$800,40%,"$6,000","$12,000","$6,400","$12,800",,,,,,,,,6
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,1,79763,IL,Individual,No,90-0962741,79763IL0670002,Land of Lincoln Preferred PPO Silver,79763IL067,,ILN001,ILS001,ILF003,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $8000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-067S-SBC-Preferred.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0670002-01,Standard Silver On Exchange Plan,,0.681234121322632,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$8,000","$16,000","$9,500","$19,000",,,,,,,,,9
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,1,79763,IL,Individual,No,90-0962741,79763IL0670002,Land of Lincoln Preferred PPO Silver,79763IL067,,ILN001,ILS001,ILF003,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $8000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-067S-SBC-Preferred.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0670002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,1,79763,IL,Individual,No,90-0962741,79763IL0670002,Land of Lincoln Preferred PPO Silver,79763IL067,,ILN001,ILS001,ILF003,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $8000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-067S-SBC-Preferred.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0670002-03,Limited Cost Sharing Plan Variation,,0.681234121322632,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$8,000","$16,000","$9,500","$19,000",,,,,,,,,11
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,1,79763,IL,Individual,No,90-0962741,79763IL0670002,Land of Lincoln Preferred PPO Silver,79763IL067,,ILN001,ILS001,ILF003,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $8000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-067S-SBC-Preferred.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0670002-04,73% AV Level Silver Plan,,0.737859785556793,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$800,"$1,600",30%,,,,"$8,000","$16,000","$8,800","$17,600",,,,,,,,,12
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,1,79763,IL,Individual,No,90-0962741,79763IL0670002,Land of Lincoln Preferred PPO Silver,79763IL067,,ILN001,ILS001,ILF003,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $8000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-067S-SBC-Preferred.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0670002-05,87% AV Level Silver Plan,,0.878732919692993,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$8,000","$16,000",$0,$0,,,,,,,,,13
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,1,79763,IL,Individual,No,90-0962741,79763IL0670002,Land of Lincoln Preferred PPO Silver,79763IL067,,ILN001,ILS001,ILF003,New,PPO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $8000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-067S-SBC-Preferred.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0670002-06,94% AV Level Silver Plan,,0.948965549468994,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$850,"$1,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$8,000","$16,000",$0,$0,,,,,,,,,14
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,1,79763,IL,Individual,No,90-0962741,79763IL0670003,Land of Lincoln Preferred PPO Bronze,79763IL067,,ILN001,ILS001,ILF004,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $12000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-067B-SBC-Preferred.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0670003-00,Standard Bronze Off Exchange Plan,,0.59501326084137,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,15
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,1,79763,IL,Individual,No,90-0962741,79763IL0670003,Land of Lincoln Preferred PPO Bronze,79763IL067,,ILN001,ILS001,ILF004,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $12000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-067B-SBC-Preferred.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0670003-01,Standard Bronze On Exchange Plan,,0.59501326084137,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,16
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,1,79763,IL,Individual,No,90-0962741,79763IL0670003,Land of Lincoln Preferred PPO Bronze,79763IL067,,ILN001,ILS001,ILF004,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $12000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-067B-SBC-Preferred.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0670003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,17
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,1,79763,IL,Individual,No,90-0962741,79763IL0670003,Land of Lincoln Preferred PPO Bronze,79763IL067,,ILN001,ILS001,ILF004,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $12000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-067B-SBC-Preferred.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0670003-03,Limited Cost Sharing Plan Variation,,0.59501326084137,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,18
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,2,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0720001,Land of Lincoln  Freedom PPO Gold,79763IL072,,ILN002,ILS003,ILF002,New,PPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $6000 deductible; MOOP is unlmited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-072G-SBC-Freedom.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0720001-00,Standard Gold Off Exchange Plan,78.13%,0.764799892902374,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",25%,$500,"$1,000",25%,"$6,000","$12,000","$6,500","$13,000",,,,,,,,,4
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,3,79763,IL,Individual,No,90-0962741,79763IL0690002,Land of Lincoln Freedom PPO Silver,79763IL069,,ILN002,ILS003,ILF014,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-069S-SBC-Freedom.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0690002-03,Limited Cost Sharing Plan Variation,68.03%,0.599788963794708,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,200","$12,400","$6,200","$12,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500",30%,"$4,250","$8,500",30%,"$10,000","$20,000","$14,250","$28,500",,,,,,,,,11
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,3,79763,IL,Individual,No,90-0962741,79763IL0690002,Land of Lincoln Freedom PPO Silver,79763IL069,,ILN002,ILS003,ILF014,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-069S-SBC-Freedom.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0690002-04,73% AV Level Silver Plan,73.87%,0.713276863098145,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",30%,$750,"$1,500",30%,"$10,000","$20,000","$10,750","$21,500",,,,,,,,,12
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,3,79763,IL,Individual,No,90-0962741,79763IL0690002,Land of Lincoln Freedom PPO Silver,79763IL069,,ILN002,ILS003,ILF014,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-069S-SBC-Freedom.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0690002-05,87% AV Level Silver Plan,88.00%,0.876851618289948,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,10%,"$10,000","$20,000",$0,$0,,,,,,,,,13
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,3,79763,IL,Individual,No,90-0962741,79763IL0690002,Land of Lincoln Freedom PPO Silver,79763IL069,,ILN002,ILS003,ILF014,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-069S-SBC-Freedom.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0690002-06,94% AV Level Silver Plan,93.63%,0.936027765274048,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$600,"$1,200",$600,"$1,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,10%,"$10,000","$20,000",$0,$0,,,,,,,,,14
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,4,79763,IL,Individual,No,90-0962741,79763IL0690003,Land of Lincoln Freedom PPO Bronze,79763IL069,,ILN002,ILS003,ILF004,New,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $15,000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-069B-SBC-Freedom.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0690003-00,Standard Bronze Off Exchange Plan,59.75%,0.599181890487671,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,500","$13,000","$6,500","$13,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,"$5,500","$11,000",50%,"$15,000","$30,000","$20,500","$41,000",,,,,,,,,4
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,4,79763,IL,Individual,No,90-0962741,79763IL0690003,Land of Lincoln Freedom PPO Bronze,79763IL069,,ILN002,ILS003,ILF004,New,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $15,000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-069B-SBC-Freedom.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0690003-01,Standard Bronze On Exchange Plan,59.75%,0.599181890487671,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,500","$13,000","$6,500","$13,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,"$5,500","$11,000",50%,"$15,000","$30,000","$20,500","$41,000",,,,,,,,,5
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,4,79763,IL,Individual,No,90-0962741,79763IL0690003,Land of Lincoln Freedom PPO Bronze,79763IL069,,ILN002,ILS003,ILF004,New,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $15,000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-069B-SBC-Freedom.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0690003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,4,79763,IL,Individual,No,90-0962741,79763IL0690003,Land of Lincoln Freedom PPO Bronze,79763IL069,,ILN002,ILS003,ILF004,New,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $15,000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-069B-SBC-Freedom.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-LLH.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0690003-03,Limited Cost Sharing Plan Variation,59.75%,0.599181890487671,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,500","$13,000","$6,500","$13,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",40%,"$5,500","$11,000",50%,"$15,000","$30,000","$20,500","$41,000",,,,,,,,,7
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,5,79763,IL,Individual,No,90-0962741,79763IL0430004,Swedish Covenant Land of Lincoln Platinum,79763IL043,,ILN005,ILS002,ILF011,New,PPO,Platinum,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-043P-SBC-Swedish.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Swedish.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0430004-00,Standard Platinum Off Exchange Plan,88.39%,0.883317410945892,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,40%,"$5,000","$10,000",$0,$0,,,,,,,,,4
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,5,79763,IL,Individual,No,90-0962741,79763IL0430002,Swedish Covenant Land of Lincoln Silver,79763IL043,,ILN005,ILS002,ILF010,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-043S-SBC-Swedish.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Swedish.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0430002-01,Standard Silver On Exchange Plan,68.73%,0.625396847724915,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,"$2,500","$5,000",45%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,13
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,5,79763,IL,Individual,No,90-0962741,79763IL0430002,Swedish Covenant Land of Lincoln Silver,79763IL043,,ILN005,ILS002,ILF010,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-043S-SBC-Swedish.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Swedish.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0430002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,14
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,5,79763,IL,Individual,No,90-0962741,79763IL0430002,Swedish Covenant Land of Lincoln Silver,79763IL043,,ILN005,ILS002,ILF010,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-043S-SBC-Swedish.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Swedish.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0430002-03,Limited Cost Sharing Plan Variation,68.73%,0.625396847724915,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,"$2,500","$5,000",45%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,15
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,5,79763,IL,Individual,No,90-0962741,79763IL0430002,Swedish Covenant Land of Lincoln Silver,79763IL043,,ILN005,ILS002,ILF010,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-043S-SBC-Swedish.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Swedish.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0430002-04,73% AV Level Silver Plan,73.80%,0.707599699497223,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$950,"$1,900",20%,$950,"$1,900",45%,"$10,000","$20,000","$10,950","$21,900",,,,,,,,,16
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,6,79763,IL,Individual,No,90-0962741,79763IL0440004,Land of Lincoln Champion PPO Platinum,79763IL044,,ILN006,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-044P-SBC-Champion.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Champion.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0440004-00,Standard Platinum Off Exchange Plan,,0.883790910243988,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,40%,"$5,000","$10,000",$0,$0,,,,,,,,,4
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,6,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0550004,Swedish Covenant Land of Lincoln Platinum,79763IL055,,ILN005,ILS002,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $5000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-055P-SBC-Swedish.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Swedish.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0550004-00,Standard Platinum Off Exchange Plan,,0.883317410945892,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,40%,"$5,000","$10,000",$0,$0,,,,,,,,,4
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,6,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0550004,Swedish Covenant Land of Lincoln Platinum,79763IL055,,ILN005,ILS002,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $5000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-055P-SBC-Swedish.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Swedish.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0550004-01,Standard Platinum On Exchange Plan,,0.883317410945892,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,40%,"$5,000","$10,000",$0,$0,,,,,,,,,5
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,6,79763,IL,Individual,No,90-0962741,79763IL0440004,Land of Lincoln Champion PPO Platinum,79763IL044,,ILN006,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-044P-SBC-Champion.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Champion.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0440004-01,Standard Platinum On Exchange Plan,,0.883790910243988,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,40%,"$5,000","$10,000",$0,$0,,,,,,,,,5
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,6,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0550001,Swedish Covenant Land of Lincoln Gold,79763IL055,,ILN005,ILS002,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $6000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-055G-SBC-Swedish.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Swedish.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0550001-01,Standard Gold On Exchange Plan,78.48%,0.771818518638611,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,20%,$400,$800,40%,"$6,000","$12,000","$6,400","$12,800",,,,,,,,,7
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,8,79763,IL,Individual,No,90-0962741,79763IL0460002,Presence Health Land of Lincoln Silver PPO,79763IL046,,ILN010,ILS004,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-046S-SBC-Presence.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Presence.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0460002-00,Standard Silver Off Exchange Plan,68.67%,0.613909184932709,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,"$3,000","$6,000",45%,"$10,000","$20,000","$13,000","$26,000",,,,,,,,,12
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,8,79763,IL,Individual,No,90-0962741,79763IL0460002,Presence Health Land of Lincoln Silver PPO,79763IL046,,ILN010,ILS004,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-046S-SBC-Presence.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Presence.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0460002-05,87% AV Level Silver Plan,87.35%,0.872738778591156,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,$100,$200,40%,"$10,000","$20,000","$10,100","$20,200",,,,,,,,,17
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,8,79763,IL,Individual,No,90-0962741,79763IL0460002,Presence Health Land of Lincoln Silver PPO,79763IL046,,ILN010,ILS004,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-046S-SBC-Presence.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Presence.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0460002-06,94% AV Level Silver Plan,93.77%,0.937750101089478,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$700,"$1,400",$700,"$1,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,40%,"$10,000","$20,000",$0,$0,,,,,,,,,18
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,12,79763,IL,Individual,No,90-0962741,79763IL0500004,Adventist Land of Lincoln Platinum PPO 250,79763IL050,,ILN007,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-050P-SBC-Adventist.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0500004-00,Standard Platinum Off Exchange Plan,,0.885192096233368,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,$250,$500,40%,"$5,000","$10,000","$5,250","$10,500",,,,,,,,,4
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,12,79763,IL,Individual,No,90-0962741,79763IL0500004,Adventist Land of Lincoln Platinum PPO 250,79763IL050,,ILN007,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-050P-SBC-Adventist.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0500004-01,Standard Platinum On Exchange Plan,,0.885192096233368,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,$250,$500,40%,"$5,000","$10,000","$5,250","$10,500",,,,,,,,,5
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,12,79763,IL,Individual,No,90-0962741,79763IL0500004,Adventist Land of Lincoln Platinum PPO 250,79763IL050,,ILN007,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-050P-SBC-Adventist.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0500004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,12,79763,IL,Individual,No,90-0962741,79763IL0500004,Adventist Land of Lincoln Platinum PPO 250,79763IL050,,ILN007,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-050P-SBC-Adventist.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0500004-03,Limited Cost Sharing Plan Variation,,0.885192096233368,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,$250,$500,40%,"$5,000","$10,000","$5,250","$10,500",,,,,,,,,7
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,12,79763,IL,Individual,No,90-0962741,79763IL0500001,Adventist Land of Lincoln Gold PPO 500,79763IL050,,ILN007,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-050G-SBC-Adventist.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0500001-00,Standard Gold Off Exchange Plan,78.42%,0.76740688085556,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,200","$8,400","$4,200","$8,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,$500,"$1,000",40%,"$6,000","$12,000","$6,500","$13,000",,,,,,,,,8
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,12,79763,IL,Individual,No,90-0962741,79763IL0500001,Adventist Land of Lincoln Gold PPO 500,79763IL050,,ILN007,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-050G-SBC-Adventist.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0500001-01,Standard Gold On Exchange Plan,78.42%,0.76740688085556,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,200","$8,400","$4,200","$8,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,$500,"$1,000",40%,"$6,000","$12,000","$6,500","$13,000",,,,,,,,,9
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,12,79763,IL,Individual,No,90-0962741,79763IL0500001,Adventist Land of Lincoln Gold PPO 500,79763IL050,,ILN007,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-050G-SBC-Adventist.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0500001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,10
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,12,79763,IL,Individual,No,90-0962741,79763IL0500001,Adventist Land of Lincoln Gold PPO 500,79763IL050,,ILN007,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-050G-SBC-Adventist.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0500001-03,Limited Cost Sharing Plan Variation,78.42%,0.76740688085556,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,200","$8,400","$4,200","$8,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,$500,"$1,000",40%,"$6,000","$12,000","$6,500","$13,000",,,,,,,,,11
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,12,79763,IL,Individual,No,90-0962741,79763IL0500002,Adventist Land of Lincoln Silver PPO 3000,79763IL050,,ILN007,ILS004,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-050S-SBC-Adventist.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0500002-00,Standard Silver Off Exchange Plan,68.62%,0.613705098628998,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,"$3,000","$6,000",45%,"$10,000","$20,000","$13,000","$26,000",,,,,,,,,12
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,14,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0620001,Adventist Land of Lincoln Gold PPO 500,79763IL062,,ILN007,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $6000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-062G-SBC-Adventist.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0620001-01,Standard Gold On Exchange Plan,78.42%,0.76740700006485,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,200","$8,400","$4,200","$8,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,$500,"$1,000",40%,"$6,000","$12,000","$6,500","$13,000",,,,,,,,,7
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,14,79763,IL,Individual,No,90-0962741,79763IL0520001,Chicago Health System | Land of Lincoln PPO Gold,79763IL052,,ILN003,ILS002,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-052G-SBC-CHS.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-CHS.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0520001-03,Limited Cost Sharing Plan Variation,78.35%,0.757569491863251,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,$750,"$1,500",30%,"$6,000","$12,000","$6,750","$13,500",,,,,,,,,7
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,6,79763,IL,Individual,No,90-0962741,79763IL0440004,Land of Lincoln Champion PPO Platinum,79763IL044,,ILN006,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-044P-SBC-Champion.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Champion.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0440004-03,Limited Cost Sharing Plan Variation,,0.883790910243988,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,40%,"$5,000","$10,000",$0,$0,,,,,,,,,7
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,12,79763,IL,Individual,No,90-0962741,79763IL0500002,Adventist Land of Lincoln Silver PPO 3000,79763IL050,,ILN007,ILS004,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-050S-SBC-Adventist.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0500002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,14
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,12,79763,IL,Individual,No,90-0962741,79763IL0500002,Adventist Land of Lincoln Silver PPO 3000,79763IL050,,ILN007,ILS004,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-050S-SBC-Adventist.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0500002-03,Limited Cost Sharing Plan Variation,68.62%,0.613705098628998,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,"$3,000","$6,000",45%,"$10,000","$20,000","$13,000","$26,000",,,,,,,,,15
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,12,79763,IL,Individual,No,90-0962741,79763IL0500002,Adventist Land of Lincoln Silver PPO 3000,79763IL050,,ILN007,ILS004,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-050S-SBC-Adventist.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0500002-04,73% AV Level Silver Plan,73.76%,0.700336337089539,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300",20%,"$1,150","$2,300",45%,"$10,000","$20,000","$11,150","$22,300",,,,,,,,,16
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,12,79763,IL,Individual,No,90-0962741,79763IL0500002,Adventist Land of Lincoln Silver PPO 3000,79763IL050,,ILN007,ILS004,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-050S-SBC-Adventist.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0500002-05,87% AV Level Silver Plan,87.26%,0.871874570846558,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,$100,$200,40%,"$10,000","$20,000","$10,100","$20,200",,,,,,,,,17
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,9,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0580004,Presence Health Land of Lincoln Platinum PPO,79763IL058,,ILN010,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $5000 deductible; MOOP in unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-058P-SBC-Presence.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Presence.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0580004-00,Standard Platinum Off Exchange Plan,,0.883206784725189,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,30%,"$5,000","$10,000",$0,$0,,,,,,,,,4
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,12,79763,IL,Individual,No,90-0962741,79763IL0500003,Adventist Land of Lincoln Bronze PPO 5000,79763IL050,,ILN007,ILS004,ILF006,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $15,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-050B-SBC-Adventist.pdf,landoflincolnhealth.org/member/make-a-payment,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0500003-01,Standard Bronze On Exchange Plan,,0.601510286331177,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,"$5,000","$10,000",50%,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,20
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,12,79763,IL,Individual,No,90-0962741,79763IL0500003,Adventist Land of Lincoln Bronze PPO 5000,79763IL050,,ILN007,ILS004,ILF006,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $15,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-050B-SBC-Adventist.pdf,landoflincolnhealth.org/member/make-a-payment,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0500003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,21
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,12,79763,IL,Individual,No,90-0962741,79763IL0500003,Adventist Land of Lincoln Bronze PPO 5000,79763IL050,,ILN007,ILS004,ILF006,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $15,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-050B-SBC-Adventist.pdf,landoflincolnhealth.org/member/make-a-payment,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0500003-03,Limited Cost Sharing Plan Variation,,0.601510286331177,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,"$5,000","$10,000",50%,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,22
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,13,79763,IL,Individual,No,90-0962741,79763IL0510002,LLH Family Health Network Silver 3100,79763IL051,,ILN012,ILS002,ILF016,New,PPO,Silver,Yes,Both,Yes,Yes,All specialists in Tier 1/Preferred Network.,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-051S-SBC-FHN.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-FHN.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0510002-00,Standard Silver Off Exchange Plan,68.38%,0.613331317901611,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,100","$6,200",35%,"$3,100","$6,200",45%,"$10,000","$20,000","$13,100","$26,200",,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,3,96601,IL,Individual,No,37-1241037,96601IL0190003,Coventry Bronze $20 Copay Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF008,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48745,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190003-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,3,96601,IL,Individual,No,37-1241037,96601IL0190003,Coventry Bronze $20 Copay Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF008,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48745,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,2,96601,IL,Individual,No,37-1241037,96601IL0210003,Coventry Bronze $20 Copay Carelink St. John's,96601IL021,,ILN005,ILS005,ILF023,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48757,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210003-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,2,96601,IL,Individual,No,37-1241037,96601IL0210003,Coventry Bronze $20 Copay Carelink St. John's,96601IL021,,ILN005,ILS005,ILF023,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48757,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,6,79763,IL,Individual,No,90-0962741,79763IL0440001,Land of Lincoln Champion PPO Gold,79763IL044,,ILN006,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-044G-SBC-Champion.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Champion.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0440001-00,Standard Gold Off Exchange Plan,78.46%,0.771381437778473,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,800","$9,600","$4,800","$9,600",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,20%,$400,$800,40%,"$6,000","$12,000","$6,400","$12,800",,,,,,,,,8
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,6,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0550002,Swedish Covenant Land of Lincoln Silver,79763IL055,,ILN005,ILS002,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $10000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-055S-SBC-Swedish.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Swedish.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0550002-00,Standard Silver Off Exchange Plan,68.73%,0.625396847724915,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,"$2,500","$5,000",45%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,8
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,6,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0550002,Swedish Covenant Land of Lincoln Silver,79763IL055,,ILN005,ILS002,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $10000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-055S-SBC-Swedish.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Swedish.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0550002-01,Standard Silver On Exchange Plan,68.73%,0.625396847724915,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,"$2,500","$5,000",45%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,9
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,6,79763,IL,Individual,No,90-0962741,79763IL0440001,Land of Lincoln Champion PPO Gold,79763IL044,,ILN006,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-044G-SBC-Champion.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Champion.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0440001-01,Standard Gold On Exchange Plan,78.46%,0.771381437778473,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,800","$9,600","$4,800","$9,600",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,20%,$400,$800,40%,"$6,000","$12,000","$6,400","$12,800",,,,,,,,,9
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,6,79763,IL,Individual,No,90-0962741,79763IL0440001,Land of Lincoln Champion PPO Gold,79763IL044,,ILN006,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-044G-SBC-Champion.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Champion.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0440001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,10
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,6,79763,IL,Individual,No,90-0962741,79763IL0440001,Land of Lincoln Champion PPO Gold,79763IL044,,ILN006,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-044G-SBC-Champion.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Champion.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0440001-03,Limited Cost Sharing Plan Variation,78.46%,0.771381437778473,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,800","$9,600","$4,800","$9,600",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,20%,$400,$800,40%,"$6,000","$12,000","$6,400","$12,800",,,,,,,,,11
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,7,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0560001,Land of Lincoln Champion PPO Gold,79763IL056,,ILN006,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $6000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-056G-SBC-Champion.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Champion.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0560001-01,Standard Gold On Exchange Plan,78.46%,0.771381437778473,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,800","$9,600","$4,800","$9,600",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,20%,$400,$800,40%,"$6,000","$12,000","$6,400","$12,800",,,,,,,,,7
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,7,79763,IL,Individual,No,90-0962741,79763IL0450004,Illinois Health Partners Land of Lincoln Platinum,79763IL045,,ILN004,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-045P-SBC-IHP.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-IHP.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0450004-03,Limited Cost Sharing Plan Variation,,0.884297609329224,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,40%,"$5,000","$10,000",$0,$0,,,,,,,,,7
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,10,79763,IL,Individual,No,90-0962741,79763IL0480002,Centegra Land of Lincoln Health Plan - Silver,79763IL048,,ILN008,ILS007,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-048S-SBC-Centegra.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Centegra.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0480002-00,Standard Silver Off Exchange Plan,68.75%,0.624128043651581,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,"$2,500","$5,000",45%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,12
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,10,79763,IL,Individual,No,90-0962741,79763IL0480002,Centegra Land of Lincoln Health Plan - Silver,79763IL048,,ILN008,ILS007,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-048S-SBC-Centegra.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Centegra.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0480002-01,Standard Silver On Exchange Plan,68.75%,0.624128043651581,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,"$2,500","$5,000",45%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,13
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,10,79763,IL,Individual,No,90-0962741,79763IL0480002,Centegra Land of Lincoln Health Plan - Silver,79763IL048,,ILN008,ILS007,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-048S-SBC-Centegra.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Centegra.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0480002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,14
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,10,79763,IL,Individual,No,90-0962741,79763IL0480002,Centegra Land of Lincoln Health Plan - Silver,79763IL048,,ILN008,ILS007,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-048S-SBC-Centegra.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Centegra.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0480002-03,Limited Cost Sharing Plan Variation,68.75%,0.624128043651581,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,"$2,500","$5,000",45%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,15
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,10,79763,IL,Individual,No,90-0962741,79763IL0480002,Centegra Land of Lincoln Health Plan - Silver,79763IL048,,ILN008,ILS007,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-048S-SBC-Centegra.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Centegra.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0480002-04,73% AV Level Silver Plan,73.64%,0.704344511032104,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,"$1,000","$2,000",45%,"$10,000","$20,000","$11,000","$22,000",,,,,,,,,16
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,10,79763,IL,Individual,No,90-0962741,79763IL0480002,Centegra Land of Lincoln Health Plan - Silver,79763IL048,,ILN008,ILS007,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-048S-SBC-Centegra.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Centegra.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0480002-05,87% AV Level Silver Plan,87.15%,0.870747447013855,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,$100,$200,40%,"$10,000","$20,000","$10,100","$20,200",,,,,,,,,17
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,10,79763,IL,Individual,No,90-0962741,79763IL0480002,Centegra Land of Lincoln Health Plan - Silver,79763IL048,,ILN008,ILS007,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-048S-SBC-Centegra.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Centegra.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0480002-06,94% AV Level Silver Plan,93.77%,0.937750101089478,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$700,"$1,400",$700,"$1,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,40%,"$10,000","$20,000",$0,$0,,,,,,,,,18
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,11,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0600004,Centegra Land of Lincoln Health Plan Platinum,79763IL060,,ILN008,ILS007,ILF012,New,PPO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $5000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-060P-SBC-Centegra.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Centegra.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0600004-00,Standard Platinum Off Exchange Plan,88.26%,0.875700235366821,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,500","$5,000","$2,500","$5,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,$250,$500,30%,"$5,000","$10,000","$5,250","$10,500",,,,,,,,,4
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,11,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0600004,Centegra Land of Lincoln Health Plan Platinum,79763IL060,,ILN008,ILS007,ILF012,New,PPO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $5000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-060P-SBC-Centegra.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Centegra.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0600004-01,Standard Platinum On Exchange Plan,88.26%,0.875700235366821,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,500","$5,000","$2,500","$5,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,$250,$500,30%,"$5,000","$10,000","$5,250","$10,500",,,,,,,,,5
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,11,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0600001,Centegra Land of Lincoln Health Plan Gold,79763IL060,,ILN008,ILS007,ILF019,New,PPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $6000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-060G-SBC-Centegra.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Centegra.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0600001-00,Standard Gold Off Exchange Plan,78.52%,0.767936289310455,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",15%,$500,"$1,000",40%,"$6,000","$12,000","$6,500","$13,000",,,,,,,,,6
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,11,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0600001,Centegra Land of Lincoln Health Plan Gold,79763IL060,,ILN008,ILS007,ILF019,New,PPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $6000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-060G-SBC-Centegra.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Centegra.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0600001-01,Standard Gold On Exchange Plan,78.52%,0.767936289310455,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",15%,$500,"$1,000",40%,"$6,000","$12,000","$6,500","$13,000",,,,,,,,,7
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,7,79763,IL,Individual,No,90-0962741,79763IL0450001,Illinois Health Partners Land of Lincoln Gold,79763IL045,,ILN004,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-045G-SBC-IHP.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-IHP.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0450001-00,Standard Gold Off Exchange Plan,78.46%,0.771434485912323,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,20%,$400,$800,40%,"$6,000","$12,000","$6,400","$12,800",,,,,,,,,8
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,7,79763,IL,Individual,No,90-0962741,79763IL0450001,Illinois Health Partners Land of Lincoln Gold,79763IL045,,ILN004,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-045G-SBC-IHP.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-IHP.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0450001-01,Standard Gold On Exchange Plan,78.46%,0.771434485912323,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,20%,$400,$800,40%,"$6,000","$12,000","$6,400","$12,800",,,,,,,,,9
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,7,79763,IL,Individual,No,90-0962741,79763IL0450001,Illinois Health Partners Land of Lincoln Gold,79763IL045,,ILN004,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-045G-SBC-IHP.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-IHP.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0450001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,10
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,7,79763,IL,Individual,No,90-0962741,79763IL0450001,Illinois Health Partners Land of Lincoln Gold,79763IL045,,ILN004,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-045G-SBC-IHP.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-IHP.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0450001-03,Limited Cost Sharing Plan Variation,78.46%,0.771434485912323,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,20%,$400,$800,40%,"$6,000","$12,000","$6,400","$12,800",,,,,,,,,11
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,7,79763,IL,Individual,No,90-0962741,79763IL0450002,Illinois Health Partners Land of Lincoln Silver,79763IL045,,ILN004,ILS004,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-045S-SBC-IHP.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-IHP.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0450002-00,Standard Silver Off Exchange Plan,68.68%,0.62547504901886,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,"$2,500","$5,000",45%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,12
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,7,79763,IL,Individual,No,90-0962741,79763IL0450002,Illinois Health Partners Land of Lincoln Silver,79763IL045,,ILN004,ILS004,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-045S-SBC-IHP.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-IHP.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0450002-01,Standard Silver On Exchange Plan,68.68%,0.62547504901886,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,"$2,500","$5,000",45%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,13
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,7,79763,IL,Individual,No,90-0962741,79763IL0450002,Illinois Health Partners Land of Lincoln Silver,79763IL045,,ILN004,ILS004,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-045S-SBC-IHP.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-IHP.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0450002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,14
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,7,79763,IL,Individual,No,90-0962741,79763IL0450002,Illinois Health Partners Land of Lincoln Silver,79763IL045,,ILN004,ILS004,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-045S-SBC-IHP.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-IHP.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0450002-03,Limited Cost Sharing Plan Variation,68.68%,0.62547504901886,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,"$2,500","$5,000",45%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,15
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,7,79763,IL,Individual,No,90-0962741,79763IL0450002,Illinois Health Partners Land of Lincoln Silver,79763IL045,,ILN004,ILS004,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-045S-SBC-IHP.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-IHP.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0450002-04,73% AV Level Silver Plan,73.74%,0.707359135150909,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$950,"$1,900",20%,$950,"$1,900",45%,"$10,000","$20,000","$10,950","$21,900",,,,,,,,,16
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,7,79763,IL,Individual,No,90-0962741,79763IL0450002,Illinois Health Partners Land of Lincoln Silver,79763IL045,,ILN004,ILS004,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-045S-SBC-IHP.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-IHP.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0450002-05,87% AV Level Silver Plan,86.88%,0.86799943447113,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,$100,$200,40%,"$10,000","$20,000","$10,100","$20,200",,,,,,,,,17
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,7,79763,IL,Individual,No,90-0962741,79763IL0450002,Illinois Health Partners Land of Lincoln Silver,79763IL045,,ILN004,ILS004,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-045S-SBC-IHP.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-IHP.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0450002-06,94% AV Level Silver Plan,93.77%,0.937750101089478,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$700,"$1,400",$700,"$1,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,40%,"$10,000","$20,000",$0,$0,,,,,,,,,18
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,8,79763,IL,Individual,No,90-0962741,79763IL0460004,Presence Health Land of Lincoln Platinum PPO,79763IL046,,ILN010,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-046P-SBC-Presence.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Presence.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0460004-00,Standard Platinum Off Exchange Plan,,0.883206784725189,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,30%,"$5,000","$10,000",$0,$0,,,,,,,,,4
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,8,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0570004,Illinois Health Partners Land of Lincoln Platinum,79763IL057,,ILN004,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $5000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-057P-SBC-IHP.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-IHP.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0570004-00,Standard Platinum Off Exchange Plan,,0.884297609329224,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,40%,"$5,000","$10,000",$0,$0,,,,,,,,,4
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,8,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0570004,Illinois Health Partners Land of Lincoln Platinum,79763IL057,,ILN004,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $5000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-057P-SBC-IHP.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-IHP.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0570004-01,Standard Platinum On Exchange Plan,,0.884297609329224,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,40%,"$5,000","$10,000",$0,$0,,,,,,,,,5
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,8,79763,IL,Individual,No,90-0962741,79763IL0460004,Presence Health Land of Lincoln Platinum PPO,79763IL046,,ILN010,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-046P-SBC-Presence.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Presence.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0460004-01,Standard Platinum On Exchange Plan,,0.883206784725189,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,30%,"$5,000","$10,000",$0,$0,,,,,,,,,5
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,8,79763,IL,Individual,No,90-0962741,79763IL0460004,Presence Health Land of Lincoln Platinum PPO,79763IL046,,ILN010,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-046P-SBC-Presence.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Presence.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0460004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,8,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0570001,Illinois Health Partners Land of Lincoln Gold,79763IL057,,ILN004,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $6000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-057G-SBC-IHP.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-IHP.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0570001-00,Standard Gold Off Exchange Plan,78.46%,0.771434485912323,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,20%,$400,$800,40%,"$6,000","$12,000","$6,400","$12,800",,,,,,,,,6
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,8,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0570001,Illinois Health Partners Land of Lincoln Gold,79763IL057,,ILN004,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $6000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-057G-SBC-IHP.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-IHP.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0570001-01,Standard Gold On Exchange Plan,78.46%,0.771434485912323,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,20%,$400,$800,40%,"$6,000","$12,000","$6,400","$12,800",,,,,,,,,7
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,8,79763,IL,Individual,No,90-0962741,79763IL0460004,Presence Health Land of Lincoln Platinum PPO,79763IL046,,ILN010,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-046P-SBC-Presence.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Presence.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0460004-03,Limited Cost Sharing Plan Variation,,0.883206784725189,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,30%,"$5,000","$10,000",$0,$0,,,,,,,,,7
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,8,79763,IL,Individual,No,90-0962741,79763IL0460001,Presence Health Land of Lincoln Gold PPO,79763IL046,,ILN010,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-046G-SBC-Presence.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Presence.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0460001-00,Standard Gold Off Exchange Plan,78.02%,0.771402299404144,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,20%,$400,$800,40%,"$6,000","$12,000","$6,400","$12,800",,,,,,,,,8
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,8,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0570002,Illinois Health Partners Land of Lincoln Silver,79763IL057,,ILN004,ILS004,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $10000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-057S-SBC-IHP.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-IHP.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0570002-00,Standard Silver Off Exchange Plan,68.68%,0.62547504901886,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,"$2,500","$5,000",45%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,8
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,8,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0570002,Illinois Health Partners Land of Lincoln Silver,79763IL057,,ILN004,ILS004,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $10000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-057S-SBC-IHP.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-IHP.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0570002-01,Standard Silver On Exchange Plan,68.68%,0.62547504901886,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,"$2,500","$5,000",45%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,9
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,8,79763,IL,Individual,No,90-0962741,79763IL0460001,Presence Health Land of Lincoln Gold PPO,79763IL046,,ILN010,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-046G-SBC-Presence.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Presence.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0460001-01,Standard Gold On Exchange Plan,78.02%,0.771402299404144,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,20%,$400,$800,40%,"$6,000","$12,000","$6,400","$12,800",,,,,,,,,9
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,8,79763,IL,Individual,No,90-0962741,79763IL0460001,Presence Health Land of Lincoln Gold PPO,79763IL046,,ILN010,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-046G-SBC-Presence.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Presence.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0460001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,10
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,8,79763,IL,Individual,No,90-0962741,79763IL0460001,Presence Health Land of Lincoln Gold PPO,79763IL046,,ILN010,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-046G-SBC-Presence.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Presence.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0460001-03,Limited Cost Sharing Plan Variation,78.02%,0.771402299404144,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,20%,$400,$800,40%,"$6,000","$12,000","$6,400","$12,800",,,,,,,,,11
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,12,79763,IL,Individual,No,90-0962741,79763IL0500002,Adventist Land of Lincoln Silver PPO 3000,79763IL050,,ILN007,ILS004,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-050S-SBC-Adventist.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0500002-01,Standard Silver On Exchange Plan,68.62%,0.613705098628998,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,"$3,000","$6,000",45%,"$10,000","$20,000","$13,000","$26,000",,,,,,,,,13
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,9,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0580004,Presence Health Land of Lincoln Platinum PPO,79763IL058,,ILN010,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $5000 deductible; MOOP in unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-058P-SBC-Presence.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Presence.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0580004-01,Standard Platinum On Exchange Plan,,0.883206784725189,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,30%,"$5,000","$10,000",$0,$0,,,,,,,,,5
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,9,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0580001,Presence Health Land of Lincoln Gold PPO,79763IL058,,ILN010,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $6000 deductible; MOOP in unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-058G-SBC-Presence.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Presence.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0580001-00,Standard Gold Off Exchange Plan,78.46%,0.771402299404144,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,20%,$400,$800,40%,"$6,000","$12,000","$6,400","$12,800",,,,,,,,,6
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,10,79763,IL,Individual,No,90-0962741,79763IL0480004,Centegra Land of Lincoln Health Plan - Platinum,79763IL048,,ILN008,ILS007,ILF012,New,PPO,Platinum,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-048P-SBC-Centegra.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Centegra.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0480004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,10,79763,IL,Individual,No,90-0962741,79763IL0480004,Centegra Land of Lincoln Health Plan - Platinum,79763IL048,,ILN008,ILS007,ILF012,New,PPO,Platinum,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $5000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-048P-SBC-Centegra.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Centegra.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0480004-03,Limited Cost Sharing Plan Variation,88.28%,0.87568998336792,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,500","$5,000","$2,500","$5,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,$250,$500,30%,"$5,000","$10,000","$5,250","$10,500",,,,,,,,,7
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,13,79763,IL,Individual,No,90-0962741,79763IL0510002,LLH Family Health Network Silver 3100,79763IL051,,ILN012,ILS002,ILF016,New,PPO,Silver,Yes,Both,Yes,Yes,All specialists in Tier 1/Preferred Network.,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-051S-SBC-FHN.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-FHN.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0510002-05,87% AV Level Silver Plan,87.93%,0.869208216667175,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,$100,$200,40%,"$10,000","$20,000","$10,100","$20,200",,,,,,,,,9
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,13,79763,IL,Individual,No,90-0962741,79763IL0510002,LLH Family Health Network Silver 3100,79763IL051,,ILN012,ILS002,ILF016,New,PPO,Silver,Yes,Both,Yes,Yes,All specialists in Tier 1/Preferred Network.,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-051S-SBC-FHN.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-FHN.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0510002-06,94% AV Level Silver Plan,94.32%,0.939895212650299,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,$600,"$1,200",$600,"$1,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,5%,$0,$0,30%,"$10,000","$20,000",$0,$0,,,,,,,,,10
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,14,79763,IL,Individual,No,90-0962741,79763IL0520001,Chicago Health System | Land of Lincoln PPO Gold,79763IL052,,ILN003,ILS002,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-052G-SBC-CHS.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-CHS.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0520001-00,Standard Gold Off Exchange Plan,78.35%,0.759381830692291,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,$750,"$1,500",40%,"$6,000","$12,000","$6,750","$13,500",,,,,,,,,4
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,14,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0620004,Adventist Land of Lincoln Platinum PPO 250,79763IL062,,ILN007,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $5000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-062P-SBC-Adventist.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0620004-00,Standard Platinum Off Exchange Plan,,0.885192036628723,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,$250,$500,40%,"$5,000","$10,000","$5,250","$10,500",,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,16,96601,IL,Individual,No,37-1241037,96601IL0200002,Coventry Silver $10 Copay Carelink Methodist,96601IL020,,ILN004,ILS004,ILF012,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48725,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200002-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,17,96601,IL,Individual,No,37-1241037,96601IL0210002,Coventry Silver $10 Copay Carelink St. John's,96601IL021,,ILN005,ILS005,ILF022,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48749,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210002-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,17,96601,IL,Individual,No,37-1241037,96601IL0210002,Coventry Silver $10 Copay Carelink St. John's,96601IL021,,ILN005,ILS005,ILF022,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48749,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210002-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,17,96601,IL,Individual,No,37-1241037,96601IL0210002,Coventry Silver $10 Copay Carelink St. John's,96601IL021,,ILN005,ILS005,ILF022,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48749,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,17,96601,IL,Individual,No,37-1241037,96601IL0210002,Coventry Silver $10 Copay Carelink St. John's,96601IL021,,ILN005,ILS005,ILF022,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48749,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210002-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,17,96601,IL,Individual,No,37-1241037,96601IL0210002,Coventry Silver $10 Copay Carelink St. John's,96601IL021,,ILN005,ILS005,ILF022,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48749,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210002-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,17,96601,IL,Individual,No,37-1241037,96601IL0210002,Coventry Silver $10 Copay Carelink St. John's,96601IL021,,ILN005,ILS005,ILF022,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48749,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210002-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,17,96601,IL,Individual,No,37-1241037,96601IL0210002,Coventry Silver $10 Copay Carelink St. John's,96601IL021,,ILN005,ILS005,ILF022,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48749,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210002-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,26,96601,IL,Individual,No,37-1241037,96601IL0200010,Coventry Silver $5 Copay 2750 UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF019,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48862,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200010-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,26,96601,IL,Individual,No,37-1241037,96601IL0200010,Coventry Silver $5 Copay 2750 UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF019,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48862,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200010-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,10,79763,IL,Individual,No,90-0962741,79763IL0480001,Centegra Land of Lincoln Health Plan - Gold,79763IL048,,ILN008,ILS007,ILF019,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-048G-SBC-Centegra.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Centegra.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0480001-00,Standard Gold Off Exchange Plan,78.12%,0.764016628265381,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",15%,$500,"$1,000",40%,"$6,000","$12,000","$6,500","$13,000",,,,,,,,,8
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,10,79763,IL,Individual,No,90-0962741,79763IL0480001,Centegra Land of Lincoln Health Plan - Gold,79763IL048,,ILN008,ILS007,ILF019,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-048G-SBC-Centegra.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Centegra.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0480001-01,Standard Gold On Exchange Plan,78.12%,0.764016628265381,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",15%,$500,"$1,000",40%,"$6,000","$12,000","$6,500","$13,000",,,,,,,,,9
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,10,79763,IL,Individual,No,90-0962741,79763IL0480001,Centegra Land of Lincoln Health Plan - Gold,79763IL048,,ILN008,ILS007,ILF019,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-048G-SBC-Centegra.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Centegra.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0480001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,10
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,10,79763,IL,Individual,No,90-0962741,79763IL0480001,Centegra Land of Lincoln Health Plan - Gold,79763IL048,,ILN008,ILS007,ILF019,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-048G-SBC-Centegra.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Centegra.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0480001-03,Limited Cost Sharing Plan Variation,78.12%,0.764016628265381,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",15%,$500,"$1,000",40%,"$6,000","$12,000","$6,500","$13,000",,,,,,,,,11
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,11,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0600002,Centegra Land of Lincoln Health Plan Silver,79763IL060,,ILN008,ILS007,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $10000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-060S-SBC-Centegra.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Centegra.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0600002-00,Standard Silver Off Exchange Plan,68.75%,0.624751627445221,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,"$2,500","$5,000",45%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,8
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,11,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0600002,Centegra Land of Lincoln Health Plan Silver,79763IL060,,ILN008,ILS007,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $10000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-060S-SBC-Centegra.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Centegra.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0600002-01,Standard Silver On Exchange Plan,68.75%,0.624751627445221,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,"$2,500","$5,000",45%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,9
2015,IL,83350,SERFF,2,2014-09-09 16:12:42,1,83350,IL,SHOP (Small Group),Yes,13-5581829,83350IL0170001,EHB Basic Dental Plan (Low),83350IL017,,ILN001,ILS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$14.27,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48039,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48038,,83350IL0170001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,83350,SERFF,2,2014-09-09 16:12:42,2,83350,IL,SHOP (Small Group),Yes,13-5581829,83350IL0180001,EHB Enhanced Dental Plan (High),83350IL018,,ILN002,ILS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$19.53,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49082,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49081,,83350IL0180001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,83350,SERFF,2,2014-09-09 16:12:42,2,83350,IL,SHOP (Small Group),Yes,13-5581829,83350IL0180001,EHB Enhanced Dental Plan (High),83350IL018,,ILN002,ILS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$19.53,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49082,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49081,,83350IL0180001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,9,96601,IL,Individual,No,37-1241037,96601IL0210004,Coventry Bronze Deductible Only HSA Eligible Carelink St. John's,96601IL021,,ILN005,ILS005,ILF024,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48758,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210004-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,10,96601,IL,Individual,No,37-1241037,96601IL0190004,Coventry Bronze Deductible Only HSA Eligible Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF009,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48746,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190004-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,10,96601,IL,Individual,No,37-1241037,96601IL0190004,Coventry Bronze Deductible Only HSA Eligible Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF009,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48746,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190004-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,10,96601,IL,Individual,No,37-1241037,96601IL0190004,Coventry Bronze Deductible Only HSA Eligible Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF009,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48746,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,10,96601,IL,Individual,No,37-1241037,96601IL0190004,Coventry Bronze Deductible Only HSA Eligible Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF009,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48746,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190004-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,11,96601,IL,Individual,No,37-1241037,96601IL0200001,Coventry Gold $5 Copay Carelink Methodist,96601IL020,,ILN004,ILS004,ILF011,Existing,PPO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48724,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200001-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,KS,11339,SERFF,7,2014-11-15 10:06:04,2,11339,KS,SHOP (Small Group),Yes,75-1233841,11339KS0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,11339KS002,,KSN001,KSS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.91,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ks/11339ks0020006-15,,11339KS0020006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,11339,SERFF,7,2014-11-15 10:06:04,2,11339,KS,SHOP (Small Group),Yes,75-1233841,11339KS0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,11339KS002,,KSN001,KSS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.91,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ks/11339ks0020006-15,,11339KS0020006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,11339,SERFF,7,2014-11-15 10:06:04,2,11339,KS,Individual,Yes,75-1233841,11339KS0010006,Dentegra Dental PPO Family Basic Plan,11339KS001,,KSN001,KSS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.75,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ks/11339ks0010006-15,,11339KS0010006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,1,18558,KS,Individual,No,48-0952857,18558KS0360001,BlueCare Elite with pediatric dental,18558KS036,,KSN001,KSS001,KSF005,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360001,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360001&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360001-00,Standard Platinum Off Exchange Plan,,0.882025182247162,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,"$1,200",$200,$0,$0,"$1,200",$40,4
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,1,18558,KS,SHOP (Small Group),No,48-0952857,18558KS0370001,BlueCare PremierSHOP,18558KS037,,KSN001,KSS001,KSF002,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370001,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370001&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0370001-00,Standard Gold Off Exchange Plan,78.55%,0.785494446754456,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,400",$20,"$1,200",$200,$500,"$1,300",$0,$40,4
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,12,79763,IL,Individual,No,90-0962741,79763IL0500002,Adventist Land of Lincoln Silver PPO 3000,79763IL050,,ILN007,ILS004,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-050S-SBC-Adventist.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0500002-06,94% AV Level Silver Plan,93.77%,0.937750101089478,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$700,"$1,400",$700,"$1,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,40%,"$10,000","$20,000",$0,$0,,,,,,,,,18
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,12,79763,IL,Individual,No,90-0962741,79763IL0500003,Adventist Land of Lincoln Bronze PPO 5000,79763IL050,,ILN007,ILS004,ILF006,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $15,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-050B-SBC-Adventist.pdf,landoflincolnhealth.org/member/make-a-payment,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0500003-00,Standard Bronze Off Exchange Plan,,0.601510286331177,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,"$5,000","$10,000",50%,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,19
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,3,96601,IL,Individual,No,37-1241037,96601IL0190003,Coventry Bronze $20 Copay Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF008,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48745,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190003-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,4,96601,IL,Individual,No,37-1241037,96601IL0230003,Coventry Bronze $20 Copay Select,96601IL023,,ILN002,ILS002,ILF028,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48721,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230003-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,4,96601,IL,Individual,No,37-1241037,96601IL0230003,Coventry Bronze $20 Copay Select,96601IL023,,ILN002,ILS002,ILF028,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48721,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230003-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,4,96601,IL,Individual,No,37-1241037,96601IL0230003,Coventry Bronze $20 Copay Select,96601IL023,,ILN002,ILS002,ILF028,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48721,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,4,96601,IL,Individual,No,37-1241037,96601IL0230003,Coventry Bronze $20 Copay Select,96601IL023,,ILN002,ILS002,ILF028,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48721,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230003-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,5,96601,IL,Individual,No,37-1241037,96601IL0200011,Coventry Bronze $20 Copay UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF020,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48868,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200011-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,5,96601,IL,Individual,No,37-1241037,96601IL0200011,Coventry Bronze $20 Copay UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF020,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48868,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200011-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,5,96601,IL,Individual,No,37-1241037,96601IL0200011,Coventry Bronze $20 Copay UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF020,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48868,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200011-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,13,79763,IL,Individual,No,90-0962741,79763IL0510002,LLH Family Health Network Silver 3100,79763IL051,,ILN012,ILS002,ILF016,New,PPO,Silver,Yes,Both,Yes,Yes,All specialists in Tier 1/Preferred Network.,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-051S-SBC-FHN.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-FHN.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0510002-01,Standard Silver On Exchange Plan,68.38%,0.613331317901611,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,100","$6,200",35%,"$3,100","$6,200",45%,"$10,000","$20,000","$13,100","$26,200",,,,,,,,,5
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,13,79763,IL,Individual,No,90-0962741,79763IL0510002,LLH Family Health Network Silver 3100,79763IL051,,ILN012,ILS002,ILF016,New,PPO,Silver,Yes,Both,Yes,Yes,All specialists in Tier 1/Preferred Network.,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-051S-SBC-FHN.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-FHN.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0510002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,13,79763,IL,Individual,No,90-0962741,79763IL0510002,LLH Family Health Network Silver 3100,79763IL051,,ILN012,ILS002,ILF016,New,PPO,Silver,Yes,Both,Yes,Yes,All specialists in Tier 1/Preferred Network.,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-051S-SBC-FHN.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-FHN.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0510002-03,Limited Cost Sharing Plan Variation,68.38%,0.613331317901611,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,100","$6,200",35%,"$3,100","$6,200",45%,"$10,000","$20,000","$13,100","$26,200",,,,,,,,,7
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,13,79763,IL,Individual,No,90-0962741,79763IL0510002,LLH Family Health Network Silver 3100,79763IL051,,ILN012,ILS002,ILF016,New,PPO,Silver,Yes,Both,Yes,Yes,All specialists in Tier 1/Preferred Network.,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-051S-SBC-FHN.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-FHN.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0510002-04,73% AV Level Silver Plan,73.60%,0.70441609621048,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",25%,"$1,000","$2,000",45%,"$10,000","$20,000","$11,000","$22,000",,,,,,,,,8
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,14,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0620004,Adventist Land of Lincoln Platinum PPO 250,79763IL062,,ILN007,ILS004,ILF011,New,PPO,Platinum,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $5000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-062P-SBC-Adventist.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0620004-01,Standard Platinum On Exchange Plan,,0.885192036628723,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,$250,$500,40%,"$5,000","$10,000","$5,250","$10,500",,,,,,,,,5
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,14,79763,IL,Individual,No,90-0962741,79763IL0520001,Chicago Health System | Land of Lincoln PPO Gold,79763IL052,,ILN003,ILS002,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-052G-SBC-CHS.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-CHS.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0520001-01,Standard Gold On Exchange Plan,78.35%,0.757569491863251,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,$750,"$1,500",30%,"$6,000","$12,000","$6,750","$13,500",,,,,,,,,5
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,14,79763,IL,Individual,No,90-0962741,79763IL0520001,Chicago Health System | Land of Lincoln PPO Gold,79763IL052,,ILN003,ILS002,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,50% coinsurance after $6000 Deductible; MOOP is unlimited.,Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-052G-SBC-CHS.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-CHS.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0520001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,14,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0620001,Adventist Land of Lincoln Gold PPO 500,79763IL062,,ILN007,ILS004,ILF013,New,PPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $6000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-062G-SBC-Adventist.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0620001-00,Standard Gold Off Exchange Plan,78.42%,0.76740700006485,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,200","$8,400","$4,200","$8,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,$500,"$1,000",40%,"$6,000","$12,000","$6,500","$13,000",,,,,,,,,6
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,14,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0620002,Adventist Land of Lincoln Silver PPO 2500,79763IL062,,ILN007,ILS004,ILF016,New,PPO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $10000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-062S-SBC-Adventist.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0620002-00,Standard Silver Off Exchange Plan,68.78%,0.626273989677429,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",25%,"$2,500","$5,000",50%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,8
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,14,79763,IL,Individual,No,90-0962741,79763IL0520002,Chicago Health System | Land of Lincoln PPO Silver,79763IL052,,ILN003,ILS002,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-052S-SBC-CHS.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-CHS.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0520002-00,Standard Silver Off Exchange Plan,68.75%,0.624751627445221,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,"$2,500","$5,000",45%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,8
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,14,79763,IL,Individual,No,90-0962741,79763IL0520002,Chicago Health System | Land of Lincoln PPO Silver,79763IL052,,ILN003,ILS002,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-052S-SBC-CHS.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-CHS.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0520002-01,Standard Silver On Exchange Plan,68.75%,0.624751627445221,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,"$2,500","$5,000",45%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,9
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,14,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0620002,Adventist Land of Lincoln Silver PPO 2500,79763IL062,,ILN007,ILS004,ILF016,New,PPO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $10000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-062S-SBC-Adventist.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0620002-01,Standard Silver On Exchange Plan,68.78%,0.626273989677429,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",25%,"$2,500","$5,000",50%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,9
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,14,79763,IL,Individual,No,90-0962741,79763IL0520002,Chicago Health System | Land of Lincoln PPO Silver,79763IL052,,ILN003,ILS002,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-052S-SBC-CHS.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-CHS.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0520002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,10
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,14,79763,IL,Individual,No,90-0962741,79763IL0520002,Chicago Health System | Land of Lincoln PPO Silver,79763IL052,,ILN003,ILS002,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-052S-SBC-CHS.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-CHS.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0520002-03,Limited Cost Sharing Plan Variation,68.75%,0.624751627445221,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,"$2,500","$5,000",45%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,11
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,14,79763,IL,Individual,No,90-0962741,79763IL0520002,Chicago Health System | Land of Lincoln PPO Silver,79763IL052,,ILN003,ILS002,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-052S-SBC-CHS.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-CHS.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0520002-04,73% AV Level Silver Plan,73.64%,0.704344511032104,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,"$1,000","$2,000",45%,"$10,000","$20,000","$11,000","$22,000",,,,,,,,,12
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,14,79763,IL,Individual,No,90-0962741,79763IL0520002,Chicago Health System | Land of Lincoln PPO Silver,79763IL052,,ILN003,ILS002,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-052S-SBC-CHS.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-CHS.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0520002-05,87% AV Level Silver Plan,87.15%,0.870747447013855,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,$100,$200,40%,"$10,000","$20,000","$10,100","$20,200",,,,,,,,,13
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,14,79763,IL,Individual,No,90-0962741,79763IL0520002,Chicago Health System | Land of Lincoln PPO Silver,79763IL052,,ILN003,ILS002,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance after $10,000 Deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-052S-SBC-CHS.pdf,https://individual.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/I-BR-CHS.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0520002-06,94% AV Level Silver Plan,93.77%,0.937750101089478,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$700,"$1,400",$700,"$1,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,40%,"$10,000","$20,000",$0,$0,,,,,,,,,14
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,15,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0620003,Adventist Land of Lincoln Bronze PPO 5000,79763IL062,,ILN007,ILS004,ILF006,New,PPO,Bronze,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $15000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-062B-SBC-Adventist.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0620003-00,Standard Bronze Off Exchange Plan,,0.601585328578949,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,"$5,000","$10,000",50%,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,4
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,15,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0620003,Adventist Land of Lincoln Bronze PPO 5000,79763IL062,,ILN007,ILS004,ILF006,New,PPO,Bronze,No,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $15000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-062B-SBC-Adventist.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-Adventist.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0620003-01,Standard Bronze On Exchange Plan,,0.601585328578949,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,"$5,000","$10,000",50%,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,5
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,16,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0630001,Chicago Health System  Land of Lincoln PPO Gold,79763IL063,,ILN003,ILS002,ILF019,New,PPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $6000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-063G-SBC-CHS.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-CHS.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0630001-00,Standard Gold Off Exchange Plan,78.35%,0.757424116134644,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,$750,"$1,500",40%,"$6,000","$12,000","$6,750","$13,500",,,,,,,,,4
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,16,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0630001,Chicago Health System  Land of Lincoln PPO Gold,79763IL063,,ILN003,ILS002,ILF019,New,PPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $6000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-063G-SBC-CHS.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-CHS.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0630001-01,Standard Gold On Exchange Plan,78.35%,0.757424116134644,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,$750,"$1,500",40%,"$6,000","$12,000","$6,750","$13,500",,,,,,,,,5
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,16,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0630002,Chicago Health System  Land of Lincoln PPO Silver,79763IL063,,ILN003,ILS002,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $10000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-063S-SBC-CHS.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-CHS.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0630002-00,Standard Silver Off Exchange Plan,68.75%,0.624751627445221,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,"$2,500","$5,000",45%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,6
2015,IL,79763,SERFF,4,2014-11-20 15:54:16,16,79763,IL,SHOP (Small Group),No,90-0962741,79763IL0630002,Chicago Health System  Land of Lincoln PPO Silver,79763IL063,,ILN003,ILS002,ILF015,New,PPO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,3,0,0,2015-01-01,,Yes,Benefits paid as out-of-network.,Yes,"50% coinsurance, $10000 deductible; MOOP is unlimited.",Yes,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-063S-SBC-CHS.pdf,http://smallgroup.landoflincolnhealth.org,https://www.landoflincolnhealth.org/wp-content/uploads/2014/10/SG-BR-CHS.pdf,https://www.landoflincolnhealth.org/shop-for-plans/formulary,79763IL0630002-01,Standard Silver On Exchange Plan,68.75%,0.624751627445221,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,"$2,500","$5,000",45%,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,7
2015,IL,83350,SERFF,2,2014-09-09 16:12:42,1,83350,IL,SHOP (Small Group),Yes,13-5581829,83350IL0170001,EHB Basic Dental Plan (Low),83350IL017,,ILN001,ILS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$14.27,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48039,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48038,,83350IL0170001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,83350,SERFF,2,2014-09-09 16:12:42,3,83350,IL,SHOP (Small Group),Yes,13-5581829,83350IL0190001,Family Basic Dental Plan (Low),83350IL019,,ILN003,ILS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$14.27,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49084,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49083,,83350IL0190001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,83350,SERFF,2,2014-09-09 16:12:42,3,83350,IL,SHOP (Small Group),Yes,13-5581829,83350IL0190001,Family Basic Dental Plan (Low),83350IL019,,ILN003,ILS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$14.27,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49084,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49083,,83350IL0190001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,83350,SERFF,2,2014-09-09 16:12:42,4,83350,IL,SHOP (Small Group),Yes,13-5581829,83350IL0200001,Family Enhanced Dental Plan (High),83350IL020,,ILN004,ILS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$19.53,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49086,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49085,,83350IL0200001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,83350,SERFF,2,2014-09-09 16:12:42,4,83350,IL,SHOP (Small Group),Yes,13-5581829,83350IL0200001,Family Enhanced Dental Plan (High),83350IL020,,ILN004,ILS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$19.53,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49086,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49085,,83350IL0200001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,84033,SERFF,3,2014-10-28 20:25:58,1,84033,IL,Individual,Yes,95-6042390,84033IL0020001,BESTOne Dental Plus-Silver,84033IL002,,ILN001,ILS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$35.45,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IL/2015/IL_BESTOne_Dental_Plus-Silver_Plan.pdf,,84033IL0020001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,84033,SERFF,3,2014-10-28 20:25:58,1,84033,IL,SHOP (Small Group),Yes,95-6042390,84033IL0010001,BEST Dental PPO M-15,84033IL001,,ILN001,ILS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.36,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IL/2015/IL_BESTDental_PPO_M-15_Plan.pdf,,84033IL0010001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,84033,SERFF,3,2014-10-28 20:25:58,1,84033,IL,SHOP (Small Group),Yes,95-6042390,84033IL0010001,BEST Dental PPO M-15,84033IL001,,ILN001,ILS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.36,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IL/2015/IL_BESTDental_PPO_M-15_Plan.pdf,,84033IL0010001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,84033,SERFF,3,2014-10-28 20:25:58,1,84033,IL,Individual,Yes,95-6042390,84033IL0020001,BESTOne Dental Plus-Silver,84033IL002,,ILN001,ILS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$35.45,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/IL/2015/IL_BESTOne_Dental_Plus-Silver_Plan.pdf,,84033IL0020001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,85099,SERFF,2,2014-09-09 16:12:42,1,85099,IL,SHOP (Small Group),Yes,13-5123390,85099IL0190002,Guardian Pediatric Advantage,85099IL019,,ILN001,ILS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$22.43,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,85099IL0190002-00,Standard High Off Exchange Plan,85.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,85099,SERFF,2,2014-09-09 16:12:42,1,85099,IL,SHOP (Small Group),Yes,13-5123390,85099IL0200002,Guardian Pediatric Essentials,85099IL020,,ILN001,ILS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$15.84,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,85099IL0200002-00,Standard Low Off Exchange Plan,68.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,85099,SERFF,2,2014-09-09 16:12:42,2,85099,IL,SHOP (Small Group),Yes,13-5123390,85099IL0160002,Guardian Family Advantage,85099IL016,,ILN001,ILS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.43,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,85099IL0160002-00,Standard High Off Exchange Plan,85.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,85099,SERFF,2,2014-09-09 16:12:42,2,85099,IL,SHOP (Small Group),Yes,13-5123390,85099IL0160002,Guardian Family Advantage,85099IL016,,ILN001,ILS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.43,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,85099IL0160002-01,Standard High On Exchange Plan,85.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,85099,SERFF,2,2014-09-09 16:12:42,2,85099,IL,SHOP (Small Group),Yes,13-5123390,85099IL0180002,Guardian Family Essentials,85099IL018,,ILN001,ILS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$15.84,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,85099IL0180002-00,Standard Low Off Exchange Plan,68.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IL,85099,SERFF,2,2014-09-09 16:12:42,2,85099,IL,SHOP (Small Group),Yes,13-5123390,85099IL0180002,Guardian Family Essentials,85099IL018,,ILN001,ILS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$15.84,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,85099IL0180002-01,Standard Low On Exchange Plan,68.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IL,86600,SERFF,2,2014-09-09 16:12:42,1,86600,IL,SHOP (Small Group),Yes,35-0472300,86600IL0010001,Lincoln Dental Connect?,86600IL001,,ILN001,ILS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$37.50,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,86600IL0010001-00,Standard High Off Exchange Plan,85.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,86600,SERFF,2,2014-09-09 16:12:42,1,86600,IL,SHOP (Small Group),Yes,35-0472300,86600IL0010002,Lincoln Dental Connect?,86600IL001,,ILN001,ILS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.23,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,86600IL0010002-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,86600,SERFF,2,2014-09-09 16:12:42,1,86600,IL,SHOP (Small Group),Yes,35-0472300,86600IL0010003,Lincoln Dental Connect?,86600IL001,,ILN001,ILS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.84,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,86600IL0010003-00,Standard Low Off Exchange Plan,69.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IL,86600,SERFF,2,2014-09-09 16:12:42,1,86600,IL,SHOP (Small Group),Yes,35-0472300,86600IL0010005,Lincoln Dental Connect?,86600IL001,,ILN001,ILS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.65,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,86600IL0010005-00,Standard High Off Exchange Plan,85.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IL,86600,SERFF,2,2014-09-09 16:12:42,1,86600,IL,SHOP (Small Group),Yes,35-0472300,86600IL0010006,Lincoln Dental Connect?,86600IL001,,ILN001,ILS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.18,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,86600IL0010006-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,IL,86600,SERFF,2,2014-09-09 16:12:42,2,86600,IL,SHOP (Small Group),Yes,35-0472300,86600IL0010004,Lincoln Dental Connect?,86600IL001,,ILN001,ILS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.16,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,86600IL0010004-00,Standard High Off Exchange Plan,86.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,86600,SERFF,2,2014-09-09 16:12:42,2,86600,IL,SHOP (Small Group),Yes,35-0472300,86600IL0010007,Lincoln Dental Connect?,86600IL001,,ILN001,ILS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.92,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,86600IL0010007-00,Standard High Off Exchange Plan,86.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,87304,SERFF,4,2014-12-11 11:35:20,1,87304,IL,SHOP (Small Group),Yes,36-4189451,87304IL0020002,Managed DentalGuard IL Child Essentials 1,87304IL002,,ILN001,ILS001,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$14.59,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,87304IL0020002-00,Standard Low Off Exchange Plan,70.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,87304,SERFF,4,2014-12-11 11:35:20,1,87304,IL,Individual,Yes,36-4189451,87304IL0060001,Managed DentalGuard IL Essentials 1,87304IL006,,ILN001,ILS001,,New,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$14.59,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,https://mydental.guardianlife.com/exchange/illinois,,https://mydental.guardianlife.com/exchange/illinois,,87304IL0060001-00,Standard Low Off Exchange Plan,70.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,87304,SERFF,4,2014-12-11 11:35:20,1,87304,IL,Individual,Yes,36-4189451,87304IL0060001,Managed DentalGuard IL Essentials 1,87304IL006,,ILN001,ILS001,,New,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$14.59,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,https://mydental.guardianlife.com/exchange/illinois,,https://mydental.guardianlife.com/exchange/illinois,,87304IL0060001-01,Standard Low On Exchange Plan,70.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,87304,SERFF,4,2014-12-11 11:35:20,2,87304,IL,SHOP (Small Group),Yes,36-4189451,87304IL0030002,Managed DentalGuard IL10 Family Plan,87304IL003,,ILN001,ILS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$14.59,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,87304IL0030002-00,Standard Low Off Exchange Plan,70.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,IL,87304,SERFF,4,2014-12-11 11:35:20,2,87304,IL,SHOP (Small Group),Yes,36-4189451,87304IL0030002,Managed DentalGuard IL10 Family Plan,87304IL003,,ILN001,ILS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$14.59,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,87304IL0030002-01,Standard Low On Exchange Plan,70.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,IL,87304,SERFF,4,2014-12-11 11:35:20,2,87304,IL,SHOP (Small Group),Yes,36-4189451,87304IL0040002,Managed DentalGuard IL20 Family Plan,87304IL004,,ILN001,ILS001,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$14.59,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,87304IL0040002-00,Standard Low Off Exchange Plan,70.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,IL,87304,SERFF,4,2014-12-11 11:35:20,2,87304,IL,SHOP (Small Group),Yes,36-4189451,87304IL0050002,Managed DentalGuard IL30 Family Plan,87304IL005,,ILN001,ILS001,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$14.59,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,87304IL0050002-00,Standard Low Off Exchange Plan,70.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,1,96601,IL,Individual,No,37-1241037,96601IL0200003,Coventry Bronze $20 Copay Carelink Methodist,96601IL020,,ILN004,ILS004,ILF013,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48733,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200003-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,1,96601,IL,Individual,No,37-1241037,96601IL0200003,Coventry Bronze $20 Copay Carelink Methodist,96601IL020,,ILN004,ILS004,ILF013,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48733,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200003-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,1,96601,IL,Individual,No,37-1241037,96601IL0200003,Coventry Bronze $20 Copay Carelink Methodist,96601IL020,,ILN004,ILS004,ILF013,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48733,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,1,96601,IL,Individual,No,37-1241037,96601IL0200003,Coventry Bronze $20 Copay Carelink Methodist,96601IL020,,ILN004,ILS004,ILF013,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48733,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200003-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,2,96601,IL,Individual,No,37-1241037,96601IL0210003,Coventry Bronze $20 Copay Carelink St. John's,96601IL021,,ILN005,ILS005,ILF023,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48757,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210003-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,2,96601,IL,Individual,No,37-1241037,96601IL0210003,Coventry Bronze $20 Copay Carelink St. John's,96601IL021,,ILN005,ILS005,ILF023,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48757,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210003-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,3,96601,IL,Individual,No,37-1241037,96601IL0190003,Coventry Bronze $20 Copay Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF008,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48745,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190003-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,5,96601,IL,Individual,No,37-1241037,96601IL0200011,Coventry Bronze $20 Copay UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF020,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48868,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200011-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,6,96601,IL,Individual,No,37-1241037,96601IL0170003,Coventry Bronze $25 Copay,96601IL017,,ILN001,ILS001,ILF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48709,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170003-00,Standard Bronze Off Exchange Plan,61.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,6,96601,IL,Individual,No,37-1241037,96601IL0170003,Coventry Bronze $25 Copay,96601IL017,,ILN001,ILS001,ILF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48709,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170003-01,Standard Bronze On Exchange Plan,61.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,6,96601,IL,Individual,No,37-1241037,96601IL0170003,Coventry Bronze $25 Copay,96601IL017,,ILN001,ILS001,ILF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48709,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,6,96601,IL,Individual,No,37-1241037,96601IL0170003,Coventry Bronze $25 Copay,96601IL017,,ILN001,ILS001,ILF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48709,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170003-03,Limited Cost Sharing Plan Variation,61.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,7,96601,IL,Individual,No,37-1241037,96601IL0170004,Coventry Bronze Deductible Only HSA Eligible,96601IL017,,ILN001,ILS001,ILF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48710,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170004-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,7,96601,IL,Individual,No,37-1241037,96601IL0170004,Coventry Bronze Deductible Only HSA Eligible,96601IL017,,ILN001,ILS001,ILF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48710,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170004-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,7,96601,IL,Individual,No,37-1241037,96601IL0170004,Coventry Bronze Deductible Only HSA Eligible,96601IL017,,ILN001,ILS001,ILF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48710,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,7,96601,IL,Individual,No,37-1241037,96601IL0170004,Coventry Bronze Deductible Only HSA Eligible,96601IL017,,ILN001,ILS001,ILF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48710,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170004-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,8,96601,IL,Individual,No,37-1241037,96601IL0200004,Coventry Bronze Deductible Only HSA Eligible Carelink Methodist,96601IL020,,ILN004,ILS004,ILF014,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48734,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200004-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,8,96601,IL,Individual,No,37-1241037,96601IL0200004,Coventry Bronze Deductible Only HSA Eligible Carelink Methodist,96601IL020,,ILN004,ILS004,ILF014,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48734,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200004-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,8,96601,IL,Individual,No,37-1241037,96601IL0200004,Coventry Bronze Deductible Only HSA Eligible Carelink Methodist,96601IL020,,ILN004,ILS004,ILF014,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48734,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,8,96601,IL,Individual,No,37-1241037,96601IL0200004,Coventry Bronze Deductible Only HSA Eligible Carelink Methodist,96601IL020,,ILN004,ILS004,ILF014,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48734,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200004-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,9,96601,IL,Individual,No,37-1241037,96601IL0210004,Coventry Bronze Deductible Only HSA Eligible Carelink St. John's,96601IL021,,ILN005,ILS005,ILF024,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48758,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210004-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,9,96601,IL,Individual,No,37-1241037,96601IL0210004,Coventry Bronze Deductible Only HSA Eligible Carelink St. John's,96601IL021,,ILN005,ILS005,ILF024,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48758,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210004-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,9,96601,IL,Individual,No,37-1241037,96601IL0210004,Coventry Bronze Deductible Only HSA Eligible Carelink St. John's,96601IL021,,ILN005,ILS005,ILF024,Existing,PPO,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48758,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,11,96601,IL,Individual,No,37-1241037,96601IL0200001,Coventry Gold $5 Copay Carelink Methodist,96601IL020,,ILN004,ILS004,ILF011,Existing,PPO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48724,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200001-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,11,96601,IL,Individual,No,37-1241037,96601IL0200001,Coventry Gold $5 Copay Carelink Methodist,96601IL020,,ILN004,ILS004,ILF011,Existing,PPO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48724,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,11,96601,IL,Individual,No,37-1241037,96601IL0200001,Coventry Gold $5 Copay Carelink Methodist,96601IL020,,ILN004,ILS004,ILF011,Existing,PPO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48724,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200001-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,12,96601,IL,Individual,No,37-1241037,96601IL0230004,Coventry Bronze Deductible Only HSA Eligible Select,96601IL023,,ILN002,ILS002,ILF029,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48722,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230004-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,12,96601,IL,Individual,No,37-1241037,96601IL0230004,Coventry Bronze Deductible Only HSA Eligible Select,96601IL023,,ILN002,ILS002,ILF029,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48722,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230004-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,12,96601,IL,Individual,No,37-1241037,96601IL0230004,Coventry Bronze Deductible Only HSA Eligible Select,96601IL023,,ILN002,ILS002,ILF029,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48722,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,12,96601,IL,Individual,No,37-1241037,96601IL0230004,Coventry Bronze Deductible Only HSA Eligible Select,96601IL023,,ILN002,ILS002,ILF029,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48722,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230004-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,13,96601,IL,Individual,No,37-1241037,96601IL0230001,Coventry Gold $5 Copay Select,96601IL023,,ILN002,ILS002,ILF026,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48712,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230001-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,13,96601,IL,Individual,No,37-1241037,96601IL0230001,Coventry Gold $5 Copay Select,96601IL023,,ILN002,ILS002,ILF026,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48712,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230001-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,13,96601,IL,Individual,No,37-1241037,96601IL0230001,Coventry Gold $5 Copay Select,96601IL023,,ILN002,ILS002,ILF026,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48712,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,13,96601,IL,Individual,No,37-1241037,96601IL0230001,Coventry Gold $5 Copay Select,96601IL023,,ILN002,ILS002,ILF026,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48712,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230001-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,14,96601,IL,Individual,No,37-1241037,96601IL0200006,Coventry Bronze Deductible Only HSA UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF015,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48873,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200006-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,14,96601,IL,Individual,No,37-1241037,96601IL0200006,Coventry Bronze Deductible Only HSA UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF015,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48873,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200006-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,14,96601,IL,Individual,No,37-1241037,96601IL0200006,Coventry Bronze Deductible Only HSA UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF015,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48873,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,14,96601,IL,Individual,No,37-1241037,96601IL0200006,Coventry Bronze Deductible Only HSA UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF015,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48873,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200006-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,15,96601,IL,Individual,No,37-1241037,96601IL0170006,Coventry Silver $10 Copay 2750,96601IL017,,ILN001,ILS001,ILF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48707,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170006-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,15,96601,IL,Individual,No,37-1241037,96601IL0170006,Coventry Silver $10 Copay 2750,96601IL017,,ILN001,ILS001,ILF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48707,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170006-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,15,96601,IL,Individual,No,37-1241037,96601IL0170006,Coventry Silver $10 Copay 2750,96601IL017,,ILN001,ILS001,ILF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48707,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,15,96601,IL,Individual,No,37-1241037,96601IL0170006,Coventry Silver $10 Copay 2750,96601IL017,,ILN001,ILS001,ILF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48707,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170006-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,15,96601,IL,Individual,No,37-1241037,96601IL0170006,Coventry Silver $10 Copay 2750,96601IL017,,ILN001,ILS001,ILF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48707,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170006-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,950","$9,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,15,96601,IL,Individual,No,37-1241037,96601IL0170006,Coventry Silver $10 Copay 2750,96601IL017,,ILN001,ILS001,ILF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48707,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170006-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,15,96601,IL,Individual,No,37-1241037,96601IL0170006,Coventry Silver $10 Copay 2750,96601IL017,,ILN001,ILS001,ILF005,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48707,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170006-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,16,96601,IL,Individual,No,37-1241037,96601IL0200002,Coventry Silver $10 Copay Carelink Methodist,96601IL020,,ILN004,ILS004,ILF012,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48725,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200002-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,16,96601,IL,Individual,No,37-1241037,96601IL0200002,Coventry Silver $10 Copay Carelink Methodist,96601IL020,,ILN004,ILS004,ILF012,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48725,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200002-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,16,96601,IL,Individual,No,37-1241037,96601IL0200002,Coventry Silver $10 Copay Carelink Methodist,96601IL020,,ILN004,ILS004,ILF012,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48725,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,16,96601,IL,Individual,No,37-1241037,96601IL0200002,Coventry Silver $10 Copay Carelink Methodist,96601IL020,,ILN004,ILS004,ILF012,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48725,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200002-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,16,96601,IL,Individual,No,37-1241037,96601IL0200002,Coventry Silver $10 Copay Carelink Methodist,96601IL020,,ILN004,ILS004,ILF012,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48725,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200002-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,16,96601,IL,Individual,No,37-1241037,96601IL0200002,Coventry Silver $10 Copay Carelink Methodist,96601IL020,,ILN004,ILS004,ILF012,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48725,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200002-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,24,96601,IL,Individual,No,37-1241037,96601IL0190006,Coventry Silver $5 Copay 2750 Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF010,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48743,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190006-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,24,96601,IL,Individual,No,37-1241037,96601IL0190006,Coventry Silver $5 Copay 2750 Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF010,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48743,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190006-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,24,96601,IL,Individual,No,37-1241037,96601IL0190006,Coventry Silver $5 Copay 2750 Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF010,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48743,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190006-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,24,96601,IL,Individual,No,37-1241037,96601IL0190006,Coventry Silver $5 Copay 2750 Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF010,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48743,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190006-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,18,96601,IL,Individual,No,37-1241037,96601IL0190002,Coventry Silver $10 Copay Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF007,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48737,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190002-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,18,96601,IL,Individual,No,37-1241037,96601IL0190002,Coventry Silver $10 Copay Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF007,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48737,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190002-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,18,96601,IL,Individual,No,37-1241037,96601IL0190002,Coventry Silver $10 Copay Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF007,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48737,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,18,96601,IL,Individual,No,37-1241037,96601IL0190002,Coventry Silver $10 Copay Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF007,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48737,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190002-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,18,96601,IL,Individual,No,37-1241037,96601IL0190002,Coventry Silver $10 Copay Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF007,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48737,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190002-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,18,96601,IL,Individual,No,37-1241037,96601IL0190002,Coventry Silver $10 Copay Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF007,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48737,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190002-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,18,96601,IL,Individual,No,37-1241037,96601IL0190002,Coventry Silver $10 Copay Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF007,Existing,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48737,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190002-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,19,96601,IL,Individual,No,37-1241037,96601IL0230002,Coventry Silver $10 Copay Select,96601IL023,,ILN002,ILS002,ILF027,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48714,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230002-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,19,96601,IL,Individual,No,37-1241037,96601IL0230002,Coventry Silver $10 Copay Select,96601IL023,,ILN002,ILS002,ILF027,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48714,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230002-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,19,96601,IL,Individual,No,37-1241037,96601IL0230002,Coventry Silver $10 Copay Select,96601IL023,,ILN002,ILS002,ILF027,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48714,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,19,96601,IL,Individual,No,37-1241037,96601IL0230002,Coventry Silver $10 Copay Select,96601IL023,,ILN002,ILS002,ILF027,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48714,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230002-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,19,96601,IL,Individual,No,37-1241037,96601IL0230002,Coventry Silver $10 Copay Select,96601IL023,,ILN002,ILS002,ILF027,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48714,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230002-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,19,96601,IL,Individual,No,37-1241037,96601IL0230002,Coventry Silver $10 Copay Select,96601IL023,,ILN002,ILS002,ILF027,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48714,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230002-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,19,96601,IL,Individual,No,37-1241037,96601IL0230002,Coventry Silver $10 Copay Select,96601IL023,,ILN002,ILS002,ILF027,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48714,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230002-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,20,96601,IL,Individual,No,37-1241037,96601IL0200008,Coventry Silver $10 Copay UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF017,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48855,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200008-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,20,96601,IL,Individual,No,37-1241037,96601IL0200008,Coventry Silver $10 Copay UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF017,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48855,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200008-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,20,96601,IL,Individual,No,37-1241037,96601IL0200008,Coventry Silver $10 Copay UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF017,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48855,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200008-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,20,96601,IL,Individual,No,37-1241037,96601IL0200008,Coventry Silver $10 Copay UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF017,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48855,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200008-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,20,96601,IL,Individual,No,37-1241037,96601IL0200008,Coventry Silver $10 Copay UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF017,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48855,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200008-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,20,96601,IL,Individual,No,37-1241037,96601IL0200008,Coventry Silver $10 Copay UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF017,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48855,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200008-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,20,96601,IL,Individual,No,37-1241037,96601IL0200008,Coventry Silver $10 Copay UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF017,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48855,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200008-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,21,96601,IL,Individual,No,37-1241037,96601IL0170002,Coventry Silver $15 Copay,96601IL017,,ILN001,ILS001,ILF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48703,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170002-00,Standard Silver Off Exchange Plan,68.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,21,96601,IL,Individual,No,37-1241037,96601IL0170002,Coventry Silver $15 Copay,96601IL017,,ILN001,ILS001,ILF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48703,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170002-01,Standard Silver On Exchange Plan,68.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,21,96601,IL,Individual,No,37-1241037,96601IL0170002,Coventry Silver $15 Copay,96601IL017,,ILN001,ILS001,ILF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48703,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,21,96601,IL,Individual,No,37-1241037,96601IL0170002,Coventry Silver $15 Copay,96601IL017,,ILN001,ILS001,ILF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48703,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170002-03,Limited Cost Sharing Plan Variation,68.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,21,96601,IL,Individual,No,37-1241037,96601IL0170002,Coventry Silver $15 Copay,96601IL017,,ILN001,ILS001,ILF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48703,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170002-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,21,96601,IL,Individual,No,37-1241037,96601IL0170002,Coventry Silver $15 Copay,96601IL017,,ILN001,ILS001,ILF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48703,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170002-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,050","$4,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,21,96601,IL,Individual,No,37-1241037,96601IL0170002,Coventry Silver $15 Copay,96601IL017,,ILN001,ILS001,ILF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48703,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170002-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,22,96601,IL,Individual,No,37-1241037,96601IL0200009,Coventry Silver $5 Copay 2750 Carelink Methodist,96601IL020,,ILN004,ILS004,ILF018,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48731,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200009-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,22,96601,IL,Individual,No,37-1241037,96601IL0200009,Coventry Silver $5 Copay 2750 Carelink Methodist,96601IL020,,ILN004,ILS004,ILF018,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48731,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200009-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,22,96601,IL,Individual,No,37-1241037,96601IL0200009,Coventry Silver $5 Copay 2750 Carelink Methodist,96601IL020,,ILN004,ILS004,ILF018,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48731,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200009-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,22,96601,IL,Individual,No,37-1241037,96601IL0200009,Coventry Silver $5 Copay 2750 Carelink Methodist,96601IL020,,ILN004,ILS004,ILF018,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48731,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200009-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,22,96601,IL,Individual,No,37-1241037,96601IL0200009,Coventry Silver $5 Copay 2750 Carelink Methodist,96601IL020,,ILN004,ILS004,ILF018,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48731,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200009-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,22,96601,IL,Individual,No,37-1241037,96601IL0200009,Coventry Silver $5 Copay 2750 Carelink Methodist,96601IL020,,ILN004,ILS004,ILF018,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48731,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200009-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,1,18558,KS,SHOP (Small Group),No,48-0952857,18558KS0370001,BlueCare PremierSHOP,18558KS037,,KSN001,KSS001,KSF002,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370001,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370001&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0370001-01,Standard Gold On Exchange Plan,78.55%,0.785494446754456,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,400",$20,"$1,200",$200,$500,"$1,300",$0,$40,5
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,1,18558,KS,Individual,No,48-0952857,18558KS0360001,BlueCare Elite with pediatric dental,18558KS036,,KSN001,KSS001,KSF005,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360001,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360001&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360001-01,Standard Platinum On Exchange Plan,,0.882025182247162,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,"$1,200",$200,$0,$0,"$1,200",$40,5
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,1,18558,KS,Individual,No,48-0952857,18558KS0360001,BlueCare Elite with pediatric dental,18558KS036,,KSN001,KSS001,KSF005,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360001,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360001&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,1,18558,KS,Individual,No,48-0952857,18558KS0360001,BlueCare Elite with pediatric dental,18558KS036,,KSN001,KSS001,KSF005,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360001,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360001&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360001-03,Limited Cost Sharing Plan Variation,,0.882025182247162,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,"$1,200",$200,$0,$0,"$1,200",$40,7
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,2,18558,KS,Individual,No,48-0952857,18558KS0360007,BlueCare Elite,18558KS036,,KSN001,KSS001,KSF005,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360007,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360008&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360007-00,Standard Platinum Off Exchange Plan,,0.882025182247162,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,"$1,200",$200,$0,$0,"$1,200",$40,4
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,12,18558,KS,Individual,No,48-0952857,18558KS0360027,BlueCare SaverPlus Select,18558KS036,,KSN002,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360027,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360027&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360027-04,73% AV Level Silver Plan,72.01%,0.720133721828461,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,400","$4,800",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,400",$20,"$1,000",$200,$400,"$1,300",$0,$40,15
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,12,18558,KS,Individual,No,48-0952857,18558KS0360027,BlueCare SaverPlus Select,18558KS036,,KSN002,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360027,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360027&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360027-05,87% AV Level Silver Plan,86.36%,0.863579392433167,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$800,$0,$800,$200,$400,"$1,100",$0,$40,16
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,6,18558,KS,SHOP (Small Group),No,48-0952857,18558KS0370017,BlueCare SignatureSSHOP Select,18558KS037,,KSN002,KSS001,KSF003,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370017,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370017&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0370017-00,Standard Silver Off Exchange Plan,,0.681725680828094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,600",$200,"$2,000",$400,$800,$40,6
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,6,18558,KS,SHOP (Small Group),No,48-0952857,18558KS0370017,BlueCare SignatureSSHOP Select,18558KS037,,KSN002,KSS001,KSF003,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370017,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370017&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0370017-01,Standard Silver On Exchange Plan,,0.681725680828094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,600",$200,"$2,000",$400,$800,$40,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,22,96601,IL,Individual,No,37-1241037,96601IL0200009,Coventry Silver $5 Copay 2750 Carelink Methodist,96601IL020,,ILN004,ILS004,ILF018,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48731,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkMethodistIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200009-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,23,96601,IL,Individual,No,37-1241037,96601IL0210006,Coventry Silver $5 Copay 2750 Carelink St. John's,96601IL021,,ILN005,ILS005,ILF025,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48755,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210006-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,23,96601,IL,Individual,No,37-1241037,96601IL0210006,Coventry Silver $5 Copay 2750 Carelink St. John's,96601IL021,,ILN005,ILS005,ILF025,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48755,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210006-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,23,96601,IL,Individual,No,37-1241037,96601IL0210006,Coventry Silver $5 Copay 2750 Carelink St. John's,96601IL021,,ILN005,ILS005,ILF025,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48755,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,23,96601,IL,Individual,No,37-1241037,96601IL0210006,Coventry Silver $5 Copay 2750 Carelink St. John's,96601IL021,,ILN005,ILS005,ILF025,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48755,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210006-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,23,96601,IL,Individual,No,37-1241037,96601IL0210006,Coventry Silver $5 Copay 2750 Carelink St. John's,96601IL021,,ILN005,ILS005,ILF025,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48755,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210006-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,23,96601,IL,Individual,No,37-1241037,96601IL0210006,Coventry Silver $5 Copay 2750 Carelink St. John's,96601IL021,,ILN005,ILS005,ILF025,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48755,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210006-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,23,96601,IL,Individual,No,37-1241037,96601IL0210006,Coventry Silver $5 Copay 2750 Carelink St. John's,96601IL021,,ILN005,ILS005,ILF025,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48755,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210006-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,24,96601,IL,Individual,No,37-1241037,96601IL0190006,Coventry Silver $5 Copay 2750 Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF010,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48743,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190006-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,24,96601,IL,Individual,No,37-1241037,96601IL0190006,Coventry Silver $5 Copay 2750 Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF010,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48743,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190006-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,24,96601,IL,Individual,No,37-1241037,96601IL0190006,Coventry Silver $5 Copay 2750 Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF010,New,PPO,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48743,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,25,96601,IL,Individual,No,37-1241037,96601IL0230006,Coventry Silver $5 Copay 2750 Select,96601IL023,,ILN002,ILS002,ILF030,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48719,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230006-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,25,96601,IL,Individual,No,37-1241037,96601IL0230006,Coventry Silver $5 Copay 2750 Select,96601IL023,,ILN002,ILS002,ILF030,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48719,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230006-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,25,96601,IL,Individual,No,37-1241037,96601IL0230006,Coventry Silver $5 Copay 2750 Select,96601IL023,,ILN002,ILS002,ILF030,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48719,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,25,96601,IL,Individual,No,37-1241037,96601IL0230006,Coventry Silver $5 Copay 2750 Select,96601IL023,,ILN002,ILS002,ILF030,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48719,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230006-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,25,96601,IL,Individual,No,37-1241037,96601IL0230006,Coventry Silver $5 Copay 2750 Select,96601IL023,,ILN002,ILS002,ILF030,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48719,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230006-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,25,96601,IL,Individual,No,37-1241037,96601IL0230006,Coventry Silver $5 Copay 2750 Select,96601IL023,,ILN002,ILS002,ILF030,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48719,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230006-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,25,96601,IL,Individual,No,37-1241037,96601IL0230006,Coventry Silver $5 Copay 2750 Select,96601IL023,,ILN002,ILS002,ILF030,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48719,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/SelectIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0230006-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,26,96601,IL,Individual,No,37-1241037,96601IL0200010,Coventry Silver $5 Copay 2750 UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF019,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48862,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200010-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,26,96601,IL,Individual,No,37-1241037,96601IL0200010,Coventry Silver $5 Copay 2750 UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF019,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48862,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200010-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,26,96601,IL,Individual,No,37-1241037,96601IL0200010,Coventry Silver $5 Copay 2750 UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF019,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48862,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200010-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,26,96601,IL,Individual,No,37-1241037,96601IL0200010,Coventry Silver $5 Copay 2750 UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF019,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48862,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200010-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,26,96601,IL,Individual,No,37-1241037,96601IL0200010,Coventry Silver $5 Copay 2750 UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF019,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48862,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200010-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,27,96601,IL,Individual,No,37-1241037,96601IL0200007,Coventry Gold $5 Copay UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF016,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48852,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200007-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,27,96601,IL,Individual,No,37-1241037,96601IL0200007,Coventry Gold $5 Copay UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF016,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48852,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200007-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,27,96601,IL,Individual,No,37-1241037,96601IL0200007,Coventry Gold $5 Copay UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF016,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48852,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200007-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,27,96601,IL,Individual,No,37-1241037,96601IL0200007,Coventry Gold $5 Copay UnityPoint Health Quad Cities,96601IL020,,ILN006,ILS006,ILF016,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48852,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/UnityPointQuadCitiesIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0200007-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,28,96601,IL,Individual,No,37-1241037,96601IL0190001,Coventry Gold $5 Copay Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF006,Existing,PPO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48736,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190001-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,4,18558,KS,Individual,No,48-0952857,18558KS0360018,BlueCare Signature Select,18558KS036,,KSN002,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360018,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360018&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360018-03,Limited Cost Sharing Plan Variation,,0.682029366493225,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$100,$200,50%,,,,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$0,$900,$200,$400,$400,"$2,000",$40,18
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,4,18558,KS,Individual,No,48-0952857,18558KS0360018,BlueCare Signature Select,18558KS036,,KSN002,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360018,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360018&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360018-04,73% AV Level Silver Plan,,0.723213791847229,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$100,$200,50%,,,,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$20,"$1,000",$200,$400,"$1,300",$0,$40,19
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,11,18558,KS,Individual,No,48-0952857,18558KS0360021,BlueCare SaverPlus with pediatric dental,18558KS036,,KSN001,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360021,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360021&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360021-03,Limited Cost Sharing Plan Variation,68.25%,0.682458579540253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,$800,$200,$400,"$1,400",$0,$40,7
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,11,18558,KS,Individual,No,48-0952857,18558KS0360021,BlueCare SaverPlus with pediatric dental,18558KS036,,KSN001,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360021,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360021&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360021-04,73% AV Level Silver Plan,72.01%,0.720133721828461,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,400","$4,800",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,400",$20,"$1,000",$200,$400,"$1,300",$0,$40,8
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,11,18558,KS,Individual,No,48-0952857,18558KS0360021,BlueCare SaverPlus with pediatric dental,18558KS036,,KSN001,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360021,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360021&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360021-05,87% AV Level Silver Plan,86.36%,0.863579392433167,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$800,$0,$800,$200,$400,"$1,100",$0,$40,9
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,5,18558,KS,Individual,No,48-0952857,18558KS0360019,BlueCare Premier with pediatric dental,18558KS036,,KSN001,KSS001,KSF002,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360019,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360019&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360019-00,Standard Gold Off Exchange Plan,78.55%,0.785494446754456,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,400",$20,"$1,200",$200,$500,"$1,300",$0,$40,4
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,5,18558,KS,SHOP (Small Group),No,48-0952857,18558KS0370015,BlueCare PremierSSHOP,18558KS037,,KSN001,KSS001,KSF002,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370015,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370015&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0370015-00,Standard Gold Off Exchange Plan,78.55%,0.785494446754456,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,400",$20,"$1,200",$200,$500,"$1,300",$0,$40,4
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,5,18558,KS,SHOP (Small Group),No,48-0952857,18558KS0370015,BlueCare PremierSSHOP,18558KS037,,KSN001,KSS001,KSF002,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370015,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370015&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0370015-01,Standard Gold On Exchange Plan,78.55%,0.785494446754456,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,400",$20,"$1,200",$200,$500,"$1,300",$0,$40,5
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,5,18558,KS,Individual,No,48-0952857,18558KS0360019,BlueCare Premier with pediatric dental,18558KS036,,KSN001,KSS001,KSF002,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360019,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360019&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360019-01,Standard Gold On Exchange Plan,78.55%,0.785494446754456,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,400",$20,"$1,200",$200,$500,"$1,300",$0,$40,5
2015,KS,51687,SERFF,1,2014-09-04 06:14:21,2,51687,KS,SHOP (Small Group),Yes,44-0308260,51687KS0010002,KCL EHB High PPO,51687KS001,,KSN001,KSS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$49.99,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,51687KS0010002-00,Standard High Off Exchange Plan,85.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,51687,SERFF,1,2014-09-04 06:14:21,2,51687,KS,SHOP (Small Group),Yes,44-0308260,51687KS0010004,KCL EHB High MAC,51687KS001,,KSN001,KSS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$37.59,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,51687KS0010004-00,Standard High Off Exchange Plan,85.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,51687,SERFF,1,2014-09-04 06:14:21,2,51687,KS,SHOP (Small Group),Yes,44-0308260,51687KS0010006,KCL Fam High PPO,51687KS001,,KSN001,KSS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$49.99,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,51687KS0010006-00,Standard High Off Exchange Plan,85.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,KS,51687,SERFF,1,2014-09-04 06:14:21,2,51687,KS,SHOP (Small Group),Yes,44-0308260,51687KS0010008,KCL Fam High MAC,51687KS001,,KSN001,KSS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$37.59,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,51687KS0010008-00,Standard High Off Exchange Plan,85.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,1,61430,KS,Individual,No,75-1296086,61430KS0110003,Coventry Bronze $20 Copay KCPPO,61430KS011,,KSN002,KSS002,KSF009,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48300,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110003-00,Standard Bronze Off Exchange Plan,61.30%,,Yes,Yes,Yes,92%,8%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,1,61430,KS,Individual,No,75-1296086,61430KS0110003,Coventry Bronze $20 Copay KCPPO,61430KS011,,KSN002,KSS002,KSF009,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48300,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110003-01,Standard Bronze On Exchange Plan,61.30%,,Yes,Yes,Yes,92%,8%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,1,61430,KS,Individual,No,75-1296086,61430KS0110003,Coventry Bronze $20 Copay KCPPO,61430KS011,,KSN002,KSS002,KSF009,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48300,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,92%,8%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,1,61430,KS,Individual,No,75-1296086,61430KS0110003,Coventry Bronze $20 Copay KCPPO,61430KS011,,KSN002,KSS002,KSF009,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48300,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110003-03,Limited Cost Sharing Plan Variation,61.30%,,Yes,Yes,Yes,92%,8%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,11,18558,KS,Individual,No,48-0952857,18558KS0360021,BlueCare SaverPlus with pediatric dental,18558KS036,,KSN001,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360021,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360021&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360021-06,94% AV Level Silver Plan,93.35%,0.933524310588837,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$300,$0,$300,$200,$300,$200,$10,$40,10
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,14,61430,KS,Individual,No,75-1296086,61430KS0100007,Coventry Silver HSA Eligible PPO,61430KS010,,KSN001,KSS001,KSF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48350,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100007-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,14,61430,KS,Individual,No,75-1296086,61430KS0100007,Coventry Silver HSA Eligible PPO,61430KS010,,KSN001,KSS001,KSF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48350,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100007-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,14,61430,KS,Individual,No,75-1296086,61430KS0100007,Coventry Silver HSA Eligible PPO,61430KS010,,KSN001,KSS001,KSF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48350,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100007-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,28,96601,IL,Individual,No,37-1241037,96601IL0190001,Coventry Gold $5 Copay Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF006,Existing,PPO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48736,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190001-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,28,96601,IL,Individual,No,37-1241037,96601IL0190001,Coventry Gold $5 Copay Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF006,Existing,PPO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48736,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,28,96601,IL,Individual,No,37-1241037,96601IL0190001,Coventry Gold $5 Copay Carelink SwedishAmerican,96601IL019,,ILN003,ILS003,ILF006,Existing,PPO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48736,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkSwedishAmericanIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0190001-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,29,96601,IL,Individual,No,37-1241037,96601IL0210001,Coventry Gold $5 Copay Carelink St. John's,96601IL021,,ILN005,ILS005,ILF021,Existing,PPO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48748,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210001-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,29,96601,IL,Individual,No,37-1241037,96601IL0210001,Coventry Gold $5 Copay Carelink St. John's,96601IL021,,ILN005,ILS005,ILF021,Existing,PPO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48748,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210001-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,29,96601,IL,Individual,No,37-1241037,96601IL0210001,Coventry Gold $5 Copay Carelink St. John's,96601IL021,,ILN005,ILS005,ILF021,Existing,PPO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48748,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,29,96601,IL,Individual,No,37-1241037,96601IL0210001,Coventry Gold $5 Copay Carelink St. John's,96601IL021,,ILN005,ILS005,ILF021,Existing,PPO,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48748,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/CarelinkStJohnIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0210001-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,30,96601,IL,Individual,No,37-1241037,96601IL0170001,Coventry Gold $10 Copay,96601IL017,,ILN001,ILS001,ILF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48700,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170001-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,30,96601,IL,Individual,No,37-1241037,96601IL0170001,Coventry Gold $10 Copay,96601IL017,,ILN001,ILS001,ILF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48700,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170001-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,30,96601,IL,Individual,No,37-1241037,96601IL0170001,Coventry Gold $10 Copay,96601IL017,,ILN001,ILS001,ILF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48700,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,IL,96601,SERFF,3,2014-10-06 10:59:03,30,96601,IL,Individual,No,37-1241037,96601IL0170001,Coventry Gold $10 Copay,96601IL017,,ILN001,ILS001,ILF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/IL48700,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/PPOIL2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,96601IL0170001-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,KS,11339,SERFF,7,2014-11-15 10:06:04,1,11339,KS,Individual,Yes,75-1233841,11339KS0010001,Dentegra Dental PPO Pediatric Basic Plan,11339KS001,,KSN001,KSS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.75,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ks/11339ks0010001-15,,11339KS0010001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,11339,SERFF,7,2014-11-15 10:06:04,1,11339,KS,SHOP (Small Group),Yes,75-1233841,11339KS0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,11339KS002,,KSN001,KSS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.91,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ks/11339ks0020001-15,,11339KS0020001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,11339,SERFF,7,2014-11-15 10:06:04,1,11339,KS,SHOP (Small Group),Yes,75-1233841,11339KS0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,11339KS002,,KSN001,KSS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.91,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ks/11339ks0020001-15,,11339KS0020001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,11339,SERFF,7,2014-11-15 10:06:04,1,11339,KS,Individual,Yes,75-1233841,11339KS0010001,Dentegra Dental PPO Pediatric Basic Plan,11339KS001,,KSN001,KSS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.75,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ks/11339ks0010001-15,,11339KS0010001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,11339,SERFF,7,2014-11-15 10:06:04,2,11339,KS,Individual,Yes,75-1233841,11339KS0010006,Dentegra Dental PPO Family Basic Plan,11339KS001,,KSN001,KSS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.75,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ks/11339ks0010006-15,,11339KS0010006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,4,61430,KS,Individual,No,75-1296086,61430KS0110004,Coventry Bronze Deductible Only HSA Eligible KCPPO,61430KS011,,KSN002,KSS002,KSF010,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48303,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,4,61430,KS,Individual,No,75-1296086,61430KS0110004,Coventry Bronze Deductible Only HSA Eligible KCPPO,61430KS011,,KSN002,KSS002,KSF010,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48303,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110004-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$14,000","$28,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,5,61430,KS,Individual,No,75-1296086,61430KS0100004,Coventry Bronze Deductible Only HSA Eligible PPO,61430KS010,,KSN001,KSS001,KSF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48331,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100004-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$14,000","$28,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,5,61430,KS,Individual,No,75-1296086,61430KS0100004,Coventry Bronze Deductible Only HSA Eligible PPO,61430KS010,,KSN001,KSS001,KSF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48331,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100004-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$14,000","$28,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,5,61430,KS,Individual,No,75-1296086,61430KS0100004,Coventry Bronze Deductible Only HSA Eligible PPO,61430KS010,,KSN001,KSS001,KSF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48331,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,5,61430,KS,Individual,No,75-1296086,61430KS0100004,Coventry Bronze Deductible Only HSA Eligible PPO,61430KS010,,KSN001,KSS001,KSF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48331,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100004-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$14,000","$28,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,7,61430,KS,Individual,No,75-1296086,61430KS0110002,Coventry Silver $10 Copay KCPPO,61430KS011,,KSN002,KSS002,KSF008,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48310,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110002-00,Standard Silver Off Exchange Plan,68.30%,,No,Yes,Yes,92%,8%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,000","$32,000",Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,$500,Not Applicable,40%,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,2,18558,KS,SHOP (Small Group),No,48-0952857,18558KS0370002,BlueCare SignatureSHOP,18558KS037,,KSN001,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370002,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370002&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0370002-00,Standard Silver Off Exchange Plan,,0.681725680828094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,600",$200,"$2,000",$400,$800,$40,4
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,2,18558,KS,SHOP (Small Group),No,48-0952857,18558KS0370002,BlueCare SignatureSHOP,18558KS037,,KSN001,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370002,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370002&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0370002-01,Standard Silver On Exchange Plan,,0.681725680828094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,600",$200,"$2,000",$400,$800,$40,5
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,2,18558,KS,Individual,No,48-0952857,18558KS0360007,BlueCare Elite,18558KS036,,KSN001,KSS001,KSF005,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360007,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360008&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360007-01,Standard Platinum On Exchange Plan,,0.882025182247162,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,"$1,200",$200,$0,$0,"$1,200",$40,5
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,2,18558,KS,Individual,No,48-0952857,18558KS0360007,BlueCare Elite,18558KS036,,KSN001,KSS001,KSF005,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360007,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360008&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,2,18558,KS,SHOP (Small Group),No,48-0952857,18558KS0370003,BlueCare SignatureSHOP Select,18558KS037,,KSN002,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370003,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370003&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0370003-00,Standard Silver Off Exchange Plan,,0.681725680828094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,600",$200,"$2,000",$400,$800,$40,6
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,2,18558,KS,SHOP (Small Group),No,48-0952857,18558KS0370003,BlueCare SignatureSHOP Select,18558KS037,,KSN002,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370003,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370003&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0370003-01,Standard Silver On Exchange Plan,,0.681725680828094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,600",$200,"$2,000",$400,$800,$40,7
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,2,18558,KS,Individual,No,48-0952857,18558KS0360007,BlueCare Elite,18558KS036,,KSN001,KSS001,KSF005,Existing,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360007,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360008&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360007-03,Limited Cost Sharing Plan Variation,,0.882025182247162,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,50%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,"$1,200",$200,$0,$0,"$1,200",$40,7
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,3,18558,KS,SHOP (Small Group),No,48-0952857,18558KS0370004,BlueCare SaverSHOP,18558KS037,,KSN001,KSS001,KSF004,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370004,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370004&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0370004-00,Standard Bronze Off Exchange Plan,,0.594008922576904,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,600",50%,,,,"$6,800","$13,600",Not Applicable,Not Applicable,"$3,400",$0,"$1,900",$200,"$3,400",$0,"$1,000",$40,4
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,3,18558,KS,SHOP (Small Group),No,48-0952857,18558KS0370004,BlueCare SaverSHOP,18558KS037,,KSN001,KSS001,KSF004,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370004,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370004&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0370004-01,Standard Bronze On Exchange Plan,,0.594008922576904,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,600",50%,,,,"$6,800","$13,600",Not Applicable,Not Applicable,"$3,400",$0,"$1,900",$200,"$3,400",$0,"$1,000",$40,5
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,3,18558,KS,SHOP (Small Group),No,48-0952857,18558KS0370005,BlueCare SaverSHOP Select,18558KS037,,KSN001,KSS001,KSF004,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370005,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370005&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0370005-00,Standard Bronze Off Exchange Plan,,0.594008922576904,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,600",50%,,,,"$6,800","$13,600",Not Applicable,Not Applicable,"$3,400",$0,"$1,900",$200,"$3,400",$0,"$1,000",$40,6
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,3,18558,KS,SHOP (Small Group),No,48-0952857,18558KS0370005,BlueCare SaverSHOP Select,18558KS037,,KSN001,KSS001,KSF004,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370005,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370005&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0370005-01,Standard Bronze On Exchange Plan,,0.594008922576904,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,600",50%,,,,"$6,800","$13,600",Not Applicable,Not Applicable,"$3,400",$0,"$1,900",$200,"$3,400",$0,"$1,000",$40,7
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,4,18558,KS,Individual,No,48-0952857,18558KS0360016,BlueCare PremierPlus,18558KS036,,KSN001,KSS001,KSF006,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360016,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360016&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360016-00,Standard Gold Off Exchange Plan,,0.785770952701569,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$100,$200,50%,,,,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,"$1,200",$200,$400,$400,"$1,700",$40,4
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,4,18558,KS,Individual,No,48-0952857,18558KS0360016,BlueCare PremierPlus,18558KS036,,KSN001,KSS001,KSF006,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360016,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360016&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360016-01,Standard Gold On Exchange Plan,,0.785770952701569,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$100,$200,50%,,,,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,"$1,200",$200,$400,$400,"$1,700",$40,5
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,4,18558,KS,Individual,No,48-0952857,18558KS0360016,BlueCare PremierPlus,18558KS036,,KSN001,KSS001,KSF006,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360016,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360016&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360016-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,4,18558,KS,Individual,No,48-0952857,18558KS0360016,BlueCare PremierPlus,18558KS036,,KSN001,KSS001,KSF006,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360016,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360016&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360016-03,Limited Cost Sharing Plan Variation,,0.785770952701569,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$100,$200,50%,,,,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$0,"$1,200",$200,$400,$400,"$1,700",$40,7
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,4,18558,KS,Individual,No,48-0952857,18558KS0360017,BlueCare Signature,18558KS036,,KSN001,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360017,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360017&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360017-00,Standard Silver Off Exchange Plan,,0.682029366493225,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$100,$200,50%,,,,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$0,$900,$200,$400,$400,"$2,000",$40,8
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,4,18558,KS,Individual,No,48-0952857,18558KS0360017,BlueCare Signature,18558KS036,,KSN001,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360017,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360017&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360017-01,Standard Silver On Exchange Plan,,0.682029366493225,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$100,$200,50%,,,,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$0,$900,$200,$400,$400,"$2,000",$40,9
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,4,18558,KS,Individual,No,48-0952857,18558KS0360017,BlueCare Signature,18558KS036,,KSN001,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360017,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360017&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360017-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$40,10
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,4,18558,KS,Individual,No,48-0952857,18558KS0360017,BlueCare Signature,18558KS036,,KSN001,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360017,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360017&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360017-03,Limited Cost Sharing Plan Variation,,0.682029366493225,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$100,$200,50%,,,,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$0,$900,$200,$400,$400,"$2,000",$40,11
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,4,18558,KS,Individual,No,48-0952857,18558KS0360017,BlueCare Signature,18558KS036,,KSN001,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360017,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360017&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360017-04,73% AV Level Silver Plan,,0.723213791847229,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$100,$200,50%,,,,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,"$2,400",$20,"$1,000",$200,$400,"$1,300",$0,$40,12
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,4,18558,KS,Individual,No,48-0952857,18558KS0360017,BlueCare Signature,18558KS036,,KSN001,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360017,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360017&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360017-05,87% AV Level Silver Plan,,0.864288926124573,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$50,$100,20%,,,,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,$800,$0,$800,$200,$400,"$1,100",$0,$40,13
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,4,18558,KS,Individual,No,48-0952857,18558KS0360017,BlueCare Signature,18558KS036,,KSN001,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360017,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360017&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360017-06,94% AV Level Silver Plan,,0.931155264377594,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$250,$500,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$25,$50,20%,,,,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,$300,$0,$300,$200,$300,$200,$10,$40,14
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,4,18558,KS,Individual,No,48-0952857,18558KS0360018,BlueCare Signature Select,18558KS036,,KSN002,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360018,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360018&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360018-00,Standard Silver Off Exchange Plan,,0.682029366493225,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$100,$200,50%,,,,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$0,$900,$200,$400,$400,"$2,000",$40,15
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,4,18558,KS,Individual,No,48-0952857,18558KS0360018,BlueCare Signature Select,18558KS036,,KSN002,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360018,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360018&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360018-01,Standard Silver On Exchange Plan,,0.682029366493225,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$100,$200,50%,,,,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$0,$900,$200,$400,$400,"$2,000",$40,16
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,4,18558,KS,Individual,No,48-0952857,18558KS0360018,BlueCare Signature Select,18558KS036,,KSN002,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360018,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360018&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360018-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$40,17
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,4,18558,KS,Individual,No,48-0952857,18558KS0360018,BlueCare Signature Select,18558KS036,,KSN002,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360018,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360018&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360018-05,87% AV Level Silver Plan,,0.864288926124573,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$50,$100,20%,,,,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,$800,$0,$800,$200,$400,"$1,100",$0,$40,20
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,4,18558,KS,Individual,No,48-0952857,18558KS0360018,BlueCare Signature Select,18558KS036,,KSN002,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360018,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360018&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360018-06,94% AV Level Silver Plan,,0.931155264377594,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$250,$500,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$25,$50,20%,,,,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,$300,$0,$300,$200,$300,$200,$10,$40,21
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,5,18558,KS,Individual,No,48-0952857,18558KS0360019,BlueCare Premier with pediatric dental,18558KS036,,KSN001,KSS001,KSF002,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360019,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360019&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360019-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,5,18558,KS,Individual,No,48-0952857,18558KS0360019,BlueCare Premier with pediatric dental,18558KS036,,KSN001,KSS001,KSF002,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360019,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360019&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360019-03,Limited Cost Sharing Plan Variation,78.55%,0.785494446754456,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,400",$20,"$1,200",$200,$500,"$1,300",$0,$40,7
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,6,18558,KS,Individual,No,48-0952857,18558KS0360025,BlueCare Premier,18558KS036,,KSN001,KSS001,KSF002,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360025,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360025&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360025-00,Standard Gold Off Exchange Plan,78.55%,0.785494446754456,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,400",$20,"$1,200",$200,$500,"$1,300",$0,$40,4
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,6,18558,KS,SHOP (Small Group),No,48-0952857,18558KS0370016,BlueCare SignatureSSHOP,18558KS037,,KSN001,KSS001,KSF003,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370016,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370016&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0370016-00,Standard Silver Off Exchange Plan,,0.681725680828094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,600",$200,"$2,000",$400,$800,$40,4
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,6,18558,KS,SHOP (Small Group),No,48-0952857,18558KS0370016,BlueCare SignatureSSHOP,18558KS037,,KSN001,KSS001,KSF003,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370016,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370016&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0370016-01,Standard Silver On Exchange Plan,,0.681725680828094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,600",$200,"$2,000",$400,$800,$40,5
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,6,18558,KS,Individual,No,48-0952857,18558KS0360025,BlueCare Premier,18558KS036,,KSN001,KSS001,KSF002,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360025,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360025&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360025-01,Standard Gold On Exchange Plan,78.55%,0.785494446754456,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,400",$20,"$1,200",$200,$500,"$1,300",$0,$40,5
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,6,18558,KS,Individual,No,48-0952857,18558KS0360025,BlueCare Premier,18558KS036,,KSN001,KSS001,KSF002,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360025,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360025&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360025-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,6,18558,KS,Individual,No,48-0952857,18558KS0360025,BlueCare Premier,18558KS036,,KSN001,KSS001,KSF002,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360025,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360025&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360025-03,Limited Cost Sharing Plan Variation,78.55%,0.785494446754456,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,400",$20,"$1,200",$200,$500,"$1,300",$0,$40,7
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,7,18558,KS,Individual,No,48-0952857,18558KS0360031,BlueCare Essential with pediatric dental,18558KS036,,KSN001,KSS001,KSF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360031,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360031&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360031-00,Standard Bronze Off Exchange Plan,,0.595843911170959,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$1,200","$1,000",$0,$40,4
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,8,18558,KS,Individual,No,48-0952857,18558KS0360035,BlueCare Essential,18558KS036,,KSN001,KSS001,KSF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360035,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360035&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360035-00,Standard Bronze Off Exchange Plan,,0.595843911170959,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$1,200","$1,000",$0,$40,4
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,7,18558,KS,SHOP (Small Group),No,48-0952857,18558KS0370018,BlueCare SaverSSHOP,18558KS037,,KSN001,KSS001,KSF004,New,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370018,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370018&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0370018-00,Standard Bronze Off Exchange Plan,,0.594008922576904,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,600",50%,,,,"$6,800","$13,600",Not Applicable,Not Applicable,"$3,400",$0,"$1,900",$200,"$3,400",$0,"$1,000",$40,4
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,7,18558,KS,SHOP (Small Group),No,48-0952857,18558KS0370018,BlueCare SaverSSHOP,18558KS037,,KSN001,KSS001,KSF004,New,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370018,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370018&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0370018-01,Standard Bronze On Exchange Plan,,0.594008922576904,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,600",50%,,,,"$6,800","$13,600",Not Applicable,Not Applicable,"$3,400",$0,"$1,900",$200,"$3,400",$0,"$1,000",$40,5
2015,KS,21004,SERFF,1,2014-09-05 06:40:30,1,21004,KS,SHOP (Small Group),Yes,35-0472300,21004KS0010003,Lincoln Dental Connect?,21004KS001,,KSN001,KSS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.42,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,21004KS0010003-00,Standard Low Off Exchange Plan,69.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,KS,21004,SERFF,1,2014-09-05 06:40:30,1,21004,KS,SHOP (Small Group),Yes,35-0472300,21004KS0010005,Lincoln Dental Connect?,21004KS001,,KSN001,KSS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.67,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,21004KS0010005-00,Standard High Off Exchange Plan,83.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,KS,21004,SERFF,1,2014-09-05 06:40:30,1,21004,KS,SHOP (Small Group),Yes,35-0472300,21004KS0010006,Lincoln Dental Connect?,21004KS001,,KSN001,KSS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.86,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,21004KS0010006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,KS,21004,SERFF,1,2014-09-05 06:40:30,1,21004,KS,SHOP (Small Group),Yes,35-0472300,21004KS0010007,Lincoln Dental Connect?,21004KS001,,KSN001,KSS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.21,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,21004KS0010007-00,Standard Low Off Exchange Plan,69.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,KS,21004,SERFF,1,2014-09-05 06:40:30,2,21004,KS,SHOP (Small Group),Yes,35-0472300,21004KS0010004,Lincoln Dental Connect?,21004KS001,,KSN001,KSS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.87,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,21004KS0010004-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,21004,SERFF,1,2014-09-05 06:40:30,2,21004,KS,SHOP (Small Group),Yes,35-0472300,21004KS0010008,Lincoln Dental Connect?,21004KS001,,KSN001,KSS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.29,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,21004KS0010008-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,1,27811,KS,Individual,No,80-0968685,27811KS0010001,BlueCare Solutions Gold,27811KS001,,KSN001,KSS001,KSF001,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010001,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010001&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0010001-00,Standard Gold Off Exchange Plan,78.55%,0.785494446754456,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400",$20,"$1,200",$200,$500,"$1,300",$0,$40,4
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,1,27811,KS,SHOP (Small Group),No,80-0968685,27811KS0020001,BlueCare Solutions GoldSHOP,27811KS002,,KSN001,KSS001,KSF001,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020001,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020001&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0020001-00,Standard Gold Off Exchange Plan,78.55%,0.785494446754456,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400",$20,"$1,200",$200,$500,"$1,300",$0,$40,4
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,1,27811,KS,SHOP (Small Group),No,80-0968685,27811KS0020001,BlueCare Solutions GoldSHOP,27811KS002,,KSN001,KSS001,KSF001,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020001,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020001&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0020001-01,Standard Gold On Exchange Plan,78.55%,0.785494446754456,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400",$20,"$1,200",$200,$500,"$1,300",$0,$40,5
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,1,27811,KS,Individual,No,80-0968685,27811KS0010001,BlueCare Solutions Gold,27811KS001,,KSN001,KSS001,KSF001,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010001,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010001&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0010001-01,Standard Gold On Exchange Plan,78.55%,0.785494446754456,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400",$20,"$1,200",$200,$500,"$1,300",$0,$40,5
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,1,27811,KS,Individual,No,80-0968685,27811KS0010001,BlueCare Solutions Gold,27811KS001,,KSN001,KSS001,KSF001,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010001,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010001&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0010001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,1,27811,KS,SHOP (Small Group),No,80-0968685,27811KS0020007,BlueCare Solutions GoldSSHOP,27811KS002,,KSN001,KSS001,KSF001,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020007,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020007&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0020007-00,Standard Gold Off Exchange Plan,78.55%,0.785494446754456,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400",$20,"$1,200",$200,$500,"$1,300",$0,$40,6
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,1,27811,KS,SHOP (Small Group),No,80-0968685,27811KS0020007,BlueCare Solutions GoldSSHOP,27811KS002,,KSN001,KSS001,KSF001,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020007,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020007&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0020007-01,Standard Gold On Exchange Plan,78.55%,0.785494446754456,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400",$20,"$1,200",$200,$500,"$1,300",$0,$40,7
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,1,27811,KS,Individual,No,80-0968685,27811KS0010001,BlueCare Solutions Gold,27811KS001,,KSN001,KSS001,KSF001,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,5,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010001,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010001&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0010001-03,Limited Cost Sharing Plan Variation,78.55%,0.785494446754456,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400",$20,"$1,200",$200,$500,"$1,300",$0,$40,7
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,2,27811,KS,Individual,No,80-0968685,27811KS0010003,BlueCare Solutions Bronze,27811KS001,,KSN001,KSS001,KSF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,2,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010003,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010003&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0010003-00,Standard Bronze Off Exchange Plan,,0.595843911170959,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$1,200","$1,000",$0,$40,4
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,2,27811,KS,SHOP (Small Group),No,80-0968685,27811KS0020002,BlueCare Solutions SilverSHOP,27811KS002,,KSN001,KSS001,KSF002,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,3,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020002,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020002&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0020002-00,Standard Silver Off Exchange Plan,,0.681725680828094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$20,"$1,600",$200,$600,"$1,300",$0,$40,4
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,7,18558,KS,Individual,No,48-0952857,18558KS0360031,BlueCare Essential with pediatric dental,18558KS036,,KSN001,KSS001,KSF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360031,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360031&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360031-01,Standard Bronze On Exchange Plan,,0.595843911170959,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$1,200","$1,000",$0,$40,5
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,7,18558,KS,Individual,No,48-0952857,18558KS0360031,BlueCare Essential with pediatric dental,18558KS036,,KSN001,KSS001,KSF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360031,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360031&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360031-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,7,18558,KS,SHOP (Small Group),No,48-0952857,18558KS0370019,BlueCare SaverSSHOP Select,18558KS037,,KSN002,KSS001,KSF004,New,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370019,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370019&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0370019-00,Standard Bronze Off Exchange Plan,,0.594008922576904,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,600",50%,,,,"$6,800","$13,600",Not Applicable,Not Applicable,"$3,400",$0,"$1,900",$200,"$3,400",$0,"$1,000",$40,6
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,7,18558,KS,SHOP (Small Group),No,48-0952857,18558KS0370019,BlueCare SaverSSHOP Select,18558KS037,,KSN002,KSS001,KSF004,New,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370019,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0370019&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0370019-01,Standard Bronze On Exchange Plan,,0.594008922576904,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,600",50%,,,,"$6,800","$13,600",Not Applicable,Not Applicable,"$3,400",$0,"$1,900",$200,"$3,400",$0,"$1,000",$40,7
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,7,18558,KS,Individual,No,48-0952857,18558KS0360031,BlueCare Essential with pediatric dental,18558KS036,,KSN001,KSS001,KSF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360031,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360031&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360031-03,Limited Cost Sharing Plan Variation,,0.595843911170959,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$1,200","$1,000",$0,$40,7
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,7,18558,KS,Individual,No,48-0952857,18558KS0360033,BlueCare Essential Select with pediatric dental,18558KS036,,KSN002,KSS001,KSF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360033,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360034&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360033-00,Standard Bronze Off Exchange Plan,,0.595843911170959,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$1,200","$1,000",$0,$40,9
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,7,18558,KS,Individual,No,48-0952857,18558KS0360033,BlueCare Essential Select with pediatric dental,18558KS036,,KSN002,KSS001,KSF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360033,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360034&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360033-01,Standard Bronze On Exchange Plan,,0.595843911170959,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$1,200","$1,000",$0,$40,10
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,7,18558,KS,Individual,No,48-0952857,18558KS0360033,BlueCare Essential Select with pediatric dental,18558KS036,,KSN002,KSS001,KSF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360033,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360034&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360033-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,11
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,7,18558,KS,Individual,No,48-0952857,18558KS0360033,BlueCare Essential Select with pediatric dental,18558KS036,,KSN002,KSS001,KSF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360033,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360034&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360033-03,Limited Cost Sharing Plan Variation,,0.595843911170959,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$1,200","$1,000",$0,$40,12
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,8,18558,KS,Individual,No,48-0952857,18558KS0360035,BlueCare Essential,18558KS036,,KSN001,KSS001,KSF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360035,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360035&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360035-01,Standard Bronze On Exchange Plan,,0.595843911170959,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$1,200","$1,000",$0,$40,5
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,8,18558,KS,Individual,No,48-0952857,18558KS0360035,BlueCare Essential,18558KS036,,KSN001,KSS001,KSF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360035,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360035&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360035-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,8,18558,KS,Individual,No,48-0952857,18558KS0360035,BlueCare Essential,18558KS036,,KSN001,KSS001,KSF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360035,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360035&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360035-03,Limited Cost Sharing Plan Variation,,0.595843911170959,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$1,200","$1,000",$0,$40,7
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,8,18558,KS,Individual,No,48-0952857,18558KS0360036,BlueCare Essential Select,18558KS036,,KSN002,KSS001,KSF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360036,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360036&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360036-00,Standard Bronze Off Exchange Plan,,0.595843911170959,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$1,200","$1,000",$0,$40,8
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,8,18558,KS,Individual,No,48-0952857,18558KS0360036,BlueCare Essential Select,18558KS036,,KSN002,KSS001,KSF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360036,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360036&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360036-01,Standard Bronze On Exchange Plan,,0.595843911170959,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$1,200","$1,000",$0,$40,9
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,8,18558,KS,Individual,No,48-0952857,18558KS0360036,BlueCare Essential Select,18558KS036,,KSN002,KSS001,KSF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360036,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360036&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360036-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,10
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,8,18558,KS,Individual,No,48-0952857,18558KS0360036,BlueCare Essential Select,18558KS036,,KSN002,KSS001,KSF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360036,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360036&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360036-03,Limited Cost Sharing Plan Variation,,0.595843911170959,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$1,200","$1,000",$0,$40,11
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,10,18558,KS,Individual,No,48-0952857,18558KS0360041,BlueCare Vital,18558KS036,,KSN002,KSS001,KSF001,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360041,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360041&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360041-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,100",$80,$0,$40,4
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,10,18558,KS,Individual,No,48-0952857,18558KS0360041,BlueCare Vital,18558KS036,,KSN002,KSS001,KSF001,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360041,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360041&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360041-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,100",$80,$0,$40,5
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,10,18558,KS,Individual,No,48-0952857,18558KS0360042,BlueCare Vital Select,18558KS036,,KSN004,KSS001,KSF001,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360042,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360042&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360042-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,100",$80,$0,$40,6
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,10,18558,KS,Individual,No,48-0952857,18558KS0360042,BlueCare Vital Select,18558KS036,,KSN004,KSS001,KSF001,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360042,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360042&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360042-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,100",$80,$0,$40,7
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,11,18558,KS,Individual,No,48-0952857,18558KS0360021,BlueCare SaverPlus with pediatric dental,18558KS036,,KSN001,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360021,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360021&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360021-00,Standard Silver Off Exchange Plan,68.25%,0.682458579540253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,$800,$200,$400,"$1,400",$0,$40,4
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,11,18558,KS,Individual,No,48-0952857,18558KS0360021,BlueCare SaverPlus with pediatric dental,18558KS036,,KSN001,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360021,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360021&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360021-01,Standard Silver On Exchange Plan,68.25%,0.682458579540253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,$800,$200,$400,"$1,400",$0,$40,5
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,11,18558,KS,Individual,No,48-0952857,18558KS0360021,BlueCare SaverPlus with pediatric dental,18558KS036,,KSN001,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360021,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360021&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360021-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,11,18558,KS,Individual,No,48-0952857,18558KS0360023,BlueCare SaverPlus Select with pediatric dental,18558KS036,,KSN002,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360023,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360023&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360023-00,Standard Silver Off Exchange Plan,68.25%,0.682458579540253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,$800,$200,$400,"$1,400",$0,$40,12
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,11,18558,KS,Individual,No,48-0952857,18558KS0360023,BlueCare SaverPlus Select with pediatric dental,18558KS036,,KSN002,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360023,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360023&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360023-01,Standard Silver On Exchange Plan,68.25%,0.682458579540253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,$800,$200,$400,"$1,400",$0,$40,13
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,11,18558,KS,Individual,No,48-0952857,18558KS0360023,BlueCare SaverPlus Select with pediatric dental,18558KS036,,KSN002,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360023,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360023&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360023-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,14
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,11,18558,KS,Individual,No,48-0952857,18558KS0360023,BlueCare SaverPlus Select with pediatric dental,18558KS036,,KSN002,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360023,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360023&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360023-03,Limited Cost Sharing Plan Variation,68.25%,0.682458579540253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,$800,$200,$400,"$1,400",$0,$40,15
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,11,18558,KS,Individual,No,48-0952857,18558KS0360023,BlueCare SaverPlus Select with pediatric dental,18558KS036,,KSN002,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360023,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360023&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360023-04,73% AV Level Silver Plan,72.01%,0.720133721828461,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,400","$4,800",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,400",$20,"$1,000",$200,$400,"$1,300",$0,$40,16
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,11,18558,KS,Individual,No,48-0952857,18558KS0360023,BlueCare SaverPlus Select with pediatric dental,18558KS036,,KSN002,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360023,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360023&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360023-05,87% AV Level Silver Plan,86.36%,0.863579392433167,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$800,$0,$800,$200,$400,"$1,100",$0,$40,17
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,11,18558,KS,Individual,No,48-0952857,18558KS0360023,BlueCare SaverPlus Select with pediatric dental,18558KS036,,KSN002,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360023,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360023&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360023-06,94% AV Level Silver Plan,93.35%,0.933524310588837,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$300,$0,$300,$200,$300,$200,$10,$40,18
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,12,18558,KS,Individual,No,48-0952857,18558KS0360026,BlueCare SaverPlus,18558KS036,,KSN001,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360026,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360026&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360026-00,Standard Silver Off Exchange Plan,68.25%,0.682458579540253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,$800,$200,$400,"$1,400",$0,$40,4
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,12,18558,KS,Individual,No,48-0952857,18558KS0360026,BlueCare SaverPlus,18558KS036,,KSN001,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360026,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360026&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360026-01,Standard Silver On Exchange Plan,68.25%,0.682458579540253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,$800,$200,$400,"$1,400",$0,$40,5
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,12,18558,KS,Individual,No,48-0952857,18558KS0360026,BlueCare SaverPlus,18558KS036,,KSN001,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360026,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360026&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360026-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,12,18558,KS,Individual,No,48-0952857,18558KS0360026,BlueCare SaverPlus,18558KS036,,KSN001,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360026,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360026&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360026-03,Limited Cost Sharing Plan Variation,68.25%,0.682458579540253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,$800,$200,$400,"$1,400",$0,$40,7
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,12,18558,KS,Individual,No,48-0952857,18558KS0360026,BlueCare SaverPlus,18558KS036,,KSN001,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360026,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360026&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360026-04,73% AV Level Silver Plan,72.01%,0.720133721828461,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,400","$4,800",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,400",$20,"$1,000",$200,$400,"$1,300",$0,$40,8
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,12,18558,KS,Individual,No,48-0952857,18558KS0360026,BlueCare SaverPlus,18558KS036,,KSN001,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360026,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360026&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360026-05,87% AV Level Silver Plan,86.36%,0.863579392433167,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$800,$0,$800,$200,$400,"$1,100",$0,$40,9
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,12,18558,KS,Individual,No,48-0952857,18558KS0360026,BlueCare SaverPlus,18558KS036,,KSN001,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360026,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360026&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360026-06,94% AV Level Silver Plan,93.35%,0.933524310588837,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$300,$0,$300,$200,$300,$200,$10,$40,10
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,12,18558,KS,Individual,No,48-0952857,18558KS0360027,BlueCare SaverPlus Select,18558KS036,,KSN002,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360027,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360027&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360027-00,Standard Silver Off Exchange Plan,68.25%,0.682458579540253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,$800,$200,$400,"$1,400",$0,$40,11
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,12,18558,KS,Individual,No,48-0952857,18558KS0360027,BlueCare SaverPlus Select,18558KS036,,KSN002,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360027,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360027&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360027-01,Standard Silver On Exchange Plan,68.25%,0.682458579540253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,$800,$200,$400,"$1,400",$0,$40,12
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,12,18558,KS,Individual,No,48-0952857,18558KS0360027,BlueCare SaverPlus Select,18558KS036,,KSN002,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360027,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360027&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360027-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,13
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,12,18558,KS,Individual,No,48-0952857,18558KS0360027,BlueCare SaverPlus Select,18558KS036,,KSN002,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360027,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360027&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360027-03,Limited Cost Sharing Plan Variation,68.25%,0.682458579540253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,$800,$200,$400,"$1,400",$0,$40,14
2015,KS,18558,SERFF,3,2014-09-05 06:40:30,12,18558,KS,Individual,No,48-0952857,18558KS0360027,BlueCare SaverPlus Select,18558KS036,,KSN002,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,Yes,Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360027,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=18558KS0360027&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,18558KS0360027-06,94% AV Level Silver Plan,93.35%,0.933524310588837,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$300,$0,$300,$200,$300,$200,$10,$40,17
2015,KS,21004,SERFF,1,2014-09-05 06:40:30,1,21004,KS,SHOP (Small Group),Yes,35-0472300,21004KS0010001,Lincoln Dental Connect?,21004KS001,,KSN001,KSS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.12,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,21004KS0010001-00,Standard High Off Exchange Plan,83.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,21004,SERFF,1,2014-09-05 06:40:30,1,21004,KS,SHOP (Small Group),Yes,35-0472300,21004KS0010002,Lincoln Dental Connect?,21004KS001,,KSN001,KSS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.70,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,21004KS0010002-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,2,27811,KS,SHOP (Small Group),No,80-0968685,27811KS0020002,BlueCare Solutions SilverSHOP,27811KS002,,KSN001,KSS001,KSF002,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,3,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020002,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020002&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0020002-01,Standard Silver On Exchange Plan,,0.681725680828094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$20,"$1,600",$200,$600,"$1,300",$0,$40,5
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,2,27811,KS,Individual,No,80-0968685,27811KS0010003,BlueCare Solutions Bronze,27811KS001,,KSN001,KSS001,KSF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,2,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010003,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010003&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0010003-01,Standard Bronze On Exchange Plan,,0.595843911170959,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$1,200","$1,000",$0,$40,5
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,2,27811,KS,Individual,No,80-0968685,27811KS0010003,BlueCare Solutions Bronze,27811KS001,,KSN001,KSS001,KSF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,2,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010003,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010003&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0010003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,2,27811,KS,SHOP (Small Group),No,80-0968685,27811KS0020008,BlueCare Solutions SilverSSHOP,27811KS002,,KSN001,KSS001,KSF002,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,3,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020008,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020008&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0020008-00,Standard Silver Off Exchange Plan,,0.681725680828094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$20,"$1,600",$200,$600,"$1,300",$0,$40,6
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,2,27811,KS,SHOP (Small Group),No,80-0968685,27811KS0020008,BlueCare Solutions SilverSSHOP,27811KS002,,KSN001,KSS001,KSF002,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,3,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020008,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020008&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0020008-01,Standard Silver On Exchange Plan,,0.681725680828094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$20,"$1,600",$200,$600,"$1,300",$0,$40,7
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,2,27811,KS,Individual,No,80-0968685,27811KS0010003,BlueCare Solutions Bronze,27811KS001,,KSN001,KSS001,KSF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,2,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010003,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010003&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0010003-03,Limited Cost Sharing Plan Variation,,0.595843911170959,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$1,200","$1,000",$0,$40,7
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,3,27811,KS,SHOP (Small Group),No,80-0968685,27811KS0020003,BlueCare Solutions BronzeSHOP,27811KS002,,KSN001,KSS001,KSF003,New,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020003,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020003&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0020003-00,Standard Bronze Off Exchange Plan,,0.594008922576904,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400",$0,"$1,900",$200,"$3,400",$0,"$1,000",$40,4
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,3,27811,KS,SHOP (Small Group),No,80-0968685,27811KS0020003,BlueCare Solutions BronzeSHOP,27811KS002,,KSN001,KSS001,KSF003,New,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020003,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020003&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0020003-01,Standard Bronze On Exchange Plan,,0.594008922576904,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400",$0,"$1,900",$200,"$3,400",$0,"$1,000",$40,5
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,3,27811,KS,SHOP (Small Group),No,80-0968685,27811KS0020009,BlueCare Solutions BronzeSSHOP,27811KS002,,KSN001,KSS001,KSF003,New,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020009,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020009&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0020009-00,Standard Bronze Off Exchange Plan,,0.594008922576904,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400",$0,"$1,900",$200,"$3,400",$0,"$1,000",$40,6
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,3,27811,KS,SHOP (Small Group),No,80-0968685,27811KS0020009,BlueCare Solutions BronzeSSHOP,27811KS002,,KSN001,KSS001,KSF003,New,HMO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020009,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0020009&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0020009-01,Standard Bronze On Exchange Plan,,0.594008922576904,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,400","$6,600",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400",$0,"$1,900",$200,"$3,400",$0,"$1,000",$40,7
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,5,27811,KS,Individual,No,80-0968685,27811KS0010002,BlueCare Solutions Silver,27811KS001,,KSN001,KSS001,KSF001,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010002,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010002&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0010002-00,Standard Silver Off Exchange Plan,68.25%,0.682458579540253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$20,$800,$200,$400,"$1,400",$0,$40,4
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,5,27811,KS,Individual,No,80-0968685,27811KS0010002,BlueCare Solutions Silver,27811KS001,,KSN001,KSS001,KSF001,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010002,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010002&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0010002-01,Standard Silver On Exchange Plan,68.25%,0.682458579540253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$20,$800,$200,$400,"$1,400",$0,$40,5
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,5,27811,KS,Individual,No,80-0968685,27811KS0010002,BlueCare Solutions Silver,27811KS001,,KSN001,KSS001,KSF001,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010002,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010002&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0010002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,5,27811,KS,Individual,No,80-0968685,27811KS0010002,BlueCare Solutions Silver,27811KS001,,KSN001,KSS001,KSF001,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010002,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010002&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0010002-03,Limited Cost Sharing Plan Variation,68.25%,0.682458579540253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$20,$800,$200,$400,"$1,400",$0,$40,7
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,5,27811,KS,Individual,No,80-0968685,27811KS0010002,BlueCare Solutions Silver,27811KS001,,KSN001,KSS001,KSF001,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010002,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010002&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0010002-04,73% AV Level Silver Plan,72.01%,0.720133721828461,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,400","$4,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400",$20,"$1,000",$200,$400,"$1,300",$0,$40,8
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,5,27811,KS,Individual,No,80-0968685,27811KS0010002,BlueCare Solutions Silver,27811KS001,,KSN001,KSS001,KSF001,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010002,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010002&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0010002-05,87% AV Level Silver Plan,86.36%,0.863579392433167,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$800,$0,$800,$200,$400,"$1,100",$0,$40,9
2015,KS,27811,SERFF,2,2014-09-04 06:14:21,5,27811,KS,Individual,No,80-0968685,27811KS0010002,BlueCare Solutions Silver,27811KS001,,KSN001,KSS001,KSF001,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010002,,http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2015&hi=27811KS0010002&sb=b,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_KS_BlueCareML.pdf,27811KS0010002-06,94% AV Level Silver Plan,93.35%,0.933524310588837,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$0,$300,$200,$300,$200,$10,$40,10
2015,KS,31098,SERFF,1,2014-09-05 06:40:30,1,31098,KS,SHOP (Small Group),Yes,47-0098400,31098KS0040002,EHB High PPO,31098KS004,,KSN001,KSS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$41.35,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,31098KS0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,17,61430,KS,Individual,No,75-1296086,61430KS0100001,Coventry Gold $5 Copay PPO,61430KS010,,KSN001,KSS001,KSF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48335,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100001-01,Standard Gold On Exchange Plan,78.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",25%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,17,61430,KS,Individual,No,75-1296086,61430KS0100001,Coventry Gold $5 Copay PPO,61430KS010,,KSN001,KSS001,KSF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48335,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,17,61430,KS,Individual,No,75-1296086,61430KS0100001,Coventry Gold $5 Copay PPO,61430KS010,,KSN001,KSS001,KSF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48335,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100001-03,Limited Cost Sharing Plan Variation,78.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",25%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,KS,61779,SERFF,2,2014-09-05 06:40:30,1,61779,KS,SHOP (Small Group),Yes,13-5123390,61779KS0010002,Guardian Pediatric Advantage,61779KS001,,KSN001,KSS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.21,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,61779KS0010002-00,Standard High Off Exchange Plan,84.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,61779,SERFF,2,2014-09-05 06:40:30,1,61779,KS,SHOP (Small Group),Yes,13-5123390,61779KS0020002,Guardian Pediatric Essentials,61779KS002,,KSN001,KSS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$20.21,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,61779KS0020002-00,Standard Low Off Exchange Plan,70.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,13,65598,KS,Individual,No,48-0840330,65598KS0070006,Coventry Silver $5 Copay 2750,65598KS007,,KSN001,KSS001,KSF005,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48372,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070006-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,13,65598,KS,Individual,No,48-0840330,65598KS0070006,Coventry Silver $5 Copay 2750,65598KS007,,KSN001,KSS001,KSF005,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48372,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070006-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,15,65598,KS,Individual,No,48-0840330,65598KS0080006,Coventry Silver $5 Copay 2750 Preferred,65598KS008,,KSN002,KSS002,KSF011,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080006-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,15,65598,KS,Individual,No,48-0840330,65598KS0080006,Coventry Silver $5 Copay 2750 Preferred,65598KS008,,KSN002,KSS002,KSF011,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080006-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,KS,61779,SERFF,2,2014-09-05 06:40:30,2,61779,KS,SHOP (Small Group),Yes,13-5123390,61779KS0040002,Guardian Family Advantage,61779KS004,,KSN001,KSS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.21,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,61779KS0040002-00,Standard High Off Exchange Plan,84.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,61779,SERFF,2,2014-09-05 06:40:30,2,61779,KS,SHOP (Small Group),Yes,13-5123390,61779KS0040002,Guardian Family Advantage,61779KS004,,KSN001,KSS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.21,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,61779KS0040002-01,Standard High On Exchange Plan,84.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,61779,SERFF,2,2014-09-05 06:40:30,2,61779,KS,SHOP (Small Group),Yes,13-5123390,61779KS0060002,Guardian Family Essentials,61779KS006,,KSN001,KSS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.21,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,61779KS0060002-00,Standard Low Off Exchange Plan,70.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,KS,61779,SERFF,2,2014-09-05 06:40:30,2,61779,KS,SHOP (Small Group),Yes,13-5123390,61779KS0060002,Guardian Family Essentials,61779KS006,,KSN001,KSS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.21,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,61779KS0060002-01,Standard Low On Exchange Plan,70.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,1,63790,KS,Individual,Yes,95-6042390,63790KS0020001,BESTOne Child Dental Plus,63790KS002,,KSN001,KSS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$31.72,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BESTOne_Child_Dental_Plus_Plan.pdf,,63790KS0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,1,63790,KS,SHOP (Small Group),Yes,95-6042390,63790KS0010001,BEST Life Child Dental Plus,63790KS001,,KSN001,KSS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.38,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BEST_Life_Child_Dental_Plus_Plan.pdf,,63790KS0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,2,63790,KS,SHOP (Small Group),Yes,95-6042390,63790KS0010002,BEST Life Child Dental,63790KS001,,KSN001,KSS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$22.31,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BEST_Life_Child_Dental_Plan.pdf,,63790KS0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,2,63790,KS,Individual,Yes,95-6042390,63790KS0020002,BESTOne Child Dental,63790KS002,,KSN001,KSS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$27.91,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BESTOne_Child_Dental_Plan.pdf,,63790KS0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,3,63790,KS,SHOP (Small Group),Yes,95-6042390,63790KS0010007,BEST Dental Premium,63790KS001,,KSN001,KSS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.38,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BESTDental_Premium_Plan.pdf,,63790KS0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,31098,SERFF,1,2014-09-05 06:40:30,1,31098,KS,SHOP (Small Group),Yes,47-0098400,31098KS0040001,EHB Low PPO,31098KS004,,KSN001,KSS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.84,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,31098KS0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,31098,SERFF,1,2014-09-05 06:40:30,1,31098,KS,SHOP (Small Group),Yes,47-0098400,31098KS0030002,EHB High Passive,31098KS003,,KSN001,KSS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$43.57,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,31098KS0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,KS,31098,SERFF,1,2014-09-05 06:40:30,1,31098,KS,SHOP (Small Group),Yes,47-0098400,31098KS0030001,EHB Low Passive,31098KS003,,KSN001,KSS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.01,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,31098KS0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,KS,38804,SERFF,3,2014-09-09 16:12:42,1,38804,KS,SHOP (Small Group),Yes,81-0170040,38804KS0010001,Assurant Dental ACAFFO High,38804KS001,,KSN001,KSS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$44.60,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same coverage as in service area,Yes,,,,,38804KS0010001-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,38804,SERFF,3,2014-09-09 16:12:42,2,38804,KS,SHOP (Small Group),Yes,81-0170040,38804KS0010002,Assurant Dental ACAFFO Low,38804KS001,,KSN001,KSS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$37.19,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same coverage as in service area,Yes,,,,,38804KS0010002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,51687,SERFF,1,2014-09-04 06:14:21,1,51687,KS,SHOP (Small Group),Yes,44-0308260,51687KS0010001,KCL EHB Low PPO,51687KS001,,KSN001,KSS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$41.20,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,51687KS0010001-00,Standard Low Off Exchange Plan,70.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,51687,SERFF,1,2014-09-04 06:14:21,1,51687,KS,SHOP (Small Group),Yes,44-0308260,51687KS0010003,KCL EHB Low MAC,51687KS001,,KSN001,KSS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$30.14,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,51687KS0010003-00,Standard Low Off Exchange Plan,70.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,51687,SERFF,1,2014-09-04 06:14:21,1,51687,KS,SHOP (Small Group),Yes,44-0308260,51687KS0010005,KCL Fam Low PPO,51687KS001,,KSN001,KSS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$41.20,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,51687KS0010005-00,Standard Low Off Exchange Plan,70.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,KS,51687,SERFF,1,2014-09-04 06:14:21,1,51687,KS,SHOP (Small Group),Yes,44-0308260,51687KS0010007,KCL Fam Low MAC,51687KS001,,KSN001,KSS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$30.14,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,51687KS0010007-00,Standard Low Off Exchange Plan,70.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,2,61430,KS,Individual,No,75-1296086,61430KS0100003,Coventry Bronze $20 Copay PPO,61430KS010,,KSN001,KSS001,KSF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48328,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100003-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,2,61430,KS,Individual,No,75-1296086,61430KS0100003,Coventry Bronze $20 Copay PPO,61430KS010,,KSN001,KSS001,KSF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48328,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100003-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,2,61430,KS,Individual,No,75-1296086,61430KS0100003,Coventry Bronze $20 Copay PPO,61430KS010,,KSN001,KSS001,KSF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48328,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,2,61430,KS,Individual,No,75-1296086,61430KS0100003,Coventry Bronze $20 Copay PPO,61430KS010,,KSN001,KSS001,KSF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48328,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100003-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,4,61430,KS,Individual,No,75-1296086,61430KS0110004,Coventry Bronze Deductible Only HSA Eligible KCPPO,61430KS011,,KSN002,KSS002,KSF010,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48303,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110004-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$14,000","$28,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,4,61430,KS,Individual,No,75-1296086,61430KS0110004,Coventry Bronze Deductible Only HSA Eligible KCPPO,61430KS011,,KSN002,KSS002,KSF010,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48303,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110004-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$14,000","$28,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,7,61430,KS,Individual,No,75-1296086,61430KS0110002,Coventry Silver $10 Copay KCPPO,61430KS011,,KSN002,KSS002,KSF008,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48310,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110002-01,Standard Silver On Exchange Plan,68.30%,,No,Yes,Yes,92%,8%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,000","$32,000",Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,$500,Not Applicable,40%,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,7,61430,KS,Individual,No,75-1296086,61430KS0110002,Coventry Silver $10 Copay KCPPO,61430KS011,,KSN002,KSS002,KSF008,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48310,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,92%,8%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,7,61430,KS,Individual,No,75-1296086,61430KS0110002,Coventry Silver $10 Copay KCPPO,61430KS011,,KSN002,KSS002,KSF008,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48310,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110002-03,Limited Cost Sharing Plan Variation,68.30%,,No,Yes,Yes,92%,8%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,000","$32,000",Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,$500,Not Applicable,40%,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,7,61430,KS,Individual,No,75-1296086,61430KS0110002,Coventry Silver $10 Copay KCPPO,61430KS011,,KSN002,KSS002,KSF008,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48310,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110002-04,73% AV Level Silver Plan,72.50%,,No,Yes,Yes,92%,8%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$16,000","$32,000",Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$5,000","$10,000",40%,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,$500,Not Applicable,40%,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,7,61430,KS,Individual,No,75-1296086,61430KS0110002,Coventry Silver $10 Copay KCPPO,61430KS011,,KSN002,KSS002,KSF008,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48310,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110002-05,87% AV Level Silver Plan,87.90%,,No,Yes,Yes,92%,8%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$16,000","$32,000",Not Applicable,Not Applicable,$0,$0,30%,"$1,500","$3,000",40%,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,30%,$0,Not Applicable,40%,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,7,61430,KS,Individual,No,75-1296086,61430KS0110002,Coventry Silver $10 Copay KCPPO,61430KS011,,KSN002,KSS002,KSF008,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48310,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110002-06,94% AV Level Silver Plan,93.10%,,No,Yes,Yes,92%,8%,,,,,,,,,,,,,,,,,"$1,550","$3,100","$2,250","$4,500","$16,000","$32,000",Not Applicable,Not Applicable,$0,$0,10%,$0,$0,20%,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,$0,Not Applicable,20%,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,8,61430,KS,Individual,No,75-1296086,61430KS0100002,Coventry Silver $10 Copay PPO,61430KS010,,KSN001,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48338,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100002-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$16,000","$32,000",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,8,61430,KS,Individual,No,75-1296086,61430KS0100002,Coventry Silver $10 Copay PPO,61430KS010,,KSN001,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48338,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100002-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$16,000","$32,000",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,8,61430,KS,Individual,No,75-1296086,61430KS0100002,Coventry Silver $10 Copay PPO,61430KS010,,KSN001,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48338,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,8,61430,KS,Individual,No,75-1296086,61430KS0100002,Coventry Silver $10 Copay PPO,61430KS010,,KSN001,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48338,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100002-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$16,000","$32,000",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,8,61430,KS,Individual,No,75-1296086,61430KS0100002,Coventry Silver $10 Copay PPO,61430KS010,,KSN001,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48338,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100002-04,73% AV Level Silver Plan,72.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$16,000","$32,000",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,8,61430,KS,Individual,No,75-1296086,61430KS0100002,Coventry Silver $10 Copay PPO,61430KS010,,KSN001,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48338,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100002-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$16,000","$32,000",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,8,61430,KS,Individual,No,75-1296086,61430KS0100002,Coventry Silver $10 Copay PPO,61430KS010,,KSN001,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48338,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100002-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$16,000","$32,000",Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,10,61430,KS,Individual,No,75-1296086,61430KS0110006,Coventry Silver $5 Copay 2750 KCPPO,61430KS011,,KSN002,KSS002,KSF011,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48316,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110006-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,Yes,92%,8%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,"$5,750","$11,500",40%,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,10,61430,KS,Individual,No,75-1296086,61430KS0110006,Coventry Silver $5 Copay 2750 KCPPO,61430KS011,,KSN002,KSS002,KSF011,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48316,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110006-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,Yes,92%,8%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,"$5,750","$11,500",40%,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,10,61430,KS,Individual,No,75-1296086,61430KS0110006,Coventry Silver $5 Copay 2750 KCPPO,61430KS011,,KSN002,KSS002,KSF011,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48316,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,92%,8%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,10,61430,KS,Individual,No,75-1296086,61430KS0110006,Coventry Silver $5 Copay 2750 KCPPO,61430KS011,,KSN002,KSS002,KSF011,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48316,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110006-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,Yes,92%,8%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,"$5,750","$11,500",40%,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,10,61430,KS,Individual,No,75-1296086,61430KS0110006,Coventry Silver $5 Copay 2750 KCPPO,61430KS011,,KSN002,KSS002,KSF011,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48316,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110006-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,Yes,92%,8%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$4,500","$9,000",40%,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,10,61430,KS,Individual,No,75-1296086,61430KS0110006,Coventry Silver $5 Copay 2750 KCPPO,61430KS011,,KSN002,KSS002,KSF011,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48316,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110006-05,87% AV Level Silver Plan,87.70%,,Yes,Yes,Yes,92%,8%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,"$1,500","$3,000",40%,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,10,61430,KS,Individual,No,75-1296086,61430KS0110006,Coventry Silver $5 Copay 2750 KCPPO,61430KS011,,KSN002,KSS002,KSF011,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48316,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110006-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,Yes,92%,8%,,,,,,,,,,,,,,,,,"$1,550","$3,100","$2,250","$4,500","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,11,61430,KS,Individual,No,75-1296086,61430KS0100006,Coventry Silver $5 Copay 2750 PPO,61430KS010,,KSN001,KSS001,KSF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48344,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100006-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,11,61430,KS,Individual,No,75-1296086,61430KS0100006,Coventry Silver $5 Copay 2750 PPO,61430KS010,,KSN001,KSS001,KSF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48344,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100006-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,11,61430,KS,Individual,No,75-1296086,61430KS0100006,Coventry Silver $5 Copay 2750 PPO,61430KS010,,KSN001,KSS001,KSF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48344,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,11,61430,KS,Individual,No,75-1296086,61430KS0100006,Coventry Silver $5 Copay 2750 PPO,61430KS010,,KSN001,KSS001,KSF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48344,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100006-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,11,61430,KS,Individual,No,75-1296086,61430KS0100006,Coventry Silver $5 Copay 2750 PPO,61430KS010,,KSN001,KSS001,KSF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48344,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100006-04,73% AV Level Silver Plan,72.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,11,61430,KS,Individual,No,75-1296086,61430KS0100006,Coventry Silver $5 Copay 2750 PPO,61430KS010,,KSN001,KSS001,KSF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48344,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100006-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,11,61430,KS,Individual,No,75-1296086,61430KS0100006,Coventry Silver $5 Copay 2750 PPO,61430KS010,,KSN001,KSS001,KSF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48344,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100006-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,13,61430,KS,Individual,No,75-1296086,61430KS0110007,Coventry Silver HSA Eligible KCPPO,61430KS011,,KSN002,KSS002,KSF012,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48322,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110007-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,13,61430,KS,Individual,No,75-1296086,61430KS0110007,Coventry Silver HSA Eligible KCPPO,61430KS011,,KSN002,KSS002,KSF012,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48322,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110007-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,13,61430,KS,Individual,No,75-1296086,61430KS0110007,Coventry Silver HSA Eligible KCPPO,61430KS011,,KSN002,KSS002,KSF012,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48322,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110007-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,13,61430,KS,Individual,No,75-1296086,61430KS0110007,Coventry Silver HSA Eligible KCPPO,61430KS011,,KSN002,KSS002,KSF012,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48322,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110007-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,13,61430,KS,Individual,No,75-1296086,61430KS0110007,Coventry Silver HSA Eligible KCPPO,61430KS011,,KSN002,KSS002,KSF012,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48322,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110007-04,73% AV Level Silver Plan,72.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,8
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,13,61430,KS,Individual,No,75-1296086,61430KS0110007,Coventry Silver HSA Eligible KCPPO,61430KS011,,KSN002,KSS002,KSF012,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48322,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110007-05,87% AV Level Silver Plan,86.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,950","$3,900",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,13,61430,KS,Individual,No,75-1296086,61430KS0110007,Coventry Silver HSA Eligible KCPPO,61430KS011,,KSN002,KSS002,KSF012,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48322,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110007-06,94% AV Level Silver Plan,93.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,600","$3,200",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,10
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,14,61430,KS,Individual,No,75-1296086,61430KS0100007,Coventry Silver HSA Eligible PPO,61430KS010,,KSN001,KSS001,KSF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48350,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100007-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,14,61430,KS,Individual,No,75-1296086,61430KS0100007,Coventry Silver HSA Eligible PPO,61430KS010,,KSN001,KSS001,KSF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48350,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100007-04,73% AV Level Silver Plan,72.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,8
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,14,61430,KS,Individual,No,75-1296086,61430KS0100007,Coventry Silver HSA Eligible PPO,61430KS010,,KSN001,KSS001,KSF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48350,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100007-05,87% AV Level Silver Plan,86.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,950","$3,900",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,14,61430,KS,Individual,No,75-1296086,61430KS0100007,Coventry Silver HSA Eligible PPO,61430KS010,,KSN001,KSS001,KSF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48350,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100007-06,94% AV Level Silver Plan,93.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,600","$3,200",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,10
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,16,61430,KS,Individual,No,75-1296086,61430KS0110001,Coventry Gold $5 Copay KCPPO,61430KS011,,KSN002,KSS002,KSF007,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48307,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110001-00,Standard Gold Off Exchange Plan,78.00%,,Yes,Yes,Yes,92%,8%,,,,,,,,,,,,,,,,,"$5,500","$11,000","$6,600","$13,200","$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",30%,"$1,450","$2,900",30%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,16,61430,KS,Individual,No,75-1296086,61430KS0110001,Coventry Gold $5 Copay KCPPO,61430KS011,,KSN002,KSS002,KSF007,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48307,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110001-01,Standard Gold On Exchange Plan,78.00%,,Yes,Yes,Yes,92%,8%,,,,,,,,,,,,,,,,,"$5,500","$11,000","$6,600","$13,200","$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",30%,"$1,450","$2,900",30%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,16,61430,KS,Individual,No,75-1296086,61430KS0110001,Coventry Gold $5 Copay KCPPO,61430KS011,,KSN002,KSS002,KSF007,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48307,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,92%,8%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,16,61430,KS,Individual,No,75-1296086,61430KS0110001,Coventry Gold $5 Copay KCPPO,61430KS011,,KSN002,KSS002,KSF007,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48307,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/kansascityppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0110001-03,Limited Cost Sharing Plan Variation,78.00%,,Yes,Yes,Yes,92%,8%,,,,,,,,,,,,,,,,,"$5,500","$11,000","$6,600","$13,200","$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",30%,"$1,450","$2,900",30%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,KS,61430,SERFF,10,2014-12-10 23:15:01,17,61430,KS,Individual,No,75-1296086,61430KS0100001,Coventry Gold $5 Copay PPO,61430KS010,,KSN001,KSS001,KSF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48335,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/ppoKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,61430KS0100001-00,Standard Gold Off Exchange Plan,78.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",25%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,3,63790,KS,Individual,Yes,95-6042390,63790KS0020003,BESTOne Dental Advantage - Gold,63790KS002,,KSN001,KSS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.72,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BESTOne_Dental_Advantage-Gold_Plan.pdf,,63790KS0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,3,63790,KS,Individual,Yes,95-6042390,63790KS0020003,BESTOne Dental Advantage - Gold,63790KS002,,KSN001,KSS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.72,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BESTOne_Dental_Advantage-Gold_Plan.pdf,,63790KS0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,15,65598,KS,Individual,No,48-0840330,65598KS0080006,Coventry Silver $5 Copay 2750 Preferred,65598KS008,,KSN002,KSS002,KSF011,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080006-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,4,94248,KS,Individual,No,43-1257251,94248KS0160002,Blue & U Classic PCB Gold,94248KS016,7023011258,KSN001,KSS001,KSF003,Existing,PPO,Gold,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/classicpcbgold.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0160002-03,Limited Cost Sharing Plan Variation,,0.783181190490723,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,"$1,500","$3,000",10%,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100",$900,$0,$200,$0,$900,$0,$40,7
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,3,63790,KS,SHOP (Small Group),Yes,95-6042390,63790KS0010007,BEST Dental Premium,63790KS001,,KSN001,KSS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.38,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BESTDental_Premium_Plan.pdf,,63790KS0010007-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,21,65598,KS,Individual,No,48-0840330,65598KS0070001,Coventry Gold $5 Copay,65598KS007,,KSN001,KSS001,KSF001,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48363,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070001-03,Limited Cost Sharing Plan Variation,78.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",25%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,23,65598,KS,Individual,No,48-0840330,65598KS0080001,Coventry Gold $5 Copay Preferred,65598KS008,,KSN002,KSS002,KSF007,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48391,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080001-00,Standard Gold Off Exchange Plan,78.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",25%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,4,94248,KS,Individual,No,43-1257251,94248KS0160002,Blue & U Classic PCB Gold,94248KS016,7023011258,KSN001,KSS001,KSF003,Existing,PPO,Gold,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/classicpcbgold.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0160002-01,Standard Gold On Exchange Plan,,0.783181190490723,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,"$1,500","$3,000",10%,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100",$900,$0,$200,$0,$900,$0,$40,5
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,4,94248,KS,Individual,No,43-1257251,94248KS0160002,Blue & U Classic PCB Gold,94248KS016,7023011258,KSN001,KSS001,KSF003,Existing,PPO,Gold,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/classicpcbgold.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0160002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,3,63790,KS,Individual,Yes,95-6042390,63790KS0020004,BESTOne Dental Plus - Gold,63790KS002,,KSN001,KSS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.72,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BESTOne_Dental_Plus-Gold_Plan.pdf,,63790KS0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,3,63790,KS,SHOP (Small Group),Yes,95-6042390,63790KS0010008,BEST Dental Standard-H,63790KS001,,KSN001,KSS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.38,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BESTDental_Standard-H_Plan.pdf,,63790KS0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,3,63790,KS,SHOP (Small Group),Yes,95-6042390,63790KS0010008,BEST Dental Standard-H,63790KS001,,KSN001,KSS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.38,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BESTDental_Standard-H_Plan.pdf,,63790KS0010008-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,3,63790,KS,Individual,Yes,95-6042390,63790KS0020004,BESTOne Dental Plus - Gold,63790KS002,,KSN001,KSS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.72,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BESTOne_Dental_Plus-Gold_Plan.pdf,,63790KS0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,3,63790,KS,SHOP (Small Group),Yes,95-6042390,63790KS0010010,BEST Dental Choice-H,63790KS001,,KSN001,KSS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.38,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BESTDental_Choice-H_Plan.pdf,,63790KS0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,3,63790,KS,SHOP (Small Group),Yes,95-6042390,63790KS0010010,BEST Dental Choice-H,63790KS001,,KSN001,KSS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.38,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BESTDental_Choice-H_Plan.pdf,,63790KS0010010-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,4,63790,KS,Individual,Yes,95-6042390,63790KS0020005,BESTOne Dental Plus - Silver,63790KS002,,KSN001,KSS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.91,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BESTOne_Dental_Plus-Silver_Plan.pdf,,63790KS0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,4,63790,KS,SHOP (Small Group),Yes,95-6042390,63790KS0010009,BEST Dental Standard-L,63790KS001,,KSN001,KSS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.31,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BESTDental_Standard-L_Plan.pdf,,63790KS0010009-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,4,63790,KS,SHOP (Small Group),Yes,95-6042390,63790KS0010009,BEST Dental Standard-L,63790KS001,,KSN001,KSS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.31,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BESTDental_Standard-L_Plan.pdf,,63790KS0010009-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,4,63790,KS,Individual,Yes,95-6042390,63790KS0020005,BESTOne Dental Plus - Silver,63790KS002,,KSN001,KSS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.91,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BESTOne_Dental_Plus-Silver_Plan.pdf,,63790KS0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,4,63790,KS,Individual,Yes,95-6042390,63790KS0020006,BESTOne Dental Basic - Silver,63790KS002,,KSN001,KSS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.91,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BESTOne_Dental_Basic-Silver_Plan.pdf,,63790KS0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,4,63790,KS,SHOP (Small Group),Yes,95-6042390,63790KS0010011,BEST Dental Choice-L,63790KS001,,KSN001,KSS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.31,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BESTDental_Choice-L_Plan.pdf,,63790KS0010011-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,4,63790,KS,SHOP (Small Group),Yes,95-6042390,63790KS0010011,BEST Dental Choice-L,63790KS001,,KSN001,KSS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.31,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BESTDental_Choice-L_Plan.pdf,,63790KS0010011-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,4,63790,KS,Individual,Yes,95-6042390,63790KS0020006,BESTOne Dental Basic - Silver,63790KS002,,KSN001,KSS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.91,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BESTOne_Dental_Basic-Silver_Plan.pdf,,63790KS0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,4,63790,KS,SHOP (Small Group),Yes,95-6042390,63790KS0010012,BEST Dental Value,63790KS001,,KSN001,KSS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.31,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BESTDental_Value_Plan.pdf,,63790KS0010012-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,KS,63790,SERFF,6,2014-11-04 20:29:03,4,63790,KS,SHOP (Small Group),Yes,95-6042390,63790KS0010012,BEST Dental Value,63790KS001,,KSN001,KSS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.31,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/KS/2015/KS_BESTDental_Value_Plan.pdf,,63790KS0010012-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,1,65598,KS,Individual,No,48-0840330,65598KS0070003,Coventry Bronze $20 Copay,65598KS007,,KSN001,KSS001,KSF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48356,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070003-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,1,65598,KS,Individual,No,48-0840330,65598KS0070003,Coventry Bronze $20 Copay,65598KS007,,KSN001,KSS001,KSF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48356,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070003-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,1,65598,KS,Individual,No,48-0840330,65598KS0070003,Coventry Bronze $20 Copay,65598KS007,,KSN001,KSS001,KSF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48356,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,1,65598,KS,Individual,No,48-0840330,65598KS0070003,Coventry Bronze $20 Copay,65598KS007,,KSN001,KSS001,KSF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48356,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070003-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,3,65598,KS,Individual,No,48-0840330,65598KS0080003,Coventry Bronze $20 Copay Preferred,65598KS008,,KSN002,KSS002,KSF009,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48384,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080003-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,3,65598,KS,Individual,No,48-0840330,65598KS0080003,Coventry Bronze $20 Copay Preferred,65598KS008,,KSN002,KSS002,KSF009,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48384,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080003-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,3,65598,KS,Individual,No,48-0840330,65598KS0080003,Coventry Bronze $20 Copay Preferred,65598KS008,,KSN002,KSS002,KSF009,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48384,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,3,65598,KS,Individual,No,48-0840330,65598KS0080003,Coventry Bronze $20 Copay Preferred,65598KS008,,KSN002,KSS002,KSF009,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48384,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080003-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,5,65598,KS,Individual,No,48-0840330,65598KS0070004,Coventry Bronze Deductible Only HSA Eligible,65598KS007,,KSN001,KSS001,KSF004,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48359,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070004-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$14,000","$28,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,5,65598,KS,Individual,No,48-0840330,65598KS0070004,Coventry Bronze Deductible Only HSA Eligible,65598KS007,,KSN001,KSS001,KSF004,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48359,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070004-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$14,000","$28,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,5,65598,KS,Individual,No,48-0840330,65598KS0070004,Coventry Bronze Deductible Only HSA Eligible,65598KS007,,KSN001,KSS001,KSF004,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48359,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,5,65598,KS,Individual,No,48-0840330,65598KS0070004,Coventry Bronze Deductible Only HSA Eligible,65598KS007,,KSN001,KSS001,KSF004,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48359,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070004-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$14,000","$28,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,8,65598,KS,Individual,No,48-0840330,65598KS0080004,Coventry Bronze Deductible Only HSA Eligible Preferred,65598KS008,,KSN002,KSS002,KSF010,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48387,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080004-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$14,000","$28,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,8,65598,KS,Individual,No,48-0840330,65598KS0080004,Coventry Bronze Deductible Only HSA Eligible Preferred,65598KS008,,KSN002,KSS002,KSF010,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48387,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080004-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$14,000","$28,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,8,65598,KS,Individual,No,48-0840330,65598KS0080004,Coventry Bronze Deductible Only HSA Eligible Preferred,65598KS008,,KSN002,KSS002,KSF010,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48387,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,8,65598,KS,Individual,No,48-0840330,65598KS0080004,Coventry Bronze Deductible Only HSA Eligible Preferred,65598KS008,,KSN002,KSS002,KSF010,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48387,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080004-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$14,000","$28,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,9,65598,KS,Individual,No,48-0840330,65598KS0070002,Coventry Silver $10 Copay,65598KS007,,KSN001,KSS001,KSF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48366,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070002-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$16,000","$32,000",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,9,65598,KS,Individual,No,48-0840330,65598KS0070002,Coventry Silver $10 Copay,65598KS007,,KSN001,KSS001,KSF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48366,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070002-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$16,000","$32,000",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,9,65598,KS,Individual,No,48-0840330,65598KS0070002,Coventry Silver $10 Copay,65598KS007,,KSN001,KSS001,KSF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48366,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,9,65598,KS,Individual,No,48-0840330,65598KS0070002,Coventry Silver $10 Copay,65598KS007,,KSN001,KSS001,KSF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48366,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070002-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$16,000","$32,000",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,9,65598,KS,Individual,No,48-0840330,65598KS0070002,Coventry Silver $10 Copay,65598KS007,,KSN001,KSS001,KSF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48366,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070002-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$16,000","$32,000",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,9,65598,KS,Individual,No,48-0840330,65598KS0070002,Coventry Silver $10 Copay,65598KS007,,KSN001,KSS001,KSF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48366,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070002-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$16,000","$32,000",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,9,65598,KS,Individual,No,48-0840330,65598KS0070002,Coventry Silver $10 Copay,65598KS007,,KSN001,KSS001,KSF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48366,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070002-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$16,000","$32,000",Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,11,65598,KS,Individual,No,48-0840330,65598KS0080002,Coventry Silver $10 Copay Preferred,65598KS008,,KSN002,KSS002,KSF008,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48394,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080002-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$16,000","$32,000",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,11,65598,KS,Individual,No,48-0840330,65598KS0080002,Coventry Silver $10 Copay Preferred,65598KS008,,KSN002,KSS002,KSF008,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48394,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080002-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$16,000","$32,000",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,11,65598,KS,Individual,No,48-0840330,65598KS0080002,Coventry Silver $10 Copay Preferred,65598KS008,,KSN002,KSS002,KSF008,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48394,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,11,65598,KS,Individual,No,48-0840330,65598KS0080002,Coventry Silver $10 Copay Preferred,65598KS008,,KSN002,KSS002,KSF008,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48394,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080002-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$16,000","$32,000",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,11,65598,KS,Individual,No,48-0840330,65598KS0080002,Coventry Silver $10 Copay Preferred,65598KS008,,KSN002,KSS002,KSF008,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48394,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080002-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$16,000","$32,000",Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,11,65598,KS,Individual,No,48-0840330,65598KS0080002,Coventry Silver $10 Copay Preferred,65598KS008,,KSN002,KSS002,KSF008,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48394,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080002-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$16,000","$32,000",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,11,65598,KS,Individual,No,48-0840330,65598KS0080002,Coventry Silver $10 Copay Preferred,65598KS008,,KSN002,KSS002,KSF008,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48394,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080002-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$16,000","$32,000",Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,13,65598,KS,Individual,No,48-0840330,65598KS0070006,Coventry Silver $5 Copay 2750,65598KS007,,KSN001,KSS001,KSF005,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48372,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070006-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,13,65598,KS,Individual,No,48-0840330,65598KS0070006,Coventry Silver $5 Copay 2750,65598KS007,,KSN001,KSS001,KSF005,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48372,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070006-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,13,65598,KS,Individual,No,48-0840330,65598KS0070006,Coventry Silver $5 Copay 2750,65598KS007,,KSN001,KSS001,KSF005,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48372,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,13,65598,KS,Individual,No,48-0840330,65598KS0070006,Coventry Silver $5 Copay 2750,65598KS007,,KSN001,KSS001,KSF005,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48372,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070006-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,13,65598,KS,Individual,No,48-0840330,65598KS0070006,Coventry Silver $5 Copay 2750,65598KS007,,KSN001,KSS001,KSF005,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48372,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070006-04,73% AV Level Silver Plan,72.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,15,65598,KS,Individual,No,48-0840330,65598KS0080006,Coventry Silver $5 Copay 2750 Preferred,65598KS008,,KSN002,KSS002,KSF011,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,15,65598,KS,Individual,No,48-0840330,65598KS0080006,Coventry Silver $5 Copay 2750 Preferred,65598KS008,,KSN002,KSS002,KSF011,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080006-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,15,65598,KS,Individual,No,48-0840330,65598KS0080006,Coventry Silver $5 Copay 2750 Preferred,65598KS008,,KSN002,KSS002,KSF011,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080006-04,73% AV Level Silver Plan,72.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,4,94248,KS,Individual,No,43-1257251,94248KS0160004,Blue & U Classic PCB Silver,94248KS016,7023011258,KSN001,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/classicpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0160004-00,Standard Silver Off Exchange Plan,,0.687620997428894,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$12,500","$25,000",Not Applicable,Not Applicable,"$5,000","$10,000",10%,"$5,000","$10,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100","$1,100",$0,$200,$0,"$1,000",$0,$40,8
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,5,94248,KS,Individual,No,43-1257251,94248KS0170004,Blue & U Classic Select Silver,94248KS017,7023011258,KSN002,KSS001,KSF004,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/classicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0170004-06,94% AV Level Silver Plan,,0.935858845710754,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$600,"$1,200",$600,"$1,200","$25,000","$50,000",Not Applicable,Not Applicable,$250,$500,10%,$250,$500,10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,10%,$0,$0,10%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,$200,$200,$80,$200,$0,$600,$0,$40,14
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,6,94248,KS,Individual,No,43-1257251,94248KS0180003,Blue & U Saver PCB Silver,94248KS018,7023011258,KSN001,KSS001,KSF005,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saverpcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0180003-00,Standard Silver Off Exchange Plan,,0.683051764965057,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,"$2,500",$20,$500,$200,"$2,500",$400,$20,$40,4
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,6,94248,KS,Individual,No,43-1257251,94248KS0180003,Blue & U Saver PCB Silver,94248KS018,7023011258,KSN001,KSS001,KSF005,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saverpcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0180003-05,87% AV Level Silver Plan,,0.870086133480072,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$800,"$1,600",10%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$800,$0,$400,$200,$800,$200,$70,$40,9
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,6,94248,KS,Individual,No,43-1257251,94248KS0180003,Blue & U Saver PCB Silver,94248KS018,7023011258,KSN001,KSS001,KSF005,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saverpcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0180003-06,94% AV Level Silver Plan,,0.940562903881073,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$200,$0,$200,$200,$200,$90,$50,$40,10
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,7,94248,KS,Individual,No,43-1257251,94248KS0190009,Blue & U Saver Select Bronze,94248KS019,7023011258,KSN002,KSS001,KSF006,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saverselectbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0190009-03,Limited Cost Sharing Plan Variation,,0.591562926769257,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",10%,"$5,000","$10,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,"$5,000",$20,$200,$200,"$5,000",$0,$0,$40,21
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,7,94248,KS,Individual,No,43-1257251,94248KS0190010,Blue & U Saver 2 Select Bronze,94248KS019,7023011258,KSN003,KSS001,KSF026,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saver2selectbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0190010-00,Standard Bronze Off Exchange Plan,,0.608896374702454,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,"$3,000","$6,000",50%,"$3,000","$6,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,100",$200,"$3,000",$0,"$1,000",$40,22
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,15,65598,KS,Individual,No,48-0840330,65598KS0080006,Coventry Silver $5 Copay 2750 Preferred,65598KS008,,KSN002,KSS002,KSF011,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48400,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080006-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,1,94248,KS,Individual,No,43-1257251,94248KS0140004,Blue & U First PCB Silver,94248KS014,7023011258,KSN001,KSS001,KSF018,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/firstpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0140004-01,Standard Silver On Exchange Plan,68.00%,0.683626294136047,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$8,400","$16,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",0%,,,,"$4,200","$8,400",Not Applicable,Not Applicable,"$4,200",$0,$0,$200,$300,$300,$0,$40,5
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,1,94248,KS,Individual,No,43-1257251,94248KS0140004,Blue & U First PCB Silver,94248KS014,7023011258,KSN001,KSS001,KSF018,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/firstpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0140004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,7,94248,KS,Individual,No,43-1257251,94248KS0190007,Blue & U Saver Select Silver,94248KS019,7023011258,KSN002,KSS001,KSF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saverselectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0190007-03,Limited Cost Sharing Plan Variation,,0.686538398265839,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,"$2,500","$5,000",10%,"$2,500","$5,000",Not Applicable,Not Applicable,"$2,500",$20,$500,$200,"$2,500",$400,$20,$40,7
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,7,94248,KS,Individual,No,43-1257251,94248KS0190007,Blue & U Saver Select Silver,94248KS019,7023011258,KSN002,KSS001,KSF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saverselectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0190007-04,73% AV Level Silver Plan,,0.725525796413422,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,125","$6,250","$3,125","$6,250","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,"$2,000","$4,000",10%,"$2,500","$5,000",Not Applicable,Not Applicable,"$2,000",$20,$500,$200,"$2,000",$500,$20,$40,8
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,17,65598,KS,Individual,No,48-0840330,65598KS0070007,Coventry Silver HSA Eligible,65598KS007,,KSN001,KSS001,KSF006,New,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48378,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070007-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,17,65598,KS,Individual,No,48-0840330,65598KS0070007,Coventry Silver HSA Eligible,65598KS007,,KSN001,KSS001,KSF006,New,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48378,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070007-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,17,65598,KS,Individual,No,48-0840330,65598KS0070007,Coventry Silver HSA Eligible,65598KS007,,KSN001,KSS001,KSF006,New,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48378,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070007-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,17,65598,KS,Individual,No,48-0840330,65598KS0070007,Coventry Silver HSA Eligible,65598KS007,,KSN001,KSS001,KSF006,New,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48378,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070007-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,17,65598,KS,Individual,No,48-0840330,65598KS0070007,Coventry Silver HSA Eligible,65598KS007,,KSN001,KSS001,KSF006,New,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48378,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070007-04,73% AV Level Silver Plan,72.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,8
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,17,65598,KS,Individual,No,48-0840330,65598KS0070007,Coventry Silver HSA Eligible,65598KS007,,KSN001,KSS001,KSF006,New,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48378,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070007-05,87% AV Level Silver Plan,86.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,950","$3,900",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,17,65598,KS,Individual,No,48-0840330,65598KS0070007,Coventry Silver HSA Eligible,65598KS007,,KSN001,KSS001,KSF006,New,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48378,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070007-06,94% AV Level Silver Plan,93.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,600","$3,200",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,10
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,19,65598,KS,Individual,No,48-0840330,65598KS0080007,Coventry Silver HSA Eligible Preferred,65598KS008,,KSN002,KSS002,KSF012,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48406,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080007-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,19,65598,KS,Individual,No,48-0840330,65598KS0080007,Coventry Silver HSA Eligible Preferred,65598KS008,,KSN002,KSS002,KSF012,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48406,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080007-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,19,65598,KS,Individual,No,48-0840330,65598KS0080007,Coventry Silver HSA Eligible Preferred,65598KS008,,KSN002,KSS002,KSF012,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48406,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080007-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,19,65598,KS,Individual,No,48-0840330,65598KS0080007,Coventry Silver HSA Eligible Preferred,65598KS008,,KSN002,KSS002,KSF012,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48406,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080007-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,19,65598,KS,Individual,No,48-0840330,65598KS0080007,Coventry Silver HSA Eligible Preferred,65598KS008,,KSN002,KSS002,KSF012,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48406,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080007-04,73% AV Level Silver Plan,72.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,8
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,19,65598,KS,Individual,No,48-0840330,65598KS0080007,Coventry Silver HSA Eligible Preferred,65598KS008,,KSN002,KSS002,KSF012,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48406,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080007-05,87% AV Level Silver Plan,86.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,950","$3,900",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,19,65598,KS,Individual,No,48-0840330,65598KS0080007,Coventry Silver HSA Eligible Preferred,65598KS008,,KSN002,KSS002,KSF012,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48406,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080007-06,94% AV Level Silver Plan,93.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,600","$3,200",,,"$16,350","$32,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$5,200","$10,400",Not Applicable,Not Applicable,,,,,,,,,10
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,21,65598,KS,Individual,No,48-0840330,65598KS0070001,Coventry Gold $5 Copay,65598KS007,,KSN001,KSS001,KSF001,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48363,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070001-00,Standard Gold Off Exchange Plan,78.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",25%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,21,65598,KS,Individual,No,48-0840330,65598KS0070001,Coventry Gold $5 Copay,65598KS007,,KSN001,KSS001,KSF001,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48363,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070001-01,Standard Gold On Exchange Plan,78.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",25%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,21,65598,KS,Individual,No,48-0840330,65598KS0070001,Coventry Gold $5 Copay,65598KS007,,KSN001,KSS001,KSF001,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48363,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/openaccessposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0070001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,23,65598,KS,Individual,No,48-0840330,65598KS0080001,Coventry Gold $5 Copay Preferred,65598KS008,,KSN002,KSS002,KSF007,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48391,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080001-01,Standard Gold On Exchange Plan,78.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",25%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,23,65598,KS,Individual,No,48-0840330,65598KS0080001,Coventry Gold $5 Copay Preferred,65598KS008,,KSN002,KSS002,KSF007,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48391,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,KS,65598,SERFF,5,2014-12-10 23:15:01,23,65598,KS,Individual,No,48-0840330,65598KS0080001,Coventry Gold $5 Copay Preferred,65598KS008,,KSN002,KSS002,KSF007,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/KS48391,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/preferredposKS2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,65598KS0080001-03,Limited Cost Sharing Plan Variation,78.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,"$17,000","$34,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$600,"$1,200",25%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,KS,79684,SERFF,1,2014-09-07 12:14:41,1,79684,KS,SHOP (Small Group),Yes,36-0883760,79684KS0040002,EHB High PPO,79684KS004,,KSN001,KSS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$41.93,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,79684KS0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,79684,SERFF,1,2014-09-07 12:14:41,1,79684,KS,SHOP (Small Group),Yes,36-0883760,79684KS0040001,EHB Low PPO,79684KS004,,KSN001,KSS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.15,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,79684KS0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,79684,SERFF,1,2014-09-07 12:14:41,1,79684,KS,SHOP (Small Group),Yes,36-0883760,79684KS0030002,EHB High Passive,79684KS003,,KSN001,KSS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$44.18,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,79684KS0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,KS,79684,SERFF,1,2014-09-07 12:14:41,1,79684,KS,SHOP (Small Group),Yes,36-0883760,79684KS0030001,EHB Low Passive,79684KS003,,KSN001,KSS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.37,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,79684KS0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,4,94248,KS,Individual,No,43-1257251,94248KS0160004,Blue & U Classic PCB Silver,94248KS016,7023011258,KSN001,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/classicpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0160004-03,Limited Cost Sharing Plan Variation,,0.687620997428894,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$12,500","$25,000",Not Applicable,Not Applicable,"$5,000","$10,000",10%,"$5,000","$10,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100","$1,100",$0,$200,$0,"$1,000",$0,$40,11
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,4,94248,KS,Individual,No,43-1257251,94248KS0160004,Blue & U Classic PCB Silver,94248KS016,7023011258,KSN001,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/classicpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0160004-04,73% AV Level Silver Plan,,0.723574995994568,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$12,500","$25,000",Not Applicable,Not Applicable,"$3,000","$6,000",10%,"$3,000","$6,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100",$900,$0,$200,$0,"$1,000",$0,$40,12
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,7,94248,KS,Individual,No,43-1257251,94248KS0190007,Blue & U Saver Select Silver,94248KS019,7023011258,KSN002,KSS001,KSF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saverselectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0190007-01,Standard Silver On Exchange Plan,,0.686538398265839,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,"$2,500","$5,000",10%,"$2,500","$5,000",Not Applicable,Not Applicable,"$2,500",$20,$500,$200,"$2,500",$400,$20,$40,5
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,7,94248,KS,Individual,No,43-1257251,94248KS0190007,Blue & U Saver Select Silver,94248KS019,7023011258,KSN002,KSS001,KSF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saverselectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0190007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,9,94248,KS,Individual,No,43-1257251,94248KS0420001,Blue & U Basic Select Silver,94248KS042,7023011258,KSN004,KSS001,KSF019,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, such services will be provided at the out-of-network benefit level.",No,http://www.bluekc.com/qhp/2015/dp/ks/basicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0420001-01,Standard Silver On Exchange Plan,,0.702799558639526,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$3,500","$7,000",40%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,"$1,000","$2,000",40%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$0,"$1,500",$200,$500,$300,$0,$40,5
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,9,94248,KS,Individual,No,43-1257251,94248KS0420001,Blue & U Basic Select Silver,94248KS042,7023011258,KSN004,KSS001,KSF019,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, such services will be provided at the out-of-network benefit level.",No,http://www.bluekc.com/qhp/2015/dp/ks/basicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0420001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,ME,20974,SERFF,5,2014-11-14 14:52:18,2,20974,ME,Individual,Yes,75-1233841,20974ME0010006,Dentegra Dental PPO Family Basic Plan,20974ME001,,MEN001,MES001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.28,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/me/20974me0010006-15,,20974ME0010006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$85,Not Applicable,,,,,$85,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,20974,SERFF,5,2014-11-14 14:52:18,2,20974,ME,SHOP (Small Group),Yes,75-1233841,20974ME0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,20974ME002,,MEN001,MES001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.53,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/me/20974me0020006-15,,20974ME0020006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$85,Not Applicable,,,,,$85,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,1,33653,ME,Individual,No,45-3416923,33653ME0010001,Community Safe Harbor,33653ME001,,MEN001,MES001,MEF001,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9967,,,0,3,3,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-SAFEHARBOR-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0010001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,1,33653,ME,Individual,No,45-3416923,33653ME0010001,Community Safe Harbor,33653ME001,,MEN001,MES001,MEF001,Existing,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9967,,,0,3,3,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-SAFEHARBOR-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0010001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,1,33653,ME,SHOP (Small Group),No,45-3416923,33653ME0160001,Community Option HSA,33653ME016,,MEN001,MES001,MEF002,New,PPO,Bronze,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-SG-OPTIONHSA-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0160001-01,Standard Bronze On Exchange Plan,58.60%,0.585511147975922,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,2,33653,ME,SHOP (Small Group),No,45-3416923,33653ME0170001,Community Option,33653ME017,,MEN001,MES001,MEF003,New,PPO,Bronze,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.997,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-SG-OPTION-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0170001-00,Standard Bronze Off Exchange Plan,61.70%,0.609969615936279,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,KS,81711,SERFF,5,2014-09-07 12:14:41,1,81711,KS,Individual,Yes,48-0793267,81711KS0010003,Delta Dental Individual & Family - Basic+POEHB,81711KS001,7427051660,KSN001,KSS001,,New,PPO,Low,,Both,,,,Please see Plan Brochure,,,,,Allows Adult and Child-Only,,,,$26.97,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Allows services in the United States and Canada only.,Yes,Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.,Yes,https://www.deltadentalcoversme.com/plan-options/KS-plans,https://auth.deltadentalcoversme.com/sp/ACS.saml2,https://www.deltadentalcoversme.com/plan-options/KS-plans,,81711KS0010003-00,Standard Low Off Exchange Plan,70.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,$225,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,81711,SERFF,5,2014-09-07 12:14:41,1,81711,KS,SHOP (Small Group),Yes,48-0793267,81711KS0020009,Delta Dental PPO - Basic Family+POEHB,81711KS002,7427051660,KSN002,KSS001,,New,PPO,Low,,Both,,,,Please see Plan Brochure,,,,,Allows Adult and Child-Only,,,,$28.74,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Allows services in the United States and Canada only.,Yes,Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.,Yes,http://www.deltadentalks.com/IndividualOptions/SHOP/,,http://www.deltadentalks.com/IndividualOptions/SHOP/,,81711KS0020009-00,Standard Low Off Exchange Plan,70.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,$225,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,81711,SERFF,5,2014-09-07 12:14:41,1,81711,KS,SHOP (Small Group),Yes,48-0793267,81711KS0020009,Delta Dental PPO - Basic Family+POEHB,81711KS002,7427051660,KSN002,KSS001,,New,PPO,Low,,Both,,,,Please see Plan Brochure,,,,,Allows Adult and Child-Only,,,,$28.74,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Allows services in the United States and Canada only.,Yes,Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.,Yes,http://www.deltadentalks.com/IndividualOptions/SHOP/,,http://www.deltadentalks.com/IndividualOptions/SHOP/,,81711KS0020009-01,Standard Low On Exchange Plan,70.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,$225,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,81711,SERFF,5,2014-09-07 12:14:41,1,81711,KS,Individual,Yes,48-0793267,81711KS0010003,Delta Dental Individual & Family - Basic+POEHB,81711KS001,7427051660,KSN001,KSS001,,New,PPO,Low,,Both,,,,Please see Plan Brochure,,,,,Allows Adult and Child-Only,,,,$26.97,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Allows services in the United States and Canada only.,Yes,Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.,Yes,https://www.deltadentalcoversme.com/plan-options/KS-plans,https://auth.deltadentalcoversme.com/sp/ACS.saml2,https://www.deltadentalcoversme.com/plan-options/KS-plans,,81711KS0010003-01,Standard Low On Exchange Plan,70.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,$225,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,81711,SERFF,5,2014-09-07 12:14:41,2,81711,KS,Individual,Yes,48-0793267,81711KS0010004,Delta Dental Individual & Family - Preferred+POEHB,81711KS001,7427051660,KSN001,KSS001,,New,PPO,High,,Both,,,,Please see Plan Brochure,,,,,Allows Adult and Child-Only,,,,$33.12,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Allows services in the United States and Canada only.,Yes,Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.,Yes,https://www.deltadentalcoversme.com/plan-options/KS-plans,https://auth.deltadentalcoversme.com/sp/ACS.saml2,https://www.deltadentalcoversme.com/plan-options/KS-plans,,81711KS0010004-00,Standard High Off Exchange Plan,86.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,81711,SERFF,5,2014-09-07 12:14:41,2,81711,KS,Individual,Yes,48-0793267,81711KS0010004,Delta Dental Individual & Family - Preferred+POEHB,81711KS001,7427051660,KSN001,KSS001,,New,PPO,High,,Both,,,,Please see Plan Brochure,,,,,Allows Adult and Child-Only,,,,$33.12,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Allows services in the United States and Canada only.,Yes,Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.,Yes,https://www.deltadentalcoversme.com/plan-options/KS-plans,https://auth.deltadentalcoversme.com/sp/ACS.saml2,https://www.deltadentalcoversme.com/plan-options/KS-plans,,81711KS0010004-01,Standard High On Exchange Plan,86.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,81711,SERFF,5,2014-09-07 12:14:41,3,81711,KS,SHOP (Small Group),Yes,48-0793267,81711KS0020011,Delta Dental PPO - Basic POEHB Addendum,81711KS002,7427051660,KSN002,KSS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$28.74,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Provides Coverage in United States and Canada Only,Yes,Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.,Yes,,,,,81711KS0020011-00,Standard Low Off Exchange Plan,70.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,$225,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,81711,SERFF,5,2014-09-07 12:14:41,3,81711,KS,SHOP (Small Group),Yes,48-0793267,81711KS0020013,Delta Dental Premier - Basic POEHB Addendum,81711KS002,7427051660,KSN003,KSS001,,New,POS,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$31.81,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Provides Coverage in United States and Canada Only,Yes,Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.,Yes,,,,,81711KS0020013-00,Standard Low Off Exchange Plan,71.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$85,$255,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,81711,SERFF,5,2014-09-07 12:14:41,4,81711,KS,SHOP (Small Group),Yes,48-0793267,81711KS0020012,Delta Dental PPO - Preferred POEHB Addendum,81711KS002,7427051660,KSN002,KSS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$35.29,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Provides Coverage in United States and Canada Only,Yes,Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.,Yes,,,,,81711KS0020012-00,Standard High Off Exchange Plan,86.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,81711,SERFF,5,2014-09-07 12:14:41,4,81711,KS,SHOP (Small Group),Yes,48-0793267,81711KS0020014,Delta Dental Premier - Preferred POEHB Addendum,81711KS002,7427051660,KSN003,KSS001,,New,POS,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$39.21,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Provides Coverage in United States and Canada Only,Yes,Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.,Yes,,,,,81711KS0020014-00,Standard High Off Exchange Plan,84.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,81711,SERFF,5,2014-09-07 12:14:41,5,81711,KS,SHOP (Small Group),Yes,48-0793267,81711KS0020010,Delta Dental PPO - Preferred Family+POEHB,81711KS002,7427051660,KSN002,KSS001,,New,PPO,High,,Both,,,,Please see Plan Brochure,,,,,Allows Adult and Child-Only,,,,$35.29,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Allows services in the United States and Canada only.,Yes,Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.,Yes,http://www.deltadentalks.com/IndividualOptions/SHOP/,,http://www.deltadentalks.com/IndividualOptions/SHOP/,,81711KS0020010-00,Standard High Off Exchange Plan,86.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,81711,SERFF,5,2014-09-07 12:14:41,5,81711,KS,SHOP (Small Group),Yes,48-0793267,81711KS0020010,Delta Dental PPO - Preferred Family+POEHB,81711KS002,7427051660,KSN002,KSS001,,New,PPO,High,,Both,,,,Please see Plan Brochure,,,,,Allows Adult and Child-Only,,,,$35.29,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Allows services in the United States and Canada only.,Yes,Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.,Yes,http://www.deltadentalks.com/IndividualOptions/SHOP/,,http://www.deltadentalks.com/IndividualOptions/SHOP/,,81711KS0020010-01,Standard High On Exchange Plan,86.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,86067,SERFF,2,2014-09-11 12:10:19,1,86067,KS,SHOP (Small Group),Yes,57-0523959,86067KS0010001,Group Pediatric Dental EHB Rider,86067KS001,,KSN001,KSS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$34.03,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,86067KS0010001-00,Standard High Off Exchange Plan,84.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,86067,SERFF,2,2014-09-11 12:10:19,1,86067,KS,SHOP (Small Group),Yes,57-0523959,86067KS0010002,Group Pediatric Dental EHB Rider,86067KS001,,KSN001,KSS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$27.15,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,86067KS0010002-00,Standard Low Off Exchange Plan,68.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,86246,SERFF,1,2014-09-05 06:40:30,1,86246,KS,SHOP (Small Group),Yes,93-0242990,86246KS0040002,EHB High PPO,86246KS004,,KSN001,KSS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$42.05,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,86246KS0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,86246,SERFF,1,2014-09-05 06:40:30,1,86246,KS,SHOP (Small Group),Yes,93-0242990,86246KS0040001,EHB Low PPO,86246KS004,,KSN001,KSS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.21,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,86246KS0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,86246,SERFF,1,2014-09-05 06:40:30,1,86246,KS,SHOP (Small Group),Yes,93-0242990,86246KS0030002,EHB High Passive,86246KS003,,KSN001,KSS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$44.31,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,86246KS0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,KS,86246,SERFF,1,2014-09-05 06:40:30,1,86246,KS,SHOP (Small Group),Yes,93-0242990,86246KS0030001,EHB Low Passive,86246KS003,,KSN001,KSS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.45,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,86246KS0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,KS,93384,SERFF,2,2014-09-11 12:10:19,1,93384,KS,SHOP (Small Group),Yes,13-5581829,93384KS0090001,EHB Basic Dental Plan (Low),93384KS009,,KSN001,KSS001,,New,PPO,Low,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$14.99,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,93384KS0090001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,1,94248,KS,Individual,No,43-1257251,94248KS0140004,Blue & U First PCB Silver,94248KS014,7023011258,KSN001,KSS001,KSF018,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/firstpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0140004-00,Standard Silver Off Exchange Plan,68.00%,0.683626294136047,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$8,400","$16,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",0%,,,,"$4,200","$8,400",Not Applicable,Not Applicable,"$4,200",$0,$0,$200,$300,$300,$0,$40,4
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,1,94248,KS,SHOP (Small Group),No,43-1257251,94248KS0220001,Blue & U First 1500 PCB Gold,94248KS022,7023011258,KSN001,KSS001,KSF001,Existing,PPO,Gold,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/sg/ks/firstpcbgold1500.html,http://www.bluekc.com/qhp/2015/payment.html,http://www.bluekc.com/qhp/2015/sgbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0220001-00,Standard Gold Off Exchange Plan,,0.792361259460449,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$5,600","$11,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",15%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,"$1,500",$10,$800,$200,$300,$300,$0,$40,4
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,1,94248,KS,SHOP (Small Group),No,43-1257251,94248KS0220001,Blue & U First 1500 PCB Gold,94248KS022,7023011258,KSN001,KSS001,KSF001,Existing,PPO,Gold,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/sg/ks/firstpcbgold1500.html,http://www.bluekc.com/qhp/2015/payment.html,http://www.bluekc.com/qhp/2015/sgbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0220001-01,Standard Gold On Exchange Plan,,0.792361259460449,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$5,600","$11,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",15%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,"$1,500",$10,$800,$200,$300,$300,$0,$40,5
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,1,94248,KS,SHOP (Small Group),No,43-1257251,94248KS0220002,Blue & U First 2000 PCB Silver,94248KS022,7023011258,KSN001,KSS001,KSF007,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/sg/ks/firstpcbsilver2000.html,http://www.bluekc.com/qhp/2015/payment.html,http://www.bluekc.com/qhp/2015/sgbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0220002-00,Standard Silver Off Exchange Plan,,0.698544263839722,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$2,000",$10,"$1,500",$200,$300,$300,$0,$40,6
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,1,94248,KS,SHOP (Small Group),No,43-1257251,94248KS0220002,Blue & U First 2000 PCB Silver,94248KS022,7023011258,KSN001,KSS001,KSF007,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/sg/ks/firstpcbsilver2000.html,http://www.bluekc.com/qhp/2015/payment.html,http://www.bluekc.com/qhp/2015/sgbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0220002-01,Standard Silver On Exchange Plan,,0.698544263839722,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$2,000",$10,"$1,500",$200,$300,$300,$0,$40,7
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,1,94248,KS,Individual,No,43-1257251,94248KS0140004,Blue & U First PCB Silver,94248KS014,7023011258,KSN001,KSS001,KSF018,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/firstpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0140004-03,Limited Cost Sharing Plan Variation,68.00%,0.683626294136047,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$8,400","$16,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",0%,,,,"$4,200","$8,400",Not Applicable,Not Applicable,"$4,200",$0,$0,$200,$300,$300,$0,$40,7
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,1,94248,KS,Individual,No,43-1257251,94248KS0140004,Blue & U First PCB Silver,94248KS014,7023011258,KSN001,KSS001,KSF018,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/firstpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0140004-04,73% AV Level Silver Plan,73.70%,0.737449705600739,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,400","$16,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,"$4,200","$8,400",Not Applicable,Not Applicable,"$4,000",$0,$0,$200,$300,$300,$0,$40,8
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,1,94248,KS,Individual,No,43-1257251,94248KS0140004,Blue & U First PCB Silver,94248KS014,7023011258,KSN001,KSS001,KSF018,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/firstpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0140004-05,87% AV Level Silver Plan,86.40%,0.863930761814117,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$8,400","$16,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$4,200","$8,400",Not Applicable,Not Applicable,"$1,500",$0,$0,$200,$300,$300,$0,$40,9
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,1,94248,KS,Individual,No,43-1257251,94248KS0140004,Blue & U First PCB Silver,94248KS014,7023011258,KSN001,KSS001,KSF018,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/firstpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0140004-06,94% AV Level Silver Plan,93.20%,0.937213659286499,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$450,$900,,,"$8,400","$16,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$450,$900,0%,,,,"$4,200","$8,400",Not Applicable,Not Applicable,$400,$0,$0,$200,$200,$200,$0,$40,10
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,2,94248,KS,Individual,No,43-1257251,94248KS0140006,Blue & U First PCB Bronze,94248KS014,7023011258,KSN001,KSS001,KSF007,Existing,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/firstpcbbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0140006-00,Standard Bronze Off Exchange Plan,,0.611002326011658,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$6,250","$12,500",Not Applicable,Not Applicable,"$6,200",$0,$0,$200,"$4,500",$0,$0,$40,4
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,2,94248,KS,Individual,No,43-1257251,94248KS0140006,Blue & U First PCB Bronze,94248KS014,7023011258,KSN001,KSS001,KSF007,Existing,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/firstpcbbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0140006-01,Standard Bronze On Exchange Plan,,0.611002326011658,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$6,250","$12,500",Not Applicable,Not Applicable,"$6,200",$0,$0,$200,"$4,500",$0,$0,$40,5
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,2,94248,KS,Individual,No,43-1257251,94248KS0140006,Blue & U First PCB Bronze,94248KS014,7023011258,KSN001,KSS001,KSF007,Existing,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/firstpcbbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0140006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,2,94248,KS,Individual,No,43-1257251,94248KS0140006,Blue & U First PCB Bronze,94248KS014,7023011258,KSN001,KSS001,KSF007,Existing,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/firstpcbbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0140006-03,Limited Cost Sharing Plan Variation,,0.611002326011658,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$6,250","$12,500",Not Applicable,Not Applicable,"$6,200",$0,$0,$200,"$4,500",$0,$0,$40,7
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,2,94248,KS,Individual,No,43-1257251,94248KS0150006,Blue & U First Select Bronze,94248KS015,7023011258,KSN003,KSS001,KSF008,Existing,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/firstselectbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0150006-00,Standard Bronze Off Exchange Plan,,0.611002326011658,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$6,250","$12,500",Not Applicable,Not Applicable,"$6,200",$0,$0,$200,"$4,500",$0,$0,$40,8
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,2,94248,KS,Individual,No,43-1257251,94248KS0150006,Blue & U First Select Bronze,94248KS015,7023011258,KSN003,KSS001,KSF008,Existing,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/firstselectbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0150006-01,Standard Bronze On Exchange Plan,,0.611002326011658,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$6,250","$12,500",Not Applicable,Not Applicable,"$6,200",$0,$0,$200,"$4,500",$0,$0,$40,9
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,2,94248,KS,Individual,No,43-1257251,94248KS0150006,Blue & U First Select Bronze,94248KS015,7023011258,KSN003,KSS001,KSF008,Existing,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/firstselectbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0150006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,10
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,2,94248,KS,Individual,No,43-1257251,94248KS0150006,Blue & U First Select Bronze,94248KS015,7023011258,KSN003,KSS001,KSF008,Existing,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/firstselectbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0150006-03,Limited Cost Sharing Plan Variation,,0.611002326011658,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$6,250","$12,500",Not Applicable,Not Applicable,"$6,200",$0,$0,$200,"$4,500",$0,$0,$40,11
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,3,94248,KS,Individual,No,43-1257251,94248KS0150004,Blue & U First Select Silver,94248KS015,7023011258,KSN002,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/firstselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0150004-00,Standard Silver Off Exchange Plan,70.90%,0.710290610790253,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,200","$8,400","$4,200","$8,400","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",0%,"$4,200","$8,400",0%,"$4,200","$8,400",Not Applicable,Not Applicable,"$4,200",$0,$0,$200,$300,$700,$0,$40,4
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,3,94248,KS,Individual,No,43-1257251,94248KS0150004,Blue & U First Select Silver,94248KS015,7023011258,KSN002,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/firstselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0150004-01,Standard Silver On Exchange Plan,70.90%,0.710290610790253,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,200","$8,400","$4,200","$8,400","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",0%,"$4,200","$8,400",0%,"$4,200","$8,400",Not Applicable,Not Applicable,"$4,200",$0,$0,$200,$300,$700,$0,$40,5
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,3,94248,KS,Individual,No,43-1257251,94248KS0150004,Blue & U First Select Silver,94248KS015,7023011258,KSN002,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/firstselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0150004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,3,94248,KS,Individual,No,43-1257251,94248KS0150004,Blue & U First Select Silver,94248KS015,7023011258,KSN002,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/firstselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0150004-03,Limited Cost Sharing Plan Variation,70.90%,0.710290610790253,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,200","$8,400","$4,200","$8,400","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",0%,"$4,200","$8,400",0%,"$4,200","$8,400",Not Applicable,Not Applicable,"$4,200",$0,$0,$200,$300,$700,$0,$40,7
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,3,94248,KS,Individual,No,43-1257251,94248KS0150004,Blue & U First Select Silver,94248KS015,7023011258,KSN002,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/firstselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0150004-04,73% AV Level Silver Plan,72.90%,0.730347990989685,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,900","$7,800","$3,900","$7,800","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,900","$7,800",0%,"$3,900","$7,800",0%,"$4,200","$8,400",Not Applicable,Not Applicable,"$3,900",$0,$0,$200,$300,$700,$0,$40,8
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,3,94248,KS,Individual,No,43-1257251,94248KS0150004,Blue & U First Select Silver,94248KS015,7023011258,KSN002,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/firstselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0150004-05,87% AV Level Silver Plan,86.20%,0.862267374992371,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,"$1,500","$3,000",0%,"$4,200","$8,400",Not Applicable,Not Applicable,"$1,500",$0,$0,$200,$300,$700,$0,$40,9
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,3,94248,KS,Individual,No,43-1257251,94248KS0150004,Blue & U First Select Silver,94248KS015,7023011258,KSN002,KSS001,KSF002,Existing,PPO,Silver,Yes,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/firstselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0150004-06,94% AV Level Silver Plan,93.70%,0.940446496009827,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$450,$900,$450,$900,"$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$450,$900,0%,$450,$900,0%,"$4,200","$8,400",Not Applicable,Not Applicable,$400,$0,$0,$200,$90,$400,$0,$40,10
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,4,94248,KS,Individual,No,43-1257251,94248KS0160002,Blue & U Classic PCB Gold,94248KS016,7023011258,KSN001,KSS001,KSF003,Existing,PPO,Gold,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/classicpcbgold.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0160002-00,Standard Gold Off Exchange Plan,,0.783181190490723,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,"$1,500","$3,000",10%,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100",$900,$0,$200,$0,$900,$0,$40,4
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,4,94248,KS,Individual,No,43-1257251,94248KS0160004,Blue & U Classic PCB Silver,94248KS016,7023011258,KSN001,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/classicpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0160004-01,Standard Silver On Exchange Plan,,0.687620997428894,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$12,500","$25,000",Not Applicable,Not Applicable,"$5,000","$10,000",10%,"$5,000","$10,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100","$1,100",$0,$200,$0,"$1,000",$0,$40,9
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,4,94248,KS,Individual,No,43-1257251,94248KS0160004,Blue & U Classic PCB Silver,94248KS016,7023011258,KSN001,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/classicpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0160004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$40,10
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,4,94248,KS,Individual,No,43-1257251,94248KS0160004,Blue & U Classic PCB Silver,94248KS016,7023011258,KSN001,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/classicpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0160004-05,87% AV Level Silver Plan,,0.867246627807617,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000","$12,500","$25,000",Not Applicable,Not Applicable,"$1,000","$2,000",10%,"$1,000","$2,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$600,$10,$200,$0,$500,$0,$40,13
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,4,94248,KS,Individual,No,43-1257251,94248KS0160004,Blue & U Classic PCB Silver,94248KS016,7023011258,KSN001,KSS001,KSF003,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/classicpcbsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0160004-06,94% AV Level Silver Plan,,0.938696026802063,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$600,"$1,200",$600,"$1,200","$12,500","$25,000",Not Applicable,Not Applicable,$250,$500,10%,$250,$500,10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,$200,$200,$80,$200,$0,$500,$0,$40,14
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,5,94248,KS,Individual,No,43-1257251,94248KS0170002,Blue & U Classic Select Gold,94248KS017,7023011258,KSN002,KSS001,KSF004,Existing,PPO,Gold,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/classicselectgold.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0170002-00,Standard Gold Off Exchange Plan,,0.784470677375793,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$25,000","$50,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,"$1,500","$3,000",10%,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,10%,$0,$0,10%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100",$900,$0,$200,$0,"$1,000",$0,$40,4
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,5,94248,KS,Individual,No,43-1257251,94248KS0170002,Blue & U Classic Select Gold,94248KS017,7023011258,KSN002,KSS001,KSF004,Existing,PPO,Gold,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/classicselectgold.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0170002-01,Standard Gold On Exchange Plan,,0.784470677375793,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$25,000","$50,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,"$1,500","$3,000",10%,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,10%,$0,$0,10%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100",$900,$0,$200,$0,"$1,000",$0,$40,5
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,5,94248,KS,Individual,No,43-1257251,94248KS0170002,Blue & U Classic Select Gold,94248KS017,7023011258,KSN002,KSS001,KSF004,Existing,PPO,Gold,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/classicselectgold.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0170002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,5,94248,KS,Individual,No,43-1257251,94248KS0170002,Blue & U Classic Select Gold,94248KS017,7023011258,KSN002,KSS001,KSF004,Existing,PPO,Gold,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/classicselectgold.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0170002-03,Limited Cost Sharing Plan Variation,,0.784470677375793,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$25,000","$50,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,"$1,500","$3,000",10%,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,10%,$0,$0,10%,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100",$900,$0,$200,$0,"$1,000",$0,$40,7
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,5,94248,KS,Individual,No,43-1257251,94248KS0170004,Blue & U Classic Select Silver,94248KS017,7023011258,KSN002,KSS001,KSF004,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/classicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0170004-00,Standard Silver Off Exchange Plan,,0.684849500656128,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$25,000","$50,000",Not Applicable,Not Applicable,"$5,000","$10,000",10%,"$5,000","$10,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,10%,$0,$0,10%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100","$1,100",$0,$200,$0,"$1,100",$0,$40,8
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,5,94248,KS,Individual,No,43-1257251,94248KS0170004,Blue & U Classic Select Silver,94248KS017,7023011258,KSN002,KSS001,KSF004,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/classicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0170004-01,Standard Silver On Exchange Plan,,0.684849500656128,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$25,000","$50,000",Not Applicable,Not Applicable,"$5,000","$10,000",10%,"$5,000","$10,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,10%,$0,$0,10%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100","$1,100",$0,$200,$0,"$1,100",$0,$40,9
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,5,94248,KS,Individual,No,43-1257251,94248KS0170004,Blue & U Classic Select Silver,94248KS017,7023011258,KSN002,KSS001,KSF004,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/classicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0170004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$40,10
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,5,94248,KS,Individual,No,43-1257251,94248KS0170004,Blue & U Classic Select Silver,94248KS017,7023011258,KSN002,KSS001,KSF004,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/classicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0170004-03,Limited Cost Sharing Plan Variation,,0.684849500656128,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$25,000","$50,000",Not Applicable,Not Applicable,"$5,000","$10,000",10%,"$5,000","$10,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,10%,$0,$0,10%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100","$1,100",$0,$200,$0,"$1,100",$0,$40,11
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,5,94248,KS,Individual,No,43-1257251,94248KS0170004,Blue & U Classic Select Silver,94248KS017,7023011258,KSN002,KSS001,KSF004,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/classicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0170004-04,73% AV Level Silver Plan,,0.722733199596405,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$25,000","$50,000",Not Applicable,Not Applicable,"$3,000","$6,000",10%,"$3,000","$6,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,10%,$0,$0,10%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,100",$900,$0,$200,$0,"$1,100",$0,$40,12
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,5,94248,KS,Individual,No,43-1257251,94248KS0170004,Blue & U Classic Select Silver,94248KS017,7023011258,KSN002,KSS001,KSF004,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/classicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0170004-05,87% AV Level Silver Plan,,0.861019134521484,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000","$25,000","$50,000",Not Applicable,Not Applicable,"$1,000","$2,000",10%,"$1,000","$2,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,10%,$0,$0,10%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$700,$10,$200,$0,$900,$0,$40,13
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,6,94248,KS,Individual,No,43-1257251,94248KS0180003,Blue & U Saver PCB Silver,94248KS018,7023011258,KSN001,KSS001,KSF005,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saverpcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0180003-01,Standard Silver On Exchange Plan,,0.683051764965057,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,"$2,500",$20,$500,$200,"$2,500",$400,$20,$40,5
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,6,94248,KS,Individual,No,43-1257251,94248KS0180003,Blue & U Saver PCB Silver,94248KS018,7023011258,KSN001,KSS001,KSF005,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saverpcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0180003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,6
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,6,94248,KS,Individual,No,43-1257251,94248KS0180003,Blue & U Saver PCB Silver,94248KS018,7023011258,KSN001,KSS001,KSF005,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saverpcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0180003-03,Limited Cost Sharing Plan Variation,,0.683051764965057,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,"$2,500",$20,$500,$200,"$2,500",$400,$20,$40,7
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,6,94248,KS,Individual,No,43-1257251,94248KS0180003,Blue & U Saver PCB Silver,94248KS018,7023011258,KSN001,KSS001,KSF005,Existing,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saverpcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0180003-04,73% AV Level Silver Plan,,0.722181975841522,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,125","$6,250",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,"$2,000",$20,$500,$200,"$2,000",$500,$20,$40,8
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,6,94248,KS,Individual,No,43-1257251,94248KS0180008,Blue & U Saver2 PCB Silver,94248KS018,7023011258,KSN001,KSS001,KSF005,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saver2pcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0180008-00,Standard Silver Off Exchange Plan,,0.684860467910767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",40%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,"$1,800",$20,"$2,100",$200,"$1,800",$500,$100,$40,11
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,6,94248,KS,Individual,No,43-1257251,94248KS0180008,Blue & U Saver2 PCB Silver,94248KS018,7023011258,KSN001,KSS001,KSF005,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saver2pcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0180008-01,Standard Silver On Exchange Plan,,0.684860467910767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",40%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,"$1,800",$20,"$2,100",$200,"$1,800",$500,$100,$40,12
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,6,94248,KS,Individual,No,43-1257251,94248KS0180008,Blue & U Saver2 PCB Silver,94248KS018,7023011258,KSN001,KSS001,KSF005,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saver2pcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0180008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,13
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,6,94248,KS,Individual,No,43-1257251,94248KS0180008,Blue & U Saver2 PCB Silver,94248KS018,7023011258,KSN001,KSS001,KSF005,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saver2pcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0180008-03,Limited Cost Sharing Plan Variation,,0.684860467910767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",40%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,"$1,800",$20,"$2,100",$200,"$1,800",$500,$100,$40,14
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,6,94248,KS,Individual,No,43-1257251,94248KS0180008,Blue & U Saver2 PCB Silver,94248KS018,7023011258,KSN001,KSS001,KSF005,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saver2pcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0180008-04,73% AV Level Silver Plan,,0.722767114639282,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",40%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,"$1,500",$0,"$2,000",$200,"$1,500",$500,$100,$40,15
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,6,94248,KS,Individual,No,43-1257251,94248KS0180008,Blue & U Saver2 PCB Silver,94248KS018,7023011258,KSN001,KSS001,KSF005,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saver2pcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0180008-05,87% AV Level Silver Plan,,0.867958784103394,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",40%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,$700,$0,$500,$200,$700,$200,$300,$40,16
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,6,94248,KS,Individual,No,43-1257251,94248KS0180008,Blue & U Saver2 PCB Silver,94248KS018,7023011258,KSN001,KSS001,KSF005,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saver2pcbsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0180008-06,94% AV Level Silver Plan,,0.937017142772675,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,40%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,$200,$0,$200,$200,$200,$20,$200,$40,17
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,6,94248,KS,Individual,No,43-1257251,94248KS0180009,Blue & U Saver PCB Bronze,94248KS018,7023011258,KSN001,KSS001,KSF005,New,PPO,Bronze,No,Both,Yes,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saverpcbbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0180009-00,Standard Bronze Off Exchange Plan,,0.589854598045349,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$5,000",$20,$200,$200,"$5,000",$0,$0,$40,18
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,6,94248,KS,Individual,No,43-1257251,94248KS0180009,Blue & U Saver PCB Bronze,94248KS018,7023011258,KSN001,KSS001,KSF005,New,PPO,Bronze,No,Both,Yes,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saverpcbbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0180009-01,Standard Bronze On Exchange Plan,,0.589854598045349,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$5,000",$20,$200,$200,"$5,000",$0,$0,$40,19
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,6,94248,KS,Individual,No,43-1257251,94248KS0180009,Blue & U Saver PCB Bronze,94248KS018,7023011258,KSN001,KSS001,KSF005,New,PPO,Bronze,No,Both,Yes,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saverpcbbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0180009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,20
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,6,94248,KS,Individual,No,43-1257251,94248KS0180009,Blue & U Saver PCB Bronze,94248KS018,7023011258,KSN001,KSS001,KSF005,New,PPO,Bronze,No,Both,Yes,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saverpcbbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0180009-03,Limited Cost Sharing Plan Variation,,0.589854598045349,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$5,000",$20,$200,$200,"$5,000",$0,$0,$40,21
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,6,94248,KS,Individual,No,43-1257251,94248KS0180010,Blue & U Saver2 PCB Bronze,94248KS018,7023011258,KSN001,KSS001,KSF025,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saver2pcbbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0180010-00,Standard Bronze Off Exchange Plan,,0.608896374702454,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,100",$200,"$3,000",$0,"$1,000",$40,22
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,6,94248,KS,Individual,No,43-1257251,94248KS0180010,Blue & U Saver2 PCB Bronze,94248KS018,7023011258,KSN001,KSS001,KSF025,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saver2pcbbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0180010-01,Standard Bronze On Exchange Plan,,0.608896374702454,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,100",$200,"$3,000",$0,"$1,000",$40,23
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,6,94248,KS,Individual,No,43-1257251,94248KS0180010,Blue & U Saver2 PCB Bronze,94248KS018,7023011258,KSN001,KSS001,KSF025,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saver2pcbbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0180010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,24
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,6,94248,KS,Individual,No,43-1257251,94248KS0180010,Blue & U Saver2 PCB Bronze,94248KS018,7023011258,KSN001,KSS001,KSF025,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saver2pcbbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0180010-03,Limited Cost Sharing Plan Variation,,0.608896374702454,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,100",$200,"$3,000",$0,"$1,000",$40,25
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,7,94248,KS,Individual,No,43-1257251,94248KS0190007,Blue & U Saver Select Silver,94248KS019,7023011258,KSN002,KSS001,KSF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saverselectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0190007-00,Standard Silver Off Exchange Plan,,0.686538398265839,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,"$2,500","$5,000",10%,"$2,500","$5,000",Not Applicable,Not Applicable,"$2,500",$20,$500,$200,"$2,500",$400,$20,$40,4
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,7,94248,KS,Individual,No,43-1257251,94248KS0190007,Blue & U Saver Select Silver,94248KS019,7023011258,KSN002,KSS001,KSF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saverselectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0190007-05,87% AV Level Silver Plan,,0.868339836597443,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,200","$2,400","$1,200","$2,400","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$800,"$1,600",10%,$800,"$1,600",10%,"$2,500","$5,000",Not Applicable,Not Applicable,$800,$0,$400,$200,$800,$300,$40,$40,9
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,7,94248,KS,Individual,No,43-1257251,94248KS0190007,Blue & U Saver Select Silver,94248KS019,7023011258,KSN002,KSS001,KSF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saverselectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0190007-06,94% AV Level Silver Plan,,0.939264476299286,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$500,"$1,000",$500,"$1,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,$250,$500,10%,"$2,500","$5,000",Not Applicable,Not Applicable,$200,$0,$200,$200,$200,$90,$50,$40,10
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,7,94248,KS,Individual,No,43-1257251,94248KS0190008,Blue & U Saver2 Select Silver,94248KS019,7023011258,KSN002,KSS001,KSF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saver2selectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0190008-00,Standard Silver Off Exchange Plan,,0.687736034393311,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",40%,"$1,800","$3,600",40%,"$1,800","$3,600",Not Applicable,Not Applicable,"$1,800",$20,"$2,100",$200,"$1,800",$600,$100,$40,11
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,7,94248,KS,Individual,No,43-1257251,94248KS0190008,Blue & U Saver2 Select Silver,94248KS019,7023011258,KSN002,KSS001,KSF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saver2selectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0190008-01,Standard Silver On Exchange Plan,,0.687736034393311,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",40%,"$1,800","$3,600",40%,"$1,800","$3,600",Not Applicable,Not Applicable,"$1,800",$20,"$2,100",$200,"$1,800",$600,$100,$40,12
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,7,94248,KS,Individual,No,43-1257251,94248KS0190008,Blue & U Saver2 Select Silver,94248KS019,7023011258,KSN002,KSS001,KSF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saver2selectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0190008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,13
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,7,94248,KS,Individual,No,43-1257251,94248KS0190008,Blue & U Saver2 Select Silver,94248KS019,7023011258,KSN002,KSS001,KSF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saver2selectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0190008-03,Limited Cost Sharing Plan Variation,,0.687736034393311,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",40%,"$1,800","$3,600",40%,"$1,800","$3,600",Not Applicable,Not Applicable,"$1,800",$20,"$2,100",$200,"$1,800",$600,$100,$40,14
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,7,94248,KS,Individual,No,43-1257251,94248KS0190008,Blue & U Saver2 Select Silver,94248KS019,7023011258,KSN002,KSS001,KSF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saver2selectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0190008-04,73% AV Level Silver Plan,,0.725340247154236,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",40%,"$1,500","$3,000",40%,"$1,800","$3,600",Not Applicable,Not Applicable,"$1,500",$0,"$2,000",$200,"$1,500",$600,$100,$40,15
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,7,94248,KS,Individual,No,43-1257251,94248KS0190008,Blue & U Saver2 Select Silver,94248KS019,7023011258,KSN002,KSS001,KSF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saver2selectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0190008-05,87% AV Level Silver Plan,,0.867297887802124,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,200","$2,400","$1,200","$2,400","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",40%,$700,"$1,400",40%,"$1,800","$3,600",Not Applicable,Not Applicable,$700,$0,$500,$200,$700,$200,$200,$40,16
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,7,94248,KS,Individual,No,43-1257251,94248KS0190008,Blue & U Saver2 Select Silver,94248KS019,7023011258,KSN002,KSS001,KSF006,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saver2selectsilver2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0190008-06,94% AV Level Silver Plan,,0.936714768409729,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$500,"$1,000",$500,"$1,000","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,40%,$250,$500,40%,"$1,800","$3,600",Not Applicable,Not Applicable,$200,$0,$200,$200,$200,$40,$200,$40,17
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,7,94248,KS,Individual,No,43-1257251,94248KS0190009,Blue & U Saver Select Bronze,94248KS019,7023011258,KSN002,KSS001,KSF006,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saverselectbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0190009-00,Standard Bronze Off Exchange Plan,,0.591562926769257,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",10%,"$5,000","$10,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,"$5,000",$20,$200,$200,"$5,000",$0,$0,$40,18
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,7,94248,KS,Individual,No,43-1257251,94248KS0190009,Blue & U Saver Select Bronze,94248KS019,7023011258,KSN002,KSS001,KSF006,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saverselectbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0190009-01,Standard Bronze On Exchange Plan,,0.591562926769257,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",10%,"$5,000","$10,000",10%,"$5,000","$10,000",Not Applicable,Not Applicable,"$5,000",$20,$200,$200,"$5,000",$0,$0,$40,19
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,7,94248,KS,Individual,No,43-1257251,94248KS0190009,Blue & U Saver Select Bronze,94248KS019,7023011258,KSN002,KSS001,KSF006,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saverselectbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0190009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,20
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,7,94248,KS,Individual,No,43-1257251,94248KS0190010,Blue & U Saver 2 Select Bronze,94248KS019,7023011258,KSN003,KSS001,KSF026,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saver2selectbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0190010-01,Standard Bronze On Exchange Plan,,0.608896374702454,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,"$3,000","$6,000",50%,"$3,000","$6,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,100",$200,"$3,000",$0,"$1,000",$40,23
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,7,94248,KS,Individual,No,43-1257251,94248KS0190010,Blue & U Saver 2 Select Bronze,94248KS019,7023011258,KSN003,KSS001,KSF026,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saver2selectbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0190010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$40,24
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,7,94248,KS,Individual,No,43-1257251,94248KS0190010,Blue & U Saver 2 Select Bronze,94248KS019,7023011258,KSN003,KSS001,KSF026,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.",Yes,http://www.bluekc.com/qhp/2015/dp/ks/saver2selectbronze2.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0190010-03,Limited Cost Sharing Plan Variation,,0.608896374702454,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$25,000","$50,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,"$3,000","$6,000",50%,"$3,000","$6,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,100",$200,"$3,000",$0,"$1,000",$40,25
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,9,94248,KS,Individual,No,43-1257251,94248KS0420001,Blue & U Basic Select Silver,94248KS042,7023011258,KSN004,KSS001,KSF019,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, such services will be provided at the out-of-network benefit level.",No,http://www.bluekc.com/qhp/2015/dp/ks/basicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0420001-00,Standard Silver Off Exchange Plan,,0.702799558639526,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$3,500","$7,000",40%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,"$1,000","$2,000",40%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$0,"$1,500",$200,$500,$300,$0,$40,4
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,9,94248,KS,Individual,No,43-1257251,94248KS0420001,Blue & U Basic Select Silver,94248KS042,7023011258,KSN004,KSS001,KSF019,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, such services will be provided at the out-of-network benefit level.",No,http://www.bluekc.com/qhp/2015/dp/ks/basicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0420001-03,Limited Cost Sharing Plan Variation,,0.702799558639526,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$3,500","$7,000",40%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,"$1,000","$2,000",40%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$0,"$1,500",$200,$500,$300,$0,$40,7
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,9,94248,KS,Individual,No,43-1257251,94248KS0420001,Blue & U Basic Select Silver,94248KS042,7023011258,KSN004,KSS001,KSF019,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, such services will be provided at the out-of-network benefit level.",No,http://www.bluekc.com/qhp/2015/dp/ks/basicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0420001-04,73% AV Level Silver Plan,,0.732099652290344,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$2,750","$5,500",40%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$750,"$1,500",40%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,"$2,800",$0,"$1,200",$200,$500,$300,$0,$40,8
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,9,94248,KS,Individual,No,43-1257251,94248KS0420001,Blue & U Basic Select Silver,94248KS042,7023011258,KSN004,KSS001,KSF019,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, such services will be provided at the out-of-network benefit level.",No,http://www.bluekc.com/qhp/2015/dp/ks/basicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0420001-05,87% AV Level Silver Plan,,0.861657977104187,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$25,000","$50,000",Not Applicable,Not Applicable,$800,"$1,600",40%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$400,$800,40%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,$800,$0,"$1,000",$200,$500,$300,$0,$40,9
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,9,94248,KS,Individual,No,43-1257251,94248KS0420001,Blue & U Basic Select Silver,94248KS042,7023011258,KSN004,KSS001,KSF019,New,PPO,Silver,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, such services will be provided at the out-of-network benefit level.",No,http://www.bluekc.com/qhp/2015/dp/ks/basicselectsilver.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0420001-06,94% AV Level Silver Plan,,0.934593498706818,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,"$25,000","$50,000",Not Applicable,Not Applicable,$350,$700,40%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$150,$300,40%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,$400,$0,$300,$200,$400,$200,$60,$40,10
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,9,94248,KS,Individual,No,43-1257251,94248KS0420002,Blue & U Basic Select Bronze,94248KS042,7023011258,KSN004,KSS001,KSF020,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, such services will be provided at the out-of-network benefit level.",No,http://www.bluekc.com/qhp/2015/dp/ks/basicselectbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0420002-00,Standard Bronze Off Exchange Plan,,0.619391083717346,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$6,000","$12,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$600,"$1,200",40%,,,,$600,"$1,200",Not Applicable,Not Applicable,,,,,,,,,,,"$6,000",$0,$600,$200,$500,"$1,200",$0,$40,11
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,9,94248,KS,Individual,No,43-1257251,94248KS0420002,Blue & U Basic Select Bronze,94248KS042,7023011258,KSN004,KSS001,KSF020,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, such services will be provided at the out-of-network benefit level.",No,http://www.bluekc.com/qhp/2015/dp/ks/basicselectbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0420002-01,Standard Bronze On Exchange Plan,,0.619391083717346,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$6,000","$12,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$600,"$1,200",40%,,,,$600,"$1,200",Not Applicable,Not Applicable,,,,,,,,,,,"$6,000",$0,$600,$200,$500,"$1,200",$0,$40,12
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,9,94248,KS,Individual,No,43-1257251,94248KS0420002,Blue & U Basic Select Bronze,94248KS042,7023011258,KSN004,KSS001,KSF020,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, such services will be provided at the out-of-network benefit level.",No,http://www.bluekc.com/qhp/2015/dp/ks/basicselectbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0420002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$40,13
2015,KS,94248,SERFF,5,2015-01-21 12:15:34,9,94248,KS,Individual,No,43-1257251,94248KS0420002,Blue & U Basic Select Bronze,94248KS042,7023011258,KSN004,KSS001,KSF020,New,PPO,Bronze,No,Both,No,No,,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,"We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.",Yes,"If You receive services outside of Our Service Area, such services will be provided at the out-of-network benefit level.",No,http://www.bluekc.com/qhp/2015/dp/ks/basicselectbronze.html,https://bluekc.oicusa.com/ste/ffmpayment,http://www.bluekc.com/qhp/2015/dpbrochure.html,http://www.bluekc.com/qhp/2015/ksdruglist.html,94248KS0420002-03,Limited Cost Sharing Plan Variation,,0.619391083717346,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$25,000","$50,000",Not Applicable,Not Applicable,"$6,000","$12,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$600,"$1,200",40%,,,,$600,"$1,200",Not Applicable,Not Applicable,,,,,,,,,,,"$6,000",$0,$600,$200,$500,"$1,200",$0,$40,14
2015,KS,95038,SERFF,1,2014-09-07 12:14:41,1,95038,KS,Individual,Yes,47-0397286,95038KS0010001,"Delta Dental Individual PPO, EHB Certified",95038KS001,,KSN002,KSS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.89,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,95038KS0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,95038,SERFF,1,2014-09-07 12:14:41,1,95038,KS,SHOP (Small Group),Yes,47-0397286,95038KS0030001,"Renaissance Group Dental PPO, EHB Certified",95038KS003,,KSN001,KSS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.70,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,95038KS0030001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,KS,95038,SERFF,1,2014-09-07 12:14:41,1,95038,KS,SHOP (Small Group),Yes,47-0397286,95038KS0030002,"Renaissance Group Dental PPO, EHB Certified",95038KS003,,KSN001,KSS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.45,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,95038KS0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,95038,SERFF,1,2014-09-07 12:14:41,1,95038,KS,Individual,Yes,47-0397286,95038KS0010002,"Delta Dental Individual PPO, EHB Certified",95038KS001,,KSN002,KSS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.45,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,95038KS0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,KS,95038,SERFF,1,2014-09-07 12:14:41,1,95038,KS,Individual,Yes,47-0397286,95038KS0020001,"Renaissance Individual Dental PPO, EHB Certified",95038KS002,,KSN001,KSS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.93,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,95038KS0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,KS,95038,SERFF,1,2014-09-07 12:14:41,1,95038,KS,Individual,Yes,47-0397286,95038KS0020002,"Renaissance Individual Dental PPO, EHB Certified",95038KS002,,KSN001,KSS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.13,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,95038KS0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,ME,28804,SERFF,2,2014-09-09 16:12:42,1,28804,ME,SHOP (Small Group),Yes,13-5581829,28804ME0100001,EHB Basic Dental Plan (Low),28804ME010,,MEN001,MES001,,New,PPO,Low,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$20.68,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,28804ME0100001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,1,33653,ME,SHOP (Small Group),No,45-3416923,33653ME0160001,Community Option HSA,33653ME016,,MEN001,MES001,MEF002,New,PPO,Bronze,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-SG-OPTIONHSA-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0160001-00,Standard Bronze Off Exchange Plan,58.60%,0.585511147975922,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,2,33653,ME,SHOP (Small Group),No,45-3416923,33653ME0170001,Community Option,33653ME017,,MEN001,MES001,MEF003,New,PPO,Bronze,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.997,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-SG-OPTION-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0170001-01,Standard Bronze On Exchange Plan,61.70%,0.609969615936279,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,2,33653,ME,Individual,No,45-3416923,33653ME0030001,Community Option,33653ME003,,MEN001,MES001,MEF003,Existing,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9972,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-OPTION-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0030001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,3,33653,ME,Individual,No,45-3416923,33653ME0040001,Community Choice,33653ME004,,MEN001,MES001,MEF005,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9978,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hopsital service with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-CHOICE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0040001-01,Standard Silver On Exchange Plan,68.60%,0.680941760540009,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,3,33653,ME,Individual,No,45-3416923,33653ME0040001,Community Choice,33653ME004,,MEN001,MES001,MEF005,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9978,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hopsital service with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-CHOICE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0040001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,6,33653,ME,SHOP (Small Group),No,45-3416923,33653ME0290001,Community Premier,33653ME029,,MEN001,MES001,MEF009,New,PPO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9982,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap netwrok provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-SG-PREMIER-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0290001-01,Standard Platinum On Exchange Plan,89.70%,0.894532740116119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,6,33653,ME,Individual,No,45-3416923,33653ME0130001,Community Value Plus,33653ME013,,MEN001,MES001,MEF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9978,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-VALUEPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0130001-01,Standard Silver On Exchange Plan,68.50%,0.696940898895264,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700",50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,6,33653,ME,Individual,No,45-3416923,33653ME0130001,Community Value Plus,33653ME013,,MEN001,MES001,MEF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9978,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-VALUEPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0130001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,6,33653,ME,Individual,No,45-3416923,33653ME0130001,Community Value Plus,33653ME013,,MEN001,MES001,MEF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9978,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-VALUEPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0130001-03,Limited Cost Sharing Plan Variation,68.50%,0.696940898895264,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700",50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,6,33653,ME,Individual,No,45-3416923,33653ME0130001,Community Value Plus,33653ME013,,MEN001,MES001,MEF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9978,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-VALUEPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0130001-04,73% AV Level Silver Plan,73.90%,0.750189304351807,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,6,33653,ME,Individual,No,45-3416923,33653ME0130001,Community Value Plus,33653ME013,,MEN001,MES001,MEF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9978,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-VALUEPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0130001-05,87% AV Level Silver Plan,87.60%,0.875916123390198,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,6,33653,ME,Individual,No,45-3416923,33653ME0130001,Community Value Plus,33653ME013,,MEN001,MES001,MEF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9978,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-VALUEPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0130001-06,94% AV Level Silver Plan,94.60%,0.945718586444855,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,7,33653,ME,Individual,No,45-3416923,33653ME0090001,Community Preferred Plus,33653ME009,,MEN001,MES001,MEF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.998,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-PREFERREDPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0090001-00,Standard Silver Off Exchange Plan,71.70%,0.715136408805847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,7,33653,ME,SHOP (Small Group),No,45-3416923,33653ME0210001,Community Basic,33653ME021,,MEN001,MES001,MEF008,New,PPO,Bronze,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9973,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap netwrok provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-SG-BASICHSA-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0210001-00,Standard Bronze Off Exchange Plan,61.70%,0.616079151630402,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,7,33653,ME,SHOP (Small Group),No,45-3416923,33653ME0210001,Community Basic,33653ME021,,MEN001,MES001,MEF008,New,PPO,Bronze,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9973,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap netwrok provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-SG-BASICHSA-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0210001-01,Standard Bronze On Exchange Plan,61.70%,0.616079151630402,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,7,33653,ME,Individual,No,45-3416923,33653ME0090001,Community Preferred Plus,33653ME009,,MEN001,MES001,MEF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.998,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-PREFERREDPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0090001-01,Standard Silver On Exchange Plan,71.70%,0.715136408805847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,7,33653,ME,Individual,No,45-3416923,33653ME0090001,Community Preferred Plus,33653ME009,,MEN001,MES001,MEF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.998,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-PREFERREDPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0090001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,13808,SERFF,2,2014-09-09 16:12:42,1,13808,ME,SHOP (Small Group),Yes,35-0472300,13808ME0010001,Lincoln Dental Connect?,13808ME001,,MEN001,MES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$41.29,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,13808ME0010001-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,13808,SERFF,2,2014-09-09 16:12:42,1,13808,ME,SHOP (Small Group),Yes,35-0472300,13808ME0010002,Lincoln Dental Connect?,13808ME001,,MEN001,MES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.09,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,13808ME0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ME,13808,SERFF,2,2014-09-09 16:12:42,1,13808,ME,SHOP (Small Group),Yes,35-0472300,13808ME0010003,Lincoln Dental Connect?,13808ME001,,MEN001,MES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.67,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,13808ME0010003-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,ME,13808,SERFF,2,2014-09-09 16:12:42,1,13808,ME,SHOP (Small Group),Yes,35-0472300,13808ME0010005,Lincoln Dental Connect?,13808ME001,,MEN001,MES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.66,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,13808ME0010005-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,ME,13808,SERFF,2,2014-09-09 16:12:42,1,13808,ME,SHOP (Small Group),Yes,35-0472300,13808ME0010006,Lincoln Dental Connect?,13808ME001,,MEN001,MES001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.77,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,13808ME0010006-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,ME,13808,SERFF,2,2014-09-09 16:12:42,1,13808,ME,SHOP (Small Group),Yes,35-0472300,13808ME0010007,Lincoln Dental Connect?,13808ME001,,MEN001,MES001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.02,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,13808ME0010007-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,ME,13808,SERFF,2,2014-09-09 16:12:42,2,13808,ME,SHOP (Small Group),Yes,35-0472300,13808ME0010004,Lincoln Dental Connect?,13808ME001,,MEN001,MES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.64,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,13808ME0010004-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,13808,SERFF,2,2014-09-09 16:12:42,2,13808,ME,SHOP (Small Group),Yes,35-0472300,13808ME0010008,Lincoln Dental Connect?,13808ME001,,MEN001,MES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$40.12,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,13808ME0010008-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$350,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ME,20974,SERFF,5,2014-11-14 14:52:18,1,20974,ME,Individual,Yes,75-1233841,20974ME0010001,Dentegra Dental PPO Pediatric Basic Plan,20974ME001,,MEN001,MES001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$31.28,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/me/20974me0010001-15,,20974ME0010001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$85,Not Applicable,,,,,$85,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,20974,SERFF,5,2014-11-14 14:52:18,1,20974,ME,SHOP (Small Group),Yes,75-1233841,20974ME0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,20974ME002,,MEN001,MES001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.53,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/me/20974me0020001-15,,20974ME0020001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$85,Not Applicable,,,,,$85,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,20974,SERFF,5,2014-11-14 14:52:18,1,20974,ME,SHOP (Small Group),Yes,75-1233841,20974ME0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,20974ME002,,MEN001,MES001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.53,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/me/20974me0020001-15,,20974ME0020001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$85,Not Applicable,,,,,$85,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ME,20974,SERFF,5,2014-11-14 14:52:18,1,20974,ME,Individual,Yes,75-1233841,20974ME0010001,Dentegra Dental PPO Pediatric Basic Plan,20974ME001,,MEN001,MES001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$31.28,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/me/20974me0010001-15,,20974ME0010001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$85,Not Applicable,,,,,$85,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,2,33653,ME,Individual,No,45-3416923,33653ME0030001,Community Option,33653ME003,,MEN001,MES001,MEF003,Existing,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9972,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-OPTION-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0030001-00,Standard Bronze Off Exchange Plan,61.70%,0.609742343425751,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,2,33653,ME,Individual,No,45-3416923,33653ME0030001,Community Option,33653ME003,,MEN001,MES001,MEF003,Existing,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9972,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-OPTION-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0030001-01,Standard Bronze On Exchange Plan,61.70%,0.609742343425751,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,6,33653,ME,Individual,No,45-3416923,33653ME0130001,Community Value Plus,33653ME013,,MEN001,MES001,MEF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9978,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-VALUEPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0130001-00,Standard Silver Off Exchange Plan,68.50%,0.696940898895264,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700",50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,6,33653,ME,SHOP (Small Group),No,45-3416923,33653ME0290001,Community Premier,33653ME029,,MEN001,MES001,MEF009,New,PPO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9982,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap netwrok provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-SG-PREMIER-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0290001-00,Standard Platinum Off Exchange Plan,89.70%,0.894532740116119,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,7,33653,ME,Individual,No,45-3416923,33653ME0090001,Community Preferred Plus,33653ME009,,MEN001,MES001,MEF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.998,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-PREFERREDPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0090001-03,Limited Cost Sharing Plan Variation,71.70%,0.715136408805847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,7,33653,ME,Individual,No,45-3416923,33653ME0090001,Community Preferred Plus,33653ME009,,MEN001,MES001,MEF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.998,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-PREFERREDPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0090001-04,73% AV Level Silver Plan,73.90%,0.735022187232971,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,7,33653,ME,Individual,No,45-3416923,33653ME0090001,Community Preferred Plus,33653ME009,,MEN001,MES001,MEF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.998,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-PREFERREDPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0090001-05,87% AV Level Silver Plan,87.40%,0.871783018112183,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,7,33653,ME,Individual,No,45-3416923,33653ME0090001,Community Preferred Plus,33653ME009,,MEN001,MES001,MEF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.998,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-PREFERREDPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0090001-06,94% AV Level Silver Plan,94.60%,0.94432258605957,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,1,48396,ME,Individual,No,31-1705652,48396ME0720022,Anthem Catastrophic X POS 6600 0,48396ME072,,MEN003,MES005,MEF001,Existing,POS,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J30,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720022-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$20,250","$40,500",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,1,48396,ME,SHOP (Small Group),No,31-1705652,48396ME0730004,Anthem Gold X HMO Maine 500 20 5000 Plus,48396ME073,,MEN009,MES001,MEF001,Existing,HMO,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986709170412718,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LTG,,http://sgplans.anthem.com/me/brochure/,www.anthem.com/MESelectdrugtier4,48396ME0730004-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",$500,"$1,500",20%,,,,Not Applicable,Not Applicable,$500,"$1,500",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,7,48396,ME,Individual,No,31-1705652,48396ME0720018,Anthem Bronze X POS 3600 25 for HSA,48396ME072,,MEN003,MES005,MEF004,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3B,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720018-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,7,48396,ME,Individual,No,31-1705652,48396ME0720018,Anthem Bronze X POS 3600 25 for HSA,48396ME072,,MEN003,MES005,MEF004,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3B,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720018-03,Limited Cost Sharing Plan Variation,61.68%,0.612091839313507,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",25%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,7,48396,ME,Individual,No,31-1705652,48396ME0720032,Anthem Bronze X POS 3600 25 for HSA,48396ME072,,MEN003,MES006,MEF004,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3B,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720032-00,Standard Bronze Off Exchange Plan,61.68%,0.612091839313507,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",25%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,7,48396,ME,Individual,No,31-1705652,48396ME0720032,Anthem Bronze X POS 3600 25 for HSA,48396ME072,,MEN003,MES006,MEF004,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3B,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720032-01,Standard Bronze On Exchange Plan,61.68%,0.612091839313507,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",25%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,7,48396,ME,Individual,No,31-1705652,48396ME0720032,Anthem Bronze X POS 3600 25 for HSA,48396ME072,,MEN003,MES006,MEF004,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3B,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720032-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,7,48396,ME,Individual,No,31-1705652,48396ME0720032,Anthem Bronze X POS 3600 25 for HSA,48396ME072,,MEN003,MES006,MEF004,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3B,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720032-03,Limited Cost Sharing Plan Variation,61.68%,0.612091839313507,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",25%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,2,48396,ME,Individual,Yes,31-1705652,48396ME0860003,Anthem Dental Family,48396ME086,,MEN010,MES008,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.53,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/me/f0/s0/t0/pw_e214655.pdf,,,,48396ME0860003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,2,48396,ME,SHOP (Small Group),Yes,31-1705652,48396ME0830003,Anthem Dental Family,48396ME083,,MEN010,MES008,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.53,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/me/f0/s0/t0/pw_e214655.pdf,,,,48396ME0830003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,2,48396,ME,SHOP (Small Group),Yes,31-1705652,48396ME0830004,Anthem Dental Family Enhanced,48396ME083,,MEN010,MES008,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.66,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/me/f0/s0/t0/pw_e214656.pdf,,,,48396ME0830004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,2,33653,ME,Individual,No,45-3416923,33653ME0030001,Community Option,33653ME003,,MEN001,MES001,MEF003,Existing,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9972,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-OPTION-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0030001-03,Limited Cost Sharing Plan Variation,61.70%,0.609742343425751,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,3,33653,ME,Individual,No,45-3416923,33653ME0040001,Community Choice,33653ME004,,MEN001,MES001,MEF005,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9978,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hopsital service with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-CHOICE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0040001-00,Standard Silver Off Exchange Plan,68.60%,0.680941760540009,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,3,33653,ME,SHOP (Small Group),No,45-3416923,33653ME0200001,Community Choice,33653ME020,,MEN001,MES001,MEF005,Existing,PPO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9976,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-SG-CHOICE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0200001-00,Standard Silver Off Exchange Plan,68.60%,0.680941760540009,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,3,33653,ME,SHOP (Small Group),No,45-3416923,33653ME0200001,Community Choice,33653ME020,,MEN001,MES001,MEF005,Existing,PPO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9976,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-SG-CHOICE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0200001-01,Standard Silver On Exchange Plan,68.60%,0.680941760540009,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,8,33653,ME,Individual,No,45-3416923,33653ME0020001,Community Option HSA,33653ME002,,MEN001,MES001,MEF002,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-OPTIONHSA-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0020001-00,Standard Bronze Off Exchange Plan,,0.585511147975922,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,8,33653,ME,SHOP (Small Group),No,45-3416923,33653ME0230001,Community Balance,33653ME023,,MEN001,MES001,MEF008,New,PPO,Silver,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9975,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap netwrok provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-SG-BALANCEHSA-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0230001-00,Standard Silver Off Exchange Plan,69.30%,0.692726910114288,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,8,33653,ME,SHOP (Small Group),No,45-3416923,33653ME0230001,Community Balance,33653ME023,,MEN001,MES001,MEF008,New,PPO,Silver,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9975,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap netwrok provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-SG-BALANCEHSA-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0230001-01,Standard Silver On Exchange Plan,69.30%,0.692726910114288,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,8,33653,ME,Individual,No,45-3416923,33653ME0020001,Community Option HSA,33653ME002,,MEN001,MES001,MEF002,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-OPTIONHSA-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0020001-01,Standard Bronze On Exchange Plan,,0.585511147975922,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,8,33653,ME,Individual,No,45-3416923,33653ME0020001,Community Option HSA,33653ME002,,MEN001,MES001,MEF002,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-OPTIONHSA-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0020001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,8,33653,ME,Individual,No,45-3416923,33653ME0020001,Community Option HSA,33653ME002,,MEN001,MES001,MEF002,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-OPTIONHSA-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0020001-03,Limited Cost Sharing Plan Variation,,0.585511147975922,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,46874,SERFF,2,2014-09-09 16:12:42,1,46874,ME,SHOP (Small Group),Yes,42-0127290,46874ME0040001,Principal Plan Dental 70,46874ME004,,MEN001,MES001,,New,PPO,Low,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$31.64,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,46874ME0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,46874,SERFF,2,2014-09-09 16:12:42,1,46874,ME,SHOP (Small Group),Yes,42-0127290,46874ME0040002,Principal Plan Dental 80,46874ME004,,MEN001,MES001,,New,PPO,High,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$33.51,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,46874ME0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ME,47540,SERFF,2,2014-09-09 16:12:42,1,47540,ME,SHOP (Small Group),Yes,93-0242990,47540ME0040002,EHB High PPO,47540ME004,,MEN001,MES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$48.30,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,47540ME0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,47540,SERFF,2,2014-09-09 16:12:42,1,47540,ME,SHOP (Small Group),Yes,93-0242990,47540ME0040001,EHB Low PPO,47540ME004,,MEN001,MES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.27,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,47540ME0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ME,47540,SERFF,2,2014-09-09 16:12:42,1,47540,ME,SHOP (Small Group),Yes,93-0242990,47540ME0030002,EHB High Passive,47540ME003,,MEN001,MES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$48.97,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,47540ME0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,ME,47540,SERFF,2,2014-09-09 16:12:42,1,47540,ME,SHOP (Small Group),Yes,93-0242990,47540ME0030001,EHB Low Passive,47540ME003,,MEN001,MES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.50,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,47540ME0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,8,48396,ME,Individual,No,31-1705652,48396ME0720020,Anthem Silver X POS 3000 10 for HSA,48396ME072,,MEN003,MES005,MEF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3D,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720020-00,Standard Silver Off Exchange Plan,68.46%,0.680009722709656,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,950","$7,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,8,48396,ME,Individual,No,31-1705652,48396ME0720020,Anthem Silver X POS 3000 10 for HSA,48396ME072,,MEN003,MES005,MEF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3D,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720020-01,Standard Silver On Exchange Plan,68.46%,0.680009722709656,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,950","$7,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,3,33653,ME,Individual,No,45-3416923,33653ME0040001,Community Choice,33653ME004,,MEN001,MES001,MEF005,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9978,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hopsital service with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-CHOICE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0040001-03,Limited Cost Sharing Plan Variation,68.60%,0.680941760540009,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,3,33653,ME,Individual,No,45-3416923,33653ME0040001,Community Choice,33653ME004,,MEN001,MES001,MEF005,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9978,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hopsital service with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-CHOICE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0040001-04,73% AV Level Silver Plan,73.70%,0.734334588050842,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,3,33653,ME,Individual,No,45-3416923,33653ME0040001,Community Choice,33653ME004,,MEN001,MES001,MEF005,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9978,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hopsital service with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-CHOICE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0040001-05,87% AV Level Silver Plan,87.60%,0.874723374843597,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,3,33653,ME,Individual,No,45-3416923,33653ME0040001,Community Choice,33653ME004,,MEN001,MES001,MEF005,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9978,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hopsital service with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-CHOICE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0040001-06,94% AV Level Silver Plan,94.60%,0.945503175258636,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,3,33653,ME,Individual,No,45-3416923,33653ME0140001,Community Value,33653ME014,,MEN001,MES001,MEF004,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9976,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hopsital service with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-VALUE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0140001-00,Standard Silver Off Exchange Plan,68.50%,0.679793536663055,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700",50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,3,33653,ME,Individual,No,45-3416923,33653ME0140001,Community Value,33653ME014,,MEN001,MES001,MEF004,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9976,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hopsital service with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-VALUE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0140001-01,Standard Silver On Exchange Plan,68.50%,0.679793536663055,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700",50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,3,33653,ME,Individual,No,45-3416923,33653ME0140001,Community Value,33653ME014,,MEN001,MES001,MEF004,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9976,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hopsital service with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-VALUE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0140001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,3,33653,ME,Individual,No,45-3416923,33653ME0140001,Community Value,33653ME014,,MEN001,MES001,MEF004,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9976,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hopsital service with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-VALUE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0140001-03,Limited Cost Sharing Plan Variation,68.50%,0.679793536663055,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700",50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,1,48396,ME,Individual,Yes,31-1705652,48396ME0840003,Anthem Dental Pediatric,48396ME084,,MEN010,MES008,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$25.11,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/me/f0/s0/t0/pw_e214657.pdf,,,,48396ME0840003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,1,48396,ME,SHOP (Small Group),Yes,31-1705652,48396ME0870003,Anthem Dental Pediatric,48396ME087,,MEN010,MES008,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.11,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/me/f0/s0/t0/pw_e214657.pdf,,,,48396ME0870003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,1,48396,ME,Individual,Yes,31-1705652,48396ME0900003,Anthem Dental Pediatric,48396ME090,,MEN010,MES008,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.11,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/me/f0/s0/t0/pw_e214657.pdf,,,,48396ME0900003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,1,48396,ME,SHOP (Small Group),No,31-1705652,48396ME0730004,Anthem Gold X HMO Maine 500 20 5000 Plus,48396ME073,,MEN009,MES001,MEF001,Existing,HMO,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986709170412718,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LTG,,http://sgplans.anthem.com/me/brochure/,www.anthem.com/MESelectdrugtier4,48396ME0730004-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",$500,"$1,500",20%,,,,Not Applicable,Not Applicable,$500,"$1,500",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,1,48396,ME,Individual,No,31-1705652,48396ME0720022,Anthem Catastrophic X POS 6600 0,48396ME072,,MEN003,MES005,MEF001,Existing,POS,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J30,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720022-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$20,250","$40,500",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,1,48396,ME,Individual,No,31-1705652,48396ME0720034,Anthem Catastrophic X POS 6600 0,48396ME072,,MEN003,MES006,MEF001,Existing,POS,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J30,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720034-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$20,250","$40,500",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,1,48396,ME,Individual,No,31-1705652,48396ME0720034,Anthem Catastrophic X POS 6600 0,48396ME072,,MEN003,MES006,MEF001,Existing,POS,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J30,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720034-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$20,250","$40,500",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,2,48396,ME,Individual,No,31-1705652,48396ME0720015,Anthem Bronze X POS 6000 0,48396ME072,,MEN003,MES005,MEF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J31,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720015-00,Standard Bronze Off Exchange Plan,60.37%,0.601452350616455,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,2,48396,ME,SHOP (Small Group),No,31-1705652,48396ME0730008,Anthem Bronze X HMO Maine 5000 30 6600 Plus,48396ME073,,MEN009,MES001,MEF001,Existing,HMO,Bronze,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.979270195058552,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LRD,,http://sgplans.anthem.com/me/brochure/,www.anthem.com/MESelectdrugtier4,48396ME0730008-00,Standard Bronze Off Exchange Plan,61.69%,0.644904553890228,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,"$5,000","$10,000",$500,"$1,000",30%,,,,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,4
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,3,33653,ME,Individual,No,45-3416923,33653ME0140001,Community Value,33653ME014,,MEN001,MES001,MEF004,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9976,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hopsital service with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-VALUE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0140001-04,73% AV Level Silver Plan,73.90%,0.736676096916199,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,3,33653,ME,Individual,No,45-3416923,33653ME0140001,Community Value,33653ME014,,MEN001,MES001,MEF004,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9976,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hopsital service with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-VALUE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0140001-05,87% AV Level Silver Plan,87.60%,0.874723374843597,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,3,33653,ME,Individual,No,45-3416923,33653ME0140001,Community Value,33653ME014,,MEN001,MES001,MEF004,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9976,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hopsital service with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-VALUE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0140001-06,94% AV Level Silver Plan,94.60%,0.945503175258636,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,4,33653,ME,Individual,No,45-3416923,33653ME0080001,Community Preferred,33653ME008,,MEN001,MES001,MEF006,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9979,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek Reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0080001-00,Standard Silver Off Exchange Plan,71.70%,0.715136408805847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,4,33653,ME,SHOP (Small Group),No,45-3416923,33653ME0240001,Community Preferred,33653ME024,,MEN001,MES001,MEF006,Existing,PPO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9977,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-SG-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0240001-00,Standard Silver Off Exchange Plan,71.70%,0.715136408805847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,4,33653,ME,SHOP (Small Group),No,45-3416923,33653ME0240001,Community Preferred,33653ME024,,MEN001,MES001,MEF006,Existing,PPO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9977,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-SG-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0240001-01,Standard Silver On Exchange Plan,71.70%,0.715136408805847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,4,33653,ME,Individual,No,45-3416923,33653ME0080001,Community Preferred,33653ME008,,MEN001,MES001,MEF006,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9979,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek Reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0080001-01,Standard Silver On Exchange Plan,71.70%,0.715136408805847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,4,33653,ME,Individual,No,45-3416923,33653ME0080001,Community Preferred,33653ME008,,MEN001,MES001,MEF006,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9979,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek Reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0080001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,4,33653,ME,Individual,No,45-3416923,33653ME0080001,Community Preferred,33653ME008,,MEN001,MES001,MEF006,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9979,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek Reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0080001-03,Limited Cost Sharing Plan Variation,71.70%,0.715136408805847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,4,33653,ME,Individual,No,45-3416923,33653ME0080001,Community Preferred,33653ME008,,MEN001,MES001,MEF006,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9979,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek Reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0080001-04,73% AV Level Silver Plan,73.90%,0.731541335582733,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,4,33653,ME,Individual,No,45-3416923,33653ME0080001,Community Preferred,33653ME008,,MEN001,MES001,MEF006,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9979,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek Reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0080001-05,87% AV Level Silver Plan,87.40%,0.871783018112183,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,4,33653,ME,Individual,No,45-3416923,33653ME0080001,Community Preferred,33653ME008,,MEN001,MES001,MEF006,Existing,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9979,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek Reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0080001-06,94% AV Level Silver Plan,94.60%,0.94432258605957,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,4,33653,ME,Individual,No,45-3416923,33653ME0120001,Community Advantage,33653ME012,,MEN001,MES001,MEF007,Existing,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9981,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek Reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-ADVANTAGE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0120001-00,Standard Gold Off Exchange Plan,80.30%,0.799298703670502,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$650,"$1,300",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,4,33653,ME,Individual,No,45-3416923,33653ME0120001,Community Advantage,33653ME012,,MEN001,MES001,MEF007,Existing,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9981,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek Reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-ADVANTAGE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0120001-01,Standard Gold On Exchange Plan,80.30%,0.799298703670502,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$650,"$1,300",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,4,33653,ME,Individual,No,45-3416923,33653ME0120001,Community Advantage,33653ME012,,MEN001,MES001,MEF007,Existing,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9981,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek Reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-ADVANTAGE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0120001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,4,33653,ME,Individual,No,45-3416923,33653ME0120001,Community Advantage,33653ME012,,MEN001,MES001,MEF007,Existing,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9981,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek Reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-ADVANTAGE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0120001-03,Limited Cost Sharing Plan Variation,80.30%,0.799298703670502,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$650,"$1,300",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,5,33653,ME,Individual,No,45-3416923,33653ME0050001,Community Option Plus,33653ME005,,MEN001,MES001,MEF003,New,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9974,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-OPTIONPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0050001-00,Standard Bronze Off Exchange Plan,61.70%,0.609742343425751,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,5,33653,ME,SHOP (Small Group),No,45-3416923,33653ME0280001,Community Advantage,33653ME028,,MEN001,MES001,MEF007,Existing,PPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.998,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap netwrok provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-SG-ADVANTAGE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0280001-00,Standard Gold Off Exchange Plan,80.30%,0.799298703670502,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$650,"$1,300",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,5,33653,ME,SHOP (Small Group),No,45-3416923,33653ME0280001,Community Advantage,33653ME028,,MEN001,MES001,MEF007,Existing,PPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.998,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap netwrok provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-SG-ADVANTAGE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0280001-01,Standard Gold On Exchange Plan,80.30%,0.799298703670502,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$650,"$1,300",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,5,33653,ME,Individual,No,45-3416923,33653ME0050001,Community Option Plus,33653ME005,,MEN001,MES001,MEF003,New,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9974,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-OPTIONPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0050001-01,Standard Bronze On Exchange Plan,61.70%,0.609742343425751,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,5,33653,ME,Individual,No,45-3416923,33653ME0050001,Community Option Plus,33653ME005,,MEN001,MES001,MEF003,New,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9974,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-OPTIONPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0050001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,33653,SERFF,11,2014-11-13 16:11:17,5,33653,ME,Individual,No,45-3416923,33653ME0050001,Community Option Plus,33653ME005,,MEN001,MES001,MEF003,New,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9974,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/MCHO-SBC-IND-OPTIONPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,33653ME0050001-03,Limited Cost Sharing Plan Variation,61.70%,0.609742343425751,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,8,48396,ME,Individual,No,31-1705652,48396ME0720020,Anthem Silver X POS 3000 10 for HSA,48396ME072,,MEN003,MES005,MEF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3D,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720020-06,94% AV Level Silver Plan,93.27%,0.93240350484848,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,8,48396,ME,Individual,No,31-1705652,48396ME0720033,Anthem Silver X POS 3000 10 for HSA,48396ME072,,MEN003,MES006,MEF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3D,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720033-00,Standard Silver Off Exchange Plan,68.46%,0.680009722709656,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,950","$7,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,8,48396,ME,Individual,No,31-1705652,48396ME0720033,Anthem Silver X POS 3000 10 for HSA,48396ME072,,MEN003,MES006,MEF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3D,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720033-01,Standard Silver On Exchange Plan,68.46%,0.680009722709656,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,950","$7,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,8,48396,ME,Individual,No,31-1705652,48396ME0720033,Anthem Silver X POS 3000 10 for HSA,48396ME072,,MEN003,MES006,MEF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3D,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720033-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,8,48396,ME,Individual,No,31-1705652,48396ME0720033,Anthem Silver X POS 3000 10 for HSA,48396ME072,,MEN003,MES006,MEF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3D,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720033-03,Limited Cost Sharing Plan Variation,68.46%,0.680009722709656,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,950","$7,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,8,48396,ME,Individual,No,31-1705652,48396ME0720033,Anthem Silver X POS 3000 10 for HSA,48396ME072,,MEN003,MES006,MEF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3D,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720033-04,73% AV Level Silver Plan,72.44%,0.718375682830811,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,8,48396,ME,Individual,No,31-1705652,48396ME0720033,Anthem Silver X POS 3000 10 for HSA,48396ME072,,MEN003,MES006,MEF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3D,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720033-05,87% AV Level Silver Plan,86.17%,0.861072897911072,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,8,48396,ME,Individual,No,31-1705652,48396ME0720033,Anthem Silver X POS 3000 10 for HSA,48396ME072,,MEN003,MES006,MEF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3D,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720033-06,94% AV Level Silver Plan,93.27%,0.93240350484848,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,2,48396,ME,Individual,Yes,31-1705652,48396ME0860004,Anthem Dental Family Enhanced,48396ME086,,MEN010,MES008,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.66,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/me/f0/s0/t0/pw_e214656.pdf,,,,48396ME0860004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,2,48396,ME,SHOP (Small Group),No,31-1705652,48396ME0730008,Anthem Bronze X HMO Maine 5000 30 6600 Plus,48396ME073,,MEN009,MES001,MEF001,Existing,HMO,Bronze,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.979270195058552,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LRD,,http://sgplans.anthem.com/me/brochure/,www.anthem.com/MESelectdrugtier4,48396ME0730008-01,Standard Bronze On Exchange Plan,61.69%,0.644904553890228,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,"$5,000","$10,000",$500,"$1,000",30%,,,,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,2,48396,ME,Individual,No,31-1705652,48396ME0720015,Anthem Bronze X POS 6000 0,48396ME072,,MEN003,MES005,MEF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J31,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720015-01,Standard Bronze On Exchange Plan,60.37%,0.601452350616455,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,2,48396,ME,Individual,No,31-1705652,48396ME0720015,Anthem Bronze X POS 6000 0,48396ME072,,MEN003,MES005,MEF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J31,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720015-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,2,48396,ME,SHOP (Small Group),Yes,31-1705652,48396ME0890003,Anthem Dental Family,48396ME089,,MEN010,MES008,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.53,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/me/f0/s0/t0/pw_e214655.pdf,,,,48396ME0890003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,2,48396,ME,Individual,Yes,31-1705652,48396ME0920003,Anthem Dental Family,48396ME092,,MEN010,MES008,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.53,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/me/f0/s0/t0/pw_e214655.pdf,,,,48396ME0920003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,2,48396,ME,Individual,Yes,31-1705652,48396ME0920004,Anthem Dental Family  Enhanced,48396ME092,,MEN010,MES008,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.66,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/me/f0/s0/t0/pw_e214656.pdf,,,,48396ME0920004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,2,48396,ME,SHOP (Small Group),Yes,31-1705652,48396ME0890004,Anthem Dental Family  Enhanced,48396ME089,,MEN010,MES008,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.66,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/me/f0/s0/t0/pw_e214656.pdf,,,,48396ME0890004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,2,48396,ME,Individual,No,31-1705652,48396ME0720015,Anthem Bronze X POS 6000 0,48396ME072,,MEN003,MES005,MEF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J31,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720015-03,Limited Cost Sharing Plan Variation,60.37%,0.601452350616455,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,2,48396,ME,Individual,No,31-1705652,48396ME0720027,Anthem Bronze X POS 6000 0,48396ME072,,MEN003,MES006,MEF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J31,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720027-00,Standard Bronze Off Exchange Plan,60.37%,0.601452350616455,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,2,48396,ME,Individual,No,31-1705652,48396ME0720027,Anthem Bronze X POS 6000 0,48396ME072,,MEN003,MES006,MEF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J31,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720027-01,Standard Bronze On Exchange Plan,60.37%,0.601452350616455,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,2,48396,ME,Individual,No,31-1705652,48396ME0720027,Anthem Bronze X POS 6000 0,48396ME072,,MEN003,MES006,MEF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J31,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720027-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,2,48396,ME,Individual,No,31-1705652,48396ME0720027,Anthem Bronze X POS 6000 0,48396ME072,,MEN003,MES006,MEF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J31,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720027-03,Limited Cost Sharing Plan Variation,60.37%,0.601452350616455,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,3,48396,ME,Individual,No,31-1705652,48396ME0720016,Anthem Bronze X POS 0 for HSA,48396ME072,,MEN003,MES005,MEF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J33,https://shop.anthem.com/sales/eox/payment/landing/me,https://shop.anthem.com/sales/eox/payment/landing/me,anthem.com/MESelectdrugtier4,48396ME0720016-00,Standard Bronze Off Exchange Plan,59.26%,0.58001834154129,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,700","$35,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,900","$11,800",0%,,,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,3,48396,ME,SHOP (Small Group),No,31-1705652,48396ME0730012,Anthem Silver X HMO Maine 2000 30 5500 Plus,48396ME073,,MEN009,MES001,MEF001,Existing,HMO,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.982554278730084,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LRM,,http://sgplans.anthem.com/me/brochure/,www.anthem.com/MESelectdrugtier4,48396ME0730012-00,Standard Silver Off Exchange Plan,68.81%,0.713849425315857,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,3,48396,ME,SHOP (Small Group),No,31-1705652,48396ME0730012,Anthem Silver X HMO Maine 2000 30 5500 Plus,48396ME073,,MEN009,MES001,MEF001,Existing,HMO,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.982554278730084,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LRM,,http://sgplans.anthem.com/me/brochure/,www.anthem.com/MESelectdrugtier4,48396ME0730012-01,Standard Silver On Exchange Plan,68.81%,0.713849425315857,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,3,48396,ME,Individual,No,31-1705652,48396ME0720016,Anthem Bronze X POS 0 for HSA,48396ME072,,MEN003,MES005,MEF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J33,https://shop.anthem.com/sales/eox/payment/landing/me,https://shop.anthem.com/sales/eox/payment/landing/me,anthem.com/MESelectdrugtier4,48396ME0720016-01,Standard Bronze On Exchange Plan,59.26%,0.58001834154129,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,700","$35,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,900","$11,800",0%,,,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,3,48396,ME,Individual,No,31-1705652,48396ME0720016,Anthem Bronze X POS 0 for HSA,48396ME072,,MEN003,MES005,MEF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J33,https://shop.anthem.com/sales/eox/payment/landing/me,https://shop.anthem.com/sales/eox/payment/landing/me,anthem.com/MESelectdrugtier4,48396ME0720016-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,3,48396,ME,Individual,No,31-1705652,48396ME0720016,Anthem Bronze X POS 0 for HSA,48396ME072,,MEN003,MES005,MEF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J33,https://shop.anthem.com/sales/eox/payment/landing/me,https://shop.anthem.com/sales/eox/payment/landing/me,anthem.com/MESelectdrugtier4,48396ME0720016-03,Limited Cost Sharing Plan Variation,59.26%,0.58001834154129,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,700","$35,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,900","$11,800",0%,,,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,3,48396,ME,Individual,No,31-1705652,48396ME0720030,Anthem Bronze X POS 0 for HSA,48396ME072,,MEN003,MES006,MEF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J33,https://shop.anthem.com/sales/eox/payment/landing/me,https://shop.anthem.com/sales/eox/payment/landing/me,anthem.com/MESelectdrugtier4,48396ME0720030-00,Standard Bronze Off Exchange Plan,59.26%,0.58001834154129,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,700","$35,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,900","$11,800",0%,,,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,8
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,3,48396,ME,Individual,No,31-1705652,48396ME0720030,Anthem Bronze X POS 0 for HSA,48396ME072,,MEN003,MES006,MEF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J33,https://shop.anthem.com/sales/eox/payment/landing/me,https://shop.anthem.com/sales/eox/payment/landing/me,anthem.com/MESelectdrugtier4,48396ME0720030-01,Standard Bronze On Exchange Plan,59.26%,0.58001834154129,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,700","$35,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,900","$11,800",0%,,,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,9
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,3,48396,ME,Individual,No,31-1705652,48396ME0720030,Anthem Bronze X POS 0 for HSA,48396ME072,,MEN003,MES006,MEF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J33,https://shop.anthem.com/sales/eox/payment/landing/me,https://shop.anthem.com/sales/eox/payment/landing/me,anthem.com/MESelectdrugtier4,48396ME0720030-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,3,48396,ME,Individual,No,31-1705652,48396ME0720030,Anthem Bronze X POS 0 for HSA,48396ME072,,MEN003,MES006,MEF001,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J33,https://shop.anthem.com/sales/eox/payment/landing/me,https://shop.anthem.com/sales/eox/payment/landing/me,anthem.com/MESelectdrugtier4,48396ME0720030-03,Limited Cost Sharing Plan Variation,59.26%,0.58001834154129,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,700","$35,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,900","$11,800",0%,,,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,11
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,4,48396,ME,SHOP (Small Group),No,31-1705652,48396ME0770001,Anthem Silver X Blue Choice PPO 2800 20 4000 Plus w HSA,48396ME077,,MEN007,MES001,MEF017,Existing,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.981503236016473,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LUG,,http://sgplans.anthem.com/me/brochure/,www.anthem.com/MESelectdrugtier4,48396ME0770001-00,Standard Silver Off Exchange Plan,,0.682707726955414,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",20%,,,,"$5,600","$11,200","$8,400","$16,800",,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,4,48396,ME,Individual,No,31-1705652,48396ME0720011,Anthem Bronze X POS 5500 20,48396ME072,,MEN003,MES005,MEF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J35,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720011-00,Standard Bronze Off Exchange Plan,61.56%,0.613161325454712,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,4,48396,ME,Individual,No,31-1705652,48396ME0720011,Anthem Bronze X POS 5500 20,48396ME072,,MEN003,MES005,MEF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J35,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720011-01,Standard Bronze On Exchange Plan,61.56%,0.613161325454712,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,4,48396,ME,SHOP (Small Group),No,31-1705652,48396ME0770001,Anthem Silver X Blue Choice PPO 2800 20 4000 Plus w HSA,48396ME077,,MEN007,MES001,MEF017,Existing,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.981503236016473,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LUG,,http://sgplans.anthem.com/me/brochure/,www.anthem.com/MESelectdrugtier4,48396ME0770001-01,Standard Silver On Exchange Plan,,0.682707726955414,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",20%,,,,"$5,600","$11,200","$8,400","$16,800",,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,4,48396,ME,Individual,No,31-1705652,48396ME0720011,Anthem Bronze X POS 5500 20,48396ME072,,MEN003,MES005,MEF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J35,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,4,48396,ME,Individual,No,31-1705652,48396ME0720011,Anthem Bronze X POS 5500 20,48396ME072,,MEN003,MES005,MEF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J35,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720011-03,Limited Cost Sharing Plan Variation,61.56%,0.613161325454712,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,4,48396,ME,Individual,No,31-1705652,48396ME0720023,Anthem Bronze X POS 5500 20,48396ME072,,MEN003,MES006,MEF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J35,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720023-00,Standard Bronze Off Exchange Plan,61.56%,0.613161325454712,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,4,48396,ME,Individual,No,31-1705652,48396ME0720023,Anthem Bronze X POS 5500 20,48396ME072,,MEN003,MES006,MEF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J35,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720023-01,Standard Bronze On Exchange Plan,61.56%,0.613161325454712,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,4,48396,ME,Individual,No,31-1705652,48396ME0720023,Anthem Bronze X POS 5500 20,48396ME072,,MEN003,MES006,MEF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J35,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720023-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,4,48396,ME,Individual,No,31-1705652,48396ME0720023,Anthem Bronze X POS 5500 20,48396ME072,,MEN003,MES006,MEF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J35,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720023-03,Limited Cost Sharing Plan Variation,61.56%,0.613161325454712,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,5,48396,ME,Individual,No,31-1705652,48396ME0720017,Anthem Bronze X POS 5000 20,48396ME072,,MEN003,MES005,MEF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J37,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720017-00,Standard Bronze Off Exchange Plan,61.37%,0.611403226852417,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,5,48396,ME,Individual,No,31-1705652,48396ME0720017,Anthem Bronze X POS 5000 20,48396ME072,,MEN003,MES005,MEF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J37,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720017-01,Standard Bronze On Exchange Plan,61.37%,0.611403226852417,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,5,48396,ME,Individual,No,31-1705652,48396ME0720017,Anthem Bronze X POS 5000 20,48396ME072,,MEN003,MES005,MEF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J37,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720017-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,5,48396,ME,Individual,No,31-1705652,48396ME0720017,Anthem Bronze X POS 5000 20,48396ME072,,MEN003,MES005,MEF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J37,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720017-03,Limited Cost Sharing Plan Variation,61.37%,0.611403226852417,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,5,48396,ME,Individual,No,31-1705652,48396ME0720031,Anthem Bronze X POS 5000 20,48396ME072,,MEN003,MES006,MEF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J37,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720031-00,Standard Bronze Off Exchange Plan,61.37%,0.611403226852417,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,5,48396,ME,Individual,No,31-1705652,48396ME0720031,Anthem Bronze X POS 5000 20,48396ME072,,MEN003,MES006,MEF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J37,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720031-01,Standard Bronze On Exchange Plan,61.37%,0.611403226852417,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,5,48396,ME,Individual,No,31-1705652,48396ME0720031,Anthem Bronze X POS 5000 20,48396ME072,,MEN003,MES006,MEF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J37,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720031-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,5,48396,ME,Individual,No,31-1705652,48396ME0720031,Anthem Bronze X POS 5000 20,48396ME072,,MEN003,MES006,MEF003,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J37,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720031-03,Limited Cost Sharing Plan Variation,61.37%,0.611403226852417,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,6,48396,ME,Individual,No,31-1705652,48396ME0720012,Anthem Bronze X POS 4200 40,48396ME072,,MEN003,MES005,MEF005,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J39,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720012-00,Standard Bronze Off Exchange Plan,61.74%,0.6153564453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",40%,,,,"$8,400","$16,800",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,6,48396,ME,Individual,No,31-1705652,48396ME0720012,Anthem Bronze X POS 4200 40,48396ME072,,MEN003,MES005,MEF005,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J39,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720012-01,Standard Bronze On Exchange Plan,61.74%,0.6153564453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",40%,,,,"$8,400","$16,800",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,6,48396,ME,Individual,No,31-1705652,48396ME0720012,Anthem Bronze X POS 4200 40,48396ME072,,MEN003,MES005,MEF005,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J39,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720012-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,6,48396,ME,Individual,No,31-1705652,48396ME0720012,Anthem Bronze X POS 4200 40,48396ME072,,MEN003,MES005,MEF005,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J39,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720012-03,Limited Cost Sharing Plan Variation,61.74%,0.6153564453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",40%,,,,"$8,400","$16,800",Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,6,48396,ME,Individual,No,31-1705652,48396ME0720024,Anthem Bronze X POS 4200 40,48396ME072,,MEN003,MES006,MEF005,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J39,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720024-00,Standard Bronze Off Exchange Plan,61.74%,0.6153564453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",40%,,,,"$8,400","$16,800",Not Applicable,Not Applicable,,,,,,,,,8
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,6,48396,ME,Individual,No,31-1705652,48396ME0720024,Anthem Bronze X POS 4200 40,48396ME072,,MEN003,MES006,MEF005,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J39,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720024-01,Standard Bronze On Exchange Plan,61.74%,0.6153564453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",40%,,,,"$8,400","$16,800",Not Applicable,Not Applicable,,,,,,,,,9
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,6,48396,ME,Individual,No,31-1705652,48396ME0720024,Anthem Bronze X POS 4200 40,48396ME072,,MEN003,MES006,MEF005,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J39,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720024-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,6,48396,ME,Individual,No,31-1705652,48396ME0720024,Anthem Bronze X POS 4200 40,48396ME072,,MEN003,MES006,MEF005,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J39,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720024-03,Limited Cost Sharing Plan Variation,61.74%,0.6153564453125,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400",40%,,,,"$8,400","$16,800",Not Applicable,Not Applicable,,,,,,,,,11
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,7,48396,ME,Individual,No,31-1705652,48396ME0720018,Anthem Bronze X POS 3600 25 for HSA,48396ME072,,MEN003,MES005,MEF004,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3B,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720018-00,Standard Bronze Off Exchange Plan,61.68%,0.612091839313507,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",25%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,7,48396,ME,Individual,No,31-1705652,48396ME0720018,Anthem Bronze X POS 3600 25 for HSA,48396ME072,,MEN003,MES005,MEF004,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3B,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720018-01,Standard Bronze On Exchange Plan,61.68%,0.612091839313507,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",25%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,8,48396,ME,Individual,No,31-1705652,48396ME0720020,Anthem Silver X POS 3000 10 for HSA,48396ME072,,MEN003,MES005,MEF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3D,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720020-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,8,48396,ME,Individual,No,31-1705652,48396ME0720020,Anthem Silver X POS 3000 10 for HSA,48396ME072,,MEN003,MES005,MEF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3D,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720020-03,Limited Cost Sharing Plan Variation,68.46%,0.680009722709656,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,950","$7,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,8,48396,ME,Individual,No,31-1705652,48396ME0720020,Anthem Silver X POS 3000 10 for HSA,48396ME072,,MEN003,MES005,MEF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3D,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720020-04,73% AV Level Silver Plan,72.44%,0.718375682830811,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,8,48396,ME,Individual,No,31-1705652,48396ME0720020,Anthem Silver X POS 3000 10 for HSA,48396ME072,,MEN003,MES005,MEF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3D,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720020-05,87% AV Level Silver Plan,86.17%,0.861072897911072,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,9,48396,ME,Individual,No,31-1705652,48396ME0720013,Anthem Silver X POS 2800 30,48396ME072,,MEN003,MES005,MEF014,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3J,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720013-00,Standard Silver Off Exchange Plan,68.41%,0.680491983890533,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,700","$11,400",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",30%,,,,"$5,600","$11,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,9,48396,ME,Individual,No,31-1705652,48396ME0720013,Anthem Silver X POS 2800 30,48396ME072,,MEN003,MES005,MEF014,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3J,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720013-01,Standard Silver On Exchange Plan,68.41%,0.680491983890533,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,700","$11,400",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",30%,,,,"$5,600","$11,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,9,48396,ME,Individual,No,31-1705652,48396ME0720013,Anthem Silver X POS 2800 30,48396ME072,,MEN003,MES005,MEF014,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3J,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720013-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,9,48396,ME,Individual,No,31-1705652,48396ME0720013,Anthem Silver X POS 2800 30,48396ME072,,MEN003,MES005,MEF014,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3J,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720013-03,Limited Cost Sharing Plan Variation,68.41%,0.680491983890533,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,700","$11,400",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",30%,,,,"$5,600","$11,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,9,48396,ME,Individual,No,31-1705652,48396ME0720013,Anthem Silver X POS 2800 30,48396ME072,,MEN003,MES005,MEF014,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3J,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720013-04,73% AV Level Silver Plan,72.42%,0.720930159091949,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,600","$11,200",Not Applicable,Not Applicable,,,,,,,,,8
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,9,48396,ME,Individual,No,31-1705652,48396ME0720013,Anthem Silver X POS 2800 30,48396ME072,,MEN003,MES005,MEF014,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3J,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720013-05,87% AV Level Silver Plan,86.81%,0.866431951522827,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",30%,,,,"$5,600","$11,200",Not Applicable,Not Applicable,,,,,,,,,9
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,9,48396,ME,Individual,No,31-1705652,48396ME0720013,Anthem Silver X POS 2800 30,48396ME072,,MEN003,MES005,MEF014,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3J,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720013-06,94% AV Level Silver Plan,93.80%,0.937119722366333,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,30%,,,,"$5,600","$11,200",Not Applicable,Not Applicable,,,,,,,,,10
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,9,48396,ME,Individual,No,31-1705652,48396ME0720025,Anthem Silver X POS 2800 30,48396ME072,,MEN003,MES006,MEF014,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3J,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720025-00,Standard Silver Off Exchange Plan,68.41%,0.680491983890533,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,700","$11,400",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",30%,,,,"$5,600","$11,200",Not Applicable,Not Applicable,,,,,,,,,11
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,9,48396,ME,Individual,No,31-1705652,48396ME0720025,Anthem Silver X POS 2800 30,48396ME072,,MEN003,MES006,MEF014,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3J,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720025-01,Standard Silver On Exchange Plan,68.41%,0.680491983890533,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,700","$11,400",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",30%,,,,"$5,600","$11,200",Not Applicable,Not Applicable,,,,,,,,,12
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,9,48396,ME,Individual,No,31-1705652,48396ME0720025,Anthem Silver X POS 2800 30,48396ME072,,MEN003,MES006,MEF014,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3J,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720025-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,9,48396,ME,Individual,No,31-1705652,48396ME0720025,Anthem Silver X POS 2800 30,48396ME072,,MEN003,MES006,MEF014,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3J,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720025-03,Limited Cost Sharing Plan Variation,68.41%,0.680491983890533,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,700","$11,400",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",30%,,,,"$5,600","$11,200",Not Applicable,Not Applicable,,,,,,,,,14
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,9,48396,ME,Individual,No,31-1705652,48396ME0720025,Anthem Silver X POS 2800 30,48396ME072,,MEN003,MES006,MEF014,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3J,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720025-04,73% AV Level Silver Plan,72.42%,0.720930159091949,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,600","$11,200",Not Applicable,Not Applicable,,,,,,,,,15
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,9,48396,ME,Individual,No,31-1705652,48396ME0720025,Anthem Silver X POS 2800 30,48396ME072,,MEN003,MES006,MEF014,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3J,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720025-05,87% AV Level Silver Plan,86.81%,0.866431951522827,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",30%,,,,"$5,600","$11,200",Not Applicable,Not Applicable,,,,,,,,,16
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,9,48396,ME,Individual,No,31-1705652,48396ME0720025,Anthem Silver X POS 2800 30,48396ME072,,MEN003,MES006,MEF014,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3J,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720025-06,94% AV Level Silver Plan,93.80%,0.937119722366333,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,30%,,,,"$5,600","$11,200",Not Applicable,Not Applicable,,,,,,,,,17
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,10,48396,ME,Individual,No,31-1705652,48396ME0720014,Anthem Silver X POS 1800 20,48396ME072,,MEN003,MES005,MEF013,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3U,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720014-00,Standard Silver Off Exchange Plan,71.53%,0.707635462284088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,10,48396,ME,Individual,No,31-1705652,48396ME0720014,Anthem Silver X POS 1800 20,48396ME072,,MEN003,MES005,MEF013,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3U,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720014-01,Standard Silver On Exchange Plan,71.53%,0.707635462284088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,10,48396,ME,Individual,No,31-1705652,48396ME0720014,Anthem Silver X POS 1800 20,48396ME072,,MEN003,MES005,MEF013,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3U,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720014-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,10,48396,ME,Individual,No,31-1705652,48396ME0720014,Anthem Silver X POS 1800 20,48396ME072,,MEN003,MES005,MEF013,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3U,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720014-03,Limited Cost Sharing Plan Variation,71.53%,0.707635462284088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,10,48396,ME,Individual,No,31-1705652,48396ME0720014,Anthem Silver X POS 1800 20,48396ME072,,MEN003,MES005,MEF013,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3U,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720014-04,73% AV Level Silver Plan,73.59%,0.729681611061096,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,10,48396,ME,Individual,No,31-1705652,48396ME0720014,Anthem Silver X POS 1800 20,48396ME072,,MEN003,MES005,MEF013,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3U,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720014-05,87% AV Level Silver Plan,86.44%,0.861558437347412,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,10,48396,ME,Individual,No,31-1705652,48396ME0720014,Anthem Silver X POS 1800 20,48396ME072,,MEN003,MES005,MEF013,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3U,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720014-06,94% AV Level Silver Plan,93.58%,0.933994829654694,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,10,48396,ME,Individual,No,31-1705652,48396ME0720026,Anthem Silver X POS 1800 20,48396ME072,,MEN003,MES006,MEF013,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3U,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720026-00,Standard Silver Off Exchange Plan,71.53%,0.707635462284088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,10,48396,ME,Individual,No,31-1705652,48396ME0720026,Anthem Silver X POS 1800 20,48396ME072,,MEN003,MES006,MEF013,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3U,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720026-01,Standard Silver On Exchange Plan,71.53%,0.707635462284088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,10,48396,ME,Individual,No,31-1705652,48396ME0720026,Anthem Silver X POS 1800 20,48396ME072,,MEN003,MES006,MEF013,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3U,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720026-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,10,48396,ME,Individual,No,31-1705652,48396ME0720026,Anthem Silver X POS 1800 20,48396ME072,,MEN003,MES006,MEF013,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3U,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720026-03,Limited Cost Sharing Plan Variation,71.53%,0.707635462284088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,10,48396,ME,Individual,No,31-1705652,48396ME0720026,Anthem Silver X POS 1800 20,48396ME072,,MEN003,MES006,MEF013,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3U,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720026-04,73% AV Level Silver Plan,73.59%,0.729681611061096,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,10,48396,ME,Individual,No,31-1705652,48396ME0720026,Anthem Silver X POS 1800 20,48396ME072,,MEN003,MES006,MEF013,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3U,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720026-05,87% AV Level Silver Plan,86.44%,0.861558437347412,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,10,48396,ME,Individual,No,31-1705652,48396ME0720026,Anthem Silver X POS 1800 20,48396ME072,,MEN003,MES006,MEF013,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J3U,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720026-06,94% AV Level Silver Plan,93.58%,0.933994829654694,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,11,48396,ME,Individual,No,31-1705652,48396ME0720028,Anthem Gold X POS 750 20,48396ME072,,MEN003,MES005,MEF013,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care only,Yes,Emergency/Urgent Care only,No,http://www.sbc.anthem.com/dps/CCD1J41,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720028-00,Standard Gold Off Exchange Plan,78.63%,0.776868581771851,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,11,48396,ME,Individual,No,31-1705652,48396ME0720028,Anthem Gold X POS 750 20,48396ME072,,MEN003,MES005,MEF013,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care only,Yes,Emergency/Urgent Care only,No,http://www.sbc.anthem.com/dps/CCD1J41,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720028-01,Standard Gold On Exchange Plan,78.63%,0.776868581771851,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,11,48396,ME,Individual,No,31-1705652,48396ME0720028,Anthem Gold X POS 750 20,48396ME072,,MEN003,MES005,MEF013,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care only,Yes,Emergency/Urgent Care only,No,http://www.sbc.anthem.com/dps/CCD1J41,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720028-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,11,48396,ME,Individual,No,31-1705652,48396ME0720028,Anthem Gold X POS 750 20,48396ME072,,MEN003,MES005,MEF013,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care only,Yes,Emergency/Urgent Care only,No,http://www.sbc.anthem.com/dps/CCD1J41,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720028-03,Limited Cost Sharing Plan Variation,78.63%,0.776868581771851,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,11,48396,ME,Individual,No,31-1705652,48396ME0720029,Anthem Gold X POS 750 20,48396ME072,,MEN003,MES006,MEF013,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care only,Yes,Emergency/Urgent Care only,No,http://www.sbc.anthem.com/dps/CCD1J41,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720029-00,Standard Gold Off Exchange Plan,78.63%,0.776868581771851,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,11,48396,ME,Individual,No,31-1705652,48396ME0720029,Anthem Gold X POS 750 20,48396ME072,,MEN003,MES006,MEF013,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care only,Yes,Emergency/Urgent Care only,No,http://www.sbc.anthem.com/dps/CCD1J41,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720029-01,Standard Gold On Exchange Plan,78.63%,0.776868581771851,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,11,48396,ME,Individual,No,31-1705652,48396ME0720029,Anthem Gold X POS 750 20,48396ME072,,MEN003,MES006,MEF013,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care only,Yes,Emergency/Urgent Care only,No,http://www.sbc.anthem.com/dps/CCD1J41,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720029-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,11,48396,ME,Individual,No,31-1705652,48396ME0720029,Anthem Gold X POS 750 20,48396ME072,,MEN003,MES006,MEF013,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care only,Yes,Emergency/Urgent Care only,No,http://www.sbc.anthem.com/dps/CCD1J41,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0720029-03,Limited Cost Sharing Plan Variation,78.63%,0.776868581771851,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,12,48396,ME,Individual,No,31-1705652,48396ME0710016,Anthem Catastrophic X HMO 6600 0,48396ME071,,MEN001,MES003,MEF015,Existing,HMO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J43,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710016-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,12,48396,ME,Individual,No,31-1705652,48396ME0710016,Anthem Catastrophic X HMO 6600 0,48396ME071,,MEN001,MES003,MEF015,Existing,HMO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J43,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710016-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,13,48396,ME,Individual,No,31-1705652,48396ME0710017,Anthem Bronze X HMO 0 for HSA,48396ME071,,MEN001,MES003,MEF015,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J44,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710017-00,Standard Bronze Off Exchange Plan,58.16%,0.580451905727386,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,13,48396,ME,Individual,No,31-1705652,48396ME0710017,Anthem Bronze X HMO 0 for HSA,48396ME071,,MEN001,MES003,MEF015,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J44,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710017-01,Standard Bronze On Exchange Plan,58.16%,0.580451905727386,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,13,48396,ME,Individual,No,31-1705652,48396ME0710017,Anthem Bronze X HMO 0 for HSA,48396ME071,,MEN001,MES003,MEF015,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J44,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710017-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,13,48396,ME,Individual,No,31-1705652,48396ME0710017,Anthem Bronze X HMO 0 for HSA,48396ME071,,MEN001,MES003,MEF015,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J44,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710017-03,Limited Cost Sharing Plan Variation,58.16%,0.580451905727386,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,14,48396,ME,Individual,No,31-1705652,48396ME0710018,Anthem Bronze X HMO 5750 10,48396ME071,,MEN001,MES003,MEF016,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J46,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710018-00,Standard Bronze Off Exchange Plan,59.95%,0.59667706489563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,14,48396,ME,Individual,No,31-1705652,48396ME0710018,Anthem Bronze X HMO 5750 10,48396ME071,,MEN001,MES003,MEF016,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J46,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710018-01,Standard Bronze On Exchange Plan,59.95%,0.59667706489563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,14,48396,ME,Individual,No,31-1705652,48396ME0710018,Anthem Bronze X HMO 5750 10,48396ME071,,MEN001,MES003,MEF016,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J46,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710018-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,14,48396,ME,Individual,No,31-1705652,48396ME0710018,Anthem Bronze X HMO 5750 10,48396ME071,,MEN001,MES003,MEF016,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J46,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710018-03,Limited Cost Sharing Plan Variation,59.95%,0.59667706489563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,15,48396,ME,Individual,No,31-1705652,48396ME0710011,Anthem Bronze X HMO 5000 35,48396ME071,,MEN001,MES003,MEF029,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J48,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710011-00,Standard Bronze Off Exchange Plan,61.73%,0.61568945646286,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,15,48396,ME,Individual,No,31-1705652,48396ME0710011,Anthem Bronze X HMO 5000 35,48396ME071,,MEN001,MES003,MEF029,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J48,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710011-01,Standard Bronze On Exchange Plan,61.73%,0.61568945646286,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,15,48396,ME,Individual,No,31-1705652,48396ME0710011,Anthem Bronze X HMO 5000 35,48396ME071,,MEN001,MES003,MEF029,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J48,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,15,48396,ME,Individual,No,31-1705652,48396ME0710011,Anthem Bronze X HMO 5000 35,48396ME071,,MEN001,MES003,MEF029,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J48,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710011-03,Limited Cost Sharing Plan Variation,61.73%,0.61568945646286,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,16,48396,ME,Individual,No,31-1705652,48396ME0710019,Anthem Bronze X HMO 4350 20,48396ME071,,MEN001,MES003,MEF017,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4A,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710019-00,Standard Bronze Off Exchange Plan,61.98%,0.615375757217407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,350","$8,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,16,48396,ME,Individual,No,31-1705652,48396ME0710019,Anthem Bronze X HMO 4350 20,48396ME071,,MEN001,MES003,MEF017,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4A,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710019-01,Standard Bronze On Exchange Plan,61.98%,0.615375757217407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,350","$8,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,16,48396,ME,Individual,No,31-1705652,48396ME0710019,Anthem Bronze X HMO 4350 20,48396ME071,,MEN001,MES003,MEF017,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4A,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710019-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,16,48396,ME,Individual,No,31-1705652,48396ME0710019,Anthem Bronze X HMO 4350 20,48396ME071,,MEN001,MES003,MEF017,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4A,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710019-03,Limited Cost Sharing Plan Variation,61.98%,0.615375757217407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,350","$8,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,17,48396,ME,Individual,No,31-1705652,48396ME0710020,Anthem Bronze X HMO 20 for HSA,48396ME071,,MEN001,MES003,MEF017,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4C,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710020-00,Standard Bronze Off Exchange Plan,61.27%,0.607556462287903,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,17,48396,ME,Individual,No,31-1705652,48396ME0710020,Anthem Bronze X HMO 20 for HSA,48396ME071,,MEN001,MES003,MEF017,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4C,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710020-01,Standard Bronze On Exchange Plan,61.27%,0.607556462287903,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,17,48396,ME,Individual,No,31-1705652,48396ME0710020,Anthem Bronze X HMO 20 for HSA,48396ME071,,MEN001,MES003,MEF017,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4C,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710020-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,17,48396,ME,Individual,No,31-1705652,48396ME0710020,Anthem Bronze X HMO 20 for HSA,48396ME071,,MEN001,MES003,MEF017,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4C,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710020-03,Limited Cost Sharing Plan Variation,61.27%,0.607556462287903,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,18,48396,ME,Individual,No,31-1705652,48396ME0710012,Anthem Silver X HMO 3500 20,48396ME071,,MEN001,MES003,MEF027,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4E,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710012-00,Standard Silver Off Exchange Plan,68.01%,0.676263034343719,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,18,48396,ME,Individual,No,31-1705652,48396ME0710012,Anthem Silver X HMO 3500 20,48396ME071,,MEN001,MES003,MEF027,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4E,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710012-01,Standard Silver On Exchange Plan,68.01%,0.676263034343719,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,18,48396,ME,Individual,No,31-1705652,48396ME0710012,Anthem Silver X HMO 3500 20,48396ME071,,MEN001,MES003,MEF027,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4E,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710012-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,18,48396,ME,Individual,No,31-1705652,48396ME0710012,Anthem Silver X HMO 3500 20,48396ME071,,MEN001,MES003,MEF027,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4E,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710012-03,Limited Cost Sharing Plan Variation,68.01%,0.676263034343719,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,18,48396,ME,Individual,No,31-1705652,48396ME0710012,Anthem Silver X HMO 3500 20,48396ME071,,MEN001,MES003,MEF027,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4E,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710012-04,73% AV Level Silver Plan,72.04%,0.716326832771301,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,18,48396,ME,Individual,No,31-1705652,48396ME0710012,Anthem Silver X HMO 3500 20,48396ME071,,MEN001,MES003,MEF027,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4E,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710012-05,87% AV Level Silver Plan,86.58%,0.862679183483124,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,18,48396,ME,Individual,No,31-1705652,48396ME0710012,Anthem Silver X HMO 3500 20,48396ME071,,MEN001,MES003,MEF027,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4E,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710012-06,94% AV Level Silver Plan,93.70%,0.934803664684296,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,19,48396,ME,Individual,No,31-1705652,48396ME0710021,Anthem Silver X HMO 10 for HSA,48396ME071,,MEN001,MES003,MEF016,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4Q,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710021-00,Standard Silver Off Exchange Plan,70.54%,0.698752403259277,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,50165,SERFF,4,2014-10-06 10:59:03,1,50165,ME,Individual,Yes,01-0286541,50165ME0160001,Delta Dental Family High Plan,50165ME016,,MEN001,MES001,,Existing,PPO,High,,Both,,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,Allows Adult and Child-Only,,,,$40.79,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same Coverage,Yes,Same Coverage,Yes,,https://auth.deltadentalcoversme.com/sp/ACS.saml2,http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme20151.pdf,,50165ME0160001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ME,50165,SERFF,4,2014-10-06 10:59:03,1,50165,ME,Individual,Yes,01-0286541,50165ME0170001,Delta Dental Family Low Plan,50165ME017,,MEN001,MES001,,Existing,PPO,Low,,Both,,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,Allows Adult and Child-Only,,,,$34.81,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same Coverage,Yes,Same Coverage,Yes,,https://auth.deltadentalcoversme.com/sp/ACS.saml2,http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme20152.pdf,,50165ME0170001-00,Standard Low Off Exchange Plan,69.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,$150,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,2,96667,ME,SHOP (Small Group),No,04-2452600,96667ME0100017,The Harvard Pilgrim Maine Difference Deductible Tiered Copayment HMO 2500,96667ME010,,MEN001,MES001,MEF001,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,2050-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=849,4964007&_dad=portal&_schema=PORTAL",,,https://www.harvardpilgrim.org/value5,96667ME0100017-00,Standard Silver Off Exchange Plan,71.30%,0.73128080368042,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,2,96667,ME,SHOP (Small Group),No,04-2452600,96667ME0100017,The Harvard Pilgrim Maine Difference Deductible Tiered Copayment HMO 2500,96667ME010,,MEN001,MES001,MEF001,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,2050-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=849,4964007&_dad=portal&_schema=PORTAL",,,https://www.harvardpilgrim.org/value5,96667ME0100017-01,Standard Silver On Exchange Plan,71.30%,0.73128080368042,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,2,96667,ME,Individual,No,04-2452600,96667ME0150002,Harvard Pilgrim Silver HMO,96667ME015,,MEN001,MES001,MEF001,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care. ?",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9999,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928009&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,96667ME0150002-01,Standard Silver On Exchange Plan,68.90%,0.735284149646759,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,2,96667,ME,Individual,No,04-2452600,96667ME0150002,Harvard Pilgrim Silver HMO,96667ME015,,MEN001,MES001,MEF001,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care. ?",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9999,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928009&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,96667ME0150002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,2,96667,ME,Individual,No,04-2452600,96667ME0150002,Harvard Pilgrim Silver HMO,96667ME015,,MEN001,MES001,MEF001,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care. ?",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9999,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928009&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,96667ME0150002-03,Limited Cost Sharing Plan Variation,68.90%,0.735284149646759,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,3,96667,ME,Individual,No,04-2452600,96667ME0210001,Harvard Pilgrim Silver HMO Coinsurance Plan,96667ME021,,MEN001,MES001,MEF005,New,HMO,Silver,No,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9999,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928009&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,96667ME0210001-01,Standard Silver On Exchange Plan,,0.715127468109131,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,3,96667,ME,Individual,No,04-2452600,96667ME0210001,Harvard Pilgrim Silver HMO Coinsurance Plan,96667ME021,,MEN001,MES001,MEF005,New,HMO,Silver,No,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9999,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928009&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,96667ME0210001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,3,96667,ME,Individual,No,04-2452600,96667ME0210001,Harvard Pilgrim Silver HMO Coinsurance Plan,96667ME021,,MEN001,MES001,MEF005,New,HMO,Silver,No,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9999,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928009&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,96667ME0210001-03,Limited Cost Sharing Plan Variation,,0.715127468109131,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,19,48396,ME,Individual,No,31-1705652,48396ME0710021,Anthem Silver X HMO 10 for HSA,48396ME071,,MEN001,MES003,MEF016,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4Q,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710021-01,Standard Silver On Exchange Plan,70.54%,0.698752403259277,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,19,48396,ME,Individual,No,31-1705652,48396ME0710021,Anthem Silver X HMO 10 for HSA,48396ME071,,MEN001,MES003,MEF016,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4Q,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710021-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,19,48396,ME,Individual,No,31-1705652,48396ME0710021,Anthem Silver X HMO 10 for HSA,48396ME071,,MEN001,MES003,MEF016,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4Q,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710021-03,Limited Cost Sharing Plan Variation,70.54%,0.698752403259277,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,19,48396,ME,Individual,No,31-1705652,48396ME0710021,Anthem Silver X HMO 10 for HSA,48396ME071,,MEN001,MES003,MEF016,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4Q,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710021-04,73% AV Level Silver Plan,72.69%,0.720645248889923,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,200","$4,400",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,19,48396,ME,Individual,No,31-1705652,48396ME0710021,Anthem Silver X HMO 10 for HSA,48396ME071,,MEN001,MES003,MEF016,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4Q,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710021-05,87% AV Level Silver Plan,86.17%,0.861072897911072,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,19,48396,ME,Individual,No,31-1705652,48396ME0710021,Anthem Silver X HMO 10 for HSA,48396ME071,,MEN001,MES003,MEF016,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4Q,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710021-06,94% AV Level Silver Plan,93.27%,0.93240350484848,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,20,48396,ME,Individual,No,31-1705652,48396ME0710013,Anthem Silver X HMO 1800 30,48396ME071,,MEN001,MES003,MEF028,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4V,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710013-00,Standard Silver Off Exchange Plan,70.11%,0.695627570152283,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,20,48396,ME,Individual,No,31-1705652,48396ME0710013,Anthem Silver X HMO 1800 30,48396ME071,,MEN001,MES003,MEF028,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4V,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710013-01,Standard Silver On Exchange Plan,70.11%,0.695627570152283,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,20,48396,ME,Individual,No,31-1705652,48396ME0710013,Anthem Silver X HMO 1800 30,48396ME071,,MEN001,MES003,MEF028,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4V,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710013-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,20,48396,ME,Individual,No,31-1705652,48396ME0710013,Anthem Silver X HMO 1800 30,48396ME071,,MEN001,MES003,MEF028,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4V,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710013-03,Limited Cost Sharing Plan Variation,70.11%,0.695627570152283,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,20,48396,ME,Individual,No,31-1705652,48396ME0710013,Anthem Silver X HMO 1800 30,48396ME071,,MEN001,MES003,MEF028,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4V,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710013-04,73% AV Level Silver Plan,72.69%,0.722804963588715,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,20,48396,ME,Individual,No,31-1705652,48396ME0710013,Anthem Silver X HMO 1800 30,48396ME071,,MEN001,MES003,MEF028,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4V,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710013-05,87% AV Level Silver Plan,86.82%,0.866750538349152,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,20,48396,ME,Individual,No,31-1705652,48396ME0710013,Anthem Silver X HMO 1800 30,48396ME071,,MEN001,MES003,MEF028,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J4V,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710013-06,94% AV Level Silver Plan,93.82%,0.93740701675415,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,21,48396,ME,Individual,No,31-1705652,48396ME0710014,Anthem Silver X HMO 1500 30,48396ME071,,MEN001,MES003,MEF028,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J50,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710014-00,Standard Silver Off Exchange Plan,71.20%,0.706375539302826,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,21,48396,ME,Individual,No,31-1705652,48396ME0710014,Anthem Silver X HMO 1500 30,48396ME071,,MEN001,MES003,MEF028,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J50,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710014-01,Standard Silver On Exchange Plan,71.20%,0.706375539302826,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,21,48396,ME,Individual,No,31-1705652,48396ME0710014,Anthem Silver X HMO 1500 30,48396ME071,,MEN001,MES003,MEF028,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J50,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710014-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,21,48396,ME,Individual,No,31-1705652,48396ME0710014,Anthem Silver X HMO 1500 30,48396ME071,,MEN001,MES003,MEF028,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J50,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710014-03,Limited Cost Sharing Plan Variation,71.20%,0.706375539302826,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,21,48396,ME,Individual,No,31-1705652,48396ME0710014,Anthem Silver X HMO 1500 30,48396ME071,,MEN001,MES003,MEF028,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J50,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710014-04,73% AV Level Silver Plan,73.30%,0.728658497333527,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,650","$9,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,21,48396,ME,Individual,No,31-1705652,48396ME0710014,Anthem Silver X HMO 1500 30,48396ME071,,MEN001,MES003,MEF028,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J50,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710014-05,87% AV Level Silver Plan,86.82%,0.866750538349152,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,21,48396,ME,Individual,No,31-1705652,48396ME0710014,Anthem Silver X HMO 1500 30,48396ME071,,MEN001,MES003,MEF028,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J50,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710014-06,94% AV Level Silver Plan,93.82%,0.93740701675415,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,22,48396,ME,Individual,No,31-1705652,48396ME0710015,Anthem Gold X HMO 1000 10,48396ME071,,MEN001,MES003,MEF025,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J55,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710015-00,Standard Gold Off Exchange Plan,79.14%,0.776264607906342,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,22,48396,ME,Individual,No,31-1705652,48396ME0710015,Anthem Gold X HMO 1000 10,48396ME071,,MEN001,MES003,MEF025,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J55,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710015-01,Standard Gold On Exchange Plan,79.14%,0.776264607906342,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,22,48396,ME,Individual,No,31-1705652,48396ME0710015,Anthem Gold X HMO 1000 10,48396ME071,,MEN001,MES003,MEF025,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J55,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710015-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,48396,SERFF,12,2015-04-30 14:45:44,22,48396,ME,Individual,No,31-1705652,48396ME0710015,Anthem Gold X HMO 1000 10,48396ME071,,MEN001,MES003,MEF025,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1J55,https://shop.anthem.com/sales/eox/payment/landing/me,http://file.anthem.com/03255MEMENABS.pdf,anthem.com/MESelectdrugtier4,48396ME0710015-03,Limited Cost Sharing Plan Variation,79.14%,0.776264607906342,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,50165,SERFF,4,2014-10-06 10:59:03,1,50165,ME,Individual,Yes,01-0286541,50165ME0160001,Delta Dental Family High Plan,50165ME016,,MEN001,MES001,,Existing,PPO,High,,Both,,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,Allows Adult and Child-Only,,,,$40.79,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same Coverage,Yes,Same Coverage,Yes,,https://auth.deltadentalcoversme.com/sp/ACS.saml2,http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme20151.pdf,,50165ME0160001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,50165,SERFF,4,2014-10-06 10:59:03,1,50165,ME,SHOP (Small Group),Yes,01-0286541,50165ME0200001,Delta Dental PPO Family High Plan,50165ME020,,MEN001,MES001,,Existing,PPO,High,,On the Exchange,,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,Allows Adult and Child-Only,,,,$42.98,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same Coverage,Yes,Same Coverage,Yes,,,http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme20155.pdf,,50165ME0200001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,76302,SERFF,3,2014-09-09 16:12:42,1,76302,ME,Individual,Yes,47-0397286,76302ME0020001,"Renaissance Individual Dental PPO, EHB Certified",76302ME002,,MEN001,MES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$38.78,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,76302ME0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,ME,76302,SERFF,3,2014-09-09 16:12:42,1,76302,ME,Individual,Yes,47-0397286,76302ME0020002,"Renaissance Individual Dental PPO, EHB Certified",76302ME002,,MEN001,MES001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.45,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,76302ME0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,ME,78496,SERFF,2,2014-09-09 16:12:42,1,78496,ME,SHOP (Small Group),Yes,57-0523959,78496ME0010001,Group Pediatric Dental EHB Rider,78496ME001,,MEN001,MES001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$50.32,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,78496ME0010001-00,Standard High Off Exchange Plan,86.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,78496,SERFF,2,2014-09-09 16:12:42,1,78496,ME,SHOP (Small Group),Yes,57-0523959,78496ME0010002,Group Pediatric Dental EHB Rider,78496ME001,,MEN001,MES001,,New,Indemnity,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$41.52,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,78496ME0010002-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ME,86432,SERFF,2,2014-09-08 09:42:37,1,86432,ME,SHOP (Small Group),Yes,47-0098400,86432ME0040002,EHB High PPO,86432ME004,,MEN001,MES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$47.49,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,86432ME0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,86432,SERFF,2,2014-09-08 09:42:37,1,86432,ME,SHOP (Small Group),Yes,47-0098400,86432ME0040001,EHB Low PPO,86432ME004,,MEN001,MES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.83,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,86432ME0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,Yes,38-2069753,15560MI0730001,Blue Dental EPO Standard,15560MI073,7538162760,MIN004,MIS003,,Existing,EPO,Low,,Both,,,,"$1,200 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists.",,,,,Allows Adult and Child-Only,,,,$18.18,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency,No,,Yes,,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-epo-standard.pdf,,15560MI0730001-01,Standard Low On Exchange Plan,70.26%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,No,38-2069753,15560MI0350002,Blue Cross? Premier Bronze,15560MI035,7538162760,MIN003,MIS001,MIF051,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0350002-03,Limited Cost Sharing Plan Variation,59.40%,0.579830527305603,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$12,700","$25,400",Not Applicable,Not Applicable,"$5,670",$500,$0,$150,"$5,260",$0,$0,$40,9
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0450004,Blue Dental PPO  80/50/50/50 (50/50/50/50) SG,15560MI045,7538162760,MIN004,MIS004,,Existing,PPO,Low,,Off the Exchange,,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,,,,Allows Adult and Child-Only,,,,$17.24,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-80-50-50-50-50-50-50-50-1000-sg.pdf,,15560MI0450004-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,$150,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0450005,Blue Dental PPO  80/50/50/50 (50/50/50/50) SG,15560MI045,7538162760,MIN004,MIS004,,Existing,PPO,Low,,Off the Exchange,,,,$800 annual benefit maximum for members age 19 or older when coverage begins. $800 lifetime orthodontic benefit maximum for members up to age 19.,,,,,Allows Adult and Child-Only,,,,$17.24,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-80-50-50-50-50-50-50-50-800-sg.pdf,,15560MI0450005-00,Standard Low Off Exchange Plan,70.29%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,$150,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,No,38-2069753,15560MI0350003,Blue Cross? Premier Silver,15560MI035,7538162760,MIN003,MIS001,MIF052,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0350003-00,Standard Silver Off Exchange Plan,68.90%,0.699648082256317,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,400",$500,$850,$150,"$1,400",$90,$725,$40,10
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,Yes,38-2069753,15560MI0720002,Blue Dental PPO Extra,15560MI072,7538162760,MIN004,MIS004,,New,PPO,High,,Both,,,,"$1,200 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $1,000 can be used for services provided by a non-PPO (out-of-network) dentist.",,,,,Allows Adult and Child-Only,,,,$25.81,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-extra.pdf,,15560MI0720002-00,Standard High Off Exchange Plan,83.49%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,Yes,38-2069753,15560MI0720002,Blue Dental PPO Extra,15560MI072,7538162760,MIN004,MIS004,,New,PPO,High,,Both,,,,"$1,200 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $1,000 can be used for services provided by a non-PPO (out-of-network) dentist.",,,,,Allows Adult and Child-Only,,,,$25.81,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-extra.pdf,,15560MI0720002-01,Standard High On Exchange Plan,83.49%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0470001,Blue Dental EPO 100/80/50/50 SG,15560MI047,7538162760,MIN004,MIS003,,Existing,EPO,High,,Off the Exchange,,,,"$1,250 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists. $1,250 lifetime orthodontic benefit maximum for members up to age 19.",,,,,Allows Adult and Child-Only,,,,$19.54,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,No,,Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-epo-100-80-50-50-0-0-0-0-sg.pdf,,15560MI0470001-00,Standard High Off Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,$75,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,2,96667,ME,Individual,No,04-2452600,96667ME0150002,Harvard Pilgrim Silver HMO,96667ME015,,MEN001,MES001,MEF001,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care. ?",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9999,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928009&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,96667ME0150002-04,73% AV Level Silver Plan,73.90%,0.78010880947113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,2,96667,ME,Individual,No,04-2452600,96667ME0150002,Harvard Pilgrim Silver HMO,96667ME015,,MEN001,MES001,MEF001,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care. ?",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9999,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928009&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,96667ME0150002-05,87% AV Level Silver Plan,86.30%,0.887188732624054,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,2,96667,ME,Individual,No,04-2452600,96667ME0150002,Harvard Pilgrim Silver HMO,96667ME015,,MEN001,MES001,MEF001,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care. ?",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9999,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928009&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,96667ME0150002-06,94% AV Level Silver Plan,93.20%,0.933387994766235,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$800,"$1,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$600,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,3,96667,ME,Individual,No,04-2452600,96667ME0210001,Harvard Pilgrim Silver HMO Coinsurance Plan,96667ME021,,MEN001,MES001,MEF005,New,HMO,Silver,No,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9999,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928009&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,96667ME0210001-00,Standard Silver Off Exchange Plan,,0.715127468109131,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,3,96667,ME,SHOP (Small Group),No,04-2452600,96667ME0120014,The Harvard Pilgrim Best Buy HSA HMO 4000,96667ME012,,MEN001,MES001,MEF001,New,HMO,Bronze,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care.",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,2050-12-31,Yes,Urgent and Emergency Services Only,Yes,Urgent and Emergency Services Only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=849,4964007&_dad=portal&_schema=PORTAL",,,https://www.harvardpilgrim.org/value5,96667ME0120014-00,Standard Bronze Off Exchange Plan,60.30%,0.601914703845978,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,3,96667,ME,SHOP (Small Group),No,04-2452600,96667ME0120014,The Harvard Pilgrim Best Buy HSA HMO 4000,96667ME012,,MEN001,MES001,MEF001,New,HMO,Bronze,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care.",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,2050-12-31,Yes,Urgent and Emergency Services Only,Yes,Urgent and Emergency Services Only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=849,4964007&_dad=portal&_schema=PORTAL",,,https://www.harvardpilgrim.org/value5,96667ME0120014-01,Standard Bronze On Exchange Plan,60.30%,0.601914703845978,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0430005,Blue Dental  PPO Plus  80/50/50/50 SG,15560MI043,7538162760,MIN004,MIS004,,Existing,PPO,Low,,Off the Exchange,,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,,,,Allows Adult and Child-Only,,,,$20.10,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-plus-80-50-50-50-v-sg.pdf,,15560MI0430005-00,Standard Low Off Exchange Plan,70.29%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,No,38-2069753,15560MI0350003,Blue Cross? Premier Silver,15560MI035,7538162760,MIN003,MIS001,MIF052,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0350003-03,Limited Cost Sharing Plan Variation,68.90%,0.699648082256317,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,400",$500,$850,$150,"$1,400",$90,$725,$40,13
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,No,38-2069753,15560MI0350003,Blue Cross? Premier Silver,15560MI035,7538162760,MIN003,MIS001,MIF052,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0350003-04,73% AV Level Silver Plan,73.00%,0.740858197212219,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$500,$930,$150,"$1,000",$150,$740,$40,14
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,No,38-2069753,15560MI0350003,Blue Cross? Premier Silver,15560MI035,7538162760,MIN003,MIS001,MIF052,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0350003-05,87% AV Level Silver Plan,86.50%,0.864163339138031,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$2,800","$5,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$600,10%,,,,$600,"$1,200",Not Applicable,Not Applicable,$300,$500,$540,$150,$300,$180,$430,$40,15
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,No,38-2069753,15560MI0350003,Blue Cross? Premier Silver,15560MI035,7538162760,MIN003,MIS001,MIF052,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0350003-06,94% AV Level Silver Plan,93.00%,0.931599736213684,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$175,$350,10%,,,,$350,$700,Not Applicable,Not Applicable,$175,$0,$325,$150,$175,$180,$145,$40,16
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,No,38-2069753,15560MI0350004,Blue Cross? Premier Gold,15560MI035,7538162760,MIN003,MIS001,MIF052,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0350004-00,Standard Gold Off Exchange Plan,79.40%,0.808510422706604,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"$10,200","$20,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,20%,,,,$300,$600,Not Applicable,Not Applicable,$150,$500,"$1,100",$150,$150,$180,$890,$40,17
2015,ME,50165,SERFF,4,2014-10-06 10:59:03,1,50165,ME,SHOP (Small Group),Yes,01-0286541,50165ME0210001,Delta Dental PPO Family Low Plan,50165ME021,,MEN001,MES001,,Existing,PPO,Low,,On the Exchange,,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,Allows Adult and Child-Only,,,,$36.98,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same Coverage,Yes,Same Coverage,Yes,,,http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme20156.pdf,,50165ME0210001-01,Standard Low On Exchange Plan,69.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,$150,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ME,50165,SERFF,4,2014-10-06 10:59:03,1,50165,ME,SHOP (Small Group),Yes,01-0286541,50165ME0200002,Delta Dental PPO Family High Plan,50165ME020,,MEN001,MES001,,New,PPO,High,,Off the Exchange,,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,Allows Adult and Child-Only,,,,$42.98,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same Coverage,Yes,Same Coverage,Yes,,,http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme2015c.pdf,,50165ME0200002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,ME,50165,SERFF,4,2014-10-06 10:59:03,1,50165,ME,SHOP (Small Group),Yes,01-0286541,50165ME0210002,Delta Dental PPO Family Low Plan,50165ME021,,MEN001,MES001,,New,PPO,Low,,Off the Exchange,,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,Allows Adult and Child-Only,,,,$36.98,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same Coverage,Yes,Same Coverage,Yes,,,http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme2015d.pdf,,50165ME0210002-00,Standard Low Off Exchange Plan,69.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,$150,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,ME,50165,SERFF,4,2014-10-06 10:59:03,1,50165,ME,Individual,Yes,01-0286541,50165ME0170001,Delta Dental Family Low Plan,50165ME017,,MEN001,MES001,,Existing,PPO,Low,,Both,,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,Allows Adult and Child-Only,,,,$34.81,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same Coverage,Yes,Same Coverage,Yes,,https://auth.deltadentalcoversme.com/sp/ACS.saml2,http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme20152.pdf,,50165ME0170001-01,Standard Low On Exchange Plan,69.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,$150,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,ME,50165,SERFF,4,2014-10-06 10:59:03,2,50165,ME,Individual,Yes,01-0286541,50165ME0180001,Delta Dental Pediatric High Plan,50165ME018,,MEN001,MES001,,Existing,PPO,High,,On the Exchange,,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time",,,,,Allows Child-Only,,,,$40.79,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same Coverage,Yes,Same Coverage,Yes,,https://auth.deltadentalcoversme.com/sp/ACS.saml2,http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme20153.pdf,,50165ME0180001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,50165,SERFF,4,2014-10-06 10:59:03,2,50165,ME,Individual,Yes,01-0286541,50165ME0190001,Delta Dental Pediatric Low Plan,50165ME019,,MEN001,MES001,,Existing,PPO,Low,,On the Exchange,,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,Allows Child-Only,,,,$34.81,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same Coverage,Yes,Same Coverage,Yes,,https://auth.deltadentalcoversme.com/sp/ACS.saml2,http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme20154.pdf,,50165ME0190001-01,Standard Low On Exchange Plan,69.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,$150,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ME,60657,SERFF,2,2014-09-08 09:42:37,1,60657,ME,SHOP (Small Group),Yes,44-0308260,60657ME0010001,KCL EHB Low PPO,60657ME001,,MEN001,MES001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$39.65,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,60657ME0010001-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,60657,SERFF,2,2014-09-08 09:42:37,1,60657,ME,SHOP (Small Group),Yes,44-0308260,60657ME0010003,KCL EHB Low MAC,60657ME001,,MEN001,MES001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$28.88,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,60657ME0010003-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ME,60657,SERFF,2,2014-09-08 09:42:37,1,60657,ME,SHOP (Small Group),Yes,44-0308260,60657ME0010005,KCL Fam Low PPO,60657ME001,,MEN001,MES001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$39.65,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,60657ME0010005-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,ME,60657,SERFF,2,2014-09-08 09:42:37,1,60657,ME,SHOP (Small Group),Yes,44-0308260,60657ME0010007,KCL Fam Low MAC,60657ME001,,MEN001,MES001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$28.88,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,60657ME0010007-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,ME,60657,SERFF,2,2014-09-08 09:42:37,2,60657,ME,SHOP (Small Group),Yes,44-0308260,60657ME0010002,KCL EHB High PPO,60657ME001,,MEN001,MES001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$48.45,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,60657ME0010002-00,Standard High Off Exchange Plan,83.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,60657,SERFF,2,2014-09-08 09:42:37,2,60657,ME,SHOP (Small Group),Yes,44-0308260,60657ME0010004,KCL EHB High MAC,60657ME001,,MEN001,MES001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$36.33,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,60657ME0010004-00,Standard High Off Exchange Plan,83.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ME,60657,SERFF,2,2014-09-08 09:42:37,2,60657,ME,SHOP (Small Group),Yes,44-0308260,60657ME0010006,KCL Fam High PPO,60657ME001,,MEN001,MES001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$48.45,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,60657ME0010006-00,Standard High Off Exchange Plan,83.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,ME,60657,SERFF,2,2014-09-08 09:42:37,2,60657,ME,SHOP (Small Group),Yes,44-0308260,60657ME0010008,KCL Fam High MAC,60657ME001,,MEN001,MES001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$36.33,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,60657ME0010008-00,Standard High Off Exchange Plan,83.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,ME,69227,SERFF,2,2014-09-09 16:12:42,1,69227,ME,SHOP (Small Group),Yes,13-5123390,69227ME0050002,Guardian Pediatric Advantage,69227ME005,,MEN001,MES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$33.41,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,69227ME0050002-00,Standard High Off Exchange Plan,86.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,69227,SERFF,2,2014-09-09 16:12:42,1,69227,ME,SHOP (Small Group),Yes,13-5123390,69227ME0060002,Guardian Pediatric Essentials,69227ME006,,MEN001,MES001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.70,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,69227ME0060002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ME,69227,SERFF,2,2014-09-09 16:12:42,2,69227,ME,SHOP (Small Group),Yes,13-5123390,69227ME0080002,Guardian Family Advantage,69227ME008,,MEN001,MES001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.41,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,69227ME0080002-00,Standard High Off Exchange Plan,86.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,69227,SERFF,2,2014-09-09 16:12:42,2,69227,ME,SHOP (Small Group),Yes,13-5123390,69227ME0080002,Guardian Family Advantage,69227ME008,,MEN001,MES001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.41,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,69227ME0080002-01,Standard High On Exchange Plan,86.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ME,69227,SERFF,2,2014-09-09 16:12:42,2,69227,ME,SHOP (Small Group),Yes,13-5123390,69227ME0100002,Guardian Family Essentials,69227ME010,,MEN001,MES001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.70,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,69227ME0100002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,ME,69227,SERFF,2,2014-09-09 16:12:42,2,69227,ME,SHOP (Small Group),Yes,13-5123390,69227ME0100002,Guardian Family Essentials,69227ME010,,MEN001,MES001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.70,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,69227ME0100002-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,ME,70024,SERFF,2,2014-10-06 10:59:03,1,70024,ME,SHOP (Small Group),Yes,36-0883760,70024ME0040002,EHB High PPO,70024ME004,,MEN001,MES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$48.15,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,70024ME0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,70024,SERFF,2,2014-10-06 10:59:03,1,70024,ME,SHOP (Small Group),Yes,36-0883760,70024ME0040001,EHB Low PPO,70024ME004,,MEN001,MES001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.19,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,70024ME0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ME,70024,SERFF,2,2014-10-06 10:59:03,1,70024,ME,SHOP (Small Group),Yes,36-0883760,70024ME0030002,EHB High Passive,70024ME003,,MEN001,MES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$48.82,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,70024ME0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,No,38-2069753,15560MI0350002,Blue Cross? Premier Bronze,15560MI035,7538162760,MIN003,MIS001,MIF051,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0350002-00,Standard Bronze Off Exchange Plan,59.40%,0.579830527305603,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$12,700","$25,400",Not Applicable,Not Applicable,"$5,670",$500,$0,$150,"$5,260",$0,$0,$40,6
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,Yes,38-2069753,15560MI0710001,Blue Dental PPO Plus Standard,15560MI071,7538162760,MIN004,MIS004,,Existing,PPO,Low,,Both,,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,,,,Allows Adult and Child-Only,,,,$22.87,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-plus-standard.pdf,,15560MI0710001-00,Standard Low Off Exchange Plan,69.23%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0450001,Blue Dental PPO 100/80/50/50 (80/50/50/50) SG,15560MI045,7538162760,MIN004,MIS004,,Existing,PPO,High,,Off the Exchange,,,,"$1,250 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.  $1,250 lifetime orthodontic benefit maximum for members up to age 19.",,,,,Allows Adult and Child-Only,,,,$22.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-100-80-50-50-80-50-50-50-sg.pdf,,15560MI0450001-00,Standard High Off Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,$150,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,Yes,38-2069753,15560MI0710001,Blue Dental PPO Plus Standard,15560MI071,7538162760,MIN004,MIS004,,Existing,PPO,Low,,Both,,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,,,,Allows Adult and Child-Only,,,,$22.87,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-plus-standard.pdf,,15560MI0710001-01,Standard Low On Exchange Plan,69.23%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,No,38-2069753,15560MI0350002,Blue Cross? Premier Bronze,15560MI035,7538162760,MIN003,MIS001,MIF051,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0350002-01,Standard Bronze On Exchange Plan,59.40%,0.579830527305603,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$12,700","$25,400",Not Applicable,Not Applicable,"$5,670",$500,$0,$150,"$5,260",$0,$0,$40,7
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0450002,Blue Dental PPO 100/80/50/50 (50/50/50/50) SG,15560MI045,7538162760,MIN004,MIS004,,Existing,PPO,High,,Off the Exchange,,,,"$1,500 annual benefit maximum for members age 19 or older when coverage begins. $1,500 lifetime orthodontic benefit maximum for members up to age 19.",,,,,Allows Adult and Child-Only,,,,$20.21,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-100-80-50-50-50-50-50-50-1500-sg.pdf,,15560MI0450002-00,Standard High Off Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,$150,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,No,38-2069753,15560MI0350002,Blue Cross? Premier Bronze,15560MI035,7538162760,MIN003,MIS001,MIF051,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0350002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$40,8
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0450003,Blue Dental PPO 100/80/50/50 (50/50/50/50) SG,15560MI045,7538162760,MIN004,MIS004,,Existing,PPO,High,,Off the Exchange,,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,,,,Allows Adult and Child-Only,,,,$20.21,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-100-80-50-50-50-50-50-50-1000-sg.pdf,,15560MI0450003-00,Standard High Off Exchange Plan,84.51%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,$150,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,Yes,38-2069753,15560MI0730001,Blue Dental EPO Standard,15560MI073,7538162760,MIN004,MIS003,,Existing,EPO,Low,,Both,,,,"$1,200 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists.",,,,,Allows Adult and Child-Only,,,,$18.18,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency,No,,Yes,,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-epo-standard.pdf,,15560MI0730001-00,Standard Low Off Exchange Plan,70.26%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,No,38-2069753,15560MI0350003,Blue Cross? Premier Silver,15560MI035,7538162760,MIN003,MIS001,MIF052,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0350003-01,Standard Silver On Exchange Plan,68.90%,0.699648082256317,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,400",$500,$850,$150,"$1,400",$90,$725,$40,11
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,No,38-2069753,15560MI0350003,Blue Cross? Premier Silver,15560MI035,7538162760,MIN003,MIS001,MIF052,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0350003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$40,12
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,No,38-2069753,15560MI0350004,Blue Cross? Premier Gold,15560MI035,7538162760,MIN003,MIS001,MIF052,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0350004-01,Standard Gold On Exchange Plan,79.40%,0.808510422706604,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"$10,200","$20,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,20%,,,,$300,$600,Not Applicable,Not Applicable,$150,$500,"$1,100",$150,$150,$180,$890,$40,18
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,No,38-2069753,15560MI0350004,Blue Cross? Premier Gold,15560MI035,7538162760,MIN003,MIS001,MIF052,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0350004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$40,19
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,No,38-2069753,15560MI0350004,Blue Cross? Premier Gold,15560MI035,7538162760,MIN003,MIS001,MIF052,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0350004-03,Limited Cost Sharing Plan Variation,79.40%,0.808510422706604,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"$10,200","$20,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,20%,,,,$300,$600,Not Applicable,Not Applicable,$150,$500,"$1,100",$150,$150,$180,$890,$40,20
2015,ME,70024,SERFF,2,2014-10-06 10:59:03,1,70024,ME,SHOP (Small Group),Yes,36-0883760,70024ME0030001,EHB Low Passive,70024ME003,,MEN001,MES001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.41,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,70024ME0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,ME,76302,SERFF,3,2014-09-09 16:12:42,1,76302,ME,Individual,Yes,47-0397286,76302ME0010001,"Delta Dental Individual PPO, EHB Certified",76302ME001,,MEN002,MES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$38.47,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,76302ME0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,76302,SERFF,3,2014-09-09 16:12:42,1,76302,ME,SHOP (Small Group),Yes,47-0397286,76302ME0030001,"Renaissance Group Dental PPO, EHB Certified",76302ME003,,MEN001,MES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.50,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,76302ME0030001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,ME,76302,SERFF,3,2014-09-09 16:12:42,1,76302,ME,SHOP (Small Group),Yes,47-0397286,76302ME0030002,"Renaissance Group Dental PPO, EHB Certified",76302ME003,,MEN001,MES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.93,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,76302ME0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ME,76302,SERFF,3,2014-09-09 16:12:42,1,76302,ME,Individual,Yes,47-0397286,76302ME0010002,"Delta Dental Individual PPO, EHB Certified",76302ME001,,MEN002,MES001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.22,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,76302ME0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,ME,86432,SERFF,2,2014-09-08 09:42:37,1,86432,ME,SHOP (Small Group),Yes,47-0098400,86432ME0030002,EHB High Passive,86432ME003,,MEN001,MES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$48.15,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,86432ME0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,ME,86432,SERFF,2,2014-09-08 09:42:37,1,86432,ME,SHOP (Small Group),Yes,47-0098400,86432ME0030001,EHB Low Passive,86432ME003,,MEN001,MES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.99,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,86432ME0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,1,96667,ME,Individual,No,04-2452600,96667ME0130002,Harvard Pilgrim Gold HMO 1000,96667ME013,,MEN001,MES001,MEF001,New,HMO,Gold,No,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care. ?",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9999,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928009&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,96667ME0130002-00,Standard Gold Off Exchange Plan,,0.785986244678497,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,1,96667,ME,SHOP (Small Group),No,04-2452600,96667ME0100015,The Harvard Pilgrim Maine Difference Deductible Tiered Copayment HMO 1500,96667ME010,,MEN001,MES001,MEF001,New,HMO,Gold,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,2050-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=849,4964007&_dad=portal&_schema=PORTAL",,,https://www.harvardpilgrim.org/value5,96667ME0100015-00,Standard Gold Off Exchange Plan,78.30%,0.803575158119202,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,1,96667,ME,SHOP (Small Group),No,04-2452600,96667ME0100015,The Harvard Pilgrim Maine Difference Deductible Tiered Copayment HMO 1500,96667ME010,,MEN001,MES001,MEF001,New,HMO,Gold,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,2050-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=849,4964007&_dad=portal&_schema=PORTAL",,,https://www.harvardpilgrim.org/value5,96667ME0100015-01,Standard Gold On Exchange Plan,78.30%,0.803575158119202,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,1,96667,ME,Individual,No,04-2452600,96667ME0130002,Harvard Pilgrim Gold HMO 1000,96667ME013,,MEN001,MES001,MEF001,New,HMO,Gold,No,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care. ?",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9999,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928009&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,96667ME0130002-01,Standard Gold On Exchange Plan,,0.785986244678497,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,1,96667,ME,Individual,No,04-2452600,96667ME0130002,Harvard Pilgrim Gold HMO 1000,96667ME013,,MEN001,MES001,MEF001,New,HMO,Gold,No,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care. ?",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9999,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928009&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,96667ME0130002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,1,96667,ME,Individual,No,04-2452600,96667ME0130002,Harvard Pilgrim Gold HMO 1000,96667ME013,,MEN001,MES001,MEF001,New,HMO,Gold,No,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care. ?",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9999,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928009&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,96667ME0130002-03,Limited Cost Sharing Plan Variation,,0.785986244678497,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,2,96667,ME,Individual,No,04-2452600,96667ME0150002,Harvard Pilgrim Silver HMO,96667ME015,,MEN001,MES001,MEF001,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care. ?",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9999,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928009&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,96667ME0150002-00,Standard Silver Off Exchange Plan,68.90%,0.735284149646759,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,3,96667,ME,Individual,No,04-2452600,96667ME0210001,Harvard Pilgrim Silver HMO Coinsurance Plan,96667ME021,,MEN001,MES001,MEF005,New,HMO,Silver,No,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9999,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928009&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,96667ME0210001-04,73% AV Level Silver Plan,,0.738607704639435,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,3,96667,ME,Individual,No,04-2452600,96667ME0210001,Harvard Pilgrim Silver HMO Coinsurance Plan,96667ME021,,MEN001,MES001,MEF005,New,HMO,Silver,No,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9999,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928009&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,96667ME0210001-05,87% AV Level Silver Plan,,0.873633623123169,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,5,15560,MI,Individual,No,38-2069753,15560MI0900002,Blue Cross? Metro Detroit EPO Silver Extra,15560MI090,7538162760,MIN002,MIS002,MIF053,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0900002-00,Standard Silver Off Exchange Plan,70.20%,0.704515039920807,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$0,$800,$150,"$2,000",$300,$440,$40,8
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0420002,Blue Dental PPO Plus 100/80/50 SG,15560MI042,7538162760,MIN004,MIS004,,Existing,PPO,High,,Off the Exchange,,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,,,,Allows Adult and Child-Only,,,,$25.76,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-plus-100-80-50-1000-sg.pdf,,15560MI0420002-00,Standard High Off Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,Individual,No,38-2069753,15560MI0860001,Blue Cross? Premier Bronze Extra,15560MI086,7538162760,MIN003,MIS001,MIF053,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0860001-01,Standard Bronze On Exchange Plan,62.00%,0.615190267562866,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$70,$150,"$3,970",$300,$20,$40,5
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,5,15560,MI,Individual,No,38-2069753,15560MI0900002,Blue Cross? Metro Detroit EPO Silver Extra,15560MI090,7538162760,MIN002,MIS002,MIF053,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0900002-01,Standard Silver On Exchange Plan,70.20%,0.704515039920807,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$0,$800,$150,"$2,000",$300,$440,$40,9
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,5,15560,MI,Individual,No,38-2069753,15560MI0900002,Blue Cross? Metro Detroit EPO Silver Extra,15560MI090,7538162760,MIN002,MIS002,MIF053,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0900002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$40,10
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,5,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0680001,Blue Dental EPO 100/80/50 Voluntary SG,15560MI068,7538162760,MIN004,MIS003,,Existing,EPO,High,,Off the Exchange,,,,"$1,250 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists.",,,,,Allows Adult and Child-Only,,,,$21.16,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,No,,Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-epo-100-80-50-0-0-0-v-sg.pdf,,15560MI0680001-00,Standard High Off Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,$75,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,5,15560,MI,Individual,No,38-2069753,15560MI0900002,Blue Cross? Metro Detroit EPO Silver Extra,15560MI090,7538162760,MIN002,MIS002,MIF053,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0900002-03,Limited Cost Sharing Plan Variation,70.20%,0.704515039920807,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$0,$800,$150,"$2,000",$300,$440,$40,11
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,5,15560,MI,Individual,No,38-2069753,15560MI0900002,Blue Cross? Metro Detroit EPO Silver Extra,15560MI090,7538162760,MIN002,MIS002,MIF053,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0900002-04,73% AV Level Silver Plan,72.60%,0.732052087783813,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$900,$150,"$1,500",$300,$560,$40,12
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,5,15560,MI,Individual,No,38-2069753,15560MI0900002,Blue Cross? Metro Detroit EPO Silver Extra,15560MI090,7538162760,MIN002,MIS002,MIF053,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0900002-05,87% AV Level Silver Plan,86.40%,0.871445834636688,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$600,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$0,$570,$150,$300,$300,$460,$40,13
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,5,15560,MI,Individual,No,38-2069753,15560MI0900002,Blue Cross? Metro Detroit EPO Silver Extra,15560MI090,7538162760,MIN002,MIS002,MIF053,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0900002-06,94% AV Level Silver Plan,93.00%,0.933878242969513,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$0,$590,$150,$150,$300,$50,$40,14
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,5,15560,MI,Individual,No,38-2069753,15560MI0900003,Blue Cross? Metro Detroit EPO Gold Extra,15560MI090,7538162760,MIN002,MIS002,MIF053,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0900003-00,Standard Gold Off Exchange Plan,81.80%,0.825072824954987,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,"$1,100",$150,$500,$300,$880,$40,15
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,Individual,Yes,38-2069753,15560MI0740001,Blue Dental PPO Pediatric,15560MI074,7538162760,MIN004,MIS004,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$19.87,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-pediatric.pdf,,15560MI0740001-01,Standard Low On Exchange Plan,70.26%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,Individual,No,38-2069753,15560MI0860001,Blue Cross? Premier Bronze Extra,15560MI086,7538162760,MIN003,MIS001,MIF053,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0860001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$40,6
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0420005,Blue Dental  PPO Plus 80/50/50 SG,15560MI042,7538162760,MIN004,MIS004,,Existing,PPO,Low,,Off the Exchange,,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,,,,Allows Adult and Child-Only,,,,$19.16,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-plus-80-50-50-sg.pdf,,15560MI0420005-00,Standard Low Off Exchange Plan,70.29%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,3,96667,ME,Individual,No,04-2452600,96667ME0210001,Harvard Pilgrim Silver HMO Coinsurance Plan,96667ME021,,MEN001,MES001,MEF005,New,HMO,Silver,No,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9999,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928009&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,96667ME0210001-06,94% AV Level Silver Plan,,0.949492812156677,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,4,96667,ME,Individual,No,04-2452600,96667ME0110002,Harvard Pilgrim Best Buy HMO HSA 5000,96667ME011,,MEN001,MES001,MEF006,New,HMO,Bronze,No,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care. ?",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9999,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928009&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,96667ME0110002-00,Standard Bronze Off Exchange Plan,,0.586429119110107,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,4,96667,ME,SHOP (Small Group),No,04-2452600,96667ME0120015,The Harvard Pilgrim Best Buy HSA HMO 5000,96667ME012,,MEN001,MES001,MEF001,New,HMO,Bronze,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care.",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,2050-12-31,Yes,Urgent and Emergency Services Only,Yes,Urgent and Emergency Services Only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=849,4964007&_dad=portal&_schema=PORTAL",,,https://www.harvardpilgrim.org/value5,96667ME0120015-00,Standard Bronze Off Exchange Plan,58.60%,0.585844695568085,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,4,96667,ME,SHOP (Small Group),No,04-2452600,96667ME0120015,The Harvard Pilgrim Best Buy HSA HMO 5000,96667ME012,,MEN001,MES001,MEF001,New,HMO,Bronze,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care.",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,2050-12-31,Yes,Urgent and Emergency Services Only,Yes,Urgent and Emergency Services Only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=849,4964007&_dad=portal&_schema=PORTAL",,,https://www.harvardpilgrim.org/value5,96667ME0120015-01,Standard Bronze On Exchange Plan,58.60%,0.585844695568085,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,4,96667,ME,Individual,No,04-2452600,96667ME0110002,Harvard Pilgrim Best Buy HMO HSA 5000,96667ME011,,MEN001,MES001,MEF006,New,HMO,Bronze,No,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care. ?",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9999,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928009&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,96667ME0110002-01,Standard Bronze On Exchange Plan,,0.586429119110107,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,4,96667,ME,Individual,No,04-2452600,96667ME0110002,Harvard Pilgrim Best Buy HMO HSA 5000,96667ME011,,MEN001,MES001,MEF006,New,HMO,Bronze,No,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care. ?",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9999,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928009&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,96667ME0110002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,ME,96667,SERFF,10,2015-07-22 12:46:44,4,96667,ME,Individual,No,04-2452600,96667ME0110002,Harvard Pilgrim Best Buy HMO HSA 5000,96667ME011,,MEN001,MES001,MEF006,New,HMO,Bronze,No,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN Care, Chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care. ?",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9999,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only,Yes,Urgent and Emergency Services only,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928009&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,96667ME0110002-03,Limited Cost Sharing Plan Variation,,0.586429119110107,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,MI,11083,SERFF,3,2014-09-11 12:10:19,1,11083,MI,SHOP (Small Group),Yes,13-5581829,11083MI0100001,EHB Basic Dental Plan (Low),11083MI010,,MIN001,MIS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$17.96,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48043,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48042,,11083MI0100001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,11083,SERFF,3,2014-09-11 12:10:19,1,11083,MI,SHOP (Small Group),Yes,13-5581829,11083MI0100001,EHB Basic Dental Plan (Low),11083MI010,,MIN001,MIS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$17.96,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48043,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48042,,11083MI0100001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,11083,SERFF,3,2014-09-11 12:10:19,2,11083,MI,SHOP (Small Group),Yes,13-5581829,11083MI0110001,EHB Enhanced Dental Plan (High),11083MI011,,MIN001,MIS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$27.21,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49088,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49087,,11083MI0110001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,11083,SERFF,3,2014-09-11 12:10:19,2,11083,MI,SHOP (Small Group),Yes,13-5581829,11083MI0110001,EHB Enhanced Dental Plan (High),11083MI011,,MIN001,MIS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$27.21,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49088,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49087,,11083MI0110001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,11083,SERFF,3,2014-09-11 12:10:19,3,11083,MI,SHOP (Small Group),Yes,13-5581829,11083MI0120001,Family Basic Dental Plan (Low),11083MI012,,MIN001,MIS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$17.96,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49090,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49089,,11083MI0120001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,11083,SERFF,3,2014-09-11 12:10:19,3,11083,MI,SHOP (Small Group),Yes,13-5581829,11083MI0120001,Family Basic Dental Plan (Low),11083MI012,,MIN001,MIS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$17.96,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49090,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49089,,11083MI0120001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,11083,SERFF,3,2014-09-11 12:10:19,4,11083,MI,SHOP (Small Group),Yes,13-5581829,11083MI0130001,Family Enhanced Dental Plan (High),11083MI013,,MIN001,MIS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$27.21,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49092,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49091,,11083MI0130001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,11083,SERFF,3,2014-09-11 12:10:19,4,11083,MI,SHOP (Small Group),Yes,13-5581829,11083MI0130001,Family Enhanced Dental Plan (High),11083MI013,,MIN001,MIS001,,Existing,PPO,High,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$27.21,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49092,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49091,,11083MI0130001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,11103,SERFF,3,2014-09-11 12:10:19,1,11103,MI,SHOP (Small Group),Yes,36-4117539,11103MI0020002,Managed DentalGuard MI Child Essentials 1,11103MI002,,MIN001,MIS001,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$16.20,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,11103MI0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,11103,SERFF,3,2014-09-11 12:10:19,2,11103,MI,SHOP (Small Group),Yes,36-4117539,11103MI0030002,Managed DentalGuard MI10 Family Plan,11103MI003,,MIN001,MIS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.20,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,11103MI0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,11103,SERFF,3,2014-09-11 12:10:19,2,11103,MI,SHOP (Small Group),Yes,36-4117539,11103MI0030002,Managed DentalGuard MI10 Family Plan,11103MI003,,MIN001,MIS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.20,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,11103MI0030002-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,11103,SERFF,3,2014-09-11 12:10:19,2,11103,MI,SHOP (Small Group),Yes,36-4117539,11103MI0040002,Managed DentalGuard MI20 Family Plan,11103MI004,,MIN001,MIS001,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$16.20,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,11103MI0040002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,11103,SERFF,3,2014-09-11 12:10:19,2,11103,MI,SHOP (Small Group),Yes,36-4117539,11103MI0050002,Managed DentalGuard MI30 Family Plan,11103MI005,,MIN001,MIS001,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$16.20,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,11103MI0050002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,12858,SERFF,4,2015-01-21 12:15:34,1,12858,MI,SHOP (Small Group),Yes,36-3757528,12858MI0030001,TruAssure Dental Small Group Basic Plan,12858MI003,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$40.87,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=MI,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=MI,,12858MI0030001-00,Standard High Off Exchange Plan,83.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,12858,SERFF,4,2015-01-21 12:15:34,1,12858,MI,Individual,Yes,36-3757528,12858MI0010001,TruAssure Dental Basic Plan,12858MI001,,MIN001,MIS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.25,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=MI,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=MI,,12858MI0010001-00,Standard Low Off Exchange Plan,68.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$110,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,12858,SERFF,4,2015-01-21 12:15:34,1,12858,MI,Individual,Yes,36-3757528,12858MI0010001,TruAssure Dental Basic Plan,12858MI001,,MIN001,MIS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.25,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=MI,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=MI,,12858MI0010001-01,Standard Low On Exchange Plan,68.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$110,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,12858,SERFF,4,2015-01-21 12:15:34,1,12858,MI,SHOP (Small Group),Yes,36-3757528,12858MI0040001,TruAssure Dental Small Group Preferred Plan,12858MI004,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$40.87,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=MI,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=MI,,12858MI0040001-00,Standard High Off Exchange Plan,83.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,12858,SERFF,4,2015-01-21 12:15:34,2,12858,MI,Individual,Yes,36-3757528,12858MI0020001,TruAssure Dental Preferred Plan,12858MI002,,MIN001,MIS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.88,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=MI,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=MI,,12858MI0020001-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,12858,SERFF,4,2015-01-21 12:15:34,2,12858,MI,Individual,Yes,36-3757528,12858MI0020001,TruAssure Dental Preferred Plan,12858MI002,,MIN001,MIS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.88,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=MI,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=MI,,12858MI0020001-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0430001,Blue Dental PPO Plus 100/80/50/50 SG,15560MI043,7538162760,MIN004,MIS004,,Existing,PPO,High,,Off the Exchange,,,,"$1,500 annual benefit maximum for members age 19 or older when coverage begins. $1,500 lifetime orthodontic benefit maximum for members up to age 19.",,,,,Allows Adult and Child-Only,,,,$26.70,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-plus-100-80-50-50-1500-sg.pdf,,15560MI0430001-00,Standard High Off Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,No,38-2069753,15560MI0350001,Blue Cross? Premier Value,15560MI035,7538162760,MIN003,MIS001,MIF051,Existing,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0350001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,170",$0,$0,$150,"$4,970",$90,$0,$40,4
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,Yes,38-2069753,15560MI0720001,Blue Dental PPO Standard,15560MI072,7538162760,MIN004,MIS004,,Existing,PPO,Low,,Both,,,,"$1,200 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,,,,Allows Adult and Child-Only,,,,$19.87,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-standard.pdf,,15560MI0720001-00,Standard Low Off Exchange Plan,70.26%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,Yes,38-2069753,15560MI0720001,Blue Dental PPO Standard,15560MI072,7538162760,MIN004,MIS004,,Existing,PPO,Low,,Both,,,,"$1,200 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,,,,Allows Adult and Child-Only,,,,$19.87,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-standard.pdf,,15560MI0720001-01,Standard Low On Exchange Plan,70.26%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,Individual,No,38-2069753,15560MI0350001,Blue Cross? Premier Value,15560MI035,7538162760,MIN003,MIS001,MIF051,Existing,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,3,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0350001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,170",$0,$0,$150,"$4,970",$90,$0,$40,5
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,1,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0430002,Blue Dental PPO Plus 100/80/50/50 SG,15560MI043,7538162760,MIN004,MIS004,,Existing,PPO,High,,Off the Exchange,,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,,,,Allows Adult and Child-Only,,,,$26.70,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-plus-100-80-50-50-1000-sg.pdf,,15560MI0430002-00,Standard High Off Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,Individual,Yes,38-2069753,15560MI0740001,Blue Dental PPO Pediatric,15560MI074,7538162760,MIN004,MIS004,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$19.87,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-pediatric.pdf,,15560MI0740001-00,Standard Low Off Exchange Plan,70.26%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,Individual,No,38-2069753,15560MI0860001,Blue Cross? Premier Bronze Extra,15560MI086,7538162760,MIN003,MIS001,MIF053,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0860001-00,Standard Bronze Off Exchange Plan,62.00%,0.615190267562866,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$70,$150,"$3,970",$300,$20,$40,4
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,4,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0670003,Blue Dental?PPO 80/50/50/50 (50/50/50/50)  Voluntary SG,15560MI067,7538162760,MIN004,MIS004,,Existing,PPO,Low,,Off the Exchange,,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.  $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,,,,Allows Adult and Child-Only,,,,$19.71,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-80-50-50-50-50-50-50-50-v-sg.pdf,,15560MI0670003-00,Standard Low Off Exchange Plan,70.29%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,$150,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,4,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0690001,Blue Dental EPO 100/80/50/50 Voluntary SG,15560MI069,7538162760,MIN004,MIS003,,Existing,EPO,High,,Off the Exchange,,,,"$1,250 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists. $1,250 lifetime orthodontic benefit maximum for members up to age 19.",,,,,Allows Adult and Child-Only,,,,$22.10,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,No,,Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-epo-100-80-50-50-0-0-0-0-v-sg.pdf,,15560MI0690001-00,Standard High Off Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,$75,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,4,15560,MI,Individual,No,38-2069753,15560MI0890002,Blue Cross? Metro Detroit EPO Silver,15560MI089,7538162760,MIN002,MIS002,MIF052,New,EPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0890002-01,Standard Silver On Exchange Plan,68.90%,0.699648082256317,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400",$500,$850,$150,"$1,400",$90,$725,$40,9
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,4,15560,MI,Individual,No,38-2069753,15560MI0890002,Blue Cross? Metro Detroit EPO Silver,15560MI089,7538162760,MIN002,MIS002,MIF052,New,EPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0890002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$40,10
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,4,15560,MI,Individual,No,38-2069753,15560MI0890002,Blue Cross? Metro Detroit EPO Silver,15560MI089,7538162760,MIN002,MIS002,MIF052,New,EPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0890002-03,Limited Cost Sharing Plan Variation,68.90%,0.699648082256317,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400",$500,$850,$150,"$1,400",$90,$725,$40,11
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,4,15560,MI,Individual,No,38-2069753,15560MI0890002,Blue Cross? Metro Detroit EPO Silver,15560MI089,7538162760,MIN002,MIS002,MIF052,New,EPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0890002-04,73% AV Level Silver Plan,73.00%,0.740858197212219,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$500,$930,$150,"$1,000",$150,$740,$40,12
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,4,15560,MI,Individual,No,38-2069753,15560MI0890002,Blue Cross? Metro Detroit EPO Silver,15560MI089,7538162760,MIN002,MIS002,MIF052,New,EPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0890002-05,87% AV Level Silver Plan,86.50%,0.864163339138031,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$600,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$500,$540,$150,$300,$180,$430,$40,13
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,4,15560,MI,Individual,No,38-2069753,15560MI0890002,Blue Cross? Metro Detroit EPO Silver,15560MI089,7538162760,MIN002,MIS002,MIF052,New,EPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0890002-06,94% AV Level Silver Plan,93.00%,0.931599736213684,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$175,$350,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$175,$0,$325,$150,$175,$180,$145,$40,14
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,5,15560,MI,Individual,No,38-2069753,15560MI0900001,Blue Cross? Metro Detroit EPO Bronze Extra,15560MI090,7538162760,MIN002,MIS002,MIF053,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0900001-00,Standard Bronze Off Exchange Plan,62.00%,0.615190267562866,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$70,$150,"$3,970",$300,$20,$40,4
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,5,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0660002,Blue Dental PPO 100/80/50 (80/50/50) Voluntary SG,15560MI066,7538162760,MIN004,MIS004,,Existing,PPO,High,,Off the Exchange,,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,,,,Allows Adult and Child-Only,,,,$23.65,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-100-80-50-80-50-50-1000-v-sg.pdf,,15560MI0660002-00,Standard High Off Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,$150,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,2,20393,MI,Individual,No,38-3252216,20393MI0040011,McLaren Bronze,20393MI004,,MIN001,MIS001,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.mclarenhealthplan.org,www.mclarenhealthplan.org,www.mclarenhealthplan.org,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0040011-03,Limited Cost Sharing Plan Variation,,0.600874364376068,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$5,000","$10,000",50%,,,,Not Applicable,Not Applicable,"$5,000","$10,000",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,3,20393,MI,Individual,No,38-3252216,20393MI0040004,McLaren Young Adult,20393MI004,,MIN001,MIS001,MIF004,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.mclarenhealthplan.org,www.mclarenhealthplan.org,www.mclarenhealthplan.org,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0040004-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,4
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,3,20393,MI,Individual,No,38-3252216,20393MI0040004,McLaren Young Adult,20393MI004,,MIN001,MIS001,MIF004,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.mclarenhealthplan.org,www.mclarenhealthplan.org,www.mclarenhealthplan.org,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0040004-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,5
2015,MI,26380,SERFF,1,2014-08-08 13:45:50,1,26380,MI,SHOP (Small Group),Yes,57-0523959,26380MI0010001,Group Pediatric Dental EHB Rider,26380MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$28.60,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,26380MI0010001-00,Standard High Off Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,26380,SERFF,1,2014-08-08 13:45:50,1,26380,MI,SHOP (Small Group),Yes,57-0523959,26380MI0010002,Group Pediatric Dental EHB Rider,26380MI001,,MIN001,MIS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$23.06,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,26380MI0010002-00,Standard Low Off Exchange Plan,68.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0420001,Blue Dental PPO Plus 100/80/50 SG,15560MI042,7538162760,MIN004,MIS004,,Existing,PPO,High,,Off the Exchange,,,,"$1,500 annual benefit maximum for members age 19 or older when coverage begins.",,,,,Allows Adult and Child-Only,,,,$25.76,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-plus-100-80-50-1500-sg.pdf,,15560MI0420001-00,Standard High Off Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,5,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0490001,Blue Dental PPO Plus 100/80/50 Voluntary SG,15560MI049,7538162760,MIN004,MIS004,,Existing,PPO,High,,Off the Exchange,,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,,,,Allows Adult and Child-Only,,,,$29.01,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-plus-100-80-50-v-sg.pdf,,15560MI0490001-00,Standard High Off Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,5,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0490002,Blue Dental?PPO Plus 80/50/50 Voluntary SG,15560MI049,7538162760,MIN004,MIS004,,Existing,PPO,Low,,Both,,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,,,,Allows Adult and Child-Only,,,,$21.63,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-plus-80-50-50-v-sg.pdf,,15560MI0490002-00,Standard Low Off Exchange Plan,70.28%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,5,15560,MI,Individual,No,38-2069753,15560MI0900001,Blue Cross? Metro Detroit EPO Bronze Extra,15560MI090,7538162760,MIN002,MIS002,MIF053,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0900001-01,Standard Bronze On Exchange Plan,62.00%,0.615190267562866,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$70,$150,"$3,970",$300,$20,$40,5
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,5,15560,MI,Individual,No,38-2069753,15560MI0900001,Blue Cross? Metro Detroit EPO Bronze Extra,15560MI090,7538162760,MIN002,MIS002,MIF053,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0900001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$40,6
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,5,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0490002,Blue Dental?PPO Plus 80/50/50 Voluntary SG,15560MI049,7538162760,MIN004,MIS004,,Existing,PPO,Low,,Both,,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,,,,Allows Adult and Child-Only,,,,$21.63,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-plus-80-50-50-v-sg.pdf,,15560MI0490002-01,Standard Low On Exchange Plan,70.28%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,5,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0660001,Blue Dental PPO 100/80/50 (80/50/50) Voluntary SG,15560MI066,7538162760,MIN004,MIS004,,Existing,PPO,High,,Off the Exchange,,,,"$1,250 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,,,,Allows Adult and Child-Only,,,,$23.65,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-100-80-50-80-50-50-1250-v-sg.pdf,,15560MI0660001-00,Standard High Off Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,$150,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,5,15560,MI,Individual,No,38-2069753,15560MI0900001,Blue Cross? Metro Detroit EPO Bronze Extra,15560MI090,7538162760,MIN002,MIS002,MIF053,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0900001-03,Limited Cost Sharing Plan Variation,62.00%,0.615190267562866,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$70,$150,"$3,970",$300,$20,$40,7
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0440001,Blue Dental PPO 100/80/50 (80/50/50) SG,15560MI044,7538162760,MIN004,MIS004,,Existing,PPO,High,,Off the Exchange,,,,"$1,250 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,,,,Allows Adult and Child-Only,,,,$21.06,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-10-80-50-80-50-50-sg.pdf,,15560MI0440001-00,Standard High Off Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,$150,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,Individual,No,38-2069753,15560MI0860001,Blue Cross? Premier Bronze Extra,15560MI086,7538162760,MIN003,MIS001,MIF053,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0860001-03,Limited Cost Sharing Plan Variation,62.00%,0.615190267562866,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$70,$150,"$3,970",$300,$20,$40,7
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,Individual,No,38-2069753,15560MI0860002,Blue Cross? Premier Silver Extra,15560MI086,7538162760,MIN003,MIS001,MIF053,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0860002-00,Standard Silver Off Exchange Plan,70.20%,0.704515039920807,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,$800,$150,"$2,000",$300,$440,$40,8
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0440002,Blue Dental PPO 100/80/50 (50/50/50) SG,15560MI044,7538162760,MIN004,MIS004,,Existing,PPO,High,,Off the Exchange,,,,"$1,500 annual benefit maximum for members age 19 or older when coverage begins.",,,,,Allows Adult and Child-Only,,,,$19.27,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-100-80-50-50-50-50-1500-sg.pdf,,15560MI0440002-00,Standard High Off Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,$150,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0440003,Blue Dental PPO 100/80/50 (50/50/50) SG,15560MI044,7538162760,MIN004,MIS004,,Existing,PPO,High,,Off the Exchange,,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,,,,Allows Adult and Child-Only,,,,$19.27,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-100-80-50-50-50-50-1000-sg.pdf,,15560MI0440003-00,Standard High Off Exchange Plan,84.51%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,$150,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,Individual,No,38-2069753,15560MI0860002,Blue Cross? Premier Silver Extra,15560MI086,7538162760,MIN003,MIS001,MIF053,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0860002-01,Standard Silver On Exchange Plan,70.20%,0.704515039920807,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,$800,$150,"$2,000",$300,$440,$40,9
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,Individual,No,38-2069753,15560MI0860002,Blue Cross? Premier Silver Extra,15560MI086,7538162760,MIN003,MIS001,MIF053,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0860002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$40,10
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0440004,Blue Dental PPO 80/50/50 (50/50/50) SG,15560MI044,7538162760,MIN004,MIS004,,Existing,PPO,Low,,Off the Exchange,,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,,,,Allows Adult and Child-Only,,,,$16.30,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-80-50-50-50-50-50-1000-sg.pdf,,15560MI0440004-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,$150,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0440005,Blue Dental PPO 80/50/50 (50/50/50) SG,15560MI044,7538162760,MIN004,MIS004,,Existing,PPO,Low,,Off the Exchange,,,,$800 annual benefit maximum for members age 19 or older when coverage begins.,,,,,Allows Adult and Child-Only,,,,$16.30,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-80-50-50-50-50-50-800-sg.pdf,,15560MI0440005-00,Standard Low Off Exchange Plan,70.29%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,$150,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,Individual,No,38-2069753,15560MI0860002,Blue Cross? Premier Silver Extra,15560MI086,7538162760,MIN003,MIS001,MIF053,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0860002-03,Limited Cost Sharing Plan Variation,70.20%,0.704515039920807,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,$800,$150,"$2,000",$300,$440,$40,11
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,Individual,No,38-2069753,15560MI0860002,Blue Cross? Premier Silver Extra,15560MI086,7538162760,MIN003,MIS001,MIF053,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0860002-04,73% AV Level Silver Plan,72.60%,0.732052087783813,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$0,$900,$150,"$1,500",$300,$560,$40,12
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0460001,Blue Dental EPO 100/80/50 SG,15560MI046,7538162760,MIN004,MIS003,,Existing,EPO,High,,Off the Exchange,,,,"$1,250 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists.",,,,,Allows Adult and Child-Only,,,,$18.60,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,No,,Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-epo-100-80-50-0-0-0-sg.pdf,,15560MI0460001-00,Standard High Off Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,$75,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,Individual,No,38-2069753,15560MI0860002,Blue Cross? Premier Silver Extra,15560MI086,7538162760,MIN003,MIS001,MIF053,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0860002-05,87% AV Level Silver Plan,86.40%,0.871445834636688,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$2,800","$5,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$600,10%,,,,$600,"$1,200",Not Applicable,Not Applicable,$300,$0,$570,$150,$300,$300,$460,$40,13
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,Individual,No,38-2069753,15560MI0860002,Blue Cross? Premier Silver Extra,15560MI086,7538162760,MIN003,MIS001,MIF053,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0860002-06,94% AV Level Silver Plan,93.00%,0.933878242969513,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,10%,,,,$300,$600,Not Applicable,Not Applicable,$150,$0,$590,$150,$150,$300,$50,$40,14
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,Individual,No,38-2069753,15560MI0860003,Blue Cross? Premier Gold Extra,15560MI086,7538162760,MIN003,MIS001,MIF053,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0860003-00,Standard Gold Off Exchange Plan,81.80%,0.825072824954987,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$0,"$1,100",$150,$500,$300,$880,$40,15
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,Individual,No,38-2069753,15560MI0860003,Blue Cross? Premier Gold Extra,15560MI086,7538162760,MIN003,MIS001,MIF053,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0860003-01,Standard Gold On Exchange Plan,81.80%,0.825072824954987,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$0,"$1,100",$150,$500,$300,$880,$40,16
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,Individual,No,38-2069753,15560MI0860003,Blue Cross? Premier Gold Extra,15560MI086,7538162760,MIN003,MIS001,MIF053,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0860003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$40,17
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,2,15560,MI,Individual,No,38-2069753,15560MI0860003,Blue Cross? Premier Gold Extra,15560MI086,7538162760,MIN003,MIS001,MIF053,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0860003-03,Limited Cost Sharing Plan Variation,81.80%,0.825072824954987,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$0,"$1,100",$150,$500,$300,$880,$40,18
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,3,15560,MI,Individual,No,38-2069753,15560MI0870001,Blue Cross? Premier Platinum Extra with Dental and Vision,15560MI087,7538162760,MIN003,MIS001,MIF053,New,PPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9205,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0870001-00,Standard Platinum Off Exchange Plan,89.20%,0.89925754070282,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,,,,$200,$400,Not Applicable,Not Applicable,$100,$0,$590,$150,$100,$300,$480,$40,4
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,3,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0480002,Blue Dental PPO Plus 80/50/50 Pediatric SG,15560MI048,7538162760,MIN004,MIS004,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.16,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-plus-80-50-50-pediatric-sg.pdf,,15560MI0480002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,3,15560,MI,Individual,No,38-2069753,15560MI0870001,Blue Cross? Premier Platinum Extra with Dental and Vision,15560MI087,7538162760,MIN003,MIS001,MIF053,New,PPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9205,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0870001-01,Standard Platinum On Exchange Plan,89.20%,0.89925754070282,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,,,,$200,$400,Not Applicable,Not Applicable,$100,$0,$590,$150,$100,$300,$480,$40,5
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,3,15560,MI,Individual,No,38-2069753,15560MI0870001,Blue Cross? Premier Platinum Extra with Dental and Vision,15560MI087,7538162760,MIN003,MIS001,MIF053,New,PPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9205,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0870001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$40,6
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,3,15560,MI,Individual,No,38-2069753,15560MI0870001,Blue Cross? Premier Platinum Extra with Dental and Vision,15560MI087,7538162760,MIN003,MIS001,MIF053,New,PPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9205,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,All covered benefits,Yes,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0870001-03,Limited Cost Sharing Plan Variation,89.20%,0.89925754070282,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,,,,$200,$400,Not Applicable,Not Applicable,$100,$0,$590,$150,$100,$300,$480,$40,7
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,4,15560,MI,Individual,No,38-2069753,15560MI0890001,Blue Cross? Metro Detroit EPO Bronze,15560MI089,7538162760,MIN002,MIS002,MIF051,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0890001-00,Standard Bronze Off Exchange Plan,59.40%,0.579830527305603,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,670",$500,$0,$150,"$5,260",$0,$0,$40,4
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,4,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0650001,Blue Dental PPO Plus 100/80/50/50 Voluntary SG,15560MI065,7538162760,MIN004,MIS004,,Existing,PPO,High,,Off the Exchange,,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,,,,Allows Adult and Child-Only,,,,$29.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-plus-100-80-50-50-v-sg.pdf,,15560MI0650001-00,Standard High Off Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,4,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0650002,Blue Dental PPO Plus 80/50/50/50 Voluntary SG,15560MI065,7538162760,MIN004,MIS004,,Existing,PPO,Low,,Off the Exchange,,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,,,,Allows Adult and Child-Only,,,,$22.57,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-plus-80-50-50-50-v-sg.pdf,,15560MI0650002-00,Standard Low Off Exchange Plan,70.28%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,4,15560,MI,Individual,No,38-2069753,15560MI0890001,Blue Cross? Metro Detroit EPO Bronze,15560MI089,7538162760,MIN002,MIS002,MIF051,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0890001-01,Standard Bronze On Exchange Plan,59.40%,0.579830527305603,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,670",$500,$0,$150,"$5,260",$0,$0,$40,5
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,4,15560,MI,Individual,No,38-2069753,15560MI0890001,Blue Cross? Metro Detroit EPO Bronze,15560MI089,7538162760,MIN002,MIS002,MIF051,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0890001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$40,6
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,4,15560,MI,SHOP (Small Group),No,38-2069753,15560MI0370015,Simply Blue Gold $1500,15560MI037,,MIN001,MIS001,MIF005,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pain Management",,1,,$300,0,0,0,2015-01-01,,Yes,Coverage provided through BlueCard Worldwide program,Yes,Out of service area coverage provided through BlueCard PPO program,Yes,http://www.bcbsm.com/employer/sbc/simply-blue-gold-370015,http://www.bcbsm.com/employers/help/faqs/choosing-coverage/employer-enrollment.html,http://www.bcbsm.com/employer-plan-brochures,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0370015-00,Standard Gold Off Exchange Plan,78.90%,0.743914902210236,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$730,$20,$150,"$1,500",$120,$680,$80,6
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,4,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0670001,Blue Dental PPO 100/80/50/50 (80/50/50/50) Voluntary SG,15560MI067,7538162760,MIN004,MIS004,,Existing,PPO,High,,Off the Exchange,,,,"$1,250 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.  $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,,,,Allows Adult and Child-Only,,,,$24.59,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-100-80-50-50-80-50-50-50-1250-v-sg.pdf,,15560MI0670001-00,Standard High Off Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,$150,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,4,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0670002,Blue Dental PPO 100/80/50/50 (80/50/50/50) Voluntary SG,15560MI067,7538162760,MIN004,MIS004,,Existing,PPO,High,,Off the Exchange,,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.  $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,,,,Allows Adult and Child-Only,,,,$24.59,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-100-80-50-50-80-50-50-50-1000-v-sg.pdf,,15560MI0670002-00,Standard High Off Exchange Plan,84.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,$150,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,4,15560,MI,SHOP (Small Group),No,38-2069753,15560MI0370015,Simply Blue Gold $1500,15560MI037,,MIN001,MIS001,MIF005,New,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pain Management",,1,,$300,0,0,0,2015-01-01,,Yes,Coverage provided through BlueCard Worldwide program,Yes,Out of service area coverage provided through BlueCard PPO program,Yes,http://www.bcbsm.com/employer/sbc/simply-blue-gold-370015,http://www.bcbsm.com/employers/help/faqs/choosing-coverage/employer-enrollment.html,http://www.bcbsm.com/employer-plan-brochures,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0370015-01,Standard Gold On Exchange Plan,78.90%,0.743914902210236,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$730,$20,$150,"$1,500",$120,$680,$80,7
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,4,15560,MI,Individual,No,38-2069753,15560MI0890001,Blue Cross? Metro Detroit EPO Bronze,15560MI089,7538162760,MIN002,MIS002,MIF051,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0890001-03,Limited Cost Sharing Plan Variation,59.40%,0.579830527305603,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,670",$500,$0,$150,"$5,260",$0,$0,$40,7
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,4,15560,MI,Individual,No,38-2069753,15560MI0890002,Blue Cross? Metro Detroit EPO Silver,15560MI089,7538162760,MIN002,MIS002,MIF052,New,EPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0890002-00,Standard Silver Off Exchange Plan,68.90%,0.699648082256317,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400",$500,$850,$150,"$1,400",$90,$725,$40,8
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,5,15560,MI,SHOP (Small Group),Yes,38-2069753,15560MI0660003,Blue Dental PPO 80/50/50 (50/50/50) Voluntary SG,15560MI066,7538162760,MIN004,MIS004,,Existing,PPO,Low,,Off the Exchange,,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,,,,Allows Adult and Child-Only,,,,$18.77,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency,Yes,"Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues? approved amount as full payment for covered services, less your plan?s deductible or any copay.",Yes,,,http://www.bcbsm.com/content/dam/public/brochures/2015/blue-dental-ppo-80-50-50-50-50-50-v-sg.pdf,,15560MI0660003-00,Standard Low Off Exchange Plan,70.29%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,$150,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270061,MyPriority PPO RxPlus Silver 1900,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29241MI0270065,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/1E080C6BE5644091B355AF193DAFB96E.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_SilverHigh&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270061-00,Standard Silver Off Exchange Plan,,0.697726964950562,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,"$1,900","$3,800",30%,,,,"$3,800","$7,600",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$20,$980,$150,"$1,900",$300,$590,$80,4
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270061,MyPriority PPO RxPlus Silver 1900,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29241MI0270065,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/1E080C6BE5644091B355AF193DAFB96E.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_SilverHigh&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270061-01,Standard Silver On Exchange Plan,,0.697726964950562,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,"$1,900","$3,800",30%,,,,"$3,800","$7,600",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$20,$980,$150,"$1,900",$300,$590,$80,5
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270061,MyPriority PPO RxPlus Silver 1900,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29241MI0270065,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/1E080C6BE5644091B355AF193DAFB96E.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_SilverHigh&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270061-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270061,MyPriority PPO RxPlus Silver 1900,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29241MI0270065,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/1E080C6BE5644091B355AF193DAFB96E.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_SilverHigh&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270061-03,Limited Cost Sharing Plan Variation,,0.697726964950562,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,"$1,900","$3,800",30%,,,,"$3,800","$7,600",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$20,$980,$150,"$1,900",$300,$590,$80,7
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270061,MyPriority PPO RxPlus Silver 1900,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29241MI0270065,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/1E080C6BE5644091B355AF193DAFB96E.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_SilverHigh&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270061-04,73% AV Level Silver Plan,,0.736609518527985,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$1,200","$2,400",30%,,,,"$2,400","$4,800",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,200",$20,"$1,190",$150,"$1,200",$360,$680,$80,8
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,5,15560,MI,Individual,No,38-2069753,15560MI0900003,Blue Cross? Metro Detroit EPO Gold Extra,15560MI090,7538162760,MIN002,MIS002,MIF053,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0900003-01,Standard Gold On Exchange Plan,81.80%,0.825072824954987,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,"$1,100",$150,$500,$300,$880,$40,16
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,5,15560,MI,Individual,No,38-2069753,15560MI0900003,Blue Cross? Metro Detroit EPO Gold Extra,15560MI090,7538162760,MIN002,MIS002,MIF053,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0900003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$40,17
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,5,15560,MI,Individual,No,38-2069753,15560MI0900003,Blue Cross? Metro Detroit EPO Gold Extra,15560MI090,7538162760,MIN002,MIS002,MIF053,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency only,Yes,Emergency only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/cmsinbound.do,http://www.bcbsm.com/plan-details,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0900003-03,Limited Cost Sharing Plan Variation,81.80%,0.825072824954987,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,"$1,100",$150,$500,$300,$880,$40,18
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270063,MyPriority PPO RxPlus Gold 125,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/64FDA796E253492AAAE87951F5F86AD0.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_Gold125&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270063-01,Standard Gold On Exchange Plan,,0.817108690738678,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$125,$250,20%,,,,$250,$500,Not Applicable,Not Applicable,$125,$20,"$1,010",$150,$125,$980,$230,$80,12
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270063,MyPriority PPO RxPlus Gold 125,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/64FDA796E253492AAAE87951F5F86AD0.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_Gold125&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270063-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,13
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270063,MyPriority PPO RxPlus Gold 125,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/64FDA796E253492AAAE87951F5F86AD0.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_Gold125&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270063-03,Limited Cost Sharing Plan Variation,,0.817108690738678,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$125,$250,20%,,,,$250,$500,Not Applicable,Not Applicable,$125,$20,"$1,010",$150,$125,$980,$230,$80,14
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270064,MyPriority PPO RxPlus Bronze 3975,29241MI027,,MIN001,MIS001,MIF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/870A972E78074C3F966EC6DB71B8EFDF.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270064-00,Standard Bronze Off Exchange Plan,,0.617907404899597,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,975","$7,950",40%,,,,"$7,950","$15,900",Not Applicable,Not Applicable,"$3,975",$20,$480,$150,"$3,975",$260,$200,$80,15
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270064,MyPriority PPO RxPlus Bronze 3975,29241MI027,,MIN001,MIS001,MIF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/870A972E78074C3F966EC6DB71B8EFDF.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270064-01,Standard Bronze On Exchange Plan,,0.617907404899597,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,975","$7,950",40%,,,,"$7,950","$15,900",Not Applicable,Not Applicable,"$3,975",$20,$480,$150,"$3,975",$260,$200,$80,16
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,10,15560,MI,SHOP (Small Group),No,38-2069753,15560MI0390003,Simply Blue HSA Silver $2000 ($0),15560MI039,7538162760,MIN001,MIS001,MIF017,Existing,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pain Management",,1,,$300,0,0,0,2015-01-01,,Yes,Coverage provided through BlueCard Worldwide program,Yes,Out of service area coverage provided through BlueCard PPO program,Yes,http://www.bcbsm.com/employer/sbc/simply-blue-hsa-silver-390003,http://www.bcbsm.com/employers/help/faqs/choosing-coverage/employer-enrollment.html,http://www.bcbsm.com/employer-plan-brochures,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0390003-00,Standard Silver Off Exchange Plan,68.70%,0.68443089723587,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$630,$20,$150,"$2,000",$260,$440,$80,6
2015,MI,15560,SERFF,10,2015-05-22 14:18:43,10,15560,MI,SHOP (Small Group),No,38-2069753,15560MI0390003,Simply Blue HSA Silver $2000 ($0),15560MI039,7538162760,MIN001,MIS001,MIF017,Existing,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pain Management",,1,,$300,0,0,0,2015-01-01,,Yes,Coverage provided through BlueCard Worldwide program,Yes,Out of service area coverage provided through BlueCard PPO program,Yes,http://www.bcbsm.com/employer/sbc/simply-blue-hsa-silver-390003,http://www.bcbsm.com/employers/help/faqs/choosing-coverage/employer-enrollment.html,http://www.bcbsm.com/employer-plan-brochures,http://www.bcbsm.com/custom-select-formulary-drug-list-ppo,15560MI0390003-01,Standard Silver On Exchange Plan,68.70%,0.68443089723587,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$630,$20,$150,"$2,000",$260,$440,$80,7
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270064,MyPriority PPO RxPlus Bronze 3975,29241MI027,,MIN001,MIS001,MIF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/870A972E78074C3F966EC6DB71B8EFDF.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270064-03,Limited Cost Sharing Plan Variation,,0.617907404899597,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,975","$7,950",40%,,,,"$7,950","$15,900",Not Applicable,Not Applicable,"$3,975",$20,$480,$150,"$3,975",$260,$200,$80,18
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270065,MyPriority PPO RxPlus Silver 1800,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/ACD29906F9FC4F64B9513D847A701A26.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270065-00,Standard Silver Off Exchange Plan,,0.683217763900757,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,"$3,600","$7,200",Not Applicable,Not Applicable,"$1,800",$20,"$1,010",$150,"$1,800",$310,$590,$80,19
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270065,MyPriority PPO RxPlus Silver 1800,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/ACD29906F9FC4F64B9513D847A701A26.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270065-01,Standard Silver On Exchange Plan,,0.683217763900757,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,"$3,600","$7,200",Not Applicable,Not Applicable,"$1,800",$20,"$1,010",$150,"$1,800",$310,$590,$80,20
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270065,MyPriority PPO RxPlus Silver 1800,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/ACD29906F9FC4F64B9513D847A701A26.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270065-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,$0,$0,$150,$0,$0,$0,$80,21
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270065,MyPriority PPO RxPlus Silver 1800,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/ACD29906F9FC4F64B9513D847A701A26.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270065-03,Limited Cost Sharing Plan Variation,,0.683217763900757,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,"$3,600","$7,200",Not Applicable,Not Applicable,"$1,800",$20,"$1,010",$150,"$1,800",$310,$590,$80,22
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,1,20393,MI,Individual,No,38-3252216,20393MI0040001,McLaren Rewards Platinum,20393MI004,,MIN001,MIS001,MIF001,Existing,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.mclarenhealthplan.org,www.mclarenhealthplan.org,www.mclarenhealthplan.org,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0040001-00,Standard Platinum Off Exchange Plan,,0.896160066127777,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,250","$2,500","$1,250","$2,500",Not Applicable,Not Applicable,"$1,250","$2,500",$500,"$1,000",10%,$500,"$1,000",10%,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,1,20393,MI,SHOP (Small Group),No,38-3252216,20393MI0010001,McLaren Rewards Platinum,20393MI001,,MIN001,MIS001,MIF001,Existing,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.McLarenHealthPlan.com,www.McLarenHealthPlan.com,www.McLarenHealthPlan.com,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0010001-00,Standard Platinum Off Exchange Plan,,0.896160066127777,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,250","$2,500","$1,250","$2,500",Not Applicable,Not Applicable,"$1,250","$2,500",$500,"$1,000",10%,$500,"$1,000",10%,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,1,20393,MI,SHOP (Small Group),No,38-3252216,20393MI0010001,McLaren Rewards Platinum,20393MI001,,MIN001,MIS001,MIF001,Existing,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.McLarenHealthPlan.com,www.McLarenHealthPlan.com,www.McLarenHealthPlan.com,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0010001-01,Standard Platinum On Exchange Plan,,0.896160066127777,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,250","$2,500","$1,250","$2,500",Not Applicable,Not Applicable,"$1,250","$2,500",$500,"$1,000",10%,$500,"$1,000",10%,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,1,20393,MI,Individual,No,38-3252216,20393MI0040001,McLaren Rewards Platinum,20393MI004,,MIN001,MIS001,MIF001,Existing,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.mclarenhealthplan.org,www.mclarenhealthplan.org,www.mclarenhealthplan.org,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0040001-01,Standard Platinum On Exchange Plan,,0.896160066127777,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,250","$2,500","$1,250","$2,500",Not Applicable,Not Applicable,"$1,250","$2,500",$500,"$1,000",10%,$500,"$1,000",10%,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,1,20393,MI,Individual,No,38-3252216,20393MI0040001,McLaren Rewards Platinum,20393MI004,,MIN001,MIS001,MIF001,Existing,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.mclarenhealthplan.org,www.mclarenhealthplan.org,www.mclarenhealthplan.org,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0040001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,1,20393,MI,SHOP (Small Group),No,38-3252216,20393MI0010002,McLaren Rewards Gold,20393MI001,,MIN001,MIS001,MIF001,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.McLarenHealthPlan.com,www.McLarenHealthPlan.com,www.McLarenHealthPlan.com,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0010002-00,Standard Gold Off Exchange Plan,,0.816014766693115,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$4,250","$8,500",Not Applicable,Not Applicable,"$4,250","$8,500","$1,000","$2,000",25%,"$1,000","$2,000",25%,Not Applicable,Not Applicable,"$1,000","$2,000",$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,1,20393,MI,SHOP (Small Group),No,38-3252216,20393MI0010002,McLaren Rewards Gold,20393MI001,,MIN001,MIS001,MIF001,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.McLarenHealthPlan.com,www.McLarenHealthPlan.com,www.McLarenHealthPlan.com,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0010002-01,Standard Gold On Exchange Plan,,0.816014766693115,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$4,250","$8,500",Not Applicable,Not Applicable,"$4,250","$8,500","$1,000","$2,000",25%,"$1,000","$2,000",25%,Not Applicable,Not Applicable,"$1,000","$2,000",$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,1,20393,MI,Individual,No,38-3252216,20393MI0040001,McLaren Rewards Platinum,20393MI004,,MIN001,MIS001,MIF001,Existing,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.mclarenhealthplan.org,www.mclarenhealthplan.org,www.mclarenhealthplan.org,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0040001-03,Limited Cost Sharing Plan Variation,,0.896160066127777,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,250","$2,500","$1,250","$2,500",Not Applicable,Not Applicable,"$1,250","$2,500",$500,"$1,000",10%,$500,"$1,000",10%,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,1,20393,MI,Individual,No,38-3252216,20393MI0040002,McLaren Rewards Gold,20393MI004,,MIN001,MIS001,MIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.mclarenhealthplan.org,www.mclarenhealthplan.org,www.mclarenhealthplan.org,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0040002-00,Standard Gold Off Exchange Plan,,0.816014766693115,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$4,250","$8,500",Not Applicable,Not Applicable,"$4,250","$8,500","$1,000","$2,000",25%,"$1,000","$2,000",25%,Not Applicable,Not Applicable,"$1,000","$2,000",$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,1,20393,MI,SHOP (Small Group),No,38-3252216,20393MI0010003,McLaren Rewards Silver,20393MI001,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.McLarenHealthPlan.com,www.McLarenHealthPlan.com,www.McLarenHealthPlan.com,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0010003-00,Standard Silver Off Exchange Plan,,0.715289354324341,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",40%,"$2,000","$4,000",40%,Not Applicable,Not Applicable,"$2,000","$4,000",$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,1,20393,MI,SHOP (Small Group),No,38-3252216,20393MI0010003,McLaren Rewards Silver,20393MI001,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.McLarenHealthPlan.com,www.McLarenHealthPlan.com,www.McLarenHealthPlan.com,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0010003-01,Standard Silver On Exchange Plan,,0.715289354324341,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",40%,"$2,000","$4,000",40%,Not Applicable,Not Applicable,"$2,000","$4,000",$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,1,20393,MI,Individual,No,38-3252216,20393MI0040002,McLaren Rewards Gold,20393MI004,,MIN001,MIS001,MIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.mclarenhealthplan.org,www.mclarenhealthplan.org,www.mclarenhealthplan.org,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0040002-01,Standard Gold On Exchange Plan,,0.816014766693115,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$4,250","$8,500",Not Applicable,Not Applicable,"$4,250","$8,500","$1,000","$2,000",25%,"$1,000","$2,000",25%,Not Applicable,Not Applicable,"$1,000","$2,000",$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,1,20393,MI,Individual,No,38-3252216,20393MI0040002,McLaren Rewards Gold,20393MI004,,MIN001,MIS001,MIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.mclarenhealthplan.org,www.mclarenhealthplan.org,www.mclarenhealthplan.org,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0040002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,1,20393,MI,Individual,No,38-3252216,20393MI0040002,McLaren Rewards Gold,20393MI004,,MIN001,MIS001,MIF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.mclarenhealthplan.org,www.mclarenhealthplan.org,www.mclarenhealthplan.org,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0040002-03,Limited Cost Sharing Plan Variation,,0.816014766693115,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$4,250","$8,500",Not Applicable,Not Applicable,"$4,250","$8,500","$1,000","$2,000",25%,"$1,000","$2,000",25%,Not Applicable,Not Applicable,"$1,000","$2,000",$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,1,20393,MI,Individual,No,38-3252216,20393MI0040003,McLaren Rewards Silver,20393MI004,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.mclarenhealthplan.org,www.mclarenhealthplan.org,www.mclarenhealthplan.org,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0040003-00,Standard Silver Off Exchange Plan,,0.715289354324341,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",40%,"$2,000","$4,000",40%,Not Applicable,Not Applicable,"$2,000","$4,000",$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,1,20393,MI,Individual,No,38-3252216,20393MI0040003,McLaren Rewards Silver,20393MI004,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.mclarenhealthplan.org,www.mclarenhealthplan.org,www.mclarenhealthplan.org,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0040003-01,Standard Silver On Exchange Plan,,0.715289354324341,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",40%,"$2,000","$4,000",40%,Not Applicable,Not Applicable,"$2,000","$4,000",$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,1,20393,MI,Individual,No,38-3252216,20393MI0040003,McLaren Rewards Silver,20393MI004,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.mclarenhealthplan.org,www.mclarenhealthplan.org,www.mclarenhealthplan.org,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0040003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,1,20393,MI,Individual,No,38-3252216,20393MI0040003,McLaren Rewards Silver,20393MI004,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.mclarenhealthplan.org,www.mclarenhealthplan.org,www.mclarenhealthplan.org,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0040003-03,Limited Cost Sharing Plan Variation,,0.715289354324341,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",40%,"$2,000","$4,000",40%,Not Applicable,Not Applicable,"$2,000","$4,000",$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,1,20393,MI,Individual,No,38-3252216,20393MI0040003,McLaren Rewards Silver,20393MI004,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.mclarenhealthplan.org,www.mclarenhealthplan.org,www.mclarenhealthplan.org,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0040003-04,73% AV Level Silver Plan,,0.739921569824219,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,"$5,200","$10,400","$1,500","$3,000",40%,"$1,500","$3,000",40%,Not Applicable,Not Applicable,"$1,500","$3,000",$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,1,20393,MI,Individual,No,38-3252216,20393MI0040003,McLaren Rewards Silver,20393MI004,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.mclarenhealthplan.org,www.mclarenhealthplan.org,www.mclarenhealthplan.org,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0040003-05,87% AV Level Silver Plan,,0.860386669635773,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000",Not Applicable,Not Applicable,"$2,000","$4,000",$500,"$1,000",20%,$500,"$1,000",20%,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,1,20393,MI,Individual,No,38-3252216,20393MI0040003,McLaren Rewards Silver,20393MI004,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.mclarenhealthplan.org,www.mclarenhealthplan.org,www.mclarenhealthplan.org,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0040003-06,94% AV Level Silver Plan,,0.931192696094513,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$800,"$1,600",$800,"$1,600",Not Applicable,Not Applicable,$800,"$1,600",$0,$0,10%,$0,$0,10%,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,2,20393,MI,Individual,No,38-3252216,20393MI0040011,McLaren Bronze,20393MI004,,MIN001,MIS001,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.mclarenhealthplan.org,www.mclarenhealthplan.org,www.mclarenhealthplan.org,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0040011-00,Standard Bronze Off Exchange Plan,,0.600874364376068,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$5,000","$10,000",50%,,,,Not Applicable,Not Applicable,"$5,000","$10,000",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,2,20393,MI,Individual,No,38-3252216,20393MI0040011,McLaren Bronze,20393MI004,,MIN001,MIS001,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.mclarenhealthplan.org,www.mclarenhealthplan.org,www.mclarenhealthplan.org,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0040011-01,Standard Bronze On Exchange Plan,,0.600874364376068,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$5,000","$10,000",50%,,,,Not Applicable,Not Applicable,"$5,000","$10,000",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,MI,20393,SERFF,5,2015-01-21 12:15:34,2,20393,MI,Individual,No,38-3252216,20393MI0040011,McLaren Bronze,20393MI004,,MIN001,MIS001,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,www.mclarenhealthplan.org,www.mclarenhealthplan.org,www.mclarenhealthplan.org,http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx,20393MI0040011-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MI,27093,SERFF,1,2014-08-09 13:12:30,1,27093,MI,SHOP (Small Group),Yes,44-0308260,27093MI0010001,KCL EHB Low PPO,27093MI001,,MIN001,MIS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$44.64,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,27093MI0010001-00,Standard Low Off Exchange Plan,69.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,27093,SERFF,1,2014-08-09 13:12:30,1,27093,MI,SHOP (Small Group),Yes,44-0308260,27093MI0010003,KCL EHB Low MAC,27093MI001,,MIN001,MIS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$33.28,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,27093MI0010003-00,Standard Low Off Exchange Plan,69.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,27093,SERFF,1,2014-08-09 13:12:30,1,27093,MI,SHOP (Small Group),Yes,44-0308260,27093MI0010005,KCL Fam Low PPO,27093MI001,,MIN001,MIS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$44.64,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,27093MI0010005-00,Standard Low Off Exchange Plan,69.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,27093,SERFF,1,2014-08-09 13:12:30,1,27093,MI,SHOP (Small Group),Yes,44-0308260,27093MI0010007,KCL Fam Low MAC,27093MI001,,MIN001,MIS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$33.28,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,27093MI0010007-00,Standard Low Off Exchange Plan,69.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,3,29241,MI,Individual,No,20-1529553,29241MI0270069,MyPriority PPO HSA Gold 1300,29241MI027,,MIN001,MIS001,MIF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/75AD58C971444F2E85BD7339D3F2E1B3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270069-01,Standard Gold On Exchange Plan,,0.791826367378235,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,"$1,300",$0,$700,$150,"$1,300",$380,$320,$80,16
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,3,29241,MI,Individual,No,20-1529553,29241MI0270069,MyPriority PPO HSA Gold 1300,29241MI027,,MIN001,MIS001,MIF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/75AD58C971444F2E85BD7339D3F2E1B3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270069-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,17
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,3,29241,MI,Individual,No,20-1529553,29241MI0270069,MyPriority PPO HSA Gold 1300,29241MI027,,MIN001,MIS001,MIF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/75AD58C971444F2E85BD7339D3F2E1B3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270069-03,Limited Cost Sharing Plan Variation,,0.791826367378235,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,"$1,300",$0,$700,$150,"$1,300",$380,$320,$80,18
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540001,MyPriority HMO RxPlus Silver 1900,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0540005,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/EC7FFE7FA5D240E29F1652FE951D8E70.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_SilverHigh&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540001-00,Standard Silver Off Exchange Plan,,0.697726964950562,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900","$3,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$20,$980,$150,"$1,900",$300,$590,$80,4
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540001,MyPriority HMO RxPlus Silver 1900,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0540005,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/EC7FFE7FA5D240E29F1652FE951D8E70.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_SilverHigh&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540001-01,Standard Silver On Exchange Plan,,0.697726964950562,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900","$3,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$20,$980,$150,"$1,900",$300,$590,$80,5
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0550002,PriorityHMO 250 90,29698MI055,,MIN001,MIS001,MIF001,Existing,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,$200,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Urgent/Emergency Care; Out of area dependent coverage,No,http://www.priorityhealth.com/~/media/70E452C4B6F8473282A020D6CAE6347B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=57BAF1F0D422440FA708DDF5FDDADF48&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0550002-00,Standard Platinum Off Exchange Plan,,0.884185135364532,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$250,$20,$490,$150,$250,$650,$530,$80,5
2015,MI,27093,SERFF,1,2014-08-09 13:12:30,2,27093,MI,SHOP (Small Group),Yes,44-0308260,27093MI0010002,KCL EHB High PPO,27093MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$55.39,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,27093MI0010002-00,Standard High Off Exchange Plan,86.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,27093,SERFF,1,2014-08-09 13:12:30,2,27093,MI,SHOP (Small Group),Yes,44-0308260,27093MI0010004,KCL EHB High MAC,27093MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$42.80,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,27093MI0010004-00,Standard High Off Exchange Plan,86.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,27093,SERFF,1,2014-08-09 13:12:30,2,27093,MI,SHOP (Small Group),Yes,44-0308260,27093MI0010006,KCL Fam High PPO,27093MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$55.39,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,27093MI0010006-00,Standard High Off Exchange Plan,86.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,27093,SERFF,1,2014-08-09 13:12:30,2,27093,MI,SHOP (Small Group),Yes,44-0308260,27093MI0010008,KCL Fam High MAC,27093MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$42.80,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,27093MI0010008-00,Standard High Off Exchange Plan,86.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270061,MyPriority PPO RxPlus Silver 1900,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29241MI0270065,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/1E080C6BE5644091B355AF193DAFB96E.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_SilverHigh&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270061-05,87% AV Level Silver Plan,,0.878771841526031,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$150,$300,30%,,,,$300,$600,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$1,350",$150,$150,$400,$910,$80,9
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270061,MyPriority PPO RxPlus Silver 1900,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29241MI0270065,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/1E080C6BE5644091B355AF193DAFB96E.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_SilverHigh&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270061-06,94% AV Level Silver Plan,,0.948064506053925,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$450,$900,,,$900,"$1,800",Not Applicable,Not Applicable,$25,$50,30%,,,,$50,$100,Not Applicable,Not Applicable,$50,$100,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$25,$0,$425,$150,$25,$70,$355,$80,10
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270063,MyPriority PPO RxPlus Gold 125,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/64FDA796E253492AAAE87951F5F86AD0.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_Gold125&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270063-00,Standard Gold Off Exchange Plan,,0.817108690738678,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$125,$250,20%,,,,$250,$500,Not Applicable,Not Applicable,$125,$20,"$1,010",$150,$125,$980,$230,$80,11
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270064,MyPriority PPO RxPlus Bronze 3975,29241MI027,,MIN001,MIS001,MIF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/870A972E78074C3F966EC6DB71B8EFDF.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270064-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,17
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270065,MyPriority PPO RxPlus Silver 1800,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/ACD29906F9FC4F64B9513D847A701A26.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270065-04,73% AV Level Silver Plan,,0.738309621810913,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$900,"$1,800",30%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,$900,$20,"$1,280",$150,$900,$360,$770,$80,23
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270065,MyPriority PPO RxPlus Silver 1800,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/ACD29906F9FC4F64B9513D847A701A26.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270065-05,87% AV Level Silver Plan,,0.877067565917969,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,30%,,,,$100,$200,Not Applicable,Not Applicable,$50,$0,"$1,450",$150,$50,$400,$960,$80,24
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270065,MyPriority PPO RxPlus Silver 1800,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/ACD29906F9FC4F64B9513D847A701A26.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270065-06,94% AV Level Silver Plan,,0.947485625743866,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$450,$900,,,$900,"$1,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$25,$50,30%,,,,$50,$100,Not Applicable,Not Applicable,$25,$0,$375,$150,$25,$80,$295,$80,25
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270066,MyPriority PPO RxPlus Silver 1000,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/C3EE532765B4416DA9D7C8DBEC5FD2A4.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270066-00,Standard Silver Off Exchange Plan,,0.717527210712433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$400,$610,$80,26
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270066,MyPriority PPO RxPlus Silver 1000,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/C3EE532765B4416DA9D7C8DBEC5FD2A4.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270066-01,Standard Silver On Exchange Plan,,0.717527210712433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$400,$610,$80,27
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270066,MyPriority PPO RxPlus Silver 1000,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/C3EE532765B4416DA9D7C8DBEC5FD2A4.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270066-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,$0,$0,$150,$0,$0,$0,$80,28
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270066,MyPriority PPO RxPlus Silver 1000,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/C3EE532765B4416DA9D7C8DBEC5FD2A4.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270066-03,Limited Cost Sharing Plan Variation,,0.717527210712433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$400,$610,$80,29
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270066,MyPriority PPO RxPlus Silver 1000,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/C3EE532765B4416DA9D7C8DBEC5FD2A4.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270066-04,73% AV Level Silver Plan,,0.738309621810913,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$900,"$1,800",30%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,$900,$20,"$1,280",$150,$900,$400,$660,$80,30
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270066,MyPriority PPO RxPlus Silver 1000,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/C3EE532765B4416DA9D7C8DBEC5FD2A4.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270066-05,87% AV Level Silver Plan,,0.877067565917969,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,30%,,,,$100,$200,Not Applicable,Not Applicable,$50,$0,"$1,450",$150,$50,$400,$960,$80,31
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,1,29241,MI,Individual,No,20-1529553,29241MI0270066,MyPriority PPO RxPlus Silver 1000,29241MI027,,MIN001,MIS001,MIF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/C3EE532765B4416DA9D7C8DBEC5FD2A4.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270066-06,94% AV Level Silver Plan,,0.947485625743866,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$450,$900,,,$900,"$1,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$25,$50,30%,,,,$50,$100,Not Applicable,Not Applicable,$25,$0,$375,$150,$25,$80,$295,$80,32
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,2,29241,MI,Individual,No,20-1529553,29241MI0270062,MyPriority PPO Plus Gold 400,29241MI027,,MIN001,MIS001,MIF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/550B98B1867D4B339DAFB295A7DADA2F.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270062-00,Standard Gold Off Exchange Plan,,0.780824363231659,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,$400,$800,20%,,,,$800,"$1,600",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$400,$20,$950,$150,$400,$780,$750,$80,4
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,2,29241,MI,Individual,No,20-1529553,29241MI0270062,MyPriority PPO Plus Gold 400,29241MI027,,MIN001,MIS001,MIF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/550B98B1867D4B339DAFB295A7DADA2F.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270062-01,Standard Gold On Exchange Plan,,0.780824363231659,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,$400,$800,20%,,,,$800,"$1,600",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$400,$20,$950,$150,$400,$780,$750,$80,5
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,2,29241,MI,Individual,No,20-1529553,29241MI0270062,MyPriority PPO Plus Gold 400,29241MI027,,MIN001,MIS001,MIF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/550B98B1867D4B339DAFB295A7DADA2F.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270062-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,2,29241,MI,Individual,No,20-1529553,29241MI0270062,MyPriority PPO Plus Gold 400,29241MI027,,MIN001,MIS001,MIF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/550B98B1867D4B339DAFB295A7DADA2F.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_Rxplus_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270062-03,Limited Cost Sharing Plan Variation,,0.780824363231659,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,$400,$800,20%,,,,$800,"$1,600",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$400,$20,$950,$150,$400,$780,$750,$80,7
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,3,29241,MI,Individual,No,20-1529553,29241MI0270067,MyPriority PPO HSA Bronze 6300,29241MI027,,MIN001,MIS001,MIF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/0902716184644B9DB0503F7F577A9B77.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270067-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,400",$0,$0,$80,4
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,3,29241,MI,Individual,No,20-1529553,29241MI0270067,MyPriority PPO HSA Bronze 6300,29241MI027,,MIN001,MIS001,MIF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/0902716184644B9DB0503F7F577A9B77.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270067-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,400",$0,$0,$80,5
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,3,29241,MI,Individual,No,20-1529553,29241MI0270067,MyPriority PPO HSA Bronze 6300,29241MI027,,MIN001,MIS001,MIF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/0902716184644B9DB0503F7F577A9B77.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270067-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,3,29241,MI,Individual,No,20-1529553,29241MI0270067,MyPriority PPO HSA Bronze 6300,29241MI027,,MIN001,MIS001,MIF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/0902716184644B9DB0503F7F577A9B77.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270067-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,400",$0,$0,$80,7
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,3,29241,MI,Individual,No,20-1529553,29241MI0270068,MyPriority PPO HSA Silver 1500,29241MI027,,MIN001,MIS001,MIF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/1CD69C42FC934FF4B6B9C1D91D859C2F.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270068-00,Standard Silver Off Exchange Plan,,0.681715130805969,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"$10,200","$20,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,100",$150,"$1,500",$660,$650,$80,8
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,3,29241,MI,Individual,No,20-1529553,29241MI0270068,MyPriority PPO HSA Silver 1500,29241MI027,,MIN001,MIS001,MIF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/1CD69C42FC934FF4B6B9C1D91D859C2F.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270068-01,Standard Silver On Exchange Plan,,0.681715130805969,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"$10,200","$20,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,100",$150,"$1,500",$660,$650,$80,9
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,3,29241,MI,Individual,No,20-1529553,29241MI0270068,MyPriority PPO HSA Silver 1500,29241MI027,,MIN001,MIS001,MIF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/1CD69C42FC934FF4B6B9C1D91D859C2F.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270068-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,3,29241,MI,Individual,No,20-1529553,29241MI0270068,MyPriority PPO HSA Silver 1500,29241MI027,,MIN001,MIS001,MIF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/1CD69C42FC934FF4B6B9C1D91D859C2F.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270068-03,Limited Cost Sharing Plan Variation,,0.681715130805969,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"$10,200","$20,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,100",$150,"$1,500",$660,$650,$80,11
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,3,29241,MI,Individual,No,20-1529553,29241MI0270068,MyPriority PPO HSA Silver 1500,29241MI027,,MIN001,MIS001,MIF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/1CD69C42FC934FF4B6B9C1D91D859C2F.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270068-04,73% AV Level Silver Plan,,0.739735305309296,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",30%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$750,$20,"$1,330",$150,$750,$720,$820,$80,12
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,3,29241,MI,Individual,No,20-1529553,29241MI0270068,MyPriority PPO HSA Silver 1500,29241MI027,,MIN001,MIS001,MIF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/1CD69C42FC934FF4B6B9C1D91D859C2F.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270068-05,87% AV Level Silver Plan,,0.877512097358704,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,30%,,,,$100,$200,Not Applicable,Not Applicable,$50,$0,"$1,200",$150,$50,$500,$700,$80,13
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,3,29241,MI,Individual,No,20-1529553,29241MI0270068,MyPriority PPO HSA Silver 1500,29241MI027,,MIN001,MIS001,MIF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/1CD69C42FC934FF4B6B9C1D91D859C2F.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270068-06,94% AV Level Silver Plan,,0.945953547954559,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,$800,"$1,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$25,$50,30%,,,,$50,$100,Not Applicable,Not Applicable,$25,$0,$375,$150,$25,$80,$295,$80,14
2015,MI,29241,SERFF,4,2014-11-15 10:06:04,3,29241,MI,Individual,No,20-1529553,29241MI0270069,MyPriority PPO HSA Gold 1300,29241MI027,,MIN001,MIS001,MIF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Out of Network Benefit Level,No,http://www.priorityhealth.com/~/media/75AD58C971444F2E85BD7339D3F2E1B3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/ppo-plans/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29241MI0270069-00,Standard Gold Off Exchange Plan,,0.791826367378235,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,"$1,300",$0,$700,$150,"$1,300",$380,$320,$80,15
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0550002,PriorityHMO 250 90,29698MI055,,MIN001,MIS001,MIF001,Existing,HMO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,$200,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Urgent/Emergency Care; Out of area dependent coverage,No,http://www.priorityhealth.com/~/media/70E452C4B6F8473282A020D6CAE6347B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=57BAF1F0D422440FA708DDF5FDDADF48&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0550002-01,Standard Platinum On Exchange Plan,,0.884185135364532,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$250,$20,$490,$150,$250,$650,$530,$80,6
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540001,MyPriority HMO RxPlus Silver 1900,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0540005,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/EC7FFE7FA5D240E29F1652FE951D8E70.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_SilverHigh&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540001,MyPriority HMO RxPlus Silver 1900,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0540005,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/EC7FFE7FA5D240E29F1652FE951D8E70.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_SilverHigh&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540001-03,Limited Cost Sharing Plan Variation,,0.697726964950562,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900","$3,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$20,$980,$150,"$1,900",$300,$590,$80,7
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540001,MyPriority HMO RxPlus Silver 1900,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0540005,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/EC7FFE7FA5D240E29F1652FE951D8E70.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_SilverHigh&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540001-04,73% AV Level Silver Plan,,0.736609518527985,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,200",$20,"$1,190",$150,"$1,200",$360,$680,$80,8
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540001,MyPriority HMO RxPlus Silver 1900,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0540005,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/EC7FFE7FA5D240E29F1652FE951D8E70.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_SilverHigh&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540001-05,87% AV Level Silver Plan,,0.878771841526031,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$1,350",$150,$150,$400,$910,$80,9
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0550005,PriorityHMO 1000,29698MI055,,MIN001,MIS001,MIF004,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,$300,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Urgent/Emergency Care; Out of area dependent coverage,No,http://www.priorityhealth.com/~/media/87623B062C6D4A1A9A10CAFF9E4A8EBB.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=57BAF1F0D422440FA708DDF5FDDADF48&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0550005-00,Standard Gold Off Exchange Plan,,0.782713234424591,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$830,$150,"$1,000",$680,$530,$80,9
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0550005,PriorityHMO 1000,29698MI055,,MIN001,MIS001,MIF004,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,$300,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Urgent/Emergency Care; Out of area dependent coverage,No,http://www.priorityhealth.com/~/media/87623B062C6D4A1A9A10CAFF9E4A8EBB.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=57BAF1F0D422440FA708DDF5FDDADF48&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0550005-01,Standard Gold On Exchange Plan,,0.782713234424591,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$830,$150,"$1,000",$680,$530,$80,10
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540001,MyPriority HMO RxPlus Silver 1900,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0540005,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/EC7FFE7FA5D240E29F1652FE951D8E70.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_SilverHigh&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540001-06,94% AV Level Silver Plan,,0.948064506053925,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$450,$900,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$25,$50,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$30,$0,$430,$150,$30,$70,$360,$80,10
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540003,MyPriority HMO RxPlus Gold 125,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/0FCA33018AEC444DABDC843AF9E17123.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_Gold125&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540003-00,Standard Gold Off Exchange Plan,,0.817108690738678,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$125,$250,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400",$0,"$1,140",$150,"$1,400",$100,"$1,180",$80,11
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540003,MyPriority HMO RxPlus Gold 125,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/0FCA33018AEC444DABDC843AF9E17123.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_Gold125&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540003-01,Standard Gold On Exchange Plan,,0.817108690738678,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$125,$250,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400",$0,"$1,140",$150,"$1,400",$100,"$1,180",$80,12
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540003,MyPriority HMO RxPlus Gold 125,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/0FCA33018AEC444DABDC843AF9E17123.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_Gold125&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,13
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540003,MyPriority HMO RxPlus Gold 125,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/0FCA33018AEC444DABDC843AF9E17123.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_Gold125&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540003-03,Limited Cost Sharing Plan Variation,,0.817108690738678,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$125,$250,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400",$0,"$1,140",$150,"$1,400",$100,"$1,180",$80,14
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540004,MyPriority HMO RxPlus Bronze 3975,29698MI054,,MIN001,MIS001,MIF006,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/AB9AB89090E54C43B92B08CF86B0F8EC.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540004-00,Standard Bronze Off Exchange Plan,,0.617907404899597,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,975","$7,950",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,975",$20,$480,$150,"$3,975",$260,$200,$80,15
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540004,MyPriority HMO RxPlus Bronze 3975,29698MI054,,MIN001,MIS001,MIF006,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/AB9AB89090E54C43B92B08CF86B0F8EC.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540004-01,Standard Bronze On Exchange Plan,,0.617907404899597,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,975","$7,950",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,975",$20,$480,$150,"$3,975",$260,$200,$80,16
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540004,MyPriority HMO RxPlus Bronze 3975,29698MI054,,MIN001,MIS001,MIF006,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/AB9AB89090E54C43B92B08CF86B0F8EC.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,17
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540004,MyPriority HMO RxPlus Bronze 3975,29698MI054,,MIN001,MIS001,MIF006,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/AB9AB89090E54C43B92B08CF86B0F8EC.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540004-03,Limited Cost Sharing Plan Variation,,0.617907404899597,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,975","$7,950",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,975",$20,$480,$150,"$3,975",$260,$200,$80,18
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540005,MyPriority HMO RxPlus Silver 1800,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/46B14EE4407947069373B94087C9167F.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540005-00,Standard Silver Off Exchange Plan,,0.683217763900757,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,800",$20,"$1,010",$150,"$1,800",$310,$590,$80,19
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540005,MyPriority HMO RxPlus Silver 1800,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/46B14EE4407947069373B94087C9167F.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540005-01,Standard Silver On Exchange Plan,,0.683217763900757,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,800",$20,"$1,010",$150,"$1,800",$310,$590,$80,20
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540005,MyPriority HMO RxPlus Silver 1800,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/46B14EE4407947069373B94087C9167F.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,21
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540005,MyPriority HMO RxPlus Silver 1800,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/46B14EE4407947069373B94087C9167F.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540005-03,Limited Cost Sharing Plan Variation,,0.683217763900757,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,800",$20,"$1,010",$150,"$1,800",$310,$590,$80,22
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540005,MyPriority HMO RxPlus Silver 1800,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/46B14EE4407947069373B94087C9167F.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540005-04,73% AV Level Silver Plan,,0.738309621810913,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$900,"$1,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,$20,"$1,280",$150,$900,$360,$770,$80,23
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540005,MyPriority HMO RxPlus Silver 1800,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/46B14EE4407947069373B94087C9167F.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540005-05,87% AV Level Silver Plan,,0.877067565917969,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$0,"$1,450",$150,$50,$400,$960,$80,24
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540005,MyPriority HMO RxPlus Silver 1800,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/46B14EE4407947069373B94087C9167F.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540005-06,94% AV Level Silver Plan,,0.947485625743866,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$450,$900,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$25,$50,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$25,$0,$375,$150,$25,$80,$295,$80,25
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540006,MyPriority HMO RxPlus Silver 1000,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/7988AA315A1941DDA07E5A21EE2F86F9.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540006-00,Standard Silver Off Exchange Plan,,0.717527210712433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$400,$610,$80,26
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540006,MyPriority HMO RxPlus Silver 1000,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/7988AA315A1941DDA07E5A21EE2F86F9.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540006-01,Standard Silver On Exchange Plan,,0.717527210712433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$400,$610,$80,27
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540006,MyPriority HMO RxPlus Silver 1000,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/7988AA315A1941DDA07E5A21EE2F86F9.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,28
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540006,MyPriority HMO RxPlus Silver 1000,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/7988AA315A1941DDA07E5A21EE2F86F9.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540006-03,Limited Cost Sharing Plan Variation,,0.717527210712433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$400,$610,$80,29
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540006,MyPriority HMO RxPlus Silver 1000,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/7988AA315A1941DDA07E5A21EE2F86F9.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540006-04,73% AV Level Silver Plan,,0.738309621810913,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$900,"$1,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,$20,"$1,280",$150,$900,$400,$660,$80,30
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540006,MyPriority HMO RxPlus Silver 1000,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/7988AA315A1941DDA07E5A21EE2F86F9.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540006-05,87% AV Level Silver Plan,,0.877067565917969,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$0,"$1,450",$150,$50,$400,$960,$80,31
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,1,29698,MI,Individual,No,38-2715520,29698MI0540006,MyPriority HMO RxPlus Silver 1000,29698MI054,,MIN001,MIS001,MIF005,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/7988AA315A1941DDA07E5A21EE2F86F9.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540006-06,94% AV Level Silver Plan,,0.947485625743866,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$450,$900,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$25,$50,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$25,$0,$375,$150,$25,$80,$295,$80,32
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,2,29698,MI,Individual,No,38-2715520,29698MI0540002,MyPriority HMO Plus Gold 400,29698MI054,,MIN001,MIS001,MIF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/FC01DD2BE8FE4E6EBCDF6DCC0D3A764E.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540002-00,Standard Gold Off Exchange Plan,,0.780824363231659,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$400,$20,$950,$150,$400,$780,$750,$80,4
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,2,29698,MI,Individual,No,38-2715520,29698MI0540002,MyPriority HMO Plus Gold 400,29698MI054,,MIN001,MIS001,MIF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/FC01DD2BE8FE4E6EBCDF6DCC0D3A764E.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540002-01,Standard Gold On Exchange Plan,,0.780824363231659,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$400,$20,$950,$150,$400,$780,$750,$80,5
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,2,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0550008,PriorityHMO Integrated 2000,29698MI055,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Urgent/Emergency Care; Out of area dependent coverage,No,http://www.priorityhealth.com/~/media/B69ADE7BD4CE42498598B0C6D2EB0C0D.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=2D115F2363E34FFCB08C124B9AA91669&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0550008-00,Standard Silver Off Exchange Plan,,0.686840713024139,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$20,$950,$150,"$2,000",$750,$460,$80,5
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,2,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0550008,PriorityHMO Integrated 2000,29698MI055,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Urgent/Emergency Care; Out of area dependent coverage,No,http://www.priorityhealth.com/~/media/B69ADE7BD4CE42498598B0C6D2EB0C0D.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=2D115F2363E34FFCB08C124B9AA91669&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0550008-01,Standard Silver On Exchange Plan,,0.686840713024139,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$20,$950,$150,"$2,000",$750,$460,$80,6
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,2,29698,MI,Individual,No,38-2715520,29698MI0540002,MyPriority HMO Plus Gold 400,29698MI054,,MIN001,MIS001,MIF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/FC01DD2BE8FE4E6EBCDF6DCC0D3A764E.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,2,29698,MI,Individual,No,38-2715520,29698MI0540002,MyPriority HMO Plus Gold 400,29698MI054,,MIN001,MIS001,MIF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/FC01DD2BE8FE4E6EBCDF6DCC0D3A764E.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_Rxplus_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540002-03,Limited Cost Sharing Plan Variation,,0.780824363231659,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$400,$20,$950,$150,$400,$780,$750,$80,7
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,3,29698,MI,Individual,No,38-2715520,29698MI0540007,MyPriority HMO HSA Bronze 6300,29698MI054,,MIN001,MIS001,MIF002,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/8140A4AA1DCA486FB3DF5FA80B9D8C27.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540007-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,400",$0,$0,$80,4
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,3,29698,MI,Individual,No,38-2715520,29698MI0540007,MyPriority HMO HSA Bronze 6300,29698MI054,,MIN001,MIS001,MIF002,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/8140A4AA1DCA486FB3DF5FA80B9D8C27.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540007-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,400",$0,$0,$80,5
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,3,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0550011,PriorityValue HMO 1000,29698MI055,,MIN001,MIS001,MIF002,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Urgent/Emergency Care; Out of area dependent coverage,No,http://www.priorityhealth.com/~/media/B650026418F04D989E1FF51F795320E3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=7C9506BDE7A949648B5FA625D759AFDA&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0550011-00,Standard Gold Off Exchange Plan,,0.784095287322998,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,$0,$0,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$830,$150,"$1,000",$720,$670,$80,5
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,3,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0550011,PriorityValue HMO 1000,29698MI055,,MIN001,MIS001,MIF002,Existing,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Urgent/Emergency Care; Out of area dependent coverage,No,http://www.priorityhealth.com/~/media/B650026418F04D989E1FF51F795320E3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=7C9506BDE7A949648B5FA625D759AFDA&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0550011-01,Standard Gold On Exchange Plan,,0.784095287322998,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,$0,$0,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$830,$150,"$1,000",$720,$670,$80,6
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,3,29698,MI,Individual,No,38-2715520,29698MI0540007,MyPriority HMO HSA Bronze 6300,29698MI054,,MIN001,MIS001,MIF002,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/8140A4AA1DCA486FB3DF5FA80B9D8C27.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,3,29698,MI,Individual,No,38-2715520,29698MI0540007,MyPriority HMO HSA Bronze 6300,29698MI054,,MIN001,MIS001,MIF002,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/8140A4AA1DCA486FB3DF5FA80B9D8C27.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540007-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,400",$0,$0,$80,7
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,3,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0550029,PriorityValue HMO 2000,29698MI055,,MIN001,MIS001,MIF002,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Urgent/Emergency Care; Out of area dependent coverage,No,http://www.priorityhealth.com/~/media/B5299C5C374F4A598F6C1243BDEB9732.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=7C9506BDE7A949648B5FA625D759AFDA&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0550029-00,Standard Silver Off Exchange Plan,,0.70940488576889,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,$150,"$2,000",$580,$530,$80,7
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,3,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0550029,PriorityValue HMO 2000,29698MI055,,MIN001,MIS001,MIF002,New,HMO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Urgent/Emergency Care; Out of area dependent coverage,No,http://www.priorityhealth.com/~/media/B5299C5C374F4A598F6C1243BDEB9732.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=7C9506BDE7A949648B5FA625D759AFDA&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0550029-01,Standard Silver On Exchange Plan,,0.70940488576889,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,$150,"$2,000",$580,$530,$80,8
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,3,29698,MI,Individual,No,38-2715520,29698MI0540008,MyPriority HMO HSA Silver 1500,29698MI054,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/66D8705D898C49A5B13A2104CFE7A53B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540008-00,Standard Silver Off Exchange Plan,,0.681715130805969,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$20,"$1,100",$150,"$1,500",$660,$650,$80,8
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,3,29698,MI,Individual,No,38-2715520,29698MI0540008,MyPriority HMO HSA Silver 1500,29698MI054,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/66D8705D898C49A5B13A2104CFE7A53B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540008-01,Standard Silver On Exchange Plan,,0.681715130805969,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$20,"$1,100",$150,"$1,500",$660,$650,$80,9
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,3,29698,MI,Individual,No,38-2715520,29698MI0540008,MyPriority HMO HSA Silver 1500,29698MI054,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/66D8705D898C49A5B13A2104CFE7A53B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,3,29698,MI,Individual,No,38-2715520,29698MI0540008,MyPriority HMO HSA Silver 1500,29698MI054,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/66D8705D898C49A5B13A2104CFE7A53B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540008-03,Limited Cost Sharing Plan Variation,,0.681715130805969,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$20,"$1,100",$150,"$1,500",$660,$650,$80,11
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,3,29698,MI,Individual,No,38-2715520,29698MI0540008,MyPriority HMO HSA Silver 1500,29698MI054,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/66D8705D898C49A5B13A2104CFE7A53B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540008-04,73% AV Level Silver Plan,,0.739735305309296,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,$20,"$1,330",$150,$750,$720,$820,$80,12
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,3,29698,MI,Individual,No,38-2715520,29698MI0540008,MyPriority HMO HSA Silver 1500,29698MI054,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/66D8705D898C49A5B13A2104CFE7A53B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540008-05,87% AV Level Silver Plan,,0.877512097358704,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$0,"$1,200",$150,$50,$500,$700,$80,13
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,3,29698,MI,Individual,No,38-2715520,29698MI0540008,MyPriority HMO HSA Silver 1500,29698MI054,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/66D8705D898C49A5B13A2104CFE7A53B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540008-06,94% AV Level Silver Plan,,0.945953547954559,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$25,$50,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$25,$0,$375,$150,$25,$80,$295,$80,14
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,3,29698,MI,Individual,No,38-2715520,29698MI0540009,MyPriority HMO HSA Gold 1300,29698MI054,,MIN001,MIS001,MIF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/1BF248883FCB46BBA45FEEC7455ECF96.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540009-00,Standard Gold Off Exchange Plan,,0.791826367378235,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300",$0,$700,$150,"$1,300",$380,$320,$80,15
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,3,29698,MI,Individual,No,38-2715520,29698MI0540009,MyPriority HMO HSA Gold 1300,29698MI054,,MIN001,MIS001,MIF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/1BF248883FCB46BBA45FEEC7455ECF96.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540009-01,Standard Gold On Exchange Plan,,0.791826367378235,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300",$0,$700,$150,"$1,300",$380,$320,$80,16
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,3,29698,MI,Individual,No,38-2715520,29698MI0540009,MyPriority HMO HSA Gold 1300,29698MI054,,MIN001,MIS001,MIF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/1BF248883FCB46BBA45FEEC7455ECF96.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,17
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,3,29698,MI,Individual,No,38-2715520,29698MI0540009,MyPriority HMO HSA Gold 1300,29698MI054,,MIN001,MIS001,MIF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/1BF248883FCB46BBA45FEEC7455ECF96.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540009-03,Limited Cost Sharing Plan Variation,,0.791826367378235,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300",$0,$700,$150,"$1,300",$380,$320,$80,18
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,Individual,No,38-2715520,29698MI0540012,MyPriority HMO Bronze 6000,29698MI054,,MIN001,MIS001,MIF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/63FA94B15A38413F9C226E9542ADB78E.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo?utm_source=FFM&utm_content=HMO_BronzeHigh&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540012-00,Standard Bronze Off Exchange Plan,,0.607166111469269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,400",$0,$0,$80,4
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0550012,PriorityHSA HMO 1300 2 tier Rx,29698MI055,,MIN001,MIS001,MIF003,Existing,HMO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Urgent/Emergency Care; Out of area dependent coverage,No,http://www.priorityhealth.com/~/media/8EE7000C7E2F4B008AF9C3691DCB378D.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=5ADA571B6E764CEDA1A9A5EF0DE4C633&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0550012-00,Standard Gold Off Exchange Plan,,0.786711633205414,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,400","$4,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300",$20,$390,$150,"$1,300",$360,$570,$80,4
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0550012,PriorityHSA HMO 1300 2 tier Rx,29698MI055,,MIN001,MIS001,MIF003,Existing,HMO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Urgent/Emergency Care; Out of area dependent coverage,No,http://www.priorityhealth.com/~/media/8EE7000C7E2F4B008AF9C3691DCB378D.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=5ADA571B6E764CEDA1A9A5EF0DE4C633&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0550012-01,Standard Gold On Exchange Plan,,0.786711633205414,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,400","$4,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300",$20,$390,$150,"$1,300",$360,$570,$80,5
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,Individual,No,38-2715520,29698MI0540012,MyPriority HMO Bronze 6000,29698MI054,,MIN001,MIS001,MIF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/63FA94B15A38413F9C226E9542ADB78E.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo?utm_source=FFM&utm_content=HMO_BronzeHigh&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540012-01,Standard Bronze On Exchange Plan,,0.607166111469269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,400",$0,$0,$80,5
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,Individual,No,38-2715520,29698MI0540012,MyPriority HMO Bronze 6000,29698MI054,,MIN001,MIS001,MIF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/63FA94B15A38413F9C226E9542ADB78E.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo?utm_source=FFM&utm_content=HMO_BronzeHigh&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,Individual,No,38-2715520,29698MI0540012,MyPriority HMO Bronze 6000,29698MI054,,MIN001,MIS001,MIF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/63FA94B15A38413F9C226E9542ADB78E.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo?utm_source=FFM&utm_content=HMO_BronzeHigh&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540012-03,Limited Cost Sharing Plan Variation,,0.607166111469269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,400",$0,$0,$80,7
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,Individual,No,38-2715520,29698MI0540014,MyPriority HMO Silver 1400,29698MI054,,MIN001,MIS001,MIF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/33AA163DB60C470B9100D4ACAC530CB3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo?utm_source=FFM&utm_content=HMO_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540014-00,Standard Silver Off Exchange Plan,,0.682635962963104,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400",$0,"$1,140",$150,"$1,400",$100,"$1,180",$80,8
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0550015,PriorityHSA HMO 2000,29698MI055,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Urgent/Emergency Care; Out of area dependent coverage,No,http://www.priorityhealth.com/~/media/80BD297EA15A44799ED4D7C5FD0D5AEB.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=5ADA571B6E764CEDA1A9A5EF0DE4C633&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0550015-00,Standard Silver Off Exchange Plan,,0.687539637088776,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$20,$950,$150,"$2,000",$580,$570,$80,8
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0550015,PriorityHSA HMO 2000,29698MI055,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Urgent/Emergency Care; Out of area dependent coverage,No,http://www.priorityhealth.com/~/media/80BD297EA15A44799ED4D7C5FD0D5AEB.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=5ADA571B6E764CEDA1A9A5EF0DE4C633&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0550015-01,Standard Silver On Exchange Plan,,0.687539637088776,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$20,$950,$150,"$2,000",$580,$570,$80,9
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,Individual,No,38-2715520,29698MI0540014,MyPriority HMO Silver 1400,29698MI054,,MIN001,MIS001,MIF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/33AA163DB60C470B9100D4ACAC530CB3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo?utm_source=FFM&utm_content=HMO_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540014-01,Standard Silver On Exchange Plan,,0.682635962963104,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400",$0,"$1,140",$150,"$1,400",$100,"$1,180",$80,9
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,Individual,No,38-2715520,29698MI0540014,MyPriority HMO Silver 1400,29698MI054,,MIN001,MIS001,MIF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/33AA163DB60C470B9100D4ACAC530CB3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo?utm_source=FFM&utm_content=HMO_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,Individual,No,38-2715520,29698MI0540014,MyPriority HMO Silver 1400,29698MI054,,MIN001,MIS001,MIF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/33AA163DB60C470B9100D4ACAC530CB3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo?utm_source=FFM&utm_content=HMO_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540014-03,Limited Cost Sharing Plan Variation,,0.682635962963104,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400",$0,"$1,140",$150,"$1,400",$100,"$1,180",$80,11
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0550027,PriorityHSA HMO 4000,29698MI055,,MIN001,MIS001,MIF002,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Urgent/Emergency Care; Out of area dependent coverage,No,http://www.priorityhealth.com/~/media/2923AD71F04E416FB2B00CD7F869CB30.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=5ADA571B6E764CEDA1A9A5EF0DE4C633&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0550027-00,Standard Bronze Off Exchange Plan,,0.595907390117645,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,$470,$150,"$4,000",$260,$200,$80,11
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0550027,PriorityHSA HMO 4000,29698MI055,,MIN001,MIS001,MIF002,Existing,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Urgent/Emergency Care; Out of area dependent coverage,No,http://www.priorityhealth.com/~/media/2923AD71F04E416FB2B00CD7F869CB30.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=5ADA571B6E764CEDA1A9A5EF0DE4C633&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0550027-01,Standard Bronze On Exchange Plan,,0.595907390117645,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,$470,$150,"$4,000",$260,$200,$80,12
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,Individual,No,38-2715520,29698MI0540014,MyPriority HMO Silver 1400,29698MI054,,MIN001,MIS001,MIF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/33AA163DB60C470B9100D4ACAC530CB3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo?utm_source=FFM&utm_content=HMO_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540014-04,73% AV Level Silver Plan,,0.739561200141907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$575,"$1,150",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$575,$20,"$1,380",$150,$575,$740,$870,$80,12
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,Individual,No,38-2715520,29698MI0540014,MyPriority HMO Silver 1400,29698MI054,,MIN001,MIS001,MIF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/33AA163DB60C470B9100D4ACAC530CB3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo?utm_source=FFM&utm_content=HMO_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540014-05,87% AV Level Silver Plan,,0.876174330711365,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$0,"$1,250",$150,$50,$230,"$1,020",$80,13
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,Individual,No,38-2715520,29698MI0540014,MyPriority HMO Silver 1400,29698MI054,,MIN001,MIS001,MIF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/33AA163DB60C470B9100D4ACAC530CB3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo?utm_source=FFM&utm_content=HMO_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540014-06,94% AV Level Silver Plan,,0.946934282779694,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$25,$50,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$25,$0,$375,$150,$25,$80,$295,$80,14
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,Individual,No,38-2715520,29698MI0540015,MyPriority HMO Silver 650,29698MI054,,MIN001,MIS001,MIF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0540014,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/24ED821D503F4F6DBF3C51075AD35FAA.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo?utm_source=FFM&utm_content=HMO_SilverLow&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540015-00,Standard Silver Off Exchange Plan,,0.719465851783752,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$650,"$1,300",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$650,$20,"$1,360",$150,$650,$720,$850,$80,15
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,Individual,No,38-2715520,29698MI0540015,MyPriority HMO Silver 650,29698MI054,,MIN001,MIS001,MIF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0540014,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/24ED821D503F4F6DBF3C51075AD35FAA.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo?utm_source=FFM&utm_content=HMO_SilverLow&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540015-01,Standard Silver On Exchange Plan,,0.719465851783752,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$650,"$1,300",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$650,$20,"$1,360",$150,$650,$720,$850,$80,16
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,Individual,No,38-2715520,29698MI0540015,MyPriority HMO Silver 650,29698MI054,,MIN001,MIS001,MIF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0540014,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/24ED821D503F4F6DBF3C51075AD35FAA.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo?utm_source=FFM&utm_content=HMO_SilverLow&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540015-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,17
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,Individual,No,38-2715520,29698MI0540015,MyPriority HMO Silver 650,29698MI054,,MIN001,MIS001,MIF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0540014,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/24ED821D503F4F6DBF3C51075AD35FAA.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo?utm_source=FFM&utm_content=HMO_SilverLow&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540015-03,Limited Cost Sharing Plan Variation,,0.719465851783752,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$650,"$1,300",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$650,$20,"$1,360",$150,$650,$720,$850,$80,18
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,Individual,No,38-2715520,29698MI0540015,MyPriority HMO Silver 650,29698MI054,,MIN001,MIS001,MIF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0540014,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/24ED821D503F4F6DBF3C51075AD35FAA.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo?utm_source=FFM&utm_content=HMO_SilverLow&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540015-04,73% AV Level Silver Plan,,0.739561200141907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$575,"$1,150",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$575,$0,$570,$150,$575,$200,$370,$80,19
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,Individual,No,38-2715520,29698MI0540015,MyPriority HMO Silver 650,29698MI054,,MIN001,MIS001,MIF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0540014,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/24ED821D503F4F6DBF3C51075AD35FAA.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo?utm_source=FFM&utm_content=HMO_SilverLow&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540015-05,87% AV Level Silver Plan,,0.876174330711365,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$0,"$1,250",$150,$50,$890,$360,$80,20
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,4,29698,MI,Individual,No,38-2715520,29698MI0540015,MyPriority HMO Silver 650,29698MI054,,MIN001,MIS001,MIF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0540014,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/24ED821D503F4F6DBF3C51075AD35FAA.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/hmo-plans/mypriority-hmo?utm_source=FFM&utm_content=HMO_SilverLow&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540015-06,94% AV Level Silver Plan,,0.946934282779694,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$25,$50,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$25,$0,$375,$150,$25,$80,$295,$80,21
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,5,29698,MI,Individual,No,38-2715520,29698MI0540010,MyPriority Vida,29698MI054,,MIN001,MIS001,MIF002,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/2161DD45B73D44F3A8B02D94F33CF912.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/catastrophic-plan?utm_source=FFM&utm_content=HMO_Vida&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540010-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$0,$150,"$5,270",$0,$0,$80,4
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,5,29698,MI,Individual,No,38-2715520,29698MI0540010,MyPriority Vida,29698MI054,,MIN001,MIS001,MIF002,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Care Only,Yes,Urgent/Emergency Care Only,No,http://www.priorityhealth.com/~/media/2161DD45B73D44F3A8B02D94F33CF912.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/catastrophic-plan?utm_source=FFM&utm_content=HMO_Vida&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0540010-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$0,$150,"$5,270",$0,$0,$80,5
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,5,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560002,PriorityPOS 250 90,29698MI056,,MIN001,MIS003,MIF001,Existing,POS,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/F1D27FBCA08E4D8EA7604AD52EBD2F05.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=6FF9DF75CB934F329325DB9C8737A8D7&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560002-00,Standard Platinum Off Exchange Plan,,0.884185135364532,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$250,$500,10%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$250,$20,$490,$150,$250,$650,$530,$80,6
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570011,MyPriority POS RxPlus Gold 125,29698MI057,,MIN001,MIS002,MIF005,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/C956B56D45C94B79A5383BE159D45423.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Gold125&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570011-00,Standard Gold Off Exchange Plan,,0.817108690738678,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$125,$250,20%,,,,$250,$500,Not Applicable,Not Applicable,$125,$20,"$1,010",$150,$125,$980,$230,$80,26
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570011,MyPriority POS RxPlus Gold 125,29698MI057,,MIN001,MIS002,MIF005,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/C956B56D45C94B79A5383BE159D45423.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Gold125&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570011-01,Standard Gold On Exchange Plan,,0.817108690738678,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$125,$250,20%,,,,$250,$500,Not Applicable,Not Applicable,$125,$20,"$1,010",$150,$125,$980,$230,$80,27
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570011,MyPriority POS RxPlus Gold 125,29698MI057,,MIN001,MIS002,MIF005,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/C956B56D45C94B79A5383BE159D45423.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Gold125&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,28
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570011,MyPriority POS RxPlus Gold 125,29698MI057,,MIN001,MIS002,MIF005,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/C956B56D45C94B79A5383BE159D45423.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Gold125&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570011-03,Limited Cost Sharing Plan Variation,,0.817108690738678,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$125,$250,20%,,,,$250,$500,Not Applicable,Not Applicable,$125,$20,"$1,010",$150,$125,$980,$230,$80,29
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570012,MyPriority POS RxPlus Bronze 3975,29698MI057,,MIN001,MIS002,MIF005,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/F9A23F5226884F0A861C58E9B3D135EA.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570012-00,Standard Bronze Off Exchange Plan,,0.617907404899597,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,975","$7,950",40%,,,,"$7,950","$15,900",Not Applicable,Not Applicable,"$3,975",$20,$480,$150,"$3,975",$260,$200,$80,30
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570012,MyPriority POS RxPlus Bronze 3975,29698MI057,,MIN001,MIS002,MIF005,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/F9A23F5226884F0A861C58E9B3D135EA.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570012-01,Standard Bronze On Exchange Plan,,0.617907404899597,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,975","$7,950",40%,,,,"$7,950","$15,900",Not Applicable,Not Applicable,"$3,975",$20,$480,$150,"$3,975",$260,$200,$80,31
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570012,MyPriority POS RxPlus Bronze 3975,29698MI057,,MIN001,MIS002,MIF005,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/F9A23F5226884F0A861C58E9B3D135EA.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,32
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,5,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560002,PriorityPOS 250 90,29698MI056,,MIN001,MIS003,MIF001,Existing,POS,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/F1D27FBCA08E4D8EA7604AD52EBD2F05.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=6FF9DF75CB934F329325DB9C8737A8D7&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560002-01,Standard Platinum On Exchange Plan,,0.884185135364532,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$250,$500,10%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$250,$20,$490,$150,$250,$650,$530,$80,7
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,5,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560037,PriorityPOS 250 90,29698MI056,,MIN001,MIS002,MIF001,New,POS,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/F1D27FBCA08E4D8EA7604AD52EBD2F05.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=6FF9DF75CB934F329325DB9C8737A8D7&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560037-00,Standard Platinum Off Exchange Plan,,0.884185135364532,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$250,$500,10%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$250,$20,$490,$150,$250,$650,$530,$80,8
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,5,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560037,PriorityPOS 250 90,29698MI056,,MIN001,MIS002,MIF001,New,POS,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/F1D27FBCA08E4D8EA7604AD52EBD2F05.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=6FF9DF75CB934F329325DB9C8737A8D7&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560037-01,Standard Platinum On Exchange Plan,,0.884185135364532,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$250,$500,10%,,,,$500,"$1,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$250,$20,$490,$150,$250,$650,$530,$80,9
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,5,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560005,PriorityPOS 1000,29698MI056,,MIN001,MIS003,MIF004,Existing,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/CAAF7B2FCE154563A86B914B261D6F19.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=6FF9DF75CB934F329325DB9C8737A8D7&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560005-00,Standard Gold Off Exchange Plan,,0.782713234424591,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$7,600","$15,200",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$830,$150,"$1,000",$680,$530,$80,14
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,5,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560005,PriorityPOS 1000,29698MI056,,MIN001,MIS003,MIF004,Existing,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/CAAF7B2FCE154563A86B914B261D6F19.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=6FF9DF75CB934F329325DB9C8737A8D7&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560005-01,Standard Gold On Exchange Plan,,0.782713234424591,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$7,600","$15,200",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$830,$150,"$1,000",$680,$530,$80,15
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,5,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560040,PriorityPOS 1000,29698MI056,,MIN001,MIS002,MIF004,New,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/CAAF7B2FCE154563A86B914B261D6F19.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=6FF9DF75CB934F329325DB9C8737A8D7&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560040-00,Standard Gold Off Exchange Plan,,0.782713234424591,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$7,600","$15,200",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$830,$150,"$1,000",$680,$530,$80,16
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,5,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560040,PriorityPOS 1000,29698MI056,,MIN001,MIS002,MIF004,New,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/CAAF7B2FCE154563A86B914B261D6F19.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=6FF9DF75CB934F329325DB9C8737A8D7&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560040-01,Standard Gold On Exchange Plan,,0.782713234424591,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$7,600","$15,200",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$830,$150,"$1,000",$680,$530,$80,17
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570001,MyPriority POS RxPlus Gold 125,29698MI057,,MIN001,MIS003,MIF005,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/C956B56D45C94B79A5383BE159D45423.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Gold125&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570001-00,Standard Gold Off Exchange Plan,,0.817108690738678,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$125,$250,20%,,,,$250,$500,Not Applicable,Not Applicable,$125,$20,"$1,010",$150,$125,$980,$230,$80,4
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570001,MyPriority POS RxPlus Gold 125,29698MI057,,MIN001,MIS003,MIF005,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/C956B56D45C94B79A5383BE159D45423.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Gold125&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570001-01,Standard Gold On Exchange Plan,,0.817108690738678,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$125,$250,20%,,,,$250,$500,Not Applicable,Not Applicable,$125,$20,"$1,010",$150,$125,$980,$230,$80,5
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570001,MyPriority POS RxPlus Gold 125,29698MI057,,MIN001,MIS003,MIF005,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/C956B56D45C94B79A5383BE159D45423.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Gold125&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560008,PriorityPOS Integrated 2000,29698MI056,,MIN001,MIS003,MIF002,Existing,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/8B23F0212439452987B2B5927928ACEC.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=3A6E2ABE60AB4609A935FB54F16B9CFC&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560008-00,Standard Silver Off Exchange Plan,,0.686840713024139,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,$950,$150,"$2,000",$750,$460,$80,6
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560008,PriorityPOS Integrated 2000,29698MI056,,MIN001,MIS003,MIF002,Existing,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/8B23F0212439452987B2B5927928ACEC.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=3A6E2ABE60AB4609A935FB54F16B9CFC&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560008-01,Standard Silver On Exchange Plan,,0.686840713024139,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,$950,$150,"$2,000",$750,$460,$80,7
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570001,MyPriority POS RxPlus Gold 125,29698MI057,,MIN001,MIS003,MIF005,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/C956B56D45C94B79A5383BE159D45423.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Gold125&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570001-03,Limited Cost Sharing Plan Variation,,0.817108690738678,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$125,$250,20%,,,,$250,$500,Not Applicable,Not Applicable,$125,$20,"$1,010",$150,$125,$980,$230,$80,7
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570002,MyPriority POS RxPlus Bronze 3975,29698MI057,,MIN001,MIS003,MIF005,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/F9A23F5226884F0A861C58E9B3D135EA.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570002-00,Standard Bronze Off Exchange Plan,,0.617907404899597,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,975","$7,950",40%,,,,"$7,950","$15,900",Not Applicable,Not Applicable,"$3,975",$20,$480,$150,"$3,975",$260,$200,$80,8
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560044,PriorityPOS Integrated 2000,29698MI056,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/8B23F0212439452987B2B5927928ACEC.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=3A6E2ABE60AB4609A935FB54F16B9CFC&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560044-00,Standard Silver Off Exchange Plan,,0.686840713024139,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,$950,$150,"$2,000",$750,$460,$80,8
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560044,PriorityPOS Integrated 2000,29698MI056,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9962,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/8B23F0212439452987B2B5927928ACEC.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=3A6E2ABE60AB4609A935FB54F16B9CFC&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560044-01,Standard Silver On Exchange Plan,,0.686840713024139,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,$950,$150,"$2,000",$750,$460,$80,9
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570002,MyPriority POS RxPlus Bronze 3975,29698MI057,,MIN001,MIS003,MIF005,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/F9A23F5226884F0A861C58E9B3D135EA.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570002-01,Standard Bronze On Exchange Plan,,0.617907404899597,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,975","$7,950",40%,,,,"$7,950","$15,900",Not Applicable,Not Applicable,"$3,975",$20,$480,$150,"$3,975",$260,$200,$80,9
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570002,MyPriority POS RxPlus Bronze 3975,29698MI057,,MIN001,MIS003,MIF005,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/F9A23F5226884F0A861C58E9B3D135EA.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570002,MyPriority POS RxPlus Bronze 3975,29698MI057,,MIN001,MIS003,MIF005,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/F9A23F5226884F0A861C58E9B3D135EA.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570002-03,Limited Cost Sharing Plan Variation,,0.617907404899597,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,975","$7,950",40%,,,,"$7,950","$15,900",Not Applicable,Not Applicable,"$3,975",$20,$480,$150,"$3,975",$260,$200,$80,11
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570003,MyPriority POS RxPlus Silver 1800,29698MI057,,MIN001,MIS003,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/9EC39CDA0FFA4085A26F979BC4E39D40.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570003-00,Standard Silver Off Exchange Plan,,0.683217763900757,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,"$3,600","$7,200",Not Applicable,Not Applicable,"$1,800",$20,"$1,010",$150,"$1,800",$310,$590,$80,12
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570003,MyPriority POS RxPlus Silver 1800,29698MI057,,MIN001,MIS003,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/9EC39CDA0FFA4085A26F979BC4E39D40.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570003-01,Standard Silver On Exchange Plan,,0.683217763900757,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,"$3,600","$7,200",Not Applicable,Not Applicable,"$1,800",$20,"$1,010",$150,"$1,800",$310,$590,$80,13
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570003,MyPriority POS RxPlus Silver 1800,29698MI057,,MIN001,MIS003,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/9EC39CDA0FFA4085A26F979BC4E39D40.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,14
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570003,MyPriority POS RxPlus Silver 1800,29698MI057,,MIN001,MIS003,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/9EC39CDA0FFA4085A26F979BC4E39D40.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570003-03,Limited Cost Sharing Plan Variation,,0.683217763900757,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,"$3,600","$7,200",Not Applicable,Not Applicable,"$1,800",$20,"$1,010",$150,"$1,800",$310,$590,$80,15
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570003,MyPriority POS RxPlus Silver 1800,29698MI057,,MIN001,MIS003,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/9EC39CDA0FFA4085A26F979BC4E39D40.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570003-04,73% AV Level Silver Plan,,0.738309621810913,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$900,"$1,800",30%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,$900,$20,"$1,280",$150,$900,$360,$770,$80,16
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570003,MyPriority POS RxPlus Silver 1800,29698MI057,,MIN001,MIS003,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/9EC39CDA0FFA4085A26F979BC4E39D40.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570003-05,87% AV Level Silver Plan,,0.877067565917969,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,30%,,,,$100,$200,Not Applicable,Not Applicable,$50,$0,"$1,450",$150,$50,$400,$960,$80,17
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570003,MyPriority POS RxPlus Silver 1800,29698MI057,,MIN001,MIS003,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/9EC39CDA0FFA4085A26F979BC4E39D40.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570003-06,94% AV Level Silver Plan,,0.947485625743866,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$450,$900,,,$900,"$1,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$25,$50,30%,,,,$50,$100,Not Applicable,Not Applicable,$25,$0,$375,$150,$25,$80,$295,$80,18
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570004,MyPriority POS RxPlus Silver 1000,29698MI057,,MIN001,MIS003,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570003,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/2E766DD24AF448F09D7FCD5C961840CC.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570004-00,Standard Silver Off Exchange Plan,,0.717527210712433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$400,$610,$80,19
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570004,MyPriority POS RxPlus Silver 1000,29698MI057,,MIN001,MIS003,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570003,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/2E766DD24AF448F09D7FCD5C961840CC.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570004-01,Standard Silver On Exchange Plan,,0.717527210712433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$400,$610,$80,20
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570004,MyPriority POS RxPlus Silver 1000,29698MI057,,MIN001,MIS003,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570003,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/2E766DD24AF448F09D7FCD5C961840CC.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,21
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570004,MyPriority POS RxPlus Silver 1000,29698MI057,,MIN001,MIS003,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570003,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/2E766DD24AF448F09D7FCD5C961840CC.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570004-03,Limited Cost Sharing Plan Variation,,0.717527210712433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$400,$610,$80,22
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570004,MyPriority POS RxPlus Silver 1000,29698MI057,,MIN001,MIS003,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570003,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/2E766DD24AF448F09D7FCD5C961840CC.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570004-04,73% AV Level Silver Plan,,0.738309621810913,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$900,"$1,800",30%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,$900,$20,"$1,280",$150,$900,$400,$660,$80,23
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570004,MyPriority POS RxPlus Silver 1000,29698MI057,,MIN001,MIS003,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570003,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/2E766DD24AF448F09D7FCD5C961840CC.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570004-05,87% AV Level Silver Plan,,0.877067565917969,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,30%,,,,$100,$200,Not Applicable,Not Applicable,$50,$0,"$1,450",$150,$50,$400,$960,$80,24
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570004,MyPriority POS RxPlus Silver 1000,29698MI057,,MIN001,MIS003,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570003,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/2E766DD24AF448F09D7FCD5C961840CC.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570004-06,94% AV Level Silver Plan,,0.947485625743866,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$450,$900,,,$900,"$1,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$25,$50,30%,,,,$50,$100,Not Applicable,Not Applicable,$25,$0,$375,$150,$25,$80,$295,$80,25
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570012,MyPriority POS RxPlus Bronze 3975,29698MI057,,MIN001,MIS002,MIF005,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/F9A23F5226884F0A861C58E9B3D135EA.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570012-03,Limited Cost Sharing Plan Variation,,0.617907404899597,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,975","$7,950",40%,,,,"$7,950","$15,900",Not Applicable,Not Applicable,"$3,975",$20,$480,$150,"$3,975",$260,$200,$80,33
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570013,MyPriority POS RxPlus Silver 1800,29698MI057,,MIN001,MIS002,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/9EC39CDA0FFA4085A26F979BC4E39D40.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570013-00,Standard Silver Off Exchange Plan,,0.683217763900757,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,"$3,600","$7,200",Not Applicable,Not Applicable,"$1,800",$20,"$1,010",$150,"$1,800",$310,$590,$80,34
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570013,MyPriority POS RxPlus Silver 1800,29698MI057,,MIN001,MIS002,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/9EC39CDA0FFA4085A26F979BC4E39D40.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570013-01,Standard Silver On Exchange Plan,,0.683217763900757,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,"$3,600","$7,200",Not Applicable,Not Applicable,"$1,800",$20,"$1,010",$150,"$1,800",$310,$590,$80,35
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570013,MyPriority POS RxPlus Silver 1800,29698MI057,,MIN001,MIS002,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/9EC39CDA0FFA4085A26F979BC4E39D40.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,36
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570013,MyPriority POS RxPlus Silver 1800,29698MI057,,MIN001,MIS002,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/9EC39CDA0FFA4085A26F979BC4E39D40.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570013-03,Limited Cost Sharing Plan Variation,,0.683217763900757,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,"$3,600","$7,200",Not Applicable,Not Applicable,"$1,800",$20,"$1,010",$150,"$1,800",$310,$590,$80,37
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570013,MyPriority POS RxPlus Silver 1800,29698MI057,,MIN001,MIS002,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/9EC39CDA0FFA4085A26F979BC4E39D40.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570013-04,73% AV Level Silver Plan,,0.738309621810913,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$900,"$1,800",30%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,$900,$20,"$1,280",$150,$900,$360,$770,$80,38
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570013,MyPriority POS RxPlus Silver 1800,29698MI057,,MIN001,MIS002,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/9EC39CDA0FFA4085A26F979BC4E39D40.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570013-05,87% AV Level Silver Plan,,0.877067565917969,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,30%,,,,$100,$200,Not Applicable,Not Applicable,$50,$0,"$1,450",$150,$50,$400,$960,$80,39
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570013,MyPriority POS RxPlus Silver 1800,29698MI057,,MIN001,MIS002,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/9EC39CDA0FFA4085A26F979BC4E39D40.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570013-06,94% AV Level Silver Plan,,0.947485625743866,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$450,$900,,,$900,"$1,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$25,$50,30%,,,,$50,$100,Not Applicable,Not Applicable,$25,$0,$375,$150,$25,$80,$295,$80,40
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570014,MyPriority POS RxPlus Silver 1000,29698MI057,,MIN001,MIS002,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570013,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/2E766DD24AF448F09D7FCD5C961840CC.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570014-00,Standard Silver Off Exchange Plan,,0.717527210712433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$400,$610,$80,41
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570014,MyPriority POS RxPlus Silver 1000,29698MI057,,MIN001,MIS002,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570013,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/2E766DD24AF448F09D7FCD5C961840CC.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570014-01,Standard Silver On Exchange Plan,,0.717527210712433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$400,$610,$80,42
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570014,MyPriority POS RxPlus Silver 1000,29698MI057,,MIN001,MIS002,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570013,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/2E766DD24AF448F09D7FCD5C961840CC.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,43
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570014,MyPriority POS RxPlus Silver 1000,29698MI057,,MIN001,MIS002,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570013,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/2E766DD24AF448F09D7FCD5C961840CC.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570014-03,Limited Cost Sharing Plan Variation,,0.717527210712433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",30%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$400,$610,$80,44
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570014,MyPriority POS RxPlus Silver 1000,29698MI057,,MIN001,MIS002,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570013,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/2E766DD24AF448F09D7FCD5C961840CC.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570014-04,73% AV Level Silver Plan,,0.738309621810913,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$900,"$1,800",30%,,,,"$1,800","$3,600",Not Applicable,Not Applicable,$900,$20,"$1,280",$150,$900,$400,$660,$80,45
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570014,MyPriority POS RxPlus Silver 1000,29698MI057,,MIN001,MIS002,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570013,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/2E766DD24AF448F09D7FCD5C961840CC.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570014-05,87% AV Level Silver Plan,,0.877067565917969,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,30%,,,,$100,$200,Not Applicable,Not Applicable,$50,$0,"$1,450",$150,$50,$400,$960,$80,46
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,6,29698,MI,Individual,No,38-2715520,29698MI0570014,MyPriority POS RxPlus Silver 1000,29698MI057,,MIN001,MIS002,MIF005,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570013,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,4,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/2E766DD24AF448F09D7FCD5C961840CC.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_Rxplus_Silver1000&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570014-06,94% AV Level Silver Plan,,0.947485625743866,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$450,$900,,,$900,"$1,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$25,$50,30%,,,,$50,$100,Not Applicable,Not Applicable,$25,$0,$375,$150,$25,$80,$295,$80,47
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570005,MyPriority POS HSA Bronze 6300,29698MI057,,MIN001,MIS003,MIF002,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/D8FEB1B1C3CB4F4D8419D6978EB3CDBE.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570005-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,400",$0,$0,$80,4
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570005,MyPriority POS HSA Bronze 6300,29698MI057,,MIN001,MIS003,MIF002,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/D8FEB1B1C3CB4F4D8419D6978EB3CDBE.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570005-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,400",$0,$0,$80,5
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570005,MyPriority POS HSA Bronze 6300,29698MI057,,MIN001,MIS003,MIF002,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/D8FEB1B1C3CB4F4D8419D6978EB3CDBE.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560011,PriorityValue POS 1000,29698MI056,,MIN001,MIS003,MIF002,Existing,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/260F0886369B46A58CBF6658BCA9B9F3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=7C9506BDE7A949648B5FA625D759AFDA&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560011-00,Standard Gold Off Exchange Plan,,0.784095287322998,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$830,$150,"$1,000",$720,$670,$80,6
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570017,MyPriority POS HSA Gold 1300,29698MI057,,MIN001,MIS002,MIF002,New,POS,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/BC2100742CE54347B0785B165E04AB09.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570017-01,Standard Gold On Exchange Plan,,0.791826367378235,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,"$1,300",$0,$700,$150,"$1,300",$380,$320,$80,31
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570017,MyPriority POS HSA Gold 1300,29698MI057,,MIN001,MIS002,MIF002,New,POS,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/BC2100742CE54347B0785B165E04AB09.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,32
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570017,MyPriority POS HSA Gold 1300,29698MI057,,MIN001,MIS002,MIF002,New,POS,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/BC2100742CE54347B0785B165E04AB09.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570017-03,Limited Cost Sharing Plan Variation,,0.791826367378235,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,"$1,300",$0,$700,$150,"$1,300",$380,$320,$80,33
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560012,PriorityHSA POS 1300 2 tier Rx,29698MI056,,MIN001,MIS003,MIF003,Existing,POS,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/B2F5956B843349F0BA8B1F96B0644FF6.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=5ADA571B6E764CEDA1A9A5EF0DE4C633&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560012-00,Standard Gold Off Exchange Plan,,0.786711633205414,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,400","$4,800",,,"$4,800","$9,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,"$1,300",$20,$390,$150,"$1,300",$360,$570,$80,4
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570008,MyPriority POS Bronze 6000,29698MI057,,MIN001,MIS003,MIF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/0C417C36D7F647E5BBA99046E25D3A9B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570008-00,Standard Bronze Off Exchange Plan,,0.607166111469269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$150,"$5,400",$0,$0,$80,4
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560011,PriorityValue POS 1000,29698MI056,,MIN001,MIS003,MIF002,Existing,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/260F0886369B46A58CBF6658BCA9B9F3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=7C9506BDE7A949648B5FA625D759AFDA&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560011-01,Standard Gold On Exchange Plan,,0.784095287322998,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$830,$150,"$1,000",$720,$670,$80,7
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570005,MyPriority POS HSA Bronze 6300,29698MI057,,MIN001,MIS003,MIF002,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/D8FEB1B1C3CB4F4D8419D6978EB3CDBE.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570005-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,400",$0,$0,$80,7
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570006,MyPriority POS HSA Silver 1500,29698MI057,,MIN001,MIS003,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/E4F240FC69374D998620C6F1CA211FA3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570006-00,Standard Silver Off Exchange Plan,,0.681715130805969,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"$10,200","$20,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,100",$150,"$1,500",$660,$650,$80,8
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560047,PriorityValue POS 1000,29698MI056,,MIN001,MIS002,MIF002,New,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/260F0886369B46A58CBF6658BCA9B9F3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=7C9506BDE7A949648B5FA625D759AFDA&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560047-00,Standard Gold Off Exchange Plan,,0.784095287322998,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$830,$150,"$1,000",$720,$670,$80,8
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560047,PriorityValue POS 1000,29698MI056,,MIN001,MIS002,MIF002,New,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/260F0886369B46A58CBF6658BCA9B9F3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=7C9506BDE7A949648B5FA625D759AFDA&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560047-01,Standard Gold On Exchange Plan,,0.784095287322998,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,$830,$150,"$1,000",$720,$670,$80,9
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570006,MyPriority POS HSA Silver 1500,29698MI057,,MIN001,MIS003,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/E4F240FC69374D998620C6F1CA211FA3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570006-01,Standard Silver On Exchange Plan,,0.681715130805969,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"$10,200","$20,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,100",$150,"$1,500",$660,$650,$80,9
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570006,MyPriority POS HSA Silver 1500,29698MI057,,MIN001,MIS003,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/E4F240FC69374D998620C6F1CA211FA3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560029,PriorityValue POS 2000,29698MI056,,MIN001,MIS003,MIF002,New,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/8157DD1A40EB4299B9F344A50FA7EB37.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=7C9506BDE7A949648B5FA625D759AFDA&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560029-00,Standard Silver Off Exchange Plan,,0.70940488576889,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,$150,"$2,000",$580,$530,$80,10
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560029,PriorityValue POS 2000,29698MI056,,MIN001,MIS003,MIF002,New,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/8157DD1A40EB4299B9F344A50FA7EB37.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=7C9506BDE7A949648B5FA625D759AFDA&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560029-01,Standard Silver On Exchange Plan,,0.70940488576889,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,$150,"$2,000",$580,$530,$80,11
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570006,MyPriority POS HSA Silver 1500,29698MI057,,MIN001,MIS003,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/E4F240FC69374D998620C6F1CA211FA3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570006-03,Limited Cost Sharing Plan Variation,,0.681715130805969,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"$10,200","$20,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,100",$150,"$1,500",$660,$650,$80,11
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570006,MyPriority POS HSA Silver 1500,29698MI057,,MIN001,MIS003,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/E4F240FC69374D998620C6F1CA211FA3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570006-04,73% AV Level Silver Plan,,0.739735305309296,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",30%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$750,$20,"$1,330",$150,$750,$720,$820,$80,12
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560048,PriorityValue POS 2000,29698MI056,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/8157DD1A40EB4299B9F344A50FA7EB37.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=7C9506BDE7A949648B5FA625D759AFDA&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560048-00,Standard Silver Off Exchange Plan,,0.70940488576889,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,$150,"$2,000",$580,$530,$80,12
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560048,PriorityValue POS 2000,29698MI056,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/8157DD1A40EB4299B9F344A50FA7EB37.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=7C9506BDE7A949648B5FA625D759AFDA&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560048-01,Standard Silver On Exchange Plan,,0.70940488576889,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,$630,$150,"$2,000",$580,$530,$80,13
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570006,MyPriority POS HSA Silver 1500,29698MI057,,MIN001,MIS003,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/E4F240FC69374D998620C6F1CA211FA3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570006-05,87% AV Level Silver Plan,,0.877512097358704,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,30%,,,,$100,$200,Not Applicable,Not Applicable,$50,$0,"$1,200",$150,$50,$500,$700,$80,13
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570006,MyPriority POS HSA Silver 1500,29698MI057,,MIN001,MIS003,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/E4F240FC69374D998620C6F1CA211FA3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570006-06,94% AV Level Silver Plan,,0.945953547954559,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,$800,"$1,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$25,$50,30%,,,,$50,$100,Not Applicable,Not Applicable,$25,$0,$375,$150,$25,$80,$295,$80,14
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570007,MyPriority POS HSA Gold 1300,29698MI057,,MIN001,MIS003,MIF002,New,POS,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/BC2100742CE54347B0785B165E04AB09.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570007-00,Standard Gold Off Exchange Plan,,0.791826367378235,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,"$1,300",$0,$700,$150,"$1,300",$380,$320,$80,15
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570007,MyPriority POS HSA Gold 1300,29698MI057,,MIN001,MIS003,MIF002,New,POS,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/BC2100742CE54347B0785B165E04AB09.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570007-01,Standard Gold On Exchange Plan,,0.791826367378235,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,"$1,300",$0,$700,$150,"$1,300",$380,$320,$80,16
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570007,MyPriority POS HSA Gold 1300,29698MI057,,MIN001,MIS003,MIF002,New,POS,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/BC2100742CE54347B0785B165E04AB09.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,17
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570007,MyPriority POS HSA Gold 1300,29698MI057,,MIN001,MIS003,MIF002,New,POS,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/BC2100742CE54347B0785B165E04AB09.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570007-03,Limited Cost Sharing Plan Variation,,0.791826367378235,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,"$1,300",$0,$700,$150,"$1,300",$380,$320,$80,18
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570015,MyPriority POS HSA Bronze 6300,29698MI057,,MIN001,MIS002,MIF002,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/D8FEB1B1C3CB4F4D8419D6978EB3CDBE.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570015-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,400",$0,$0,$80,19
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570015,MyPriority POS HSA Bronze 6300,29698MI057,,MIN001,MIS002,MIF002,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/D8FEB1B1C3CB4F4D8419D6978EB3CDBE.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570015-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,400",$0,$0,$80,20
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570015,MyPriority POS HSA Bronze 6300,29698MI057,,MIN001,MIS002,MIF002,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/D8FEB1B1C3CB4F4D8419D6978EB3CDBE.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570015-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,21
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570015,MyPriority POS HSA Bronze 6300,29698MI057,,MIN001,MIS002,MIF002,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/D8FEB1B1C3CB4F4D8419D6978EB3CDBE.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570015-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,"$5,400",$0,$0,$80,22
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570016,MyPriority POS HSA Silver 1500,29698MI057,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/E4F240FC69374D998620C6F1CA211FA3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570016-00,Standard Silver Off Exchange Plan,,0.681715130805969,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"$10,200","$20,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,100",$150,"$1,500",$660,$650,$80,23
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570016,MyPriority POS HSA Silver 1500,29698MI057,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/E4F240FC69374D998620C6F1CA211FA3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570016-01,Standard Silver On Exchange Plan,,0.681715130805969,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"$10,200","$20,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,100",$150,"$1,500",$660,$650,$80,24
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570016,MyPriority POS HSA Silver 1500,29698MI057,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/E4F240FC69374D998620C6F1CA211FA3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,25
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570016,MyPriority POS HSA Silver 1500,29698MI057,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/E4F240FC69374D998620C6F1CA211FA3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570016-03,Limited Cost Sharing Plan Variation,,0.681715130805969,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"$10,200","$20,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,100",$150,"$1,500",$660,$650,$80,26
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570016,MyPriority POS HSA Silver 1500,29698MI057,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/E4F240FC69374D998620C6F1CA211FA3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570016-04,73% AV Level Silver Plan,,0.739735305309296,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",30%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$750,$20,"$1,330",$150,$750,$720,$820,$80,27
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570016,MyPriority POS HSA Silver 1500,29698MI057,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/E4F240FC69374D998620C6F1CA211FA3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570016-05,87% AV Level Silver Plan,,0.877512097358704,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,30%,,,,$100,$200,Not Applicable,Not Applicable,$50,$0,"$1,200",$150,$50,$500,$700,$80,28
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570016,MyPriority POS HSA Silver 1500,29698MI057,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/E4F240FC69374D998620C6F1CA211FA3.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Silver&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570016-06,94% AV Level Silver Plan,,0.945953547954559,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,$800,"$1,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$25,$50,30%,,,,$50,$100,Not Applicable,Not Applicable,$25,$0,$375,$150,$25,$80,$295,$80,29
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,7,29698,MI,Individual,No,38-2715520,29698MI0570017,MyPriority POS HSA Gold 1300,29698MI057,,MIN001,MIS002,MIF002,New,POS,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/BC2100742CE54347B0785B165E04AB09.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA_Gold&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570017-00,Standard Gold Off Exchange Plan,,0.791826367378235,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,"$1,300",$0,$700,$150,"$1,300",$380,$320,$80,30
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570008,MyPriority POS Bronze 6000,29698MI057,,MIN001,MIS003,MIF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/0C417C36D7F647E5BBA99046E25D3A9B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570008-01,Standard Bronze On Exchange Plan,,0.607166111469269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$150,"$5,400",$0,$0,$80,5
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560012,PriorityHSA POS 1300 2 tier Rx,29698MI056,,MIN001,MIS003,MIF003,Existing,POS,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/B2F5956B843349F0BA8B1F96B0644FF6.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=5ADA571B6E764CEDA1A9A5EF0DE4C633&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560012-01,Standard Gold On Exchange Plan,,0.786711633205414,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,400","$4,800",,,"$4,800","$9,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,"$1,300",$20,$390,$150,"$1,300",$360,$570,$80,5
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570008,MyPriority POS Bronze 6000,29698MI057,,MIN001,MIS003,MIF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/0C417C36D7F647E5BBA99046E25D3A9B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560049,PriorityHSA POS 1300 2 tier Rx,29698MI056,,MIN001,MIS002,MIF003,New,POS,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/B2F5956B843349F0BA8B1F96B0644FF6.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=5ADA571B6E764CEDA1A9A5EF0DE4C633&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560049-00,Standard Gold Off Exchange Plan,,0.786711633205414,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,400","$4,800",,,"$4,800","$9,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,"$1,300",$20,$390,$150,"$1,300",$360,$570,$80,6
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560049,PriorityHSA POS 1300 2 tier Rx,29698MI056,,MIN001,MIS002,MIF003,New,POS,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/B2F5956B843349F0BA8B1F96B0644FF6.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=5ADA571B6E764CEDA1A9A5EF0DE4C633&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560049-01,Standard Gold On Exchange Plan,,0.786711633205414,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,400","$4,800",,,"$4,800","$9,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,"$1,300",$20,$390,$150,"$1,300",$360,$570,$80,7
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570020,MyPriority POS Silver 650,29698MI057,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570019,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/23D48EA6EFF74E30BBFD8D85E1665750.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverLow&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570020-01,Standard Silver On Exchange Plan,,0.719465851783752,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$650,"$1,300",30%,,,,"$1,300","$2,600",Not Applicable,Not Applicable,$650,$20,"$1,360",$150,$650,$720,$850,$80,34
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570020,MyPriority POS Silver 650,29698MI057,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570019,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/23D48EA6EFF74E30BBFD8D85E1665750.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverLow&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570020-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,35
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570008,MyPriority POS Bronze 6000,29698MI057,,MIN001,MIS003,MIF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/0C417C36D7F647E5BBA99046E25D3A9B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570008-03,Limited Cost Sharing Plan Variation,,0.607166111469269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$150,"$5,400",$0,$0,$80,7
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570009,MyPriority POS Silver 1400,29698MI057,,MIN001,MIS003,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/7838C4AC30B749AABE84CF71F516AB3B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570009-00,Standard Silver Off Exchange Plan,,0.682635962963104,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,400",$0,"$1,140",$150,"$1,400",$100,"$1,180",$80,8
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570009,MyPriority POS Silver 1400,29698MI057,,MIN001,MIS003,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/7838C4AC30B749AABE84CF71F516AB3B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570009-01,Standard Silver On Exchange Plan,,0.682635962963104,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,400",$0,"$1,140",$150,"$1,400",$100,"$1,180",$80,9
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570009,MyPriority POS Silver 1400,29698MI057,,MIN001,MIS003,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/7838C4AC30B749AABE84CF71F516AB3B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570009,MyPriority POS Silver 1400,29698MI057,,MIN001,MIS003,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/7838C4AC30B749AABE84CF71F516AB3B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570009-03,Limited Cost Sharing Plan Variation,,0.682635962963104,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,400",$0,"$1,140",$150,"$1,400",$100,"$1,180",$80,11
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570009,MyPriority POS Silver 1400,29698MI057,,MIN001,MIS003,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/7838C4AC30B749AABE84CF71F516AB3B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570009-04,73% AV Level Silver Plan,,0.739561200141907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$575,"$1,150",30%,,,,"$1,150","$2,300",Not Applicable,Not Applicable,$575,$20,"$1,380",$150,$575,$740,$870,$80,12
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560015,PriorityHSA POS 2000,29698MI056,,MIN001,MIS003,MIF002,Existing,POS,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/DDCEA9BBD61F4AC3B9ACFB55744B6F96.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=5ADA571B6E764CEDA1A9A5EF0DE4C633&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560015-00,Standard Silver Off Exchange Plan,,0.687539637088776,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,$950,$150,"$2,000",$580,$570,$80,12
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560015,PriorityHSA POS 2000,29698MI056,,MIN001,MIS003,MIF002,Existing,POS,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/DDCEA9BBD61F4AC3B9ACFB55744B6F96.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=5ADA571B6E764CEDA1A9A5EF0DE4C633&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560015-01,Standard Silver On Exchange Plan,,0.687539637088776,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,$950,$150,"$2,000",$580,$570,$80,13
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570009,MyPriority POS Silver 1400,29698MI057,,MIN001,MIS003,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/7838C4AC30B749AABE84CF71F516AB3B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570009-05,87% AV Level Silver Plan,,0.876174330711365,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$2,600","$5,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,30%,,,,$100,$200,Not Applicable,Not Applicable,$50,$0,"$1,250",$150,$50,$230,"$1,020",$80,13
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570009,MyPriority POS Silver 1400,29698MI057,,MIN001,MIS003,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/7838C4AC30B749AABE84CF71F516AB3B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570009-06,94% AV Level Silver Plan,,0.946934282779694,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,$800,"$1,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$25,$50,30%,,,,$50,$100,Not Applicable,Not Applicable,$25,$0,$375,$150,$25,$80,$295,$80,14
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560052,PriorityHSA POS 2000,29698MI056,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/DDCEA9BBD61F4AC3B9ACFB55744B6F96.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=5ADA571B6E764CEDA1A9A5EF0DE4C633&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560052-00,Standard Silver Off Exchange Plan,,0.687539637088776,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,$950,$150,"$2,000",$580,$570,$80,14
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560052,PriorityHSA POS 2000,29698MI056,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/DDCEA9BBD61F4AC3B9ACFB55744B6F96.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=5ADA571B6E764CEDA1A9A5EF0DE4C633&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560052-01,Standard Silver On Exchange Plan,,0.687539637088776,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,$950,$150,"$2,000",$580,$570,$80,15
2015,MI,34620,SERFF,5,2014-11-14 14:52:18,3,34620,MI,Individual,No,38-3295207,34620MI0040001,Harbor Choice Bronze,34620MI004,,MIN001,MIS001,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://www.harborhealthchoice.com/HMOBronze,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI,,https://www.harborhealthchoice.com/formulary,34620MI0040001-01,Standard Bronze On Exchange Plan,,0.587491035461426,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,MI,34620,SERFF,5,2014-11-14 14:52:18,3,34620,MI,Individual,No,38-3295207,34620MI0040001,Harbor Choice Bronze,34620MI004,,MIN001,MIS001,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://www.harborhealthchoice.com/HMOBronze,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI,,https://www.harborhealthchoice.com/formulary,34620MI0040001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570010,MyPriority POS Silver 650,29698MI057,,MIN001,MIS003,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570009,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/23D48EA6EFF74E30BBFD8D85E1665750.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverLow&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570010-00,Standard Silver Off Exchange Plan,,0.719465851783752,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$650,"$1,300",30%,,,,"$1,300","$2,600",Not Applicable,Not Applicable,$650,$20,"$1,360",$150,$650,$720,$850,$80,15
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570010,MyPriority POS Silver 650,29698MI057,,MIN001,MIS003,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570009,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/23D48EA6EFF74E30BBFD8D85E1665750.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverLow&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570010-01,Standard Silver On Exchange Plan,,0.719465851783752,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$650,"$1,300",30%,,,,"$1,300","$2,600",Not Applicable,Not Applicable,$650,$20,"$1,360",$150,$650,$720,$850,$80,16
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570010,MyPriority POS Silver 650,29698MI057,,MIN001,MIS003,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570009,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/23D48EA6EFF74E30BBFD8D85E1665750.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverLow&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,17
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570010,MyPriority POS Silver 650,29698MI057,,MIN001,MIS003,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570009,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/23D48EA6EFF74E30BBFD8D85E1665750.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverLow&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570010-03,Limited Cost Sharing Plan Variation,,0.719465851783752,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$650,"$1,300",30%,,,,"$1,300","$2,600",Not Applicable,Not Applicable,$650,$20,"$1,360",$150,$650,$720,$850,$80,18
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560027,PriorityHSA POS 4000,29698MI056,,MIN001,MIS003,MIF002,Existing,POS,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/36FF737605B841F5ABE26F098CB0EE53.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=5ADA571B6E764CEDA1A9A5EF0DE4C633&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560027-00,Standard Bronze Off Exchange Plan,,0.595907390117645,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$20,$470,$150,"$4,000",$260,$200,$80,18
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560027,PriorityHSA POS 4000,29698MI056,,MIN001,MIS003,MIF002,Existing,POS,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/36FF737605B841F5ABE26F098CB0EE53.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=5ADA571B6E764CEDA1A9A5EF0DE4C633&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560027-01,Standard Bronze On Exchange Plan,,0.595907390117645,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$20,$470,$150,"$4,000",$260,$200,$80,19
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570010,MyPriority POS Silver 650,29698MI057,,MIN001,MIS003,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570009,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/23D48EA6EFF74E30BBFD8D85E1665750.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverLow&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570010-04,73% AV Level Silver Plan,,0.739561200141907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$575,"$1,150",30%,,,,"$1,150","$2,300",Not Applicable,Not Applicable,$575,$0,$570,$150,$575,$200,$370,$80,19
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570010,MyPriority POS Silver 650,29698MI057,,MIN001,MIS003,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570009,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/23D48EA6EFF74E30BBFD8D85E1665750.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverLow&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570010-05,87% AV Level Silver Plan,,0.876174330711365,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$2,600","$5,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,30%,,,,$100,$200,Not Applicable,Not Applicable,$50,$0,"$1,250",$150,$50,$890,$360,$80,20
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560054,PriorityHSA POS 4000,29698MI056,,MIN001,MIS002,MIF002,New,POS,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/36FF737605B841F5ABE26F098CB0EE53.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=5ADA571B6E764CEDA1A9A5EF0DE4C633&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560054-00,Standard Bronze Off Exchange Plan,,0.595907390117645,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$20,$470,$150,"$4,000",$260,$200,$80,20
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,SHOP (Small Group),No,38-2715520,29698MI0560054,PriorityHSA POS 4000,29698MI056,,MIN001,MIS002,MIF002,New,POS,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Coverage Only,Yes,Alternate/Out of Network Benefit Coverage,No,http://www.priorityhealth.com/~/media/36FF737605B841F5ABE26F098CB0EE53.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/~/link.aspx?_id=5ADA571B6E764CEDA1A9A5EF0DE4C633&_z=z,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0560054-01,Standard Bronze On Exchange Plan,,0.595907390117645,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$20,$470,$150,"$4,000",$260,$200,$80,21
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570010,MyPriority POS Silver 650,29698MI057,,MIN001,MIS003,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570009,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/23D48EA6EFF74E30BBFD8D85E1665750.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverLow&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570010-06,94% AV Level Silver Plan,,0.946934282779694,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,$800,"$1,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$25,$50,30%,,,,$50,$100,Not Applicable,Not Applicable,$25,$0,$375,$150,$25,$80,$295,$80,21
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570018,MyPriority POS Bronze 6000,29698MI057,,MIN001,MIS002,MIF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/0C417C36D7F647E5BBA99046E25D3A9B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570018-00,Standard Bronze Off Exchange Plan,,0.607166111469269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$150,"$5,400",$0,$0,$80,22
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570018,MyPriority POS Bronze 6000,29698MI057,,MIN001,MIS002,MIF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/0C417C36D7F647E5BBA99046E25D3A9B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570018-01,Standard Bronze On Exchange Plan,,0.607166111469269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$150,"$5,400",$0,$0,$80,23
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570018,MyPriority POS Bronze 6000,29698MI057,,MIN001,MIS002,MIF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/0C417C36D7F647E5BBA99046E25D3A9B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570018-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,24
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570018,MyPriority POS Bronze 6000,29698MI057,,MIN001,MIS002,MIF002,New,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/0C417C36D7F647E5BBA99046E25D3A9B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_Bronze&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570018-03,Limited Cost Sharing Plan Variation,,0.607166111469269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$150,"$5,400",$0,$0,$80,25
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570019,MyPriority POS Silver 1400,29698MI057,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/7838C4AC30B749AABE84CF71F516AB3B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570019-00,Standard Silver Off Exchange Plan,,0.682635962963104,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,400",$0,"$1,140",$150,"$1,400",$100,"$1,180",$80,26
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570019,MyPriority POS Silver 1400,29698MI057,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/7838C4AC30B749AABE84CF71F516AB3B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570019-01,Standard Silver On Exchange Plan,,0.682635962963104,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,400",$0,"$1,140",$150,"$1,400",$100,"$1,180",$80,27
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570019,MyPriority POS Silver 1400,29698MI057,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/7838C4AC30B749AABE84CF71F516AB3B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570019-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,28
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570019,MyPriority POS Silver 1400,29698MI057,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/7838C4AC30B749AABE84CF71F516AB3B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570019-03,Limited Cost Sharing Plan Variation,,0.682635962963104,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",30%,,,,"$2,800","$5,600",Not Applicable,Not Applicable,"$1,400",$0,"$1,140",$150,"$1,400",$100,"$1,180",$80,29
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570019,MyPriority POS Silver 1400,29698MI057,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/7838C4AC30B749AABE84CF71F516AB3B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570019-04,73% AV Level Silver Plan,,0.739561200141907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$575,"$1,150",30%,,,,"$1,150","$2,300",Not Applicable,Not Applicable,$575,$20,"$1,380",$150,$575,$740,$870,$80,30
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570019,MyPriority POS Silver 1400,29698MI057,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/7838C4AC30B749AABE84CF71F516AB3B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570019-05,87% AV Level Silver Plan,,0.876174330711365,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$2,600","$5,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,30%,,,,$100,$200,Not Applicable,Not Applicable,$50,$0,"$1,250",$150,$50,$230,"$1,020",$80,31
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570019,MyPriority POS Silver 1400,29698MI057,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/7838C4AC30B749AABE84CF71F516AB3B.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverMid&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570019-06,94% AV Level Silver Plan,,0.946934282779694,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,$800,"$1,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$25,$50,30%,,,,$50,$100,Not Applicable,Not Applicable,$25,$0,$375,$150,$25,$80,$295,$80,32
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570020,MyPriority POS Silver 650,29698MI057,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570019,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/23D48EA6EFF74E30BBFD8D85E1665750.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverLow&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570020-00,Standard Silver Off Exchange Plan,,0.719465851783752,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$650,"$1,300",30%,,,,"$1,300","$2,600",Not Applicable,Not Applicable,$650,$20,"$1,360",$150,$650,$720,$850,$80,33
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570020,MyPriority POS Silver 650,29698MI057,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570019,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/23D48EA6EFF74E30BBFD8D85E1665750.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverLow&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570020-03,Limited Cost Sharing Plan Variation,,0.719465851783752,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$650,"$1,300",30%,,,,"$1,300","$2,600",Not Applicable,Not Applicable,$650,$20,"$1,360",$150,$650,$720,$850,$80,36
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570020,MyPriority POS Silver 650,29698MI057,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570019,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/23D48EA6EFF74E30BBFD8D85E1665750.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverLow&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570020-04,73% AV Level Silver Plan,,0.739561200141907,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$575,"$1,150",30%,,,,"$1,150","$2,300",Not Applicable,Not Applicable,$575,$0,$570,$150,$575,$200,$370,$80,37
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570020,MyPriority POS Silver 650,29698MI057,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570019,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/23D48EA6EFF74E30BBFD8D85E1665750.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverLow&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570020-05,87% AV Level Silver Plan,,0.876174330711365,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$2,600","$5,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,30%,,,,$100,$200,Not Applicable,Not Applicable,$50,$0,"$1,250",$150,$50,$890,$360,$80,38
2015,MI,29698,SERFF,11,2015-05-22 14:18:43,8,29698,MI,Individual,No,38-2715520,29698MI0570020,MyPriority POS Silver 650,29698MI057,,MIN001,MIS002,MIF002,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,29698MI0570019,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$400,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Alternate Benefit Level,No,http://www.priorityhealth.com/~/media/23D48EA6EFF74E30BBFD8D85E1665750.pdf,https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection,http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2015/pos-plans/mypriority-pos?utm_source=FFM&utm_content=POS_SilverLow&utm_campaign=2015OEP,https://www.priorityhealth.com/~/media/documents/individual/2015-mypriority-formulary.pdf,29698MI0570020-06,94% AV Level Silver Plan,,0.946934282779694,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,$800,"$1,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$25,$50,30%,,,,$50,$100,Not Applicable,Not Applicable,$25,$0,$375,$150,$25,$80,$295,$80,39
2015,MI,34620,SERFF,5,2014-11-14 14:52:18,1,34620,MI,Individual,No,38-3295207,34620MI0020001,Harbor Choice Gold,34620MI002,,MIN001,MIS001,MIF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://www.harborhealthchoice.com/HMOGold,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI,,https://www.harborhealthchoice.com/formulary,34620MI0020001-00,Standard Gold Off Exchange Plan,,0.787902593612671,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,MI,34620,SERFF,5,2014-11-14 14:52:18,1,34620,MI,Individual,No,38-3295207,34620MI0020001,Harbor Choice Gold,34620MI002,,MIN001,MIS001,MIF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://www.harborhealthchoice.com/HMOGold,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI,,https://www.harborhealthchoice.com/formulary,34620MI0020001-01,Standard Gold On Exchange Plan,,0.787902593612671,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,MI,34620,SERFF,5,2014-11-14 14:52:18,1,34620,MI,Individual,No,38-3295207,34620MI0020001,Harbor Choice Gold,34620MI002,,MIN001,MIS001,MIF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://www.harborhealthchoice.com/HMOGold,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI,,https://www.harborhealthchoice.com/formulary,34620MI0020001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MI,34620,SERFF,5,2014-11-14 14:52:18,1,34620,MI,Individual,No,38-3295207,34620MI0020001,Harbor Choice Gold,34620MI002,,MIN001,MIS001,MIF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://www.harborhealthchoice.com/HMOGold,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI,,https://www.harborhealthchoice.com/formulary,34620MI0020001-03,Limited Cost Sharing Plan Variation,,0.787902593612671,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,MI,34620,SERFF,5,2014-11-14 14:52:18,2,34620,MI,Individual,No,38-3295207,34620MI0030001,Harbor Choice Silver,34620MI003,,MIN001,MIS001,MIF002,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://www.harborhealthchoice.com/HMOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI,,https://www.harborhealthchoice.com/formulary,34620MI0030001-00,Standard Silver Off Exchange Plan,68.06%,0.680624902248383,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,400","$4,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,MI,34620,SERFF,5,2014-11-14 14:52:18,2,34620,MI,Individual,No,38-3295207,34620MI0030001,Harbor Choice Silver,34620MI003,,MIN001,MIS001,MIF002,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://www.harborhealthchoice.com/HMOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI,,https://www.harborhealthchoice.com/formulary,34620MI0030001-01,Standard Silver On Exchange Plan,68.06%,0.680624902248383,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,400","$4,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,MI,34620,SERFF,5,2014-11-14 14:52:18,2,34620,MI,Individual,No,38-3295207,34620MI0030001,Harbor Choice Silver,34620MI003,,MIN001,MIS001,MIF002,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://www.harborhealthchoice.com/HMOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI,,https://www.harborhealthchoice.com/formulary,34620MI0030001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MI,34620,SERFF,5,2014-11-14 14:52:18,2,34620,MI,Individual,No,38-3295207,34620MI0030001,Harbor Choice Silver,34620MI003,,MIN001,MIS001,MIF002,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://www.harborhealthchoice.com/HMOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI,,https://www.harborhealthchoice.com/formulary,34620MI0030001-03,Limited Cost Sharing Plan Variation,68.06%,0.680624902248383,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,400","$4,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,MI,34620,SERFF,5,2014-11-14 14:52:18,2,34620,MI,Individual,No,38-3295207,34620MI0030001,Harbor Choice Silver,34620MI003,,MIN001,MIS001,MIF002,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://www.harborhealthchoice.com/HMOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI,,https://www.harborhealthchoice.com/formulary,34620MI0030001-04,73% AV Level Silver Plan,73.94%,0.739357948303223,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,950","$7,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,MI,34620,SERFF,5,2014-11-14 14:52:18,2,34620,MI,Individual,No,38-3295207,34620MI0030001,Harbor Choice Silver,34620MI003,,MIN001,MIS001,MIF002,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://www.harborhealthchoice.com/HMOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI,,https://www.harborhealthchoice.com/formulary,34620MI0030001-05,87% AV Level Silver Plan,87.98%,0.870021224021912,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,MI,34620,SERFF,5,2014-11-14 14:52:18,2,34620,MI,Individual,No,38-3295207,34620MI0030001,Harbor Choice Silver,34620MI003,,MIN001,MIS001,MIF002,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://www.harborhealthchoice.com/HMOSilver,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI,,https://www.harborhealthchoice.com/formulary,34620MI0030001-06,94% AV Level Silver Plan,94.97%,0.932009756565094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$575,"$1,150",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,MI,34620,SERFF,5,2014-11-14 14:52:18,3,34620,MI,Individual,No,38-3295207,34620MI0040001,Harbor Choice Bronze,34620MI004,,MIN001,MIS001,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://www.harborhealthchoice.com/HMOBronze,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI,,https://www.harborhealthchoice.com/formulary,34620MI0040001-00,Standard Bronze Off Exchange Plan,,0.587491035461426,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,MI,34620,SERFF,5,2014-11-14 14:52:18,3,34620,MI,Individual,No,38-3295207,34620MI0040001,Harbor Choice Bronze,34620MI004,,MIN001,MIS001,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Emergency Services Only,No,https://www.harborhealthchoice.com/HMOBronze,https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI,,https://www.harborhealthchoice.com/formulary,34620MI0040001-03,Limited Cost Sharing Plan Variation,,0.587491035461426,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,MI,34930,SERFF,3,2014-08-11 09:11:26,1,34930,MI,Individual,Yes,38-1791480,34930MI0090001,"Delta Dental Individual PPO, EHB Certified",34930MI009,,MIN001,MIS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.75,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34930MI0090001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,$50,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,34930,SERFF,3,2014-08-11 09:11:26,1,34930,MI,SHOP (Small Group),Yes,38-1791480,34930MI0100001,"Delta Dental Group PPO, EHB Certified",34930MI010,,MIN001,MIS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.03,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34930MI0100001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,34930,SERFF,3,2014-08-11 09:11:26,1,34930,MI,Individual,Yes,38-1791480,34930MI0090002,"Delta Dental Individual PPO, EHB Certified",34930MI009,,MIN001,MIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.63,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34930MI0090002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,$50,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,34930,SERFF,3,2014-08-11 09:11:26,1,34930,MI,SHOP (Small Group),Yes,38-1791480,34930MI0100002,"Delta Dental Group PPO, EHB Certified",34930MI010,,MIN001,MIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.25,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34930MI0100002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,34930,SERFF,3,2014-08-11 09:11:26,1,34930,MI,SHOP (Small Group),Yes,38-1791480,34930MI0100003,"Delta Dental Group PPO, EHB Certified",34930MI010,,MIN001,MIS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.03,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34930MI0100003-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,34930,SERFF,3,2014-08-11 09:11:26,1,34930,MI,SHOP (Small Group),Yes,38-1791480,34930MI0100004,"Delta Dental Group PPO, EHB Certified",34930MI010,,MIN001,MIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.25,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34930MI0100004-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,34930,SERFF,3,2014-08-11 09:11:26,1,34930,MI,SHOP (Small Group),Yes,38-1791480,34930MI0130001,"Delta Dental Group PPO Network Only, EHB Certified",34930MI013,,MIN002,MIS002,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.80,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34930MI0130001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MI,34930,SERFF,3,2014-08-11 09:11:26,1,34930,MI,SHOP (Small Group),Yes,38-1791480,34930MI0130002,"Delta Dental Group PPO Network Only, EHB Certified",34930MI013,,MIN002,MIS002,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.93,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34930MI0130002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MI,34930,SERFF,3,2014-08-11 09:11:26,1,34930,MI,SHOP (Small Group),Yes,38-1791480,34930MI0130003,"Delta Dental Group PPO Network Only, EHB Certified",34930MI013,,MIN002,MIS002,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.80,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34930MI0130003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,MI,34930,SERFF,3,2014-08-11 09:11:26,1,34930,MI,SHOP (Small Group),Yes,38-1791480,34930MI0130004,"Delta Dental Group PPO Network Only, EHB Certified",34930MI013,,MIN002,MIS002,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.93,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34930MI0130004-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,MI,34930,SERFF,3,2014-08-11 09:11:26,2,34930,MI,SHOP (Small Group),Yes,38-1791480,34930MI0110001,"Delta Dental Group Pediatric-Only PPO, EHB Certified",34930MI011,,MIN001,MIS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$33.03,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34930MI0110001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,34930,SERFF,3,2014-08-11 09:11:26,2,34930,MI,Individual,Yes,38-1791480,34930MI0120001,"Delta Dental Individual Pediatric-Only PPO, EHB Certified",34930MI012,,MIN001,MIS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$34.75,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34930MI0120001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,$0,$0,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,34930,SERFF,3,2014-08-11 09:11:26,2,34930,MI,Individual,Yes,38-1791480,34930MI0120002,"Delta Dental Individual Pediatric-Only PPO, EHB Certified",34930MI012,,MIN001,MIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.63,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34930MI0120002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,$0,$0,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,34930,SERFF,3,2014-08-11 09:11:26,2,34930,MI,SHOP (Small Group),Yes,38-1791480,34930MI0110002,"Delta Dental Group Pediatric-Only PPO, EHB Certified",34930MI011,,MIN001,MIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$27.25,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34930MI0110002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,34930,SERFF,3,2014-08-11 09:11:26,2,34930,MI,SHOP (Small Group),Yes,38-1791480,34930MI0110003,"Delta Dental Group Pediatric-Only PPO, EHB Certified",34930MI011,,MIN001,MIS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$33.03,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34930MI0110003-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,34930,SERFF,3,2014-08-11 09:11:26,2,34930,MI,SHOP (Small Group),Yes,38-1791480,34930MI0110004,"Delta Dental Group Pediatric-Only PPO, EHB Certified",34930MI011,,MIN001,MIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$27.25,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34930MI0110004-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,34930,SERFF,3,2014-08-11 09:11:26,2,34930,MI,SHOP (Small Group),Yes,38-1791480,34930MI0140001,"Delta Dental Group Pediatric-Only PPO, EHB Certified",34930MI014,,MIN002,MIS002,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$30.80,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34930MI0140001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MI,34930,SERFF,3,2014-08-11 09:11:26,2,34930,MI,SHOP (Small Group),Yes,38-1791480,34930MI0140002,"Delta Dental Group Pediatric-Only PPO, EHB Certified",34930MI014,,MIN002,MIS002,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.93,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34930MI0140002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MI,34930,SERFF,3,2014-08-11 09:11:26,2,34930,MI,SHOP (Small Group),Yes,38-1791480,34930MI0140003,"Delta Dental Group Pediatric-Only PPO, EHB Certified",34930MI014,,MIN002,MIS002,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$30.80,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34930MI0140003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,MI,34930,SERFF,3,2014-08-11 09:11:26,2,34930,MI,SHOP (Small Group),Yes,38-1791480,34930MI0140004,"Delta Dental Group Pediatric-Only PPO, EHB Certified",34930MI014,,MIN002,MIS002,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.93,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,34930MI0140004-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,1,35700,MI,Individual,Yes,95-6042390,35700MI0020001,BESTOne Child Dental Plus,35700MI002,,MIN001,MIS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$39.36,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BESTOne_Child_Dental_Plus_Plan.pdf,,35700MI0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,1,35700,MI,SHOP (Small Group),Yes,95-6042390,35700MI0010001,BEST Life Child Dental Plus,35700MI001,,MIN001,MIS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$31.48,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BEST_Life_Child_Dental_Plus_Plan.pdf,,35700MI0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,2,35700,MI,SHOP (Small Group),Yes,95-6042390,35700MI0010002,BESTLife Child Dental,35700MI001,,MIN001,MIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.13,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BEST_Life_Child_Dental_Plan.pdf,,35700MI0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,2,35700,MI,Individual,Yes,95-6042390,35700MI0020002,BESTOne Child Dental,35700MI002,,MIN001,MIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$32.66,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BESTOne_Child_Dental_Plan.pdf,,35700MI0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,3,35700,MI,Individual,Yes,95-6042390,35700MI0020003,BESTOne Dental Advantage-Gold,35700MI002,,MIN001,MIS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.36,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BESTOne_Dental_Advantage-Gold_Plan.pdf,,35700MI0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,3,35700,MI,SHOP (Small Group),Yes,95-6042390,35700MI0010037,BEST Dental Premium,35700MI001,,MIN001,MIS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.48,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BESTDental_Premium_Plan.pdf,,35700MI0010037-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,3,35700,MI,SHOP (Small Group),Yes,95-6042390,35700MI0010037,BEST Dental Premium,35700MI001,,MIN001,MIS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.48,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BESTDental_Premium_Plan.pdf,,35700MI0010037-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,3,35700,MI,Individual,Yes,95-6042390,35700MI0020003,BESTOne Dental Advantage-Gold,35700MI002,,MIN001,MIS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.36,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BESTOne_Dental_Advantage-Gold_Plan.pdf,,35700MI0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,3,35700,MI,Individual,Yes,95-6042390,35700MI0020004,BESTOne Dental Plus-Gold,35700MI002,,MIN001,MIS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.36,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BESTOne_Dental_Plus-Gold_Plan.pdf,,35700MI0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,3,35700,MI,SHOP (Small Group),Yes,95-6042390,35700MI0010038,BEST Dental Standard-H,35700MI001,,MIN001,MIS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.48,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BESTDental_Standard-H_Plan.pdf,,35700MI0010038-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,3,35700,MI,SHOP (Small Group),Yes,95-6042390,35700MI0010038,BEST Dental Standard-H,35700MI001,,MIN001,MIS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.48,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BESTDental_Standard-H_Plan.pdf,,35700MI0010038-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,3,35700,MI,Individual,Yes,95-6042390,35700MI0020004,BESTOne Dental Plus-Gold,35700MI002,,MIN001,MIS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.36,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BESTOne_Dental_Plus-Gold_Plan.pdf,,35700MI0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,3,35700,MI,SHOP (Small Group),Yes,95-6042390,35700MI0010040,BEST Dental Choice-H,35700MI001,,MIN001,MIS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.48,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BESTDental_Choice-H_Plan.pdf,,35700MI0010040-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,3,35700,MI,SHOP (Small Group),Yes,95-6042390,35700MI0010040,BEST Dental Choice-H,35700MI001,,MIN001,MIS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.48,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BESTDental_Choice-H_Plan.pdf,,35700MI0010040-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,4,35700,MI,Individual,Yes,95-6042390,35700MI0020005,BESTOne Dental Plus-Silver,35700MI002,,MIN001,MIS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.66,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BESTOne_Dental_Plus-Silver_Plan.pdf,,35700MI0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,4,35700,MI,SHOP (Small Group),Yes,95-6042390,35700MI0010039,BEST Dental Standard-L,35700MI001,,MIN001,MIS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.13,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BESTDental_Standard-L_Plan.pdf,,35700MI0010039-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,4,35700,MI,SHOP (Small Group),Yes,95-6042390,35700MI0010039,BEST Dental Standard-L,35700MI001,,MIN001,MIS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.13,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BESTDental_Standard-L_Plan.pdf,,35700MI0010039-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,4,35700,MI,Individual,Yes,95-6042390,35700MI0020005,BESTOne Dental Plus-Silver,35700MI002,,MIN001,MIS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.66,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BESTOne_Dental_Plus-Silver_Plan.pdf,,35700MI0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,4,35700,MI,Individual,Yes,95-6042390,35700MI0020006,BESTOne Dental Basic-Silver,35700MI002,,MIN001,MIS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.66,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BESTOne_Dental_Basic-Silver_Plan.pdf,,35700MI0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,4,35700,MI,SHOP (Small Group),Yes,95-6042390,35700MI0010041,BEST Dental Choice-L,35700MI001,,MIN001,MIS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.13,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BESTDental_Choice-L_Plan.pdf,,35700MI0010041-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,4,35700,MI,SHOP (Small Group),Yes,95-6042390,35700MI0010041,BEST Dental Choice-L,35700MI001,,MIN001,MIS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.13,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BESTDental_Choice-L_Plan.pdf,,35700MI0010041-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,4,35700,MI,Individual,Yes,95-6042390,35700MI0020006,BESTOne Dental Basic-Silver,35700MI002,,MIN001,MIS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$32.66,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BESTOne_Dental_Basic-Silver_Plan.pdf,,35700MI0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,4,35700,MI,SHOP (Small Group),Yes,95-6042390,35700MI0010042,BEST Dental Value,35700MI001,,MIN001,MIS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.13,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BESTDental_Value_Plan.pdf,,35700MI0010042-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MI,35700,SERFF,4,2014-09-11 12:10:19,4,35700,MI,SHOP (Small Group),Yes,95-6042390,35700MI0010042,BEST Dental Value,35700MI001,,MIN001,MIS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.13,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MI/2015/MI_BESTDental_Value_Plan.pdf,,35700MI0010042-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MI,36380,SERFF,3,2014-09-11 12:10:19,1,36380,MI,SHOP (Small Group),Yes,81-0170040,36380MI0010001,Assurant Dental ACAFFO High,36380MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$44.01,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same coverage as in service area,Yes,,,,,36380MI0010001-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,36380,SERFF,3,2014-09-11 12:10:19,2,36380,MI,SHOP (Small Group),Yes,81-0170040,36380MI0010002,Assurant Dental ACAFFO Low,36380MI001,,MIN001,MIS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$40.21,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same coverage as in service area,Yes,,,,,36380MI0010002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$80,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,1,37651,MI,Individual,No,38-2242827,37651MI0150001,HAP Personal Alliance 500 HMO,37651MI015,,MIN001,MIS001,MIF014,Existing,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9945,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-500hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150001-00,Standard Platinum Off Exchange Plan,,0.883794963359833,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,$0,$0,"$1,500","$3,000",$500,"$1,000",20%,,,,$0,$0,$500,"$1,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,1,37651,MI,Individual,No,38-2242827,37651MI0150001,HAP Personal Alliance 500 HMO,37651MI015,,MIN001,MIS001,MIF014,Existing,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9945,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-500hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150001-01,Standard Platinum On Exchange Plan,,0.883794963359833,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,$0,$0,"$1,500","$3,000",$500,"$1,000",20%,,,,$0,$0,$500,"$1,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,1,37651,MI,Individual,No,38-2242827,37651MI0150001,HAP Personal Alliance 500 HMO,37651MI015,,MIN001,MIS001,MIF014,Existing,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9945,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-500hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,1,37651,MI,Individual,No,38-2242827,37651MI0150001,HAP Personal Alliance 500 HMO,37651MI015,,MIN001,MIS001,MIF014,Existing,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9945,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-500hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150001-03,Limited Cost Sharing Plan Variation,,0.883794963359833,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,$0,$0,"$1,500","$3,000",$500,"$1,000",20%,,,,$0,$0,$500,"$1,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,1,37651,MI,Individual,No,38-2242827,37651MI0150005,HAP Personal Alliance 2500 HMO,37651MI015,,MIN001,MIS001,MIF012,Existing,HMO,Silver,No,Both,No,No,,,0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9931,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,http://www.hap.org/sbc/2015-pa-2500hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150005-00,Standard Silver Off Exchange Plan,,0.68641197681427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,"$6,350","$12,700","$2,500","$5,000",20%,,,,$0,$0,"$2,500","$5,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,1,37651,MI,Individual,No,38-2242827,37651MI0150005,HAP Personal Alliance 2500 HMO,37651MI015,,MIN001,MIS001,MIF012,Existing,HMO,Silver,No,Both,No,No,,,0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9931,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,http://www.hap.org/sbc/2015-pa-2500hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150005-01,Standard Silver On Exchange Plan,,0.68641197681427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,"$6,350","$12,700","$2,500","$5,000",20%,,,,$0,$0,"$2,500","$5,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,1,37651,MI,Individual,No,38-2242827,37651MI0150005,HAP Personal Alliance 2500 HMO,37651MI015,,MIN001,MIS001,MIF012,Existing,HMO,Silver,No,Both,No,No,,,0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9931,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,http://www.hap.org/sbc/2015-pa-2500hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,1,37651,MI,Individual,No,38-2242827,37651MI0150005,HAP Personal Alliance 2500 HMO,37651MI015,,MIN001,MIS001,MIF012,Existing,HMO,Silver,No,Both,No,No,,,0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9931,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,http://www.hap.org/sbc/2015-pa-2500hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150005-03,Limited Cost Sharing Plan Variation,,0.68641197681427,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,"$6,350","$12,700","$2,500","$5,000",20%,,,,$0,$0,"$2,500","$5,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,1,37651,MI,Individual,No,38-2242827,37651MI0150005,HAP Personal Alliance 2500 HMO,37651MI015,,MIN001,MIS001,MIF012,Existing,HMO,Silver,No,Both,No,No,,,0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9931,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,http://www.hap.org/sbc/2015-pa-2500hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150005-04,73% AV Level Silver Plan,,0.736137211322784,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,$0,$0,"$5,000","$10,000","$2,500","$5,000",20%,,,,$0,$0,"$2,500","$5,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,1,37651,MI,Individual,No,38-2242827,37651MI0150005,HAP Personal Alliance 2500 HMO,37651MI015,,MIN001,MIS001,MIF012,Existing,HMO,Silver,No,Both,No,No,,,0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9931,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,http://www.hap.org/sbc/2015-pa-2500hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150005-05,87% AV Level Silver Plan,,0.866551399230957,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,$0,$0,"$1,500","$3,000",$500,"$1,000",0%,,,,$0,$0,$500,"$1,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,1,37651,MI,Individual,No,38-2242827,37651MI0150005,HAP Personal Alliance 2500 HMO,37651MI015,,MIN001,MIS001,MIF012,Existing,HMO,Silver,No,Both,No,No,,,0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9931,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,http://www.hap.org/sbc/2015-pa-2500hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150005-06,94% AV Level Silver Plan,,0.930617272853851,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,$0,$0,$750,"$1,500",$100,$200,0%,,,,$0,$0,$100,$200,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,2,37651,MI,Individual,No,38-2242827,37651MI0150009,HAP Personal Alliance 1500 HMO,37651MI015,,MIN001,MIS001,MIF009,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-1500hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150009-00,Standard Gold Off Exchange Plan,,0.780206501483917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,$0,$0,"$3,500","$7,000","$1,500","$3,000",20%,,,,$0,$0,"$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,2,37651,MI,Individual,No,38-2242827,37651MI0150009,HAP Personal Alliance 1500 HMO,37651MI015,,MIN001,MIS001,MIF009,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-1500hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150009-01,Standard Gold On Exchange Plan,,0.780206501483917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,$0,$0,"$3,500","$7,000","$1,500","$3,000",20%,,,,$0,$0,"$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,2,37651,MI,Individual,No,38-2242827,37651MI0150009,HAP Personal Alliance 1500 HMO,37651MI015,,MIN001,MIS001,MIF009,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-1500hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150009-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,2,37651,MI,Individual,No,38-2242827,37651MI0150009,HAP Personal Alliance 1500 HMO,37651MI015,,MIN001,MIS001,MIF009,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-1500hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150009-03,Limited Cost Sharing Plan Variation,,0.780206501483917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,$0,$0,"$3,500","$7,000","$1,500","$3,000",20%,,,,$0,$0,"$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,3,37651,MI,Individual,No,38-2242827,37651MI0150010,HAP Personal Alliance 2000 HMO (HSA),37651MI015,,MIN001,MIS001,MIF011,New,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2000hmoHSA.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150010-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,"$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,$0,$0,"$2,000","$4,000",,,,,,,,,4
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,3,37651,MI,Individual,No,38-2242827,37651MI0150010,HAP Personal Alliance 2000 HMO (HSA),37651MI015,,MIN001,MIS001,MIF011,New,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2000hmoHSA.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150010-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,"$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,$0,$0,"$2,000","$4,000",,,,,,,,,5
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,3,37651,MI,Individual,No,38-2242827,37651MI0150010,HAP Personal Alliance 2000 HMO (HSA),37651MI015,,MIN001,MIS001,MIF011,New,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2000hmoHSA.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,3,37651,MI,Individual,No,38-2242827,37651MI0150010,HAP Personal Alliance 2000 HMO (HSA),37651MI015,,MIN001,MIS001,MIF011,New,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2000hmoHSA.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150010-03,Limited Cost Sharing Plan Variation,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,"$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,$0,$0,"$2,000","$4,000",,,,,,,,,7
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,3,37651,MI,Individual,No,38-2242827,37651MI0150012,HAP Personal Alliance 5000 HMO (HSA),37651MI015,,MIN001,MIS001,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmoHSA.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150012-00,Standard Bronze Off Exchange Plan,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,$0,$0,"$6,450","$12,900",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,$0,$0,"$5,000","$10,000",,,,,,,,,8
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,3,37651,MI,Individual,No,38-2242827,37651MI0150012,HAP Personal Alliance 5000 HMO (HSA),37651MI015,,MIN001,MIS001,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmoHSA.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150012-01,Standard Bronze On Exchange Plan,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,$0,$0,"$6,450","$12,900",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,$0,$0,"$5,000","$10,000",,,,,,,,,9
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,3,37651,MI,Individual,No,38-2242827,37651MI0150012,HAP Personal Alliance 5000 HMO (HSA),37651MI015,,MIN001,MIS001,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmoHSA.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,3,37651,MI,Individual,No,38-2242827,37651MI0150012,HAP Personal Alliance 5000 HMO (HSA),37651MI015,,MIN001,MIS001,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmoHSA.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150012-03,Limited Cost Sharing Plan Variation,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,$0,$0,"$6,450","$12,900",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,$0,$0,"$5,000","$10,000",,,,,,,,,11
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,4,37651,MI,Individual,No,38-2242827,37651MI0150011,HAP Personal Alliance 3000 HMO,37651MI015,,MIN001,MIS001,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-3000hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150011-00,Standard Silver Off Exchange Plan,,0.691167831420898,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,"$6,000","$12,000","$3,000","$6,000",20%,,,,$0,$0,"$3,000","$6,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,4,37651,MI,Individual,No,38-2242827,37651MI0150011,HAP Personal Alliance 3000 HMO,37651MI015,,MIN001,MIS001,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-3000hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150011-01,Standard Silver On Exchange Plan,,0.691167831420898,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,"$6,000","$12,000","$3,000","$6,000",20%,,,,$0,$0,"$3,000","$6,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,4,37651,MI,Individual,No,38-2242827,37651MI0150011,HAP Personal Alliance 3000 HMO,37651MI015,,MIN001,MIS001,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-3000hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150011-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,4,37651,MI,Individual,No,38-2242827,37651MI0150011,HAP Personal Alliance 3000 HMO,37651MI015,,MIN001,MIS001,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-3000hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150011-03,Limited Cost Sharing Plan Variation,,0.691167831420898,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,"$6,000","$12,000","$3,000","$6,000",20%,,,,$0,$0,"$3,000","$6,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,4,37651,MI,Individual,No,38-2242827,37651MI0150011,HAP Personal Alliance 3000 HMO,37651MI015,,MIN001,MIS001,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-3000hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150011-04,73% AV Level Silver Plan,,0.726643204689026,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,$0,$0,"$5,000","$10,000","$2,500","$5,000",20%,,,,$0,$0,"$2,500","$5,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,4,37651,MI,Individual,No,38-2242827,37651MI0150011,HAP Personal Alliance 3000 HMO,37651MI015,,MIN001,MIS001,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-3000hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150011-05,87% AV Level Silver Plan,,0.86523711681366,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,$0,$0,"$1,500","$3,000",$500,"$1,000",20%,,,,$0,$0,$500,"$1,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,4,37651,MI,Individual,No,38-2242827,37651MI0150011,HAP Personal Alliance 3000 HMO,37651MI015,,MIN001,MIS001,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-3000hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150011-06,94% AV Level Silver Plan,,0.931623220443726,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,$0,$0,$750,"$1,500",$150,$300,20%,,,,$0,$0,$150,$300,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,5,37651,MI,Individual,No,38-2242827,37651MI0150013,HAP Personal Alliance 6600 HMO,37651MI015,,MIN001,MIS001,MIF011,New,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-6600hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150013-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,$0,$0,"$6,600","$13,200",,,,,,,,,4
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,5,37651,MI,Individual,No,38-2242827,37651MI0150013,HAP Personal Alliance 6600 HMO,37651MI015,,MIN001,MIS001,MIF011,New,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-6600hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150013-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,$0,$0,"$6,600","$13,200",,,,,,,,,5
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,6,37651,MI,Individual,No,38-2242827,37651MI0190001,HAP Personal Alliance 500 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF013,New,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-500hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190001-00,Standard Platinum Off Exchange Plan,,0.881891250610352,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,$0,$0,"$1,500","$3,000",$500,"$1,000",20%,,,,$0,$0,$500,"$1,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,6,37651,MI,Individual,No,38-2242827,37651MI0190001,HAP Personal Alliance 500 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF013,New,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-500hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190001-01,Standard Platinum On Exchange Plan,,0.881891250610352,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,$0,$0,"$1,500","$3,000",$500,"$1,000",20%,,,,$0,$0,$500,"$1,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,6,37651,MI,Individual,No,38-2242827,37651MI0190001,HAP Personal Alliance 500 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF013,New,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-500hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,6,37651,MI,Individual,No,38-2242827,37651MI0190001,HAP Personal Alliance 500 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF013,New,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-500hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190001-03,Limited Cost Sharing Plan Variation,,0.881891250610352,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,$0,$0,"$1,500","$3,000",$500,"$1,000",20%,,,,$0,$0,$500,"$1,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,6,37651,MI,Individual,No,38-2242827,37651MI0190002,HAP Personal Alliance 1500 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF009,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-1500hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190002-00,Standard Gold Off Exchange Plan,,0.780206501483917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,$0,$0,"$3,500","$7,000","$1,500","$3,000",20%,,,,$0,$0,"$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,6,37651,MI,Individual,No,38-2242827,37651MI0190002,HAP Personal Alliance 1500 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF009,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-1500hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190002-01,Standard Gold On Exchange Plan,,0.780206501483917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,$0,$0,"$3,500","$7,000","$1,500","$3,000",20%,,,,$0,$0,"$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,6,37651,MI,Individual,No,38-2242827,37651MI0190002,HAP Personal Alliance 1500 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF009,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-1500hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,6,37651,MI,Individual,No,38-2242827,37651MI0190002,HAP Personal Alliance 1500 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF009,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-1500hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190002-03,Limited Cost Sharing Plan Variation,,0.780206501483917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,$0,$0,"$3,500","$7,000","$1,500","$3,000",20%,,,,$0,$0,"$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,7,37651,MI,Individual,No,38-2242827,37651MI0190004,HAP Personal Alliance 2500 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2500hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190004-00,Standard Silver Off Exchange Plan,,0.700386166572571,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,"$6,000","$12,000","$2,500","$5,000",20%,,,,$0,$0,"$2,500","$5,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,7,37651,MI,Individual,No,38-2242827,37651MI0190004,HAP Personal Alliance 2500 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2500hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190004-01,Standard Silver On Exchange Plan,,0.700386166572571,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,"$6,000","$12,000","$2,500","$5,000",20%,,,,$0,$0,"$2,500","$5,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,7,37651,MI,Individual,No,38-2242827,37651MI0190004,HAP Personal Alliance 2500 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2500hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,7,37651,MI,Individual,No,38-2242827,37651MI0190004,HAP Personal Alliance 2500 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2500hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190004-03,Limited Cost Sharing Plan Variation,,0.700386166572571,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,"$6,000","$12,000","$2,500","$5,000",20%,,,,$0,$0,"$2,500","$5,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,7,37651,MI,Individual,No,38-2242827,37651MI0190004,HAP Personal Alliance 2500 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2500hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190004-04,73% AV Level Silver Plan,,0.726643204689026,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,$0,$0,"$5,000","$10,000","$2,500","$5,000",20%,,,,$0,$0,"$2,500","$5,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,7,37651,MI,Individual,No,38-2242827,37651MI0190004,HAP Personal Alliance 2500 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2500hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190004-05,87% AV Level Silver Plan,,0.86523711681366,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,$0,$0,"$1,500","$3,000",$500,"$1,000",20%,,,,$0,$0,$500,"$1,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,7,37651,MI,Individual,No,38-2242827,37651MI0190004,HAP Personal Alliance 2500 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2500hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190004-06,94% AV Level Silver Plan,,0.931623220443726,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,$0,$0,$750,"$1,500",$150,$300,20%,,,,$0,$0,$150,$300,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,7,37651,MI,Individual,No,38-2242827,37651MI0190005,HAP Personal Alliance 3000 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-3000hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190005-00,Standard Silver Off Exchange Plan,,0.691167831420898,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,"$6,000","$12,000","$3,000","$6,000",20%,,,,$0,$0,"$3,000","$6,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,7,37651,MI,Individual,No,38-2242827,37651MI0190005,HAP Personal Alliance 3000 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-3000hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190005-01,Standard Silver On Exchange Plan,,0.691167831420898,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,"$6,000","$12,000","$3,000","$6,000",20%,,,,$0,$0,"$3,000","$6,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,7,37651,MI,Individual,No,38-2242827,37651MI0190005,HAP Personal Alliance 3000 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-3000hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,7,37651,MI,Individual,No,38-2242827,37651MI0190005,HAP Personal Alliance 3000 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-3000hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190005-03,Limited Cost Sharing Plan Variation,,0.691167831420898,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,"$6,000","$12,000","$3,000","$6,000",20%,,,,$0,$0,"$3,000","$6,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,7,37651,MI,Individual,No,38-2242827,37651MI0190005,HAP Personal Alliance 3000 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-3000hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190005-04,73% AV Level Silver Plan,,0.726643204689026,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,$0,$0,"$5,000","$10,000","$2,500","$5,000",20%,,,,$0,$0,"$2,500","$5,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,7,37651,MI,Individual,No,38-2242827,37651MI0190005,HAP Personal Alliance 3000 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-3000hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190005-05,87% AV Level Silver Plan,,0.86523711681366,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,$0,$0,"$1,500","$3,000",$500,"$1,000",20%,,,,$0,$0,$500,"$1,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,7,37651,MI,Individual,No,38-2242827,37651MI0190005,HAP Personal Alliance 3000 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-3000hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190005-06,94% AV Level Silver Plan,,0.931623220443726,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,$0,$0,$750,"$1,500",$150,$300,20%,,,,$0,$0,$150,$300,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,7,37651,MI,Individual,No,38-2242827,37651MI0190006,HAP Personal Alliance 5000 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190006-00,Standard Bronze Off Exchange Plan,,0.608052730560303,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,"$6,600","$13,200","$5,000","$10,000",20%,,,,$0,$0,"$5,000","$10,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,7,37651,MI,Individual,No,38-2242827,37651MI0190006,HAP Personal Alliance 5000 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190006-01,Standard Bronze On Exchange Plan,,0.608052730560303,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,"$6,600","$13,200","$5,000","$10,000",20%,,,,$0,$0,"$5,000","$10,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,19
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,7,37651,MI,Individual,No,38-2242827,37651MI0190006,HAP Personal Alliance 5000 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,7,37651,MI,Individual,No,38-2242827,37651MI0190006,HAP Personal Alliance 5000 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190006-03,Limited Cost Sharing Plan Variation,,0.608052730560303,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,"$6,600","$13,200","$5,000","$10,000",20%,,,,$0,$0,"$5,000","$10,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,8,37651,MI,Individual,No,38-2242827,37651MI0190003,HAP Personal Alliance 2000 HMO (HSA) Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF011,New,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2000hmoHSA-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190003-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,"$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,$0,$0,"$2,000","$4,000",,,,,,,,,4
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,8,37651,MI,Individual,No,38-2242827,37651MI0190003,HAP Personal Alliance 2000 HMO (HSA) Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF011,New,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2000hmoHSA-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190003-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,"$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,$0,$0,"$2,000","$4,000",,,,,,,,,5
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,8,37651,MI,Individual,No,38-2242827,37651MI0190003,HAP Personal Alliance 2000 HMO (HSA) Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF011,New,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2000hmoHSA-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,8,37651,MI,Individual,No,38-2242827,37651MI0190003,HAP Personal Alliance 2000 HMO (HSA) Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF011,New,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2000hmoHSA-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190003-03,Limited Cost Sharing Plan Variation,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,"$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,$0,$0,"$2,000","$4,000",,,,,,,,,7
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,8,37651,MI,Individual,No,38-2242827,37651MI0190007,HAP Personal Alliance 5000 HMO (HSA) Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmoHSA-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190007-00,Standard Bronze Off Exchange Plan,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,$0,$0,"$6,450","$12,900",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,$0,$0,"$5,000","$10,000",,,,,,,,,8
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,8,37651,MI,Individual,No,38-2242827,37651MI0190007,HAP Personal Alliance 5000 HMO (HSA) Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmoHSA-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190007-01,Standard Bronze On Exchange Plan,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,$0,$0,"$6,450","$12,900",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,$0,$0,"$5,000","$10,000",,,,,,,,,9
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,8,37651,MI,Individual,No,38-2242827,37651MI0190007,HAP Personal Alliance 5000 HMO (HSA) Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmoHSA-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,8,37651,MI,Individual,No,38-2242827,37651MI0190007,HAP Personal Alliance 5000 HMO (HSA) Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmoHSA-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190007-03,Limited Cost Sharing Plan Variation,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,$0,$0,"$6,450","$12,900",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,$0,$0,"$5,000","$10,000",,,,,,,,,11
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,9,37651,MI,Individual,No,38-2242827,37651MI0190008,HAP Personal Alliance 6600 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF011,New,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-6600hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190008-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,$0,$0,"$6,600","$13,200",,,,,,,,,4
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,9,37651,MI,Individual,No,38-2242827,37651MI0190008,HAP Personal Alliance 6600 HMO Henry Ford Choice,37651MI019,,MIN004,MIS004,MIF011,New,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-6600hmo-henryfordchoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0190008-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,$0,$0,"$6,600","$13,200",,,,,,,,,5
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,14,37651,MI,Individual,No,38-2242827,37651MI0300001,HAP Personal Alliance 500 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF013,New,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-500hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300001-00,Standard Platinum Off Exchange Plan,,0.881891250610352,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,$0,$0,"$1,500","$3,000",$500,"$1,000",20%,,,,$0,$0,$500,"$1,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,14,37651,MI,Individual,No,38-2242827,37651MI0300001,HAP Personal Alliance 500 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF013,New,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-500hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300001-01,Standard Platinum On Exchange Plan,,0.881891250610352,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,$0,$0,"$1,500","$3,000",$500,"$1,000",20%,,,,$0,$0,$500,"$1,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,14,37651,MI,Individual,No,38-2242827,37651MI0300001,HAP Personal Alliance 500 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF013,New,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-500hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,14,37651,MI,Individual,No,38-2242827,37651MI0300001,HAP Personal Alliance 500 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF013,New,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-500hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300001-03,Limited Cost Sharing Plan Variation,,0.881891250610352,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,$0,$0,"$1,500","$3,000",$500,"$1,000",20%,,,,$0,$0,$500,"$1,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,14,37651,MI,Individual,No,38-2242827,37651MI0300002,HAP Personal Alliance 1500 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF009,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-1500hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300002-00,Standard Gold Off Exchange Plan,,0.780206501483917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,$0,$0,"$3,500","$7,000","$1,500","$3,000",20%,,,,$0,$0,"$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,14,37651,MI,Individual,No,38-2242827,37651MI0300002,HAP Personal Alliance 1500 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF009,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-1500hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300002-01,Standard Gold On Exchange Plan,,0.780206501483917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,$0,$0,"$3,500","$7,000","$1,500","$3,000",20%,,,,$0,$0,"$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,14,37651,MI,Individual,No,38-2242827,37651MI0300002,HAP Personal Alliance 1500 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF009,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-1500hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,14,37651,MI,Individual,No,38-2242827,37651MI0300002,HAP Personal Alliance 1500 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF009,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-1500hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300002-03,Limited Cost Sharing Plan Variation,,0.780206501483917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,$0,$0,"$3,500","$7,000","$1,500","$3,000",20%,,,,$0,$0,"$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,15,37651,MI,Individual,No,38-2242827,37651MI0300004,HAP Personal Alliance 2500 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2500hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300004-00,Standard Silver Off Exchange Plan,,0.700386166572571,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,"$6,000","$12,000","$2,500","$5,000",20%,,,,$0,$0,"$2,500","$5,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,15,37651,MI,Individual,No,38-2242827,37651MI0300004,HAP Personal Alliance 2500 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2500hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300004-01,Standard Silver On Exchange Plan,,0.700386166572571,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,"$6,000","$12,000","$2,500","$5,000",20%,,,,$0,$0,"$2,500","$5,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,15,37651,MI,Individual,No,38-2242827,37651MI0300004,HAP Personal Alliance 2500 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2500hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,15,37651,MI,Individual,No,38-2242827,37651MI0300004,HAP Personal Alliance 2500 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2500hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300004-03,Limited Cost Sharing Plan Variation,,0.700386166572571,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,"$6,000","$12,000","$2,500","$5,000",20%,,,,$0,$0,"$2,500","$5,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,15,37651,MI,Individual,No,38-2242827,37651MI0300004,HAP Personal Alliance 2500 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2500hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300004-04,73% AV Level Silver Plan,,0.726643204689026,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,$0,$0,"$5,000","$10,000","$2,500","$5,000",20%,,,,$0,$0,"$2,500","$5,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,15,37651,MI,Individual,No,38-2242827,37651MI0300004,HAP Personal Alliance 2500 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2500hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300004-05,87% AV Level Silver Plan,,0.86523711681366,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,$0,$0,"$1,500","$3,000",$500,"$1,000",20%,,,,$0,$0,$500,"$1,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,15,37651,MI,Individual,No,38-2242827,37651MI0300004,HAP Personal Alliance 2500 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2500hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300004-06,94% AV Level Silver Plan,,0.931623220443726,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,$0,$0,$750,"$1,500",$150,$300,20%,,,,$0,$0,$150,$300,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,15,37651,MI,Individual,No,38-2242827,37651MI0300005,HAP Personal Alliance 3000 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-3000hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300005-00,Standard Silver Off Exchange Plan,,0.691167831420898,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,"$6,000","$12,000","$3,000","$6,000",20%,,,,$0,$0,"$3,000","$6,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,15,37651,MI,Individual,No,38-2242827,37651MI0300005,HAP Personal Alliance 3000 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-3000hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300005-01,Standard Silver On Exchange Plan,,0.691167831420898,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,"$6,000","$12,000","$3,000","$6,000",20%,,,,$0,$0,"$3,000","$6,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,15,37651,MI,Individual,No,38-2242827,37651MI0300005,HAP Personal Alliance 3000 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-3000hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,15,37651,MI,Individual,No,38-2242827,37651MI0300005,HAP Personal Alliance 3000 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-3000hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300005-03,Limited Cost Sharing Plan Variation,,0.691167831420898,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,"$6,000","$12,000","$3,000","$6,000",20%,,,,$0,$0,"$3,000","$6,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,15,37651,MI,Individual,No,38-2242827,37651MI0300005,HAP Personal Alliance 3000 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-3000hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300005-04,73% AV Level Silver Plan,,0.726643204689026,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,$0,$0,"$5,000","$10,000","$2,500","$5,000",20%,,,,$0,$0,"$2,500","$5,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,15,37651,MI,Individual,No,38-2242827,37651MI0300005,HAP Personal Alliance 3000 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-3000hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300005-05,87% AV Level Silver Plan,,0.86523711681366,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,$0,$0,"$1,500","$3,000",$500,"$1,000",20%,,,,$0,$0,$500,"$1,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,15,37651,MI,Individual,No,38-2242827,37651MI0300005,HAP Personal Alliance 3000 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF009,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-3000hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300005-06,94% AV Level Silver Plan,,0.931623220443726,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,$0,$0,$750,"$1,500",$150,$300,20%,,,,$0,$0,$150,$300,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,15,37651,MI,Individual,No,38-2242827,37651MI0300006,HAP Personal Alliance 5000 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300006-00,Standard Bronze Off Exchange Plan,,0.608052730560303,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,"$6,600","$13,200","$5,000","$10,000",20%,,,,$0,$0,"$5,000","$10,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,15,37651,MI,Individual,No,38-2242827,37651MI0300006,HAP Personal Alliance 5000 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300006-01,Standard Bronze On Exchange Plan,,0.608052730560303,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,"$6,600","$13,200","$5,000","$10,000",20%,,,,$0,$0,"$5,000","$10,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,19
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,15,37651,MI,Individual,No,38-2242827,37651MI0300006,HAP Personal Alliance 5000 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,15,37651,MI,Individual,No,38-2242827,37651MI0300006,HAP Personal Alliance 5000 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300006-03,Limited Cost Sharing Plan Variation,,0.608052730560303,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,"$6,600","$13,200","$5,000","$10,000",20%,,,,$0,$0,"$5,000","$10,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,16,37651,MI,Individual,No,38-2242827,37651MI0300003,HAP Personal Alliance 2000 HMO (HSA) Genesys Choice,37651MI030,,MIN003,MIS003,MIF011,New,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2000hmoHSA-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300003-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,"$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,$0,$0,"$2,000","$4,000",,,,,,,,,4
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,16,37651,MI,Individual,No,38-2242827,37651MI0300003,HAP Personal Alliance 2000 HMO (HSA) Genesys Choice,37651MI030,,MIN003,MIS003,MIF011,New,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2000hmoHSA-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300003-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,"$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,$0,$0,"$2,000","$4,000",,,,,,,,,5
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,16,37651,MI,Individual,No,38-2242827,37651MI0300003,HAP Personal Alliance 2000 HMO (HSA) Genesys Choice,37651MI030,,MIN003,MIS003,MIF011,New,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2000hmoHSA-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,16,37651,MI,Individual,No,38-2242827,37651MI0300003,HAP Personal Alliance 2000 HMO (HSA) Genesys Choice,37651MI030,,MIN003,MIS003,MIF011,New,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-2000hmoHSA-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300003-03,Limited Cost Sharing Plan Variation,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,"$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,$0,$0,"$2,000","$4,000",,,,,,,,,7
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,16,37651,MI,Individual,No,38-2242827,37651MI0300007,HAP Personal Alliance 5000 HMO (HSA) Genesys Choice,37651MI030,,MIN003,MIS003,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmoHSA-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300007-00,Standard Bronze Off Exchange Plan,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,$0,$0,"$6,450","$12,900",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,$0,$0,"$5,000","$10,000",,,,,,,,,8
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,16,37651,MI,Individual,No,38-2242827,37651MI0300007,HAP Personal Alliance 5000 HMO (HSA) Genesys Choice,37651MI030,,MIN003,MIS003,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmoHSA-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300007-01,Standard Bronze On Exchange Plan,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,$0,$0,"$6,450","$12,900",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,$0,$0,"$5,000","$10,000",,,,,,,,,9
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,16,37651,MI,Individual,No,38-2242827,37651MI0300007,HAP Personal Alliance 5000 HMO (HSA) Genesys Choice,37651MI030,,MIN003,MIS003,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmoHSA-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,16,37651,MI,Individual,No,38-2242827,37651MI0300007,HAP Personal Alliance 5000 HMO (HSA) Genesys Choice,37651MI030,,MIN003,MIS003,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmoHSA-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300007-03,Limited Cost Sharing Plan Variation,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,$0,$0,"$6,450","$12,900",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,$0,$0,"$5,000","$10,000",,,,,,,,,11
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,17,37651,MI,Individual,No,38-2242827,37651MI0300008,HAP Personal Alliance 6600 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF011,New,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-6600hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300008-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,$0,$0,"$6,600","$13,200",,,,,,,,,4
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,17,37651,MI,Individual,No,38-2242827,37651MI0300008,HAP Personal Alliance 6600 HMO Genesys Choice,37651MI030,,MIN003,MIS003,MIF011,New,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-6600hmo-genesyschoice.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0300008-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,$0,$0,"$6,600","$13,200",,,,,,,,,5
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,18,37651,MI,Individual,No,38-2242827,37651MI0150007,HAP Personal Alliance 5000 HMO,37651MI015,,MIN001,MIS001,MIF012,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150007-00,Standard Bronze Off Exchange Plan,,0.597088992595673,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,"$6,350","$12,700","$5,000","$10,000",20%,,,,$0,$0,"$5,000","$10,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,18,37651,MI,Individual,No,38-2242827,37651MI0150007,HAP Personal Alliance 5000 HMO,37651MI015,,MIN001,MIS001,MIF012,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150007-01,Standard Bronze On Exchange Plan,,0.597088992595673,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,"$6,350","$12,700","$5,000","$10,000",20%,,,,$0,$0,"$5,000","$10,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,18,37651,MI,Individual,No,38-2242827,37651MI0150007,HAP Personal Alliance 5000 HMO,37651MI015,,MIN001,MIS001,MIF012,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MI,37651,SERFF,7,2015-01-21 12:15:34,18,37651,MI,Individual,No,38-2242827,37651MI0150007,HAP Personal Alliance 5000 HMO,37651MI015,,MIN001,MIS001,MIF012,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9923,,,0,0,0,2015-01-01,,No,Emergency Services Only,No,Emergency Services Only,No,www.hap.org/sbc/2015-pa-5000hmo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAllianceHMODrugFormularly.pdf,37651MI0150007-03,Limited Cost Sharing Plan Variation,,0.597088992595673,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,"$6,350","$12,700","$5,000","$10,000",20%,,,,$0,$0,"$5,000","$10,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010004,Consumers Mutual Choice - Low Deductible,41895MI001,,MIN001,MIS001,MIF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010004-00,Standard Silver Off Exchange Plan,68.04%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,"$1,000","$2,000",30%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010004,Consumers Mutual Choice - Low Deductible,41895MI001,,MIN001,MIS001,MIF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010004-01,Standard Silver On Exchange Plan,68.04%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,"$1,000","$2,000",30%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0020045,Consumers Mutual Basic - HSA,41895MI002,,MIN001,MIS001,MIF008,New,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0020045-00,Standard Bronze Off Exchange Plan,60.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,"$3,000","$6,000",60%,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0020045,Consumers Mutual Basic - HSA,41895MI002,,MIN001,MIS001,MIF008,New,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0020045-01,Standard Bronze On Exchange Plan,60.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,"$3,000","$6,000",60%,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,MI,38791,SERFF,2,2014-08-09 13:12:30,1,38791,MI,SHOP (Small Group),Yes,47-0098400,38791MI0040002,EHB High PPO,38791MI004,,MIN001,MIS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.16,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,38791MI0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,38791,SERFF,2,2014-08-09 13:12:30,1,38791,MI,SHOP (Small Group),Yes,47-0098400,38791MI0040001,EHB Low PPO,38791MI004,,MIN001,MIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$16.58,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,38791MI0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,38791,SERFF,2,2014-08-09 13:12:30,1,38791,MI,SHOP (Small Group),Yes,47-0098400,38791MI0030002,EHB High Passive,38791MI003,,MIN001,MIS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.24,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,38791MI0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010042,Consumers Mutual Choice - HSA,41895MI001,,MIN001,MIS001,MIF007,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010042-01,Standard Silver On Exchange Plan,68.01%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,"$2,000","$4,000",30%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010042,Consumers Mutual Choice - HSA,41895MI001,,MIN001,MIS001,MIF007,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010042-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,36
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010042,Consumers Mutual Choice - HSA,41895MI001,,MIN001,MIS001,MIF007,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010042-03,Limited Cost Sharing Plan Variation,68.01%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,"$2,000","$4,000",30%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010042,Consumers Mutual Choice - HSA,41895MI001,,MIN001,MIS001,MIF007,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010042-04,73% AV Level Silver Plan,72.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,"$2,000","$4,000",20%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,3,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0040004,Consumers Mutual Value Network - Basic,41895MI004,,MIN002,MIS002,MIF002,New,EPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0040004-00,Standard Bronze Off Exchange Plan,58.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",60%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,3,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0040004,Consumers Mutual Value Network - Basic,41895MI004,,MIN002,MIS002,MIF002,New,EPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0040004-01,Standard Bronze On Exchange Plan,58.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",60%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,3,41895,MI,Individual,No,45-3758112,41895MI0030002,Consumers Mutual Value Network - Choice,41895MI003,,MIN002,MIS002,MIF001,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0030002-01,Standard Silver On Exchange Plan,68.04%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,3,41895,MI,Individual,No,45-3758112,41895MI0030002,Consumers Mutual Value Network - Choice,41895MI003,,MIN002,MIS002,MIF001,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0030002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,3,41895,MI,Individual,No,45-3758112,41895MI0030002,Consumers Mutual Value Network - Choice,41895MI003,,MIN002,MIS002,MIF001,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0030002-03,Limited Cost Sharing Plan Variation,68.04%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,3,41895,MI,Individual,No,45-3758112,41895MI0030002,Consumers Mutual Value Network - Choice,41895MI003,,MIN002,MIS002,MIF001,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0030002-04,73% AV Level Silver Plan,73.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,3,41895,MI,Individual,No,45-3758112,41895MI0030002,Consumers Mutual Value Network - Choice,41895MI003,,MIN002,MIS002,MIF001,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0030002-05,87% AV Level Silver Plan,87.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,3,41895,MI,Individual,No,45-3758112,41895MI0030002,Consumers Mutual Value Network - Choice,41895MI003,,MIN002,MIS002,MIF001,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0030002-06,94% AV Level Silver Plan,94.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,MI,46016,SERFF,1,2014-08-12 09:41:38,1,46016,MI,SHOP (Small Group),Yes,36-0883760,46016MI0030002,EHB High Passive,46016MI003,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.79,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,46016MI0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,46016,SERFF,1,2014-08-12 09:41:38,1,46016,MI,SHOP (Small Group),Yes,36-0883760,46016MI0030001,EHB Low Passive,46016MI003,,MIN001,MIS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.77,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,46016MI0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0020040,Consumers Mutual Platinum,41895MI002,,MIN001,MIS001,MIF013,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0020040-01,Standard Platinum On Exchange Plan,88.15%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000","$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,$500,"$1,000",20%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010003,Consumers Mutual Choice - Medium Deductible,41895MI001,,MIN001,MIS001,MIF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010003-04,73% AV Level Silver Plan,72.09%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,"$1,000","$2,000",20%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010004,Consumers Mutual Choice - Low Deductible,41895MI001,,MIN001,MIS001,MIF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010004-06,94% AV Level Silver Plan,93.09%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010013,Consumers Mutual Basic - High Deductible,41895MI001,,MIN001,MIS001,MIF010,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010013-00,Standard Bronze Off Exchange Plan,58.14%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",20%,"$6,000","$12,000",30%,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010013,Consumers Mutual Basic - High Deductible,41895MI001,,MIN001,MIS001,MIF010,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010013-01,Standard Bronze On Exchange Plan,58.14%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",20%,"$6,000","$12,000",30%,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010013,Consumers Mutual Basic - High Deductible,41895MI001,,MIN001,MIS001,MIF010,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010013-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,28
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010013,Consumers Mutual Basic - High Deductible,41895MI001,,MIN001,MIS001,MIF010,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010013-03,Limited Cost Sharing Plan Variation,58.14%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",20%,"$6,000","$12,000",30%,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010004,Consumers Mutual Choice - Low Deductible,41895MI001,,MIN001,MIS001,MIF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010004-04,73% AV Level Silver Plan,72.26%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,"$1,000","$2,000",30%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010004,Consumers Mutual Choice - Low Deductible,41895MI001,,MIN001,MIS001,MIF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010004-05,87% AV Level Silver Plan,86.29%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0020051,Consumers Mutual Basic - Integrated Deductible,41895MI002,,MIN001,MIS001,MIF009,New,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0020051-00,Standard Bronze Off Exchange Plan,58.32%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,"$2,000","$4,000",20%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0020051,Consumers Mutual Basic - Integrated Deductible,41895MI002,,MIN001,MIS001,MIF009,New,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0020051-01,Standard Bronze On Exchange Plan,58.32%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,"$2,000","$4,000",20%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,MI,38791,SERFF,2,2014-08-09 13:12:30,1,38791,MI,SHOP (Small Group),Yes,47-0098400,38791MI0030001,EHB Low Passive,38791MI003,,MIN001,MIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.47,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,38791MI0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,40047,SERFF,3,2014-09-11 12:10:19,1,40047,MI,Individual,No,38-3341599,40047MI0010001,Molina Marketplace Gold Plan,40047MI001,,MIN001,MIS001,MIF001,Existing,HMO,Gold,No,Both,No,Yes,All other than OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,40047MI0010001-00,Standard Gold Off Exchange Plan,,0.795843720436096,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,MI,40047,SERFF,3,2014-09-11 12:10:19,1,40047,MI,Individual,No,38-3341599,40047MI0010001,Molina Marketplace Gold Plan,40047MI001,,MIN001,MIS001,MIF001,Existing,HMO,Gold,No,Both,No,Yes,All other than OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,40047MI0010001-01,Standard Gold On Exchange Plan,,0.795843720436096,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,MI,40047,SERFF,3,2014-09-11 12:10:19,1,40047,MI,Individual,No,38-3341599,40047MI0010001,Molina Marketplace Gold Plan,40047MI001,,MIN001,MIS001,MIF001,Existing,HMO,Gold,No,Both,No,Yes,All other than OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,40047MI0010001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MI,40047,SERFF,3,2014-09-11 12:10:19,1,40047,MI,Individual,No,38-3341599,40047MI0010001,Molina Marketplace Gold Plan,40047MI001,,MIN001,MIS001,MIF001,Existing,HMO,Gold,No,Both,No,Yes,All other than OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,40047MI0010001-03,Limited Cost Sharing Plan Variation,,0.795843720436096,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,MI,40047,SERFF,3,2014-09-11 12:10:19,2,40047,MI,Individual,No,38-3341599,40047MI0010002,Molina Marketplace Silver Plan,40047MI001,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,Yes,All other than OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.991425457001332,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,40047MI0010002-00,Standard Silver Off Exchange Plan,,0.706084549427032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$200,$400,30%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,4
2015,MI,40047,SERFF,3,2014-09-11 12:10:19,2,40047,MI,Individual,No,38-3341599,40047MI0010002,Molina Marketplace Silver Plan,40047MI001,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,Yes,All other than OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.991425457001332,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,40047MI0010002-01,Standard Silver On Exchange Plan,,0.706084549427032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$200,$400,30%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,5
2015,MI,40047,SERFF,3,2014-09-11 12:10:19,2,40047,MI,Individual,No,38-3341599,40047MI0010002,Molina Marketplace Silver Plan,40047MI001,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,Yes,All other than OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.991425457001332,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,40047MI0010002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MI,40047,SERFF,3,2014-09-11 12:10:19,2,40047,MI,Individual,No,38-3341599,40047MI0010002,Molina Marketplace Silver Plan,40047MI001,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,Yes,All other than OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.991425457001332,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,40047MI0010002-03,Limited Cost Sharing Plan Variation,,0.706084549427032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$200,$400,30%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,7
2015,MI,40047,SERFF,3,2014-09-11 12:10:19,2,40047,MI,Individual,No,38-3341599,40047MI0010002,Molina Marketplace Silver Plan,40047MI001,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,Yes,All other than OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.991425457001332,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,40047MI0010002-04,73% AV Level Silver Plan,,0.739861905574799,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,"$5,200","$10,400","$1,700","$3,400",30%,,,,Not Applicable,Not Applicable,"$1,700","$3,400",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,MI,40047,SERFF,3,2014-09-11 12:10:19,2,40047,MI,Individual,No,38-3341599,40047MI0010002,Molina Marketplace Silver Plan,40047MI001,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,Yes,All other than OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.991425457001332,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,40047MI0010002-05,87% AV Level Silver Plan,,0.874694764614105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,"$2,250","$4,500",$250,$500,20%,,,,Not Applicable,Not Applicable,$250,$500,$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,MI,40047,SERFF,3,2014-09-11 12:10:19,2,40047,MI,Individual,No,38-3341599,40047MI0010002,Molina Marketplace Silver Plan,40047MI001,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,Yes,All other than OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.991425457001332,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/mi/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,40047MI0010002-06,94% AV Level Silver Plan,,0.943551361560822,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,"$2,250","$4,500",$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,MI,40047,SERFF,3,2014-09-11 12:10:19,3,40047,MI,Individual,No,38-3341599,40047MI0010003,Molina Marketplace Bronze Plan,40047MI001,,MIN001,MIS001,MIF003,Existing,HMO,Bronze,No,Both,No,Yes,All other than OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,40047MI0010003-00,Standard Bronze Off Exchange Plan,,0.619724571704865,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,4
2015,MI,40047,SERFF,3,2014-09-11 12:10:19,3,40047,MI,Individual,No,38-3341599,40047MI0010003,Molina Marketplace Bronze Plan,40047MI001,,MIN001,MIS001,MIF003,Existing,HMO,Bronze,No,Both,No,Yes,All other than OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,40047MI0010003-01,Standard Bronze On Exchange Plan,,0.619724571704865,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,5
2015,MI,40047,SERFF,3,2014-09-11 12:10:19,3,40047,MI,Individual,No,38-3341599,40047MI0010003,Molina Marketplace Bronze Plan,40047MI001,,MIN001,MIS001,MIF003,Existing,HMO,Bronze,No,Both,No,Yes,All other than OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,40047MI0010003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,6
2015,MI,40047,SERFF,3,2014-09-11 12:10:19,3,40047,MI,Individual,No,38-3341599,40047MI0010003,Molina Marketplace Bronze Plan,40047MI001,,MIN001,MIS001,MIF003,Existing,HMO,Bronze,No,Both,No,Yes,All other than OB/GYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,40047MI0010003-03,Limited Cost Sharing Plan Variation,,0.619724571704865,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,7
2015,MI,41183,SERFF,1,2014-08-08 13:45:50,1,41183,MI,SHOP (Small Group),Yes,93-0242990,41183MI0040002,EHB High PPO,41183MI004,,MIN001,MIS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.77,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,41183MI0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,41183,SERFF,1,2014-08-08 13:45:50,1,41183,MI,SHOP (Small Group),Yes,93-0242990,41183MI0040001,EHB Low PPO,41183MI004,,MIN001,MIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$16.86,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,41183MI0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,41183,SERFF,1,2014-08-08 13:45:50,1,41183,MI,SHOP (Small Group),Yes,93-0242990,41183MI0030002,EHB High Passive,41183MI003,,MIN001,MIS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.91,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,41183MI0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,41183,SERFF,1,2014-08-08 13:45:50,1,41183,MI,SHOP (Small Group),Yes,93-0242990,41183MI0030001,EHB Low Passive,41183MI003,,MIN001,MIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.83,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,41183MI0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0020001,Consumers Mutual Premier - Low Deductible,41895MI002,,MIN001,MIS001,MIF001,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0020001-00,Standard Gold Off Exchange Plan,78.04%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,"$1,000","$2,000",20%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010001,Consumers Mutual Premier - Low Deductible,41895MI001,,MIN001,MIS001,MIF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010001-00,Standard Gold Off Exchange Plan,78.04%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,"$1,000","$2,000",20%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010001,Consumers Mutual Premier - Low Deductible,41895MI001,,MIN001,MIS001,MIF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010001-01,Standard Gold On Exchange Plan,78.04%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,"$1,000","$2,000",20%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0020001,Consumers Mutual Premier - Low Deductible,41895MI002,,MIN001,MIS001,MIF001,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0020001-01,Standard Gold On Exchange Plan,78.04%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,"$1,000","$2,000",20%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0020002,Consumers Mutual Premier - No Deductible,41895MI002,,MIN001,MIS001,MIF001,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0020002-00,Standard Gold Off Exchange Plan,78.20%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010001,Consumers Mutual Premier - Low Deductible,41895MI001,,MIN001,MIS001,MIF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010001,Consumers Mutual Premier - Low Deductible,41895MI001,,MIN001,MIS001,MIF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010001-03,Limited Cost Sharing Plan Variation,78.04%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,"$1,000","$2,000",20%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0020002,Consumers Mutual Premier - No Deductible,41895MI002,,MIN001,MIS001,MIF001,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0020002-01,Standard Gold On Exchange Plan,78.20%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0020003,Consumers Mutual Choice - Medium Deductible,41895MI002,,MIN001,MIS001,MIF001,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0020003-00,Standard Silver Off Exchange Plan,68.04%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,"$2,000","$4,000",30%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010002,Consumers Mutual Premier - No Deductible,41895MI001,,MIN001,MIS001,MIF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010002-00,Standard Gold Off Exchange Plan,78.20%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010002,Consumers Mutual Premier - No Deductible,41895MI001,,MIN001,MIS001,MIF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010002-01,Standard Gold On Exchange Plan,78.20%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0020003,Consumers Mutual Choice - Medium Deductible,41895MI002,,MIN001,MIS001,MIF001,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0020003-01,Standard Silver On Exchange Plan,68.04%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,"$2,000","$4,000",30%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010002,Consumers Mutual Premier - No Deductible,41895MI001,,MIN001,MIS001,MIF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,10
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0020004,Consumers Mutual Choice - Low Deductible,41895MI002,,MIN001,MIS001,MIF001,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0020004-00,Standard Silver Off Exchange Plan,68.04%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,"$1,000","$2,000",30%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0020004,Consumers Mutual Choice - Low Deductible,41895MI002,,MIN001,MIS001,MIF001,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0020004-01,Standard Silver On Exchange Plan,68.04%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,"$1,000","$2,000",30%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010002,Consumers Mutual Premier - No Deductible,41895MI001,,MIN001,MIS001,MIF001,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010002-03,Limited Cost Sharing Plan Variation,78.20%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0020012,Consumers Mutual Basic - High Deductible,41895MI002,,MIN001,MIS001,MIF010,Existing,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0020012-00,Standard Bronze Off Exchange Plan,58.14%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",20%,"$6,000","$12,000",30%,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010003,Consumers Mutual Choice - Medium Deductible,41895MI001,,MIN001,MIS001,MIF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010003-00,Standard Silver Off Exchange Plan,68.04%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,"$2,000","$4,000",30%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010003,Consumers Mutual Choice - Medium Deductible,41895MI001,,MIN001,MIS001,MIF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010003-01,Standard Silver On Exchange Plan,68.04%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,"$2,000","$4,000",30%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0020012,Consumers Mutual Basic - High Deductible,41895MI002,,MIN001,MIS001,MIF010,Existing,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0020012-01,Standard Bronze On Exchange Plan,58.14%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",20%,"$6,000","$12,000",30%,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0020040,Consumers Mutual Platinum,41895MI002,,MIN001,MIS001,MIF013,New,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0020040-00,Standard Platinum Off Exchange Plan,88.15%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000","$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,$500,"$1,000",20%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010003,Consumers Mutual Choice - Medium Deductible,41895MI001,,MIN001,MIS001,MIF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,14
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010003,Consumers Mutual Choice - Medium Deductible,41895MI001,,MIN001,MIS001,MIF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010003-03,Limited Cost Sharing Plan Variation,68.04%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,"$2,000","$4,000",30%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010003,Consumers Mutual Choice - Medium Deductible,41895MI001,,MIN001,MIS001,MIF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010003-05,87% AV Level Silver Plan,86.18%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010003,Consumers Mutual Choice - Medium Deductible,41895MI001,,MIN001,MIS001,MIF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010003-06,94% AV Level Silver Plan,93.09%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010004,Consumers Mutual Choice - Low Deductible,41895MI001,,MIN001,MIS001,MIF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,21
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010004,Consumers Mutual Choice - Low Deductible,41895MI001,,MIN001,MIS001,MIF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010004-03,Limited Cost Sharing Plan Variation,68.04%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,"$1,000","$2,000",30%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010042,Consumers Mutual Choice - HSA,41895MI001,,MIN001,MIS001,MIF007,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010042-00,Standard Silver Off Exchange Plan,68.01%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,"$2,000","$4,000",30%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010042,Consumers Mutual Choice - HSA,41895MI001,,MIN001,MIS001,MIF007,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010042-05,87% AV Level Silver Plan,86.22%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,$500,"$1,000",20%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010042,Consumers Mutual Choice - HSA,41895MI001,,MIN001,MIS001,MIF007,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010042-06,94% AV Level Silver Plan,93.01%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,MI,45002,SERFF,4,2014-12-11 11:35:20,1,45002,MI,SHOP (Small Group),No,86-0207231,45002MI0140003,UnitedHealthcare Bronze Choice Plus HSA 5000,45002MI014,,MIN002,MIS003,MIF001,Existing,POS,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shopmi,,,www.uhc.com/shopmi,45002MI0140003-00,Standard Bronze Off Exchange Plan,59.1%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MI,45002,SERFF,4,2014-12-11 11:35:20,1,45002,MI,SHOP (Small Group),No,86-0207231,45002MI0140003,UnitedHealthcare Bronze Choice Plus HSA 5000,45002MI014,,MIN002,MIS003,MIF001,Existing,POS,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shopmi,,,www.uhc.com/shopmi,45002MI0140003-01,Standard Bronze On Exchange Plan,59.1%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MI,45002,SERFF,4,2014-12-11 11:35:20,2,45002,MI,SHOP (Small Group),No,86-0207231,45002MI0140001,UnitedHealthcare Gold Navigate Plus 1500,45002MI014,,MIN013,MIS002,MIF001,Existing,POS,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shopmi,,,www.uhc.com/shopmi,45002MI0140001-00,Standard Gold Off Exchange Plan,78.1%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,MI,45002,SERFF,4,2014-12-11 11:35:20,2,45002,MI,SHOP (Small Group),No,86-0207231,45002MI0140001,UnitedHealthcare Gold Navigate Plus 1500,45002MI014,,MIN013,MIS002,MIF001,Existing,POS,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shopmi,,,www.uhc.com/shopmi,45002MI0140001-01,Standard Gold On Exchange Plan,78.1%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,MI,45002,SERFF,4,2014-12-11 11:35:20,2,45002,MI,SHOP (Small Group),No,86-0207231,45002MI0140002,UnitedHealthcare Silver Navigate Plus  2000,45002MI014,,MIN013,MIS002,MIF001,Existing,POS,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shopmi,,,www.uhc.com/shopmi,45002MI0140002-00,Standard Silver Off Exchange Plan,71%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,MI,45002,SERFF,4,2014-12-11 11:35:20,2,45002,MI,SHOP (Small Group),No,86-0207231,45002MI0140002,UnitedHealthcare Silver Navigate Plus  2000,45002MI014,,MIN013,MIS002,MIF001,Existing,POS,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shopmi,,,www.uhc.com/shopmi,45002MI0140002-01,Standard Silver On Exchange Plan,71%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,MI,45002,SERFF,4,2014-12-11 11:35:20,2,45002,MI,SHOP (Small Group),No,86-0207231,45002MI0140004,UnitedHealthcare Gold Navigate Plus 1500,45002MI014,,MIN013,MIS001,MIF001,New,POS,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shopmi,,,www.uhc.com/shopmi,45002MI0140004-00,Standard Gold Off Exchange Plan,78.1%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,MI,45002,SERFF,4,2014-12-11 11:35:20,2,45002,MI,SHOP (Small Group),No,86-0207231,45002MI0140004,UnitedHealthcare Gold Navigate Plus 1500,45002MI014,,MIN013,MIS001,MIF001,New,POS,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shopmi,,,www.uhc.com/shopmi,45002MI0140004-01,Standard Gold On Exchange Plan,78.1%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,MI,45002,SERFF,4,2014-12-11 11:35:20,2,45002,MI,SHOP (Small Group),No,86-0207231,45002MI0140005,UnitedHealthcare Silver Navigate Plus  2000,45002MI014,,MIN013,MIS001,MIF001,New,POS,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shopmi,,,www.uhc.com/shopmi,45002MI0140005-00,Standard Silver Off Exchange Plan,71%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,MI,45002,SERFF,4,2014-12-11 11:35:20,2,45002,MI,SHOP (Small Group),No,86-0207231,45002MI0140005,UnitedHealthcare Silver Navigate Plus  2000,45002MI014,,MIN013,MIS001,MIF001,New,POS,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,No,No,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",Yes,www.uhc.com/shopmi,,,www.uhc.com/shopmi,45002MI0140005-01,Standard Silver On Exchange Plan,71%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,MI,46016,SERFF,1,2014-08-12 09:41:38,1,46016,MI,SHOP (Small Group),Yes,36-0883760,46016MI0040002,EHB High PPO,46016MI004,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.67,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,46016MI0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,46016,SERFF,1,2014-08-12 09:41:38,1,46016,MI,SHOP (Small Group),Yes,36-0883760,46016MI0040001,EHB Low PPO,46016MI004,,MIN001,MIS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$16.81,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,46016MI0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010044,Consumers Mutual Basic - HSA,41895MI001,,MIN001,MIS001,MIF008,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010044-00,Standard Bronze Off Exchange Plan,60.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,"$3,000","$6,000",60%,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010044,Consumers Mutual Basic - HSA,41895MI001,,MIN001,MIS001,MIF008,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010044-01,Standard Bronze On Exchange Plan,60.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,"$3,000","$6,000",60%,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010044,Consumers Mutual Basic - HSA,41895MI001,,MIN001,MIS001,MIF008,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010044-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,50
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010003,Humana Silver 4600/Detroit HMOx,46275MI001,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342028,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333422,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010003-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010003,Humana Silver 4600/Detroit HMOx,46275MI001,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342028,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333422,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010003-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010003,Humana Silver 4600/Detroit HMOx,46275MI001,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342028,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333422,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010003,Humana Silver 4600/Detroit HMOx,46275MI001,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342028,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333422,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010003-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010004,Humana Gold 2500/Detroit HMOx,46275MI001,,MIN001,MIS001,MIF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341950,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333474,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010004-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010004,Humana Gold 2500/Detroit HMOx,46275MI001,,MIN001,MIS001,MIF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341950,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333474,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010004,Humana Gold 2500/Detroit HMOx,46275MI001,,MIN001,MIS001,MIF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341950,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333474,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010004-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010005,Humana Platinum 1000/Detroit HMOx,46275MI001,,MIN001,MIS001,MIF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341976,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333487,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010005-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,MI,47822,SERFF,1,2014-08-12 09:41:38,1,47822,MI,SHOP (Small Group),Yes,41-1412669,47822MI0010002,Securian Dental with Essential Health Benefits - Employer Paid D-2,47822MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.05,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,,,,,47822MI0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,47822,SERFF,1,2014-08-12 09:41:38,1,47822,MI,SHOP (Small Group),Yes,41-1412669,47822MI0010003,Securian Dental with Essential Health Benefits - Employer Paid D-3,47822MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.05,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,,,,,47822MI0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,47822,SERFF,1,2014-08-12 09:41:38,1,47822,MI,SHOP (Small Group),Yes,41-1412669,47822MI0010004,Securian Dental with Essential Health Benefits - Employer Paid D-4,47822MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.05,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,,,,,47822MI0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,1,67183,MI,SHOP (Small Group),No,38-3240485,67183MI0010004,Total Platinum Complete,67183MI001,,MIN001,MIS001,MIF001,Existing,HMO,Platinum,Yes,Both,No,Yes,"Podiatry, Chiropractic",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,http://sbc.thcmi.com/shop/67183MI0010004.pdf,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0010004-01,Standard Platinum On Exchange Plan,91.44%,0.914255023002625,No,No,No,100%,,$950,$1900,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$1000,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$290,$0,$150,$0,$600,$0,$80,11
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,1,67183,MI,Individual,No,38-3240485,67183MI0030002,Totally You,67183MI003,,MIN001,MIS001,MIF002,Existing,HMO,Silver,Yes,Both,No,Yes,"Podiatry, Chiropractic",,$0,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,https://thcmi.com/sbc-individual-ty,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0030002-03,Limited Cost Sharing Plan Variation,70.60%,0.706470966339111,No,No,No,100%,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$1000,$50,$0,$150,$3000,$320,$0,$80,11
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,1,67183,MI,Individual,No,38-3240485,67183MI0030002,Totally You,67183MI003,,MIN001,MIS001,MIF002,Existing,HMO,Silver,Yes,Both,No,Yes,"Podiatry, Chiropractic",,$0,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,https://thcmi.com/sbc-individual-ty,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0030002-04,73% AV Level Silver Plan,73.40%,0.742055237293243,No,No,No,100%,,"$4,200","$8,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$2500,$20,$0,$150,$2500,$390,$0,$80,12
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,1,67183,MI,SHOP (Small Group),No,38-3240485,67183MI0010005,Total Gold Premier,67183MI001,,MIN001,MIS001,MIF001,Existing,HMO,Gold,Yes,Both,No,Yes,"Podiatry, Chiropractic",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,http://sbc.thcmi.com/shop/67183MI0010005.pdf,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0010005-00,Standard Gold Off Exchange Plan,81.78%,0.817814826965332,No,No,No,100%,,$5000,$10000,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1250,$2500,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$1570,$150,$0,$700,$0,$80,12
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010003,Humana Silver 4600/Detroit HMOx,46275MI001,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342028,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333422,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010003-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010004,Humana Gold 2500/Detroit HMOx,46275MI001,,MIN001,MIS001,MIF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341950,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333474,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010004-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010044,Consumers Mutual Basic - HSA,41895MI001,,MIN001,MIS001,MIF008,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010044-03,Limited Cost Sharing Plan Variation,60.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,"$3,000","$6,000",60%,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,51
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010046,Consumers Mutual Basic - Low Deductible,41895MI001,,MIN001,MIS001,MIF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010046-00,Standard Bronze Off Exchange Plan,58.93%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",60%,"$2,000","$4,000",70%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,52
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010046,Consumers Mutual Basic - Low Deductible,41895MI001,,MIN001,MIS001,MIF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010046-01,Standard Bronze On Exchange Plan,58.93%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",60%,"$2,000","$4,000",70%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,53
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010046,Consumers Mutual Basic - Low Deductible,41895MI001,,MIN001,MIS001,MIF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010046-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,54
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010046,Consumers Mutual Basic - Low Deductible,41895MI001,,MIN001,MIS001,MIF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010046-03,Limited Cost Sharing Plan Variation,58.93%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",60%,"$2,000","$4,000",70%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,55
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010050,Consumers Mutual Basic - Integrated Deductible,41895MI001,,MIN001,MIS001,MIF009,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010050-00,Standard Bronze Off Exchange Plan,58.32%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,"$2,000","$4,000",20%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,60
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010050,Consumers Mutual Basic - Integrated Deductible,41895MI001,,MIN001,MIS001,MIF009,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010050-01,Standard Bronze On Exchange Plan,58.32%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,"$2,000","$4,000",20%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,61
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010050,Consumers Mutual Basic - Integrated Deductible,41895MI001,,MIN001,MIS001,MIF009,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010050-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,62
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,1,41895,MI,Individual,No,45-3758112,41895MI0010050,Consumers Mutual Basic - Integrated Deductible,41895MI001,,MIN001,MIS001,MIF009,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010050-03,Limited Cost Sharing Plan Variation,58.32%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,"$2,000","$4,000",20%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,63
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,2,41895,MI,Individual,No,45-3758112,41895MI0010014,Consumers Mutual - Generation Y,41895MI001,,MIN001,MIS001,MIF014,Existing,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010014-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",20%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,2,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0020010,Consumers Mutual Choice HSA - Medium Deductible,41895MI002,,MIN001,MIS001,MIF007,Existing,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0020010-00,Standard Silver Off Exchange Plan,68.01%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,"$2,000","$4,000",30%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,2,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0020010,Consumers Mutual Choice HSA - Medium Deductible,41895MI002,,MIN001,MIS001,MIF007,Existing,PPO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0020010-01,Standard Silver On Exchange Plan,68.01%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,350","$12,700","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,"$2,000","$4,000",30%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,2,41895,MI,Individual,No,45-3758112,41895MI0010014,Consumers Mutual - Generation Y,41895MI001,,MIN001,MIS001,MIF014,Existing,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0010014-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",20%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,2,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0020011,Consumers Mutual Basic - Medium Deductible,41895MI002,,MIN001,MIS001,MIF002,Existing,PPO,Bronze,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0020011-00,Standard Bronze Off Exchange Plan,58.93%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",60%,"$2,000","$4,000",70%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,2,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0020011,Consumers Mutual Basic - Medium Deductible,41895MI002,,MIN001,MIS001,MIF002,Existing,PPO,Bronze,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,5,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0020011-01,Standard Bronze On Exchange Plan,58.93%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",60%,"$2,000","$4,000",70%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,3,41895,MI,Individual,No,45-3758112,41895MI0030001,Consumers Mutual Value Network - Premier,41895MI003,,MIN002,MIS002,MIF001,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0030001-00,Standard Gold Off Exchange Plan,78.04%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,3,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0040001,Consumers Mutual Value Network - Premier,41895MI004,,MIN002,MIS002,MIF001,New,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0040001-00,Standard Gold Off Exchange Plan,78.04%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,3,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0040001,Consumers Mutual Value Network - Premier,41895MI004,,MIN002,MIS002,MIF001,New,EPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0040001-01,Standard Gold On Exchange Plan,78.04%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,3,41895,MI,Individual,No,45-3758112,41895MI0030001,Consumers Mutual Value Network - Premier,41895MI003,,MIN002,MIS002,MIF001,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0030001-01,Standard Gold On Exchange Plan,78.04%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,3,41895,MI,Individual,No,45-3758112,41895MI0030001,Consumers Mutual Value Network - Premier,41895MI003,,MIN002,MIS002,MIF001,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0030001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,3,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0040002,Consumers Mutual Value Network - Choice,41895MI004,,MIN002,MIS002,MIF001,New,EPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0040002-00,Standard Silver Off Exchange Plan,68.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,3,41895,MI,SHOP (Small Group),No,45-3758112,41895MI0040002,Consumers Mutual Value Network - Choice,41895MI004,,MIN002,MIS002,MIF001,New,EPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage offered at the Alternate Benefit Level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0040002-01,Standard Silver On Exchange Plan,68.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,3,41895,MI,Individual,No,45-3758112,41895MI0030001,Consumers Mutual Value Network - Premier,41895MI003,,MIN002,MIS002,MIF001,New,EPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0030001-03,Limited Cost Sharing Plan Variation,78.04%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,MI,41895,SERFF,8,2015-02-22 21:18:17,3,41895,MI,Individual,No,45-3758112,41895MI0030002,Consumers Mutual Value Network - Choice,41895MI003,,MIN002,MIS002,MIF001,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Coverage Only,Yes,Coverage available at the Alternate Benefit level,Yes,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/members/individual-and-family-insurance-plans,http://www.consumersmutual.org/individual-and-family-insurance-plans,http://www.consumersmutual.org/medication-formulary,41895MI0030002-00,Standard Silver Off Exchange Plan,68.04%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010003,Humana Silver 4600/Detroit HMOx,46275MI001,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342028,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333422,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010003-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010003,Humana Silver 4600/Detroit HMOx,46275MI001,,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342028,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333422,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010003-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,MI,58594,SERFF,3,2015-02-22 21:18:17,3,58594,MI,Individual,No,38-3253977,58594MI0010004,Meridian Choice: Your Connection to Bronson Healthcare,58594MI001,7992708124,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Emergent,Yes,www.mhplan.com/meridianchoice/sbc,www.mhplan.com/meridianchoice/member,,http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf,58594MI0010004-05,87% AV Level Silver Plan,,0.879261374473572,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,MI,58594,SERFF,3,2015-02-22 21:18:17,3,58594,MI,Individual,No,38-3253977,58594MI0010004,Meridian Choice: Your Connection to Bronson Healthcare,58594MI001,7992708124,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Emergent,Yes,www.mhplan.com/meridianchoice/sbc,www.mhplan.com/meridianchoice/member,,http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf,58594MI0010004-06,94% AV Level Silver Plan,,0.948911011219025,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$125,$250,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,MI,58594,SERFF,3,2015-02-22 21:18:17,4,58594,MI,Individual,No,38-3253977,58594MI0010005,Meridian Choice: Your Connection to Bronson Healthcare,58594MI001,7992708124,MIN001,MIS001,MIF001,Existing,HMO,Gold,No,Both,No,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Emergent,Yes,www.mhplan.com/meridianchoice/sbc,www.mhplan.com/meridianchoice/member,,http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf,58594MI0010005-00,Standard Gold Off Exchange Plan,,0.806101202964783,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,MI,58594,SERFF,3,2015-02-22 21:18:17,4,58594,MI,Individual,No,38-3253977,58594MI0010005,Meridian Choice: Your Connection to Bronson Healthcare,58594MI001,7992708124,MIN001,MIS001,MIF001,Existing,HMO,Gold,No,Both,No,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Emergent,Yes,www.mhplan.com/meridianchoice/sbc,www.mhplan.com/meridianchoice/member,,http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf,58594MI0010005-01,Standard Gold On Exchange Plan,,0.806101202964783,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,MI,58594,SERFF,3,2015-02-22 21:18:17,4,58594,MI,Individual,No,38-3253977,58594MI0010005,Meridian Choice: Your Connection to Bronson Healthcare,58594MI001,7992708124,MIN001,MIS001,MIF001,Existing,HMO,Gold,No,Both,No,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Emergent,Yes,www.mhplan.com/meridianchoice/sbc,www.mhplan.com/meridianchoice/member,,http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf,58594MI0010005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MI,58594,SERFF,3,2015-02-22 21:18:17,4,58594,MI,Individual,No,38-3253977,58594MI0010005,Meridian Choice: Your Connection to Bronson Healthcare,58594MI001,7992708124,MIN001,MIS001,MIF001,Existing,HMO,Gold,No,Both,No,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Emergent,Yes,www.mhplan.com/meridianchoice/sbc,www.mhplan.com/meridianchoice/member,,http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf,58594MI0010005-03,Limited Cost Sharing Plan Variation,,0.806101202964783,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0200001,Sparrow PHP Platinum Select,60829MI020,7639172866,MIN001,MIS001,MIF001,New,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200001-00,Standard Platinum Off Exchange Plan,,0.898475289344788,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,$0,$0,$0,$0,$250,$500,10%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$250,$15,$687,$150,$250,$734,$16,$97,4
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0200001,Sparrow PHP Platinum Select,60829MI020,7639172866,MIN001,MIS001,MIF001,New,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200001-01,Standard Platinum On Exchange Plan,,0.898475289344788,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,$0,$0,$0,$0,$250,$500,10%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$250,$15,$687,$150,$250,$734,$16,$97,5
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0200001,Sparrow PHP Platinum Select,60829MI020,7639172866,MIN001,MIS001,MIF001,New,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0200001,Sparrow PHP Platinum Select,60829MI020,7639172866,MIN001,MIS001,MIF001,New,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200001-03,Limited Cost Sharing Plan Variation,,0.898475289344788,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,$0,$0,$0,$0,$250,$500,10%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$250,$15,$687,$150,$250,$734,$16,$97,7
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0200002,Sparrow PHP Gold Premier,60829MI020,7639172866,MIN001,MIS001,MIF002,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200002-00,Standard Gold Off Exchange Plan,,0.819484889507294,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,$0,$0,$0,$0,$500,"$1,000",20%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$500,$23,"$1,325",$150,$412,"$1,639",$0,$97,8
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0200002,Sparrow PHP Gold Premier,60829MI020,7639172866,MIN001,MIS001,MIF002,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200002-01,Standard Gold On Exchange Plan,,0.819484889507294,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,$0,$0,$0,$0,$500,"$1,000",20%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$500,$23,"$1,325",$150,$412,"$1,639",$0,$97,9
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0200002,Sparrow PHP Gold Premier,60829MI020,7639172866,MIN001,MIS001,MIF002,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0200002,Sparrow PHP Gold Premier,60829MI020,7639172866,MIN001,MIS001,MIF002,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200002-03,Limited Cost Sharing Plan Variation,,0.819484889507294,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,$0,$0,$0,$0,$500,"$1,000",20%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$500,$23,"$1,325",$150,$412,"$1,639",$0,$97,11
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0190001,Sparrow PHP Gold Select Exclusive,60829MI019,7639172866,MIN002,MIS002,MIF002,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/exclusive-network-plans,,http://www.phphealthanswers.com/exclusive-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0190001-00,Standard Gold Off Exchange Plan,,0.798226058483124,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,300","$6,600",,,$0,$0,$0,$0,"$1,000","$2,000",20%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,000",$23,"$1,225",$150,$412,"$1,639",$0,$97,12
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,3,67183,MI,SHOP (Small Group),No,38-3240485,67183MI0010009,Total Value Complete,67183MI001,,MIN001,MIS001,MIF001,Existing,HMO,Silver,Yes,Both,No,Yes,"Podiatry, Chiropractic",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,http://sbc.thcmi.com/shop/67183MI0010009.pdf,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0010009-01,Standard Silver On Exchange Plan,71.81%,0.694453716278076,No,No,No,100%,,$5500,$11000,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,$1500,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$1800,$3600,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$1800,$50,$2240,$150,$1800,$370,$0,$80,9
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,3,67183,MI,SHOP (Small Group),No,38-3240485,67183MI0010010,Total Saver Plus,67183MI001,,MIN001,MIS001,MIF004,Existing,HMO,Bronze,Yes,Both,No,Yes,"Podiatry, Chiropractic",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,http://sbc.thcmi.com/shop/67183MI0010010.pdf,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0010010-00,Standard Bronze Off Exchange Plan,61.44%,0.611696302890778,No,No,No,100%,,$5600,$11200,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$2000,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$4500,$9000,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$4500,$20,$620,$150,$3860,$0,$0,$80,10
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010005,Humana Platinum 1000/Detroit HMOx,46275MI001,,MIN001,MIS001,MIF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341976,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333487,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010005-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010005,Humana Platinum 1000/Detroit HMOx,46275MI001,,MIN001,MIS001,MIF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341976,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333487,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010005,Humana Platinum 1000/Detroit HMOx,46275MI001,,MIN001,MIS001,MIF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341976,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333487,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010005-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010018,Humana Silver 4600/Grand Rapids HMOx,46275MI001,,MIN002,MIS002,MIF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342041,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327143,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010018-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010018,Humana Silver 4600/Grand Rapids HMOx,46275MI001,,MIN002,MIS002,MIF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342041,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327143,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010018-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010018,Humana Silver 4600/Grand Rapids HMOx,46275MI001,,MIN002,MIS002,MIF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342041,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327143,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010018-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010018,Humana Silver 4600/Grand Rapids HMOx,46275MI001,,MIN002,MIS002,MIF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342041,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327143,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010018-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010018,Humana Silver 4600/Grand Rapids HMOx,46275MI001,,MIN002,MIS002,MIF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342041,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327143,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010018-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010018,Humana Silver 4600/Grand Rapids HMOx,46275MI001,,MIN002,MIS002,MIF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342041,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327143,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010018-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010018,Humana Silver 4600/Grand Rapids HMOx,46275MI001,,MIN002,MIS002,MIF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342041,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327143,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010018-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010019,Humana Gold 2500/Grand Rapids HMOx,46275MI001,,MIN002,MIS002,MIF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341963,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327195,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010019-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010019,Humana Gold 2500/Grand Rapids HMOx,46275MI001,,MIN002,MIS002,MIF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341963,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327195,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010019-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010019,Humana Gold 2500/Grand Rapids HMOx,46275MI001,,MIN002,MIS002,MIF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341963,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327195,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010019-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,28
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010019,Humana Gold 2500/Grand Rapids HMOx,46275MI001,,MIN002,MIS002,MIF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341963,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327195,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010019-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010020,Humana Platinum 1000/Grand Rapids HMOx,46275MI001,,MIN002,MIS002,MIF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341989,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327208,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010020-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010020,Humana Platinum 1000/Grand Rapids HMOx,46275MI001,,MIN002,MIS002,MIF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341989,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327208,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010020-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010020,Humana Platinum 1000/Grand Rapids HMOx,46275MI001,,MIN002,MIS002,MIF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341989,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327208,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010020-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,32
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,1,46275,MI,Individual,No,27-3991410,46275MI0010020,Humana Platinum 1000/Grand Rapids HMOx,46275MI001,,MIN002,MIS002,MIF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341989,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2327208,http://apps.humana.com/marketing/documents.asp?file=2323815,46275MI0010020-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,2,46275,MI,Individual,No,27-3991410,46275MI0010001,Humana Basic 6600/Detroit HMOx,46275MI001,,MIN001,MIS001,MIF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341898,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333396,http://apps.humana.com/marketing/documents.asp?file=2323880,46275MI0010001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,2,46275,MI,Individual,No,27-3991410,46275MI0010001,Humana Basic 6600/Detroit HMOx,46275MI001,,MIN001,MIS001,MIF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341898,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333396,http://apps.humana.com/marketing/documents.asp?file=2323880,46275MI0010001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,2,46275,MI,Individual,No,27-3991410,46275MI0010002,Humana Bronze 6300/Detroit HMOx,46275MI001,,MIN001,MIS001,MIF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341924,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333409,http://apps.humana.com/marketing/documents.asp?file=2323880,46275MI0010002-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,2,46275,MI,Individual,No,27-3991410,46275MI0010002,Humana Bronze 6300/Detroit HMOx,46275MI001,,MIN001,MIS001,MIF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341924,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333409,http://apps.humana.com/marketing/documents.asp?file=2323880,46275MI0010002-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,2,46275,MI,Individual,No,27-3991410,46275MI0010002,Humana Bronze 6300/Detroit HMOx,46275MI001,,MIN001,MIS001,MIF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341924,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333409,http://apps.humana.com/marketing/documents.asp?file=2323880,46275MI0010002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,2,46275,MI,Individual,No,27-3991410,46275MI0010002,Humana Bronze 6300/Detroit HMOx,46275MI001,,MIN001,MIS001,MIF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2341924,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333409,http://apps.humana.com/marketing/documents.asp?file=2323880,46275MI0010002-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,2,46275,MI,Individual,No,27-3991410,46275MI0010016,Humana Basic 6600/Grand Rapids HMOx,46275MI001,,MIN002,MIS002,MIF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2327117,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2341911,http://apps.humana.com/marketing/documents.asp?file=2323880,46275MI0010016-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,2,46275,MI,Individual,No,27-3991410,46275MI0010016,Humana Basic 6600/Grand Rapids HMOx,46275MI001,,MIN002,MIS002,MIF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2327117,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2341911,http://apps.humana.com/marketing/documents.asp?file=2323880,46275MI0010016-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,2,46275,MI,Individual,No,27-3991410,46275MI0010017,Humana Bronze 6300/Grand Rapids HMOx,46275MI001,,MIN002,MIS002,MIF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2327130,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2341937,http://apps.humana.com/marketing/documents.asp?file=2323880,46275MI0010017-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,2,46275,MI,Individual,No,27-3991410,46275MI0010017,Humana Bronze 6300/Grand Rapids HMOx,46275MI001,,MIN002,MIS002,MIF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2327130,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2341937,http://apps.humana.com/marketing/documents.asp?file=2323880,46275MI0010017-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,2,46275,MI,Individual,No,27-3991410,46275MI0010017,Humana Bronze 6300/Grand Rapids HMOx,46275MI001,,MIN002,MIS002,MIF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2327130,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2341937,http://apps.humana.com/marketing/documents.asp?file=2323880,46275MI0010017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,MI,46275,SERFF,4,2014-09-11 12:10:19,2,46275,MI,Individual,No,27-3991410,46275MI0010017,Humana Bronze 6300/Grand Rapids HMOx,46275MI001,,MIN002,MIS002,MIF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2327130,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2341937,http://apps.humana.com/marketing/documents.asp?file=2323880,46275MI0010017-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,MI,47007,SERFF,3,2014-09-11 12:10:19,1,47007,MI,SHOP (Small Group),Yes,42-0127290,47007MI0040001,Principal Plan Dental 70,47007MI004,,MIN001,MIS001,,New,PPO,Low,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$26.90,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,47007MI0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,47007,SERFF,3,2014-09-11 12:10:19,1,47007,MI,SHOP (Small Group),Yes,42-0127290,47007MI0040002,Principal Plan Dental 80,47007MI004,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$28.72,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,47007MI0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,47822,SERFF,1,2014-08-12 09:41:38,1,47822,MI,SHOP (Small Group),Yes,41-1412669,47822MI0010001,Securian Dental with Essential Health Benefits - Employer Paid D-1,47822MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.05,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,,,,,47822MI0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,1,67183,MI,SHOP (Small Group),No,38-3240485,67183MI0010005,Total Gold Premier,67183MI001,,MIN001,MIS001,MIF001,Existing,HMO,Gold,Yes,Both,No,Yes,"Podiatry, Chiropractic",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,http://sbc.thcmi.com/shop/67183MI0010005.pdf,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0010005-01,Standard Gold On Exchange Plan,81.78%,0.817814826965332,No,No,No,100%,,$5000,$10000,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1250,$2500,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$50,$1570,$150,$0,$700,$0,$80,13
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,1,67183,MI,Individual,No,38-3240485,67183MI0030002,Totally You,67183MI003,,MIN001,MIS001,MIF002,Existing,HMO,Silver,Yes,Both,No,Yes,"Podiatry, Chiropractic",,$0,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,https://thcmi.com/sbc-individual-ty,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0030002-05,87% AV Level Silver Plan,87.80%,0.877965450286865,No,No,No,100%,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$750,$30,$450,$150,$750,$610,$0,$80,13
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,1,67183,MI,Individual,No,38-3240485,67183MI0030002,Totally You,67183MI003,,MIN001,MIS001,MIF002,Existing,HMO,Silver,Yes,Both,No,Yes,"Podiatry, Chiropractic",,$0,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,https://thcmi.com/sbc-individual-ty,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0030002-06,94% AV Level Silver Plan,94.30%,0.948461532592773,No,No,No,100%,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$10,$890,$150,$0,$100,$0,$80,14
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,2,67183,MI,SHOP (Small Group),No,38-3240485,67183MI0010006,Total Gold Signature,67183MI001,,MIN001,MIS001,MIF001,Existing,HMO,Gold,Yes,Both,No,Yes,"Podiatry, Chiropractic",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,http://sbc.thcmi.com/shop/67183MI0010006.pdf,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0010006-00,Standard Gold Off Exchange Plan,81.44%,0.814409077167511,No,No,No,100%,,$3500,$7000,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,$1500,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$750,$1500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$750,$50,$1340,$150,$750,$550,$0,$80,4
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,2,67183,MI,SHOP (Small Group),No,38-3240485,67183MI0010006,Total Gold Signature,67183MI001,,MIN001,MIS001,MIF001,Existing,HMO,Gold,Yes,Both,No,Yes,"Podiatry, Chiropractic",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,http://sbc.thcmi.com/shop/67183MI0010006.pdf,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0010006-01,Standard Gold On Exchange Plan,81.44%,0.814409077167511,No,No,No,100%,,$3500,$7000,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,$1500,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$750,$1500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$750,$50,$1340,$150,$750,$550,$0,$80,5
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,3,67183,MI,SHOP (Small Group),No,38-3240485,67183MI0010007,Total Gold Complete,67183MI001,,MIN001,MIS001,MIF002,Existing,HMO,Gold,Yes,Both,No,Yes,"Podiatry, Chiropractic",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,http://sbc.thcmi.com/shop/67183MI0010007.pdf,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0010007-00,Standard Gold Off Exchange Plan,81.19%,0.811885118484497,No,No,No,100%,,$1750,$3500,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$1750,$3500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$1750,$0,$0,$150,$1750,$0,$0,$80,4
2015,MI,47822,SERFF,1,2014-08-12 09:41:38,1,47822,MI,SHOP (Small Group),Yes,41-1412669,47822MI0010005,Securian Dental with Essential Health Benefits - Employer Paid D-5,47822MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.05,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,,,,,47822MI0010005-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MI,47822,SERFF,1,2014-08-12 09:41:38,1,47822,MI,SHOP (Small Group),Yes,41-1412669,47822MI0010006,Securian Dental with Essential Health Benefits - Employer Paid D-6,47822MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.05,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,,,,,47822MI0010006-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MI,47822,SERFF,1,2014-08-12 09:41:38,1,47822,MI,SHOP (Small Group),Yes,41-1412669,47822MI0020001,Securian Dental with Essential Health Benefits - Voluntary D-1,47822MI002,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.05,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,,,,,47822MI0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,1,67183,MI,Individual,No,38-3240485,67183MI0030002,Totally You,67183MI003,,MIN001,MIS001,MIF002,Existing,HMO,Silver,Yes,Both,No,Yes,"Podiatry, Chiropractic",,$0,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,https://thcmi.com/sbc-individual-ty,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0030002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,No,No,100%,,$0,$0,,,$0,$0,$0,$0,$0,$0,,,$0,$0,$0,$0,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,1,67183,MI,SHOP (Small Group),No,38-3240485,67183MI0010004,Total Platinum Complete,67183MI001,,MIN001,MIS001,MIF001,Existing,HMO,Platinum,Yes,Both,No,Yes,"Podiatry, Chiropractic",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,http://sbc.thcmi.com/shop/67183MI0010004.pdf,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0010004-00,Standard Platinum Off Exchange Plan,91.44%,0.914255023002625,No,No,No,100%,,$950,$1900,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$1000,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$290,$0,$150,$0,$600,$0,$80,10
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,3,67183,MI,SHOP (Small Group),No,38-3240485,67183MI0010007,Total Gold Complete,67183MI001,,MIN001,MIS001,MIF002,Existing,HMO,Gold,Yes,Both,No,Yes,"Podiatry, Chiropractic",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,http://sbc.thcmi.com/shop/67183MI0010007.pdf,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0010007-01,Standard Gold On Exchange Plan,81.19%,0.811885118484497,No,No,No,100%,,$1750,$3500,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$1750,$3500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$1750,$0,$0,$150,$1750,$0,$0,$80,5
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,3,67183,MI,SHOP (Small Group),No,38-3240485,67183MI0010008,Total Value Plus,67183MI001,,MIN001,MIS001,MIF003,Existing,HMO,Silver,Yes,Both,No,Yes,"Podiatry, Chiropractic",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,http://sbc.thcmi.com/shop/67183MI0010008.pdf,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0010008-00,Standard Silver Off Exchange Plan,71.98%,0.719764888286591,No,No,No,100%,,$5500,$11000,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$1000,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$2000,$4000,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$2000,$0,$920,$150,$2000,$0,$370,$80,6
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,3,67183,MI,SHOP (Small Group),No,38-3240485,67183MI0010008,Total Value Plus,67183MI001,,MIN001,MIS001,MIF003,Existing,HMO,Silver,Yes,Both,No,Yes,"Podiatry, Chiropractic",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,http://sbc.thcmi.com/shop/67183MI0010008.pdf,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0010008-01,Standard Silver On Exchange Plan,71.98%,0.719764888286591,No,No,No,100%,,$5500,$11000,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$1000,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$2000,$4000,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$2000,$0,$920,$150,$2000,$0,$370,$80,7
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,3,67183,MI,SHOP (Small Group),No,38-3240485,67183MI0010009,Total Value Complete,67183MI001,,MIN001,MIS001,MIF001,Existing,HMO,Silver,Yes,Both,No,Yes,"Podiatry, Chiropractic",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,http://sbc.thcmi.com/shop/67183MI0010009.pdf,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0010009-00,Standard Silver Off Exchange Plan,71.81%,0.694453716278076,No,No,No,100%,,$5500,$11000,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,$1500,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$1800,$3600,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$1800,$50,$2240,$150,$1800,$370,$0,$80,8
2015,MI,47822,SERFF,1,2014-08-12 09:41:38,1,47822,MI,SHOP (Small Group),Yes,41-1412669,47822MI0020002,Securian Dental with Essential Health Benefits - Voluntary D-2,47822MI002,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.05,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,,,,,47822MI0020002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,MI,58594,SERFF,3,2015-02-22 21:18:17,1,58594,MI,Individual,No,38-3253977,58594MI0010001,Meridian Choice: Your Connection to Bronson Healthcare,58594MI001,7992708124,MIN001,MIS001,MIF004,Existing,HMO,Catastrophic,No,Both,No,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Emergent,Yes,www.mhplan.com/meridianchoice/sbc,www.mhplan.com/meridianchoice/member,,http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf,58594MI0010001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,MI,58594,SERFF,3,2015-02-22 21:18:17,1,58594,MI,Individual,No,38-3253977,58594MI0010001,Meridian Choice: Your Connection to Bronson Healthcare,58594MI001,7992708124,MIN001,MIS001,MIF004,Existing,HMO,Catastrophic,No,Both,No,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Emergent,Yes,www.mhplan.com/meridianchoice/sbc,www.mhplan.com/meridianchoice/member,,http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf,58594MI0010001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,MI,58594,SERFF,3,2015-02-22 21:18:17,2,58594,MI,Individual,No,38-3253977,58594MI0010002,Meridian Choice: Your Connection to Bronson Healthcare,58594MI001,7992708124,MIN001,MIS001,MIF003,Existing,HMO,Bronze,No,Both,No,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Emergent,Yes,www.mhplan.com/meridianchoice/sbc,www.mhplan.com/meridianchoice/member,,http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf,58594MI0010002-00,Standard Bronze Off Exchange Plan,,0.580049633979797,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,200","$12,400",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,MI,58594,SERFF,3,2015-02-22 21:18:17,2,58594,MI,Individual,No,38-3253977,58594MI0010002,Meridian Choice: Your Connection to Bronson Healthcare,58594MI001,7992708124,MIN001,MIS001,MIF003,Existing,HMO,Bronze,No,Both,No,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Emergent,Yes,www.mhplan.com/meridianchoice/sbc,www.mhplan.com/meridianchoice/member,,http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf,58594MI0010002-01,Standard Bronze On Exchange Plan,,0.580049633979797,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,200","$12,400",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,MI,58594,SERFF,3,2015-02-22 21:18:17,2,58594,MI,Individual,No,38-3253977,58594MI0010002,Meridian Choice: Your Connection to Bronson Healthcare,58594MI001,7992708124,MIN001,MIS001,MIF003,Existing,HMO,Bronze,No,Both,No,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Emergent,Yes,www.mhplan.com/meridianchoice/sbc,www.mhplan.com/meridianchoice/member,,http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf,58594MI0010002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MI,58594,SERFF,3,2015-02-22 21:18:17,2,58594,MI,Individual,No,38-3253977,58594MI0010002,Meridian Choice: Your Connection to Bronson Healthcare,58594MI001,7992708124,MIN001,MIS001,MIF003,Existing,HMO,Bronze,No,Both,No,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Emergent,Yes,www.mhplan.com/meridianchoice/sbc,www.mhplan.com/meridianchoice/member,,http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf,58594MI0010002-03,Limited Cost Sharing Plan Variation,,0.580049633979797,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,200","$12,400",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,MI,58594,SERFF,3,2015-02-22 21:18:17,3,58594,MI,Individual,No,38-3253977,58594MI0010004,Meridian Choice: Your Connection to Bronson Healthcare,58594MI001,7992708124,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Emergent,Yes,www.mhplan.com/meridianchoice/sbc,www.mhplan.com/meridianchoice/member,,http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf,58594MI0010004-00,Standard Silver Off Exchange Plan,,0.682759582996368,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,MI,58594,SERFF,3,2015-02-22 21:18:17,3,58594,MI,Individual,No,38-3253977,58594MI0010004,Meridian Choice: Your Connection to Bronson Healthcare,58594MI001,7992708124,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Emergent,Yes,www.mhplan.com/meridianchoice/sbc,www.mhplan.com/meridianchoice/member,,http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf,58594MI0010004-01,Standard Silver On Exchange Plan,,0.682759582996368,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,MI,58594,SERFF,3,2015-02-22 21:18:17,3,58594,MI,Individual,No,38-3253977,58594MI0010004,Meridian Choice: Your Connection to Bronson Healthcare,58594MI001,7992708124,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Emergent,Yes,www.mhplan.com/meridianchoice/sbc,www.mhplan.com/meridianchoice/member,,http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf,58594MI0010004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MI,58594,SERFF,3,2015-02-22 21:18:17,3,58594,MI,Individual,No,38-3253977,58594MI0010004,Meridian Choice: Your Connection to Bronson Healthcare,58594MI001,7992708124,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Emergent,Yes,www.mhplan.com/meridianchoice/sbc,www.mhplan.com/meridianchoice/member,,http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf,58594MI0010004-03,Limited Cost Sharing Plan Variation,,0.682759582996368,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$400,$800,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,MI,58594,SERFF,3,2015-02-22 21:18:17,3,58594,MI,Individual,No,38-3253977,58594MI0010004,Meridian Choice: Your Connection to Bronson Healthcare,58594MI001,7992708124,MIN001,MIS001,MIF002,Existing,HMO,Silver,No,Both,No,Yes,All Specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Emergent,Yes,www.mhplan.com/meridianchoice/sbc,www.mhplan.com/meridianchoice/member,,http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf,58594MI0010004-04,73% AV Level Silver Plan,,0.739282846450806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,550","$3,100",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0190001,Sparrow PHP Gold Select Exclusive,60829MI019,7639172866,MIN002,MIS002,MIF002,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/exclusive-network-plans,,http://www.phphealthanswers.com/exclusive-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0190001-01,Standard Gold On Exchange Plan,,0.798226058483124,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,300","$6,600",,,$0,$0,$0,$0,"$1,000","$2,000",20%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,000",$23,"$1,225",$150,$412,"$1,639",$0,$97,13
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0190001,Sparrow PHP Gold Select Exclusive,60829MI019,7639172866,MIN002,MIS002,MIF002,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/exclusive-network-plans,,http://www.phphealthanswers.com/exclusive-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0190001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0190001,Sparrow PHP Gold Select Exclusive,60829MI019,7639172866,MIN002,MIS002,MIF002,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/exclusive-network-plans,,http://www.phphealthanswers.com/exclusive-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0190001-03,Limited Cost Sharing Plan Variation,,0.798226058483124,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,300","$6,600",,,$0,$0,$0,$0,"$1,000","$2,000",20%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,000",$23,"$1,225",$150,$412,"$1,639",$0,$97,15
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0200003,Sparrow PHP Silver Premier,60829MI020,7639172866,MIN001,MIS001,MIF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200003-00,Standard Silver Off Exchange Plan,,0.71866774559021,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,$0,$0,$0,$0,"$2,500","$5,000",20%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,500",$23,$925,$150,$412,"$1,974",$0,$97,16
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0200003,Sparrow PHP Silver Premier,60829MI020,7639172866,MIN001,MIS001,MIF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200003-01,Standard Silver On Exchange Plan,,0.71866774559021,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,$0,$0,$0,$0,"$2,500","$5,000",20%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,500",$23,$925,$150,$412,"$1,974",$0,$97,17
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0200003,Sparrow PHP Silver Premier,60829MI020,7639172866,MIN001,MIS001,MIF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0200003,Sparrow PHP Silver Premier,60829MI020,7639172866,MIN001,MIS001,MIF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200003-03,Limited Cost Sharing Plan Variation,,0.71866774559021,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,$0,$0,$0,$0,"$2,500","$5,000",20%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,500",$23,$925,$150,$412,"$1,974",$0,$97,19
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0200003,Sparrow PHP Silver Premier,60829MI020,7639172866,MIN001,MIS001,MIF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200003-04,73% AV Level Silver Plan,,0.738706827163696,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,$0,$0,$0,$0,"$1,750","$3,500",20%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,000",$23,"$1,025",$150,$412,"$1,974",$0,$97,20
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0200003,Sparrow PHP Silver Premier,60829MI020,7639172866,MIN001,MIS001,MIF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200003-05,87% AV Level Silver Plan,,0.87890088558197,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,$0,$0,$0,$0,$500,"$1,000",10%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$500,$15,$662,$150,$412,"$1,189",$0,$97,21
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,1,71667,MI,Individual,No,38-3204052,71667MI0010004,UnitedHealthcare Silver Compass HSA 2600,71667MI001,,MIN014,MIS001,MIF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010004-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,1,71667,MI,Individual,No,38-3204052,71667MI0010004,UnitedHealthcare Silver Compass HSA 2600,71667MI001,,MIN014,MIS001,MIF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010004-05,87% AV Level Silver Plan,86.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$550,"$1,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,1,67577,MI,Individual,No,38-3291563,67577MI0390004,HAP Personal Alliance 3000 PPO,67577MI039,,MIN001,MIS001,MIF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9921,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-3000ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390004-01,Standard Silver On Exchange Plan,,0.681106269359589,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","$18,350","$36,700","$3,000","$6,000",20%,,,,"$6,000","$12,000","$9,000","$18,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,1,67577,MI,Individual,No,38-3291563,67577MI0390004,HAP Personal Alliance 3000 PPO,67577MI039,,MIN001,MIS001,MIF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9921,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-3000ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0200003,Sparrow PHP Silver Premier,60829MI020,7639172866,MIN001,MIS001,MIF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200003-06,94% AV Level Silver Plan,,0.933187186717987,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$10,$0,$150,$0,$519,$0,$97,22
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0190002,Sparrow PHP Silver Select Exclusive,60829MI019,7639172866,MIN002,MIS002,MIF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/exclusive-network-plans,,http://www.phphealthanswers.com/exclusive-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0190002-00,Standard Silver Off Exchange Plan,,0.702011168003082,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,$0,$0,"$2,000","$4,000",30%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,000",$23,"$1,537",$150,"$1,974",$0,$0,$97,23
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0190002,Sparrow PHP Silver Select Exclusive,60829MI019,7639172866,MIN002,MIS002,MIF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/exclusive-network-plans,,http://www.phphealthanswers.com/exclusive-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0190002-01,Standard Silver On Exchange Plan,,0.702011168003082,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,$0,$0,"$2,000","$4,000",30%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,000",$23,"$1,537",$150,"$1,974",$0,$0,$97,24
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0190002,Sparrow PHP Silver Select Exclusive,60829MI019,7639172866,MIN002,MIS002,MIF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/exclusive-network-plans,,http://www.phphealthanswers.com/exclusive-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0190002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,25
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0190002,Sparrow PHP Silver Select Exclusive,60829MI019,7639172866,MIN002,MIS002,MIF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/exclusive-network-plans,,http://www.phphealthanswers.com/exclusive-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0190002-03,Limited Cost Sharing Plan Variation,,0.702011168003082,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,$0,$0,"$2,000","$4,000",30%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,000",$23,"$1,537",$150,"$1,974",$0,$0,$97,26
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0190002,Sparrow PHP Silver Select Exclusive,60829MI019,7639172866,MIN002,MIS002,MIF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/exclusive-network-plans,,http://www.phphealthanswers.com/exclusive-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0190002-04,73% AV Level Silver Plan,,0.735135197639465,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,$0,$0,$0,$0,"$2,000","$4,000",20%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,000",$23,"$1,025",$150,$412,"$1,974",$0,$97,27
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0190002,Sparrow PHP Silver Select Exclusive,60829MI019,7639172866,MIN002,MIS002,MIF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/exclusive-network-plans,,http://www.phphealthanswers.com/exclusive-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0190002-05,87% AV Level Silver Plan,,0.874861180782318,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,$0,$0,$500,"$1,000",20%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$500,$15,"$1,325",$150,$412,"$1,029",$0,$97,28
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0190002,Sparrow PHP Silver Select Exclusive,60829MI019,7639172866,MIN002,MIS002,MIF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/exclusive-network-plans,,http://www.phphealthanswers.com/exclusive-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0190002-06,94% AV Level Silver Plan,,0.934004485607147,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$10,$0,$150,$0,$559,$31,$97,29
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0200004,Sparrow PHP Silver,60829MI020,7639172866,MIN001,MIS001,MIF005,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200004-00,Standard Silver Off Exchange Plan,,0.681561648845673,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,$0,$0,"$3,000","$6,000",30%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$3,000",$23,"$1,237",$150,$412,"$1,994",$0,$97,30
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0200004,Sparrow PHP Silver,60829MI020,7639172866,MIN001,MIS001,MIF005,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200004-01,Standard Silver On Exchange Plan,,0.681561648845673,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,$0,$0,"$3,000","$6,000",30%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$3,000",$23,"$1,237",$150,$412,"$1,994",$0,$97,31
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0200004,Sparrow PHP Silver,60829MI020,7639172866,MIN001,MIS001,MIF005,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,32
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0200004,Sparrow PHP Silver,60829MI020,7639172866,MIN001,MIS001,MIF005,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200004-03,Limited Cost Sharing Plan Variation,,0.681561648845673,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,$0,$0,"$3,000","$6,000",30%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$3,000",$23,"$1,237",$150,$412,"$1,994",$0,$97,33
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0200004,Sparrow PHP Silver,60829MI020,7639172866,MIN001,MIS001,MIF005,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200004-04,73% AV Level Silver Plan,,0.727352559566498,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,$0,$0,$0,$0,"$2,000","$4,000",20%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,000",$23,"$1,025",$150,$412,"$1,954",$0,$97,34
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0200004,Sparrow PHP Silver,60829MI020,7639172866,MIN001,MIS001,MIF005,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200004-05,87% AV Level Silver Plan,,0.862679719924927,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,$0,$0,$0,$0,"$1,000","$2,000",20%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,000",$15,$985,$150,$412,$909,$0,$97,35
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,1,60829,MI,Individual,No,38-2356288,60829MI0200004,Sparrow PHP Silver,60829MI020,7639172866,MIN001,MIS001,MIF005,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200004-06,94% AV Level Silver Plan,,0.938777983188629,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,$0,$0,$0,$0,$100,$200,10%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$100,$10,$702,$150,$100,$31,$31,$97,36
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,2,60829,MI,Individual,No,38-2356288,60829MI0200005,Sparrow PHP Healthy,60829MI020,7639172866,MIN001,MIS001,MIF011,New,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200005-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,$0,$0,$0,$0,"$6,000",$0,$0,$150,"$5,138",$0,$0,$97,4
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,2,60829,MI,Individual,No,38-2356288,60829MI0200005,Sparrow PHP Healthy,60829MI020,7639172866,MIN001,MIS001,MIF011,New,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0200005-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,$0,$0,$0,$0,"$6,000",$0,$0,$150,"$5,138",$0,$0,$97,5
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,3,60829,MI,Individual,No,38-2356288,60829MI0210001,Sparrow PHP Bronze Premier,60829MI021,7639172866,MIN001,MIS001,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0210001-00,Standard Bronze Off Exchange Plan,,0.619128525257111,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,$0,$0,$0,$0,"$3,500",$23,$725,$150,"$3,500",$653,$20,$97,4
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,3,60829,MI,Individual,No,38-2356288,60829MI0210001,Sparrow PHP Bronze Premier,60829MI021,7639172866,MIN001,MIS001,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0210001-01,Standard Bronze On Exchange Plan,,0.619128525257111,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,$0,$0,$0,$0,"$3,500",$23,$725,$150,"$3,500",$653,$20,$97,5
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,3,60829,MI,Individual,No,38-2356288,60829MI0210001,Sparrow PHP Bronze Premier,60829MI021,7639172866,MIN001,MIS001,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0210001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,3,60829,MI,Individual,No,38-2356288,60829MI0210001,Sparrow PHP Bronze Premier,60829MI021,7639172866,MIN001,MIS001,MIF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0210001-03,Limited Cost Sharing Plan Variation,,0.619128525257111,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,$0,$0,$0,$0,"$3,500",$23,$725,$150,"$3,500",$653,$20,$97,7
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,3,60829,MI,Individual,No,38-2356288,60829MI0210002,Sparrow PHP Bronze,60829MI021,7639172866,MIN001,MIS001,MIF006,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0210002-00,Standard Bronze Off Exchange Plan,,0.585461854934692,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,$0,$0,$0,$0,"$5,000",$23,$849,$150,"$5,000",$118,$0,$97,8
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,3,60829,MI,Individual,No,38-2356288,60829MI0210002,Sparrow PHP Bronze,60829MI021,7639172866,MIN001,MIS001,MIF006,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0210002-01,Standard Bronze On Exchange Plan,,0.585461854934692,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,$0,$0,$0,$0,"$5,000",$23,$849,$150,"$5,000",$118,$0,$97,9
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,3,60829,MI,Individual,No,38-2356288,60829MI0210002,Sparrow PHP Bronze,60829MI021,7639172866,MIN001,MIS001,MIF006,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0210002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,MI,60829,SERFF,3,2014-09-11 12:10:19,3,60829,MI,Individual,No,38-2356288,60829MI0210002,Sparrow PHP Bronze,60829MI021,7639172866,MIN001,MIS001,MIF006,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Coverage for emergency and urgent care only,Yes,Coverage for emergency and urgent care only,No,http://www.phphealthanswers.com/traditional-network-plans,,http://www.phphealthanswers.com/traditional-network-plans,http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF,60829MI0210002-03,Limited Cost Sharing Plan Variation,,0.585461854934692,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,$0,$0,$0,$0,"$5,000",$23,$849,$150,"$5,000",$118,$0,$97,11
2015,MI,61465,SERFF,3,2014-09-11 12:10:19,1,61465,MI,SHOP (Small Group),Yes,470322111,61465MI0010001,Certified Dental Plan Policy 1,61465MI001,,MIN001,MIS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.83,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,61465MI0010001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,61465,SERFF,3,2014-09-11 12:10:19,1,61465,MI,SHOP (Small Group),Yes,470322111,61465MI0010002,Certified Dental Plan Policy 2,61465MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.00,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,61465MI0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,61465,SERFF,3,2014-09-11 12:10:19,1,61465,MI,SHOP (Small Group),Yes,470322111,61465MI0010003,Certified Dental Plan Policy 3,61465MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.55,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,61465MI0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,61465,SERFF,3,2014-09-11 12:10:19,1,61465,MI,SHOP (Small Group),Yes,470322111,61465MI0010004,Certified Dental Plan Policy 4,61465MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.18,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,61465MI0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,62294,SERFF,6,2015-01-21 12:15:34,1,62294,MI,Individual,Yes,39-1263473,62294MI0420001,Humana Dental Smart Choice,62294MI042,,MIN001,MIS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.80,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541292,,62294MI0420001-01,Standard Low On Exchange Plan,71.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,66587,SERFF,3,2014-09-09 16:12:42,1,66587,MI,SHOP (Small Group),Yes,13-5123390,66587MI0010002,Guardian Pediatric Advantage,66587MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$27.76,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,66587MI0010002-00,Standard High Off Exchange Plan,86.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,66587,SERFF,3,2014-09-09 16:12:42,1,66587,MI,SHOP (Small Group),Yes,13-5123390,66587MI0020002,Guardian Pediatric Essentials,66587MI002,,MIN001,MIS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$20.24,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,66587MI0020002-00,Standard Low Off Exchange Plan,68.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,66587,SERFF,3,2014-09-09 16:12:42,2,66587,MI,SHOP (Small Group),Yes,13-5123390,66587MI0040002,Guardian Family Advantage,66587MI004,,MIN001,MIS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.76,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,66587MI0040002-00,Standard High Off Exchange Plan,86.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,66587,SERFF,3,2014-09-09 16:12:42,2,66587,MI,SHOP (Small Group),Yes,13-5123390,66587MI0040002,Guardian Family Advantage,66587MI004,,MIN001,MIS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.76,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,66587MI0040002-01,Standard High On Exchange Plan,86.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,66587,SERFF,3,2014-09-09 16:12:42,2,66587,MI,SHOP (Small Group),Yes,13-5123390,66587MI0060002,Guardian Family Essentials,66587MI006,,MIN001,MIS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.24,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,66587MI0060002-00,Standard Low Off Exchange Plan,68.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,66587,SERFF,3,2014-09-09 16:12:42,2,66587,MI,SHOP (Small Group),Yes,13-5123390,66587MI0060002,Guardian Family Essentials,66587MI006,,MIN001,MIS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.24,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,66587MI0060002-01,Standard Low On Exchange Plan,68.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,1,67183,MI,Individual,No,38-3240485,67183MI0030001,Total HMO Standard,67183MI003,,MIN001,MIS001,MIF001,Existing,HMO,Gold,Yes,Both,No,Yes,"Podiatry, Chiropractic",,$0,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,https://thcmi.com/sbc-individual-ths,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0030001-00,Standard Gold Off Exchange Plan,81.00%,0.808100581169128,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$1000,$1000,$50,$150,$1000,$750,$0,$80,4
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,1,67183,MI,SHOP (Small Group),No,38-3240485,67183MI0010001,Total Platinum Premier,67183MI001,,MIN001,MIS001,MIF001,Existing,HMO,Platinum,Yes,Both,No,Yes,"Podiatry, Chiropractic",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,http://sbc.thcmi.com/shop/67183MI0010001.pdf,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0010001-00,Standard Platinum Off Exchange Plan,89.75%,0.898929417133331,No,No,No,100%,,$1000,$2000,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$1000,$2000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$1000,$0,$0,$150,$1000,$0,$0,$80,4
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,1,67183,MI,SHOP (Small Group),No,38-3240485,67183MI0010001,Total Platinum Premier,67183MI001,,MIN001,MIS001,MIF001,Existing,HMO,Platinum,Yes,Both,No,Yes,"Podiatry, Chiropractic",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,http://sbc.thcmi.com/shop/67183MI0010001.pdf,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0010001-01,Standard Platinum On Exchange Plan,89.75%,0.898929417133331,No,No,No,100%,,$1000,$2000,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$1000,$2000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$1000,$0,$0,$150,$1000,$0,$0,$80,5
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,1,67183,MI,Individual,No,38-3240485,67183MI0030001,Total HMO Standard,67183MI003,,MIN001,MIS001,MIF001,Existing,HMO,Gold,Yes,Both,No,Yes,"Podiatry, Chiropractic",,$0,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,https://thcmi.com/sbc-individual-ths,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0030001-01,Standard Gold On Exchange Plan,81.00%,0.808100581169128,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$1000,$1000,$50,$150,$1000,$750,$0,$80,5
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,1,67183,MI,Individual,No,38-3240485,67183MI0030001,Total HMO Standard,67183MI003,,MIN001,MIS001,MIF001,Existing,HMO,Gold,Yes,Both,No,Yes,"Podiatry, Chiropractic",,$0,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,https://thcmi.com/sbc-individual-ths,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0030001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,No,No,100%,,$0,$0,,,$0,$0,$0,$0,$0,$0,,,$0,$0,$0,$0,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,1,67183,MI,SHOP (Small Group),No,38-3240485,67183MI0010002,Total Platinum Ultimate,67183MI001,,MIN001,MIS001,MIF001,Existing,HMO,Platinum,Yes,Both,No,Yes,"Podiatry, Chiropractic",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,http://sbc.thcmi.com/shop/67183MI0010002.pdf,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0010002-00,Standard Platinum Off Exchange Plan,90.39%,0.913333833217621,No,No,No,100%,,$1200,$2400,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,$1200,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$40,$0,$150,$0,$550,$0,$80,6
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,1,67183,MI,SHOP (Small Group),No,38-3240485,67183MI0010002,Total Platinum Ultimate,67183MI001,,MIN001,MIS001,MIF001,Existing,HMO,Platinum,Yes,Both,No,Yes,"Podiatry, Chiropractic",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,http://sbc.thcmi.com/shop/67183MI0010002.pdf,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0010002-01,Standard Platinum On Exchange Plan,90.39%,0.913333833217621,No,No,No,100%,,$1200,$2400,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,$1200,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$40,$0,$150,$0,$550,$0,$80,7
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,1,67183,MI,Individual,No,38-3240485,67183MI0030001,Total HMO Standard,67183MI003,,MIN001,MIS001,MIF001,Existing,HMO,Gold,Yes,Both,No,Yes,"Podiatry, Chiropractic",,$0,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,https://thcmi.com/sbc-individual-ths,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0030001-03,Limited Cost Sharing Plan Variation,81.00%,0.808100581169128,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$1000,$50,$0,$150,$1000,$750,$0,$80,7
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,1,67183,MI,Individual,No,38-3240485,67183MI0030002,Totally You,67183MI003,,MIN001,MIS001,MIF002,Existing,HMO,Silver,Yes,Both,No,Yes,"Podiatry, Chiropractic",,$0,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,https://thcmi.com/sbc-individual-ty,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0030002-00,Standard Silver Off Exchange Plan,70.60%,0.706470966339111,No,No,No,100%,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$1000,$50,$0,$150,$3000,$320,$0,$80,8
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,1,67183,MI,SHOP (Small Group),No,38-3240485,67183MI0010003,Total Platinum Signature,67183MI001,,MIN001,MIS001,MIF001,Existing,HMO,Platinum,Yes,Both,No,Yes,"Podiatry, Chiropractic",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,http://sbc.thcmi.com/shop/67183MI0010003.pdf,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0010003-00,Standard Platinum Off Exchange Plan,90.84%,0.909552037715912,No,No,No,100%,,$1000,$2000,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$500,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$30,$0,$150,$500,$500,$0,$80,8
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,1,67183,MI,SHOP (Small Group),No,38-3240485,67183MI0010003,Total Platinum Signature,67183MI001,,MIN001,MIS001,MIF001,Existing,HMO,Platinum,Yes,Both,No,Yes,"Podiatry, Chiropractic",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,http://sbc.thcmi.com/shop/67183MI0010003.pdf,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0010003-01,Standard Platinum On Exchange Plan,90.84%,0.909552037715912,No,No,No,100%,,$1000,$2000,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$500,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$30,$0,$150,$500,$500,$0,$80,9
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,1,67183,MI,Individual,No,38-3240485,67183MI0030002,Totally You,67183MI003,,MIN001,MIS001,MIF002,Existing,HMO,Silver,Yes,Both,No,Yes,"Podiatry, Chiropractic",,$0,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,https://thcmi.com/sbc-individual-ty,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0030002-01,Standard Silver On Exchange Plan,70.60%,0.706470966339111,No,No,No,100%,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$1000,$50,$0,$150,$3000,$320,$0,$80,9
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,3,67183,MI,SHOP (Small Group),No,38-3240485,67183MI0010010,Total Saver Plus,67183MI001,,MIN001,MIS001,MIF004,Existing,HMO,Bronze,Yes,Both,No,Yes,"Podiatry, Chiropractic",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,http://sbc.thcmi.com/shop/67183MI0010010.pdf,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0010010-01,Standard Bronze On Exchange Plan,61.44%,0.611696302890778,No,No,No,100%,,$5600,$11200,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$2000,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$4500,$9000,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$4500,$20,$620,$150,$3860,$0,$0,$80,11
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,3,67183,MI,SHOP (Small Group),No,38-3240485,67183MI0010011,Total Saver Complete,67183MI001,,MIN001,MIS001,MIF004,Existing,HMO,Bronze,Yes,Both,No,Yes,"Podiatry, Chiropractic",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,http://sbc.thcmi.com/shop/67183MI0010011.pdf,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0010011-00,Standard Bronze Off Exchange Plan,60.05%,0.600522756576538,No,No,No,100%,,$5600,$11200,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$2000,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$3500,$7000,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$3500,$20,$1530,$150,$3500,$150,$0,$80,12
2015,MI,67183,SERFF,5,2014-11-15 10:06:04,3,67183,MI,SHOP (Small Group),No,38-3240485,67183MI0010011,Total Saver Complete,67183MI001,,MIN001,MIS001,MIF004,Existing,HMO,Bronze,Yes,Both,No,Yes,"Podiatry, Chiropractic",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,1,,,0,0,0,2015-01-01,,Yes,Emergency,Yes,Emergency,No,http://sbc.thcmi.com/shop/67183MI0010011.pdf,https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://brochure.thcmi.com/,https://thcmi.com/pharmacy/,67183MI0010011-01,Standard Bronze On Exchange Plan,60.05%,0.600522756576538,No,No,No,100%,,$5600,$11200,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$2000,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,$3500,$7000,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$3500,$20,$1530,$150,$3500,$150,$0,$80,13
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,1,67577,MI,Individual,No,38-3291563,67577MI0390001,HAP Personal Alliance 1500 PPO,67577MI039,,MIN001,MIS001,MIF010,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9932,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-1500ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390001-00,Standard Gold Off Exchange Plan,,0.785503685474396,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000","$13,500","$27,000","$1,500","$3,000",0%,,,,"$5,000","$10,000","$6,500","$13,500",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,1,67577,MI,Individual,No,38-3291563,67577MI0390001,HAP Personal Alliance 1500 PPO,67577MI039,,MIN001,MIS001,MIF010,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9932,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-1500ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390001-01,Standard Gold On Exchange Plan,,0.785503685474396,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000","$13,500","$27,000","$1,500","$3,000",0%,,,,"$5,000","$10,000","$6,500","$13,500",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,1,67577,MI,Individual,No,38-3291563,67577MI0390001,HAP Personal Alliance 1500 PPO,67577MI039,,MIN001,MIS001,MIF010,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9932,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-1500ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,1,67577,MI,Individual,No,38-3291563,67577MI0390001,HAP Personal Alliance 1500 PPO,67577MI039,,MIN001,MIS001,MIF010,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9932,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-1500ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390001-03,Limited Cost Sharing Plan Variation,,0.785503685474396,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000","$13,500","$27,000","$1,500","$3,000",0%,,,,"$5,000","$10,000","$6,500","$13,500",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,1,67577,MI,Individual,No,38-3291563,67577MI0390004,HAP Personal Alliance 3000 PPO,67577MI039,,MIN001,MIS001,MIF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9921,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-3000ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390004-00,Standard Silver Off Exchange Plan,,0.681106269359589,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","$18,350","$36,700","$3,000","$6,000",20%,,,,"$6,000","$12,000","$9,000","$18,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,4,86217,MI,Individual,Yes,38-2724203,86217MI0040006,Select Dental Healthy Kids Value - Monroe,86217MI004,,MIN001,MIS005,,Existing,EPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hkvalue/summary,www.goldendentalplans.com/plans/select/hkvalue/buy,www.goldendentalplans.com/plans/select/hkvalue,,86217MI0040006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,4,86217,MI,Individual,Yes,38-2724203,86217MI0040007,Select Dental Healthy Kids Value - Oakland,86217MI004,,MIN001,MIS006,,Existing,EPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hkvalue/summary,www.goldendentalplans.com/plans/select/hkvalue/buy,www.goldendentalplans.com/plans/select/hkvalue,,86217MI0040007-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,4,86217,MI,Individual,Yes,38-2724203,86217MI0040008,Select Dental Healthy Kids Value - Saint Clair,86217MI004,,MIN001,MIS007,,Existing,EPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hkvalue/summary,www.goldendentalplans.com/plans/select/hkvalue/buy,www.goldendentalplans.com/plans/select/hkvalue,,86217MI0040008-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,4,86217,MI,Individual,Yes,38-2724203,86217MI0040009,Select Dental Healthy Kids Value - Washtenaw,86217MI004,,MIN001,MIS008,,Existing,EPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hkvalue/summary,www.goldendentalplans.com/plans/select/hkvalue/buy,www.goldendentalplans.com/plans/select/hkvalue,,86217MI0040009-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,4,86217,MI,Individual,Yes,38-2724203,86217MI0040010,Select Dental Healthy Kids Value - Wayne,86217MI004,,MIN001,MIS009,,Existing,EPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hkvalue/summary,www.goldendentalplans.com/plans/select/hkvalue/buy,www.goldendentalplans.com/plans/select/hkvalue,,86217MI0040010-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,5,86217,MI,Individual,Yes,38-2724203,86217MI0070002,Select Dental Healthy Family Max - Genesee,86217MI007,,MIN001,MIS001,,Existing,EPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hfmax/summary,www.goldendentalplans.com/plans/select/oe/hfmax/buy,www.goldendentalplans.com/plans/select/oe/hfmax,,86217MI0070002-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010003,UnitedHealthcare Gold Compass 500,71667MI001,,MIN014,MIS001,MIF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010003-03,Limited Cost Sharing Plan Variation,78.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010006,UnitedHealthcare Silver Compass 2000,71667MI001,,MIN014,MIS001,MIF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010006-00,Standard Silver Off Exchange Plan,69.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,1,71667,MI,Individual,No,38-3204052,71667MI0010004,UnitedHealthcare Silver Compass HSA 2600,71667MI001,,MIN014,MIS001,MIF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010004-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,1,67577,MI,Individual,No,38-3291563,67577MI0390004,HAP Personal Alliance 3000 PPO,67577MI039,,MIN001,MIS001,MIF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9921,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-3000ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390004-03,Limited Cost Sharing Plan Variation,,0.681106269359589,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","$18,350","$36,700","$3,000","$6,000",20%,,,,"$6,000","$12,000","$9,000","$18,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,1,67577,MI,Individual,No,38-3291563,67577MI0390004,HAP Personal Alliance 3000 PPO,67577MI039,,MIN001,MIS001,MIF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9921,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-3000ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390004-04,73% AV Level Silver Plan,,0.736137211322784,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$2,500","$5,000",20%,,,,"$5,000","$10,000","$7,500","$15,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,1,67577,MI,Individual,No,38-3291563,67577MI0390004,HAP Personal Alliance 3000 PPO,67577MI039,,MIN001,MIS001,MIF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9921,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-3000ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390004-05,87% AV Level Silver Plan,,0.866551399230957,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",0%,,,,"$1,000","$2,000","$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,1,67577,MI,Individual,No,38-3291563,67577MI0390004,HAP Personal Alliance 3000 PPO,67577MI039,,MIN001,MIS001,MIF010,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9921,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-3000ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390004-06,94% AV Level Silver Plan,,0.930617272853851,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$1,500","$3,000","$2,250","$4,500",$100,$200,0%,,,,$200,$400,$300,$600,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,2,67577,MI,Individual,No,38-3291563,67577MI0390006,HAP Personal Alliance 5000 PPO (HSA),67577MI039,,MIN001,MIS001,MIF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9887,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-5000ppoHSA.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390006-00,Standard Bronze Off Exchange Plan,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$15,000","$30,000","$21,450","$42,900",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,4
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,2,67577,MI,Individual,No,38-3291563,67577MI0390006,HAP Personal Alliance 5000 PPO (HSA),67577MI039,,MIN001,MIS001,MIF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9887,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-5000ppoHSA.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390006-01,Standard Bronze On Exchange Plan,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$15,000","$30,000","$21,450","$42,900",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,5
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,2,67577,MI,Individual,No,38-3291563,67577MI0390006,HAP Personal Alliance 5000 PPO (HSA),67577MI039,,MIN001,MIS001,MIF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9887,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-5000ppoHSA.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,2,67577,MI,Individual,No,38-3291563,67577MI0390006,HAP Personal Alliance 5000 PPO (HSA),67577MI039,,MIN001,MIS001,MIF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9887,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-5000ppoHSA.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390006-03,Limited Cost Sharing Plan Variation,,0.591681838035584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$15,000","$30,000","$21,450","$42,900",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,7
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010001,UnitedHealthcare Platinum Compass 250,71667MI001,,MIN014,MIS001,MIF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010001-03,Limited Cost Sharing Plan Variation,88.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010002,UnitedHealthcare Gold Compass 1250,71667MI001,,MIN014,MIS001,MIF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010002-00,Standard Gold Off Exchange Plan,79.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010002,UnitedHealthcare Gold Compass 1250,71667MI001,,MIN014,MIS001,MIF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010002-01,Standard Gold On Exchange Plan,79.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010002,UnitedHealthcare Gold Compass 1250,71667MI001,,MIN014,MIS001,MIF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,2,86217,MI,Individual,Yes,38-2724203,86217MI0020010,Select Dental Healthy Family Value - Wayne,86217MI002,,MIN001,MIS009,,Existing,EPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hfvalue/summary,www.goldendentalplans.com/plans/select/hfvalue/buy,www.goldendentalplans.com/plans/select/hfvalue,,86217MI0020010-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,3,86217,MI,Individual,Yes,38-2724203,86217MI0030002,Select Dental Healthy Kids Max - Genesee,86217MI003,,MIN001,MIS001,,Existing,EPO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hkmax/summary,www.goldendentalplans.com/plans/select/hkmax/buy,www.goldendentalplans.com/plans/select/hkmax,,86217MI0030002-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,2,67577,MI,Individual,No,38-3291563,67577MI0390010,HAP Personal Alliance 2000 PPO (HSA),67577MI039,,MIN001,MIS001,MIF011,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9931,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-2000ppoHSA.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390010-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,8
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,2,67577,MI,Individual,No,38-3291563,67577MI0390010,HAP Personal Alliance 2000 PPO (HSA),67577MI039,,MIN001,MIS001,MIF011,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9931,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-2000ppoHSA.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390010-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,9
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,2,67577,MI,Individual,No,38-3291563,67577MI0390010,HAP Personal Alliance 2000 PPO (HSA),67577MI039,,MIN001,MIS001,MIF011,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9931,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-2000ppoHSA.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,2,67577,MI,Individual,No,38-3291563,67577MI0390010,HAP Personal Alliance 2000 PPO (HSA),67577MI039,,MIN001,MIS001,MIF011,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9931,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-2000ppoHSA.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390010-03,Limited Cost Sharing Plan Variation,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,11
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,3,67577,MI,Individual,No,38-3291563,67577MI0390011,HAP Personal Alliance 2500 PPO,67577MI039,,MIN001,MIS001,MIF009,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-2500ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390011-00,Standard Silver Off Exchange Plan,,0.700386166572571,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000","$2,500","$5,000",20%,,,,"$5,000","$10,000","$7,500","$15,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,3,67577,MI,Individual,No,38-3291563,67577MI0390011,HAP Personal Alliance 2500 PPO,67577MI039,,MIN001,MIS001,MIF009,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-2500ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390011-01,Standard Silver On Exchange Plan,,0.700386166572571,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000","$2,500","$5,000",20%,,,,"$5,000","$10,000","$7,500","$15,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,3,67577,MI,Individual,No,38-3291563,67577MI0390011,HAP Personal Alliance 2500 PPO,67577MI039,,MIN001,MIS001,MIF009,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-2500ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390011-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,3,67577,MI,Individual,No,38-3291563,67577MI0390011,HAP Personal Alliance 2500 PPO,67577MI039,,MIN001,MIS001,MIF009,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-2500ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390011-03,Limited Cost Sharing Plan Variation,,0.700386166572571,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000","$2,500","$5,000",20%,,,,"$5,000","$10,000","$7,500","$15,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,3,67577,MI,Individual,No,38-3291563,67577MI0390011,HAP Personal Alliance 2500 PPO,67577MI039,,MIN001,MIS001,MIF009,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-2500ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390011-04,73% AV Level Silver Plan,,0.726643204689026,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$2,500","$5,000",20%,,,,"$5,000","$10,000","$7,500","$15,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,3,67577,MI,Individual,No,38-3291563,67577MI0390011,HAP Personal Alliance 2500 PPO,67577MI039,,MIN001,MIS001,MIF009,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-2500ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390011-05,87% AV Level Silver Plan,,0.86523711681366,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,3,67577,MI,Individual,No,38-3291563,67577MI0390011,HAP Personal Alliance 2500 PPO,67577MI039,,MIN001,MIS001,MIF009,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-2500ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390011-06,94% AV Level Silver Plan,,0.931623220443726,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$1,500","$3,000","$2,250","$4,500",$150,$300,20%,,,,$300,$600,$450,$900,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,3,67577,MI,Individual,No,38-3291563,67577MI0390012,HAP Personal Alliance 5000 PPO,67577MI039,,MIN001,MIS001,MIF002,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-5000ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390012-00,Standard Bronze Off Exchange Plan,,0.608052730560303,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$15,000","$30,000","$21,600","$43,200","$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,3,67577,MI,Individual,No,38-3291563,67577MI0390012,HAP Personal Alliance 5000 PPO,67577MI039,,MIN001,MIS001,MIF002,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-5000ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390012-01,Standard Bronze On Exchange Plan,,0.608052730560303,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$15,000","$30,000","$21,600","$43,200","$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,3,67577,MI,Individual,No,38-3291563,67577MI0390012,HAP Personal Alliance 5000 PPO,67577MI039,,MIN001,MIS001,MIF002,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-5000ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390012-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,3,67577,MI,Individual,No,38-3291563,67577MI0390012,HAP Personal Alliance 5000 PPO,67577MI039,,MIN001,MIS001,MIF002,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-5000ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390012-03,Limited Cost Sharing Plan Variation,,0.608052730560303,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$15,000","$30,000","$21,600","$43,200","$5,000","$10,000",20%,,,,"$10,000","$20,000","$15,000","$30,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,4,67577,MI,Individual,No,38-3291563,67577MI0390008,HAP Personal Alliance 6600 PPO,67577MI039,,MIN001,MIS001,MIF011,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9828,,,0,3,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-6600ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390008-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$15,000","$30,000","$21,600","$43,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$15,000","$30,000","$21,600","$43,200",,,,,,,,,4
2015,MI,67577,SERFF,6,2015-01-21 12:15:34,4,67577,MI,Individual,No,38-3291563,67577MI0390008,HAP Personal Alliance 6600 PPO,67577MI039,,MIN001,MIS001,MIF011,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9828,,,0,3,0,2015-01-01,,No,Emergency Services and Out of Network Benefits Apply,Yes,Emergency Services and Out of Network Benefits Apply,No,www.hap.org/sbc/2015-pa-6600ppo.pdf,https://pay.hap.org/paymentRequest/ffm/saml/web,www.hap.org/healthinsurance/personalalliance/pdf/2015sales.pdf,http://www.hap.org/prescriptions/docs/2015PersonalAlliancePPODrugFormulary.pdf,67577MI0390008-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$15,000","$30,000","$21,600","$43,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$15,000","$30,000","$21,600","$43,200",,,,,,,,,5
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,1,71667,MI,Individual,No,38-3204052,71667MI0010004,UnitedHealthcare Silver Compass HSA 2600,71667MI001,,MIN014,MIS001,MIF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010004-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,1,71667,MI,Individual,No,38-3204052,71667MI0010004,UnitedHealthcare Silver Compass HSA 2600,71667MI001,,MIN014,MIS001,MIF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010004-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,1,71667,MI,Individual,No,38-3204052,71667MI0010004,UnitedHealthcare Silver Compass HSA 2600,71667MI001,,MIN014,MIS001,MIF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,1,71667,MI,Individual,No,38-3204052,71667MI0010004,UnitedHealthcare Silver Compass HSA 2600,71667MI001,,MIN014,MIS001,MIF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010004-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$75,$150,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,1,71667,MI,Individual,No,38-3204052,71667MI0010005,UnitedHealthcare Silver Compass HSA1600,71667MI001,,MIN014,MIS001,MIF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010005-00,Standard Silver Off Exchange Plan,68.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,1,71667,MI,Individual,No,38-3204052,71667MI0010005,UnitedHealthcare Silver Compass HSA1600,71667MI001,,MIN014,MIS001,MIF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010005-01,Standard Silver On Exchange Plan,68.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,1,71667,MI,Individual,No,38-3204052,71667MI0010005,UnitedHealthcare Silver Compass HSA1600,71667MI001,,MIN014,MIS001,MIF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010005-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,1,71667,MI,Individual,No,38-3204052,71667MI0010005,UnitedHealthcare Silver Compass HSA1600,71667MI001,,MIN014,MIS001,MIF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010005-03,Limited Cost Sharing Plan Variation,68.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,1,71667,MI,Individual,No,38-3204052,71667MI0010005,UnitedHealthcare Silver Compass HSA1600,71667MI001,,MIN014,MIS001,MIF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010005-04,73% AV Level Silver Plan,72.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,1,71667,MI,Individual,No,38-3204052,71667MI0010005,UnitedHealthcare Silver Compass HSA1600,71667MI001,,MIN014,MIS001,MIF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010005-05,87% AV Level Silver Plan,86.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,1,71667,MI,Individual,No,38-3204052,71667MI0010005,UnitedHealthcare Silver Compass HSA1600,71667MI001,,MIN014,MIS001,MIF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010005-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,1,71667,MI,Individual,No,38-3204052,71667MI0010009,UnitedHealthcare Bronze Compass HSA 4900,71667MI001,,MIN014,MIS001,MIF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010009-00,Standard Bronze Off Exchange Plan,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,1,71667,MI,Individual,No,38-3204052,71667MI0010009,UnitedHealthcare Bronze Compass HSA 4900,71667MI001,,MIN014,MIS001,MIF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010009-01,Standard Bronze On Exchange Plan,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,1,71667,MI,Individual,No,38-3204052,71667MI0010009,UnitedHealthcare Bronze Compass HSA 4900,71667MI001,,MIN014,MIS001,MIF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010009-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,1,71667,MI,Individual,No,38-3204052,71667MI0010009,UnitedHealthcare Bronze Compass HSA 4900,71667MI001,,MIN014,MIS001,MIF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010009-03,Limited Cost Sharing Plan Variation,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010001,UnitedHealthcare Platinum Compass 250,71667MI001,,MIN014,MIS001,MIF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010001-00,Standard Platinum Off Exchange Plan,88.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010001,UnitedHealthcare Platinum Compass 250,71667MI001,,MIN014,MIS001,MIF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010001-01,Standard Platinum On Exchange Plan,88.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010001,UnitedHealthcare Platinum Compass 250,71667MI001,,MIN014,MIS001,MIF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,2,86217,MI,Individual,Yes,38-2724203,86217MI0020004,Select Dental Healthy Family Value - Livingston,86217MI002,,MIN001,MIS003,,Existing,EPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hfvalue/summary,www.goldendentalplans.com/plans/select/hfvalue/buy,www.goldendentalplans.com/plans/select/hfvalue,,86217MI0020004-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,2,86217,MI,Individual,Yes,38-2724203,86217MI0020005,Select Dental Healthy Family Value - Macomb,86217MI002,,MIN001,MIS004,,Existing,EPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hfvalue/summary,www.goldendentalplans.com/plans/select/hfvalue/buy,www.goldendentalplans.com/plans/select/hfvalue,,86217MI0020005-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,2,86217,MI,Individual,Yes,38-2724203,86217MI0020006,Select Dental Healthy Family Value - Monroe,86217MI002,,MIN001,MIS005,,Existing,EPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hfvalue/summary,www.goldendentalplans.com/plans/select/hfvalue/buy,www.goldendentalplans.com/plans/select/hfvalue,,86217MI0020006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,2,86217,MI,Individual,Yes,38-2724203,86217MI0020007,Select Dental Healthy Family Value - Oakland,86217MI002,,MIN001,MIS006,,Existing,EPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hfvalue/summary,www.goldendentalplans.com/plans/select/hfvalue/buy,www.goldendentalplans.com/plans/select/hfvalue,,86217MI0020007-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,3,86217,MI,Individual,Yes,38-2724203,86217MI0030003,Select Dental Healthy Kids Max - Ingham,86217MI003,,MIN001,MIS002,,Existing,EPO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hkmax/summary,www.goldendentalplans.com/plans/select/hkmax/buy,www.goldendentalplans.com/plans/select/hkmax,,86217MI0030003-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,3,86217,MI,Individual,Yes,38-2724203,86217MI0030004,Select Dental Healthy Kids Max - Livingston,86217MI003,,MIN001,MIS003,,Existing,EPO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hkmax/summary,www.goldendentalplans.com/plans/select/hkmax/buy,www.goldendentalplans.com/plans/select/hkmax,,86217MI0030004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,3,86217,MI,Individual,Yes,38-2724203,86217MI0030005,Select Dental Healthy Kids Max - Macomb,86217MI003,,MIN001,MIS004,,Existing,EPO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hkmax/summary,www.goldendentalplans.com/plans/select/hkmax/buy,www.goldendentalplans.com/plans/select/hkmax,,86217MI0030005-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,3,86217,MI,Individual,Yes,38-2724203,86217MI0030006,Select Dental Healthy Kids Max - Monroe,86217MI003,,MIN001,MIS005,,Existing,EPO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hkmax/summary,www.goldendentalplans.com/plans/select/hkmax/buy,www.goldendentalplans.com/plans/select/hkmax,,86217MI0030006-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,3,86217,MI,Individual,Yes,38-2724203,86217MI0030007,Select Dental Healthy Kids Max - Oakland,86217MI003,,MIN001,MIS006,,Existing,EPO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hkmax/summary,www.goldendentalplans.com/plans/select/hkmax/buy,www.goldendentalplans.com/plans/select/hkmax,,86217MI0030007-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,3,86217,MI,Individual,Yes,38-2724203,86217MI0030008,Select Dental Healthy Kids Max - Saint Clair,86217MI003,,MIN001,MIS007,,Existing,EPO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hkmax/summary,www.goldendentalplans.com/plans/select/hkmax/buy,www.goldendentalplans.com/plans/select/hkmax,,86217MI0030008-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010002,UnitedHealthcare Gold Compass 1250,71667MI001,,MIN014,MIS001,MIF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010002-03,Limited Cost Sharing Plan Variation,79.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010003,UnitedHealthcare Gold Compass 500,71667MI001,,MIN014,MIS001,MIF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010003-00,Standard Gold Off Exchange Plan,78.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010003,UnitedHealthcare Gold Compass 500,71667MI001,,MIN014,MIS001,MIF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010003-01,Standard Gold On Exchange Plan,78.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010003,UnitedHealthcare Gold Compass 500,71667MI001,,MIN014,MIS001,MIF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010003-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010006,UnitedHealthcare Silver Compass 2000,71667MI001,,MIN014,MIS001,MIF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010006-01,Standard Silver On Exchange Plan,69.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010006,UnitedHealthcare Silver Compass 2000,71667MI001,,MIN014,MIS001,MIF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010006-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010006,UnitedHealthcare Silver Compass 2000,71667MI001,,MIN014,MIS001,MIF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010006-03,Limited Cost Sharing Plan Variation,69.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010006,UnitedHealthcare Silver Compass 2000,71667MI001,,MIN014,MIS001,MIF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010006-04,73% AV Level Silver Plan,73.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010006,UnitedHealthcare Silver Compass 2000,71667MI001,,MIN014,MIS001,MIF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010006-05,87% AV Level Silver Plan,86.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010006,UnitedHealthcare Silver Compass 2000,71667MI001,,MIN014,MIS001,MIF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010006-06,94% AV Level Silver Plan,93.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010007,UnitedHealthcare Silver Compass 3500,71667MI001,,MIN014,MIS001,MIF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010007-00,Standard Silver Off Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010007,UnitedHealthcare Silver Compass 3500,71667MI001,,MIN014,MIS001,MIF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010007-01,Standard Silver On Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010007,UnitedHealthcare Silver Compass 3500,71667MI001,,MIN014,MIS001,MIF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010007-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,25
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010007,UnitedHealthcare Silver Compass 3500,71667MI001,,MIN014,MIS001,MIF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010007-03,Limited Cost Sharing Plan Variation,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010007,UnitedHealthcare Silver Compass 3500,71667MI001,,MIN014,MIS001,MIF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010007-04,73% AV Level Silver Plan,73.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010007,UnitedHealthcare Silver Compass 3500,71667MI001,,MIN014,MIS001,MIF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010007-05,87% AV Level Silver Plan,86.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010007,UnitedHealthcare Silver Compass 3500,71667MI001,,MIN014,MIS001,MIF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010007-06,94% AV Level Silver Plan,93.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010008,UnitedHealthcare Silver Compass 5000,71667MI001,,MIN014,MIS001,MIF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010008-00,Standard Silver Off Exchange Plan,69.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010008,UnitedHealthcare Silver Compass 5000,71667MI001,,MIN014,MIS001,MIF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010008-01,Standard Silver On Exchange Plan,69.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010008,UnitedHealthcare Silver Compass 5000,71667MI001,,MIN014,MIS001,MIF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010008-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,32
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010008,UnitedHealthcare Silver Compass 5000,71667MI001,,MIN014,MIS001,MIF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010008-03,Limited Cost Sharing Plan Variation,69.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010008,UnitedHealthcare Silver Compass 5000,71667MI001,,MIN014,MIS001,MIF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010008-04,73% AV Level Silver Plan,73.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,$750,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010008,UnitedHealthcare Silver Compass 5000,71667MI001,,MIN014,MIS001,MIF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010008-05,87% AV Level Silver Plan,86.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,2,71667,MI,Individual,No,38-3204052,71667MI0010008,UnitedHealthcare Silver Compass 5000,71667MI001,,MIN014,MIS001,MIF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010008-06,94% AV Level Silver Plan,93.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,3,71667,MI,Individual,No,38-3204052,71667MI0010010,UnitedHealthcare Bronze Compass 5500,71667MI001,,MIN014,MIS001,MIF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010010-00,Standard Bronze Off Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,3,71667,MI,Individual,No,38-3204052,71667MI0010010,UnitedHealthcare Bronze Compass 5500,71667MI001,,MIN014,MIS001,MIF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010010-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,3,71667,MI,Individual,No,38-3204052,71667MI0010010,UnitedHealthcare Bronze Compass 5500,71667MI001,,MIN014,MIS001,MIF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010010-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MI,71667,SERFF,5,2014-12-11 11:35:20,3,71667,MI,Individual,No,38-3204052,71667MI0010010,UnitedHealthcare Bronze Compass 5500,71667MI001,,MIN014,MIS001,MIF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xmi,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xmi,71667MI0010010-03,Limited Cost Sharing Plan Variation,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,MI,74709,SERFF,1,2014-08-08 13:45:50,1,74709,MI,SHOP (Small Group),Yes,35-0472300,74709MI0010001,Lincoln Dental Connect?,74709MI001,,MIN001,MIS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.87,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,74709MI0010001-00,Standard High Off Exchange Plan,83.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,74709,SERFF,1,2014-08-08 13:45:50,1,74709,MI,SHOP (Small Group),Yes,35-0472300,74709MI0010002,Lincoln Dental Connect?,74709MI001,,MIN001,MIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.10,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,74709MI0010002-00,Standard Low Off Exchange Plan,71.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,74709,SERFF,1,2014-08-08 13:45:50,1,74709,MI,SHOP (Small Group),Yes,35-0472300,74709MI0010003,Lincoln Dental Connect?,74709MI001,,MIN001,MIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.13,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,74709MI0010003-00,Standard Low Off Exchange Plan,71.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,74709,SERFF,1,2014-08-08 13:45:50,1,74709,MI,SHOP (Small Group),Yes,35-0472300,74709MI0010005,Lincoln Dental Connect?,74709MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.10,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,74709MI0010005-00,Standard High Off Exchange Plan,83.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,74709,SERFF,1,2014-08-08 13:45:50,1,74709,MI,SHOP (Small Group),Yes,35-0472300,74709MI0010006,Lincoln Dental Connect?,74709MI001,,MIN001,MIS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.05,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,74709MI0010006-00,Standard Low Off Exchange Plan,71.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MI,74709,SERFF,1,2014-08-08 13:45:50,1,74709,MI,SHOP (Small Group),Yes,35-0472300,74709MI0010007,Lincoln Dental Connect?,74709MI001,,MIN001,MIS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.01,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,74709MI0010007-00,Standard Low Off Exchange Plan,71.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MI,74709,SERFF,1,2014-08-08 13:45:50,2,74709,MI,SHOP (Small Group),Yes,35-0472300,74709MI0010004,Lincoln Dental Connect?,74709MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.10,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,74709MI0010004-00,Standard High Off Exchange Plan,85.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,74709,SERFF,1,2014-08-08 13:45:50,2,74709,MI,SHOP (Small Group),Yes,35-0472300,74709MI0010008,Lincoln Dental Connect?,74709MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.68,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,74709MI0010008-00,Standard High Off Exchange Plan,85.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,75936,SERFF,2,2014-08-09 13:12:30,1,75936,MI,Individual,Yes,47-0397286,75936MI0010001,"Delta Dental Individual PPO, EHB Certified",75936MI001,,MIN002,MIS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.86,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,75936MI0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,75936,SERFF,2,2014-08-09 13:12:30,1,75936,MI,SHOP (Small Group),Yes,47-0397286,75936MI0030001,"Renaissance Group Dental PPO, EHB Certified",75936MI003,,MIN001,MIS002,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.06,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,75936MI0030001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,75936,SERFF,2,2014-08-09 13:12:30,1,75936,MI,SHOP (Small Group),Yes,47-0397286,75936MI0030002,"Renaissance Group Dental PPO, EHB Certified",75936MI003,,MIN001,MIS002,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.99,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,75936MI0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,75936,SERFF,2,2014-08-09 13:12:30,1,75936,MI,Individual,Yes,47-0397286,75936MI0010002,"Delta Dental Individual PPO, EHB Certified",75936MI001,,MIN002,MIS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.75,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,75936MI0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,75936,SERFF,2,2014-08-09 13:12:30,1,75936,MI,Individual,Yes,47-0397286,75936MI0020001,"Renaissance Individual Dental PPO, EHB Certified",75936MI002,,MIN001,MIS002,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$38.99,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,75936MI0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,75936,SERFF,2,2014-08-09 13:12:30,1,75936,MI,Individual,Yes,47-0397286,75936MI0020002,"Renaissance Individual Dental PPO, EHB Certified",75936MI002,,MIN001,MIS002,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.27,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,75936MI0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,79116,SERFF,1,2014-08-08 13:45:50,1,79116,MI,SHOP (Small Group),Yes,41-0808596,79116MI0010001,"Plan 1. Passive PPO, $1000 Annual Maximum, no Ortho",79116MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,79116MI0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,79116,SERFF,1,2014-08-08 13:45:50,1,79116,MI,SHOP (Small Group),Yes,41-0808596,79116MI0010002,"Plan 2.  Passive PPO, $1000 Annual Maximum, Ortho",79116MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,79116MI0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,79116,SERFF,1,2014-08-08 13:45:50,1,79116,MI,SHOP (Small Group),Yes,41-0808596,79116MI0010003,"Plan 3. Passive PPO, $1500 Annual Maximum, no Ortho",79116MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,79116MI0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,79116,SERFF,1,2014-08-08 13:45:50,1,79116,MI,SHOP (Small Group),Yes,41-0808596,79116MI0010004,"Plan 4.  Passive PPO, $1500 Annual Maximum, Ortho",79116MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,79116MI0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,79116,SERFF,1,2014-08-08 13:45:50,1,79116,MI,SHOP (Small Group),Yes,41-0808596,79116MI0010005,"Plan 5.  Passive PPO, $2000 Annual Maximum, Ortho",79116MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,79116MI0010005-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MI,79116,SERFF,1,2014-08-08 13:45:50,1,79116,MI,SHOP (Small Group),Yes,41-0808596,79116MI0010006,"Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho",79116MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,79116MI0010006-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MI,79116,SERFF,1,2014-08-08 13:45:50,1,79116,MI,SHOP (Small Group),Yes,41-0808596,79116MI0010007,"Plan 7. Graded Passive PPO, $1500 Annual Maximum, Ortho",79116MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,79116MI0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,MI,79116,SERFF,1,2014-08-08 13:45:50,1,79116,MI,SHOP (Small Group),Yes,41-0808596,79116MI0010008,"Plan 8. MAC PPO, $1000 Annual Maximum, no Ortho",79116MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,79116MI0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,MI,79116,SERFF,1,2014-08-08 13:45:50,1,79116,MI,SHOP (Small Group),Yes,41-0808596,79116MI0010009,"Plan 9. MAC PPO, $1500 Annual Maximum, Ortho",79116MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,79116MI0010009-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,MI,79116,SERFF,1,2014-08-08 13:45:50,1,79116,MI,SHOP (Small Group),Yes,41-0808596,79116MI0010010,"Plan 10. Graded MAC PPO, $1000 Annual Maximum, no Ortho",79116MI001,,MIN001,MIS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,79116MI0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,13
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,1,86217,MI,Individual,Yes,38-2724203,86217MI0010002,Select Dental Healthy Family Max - Genesee,86217MI001,,MIN001,MIS001,,Existing,EPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hfmax/summary,www.goldendentalplans.com/plans/select/hfmax/buy,www.goldendentalplans.com/plans/select/hfmax,,86217MI0010002-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,1,86217,MI,Individual,Yes,38-2724203,86217MI0010003,Select Dental Healthy Family Max - Ingham,86217MI001,,MIN001,MIS002,,Existing,EPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hfmax/summary,www.goldendentalplans.com/plans/select/hfmax/buy,www.goldendentalplans.com/plans/select/hfmax,,86217MI0010003-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,1,86217,MI,Individual,Yes,38-2724203,86217MI0010004,Select Dental Healthy Family Max - Livingston,86217MI001,,MIN001,MIS003,,Existing,EPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hfmax/summary,www.goldendentalplans.com/plans/select/hfmax/buy,www.goldendentalplans.com/plans/select/hfmax,,86217MI0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,1,86217,MI,Individual,Yes,38-2724203,86217MI0010005,Select Dental Healthy Family Max - Macomb,86217MI001,,MIN001,MIS004,,Existing,EPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hfmax/summary,www.goldendentalplans.com/plans/select/hfmax/buy,www.goldendentalplans.com/plans/select/hfmax,,86217MI0010005-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,1,86217,MI,Individual,Yes,38-2724203,86217MI0010006,Select Dental Healthy Family Max - Monroe,86217MI001,,MIN001,MIS005,,Existing,EPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hfmax/summary,www.goldendentalplans.com/plans/select/hfmax/buy,www.goldendentalplans.com/plans/select/hfmax,,86217MI0010006-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,1,86217,MI,Individual,Yes,38-2724203,86217MI0010007,Select Dental Healthy Family Max - Oakland,86217MI001,,MIN001,MIS006,,Existing,EPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hfmax/summary,www.goldendentalplans.com/plans/select/hfmax/buy,www.goldendentalplans.com/plans/select/hfmax,,86217MI0010007-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,1,86217,MI,Individual,Yes,38-2724203,86217MI0010008,Select Dental Healthy Family Max - Saint Clair,86217MI001,,MIN001,MIS007,,Existing,EPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hfmax/summary,www.goldendentalplans.com/plans/select/hfmax/buy,www.goldendentalplans.com/plans/select/hfmax,,86217MI0010008-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,1,86217,MI,Individual,Yes,38-2724203,86217MI0010009,Select Dental Healthy Family Max - Washtenaw,86217MI001,,MIN001,MIS008,,Existing,EPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hfmax/summary,www.goldendentalplans.com/plans/select/hfmax/buy,www.goldendentalplans.com/plans/select/hfmax,,86217MI0010009-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,1,86217,MI,Individual,Yes,38-2724203,86217MI0010010,Select Dental Healthy Family Max - Wayne,86217MI001,,MIN001,MIS009,,Existing,EPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hfmax/summary,www.goldendentalplans.com/plans/select/hfmax/buy,www.goldendentalplans.com/plans/select/hfmax,,86217MI0010010-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,2,86217,MI,Individual,Yes,38-2724203,86217MI0020002,Select Dental Healthy Family Value - Genesee,86217MI002,,MIN001,MIS001,,Existing,EPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hfvalue/summary,www.goldendentalplans.com/plans/select/hfvalue/buy,www.goldendentalplans.com/plans/select/hfvalue,,86217MI0020002-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,2,86217,MI,Individual,Yes,38-2724203,86217MI0020003,Select Dental Healthy Family Value - Ingham,86217MI002,,MIN001,MIS002,,Existing,EPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hfvalue/summary,www.goldendentalplans.com/plans/select/hfvalue/buy,www.goldendentalplans.com/plans/select/hfvalue,,86217MI0020003-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,2,86217,MI,Individual,Yes,38-2724203,86217MI0020008,Select Dental Healthy Family Value - Saint Clair,86217MI002,,MIN001,MIS007,,Existing,EPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hfvalue/summary,www.goldendentalplans.com/plans/select/hfvalue/buy,www.goldendentalplans.com/plans/select/hfvalue,,86217MI0020008-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,2,86217,MI,Individual,Yes,38-2724203,86217MI0020009,Select Dental Healthy Family Value - Washtenaw,86217MI002,,MIN001,MIS008,,Existing,EPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hfvalue/summary,www.goldendentalplans.com/plans/select/hfvalue/buy,www.goldendentalplans.com/plans/select/hfvalue,,86217MI0020009-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,3,86217,MI,Individual,Yes,38-2724203,86217MI0030009,Select Dental Healthy Kids Max - Washtenaw,86217MI003,,MIN001,MIS008,,Existing,EPO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hkmax/summary,www.goldendentalplans.com/plans/select/hkmax/buy,www.goldendentalplans.com/plans/select/hkmax,,86217MI0030009-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,3,86217,MI,Individual,Yes,38-2724203,86217MI0030010,Select Dental Healthy Kids Max - Wayne,86217MI003,,MIN001,MIS009,,Existing,EPO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hkmax/summary,www.goldendentalplans.com/plans/select/hkmax/buy,www.goldendentalplans.com/plans/select/hkmax,,86217MI0030010-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,4,86217,MI,Individual,Yes,38-2724203,86217MI0040002,Select Dental Healthy Kids Value - Genesee,86217MI004,,MIN001,MIS001,,Existing,EPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hkvalue/summary,www.goldendentalplans.com/plans/select/hkvalue/buy,www.goldendentalplans.com/plans/select/hkvalue,,86217MI0040002-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,4,86217,MI,Individual,Yes,38-2724203,86217MI0040003,Select Dental Healthy Kids Value - Ingham,86217MI004,,MIN001,MIS002,,Existing,EPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hkvalue/summary,www.goldendentalplans.com/plans/select/hkvalue/buy,www.goldendentalplans.com/plans/select/hkvalue,,86217MI0040003-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,4,86217,MI,Individual,Yes,38-2724203,86217MI0040004,Select Dental Healthy Kids Value - Livingston,86217MI004,,MIN001,MIS003,,Existing,EPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hkvalue/summary,www.goldendentalplans.com/plans/select/hkvalue/buy,www.goldendentalplans.com/plans/select/hkvalue,,86217MI0040004-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,4,86217,MI,Individual,Yes,38-2724203,86217MI0040005,Select Dental Healthy Kids Value - Macomb,86217MI004,,MIN001,MIS004,,Existing,EPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/hkvalue/summary,www.goldendentalplans.com/plans/select/hkvalue/buy,www.goldendentalplans.com/plans/select/hkvalue,,86217MI0040005-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,5,86217,MI,Individual,Yes,38-2724203,86217MI0070003,Select Dental Healthy Family Max - Ingham,86217MI007,,MIN001,MIS002,,Existing,EPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hfmax/summary,www.goldendentalplans.com/plans/select/oe/hfmax/buy,www.goldendentalplans.com/plans/select/oe/hfmax,,86217MI0070003-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,5,86217,MI,Individual,Yes,38-2724203,86217MI0070004,Select Dental Healthy Family Max - Livingston,86217MI007,,MIN001,MIS003,,Existing,EPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hfmax/summary,www.goldendentalplans.com/plans/select/oe/hfmax/buy,www.goldendentalplans.com/plans/select/oe/hfmax,,86217MI0070004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,5,86217,MI,Individual,Yes,38-2724203,86217MI0070005,Select Dental Healthy Family Max - Macomb,86217MI007,,MIN001,MIS004,,Existing,EPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hfmax/summary,www.goldendentalplans.com/plans/select/oe/hfmax/buy,www.goldendentalplans.com/plans/select/oe/hfmax,,86217MI0070005-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,5,86217,MI,Individual,Yes,38-2724203,86217MI0070006,Select Dental Healthy Family Max - Monroe,86217MI007,,MIN001,MIS005,,Existing,EPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hfmax/summary,www.goldendentalplans.com/plans/select/oe/hfmax/buy,www.goldendentalplans.com/plans/select/oe/hfmax,,86217MI0070006-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,5,86217,MI,Individual,Yes,38-2724203,86217MI0070007,Select Dental Healthy Family Max - Oakland,86217MI007,,MIN001,MIS006,,Existing,EPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hfmax/summary,www.goldendentalplans.com/plans/select/oe/hfmax/buy,www.goldendentalplans.com/plans/select/oe/hfmax,,86217MI0070007-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,5,86217,MI,Individual,Yes,38-2724203,86217MI0070008,Select Dental Healthy Family Max - Saint Clair,86217MI007,,MIN001,MIS007,,Existing,EPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hfmax/summary,www.goldendentalplans.com/plans/select/oe/hfmax/buy,www.goldendentalplans.com/plans/select/oe/hfmax,,86217MI0070008-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,5,86217,MI,Individual,Yes,38-2724203,86217MI0070009,Select Dental Healthy Family Max - Washtenaw,86217MI007,,MIN001,MIS008,,Existing,EPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hfmax/summary,www.goldendentalplans.com/plans/select/oe/hfmax/buy,www.goldendentalplans.com/plans/select/oe/hfmax,,86217MI0070009-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,5,86217,MI,Individual,Yes,38-2724203,86217MI0070010,Select Dental Healthy Family Max - Wayne,86217MI007,,MIN001,MIS009,,Existing,EPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hfmax/summary,www.goldendentalplans.com/plans/select/oe/hfmax/buy,www.goldendentalplans.com/plans/select/oe/hfmax,,86217MI0070010-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,6,86217,MI,Individual,Yes,38-2724203,86217MI0080002,Select Dental Healthy Family Value - Genesee,86217MI008,,MIN001,MIS001,,Existing,EPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hfvalue/summary,www.goldendentalplans.com/plans/select/oe/hfvalue/buy,www.goldendentalplans.com/plans/select/oe/hfvalue,,86217MI0080002-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,6,86217,MI,Individual,Yes,38-2724203,86217MI0080003,Select Dental Healthy Family Value - Ingham,86217MI008,,MIN001,MIS002,,Existing,EPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hfvalue/summary,www.goldendentalplans.com/plans/select/oe/hfvalue/buy,www.goldendentalplans.com/plans/select/oe/hfvalue,,86217MI0080003-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,6,86217,MI,Individual,Yes,38-2724203,86217MI0080004,Select Dental Healthy Family Value - Livingston,86217MI008,,MIN001,MIS003,,Existing,EPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hfvalue/summary,www.goldendentalplans.com/plans/select/oe/hfvalue/buy,www.goldendentalplans.com/plans/select/oe/hfvalue,,86217MI0080004-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,6,86217,MI,Individual,Yes,38-2724203,86217MI0080005,Select Dental Healthy Family Value - Macomb,86217MI008,,MIN001,MIS004,,Existing,EPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hfvalue/summary,www.goldendentalplans.com/plans/select/oe/hfvalue/buy,www.goldendentalplans.com/plans/select/oe/hfvalue,,86217MI0080005-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,6,86217,MI,Individual,Yes,38-2724203,86217MI0080006,Select Dental Healthy Family Value - Monroe,86217MI008,,MIN001,MIS005,,Existing,EPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hfvalue/summary,www.goldendentalplans.com/plans/select/oe/hfvalue/buy,www.goldendentalplans.com/plans/select/oe/hfvalue,,86217MI0080006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,6,86217,MI,Individual,Yes,38-2724203,86217MI0080007,Select Dental Healthy Family Value - Oakland,86217MI008,,MIN001,MIS006,,Existing,EPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hfvalue/summary,www.goldendentalplans.com/plans/select/oe/hfvalue/buy,www.goldendentalplans.com/plans/select/oe/hfvalue,,86217MI0080007-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,6,86217,MI,Individual,Yes,38-2724203,86217MI0080008,Select Dental Healthy Family Value - Saint Clair,86217MI008,,MIN001,MIS007,,Existing,EPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hfvalue/summary,www.goldendentalplans.com/plans/select/oe/hfvalue/buy,www.goldendentalplans.com/plans/select/oe/hfvalue,,86217MI0080008-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,6,86217,MI,Individual,Yes,38-2724203,86217MI0080009,Select Dental Healthy Family Value - Washtenaw,86217MI008,,MIN001,MIS008,,Existing,EPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hfvalue/summary,www.goldendentalplans.com/plans/select/oe/hfvalue/buy,www.goldendentalplans.com/plans/select/oe/hfvalue,,86217MI0080009-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,6,86217,MI,Individual,Yes,38-2724203,86217MI0080010,Select Dental Healthy Family Value - Wayne,86217MI008,,MIN001,MIS009,,Existing,EPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hfvalue/summary,www.goldendentalplans.com/plans/select/oe/hfvalue/buy,www.goldendentalplans.com/plans/select/oe/hfvalue,,86217MI0080010-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,7,86217,MI,Individual,Yes,38-2724203,86217MI0090002,Select Dental Healthy Kids Max - Genesee,86217MI009,,MIN001,MIS001,,Existing,EPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hkmax/summary,www.goldendentalplans.com/plans/select/oe/hkmax/buy,www.goldendentalplans.com/plans/select/oe/hkmax,,86217MI0090002-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,7,86217,MI,Individual,Yes,38-2724203,86217MI0090003,Select Dental Healthy Kids Max - Ingham,86217MI009,,MIN001,MIS002,,Existing,EPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hkmax/summary,www.goldendentalplans.com/plans/select/oe/hkmax/buy,www.goldendentalplans.com/plans/select/oe/hkmax,,86217MI0090003-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,7,86217,MI,Individual,Yes,38-2724203,86217MI0090004,Select Dental Healthy Kids Max - Livingston,86217MI009,,MIN001,MIS003,,Existing,EPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hkmax/summary,www.goldendentalplans.com/plans/select/oe/hkmax/buy,www.goldendentalplans.com/plans/select/oe/hkmax,,86217MI0090004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,7,86217,MI,Individual,Yes,38-2724203,86217MI0090005,Select Dental Healthy Kids Max - Macomb,86217MI009,,MIN001,MIS004,,Existing,EPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hkmax/summary,www.goldendentalplans.com/plans/select/oe/hkmax/buy,www.goldendentalplans.com/plans/select/oe/hkmax,,86217MI0090005-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,7,86217,MI,Individual,Yes,38-2724203,86217MI0090006,Select Dental Healthy Kids Max - Monroe,86217MI009,,MIN001,MIS005,,Existing,EPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hkmax/summary,www.goldendentalplans.com/plans/select/oe/hkmax/buy,www.goldendentalplans.com/plans/select/oe/hkmax,,86217MI0090006-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,7,86217,MI,Individual,Yes,38-2724203,86217MI0090007,Select Dental Healthy Kids Max - Oakland,86217MI009,,MIN001,MIS006,,Existing,EPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hkmax/summary,www.goldendentalplans.com/plans/select/oe/hkmax/buy,www.goldendentalplans.com/plans/select/oe/hkmax,,86217MI0090007-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,7,86217,MI,Individual,Yes,38-2724203,86217MI0090008,Select Dental Healthy Kids Max - Saint Clair,86217MI009,,MIN001,MIS007,,Existing,EPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hkmax/summary,www.goldendentalplans.com/plans/select/oe/hkmax/buy,www.goldendentalplans.com/plans/select/oe/hkmax,,86217MI0090008-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,7,86217,MI,Individual,Yes,38-2724203,86217MI0090009,Select Dental Healthy Kids Max - Washtenaw,86217MI009,,MIN001,MIS008,,Existing,EPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hkmax/summary,www.goldendentalplans.com/plans/select/oe/hkmax/buy,www.goldendentalplans.com/plans/select/oe/hkmax,,86217MI0090009-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,7,86217,MI,Individual,Yes,38-2724203,86217MI0090010,Select Dental Healthy Kids Max - Wayne,86217MI009,,MIN001,MIS009,,Existing,EPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$45.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hkmax/summary,www.goldendentalplans.com/plans/select/oe/hkmax/buy,www.goldendentalplans.com/plans/select/oe/hkmax,,86217MI0090010-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,8,86217,MI,Individual,Yes,38-2724203,86217MI0100002,Select Dental Healthy Kids Value - Genesee,86217MI010,,MIN001,MIS001,,Existing,EPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hkvalue/summary,www.goldendentalplans.com/plans/select/oe/hkvalue/buy,www.goldendentalplans.com/plans/select/oe/hkvalue,,86217MI0100002-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,8,86217,MI,Individual,Yes,38-2724203,86217MI0100003,Select Dental Healthy Kids Value - Ingham,86217MI010,,MIN001,MIS002,,Existing,EPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hkvalue/summary,www.goldendentalplans.com/plans/select/oe/hkvalue/buy,www.goldendentalplans.com/plans/select/oe/hkvalue,,86217MI0100003-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,8,86217,MI,Individual,Yes,38-2724203,86217MI0100004,Select Dental Healthy Kids Value - Livingston,86217MI010,,MIN001,MIS003,,Existing,EPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hkvalue/summary,www.goldendentalplans.com/plans/select/oe/hkvalue/buy,www.goldendentalplans.com/plans/select/oe/hkvalue,,86217MI0100004-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,8,86217,MI,Individual,Yes,38-2724203,86217MI0100005,Select Dental Healthy Kids Value - Macomb,86217MI010,,MIN001,MIS004,,Existing,EPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hkvalue/summary,www.goldendentalplans.com/plans/select/oe/hkvalue/buy,www.goldendentalplans.com/plans/select/oe/hkvalue,,86217MI0100005-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,8,86217,MI,Individual,Yes,38-2724203,86217MI0100006,Select Dental Healthy Kids Value - Monroe,86217MI010,,MIN001,MIS005,,Existing,EPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hkvalue/summary,www.goldendentalplans.com/plans/select/oe/hkvalue/buy,www.goldendentalplans.com/plans/select/oe/hkvalue,,86217MI0100006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,8,86217,MI,Individual,Yes,38-2724203,86217MI0100007,Select Dental Healthy Kids Value - Oakland,86217MI010,,MIN001,MIS006,,Existing,EPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hkvalue/summary,www.goldendentalplans.com/plans/select/oe/hkvalue/buy,www.goldendentalplans.com/plans/select/oe/hkvalue,,86217MI0100007-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,8,86217,MI,Individual,Yes,38-2724203,86217MI0100008,Select Dental Healthy Kids Value - Saint Clair,86217MI010,,MIN001,MIS007,,Existing,EPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hkvalue/summary,www.goldendentalplans.com/plans/select/oe/hkvalue/buy,www.goldendentalplans.com/plans/select/oe/hkvalue,,86217MI0100008-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,8,86217,MI,Individual,Yes,38-2724203,86217MI0100009,Select Dental Healthy Kids Value - Washtenaw,86217MI010,,MIN001,MIS008,,Existing,EPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hkvalue/summary,www.goldendentalplans.com/plans/select/oe/hkvalue/buy,www.goldendentalplans.com/plans/select/oe/hkvalue,,86217MI0100009-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,MI,86217,SERFF,4,2014-11-17 10:57:52,8,86217,MI,Individual,Yes,38-2724203,86217MI0100010,Select Dental Healthy Kids Value - Wayne,86217MI010,,MIN001,MIS009,,Existing,EPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$36.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency only. $100 limit.,Yes,Emergency only. $100 limit.,No,www.goldendentalplans.com/plans/select/oe/hkvalue/summary,www.goldendentalplans.com/plans/select/oe/hkvalue/buy,www.goldendentalplans.com/plans/select/oe/hkvalue,,86217MI0100010-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250001,Assurant Health Bronze Plan 001,89029MI025,,MIN001,MIS001,MIF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250001-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250002,Assurant Health Bronze Plan 001,89029MI025,,MIN001,MIS002,MIF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250002-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250002,Assurant Health Bronze Plan 001,89029MI025,,MIN001,MIS002,MIF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,17
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250002,Assurant Health Bronze Plan 001,89029MI025,,MIN001,MIS002,MIF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250002-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250003,Assurant Health Bronze Plan 001,89029MI025,,MIN001,MIS003,MIF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250003-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250003,Assurant Health Bronze Plan 001,89029MI025,,MIN001,MIS003,MIF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250003-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250003,Assurant Health Bronze Plan 001,89029MI025,,MIN001,MIS003,MIF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,21
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,4,89029,MI,Individual,No,39-0658730,89029MI0250014,Assurant Health Bronze Plan 002,89029MI025,,MIN001,MIS004,MIF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250014-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,25
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,4,89029,MI,Individual,No,39-0658730,89029MI0250014,Assurant Health Bronze Plan 002,89029MI025,,MIN001,MIS004,MIF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250014-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,4,89029,MI,Individual,No,39-0658730,89029MI0250015,Assurant Health Bronze Plan 002,89029MI025,,MIN001,MIS005,MIF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250015-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,4,89029,MI,Individual,No,39-0658730,89029MI0250015,Assurant Health Bronze Plan 002,89029MI025,,MIN001,MIS005,MIF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250015-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,4,89029,MI,Individual,No,39-0658730,89029MI0250015,Assurant Health Bronze Plan 002,89029MI025,,MIN001,MIS005,MIF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250015-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,29
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,4,89029,MI,Individual,No,39-0658730,89029MI0250015,Assurant Health Bronze Plan 002,89029MI025,,MIN001,MIS005,MIF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250015-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250016,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS001,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250016-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250016,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS001,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250016-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250018,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS003,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250018-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,27
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250018,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS003,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250018-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250007,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS002,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,47
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250007,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS002,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250007-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250007,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS002,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250007-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250007,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS002,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250007-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,50
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250007,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS002,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250007-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,51
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250008,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS003,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250008-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,52
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250006,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS001,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250006-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,43
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250006,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS001,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250006-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250007,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS002,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250007-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250007,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS002,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250007-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,46
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250008,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS003,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250008-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,55
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250008,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS003,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250008-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250017,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS002,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250017-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250017,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS002,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250017-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250017,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS002,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250017-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250017,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS002,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250017-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250028,Assurant Health Platinum Plan 002,89029MI025,,MIN001,MIS003,MIF011,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_P002.pdf,,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250028-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,96
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250028,Assurant Health Platinum Plan 002,89029MI025,,MIN001,MIS003,MIF011,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_P002.pdf,,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250028-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,97
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250008,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS003,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250008-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,53
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250008,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS003,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,54
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250016,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS001,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250016-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250017,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS002,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250017-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250018,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS003,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250018-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250018,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS003,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250018-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250019,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS004,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250019-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250019,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS004,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250019-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,34
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250027,Assurant Health Platinum Plan 002,89029MI025,,MIN001,MIS002,MIF011,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_P002.pdf,,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250027-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,92
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250027,Assurant Health Platinum Plan 002,89029MI025,,MIN001,MIS002,MIF011,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_P002.pdf,,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250027-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,93
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250027,Assurant Health Platinum Plan 002,89029MI025,,MIN001,MIS002,MIF011,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_P002.pdf,,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250027-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,94
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250028,Assurant Health Platinum Plan 002,89029MI025,,MIN001,MIS003,MIF011,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_P002.pdf,,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250028-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,95
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180007,Blue Cross? Partnered Silver,98185MI018,,MIN003,MIS005,MIF022,Existing,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180007-06,94% AV Level Silver Plan,93.66%,0.939949095249176,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$175,$350,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$175,$0,$320,$150,$175,$190,$120,$80,26
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180008,Blue Cross? Select Gold,98185MI018,,MIN006,MIS004,MIF022,Existing,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180008-00,Standard Gold Off Exchange Plan,78.39%,0.816931307315826,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$510,$960,$150,$250,$340,$270,$80,27
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180008,Blue Cross? Select Gold,98185MI018,,MIN006,MIS004,MIF022,Existing,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180008-01,Standard Gold On Exchange Plan,78.39%,0.816931307315826,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$510,$960,$150,$250,$340,$270,$80,28
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180008,Blue Cross? Select Gold,98185MI018,,MIN006,MIS004,MIF022,Existing,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180008-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,29
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180008,Blue Cross? Select Gold,98185MI018,,MIN006,MIS004,MIF022,Existing,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180008-03,Limited Cost Sharing Plan Variation,78.39%,0.816931307315826,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$510,$960,$150,$250,$340,$270,$80,30
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180009,Blue Cross? Preferred Gold,98185MI018,,MIN005,MIS003,MIF022,Existing,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180009-00,Standard Gold Off Exchange Plan,78.39%,0.816931307315826,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$510,$960,$150,$250,$340,$270,$80,31
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250018,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS003,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250018-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250018,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS003,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250018-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250018,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS003,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250018-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250019,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS004,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250019-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250001,Assurant Health Bronze Plan 001,89029MI025,,MIN001,MIS001,MIF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250001-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250001,Assurant Health Bronze Plan 001,89029MI025,,MIN001,MIS001,MIF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,13
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250001,Assurant Health Bronze Plan 001,89029MI025,,MIN001,MIS001,MIF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250001-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250002,Assurant Health Bronze Plan 001,89029MI025,,MIN001,MIS002,MIF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250002-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250003,Assurant Health Bronze Plan 001,89029MI025,,MIN001,MIS003,MIF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250003-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250004,Assurant Health Bronze Plan 001,89029MI025,,MIN001,MIS004,MIF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250004-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250004,Assurant Health Bronze Plan 001,89029MI025,,MIN001,MIS004,MIF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250004-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250004,Assurant Health Bronze Plan 001,89029MI025,,MIN001,MIS004,MIF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,25
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250004,Assurant Health Bronze Plan 001,89029MI025,,MIN001,MIS004,MIF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250004-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250005,Assurant Health Bronze Plan 001,89029MI025,,MIN001,MIS005,MIF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250005-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250005,Assurant Health Bronze Plan 001,89029MI025,,MIN001,MIS005,MIF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250005-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250005,Assurant Health Bronze Plan 001,89029MI025,,MIN001,MIS005,MIF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,29
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250005,Assurant Health Bronze Plan 001,89029MI025,,MIN001,MIS005,MIF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250005-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250006,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS001,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250006-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250006,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS001,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250006-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250006,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS001,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,40
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250006,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS001,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250006-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250006,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS001,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250006-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,42
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250008,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS003,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250008-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,57
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250008,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS003,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250008-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,58
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250009,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS004,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250009-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,59
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250009,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS004,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250009-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,60
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250009,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS004,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,61
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250009,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS004,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250009-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,62
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250009,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS004,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250009-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,63
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250009,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS004,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250009-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,64
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250009,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS004,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250009-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,65
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250010,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS005,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250010-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,66
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250010,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS005,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250010-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,67
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250010,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS005,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,68
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250010,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS005,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250010-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,69
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250010,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS005,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250010-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,70
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250010,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS005,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250010-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,71
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,1,89029,MI,Individual,No,39-0658730,89029MI0250010,Assurant Health Silver Plan 001,89029MI025,,MIN001,MIS005,MIF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250010-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,72
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,4,89029,MI,Individual,No,39-0658730,89029MI0250011,Assurant Health Bronze Plan 002,89029MI025,,MIN001,MIS001,MIF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250011-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,4,89029,MI,Individual,No,39-0658730,89029MI0250011,Assurant Health Bronze Plan 002,89029MI025,,MIN001,MIS001,MIF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250011-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,4,89029,MI,Individual,No,39-0658730,89029MI0250011,Assurant Health Bronze Plan 002,89029MI025,,MIN001,MIS001,MIF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,13
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,4,89029,MI,Individual,No,39-0658730,89029MI0250011,Assurant Health Bronze Plan 002,89029MI025,,MIN001,MIS001,MIF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250011-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,4,89029,MI,Individual,No,39-0658730,89029MI0250012,Assurant Health Bronze Plan 002,89029MI025,,MIN001,MIS002,MIF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250012-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,4,89029,MI,Individual,No,39-0658730,89029MI0250012,Assurant Health Bronze Plan 002,89029MI025,,MIN001,MIS002,MIF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250012-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,4,89029,MI,Individual,No,39-0658730,89029MI0250012,Assurant Health Bronze Plan 002,89029MI025,,MIN001,MIS002,MIF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250012-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,17
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,4,89029,MI,Individual,No,39-0658730,89029MI0250012,Assurant Health Bronze Plan 002,89029MI025,,MIN001,MIS002,MIF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250012-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,4,89029,MI,Individual,No,39-0658730,89029MI0250013,Assurant Health Bronze Plan 002,89029MI025,,MIN001,MIS003,MIF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250013-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,4,89029,MI,Individual,No,39-0658730,89029MI0250013,Assurant Health Bronze Plan 002,89029MI025,,MIN001,MIS003,MIF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250013-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,4,89029,MI,Individual,No,39-0658730,89029MI0250013,Assurant Health Bronze Plan 002,89029MI025,,MIN001,MIS003,MIF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250013-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,21
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,4,89029,MI,Individual,No,39-0658730,89029MI0250013,Assurant Health Bronze Plan 002,89029MI025,,MIN001,MIS003,MIF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250013-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,4,89029,MI,Individual,No,39-0658730,89029MI0250014,Assurant Health Bronze Plan 002,89029MI025,,MIN001,MIS004,MIF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250014-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,4,89029,MI,Individual,No,39-0658730,89029MI0250014,Assurant Health Bronze Plan 002,89029MI025,,MIN001,MIS004,MIF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,89029MI0250014-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250016,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS001,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250016-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,13
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250016,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS001,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250016-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,SHOP (Small Group),No,38-2359234,98185MI0130035,BCN PCP Focus Silver $3000,98185MI013,7457354687,MIN002,MIS002,MIF001,New,HMO,Silver,Yes,Both,No,Yes,"All except for routine OB/GYN, behavioral health, and pediatric visits",Out-of-network services,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2016-12-31,Yes,Emergent care only,Yes,Emergency and urgent care only,No,http://www.bcbsm.com/employer/sbc/bcn-hmo-silver-130017,http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html,http://www.bcbsm.com/employer-hmo-plan-brochures,www.bcbsm.com/hmo-drug-list,98185MI0130035-01,Standard Silver On Exchange Plan,70.29%,0.719110727310181,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$10,$850,$150,"$1,150",$240,$250,$80,16
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180005,Blue Cross? Preferred Silver,98185MI018,,MIN005,MIS001,MIF022,Existing,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180005-03,Limited Cost Sharing Plan Variation,68.36%,0.705848217010498,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,650",$510,"$1,020",$150,"$1,650",$290,$270,$80,16
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180005,Blue Cross? Preferred Silver,98185MI018,,MIN005,MIS001,MIF022,Existing,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180005-04,73% AV Level Silver Plan,72.23%,0.741437375545502,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,450","$2,900",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,450",$510,"$1,080",$150,"$1,450",$290,$310,$80,17
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180005,Blue Cross? Preferred Silver,98185MI018,,MIN005,MIS001,MIF022,Existing,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180005-05,87% AV Level Silver Plan,86.22%,0.867526888847351,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$450,$900,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$450,$510,$460,$150,$450,$340,$130,$80,18
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180005,Blue Cross? Preferred Silver,98185MI018,,MIN005,MIS001,MIF022,Existing,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180005-06,94% AV Level Silver Plan,93.66%,0.939949095249176,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$175,$350,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$175,$0,$320,$150,$175,$190,$120,$80,19
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180007,Blue Cross? Partnered Silver,98185MI018,,MIN003,MIS005,MIF022,Existing,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180007-00,Standard Silver Off Exchange Plan,68.36%,0.705848217010498,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,650",$510,"$1,020",$150,"$1,650",$290,$270,$80,20
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180007,Blue Cross? Partnered Silver,98185MI018,,MIN003,MIS005,MIF022,Existing,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180007-01,Standard Silver On Exchange Plan,68.36%,0.705848217010498,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,650",$510,"$1,020",$150,"$1,650",$290,$270,$80,21
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180007,Blue Cross? Partnered Silver,98185MI018,,MIN003,MIS005,MIF022,Existing,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180007,Blue Cross? Partnered Silver,98185MI018,,MIN003,MIS005,MIF022,Existing,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180007-03,Limited Cost Sharing Plan Variation,68.36%,0.705848217010498,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,650",$510,"$1,020",$150,"$1,650",$290,$270,$80,23
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180007,Blue Cross? Partnered Silver,98185MI018,,MIN003,MIS005,MIF022,Existing,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180007-04,73% AV Level Silver Plan,72.23%,0.741437375545502,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,450","$2,900",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,450",$510,"$1,080",$150,"$1,450",$290,$310,$80,24
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180007,Blue Cross? Partnered Silver,98185MI018,,MIN003,MIS005,MIF022,Existing,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180007-05,87% AV Level Silver Plan,86.22%,0.867526888847351,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$450,$900,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$450,$510,$460,$150,$450,$340,$130,$80,25
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180009,Blue Cross? Preferred Gold,98185MI018,,MIN005,MIS003,MIF022,Existing,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180009-01,Standard Gold On Exchange Plan,78.39%,0.816931307315826,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$510,$960,$150,$250,$340,$270,$80,32
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180009,Blue Cross? Preferred Gold,98185MI018,,MIN005,MIS003,MIF022,Existing,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180009-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,33
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250016,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS001,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250016-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250016,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS001,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250016-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250017,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS002,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250017-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250017,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS002,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250017-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,20
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250028,Assurant Health Platinum Plan 002,89029MI025,,MIN001,MIS003,MIF011,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_P002.pdf,,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250028-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,98
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250029,Assurant Health Platinum Plan 002,89029MI025,,MIN001,MIS004,MIF011,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_P002.pdf,,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250029-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,99
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,2,98185,MI,Individual,No,38-2359234,98185MI0440001,Blue Cross? Select Bronze,98185MI044,,MIN006,MIS004,MIF022,Existing,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0440001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,2,98185,MI,Individual,No,38-2359234,98185MI0440001,Blue Cross? Select Bronze,98185MI044,,MIN006,MIS004,MIF022,Existing,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0440001-03,Limited Cost Sharing Plan Variation,58.23%,0.599410533905029,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,950","$11,900",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,950",$140,$0,$150,"$5,260",$0,$0,$40,7
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,2,98185,MI,Individual,No,38-2359234,98185MI0440002,Blue Cross? Preferred Bronze,98185MI044,,MIN005,MIS001,MIF022,Existing,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0440002-00,Standard Bronze Off Exchange Plan,58.23%,0.599410533905029,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,950","$11,900",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,950",$140,$0,$150,"$5,260",$0,$0,$40,8
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,2,98185,MI,Individual,No,38-2359234,98185MI0440002,Blue Cross? Preferred Bronze,98185MI044,,MIN005,MIS001,MIF022,Existing,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0440002-01,Standard Bronze On Exchange Plan,58.23%,0.599410533905029,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,950","$11,900",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,950",$140,$0,$150,"$5,260",$0,$0,$40,9
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550006,Blue Cross? Preferred Gold Extra,98185MI055,,MIN005,MIS003,MIF022,New,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,54
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550006,Blue Cross? Preferred Gold Extra,98185MI055,,MIN005,MIS003,MIF022,New,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550006-03,Limited Cost Sharing Plan Variation,81.92%,0.838530480861664,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$10,"$1,250",$150,$500,$360,$520,$80,55
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250019,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS004,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250019-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250019,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS004,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250019-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180010,Blue Cross? Partnered Gold,98185MI018,,MIN003,MIS005,MIF022,Existing,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180010-03,Limited Cost Sharing Plan Variation,78.39%,0.816931307315826,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$510,$960,$150,$250,$340,$270,$80,38
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180011,Blue Cross? Metro Detroit HMO Silver,98185MI018,,MIN004,MIS006,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180011-00,Standard Silver Off Exchange Plan,68.36%,0.705848217010498,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,650",$510,"$1,020",$150,"$1,650",$290,$270,$80,39
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180011,Blue Cross? Metro Detroit HMO Silver,98185MI018,,MIN004,MIS006,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180011-01,Standard Silver On Exchange Plan,68.36%,0.705848217010498,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,650",$510,"$1,020",$150,"$1,650",$290,$270,$80,40
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180011,Blue Cross? Metro Detroit HMO Silver,98185MI018,,MIN004,MIS006,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,41
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180011,Blue Cross? Metro Detroit HMO Silver,98185MI018,,MIN004,MIS006,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180011-03,Limited Cost Sharing Plan Variation,68.36%,0.705848217010498,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,650",$510,"$1,020",$150,"$1,650",$290,$270,$80,42
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180011,Blue Cross? Metro Detroit HMO Silver,98185MI018,,MIN004,MIS006,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180011-04,73% AV Level Silver Plan,72.23%,0.741437375545502,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,450","$2,900",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,450",$510,"$1,080",$150,"$1,450",$290,$310,$80,43
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180011,Blue Cross? Metro Detroit HMO Silver,98185MI018,,MIN004,MIS006,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180011-05,87% AV Level Silver Plan,86.22%,0.867526888847351,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$450,$900,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$450,$510,$460,$150,$450,$340,$130,$80,44
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180011,Blue Cross? Metro Detroit HMO Silver,98185MI018,,MIN004,MIS006,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180011-06,94% AV Level Silver Plan,93.66%,0.939949095249176,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$175,$350,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$175,$0,$320,$150,$175,$190,$120,$80,45
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,2,98185,MI,Individual,No,38-2359234,98185MI0440001,Blue Cross? Select Bronze,98185MI044,,MIN006,MIS004,MIF022,Existing,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0440001-00,Standard Bronze Off Exchange Plan,58.23%,0.599410533905029,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,950","$11,900",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,950",$140,$0,$150,"$5,260",$0,$0,$40,4
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,2,98185,MI,Individual,No,38-2359234,98185MI0440001,Blue Cross? Select Bronze,98185MI044,,MIN006,MIS004,MIF022,Existing,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0440001-01,Standard Bronze On Exchange Plan,58.23%,0.599410533905029,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,950","$11,900",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,950",$140,$0,$150,"$5,260",$0,$0,$40,5
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550005,Blue Cross? Select Gold Extra,98185MI055,,MIN006,MIS004,MIF022,New,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,50
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550005,Blue Cross? Select Gold Extra,98185MI055,,MIN006,MIS004,MIF022,New,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550005-03,Limited Cost Sharing Plan Variation,81.92%,0.838530480861664,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$10,"$1,250",$150,$500,$360,$520,$80,51
2015,MI,94523,SERFF,5,2014-11-14 14:52:18,3,94523,MI,SHOP (Small Group),Yes,75-1233841,94523MI0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,94523MI002,,MIN001,MIS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.42,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/mi/94523mi0020006-15,,94523MI0020006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$85,Not Applicable,,,,,$85,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,94523,SERFF,5,2014-11-14 14:52:18,3,94523,MI,Individual,Yes,75-1233841,94523MI0010006,Dentegra Dental PPO Family Basic Plan,94523MI001,,MIN001,MIS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.26,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/mi/94523mi0010006-15,,94523MI0010006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$85,Not Applicable,,,,,$85,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,94523,SERFF,5,2014-11-14 14:52:18,3,94523,MI,Individual,Yes,75-1233841,94523MI0010006,Dentegra Dental PPO Family Basic Plan,94523MI001,,MIN001,MIS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.26,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/mi/94523mi0010006-15,,94523MI0010006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$85,Not Applicable,,,,,$85,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,94523,SERFF,5,2014-11-14 14:52:18,3,94523,MI,SHOP (Small Group),Yes,75-1233841,94523MI0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,94523MI002,,MIN001,MIS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.42,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/mi/94523mi0020006-15,,94523MI0020006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$85,Not Applicable,,,,,$85,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180001,Blue Cross? Select Value,98185MI018,,MIN006,MIS004,MIF021,Existing,HMO,Catastrophic,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,170",$0,$0,$150,"$4,970",$90,$0,$80,4
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550010,Blue Cross? Preferred Bronze Extra,98185MI055,,MIN005,MIS001,MIF022,New,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550010-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550010,Blue Cross? Preferred Bronze Extra,98185MI055,,MIN005,MIS001,MIF022,New,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550010-03,Limited Cost Sharing Plan Variation,61.96%,0.635560035705566,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$10,$170,$150,"$5,130",$0,$0,$80,11
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550011,Blue Cross? Partnered Bronze Extra,98185MI055,,MIN003,MIS005,MIF022,New,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550011-00,Standard Bronze Off Exchange Plan,61.96%,0.635560035705566,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$10,$170,$150,"$5,130",$0,$0,$80,12
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550011,Blue Cross? Partnered Bronze Extra,98185MI055,,MIN003,MIS005,MIF022,New,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550011-01,Standard Bronze On Exchange Plan,61.96%,0.635560035705566,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$10,$170,$150,"$5,130",$0,$0,$80,13
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550011,Blue Cross? Partnered Bronze Extra,98185MI055,,MIN003,MIS005,MIF022,New,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550011,Blue Cross? Partnered Bronze Extra,98185MI055,,MIN003,MIS005,MIF022,New,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550011-03,Limited Cost Sharing Plan Variation,61.96%,0.635560035705566,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$10,$170,$150,"$5,130",$0,$0,$80,15
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250019,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS004,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250019-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250019,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS004,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250019-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250020,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS005,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250020-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250020,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS005,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250020-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250020,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS005,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250020-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,41
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250020,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS005,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250020-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,42
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250020,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS005,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250020-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,43
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250020,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS005,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250020-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250020,Assurant Health Silver Plan 002,89029MI025,,MIN001,MIS005,MIF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,www.assuranthealth.com/sbc/PROD/SBC_MI_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250020-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250021,Assurant Health Gold Plan 002,89029MI025,,MIN001,MIS001,MIF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250021-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,60
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250021,Assurant Health Gold Plan 002,89029MI025,,MIN001,MIS001,MIF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250021-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,61
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250021,Assurant Health Gold Plan 002,89029MI025,,MIN001,MIS001,MIF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250021-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,62
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250021,Assurant Health Gold Plan 002,89029MI025,,MIN001,MIS001,MIF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250021-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,63
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250022,Assurant Health Gold Plan 002,89029MI025,,MIN001,MIS002,MIF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250022-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,64
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250022,Assurant Health Gold Plan 002,89029MI025,,MIN001,MIS002,MIF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250022-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,65
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250022,Assurant Health Gold Plan 002,89029MI025,,MIN001,MIS002,MIF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250022-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,66
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250022,Assurant Health Gold Plan 002,89029MI025,,MIN001,MIS002,MIF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250022-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,67
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250023,Assurant Health Gold Plan 002,89029MI025,,MIN001,MIS003,MIF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250023-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,68
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250023,Assurant Health Gold Plan 002,89029MI025,,MIN001,MIS003,MIF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250023-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,69
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250023,Assurant Health Gold Plan 002,89029MI025,,MIN001,MIS003,MIF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250023-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,70
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250023,Assurant Health Gold Plan 002,89029MI025,,MIN001,MIS003,MIF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250023-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,71
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250024,Assurant Health Gold Plan 002,89029MI025,,MIN001,MIS004,MIF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250024-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,72
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250024,Assurant Health Gold Plan 002,89029MI025,,MIN001,MIS004,MIF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250024-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,73
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250024,Assurant Health Gold Plan 002,89029MI025,,MIN001,MIS004,MIF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250024-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,74
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250024,Assurant Health Gold Plan 002,89029MI025,,MIN001,MIS004,MIF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250024-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,75
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250025,Assurant Health Gold Plan 002,89029MI025,,MIN001,MIS005,MIF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250025-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,76
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250025,Assurant Health Gold Plan 002,89029MI025,,MIN001,MIS005,MIF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250025-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,77
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250025,Assurant Health Gold Plan 002,89029MI025,,MIN001,MIS005,MIF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250025-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,78
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250025,Assurant Health Gold Plan 002,89029MI025,,MIN001,MIS005,MIF009,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250025-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,79
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250026,Assurant Health Platinum Plan 002,89029MI025,,MIN001,MIS001,MIF011,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_P002.pdf,,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250026-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,87
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250026,Assurant Health Platinum Plan 002,89029MI025,,MIN001,MIS001,MIF011,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_P002.pdf,,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250026-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,88
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250026,Assurant Health Platinum Plan 002,89029MI025,,MIN001,MIS001,MIF011,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_P002.pdf,,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250026-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,89
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250026,Assurant Health Platinum Plan 002,89029MI025,,MIN001,MIS001,MIF011,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_P002.pdf,,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250026-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,90
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250027,Assurant Health Platinum Plan 002,89029MI025,,MIN001,MIS002,MIF011,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_P002.pdf,,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250027-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,91
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250029,Assurant Health Platinum Plan 002,89029MI025,,MIN001,MIS004,MIF011,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_P002.pdf,,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250029-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,100
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250029,Assurant Health Platinum Plan 002,89029MI025,,MIN001,MIS004,MIF011,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_P002.pdf,,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250029-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,101
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250029,Assurant Health Platinum Plan 002,89029MI025,,MIN001,MIS004,MIF011,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_P002.pdf,,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250029-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,102
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250030,Assurant Health Platinum Plan 002,89029MI025,,MIN001,MIS005,MIF011,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_P002.pdf,,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250030-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,103
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250030,Assurant Health Platinum Plan 002,89029MI025,,MIN001,MIS005,MIF011,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_P002.pdf,,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250030-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,104
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250030,Assurant Health Platinum Plan 002,89029MI025,,MIN001,MIS005,MIF011,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_P002.pdf,,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250030-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,105
2015,MI,89029,SERFF,9,2014-11-15 10:06:04,6,89029,MI,Individual,No,39-0658730,89029MI0250030,Assurant Health Platinum Plan 002,89029MI025,,MIN001,MIS005,MIF011,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MI_P002.pdf,,http://www.assuranthealth.com/brochures/30740-MI.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,89029MI0250030-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,106
2015,MI,94523,SERFF,5,2014-11-14 14:52:18,1,94523,MI,SHOP (Small Group),Yes,75-1233841,94523MI0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,94523MI002,,MIN001,MIS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.42,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/mi/94523mi0020001-15,,94523MI0020001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$85,Not Applicable,,,,,$85,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,94523,SERFF,5,2014-11-14 14:52:18,1,94523,MI,Individual,Yes,75-1233841,94523MI0010001,Dentegra Dental PPO Pediatric Basic Plan,94523MI001,,MIN001,MIS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.26,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/mi/94523mi0010001-15,,94523MI0010001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$85,Not Applicable,,,,,$85,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,94523,SERFF,5,2014-11-14 14:52:18,1,94523,MI,Individual,Yes,75-1233841,94523MI0010001,Dentegra Dental PPO Pediatric Basic Plan,94523MI001,,MIN001,MIS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$21.26,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/mi/94523mi0010001-15,,94523MI0010001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$85,Not Applicable,,,,,$85,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,94523,SERFF,5,2014-11-14 14:52:18,1,94523,MI,SHOP (Small Group),Yes,75-1233841,94523MI0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,94523MI002,,MIN001,MIS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.42,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/mi/94523mi0020001-15,,94523MI0020001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$85,Not Applicable,,,,,$85,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,94523,SERFF,5,2014-11-14 14:52:18,2,94523,MI,SHOP (Small Group),Yes,75-1233841,94523MI0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,94523MI002,,MIN001,MIS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.98,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/mi/94523mi0020004-15,,94523MI0020004-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$35,Not Applicable,$35,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,94523,SERFF,5,2014-11-14 14:52:18,2,94523,MI,Individual,Yes,75-1233841,94523MI0010004,Dentegra Dental PPO Family Preferred Plan,94523MI001,,MIN001,MIS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.77,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/mi/94523mi0010004-15,,94523MI0010004-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$35,Not Applicable,$35,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MI,94523,SERFF,5,2014-11-14 14:52:18,2,94523,MI,Individual,Yes,75-1233841,94523MI0010004,Dentegra Dental PPO Family Preferred Plan,94523MI001,,MIN001,MIS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.77,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/mi/94523mi0010004-15,,94523MI0010004-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$35,Not Applicable,$35,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,94523,SERFF,5,2014-11-14 14:52:18,2,94523,MI,SHOP (Small Group),Yes,75-1233841,94523MI0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,94523MI002,,MIN001,MIS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.98,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/mi/94523mi0020004-15,,94523MI0020004-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$35,Not Applicable,$35,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180001,Blue Cross? Select Value,98185MI018,,MIN006,MIS004,MIF021,Existing,HMO,Catastrophic,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,170",$0,$0,$150,"$4,970",$90,$0,$80,5
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180004,Blue Cross? Select Silver,98185MI018,,MIN006,MIS004,MIF022,Existing,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180004-00,Standard Silver Off Exchange Plan,68.36%,0.705848217010498,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,650",$510,"$1,020",$150,"$1,650",$290,$270,$80,6
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180004,Blue Cross? Select Silver,98185MI018,,MIN006,MIS004,MIF022,Existing,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180004-01,Standard Silver On Exchange Plan,68.36%,0.705848217010498,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,650",$510,"$1,020",$150,"$1,650",$290,$270,$80,7
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,SHOP (Small Group),No,38-2359234,98185MI0130025,BCN Gold $1500,98185MI013,7457354687,MIN001,MIS001,MIF001,New,HMO,Gold,Yes,Both,No,Yes,"All except for routine OB/GYN, behavioral health, and pediatric visits",Out-of-network services,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2016-12-31,Yes,Emergent care only,Yes,Emergency and urgent care only,No,http://www.bcbsm.com/employer/sbc/bcn-hmo-gold-130007,http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html,http://www.bcbsm.com/employer-hmo-plan-brochures,www.bcbsm.com/hmo-drug-list,98185MI0130025-00,Standard Gold Off Exchange Plan,78.97%,0.771554589271545,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$10,"$1,010",$150,"$1,150",$160,$250,$80,7
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,SHOP (Small Group),No,38-2359234,98185MI0130025,BCN Gold $1500,98185MI013,7457354687,MIN001,MIS001,MIF001,New,HMO,Gold,Yes,Both,No,Yes,"All except for routine OB/GYN, behavioral health, and pediatric visits",Out-of-network services,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2016-12-31,Yes,Emergent care only,Yes,Emergency and urgent care only,No,http://www.bcbsm.com/employer/sbc/bcn-hmo-gold-130007,http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html,http://www.bcbsm.com/employer-hmo-plan-brochures,www.bcbsm.com/hmo-drug-list,98185MI0130025-01,Standard Gold On Exchange Plan,78.97%,0.771554589271545,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$10,"$1,010",$150,"$1,150",$160,$250,$80,8
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180004,Blue Cross? Select Silver,98185MI018,,MIN006,MIS004,MIF022,Existing,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,8
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180004,Blue Cross? Select Silver,98185MI018,,MIN006,MIS004,MIF022,Existing,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180004-03,Limited Cost Sharing Plan Variation,68.36%,0.705848217010498,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,650",$510,"$1,020",$150,"$1,650",$290,$270,$80,9
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,SHOP (Small Group),No,38-2359234,98185MI0130027,BCN PCP Focus Gold $1500,98185MI013,7457354687,MIN002,MIS002,MIF001,New,HMO,Gold,Yes,Both,No,Yes,"All except for routine OB/GYN, behavioral health, and pediatric visits",Out-of-network services,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2016-12-31,Yes,Emergent care only,Yes,Emergency and urgent care only,No,http://www.bcbsm.com/employer/sbc/bcn-hmo-gold-130009,http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html,http://www.bcbsm.com/employer-hmo-plan-brochures,www.bcbsm.com/hmo-drug-list,98185MI0130027-00,Standard Gold Off Exchange Plan,78.97%,0.771554589271545,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$10,"$1,010",$150,"$1,150",$150,$250,$80,9
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,SHOP (Small Group),No,38-2359234,98185MI0130027,BCN PCP Focus Gold $1500,98185MI013,7457354687,MIN002,MIS002,MIF001,New,HMO,Gold,Yes,Both,No,Yes,"All except for routine OB/GYN, behavioral health, and pediatric visits",Out-of-network services,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2016-12-31,Yes,Emergent care only,Yes,Emergency and urgent care only,No,http://www.bcbsm.com/employer/sbc/bcn-hmo-gold-130009,http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html,http://www.bcbsm.com/employer-hmo-plan-brochures,www.bcbsm.com/hmo-drug-list,98185MI0130027-01,Standard Gold On Exchange Plan,78.97%,0.771554589271545,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$10,"$1,010",$150,"$1,150",$150,$250,$80,10
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180004,Blue Cross? Select Silver,98185MI018,,MIN006,MIS004,MIF022,Existing,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180004-04,73% AV Level Silver Plan,72.23%,0.741437375545502,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,450","$2,900",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,450",$510,"$1,080",$150,"$1,450",$290,$310,$80,10
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180004,Blue Cross? Select Silver,98185MI018,,MIN006,MIS004,MIF022,Existing,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180004-05,87% AV Level Silver Plan,86.22%,0.867526888847351,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$450,$900,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$450,$510,$460,$150,$450,$340,$130,$80,11
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180004,Blue Cross? Select Silver,98185MI018,,MIN006,MIS004,MIF022,Existing,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180004-06,94% AV Level Silver Plan,93.66%,0.939949095249176,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$175,$350,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$175,$0,$320,$150,$175,$190,$120,$80,12
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180005,Blue Cross? Preferred Silver,98185MI018,,MIN005,MIS001,MIF022,Existing,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180005-00,Standard Silver Off Exchange Plan,68.36%,0.705848217010498,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,650",$510,"$1,020",$150,"$1,650",$290,$270,$80,13
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,SHOP (Small Group),No,38-2359234,98185MI0130033,BCN Silver $3000,98185MI013,7457354687,MIN001,MIS001,MIF001,New,HMO,Silver,Yes,Both,No,Yes,"All except for routine OB/GYN, behavioral health, and pediatric visits",Out-of-network services,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2016-12-31,Yes,Emergent care only,Yes,Emergency and urgent care only,No,http://www.bcbsm.com/employer/sbc/bcn-hmo-silver-130015,http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html,http://www.bcbsm.com/employer-hmo-plan-brochures,www.bcbsm.com/hmo-drug-list,98185MI0130033-00,Standard Silver Off Exchange Plan,70.29%,0.719110727310181,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$10,$850,$150,"$1,150",$240,$250,$80,13
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,SHOP (Small Group),No,38-2359234,98185MI0130033,BCN Silver $3000,98185MI013,7457354687,MIN001,MIS001,MIF001,New,HMO,Silver,Yes,Both,No,Yes,"All except for routine OB/GYN, behavioral health, and pediatric visits",Out-of-network services,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2016-12-31,Yes,Emergent care only,Yes,Emergency and urgent care only,No,http://www.bcbsm.com/employer/sbc/bcn-hmo-silver-130015,http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html,http://www.bcbsm.com/employer-hmo-plan-brochures,www.bcbsm.com/hmo-drug-list,98185MI0130033-01,Standard Silver On Exchange Plan,70.29%,0.719110727310181,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$10,$850,$150,"$1,150",$240,$250,$80,14
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180005,Blue Cross? Preferred Silver,98185MI018,,MIN005,MIS001,MIF022,Existing,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180005-01,Standard Silver On Exchange Plan,68.36%,0.705848217010498,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,650",$510,"$1,020",$150,"$1,650",$290,$270,$80,14
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180005,Blue Cross? Preferred Silver,98185MI018,,MIN005,MIS001,MIF022,Existing,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,15
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,SHOP (Small Group),No,38-2359234,98185MI0130035,BCN PCP Focus Silver $3000,98185MI013,7457354687,MIN002,MIS002,MIF001,New,HMO,Silver,Yes,Both,No,Yes,"All except for routine OB/GYN, behavioral health, and pediatric visits",Out-of-network services,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2016-12-31,Yes,Emergent care only,Yes,Emergency and urgent care only,No,http://www.bcbsm.com/employer/sbc/bcn-hmo-silver-130017,http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html,http://www.bcbsm.com/employer-hmo-plan-brochures,www.bcbsm.com/hmo-drug-list,98185MI0130035-00,Standard Silver Off Exchange Plan,70.29%,0.719110727310181,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$10,$850,$150,"$1,150",$240,$250,$80,15
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180009,Blue Cross? Preferred Gold,98185MI018,,MIN005,MIS003,MIF022,Existing,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180009-03,Limited Cost Sharing Plan Variation,78.39%,0.816931307315826,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$510,$960,$150,$250,$340,$270,$80,34
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180010,Blue Cross? Partnered Gold,98185MI018,,MIN003,MIS005,MIF022,Existing,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180010-00,Standard Gold Off Exchange Plan,78.39%,0.816931307315826,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$510,$960,$150,$250,$340,$270,$80,35
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180010,Blue Cross? Partnered Gold,98185MI018,,MIN003,MIS005,MIF022,Existing,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180010-01,Standard Gold On Exchange Plan,78.39%,0.816931307315826,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$510,$960,$150,$250,$340,$270,$80,36
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,1,98185,MI,Individual,No,38-2359234,98185MI0180010,Blue Cross? Partnered Gold,98185MI018,,MIN003,MIS005,MIF022,Existing,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0180010-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,37
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550004,Blue Cross? Metro Detroit HMO Silver Extra,98185MI055,,MIN004,MIS006,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550004-03,Limited Cost Sharing Plan Variation,70.71%,0.720835268497467,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$10,"$1,420",$150,"$2,000",$190,$440,$80,44
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550004,Blue Cross? Metro Detroit HMO Silver Extra,98185MI055,,MIN004,MIS006,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550004-04,73% AV Level Silver Plan,72.76%,0.742072999477386,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,800",$10,"$1,480",$150,"$1,800",$220,$450,$80,45
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550004,Blue Cross? Metro Detroit HMO Silver Extra,98185MI055,,MIN004,MIS006,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550004-05,87% AV Level Silver Plan,86.10%,0.86424732208252,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$700,$10,$600,$150,$700,$300,$450,$80,46
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550004,Blue Cross? Metro Detroit HMO Silver Extra,98185MI055,,MIN004,MIS006,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550004-06,94% AV Level Silver Plan,93.00%,0.941509068012238,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$175,$350,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$180,$0,$330,$150,$180,$130,$200,$80,47
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550005,Blue Cross? Select Gold Extra,98185MI055,,MIN006,MIS004,MIF022,New,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550005-00,Standard Gold Off Exchange Plan,81.92%,0.838530480861664,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$10,"$1,250",$150,$500,$360,$520,$80,48
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550005,Blue Cross? Select Gold Extra,98185MI055,,MIN006,MIS004,MIF022,New,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550005-01,Standard Gold On Exchange Plan,81.92%,0.838530480861664,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$10,"$1,250",$150,$500,$360,$520,$80,49
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550006,Blue Cross? Preferred Gold Extra,98185MI055,,MIN005,MIS003,MIF022,New,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550006-00,Standard Gold Off Exchange Plan,81.92%,0.838530480861664,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$10,"$1,250",$150,$500,$360,$520,$80,52
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550006,Blue Cross? Preferred Gold Extra,98185MI055,,MIN005,MIS003,MIF022,New,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550006-01,Standard Gold On Exchange Plan,81.92%,0.838530480861664,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$10,"$1,250",$150,$500,$360,$520,$80,53
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550007,Blue Cross? Partnered Gold Extra,98185MI055,,MIN003,MIS005,MIF022,New,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550007-00,Standard Gold Off Exchange Plan,81.92%,0.838530480861664,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$10,"$1,250",$150,$500,$360,$520,$80,56
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550007,Blue Cross? Partnered Gold Extra,98185MI055,,MIN003,MIS005,MIF022,New,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550007-01,Standard Gold On Exchange Plan,81.92%,0.838530480861664,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$10,"$1,250",$150,$500,$360,$520,$80,57
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550007,Blue Cross? Partnered Gold Extra,98185MI055,,MIN003,MIS005,MIF022,New,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,58
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550007,Blue Cross? Partnered Gold Extra,98185MI055,,MIN003,MIS005,MIF022,New,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550007-03,Limited Cost Sharing Plan Variation,81.92%,0.838530480861664,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$10,"$1,250",$150,$500,$360,$520,$80,59
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,2,98185,MI,Individual,No,38-2359234,98185MI0440002,Blue Cross? Preferred Bronze,98185MI044,,MIN005,MIS001,MIF022,Existing,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0440002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,2,98185,MI,Individual,No,38-2359234,98185MI0440002,Blue Cross? Preferred Bronze,98185MI044,,MIN005,MIS001,MIF022,Existing,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0440002-03,Limited Cost Sharing Plan Variation,58.23%,0.599410533905029,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,950","$11,900",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,950",$140,$0,$150,"$5,260",$0,$0,$40,11
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,2,98185,MI,Individual,No,38-2359234,98185MI0440004,Blue Cross? Partnered Bronze,98185MI044,,MIN003,MIS005,MIF022,Existing,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0440004-00,Standard Bronze Off Exchange Plan,58.23%,0.599410533905029,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,950","$11,900",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,950",$140,$0,$150,"$5,260",$0,$0,$40,12
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,2,98185,MI,Individual,No,38-2359234,98185MI0440004,Blue Cross? Partnered Bronze,98185MI044,,MIN003,MIS005,MIF022,Existing,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0440004-01,Standard Bronze On Exchange Plan,58.23%,0.599410533905029,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,950","$11,900",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,950",$140,$0,$150,"$5,260",$0,$0,$40,13
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550008,Blue Cross? Metro Detroit HMO Gold Extra,98185MI055,,MIN004,MIS006,MIF022,New,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550008-00,Standard Gold Off Exchange Plan,81.92%,0.838530480861664,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$10,"$1,250",$150,$500,$360,$520,$80,60
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550008,Blue Cross? Metro Detroit HMO Gold Extra,98185MI055,,MIN004,MIS006,MIF022,New,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550008-01,Standard Gold On Exchange Plan,81.92%,0.838530480861664,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$10,"$1,250",$150,$500,$360,$520,$80,61
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,2,98185,MI,Individual,No,38-2359234,98185MI0440004,Blue Cross? Partnered Bronze,98185MI044,,MIN003,MIS005,MIF022,Existing,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0440004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,2,98185,MI,Individual,No,38-2359234,98185MI0440004,Blue Cross? Partnered Bronze,98185MI044,,MIN003,MIS005,MIF022,Existing,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0440004-03,Limited Cost Sharing Plan Variation,58.23%,0.599410533905029,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,950","$11,900",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,950",$140,$0,$150,"$5,260",$0,$0,$40,15
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,2,98185,MI,Individual,No,38-2359234,98185MI0440005,Blue Cross? Metro Detroit HMO Bronze,98185MI044,,MIN004,MIS006,MIF022,New,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0440005-00,Standard Bronze Off Exchange Plan,58.23%,0.599410533905029,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,950","$11,900",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,950",$140,$0,$150,"$5,260",$0,$0,$40,16
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,2,98185,MI,Individual,No,38-2359234,98185MI0440005,Blue Cross? Metro Detroit HMO Bronze,98185MI044,,MIN004,MIS006,MIF022,New,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0440005-01,Standard Bronze On Exchange Plan,58.23%,0.599410533905029,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,950","$11,900",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,950",$140,$0,$150,"$5,260",$0,$0,$40,17
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,2,98185,MI,Individual,No,38-2359234,98185MI0440005,Blue Cross? Metro Detroit HMO Bronze,98185MI044,,MIN004,MIS006,MIF022,New,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0440005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,2,98185,MI,Individual,No,38-2359234,98185MI0440005,Blue Cross? Metro Detroit HMO Bronze,98185MI044,,MIN004,MIS006,MIF022,New,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0440005-03,Limited Cost Sharing Plan Variation,58.23%,0.599410533905029,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,950","$11,900",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,950",$140,$0,$150,"$5,260",$0,$0,$40,19
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550009,Blue Cross? Select Bronze Extra,98185MI055,,MIN006,MIS004,MIF022,New,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550009-00,Standard Bronze Off Exchange Plan,61.96%,0.635560035705566,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$10,$170,$150,"$5,130",$0,$0,$80,4
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550009,Blue Cross? Select Bronze Extra,98185MI055,,MIN006,MIS004,MIF022,New,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550009-01,Standard Bronze On Exchange Plan,61.96%,0.635560035705566,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$10,$170,$150,"$5,130",$0,$0,$80,5
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550009,Blue Cross? Select Bronze Extra,98185MI055,,MIN006,MIS004,MIF022,New,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550009-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550009,Blue Cross? Select Bronze Extra,98185MI055,,MIN006,MIS004,MIF022,New,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550009-03,Limited Cost Sharing Plan Variation,61.96%,0.635560035705566,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$10,$170,$150,"$5,130",$0,$0,$80,7
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550010,Blue Cross? Preferred Bronze Extra,98185MI055,,MIN005,MIS001,MIF022,New,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550010-00,Standard Bronze Off Exchange Plan,61.96%,0.635560035705566,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$10,$170,$150,"$5,130",$0,$0,$80,8
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550010,Blue Cross? Preferred Bronze Extra,98185MI055,,MIN005,MIS001,MIF022,New,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550010-01,Standard Bronze On Exchange Plan,61.96%,0.635560035705566,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$10,$170,$150,"$5,130",$0,$0,$80,9
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550012,Blue Cross? Metro Detroit HMO Bronze Extra,98185MI055,,MIN004,MIS006,MIF022,New,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550012-00,Standard Bronze Off Exchange Plan,61.96%,0.635560035705566,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$10,$170,$150,"$5,130",$0,$0,$80,16
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550012,Blue Cross? Metro Detroit HMO Bronze Extra,98185MI055,,MIN004,MIS006,MIF022,New,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550012-01,Standard Bronze On Exchange Plan,61.96%,0.635560035705566,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$10,$170,$150,"$5,130",$0,$0,$80,17
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550012,Blue Cross? Metro Detroit HMO Bronze Extra,98185MI055,,MIN004,MIS006,MIF022,New,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550012-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550012,Blue Cross? Metro Detroit HMO Bronze Extra,98185MI055,,MIN004,MIS006,MIF022,New,HMO,Bronze,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550012-03,Limited Cost Sharing Plan Variation,61.96%,0.635560035705566,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$10,$170,$150,"$5,130",$0,$0,$80,19
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550001,Blue Cross? Select Silver Extra,98185MI055,,MIN006,MIS004,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550001-00,Standard Silver Off Exchange Plan,70.70%,0.720835268497467,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$10,"$1,420",$150,"$2,000",$190,$440,$80,20
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550001,Blue Cross? Select Silver Extra,98185MI055,,MIN006,MIS004,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550001-01,Standard Silver On Exchange Plan,70.71%,0.720835268497467,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$10,"$1,420",$150,"$2,000",$190,$440,$80,21
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550001,Blue Cross? Select Silver Extra,98185MI055,,MIN006,MIS004,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550001,Blue Cross? Select Silver Extra,98185MI055,,MIN006,MIS004,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550001-03,Limited Cost Sharing Plan Variation,70.71%,0.720835268497467,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$10,"$1,420",$150,"$2,000",$190,$440,$80,23
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550001,Blue Cross? Select Silver Extra,98185MI055,,MIN006,MIS004,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550001-04,73% AV Level Silver Plan,72.76%,0.742072999477386,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,800",$10,"$1,480",$150,"$1,800",$220,$450,$80,24
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550001,Blue Cross? Select Silver Extra,98185MI055,,MIN006,MIS004,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550001-05,87% AV Level Silver Plan,86.10%,0.86424732208252,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$700,$10,$600,$150,$700,$300,$450,$80,25
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550001,Blue Cross? Select Silver Extra,98185MI055,,MIN006,MIS004,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550001-06,94% AV Level Silver Plan,93.00%,0.941509068012238,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$175,$350,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$180,$0,$330,$150,$180,$130,$200,$80,26
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550002,Blue Cross? Preferred Silver Extra,98185MI055,,MIN005,MIS001,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550002-00,Standard Silver Off Exchange Plan,70.71%,0.720835268497467,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$10,"$1,420",$150,"$2,000",$190,$440,$80,27
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550002,Blue Cross? Preferred Silver Extra,98185MI055,,MIN005,MIS001,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550002-01,Standard Silver On Exchange Plan,70.71%,0.720835268497467,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$10,"$1,420",$150,"$2,000",$190,$440,$80,28
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550002,Blue Cross? Preferred Silver Extra,98185MI055,,MIN005,MIS001,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,29
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550002,Blue Cross? Preferred Silver Extra,98185MI055,,MIN005,MIS001,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550002-03,Limited Cost Sharing Plan Variation,70.71%,0.720835268497467,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$10,"$1,420",$150,"$2,000",$190,$440,$80,30
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550002,Blue Cross? Preferred Silver Extra,98185MI055,,MIN005,MIS001,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550002-04,73% AV Level Silver Plan,72.76%,0.742072999477386,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,800",$10,"$1,480",$150,"$1,800",$220,$450,$80,31
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550002,Blue Cross? Preferred Silver Extra,98185MI055,,MIN005,MIS001,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550002-05,87% AV Level Silver Plan,86.10%,0.86424732208252,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$700,$10,$600,$150,$700,$300,$450,$80,32
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550002,Blue Cross? Preferred Silver Extra,98185MI055,,MIN005,MIS001,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550002-06,94% AV Level Silver Plan,93.00%,0.941509068012238,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$175,$350,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$180,$0,$330,$150,$180,$130,$200,$80,33
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550003,Blue Cross? Partnered Silver Extra,98185MI055,,MIN003,MIS005,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550003-00,Standard Silver Off Exchange Plan,70.71%,0.720835268497467,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$10,"$1,420",$150,"$2,000",$190,$440,$80,34
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550003,Blue Cross? Partnered Silver Extra,98185MI055,,MIN003,MIS005,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550003-01,Standard Silver On Exchange Plan,70.71%,0.720835268497467,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$10,"$1,420",$150,"$2,000",$190,$440,$80,35
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550003,Blue Cross? Partnered Silver Extra,98185MI055,,MIN003,MIS005,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,36
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550003,Blue Cross? Partnered Silver Extra,98185MI055,,MIN003,MIS005,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550003-03,Limited Cost Sharing Plan Variation,70.71%,0.720835268497467,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$10,"$1,420",$150,"$2,000",$190,$440,$80,37
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,3,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180012,SmartHealth Balance Silver 1500,23603MT018,,MTN002,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180012-00,Standard Silver Off Exchange Plan,,0.715258479118347,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$510,$310,$80,6
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,3,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180012,SmartHealth Balance Silver 1500,23603MT018,,MTN002,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180012-01,Standard Silver On Exchange Plan,,0.715258479118347,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$510,$310,$80,7
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,3,23603,MT,Individual,No,93-0245545,23603MT0160010,SmartHealth Balance Bronze 4000,23603MT016,,MTN002,MTS001,MTF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160010-03,Limited Cost Sharing Plan Variation,,0.616079568862915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,"$1,640",$150,"$4,000",$30,$580,$80,7
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,3,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180011,SmartHealth Balance Silver 2000,23603MT018,,MTN002,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180011-00,Standard Silver Off Exchange Plan,,0.705020010471344,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,580",$150,"$2,000",$460,$280,$80,8
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,1,24867,MT,Individual,No,39-0658730,24867MT0290003,Assurant Health Silver Plan 001,24867MT029,,MTN001,MTS001,MTF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290003-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,1,24867,MT,Individual,No,39-0658730,24867MT0290003,Assurant Health Silver Plan 001,24867MT029,,MTN001,MTS001,MTF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290003-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,1,24867,MT,Individual,No,39-0658730,24867MT0290003,Assurant Health Silver Plan 001,24867MT029,,MTN001,MTS001,MTF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290003-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,1,24867,MT,Individual,No,39-0658730,24867MT0290003,Assurant Health Silver Plan 001,24867MT029,,MTN001,MTS001,MTF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290003-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,3,24867,MT,Individual,No,39-0658730,24867MT0290011,Assurant Health Platinum Plan 002,24867MT029,,MTN001,MTS001,MTF006,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290011-01,Standard Platinum On Exchange Plan,,0.886753857135773,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,3,24867,MT,Individual,No,39-0658730,24867MT0290011,Assurant Health Platinum Plan 002,24867MT029,,MTN001,MTS001,MTF006,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,22
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550003,Blue Cross? Partnered Silver Extra,98185MI055,,MIN003,MIS005,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550003-04,73% AV Level Silver Plan,72.76%,0.742072999477386,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,800",$10,"$1,480",$150,"$1,800",$220,$450,$80,38
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550003,Blue Cross? Partnered Silver Extra,98185MI055,,MIN003,MIS005,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550003-05,87% AV Level Silver Plan,86.10%,0.86424732208252,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$700,$10,$600,$150,$700,$300,$450,$80,39
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550003,Blue Cross? Partnered Silver Extra,98185MI055,,MIN003,MIS005,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550003-06,94% AV Level Silver Plan,93.00%,0.941509068012238,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$175,$350,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$180,$0,$330,$150,$180,$130,$200,$80,40
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550004,Blue Cross? Metro Detroit HMO Silver Extra,98185MI055,,MIN004,MIS006,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550004-00,Standard Silver Off Exchange Plan,70.71%,0.720835268497467,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$10,"$1,420",$150,"$2,000",$190,$440,$80,41
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550004,Blue Cross? Metro Detroit HMO Silver Extra,98185MI055,,MIN004,MIS006,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550004-01,Standard Silver On Exchange Plan,70.71%,0.720835268497467,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$10,"$1,420",$150,"$2,000",$190,$440,$80,42
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550004,Blue Cross? Metro Detroit HMO Silver Extra,98185MI055,,MIN004,MIS006,MIF022,New,HMO,Silver,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,43
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550008,Blue Cross? Metro Detroit HMO Gold Extra,98185MI055,,MIN004,MIS006,MIF022,New,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550008-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,62
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,3,98185,MI,Individual,No,38-2359234,98185MI0550008,Blue Cross? Metro Detroit HMO Gold Extra,98185MI055,,MIN004,MIS006,MIF022,New,HMO,Gold,Yes,Both,No,Yes,All except routine ob/gyn & pediatric visits,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,1,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,No,http://www.bcbsm.com/sbc,https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do,http://www.bcbsm.com/plan-details,www.bcbsm.com/hmo-drug-list,98185MI0550008-03,Limited Cost Sharing Plan Variation,81.92%,0.838530480861664,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$10,"$1,250",$150,$500,$360,$520,$80,63
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,4,98185,MI,SHOP (Small Group),No,38-2359234,98185MI0160009,BCN HSA PCP Focus Bronze $4000 ($0),98185MI016,7457354687,MIN002,MIS002,MIF011,Existing,HMO,Bronze,Yes,Both,No,Yes,"All except for routine OB/GYN, behavioral health, and pediatric visits",Out-of-network services,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2017-12-31,Yes,Emergent Care only,Yes,Emergency and urgent care only,No,http://www.bcbsm.com/employer/sbc/bcn-hsa-bronze-160009,http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html,http://www.bcbsm.com/employer-hmo-plan-brochures,www.bcbsm.com/hmo-drug-list,98185MI0160009-00,Standard Bronze Off Exchange Plan,60.10%,0.60278332233429,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,$650,$150,"$2,420",$400,$0,$80,8
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,4,98185,MI,SHOP (Small Group),No,38-2359234,98185MI0160009,BCN HSA PCP Focus Bronze $4000 ($0),98185MI016,7457354687,MIN002,MIS002,MIF011,Existing,HMO,Bronze,Yes,Both,No,Yes,"All except for routine OB/GYN, behavioral health, and pediatric visits",Out-of-network services,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2017-12-31,Yes,Emergent Care only,Yes,Emergency and urgent care only,No,http://www.bcbsm.com/employer/sbc/bcn-hsa-bronze-160009,http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html,http://www.bcbsm.com/employer-hmo-plan-brochures,www.bcbsm.com/hmo-drug-list,98185MI0160009-01,Standard Bronze On Exchange Plan,60.10%,0.60278332233429,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,$650,$150,"$2,420",$400,$0,$80,9
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,4,98185,MI,SHOP (Small Group),No,38-2359234,98185MI0160013,BCN HSA PCP Focus Bronze $3000 ($0),98185MI016,7457354687,MIN002,MIS002,MIF011,Existing,HMO,Bronze,Yes,Both,No,Yes,"All except for routine OB/GYN, behavioral health, and pediatric visits",Out-of-network services,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2017-12-31,Yes,Emergent Care only,Yes,Emergency and urgent care only,No,http://www.bcbsm.com/employer/sbc/bcn-hsa-bronze-160013,http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html,http://www.bcbsm.com/employer-hmo-plan-brochures,www.bcbsm.com/hmo-drug-list,98185MI0160013-00,Standard Bronze Off Exchange Plan,61.97%,0.622332394123077,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$20,"$1,250",$150,"$2,420",$400,$0,$80,11
2015,MI,98185,SERFF,5,2015-04-30 14:45:44,4,98185,MI,SHOP (Small Group),No,38-2359234,98185MI0160013,BCN HSA PCP Focus Bronze $3000 ($0),98185MI016,7457354687,MIN002,MIS002,MIF011,Existing,HMO,Bronze,Yes,Both,No,Yes,"All except for routine OB/GYN, behavioral health, and pediatric visits",Out-of-network services,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2017-12-31,Yes,Emergent Care only,Yes,Emergency and urgent care only,No,http://www.bcbsm.com/employer/sbc/bcn-hsa-bronze-160013,http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html,http://www.bcbsm.com/employer-hmo-plan-brochures,www.bcbsm.com/hmo-drug-list,98185MI0160013-01,Standard Bronze On Exchange Plan,61.97%,0.622332394123077,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$20,"$1,250",$150,"$2,420",$400,$0,$80,12
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180016,SmartHealth Balance Silver 1500 VH,23603MT018,,MTN002,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.976628177509437,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180016-01,Standard Silver On Exchange Plan,,0.715258479118347,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$510,$310,$80,19
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180006,Balance Silver PSN 2000 VH,23603MT018,,MTN001,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.977468810400368,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180006-00,Standard Silver Off Exchange Plan,,0.703793525695801,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,580",$150,"$2,000",$460,$280,$80,20
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,1,24867,MT,Individual,No,39-0658730,24867MT0290002,Assurant Health Bronze Plan 001,24867MT029,,MTN001,MTS002,MTF009,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290002-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,3,24867,MT,Individual,No,39-0658730,24867MT0290009,Assurant Health Gold Plan 002,24867MT029,,MTN001,MTS001,MTF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290009-00,Standard Gold Off Exchange Plan,,0.81914895772934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,3,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180023,SmartHealth Balance Gold 500,23603MT018,,MTN001,MTS001,MTF008,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180023-01,Standard Gold On Exchange Plan,,0.813321590423584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$20,"$1,350",$150,$500,$730,$240,$80,13
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,4,23603,MT,Individual,No,93-0245545,23603MT0160004,SmartHealth Balance Bronze 6600,23603MT016,,MTN002,MTS001,MTF005,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0160004-00,Standard Bronze Off Exchange Plan,,0.617607593536377,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,4
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,No,36-1236610,30751MT0550004,Blue Preferred Silver PPO? 004,30751MT055,,MTN001,MTS001,MTF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550004-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000","$10,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,No,36-1236610,30751MT0550004,Blue Preferred Silver PPO? 004,30751MT055,,MTN001,MTS001,MTF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550004-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,1,23603,MT,SHOP (Small Group),Yes,93-0245545,23603MT0200001,Dental Choice 0/20/50 750,23603MT020,,MTN003,MTS001,,Existing,Indemnity,High,,Both,,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,Allows Adult and Child-Only,,,,$42.08,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,,23603MT0200001-00,Standard High Off Exchange Plan,83.19%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,1,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0170004,Value Bronze PSN 3000,23603MT017,,MTN001,MTS001,MTF006,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0170004-00,Standard Bronze Off Exchange Plan,,0.603760778903961,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,140",$150,"$3,000",$0,"$1,140",$80,4
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,1,23603,MT,Individual,Yes,93-0245545,23603MT0260001,Dental Choice 0/20/50,23603MT026,,MTN003,MTS002,,New,Indemnity,High,,Both,,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,Allows Adult and Child-Only,,,,$38.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",Yes,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,,23603MT0260001-00,Standard High Off Exchange Plan,83.19%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,1,23603,MT,Individual,No,93-0245545,23603MT0140002,SmartHealth Catastrophic,23603MT014,,MTN002,MTS001,MTF005,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,3,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0140002-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,4
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,1,23603,MT,Individual,No,93-0245545,23603MT0140002,SmartHealth Catastrophic,23603MT014,,MTN002,MTS001,MTF005,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,3,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0140002-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,1,23603,MT,Individual,Yes,93-0245545,23603MT0260001,Dental Choice 0/20/50,23603MT026,,MTN003,MTS002,,New,Indemnity,High,,Both,,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,Allows Adult and Child-Only,,,,$38.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",Yes,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,,23603MT0260001-01,Standard High On Exchange Plan,83.19%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,1,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0170004,Value Bronze PSN 3000,23603MT017,,MTN001,MTS001,MTF006,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0170004-01,Standard Bronze On Exchange Plan,,0.603760778903961,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,140",$150,"$3,000",$0,"$1,140",$80,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,1,23603,MT,SHOP (Small Group),Yes,93-0245545,23603MT0200001,Dental Choice 0/20/50 750,23603MT020,,MTN003,MTS001,,Existing,Indemnity,High,,Both,,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,Allows Adult and Child-Only,,,,$42.08,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,,23603MT0200001-01,Standard High On Exchange Plan,83.19%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,1,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0170007,SmartHealth Value Bronze 3000,23603MT017,,MTN002,MTS001,MTF006,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0170007-00,Standard Bronze Off Exchange Plan,,0.603760778903961,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,140",$150,"$3,000",$0,"$1,140",$80,6
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,1,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0170007,SmartHealth Value Bronze 3000,23603MT017,,MTN002,MTS001,MTF006,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0170007-01,Standard Bronze On Exchange Plan,,0.603760778903961,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,140",$150,"$3,000",$0,"$1,140",$80,7
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,1,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0170013,Value Bronze PSN 6000,23603MT017,,MTN001,MTS001,MTF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.om,23603MT0170013-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$150,"$5,270",$0,$0,$80,8
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,1,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0170013,Value Bronze PSN 6000,23603MT017,,MTN001,MTS001,MTF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.om,23603MT0170013-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$150,"$5,270",$0,$0,$80,9
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,1,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0170014,SmartHealth Value Bronze 6000,23603MT017,,MTN002,MTS001,MTF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.om,23603MT0170014-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$150,"$5,270",$0,$0,$80,10
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,1,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0170014,SmartHealth Value Bronze 6000,23603MT017,,MTN002,MTS001,MTF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.om,23603MT0170014-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$150,"$5,270",$0,$0,$80,11
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,1,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0170005,Value Silver PSN 3000,23603MT017,,MTN001,MTS001,MTF005,Existing,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.om,23603MT0170005-00,Standard Silver Off Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$0,$0,$150,"$3,000",$0,$0,$80,12
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,1,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0170005,Value Silver PSN 3000,23603MT017,,MTN001,MTS001,MTF005,Existing,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.om,23603MT0170005-01,Standard Silver On Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$0,$0,$150,"$3,000",$0,$0,$80,13
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,1,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0170008,SmartHealth Value Silver 3000,23603MT017,,MTN002,MTS001,MTF005,Existing,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.om,23603MT0170008-00,Standard Silver Off Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$0,$0,$150,"$3,000",$0,$0,$80,14
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,1,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0170008,SmartHealth Value Silver 3000,23603MT017,,MTN002,MTS001,MTF005,Existing,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.om,23603MT0170008-01,Standard Silver On Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$0,$0,$150,"$3,000",$0,$0,$80,15
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180010,SmartHealth Balance Bronze 4000,23603MT018,,MTN002,MTS001,MTF006,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,10,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180010-00,Standard Bronze Off Exchange Plan,,0.606374084949493,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,"$1,640",$150,"$4,000",$50,$580,$80,4
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,Yes,93-0245545,23603MT0190002,Kids Dental Choice 0/20/50,23603MT019,,MTN003,MTS002,,Existing,Indemnity,High,,Both,,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,Allows Child-Only,,,,$36.04,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",Yes,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,,23603MT0190002-00,Standard High Off Exchange Plan,83.19%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,SHOP (Small Group),Yes,93-0245545,23603MT0200002,Dental Choice Core,23603MT020,,MTN003,MTS001,,Existing,Indemnity,High,,Both,,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,Allows Adult and Child-Only,,,,$42.08,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,,23603MT0200002-00,Standard High Off Exchange Plan,83.19%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150009,Value Bronze PSN 6250,23603MT015,,MTN001,MTS001,MTF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0150009-00,Standard Bronze Off Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,"$6,250",$0,$0,$150,"$5,270",$0,$0,$80,4
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150009,Value Bronze PSN 6250,23603MT015,,MTN001,MTS001,MTF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0150009-01,Standard Bronze On Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,"$6,250",$0,$0,$150,"$5,270",$0,$0,$80,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,SHOP (Small Group),Yes,93-0245545,23603MT0200002,Dental Choice Core,23603MT020,,MTN003,MTS001,,Existing,Indemnity,High,,Both,,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,Allows Adult and Child-Only,,,,$42.08,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,,23603MT0200002-01,Standard High On Exchange Plan,83.19%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,Yes,93-0245545,23603MT0190002,Kids Dental Choice 0/20/50,23603MT019,,MTN003,MTS002,,Existing,Indemnity,High,,Both,,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,Allows Child-Only,,,,$36.04,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",Yes,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,,23603MT0190002-01,Standard High On Exchange Plan,83.19%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180010,SmartHealth Balance Bronze 4000,23603MT018,,MTN002,MTS001,MTF006,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,10,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180010-01,Standard Bronze On Exchange Plan,,0.606374084949493,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,"$1,640",$150,"$4,000",$50,$580,$80,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150009,Value Bronze PSN 6250,23603MT015,,MTN001,MTS001,MTF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0150009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150009,Value Bronze PSN 6250,23603MT015,,MTN001,MTS001,MTF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0150009-03,Limited Cost Sharing Plan Variation,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,"$6,250",$0,$0,$150,"$5,270",$0,$0,$80,7
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,3,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180021,SmartHealth Balance Gold 1000 3000,23603MT018,,MTN002,MTS001,MTF004,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180021-01,Standard Gold On Exchange Plan,,0.801849186420441,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$610,$220,$80,11
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,3,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180023,SmartHealth Balance Gold 500,23603MT018,,MTN001,MTS001,MTF008,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180023-00,Standard Gold Off Exchange Plan,,0.813321590423584,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$20,"$1,350",$150,$500,$730,$240,$80,12
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,Individual,No,93-0245545,23603MT0160006,SmartHealth Balance Silver 1500,23603MT016,,MTN002,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160006-06,94% AV Level Silver Plan,,0.931989848613739,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,"$1,400","$2,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$600,30%,,,,$600,"$1,200",Not Applicable,Not Applicable,$300,$0,$400,$150,$300,$230,$170,$80,17
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180016,SmartHealth Balance Silver 1500 VH,23603MT018,,MTN002,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.976628177509437,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180016-00,Standard Silver Off Exchange Plan,,0.715258479118347,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$510,$310,$80,18
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,No,36-1236610,30751MT0550001,Blue Preferred Gold PPO? 001,30751MT055,,MTN001,MTS001,MTF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550001-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$6,500","$13,000",Not Applicable,Not Applicable,"$3,250","$6,500",0%,,,,"$6,500","$13,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,SHOP (Small Group),Yes,36-1236610,30751MT0590008,BlueCare Dental? 1F,30751MT059,,MTN002,MTS002,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.79,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx,,https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx,,30751MT0590008-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180020,Balance Gold PSN 500 VH,23603MT018,,MTN001,MTS001,MTF008,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.981998717331393,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180020-00,Standard Gold Off Exchange Plan,,0.813321650028229,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$20,"$1,350",$150,$500,$730,$240,$80,12
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180020,Balance Gold PSN 500 VH,23603MT018,,MTN001,MTS001,MTF008,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.981998717331393,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180020-01,Standard Gold On Exchange Plan,,0.813321650028229,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$20,"$1,350",$150,$500,$730,$240,$80,13
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,Individual,No,93-0245545,23603MT0160006,SmartHealth Balance Silver 1500,23603MT016,,MTN002,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,13
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,Individual,No,93-0245545,23603MT0160006,SmartHealth Balance Silver 1500,23603MT016,,MTN002,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160006-03,Limited Cost Sharing Plan Variation,,0.704070448875427,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$580,$310,$80,14
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180024,SmartHealth Balance Gold 500 VH,23603MT018,,MTN002,MTS001,MTF008,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.980831760000973,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180024-00,Standard Gold Off Exchange Plan,,0.813321650028229,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$20,"$1,350",$150,$500,$730,$240,$80,14
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180024,SmartHealth Balance Gold 500 VH,23603MT018,,MTN002,MTS001,MTF008,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.980831760000973,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180024-01,Standard Gold On Exchange Plan,,0.813321650028229,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$20,"$1,350",$150,$500,$730,$240,$80,15
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,Individual,No,93-0245545,23603MT0160006,SmartHealth Balance Silver 1500,23603MT016,,MTN002,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160006-04,73% AV Level Silver Plan,,0.734769582748413,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,150",$150,"$1,500",$580,$210,$80,15
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,Individual,No,93-0245545,23603MT0160006,SmartHealth Balance Silver 1500,23603MT016,,MTN002,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160006-05,87% AV Level Silver Plan,,0.864007592201233,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$10,"$1,350",$150,$500,$390,$240,$80,16
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,1,24867,MT,Individual,No,39-0658730,24867MT0290004,Assurant Health Silver Plan 001,24867MT029,,MTN001,MTS002,MTF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290004-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,1,24867,MT,Individual,No,39-0658730,24867MT0290004,Assurant Health Silver Plan 001,24867MT029,,MTN001,MTS002,MTF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,33
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,1,24867,MT,Individual,No,39-0658730,24867MT0290004,Assurant Health Silver Plan 001,24867MT029,,MTN001,MTS002,MTF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290004-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,1,24867,MT,Individual,No,39-0658730,24867MT0290004,Assurant Health Silver Plan 001,24867MT029,,MTN001,MTS002,MTF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290004-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,Individual,No,93-0245545,23603MT0160005,SmartHealth Balance Silver 2500,23603MT016,,MTN002,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160005-00,Standard Silver Off Exchange Plan,,0.699501097202301,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,430",$150,"$2,500",$360,$230,$80,18
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,Individual,No,93-0245545,23603MT0160005,SmartHealth Balance Silver 2500,23603MT016,,MTN002,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160005-01,Standard Silver On Exchange Plan,,0.699501097202301,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,430",$150,"$2,500",$360,$230,$80,19
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,Individual,No,93-0245545,23603MT0160005,SmartHealth Balance Silver 2500,23603MT016,,MTN002,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,20
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,Individual,No,93-0245545,23603MT0160005,SmartHealth Balance Silver 2500,23603MT016,,MTN002,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160005-03,Limited Cost Sharing Plan Variation,,0.699501097202301,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,430",$150,"$2,500",$360,$230,$80,21
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,1,24867,MT,Individual,No,39-0658730,24867MT0290003,Assurant Health Silver Plan 001,24867MT029,,MTN001,MTS001,MTF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,26
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,1,24867,MT,Individual,No,39-0658730,24867MT0290003,Assurant Health Silver Plan 001,24867MT029,,MTN001,MTS001,MTF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290003-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,SHOP (Small Group),No,36-1236610,30751MT0560006,Blue Preferred Gold PPO? 006,30751MT056,,MTN001,MTS001,MTF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0560006-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150005,SmartHealth Value Bronze 6250,23603MT015,,MTN002,MTS001,MTF005,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0150005-00,Standard Bronze Off Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,"$6,250",$0,$0,$150,"$5,270",$0,$0,$80,8
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150005,SmartHealth Value Bronze 6250,23603MT015,,MTN002,MTS001,MTF005,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0150005-01,Standard Bronze On Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,"$6,250",$0,$0,$150,"$5,270",$0,$0,$80,9
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150005,SmartHealth Value Bronze 6250,23603MT015,,MTN002,MTS001,MTF005,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0150005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150005,SmartHealth Value Bronze 6250,23603MT015,,MTN002,MTS001,MTF005,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0150005-03,Limited Cost Sharing Plan Variation,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$12,500","$25,000",Not Applicable,Not Applicable,"$6,250",$0,$0,$150,"$5,270",$0,$0,$80,11
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150008,SmartHealth Value Silver 3000,23603MT015,,MTN002,MTS001,MTF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0150008-00,Standard Silver Off Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$0,$0,$150,"$3,000",$0,$0,$80,12
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150008,SmartHealth Value Silver 3000,23603MT015,,MTN002,MTS001,MTF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0150008-01,Standard Silver On Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$0,$0,$150,"$3,000",$0,$0,$80,13
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150008,SmartHealth Value Silver 3000,23603MT015,,MTN002,MTS001,MTF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0150008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,14
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150008,SmartHealth Value Silver 3000,23603MT015,,MTN002,MTS001,MTF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0150008-03,Limited Cost Sharing Plan Variation,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$0,$0,$150,"$3,000",$0,$0,$80,15
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150008,SmartHealth Value Silver 3000,23603MT015,,MTN002,MTS001,MTF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0150008-04,73% AV Level Silver Plan,,0.738942980766296,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,"$5,300","$10,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,650","$5,300",0%,,,,"$5,300","$10,600",Not Applicable,Not Applicable,"$2,650",$0,$0,$150,"$2,650",$0,$0,$80,16
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150008,SmartHealth Value Silver 3000,23603MT015,,MTN002,MTS001,MTF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0150008-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$2,200","$4,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,"$2,200","$4,400",Not Applicable,Not Applicable,"$1,100",$0,$0,$150,"$1,100",$0,$0,$80,17
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150008,SmartHealth Value Silver 3000,23603MT015,,MTN002,MTS001,MTF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0150008-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,18
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150006,SmartHealth Value Bronze 3000,23603MT015,,MTN002,MTS001,MTF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0150006-00,Standard Bronze Off Exchange Plan,,0.603760778903961,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,140",$150,"$3,000",$0,"$1,140",$80,19
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150006,SmartHealth Value Bronze 3000,23603MT015,,MTN002,MTS001,MTF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0150006-01,Standard Bronze On Exchange Plan,,0.603760778903961,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,140",$150,"$3,000",$0,"$1,140",$80,20
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150006,SmartHealth Value Bronze 3000,23603MT015,,MTN002,MTS001,MTF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0150006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,21
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150006,SmartHealth Value Bronze 3000,23603MT015,,MTN002,MTS001,MTF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0150006-03,Limited Cost Sharing Plan Variation,,0.603760778903961,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,140",$150,"$3,000",$0,"$1,140",$80,22
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150007,SmartHealth Value Silver 3600,23603MT015,,MTN002,MTS001,MTF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0150007-00,Standard Silver Off Exchange Plan,,0.683036506175995,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$7,200","$14,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,"$7,200","$14,400",Not Applicable,Not Applicable,"$3,600",$0,$0,$150,"$3,600",$0,$0,$80,23
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150007,SmartHealth Value Silver 3600,23603MT015,,MTN002,MTS001,MTF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0150007-01,Standard Silver On Exchange Plan,,0.683036506175995,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$7,200","$14,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,"$7,200","$14,400",Not Applicable,Not Applicable,"$3,600",$0,$0,$150,"$3,600",$0,$0,$80,24
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150007,SmartHealth Value Silver 3600,23603MT015,,MTN002,MTS001,MTF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0150007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,25
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150007,SmartHealth Value Silver 3600,23603MT015,,MTN002,MTS001,MTF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0150007-03,Limited Cost Sharing Plan Variation,,0.683036506175995,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$7,200","$14,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,"$7,200","$14,400",Not Applicable,Not Applicable,"$3,600",$0,$0,$150,"$3,600",$0,$0,$80,26
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150007,SmartHealth Value Silver 3600,23603MT015,,MTN002,MTS001,MTF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0150007-04,73% AV Level Silver Plan,,0.729270815849304,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$5,600","$11,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",0%,,,,"$5,600","$11,200",Not Applicable,Not Applicable,"$2,800",$0,$0,$150,"$2,800",$0,$0,$80,27
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150007,SmartHealth Value Silver 3600,23603MT015,,MTN002,MTS001,MTF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0150007-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$2,200","$4,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,"$2,200","$4,400",Not Applicable,Not Applicable,"$1,100",$0,$0,$150,"$1,100",$0,$0,$80,28
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,2,23603,MT,Individual,No,93-0245545,23603MT0150007,SmartHealth Value Silver 3600,23603MT015,,MTN002,MTS001,MTF005,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0150007-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,29
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,3,23603,MT,Individual,No,93-0245545,23603MT0160010,SmartHealth Balance Bronze 4000,23603MT016,,MTN002,MTS001,MTF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160010-00,Standard Bronze Off Exchange Plan,,0.616079568862915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,"$1,640",$150,"$4,000",$30,$580,$80,4
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,3,23603,MT,Individual,Yes,93-0245545,23603MT0190001,Kids Dental Choice 20/40/50/50,23603MT019,,MTN003,MTS002,,Existing,Indemnity,Low,,Off the Exchange,,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,Allows Child-Only,,,,$29.59,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",Yes,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,,23603MT0190001-00,Standard Low Off Exchange Plan,68.18%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,3,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180013,SmartHealth Balance Gold 1000 5000,23603MT018,,MTN002,MTS001,MTF004,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180013-00,Standard Gold Off Exchange Plan,,0.78338348865509,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$540,$220,$80,4
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,3,23603,MT,SHOP (Small Group),Yes,93-0245545,23603MT0210007,Dental Choice Plus 0/20/50 25/1000,23603MT021,,MTN003,MTS001,,New,Indemnity,High,,Off the Exchange,,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,Allows Adult and Child-Only,,,,$40.75,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,,23603MT0210007-00,Standard High Off Exchange Plan,83.19%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180019,Balance Gold PSN 1000 3000 VH,23603MT018,,MTN001,MTS001,MTF004,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.98098675643719,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180019-01,Standard Gold On Exchange Plan,,0.80184930562973,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$610,$220,$80,9
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180022,SmartHealth Balance Gold 1000 3000 VH,23603MT018,,MTN002,MTS001,MTF004,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.979751723072805,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180022-00,Standard Gold Off Exchange Plan,,0.80184930562973,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$610,$220,$80,10
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,2,24867,MT,Individual,No,39-0658730,24867MT0290005,Assurant Health Bronze Plan 002,24867MT029,,MTN001,MTS001,MTF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290005-01,Standard Bronze On Exchange Plan,61.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,2,24867,MT,Individual,No,39-0658730,24867MT0290005,Assurant Health Bronze Plan 002,24867MT029,,MTN001,MTS001,MTF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290005-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,10
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,2,24867,MT,Individual,No,39-0658730,24867MT0290005,Assurant Health Bronze Plan 002,24867MT029,,MTN001,MTS001,MTF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290005-03,Limited Cost Sharing Plan Variation,61.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,2,24867,MT,Individual,No,39-0658730,24867MT0290006,Assurant Health Bronze Plan 002,24867MT029,,MTN001,MTS002,MTF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290006-00,Standard Bronze Off Exchange Plan,61.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,SHOP (Small Group),Yes,36-1236610,30751MT0590002,BlueCare Dental? 1B,30751MT059,,MTN002,MTS002,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.79,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx,,https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx,,30751MT0590002-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,Yes,36-1236610,30751MT0580001,BlueCare Dental? 1A,30751MT058,,MTN002,MTS002,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$42.92,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx,,30751MT0580001-01,Standard High On Exchange Plan,86.90%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,SHOP (Small Group),No,36-1236610,30751MT0560005,Blue Preferred Gold PPO? 005,30751MT056,,MTN001,MTS001,MTF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0560005-01,Standard Gold On Exchange Plan,,0.790639460086823,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$6,500","$13,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,3,23603,MT,SHOP (Small Group),Yes,93-0245545,23603MT0210008,Dental Choice Plus 0/20/50 50/1000,23603MT021,,MTN003,MTS001,,New,Indemnity,High,,Off the Exchange,,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,Allows Adult and Child-Only,,,,$40.75,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,,23603MT0210008-00,Standard High Off Exchange Plan,83.19%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,3,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180013,SmartHealth Balance Gold 1000 5000,23603MT018,,MTN002,MTS001,MTF004,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180013-01,Standard Gold On Exchange Plan,,0.78338348865509,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$540,$220,$80,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,3,23603,MT,Individual,No,93-0245545,23603MT0160010,SmartHealth Balance Bronze 4000,23603MT016,,MTN002,MTS001,MTF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160010-01,Standard Bronze On Exchange Plan,,0.616079568862915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,"$1,640",$150,"$4,000",$30,$580,$80,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,3,23603,MT,Individual,No,93-0245545,23603MT0160010,SmartHealth Balance Bronze 4000,23603MT016,,MTN002,MTS001,MTF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,3,23603,MT,Individual,No,93-0245545,23603MT0160008,Balance Bronze PSN 4000,23603MT016,,MTN001,MTS001,MTF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160008-00,Standard Bronze Off Exchange Plan,,0.616079568862915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,"$1,640",$150,"$4,000",$30,$580,$80,8
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,3,23603,MT,Individual,No,93-0245545,23603MT0160008,Balance Bronze PSN 4000,23603MT016,,MTN001,MTS001,MTF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160008-01,Standard Bronze On Exchange Plan,,0.616079568862915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,"$1,640",$150,"$4,000",$30,$580,$80,9
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,3,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180011,SmartHealth Balance Silver 2000,23603MT018,,MTN002,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180011-01,Standard Silver On Exchange Plan,,0.705020010471344,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,580",$150,"$2,000",$460,$280,$80,9
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,3,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180021,SmartHealth Balance Gold 1000 3000,23603MT018,,MTN002,MTS001,MTF004,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180021-00,Standard Gold Off Exchange Plan,,0.801849186420441,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$610,$220,$80,10
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,3,23603,MT,Individual,No,93-0245545,23603MT0160008,Balance Bronze PSN 4000,23603MT016,,MTN001,MTS001,MTF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,3,23603,MT,Individual,No,93-0245545,23603MT0160008,Balance Bronze PSN 4000,23603MT016,,MTN001,MTS001,MTF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160008-03,Limited Cost Sharing Plan Variation,,0.616079568862915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,"$1,640",$150,"$4,000",$30,$580,$80,11
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,4,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180005,Balance Bronze PSN 4000 VH,23603MT018,,MTN001,MTS001,MTF006,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.972034841010743,,,0,0,10,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180005-00,Standard Bronze Off Exchange Plan,,0.606374263763428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,"$1,640",$150,"$4,000",$50,$580,$80,4
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,4,23603,MT,SHOP (Small Group),Yes,93-0245545,23603MT0210009,Dental Choice Plus 0/20/50 25/1500,23603MT021,,MTN003,MTS001,,New,Indemnity,High,,Off the Exchange,,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,Allows Adult and Child-Only,,,,$40.75,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,,23603MT0210009-00,Standard High Off Exchange Plan,83.19%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,4,23603,MT,SHOP (Small Group),Yes,93-0245545,23603MT0210010,Dental Choice Plus 0/20/50 50/1500,23603MT021,,MTN003,MTS001,,New,Indemnity,High,,Off the Exchange,,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,Allows Adult and Child-Only,,,,$40.75,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,,23603MT0210010-00,Standard High Off Exchange Plan,83.19%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,4,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180005,Balance Bronze PSN 4000 VH,23603MT018,,MTN001,MTS001,MTF006,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.972034841010743,,,0,0,10,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180005-01,Standard Bronze On Exchange Plan,,0.606374263763428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,"$1,640",$150,"$4,000",$50,$580,$80,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,4,23603,MT,Individual,No,93-0245545,23603MT0160004,SmartHealth Balance Bronze 6600,23603MT016,,MTN002,MTS001,MTF005,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0160004-01,Standard Bronze On Exchange Plan,,0.617607593536377,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,4,23603,MT,Individual,No,93-0245545,23603MT0160004,SmartHealth Balance Bronze 6600,23603MT016,,MTN002,MTS001,MTF005,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0160004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,4,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180014,SmartHealth Balance Bronze 4000 VH,23603MT018,,MTN002,MTS001,MTF006,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.970433471286774,,,0,0,10,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180014-00,Standard Bronze Off Exchange Plan,,0.606374263763428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,"$1,640",$150,"$4,000",$50,$580,$80,6
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,4,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180014,SmartHealth Balance Bronze 4000 VH,23603MT018,,MTN002,MTS001,MTF006,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.970433471286774,,,0,0,10,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180014-01,Standard Bronze On Exchange Plan,,0.606374263763428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$0,"$1,640",$150,"$4,000",$50,$580,$80,7
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,4,23603,MT,Individual,No,93-0245545,23603MT0160004,SmartHealth Balance Bronze 6600,23603MT016,,MTN002,MTS001,MTF005,Existing,PPO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.om,23603MT0160004-03,Limited Cost Sharing Plan Variation,,0.617607593536377,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,7
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180009,Balance Gold PSN 1000 5000 VH,23603MT018,,MTN001,MTS001,MTF004,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.980580357213263,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180009-00,Standard Gold Off Exchange Plan,,0.783383548259735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$540,$220,$80,4
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,SHOP (Small Group),Yes,93-0245545,23603MT0210011,Dental Choice Plus 0/20/50 25/1000 1000 Ortho,23603MT021,,MTN003,MTS001,,New,Indemnity,High,,Off the Exchange,,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,Allows Adult and Child-Only,,,,$39.61,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,,23603MT0210011-00,Standard High Off Exchange Plan,83.19%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,Individual,No,93-0245545,23603MT0160009,Balance Silver PSN 2500,23603MT016,,MTN001,MTS001,MTF008,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160009-00,Standard Silver Off Exchange Plan,,0.699501097202301,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,430",$150,"$2,500",$360,$230,$80,4
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,Individual,No,93-0245545,23603MT0160009,Balance Silver PSN 2500,23603MT016,,MTN001,MTS001,MTF008,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160009-01,Standard Silver On Exchange Plan,,0.699501097202301,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,430",$150,"$2,500",$360,$230,$80,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,SHOP (Small Group),Yes,93-0245545,23603MT0210014,Dental Choice Plus 0/20/50 50/1000 1000 Ortho,23603MT021,,MTN003,MTS001,,New,Indemnity,High,,Off the Exchange,,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,Allows Adult and Child-Only,,,,$39.61,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,,23603MT0210014-00,Standard High Off Exchange Plan,83.19%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180009,Balance Gold PSN 1000 5000 VH,23603MT018,,MTN001,MTS001,MTF004,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.980580357213263,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180009-01,Standard Gold On Exchange Plan,,0.783383548259735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$540,$220,$80,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180017,SmartHealth Balance Gold 1000 5000 VH,23603MT018,,MTN002,MTS001,MTF004,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.979319328759284,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180017-00,Standard Gold Off Exchange Plan,,0.783383548259735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$540,$220,$80,6
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,Individual,No,93-0245545,23603MT0160009,Balance Silver PSN 2500,23603MT016,,MTN001,MTS001,MTF008,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,Individual,No,93-0245545,23603MT0160009,Balance Silver PSN 2500,23603MT016,,MTN001,MTS001,MTF008,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160009-03,Limited Cost Sharing Plan Variation,,0.699501097202301,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,430",$150,"$2,500",$360,$230,$80,7
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180017,SmartHealth Balance Gold 1000 5000 VH,23603MT018,,MTN002,MTS001,MTF004,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.979319328759284,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180017-01,Standard Gold On Exchange Plan,,0.783383548259735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$540,$220,$80,7
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180019,Balance Gold PSN 1000 3000 VH,23603MT018,,MTN001,MTS001,MTF004,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.98098675643719,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180019-00,Standard Gold Off Exchange Plan,,0.80184930562973,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$610,$220,$80,8
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,Individual,No,93-0245545,23603MT0160009,Balance Silver PSN 2500,23603MT016,,MTN001,MTS001,MTF008,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160009-04,73% AV Level Silver Plan,,0.728238642215729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,580",$150,"$2,000",$390,$280,$80,8
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,Individual,No,93-0245545,23603MT0160009,Balance Silver PSN 2500,23603MT016,,MTN001,MTS001,MTF008,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160009-05,87% AV Level Silver Plan,,0.863799929618835,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,600","$3,200",,,"$3,200","$6,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$0,"$1,100",$150,$500,$580,$350,$80,9
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,Individual,No,93-0245545,23603MT0160009,Balance Silver PSN 2500,23603MT016,,MTN001,MTS001,MTF008,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160009-06,94% AV Level Silver Plan,,0.938857674598694,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$1,200","$2,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,30%,,,,$500,"$1,000",Not Applicable,Not Applicable,$250,$0,$450,$150,$250,$220,$230,$80,10
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180022,SmartHealth Balance Gold 1000 3000 VH,23603MT018,,MTN002,MTS001,MTF004,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.979751723072805,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180022-01,Standard Gold On Exchange Plan,,0.80184930562973,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$610,$220,$80,11
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,Individual,No,93-0245545,23603MT0160006,SmartHealth Balance Silver 1500,23603MT016,,MTN002,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160006-00,Standard Silver Off Exchange Plan,,0.704070448875427,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$580,$310,$80,11
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,Individual,No,93-0245545,23603MT0160006,SmartHealth Balance Silver 1500,23603MT016,,MTN002,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160006-01,Standard Silver On Exchange Plan,,0.704070448875427,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$580,$310,$80,12
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180007,Balance Silver PSN 1500 VH,23603MT018,,MTN001,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.978059761778852,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180007-00,Standard Silver Off Exchange Plan,,0.715258479118347,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$510,$310,$80,16
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180007,Balance Silver PSN 1500 VH,23603MT018,,MTN001,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.978059761778852,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180007-01,Standard Silver On Exchange Plan,,0.715258479118347,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$510,$310,$80,17
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180006,Balance Silver PSN 2000 VH,23603MT018,,MTN001,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.977468810400368,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180006-01,Standard Silver On Exchange Plan,,0.703793525695801,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,580",$150,"$2,000",$460,$280,$80,21
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180015,SmartHealth Balance Silver 2000 VH,23603MT018,,MTN002,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.97599760590478,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180015-00,Standard Silver Off Exchange Plan,,0.705020010471344,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,580",$150,"$2,000",$460,$280,$80,22
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,Individual,No,93-0245545,23603MT0160005,SmartHealth Balance Silver 2500,23603MT016,,MTN002,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160005-04,73% AV Level Silver Plan,,0.728238642215729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,580",$150,"$2,000",$390,$280,$80,22
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,Individual,No,93-0245545,23603MT0160005,SmartHealth Balance Silver 2500,23603MT016,,MTN002,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160005-05,87% AV Level Silver Plan,,0.863799929618835,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,600","$3,200",,,"$3,200","$6,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$0,"$1,100",$150,$500,$580,$350,$80,23
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180015,SmartHealth Balance Silver 2000 VH,23603MT018,,MTN002,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.97599760590478,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180015-01,Standard Silver On Exchange Plan,,0.705020010471344,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,580",$150,"$2,000",$460,$280,$80,23
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,5,23603,MT,Individual,No,93-0245545,23603MT0160005,SmartHealth Balance Silver 2500,23603MT016,,MTN002,MTS001,MTF008,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160005-06,94% AV Level Silver Plan,,0.938857674598694,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,"$1,200","$2,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,30%,,,,$500,"$1,000",Not Applicable,Not Applicable,$250,$0,$450,$150,$250,$220,$230,$80,24
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,6,23603,MT,Individual,No,93-0245545,23603MT0160007,SmartHealth Balance Gold 1000,23603MT016,,MTN002,MTS001,MTF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160007-00,Standard Gold Off Exchange Plan,,0.781424105167389,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$540,$220,$80,4
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,6,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180018,SmartHealth Balance Gold HRA 3000,23603MT018,,MTN002,MTS001,MTF004,Existing,PPO,Gold,Yes,Both,No,No,,,,No,Yes,"$1,000.00",Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180018-00,Standard Gold Off Exchange Plan,78.67%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,"$1,280",$150,"$3,000",$340,$180,$80,4
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,6,23603,MT,SHOP (Small Group),Yes,93-0245545,23603MT0210012,Dental Choice Plus 0/20/50 25/1500 1000 Ortho,23603MT021,,MTN003,MTS001,,New,Indemnity,High,,Off the Exchange,,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,Allows Adult and Child-Only,,,,$39.61,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,,23603MT0210012-00,Standard High Off Exchange Plan,83.19%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,6,23603,MT,SHOP (Small Group),Yes,93-0245545,23603MT0210015,Dental Choice Plus 0/20/50 50/1500 1000 Ortho,23603MT021,,MTN003,MTS001,,New,Indemnity,High,,Off the Exchange,,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,Allows Adult and Child-Only,,,,$39.61,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,,23603MT0210015-00,Standard High Off Exchange Plan,83.19%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,6,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180018,SmartHealth Balance Gold HRA 3000,23603MT018,,MTN002,MTS001,MTF004,Existing,PPO,Gold,Yes,Both,No,No,,,,No,Yes,"$1,000.00",Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180018-01,Standard Gold On Exchange Plan,78.67%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,"$1,280",$150,"$3,000",$340,$180,$80,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,6,23603,MT,Individual,No,93-0245545,23603MT0160007,SmartHealth Balance Gold 1000,23603MT016,,MTN002,MTS001,MTF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160007-01,Standard Gold On Exchange Plan,,0.781424105167389,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$540,$220,$80,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,6,23603,MT,Individual,No,93-0245545,23603MT0160007,SmartHealth Balance Gold 1000,23603MT016,,MTN002,MTS001,MTF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,6,23603,MT,Individual,No,93-0245545,23603MT0160007,SmartHealth Balance Gold 1000,23603MT016,,MTN002,MTS001,MTF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-montana-individual-plan-details/,www.pacificsource.com,23603MT0160007-03,Limited Cost Sharing Plan Variation,,0.781424105167389,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,"$1,000",$540,$220,$80,7
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,7,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180008,Balance Gold PSN HRA 3000 VH,23603MT018,,MTN001,MTS001,MTF004,Existing,PPO,Gold,Yes,Both,No,No,,,,No,Yes,"$1,000.00",Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.976137833948131,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180008-00,Standard Gold Off Exchange Plan,78.68%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,"$1,280",$150,"$3,000",$340,$180,$80,4
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,7,23603,MT,SHOP (Small Group),Yes,93-0245545,23603MT0210013,Dental Choice 0/20/50 25/2000 1000 Ortho,23603MT021,,MTN003,MTS001,,New,Indemnity,High,,Off the Exchange,,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,Allows Adult and Child-Only,,,,$39.61,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,,23603MT0210013-00,Standard High Off Exchange Plan,83.19%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,7,23603,MT,SHOP (Small Group),Yes,93-0245545,23603MT0210016,Dental Choice 0/20/50 50/2000 1000 Ortho,23603MT021,,MTN003,MTS001,,New,Indemnity,High,,Off the Exchange,,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,Allows Adult and Child-Only,,,,$39.61,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,,23603MT0210016-00,Standard High Off Exchange Plan,83.19%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,7,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180008,Balance Gold PSN HRA 3000 VH,23603MT018,,MTN001,MTS001,MTF004,Existing,PPO,Gold,Yes,Both,No,No,,,,No,Yes,"$1,000.00",Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.976137833948131,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180008-01,Standard Gold On Exchange Plan,78.68%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,"$1,280",$150,"$3,000",$340,$180,$80,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,7,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180025,SmartHealth Balance Gold HRA 3000 VH,23603MT018,,MTN002,MTS001,MTF004,Existing,PPO,Gold,No,Both,No,No,,,,No,Yes,"$1,000.00",Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.974577460868885,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180025-00,Standard Gold Off Exchange Plan,,0.786730170249939,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,"$1,280",$150,"$3,000",$340,$180,$80,6
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,7,23603,MT,SHOP (Small Group),No,93-0245545,23603MT0180025,SmartHealth Balance Gold HRA 3000 VH,23603MT018,,MTN002,MTS001,MTF004,Existing,PPO,Gold,No,Both,No,No,,,,No,Yes,"$1,000.00",Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.974577460868885,,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,PacificSource has SmartHealth contracts with providers in several service areas and states. Services received from these providers are paid at participating benefit levels. Services received from providers outside the SmartHealth network are paid at nonparticipating benefit levels unless sought for urgent or emergent situations or authorized in advance.,No,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,www.pacificsource.com,23603MT0180025-01,Standard Gold On Exchange Plan,,0.786730170249939,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,"$1,280",$150,"$3,000",$340,$180,$80,7
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,8,23603,MT,SHOP (Small Group),Yes,93-0245545,23603MT0220001,Kids Dental Choice 20/40/50,23603MT022,,MTN003,MTS001,,Existing,Indemnity,Low,,Off the Exchange,,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,Allows Child-Only,,,,$30.76,,Guaranteed Rate,,0,0,0,2014-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,,23603MT0220001-00,Standard Low Off Exchange Plan,68.18%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$700,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,8,23603,MT,SHOP (Small Group),Yes,93-0245545,23603MT0220002,Kids Dental Choice 0/20/50,23603MT022,,MTN003,MTS001,,Existing,Indemnity,High,,Both,,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,Allows Child-Only,,,,$38.69,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,,23603MT0220002-00,Standard High Off Exchange Plan,83.19%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$700,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,23603,SERFF,7,2014-12-11 11:35:20,8,23603,MT,SHOP (Small Group),Yes,93-0245545,23603MT0220002,Kids Dental Choice 0/20/50,23603MT022,,MTN003,MTS001,,Existing,Indemnity,High,,Both,,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,Allows Child-Only,,,,$38.69,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",Yes,http://www.pacificsource.com/2015-montana-small-group-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Employer/,http://www.pacificsource.com/2015-montana-small-group-plan-details/,,23603MT0220002-01,Standard High On Exchange Plan,83.19%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$700,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,1,24867,MT,Individual,No,39-0658730,24867MT0290001,Assurant Health Bronze Plan 001,24867MT029,,MTN001,MTS001,MTF003,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290001-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,1,24867,MT,Individual,No,39-0658730,24867MT0290001,Assurant Health Bronze Plan 001,24867MT029,,MTN001,MTS001,MTF003,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290001-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,1,24867,MT,Individual,No,39-0658730,24867MT0290001,Assurant Health Bronze Plan 001,24867MT029,,MTN001,MTS001,MTF003,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,10
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,1,24867,MT,Individual,No,39-0658730,24867MT0290001,Assurant Health Bronze Plan 001,24867MT029,,MTN001,MTS001,MTF003,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290001-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,1,24867,MT,Individual,No,39-0658730,24867MT0290002,Assurant Health Bronze Plan 001,24867MT029,,MTN001,MTS002,MTF009,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290002-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,1,24867,MT,Individual,No,39-0658730,24867MT0290002,Assurant Health Bronze Plan 001,24867MT029,,MTN001,MTS002,MTF009,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290002-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,1,24867,MT,Individual,No,39-0658730,24867MT0290002,Assurant Health Bronze Plan 001,24867MT029,,MTN001,MTS002,MTF009,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,14
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,1,24867,MT,Individual,No,39-0658730,24867MT0290003,Assurant Health Silver Plan 001,24867MT029,,MTN001,MTS001,MTF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290003-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,1,24867,MT,Individual,No,39-0658730,24867MT0290004,Assurant Health Silver Plan 001,24867MT029,,MTN001,MTS002,MTF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290004-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,1,24867,MT,Individual,No,39-0658730,24867MT0290004,Assurant Health Silver Plan 001,24867MT029,,MTN001,MTS002,MTF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290004-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,1,24867,MT,Individual,No,39-0658730,24867MT0290004,Assurant Health Silver Plan 001,24867MT029,,MTN001,MTS002,MTF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290004-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,2,24867,MT,Individual,No,39-0658730,24867MT0290005,Assurant Health Bronze Plan 002,24867MT029,,MTN001,MTS001,MTF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290005-00,Standard Bronze Off Exchange Plan,61.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,2,24867,MT,Individual,No,39-0658730,24867MT0290006,Assurant Health Bronze Plan 002,24867MT029,,MTN001,MTS002,MTF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290006-01,Standard Bronze On Exchange Plan,61.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,5,32225,MT,Individual,No,45-1295465,32225MT0010004,Access Care Bronze Plus,32225MT001,,MTN002,MTS001,MTF012,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Bronze-Plus-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0010004-00,Standard Bronze Off Exchange Plan,,0.589613795280457,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900",50%,,,,"$7,900","$15,800",Not Applicable,Not Applicable,"$3,950",$0,"$1,090",$150,"$3,210",$0,$0,$80,4
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,5,32225,MT,SHOP (Small Group),No,45-1295465,32225MT0040004,Access Care Bronze Plus,32225MT004,,MTN002,MTS001,MTF012,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Care-Grp-BRZ-PLUS-SBC.pdf,https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs,http://www.mhc.coop/wp-content/uploads/docs/MHC-Small-Group-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0040004-00,Standard Bronze Off Exchange Plan,,0.589613795280457,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900",50%,,,,"$7,900","$15,800",Not Applicable,Not Applicable,"$3,950",$0,"$1,090",$150,"$3,210",$0,$0,$80,4
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,5,32225,MT,SHOP (Small Group),No,45-1295465,32225MT0040004,Access Care Bronze Plus,32225MT004,,MTN002,MTS001,MTF012,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Care-Grp-BRZ-PLUS-SBC.pdf,https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs,http://www.mhc.coop/wp-content/uploads/docs/MHC-Small-Group-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0040004-01,Standard Bronze On Exchange Plan,,0.589613795280457,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900",50%,,,,"$7,900","$15,800",Not Applicable,Not Applicable,"$3,950",$0,"$1,090",$150,"$3,210",$0,$0,$80,5
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,5,32225,MT,Individual,No,45-1295465,32225MT0010004,Access Care Bronze Plus,32225MT001,,MTN002,MTS001,MTF012,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Bronze-Plus-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0010004-01,Standard Bronze On Exchange Plan,,0.589613795280457,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900",50%,,,,"$7,900","$15,800",Not Applicable,Not Applicable,"$3,950",$0,"$1,090",$150,"$3,210",$0,$0,$80,5
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,SHOP (Small Group),No,36-1236610,30751MT0560014,Blue Preferred Silver PPO? 014,30751MT056,,MTN001,MTS001,MTF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0560014-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,SHOP (Small Group),No,36-1236610,30751MT0560014,Blue Preferred Silver PPO? 014,30751MT056,,MTN001,MTS001,MTF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0560014-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,3,32225,MT,Individual,No,45-1295465,32225MT0010002,Access Care Silver,32225MT001,,MTN002,MTS001,MTF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Silver-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0010002-01,Standard Silver On Exchange Plan,,0.694546818733215,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",40%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,"$1,750",$60,"$2,030",$150,"$1,660",$510,$0,$80,5
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,3,32225,MT,Individual,No,45-1295465,32225MT0010002,Access Care Silver,32225MT001,,MTN002,MTS001,MTF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Silver-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0010002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,3,32225,MT,Individual,No,45-1295465,32225MT0010002,Access Care Silver,32225MT001,,MTN002,MTS001,MTF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Silver-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0010002-03,Limited Cost Sharing Plan Variation,,0.694546818733215,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",40%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,"$1,750",$60,"$2,030",$150,"$1,660",$510,$0,$80,7
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,3,32225,MT,Individual,No,45-1295465,32225MT0010002,Access Care Silver,32225MT001,,MTN002,MTS001,MTF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Silver-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0010002-04,73% AV Level Silver Plan,,0.725025534629822,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$6,500","$13,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,450","$2,900",40%,,,,"$2,900","$5,800",Not Applicable,Not Applicable,"$1,450",$60,"$2,030",$150,"$1,450",$600,$210,$80,8
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,5,32225,MT,Individual,No,45-1295465,32225MT0010004,Access Care Bronze Plus,32225MT001,,MTN002,MTS001,MTF012,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Bronze-Plus-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0010004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,5,32225,MT,Individual,No,45-1295465,32225MT0010004,Access Care Bronze Plus,32225MT001,,MTN002,MTS001,MTF012,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Bronze-Plus-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0010004-03,Limited Cost Sharing Plan Variation,,0.589613795280457,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900",50%,,,,"$7,900","$15,800",Not Applicable,Not Applicable,"$3,950",$0,"$1,090",$150,"$3,210",$0,$0,$80,7
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,2,24867,MT,Individual,No,39-0658730,24867MT0290006,Assurant Health Bronze Plan 002,24867MT029,,MTN001,MTS002,MTF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,14
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,2,24867,MT,Individual,No,39-0658730,24867MT0290006,Assurant Health Bronze Plan 002,24867MT029,,MTN001,MTS002,MTF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290006-03,Limited Cost Sharing Plan Variation,61.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,3,24867,MT,Individual,No,39-0658730,24867MT0290009,Assurant Health Gold Plan 002,24867MT029,,MTN001,MTS001,MTF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290009-01,Standard Gold On Exchange Plan,,0.81914895772934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,3,24867,MT,Individual,No,39-0658730,24867MT0290009,Assurant Health Gold Plan 002,24867MT029,,MTN001,MTS001,MTF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,10
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,3,24867,MT,Individual,No,39-0658730,24867MT0290009,Assurant Health Gold Plan 002,24867MT029,,MTN001,MTS001,MTF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290009-03,Limited Cost Sharing Plan Variation,,0.81914895772934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,3,24867,MT,Individual,No,39-0658730,24867MT0290010,Assurant Health Gold Plan 002,24867MT029,,MTN001,MTS002,MTF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290010-00,Standard Gold Off Exchange Plan,,0.81914895772934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,3,24867,MT,Individual,No,39-0658730,24867MT0290010,Assurant Health Gold Plan 002,24867MT029,,MTN001,MTS002,MTF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290010-01,Standard Gold On Exchange Plan,,0.81914895772934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,3,24867,MT,Individual,No,39-0658730,24867MT0290010,Assurant Health Gold Plan 002,24867MT029,,MTN001,MTS002,MTF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,14
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,3,24867,MT,Individual,No,39-0658730,24867MT0290010,Assurant Health Gold Plan 002,24867MT029,,MTN001,MTS002,MTF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290010-03,Limited Cost Sharing Plan Variation,,0.81914895772934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,3,24867,MT,Individual,No,39-0658730,24867MT0290011,Assurant Health Platinum Plan 002,24867MT029,,MTN001,MTS001,MTF006,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290011-00,Standard Platinum Off Exchange Plan,,0.886753857135773,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,3,24867,MT,Individual,No,39-0658730,24867MT0290011,Assurant Health Platinum Plan 002,24867MT029,,MTN001,MTS001,MTF006,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290011-03,Limited Cost Sharing Plan Variation,,0.886753857135773,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,3,24867,MT,Individual,No,39-0658730,24867MT0290012,Assurant Health Platinum Plan 002,24867MT029,,MTN001,MTS002,MTF006,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290012-00,Standard Platinum Off Exchange Plan,,0.886753857135773,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,3,24867,MT,Individual,No,39-0658730,24867MT0290012,Assurant Health Platinum Plan 002,24867MT029,,MTN001,MTS002,MTF006,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290012-01,Standard Platinum On Exchange Plan,,0.886753857135773,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,3,24867,MT,Individual,No,39-0658730,24867MT0290012,Assurant Health Platinum Plan 002,24867MT029,,MTN001,MTS002,MTF006,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,26
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,3,24867,MT,Individual,No,39-0658730,24867MT0290012,Assurant Health Platinum Plan 002,24867MT029,,MTN001,MTS002,MTF006,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,24867MT0290012-03,Limited Cost Sharing Plan Variation,,0.886753857135773,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,4,24867,MT,Individual,No,39-0658730,24867MT0290007,Assurant Health Silver Plan 002,24867MT029,,MTN001,MTS001,MTF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3i.pdf,24867MT0290007-00,Standard Silver Off Exchange Plan,70.11%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,4,24867,MT,Individual,No,39-0658730,24867MT0290007,Assurant Health Silver Plan 002,24867MT029,,MTN001,MTS001,MTF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3i.pdf,24867MT0290007-01,Standard Silver On Exchange Plan,70.11%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,4,24867,MT,Individual,No,39-0658730,24867MT0290007,Assurant Health Silver Plan 002,24867MT029,,MTN001,MTS001,MTF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3i.pdf,24867MT0290007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,10
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,4,24867,MT,Individual,No,39-0658730,24867MT0290007,Assurant Health Silver Plan 002,24867MT029,,MTN001,MTS001,MTF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3i.pdf,24867MT0290007-03,Limited Cost Sharing Plan Variation,70.11%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,4,24867,MT,Individual,No,39-0658730,24867MT0290007,Assurant Health Silver Plan 002,24867MT029,,MTN001,MTS001,MTF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3i.pdf,24867MT0290007-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,4,24867,MT,Individual,No,39-0658730,24867MT0290007,Assurant Health Silver Plan 002,24867MT029,,MTN001,MTS001,MTF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3i.pdf,24867MT0290007-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,4,24867,MT,Individual,No,39-0658730,24867MT0290007,Assurant Health Silver Plan 002,24867MT029,,MTN001,MTS001,MTF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3i.pdf,24867MT0290007-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,4,24867,MT,Individual,No,39-0658730,24867MT0290008,Assurant Health Silver Plan 002,24867MT029,,MTN001,MTS002,MTF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3i.pdf,24867MT0290008-00,Standard Silver Off Exchange Plan,70.11%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,4,24867,MT,Individual,No,39-0658730,24867MT0290008,Assurant Health Silver Plan 002,24867MT029,,MTN001,MTS002,MTF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3i.pdf,24867MT0290008-01,Standard Silver On Exchange Plan,70.11%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,4,24867,MT,Individual,No,39-0658730,24867MT0290008,Assurant Health Silver Plan 002,24867MT029,,MTN001,MTS002,MTF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3i.pdf,24867MT0290008-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,17
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,4,24867,MT,Individual,No,39-0658730,24867MT0290008,Assurant Health Silver Plan 002,24867MT029,,MTN001,MTS002,MTF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3i.pdf,24867MT0290008-03,Limited Cost Sharing Plan Variation,70.11%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,4,24867,MT,Individual,No,39-0658730,24867MT0290008,Assurant Health Silver Plan 002,24867MT029,,MTN001,MTS002,MTF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3i.pdf,24867MT0290008-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,4,24867,MT,Individual,No,39-0658730,24867MT0290008,Assurant Health Silver Plan 002,24867MT029,,MTN001,MTS002,MTF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3i.pdf,24867MT0290008-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,MT,24867,SERFF,8,2014-11-04 20:29:03,4,24867,MT,Individual,No,39-0658730,24867MT0290008,Assurant Health Silver Plan 002,24867MT029,,MTN001,MTS002,MTF010,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_MT_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-MT.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3i.pdf,24867MT0290008-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,No,36-1236610,30751MT0550001,Blue Preferred Gold PPO? 001,30751MT055,,MTN001,MTS001,MTF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550001-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$6,500","$13,000",Not Applicable,Not Applicable,"$3,250","$6,500",0%,,,,"$6,500","$13,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,SHOP (Small Group),No,36-1236610,30751MT0560005,Blue Preferred Gold PPO? 005,30751MT056,,MTN001,MTS001,MTF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0560005-00,Standard Gold Off Exchange Plan,,0.790639460086823,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$6,500","$13,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,Yes,36-1236610,30751MT0580001,BlueCare Dental? 1A,30751MT058,,MTN002,MTS002,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$42.92,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx,,30751MT0580001-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,No,36-1236610,30751MT0550001,Blue Preferred Gold PPO? 001,30751MT055,,MTN001,MTS001,MTF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,SHOP (Small Group),No,36-1236610,30751MT0560006,Blue Preferred Gold PPO? 006,30751MT056,,MTN001,MTS001,MTF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0560006-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,SHOP (Small Group),Yes,36-1236610,30751MT0590006,BlueCare Dental? 1D,30751MT059,,MTN002,MTS002,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.72,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx,,https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx,,30751MT0590006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,No,36-1236610,30751MT0550001,Blue Preferred Gold PPO? 001,30751MT055,,MTN001,MTS001,MTF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550001-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$6,500","$13,000",Not Applicable,Not Applicable,"$3,250","$6,500",0%,,,,"$6,500","$13,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,No,36-1236610,30751MT0550002,Blue Preferred Gold PPO? 002,30751MT055,,MTN001,MTS001,MTF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550002-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,2,30751,MT,Individual,No,36-1236610,30751MT0550005,Blue Preferred Bronze PPO? 005,30751MT055,,MTN001,MTS001,MTF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550005-01,Standard Bronze On Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,3,32225,MT,Individual,No,45-1295465,32225MT0010002,Access Care Silver,32225MT001,,MTN002,MTS001,MTF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Silver-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0010002-05,87% AV Level Silver Plan,,0.871614336967468,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,950","$3,900",,,"$3,900","$7,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$20,"$1,010",$150,$500,$260,$260,$80,9
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,3,32225,MT,Individual,No,45-1295465,32225MT0010002,Access Care Silver,32225MT001,,MTN002,MTS001,MTF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Silver-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0010002-06,94% AV Level Silver Plan,,0.939218640327454,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,$0,$0,Not Applicable,Not Applicable,$0,$20,$520,$150,$0,$300,$140,$80,10
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,4,32225,MT,Individual,No,45-1295465,32225MT0010003,Access Care Bronze,32225MT001,,MTN002,MTS001,MTF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Bronze-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0010003-00,Standard Bronze Off Exchange Plan,,0.589613795280457,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900",50%,,,,"$7,900","$12,000",Not Applicable,Not Applicable,"$3,950",$0,"$1,090",$150,"$3,210",$0,$0,$80,4
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,4,32225,MT,SHOP (Small Group),No,45-1295465,32225MT0040003,Access Care Bronze,32225MT004,,MTN002,MTS001,MTF004,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Care-Grp-BRZ-SBC.pdf,https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs,http://www.mhc.coop/wp-content/uploads/docs/MHC-Small-Group-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0040003-00,Standard Bronze Off Exchange Plan,,0.589613795280457,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900",50%,,,,"$7,900","$12,000",Not Applicable,Not Applicable,"$3,950",$0,"$1,090",$150,"$3,210",$0,$0,$80,4
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,4,32225,MT,SHOP (Small Group),No,45-1295465,32225MT0040003,Access Care Bronze,32225MT004,,MTN002,MTS001,MTF004,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Care-Grp-BRZ-SBC.pdf,https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs,http://www.mhc.coop/wp-content/uploads/docs/MHC-Small-Group-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0040003-01,Standard Bronze On Exchange Plan,,0.589613795280457,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900",50%,,,,"$7,900","$12,000",Not Applicable,Not Applicable,"$3,950",$0,"$1,090",$150,"$3,210",$0,$0,$80,5
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,4,32225,MT,Individual,No,45-1295465,32225MT0010003,Access Care Bronze,32225MT001,,MTN002,MTS001,MTF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Bronze-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0010003-01,Standard Bronze On Exchange Plan,,0.589613795280457,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900",50%,,,,"$7,900","$12,000",Not Applicable,Not Applicable,"$3,950",$0,"$1,090",$150,"$3,210",$0,$0,$80,5
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,4,32225,MT,Individual,No,45-1295465,32225MT0010003,Access Care Bronze,32225MT001,,MTN002,MTS001,MTF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Bronze-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0010003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,4,32225,MT,Individual,No,45-1295465,32225MT0010003,Access Care Bronze,32225MT001,,MTN002,MTS001,MTF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Bronze-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0010003-03,Limited Cost Sharing Plan Variation,,0.589613795280457,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900",50%,,,,"$7,900","$12,000",Not Applicable,Not Applicable,"$3,950",$0,"$1,090",$150,"$3,210",$0,$0,$80,7
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,6,32225,MT,Individual,No,45-1295465,32225MT0020001,Connected Care Platinum,32225MT002,,MTN001,MTS002,MTF005,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Platinum-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020001-00,Standard Platinum Off Exchange Plan,,0.899816393852234,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$2,400","$4,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$350,$700,10%,,,,$700,"$1,400",Not Applicable,Not Applicable,$350,$30,$510,$150,$350,$340,$130,$80,4
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,6,32225,MT,SHOP (Small Group),No,45-1295465,32225MT0050001,Connected Care Platinum,32225MT005,,MTN001,MTS002,MTF005,Existing,POS,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Care-Grp-PLT-SBC.pdf,https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs,http://www.mhc.coop/wp-content/uploads/docs/MHC-Small-Group-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0050001-00,Standard Platinum Off Exchange Plan,,0.899816393852234,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$2,400","$4,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$350,$700,10%,,,,$700,"$1,400",Not Applicable,Not Applicable,$350,$30,$510,$150,$350,$340,$130,$80,4
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,6,32225,MT,SHOP (Small Group),No,45-1295465,32225MT0050001,Connected Care Platinum,32225MT005,,MTN001,MTS002,MTF005,Existing,POS,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Care-Grp-PLT-SBC.pdf,https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs,http://www.mhc.coop/wp-content/uploads/docs/MHC-Small-Group-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0050001-01,Standard Platinum On Exchange Plan,,0.899816393852234,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$2,400","$4,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$350,$700,10%,,,,$700,"$1,400",Not Applicable,Not Applicable,$350,$30,$510,$150,$350,$340,$130,$80,5
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,6,32225,MT,Individual,No,45-1295465,32225MT0020001,Connected Care Platinum,32225MT002,,MTN001,MTS002,MTF005,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Platinum-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020001-01,Standard Platinum On Exchange Plan,,0.899816393852234,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$2,400","$4,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$350,$700,10%,,,,$700,"$1,400",Not Applicable,Not Applicable,$350,$30,$510,$150,$350,$340,$130,$80,5
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,6,32225,MT,Individual,No,45-1295465,32225MT0020001,Connected Care Platinum,32225MT002,,MTN001,MTS002,MTF005,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Platinum-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,6,32225,MT,Individual,No,45-1295465,32225MT0020001,Connected Care Platinum,32225MT002,,MTN001,MTS002,MTF005,Existing,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Platinum-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020001-03,Limited Cost Sharing Plan Variation,,0.899816393852234,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$2,400","$4,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$350,$700,10%,,,,$700,"$1,400",Not Applicable,Not Applicable,$350,$30,$510,$150,$350,$340,$130,$80,7
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,7,32225,MT,Individual,No,45-1295465,32225MT0020002,Connected Care Gold,32225MT002,,MTN001,MTS002,MTF006,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Gold-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020002-00,Standard Gold Off Exchange Plan,,0.782687783241272,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",30%,,,,"$1,400","$2,800",Not Applicable,Not Applicable,$700,$40,"$1,520",$150,$700,$530,$390,$80,4
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,7,32225,MT,SHOP (Small Group),No,45-1295465,32225MT0050002,Connected Care Gold,32225MT005,,MTN001,MTS002,MTF006,Existing,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Care-Grp-GLD-SBC.pdf,https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs,http://www.mhc.coop/wp-content/uploads/docs/MHC-Small-Group-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0050002-00,Standard Gold Off Exchange Plan,,0.782687783241272,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",30%,,,,"$1,400","$2,800",Not Applicable,Not Applicable,$700,$40,"$1,520",$150,$700,$530,$390,$80,4
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,3,30751,MT,Individual,No,36-1236610,30751MT0550006,Blue Preferred Bronze PPO? 006,30751MT055,,MTN001,MTS001,MTF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550006-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,3,30751,MT,Individual,No,36-1236610,30751MT0550006,Blue Preferred Bronze PPO? 006,30751MT055,,MTN001,MTS001,MTF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MT,62818,SERFF,2,2014-09-09 16:12:42,2,62818,MT,SHOP (Small Group),Yes,13-5123390,62818MT0060002,Guardian Family Essentials,62818MT006,,MTN001,MTS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.52,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,62818MT0060002-00,Standard Low Off Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MT,62818,SERFF,2,2014-09-09 16:12:42,2,62818,MT,SHOP (Small Group),Yes,13-5123390,62818MT0060002,Guardian Family Essentials,62818MT006,,MTN001,MTS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.52,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,62818MT0060002-01,Standard Low On Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MT,70415,SERFF,2,2014-09-09 16:12:42,1,70415,MT,SHOP (Small Group),Yes,47-0098400,70415MT0030002,EHB High Passive,70415MT003,,MTN001,MTS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$45.64,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,70415MT0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,13,15438,NE,Individual,No,42-1308659,15438NE0180005,Coventry Bronze Deductible Only HSA Eligible,15438NE018,,NEN007,NES007,NEF019,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51230,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180005-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,16,15438,NE,Individual,No,42-1308659,15438NE0170005,Coventry Bronze Deductible Only HSA Eligible Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF014,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73230,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170005-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,16,15438,NE,Individual,No,42-1308659,15438NE0170005,Coventry Bronze Deductible Only HSA Eligible Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF014,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73230,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170005-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,16,15438,NE,Individual,No,42-1308659,15438NE0170005,Coventry Bronze Deductible Only HSA Eligible Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF014,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73230,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170005-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,No,36-1236610,30751MT0550002,Blue Preferred Gold PPO? 002,30751MT055,,MTN001,MTS001,MTF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550002-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,No,36-1236610,30751MT0550002,Blue Preferred Gold PPO? 002,30751MT055,,MTN001,MTS001,MTF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,SHOP (Small Group),No,36-1236610,30751MT0560020,Blue Preferred Silver PPO? 020,30751MT056,,MTN001,MTS001,MTF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0560020-00,Standard Silver Off Exchange Plan,,0.71602863073349,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,SHOP (Small Group),No,36-1236610,30751MT0560020,Blue Preferred Silver PPO? 020,30751MT056,,MTN001,MTS001,MTF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0560020-01,Standard Silver On Exchange Plan,,0.71602863073349,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,No,36-1236610,30751MT0550002,Blue Preferred Gold PPO? 002,30751MT055,,MTN001,MTS001,MTF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550002-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,No,36-1236610,30751MT0550003,Blue Preferred Silver PPO? 003,30751MT055,,MTN001,MTS001,MTF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550003-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,No,36-1236610,30751MT0550003,Blue Preferred Silver PPO? 003,30751MT055,,MTN001,MTS001,MTF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550003-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,No,36-1236610,30751MT0550003,Blue Preferred Silver PPO? 003,30751MT055,,MTN001,MTS001,MTF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,No,36-1236610,30751MT0550003,Blue Preferred Silver PPO? 003,30751MT055,,MTN001,MTS001,MTF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550003-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,No,36-1236610,30751MT0550003,Blue Preferred Silver PPO? 003,30751MT055,,MTN001,MTS001,MTF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550003-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,No,36-1236610,30751MT0550003,Blue Preferred Silver PPO? 003,30751MT055,,MTN001,MTS001,MTF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550003-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,No,36-1236610,30751MT0550003,Blue Preferred Silver PPO? 003,30751MT055,,MTN001,MTS001,MTF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550003-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,No,36-1236610,30751MT0550004,Blue Preferred Silver PPO? 004,30751MT055,,MTN001,MTS001,MTF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550004-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,No,36-1236610,30751MT0550004,Blue Preferred Silver PPO? 004,30751MT055,,MTN001,MTS001,MTF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550004-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,12,32225,MT,SHOP (Small Group),No,45-1295465,32225MT0050005,Connected Care Gold Plus,32225MT005,,MTN001,MTS002,MTF011,New,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Care-Grp-GLD-PLUS-SBC.pdf,https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs,http://www.mhc.coop/wp-content/uploads/docs/MHC-Small-Group-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0050005-01,Standard Gold On Exchange Plan,,0.780541837215424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$4,200","$8,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400",Not Applicable,Not Applicable,"$2,100",$0,$0,$150,"$2,100",$0,$0,$80,5
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,12,32225,MT,Individual,No,45-1295465,32225MT0020005,Connected Care Gold Plus,32225MT002,,MTN001,MTS002,MTF011,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Gold-Plus-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020005-01,Standard Gold On Exchange Plan,,0.780541837215424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$4,200","$8,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400",Not Applicable,Not Applicable,"$2,100",$0,$0,$150,"$2,100",$0,$0,$80,5
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,12,32225,MT,Individual,No,45-1295465,32225MT0020005,Connected Care Gold Plus,32225MT002,,MTN001,MTS002,MTF011,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Gold-Plus-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,12,32225,MT,Individual,No,45-1295465,32225MT0020005,Connected Care Gold Plus,32225MT002,,MTN001,MTS002,MTF011,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Gold-Plus-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020005-03,Limited Cost Sharing Plan Variation,,0.780541837215424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$4,200","$8,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400",Not Applicable,Not Applicable,"$2,100",$0,$0,$150,"$2,100",$0,$0,$80,7
2015,MT,46668,SERFF,2,2014-09-09 16:12:42,1,46668,MT,Individual,Yes,47-0397286,46668MT0070001,"Renaissance Individual Dental Indemnity, EHB Certified",46668MT007,,MTN001,MTS001,,Existing,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.86,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,46668MT0070001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,46668,SERFF,2,2014-09-09 16:12:42,1,46668,MT,SHOP (Small Group),Yes,47-0397286,46668MT0060001,"Renaissance Group Dental Indemnity, EHB Certified",46668MT006,,MTN001,MTS001,,Existing,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.21,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,46668MT0060001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,46668,SERFF,2,2014-09-09 16:12:42,1,46668,MT,SHOP (Small Group),Yes,47-0397286,46668MT0060002,"Renaissance Group Dental Indemnity, EHB Certified",46668MT006,,MTN001,MTS001,,Existing,Indemnity,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.99,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,46668MT0060002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,46668,SERFF,2,2014-09-09 16:12:42,1,46668,MT,Individual,Yes,47-0397286,46668MT0070002,"Renaissance Individual Dental Indemnity, EHB Certified",46668MT007,,MTN001,MTS001,,Existing,Indemnity,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.12,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,46668MT0070002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,59110,SERFF,2,2014-09-09 16:12:42,1,59110,MT,SHOP (Small Group),Yes,57-0523959,59110MT0010001,Group Pediatric EHB,59110MT001,,MTN001,MTS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$40.88,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximums,Yes,Traditional with inside maximums,No,,,,,59110MT0010001-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,59110,SERFF,2,2014-09-09 16:12:42,1,59110,MT,SHOP (Small Group),Yes,57-0523959,59110MT0010002,Group Pediatric EHB,59110MT001,,MTN001,MTS001,,New,Indemnity,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$33.33,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximums,Yes,Traditional with inside maximums,No,,,,,59110MT0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,59968,SERFF,2,2014-09-09 16:12:42,1,59968,MT,SHOP (Small Group),Yes,36-0883760,59968MT0030002,EHB High Passive,59968MT003,,MTN001,MTS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$46.28,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,59968MT0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,59968,SERFF,2,2014-09-09 16:12:42,1,59968,MT,SHOP (Small Group),Yes,36-0883760,59968MT0030001,EHB Low Passive,59968MT003,,MTN001,MTS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.47,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,59968MT0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,62818,SERFF,2,2014-09-09 16:12:42,1,62818,MT,SHOP (Small Group),Yes,13-5123390,62818MT0010002,Guardian Pediatric Advantage,62818MT001,,MTN001,MTS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$44.13,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,62818MT0010002-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,8,15438,NE,Individual,No,42-1308659,15438NE0160003,Coventry Bronze $20 Copay MIPPA,15438NE016,,NEN003,NES003,NEF008,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51171,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,8,15438,NE,Individual,No,42-1308659,15438NE0160003,Coventry Bronze $20 Copay MIPPA,15438NE016,,NEN003,NES003,NEF008,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51171,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160003-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,No,36-1236610,30751MT0550004,Blue Preferred Silver PPO? 004,30751MT055,,MTN001,MTS001,MTF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,No,36-1236610,30751MT0550004,Blue Preferred Silver PPO? 004,30751MT055,,MTN001,MTS001,MTF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550004-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,1,30751,MT,Individual,No,36-1236610,30751MT0550004,Blue Preferred Silver PPO? 004,30751MT055,,MTN001,MTS001,MTF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550004-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,"$1,000",0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,2,30751,MT,Individual,No,36-1236610,30751MT0550005,Blue Preferred Bronze PPO? 005,30751MT055,,MTN001,MTS001,MTF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550005-00,Standard Bronze Off Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,2,30751,MT,SHOP (Small Group),No,36-1236610,30751MT0560018,Blue Preferred Bronze PPO? 018,30751MT056,,MTN001,MTS001,MTF003,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0560018-00,Standard Bronze Off Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,2,30751,MT,SHOP (Small Group),Yes,36-1236610,30751MT0590003,BlueCare Dental 4 Kids? 1A,30751MT059,,MTN002,MTS002,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.14,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx,,https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx,,30751MT0590003-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,2,30751,MT,Individual,Yes,36-1236610,30751MT0580003,BlueCare Dental 4 Kids? 1A,30751MT058,,MTN002,MTS002,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$42.92,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx,,30751MT0580003-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,2,30751,MT,Individual,Yes,36-1236610,30751MT0580003,BlueCare Dental 4 Kids? 1A,30751MT058,,MTN002,MTS002,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$42.92,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx,,30751MT0580003-01,Standard High On Exchange Plan,86.90%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,2,30751,MT,SHOP (Small Group),No,36-1236610,30751MT0560018,Blue Preferred Bronze PPO? 018,30751MT056,,MTN001,MTS001,MTF003,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0560018-01,Standard Bronze On Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,2,30751,MT,Individual,No,36-1236610,30751MT0550005,Blue Preferred Bronze PPO? 005,30751MT055,,MTN001,MTS001,MTF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,2,30751,MT,Individual,No,36-1236610,30751MT0550005,Blue Preferred Bronze PPO? 005,30751MT055,,MTN001,MTS001,MTF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550005-03,Limited Cost Sharing Plan Variation,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,3,30751,MT,Individual,No,36-1236610,30751MT0550006,Blue Preferred Bronze PPO? 006,30751MT055,,MTN001,MTS001,MTF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550006-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,3,30751,MT,SHOP (Small Group),No,36-1236610,30751MT0560019,Blue Preferred Bronze PPO? 019,30751MT056,,MTN001,MTS001,MTF003,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0560019-00,Standard Bronze Off Exchange Plan,,0.581020891666412,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",20%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,3,30751,MT,Individual,Yes,36-1236610,30751MT0580002,BlueCare Dental? 1B,30751MT058,,MTN002,MTS002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.40,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx,,30751MT0580002-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,3,30751,MT,SHOP (Small Group),Yes,36-1236610,30751MT0590005,BlueCare Dental? 1C,30751MT059,,MTN002,MTS002,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.37,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx,,https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx,,30751MT0590005-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,3,30751,MT,Individual,Yes,36-1236610,30751MT0580002,BlueCare Dental? 1B,30751MT058,,MTN002,MTS002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.40,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx,,30751MT0580002-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,3,30751,MT,SHOP (Small Group),Yes,36-1236610,30751MT0590007,BlueCare Dental? 1E,30751MT059,,MTN002,MTS002,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.88,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx,,https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx,,30751MT0590007-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,3,30751,MT,SHOP (Small Group),No,36-1236610,30751MT0560019,Blue Preferred Bronze PPO? 019,30751MT056,,MTN001,MTS001,MTF003,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,,https://www.bcbsmt.com/pages/employer_products_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0560019-01,Standard Bronze On Exchange Plan,,0.581020891666412,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",20%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,3,30751,MT,Individual,No,36-1236610,30751MT0550006,Blue Preferred Bronze PPO? 006,30751MT055,,MTN001,MTS001,MTF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550006-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,3,30751,MT,Individual,No,36-1236610,30751MT0550007,Blue Preferred Security PPO? 007,30751MT055,,MTN001,MTS001,MTF003,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550007-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,8
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,3,30751,MT,Individual,No,36-1236610,30751MT0550007,Blue Preferred Security PPO? 007,30751MT055,,MTN001,MTS001,MTF003,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_MT_HealthInsMarketplace5TierStandardDrugList.pdf,30751MT0550007-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,4,30751,MT,Individual,Yes,36-1236610,30751MT0580004,BlueCare Dental 4 Kids? 1B,30751MT058,,MTN002,MTS002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$33.40,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx,,30751MT0580004-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,4,30751,MT,SHOP (Small Group),Yes,36-1236610,30751MT0590001,BlueCare Dental? 1A,30751MT059,,MTN002,MTS002,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.14,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx,,https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx,,30751MT0590001-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,4,30751,MT,Individual,Yes,36-1236610,30751MT0580004,BlueCare Dental 4 Kids? 1B,30751MT058,,MTN002,MTS002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$33.40,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx,https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred,https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx,,30751MT0580004-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,30751,SERFF,12,2015-02-19 12:05:50,5,30751,MT,SHOP (Small Group),Yes,36-1236610,30751MT0590004,BlueCare Dental 4 Kids? 1B,30751MT059,,MTN002,MTS002,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.79,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx,,https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx,,30751MT0590004-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,1,32225,MT,Individual,No,45-1295465,32225MT0030001,Access Care Catastrophic,32225MT003,,MTN002,MTS001,MTF001,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Catastrophic-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0030001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,4
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,1,32225,MT,SHOP (Small Group),No,45-1295465,32225MT0040001,Access Care Gold,32225MT004,,MTN002,MTS001,MTF002,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Care-Grp-GLD-SBC.pdf,https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs,http://www.mhc.coop/wp-content/uploads/docs/MHC-Small-Group-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0040001-00,Standard Gold Off Exchange Plan,,0.783650755882263,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",30%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$750,$40,"$1,520",$150,$750,$510,$390,$80,4
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,1,32225,MT,SHOP (Small Group),No,45-1295465,32225MT0040001,Access Care Gold,32225MT004,,MTN002,MTS001,MTF002,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Care-Grp-GLD-SBC.pdf,https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs,http://www.mhc.coop/wp-content/uploads/docs/MHC-Small-Group-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0040001-01,Standard Gold On Exchange Plan,,0.783650755882263,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",30%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$750,$40,"$1,520",$150,$750,$510,$390,$80,5
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,1,32225,MT,Individual,No,45-1295465,32225MT0030001,Access Care Catastrophic,32225MT003,,MTN002,MTS001,MTF001,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Catastrophic-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0030001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,5
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,2,32225,MT,Individual,No,45-1295465,32225MT0010001,Access Care Gold,32225MT001,,MTN002,MTS001,MTF002,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Gold-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0010001-00,Standard Gold Off Exchange Plan,,0.783650755882263,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",30%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$750,$40,"$1,520",$150,$750,$510,$390,$80,4
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,2,32225,MT,Individual,No,45-1295465,32225MT0010001,Access Care Gold,32225MT001,,MTN002,MTS001,MTF002,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Gold-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0010001-01,Standard Gold On Exchange Plan,,0.783650755882263,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",30%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$750,$40,"$1,520",$150,$750,$510,$390,$80,5
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,2,32225,MT,Individual,No,45-1295465,32225MT0010001,Access Care Gold,32225MT001,,MTN002,MTS001,MTF002,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Gold-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0010001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,2,32225,MT,Individual,No,45-1295465,32225MT0010001,Access Care Gold,32225MT001,,MTN002,MTS001,MTF002,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Gold-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0010001-03,Limited Cost Sharing Plan Variation,,0.783650755882263,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",30%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$750,$40,"$1,520",$150,$750,$510,$390,$80,7
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,3,32225,MT,Individual,No,45-1295465,32225MT0010002,Access Care Silver,32225MT001,,MTN002,MTS001,MTF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Silver-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0010002-00,Standard Silver Off Exchange Plan,,0.694546818733215,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",40%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,"$1,750",$60,"$2,030",$150,"$1,660",$510,$0,$80,4
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,3,32225,MT,SHOP (Small Group),No,45-1295465,32225MT0040002,Access Care Silver,32225MT004,,MTN002,MTS001,MTF003,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Care-Grp-SIL-SBC.pdf,https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs,http://www.mhc.coop/wp-content/uploads/docs/MHC-Small-Group-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0040002-00,Standard Silver Off Exchange Plan,,0.694546818733215,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",40%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,"$1,750",$60,"$2,030",$150,"$1,660",$510,$0,$80,4
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,3,32225,MT,SHOP (Small Group),No,45-1295465,32225MT0040002,Access Care Silver,32225MT004,,MTN002,MTS001,MTF003,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Access-Care-Grp-SIL-SBC.pdf,https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs,http://www.mhc.coop/wp-content/uploads/docs/MHC-Small-Group-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0040002-01,Standard Silver On Exchange Plan,,0.694546818733215,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",40%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,"$1,750",$60,"$2,030",$150,"$1,660",$510,$0,$80,5
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,7,32225,MT,SHOP (Small Group),No,45-1295465,32225MT0050002,Connected Care Gold,32225MT005,,MTN001,MTS002,MTF006,Existing,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Care-Grp-GLD-SBC.pdf,https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs,http://www.mhc.coop/wp-content/uploads/docs/MHC-Small-Group-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0050002-01,Standard Gold On Exchange Plan,,0.782687783241272,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",30%,,,,"$1,400","$2,800",Not Applicable,Not Applicable,$700,$40,"$1,520",$150,$700,$530,$390,$80,5
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,7,32225,MT,Individual,No,45-1295465,32225MT0020002,Connected Care Gold,32225MT002,,MTN001,MTS002,MTF006,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Gold-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020002-01,Standard Gold On Exchange Plan,,0.782687783241272,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",30%,,,,"$1,400","$2,800",Not Applicable,Not Applicable,$700,$40,"$1,520",$150,$700,$530,$390,$80,5
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,7,32225,MT,Individual,No,45-1295465,32225MT0020002,Connected Care Gold,32225MT002,,MTN001,MTS002,MTF006,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Gold-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,7,32225,MT,Individual,No,45-1295465,32225MT0020002,Connected Care Gold,32225MT002,,MTN001,MTS002,MTF006,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Gold-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020002-03,Limited Cost Sharing Plan Variation,,0.782687783241272,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",30%,,,,"$1,400","$2,800",Not Applicable,Not Applicable,$700,$40,"$1,520",$150,$700,$530,$390,$80,7
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,8,32225,MT,Individual,No,45-1295465,32225MT0020003,Connected Care Silver,32225MT002,,MTN001,MTS002,MTF007,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Silver-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020003-00,Standard Silver Off Exchange Plan,,0.693370044231415,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",40%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,"$1,750",$60,"$2,030",$150,"$1,750",$510,$0,$80,4
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,8,32225,MT,SHOP (Small Group),No,45-1295465,32225MT0050003,Connected Care Silver,32225MT005,,MTN001,MTS002,MTF007,Existing,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Care-Grp-SIL-SBC.pdf,https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs,http://www.mhc.coop/wp-content/uploads/docs/MHC-Small-Group-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0050003-00,Standard Silver Off Exchange Plan,,0.693370044231415,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",40%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,"$1,750",$60,"$2,030",$150,"$1,750",$510,$0,$80,4
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,8,32225,MT,SHOP (Small Group),No,45-1295465,32225MT0050003,Connected Care Silver,32225MT005,,MTN001,MTS002,MTF007,Existing,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Care-Grp-SIL-SBC.pdf,https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs,http://www.mhc.coop/wp-content/uploads/docs/MHC-Small-Group-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0050003-01,Standard Silver On Exchange Plan,,0.693370044231415,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",40%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,"$1,750",$60,"$2,030",$150,"$1,750",$510,$0,$80,5
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,8,32225,MT,Individual,No,45-1295465,32225MT0020003,Connected Care Silver,32225MT002,,MTN001,MTS002,MTF007,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Silver-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020003-01,Standard Silver On Exchange Plan,,0.693370044231415,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",40%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,"$1,750",$60,"$2,030",$150,"$1,750",$510,$0,$80,5
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,8,32225,MT,Individual,No,45-1295465,32225MT0020003,Connected Care Silver,32225MT002,,MTN001,MTS002,MTF007,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Silver-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,8,32225,MT,Individual,No,45-1295465,32225MT0020003,Connected Care Silver,32225MT002,,MTN001,MTS002,MTF007,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Silver-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020003-03,Limited Cost Sharing Plan Variation,,0.693370044231415,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",40%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,"$1,750",$60,"$2,030",$150,"$1,750",$510,$0,$80,7
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,8,32225,MT,Individual,No,45-1295465,32225MT0020003,Connected Care Silver,32225MT002,,MTN001,MTS002,MTF007,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Silver-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020003-04,73% AV Level Silver Plan,,0.739711046218872,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$6,500","$13,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",40%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,"$1,750",$60,"$2,030",$150,"$1,750",$510,$0,$80,8
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,8,32225,MT,Individual,No,45-1295465,32225MT0020003,Connected Care Silver,32225MT002,,MTN001,MTS002,MTF007,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Silver-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020003-05,87% AV Level Silver Plan,,0.869129300117493,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$3,500","$7,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,30%,,,,$500,"$1,000",Not Applicable,Not Applicable,$250,$30,"$1,520",$150,$250,$540,$390,$80,9
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,8,32225,MT,Individual,No,45-1295465,32225MT0020003,Connected Care Silver,32225MT002,,MTN001,MTS002,MTF007,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Silver-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020003-06,94% AV Level Silver Plan,,0.932757973670959,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$800,"$1,600",,,"$1,600","$3,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$20,"$1,030",$150,$0,$300,$280,$80,10
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,9,32225,MT,Individual,No,45-1295465,32225MT0020004,Connected Care Bronze,32225MT002,,MTN001,MTS002,MTF008,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Bronze-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020004-00,Standard Bronze Off Exchange Plan,,0.615802347660065,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900",50%,,,,"$7,900","$12,000",Not Applicable,Not Applicable,"$3,950",$0,"$1,090",$150,"$3,210",$0,$0,$80,4
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,9,32225,MT,SHOP (Small Group),No,45-1295465,32225MT0050004,Connected Care Bronze,32225MT005,,MTN001,MTS002,MTF008,Existing,POS,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Care-Grp-BRZ-SBC.pdf,https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs,http://www.mhc.coop/wp-content/uploads/docs/MHC-Small-Group-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0050004-00,Standard Bronze Off Exchange Plan,,0.615802347660065,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900",50%,,,,"$7,900","$12,000",Not Applicable,Not Applicable,"$3,950",$0,"$1,090",$150,"$3,210",$0,$0,$80,4
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,9,32225,MT,SHOP (Small Group),No,45-1295465,32225MT0050004,Connected Care Bronze,32225MT005,,MTN001,MTS002,MTF008,Existing,POS,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Care-Grp-BRZ-SBC.pdf,https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs,http://www.mhc.coop/wp-content/uploads/docs/MHC-Small-Group-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0050004-01,Standard Bronze On Exchange Plan,,0.615802347660065,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900",50%,,,,"$7,900","$12,000",Not Applicable,Not Applicable,"$3,950",$0,"$1,090",$150,"$3,210",$0,$0,$80,5
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,9,32225,MT,Individual,No,45-1295465,32225MT0020004,Connected Care Bronze,32225MT002,,MTN001,MTS002,MTF008,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Bronze-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020004-01,Standard Bronze On Exchange Plan,,0.615802347660065,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900",50%,,,,"$7,900","$12,000",Not Applicable,Not Applicable,"$3,950",$0,"$1,090",$150,"$3,210",$0,$0,$80,5
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,9,32225,MT,Individual,No,45-1295465,32225MT0020004,Connected Care Bronze,32225MT002,,MTN001,MTS002,MTF008,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Bronze-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,9,32225,MT,Individual,No,45-1295465,32225MT0020004,Connected Care Bronze,32225MT002,,MTN001,MTS002,MTF008,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Bronze-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020004-03,Limited Cost Sharing Plan Variation,,0.615802347660065,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900",50%,,,,"$7,900","$12,000",Not Applicable,Not Applicable,"$3,950",$0,"$1,090",$150,"$3,210",$0,$0,$80,7
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,10,32225,MT,Individual,No,45-1295465,32225MT0020007,Connected Care Bronze Plus,32225MT002,,MTN001,MTS002,MTF009,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Bronze-Plus-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020007-00,Standard Bronze Off Exchange Plan,,0.589613795280457,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900",50%,,,,"$7,900","$15,800",Not Applicable,Not Applicable,"$3,950",$0,"$1,090",$150,"$3,210",$0,$0,$80,4
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,10,32225,MT,SHOP (Small Group),No,45-1295465,32225MT0050007,Connected Care Bronze Plus,32225MT005,,MTN001,MTS002,MTF009,New,POS,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Care-Grp-BRZ-PLUS-SBC.pdf,https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs,http://www.mhc.coop/wp-content/uploads/docs/MHC-Small-Group-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0050007-00,Standard Bronze Off Exchange Plan,,0.589613795280457,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900",50%,,,,"$7,900","$15,800",Not Applicable,Not Applicable,"$3,950",$0,"$1,090",$150,"$3,210",$0,$0,$80,4
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,10,32225,MT,SHOP (Small Group),No,45-1295465,32225MT0050007,Connected Care Bronze Plus,32225MT005,,MTN001,MTS002,MTF009,New,POS,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Care-Grp-BRZ-PLUS-SBC.pdf,https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs,http://www.mhc.coop/wp-content/uploads/docs/MHC-Small-Group-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0050007-01,Standard Bronze On Exchange Plan,,0.589613795280457,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900",50%,,,,"$7,900","$15,800",Not Applicable,Not Applicable,"$3,950",$0,"$1,090",$150,"$3,210",$0,$0,$80,5
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,10,32225,MT,Individual,No,45-1295465,32225MT0020007,Connected Care Bronze Plus,32225MT002,,MTN001,MTS002,MTF009,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Bronze-Plus-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020007-01,Standard Bronze On Exchange Plan,,0.589613795280457,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900",50%,,,,"$7,900","$15,800",Not Applicable,Not Applicable,"$3,950",$0,"$1,090",$150,"$3,210",$0,$0,$80,5
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,10,32225,MT,Individual,No,45-1295465,32225MT0020007,Connected Care Bronze Plus,32225MT002,,MTN001,MTS002,MTF009,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Bronze-Plus-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,10,32225,MT,Individual,No,45-1295465,32225MT0020007,Connected Care Bronze Plus,32225MT002,,MTN001,MTS002,MTF009,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Bronze-Plus-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020007-03,Limited Cost Sharing Plan Variation,,0.589613795280457,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900",50%,,,,"$7,900","$15,800",Not Applicable,Not Applicable,"$3,950",$0,"$1,090",$150,"$3,210",$0,$0,$80,7
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,11,32225,MT,Individual,No,45-1295465,32225MT0020006,Connected Care Silver Plus,32225MT002,,MTN001,MTS002,MTF010,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Silver-Plus-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020006-00,Standard Silver Off Exchange Plan,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,"$3,650",$0,$0,$150,"$3,650",$0,$0,$80,4
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,11,32225,MT,SHOP (Small Group),No,45-1295465,32225MT0050006,Connected Care Silver Plus,32225MT005,,MTN001,MTS002,MTF010,New,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Care-Grp-SIL-PLUS-SBC.pdf,https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs,http://www.mhc.coop/wp-content/uploads/docs/MHC-Small-Group-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0050006-00,Standard Silver Off Exchange Plan,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,"$3,650",$0,$0,$150,"$3,650",$0,$0,$80,4
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,11,32225,MT,SHOP (Small Group),No,45-1295465,32225MT0050006,Connected Care Silver Plus,32225MT005,,MTN001,MTS002,MTF010,New,POS,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Care-Grp-SIL-PLUS-SBC.pdf,https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs,http://www.mhc.coop/wp-content/uploads/docs/MHC-Small-Group-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0050006-01,Standard Silver On Exchange Plan,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,"$3,650",$0,$0,$150,"$3,650",$0,$0,$80,5
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,11,32225,MT,Individual,No,45-1295465,32225MT0020006,Connected Care Silver Plus,32225MT002,,MTN001,MTS002,MTF010,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Silver-Plus-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020006-01,Standard Silver On Exchange Plan,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,"$3,650",$0,$0,$150,"$3,650",$0,$0,$80,5
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,11,32225,MT,Individual,No,45-1295465,32225MT0020006,Connected Care Silver Plus,32225MT002,,MTN001,MTS002,MTF010,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Silver-Plus-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,11,32225,MT,Individual,No,45-1295465,32225MT0020006,Connected Care Silver Plus,32225MT002,,MTN001,MTS002,MTF010,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Silver-Plus-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020006-03,Limited Cost Sharing Plan Variation,,0.680402517318726,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$7,300","$14,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300",0%,,,,"$7,300","$14,600",Not Applicable,Not Applicable,"$3,650",$0,$0,$150,"$3,650",$0,$0,$80,7
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,11,32225,MT,Individual,No,45-1295465,32225MT0020006,Connected Care Silver Plus,32225MT002,,MTN001,MTS002,MTF010,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Silver-Plus-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020006-04,73% AV Level Silver Plan,,0.720003962516785,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,950","$5,900",,,"$5,900","$11,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,950","$5,900",0%,,,,"$5,900","$11,800",Not Applicable,Not Applicable,"$2,950",$0,$0,$150,"$2,950",$0,$0,$80,8
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,11,32225,MT,Individual,No,45-1295465,32225MT0020006,Connected Care Silver Plus,32225MT002,,MTN001,MTS002,MTF010,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Silver-Plus-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020006-05,87% AV Level Silver Plan,,0.861683309078217,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"$2,300","$4,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300",0%,,,,"$2,300","$4,600",Not Applicable,Not Applicable,"$1,150",$0,$0,$150,"$1,150",$0,$0,$80,9
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,11,32225,MT,Individual,No,45-1295465,32225MT0020006,Connected Care Silver Plus,32225MT002,,MTN001,MTS002,MTF010,New,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Silver-Plus-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020006-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,10
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,12,32225,MT,Individual,No,45-1295465,32225MT0020005,Connected Care Gold Plus,32225MT002,,MTN001,MTS002,MTF011,New,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Gold-Plus-Summary.pdf,https://service.healthplan.com/,http://www.mhc.coop/wp-content/uploads/docs/MHC-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0020005-00,Standard Gold Off Exchange Plan,,0.780541837215424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$4,200","$8,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400",Not Applicable,Not Applicable,"$2,100",$0,$0,$150,"$2,100",$0,$0,$80,4
2015,MT,32225,SERFF,5,2015-01-16 20:59:55,12,32225,MT,SHOP (Small Group),No,45-1295465,32225MT0050005,Connected Care Gold Plus,32225MT005,,MTN001,MTS002,MTF011,New,POS,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency Only,Yes,http://www.mhc.coop/wp-content/uploads/docs/Connected-Care-Grp-GLD-PLUS-SBC.pdf,https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs,http://www.mhc.coop/wp-content/uploads/docs/MHC-Small-Group-Plan-Comparison.pdf,http://www.mhc.coop/wp-content/uploads/2014/10/pharmacyformulary.pdf,32225MT0050005-00,Standard Gold Off Exchange Plan,,0.780541837215424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$4,200","$8,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",0%,,,,"$4,200","$8,400",Not Applicable,Not Applicable,"$2,100",$0,$0,$150,"$2,100",$0,$0,$80,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,11,15438,NE,Individual,No,42-1308659,15438NE0280002,Coventry Bronze $20 Copay Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF052,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51257,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280002-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,11,15438,NE,Individual,No,42-1308659,15438NE0280002,Coventry Bronze $20 Copay Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF052,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51257,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280002-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,11,15438,NE,Individual,No,42-1308659,15438NE0280002,Coventry Bronze $20 Copay Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF052,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51257,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,11,15438,NE,Individual,No,42-1308659,15438NE0280002,Coventry Bronze $20 Copay Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF052,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51257,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280002-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,MT,62818,SERFF,2,2014-09-09 16:12:42,1,62818,MT,SHOP (Small Group),Yes,13-5123390,62818MT0020002,Guardian Pediatric Essentials,62818MT002,,MTN001,MTS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$34.52,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,62818MT0020002-00,Standard Low Off Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,62818,SERFF,2,2014-09-09 16:12:42,2,62818,MT,SHOP (Small Group),Yes,13-5123390,62818MT0040002,Guardian Family Advantage,62818MT004,,MTN001,MTS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$44.13,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,62818MT0040002-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,62818,SERFF,2,2014-09-09 16:12:42,2,62818,MT,SHOP (Small Group),Yes,13-5123390,62818MT0040002,Guardian Family Advantage,62818MT004,,MTN001,MTS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$44.13,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,62818MT0040002-01,Standard High On Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,13,15438,NE,Individual,No,42-1308659,15438NE0180005,Coventry Bronze Deductible Only HSA Eligible,15438NE018,,NEN007,NES007,NEF019,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51230,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180005-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,14,15438,NE,Individual,No,42-1308659,15438NE0280003,Coventry Bronze Deductible Only HSA Eligible Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF053,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51202,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280003-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,14,15438,NE,Individual,No,42-1308659,15438NE0280003,Coventry Bronze Deductible Only HSA Eligible Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF053,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51202,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280003-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,14,15438,NE,Individual,No,42-1308659,15438NE0280003,Coventry Bronze Deductible Only HSA Eligible Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF053,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51202,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,14,15438,NE,Individual,No,42-1308659,15438NE0280003,Coventry Bronze Deductible Only HSA Eligible Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF053,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51202,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280003-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,MT,70415,SERFF,2,2014-09-09 16:12:42,1,70415,MT,SHOP (Small Group),Yes,47-0098400,70415MT0030001,EHB Low Passive,70415MT003,,MTN001,MTS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.08,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,70415MT0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,71788,SERFF,10,2014-11-04 20:29:03,1,71788,MT,Individual,Yes,94-2761537,71788MT0010002,Delta Dental PPO Pediatric Preferred Plan,71788MT001,,MTN001,MTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$27.99,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/mt/71788mt0010002-15,,71788MT0010002-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$85,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,71788,SERFF,10,2014-11-04 20:29:03,1,71788,MT,SHOP (Small Group),Yes,94-2761537,71788MT0020002,Delta Dental PPO Pediatric Preferred Plan for Small Businesses,71788MT002,,MTN001,MTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/mt/71788mt0020002-15,,71788MT0020002-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$85,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,71788,SERFF,10,2014-11-04 20:29:03,1,71788,MT,SHOP (Small Group),Yes,94-2761537,71788MT0020002,Delta Dental PPO Pediatric Preferred Plan for Small Businesses,71788MT002,,MTN001,MTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/mt/71788mt0020002-15,,71788MT0020002-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$85,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,71788,SERFF,10,2014-11-04 20:29:03,1,71788,MT,Individual,Yes,94-2761537,71788MT0010002,Delta Dental PPO Pediatric Preferred Plan,71788MT001,,MTN001,MTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$27.99,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/mt/71788mt0010002-15,,71788MT0010002-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$85,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,71788,SERFF,10,2014-11-04 20:29:03,1,71788,MT,Individual,Yes,94-2761537,71788MT0010001,Delta Dental PPO Pediatric Basic Plan,71788MT001,,MTN001,MTS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$22.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/mt/71788mt0010001-15,,71788MT0010001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$90,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MT,71788,SERFF,10,2014-11-04 20:29:03,1,71788,MT,SHOP (Small Group),Yes,94-2761537,71788MT0020001,Delta Dental PPO Pediatric Basic Plan for Small Businesses,71788MT002,,MTN001,MTS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/mt/71788mt0020001-15,,71788MT0020001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$90,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MT,71788,SERFF,10,2014-11-04 20:29:03,1,71788,MT,SHOP (Small Group),Yes,94-2761537,71788MT0020001,Delta Dental PPO Pediatric Basic Plan for Small Businesses,71788MT002,,MTN001,MTS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/mt/71788mt0020001-15,,71788MT0020001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$90,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MT,71788,SERFF,10,2014-11-04 20:29:03,1,71788,MT,Individual,Yes,94-2761537,71788MT0010001,Delta Dental PPO Pediatric Basic Plan,71788MT001,,MTN001,MTS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$22.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/mt/71788mt0010001-15,,71788MT0010001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$90,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MT,71788,SERFF,10,2014-11-04 20:29:03,2,71788,MT,Individual,Yes,94-2761537,71788MT0010004,Delta Dental PPO Preferred Plan for Families,71788MT001,,MTN001,MTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.99,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/mt/71788mt0010004-15,,71788MT0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$85,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,71788,SERFF,10,2014-11-04 20:29:03,2,71788,MT,SHOP (Small Group),Yes,94-2761537,71788MT0020004,Delta Dental PPO Preferred Plan for Families for Small Businesses,71788MT002,,MTN001,MTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/mt/71788mt0020004-15,,71788MT0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$85,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,71788,SERFF,10,2014-11-04 20:29:03,2,71788,MT,SHOP (Small Group),Yes,94-2761537,71788MT0020004,Delta Dental PPO Preferred Plan for Families for Small Businesses,71788MT002,,MTN001,MTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/mt/71788mt0020004-15,,71788MT0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$85,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,71788,SERFF,10,2014-11-04 20:29:03,2,71788,MT,Individual,Yes,94-2761537,71788MT0010004,Delta Dental PPO Preferred Plan for Families,71788MT001,,MTN001,MTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.99,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/mt/71788mt0010004-15,,71788MT0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$85,Not Applicable,$85,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,71788,SERFF,10,2014-11-04 20:29:03,3,71788,MT,Individual,Yes,94-2761537,71788MT0010009,Delta Dental PPO Basic Plan for Families,71788MT001,,MTN001,MTS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/mt/71788mt0010009-15,,71788MT0010009-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$90,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,71788,SERFF,10,2014-11-04 20:29:03,3,71788,MT,SHOP (Small Group),Yes,94-2761537,71788MT0020009,Delta Dental PPO Basic Plan for Families for Small Businesses,71788MT002,,MTN001,MTS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/mt/71788mt0020009-15,,71788MT0020009-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$90,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,71788,SERFF,10,2014-11-04 20:29:03,3,71788,MT,SHOP (Small Group),Yes,94-2761537,71788MT0020009,Delta Dental PPO Basic Plan for Families for Small Businesses,71788MT002,,MTN001,MTS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/mt/71788mt0020009-15,,71788MT0020009-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$90,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,71788,SERFF,10,2014-11-04 20:29:03,3,71788,MT,Individual,Yes,94-2761537,71788MT0010009,Delta Dental PPO Basic Plan for Families,71788MT001,,MTN001,MTS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/mt/71788mt0010009-15,,71788MT0010009-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$90,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,92216,SERFF,2,2014-09-09 16:12:42,1,92216,MT,SHOP (Small Group),Yes,93-0242990,92216MT0030002,EHB High Passive,92216MT003,,MTN001,MTS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$46.42,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,92216MT0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,92216,SERFF,2,2014-09-09 16:12:42,1,92216,MT,SHOP (Small Group),Yes,93-0242990,92216MT0030001,EHB Low Passive,92216MT003,,MTN001,MTS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.56,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,92216MT0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,1,93895,MT,Individual,Yes,95-6042390,93895MT0020001,BESTOne Child Dental Plus,93895MT002,,MTN001,MTS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$50.09,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BESTOne_Child_Dental_Plus_Plan.pdf,,93895MT0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,1,93895,MT,SHOP (Small Group),Yes,95-6042390,93895MT0010001,BEST Life Child Dental Plus,93895MT001,,MTN001,MTS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$40.09,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BEST_Life_Child_Dental_Plus_Plan.pdf,,93895MT0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,2,93895,MT,SHOP (Small Group),Yes,95-6042390,93895MT0010002,BEST Life Child Dental,93895MT001,,MTN001,MTS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$36.25,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BEST_Life_Child_Dental_Plan.pdf,,93895MT0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,2,93895,MT,Individual,Yes,95-6042390,93895MT0020002,BESTOne Child Dental Plus,93895MT002,,MTN001,MTS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$45.31,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BESTOne_Child_Dental_Plan.pdf,,93895MT0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,3,93895,MT,SHOP (Small Group),Yes,95-6042390,93895MT0010007,BEST Dental Premium,93895MT001,,MTN001,MTS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$40.09,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BESTDental_Premium_Plan.pdf,,93895MT0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,3,93895,MT,Individual,Yes,95-6042390,93895MT0020003,BESTOne Dental Advantage-High,93895MT002,,MTN001,MTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$50.09,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BESTOne_Dental_Advantage-High_Plan.pdf,,93895MT0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,3,93895,MT,Individual,Yes,95-6042390,93895MT0020003,BESTOne Dental Advantage-High,93895MT002,,MTN001,MTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$50.09,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BESTOne_Dental_Advantage-High_Plan.pdf,,93895MT0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,3,93895,MT,SHOP (Small Group),Yes,95-6042390,93895MT0010007,BEST Dental Premium,93895MT001,,MTN001,MTS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$40.09,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BESTDental_Premium_Plan.pdf,,93895MT0010007-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,3,93895,MT,SHOP (Small Group),Yes,95-6042390,93895MT0010008,BEST Dental Standard-H,93895MT001,,MTN001,MTS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$40.09,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BESTDental_Standard-H_Plan.pdf,,93895MT0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,3,93895,MT,Individual,Yes,95-6042390,93895MT0020004,BESTOne Dental Plus-High,93895MT002,,MTN001,MTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$50.09,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BESTOne_Dental_Plus-High_Plan.pdf,,93895MT0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,3,93895,MT,Individual,Yes,95-6042390,93895MT0020004,BESTOne Dental Plus-High,93895MT002,,MTN001,MTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$50.09,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BESTOne_Dental_Plus-High_Plan.pdf,,93895MT0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,3,93895,MT,SHOP (Small Group),Yes,95-6042390,93895MT0010008,BEST Dental Standard-H,93895MT001,,MTN001,MTS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$40.09,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BESTDental_Standard-H_Plan.pdf,,93895MT0010008-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,3,93895,MT,SHOP (Small Group),Yes,95-6042390,93895MT0010010,BEST Dental Choice-H,93895MT001,,MTN001,MTS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$40.09,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BESTDental_Choice-H_Plan.pdf,,93895MT0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,3,93895,MT,SHOP (Small Group),Yes,95-6042390,93895MT0010010,BEST Dental Choice-H,93895MT001,,MTN001,MTS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$40.09,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BESTDental_Choice-H_Plan.pdf,,93895MT0010010-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,3,93895,MT,SHOP (Small Group),Yes,95-6042390,93895MT0010013,BEST Dental Premium-H-OR,93895MT001,,MTN001,MTS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$40.09,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,,,93895MT0010013-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,3,93895,MT,SHOP (Small Group),Yes,95-6042390,93895MT0010014,BEST Dental Standard-H-OR,93895MT001,,MTN001,MTS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$40.09,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,,,93895MT0010014-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,4,93895,MT,Individual,Yes,95-6042390,93895MT0020005,BESTOne Dental Plus-Low,93895MT002,,MTN001,MTS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$45.31,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BESTOne_Dental_Plus-Low_Plan.pdf,,93895MT0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,4,93895,MT,SHOP (Small Group),Yes,95-6042390,93895MT0010009,BEST Dental Standard-L,93895MT001,,MTN001,MTS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.25,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BESTDental_Standard-L_Plan.pdf,,93895MT0010009-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,4,93895,MT,SHOP (Small Group),Yes,95-6042390,93895MT0010009,BEST Dental Standard-L,93895MT001,,MTN001,MTS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.25,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BESTDental_Standard-L_Plan.pdf,,93895MT0010009-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,4,93895,MT,Individual,Yes,95-6042390,93895MT0020005,BESTOne Dental Plus-Low,93895MT002,,MTN001,MTS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$45.31,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BESTOne_Dental_Plus-Low_Plan.pdf,,93895MT0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,4,93895,MT,SHOP (Small Group),Yes,95-6042390,93895MT0010011,BEST Dental Choice-L,93895MT001,,MTN001,MTS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.25,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BESTDental_Choice-L_Plan.pdf,,93895MT0010011-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,4,93895,MT,Individual,Yes,95-6042390,93895MT0020006,BESTOne Dental Basic-Low,93895MT002,,MTN001,MTS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$45.31,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BESTOne_Dental_Basic-Low_Plan.pdf,,93895MT0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,4,93895,MT,Individual,Yes,95-6042390,93895MT0020006,BESTOne Dental Basic-Low,93895MT002,,MTN001,MTS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$45.31,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BESTOne_Dental_Basic-Low_Plan.pdf,,93895MT0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,4,93895,MT,SHOP (Small Group),Yes,95-6042390,93895MT0010011,BEST Dental Choice-L,93895MT001,,MTN001,MTS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.25,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BESTDental_Choice-L_Plan.pdf,,93895MT0010011-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,4,93895,MT,SHOP (Small Group),Yes,95-6042390,93895MT0010012,BEST Dental Value,93895MT001,,MTN001,MTS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.25,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BESTDental_Value_Plan.pdf,,93895MT0010012-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,MT,93895,SERFF,6,2014-11-04 20:29:03,4,93895,MT,SHOP (Small Group),Yes,95-6042390,93895MT0010012,BEST Dental Value,93895MT001,,MTN001,MTS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.25,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/MT/2015/MT_BESTDental_Value_Plan.pdf,,93895MT0010012-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,NE,10739,SERFF,5,2014-11-14 14:52:18,1,10739,NE,Individual,Yes,75-1233841,10739NE0010007,Dentegra Dental PPO Pediatric Basic Plan,10739NE001,,NEN001,NES001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$19.98,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ne/10739ne0010007-15,,10739NE0010007-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,10739,SERFF,5,2014-11-14 14:52:18,1,10739,NE,SHOP (Small Group),Yes,75-1233841,10739NE0020007,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,10739NE002,,NEN001,NES001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.14,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ne/10739ne0020007-15,,10739NE0020007-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,10739,SERFF,5,2014-11-14 14:52:18,1,10739,NE,SHOP (Small Group),Yes,75-1233841,10739NE0020007,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,10739NE002,,NEN001,NES001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.14,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ne/10739ne0020007-15,,10739NE0020007-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,10739,SERFF,5,2014-11-14 14:52:18,1,10739,NE,Individual,Yes,75-1233841,10739NE0010007,Dentegra Dental PPO Pediatric Basic Plan,10739NE001,,NEN001,NES001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$19.98,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ne/10739ne0010007-15,,10739NE0010007-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,10739,SERFF,5,2014-11-14 14:52:18,2,10739,NE,Individual,Yes,75-1233841,10739NE0010009,Dentegra Dental PPO Family Basic Plan,10739NE001,,NEN001,NES001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.98,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ne/10739ne0010009-15,,10739NE0010009-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,10739,SERFF,5,2014-11-14 14:52:18,2,10739,NE,SHOP (Small Group),Yes,75-1233841,10739NE0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,10739NE002,,NEN001,NES001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.14,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ne/10739ne0020009-15,,10739NE0020009-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,10739,SERFF,5,2014-11-14 14:52:18,2,10739,NE,SHOP (Small Group),Yes,75-1233841,10739NE0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,10739NE002,,NEN001,NES001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.14,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/ne/10739ne0020009-15,,10739NE0020009-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,10739,SERFF,5,2014-11-14 14:52:18,2,10739,NE,Individual,Yes,75-1233841,10739NE0010009,Dentegra Dental PPO Family Basic Plan,10739NE001,,NEN001,NES001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.98,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ne/10739ne0010009-15,,10739NE0010009-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,1,15438,NE,Individual,No,42-1308659,15438NE0180003,Coventry Bronze $20 Copay,15438NE018,,NEN007,NES007,NEF018,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51227,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180003-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,1,15438,NE,Individual,No,42-1308659,15438NE0180003,Coventry Bronze $20 Copay,15438NE018,,NEN007,NES007,NEF018,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51227,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180003-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,1,15438,NE,Individual,No,42-1308659,15438NE0180003,Coventry Bronze $20 Copay,15438NE018,,NEN007,NES007,NEF018,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51227,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,1,15438,NE,Individual,No,42-1308659,15438NE0180003,Coventry Bronze $20 Copay,15438NE018,,NEN007,NES007,NEF018,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51227,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180003-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,2,15438,NE,Individual,No,42-1308659,15438NE0280001,Coventry Bronze $20 Copay Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF051,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51199,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280001-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,2,15438,NE,Individual,No,42-1308659,15438NE0280001,Coventry Bronze $20 Copay Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF051,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51199,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280001-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,2,15438,NE,Individual,No,42-1308659,15438NE0280001,Coventry Bronze $20 Copay Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF051,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51199,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,2,15438,NE,Individual,No,42-1308659,15438NE0280001,Coventry Bronze $20 Copay Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF051,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51199,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280001-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,4,15438,NE,Individual,No,42-1308659,15438NE0170003,Coventry Bronze $20 Copay Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF013,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73227,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170003-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,4,15438,NE,Individual,No,42-1308659,15438NE0170003,Coventry Bronze $20 Copay Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF013,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73227,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170003-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,4,15438,NE,Individual,No,42-1308659,15438NE0170003,Coventry Bronze $20 Copay Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF013,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73227,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,4,15438,NE,Individual,No,42-1308659,15438NE0170003,Coventry Bronze $20 Copay Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF013,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73227,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170003-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,6,15438,NE,Individual,No,42-1308659,15438NE0150003,Coventry Bronze $20 Copay Methodist Health Partners,15438NE015,,NEN004,NES004,NEF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73201,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150003-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,6,15438,NE,Individual,No,42-1308659,15438NE0150003,Coventry Bronze $20 Copay Methodist Health Partners,15438NE015,,NEN004,NES004,NEF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73201,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150003-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,6,15438,NE,Individual,No,42-1308659,15438NE0150003,Coventry Bronze $20 Copay Methodist Health Partners,15438NE015,,NEN004,NES004,NEF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73201,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,6,15438,NE,Individual,No,42-1308659,15438NE0150003,Coventry Bronze $20 Copay Methodist Health Partners,15438NE015,,NEN004,NES004,NEF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73201,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150003-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,8,15438,NE,Individual,No,42-1308659,15438NE0160003,Coventry Bronze $20 Copay MIPPA,15438NE016,,NEN003,NES003,NEF008,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51171,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160003-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,8,15438,NE,Individual,No,42-1308659,15438NE0160003,Coventry Bronze $20 Copay MIPPA,15438NE016,,NEN003,NES003,NEF008,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51171,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160003-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,13,15438,NE,Individual,No,42-1308659,15438NE0180005,Coventry Bronze Deductible Only HSA Eligible,15438NE018,,NEN007,NES007,NEF019,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51230,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180005-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,13,15438,NE,Individual,No,42-1308659,15438NE0180005,Coventry Bronze Deductible Only HSA Eligible,15438NE018,,NEN007,NES007,NEF019,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51230,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180005-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,16,15438,NE,Individual,No,42-1308659,15438NE0170005,Coventry Bronze Deductible Only HSA Eligible Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF014,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73230,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170005-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,18,15438,NE,Individual,No,42-1308659,15438NE0150005,Coventry Bronze Deductible Only HSA Eligible Methodist Health Partners,15438NE015,,NEN004,NES004,NEF004,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73204,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150005-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,18,15438,NE,Individual,No,42-1308659,15438NE0150005,Coventry Bronze Deductible Only HSA Eligible Methodist Health Partners,15438NE015,,NEN004,NES004,NEF004,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73204,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150005-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,18,15438,NE,Individual,No,42-1308659,15438NE0150005,Coventry Bronze Deductible Only HSA Eligible Methodist Health Partners,15438NE015,,NEN004,NES004,NEF004,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73204,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150005-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,18,15438,NE,Individual,No,42-1308659,15438NE0150005,Coventry Bronze Deductible Only HSA Eligible Methodist Health Partners,15438NE015,,NEN004,NES004,NEF004,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73204,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150005-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,20,15438,NE,Individual,No,42-1308659,15438NE0160005,Coventry Bronze Deductible Only HSA Eligible MIPPA,15438NE016,,NEN003,NES003,NEF009,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51174,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160005-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,20,15438,NE,Individual,No,42-1308659,15438NE0160005,Coventry Bronze Deductible Only HSA Eligible MIPPA,15438NE016,,NEN003,NES003,NEF009,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51174,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160005-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,20,15438,NE,Individual,No,42-1308659,15438NE0160005,Coventry Bronze Deductible Only HSA Eligible MIPPA,15438NE016,,NEN003,NES003,NEF009,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51174,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160005-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,20,15438,NE,Individual,No,42-1308659,15438NE0160005,Coventry Bronze Deductible Only HSA Eligible MIPPA,15438NE016,,NEN003,NES003,NEF009,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51174,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160005-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,23,15438,NE,Individual,No,42-1308659,15438NE0280004,Coventry Bronze Deductible Only HSA Eligible Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF054,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51260,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280004-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,23,15438,NE,Individual,No,42-1308659,15438NE0280004,Coventry Bronze Deductible Only HSA Eligible Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF054,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51260,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280004-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,23,15438,NE,Individual,No,42-1308659,15438NE0280004,Coventry Bronze Deductible Only HSA Eligible Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF054,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51260,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,23,15438,NE,Individual,No,42-1308659,15438NE0280004,Coventry Bronze Deductible Only HSA Eligible Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF054,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51260,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280004-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,25,15438,NE,Individual,No,42-1308659,15438NE0180002,Coventry Silver $10 Copay,15438NE018,,NEN007,NES007,NEF017,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51215,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180002-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,25,15438,NE,Individual,No,42-1308659,15438NE0180002,Coventry Silver $10 Copay,15438NE018,,NEN007,NES007,NEF017,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51215,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180002-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,25,15438,NE,Individual,No,42-1308659,15438NE0180002,Coventry Silver $10 Copay,15438NE018,,NEN007,NES007,NEF017,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51215,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,25,15438,NE,Individual,No,42-1308659,15438NE0180002,Coventry Silver $10 Copay,15438NE018,,NEN007,NES007,NEF017,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51215,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180002-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,25,15438,NE,Individual,No,42-1308659,15438NE0180002,Coventry Silver $10 Copay,15438NE018,,NEN007,NES007,NEF017,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51215,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180002-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,25,15438,NE,Individual,No,42-1308659,15438NE0180002,Coventry Silver $10 Copay,15438NE018,,NEN007,NES007,NEF017,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51215,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180002-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,25,15438,NE,Individual,No,42-1308659,15438NE0180002,Coventry Silver $10 Copay,15438NE018,,NEN007,NES007,NEF017,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51215,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180002-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,26,15438,NE,Individual,No,42-1308659,15438NE0280007,Coventry Silver $10 Copay Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF057,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51187,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280007-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,26,15438,NE,Individual,No,42-1308659,15438NE0280007,Coventry Silver $10 Copay Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF057,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51187,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280007-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,26,15438,NE,Individual,No,42-1308659,15438NE0280007,Coventry Silver $10 Copay Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF057,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51187,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280007-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,26,15438,NE,Individual,No,42-1308659,15438NE0280007,Coventry Silver $10 Copay Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF057,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51187,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280007-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,26,15438,NE,Individual,No,42-1308659,15438NE0280007,Coventry Silver $10 Copay Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF057,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51187,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280007-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,26,15438,NE,Individual,No,42-1308659,15438NE0280007,Coventry Silver $10 Copay Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF057,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51187,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280007-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,26,15438,NE,Individual,No,42-1308659,15438NE0280007,Coventry Silver $10 Copay Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF057,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51187,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280007-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,28,15438,NE,Individual,No,42-1308659,15438NE0170002,Coventry Silver $10 Copay Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF012,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73215,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170002-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,28,15438,NE,Individual,No,42-1308659,15438NE0170002,Coventry Silver $10 Copay Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF012,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73215,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170002-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,28,15438,NE,Individual,No,42-1308659,15438NE0170002,Coventry Silver $10 Copay Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF012,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73215,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,28,15438,NE,Individual,No,42-1308659,15438NE0170002,Coventry Silver $10 Copay Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF012,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73215,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170002-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,28,15438,NE,Individual,No,42-1308659,15438NE0170002,Coventry Silver $10 Copay Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF012,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73215,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170002-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,28,15438,NE,Individual,No,42-1308659,15438NE0170002,Coventry Silver $10 Copay Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF012,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73215,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170002-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,28,15438,NE,Individual,No,42-1308659,15438NE0170002,Coventry Silver $10 Copay Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF012,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73215,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170002-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,30,15438,NE,Individual,No,42-1308659,15438NE0150002,Coventry Silver $10 Copay Methodist Health Partners,15438NE015,,NEN004,NES004,NEF002,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73189,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150002-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,30,15438,NE,Individual,No,42-1308659,15438NE0150002,Coventry Silver $10 Copay Methodist Health Partners,15438NE015,,NEN004,NES004,NEF002,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73189,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150002-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,30,15438,NE,Individual,No,42-1308659,15438NE0150002,Coventry Silver $10 Copay Methodist Health Partners,15438NE015,,NEN004,NES004,NEF002,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73189,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,30,15438,NE,Individual,No,42-1308659,15438NE0150002,Coventry Silver $10 Copay Methodist Health Partners,15438NE015,,NEN004,NES004,NEF002,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73189,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150002-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,30,15438,NE,Individual,No,42-1308659,15438NE0150002,Coventry Silver $10 Copay Methodist Health Partners,15438NE015,,NEN004,NES004,NEF002,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73189,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150002-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,30,15438,NE,Individual,No,42-1308659,15438NE0150002,Coventry Silver $10 Copay Methodist Health Partners,15438NE015,,NEN004,NES004,NEF002,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73189,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150002-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,30,15438,NE,Individual,No,42-1308659,15438NE0150002,Coventry Silver $10 Copay Methodist Health Partners,15438NE015,,NEN004,NES004,NEF002,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73189,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150002-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,32,15438,NE,Individual,No,42-1308659,15438NE0160002,Coventry Silver $10 Copay MIPPA,15438NE016,,NEN003,NES003,NEF007,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51159,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160002-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,32,15438,NE,Individual,No,42-1308659,15438NE0160002,Coventry Silver $10 Copay MIPPA,15438NE016,,NEN003,NES003,NEF007,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51159,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160002-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,32,15438,NE,Individual,No,42-1308659,15438NE0160002,Coventry Silver $10 Copay MIPPA,15438NE016,,NEN003,NES003,NEF007,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51159,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,32,15438,NE,Individual,No,42-1308659,15438NE0160002,Coventry Silver $10 Copay MIPPA,15438NE016,,NEN003,NES003,NEF007,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51159,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160002-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,32,15438,NE,Individual,No,42-1308659,15438NE0160002,Coventry Silver $10 Copay MIPPA,15438NE016,,NEN003,NES003,NEF007,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51159,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160002-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,32,15438,NE,Individual,No,42-1308659,15438NE0160002,Coventry Silver $10 Copay MIPPA,15438NE016,,NEN003,NES003,NEF007,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51159,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160002-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,32,15438,NE,Individual,No,42-1308659,15438NE0160002,Coventry Silver $10 Copay MIPPA,15438NE016,,NEN003,NES003,NEF007,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51159,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160002-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,35,15438,NE,Individual,No,42-1308659,15438NE0280008,Coventry Silver $10 Copay Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF058,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51245,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280008-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,35,15438,NE,Individual,No,42-1308659,15438NE0280008,Coventry Silver $10 Copay Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF058,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51245,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280008-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,35,15438,NE,Individual,No,42-1308659,15438NE0280008,Coventry Silver $10 Copay Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF058,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51245,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280008-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,35,15438,NE,Individual,No,42-1308659,15438NE0280008,Coventry Silver $10 Copay Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF058,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51245,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280008-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,35,15438,NE,Individual,No,42-1308659,15438NE0280008,Coventry Silver $10 Copay Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF058,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51245,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280008-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,35,15438,NE,Individual,No,42-1308659,15438NE0280008,Coventry Silver $10 Copay Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF058,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51245,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280008-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,35,15438,NE,Individual,No,42-1308659,15438NE0280008,Coventry Silver $10 Copay Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF058,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51245,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280008-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,37,15438,NE,Individual,No,42-1308659,15438NE0180011,Coventry Silver $5 Copay 2750,15438NE018,,NEN007,NES007,NEF020,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51221,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180011-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,37,15438,NE,Individual,No,42-1308659,15438NE0180011,Coventry Silver $5 Copay 2750,15438NE018,,NEN007,NES007,NEF020,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51221,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180011-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,37,15438,NE,Individual,No,42-1308659,15438NE0180011,Coventry Silver $5 Copay 2750,15438NE018,,NEN007,NES007,NEF020,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51221,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180011-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,37,15438,NE,Individual,No,42-1308659,15438NE0180011,Coventry Silver $5 Copay 2750,15438NE018,,NEN007,NES007,NEF020,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51221,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180011-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,37,15438,NE,Individual,No,42-1308659,15438NE0180011,Coventry Silver $5 Copay 2750,15438NE018,,NEN007,NES007,NEF020,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51221,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180011-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,37,15438,NE,Individual,No,42-1308659,15438NE0180011,Coventry Silver $5 Copay 2750,15438NE018,,NEN007,NES007,NEF020,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51221,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180011-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,37,15438,NE,Individual,No,42-1308659,15438NE0180011,Coventry Silver $5 Copay 2750,15438NE018,,NEN007,NES007,NEF020,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51221,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180011-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,38,15438,NE,Individual,No,42-1308659,15438NE0280009,Coventry Silver $5 Copay 2750 Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF059,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51193,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280009-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,38,15438,NE,Individual,No,42-1308659,15438NE0280009,Coventry Silver $5 Copay 2750 Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF059,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51193,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280009-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,38,15438,NE,Individual,No,42-1308659,15438NE0280009,Coventry Silver $5 Copay 2750 Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF059,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51193,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280009-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,38,15438,NE,Individual,No,42-1308659,15438NE0280009,Coventry Silver $5 Copay 2750 Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF059,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51193,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280009-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,38,15438,NE,Individual,No,42-1308659,15438NE0280009,Coventry Silver $5 Copay 2750 Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF059,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51193,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280009-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,38,15438,NE,Individual,No,42-1308659,15438NE0280009,Coventry Silver $5 Copay 2750 Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF059,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51193,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280009-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,38,15438,NE,Individual,No,42-1308659,15438NE0280009,Coventry Silver $5 Copay 2750 Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF059,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51193,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280009-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,40,15438,NE,Individual,No,42-1308659,15438NE0170011,Coventry Silver $5 Copay 2750 Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF015,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73221,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170011-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,40,15438,NE,Individual,No,42-1308659,15438NE0170011,Coventry Silver $5 Copay 2750 Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF015,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73221,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170011-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,40,15438,NE,Individual,No,42-1308659,15438NE0170011,Coventry Silver $5 Copay 2750 Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF015,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73221,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170011-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,40,15438,NE,Individual,No,42-1308659,15438NE0170011,Coventry Silver $5 Copay 2750 Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF015,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73221,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170011-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,40,15438,NE,Individual,No,42-1308659,15438NE0170011,Coventry Silver $5 Copay 2750 Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF015,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73221,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170011-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,40,15438,NE,Individual,No,42-1308659,15438NE0170011,Coventry Silver $5 Copay 2750 Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF015,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73221,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170011-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,40,15438,NE,Individual,No,42-1308659,15438NE0170011,Coventry Silver $5 Copay 2750 Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF015,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73221,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170011-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,42,15438,NE,Individual,No,42-1308659,15438NE0150011,Coventry Silver $5 Copay 2750 Methodist Health Partners,15438NE015,,NEN004,NES004,NEF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73195,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150011-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,42,15438,NE,Individual,No,42-1308659,15438NE0150011,Coventry Silver $5 Copay 2750 Methodist Health Partners,15438NE015,,NEN004,NES004,NEF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73195,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150011-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,42,15438,NE,Individual,No,42-1308659,15438NE0150011,Coventry Silver $5 Copay 2750 Methodist Health Partners,15438NE015,,NEN004,NES004,NEF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73195,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150011-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,42,15438,NE,Individual,No,42-1308659,15438NE0150011,Coventry Silver $5 Copay 2750 Methodist Health Partners,15438NE015,,NEN004,NES004,NEF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73195,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150011-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,42,15438,NE,Individual,No,42-1308659,15438NE0150011,Coventry Silver $5 Copay 2750 Methodist Health Partners,15438NE015,,NEN004,NES004,NEF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73195,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150011-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,42,15438,NE,Individual,No,42-1308659,15438NE0150011,Coventry Silver $5 Copay 2750 Methodist Health Partners,15438NE015,,NEN004,NES004,NEF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73195,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150011-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,42,15438,NE,Individual,No,42-1308659,15438NE0150011,Coventry Silver $5 Copay 2750 Methodist Health Partners,15438NE015,,NEN004,NES004,NEF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73195,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150011-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,44,15438,NE,Individual,No,42-1308659,15438NE0160011,Coventry Silver $5 Copay 2750 MIPPA,15438NE016,,NEN003,NES003,NEF010,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51165,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160011-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,44,15438,NE,Individual,No,42-1308659,15438NE0160011,Coventry Silver $5 Copay 2750 MIPPA,15438NE016,,NEN003,NES003,NEF010,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51165,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160011-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,44,15438,NE,Individual,No,42-1308659,15438NE0160011,Coventry Silver $5 Copay 2750 MIPPA,15438NE016,,NEN003,NES003,NEF010,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51165,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160011-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,44,15438,NE,Individual,No,42-1308659,15438NE0160011,Coventry Silver $5 Copay 2750 MIPPA,15438NE016,,NEN003,NES003,NEF010,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51165,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160011-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,44,15438,NE,Individual,No,42-1308659,15438NE0160011,Coventry Silver $5 Copay 2750 MIPPA,15438NE016,,NEN003,NES003,NEF010,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51165,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160011-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,44,15438,NE,Individual,No,42-1308659,15438NE0160011,Coventry Silver $5 Copay 2750 MIPPA,15438NE016,,NEN003,NES003,NEF010,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51165,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160011-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,44,15438,NE,Individual,No,42-1308659,15438NE0160011,Coventry Silver $5 Copay 2750 MIPPA,15438NE016,,NEN003,NES003,NEF010,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51165,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160011-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,47,15438,NE,Individual,No,42-1308659,15438NE0280010,Coventry Silver $5 Copay 2750 Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF060,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51251,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280010-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,47,15438,NE,Individual,No,42-1308659,15438NE0280010,Coventry Silver $5 Copay 2750 Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF060,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51251,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280010-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,47,15438,NE,Individual,No,42-1308659,15438NE0280010,Coventry Silver $5 Copay 2750 Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF060,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51251,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280010-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,47,15438,NE,Individual,No,42-1308659,15438NE0280010,Coventry Silver $5 Copay 2750 Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF060,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51251,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280010-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,47,15438,NE,Individual,No,42-1308659,15438NE0280010,Coventry Silver $5 Copay 2750 Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF060,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51251,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280010-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,47,15438,NE,Individual,No,42-1308659,15438NE0280010,Coventry Silver $5 Copay 2750 Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF060,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51251,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280010-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,47,15438,NE,Individual,No,42-1308659,15438NE0280010,Coventry Silver $5 Copay 2750 Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF060,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51251,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280010-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,49,15438,NE,Individual,No,42-1308659,15438NE0180001,Coventry Gold $5 Copay,15438NE018,,NEN007,NES007,NEF016,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51212,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180001-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,49,15438,NE,Individual,No,42-1308659,15438NE0180001,Coventry Gold $5 Copay,15438NE018,,NEN007,NES007,NEF016,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51212,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180001-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,49,15438,NE,Individual,No,42-1308659,15438NE0180001,Coventry Gold $5 Copay,15438NE018,,NEN007,NES007,NEF016,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51212,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,49,15438,NE,Individual,No,42-1308659,15438NE0180001,Coventry Gold $5 Copay,15438NE018,,NEN007,NES007,NEF016,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE51212,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSCHCNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0180001-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,50,15438,NE,Individual,No,42-1308659,15438NE0280005,Coventry Gold $5 Copay Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF055,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51184,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280005-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,50,15438,NE,Individual,No,42-1308659,15438NE0280005,Coventry Gold $5 Copay Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF055,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51184,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280005-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,50,15438,NE,Individual,No,42-1308659,15438NE0280005,Coventry Gold $5 Copay Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF055,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51184,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280005-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,50,15438,NE,Individual,No,42-1308659,15438NE0280005,Coventry Gold $5 Copay Accountable Care Alliance,15438NE028,,NEN005,NES005,NEF055,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51184,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOaccountablecareNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280005-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,52,15438,NE,Individual,No,42-1308659,15438NE0170001,Coventry Gold $5 Copay Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF011,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73212,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170001-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,52,15438,NE,Individual,No,42-1308659,15438NE0170001,Coventry Gold $5 Copay Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF011,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73212,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170001-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,52,15438,NE,Individual,No,42-1308659,15438NE0170001,Coventry Gold $5 Copay Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF011,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73212,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,52,15438,NE,Individual,No,42-1308659,15438NE0170001,Coventry Gold $5 Copay Alegent Creighton Health,15438NE017,,NEN002,NES002,NEF011,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73212,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOalegentcreightonNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0170001-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,54,15438,NE,Individual,No,42-1308659,15438NE0150001,Coventry Gold $5 Copay Methodist Health Partners,15438NE015,,NEN004,NES004,NEF001,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73186,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150001-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,20%,,,,Not Applicable,Not Applicable,$250,$0,,,,,,,,,,,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,54,15438,NE,Individual,No,42-1308659,15438NE0150001,Coventry Gold $5 Copay Methodist Health Partners,15438NE015,,NEN004,NES004,NEF001,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73186,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150001-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,54,15438,NE,Individual,No,42-1308659,15438NE0150001,Coventry Gold $5 Copay Methodist Health Partners,15438NE015,,NEN004,NES004,NEF001,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73186,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,54,15438,NE,Individual,No,42-1308659,15438NE0150001,Coventry Gold $5 Copay Methodist Health Partners,15438NE015,,NEN004,NES004,NEF001,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE73186,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOmethodisthealthNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0150001-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,56,15438,NE,Individual,No,42-1308659,15438NE0160001,Coventry Gold $5 Copay MIPPA,15438NE016,,NEN003,NES003,NEF006,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE73238,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160001-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,56,15438,NE,Individual,No,42-1308659,15438NE0160001,Coventry Gold $5 Copay MIPPA,15438NE016,,NEN003,NES003,NEF006,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE73238,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160001-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,56,15438,NE,Individual,No,42-1308659,15438NE0160001,Coventry Gold $5 Copay MIPPA,15438NE016,,NEN003,NES003,NEF006,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE73238,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,56,15438,NE,Individual,No,42-1308659,15438NE0160001,Coventry Gold $5 Copay MIPPA,15438NE016,,NEN003,NES003,NEF006,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/NE73238,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSMIPPANE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0160001-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,59,15438,NE,Individual,No,42-1308659,15438NE0280006,Coventry Gold $5 Copay Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF056,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51242,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280006-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,,,,$250,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,4
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,59,15438,NE,Individual,No,42-1308659,15438NE0280006,Coventry Gold $5 Copay Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF056,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51242,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280006-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,,,,$250,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,5
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,59,15438,NE,Individual,No,42-1308659,15438NE0280006,Coventry Gold $5 Copay Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF056,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51242,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280006-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,6
2015,NE,15438,SERFF,9,2014-12-12 12:37:36,59,15438,NE,Individual,No,42-1308659,15438NE0280006,Coventry Gold $5 Copay Saint Elizabeth Regional Medical Center,15438NE028,,NEN006,NES006,NEF056,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/NE51242,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOstelizabethNE2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,15438NE0280006-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,,,,$250,Not Applicable,Not Applicable,$0,,,,,,,,,,,,,,,,,,,7
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180001,Assurant Health Bronze Plan 001,19524NE018,,NEN001,NES001,NEF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180001-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180014,Assurant Health Gold Plan 002,19524NE018,,NEN001,NES002,NEF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180014-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180014,Assurant Health Gold Plan 002,19524NE018,,NEN001,NES002,NEF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180014-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180014,Assurant Health Gold Plan 002,19524NE018,,NEN001,NES002,NEF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,31
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180014,Assurant Health Gold Plan 002,19524NE018,,NEN001,NES002,NEF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180014-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180015,Assurant Health Gold Plan 002,19524NE018,,NEN001,NES003,NEF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180015-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180015,Assurant Health Gold Plan 002,19524NE018,,NEN001,NES003,NEF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180015-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180001,Assurant Health Bronze Plan 001,19524NE018,,NEN001,NES001,NEF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180001-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180001,Assurant Health Bronze Plan 001,19524NE018,,NEN001,NES001,NEF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180005,Assurant Health Silver Plan 001,19524NE018,,NEN001,NES002,NEF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180005-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180006,Assurant Health Silver Plan 001,19524NE018,,NEN001,NES003,NEF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180006-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180006,Assurant Health Silver Plan 001,19524NE018,,NEN001,NES003,NEF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180006-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180006,Assurant Health Silver Plan 001,19524NE018,,NEN001,NES003,NEF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,32
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180006,Assurant Health Silver Plan 001,19524NE018,,NEN001,NES003,NEF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180006-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180006,Assurant Health Silver Plan 001,19524NE018,,NEN001,NES003,NEF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180006-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180015,Assurant Health Gold Plan 002,19524NE018,,NEN001,NES003,NEF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180015-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180016,Assurant Health Platinum Plan 002,19524NE018,,NEN001,NES001,NEF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180016-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180001,Assurant Health Bronze Plan 001,19524NE018,,NEN001,NES001,NEF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180001-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180002,Assurant Health Bronze Plan 001,19524NE018,,NEN001,NES002,NEF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180002-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180010,Assurant Health Silver Plan 002,19524NE018,,NEN001,NES001,NEF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180010-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180010,Assurant Health Silver Plan 002,19524NE018,,NEN001,NES001,NEF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180010-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180017,Assurant Health Platinum Plan 002,19524NE018,,NEN001,NES002,NEF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180017-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,42
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180017,Assurant Health Platinum Plan 002,19524NE018,,NEN001,NES002,NEF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,43
2015,NE,41106,SERFF,2,2014-09-02 11:19:24,2,41106,NE,SHOP (Small Group),Yes,44-0308260,41106NE0010002,KCL EHB High PPO,41106NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$41.78,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,41106NE0010002-00,Standard High Off Exchange Plan,83.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,41106,SERFF,2,2014-09-02 11:19:24,2,41106,NE,SHOP (Small Group),Yes,44-0308260,41106NE0010004,KCL EHB High MAC,41106NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$32.25,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,41106NE0010004-00,Standard High Off Exchange Plan,83.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,41106,SERFF,2,2014-09-02 11:19:24,2,41106,NE,SHOP (Small Group),Yes,44-0308260,41106NE0010006,KCL Fam High PPO,41106NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$41.78,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,41106NE0010006-00,Standard High Off Exchange Plan,83.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NE,41106,SERFF,2,2014-09-02 11:19:24,2,41106,NE,SHOP (Small Group),Yes,44-0308260,41106NE0010008,KCL Fam High MAC,41106NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$32.25,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,41106NE0010008-00,Standard High Off Exchange Plan,83.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180010,Assurant Health Silver Plan 002,19524NE018,,NEN001,NES001,NEF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180010-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180011,Assurant Health Silver Plan 002,19524NE018,,NEN001,NES002,NEF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180011-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180011,Assurant Health Silver Plan 002,19524NE018,,NEN001,NES002,NEF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180011-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180011,Assurant Health Silver Plan 002,19524NE018,,NEN001,NES002,NEF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,13
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180011,Assurant Health Silver Plan 002,19524NE018,,NEN001,NES002,NEF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180011-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180011,Assurant Health Silver Plan 002,19524NE018,,NEN001,NES002,NEF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180011-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,1,29678,NE,SHOP (Small Group),No,47-0095156,29678NE1120001,BluePride Option 101 Gold,29678NE112,,NEN001,NES001,NEF008,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/bp101gold_sbc,,nebraskabluecom/bluepride_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_SmallGroup4TPDL.pdf,29678NE1120001-00,Standard Gold Off Exchange Plan,80.55%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000",$500,"$1,000",30%,,,,"$1,000","$2,000","$1,500","$3,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,000",$40,"$1,800",$200,$300,"$1,700",$0,$0,4
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,1,29678,NE,SHOP (Small Group),No,47-0095156,29678NE1120001,BluePride Option 101 Gold,29678NE112,,NEN001,NES001,NEF008,Existing,PPO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/bp101gold_sbc,,nebraskabluecom/bluepride_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_SmallGroup4TPDL.pdf,29678NE1120001-01,Standard Gold On Exchange Plan,80.55%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000",$500,"$1,000",30%,,,,"$1,000","$2,000","$1,500","$3,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,000",$40,"$1,800",$200,$300,"$1,700",$0,$0,5
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,7,29678,NE,Individual,No,47-0095156,29678NE0970001,SelectBlue 1500 HSA Silver,29678NE097,,NEN002,NES002,NEF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb1500HSAsilver_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0970001-05,87% AV Level Silver Plan,87.98%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,500","$3,000","$12,000","$24,000","$13,000","$26,000",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,"$1,000","$1,500",20%,"$6,000","$12,000","$6,500","$13,000","$1,000",$0,$500,$200,$500,$0,$500,$0,9
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,7,29678,NE,Individual,No,47-0095156,29678NE0970001,SelectBlue 1500 HSA Silver,29678NE097,,NEN002,NES002,NEF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb1500HSAsilver_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0970001-06,94% AV Level Silver Plan,94.46%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$400,$800,$600,"$1,200","$12,000","$24,000","$12,400","$24,800",,,,,,,,,,,,,,,,,,,,,$200,$400,10%,$300,$600,10%,"$6,000","$12,000","$6,200","$12,400",$400,$0,$300,$200,$200,$0,$200,$0,10
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,7,29678,NE,Individual,No,47-0095156,29678NE0980001,SelectBlue 2750 HSA Bronze,29678NE098,,NEN002,NES002,NEF005,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb2750HSAbronze_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0980001-00,Standard Bronze Off Exchange Plan,61.48%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,500","$11,000","$6,350","$12,700","$12,700","$25,400","$18,200","$36,600",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,"$5,000","$10,000",50%,"$10,000","$20,000","$12,750","$25,250","$3,600",$0,"$1,400",$200,"$2,800",$0,"$1,000",$0,11
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,7,29678,NE,Individual,No,47-0095156,29678NE0980001,SelectBlue 2750 HSA Bronze,29678NE098,,NEN002,NES002,NEF005,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb2750HSAbronze_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0980001-01,Standard Bronze On Exchange Plan,61.48%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,500","$11,000","$6,350","$12,700","$12,700","$25,400","$18,200","$36,600",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,"$5,000","$10,000",50%,"$10,000","$20,000","$12,750","$25,250","$3,600",$0,"$1,400",$200,"$2,800",$0,"$1,000",$0,12
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180010,Assurant Health Silver Plan 002,19524NE018,,NEN001,NES001,NEF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180010-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180010,Assurant Health Silver Plan 002,19524NE018,,NEN001,NES001,NEF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180010-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180002,Assurant Health Bronze Plan 001,19524NE018,,NEN001,NES002,NEF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180002-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180002,Assurant Health Bronze Plan 001,19524NE018,,NEN001,NES002,NEF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,10
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180002,Assurant Health Bronze Plan 001,19524NE018,,NEN001,NES002,NEF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180002-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180003,Assurant Health Bronze Plan 001,19524NE018,,NEN001,NES003,NEF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180003-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180003,Assurant Health Bronze Plan 001,19524NE018,,NEN001,NES003,NEF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180003-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180003,Assurant Health Bronze Plan 001,19524NE018,,NEN001,NES003,NEF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,14
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180003,Assurant Health Bronze Plan 001,19524NE018,,NEN001,NES003,NEF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180003-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180004,Assurant Health Silver Plan 001,19524NE018,,NEN001,NES001,NEF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180004-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180004,Assurant Health Silver Plan 001,19524NE018,,NEN001,NES001,NEF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180004-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180004,Assurant Health Silver Plan 001,19524NE018,,NEN001,NES001,NEF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,18
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180004,Assurant Health Silver Plan 001,19524NE018,,NEN001,NES001,NEF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180004-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180004,Assurant Health Silver Plan 001,19524NE018,,NEN001,NES001,NEF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180004-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180004,Assurant Health Silver Plan 001,19524NE018,,NEN001,NES001,NEF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180004-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180004,Assurant Health Silver Plan 001,19524NE018,,NEN001,NES001,NEF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180004-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180005,Assurant Health Silver Plan 001,19524NE018,,NEN001,NES002,NEF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180005-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180005,Assurant Health Silver Plan 001,19524NE018,,NEN001,NES002,NEF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180005-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180005,Assurant Health Silver Plan 001,19524NE018,,NEN001,NES002,NEF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,25
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180005,Assurant Health Silver Plan 001,19524NE018,,NEN001,NES002,NEF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180005-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180005,Assurant Health Silver Plan 001,19524NE018,,NEN001,NES002,NEF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180005-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180005,Assurant Health Silver Plan 001,19524NE018,,NEN001,NES002,NEF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180005-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180006,Assurant Health Silver Plan 001,19524NE018,,NEN001,NES003,NEF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180006-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,1,19524,NE,Individual,No,39-0658730,19524NE0180006,Assurant Health Silver Plan 001,19524NE018,,NEN001,NES003,NEF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180006-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,2,19524,NE,Individual,No,39-0658730,19524NE0180007,Assurant Health Bronze Plan 002,19524NE018,,NEN001,NES001,NEF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180007-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,2,19524,NE,Individual,No,39-0658730,19524NE0180007,Assurant Health Bronze Plan 002,19524NE018,,NEN001,NES001,NEF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180007-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,2,19524,NE,Individual,No,39-0658730,19524NE0180007,Assurant Health Bronze Plan 002,19524NE018,,NEN001,NES001,NEF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,2,19524,NE,Individual,No,39-0658730,19524NE0180007,Assurant Health Bronze Plan 002,19524NE018,,NEN001,NES001,NEF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180007-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,2,19524,NE,Individual,No,39-0658730,19524NE0180008,Assurant Health Bronze Plan 002,19524NE018,,NEN001,NES002,NEF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180008-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,2,19524,NE,Individual,No,39-0658730,19524NE0180008,Assurant Health Bronze Plan 002,19524NE018,,NEN001,NES002,NEF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180008-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,2,19524,NE,Individual,No,39-0658730,19524NE0180008,Assurant Health Bronze Plan 002,19524NE018,,NEN001,NES002,NEF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180008-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,10
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,2,19524,NE,Individual,No,39-0658730,19524NE0180008,Assurant Health Bronze Plan 002,19524NE018,,NEN001,NES002,NEF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180008-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,2,19524,NE,Individual,No,39-0658730,19524NE0180009,Assurant Health Bronze Plan 002,19524NE018,,NEN001,NES003,NEF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180009-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,2,19524,NE,Individual,No,39-0658730,19524NE0180009,Assurant Health Bronze Plan 002,19524NE018,,NEN001,NES003,NEF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180009-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,2,19524,NE,Individual,No,39-0658730,19524NE0180009,Assurant Health Bronze Plan 002,19524NE018,,NEN001,NES003,NEF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180009-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,14
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,2,19524,NE,Individual,No,39-0658730,19524NE0180009,Assurant Health Bronze Plan 002,19524NE018,,NEN001,NES003,NEF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,19524NE0180009-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180010,Assurant Health Silver Plan 002,19524NE018,,NEN001,NES001,NEF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180010-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180010,Assurant Health Silver Plan 002,19524NE018,,NEN001,NES001,NEF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180010-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,1,29678,NE,Individual,No,47-0095156,29678NE1040001,BlueEssentials 2500 Silver,29678NE104,,NEN001,NES003,NEF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be2500silver_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1040001-05,87% AV Level Silver Plan,87.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,700","$25,400","$14,200","$28,400",$750,"$1,500",20%,,,,"$5,000","$10,000","$5,750","$11,500",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,500",$20,$700,$200,$300,"$1,200",$0,$0,13
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,1,29678,NE,Individual,No,47-0095156,29678NE1040001,BlueEssentials 2500 Silver,29678NE104,,NEN001,NES003,NEF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be2500silver_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1040001-06,94% AV Level Silver Plan,93.73%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$450,$900,,,"$12,700","$25,400","$13,150","$26,300",$225,$450,10%,,,,"$5,000","$10,000","$5,225","$10,450",$0,$0,10%,,,,$0,$0,$0,$0,,,,,,,,,,,$500,$10,$300,$200,$100,$300,$0,$0,14
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,7,29678,NE,Individual,No,47-0095156,29678NE0980002,SelectBlue 4750 HSA Bronze,29678NE098,,NEN002,NES002,NEF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb4750HSAbronze_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0980002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$0,17
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,7,29678,NE,Individual,No,47-0095156,29678NE0980002,SelectBlue 4750 HSA Bronze,29678NE098,,NEN002,NES002,NEF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb4750HSAbronze_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0980002-03,Limited Cost Sharing Plan Variation,58.88%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,750","$9,500","$6,350","$12,700","$12,700","$25,400","$17,950","$35,900",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",1%,"$6,350","$12,700",0%,"$12,700","$25,400","$17,450","$34,900","$5,600",$0,$0,$200,"$4,800",$0,$60,$0,18
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,8,29678,NE,Individual,No,47-0095156,29678NE1090001,BlueEssentials 1900 HSA Silver,29678NE109,,NEN001,NES003,NEF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be1900HSAsilver_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1090001-00,Standard Silver Off Exchange Plan,68.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800",20%,,,,"$3,800","$7,600","$5,700","$11,400","$2,800",$0,$900,$200,"$1,900",$0,$700,$0,4
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,8,29678,NE,Individual,No,47-0095156,29678NE1090001,BlueEssentials 1900 HSA Silver,29678NE109,,NEN001,NES003,NEF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be1900HSAsilver_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1090001-01,Standard Silver On Exchange Plan,68.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800",20%,,,,"$3,800","$7,600","$5,700","$11,400","$2,800",$0,$900,$200,"$1,900",$0,$700,$0,5
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,8,29678,NE,Individual,No,47-0095156,29678NE1090001,BlueEssentials 1900 HSA Silver,29678NE109,,NEN001,NES003,NEF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be1900HSAsilver_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1090001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$0,6
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,8,29678,NE,Individual,No,47-0095156,29678NE1090001,BlueEssentials 1900 HSA Silver,29678NE109,,NEN001,NES003,NEF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be1900HSAsilver_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1090001-03,Limited Cost Sharing Plan Variation,68.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800",20%,,,,"$3,800","$7,600","$5,700","$11,400","$2,800",$0,$900,$200,"$1,900",$0,$700,$0,7
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180011,Assurant Health Silver Plan 002,19524NE018,,NEN001,NES002,NEF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180011-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180011,Assurant Health Silver Plan 002,19524NE018,,NEN001,NES002,NEF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180011-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180012,Assurant Health Silver Plan 002,19524NE018,,NEN001,NES003,NEF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180012-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180012,Assurant Health Silver Plan 002,19524NE018,,NEN001,NES003,NEF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180012-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180012,Assurant Health Silver Plan 002,19524NE018,,NEN001,NES003,NEF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180012-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,20
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180012,Assurant Health Silver Plan 002,19524NE018,,NEN001,NES003,NEF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180012-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180012,Assurant Health Silver Plan 002,19524NE018,,NEN001,NES003,NEF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180012-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180012,Assurant Health Silver Plan 002,19524NE018,,NEN001,NES003,NEF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180012-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180012,Assurant Health Silver Plan 002,19524NE018,,NEN001,NES003,NEF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180012-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180013,Assurant Health Gold Plan 002,19524NE018,,NEN001,NES001,NEF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180013-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180013,Assurant Health Gold Plan 002,19524NE018,,NEN001,NES001,NEF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180013-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180013,Assurant Health Gold Plan 002,19524NE018,,NEN001,NES001,NEF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,27
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180013,Assurant Health Gold Plan 002,19524NE018,,NEN001,NES001,NEF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180013-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180015,Assurant Health Gold Plan 002,19524NE018,,NEN001,NES003,NEF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180015-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,35
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180016,Assurant Health Platinum Plan 002,19524NE018,,NEN001,NES001,NEF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180016-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180016,Assurant Health Platinum Plan 002,19524NE018,,NEN001,NES001,NEF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,39
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180016,Assurant Health Platinum Plan 002,19524NE018,,NEN001,NES001,NEF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180016-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180017,Assurant Health Platinum Plan 002,19524NE018,,NEN001,NES002,NEF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180017-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180017,Assurant Health Platinum Plan 002,19524NE018,,NEN001,NES002,NEF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180017-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180018,Assurant Health Platinum Plan 002,19524NE018,,NEN001,NES003,NEF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180018-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180018,Assurant Health Platinum Plan 002,19524NE018,,NEN001,NES003,NEF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180018-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,46
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180018,Assurant Health Platinum Plan 002,19524NE018,,NEN001,NES003,NEF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180018-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,47
2015,NE,19524,SERFF,10,2014-11-14 14:52:18,3,19524,NE,Individual,No,39-0658730,19524NE0180018,Assurant Health Platinum Plan 002,19524NE018,,NEN001,NES003,NEF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NE_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NE.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,19524NE0180018-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,NE,26099,SERFF,2,2014-09-04 06:14:21,1,26099,NE,SHOP (Small Group),Yes,47-0322111,26099NE0010001,Certfied Dental Plan 1,26099NE001,,NEN001,NES001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.04,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,26099NE0010001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,26099,SERFF,2,2014-09-04 06:14:21,1,26099,NE,SHOP (Small Group),Yes,47-0322111,26099NE0010002,Certfied Dental Plan 2,26099NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.40,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,26099NE0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,26099,SERFF,2,2014-09-04 06:14:21,1,26099,NE,SHOP (Small Group),Yes,47-0322111,26099NE0010003,Certfied Dental Plan 3,26099NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.46,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,26099NE0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NE,26099,SERFF,2,2014-09-04 06:14:21,1,26099,NE,SHOP (Small Group),Yes,47-0322111,26099NE0010004,Certfied Dental Plan 4,26099NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.77,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"Allows for out of Service Area, if inside of Country",Yes,,,,,26099NE0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,1,29678,NE,Individual,No,47-0095156,29678NE1030001,BlueEssentials 1000 Gold,29678NE103,,NEN001,NES003,NEF017,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be1000gold_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1030001-00,Standard Gold Off Exchange Plan,78.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,900",$30,"$1,100",$200,$300,"$1,700",$0,$0,4
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,1,29678,NE,Individual,No,47-0095156,29678NE1030001,BlueEssentials 1000 Gold,29678NE103,,NEN001,NES003,NEF017,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be1000gold_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1030001-01,Standard Gold On Exchange Plan,78.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,900",$30,"$1,100",$200,$300,"$1,700",$0,$0,5
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,1,29678,NE,Individual,No,47-0095156,29678NE1030001,BlueEssentials 1000 Gold,29678NE103,,NEN001,NES003,NEF017,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be1000gold_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1030001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$0,6
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,1,29678,NE,Individual,No,47-0095156,29678NE1030001,BlueEssentials 1000 Gold,29678NE103,,NEN001,NES003,NEF017,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be1000gold_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1030001-03,Limited Cost Sharing Plan Variation,78.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,900",$30,"$1,100",$200,$300,"$1,700",$0,$0,7
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,1,29678,NE,Individual,No,47-0095156,29678NE1040001,BlueEssentials 2500 Silver,29678NE104,,NEN001,NES003,NEF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be2500silver_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1040001-00,Standard Silver Off Exchange Plan,70.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,500","$5,000",20%,,,,"$5,000","$10,000","$7,500","$15,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,"$3,400",$30,$800,$200,$300,"$1,800",$0,$0,8
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,1,29678,NE,Individual,No,47-0095156,29678NE1040001,BlueEssentials 2500 Silver,29678NE104,,NEN001,NES003,NEF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be2500silver_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1040001-01,Standard Silver On Exchange Plan,70.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,500","$5,000",20%,,,,"$5,000","$10,000","$7,500","$15,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,"$3,400",$30,$800,$200,$300,"$1,800",$0,$0,9
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,1,29678,NE,Individual,No,47-0095156,29678NE1040001,BlueEssentials 2500 Silver,29678NE104,,NEN001,NES003,NEF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be2500silver_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1040001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$0,10
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,1,29678,NE,Individual,No,47-0095156,29678NE1040001,BlueEssentials 2500 Silver,29678NE104,,NEN001,NES003,NEF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be2500silver_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1040001-03,Limited Cost Sharing Plan Variation,70.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,500","$5,000",20%,,,,"$5,000","$10,000","$7,500","$15,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,"$3,400",$30,$800,$200,$300,"$1,800",$0,$0,11
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,1,29678,NE,Individual,No,47-0095156,29678NE1040001,BlueEssentials 2500 Silver,29678NE104,,NEN001,NES003,NEF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be2500silver_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1040001-04,73% AV Level Silver Plan,73.21%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,700","$25,400","$17,700","$35,400","$2,000","$4,000",20%,,,,"$5,000","$10,000","$7,000","$14,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,900",$30,$900,$200,$300,"$1,800",$0,$0,12
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,2,29678,NE,Individual,No,47-0095156,29678NE0930001,SelectBlue 2000 Silver,29678NE093,,NEN002,NES002,NEF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb2000silver_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0930001-00,Standard Silver Off Exchange Plan,71.66%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,350","$12,700","$12,700","$25,400","$17,700","$35,400","$2,000","$4,000",30%,"$4,000","$8,000",50%,"$8,000","$16,000","$12,000","$24,000",$0,$0,30%,$0,$0,50%,$0,$0,$0,$0,,,,,,,,,,,"$2,900",$30,"$1,300",$200,$300,"$1,700",$0,$0,4
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,2,29678,NE,Individual,No,47-0095156,29678NE0930001,SelectBlue 2000 Silver,29678NE093,,NEN002,NES002,NEF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb2000silver_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0930001-01,Standard Silver On Exchange Plan,71.66%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,350","$12,700","$12,700","$25,400","$17,700","$35,400","$2,000","$4,000",30%,"$4,000","$8,000",50%,"$8,000","$16,000","$12,000","$24,000",$0,$0,30%,$0,$0,50%,$0,$0,$0,$0,,,,,,,,,,,"$2,900",$30,"$1,300",$200,$300,"$1,700",$0,$0,5
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,2,29678,NE,Individual,No,47-0095156,29678NE0930001,SelectBlue 2000 Silver,29678NE093,,NEN002,NES002,NEF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb2000silver_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0930001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$0,6
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,2,29678,NE,Individual,No,47-0095156,29678NE0930001,SelectBlue 2000 Silver,29678NE093,,NEN002,NES002,NEF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb2000silver_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0930001-03,Limited Cost Sharing Plan Variation,71.66%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,350","$12,700","$12,700","$25,400","$17,700","$35,400","$2,000","$4,000",30%,"$4,000","$8,000",50%,"$8,000","$16,000","$12,000","$24,000",$0,$0,30%,$0,$0,50%,$0,$0,$0,$0,,,,,,,,,,,"$2,900",$30,"$1,300",$200,$300,"$1,700",$0,$0,7
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,2,29678,NE,Individual,No,47-0095156,29678NE0930001,SelectBlue 2000 Silver,29678NE093,,NEN002,NES002,NEF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb2000silver_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0930001-04,73% AV Level Silver Plan,74.00%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,200","$10,400","$12,700","$25,400","$16,700","$33,400","$2,000","$4,000",30%,"$4,000","$8,000",50%,"$8,000","$16,000","$9,500","$19,000",$0,$0,30%,$0,$0,50%,$0,$0,$0,$0,,,,,,,,,,,"$2,900",$30,"$1,300",$200,$300,"$1,700",$0,$0,8
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,2,29678,NE,Individual,No,47-0095156,29678NE0930001,SelectBlue 2000 Silver,29678NE093,,NEN002,NES002,NEF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb2000silver_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0930001-05,87% AV Level Silver Plan,87.55%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,100","$2,200","$2,200","$4,400","$12,700","$25,400","$13,800","$27,600",$550,"$1,100",20%,"$1,100","$2,200",50%,"$8,000","$16,000","$8,550","$17,100",$0,$0,20%,$0,$0,50%,$0,$0,$0,$0,,,,,,,,,,,"$1,100",$20,$600,$200,$200,$900,$0,$0,9
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,2,29678,NE,Individual,No,47-0095156,29678NE0930001,SelectBlue 2000 Silver,29678NE093,,NEN002,NES002,NEF006,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb2000silver_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0930001-06,94% AV Level Silver Plan,94.24%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$350,$700,$700,"$1,400","$12,700","$25,400","$13,050","$26,100",$175,$350,20%,$350,$700,50%,"$8,000","$16,000","$8,175","$16,350",$0,$0,20%,$0,$0,50%,$0,$0,$0,$0,,,,,,,,,,,$400,$20,$300,$20,$90,$300,$0,$0,10
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,2,29678,NE,Individual,No,47-0095156,29678NE0920001,SelectBlue 750 Gold,29678NE092,,NEN002,NES002,NEF017,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb750gold_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0920001-00,Standard Gold Off Exchange Plan,80.07%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$2,500","$5,000","$5,000","$10,000","$10,000","$20,000","$12,500","$25,000",$750,"$1,500",10%,"$2,000","$4,000",50%,"$4,000","$8,000","$4,750","$9,500",$0,$0,10%,$0,$0,20%,$0,$0,$0,$0,,,,,,,,,,,"$1,500",$30,$600,$200,$300,"$1,700",$0,$0,11
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,2,29678,NE,Individual,No,47-0095156,29678NE0920001,SelectBlue 750 Gold,29678NE092,,NEN002,NES002,NEF017,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb750gold_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0920001-01,Standard Gold On Exchange Plan,80.07%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$2,500","$5,000","$5,000","$10,000","$10,000","$20,000","$12,500","$25,000",$750,"$1,500",10%,"$2,000","$4,000",50%,"$4,000","$8,000","$4,750","$9,500",$0,$0,10%,$0,$0,20%,$0,$0,$0,$0,,,,,,,,,,,"$1,500",$30,$600,$200,$300,"$1,700",$0,$0,12
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,2,29678,NE,Individual,No,47-0095156,29678NE0920001,SelectBlue 750 Gold,29678NE092,,NEN002,NES002,NEF017,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb750gold_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0920001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$0,13
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,2,29678,NE,Individual,No,47-0095156,29678NE0920001,SelectBlue 750 Gold,29678NE092,,NEN002,NES002,NEF017,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb750gold_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0920001-03,Limited Cost Sharing Plan Variation,80.07%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$2,500","$5,000","$5,000","$10,000","$10,000","$20,000","$12,500","$25,000",$750,"$1,500",10%,"$2,000","$4,000",50%,"$4,000","$8,000","$4,750","$9,500",$0,$0,10%,$0,$0,20%,$0,$0,$0,$0,,,,,,,,,,,"$1,500",$30,$600,$200,$300,"$1,700",$0,$0,14
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,3,29678,NE,SHOP (Small Group),No,47-0095156,29678NE1140001,BluePride Option 201 Silver,29678NE114,,NEN001,NES001,NEF008,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/bp201silver_sbc,,nebraskabluecom/bluepride_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_SmallGroup4TPDL.pdf,29678NE1140001-00,Standard Silver Off Exchange Plan,70.43%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,900",$40,"$1,300",$200,$300,"$1,800",$0,$0,4
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,3,29678,NE,Individual,No,47-0095156,29678NE1050004,BlueEssentials 5500 Bronze,29678NE105,,NEN001,NES001,NEF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be5500bronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1050004-00,Standard Bronze Off Exchange Plan,60.68%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000","$16,500","$33,000","$6,400",$0,$200,$200,"$1,100","$1,400",$0,$0,4
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,3,29678,NE,Individual,No,47-0095156,29678NE1050004,BlueEssentials 5500 Bronze,29678NE105,,NEN001,NES001,NEF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be5500bronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1050004-01,Standard Bronze On Exchange Plan,60.68%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000","$16,500","$33,000","$6,400",$0,$200,$200,"$1,100","$1,400",$0,$0,5
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,3,29678,NE,SHOP (Small Group),No,47-0095156,29678NE1140001,BluePride Option 201 Silver,29678NE114,,NEN001,NES001,NEF008,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$100,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/bp201silver_sbc,,nebraskabluecom/bluepride_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_SmallGroup4TPDL.pdf,29678NE1140001-01,Standard Silver On Exchange Plan,70.43%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,900",$40,"$1,300",$200,$300,"$1,800",$0,$0,5
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,3,29678,NE,Individual,No,47-0095156,29678NE1050004,BlueEssentials 5500 Bronze,29678NE105,,NEN001,NES001,NEF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be5500bronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1050004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$0,6
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,3,29678,NE,Individual,No,47-0095156,29678NE1050004,BlueEssentials 5500 Bronze,29678NE105,,NEN001,NES001,NEF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be5500bronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1050004-03,Limited Cost Sharing Plan Variation,60.68%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$11,000","$22,000","$16,500","$33,000","$6,400",$0,$200,$200,"$1,100","$1,400",$0,$0,7
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,4,29678,NE,Individual,No,47-0095156,29678NE0940001,SelectBlue 4500 Bronze,29678NE094,,NEN002,NES002,NEF016,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb4500bronze_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0940001-00,Standard Bronze Off Exchange Plan,61.90%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,600","$13,200","$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,"$6,600","$13,200",0%,"$12,700","$25,400","$17,200","$34,400","$5,400",$30,$400,$200,$900,"$1,700",$0,$0,4
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,4,29678,NE,Individual,No,47-0095156,29678NE0940001,SelectBlue 4500 Bronze,29678NE094,,NEN002,NES002,NEF016,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb4500bronze_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0940001-01,Standard Bronze On Exchange Plan,61.90%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,600","$13,200","$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,"$6,600","$13,200",0%,"$12,700","$25,400","$17,200","$34,400","$5,400",$30,$400,$200,$900,"$1,700",$0,$0,5
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,4,29678,NE,Individual,No,47-0095156,29678NE0940001,SelectBlue 4500 Bronze,29678NE094,,NEN002,NES002,NEF016,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb4500bronze_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0940001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$0,6
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,4,29678,NE,Individual,No,47-0095156,29678NE0940001,SelectBlue 4500 Bronze,29678NE094,,NEN002,NES002,NEF016,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb4500bronze_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0940001-03,Limited Cost Sharing Plan Variation,61.90%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,600","$13,200","$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",20%,"$6,600","$13,200",0%,"$12,700","$25,400","$17,200","$34,400","$5,400",$30,$400,$200,$900,"$1,700",$0,$0,7
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,5,29678,NE,Individual,No,47-0095156,29678NE1050001,BlueEssentials 3500 Bronze,29678NE105,,NEN001,NES001,NEF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be3500bronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1050001-00,Standard Bronze Off Exchange Plan,61.07%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",50%,,,,"$7,000","$14,000","$10,500","$21,000","$4,400",$20,"$1,400",$200,"$3,500",$100,$800,$0,4
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,5,29678,NE,Individual,No,47-0095156,29678NE1050001,BlueEssentials 3500 Bronze,29678NE105,,NEN001,NES001,NEF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be3500bronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1050001-01,Standard Bronze On Exchange Plan,61.07%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",50%,,,,"$7,000","$14,000","$10,500","$21,000","$4,400",$20,"$1,400",$200,"$3,500",$100,$800,$0,5
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,5,29678,NE,Individual,No,47-0095156,29678NE1050001,BlueEssentials 3500 Bronze,29678NE105,,NEN001,NES001,NEF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be3500bronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1050001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$0,6
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,5,29678,NE,Individual,No,47-0095156,29678NE1050001,BlueEssentials 3500 Bronze,29678NE105,,NEN001,NES001,NEF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be3500bronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1050001-03,Limited Cost Sharing Plan Variation,61.07%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",50%,,,,"$7,000","$14,000","$10,500","$21,000","$4,400",$20,"$1,400",$200,"$3,500",$100,$800,$0,7
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,6,29678,NE,Individual,No,47-0095156,29678NE1050003,BlueEssentials 4500 Bronze,29678NE105,,NEN001,NES001,NEF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be4500bronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1050003-00,Standard Bronze Off Exchange Plan,61.46%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,"$9,000","$18,000","$13,500","$27,000","$5,400",$0,$500,$200,"$1,100","$1,400",$0,$0,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,3,45550,NE,Individual,Yes,47-0685003,45550NE0030001,Pediatric Dental A + Adult B,45550NE003,,NEN001,NES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0030001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,4,45550,NE,Individual,Yes,47-0685003,45550NE0040001,Pediatric Dental A + Adult C,45550NE004,,NEN001,NES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,4,45550,NE,SHOP (Small Group),Yes,47-0685003,45550NE0200001,Pediatric Dental A + Adult C,45550NE020,,NEN001,NES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0200001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,4,45550,NE,Individual,Yes,47-0685003,45550NE0040001,Pediatric Dental A + Adult C,45550NE004,,NEN001,NES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0040001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,5,45550,NE,Individual,Yes,47-0685003,45550NE0050001,Pediatric Dental A + Adult D,45550NE005,,NEN001,NES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0050001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,5,45550,NE,SHOP (Small Group),Yes,47-0685003,45550NE0210001,Pediatric Dental A + Adult D,45550NE021,,NEN001,NES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0210001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,5,45550,NE,Individual,Yes,47-0685003,45550NE0050001,Pediatric Dental A + Adult D,45550NE005,,NEN001,NES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0050001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,6,45550,NE,Individual,Yes,47-0685003,45550NE0060001,Pediatric Dental A + Adult E,45550NE006,,NEN001,NES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0060001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,6,45550,NE,SHOP (Small Group),Yes,47-0685003,45550NE0220001,Pediatric Dental A + Adult E,45550NE022,,NEN001,NES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0220001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,6,45550,NE,Individual,Yes,47-0685003,45550NE0060001,Pediatric Dental A + Adult E,45550NE006,,NEN001,NES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0060001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,7,45550,NE,Individual,Yes,47-0685003,45550NE0070001,Pediatric Dental A + Adult F,45550NE007,,NEN001,NES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0070001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,7,45550,NE,SHOP (Small Group),Yes,47-0685003,45550NE0230001,Pediatric Dental A + Adult F,45550NE023,,NEN001,NES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0230001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,7,45550,NE,Individual,Yes,47-0685003,45550NE0070001,Pediatric Dental A + Adult F,45550NE007,,NEN001,NES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0070001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,8,45550,NE,Individual,Yes,47-0685003,45550NE0080001,Pediatric Dental A + Adult G,45550NE008,,NEN001,NES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0080001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,8,45550,NE,SHOP (Small Group),Yes,47-0685003,45550NE0240001,Pediatric Dental A + Adult G,45550NE024,,NEN001,NES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0240001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,8,45550,NE,Individual,Yes,47-0685003,45550NE0080001,Pediatric Dental A + Adult G,45550NE008,,NEN001,NES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0080001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,9,45550,NE,Individual,Yes,47-0685003,45550NE0090001,Pediatric Dental B,45550NE009,,NEN001,NES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0090001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,9,45550,NE,SHOP (Small Group),Yes,47-0685003,45550NE0250001,Pediatric Dental B,45550NE025,,NEN001,NES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0250001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,1,19304,NH,Individual,No,45-3416923,19304NH0010001,Community Safe Harbor,19304NH001,,NHN001,NHS001,NHF001,New,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9967,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-SAFEHARBOR-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0010001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,2,19304,NH,SHOP (Small Group),No,45-3416923,19304NH0170001,Community Option,19304NH017,,NHN001,NHS001,NHF003,New,PPO,Bronze,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9969,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-SG-OPTION-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,www.communityoptions.coop,19304NH0170001-00,Standard Bronze Off Exchange Plan,61.70%,0.58194237947464,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,6,29678,NE,Individual,No,47-0095156,29678NE1050003,BlueEssentials 4500 Bronze,29678NE105,,NEN001,NES001,NEF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be4500bronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1050003-01,Standard Bronze On Exchange Plan,61.46%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,"$9,000","$18,000","$13,500","$27,000","$5,400",$0,$500,$200,"$1,100","$1,400",$0,$0,5
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,6,29678,NE,Individual,No,47-0095156,29678NE1050003,BlueEssentials 4500 Bronze,29678NE105,,NEN001,NES001,NEF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be4500bronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1050003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$0,6
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,6,29678,NE,Individual,No,47-0095156,29678NE1050003,BlueEssentials 4500 Bronze,29678NE105,,NEN001,NES001,NEF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be4500bronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1050003-03,Limited Cost Sharing Plan Variation,61.46%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,"$9,000","$18,000","$13,500","$27,000","$5,400",$0,$500,$200,"$1,100","$1,400",$0,$0,7
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,7,29678,NE,Individual,No,47-0095156,29678NE0970001,SelectBlue 1500 HSA Silver,29678NE097,,NEN002,NES002,NEF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb1500HSAsilver_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0970001-00,Standard Silver Off Exchange Plan,69.84%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$6,000","$12,000","$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,"$3,000","$6,000",40%,"$6,000","$12,000","$7,500","$15,000","$2,400",$0,"$1,000",$200,"$1,500",$0,$800,$0,4
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,7,29678,NE,Individual,No,47-0095156,29678NE0970001,SelectBlue 1500 HSA Silver,29678NE097,,NEN002,NES002,NEF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb1500HSAsilver_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0970001-01,Standard Silver On Exchange Plan,69.84%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$6,000","$12,000","$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,"$3,000","$6,000",40%,"$6,000","$12,000","$7,500","$15,000","$2,400",$0,"$1,000",$200,"$1,500",$0,$800,$0,5
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,7,29678,NE,Individual,No,47-0095156,29678NE0970001,SelectBlue 1500 HSA Silver,29678NE097,,NEN002,NES002,NEF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb1500HSAsilver_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0970001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$0,6
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,7,29678,NE,Individual,No,47-0095156,29678NE0970001,SelectBlue 1500 HSA Silver,29678NE097,,NEN002,NES002,NEF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb1500HSAsilver_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0970001-03,Limited Cost Sharing Plan Variation,69.84%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$6,000","$12,000","$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,"$3,000","$6,000",40%,"$6,000","$12,000","$7,500","$15,000",$0,$0,"$1,000",$200,"$1,500",$0,$800,$0,7
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,7,29678,NE,Individual,No,47-0095156,29678NE0970001,SelectBlue 1500 HSA Silver,29678NE097,,NEN002,NES002,NEF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb1500HSAsilver_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0970001-04,73% AV Level Silver Plan,73.54%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$4,500","$9,000","$12,000","$24,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,"$2,500","$5,000",30%,"$6,000","$12,000","$7,250","$14,500","$2,200",$0,"$1,000",$200,"$1,300",$0,$800,$0,8
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,7,29678,NE,Individual,No,47-0095156,29678NE0980001,SelectBlue 2750 HSA Bronze,29678NE098,,NEN002,NES002,NEF005,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb2750HSAbronze_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0980001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$0,13
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,7,29678,NE,Individual,No,47-0095156,29678NE0980001,SelectBlue 2750 HSA Bronze,29678NE098,,NEN002,NES002,NEF005,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb2750HSAbronze_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0980001-03,Limited Cost Sharing Plan Variation,61.48%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,500","$11,000","$6,350","$12,700","$12,700","$25,400","$18,200","$36,600",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,"$5,000","$10,000",50%,"$10,000","$20,000","$12,750","$25,250","$3,600",$0,"$1,400",$200,"$2,800",$0,"$1,000",$0,14
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,7,29678,NE,Individual,No,47-0095156,29678NE0980002,SelectBlue 4750 HSA Bronze,29678NE098,,NEN002,NES002,NEF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb4750HSAbronze_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0980002-00,Standard Bronze Off Exchange Plan,58.88%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,750","$9,500","$6,350","$12,700","$12,700","$25,400","$17,950","$35,900",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",1%,"$6,350","$12,700",0%,"$12,700","$25,400","$17,450","$34,900","$5,600",$0,$0,$200,"$4,800",$0,$0,$0,15
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,7,29678,NE,Individual,No,47-0095156,29678NE0980002,SelectBlue 4750 HSA Bronze,29678NE098,,NEN002,NES002,NEF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/m_sb4750HSAbronze_sbc,,nebraskablue.com/selectblue_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE0980002-01,Standard Bronze On Exchange Plan,58.88%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,750","$9,500","$6,350","$12,700","$12,700","$25,400","$17,950","$35,900",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",1%,"$6,350","$12,700",0%,"$12,700","$25,400","$17,450","$34,900","$5,600",$0,$0,$200,"$4,800",$0,$60,$0,16
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,16,45550,NE,Individual,Yes,47-0685003,45550NE0160001,Pediatric Dental B + Adult G,45550NE016,,NEN001,NES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0160001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,1,50022,NE,Individual,Yes,95-6042390,50022NE0020001,BESTOne Child Dental Plus,50022NE002,,NEN001,NES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$39.44,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BESTOne_Child_Dental_Plus_Plan.pdf,,50022NE0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,1,50022,NE,SHOP (Small Group),Yes,95-6042390,50022NE0010001,BEST Life Child Dental Plus,50022NE001,,NEN001,NES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$31.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BEST_Life_Child_Dental_Plus_Plan.pdf,,50022NE0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,2,50022,NE,SHOP (Small Group),Yes,95-6042390,50022NE0010002,BEST Life Child Dental,50022NE001,,NEN001,NES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.43,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BEST_Life_Child_Dental_Plan.pdf,,50022NE0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,2,50022,NE,Individual,Yes,95-6042390,50022NE0020002,BESTOne Child Dental,50022NE002,,NEN001,NES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$30.53,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BESTOne_Child_Dental_Plan.pdf,,50022NE0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,3,50022,NE,Individual,Yes,95-6042390,50022NE0020003,BESTOne Dental Advantage-Gold,50022NE002,,NEN001,NES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.44,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BESTOne_Dental_Advantage-Gold_Plan.pdf,,50022NE0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,3,50022,NE,SHOP (Small Group),Yes,95-6042390,50022NE0010007,BEST Dental Premium,50022NE001,,NEN001,NES001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BESTDental_Premium_Plan.pdf,,50022NE0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,3,50022,NE,SHOP (Small Group),Yes,95-6042390,50022NE0010007,BEST Dental Premium,50022NE001,,NEN001,NES001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BESTDental_Premium_Plan.pdf,,50022NE0010007-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,3,50022,NE,Individual,Yes,95-6042390,50022NE0020003,BESTOne Dental Advantage-Gold,50022NE002,,NEN001,NES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.44,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BESTOne_Dental_Advantage-Gold_Plan.pdf,,50022NE0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,3,50022,NE,SHOP (Small Group),Yes,95-6042390,50022NE0010008,BEST Dental Standard-H,50022NE001,,NEN001,NES001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BESTDental_Standard-H_Plan.pdf,,50022NE0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,3,50022,NE,Individual,Yes,95-6042390,50022NE0020004,BESTOne Dental Plus-Gold,50022NE002,,NEN001,NES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.44,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BESTOne_Dental_Plus-Gold_Plan.pdf,,50022NE0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,3,50022,NE,Individual,Yes,95-6042390,50022NE0020004,BESTOne Dental Plus-Gold,50022NE002,,NEN001,NES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.44,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BESTOne_Dental_Plus-Gold_Plan.pdf,,50022NE0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,3,50022,NE,SHOP (Small Group),Yes,95-6042390,50022NE0010008,BEST Dental Standard-H,50022NE001,,NEN001,NES001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BESTDental_Standard-H_Plan.pdf,,50022NE0010008-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,3,50022,NE,SHOP (Small Group),Yes,95-6042390,50022NE0010010,BEST Dental Choice-H,50022NE001,,NEN001,NES001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BESTDental_Choice-H_Plan.pdf,,50022NE0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,3,50022,NE,SHOP (Small Group),Yes,95-6042390,50022NE0010010,BEST Dental Choice-H,50022NE001,,NEN001,NES001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BESTDental_Choice-H_Plan.pdf,,50022NE0010010-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,8,29678,NE,Individual,No,47-0095156,29678NE1090001,BlueEssentials 1900 HSA Silver,29678NE109,,NEN001,NES003,NEF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be1900HSAsilver_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1090001-04,73% AV Level Silver Plan,72.63%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$12,700","$25,400","$17,300","$34,600",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,800","$7,600","$5,300","$10,600","$2,400",$0,"$1,000",$200,"$1,500",$0,$800,$0,8
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,8,29678,NE,Individual,No,47-0095156,29678NE1090001,BlueEssentials 1900 HSA Silver,29678NE109,,NEN001,NES003,NEF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be1900HSAsilver_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1090001-05,87% AV Level Silver Plan,87.38%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,700","$25,400","$13,950","$27,900",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$3,800","$7,600","$4,300","$8,600","$1,000",$0,$800,$200,$500,$0,$600,$0,9
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,8,29678,NE,Individual,No,47-0095156,29678NE1090001,BlueEssentials 1900 HSA Silver,29678NE109,,NEN001,NES003,NEF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be1900HSAsilver_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1090001-06,94% AV Level Silver Plan,94.37%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,700","$25,400","$13,200","$26,400",,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$3,800","$7,600","$4,000","$8,000",$400,$0,$400,$200,$200,$0,$300,$0,10
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,8,29678,NE,Individual,No,47-0095156,29678NE1100001,BlueEssentials 2500 HSA Bronze,29678NE110,,NEN001,NES001,NEF006,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be2500HSAbronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1100001-00,Standard Bronze Off Exchange Plan,60.91%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$5,000","$10,000","$7,500","$1,500","$3,400",$0,"$1,900",$200,"$2,500",$0,"$1,400",$0,11
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,8,29678,NE,Individual,No,47-0095156,29678NE1100001,BlueEssentials 2500 HSA Bronze,29678NE110,,NEN001,NES001,NEF006,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be2500HSAbronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1100001-01,Standard Bronze On Exchange Plan,60.91%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$5,000","$10,000","$7,500","$1,500","$3,400",$0,"$1,900",$200,"$2,500",$0,"$1,400",$0,12
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,8,29678,NE,Individual,No,47-0095156,29678NE1100001,BlueEssentials 2500 HSA Bronze,29678NE110,,NEN001,NES001,NEF006,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be2500HSAbronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1100001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$0,13
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,8,29678,NE,Individual,No,47-0095156,29678NE1100001,BlueEssentials 2500 HSA Bronze,29678NE110,,NEN001,NES001,NEF006,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be2500HSAbronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1100001-03,Limited Cost Sharing Plan Variation,60.91%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$5,000","$10,000","$7,500","$1,500","$3,400",$0,"$1,900",$200,"$2,500",$0,"$1,400",$0,14
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,8,29678,NE,Individual,No,47-0095156,29678NE1100003,BlueEssentials 4750 HSA Bronze,29678NE110,,NEN001,NES001,NEF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be4750HSAbronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1100003-00,Standard Bronze Off Exchange Plan,60.87%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",10%,,,,"$9,500","$19,000","$14,250","$28,500","$5,600",$0,$200,$200,"$4,800",$0,$60,$0,15
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,8,29678,NE,Individual,No,47-0095156,29678NE1100003,BlueEssentials 4750 HSA Bronze,29678NE110,,NEN001,NES001,NEF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be4750HSAbronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1100003-01,Standard Bronze On Exchange Plan,60.87%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",10%,,,,"$9,500","$19,000","$14,250","$28,500","$5,600",$0,$200,$200,"$4,800",$0,$60,$0,16
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,8,29678,NE,Individual,No,47-0095156,29678NE1100003,BlueEssentials 4750 HSA Bronze,29678NE110,,NEN001,NES001,NEF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be4750HSAbronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1100003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$0,17
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,8,29678,NE,Individual,No,47-0095156,29678NE1100003,BlueEssentials 4750 HSA Bronze,29678NE110,,NEN001,NES001,NEF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be4750HSAbronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1100003-03,Limited Cost Sharing Plan Variation,60.87%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",10%,,,,"$9,500","$19,000","$14,250","$28,500","$5,600",$0,$200,$200,"$4,800",$0,$60,$0,18
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,9,29678,NE,Individual,No,47-0095156,29678NE1060001,BlueEssentials 6600 Catastrophic,29678NE106,,NEN001,NES001,NEF004,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/catastrophic_aca,,nebraskablue.com/becatastrophic_sbc,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1060001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$3,800","$7,600","$5,300","$10,600","$7,200",$0,$0,$200,"$4,900",$0,$0,$0,4
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,9,29678,NE,Individual,No,47-0095156,29678NE1060001,BlueEssentials 6600 Catastrophic,29678NE106,,NEN001,NES001,NEF004,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/catastrophic_aca,,nebraskablue.com/becatastrophic_sbc,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1060001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400","$19,800","$39,600",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$3,800","$7,600","$5,300","$10,600","$7,200",$0,$0,$200,"$4,900",$0,$0,$0,5
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,10,29678,NE,Individual,No,47-0095156,29678NE1100004,BlueEssentials 6325 HSA Bronze,29678NE110,,NEN001,NES001,NEF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be6325HSAbronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1100004-00,Standard Bronze Off Exchange Plan,,0.580779373645782,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,325","$12,650",,,"$12,650","$25,300","$18,975","$37,950",,,,,,,,,,,,,,,,,,,,,"$6,325","$12,650",1%,,,,"$12,650","$25,300","$18,975","$37,950","$7,200",$0,$0,$200,"$5,300",$0,$0,$0,4
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,10,29678,NE,Individual,No,47-0095156,29678NE1100004,BlueEssentials 6325 HSA Bronze,29678NE110,,NEN001,NES001,NEF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be6325HSAbronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1100004-01,Standard Bronze On Exchange Plan,,0.580779373645782,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,325","$12,650",,,"$12,650","$25,300","$18,975","$37,950",,,,,,,,,,,,,,,,,,,,,"$6,325","$12,650",1%,,,,"$12,650","$25,300","$18,975","$37,950","$7,200",$0,$0,$200,"$5,300",$0,$0,$0,5
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,10,29678,NE,Individual,No,47-0095156,29678NE1100004,BlueEssentials 6325 HSA Bronze,29678NE110,,NEN001,NES001,NEF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be6325HSAbronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1100004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,1%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$0,6
2015,NE,29678,SERFF,5,2014-11-10 10:02:31,10,29678,NE,Individual,No,47-0095156,29678NE1100004,BlueEssentials 6325 HSA Bronze,29678NE110,,NEN001,NES001,NEF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.,Yes,Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.,Yes,nebraskablue.com/be6325HSAbronze_sbc,,nebraskablue.com/blueessentials_aca,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NE_Individual5TPDL.pdf,29678NE1100004-03,Limited Cost Sharing Plan Variation,,0.580779373645782,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,325","$12,650",,,"$12,650","$25,300","$18,975","$37,950",,,,,,,,,,,,,,,,,,,,,"$6,325","$12,650",1%,,,,"$12,650","$25,300","$18,975","$37,950","$7,200",$0,$0,$200,"$5,300",$0,$0,$0,7
2015,NE,32600,SERFF,2,2014-09-05 06:40:30,1,32600,NE,Individual,Yes,95-2371728,32600NE0010001,PPO MAC,32600NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$36.89,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Nebraska,Yes,,,,,32600NE0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,32600,SERFF,2,2014-09-05 06:40:30,1,32600,NE,SHOP (Small Group),Yes,95-2371728,32600NE0020001,PPO MAC,32600NE002,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$27.82,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Nebraska,Yes,,,,,32600NE0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,32600,SERFF,2,2014-09-05 06:40:30,1,32600,NE,SHOP (Small Group),Yes,95-2371728,32600NE0020002,PPO MAC,32600NE002,,NEN001,NES001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$21.61,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Nebraska,Yes,,,,,32600NE0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,32600,SERFF,2,2014-09-05 06:40:30,1,32600,NE,Individual,Yes,95-2371728,32600NE0010002,PPO MAC,32600NE001,,NEN001,NES001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$30.13,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Nebraska,Yes,,,,,32600NE0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,32600,SERFF,2,2014-09-05 06:40:30,2,32600,NE,Individual,Yes,95-2371728,32600NE0010003,PPO MAC,32600NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$38.03,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Nebraska,Yes,,,,,32600NE0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,32600,SERFF,2,2014-09-05 06:40:30,2,32600,NE,SHOP (Small Group),Yes,95-2371728,32600NE0020003,PPO MAC,32600NE002,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$28.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Nebraska,Yes,,,,,32600NE0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,36768,SERFF,2,2014-08-22 08:51:38,1,36768,NE,SHOP (Small Group),Yes,47-0098400,36768NE0040002,EHB High PPO,36768NE004,,NEN001,NES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$41.01,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,36768NE0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,36768,SERFF,2,2014-08-22 08:51:38,1,36768,NE,SHOP (Small Group),Yes,47-0098400,36768NE0040001,EHB Low PPO,36768NE004,,NEN001,NES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.67,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,36768NE0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,36768,SERFF,2,2014-08-22 08:51:38,1,36768,NE,SHOP (Small Group),Yes,47-0098400,36768NE0030002,EHB High Passive,36768NE003,,NEN001,NES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$43.27,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,36768NE0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NE,36768,SERFF,2,2014-08-22 08:51:38,1,36768,NE,SHOP (Small Group),Yes,47-0098400,36768NE0030001,EHB Low Passive,36768NE003,,NEN001,NES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.34,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,36768NE0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NE,41106,SERFF,2,2014-09-02 11:19:24,1,41106,NE,SHOP (Small Group),Yes,44-0308260,41106NE0010001,KCL EHB Low PPO,41106NE001,,NEN001,NES001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$33.94,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,41106NE0010001-00,Standard Low Off Exchange Plan,68.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,41106,SERFF,2,2014-09-02 11:19:24,1,41106,NE,SHOP (Small Group),Yes,44-0308260,41106NE0010003,KCL EHB Low MAC,41106NE001,,NEN001,NES001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$25.50,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,41106NE0010003-00,Standard Low Off Exchange Plan,68.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,41106,SERFF,2,2014-09-02 11:19:24,1,41106,NE,SHOP (Small Group),Yes,44-0308260,41106NE0010005,KCL Fam Low PPO,41106NE001,,NEN001,NES001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$33.94,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,41106NE0010005-00,Standard Low Off Exchange Plan,68.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NE,41106,SERFF,2,2014-09-02 11:19:24,1,41106,NE,SHOP (Small Group),Yes,44-0308260,41106NE0010007,KCL Fam Low MAC,41106NE001,,NEN001,NES001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$25.50,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,41106NE0010007-00,Standard Low Off Exchange Plan,68.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NE,88667,SERFF,1,2014-08-12 09:41:38,1,88667,NE,SHOP (Small Group),Yes,13-5581829,88667NE0060001,EHB Basic Dental Plan (Low),88667NE006,,NEN001,NES001,,New,PPO,Low,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$15.99,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,88667NE0060001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,90142,SERFF,1,2014-08-07 16:35:18,1,90142,NE,SHOP (Small Group),Yes,35-0472300,90142NE0010001,Lincoln DentalConnect?,90142NE001,,NEN001,NES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.66,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,90142NE0010001-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,90142,SERFF,1,2014-08-07 16:35:18,1,90142,NE,SHOP (Small Group),Yes,35-0472300,90142NE0010002,Lincoln DentalConnect?,90142NE001,,NEN001,NES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.61,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,90142NE0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,90142,SERFF,1,2014-08-07 16:35:18,1,90142,NE,SHOP (Small Group),Yes,35-0472300,90142NE0010003,Lincoln DentalConnect?,90142NE001,,NEN001,NES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.65,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,90142NE0010003-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NE,90142,SERFF,1,2014-08-07 16:35:18,1,90142,NE,SHOP (Small Group),Yes,35-0472300,90142NE0010005,Lincoln DentalConnect?,90142NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.74,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,90142NE0010005-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NE,90142,SERFF,1,2014-08-07 16:35:18,1,90142,NE,SHOP (Small Group),Yes,35-0472300,90142NE0010006,Lincoln DentalConnect?,90142NE001,,NEN001,NES001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.47,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,90142NE0010006-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,4,50022,NE,SHOP (Small Group),Yes,95-6042390,50022NE0010011,BEST Dental Choice-L,50022NE001,,NEN001,NES001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.43,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BESTDental_Choice-L_Plan.pdf,,50022NE0010011-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,4,50022,NE,Individual,Yes,95-6042390,50022NE0020006,BESTOne Dental Basic-Silver,50022NE002,,NEN001,NES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.53,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BESTOne_Dental_Basic-Silver_Plan.pdf,,50022NE0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,4,50022,NE,SHOP (Small Group),Yes,95-6042390,50022NE0010012,BEST Dental Value,50022NE001,,NEN001,NES001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.43,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BESTDental_Value_Plan.pdf,,50022NE0010012-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,4,50022,NE,SHOP (Small Group),Yes,95-6042390,50022NE0010012,BEST Dental Value,50022NE001,,NEN001,NES001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.43,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BESTDental_Value_Plan.pdf,,50022NE0010012-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,NE,64117,SERFF,2,2014-09-05 06:40:30,1,64117,NE,Individual,Yes,47-0397286,64117NE0010001,"Delta Dental Individual PPO, EHB Certified",64117NE001,,NEN002,NES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.85,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,64117NE0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,64117,SERFF,2,2014-09-05 06:40:30,1,64117,NE,SHOP (Small Group),Yes,47-0397286,64117NE0030001,"Renaissance Group Dental PPO, EHB Certified",64117NE003,,NEN001,NES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.84,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,64117NE0030001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,1,45550,NE,SHOP (Small Group),Yes,47-0685003,45550NE0170001,Pediatric Dental A,45550NE017,,NEN001,NES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0170001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,1,45550,NE,Individual,Yes,47-0685003,45550NE0010001,Pediatric Dental A,45550NE001,,NEN001,NES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0010001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,1,45550,NE,Individual,Yes,47-0685003,45550NE0010001,Pediatric Dental A,45550NE001,,NEN001,NES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0010001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,2,45550,NE,Individual,Yes,47-0685003,45550NE0020001,Pediatric Dental A + Adult A,45550NE002,,NEN001,NES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0020001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,2,45550,NE,SHOP (Small Group),Yes,47-0685003,45550NE0180001,Pediatric Dental A + Adult A,45550NE018,,NEN001,NES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0180001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,2,45550,NE,Individual,Yes,47-0685003,45550NE0020001,Pediatric Dental A + Adult A,45550NE002,,NEN001,NES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0020001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,3,45550,NE,Individual,Yes,47-0685003,45550NE0030001,Pediatric Dental A + Adult B,45550NE003,,NEN001,NES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,3,45550,NE,SHOP (Small Group),Yes,47-0685003,45550NE0190001,Pediatric Dental A + Adult B,45550NE019,,NEN001,NES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.45,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0190001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,9,45550,NE,Individual,Yes,47-0685003,45550NE0090001,Pediatric Dental B,45550NE009,,NEN001,NES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0090001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,10,45550,NE,Individual,Yes,47-0685003,45550NE0100001,Pediatric Dental B + Adult A,45550NE010,,NEN001,NES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0100001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,10,45550,NE,SHOP (Small Group),Yes,47-0685003,45550NE0260001,Pediatric Dental B + Adult A,45550NE026,,NEN001,NES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0260001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,10,45550,NE,Individual,Yes,47-0685003,45550NE0100001,Pediatric Dental B + Adult A,45550NE010,,NEN001,NES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0100001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,11,45550,NE,Individual,Yes,47-0685003,45550NE0110001,Pediatric Dental B + Adult B,45550NE011,,NEN001,NES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0110001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,11,45550,NE,SHOP (Small Group),Yes,47-0685003,45550NE0270001,Pediatric Dental B + Adult B,45550NE027,,NEN001,NES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0270001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,11,45550,NE,Individual,Yes,47-0685003,45550NE0110001,Pediatric Dental B + Adult B,45550NE011,,NEN001,NES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0110001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,12,45550,NE,Individual,Yes,47-0685003,45550NE0120001,Pediatric Dental B + Adult C,45550NE012,,NEN001,NES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0120001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,12,45550,NE,SHOP (Small Group),Yes,47-0685003,45550NE0280001,Pediatric Dental B + Adult C,45550NE028,,NEN001,NES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0280001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,12,45550,NE,Individual,Yes,47-0685003,45550NE0120001,Pediatric Dental B + Adult C,45550NE012,,NEN001,NES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0120001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,13,45550,NE,Individual,Yes,47-0685003,45550NE0130001,Pediatric Dental B + Adult D,45550NE013,,NEN001,NES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0130001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,13,45550,NE,SHOP (Small Group),Yes,47-0685003,45550NE0290001,Pediatric Dental B + Adult D,45550NE029,,NEN001,NES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0290001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,13,45550,NE,Individual,Yes,47-0685003,45550NE0130001,Pediatric Dental B + Adult D,45550NE013,,NEN001,NES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0130001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,14,45550,NE,Individual,Yes,47-0685003,45550NE0140001,Pediatric Dental B + Adult E,45550NE014,,NEN001,NES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0140001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,14,45550,NE,SHOP (Small Group),Yes,47-0685003,45550NE0300001,Pediatric Dental B + Adult E,45550NE030,,NEN001,NES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0300001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,14,45550,NE,Individual,Yes,47-0685003,45550NE0140001,Pediatric Dental B + Adult E,45550NE014,,NEN001,NES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0140001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,15,45550,NE,Individual,Yes,47-0685003,45550NE0150001,Pediatric Dental B + Adult F,45550NE015,,NEN001,NES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0150001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,15,45550,NE,SHOP (Small Group),Yes,47-0685003,45550NE0310001,Pediatric Dental B + Adult F,45550NE031,,NEN001,NES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0310001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,15,45550,NE,Individual,Yes,47-0685003,45550NE0150001,Pediatric Dental B + Adult F,45550NE015,,NEN001,NES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0150001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,16,45550,NE,Individual,Yes,47-0685003,45550NE0160001,Pediatric Dental B + Adult G,45550NE016,,NEN001,NES001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0160001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,45550,SERFF,4,2015-01-22 16:02:51,16,45550,NE,SHOP (Small Group),Yes,47-0685003,45550NE0320001,Pediatric Dental B + Adult G,45550NE032,,NEN001,NES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.10,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency services only,Yes,Similar benefits as In Service Area,Yes,,,,,45550NE0320001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,4,50022,NE,Individual,Yes,95-6042390,50022NE0020005,BESTOne Dental Plus-Silver,50022NE002,,NEN001,NES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.53,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BESTOne_Dental_Plus-Silver_Plan.pdf,,50022NE0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,4,50022,NE,SHOP (Small Group),Yes,95-6042390,50022NE0010009,BEST Dental Standard-L,50022NE001,,NEN001,NES001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.43,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BESTDental_Standard-L_Plan.pdf,,50022NE0010009-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,4,50022,NE,SHOP (Small Group),Yes,95-6042390,50022NE0010009,BEST Dental Standard-L,50022NE001,,NEN001,NES001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.43,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BESTDental_Standard-L_Plan.pdf,,50022NE0010009-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,4,50022,NE,Individual,Yes,95-6042390,50022NE0020005,BESTOne Dental Plus-Silver,50022NE002,,NEN001,NES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.53,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BESTOne_Dental_Plus-Silver_Plan.pdf,,50022NE0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,4,50022,NE,Individual,Yes,95-6042390,50022NE0020006,BESTOne Dental Basic-Silver,50022NE002,,NEN001,NES001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.53,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BESTOne_Dental_Basic-Silver_Plan.pdf,,50022NE0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NE,50022,SERFF,2,2014-09-05 06:40:30,4,50022,NE,SHOP (Small Group),Yes,95-6042390,50022NE0010011,BEST Dental Choice-L,50022NE001,,NEN001,NES001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.43,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NE/2015/NE_BESTDental_Choice-L_Plan.pdf,,50022NE0010011-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NE,64117,SERFF,2,2014-09-05 06:40:30,1,64117,NE,Individual,Yes,47-0397286,64117NE0010002,"Delta Dental Individual PPO, EHB Certified",64117NE001,,NEN002,NES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.57,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,64117NE0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,64117,SERFF,2,2014-09-05 06:40:30,1,64117,NE,SHOP (Small Group),Yes,47-0397286,64117NE0030002,"Renaissance Group Dental PPO, EHB Certified",64117NE003,,NEN001,NES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.15,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,64117NE0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,64117,SERFF,2,2014-09-05 06:40:30,1,64117,NE,Individual,Yes,47-0397286,64117NE0020001,"Renaissance Individual Dental PPO, EHB Certified",64117NE002,,NEN001,NES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.85,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,64117NE0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NE,64117,SERFF,2,2014-09-05 06:40:30,1,64117,NE,Individual,Yes,47-0397286,64117NE0020002,"Renaissance Individual Dental PPO, EHB Certified",64117NE002,,NEN001,NES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.67,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,64117NE0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NE,78502,SERFF,1,2014-08-07 16:35:18,1,78502,NE,SHOP (Small Group),Yes,57-0523959,78502NE0010001,Group Pediatric Dental EHB Rider,78502NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$27.36,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,78502NE0010001-00,Standard High Off Exchange Plan,86.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,78502,SERFF,1,2014-08-07 16:35:18,1,78502,NE,SHOP (Small Group),Yes,57-0523959,78502NE0010002,Group Pediatric Dental EHB Rider,78502NE001,,NEN001,NES001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$22.59,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,78502NE0010002-00,Standard Low Off Exchange Plan,71.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,90142,SERFF,1,2014-08-07 16:35:18,1,90142,NE,SHOP (Small Group),Yes,35-0472300,90142NE0010007,Lincoln DentalConnect?,90142NE001,,NEN001,NES001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.36,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,90142NE0010007-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,NE,90142,SERFF,1,2014-08-07 16:35:18,2,90142,NE,SHOP (Small Group),Yes,35-0472300,90142NE0010004,Lincoln DentalConnect?,90142NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.33,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,90142NE0010004-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,90142,SERFF,1,2014-08-07 16:35:18,2,90142,NE,SHOP (Small Group),Yes,35-0472300,90142NE0010008,Lincoln DentalConnect?,90142NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.07,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,90142NE0010008-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,95796,SERFF,2,2014-08-22 08:51:38,1,95796,NE,SHOP (Small Group),Yes,93-0242990,95796NE0040002,EHB High PPO,95796NE004,,NEN001,NES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$41.71,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,95796NE0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,95796,SERFF,2,2014-08-22 08:51:38,1,95796,NE,SHOP (Small Group),Yes,93-0242990,95796NE0040001,EHB Low PPO,95796NE004,,NEN001,NES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.02,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,95796NE0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,95796,SERFF,2,2014-08-22 08:51:38,1,95796,NE,SHOP (Small Group),Yes,93-0242990,95796NE0030002,EHB High Passive,95796NE003,,NEN001,NES001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$44.01,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,95796NE0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,2,59025,NH,Individual,No,04-2663394,59025NH0290006,Harvard Pilgrim ElevateHealth Silver HSA HMO,59025NH029,,NHN002,NHS002,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0290006-01,Standard Silver On Exchange Plan,68.18%,0.684454619884491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,2,59025,NH,Individual,No,04-2663394,59025NH0290006,Harvard Pilgrim ElevateHealth Silver HSA HMO,59025NH029,,NHN002,NHS002,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0290006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,2,59025,NH,Individual,No,04-2663394,59025NH0290006,Harvard Pilgrim ElevateHealth Silver HSA HMO,59025NH029,,NHN002,NHS002,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0290006-03,Limited Cost Sharing Plan Variation,68.18%,0.684454619884491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,2,59025,NH,Individual,No,04-2663394,59025NH0290006,Harvard Pilgrim ElevateHealth Silver HSA HMO,59025NH029,,NHN002,NHS002,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0290006-04,73% AV Level Silver Plan,72.65%,0.723076283931732,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,2,61163,NH,Individual,No,45-3596033,61163NH0350001,MyDoc HMO Bronze HSA 6300,61163NH035,,NHN001,NHS001,NHF009,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0350001-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,2,61163,NH,Individual,No,45-3596033,61163NH0350001,MyDoc HMO Bronze HSA 6300,61163NH035,,NHN001,NHS001,NHF009,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0350001-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,7,19304,NH,SHOP (Small Group),No,45-3416923,19304NH0280001,Community Advantage,19304NH028,,NHN001,NHS001,NHF007,New,PPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9979,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-SG-ADVANTAGE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,www.communityoptions.coop,19304NH0280001-00,Standard Gold Off Exchange Plan,80.30%,0.797655701637268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$650,"$1,300",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,7,19304,NH,SHOP (Small Group),No,45-3416923,19304NH0280001,Community Advantage,19304NH028,,NHN001,NHS001,NHF007,New,PPO,Gold,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9979,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-SG-ADVANTAGE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,www.communityoptions.coop,19304NH0280001-01,Standard Gold On Exchange Plan,80.30%,0.797655701637268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$650,"$1,300",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,7,19304,NH,Individual,No,45-3416923,19304NH0040001,Community Choice,19304NH004,,NHN001,NHS001,NHF005,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9977,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-CHOICE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0040001-01,Standard Silver On Exchange Plan,68.60%,0.641267418861389,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,7,19304,NH,Individual,No,45-3416923,19304NH0040001,Community Choice,19304NH004,,NHN001,NHS001,NHF005,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9977,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-CHOICE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0040001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,2,42260,NH,Individual,No,39-0658730,42260NH0110003,Assurant Health Bronze Plan 002,42260NH011,,NHN001,NHS001,NHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,42260NH0110003-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,2,42260,NH,Individual,No,39-0658730,42260NH0110003,Assurant Health Bronze Plan 002,42260NH011,,NHN001,NHS001,NHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,42260NH0110003-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,1,42260,NH,Individual,No,39-0658730,42260NH0110001,Assurant Health Bronze Plan 001,42260NH011,,NHN001,NHS001,NHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,42260NH0110001-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,1,42260,NH,Individual,No,39-0658730,42260NH0110001,Assurant Health Bronze Plan 001,42260NH011,,NHN001,NHS001,NHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,42260NH0110001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,1,42260,NH,Individual,No,39-0658730,42260NH0110001,Assurant Health Bronze Plan 001,42260NH011,,NHN001,NHS001,NHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,42260NH0110001-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,1,42260,NH,Individual,No,39-0658730,42260NH0110002,Assurant Health Silver Plan 001,42260NH011,,NHN001,NHS001,NHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,42260NH0110002-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,3,59025,NH,Individual,No,04-2663394,59025NH0280001,Harvard Pilgrim NH Network Bronze HSA HMO,59025NH028,,NHN003,NHS003,NHF007,New,HMO,Bronze,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0280001-03,Limited Cost Sharing Plan Variation,60.99%,0.608045637607574,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,4,59025,NH,Individual,No,04-2663394,59025NH0260005,Harvard Pilgrim ElevateHealth Silver HMO,59025NH026,,NHN002,NHS002,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,Yes,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0260005-00,Standard Silver Off Exchange Plan,68.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,7,19304,NH,Individual,No,45-3416923,19304NH0040001,Community Choice,19304NH004,,NHN001,NHS001,NHF005,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9977,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-CHOICE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0040001-03,Limited Cost Sharing Plan Variation,68.60%,0.641267418861389,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,7,19304,NH,Individual,No,45-3416923,19304NH0040001,Community Choice,19304NH004,,NHN001,NHS001,NHF005,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9977,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-CHOICE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0040001-04,73% AV Level Silver Plan,73.70%,0.689679503440857,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,7,19304,NH,Individual,No,45-3416923,19304NH0040001,Community Choice,19304NH004,,NHN001,NHS001,NHF005,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9977,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-CHOICE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0040001-05,87% AV Level Silver Plan,87.60%,0.860575258731842,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,7,19304,NH,Individual,No,45-3416923,19304NH0040001,Community Choice,19304NH004,,NHN001,NHS001,NHF005,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9977,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-CHOICE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0040001-06,94% AV Level Silver Plan,94.60%,0.941530168056488,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,NE,95796,SERFF,2,2014-08-22 08:51:38,1,95796,NE,SHOP (Small Group),Yes,93-0242990,95796NE0030001,EHB Low Passive,95796NE003,,NEN001,NES001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.74,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,95796NE0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NE,98048,SERFF,3,2014-09-02 11:19:24,1,98048,NE,SHOP (Small Group),Yes,13-5123390,98048NE0010002,Guardian Pediatric Advantage,98048NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.70,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,98048NE0010002-00,Standard High Off Exchange Plan,84.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,98048,SERFF,3,2014-09-02 11:19:24,1,98048,NE,SHOP (Small Group),Yes,13-5123390,98048NE0020002,Guardian Pediatric Essentials,98048NE002,,NEN001,NES001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$19.88,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,98048NE0020002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,98048,SERFF,3,2014-09-02 11:19:24,2,98048,NE,SHOP (Small Group),Yes,13-5123390,98048NE0040002,Guardian Family Advantage,98048NE004,,NEN001,NES001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.70,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,98048NE0040002-00,Standard High Off Exchange Plan,84.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,98048,SERFF,3,2014-09-02 11:19:24,2,98048,NE,SHOP (Small Group),Yes,13-5123390,98048NE0040002,Guardian Family Advantage,98048NE004,,NEN001,NES001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.70,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,98048NE0040002-01,Standard High On Exchange Plan,84.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,98048,SERFF,3,2014-09-02 11:19:24,2,98048,NE,SHOP (Small Group),Yes,13-5123390,98048NE0060002,Guardian Family Essentials,98048NE006,,NEN001,NES001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.88,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,98048NE0060002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NE,98048,SERFF,3,2014-09-02 11:19:24,2,98048,NE,SHOP (Small Group),Yes,13-5123390,98048NE0060002,Guardian Family Essentials,98048NE006,,NEN001,NES001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.88,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,98048NE0060002-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NE,99568,SERFF,2,2014-09-05 06:40:30,1,99568,NE,SHOP (Small Group),Yes,41-0808596,99568NE0010001,"Plan 1. Passive PPO, $1000 Annual Maximum, no Ortho",99568NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,99568NE0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NE,99568,SERFF,2,2014-09-05 06:40:30,1,99568,NE,SHOP (Small Group),Yes,41-0808596,99568NE0010002,"Plan 2.  Passive PPO, $1000 Annual Maximum, Ortho",99568NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,99568NE0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NE,99568,SERFF,2,2014-09-05 06:40:30,1,99568,NE,SHOP (Small Group),Yes,41-0808596,99568NE0010003,"Plan 3. Passive PPO, $1500 Annual Maximum, no Ortho",99568NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,99568NE0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NE,99568,SERFF,2,2014-09-05 06:40:30,1,99568,NE,SHOP (Small Group),Yes,41-0808596,99568NE0010004,"Plan 4.  Passive PPO, $1500 Annual Maximum, Ortho",99568NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,99568NE0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NE,99568,SERFF,2,2014-09-05 06:40:30,1,99568,NE,SHOP (Small Group),Yes,41-0808596,99568NE0010005,"Plan 5.  Passive PPO, $2000 Annual Maximum, Ortho",99568NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,99568NE0010005-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,NE,99568,SERFF,2,2014-09-05 06:40:30,1,99568,NE,SHOP (Small Group),Yes,41-0808596,99568NE0010006,"Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho",99568NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,99568NE0010006-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,NE,99568,SERFF,2,2014-09-05 06:40:30,1,99568,NE,SHOP (Small Group),Yes,41-0808596,99568NE0010007,"Plan 7. Graded Passive PPO, $1500 Annual Maximum, Ortho",99568NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,99568NE0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,NE,99568,SERFF,2,2014-09-05 06:40:30,1,99568,NE,SHOP (Small Group),Yes,41-0808596,99568NE0010008,"Plan 8. MAC PPO, $1000 Annual Maximum, no Ortho",99568NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,99568NE0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,NE,99568,SERFF,2,2014-09-05 06:40:30,1,99568,NE,SHOP (Small Group),Yes,41-0808596,99568NE0010009,"Plan 9. MAC PPO, $1500 Annual Maximum, Ortho",99568NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,99568NE0010009-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,NE,99568,SERFF,2,2014-09-05 06:40:30,1,99568,NE,SHOP (Small Group),Yes,41-0808596,99568NE0010010,"Plan 10. Graded MAC PPO, $1000 Annual Maximum, no Ortho",99568NE001,,NEN001,NES001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,99568NE0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,13
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,1,19304,NH,Individual,No,45-3416923,19304NH0010001,Community Safe Harbor,19304NH001,,NHN001,NHS001,NHF001,New,PPO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9967,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-SAFEHARBOR-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0010001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,000","$38,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,1,19304,NH,SHOP (Small Group),No,45-3416923,19304NH0160001,Community Option HSA,19304NH016,,NHN001,NHS001,NHF002,New,PPO,Bronze,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-SG-OPTIONHSA-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,www.communityoptions.coop,19304NH0160001-00,Standard Bronze Off Exchange Plan,58.60%,0.585511147975922,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,1,19304,NH,SHOP (Small Group),No,45-3416923,19304NH0160001,Community Option HSA,19304NH016,,NHN001,NHS001,NHF002,New,PPO,Bronze,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-SG-OPTIONHSA-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,www.communityoptions.coop,19304NH0160001-01,Standard Bronze On Exchange Plan,58.60%,0.585511147975922,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,2,19304,NH,Individual,No,45-3416923,19304NH0020001,Community Option HSA,19304NH002,,NHN001,NHS001,NHF001,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-OPTIONHSA-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0020001-00,Standard Bronze Off Exchange Plan,,0.585511147975922,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,2,19304,NH,Individual,No,45-3416923,19304NH0020001,Community Option HSA,19304NH002,,NHN001,NHS001,NHF001,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-OPTIONHSA-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0020001-01,Standard Bronze On Exchange Plan,,0.585511147975922,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,2,19304,NH,SHOP (Small Group),No,45-3416923,19304NH0170001,Community Option,19304NH017,,NHN001,NHS001,NHF003,New,PPO,Bronze,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9969,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-SG-OPTION-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,www.communityoptions.coop,19304NH0170001-01,Standard Bronze On Exchange Plan,61.70%,0.58194237947464,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,2,19304,NH,Individual,No,45-3416923,19304NH0020001,Community Option HSA,19304NH002,,NHN001,NHS001,NHF001,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-OPTIONHSA-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0020001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,2,19304,NH,Individual,No,45-3416923,19304NH0020001,Community Option HSA,19304NH002,,NHN001,NHS001,NHF001,New,PPO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,1,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-OPTIONHSA-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0020001-03,Limited Cost Sharing Plan Variation,,0.585511147975922,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,3,19304,NH,SHOP (Small Group),No,45-3416923,19304NH0210001,Community Basic,19304NH021,,NHN001,NHS001,NHF008,New,PPO,Bronze,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9972,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-SG-BASICHSA-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,www.communityoptions.coop,19304NH0210001-00,Standard Bronze Off Exchange Plan,61.70%,0.616079151630402,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,3,19304,NH,Individual,No,45-3416923,19304NH0030001,Community Option,19304NH003,,NHN001,NHS001,NHF003,New,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9972,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-OPTION-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0030001-00,Standard Bronze Off Exchange Plan,61.70%,0.58194237947464,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,3,19304,NH,Individual,No,45-3416923,19304NH0030001,Community Option,19304NH003,,NHN001,NHS001,NHF003,New,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9972,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-OPTION-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0030001-01,Standard Bronze On Exchange Plan,61.70%,0.58194237947464,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,3,19304,NH,SHOP (Small Group),No,45-3416923,19304NH0210001,Community Basic,19304NH021,,NHN001,NHS001,NHF008,New,PPO,Bronze,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9972,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-SG-BASICHSA-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,www.communityoptions.coop,19304NH0210001-01,Standard Bronze On Exchange Plan,61.70%,0.616079151630402,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,3,19304,NH,Individual,No,45-3416923,19304NH0030001,Community Option,19304NH003,,NHN001,NHS001,NHF003,New,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9972,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-OPTION-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0030001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,9,19304,NH,Individual,No,45-3416923,19304NH0090001,Community Preferred Plus,19304NH009,,NHN001,NHS001,NHF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9979,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0090001-01,Standard Silver On Exchange Plan,71.70%,0.654569685459137,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,9,19304,NH,Individual,No,45-3416923,19304NH0090001,Community Preferred Plus,19304NH009,,NHN001,NHS001,NHF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9979,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0090001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,9,19304,NH,Individual,No,45-3416923,19304NH0090001,Community Preferred Plus,19304NH009,,NHN001,NHS001,NHF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9979,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0090001-03,Limited Cost Sharing Plan Variation,71.70%,0.654569685459137,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,9,19304,NH,Individual,No,45-3416923,19304NH0090001,Community Preferred Plus,19304NH009,,NHN001,NHS001,NHF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9979,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0090001-04,73% AV Level Silver Plan,73.90%,0.681363701820374,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,9,19304,NH,Individual,No,45-3416923,19304NH0090001,Community Preferred Plus,19304NH009,,NHN001,NHS001,NHF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9979,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0090001-05,87% AV Level Silver Plan,87.40%,0.856676161289215,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,9,19304,NH,Individual,No,45-3416923,19304NH0090001,Community Preferred Plus,19304NH009,,NHN001,NHS001,NHF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9979,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0090001-06,94% AV Level Silver Plan,94.60%,0.940189778804779,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,3,19304,NH,Individual,No,45-3416923,19304NH0030001,Community Option,19304NH003,,NHN001,NHS001,NHF003,New,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9972,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-OPTION-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0030001-03,Limited Cost Sharing Plan Variation,61.70%,0.58194237947464,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,4,19304,NH,Individual,No,45-3416923,19304NH0050001,Community Option Plus,19304NH005,,NHN001,NHS001,NHF003,New,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9974,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-OPTIONPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0050001-00,Standard Bronze Off Exchange Plan,61.70%,0.58194237947464,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,4,19304,NH,SHOP (Small Group),No,45-3416923,19304NH0200001,Community Choice,19304NH020,,NHN001,NHS001,NHF005,New,PPO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9975,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-SG-CHOICE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,www.communityoptions.coop,19304NH0200001-00,Standard Silver Off Exchange Plan,68.60%,0.680941760540009,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,4,19304,NH,SHOP (Small Group),No,45-3416923,19304NH0200001,Community Choice,19304NH020,,NHN001,NHS001,NHF005,New,PPO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9975,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-SG-CHOICE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,www.communityoptions.coop,19304NH0200001-01,Standard Silver On Exchange Plan,68.60%,0.680941760540009,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,4,19304,NH,Individual,No,45-3416923,19304NH0050001,Community Option Plus,19304NH005,,NHN001,NHS001,NHF003,New,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9974,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-OPTIONPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0050001-01,Standard Bronze On Exchange Plan,61.70%,0.58194237947464,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,4,19304,NH,Individual,No,45-3416923,19304NH0050001,Community Option Plus,19304NH005,,NHN001,NHS001,NHF003,New,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9974,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-OPTIONPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0050001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,4,19304,NH,Individual,No,45-3416923,19304NH0050001,Community Option Plus,19304NH005,,NHN001,NHS001,NHF003,New,PPO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9974,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-OPTIONPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0050001-03,Limited Cost Sharing Plan Variation,61.70%,0.58194237947464,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,5,19304,NH,Individual,No,45-3416923,19304NH0140001,Community Value,19304NH014,,NHN001,NHS001,NHF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9976,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-VALUE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0140001-00,Standard Silver Off Exchange Plan,68.50%,0.632086515426636,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700",50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,5,19304,NH,SHOP (Small Group),No,45-3416923,19304NH0230001,Community Balance,19304NH023,,NHN001,NHS001,NHF008,New,PPO,Silver,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9974,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-SG-BALANCEHSA-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,www.communityoptions.coop,19304NH0230001-00,Standard Silver Off Exchange Plan,69.30%,0.692726910114288,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,5,19304,NH,SHOP (Small Group),No,45-3416923,19304NH0230001,Community Balance,19304NH023,,NHN001,NHS001,NHF008,New,PPO,Silver,Yes,Both,Yes,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9974,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-SG-BALANCEHSA-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,www.communityoptions.coop,19304NH0230001-01,Standard Silver On Exchange Plan,69.30%,0.692726910114288,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,5,19304,NH,Individual,No,45-3416923,19304NH0140001,Community Value,19304NH014,,NHN001,NHS001,NHF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9976,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-VALUE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0140001-01,Standard Silver On Exchange Plan,68.50%,0.632086515426636,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700",50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,5,19304,NH,Individual,No,45-3416923,19304NH0140001,Community Value,19304NH014,,NHN001,NHS001,NHF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9976,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-VALUE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0140001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,5,19304,NH,Individual,No,45-3416923,19304NH0140001,Community Value,19304NH014,,NHN001,NHS001,NHF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9976,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-VALUE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0140001-03,Limited Cost Sharing Plan Variation,68.50%,0.632086515426636,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700",50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,5,19304,NH,Individual,No,45-3416923,19304NH0140001,Community Value,19304NH014,,NHN001,NHS001,NHF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9976,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-VALUE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0140001-04,73% AV Level Silver Plan,73.90%,0.690073728561401,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,5,19304,NH,Individual,No,45-3416923,19304NH0140001,Community Value,19304NH014,,NHN001,NHS001,NHF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9976,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-VALUE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0140001-05,87% AV Level Silver Plan,87.60%,0.860575258731842,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,5,19304,NH,Individual,No,45-3416923,19304NH0140001,Community Value,19304NH014,,NHN001,NHS001,NHF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9976,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-VALUE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0140001-06,94% AV Level Silver Plan,94.60%,0.941530168056488,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,6,19304,NH,Individual,No,45-3416923,19304NH0130001,Community Value Plus,19304NH013,,NHN001,NHS001,NHF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9977,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-VALUEPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0130001-00,Standard Silver Off Exchange Plan,68.50%,0.632086515426636,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700",50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,6,19304,NH,SHOP (Small Group),No,45-3416923,19304NH0240001,Community Preferred,19304NH024,,NHN001,NHS001,NHF006,New,PPO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9976,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-SG-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,www.communityoptions.coop,19304NH0240001-00,Standard Silver Off Exchange Plan,71.70%,0.703184127807617,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,6,19304,NH,SHOP (Small Group),No,45-3416923,19304NH0240001,Community Preferred,19304NH024,,NHN001,NHS001,NHF006,New,PPO,Silver,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9976,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-SG-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,www.communityoptions.coop,19304NH0240001-01,Standard Silver On Exchange Plan,71.70%,0.703184127807617,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,6,19304,NH,Individual,No,45-3416923,19304NH0130001,Community Value Plus,19304NH013,,NHN001,NHS001,NHF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9977,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-VALUEPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0130001-01,Standard Silver On Exchange Plan,68.50%,0.632086515426636,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700",50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,6,19304,NH,Individual,No,45-3416923,19304NH0130001,Community Value Plus,19304NH013,,NHN001,NHS001,NHF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9977,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-VALUEPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0130001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,6,19304,NH,Individual,No,45-3416923,19304NH0130001,Community Value Plus,19304NH013,,NHN001,NHS001,NHF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9977,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-VALUEPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0130001-03,Limited Cost Sharing Plan Variation,68.50%,0.632086515426636,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700",50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,6,19304,NH,Individual,No,45-3416923,19304NH0130001,Community Value Plus,19304NH013,,NHN001,NHS001,NHF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9977,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-VALUEPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0130001-04,73% AV Level Silver Plan,73.90%,0.690073728561401,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,6,19304,NH,Individual,No,45-3416923,19304NH0130001,Community Value Plus,19304NH013,,NHN001,NHS001,NHF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9977,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-VALUEPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0130001-05,87% AV Level Silver Plan,87.60%,0.860575258731842,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,6,19304,NH,Individual,No,45-3416923,19304NH0130001,Community Value Plus,19304NH013,,NHN001,NHS001,NHF004,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9977,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-VALUEPLUS-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0130001-06,94% AV Level Silver Plan,94.60%,0.941530168056488,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,7,19304,NH,Individual,No,45-3416923,19304NH0040001,Community Choice,19304NH004,,NHN001,NHS001,NHF005,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9977,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-CHOICE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0040001-00,Standard Silver Off Exchange Plan,68.60%,0.641267418861389,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,2,42260,NH,Individual,No,39-0658730,42260NH0110003,Assurant Health Bronze Plan 002,42260NH011,,NHN001,NHS001,NHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,42260NH0110003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,2,42260,NH,Individual,No,39-0658730,42260NH0110003,Assurant Health Bronze Plan 002,42260NH011,,NHN001,NHS001,NHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,42260NH0110003-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,4,42260,NH,Individual,No,39-0658730,42260NH0110004,Assurant Health Silver Plan 002,42260NH011,,NHN001,NHS001,NHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,42260NH0110004-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,4,42260,NH,Individual,No,39-0658730,42260NH0110004,Assurant Health Silver Plan 002,42260NH011,,NHN001,NHS001,NHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,42260NH0110004-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,4,59025,NH,Individual,No,04-2663394,59025NH0260005,Harvard Pilgrim ElevateHealth Silver HMO,59025NH026,,NHN002,NHS002,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,Yes,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0260005-03,Limited Cost Sharing Plan Variation,68.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,4,59025,NH,Individual,No,04-2663394,59025NH0260005,Harvard Pilgrim ElevateHealth Silver HMO,59025NH026,,NHN002,NHS002,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,Yes,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0260005-04,73% AV Level Silver Plan,73.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,4,59025,NH,Individual,No,04-2663394,59025NH0260005,Harvard Pilgrim ElevateHealth Silver HMO,59025NH026,,NHN002,NHS002,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,Yes,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0260005-05,87% AV Level Silver Plan,87.03%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,4,59025,NH,Individual,No,04-2663394,59025NH0260005,Harvard Pilgrim ElevateHealth Silver HMO,59025NH026,,NHN002,NHS002,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,Yes,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0260005-06,94% AV Level Silver Plan,93.07%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,9,61163,NH,SHOP (Small Group),No,45-3596033,61163NH0380001,MyDoc HMO Silver HSA 3000,61163NH038,,NHN002,NHS002,NHF008,New,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.999725620200571,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/employers-offe-nh,,http://minutemanhealth.org/plan%20descriptions-employers-nh,https://www.minutemanhealthdirect.org/formulary_search/default.aspx,61163NH0380001-01,Standard Silver On Exchange Plan,,0.680222690105438,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,9,61163,NH,SHOP (Small Group),No,45-3596033,61163NH0400001,MyDoc HMO Bronze HSA 6000,61163NH040,,NHN002,NHS002,NHF007,New,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.999619519898767,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/employers-offe-nh,,http://minutemanhealth.org/plan%20descriptions-employers-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0400001-00,Standard Bronze Off Exchange Plan,58.70%,0.586244583129883,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,8,19304,NH,SHOP (Small Group),No,45-3416923,19304NH0290001,Community Premier,19304NH029,,NHN001,NHS001,NHF009,New,PPO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9982,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-SG-PREMIER-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,www.communityoptions.coop,19304NH0290001-00,Standard Platinum Off Exchange Plan,89.70%,0.894814074039459,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,8,19304,NH,Individual,No,45-3416923,19304NH0080001,Community Preferred,19304NH008,,NHN001,NHS001,NHF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9978,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0080001-00,Standard Silver Off Exchange Plan,71.70%,0.654569685459137,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,8,19304,NH,Individual,No,45-3416923,19304NH0080001,Community Preferred,19304NH008,,NHN001,NHS001,NHF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9978,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0080001-01,Standard Silver On Exchange Plan,71.70%,0.654569685459137,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,8,19304,NH,SHOP (Small Group),No,45-3416923,19304NH0290001,Community Premier,19304NH029,,NHN001,NHS001,NHF009,New,PPO,Platinum,Yes,Both,Yes,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9982,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-SG-PREMIER-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,www.communityoptions.coop,19304NH0290001-01,Standard Platinum On Exchange Plan,89.70%,0.894814074039459,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,8,19304,NH,Individual,No,45-3416923,19304NH0080001,Community Preferred,19304NH008,,NHN001,NHS001,NHF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9978,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0080001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,8,19304,NH,Individual,No,45-3416923,19304NH0080001,Community Preferred,19304NH008,,NHN001,NHS001,NHF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9978,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0080001-03,Limited Cost Sharing Plan Variation,71.70%,0.654569685459137,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,8,19304,NH,Individual,No,45-3416923,19304NH0080001,Community Preferred,19304NH008,,NHN001,NHS001,NHF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9978,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0080001-04,73% AV Level Silver Plan,73.90%,0.681363701820374,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,8,19304,NH,Individual,No,45-3416923,19304NH0080001,Community Preferred,19304NH008,,NHN001,NHS001,NHF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9978,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0080001-05,87% AV Level Silver Plan,87.40%,0.856676161289215,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,8,19304,NH,Individual,No,45-3416923,19304NH0080001,Community Preferred,19304NH008,,NHN001,NHS001,NHF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9978,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0080001-06,94% AV Level Silver Plan,94.60%,0.940189778804779,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,9,19304,NH,Individual,No,45-3416923,19304NH0090001,Community Preferred Plus,19304NH009,,NHN001,NHS001,NHF006,New,PPO,Silver,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9979,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-PREFERRED-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0090001-00,Standard Silver Off Exchange Plan,71.70%,0.654569685459137,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,4,42260,NH,Individual,No,39-0658730,42260NH0110005,Assurant Health Gold Plan 002,42260NH011,,NHN001,NHS001,NHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,42260NH0110005-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,4,42260,NH,Individual,No,39-0658730,42260NH0110006,Assurant Health Platinum Plan 002,42260NH011,,NHN001,NHS001,NHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,42260NH0110006-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,18
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,4,42260,NH,Individual,No,39-0658730,42260NH0110006,Assurant Health Platinum Plan 002,42260NH011,,NHN001,NHS001,NHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,42260NH0110006-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,4,42260,NH,Individual,No,39-0658730,42260NH0110006,Assurant Health Platinum Plan 002,42260NH011,,NHN001,NHS001,NHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,42260NH0110006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,20
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,5,59025,NH,Individual,No,04-2663394,59025NH0260003,Harvard Pilgrim ElevateHealth Bronze HMO,59025NH026,,NHN002,NHS002,NHF006,New,HMO,Bronze,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0260003-03,Limited Cost Sharing Plan Variation,59.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,6,59025,NH,Individual,No,04-2663394,59025NH0270010,Harvard Pilgrim NH HMO Gold,59025NH027,,NHN003,NHS003,NHF001,New,HMO,Gold,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0270010-00,Standard Gold Off Exchange Plan,78.42%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,10,19304,NH,Individual,No,45-3416923,19304NH0120001,Community Advantage,19304NH012,,NHN001,NHS001,NHF007,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9981,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-ADVANTAGE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0120001-00,Standard Gold Off Exchange Plan,80.30%,0.780511140823364,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$650,"$1,300",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,10,19304,NH,Individual,No,45-3416923,19304NH0120001,Community Advantage,19304NH012,,NHN001,NHS001,NHF007,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9981,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-ADVANTAGE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0120001-01,Standard Gold On Exchange Plan,80.30%,0.780511140823364,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$650,"$1,300",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,10,19304,NH,Individual,No,45-3416923,19304NH0120001,Community Advantage,19304NH012,,NHN001,NHS001,NHF007,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9981,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-ADVANTAGE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0120001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NH,19304,SERFF,9,2014-12-09 19:45:23,10,19304,NH,Individual,No,45-3416923,19304NH0120001,Community Advantage,19304NH012,,NHN001,NHS001,NHF007,New,PPO,Gold,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,0.9981,,,0,0,0,2015-01-01,,Yes,Inpatient/Outpatient Hospital services with Prior Approval. Seek reimbursement.,Yes,National wrap network provided by FirstHealth.,Yes,http://www.maineoptions.org/Documents/NHMCHO-SBC-IND-ADVANTAGE-2015.pdf,https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs,www.maineoptions.org,https://www.maineoptions.org/Documents/Maine-Comple-formulary,19304NH0120001-03,Limited Cost Sharing Plan Variation,80.30%,0.780511140823364,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$650,"$1,300",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,1,59025,NH,Individual,No,04-2663394,59025NH0290001,Harvard Pilgrim ElevateHealth Gold HSA HMO,59025NH029,,NHN002,NHS002,NHF002,New,HMO,Gold,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0290001-03,Limited Cost Sharing Plan Variation,78.10%,0.780939161777496,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,700","$5,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,2,59025,NH,Individual,No,04-2663394,59025NH0290006,Harvard Pilgrim ElevateHealth Silver HSA HMO,59025NH029,,NHN002,NHS002,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0290006-00,Standard Silver Off Exchange Plan,68.18%,0.684454619884491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,21709,SERFF,2,2014-09-05 06:40:30,1,21709,NH,SHOP (Small Group),Yes,93-0242990,21709NH0040002,EHB High PPO,21709NH004,,NHN001,NHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$53.36,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,21709NH0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NH,21709,SERFF,2,2014-09-05 06:40:30,1,21709,NH,SHOP (Small Group),Yes,93-0242990,21709NH0040001,EHB Low PPO,21709NH004,,NHN001,NHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.16,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,21709NH0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NH,21709,SERFF,2,2014-09-05 06:40:30,1,21709,NH,SHOP (Small Group),Yes,93-0242990,21709NH0030002,EHB High Passive,21709NH003,,NHN001,NHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$57.52,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,21709NH0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NH,21709,SERFF,2,2014-09-05 06:40:30,1,21709,NH,SHOP (Small Group),Yes,93-0242990,21709NH0030001,EHB Low Passive,21709NH003,,NHN001,NHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$38.17,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,21709NH0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NH,23090,SERFF,2,2014-09-05 06:40:30,1,23090,NH,SHOP (Small Group),Yes,57-0523959,23090NH0010001,Group Pediatric Dental EHB Rider,23090NH001,,NHN001,NHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$35.80,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,23090NH0010001-00,Standard High Off Exchange Plan,85.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NH,23090,SERFF,2,2014-09-05 06:40:30,1,23090,NH,SHOP (Small Group),Yes,57-0523959,23090NH0010002,Group Pediatric Dental EHB Rider,23090NH001,,NHN001,NHS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$29.66,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,23090NH0010002-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NH,24847,SERFF,2,2014-09-09 16:12:42,1,24847,NH,SHOP (Small Group),Yes,13-5123390,24847NH0090002,Guardian Pediatric Advantage,24847NH009,,NHN001,NHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$30.39,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,24847NH0090002-00,Standard High Off Exchange Plan,85.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NH,24847,SERFF,2,2014-09-09 16:12:42,1,24847,NH,SHOP (Small Group),Yes,13-5123390,24847NH0100002,Guardian Pediatric Essentials,24847NH010,,NHN001,NHS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$21.50,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,24847NH0100002-00,Standard Low Off Exchange Plan,68.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NH,24847,SERFF,2,2014-09-09 16:12:42,2,24847,NH,SHOP (Small Group),Yes,13-5123390,24847NH0060002,Guardian Family Advantage,24847NH006,,NHN001,NHS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.39,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,24847NH0060002-00,Standard High Off Exchange Plan,85.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,9,61163,NH,SHOP (Small Group),No,45-3596033,61163NH0380001,MyDoc HMO Silver HSA 3000,61163NH038,,NHN002,NHS002,NHF008,New,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.999725620200571,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/employers-offe-nh,,http://minutemanhealth.org/plan%20descriptions-employers-nh,https://www.minutemanhealthdirect.org/formulary_search/default.aspx,61163NH0380001-00,Standard Silver Off Exchange Plan,,0.680222690105438,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,9,61163,NH,SHOP (Small Group),No,45-3596033,61163NH0400001,MyDoc HMO Bronze HSA 6000,61163NH040,,NHN002,NHS002,NHF007,New,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.999619519898767,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/employers-offe-nh,,http://minutemanhealth.org/plan%20descriptions-employers-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0400001-01,Standard Bronze On Exchange Plan,58.70%,0.586244583129883,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,72953,SERFF,2,2014-09-05 06:40:30,1,72953,NH,Individual,Yes,47-0397286,72953NH0010001,"Delta Dental Individual PPO, EHB Certified",72953NH001,,NHN002,NHS002,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$48.90,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,72953NH0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NH,72953,SERFF,2,2014-09-05 06:40:30,1,72953,NH,SHOP (Small Group),Yes,47-0397286,72953NH0030001,"Renaissance Group Dental PPO, EHB Certified",72953NH003,,NHN001,NHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$44.03,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,72953NH0030001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NH,72953,SERFF,2,2014-09-05 06:40:30,1,72953,NH,SHOP (Small Group),Yes,47-0397286,72953NH0030002,"Renaissance Group Dental PPO, EHB Certified",72953NH003,,NHN001,NHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.86,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,72953NH0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NH,72953,SERFF,2,2014-09-05 06:40:30,1,72953,NH,Individual,Yes,47-0397286,72953NH0010002,"Delta Dental Individual PPO, EHB Certified",72953NH001,,NHN002,NHS002,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$38.63,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,72953NH0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NH,72953,SERFF,2,2014-09-05 06:40:30,1,72953,NH,Individual,Yes,47-0397286,72953NH0020001,"Renaissance Individual Dental PPO, EHB Certified",72953NH002,,NHN001,NHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$48.17,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,72953NH0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NH,72953,SERFF,2,2014-09-05 06:40:30,1,72953,NH,Individual,Yes,47-0397286,72953NH0020002,"Renaissance Individual Dental PPO, EHB Certified",72953NH002,,NHN001,NHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$38.07,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,72953NH0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NH,74839,SERFF,2,2014-09-05 06:40:30,1,74839,NH,SHOP (Small Group),Yes,42-0127290,74839NH0040001,Principal Plan Dental 70,74839NH004,,NHN001,NHS001,,New,PPO,Low,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$30.96,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,74839NH0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NH,74839,SERFF,2,2014-09-05 06:40:30,1,74839,NH,SHOP (Small Group),Yes,42-0127290,74839NH0040002,Principal Plan Dental 80,74839NH004,,NHN001,NHS001,,New,PPO,High,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$32.42,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,74839NH0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,4,96751,NH,Individual,No,02-0494919,96751NH0150018,Anthem Bronze Pathway X Enhanced HMO 5750 10,96751NH015,,NHN002,NHS001,NHF006,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996309113414172,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPK,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150018-01,Standard Bronze On Exchange Plan,59.33%,0.596491277217865,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,4,96751,NH,Individual,No,02-0494919,96751NH0150018,Anthem Bronze Pathway X Enhanced HMO 5750 10,96751NH015,,NHN002,NHS001,NHF006,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996309113414172,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPK,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150018-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NH,24847,SERFF,2,2014-09-09 16:12:42,2,24847,NH,SHOP (Small Group),Yes,13-5123390,24847NH0060002,Guardian Family Advantage,24847NH006,,NHN001,NHS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.39,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,24847NH0060002-01,Standard High On Exchange Plan,85.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NH,24847,SERFF,2,2014-09-09 16:12:42,2,24847,NH,SHOP (Small Group),Yes,13-5123390,24847NH0080002,Guardian Family Essentials,24847NH008,,NHN001,NHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.50,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,24847NH0080002-00,Standard Low Off Exchange Plan,68.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NH,24847,SERFF,2,2014-09-09 16:12:42,2,24847,NH,SHOP (Small Group),Yes,13-5123390,24847NH0080002,Guardian Family Essentials,24847NH008,,NHN001,NHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.50,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,24847NH0080002-01,Standard Low On Exchange Plan,68.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NH,36773,SERFF,2,2014-09-05 06:40:30,1,36773,NH,SHOP (Small Group),Yes,36-0883760,36773NH0040002,EHB High PPO,36773NH004,,NHN001,NHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$53.20,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,36773NH0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NH,36773,SERFF,2,2014-09-05 06:40:30,1,36773,NH,SHOP (Small Group),Yes,36-0883760,36773NH0040001,EHB Low PPO,36773NH004,,NHN001,NHS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.08,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,36773NH0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NH,36773,SERFF,2,2014-09-05 06:40:30,1,36773,NH,SHOP (Small Group),Yes,36-0883760,36773NH0030002,EHB High Passive,36773NH003,,NHN001,NHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$57.35,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,36773NH0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NH,36773,SERFF,2,2014-09-05 06:40:30,1,36773,NH,SHOP (Small Group),Yes,36-0883760,36773NH0030001,EHB Low Passive,36773NH003,,NHN001,NHS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$38.06,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,36773NH0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,1,42260,NH,Individual,No,39-0658730,42260NH0110001,Assurant Health Bronze Plan 001,42260NH011,,NHN001,NHS001,NHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,42260NH0110001-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,1,42260,NH,Individual,No,39-0658730,42260NH0110002,Assurant Health Silver Plan 001,42260NH011,,NHN001,NHS001,NHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,42260NH0110002-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,1,42260,NH,Individual,No,39-0658730,42260NH0110002,Assurant Health Silver Plan 001,42260NH011,,NHN001,NHS001,NHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,42260NH0110002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,12
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,1,42260,NH,Individual,No,39-0658730,42260NH0110002,Assurant Health Silver Plan 001,42260NH011,,NHN001,NHS001,NHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,42260NH0110002-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,1,42260,NH,Individual,No,39-0658730,42260NH0110002,Assurant Health Silver Plan 001,42260NH011,,NHN001,NHS001,NHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,42260NH0110002-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,1,42260,NH,Individual,No,39-0658730,42260NH0110002,Assurant Health Silver Plan 001,42260NH011,,NHN001,NHS001,NHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,42260NH0110002-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,1,42260,NH,Individual,No,39-0658730,42260NH0110002,Assurant Health Silver Plan 001,42260NH011,,NHN001,NHS001,NHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,42260NH0110002-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,4,42260,NH,Individual,No,39-0658730,42260NH0110004,Assurant Health Silver Plan 002,42260NH011,,NHN001,NHS001,NHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,42260NH0110004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,4,42260,NH,Individual,No,39-0658730,42260NH0110004,Assurant Health Silver Plan 002,42260NH011,,NHN001,NHS001,NHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,42260NH0110004-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,4,42260,NH,Individual,No,39-0658730,42260NH0110004,Assurant Health Silver Plan 002,42260NH011,,NHN001,NHS001,NHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,42260NH0110004-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,4,42260,NH,Individual,No,39-0658730,42260NH0110004,Assurant Health Silver Plan 002,42260NH011,,NHN001,NHS001,NHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,42260NH0110004-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,4,42260,NH,Individual,No,39-0658730,42260NH0110004,Assurant Health Silver Plan 002,42260NH011,,NHN001,NHS001,NHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,42260NH0110004-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,4,42260,NH,Individual,No,39-0658730,42260NH0110005,Assurant Health Gold Plan 002,42260NH011,,NHN001,NHS001,NHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,42260NH0110005-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,4,42260,NH,Individual,No,39-0658730,42260NH0110005,Assurant Health Gold Plan 002,42260NH011,,NHN001,NHS001,NHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,42260NH0110005-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,4,42260,NH,Individual,No,39-0658730,42260NH0110005,Assurant Health Gold Plan 002,42260NH011,,NHN001,NHS001,NHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,42260NH0110005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,15
2015,NH,42260,SERFF,4,2014-11-10 10:02:31,4,42260,NH,Individual,No,39-0658730,42260NH0110006,Assurant Health Platinum Plan 002,42260NH011,,NHN001,NHS001,NHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,42260NH0110006-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,NH,44500,SERFF,2,2014-09-05 06:40:30,1,44500,NH,SHOP (Small Group),Yes,13-5581829,44500NH0080001,EHB Basic Dental Plan (Low),44500NH008,,NHN001,NHS001,,Existing,PPO,Low,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$23.11,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,44500NH0080001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NH,44500,SERFF,2,2014-09-05 06:40:30,2,44500,NH,SHOP (Small Group),Yes,13-5581829,44500NH0090001,EHB Enhanced Dental Plan (High),44500NH009,,NHN002,NHS001,,Existing,PPO,High,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$28.35,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,44500NH0090001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NH,44500,SERFF,2,2014-09-05 06:40:30,3,44500,NH,SHOP (Small Group),Yes,13-5581829,44500NH0100001,Family Basic Dental Plan (Low),44500NH010,,NHN003,NHS001,,Existing,PPO,Low,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$23.11,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,44500NH0100001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NH,44500,SERFF,2,2014-09-05 06:40:30,4,44500,NH,SHOP (Small Group),Yes,13-5581829,44500NH0110001,Family Enhanced Dental Plan (High),44500NH011,,NHN004,NHS001,,Existing,PPO,High,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$28.35,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,44500NH0110001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NH,57601,SERFF,8,2014-11-14 14:52:18,1,57601,NH,SHOP (Small Group),Yes,02-0510530,57601NH0370003,Anthem Dental Pediatric,57601NH037,,NHN001,NHS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$29.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213906.pdf,,,,57601NH0370003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NH,57601,SERFF,8,2014-11-14 14:52:18,1,57601,NH,Individual,Yes,02-0510530,57601NH0400003,Anthem Dental Pediatric,57601NH040,,NHN001,NHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$29.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213906.pdf,,,,57601NH0400003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NH,57601,SERFF,8,2014-11-14 14:52:18,1,57601,NH,Individual,Yes,02-0510530,57601NH0400003,Anthem Dental Pediatric,57601NH040,,NHN001,NHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$29.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213906.pdf,,,,57601NH0400003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NH,57601,SERFF,8,2014-11-14 14:52:18,2,57601,NH,Individual,Yes,02-0510530,57601NH0420003,Anthem Dental Family,57601NH042,,NHN001,NHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.32,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213904.pdf,,,,57601NH0420003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NH,57601,SERFF,8,2014-11-14 14:52:18,2,57601,NH,SHOP (Small Group),Yes,02-0510530,57601NH0390003,Anthem Dental Family,57601NH039,,NHN001,NHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.32,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213904.pdf,,,,57601NH0390003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NH,57601,SERFF,8,2014-11-14 14:52:18,2,57601,NH,SHOP (Small Group),Yes,02-0510530,57601NH0390003,Anthem Dental Family,57601NH039,,NHN001,NHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.32,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213904.pdf,,,,57601NH0390003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NH,57601,SERFF,8,2014-11-14 14:52:18,2,57601,NH,Individual,Yes,02-0510530,57601NH0420003,Anthem Dental Family,57601NH042,,NHN001,NHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.32,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213904.pdf,,,,57601NH0420003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NH,57601,SERFF,8,2014-11-14 14:52:18,2,57601,NH,Individual,Yes,02-0510530,57601NH0420004,Anthem Dental Family Enhanced,57601NH042,,NHN001,NHS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.97,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213905.pdf,,,,57601NH0420004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NH,57601,SERFF,8,2014-11-14 14:52:18,2,57601,NH,SHOP (Small Group),Yes,02-0510530,57601NH0390004,Anthem Dental Family Enhanced,57601NH039,,NHN001,NHS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.97,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213905.pdf,,,,57601NH0390004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NH,57601,SERFF,8,2014-11-14 14:52:18,2,57601,NH,SHOP (Small Group),Yes,02-0510530,57601NH0390004,Anthem Dental Family Enhanced,57601NH039,,NHN001,NHS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.97,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213905.pdf,,,,57601NH0390004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NH,57601,SERFF,8,2014-11-14 14:52:18,2,57601,NH,Individual,Yes,02-0510530,57601NH0420004,Anthem Dental Family Enhanced,57601NH042,,NHN001,NHS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.97,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213905.pdf,,,,57601NH0420004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,1,59025,NH,Individual,No,04-2663394,59025NH0290001,Harvard Pilgrim ElevateHealth Gold HSA HMO,59025NH029,,NHN002,NHS002,NHF002,New,HMO,Gold,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0290001-00,Standard Gold Off Exchange Plan,78.10%,0.780939161777496,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,700","$5,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,1,59025,NH,Individual,No,04-2663394,59025NH0290001,Harvard Pilgrim ElevateHealth Gold HSA HMO,59025NH029,,NHN002,NHS002,NHF002,New,HMO,Gold,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0290001-01,Standard Gold On Exchange Plan,78.10%,0.780939161777496,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,700","$5,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,1,59025,NH,Individual,No,04-2663394,59025NH0290001,Harvard Pilgrim ElevateHealth Gold HSA HMO,59025NH029,,NHN002,NHS002,NHF002,New,HMO,Gold,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0290001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,2,59025,NH,Individual,No,04-2663394,59025NH0290006,Harvard Pilgrim ElevateHealth Silver HSA HMO,59025NH029,,NHN002,NHS002,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0290006-05,87% AV Level Silver Plan,86.42%,0.862857341766357,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,2,59025,NH,Individual,No,04-2663394,59025NH0290006,Harvard Pilgrim ElevateHealth Silver HSA HMO,59025NH029,,NHN002,NHS002,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0290006-06,94% AV Level Silver Plan,93.35%,0.932278037071228,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,3,59025,NH,Individual,No,04-2663394,59025NH0280001,Harvard Pilgrim NH Network Bronze HSA HMO,59025NH028,,NHN003,NHS003,NHF007,New,HMO,Bronze,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0280001-00,Standard Bronze Off Exchange Plan,60.99%,0.608045637607574,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,3,59025,NH,Individual,No,04-2663394,59025NH0280001,Harvard Pilgrim NH Network Bronze HSA HMO,59025NH028,,NHN003,NHS003,NHF007,New,HMO,Bronze,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0280001-01,Standard Bronze On Exchange Plan,60.99%,0.608045637607574,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,3,59025,NH,Individual,No,04-2663394,59025NH0280001,Harvard Pilgrim NH Network Bronze HSA HMO,59025NH028,,NHN003,NHS003,NHF007,New,HMO,Bronze,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0280001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,4,59025,NH,Individual,No,04-2663394,59025NH0260005,Harvard Pilgrim ElevateHealth Silver HMO,59025NH026,,NHN002,NHS002,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,Yes,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0260005-01,Standard Silver On Exchange Plan,68.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,4,59025,NH,Individual,No,04-2663394,59025NH0260005,Harvard Pilgrim ElevateHealth Silver HMO,59025NH026,,NHN002,NHS002,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,Yes,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0260005-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,8,61163,NH,SHOP (Small Group),No,45-3596033,61163NH0360001,MyDoc HMO Gold Basic 1000,61163NH036,,NHN002,NHS002,NHF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.999800700522426,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/employers-offe-nh,,http://minutemanhealth.org/plan%20descriptions-employers-nh,https://www.minutemanhealthdirect.org/formulary_search/default.aspx,61163NH0360001-01,Standard Gold On Exchange Plan,,0.781630098819733,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,4,96751,NH,Individual,No,02-0494919,96751NH0150018,Anthem Bronze Pathway X Enhanced HMO 5750 10,96751NH015,,NHN002,NHS001,NHF006,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996309113414172,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPK,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150018-03,Limited Cost Sharing Plan Variation,59.33%,0.596491277217865,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,5,96751,NH,Individual,No,02-0494919,96751NH0150020,Anthem Silver Pathway X Enhanced HMO 10 for HSA,96751NH015,,NHN002,NHS001,NHF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997085995148335,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPL,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150020-00,Standard Silver Off Exchange Plan,70.54%,0.708982825279236,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,5,59025,NH,Individual,No,04-2663394,59025NH0260003,Harvard Pilgrim ElevateHealth Bronze HMO,59025NH026,,NHN002,NHS002,NHF006,New,HMO,Bronze,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0260003-00,Standard Bronze Off Exchange Plan,59.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,5,59025,NH,Individual,No,04-2663394,59025NH0260003,Harvard Pilgrim ElevateHealth Bronze HMO,59025NH026,,NHN002,NHS002,NHF006,New,HMO,Bronze,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0260003-01,Standard Bronze On Exchange Plan,59.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,3,61163,NH,Individual,No,45-3596033,61163NH0370001,MyDoc HMO Simple Care,61163NH037,,NHN001,NHS001,NHF009,New,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9994,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0370001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,3,61163,NH,Individual,No,45-3596033,61163NH0370001,MyDoc HMO Simple Care,61163NH037,,NHN001,NHS001,NHF009,New,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9994,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0370001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,4,61163,NH,Individual,No,45-3596033,61163NH0130001,MyDoc HMO Silver Basic 2000,61163NH013,,NHN001,NHS001,NHF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9998,,,0,0,3,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0130001-00,Standard Silver Off Exchange Plan,,0.688909590244293,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,4,61163,NH,Individual,No,45-3596033,61163NH0130001,MyDoc HMO Silver Basic 2000,61163NH013,,NHN001,NHS001,NHF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9998,,,0,0,3,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0130001-01,Standard Silver On Exchange Plan,,0.688909590244293,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,4,61163,NH,Individual,No,45-3596033,61163NH0130001,MyDoc HMO Silver Basic 2000,61163NH013,,NHN001,NHS001,NHF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9998,,,0,0,3,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0130001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,4,61163,NH,Individual,No,45-3596033,61163NH0130001,MyDoc HMO Silver Basic 2000,61163NH013,,NHN001,NHS001,NHF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9998,,,0,0,3,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0130001-03,Limited Cost Sharing Plan Variation,,0.688909590244293,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,4,61163,NH,Individual,No,45-3596033,61163NH0130001,MyDoc HMO Silver Basic 2000,61163NH013,,NHN001,NHS001,NHF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9998,,,0,0,3,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0130001-04,73% AV Level Silver Plan,,0.723313212394714,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,4,61163,NH,Individual,No,45-3596033,61163NH0130001,MyDoc HMO Silver Basic 2000,61163NH013,,NHN001,NHS001,NHF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9998,,,0,0,3,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0130001-05,87% AV Level Silver Plan,,0.864930629730225,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$800,"$1,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,4,61163,NH,Individual,No,45-3596033,61163NH0130001,MyDoc HMO Silver Basic 2000,61163NH013,,NHN001,NHS001,NHF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9998,,,0,0,3,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0130001-06,94% AV Level Silver Plan,,0.938218176364899,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$175,$350,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,5,61163,NH,Individual,No,45-3596033,61163NH0250001,MyDoc HMO Bronze Value 3750,61163NH025,,NHN001,NHS001,NHF003,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0250001-00,Standard Bronze Off Exchange Plan,58.00%,0.588997960090637,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,5,61163,NH,Individual,No,45-3596033,61163NH0250001,MyDoc HMO Bronze Value 3750,61163NH025,,NHN001,NHS001,NHF003,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0250001-01,Standard Bronze On Exchange Plan,58.80%,0.588997960090637,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,5,61163,NH,Individual,No,45-3596033,61163NH0250001,MyDoc HMO Bronze Value 3750,61163NH025,,NHN001,NHS001,NHF003,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0250001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,5,59025,NH,Individual,No,04-2663394,59025NH0260003,Harvard Pilgrim ElevateHealth Bronze HMO,59025NH026,,NHN002,NHS002,NHF006,New,HMO,Bronze,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, physical therapy, occupational therapy, speech therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0260003-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,6,59025,NH,Individual,No,04-2663394,59025NH0270010,Harvard Pilgrim NH HMO Gold,59025NH027,,NHN003,NHS003,NHF001,New,HMO,Gold,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0270010-01,Standard Gold On Exchange Plan,78.42%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,6,59025,NH,Individual,No,04-2663394,59025NH0270010,Harvard Pilgrim NH HMO Gold,59025NH027,,NHN003,NHS003,NHF001,New,HMO,Gold,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0270010-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NH,59822,SERFF,2,2014-09-05 06:40:30,1,59822,NH,SHOP (Small Group),Yes,44-0308260,59822NH0010001,KCL EHB Low PPO,59822NH001,,NHN001,NHS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$45.54,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,59822NH0010001-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NH,59822,SERFF,2,2014-09-05 06:40:30,1,59822,NH,SHOP (Small Group),Yes,44-0308260,59822NH0010003,KCL EHB Low MAC,59822NH001,,NHN001,NHS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$30.54,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,59822NH0010003-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NH,59822,SERFF,2,2014-09-05 06:40:30,1,59822,NH,SHOP (Small Group),Yes,44-0308260,59822NH0010005,KCL Fam Low PPO,59822NH001,,NHN001,NHS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$45.54,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,59822NH0010005-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NH,59822,SERFF,2,2014-09-05 06:40:30,1,59822,NH,SHOP (Small Group),Yes,44-0308260,59822NH0010007,KCL Fam Low MAC,59822NH001,,NHN001,NHS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$30.54,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,59822NH0010007-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NH,59822,SERFF,2,2014-09-05 06:40:30,2,59822,NH,SHOP (Small Group),Yes,44-0308260,59822NH0010002,KCL EHB High PPO,59822NH001,,NHN001,NHS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$55.06,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,59822NH0010002-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NH,59822,SERFF,2,2014-09-05 06:40:30,2,59822,NH,SHOP (Small Group),Yes,44-0308260,59822NH0010004,KCL EHB High MAC,59822NH001,,NHN001,NHS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$38.15,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,59822NH0010004-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,6,96751,NH,Individual,No,02-0494919,96751NH0150022,Anthem Silver Pathway X Enhanced HMO 3250 0,96751NH015,,NHN002,NHS001,NHF008,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997217264489743,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPU,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150022-04,73% AV Level Silver Plan,72.04%,0.717262864112854,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,150","$8,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,900","$5,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,6,96751,NH,Individual,No,02-0494919,96751NH0150022,Anthem Silver Pathway X Enhanced HMO 3250 0,96751NH015,,NHN002,NHS001,NHF008,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997217264489743,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPU,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150022-05,87% AV Level Silver Plan,86.22%,0.859875202178955,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,6,96751,NH,Individual,No,02-0494919,96751NH0150022,Anthem Silver Pathway X Enhanced HMO 3250 0,96751NH015,,NHN002,NHS001,NHF008,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997217264489743,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPU,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150022-06,94% AV Level Silver Plan,93.43%,0.929156482219696,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,6,59025,NH,Individual,No,04-2663394,59025NH0270010,Harvard Pilgrim NH HMO Gold,59025NH027,,NHN003,NHS003,NHF001,New,HMO,Gold,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0270010-03,Limited Cost Sharing Plan Variation,78.42%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,7,59025,NH,Individual,No,04-2663394,59025NH0270003,Harvard Pilgrim NH Network Silver HMO Premium,59025NH027,,NHN003,NHS003,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0270003-00,Standard Silver Off Exchange Plan,70.64%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,7,59025,NH,Individual,No,04-2663394,59025NH0270003,Harvard Pilgrim NH Network Silver HMO Premium,59025NH027,,NHN003,NHS003,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0270003-01,Standard Silver On Exchange Plan,70.64%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,7,59025,NH,Individual,No,04-2663394,59025NH0270003,Harvard Pilgrim NH Network Silver HMO Premium,59025NH027,,NHN003,NHS003,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0270003-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,7,59025,NH,Individual,No,04-2663394,59025NH0270003,Harvard Pilgrim NH Network Silver HMO Premium,59025NH027,,NHN003,NHS003,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0270003-03,Limited Cost Sharing Plan Variation,70.64%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,7,59025,NH,Individual,No,04-2663394,59025NH0270003,Harvard Pilgrim NH Network Silver HMO Premium,59025NH027,,NHN003,NHS003,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0270003-04,73% AV Level Silver Plan,73.82%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,7,59025,NH,Individual,No,04-2663394,59025NH0270003,Harvard Pilgrim NH Network Silver HMO Premium,59025NH027,,NHN003,NHS003,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0270003-05,87% AV Level Silver Plan,87.45%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,7,59025,NH,Individual,No,04-2663394,59025NH0270003,Harvard Pilgrim NH Network Silver HMO Premium,59025NH027,,NHN003,NHS003,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Services only.,Yes,Urgent and Emergency Services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0270003-06,94% AV Level Silver Plan,93.09%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,8,59025,NH,Individual,No,04-2663394,59025NH0270002,Harvard Pilgrim NH Network Silver HMO Preferred,59025NH027,,NHN003,NHS003,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency services only,Yes,Urgent and Emergency services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0270002-00,Standard Silver Off Exchange Plan,69.12%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,8,59025,NH,Individual,No,04-2663394,59025NH0270002,Harvard Pilgrim NH Network Silver HMO Preferred,59025NH027,,NHN003,NHS003,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency services only,Yes,Urgent and Emergency services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0270002-01,Standard Silver On Exchange Plan,69.12%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,8,59025,NH,Individual,No,04-2663394,59025NH0270002,Harvard Pilgrim NH Network Silver HMO Preferred,59025NH027,,NHN003,NHS003,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency services only,Yes,Urgent and Emergency services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0270002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,8,59025,NH,Individual,No,04-2663394,59025NH0270002,Harvard Pilgrim NH Network Silver HMO Preferred,59025NH027,,NHN003,NHS003,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency services only,Yes,Urgent and Emergency services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0270002-03,Limited Cost Sharing Plan Variation,69.12%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,8,59025,NH,Individual,No,04-2663394,59025NH0270002,Harvard Pilgrim NH Network Silver HMO Preferred,59025NH027,,NHN003,NHS003,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency services only,Yes,Urgent and Emergency services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0270002-04,73% AV Level Silver Plan,73.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,8,59025,NH,Individual,No,04-2663394,59025NH0270002,Harvard Pilgrim NH Network Silver HMO Preferred,59025NH027,,NHN003,NHS003,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency services only,Yes,Urgent and Emergency services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0270002-05,87% AV Level Silver Plan,87.03%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,8,59025,NH,Individual,No,04-2663394,59025NH0270002,Harvard Pilgrim NH Network Silver HMO Preferred,59025NH027,,NHN003,NHS003,NHF003,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy and mental health care.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency services only,Yes,Urgent and Emergency services only.,No,"https://www.harvardpilgrim.org/portal/page?_pageid=213,5928022&_dad=portal&_schema=PORTAL",https://premiums.payspanhealth.com/binder?entryPointToken=ffe,,https://www.harvardpilgrim.org/value4,59025NH0270002-06,94% AV Level Silver Plan,93.07%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,11,59025,NH,SHOP (Small Group),No,04-2663394,59025NH0250020,ElevateHealth HMO 2000,59025NH025,,NHN002,NHS002,NHF001,New,HMO,Gold,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Care are only covered,Yes,Urgent and Emergency Care are only covered,No,"https://www.harvardpilgrim.org/portal/page?_pageid=849,4964018&_dad=portal&_schema=PORTAL",,,https://www.harvardpilgrim.org/pls/ext/f?p=768:45:4010765117470618::NO:::,59025NH0250020-00,Standard Gold Off Exchange Plan,79.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,11,59025,NH,SHOP (Small Group),No,04-2663394,59025NH0250020,ElevateHealth HMO 2000,59025NH025,,NHN002,NHS002,NHF001,New,HMO,Gold,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Care are only covered,Yes,Urgent and Emergency Care are only covered,No,"https://www.harvardpilgrim.org/portal/page?_pageid=849,4964018&_dad=portal&_schema=PORTAL",,,https://www.harvardpilgrim.org/pls/ext/f?p=768:45:4010765117470618::NO:::,59025NH0250020-01,Standard Gold On Exchange Plan,79.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,11,59025,NH,SHOP (Small Group),No,04-2663394,59025NH0250022,ElevateHealth HMO 4000,59025NH025,,NHN002,NHS002,NHF002,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Care are only covered,Yes,Urgent and Emergency Care are only covered,No,"https://www.harvardpilgrim.org/portal/page?_pageid=849,4964018&_dad=portal&_schema=PORTAL",,,https://www.harvardpilgrim.org/pls/ext/f?p=768:45:4010765117470618::NO:::,59025NH0250022-00,Standard Silver Off Exchange Plan,69.39%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,11,59025,NH,SHOP (Small Group),No,04-2663394,59025NH0250022,ElevateHealth HMO 4000,59025NH025,,NHN002,NHS002,NHF002,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Care are only covered,Yes,Urgent and Emergency Care are only covered,No,"https://www.harvardpilgrim.org/portal/page?_pageid=849,4964018&_dad=portal&_schema=PORTAL",,,https://www.harvardpilgrim.org/pls/ext/f?p=768:45:4010765117470618::NO:::,59025NH0250022-01,Standard Silver On Exchange Plan,69.39%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,13,59025,NH,SHOP (Small Group),No,04-2663394,59025NH0220015,Best Buy Tiered HMO LP 2000,59025NH022,,NHN001,NHS001,NHF001,New,HMO,Gold,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Care are only covered,Yes,Urgent and Emergency Care are only covered,No,"https://www.harvardpilgrim.org/portal/page?_pageid=849,4964018&_dad=portal&_schema=PORTAL",,,https://www.harvardpilgrim.org/pls/ext/f?p=768:45:4010765117470618::NO:::,59025NH0220015-00,Standard Gold Off Exchange Plan,78.96%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,500","$7,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",10%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,13,59025,NH,SHOP (Small Group),No,04-2663394,59025NH0220015,Best Buy Tiered HMO LP 2000,59025NH022,,NHN001,NHS001,NHF001,New,HMO,Gold,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Care are only covered,Yes,Urgent and Emergency Care are only covered,No,"https://www.harvardpilgrim.org/portal/page?_pageid=849,4964018&_dad=portal&_schema=PORTAL",,,https://www.harvardpilgrim.org/pls/ext/f?p=768:45:4010765117470618::NO:::,59025NH0220015-01,Standard Gold On Exchange Plan,78.96%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,500","$7,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",10%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,13,59025,NH,SHOP (Small Group),No,04-2663394,59025NH0220019,Best Buy Tiered Copay HMO LP,59025NH022,,NHN001,NHS001,NHF002,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Care are only covered,Yes,Urgent and Emergency Care are only covered,No,"https://www.harvardpilgrim.org/portal/page?_pageid=849,4964018&_dad=portal&_schema=PORTAL",,,https://www.harvardpilgrim.org/pls/ext/f?p=768:45:4010765117470618::NO:::,59025NH0220019-00,Standard Silver Off Exchange Plan,69.04%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,500","$13,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,NH,59025,SERFF,11,2015-07-22 12:46:44,13,59025,NH,SHOP (Small Group),No,04-2663394,59025NH0220019,Best Buy Tiered Copay HMO LP,59025NH022,,NHN001,NHS001,NHF002,New,HMO,Silver,Yes,Both,No,Yes,"A referral is required for all specialist services, except OB\GYN care, chiropractic care, routine eye exams, Physical Therapy, Occupational Therapy, Speech Therapy, and mental health care.",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999833601893653,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and Emergency Care are only covered,Yes,Urgent and Emergency Care are only covered,No,"https://www.harvardpilgrim.org/portal/page?_pageid=849,4964018&_dad=portal&_schema=PORTAL",,,https://www.harvardpilgrim.org/pls/ext/f?p=768:45:4010765117470618::NO:::,59025NH0220019-01,Standard Silver On Exchange Plan,69.04%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,500","$13,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,NH,59822,SERFF,2,2014-09-05 06:40:30,2,59822,NH,SHOP (Small Group),Yes,44-0308260,59822NH0010006,KCL Fam High PPO,59822NH001,,NHN001,NHS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$55.06,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,59822NH0010006-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NH,59822,SERFF,2,2014-09-05 06:40:30,2,59822,NH,SHOP (Small Group),Yes,44-0308260,59822NH0010008,KCL Fam High MAC,59822NH001,,NHN001,NHS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$38.15,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,59822NH0010008-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,1,61163,NH,Individual,No,45-3596033,61163NH0030001,MyDoc HMO Gold Basic 1000,61163NH003,,NHN001,NHS001,NHF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0030001-00,Standard Gold Off Exchange Plan,,0.781630098819733,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,1,61163,NH,Individual,No,45-3596033,61163NH0030001,MyDoc HMO Gold Basic 1000,61163NH003,,NHN001,NHS001,NHF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0030001-01,Standard Gold On Exchange Plan,,0.781630098819733,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,1,61163,NH,Individual,No,45-3596033,61163NH0030001,MyDoc HMO Gold Basic 1000,61163NH003,,NHN001,NHS001,NHF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0030001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,1,61163,NH,Individual,No,45-3596033,61163NH0030001,MyDoc HMO Gold Basic 1000,61163NH003,,NHN001,NHS001,NHF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0030001-03,Limited Cost Sharing Plan Variation,,0.781630098819733,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,2,61163,NH,Individual,No,45-3596033,61163NH0150001,MyDoc HMO Silver HSA 3000,61163NH015,,NHN001,NHS001,NHF008,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0150001-00,Standard Silver Off Exchange Plan,,0.680222690105438,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,2,61163,NH,Individual,No,45-3596033,61163NH0150001,MyDoc HMO Silver HSA 3000,61163NH015,,NHN001,NHS001,NHF008,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0150001-01,Standard Silver On Exchange Plan,,0.680222690105438,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,2,61163,NH,Individual,No,45-3596033,61163NH0150001,MyDoc HMO Silver HSA 3000,61163NH015,,NHN001,NHS001,NHF008,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0150001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,2,61163,NH,Individual,No,45-3596033,61163NH0150001,MyDoc HMO Silver HSA 3000,61163NH015,,NHN001,NHS001,NHF008,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0150001-03,Limited Cost Sharing Plan Variation,,0.680222690105438,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,2,61163,NH,Individual,No,45-3596033,61163NH0150001,MyDoc HMO Silver HSA 3000,61163NH015,,NHN001,NHS001,NHF008,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0150001-04,73% AV Level Silver Plan,,0.73337197303772,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,050","$4,100",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,2,61163,NH,Individual,No,45-3596033,61163NH0150001,MyDoc HMO Silver HSA 3000,61163NH015,,NHN001,NHS001,NHF008,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0150001-05,87% AV Level Silver Plan,,0.871334493160248,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$675,"$1,350",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,2,61163,NH,Individual,No,45-3596033,61163NH0150001,MyDoc HMO Silver HSA 3000,61163NH015,,NHN001,NHS001,NHF008,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0150001-06,94% AV Level Silver Plan,,0.940503299236298,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,2,61163,NH,Individual,No,45-3596033,61163NH0330001,MyDoc HMO Bronze HSA 5800,61163NH033,,NHN001,NHS001,NHF008,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0330001-00,Standard Bronze Off Exchange Plan,,0.584383547306061,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,800","$11,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,2,61163,NH,Individual,No,45-3596033,61163NH0330001,MyDoc HMO Bronze HSA 5800,61163NH033,,NHN001,NHS001,NHF008,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0330001-01,Standard Bronze On Exchange Plan,,0.584383547306061,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,800","$11,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,2,61163,NH,Individual,No,45-3596033,61163NH0330001,MyDoc HMO Bronze HSA 5800,61163NH033,,NHN001,NHS001,NHF008,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0330001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,2,61163,NH,Individual,No,45-3596033,61163NH0330001,MyDoc HMO Bronze HSA 5800,61163NH033,,NHN001,NHS001,NHF008,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0330001-03,Limited Cost Sharing Plan Variation,,0.584383547306061,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,800","$11,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,2,61163,NH,Individual,No,45-3596033,61163NH0350001,MyDoc HMO Bronze HSA 6300,61163NH035,,NHN001,NHS001,NHF009,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0350001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,17
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,2,61163,NH,Individual,No,45-3596033,61163NH0350001,MyDoc HMO Bronze HSA 6300,61163NH035,,NHN001,NHS001,NHF009,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0350001-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,5,61163,NH,Individual,No,45-3596033,61163NH0250001,MyDoc HMO Bronze Value 3750,61163NH025,,NHN001,NHS001,NHF003,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9996,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0250001-03,Limited Cost Sharing Plan Variation,58.80%,0.588997960090637,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,5,61163,NH,Individual,No,45-3596033,61163NH0310001,MyDoc HMO Bronze Basic 4500,61163NH031,,NHN001,NHS001,NHF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0310001-00,Standard Bronze Off Exchange Plan,,0.581617593765259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,5,61163,NH,Individual,No,45-3596033,61163NH0310001,MyDoc HMO Bronze Basic 4500,61163NH031,,NHN001,NHS001,NHF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0310001-01,Standard Bronze On Exchange Plan,,0.581617593765259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,5,61163,NH,Individual,No,45-3596033,61163NH0310001,MyDoc HMO Bronze Basic 4500,61163NH031,,NHN001,NHS001,NHF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0310001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,5,61163,NH,Individual,No,45-3596033,61163NH0310001,MyDoc HMO Bronze Basic 4500,61163NH031,,NHN001,NHS001,NHF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9997,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/members-one-nh,https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx,http://minutemanhealth.org/plan-descriptions-members-nh,https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE,61163NH0310001-03,Limited Cost Sharing Plan Variation,,0.581617593765259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,NH,61163,SERFF,9,2015-01-16 20:59:55,8,61163,NH,SHOP (Small Group),No,45-3596033,61163NH0360001,MyDoc HMO Gold Basic 1000,61163NH036,,NHN002,NHS002,NHF001,New,HMO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.999800700522426,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://minutemanhealth.org/employers-offe-nh,,http://minutemanhealth.org/plan%20descriptions-employers-nh,https://www.minutemanhealthdirect.org/formulary_search/default.aspx,61163NH0360001-00,Standard Gold Off Exchange Plan,,0.781630098819733,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,81787,SERFF,3,2014-09-08 09:42:37,1,81787,NH,SHOP (Small Group),Yes,47-0098400,81787NH0040002,EHB High PPO,81787NH004,,NHN001,NHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$52.47,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,81787NH0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NH,81787,SERFF,3,2014-09-08 09:42:37,1,81787,NH,SHOP (Small Group),Yes,47-0098400,81787NH0040001,EHB Low PPO,81787NH004,,NHN001,NHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.69,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,81787NH0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NH,81787,SERFF,3,2014-09-08 09:42:37,1,81787,NH,SHOP (Small Group),Yes,47-0098400,81787NH0030002,EHB High Passive,81787NH003,,NHN001,NHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$56.56,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,81787NH0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,5,96751,NH,Individual,No,02-0494919,96751NH0150020,Anthem Silver Pathway X Enhanced HMO 10 for HSA,96751NH015,,NHN002,NHS001,NHF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997085995148335,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPL,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150020-05,87% AV Level Silver Plan,86.17%,0.861683309078217,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,5,96751,NH,Individual,No,02-0494919,96751NH0150020,Anthem Silver Pathway X Enhanced HMO 10 for HSA,96751NH015,,NHN002,NHS001,NHF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997085995148335,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPL,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150020-06,94% AV Level Silver Plan,93.27%,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,6,96751,NH,Individual,No,02-0494919,96751NH0150022,Anthem Silver Pathway X Enhanced HMO 3250 0,96751NH015,,NHN002,NHS001,NHF008,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997217264489743,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPU,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150022-00,Standard Silver Off Exchange Plan,69.06%,0.684714019298553,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,250","$6,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,6,96751,NH,Individual,No,02-0494919,96751NH0150022,Anthem Silver Pathway X Enhanced HMO 3250 0,96751NH015,,NHN002,NHS001,NHF008,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997217264489743,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPU,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150022-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,1,57173,NM,Individual,No,94-3037165,57173NM0130005,Individual HMO Silver B w/Gym Membership,57173NM013,,NMN001,NMS001,NMF009,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,Emergency and Non-emergency when prior authorization is obtained,Yes,Emergency and Non-emergency when prior authorization is obtianed,No,https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130005-01,Standard Silver On Exchange Plan,,0.709630072116852,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,1,57173,NM,Individual,No,94-3037165,57173NM0130005,Individual HMO Silver B w/Gym Membership,57173NM013,,NMN001,NMS001,NMF009,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,Emergency and Non-emergency when prior authorization is obtained,Yes,Emergency and Non-emergency when prior authorization is obtianed,No,https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,1,57173,NM,Individual,No,94-3037165,57173NM0130005,Individual HMO Silver B w/Gym Membership,57173NM013,,NMN001,NMS001,NMF009,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,Emergency and Non-emergency when prior authorization is obtained,Yes,Emergency and Non-emergency when prior authorization is obtianed,No,https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130005-03,Limited Cost Sharing Plan Variation,,0.709630072116852,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,1,57173,NM,Individual,No,94-3037165,57173NM0130005,Individual HMO Silver B w/Gym Membership,57173NM013,,NMN001,NMS001,NMF009,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,Emergency and Non-emergency when prior authorization is obtained,Yes,Emergency and Non-emergency when prior authorization is obtianed,No,https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130005-04,73% AV Level Silver Plan,,0.737468361854553,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NH,81787,SERFF,3,2014-09-08 09:42:37,1,81787,NH,SHOP (Small Group),Yes,47-0098400,81787NH0030001,EHB Low Passive,81787NH003,,NHN001,NHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$37.53,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,81787NH0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NH,87701,SERFF,8,2015-01-22 16:02:51,1,87701,NH,Individual,Yes,02-0273013,87701NH0070001,Delta Dental Family High Plan,87701NH007,,NHN001,NHS001,,Existing,PPO,High,,Both,,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,Allows Adult and Child-Only,,,,$42.01,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same Coverage,Yes,Same Coverage,Yes,,https://auth.deltadentalcoversme.com/sp/ACS.saml2,http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/nh/oocnh20151.pdf,,87701NH0070001-00,Standard High Off Exchange Plan,85.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NH,87701,SERFF,8,2015-01-22 16:02:51,1,87701,NH,SHOP (Small Group),Yes,02-0273013,87701NH0110001,Delta Dental PPO Family High Plan,87701NH011,,NHN001,NHS001,,Existing,PPO,High,,On the Exchange,,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,Allows Adult and Child-Only,,,,$42.01,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same Coverage,Yes,Same Coverage,Yes,,,http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/nh/oocnh20155.pdf,,87701NH0110001-01,Standard High On Exchange Plan,85.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NH,87701,SERFF,8,2015-01-22 16:02:51,1,87701,NH,Individual,Yes,02-0273013,87701NH0070001,Delta Dental Family High Plan,87701NH007,,NHN001,NHS001,,Existing,PPO,High,,Both,,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,Allows Adult and Child-Only,,,,$42.01,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same Coverage,Yes,Same Coverage,Yes,,https://auth.deltadentalcoversme.com/sp/ACS.saml2,http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/nh/oocnh20151.pdf,,87701NH0070001-01,Standard High On Exchange Plan,85.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NH,87701,SERFF,8,2015-01-22 16:02:51,1,87701,NH,SHOP (Small Group),Yes,02-0273013,87701NH0120001,Delta Dental PPO Family Low Plan,87701NH012,,NHN001,NHS001,,Existing,PPO,Low,,On the Exchange,,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,Allows Adult and Child-Only,,,,$35.56,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same Coverage,Yes,Same Coverage,Yes,,,http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/nh/oocnh20156.pdf,,87701NH0120001-01,Standard Low On Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,$150,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NH,87701,SERFF,8,2015-01-22 16:02:51,1,87701,NH,Individual,Yes,02-0273013,87701NH0080001,Delta Dental Family Low Plan,87701NH008,,NHN001,NHS001,,Existing,PPO,Low,,Both,,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,Allows Adult and Child-Only,,,,$35.56,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same Coverage,Yes,Same Coverage,Yes,,https://auth.deltadentalcoversme.com/sp/ACS.saml2,http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/nh/oocnh20152.pdf,,87701NH0080001-00,Standard Low Off Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,$150,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NH,87701,SERFF,8,2015-01-22 16:02:51,1,87701,NH,SHOP (Small Group),Yes,02-0273013,87701NH0110002,Delta Dental PPO Family High Plan,87701NH011,,NHN001,NHS001,,New,PPO,High,,Off the Exchange,,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,Allows Adult and Child-Only,,,,$42.01,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same Coverage,Yes,Same Coverage,Yes,,,http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/nh/oocnh2015c.pdf,,87701NH0110002-00,Standard High Off Exchange Plan,85.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NH,87701,SERFF,8,2015-01-22 16:02:51,1,87701,NH,SHOP (Small Group),Yes,02-0273013,87701NH0120002,Delta Dental PPO Family Low Plan,87701NH012,,NHN001,NHS001,,New,PPO,Low,,Off the Exchange,,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,Allows Adult and Child-Only,,,,$35.56,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same Coverage,Yes,Same Coverage,Yes,,,http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/nh/oocnh2015d.pdf,,87701NH0120002-00,Standard Low Off Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,$150,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NH,87701,SERFF,8,2015-01-22 16:02:51,1,87701,NH,Individual,Yes,02-0273013,87701NH0080001,Delta Dental Family Low Plan,87701NH008,,NHN001,NHS001,,Existing,PPO,Low,,Both,,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,Allows Adult and Child-Only,,,,$35.56,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same Coverage,Yes,Same Coverage,Yes,,https://auth.deltadentalcoversme.com/sp/ACS.saml2,http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/nh/oocnh20152.pdf,,87701NH0080001-01,Standard Low On Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,$150,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NH,87701,SERFF,8,2015-01-22 16:02:51,2,87701,NH,Individual,Yes,02-0273013,87701NH0090001,Delta Dental Pediatric High Plan,87701NH009,,NHN001,NHS001,,Existing,PPO,High,,On the Exchange,,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,Allows Child-Only,,,,$42.01,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same Coverage,Yes,Same Coverage,Yes,,https://auth.deltadentalcoversme.com/sp/ACS.saml2,http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/nh/oocnh20153.pdf,,87701NH0090001-01,Standard High On Exchange Plan,85.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NH,87701,SERFF,8,2015-01-22 16:02:51,2,87701,NH,Individual,Yes,02-0273013,87701NH0100001,Delta Dental Pediatric Low Plan,87701NH010,,NHN001,NHS001,,Existing,PPO,Low,,On the Exchange,,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,Allows Child-Only,,,,$35.56,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Same Coverage,Yes,Same Coverage,Yes,,https://auth.deltadentalcoversme.com/sp/ACS.saml2,http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/nh/oocnh20154.pdf,,87701NH0100001-01,Standard Low On Exchange Plan,71.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,$150,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,1,96751,NH,Individual,No,02-0494919,96751NH0150015,Anthem Bronze Pathway X Enhanced HMO 25 for HSA,96751NH015,,NHN002,NHS001,NHF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996384572237178,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPG,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150015-00,Standard Bronze Off Exchange Plan,61.21%,0.617264628410339,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,1,96751,NH,Individual,No,02-0494919,96751NH0150015,Anthem Bronze Pathway X Enhanced HMO 25 for HSA,96751NH015,,NHN002,NHS001,NHF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996384572237178,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPG,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150015-01,Standard Bronze On Exchange Plan,61.21%,0.617264628410339,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,1,96751,NH,Individual,No,02-0494919,96751NH0150015,Anthem Bronze Pathway X Enhanced HMO 25 for HSA,96751NH015,,NHN002,NHS001,NHF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996384572237178,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPG,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150015-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,1,96751,NH,Individual,No,02-0494919,96751NH0150015,Anthem Bronze Pathway X Enhanced HMO 25 for HSA,96751NH015,,NHN002,NHS001,NHF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996384572237178,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPG,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150015-03,Limited Cost Sharing Plan Variation,61.21%,0.617264628410339,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,2,96751,NH,Individual,No,02-0494919,96751NH0150016,Anthem Bronze Pathway X Enhanced HMO 0 for HSA,96751NH015,,NHN002,NHS001,NHF002,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99630896150593,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPH,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150016-00,Standard Bronze Off Exchange Plan,60.16%,0.580183506011963,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,2,96751,NH,Individual,No,02-0494919,96751NH0150016,Anthem Bronze Pathway X Enhanced HMO 0 for HSA,96751NH015,,NHN002,NHS001,NHF002,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99630896150593,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPH,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150016-01,Standard Bronze On Exchange Plan,60.16%,0.580183506011963,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,2,96751,NH,Individual,No,02-0494919,96751NH0150016,Anthem Bronze Pathway X Enhanced HMO 0 for HSA,96751NH015,,NHN002,NHS001,NHF002,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99630896150593,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPH,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150016-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,2,96751,NH,Individual,No,02-0494919,96751NH0150016,Anthem Bronze Pathway X Enhanced HMO 0 for HSA,96751NH015,,NHN002,NHS001,NHF002,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99630896150593,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPH,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150016-03,Limited Cost Sharing Plan Variation,60.16%,0.580183506011963,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,3,96751,NH,Individual,No,02-0494919,96751NH0150017,Anthem Bronze Pathway X Enhanced HMO 4400 20,96751NH015,,NHN002,NHS001,NHF003,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996422193146028,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPJ,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150017-00,Standard Bronze Off Exchange Plan,61.32%,0.616796135902405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,400","$8,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,3,96751,NH,Individual,No,02-0494919,96751NH0150017,Anthem Bronze Pathway X Enhanced HMO 4400 20,96751NH015,,NHN002,NHS001,NHF003,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996422193146028,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPJ,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150017-01,Standard Bronze On Exchange Plan,61.32%,0.616796135902405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,400","$8,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,3,96751,NH,Individual,No,02-0494919,96751NH0150017,Anthem Bronze Pathway X Enhanced HMO 4400 20,96751NH015,,NHN002,NHS001,NHF003,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996422193146028,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPJ,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150017-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,3,96751,NH,Individual,No,02-0494919,96751NH0150017,Anthem Bronze Pathway X Enhanced HMO 4400 20,96751NH015,,NHN002,NHS001,NHF003,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996422193146028,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPJ,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150017-03,Limited Cost Sharing Plan Variation,61.32%,0.616796135902405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,400","$8,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,4,96751,NH,Individual,No,02-0494919,96751NH0150018,Anthem Bronze Pathway X Enhanced HMO 5750 10,96751NH015,,NHN002,NHS001,NHF006,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996309113414172,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPK,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150018-00,Standard Bronze Off Exchange Plan,59.33%,0.596491277217865,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,5,96751,NH,Individual,No,02-0494919,96751NH0150020,Anthem Silver Pathway X Enhanced HMO 10 for HSA,96751NH015,,NHN002,NHS001,NHF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997085995148335,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPL,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150020-01,Standard Silver On Exchange Plan,70.54%,0.708982825279236,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,5,96751,NH,Individual,No,02-0494919,96751NH0150020,Anthem Silver Pathway X Enhanced HMO 10 for HSA,96751NH015,,NHN002,NHS001,NHF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997085995148335,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPL,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150020-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,5,96751,NH,Individual,No,02-0494919,96751NH0150020,Anthem Silver Pathway X Enhanced HMO 10 for HSA,96751NH015,,NHN002,NHS001,NHF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997085995148335,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPL,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150020-03,Limited Cost Sharing Plan Variation,70.54%,0.708982825279236,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,5,96751,NH,Individual,No,02-0494919,96751NH0150020,Anthem Silver Pathway X Enhanced HMO 10 for HSA,96751NH015,,NHN002,NHS001,NHF006,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997085995148335,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPL,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150020-04,73% AV Level Silver Plan,72.63%,0.729694128036499,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,400","$6,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,6,96751,NH,Individual,No,02-0494919,96751NH0150022,Anthem Silver Pathway X Enhanced HMO 3250 0,96751NH015,,NHN002,NHS001,NHF008,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997217264489743,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPU,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150022-01,Standard Silver On Exchange Plan,69.06%,0.684714019298553,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,250","$6,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,6,96751,NH,Individual,No,02-0494919,96751NH0150022,Anthem Silver Pathway X Enhanced HMO 3250 0,96751NH015,,NHN002,NHS001,NHF008,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997217264489743,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPU,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150022-03,Limited Cost Sharing Plan Variation,69.06%,0.684714019298553,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,250","$6,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,7,96751,NH,Individual,No,02-0494919,96751NH0150023,Anthem Gold Pathway X Enhanced HMO 1000 10,96751NH015,,NHN002,NHS001,NHF004,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997672760381588,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPY,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150023-00,Standard Gold Off Exchange Plan,79.82%,0.805724143981934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,7,96751,NH,Individual,No,02-0494919,96751NH0150023,Anthem Gold Pathway X Enhanced HMO 1000 10,96751NH015,,NHN002,NHS001,NHF004,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997672760381588,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPY,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150023-01,Standard Gold On Exchange Plan,79.82%,0.805724143981934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,7,96751,NH,Individual,No,02-0494919,96751NH0150023,Anthem Gold Pathway X Enhanced HMO 1000 10,96751NH015,,NHN002,NHS001,NHF004,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997672760381588,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPY,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150023-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,7,96751,NH,Individual,No,02-0494919,96751NH0150023,Anthem Gold Pathway X Enhanced HMO 1000 10,96751NH015,,NHN002,NHS001,NHF004,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997672760381588,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPY,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150023-03,Limited Cost Sharing Plan Variation,79.82%,0.805724143981934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,8,96751,NH,Individual,No,02-0494919,96751NH0150024,Anthem Catastrophic Pathway X Enhanced HMO 6600 0,96751NH015,,NHN002,NHS001,NHF002,Existing,HMO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.994991387579918,,,0,0,3,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPZ,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150024-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,8,96751,NH,Individual,No,02-0494919,96751NH0150024,Anthem Catastrophic Pathway X Enhanced HMO 6600 0,96751NH015,,NHN002,NHS001,NHF002,Existing,HMO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.994991387579918,,,0,0,3,2015-01-01,,Yes,Emergency/ Urgent Care Only,Yes,Emergency/ Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GPZ,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NHSelectdrugtier4,96751NH0150024-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,15,96751,NH,SHOP (Small Group),No,02-0494919,96751NH0160005,Anthem Gold Pathway X HMO 500 20 5000 Plus,96751NH016,,NHN002,NHS001,NHF001,Existing,HMO,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991708419926168,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1M18,,http://sgplans.anthem.com/nh/brochure/,www.anthem.com/NHSelectdrugtier4,96751NH0160005-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",$500,"$1,500",20%,,,,Not Applicable,Not Applicable,$500,"$1,500",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,15,96751,NH,SHOP (Small Group),No,02-0494919,96751NH0160005,Anthem Gold Pathway X HMO 500 20 5000 Plus,96751NH016,,NHN002,NHS001,NHF001,Existing,HMO,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991708419926168,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1M18,,http://sgplans.anthem.com/nh/brochure/,www.anthem.com/NHSelectdrugtier4,96751NH0160005-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",$500,"$1,500",20%,,,,Not Applicable,Not Applicable,$500,"$1,500",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,16,96751,NH,SHOP (Small Group),No,02-0494919,96751NH0160006,Anthem Silver Pathway X HMO 2000 30 5500 Plus,96751NH016,,NHN002,NHS001,NHF001,Existing,HMO,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency  Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98888822622945,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1M06,,http://sgplans.anthem.com/nh/brochure/,www.anthem.com/NHSelectdrugtier4,96751NH0160006-00,Standard Silver Off Exchange Plan,68.87%,0.705991268157959,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$250,$500,30%,,,,Not Applicable,Not Applicable,$250,$500,,,,,,,,,,,,,,,,,,,4
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,16,96751,NH,SHOP (Small Group),No,02-0494919,96751NH0160006,Anthem Silver Pathway X HMO 2000 30 5500 Plus,96751NH016,,NHN002,NHS001,NHF001,Existing,HMO,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency  Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98888822622945,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1M06,,http://sgplans.anthem.com/nh/brochure/,www.anthem.com/NHSelectdrugtier4,96751NH0160006-01,Standard Silver On Exchange Plan,68.87%,0.705991268157959,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,"$5,500","$11,000","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$250,$500,30%,,,,Not Applicable,Not Applicable,$250,$500,,,,,,,,,,,,,,,,,,,5
2015,NM,26075,SERFF,6,2014-11-04 20:29:03,1,26075,NM,Individual,Yes,95-6042390,26075NM0020004,BESTOne Dental Plus-Gold,26075NM002,,NMN001,NMS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.84,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NM/2015/NM_BESTOne_Dental_Plus-Gold_Plan.pdf,,26075NM0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NM,26075,SERFF,6,2014-11-04 20:29:03,2,26075,NM,Individual,Yes,95-6042390,26075NM0020005,BESTOne Dental Plus-Silver,26075NM002,,NMN001,NMS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.53,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NM/2015/NM_BESTOne_Dental_Plus-Silver_Plan.pdf,,26075NM0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NM,26075,SERFF,6,2014-11-04 20:29:03,2,26075,NM,Individual,Yes,95-6042390,26075NM0020005,BESTOne Dental Plus-Silver,26075NM002,,NMN001,NMS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.53,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NM/2015/NM_BESTOne_Dental_Plus-Silver_Plan.pdf,,26075NM0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NM,26075,SERFF,6,2014-11-04 20:29:03,2,26075,NM,Individual,Yes,95-6042390,26075NM0020006,BESTOne Dental Basic-Silver,26075NM002,,NMN001,NMS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.53,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NM/2015/NM_BESTOne_Dental_Basic-Silver_Plan.pdf,,26075NM0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NM,26075,SERFF,6,2014-11-04 20:29:03,2,26075,NM,Individual,Yes,95-6042390,26075NM0020006,BESTOne Dental Basic-Silver,26075NM002,,NMN001,NMS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.53,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NM/2015/NM_BESTOne_Dental_Basic-Silver_Plan.pdf,,26075NM0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,1,57173,NM,Individual,No,94-3037165,57173NM0130005,Individual HMO Silver B w/Gym Membership,57173NM013,,NMN001,NMS001,NMF009,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,Emergency and Non-emergency when prior authorization is obtained,Yes,Emergency and Non-emergency when prior authorization is obtianed,No,https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130005-00,Standard Silver Off Exchange Plan,,0.709630072116852,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,1,57173,NM,Individual,No,94-3037165,57173NM0130005,Individual HMO Silver B w/Gym Membership,57173NM013,,NMN001,NMS001,NMF009,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,Emergency and Non-emergency when prior authorization is obtained,Yes,Emergency and Non-emergency when prior authorization is obtianed,No,https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130005-05,87% AV Level Silver Plan,,0.871420621871948,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,1,57173,NM,Individual,No,94-3037165,57173NM0130005,Individual HMO Silver B w/Gym Membership,57173NM013,,NMN001,NMS001,NMF009,Existing,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,Emergency and Non-emergency when prior authorization is obtained,Yes,Emergency and Non-emergency when prior authorization is obtianed,No,https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130005-06,94% AV Level Silver Plan,,0.946682512760162,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,1,57173,NM,Individual,No,94-3037165,57173NM0140001,Individual HMO Bronze A w/Gym Membership,57173NM014,,NMN001,NMS001,NMF007,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988798452241781,,,0,0,0,2015-01-01,,Yes,Emergency and Non-emergency when prior authorization is obtained,Yes,Emergency and Non-emergency when prior authorization is obtianed,No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0140001-00,Standard Bronze Off Exchange Plan,,0.613545417785645,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,2,57173,NM,Individual,No,94-3037165,57173NM0120001,Individual HMO Gold A w/Gym Membership,57173NM012,,NMN001,NMS001,NMF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.989040307043389,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0120001-01,Standard Gold On Exchange Plan,,0.814495980739594,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,2,57173,NM,Individual,No,94-3037165,57173NM0120001,Individual HMO Gold A w/Gym Membership,57173NM012,,NMN001,NMS001,NMF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.989040307043389,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0120001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,2,57173,NM,Individual,No,94-3037165,57173NM0120001,Individual HMO Gold A w/Gym Membership,57173NM012,,NMN001,NMS001,NMF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.989040307043389,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0120001-03,Limited Cost Sharing Plan Variation,,0.814495980739594,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,2,57173,NM,Individual,No,94-3037165,57173NM0120003,Individual HMO Gold C w/Gym Membership,57173NM012,,NMN001,NMS001,NMF017,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.989040307043389,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0120003-00,Standard Gold Off Exchange Plan,,0.814687192440033,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,2,57173,NM,Individual,No,94-3037165,57173NM0120003,Individual HMO Gold C w/Gym Membership,57173NM012,,NMN001,NMS001,NMF017,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.989040307043389,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0120003-01,Standard Gold On Exchange Plan,,0.814687192440033,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,4,57173,NM,Individual,No,94-3037165,57173NM0130009,Individual HMO Silver C w/Gym Membership,57173NM013,,NMN001,NMS001,NMF011,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130009-04,73% AV Level Silver Plan,,0.7303107380867,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,4,57173,NM,Individual,No,94-3037165,57173NM0130009,Individual HMO Silver C w/Gym Membership,57173NM013,,NMN001,NMS001,NMF011,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130009-05,87% AV Level Silver Plan,,0.873809933662415,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0170001,New Mexico Silver LD,72034NM017,,NMN001,NMS002,NMF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Silver%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0170001-05,87% AV Level Silver Plan,,0.873094499111176,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0170001,New Mexico Silver LD,72034NM017,,NMN001,NMS002,NMF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Silver%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0170001-06,94% AV Level Silver Plan,,0.947982609272003,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,4,57173,NM,Individual,No,94-3037165,57173NM0130009,Individual HMO Silver C w/Gym Membership,57173NM013,,NMN001,NMS001,NMF011,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130009-06,94% AV Level Silver Plan,,0.931100845336914,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,5,57173,NM,Individual,No,94-3037165,57173NM0120002,Individual HMO Gold B w/Gym Membership,57173NM012,,NMN001,NMS001,NMF003,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.989040307043389,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0120002-00,Standard Gold Off Exchange Plan,,0.818986117839813,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,5,57173,NM,Individual,No,94-3037165,57173NM0120002,Individual HMO Gold B w/Gym Membership,57173NM012,,NMN001,NMS001,NMF003,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.989040307043389,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0120002-01,Standard Gold On Exchange Plan,,0.818986117839813,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,5,57173,NM,Individual,No,94-3037165,57173NM0120002,Individual HMO Gold B w/Gym Membership,57173NM012,,NMN001,NMS001,NMF003,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.989040307043389,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0120002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,2,57173,NM,Individual,No,94-3037165,57173NM0120003,Individual HMO Gold C w/Gym Membership,57173NM012,,NMN001,NMS001,NMF017,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.989040307043389,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0120003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,1,57173,NM,Individual,No,94-3037165,57173NM0140002,Individual HMO Bronze B w/Gym Membership,57173NM014,,NMN001,NMS001,NMF003,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988798452241781,,,0,0,0,2015-01-01,,Yes,Emergency and Non-emergency when prior authorization is obtained,Yes,Emergency and Non-emergency when prior authorization is obtianed,No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0140002-03,Limited Cost Sharing Plan Variation,,0.614887595176697,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,1,57173,NM,Individual,No,94-3037165,57173NM0150001,Individual HMO Catastrophic w/Gym Membership,57173NM015,,NMN001,NMS001,NMF017,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.987710105634544,,,0,0,0,2015-01-01,,Yes,Emergency and Non-emergency when prior authorization is obtained,Yes,Emergency and Non-emergency when prior authorization is obtianed,No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0150001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$6,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,1,57173,NM,Individual,No,94-3037165,57173NM0150001,Individual HMO Catastrophic w/Gym Membership,57173NM015,,NMN001,NMS001,NMF017,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.987710105634544,,,0,0,0,2015-01-01,,Yes,Emergency and Non-emergency when prior authorization is obtained,Yes,Emergency and Non-emergency when prior authorization is obtianed,No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0150001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$6,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,2,57173,NM,Individual,No,94-3037165,57173NM0120001,Individual HMO Gold A w/Gym Membership,57173NM012,,NMN001,NMS001,NMF002,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.989040307043389,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0120001-00,Standard Gold Off Exchange Plan,,0.814495980739594,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,3,57173,NM,Individual,No,94-3037165,57173NM0140003,Individual HMO Bronze C w/Gym Membership,57173NM014,,NMN001,NMS001,NMF017,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988798452241781,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0140003-00,Standard Bronze Off Exchange Plan,,0.603291273117065,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,3,57173,NM,Individual,No,94-3037165,57173NM0140003,Individual HMO Bronze C w/Gym Membership,57173NM014,,NMN001,NMS001,NMF017,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988798452241781,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0140003-01,Standard Bronze On Exchange Plan,,0.603291273117065,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,2,72034,NM,Individual,No,45-2106295,72034NM0130001,New Mexico Silver HD,72034NM013,,NMN001,NMS002,NMF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Silver%20High%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0130001-06,94% AV Level Silver Plan,,0.947982609272003,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,2,72034,NM,Individual,No,45-2106295,72034NM0070001,New Mexico Gold HD,72034NM007,,NMN001,NMS002,NMF004,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Gold%20High%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0070001-00,Standard Gold Off Exchange Plan,,0.79190456867218,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,2,72034,NM,Individual,No,45-2106295,72034NM0070001,New Mexico Gold HD,72034NM007,,NMN001,NMS002,NMF004,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Gold%20High%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0070001-01,Standard Gold On Exchange Plan,,0.79190456867218,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,2,72034,NM,Individual,No,45-2106295,72034NM0070001,New Mexico Gold HD,72034NM007,,NMN001,NMS002,NMF004,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Gold%20High%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0070001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,2,72034,NM,Individual,No,45-2106295,72034NM0070001,New Mexico Gold HD,72034NM007,,NMN001,NMS002,NMF004,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Gold%20High%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0070001-03,Limited Cost Sharing Plan Variation,,0.79190456867218,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0030001,New Mexico Bronze LD,72034NM003,,NMN001,NMS002,NMF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Bronze%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0030001-00,Standard Bronze Off Exchange Plan,,0.611843168735504,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,2,57173,NM,Individual,No,94-3037165,57173NM0120003,Individual HMO Gold C w/Gym Membership,57173NM012,,NMN001,NMS001,NMF017,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.989040307043389,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0120003-03,Limited Cost Sharing Plan Variation,,0.814687192440033,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,2,57173,NM,Individual,No,94-3037165,57173NM0130013,Individual HMO Silver D w/Gym Membership,57173NM013,,NMN001,NMS001,NMF015,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130013-00,Standard Silver Off Exchange Plan,,0.715132832527161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,2,57173,NM,Individual,No,94-3037165,57173NM0130013,Individual HMO Silver D w/Gym Membership,57173NM013,,NMN001,NMS001,NMF015,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130013-01,Standard Silver On Exchange Plan,,0.715132832527161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,2,57173,NM,Individual,No,94-3037165,57173NM0130013,Individual HMO Silver D w/Gym Membership,57173NM013,,NMN001,NMS001,NMF015,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,2,57173,NM,Individual,No,94-3037165,57173NM0130013,Individual HMO Silver D w/Gym Membership,57173NM013,,NMN001,NMS001,NMF015,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130013-03,Limited Cost Sharing Plan Variation,,0.715132832527161,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,2,57173,NM,Individual,No,94-3037165,57173NM0130013,Individual HMO Silver D w/Gym Membership,57173NM013,,NMN001,NMS001,NMF015,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130013-04,73% AV Level Silver Plan,,0.737287163734436,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,150","$10,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,2,57173,NM,Individual,No,94-3037165,57173NM0130013,Individual HMO Silver D w/Gym Membership,57173NM013,,NMN001,NMS001,NMF015,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130013-05,87% AV Level Silver Plan,,0.875683009624481,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,2,57173,NM,Individual,No,94-3037165,57173NM0130013,Individual HMO Silver D w/Gym Membership,57173NM013,,NMN001,NMS001,NMF015,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130013-06,94% AV Level Silver Plan,,0.931100845336914,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,29,96751,NH,SHOP (Small Group),No,02-0494919,96751NH0160008,Anthem Bronze Pathway X HMO 6000 30 6600 Plus,96751NH016,,NHN002,NHS001,NHF001,Existing,HMO,Bronze,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency  Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986988443186422,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LZ1,,http://sgplans.anthem.com/nh/brochure/,www.anthem.com/NHSelectdrugtier4,96751NH0160008-00,Standard Bronze Off Exchange Plan,61.62%,0.650992751121521,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$6,000","$12,000",30%,,,,Not Applicable,Not Applicable,"$6,000","$12,000",$250,$500,30%,,,,Not Applicable,Not Applicable,$250,$500,,,,,,,,,,,,,,,,,,,4
2015,NH,96751,SERFF,18,2015-04-22 14:50:56,29,96751,NH,SHOP (Small Group),No,02-0494919,96751NH0160008,Anthem Bronze Pathway X HMO 6000 30 6600 Plus,96751NH016,,NHN002,NHS001,NHF001,Existing,HMO,Bronze,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency  Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986988443186422,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1LZ1,,http://sgplans.anthem.com/nh/brochure/,www.anthem.com/NHSelectdrugtier4,96751NH0160008-01,Standard Bronze On Exchange Plan,61.62%,0.650992751121521,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$6,000","$12,000",30%,,,,Not Applicable,Not Applicable,"$6,000","$12,000",$250,$500,30%,,,,Not Applicable,Not Applicable,$250,$500,,,,,,,,,,,,,,,,,,,5
2015,NM,17911,SERFF,4,2014-11-04 20:29:03,1,17911,NM,Individual,Yes,47-0397286,17911NM0060001,"Delta Dental Individual PPO, EHB Certified (Exchange)",17911NM006,,NMN002,NMS001,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.73,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.deltadentalnm.com/NM_EHB_High_2015,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/17911,http://www.deltadentalnm.com/NM_EHB_High_2015,,17911NM0060001-01,Standard High On Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NM,17911,SERFF,4,2014-11-04 20:29:03,1,17911,NM,Individual,Yes,47-0397286,17911NM0060002,"Delta Dental Individual PPO, EHB Certified (Exchange)",17911NM006,,NMN002,NMS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$17.51,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.deltadentalnm.com/NM_EHB_Low_2015,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/17911,http://www.deltadentalnm.com/NM_EHB_Low_2015,,17911NM0060002-01,Standard Low On Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NM,17911,SERFF,4,2014-11-04 20:29:03,2,17911,NM,Individual,Yes,47-0397286,17911NM0090001,"Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)",17911NM009,,NMN002,NMS001,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$29.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.deltadentalnm.com/NM_Ped_High_2015,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/17911,http://www.deltadentalnm.com/NM_Ped_High_2015,,17911NM0090001-01,Standard High On Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NM,17911,SERFF,4,2014-11-04 20:29:03,2,17911,NM,Individual,Yes,47-0397286,17911NM0090002,"Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)",17911NM009,,NMN002,NMS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$24.04,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,http://www.deltadentalnm.com/NM_Ped_Low_2015,https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/17911,http://www.deltadentalnm.com/NM_Ped_Low_2015,,17911NM0090002-01,Standard Low On Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NM,19722,SERFF,3,2014-09-11 12:10:19,1,19722,NM,Individual,No,85-0408506,19722NM0010001,Molina Marketplace Gold Plan,19722NM001,,NMN001,NMS001,NMF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.995301709493349,,,0,0,0,2015-01-01,,Yes,Emergency Service and Urgent Care Services are covered,Yes,Emergency Service and Urgent Care Services are covered,No,http://www.molinahealthcare.com/marketplace/nm/plans/gold/2015/SBC,www.molinahealthcare.com/paymentnm,www.molinahealthcare.com/marketplace/nm/2015/brochure,http://www.molinahealthcare.com/members/nm/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,19722NM0010001-00,Standard Gold Off Exchange Plan,,0.797688841819763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$500,$240,$890,$150,$500,$770,$210,$80,4
2015,NM,19722,SERFF,3,2014-09-11 12:10:19,1,19722,NM,Individual,No,85-0408506,19722NM0010001,Molina Marketplace Gold Plan,19722NM001,,NMN001,NMS001,NMF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.995301709493349,,,0,0,0,2015-01-01,,Yes,Emergency Service and Urgent Care Services are covered,Yes,Emergency Service and Urgent Care Services are covered,No,http://www.molinahealthcare.com/marketplace/nm/plans/gold/2015/SBC,www.molinahealthcare.com/paymentnm,www.molinahealthcare.com/marketplace/nm/2015/brochure,http://www.molinahealthcare.com/members/nm/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,19722NM0010001-01,Standard Gold On Exchange Plan,,0.797688841819763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$500,$240,$890,$150,$500,$770,$210,$80,5
2015,NM,19722,SERFF,3,2014-09-11 12:10:19,1,19722,NM,Individual,No,85-0408506,19722NM0010001,Molina Marketplace Gold Plan,19722NM001,,NMN001,NMS001,NMF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.995301709493349,,,0,0,0,2015-01-01,,Yes,Emergency Service and Urgent Care Services are covered,Yes,Emergency Service and Urgent Care Services are covered,No,http://www.molinahealthcare.com/marketplace/nm/plans/gold/2015/SBC,www.molinahealthcare.com/paymentnm,www.molinahealthcare.com/marketplace/nm/2015/brochure,http://www.molinahealthcare.com/members/nm/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,19722NM0010001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,NM,19722,SERFF,3,2014-09-11 12:10:19,1,19722,NM,Individual,No,85-0408506,19722NM0010001,Molina Marketplace Gold Plan,19722NM001,,NMN001,NMS001,NMF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.995301709493349,,,0,0,0,2015-01-01,,Yes,Emergency Service and Urgent Care Services are covered,Yes,Emergency Service and Urgent Care Services are covered,No,http://www.molinahealthcare.com/marketplace/nm/plans/gold/2015/SBC,www.molinahealthcare.com/paymentnm,www.molinahealthcare.com/marketplace/nm/2015/brochure,http://www.molinahealthcare.com/members/nm/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,19722NM0010001-03,Limited Cost Sharing Plan Variation,,0.797688841819763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$500,$240,$890,$150,$500,$770,$210,$80,7
2015,NM,19722,SERFF,3,2014-09-11 12:10:19,2,19722,NM,Individual,No,85-0408506,19722NM0010002,Molina Marketplace Silver Plan,19722NM001,,NMN001,NMS001,NMF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy",,0.988940255873685,,,0,0,0,2015-01-01,,Yes,Emergency Service and Urgent Care Services are covered,Yes,Emergency Service and Urgent Care Services are covered,No,http://www.molinahealthcare.com/marketplace/nm/plans/silver/2015/SBC,www.molinahealthcare.com/paymentnm,www.molinahealthcare.com/marketplace/nm/2015/brochure,http://www.molinahealthcare.com/members/nm/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,19722NM0010002-00,Standard Silver Off Exchange Plan,,0.706084549427032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$200,$400,30%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,"$2,000",$340,"$1,340",$150,"$2,000",$630,$100,$80,4
2015,NM,19722,SERFF,3,2014-09-11 12:10:19,2,19722,NM,Individual,No,85-0408506,19722NM0010002,Molina Marketplace Silver Plan,19722NM001,,NMN001,NMS001,NMF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy",,0.988940255873685,,,0,0,0,2015-01-01,,Yes,Emergency Service and Urgent Care Services are covered,Yes,Emergency Service and Urgent Care Services are covered,No,http://www.molinahealthcare.com/marketplace/nm/plans/silver/2015/SBC,www.molinahealthcare.com/paymentnm,www.molinahealthcare.com/marketplace/nm/2015/brochure,http://www.molinahealthcare.com/members/nm/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,19722NM0010002-01,Standard Silver On Exchange Plan,,0.706084549427032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$200,$400,30%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,"$2,000",$340,"$1,340",$150,"$2,000",$630,$100,$80,5
2015,NM,19722,SERFF,3,2014-09-11 12:10:19,2,19722,NM,Individual,No,85-0408506,19722NM0010002,Molina Marketplace Silver Plan,19722NM001,,NMN001,NMS001,NMF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy",,0.988940255873685,,,0,0,0,2015-01-01,,Yes,Emergency Service and Urgent Care Services are covered,Yes,Emergency Service and Urgent Care Services are covered,No,http://www.molinahealthcare.com/marketplace/nm/plans/silver/2015/SBC,www.molinahealthcare.com/paymentnm,www.molinahealthcare.com/marketplace/nm/2015/brochure,http://www.molinahealthcare.com/members/nm/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,19722NM0010002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,NM,19722,SERFF,3,2014-09-11 12:10:19,2,19722,NM,Individual,No,85-0408506,19722NM0010002,Molina Marketplace Silver Plan,19722NM001,,NMN001,NMS001,NMF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy",,0.988940255873685,,,0,0,0,2015-01-01,,Yes,Emergency Service and Urgent Care Services are covered,Yes,Emergency Service and Urgent Care Services are covered,No,http://www.molinahealthcare.com/marketplace/nm/plans/silver/2015/SBC,www.molinahealthcare.com/paymentnm,www.molinahealthcare.com/marketplace/nm/2015/brochure,http://www.molinahealthcare.com/members/nm/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,19722NM0010002-03,Limited Cost Sharing Plan Variation,,0.706084549427032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$200,$400,30%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,"$2,000",$340,"$1,340",$150,"$2,000",$630,$100,$80,7
2015,NM,19722,SERFF,3,2014-09-11 12:10:19,2,19722,NM,Individual,No,85-0408506,19722NM0010002,Molina Marketplace Silver Plan,19722NM001,,NMN001,NMS001,NMF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy",,0.988940255873685,,,0,0,0,2015-01-01,,Yes,Emergency Service and Urgent Care Services are covered,Yes,Emergency Service and Urgent Care Services are covered,No,http://www.molinahealthcare.com/marketplace/nm/plans/silver/2015/SBC,www.molinahealthcare.com/paymentnm,www.molinahealthcare.com/marketplace/nm/2015/brochure,http://www.molinahealthcare.com/members/nm/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,19722NM0010002-04,73% AV Level Silver Plan,,0.739861905574799,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,"$5,200","$10,400","$1,700","$3,400",30%,,,,Not Applicable,Not Applicable,"$1,700","$3,400",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,"$1,700",$340,"$1,340",$150,"$1,700",$650,$180,$80,8
2015,NM,19722,SERFF,3,2014-09-11 12:10:19,2,19722,NM,Individual,No,85-0408506,19722NM0010002,Molina Marketplace Silver Plan,19722NM001,,NMN001,NMS001,NMF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy",,0.988940255873685,,,0,0,0,2015-01-01,,Yes,Emergency Service and Urgent Care Services are covered,Yes,Emergency Service and Urgent Care Services are covered,No,http://www.molinahealthcare.com/marketplace/nm/plans/silver/2015/SBC,www.molinahealthcare.com/paymentnm,www.molinahealthcare.com/marketplace/nm/2015/brochure,http://www.molinahealthcare.com/members/nm/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,19722NM0010002-05,87% AV Level Silver Plan,,0.874694645404816,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,"$2,250","$4,500",$250,$500,20%,,,,Not Applicable,Not Applicable,$250,$500,$0,$0,25%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$250,$180,$890,$150,$250,$590,$210,$80,9
2015,NM,19722,SERFF,3,2014-09-11 12:10:19,2,19722,NM,Individual,No,85-0408506,19722NM0010002,Molina Marketplace Silver Plan,19722NM001,,NMN001,NMS001,NMF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy",,0.988940255873685,,,0,0,0,2015-01-01,,Yes,Emergency Service and Urgent Care Services are covered,Yes,Emergency Service and Urgent Care Services are covered,No,http://www.molinahealthcare.com/marketplace/nm/plans/silver/2015/SBC,www.molinahealthcare.com/paymentnm,www.molinahealthcare.com/marketplace/nm/2015/brochure,http://www.molinahealthcare.com/members/nm/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,19722NM0010002-06,94% AV Level Silver Plan,,0.943551361560822,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,"$2,250","$4,500",$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,$0,$20,$450,$150,$0,$120,$130,$80,10
2015,NM,19722,SERFF,3,2014-09-11 12:10:19,3,19722,NM,Individual,No,85-0408506,19722NM0010003,Molina Marketplace Bronze Plan,19722NM001,,NMN001,NMS001,NMF003,Existing,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.993480320648418,,,0,0,3,2015-01-01,,Yes,Emergency Service and Urgent Care Services are covered,Yes,Emergency Service and Urgent Care Services are covered,No,http://www.molinahealthcare.com/marketplace/nm/plans/bronze/2015/SBC,www.molinahealthcare.com/paymentnm,www.molinahealthcare.com/marketplace/nm/2015/brochure,http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,19722NM0010003-00,Standard Bronze Off Exchange Plan,,0.61972439289093,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,"$4,500","$9,000","$4,500",$20,"$1,100",$150,"$2,420",$640,$0,$80,4
2015,NM,19722,SERFF,3,2014-09-11 12:10:19,3,19722,NM,Individual,No,85-0408506,19722NM0010003,Molina Marketplace Bronze Plan,19722NM001,,NMN001,NMS001,NMF003,Existing,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.993480320648418,,,0,0,3,2015-01-01,,Yes,Emergency Service and Urgent Care Services are covered,Yes,Emergency Service and Urgent Care Services are covered,No,http://www.molinahealthcare.com/marketplace/nm/plans/bronze/2015/SBC,www.molinahealthcare.com/paymentnm,www.molinahealthcare.com/marketplace/nm/2015/brochure,http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,19722NM0010003-01,Standard Bronze On Exchange Plan,,0.61972439289093,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,"$4,500","$9,000","$4,500",$20,"$1,100",$150,"$2,420",$640,$0,$80,5
2015,NM,19722,SERFF,3,2014-09-11 12:10:19,3,19722,NM,Individual,No,85-0408506,19722NM0010003,Molina Marketplace Bronze Plan,19722NM001,,NMN001,NMS001,NMF003,Existing,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.993480320648418,,,0,0,3,2015-01-01,,Yes,Emergency Service and Urgent Care Services are covered,Yes,Emergency Service and Urgent Care Services are covered,No,http://www.molinahealthcare.com/marketplace/nm/plans/bronze/2015/SBC,www.molinahealthcare.com/paymentnm,www.molinahealthcare.com/marketplace/nm/2015/brochure,http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,19722NM0010003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,NM,19722,SERFF,3,2014-09-11 12:10:19,3,19722,NM,Individual,No,85-0408506,19722NM0010003,Molina Marketplace Bronze Plan,19722NM001,,NMN001,NMS001,NMF003,Existing,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.993480320648418,,,0,0,3,2015-01-01,,Yes,Emergency Service and Urgent Care Services are covered,Yes,Emergency Service and Urgent Care Services are covered,No,http://www.molinahealthcare.com/marketplace/nm/plans/bronze/2015/SBC,www.molinahealthcare.com/paymentnm,www.molinahealthcare.com/marketplace/nm/2015/brochure,http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,19722NM0010003-03,Limited Cost Sharing Plan Variation,,0.61972439289093,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,"$4,500","$9,000","$4,500",$20,"$1,100",$150,"$2,420",$640,$0,$80,7
2015,NM,26075,SERFF,6,2014-11-04 20:29:03,1,26075,NM,Individual,Yes,95-6042390,26075NM0020003,BESTOne Dental Advantage-Gold,26075NM002,,NMN001,NMS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.84,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NM/2015/NM_BESTOne_Dental_Advantage-Gold_Plan.pdf,,26075NM0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NM,26075,SERFF,6,2014-11-04 20:29:03,1,26075,NM,Individual,Yes,95-6042390,26075NM0020003,BESTOne Dental Advantage-Gold,26075NM002,,NMN001,NMS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.84,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NM/2015/NM_BESTOne_Dental_Advantage-Gold_Plan.pdf,,26075NM0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NM,26075,SERFF,6,2014-11-04 20:29:03,1,26075,NM,Individual,Yes,95-6042390,26075NM0020004,BESTOne Dental Plus-Gold,26075NM002,,NMN001,NMS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$24.84,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NM/2015/NM_BESTOne_Dental_Plus-Gold_Plan.pdf,,26075NM0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,1,57173,NM,Individual,No,94-3037165,57173NM0140001,Individual HMO Bronze A w/Gym Membership,57173NM014,,NMN001,NMS001,NMF007,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988798452241781,,,0,0,0,2015-01-01,,Yes,Emergency and Non-emergency when prior authorization is obtained,Yes,Emergency and Non-emergency when prior authorization is obtianed,No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0140001-01,Standard Bronze On Exchange Plan,,0.613545417785645,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,1,57173,NM,Individual,No,94-3037165,57173NM0140001,Individual HMO Bronze A w/Gym Membership,57173NM014,,NMN001,NMS001,NMF007,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988798452241781,,,0,0,0,2015-01-01,,Yes,Emergency and Non-emergency when prior authorization is obtained,Yes,Emergency and Non-emergency when prior authorization is obtianed,No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0140001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,1,57173,NM,Individual,No,94-3037165,57173NM0140001,Individual HMO Bronze A w/Gym Membership,57173NM014,,NMN001,NMS001,NMF007,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988798452241781,,,0,0,0,2015-01-01,,Yes,Emergency and Non-emergency when prior authorization is obtained,Yes,Emergency and Non-emergency when prior authorization is obtianed,No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0140001-03,Limited Cost Sharing Plan Variation,,0.613545417785645,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,1,57173,NM,Individual,No,94-3037165,57173NM0140002,Individual HMO Bronze B w/Gym Membership,57173NM014,,NMN001,NMS001,NMF003,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988798452241781,,,0,0,0,2015-01-01,,Yes,Emergency and Non-emergency when prior authorization is obtained,Yes,Emergency and Non-emergency when prior authorization is obtianed,No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0140002-00,Standard Bronze Off Exchange Plan,,0.614887595176697,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,1,57173,NM,Individual,No,94-3037165,57173NM0140002,Individual HMO Bronze B w/Gym Membership,57173NM014,,NMN001,NMS001,NMF003,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988798452241781,,,0,0,0,2015-01-01,,Yes,Emergency and Non-emergency when prior authorization is obtained,Yes,Emergency and Non-emergency when prior authorization is obtianed,No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0140002-01,Standard Bronze On Exchange Plan,,0.614887595176697,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,1,57173,NM,Individual,No,94-3037165,57173NM0140002,Individual HMO Bronze B w/Gym Membership,57173NM014,,NMN001,NMS001,NMF003,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988798452241781,,,0,0,0,2015-01-01,,Yes,Emergency and Non-emergency when prior authorization is obtained,Yes,Emergency and Non-emergency when prior authorization is obtianed,No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0140002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,17
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,3,57173,NM,Individual,No,94-3037165,57173NM0140003,Individual HMO Bronze C w/Gym Membership,57173NM014,,NMN001,NMS001,NMF017,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988798452241781,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0140003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,3,57173,NM,Individual,No,94-3037165,57173NM0140003,Individual HMO Bronze C w/Gym Membership,57173NM014,,NMN001,NMS001,NMF017,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988798452241781,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0140003-03,Limited Cost Sharing Plan Variation,,0.603291273117065,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,4,57173,NM,Individual,No,94-3037165,57173NM0130009,Individual HMO Silver C w/Gym Membership,57173NM013,,NMN001,NMS001,NMF011,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130009-00,Standard Silver Off Exchange Plan,,0.709696888923645,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,4,57173,NM,Individual,No,94-3037165,57173NM0130009,Individual HMO Silver C w/Gym Membership,57173NM013,,NMN001,NMS001,NMF011,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130009-01,Standard Silver On Exchange Plan,,0.709696888923645,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,4,57173,NM,Individual,No,94-3037165,57173NM0130009,Individual HMO Silver C w/Gym Membership,57173NM013,,NMN001,NMS001,NMF011,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,4,57173,NM,Individual,No,94-3037165,57173NM0130009,Individual HMO Silver C w/Gym Membership,57173NM013,,NMN001,NMS001,NMF011,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130009-03,Limited Cost Sharing Plan Variation,,0.709696888923645,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0180001,New Mexico Silver SLD,72034NM018,,NMN001,NMS001,NMF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20State%20Silver%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0180001-00,Standard Silver Off Exchange Plan,,0.701475858688354,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0180001,New Mexico Silver SLD,72034NM018,,NMN001,NMS001,NMF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20State%20Silver%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0180001-01,Standard Silver On Exchange Plan,,0.701475858688354,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,24
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,5,57173,NM,Individual,No,94-3037165,57173NM0120002,Individual HMO Gold B w/Gym Membership,57173NM012,,NMN001,NMS001,NMF003,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.989040307043389,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0120002-03,Limited Cost Sharing Plan Variation,,0.818986117839813,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,5,57173,NM,Individual,No,94-3037165,57173NM0130001,Individual HMO Silver A w/Gym Membership,57173NM013,,NMN001,NMS001,NMF017,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130001-00,Standard Silver Off Exchange Plan,,0.717606008052826,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0180001,New Mexico Silver SLD,72034NM018,,NMN001,NMS001,NMF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20State%20Silver%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0180001-06,94% AV Level Silver Plan,,0.947982609272003,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,29
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0090001,New Mexico Gold SLD,72034NM009,,NMN001,NMS001,NMF004,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Gold%20State%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0090001-00,Standard Gold Off Exchange Plan,,0.796929717063904,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,30
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0090001,New Mexico Gold SLD,72034NM009,,NMN001,NMS001,NMF004,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Gold%20State%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0090001-01,Standard Gold On Exchange Plan,,0.796929717063904,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,31
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0090001,New Mexico Gold SLD,72034NM009,,NMN001,NMS001,NMF004,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Gold%20State%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0090001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,32
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0090001,New Mexico Gold SLD,72034NM009,,NMN001,NMS001,NMF004,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Gold%20State%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0090001-03,Limited Cost Sharing Plan Variation,,0.796929717063904,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,33
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,Yes,36-1236610,75605NM0430001,BlueCare Dental? 1A,75605NM043,,NMN004,NMS004,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.02,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/dental/,,75605NM0430001-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0370002,Blue Advantage Gold HMO? 002,75605NM037,,NMN003,NMS003,NMF005,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370002-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0370002,Blue Advantage Gold HMO? 002,75605NM037,,NMN003,NMS003,NMF005,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370002-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,5,57173,NM,Individual,No,94-3037165,57173NM0130001,Individual HMO Silver A w/Gym Membership,57173NM013,,NMN001,NMS001,NMF017,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130001-01,Standard Silver On Exchange Plan,,0.717606008052826,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,5,57173,NM,Individual,No,94-3037165,57173NM0130001,Individual HMO Silver A w/Gym Membership,57173NM013,,NMN001,NMS001,NMF017,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390015,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS032,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390015-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,66
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390021,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS042,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390021-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,67
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,5,57173,NM,Individual,No,94-3037165,57173NM0130001,Individual HMO Silver A w/Gym Membership,57173NM013,,NMN001,NMS001,NMF017,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130001-03,Limited Cost Sharing Plan Variation,,0.717606008052826,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,5,57173,NM,Individual,No,94-3037165,57173NM0130001,Individual HMO Silver A w/Gym Membership,57173NM013,,NMN001,NMS001,NMF017,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130001-04,73% AV Level Silver Plan,,0.738397181034088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$75,$150,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,5,57173,NM,Individual,No,94-3037165,57173NM0130001,Individual HMO Silver A w/Gym Membership,57173NM013,,NMN001,NMS001,NMF017,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130001-05,87% AV Level Silver Plan,,0.86753648519516,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,5,57173,NM,Individual,No,94-3037165,57173NM0130001,Individual HMO Silver A w/Gym Membership,57173NM013,,NMN001,NMS001,NMF017,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130001-06,94% AV Level Silver Plan,,0.946914613246918,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$50,$100,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,6,57173,NM,Individual,No,94-3037165,57173NM0130014,Individual HMO Silver E w/Gym Membership,57173NM013,,NMN001,NMS001,NMF016,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130014-00,Standard Silver Off Exchange Plan,,0.709495782852173,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,6,57173,NM,Individual,No,94-3037165,57173NM0130014,Individual HMO Silver E w/Gym Membership,57173NM013,,NMN001,NMS001,NMF016,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130014-01,Standard Silver On Exchange Plan,,0.709495782852173,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,6,57173,NM,Individual,No,94-3037165,57173NM0130014,Individual HMO Silver E w/Gym Membership,57173NM013,,NMN001,NMS001,NMF016,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,6,57173,NM,Individual,No,94-3037165,57173NM0130014,Individual HMO Silver E w/Gym Membership,57173NM013,,NMN001,NMS001,NMF016,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130014-03,Limited Cost Sharing Plan Variation,,0.709495782852173,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,6,57173,NM,Individual,No,94-3037165,57173NM0130014,Individual HMO Silver E w/Gym Membership,57173NM013,,NMN001,NMS001,NMF016,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130014-04,73% AV Level Silver Plan,,0.739228188991547,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,6,57173,NM,Individual,No,94-3037165,57173NM0130014,Individual HMO Silver E w/Gym Membership,57173NM013,,NMN001,NMS001,NMF016,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130014-05,87% AV Level Silver Plan,,0.873980045318604,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,6,57173,NM,Individual,No,94-3037165,57173NM0130014,Individual HMO Silver E w/Gym Membership,57173NM013,,NMN001,NMS001,NMF016,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.988893550489015,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0130014-06,94% AV Level Silver Plan,,0.931100845336914,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,6,57173,NM,Individual,No,94-3037165,57173NM0200001,Individual HMO Platinum w/Gym Membership,57173NM020,,NMN001,NMS001,NMF001,New,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.989224327001135,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0200001-00,Standard Platinum Off Exchange Plan,,0.897265136241913,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,6,57173,NM,Individual,No,94-3037165,57173NM0200001,Individual HMO Platinum w/Gym Membership,57173NM020,,NMN001,NMS001,NMF001,New,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.989224327001135,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0200001-01,Standard Platinum On Exchange Plan,,0.897265136241913,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,6,57173,NM,Individual,No,94-3037165,57173NM0200001,Individual HMO Platinum w/Gym Membership,57173NM020,,NMN001,NMS001,NMF001,New,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.989224327001135,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0200001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,NM,57173,SERFF,6,2015-01-21 12:15:34,6,57173,NM,Individual,No,94-3037165,57173NM0200001,Individual HMO Platinum w/Gym Membership,57173NM020,,NMN001,NMS001,NMF001,New,HMO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,0.989224327001135,,,0,0,0,2015-01-01,,Yes,"Emergency, and Non-Emergency when prior authorization is obtained",Yes,"Emergency, and Non-Emergency when prior authorization is obtained",No,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,https://prescoverage.phs.org/sps/prescoverage/saml20/login,https://www.phs.org/health-plans/member-information/Pages/forms-and-documents.aspx?plantype=Individual+%,http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf,57173NM0200001-03,Limited Cost Sharing Plan Variation,,0.897265136241913,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,1,72034,NM,Individual,No,45-2106295,72034NM0060001,New Mexico Catastrophic,72034NM006,,NMN001,NMS002,NMF001,New,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Catastrophic.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/Evidence%20of%20Coverage%20Catastrophic%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0060001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,1,72034,NM,Individual,No,45-2106295,72034NM0060001,New Mexico Catastrophic,72034NM006,,NMN001,NMS002,NMF001,New,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Catastrophic.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/Evidence%20of%20Coverage%20Catastrophic%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0060001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,1,72034,NM,Individual,No,45-2106295,72034NM0050001,New Mexico Catastrophic S,72034NM005,,NMN001,NMS001,NMF001,New,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Catastrophic%20State.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/Evidence%20of%20Coverage%20Catastrophic%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0050001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,1,72034,NM,Individual,No,45-2106295,72034NM0050001,New Mexico Catastrophic S,72034NM005,,NMN001,NMS001,NMF001,New,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Catastrophic%20State.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/Evidence%20of%20Coverage%20Catastrophic%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0050001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,2,72034,NM,Individual,No,45-2106295,72034NM0010001,New Mexico Bronze HD,72034NM001,,NMN001,NMS002,NMF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Bronze%20High%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0010001-00,Standard Bronze Off Exchange Plan,,0.612737596035004,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,2,72034,NM,Individual,No,45-2106295,72034NM0010001,New Mexico Bronze HD,72034NM001,,NMN001,NMS002,NMF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Bronze%20High%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0010001-01,Standard Bronze On Exchange Plan,,0.612737596035004,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,2,72034,NM,Individual,No,45-2106295,72034NM0010001,New Mexico Bronze HD,72034NM001,,NMN001,NMS002,NMF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Bronze%20High%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0010001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,2,72034,NM,Individual,No,45-2106295,72034NM0010001,New Mexico Bronze HD,72034NM001,,NMN001,NMS002,NMF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Bronze%20High%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0010001-03,Limited Cost Sharing Plan Variation,,0.612737596035004,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,2,72034,NM,Individual,No,45-2106295,72034NM0130001,New Mexico Silver HD,72034NM013,,NMN001,NMS002,NMF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Silver%20High%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0130001-00,Standard Silver Off Exchange Plan,,0.699911117553711,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,2,72034,NM,Individual,No,45-2106295,72034NM0130001,New Mexico Silver HD,72034NM013,,NMN001,NMS002,NMF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Silver%20High%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0130001-01,Standard Silver On Exchange Plan,,0.699911117553711,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,2,72034,NM,Individual,No,45-2106295,72034NM0130001,New Mexico Silver HD,72034NM013,,NMN001,NMS002,NMF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Silver%20High%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0130001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,2,72034,NM,Individual,No,45-2106295,72034NM0130001,New Mexico Silver HD,72034NM013,,NMN001,NMS002,NMF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Silver%20High%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0130001-03,Limited Cost Sharing Plan Variation,,0.699911117553711,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,2,72034,NM,Individual,No,45-2106295,72034NM0130001,New Mexico Silver HD,72034NM013,,NMN001,NMS002,NMF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Silver%20High%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0130001-04,73% AV Level Silver Plan,,0.736360132694244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,250","$6,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,2,72034,NM,Individual,No,45-2106295,72034NM0130001,New Mexico Silver HD,72034NM013,,NMN001,NMS002,NMF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Silver%20High%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0130001-05,87% AV Level Silver Plan,,0.875949203968048,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0030001,New Mexico Bronze LD,72034NM003,,NMN001,NMS002,NMF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Bronze%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0030001-01,Standard Bronze On Exchange Plan,,0.611843168735504,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0030001,New Mexico Bronze LD,72034NM003,,NMN001,NMS002,NMF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Bronze%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0030001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0030001,New Mexico Bronze LD,72034NM003,,NMN001,NMS002,NMF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Bronze%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0030001-03,Limited Cost Sharing Plan Variation,,0.611843168735504,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0170001,New Mexico Silver LD,72034NM017,,NMN001,NMS002,NMF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Silver%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0170001-00,Standard Silver Off Exchange Plan,,0.701475858688354,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0170001,New Mexico Silver LD,72034NM017,,NMN001,NMS002,NMF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Silver%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0170001-01,Standard Silver On Exchange Plan,,0.701475858688354,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0170001,New Mexico Silver LD,72034NM017,,NMN001,NMS002,NMF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Silver%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0170001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0170001,New Mexico Silver LD,72034NM017,,NMN001,NMS002,NMF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Silver%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0170001-03,Limited Cost Sharing Plan Variation,,0.701475858688354,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0170001,New Mexico Silver LD,72034NM017,,NMN001,NMS002,NMF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Silver%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0170001-04,73% AV Level Silver Plan,,0.738149404525757,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0080001,New Mexico Gold LD,72034NM008,,NMN001,NMS002,NMF004,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Gold%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0080001-00,Standard Gold Off Exchange Plan,,0.796929717063904,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0080001,New Mexico Gold LD,72034NM008,,NMN001,NMS002,NMF004,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Gold%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0080001-01,Standard Gold On Exchange Plan,,0.796929717063904,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0080001,New Mexico Gold LD,72034NM008,,NMN001,NMS002,NMF004,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Gold%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0080001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0080001,New Mexico Gold LD,72034NM008,,NMN001,NMS002,NMF004,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Gold%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0080001-03,Limited Cost Sharing Plan Variation,,0.796929717063904,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0040001,New Mexico Bronze SLD,72034NM004,,NMN001,NMS001,NMF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Bronze%20State%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0040001-00,Standard Bronze Off Exchange Plan,,0.611843168735504,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0040001,New Mexico Bronze SLD,72034NM004,,NMN001,NMS001,NMF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Bronze%20State%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0040001-01,Standard Bronze On Exchange Plan,,0.611843168735504,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0040001,New Mexico Bronze SLD,72034NM004,,NMN001,NMS001,NMF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Bronze%20State%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0040001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0040001,New Mexico Bronze SLD,72034NM004,,NMN001,NMS001,NMF002,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20Bronze%20State%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0040001-03,Limited Cost Sharing Plan Variation,,0.611843168735504,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0180001,New Mexico Silver SLD,72034NM018,,NMN001,NMS001,NMF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20State%20Silver%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0180001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0180001,New Mexico Silver SLD,72034NM018,,NMN001,NMS001,NMF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20State%20Silver%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0180001-03,Limited Cost Sharing Plan Variation,,0.701475858688354,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,26
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0180001,New Mexico Silver SLD,72034NM018,,NMN001,NMS001,NMF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20State%20Silver%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0180001-04,73% AV Level Silver Plan,,0.738149404525757,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,27
2015,NM,72034,SERFF,5,2014-12-08 10:10:53,3,72034,NM,Individual,No,45-2106295,72034NM0180001,New Mexico Silver SLD,72034NM018,,NMN001,NMS001,NMF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,1,,,0,0,0,2015-01-01,,Yes,Emergancy Sevices Only,No,,No,http://www.christushealthplan.com/workfiles/NM%20HIX/Summary%20of%20Benefits%20State%20Silver%20Low%20Deductible.pdf,www.christushealthplan.org,http://www.christushealthplan.org/workfiles/NM%20HIX/New%20Mexico%20Evidence%20of%20Covereage%20Qualified%20Health%20Plan%2011.18.14.pdf,http://www.christushealthplan.org/workfiles/NM%20HIX/2015%20CHRISTUS%20Health%20Plan%20Qualified%20Health%20Plan%20Formulary%2011.17.14.pdf,72034NM0180001-05,87% AV Level Silver Plan,,0.873094499111176,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,28
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390009,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS022,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390009-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,57
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390009,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS022,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390009-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,58
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390009,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS022,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390009-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,59
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390009,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS022,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390009-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,60
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0370001,Blue Advantage Gold HMO? 001,75605NM037,,NMN003,NMS003,NMF005,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370001-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0330001,Blue PPO Gold? 001,75605NM033,,NMN001,NMS001,NMF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330001-00,Standard Gold Off Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390028,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS052,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390028-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,115
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,No,36-1236610,75605NM0330005,Blue PPO Bronze? 005,75605NM033,,NMN001,NMS001,NMF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330005-00,Standard Bronze Off Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390015,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS032,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390015-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,65
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390021,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS042,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390021-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,68
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390021,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS042,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390021-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,69
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0330004,Blue PPO Silver? 004,75605NM033,,NMN001,NMS001,NMF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330004-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,4,75605,NM,Individual,Yes,36-1236610,75605NM0430004,BlueCare Dental 4 Kids? 1B,75605NM043,,NMN004,NMS004,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$26.86,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/dental/,,75605NM0430004-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,1,93091,NM,Individual,No,45-1294709,93091NM0170001,Healthy Connect Gold HMO,93091NM017,,NMN001,NMS006,NMF014,New,HMO,Gold,Yes,Both,No,No,,,$36.58,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0170001-00,Standard Gold Off Exchange Plan,78.00%,0.778895258903503,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$210,$890,$150,"$1,000",$480,$210,$80,4
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,1,93091,NM,Individual,No,45-1294709,93091NM0170001,Healthy Connect Gold HMO,93091NM017,,NMN001,NMS006,NMF014,New,HMO,Gold,Yes,Both,No,No,,,$36.58,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0170001-01,Standard Gold On Exchange Plan,78.00%,0.778895258903503,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$210,$890,$150,"$1,000",$480,$210,$80,5
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,1,93091,NM,Individual,No,45-1294709,93091NM0170001,Healthy Connect Gold HMO,93091NM017,,NMN001,NMS006,NMF014,New,HMO,Gold,Yes,Both,No,No,,,$36.58,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0170001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,1,93091,NM,Individual,No,45-1294709,93091NM0170001,Healthy Connect Gold HMO,93091NM017,,NMN001,NMS006,NMF014,New,HMO,Gold,Yes,Both,No,No,,,$36.58,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0170001-03,Limited Cost Sharing Plan Variation,78.00%,0.778895258903503,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$210,$890,$150,"$1,000",$480,$210,$80,7
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,1,93091,NM,Individual,No,45-1294709,93091NM0170002,Healthy Connect Silver HMO,93091NM017,,NMN001,NMS006,NMF018,New,HMO,Silver,Yes,Both,No,No,,,$48.73,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0170002-00,Standard Silver Off Exchange Plan,70.10%,0.697313487529755,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$230,"$1,340",$150,"$2,000",$820,$260,$80,8
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,1,93091,NM,Individual,No,45-1294709,93091NM0170002,Healthy Connect Silver HMO,93091NM017,,NMN001,NMS006,NMF018,New,HMO,Silver,Yes,Both,No,No,,,$48.73,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0170002-01,Standard Silver On Exchange Plan,70.10%,0.697313487529755,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$230,"$1,340",$150,"$2,000",$820,$260,$80,9
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390028,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS052,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390028-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,111
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390028,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS052,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390028-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,112
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,Yes,36-1236610,75605NM0430003,BlueCare Dental 4 Kids? 1A,75605NM043,,NMN004,NMS004,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$33.02,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/dental/,,75605NM0430003-01,Standard High On Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,No,36-1236610,75605NM0370005,Blue Advantage Bronze HMO? 005,75605NM037,,NMN003,NMS003,NMF008,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370005-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,No,36-1236610,75605NM0330005,Blue PPO Bronze? 005,75605NM033,,NMN001,NMS001,NMF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330005-01,Standard Bronze On Exchange Plan,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,No,36-1236610,75605NM0330005,Blue PPO Bronze? 005,75605NM033,,NMN001,NMS001,NMF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390021,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS042,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390021-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,70
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390002,Blue Community Gold HMO? 002,75605NM039,,NMN002,NMS012,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390002-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390002,Blue Community Gold HMO? 002,75605NM039,,NMN002,NMS012,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390027,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS052,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390027-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,77
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390027,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS052,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390027-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,78
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0330001,Blue PPO Gold? 001,75605NM033,,NMN001,NMS001,NMF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330001-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0370001,Blue Advantage Gold HMO? 001,75605NM037,,NMN003,NMS003,NMF005,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370001-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,Yes,36-1236610,75605NM0430001,BlueCare Dental? 1A,75605NM043,,NMN004,NMS004,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.02,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/dental/,,75605NM0430001-01,Standard High On Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0370001,Blue Advantage Gold HMO? 001,75605NM037,,NMN003,NMS003,NMF005,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0330001,Blue PPO Gold? 001,75605NM033,,NMN001,NMS001,NMF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0330001,Blue PPO Gold? 001,75605NM033,,NMN001,NMS001,NMF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330001-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500",Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,"$6,500","$19,500",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0370001,Blue Advantage Gold HMO? 001,75605NM037,,NMN003,NMS003,NMF005,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370001-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0330002,Blue PPO Gold? 002,75605NM033,,NMN001,NMS001,NMF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330002-00,Standard Gold Off Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390001,Blue Community Gold HMO? 001,75605NM039,,NMN002,NMS012,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390001-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390001,Blue Community Gold HMO? 001,75605NM039,,NMN002,NMS012,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0330002,Blue PPO Gold? 002,75605NM033,,NMN001,NMS001,NMF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330002-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0330002,Blue PPO Gold? 002,75605NM033,,NMN001,NMS001,NMF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390001,Blue Community Gold HMO? 001,75605NM039,,NMN002,NMS012,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390001-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0330002,Blue PPO Gold? 002,75605NM033,,NMN001,NMS001,NMF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330002-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000",Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390007,Blue Community Gold HMO? 001,75605NM039,,NMN002,NMS022,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390007-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390007,Blue Community Gold HMO? 001,75605NM039,,NMN002,NMS022,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0330003,Blue PPO Silver? 003,75605NM033,,NMN001,NMS001,NMF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330003-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0330003,Blue PPO Silver? 003,75605NM033,,NMN001,NMS001,NMF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330003-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390007,Blue Community Gold HMO? 001,75605NM039,,NMN002,NMS022,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390007-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0330003,Blue PPO Silver? 003,75605NM033,,NMN001,NMS001,NMF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390013,Blue Community Gold HMO? 001,75605NM039,,NMN002,NMS032,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390013-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390013,Blue Community Gold HMO? 001,75605NM039,,NMN002,NMS032,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390013-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0330003,Blue PPO Silver? 003,75605NM033,,NMN001,NMS001,NMF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330003-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0330003,Blue PPO Silver? 003,75605NM033,,NMN001,NMS001,NMF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330003-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800",Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,"$10,000","$20,800",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390013,Blue Community Gold HMO? 001,75605NM039,,NMN002,NMS032,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390013-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0330003,Blue PPO Silver? 003,75605NM033,,NMN001,NMS001,NMF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330003-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,"$3,000","$9,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390019,Blue Community Gold HMO? 001,75605NM039,,NMN002,NMS042,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390019-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390019,Blue Community Gold HMO? 001,75605NM039,,NMN002,NMS042,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390019-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0330003,Blue PPO Silver? 003,75605NM033,,NMN001,NMS001,NMF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330003-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,"$1,000","$3,000",Not Applicable,Not Applicable,$500,"$1,500",0%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0330004,Blue PPO Silver? 004,75605NM033,,NMN001,NMS001,NMF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330004-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390019,Blue Community Gold HMO? 001,75605NM039,,NMN002,NMS042,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390019-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0330004,Blue PPO Silver? 004,75605NM033,,NMN001,NMS001,NMF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330004-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390025,Blue Community Gold HMO? 001,75605NM039,,NMN002,NMS052,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390025-01,Standard Gold On Exchange Plan,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390025,Blue Community Gold HMO? 001,75605NM039,,NMN002,NMS052,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390025-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0330004,Blue PPO Silver? 004,75605NM033,,NMN001,NMS001,NMF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0330004,Blue PPO Silver? 004,75605NM033,,NMN001,NMS001,NMF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330004-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,"$6,000","$18,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390025,Blue Community Gold HMO? 001,75605NM039,,NMN002,NMS052,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390025-03,Limited Cost Sharing Plan Variation,,0.790385127067566,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$9,750",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0330004,Blue PPO Silver? 004,75605NM033,,NMN001,NMS001,NMF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330004-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800",Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,"$5,000","$15,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0330004,Blue PPO Silver? 004,75605NM033,,NMN001,NMS001,NMF003,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330004-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000",Not Applicable,Not Applicable,$500,"$1,500",20%,,,,"$1,000","$3,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0370002,Blue Advantage Gold HMO? 002,75605NM037,,NMN003,NMS003,NMF005,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0370002,Blue Advantage Gold HMO? 002,75605NM037,,NMN003,NMS003,NMF005,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370002-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390002,Blue Community Gold HMO? 002,75605NM039,,NMN002,NMS012,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390002-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390008,Blue Community Gold HMO? 002,75605NM039,,NMN002,NMS022,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390008-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390008,Blue Community Gold HMO? 002,75605NM039,,NMN002,NMS022,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390008,Blue Community Gold HMO? 002,75605NM039,,NMN002,NMS022,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390008-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390014,Blue Community Gold HMO? 002,75605NM039,,NMN002,NMS032,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390014-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390014,Blue Community Gold HMO? 002,75605NM039,,NMN002,NMS032,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390014,Blue Community Gold HMO? 002,75605NM039,,NMN002,NMS032,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390014-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390020,Blue Community Gold HMO? 002,75605NM039,,NMN002,NMS042,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390020-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390020,Blue Community Gold HMO? 002,75605NM039,,NMN002,NMS042,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390020-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390020,Blue Community Gold HMO? 002,75605NM039,,NMN002,NMS042,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390020-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390026,Blue Community Gold HMO? 002,75605NM039,,NMN002,NMS052,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390026-01,Standard Gold On Exchange Plan,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390026,Blue Community Gold HMO? 002,75605NM039,,NMN002,NMS052,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390026-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,40
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390026,Blue Community Gold HMO? 002,75605NM039,,NMN002,NMS052,NMF005,Existing,HMO,Gold,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390026-03,Limited Cost Sharing Plan Variation,,0.799542129039764,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0370003,Blue Advantage Silver HMO? 003,75605NM037,,NMN003,NMS003,NMF006,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370003-00,Standard Silver Off Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0370003,Blue Advantage Silver HMO? 003,75605NM037,,NMN003,NMS003,NMF006,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370003-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0370003,Blue Advantage Silver HMO? 003,75605NM037,,NMN003,NMS003,NMF006,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,44
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0370003,Blue Advantage Silver HMO? 003,75605NM037,,NMN003,NMS003,NMF006,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370003-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0370003,Blue Advantage Silver HMO? 003,75605NM037,,NMN003,NMS003,NMF006,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370003-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0370003,Blue Advantage Silver HMO? 003,75605NM037,,NMN003,NMS003,NMF006,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370003-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,47
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0370003,Blue Advantage Silver HMO? 003,75605NM037,,NMN003,NMS003,NMF006,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370003-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390003,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS012,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390003-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,49
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390003,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS012,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,50
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390003,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS012,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390003-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,51
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390003,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS012,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390003-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,52
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390003,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS012,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390003-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,53
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390003,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS012,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390003-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,54
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390009,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS022,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390009-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,55
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390009,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS022,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390009-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,56
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390015,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS032,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390015-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,61
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390015,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS032,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,62
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390015,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS032,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390015-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,63
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390015,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS032,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390015-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,64
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390021,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS042,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390021-05,87% AV Level Silver Plan,,0.875661015510559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,71
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390021,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS042,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390021-06,94% AV Level Silver Plan,,0.947184801101685,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,72
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390027,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS052,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390027-01,Standard Silver On Exchange Plan,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,73
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390027,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS052,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390027-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,74
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390028,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS052,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390028-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,113
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390028,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS052,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390028-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,114
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,No,36-1236610,75605NM0370005,Blue Advantage Bronze HMO? 005,75605NM037,,NMN003,NMS003,NMF008,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370005-00,Standard Bronze Off Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,Yes,36-1236610,75605NM0430003,BlueCare Dental 4 Kids? 1A,75605NM043,,NMN004,NMS004,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$33.02,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/dental/,,75605NM0430003-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,1,93091,NM,Individual,No,45-1294709,93091NM0170002,Healthy Connect Silver HMO,93091NM017,,NMN001,NMS006,NMF018,New,HMO,Silver,Yes,Both,No,No,,,$48.73,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0170002-03,Limited Cost Sharing Plan Variation,70.10%,0.697313487529755,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$230,"$1,340",$150,"$2,000",$820,$260,$80,11
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,1,93091,NM,Individual,No,45-1294709,93091NM0170002,Healthy Connect Silver HMO,93091NM017,,NMN001,NMS006,NMF018,New,HMO,Silver,Yes,Both,No,No,,,$48.73,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0170002-04,73% AV Level Silver Plan,73.80%,0.718638777732849,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$230,"$1,340",$150,"$2,000",$990,$260,$80,12
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,2,93091,NM,Individual,No,45-1294709,93091NM0170003,Healthy Connect Bronze HMO,93091NM017,,NMN001,NMS006,NMF009,New,HMO,Bronze,Yes,Both,No,No,,,$78.27,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0170003-01,Standard Bronze On Exchange Plan,61.00%,0.609506070613861,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$890,$150,"$5,000",$0,$70,$80,5
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,2,93091,NM,Individual,No,45-1294709,93091NM0170003,Healthy Connect Bronze HMO,93091NM017,,NMN001,NMS006,NMF009,New,HMO,Bronze,Yes,Both,No,No,,,$78.27,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0170003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,2,93091,NM,Individual,No,45-1294709,93091NM0170003,Healthy Connect Bronze HMO,93091NM017,,NMN001,NMS006,NMF009,New,HMO,Bronze,Yes,Both,No,No,,,$78.27,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0170003-03,Limited Cost Sharing Plan Variation,61.00%,0.609506070613861,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$890,$150,"$5,000",$0,$70,$80,7
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390027,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS052,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390027-03,Limited Cost Sharing Plan Variation,,0.701050579547882,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,75
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390027,Blue Community Silver HMO? 003,75605NM039,,NMN002,NMS052,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390027-04,73% AV Level Silver Plan,,0.730194807052612,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,76
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0370004,Blue Advantage Silver HMO? 004,75605NM037,,NMN003,NMS003,NMF006,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370004-00,Standard Silver Off Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,79
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0370004,Blue Advantage Silver HMO? 004,75605NM037,,NMN003,NMS003,NMF006,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370004-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,80
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0370004,Blue Advantage Silver HMO? 004,75605NM037,,NMN003,NMS003,NMF006,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,81
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0370004,Blue Advantage Silver HMO? 004,75605NM037,,NMN003,NMS003,NMF006,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370004-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,82
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,No,36-1236610,75605NM0390011,Blue Community Bronze HMO? 005,75605NM039,,NMN002,NMS022,NMF008,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390011-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,No,36-1236610,75605NM0390011,Blue Community Bronze HMO? 005,75605NM039,,NMN002,NMS022,NMF008,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,No,36-1236610,75605NM0390011,Blue Community Bronze HMO? 005,75605NM039,,NMN002,NMS022,NMF008,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390011-03,Limited Cost Sharing Plan Variation,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,No,36-1236610,75605NM0390017,Blue Community Bronze HMO? 005,75605NM039,,NMN002,NMS032,NMF008,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390017-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,No,36-1236610,75605NM0390017,Blue Community Bronze HMO? 005,75605NM039,,NMN002,NMS032,NMF008,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,No,36-1236610,75605NM0390017,Blue Community Bronze HMO? 005,75605NM039,,NMN002,NMS032,NMF008,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390017-03,Limited Cost Sharing Plan Variation,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,No,36-1236610,75605NM0390023,Blue Community Bronze HMO? 005,75605NM039,,NMN002,NMS042,NMF008,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390023-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,No,36-1236610,75605NM0390023,Blue Community Bronze HMO? 005,75605NM039,,NMN002,NMS042,NMF008,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390023-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,1,93091,NM,Individual,No,45-1294709,93091NM0170002,Healthy Connect Silver HMO,93091NM017,,NMN001,NMS006,NMF018,New,HMO,Silver,Yes,Both,No,No,,,$48.73,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0170002-05,87% AV Level Silver Plan,87.10%,0.867218673229218,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$190,"$1,310",$150,$500,$490,$210,$80,13
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,1,93091,NM,Individual,No,45-1294709,93091NM0170002,Healthy Connect Silver HMO,93091NM017,,NMN001,NMS006,NMF018,New,HMO,Silver,Yes,Both,No,No,,,$48.73,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0170002-06,94% AV Level Silver Plan,94.00%,0.937976658344269,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$190,$450,$150,$100,$250,$120,$80,14
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,2,93091,NM,Individual,No,45-1294709,93091NM0170003,Healthy Connect Bronze HMO,93091NM017,,NMN001,NMS006,NMF009,New,HMO,Bronze,Yes,Both,No,No,,,$78.27,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0170003-00,Standard Bronze Off Exchange Plan,61.00%,0.609506070613861,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$890,$150,"$5,000",$0,$70,$80,4
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0370004,Blue Advantage Silver HMO? 004,75605NM037,,NMN003,NMS003,NMF006,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370004-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,83
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0370004,Blue Advantage Silver HMO? 004,75605NM037,,NMN003,NMS003,NMF006,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370004-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,84
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0370004,Blue Advantage Silver HMO? 004,75605NM037,,NMN003,NMS003,NMF006,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370004-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,85
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390004,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS012,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390004-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,86
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390004,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS012,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,87
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390004,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS012,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390004-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,88
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390004,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS012,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390004-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,89
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390004,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS012,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390004-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,90
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390004,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS012,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390004-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,91
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390010,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS022,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390010-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,92
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390010,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS022,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,93
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390010,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS022,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390010-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,94
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390010,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS022,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390010-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,95
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390010,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS022,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390010-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,96
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390010,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS022,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390010-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,97
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390016,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS032,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390016-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,98
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390016,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS032,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390016-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,99
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390016,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS032,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390016-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,100
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390016,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS032,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390016-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,101
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390016,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS032,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390016-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,102
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,9,16698,NV,Individual,No,88-0293082,16698NV0450009,Prominence Health Plan Bronze 3 ChoicePlus,16698NV045,,NVN002,NVS001,NVF004,New,HMO,Bronze,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,3,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450009-03,Limited Cost Sharing Plan Variation,60.60%,0.66942310333252,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$870,$0,$150,$0,"$1,670",$0,$80,7
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,10,16698,NV,Individual,No,88-0293082,16698NV0450010,Prominence Health Plan Silver 20 ChoicePlus,16698NV045,,NVN002,NVS001,NVF006,New,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450010-00,Standard Silver Off Exchange Plan,71.20%,0.772495985031128,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$890,$0,$150,$0,"$1,720",$0,$80,4
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,10,16698,NV,Individual,No,88-0293082,16698NV0450010,Prominence Health Plan Silver 20 ChoicePlus,16698NV045,,NVN002,NVS001,NVF006,New,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450010-01,Standard Silver On Exchange Plan,71.20%,0.772495985031128,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$890,$0,$150,$0,"$1,720",$0,$80,5
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,10,16698,NV,Individual,No,88-0293082,16698NV0450010,Prominence Health Plan Silver 20 ChoicePlus,16698NV045,,NVN002,NVS001,NVF006,New,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450010-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,10,16698,NV,Individual,No,88-0293082,16698NV0450010,Prominence Health Plan Silver 20 ChoicePlus,16698NV045,,NVN002,NVS001,NVF006,New,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450010-03,Limited Cost Sharing Plan Variation,71.20%,0.772495985031128,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$890,$0,$150,$0,"$1,720",$0,$80,7
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,10,16698,NV,Individual,No,88-0293082,16698NV0450010,Prominence Health Plan Silver 20 ChoicePlus,16698NV045,,NVN002,NVS001,NVF006,New,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450010-04,73% AV Level Silver Plan,73.40%,0.787050187587738,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$890,$0,$150,$0,"$1,670",$0,$80,8
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,12,16698,NV,Individual,No,88-0293082,16698NV0450012,Prominence Health Plan Silver 40 Premier,16698NV045,,NVN001,NVS001,NVF016,New,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,3,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450012-00,Standard Silver Off Exchange Plan,68.00%,0.684939324855804,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,275","$12,550",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$200,$410,$150,"$1,270",$230,$0,$80,4
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,12,16698,NV,Individual,No,88-0293082,16698NV0450012,Prominence Health Plan Silver 40 Premier,16698NV045,,NVN001,NVS001,NVF016,New,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,3,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450012-01,Standard Silver On Exchange Plan,68.00%,0.684939324855804,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,275","$12,550",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$200,$410,$150,"$1,270",$230,$0,$80,5
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390016,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS032,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390016-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,103
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390022,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS042,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390022-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,104
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390022,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS042,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390022-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,105
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390022,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS042,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390022-03,Limited Cost Sharing Plan Variation,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,106
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390022,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS042,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390022-04,73% AV Level Silver Plan,,0.737334966659546,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,107
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390022,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS042,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390022-05,87% AV Level Silver Plan,,0.875085771083832,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,108
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390022,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS042,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390022-06,94% AV Level Silver Plan,,0.947438538074493,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,109
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,1,75605,NM,Individual,No,36-1236610,75605NM0390028,Blue Community Silver HMO? 004,75605NM039,,NMN002,NMS052,NMF006,Existing,HMO,Silver,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390028-01,Standard Silver On Exchange Plan,,0.711438596248627,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,110
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,No,36-1236610,75605NM0370005,Blue Advantage Bronze HMO? 005,75605NM037,,NMN003,NMS003,NMF008,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,No,36-1236610,75605NM0370005,Blue Advantage Bronze HMO? 005,75605NM037,,NMN003,NMS003,NMF008,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370005-03,Limited Cost Sharing Plan Variation,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,No,36-1236610,75605NM0330005,Blue PPO Bronze? 005,75605NM033,,NMN001,NMS001,NMF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330005-03,Limited Cost Sharing Plan Variation,,0.618678152561188,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,"$10,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,No,36-1236610,75605NM0390005,Blue Community Bronze HMO? 005,75605NM039,,NMN002,NMS012,NMF008,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390005-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,No,36-1236610,75605NM0390005,Blue Community Bronze HMO? 005,75605NM039,,NMN002,NMS012,NMF008,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,No,36-1236610,75605NM0390005,Blue Community Bronze HMO? 005,75605NM039,,NMN002,NMS012,NMF008,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390005-03,Limited Cost Sharing Plan Variation,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,No,36-1236610,75605NM0390023,Blue Community Bronze HMO? 005,75605NM039,,NMN002,NMS042,NMF008,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390023-03,Limited Cost Sharing Plan Variation,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,No,36-1236610,75605NM0390029,Blue Community Bronze HMO? 005,75605NM039,,NMN002,NMS052,NMF008,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390029-01,Standard Bronze On Exchange Plan,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,No,36-1236610,75605NM0390029,Blue Community Bronze HMO? 005,75605NM039,,NMN002,NMS052,NMF008,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390029-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,2,75605,NM,Individual,No,36-1236610,75605NM0390029,Blue Community Bronze HMO? 005,75605NM039,,NMN002,NMS052,NMF008,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390029-03,Limited Cost Sharing Plan Variation,,0.618476450443268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0370006,Blue Advantage Bronze HMO? 006,75605NM037,,NMN003,NMS003,NMF007,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370006-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,Yes,36-1236610,75605NM0430002,BlueCare Dental? 1B,75605NM043,,NMN004,NMS004,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.86,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/dental/,,75605NM0430002-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0330006,Blue PPO Bronze? 006,75605NM033,,NMN001,NMS001,NMF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330006-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0330006,Blue PPO Bronze? 006,75605NM033,,NMN001,NMS001,NMF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330006-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,Yes,36-1236610,75605NM0430002,BlueCare Dental? 1B,75605NM043,,NMN004,NMS004,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.86,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/dental/,,75605NM0430002-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0370006,Blue Advantage Bronze HMO? 006,75605NM037,,NMN003,NMS003,NMF007,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370006-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0370006,Blue Advantage Bronze HMO? 006,75605NM037,,NMN003,NMS003,NMF007,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0330006,Blue PPO Bronze? 006,75605NM033,,NMN001,NMS001,NMF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0330006,Blue PPO Bronze? 006,75605NM033,,NMN001,NMS001,NMF004,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330006-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,"$12,000","$25,400",Not Applicable,Not Applicable,,,,,,,,,7
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0370006,Blue Advantage Bronze HMO? 006,75605NM037,,NMN003,NMS003,NMF007,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370006-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0330010,Blue Security PPO? 010,75605NM033,,NMN001,NMS001,NMF004,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330010-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,8
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0390006,Blue Community Bronze HMO? 006,75605NM039,,NMN002,NMS012,NMF007,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390006-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0390006,Blue Community Bronze HMO? 006,75605NM039,,NMN002,NMS012,NMF007,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0330010,Blue Security PPO? 010,75605NM033,,NMN001,NMS001,NMF004,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierStandardDrugList.pdf,75605NM0330010-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0390006,Blue Community Bronze HMO? 006,75605NM039,,NMN002,NMS012,NMF007,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390006-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0390012,Blue Community Bronze HMO? 006,75605NM039,,NMN002,NMS022,NMF007,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390012-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0390012,Blue Community Bronze HMO? 006,75605NM039,,NMN002,NMS022,NMF007,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0390012,Blue Community Bronze HMO? 006,75605NM039,,NMN002,NMS022,NMF007,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390012-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0390018,Blue Community Bronze HMO? 006,75605NM039,,NMN002,NMS032,NMF007,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390018-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0390018,Blue Community Bronze HMO? 006,75605NM039,,NMN002,NMS032,NMF007,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390018-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0390018,Blue Community Bronze HMO? 006,75605NM039,,NMN002,NMS032,NMF007,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390018-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0390024,Blue Community Bronze HMO? 006,75605NM039,,NMN002,NMS042,NMF007,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390024-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0390024,Blue Community Bronze HMO? 006,75605NM039,,NMN002,NMS042,NMF007,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390024-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0390024,Blue Community Bronze HMO? 006,75605NM039,,NMN002,NMS042,NMF007,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390024-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0390030,Blue Community Bronze HMO? 006,75605NM039,,NMN002,NMS052,NMF007,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390030-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,20
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0390030,Blue Community Bronze HMO? 006,75605NM039,,NMN002,NMS052,NMF007,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390030-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0390030,Blue Community Bronze HMO? 006,75605NM039,,NMN002,NMS052,NMF007,Existing,HMO,Bronze,No,On the Exchange,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0390030-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0370010,Blue Advantage Security HMO? 010,75605NM037,,NMN003,NMS003,NMF007,New,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370010-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,3,75605,NM,Individual,No,36-1236610,75605NM0370010,Blue Advantage Security HMO? 010,75605NM037,,NMN003,NMS003,NMF007,New,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,"This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",No,Coverage outside our service area is available for Emergency services only.,No,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/,https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2015_NM_HealthIns5TierGenericsPlusDrugList.pdf,75605NM0370010-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,24
2015,NM,75605,SERFF,8,2015-02-22 21:18:17,4,75605,NM,Individual,Yes,36-1236610,75605NM0430004,BlueCare Dental 4 Kids? 1B,75605NM043,,NMN004,NMS004,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$26.86,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.",Yes,"When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ?Participating Providers?) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (?Host Blue?). In some instances, you may obtain care from Non-Participating Providers.",Yes,,https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred,http://www.bcbsnm.com/coverage/individual/on-exchange/dental/,,75605NM0430004-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,$225,,,,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,1,93091,NM,Individual,No,45-1294709,93091NM0170002,Healthy Connect Silver HMO,93091NM017,,NMN001,NMS006,NMF018,New,HMO,Silver,Yes,Both,No,No,,,$48.73,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0170002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,3,93091,NM,Individual,No,45-1294709,93091NM0010001,Care Connect Gold $750 HMO,93091NM001,,NMN001,NMS006,NMF002,Existing,HMO,Gold,Yes,Both,No,No,,,$37.06,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0010001-00,Standard Gold Off Exchange Plan,79.40%,0.773985087871552,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,230",$0,$150,$750,$800,$210,$80,4
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,3,93091,NM,Individual,No,45-1294709,93091NM0010001,Care Connect Gold $750 HMO,93091NM001,,NMN001,NMS006,NMF002,Existing,HMO,Gold,Yes,Both,No,No,,,$37.06,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0010001-01,Standard Gold On Exchange Plan,79.40%,0.773985087871552,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,230",$0,$150,$750,$800,$210,$80,5
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,3,93091,NM,Individual,No,45-1294709,93091NM0010001,Care Connect Gold $750 HMO,93091NM001,,NMN001,NMS006,NMF002,Existing,HMO,Gold,Yes,Both,No,No,,,$37.06,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0010001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,3,93091,NM,Individual,No,45-1294709,93091NM0010001,Care Connect Gold $750 HMO,93091NM001,,NMN001,NMS006,NMF002,Existing,HMO,Gold,Yes,Both,No,No,,,$37.06,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0010001-03,Limited Cost Sharing Plan Variation,79.40%,0.773985087871552,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,230",$0,$150,$750,$800,$210,$80,7
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,3,93091,NM,Individual,No,45-1294709,93091NM0010002,"Care Connect Silver $2,000 HMO",93091NM001,,NMN001,NMS006,NMF007,Existing,HMO,Silver,Yes,Both,No,No,,,$46.86,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0010002-00,Standard Silver Off Exchange Plan,70.80%,0.687054634094238,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$2,720",$0,$150,"$2,000",$800,$260,$80,8
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,3,93091,NM,Individual,No,45-1294709,93091NM0010002,"Care Connect Silver $2,000 HMO",93091NM001,,NMN001,NMS006,NMF007,Existing,HMO,Silver,Yes,Both,No,No,,,$46.86,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0010002-01,Standard Silver On Exchange Plan,70.80%,0.687054634094238,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$2,720",$0,$150,"$2,000",$800,$260,$80,9
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,3,93091,NM,Individual,No,45-1294709,93091NM0010002,"Care Connect Silver $2,000 HMO",93091NM001,,NMN001,NMS006,NMF007,Existing,HMO,Silver,Yes,Both,No,No,,,$46.86,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0010002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,3,93091,NM,Individual,No,45-1294709,93091NM0010002,"Care Connect Silver $2,000 HMO",93091NM001,,NMN001,NMS006,NMF007,Existing,HMO,Silver,Yes,Both,No,No,,,$46.86,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0010002-03,Limited Cost Sharing Plan Variation,70.80%,0.687054634094238,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$2,720",$0,$150,"$2,000",$800,$260,$80,11
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,3,93091,NM,Individual,No,45-1294709,93091NM0010002,"Care Connect Silver $2,000 HMO",93091NM001,,NMN001,NMS006,NMF007,Existing,HMO,Silver,Yes,Both,No,No,,,$46.86,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0010002-04,73% AV Level Silver Plan,73.90%,0.73034656047821,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$2,220",$0,$150,"$1,750",$890,$0,$80,12
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,3,93091,NM,Individual,No,45-1294709,93091NM0010002,"Care Connect Silver $2,000 HMO",93091NM001,,NMN001,NMS006,NMF007,Existing,HMO,Silver,Yes,Both,No,No,,,$46.86,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0010002-05,87% AV Level Silver Plan,87.40%,0.870999157428741,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$490,$0,$150,$250,$740,$0,$80,13
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,3,93091,NM,Individual,No,45-1294709,93091NM0010002,"Care Connect Silver $2,000 HMO",93091NM001,,NMN001,NMS006,NMF007,Existing,HMO,Silver,Yes,Both,No,No,,,$46.86,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0010002-06,94% AV Level Silver Plan,93.60%,0.935285210609436,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$130,$0,$150,$0,$50,$0,$80,14
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,4,93091,NM,Individual,No,45-1294709,93091NM0010006,Care Connect Bronze,93091NM001,,NMN001,NMS006,NMF009,Existing,HMO,Bronze,Yes,Both,No,No,,,$69.34,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0010006-00,Standard Bronze Off Exchange Plan,60.90%,0.638540804386139,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$0,"$2,390",$150,"$2,500",$0,"$1,390",$80,4
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,4,93091,NM,Individual,No,45-1294709,93091NM0010006,Care Connect Bronze,93091NM001,,NMN001,NMS006,NMF009,Existing,HMO,Bronze,Yes,Both,No,No,,,$69.34,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0010006-01,Standard Bronze On Exchange Plan,60.90%,0.638540804386139,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$0,"$2,390",$150,"$2,500",$0,"$1,390",$80,5
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,4,93091,NM,Individual,No,45-1294709,93091NM0010006,Care Connect Bronze,93091NM001,,NMN001,NMS006,NMF009,Existing,HMO,Bronze,Yes,Both,No,No,,,$69.34,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0010006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,4,93091,NM,Individual,No,45-1294709,93091NM0010006,Care Connect Bronze,93091NM001,,NMN001,NMS006,NMF009,Existing,HMO,Bronze,Yes,Both,No,No,,,$69.34,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0010006-03,Limited Cost Sharing Plan Variation,60.90%,0.638540804386139,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$0,"$2,390",$150,"$2,500",$0,"$1,390",$80,7
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,5,93091,NM,Individual,No,45-1294709,93091NM0030001,Choice Connect Gold $500 PPO,93091NM003,,NMN001,NMS006,NMF016,Existing,PPO,Gold,Yes,Both,No,No,,,$48.36,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,$250,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Within USA,Yes,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0030001-00,Standard Gold Off Exchange Plan,79.40%,0.800790548324585,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$210,"$1,340",$150,$500,$580,$310,$80,4
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,5,93091,NM,Individual,No,45-1294709,93091NM0030001,Choice Connect Gold $500 PPO,93091NM003,,NMN001,NMS006,NMF016,Existing,PPO,Gold,Yes,Both,No,No,,,$48.36,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,$250,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Within USA,Yes,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0030001-01,Standard Gold On Exchange Plan,79.40%,0.800790548324585,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$210,"$1,340",$150,$500,$580,$310,$80,5
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,5,93091,NM,Individual,No,45-1294709,93091NM0030001,Choice Connect Gold $500 PPO,93091NM003,,NMN001,NMS006,NMF016,Existing,PPO,Gold,Yes,Both,No,No,,,$48.36,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,$250,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Within USA,Yes,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0030001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,5,93091,NM,Individual,No,45-1294709,93091NM0030001,Choice Connect Gold $500 PPO,93091NM003,,NMN001,NMS006,NMF016,Existing,PPO,Gold,Yes,Both,No,No,,,$48.36,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,$250,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Within USA,Yes,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0030001-03,Limited Cost Sharing Plan Variation,79.40%,0.800790548324585,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$210,"$1,340",$150,$500,$580,$310,$80,7
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,5,93091,NM,Individual,No,45-1294709,93091NM0030002,Choice Connect Silver $2000 PPO,93091NM003,,NMN001,NMS006,NMF007,Existing,PPO,Silver,Yes,Both,No,No,,,$66.16,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Within USA,Yes,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0030002-00,Standard Silver Off Exchange Plan,70.40%,0.692756116390228,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$230,"$1,790",$150,"$2,000",$820,$350,$80,8
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,5,93091,NM,Individual,No,45-1294709,93091NM0030002,Choice Connect Silver $2000 PPO,93091NM003,,NMN001,NMS006,NMF007,Existing,PPO,Silver,Yes,Both,No,No,,,$66.16,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Within USA,Yes,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0030002-01,Standard Silver On Exchange Plan,70.40%,0.692756116390228,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$230,"$1,790",$150,"$2,000",$820,$350,$80,9
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,5,93091,NM,Individual,No,45-1294709,93091NM0030002,Choice Connect Silver $2000 PPO,93091NM003,,NMN001,NMS006,NMF007,Existing,PPO,Silver,Yes,Both,No,No,,,$66.16,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Within USA,Yes,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0030002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,5,93091,NM,Individual,No,45-1294709,93091NM0030002,Choice Connect Silver $2000 PPO,93091NM003,,NMN001,NMS006,NMF007,Existing,PPO,Silver,Yes,Both,No,No,,,$66.16,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Within USA,Yes,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0030002-03,Limited Cost Sharing Plan Variation,70.40%,0.692756116390228,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",40%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$230,"$1,790",$150,"$2,000",$820,$350,$80,11
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,5,93091,NM,Individual,No,45-1294709,93091NM0030002,Choice Connect Silver $2000 PPO,93091NM003,,NMN001,NMS006,NMF007,Existing,PPO,Silver,Yes,Both,No,No,,,$66.16,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Within USA,Yes,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0030002-04,73% AV Level Silver Plan,73.90%,0.732415378093719,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$230,"$1,340",$0,"$2,000",$820,$260,$80,12
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,5,93091,NM,Individual,No,45-1294709,93091NM0030002,Choice Connect Silver $2000 PPO,93091NM003,,NMN001,NMS006,NMF007,Existing,PPO,Silver,Yes,Both,No,No,,,$66.16,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Within USA,Yes,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0030002-05,87% AV Level Silver Plan,87.40%,0.875290155410767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$150,$210,"$1,340",$150,$150,$750,$340,$80,13
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,5,93091,NM,Individual,No,45-1294709,93091NM0030002,Choice Connect Silver $2000 PPO,93091NM003,,NMN001,NMS006,NMF007,Existing,PPO,Silver,Yes,Both,No,No,,,$66.16,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,3,0,2015-01-01,,Yes,Emergency Only,Yes,Within USA,Yes,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0030002-06,94% AV Level Silver Plan,94.00%,0.945360958576202,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$100,$60,$600,$150,$100,$50,$0,$80,14
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,6,93091,NM,Individual,No,45-1294709,93091NM0010007,Care Connect Catastrophic HMO,93091NM001,,NMN001,NMS006,NMF005,New,HMO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0010007-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,350",$0,$0,$150,"$5,410",$0,$0,$80,4
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,6,93091,NM,Individual,No,45-1294709,93091NM0010007,Care Connect Catastrophic HMO,93091NM001,,NMN001,NMS006,NMF005,New,HMO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0010007-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,350",$0,$0,$150,"$5,410",$0,$0,$80,5
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,7,93091,NM,Individual,No,45-1294709,93091NM0010008,"Care Connect Bronze $4,000 HMO",93091NM001,,NMN001,NMS006,NMF009,New,HMO,Bronze,Yes,Both,No,No,,,$78.64,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0010008-00,Standard Bronze Off Exchange Plan,58.70%,0.586705803871155,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,"$1,640",$150,"$4,000",$0,$640,$80,4
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,7,93091,NM,Individual,No,45-1294709,93091NM0010008,"Care Connect Bronze $4,000 HMO",93091NM001,,NMN001,NMS006,NMF009,New,HMO,Bronze,Yes,Both,No,No,,,$78.64,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0010008-01,Standard Bronze On Exchange Plan,58.70%,0.586705803871155,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,"$1,640",$150,"$4,000",$0,$640,$80,5
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,7,93091,NM,Individual,No,45-1294709,93091NM0010008,"Care Connect Bronze $4,000 HMO",93091NM001,,NMN001,NMS006,NMF009,New,HMO,Bronze,Yes,Both,No,No,,,$78.64,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0010008-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NM,93091,SERFF,10,2015-01-21 12:15:34,7,93091,NM,Individual,No,45-1294709,93091NM0010008,"Care Connect Bronze $4,000 HMO",93091NM001,,NMN001,NMS006,NMF009,New,HMO,Bronze,Yes,Both,No,No,,,$78.64,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,http://www.mynmhc.org/shop-plans-on-exchange.aspx,https://nmhc.benefitalign.com/nmhc/Application/FFMInitialPayment,http://www.mynmhc.org/Member_Handbook.aspx,http://www.mynmhc.org/Formulary.aspx,93091NM0010008-03,Limited Cost Sharing Plan Variation,58.70%,0.586705803871155,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,"$1,640",$150,"$4,000",$0,$640,$80,7
2015,NV,11245,SERFF,1,2014-09-09 16:12:42,1,11245,NV,Individual,Yes,91-1857813,11245NV0010001,Smile for Kids EHB,11245NV001,,NVN001,NVS001,,Existing,PPO,Low,,Both,,,,See Schedule of Benefits for Limitations and Exclusions,,,,,Allows Child-Only,,,,$28.57,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.",Yes,https://www.premierlife.com/prospective-members/hbex/nevadahealthlink/,www.premierlife.com/payment,https://www.premierlife.com/prospective-members/hbex/nevadahealthlink/,,11245NV0010001-00,Standard Low Off Exchange Plan,71.57%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$200,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,11245,SERFF,1,2014-09-09 16:12:42,1,11245,NV,Individual,Yes,91-1857813,11245NV0010001,Smile for Kids EHB,11245NV001,,NVN001,NVS001,,Existing,PPO,Low,,Both,,,,See Schedule of Benefits for Limitations and Exclusions,,,,,Allows Child-Only,,,,$28.57,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.",Yes,https://www.premierlife.com/prospective-members/hbex/nevadahealthlink/,www.premierlife.com/payment,https://www.premierlife.com/prospective-members/hbex/nevadahealthlink/,,11245NV0010001-01,Standard Low On Exchange Plan,71.57%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$200,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,9,16698,NV,Individual,No,88-0293082,16698NV0450009,Prominence Health Plan Bronze 3 ChoicePlus,16698NV045,,NVN002,NVS001,NVF004,New,HMO,Bronze,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,3,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450009-01,Standard Bronze On Exchange Plan,60.60%,0.66942310333252,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$870,$0,$150,$0,"$1,670",$0,$80,5
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,9,16698,NV,Individual,No,88-0293082,16698NV0450009,Prominence Health Plan Bronze 3 ChoicePlus,16698NV045,,NVN002,NVS001,NVF004,New,HMO,Bronze,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,3,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450009-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,NV,11245,SERFF,1,2014-09-09 16:12:42,2,11245,NV,Individual,Yes,91-1857813,11245NV0010002,PPO Family Plan with EHB,11245NV001,,NVN001,NVS001,,Existing,PPO,Low,,Both,,,,See Schedule of Benefits for Limitations and Exclusions,,,,,Allows Adult and Child-Only,,,,$28.57,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.",Yes,www.premierlife.com/nvhealthlink,www.premierlife.com/payment,www.premierlife.com/nvhealthlink,,11245NV0010002-00,Standard Low Off Exchange Plan,71.57%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$200,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,12,16698,NV,Individual,No,88-0293082,16698NV0450012,Prominence Health Plan Silver 40 Premier,16698NV045,,NVN001,NVS001,NVF016,New,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,3,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450012-05,87% AV Level Silver Plan,86.20%,0.864165842533112,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$200,$300,$150,"$1,000",$180,$50,$80,9
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,12,16698,NV,Individual,No,88-0293082,16698NV0450012,Prominence Health Plan Silver 40 Premier,16698NV045,,NVN001,NVS001,NVF016,New,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,3,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450012-06,94% AV Level Silver Plan,94.40%,0.94056099653244,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$300,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$100,$100,$300,$150,$100,$130,$120,$80,10
2015,NV,11245,SERFF,1,2014-09-09 16:12:42,2,11245,NV,Individual,Yes,91-1857813,11245NV0010002,PPO Family Plan with EHB,11245NV001,,NVN001,NVS001,,Existing,PPO,Low,,Both,,,,See Schedule of Benefits for Limitations and Exclusions,,,,,Allows Adult and Child-Only,,,,$28.57,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.",Yes,www.premierlife.com/nvhealthlink,www.premierlife.com/payment,www.premierlife.com/nvhealthlink,,11245NV0010002-01,Standard Low On Exchange Plan,71.57%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$200,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,11245,SERFF,1,2014-09-09 16:12:42,2,11245,NV,Individual,Yes,91-1857813,11245NV0010003,PLUS Family Plan with EHB,11245NV001,,NVN001,NVS001,,Existing,PPO,Low,,Both,,,,See Schedule of Benefits for Limitations and Exclusions,,,,,Allows Adult and Child-Only,,,,$28.57,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.",Yes,https://www.premierlife.com/prospective-members/hbex/nevadahealthlink/,www.premierlife.com/payment,https://www.premierlife.com/prospective-members/hbex/nevadahealthlink/,,11245NV0010003-00,Standard Low Off Exchange Plan,71.57%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$200,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,10,16698,NV,Individual,No,88-0293082,16698NV0450010,Prominence Health Plan Silver 20 ChoicePlus,16698NV045,,NVN002,NVS001,NVF006,New,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450010-05,87% AV Level Silver Plan,86.20%,0.898050546646118,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$900,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$760,$0,$150,$0,"$1,180",$0,$80,9
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,10,16698,NV,Individual,No,88-0293082,16698NV0450010,Prominence Health Plan Silver 20 ChoicePlus,16698NV045,,NVN002,NVS001,NVF006,New,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450010-06,94% AV Level Silver Plan,93.20%,0.948262274265289,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$300,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$420,$0,$150,$0,$750,$0,$80,10
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,11,16698,NV,Individual,No,88-0293082,16698NV0450011,Prominence Health Plan Gold 1 ChoicePlus,16698NV045,,NVN002,NVS001,NVF008,New,HMO,Gold,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,2,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450011-00,Standard Gold Off Exchange Plan,80.90%,0.753549993038177,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$770,$0,$150,$0,"$1,320",$0,$80,4
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,11,16698,NV,Individual,No,88-0293082,16698NV0450011,Prominence Health Plan Gold 1 ChoicePlus,16698NV045,,NVN002,NVS001,NVF008,New,HMO,Gold,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,2,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450011-01,Standard Gold On Exchange Plan,80.90%,0.753549993038177,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$770,$0,$150,$0,"$1,320",$0,$80,5
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,11,16698,NV,Individual,No,88-0293082,16698NV0450011,Prominence Health Plan Gold 1 ChoicePlus,16698NV045,,NVN002,NVS001,NVF008,New,HMO,Gold,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,2,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450011-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,11,16698,NV,Individual,No,88-0293082,16698NV0450011,Prominence Health Plan Gold 1 ChoicePlus,16698NV045,,NVN002,NVS001,NVF008,New,HMO,Gold,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,2,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450011-03,Limited Cost Sharing Plan Variation,80.90%,0.753549993038177,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$770,$0,$150,$0,"$1,320",$0,$80,7
2015,NV,11245,SERFF,1,2014-09-09 16:12:42,2,11245,NV,Individual,Yes,91-1857813,11245NV0010003,PLUS Family Plan with EHB,11245NV001,,NVN001,NVS001,,Existing,PPO,Low,,Both,,,,See Schedule of Benefits for Limitations and Exclusions,,,,,Allows Adult and Child-Only,,,,$28.57,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.",Yes,https://www.premierlife.com/prospective-members/hbex/nevadahealthlink/,www.premierlife.com/payment,https://www.premierlife.com/prospective-members/hbex/nevadahealthlink/,,11245NV0010003-01,Standard Low On Exchange Plan,71.57%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$200,Not Applicable,,,,,$200,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NV,12553,SERFF,9,2014-11-04 20:29:03,1,12553,NV,Individual,Yes,94-2761537,12553NV0010002,Delta Dental PPO Pediatric Preferred Plan,12553NV001,,NVN001,NVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$26.78,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/12553nv0010002-15,,12553NV0010002-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,$70,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,12553,SERFF,9,2014-11-04 20:29:03,1,12553,NV,Individual,Yes,94-2761537,12553NV0010002,Delta Dental PPO Pediatric Preferred Plan,12553NV001,,NVN001,NVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$26.78,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/12553nv0010002-15,,12553NV0010002-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,$70,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,12553,SERFF,9,2014-11-04 20:29:03,1,12553,NV,Individual,Yes,94-2761537,12553NV0010001,Delta Dental PPO Pediatric Basic Plan,12553NV001,,NVN001,NVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$22.00,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/12553nv0010001-15,,12553NV0010001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NV,12553,SERFF,9,2014-11-04 20:29:03,1,12553,NV,Individual,Yes,94-2761537,12553NV0010001,Delta Dental PPO Pediatric Basic Plan,12553NV001,,NVN001,NVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$22.00,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/12553nv0010001-15,,12553NV0010001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NV,12553,SERFF,9,2014-11-04 20:29:03,2,12553,NV,SHOP (Small Group),Yes,94-2761537,12553NV0020004,Delta Dental PPO Preferred Plan for Families for Small Businesses,12553NV002,,NVN001,NVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.78,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/12553nv0020004-15,,12553NV0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,$70,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,12553,SERFF,9,2014-11-04 20:29:03,2,12553,NV,Individual,Yes,94-2761537,12553NV0010004,Delta Dental PPO Preferred Plan for Families,12553NV001,,NVN001,NVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.78,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/12553nv0010004-15,,12553NV0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,$70,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,12553,SERFF,9,2014-11-04 20:29:03,2,12553,NV,Individual,Yes,94-2761537,12553NV0010004,Delta Dental PPO Preferred Plan for Families,12553NV001,,NVN001,NVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.78,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/12553nv0010004-15,,12553NV0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,$70,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,12553,SERFF,9,2014-11-04 20:29:03,2,12553,NV,SHOP (Small Group),Yes,94-2761537,12553NV0020004,Delta Dental PPO Preferred Plan for Families for Small Businesses,12553NV002,,NVN001,NVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.78,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/12553nv0020004-15,,12553NV0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,$70,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,12553,SERFF,9,2014-11-04 20:29:03,3,12553,NV,SHOP (Small Group),Yes,94-2761537,12553NV0020006,Delta Dental PPO Basic Plan for Families for Small Businesses,12553NV002,,NVN001,NVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.00,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/12553nv0020006-15,,12553NV0020006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,12553,SERFF,9,2014-11-04 20:29:03,3,12553,NV,Individual,Yes,94-2761537,12553NV0010006,Delta Dental PPO Basic Plan for Families,12553NV001,,NVN001,NVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.00,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/12553nv0010006-15,,12553NV0010006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,12553,SERFF,9,2014-11-04 20:29:03,3,12553,NV,Individual,Yes,94-2761537,12553NV0010006,Delta Dental PPO Basic Plan for Families,12553NV001,,NVN001,NVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.00,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/12553nv0010006-15,,12553NV0010006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,12553,SERFF,9,2014-11-04 20:29:03,3,12553,NV,SHOP (Small Group),Yes,94-2761537,12553NV0020006,Delta Dental PPO Basic Plan for Families for Small Businesses,12553NV002,,NVN001,NVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.00,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/12553nv0020006-15,,12553NV0020006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,1,16698,NV,Individual,No,88-0293082,16698NV0450001,Prominence Health Plan Bronze 1 Premier,16698NV045,,NVN001,NVS001,NVF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,3,0,3,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450001-00,Standard Bronze Off Exchange Plan,61.40%,0.633227348327637,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$1,280",$0,$150,$0,"$1,870",$0,$80,4
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,1,16698,NV,Individual,No,88-0293082,16698NV0450001,Prominence Health Plan Bronze 1 Premier,16698NV045,,NVN001,NVS001,NVF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,3,0,3,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450001-01,Standard Bronze On Exchange Plan,61.40%,0.633227348327637,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$1,280",$0,$150,$0,"$1,870",$0,$80,5
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,1,16698,NV,Individual,No,88-0293082,16698NV0450001,Prominence Health Plan Bronze 1 Premier,16698NV045,,NVN001,NVS001,NVF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,3,0,3,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,1,16698,NV,Individual,No,88-0293082,16698NV0450001,Prominence Health Plan Bronze 1 Premier,16698NV045,,NVN001,NVS001,NVF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,3,0,3,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450001-03,Limited Cost Sharing Plan Variation,61.40%,0.633227348327637,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,"$1,280",$0,$150,$0,"$1,870",$0,$80,7
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,2,16698,NV,Individual,No,88-0293082,16698NV0450002,Prominence Health Plan Bronze 2 Premier,16698NV045,,NVN001,NVS001,NVF003,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,2,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450002-00,Standard Bronze Off Exchange Plan,60.50%,0.628260254859924,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$900,$0,$150,$0,"$1,970",$0,$80,4
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,2,16698,NV,Individual,No,88-0293082,16698NV0450002,Prominence Health Plan Bronze 2 Premier,16698NV045,,NVN001,NVS001,NVF003,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,2,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450002-01,Standard Bronze On Exchange Plan,60.50%,0.628260254859924,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$900,$0,$150,$0,"$1,970",$0,$80,5
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,2,16698,NV,Individual,No,88-0293082,16698NV0450002,Prominence Health Plan Bronze 2 Premier,16698NV045,,NVN001,NVS001,NVF003,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,2,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,2,16698,NV,Individual,No,88-0293082,16698NV0450002,Prominence Health Plan Bronze 2 Premier,16698NV045,,NVN001,NVS001,NVF003,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,2,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450002-03,Limited Cost Sharing Plan Variation,60.50%,0.628260254859924,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$900,$0,$150,$0,"$1,970",$0,$80,7
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,3,16698,NV,Individual,No,88-0293082,16698NV0450003,Prominence Health Plan Bronze 3 Premier,16698NV045,,NVN001,NVS001,NVF004,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,3,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450003-00,Standard Bronze Off Exchange Plan,60.60%,0.66942310333252,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$870,$0,$150,$0,"$1,670",$0,$80,4
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,3,16698,NV,Individual,No,88-0293082,16698NV0450003,Prominence Health Plan Bronze 3 Premier,16698NV045,,NVN001,NVS001,NVF004,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,3,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450003-01,Standard Bronze On Exchange Plan,60.60%,0.66942310333252,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$870,$0,$150,$0,"$1,670",$0,$80,5
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,3,16698,NV,Individual,No,88-0293082,16698NV0450003,Prominence Health Plan Bronze 3 Premier,16698NV045,,NVN001,NVS001,NVF004,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,3,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,3,16698,NV,Individual,No,88-0293082,16698NV0450003,Prominence Health Plan Bronze 3 Premier,16698NV045,,NVN001,NVS001,NVF004,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,3,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450003-03,Limited Cost Sharing Plan Variation,60.60%,0.66942310333252,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$870,$0,$150,$0,"$1,670",$0,$80,7
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,4,16698,NV,Individual,No,88-0293082,16698NV0450004,Prominence Health Plan Silver 10 Premier,16698NV045,,NVN001,NVS001,NVF007,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450004-00,Standard Silver Off Exchange Plan,68.70%,0.737481892108917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,200","$12,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$890,$0,$150,$0,"$1,720",$0,$80,4
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,4,16698,NV,Individual,No,88-0293082,16698NV0450004,Prominence Health Plan Silver 10 Premier,16698NV045,,NVN001,NVS001,NVF007,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450004-01,Standard Silver On Exchange Plan,68.70%,0.737481892108917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,200","$12,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$890,$0,$150,$0,"$1,720",$0,$80,5
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,4,16698,NV,Individual,No,88-0293082,16698NV0450004,Prominence Health Plan Silver 10 Premier,16698NV045,,NVN001,NVS001,NVF007,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450004-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,4,16698,NV,Individual,No,88-0293082,16698NV0450004,Prominence Health Plan Silver 10 Premier,16698NV045,,NVN001,NVS001,NVF007,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450004-03,Limited Cost Sharing Plan Variation,68.70%,0.737481892108917,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,200","$12,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$890,$0,$150,$0,"$1,720",$0,$80,7
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,4,16698,NV,Individual,No,88-0293082,16698NV0450004,Prominence Health Plan Silver 10 Premier,16698NV045,,NVN001,NVS001,NVF007,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450004-04,73% AV Level Silver Plan,72.70%,0.756268560886383,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$890,$0,$150,$0,"$1,570",$0,$80,8
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,4,16698,NV,Individual,No,88-0293082,16698NV0450004,Prominence Health Plan Silver 10 Premier,16698NV045,,NVN001,NVS001,NVF007,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450004-05,87% AV Level Silver Plan,86.20%,0.897504508495331,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$900,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$850,$0,$150,$0,"$1,180",$0,$80,9
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,4,16698,NV,Individual,No,88-0293082,16698NV0450004,Prominence Health Plan Silver 10 Premier,16698NV045,,NVN001,NVS001,NVF007,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450004-06,94% AV Level Silver Plan,93.10%,0.946947753429413,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$125,$375,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$480,$0,$150,$0,$750,$0,$80,10
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,5,16698,NV,Individual,No,88-0293082,16698NV0450005,Prominence Health Plan Silver 30 Premier,16698NV045,,NVN001,NVS001,NVF005,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,2,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450005-00,Standard Silver Off Exchange Plan,71.40%,0.772910296916962,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$800,$0,$150,$0,"$1,670",$0,$80,4
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,5,16698,NV,Individual,No,88-0293082,16698NV0450005,Prominence Health Plan Silver 30 Premier,16698NV045,,NVN001,NVS001,NVF005,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,2,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450005-01,Standard Silver On Exchange Plan,71.40%,0.772910296916962,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$800,$0,$150,$0,"$1,670",$0,$80,5
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,5,16698,NV,Individual,No,88-0293082,16698NV0450005,Prominence Health Plan Silver 30 Premier,16698NV045,,NVN001,NVS001,NVF005,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,2,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450005-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,5,16698,NV,Individual,No,88-0293082,16698NV0450005,Prominence Health Plan Silver 30 Premier,16698NV045,,NVN001,NVS001,NVF005,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,2,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450005-03,Limited Cost Sharing Plan Variation,71.40%,0.772910296916962,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$800,$0,$150,$0,"$1,670",$0,$80,7
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,5,16698,NV,Individual,No,88-0293082,16698NV0450005,Prominence Health Plan Silver 30 Premier,16698NV045,,NVN001,NVS001,NVF005,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,2,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450005-04,73% AV Level Silver Plan,73.90%,0.795626103878021,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$770,$0,$150,$0,"$1,670",$0,$80,8
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,5,16698,NV,Individual,No,88-0293082,16698NV0450005,Prominence Health Plan Silver 30 Premier,16698NV045,,NVN001,NVS001,NVF005,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,2,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450005-05,87% AV Level Silver Plan,86.30%,0.895004034042358,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$770,$0,$150,$0,"$1,230",$0,$80,9
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,5,16698,NV,Individual,No,88-0293082,16698NV0450005,Prominence Health Plan Silver 30 Premier,16698NV045,,NVN001,NVS001,NVF005,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,2,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450005-06,94% AV Level Silver Plan,93.40%,0.949199855327606,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$300,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$310,$0,$150,$0,$590,$0,$80,10
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,6,16698,NV,Individual,No,88-0293082,16698NV0450006,Prominence Health Plan Silver 20 Premier,16698NV045,,NVN001,NVS001,NVF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450006-00,Standard Silver Off Exchange Plan,71.20%,0.772495985031128,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$890,$0,$150,$0,"$1,720",$0,$80,4
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,6,16698,NV,Individual,No,88-0293082,16698NV0450006,Prominence Health Plan Silver 20 Premier,16698NV045,,NVN001,NVS001,NVF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450006-01,Standard Silver On Exchange Plan,71.20%,0.772495985031128,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$890,$0,$150,$0,"$1,720",$0,$80,5
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,6,16698,NV,Individual,No,88-0293082,16698NV0450006,Prominence Health Plan Silver 20 Premier,16698NV045,,NVN001,NVS001,NVF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450006-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,6,16698,NV,Individual,No,88-0293082,16698NV0450006,Prominence Health Plan Silver 20 Premier,16698NV045,,NVN001,NVS001,NVF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450006-03,Limited Cost Sharing Plan Variation,71.20%,0.772495985031128,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$890,$0,$150,$0,"$1,720",$0,$80,7
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,6,16698,NV,Individual,No,88-0293082,16698NV0450006,Prominence Health Plan Silver 20 Premier,16698NV045,,NVN001,NVS001,NVF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450006-04,73% AV Level Silver Plan,73.40%,0.787050187587738,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$890,$0,$150,$0,"$1,670",$0,$80,8
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,6,16698,NV,Individual,No,88-0293082,16698NV0450006,Prominence Health Plan Silver 20 Premier,16698NV045,,NVN001,NVS001,NVF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450006-05,87% AV Level Silver Plan,86.20%,0.898050546646118,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$900,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$760,$0,$150,$0,"$1,180",$0,$80,9
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,6,16698,NV,Individual,No,88-0293082,16698NV0450006,Prominence Health Plan Silver 20 Premier,16698NV045,,NVN001,NVS001,NVF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,5,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450006-06,94% AV Level Silver Plan,93.20%,0.948262274265289,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$300,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$420,$0,$150,$0,$750,$0,$80,10
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,7,16698,NV,Individual,No,88-0293082,16698NV0450007,Prominence Health Plan Gold 1 Premier,16698NV045,,NVN001,NVS001,NVF008,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,2,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450007-00,Standard Gold Off Exchange Plan,80.90%,0.753549993038177,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$770,$0,$150,$0,"$1,320",$0,$80,4
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,7,16698,NV,Individual,No,88-0293082,16698NV0450007,Prominence Health Plan Gold 1 Premier,16698NV045,,NVN001,NVS001,NVF008,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,2,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450007-01,Standard Gold On Exchange Plan,80.90%,0.753549993038177,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$770,$0,$150,$0,"$1,320",$0,$80,5
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,7,16698,NV,Individual,No,88-0293082,16698NV0450007,Prominence Health Plan Gold 1 Premier,16698NV045,,NVN001,NVS001,NVF008,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,2,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450007-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,7,16698,NV,Individual,No,88-0293082,16698NV0450007,Prominence Health Plan Gold 1 Premier,16698NV045,,NVN001,NVS001,NVF008,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,2,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450007-03,Limited Cost Sharing Plan Variation,80.90%,0.753549993038177,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$770,$0,$150,$0,"$1,320",$0,$80,7
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,8,16698,NV,Individual,No,88-0293082,16698NV0450008,Prominence Health Plan HSA 1 Premier,16698NV045,,NVN001,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450008-00,Standard Bronze Off Exchange Plan,59.70%,0.598030984401703,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$10,$0,$150,"$5,000",$20,$0,$80,4
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,8,16698,NV,Individual,No,88-0293082,16698NV0450008,Prominence Health Plan HSA 1 Premier,16698NV045,,NVN001,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450008-01,Standard Bronze On Exchange Plan,59.70%,0.598030984401703,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$10,$0,$150,"$5,000",$20,$0,$80,5
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,8,16698,NV,Individual,No,88-0293082,16698NV0450008,Prominence Health Plan HSA 1 Premier,16698NV045,,NVN001,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450008-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,8,16698,NV,Individual,No,88-0293082,16698NV0450008,Prominence Health Plan HSA 1 Premier,16698NV045,,NVN001,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450008-03,Limited Cost Sharing Plan Variation,59.70%,0.598030984401703,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$10,$0,$150,"$5,000",$20,$0,$80,7
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,9,16698,NV,Individual,No,88-0293082,16698NV0450009,Prominence Health Plan Bronze 3 ChoicePlus,16698NV045,,NVN002,NVS001,NVF004,New,HMO,Bronze,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,3,0,0,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450009-00,Standard Bronze Off Exchange Plan,60.60%,0.66942310333252,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$870,$0,$150,$0,"$1,670",$0,$80,4
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,12,16698,NV,Individual,No,88-0293082,16698NV0450012,Prominence Health Plan Silver 40 Premier,16698NV045,,NVN001,NVS001,NVF016,New,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,3,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450012-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,12,16698,NV,Individual,No,88-0293082,16698NV0450012,Prominence Health Plan Silver 40 Premier,16698NV045,,NVN001,NVS001,NVF016,New,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,3,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450012-03,Limited Cost Sharing Plan Variation,68.00%,0.684939324855804,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,275","$12,550",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$9,000",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$200,$410,$150,"$1,270",$230,$0,$80,7
2015,NV,16698,SERFF,4,2014-10-06 10:59:03,12,16698,NV,Individual,No,88-0293082,16698NV0450012,Prominence Health Plan Silver 40 Premier,16698NV045,,NVN001,NVS001,NVF016,New,HMO,Silver,Yes,Both,No,Yes,All specialists,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,3,2015-01-01,,Yes,Emergency only,Yes,Emergency only,Yes,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://prominencehealthplan.com/nevada-health-link-individual-and-family-plans/,http://prominencehealthplan.com/members/products-and-services/pharmacy-services/,16698NV0450012-04,73% AV Level Silver Plan,73.80%,0.735096871852875,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$7,500",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$200,$540,$150,"$1,270",$230,$0,$80,8
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,1,29211,NV,Individual,No,39-0658730,29211NV0320001,Assurant Health Bronze Plan 001,29211NV032,,NVN001,NVS001,NVF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320001-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$0,"$5,400",$0,$0,$0,9
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320008,Assurant Health Silver Plan 002,29211NV032,,NVN001,NVS002,NVF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320008-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320008,Assurant Health Silver Plan 002,29211NV032,,NVN001,NVS002,NVF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320008-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000",$30,"$2,700",$0,"$1,800",$700,$0,$0,19
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0070002,Southern Star/Estrella Gold,34996NV007,,NVN004,NVS001,NVF007,Existing,POS,Gold,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Star-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Star-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0070002-01,Standard Gold On Exchange Plan,82.00%,0.77831494808197,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$3500,$7000,$3500,$7000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,$500,$1000,20%,$6350,$12700,$6350,$12700,$500,$25,$860,$0,$500,$592,$29,$0,13
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0010002,Southern Simple/F?cil Silver,34996NV001,,NVN001,NVS001,NVF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9981,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0010002-05,87% AV Level Silver Plan,87.70%,0.861581802368164,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$2100,$4200,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$300,$600,15%,,,,$6500,$13000,$6500,$13000,$300,$12,$675,$0,$300,$359,$22,$0,13
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0010002,Southern Simple/F?cil Silver,34996NV001,,NVN001,NVS001,NVF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9981,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0010002-06,94% AV Level Silver Plan,94.30%,0.934890806674957,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$850,$1700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$0,$0,5%,,,,$6500,$13000,$0,$0,$0,$12,$240,$0,$0,$442,$7,$0,14
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0070003,Southern Star/Estrella Silver,34996NV007,,NVN004,NVS001,NVF008,Existing,POS,Silver,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9977,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Star-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Star-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0070003-00,Standard Silver Off Exchange Plan,69.89%,0.587183773517609,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$6350,$12700,$6350,$12700,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$4250,$8500,30%,$4250,$8500,30%,$6350,$12700,$6350,$12700,"$4,250",$25,$165,$0,"$1,306",$0,$0,$0,14
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0070003,Southern Star/Estrella Silver,34996NV007,,NVN004,NVS001,NVF008,Existing,POS,Silver,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9977,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Star-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Star-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0070003-01,Standard Silver On Exchange Plan,69.89%,0.587183773517609,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$6350,$12700,$6350,$12700,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$4250,$8500,30%,$4250,$8500,30%,$6350,$12700,$6350,$12700,"$4,250",$25,$165,$0,"$1,306",$0,$0,$0,15
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0010005,Southern Simple/F?cil Platinum,34996NV001,,NVN001,NVS001,NVF012,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9984,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0010005-00,Standard Platinum Off Exchange Plan,88.05%,0.894542396068573,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$2500,$5000,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,$6500,$13000,$0,$0,$0,$25,$480,$0,$0,$918,$29,$0,15
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0010005,Southern Simple/F?cil Platinum,34996NV001,,NVN001,NVS001,NVF012,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9984,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0010005-01,Standard Platinum On Exchange Plan,88.05%,0.894542396068573,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$2500,$5000,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,$6500,$13000,$0,$0,$0,$25,$480,$0,$0,$918,$29,$0,16
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0070004,Union Star/Estrella Platinum,34996NV007,,NVN004,NVS001,NVF015,Existing,POS,Platinum,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9981,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Union-Star-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Union-Star-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union,34996NV0070004-00,Standard Platinum Off Exchange Plan,89.00%,0.863221406936646,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$2000,$4000,$2000,$4000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$400,$800,10%,$400,$800,10%,$6350,$12700,$6350,$12700,$400,$0,$440,$0,$377,$0,$0,$0,16
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320009,Assurant Health Gold Plan 002,29211NV032,,NVN001,NVS001,NVF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320009-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$30,"$1,800",$0,$0,$700,$500,$0,36
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320010,Assurant Health Gold Plan 002,29211NV032,,NVN001,NVS002,NVF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320010-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$30,"$1,800",$0,$0,$700,$500,$0,37
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320008,Assurant Health Silver Plan 002,29211NV032,,NVN001,NVS002,NVF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320008-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$470,$30,$0,$0,$0,$500,$0,$0,22
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030003,Southern Star/Estrella Silver,34996NV003,,NVN004,NVS001,NVF008,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Star-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Star-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0030003-00,Standard Silver Off Exchange Plan,69.80%,0.584126114845276,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$6350,$12700,$6350,$12700,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$4250,$8500,30%,$4250,$8500,30%,$6350,$12700,$6350,$12700,"$4,250",$25,$165,$0,"$1,297",$0,$0,$0,27
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030003,Southern Star/Estrella Silver,34996NV003,,NVN004,NVS001,NVF008,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Star-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Star-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0030003-01,Standard Silver On Exchange Plan,69.80%,0.584126114845276,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$6350,$12700,$6350,$12700,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$4250,$8500,30%,$4250,$8500,30%,$6350,$12700,$6350,$12700,"$4,250",$25,$165,$0,"$1,297",$0,$0,$0,28
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320009,Assurant Health Gold Plan 002,29211NV032,,NVN001,NVS001,NVF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320009-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$30,"$1,800",$0,$0,$700,$500,$0,33
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0070005,Union Star/Estrella Gold,34996NV007,,NVN004,NVS001,NVF016,Existing,POS,Gold,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Union-Star-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Union-Star-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union,34996NV0070005-01,Standard Gold On Exchange Plan,82.00%,0.77831494808197,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$3500,$7000,$3500,$7000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,$500,$1000,20%,$6350,$12700,$6350,$12700,$500,$25,$860,$0,$500,$592,$29,$0,19
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030001,Southern Star/Estrella Platinum,34996NV003,,NVN004,NVS001,NVF006,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9983,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Star-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Star-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0030001-00,Standard Platinum Off Exchange Plan,88.20%,0.84987884759903,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$2000,$4000,$2000,$4000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$400,$800,10%,$400,$800,10%,$6350,$12700,$6350,$12700,$400,$0,$440,$0,$0,$90,$29,$0,19
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030001,Southern Star/Estrella Platinum,34996NV003,,NVN004,NVS001,NVF006,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9983,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Star-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Star-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0030001-01,Standard Platinum On Exchange Plan,88.20%,0.84987884759903,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$2000,$4000,$2000,$4000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$400,$800,10%,$400,$800,10%,$6350,$12700,$6350,$12700,$400,$0,$440,$0,$0,$90,$29,$0,20
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0070006,Union Star/Estrella Silver,34996NV007,,NVN004,NVS001,NVF017,Existing,POS,Silver,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9977,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Union-Star-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Union-Star-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union,34996NV0070006-00,Standard Silver Off Exchange Plan,72.00%,0.587183773517609,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$6350,$12700,$6350,$12700,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$4250,$8500,30%,$4250,$8500,30%,$6350,$12700,$6350,$12700,"$4,250",$25,$165,$0,"$1,306",$0,$0,$0,20
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0070006,Union Star/Estrella Silver,34996NV007,,NVN004,NVS001,NVF017,Existing,POS,Silver,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9977,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Union-Star-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Union-Star-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union,34996NV0070006-01,Standard Silver On Exchange Plan,72.00%,0.587183773517609,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$6350,$12700,$6350,$12700,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$4250,$8500,30%,$4250,$8500,30%,$6350,$12700,$6350,$12700,"$4,250",$25,$165,$0,"$1,306",$0,$0,$0,21
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030001,Southern Star/Estrella Platinum,34996NV003,,NVN004,NVS001,NVF006,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9983,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Star-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Star-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0030001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,21
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,1,29211,NV,Individual,No,39-0658730,29211NV0320001,Assurant Health Bronze Plan 001,29211NV032,,NVN001,NVS001,NVF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320001-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$0,"$5,400",$0,$0,$0,10
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,1,29211,NV,Individual,No,39-0658730,29211NV0320001,Assurant Health Bronze Plan 001,29211NV032,,NVN001,NVS001,NVF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,11
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,1,29211,NV,Individual,No,39-0658730,29211NV0320001,Assurant Health Bronze Plan 001,29211NV032,,NVN001,NVS001,NVF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320001-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$0,"$5,400",$0,$0,$0,12
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,1,29211,NV,Individual,No,39-0658730,29211NV0320002,Assurant Health Bronze Plan 001,29211NV032,,NVN001,NVS002,NVF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320002-00,Standard Bronze Off Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$0,"$5,400",$0,$0,$0,13
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,1,29211,NV,Individual,No,39-0658730,29211NV0320002,Assurant Health Bronze Plan 001,29211NV032,,NVN001,NVS002,NVF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320002-01,Standard Bronze On Exchange Plan,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$0,"$5,400",$0,$0,$0,14
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,1,29211,NV,Individual,No,39-0658730,29211NV0320002,Assurant Health Bronze Plan 001,29211NV032,,NVN001,NVS002,NVF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,15
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,1,29211,NV,Individual,No,39-0658730,29211NV0320002,Assurant Health Bronze Plan 001,29211NV032,,NVN001,NVS002,NVF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320002-03,Limited Cost Sharing Plan Variation,,0.591769576072693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,"$6,000",$0,$0,$0,"$5,400",$0,$0,$0,16
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,1,29211,NV,Individual,No,39-0658730,29211NV0320003,Assurant Health Silver Plan 001,29211NV032,,NVN001,NVS001,NVF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320003-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,$0,$0,"$3,500",$0,$0,$0,27
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,1,29211,NV,Individual,No,39-0658730,29211NV0320003,Assurant Health Silver Plan 001,29211NV032,,NVN001,NVS001,NVF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320003-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,$0,$0,"$3,500",$0,$0,$0,28
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,1,29211,NV,Individual,No,39-0658730,29211NV0320003,Assurant Health Silver Plan 001,29211NV032,,NVN001,NVS001,NVF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,29
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,1,29211,NV,Individual,No,39-0658730,29211NV0320003,Assurant Health Silver Plan 001,29211NV032,,NVN001,NVS001,NVF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320003-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,$0,$0,"$3,500",$0,$0,$0,30
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,1,29211,NV,Individual,No,39-0658730,29211NV0320003,Assurant Health Silver Plan 001,29211NV032,,NVN001,NVS001,NVF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320003-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$2,750",$0,$0,$0,"$2,750",$0,$0,$0,31
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,1,29211,NV,Individual,No,39-0658730,29211NV0320003,Assurant Health Silver Plan 001,29211NV032,,NVN001,NVS001,NVF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320003-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$1,000",$0,$0,$0,"$1,000",$0,$0,$0,32
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,1,29211,NV,Individual,No,39-0658730,29211NV0320003,Assurant Health Silver Plan 001,29211NV032,,NVN001,NVS001,NVF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320003-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,$500,$0,$0,$0,$500,$0,$0,$0,33
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,1,29211,NV,Individual,No,39-0658730,29211NV0320004,Assurant Health Silver Plan 001,29211NV032,,NVN001,NVS002,NVF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320004-00,Standard Silver Off Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,$0,$0,"$3,500",$0,$0,$0,34
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,1,29211,NV,Individual,No,39-0658730,29211NV0320004,Assurant Health Silver Plan 001,29211NV032,,NVN001,NVS002,NVF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320004-01,Standard Silver On Exchange Plan,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,$0,$0,"$3,500",$0,$0,$0,35
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,1,29211,NV,Individual,No,39-0658730,29211NV0320004,Assurant Health Silver Plan 001,29211NV032,,NVN001,NVS002,NVF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,36
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,1,29211,NV,Individual,No,39-0658730,29211NV0320004,Assurant Health Silver Plan 001,29211NV032,,NVN001,NVS002,NVF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320004-03,Limited Cost Sharing Plan Variation,,0.688028395175934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,$0,$0,"$3,500",$0,$0,$0,37
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,1,29211,NV,Individual,No,39-0658730,29211NV0320004,Assurant Health Silver Plan 001,29211NV032,,NVN001,NVS002,NVF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320004-04,73% AV Level Silver Plan,,0.732050776481628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$2,750",$0,$0,$0,"$2,750",$0,$0,$0,38
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,1,29211,NV,Individual,No,39-0658730,29211NV0320004,Assurant Health Silver Plan 001,29211NV032,,NVN001,NVS002,NVF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320004-05,87% AV Level Silver Plan,,0.876233458518982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$1,000",$0,$0,$0,"$1,000",$0,$0,$0,39
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,1,29211,NV,Individual,No,39-0658730,29211NV0320004,Assurant Health Silver Plan 001,29211NV032,,NVN001,NVS002,NVF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320004-06,94% AV Level Silver Plan,,0.932602822780609,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,$500,$0,$0,$0,$500,$0,$0,$0,40
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,3,29211,NV,Individual,No,39-0658730,29211NV0320005,Assurant Health Bronze Plan 002,29211NV032,,NVN001,NVS001,NVF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320005-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000",$0,$600,$0,"$4,700",$100,$0,$0,9
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,3,29211,NV,Individual,No,39-0658730,29211NV0320005,Assurant Health Bronze Plan 002,29211NV032,,NVN001,NVS001,NVF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320005-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000",$0,$600,$0,"$4,700",$100,$0,$0,10
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,3,29211,NV,Individual,No,39-0658730,29211NV0320005,Assurant Health Bronze Plan 002,29211NV032,,NVN001,NVS001,NVF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,11
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,3,29211,NV,Individual,No,39-0658730,29211NV0320005,Assurant Health Bronze Plan 002,29211NV032,,NVN001,NVS001,NVF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320005-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000",$0,$600,$0,"$4,700",$100,$0,$0,12
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,3,29211,NV,Individual,No,39-0658730,29211NV0320006,Assurant Health Bronze Plan 002,29211NV032,,NVN001,NVS002,NVF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320006-00,Standard Bronze Off Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000",$0,$600,$0,"$4,700",$100,$0,$0,13
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,3,29211,NV,Individual,No,39-0658730,29211NV0320006,Assurant Health Bronze Plan 002,29211NV032,,NVN001,NVS002,NVF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320006-01,Standard Bronze On Exchange Plan,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000",$0,$600,$0,"$4,700",$100,$0,$0,14
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,3,29211,NV,Individual,No,39-0658730,29211NV0320006,Assurant Health Bronze Plan 002,29211NV032,,NVN001,NVS002,NVF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,15
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,3,29211,NV,Individual,No,39-0658730,29211NV0320006,Assurant Health Bronze Plan 002,29211NV032,,NVN001,NVS002,NVF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,29211NV0320006-03,Limited Cost Sharing Plan Variation,61.30%,0.627641201019287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000",$0,$600,$0,"$4,700",$100,$0,$0,16
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320007,Assurant Health Silver Plan 002,29211NV032,,NVN001,NVS001,NVF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320007-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000",$30,"$2,700",$0,"$1,800",$700,$0,$0,9
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320007,Assurant Health Silver Plan 002,29211NV032,,NVN001,NVS001,NVF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320007-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000",$30,"$2,700",$0,"$1,800",$700,$0,$0,10
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320007,Assurant Health Silver Plan 002,29211NV032,,NVN001,NVS001,NVF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,11
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320007,Assurant Health Silver Plan 002,29211NV032,,NVN001,NVS001,NVF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320007-03,Limited Cost Sharing Plan Variation,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000",$30,"$2,700",$0,"$1,800",$700,$0,$0,12
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320007,Assurant Health Silver Plan 002,29211NV032,,NVN001,NVS001,NVF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320007-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000",$30,"$2,700",$0,"$1,800",$700,$0,$0,13
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320007,Assurant Health Silver Plan 002,29211NV032,,NVN001,NVS001,NVF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320007-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,470",$30,$0,$0,$800,$700,$0,$0,14
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320007,Assurant Health Silver Plan 002,29211NV032,,NVN001,NVS001,NVF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320007-06,94% AV Level Silver Plan,94.28%,0.942808270454407,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$470,$30,$0,$0,$0,$500,$0,$0,15
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320008,Assurant Health Silver Plan 002,29211NV032,,NVN001,NVS002,NVF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320008-00,Standard Silver Off Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000",$30,"$2,700",$0,"$1,800",$700,$0,$0,16
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320008,Assurant Health Silver Plan 002,29211NV032,,NVN001,NVS002,NVF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320008-01,Standard Silver On Exchange Plan,70.06%,0.701056003570557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000",$30,"$2,700",$0,"$1,800",$700,$0,$0,17
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320008,Assurant Health Silver Plan 002,29211NV032,,NVN001,NVS002,NVF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320008-04,73% AV Level Silver Plan,72.75%,0.727466285228729,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000",$30,"$2,700",$0,"$1,800",$700,$0,$0,20
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320008,Assurant Health Silver Plan 002,29211NV032,,NVN001,NVS002,NVF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320008-05,87% AV Level Silver Plan,86.29%,0.862907648086548,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,470",$30,$0,$0,$800,$700,$0,$0,21
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320009,Assurant Health Gold Plan 002,29211NV032,,NVN001,NVS001,NVF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320009-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$30,"$1,800",$0,$0,$700,$500,$0,34
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320009,Assurant Health Gold Plan 002,29211NV032,,NVN001,NVS001,NVF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,35
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320010,Assurant Health Gold Plan 002,29211NV032,,NVN001,NVS002,NVF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320010-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$30,"$1,800",$0,$0,$700,$500,$0,38
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320010,Assurant Health Gold Plan 002,29211NV032,,NVN001,NVS002,NVF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,39
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0080003,VIP Platinum,34996NV008,,NVN003,NVS001,NVF013,New,POS,Platinum,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9981,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-VIP-Plan-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-VIP-Plan-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0080003-01,Standard Platinum On Exchange Plan,89.00%,0.871102929115295,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$2500,$5000,$2500,$5000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,$200,$400,10%,$6350,$12700,$6350,$12700,$200,$15,$460,$0,$200,$438,$15,$0,23
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030002,Southern Star/Estrella Gold,34996NV003,,NVN004,NVS001,NVF007,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9982,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Star-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Star-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0030002-00,Standard Gold Off Exchange Plan,80.20%,0.763286232948303,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$3500,$7000,$3500,$7000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,$500,$1000,20%,$6350,$12700,$6350,$12700,$500,$25,$860,$0,$500,$582,$29,$0,23
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030002,Southern Star/Estrella Gold,34996NV003,,NVN004,NVS001,NVF007,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9982,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Star-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Star-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0030002-01,Standard Gold On Exchange Plan,80.20%,0.763286232948303,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$3500,$7000,$3500,$7000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,$500,$1000,20%,$6350,$12700,$6350,$12700,$500,$25,$860,$0,$500,$582,$29,$0,24
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0080001,VIP Gold,34996NV008,,NVN003,NVS001,NVF009,Existing,POS,Gold,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-VIP-Plan-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-VIP-Plan-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0080001-00,Standard Gold Off Exchange Plan,82.00%,0.775455832481384,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$4500,$9000,$4500,$9000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,$500,$1000,20%,$6350,$12700,$6350,$12700,$500,$15,$860,$0,$500,$211,$28,$0,24
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0080001,VIP Gold,34996NV008,,NVN003,NVS001,NVF009,Existing,POS,Gold,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-VIP-Plan-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-VIP-Plan-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0080001-01,Standard Gold On Exchange Plan,82.00%,0.775455832481384,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$4500,$9000,$4500,$9000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,$500,$1000,20%,$6350,$12700,$6350,$12700,$500,$15,$860,$0,$500,$211,$28,$0,25
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030002,Southern Star/Estrella Gold,34996NV003,,NVN004,NVS001,NVF007,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9982,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Star-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Star-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0030002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,25
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320010,Assurant Health Gold Plan 002,29211NV032,,NVN001,NVS002,NVF008,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320010-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$30,"$1,800",$0,$0,$700,$500,$0,40
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320011,Assurant Health Platinum Plan 002,29211NV032,,NVN001,NVS001,NVF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320011-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$20,"$1,800",$0,$0,$500,$500,$0,46
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320011,Assurant Health Platinum Plan 002,29211NV032,,NVN001,NVS001,NVF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320011-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$20,"$1,800",$0,$0,$500,$500,$0,47
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320011,Assurant Health Platinum Plan 002,29211NV032,,NVN001,NVS001,NVF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,48
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320011,Assurant Health Platinum Plan 002,29211NV032,,NVN001,NVS001,NVF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320011-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$20,"$1,800",$0,$0,$500,$500,$0,49
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320012,Assurant Health Platinum Plan 002,29211NV032,,NVN001,NVS002,NVF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320012-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$20,"$1,800",$0,$0,$500,$500,$0,50
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320012,Assurant Health Platinum Plan 002,29211NV032,,NVN001,NVS002,NVF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320012-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$20,"$1,800",$0,$0,$500,$500,$0,51
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320012,Assurant Health Platinum Plan 002,29211NV032,,NVN001,NVS002,NVF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$0,$0,$0,52
2015,NV,29211,SERFF,9,2014-11-15 10:06:04,5,29211,NV,Individual,No,39-0658730,29211NV0320012,Assurant Health Platinum Plan 002,29211NV032,,NVN001,NVS002,NVF009,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_NV_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-NV.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,29211NV0320012-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$20,"$1,800",$0,$0,$500,$500,$0,53
2015,NV,33670,SERFF,3,2014-09-09 16:12:42,1,33670,NV,Individual,Yes,84-0747736,33670NV0960003,Anthem Dental Pediatric,33670NV096,,NVN001,NVS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$26.27,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214672.pdf,,http://www.anthem.com/agent/nv/f0/s0/t0/pw_e215624.pdf,,33670NV0960003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,33670,SERFF,3,2014-09-09 16:12:42,1,33670,NV,Individual,Yes,84-0747736,33670NV0960003,Anthem Dental Pediatric,33670NV096,,NVN001,NVS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$26.27,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214672.pdf,,http://www.anthem.com/agent/nv/f0/s0/t0/pw_e215624.pdf,,33670NV0960003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,33670,SERFF,3,2014-09-09 16:12:42,2,33670,NV,Individual,Yes,84-0747736,33670NV0980003,Anthem Dental Family,33670NV098,,NVN001,NVS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.73,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214670.pdf,,http://www.anthem.com/agent/nv/f0/s0/t0/pw_e215622.pdf,,33670NV0980003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,33670,SERFF,3,2014-09-09 16:12:42,2,33670,NV,Individual,Yes,84-0747736,33670NV0980003,Anthem Dental Family,33670NV098,,NVN001,NVS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.73,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214670.pdf,,http://www.anthem.com/agent/nv/f0/s0/t0/pw_e215622.pdf,,33670NV0980003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,33670,SERFF,3,2014-09-09 16:12:42,2,33670,NV,Individual,Yes,84-0747736,33670NV0980004,Anthem Dental Family Enhanced,33670NV098,,NVN001,NVS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.73,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214671.pdf,,http://www.anthem.com/agent/nv/f0/s0/t0/pw_e215623.pdf,,33670NV0980004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NV,33670,SERFF,3,2014-09-09 16:12:42,2,33670,NV,Individual,Yes,84-0747736,33670NV0980004,Anthem Dental Family Enhanced,33670NV098,,NVN001,NVS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.73,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214671.pdf,,http://www.anthem.com/agent/nv/f0/s0/t0/pw_e215623.pdf,,33670NV0980004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NV,34962,SERFF,8,2014-11-04 20:29:03,1,34962,NV,Individual,Yes,88-0244893,34962NV0010002,DeltaCare USA Pediatric Preferred Plan,34962NV001,,NVN001,NVS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Child-Only,,,,$22.99,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/34962nv0010002-15,,34962NV0010002-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,34962,SERFF,8,2014-11-04 20:29:03,1,34962,NV,Individual,Yes,88-0244893,34962NV0010002,DeltaCare USA Pediatric Preferred Plan,34962NV001,,NVN001,NVS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Child-Only,,,,$22.99,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/34962nv0010002-15,,34962NV0010002-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,34962,SERFF,8,2014-11-04 20:29:03,1,34962,NV,Individual,Yes,88-0244893,34962NV0010001,DeltaCare USA Pediatric Basic Plan,34962NV001,,NVN001,NVS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$18.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/34962nv0010001-15,,34962NV0010001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NV,34962,SERFF,8,2014-11-04 20:29:03,1,34962,NV,Individual,Yes,88-0244893,34962NV0010001,DeltaCare USA Pediatric Basic Plan,34962NV001,,NVN001,NVS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$18.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/34962nv0010001-15,,34962NV0010001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NV,34962,SERFF,8,2014-11-04 20:29:03,2,34962,NV,Individual,Yes,88-0244893,34962NV0010004,DeltaCare USA Preferred Plan for Families,34962NV001,,NVN001,NVS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.99,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/34962nv0010004-15,,34962NV0010004-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,34962,SERFF,8,2014-11-04 20:29:03,2,34962,NV,SHOP (Small Group),Yes,88-0244893,34962NV0020004,DeltaCare USA Preferred Plan for Families for Small Businesses,34962NV002,,NVN001,NVS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.99,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/34962nv0020004-15,,34962NV0020004-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,34962,SERFF,8,2014-11-04 20:29:03,2,34962,NV,SHOP (Small Group),Yes,88-0244893,34962NV0020004,DeltaCare USA Preferred Plan for Families for Small Businesses,34962NV002,,NVN001,NVS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.99,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/34962nv0020004-15,,34962NV0020004-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,34962,SERFF,8,2014-11-04 20:29:03,2,34962,NV,Individual,Yes,88-0244893,34962NV0010004,DeltaCare USA Preferred Plan for Families,34962NV001,,NVN001,NVS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.99,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/34962nv0010004-15,,34962NV0010004-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,34962,SERFF,8,2014-11-04 20:29:03,3,34962,NV,Individual,Yes,88-0244893,34962NV0010006,DeltaCare USA Basic Plan for Families,34962NV001,,NVN001,NVS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/34962nv0010006-15,,34962NV0010006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,34962,SERFF,8,2014-11-04 20:29:03,3,34962,NV,SHOP (Small Group),Yes,88-0244893,34962NV0020006,DeltaCare USA Basic Plan for Families for Small Businesses,34962NV002,,NVN001,NVS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/34962nv0020006-15,,34962NV0020006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,34962,SERFF,8,2014-11-04 20:29:03,3,34962,NV,SHOP (Small Group),Yes,88-0244893,34962NV0020006,DeltaCare USA Basic Plan for Families for Small Businesses,34962NV002,,NVN001,NVS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.49,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/34962nv0020006-15,,34962NV0020006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,34962,SERFF,8,2014-11-04 20:29:03,3,34962,NV,Individual,Yes,88-0244893,34962NV0010006,DeltaCare USA Basic Plan for Families,34962NV001,,NVN001,NVS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/nv/34962nv0010006-15,,34962NV0010006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0010001,Southern Simple/F?cil Gold,34996NV001,,NVN001,NVS001,NVF001,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9983,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/members/benefits-glance/,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/plans/choose-plan/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0010001-00,Standard Gold Off Exchange Plan,79.50%,0.769230544567108,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,,,,$6500,$13000,$6500,$13000,$500,$25,$860,$0,$500,$622,$29,$0,4
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0050004,Southern Simple/F?cil Platinum,34996NV005,,NVN001,NVS001,NVF012,New,POS,Platinum,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9981,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Simple-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Simple-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0050004-00,Standard Platinum Off Exchange Plan,90.00%,0.894542396068573,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$2500,$5000,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,$6500,$13000,$0,$0,$0,$25,$480,$0,$0,$918,$29,$0,4
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0050004,Southern Simple/F?cil Platinum,34996NV005,,NVN001,NVS001,NVF012,New,POS,Platinum,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9981,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Simple-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Simple-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0050004-01,Standard Platinum On Exchange Plan,90.00%,0.894542396068573,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$2500,$5000,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,$6500,$13000,$0,$0,$0,$25,$480,$0,$0,$918,$29,$0,5
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0010001,Southern Simple/F?cil Gold,34996NV001,,NVN001,NVS001,NVF001,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9983,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/members/benefits-glance/,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/plans/choose-plan/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0010001-01,Standard Gold On Exchange Plan,79.50%,0.769230544567108,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,,,,$6500,$13000,$6500,$13000,$500,$25,$860,$0,$500,$622,$29,$0,5
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0010001,Southern Simple/F?cil Gold,34996NV001,,NVN001,NVS001,NVF001,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9983,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/members/benefits-glance/,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/plans/choose-plan/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0010001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0050001,Southern Simple/F?cil Gold,34996NV005,,NVN001,NVS001,NVF001,Existing,POS,Gold,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Simple-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Simple-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0050001-00,Standard Gold Off Exchange Plan,78.00%,0.769230544567108,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,,,,$6500,$13000,$6500,$13000,$500,$25,$860,$0,$500,$622,$29,$0,6
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0050001,Southern Simple/F?cil Gold,34996NV005,,NVN001,NVS001,NVF001,Existing,POS,Gold,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Simple-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Simple-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0050001-01,Standard Gold On Exchange Plan,78.00%,0.769230544567108,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,,,,$6500,$13000,$6500,$13000,$500,$25,$860,$0,$500,$622,$29,$0,7
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0010001,Southern Simple/F?cil Gold,34996NV001,,NVN001,NVS001,NVF001,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9983,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/members/benefits-glance/,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/plans/choose-plan/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0010001-03,Limited Cost Sharing Plan Variation,79.50%,0.769230544567108,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,,,,$6500,$13000,$6500,$13000,$500,$25,$860,$0,$500,$622,$29,$0,7
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0010002,Southern Simple/F?cil Silver,34996NV001,,NVN001,NVS001,NVF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9981,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0010002-00,Standard Silver Off Exchange Plan,68.30%,0.603161036968231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$3000,$6000,30%,,,,$6500,$13000,$6500,$13000,"$3,000",$25,$540,$0,"$1,446",$0,$0,$0,8
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0050002,Southern Simple/F?cil Silver,34996NV005,,NVN001,NVS001,NVF002,Existing,POS,Silver,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9979,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0050002-00,Standard Silver Off Exchange Plan,69.89%,0.603161036968231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$3000,$6000,30%,,,,$6500,$13000,$6500,$13000,"$3,000",$25,$540,$0,"$1,446",$0,$0,$0,8
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0050002,Southern Simple/F?cil Silver,34996NV005,,NVN001,NVS001,NVF002,Existing,POS,Silver,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9979,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0050002-01,Standard Silver On Exchange Plan,69.89%,0.603161036968231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$3000,$6000,30%,,,,$6500,$13000,$6500,$13000,"$3,000",$25,$540,$0,"$1,446",$0,$0,$0,9
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0010002,Southern Simple/F?cil Silver,34996NV001,,NVN001,NVS001,NVF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9981,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0010002-01,Standard Silver On Exchange Plan,68.30%,0.603161036968231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$3000,$6000,30%,,,,$6500,$13000,$6500,$13000,"$3,000",$25,$540,$0,"$1,446",$0,$0,$0,9
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0010002,Southern Simple/F?cil Silver,34996NV001,,NVN001,NVS001,NVF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9981,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0010002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0070001,Southern Star/Estrella Platinum,34996NV007,,NVN004,NVS001,NVF006,Existing,POS,Platinum,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9981,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Star-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Star-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0070001-00,Standard Platinum Off Exchange Plan,89.00%,0.863221406936646,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$2000,$4000,$2000,$4000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$400,$800,10%,$400,$800,10%,$6350,$12700,$6350,$12700,$400,$0,$440,$0,$377,$0,$0,$0,10
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0070001,Southern Star/Estrella Platinum,34996NV007,,NVN004,NVS001,NVF006,Existing,POS,Platinum,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9981,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Star-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Star-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0070001-01,Standard Platinum On Exchange Plan,89.00%,0.863221406936646,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$2000,$4000,$2000,$4000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$400,$800,10%,$400,$800,10%,$6350,$12700,$6350,$12700,$400,$0,$440,$0,$377,$0,$0,$0,11
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0010002,Southern Simple/F?cil Silver,34996NV001,,NVN001,NVS001,NVF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9981,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0010002-03,Limited Cost Sharing Plan Variation,68.30%,0.603161036968231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$3000,$6000,30%,,,,$6500,$13000,$6500,$13000,"$3,000",$25,$540,$0,"$1,446",$0,$0,$0,11
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0010002,Southern Simple/F?cil Silver,34996NV001,,NVN001,NVS001,NVF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9981,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0010002-04,73% AV Level Silver Plan,72.60%,0.689823687076569,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$5200,$10400,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$1000,$2000,30%,,,,$6500,$13000,$6500,$13000,"$1,000",$25,"$1,140",$0,"$1,000",$415,$9,$0,12
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0070002,Southern Star/Estrella Gold,34996NV007,,NVN004,NVS001,NVF007,Existing,POS,Gold,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Star-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Star-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0070002-00,Standard Gold Off Exchange Plan,82.00%,0.77831494808197,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$3500,$7000,$3500,$7000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,$500,$1000,20%,$6350,$12700,$6350,$12700,$500,$25,$860,$0,$500,$592,$29,$0,12
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0070004,Union Star/Estrella Platinum,34996NV007,,NVN004,NVS001,NVF015,Existing,POS,Platinum,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9981,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Union-Star-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Union-Star-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union,34996NV0070004-01,Standard Platinum On Exchange Plan,89.00%,0.863221406936646,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$2000,$4000,$2000,$4000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$400,$800,10%,$400,$800,10%,$6350,$12700,$6350,$12700,$400,$0,$440,$0,$377,$0,$0,$0,17
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0010005,Southern Simple/F?cil Platinum,34996NV001,,NVN001,NVS001,NVF012,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9984,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0010005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,17
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0010005,Southern Simple/F?cil Platinum,34996NV001,,NVN001,NVS001,NVF012,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9984,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0010005-03,Limited Cost Sharing Plan Variation,88.05%,0.894542396068573,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$2500,$5000,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,$6500,$13000,$0,$0,$0,$25,$480,$0,$0,$918,$29,$0,18
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0070005,Union Star/Estrella Gold,34996NV007,,NVN004,NVS001,NVF016,Existing,POS,Gold,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Union-Star-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Union-Star-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union,34996NV0070005-00,Standard Gold Off Exchange Plan,82.00%,0.77831494808197,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$3500,$7000,$3500,$7000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,$500,$1000,20%,$6350,$12700,$6350,$12700,$500,$25,$860,$0,$500,$592,$29,$0,18
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030001,Southern Star/Estrella Platinum,34996NV003,,NVN004,NVS001,NVF006,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9983,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Star-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Star-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0030001-03,Limited Cost Sharing Plan Variation,88.20%,0.84987884759903,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$2000,$4000,$2000,$4000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$400,$800,10%,$400,$800,10%,$6350,$12700,$6350,$12700,$400,$0,$440,$0,$0,$90,$29,$0,22
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0080003,VIP Platinum,34996NV008,,NVN003,NVS001,NVF013,New,POS,Platinum,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9981,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-VIP-Plan-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-VIP-Plan-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0080003-00,Standard Platinum Off Exchange Plan,89.00%,0.871102929115295,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$2500,$5000,$2500,$5000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,$200,$400,10%,$6350,$12700,$6350,$12700,$200,$15,$460,$0,$200,$438,$15,$0,22
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030002,Southern Star/Estrella Gold,34996NV003,,NVN004,NVS001,NVF007,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9982,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Star-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Star-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0030002-03,Limited Cost Sharing Plan Variation,80.20%,0.763286232948303,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$3500,$7000,$3500,$7000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,$500,$1000,20%,$6350,$12700,$6350,$12700,$500,$25,$860,$0,$500,$582,$29,$0,26
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0080002,VIP Silver,34996NV008,,NVN003,NVS001,NVF008,Existing,POS,Silver,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9978,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-VIP-Plan-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-VIP-Plan-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0080002-00,Standard Silver Off Exchange Plan,72.00%,0.575998663902283,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$6350,$12700,$6350,$12700,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$5500,$11000,30%,$5500,$11000,30%,$6350,$12700,$6350,$12700,"$4,799",$25,$0,$0,"$1,246",$0,$0,$0,26
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0080002,VIP Silver,34996NV008,,NVN003,NVS001,NVF008,Existing,POS,Silver,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9978,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-VIP-Plan-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-VIP-Plan-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0080002-01,Standard Silver On Exchange Plan,72.00%,0.575998663902283,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$6350,$12700,$6350,$12700,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$5500,$11000,30%,$5500,$11000,30%,$6350,$12700,$6350,$12700,"$4,799",$25,$0,$0,"$1,246",$0,$0,$0,27
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0260001,Connected/Conectado Platinum,34996NV026,,NVN006,NVS001,NVF010,New,POS,Platinum,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Connected-Conectado-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Connected-Conectado-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0260001-00,Standard Platinum Off Exchange Plan,89.00%,0.871444523334503,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$2000,$4000,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,$6350,$12700,$6350,$12700,$250,$25,$455,$0,$250,$759,$15,$0,28
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0260001,Connected/Conectado Platinum,34996NV026,,NVN006,NVS001,NVF010,New,POS,Platinum,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Connected-Conectado-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Connected-Conectado-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0260001-01,Standard Platinum On Exchange Plan,89.00%,0.871444523334503,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$2000,$4000,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,$6350,$12700,$6350,$12700,$250,$25,$455,$0,$250,$759,$15,$0,29
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030003,Southern Star/Estrella Silver,34996NV003,,NVN004,NVS001,NVF008,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Star-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Star-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0030003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,29
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030003,Southern Star/Estrella Silver,34996NV003,,NVN004,NVS001,NVF008,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Star-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Star-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0030003-03,Limited Cost Sharing Plan Variation,69.80%,0.584126114845276,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$6350,$12700,$6350,$12700,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$4250,$8500,30%,$4250,$8500,30%,$6350,$12700,$6350,$12700,"$4,250",$25,$165,$0,"$1,297",$0,$0,$0,30
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0260002,Connected/Conectado Gold,34996NV026,,NVN006,NVS001,NVF007,New,POS,Gold,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9979,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Connected-Conectado-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Connected-Conectado-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0260002-00,Standard Gold Off Exchange Plan,82.00%,0.764979541301727,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6000,$12000,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,,,,$6350,$12700,$6350,$12700,$500,$25,$860,$0,$500,$592,$29,$0,30
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0260002,Connected/Conectado Gold,34996NV026,,NVN006,NVS001,NVF007,New,POS,Gold,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9979,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Connected-Conectado-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Connected-Conectado-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0260002-01,Standard Gold On Exchange Plan,82.00%,0.764979541301727,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6000,$12000,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,,,,$6350,$12700,$6350,$12700,$500,$25,$860,$0,$500,$592,$29,$0,31
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030003,Southern Star/Estrella Silver,34996NV003,,NVN004,NVS001,NVF008,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Star-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Star-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0030003-04,73% AV Level Silver Plan,73.70%,0.629627823829651,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$5200,$10400,$5200,$10400,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$3000,$6000,15%,$3000,$6000,15%,$6350,$12700,$6350,$12700,"$3,000",$25,$270,$0,"$1,236",$0,$0,$0,31
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030003,Southern Star/Estrella Silver,34996NV003,,NVN004,NVS001,NVF008,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Star-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Star-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0030003-05,87% AV Level Silver Plan,87.40%,0.838537812232971,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$1500,$3000,$1500,$3000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$750,$1500,15%,$750,$1500,15%,$6350,$12700,$6350,$12700,$750,$15,$607,$0,$750,$51,$0,$0,32
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0260003,Connected/Conectado Silver,34996NV026,,NVN006,NVS001,NVF008,New,POS,Silver,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9977,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Connected-Conectado-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Connected-Conectado-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0260003-00,Standard Silver Off Exchange Plan,72.00%,0.577916741371155,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6450,$12900,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$5000,$10000,30%,,,,$6350,$12700,$6350,$12700,"$4,799",$25,$0,$0,"$1,306",$0,$0,$0,32
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0260003,Connected/Conectado Silver,34996NV026,,NVN006,NVS001,NVF008,New,POS,Silver,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9977,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Connected-Conectado-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Connected-Conectado-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0260003-01,Standard Silver On Exchange Plan,72.00%,0.577916741371155,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6450,$12900,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$5000,$10000,30%,,,,$6350,$12700,$6350,$12700,"$4,799",$25,$0,$0,"$1,306",$0,$0,$0,33
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030003,Southern Star/Estrella Silver,34996NV003,,NVN004,NVS001,NVF008,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Star-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Star-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0030003-06,94% AV Level Silver Plan,94.10%,0.921307742595673,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$500,$1000,$500,$1000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,$100,$200,5%,$6350,$12700,$6350,$12700,$100,$0,$235,$0,$100,$25,$10,$0,33
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030004,Union Star/Estrella Platinum,34996NV003,,NVN004,NVS001,NVF015,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9983,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Union-Star-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Union-Star-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union,34996NV0030004-00,Standard Platinum Off Exchange Plan,88.20%,0.84987884759903,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$2000,$4000,$2000,$4000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$400,$800,10%,$400,$800,10%,$6350,$12700,$6350,$12700,$400,$0,$440,$0,$0,$90,$29,$0,34
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030004,Union Star/Estrella Platinum,34996NV003,,NVN004,NVS001,NVF015,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9983,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Union-Star-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Union-Star-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union,34996NV0030004-01,Standard Platinum On Exchange Plan,88.20%,0.84987884759903,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$2000,$4000,$2000,$4000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$400,$800,10%,$400,$800,10%,$6350,$12700,$6350,$12700,$400,$0,$440,$0,$0,$90,$29,$0,35
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030004,Union Star/Estrella Platinum,34996NV003,,NVN004,NVS001,NVF015,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9983,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Union-Star-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Union-Star-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union,34996NV0030004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,36
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030004,Union Star/Estrella Platinum,34996NV003,,NVN004,NVS001,NVF015,Existing,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9983,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Union-Star-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Union-Star-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union,34996NV0030004-03,Limited Cost Sharing Plan Variation,88.20%,0.84987884759903,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$2000,$4000,$2000,$4000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$400,$800,10%,$400,$800,10%,$6350,$12700,$6350,$12700,$400,$0,$440,$0,$0,$90,$29,$0,37
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030005,Union Star/Estrella Gold,34996NV003,,NVN004,NVS001,NVF016,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9982,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Union-Star-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Union-Star-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union,34996NV0030005-00,Standard Gold Off Exchange Plan,80.20%,0.763286232948303,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$3500,$7000,$3500,$7000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,$500,$1000,20%,$6350,$12700,$6350,$12700,$500,$25,$860,$0,$500,$582,$29,$0,38
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030005,Union Star/Estrella Gold,34996NV003,,NVN004,NVS001,NVF016,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9982,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Union-Star-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Union-Star-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union,34996NV0030005-01,Standard Gold On Exchange Plan,80.20%,0.763286232948303,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$3500,$7000,$3500,$7000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,$500,$1000,20%,$6350,$12700,$6350,$12700,$500,$25,$860,$0,$500,$582,$29,$0,39
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030005,Union Star/Estrella Gold,34996NV003,,NVN004,NVS001,NVF016,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9982,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Union-Star-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Union-Star-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union,34996NV0030005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,40
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030005,Union Star/Estrella Gold,34996NV003,,NVN004,NVS001,NVF016,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9982,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Union-Star-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Union-Star-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union,34996NV0030005-03,Limited Cost Sharing Plan Variation,80.20%,0.763286232948303,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$3500,$7000,$3500,$7000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,$500,$1000,20%,$6350,$12700,$6350,$12700,$500,$25,$860,$0,$500,$582,$29,$0,41
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030006,Union Star/Estrella Silver,34996NV003,,NVN004,NVS001,NVF017,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Union-Star-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Union-Star-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union,34996NV0030006-00,Standard Silver Off Exchange Plan,69.80%,0.584126114845276,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$6350,$12700,$6350,$12700,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$4250,$8500,30%,$4250,$8500,30%,$6350,$12700,$6350,$12700,"$4,250",$25,$165,$0,"$1,291",$0,$0,$0,42
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030006,Union Star/Estrella Silver,34996NV003,,NVN004,NVS001,NVF017,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Union-Star-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Union-Star-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union,34996NV0030006-01,Standard Silver On Exchange Plan,69.80%,0.584126114845276,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$6350,$12700,$6350,$12700,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$4250,$8500,30%,$4250,$8500,30%,$6350,$12700,$6350,$12700,"$4,250",$25,$165,$0,"$1,291",$0,$0,$0,43
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030006,Union Star/Estrella Silver,34996NV003,,NVN004,NVS001,NVF017,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Union-Star-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Union-Star-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union,34996NV0030006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,44
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030006,Union Star/Estrella Silver,34996NV003,,NVN004,NVS001,NVF017,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Union-Star-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Union-Star-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union,34996NV0030006-03,Limited Cost Sharing Plan Variation,69.80%,0.584126114845276,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$6350,$12700,$6350,$12700,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$4250,$8500,30%,$4250,$8500,30%,$6350,$12700,$6350,$12700,"$4,250",$25,$165,$0,"$1,291",$0,$0,$0,45
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030006,Union Star/Estrella Silver,34996NV003,,NVN004,NVS001,NVF017,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Union-Star-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Union-Star-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union,34996NV0030006-04,73% AV Level Silver Plan,73.70%,0.629627823829651,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$5200,$10400,$5200,$10400,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$3000,$6000,15%,$3000,$6000,15%,$6350,$12700,$6350,$12700,"$3,000",$25,$270,$0,"$1,236",$0,$0,$0,46
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030006,Union Star/Estrella Silver,34996NV003,,NVN004,NVS001,NVF017,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Union-Star-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Union-Star-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union,34996NV0030006-05,87% AV Level Silver Plan,87.40%,0.838537812232971,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$1500,$3000,$1500,$3000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$750,$1500,15%,$750,$1500,15%,$6350,$12700,$6350,$12700,$750,$15,$607,$0,$950,$51,$0,$0,47
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0030006,Union Star/Estrella Silver,34996NV003,,NVN004,NVS001,NVF017,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Union-Star-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Union-Star-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union,34996NV0030006-06,94% AV Level Silver Plan,94.10%,0.921307742595673,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$500,$1000,$500,$1000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,$100,$200,5%,$6350,$12700,$6350,$12700,$100,$0,$235,$0,$100,$28,$7,$0,48
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0040003,VIP Platinum,34996NV004,,NVN003,NVS001,NVF013,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9983,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-VIP-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-VIP-Plan-formally-known-as-Neighborhood-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0040003-00,Standard Platinum Off Exchange Plan,88.50%,0.851284384727478,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$2500,$5000,$2500,$5000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,$200,$400,10%,$6350,$12700,$6350,$12700,$300,$15,$460,$0,$200,$435,$15,$0,49
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0040003,VIP Platinum,34996NV004,,NVN003,NVS001,NVF013,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9983,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-VIP-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-VIP-Plan-formally-known-as-Neighborhood-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0040003-01,Standard Platinum On Exchange Plan,88.50%,0.851284384727478,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$2500,$5000,$2500,$5000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,$200,$400,10%,$6350,$12700,$6350,$12700,$300,$15,$460,$0,$200,$435,$15,$0,50
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0040003,VIP Platinum,34996NV004,,NVN003,NVS001,NVF013,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9983,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-VIP-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-VIP-Plan-formally-known-as-Neighborhood-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0040003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,51
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0040003,VIP Platinum,34996NV004,,NVN003,NVS001,NVF013,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9983,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-VIP-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-VIP-Plan-formally-known-as-Neighborhood-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0040003-03,Limited Cost Sharing Plan Variation,88.50%,0.851284384727478,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$2500,$5000,$2500,$5000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,$200,$400,10%,$6350,$12700,$6350,$12700,$300,$15,$460,$0,$200,$435,$15,$0,52
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0040001,VIP Gold,34996NV004,,NVN003,NVS001,NVF009,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9982,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-VIP-Plan-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-VIP-Plan-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0040001-00,Standard Gold Off Exchange Plan,80.10%,0.756619095802307,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$4500,$9000,$4500,$9000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,$500,$1000,20%,$6350,$12700,$6350,$12700,$500,$15,$860,$0,$500,$211,$28,$0,53
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0040001,VIP Gold,34996NV004,,NVN003,NVS001,NVF009,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9982,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-VIP-Plan-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-VIP-Plan-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0040001-01,Standard Gold On Exchange Plan,80.10%,0.756619095802307,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$4500,$9000,$4500,$9000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,$500,$1000,20%,$6350,$12700,$6350,$12700,$500,$15,$860,$0,$500,$211,$28,$0,54
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0040001,VIP Gold,34996NV004,,NVN003,NVS001,NVF009,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9982,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-VIP-Plan-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-VIP-Plan-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0040001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,55
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0040001,VIP Gold,34996NV004,,NVN003,NVS001,NVF009,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9982,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-VIP-Plan-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-VIP-Plan-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0040001-03,Limited Cost Sharing Plan Variation,80.10%,0.756619095802307,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$4500,$9000,$4500,$9000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,$500,$1000,20%,$6350,$12700,$6350,$12700,$500,$15,$860,$0,$500,$211,$28,$0,56
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0040002,VIP Silver,34996NV004,,NVN003,NVS001,NVF008,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-VIP-Plan-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-VIP-Plan-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0040002-00,Standard Silver Off Exchange Plan,69.30%,0.572999119758606,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$6350,$12700,$6350,$12700,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$5500,$11000,30%,$5500,$11000,30%,$6350,$12700,$6350,$12700,"$4,799",$25,$0,$0,"$1,246",$0,$0,$0,57
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0040002,VIP Silver,34996NV004,,NVN003,NVS001,NVF008,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-VIP-Plan-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-VIP-Plan-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0040002-01,Standard Silver On Exchange Plan,69.30%,0.572999119758606,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$6350,$12700,$6350,$12700,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$5500,$11000,30%,$5500,$11000,30%,$6350,$12700,$6350,$12700,"$4,799",$25,$0,$0,"$1,246",$0,$0,$0,58
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0040002,VIP Silver,34996NV004,,NVN003,NVS001,NVF008,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-VIP-Plan-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-VIP-Plan-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0040002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,59
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0040002,VIP Silver,34996NV004,,NVN003,NVS001,NVF008,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-VIP-Plan-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-VIP-Plan-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0040002-03,Limited Cost Sharing Plan Variation,69.30%,0.572999119758606,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$6350,$12700,$6350,$12700,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$5500,$11000,30%,$5500,$11000,30%,$6350,$12700,$6350,$12700,"$4,799",$25,$0,$0,"$1,246",$0,$0,$0,60
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0040002,VIP Silver,34996NV004,,NVN003,NVS001,NVF008,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-VIP-Plan-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-VIP-Plan-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0040002-04,73% AV Level Silver Plan,73.80%,0.627585351467133,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$5200,$10400,$5200,$10400,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$3000,$6000,15%,$3000,$6000,15%,$6350,$12700,$6350,$12700,"$3,000",$25,$270,$0,"$1,216",$0,$0,$0,61
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0040002,VIP Silver,34996NV004,,NVN003,NVS001,NVF008,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-VIP-Plan-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-VIP-Plan-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0040002-05,87% AV Level Silver Plan,87.80%,0.836833894252777,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$1500,$3000,$1500,$3000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$750,$1500,10%,$750,$1500,10%,$6350,$12700,$6350,$12700,$750,$0,$405,$0,$347,$0,$0,$0,62
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0040002,VIP Silver,34996NV004,,NVN003,NVS001,NVF008,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-VIP-Plan-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-VIP-Plan-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0040002-06,94% AV Level Silver Plan,94.30%,0.9283567070961,Yes,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$500,$1000,$500,$1000,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,$200,$400,10%,$6350,$12700,$6350,$12700,$200,$0,$460,$0,$200,$0,$13,$0,63
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0230001,Connected/Conectado Platinum,34996NV023,,NVN006,NVS001,NVF010,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9982,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Connected-Conectado-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Connected-Conectado-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0230001-00,Standard Platinum Off Exchange Plan,88.40%,0.871444523334503,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$2000,$4000,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,$6350,$12700,$6350,$12700,$250,$25,$455,$0,$250,$773,$0,$0,64
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0230001,Connected/Conectado Platinum,34996NV023,,NVN006,NVS001,NVF010,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9982,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Connected-Conectado-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Connected-Conectado-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0230001-01,Standard Platinum On Exchange Plan,88.40%,0.871444523334503,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$2000,$4000,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,$6350,$12700,$6350,$12700,$250,$25,$455,$0,$250,$773,$0,$0,65
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0230001,Connected/Conectado Platinum,34996NV023,,NVN006,NVS001,NVF010,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9982,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Connected-Conectado-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Connected-Conectado-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0230001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,66
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0230001,Connected/Conectado Platinum,34996NV023,,NVN006,NVS001,NVF010,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9982,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Connected-Conectado-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Connected-Conectado-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0230001-03,Limited Cost Sharing Plan Variation,88.40%,0.871444523334503,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$2000,$4000,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,$6350,$12700,$6350,$12700,$250,$25,$455,$0,$250,$773,$0,$0,67
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0230002,Connected/Conectado Gold,34996NV023,,NVN006,NVS001,NVF007,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9981,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Connected-Conectado-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Connected-Conectado-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0230002-00,Standard Gold Off Exchange Plan,79.00%,0.764979541301727,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6000,$12000,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,,,,$6350,$12700,$6350,$12700,$500,$25,$860,$0,$500,$621,$0,$0,68
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0230002,Connected/Conectado Gold,34996NV023,,NVN006,NVS001,NVF007,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9981,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Connected-Conectado-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Connected-Conectado-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0230002-01,Standard Gold On Exchange Plan,79.00%,0.764979541301727,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6000,$12000,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,,,,$6350,$12700,$6350,$12700,$500,$25,$860,$0,$500,$621,$0,$0,69
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0230002,Connected/Conectado Gold,34996NV023,,NVN006,NVS001,NVF007,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9981,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Connected-Conectado-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Connected-Conectado-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0230002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,70
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0230002,Connected/Conectado Gold,34996NV023,,NVN006,NVS001,NVF007,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9981,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Connected-Conectado-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Connected-Conectado-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0230002-03,Limited Cost Sharing Plan Variation,79.00%,0.764979541301727,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6000,$12000,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$500,$1000,20%,,,,$6350,$12700,$6350,$12700,$500,$25,$860,$0,$500,$621,$0,$0,71
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0230003,Connected/Conectado Silver,34996NV023,,NVN006,NVS001,NVF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Connected-Conectado-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Connected-Conectado-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0230003-00,Standard Silver Off Exchange Plan,70.00%,0.578111886978149,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6450,$12900,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$5000,$10000,30%,,,,$6350,$12700,$6350,$12700,"$4,259",$25,$0,$0,"$1,306",$0,$0,$0,72
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0230003,Connected/Conectado Silver,34996NV023,,NVN006,NVS001,NVF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Connected-Conectado-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Connected-Conectado-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0230003-01,Standard Silver On Exchange Plan,70.00%,0.578111886978149,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6450,$12900,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$5000,$10000,30%,,,,$6350,$12700,$6350,$12700,"$4,259",$25,$0,$0,"$1,306",$0,$0,$0,73
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0230003,Connected/Conectado Silver,34996NV023,,NVN006,NVS001,NVF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Connected-Conectado-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Connected-Conectado-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0230003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,74
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0230003,Connected/Conectado Silver,34996NV023,,NVN006,NVS001,NVF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Connected-Conectado-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Connected-Conectado-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0230003-03,Limited Cost Sharing Plan Variation,70.00%,0.578111886978149,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6450,$12900,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$5000,$10000,30%,,,,$6350,$12700,$6350,$12700,"$4,259",$25,$0,$0,"$1,306",$0,$0,$0,75
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0230003,Connected/Conectado Silver,34996NV023,,NVN006,NVS001,NVF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Connected-Conectado-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Connected-Conectado-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0230003-04,73% AV Level Silver Plan,74.00%,0.623575031757355,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$5200,$10400,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$4000,$8000,20%,,,,$6350,$12700,$6350,$12700,"$4,000",$25,$160,$0,"$1,236",$0,$0,$0,76
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0230003,Connected/Conectado Silver,34996NV023,,NVN006,NVS001,NVF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Connected-Conectado-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Connected-Conectado-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0230003-05,87% AV Level Silver Plan,88.00%,0.847471654415131,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$1500,$3000,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$800,$1600,15%,,,,$6350,$12700,$6350,$12700,$800,$15,$600,$0,$800,$3,$0,$0,77
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,1,34996,NV,Individual,No,90-0917673,34996NV0230003,Connected/Conectado Silver,34996NV023,,NVN006,NVS001,NVF008,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Connected-Conectado-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Connected-Conectado-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0230003-06,94% AV Level Silver Plan,94.70%,0.939710140228271,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,$1000,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$150,$300,5%,,,,$6350,$12700,$6350,$12700,$150,$0,$232,$0,$150,$25,$8,$0,78
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0010003,Southern Simple/F?cil Bronze,34996NV001,,NVN001,NVS001,NVF003,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9978,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Bronze.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-bronze.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0010003-00,Standard Bronze Off Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6250,$12500,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$6250,$12500,50%,,,,$10000,$20000,$10000,$20000,"$4,311",$0,$0,$0,"$5,349",$0,$0,$0,4
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0050003,Southern Simple/F?cil Bronze,34996NV005,,NVN001,NVS001,NVF003,Existing,POS,Bronze,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9974,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Simple-Bronze.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Simple-Bronze.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0050003-00,Standard Bronze Off Exchange Plan,62.00%,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6250,$12500,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$6250,$12500,50%,,,,$10000,$20000,$10000,$20000,"$5,851",$0,$0,$0,"$5,349",$0,$0,$0,4
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0050003,Southern Simple/F?cil Bronze,34996NV005,,NVN001,NVS001,NVF003,Existing,POS,Bronze,Yes,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9974,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Simple-Bronze.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Simple-Bronze.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0050003-01,Standard Bronze On Exchange Plan,62.00%,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6250,$12500,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$6250,$12500,50%,,,,$10000,$20000,$10000,$20000,"$5,851",$0,$0,$0,"$5,349",$0,$0,$0,5
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0010003,Southern Simple/F?cil Bronze,34996NV001,,NVN001,NVS001,NVF003,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9978,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Bronze.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-bronze.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0010003-01,Standard Bronze On Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6250,$12500,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$6250,$12500,50%,,,,$10000,$20000,$10000,$20000,"$4,311",$0,$0,$0,"$5,349",$0,$0,$0,5
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0010003,Southern Simple/F?cil Bronze,34996NV001,,NVN001,NVS001,NVF003,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9978,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Bronze.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-bronze.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0010003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0060004,Northern Simple/F?cil Platinum,34996NV006,,NVN002,NVS002,NVF011,New,POS,Platinum,No,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9988,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Northern-Simple-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Northern-Simple-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0060004-00,Standard Platinum Off Exchange Plan,,0.882221937179565,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,$6500,$13000,$6500,$13000,$250,$5,$455,$0,$250,$510,$760,$0,6
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0060004,Northern Simple/F?cil Platinum,34996NV006,,NVN002,NVS002,NVF011,New,POS,Platinum,No,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9988,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Northern-Simple-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Northern-Simple-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0060004-01,Standard Platinum On Exchange Plan,,0.882221937179565,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,$6500,$13000,$6500,$13000,$250,$5,$455,$0,$250,$510,$760,$0,7
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0010003,Southern Simple/F?cil Bronze,34996NV001,,NVN001,NVS001,NVF003,Existing,POS,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9978,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Bronze.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-bronze.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0010003-03,Limited Cost Sharing Plan Variation,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6250,$12500,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$6250,$12500,50%,,,,$10000,$20000,$10000,$20000,"$4,311",$0,$0,$0,"$5,349",$0,$0,$0,7
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0060001,Northern Simple/F?cil Gold,34996NV006,,NVN002,NVS002,NVF004,Existing,POS,Gold,No,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9987,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Northern-Simple-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Northern-Simple-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0060001-00,Standard Gold Off Exchange Plan,,0.780786752700806,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$650,$1300,20%,,,,$6500,$13000,$6500,$13000,$650,$11,$830,$0,$650,$945,"$1,595",$0,8
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0010004,Southern Simple/F?cil Catastrophic,34996NV001,,NVN001,NVS001,NVF003,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9961,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Catastrophic.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-Catastrophic.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0010004-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6600,$13200,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$6600,$13200,50%,,,,$10000,$20000,$10000,$20000,"$4,851",$0,$0,$0,"$5,060",$0,$0,$0,8
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0010004,Southern Simple/F?cil Catastrophic,34996NV001,,NVN001,NVS001,NVF003,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9961,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Catastrophic.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-Catastrophic.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0010004-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6600,$13200,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$6600,$13200,50%,,,,$10000,$20000,$10000,$20000,"$4,851",$0,$0,$0,"$5,060",$0,$0,$0,9
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0060001,Northern Simple/F?cil Gold,34996NV006,,NVN002,NVS002,NVF004,Existing,POS,Gold,No,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9987,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Northern-Simple-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Northern-Simple-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0060001-01,Standard Gold On Exchange Plan,,0.780786752700806,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$650,$1300,20%,,,,$6500,$13000,$6500,$13000,$650,$11,$830,$0,$650,$945,"$1,595",$0,9
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0060002,Northern Simple/F?cil Silver,34996NV006,,NVN002,NVS002,NVF005,Existing,POS,Silver,No,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9986,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Northern-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Northern-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0060002-00,Standard Silver Off Exchange Plan,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$1500,$3000,30%,,,,$6500,$13000,$6500,$13000,"$1,500",$16,$990,$0,"$1,500",$0,"$1,155",$0,10
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020010,Northern Simple/F?cil Platinum,34996NV002,,NVN002,NVS002,NVF011,New,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.999,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Northern-Simple-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Northern-Simple-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020010-00,Standard Platinum Off Exchange Plan,,0.882221937179565,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,$6500,$13000,$6500,$13000,$250,$5,$455,$0,$250,$0,$510,$0,10
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020010,Northern Simple/F?cil Platinum,34996NV002,,NVN002,NVS002,NVF011,New,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.999,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Northern-Simple-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Northern-Simple-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020010-01,Standard Platinum On Exchange Plan,,0.882221937179565,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,$6500,$13000,$6500,$13000,$250,$5,$455,$0,$250,$0,$510,$0,11
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0060002,Northern Simple/F?cil Silver,34996NV006,,NVN002,NVS002,NVF005,Existing,POS,Silver,No,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9986,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Northern-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Northern-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0060002-01,Standard Silver On Exchange Plan,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$1500,$3000,30%,,,,$6500,$13000,$6500,$13000,"$1,500",$16,$990,$0,"$1,500",$0,"$1,155",$0,11
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020010,Northern Simple/F?cil Platinum,34996NV002,,NVN002,NVS002,NVF011,New,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.999,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Northern-Simple-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Northern-Simple-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,12
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0060003,Northern Simple/F?cil Bronze HSA,34996NV006,,NVN002,NVS002,NVF003,Existing,POS,Bronze,No,Both,No,No,,Refer to benefit plan documents for details,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9985,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Northern-Simple-Bronze-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Northern-Simple-Bronze-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0060003-00,Standard Bronze Off Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6250,$12500,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$6250,$12500,50%,,,,$10000,$20000,$10000,$20000,"$8,387",$0,$0,$0,"$5,350",$0,$0,$0,12
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0060003,Northern Simple/F?cil Bronze HSA,34996NV006,,NVN002,NVS002,NVF003,Existing,POS,Bronze,No,Both,No,No,,Refer to benefit plan documents for details,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9985,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Northern-Simple-Bronze-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Northern-Simple-Bronze-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0060003-01,Standard Bronze On Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6250,$12500,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$6250,$12500,50%,,,,$10000,$20000,$10000,$20000,"$8,387",$0,$0,$0,"$5,350",$0,$0,$0,13
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020010,Northern Simple/F?cil Platinum,34996NV002,,NVN002,NVS002,NVF011,New,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.999,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Northern-Simple-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Northern-Simple-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020010-03,Limited Cost Sharing Plan Variation,,0.882221937179565,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,$6500,$13000,$6500,$13000,$250,$5,$455,$0,$250,$0,$510,$0,13
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0060008,Frontier Simple/F?cil Platinum,34996NV006,,NVN005,NVS003,NVF011,New,POS,Platinum,No,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9988,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0060008-00,Standard Platinum Off Exchange Plan,,0.882221937179565,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,$6500,$13000,$6500,$13000,$250,$5,$455,$0,$250,$0,$510,$0,14
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020001,Northern Simple/F?cil Gold,34996NV002,,NVN002,NVS002,NVF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9989,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Northern-Simple-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Northern-Simple-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020001-00,Standard Gold Off Exchange Plan,,0.780786752700806,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$650,$1300,20%,,,,$6500,$13000,$6500,$13000,$650,$11,$830,$0,$650,$0,$940,$0,14
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020001,Northern Simple/F?cil Gold,34996NV002,,NVN002,NVS002,NVF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9989,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Northern-Simple-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Northern-Simple-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020001-01,Standard Gold On Exchange Plan,,0.780786752700806,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$650,$1300,20%,,,,$6500,$13000,$6500,$13000,$650,$11,$830,$0,$650,$0,$940,$0,15
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0060008,Frontier Simple/F?cil Platinum,34996NV006,,NVN005,NVS003,NVF011,New,POS,Platinum,No,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9988,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0060008-01,Standard Platinum On Exchange Plan,,0.882221937179565,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,$6500,$13000,$6500,$13000,$250,$5,$455,$0,$250,$0,$510,$0,15
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0060005,Frontier Simple/F?cil Gold,34996NV006,,NVN005,NVS003,NVF004,Existing,POS,Gold,No,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9987,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0060005-00,Standard Gold Off Exchange Plan,,0.780786752700806,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$650,$1300,20%,,,,$6500,$13000,$6500,$13000,$650,$11,$830,$0,$650,$0,$945,$0,16
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020001,Northern Simple/F?cil Gold,34996NV002,,NVN002,NVS002,NVF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9989,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Northern-Simple-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Northern-Simple-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,16
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020001,Northern Simple/F?cil Gold,34996NV002,,NVN002,NVS002,NVF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9989,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Northern-Simple-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Northern-Simple-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020001-03,Limited Cost Sharing Plan Variation,,0.780786752700806,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$650,$1300,20%,,,,$6500,$13000,$6500,$13000,$650,$11,$830,$0,$650,$0,$940,$0,17
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0060005,Frontier Simple/F?cil Gold,34996NV006,,NVN005,NVS003,NVF004,Existing,POS,Gold,No,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9987,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0060005-01,Standard Gold On Exchange Plan,,0.780786752700806,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$650,$1300,20%,,,,$6500,$13000,$6500,$13000,$650,$11,$830,$0,$650,$0,$945,$0,17
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0060006,Frontier Simple/F?cil Silver,34996NV006,,NVN005,NVS003,NVF005,Existing,POS,Silver,No,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9986,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0060006-00,Standard Silver Off Exchange Plan,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$1500,$3000,30%,,,,$6500,$13000,$6500,$13000,$650,$0,$840,$0,$650,$0,$945,$0,18
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020002,Northern Simple/F?cil Silver,34996NV002,,NVN002,NVS002,NVF005,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9988,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Northern-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Northern-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020002-00,Standard Silver Off Exchange Plan,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$1500,$3000,30%,,,,$6500,$13000,$6500,$13000,"$1,500",$16,$990,$0,"$1,500",$0,"$1,155",$0,18
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020002,Northern Simple/F?cil Silver,34996NV002,,NVN002,NVS002,NVF005,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9988,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Northern-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Northern-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020002-01,Standard Silver On Exchange Plan,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$1500,$3000,30%,,,,$6500,$13000,$6500,$13000,"$1,500",$16,$990,$0,"$1,500",$0,"$1,155",$0,19
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0060006,Frontier Simple/F?cil Silver,34996NV006,,NVN005,NVS003,NVF005,Existing,POS,Silver,No,Both,No,No,,Refer to benefit plan documents for details,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9986,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0060006-01,Standard Silver On Exchange Plan,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$1500,$3000,30%,,,,$6500,$13000,$6500,$13000,$650,$0,$840,$0,$650,$0,$945,$0,19
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0060007,Frontier Simple/F?cil Bronze HSA,34996NV006,,NVN005,NVS003,NVF003,Existing,POS,Bronze,No,Both,No,No,,Refer to benefit plan documents for details,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9985,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Bronze-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Bronze-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0060007-00,Standard Bronze Off Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6250,$12500,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$6250,$12500,50%,,,,$10000,$20000,$10000,$20000,"$8,387",$0,$0,$0,"$5,350",$0,$0,$0,20
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020002,Northern Simple/F?cil Silver,34996NV002,,NVN002,NVS002,NVF005,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9988,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Northern-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Northern-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,20
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020002,Northern Simple/F?cil Silver,34996NV002,,NVN002,NVS002,NVF005,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9988,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Northern-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Northern-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020002-03,Limited Cost Sharing Plan Variation,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$1500,$3000,30%,,,,$6500,$13000,$6500,$13000,"$1,500",$16,$990,$0,"$1,500",$0,"$1,155",$0,21
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0060007,Frontier Simple/F?cil Bronze HSA,34996NV006,,NVN005,NVS003,NVF003,Existing,POS,Bronze,No,Both,No,No,,Refer to benefit plan documents for details,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.9985,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Bronze-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Bronze-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0060007-01,Standard Bronze On Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6250,$12500,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$6250,$12500,50%,,,,$10000,$20000,$10000,$20000,"$8,387",$0,$0,$0,"$5,350",$0,$0,$0,21
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0270001,Southern Simple/Facil Gold HSA,34996NV027,,NVN007,NVS001,NVF011,New,POS,Gold,No,Both,No,No,,Refer to benefit plan documents for details,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Simple-Gold-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Simple-Gold-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0270001-00,Standard Gold Off Exchange Plan,,0.780109941959381,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6000,$12000,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$1300,$2600,10%,,,,$6500,$13000,$6500,$13000,"$1,300",$0,$446,$0,"$1,300",$0,$442,$0,22
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020002,Northern Simple/F?cil Silver,34996NV002,,NVN002,NVS002,NVF005,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9988,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Northern-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Northern-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020002-04,73% AV Level Silver Plan,,0.731158435344696,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$5200,$10400,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$900,$1800,30%,,,,$6500,$13000,$6500,$13000,$0,$16,"$1,170",$0,$900,$0,"$1,334",$0,22
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020002,Northern Simple/F?cil Silver,34996NV002,,NVN002,NVS002,NVF005,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9988,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Northern-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Northern-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020002-05,87% AV Level Silver Plan,,0.873590350151062,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$2250,$4500,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$300,$600,15%,,,,$6500,$13000,$6500,$13000,$345,$8,$675,$0,$300,$0,$757,$0,23
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0270001,Southern Simple/Facil Gold HSA,34996NV027,,NVN007,NVS001,NVF011,New,POS,Gold,No,Both,No,No,,Refer to benefit plan documents for details,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,0.998,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Simple-Gold-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Simple-Gold-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0270001-01,Standard Gold On Exchange Plan,,0.780109941959381,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6000,$12000,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$1300,$2600,10%,,,,$6500,$13000,$6500,$13000,"$1,300",$0,$446,$0,"$1,300",$0,$442,$0,23
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0270003,Southern Simple/Facil Bronze HSA,34996NV027,,NVN007,NVS001,NVF014,New,POS,Bronze,No,Both,No,No,,Refer to benefit plan documents for details,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Simple-Bronze-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Simple-Bronze-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0270003-00,Standard Bronze Off Exchange Plan,,0.590558171272278,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6450,$12900,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$4000,$8000,50%,,,,$6500,$13000,$6500,$13000,"$4,000",$0,$426,$0,"$4,000",$0,$675,$0,24
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020002,Northern Simple/F?cil Silver,34996NV002,,NVN002,NVS002,NVF005,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9988,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Northern-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Northern-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020002-06,94% AV Level Silver Plan,,0.938361823558807,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,$1500,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$250,$500,5%,,,,$6500,$13000,$6500,$13000,$300,$3,$227,$0,$250,$0,$255,$0,24
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020003,Northern Simple/F?cil Bronze HSA,34996NV002,,NVN002,NVS002,NVF003,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9987,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Northern-Simple-Bronze-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Northern-Simple-Bronze-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020003-00,Standard Bronze Off Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6250,$12500,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$6250,$12500,50%,,,,$10000,$20000,$10000,$20000,"$8,387",$0,$0,$0,"$5,350",$0,$0,$0,25
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,SHOP (Small Group),No,90-0917673,34996NV0270003,Southern Simple/Facil Bronze HSA,34996NV027,,NVN007,NVS001,NVF014,New,POS,Bronze,No,Both,No,No,,Refer to benefit plan documents for details,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Simple-Bronze-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Simple-Bronze-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0270003-01,Standard Bronze On Exchange Plan,,0.590558171272278,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6450,$12900,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$4000,$8000,50%,,,,$6500,$13000,$6500,$13000,"$4,000",$0,$426,$0,"$4,000",$0,$675,$0,25
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020003,Northern Simple/F?cil Bronze HSA,34996NV002,,NVN002,NVS002,NVF003,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9987,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Northern-Simple-Bronze-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Northern-Simple-Bronze-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020003-01,Standard Bronze On Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6250,$12500,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$6250,$12500,50%,,,,$10000,$20000,$10000,$20000,"$8,387",$0,$0,$0,"$5,350",$0,$0,$0,26
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020003,Northern Simple/F?cil Bronze HSA,34996NV002,,NVN002,NVS002,NVF003,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9987,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Northern-Simple-Bronze-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Northern-Simple-Bronze-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,27
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020003,Northern Simple/F?cil Bronze HSA,34996NV002,,NVN002,NVS002,NVF003,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9987,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Northern-Simple-Bronze-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Northern-Simple-Bronze-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020003-03,Limited Cost Sharing Plan Variation,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6250,$12500,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$6250,$12500,50%,,,,$10000,$20000,$10000,$20000,"$8,387",$0,$0,$0,"$5,350",$0,$0,$0,28
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020004,Northern Simple/F?cil Catastrophic,34996NV002,,NVN002,NVS002,NVF003,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9977,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Northern-Simple-Catastrophic.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Northern-Simple-Catastrophic.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020004-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6600,$13200,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$6600,$13200,50%,,,,$10000,$20000,$10000,$20000,"$8,737",$0,$0,$0,"$5,350",$0,$0,$0,29
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020004,Northern Simple/F?cil Catastrophic,34996NV002,,NVN002,NVS002,NVF003,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9977,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Northern-Simple-Catastrophic.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Northern-Simple-Catastrophic.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020004-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6600,$13200,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$6600,$13200,50%,,,,$10000,$20000,$10000,$20000,"$8,737",$0,$0,$0,"$5,350",$0,$0,$0,30
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020009,Frontier Simple/F?cil Platinum,34996NV002,,NVN005,NVS003,NVF011,New,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.999,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Frontier-Simple-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Frontier-Simple-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020009-00,Standard Platinum Off Exchange Plan,,0.882221937179565,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,$6500,$13000,$6500,$13000,$250,$5,$455,$0,$350,$0,$510,$0,31
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020009,Frontier Simple/F?cil Platinum,34996NV002,,NVN005,NVS003,NVF011,New,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.999,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Frontier-Simple-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Frontier-Simple-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020009-01,Standard Platinum On Exchange Plan,,0.882221937179565,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,$6500,$13000,$6500,$13000,$250,$5,$455,$0,$350,$0,$510,$0,32
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020009,Frontier Simple/F?cil Platinum,34996NV002,,NVN005,NVS003,NVF011,New,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.999,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Frontier-Simple-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Frontier-Simple-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,33
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020009,Frontier Simple/F?cil Platinum,34996NV002,,NVN005,NVS003,NVF011,New,POS,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.999,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Frontier-Simple-Platinum.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Frontier-Simple-Platinum.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020009-03,Limited Cost Sharing Plan Variation,,0.882221937179565,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,$6500,$13000,$6500,$13000,$250,$5,$455,$0,$350,$0,$510,$0,34
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020005,Frontier Simple/F?cil Gold,34996NV002,,NVN005,NVS003,NVF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9989,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Frontier-Simple-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Frontier-Simple-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020005-00,Standard Gold Off Exchange Plan,,0.780786752700806,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$650,$1300,20%,,,,$6500,$13000,$6500,$13000,$650,$0,$840,$0,$650,$0,$940,$0,35
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020005,Frontier Simple/F?cil Gold,34996NV002,,NVN005,NVS003,NVF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9989,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Frontier-Simple-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Frontier-Simple-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020005-01,Standard Gold On Exchange Plan,,0.780786752700806,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$650,$1300,20%,,,,$6500,$13000,$6500,$13000,$650,$0,$840,$0,$650,$0,$940,$0,36
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020005,Frontier Simple/F?cil Gold,34996NV002,,NVN005,NVS003,NVF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9989,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Frontier-Simple-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Frontier-Simple-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,37
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020005,Frontier Simple/F?cil Gold,34996NV002,,NVN005,NVS003,NVF004,Existing,POS,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9989,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Frontier-Simple-Gold.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Frontier-Simple-Gold.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020005-03,Limited Cost Sharing Plan Variation,,0.780786752700806,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$650,$1300,20%,,,,$6500,$13000,$6500,$13000,$650,$0,$840,$0,$650,$0,$940,$0,38
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020006,Frontier Simple/F?cil Silver,34996NV002,,NVN005,NVS003,NVF005,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9988,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Frontier-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Frontier-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020006-00,Standard Silver Off Exchange Plan,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$1500,$3000,30%,,,,$6500,$13000,$6500,$13000,"$1,500",$16,$990,$0,"$1,500",$0,"$1,155",$0,39
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020006,Frontier Simple/F?cil Silver,34996NV002,,NVN005,NVS003,NVF005,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9988,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Frontier-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Frontier-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020006-01,Standard Silver On Exchange Plan,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$1500,$3000,30%,,,,$6500,$13000,$6500,$13000,"$1,500",$16,$990,$0,"$1,500",$0,"$1,155",$0,40
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020006,Frontier Simple/F?cil Silver,34996NV002,,NVN005,NVS003,NVF005,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9988,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Frontier-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Frontier-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,41
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020006,Frontier Simple/F?cil Silver,34996NV002,,NVN005,NVS003,NVF005,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9988,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Frontier-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Frontier-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020006-03,Limited Cost Sharing Plan Variation,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6350,$12700,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$1500,$3000,30%,,,,$6500,$13000,$6500,$13000,"$1,500",$16,$990,$0,"$1,500",$0,"$1,155",$0,42
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020006,Frontier Simple/F?cil Silver,34996NV002,,NVN005,NVS003,NVF005,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9988,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Frontier-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Frontier-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020006-04,73% AV Level Silver Plan,,0.731158435344696,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$5200,$10400,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$900,$1800,30%,,,,$6500,$13000,$6500,$13000,$900,$16,"$1,170",$0,$900,$0,"$1,334",$0,43
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020006,Frontier Simple/F?cil Silver,34996NV002,,NVN005,NVS003,NVF005,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9988,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Frontier-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Frontier-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020006-05,87% AV Level Silver Plan,,0.873590350151062,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$2250,$4500,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$300,$600,15%,,,,$6500,$13000,$6500,$13000,$300,$8,$677,$0,$300,$0,$757,$0,44
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020006,Frontier Simple/F?cil Silver,34996NV002,,NVN005,NVS003,NVF005,Existing,POS,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9988,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Frontier-Simple-Silver.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Frontier-Simple-Silver.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020006-06,94% AV Level Silver Plan,,0.939013063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,$1500,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$250,$500,5%,,,,$6500,$13000,$6500,$13000,$250,$3,$227,$0,$250,$0,$255,$0,45
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020007,Frontier Simple/F?cil Bronze HSA,34996NV002,,NVN005,NVS003,NVF003,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9987,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Frontier-Simple-Bronze-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Frontier-Simple-Bronze-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020007-00,Standard Bronze Off Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6250,$12500,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$6250,$12500,50%,,,,$10000,$20000,$10000,$20000,"$8,387",$0,$0,$0,"$5,350",$0,$0,$0,46
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020007,Frontier Simple/F?cil Bronze HSA,34996NV002,,NVN005,NVS003,NVF003,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9987,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Frontier-Simple-Bronze-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Frontier-Simple-Bronze-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020007-01,Standard Bronze On Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6250,$12500,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$6250,$12500,50%,,,,$10000,$20000,$10000,$20000,"$8,387",$0,$0,$0,"$5,350",$0,$0,$0,47
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020007,Frontier Simple/F?cil Bronze HSA,34996NV002,,NVN005,NVS003,NVF003,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9987,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Frontier-Simple-Bronze-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Frontier-Simple-Bronze-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,48
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020007,Frontier Simple/F?cil Bronze HSA,34996NV002,,NVN005,NVS003,NVF003,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9987,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Frontier-Simple-Bronze-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Frontier-Simple-Bronze-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020007-03,Limited Cost Sharing Plan Variation,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6250,$12500,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$6250,$12500,50%,,,,$10000,$20000,$10000,$20000,"$8,387",$0,$0,$0,"$5,350",$0,$0,$0,49
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020008,Frontier Simple/F?cil Catastrophic,34996NV002,,NVN005,NVS003,NVF003,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9977,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Frontier-Simple-Catastrophic.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Frontier-Simple-Catastrophic.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020008-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6600,$13200,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$6600,$13200,50%,,,,$10000,$20000,$10000,$20000,"$8,737",$0,$0,$0,"$5,350",$0,$0,$0,50
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0020008,Frontier Simple/F?cil Catastrophic,34996NV002,,NVN005,NVS003,NVF003,Existing,POS,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9977,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Frontier-Simple-Catastrophic.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Frontier-Simple-Catastrophic.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0020008-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6600,$13200,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$6600,$13200,50%,,,,$10000,$20000,$10000,$20000,"$8,737",$0,$0,$0,"$5,350",$0,$0,$0,51
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0240001,Southern Simple/Facil Gold HSA,34996NV024,,NVN007,NVS001,NVF011,New,POS,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9982,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Gold-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-Gold-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0240001-00,Standard Gold Off Exchange Plan,,0.780109941959381,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6000,$12000,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$1300,$2600,10%,,,,$6500,$13000,$6500,$13000,"$1,300",$355,"$1,655",$0,"$1,300",$0,$99,$0,52
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0240001,Southern Simple/Facil Gold HSA,34996NV024,,NVN007,NVS001,NVF011,New,POS,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9982,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Gold-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-Gold-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0240001-01,Standard Gold On Exchange Plan,,0.780109941959381,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6000,$12000,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$1300,$2600,10%,,,,$6500,$13000,$6500,$13000,"$1,300",$355,"$1,655",$0,"$1,300",$0,$99,$0,53
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0240001,Southern Simple/Facil Gold HSA,34996NV024,,NVN007,NVS001,NVF011,New,POS,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9982,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Gold-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-Gold-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0240001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,54
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0240001,Southern Simple/Facil Gold HSA,34996NV024,,NVN007,NVS001,NVF011,New,POS,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9982,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Gold-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-Gold-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0240001-03,Limited Cost Sharing Plan Variation,,0.780109941959381,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6000,$12000,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$1300,$2600,10%,,,,$6500,$13000,$6500,$13000,"$1,300",$355,"$1,655",$0,"$1,300",$0,$99,$0,55
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0240003,Southern Simple/Facil Bronze HSA,34996NV024,,NVN007,NVS001,NVF014,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9979,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Bronze-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-Bronze-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0240003-00,Standard Bronze Off Exchange Plan,,0.590558171272278,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6450,$12900,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$4000,$8000,50%,,,,$6500,$13000,$6500,$13000,"$4,000",$0,$426,$0,"$4,000",$0,$676,$0,56
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0240003,Southern Simple/Facil Bronze HSA,34996NV024,,NVN007,NVS001,NVF014,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9979,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Bronze-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-Bronze-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0240003-01,Standard Bronze On Exchange Plan,,0.590558171272278,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6450,$12900,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$4000,$8000,50%,,,,$6500,$13000,$6500,$13000,"$4,000",$0,$426,$0,"$4,000",$0,$676,$0,57
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0240003,Southern Simple/Facil Bronze HSA,34996NV024,,NVN007,NVS001,NVF014,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9979,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Bronze-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-Bronze-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0240003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,58
2015,NV,34996,SERFF,11,2014-12-10 23:15:01,2,34996,NV,Individual,No,90-0917673,34996NV0240003,Southern Simple/Facil Bronze HSA,34996NV024,,NVN007,NVS001,NVF014,New,POS,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes",,0.9979,,,0,0,0,2015-01-01,,No,,No,,No,http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-Southern-Simple-Bronze-HSA.pdf,enroll.nevadahealthcoop.org/paymentredirect/,http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-Southern-Simple-Bronze-HSA.pdf,http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One,34996NV0240003-03,Limited Cost Sharing Plan Variation,,0.590558171272278,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$6450,$12900,,,$20000,$40000,$20000,$40000,,,,,,,,,,,,,,,,,,,,,$4000,$8000,50%,,,,$6500,$13000,$6500,$13000,"$4,000",$0,$426,$0,"$4,000",$0,$676,$0,59
2015,NV,43126,SERFF,4,2014-12-10 23:15:01,1,43126,NV,Individual,Yes,26-3486277,43126NV0110001,NDB Nevada Kids Gold,43126NV011,,NVN001,NVS001,,Existing,HMO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$19.13,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,Emergency Services $100.00,No,www.nevadadentalbenefits.com/benefits.php,www.nevadadentalbenefits.com/benefits/payments,www.nevadadentalbenefits.com/benefits/kidsgold.php,,43126NV0110001-01,Standard High On Exchange Plan,83.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,43126,SERFF,4,2014-12-10 23:15:01,1,43126,NV,Individual,Yes,26-3486277,43126NV0110003,NDB Nevada Kids Silver,43126NV011,,NVN001,NVS001,,Existing,HMO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$15.90,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,Emergency Services $100.00,No,www.nevadadentalbenefits.com/benefits.php,www.nevadadentalbenefits.com/benefits/payments,www.nevadadentalbenefits.com/benefits/kidssilver.php,,43126NV0110003-01,Standard Low On Exchange Plan,69.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,43126,SERFF,4,2014-12-10 23:15:01,2,43126,NV,Individual,Yes,26-3486277,43126NV0120001,NDB Nevada Kids Gold,43126NV012,,NVN002,NVS002,,Existing,HMO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$21.14,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,Emergency Services $100.00,No,www.nevadadentalbenefits.com/benefits.php,www.nevadadentalbenefits.com/benefits/payments,www.nevadadentalbenefits.com/benefits/kidsgold.php,,43126NV0120001-01,Standard High On Exchange Plan,84.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,43126,SERFF,4,2014-12-10 23:15:01,2,43126,NV,Individual,Yes,26-3486277,43126NV0120003,NDB Nevada Kids Silver,43126NV012,,NVN002,NVS002,,Existing,HMO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$17.90,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,Emergency Services $100.00,No,www.nevadadentalbenefits.com/benefits.php,www.nevadadentalbenefits.com/benefits/payments,www.nevadadentalbenefits.com/benefits/kidssilver.php,,43126NV0120003-01,Standard Low On Exchange Plan,71.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,43126,SERFF,4,2014-12-10 23:15:01,3,43126,NV,Individual,Yes,26-3486277,43126NV0150001,NDB Nevada Kids + Adult Silver,43126NV015,,NVN001,NVS001,,New,HMO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$13.40,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,Emergency Services $100.00,No,www.nevadadentalbenefits.com/benefits.php,www.nevadadentalbenefits.com/benefits/payments,www.nevadadentalbenefits.com/benefits/adultsilver.php,,43126NV0150001-01,Standard Low On Exchange Plan,69.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,43126,SERFF,4,2014-12-10 23:15:01,4,43126,NV,Individual,Yes,26-3486277,43126NV0160001,NDB Nevada Kids + Adult Silver,43126NV016,,NVN002,NVS002,,New,HMO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$15.40,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,Emergency Services $100.00,No,www.nevadadentalbenefits.com/benefits.php,www.nevadadentalbenefits.com/benefits/payments,www.nevadadentalbenefits.com/benefits/adultsilver.php,,43126NV0160001-01,Standard Low On Exchange Plan,71.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,53694,SERFF,3,2014-09-09 16:12:42,2,53694,NV,SHOP (Small Group),Yes,13-5123390,53694NV0040002,Guardian Family Advantage,53694NV004,,NVN001,NVS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$37.12,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,53694NV0040002-00,Standard High Off Exchange Plan,86.60%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,53694,SERFF,3,2014-09-09 16:12:42,2,53694,NV,SHOP (Small Group),Yes,13-5123390,53694NV0040002,Guardian Family Advantage,53694NV004,,NVN001,NVS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$37.12,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,53694NV0040002-01,Standard High On Exchange Plan,86.60%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,53694,SERFF,3,2014-09-09 16:12:42,2,53694,NV,SHOP (Small Group),Yes,13-5123390,53694NV0060002,Guardian Family Essentials,53694NV006,,NVN001,NVS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.08,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,53694NV0060002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NV,53694,SERFF,3,2014-09-09 16:12:42,2,53694,NV,SHOP (Small Group),Yes,13-5123390,53694NV0060002,Guardian Family Essentials,53694NV006,,NVN001,NVS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.08,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,53694NV0060002-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NV,54199,SERFF,4,2014-09-09 16:12:42,1,54199,NV,Individual,Yes,46-2243044,54199NV0010001,Smile for Kids,54199NV001,,NVN001,NVS001,,Existing,HMO,Low,,Both,,,,See Schedule of Benefits for limitations and exclusions,,,,,Allows Child-Only,,,,$19.05,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.premierlife.com/prospective-members/hbex/nevadahealthlink/,www.premierlife.com/payment,https://www.premierlife.com/prospective-members/hbex/nevadahealthlink/,,54199NV0010001-00,Standard Low Off Exchange Plan,69.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,54199,SERFF,4,2014-09-09 16:12:42,1,54199,NV,Individual,Yes,46-2243044,54199NV0010001,Smile for Kids,54199NV001,,NVN001,NVS001,,Existing,HMO,Low,,Both,,,,See Schedule of Benefits for limitations and exclusions,,,,,Allows Child-Only,,,,$19.05,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.premierlife.com/prospective-members/hbex/nevadahealthlink/,www.premierlife.com/payment,https://www.premierlife.com/prospective-members/hbex/nevadahealthlink/,,54199NV0010001-01,Standard Low On Exchange Plan,69.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,54199,SERFF,4,2014-09-09 16:12:42,2,54199,NV,Individual,Yes,46-2243044,54199NV0010002,Family DHMO Plan with EHB,54199NV001,,NVN001,NVS001,,Existing,HMO,Low,,Both,,,,See Schedule of Benefits for limitations and exclusions,,,,,Allows Adult and Child-Only,,,,$19.05,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.premierlife.com/prospective-members/hbex/nevadahealthlink/,www.premierlife.com/payment,https://www.premierlife.com/prospective-members/hbex/nevadahealthlink/,,54199NV0010002-00,Standard Low Off Exchange Plan,69.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,54199,SERFF,4,2014-09-09 16:12:42,2,54199,NV,SHOP (Small Group),Yes,46-2243044,54199NV0020002,Family DHMO Plan with EHB,54199NV002,,NVN001,NVS001,,Existing,HMO,Low,,Both,,,,See Schedule of Benefits for limitations and exclusions,,,,,Allows Adult and Child-Only,,,,$18.41,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.premierlife.com/prospective-members/hbex/nevadahealthlink/,www.premierlife.com/payment,https://www.premierlife.com/prospective-members/hbex/nevadahealthlink/,,54199NV0020002-00,Standard Low Off Exchange Plan,68.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,54199,SERFF,4,2014-09-09 16:12:42,2,54199,NV,SHOP (Small Group),Yes,46-2243044,54199NV0020002,Family DHMO Plan with EHB,54199NV002,,NVN001,NVS001,,Existing,HMO,Low,,Both,,,,See Schedule of Benefits for limitations and exclusions,,,,,Allows Adult and Child-Only,,,,$18.41,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.premierlife.com/prospective-members/hbex/nevadahealthlink/,www.premierlife.com/payment,https://www.premierlife.com/prospective-members/hbex/nevadahealthlink/,,54199NV0020002-01,Standard Low On Exchange Plan,68.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,54199,SERFF,4,2014-09-09 16:12:42,2,54199,NV,Individual,Yes,46-2243044,54199NV0010002,Family DHMO Plan with EHB,54199NV001,,NVN001,NVS001,,Existing,HMO,Low,,Both,,,,See Schedule of Benefits for limitations and exclusions,,,,,Allows Adult and Child-Only,,,,$19.05,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,https://www.premierlife.com/prospective-members/hbex/nevadahealthlink/,www.premierlife.com/payment,https://www.premierlife.com/prospective-members/hbex/nevadahealthlink/,,54199NV0010002-01,Standard Low On Exchange Plan,69.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,1,60156,NV,Individual,No,84-1017384,60156NV0230022,Anthem Bronze Pathway X HMO  5000 40,60156NV023,,NVN002,NVS001,NVF005,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G3Z,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230022-00,Standard Bronze Off Exchange Plan,59.23%,0.593826413154602,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$910,"$6,060","$5,000",$0,$110,"$5,190",4
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,1,60156,NV,Individual,No,84-1017384,60156NV0230022,Anthem Bronze Pathway X HMO  5000 40,60156NV023,,NVN002,NVS001,NVF005,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G3Z,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230022-01,Standard Bronze On Exchange Plan,59.23%,0.593826413154602,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$910,"$6,060","$5,000",$0,$110,"$5,190",5
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,1,60156,NV,Individual,No,84-1017384,60156NV0230022,Anthem Bronze Pathway X HMO  5000 40,60156NV023,,NVN002,NVS001,NVF005,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G3Z,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230022-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,1,60156,NV,Individual,No,84-1017384,60156NV0230022,Anthem Bronze Pathway X HMO  5000 40,60156NV023,,NVN002,NVS001,NVF005,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G3Z,https://shop.anthem.com/sales/eox/payment/landing/nh,http://file.anthem.com/03264NHMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230022-03,Limited Cost Sharing Plan Variation,59.23%,0.593826413154602,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$910,"$6,060","$5,000",$0,$110,"$5,190",7
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,2,60156,NV,Individual,No,84-1017384,60156NV0230021,Anthem Bronze Pathway X HMO 5750 30,60156NV023,,NVN002,NVS001,NVF005,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4Q,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230021-00,Standard Bronze Off Exchange Plan,58.93%,0.59029084444046,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,750",$0,$460,"$6,360","$5,270",$0,$0,"$5,350",4
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,2,60156,NV,Individual,No,84-1017384,60156NV0230021,Anthem Bronze Pathway X HMO 5750 30,60156NV023,,NVN002,NVS001,NVF005,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4Q,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230021-01,Standard Bronze On Exchange Plan,58.93%,0.59029084444046,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,750",$0,$460,"$6,360","$5,270",$0,$0,"$5,350",5
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,2,60156,NV,Individual,No,84-1017384,60156NV0230021,Anthem Bronze Pathway X HMO 5750 30,60156NV023,,NVN002,NVS001,NVF005,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4Q,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230021-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,2,60156,NV,Individual,No,84-1017384,60156NV0230021,Anthem Bronze Pathway X HMO 5750 30,60156NV023,,NVN002,NVS001,NVF005,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4Q,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230021-03,Limited Cost Sharing Plan Variation,58.93%,0.59029084444046,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,750",$0,$460,"$6,360","$5,270",$0,$0,"$5,350",7
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,3,60156,NV,Individual,No,84-1017384,60156NV0230019,Anthem Bronze Pathway X  HMO 0 for HSA,60156NV023,,NVN002,NVS001,NVF005,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.994710176088545,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G43,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230019-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$0,$0,"$6,450","$5,270",$0,$0,"$5,350",4
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,3,60156,NV,Individual,No,84-1017384,60156NV0230019,Anthem Bronze Pathway X  HMO 0 for HSA,60156NV023,,NVN002,NVS001,NVF005,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.994710176088545,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G43,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230019-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$0,$0,"$6,450","$5,270",$0,$0,"$5,350",5
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,3,60156,NV,Individual,No,84-1017384,60156NV0230019,Anthem Bronze Pathway X  HMO 0 for HSA,60156NV023,,NVN002,NVS001,NVF005,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.994710176088545,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G43,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230019-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,3,60156,NV,Individual,No,84-1017384,60156NV0230019,Anthem Bronze Pathway X  HMO 0 for HSA,60156NV023,,NVN002,NVS001,NVF005,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.994710176088545,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G43,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230019-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,300",$0,$0,"$6,450","$5,270",$0,$0,"$5,350",7
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,4,60156,NV,Individual,No,84-1017384,60156NV0230023,Anthem Bronze Pathway X HMO 25 for HSA,60156NV023,,NVN002,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.995302527839556,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G45,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230023-00,Standard Bronze Off Exchange Plan,61.37%,0.617264628410339,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,600",$0,$920,"$4,670","$3,600",$0,$420,"$4,100",4
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,4,60156,NV,Individual,No,84-1017384,60156NV0230023,Anthem Bronze Pathway X HMO 25 for HSA,60156NV023,,NVN002,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.995302527839556,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G45,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230023-01,Standard Bronze On Exchange Plan,61.37%,0.617264628410339,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,600",$0,$920,"$4,670","$3,600",$0,$420,"$4,100",5
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,4,60156,NV,Individual,No,84-1017384,60156NV0230023,Anthem Bronze Pathway X HMO 25 for HSA,60156NV023,,NVN002,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.995302527839556,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G45,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230023-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,4,60156,NV,Individual,No,84-1017384,60156NV0230023,Anthem Bronze Pathway X HMO 25 for HSA,60156NV023,,NVN002,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.995302527839556,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G45,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230023-03,Limited Cost Sharing Plan Variation,61.37%,0.617264628410339,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,600",$0,$920,"$4,670","$3,600",$0,$420,"$4,100",7
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,5,60156,NV,Individual,No,84-1017384,60156NV0230020,Anthem Bronze Pathway X HMO 6150 20,60156NV023,,NVN002,NVS001,NVF004,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G47,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230020-00,Standard Bronze Off Exchange Plan,,0.616825580596924,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,150","$12,300",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,150",$0,$200,"$6,500","$5,270",$0,$0,"$5,350",4
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,5,60156,NV,Individual,No,84-1017384,60156NV0230020,Anthem Bronze Pathway X HMO 6150 20,60156NV023,,NVN002,NVS001,NVF004,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G47,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230020-01,Standard Bronze On Exchange Plan,,0.616825580596924,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,150","$12,300",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,150",$0,$200,"$6,500","$5,270",$0,$0,"$5,350",5
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,5,60156,NV,Individual,No,84-1017384,60156NV0230020,Anthem Bronze Pathway X HMO 6150 20,60156NV023,,NVN002,NVS001,NVF004,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G47,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230020-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,5,60156,NV,Individual,No,84-1017384,60156NV0230020,Anthem Bronze Pathway X HMO 6150 20,60156NV023,,NVN002,NVS001,NVF004,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G47,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230020-03,Limited Cost Sharing Plan Variation,,0.616825580596924,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,150","$12,300",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,150",$0,$200,"$6,500","$5,270",$0,$0,"$5,350",7
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,6,60156,NV,Individual,No,84-1017384,60156NV0230026,Anthem Silver Pathway X HMO 2250 30,60156NV023,,NVN002,NVS001,NVF003,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4J,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230026-00,Standard Silver Off Exchange Plan,68.19%,0.685738563537598,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,250",$20,"$1,500","$3,920","$2,250",$410,$350,"$3,090",4
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,6,60156,NV,Individual,No,84-1017384,60156NV0230026,Anthem Silver Pathway X HMO 2250 30,60156NV023,,NVN002,NVS001,NVF003,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4J,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230026-01,Standard Silver On Exchange Plan,68.19%,0.685738563537598,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,250",$20,"$1,500","$3,920","$2,250",$410,$350,"$3,090",5
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,6,60156,NV,Individual,No,84-1017384,60156NV0230026,Anthem Silver Pathway X HMO 2250 30,60156NV023,,NVN002,NVS001,NVF003,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4J,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230026-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,6,60156,NV,Individual,No,84-1017384,60156NV0230026,Anthem Silver Pathway X HMO 2250 30,60156NV023,,NVN002,NVS001,NVF003,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4J,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230026-03,Limited Cost Sharing Plan Variation,68.19%,0.685738563537598,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,250",$20,"$1,500","$3,920","$2,250",$410,$350,"$3,090",7
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,6,60156,NV,Individual,No,84-1017384,60156NV0230026,Anthem Silver Pathway X HMO 2250 30,60156NV023,,NVN002,NVS001,NVF003,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4J,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230026-04,73% AV Level Silver Plan,72.61%,0.729738652706146,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$20,"$1,730","$3,400","$1,500",$500,$450,"$2,530",8
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,6,60156,NV,Individual,No,84-1017384,60156NV0230026,Anthem Silver Pathway X HMO 2250 30,60156NV023,,NVN002,NVS001,NVF003,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4J,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230026-05,87% AV Level Silver Plan,86.23%,0.863286912441254,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$700,$0,$800,"$1,650",$700,$250,$550,"$1,580",9
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,6,60156,NV,Individual,No,84-1017384,60156NV0230026,Anthem Silver Pathway X HMO 2250 30,60156NV023,,NVN002,NVS001,NVF003,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4J,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230026-06,94% AV Level Silver Plan,93.43%,0.934769809246063,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$175,$350,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$180,$0,$430,$760,$180,$130,$300,$690,10
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,7,60156,NV,Individual,No,84-1017384,60156NV0230027,Anthem Silver Pathway X HMO 2250 20,60156NV023,,NVN002,NVS001,NVF021,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4P,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230027-00,Standard Silver Off Exchange Plan,69.57%,0.701171338558197,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,250",$20,"$1,000","$3,420","$2,250",$550,$160,"$3,040",4
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,7,60156,NV,Individual,No,84-1017384,60156NV0230027,Anthem Silver Pathway X HMO 2250 20,60156NV023,,NVN002,NVS001,NVF021,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4P,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230027-01,Standard Silver On Exchange Plan,69.57%,0.701171338558197,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,250",$20,"$1,000","$3,420","$2,250",$550,$160,"$3,040",5
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,7,60156,NV,Individual,No,84-1017384,60156NV0230027,Anthem Silver Pathway X HMO 2250 20,60156NV023,,NVN002,NVS001,NVF021,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4P,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230027-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,7,60156,NV,Individual,No,84-1017384,60156NV0230027,Anthem Silver Pathway X HMO 2250 20,60156NV023,,NVN002,NVS001,NVF021,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4P,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230027-03,Limited Cost Sharing Plan Variation,69.57%,0.701171338558197,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,250",$20,"$1,000","$3,420","$2,250",$550,$160,"$3,040",7
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,7,60156,NV,Individual,No,84-1017384,60156NV0230027,Anthem Silver Pathway X HMO 2250 20,60156NV023,,NVN002,NVS001,NVF021,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4P,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230027-04,73% AV Level Silver Plan,72.72%,0.731244564056396,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,150","$4,300",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,150",$20,"$1,020","$3,340","$2,150",$530,$180,"$2,940",8
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,7,60156,NV,Individual,No,84-1017384,60156NV0230027,Anthem Silver Pathway X HMO 2250 20,60156NV023,,NVN002,NVS001,NVF021,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4P,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230027-05,87% AV Level Silver Plan,86.05%,0.861808359622955,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,$0,$750,"$1,650",$750,$560,$190,"$1,580",9
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,7,60156,NV,Individual,No,84-1017384,60156NV0230027,Anthem Silver Pathway X HMO 2250 20,60156NV023,,NVN002,NVS001,NVF021,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4P,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230027-06,94% AV Level Silver Plan,93.40%,0.934675872325897,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$175,$350,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$180,$0,$420,$750,$180,$300,$130,$690,10
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,8,60156,NV,Individual,No,84-1017384,60156NV0230024,Anthem Silver Pathway X HMO 2500 10,60156NV023,,NVN002,NVS001,NVF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4V,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230024-00,Standard Silver Off Exchange Plan,70.31%,0.71060836315155,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$20,$480,"$3,150","$2,500",$540,$80,"$3,200",4
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,8,60156,NV,Individual,No,84-1017384,60156NV0230024,Anthem Silver Pathway X HMO 2500 10,60156NV023,,NVN002,NVS001,NVF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4V,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230024-01,Standard Silver On Exchange Plan,70.31%,0.71060836315155,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$20,$480,"$3,150","$2,500",$540,$80,"$3,200",5
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,8,60156,NV,Individual,No,84-1017384,60156NV0230024,Anthem Silver Pathway X HMO 2500 10,60156NV023,,NVN002,NVS001,NVF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4V,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230024-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,8,60156,NV,Individual,No,84-1017384,60156NV0230024,Anthem Silver Pathway X HMO 2500 10,60156NV023,,NVN002,NVS001,NVF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4V,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230024-03,Limited Cost Sharing Plan Variation,70.31%,0.71060836315155,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$20,$480,"$3,150","$2,500",$540,$80,"$3,200",7
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,8,60156,NV,Individual,No,84-1017384,60156NV0230024,Anthem Silver Pathway X HMO 2500 10,60156NV023,,NVN002,NVS001,NVF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4V,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230024-04,73% AV Level Silver Plan,72.49%,0.730786025524139,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$20,$480,"$3,150","$2,500",$480,$80,"$3,140",8
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,8,60156,NV,Individual,No,84-1017384,60156NV0230024,Anthem Silver Pathway X HMO 2500 10,60156NV023,,NVN002,NVS001,NVF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4V,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230024-05,87% AV Level Silver Plan,86.20%,0.864119350910187,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,$20,$650,"$1,570",$750,$640,$110,"$1,580",9
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,8,60156,NV,Individual,No,84-1017384,60156NV0230024,Anthem Silver Pathway X HMO 2500 10,60156NV023,,NVN002,NVS001,NVF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G4V,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230024-06,94% AV Level Silver Plan,93.24%,0.93367612361908,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$0,$400,$750,$200,$320,$80,$680,10
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,9,60156,NV,Individual,No,84-1017384,60156NV0230025,Anthem Silver Pathway X HMO 2250 10,60156NV023,,NVN002,NVS001,NVF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G2J,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230025-00,Standard Silver Off Exchange Plan,70.33%,0.707693040370941,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,250",$20,$500,"$2,920","$2,250",$410,$120,"$2,860",4
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,9,60156,NV,Individual,No,84-1017384,60156NV0230025,Anthem Silver Pathway X HMO 2250 10,60156NV023,,NVN002,NVS001,NVF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G2J,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230025-01,Standard Silver On Exchange Plan,70.33%,0.707693040370941,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,250",$20,$500,"$2,920","$2,250",$410,$120,"$2,860",5
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,9,60156,NV,Individual,No,84-1017384,60156NV0230025,Anthem Silver Pathway X HMO 2250 10,60156NV023,,NVN002,NVS001,NVF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G2J,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230025-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,9,60156,NV,Individual,No,84-1017384,60156NV0230025,Anthem Silver Pathway X HMO 2250 10,60156NV023,,NVN002,NVS001,NVF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G2J,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230025-03,Limited Cost Sharing Plan Variation,70.33%,0.707693040370941,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,250",$20,$500,"$2,920","$2,250",$410,$120,"$2,860",7
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,9,60156,NV,Individual,No,84-1017384,60156NV0230025,Anthem Silver Pathway X HMO 2250 10,60156NV023,,NVN002,NVS001,NVF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G2J,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230025-04,73% AV Level Silver Plan,72.62%,0.729787647724152,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,250",$20,$500,"$2,920","$2,250",$410,$120,"$2,860",8
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,9,60156,NV,Individual,No,84-1017384,60156NV0230025,Anthem Silver Pathway X HMO 2250 10,60156NV023,,NVN002,NVS001,NVF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G2J,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230025-05,87% AV Level Silver Plan,86.42%,0.865789949893951,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,$0,$500,"$1,400",$750,$310,$190,"$1,330",9
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,9,60156,NV,Individual,No,84-1017384,60156NV0230025,Anthem Silver Pathway X HMO 2250 10,60156NV023,,NVN002,NVS001,NVF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G2J,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230025-06,94% AV Level Silver Plan,93.08%,0.930827736854553,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$0,$400,$750,$200,$230,$170,$680,10
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,10,60156,NV,Individual,No,84-1017384,60156NV0230018,Anthem Catastrophic Pathway X HMO 6600 0,60156NV023,,NVN002,NVS001,NVF024,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G2V,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230018-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600",$0,$0,"$6,750","$5,270",$0,$0,"$5,350",4
2015,NV,60156,SERFF,10,2014-12-10 23:15:01,10,60156,NV,Individual,No,84-1017384,60156NV0230018,Anthem Catastrophic Pathway X HMO 6600 0,60156NV023,,NVN002,NVS001,NVF024,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G2V,https://shop.anthem.com/sales/eox/payment/landing/nv,http://file.anthem.com/03257NVMENABS.pdf,anthem.com/NVSelectdrugtier4,60156NV0230018-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600",$0,$0,"$6,750","$5,270",$0,$0,"$5,350",5
2015,NV,75719,SERFF,4,2014-10-06 10:59:03,3,75719,NV,Individual,Yes,95-6042390,75719NV0020003,BESTOne Dental Advantage-Gold,75719NV002,,NVN001,NVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$40.29,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NV/2015/NV_BESTOne_Dental_Advantage-Gold_Plan.pdf,,75719NV0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,75719,SERFF,4,2014-10-06 10:59:03,3,75719,NV,SHOP (Small Group),Yes,95-6042390,75719NV0010007,BEST Dental Premium,75719NV001,,NVN001,NVS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.62,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NV/2015/NV_BESTDental_Premium_Plan.pdf,,75719NV0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,75719,SERFF,4,2014-10-06 10:59:03,3,75719,NV,SHOP (Small Group),Yes,95-6042390,75719NV0010007,BEST Dental Premium,75719NV001,,NVN001,NVS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.62,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NV/2015/NV_BESTDental_Premium_Plan.pdf,,75719NV0010007-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,75719,SERFF,4,2014-10-06 10:59:03,3,75719,NV,Individual,Yes,95-6042390,75719NV0020003,BESTOne Dental Advantage-Gold,75719NV002,,NVN001,NVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$40.29,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NV/2015/NV_BESTOne_Dental_Advantage-Gold_Plan.pdf,,75719NV0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,75719,SERFF,4,2014-10-06 10:59:03,3,75719,NV,SHOP (Small Group),Yes,95-6042390,75719NV0010008,BEST Dental Standard-H,75719NV001,,NVN001,NVS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.62,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NV/2015/NV_BESTDental_Standard-H_Plan.pdf,,75719NV0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NV,75719,SERFF,4,2014-10-06 10:59:03,3,75719,NV,Individual,Yes,95-6042390,75719NV0020004,BESTOne Dental Plus-Gold,75719NV002,,NVN001,NVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$40.29,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NV/2015/NV_BESTOne_Dental_Plus-Gold_Plan.pdf,,75719NV0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NV,75719,SERFF,4,2014-10-06 10:59:03,3,75719,NV,Individual,Yes,95-6042390,75719NV0020004,BESTOne Dental Plus-Gold,75719NV002,,NVN001,NVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$40.29,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NV/2015/NV_BESTOne_Dental_Plus-Gold_Plan.pdf,,75719NV0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NV,75719,SERFF,4,2014-10-06 10:59:03,3,75719,NV,SHOP (Small Group),Yes,95-6042390,75719NV0010008,BEST Dental Standard-H,75719NV001,,NVN001,NVS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.62,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NV/2015/NV_BESTDental_Standard-H_Plan.pdf,,75719NV0010008-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NV,75719,SERFF,4,2014-10-06 10:59:03,3,75719,NV,SHOP (Small Group),Yes,95-6042390,75719NV0010010,BEST Dental Choice-H,75719NV001,,NVN001,NVS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.62,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NV/2015/NV_BESTDental_Choice-H_Plan.pdf,,75719NV0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,NV,75719,SERFF,4,2014-10-06 10:59:03,3,75719,NV,SHOP (Small Group),Yes,95-6042390,75719NV0010010,BEST Dental Choice-H,75719NV001,,NVN001,NVS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.62,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NV/2015/NV_BESTDental_Choice-H_Plan.pdf,,75719NV0010010-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,NV,75719,SERFF,4,2014-10-06 10:59:03,4,75719,NV,SHOP (Small Group),Yes,95-6042390,75719NV0010009,BEST Dental Standard-L,75719NV001,,NVN001,NVS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.71,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NV/2015/NV_BESTDental_Standard-L_Plan.pdf,,75719NV0010009-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,75719,SERFF,4,2014-10-06 10:59:03,4,75719,NV,Individual,Yes,95-6042390,75719NV0020005,BESTOne Dental Plus-Silver,75719NV002,,NVN001,NVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.79,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NV/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf,,75719NV0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,75719,SERFF,4,2014-10-06 10:59:03,4,75719,NV,Individual,Yes,95-6042390,75719NV0020005,BESTOne Dental Plus-Silver,75719NV002,,NVN001,NVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.79,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NV/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf,,75719NV0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,75719,SERFF,4,2014-10-06 10:59:03,4,75719,NV,SHOP (Small Group),Yes,95-6042390,75719NV0010009,BEST Dental Standard-L,75719NV001,,NVN001,NVS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.71,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NV/2015/NV_BESTDental_Standard-L_Plan.pdf,,75719NV0010009-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,75719,SERFF,4,2014-10-06 10:59:03,4,75719,NV,Individual,Yes,95-6042390,75719NV0020006,BESTOne Dental Basic-Silver,75719NV002,,NVN001,NVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.79,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NV/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf,,75719NV0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030019,MyHPN Silver 4,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030019-01,Standard Silver On Exchange Plan,68.10%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500","$3,000","$6,000",0%,,,,$0,$0,"$3,000","$6,000",$250,$500,0%,,,,$0,$0,$250,$500,,,,,,,,,,,"$3,000",$150,$0,$0,"$3,000",$210,$0,$0,58
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030019,MyHPN Silver 4,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030019-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,59
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030019,MyHPN Silver 4,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030019-03,Limited Cost Sharing Plan Variation,68.10%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500","$3,000","$6,000",0%,,,,$0,$0,"$3,000","$6,000",$250,$500,0%,,,,$0,$0,$250,$500,,,,,,,,,,,"$3,000",$150,$0,$0,"$3,000",$210,$0,$0,60
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030019,MyHPN Silver 4,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030019-04,73% AV Level Silver Plan,72.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,$0,$0,"$4,200","$8,400","$3,000","$6,000",0%,,,,$0,$0,"$3,000","$6,000",$250,$500,0%,,,,$0,$0,$250,$500,,,,,,,,,,,"$3,000",$150,$0,$0,"$3,000",$210,$0,$0,61
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030019,MyHPN Silver 4,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030019-05,87% AV Level Silver Plan,86.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,$0,$0,"$1,250","$2,500",$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$520,"$2,000",$0,$0,"$2,030",$0,$0,62
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030019,MyHPN Silver 4,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030019-06,94% AV Level Silver Plan,93.80%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,$0,$0,$400,$800,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$520,"$2,000",$0,$0,"$2,030",$0,$0,63
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030047,MyHPN Silver 5,95865NV003,,NVN001,NVS001,NVF002,New,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030047-00,Standard Silver Off Exchange Plan,69.70%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,"$6,600","$13,200","$5,000","$10,000",0%,,,,$0,$0,"$5,000","$10,000",$250,$500,0%,,,,$0,$0,$250,$500,,,,,,,,,,,"$5,000",$540,"$2,000",$0,"$5,000","$2,090",$0,$0,64
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030047,MyHPN Silver 5,95865NV003,,NVN001,NVS001,NVF002,New,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030047-01,Standard Silver On Exchange Plan,69.70%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,"$6,600","$13,200","$5,000","$10,000",0%,,,,$0,$0,"$5,000","$10,000",$250,$500,0%,,,,$0,$0,$250,$500,,,,,,,,,,,"$5,000",$540,"$2,000",$0,"$5,000","$2,090",$0,$0,65
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030047,MyHPN Silver 5,95865NV003,,NVN001,NVS001,NVF002,New,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030047-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,66
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030047,MyHPN Silver 5,95865NV003,,NVN001,NVS001,NVF002,New,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030047-03,Limited Cost Sharing Plan Variation,69.70%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,"$6,600","$13,200","$5,000","$10,000",0%,,,,$0,$0,"$5,000","$10,000",$250,$500,0%,,,,$0,$0,$250,$500,,,,,,,,,,,"$5,000",$540,"$2,000",$0,"$5,000","$2,090",$0,$0,67
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030047,MyHPN Silver 5,95865NV003,,NVN001,NVS001,NVF002,New,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030047-04,73% AV Level Silver Plan,72.60%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,$0,$0,"$4,900","$9,800","$3,500","$7,000",0%,,,,$0,$0,"$3,500","$7,000",$250,$500,0%,,,,$0,$0,$250,$500,,,,,,,,,,,"$3,500",$540,"$2,000",$0,"$3,500","$2,090",$0,$0,68
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030014,MyHPN Silver 3,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030014-03,Limited Cost Sharing Plan Variation,68.50%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500","$4,000","$8,000",0%,,,,$0,$0,"$4,000","$8,000",$250,$500,0%,,,,$0,$0,$250,$500,,,,,,,,,,,"$4,000",$150,$0,$0,"$4,000",$210,$0,$0,53
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030014,MyHPN Silver 3,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030014-04,73% AV Level Silver Plan,73.10%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,$0,$0,"$4,200","$8,400","$3,000","$6,000",0%,,,,$0,$0,"$3,000","$6,000",$250,$500,0%,,,,$0,$0,$250,$500,,,,,,,,,,,"$3,000",$150,$0,$0,"$3,000",$210,$0,$0,54
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030014,MyHPN Silver 3,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030014-05,87% AV Level Silver Plan,86.80%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,$0,$0,"$1,250","$2,500",$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$520,"$2,000",$0,$0,"$1,970",$0,$0,55
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030014,MyHPN Silver 3,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030014-06,94% AV Level Silver Plan,94.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,$0,$0,$400,$800,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$520,"$2,000",$0,$0,"$1,970",$0,$0,56
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030019,MyHPN Silver 4,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030019-00,Standard Silver Off Exchange Plan,68.10%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500","$3,000","$6,000",0%,,,,$0,$0,"$3,000","$6,000",$250,$500,0%,,,,$0,$0,$250,$500,,,,,,,,,,,"$3,000",$150,$0,$0,"$3,000",$210,$0,$0,57
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230008,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS002,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230008-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,60
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230008,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS002,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,61
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230001,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS001,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230001-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230001,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS001,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230001-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,NV,75719,SERFF,4,2014-10-06 10:59:03,4,75719,NV,SHOP (Small Group),Yes,95-6042390,75719NV0010011,BEST Dental Choice-L,75719NV001,,NVN001,NVS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.71,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NV/2015/NV_BESTDental_Choice-L_Plan.pdf,,75719NV0010011-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NV,75719,SERFF,4,2014-10-06 10:59:03,4,75719,NV,SHOP (Small Group),Yes,95-6042390,75719NV0010011,BEST Dental Choice-L,75719NV001,,NVN001,NVS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.71,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NV/2015/NV_BESTDental_Choice-L_Plan.pdf,,75719NV0010011-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NV,75719,SERFF,4,2014-10-06 10:59:03,4,75719,NV,Individual,Yes,95-6042390,75719NV0020006,BESTOne Dental Basic-Silver,75719NV002,,NVN001,NVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$33.79,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NV/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf,,75719NV0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030047,MyHPN Silver 5,95865NV003,,NVN001,NVS001,NVF002,New,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030047-05,87% AV Level Silver Plan,86.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,$0,$0,"$1,500","$3,000",$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$540,"$2,000",$0,$0,"$2,090",$0,$0,69
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030047,MyHPN Silver 5,95865NV003,,NVN001,NVS001,NVF002,New,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030047-06,94% AV Level Silver Plan,93.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,$0,$0,$500,"$1,000",$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$540,"$2,000",$0,$0,"$2,090",$0,$0,70
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030046,MyHPN Gold 4,95865NV003,,NVN001,NVS001,NVF003,New,HMO,Gold,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030046-00,Standard Gold Off Exchange Plan,79.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,$0,$0,"$4,500","$9,000","$1,000","$2,000",0%,,,,$0,$0,"$1,000","$2,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,000",$440,"$1,300",$0,"$1,000","$1,850",$0,$0,71
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030046,MyHPN Gold 4,95865NV003,,NVN001,NVS001,NVF003,New,HMO,Gold,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030046-01,Standard Gold On Exchange Plan,79.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,$0,$0,"$4,500","$9,000","$1,000","$2,000",0%,,,,$0,$0,"$1,000","$2,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,000",$440,"$1,300",$0,"$1,000","$1,850",$0,$0,72
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030046,MyHPN Gold 4,95865NV003,,NVN001,NVS001,NVF003,New,HMO,Gold,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030046-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,73
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030046,MyHPN Gold 4,95865NV003,,NVN001,NVS001,NVF003,New,HMO,Gold,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030046-03,Limited Cost Sharing Plan Variation,79.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,$0,$0,"$4,500","$9,000","$1,000","$2,000",0%,,,,$0,$0,"$1,000","$2,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,000",$440,"$1,300",$0,"$1,000","$1,850",$0,$0,74
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,2,95865,NV,Individual,No,88-0201035,95865NV0030023,MyHPN Catastrophic Plan,95865NV003,,NVN001,NVS001,NVF005,Existing,HMO,Catastrophic,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030023-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,$0,$0,"$6,600","$13,200","$6,600",$150,$0,$0,"$6,600",$210,$0,$0,4
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,2,95865,NV,Individual,No,88-0201035,95865NV0030023,MyHPN Catastrophic Plan,95865NV003,,NVN001,NVS001,NVF005,Existing,HMO,Catastrophic,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030023-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,$0,$0,"$6,600","$13,200","$6,600",$150,$0,$0,"$6,600",$210,$0,$0,5
2015,NV,75719,SERFF,4,2014-10-06 10:59:03,4,75719,NV,SHOP (Small Group),Yes,95-6042390,75719NV0010012,BEST Dental Value,75719NV001,,NVN001,NVS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.71,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NV/2015/NV_BESTDental_Value_Plan.pdf,,75719NV0010012-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,NV,75719,SERFF,4,2014-10-06 10:59:03,4,75719,NV,SHOP (Small Group),Yes,95-6042390,75719NV0010012,BEST Dental Value,75719NV001,,NVN001,NVS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.71,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the Maximum Allowable Charge,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/NV/2015/NV_BESTDental_Value_Plan.pdf,,75719NV0010012-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,NV,86438,SERFF,4,2014-11-15 10:06:04,1,86438,NV,SHOP (Small Group),Yes,26-0424586,86438NV0030001,LIBERTY Dental Plan NV Pediatric Low with Adult Option,86438NV003,,NVN001,NVS001,,New,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.38,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,,,http://www.libertydentalplan.com/Resources/Documents/LIBERTY_Dental_Plan_Nevada_Pediatric_Low_With_Adult_Option.pdf,,86438NV0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,86438,SERFF,4,2014-11-15 10:06:04,1,86438,NV,SHOP (Small Group),Yes,26-0424586,86438NV0030001,LIBERTY Dental Plan NV Pediatric Low with Adult Option,86438NV003,,NVN001,NVS001,,New,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.38,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,,,http://www.libertydentalplan.com/Resources/Documents/LIBERTY_Dental_Plan_Nevada_Pediatric_Low_With_Adult_Option.pdf,,86438NV0030001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,86438,SERFF,4,2014-11-15 10:06:04,1,86438,NV,SHOP (Small Group),Yes,26-0424586,86438NV0030002,LIBERTY Dental Plan NV Pediatric High with Adult Option,86438NV003,,NVN001,NVS001,,New,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.39,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,,,http://www.libertydentalplan.com/Resources/Documents/LIBERTY_Dental_Plan_Nevada_Pediatric_High_With_Adult_Option.pdf,,86438NV0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,NV,86438,SERFF,4,2014-11-15 10:06:04,1,86438,NV,SHOP (Small Group),Yes,26-0424586,86438NV0030002,LIBERTY Dental Plan NV Pediatric High with Adult Option,86438NV003,,NVN001,NVS001,,New,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$20.39,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,,,http://www.libertydentalplan.com/Resources/Documents/LIBERTY_Dental_Plan_Nevada_Pediatric_High_With_Adult_Option.pdf,,86438NV0030002-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,NV,88671,SERFF,9,2014-11-04 20:29:03,1,88671,NV,Individual,Yes,75-1233841,88671NV0020001,Dentegra Dental PPO Pediatric Basic Plan,88671NV002,,NVN001,NVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$22.00,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nv/88671nv0020001-15,,88671NV0020001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,88671,SERFF,9,2014-11-04 20:29:03,1,88671,NV,Individual,Yes,75-1233841,88671NV0020001,Dentegra Dental PPO Pediatric Basic Plan,88671NV002,,NVN001,NVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$22.00,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nv/88671nv0020001-15,,88671NV0020001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,88671,SERFF,9,2014-11-04 20:29:03,2,88671,NV,SHOP (Small Group),Yes,75-1233841,88671NV0030004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,88671NV003,,NVN001,NVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.63,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nv/88671nv0030004-15,,88671NV0030004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$80,Not Applicable,,,,,$80,Not Applicable,$80,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,88671,SERFF,9,2014-11-04 20:29:03,2,88671,NV,Individual,Yes,75-1233841,88671NV0020004,Dentegra Dental PPO Family Preferred Plan,88671NV002,,NVN001,NVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.78,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nv/88671nv0020004-15,,88671NV0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$80,Not Applicable,,,,,$80,Not Applicable,$80,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,88671,SERFF,9,2014-11-04 20:29:03,2,88671,NV,Individual,Yes,75-1233841,88671NV0020004,Dentegra Dental PPO Family Preferred Plan,88671NV002,,NVN001,NVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$26.78,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nv/88671nv0020004-15,,88671NV0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$80,Not Applicable,,,,,$80,Not Applicable,$80,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,88671,SERFF,9,2014-11-04 20:29:03,2,88671,NV,SHOP (Small Group),Yes,75-1233841,88671NV0030004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,88671NV003,,NVN001,NVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.63,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nv/88671nv0030004-15,,88671NV0030004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$80,Not Applicable,,,,,$80,Not Applicable,$80,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,88671,SERFF,9,2014-11-04 20:29:03,3,88671,NV,SHOP (Small Group),Yes,75-1233841,88671NV0030006,Dentegra Dental PPO for Small Businesses Family Basic Plan,88671NV003,,NVN001,NVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.98,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nv/88671nv0030006-15,,88671NV0030006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,88671,SERFF,9,2014-11-04 20:29:03,3,88671,NV,Individual,Yes,75-1233841,88671NV0020006,Dentegra Dental PPO Family Basic Plan,88671NV002,,NVN001,NVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.00,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nv/88671nv0020006-15,,88671NV0020006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,NV,88671,SERFF,9,2014-11-04 20:29:03,3,88671,NV,Individual,Yes,75-1233841,88671NV0020006,Dentegra Dental PPO Family Basic Plan,88671NV002,,NVN001,NVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.00,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nv/88671nv0020006-15,,88671NV0020006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,88671,SERFF,9,2014-11-04 20:29:03,3,88671,NV,SHOP (Small Group),Yes,75-1233841,88671NV0030006,Dentegra Dental PPO for Small Businesses Family Basic Plan,88671NV003,,NVN001,NVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.98,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/nv/88671nv0030006-15,,88671NV0030006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030009,MyHPN Bronze 2,95865NV003,,NVN001,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030009-00,Standard Bronze Off Exchange Plan,60.50%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,$0,$0,"$6,000","$12,000","$6,000",$150,$0,$0,"$5,190",$210,$0,$0,4
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030009,MyHPN Bronze 2,95865NV003,,NVN001,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030009-01,Standard Bronze On Exchange Plan,60.50%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,$0,$0,"$6,000","$12,000","$6,000",$150,$0,$0,"$5,190",$210,$0,$0,5
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030009,MyHPN Bronze 2,95865NV003,,NVN001,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030009-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030009,MyHPN Bronze 2,95865NV003,,NVN001,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030009-03,Limited Cost Sharing Plan Variation,60.50%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,$0,$0,"$6,000","$12,000","$6,000",$150,$0,$0,"$5,190",$210,$0,$0,7
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030010,MyHPN Bronze 4,95865NV003,,NVN001,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030010-00,Standard Bronze Off Exchange Plan,60.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,,,,$0,$0,"$4,500","$9,000","$4,500",$150,$0,$0,"$4,500",$210,$0,$0,8
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030010,MyHPN Bronze 4,95865NV003,,NVN001,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030010-01,Standard Bronze On Exchange Plan,60.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,,,,$0,$0,"$4,500","$9,000","$4,500",$150,$0,$0,"$4,500",$210,$0,$0,9
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030010,MyHPN Bronze 4,95865NV003,,NVN001,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030010-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030010,MyHPN Bronze 4,95865NV003,,NVN001,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030010-03,Limited Cost Sharing Plan Variation,60.00%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",0%,,,,$0,$0,"$4,500","$9,000","$4,500",$150,$0,$0,"$4,500",$210,$0,$0,11
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030011,MyHPN Bronze 1,95865NV003,,NVN001,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030011-00,Standard Bronze Off Exchange Plan,61.90%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,$0,$0,"$5,000","$10,000","$5,000",$150,$0,$0,"$5,000",$210,$0,$0,12
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030011,MyHPN Bronze 1,95865NV003,,NVN001,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030011-01,Standard Bronze On Exchange Plan,61.90%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,$0,$0,"$5,000","$10,000","$5,000",$150,$0,$0,"$5,000",$210,$0,$0,13
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030011,MyHPN Bronze 1,95865NV003,,NVN001,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030011,MyHPN Bronze 1,95865NV003,,NVN001,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030011-03,Limited Cost Sharing Plan Variation,61.90%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,$0,$0,"$5,000","$10,000","$5,000",$150,$0,$0,"$5,000",$210,$0,$0,15
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030013,MyHPN Bronze 3,95865NV003,,NVN001,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030013-00,Standard Bronze Off Exchange Plan,59.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",0%,,,,$0,$0,"$4,750","$9,500","$4,750",$150,$0,$0,"$4,750",$210,$0,$0,16
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030013,MyHPN Bronze 3,95865NV003,,NVN001,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030013-01,Standard Bronze On Exchange Plan,59.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",0%,,,,$0,$0,"$4,750","$9,500","$4,750",$150,$0,$0,"$4,750",$210,$0,$0,17
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030013,MyHPN Bronze 3,95865NV003,,NVN001,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030013-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,18
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030013,MyHPN Bronze 3,95865NV003,,NVN001,NVS001,NVF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030013-03,Limited Cost Sharing Plan Variation,59.70%,0,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",0%,,,,$0,$0,"$4,750","$9,500","$4,750",$150,$0,$0,"$4,750",$210,$0,$0,19
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030020,MyHPN Gold 3,95865NV003,,NVN001,NVS001,NVF003,Existing,HMO,Gold,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030020-00,Standard Gold Off Exchange Plan,79.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,$0,$0,"$4,000","$8,000","$1,000","$2,000",0%,,,,$0,$0,"$1,000","$2,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,000",$180,$560,$0,"$1,000",$970,$0,$0,20
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030020,MyHPN Gold 3,95865NV003,,NVN001,NVS001,NVF003,Existing,HMO,Gold,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030020-01,Standard Gold On Exchange Plan,79.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,$0,$0,"$4,000","$8,000","$1,000","$2,000",0%,,,,$0,$0,"$1,000","$2,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,000",$180,$560,$0,"$1,000",$970,$0,$0,21
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030020,MyHPN Gold 3,95865NV003,,NVN001,NVS001,NVF003,Existing,HMO,Gold,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030020-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030020,MyHPN Gold 3,95865NV003,,NVN001,NVS001,NVF003,Existing,HMO,Gold,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030020-03,Limited Cost Sharing Plan Variation,79.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,$0,$0,"$4,000","$8,000","$1,000","$2,000",0%,,,,$0,$0,"$1,000","$2,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,000",$180,$560,$0,"$1,000",$970,$0,$0,23
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030021,MyHPN Gold 2,95865NV003,,NVN001,NVS001,NVF003,Existing,HMO,Gold,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030021-00,Standard Gold Off Exchange Plan,81.80%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,"$6,000","$12,000",$750,"$1,500",0%,,,,$0,$0,$750,"$1,500",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$750,$180,$810,$0,$750,"$1,040",$0,$0,24
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030021,MyHPN Gold 2,95865NV003,,NVN001,NVS001,NVF003,Existing,HMO,Gold,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030021-01,Standard Gold On Exchange Plan,81.80%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,"$6,000","$12,000",$750,"$1,500",0%,,,,$0,$0,$750,"$1,500",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$750,$180,$810,$0,$750,"$1,040",$0,$0,25
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030021,MyHPN Gold 2,95865NV003,,NVN001,NVS001,NVF003,Existing,HMO,Gold,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030021-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,26
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030021,MyHPN Gold 2,95865NV003,,NVN001,NVS001,NVF003,Existing,HMO,Gold,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030021-03,Limited Cost Sharing Plan Variation,81.80%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,"$6,000","$12,000",$750,"$1,500",0%,,,,$0,$0,$750,"$1,500",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$750,$180,$810,$0,$750,"$1,040",$0,$0,27
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030022,MyHPN Gold 1,95865NV003,,NVN001,NVS001,NVF003,Existing,HMO,Gold,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030022-00,Standard Gold Off Exchange Plan,79.60%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500",$500,"$1,000",0%,,,,$0,$0,$500,"$1,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$500,$330,$910,$0,$500,"$1,290",$0,$0,28
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030022,MyHPN Gold 1,95865NV003,,NVN001,NVS001,NVF003,Existing,HMO,Gold,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030022-01,Standard Gold On Exchange Plan,79.60%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500",$500,"$1,000",0%,,,,$0,$0,$500,"$1,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$500,$330,$910,$0,$500,"$1,290",$0,$0,29
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030022,MyHPN Gold 1,95865NV003,,NVN001,NVS001,NVF003,Existing,HMO,Gold,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030022-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,30
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030022,MyHPN Gold 1,95865NV003,,NVN001,NVS001,NVF003,Existing,HMO,Gold,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030022-03,Limited Cost Sharing Plan Variation,79.60%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500",$500,"$1,000",0%,,,,$0,$0,$500,"$1,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$500,$330,$910,$0,$500,"$1,290",$0,$0,31
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030044,MyHPN Platinum 1,95865NV003,,NVN001,NVS001,NVF004,Existing,HMO,Platinum,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030044-00,Standard Platinum Off Exchange Plan,88.10%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,$0,$0,"$3,500","$7,000",$100,$200,0%,,,,$0,$0,$100,$200,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$100,$310,$600,$0,$100,"$1,000",$0,$0,32
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030044,MyHPN Platinum 1,95865NV003,,NVN001,NVS001,NVF004,Existing,HMO,Platinum,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030044-01,Standard Platinum On Exchange Plan,88.10%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,$0,$0,"$3,500","$7,000",$100,$200,0%,,,,$0,$0,$100,$200,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$100,$310,$600,$0,$100,"$1,000",$0,$0,33
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030044,MyHPN Platinum 1,95865NV003,,NVN001,NVS001,NVF004,Existing,HMO,Platinum,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030044-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,34
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030044,MyHPN Platinum 1,95865NV003,,NVN001,NVS001,NVF004,Existing,HMO,Platinum,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030044-03,Limited Cost Sharing Plan Variation,88.10%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,$0,$0,"$3,500","$7,000",$100,$200,0%,,,,$0,$0,$100,$200,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$100,$310,$600,$0,$100,"$1,000",$0,$0,35
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030017,MyHPN Silver 2/Medicaid Transition,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030017-00,Standard Silver Off Exchange Plan,69.80%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500","$2,500","$5,000",0%,,,,$0,$0,"$2,500","$5,000",$250,$500,0%,,,,$0,$0,$250,$500,,,,,,,,,,,"$2,500",$150,$0,$0,"$2,500",$210,$0,$0,36
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030017,MyHPN Silver 2/Medicaid Transition,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030017-01,Standard Silver On Exchange Plan,69.80%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500","$2,500","$5,000",0%,,,,$0,$0,"$2,500","$5,000",$250,$500,0%,,,,$0,$0,$250,$500,,,,,,,,,,,"$2,500",$150,$0,$0,"$2,500",$210,$0,$0,37
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030017,MyHPN Silver 2/Medicaid Transition,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030017-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,38
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030017,MyHPN Silver 2/Medicaid Transition,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030017-03,Limited Cost Sharing Plan Variation,69.80%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500","$2,500","$5,000",0%,,,,$0,$0,"$2,500","$5,000",$250,$500,0%,,,,$0,$0,$250,$500,,,,,,,,,,,"$2,500",$150,$0,$0,"$2,500",$210,$0,$0,39
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030017,MyHPN Silver 2/Medicaid Transition,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030017-04,73% AV Level Silver Plan,73.30%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,300","$8,600",,,$0,$0,"$4,300","$8,600","$2,500","$5,000",0%,,,,$0,$0,"$2,500","$5,000",$250,$500,0%,,,,$0,$0,$250,$500,,,,,,,,,,,"$2,500",$150,$0,$0,"$2,500",$210,$0,$0,40
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030017,MyHPN Silver 2/Medicaid Transition,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030017-05,87% AV Level Silver Plan,86.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,$0,$0,"$1,250","$2,500",$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$520,"$1,300",$0,$0,"$1,910",$0,$0,41
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030017,MyHPN Silver 2/Medicaid Transition,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030017-06,94% AV Level Silver Plan,93.20%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,$0,$0,$400,$800,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$520,"$1,300",$0,$0,"$1,910",$0,$0,42
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030018,MyHPN Silver 1,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030018-00,Standard Silver Off Exchange Plan,70.10%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,"$6,600","$13,200","$3,000","$6,000",0%,,,,$0,$0,"$3,000","$6,000",$250,$500,0%,,,,$0,$0,$250,$500,,,,,,,,,,,"$3,000",$150,$0,$0,"$3,000",$210,$0,$0,43
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030018,MyHPN Silver 1,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030018-01,Standard Silver On Exchange Plan,70.10%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,"$6,600","$13,200","$3,000","$6,000",0%,,,,$0,$0,"$3,000","$6,000",$250,$500,0%,,,,$0,$0,$250,$500,,,,,,,,,,,"$3,000",$150,$0,$0,"$3,000",$210,$0,$0,44
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030018,MyHPN Silver 1,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030018-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,45
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030018,MyHPN Silver 1,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030018-03,Limited Cost Sharing Plan Variation,70.10%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,"$6,600","$13,200","$3,000","$6,000",0%,,,,$0,$0,"$3,000","$6,000",$250,$500,0%,,,,$0,$0,$250,$500,,,,,,,,,,,"$3,000",$150,$0,$0,"$3,000",$210,$0,$0,46
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030018,MyHPN Silver 1,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030018-04,73% AV Level Silver Plan,74.00%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,$0,$0,"$4,500","$9,000","$3,000","$6,000",0%,,,,$0,$0,"$3,000","$6,000",$250,$500,0%,,,,$0,$0,$250,$500,,,,,,,,,,,"$3,000",$150,$0,$0,"$3,000",$210,$0,$0,47
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030018,MyHPN Silver 1,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030018-05,87% AV Level Silver Plan,87.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,$0,$0,"$1,250","$2,500",$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$520,"$2,000",$0,$0,"$1,790",$0,$0,48
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030018,MyHPN Silver 1,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030018-06,94% AV Level Silver Plan,94.40%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,$0,$0,$400,$800,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$520,"$2,000",$0,$0,"$1,790",$0,$0,49
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030014,MyHPN Silver 3,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030014-00,Standard Silver Off Exchange Plan,68.50%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500","$4,000","$8,000",0%,,,,$0,$0,"$4,000","$8,000",$250,$500,0%,,,,$0,$0,$250,$500,,,,,,,,,,,"$4,000",$150,$0,$0,"$4,000",$210,$0,$0,50
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030014,MyHPN Silver 3,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030014-01,Standard Silver On Exchange Plan,68.50%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,$0,$0,"$6,250","$12,500","$4,000","$8,000",0%,,,,$0,$0,"$4,000","$8,000",$250,$500,0%,,,,$0,$0,$250,$500,,,,,,,,,,,"$4,000",$150,$0,$0,"$4,000",$210,$0,$0,51
2015,NV,95865,SERFF,5,2014-10-06 10:59:03,1,95865,NV,Individual,No,88-0201035,95865NV0030014,MyHPN Silver 3,95865NV003,,NVN001,NVS001,NVF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Urgent and Emergent,No,www.myhpnonline.com,https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974,www.myhpnonline.com,myhpnonline.com,95865NV0030014-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,52
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230008,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS002,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230008-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,62
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230008,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS002,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230008-04,73% AV Level Silver Plan,,0.732454240322113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,63
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230007,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS001,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230007-04,73% AV Level Silver Plan,,0.732454240322113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230007,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS001,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230007-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,57
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230007,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS001,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230007-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,58
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230008,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS002,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230008-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,59
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230024,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS006,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230024-03,Limited Cost Sharing Plan Variation,70.06%,0.701249122619629,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,54
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230024,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS006,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230024-04,73% AV Level Silver Plan,72.76%,0.72764378786087,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,55
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230036,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS006,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230036-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230036,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS006,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230036-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,Individual,No,34-0922268,20126OH0560010,HealthSpanOne Silver 3000 HSA,20126OH056,,OHN001,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560010-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,Individual,No,34-0922268,20126OH0560010,HealthSpanOne Silver 3000 HSA,20126OH056,,OHN001,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560010-03,Limited Cost Sharing Plan Variation,71.70%,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$200,$0,"$3,000",$0,$0,$0,14
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,Individual,No,34-0922268,20126OH0560010,HealthSpanOne Silver 3000 HSA,20126OH056,,OHN001,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560010-04,73% AV Level Silver Plan,73.90%,0.738942980766296,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,650","$5,300",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,650",$15,$0,$0,"$2,750",$975,$0,$0,15
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,Individual,No,34-0922268,20126OH0560010,HealthSpanOne Silver 3000 HSA,20126OH056,,OHN001,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560010-05,87% AV Level Silver Plan,87.70%,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$0,$0,$0,"$1,000",$0,$0,$0,16
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,Individual,No,34-0922268,20126OH0560010,HealthSpanOne Silver 3000 HSA,20126OH056,,OHN001,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560010-06,94% AV Level Silver Plan,93.30%,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$0,$500,$0,$0,$0,17
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,Individual,No,34-0922268,20126OH0560007,HealthSpanOne Bronze 4000-70 HSA,20126OH056,,OHN001,OHS001,OHF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560007-00,Standard Bronze Off Exchange Plan,60.30%,0.602802217006683,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,900",$0,$725,$0,"$4,000",$0,$400,$0,18
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230009,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS003,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230009-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,66
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230009,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS003,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230009-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,67
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230009,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS003,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,68
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230009,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS003,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230009-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,69
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230010,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS004,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230010-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,74
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230010,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS004,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,75
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230027,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS003,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230027-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,90
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230027,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS003,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230027-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,91
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230008,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS002,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230008-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,64
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230008,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS002,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230008-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,65
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230018,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS006,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230018-00,Standard Bronze Off Exchange Plan,61.30%,0.627785980701447,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230018,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS006,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230018-01,Standard Bronze On Exchange Plan,61.30%,0.627785980701447,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230001,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS001,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,18
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230001,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS001,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230001-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230002,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS002,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230002-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230002,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS002,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230002-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230010,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS004,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230010-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,78
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230010,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS004,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230010-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,79
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230009,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS003,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230009-04,73% AV Level Silver Plan,,0.732454240322113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,70
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230009,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS003,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230009-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,71
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230009,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS003,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230009-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,72
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230010,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS004,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230010-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,73
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230011,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS005,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230011-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,80
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230011,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS005,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230011-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,81
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230011,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS005,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,82
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230011,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS005,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230011-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,83
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230011,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS005,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230011-04,73% AV Level Silver Plan,,0.732454240322113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,84
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230011,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS005,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230011-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,85
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230011,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS005,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230011-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,86
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230012,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS006,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230012-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,87
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230002,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS002,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,22
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230002,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS002,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230002-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230003,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS003,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230003-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230003,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS003,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230003-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230003,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS003,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,26
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230003,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS003,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230003-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230004,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS004,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230004-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230004,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS004,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230004-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230004,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS004,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,30
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230004,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS004,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230004-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230005,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS005,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230005-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230005,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS005,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230005-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230005,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS005,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,34
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230005,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS005,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230005-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230006,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS006,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230006-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230006,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS006,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230006-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230006,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS006,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,38
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230006,Assurant Health Bronze Plan 001,14650OH023,,OHN001,OHS006,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230006-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230007,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS001,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230007-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,52
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230007,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS001,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230007-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,53
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230007,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS001,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,54
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230007,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS001,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230007-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,55
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230010,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS004,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230010-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,76
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230010,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS004,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230010-04,73% AV Level Silver Plan,,0.732454240322113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,77
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230021,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS003,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230021-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,32
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230021,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS003,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230021-03,Limited Cost Sharing Plan Variation,70.06%,0.701249122619629,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230030,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS006,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230030-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,102
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230030,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS006,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230030-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,103
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230030,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS006,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230030-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,104
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230030,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS006,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230030-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,105
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230031,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS001,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230031-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230031,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS001,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230031-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230031,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS001,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230031-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,18
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230031,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS001,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230031-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,4,16204,OH,Individual,No,45-4748792,16204OH0070005,InHealth Silver 2000-DC70,16204OH007,,OHN001,OHS001,OHF005,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9991,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-silver-2000-dc70,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070005-05,87% AV Level Silver Plan,,0.860178112983704,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,4,16204,OH,Individual,No,45-4748792,16204OH0070005,InHealth Silver 2000-DC70,16204OH007,,OHN001,OHS001,OHF005,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9991,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-silver-2000-dc70,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070005-06,94% AV Level Silver Plan,,0.940738439559937,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230012,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS006,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230012-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,88
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230012,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS006,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,89
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230012,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS006,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230012-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,90
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230012,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS006,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230012-04,73% AV Level Silver Plan,,0.732454240322113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,91
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230012,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS006,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230012-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,92
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,1,14650,OH,Individual,No,39-0658730,14650OH0230012,Assurant Health Silver Plan 001,14650OH023,,OHN001,OHS006,OHF001,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S001.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230012-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,93
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230013,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS001,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230013-00,Standard Bronze Off Exchange Plan,61.30%,0.627785980701447,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230013,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS001,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230013-01,Standard Bronze On Exchange Plan,61.30%,0.627785980701447,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230013,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS001,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230013-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,18
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230013,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS001,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230013-03,Limited Cost Sharing Plan Variation,61.30%,0.627785980701447,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230014,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS002,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230014-00,Standard Bronze Off Exchange Plan,61.30%,0.627785980701447,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230014,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS002,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230014-01,Standard Bronze On Exchange Plan,61.30%,0.627785980701447,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230014,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS002,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230014-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,22
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230014,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS002,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230014-03,Limited Cost Sharing Plan Variation,61.30%,0.627785980701447,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230015,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS003,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230015-00,Standard Bronze Off Exchange Plan,61.30%,0.627785980701447,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230015,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS003,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230015-01,Standard Bronze On Exchange Plan,61.30%,0.627785980701447,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230015,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS003,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230015-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,26
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230015,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS003,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230015-03,Limited Cost Sharing Plan Variation,61.30%,0.627785980701447,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230016,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS004,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230016-00,Standard Bronze Off Exchange Plan,61.30%,0.627785980701447,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230016,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS004,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230016-01,Standard Bronze On Exchange Plan,61.30%,0.627785980701447,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230016,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS004,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230016-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,30
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230016,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS004,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230016-03,Limited Cost Sharing Plan Variation,61.30%,0.627785980701447,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230017,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS005,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230017-00,Standard Bronze Off Exchange Plan,61.30%,0.627785980701447,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230017,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS005,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230017-01,Standard Bronze On Exchange Plan,61.30%,0.627785980701447,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230017,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS005,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230017-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,34
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230017,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS005,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230017-03,Limited Cost Sharing Plan Variation,61.30%,0.627785980701447,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230018,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS006,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230018-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,38
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,5,14650,OH,Individual,No,39-0658730,14650OH0230018,Assurant Health Bronze Plan 002,14650OH023,,OHN001,OHS006,OHF003,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Low Back Pain",,1,,,0,0,4,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_B002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier2.pdf,14650OH0230018-03,Limited Cost Sharing Plan Variation,61.30%,0.627785980701447,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",25%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230019,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS001,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230019-00,Standard Silver Off Exchange Plan,70.06%,0.701249122619629,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230019,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS001,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230019-01,Standard Silver On Exchange Plan,70.06%,0.701249122619629,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230026,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS002,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230026-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,88
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230026,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS002,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230026-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,89
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230027,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS003,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230027-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,92
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230027,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS003,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230027-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,93
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,2,16204,OH,Individual,No,45-4748792,16204OH0070003,InHealth Bronze 6000-DC60,16204OH007,,OHN001,OHS001,OHF003,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9989,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-bronze-6000-dc60,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070003-03,Limited Cost Sharing Plan Variation,,0.619362652301788,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$6,000","$12,000",40%,,,,"$18,000","$36,000","$24,000","$48,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,3,16204,OH,Individual,No,45-4748792,16204OH0070004,InHealth Gold 1000-DC80,16204OH007,,OHN001,OHS001,OHF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9992,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-gold-1000-dc80,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070004-00,Standard Gold Off Exchange Plan,,0.794395089149475,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$3,000","$6,000","$4,000","$8,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,3,16204,OH,Individual,No,45-4748792,16204OH0070004,InHealth Gold 1000-DC80,16204OH007,,OHN001,OHS001,OHF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9992,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-gold-1000-dc80,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070004-01,Standard Gold On Exchange Plan,,0.794395089149475,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$3,000","$6,000","$4,000","$8,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,3,16204,OH,Individual,No,45-4748792,16204OH0070004,InHealth Gold 1000-DC80,16204OH007,,OHN001,OHS001,OHF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9992,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-gold-1000-dc80,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,3,16204,OH,Individual,No,45-4748792,16204OH0070004,InHealth Gold 1000-DC80,16204OH007,,OHN001,OHS001,OHF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9992,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-gold-1000-dc80,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070004-03,Limited Cost Sharing Plan Variation,,0.794395089149475,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$3,000","$6,000","$4,000","$8,000",$0,$0,20%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,4,16204,OH,Individual,No,45-4748792,16204OH0070005,InHealth Silver 2000-DC70,16204OH007,,OHN001,OHS001,OHF005,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9991,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-silver-2000-dc70,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070005-00,Standard Silver Off Exchange Plan,,0.702601075172424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230019,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS001,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230019-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,18
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230019,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS001,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230019-03,Limited Cost Sharing Plan Variation,70.06%,0.701249122619629,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230019,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS001,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230019-04,73% AV Level Silver Plan,72.76%,0.72764378786087,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230019,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS001,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230019-05,87% AV Level Silver Plan,86.33%,0.863292634487152,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230019,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS001,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230019-06,94% AV Level Silver Plan,94.29%,0.942939519882202,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,22
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230020,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS002,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230020-00,Standard Silver Off Exchange Plan,70.06%,0.701249122619629,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230020,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS002,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230020-01,Standard Silver On Exchange Plan,70.06%,0.701249122619629,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230020,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS002,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230020-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,25
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230020,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS002,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230020-03,Limited Cost Sharing Plan Variation,70.06%,0.701249122619629,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,26
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230020,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS002,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230020-04,73% AV Level Silver Plan,72.76%,0.72764378786087,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230020,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS002,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230020-05,87% AV Level Silver Plan,86.33%,0.863292634487152,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230020,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS002,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230020-06,94% AV Level Silver Plan,94.29%,0.942939519882202,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230021,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS003,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230021-00,Standard Silver Off Exchange Plan,70.06%,0.701249122619629,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,30
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230021,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS003,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230021-01,Standard Silver On Exchange Plan,70.06%,0.701249122619629,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230021,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS003,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230021-04,73% AV Level Silver Plan,72.76%,0.72764378786087,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230021,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS003,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230021-05,87% AV Level Silver Plan,86.33%,0.863292634487152,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230021,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS003,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230021-06,94% AV Level Silver Plan,94.29%,0.942939519882202,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,36
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230022,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS004,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230022-00,Standard Silver Off Exchange Plan,70.06%,0.701249122619629,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,37
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230022,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS004,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230022-01,Standard Silver On Exchange Plan,70.06%,0.701249122619629,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,38
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230022,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS004,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230022-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,39
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230022,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS004,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230022-03,Limited Cost Sharing Plan Variation,70.06%,0.701249122619629,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,40
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230022,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS004,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230022-04,73% AV Level Silver Plan,72.76%,0.72764378786087,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,41
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230022,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS004,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230022-05,87% AV Level Silver Plan,86.33%,0.863292634487152,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,42
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230022,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS004,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230022-06,94% AV Level Silver Plan,94.29%,0.942939519882202,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,43
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230023,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS005,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230023-00,Standard Silver Off Exchange Plan,70.06%,0.701249122619629,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,44
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230023,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS005,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230023-01,Standard Silver On Exchange Plan,70.06%,0.701249122619629,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230023,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS005,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230023-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,46
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230023,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS005,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230023-03,Limited Cost Sharing Plan Variation,70.06%,0.701249122619629,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,47
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230023,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS005,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230023-04,73% AV Level Silver Plan,72.76%,0.72764378786087,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230023,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS005,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230023-05,87% AV Level Silver Plan,86.33%,0.863292634487152,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,49
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230023,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS005,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230023-06,94% AV Level Silver Plan,94.29%,0.942939519882202,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,50
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230024,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS006,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230024-00,Standard Silver Off Exchange Plan,70.06%,0.701249122619629,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,51
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230024,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS006,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230024-01,Standard Silver On Exchange Plan,70.06%,0.701249122619629,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",50%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,52
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230024,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS006,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230024-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,53
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230024,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS006,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230024-05,87% AV Level Silver Plan,86.33%,0.863292634487152,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,56
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230024,Assurant Health Silver Plan 002,14650OH023,,OHN001,OHS006,OHF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,10,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_S002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230024-06,94% AV Level Silver Plan,94.29%,0.942939519882202,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,57
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230025,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS001,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230025-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,82
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230025,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS001,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230025-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,83
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230025,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS001,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230025-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,84
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230025,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS001,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230025-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,85
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,1,16204,OH,Individual,No,45-4748792,16204OH0070002,InHealth Silver 2000-3070,16204OH007,,OHN001,OHS001,OHF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9991,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-silver-2000-3070,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070002-06,94% AV Level Silver Plan,,0.945085525512695,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$250,$500,30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,2,16204,OH,Individual,No,45-4748792,16204OH0070003,InHealth Bronze 6000-DC60,16204OH007,,OHN001,OHS001,OHF003,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9989,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-bronze-6000-dc60,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070003-00,Standard Bronze Off Exchange Plan,,0.619362652301788,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$6,000","$12,000",40%,,,,"$18,000","$36,000","$24,000","$48,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,2,16204,OH,Individual,No,45-4748792,16204OH0070003,InHealth Bronze 6000-DC60,16204OH007,,OHN001,OHS001,OHF003,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9989,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-bronze-6000-dc60,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070003-01,Standard Bronze On Exchange Plan,,0.619362652301788,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,400","$12,800",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$6,000","$12,000",40%,,,,"$18,000","$36,000","$24,000","$48,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,2,16204,OH,Individual,No,45-4748792,16204OH0070003,InHealth Bronze 6000-DC60,16204OH007,,OHN001,OHS001,OHF003,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9989,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-bronze-6000-dc60,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,4,16204,OH,Individual,No,45-4748792,16204OH0070005,InHealth Silver 2000-DC70,16204OH007,,OHN001,OHS001,OHF005,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9991,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-silver-2000-dc70,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070005-01,Standard Silver On Exchange Plan,,0.702601075172424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,4,16204,OH,Individual,No,45-4748792,16204OH0070005,InHealth Silver 2000-DC70,16204OH007,,OHN001,OHS001,OHF005,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9991,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-silver-2000-dc70,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,4,16204,OH,Individual,No,45-4748792,16204OH0070005,InHealth Silver 2000-DC70,16204OH007,,OHN001,OHS001,OHF005,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9991,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-silver-2000-dc70,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070005-03,Limited Cost Sharing Plan Variation,,0.702601075172424,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,4,16204,OH,Individual,No,45-4748792,16204OH0070005,InHealth Silver 2000-DC70,16204OH007,,OHN001,OHS001,OHF005,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9991,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-silver-2000-dc70,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070005-04,73% AV Level Silver Plan,,0.728946208953857,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,5,16204,OH,Individual,No,45-4748792,16204OH0070006,InHealth Gold 2000 HSA,16204OH007,,OHN001,OHS001,OHF004,New,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9992,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-gold-2000-hsa,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070006-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,5,16204,OH,Individual,No,45-4748792,16204OH0070006,InHealth Gold 2000 HSA,16204OH007,,OHN001,OHS001,OHF004,New,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9992,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-gold-2000-hsa,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070006-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,5,16204,OH,Individual,No,45-4748792,16204OH0070006,InHealth Gold 2000 HSA,16204OH007,,OHN001,OHS001,OHF004,New,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9992,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-gold-2000-hsa,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,5,16204,OH,Individual,No,45-4748792,16204OH0070006,InHealth Gold 2000 HSA,16204OH007,,OHN001,OHS001,OHF004,New,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9992,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-gold-2000-hsa,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070006-03,Limited Cost Sharing Plan Variation,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,5,16204,OH,Individual,No,45-4748792,16204OH0070007,InHealth Silver 3500 HSA,16204OH007,,OHN001,OHS001,OHF004,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-silver-3500-hsa,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070007-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,5,16204,OH,Individual,No,45-4748792,16204OH0070008,InHealth Bronze 6000 HSA,16204OH007,,OHN001,OHS001,OHF004,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9988,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-bronze-6000-hsa,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070008-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$25,400","$50,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,15
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230026,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS002,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230026-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,86
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230026,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS002,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230026-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,87
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230028,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS004,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230028-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,94
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230028,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS004,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230028-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,95
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230028,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS004,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230028-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,96
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230028,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS004,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230028-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,97
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230029,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS005,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230029-00,Standard Gold Off Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,98
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230029,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS005,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230029-01,Standard Gold On Exchange Plan,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,99
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230029,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS005,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230029-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,100
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,7,14650,OH,Individual,No,39-0658730,14650OH0230029,Assurant Health Gold Plan 002,14650OH023,,OHN001,OHS005,OHF006,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_G002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230029-03,Limited Cost Sharing Plan Variation,,0.816743195056915,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,101
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,5,16204,OH,Individual,No,45-4748792,16204OH0070007,InHealth Silver 3500 HSA,16204OH007,,OHN001,OHS001,OHF004,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-silver-3500-hsa,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070007-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,5,16204,OH,Individual,No,45-4748792,16204OH0070007,InHealth Silver 3500 HSA,16204OH007,,OHN001,OHS001,OHF004,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-silver-3500-hsa,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070007-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,5,16204,OH,Individual,No,45-4748792,16204OH0070007,InHealth Silver 3500 HSA,16204OH007,,OHN001,OHS001,OHF004,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-silver-3500-hsa,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,5,16204,OH,Individual,No,45-4748792,16204OH0070007,InHealth Silver 3500 HSA,16204OH007,,OHN001,OHS001,OHF004,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-silver-3500-hsa,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070007-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,5,16204,OH,Individual,No,45-4748792,16204OH0070007,InHealth Silver 3500 HSA,16204OH007,,OHN001,OHS001,OHF004,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-silver-3500-hsa,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070007-04,73% AV Level Silver Plan,,0.732454240322113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,5,16204,OH,Individual,No,45-4748792,16204OH0070007,InHealth Silver 3500 HSA,16204OH007,,OHN001,OHS001,OHF004,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-silver-3500-hsa,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070007-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230032,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS002,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230032-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230032,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS002,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230032-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230032,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS002,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230032-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,22
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230032,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS002,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230032-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230033,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS003,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230033-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,24
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230033,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS003,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230033-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,25
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230033,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS003,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230033-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,26
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230033,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS003,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230033-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,27
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230034,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS004,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230034-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230034,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS004,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230034-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230034,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS004,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230034-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,30
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230034,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS004,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230034-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230035,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS005,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230035-00,Standard Platinum Off Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230035,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS005,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230035-01,Standard Platinum On Exchange Plan,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230035,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS005,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230035-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,34
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230035,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS005,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230035-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,35
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230036,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS006,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230036-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,38
2015,OH,14650,SERFF,10,2014-11-15 10:06:04,8,14650,OH,Individual,No,39-0658730,14650OH0230036,Assurant Health Platinum Plan 002,14650OH023,,OHN001,OHS006,OHF007,New,PPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Depression, Low Back Pain",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Coverage will be provided for any treatment received outside of the United States, at the Participating Provider benefit level and may be subject to the Maximum Allowable Amount",Yes,Non-Participating Providers may bill more than We determine to be a Maximum Allowable Amount and the Covered Person is responsible for payment of any amount billed above the Maximum Allowable Amount,Yes,http://www.assuranthealth.com/sbc/PROD/SBC_OH_P002.pdf,https://consumer.eassuranthealth.com/IM/Consumer/EASE/Application/MarketplaceCheckout,http://www.assuranthealth.com/brochures/30740-OH.pdf,http://www.assuranthealth.com/brochures/preferred-drug-list/AssurantHealthPreferredDrugListTier3.pdf,14650OH0230036-03,Limited Cost Sharing Plan Variation,,0.88065505027771,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,25%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,39
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,1,16204,OH,Individual,No,45-4748792,16204OH0070001,InHealth Gold 2000-2080,16204OH007,,OHN001,OHS001,OHF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9992,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-gold-2000-2080,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070001-00,Standard Gold Off Exchange Plan,,0.786710381507874,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,1,16204,OH,SHOP (Small Group),No,45-4748792,16204OH0020009,InHealth Gold 2000 HSA,16204OH002,,OHN001,OHS001,OHF004,New,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,Yes,http://inhealthohio.org/summary-of-benefits-coverage/small-group-inhealth-gold-2000-hsa,,http://inhealthohio.org/plan-brochure-group,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0020009-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,1,16204,OH,SHOP (Small Group),No,45-4748792,16204OH0020009,InHealth Gold 2000 HSA,16204OH002,,OHN001,OHS001,OHF004,New,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9989,,,0,0,0,2015-01-01,2015-12-31,No,,No,,Yes,http://inhealthohio.org/summary-of-benefits-coverage/small-group-inhealth-gold-2000-hsa,,http://inhealthohio.org/plan-brochure-group,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0020009-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,1,16204,OH,Individual,No,45-4748792,16204OH0070001,InHealth Gold 2000-2080,16204OH007,,OHN001,OHS001,OHF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9992,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-gold-2000-2080,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070001-01,Standard Gold On Exchange Plan,,0.786710381507874,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,1,16204,OH,Individual,No,45-4748792,16204OH0070001,InHealth Gold 2000-2080,16204OH007,,OHN001,OHS001,OHF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9992,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-gold-2000-2080,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,1,16204,OH,SHOP (Small Group),No,45-4748792,16204OH0020010,InHealth Silver  2050 HSA,16204OH002,,OHN001,OHS001,OHF006,New,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9987,,,0,0,0,2015-01-01,2015-12-31,No,,No,,Yes,http://inhealthohio.org/summary-of-benefits-coverage/small-group-inhealth-silver-2050-hsa,,http://inhealthohio.org/plan-brochure-group,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0020010-00,Standard Silver Off Exchange Plan,,0.686099529266357,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,050","$4,100",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,1,16204,OH,SHOP (Small Group),No,45-4748792,16204OH0020010,InHealth Silver  2050 HSA,16204OH002,,OHN001,OHS001,OHF006,New,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9987,,,0,0,0,2015-01-01,2015-12-31,No,,No,,Yes,http://inhealthohio.org/summary-of-benefits-coverage/small-group-inhealth-silver-2050-hsa,,http://inhealthohio.org/plan-brochure-group,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0020010-01,Standard Silver On Exchange Plan,,0.686099529266357,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,050","$4,100",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,1,16204,OH,Individual,No,45-4748792,16204OH0070001,InHealth Gold 2000-2080,16204OH007,,OHN001,OHS001,OHF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9992,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-gold-2000-2080,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070001-03,Limited Cost Sharing Plan Variation,,0.786710381507874,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,1,16204,OH,Individual,No,45-4748792,16204OH0070002,InHealth Silver 2000-3070,16204OH007,,OHN001,OHS001,OHF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9991,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-silver-2000-3070,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070002-00,Standard Silver Off Exchange Plan,,0.706096768379211,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,1,16204,OH,Individual,No,45-4748792,16204OH0070002,InHealth Silver 2000-3070,16204OH007,,OHN001,OHS001,OHF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9991,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-silver-2000-3070,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070002-01,Standard Silver On Exchange Plan,,0.706096768379211,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,1,16204,OH,Individual,No,45-4748792,16204OH0070002,InHealth Silver 2000-3070,16204OH007,,OHN001,OHS001,OHF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9991,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-silver-2000-3070,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,1,16204,OH,Individual,No,45-4748792,16204OH0070002,InHealth Silver 2000-3070,16204OH007,,OHN001,OHS001,OHF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9991,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-silver-2000-3070,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070002-03,Limited Cost Sharing Plan Variation,,0.706096768379211,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,1,16204,OH,Individual,No,45-4748792,16204OH0070002,InHealth Silver 2000-3070,16204OH007,,OHN001,OHS001,OHF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9991,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-silver-2000-3070,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070002-04,73% AV Level Silver Plan,,0.737597286701202,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,1,16204,OH,Individual,No,45-4748792,16204OH0070002,InHealth Silver 2000-3070,16204OH007,,OHN001,OHS001,OHF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9991,,,0,2,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-silver-2000-3070,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070002-05,87% AV Level Silver Plan,,0.863263785839081,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,5,16204,OH,Individual,No,45-4748792,16204OH0070008,InHealth Bronze 6000 HSA,16204OH007,,OHN001,OHS001,OHF004,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9988,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-bronze-6000-hsa,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070008-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$25,400","$50,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,16
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,5,16204,OH,Individual,No,45-4748792,16204OH0070008,InHealth Bronze 6000 HSA,16204OH007,,OHN001,OHS001,OHF004,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9988,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-bronze-6000-hsa,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,17
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,5,16204,OH,Individual,No,45-4748792,16204OH0070008,InHealth Bronze 6000 HSA,16204OH007,,OHN001,OHS001,OHF004,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9988,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-bronze-6000-hsa,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070008-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$25,400","$50,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,18
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,6,16204,OH,Individual,No,45-4748792,16204OH0070009,InHealth Catastrophic 6600-DC100,16204OH007,,OHN001,OHS001,OHF004,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9978,,,0,3,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-catastrophic-6600-dc100,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070009-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,16204,SERFF,8,2014-11-04 20:29:03,6,16204,OH,Individual,No,45-4748792,16204OH0070009,InHealth Catastrophic 6600-DC100,16204OH007,,OHN001,OHS001,OHF004,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9978,,,0,3,0,2015-01-01,2015-12-31,No,,Yes,As required under Ohio law.,Yes,http://inhealthohio.org/summary-of-benefits-coverage/individual-inhealth-catastrophic-6600-dc100,,http://inhealthohio.org/plan-brochure-individual,https://inhealthmutual.procarerx.com/BenefitsAndCoveragePP/FormularySearch,16204OH0070009-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,1,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550001,HealthSpan Gold 250-70,20126OH055,,OHN001,OHS001,OHF002,Existing,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550001-00,Standard Gold Off Exchange Plan,79.90%,0.797928094863892,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500.00,$15.00,"$2,050.00",$0.00,$100.00,$760.00,$0.00,$0.00,4
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,1,20126,OH,Individual,No,34-0922268,20126OH0560001,HealthSpanOne Gold 250-70,20126OH056,,OHN001,OHS001,OHF002,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560001-00,Standard Gold Off Exchange Plan,79.90%,0.797928094863892,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$15,"$2,050",$0,$100,$900,$0,$0,4
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,1,20126,OH,Individual,No,34-0922268,20126OH0560001,HealthSpanOne Gold 250-70,20126OH056,,OHN001,OHS001,OHF002,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560001-01,Standard Gold On Exchange Plan,79.90%,0.797928094863892,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$15,"$2,050",$0,$100,$900,$0,$0,5
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,1,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550001,HealthSpan Gold 250-70,20126OH055,,OHN001,OHS001,OHF002,Existing,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550001-01,Standard Gold On Exchange Plan,79.90%,0.797928094863892,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500.00,$15.00,"$2,050.00",$0.00,$100.00,$760.00,$0.00,$0.00,5
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,1,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550002,HealthSpan Gold 500-80,20126OH055,,OHN001,OHS001,OHF002,Existing,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550002-00,Standard Gold Off Exchange Plan,81.60%,0.815024197101593,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000.00",$15.00,"$1,200.00",$0.00,$100.00,$775.00,$0.00,$0.00,6
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,1,20126,OH,Individual,No,34-0922268,20126OH0560001,HealthSpanOne Gold 250-70,20126OH056,,OHN001,OHS001,OHF002,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,1,20126,OH,Individual,No,34-0922268,20126OH0560001,HealthSpanOne Gold 250-70,20126OH056,,OHN001,OHS001,OHF002,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560001-03,Limited Cost Sharing Plan Variation,79.90%,0.797928094863892,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$15,"$2,050",$0,$100,$900,$0,$0,7
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,1,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550002,HealthSpan Gold 500-80,20126OH055,,OHN001,OHS001,OHF002,Existing,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550002-01,Standard Gold On Exchange Plan,81.60%,0.815024197101593,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000.00",$15.00,"$1,200.00",$0.00,$100.00,$775.00,$0.00,$0.00,7
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,1,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550003,HealthSpan Gold 1000-80,20126OH055,,OHN001,OHS001,OHF002,Existing,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550003-00,Standard Gold Off Exchange Plan,80.70%,0.805820167064667,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900.00",$15.00,"$1,075.00",$0.00,$100.00,$760.00,$0.00,$0.00,8
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,1,20126,OH,Individual,No,34-0922268,20126OH0560002,HealthSpanOne Gold 1000-80,20126OH056,,OHN001,OHS001,OHF002,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560002-00,Standard Gold Off Exchange Plan,78.90%,0.787488698959351,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$15,"$1,075",$0,$100,$900,$0,$0,8
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,1,20126,OH,Individual,No,34-0922268,20126OH0560002,HealthSpanOne Gold 1000-80,20126OH056,,OHN001,OHS001,OHF002,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560002-01,Standard Gold On Exchange Plan,78.90%,0.787488698959351,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$15,"$1,075",$0,$100,$900,$0,$0,9
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,1,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550003,HealthSpan Gold 1000-80,20126OH055,,OHN001,OHS001,OHF002,Existing,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550003-01,Standard Gold On Exchange Plan,80.70%,0.805820167064667,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900.00",$15.00,"$1,075.00",$0.00,$100.00,$760.00,$0.00,$0.00,9
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,1,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550012,HealthSpan Gold 1500-80,20126OH055,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550012-00,Standard Gold Off Exchange Plan,80.30%,0.802451968193054,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400.00",$15.00,$975.00,$0.00,$100.00,$760.00,$0.00,$0.00,10
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,1,20126,OH,Individual,No,34-0922268,20126OH0560002,HealthSpanOne Gold 1000-80,20126OH056,,OHN001,OHS001,OHF002,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,1,20126,OH,Individual,No,34-0922268,20126OH0560002,HealthSpanOne Gold 1000-80,20126OH056,,OHN001,OHS001,OHF002,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560002-03,Limited Cost Sharing Plan Variation,78.90%,0.787488698959351,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900",$15,"$1,075",$0,$100,$900,$0,$0,11
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,1,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550012,HealthSpan Gold 1500-80,20126OH055,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550012-01,Standard Gold On Exchange Plan,80.30%,0.802451968193054,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400.00",$15.00,$975.00,$0.00,$100.00,$760.00,$0.00,$0.00,11
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,1,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550013,HealthSpan Gold 2000-100,20126OH055,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550013-00,Standard Gold Off Exchange Plan,79.60%,0.79167252779007,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900.00",$15.00,$0.00,$0.00,$100.00,$760.00,$0.00,$0.00,12
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,1,20126,OH,Individual,No,34-0922268,20126OH0560008,HealthSpanOne Gold 2000-100,20126OH056,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560008-00,Standard Gold Off Exchange Plan,79.60%,0.794934391975403,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$15,$0,$0,$100,$900,$0,$0,12
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,1,20126,OH,Individual,No,34-0922268,20126OH0560008,HealthSpanOne Gold 2000-100,20126OH056,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560008-01,Standard Gold On Exchange Plan,79.60%,0.794934391975403,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$15,$0,$0,$100,$900,$0,$0,13
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,1,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550013,HealthSpan Gold 2000-100,20126OH055,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550013-01,Standard Gold On Exchange Plan,79.60%,0.79167252779007,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900.00",$15.00,$0.00,$0.00,$100.00,$760.00,$0.00,$0.00,13
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,1,20126,OH,Individual,No,34-0922268,20126OH0560008,HealthSpanOne Gold 2000-100,20126OH056,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560008-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,1,20126,OH,Individual,No,34-0922268,20126OH0560008,HealthSpanOne Gold 2000-100,20126OH056,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560008-03,Limited Cost Sharing Plan Variation,79.60%,0.794934391975403,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$15,$0,$0,$100,$900,$0,$0,15
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,Individual,No,34-0922268,20126OH0560006,HealthSpanOne Silver 1500-70 HSA,20126OH056,,OHN001,OHS001,OHF003,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560006-00,Standard Silver Off Exchange Plan,70.10%,0.70112931728363,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$0,"$1,300",$0,"$1,500",$0,"$1,150",$0,4
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550008,HealthSpan Silver 1500-70 HSA,20126OH055,,OHN001,OHS001,OHF003,Existing,HMO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550008-00,Standard Silver Off Exchange Plan,70.10%,0.70112931728363,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000.00",$0.00,"$1,300.00",$0.00,"$3,000.00",$0.00,$700.00,$0.00,4
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550008,HealthSpan Silver 1500-70 HSA,20126OH055,,OHN001,OHS001,OHF003,Existing,HMO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550008-01,Standard Silver On Exchange Plan,70.10%,0.70112931728363,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000.00",$0.00,"$1,300.00",$0.00,"$3,000.00",$0.00,$700.00,$0.00,5
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,Individual,No,34-0922268,20126OH0560006,HealthSpanOne Silver 1500-70 HSA,20126OH056,,OHN001,OHS001,OHF003,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560006-01,Standard Silver On Exchange Plan,70.10%,0.70112931728363,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$0,"$1,300",$0,"$1,500",$0,"$1,150",$0,5
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,Individual,No,34-0922268,20126OH0560006,HealthSpanOne Silver 1500-70 HSA,20126OH056,,OHN001,OHS001,OHF003,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550015,HealthSpan Silver 3000 HSA,20126OH055,,OHN001,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550015-00,Standard Silver Off Exchange Plan,71.70%,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900.00",$0.00,$0.00,$0.00,"$3,000.00",$0.00,$0.00,$0.00,6
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550015,HealthSpan Silver 3000 HSA,20126OH055,,OHN001,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550015-01,Standard Silver On Exchange Plan,71.70%,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900.00",$0.00,$0.00,$0.00,"$3,000.00",$0.00,$0.00,$0.00,7
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,Individual,No,34-0922268,20126OH0560006,HealthSpanOne Silver 1500-70 HSA,20126OH056,,OHN001,OHS001,OHF003,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560006-03,Limited Cost Sharing Plan Variation,70.10%,0.70112931728363,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$0,"$1,300",$0,"$1,500",$0,"$1,150",$0,7
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,Individual,No,34-0922268,20126OH0560006,HealthSpanOne Silver 1500-70 HSA,20126OH056,,OHN001,OHS001,OHF003,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560006-04,73% AV Level Silver Plan,73.30%,0.733255684375763,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,200",$0,"$1,800",$0,"$1,300",$0,"$1,200",$0,8
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550011,HealthSpan Bronze 4000-70 HSA,20126OH055,,OHN001,OHS001,OHF003,Existing,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550011-00,Standard Bronze Off Exchange Plan,60.30%,0.602802217006683,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,900.00",$0.00,$725.00,$0.00,$400.00,$0.00,$370.00,$0.00,8
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550011,HealthSpan Bronze 4000-70 HSA,20126OH055,,OHN001,OHS001,OHF003,Existing,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550011-01,Standard Bronze On Exchange Plan,60.30%,0.602802217006683,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,900.00",$0.00,$725.00,$0.00,$400.00,$0.00,$370.00,$0.00,9
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,Individual,No,34-0922268,20126OH0560006,HealthSpanOne Silver 1500-70 HSA,20126OH056,,OHN001,OHS001,OHF003,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560006-05,87% AV Level Silver Plan,86.80%,0.86842954158783,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,"$1,360",$0,$250,$0,"$1,425",$0,9
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,Individual,No,34-0922268,20126OH0560006,HealthSpanOne Silver 1500-70 HSA,20126OH056,,OHN001,OHS001,OHF003,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560006-06,94% AV Level Silver Plan,93.60%,0.935748636722565,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$730,$0,$0,$0,"$1,415",$0,10
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550016,HealthSpan Bronze 6000 HSA,20126OH055,,OHN001,OHS001,OHF005,New,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550016-00,Standard Bronze Off Exchange Plan,59.20%,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900.00",$0.00,$0.00,$0.00,"$5,325.00",$0.00,$0.00,$0.00,10
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550016,HealthSpan Bronze 6000 HSA,20126OH055,,OHN001,OHS001,OHF005,New,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550016-01,Standard Bronze On Exchange Plan,59.20%,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,900.00",$0.00,$0.00,$0.00,"$5,325.00",$0.00,$0.00,$0.00,11
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,Individual,No,34-0922268,20126OH0560010,HealthSpanOne Silver 3000 HSA,20126OH056,,OHN001,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560010-00,Standard Silver Off Exchange Plan,71.70%,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$200,$0,"$3,000",$0,$0,$0,11
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,Individual,No,34-0922268,20126OH0560010,HealthSpanOne Silver 3000 HSA,20126OH056,,OHN001,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560010-01,Standard Silver On Exchange Plan,71.70%,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,900",$0,$200,$0,"$3,000",$0,$0,$0,12
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,Individual,No,34-0922268,20126OH0560007,HealthSpanOne Bronze 4000-70 HSA,20126OH056,,OHN001,OHS001,OHF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560007-01,Standard Bronze On Exchange Plan,60.30%,0.602802217006683,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,900",$0,$725,$0,"$4,000",$0,$400,$0,19
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,Individual,No,34-0922268,20126OH0560007,HealthSpanOne Bronze 4000-70 HSA,20126OH056,,OHN001,OHS001,OHF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,Individual,No,34-0922268,20126OH0560007,HealthSpanOne Bronze 4000-70 HSA,20126OH056,,OHN001,OHS001,OHF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560007-03,Limited Cost Sharing Plan Variation,60.30%,0.602802217006683,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,900",$0,$725,$0,"$4,000",$0,$400,$0,21
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,Individual,No,34-0922268,20126OH0560011,HealthSpanOne Bronze 6000 HSA,20126OH056,,OHN001,OHS001,OHF005,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560011-00,Standard Bronze Off Exchange Plan,59.20%,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$0,$0,"$5,325",$0,$0,$0,22
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,Individual,No,34-0922268,20126OH0560011,HealthSpanOne Bronze 6000 HSA,20126OH056,,OHN001,OHS001,OHF005,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560011-01,Standard Bronze On Exchange Plan,59.20%,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$0,$0,"$5,325",$0,$0,$0,23
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,Individual,No,34-0922268,20126OH0560011,HealthSpanOne Bronze 6000 HSA,20126OH056,,OHN001,OHS001,OHF005,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560011-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,24
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,2,20126,OH,Individual,No,34-0922268,20126OH0560011,HealthSpanOne Bronze 6000 HSA,20126OH056,,OHN001,OHS001,OHF005,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560011-03,Limited Cost Sharing Plan Variation,59.20%,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$0,$0,"$5,325",$0,$0,$0,25
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,3,20126,OH,Individual,No,34-0922268,20126OH0560004,HealthSpanOne Bronze 5000-80,20126OH056,,OHN001,OHS001,OHF006,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560004-00,Standard Bronze Off Exchange Plan,62.00%,0.583613932132721,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$20,$275,$0,$275,"$1,375",$0,$0,4
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,3,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550007,HealthSpan Bronze 5000-80,20126OH055,,OHN001,OHS001,OHF006,Existing,HMO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,$200,0,0,3,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550007-00,Standard Bronze Off Exchange Plan,62.00%,0.603662967681885,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900.00",$15.00,$275.00,$0.00,$875.00,$900.00,$0.00,$0.00,4
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,3,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550007,HealthSpan Bronze 5000-80,20126OH055,,OHN001,OHS001,OHF006,Existing,HMO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,$200,0,0,3,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550007-01,Standard Bronze On Exchange Plan,62.00%,0.603662967681885,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900.00",$15.00,$275.00,$0.00,$875.00,$900.00,$0.00,$0.00,5
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,3,20126,OH,Individual,No,34-0922268,20126OH0560004,HealthSpanOne Bronze 5000-80,20126OH056,,OHN001,OHS001,OHF006,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560004-01,Standard Bronze On Exchange Plan,62.00%,0.583613932132721,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$20,$275,$0,$275,"$1,375",$0,$0,5
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,3,20126,OH,Individual,No,34-0922268,20126OH0560004,HealthSpanOne Bronze 5000-80,20126OH056,,OHN001,OHS001,OHF006,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,3,20126,OH,Individual,No,34-0922268,20126OH0560004,HealthSpanOne Bronze 5000-80,20126OH056,,OHN001,OHS001,OHF006,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560004-03,Limited Cost Sharing Plan Variation,62.00%,0.583613932132721,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,900",$20,$275,$0,$275,"$1,375",$0,$0,7
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,4,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550004,HealthSpan Silver 2000-70,20126OH055,,OHN001,OHS001,OHF004,Existing,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550004-00,Standard Silver Off Exchange Plan,72.00%,0.718712449073792,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900.00",$15.00,"$1,300.00",$0.00,$100.00,$850.00,$0.00,$0.00,4
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,4,20126,OH,Individual,No,34-0922268,20126OH0560003,HealthSpanOne Silver 2000-70,20126OH056,,OHN001,OHS001,OHF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560003-00,Standard Silver Off Exchange Plan,71.99%,0.718712449073792,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$15,"$1,300",$0,$100,$975,$0,$0,4
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,4,20126,OH,Individual,No,34-0922268,20126OH0560003,HealthSpanOne Silver 2000-70,20126OH056,,OHN001,OHS001,OHF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560003-01,Standard Silver On Exchange Plan,71.99%,0.718712449073792,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$15,"$1,300",$0,$100,$975,$0,$0,5
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,4,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550004,HealthSpan Silver 2000-70,20126OH055,,OHN001,OHS001,OHF004,Existing,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550004-01,Standard Silver On Exchange Plan,72.00%,0.718712449073792,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900.00",$15.00,"$1,300.00",$0.00,$100.00,$850.00,$0.00,$0.00,5
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,4,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550014,HealthSpan Silver 2500-80,20126OH055,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550014-00,Standard Silver Off Exchange Plan,71.60%,0.716014742851257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400.00",$15.00,$775.00,$0.00,$100.00,$850.00,$0.00,$0.00,6
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,4,20126,OH,Individual,No,34-0922268,20126OH0560003,HealthSpanOne Silver 2000-70,20126OH056,,OHN001,OHS001,OHF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,4,20126,OH,Individual,No,34-0922268,20126OH0560003,HealthSpanOne Silver 2000-70,20126OH056,,OHN001,OHS001,OHF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560003-03,Limited Cost Sharing Plan Variation,71.99%,0.718712449073792,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$15,"$1,300",$0,$100,$975,$0,$0,7
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,4,20126,OH,SHOP (Small Group),No,34-0922268,20126OH0550014,HealthSpan Silver 2500-80,20126OH055,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.983129585599349,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0550014-01,Standard Silver On Exchange Plan,71.60%,0.716014742851257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400.00",$15.00,$775.00,$0.00,$100.00,$850.00,$0.00,$0.00,7
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,4,20126,OH,Individual,No,34-0922268,20126OH0560003,HealthSpanOne Silver 2000-70,20126OH056,,OHN001,OHS001,OHF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560003-04,73% AV Level Silver Plan,73.99%,0.739430904388428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,900",$15,"$1,300",$0,$100,"$1,260",$0,$0,8
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,4,20126,OH,Individual,No,34-0922268,20126OH0560003,HealthSpanOne Silver 2000-70,20126OH056,,OHN001,OHS001,OHF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560003-05,87% AV Level Silver Plan,86.60%,0.864624977111816,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$15,"$1,250",$0,$100,$975,$0,$0,9
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,4,20126,OH,Individual,No,34-0922268,20126OH0560003,HealthSpanOne Silver 2000-70,20126OH056,,OHN001,OHS001,OHF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560003-06,94% AV Level Silver Plan,93.80%,0.937414407730103,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$15,$725,$0,$0,$450,$10,$0,10
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,4,20126,OH,Individual,No,34-0922268,20126OH0560009,HealthSpanOne  Silver 2500-80,20126OH056,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560009-00,Standard Silver Off Exchange Plan,71.70%,0.716014742851257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400",$15,$775,$0,$100,$975,$0,$0,11
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,4,20126,OH,Individual,No,34-0922268,20126OH0560009,HealthSpanOne  Silver 2500-80,20126OH056,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560009-01,Standard Silver On Exchange Plan,71.70%,0.716014742851257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400",$15,$775,$0,$100,$975,$0,$0,12
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,4,20126,OH,Individual,No,34-0922268,20126OH0560009,HealthSpanOne  Silver 2500-80,20126OH056,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560009-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,4,20126,OH,Individual,No,34-0922268,20126OH0560009,HealthSpanOne  Silver 2500-80,20126OH056,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560009-03,Limited Cost Sharing Plan Variation,71.70%,0.716014742851257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400",$15,$775,$0,$100,$975,$0,$0,14
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,4,20126,OH,Individual,No,34-0922268,20126OH0560009,HealthSpanOne  Silver 2500-80,20126OH056,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560009-04,73% AV Level Silver Plan,73.70%,0.73712033033371,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,400",$15,$950,$0,$100,$975,$0,$0,15
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,4,20126,OH,Individual,No,34-0922268,20126OH0560009,HealthSpanOne  Silver 2500-80,20126OH056,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560009-05,87% AV Level Silver Plan,86.60%,0.864624977111816,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$15,"$1,350",$0,$100,$850,$0,$0,16
2015,OH,20126,SERFF,6,2014-11-15 10:06:04,4,20126,OH,Individual,No,34-0922268,20126OH0560009,HealthSpanOne  Silver 2500-80,20126OH056,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.985160215170943,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,20126OH0560009-06,94% AV Level Silver Plan,93.80%,0.937414407730103,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$15,"$1,450",$0,$0,$450,$20,$0,17
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,1,26734,OH,Individual,No,46-3024049,26734OH0010001,Premier Health One Gold 1500,26734OH001,,OHN001,OHS001,OHF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/Premier_Health_One_Gold_1500.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010001-00,Standard Gold Off Exchange Plan,,0.788009762763977,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,1,26734,OH,Individual,No,46-3024049,26734OH0010001,Premier Health One Gold 1500,26734OH001,,OHN001,OHS001,OHF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/Premier_Health_One_Gold_1500.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010001-01,Standard Gold On Exchange Plan,,0.788009762763977,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,1,26734,OH,Individual,No,46-3024049,26734OH0010001,Premier Health One Gold 1500,26734OH001,,OHN001,OHS001,OHF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/Premier_Health_One_Gold_1500.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,1,26734,OH,Individual,No,46-3024049,26734OH0010001,Premier Health One Gold 1500,26734OH001,,OHN001,OHS001,OHF001,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/Premier_Health_One_Gold_1500.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010001-03,Limited Cost Sharing Plan Variation,,0.788009762763977,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,1,26734,OH,Individual,No,46-3024049,26734OH0010002,Premier Health One Silver 3500,26734OH001,,OHN001,OHS001,OHF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/1_Premier_Health_One_Silver_3500.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010002-00,Standard Silver Off Exchange Plan,,0.706354558467865,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,1,26734,OH,Individual,No,46-3024049,26734OH0010002,Premier Health One Silver 3500,26734OH001,,OHN001,OHS001,OHF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/1_Premier_Health_One_Silver_3500.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010002-01,Standard Silver On Exchange Plan,,0.706354558467865,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,1,26734,OH,Individual,No,46-3024049,26734OH0010002,Premier Health One Silver 3500,26734OH001,,OHN001,OHS001,OHF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/1_Premier_Health_One_Silver_3500.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,1,26734,OH,Individual,No,46-3024049,26734OH0010002,Premier Health One Silver 3500,26734OH001,,OHN001,OHS001,OHF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/1_Premier_Health_One_Silver_3500.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010002-03,Limited Cost Sharing Plan Variation,,0.706354558467865,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,1,26734,OH,Individual,No,46-3024049,26734OH0010002,Premier Health One Silver 3500,26734OH001,,OHN001,OHS001,OHF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/1_Premier_Health_One_Silver_3500.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010002-04,73% AV Level Silver Plan,,0.727733194828033,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,1,26734,OH,Individual,No,46-3024049,26734OH0010002,Premier Health One Silver 3500,26734OH001,,OHN001,OHS001,OHF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/1_Premier_Health_One_Silver_3500.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010002-05,87% AV Level Silver Plan,,0.861517608165741,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,550","$3,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,1,26734,OH,Individual,No,46-3024049,26734OH0010002,Premier Health One Silver 3500,26734OH001,,OHN001,OHS001,OHF002,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/1_Premier_Health_One_Silver_3500.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010002-06,94% AV Level Silver Plan,,0.944042563438416,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,2,26734,OH,Individual,No,46-3024049,26734OH0010003,Premier Health One Silver 2000,26734OH001,,OHN001,OHS001,OHF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/7_Premier_Health_One_Silver_2000.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010003-00,Standard Silver Off Exchange Plan,,0.68211030960083,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,2,26734,OH,Individual,No,46-3024049,26734OH0010003,Premier Health One Silver 2000,26734OH001,,OHN001,OHS001,OHF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/7_Premier_Health_One_Silver_2000.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010003-01,Standard Silver On Exchange Plan,,0.68211030960083,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,2,26734,OH,Individual,No,46-3024049,26734OH0010003,Premier Health One Silver 2000,26734OH001,,OHN001,OHS001,OHF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/7_Premier_Health_One_Silver_2000.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,2,26734,OH,Individual,No,46-3024049,26734OH0010003,Premier Health One Silver 2000,26734OH001,,OHN001,OHS001,OHF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/7_Premier_Health_One_Silver_2000.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010003-03,Limited Cost Sharing Plan Variation,,0.68211030960083,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,2,26734,OH,Individual,No,46-3024049,26734OH0010003,Premier Health One Silver 2000,26734OH001,,OHN001,OHS001,OHF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/7_Premier_Health_One_Silver_2000.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010003-04,73% AV Level Silver Plan,,0.721284568309784,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,2,26734,OH,Individual,No,46-3024049,26734OH0010003,Premier Health One Silver 2000,26734OH001,,OHN001,OHS001,OHF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/7_Premier_Health_One_Silver_2000.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010003-05,87% AV Level Silver Plan,,0.860555112361908,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,2,26734,OH,Individual,No,46-3024049,26734OH0010003,Premier Health One Silver 2000,26734OH001,,OHN001,OHS001,OHF003,New,HMO,Silver,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/7_Premier_Health_One_Silver_2000.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010003-06,94% AV Level Silver Plan,,0.931151807308197,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,2,26734,OH,Individual,No,46-3024049,26734OH0010005,Premier Health One Bronze 6000,26734OH001,,OHN001,OHS001,OHF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/Premier_Health_One_Bronze_6000.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010005-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,2,26734,OH,Individual,No,46-3024049,26734OH0010005,Premier Health One Bronze 6000,26734OH001,,OHN001,OHS001,OHF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/Premier_Health_One_Bronze_6000.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010005-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,2,26734,OH,Individual,No,46-3024049,26734OH0010005,Premier Health One Bronze 6000,26734OH001,,OHN001,OHS001,OHF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/Premier_Health_One_Bronze_6000.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,2,26734,OH,Individual,No,46-3024049,26734OH0010005,Premier Health One Bronze 6000,26734OH001,,OHN001,OHS001,OHF005,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/Premier_Health_One_Bronze_6000.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010005-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,3,26734,OH,Individual,No,46-3024049,26734OH0010004,Premier Health One Bronze 5500,26734OH001,,OHN001,OHS001,OHF004,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/Premier_Health_One_Bronze_5500.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010004-00,Standard Bronze Off Exchange Plan,,0.612601459026337,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,3,26734,OH,Individual,No,46-3024049,26734OH0010004,Premier Health One Bronze 5500,26734OH001,,OHN001,OHS001,OHF004,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/Premier_Health_One_Bronze_5500.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010004-01,Standard Bronze On Exchange Plan,,0.612601459026337,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,3,26734,OH,Individual,No,46-3024049,26734OH0010004,Premier Health One Bronze 5500,26734OH001,,OHN001,OHS001,OHF004,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/Premier_Health_One_Bronze_5500.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,OH,26734,SERFF,3,2014-11-10 10:02:31,3,26734,OH,Individual,No,46-3024049,26734OH0010004,Premier Health One Bronze 5500,26734OH001,,OHN001,OHS001,OHF004,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,No,,No,http://premierhealthdocs.com/OnOff-Exchange/Premier_Health_One_Bronze_5500.pdf,https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx,http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf,www.premierhealthplan.org/Find-a-Medication,26734OH0010004-03,Limited Cost Sharing Plan Variation,,0.612601459026337,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060049,AultCare Gold 350,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc649.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure649.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060049-00,Standard Gold Off Exchange Plan,,0.781130790710449,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$350,$700,25%,,,,"$1,050","$2,100",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$350,$20,"$1,730",$30,$350,$740,$480,$80,4
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090047,AultCare Platinum 1000,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc947.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure947.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090047-00,Standard Platinum Off Exchange Plan,,0.907914519309998,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$980,$20,$0,$30,$620,$380,$0,$80,8
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),Yes,34-1624818,28162OH0200008,AultCare Pediatric Dental High Plan OON 75 50,28162OH020,7376546504,OHN003,OHS003,,New,PPO,High,,Off the Exchange,,,,"Non-Network Reimbursment for this plan is paid at the 75th percentile, patient responsible for amounts over the 75th percentile.  Employer premium contribution must be at least 50%.",,,,,Allows Child-Only,,,,$27.80,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2082015.pdf,,28162OH0200008-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060049,AultCare Gold 350,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc649.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure649.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060049-03,Limited Cost Sharing Plan Variation,,0.781130790710449,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$350,$700,25%,,,,"$1,050","$2,100",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$350,$20,"$1,730",$30,$350,$740,$480,$80,7
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060048,AultCare Gold 750,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc648.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure648.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060048-00,Standard Gold Off Exchange Plan,,0.780737996101379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$2,250","$4,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$20,"$1,300",$30,$750,$710,$280,$80,8
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060048,AultCare Gold 750,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc648.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure648.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060048-01,Standard Gold On Exchange Plan,,0.780737996101379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$2,250","$4,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$20,"$1,300",$30,$750,$710,$280,$80,9
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060048,AultCare Gold 750,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc648.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure648.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060048-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),Yes,34-1624818,28162OH0200009,AultCare Pediatric Dental High Plan OON 75 <50,28162OH020,7376546504,OHN003,OHS003,,New,PPO,High,,Off the Exchange,,,,"Non-Network Reimbursment for this plan is paid at the 75th percentile, patient responsible for amounts over the 75th percentile.  Employer premium contribution must be less than 50%.",,,,,Allows Child-Only,,,,$27.80,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2092015.pdf,,28162OH0200009-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090047,AultCare Platinum 1000,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc947.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure947.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090047-01,Standard Platinum On Exchange Plan,,0.907914519309998,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$980,$20,$0,$30,$620,$380,$0,$80,9
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),Yes,34-1624818,28162OH0200011,AultCare Pediatric Dental High Plan OON 90 50,28162OH020,7376546504,OHN003,OHS003,,New,PPO,High,,Off the Exchange,,,,"Non-Network Reimbursment for this plan is paid at the 90th percentile, patient responsible for amounts over the 90th percentile.  Employer premium contribution must be at least 50%.",,,,,Allows Child-Only,,,,$27.80,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2112015.pdf,,28162OH0200011-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090044,AultCare Gold 350,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc944.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure944.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090044-01,Standard Gold On Exchange Plan,,0.781130790710449,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$350,$700,25%,,,,"$1,050","$2,100",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$350,$20,"$1,730",$30,$350,$740,$480,$80,11
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060042,AultCare Silver 3000,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060042-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,25
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060042,AultCare Silver 3000,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060042-03,Limited Cost Sharing Plan Variation,,0.699551582336426,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$20,"$1,280",$30,"$1,700",$760,$0,$80,26
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,4,29276,OH,Individual,No,31-1440175,29276OH0740020,Anthem Bronze Pathway X PPO 5000 30,29276OH074,,OHN002,OHS001,OHF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GKX,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740020-03,Limited Cost Sharing Plan Variation,59.40%,0.60028213262558,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,"$5,000","$10,000",50%,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,5,29276,OH,Individual,No,31-1440175,29276OH0740021,Anthem Bronze Pathway X PPO 6400 20,29276OH074,,OHN002,OHS001,OHF005,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GL0,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740021-00,Standard Bronze Off Exchange Plan,59.81%,0.609279036521912,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$17,250","$34,500",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,400","$12,800",20%,"$6,400","$12,800",45%,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,5,29276,OH,Individual,No,31-1440175,29276OH0740021,Anthem Bronze Pathway X PPO 6400 20,29276OH074,,OHN002,OHS001,OHF005,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GL0,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740021-01,Standard Bronze On Exchange Plan,59.81%,0.609279036521912,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$17,250","$34,500",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,400","$12,800",20%,"$6,400","$12,800",45%,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,5,29276,OH,Individual,No,31-1440175,29276OH0740021,Anthem Bronze Pathway X PPO 6400 20,29276OH074,,OHN002,OHS001,OHF005,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GL0,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740021-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,5,29276,OH,Individual,No,31-1440175,29276OH0740021,Anthem Bronze Pathway X PPO 6400 20,29276OH074,,OHN002,OHS001,OHF005,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GL0,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740021-03,Limited Cost Sharing Plan Variation,59.81%,0.609279036521912,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$17,250","$34,500",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,400","$12,800",20%,"$6,400","$12,800",45%,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,6,29276,OH,Individual,No,31-1440175,29276OH0740022,Anthem Bronze Pathway X PPO 5550 20,29276OH074,,OHN002,OHS001,OHF005,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GL3,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740022-00,Standard Bronze Off Exchange Plan,59.46%,0.613039314746857,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$17,250","$34,500",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,550","$11,100",20%,"$5,550","$11,100",50%,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),Yes,34-1624818,28162OH0200014,AultCare Pediatric Dental Low Plan OON PPO <50,28162OH020,7376546504,OHN003,OHS003,,New,PPO,Low,,Off the Exchange,,,,"Non-Network Reimbursment for this plan is paid at the PPO Fee Schedule, patient responsible for amounts over PPO Fee Schedule.  Employer premium contribution must be less than 50%.",,,,,Allows Child-Only,,,,$20.26,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2142015.pdf,,28162OH0200014-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,15
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090042,AultCare Gold 750,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc942.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure942.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090042-01,Standard Gold On Exchange Plan,,0.780737996101379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$2,250","$4,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$20,"$1,300",$30,$750,$710,$280,$80,15
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060041,AultCare Silver 5000,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc641.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure641.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060041-05,87% AV Level Silver Plan,,0.863897502422333,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$19,050","$38,100",Not Applicable,Not Applicable,$900,"$1,800",20%,,,,"$2,700","$5,400",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$900,$20,$280,$30,$900,$300,$0,$80,35
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060041,AultCare Silver 5000,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc641.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure641.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060041-06,94% AV Level Silver Plan,,0.93430769443512,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,"$19,050","$38,100",Not Applicable,Not Applicable,$250,$500,20%,,,,$750,"$1,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$250,$20,$130,$30,$250,$150,$0,$80,36
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060026,AultCare Silver 5000 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc626.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure626.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060026-00,Standard Silver Off Exchange Plan,,0.681439697742462,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$5,000","$10,000",40%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$5,000",$20,$900,$30,"$1,700",$790,$0,$80,63
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060026,AultCare Silver 5000 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc626.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure626.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060026-01,Standard Silver On Exchange Plan,,0.681439697742462,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$5,000","$10,000",40%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$5,000",$20,$900,$30,"$1,700",$790,$0,$80,64
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060026,AultCare Silver 5000 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc626.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure626.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060026-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,65
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060026,AultCare Silver 5000 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc626.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure626.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060026-03,Limited Cost Sharing Plan Variation,,0.681439697742462,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$5,000","$10,000",40%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$5,000",$20,$900,$30,"$1,700",$790,$0,$80,66
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060040,AultCare Bronze 2500,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6402015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6402015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060040-01,Standard Bronze On Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,"$2,420",$30,"$2,500",$0,"$1,390",$80,19
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060040,AultCare Bronze 2500,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6402015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6402015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060040-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,7,29276,OH,Individual,No,31-1440175,29276OH0740023,Anthem Silver Pathway X PPO 3000 10,29276OH074,,OHN002,OHS001,OHF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GL6,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740023-01,Standard Silver On Exchange Plan,68.04%,0.696031153202057,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,650","$9,300","$4,650","$9,300","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,"$3,000","$6,000",40%,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,7,29276,OH,Individual,No,31-1440175,29276OH0740023,Anthem Silver Pathway X PPO 3000 10,29276OH074,,OHN002,OHS001,OHF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GL6,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740023-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,7,29276,OH,Individual,No,31-1440175,29276OH0740023,Anthem Silver Pathway X PPO 3000 10,29276OH074,,OHN002,OHS001,OHF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GL6,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740023-03,Limited Cost Sharing Plan Variation,68.04%,0.695764183998108,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,650","$9,300","$4,650","$9,300","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,"$3,000","$6,000",40%,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,7,29276,OH,Individual,No,31-1440175,29276OH0740023,Anthem Silver Pathway X PPO 3000 10,29276OH074,,OHN002,OHS001,OHF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GL6,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740023-04,73% AV Level Silver Plan,72.25%,0.733215510845184,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,"$2,500","$5,000",40%,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060046,AultCare Gold 1250,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc646.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure646.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060046-03,Limited Cost Sharing Plan Variation,,0.781455159187317,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$3,750","$7,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,250",$20,$600,$30,"$1,250",$710,$60,$80,15
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060045,AultCare Silver 700,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6452015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6452015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060045-00,Standard Silver Off Exchange Plan,,0.719911873340607,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,"$3,280",$30,$700,$810,$700,$80,16
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090050,AultCare Platinum 200,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc950.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure950.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090050-00,Standard Platinum Off Exchange Plan,,0.884455919265747,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$19,050","$38,100",Not Applicable,Not Applicable,$200,$400,10%,,,,$600,"$1,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$200,$20,$710,$30,$200,$710,$270,$80,4
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),Yes,34-1624818,28162OH0200001,AultCare Pediatric Dental High Plan OON PPO 85,28162OH020,7376546504,OHN003,OHS003,,New,PPO,High,,Off the Exchange,,,,"Non-Network Reimbursment for this plan is paid at the PPO Fee Schedule, patient responsible for amounts over PPO Fee Schedule.  Employer premium contribution must be at least 85%.",,,,,Allows Child-Only,,,,$27.80,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2012015.pdf,,28162OH0200001-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),Yes,34-1624818,28162OH0200005,AultCare Pediatric Dental High Plan OON PPO 50,28162OH020,7376546504,OHN003,OHS003,,New,PPO,High,,Off the Exchange,,,,"Non-Network Reimbursment for this plan is paid at the PPO Fee Schedule, patient responsible for amounts over PPO Fee Schedule.  Employer premium contribution must be at least 50%.",,,,,Allows Child-Only,,,,$27.80,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2052015.pdf,,28162OH0200005-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090050,AultCare Platinum 200,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc950.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure950.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090050-01,Standard Platinum On Exchange Plan,,0.884455919265747,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$19,050","$38,100",Not Applicable,Not Applicable,$200,$400,10%,,,,$600,"$1,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$200,$20,$710,$30,$200,$710,$270,$80,5
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060049,AultCare Gold 350,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc649.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure649.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060049-01,Standard Gold On Exchange Plan,,0.781130790710449,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$350,$700,25%,,,,"$1,050","$2,100",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$350,$20,"$1,730",$30,$350,$740,$480,$80,5
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060049,AultCare Gold 350,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc649.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure649.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060049-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090048,AultCare Platinum 500,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc948.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure948.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090048-00,Standard Platinum Off Exchange Plan,,0.880419075489044,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$19,050","$38,100",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$20,$780,$30,$500,$710,$90,$80,6
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),Yes,34-1624818,28162OH0200006,AultCare Pediatric Dental High Plan OON PPO <50,28162OH020,7376546504,OHN003,OHS003,,New,PPO,High,,Off the Exchange,,,,"Non-Network Reimbursment for this plan is paid at the PPO Fee Schedule, patient responsible for amounts over PPO Fee Schedule.  Employer premium contribution must be less than 50%.",,,,,Allows Child-Only,,,,$27.80,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2062015.pdf,,28162OH0200006-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),Yes,34-1624818,28162OH0200007,AultCare Pediatric Dental High Plan OON 75 85,28162OH020,7376546504,OHN003,OHS003,,New,PPO,High,,Off the Exchange,,,,"Non-Network Reimbursment for this plan is paid at the 75th percentile, patient responsible for amounts over the 75th percentile.  Employer premium contribution must be at least 85%.",,,,,Allows Child-Only,,,,$27.80,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2072015.pdf,,28162OH0200007-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090048,AultCare Platinum 500,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc948.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure948.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090048-01,Standard Platinum On Exchange Plan,,0.880419075489044,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$19,050","$38,100",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$20,$780,$30,$500,$710,$90,$80,7
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090044,AultCare Gold 350,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc944.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure944.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090044-00,Standard Gold Off Exchange Plan,,0.781130790710449,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$350,$700,25%,,,,"$1,050","$2,100",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$350,$20,"$1,730",$30,$350,$740,$480,$80,10
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),Yes,34-1624818,28162OH0200010,AultCare Pediatric Dental High Plan OON 90 85,28162OH020,7376546504,OHN003,OHS003,,New,PPO,High,,Off the Exchange,,,,"Non-Network Reimbursment for this plan is paid at the 90th percentile, patient responsible for amounts over the 90th percentile.  Employer premium contribution must be at least 85%.",,,,,Allows Child-Only,,,,$27.80,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2102015.pdf,,28162OH0200010-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060048,AultCare Gold 750,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc648.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure648.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060048-03,Limited Cost Sharing Plan Variation,,0.780737996101379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$2,250","$4,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$20,"$1,300",$30,$750,$710,$280,$80,11
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060046,AultCare Gold 1250,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc646.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure646.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060046-00,Standard Gold Off Exchange Plan,,0.781455159187317,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$3,750","$7,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,250",$20,$600,$30,"$1,250",$710,$60,$80,12
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090043,AultCare Gold 500,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc943.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure943.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090043-00,Standard Gold Off Exchange Plan,,0.815265119075775,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$20,"$1,350",$30,$500,$740,$370,$80,12
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),Yes,34-1624818,28162OH0200012,AultCare Pediatric Dental High Plan OON 90 <50,28162OH020,7376546504,OHN003,OHS003,,New,PPO,High,,Off the Exchange,,,,"Non-Network Reimbursment for this plan is paid at the 90th percentile, patient responsible for amounts over the 90th percentile.  Employer premium contribution must be less than 50%.",,,,,Allows Child-Only,,,,$27.80,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2122015.pdf,,28162OH0200012-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),Yes,34-1624818,28162OH0200002,AultCare Pediatric Dental Low Plan OON PPO 85,28162OH020,7376546504,OHN003,OHS003,,New,PPO,Low,,Off the Exchange,,,,"Non-Network Reimbursment for this plan is paid at the PPO Fee Schedule, patient responsible for amounts over PPO Fee Schedule.  Employer premium contribution must be at least 85%.",,,,,Allows Child-Only,,,,$20.26,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2022015.pdf,,28162OH0200002-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,13
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090043,AultCare Gold 500,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc943.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure943.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090043-01,Standard Gold On Exchange Plan,,0.815265119075775,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$20,"$1,350",$30,$500,$740,$370,$80,13
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060046,AultCare Gold 1250,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc646.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure646.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060046-01,Standard Gold On Exchange Plan,,0.781455159187317,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$3,750","$7,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,250",$20,$600,$30,"$1,250",$710,$60,$80,13
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060046,AultCare Gold 1250,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc646.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure646.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060046-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090042,AultCare Gold 750,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc942.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure942.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090042-00,Standard Gold Off Exchange Plan,,0.780737996101379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$2,250","$4,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$20,"$1,300",$30,$750,$710,$280,$80,14
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),Yes,34-1624818,28162OH0200013,AultCare Pediatric Dental Low Plan OON PPO 50,28162OH020,7376546504,OHN003,OHS003,,New,PPO,Low,,Off the Exchange,,,,"Non-Network Reimbursment for this plan is paid at the PPO Fee Schedule, patient responsible for amounts over PPO Fee Schedule.  Employer premium contribution must be at least 50%.",,,,,Allows Child-Only,,,,$20.26,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2132015.pdf,,28162OH0200013-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,14
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090041,AultCare Gold 1250,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc941.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure941.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090041-00,Standard Gold Off Exchange Plan,,0.781455159187317,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$3,750","$7,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,250",$20,$600,$30,"$1,250",$710,$60,$80,16
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),Yes,34-1624818,28162OH0200015,AultCare Pediatric Dental Low Plan OON 75 85,28162OH020,7376546504,OHN003,OHS003,,New,PPO,Low,,Off the Exchange,,,,"Non-Network Reimbursment for this plan is paid at the 75th percentile, patient responsible for amounts over the 75th percentile.  Employer premium contribution must be at least 85%.",,,,,Allows Child-Only,,,,$20.26,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2152015.pdf,,28162OH0200015-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,16
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),Yes,34-1624818,28162OH0200016,AultCare Pediatric Dental Low Plan OON 75 50,28162OH020,7376546504,OHN003,OHS003,,New,PPO,Low,,Off the Exchange,,,,"Non-Network Reimbursment for this plan is paid at the 75th percentile, patient responsible for amounts over the 75th percentile.  Employer premium contribution must be at least 50%.",,,,,Allows Child-Only,,,,$20.26,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2162015.pdf,,28162OH0200016-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,17
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090041,AultCare Gold 1250,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc941.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure941.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090041-01,Standard Gold On Exchange Plan,,0.781455159187317,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$3,750","$7,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,250",$20,$600,$30,"$1,250",$710,$60,$80,17
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060045,AultCare Silver 700,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6452015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6452015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060045-01,Standard Silver On Exchange Plan,,0.719911873340607,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,"$3,280",$30,$700,$810,$700,$80,17
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060045,AultCare Silver 700,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6452015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6452015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060045-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090058,AultCare Gold 2500,28162OH009,7376546504,OHN001,OHS002,OHF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9582015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9582015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090058-00,Standard Gold Off Exchange Plan,,0.781074345111847,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,$480,$30,"$1,850",$660,$0,$80,18
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),Yes,34-1624818,28162OH0200017,AultCare Pediatric Dental Low Plan OON 75 <50,28162OH020,7376546504,OHN003,OHS003,,New,PPO,Low,,Off the Exchange,,,,"Non-Network Reimbursment for this plan is paid at the 75th percentile, patient responsible for amounts over the 75th percentile.  Employer premium contribution must be less than 50%.",,,,,Allows Child-Only,,,,$20.26,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2172015.pdf,,28162OH0200017-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,18
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),Yes,34-1624818,28162OH0200018,AultCare Pediatric Dental Low Plan OON 90 85,28162OH020,7376546504,OHN003,OHS003,,New,PPO,Low,,Off the Exchange,,,,"Non-Network Reimbursment for this plan is paid at the 90th percentile, patient responsible for amounts over the 90th percentile.  Employer premium contribution must be at least 85%.",,,,,Allows Child-Only,,,,$20.26,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2182015.pdf,,28162OH0200018-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,19
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090058,AultCare Gold 2500,28162OH009,7376546504,OHN001,OHS002,OHF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9582015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9582015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090058-01,Standard Gold On Exchange Plan,,0.781074345111847,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,$480,$30,"$1,850",$660,$0,$80,19
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060045,AultCare Silver 700,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6452015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6452015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060045-03,Limited Cost Sharing Plan Variation,,0.719911873340607,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,"$3,280",$30,$700,$810,$700,$80,19
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060045,AultCare Silver 700,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6452015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6452015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060045-04,73% AV Level Silver Plan,,0.739934027194977,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,169","$10,338",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,"$3,280",$30,$700,$810,$700,$80,20
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090038,AultCare Silver 700,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9382015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9382015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090038-00,Standard Silver Off Exchange Plan,,0.719911873340607,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,"$3,280",$30,$700,$810,$700,$80,20
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),Yes,34-1624818,28162OH0200019,AultCare Pediatric Dental Low Plan OON 90 50,28162OH020,7376546504,OHN003,OHS003,,New,PPO,Low,,Off the Exchange,,,,"Non-Network Reimbursment for this plan is paid at the 90th percentile, patient responsible for amounts over the 90th percentile.  Employer premium contribution must be at least 50%.",,,,,Allows Child-Only,,,,$20.26,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2192015.pdf,,28162OH0200019-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,20
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),Yes,34-1624818,28162OH0200020,AultCare Pediatric Dental Low Plan OON 90 <50,28162OH020,7376546504,OHN003,OHS003,,New,PPO,Low,,Off the Exchange,,,,"Non-Network Reimbursment for this plan is paid at the 90th percentile, patient responsible for amounts over the 90th percentile.  Employer premium contribution must be less than 50%.",,,,,Allows Child-Only,,,,$20.26,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2202015.pdf,,28162OH0200020-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,21
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090038,AultCare Silver 700,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9382015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9382015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090038-01,Standard Silver On Exchange Plan,,0.719911873340607,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,"$3,280",$30,$700,$810,$700,$80,21
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060045,AultCare Silver 700,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6452015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6452015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060045-05,87% AV Level Silver Plan,,0.861903011798859,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,$680,$30,$700,$700,$0,$80,21
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060045,AultCare Silver 700,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6452015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6452015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060045-06,94% AV Level Silver Plan,,0.934247076511383,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",0%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$680,$20,$0,$30,$560,$140,$0,$80,22
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090036,AultCare Silver 2000 75,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc936.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure936.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090036-00,Standard Silver Off Exchange Plan,,0.719536542892456,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$2,000","$4,000",25%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,"$1,310",$30,"$1,850",$790,$0,$80,22
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090036,AultCare Silver 2000 75,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc936.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure936.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090036-01,Standard Silver On Exchange Plan,,0.719536542892456,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$2,000","$4,000",25%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,"$1,310",$30,"$1,850",$790,$0,$80,23
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060042,AultCare Silver 3000,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060042-00,Standard Silver Off Exchange Plan,,0.699551582336426,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$20,"$1,280",$30,"$1,700",$760,$0,$80,23
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060042,AultCare Silver 3000,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060042-01,Standard Silver On Exchange Plan,,0.699551582336426,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$20,"$1,280",$30,"$1,700",$760,$0,$80,24
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,3,29276,OH,Individual,No,31-1440175,29276OH0740019,Anthem Bronze Pathway X PPO 4300 20,29276OH074,,OHN002,OHS001,OHF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GKU,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740019-03,Limited Cost Sharing Plan Variation,60.97%,0.623022735118866,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600",20%,"$4,300","$8,600",50%,"$8,600","$17,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,4,29276,OH,Individual,No,31-1440175,29276OH0740020,Anthem Bronze Pathway X PPO 5000 30,29276OH074,,OHN002,OHS001,OHF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GKX,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740020-00,Standard Bronze Off Exchange Plan,59.40%,0.60028213262558,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,"$5,000","$10,000",50%,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,4,29276,OH,Individual,No,31-1440175,29276OH0740020,Anthem Bronze Pathway X PPO 5000 30,29276OH074,,OHN002,OHS001,OHF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GKX,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740020-01,Standard Bronze On Exchange Plan,59.40%,0.60028213262558,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,"$5,000","$10,000",50%,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,4,29276,OH,Individual,No,31-1440175,29276OH0740020,Anthem Bronze Pathway X PPO 5000 30,29276OH074,,OHN002,OHS001,OHF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GKX,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740020-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,6,29276,OH,Individual,No,31-1440175,29276OH0740022,Anthem Bronze Pathway X PPO 5550 20,29276OH074,,OHN002,OHS001,OHF005,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GL3,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740022-01,Standard Bronze On Exchange Plan,59.46%,0.613039314746857,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$17,250","$34,500",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,550","$11,100",20%,"$5,550","$11,100",50%,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,6,29276,OH,Individual,No,31-1440175,29276OH0740022,Anthem Bronze Pathway X PPO 5550 20,29276OH074,,OHN002,OHS001,OHF005,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GL3,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740022-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,6,29276,OH,Individual,No,31-1440175,29276OH0740022,Anthem Bronze Pathway X PPO 5550 20,29276OH074,,OHN002,OHS001,OHF005,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GL3,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740022-03,Limited Cost Sharing Plan Variation,59.46%,0.613039314746857,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$17,250","$34,500",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,550","$11,100",20%,"$5,550","$11,100",50%,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,7,29276,OH,Individual,No,31-1440175,29276OH0740023,Anthem Silver Pathway X PPO 3000 10,29276OH074,,OHN002,OHS001,OHF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GL6,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740023-00,Standard Silver Off Exchange Plan,68.04%,0.696031153202057,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,650","$9,300","$4,650","$9,300","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",10%,"$3,000","$6,000",40%,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,7,29276,OH,Individual,No,31-1440175,29276OH0740023,Anthem Silver Pathway X PPO 3000 10,29276OH074,,OHN002,OHS001,OHF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GL6,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740023-05,87% AV Level Silver Plan,86.02%,0.86692601442337,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,650","$3,300","$1,650","$3,300","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",10%,$750,"$1,500",40%,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,7,29276,OH,Individual,No,31-1440175,29276OH0740023,Anthem Silver Pathway X PPO 3000 10,29276OH074,,OHN002,OHS001,OHF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GL6,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740023-06,94% AV Level Silver Plan,93.01%,0.93445885181427,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$750,"$1,500",$750,"$1,500","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,$200,$400,40%,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,8,29276,OH,Individual,No,31-1440175,29276OH0740024,Anthem Silver Pathway X PPO 10 for HSA,29276OH074,,OHN002,OHS001,OHF027,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLC,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740024-00,Standard Silver Off Exchange Plan,69.64%,0.710881888866425,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,"$2,500","$5,000",40%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,8,29276,OH,Individual,No,31-1440175,29276OH0740024,Anthem Silver Pathway X PPO 10 for HSA,29276OH074,,OHN002,OHS001,OHF027,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLC,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740024-01,Standard Silver On Exchange Plan,69.64%,0.710881888866425,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,"$2,500","$5,000",40%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,10,29276,OH,Individual,No,31-1440175,29276OH0740026,Anthem Silver Pathway X PPO 2000 20,29276OH074,,OHN002,OHS001,OHF020,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLQ,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740026-00,Standard Silver Off Exchange Plan,70.23%,0.708902895450592,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,500","$11,000","$5,500","$11,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,"$2,000","$4,000",50%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,10,29276,OH,Individual,No,31-1440175,29276OH0740026,Anthem Silver Pathway X PPO 2000 20,29276OH074,,OHN002,OHS001,OHF020,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLQ,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740026-01,Standard Silver On Exchange Plan,70.23%,0.708902895450592,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,500","$11,000","$5,500","$11,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,"$2,000","$4,000",50%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060030,AultCare Silver 700 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6302015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6302015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060030-04,73% AV Level Silver Plan,,0.739934027194977,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,169","$10,338",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,"$3,280",$30,$700,$810,$700,$80,53
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060030,AultCare Silver 700 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6302015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6302015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060030-05,87% AV Level Silver Plan,,0.861903011798859,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,$680,$30,$700,$700,$0,$80,54
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090060,AultCare Silver 3500 90,28162OH009,7376546504,OHN001,OHS002,OHF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9602015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9602015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090060-00,Standard Silver Off Exchange Plan,,0.708744943141937,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$3,500","$7,000",10%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$20,$380,$30,"$1,850",$740,$0,$80,24
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090060,AultCare Silver 3500 90,28162OH009,7376546504,OHN001,OHS002,OHF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9602015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9602015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090060-01,Standard Silver On Exchange Plan,,0.708744943141937,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$3,500","$7,000",10%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$20,$380,$30,"$1,850",$740,$0,$80,25
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060042,AultCare Silver 3000,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060042-04,73% AV Level Silver Plan,,0.722603440284729,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$20,"$1,280",$30,"$1,850",$740,$0,$80,27
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060042,AultCare Silver 3000,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060042-05,87% AV Level Silver Plan,,0.866210162639618,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$800,"$1,600",20%,,,,"$2,400","$4,800",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$800,$20,$680,$30,$800,$700,$0,$80,28
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060042,AultCare Silver 3000,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060042-06,94% AV Level Silver Plan,,0.934562087059021,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$200,$400,20%,,,,$600,"$1,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$200,$20,$280,$30,$200,$300,$0,$80,29
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060041,AultCare Silver 5000,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc641.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure641.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060041-00,Standard Silver Off Exchange Plan,,0.681439697742462,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$5,000","$10,000",40%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$5,000",$20,$900,$30,"$1,700",$790,$0,$80,30
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060041,AultCare Silver 5000,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc641.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure641.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060041-01,Standard Silver On Exchange Plan,,0.681439697742462,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$5,000","$10,000",40%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$5,000",$20,$900,$30,"$1,700",$790,$0,$80,31
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060041,AultCare Silver 5000,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc641.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure641.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060041-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,32
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060041,AultCare Silver 5000,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc641.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure641.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060041-03,Limited Cost Sharing Plan Variation,,0.681439697742462,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$5,000","$10,000",40%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$5,000",$20,$900,$30,"$1,700",$790,$0,$80,33
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060041,AultCare Silver 5000,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc641.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure641.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060041-04,73% AV Level Silver Plan,,0.722446024417877,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$480,$30,"$1,850",$790,$0,$80,34
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060053,AultCare Gold 350 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc653.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure653.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060053-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,39
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060053,AultCare Gold 350 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc653.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure653.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060053-03,Limited Cost Sharing Plan Variation,,0.781130790710449,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$350,$700,25%,,,,"$1,050","$2,100",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$350,$20,"$1,730",$30,$350,$740,$480,$80,40
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,8,29276,OH,Individual,No,31-1440175,29276OH0740024,Anthem Silver Pathway X PPO 10 for HSA,29276OH074,,OHN002,OHS001,OHF027,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLC,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740024-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,8,29276,OH,Individual,No,31-1440175,29276OH0740024,Anthem Silver Pathway X PPO 10 for HSA,29276OH074,,OHN002,OHS001,OHF027,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLC,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740024-03,Limited Cost Sharing Plan Variation,69.64%,0.710881888866425,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,"$2,500","$5,000",40%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,8,29276,OH,Individual,No,31-1440175,29276OH0740024,Anthem Silver Pathway X PPO 10 for HSA,29276OH074,,OHN002,OHS001,OHF027,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLC,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740024-04,73% AV Level Silver Plan,72.11%,0.737603604793549,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",10%,"$2,000","$4,000",40%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,8,29276,OH,Individual,No,31-1440175,29276OH0740024,Anthem Silver Pathway X PPO 10 for HSA,29276OH074,,OHN002,OHS001,OHF027,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLC,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740024-05,87% AV Level Silver Plan,86.17%,0.861683309078217,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,150","$2,300","$1,150","$2,300","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300",0%,"$1,150","$2,300",0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,8,29276,OH,Individual,No,31-1440175,29276OH0740024,Anthem Silver Pathway X PPO 10 for HSA,29276OH074,,OHN002,OHS001,OHF027,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLC,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740024-06,94% AV Level Silver Plan,93.27%,0.932734072208405,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$500,"$1,000",$500,"$1,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,$500,"$1,000",0%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,9,29276,OH,Individual,No,31-1440175,29276OH0740025,Anthem Silver Pathway X PPO 3500 0,29276OH074,,OHN002,OHS001,OHF025,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLJ,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740025-00,Standard Silver Off Exchange Plan,70.25%,0.708380818367004,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,"$3,500","$7,000",30%,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,9,29276,OH,Individual,No,31-1440175,29276OH0740025,Anthem Silver Pathway X PPO 3500 0,29276OH074,,OHN002,OHS001,OHF025,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLJ,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740025-01,Standard Silver On Exchange Plan,70.25%,0.708380818367004,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,"$3,500","$7,000",30%,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,9,29276,OH,Individual,No,31-1440175,29276OH0740025,Anthem Silver Pathway X PPO 3500 0,29276OH074,,OHN002,OHS001,OHF025,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLJ,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740025-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,9,29276,OH,Individual,No,31-1440175,29276OH0740025,Anthem Silver Pathway X PPO 3500 0,29276OH074,,OHN002,OHS001,OHF025,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLJ,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740025-03,Limited Cost Sharing Plan Variation,70.25%,0.708380818367004,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,"$3,500","$7,000",30%,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,9,29276,OH,Individual,No,31-1440175,29276OH0740025,Anthem Silver Pathway X PPO 3500 0,29276OH074,,OHN002,OHS001,OHF025,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLJ,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740025-04,73% AV Level Silver Plan,72.27%,0.728907763957977,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,"$3,000","$6,000",30%,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,9,29276,OH,Individual,No,31-1440175,29276OH0740025,Anthem Silver Pathway X PPO 3500 0,29276OH074,,OHN002,OHS001,OHF025,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLJ,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740025-05,87% AV Level Silver Plan,86.09%,0.863814830780029,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$850,"$1,700",0%,$850,"$1,700",30%,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,9,29276,OH,Individual,No,31-1440175,29276OH0740025,Anthem Silver Pathway X PPO 3500 0,29276OH074,,OHN002,OHS001,OHF025,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLJ,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740025-06,94% AV Level Silver Plan,93.01%,0.933293402194977,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$650,"$1,300",$650,"$1,300","$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,0%,$200,$400,30%,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060034,AultCare Gold 350 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc634.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure634.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060034-00,Standard Gold Off Exchange Plan,,0.781130790710449,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$350,$700,25%,,,,"$1,050","$2,100",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$350,$20,"$1,730",$30,$350,$740,$480,$80,37
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060034,AultCare Gold 350 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc634.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure634.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060034-01,Standard Gold On Exchange Plan,,0.781130790710449,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$350,$700,25%,,,,"$1,050","$2,100",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$350,$20,"$1,730",$30,$350,$740,$480,$80,38
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060034,AultCare Gold 350 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc634.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure634.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060034-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,39
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060034,AultCare Gold 350 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc634.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure634.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060034-03,Limited Cost Sharing Plan Variation,,0.781130790710449,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$350,$700,25%,,,,"$1,050","$2,100",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$350,$20,"$1,730",$30,$350,$740,$480,$80,40
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060033,AultCare Gold 750 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc633.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure633.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060033-00,Standard Gold Off Exchange Plan,,0.780737996101379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$2,250","$4,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$20,"$1,300",$30,$750,$710,$280,$80,41
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060033,AultCare Gold 750 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc633.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure633.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060033-01,Standard Gold On Exchange Plan,,0.780737996101379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$2,250","$4,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$20,"$1,300",$30,$750,$710,$280,$80,42
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060033,AultCare Gold 750 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc633.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure633.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060033-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,43
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060033,AultCare Gold 750 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc633.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure633.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060033-03,Limited Cost Sharing Plan Variation,,0.780737996101379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$2,250","$4,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$20,"$1,300",$30,$750,$710,$280,$80,44
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060031,AultCare Gold 1250 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc631.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure631.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060031-00,Standard Gold Off Exchange Plan,,0.781455159187317,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$3,750","$7,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,250",$20,$600,$30,"$1,250",$710,$60,$80,45
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060031,AultCare Gold 1250 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc631.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure631.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060031-01,Standard Gold On Exchange Plan,,0.781455159187317,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$3,750","$7,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,250",$20,$600,$30,"$1,250",$710,$60,$80,46
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060031,AultCare Gold 1250 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc631.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure631.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060031-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,47
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060031,AultCare Gold 1250 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc631.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure631.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060031-03,Limited Cost Sharing Plan Variation,,0.781455159187317,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$3,750","$7,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,250",$20,$600,$30,"$1,250",$710,$60,$80,48
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060030,AultCare Silver 700 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6302015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6302015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060030-00,Standard Silver Off Exchange Plan,,0.719911873340607,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,"$3,280",$30,$700,$810,$700,$80,49
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060030,AultCare Silver 700 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6302015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6302015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060030-01,Standard Silver On Exchange Plan,,0.719911873340607,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,"$3,280",$30,$700,$810,$700,$80,50
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060030,AultCare Silver 700 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6302015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6302015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060030-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,51
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060030,AultCare Silver 700 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6302015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6302015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060030-03,Limited Cost Sharing Plan Variation,,0.719911873340607,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,"$3,280",$30,$700,$810,$700,$80,52
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060030,AultCare Silver 700 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6302015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6302015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060030-06,94% AV Level Silver Plan,,0.934247076511383,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",0%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$680,$20,$0,$30,$560,$140,$0,$80,55
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060027,AultCare Silver 3000 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc627.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure627.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060027-00,Standard Silver Off Exchange Plan,,0.699551582336426,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$20,"$1,280",$30,"$1,700",$760,$0,$80,56
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060027,AultCare Silver 3000 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc627.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure627.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060027-01,Standard Silver On Exchange Plan,,0.699551582336426,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$20,"$1,280",$30,"$1,700",$760,$0,$80,57
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060027,AultCare Silver 3000 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc627.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure627.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060027-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,58
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060027,AultCare Silver 3000 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc627.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure627.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060027-03,Limited Cost Sharing Plan Variation,,0.699551582336426,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$20,"$1,280",$30,"$1,700",$760,$0,$80,59
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060027,AultCare Silver 3000 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc627.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure627.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060027-04,73% AV Level Silver Plan,,0.722603440284729,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$20,"$1,280",$30,"$1,850",$740,$0,$80,60
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060027,AultCare Silver 3000 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc627.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure627.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060027-05,87% AV Level Silver Plan,,0.866210162639618,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$800,"$1,600",20%,,,,"$2,400","$4,800",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$800,$20,$680,$30,$800,$700,$0,$80,61
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060027,AultCare Silver 3000 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc627.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure627.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060027-06,94% AV Level Silver Plan,,0.934562087059021,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$200,$400,20%,,,,$600,"$1,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$200,$20,$280,$30,$200,$300,$0,$80,62
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060026,AultCare Silver 5000 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc626.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure626.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060026-04,73% AV Level Silver Plan,,0.722446024417877,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$480,$30,"$1,850",$790,$0,$80,67
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060026,AultCare Silver 5000 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc626.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure626.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060026-05,87% AV Level Silver Plan,,0.863897502422333,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$19,050","$38,100",Not Applicable,Not Applicable,$900,"$1,800",20%,,,,"$2,700","$5,400",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$900,$20,$280,$30,$900,$300,$0,$80,68
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,1,28162,OH,Individual,No,34-1624818,28162OH0060026,AultCare Silver 5000 Select,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc626.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure626.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060026-06,94% AV Level Silver Plan,,0.93430769443512,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,"$19,050","$38,100",Not Applicable,Not Applicable,$250,$500,20%,,,,$750,"$1,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$250,$20,$130,$30,$250,$150,$0,$80,69
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060044,AultCare Silver 2500,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc644.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060044-00,Standard Silver Off Exchange Plan,,0.694309234619141,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,$480,$30,"$2,500",$0,$280,$80,4
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090049,AultCare Platinum 250,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc949.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure949.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090049-00,Standard Platinum Off Exchange Plan,,0.88265722990036,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,$750,"$1,500",Not Applicable,Not Applicable,$250,$0,$710,$30,$250,$0,$500,$80,4
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090049,AultCare Platinum 250,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc949.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure949.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090049-01,Standard Platinum On Exchange Plan,,0.88265722990036,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,$750,"$1,500",Not Applicable,Not Applicable,$250,$0,$710,$30,$250,$0,$500,$80,5
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060044,AultCare Silver 2500,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc644.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060044-01,Standard Silver On Exchange Plan,,0.694309234619141,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,$480,$30,"$2,500",$0,$280,$80,5
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060044,AultCare Silver 2500,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc644.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060044-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090046,AultCare Platinum 1500 Health Savings 500,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Platinum,No,Both,No,No,,,,Yes,Yes,$500.00,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc946.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure946.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090046-00,Standard Platinum Off Exchange Plan,,0.896662473678589,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,500",$0,$0,$30,"$1,500",$0,$0,$80,6
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090046,AultCare Platinum 1500 Health Savings 500,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Platinum,No,Both,No,No,,,,Yes,Yes,$500.00,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc946.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure946.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090046-01,Standard Platinum On Exchange Plan,,0.896662473678589,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,500",$0,$0,$30,"$1,500",$0,$0,$80,7
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060044,AultCare Silver 2500,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc644.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060044-03,Limited Cost Sharing Plan Variation,,0.694309234619141,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,$480,$30,"$2,500",$0,$280,$80,7
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060044,AultCare Silver 2500,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc644.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060044-04,73% AV Level Silver Plan,,0.721861779689789,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,$480,$30,"$2,500",$0,$280,$80,8
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090040,AultCare Gold 1300,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc940.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure940.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090040-00,Standard Gold Off Exchange Plan,,0.796123325824738,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,300",$0,$610,$30,"$1,300",$0,$400,$80,8
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090040,AultCare Gold 1300,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc940.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure940.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090040-01,Standard Gold On Exchange Plan,,0.796123325824738,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,300",$0,$610,$30,"$1,300",$0,$400,$80,9
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060044,AultCare Silver 2500,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc644.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060044-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,"$3,300","$6,600",Not Applicable,Not Applicable,"$1,100",$0,$0,$30,"$1,100",$0,$0,$80,9
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060044,AultCare Silver 2500,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc644.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060044-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$500,$0,$0,$30,$500,$0,$0,$80,10
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090057,AultCare Gold 2000,28162OH009,7376546504,OHN001,OHS002,OHF002,New,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9572015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9572015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090057-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000",$0,$0,$30,"$2,000",$0,$0,$80,10
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090057,AultCare Gold 2000,28162OH009,7376546504,OHN001,OHS002,OHF002,New,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9572015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9572015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090057-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000",$0,$0,$30,"$2,000",$0,$0,$80,11
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060043,AultCare Silver 1500,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc643.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure643.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060043-00,Standard Silver Off Exchange Plan,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,760",$30,"$1,500",$0,"$1,130",$80,11
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060043,AultCare Silver 1500,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc643.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure643.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060043-01,Standard Silver On Exchange Plan,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,760",$30,"$1,500",$0,"$1,130",$80,12
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090037,AultCare Silver 1300,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc937.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure937.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090037-00,Standard Silver Off Exchange Plan,,0.693472266197205,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",30%,,,,"$3,900","$7,800",Not Applicable,Not Applicable,"$1,300",$0,"$1,820",$30,"$1,300",$0,"$1,190",$80,12
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090037,AultCare Silver 1300,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc937.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure937.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090037-01,Standard Silver On Exchange Plan,,0.693472266197205,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",30%,,,,"$3,900","$7,800",Not Applicable,Not Applicable,"$1,300",$0,"$1,820",$30,"$1,300",$0,"$1,190",$80,13
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060043,AultCare Silver 1500,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc643.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure643.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060043-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060043,AultCare Silver 1500,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc643.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure643.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060043-03,Limited Cost Sharing Plan Variation,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,760",$30,"$1,500",$0,"$1,130",$80,14
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090035,AultCare Silver 2000 80,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc935.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure935.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090035-00,Standard Silver Off Exchange Plan,,0.685929417610168,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,070",$30,"$2,000",$0,$650,$80,14
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090035,AultCare Silver 2000 80,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc935.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure935.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090035-01,Standard Silver On Exchange Plan,,0.685929417610168,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,070",$30,"$2,000",$0,$650,$80,15
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060043,AultCare Silver 1500,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc643.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure643.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060043-04,73% AV Level Silver Plan,,0.724138915538788,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,760",$30,"$1,500",$0,"$1,130",$80,15
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060043,AultCare Silver 1500,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc643.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure643.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060043-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,"$3,300","$6,600",Not Applicable,Not Applicable,"$1,100",$0,$0,$30,"$1,100",$0,$0,$80,16
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090059,AultCare Silver 3500 100,28162OH009,7376546504,OHN001,OHS002,OHF002,New,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9592015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9592015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090059-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,$0,$30,"$3,500",$0,$0,$80,16
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090059,AultCare Silver 3500 100,28162OH009,7376546504,OHN001,OHS002,OHF002,New,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9592015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9592015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090059-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,$0,$30,"$3,500",$0,$0,$80,17
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060043,AultCare Silver 1500,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc643.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure643.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060043-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$500,$0,$0,$30,$500,$0,$0,$80,17
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060040,AultCare Bronze 2500,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6402015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6402015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060040-00,Standard Bronze Off Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,"$2,420",$30,"$2,500",$0,"$1,390",$80,18
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090033,AultCare Bronze 2500,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9332015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9332015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090033-00,Standard Bronze Off Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,"$2,420",$30,"$2,500",$0,"$1,390",$80,18
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090033,AultCare Bronze 2500,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9332015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9332015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090033-01,Standard Bronze On Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,"$2,420",$30,"$2,500",$0,"$1,390",$80,19
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090032,AultCare Bronze 3000,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9322015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9322015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090032-00,Standard Bronze Off Exchange Plan,,0.606329083442688,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,140",$30,"$3,000",$0,"$1,140",$80,20
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090032,AultCare Bronze 3000,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9322015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9322015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090032-01,Standard Bronze On Exchange Plan,,0.606329083442688,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,140",$30,"$3,000",$0,"$1,140",$80,21
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060040,AultCare Bronze 2500,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6402015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6402015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060040-03,Limited Cost Sharing Plan Variation,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,"$2,420",$30,"$2,500",$0,"$1,390",$80,21
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060039,AultCare Bronze 3500,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc639.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure639.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060039-00,Standard Bronze Off Exchange Plan,,0.616500675678253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,"$1,130",$30,"$3,500",$0,$530,$80,22
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090031,AultCare Bronze 3500,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc931.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure931.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090031-00,Standard Bronze Off Exchange Plan,,0.616500675678253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,"$1,130",$30,"$3,500",$0,$530,$80,22
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090031,AultCare Bronze 3500,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc931.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure931.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090031-01,Standard Bronze On Exchange Plan,,0.616500675678253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,"$1,130",$30,"$3,500",$0,$530,$80,23
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060039,AultCare Bronze 3500,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc639.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure639.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060039-01,Standard Bronze On Exchange Plan,,0.616500675678253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,"$1,130",$30,"$3,500",$0,$530,$80,23
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060039,AultCare Bronze 3500,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc639.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure639.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060039-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,24
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090061,AultCare Bronze 5250,28162OH009,7376546504,OHN001,OHS002,OHF002,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9612015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9612015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090061-00,Standard Bronze Off Exchange Plan,,0.619937121868134,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",0%,,,,"$15,750","$31,500",Not Applicable,Not Applicable,"$5,250",$0,$0,$30,"$5,250",$0,$0,$80,24
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090061,AultCare Bronze 5250,28162OH009,7376546504,OHN001,OHS002,OHF002,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9612015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9612015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090061-01,Standard Bronze On Exchange Plan,,0.619937121868134,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",0%,,,,"$15,750","$31,500",Not Applicable,Not Applicable,"$5,250",$0,$0,$30,"$5,250",$0,$0,$80,25
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060039,AultCare Bronze 3500,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc639.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure639.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060039-03,Limited Cost Sharing Plan Variation,,0.616500675678253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,"$1,130",$30,"$3,500",$0,$530,$80,25
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060038,AultCare Bronze 5000,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc638.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure638.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060038-00,Standard Bronze Off Exchange Plan,,0.593480467796326,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000",$0,$460,$30,"$5,000",$0,$50,$80,26
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090062,AultCare Bronze 6250,28162OH009,7376546504,OHN001,OHS002,OHF002,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9622015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9622015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090062-00,Standard Bronze Off Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$18,750","$37,500",Not Applicable,Not Applicable,"$6,250",$0,$0,$30,"$5,270",$0,$0,$80,26
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090062,AultCare Bronze 6250,28162OH009,7376546504,OHN001,OHS002,OHF002,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9622015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9622015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090062-01,Standard Bronze On Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$18,750","$37,500",Not Applicable,Not Applicable,"$6,250",$0,$0,$30,"$5,270",$0,$0,$80,27
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060038,AultCare Bronze 5000,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc638.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure638.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060038-01,Standard Bronze On Exchange Plan,,0.593480467796326,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000",$0,$460,$30,"$5,000",$0,$50,$80,27
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060038,AultCare Bronze 5000,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc638.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure638.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060038-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,28
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060038,AultCare Bronze 5000,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc638.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure638.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060038-03,Limited Cost Sharing Plan Variation,,0.593480467796326,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000",$0,$460,$30,"$5,000",$0,$50,$80,29
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060037,AultCare Bronze 6000,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc637.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure637.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060037-00,Standard Bronze Off Exchange Plan,,0.582051515579224,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,"$6,000",$0,$130,$30,"$5,270",$0,$0,$80,30
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060037,AultCare Bronze 6000,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc637.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure637.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060037-01,Standard Bronze On Exchange Plan,,0.582051515579224,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,"$6,000",$0,$130,$30,"$5,270",$0,$0,$80,31
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060037,AultCare Bronze 6000,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc637.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure637.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060037-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,32
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060037,AultCare Bronze 6000,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc637.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure637.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060037-03,Limited Cost Sharing Plan Variation,,0.582051515579224,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,"$6,000",$0,$130,$30,"$5,270",$0,$0,$80,33
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060036,AultCare Catastrophic,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6362015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6362015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060036-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$19,800","$39,600",Not Applicable,Not Applicable,"$6,600",$0,$0,$30,"$4,940",$0,$0,$80,34
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060036,AultCare Catastrophic,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6362015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6362015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060036-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$19,800","$39,600",Not Applicable,Not Applicable,"$6,600",$0,$0,$30,"$4,940",$0,$0,$80,35
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060029,AultCare Silver 2500 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc629.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure629.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060029-00,Standard Silver Off Exchange Plan,,0.694309234619141,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,$480,$30,"$2,500",$0,$280,$80,36
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060029,AultCare Silver 2500 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc629.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure629.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060029-01,Standard Silver On Exchange Plan,,0.694309234619141,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,$480,$30,"$2,500",$0,$280,$80,37
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060029,AultCare Silver 2500 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc629.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure629.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060029-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,38
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060029,AultCare Silver 2500 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc629.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure629.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060029-03,Limited Cost Sharing Plan Variation,,0.694309234619141,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,$480,$30,"$2,500",$0,$280,$80,39
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060029,AultCare Silver 2500 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc629.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure629.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060029-04,73% AV Level Silver Plan,,0.721861779689789,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,$480,$30,"$2,500",$0,$280,$80,40
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060029,AultCare Silver 2500 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc629.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure629.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060029-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,"$3,300","$6,600",Not Applicable,Not Applicable,"$1,100",$0,$0,$30,"$1,100",$0,$0,$80,41
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060029,AultCare Silver 2500 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc629.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure629.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060029-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$500,$0,$0,$30,$500,$0,$0,$80,42
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060028,AultCare Silver 1500 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc628.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure628.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060028-00,Standard Silver Off Exchange Plan,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,760",$30,"$1,500",$0,"$1,130",$80,43
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060028,AultCare Silver 1500 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc628.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure628.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060028-01,Standard Silver On Exchange Plan,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,760",$30,"$1,500",$0,"$1,130",$80,44
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060028,AultCare Silver 1500 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc628.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure628.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060028-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,45
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060028,AultCare Silver 1500 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc628.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure628.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060028-03,Limited Cost Sharing Plan Variation,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,760",$30,"$1,500",$0,"$1,130",$80,46
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060028,AultCare Silver 1500 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc628.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure628.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060028-04,73% AV Level Silver Plan,,0.724138915538788,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,760",$30,"$1,500",$0,"$1,130",$80,47
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060028,AultCare Silver 1500 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc628.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure628.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060028-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,"$3,300","$6,600",Not Applicable,Not Applicable,"$1,100",$0,$0,$30,"$1,100",$0,$0,$80,48
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060028,AultCare Silver 1500 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc628.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure628.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060028-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$500,$0,$0,$30,$500,$0,$0,$80,49
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060025,AultCare Bronze 2500 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6252015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6252015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060025-00,Standard Bronze Off Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,"$2,420",$30,"$2,500",$0,"$1,390",$80,50
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060025,AultCare Bronze 2500 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6252015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6252015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060025-01,Standard Bronze On Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,"$2,420",$30,"$2,500",$0,"$1,390",$80,51
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060025,AultCare Bronze 2500 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6252015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6252015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060025-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,52
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060025,AultCare Bronze 2500 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6252015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6252015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060025-03,Limited Cost Sharing Plan Variation,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,"$2,420",$30,"$2,500",$0,"$1,390",$80,53
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060024,AultCare Bronze 3500 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc624.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure624.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060024-00,Standard Bronze Off Exchange Plan,,0.616500675678253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,"$1,130",$30,"$3,500",$0,$530,$80,54
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060024,AultCare Bronze 3500 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc624.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure624.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060024-01,Standard Bronze On Exchange Plan,,0.616500675678253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,"$1,130",$30,"$3,500",$0,$530,$80,55
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060024,AultCare Bronze 3500 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc624.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure624.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060024-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,56
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060024,AultCare Bronze 3500 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc624.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure624.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060024-03,Limited Cost Sharing Plan Variation,,0.616500675678253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,"$1,130",$30,"$3,500",$0,$530,$80,57
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060023,AultCare Bronze 5000 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc623.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure623.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060023-00,Standard Bronze Off Exchange Plan,,0.593480467796326,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000",$0,$460,$30,"$5,000",$0,$50,$80,58
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060023,AultCare Bronze 5000 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc623.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure623.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060023-01,Standard Bronze On Exchange Plan,,0.593480467796326,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000",$0,$460,$30,"$5,000",$0,$50,$80,59
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060023,AultCare Bronze 5000 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc623.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure623.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060023-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,60
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060023,AultCare Bronze 5000 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc623.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure623.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060023-03,Limited Cost Sharing Plan Variation,,0.593480467796326,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000",$0,$460,$30,"$5,000",$0,$50,$80,61
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060022,AultCare Bronze 6000 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc622.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure622.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060022-00,Standard Bronze Off Exchange Plan,,0.582051515579224,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,"$6,000",$0,$130,$30,"$5,270",$0,$0,$80,62
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060022,AultCare Bronze 6000 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc622.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure622.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060022-01,Standard Bronze On Exchange Plan,,0.582051515579224,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,"$6,000",$0,$130,$30,"$5,270",$0,$0,$80,63
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060022,AultCare Bronze 6000 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc622.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure622.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060022-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,64
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060022,AultCare Bronze 6000 Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc622.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure622.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060022-03,Limited Cost Sharing Plan Variation,,0.582051515579224,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,"$6,000",$0,$130,$30,"$5,270",$0,$0,$80,65
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060021,AultCare Catastrophic Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6212015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6212015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060021-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$19,800","$39,600",Not Applicable,Not Applicable,"$6,600",$0,$0,$30,"$4,940",$0,$0,$80,66
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,2,28162,OH,Individual,No,34-1624818,28162OH0060021,AultCare Catastrophic Select,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6212015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6212015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060021-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$19,800","$39,600",Not Applicable,Not Applicable,"$6,600",$0,$0,$30,"$4,940",$0,$0,$80,67
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060019,AultCare Gold 350 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc619.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure619.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060019-00,Standard Gold Off Exchange Plan,,0.781130790710449,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$350,$700,25%,,,,"$1,050","$2,100",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$350,$20,"$1,730",$30,$350,$740,$480,$80,4
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090030,AultCare Platinum 200 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc930.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure930.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090030-00,Standard Platinum Off Exchange Plan,,0.884455919265747,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$19,050","$38,100",Not Applicable,Not Applicable,$200,$400,10%,,,,$600,"$1,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$200,$20,$710,$30,$200,$710,$270,$80,4
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090030,AultCare Platinum 200 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc930.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure930.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090030-01,Standard Platinum On Exchange Plan,,0.884455919265747,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$19,050","$38,100",Not Applicable,Not Applicable,$200,$400,10%,,,,$600,"$1,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$200,$20,$710,$30,$200,$710,$270,$80,5
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060019,AultCare Gold 350 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc619.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure619.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060019-01,Standard Gold On Exchange Plan,,0.781130790710449,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$350,$700,25%,,,,"$1,050","$2,100",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$350,$20,"$1,730",$30,$350,$740,$480,$80,5
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060019,AultCare Gold 350 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc619.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure619.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060019-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090028,AultCare Platinum 500 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc928.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure928.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090028-00,Standard Platinum Off Exchange Plan,,0.880419075489044,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$19,050","$38,100",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$20,$780,$30,$500,$710,$90,$80,6
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090028,AultCare Platinum 500 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc928.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure928.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090028-01,Standard Platinum On Exchange Plan,,0.880419075489044,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$19,050","$38,100",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$20,$780,$30,$500,$710,$90,$80,7
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060019,AultCare Gold 350 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc619.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure619.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060019-03,Limited Cost Sharing Plan Variation,,0.781130790710449,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$350,$700,25%,,,,"$1,050","$2,100",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$350,$20,"$1,730",$30,$350,$740,$480,$80,7
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090027,AultCare Platinum 1000 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc927.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure927.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090027-00,Standard Platinum Off Exchange Plan,,0.907914519309998,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$980,$20,$0,$30,$620,$380,$0,$80,8
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060018,AultCare Gold 750 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc618.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure618.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060018-00,Standard Gold Off Exchange Plan,,0.780737996101379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$2,250","$4,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$20,"$1,300",$30,$750,$710,$280,$80,8
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060018,AultCare Gold 750 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc618.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure618.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060018-01,Standard Gold On Exchange Plan,,0.780737996101379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$2,250","$4,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$20,"$1,300",$30,$750,$710,$280,$80,9
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090027,AultCare Platinum 1000 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc927.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure927.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090027-01,Standard Platinum On Exchange Plan,,0.907914519309998,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$1,000","$2,000",0%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$980,$20,$0,$30,$620,$380,$0,$80,9
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090024,AultCare Gold 350 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc924.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure924.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090024-00,Standard Gold Off Exchange Plan,,0.781130790710449,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$350,$700,25%,,,,"$1,050","$2,100",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$350,$20,"$1,730",$30,$350,$740,$480,$80,10
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060018,AultCare Gold 750 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc618.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure618.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060018-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060018,AultCare Gold 750 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc618.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure618.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060018-03,Limited Cost Sharing Plan Variation,,0.780737996101379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$2,250","$4,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$20,"$1,300",$30,$750,$710,$280,$80,11
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090024,AultCare Gold 350 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc924.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure924.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090024-01,Standard Gold On Exchange Plan,,0.781130790710449,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$350,$700,25%,,,,"$1,050","$2,100",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$350,$20,"$1,730",$30,$350,$740,$480,$80,11
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090023,AultCare Gold 500 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc923.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure923.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090023-00,Standard Gold Off Exchange Plan,,0.815265119075775,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$20,"$1,350",$30,$500,$740,$370,$80,12
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060016,AultCare Gold 1250 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc616.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure616.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060016-00,Standard Gold Off Exchange Plan,,0.781455159187317,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$3,750","$7,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,250",$20,$600,$30,"$1,250",$710,$60,$80,12
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060016,AultCare Gold 1250 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc616.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure616.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060016-01,Standard Gold On Exchange Plan,,0.781455159187317,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$3,750","$7,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,250",$20,$600,$30,"$1,250",$710,$60,$80,13
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090023,AultCare Gold 500 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc923.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure923.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090023-01,Standard Gold On Exchange Plan,,0.815265119075775,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$500,$20,"$1,350",$30,$500,$740,$370,$80,13
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090022,AultCare Gold 750 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc922.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure922.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090022-00,Standard Gold Off Exchange Plan,,0.780737996101379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$2,250","$4,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$20,"$1,300",$30,$750,$710,$280,$80,14
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060016,AultCare Gold 1250 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc616.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure616.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060016-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060016,AultCare Gold 1250 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc616.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure616.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060016-03,Limited Cost Sharing Plan Variation,,0.781455159187317,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$3,750","$7,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,250",$20,$600,$30,"$1,250",$710,$60,$80,15
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090022,AultCare Gold 750 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc922.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure922.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090022-01,Standard Gold On Exchange Plan,,0.780737996101379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$2,250","$4,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$20,"$1,300",$30,$750,$710,$280,$80,15
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090021,AultCare Gold 1250 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc921.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure921.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090021-00,Standard Gold Off Exchange Plan,,0.781455159187317,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$3,750","$7,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,250",$20,$600,$30,"$1,250",$710,$60,$80,16
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060015,AultCare Silver 700 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6152015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6152015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060015-00,Standard Silver Off Exchange Plan,,0.719911873340607,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,"$3,280",$30,$700,$810,$700,$80,16
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060015,AultCare Silver 700 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6152015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6152015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060015-01,Standard Silver On Exchange Plan,,0.719911873340607,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,"$3,280",$30,$700,$810,$700,$80,17
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090021,AultCare Gold 1250 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc921.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure921.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090021-01,Standard Gold On Exchange Plan,,0.781455159187317,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$3,750","$7,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,250",$20,$600,$30,"$1,250",$710,$60,$80,17
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090052,AultCare Gold 2500 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9522015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9522015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090052-00,Standard Gold Off Exchange Plan,,0.781074345111847,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,$480,$30,"$1,850",$660,$0,$80,18
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060015,AultCare Silver 700 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6152015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6152015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060015,AultCare Silver 700 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6152015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6152015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060015-03,Limited Cost Sharing Plan Variation,,0.719911873340607,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,"$3,280",$30,$700,$810,$700,$80,19
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090052,AultCare Gold 2500 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF001,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9522015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9522015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090052-01,Standard Gold On Exchange Plan,,0.781074345111847,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,$480,$30,"$1,850",$660,$0,$80,19
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090018,AultCare Silver 700 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9182015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9182015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090018-00,Standard Silver Off Exchange Plan,,0.719911873340607,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,"$3,280",$30,$700,$810,$700,$80,20
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060015,AultCare Silver 700 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6152015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6152015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060015-04,73% AV Level Silver Plan,,0.739934027194977,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,169","$10,338",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,"$3,280",$30,$700,$810,$700,$80,20
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060015,AultCare Silver 700 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6152015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6152015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060015-05,87% AV Level Silver Plan,,0.861903011798859,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,$680,$30,$700,$700,$0,$80,21
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090018,AultCare Silver 700 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9182015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9182015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090018-01,Standard Silver On Exchange Plan,,0.719911873340607,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,"$3,280",$30,$700,$810,$700,$80,21
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090016,AultCare Silver 2000 75 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc916.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure916.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090016-00,Standard Silver Off Exchange Plan,,0.719536542892456,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$2,000","$4,000",25%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,"$1,310",$30,"$1,850",$790,$0,$80,22
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060015,AultCare Silver 700 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6152015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6152015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060015-06,94% AV Level Silver Plan,,0.934247076511383,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",0%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$680,$20,$0,$30,$560,$140,$0,$80,22
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090016,AultCare Silver 2000 75 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF001,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc916.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure916.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090016-01,Standard Silver On Exchange Plan,,0.719536542892456,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$2,000","$4,000",25%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$20,"$1,310",$30,"$1,850",$790,$0,$80,23
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060012,AultCare Silver 3000 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060012-00,Standard Silver Off Exchange Plan,,0.699551582336426,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$20,"$1,280",$30,"$1,700",$760,$0,$80,23
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060012,AultCare Silver 3000 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060012-01,Standard Silver On Exchange Plan,,0.699551582336426,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$20,"$1,280",$30,"$1,700",$760,$0,$80,24
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090054,AultCare Silver 3500 90 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9542015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9542015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090054-00,Standard Silver Off Exchange Plan,,0.708744943141937,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$3,500","$7,000",10%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$20,$380,$30,"$1,850",$740,$0,$80,24
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090054,AultCare Silver 3500 90 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF001,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9542015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9542015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0090054-01,Standard Silver On Exchange Plan,,0.708744943141937,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$3,500","$7,000",10%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$20,$380,$30,"$1,850",$740,$0,$80,25
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060012,AultCare Silver 3000 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060012-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,25
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060012,AultCare Silver 3000 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060012-03,Limited Cost Sharing Plan Variation,,0.699551582336426,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$20,"$1,280",$30,"$1,700",$760,$0,$80,26
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060012,AultCare Silver 3000 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060012-04,73% AV Level Silver Plan,,0.722603440284729,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$20,"$1,280",$30,"$1,850",$740,$0,$80,27
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060012,AultCare Silver 3000 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060012-05,87% AV Level Silver Plan,,0.866210162639618,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$800,"$1,600",20%,,,,"$2,400","$4,800",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$800,$20,$680,$30,$800,$700,$0,$80,28
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060012,AultCare Silver 3000 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060012-06,94% AV Level Silver Plan,,0.934562087059021,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$200,$400,20%,,,,$600,"$1,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$200,$20,$280,$30,$200,$300,$0,$80,29
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060011,AultCare Silver 5000 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc611.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure611.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060011-00,Standard Silver Off Exchange Plan,,0.681439697742462,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$5,000","$10,000",40%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$5,000",$20,$900,$30,"$1,700",$790,$0,$80,30
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060011,AultCare Silver 5000 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc611.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure611.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060011-01,Standard Silver On Exchange Plan,,0.681439697742462,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$5,000","$10,000",40%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$5,000",$20,$900,$30,"$1,700",$790,$0,$80,31
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060011,AultCare Silver 5000 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc611.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure611.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060011-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,32
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060011,AultCare Silver 5000 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc611.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure611.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060011-03,Limited Cost Sharing Plan Variation,,0.681439697742462,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$5,000","$10,000",40%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$5,000",$20,$900,$30,"$1,700",$790,$0,$80,33
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060011,AultCare Silver 5000 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc611.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure611.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060011-04,73% AV Level Silver Plan,,0.722446024417877,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$480,$30,"$1,850",$790,$0,$80,34
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060011,AultCare Silver 5000 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc611.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure611.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060011-05,87% AV Level Silver Plan,,0.863897502422333,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$19,050","$38,100",Not Applicable,Not Applicable,$900,"$1,800",20%,,,,"$2,700","$5,400",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$900,$20,$280,$30,$900,$300,$0,$80,35
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060011,AultCare Silver 5000 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc611.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure611.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060011-06,94% AV Level Silver Plan,,0.93430769443512,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,"$19,050","$38,100",Not Applicable,Not Applicable,$250,$500,20%,,,,$750,"$1,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$250,$20,$130,$30,$250,$150,$0,$80,36
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060053,AultCare Gold 350 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc653.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure653.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060053-00,Standard Gold Off Exchange Plan,,0.781130790710449,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$350,$700,25%,,,,"$1,050","$2,100",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$350,$20,"$1,730",$30,$350,$740,$480,$80,37
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060053,AultCare Gold 350 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc653.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure653.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060053-01,Standard Gold On Exchange Plan,,0.781130790710449,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$350,$700,25%,,,,"$1,050","$2,100",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$350,$20,"$1,730",$30,$350,$740,$480,$80,38
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060054,AultCare Gold 750 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc654.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure654.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060054-00,Standard Gold Off Exchange Plan,,0.780737996101379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$2,250","$4,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$20,"$1,300",$30,$750,$710,$280,$80,41
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060054,AultCare Gold 750 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc654.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure654.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060054-01,Standard Gold On Exchange Plan,,0.780737996101379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$2,250","$4,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$20,"$1,300",$30,$750,$710,$280,$80,42
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060054,AultCare Gold 750 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc654.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure654.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060054-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,43
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060054,AultCare Gold 750 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc654.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure654.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060054-03,Limited Cost Sharing Plan Variation,,0.780737996101379,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$2,250","$4,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$20,"$1,300",$30,$750,$710,$280,$80,44
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060056,AultCare Gold 1250 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc656.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure656.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060056-00,Standard Gold Off Exchange Plan,,0.781455159187317,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$3,750","$7,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,250",$20,$600,$30,"$1,250",$710,$60,$80,45
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060056,AultCare Gold 1250 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc656.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure656.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060056-01,Standard Gold On Exchange Plan,,0.781455159187317,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$3,750","$7,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,250",$20,$600,$30,"$1,250",$710,$60,$80,46
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060056,AultCare Gold 1250 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc656.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure656.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060056-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,47
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060056,AultCare Gold 1250 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc656.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure656.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060056-03,Limited Cost Sharing Plan Variation,,0.781455159187317,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$3,750","$7,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,250",$20,$600,$30,"$1,250",$710,$60,$80,48
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060057,AultCare Silver 700 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6572015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6572015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060057-00,Standard Silver Off Exchange Plan,,0.719911873340607,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,"$3,280",$30,$700,$810,$700,$80,49
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060057,AultCare Silver 700 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6572015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6572015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060057-01,Standard Silver On Exchange Plan,,0.719911873340607,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,"$3,280",$30,$700,$810,$700,$80,50
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060057,AultCare Silver 700 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6572015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6572015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060057-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,51
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060057,AultCare Silver 700 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6572015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6572015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060057-03,Limited Cost Sharing Plan Variation,,0.719911873340607,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,"$3,280",$30,$700,$810,$700,$80,52
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060057,AultCare Silver 700 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6572015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6572015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060057-04,73% AV Level Silver Plan,,0.739934027194977,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,169","$10,338",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,"$3,280",$30,$700,$810,$700,$80,53
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060057,AultCare Silver 700 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6572015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6572015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060057-05,87% AV Level Silver Plan,,0.861903011798859,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",50%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,$680,$30,$700,$700,$0,$80,54
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060057,AultCare Silver 700 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6572015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6572015.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060057-06,94% AV Level Silver Plan,,0.934247076511383,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,"$19,050","$38,100",Not Applicable,Not Applicable,$700,"$1,400",0%,,,,"$2,100","$4,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$680,$20,$0,$30,$560,$140,$0,$80,55
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060060,AultCare Silver 3000 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc660.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure660.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060060-00,Standard Silver Off Exchange Plan,,0.699551582336426,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$20,"$1,280",$30,"$1,700",$760,$0,$80,56
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060060,AultCare Silver 3000 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc660.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure660.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060060-01,Standard Silver On Exchange Plan,,0.699551582336426,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$20,"$1,280",$30,"$1,700",$760,$0,$80,57
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060060,AultCare Silver 3000 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc660.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure660.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060060-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,58
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060060,AultCare Silver 3000 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc660.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure660.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060060-03,Limited Cost Sharing Plan Variation,,0.699551582336426,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$20,"$1,280",$30,"$1,700",$760,$0,$80,59
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060060,AultCare Silver 3000 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc660.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure660.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060060-04,73% AV Level Silver Plan,,0.722603440284729,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$20,"$1,280",$30,"$1,850",$740,$0,$80,60
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060060,AultCare Silver 3000 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc660.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure660.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060060-05,87% AV Level Silver Plan,,0.866210162639618,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$800,"$1,600",20%,,,,"$2,400","$4,800",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$800,$20,$680,$30,$800,$700,$0,$80,61
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060060,AultCare Silver 3000 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc660.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure660.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060060-06,94% AV Level Silver Plan,,0.934562087059021,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,$200,$400,20%,,,,$600,"$1,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$200,$20,$280,$30,$200,$300,$0,$80,62
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060061,AultCare Silver 5000 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc661.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure661.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060061-00,Standard Silver Off Exchange Plan,,0.681439697742462,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$5,000","$10,000",40%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$5,000",$20,$900,$30,"$1,700",$790,$0,$80,63
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060061,AultCare Silver 5000 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc661.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure661.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060061-01,Standard Silver On Exchange Plan,,0.681439697742462,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$5,000","$10,000",40%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$5,000",$20,$900,$30,"$1,700",$790,$0,$80,64
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060061,AultCare Silver 5000 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc661.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure661.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060061-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,65
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060061,AultCare Silver 5000 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc661.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure661.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060061-03,Limited Cost Sharing Plan Variation,,0.681439697742462,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$5,000","$10,000",40%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$5,000",$20,$900,$30,"$1,700",$790,$0,$80,66
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060061,AultCare Silver 5000 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc661.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure661.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060061-04,73% AV Level Silver Plan,,0.722446024417877,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$4,000",$20,$480,$30,"$1,850",$790,$0,$80,67
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060061,AultCare Silver 5000 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc661.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure661.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060061-05,87% AV Level Silver Plan,,0.863897502422333,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$19,050","$38,100",Not Applicable,Not Applicable,$900,"$1,800",20%,,,,"$2,700","$5,400",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$900,$20,$280,$30,$900,$300,$0,$80,68
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,3,28162,OH,Individual,No,34-1624818,28162OH0060061,AultCare Silver 5000 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF001,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc661.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure661.pdf,http://www.AultCAS.com/acformularya2015.aspx,28162OH0060061-06,94% AV Level Silver Plan,,0.93430769443512,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,"$19,050","$38,100",Not Applicable,Not Applicable,$250,$500,20%,,,,$750,"$1,500",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$250,$20,$130,$30,$250,$150,$0,$80,69
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060014,AultCare Silver 2500 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc614.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure614.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060014-00,Standard Silver Off Exchange Plan,,0.694309234619141,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,$480,$30,"$2,500",$0,$280,$80,4
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090029,AultCare Platinum 250 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc929.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure929.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090029-00,Standard Platinum Off Exchange Plan,,0.88265722990036,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,$750,"$1,500",Not Applicable,Not Applicable,$250,$0,$710,$30,$250,$0,$500,$80,4
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090029,AultCare Platinum 250 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc929.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure929.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090029-01,Standard Platinum On Exchange Plan,,0.88265722990036,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,10%,,,,$750,"$1,500",Not Applicable,Not Applicable,$250,$0,$710,$30,$250,$0,$500,$80,5
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060014,AultCare Silver 2500 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc614.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure614.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060014-01,Standard Silver On Exchange Plan,,0.694309234619141,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,$480,$30,"$2,500",$0,$280,$80,5
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060014,AultCare Silver 2500 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc614.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure614.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090026,AultCare Platinum 1500 Health Savings 500 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Platinum,No,Both,No,No,,,,Yes,Yes,$500.00,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc926.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure926.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090026-00,Standard Platinum Off Exchange Plan,,0.896662473678589,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,500",$0,$0,$30,"$1,500",$0,$0,$80,6
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090026,AultCare Platinum 1500 Health Savings 500 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Platinum,No,Both,No,No,,,,Yes,Yes,$500.00,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc926.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure926.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090026-01,Standard Platinum On Exchange Plan,,0.896662473678589,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,500",$0,$0,$30,"$1,500",$0,$0,$80,7
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060014,AultCare Silver 2500 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc614.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure614.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060014-03,Limited Cost Sharing Plan Variation,,0.694309234619141,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,$480,$30,"$2,500",$0,$280,$80,7
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060014,AultCare Silver 2500 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc614.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure614.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060014-04,73% AV Level Silver Plan,,0.721861779689789,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,$480,$30,"$2,500",$0,$280,$80,8
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090020,AultCare Gold 1300 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc920.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure920.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090020-00,Standard Gold Off Exchange Plan,,0.796123325824738,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,300",$0,$610,$30,"$1,300",$0,$400,$80,8
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090020,AultCare Gold 1300 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc920.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure920.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090020-01,Standard Gold On Exchange Plan,,0.796123325824738,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,300",$0,$610,$30,"$1,300",$0,$400,$80,9
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060014,AultCare Silver 2500 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc614.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure614.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060014-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,"$3,300","$6,600",Not Applicable,Not Applicable,"$1,100",$0,$0,$30,"$1,100",$0,$0,$80,9
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060014,AultCare Silver 2500 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc614.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure614.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060014-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$500,$0,$0,$30,$500,$0,$0,$80,10
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090051,AultCare Gold 2000 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,New,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9512015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9512015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090051-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000",$0,$0,$30,"$2,000",$0,$0,$80,10
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090051,AultCare Gold 2000 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,New,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9512015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9512015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090051-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000",$0,$0,$30,"$2,000",$0,$0,$80,11
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060013,AultCare Silver 1500 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc613.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure613.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060013-00,Standard Silver Off Exchange Plan,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,760",$30,"$1,500",$0,"$1,130",$80,11
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060013,AultCare Silver 1500 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc613.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure613.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060013-01,Standard Silver On Exchange Plan,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,760",$30,"$1,500",$0,"$1,130",$80,12
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090017,AultCare Silver 1300 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc917.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure917.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090017-00,Standard Silver Off Exchange Plan,,0.693472266197205,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",30%,,,,"$3,900","$7,800",Not Applicable,Not Applicable,"$1,300",$0,"$1,820",$30,"$1,300",$0,"$1,190",$80,12
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090017,AultCare Silver 1300 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc917.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure917.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090017-01,Standard Silver On Exchange Plan,,0.693472266197205,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",30%,,,,"$3,900","$7,800",Not Applicable,Not Applicable,"$1,300",$0,"$1,820",$30,"$1,300",$0,"$1,190",$80,13
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060013,AultCare Silver 1500 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc613.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure613.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060013,AultCare Silver 1500 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc613.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure613.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060013-03,Limited Cost Sharing Plan Variation,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,760",$30,"$1,500",$0,"$1,130",$80,14
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090015,AultCare Silver 2000 80 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc915.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure915.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090015-00,Standard Silver Off Exchange Plan,,0.685929417610168,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,070",$30,"$2,000",$0,$650,$80,14
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090015,AultCare Silver 2000 80 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc915.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure915.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090015-01,Standard Silver On Exchange Plan,,0.685929417610168,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,070",$30,"$2,000",$0,$650,$80,15
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060013,AultCare Silver 1500 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc613.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure613.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060013-04,73% AV Level Silver Plan,,0.724138915538788,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,760",$30,"$1,500",$0,"$1,130",$80,15
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060013,AultCare Silver 1500 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc613.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure613.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060013-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,"$3,300","$6,600",Not Applicable,Not Applicable,"$1,100",$0,$0,$30,"$1,100",$0,$0,$80,16
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090053,AultCare Silver 3500 100 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,New,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9532015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9532015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090053-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,$0,$30,"$3,500",$0,$0,$80,16
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090053,AultCare Silver 3500 100 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,New,PPO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9532015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9532015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090053-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,$0,$30,"$3,500",$0,$0,$80,17
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060013,AultCare Silver 1500 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc613.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure613.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060013-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$500,$0,$0,$30,$500,$0,$0,$80,17
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060010,AultCare Bronze 2500 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6102015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6102015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060010-00,Standard Bronze Off Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,"$2,420",$30,"$2,500",$0,"$1,390",$80,18
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090013,AultCare Bronze 2500 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9132015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9132015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090013-00,Standard Bronze Off Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,"$2,420",$30,"$2,500",$0,"$1,390",$80,18
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090013,AultCare Bronze 2500 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9132015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9132015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090013-01,Standard Bronze On Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,"$2,420",$30,"$2,500",$0,"$1,390",$80,19
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060010,AultCare Bronze 2500 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6102015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6102015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060010-01,Standard Bronze On Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,"$2,420",$30,"$2,500",$0,"$1,390",$80,19
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060010,AultCare Bronze 2500 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6102015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6102015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090012,AultCare Bronze 3000 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9122015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9122015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090012-00,Standard Bronze Off Exchange Plan,,0.606329083442688,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,140",$30,"$3,000",$0,"$1,140",$80,20
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090012,AultCare Bronze 3000 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9122015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9122015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090012-01,Standard Bronze On Exchange Plan,,0.606329083442688,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,140",$30,"$3,000",$0,"$1,140",$80,21
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060010,AultCare Bronze 2500 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6102015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6102015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060010-03,Limited Cost Sharing Plan Variation,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,"$2,420",$30,"$2,500",$0,"$1,390",$80,21
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060009,AultCare Bronze 3500 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc609.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure609.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060009-00,Standard Bronze Off Exchange Plan,,0.616500675678253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,"$1,130",$30,"$3,500",$0,$530,$80,22
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090011,AultCare Bronze 3500 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc911.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure911.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090011-00,Standard Bronze Off Exchange Plan,,0.616500675678253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,"$1,130",$30,"$3,500",$0,$530,$80,22
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090011,AultCare Bronze 3500 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc911.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure911.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090011-01,Standard Bronze On Exchange Plan,,0.616500675678253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,"$1,130",$30,"$3,500",$0,$530,$80,23
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060009,AultCare Bronze 3500 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc609.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure609.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060009-01,Standard Bronze On Exchange Plan,,0.616500675678253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,"$1,130",$30,"$3,500",$0,$530,$80,23
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060009,AultCare Bronze 3500 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc609.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure609.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,24
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090055,AultCare Bronze 5250 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9552015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9552015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090055-00,Standard Bronze Off Exchange Plan,,0.619937121868134,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",0%,,,,"$15,750","$31,500",Not Applicable,Not Applicable,"$5,250",$0,$0,$30,"$5,250",$0,$0,$80,24
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090055,AultCare Bronze 5250 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9552015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9552015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090055-01,Standard Bronze On Exchange Plan,,0.619937121868134,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",0%,,,,"$15,750","$31,500",Not Applicable,Not Applicable,"$5,250",$0,$0,$30,"$5,250",$0,$0,$80,25
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060009,AultCare Bronze 3500 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc609.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure609.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060009-03,Limited Cost Sharing Plan Variation,,0.616500675678253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,"$1,130",$30,"$3,500",$0,$530,$80,25
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060008,AultCare Bronze 5000 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc608.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure608.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060008-00,Standard Bronze Off Exchange Plan,,0.593480467796326,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000",$0,$460,$30,"$5,000",$0,$50,$80,26
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090056,AultCare Bronze 6250 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9562015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9562015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090056-00,Standard Bronze Off Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$18,750","$37,500",Not Applicable,Not Applicable,"$6,250",$0,$0,$30,"$5,270",$0,$0,$80,26
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,SHOP (Small Group),No,34-1624818,28162OH0090056,AultCare Bronze 6250 No Pediatric Dental,28162OH009,7376546504,OHN001,OHS002,OHF002,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9562015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9562015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0090056-01,Standard Bronze On Exchange Plan,,0.583353817462921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$18,750","$37,500",Not Applicable,Not Applicable,"$6,250",$0,$0,$30,"$5,270",$0,$0,$80,27
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060008,AultCare Bronze 5000 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc608.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure608.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060008-01,Standard Bronze On Exchange Plan,,0.593480467796326,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000",$0,$460,$30,"$5,000",$0,$50,$80,27
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060008,AultCare Bronze 5000 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc608.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure608.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,28
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060008,AultCare Bronze 5000 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc608.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure608.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060008-03,Limited Cost Sharing Plan Variation,,0.593480467796326,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000",$0,$460,$30,"$5,000",$0,$50,$80,29
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060007,AultCare Bronze 6000 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc607.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure607.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060007-00,Standard Bronze Off Exchange Plan,,0.582051515579224,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,"$6,000",$0,$130,$30,"$5,270",$0,$0,$80,30
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060007,AultCare Bronze 6000 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc607.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure607.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060007-01,Standard Bronze On Exchange Plan,,0.582051515579224,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,"$6,000",$0,$130,$30,"$5,270",$0,$0,$80,31
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060007,AultCare Bronze 6000 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc607.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure607.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,32
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060007,AultCare Bronze 6000 No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc607.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure607.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060007-03,Limited Cost Sharing Plan Variation,,0.582051515579224,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,"$6,000",$0,$130,$30,"$5,270",$0,$0,$80,33
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060051,AultCare Catastrophic No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6512015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6512015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060051-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$19,800","$39,600",Not Applicable,Not Applicable,"$6,600",$0,$0,$30,"$4,940",$0,$0,$80,34
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060051,AultCare Catastrophic No Pediatric Dental,28162OH006,7376546504,OHN001,OHS001,OHF002,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6512015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6512015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060051-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$19,800","$39,600",Not Applicable,Not Applicable,"$6,600",$0,$0,$30,"$4,940",$0,$0,$80,35
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060058,AultCare Silver 2500 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc658.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure658.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060058-00,Standard Silver Off Exchange Plan,,0.694309234619141,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,$480,$30,"$2,500",$0,$280,$80,36
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060058,AultCare Silver 2500 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc658.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure658.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060058-01,Standard Silver On Exchange Plan,,0.694309234619141,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,$480,$30,"$2,500",$0,$280,$80,37
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060058,AultCare Silver 2500 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc658.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure658.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060058-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,38
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060058,AultCare Silver 2500 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc658.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure658.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060058-03,Limited Cost Sharing Plan Variation,,0.694309234619141,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,$480,$30,"$2,500",$0,$280,$80,39
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060058,AultCare Silver 2500 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc658.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure658.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060058-04,73% AV Level Silver Plan,,0.721861779689789,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,$480,$30,"$2,500",$0,$280,$80,40
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060058,AultCare Silver 2500 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc658.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure658.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060058-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,"$3,300","$6,600",Not Applicable,Not Applicable,"$1,100",$0,$0,$30,"$1,100",$0,$0,$80,41
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060058,AultCare Silver 2500 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc658.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure658.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060058-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$500,$0,$0,$30,$500,$0,$0,$80,42
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060059,AultCare Silver 1500 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc659.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure659.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060059-00,Standard Silver Off Exchange Plan,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,760",$30,"$1,500",$0,"$1,130",$80,43
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060059,AultCare Silver 1500 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc659.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure659.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060059-01,Standard Silver On Exchange Plan,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,760",$30,"$1,500",$0,"$1,130",$80,44
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060059,AultCare Silver 1500 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc659.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure659.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060059-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,45
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060059,AultCare Silver 1500 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc659.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure659.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060059-03,Limited Cost Sharing Plan Variation,,0.682375550270081,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,760",$30,"$1,500",$0,"$1,130",$80,46
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060059,AultCare Silver 1500 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc659.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure659.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060059-04,73% AV Level Silver Plan,,0.724138915538788,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$4,500","$9,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,760",$30,"$1,500",$0,"$1,130",$80,47
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060059,AultCare Silver 1500 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc659.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure659.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060059-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,"$3,300","$6,600",Not Applicable,Not Applicable,"$1,100",$0,$0,$30,"$1,100",$0,$0,$80,48
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,11,29276,OH,Individual,No,31-1440175,29276OH0740027,Anthem Silver Pathway X PPO 2500 10,29276OH074,,OHN002,OHS001,OHF026,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLW,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740027-01,Standard Silver On Exchange Plan,69.61%,0.718345582485199,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,"$2,500","$5,000",40%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,11,29276,OH,Individual,No,31-1440175,29276OH0740027,Anthem Silver Pathway X PPO 2500 10,29276OH074,,OHN002,OHS001,OHF026,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLW,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740027-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,11,29276,OH,Individual,No,31-1440175,29276OH0740027,Anthem Silver Pathway X PPO 2500 10,29276OH074,,OHN002,OHS001,OHF026,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLW,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740027-03,Limited Cost Sharing Plan Variation,69.61%,0.718345582485199,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,"$2,500","$5,000",40%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,11,29276,OH,Individual,No,31-1440175,29276OH0740027,Anthem Silver Pathway X PPO 2500 10,29276OH074,,OHN002,OHS001,OHF026,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLW,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740027-04,73% AV Level Silver Plan,72.34%,0.742346465587616,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",10%,"$2,250","$4,500",40%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,11,29276,OH,Individual,No,31-1440175,29276OH0740027,Anthem Silver Pathway X PPO 2500 10,29276OH074,,OHN002,OHS001,OHF026,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLW,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740027-05,87% AV Level Silver Plan,86.05%,0.868443131446838,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",10%,$750,"$1,500",40%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,11,29276,OH,Individual,No,31-1440175,29276OH0740027,Anthem Silver Pathway X PPO 2500 10,29276OH074,,OHN002,OHS001,OHF026,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLW,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740027-06,94% AV Level Silver Plan,93.24%,0.937319338321686,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$600,"$1,200",$600,"$1,200","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,$200,$400,40%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,12,29276,OH,Individual,No,31-1440175,29276OH0740028,Anthem Gold Pathway X PPO 1250 10,29276OH074,,OHN002,OHS001,OHF013,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GM2,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740028-00,Standard Gold Off Exchange Plan,78.07%,0.798492908477783,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,100","$6,200","$3,100","$6,200","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,"$1,250","$2,500",40%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,12,29276,OH,Individual,No,31-1440175,29276OH0740028,Anthem Gold Pathway X PPO 1250 10,29276OH074,,OHN002,OHS001,OHF013,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GM2,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740028-01,Standard Gold On Exchange Plan,78.07%,0.798492908477783,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,100","$6,200","$3,100","$6,200","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,"$1,250","$2,500",40%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,12,29276,OH,Individual,No,31-1440175,29276OH0740028,Anthem Gold Pathway X PPO 1250 10,29276OH074,,OHN002,OHS001,OHF013,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GM2,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740028-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,12,29276,OH,Individual,No,31-1440175,29276OH0740028,Anthem Gold Pathway X PPO 1250 10,29276OH074,,OHN002,OHS001,OHF013,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GM2,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740028-03,Limited Cost Sharing Plan Variation,78.07%,0.798492908477783,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$3,100","$6,200","$3,100","$6,200","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,"$1,250","$2,500",40%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,13,29276,OH,Individual,No,31-1440175,29276OH0740029,Anthem Silver Pathway X PPO 3500 25,29276OH074,,OHN002,OHS001,OHF032,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GM5,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740029-00,Standard Silver Off Exchange Plan,68.20%,0.690982937812805,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,500","$11,000","$5,500","$11,000","$14,000","$28,000",Not Applicable,Not Applicable,"$3,500","$7,000",25%,"$3,500","$7,000",25%,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,000","$1,000",40%,"$1,000","$1,000",40%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,13,29276,OH,Individual,No,31-1440175,29276OH0740029,Anthem Silver Pathway X PPO 3500 25,29276OH074,,OHN002,OHS001,OHF032,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GM5,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740029-01,Standard Silver On Exchange Plan,68.20%,0.690982937812805,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,500","$11,000","$5,500","$11,000","$14,000","$28,000",Not Applicable,Not Applicable,"$3,500","$7,000",25%,"$3,500","$7,000",25%,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,000","$1,000",40%,"$1,000","$1,000",40%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,13,29276,OH,Individual,No,31-1440175,29276OH0740029,Anthem Silver Pathway X PPO 3500 25,29276OH074,,OHN002,OHS001,OHF032,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GM5,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740029-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,13,29276,OH,Individual,No,31-1440175,29276OH0740029,Anthem Silver Pathway X PPO 3500 25,29276OH074,,OHN002,OHS001,OHF032,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GM5,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740029-03,Limited Cost Sharing Plan Variation,68.20%,0.690982937812805,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,500","$11,000","$5,500","$11,000","$14,000","$28,000",Not Applicable,Not Applicable,"$3,500","$7,000",25%,"$3,500","$7,000",25%,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,000","$1,000",40%,"$1,000","$1,000",40%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060059,AultCare Silver 1500 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc659.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure659.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060059-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$500,$0,$0,$30,$500,$0,$0,$80,49
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060062,AultCare Bronze 2500 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6622015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6622015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060062-00,Standard Bronze Off Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,"$2,420",$30,"$2,500",$0,"$1,390",$80,50
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060062,AultCare Bronze 2500 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6622015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6622015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060062-01,Standard Bronze On Exchange Plan,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,"$2,420",$30,"$2,500",$0,"$1,390",$80,51
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060062,AultCare Bronze 2500 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6622015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6622015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060062-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,52
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060062,AultCare Bronze 2500 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6622015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6622015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060062-03,Limited Cost Sharing Plan Variation,,0.615817248821259,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$0,"$2,420",$30,"$2,500",$0,"$1,390",$80,53
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060063,AultCare Bronze 3500 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc663.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure663.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060063-00,Standard Bronze Off Exchange Plan,,0.616500675678253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,"$1,130",$30,"$3,500",$0,$530,$80,54
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060063,AultCare Bronze 3500 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc663.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure663.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060063-01,Standard Bronze On Exchange Plan,,0.616500675678253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,"$1,130",$30,"$3,500",$0,$530,$80,55
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060063,AultCare Bronze 3500 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc663.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure663.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060063-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,56
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060063,AultCare Bronze 3500 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc663.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure663.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060063-03,Limited Cost Sharing Plan Variation,,0.616500675678253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$3,500",$0,"$1,130",$30,"$3,500",$0,$530,$80,57
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060064,AultCare Bronze 5000 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc664.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure664.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060064-00,Standard Bronze Off Exchange Plan,,0.593480467796326,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000",$0,$460,$30,"$5,000",$0,$50,$80,58
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060064,AultCare Bronze 5000 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc664.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure664.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060064-01,Standard Bronze On Exchange Plan,,0.593480467796326,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000",$0,$460,$30,"$5,000",$0,$50,$80,59
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060064,AultCare Bronze 5000 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc664.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure664.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060064-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,60
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060064,AultCare Bronze 5000 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc664.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure664.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060064-03,Limited Cost Sharing Plan Variation,,0.593480467796326,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,"$5,000",$0,$460,$30,"$5,000",$0,$50,$80,61
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060065,AultCare Bronze 6000 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc665.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure665.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060065-00,Standard Bronze Off Exchange Plan,,0.582051515579224,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,"$6,000",$0,$130,$30,"$5,270",$0,$0,$80,62
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060065,AultCare Bronze 6000 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc665.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure665.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060065-01,Standard Bronze On Exchange Plan,,0.582051515579224,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,"$6,000",$0,$130,$30,"$5,270",$0,$0,$80,63
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060065,AultCare Bronze 6000 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc665.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure665.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060065-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,64
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060065,AultCare Bronze 6000 Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc665.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure665.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060065-03,Limited Cost Sharing Plan Variation,,0.582051515579224,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",10%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,"$6,000",$0,$130,$30,"$5,270",$0,$0,$80,65
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060066,AultCare Catastrophic Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6662015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6662015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060066-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$19,800","$39,600",Not Applicable,Not Applicable,"$6,600",$0,$0,$30,"$4,940",$0,$0,$80,66
2015,OH,28162,SERFF,4,2014-09-11 12:10:19,4,28162,OH,Individual,No,34-1624818,28162OH0060066,AultCare Catastrophic Select No Pediatric Dental,28162OH006,7376546504,OHN002,OHS001,OHF002,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,"Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.",Yes,Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.,No,http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6662015.pdf,https://www.myaultcare.com/paymentListner.aspx,http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6662015.pdf,http://www.AultCAS.com/acformularyb2015.aspx,28162OH0060066-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$19,800","$39,600",Not Applicable,Not Applicable,"$6,600",$0,$0,$30,"$4,940",$0,$0,$80,67
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,1,29276,OH,Individual,No,31-1440175,29276OH0740017,Anthem Catastrophic Pathway X PPO 6600 0,29276OH074,,OHN002,OHS001,OHF001,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GKP,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740017-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,"$6,600","$13,200",0%,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,1,29276,OH,SHOP (Small Group),No,31-1440175,29276OH0750112,Anthem Silver Blue Access X PPO 2000 30 5000 Plus,29276OH075,,OHN005,OHS001,OHF035,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.992767129740316,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1MJT,,http://sgplans.anthem.com/oh/brochure/,www.anthem.com/OHSelectdrugtier4,29276OH0750112-00,Standard Silver Off Exchange Plan,69.85%,0.714077949523926,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$250,$500,30%,,,,$0,$0,$250,$500,,,,,,,,,,,,,,,,,,,4
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,1,29276,OH,Individual,Yes,31-1440175,29276OH0810003,Anthem Dental Pediatric,29276OH081,,OHN006,OHS002,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$20.73,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/oh/f0/s0/t0/pw_e214675.pdf,,,,29276OH0810003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,1,29276,OH,Individual,Yes,31-1440175,29276OH0870003,Anthem Dental Pediatric,29276OH087,,OHN006,OHS002,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$20.73,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/oh/f0/s0/t0/pw_e214675.pdf,,,,29276OH0870003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,1,29276,OH,SHOP (Small Group),No,31-1440175,29276OH0750112,Anthem Silver Blue Access X PPO 2000 30 5000 Plus,29276OH075,,OHN005,OHS001,OHF035,Existing,PPO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.992767129740316,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1MJT,,http://sgplans.anthem.com/oh/brochure/,www.anthem.com/OHSelectdrugtier4,29276OH0750112-01,Standard Silver On Exchange Plan,69.85%,0.714077949523926,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$250,$500,30%,,,,$0,$0,$250,$500,,,,,,,,,,,,,,,,,,,5
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,1,29276,OH,Individual,No,31-1440175,29276OH0740017,Anthem Catastrophic Pathway X PPO 6600 0,29276OH074,,OHN002,OHS001,OHF001,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GKP,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740017-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$19,050","$38,100",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,"$6,600","$13,200",0%,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,1,29276,OH,SHOP (Small Group),Yes,31-1440175,29276OH0840003,Anthem Pediatric Dental,29276OH084,,OHN006,OHS002,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$20.73,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/oh/f0/s0/t0/pw_e214675.pdf,,,,29276OH0840003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,2,29276,OH,Individual,No,31-1440175,29276OH0740018,Anthem Bronze Pathway X PPO 0 for HSA,29276OH074,,OHN002,OHS001,OHF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GKR,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740018-00,Standard Bronze Off Exchange Plan,58.33%,0.581665337085724,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,400","$12,800","$6,400","$12,800","$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,"$6,000","$12,000",30%,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,2,29276,OH,SHOP (Small Group),No,31-1440175,29276OH0750113,Anthem Bronze Blue Access X PPO 3500E 20 6450 Plus w HSA,29276OH075,,OHN005,OHS001,OHF034,Existing,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99145497436281,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1MG9,,http://sgplans.anthem.com/oh/brochure/,www.anthem.com/OHSelectdrugtier4,29276OH0750113-00,Standard Bronze Off Exchange Plan,61.14%,0.63260942697525,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,4
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,2,29276,OH,Individual,Yes,31-1440175,29276OH0830003,Anthem Dental Family,29276OH083,,OHN006,OHS002,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.26,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/oh/f0/s0/t0/pw_e214673.pdf,,,,29276OH0830003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,2,29276,OH,SHOP (Small Group),Yes,31-1440175,29276OH0800003,Anthem Family Dental,29276OH080,,OHN006,OHS002,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.26,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/oh/f0/s0/t0/pw_e214673.pdf,,,,29276OH0800003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,2,29276,OH,Individual,Yes,31-1440175,29276OH0830004,Anthem Dental Family Enhanced,29276OH083,,OHN006,OHS002,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.72,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/oh/f0/s0/t0/pw_e214674.pdf,,,,29276OH0830004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,2,29276,OH,SHOP (Small Group),No,31-1440175,29276OH0750113,Anthem Bronze Blue Access X PPO 3500E 20 6450 Plus w HSA,29276OH075,,OHN005,OHS001,OHF034,Existing,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99145497436281,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1MG9,,http://sgplans.anthem.com/oh/brochure/,www.anthem.com/OHSelectdrugtier4,29276OH0750113-01,Standard Bronze On Exchange Plan,61.14%,0.63260942697525,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$12,900","$25,800","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,5
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,2,29276,OH,Individual,No,31-1440175,29276OH0740018,Anthem Bronze Pathway X PPO 0 for HSA,29276OH074,,OHN002,OHS001,OHF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GKR,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740018-01,Standard Bronze On Exchange Plan,58.33%,0.581665337085724,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,400","$12,800","$6,400","$12,800","$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,"$6,000","$12,000",30%,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,2,29276,OH,SHOP (Small Group),Yes,31-1440175,29276OH0800004,Anthem Family Dental Enhanced,29276OH080,,OHN006,OHS002,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.72,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/oh/f0/s0/t0/pw_e214674.pdf,,,,29276OH0800004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,2,29276,OH,SHOP (Small Group),Yes,31-1440175,29276OH0860003,Anthem Family Dental,29276OH086,,OHN006,OHS002,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.26,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/oh/f0/s0/t0/pw_e214673.pdf,,,,29276OH0860003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,2,29276,OH,Individual,No,31-1440175,29276OH0740018,Anthem Bronze Pathway X PPO 0 for HSA,29276OH074,,OHN002,OHS001,OHF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GKR,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740018-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,2,29276,OH,Individual,Yes,31-1440175,29276OH0890003,Anthem Dental Family,29276OH089,,OHN006,OHS002,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.26,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/oh/f0/s0/t0/pw_e214673.pdf,,,,29276OH0890003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,2,29276,OH,Individual,Yes,31-1440175,29276OH0890004,Anthem Dental Family Enhanced,29276OH089,,OHN006,OHS002,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.72,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/oh/f0/s0/t0/pw_e214674.pdf,,,,29276OH0890004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,2,29276,OH,Individual,No,31-1440175,29276OH0740018,Anthem Bronze Pathway X PPO 0 for HSA,29276OH074,,OHN002,OHS001,OHF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GKR,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740018-03,Limited Cost Sharing Plan Variation,58.33%,0.581665337085724,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,400","$12,800","$6,400","$12,800","$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,"$6,000","$12,000",30%,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,2,29276,OH,SHOP (Small Group),Yes,31-1440175,29276OH0860004,Anthem Family Dental Enhanced,29276OH086,,OHN006,OHS002,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.72,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/oh/f0/s0/t0/pw_e214674.pdf,,,,29276OH0860004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,3,29276,OH,Individual,No,31-1440175,29276OH0740019,Anthem Bronze Pathway X PPO 4300 20,29276OH074,,OHN002,OHS001,OHF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GKU,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740019-00,Standard Bronze Off Exchange Plan,60.97%,0.623022735118866,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600",20%,"$4,300","$8,600",50%,"$8,600","$17,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,3,29276,OH,SHOP (Small Group),No,31-1440175,29276OH0750114,Anthem Gold Blue Access X PPO 1300 10 6000 Plus w HSA,29276OH075,,OHN005,OHS001,OHF033,Existing,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.993519716792576,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1N2V,,http://sgplans.anthem.com/oh/brochure/,www.anthem.com/OHSelectdrugtier4,29276OH0750114-00,Standard Gold Off Exchange Plan,,0.780109941959381,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,"$2,600","$5,200","$3,900","$7,800",,,,,,,,,4
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,3,29276,OH,SHOP (Small Group),No,31-1440175,29276OH0750114,Anthem Gold Blue Access X PPO 1300 10 6000 Plus w HSA,29276OH075,,OHN005,OHS001,OHF033,Existing,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.993519716792576,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1N2V,,http://sgplans.anthem.com/oh/brochure/,www.anthem.com/OHSelectdrugtier4,29276OH0750114-01,Standard Gold On Exchange Plan,,0.780109941959381,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,"$2,600","$5,200","$3,900","$7,800",,,,,,,,,5
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,3,29276,OH,Individual,No,31-1440175,29276OH0740019,Anthem Bronze Pathway X PPO 4300 20,29276OH074,,OHN002,OHS001,OHF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GKU,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740019-01,Standard Bronze On Exchange Plan,60.97%,0.623022735118866,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$12,900","$25,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600",20%,"$4,300","$8,600",50%,"$8,600","$17,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,3,29276,OH,Individual,No,31-1440175,29276OH0740019,Anthem Bronze Pathway X PPO 4300 20,29276OH074,,OHN002,OHS001,OHF003,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,No,Emergency care only,No,Emergency care only,Yes,http://www.sbc.anthem.com/dps/CCD1GKU,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740019-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,10,29276,OH,Individual,No,31-1440175,29276OH0740026,Anthem Silver Pathway X PPO 2000 20,29276OH074,,OHN002,OHS001,OHF020,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLQ,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740026-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,10,29276,OH,Individual,No,31-1440175,29276OH0740026,Anthem Silver Pathway X PPO 2000 20,29276OH074,,OHN002,OHS001,OHF020,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLQ,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740026-03,Limited Cost Sharing Plan Variation,70.23%,0.708902895450592,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,500","$11,000","$5,500","$11,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,"$2,000","$4,000",50%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,10,29276,OH,Individual,No,31-1440175,29276OH0740026,Anthem Silver Pathway X PPO 2000 20,29276OH074,,OHN002,OHS001,OHF020,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLQ,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740026-04,73% AV Level Silver Plan,72.76%,0.734327554702759,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400",20%,"$1,700","$3,400",50%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,10,29276,OH,Individual,No,31-1440175,29276OH0740026,Anthem Silver Pathway X PPO 2000 20,29276OH074,,OHN002,OHS001,OHF020,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLQ,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740026-05,87% AV Level Silver Plan,86.06%,0.864101052284241,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,$750,"$1,500",50%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,10,29276,OH,Individual,No,31-1440175,29276OH0740026,Anthem Silver Pathway X PPO 2000 20,29276OH074,,OHN002,OHS001,OHF020,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLQ,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740026-06,94% AV Level Silver Plan,93.25%,0.93577766418457,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$600,"$1,200",$600,"$1,200","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,$200,$400,50%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,11,29276,OH,Individual,No,31-1440175,29276OH0740027,Anthem Silver Pathway X PPO 2500 10,29276OH074,,OHN002,OHS001,OHF026,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GLW,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740027-00,Standard Silver Off Exchange Plan,69.61%,0.718345582485199,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,"$2,500","$5,000",40%,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,13,29276,OH,Individual,No,31-1440175,29276OH0740029,Anthem Silver Pathway X PPO 3500 25,29276OH074,,OHN002,OHS001,OHF032,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GM5,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740029-04,73% AV Level Silver Plan,72.13%,0.729418337345123,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,650","$9,300","$4,650","$9,300","$14,000","$28,000",Not Applicable,Not Applicable,"$2,250","$4,500",25%,"$2,250","$4,500",25%,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,000","$1,000",40%,"$1,000","$1,000",40%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,13,29276,OH,Individual,No,31-1440175,29276OH0740029,Anthem Silver Pathway X PPO 3500 25,29276OH074,,OHN002,OHS001,OHF032,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GM5,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740029-05,87% AV Level Silver Plan,86.27%,0.863236486911774,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","$14,000","$28,000",Not Applicable,Not Applicable,$750,"$1,500",25%,$750,"$1,500",25%,"$7,000","$14,000",Not Applicable,Not Applicable,$300,$300,40%,$300,$300,40%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,13,29276,OH,Individual,No,31-1440175,29276OH0740029,Anthem Silver Pathway X PPO 3500 25,29276OH074,,OHN002,OHS001,OHF032,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GM5,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740029-06,94% AV Level Silver Plan,93.16%,0.933136999607086,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$600,"$1,200",$600,"$1,200","$14,000","$28,000",Not Applicable,Not Applicable,$250,$500,25%,$250,$500,25%,"$7,000","$14,000",Not Applicable,Not Applicable,$100,$100,40%,$100,$100,40%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,14,29276,OH,Individual,No,31-1440175,29276OH0740030,Anthem Silver Pathway X PPO 2000 15,29276OH074,,OHN002,OHS001,OHF019,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GMB,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740030-00,Standard Silver Off Exchange Plan,68.20%,0.704140067100525,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,"$2,000","$4,000",45%,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,14,29276,OH,Individual,No,31-1440175,29276OH0740030,Anthem Silver Pathway X PPO 2000 15,29276OH074,,OHN002,OHS001,OHF019,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GMB,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740030-01,Standard Silver On Exchange Plan,68.20%,0.704140067100525,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,"$2,000","$4,000",45%,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,14,29276,OH,Individual,No,31-1440175,29276OH0740030,Anthem Silver Pathway X PPO 2000 15,29276OH074,,OHN002,OHS001,OHF019,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GMB,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740030-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,14,29276,OH,Individual,No,31-1440175,29276OH0740030,Anthem Silver Pathway X PPO 2000 15,29276OH074,,OHN002,OHS001,OHF019,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GMB,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740030-03,Limited Cost Sharing Plan Variation,68.20%,0.704140067100525,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",15%,"$2,000","$4,000",45%,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,14,29276,OH,Individual,No,31-1440175,29276OH0740030,Anthem Silver Pathway X PPO 2000 15,29276OH074,,OHN002,OHS001,OHF019,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GMB,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740030-04,73% AV Level Silver Plan,72.06%,0.736471831798553,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$4,250","$8,500","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",15%,"$1,750","$3,500",45%,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,14,29276,OH,Individual,No,31-1440175,29276OH0740030,Anthem Silver Pathway X PPO 2000 15,29276OH074,,OHN002,OHS001,OHF019,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GMB,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740030-05,87% AV Level Silver Plan,86.12%,0.86771297454834,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,300","$2,600","$1,300","$2,600","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",15%,$700,"$1,400",45%,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,OH,29276,SERFF,9,2015-04-22 14:50:56,14,29276,OH,Individual,No,31-1440175,29276OH0740030,Anthem Silver Pathway X PPO 2000 15,29276OH074,,OHN002,OHS001,OHF019,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Full,No,Full,Yes,http://www.sbc.anthem.com/dps/CCD1GMB,https://shop.anthem.com/sales/eox/payment/landing/oh,http://file.anthem.com/03258OHMENABS.pdf,anthem.com/OHSelectdrugtier4,29276OH0740030-06,94% AV Level Silver Plan,93.07%,0.934530377388,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$550,"$1,100",$550,"$1,100","$16,500","$33,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,15%,$250,$500,45%,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,OH,30042,SERFF,2,2014-09-09 16:12:42,1,30042,OH,SHOP (Small Group),Yes,31-1119867,30042OH0010001,SDC-Kids Plan High,30042OH001,,OHN001,OHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.43,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,Matches in country coverage,Yes,Matches in service area coverage,No,,,,,30042OH0010001-00,Standard High Off Exchange Plan,86.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,30042,SERFF,2,2014-09-09 16:12:42,1,30042,OH,SHOP (Small Group),Yes,31-1119867,30042OH0020001,SDC-Kids Plan Low,30042OH002,,OHN001,OHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$19.33,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,Matches in country coverage,Yes,Matches in service area coverage,No,,,,,30042OH0020001-00,Standard Low Off Exchange Plan,72.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$150,Not Applicable,$225,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,30042,SERFF,2,2014-09-09 16:12:42,2,30042,OH,SHOP (Small Group),Yes,31-1119867,30042OH0030001,SDC-Preferred Kids Plan High,30042OH003,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.43,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,Matches in country coverage,Yes,Matches in Service Area Coverage,No,,,,,30042OH0030001-00,Standard High Off Exchange Plan,86.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,30042,SERFF,2,2014-09-09 16:12:42,2,30042,OH,SHOP (Small Group),Yes,31-1119867,30042OH0040001,SDC-Preferred Kids Plan Low,30042OH004,,OHN001,OHS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.33,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,Matches in country coverage,Yes,Matches in Service Area Coverage,No,,,,,30042OH0040001-00,Standard Low Off Exchange Plan,72.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$150,Not Applicable,$225,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,31410,SERFF,3,2014-09-09 16:12:42,1,31410,OH,Individual,Yes,72-0977315,31410OH0010001,AlwaysCare All-Star Kids Dental Plan,31410OH001,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$20.86,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,31410OH0010001-00,Standard High Off Exchange Plan,86.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,31410,SERFF,3,2014-09-09 16:12:42,1,31410,OH,SHOP (Small Group),Yes,72-0977315,31410OH0040001,AlwaysCare Small Group - Child,31410OH004,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.22,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,31410OH0040001-00,Standard High Off Exchange Plan,86.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,1,33931,OH,Individual,No,31-1142815,33931OH0030009,UnitedHealthcare Bronze Compass HSA 4900,33931OH003,,OHN006,OHS001,OHF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030009-03,Limited Cost Sharing Plan Variation,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030001,UnitedHealthcare Platinum Compass 250,33931OH003,,OHN006,OHS001,OHF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030001-00,Standard Platinum Off Exchange Plan,88.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030003,UnitedHealthcare Gold Compass 500,33931OH003,,OHN006,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030003-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030003,UnitedHealthcare Gold Compass 500,33931OH003,,OHN006,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030003-03,Limited Cost Sharing Plan Variation,78.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030006,UnitedHealthcare Silver Compass 2000,33931OH003,,OHN006,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030006-04,73% AV Level Silver Plan,73.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,200","$2,400",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030006,UnitedHealthcare Silver Compass 2000,33931OH003,,OHN006,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030006-05,87% AV Level Silver Plan,86.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030006,UnitedHealthcare Silver Compass 2000,33931OH003,,OHN006,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030006-06,94% AV Level Silver Plan,93.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030007,UnitedHealthcare Silver Compass 3500,33931OH003,,OHN006,OHS001,OHF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030007-00,Standard Silver Off Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030007,UnitedHealthcare Silver Compass 3500,33931OH003,,OHN006,OHS001,OHF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030007-01,Standard Silver On Exchange Plan,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030007,UnitedHealthcare Silver Compass 3500,33931OH003,,OHN006,OHS001,OHF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030007-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,25
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,5,41047,OH,Individual,No,32-0045282,41047OH0010015,Ambetter Balanced Care 1,41047OH001,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.bchpohio.com/formulary,41047OH0010015-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,8
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,5,41047,OH,Individual,No,32-0045282,41047OH0010015,Ambetter Balanced Care 1,41047OH001,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.bchpohio.com/formulary,41047OH0010015-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,9
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,5,41047,OH,Individual,No,32-0045282,41047OH0010015,Ambetter Balanced Care 1,41047OH001,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.bchpohio.com/formulary,41047OH0010015-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,10
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030006,UnitedHealthcare Silver Compass 2000,33931OH003,,OHN006,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030006-00,Standard Silver Off Exchange Plan,69.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030006,UnitedHealthcare Silver Compass 2000,33931OH003,,OHN006,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030006-01,Standard Silver On Exchange Plan,69.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030006,UnitedHealthcare Silver Compass 2000,33931OH003,,OHN006,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030006-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030006,UnitedHealthcare Silver Compass 2000,33931OH003,,OHN006,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030006-03,Limited Cost Sharing Plan Variation,69.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030007,UnitedHealthcare Silver Compass 3500,33931OH003,,OHN006,OHS001,OHF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030007-03,Limited Cost Sharing Plan Variation,70.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030007,UnitedHealthcare Silver Compass 3500,33931OH003,,OHN006,OHS001,OHF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030007-04,73% AV Level Silver Plan,73.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,4,41047,OH,Individual,No,32-0045282,41047OH0010014,Ambetter Balanced Care 2,41047OH001,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.bchpohio.com/formulary,41047OH0010014-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,9
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,4,41047,OH,Individual,No,32-0045282,41047OH0010014,Ambetter Balanced Care 2,41047OH001,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.bchpohio.com/formulary,41047OH0010014-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,10
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,5,41047,OH,Individual,No,32-0045282,41047OH0010015,Ambetter Balanced Care 1,41047OH001,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.bchpohio.com/formulary,41047OH0010015-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,4
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,5,41047,OH,Individual,No,32-0045282,41047OH0010015,Ambetter Balanced Care 1,41047OH001,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.bchpohio.com/formulary,41047OH0010015-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,5
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,5,41047,OH,Individual,No,32-0045282,41047OH0010015,Ambetter Balanced Care 1,41047OH001,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.bchpohio.com/formulary,41047OH0010015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,5,41047,OH,Individual,No,32-0045282,41047OH0010015,Ambetter Balanced Care 1,41047OH001,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.bchpohio.com/formulary,41047OH0010015-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,7
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,3,33931,OH,Individual,No,31-1142815,33931OH0030010,UnitedHealthcare Bronze Compass 5500,33931OH003,,OHN006,OHS001,OHF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030010-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,3,33931,OH,Individual,No,31-1142815,33931OH0030010,UnitedHealthcare Bronze Compass 5500,33931OH003,,OHN006,OHS001,OHF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030010-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,3,33931,OH,Individual,No,31-1142815,33931OH0030010,UnitedHealthcare Bronze Compass 5500,33931OH003,,OHN006,OHS001,OHF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030010-03,Limited Cost Sharing Plan Variation,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,34968,SERFF,2,2014-09-09 16:12:42,1,34968,OH,SHOP (Small Group),Yes,13-5581829,34968OH0150002,EHB Basic Dental Plan (Low),34968OH015,,OHN001,OHS001,,Existing,PPO,Low,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$17.69,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,34968OH0150002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,34968,SERFF,2,2014-09-09 16:12:42,1,34968,OH,SHOP (Small Group),Yes,13-5581829,34968OH0150001,EHB Basic Dental Plan (Low),34968OH015,,OHN001,OHS001,,Existing,PPO,Low,,On the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$17.69,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48053,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48052,,34968OH0150001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,34968,SERFF,2,2014-09-09 16:12:42,2,34968,OH,SHOP (Small Group),Yes,13-5581829,34968OH0160002,EHB Enhanced Dental Plan (High),34968OH016,,OHN002,OHS001,,Existing,PPO,High,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$21.89,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,34968OH0160002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,34968,SERFF,2,2014-09-09 16:12:42,2,34968,OH,SHOP (Small Group),Yes,13-5581829,34968OH0160001,EHB Enhanced Dental Plan (High),34968OH016,,OHN002,OHS001,,Existing,PPO,High,,On the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$21.89,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49114,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49113,,34968OH0160001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,34968,SERFF,2,2014-09-09 16:12:42,3,34968,OH,SHOP (Small Group),Yes,13-5581829,34968OH0170002,Family Basic Dental Plan (Low),34968OH017,,OHN003,OHS001,,Existing,PPO,Low,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$17.69,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,34968OH0170002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,34968,SERFF,2,2014-09-09 16:12:42,3,34968,OH,SHOP (Small Group),Yes,13-5581829,34968OH0170001,Family Basic Dental Plan (Low),34968OH017,,OHN003,OHS001,,Existing,PPO,Low,,On the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$17.69,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49116,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49115,,34968OH0170001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,34968,SERFF,2,2014-09-09 16:12:42,4,34968,OH,SHOP (Small Group),Yes,13-5581829,34968OH0180001,Family Enhanced Dental Plan (High),34968OH018,,OHN004,OHS001,,Existing,PPO,High,,On the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$21.89,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49118,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49117,,34968OH0180001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,34968,SERFF,2,2014-09-09 16:12:42,4,34968,OH,SHOP (Small Group),Yes,13-5581829,34968OH0180002,Family Enhanced Dental Plan (High),34968OH018,,OHN004,OHS001,,Existing,PPO,High,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Adult and Child-Only,,,,$21.89,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,34968OH0180002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,31410,SERFF,3,2014-09-09 16:12:42,1,31410,OH,SHOP (Small Group),Yes,72-0977315,31410OH0040002,AlwaysCare Small Group - Child,31410OH004,,OHN001,OHS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$20.01,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,31410OH0040002-00,Standard Low Off Exchange Plan,71.27%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,31410,SERFF,3,2014-09-09 16:12:42,1,31410,OH,Individual,Yes,72-0977315,31410OH0010002,AlwaysCare All-Star Kids Dental Plan,31410OH001,,OHN001,OHS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$16.85,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,31410OH0010002-00,Standard Low Off Exchange Plan,71.27%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,31410,SERFF,3,2014-09-09 16:12:42,2,31410,OH,Individual,Yes,72-0977315,31410OH0020001,AlwaysCare All-Star Family Dental Plan,31410OH002,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.86,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,31410OH0020001-00,Standard High Off Exchange Plan,86.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,31410,SERFF,3,2014-09-09 16:12:42,2,31410,OH,SHOP (Small Group),Yes,72-0977315,31410OH0030001,AlwaysCare Small Group Dental - Adults,31410OH003,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.22,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,31410OH0030001-00,Standard High Off Exchange Plan,86.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,31410,SERFF,3,2014-09-09 16:12:42,2,31410,OH,SHOP (Small Group),Yes,72-0977315,31410OH0030002,AlwaysCare Small Group Dental - Adults,31410OH003,,OHN001,OHS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.01,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,31410OH0030002-00,Standard Low Off Exchange Plan,71.27%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,31410,SERFF,3,2014-09-09 16:12:42,2,31410,OH,Individual,Yes,72-0977315,31410OH0020002,AlwaysCare All-Star Family Dental Plan,31410OH002,,OHN001,OHS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$16.85,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,"Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured?s zip code.",Yes,,,http://www.alwayscarebenefits.com/allstar,,31410OH0020002-00,Standard Low Off Exchange Plan,71.27%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,32795,SERFF,3,2014-09-11 12:10:19,1,32795,OH,SHOP (Small Group),Yes,42-0127290,32795OH0040001,Principal Plan Dental 70,32795OH004,,OHN001,OHS001,,New,PPO,Low,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$26.56,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,32795OH0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,32795,SERFF,3,2014-09-11 12:10:19,1,32795,OH,SHOP (Small Group),Yes,42-0127290,32795OH0040002,Principal Plan Dental 85,32795OH004,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$28.12,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,32795OH0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,1,33931,OH,Individual,No,31-1142815,33931OH0030004,UnitedHealthcare Silver Compass HSA 2600,33931OH003,,OHN006,OHS001,OHF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030004-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,1,33931,OH,Individual,No,31-1142815,33931OH0030004,UnitedHealthcare Silver Compass HSA 2600,33931OH003,,OHN006,OHS001,OHF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030004-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,1,33931,OH,Individual,No,31-1142815,33931OH0030004,UnitedHealthcare Silver Compass HSA 2600,33931OH003,,OHN006,OHS001,OHF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,1,33931,OH,Individual,No,31-1142815,33931OH0030004,UnitedHealthcare Silver Compass HSA 2600,33931OH003,,OHN006,OHS001,OHF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030004-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,1,33931,OH,Individual,No,31-1142815,33931OH0030004,UnitedHealthcare Silver Compass HSA 2600,33931OH003,,OHN006,OHS001,OHF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030004-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,1,33931,OH,Individual,No,31-1142815,33931OH0030004,UnitedHealthcare Silver Compass HSA 2600,33931OH003,,OHN006,OHS001,OHF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030004-05,87% AV Level Silver Plan,86.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$550,"$1,100",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,1,33931,OH,Individual,No,31-1142815,33931OH0030004,UnitedHealthcare Silver Compass HSA 2600,33931OH003,,OHN006,OHS001,OHF002,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030004-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$75,$150,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,1,33931,OH,Individual,No,31-1142815,33931OH0030005,UnitedHealthcare Silver Compass HSA 1600,33931OH003,,OHN006,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030005-00,Standard Silver Off Exchange Plan,68.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,1,33931,OH,Individual,No,31-1142815,33931OH0030005,UnitedHealthcare Silver Compass HSA 1600,33931OH003,,OHN006,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030005-01,Standard Silver On Exchange Plan,68.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,1,33931,OH,Individual,No,31-1142815,33931OH0030005,UnitedHealthcare Silver Compass HSA 1600,33931OH003,,OHN006,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030005-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,1,33931,OH,Individual,No,31-1142815,33931OH0030005,UnitedHealthcare Silver Compass HSA 1600,33931OH003,,OHN006,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030005-03,Limited Cost Sharing Plan Variation,68.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,1,33931,OH,Individual,No,31-1142815,33931OH0030005,UnitedHealthcare Silver Compass HSA 1600,33931OH003,,OHN006,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030005-04,73% AV Level Silver Plan,72.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,1,33931,OH,Individual,No,31-1142815,33931OH0030005,UnitedHealthcare Silver Compass HSA 1600,33931OH003,,OHN006,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030005-05,87% AV Level Silver Plan,86.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,1,33931,OH,Individual,No,31-1142815,33931OH0030005,UnitedHealthcare Silver Compass HSA 1600,33931OH003,,OHN006,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030005-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$150,$300,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,1,33931,OH,Individual,No,31-1142815,33931OH0030009,UnitedHealthcare Bronze Compass HSA 4900,33931OH003,,OHN006,OHS001,OHF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030009-00,Standard Bronze Off Exchange Plan,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,1,33931,OH,Individual,No,31-1142815,33931OH0030009,UnitedHealthcare Bronze Compass HSA 4900,33931OH003,,OHN006,OHS001,OHF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030009-01,Standard Bronze On Exchange Plan,58.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,900","$9,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,1,33931,OH,Individual,No,31-1142815,33931OH0030009,UnitedHealthcare Bronze Compass HSA 4900,33931OH003,,OHN006,OHS001,OHF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030009-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030001,UnitedHealthcare Platinum Compass 250,33931OH003,,OHN006,OHS001,OHF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030001-01,Standard Platinum On Exchange Plan,88.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030001,UnitedHealthcare Platinum Compass 250,33931OH003,,OHN006,OHS001,OHF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030001,UnitedHealthcare Platinum Compass 250,33931OH003,,OHN006,OHS001,OHF001,New,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030001-03,Limited Cost Sharing Plan Variation,88.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030002,UnitedHealthcare Gold Compass 1250,33931OH003,,OHN006,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030002-00,Standard Gold Off Exchange Plan,79.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030002,UnitedHealthcare Gold Compass 1250,33931OH003,,OHN006,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030002-01,Standard Gold On Exchange Plan,79.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030002,UnitedHealthcare Gold Compass 1250,33931OH003,,OHN006,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030002,UnitedHealthcare Gold Compass 1250,33931OH003,,OHN006,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030002-03,Limited Cost Sharing Plan Variation,79.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030003,UnitedHealthcare Gold Compass 500,33931OH003,,OHN006,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030003-00,Standard Gold Off Exchange Plan,78.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030003,UnitedHealthcare Gold Compass 500,33931OH003,,OHN006,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030003-01,Standard Gold On Exchange Plan,78.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030007,UnitedHealthcare Silver Compass 3500,33931OH003,,OHN006,OHS001,OHF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030007-05,87% AV Level Silver Plan,86.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030007,UnitedHealthcare Silver Compass 3500,33931OH003,,OHN006,OHS001,OHF003,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030007-06,94% AV Level Silver Plan,93.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030008,UnitedHealthcare Silver Compass 5000,33931OH003,,OHN006,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030008-00,Standard Silver Off Exchange Plan,69.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030008,UnitedHealthcare Silver Compass 5000,33931OH003,,OHN006,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030008-01,Standard Silver On Exchange Plan,69.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030008,UnitedHealthcare Silver Compass 5000,33931OH003,,OHN006,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030008-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,32
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030008,UnitedHealthcare Silver Compass 5000,33931OH003,,OHN006,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030008-03,Limited Cost Sharing Plan Variation,69.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$1000,$1000,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030008,UnitedHealthcare Silver Compass 5000,33931OH003,,OHN006,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030008-04,73% AV Level Silver Plan,73.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,$750,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030008,UnitedHealthcare Silver Compass 5000,33931OH003,,OHN006,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030008-05,87% AV Level Silver Plan,86.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,2,33931,OH,Individual,No,31-1142815,33931OH0030008,UnitedHealthcare Silver Compass 5000,33931OH003,,OHN006,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030008-06,94% AV Level Silver Plan,93.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$550,"$1,100",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$100,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,7,41047,OH,Individual,No,32-0045282,41047OH0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,41047OH002,,OHN001,OHS001,OHF010,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979029626436741,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare3,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare3,http://ambetter.bchpohio.com/formulary,41047OH0020012-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,7,41047,OH,Individual,No,32-0045282,41047OH0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,41047OH002,,OHN001,OHS001,OHF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979029929922651,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare4,http://ambetter.bchpohio.com/formulary,41047OH0020013-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,7,41047,OH,Individual,No,32-0045282,41047OH0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,41047OH002,,OHN001,OHS001,OHF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979029929922651,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare4,http://ambetter.bchpohio.com/formulary,41047OH0020013-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,7,41047,OH,Individual,No,32-0045282,41047OH0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,41047OH002,,OHN001,OHS001,OHF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979029929922651,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare4,http://ambetter.bchpohio.com/formulary,41047OH0020013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,7,41047,OH,Individual,No,32-0045282,41047OH0020013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision,41047OH002,,OHN001,OHS001,OHF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979029929922651,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare4,http://ambetter.bchpohio.com/formulary,41047OH0020013-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,7,41047,OH,Individual,No,32-0045282,41047OH0020016,Ambetter Essential Care 2 + Vision,41047OH002,,OHN001,OHS001,OHF003,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979029626436741,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare2,http://ambetter.bchpohio.com/formulary,41047OH0020016-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,7,41047,OH,Individual,No,32-0045282,41047OH0020016,Ambetter Essential Care 2 + Vision,41047OH002,,OHN001,OHS001,OHF003,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979029626436741,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare2,http://ambetter.bchpohio.com/formulary,41047OH0020016-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,7,41047,OH,Individual,No,32-0045282,41047OH0020016,Ambetter Essential Care 2 + Vision,41047OH002,,OHN001,OHS001,OHF003,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979029626436741,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare2,http://ambetter.bchpohio.com/formulary,41047OH0020016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,7,41047,OH,Individual,No,32-0045282,41047OH0020016,Ambetter Essential Care 2 + Vision,41047OH002,,OHN001,OHS001,OHF003,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979029626436741,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare2,http://ambetter.bchpohio.com/formulary,41047OH0020016-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,7,41047,OH,Individual,No,32-0045282,41047OH0020017,Ambetter Essential Care 1 + Vision,41047OH002,,OHN001,OHS001,OHF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979029732869912,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare1,http://ambetter.bchpohio.com/formulary,41047OH0020017-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,7,41047,OH,Individual,No,32-0045282,41047OH0020017,Ambetter Essential Care 1 + Vision,41047OH002,,OHN001,OHS001,OHF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979029732869912,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare1,http://ambetter.bchpohio.com/formulary,41047OH0020017-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,7,41047,OH,Individual,No,32-0045282,41047OH0020017,Ambetter Essential Care 1 + Vision,41047OH002,,OHN001,OHS001,OHF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979029732869912,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare1,http://ambetter.bchpohio.com/formulary,41047OH0020017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,7,41047,OH,Individual,No,32-0045282,41047OH0020017,Ambetter Essential Care 1 + Vision,41047OH002,,OHN001,OHS001,OHF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979029732869912,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare1,http://ambetter.bchpohio.com/formulary,41047OH0020017-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,8,41047,OH,Individual,No,32-0045282,41047OH0020008,Ambetter Balanced Care 4 + Vision,41047OH002,,OHN001,OHS001,OHF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979288584341256,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.bchpohio.com/formulary,41047OH0020008-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,4
2015,OH,33931,SERFF,5,2014-12-11 11:35:20,3,33931,OH,Individual,No,31-1142815,33931OH0030010,UnitedHealthcare Bronze Compass 5500,33931OH003,,OHN006,OHS001,OHF005,New,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.998,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,"With network provider, same as other network benefits",No,www.uhc.com/xoh,https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143,,www.uhc.com/xoh,33931OH0030010-00,Standard Bronze Off Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,1,41047,OH,Individual,No,32-0045282,41047OH0010007,Ambetter Balanced Care 3,41047OH001,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,http://ambetter.bchpohio.com/formulary,41047OH0010007-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,11
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,1,41047,OH,Individual,No,32-0045282,41047OH0010007,Ambetter Balanced Care 3,41047OH001,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,http://ambetter.bchpohio.com/formulary,41047OH0010007-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,12
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,1,41047,OH,Individual,No,32-0045282,41047OH0010007,Ambetter Balanced Care 3,41047OH001,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,http://ambetter.bchpohio.com/formulary,41047OH0010007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,1,41047,OH,Individual,No,32-0045282,41047OH0010007,Ambetter Balanced Care 3,41047OH001,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,http://ambetter.bchpohio.com/formulary,41047OH0010007-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,14
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,1,41047,OH,Individual,No,32-0045282,41047OH0010007,Ambetter Balanced Care 3,41047OH001,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,http://ambetter.bchpohio.com/formulary,41047OH0010007-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,15
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,1,41047,OH,Individual,No,32-0045282,41047OH0010007,Ambetter Balanced Care 3,41047OH001,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,http://ambetter.bchpohio.com/formulary,41047OH0010007-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,16
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,1,41047,OH,Individual,No,32-0045282,41047OH0010007,Ambetter Balanced Care 3,41047OH001,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,http://ambetter.bchpohio.com/formulary,41047OH0010007-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,17
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,1,41047,OH,Individual,No,32-0045282,41047OH0010002,Ambetter Secure Care 2,41047OH001,,OHN001,OHS001,OHF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,http://ambetter.bchpohio.com/formulary,41047OH0010002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,18
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,1,41047,OH,Individual,No,32-0045282,41047OH0010002,Ambetter Secure Care 2,41047OH001,,OHN001,OHS001,OHF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,http://ambetter.bchpohio.com/formulary,41047OH0010002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,19
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,1,41047,OH,Individual,No,32-0045282,41047OH0010002,Ambetter Secure Care 2,41047OH001,,OHN001,OHS001,OHF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,http://ambetter.bchpohio.com/formulary,41047OH0010002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,20
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,1,41047,OH,Individual,No,32-0045282,41047OH0010002,Ambetter Secure Care 2,41047OH001,,OHN001,OHS001,OHF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,http://ambetter.bchpohio.com/formulary,41047OH0010002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,21
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,2,41047,OH,Individual,No,32-0045282,41047OH0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,41047OH001,,OHN001,OHS001,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare1,http://ambetter.bchpohio.com/formulary,41047OH0010004-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,2,41047,OH,Individual,No,32-0045282,41047OH0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,41047OH001,,OHN001,OHS001,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare1,http://ambetter.bchpohio.com/formulary,41047OH0010004-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,2,41047,OH,Individual,No,32-0045282,41047OH0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,41047OH001,,OHN001,OHS001,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare1,http://ambetter.bchpohio.com/formulary,41047OH0010004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,2,41047,OH,Individual,No,32-0045282,41047OH0010004,Ambetter Secure Care 1 with 3 Free PCP Visits,41047OH001,,OHN001,OHS001,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare1,http://ambetter.bchpohio.com/formulary,41047OH0010004-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,2,41047,OH,Individual,No,32-0045282,41047OH0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,41047OH001,,OHN001,OHS001,OHF010,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.bchpohio.com/formulary,41047OH0010012-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,2,41047,OH,Individual,No,32-0045282,41047OH0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,41047OH001,,OHN001,OHS001,OHF010,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.bchpohio.com/formulary,41047OH0010012-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,2,41047,OH,Individual,No,32-0045282,41047OH0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,41047OH001,,OHN001,OHS001,OHF010,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.bchpohio.com/formulary,41047OH0010012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,2,41047,OH,Individual,No,32-0045282,41047OH0010012,Ambetter Essential Care 3 with 3 Free PCP Visits,41047OH001,,OHN001,OHS001,OHF010,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.bchpohio.com/formulary,41047OH0010012-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,2,41047,OH,Individual,No,32-0045282,41047OH0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,41047OH001,,OHN001,OHS001,OHF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.bchpohio.com/formulary,41047OH0010013-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,2,41047,OH,Individual,No,32-0045282,41047OH0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,41047OH001,,OHN001,OHS001,OHF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.bchpohio.com/formulary,41047OH0010013-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,2,41047,OH,Individual,No,32-0045282,41047OH0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,41047OH001,,OHN001,OHS001,OHF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.bchpohio.com/formulary,41047OH0010013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,2,41047,OH,Individual,No,32-0045282,41047OH0010013,Ambetter Essential Care 4 with 3 Free PCP Visits,41047OH001,,OHN001,OHS001,OHF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.bchpohio.com/formulary,41047OH0010013-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,2,41047,OH,Individual,No,32-0045282,41047OH0010016,Ambetter Essential Care 2,41047OH001,,OHN001,OHS001,OHF003,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.bchpohio.com/formulary,41047OH0010016-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,2,41047,OH,Individual,No,32-0045282,41047OH0010016,Ambetter Essential Care 2,41047OH001,,OHN001,OHS001,OHF003,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.bchpohio.com/formulary,41047OH0010016-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,2,41047,OH,Individual,No,32-0045282,41047OH0010016,Ambetter Essential Care 2,41047OH001,,OHN001,OHS001,OHF003,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.bchpohio.com/formulary,41047OH0010016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,2,41047,OH,Individual,No,32-0045282,41047OH0010016,Ambetter Essential Care 2,41047OH001,,OHN001,OHS001,OHF003,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.bchpohio.com/formulary,41047OH0010016-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,2,41047,OH,Individual,No,32-0045282,41047OH0010017,Ambetter Essential Care 1,41047OH001,,OHN001,OHS001,OHF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.bchpohio.com/formulary,41047OH0010017-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,2,41047,OH,Individual,No,32-0045282,41047OH0010017,Ambetter Essential Care 1,41047OH001,,OHN001,OHS001,OHF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.bchpohio.com/formulary,41047OH0010017-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,2,41047,OH,Individual,No,32-0045282,41047OH0010017,Ambetter Essential Care 1,41047OH001,,OHN001,OHS001,OHF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.bchpohio.com/formulary,41047OH0010017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,2,41047,OH,Individual,No,32-0045282,41047OH0010017,Ambetter Essential Care 1,41047OH001,,OHN001,OHS001,OHF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.bchpohio.com/formulary,41047OH0010017-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,3,41047,OH,Individual,No,32-0045282,41047OH0010008,Ambetter Balanced Care 4,41047OH001,,OHN001,OHS001,OHF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.bchpohio.com/formulary,41047OH0010008-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,4
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,3,41047,OH,Individual,No,32-0045282,41047OH0010008,Ambetter Balanced Care 4,41047OH001,,OHN001,OHS001,OHF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.bchpohio.com/formulary,41047OH0010008-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,5
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,3,41047,OH,Individual,No,32-0045282,41047OH0010008,Ambetter Balanced Care 4,41047OH001,,OHN001,OHS001,OHF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.bchpohio.com/formulary,41047OH0010008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,3,41047,OH,Individual,No,32-0045282,41047OH0010008,Ambetter Balanced Care 4,41047OH001,,OHN001,OHS001,OHF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.bchpohio.com/formulary,41047OH0010008-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,7
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,3,41047,OH,Individual,No,32-0045282,41047OH0010008,Ambetter Balanced Care 4,41047OH001,,OHN001,OHS001,OHF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.bchpohio.com/formulary,41047OH0010008-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,8
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,3,41047,OH,Individual,No,32-0045282,41047OH0010008,Ambetter Balanced Care 4,41047OH001,,OHN001,OHS001,OHF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.bchpohio.com/formulary,41047OH0010008-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,9
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,3,41047,OH,Individual,No,32-0045282,41047OH0010008,Ambetter Balanced Care 4,41047OH001,,OHN001,OHS001,OHF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.bchpohio.com/formulary,41047OH0010008-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,10
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,4,41047,OH,Individual,No,32-0045282,41047OH0010014,Ambetter Balanced Care 2,41047OH001,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.bchpohio.com/formulary,41047OH0010014-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,4
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,4,41047,OH,Individual,No,32-0045282,41047OH0010014,Ambetter Balanced Care 2,41047OH001,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.bchpohio.com/formulary,41047OH0010014-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,5
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,4,41047,OH,Individual,No,32-0045282,41047OH0010014,Ambetter Balanced Care 2,41047OH001,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.bchpohio.com/formulary,41047OH0010014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,4,41047,OH,Individual,No,32-0045282,41047OH0010014,Ambetter Balanced Care 2,41047OH001,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.bchpohio.com/formulary,41047OH0010014-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,7
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,4,41047,OH,Individual,No,32-0045282,41047OH0010014,Ambetter Balanced Care 2,41047OH001,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.bchpohio.com/formulary,41047OH0010014-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,8
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,6,41047,OH,Individual,No,32-0045282,41047OH0020007,Ambetter Balanced Care 3 + Vision,41047OH002,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979462208036513,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,http://ambetter.bchpohio.com/formulary,41047OH0020007-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,11
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,6,41047,OH,Individual,No,32-0045282,41047OH0020007,Ambetter Balanced Care 3 + Vision,41047OH002,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979462208036513,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,http://ambetter.bchpohio.com/formulary,41047OH0020007-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,12
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,6,41047,OH,Individual,No,32-0045282,41047OH0020007,Ambetter Balanced Care 3 + Vision,41047OH002,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979462208036513,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,http://ambetter.bchpohio.com/formulary,41047OH0020007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,6,41047,OH,Individual,No,32-0045282,41047OH0020007,Ambetter Balanced Care 3 + Vision,41047OH002,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979462208036513,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,http://ambetter.bchpohio.com/formulary,41047OH0020007-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,14
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,6,41047,OH,Individual,No,32-0045282,41047OH0020007,Ambetter Balanced Care 3 + Vision,41047OH002,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979462208036513,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,http://ambetter.bchpohio.com/formulary,41047OH0020007-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,15
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,6,41047,OH,Individual,No,32-0045282,41047OH0020007,Ambetter Balanced Care 3 + Vision,41047OH002,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979462208036513,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,http://ambetter.bchpohio.com/formulary,41047OH0020007-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,16
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,6,41047,OH,Individual,No,32-0045282,41047OH0020007,Ambetter Balanced Care 3 + Vision,41047OH002,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979462208036513,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,http://ambetter.bchpohio.com/formulary,41047OH0020007-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,17
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,6,41047,OH,Individual,No,32-0045282,41047OH0020002,Ambetter Secure Care 2 + Vision,41047OH002,,OHN001,OHS001,OHF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.978595908379976,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,http://ambetter.bchpohio.com/formulary,41047OH0020002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,18
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,6,41047,OH,Individual,No,32-0045282,41047OH0020002,Ambetter Secure Care 2 + Vision,41047OH002,,OHN001,OHS001,OHF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.978595908379976,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,http://ambetter.bchpohio.com/formulary,41047OH0020002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,19
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,6,41047,OH,Individual,No,32-0045282,41047OH0020002,Ambetter Secure Care 2 + Vision,41047OH002,,OHN001,OHS001,OHF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.978595908379976,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,http://ambetter.bchpohio.com/formulary,41047OH0020002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,20
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,6,41047,OH,Individual,No,32-0045282,41047OH0020002,Ambetter Secure Care 2 + Vision,41047OH002,,OHN001,OHS001,OHF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.978595908379976,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,http://ambetter.bchpohio.com/formulary,41047OH0020002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,21
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,7,41047,OH,Individual,No,32-0045282,41047OH0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,41047OH002,,OHN001,OHS001,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.978594772726578,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.bchpohio.com/brochures/?plan=SecureCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.bchpohio.com/brochures/?plan=SecureCare1,http://ambetter.bchpohio.com/formulary,41047OH0020004-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,7,41047,OH,Individual,No,32-0045282,41047OH0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,41047OH002,,OHN001,OHS001,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.978594772726578,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.bchpohio.com/brochures/?plan=SecureCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.bchpohio.com/brochures/?plan=SecureCare1,http://ambetter.bchpohio.com/formulary,41047OH0020004-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,7,41047,OH,Individual,No,32-0045282,41047OH0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,41047OH002,,OHN001,OHS001,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.978594772726578,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.bchpohio.com/brochures/?plan=SecureCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.bchpohio.com/brochures/?plan=SecureCare1,http://ambetter.bchpohio.com/formulary,41047OH0020004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,7,41047,OH,Individual,No,32-0045282,41047OH0020004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision,41047OH002,,OHN001,OHS001,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.978594772726578,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.bchpohio.com/brochures/?plan=SecureCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.bchpohio.com/brochures/?plan=SecureCare1,http://ambetter.bchpohio.com/formulary,41047OH0020004-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,7,41047,OH,Individual,No,32-0045282,41047OH0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,41047OH002,,OHN001,OHS001,OHF010,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979029626436741,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare3,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare3,http://ambetter.bchpohio.com/formulary,41047OH0020012-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,7,41047,OH,Individual,No,32-0045282,41047OH0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,41047OH002,,OHN001,OHS001,OHF010,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979029626436741,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare3,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare3,http://ambetter.bchpohio.com/formulary,41047OH0020012-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,7,41047,OH,Individual,No,32-0045282,41047OH0020012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision,41047OH002,,OHN001,OHS001,OHF010,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979029626436741,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare3,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.bchpohio.com/brochures/?plan=EssentialCare3,http://ambetter.bchpohio.com/formulary,41047OH0020012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,8,41047,OH,Individual,No,32-0045282,41047OH0020008,Ambetter Balanced Care 4 + Vision,41047OH002,,OHN001,OHS001,OHF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979288584341256,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.bchpohio.com/formulary,41047OH0020008-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,5
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,8,41047,OH,Individual,No,32-0045282,41047OH0020008,Ambetter Balanced Care 4 + Vision,41047OH002,,OHN001,OHS001,OHF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979288584341256,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.bchpohio.com/formulary,41047OH0020008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,8,41047,OH,Individual,No,32-0045282,41047OH0020008,Ambetter Balanced Care 4 + Vision,41047OH002,,OHN001,OHS001,OHF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979288584341256,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.bchpohio.com/formulary,41047OH0020008-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,7
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,8,41047,OH,Individual,No,32-0045282,41047OH0020008,Ambetter Balanced Care 4 + Vision,41047OH002,,OHN001,OHS001,OHF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979288584341256,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.bchpohio.com/formulary,41047OH0020008-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,8
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,8,41047,OH,Individual,No,32-0045282,41047OH0020008,Ambetter Balanced Care 4 + Vision,41047OH002,,OHN001,OHS001,OHF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979288584341256,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.bchpohio.com/formulary,41047OH0020008-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,9
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,8,41047,OH,Individual,No,32-0045282,41047OH0020008,Ambetter Balanced Care 4 + Vision,41047OH002,,OHN001,OHS001,OHF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979288584341256,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.bchpohio.com/formulary,41047OH0020008-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,10
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,9,41047,OH,Individual,No,32-0045282,41047OH0020014,Ambetter Balanced Care 2 + Vision,41047OH002,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979468112086933,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.bchpohio.com/formulary,41047OH0020014-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,4
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,9,41047,OH,Individual,No,32-0045282,41047OH0020014,Ambetter Balanced Care 2 + Vision,41047OH002,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979468112086933,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.bchpohio.com/formulary,41047OH0020014-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,5
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,9,41047,OH,Individual,No,32-0045282,41047OH0020014,Ambetter Balanced Care 2 + Vision,41047OH002,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979468112086933,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.bchpohio.com/formulary,41047OH0020014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,9,41047,OH,Individual,No,32-0045282,41047OH0020014,Ambetter Balanced Care 2 + Vision,41047OH002,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979468112086933,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.bchpohio.com/formulary,41047OH0020014-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,7
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,9,41047,OH,Individual,No,32-0045282,41047OH0020014,Ambetter Balanced Care 2 + Vision,41047OH002,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979468112086933,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.bchpohio.com/formulary,41047OH0020014-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,8
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,9,41047,OH,Individual,No,32-0045282,41047OH0020014,Ambetter Balanced Care 2 + Vision,41047OH002,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979468112086933,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.bchpohio.com/formulary,41047OH0020014-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,9
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,9,41047,OH,Individual,No,32-0045282,41047OH0020014,Ambetter Balanced Care 2 + Vision,41047OH002,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979468112086933,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.bchpohio.com/formulary,41047OH0020014-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,10
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,10,41047,OH,Individual,No,32-0045282,41047OH0020015,Ambetter Balanced Care 1 + Vision,41047OH002,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979605295547382,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.bchpohio.com/formulary,41047OH0020015-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,4
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,10,41047,OH,Individual,No,32-0045282,41047OH0020015,Ambetter Balanced Care 1 + Vision,41047OH002,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979605295547382,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.bchpohio.com/formulary,41047OH0020015-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,5
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,10,41047,OH,Individual,No,32-0045282,41047OH0020015,Ambetter Balanced Care 1 + Vision,41047OH002,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979605295547382,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.bchpohio.com/formulary,41047OH0020015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,10,41047,OH,Individual,No,32-0045282,41047OH0020015,Ambetter Balanced Care 1 + Vision,41047OH002,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979605295547382,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.bchpohio.com/formulary,41047OH0020015-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,7
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,10,41047,OH,Individual,No,32-0045282,41047OH0020015,Ambetter Balanced Care 1 + Vision,41047OH002,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979605295547382,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.bchpohio.com/formulary,41047OH0020015-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,8
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,10,41047,OH,Individual,No,32-0045282,41047OH0020015,Ambetter Balanced Care 1 + Vision,41047OH002,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979605295547382,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.bchpohio.com/formulary,41047OH0020015-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,9
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,10,41047,OH,Individual,No,32-0045282,41047OH0020015,Ambetter Balanced Care 1 + Vision,41047OH002,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.979605295547382,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.bchpohio.com/formulary,41047OH0020015-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,10
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,11,41047,OH,Individual,No,32-0045282,41047OH0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.942931260618091,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,http://ambetter.bchpohio.com/formulary,41047OH0030007-00,Standard Silver Off Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,11
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,11,41047,OH,Individual,No,32-0045282,41047OH0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.942931260618091,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,http://ambetter.bchpohio.com/formulary,41047OH0030007-01,Standard Silver On Exchange Plan,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,12
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,11,41047,OH,Individual,No,32-0045282,41047OH0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.942931260618091,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,http://ambetter.bchpohio.com/formulary,41047OH0030007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,11,41047,OH,Individual,No,32-0045282,41047OH0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.942931260618091,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,http://ambetter.bchpohio.com/formulary,41047OH0030007-03,Limited Cost Sharing Plan Variation,,0.680991649627686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,430",$150,"$3,420",$540,$0,$80,14
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,11,41047,OH,Individual,No,32-0045282,41047OH0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.942931260618091,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,http://ambetter.bchpohio.com/formulary,41047OH0030007-04,73% AV Level Silver Plan,,0.738758504390717,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,$950,$150,"$2,920",$520,$0,$80,15
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,11,41047,OH,Individual,No,32-0045282,41047OH0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.942931260618091,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,http://ambetter.bchpohio.com/formulary,41047OH0030007-05,87% AV Level Silver Plan,,0.878752768039703,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$10,$510,$150,$700,$280,$110,$80,16
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,11,41047,OH,Individual,No,32-0045282,41047OH0030007,Ambetter Balanced Care 3 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.942931260618091,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare3,http://ambetter.bchpohio.com/formulary,41047OH0030007-06,94% AV Level Silver Plan,,0.944567024707794,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$170,$0,$250,$150,$200,$50,$60,$80,17
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,11,41047,OH,Individual,No,32-0045282,41047OH0030002,Ambetter Secure Care 2 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940594296223618,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,http://ambetter.bchpohio.com/formulary,41047OH0030002-00,Standard Gold Off Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,18
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,11,41047,OH,Individual,No,32-0045282,41047OH0030002,Ambetter Secure Care 2 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940594296223618,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,http://ambetter.bchpohio.com/formulary,41047OH0030002-01,Standard Gold On Exchange Plan,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,19
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,11,41047,OH,Individual,No,32-0045282,41047OH0030002,Ambetter Secure Care 2 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940594296223618,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,http://ambetter.bchpohio.com/formulary,41047OH0030002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,20
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,11,41047,OH,Individual,No,32-0045282,41047OH0030002,Ambetter Secure Care 2 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF002,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940594296223618,,$350,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,www.//ambetter.buckeehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare2,http://ambetter.bchpohio.com/formulary,41047OH0030002-03,Limited Cost Sharing Plan Variation,,0.781822621822357,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$520,$50,"$1,010",$150,"$1,000",$930,$220,$80,21
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,12,41047,OH,Individual,No,32-0045282,41047OH0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940591339234849,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare1,http://ambetter.bchpohio.com/formulary,41047OH0030004-00,Standard Gold Off Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,4
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,12,41047,OH,Individual,No,32-0045282,41047OH0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940591339234849,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare1,http://ambetter.bchpohio.com/formulary,41047OH0030004-01,Standard Gold On Exchange Plan,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,5
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,12,41047,OH,Individual,No,32-0045282,41047OH0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940591339234849,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare1,http://ambetter.bchpohio.com/formulary,41047OH0030004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,12,41047,OH,Individual,No,32-0045282,41047OH0030004,Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.940591339234849,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=SecureCare1,http://ambetter.bchpohio.com/formulary,41047OH0030004-03,Limited Cost Sharing Plan Variation,,0.782686412334442,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,020",$0,"$1,250",$150,"$1,500",$350,$280,$80,7
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,12,41047,OH,Individual,No,32-0045282,41047OH0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF010,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94177158010544,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.bchpohio.com/formulary,41047OH0030012-00,Standard Bronze Off Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,8
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,12,41047,OH,Individual,No,32-0045282,41047OH0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF010,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94177158010544,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.bchpohio.com/formulary,41047OH0030012-01,Standard Bronze On Exchange Plan,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,9
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,12,41047,OH,Individual,No,32-0045282,41047OH0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF010,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94177158010544,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.bchpohio.com/formulary,41047OH0030012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,12,41047,OH,Individual,No,32-0045282,41047OH0030012,Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF010,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94177158010544,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare3,http://ambetter.bchpohio.com/formulary,41047OH0030012-03,Limited Cost Sharing Plan Variation,,0.615748703479767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$350,$150,"$5,270",$0,$0,$80,11
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,12,41047,OH,Individual,No,32-0045282,41047OH0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941772403791453,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.bchpohio.com/formulary,41047OH0030013-00,Standard Bronze Off Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,12
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,12,41047,OH,Individual,No,32-0045282,41047OH0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941772403791453,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.bchpohio.com/formulary,41047OH0030013-01,Standard Bronze On Exchange Plan,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,13
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,12,41047,OH,Individual,No,32-0045282,41047OH0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941772403791453,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.bchpohio.com/formulary,41047OH0030013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,14
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,12,41047,OH,Individual,No,32-0045282,41047OH0030013,Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF011,Existing,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941772403791453,,$350,0,3,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare4,http://ambetter.bchpohio.com/formulary,41047OH0030013-03,Limited Cost Sharing Plan Variation,,0.616434097290039,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$20,"$1,300",$150,"$4,000",$320,$170,$80,15
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,12,41047,OH,Individual,No,32-0045282,41047OH0030016,Ambetter Essential Care 2 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF003,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94177158010544,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.bchpohio.com/formulary,41047OH0030016-00,Standard Bronze Off Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,16
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,12,41047,OH,Individual,No,32-0045282,41047OH0030016,Ambetter Essential Care 2 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF003,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94177158010544,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.bchpohio.com/formulary,41047OH0030016-01,Standard Bronze On Exchange Plan,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,17
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,12,41047,OH,Individual,No,32-0045282,41047OH0030016,Ambetter Essential Care 2 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF003,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94177158010544,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.bchpohio.com/formulary,41047OH0030016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,18
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,12,41047,OH,Individual,No,32-0045282,41047OH0030016,Ambetter Essential Care 2 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF003,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94177158010544,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare2,http://ambetter.bchpohio.com/formulary,41047OH0030016-03,Limited Cost Sharing Plan Variation,,0.588939130306244,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$900,$150,"$5,000",$80,$60,$80,19
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,12,41047,OH,Individual,No,32-0045282,41047OH0030017,Ambetter Essential Care 1 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941771881930537,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.bchpohio.com/formulary,41047OH0030017-00,Standard Bronze Off Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,20
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,12,41047,OH,Individual,No,32-0045282,41047OH0030017,Ambetter Essential Care 1 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941771881930537,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.bchpohio.com/formulary,41047OH0030017-01,Standard Bronze On Exchange Plan,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,21
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,12,41047,OH,Individual,No,32-0045282,41047OH0030017,Ambetter Essential Care 1 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941771881930537,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.bchpohio.com/formulary,41047OH0030017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,22
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,12,41047,OH,Individual,No,32-0045282,41047OH0030017,Ambetter Essential Care 1 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF009,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.941771881930537,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=EssentialCare1,http://ambetter.bchpohio.com/formulary,41047OH0030017-03,Limited Cost Sharing Plan Variation,,0.582362592220306,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,500","$13,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,500",$0,$0,$150,"$5,270",$0,$0,$80,23
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,13,41047,OH,Individual,No,32-0045282,41047OH0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94246694279213,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.bchpohio.com/formulary,41047OH0030008-00,Standard Silver Off Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,4
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,13,41047,OH,Individual,No,32-0045282,41047OH0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94246694279213,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.bchpohio.com/formulary,41047OH0030008-01,Standard Silver On Exchange Plan,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,5
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,13,41047,OH,Individual,No,32-0045282,41047OH0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94246694279213,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.bchpohio.com/formulary,41047OH0030008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,13,41047,OH,Individual,No,32-0045282,41047OH0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94246694279213,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.bchpohio.com/formulary,41047OH0030008-03,Limited Cost Sharing Plan Variation,,0.686699867248535,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$70,"$1,010",$150,"$2,000",$810,$190,$80,7
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,13,41047,OH,Individual,No,32-0045282,41047OH0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94246694279213,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.bchpohio.com/formulary,41047OH0030008-04,73% AV Level Silver Plan,,0.738488256931305,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$40,"$1,010",$150,"$1,150",$600,$210,$80,8
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,13,41047,OH,Individual,No,32-0045282,41047OH0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94246694279213,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.bchpohio.com/formulary,41047OH0030008-05,87% AV Level Silver Plan,,0.878983676433563,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$20,$510,$150,$500,$240,$120,$80,9
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,13,41047,OH,Individual,No,32-0045282,41047OH0030008,Ambetter Balanced Care 4 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF007,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.94246694279213,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare4,http://ambetter.bchpohio.com/formulary,41047OH0030008-06,94% AV Level Silver Plan,,0.947933852672577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$10,$250,$150,$100,$90,$70,$80,10
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,14,41047,OH,Individual,No,32-0045282,41047OH0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.942944663330429,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.bchpohio.com/formulary,41047OH0030014-00,Standard Silver Off Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,4
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,14,41047,OH,Individual,No,32-0045282,41047OH0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.942944663330429,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.bchpohio.com/formulary,41047OH0030014-01,Standard Silver On Exchange Plan,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,5
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,14,41047,OH,Individual,No,32-0045282,41047OH0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.942944663330429,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.bchpohio.com/formulary,41047OH0030014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,14,41047,OH,Individual,No,32-0045282,41047OH0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.942944663330429,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.bchpohio.com/formulary,41047OH0030014-03,Limited Cost Sharing Plan Variation,,0.686478316783905,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$0,$150,"$5,000",$0,$0,$80,7
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,14,41047,OH,Individual,No,32-0045282,41047OH0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.942944663330429,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.bchpohio.com/formulary,41047OH0030014-04,73% AV Level Silver Plan,,0.737457811832428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$4,000",$0,$0,$80,8
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,14,41047,OH,Individual,No,32-0045282,41047OH0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.942944663330429,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.bchpohio.com/formulary,41047OH0030014-05,87% AV Level Silver Plan,,0.876481950283051,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,500",$0,$0,$80,9
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,14,41047,OH,Individual,No,32-0045282,41047OH0030014,Ambetter Balanced Care 2 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.942944663330429,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare2,http://ambetter.bchpohio.com/formulary,41047OH0030014-06,94% AV Level Silver Plan,,0.948086559772491,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,10
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,15,41047,OH,Individual,No,32-0045282,41047OH0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.943307536615769,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.bchpohio.com/formulary,41047OH0030015-00,Standard Silver Off Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,4
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,15,41047,OH,Individual,No,32-0045282,41047OH0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.943307536615769,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.bchpohio.com/formulary,41047OH0030015-01,Standard Silver On Exchange Plan,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,5
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,15,41047,OH,Individual,No,32-0045282,41047OH0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.943307536615769,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.bchpohio.com/formulary,41047OH0030015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,15,41047,OH,Individual,No,32-0045282,41047OH0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.943307536615769,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.bchpohio.com/formulary,41047OH0030015-03,Limited Cost Sharing Plan Variation,,0.684868812561035,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$680,$150,"$3,170",$310,$0,$80,7
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,15,41047,OH,Individual,No,32-0045282,41047OH0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.943307536615769,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.bchpohio.com/formulary,41047OH0030015-04,73% AV Level Silver Plan,,0.739026844501495,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,770",$0,"$1,650",$150,"$2,250",$190,$170,$80,8
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,15,41047,OH,Individual,No,32-0045282,41047OH0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.943307536615769,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.bchpohio.com/formulary,41047OH0030015-05,87% AV Level Silver Plan,,0.878083288669586,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$0,"$2,100",$150,$300,$50,$380,$80,9
2015,OH,41047,SERFF,7,2015-02-20 08:57:57,15,41047,OH,Individual,No,32-0045282,41047OH0030015,Ambetter Balanced Care 1 + Vision + Adult Dental,41047OH003,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.943307536615769,,,0,0,0,2015-01-01,,No,,No,,No,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.buckeyehealthplan.com/payments,http://ambetter.buckeyehealthplan.com/brochures/?plan=BalancedCare1,http://ambetter.bchpohio.com/formulary,41047OH0030015-06,94% AV Level Silver Plan,,0.947652101516724,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$730,$150,$0,$50,$140,$80,10
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,1,47509,OH,Individual,Yes,95-6042390,47509OH0020001,BESTOne Child Dental Plus,47509OH002,,OHN001,OHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$44.44,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BESTOne_Child_Dental_Plus_Plan.pdf,,47509OH0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,1,47509,OH,SHOP (Small Group),Yes,95-6042390,47509OH0010001,BEST Life Child Dental Plus,47509OH001,,OHN001,OHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$35.55,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BEST_Life_Child_Dental_Plus_Plan.pdf,,47509OH0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,2,47509,OH,SHOP (Small Group),Yes,95-6042390,47509OH0010002,BEST Life Child Dental,47509OH001,,OHN001,OHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$27.52,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BEST_Life_Child_Dental_Plan.pdf,,47509OH0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,2,47509,OH,Individual,Yes,95-6042390,47509OH0020002,BESTOne Child Dental,47509OH002,,OHN001,OHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$34.40,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BESTOne_Child_Dental_Plan.pdf,,47509OH0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,3,47509,OH,Individual,Yes,95-6042390,47509OH0020003,BESTOne Dental Advantage-Gold,47509OH002,,OHN001,OHS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$44.44,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BESTOne_Dental_Advantage-Gold_Plan.pdf,,47509OH0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,3,47509,OH,SHOP (Small Group),Yes,95-6042390,47509OH0010007,BEST Dental Premium,47509OH001,,OHN001,OHS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$35.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BESTDental_Premium_Plan.pdf,,47509OH0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,3,47509,OH,SHOP (Small Group),Yes,95-6042390,47509OH0010007,BEST Dental Premium,47509OH001,,OHN001,OHS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$35.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BESTDental_Premium_Plan.pdf,,47509OH0010007-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,3,47509,OH,Individual,Yes,95-6042390,47509OH0020003,BESTOne Dental Advantage-Gold,47509OH002,,OHN001,OHS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$44.44,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BESTOne_Dental_Advantage-Gold_Plan.pdf,,47509OH0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,3,47509,OH,SHOP (Small Group),Yes,95-6042390,47509OH0010008,BEST Dental Standard-H,47509OH001,,OHN001,OHS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$35.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BESTDental_Standard-H_Plan.pdf,,47509OH0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,3,47509,OH,Individual,Yes,95-6042390,47509OH0020004,BESTOne Dental Plus-Gold,47509OH002,,OHN001,OHS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$44.44,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BESTOne_Dental_Plus-Gold_Plan.pdf,,47509OH0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,3,47509,OH,Individual,Yes,95-6042390,47509OH0020004,BESTOne Dental Plus-Gold,47509OH002,,OHN001,OHS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$44.44,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BESTOne_Dental_Plus-Gold_Plan.pdf,,47509OH0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,3,47509,OH,SHOP (Small Group),Yes,95-6042390,47509OH0010008,BEST Dental Standard-H,47509OH001,,OHN001,OHS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$35.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BESTDental_Standard-H_Plan.pdf,,47509OH0010008-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,3,47509,OH,SHOP (Small Group),Yes,95-6042390,47509OH0010010,BEST Dental Choice-H,47509OH001,,OHN001,OHS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$35.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BESTDental_Choice-H_Plan.pdf,,47509OH0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,3,47509,OH,SHOP (Small Group),Yes,95-6042390,47509OH0010010,BEST Dental Choice-H,47509OH001,,OHN001,OHS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$35.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BESTDental_Choice-H_Plan.pdf,,47509OH0010010-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,4,47509,OH,Individual,Yes,95-6042390,47509OH0020005,BESTOne Dental Plus-Silver,47509OH002,,OHN001,OHS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.40,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BESTOne_Dental_Plus-Silver_Plan.pdf,,47509OH0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,4,47509,OH,SHOP (Small Group),Yes,95-6042390,47509OH0010009,BEST Dental Standard-L,47509OH001,,OHN001,OHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.52,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BESTDental_Standard-L_Plan.pdf,,47509OH0010009-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,4,47509,OH,SHOP (Small Group),Yes,95-6042390,47509OH0010009,BEST Dental Standard-L,47509OH001,,OHN001,OHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.52,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BESTDental_Standard-L_Plan.pdf,,47509OH0010009-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,4,47509,OH,Individual,Yes,95-6042390,47509OH0020005,BESTOne Dental Plus-Silver,47509OH002,,OHN001,OHS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.40,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BESTOne_Dental_Plus-Silver_Plan.pdf,,47509OH0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,4,47509,OH,Individual,Yes,95-6042390,47509OH0020006,BESTOne Dental Basic-Silver,47509OH002,,OHN001,OHS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.40,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BESTOne_Dental_Basic-Silver_Plan.pdf,,47509OH0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,4,47509,OH,SHOP (Small Group),Yes,95-6042390,47509OH0010011,BEST Dental Choice-L,47509OH001,,OHN001,OHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.52,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BESTDental_Choice-L_Plan.pdf,,47509OH0010011-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,4,47509,OH,SHOP (Small Group),Yes,95-6042390,47509OH0010011,BEST Dental Choice-L,47509OH001,,OHN001,OHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.52,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BESTDental_Choice-L_Plan.pdf,,47509OH0010011-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,4,47509,OH,Individual,Yes,95-6042390,47509OH0020006,BESTOne Dental Basic-Silver,47509OH002,,OHN001,OHS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.40,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BESTOne_Dental_Basic-Silver_Plan.pdf,,47509OH0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,4,47509,OH,SHOP (Small Group),Yes,95-6042390,47509OH0010012,BEST Dental Value,47509OH001,,OHN001,OHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.52,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BESTDental_Value_Plan.pdf,,47509OH0010012-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,OH,47509,SERFF,3,2014-09-11 12:10:19,4,47509,OH,SHOP (Small Group),Yes,95-6042390,47509OH0010012,BEST Dental Value,47509OH001,,OHN001,OHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.52,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OH/2015/OH_BESTDental_Value_Plan.pdf,,47509OH0010012-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,OH,48333,SERFF,3,2014-09-11 12:10:19,1,48333,OH,SHOP (Small Group),Yes,93-0242990,48333OH0040002,EHB High PPO,48333OH004,,OHN001,OHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$37.56,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,48333OH0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510032,SummaCare Individual 2750-LK with SCConnect Network,52664OH151,,OHN001,OHS002,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual2750-LK.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual2750-LK.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510032-04,73% AV Level Silver Plan,74.00%,0.730459690093994,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$15,600","$31,200","$20,800","$41,600","$2,650","$5,300",20%,,,,"$7,950","$15,900","$10,600","$21,200",$400,Not Applicable,40%,,,,"$1,200",Not Applicable,"$1,600",Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490251,SummaCare Silver 2500-15 with SCSelect Network,52664OH149,,OHN002,OHS007,OHF007,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareSilver2500-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareSilver2500-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490251-00,Standard Silver Off Exchange Plan,,0.716720461845398,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$2,500","$5,000",20%,,,,"$7,500","$15,000","$10,000","$20,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,OH,48333,SERFF,3,2014-09-11 12:10:19,1,48333,OH,SHOP (Small Group),Yes,93-0242990,48333OH0040001,EHB Low PPO,48333OH004,,OHN001,OHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.63,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,48333OH0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,48333,SERFF,3,2014-09-11 12:10:19,1,48333,OH,SHOP (Small Group),Yes,93-0242990,48333OH0030002,EHB High Passive,48333OH003,,OHN001,OHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$40.89,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,48333OH0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,48333,SERFF,3,2014-09-11 12:10:19,1,48333,OH,SHOP (Small Group),Yes,93-0242990,48333OH0030001,EHB Low Passive,48333OH003,,OHN001,OHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.38,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,48333OH0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,Individual,No,34-1809108,52664OH1520027,SummaCare Individual 6450-LD with SCConnect Network,52664OH152,,OHN001,OHS002,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual6450-LD.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual6450-LD.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1520027-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,Individual,No,34-1809108,52664OH1520027,SummaCare Individual 6450-LD with SCConnect Network,52664OH152,,OHN001,OHS002,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual6450-LD.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual6450-LD.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1520027-03,Limited Cost Sharing Plan Variation,,0.602311432361603,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,,,,,,,,,,,,,"$6,450","$12,900",0%,,,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,15
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490251,SummaCare Silver 2500-15 with SCSelect Network,52664OH149,,OHN002,OHS007,OHF007,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareSilver2500-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareSilver2500-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490251-01,Standard Silver On Exchange Plan,,0.716720461845398,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$2,500","$5,000",20%,,,,"$7,500","$15,000","$10,000","$20,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,23
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510032,SummaCare Individual 2750-LK with SCConnect Network,52664OH151,,OHN001,OHS002,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual2750-LK.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual2750-LK.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510032-05,87% AV Level Silver Plan,86.20%,0.864562034606934,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$6,750","$13,500","$9,000","$18,000",$750,"$1,500",20%,,,,"$5,000","$10,000","$5,750","$11,500",$200,Not Applicable,40%,,,,$600,Not Applicable,$800,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510032,SummaCare Individual 2750-LK with SCConnect Network,52664OH151,,OHN001,OHS002,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual2750-LK.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual2750-LK.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510032-06,94% AV Level Silver Plan,93.20%,0.935412406921387,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$5,250","$10,500","$7,000","$14,000",$0,$0,10%,,,,"$5,000","$10,000",$0,$0,$200,Not Applicable,40%,,,,$600,Not Applicable,$800,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490252,SummaCare Silver 2500-15 with SCSelect Network,52664OH149,,OHN002,OHS003,OHF007,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareSilver2500-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareSilver2500-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490252-00,Standard Silver Off Exchange Plan,,0.716720461845398,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$2,500","$5,000",20%,,,,"$7,500","$15,000","$10,000","$20,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,24
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490252,SummaCare Silver 2500-15 with SCSelect Network,52664OH149,,OHN002,OHS003,OHF007,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareSilver2500-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareSilver2500-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490252-01,Standard Silver On Exchange Plan,,0.716720461845398,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$2,500","$5,000",20%,,,,"$7,500","$15,000","$10,000","$20,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,25
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510033,SummaCare Individual 2750-LK with SCSelect Network,52664OH151,,OHN002,OHS001,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual2750-LK.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual2750-LK.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510033-00,Standard Silver Off Exchange Plan,72.00%,0.713091552257538,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$2,750","$5,500",20%,,,,"$8,250","$16,500","$11,000","$22,000",$400,Not Applicable,40%,,,,"$1,200",Not Applicable,"$1,600",Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510033,SummaCare Individual 2750-LK with SCSelect Network,52664OH151,,OHN002,OHS001,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual2750-LK.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual2750-LK.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510033-05,87% AV Level Silver Plan,86.20%,0.864562034606934,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$6,750","$13,500","$9,000","$18,000",$750,"$1,500",20%,,,,"$5,000","$10,000","$5,750","$11,500",$200,Not Applicable,40%,,,,$600,Not Applicable,$800,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510033,SummaCare Individual 2750-LK with SCSelect Network,52664OH151,,OHN002,OHS001,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual2750-LK.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual2750-LK.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510033-01,Standard Silver On Exchange Plan,72.00%,0.713091552257538,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$2,750","$5,500",20%,,,,"$8,250","$16,500","$11,000","$22,000",$400,Not Applicable,40%,,,,"$1,200",Not Applicable,"$1,600",Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490253,SummaCare Silver 2500-15 with SCConnect Network,52664OH149,,OHN001,OHS002,OHF007,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareSilver2500-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareSilver2500-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490253-00,Standard Silver Off Exchange Plan,,0.716720461845398,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$2,500","$5,000",20%,,,,"$7,500","$15,000","$10,000","$20,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,26
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490253,SummaCare Silver 2500-15 with SCConnect Network,52664OH149,,OHN001,OHS002,OHF007,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareSilver2500-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareSilver2500-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490253-01,Standard Silver On Exchange Plan,,0.716720461845398,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$2,500","$5,000",20%,,,,"$7,500","$15,000","$10,000","$20,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,27
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510033,SummaCare Individual 2750-LK with SCSelect Network,52664OH151,,OHN002,OHS001,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual2750-LK.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual2750-LK.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510033-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,27
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510033,SummaCare Individual 2750-LK with SCSelect Network,52664OH151,,OHN002,OHS001,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual2750-LK.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual2750-LK.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510033-03,Limited Cost Sharing Plan Variation,72.00%,0.713091552257538,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$2,750","$5,500",20%,,,,"$8,250","$16,500","$11,000","$22,000",$400,Not Applicable,40%,,,,"$1,200",Not Applicable,"$1,600",Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510033,SummaCare Individual 2750-LK with SCSelect Network,52664OH151,,OHN002,OHS001,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual2750-LK.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual2750-LK.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510033-04,73% AV Level Silver Plan,74.00%,0.730459690093994,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$15,600","$31,200","$20,800","$41,600","$2,650","$5,300",20%,,,,"$7,950","$15,900","$10,600","$21,200",$400,Not Applicable,40%,,,,"$1,200",Not Applicable,"$1,600",Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490248,SummaCare Silver 2500-15 with SCSelect Network,52664OH149,,OHN002,OHS004,OHF007,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareSilver2500-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareSilver2500-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490248-00,Standard Silver Off Exchange Plan,,0.716720461845398,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$2,500","$5,000",20%,,,,"$7,500","$15,000","$10,000","$20,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490248,SummaCare Silver 2500-15 with SCSelect Network,52664OH149,,OHN002,OHS004,OHF007,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareSilver2500-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareSilver2500-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490248-01,Standard Silver On Exchange Plan,,0.716720461845398,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$2,500","$5,000",20%,,,,"$7,500","$15,000","$10,000","$20,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510032,SummaCare Individual 2750-LK with SCConnect Network,52664OH151,,OHN001,OHS002,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual2750-LK.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual2750-LK.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510032-00,Standard Silver Off Exchange Plan,72.00%,0.713091552257538,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$2,750","$5,500",20%,,,,"$8,250","$16,500","$11,000","$22,000",$400,Not Applicable,40%,,,,"$1,200",Not Applicable,"$1,600",Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490249,SummaCare Silver 2500-15 with SCSelect Network,52664OH149,,OHN002,OHS005,OHF007,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareSilver2500-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareSilver2500-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490249-00,Standard Silver Off Exchange Plan,,0.716720461845398,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$2,500","$5,000",20%,,,,"$7,500","$15,000","$10,000","$20,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490249,SummaCare Silver 2500-15 with SCSelect Network,52664OH149,,OHN002,OHS005,OHF007,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareSilver2500-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareSilver2500-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490249-01,Standard Silver On Exchange Plan,,0.716720461845398,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$2,500","$5,000",20%,,,,"$7,500","$15,000","$10,000","$20,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,19
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510032,SummaCare Individual 2750-LK with SCConnect Network,52664OH151,,OHN001,OHS002,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual2750-LK.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual2750-LK.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510032-01,Standard Silver On Exchange Plan,72.00%,0.713091552257538,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$2,750","$5,500",20%,,,,"$8,250","$16,500","$11,000","$22,000",$400,Not Applicable,40%,,,,"$1,200",Not Applicable,"$1,600",Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510032,SummaCare Individual 2750-LK with SCConnect Network,52664OH151,,OHN001,OHS002,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual2750-LK.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual2750-LK.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510032-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490250,SummaCare Silver 2500-15 with SCSelect Network,52664OH149,,OHN002,OHS006,OHF007,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareSilver2500-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareSilver2500-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490250-00,Standard Silver Off Exchange Plan,,0.716720461845398,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$2,500","$5,000",20%,,,,"$7,500","$15,000","$10,000","$20,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490250,SummaCare Silver 2500-15 with SCSelect Network,52664OH149,,OHN002,OHS006,OHF007,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareSilver2500-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareSilver2500-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490250-01,Standard Silver On Exchange Plan,,0.716720461845398,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$2,500","$5,000",20%,,,,"$7,500","$15,000","$10,000","$20,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510032,SummaCare Individual 2750-LK with SCConnect Network,52664OH151,,OHN001,OHS002,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual2750-LK.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual2750-LK.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510032-03,Limited Cost Sharing Plan Variation,72.00%,0.713091552257538,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$2,750","$5,500",20%,,,,"$8,250","$16,500","$11,000","$22,000",$400,Not Applicable,40%,,,,"$1,200",Not Applicable,"$1,600",Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510033,SummaCare Individual 2750-LK with SCSelect Network,52664OH151,,OHN002,OHS001,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual2750-LK.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual2750-LK.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510033-06,94% AV Level Silver Plan,93.20%,0.935412406921387,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$5,250","$10,500","$7,000","$14,000",$0,$0,10%,,,,"$5,000","$10,000",$0,$0,$200,Not Applicable,40%,,,,$600,Not Applicable,$800,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510038,SummaCare Individual 5000-LH with SCConnect Network,52664OH151,,OHN001,OHS002,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual5000-LH.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual5000-LH.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510038-01,Standard Silver On Exchange Plan,68.60%,0.678360223770142,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$5,000","$10,000",30%,,,,"$15,000","$30,000","$20,000","$40,000",$500,Not Applicable,40%,,,,"$1,500",Not Applicable,"$2,000",Not Applicable,,,,,,,,,,,,,,,,,,,61
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510038,SummaCare Individual 5000-LH with SCConnect Network,52664OH151,,OHN001,OHS002,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual5000-LH.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual5000-LH.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510038-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,62
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510038,SummaCare Individual 5000-LH with SCConnect Network,52664OH151,,OHN001,OHS002,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual5000-LH.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual5000-LH.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510038-03,Limited Cost Sharing Plan Variation,68.60%,0.678360223770142,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$5,000","$10,000",30%,,,,"$15,000","$30,000","$20,000","$40,000",$500,Not Applicable,40%,,,,"$1,500",Not Applicable,"$2,000",Not Applicable,,,,,,,,,,,,,,,,,,,63
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510038,SummaCare Individual 5000-LH with SCConnect Network,52664OH151,,OHN001,OHS002,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual5000-LH.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual5000-LH.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510038-04,73% AV Level Silver Plan,74.00%,0.733948290348053,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$15,600","$31,200","$20,800","$41,600","$2,650","$5,300",20%,,,,"$8,250","$16,500","$10,900","$21,800",$500,Not Applicable,40%,,,,"$1,500",Not Applicable,"$2,000",Not Applicable,,,,,,,,,,,,,,,,,,,64
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510038,SummaCare Individual 5000-LH with SCConnect Network,52664OH151,,OHN001,OHS002,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual5000-LH.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual5000-LH.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510038-05,87% AV Level Silver Plan,86.20%,0.864562034606934,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$6,750","$13,500","$9,000","$18,000",$750,"$1,500",20%,,,,"$5,000","$10,000","$5,750","$11,500",$200,Not Applicable,40%,,,,$600,Not Applicable,$800,Not Applicable,,,,,,,,,,,,,,,,,,,65
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510038,SummaCare Individual 5000-LH with SCConnect Network,52664OH151,,OHN001,OHS002,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual5000-LH.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual5000-LH.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510038-06,94% AV Level Silver Plan,93.20%,0.935412406921387,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$5,250","$10,500","$7,000","$14,000",$0,$0,10%,,,,"$5,000","$10,000",$0,$0,$200,Not Applicable,40%,,,,$600,Not Applicable,$800,Not Applicable,,,,,,,,,,,,,,,,,,,66
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510039,SummaCare Individual 5000-LH with SCSelect Network,52664OH151,,OHN002,OHS001,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual5000-LH.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual5000-LH.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510039-00,Standard Silver Off Exchange Plan,68.60%,0.678360223770142,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$5,000","$10,000",30%,,,,"$15,000","$30,000","$20,000","$40,000",$500,Not Applicable,40%,,,,"$1,500",Not Applicable,"$2,000",Not Applicable,,,,,,,,,,,,,,,,,,,67
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510039,SummaCare Individual 5000-LH with SCSelect Network,52664OH151,,OHN002,OHS001,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual5000-LH.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual5000-LH.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510039-01,Standard Silver On Exchange Plan,68.60%,0.678360223770142,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$5,000","$10,000",30%,,,,"$15,000","$30,000","$20,000","$40,000",$500,Not Applicable,40%,,,,"$1,500",Not Applicable,"$2,000",Not Applicable,,,,,,,,,,,,,,,,,,,68
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510039,SummaCare Individual 5000-LH with SCSelect Network,52664OH151,,OHN002,OHS001,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual5000-LH.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual5000-LH.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510039-04,73% AV Level Silver Plan,74.00%,0.733948290348053,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$15,600","$31,200","$20,800","$41,600","$2,650","$5,300",20%,,,,"$8,250","$16,500","$10,900","$21,800",$500,Not Applicable,40%,,,,"$1,500",Not Applicable,"$2,000",Not Applicable,,,,,,,,,,,,,,,,,,,71
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510039,SummaCare Individual 5000-LH with SCSelect Network,52664OH151,,OHN002,OHS001,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual5000-LH.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual5000-LH.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510039-05,87% AV Level Silver Plan,86.20%,0.864562034606934,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$6,750","$13,500","$9,000","$18,000",$750,"$1,500",20%,,,,"$5,000","$10,000","$5,750","$11,500",$200,Not Applicable,40%,,,,$600,Not Applicable,$800,Not Applicable,,,,,,,,,,,,,,,,,,,72
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510039,SummaCare Individual 5000-LH with SCSelect Network,52664OH151,,OHN002,OHS001,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual5000-LH.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual5000-LH.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510039-06,94% AV Level Silver Plan,93.20%,0.935412406921387,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$5,250","$10,500","$7,000","$14,000",$0,$0,10%,,,,"$5,000","$10,000",$0,$0,$200,Not Applicable,40%,,,,$600,Not Applicable,$800,Not Applicable,,,,,,,,,,,,,,,,,,,73
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510038,SummaCare Individual 5000-LH with SCConnect Network,52664OH151,,OHN001,OHS002,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual5000-LH.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual5000-LH.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510038-00,Standard Silver Off Exchange Plan,68.60%,0.678360223770142,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$5,000","$10,000",30%,,,,"$15,000","$30,000","$20,000","$40,000",$500,Not Applicable,40%,,,,"$1,500",Not Applicable,"$2,000",Not Applicable,,,,,,,,,,,,,,,,,,,60
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510039,SummaCare Individual 5000-LH with SCSelect Network,52664OH151,,OHN002,OHS001,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual5000-LH.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual5000-LH.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510039-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,69
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510039,SummaCare Individual 5000-LH with SCSelect Network,52664OH151,,OHN002,OHS001,OHF003,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual5000-LH.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual5000-LH.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510039-03,Limited Cost Sharing Plan Variation,68.60%,0.678360223770142,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800","$5,000","$10,000",30%,,,,"$15,000","$30,000","$20,000","$40,000",$500,Not Applicable,40%,,,,"$1,500",Not Applicable,"$2,000",Not Applicable,,,,,,,,,,,,,,,,,,,70
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510050,SummaCare Individual 750-LT with SCConnect Network,52664OH151,,OHN001,OHS002,OHF003,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual750-LT.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareIndividual750-LT.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510050-00,Standard Gold Off Exchange Plan,78.20%,0.782256722450256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",$750,"$1,500",20%,,,,"$2,250","$4,500","$3,000","$6,000",$250,Not Applicable,40%,,,,$750,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,120
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510050,SummaCare Individual 750-LT with SCConnect Network,52664OH151,,OHN001,OHS002,OHF003,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual750-LT.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareIndividual750-LT.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510050-01,Standard Gold On Exchange Plan,78.20%,0.782256722450256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",$750,"$1,500",20%,,,,"$2,250","$4,500","$3,000","$6,000",$250,Not Applicable,40%,,,,$750,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,121
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510050,SummaCare Individual 750-LT with SCConnect Network,52664OH151,,OHN001,OHS002,OHF003,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual750-LT.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareIndividual750-LT.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510050-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,122
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510050,SummaCare Individual 750-LT with SCConnect Network,52664OH151,,OHN001,OHS002,OHF003,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual750-LT.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareIndividual750-LT.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510050-03,Limited Cost Sharing Plan Variation,78.20%,0.782256722450256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",$750,"$1,500",20%,,,,"$2,250","$4,500","$3,000","$6,000",$250,Not Applicable,40%,,,,$750,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,123
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510051,SummaCare Individual 750-LT with SCSelect Network,52664OH151,,OHN002,OHS001,OHF003,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual750-LT.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareIndividual750-LT.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510051-00,Standard Gold Off Exchange Plan,78.20%,0.782256722450256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",$750,"$1,500",20%,,,,"$2,250","$4,500","$3,000","$6,000",$250,Not Applicable,40%,,,,$750,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,124
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510051,SummaCare Individual 750-LT with SCSelect Network,52664OH151,,OHN002,OHS001,OHF003,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual750-LT.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareIndividual750-LT.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510051-01,Standard Gold On Exchange Plan,78.20%,0.782256722450256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",$750,"$1,500",20%,,,,"$2,250","$4,500","$3,000","$6,000",$250,Not Applicable,40%,,,,$750,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,125
2015,OH,65869,SERFF,3,2014-09-11 12:10:19,1,65869,OH,Individual,Yes,47-0397286,65869OH0020001,"Renaissance Individual Dental PPO, EHB Certified",65869OH002,,OHN001,OHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.33,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,65869OH0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,65869,SERFF,3,2014-09-11 12:10:19,1,65869,OH,SHOP (Small Group),Yes,47-0397286,65869OH0030003,"Renaissance Group Dental PPO, EHB Certified",65869OH003,,OHN001,OHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.36,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,65869OH0030003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,65869,SERFF,3,2014-09-11 12:10:19,1,65869,OH,SHOP (Small Group),Yes,47-0397286,65869OH0030004,"Renaissance Group Dental PPO, EHB Certified",65869OH003,,OHN001,OHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.39,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,65869OH0030004-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,65869,SERFF,3,2014-09-11 12:10:19,1,65869,OH,Individual,Yes,47-0397286,65869OH0020002,"Renaissance Individual Dental PPO, EHB Certified",65869OH002,,OHN001,OHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.66,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,65869OH0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610003,Humana Silver 4600/Cincinnati/Northern KY HMOx,66083OH061,,OHN001,OHS001,OHF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343055,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334020,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610003-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510051,SummaCare Individual 750-LT with SCSelect Network,52664OH151,,OHN002,OHS001,OHF003,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual750-LT.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareIndividual750-LT.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510051-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,126
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,1,52664,OH,Individual,No,34-1809108,52664OH1510051,SummaCare Individual 750-LT with SCSelect Network,52664OH151,,OHN002,OHS001,OHF003,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual750-LT.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareIndividual750-LT.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1510051-03,Limited Cost Sharing Plan Variation,78.20%,0.782256722450256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",$750,"$1,500",20%,,,,"$2,250","$4,500","$3,000","$6,000",$250,Not Applicable,40%,,,,$750,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,127
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,3,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1500086,SummaCare Bronze 4000Q-15 with SCSelect Network,52664OH150,,OHN002,OHS005,OHF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze4000Q-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze4000Q-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1500086-00,Standard Bronze Off Exchange Plan,,0.613943159580231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,6
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,3,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1500086,SummaCare Bronze 4000Q-15 with SCSelect Network,52664OH150,,OHN002,OHS005,OHF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze4000Q-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze4000Q-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1500086-01,Standard Bronze On Exchange Plan,,0.613943159580231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,7
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,3,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1500087,SummaCare Bronze 4000Q-15 with SCSelect Network,52664OH150,,OHN002,OHS006,OHF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze4000Q-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze4000Q-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1500087-00,Standard Bronze Off Exchange Plan,,0.613943159580231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,8
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,3,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1500087,SummaCare Bronze 4000Q-15 with SCSelect Network,52664OH150,,OHN002,OHS006,OHF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze4000Q-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze4000Q-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1500087-01,Standard Bronze On Exchange Plan,,0.613943159580231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,9
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,3,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1500088,SummaCare Bronze 4000Q-15 with SCSelect Network,52664OH150,,OHN002,OHS007,OHF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze4000Q-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze4000Q-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1500088-00,Standard Bronze Off Exchange Plan,,0.613943159580231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,10
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,3,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1500088,SummaCare Bronze 4000Q-15 with SCSelect Network,52664OH150,,OHN002,OHS007,OHF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze4000Q-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze4000Q-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1500088-01,Standard Bronze On Exchange Plan,,0.613943159580231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,11
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,Individual,No,34-1809108,52664OH1520027,SummaCare Individual 6450-LD with SCConnect Network,52664OH152,,OHN001,OHS002,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual6450-LD.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual6450-LD.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1520027-00,Standard Bronze Off Exchange Plan,,0.602311432361603,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,,,,,,,,,,,,,"$6,450","$12,900",0%,,,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,12
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,Individual,No,34-1809108,52664OH1520027,SummaCare Individual 6450-LD with SCConnect Network,52664OH152,,OHN001,OHS002,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual6450-LD.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual6450-LD.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1520027-01,Standard Bronze On Exchange Plan,,0.602311432361603,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,,,,,,,,,,,,,"$6,450","$12,900",0%,,,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,13
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,Individual,No,34-1809108,52664OH1520028,SummaCare Individual 6450-LD with SCSelect Network,52664OH152,,OHN002,OHS001,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual6450-LD.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual6450-LD.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1520028-00,Standard Bronze Off Exchange Plan,,0.602311432361603,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,,,,,,,,,,,,,"$6,450","$12,900",0%,,,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,16
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490284,SummaCare Gold 2000-15 with SCSelect Network,52664OH149,,OHN002,OHS004,OHF007,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareGold2000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareGold2000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490284-00,Standard Gold Off Exchange Plan,,0.789840936660767,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000","$2,000","$4,000",20%,,,,"$6,000","$12,000","$8,000","$16,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490284,SummaCare Gold 2000-15 with SCSelect Network,52664OH149,,OHN002,OHS004,OHF007,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareGold2000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareGold2000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490284-01,Standard Gold On Exchange Plan,,0.789840936660767,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000","$2,000","$4,000",20%,,,,"$6,000","$12,000","$8,000","$16,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,Individual,No,34-1809108,52664OH1520028,SummaCare Individual 6450-LD with SCSelect Network,52664OH152,,OHN002,OHS001,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual6450-LD.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual6450-LD.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1520028-01,Standard Bronze On Exchange Plan,,0.602311432361603,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,,,,,,,,,,,,,"$6,450","$12,900",0%,,,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,17
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,Individual,No,34-1809108,52664OH1520028,SummaCare Individual 6450-LD with SCSelect Network,52664OH152,,OHN002,OHS001,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual6450-LD.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual6450-LD.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1520028-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,18
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490285,SummaCare Gold 2000-15 with SCSelect Network,52664OH149,,OHN002,OHS005,OHF007,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareGold2000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareGold2000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490285-00,Standard Gold Off Exchange Plan,,0.789840936660767,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000","$2,000","$4,000",20%,,,,"$6,000","$12,000","$8,000","$16,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490285,SummaCare Gold 2000-15 with SCSelect Network,52664OH149,,OHN002,OHS005,OHF007,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareGold2000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareGold2000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490285-01,Standard Gold On Exchange Plan,,0.789840936660767,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000","$2,000","$4,000",20%,,,,"$6,000","$12,000","$8,000","$16,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,19
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,Individual,No,34-1809108,52664OH1520028,SummaCare Individual 6450-LD with SCSelect Network,52664OH152,,OHN002,OHS001,OHF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividual6450-LD.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividual6450-LD.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1520028-03,Limited Cost Sharing Plan Variation,,0.602311432361603,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,,,,,,,,,,,,,"$6,450","$12,900",0%,,,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,19
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,Individual,No,34-1809108,52664OH1520029,SummaCare Individual Value-L0 with SCConnect Network,52664OH152,,OHN001,OHS002,OHF001,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividualValue-L0.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividualValue-L0.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1520029-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$19,800","$39,600","$26,400","$52,800",,,,,,,,,20
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490286,SummaCare Gold 2000-15 with SCSelect Network,52664OH149,,OHN002,OHS006,OHF007,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareGold2000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareGold2000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490286-00,Standard Gold Off Exchange Plan,,0.789840936660767,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000","$2,000","$4,000",20%,,,,"$6,000","$12,000","$8,000","$16,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490286,SummaCare Gold 2000-15 with SCSelect Network,52664OH149,,OHN002,OHS006,OHF007,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareGold2000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareGold2000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490286-01,Standard Gold On Exchange Plan,,0.789840936660767,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000","$2,000","$4,000",20%,,,,"$6,000","$12,000","$8,000","$16,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,Individual,No,34-1809108,52664OH1520029,SummaCare Individual Value-L0 with SCConnect Network,52664OH152,,OHN001,OHS002,OHF001,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividualValue-L0.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividualValue-L0.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1520029-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$19,800","$39,600","$26,400","$52,800",,,,,,,,,21
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,Individual,No,34-1809108,52664OH1520030,SummaCare Individual Value-L0 with SCSelect Network,52664OH152,,OHN002,OHS001,OHF001,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividualValue-L0.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividualValue-L0.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1520030-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$19,800","$39,600","$26,400","$52,800",,,,,,,,,22
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490287,SummaCare Gold 2000-15 with SCSelect Network,52664OH149,,OHN002,OHS007,OHF007,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareGold2000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareGold2000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490287-00,Standard Gold Off Exchange Plan,,0.789840936660767,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000","$2,000","$4,000",20%,,,,"$6,000","$12,000","$8,000","$16,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490287,SummaCare Gold 2000-15 with SCSelect Network,52664OH149,,OHN002,OHS007,OHF007,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareGold2000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareGold2000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490287-01,Standard Gold On Exchange Plan,,0.789840936660767,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000","$2,000","$4,000",20%,,,,"$6,000","$12,000","$8,000","$16,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,23
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,Individual,No,34-1809108,52664OH1520030,SummaCare Individual Value-L0 with SCSelect Network,52664OH152,,OHN002,OHS001,OHF001,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,,No,,Yes,Out of Network Deductibles and Out of Network MOOP apply,No,http://mysummacare.com/docs/sbc/SummaCareIndividualValue-L0.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/SummaCareIndividualValue-L0.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1520030-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$19,800","$39,600","$26,400","$52,800",,,,,,,,,23
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490288,SummaCare Gold 2000-15 with SCSelect Network,52664OH149,,OHN002,OHS003,OHF007,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareGold2000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareGold2000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490288-00,Standard Gold Off Exchange Plan,,0.789840936660767,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000","$2,000","$4,000",20%,,,,"$6,000","$12,000","$8,000","$16,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,24
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490288,SummaCare Gold 2000-15 with SCSelect Network,52664OH149,,OHN002,OHS003,OHF007,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareGold2000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareGold2000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490288-01,Standard Gold On Exchange Plan,,0.789840936660767,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000","$2,000","$4,000",20%,,,,"$6,000","$12,000","$8,000","$16,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,25
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490289,SummaCare Gold 2000-15 with SCConnect Network,52664OH149,,OHN001,OHS002,OHF007,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareGold2000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareGold2000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490289-00,Standard Gold Off Exchange Plan,,0.789840936660767,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000","$2,000","$4,000",20%,,,,"$6,000","$12,000","$8,000","$16,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,26
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,2,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490289,SummaCare Gold 2000-15 with SCConnect Network,52664OH149,,OHN001,OHS002,OHF007,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareGold2000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareGold2000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490289-01,Standard Gold On Exchange Plan,,0.789840936660767,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000","$2,000","$4,000",20%,,,,"$6,000","$12,000","$8,000","$16,000",$0,$0,45%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,27
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610013,Humana Silver 4600/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343068,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334124,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610013-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610013,Humana Silver 4600/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343068,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334124,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610013-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,OH,68158,SERFF,2,2014-09-09 16:12:42,2,68158,OH,SHOP (Small Group),Yes,13-5123390,68158OH0180002,Guardian Family Essentials,68158OH018,,OHN001,OHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.32,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,68158OH0180002-00,Standard Low Off Exchange Plan,69.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,68158,SERFF,2,2014-09-09 16:12:42,2,68158,OH,SHOP (Small Group),Yes,13-5123390,68158OH0180002,Guardian Family Essentials,68158OH018,,OHN001,OHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.32,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,68158OH0180002-01,Standard Low On Exchange Plan,69.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,70318,SERFF,3,2014-09-11 12:10:19,1,70318,OH,SHOP (Small Group),Yes,81-0170040,70318OH0010001,Assurant Dental ACAFFO High,70318OH001,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.98,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same Coverage as in Service Area.,Yes,,,,,70318OH0010001-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,70318,SERFF,3,2014-09-11 12:10:19,2,70318,OH,SHOP (Small Group),Yes,81-0170040,70318OH0010002,Assurant Dental ACAFFO Low,70318OH001,,OHN001,OHS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.36,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same Coverage as in Service Area,Yes,,,,,70318OH0010002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,73292,SERFF,3,2014-09-11 12:10:19,1,73292,OH,SHOP (Small Group),Yes,44-0308260,73292OH0010001,KCL EHB Low PPO,73292OH001,,OHN001,OHS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$41.05,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,73292OH0010001-00,Standard Low Off Exchange Plan,70.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,73292,SERFF,3,2014-09-11 12:10:19,1,73292,OH,SHOP (Small Group),Yes,44-0308260,73292OH0010003,KCL EHB Low MAC,73292OH001,,OHN001,OHS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$31.46,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,73292OH0010003-00,Standard Low Off Exchange Plan,70.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,73292,SERFF,3,2014-09-11 12:10:19,1,73292,OH,SHOP (Small Group),Yes,44-0308260,73292OH0010005,KCL Fam Low PPO,73292OH001,,OHN001,OHS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$41.05,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,73292OH0010005-00,Standard Low Off Exchange Plan,70.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,73292,SERFF,3,2014-09-11 12:10:19,1,73292,OH,SHOP (Small Group),Yes,44-0308260,73292OH0010007,KCL Fam Low MAC,73292OH001,,OHN001,OHS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$31.46,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,73292OH0010007-00,Standard Low Off Exchange Plan,70.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,73292,SERFF,3,2014-09-11 12:10:19,2,73292,OH,SHOP (Small Group),Yes,44-0308260,73292OH0010002,KCL EHB High PPO,73292OH001,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$49.77,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,73292OH0010002-00,Standard High Off Exchange Plan,85.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,73292,SERFF,3,2014-09-11 12:10:19,2,73292,OH,SHOP (Small Group),Yes,44-0308260,73292OH0010004,KCL EHB High MAC,73292OH001,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$39.05,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,73292OH0010004-00,Standard High Off Exchange Plan,85.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,73292,SERFF,3,2014-09-11 12:10:19,2,73292,OH,SHOP (Small Group),Yes,44-0308260,73292OH0010006,KCL Fam High PPO,73292OH001,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$49.77,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,73292OH0010006-00,Standard High Off Exchange Plan,85.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,73292,SERFF,3,2014-09-11 12:10:19,2,73292,OH,SHOP (Small Group),Yes,44-0308260,73292OH0010008,KCL Fam High MAC,73292OH001,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$39.05,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,73292OH0010008-00,Standard High Off Exchange Plan,85.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020066,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS003,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020066-00,Standard Silver Off Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,18
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020066,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS003,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020066-01,Standard Silver On Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,19
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,3,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1500085,SummaCare Bronze 4000Q-15 with SCSelect Network,52664OH150,,OHN002,OHS004,OHF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze4000Q-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze4000Q-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1500085-00,Standard Bronze Off Exchange Plan,,0.613943159580231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,4
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,3,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1500085,SummaCare Bronze 4000Q-15 with SCSelect Network,52664OH150,,OHN002,OHS004,OHF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze4000Q-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze4000Q-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1500085-01,Standard Bronze On Exchange Plan,,0.613943159580231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,5
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,3,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1500089,SummaCare Bronze 4000Q-15 with SCSelect Network,52664OH150,,OHN002,OHS003,OHF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze4000Q-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze4000Q-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1500089-00,Standard Bronze Off Exchange Plan,,0.613943159580231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,12
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,3,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1500089,SummaCare Bronze 4000Q-15 with SCSelect Network,52664OH150,,OHN002,OHS003,OHF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze4000Q-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze4000Q-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1500089-01,Standard Bronze On Exchange Plan,,0.613943159580231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,13
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,1,74313,OH,Individual,No,01-0580404,74313OH0210001,Paramount Gold 1,74313OH021,,OHN001,OHS001,OHF008,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$100,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210001-01,Standard Gold On Exchange Plan,,0.790410816669464,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$40,"$1,010",$150,"$1,000",$480,$10,$80,5
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,6,74313,OH,Individual,No,01-0580404,74313OH0210004,Paramount Catastrophic,74313OH021,,OHN001,OHS001,OHF001,Existing,HMO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,,0,0,3,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210004-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$0,$150,"$5,270",$0,$0,$80,5
2015,OH,76018,SERFF,2,2014-09-08 09:42:37,1,76018,OH,SHOP (Small Group),Yes,35-0472300,76018OH0010001,Lincoln Dental Connect?,76018OH001,,OHN001,OHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.30,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,76018OH0010001-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,76018,SERFF,2,2014-09-08 09:42:37,1,76018,OH,SHOP (Small Group),Yes,35-0472300,76018OH0010002,Lincoln Dental Connect?,76018OH001,,OHN001,OHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.07,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,76018OH0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,76018,SERFF,2,2014-09-08 09:42:37,1,76018,OH,SHOP (Small Group),Yes,35-0472300,76018OH0010003,Lincoln Dental Connect?,76018OH001,,OHN001,OHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.52,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,76018OH0010003-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,76018,SERFF,2,2014-09-08 09:42:37,1,76018,OH,SHOP (Small Group),Yes,35-0472300,76018OH0010005,Lincoln Dental Connect?,76018OH001,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.91,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,76018OH0010005-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,76018,SERFF,2,2014-09-08 09:42:37,1,76018,OH,SHOP (Small Group),Yes,35-0472300,76018OH0010006,Lincoln Dental Connect?,76018OH001,,OHN001,OHS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.36,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,76018OH0010006-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610003,Humana Silver 4600/Cincinnati/Northern KY HMOx,66083OH061,,OHN001,OHS001,OHF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343055,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334020,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610003-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610003,Humana Silver 4600/Cincinnati/Northern KY HMOx,66083OH061,,OHN001,OHS001,OHF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343055,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334020,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610003-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610028,Humana Platinum 1000/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343003,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334241,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610028-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,2,66083,OH,Individual,No,31-1154200,66083OH0610001,Humana Basic 6600/Cincinnati/Northern KY HMOx,66083OH061,,OHN001,OHS001,OHF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342873,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333994,http://apps.humana.com/marketing/documents.asp?file=2323880,66083OH0610001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,2,66083,OH,Individual,No,31-1154200,66083OH0610001,Humana Basic 6600/Cincinnati/Northern KY HMOx,66083OH061,,OHN001,OHS001,OHF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342873,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2333994,http://apps.humana.com/marketing/documents.asp?file=2323880,66083OH0610001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,2,66083,OH,Individual,No,31-1154200,66083OH0610002,Humana Bronze 5750/Cincinnati/Northern KY HMOx,66083OH061,,OHN001,OHS001,OHF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342912,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334007,http://apps.humana.com/marketing/documents.asp?file=2323880,66083OH0610002-00,Standard Bronze Off Exchange Plan,,0.601075530052185,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020029,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN004,OHS002,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020029-00,Standard Gold Off Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,16
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,3,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1500090,SummaCare Bronze 4000Q-15 with SCConnect Network,52664OH150,,OHN001,OHS002,OHF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze4000Q-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze4000Q-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1500090-00,Standard Bronze Off Exchange Plan,,0.613943159580231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,14
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,3,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1500090,SummaCare Bronze 4000Q-15 with SCConnect Network,52664OH150,,OHN001,OHS002,OHF005,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze4000Q-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze4000Q-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1500090-01,Standard Bronze On Exchange Plan,,0.613943159580231,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$19,350","$38,700","$25,800","$51,600",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,15
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,4,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490230,SummaCare Bronze 5000-15 with SCSelect Network,52664OH149,,OHN002,OHS004,OHF006,New,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze5000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze5000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490230-00,Standard Bronze Off Exchange Plan,61.60%,0.631967782974243,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000","$20,000","$30,000",,,,,,,,,4
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,4,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490230,SummaCare Bronze 5000-15 with SCSelect Network,52664OH149,,OHN002,OHS004,OHF006,New,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze5000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze5000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490230-01,Standard Bronze On Exchange Plan,61.60%,0.631967782974243,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000","$20,000","$30,000",,,,,,,,,5
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,4,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490231,SummaCare Bronze 5000-15 with SCSelect Network,52664OH149,,OHN002,OHS005,OHF006,New,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze5000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze5000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490231-00,Standard Bronze Off Exchange Plan,61.60%,0.631967782974243,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000","$20,000","$30,000",,,,,,,,,6
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,4,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490231,SummaCare Bronze 5000-15 with SCSelect Network,52664OH149,,OHN002,OHS005,OHF006,New,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze5000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze5000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490231-01,Standard Bronze On Exchange Plan,61.60%,0.631967782974243,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000","$20,000","$30,000",,,,,,,,,7
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,4,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490232,SummaCare Bronze 5000-15 with SCSelect Network,52664OH149,,OHN002,OHS006,OHF006,New,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze5000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze5000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490232-00,Standard Bronze Off Exchange Plan,61.60%,0.631967782974243,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000","$20,000","$30,000",,,,,,,,,8
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,4,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490232,SummaCare Bronze 5000-15 with SCSelect Network,52664OH149,,OHN002,OHS006,OHF006,New,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze5000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze5000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490232-01,Standard Bronze On Exchange Plan,61.60%,0.631967782974243,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000","$20,000","$30,000",,,,,,,,,9
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,4,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490233,SummaCare Bronze 5000-15 with SCSelect Network,52664OH149,,OHN002,OHS007,OHF006,New,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze5000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze5000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490233-00,Standard Bronze Off Exchange Plan,61.60%,0.631967782974243,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000","$20,000","$30,000",,,,,,,,,10
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,4,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490233,SummaCare Bronze 5000-15 with SCSelect Network,52664OH149,,OHN002,OHS007,OHF006,New,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze5000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze5000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490233-01,Standard Bronze On Exchange Plan,61.60%,0.631967782974243,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000","$20,000","$30,000",,,,,,,,,11
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,4,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490234,SummaCare Bronze 5000-15 with SCSelect Network,52664OH149,,OHN002,OHS003,OHF006,New,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze5000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze5000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490234-00,Standard Bronze Off Exchange Plan,61.60%,0.631967782974243,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000","$20,000","$30,000",,,,,,,,,12
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,4,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490234,SummaCare Bronze 5000-15 with SCSelect Network,52664OH149,,OHN002,OHS003,OHF006,New,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze5000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze5000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490234-01,Standard Bronze On Exchange Plan,61.60%,0.631967782974243,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000","$20,000","$30,000",,,,,,,,,13
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,4,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490235,SummaCare Bronze 5000-15 with SCConnect Network,52664OH149,,OHN001,OHS002,OHF006,New,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze5000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze5000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490235-00,Standard Bronze Off Exchange Plan,61.60%,0.631967782974243,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000","$20,000","$30,000",,,,,,,,,14
2015,OH,52664,SERFF,12,2015-04-30 14:45:44,4,52664,OH,SHOP (Small Group),No,34-1809108,52664OH1490235,SummaCare Bronze 5000-15 with SCConnect Network,52664OH149,,OHN001,OHS002,OHF006,New,PPO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,$300,0,0,0,2015-01-01,,No,,Yes,PPO out of network benefits with separate out of network deductible and out of network out of pocket max.,No,http://mysummacare.com/docs/sbc/SummaCareBronze5000-15.pdf,https://summacare.insxcloud.com/payment,http://mysummacare.com/docs/sob/SummaCareBronze5000-15.pdf,http://mysummacare.com/prescription-drug-benefits.html,52664OH1490235-01,Standard Bronze On Exchange Plan,61.60%,0.631967782974243,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$19,800","$39,600","$26,400","$52,800",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$15,000","$30,000","$20,000","$30,000",,,,,,,,,15
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,3,67129,OH,Individual,No,06-6033492,67129OH0100003,Aetna Bronze Deductible Only HSA,67129OH010,,OHN001,OHS001,OHF008,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100003-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,5,67129,OH,Individual,No,06-6033492,67129OH0100009,Aetna Silver $10 Copay,67129OH010,,OHN001,OHS001,OHF010,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100009-00,Standard Silver Off Exchange Plan,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,5,67129,OH,Individual,No,06-6033492,67129OH0100009,Aetna Silver $10 Copay,67129OH010,,OHN001,OHS001,OHF010,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100009-01,Standard Silver On Exchange Plan,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,5,67129,OH,Individual,No,06-6033492,67129OH0100009,Aetna Silver $10 Copay,67129OH010,,OHN001,OHS001,OHF010,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100009-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,5,67129,OH,Individual,No,06-6033492,67129OH0100009,Aetna Silver $10 Copay,67129OH010,,OHN001,OHS001,OHF010,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100009-03,Limited Cost Sharing Plan Variation,68.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,5,67129,OH,Individual,No,06-6033492,67129OH0100009,Aetna Silver $10 Copay,67129OH010,,OHN001,OHS001,OHF010,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100009-04,73% AV Level Silver Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,5,67129,OH,Individual,No,06-6033492,67129OH0100009,Aetna Silver $10 Copay,67129OH010,,OHN001,OHS001,OHF010,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100009-05,87% AV Level Silver Plan,86.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,5,67129,OH,Individual,No,06-6033492,67129OH0100009,Aetna Silver $10 Copay,67129OH010,,OHN001,OHS001,OHF010,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100009-06,94% AV Level Silver Plan,93.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,7,67129,OH,Individual,No,06-6033492,67129OH0100011,Aetna Silver $5 Copay 2750,67129OH010,,OHN001,OHS001,OHF011,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100011-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,7,67129,OH,Individual,No,06-6033492,67129OH0100011,Aetna Silver $5 Copay 2750,67129OH010,,OHN001,OHS001,OHF011,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100011-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,7,67129,OH,Individual,No,06-6033492,67129OH0100011,Aetna Silver $5 Copay 2750,67129OH010,,OHN001,OHS001,OHF011,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100011-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,7,67129,OH,Individual,No,06-6033492,67129OH0100011,Aetna Silver $5 Copay 2750,67129OH010,,OHN001,OHS001,OHF011,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100011-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,55371,SERFF,4,2014-11-14 14:52:18,1,55371,OH,Individual,Yes,75-1233841,55371OH0010007,Dentegra Dental PPO Pediatric Basic Plan,55371OH001,,OHN001,OHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$18.27,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/oh/55371oh0010007-15,,55371OH0010007-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,55371,SERFF,4,2014-11-14 14:52:18,1,55371,OH,SHOP (Small Group),Yes,75-1233841,55371OH0020007,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,55371OH002,,OHN001,OHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.41,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/oh/55371oh0020007-15,,55371OH0020007-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,55371,SERFF,4,2014-11-14 14:52:18,1,55371,OH,SHOP (Small Group),Yes,75-1233841,55371OH0020007,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,55371OH002,,OHN001,OHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.41,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/oh/55371oh0020007-15,,55371OH0020007-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,55371,SERFF,4,2014-11-14 14:52:18,1,55371,OH,Individual,Yes,75-1233841,55371OH0010007,Dentegra Dental PPO Pediatric Basic Plan,55371OH001,,OHN001,OHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$18.27,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/oh/55371oh0010007-15,,55371OH0010007-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,55371,SERFF,4,2014-11-14 14:52:18,2,55371,OH,Individual,Yes,75-1233841,55371OH0010009,Dentegra Dental PPO Family Basic Plan,55371OH001,,OHN001,OHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.27,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/oh/55371oh0010009-15,,55371OH0010009-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,55371,SERFF,4,2014-11-14 14:52:18,2,55371,OH,SHOP (Small Group),Yes,75-1233841,55371OH0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,55371OH002,,OHN001,OHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.41,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/oh/55371oh0020009-15,,55371OH0020009-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,55371,SERFF,4,2014-11-14 14:52:18,2,55371,OH,SHOP (Small Group),Yes,75-1233841,55371OH0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,55371OH002,,OHN001,OHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.41,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/oh/55371oh0020009-15,,55371OH0020009-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,55371,SERFF,4,2014-11-14 14:52:18,2,55371,OH,Individual,Yes,75-1233841,55371OH0010009,Dentegra Dental PPO Family Basic Plan,55371OH001,,OHN001,OHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.27,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/oh/55371oh0010009-15,,55371OH0010009-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,59401,SERFF,3,2014-09-11 12:10:19,1,59401,OH,SHOP (Small Group),Yes,27-4326698,59401OH0020002,Managed DentalGuard OH Child Essentials 1,59401OH002,,OHN001,OHS001,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$13.32,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,59401OH0020002-00,Standard Low Off Exchange Plan,69.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,59401,SERFF,3,2014-09-11 12:10:19,1,59401,OH,SHOP (Small Group),Yes,27-4326698,59401OH0020002,Managed DentalGuard OH Child Essentials 1,59401OH002,,OHN001,OHS001,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$13.32,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,59401OH0020002-01,Standard Low On Exchange Plan,69.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,59401,SERFF,3,2014-09-11 12:10:19,1,59401,OH,SHOP (Small Group),Yes,27-4326698,59401OH0010002,Managed DentalGuard OH Child Essentials 2,59401OH001,,OHN001,OHS001,,Existing,HMO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$21.04,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,59401OH0010002-00,Standard High Off Exchange Plan,84.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,59401,SERFF,3,2014-09-11 12:10:19,1,59401,OH,SHOP (Small Group),Yes,27-4326698,59401OH0010002,Managed DentalGuard OH Child Essentials 2,59401OH001,,OHN001,OHS001,,Existing,HMO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$21.04,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,59401OH0010002-01,Standard High On Exchange Plan,84.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,59401,SERFF,3,2014-09-11 12:10:19,2,59401,OH,SHOP (Small Group),Yes,27-4326698,59401OH0030002,Managed DentalGuard OH10 Family Plan,59401OH003,,OHN001,OHS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$13.32,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,59401OH0030002-00,Standard Low Off Exchange Plan,69.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,59401,SERFF,3,2014-09-11 12:10:19,2,59401,OH,SHOP (Small Group),Yes,27-4326698,59401OH0030002,Managed DentalGuard OH10 Family Plan,59401OH003,,OHN001,OHS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$13.32,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,59401OH0030002-01,Standard Low On Exchange Plan,69.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,59401,SERFF,3,2014-09-11 12:10:19,2,59401,OH,SHOP (Small Group),Yes,27-4326698,59401OH0040002,Managed DentalGuard OH20 Family Plan,59401OH004,,OHN001,OHS001,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$13.32,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,59401OH0040002-00,Standard Low Off Exchange Plan,69.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,59401,SERFF,3,2014-09-11 12:10:19,2,59401,OH,SHOP (Small Group),Yes,27-4326698,59401OH0050002,Managed DentalGuard OH30 Family Plan,59401OH005,,OHN001,OHS001,,Existing,HMO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$13.32,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,59401OH0050002-00,Standard Low Off Exchange Plan,69.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,64156,SERFF,3,2014-09-11 12:10:19,1,64156,OH,SHOP (Small Group),Yes,36-0883760,64156OH0040002,EHB High PPO,64156OH004,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$37.45,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,64156OH0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,64156,SERFF,3,2014-09-11 12:10:19,1,64156,OH,SHOP (Small Group),Yes,36-0883760,64156OH0040001,EHB Low PPO,64156OH004,,OHN001,OHS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.58,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,64156OH0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,64156,SERFF,3,2014-09-11 12:10:19,1,64156,OH,SHOP (Small Group),Yes,36-0883760,64156OH0030002,EHB High Passive,64156OH003,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$40.77,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,64156OH0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,64156,SERFF,3,2014-09-11 12:10:19,1,64156,OH,SHOP (Small Group),Yes,36-0883760,64156OH0030001,EHB Low Passive,64156OH003,,OHN001,OHS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.31,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,64156OH0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,64353,SERFF,3,2014-09-11 12:10:19,1,64353,OH,Individual,No,20-0750134,64353OH0010001,Molina Marketplace Gold Plan,64353OH001,,OHN001,OHS001,OHF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,64353OH0010001-00,Standard Gold Off Exchange Plan,,0.797688901424408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,OH,64353,SERFF,3,2014-09-11 12:10:19,1,64353,OH,Individual,No,20-0750134,64353OH0010001,Molina Marketplace Gold Plan,64353OH001,,OHN001,OHS001,OHF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,64353OH0010001-01,Standard Gold On Exchange Plan,,0.797688901424408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,OH,64353,SERFF,3,2014-09-11 12:10:19,1,64353,OH,Individual,No,20-0750134,64353OH0010001,Molina Marketplace Gold Plan,64353OH001,,OHN001,OHS001,OHF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,64353OH0010001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,OH,64353,SERFF,3,2014-09-11 12:10:19,1,64353,OH,Individual,No,20-0750134,64353OH0010001,Molina Marketplace Gold Plan,64353OH001,,OHN001,OHS001,OHF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,64353OH0010001-03,Limited Cost Sharing Plan Variation,,0.797688901424408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,OH,64353,SERFF,3,2014-09-11 12:10:19,2,64353,OH,Individual,No,20-0750134,64353OH0010002,Molina Marketplace Silver Plan,64353OH001,,OHN001,OHS001,OHF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.992373265428353,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,64353OH0010002-00,Standard Silver Off Exchange Plan,,0.706084549427032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$200,$400,30%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,4
2015,OH,64353,SERFF,3,2014-09-11 12:10:19,2,64353,OH,Individual,No,20-0750134,64353OH0010002,Molina Marketplace Silver Plan,64353OH001,,OHN001,OHS001,OHF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.992373265428353,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,64353OH0010002-01,Standard Silver On Exchange Plan,,0.706084549427032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$200,$400,30%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,5
2015,OH,64353,SERFF,3,2014-09-11 12:10:19,2,64353,OH,Individual,No,20-0750134,64353OH0010002,Molina Marketplace Silver Plan,64353OH001,,OHN001,OHS001,OHF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.992373265428353,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,64353OH0010002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,OH,64353,SERFF,3,2014-09-11 12:10:19,2,64353,OH,Individual,No,20-0750134,64353OH0010002,Molina Marketplace Silver Plan,64353OH001,,OHN001,OHS001,OHF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.992373265428353,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,64353OH0010002-03,Limited Cost Sharing Plan Variation,,0.706084549427032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$200,$400,30%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,7
2015,OH,64353,SERFF,3,2014-09-11 12:10:19,2,64353,OH,Individual,No,20-0750134,64353OH0010002,Molina Marketplace Silver Plan,64353OH001,,OHN001,OHS001,OHF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.992373265428353,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,64353OH0010002-04,73% AV Level Silver Plan,,0.739861905574799,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,"$5,200","$10,400","$1,700","$3,400",30%,,,,Not Applicable,Not Applicable,"$1,700","$3,400",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,OH,64353,SERFF,3,2014-09-11 12:10:19,2,64353,OH,Individual,No,20-0750134,64353OH0010002,Molina Marketplace Silver Plan,64353OH001,,OHN001,OHS001,OHF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.992373265428353,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,64353OH0010002-05,87% AV Level Silver Plan,,0.874694764614105,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,"$2,250","$4,500",$250,$500,20%,,,,Not Applicable,Not Applicable,$250,$500,$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,OH,64353,SERFF,3,2014-09-11 12:10:19,2,64353,OH,Individual,No,20-0750134,64353OH0010002,Molina Marketplace Silver Plan,64353OH001,,OHN001,OHS001,OHF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.992373265428353,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/oh/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,64353OH0010002-06,94% AV Level Silver Plan,,0.943551361560822,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,"$2,250","$4,500",$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,OH,64353,SERFF,3,2014-09-11 12:10:19,3,64353,OH,Individual,No,20-0750134,64353OH0010003,Molina Marketplace Bronze Plan,64353OH001,,OHN001,OHS002,OHF003,Existing,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,64353OH0010003-00,Standard Bronze Off Exchange Plan,,0.619724571704865,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,4
2015,OH,64353,SERFF,3,2014-09-11 12:10:19,3,64353,OH,Individual,No,20-0750134,64353OH0010003,Molina Marketplace Bronze Plan,64353OH001,,OHN001,OHS002,OHF003,Existing,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,64353OH0010003-01,Standard Bronze On Exchange Plan,,0.619724571704865,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,5
2015,OH,64353,SERFF,3,2014-09-11 12:10:19,3,64353,OH,Individual,No,20-0750134,64353OH0010003,Molina Marketplace Bronze Plan,64353OH001,,OHN001,OHS002,OHF003,Existing,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,64353OH0010003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,6
2015,OH,64353,SERFF,3,2014-09-11 12:10:19,3,64353,OH,Individual,No,20-0750134,64353OH0010003,Molina Marketplace Bronze Plan,64353OH001,,OHN001,OHS002,OHF003,Existing,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,64353OH0010003-03,Limited Cost Sharing Plan Variation,,0.619724571704865,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,7
2015,OH,65869,SERFF,3,2014-09-11 12:10:19,1,65869,OH,Individual,Yes,47-0397286,65869OH0040001,"Delta Dental Individual PPO, EHB Certified",65869OH004,,OHN002,OHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.89,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,65869OH0040001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,65869,SERFF,3,2014-09-11 12:10:19,1,65869,OH,SHOP (Small Group),Yes,47-0397286,65869OH0030001,"Renaissance Group Dental PPO, EHB Certified",65869OH003,,OHN001,OHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.36,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,65869OH0030001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,65869,SERFF,3,2014-09-11 12:10:19,1,65869,OH,SHOP (Small Group),Yes,47-0397286,65869OH0030002,"Renaissance Group Dental PPO, EHB Certified",65869OH003,,OHN001,OHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.39,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,65869OH0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,65869,SERFF,3,2014-09-11 12:10:19,1,65869,OH,Individual,Yes,47-0397286,65869OH0040002,"Delta Dental Individual PPO, EHB Certified",65869OH004,,OHN002,OHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.56,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,65869OH0040002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610003,Humana Silver 4600/Cincinnati/Northern KY HMOx,66083OH061,,OHN001,OHS001,OHF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343055,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334020,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610003-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610003,Humana Silver 4600/Cincinnati/Northern KY HMOx,66083OH061,,OHN001,OHS001,OHF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343055,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334020,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610028,Humana Platinum 1000/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343003,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334241,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610028-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610028,Humana Platinum 1000/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343003,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334241,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610028-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,40
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020074,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN004,OHS002,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020074-03,Limited Cost Sharing Plan Variation,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,28
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020074,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN004,OHS002,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020074-04,73% AV Level Silver Plan,74.00%,0.739992797374725,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$300,$0,$150,"$2,420",$0,$0,$80,29
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020074,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN004,OHS002,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020074-05,87% AV Level Silver Plan,87.90%,0.880107223987579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$0,$100,$80,30
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020074,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN004,OHS002,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020074-06,94% AV Level Silver Plan,94.22%,0.942208528518677,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$200,$300,$0,$150,$200,$0,$0,$80,31
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,1,74313,OH,Individual,No,01-0580404,74313OH0210001,Paramount Gold 1,74313OH021,,OHN001,OHS001,OHF008,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$100,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210001-00,Standard Gold Off Exchange Plan,,0.790410816669464,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$40,"$1,010",$150,"$1,000",$480,$10,$80,4
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610003,Humana Silver 4600/Cincinnati/Northern KY HMOx,66083OH061,,OHN001,OHS001,OHF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343055,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334020,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610003-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610003,Humana Silver 4600/Cincinnati/Northern KY HMOx,66083OH061,,OHN001,OHS001,OHF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343055,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334020,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610003-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,2,66083,OH,Individual,No,31-1154200,66083OH0610012,Humana Bronze 5750/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342925,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334111,http://apps.humana.com/marketing/documents.asp?file=2323880,66083OH0610012-03,Limited Cost Sharing Plan Variation,,0.601075530052185,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,2,66083,OH,Individual,No,31-1154200,66083OH0610025,Humana Basic 6600/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342886,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334202,http://apps.humana.com/marketing/documents.asp?file=2323880,66083OH0610025-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,1,74313,OH,Individual,No,01-0580404,74313OH0210002,Paramount Silver 1,74313OH021,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$200,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210002-01,Standard Silver On Exchange Plan,,0.689674139022827,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900","$3,800",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$2,030",$150,"$1,900",$790,$20,$80,9
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020015,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN002,OHS006,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020015-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,$0,$0,$0,$0,,,$0,$0,$0,$0,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020015,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN002,OHS006,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020015-03,Limited Cost Sharing Plan Variation,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,7
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020019,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS001,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020019-00,Standard Gold Off Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,8
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020019,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS001,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020019-01,Standard Gold On Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,9
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020019,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS001,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020019-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,$0,$0,$0,$0,,,$0,$0,$0,$0,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020019,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS001,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020019-03,Limited Cost Sharing Plan Variation,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,11
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020021,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS003,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020021-00,Standard Gold Off Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,12
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610004,Humana Gold 2500/Cincinnati/Northern KY HMOx,66083OH061,,OHN001,OHS001,OHF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342951,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334072,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610004-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610004,Humana Gold 2500/Cincinnati/Northern KY HMOx,66083OH061,,OHN001,OHS001,OHF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342951,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334072,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610004-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610004,Humana Gold 2500/Cincinnati/Northern KY HMOx,66083OH061,,OHN001,OHS001,OHF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342951,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334072,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610004,Humana Gold 2500/Cincinnati/Northern KY HMOx,66083OH061,,OHN001,OHS001,OHF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342951,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334072,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610004-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610005,Humana Platinum 1000/Cincinnati/Northern KY HMOx,66083OH061,,OHN001,OHS001,OHF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342990,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334085,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610005-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610005,Humana Platinum 1000/Cincinnati/Northern KY HMOx,66083OH061,,OHN001,OHS001,OHF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342990,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334085,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610005-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610005,Humana Platinum 1000/Cincinnati/Northern KY HMOx,66083OH061,,OHN001,OHS001,OHF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342990,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334085,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610005,Humana Platinum 1000/Cincinnati/Northern KY HMOx,66083OH061,,OHN001,OHS001,OHF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342990,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334085,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610005-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610013,Humana Silver 4600/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343068,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334124,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610013-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610013,Humana Silver 4600/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343068,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334124,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610013-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610013,Humana Silver 4600/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343068,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334124,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610013-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610013,Humana Silver 4600/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343068,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334124,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610013-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610013,Humana Silver 4600/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF002,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343068,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334124,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610013-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610014,Humana Gold 2500/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342964,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334176,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610014-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610014,Humana Gold 2500/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342964,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334176,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610014-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610014,Humana Gold 2500/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342964,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334176,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,28
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610014,Humana Gold 2500/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342964,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334176,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610014-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610015,Humana Platinum 1000/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343003,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334189,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610015-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610015,Humana Platinum 1000/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343003,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334189,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610015-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610015,Humana Platinum 1000/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343003,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334189,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,32
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610015,Humana Platinum 1000/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343003,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334189,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610015-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610027,Humana Gold 2500/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342964,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334228,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610027-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610027,Humana Gold 2500/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342964,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334228,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610027-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610027,Humana Gold 2500/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342964,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334228,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610027-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,36
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610027,Humana Gold 2500/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF003,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342964,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334228,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610027-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,1,66083,OH,Individual,No,31-1154200,66083OH0610028,Humana Platinum 1000/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF003,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2343003,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334241,http://apps.humana.com/marketing/documents.asp?file=2323815,66083OH0610028-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,2,66083,OH,Individual,No,31-1154200,66083OH0610002,Humana Bronze 5750/Cincinnati/Northern KY HMOx,66083OH061,,OHN001,OHS001,OHF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342912,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334007,http://apps.humana.com/marketing/documents.asp?file=2323880,66083OH0610002-01,Standard Bronze On Exchange Plan,,0.601075530052185,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,2,66083,OH,Individual,No,31-1154200,66083OH0610002,Humana Bronze 5750/Cincinnati/Northern KY HMOx,66083OH061,,OHN001,OHS001,OHF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342912,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334007,http://apps.humana.com/marketing/documents.asp?file=2323880,66083OH0610002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,8
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,2,66083,OH,Individual,No,31-1154200,66083OH0610002,Humana Bronze 5750/Cincinnati/Northern KY HMOx,66083OH061,,OHN001,OHS001,OHF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342912,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334007,http://apps.humana.com/marketing/documents.asp?file=2323880,66083OH0610002-03,Limited Cost Sharing Plan Variation,,0.601075530052185,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,2,66083,OH,Individual,No,31-1154200,66083OH0610011,Humana Basic 6600/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342886,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334098,http://apps.humana.com/marketing/documents.asp?file=2323880,66083OH0610011-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,2,66083,OH,Individual,No,31-1154200,66083OH0610011,Humana Basic 6600/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342886,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334098,http://apps.humana.com/marketing/documents.asp?file=2323880,66083OH0610011-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,2,66083,OH,Individual,No,31-1154200,66083OH0610012,Humana Bronze 5750/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342925,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334111,http://apps.humana.com/marketing/documents.asp?file=2323880,66083OH0610012-00,Standard Bronze Off Exchange Plan,,0.601075530052185,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,2,66083,OH,Individual,No,31-1154200,66083OH0610012,Humana Bronze 5750/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342925,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334111,http://apps.humana.com/marketing/documents.asp?file=2323880,66083OH0610012-01,Standard Bronze On Exchange Plan,,0.601075530052185,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,13
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,2,66083,OH,Individual,No,31-1154200,66083OH0610012,Humana Bronze 5750/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342925,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334111,http://apps.humana.com/marketing/documents.asp?file=2323880,66083OH0610012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,2,66083,OH,Individual,No,31-1154200,66083OH0610025,Humana Basic 6600/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342886,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334202,http://apps.humana.com/marketing/documents.asp?file=2323880,66083OH0610025-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,2,66083,OH,Individual,No,31-1154200,66083OH0610026,Humana Bronze 5750/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342925,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334215,http://apps.humana.com/marketing/documents.asp?file=2323880,66083OH0610026-00,Standard Bronze Off Exchange Plan,,0.601075530052185,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,2,66083,OH,Individual,No,31-1154200,66083OH0610026,Humana Bronze 5750/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342925,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334215,http://apps.humana.com/marketing/documents.asp?file=2323880,66083OH0610026-01,Standard Bronze On Exchange Plan,,0.601075530052185,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,2,66083,OH,Individual,No,31-1154200,66083OH0610026,Humana Bronze 5750/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342925,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334215,http://apps.humana.com/marketing/documents.asp?file=2323880,66083OH0610026-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,OH,66083,SERFF,5,2014-09-12 09:45:59,2,66083,OH,Individual,No,31-1154200,66083OH0610026,Humana Bronze 5750/Dayton HMOx,66083OH061,,OHN002,OHS002,OHF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2342925,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2334215,http://apps.humana.com/marketing/documents.asp?file=2323880,66083OH0610026-03,Limited Cost Sharing Plan Variation,,0.601075530052185,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,1,67129,OH,Individual,No,06-6033492,67129OH0100001,Aetna Bronze $20 Copay,67129OH010,,OHN001,OHS001,OHF007,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100001-00,Standard Bronze Off Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,1,67129,OH,Individual,No,06-6033492,67129OH0100001,Aetna Bronze $20 Copay,67129OH010,,OHN001,OHS001,OHF007,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100001-01,Standard Bronze On Exchange Plan,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,1,67129,OH,Individual,No,06-6033492,67129OH0100001,Aetna Bronze $20 Copay,67129OH010,,OHN001,OHS001,OHF007,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,1,67129,OH,Individual,No,06-6033492,67129OH0100001,Aetna Bronze $20 Copay,67129OH010,,OHN001,OHS001,OHF007,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100001-03,Limited Cost Sharing Plan Variation,61.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,3,67129,OH,Individual,No,06-6033492,67129OH0100003,Aetna Bronze Deductible Only HSA,67129OH010,,OHN001,OHS001,OHF008,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100003-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,3,67129,OH,Individual,No,06-6033492,67129OH0100003,Aetna Bronze Deductible Only HSA,67129OH010,,OHN001,OHS001,OHF008,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100003-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,3,67129,OH,Individual,No,06-6033492,67129OH0100003,Aetna Bronze Deductible Only HSA,67129OH010,,OHN001,OHS001,OHF008,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,7,67129,OH,Individual,No,06-6033492,67129OH0100011,Aetna Silver $5 Copay 2750,67129OH010,,OHN001,OHS001,OHF011,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100011-04,73% AV Level Silver Plan,72.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,7,67129,OH,Individual,No,06-6033492,67129OH0100011,Aetna Silver $5 Copay 2750,67129OH010,,OHN001,OHS001,OHF011,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100011-05,87% AV Level Silver Plan,86.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,7,67129,OH,Individual,No,06-6033492,67129OH0100011,Aetna Silver $5 Copay 2750,67129OH010,,OHN001,OHS001,OHF011,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100011-06,94% AV Level Silver Plan,93.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,9,67129,OH,Individual,No,06-6033492,67129OH0100007,Aetna Gold $5 Copay,67129OH010,,OHN001,OHS001,OHF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100007-00,Standard Gold Off Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,9,67129,OH,Individual,No,06-6033492,67129OH0100007,Aetna Gold $5 Copay,67129OH010,,OHN001,OHS001,OHF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100007-01,Standard Gold On Exchange Plan,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,9,67129,OH,Individual,No,06-6033492,67129OH0100007,Aetna Gold $5 Copay,67129OH010,,OHN001,OHS001,OHF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100007-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,OH,67129,SERFF,3,2014-09-11 12:10:19,9,67129,OH,Individual,No,06-6033492,67129OH0100007,Aetna Gold $5 Copay,67129OH010,,OHN001,OHS001,OHF009,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999991090040683,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/ohio-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=1610732201,67129OH0100007-03,Limited Cost Sharing Plan Variation,78.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,OH,68158,SERFF,2,2014-09-09 16:12:42,1,68158,OH,SHOP (Small Group),Yes,13-5123390,68158OH0130002,Guardian Pediatric Advantage,68158OH013,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$22.72,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,68158OH0130002-00,Standard High Off Exchange Plan,83.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,68158,SERFF,2,2014-09-09 16:12:42,1,68158,OH,SHOP (Small Group),Yes,13-5123390,68158OH0140002,Guardian Pediatric Essentials,68158OH014,,OHN001,OHS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$17.32,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,68158OH0140002-00,Standard Low Off Exchange Plan,69.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,68158,SERFF,2,2014-09-09 16:12:42,2,68158,OH,SHOP (Small Group),Yes,13-5123390,68158OH0160002,Guardian Family Advantage,68158OH016,,OHN001,OHS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.72,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,68158OH0160002-00,Standard High Off Exchange Plan,83.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,68158,SERFF,2,2014-09-09 16:12:42,2,68158,OH,SHOP (Small Group),Yes,13-5123390,68158OH0160002,Guardian Family Advantage,68158OH016,,OHN001,OHS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.72,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,68158OH0160002-01,Standard High On Exchange Plan,83.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020066,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS003,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020066-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020066,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS003,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020066-03,Limited Cost Sharing Plan Variation,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,21
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020066,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS003,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020066-04,73% AV Level Silver Plan,74.00%,0.739992797374725,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$300,$0,$150,"$2,420",$0,$0,$80,22
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020066,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS003,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020066-05,87% AV Level Silver Plan,87.90%,0.880107223987579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$0,$100,$80,23
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020066,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS003,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020066-06,94% AV Level Silver Plan,94.22%,0.942208528518677,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$200,$300,$0,$150,$200,$0,$0,$80,24
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020074,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN004,OHS002,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020074-00,Standard Silver Off Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,25
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020074,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN004,OHS002,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020074-01,Standard Silver On Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,26
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020074,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN004,OHS002,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020074-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,27
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,1,74313,OH,Individual,No,01-0580404,74313OH0210001,Paramount Gold 1,74313OH021,,OHN001,OHS001,OHF008,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$100,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,1,74313,OH,Individual,No,01-0580404,74313OH0210001,Paramount Gold 1,74313OH021,,OHN001,OHS001,OHF008,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$100,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210001-03,Limited Cost Sharing Plan Variation,,0.790410816669464,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$40,"$1,010",$150,"$1,000",$480,$10,$80,7
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020040,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS004,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020040-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,$0,$0,$0,$0,,,$0,$0,$0,$0,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020040,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS004,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020040-03,Limited Cost Sharing Plan Variation,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,23
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020044,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS008,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020044-00,Standard Gold Off Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,24
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020044,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS008,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020044-01,Standard Gold On Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,25
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,1,74313,OH,Individual,No,01-0580404,74313OH0210002,Paramount Silver 1,74313OH021,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$200,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210002-00,Standard Silver Off Exchange Plan,,0.689674139022827,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900","$3,800",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$2,030",$150,"$1,900",$790,$20,$80,8
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,1,74313,OH,Individual,No,01-0580404,74313OH0210002,Paramount Silver 1,74313OH021,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$200,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,1,74313,OH,Individual,No,01-0580404,74313OH0210002,Paramount Silver 1,74313OH021,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$200,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210002-03,Limited Cost Sharing Plan Variation,,0.689674139022827,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,900","$3,800",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,900",$90,"$2,030",$150,"$1,900",$790,$20,$80,11
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,1,74313,OH,Individual,No,01-0580404,74313OH0210002,Paramount Silver 1,74313OH021,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$200,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210002-04,73% AV Level Silver Plan,,0.738073885440826,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$80,"$2,030",$150,"$1,000",$960,$20,$80,12
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,1,74313,OH,Individual,No,01-0580404,74313OH0210002,Paramount Silver 1,74313OH021,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$200,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210002-05,87% AV Level Silver Plan,,0.878071844577789,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$500,$30,$510,$150,$500,$470,$10,$80,13
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,1,74313,OH,Individual,No,01-0580404,74313OH0210002,Paramount Silver 1,74313OH021,,OHN001,OHS001,OHF006,Existing,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$200,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210002-06,94% AV Level Silver Plan,,0.947871088981628,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$100,$20,$510,$150,$100,$270,$10,$80,14
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,2,74313,OH,Individual,No,01-0580404,74313OH0210005,Paramount Gold 2,74313OH021,,OHN001,OHS001,OHF007,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$200,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210005-00,Standard Gold Off Exchange Plan,,0.792365372180939,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$30,"$1,010",$150,"$1,500",$300,$10,$80,4
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,2,74313,OH,Individual,No,01-0580404,74313OH0210005,Paramount Gold 2,74313OH021,,OHN001,OHS001,OHF007,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$200,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210005-01,Standard Gold On Exchange Plan,,0.792365372180939,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$30,"$1,010",$150,"$1,500",$300,$10,$80,5
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,2,74313,OH,Individual,No,01-0580404,74313OH0210005,Paramount Gold 2,74313OH021,,OHN001,OHS001,OHF007,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$200,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,2,74313,OH,Individual,No,01-0580404,74313OH0210005,Paramount Gold 2,74313OH021,,OHN001,OHS001,OHF007,New,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$200,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210005-03,Limited Cost Sharing Plan Variation,,0.792365372180939,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$30,"$1,010",$150,"$1,500",$300,$10,$80,7
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,3,74313,OH,Individual,No,01-0580404,74313OH0210006,Paramount Silver 2,74313OH021,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$300,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210006-00,Standard Silver Off Exchange Plan,,0.719305157661438,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,"$2,500",$600,$10,$80,4
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,3,74313,OH,Individual,No,01-0580404,74313OH0210006,Paramount Silver 2,74313OH021,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$300,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210006-01,Standard Silver On Exchange Plan,,0.719305157661438,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,"$2,500",$600,$10,$80,5
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,3,74313,OH,Individual,No,01-0580404,74313OH0210006,Paramount Silver 2,74313OH021,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$300,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,3,74313,OH,Individual,No,01-0580404,74313OH0210006,Paramount Silver 2,74313OH021,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$300,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210006-03,Limited Cost Sharing Plan Variation,,0.719305157661438,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,"$2,500",$600,$10,$80,7
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,3,74313,OH,Individual,No,01-0580404,74313OH0210006,Paramount Silver 2,74313OH021,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$300,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210006-04,73% AV Level Silver Plan,,0.739546775817871,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,000",$70,"$1,520",$150,"$2,000",$670,$10,$80,8
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,3,74313,OH,Individual,No,01-0580404,74313OH0210006,Paramount Silver 2,74313OH021,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$300,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210006-05,87% AV Level Silver Plan,,0.866480708122253,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$750,$30,"$1,010",$150,$750,$450,$10,$80,9
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,3,74313,OH,Individual,No,01-0580404,74313OH0210006,Paramount Silver 2,74313OH021,,OHN001,OHS001,OHF005,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$300,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210006-06,94% AV Level Silver Plan,,0.944276034832001,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$300,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$150,$20,$510,$150,$150,$270,$10,$80,10
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,3,74313,OH,Individual,No,01-0580404,74313OH0210007,Paramount Silver 3,74313OH021,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$300,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210007-00,Standard Silver Off Exchange Plan,,0.719653427600861,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$20,$750,$150,"$3,500",$340,$0,$80,11
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,3,74313,OH,Individual,No,01-0580404,74313OH0210007,Paramount Silver 3,74313OH021,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$300,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210007-01,Standard Silver On Exchange Plan,,0.719653427600861,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$20,$750,$150,"$3,500",$340,$0,$80,12
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,3,74313,OH,Individual,No,01-0580404,74313OH0210007,Paramount Silver 3,74313OH021,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$300,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,3,74313,OH,Individual,No,01-0580404,74313OH0210007,Paramount Silver 3,74313OH021,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$300,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210007-03,Limited Cost Sharing Plan Variation,,0.719653427600861,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$20,$750,$150,"$3,500",$340,$0,$80,14
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,3,74313,OH,Individual,No,01-0580404,74313OH0210007,Paramount Silver 3,74313OH021,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$300,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210007-04,73% AV Level Silver Plan,,0.739738464355469,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,000",$20,$850,$150,"$3,000",$570,$0,$80,15
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,3,74313,OH,Individual,No,01-0580404,74313OH0210007,Paramount Silver 3,74313OH021,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$300,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210007-05,87% AV Level Silver Plan,,0.868826150894165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$900,$40,$510,$150,$900,$450,$0,$80,16
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,3,74313,OH,Individual,No,01-0580404,74313OH0210007,Paramount Silver 3,74313OH021,,OHN001,OHS001,OHF004,New,HMO,Silver,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,$300,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210007-06,94% AV Level Silver Plan,,0.945897221565247,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$800,"$1,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$100,$20,$510,$150,$100,$270,$10,$80,17
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,4,74313,OH,Individual,No,01-0580404,74313OH0210008,Paramount Bronze 1,74313OH021,,OHN001,OHS001,OHF003,New,HMO,Bronze,Yes,Both,Yes,No,,,$0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anyt",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210008-00,Standard Bronze Off Exchange Plan,61.70%,0.62205970287323,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$250,$150,"$5,270",$0,$0,$80,4
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,4,74313,OH,Individual,No,01-0580404,74313OH0210008,Paramount Bronze 1,74313OH021,,OHN001,OHS001,OHF003,New,HMO,Bronze,Yes,Both,Yes,No,,,$0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anyt",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210008-01,Standard Bronze On Exchange Plan,61.70%,0.62205970287323,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$250,$150,"$5,270",$0,$0,$80,5
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,4,74313,OH,Individual,No,01-0580404,74313OH0210008,Paramount Bronze 1,74313OH021,,OHN001,OHS001,OHF003,New,HMO,Bronze,Yes,Both,Yes,No,,,$0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anyt",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210008-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,4,74313,OH,Individual,No,01-0580404,74313OH0210008,Paramount Bronze 1,74313OH021,,OHN001,OHS001,OHF003,New,HMO,Bronze,Yes,Both,Yes,No,,,$0,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anyt",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210008-03,Limited Cost Sharing Plan Variation,61.70%,0.62205970287323,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$250,$150,"$5,270",$0,$0,$80,7
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,5,74313,OH,Individual,No,01-0580404,74313OH0210009,Paramount Bronze 2,74313OH021,,OHN001,OHS001,OHF002,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anyt",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210009-00,Standard Bronze Off Exchange Plan,,0.609567165374756,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$910,$150,"$5,000",$0,$50,$80,4
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,5,74313,OH,Individual,No,01-0580404,74313OH0210009,Paramount Bronze 2,74313OH021,,OHN001,OHS001,OHF002,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anyt",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210009-01,Standard Bronze On Exchange Plan,,0.609567165374756,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$910,$150,"$5,000",$0,$50,$80,5
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,5,74313,OH,Individual,No,01-0580404,74313OH0210009,Paramount Bronze 2,74313OH021,,OHN001,OHS001,OHF002,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anyt",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,5,74313,OH,Individual,No,01-0580404,74313OH0210009,Paramount Bronze 2,74313OH021,,OHN001,OHS001,OHF002,New,HMO,Bronze,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anyt",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210009-03,Limited Cost Sharing Plan Variation,,0.609567165374756,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$0,$910,$150,"$5,000",$0,$50,$80,7
2015,OH,74313,SERFF,3,2014-09-11 12:10:19,6,74313,OH,Individual,No,01-0580404,74313OH0210004,Paramount Catastrophic,74313OH021,,OHN001,OHS001,OHF001,Existing,HMO,Catastrophic,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,0.999,,,0,0,3,2015-01-01,2015-12-31,Yes,"Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.",Yes,Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.,No,www.paramounthealthcare.com/marketplace,www.paramount.softheon.com,www.paramounthealthcare.com/marketplace,http://www.paramounthealthcare.com/Marketplace,74313OH0210004-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$0,$150,"$5,270",$0,$0,$80,4
2015,OH,76018,SERFF,2,2014-09-08 09:42:37,1,76018,OH,SHOP (Small Group),Yes,35-0472300,76018OH0010007,Lincoln Dental Connect?,76018OH001,,OHN001,OHS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.11,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,76018OH0010007-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,OH,76018,SERFF,2,2014-09-08 09:42:37,2,76018,OH,SHOP (Small Group),Yes,35-0472300,76018OH0010004,Lincoln Dental Connect?,76018OH001,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.66,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,76018OH0010004-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,76018,SERFF,2,2014-09-08 09:42:37,2,76018,OH,SHOP (Small Group),Yes,35-0472300,76018OH0010008,Lincoln Dental Connect?,76018OH001,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.91,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,76018OH0010008-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020015,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN002,OHS006,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020015-00,Standard Gold Off Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,4
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020015,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN002,OHS006,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020015-01,Standard Gold On Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,5
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020021,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS003,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020021-01,Standard Gold On Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,13
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020021,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS003,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020021-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,$0,$0,$0,$0,,,$0,$0,$0,$0,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020021,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS003,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020021-03,Limited Cost Sharing Plan Variation,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,15
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020029,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN004,OHS002,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020029-01,Standard Gold On Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,17
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020029,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN004,OHS002,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020029-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,$0,$0,$0,$0,,,$0,$0,$0,$0,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020029,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN004,OHS002,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020029-03,Limited Cost Sharing Plan Variation,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,19
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020040,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS004,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020040-00,Standard Gold Off Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,20
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020040,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS004,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020040-01,Standard Gold On Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,21
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020044,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS008,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020044-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,$0,$0,$0,$0,,,$0,$0,$0,$0,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,26
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,1,77552,OH,Individual,No,31-1143265,77552OH0020044,CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS008,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9306,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020044-03,Limited Cost Sharing Plan Variation,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,27
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020060,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN002,OHS006,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020060-00,Standard Silver Off Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,4
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020060,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN002,OHS006,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020060-01,Standard Silver On Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,5
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020060,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN002,OHS006,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020060-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020060,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN002,OHS006,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020060-03,Limited Cost Sharing Plan Variation,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,7
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020060,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN002,OHS006,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020060-04,73% AV Level Silver Plan,74.00%,0.739992797374725,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$300,$0,$150,"$2,420",$0,$0,$80,8
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020060,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN002,OHS006,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020060-05,87% AV Level Silver Plan,87.90%,0.880107223987579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$0,$100,$80,9
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020060,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN002,OHS006,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020060-06,94% AV Level Silver Plan,94.22%,0.942208528518677,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$200,$300,$0,$150,$200,$0,$0,$80,10
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020064,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS001,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020064-00,Standard Silver Off Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,11
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020064,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS001,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020064-01,Standard Silver On Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,12
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020064,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS001,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020064-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020064,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS001,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020064-03,Limited Cost Sharing Plan Variation,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,14
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020064,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS001,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020064-04,73% AV Level Silver Plan,74.00%,0.739992797374725,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$300,$0,$150,"$2,420",$0,$0,$80,15
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020064,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS001,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020064-05,87% AV Level Silver Plan,87.90%,0.880107223987579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$0,$100,$80,16
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020064,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS001,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020064-06,94% AV Level Silver Plan,94.22%,0.942208528518677,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$200,$300,$0,$150,$200,$0,$0,$80,17
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020085,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS004,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020085-00,Standard Silver Off Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,32
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020085,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS004,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020085-01,Standard Silver On Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,33
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020085,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS004,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020085-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,34
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020085,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS004,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020085-03,Limited Cost Sharing Plan Variation,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,35
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020085,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS004,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020085-04,73% AV Level Silver Plan,74.00%,0.739992797374725,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$300,$0,$150,"$2,420",$0,$0,$80,36
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020085,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS004,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020085-05,87% AV Level Silver Plan,87.90%,0.880107223987579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$0,$100,$80,37
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020085,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS004,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020085-06,94% AV Level Silver Plan,94.22%,0.942208528518677,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$200,$300,$0,$150,$200,$0,$0,$80,38
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020089,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS008,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020089-00,Standard Silver Off Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,39
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020089,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS008,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020089-01,Standard Silver On Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,40
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020089,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS008,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020089-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,41
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020089,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS008,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020089-03,Limited Cost Sharing Plan Variation,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,42
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020089,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS008,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020089-04,73% AV Level Silver Plan,74.00%,0.739992797374725,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$300,$0,$150,"$2,420",$0,$0,$80,43
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020089,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS008,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020089-05,87% AV Level Silver Plan,87.90%,0.880107223987579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$0,$100,$80,44
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020089,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS008,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9155,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020089-06,94% AV Level Silver Plan,94.22%,0.942208528518677,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$200,$300,$0,$150,$200,$0,$0,$80,45
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020105,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN002,OHS006,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020105-00,Standard Bronze Off Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,46
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020105,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN002,OHS006,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020105-01,Standard Bronze On Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,47
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020105,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN002,OHS006,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020105-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,48
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020105,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN002,OHS006,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020105-03,Limited Cost Sharing Plan Variation,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,49
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020109,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS001,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020109-00,Standard Bronze Off Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,50
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020109,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS001,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020109-01,Standard Bronze On Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,51
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020109,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS001,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020109-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,52
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020109,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS001,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020109-03,Limited Cost Sharing Plan Variation,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,53
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020111,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS003,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020111-00,Standard Bronze Off Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,54
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020111,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS003,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020111-01,Standard Bronze On Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,55
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020111,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS003,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020111-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,56
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020111,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN003,OHS003,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020111-03,Limited Cost Sharing Plan Variation,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,57
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020119,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN004,OHS002,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020119-00,Standard Bronze Off Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,58
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020119,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN004,OHS002,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020119-01,Standard Bronze On Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,59
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020119,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN004,OHS002,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020119-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,60
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020119,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN004,OHS002,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020119-03,Limited Cost Sharing Plan Variation,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,61
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020130,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS004,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020130-00,Standard Bronze Off Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,62
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020130,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS004,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020130-01,Standard Bronze On Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,63
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020130,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS004,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020130-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,64
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020130,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS004,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020130-03,Limited Cost Sharing Plan Variation,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,65
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020134,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS008,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020134-00,Standard Bronze Off Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,66
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020134,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS008,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020134-01,Standard Bronze On Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,67
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020134,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS008,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020134-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,68
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,2,77552,OH,Individual,No,31-1143265,77552OH0020134,CareSource Just4Me  Dental and Vision! Healthcare with Heart,77552OH002,,OHN005,OHS008,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.8966,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0020134-03,Limited Cost Sharing Plan Variation,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,69
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010060,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN002,OHS006,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010060-00,Standard Silver Off Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,4
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010060,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN002,OHS006,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010060-01,Standard Silver On Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,5
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010060,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN002,OHS006,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010060-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010060,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN002,OHS006,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010060-03,Limited Cost Sharing Plan Variation,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,7
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010060,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN002,OHS006,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010060-04,73% AV Level Silver Plan,74.00%,0.739992797374725,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$300,$0,$150,"$2,420",$0,$0,$80,8
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010060,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN002,OHS006,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010060-05,87% AV Level Silver Plan,87.90%,0.880107223987579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$0,$100,$80,9
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010060,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN002,OHS006,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010060-06,94% AV Level Silver Plan,94.22%,0.942208528518677,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$200,$300,$0,$150,$200,$0,$0,$80,10
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010064,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN003,OHS001,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010064-00,Standard Silver Off Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,11
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010064,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN003,OHS001,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010064-01,Standard Silver On Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,12
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010064,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN003,OHS001,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010064-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010064,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN003,OHS001,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010064-03,Limited Cost Sharing Plan Variation,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,14
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010064,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN003,OHS001,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010064-04,73% AV Level Silver Plan,74.00%,0.739992797374725,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$300,$0,$150,"$2,420",$0,$0,$80,15
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010064,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN003,OHS001,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010064-05,87% AV Level Silver Plan,87.90%,0.880107223987579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$0,$100,$80,16
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010064,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN003,OHS001,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010064-06,94% AV Level Silver Plan,94.22%,0.942208528518677,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$200,$300,$0,$150,$200,$0,$0,$80,17
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010066,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN003,OHS003,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010066-00,Standard Silver Off Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,18
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010066,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN003,OHS003,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010066-01,Standard Silver On Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,19
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010066,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN003,OHS003,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010066-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010066,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN003,OHS003,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010066-03,Limited Cost Sharing Plan Variation,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,21
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010066,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN003,OHS003,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010066-04,73% AV Level Silver Plan,74.00%,0.739992797374725,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$300,$0,$150,"$2,420",$0,$0,$80,22
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010066,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN003,OHS003,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010066-05,87% AV Level Silver Plan,87.90%,0.880107223987579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$0,$100,$80,23
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010066,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN003,OHS003,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010066-06,94% AV Level Silver Plan,94.22%,0.942208528518677,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$200,$300,$0,$150,$200,$0,$0,$80,24
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010074,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN004,OHS002,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010074-00,Standard Silver Off Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,25
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010074,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN004,OHS002,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010074-01,Standard Silver On Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,26
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010074,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN004,OHS002,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010074-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,27
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010074,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN004,OHS002,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010074-03,Limited Cost Sharing Plan Variation,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,28
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010074,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN004,OHS002,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010074-04,73% AV Level Silver Plan,74.00%,0.739992797374725,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$300,$0,$150,"$2,420",$0,$0,$80,29
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010074,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN004,OHS002,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010074-05,87% AV Level Silver Plan,87.90%,0.880107223987579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$0,$100,$80,30
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010074,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN004,OHS002,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010074-06,94% AV Level Silver Plan,94.22%,0.942208528518677,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$200,$300,$0,$150,$200,$0,$0,$80,31
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010085,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN005,OHS004,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010085-00,Standard Silver Off Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,32
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010085,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN005,OHS004,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010085-01,Standard Silver On Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,33
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010085,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN005,OHS004,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010085-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,34
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010085,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN005,OHS004,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010085-03,Limited Cost Sharing Plan Variation,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,35
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010085,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN005,OHS004,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010085-04,73% AV Level Silver Plan,74.00%,0.739992797374725,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$300,$0,$150,"$2,420",$0,$0,$80,36
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010085,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN005,OHS004,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010085-05,87% AV Level Silver Plan,87.90%,0.880107223987579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$0,$100,$80,37
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010085,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN005,OHS004,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010085-06,94% AV Level Silver Plan,94.22%,0.942208528518677,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$200,$300,$0,$150,$200,$0,$0,$80,38
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010089,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN005,OHS008,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010089-00,Standard Silver Off Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,39
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010089,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN005,OHS008,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010089-01,Standard Silver On Exchange Plan,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,40
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010089,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN005,OHS008,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010089-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,41
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010089,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN005,OHS008,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010089-03,Limited Cost Sharing Plan Variation,70.11%,0.701068639755249,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$500,$0,$150,"$2,420",$0,$0,$80,42
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010089,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN005,OHS008,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010089-04,73% AV Level Silver Plan,74.00%,0.739992797374725,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$3,500",$300,$0,$150,"$2,420",$0,$0,$80,43
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010089,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN005,OHS008,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010089-05,87% AV Level Silver Plan,87.90%,0.880107223987579,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$0,$100,$80,44
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010089,CareSource Just4Me  Healthcare with Heart,77552OH001,,OHN005,OHS008,OHF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010089-06,94% AV Level Silver Plan,94.22%,0.942208528518677,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$200,$400,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$200,$300,$0,$150,$200,$0,$0,$80,45
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010105,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN002,OHS006,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010105-00,Standard Bronze Off Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,46
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010105,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN002,OHS006,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010105-01,Standard Bronze On Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,47
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010105,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN002,OHS006,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010105-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,48
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010105,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN002,OHS006,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010105-03,Limited Cost Sharing Plan Variation,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,49
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010109,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN003,OHS001,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010109-00,Standard Bronze Off Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,50
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010109,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN003,OHS001,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010109-01,Standard Bronze On Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,51
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010109,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN003,OHS001,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010109-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,52
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010109,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN003,OHS001,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010109-03,Limited Cost Sharing Plan Variation,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,53
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010111,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN003,OHS003,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010111-00,Standard Bronze Off Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,54
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010111,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN003,OHS003,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010111-01,Standard Bronze On Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,55
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010111,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN003,OHS003,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010111-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,56
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010111,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN003,OHS003,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010111-03,Limited Cost Sharing Plan Variation,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,57
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010119,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN004,OHS002,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010119-00,Standard Bronze Off Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,58
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010119,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN004,OHS002,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010119-01,Standard Bronze On Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,59
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010119,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN004,OHS002,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010119-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,60
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010119,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN004,OHS002,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010119-03,Limited Cost Sharing Plan Variation,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,61
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010130,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN005,OHS004,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010130-00,Standard Bronze Off Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,62
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010130,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN005,OHS004,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010130-01,Standard Bronze On Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,63
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010130,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN005,OHS004,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010130-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,64
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010130,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN005,OHS004,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010130-03,Limited Cost Sharing Plan Variation,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,65
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010134,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN005,OHS008,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010134-00,Standard Bronze Off Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,66
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010134,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN005,OHS008,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010134-01,Standard Bronze On Exchange Plan,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,67
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010134,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN005,OHS008,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010134-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,68
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,3,77552,OH,Individual,No,31-1143265,77552OH0010134,CareSource Just4Me Healthcare with Heart,77552OH001,,OHN005,OHS008,OHF001,Existing,HMO,Bronze,Yes,Both,Yes,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010134-03,Limited Cost Sharing Plan Variation,60.90%,0,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600","$13,200",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$6,600",$0,$0,$150,"$2,420",$0,$0,$80,69
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010015,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN002,OHS006,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010015-00,Standard Gold Off Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,4
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010015,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN002,OHS006,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010015-01,Standard Gold On Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,5
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010015,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN002,OHS006,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010015-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,$0,$0,$0,$0,,,$0,$0,$0,$0,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010015,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN002,OHS006,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010015-03,Limited Cost Sharing Plan Variation,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,7
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010019,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN003,OHS001,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010019-00,Standard Gold Off Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,8
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010019,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN003,OHS001,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010019-01,Standard Gold On Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,9
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010019,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN003,OHS001,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010019-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,$0,$0,$0,$0,,,$0,$0,$0,$0,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010019,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN003,OHS001,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010019-03,Limited Cost Sharing Plan Variation,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,11
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010021,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN003,OHS003,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010021-00,Standard Gold Off Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,12
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010021,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN003,OHS003,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010021-01,Standard Gold On Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,13
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010021,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN003,OHS003,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010021-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,$0,$0,$0,$0,,,$0,$0,$0,$0,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010021,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN003,OHS003,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010021-03,Limited Cost Sharing Plan Variation,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,15
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010029,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN004,OHS002,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010029-00,Standard Gold Off Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,16
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010029,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN004,OHS002,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010029-01,Standard Gold On Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,17
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010029,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN004,OHS002,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010029-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,$0,$0,$0,$0,,,$0,$0,$0,$0,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010029,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN004,OHS002,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010029-03,Limited Cost Sharing Plan Variation,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,19
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010040,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN005,OHS004,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010040-00,Standard Gold Off Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,20
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010040,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN005,OHS004,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010040-01,Standard Gold On Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,21
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010040,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN005,OHS004,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010040-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,$0,$0,$0,$0,,,$0,$0,$0,$0,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010040,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN005,OHS004,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010040-03,Limited Cost Sharing Plan Variation,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,23
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010044,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN005,OHS008,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010044-00,Standard Gold Off Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,24
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010044,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN005,OHS008,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010044-01,Standard Gold On Exchange Plan,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,25
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010044,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN005,OHS008,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010044-02,Zero Cost Sharing Plan Variation,,1,No,No,No,100%,,$0,$0,,,$0,$0,$0,$0,$0,$0,,,$0,$0,$0,$0,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,26
2015,OH,77552,SERFF,3,2014-11-15 10:06:04,4,77552,OH,Individual,No,31-1143265,77552OH0010044,CareSource Just4Me Ultra Healthcare with Heart,77552OH001,,OHN005,OHS008,OHF001,Existing,HMO,Gold,No,Both,Yes,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$300,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,www.caresource.com/just4me/oh/resources/plan-documents/,www.CareSource.com/Just4Me/enroll,www.caresource.com/documents/just4me-solicitation-document/oh,www.caresource.com/just4me/meds,77552OH0010044-03,Limited Cost Sharing Plan Variation,,0.815194547176361,No,No,No,100%,,"$1,750","$3,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$300,$60,$150,"$1,000",$250,$100,$80,27
2015,OH,79539,SERFF,4,2014-09-11 12:10:19,1,79539,OH,SHOP (Small Group),Yes,47-0098400,79539OH0040002,EHB High PPO,79539OH004,,OHN001,OHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.93,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,79539OH0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,79539,SERFF,4,2014-09-11 12:10:19,1,79539,OH,SHOP (Small Group),Yes,47-0098400,79539OH0040001,EHB Low PPO,79539OH004,,OHN001,OHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.32,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,79539OH0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,79539,SERFF,4,2014-09-11 12:10:19,1,79539,OH,SHOP (Small Group),Yes,47-0098400,79539OH0030002,EHB High Passive,79539OH003,,OHN001,OHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$40.21,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,79539OH0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,89819,SERFF,4,2015-01-23 12:43:55,1,89819,OH,SHOP (Small Group),Yes,36-3757528,89819OH0040001,TruAssure Dental Small Group Preferred Plan,89819OH004,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.74,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=OH,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=OH,,89819OH0040001-00,Standard High Off Exchange Plan,83.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,89819,SERFF,4,2015-01-23 12:43:55,2,89819,OH,Individual,Yes,36-3757528,89819OH0020001,TruAssure Dental Preferred Plan,89819OH002,,OHN001,OHS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.78,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=OH,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=OH,,89819OH0020001-00,Standard High Off Exchange Plan,83.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$30,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,89819,SERFF,4,2015-01-23 12:43:55,2,89819,OH,Individual,Yes,36-3757528,89819OH0020001,TruAssure Dental Preferred Plan,89819OH002,,OHN001,OHS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.78,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=OH,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=OH,,89819OH0020001-01,Standard High On Exchange Plan,83.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$30,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,91261,SERFF,2,2014-09-09 16:12:42,1,91261,OH,SHOP (Small Group),Yes,57-0523959,91261OH0010001,Group Pediatric Dental EHB,91261OH001,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$38.27,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,91261OH0010001-00,Standard High Off Exchange Plan,83.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,91261,SERFF,2,2014-09-09 16:12:42,1,91261,OH,SHOP (Small Group),Yes,57-0523959,91261OH0010002,Group Pediatric Dental EHB,91261OH001,,OHN001,OHS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$32.55,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,91261OH0010002-00,Standard Low Off Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,1,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540003,HealthSpan Gold 250-70,92036OH054,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540003-00,Standard Gold Off Exchange Plan,79.90%,0.797928094863892,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250.00,$15.00,"$2,100.00",$0.00,$100.00,$760.00,$0.00,$0.00,4
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,1,92036,OH,Individual,No,31-1431434,92036OH0530001,HealthSpanOne Gold 250-70,92036OH053,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530001-00,Standard Gold Off Exchange Plan,79.90%,0.797928094863892,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$15,"$2,100",$0,$100,$900,$0,$0,4
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,1,92036,OH,Individual,No,31-1431434,92036OH0530001,HealthSpanOne Gold 250-70,92036OH053,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530001-01,Standard Gold On Exchange Plan,79.90%,0.797928094863892,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$15,"$2,100",$0,$100,$900,$0,$0,5
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,1,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540003,HealthSpan Gold 250-70,92036OH054,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540003-01,Standard Gold On Exchange Plan,79.90%,0.797928094863892,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250.00,$15.00,"$2,100.00",$0.00,$100.00,$760.00,$0.00,$0.00,5
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,1,92036,OH,Individual,No,31-1431434,92036OH0530001,HealthSpanOne Gold 250-70,92036OH053,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,1,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540004,HealthSpan Gold 500-80,92036OH054,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540004-00,Standard Gold Off Exchange Plan,81.60%,0.815024197101593,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500.00,$15.00,"$1,350.00",$0.00,$100.00,$775.00,$0.00,$0.00,6
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,1,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540004,HealthSpan Gold 500-80,92036OH054,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540004-01,Standard Gold On Exchange Plan,81.60%,0.815024197101593,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500.00,$15.00,"$1,350.00",$0.00,$100.00,$775.00,$0.00,$0.00,7
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,1,92036,OH,Individual,No,31-1431434,92036OH0530001,HealthSpanOne Gold 250-70,92036OH053,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530001-03,Limited Cost Sharing Plan Variation,79.90%,0.797928094863892,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$15,"$2,100",$0,$100,$900,$0,$0,7
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,1,92036,OH,Individual,No,31-1431434,92036OH0530002,HealthSpanOne Gold 1000-80,92036OH053,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530002-00,Standard Gold Off Exchange Plan,78.90%,0.805820167064667,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$15,"$1,250",$0,$100,$900,$0,$0,8
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,1,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540005,HealthSpan Gold 1000-80,92036OH054,,OHN001,OHS001,OHF002,Existing,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540005-00,Standard Gold Off Exchange Plan,80.70%,0.805820167064667,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000.00",$15.00,"$1,250.00",$0.00,$100.00,$760.00,$0.00,$0.00,8
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,Individual,No,31-1431434,92036OH0530004,HealthSpanOne Silver 1500-70 HSA,92036OH053,,OHN001,OHS001,OHF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540011,HealthSpan Silver 3000 HSA,92036OH054,,OHN001,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540011-00,Standard Silver Off Exchange Plan,71.70%,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000.00",$0.00,$0.00,$0.00,"$3,000.00",$0.00,$0.00,$0.00,6
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540011,HealthSpan Silver 3000 HSA,92036OH054,,OHN001,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540011-01,Standard Silver On Exchange Plan,71.70%,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000.00",$0.00,$0.00,$0.00,"$3,000.00",$0.00,$0.00,$0.00,7
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,Individual,No,31-1431434,92036OH0530004,HealthSpanOne Silver 1500-70 HSA,92036OH053,,OHN001,OHS001,OHF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530004-03,Limited Cost Sharing Plan Variation,70.10%,0.70112931728363,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,"$1,750",$0,"$1,500",$0,"$1,150",$0,7
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,1,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540005,HealthSpan Gold 1000-80,92036OH054,,OHN001,OHS001,OHF002,Existing,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540005-01,Standard Gold On Exchange Plan,80.70%,0.805820167064667,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000.00",$15.00,"$1,250.00",$0.00,$100.00,$760.00,$0.00,$0.00,9
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,1,92036,OH,Individual,No,31-1431434,92036OH0530002,HealthSpanOne Gold 1000-80,92036OH053,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530002-01,Standard Gold On Exchange Plan,78.90%,0.805820167064667,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$15,"$1,250",$0,$100,$900,$0,$0,9
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,1,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540006,HealthSpan Gold 1500-80,92036OH054,,OHN001,OHS001,OHF002,Existing,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540006-01,Standard Gold On Exchange Plan,80.30%,0.802451968193054,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500.00",$15.00,"$1,150.00",$0.00,$100.00,$760.00,$0.00,$0.00,11
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,1,92036,OH,Individual,No,31-1431434,92036OH0530002,HealthSpanOne Gold 1000-80,92036OH053,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530002-03,Limited Cost Sharing Plan Variation,78.90%,0.805820167064667,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$15,"$1,250",$0,$100,$900,$0,$0,11
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,1,92036,OH,Individual,No,31-1431434,92036OH0530003,HealthSpanOne Gold 2000-100,92036OH053,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530003-00,Standard Gold Off Exchange Plan,79.60%,0.794934391975403,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$15,$0,$0,$100,$900,$0,$0,12
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,1,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540007,HealthSpan Gold 2000-100,92036OH054,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540007-00,Standard Gold Off Exchange Plan,79.60%,0.79167252779007,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000.00",$15.00,$0.00,$0.00,$100.00,$760.00,$0.00,$0.00,12
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,1,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540007,HealthSpan Gold 2000-100,92036OH054,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540007-01,Standard Gold On Exchange Plan,79.60%,0.79167252779007,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000.00",$15.00,$0.00,$0.00,$100.00,$760.00,$0.00,$0.00,13
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,1,92036,OH,Individual,No,31-1431434,92036OH0530003,HealthSpanOne Gold 2000-100,92036OH053,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530003-01,Standard Gold On Exchange Plan,79.60%,0.794934391975403,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$15,$0,$0,$100,$900,$0,$0,13
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,1,92036,OH,Individual,No,31-1431434,92036OH0530003,HealthSpanOne Gold 2000-100,92036OH053,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,1,92036,OH,Individual,No,31-1431434,92036OH0530003,HealthSpanOne Gold 2000-100,92036OH053,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530003-03,Limited Cost Sharing Plan Variation,79.60%,0.794934391975403,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$15,$0,$0,$100,$900,$0,$0,15
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,Individual,No,31-1431434,92036OH0530004,HealthSpanOne Silver 1500-70 HSA,92036OH053,,OHN001,OHS001,OHF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530004-00,Standard Silver Off Exchange Plan,70.10%,0.70112931728363,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,"$1,750",$0,"$1,500",$0,"$1,150",$0,4
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540008,HealthSpan Silver 1500-70 HSA,92036OH054,,OHN001,OHS001,OHF003,Existing,HMO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540008-00,Standard Silver Off Exchange Plan,70.10%,0.70112931728363,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500.00",$0.00,"$1,750.00",$0.00,"$3,000.00",$0.00,$700.00,$0.00,4
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540008,HealthSpan Silver 1500-70 HSA,92036OH054,,OHN001,OHS001,OHF003,Existing,HMO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540008-01,Standard Silver On Exchange Plan,70.10%,0.70112931728363,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500.00",$0.00,"$1,750.00",$0.00,"$3,000.00",$0.00,$700.00,$0.00,5
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,Individual,No,31-1431434,92036OH0530004,HealthSpanOne Silver 1500-70 HSA,92036OH053,,OHN001,OHS001,OHF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530004-01,Standard Silver On Exchange Plan,70.10%,0.70112931728363,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,"$1,750",$0,"$1,500",$0,"$1,150",$0,5
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,1,92036,OH,Individual,No,31-1431434,92036OH0530002,HealthSpanOne Gold 1000-80,92036OH053,,OHN001,OHS001,OHF002,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,1,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540006,HealthSpan Gold 1500-80,92036OH054,,OHN001,OHS001,OHF002,Existing,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540006-00,Standard Gold Off Exchange Plan,80.30%,0.802451968193054,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500.00",$15.00,"$1,150.00",$0.00,$100.00,$760.00,$0.00,$0.00,10
2015,OH,79539,SERFF,4,2014-09-11 12:10:19,1,79539,OH,SHOP (Small Group),Yes,47-0098400,79539OH0030001,EHB Low Passive,79539OH003,,OHN001,OHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.99,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,79539OH0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,1,80627,OH,Individual,Yes,34-0648820,80627OH0140005,Pediatric Dental,80627OH014,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$31.17,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0140005-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,1,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150015,Pediatric Dental - Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.65,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150015-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,1,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150032,Pediatric Dental - Non-Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$27.14,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150032-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,2,80627,OH,Individual,Yes,34-0648820,80627OH0140006,Dental Plan 1,80627OH014,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.17,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0140006-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,2,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150017,Dental Plan 3 - Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.65,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150017-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,2,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150018,Dental Plan 3 (Voluntary) - Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.65,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150018-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,2,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150021,Dental Plan 5 - Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.65,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150021-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,2,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150034,Dental Plan 3 - Non-Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.14,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150034-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,2,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150035,Dental Plan 3 (Voluntary) - Non-Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.14,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150035-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,2,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150038,Dental Plan 5 - Non-Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.14,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150038-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,3,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150019,Dental Plan 4 - Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.65,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150019-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,3,80627,OH,Individual,Yes,34-0648820,80627OH0140007,Dental Plan 2,80627OH014,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.17,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0140007-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,3,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150022,Dental Plan 6 - Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.65,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150022-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,3,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150024,Dental Plan 6 (Voluntary) - Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.65,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150024-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,3,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150025,Dental Plan 7 - Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.65,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150025-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,3,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150027,Dental Plan 7 (Voluntary) - Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.65,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150027-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,3,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150028,Dental Plan 8 - Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.65,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150028-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,3,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150030,Dental Plan 9 - Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.65,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150030-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,3,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150036,Dental Plan 4 - Non-Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.14,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150036-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,3,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150039,Dental Plan 6 - Non-Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.14,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150039-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,3,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150041,Dental Plan 6 (Voluntary) - Non-Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.14,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150041-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,13
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,3,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150042,Dental Plan 7 - Non-Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.14,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150042-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,14
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,3,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150044,Dental Plan 7 (Voluntary) - Non-Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.14,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150044-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,15
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,3,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150045,Dental Plan 8 - Non-Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.14,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150045-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,16
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,3,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150047,Dental Plan 9 - Non-Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.14,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150047-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,17
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,4,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150020,Dental Plan 4 with Ortho Rider - Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.65,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150020-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,4,80627,OH,Individual,Yes,34-0648820,80627OH0140008,Dental Plan 3,80627OH014,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.17,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0140008-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,4,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150023,Dental Plan 6 with Ortho Rider - Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.65,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150023-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,4,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150026,Dental Plan 7 with Ortho Rider - Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.65,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150026-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,4,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150029,Dental Plan 8 with Ortho Rider - Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.65,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150029-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,4,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150031,Dental Plan 9 with Ortho Rider - Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.65,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150031-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,4,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150037,Dental Plan 4 with Ortho Rider - Non-Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.14,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150037-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,4,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150040,Dental Plan 6 with Ortho Rider - Non-Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.14,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150040-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,4,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150043,Dental Plan 7 with Ortho Rider - Non-Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.14,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150043-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,4,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150046,Dental Plan 8 with Ortho Rider - Non-Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.14,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150046-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,OH,80627,SERFF,3,2014-09-11 12:10:19,4,80627,OH,SHOP (Small Group),Yes,34-0648820,80627OH0150048,Dental Plan 9 with Ortho Rider - Non-Alliance,80627OH015,,OHN001,OHS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.14,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,80627OH0150048-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,13
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,1,86728,OH,Individual,Yes,31-0685339,86728OH0260001,"Delta Dental Individual PPO, EHB Certified",86728OH026,,OHN001,OHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.01,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0260001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,$50,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,1,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0290001,"Delta Dental Group PPO, EHB Certified",86728OH029,,OHN001,OHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.37,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0290001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,1,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0290002,"Delta Dental Group PPO, EHB Certified",86728OH029,,OHN001,OHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.60,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0290002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,1,86728,OH,Individual,Yes,31-0685339,86728OH0260002,"Delta Dental Individual PPO, EHB Certified",86728OH026,,OHN001,OHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.87,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0260002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,$50,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,1,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0290003,"Delta Dental Group PPO, EHB Certified",86728OH029,,OHN001,OHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.37,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0290003-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,1,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0290004,"Delta Dental Group PPO, EHB Certified",86728OH029,,OHN001,OHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.60,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0290004-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,1,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0290005,"Delta Dental Group PPO, EHB Certified",86728OH029,,OHN001,OHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.37,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0290005-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,1,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0290006,"Delta Dental Group PPO, EHB Certified",86728OH029,,OHN001,OHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.60,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0290006-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,1,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0290007,"Delta Dental Group PPO, EHB Certified",86728OH029,,OHN001,OHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.37,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0290007-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,1,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0290008,"Delta Dental Group PPO, EHB Certified",86728OH029,,OHN001,OHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.60,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0290008-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,1,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0320001,"Delta Dental Group PPO Network Only, EHB Certified",86728OH032,,OHN002,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.10,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0320001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,1,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0320002,"Delta Dental Group PPO Network Only, EHB Certified",86728OH032,,OHN002,OHS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.67,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0320002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,13
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,1,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0320003,"Delta Dental Group PPO Network Only, EHB Certified",86728OH032,,OHN002,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.10,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0320003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,14
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,1,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0320004,"Delta Dental Group PPO Network Only, EHB Certified",86728OH032,,OHN002,OHS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.67,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0320004-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,15
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,1,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0320005,"Delta Dental Group PPO Network Only, EHB Certified",86728OH032,,OHN002,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.10,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0320005-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,16
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,1,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0320006,"Delta Dental Group PPO Network Only, EHB Certified",86728OH032,,OHN002,OHS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.67,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0320006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,17
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,1,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0320007,"Delta Dental Group PPO Network Only, EHB Certified",86728OH032,,OHN002,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.10,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0320007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,18
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,1,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0320008,"Delta Dental Group PPO Network Only, EHB Certified",86728OH032,,OHN002,OHS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.67,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0320008-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,19
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,2,86728,OH,Individual,Yes,31-0685339,86728OH0310001,"Delta Dental Individual Pediatric-Only PPO, EHB Certified",86728OH031,,OHN001,OHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$32.01,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0310001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,$50,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,2,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0300001,"Delta Dental Group Pediatric-Only, EHB Certified",86728OH030,,OHN001,OHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$30.37,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0300001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,2,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0300002,"Delta Dental Group Pediatric-Only, EHB Certified",86728OH030,,OHN001,OHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.60,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0300002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,2,86728,OH,Individual,Yes,31-0685339,86728OH0310002,"Delta Dental Individual Pediatric-Only PPO, EHB Certified",86728OH031,,OHN001,OHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$27.07,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0310002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,$50,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,2,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0300003,"Delta Dental Group Pediatric-Only, EHB Certified",86728OH030,,OHN001,OHS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$30.37,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0300003-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,2,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0300004,"Delta Dental Group Pediatric-Only, EHB Certified",86728OH030,,OHN001,OHS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$25.60,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0300004-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,2,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0330001,"Delta Dental Group Pediatric Only PPO Network Only, EHB Certified",86728OH033,,OHN002,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$29.10,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0330001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,2,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0330002,"Delta Dental Group Pediatric Only PPO Network Only, EHB Certified",86728OH033,,OHN002,OHS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.67,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0330002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,2,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0330003,"Delta Dental Group Pediatric Only PPO Network Only, EHB Certified",86728OH033,,OHN002,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$29.10,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0330003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,OH,86728,SERFF,4,2014-09-11 12:10:19,2,86728,OH,SHOP (Small Group),Yes,31-0685339,86728OH0330004,"Delta Dental Group Pediatric Only PPO Network Only, EHB Certified",86728OH033,,OHN002,OHS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.67,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,86728OH0330004-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,OH,89819,SERFF,4,2015-01-23 12:43:55,1,89819,OH,SHOP (Small Group),Yes,36-3757528,89819OH0030001,TruAssure Dental Small Group Basic Plan,89819OH003,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.74,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=OH,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=OH,,89819OH0030001-00,Standard High Off Exchange Plan,83.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,89819,SERFF,4,2015-01-23 12:43:55,1,89819,OH,Individual,Yes,36-3757528,89819OH0010001,TruAssure Dental Basic Plan,89819OH001,,OHN001,OHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.54,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=OH,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=OH,,89819OH0010001-00,Standard Low Off Exchange Plan,68.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,89819,SERFF,4,2015-01-23 12:43:55,1,89819,OH,Individual,Yes,36-3757528,89819OH0010001,TruAssure Dental Basic Plan,89819OH001,,OHN001,OHS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.54,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,All Covered Benefits,Yes,https://www.truassure.com/plan-information2?state=OH,https://www.truassure.com/payment,https://www.truassure.com/brochure?state=OH,,89819OH0010001-01,Standard Low On Exchange Plan,68.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,Individual,No,31-1431434,92036OH0530004,HealthSpanOne Silver 1500-70 HSA,92036OH053,,OHN001,OHS001,OHF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530004-04,73% AV Level Silver Plan,73.30%,0.733255684375763,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300",$0,"$1,800",$0,"$1,300",$0,"$1,200",$0,8
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540012,HealthSpan Bronze 4000-70 HSA,92036OH054,,OHN001,OHS001,OHF003,Existing,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540012-00,Standard Bronze Off Exchange Plan,60.30%,0.602802217006683,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000.00",$0.00,"$1,000.00",$0.00,$400.00,$0.00,$370.00,$0.00,8
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540012,HealthSpan Bronze 4000-70 HSA,92036OH054,,OHN001,OHS001,OHF003,Existing,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540012-01,Standard Bronze On Exchange Plan,60.30%,0.602802217006683,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000.00",$0.00,"$1,000.00",$0.00,$400.00,$0.00,$370.00,$0.00,9
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,Individual,No,31-1431434,92036OH0530004,HealthSpanOne Silver 1500-70 HSA,92036OH053,,OHN001,OHS001,OHF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530004-05,87% AV Level Silver Plan,86.80%,0.86842954158783,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$0,"$1,400",$0,$250,$0,"$1,425",$0,9
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,Individual,No,31-1431434,92036OH0530004,HealthSpanOne Silver 1500-70 HSA,92036OH053,,OHN001,OHS001,OHF003,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530004-06,94% AV Level Silver Plan,93.60%,0.930346608161926,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$730,$0,$0,$0,"$1,415",$0,10
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540014,HealthSpan Bronze 6000 HSA,92036OH054,,OHN001,OHS001,OHF005,Existing,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540014-00,Standard Bronze Off Exchange Plan,59.20%,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000.00",$0.00,$0.00,$0.00,"$5,325.00",$0.00,$0.00,$0.00,10
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540014,HealthSpan Bronze 6000 HSA,92036OH054,,OHN001,OHS001,OHF005,Existing,HMO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540014-01,Standard Bronze On Exchange Plan,59.20%,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000.00",$0.00,$0.00,$0.00,"$5,325.00",$0.00,$0.00,$0.00,11
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,Individual,No,31-1431434,92036OH0530007,HealthSpanOne Silver 3000 HSA,92036OH053,,OHN001,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530007-00,Standard Silver Off Exchange Plan,71.70%,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$0,$0,$0,"$3,000",$0,$0,$0,11
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,Individual,No,31-1431434,92036OH0530007,HealthSpanOne Silver 3000 HSA,92036OH053,,OHN001,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530007-01,Standard Silver On Exchange Plan,71.70%,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$0,$0,$0,"$3,000",$0,$0,$0,12
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,Individual,No,31-1431434,92036OH0530007,HealthSpanOne Silver 3000 HSA,92036OH053,,OHN001,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530007-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,Individual,No,31-1431434,92036OH0530007,HealthSpanOne Silver 3000 HSA,92036OH053,,OHN001,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530007-03,Limited Cost Sharing Plan Variation,71.70%,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$0,$0,$0,"$3,000",$0,$0,$0,14
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,Individual,No,31-1431434,92036OH0530007,HealthSpanOne Silver 3000 HSA,92036OH053,,OHN001,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530007-04,73% AV Level Silver Plan,73.90%,0.738942980766296,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,650","$5,300",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,750",$15,$0,$0,"$2,750",$975,$0,$0,15
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,Individual,No,31-1431434,92036OH0530007,HealthSpanOne Silver 3000 HSA,92036OH053,,OHN001,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530007-05,87% AV Level Silver Plan,87.70%,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$0,"$1,000",$0,$0,$0,16
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,Individual,No,31-1431434,92036OH0530007,HealthSpanOne Silver 3000 HSA,92036OH053,,OHN001,OHS001,OHF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530007-06,94% AV Level Silver Plan,93.30%,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$0,$500,$0,$0,$0,17
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,Individual,No,31-1431434,92036OH0530008,HealthSpanOne Bronze 4000-70 HSA,92036OH053,,OHN001,OHS001,OHF003,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530008-00,Standard Bronze Off Exchange Plan,60.30%,0.602802217006683,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,"$1,000",$0,"$4,000",$0,$400,$0,18
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,Individual,No,31-1431434,92036OH0530008,HealthSpanOne Bronze 4000-70 HSA,92036OH053,,OHN001,OHS001,OHF003,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530008-01,Standard Bronze On Exchange Plan,60.30%,0.602802217006683,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,"$1,000",$0,"$4,000",$0,$400,$0,19
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,Individual,No,31-1431434,92036OH0530008,HealthSpanOne Bronze 4000-70 HSA,92036OH053,,OHN001,OHS001,OHF003,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530008-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,Individual,No,31-1431434,92036OH0530008,HealthSpanOne Bronze 4000-70 HSA,92036OH053,,OHN001,OHS001,OHF003,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530008-03,Limited Cost Sharing Plan Variation,60.30%,0.602802217006683,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,"$1,000",$0,"$4,000",$0,$400,$0,21
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,Individual,No,31-1431434,92036OH0530010,HealthSpanOne Bronze 6000 HSA,92036OH053,,OHN001,OHS001,OHF005,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530010-00,Standard Bronze Off Exchange Plan,59.20%,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$0,$0,"$53,250",$0,$0,$0,22
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,Individual,No,31-1431434,92036OH0530010,HealthSpanOne Bronze 6000 HSA,92036OH053,,OHN001,OHS001,OHF005,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530010-01,Standard Bronze On Exchange Plan,59.20%,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$0,$0,"$53,250",$0,$0,$0,23
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,Individual,No,31-1431434,92036OH0530010,HealthSpanOne Bronze 6000 HSA,92036OH053,,OHN001,OHS001,OHF005,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530010-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,24
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,2,92036,OH,Individual,No,31-1431434,92036OH0530010,HealthSpanOne Bronze 6000 HSA,92036OH053,,OHN001,OHS001,OHF005,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530010-03,Limited Cost Sharing Plan Variation,59.20%,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,000",$0,$0,$0,"$53,250",$0,$0,$0,25
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,3,92036,OH,Individual,No,31-1431434,92036OH0530009,HealthSpanOne Bronze 5000-80,92036OH053,,OHN001,OHS001,OHF006,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,3,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530009-00,Standard Bronze Off Exchange Plan,62.00%,0.608599305152893,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$450,$0,$275,"$1,375",$0,$0,4
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,3,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540013,HealthSpan Bronze 5000-80,92036OH054,,OHN001,OHS001,OHF006,Existing,HMO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,$200,0,0,3,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540013-00,Standard Bronze Off Exchange Plan,62.00%,0.603662967681885,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000.00",$15.00,$450.00,$0.00,$875.00,$900.00,$0.00,$0.00,4
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,3,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540013,HealthSpan Bronze 5000-80,92036OH054,,OHN001,OHS001,OHF006,Existing,HMO,Bronze,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,$200,0,0,3,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540013-01,Standard Bronze On Exchange Plan,62.00%,0.603662967681885,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000.00",$15.00,$450.00,$0.00,$875.00,$900.00,$0.00,$0.00,5
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,3,92036,OH,Individual,No,31-1431434,92036OH0530009,HealthSpanOne Bronze 5000-80,92036OH053,,OHN001,OHS001,OHF006,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,3,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530009-01,Standard Bronze On Exchange Plan,62.00%,0.608599305152893,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$450,$0,$275,"$1,375",$0,$0,5
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,3,92036,OH,Individual,No,31-1431434,92036OH0530009,HealthSpanOne Bronze 5000-80,92036OH053,,OHN001,OHS001,OHF006,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,3,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530009-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,3,92036,OH,Individual,No,31-1431434,92036OH0530009,HealthSpanOne Bronze 5000-80,92036OH053,,OHN001,OHS001,OHF006,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,3,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530009-03,Limited Cost Sharing Plan Variation,62.00%,0.608599305152893,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,$450,$0,$275,"$1,375",$0,$0,7
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,4,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540009,HealthSpan Silver 2000-70,92036OH054,,OHN001,OHS001,OHF004,Existing,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540009-00,Standard Silver Off Exchange Plan,72.00%,0.718712449073792,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000.00",$15.00,"$1,575.00",$0.00,$100.00,$850.00,$0.00,$0.00,4
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,4,92036,OH,Individual,No,31-1431434,92036OH0530005,HealthSpanOne Silver 2000-70,92036OH053,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530005-00,Standard Silver Off Exchange Plan,71.99%,0.718712449073792,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$15,"$1,575",$0,$100,$975,$0,$0,4
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,4,92036,OH,Individual,No,31-1431434,92036OH0530005,HealthSpanOne Silver 2000-70,92036OH053,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530005-01,Standard Silver On Exchange Plan,71.99%,0.718712449073792,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$15,"$1,575",$0,$100,$975,$0,$0,5
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,4,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540009,HealthSpan Silver 2000-70,92036OH054,,OHN001,OHS001,OHF004,Existing,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540009-01,Standard Silver On Exchange Plan,72.00%,0.718712449073792,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000.00",$15.00,"$1,575.00",$0.00,$100.00,$850.00,$0.00,$0.00,5
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,4,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540010,HealthSpan Silver 2500-80,92036OH054,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540010-00,Standard Silver Off Exchange Plan,71.60%,0.716014742851257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500.00",$15.00,$950.00,$0.00,$100.00,$850.00,$0.00,$0.00,6
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,4,92036,OH,Individual,No,31-1431434,92036OH0530005,HealthSpanOne Silver 2000-70,92036OH053,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,4,92036,OH,Individual,No,31-1431434,92036OH0530005,HealthSpanOne Silver 2000-70,92036OH053,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530005-03,Limited Cost Sharing Plan Variation,71.99%,0.718712449073792,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$15,"$1,575",$0,$100,$975,$0,$0,7
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,4,92036,OH,SHOP (Small Group),No,31-1431434,92036OH0540010,HealthSpan Silver 2500-80,92036OH054,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,,,0.987455990594348,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,http://www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0540010-01,Standard Silver On Exchange Plan,71.60%,0.716014742851257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500.00",$15.00,$950.00,$0.00,$100.00,$850.00,$0.00,$0.00,7
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,4,92036,OH,Individual,No,31-1431434,92036OH0530005,HealthSpanOne Silver 2000-70,92036OH053,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530005-04,73% AV Level Silver Plan,73.99%,0.739430904388428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000",$15,"$1,580",$0,$100,"$1,260",$0,$0,8
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,4,92036,OH,Individual,No,31-1431434,92036OH0530005,HealthSpanOne Silver 2000-70,92036OH053,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530005-05,87% AV Level Silver Plan,86.60%,0.864624977111816,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$15,"$1,350",$0,$100,$975,$0,$0,9
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,4,92036,OH,Individual,No,31-1431434,92036OH0530005,HealthSpanOne Silver 2000-70,92036OH053,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530005-06,94% AV Level Silver Plan,93.80%,0.937414407730103,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$15,$725,$0,$0,$450,$10,$0,10
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,4,92036,OH,Individual,No,31-1431434,92036OH0530006,HealthSpanOne  Silver 2500-80,92036OH053,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530006-00,Standard Silver Off Exchange Plan,71.70%,0.716014742851257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$15,$950,$0,$100,$975,$0,$0,11
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,4,92036,OH,Individual,No,31-1431434,92036OH0530006,HealthSpanOne  Silver 2500-80,92036OH053,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530006-01,Standard Silver On Exchange Plan,71.70%,0.716014742851257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$15,$950,$0,$100,$975,$0,$0,12
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,4,92036,OH,Individual,No,31-1431434,92036OH0530006,HealthSpanOne  Silver 2500-80,92036OH053,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,4,92036,OH,Individual,No,31-1431434,92036OH0530006,HealthSpanOne  Silver 2500-80,92036OH053,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530006-03,Limited Cost Sharing Plan Variation,71.70%,0.716014742851257,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$15,$950,$0,$100,$975,$0,$0,14
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,4,92036,OH,Individual,No,31-1431434,92036OH0530006,HealthSpanOne  Silver 2500-80,92036OH053,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530006-04,73% AV Level Silver Plan,73.70%,0.73712033033371,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$15,$950,$0,$100,$975,$0,$0,15
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,4,92036,OH,Individual,No,31-1431434,92036OH0530006,HealthSpanOne  Silver 2500-80,92036OH053,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530006-05,87% AV Level Silver Plan,86.60%,0.864624977111816,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$15,"$1,350",$0,$100,$850,$0,$0,16
2015,OH,92036,SERFF,6,2014-11-15 10:06:04,4,92036,OH,Individual,No,31-1431434,92036OH0530006,HealthSpanOne  Silver 2500-80,92036OH053,,OHN001,OHS001,OHF004,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.987739309699811,,$200,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,www.healthspan.org/marketplace,https://healthspan.insxcloud.com/payment,www.healthspan.org/marketplace,www.healthspan.org/formulary,92036OH0530006-06,94% AV Level Silver Plan,93.80%,0.937414407730103,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$15,"$1,450",$0,$0,$450,$20,$0,17
2015,OH,95466,SERFF,3,2014-09-11 12:10:19,1,95466,OH,SHOP (Small Group),Yes,41-0808596,95466OH0010001,"Plan 1. Passive PPO, $1000 Annual Maximum, no Ortho",95466OH001,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,95466OH0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,95466,SERFF,3,2014-09-11 12:10:19,1,95466,OH,SHOP (Small Group),Yes,41-0808596,95466OH0010002,"Plan 2.  Passive PPO, $1000 Annual Maximum, Ortho",95466OH001,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,95466OH0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,95466,SERFF,3,2014-09-11 12:10:19,1,95466,OH,SHOP (Small Group),Yes,41-0808596,95466OH0010003,"Plan 3. Passive PPO, $1500 Annual Maximum, no Ortho",95466OH001,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,95466OH0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040003,Market HSA 2000 - Gold,99969OH004,,OHN001,OHS001,OHF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult-Only,99969OH0040004,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709188000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040003-03,Limited Cost Sharing Plan Variation,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040004,Market HSA 2000 Child Only - Gold,99969OH004,,OHN001,OHS001,OHF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709188000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040004-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000",Not Applicable,0%,,,,"$6,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040004,Market HSA 2000 Child Only - Gold,99969OH004,,OHN001,OHS001,OHF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709188000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040004-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000",Not Applicable,0%,,,,"$6,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040004,Market HSA 2000 Child Only - Gold,99969OH004,,OHN001,OHS001,OHF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709188000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,Not Applicable,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,Not Applicable,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040004,Market HSA 2000 Child Only - Gold,99969OH004,,OHN001,OHS001,OHF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709188000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040004-03,Limited Cost Sharing Plan Variation,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000",Not Applicable,0%,,,,"$6,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040007,Market HSA 4000 - Bronze,99969OH004,,OHN001,OHS001,OHF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult-Only,99969OH0040008,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709238000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040007-00,Standard Bronze Off Exchange Plan,,0.603701531887054,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040007,Market HSA 4000 - Bronze,99969OH004,,OHN001,OHS001,OHF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult-Only,99969OH0040008,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709238000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040007-01,Standard Bronze On Exchange Plan,,0.603701531887054,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040007,Market HSA 4000 - Bronze,99969OH004,,OHN001,OHS001,OHF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult-Only,99969OH0040008,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709238000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,OH,95466,SERFF,3,2014-09-11 12:10:19,1,95466,OH,SHOP (Small Group),Yes,41-0808596,95466OH0010004,"Plan 4.  Passive PPO, $1500 Annual Maximum, Ortho",95466OH001,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,95466OH0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,95466,SERFF,3,2014-09-11 12:10:19,1,95466,OH,SHOP (Small Group),Yes,41-0808596,95466OH0010005,"Plan 5.  Passive PPO, $2000 Annual Maximum, Ortho",95466OH001,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,95466OH0010005-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,OH,95466,SERFF,3,2014-09-11 12:10:19,1,95466,OH,SHOP (Small Group),Yes,41-0808596,95466OH0010006,"Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho",95466OH001,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,95466OH0010006-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,OH,95466,SERFF,3,2014-09-11 12:10:19,1,95466,OH,SHOP (Small Group),Yes,41-0808596,95466OH0010007,"Plan 7. Graded Passive PPO, $1500 Annual Maximum, Ortho",95466OH001,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,95466OH0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,OH,95466,SERFF,3,2014-09-11 12:10:19,1,95466,OH,SHOP (Small Group),Yes,41-0808596,95466OH0010008,"Plan 8. MAC PPO, $1000 Annual Maximum, no Ortho",95466OH001,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,95466OH0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,OH,95466,SERFF,3,2014-09-11 12:10:19,1,95466,OH,SHOP (Small Group),Yes,41-0808596,95466OH0010009,"Plan 9. MAC PPO, $1500 Annual Maximum, Ortho",95466OH001,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,95466OH0010009-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,OH,95466,SERFF,3,2014-09-11 12:10:19,1,95466,OH,SHOP (Small Group),Yes,41-0808596,95466OH0010010,"Plan 10. Graded MAC PPO, $1000 Annual Maximum, no Ortho",95466OH001,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,95466OH0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,13
2015,OH,97596,SERFF,6,2015-01-21 12:15:34,1,97596,OH,Individual,Yes,39-1263473,97596OH0580001,Humana Dental Smart Choice,97596OH058,,OHN001,OHS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.90,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541344,,97596OH0580001-00,Standard Low Off Exchange Plan,68.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$35,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,97596,SERFF,6,2015-01-21 12:15:34,1,97596,OH,Individual,Yes,39-1263473,97596OH0580001,Humana Dental Smart Choice,97596OH058,,OHN001,OHS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.90,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2541344,,97596OH0580001-01,Standard Low On Exchange Plan,68.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$35,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040012,Market HSA 6000 Child Only - Bronze,99969OH004,,OHN001,OHS001,OHF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709221000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040012-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000",Not Applicable,0%,,,,"$18,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040012,Market HSA 6000 Child Only - Bronze,99969OH004,,OHN001,OHS001,OHF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709221000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040012-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,Not Applicable,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,Not Applicable,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,26
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040012,Market HSA 6000 Child Only - Bronze,99969OH004,,OHN001,OHS001,OHF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709221000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040012-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000",Not Applicable,0%,,,,"$18,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,27
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040016,Market Classic 2000 - Silver,99969OH004,,OHN001,OHS001,OHF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,99969OH0040017,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709194000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040016-00,Standard Silver Off Exchange Plan,,0.683898508548737,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,28
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040008,Market HSA 4000 Child Only - Bronze,99969OH004,,OHN001,OHS001,OHF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709238000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040008-03,Limited Cost Sharing Plan Variation,,0.603701531887054,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000",Not Applicable,30%,,,,"$12,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040011,Market HSA 6000 - Bronze,99969OH004,,OHN001,OHS001,OHF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult-Only,99969OH0040012,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709221000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040011-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,20
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040011,Market HSA 6000 - Bronze,99969OH004,,OHN001,OHS001,OHF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult-Only,99969OH0040012,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709221000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040011-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,21
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040011,Market HSA 6000 - Bronze,99969OH004,,OHN001,OHS001,OHF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult-Only,99969OH0040012,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709221000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,22
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040011,Market HSA 6000 - Bronze,99969OH004,,OHN001,OHS001,OHF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult-Only,99969OH0040012,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709221000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040011-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,"$18,000","$36,000",Not Applicable,Not Applicable,,,,,,,,,23
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040012,Market HSA 6000 Child Only - Bronze,99969OH004,,OHN001,OHS001,OHF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709221000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040012-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000",Not Applicable,0%,,,,"$18,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,24
2015,OH,99734,SERFF,5,2014-11-15 10:06:04,1,99734,OH,Individual,Yes,31-1185262,99734OH0050005,Ohio DentaTrust PPO - Pediatric High Option,99734OH005,,OHN003,OHS001,,New,PPO,High,,Both,,,,Please refer to the exclusions listed in the Policy for specific plan level exclusions.,,,,,Allows Child-Only,,,,$29.91,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,Yes,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,99734OH0050005-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,99734,SERFF,5,2014-11-15 10:06:04,1,99734,OH,SHOP (Small Group),Yes,31-1185262,99734OH0010014,HMO - Plan #014,99734OH001,,OHN002,OHS002,,New,HMO,High,,Off the Exchange,,,,Please refer to the exclusions listed in the Certificate for specific plan level exclusions.,,,,,Allows Adult and Child-Only,,,,$29.75,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,"Out of Service Area coverage is limited to relief of pain, bleeding, swelling or other acute conditions.",No,,,,,99734OH0010014-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,99734,SERFF,5,2014-11-15 10:06:04,1,99734,OH,SHOP (Small Group),Yes,31-1185262,99734OH0010015,HMO - Plan #015,99734OH001,,OHN002,OHS002,,New,HMO,Low,,Off the Exchange,,,,Please refer to the exclusions listed in the Certificate for specific plan level exclusions.,,,,,Allows Adult and Child-Only,,,,$24.65,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,"Out of Service Area coverage is limited to relief of pain, bleeding, swelling or other acute conditions.",No,,,,,99734OH0010015-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040019,Market HSA 3000 Child Only - Silver,99969OH004,,OHN001,OHS001,OHF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709200000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040019-00,Standard Silver Off Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000",Not Applicable,0%,,,,"$9,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,49
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040019,Market HSA 3000 Child Only - Silver,99969OH004,,OHN001,OHS001,OHF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709200000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040019-01,Standard Silver On Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000",Not Applicable,0%,,,,"$9,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,50
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040019,Market HSA 3000 Child Only - Silver,99969OH004,,OHN001,OHS001,OHF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709200000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040019-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,Not Applicable,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,Not Applicable,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,51
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040019,Market HSA 3000 Child Only - Silver,99969OH004,,OHN001,OHS001,OHF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709200000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040019-03,Limited Cost Sharing Plan Variation,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000",Not Applicable,0%,,,,"$9,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,52
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040019,Market HSA 3000 Child Only - Silver,99969OH004,,OHN001,OHS001,OHF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709200000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040019-04,73% AV Level Silver Plan,,0.738942980766296,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,650",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,650",Not Applicable,0%,,,,"$9,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,53
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040019,Market HSA 3000 Child Only - Silver,99969OH004,,OHN001,OHS001,OHF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709200000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040019-05,87% AV Level Silver Plan,,0.861683309078217,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,150",Not Applicable,0%,,,,"$9,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,54
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040016,Market Classic 2000 - Silver,99969OH004,,OHN001,OHS001,OHF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,99969OH0040017,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709194000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040016-03,Limited Cost Sharing Plan Variation,,0.683898508548737,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,31
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040016,Market Classic 2000 - Silver,99969OH004,,OHN001,OHS001,OHF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,99969OH0040017,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709194000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040016-04,73% AV Level Silver Plan,,0.724834859371185,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,32
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040016,Market Classic 2000 - Silver,99969OH004,,OHN001,OHS001,OHF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,99969OH0040017,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709194000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040016-05,87% AV Level Silver Plan,,0.872048735618591,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,33
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040016,Market Classic 2000 - Silver,99969OH004,,OHN001,OHS001,OHF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,99969OH0040017,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709194000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040016-06,94% AV Level Silver Plan,,0.933893859386444,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,34
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040017,Market Classic 2000 Child Only - Silver,99969OH004,,OHN001,OHS001,OHF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709194000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040017-00,Standard Silver Off Exchange Plan,,0.683898508548737,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000",Not Applicable,20%,,,,"$6,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,35
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040017,Market Classic 2000 Child Only - Silver,99969OH004,,OHN001,OHS001,OHF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709194000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040017-01,Standard Silver On Exchange Plan,,0.683898508548737,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000",Not Applicable,20%,,,,"$6,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,36
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040017,Market Classic 2000 Child Only - Silver,99969OH004,,OHN001,OHS001,OHF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709194000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,Not Applicable,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,Not Applicable,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,37
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040017,Market Classic 2000 Child Only - Silver,99969OH004,,OHN001,OHS001,OHF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709194000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040017-03,Limited Cost Sharing Plan Variation,,0.683898508548737,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000",Not Applicable,20%,,,,"$6,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,38
2015,OH,99734,SERFF,5,2014-11-15 10:06:04,1,99734,OH,Individual,Yes,31-1185262,99734OH0050005,Ohio DentaTrust PPO - Pediatric High Option,99734OH005,,OHN003,OHS001,,New,PPO,High,,Both,,,,Please refer to the exclusions listed in the Policy for specific plan level exclusions.,,,,,Allows Child-Only,,,,$29.91,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,Yes,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,99734OH0050005-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,99734,SERFF,5,2014-11-15 10:06:04,1,99734,OH,Individual,Yes,31-1185262,99734OH0050006,Ohio DentaTrust PPO - Pediatric Low Option,99734OH005,,OHN003,OHS001,,New,PPO,Low,,Both,,,,Please refer to the exclusions listed in the Policy for specific plan level exclusions.,,,,,Allows Child-Only,,,,$27.02,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,Yes,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,99734OH0050006-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,99734,SERFF,5,2014-11-15 10:06:04,1,99734,OH,SHOP (Small Group),Yes,31-1185262,99734OH0020013,PPO - Plan #013 - 900,99734OH002,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,Please refer to the exclusions listed in the Certificate for specific plan level exclusions.,,,,,Allows Adult and Child-Only,,,,$32.57,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.,Yes,,,,,99734OH0020013-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,99734,SERFF,5,2014-11-15 10:06:04,1,99734,OH,SHOP (Small Group),Yes,31-1185262,99734OH0020014,PPO - Plan #014 - 900,99734OH002,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,Please refer to the exclusions listed in the Certificate for specific plan level exclusions.,,,,,Allows Adult and Child-Only,,,,$32.03,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.,Yes,,,,,99734OH0020014-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,99734,SERFF,5,2014-11-15 10:06:04,1,99734,OH,Individual,Yes,31-1185262,99734OH0050006,Ohio DentaTrust PPO - Pediatric Low Option,99734OH005,,OHN003,OHS001,,New,PPO,Low,,Both,,,,Please refer to the exclusions listed in the Policy for specific plan level exclusions.,,,,,Allows Child-Only,,,,$27.02,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,Yes,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,99734OH0050006-01,Standard Low On Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,99734,SERFF,5,2014-11-15 10:06:04,1,99734,OH,SHOP (Small Group),Yes,31-1185262,99734OH0020015,PPO - Plan #015 - 900,99734OH002,,OHN001,OHS001,,New,PPO,Low,,Off the Exchange,,,,Please refer to the exclusions listed in the Certificate for specific plan level exclusions.,,,,,Allows Adult and Child-Only,,,,$26.88,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.,Yes,,,,,99734OH0020015-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,OH,99734,SERFF,5,2014-11-15 10:06:04,1,99734,OH,SHOP (Small Group),Yes,31-1185262,99734OH0020016,PPO - Plan #016 - 900,99734OH002,,OHN001,OHS001,,New,PPO,Low,,Off the Exchange,,,,Please refer to the exclusions listed in the Certificate for specific plan level exclusions.,,,,,Allows Adult and Child-Only,,,,$26.46,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.,Yes,,,,,99734OH0020016-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,OH,99734,SERFF,5,2014-11-15 10:06:04,1,99734,OH,SHOP (Small Group),Yes,31-1185262,99734OH0020017,PPO - Plan #013 - 600,99734OH002,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,Please refer to the exclusions listed in the Certificate for specific plan level exclusions.,,,,,Allows Adult and Child-Only,,,,$30.69,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.,Yes,,,,,99734OH0020017-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,OH,99734,SERFF,5,2014-11-15 10:06:04,1,99734,OH,SHOP (Small Group),Yes,31-1185262,99734OH0020018,PPO - Plan #014 - 600,99734OH002,,OHN001,OHS001,,New,PPO,High,,Off the Exchange,,,,Please refer to the exclusions listed in the Certificate for specific plan level exclusions.,,,,,Allows Adult and Child-Only,,,,$30.19,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.,Yes,,,,,99734OH0020018-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,OH,99734,SERFF,5,2014-11-15 10:06:04,1,99734,OH,SHOP (Small Group),Yes,31-1185262,99734OH0020019,PPO - Plan #015 - 600,99734OH002,,OHN001,OHS001,,New,PPO,Low,,Off the Exchange,,,,Please refer to the exclusions listed in the Certificate for specific plan level exclusions.,,,,,Allows Adult and Child-Only,,,,$25.40,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.,Yes,,,,,99734OH0020019-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,OH,99734,SERFF,5,2014-11-15 10:06:04,1,99734,OH,SHOP (Small Group),Yes,31-1185262,99734OH0020020,PPO - Plan #016 - 600,99734OH002,,OHN001,OHS001,,New,PPO,Low,,Off the Exchange,,,,Please refer to the exclusions listed in the Certificate for specific plan level exclusions.,,,,,Allows Adult and Child-Only,,,,$25.01,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.,Yes,,,,,99734OH0020020-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,13
2015,OH,99734,SERFF,5,2014-11-15 10:06:04,2,99734,OH,SHOP (Small Group),Yes,31-1185262,99734OH0040005,DentaSpan Dental PPO - Family High Option,99734OH004,,OHN003,OHS001,,New,PPO,High,,Both,,,,Please refer to the exclusions listed in the Certificate for specific plan level exclusions.,,,,,Allows Adult and Child-Only,,,,$25.92,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,Yes,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,99734OH0040005-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,99734,SERFF,5,2014-11-15 10:06:04,2,99734,OH,Individual,Yes,31-1185262,99734OH0050007,Ohio DentaTrust PPO - Family High Option,99734OH005,,OHN003,OHS001,,New,PPO,High,,Both,,,,Please refer to the exclusions listed in the Policy for specific plan level exclusions.,,,,,Allows Adult and Child-Only,,,,$21.73,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,Yes,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,99734OH0050007-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,99734,SERFF,5,2014-11-15 10:06:04,2,99734,OH,Individual,Yes,31-1185262,99734OH0050007,Ohio DentaTrust PPO - Family High Option,99734OH005,,OHN003,OHS001,,New,PPO,High,,Both,,,,Please refer to the exclusions listed in the Policy for specific plan level exclusions.,,,,,Allows Adult and Child-Only,,,,$21.73,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,Yes,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,99734OH0050007-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,99734,SERFF,5,2014-11-15 10:06:04,2,99734,OH,SHOP (Small Group),Yes,31-1185262,99734OH0040005,DentaSpan Dental PPO - Family High Option,99734OH004,,OHN003,OHS001,,New,PPO,High,,Both,,,,Please refer to the exclusions listed in the Certificate for specific plan level exclusions.,,,,,Allows Adult and Child-Only,,,,$25.92,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,Yes,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,99734OH0040005-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,99734,SERFF,5,2014-11-15 10:06:04,2,99734,OH,SHOP (Small Group),Yes,31-1185262,99734OH0040006,DentaSpan Dental PPO - Family Low Option,99734OH004,,OHN003,OHS001,,New,PPO,Low,,Both,,,,Please refer to the exclusions listed in the Certificate for specific plan level exclusions.,,,,,Allows Adult and Child-Only,,,,$23.51,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,Yes,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,99734OH0040006-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,99734,SERFF,5,2014-11-15 10:06:04,2,99734,OH,Individual,Yes,31-1185262,99734OH0050008,Ohio DentaTrust PPO - Family Low Option,99734OH005,,OHN003,OHS001,,New,PPO,Low,,Both,,,,Please refer to the exclusions listed in the Policy for specific plan level exclusions.,,,,,Allows Adult and Child-Only,,,,$18.39,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,Yes,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,99734OH0050008-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OH,99734,SERFF,5,2014-11-15 10:06:04,2,99734,OH,Individual,Yes,31-1185262,99734OH0050008,Ohio DentaTrust PPO - Family Low Option,99734OH005,,OHN003,OHS001,,New,PPO,Low,,Both,,,,Please refer to the exclusions listed in the Policy for specific plan level exclusions.,,,,,Allows Adult and Child-Only,,,,$18.39,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,Yes,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,99734OH0050008-01,Standard Low On Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,99734,SERFF,5,2014-11-15 10:06:04,2,99734,OH,SHOP (Small Group),Yes,31-1185262,99734OH0040006,DentaSpan Dental PPO - Family Low Option,99734OH004,,OHN003,OHS001,,New,PPO,Low,,Both,,,,Please refer to the exclusions listed in the Certificate for specific plan level exclusions.,,,,,Allows Adult and Child-Only,,,,$23.51,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.,Yes,https://hixenroll.insxcloud.com/my-quote/plan-information/index,https://hixenroll.insxcloud.com/payment,https://hixenroll.insxcloud.com/my-quote/plan-information/index,,99734OH0040006-01,Standard Low On Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,1,99969,OH,Individual,No,34-1442712,99969OH0040001,Market Classic 1000 - Gold,99969OH004,,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,99969OH0040002,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$350,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709182000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040001-00,Standard Gold Off Exchange Plan,,0.780179560184479,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$100,000","$200,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,1,99969,OH,SHOP (Small Group),No,34-1442712,99969OH0050007,Market Gold 2000 - HSA,99969OH005,,OHN001,OHS001,OHF003,Existing,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,https://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709402000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0050007-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,1,99969,OH,Individual,Yes,34-1442712,99969OH0060002,Market Pediatric Dental,99969OH006,,OHN002,OHS002,,New,Indemnity,High,,Both,,,,,,,,,Allows Child-Only,,,,$38.13,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,https://bfi.shopapply.com/ProcessPayment.aspx,,,99969OH0060002-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,1,99969,OH,SHOP (Small Group),Yes,34-1442712,99969OH0070002,Pediatric Dental,99969OH007,,OHN002,OHS002,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$26.90,,Estimated Rate,,0,0,0,2014-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,,,,99969OH0070002-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,1,99969,OH,Individual,Yes,34-1442712,99969OH0060002,Market Pediatric Dental,99969OH006,,OHN002,OHS002,,New,Indemnity,High,,Both,,,,,,,,,Allows Child-Only,,,,$38.13,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,https://bfi.shopapply.com/ProcessPayment.aspx,,,99969OH0060002-01,Standard High On Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,1,99969,OH,SHOP (Small Group),No,34-1442712,99969OH0050007,Market Gold 2000 - HSA,99969OH005,,OHN001,OHS001,OHF003,Existing,PPO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,https://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709402000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0050007-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,1,99969,OH,Individual,No,34-1442712,99969OH0040001,Market Classic 1000 - Gold,99969OH004,,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,99969OH0040002,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$350,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709182000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040001-01,Standard Gold On Exchange Plan,,0.780179560184479,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$100,000","$200,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,1,99969,OH,Individual,No,34-1442712,99969OH0040001,Market Classic 1000 - Gold,99969OH004,,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,99969OH0040002,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$350,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709182000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,1,99969,OH,Individual,No,34-1442712,99969OH0040001,Market Classic 1000 - Gold,99969OH004,,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,99969OH0040002,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$350,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709182000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040001-03,Limited Cost Sharing Plan Variation,,0.780179560184479,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$100,000","$200,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,1,99969,OH,Individual,No,34-1442712,99969OH0040002,Market Classic 1000 Child Only - Gold,99969OH004,,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$350,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709182000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040002-00,Standard Gold Off Exchange Plan,,0.780179560184479,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,"$1,000",Not Applicable,20%,,,,"$3,000",Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,50%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,1,99969,OH,Individual,No,34-1442712,99969OH0040002,Market Classic 1000 Child Only - Gold,99969OH004,,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$350,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709182000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040002-01,Standard Gold On Exchange Plan,,0.780179560184479,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,"$1,000",Not Applicable,20%,,,,"$3,000",Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,50%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,1,99969,OH,Individual,No,34-1442712,99969OH0040002,Market Classic 1000 Child Only - Gold,99969OH004,,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$350,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709182000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,Not Applicable,,,$0,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,1,99969,OH,Individual,No,34-1442712,99969OH0040002,Market Classic 1000 Child Only - Gold,99969OH004,,OHN001,OHS001,OHF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$350,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709182000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040002-03,Limited Cost Sharing Plan Variation,,0.780179560184479,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,"$1,000",Not Applicable,20%,,,,"$3,000",Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,50%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,SHOP (Small Group),No,34-1442712,99969OH0050013,Market Silver 3530-2000,99969OH005,,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$350,0,0,3,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,https://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709403000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0050013-00,Standard Silver Off Exchange Plan,,0.711509227752686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,Yes,34-1442712,99969OH0060003,Market Dental Plan 1,99969OH006,,OHN002,OHS002,,New,Indemnity,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.13,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,https://bfi.shopapply.com/ProcessPayment.aspx,,,99969OH0060003-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040003,Market HSA 2000 - Gold,99969OH004,,OHN001,OHS001,OHF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult-Only,99969OH0040004,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709188000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040003-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040003,Market HSA 2000 - Gold,99969OH004,,OHN001,OHS001,OHF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult-Only,99969OH0040004,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709188000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040003-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,Yes,34-1442712,99969OH0060003,Market Dental Plan 1,99969OH006,,OHN002,OHS002,,New,Indemnity,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.13,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,https://bfi.shopapply.com/ProcessPayment.aspx,,,99969OH0060003-01,Standard High On Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,SHOP (Small Group),No,34-1442712,99969OH0050013,Market Silver 3530-2000,99969OH005,,OHN001,OHS001,OHF002,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$350,0,0,3,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,https://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709403000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0050013-01,Standard Silver On Exchange Plan,,0.711509227752686,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040003,Market HSA 2000 - Gold,99969OH004,,OHN001,OHS001,OHF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult-Only,99969OH0040004,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709188000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040007,Market HSA 4000 - Bronze,99969OH004,,OHN001,OHS001,OHF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult-Only,99969OH0040008,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709238000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040007-03,Limited Cost Sharing Plan Variation,,0.603701531887054,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040008,Market HSA 4000 Child Only - Bronze,99969OH004,,OHN001,OHS001,OHF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709238000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040008-00,Standard Bronze Off Exchange Plan,,0.603701531887054,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000",Not Applicable,30%,,,,"$12,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040008,Market HSA 4000 Child Only - Bronze,99969OH004,,OHN001,OHS001,OHF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709238000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040008-01,Standard Bronze On Exchange Plan,,0.603701531887054,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000",Not Applicable,30%,,,,"$12,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040008,Market HSA 4000 Child Only - Bronze,99969OH004,,OHN001,OHS001,OHF005,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709238000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,Not Applicable,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,Not Applicable,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040016,Market Classic 2000 - Silver,99969OH004,,OHN001,OHS001,OHF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,99969OH0040017,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709194000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040016-01,Standard Silver On Exchange Plan,,0.683898508548737,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,29
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040016,Market Classic 2000 - Silver,99969OH004,,OHN001,OHS001,OHF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,99969OH0040017,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709194000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,30
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040017,Market Classic 2000 Child Only - Silver,99969OH004,,OHN001,OHS001,OHF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709194000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040017-04,73% AV Level Silver Plan,,0.724834859371185,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500",Not Applicable,20%,,,,"$6,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,39
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040017,Market Classic 2000 Child Only - Silver,99969OH004,,OHN001,OHS001,OHF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709194000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040017-05,87% AV Level Silver Plan,,0.872048735618591,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,Not Applicable,10%,,,,"$6,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,40
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040017,Market Classic 2000 Child Only - Silver,99969OH004,,OHN001,OHS001,OHF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709194000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040017-06,94% AV Level Silver Plan,,0.933893859386444,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,Not Applicable,10%,,,,"$6,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,41
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040018,Market HSA 3000 - Silver,99969OH004,,OHN001,OHS001,OHF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult-Only,99969OH0040019,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709200000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040018-00,Standard Silver Off Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,42
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040018,Market HSA 3000 - Silver,99969OH004,,OHN001,OHS001,OHF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult-Only,99969OH0040019,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709200000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040018-01,Standard Silver On Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,43
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040018,Market HSA 3000 - Silver,99969OH004,,OHN001,OHS001,OHF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult-Only,99969OH0040019,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709200000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040018-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,44
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040018,Market HSA 3000 - Silver,99969OH004,,OHN001,OHS001,OHF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult-Only,99969OH0040019,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709200000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040018-03,Limited Cost Sharing Plan Variation,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,45
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040018,Market HSA 3000 - Silver,99969OH004,,OHN001,OHS001,OHF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult-Only,99969OH0040019,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709200000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040018-04,73% AV Level Silver Plan,,0.738942980766296,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,650","$5,300",0%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,46
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040018,Market HSA 3000 - Silver,99969OH004,,OHN001,OHS001,OHF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult-Only,99969OH0040019,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709200000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040018-05,87% AV Level Silver Plan,,0.861683309078217,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300",0%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,47
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040018,Market HSA 3000 - Silver,99969OH004,,OHN001,OHS001,OHF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult-Only,99969OH0040019,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709200000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040018-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$9,000","$18,000",Not Applicable,Not Applicable,,,,,,,,,48
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,2,99969,OH,Individual,No,34-1442712,99969OH0040019,Market HSA 3000 Child Only - Silver,99969OH004,,OHN001,OHS001,OHF003,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709200000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040019-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,Not Applicable,0%,,,,"$9,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,55
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,3,99969,OH,Individual,No,34-1442712,99969OH0040020,Market Classic 5000 - Bronze,99969OH004,,OHN001,OHS001,OHF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,99969OH0040021,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709227000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040020-00,Standard Bronze Off Exchange Plan,,0.599905848503113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,3,99969,OH,Individual,Yes,34-1442712,99969OH0060004,Market Dental Plan 2,99969OH006,,OHN002,OHS002,,New,Indemnity,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.13,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,https://bfi.shopapply.com/ProcessPayment.aspx,,,99969OH0060004-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,3,99969,OH,Individual,Yes,34-1442712,99969OH0060004,Market Dental Plan 2,99969OH006,,OHN002,OHS002,,New,Indemnity,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.13,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,https://bfi.shopapply.com/ProcessPayment.aspx,,,99969OH0060004-01,Standard High On Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,3,99969,OH,Individual,No,34-1442712,99969OH0040020,Market Classic 5000 - Bronze,99969OH004,,OHN001,OHS001,OHF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,99969OH0040021,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709227000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040020-01,Standard Bronze On Exchange Plan,,0.599905848503113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,3,99969,OH,Individual,No,34-1442712,99969OH0040020,Market Classic 5000 - Bronze,99969OH004,,OHN001,OHS001,OHF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,99969OH0040021,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709227000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040020-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,3,99969,OH,Individual,No,34-1442712,99969OH0040020,Market Classic 5000 - Bronze,99969OH004,,OHN001,OHS001,OHF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult-Only,99969OH0040021,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709227000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040020-03,Limited Cost Sharing Plan Variation,,0.599905848503113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,3,99969,OH,Individual,No,34-1442712,99969OH0040021,Market Classic 5000 Child Only - Bronze,99969OH004,,OHN001,OHS001,OHF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709227000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040021-00,Standard Bronze Off Exchange Plan,,0.599905848503113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000",Not Applicable,40%,,,,"$15,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,3,99969,OH,Individual,No,34-1442712,99969OH0040021,Market Classic 5000 Child Only - Bronze,99969OH004,,OHN001,OHS001,OHF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709227000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040021-01,Standard Bronze On Exchange Plan,,0.599905848503113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000",Not Applicable,40%,,,,"$15,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,3,99969,OH,Individual,No,34-1442712,99969OH0040021,Market Classic 5000 Child Only - Bronze,99969OH004,,OHN001,OHS001,OHF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709227000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040021-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,Not Applicable,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,Not Applicable,0%,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,3,99969,OH,Individual,No,34-1442712,99969OH0040021,Market Classic 5000 Child Only - Bronze,99969OH004,,OHN001,OHS001,OHF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709227000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040021-03,Limited Cost Sharing Plan Variation,,0.599905848503113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600",Not Applicable,,,"$100,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000",Not Applicable,40%,,,,"$15,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,4,99969,OH,Individual,No,34-1442712,99969OH0040013,Market Young Adult Essentials,99969OH004,,OHN001,OHS001,OHF003,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709275000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040013-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,4
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,4,99969,OH,Individual,Yes,34-1442712,99969OH0060005,Market Dental Plan 3,99969OH006,,OHN002,OHS002,,New,Indemnity,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.13,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,https://bfi.shopapply.com/ProcessPayment.aspx,,,99969OH0060005-00,Standard High Off Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,4,99969,OH,Individual,Yes,34-1442712,99969OH0060005,Market Dental Plan 3,99969OH006,,OHN002,OHS002,,New,Indemnity,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$38.13,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,,https://bfi.shopapply.com/ProcessPayment.aspx,,,99969OH0060005-01,Standard High On Exchange Plan,83.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OH,99969,SERFF,6,2015-01-21 12:15:34,4,99969,OH,Individual,No,34-1442712,99969OH0040013,Market Young Adult Essentials,99969OH004,,OHN001,OHS001,OHF003,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency Only,Yes,Covered as Non-Network,Yes,http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001709275000000000,https://bfi.shopapply.com/ProcessPayment.aspx,,https://www.medmutual.com/~/media/Files/Plans%20and%20Product%20PDFs/2015%20Medical%20Mutual%20Metal%20Plan%20Formulary%20eff%20010115.ashx,99969OH0040013-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$100,000","$200,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$19,800","$39,600",Not Applicable,Not Applicable,,,,,,,,,5
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380004,Value Bronze PSN 3000,10091OR038,,ORN001,ORS004,ORF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969560&libID=4294969560,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380004-00,Standard Bronze Off Exchange Plan,60.38%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,140",$150,"$3,000",$0,"$1,140",$80,4
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390015,SmartChoice Balance Silver 1500 AC,10091OR039,,ORN003,ORS001,ORF009,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.984948962151096,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969565&libID=4294969565,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390015-01,Standard Silver On Exchange Plan,71.36%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$430,$310,$80,19
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390015,SmartChoice Balance Silver 1500 AC,10091OR039,,ORN003,ORS001,ORF009,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.984948962151096,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969565&libID=4294969565,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390015-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,20
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390008,SmartHealth Balance Silver 2500 AC,10091OR039,,ORN002,ORS002,ORF009,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.983746093136647,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969577&libID=4294969577,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390008-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,41
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390008,SmartHealth Balance Silver 2500 AC,10091OR039,,ORN002,ORS002,ORF009,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.983746093136647,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969577&libID=4294969577,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390008-03,Limited Cost Sharing Plan Variation,68.37%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$3,000","$6,000",40%,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,430",$150,"$2,500",$320,$230,$80,42
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360005,PacificSource Oregon Standard Silver Plan PSN,10091OR036,,ORN001,ORS004,ORF010,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969559&libID=4294969559,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360005-04,73% AV Level Silver Plan,72.93%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,"$2,500",$500,$230,$80,8
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360005,PacificSource Oregon Standard Silver Plan PSN,10091OR036,,ORN001,ORS004,ORF010,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969559&libID=4294969559,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360005-05,87% AV Level Silver Plan,87.09%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,$750,"$1,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$20,$650,$150,$750,$510,$110,$80,9
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,3,39424,OR,Individual,No,93-0989307,39424OR1260001,Be Protected (Connexus),39424OR126,,ORN001,ORS001,ORF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProtected_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProtected_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1260001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,3,39424,OR,Individual,No,93-0989307,39424OR1260001,Be Protected (Connexus),39424OR126,,ORN001,ORS001,ORF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProtected_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProtected_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1260001-03,Limited Cost Sharing Plan Variation,,0.791267693042755,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",15%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$750,$0,"$1,000",$200,$750,$200,$500,$80,7
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,3,39424,OR,Individual,No,93-0989307,39424OR1260002,Be Prepared (Connexus),39424OR126,,ORN001,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BePrepared_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BePrepared_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1260002-04,73% AV Level Silver Plan,,0.739848732948303,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,150","$10,300",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",30%,,,,"$2,300","$4,600",Not Applicable,Not Applicable,"$1,100",$20,"$1,800",$200,"$1,100",$700,$300,$80,12
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,3,39424,OR,Individual,No,93-0989307,39424OR1260002,Be Prepared (Connexus),39424OR126,,ORN001,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BePrepared_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BePrepared_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1260002-05,87% AV Level Silver Plan,,0.877124905586243,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",30%,,,,"$2,300","$4,600",Not Applicable,Not Applicable,$500,$0,$700,$200,$500,$500,$200,$80,13
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,3,39424,OR,Individual,No,93-0989307,39424OR1260002,Be Prepared (Connexus),39424OR126,,ORN001,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BePrepared_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BePrepared_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1260002-06,94% AV Level Silver Plan,,0.939055562019348,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,30%,,,,"$2,300","$4,600",Not Applicable,Not Applicable,$100,$0,$400,$200,$100,$300,$100,$80,14
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,4,39424,OR,Individual,No,93-0989307,39424OR1270001,Be Focused (CCN),39424OR127,,ORN002,ORS003,ORF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeFocused_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeFocused_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1270001-00,Standard Gold Off Exchange Plan,,0.790212750434875,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$0,$500,$200,$500,$400,$100,$80,4
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,4,39424,OR,Individual,No,93-0989307,39424OR1270001,Be Focused (CCN),39424OR127,,ORN002,ORS003,ORF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeFocused_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeFocused_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1270001-01,Standard Gold On Exchange Plan,,0.790212750434875,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$0,$500,$200,$500,$400,$100,$80,5
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,4,39424,OR,Individual,No,93-0989307,39424OR1270001,Be Focused (CCN),39424OR127,,ORN002,ORS003,ORF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeFocused_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeFocused_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1270001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380011,SmartChoice Value Bronze 6250,10091OR038,,ORN003,ORS001,ORF001,New,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.999082161004638,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969572&libID=4294969572,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380011-01,Standard Bronze On Exchange Plan,58.34%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,250",$0,$0,$150,"$5,270",$0,$0,$80,31
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380011,SmartChoice Value Bronze 6250,10091OR038,,ORN003,ORS001,ORF001,New,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.999082161004638,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969572&libID=4294969572,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380011-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,32
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380013,SmartChoice Value Silver 3600,10091OR038,,ORN003,ORS001,ORF001,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969574&libID=4294969574,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380013-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,43
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380013,SmartChoice Value Silver 3600,10091OR038,,ORN003,ORS001,ORF001,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969574&libID=4294969574,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380013-03,Limited Cost Sharing Plan Variation,68.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,600",$0,$0,$150,"$3,600",$0,$0,$80,44
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,3,39424,OR,Individual,No,93-0989307,39424OR1260001,Be Protected (Connexus),39424OR126,,ORN001,ORS001,ORF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProtected_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProtected_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1260001-00,Standard Gold Off Exchange Plan,,0.791267693042755,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",15%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$750,$0,"$1,000",$200,$750,$200,$500,$80,4
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,3,39424,OR,Individual,No,93-0989307,39424OR1260001,Be Protected (Connexus),39424OR126,,ORN001,ORS001,ORF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProtected_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeProtected_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1260001-01,Standard Gold On Exchange Plan,,0.791267693042755,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",15%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$750,$0,"$1,000",$200,$750,$200,$500,$80,5
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,Yes,93-0245545,10091OR0470001,Kids Dental Advantage 20/40/50/50,10091OR047,,ORN004,ORS003,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$32.28,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency care only.,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",No,http://www.pacificsource.com/2015-oregon-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,,10091OR0470001-00,Standard Low Off Exchange Plan,71.98%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,Yes,93-0245545,10091OR0470001,Kids Dental Advantage 20/40/50/50,10091OR047,,ORN004,ORS003,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$32.28,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency care only.,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",No,http://www.pacificsource.com/2015-oregon-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,,10091OR0470001-01,Standard Low On Exchange Plan,71.98%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380013,SmartChoice Value Silver 3600,10091OR038,,ORN003,ORS001,ORF001,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969574&libID=4294969574,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380013-06,94% AV Level Silver Plan,93.27%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,47
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380007,SmartHealth Value Bronze 3000,10091OR038,,ORN002,ORS002,ORF002,Existing,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969582&libID=4294969582,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380007-00,Standard Bronze Off Exchange Plan,59.83%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,"$6,450","$12,900",0%,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,140",$150,"$3,000",$0,"$1,140",$80,48
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,2,10091,OR,Individual,Yes,93-0245545,10091OR0470002,Kids Dental Advantage 0/20/50,10091OR047,,ORN004,ORS003,,New,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$37.37,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",No,http://www.pacificsource.com/2015-oregon-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,,10091OR0470002-00,Standard High Off Exchange Plan,86.53%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,2,10091,OR,Individual,Yes,93-0245545,10091OR0470002,Kids Dental Advantage 0/20/50,10091OR047,,ORN004,ORS003,,New,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$37.37,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",No,http://www.pacificsource.com/2015-oregon-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,,10091OR0470002-01,Standard High On Exchange Plan,86.53%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,3,39424,OR,Individual,No,93-0989307,39424OR1260002,Be Prepared (Connexus),39424OR126,,ORN001,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BePrepared_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BePrepared_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1260002-00,Standard Silver Off Exchange Plan,,0.719688534736633,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300",30%,,,,"$2,300","$4,600",Not Applicable,Not Applicable,"$1,150",$20,"$1,950",$200,"$1,150",$700,$350,$80,8
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,3,39424,OR,Individual,No,93-0989307,39424OR1260002,Be Prepared (Connexus),39424OR126,,ORN001,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BePrepared_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BePrepared_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1260002-01,Standard Silver On Exchange Plan,,0.719688534736633,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300",30%,,,,"$2,300","$4,600",Not Applicable,Not Applicable,"$1,150",$20,"$1,950",$200,"$1,150",$700,$350,$80,9
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,3,39424,OR,Individual,No,93-0989307,39424OR1260002,Be Prepared (Connexus),39424OR126,,ORN001,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BePrepared_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BePrepared_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1260002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,10
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,3,39424,OR,Individual,No,93-0989307,39424OR1260002,Be Prepared (Connexus),39424OR126,,ORN001,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BePrepared_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BePrepared_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1260002-03,Limited Cost Sharing Plan Variation,,0.719688534736633,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300",30%,,,,"$2,300","$4,600",Not Applicable,Not Applicable,"$1,150",$20,"$1,950",$200,"$1,150",$700,$350,$80,11
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380004,Value Bronze PSN 3000,10091OR038,,ORN001,ORS004,ORF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969560&libID=4294969560,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380004-01,Standard Bronze On Exchange Plan,60.38%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,140",$150,"$3,000",$0,"$1,140",$80,5
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380004,Value Bronze PSN 3000,10091OR038,,ORN001,ORS004,ORF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969560&libID=4294969560,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380004,Value Bronze PSN 3000,10091OR038,,ORN001,ORS004,ORF002,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969560&libID=4294969560,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380004-03,Limited Cost Sharing Plan Variation,60.38%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,140",$150,"$3,000",$0,"$1,140",$80,7
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380003,Value Bronze PSN 6250,10091OR038,,ORN001,ORS004,ORF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969561&libID=4294969561,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380003-00,Standard Bronze Off Exchange Plan,58.34%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,250",$0,$0,$150,"$5,270",$0,$0,$80,8
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380003,Value Bronze PSN 6250,10091OR038,,ORN001,ORS004,ORF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969561&libID=4294969561,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380003-01,Standard Bronze On Exchange Plan,58.34%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,250",$0,$0,$150,"$5,270",$0,$0,$80,9
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380003,Value Bronze PSN 6250,10091OR038,,ORN001,ORS004,ORF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969561&libID=4294969561,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380003,Value Bronze PSN 6250,10091OR038,,ORN001,ORS004,ORF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969561&libID=4294969561,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380003-03,Limited Cost Sharing Plan Variation,58.34%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,250",$0,$0,$150,"$5,270",$0,$0,$80,11
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380005,Value Silver PSN 3000,10091OR038,,ORN001,ORS004,ORF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969562&libID=4294969562,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380005-00,Standard Silver Off Exchange Plan,71.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$3,000",$0,$0,$150,"$3,000",$0,$0,$80,12
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390014,SmartChoice Balance Silver 2500 AC,10091OR039,,ORN003,ORS001,ORF009,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.984188004433449,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969566&libID=4294969566,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390014-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$0,27
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390014,SmartChoice Balance Silver 2500 AC,10091OR039,,ORN003,ORS001,ORF009,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.984188004433449,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969566&libID=4294969566,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390014-03,Limited Cost Sharing Plan Variation,68.83%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,430",$150,"$2,500",$320,$230,$80,28
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390009,SmartHealth Balance Silver 1500 AC,10091OR039,,ORN002,ORS002,ORF009,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.984688928756481,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969576&libID=4294969576,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390009-05,87% AV Level Silver Plan,86.78%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$1,750","$3,500","$1,750","$3,500","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,"$1,000","$2,000",20%,"$7,500","$15,000",Not Applicable,Not Applicable,$500,$0,"$1,250",$150,$500,$390,$240,$80,37
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390009,SmartHealth Balance Silver 1500 AC,10091OR039,,ORN002,ORS002,ORF009,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.984688928756481,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969576&libID=4294969576,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390009-06,94% AV Level Silver Plan,93.26%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,$750,"$1,500",$750,"$1,500","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,$500,"$1,000",20%,"$7,500","$15,000",Not Applicable,Not Applicable,$200,$0,$550,$150,$200,$300,$240,$80,38
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360007,PacificSource Oregon Standard Silver Plan SHN,10091OR036,,ORN002,ORS002,ORF010,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969581&libID=4294969581,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360007-04,73% AV Level Silver Plan,72.93%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,250","$8,500","$4,250","$8,500","$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,"$2,500","$5,000",30%,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,"$2,500",$500,$230,$80,30
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360007,PacificSource Oregon Standard Silver Plan SHN,10091OR036,,ORN002,ORS002,ORF010,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969581&libID=4294969581,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360007-05,87% AV Level Silver Plan,87.09%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","$15,000","$30,000",Not Applicable,Not Applicable,$750,"$1,500",10%,$750,"$1,500",10%,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$20,$650,$150,$750,$510,$110,$80,31
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,2,39424,OR,Individual,No,93-0989307,39424OR1250001,Be Savvy (Connexus),39424OR125,,ORN001,ORS001,ORF003,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeSavvy_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeSavvy_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1250001-01,Standard Bronze On Exchange Plan,,0.582001805305481,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",40%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$5,200",$0,$800,$200,"$5,200",$0,$10,$80,5
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,2,39424,OR,Individual,No,93-0989307,39424OR1250001,Be Savvy (Connexus),39424OR125,,ORN001,ORS001,ORF003,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeSavvy_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeSavvy_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1250001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,2,39424,OR,Individual,No,93-0989307,39424OR1250001,Be Savvy (Connexus),39424OR125,,ORN001,ORS001,ORF003,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeSavvy_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeSavvy_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1250001-03,Limited Cost Sharing Plan Variation,,0.582001805305481,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",40%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$5,200",$0,$800,$200,"$5,200",$0,$10,$80,7
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,4,39424,OR,Individual,No,93-0989307,39424OR1270002,Be Focused (Rose City),39424OR127,,ORN003,ORS002,ORF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeFocusedRC_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeFocusedRC_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1270002-01,Standard Gold On Exchange Plan,,0.790212750434875,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$0,$500,$200,$500,$400,$100,$80,9
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,4,39424,OR,Individual,No,93-0989307,39424OR1270002,Be Focused (Rose City),39424OR127,,ORN003,ORS002,ORF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeFocusedRC_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeFocusedRC_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1270002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,10
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,4,39424,OR,Individual,No,93-0989307,39424OR1270002,Be Focused (Rose City),39424OR127,,ORN003,ORS002,ORF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeFocusedRC_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeFocusedRC_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1270002-03,Limited Cost Sharing Plan Variation,,0.790212750434875,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$0,$500,$200,$500,$400,$100,$80,11
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,5,39424,OR,Individual,No,93-0989307,39424OR1280001,Be Aligned (CCN),39424OR128,,ORN002,ORS003,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAligned_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAligned_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1280001-00,Standard Silver Off Exchange Plan,,0.690139532089233,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,700",$200,"$2,500",$400,$300,$80,4
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,5,39424,OR,Individual,No,93-0989307,39424OR1280001,Be Aligned (CCN),39424OR128,,ORN002,ORS003,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAligned_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAligned_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1280001-01,Standard Silver On Exchange Plan,,0.690139532089233,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,700",$200,"$2,500",$400,$300,$80,5
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380005,Value Silver PSN 3000,10091OR038,,ORN001,ORS004,ORF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969562&libID=4294969562,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380005-01,Standard Silver On Exchange Plan,71.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$3,000",$0,$0,$150,"$3,000",$0,$0,$80,13
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380005,Value Silver PSN 3000,10091OR038,,ORN001,ORS004,ORF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969562&libID=4294969562,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380005-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,14
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380005,Value Silver PSN 3000,10091OR038,,ORN001,ORS004,ORF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969562&libID=4294969562,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380005-03,Limited Cost Sharing Plan Variation,71.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$3,000",$0,$0,$150,"$3,000",$0,$0,$80,15
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380005,Value Silver PSN 3000,10091OR038,,ORN001,ORS004,ORF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969562&libID=4294969562,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380005-04,73% AV Level Silver Plan,73.89%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,650","$5,300",0%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,700",$0,$0,$150,"$2,700",$0,$0,$80,16
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380005,Value Silver PSN 3000,10091OR038,,ORN001,ORS004,ORF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969562&libID=4294969562,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380005-05,87% AV Level Silver Plan,87.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$1,000",$0,$0,$150,"$1,000",$0,$0,$80,17
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380005,Value Silver PSN 3000,10091OR038,,ORN001,ORS004,ORF001,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969562&libID=4294969562,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380005-06,94% AV Level Silver Plan,94.49%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,0%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$400,$0,$0,$150,$400,$0,$0,$80,18
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380010,Value Silver PSN 3600,10091OR038,,ORN001,ORS004,ORF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969563&libID=4294969563,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380010-00,Standard Silver Off Exchange Plan,68.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,600",$0,$0,$150,"$3,600",$0,$0,$80,19
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380010,Value Silver PSN 3600,10091OR038,,ORN001,ORS004,ORF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969563&libID=4294969563,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380010-01,Standard Silver On Exchange Plan,68.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,600",$0,$0,$150,"$3,600",$0,$0,$80,20
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380010,Value Silver PSN 3600,10091OR038,,ORN001,ORS004,ORF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969563&libID=4294969563,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380010-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,21
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380010,Value Silver PSN 3600,10091OR038,,ORN001,ORS004,ORF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969563&libID=4294969563,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380010-03,Limited Cost Sharing Plan Variation,68.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,600",$0,$0,$150,"$3,600",$0,$0,$80,22
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380010,Value Silver PSN 3600,10091OR038,,ORN001,ORS004,ORF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969563&libID=4294969563,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380010-04,73% AV Level Silver Plan,73.56%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,700","$5,400",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,700",$0,$0,$150,"$2,700",$0,$0,$80,23
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380010,Value Silver PSN 3600,10091OR038,,ORN001,ORS004,ORF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969563&libID=4294969563,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380010-05,87% AV Level Silver Plan,87.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000",$0,$0,$150,"$1,000",$0,$0,$80,24
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380010,Value Silver PSN 3600,10091OR038,,ORN001,ORS004,ORF001,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969563&libID=4294969563,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380010-06,94% AV Level Silver Plan,93.27%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,25
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380012,SmartChoice Value Bronze 3000,10091OR038,,ORN003,ORS001,ORF002,New,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969571&libID=4294969571,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380012-00,Standard Bronze Off Exchange Plan,60.38%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,140",$150,"$3,000",$0,"$1,140",$80,26
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380012,SmartChoice Value Bronze 3000,10091OR038,,ORN003,ORS001,ORF002,New,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969571&libID=4294969571,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380012-01,Standard Bronze On Exchange Plan,60.38%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,140",$150,"$3,000",$0,"$1,140",$80,27
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380012,SmartChoice Value Bronze 3000,10091OR038,,ORN003,ORS001,ORF002,New,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969571&libID=4294969571,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380012-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,28
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380012,SmartChoice Value Bronze 3000,10091OR038,,ORN003,ORS001,ORF002,New,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969571&libID=4294969571,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380012-03,Limited Cost Sharing Plan Variation,60.38%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,140",$150,"$3,000",$0,"$1,140",$80,29
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380011,SmartChoice Value Bronze 6250,10091OR038,,ORN003,ORS001,ORF001,New,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.999082161004638,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969572&libID=4294969572,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380011-00,Standard Bronze Off Exchange Plan,58.34%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,250",$0,$0,$150,"$5,270",$0,$0,$80,30
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380011,SmartChoice Value Bronze 6250,10091OR038,,ORN003,ORS001,ORF001,New,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.999082161004638,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969572&libID=4294969572,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380011-03,Limited Cost Sharing Plan Variation,58.34%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,250",$0,$0,$150,"$5,270",$0,$0,$80,33
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380014,SmartChoice Value Silver 3000,10091OR038,,ORN003,ORS001,ORF001,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.999083480122486,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969573&libID=4294969573,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380014-00,Standard Silver Off Exchange Plan,71.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$3,000",$0,$0,$150,"$3,000",$0,$0,$80,34
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380014,SmartChoice Value Silver 3000,10091OR038,,ORN003,ORS001,ORF001,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.999083480122486,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969573&libID=4294969573,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380014-01,Standard Silver On Exchange Plan,71.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$3,000",$0,$0,$150,"$3,000",$0,$0,$80,35
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380014,SmartChoice Value Silver 3000,10091OR038,,ORN003,ORS001,ORF001,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.999083480122486,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969573&libID=4294969573,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380014-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,36
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380006,SmartHealth Value Bronze 6250,10091OR038,,ORN002,ORS002,ORF001,Existing,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.998773426730428,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969583&libID=4294969583,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380006-03,Limited Cost Sharing Plan Variation,58.34%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,"$6,250","$12,500",0%,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,250",$0,$0,$150,"$5,270",$0,$0,$80,55
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380009,SmartHealth Value Silver 3000,10091OR038,,ORN002,ORS002,ORF001,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.998772955832834,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969584&libID=4294969584,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380009-00,Standard Silver Off Exchange Plan,68.93%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,000","$12,000","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,"$6,000","$12,000",0%,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,000",$0,$0,$150,"$3,000",$0,$0,$80,56
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,2,10091,OR,Individual,No,93-0245545,10091OR0390012,SmartChoice Balance Bronze 6600,10091OR039,,ORN003,ORS001,ORF001,New,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969564&libID=4294969564,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390012-03,Limited Cost Sharing Plan Variation,61.68%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,11
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,2,10091,OR,Individual,No,93-0245545,10091OR0390005,SmartHealth Balance Bronze 6600,10091OR039,,ORN002,ORS002,ORF001,Existing,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969575&libID=4294969575,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390005-00,Standard Bronze Off Exchange Plan,61.99%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,"$6,600","$13,200",0%,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,12
2015,OR,25486,SERFF,10,2014-11-14 14:52:18,1,25486,OR,Individual,Yes,93-0896677,25486OR0020001,SmartSmile,25486OR002,,ORN001,ORS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.20,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency coverage only - for the relief of pain, swelling, and bleeding.",Yes,"Emergency coverage only - for the relief of pain, swelling, and bleeding.",No,,https://www.dentalhealthservices.com/or/payment.cfm,,,25486OR0020001-00,Standard Low Off Exchange Plan,71.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OR,25486,SERFF,10,2014-11-14 14:52:18,1,25486,OR,Individual,Yes,93-0896677,25486OR0020001,SmartSmile,25486OR002,,ORN001,ORS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.20,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency coverage only - for the relief of pain, swelling, and bleeding.",Yes,"Emergency coverage only - for the relief of pain, swelling, and bleeding.",No,,https://www.dentalhealthservices.com/or/payment.cfm,,,25486OR0020001-01,Standard Low On Exchange Plan,71.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OR,25486,SERFF,10,2014-11-14 14:52:18,1,25486,OR,Individual,Yes,93-0896677,25486OR0020002,Super SmartSmile,25486OR002,,ORN001,ORS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.20,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency coverage only - for the relief of pain, swelling, and bleeding.",Yes,"Emergency coverage only - for the relief of pain, swelling, and bleeding.",No,,https://www.dentalhealthservices.com/or/payment.cfm,,,25486OR0020002-00,Standard Low Off Exchange Plan,71.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OR,25486,SERFF,10,2014-11-14 14:52:18,1,25486,OR,Individual,Yes,93-0896677,25486OR0020002,Super SmartSmile,25486OR002,,ORN001,ORS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$18.20,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency coverage only - for the relief of pain, swelling, and bleeding.",Yes,"Emergency coverage only - for the relief of pain, swelling, and bleeding.",No,,https://www.dentalhealthservices.com/or/payment.cfm,,,25486OR0020002-01,Standard Low On Exchange Plan,71.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OR,25486,SERFF,10,2014-11-14 14:52:18,1,25486,OR,Individual,Yes,93-0896677,25486OR0020003,SmartSmile Plus,25486OR002,,ORN001,ORS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.00,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency coverage only - for the relief of pain, swelling, and bleeding.",Yes,"Emergency coverage only - for the relief of pain, swelling, and bleeding.",No,,https://www.dentalhealthservices.com/or/payment.cfm,,,25486OR0020003-00,Standard High Off Exchange Plan,84.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,OR,25486,SERFF,10,2014-11-14 14:52:18,1,25486,OR,Individual,Yes,93-0896677,25486OR0020003,SmartSmile Plus,25486OR002,,ORN001,ORS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.00,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,Yes,"Emergency coverage only - for the relief of pain, swelling, and bleeding.",Yes,"Emergency coverage only - for the relief of pain, swelling, and bleeding.",No,,https://www.dentalhealthservices.com/or/payment.cfm,,,25486OR0020003-01,Standard High On Exchange Plan,84.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,4,39424,OR,Individual,No,93-0989307,39424OR1270001,Be Focused (CCN),39424OR127,,ORN002,ORS003,ORF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeFocused_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeFocused_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1270001-03,Limited Cost Sharing Plan Variation,,0.790212750434875,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$0,$500,$200,$500,$400,$100,$80,7
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,4,39424,OR,Individual,No,93-0989307,39424OR1270002,Be Focused (Rose City),39424OR127,,ORN003,ORS002,ORF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeFocusedRC_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeFocusedRC_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1270002-00,Standard Gold Off Exchange Plan,,0.790212750434875,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$0,$500,$200,$500,$400,$100,$80,8
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380014,SmartChoice Value Silver 3000,10091OR038,,ORN003,ORS001,ORF001,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.999083480122486,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969573&libID=4294969573,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380014-03,Limited Cost Sharing Plan Variation,71.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$3,000",$0,$0,$150,"$3,000",$0,$0,$80,37
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380014,SmartChoice Value Silver 3000,10091OR038,,ORN003,ORS001,ORF001,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.999083480122486,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969573&libID=4294969573,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380014-04,73% AV Level Silver Plan,73.89%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,650","$5,300",0%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,700",$0,$0,$150,"$2,700",$0,$0,$80,38
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380014,SmartChoice Value Silver 3000,10091OR038,,ORN003,ORS001,ORF001,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.999083480122486,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969573&libID=4294969573,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380014-05,87% AV Level Silver Plan,87.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$1,000",$0,$0,$150,"$1,000",$0,$0,$80,39
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380014,SmartChoice Value Silver 3000,10091OR038,,ORN003,ORS001,ORF001,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.999083480122486,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969573&libID=4294969573,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380014-06,94% AV Level Silver Plan,94.49%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,0%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$400,$0,$0,$150,$400,$0,$0,$80,40
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380013,SmartChoice Value Silver 3600,10091OR038,,ORN003,ORS001,ORF001,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969574&libID=4294969574,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380013-00,Standard Silver Off Exchange Plan,68.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,600",$0,$0,$150,"$3,600",$0,$0,$80,41
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380013,SmartChoice Value Silver 3600,10091OR038,,ORN003,ORS001,ORF001,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969574&libID=4294969574,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380013-01,Standard Silver On Exchange Plan,68.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,600",$0,$0,$150,"$3,600",$0,$0,$80,42
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380013,SmartChoice Value Silver 3600,10091OR038,,ORN003,ORS001,ORF001,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969574&libID=4294969574,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380013-04,73% AV Level Silver Plan,73.56%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,700","$5,400",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,700",$0,$0,$150,"$2,700",$0,$0,$80,45
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380013,SmartChoice Value Silver 3600,10091OR038,,ORN003,ORS001,ORF001,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969574&libID=4294969574,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380013-05,87% AV Level Silver Plan,87.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000",$0,$0,$150,"$1,000",$0,$0,$80,46
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380007,SmartHealth Value Bronze 3000,10091OR038,,ORN002,ORS002,ORF002,Existing,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969582&libID=4294969582,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380007-01,Standard Bronze On Exchange Plan,59.83%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,"$6,450","$12,900",0%,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,140",$150,"$3,000",$0,"$1,140",$80,49
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380007,SmartHealth Value Bronze 3000,10091OR038,,ORN002,ORS002,ORF002,Existing,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969582&libID=4294969582,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380007-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,50
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380007,SmartHealth Value Bronze 3000,10091OR038,,ORN002,ORS002,ORF002,Existing,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969582&libID=4294969582,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380007-03,Limited Cost Sharing Plan Variation,59.83%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",50%,"$6,450","$12,900",0%,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,000",$0,"$2,140",$150,"$3,000",$0,"$1,140",$80,51
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380006,SmartHealth Value Bronze 6250,10091OR038,,ORN002,ORS002,ORF001,Existing,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.998773426730428,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969583&libID=4294969583,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380006-00,Standard Bronze Off Exchange Plan,58.34%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,"$6,250","$12,500",0%,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,250",$0,$0,$150,"$5,270",$0,$0,$80,52
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380006,SmartHealth Value Bronze 6250,10091OR038,,ORN002,ORS002,ORF001,Existing,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.998773426730428,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969583&libID=4294969583,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380006-01,Standard Bronze On Exchange Plan,58.34%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500",0%,"$6,250","$12,500",0%,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,250",$0,$0,$150,"$5,270",$0,$0,$80,53
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380006,SmartHealth Value Bronze 6250,10091OR038,,ORN002,ORS002,ORF001,Existing,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.998773426730428,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969583&libID=4294969583,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,54
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380009,SmartHealth Value Silver 3000,10091OR038,,ORN002,ORS002,ORF001,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.998772955832834,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969584&libID=4294969584,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380009-01,Standard Silver On Exchange Plan,68.93%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,000","$12,000","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,"$6,000","$12,000",0%,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,000",$0,$0,$150,"$3,000",$0,$0,$80,57
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380009,SmartHealth Value Silver 3000,10091OR038,,ORN002,ORS002,ORF001,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.998772955832834,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969584&libID=4294969584,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380009-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,58
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380009,SmartHealth Value Silver 3000,10091OR038,,ORN002,ORS002,ORF001,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.998772955832834,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969584&libID=4294969584,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380009-03,Limited Cost Sharing Plan Variation,68.93%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,000","$12,000","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,"$6,000","$12,000",0%,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,000",$0,$0,$150,"$3,000",$0,$0,$80,59
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380009,SmartHealth Value Silver 3000,10091OR038,,ORN002,ORS002,ORF001,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.998772955832834,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969584&libID=4294969584,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380009-04,73% AV Level Silver Plan,73.68%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,500","$5,000","$3,500","$7,000","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",0%,"$3,500","$7,000",0%,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,500",$0,$0,$150,"$3,000",$0,$0,$80,60
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380009,SmartHealth Value Silver 3000,10091OR038,,ORN002,ORS002,ORF001,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.998772955832834,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969584&libID=4294969584,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380009-05,87% AV Level Silver Plan,86.86%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$900,"$1,800","$1,900","$3,800","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$900,"$1,800",0%,"$1,900","$3,800",0%,"$10,000","$20,000",Not Applicable,Not Applicable,$900,$0,$0,$150,$900,$0,$0,$80,61
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380009,SmartHealth Value Silver 3000,10091OR038,,ORN002,ORS002,ORF001,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.998772955832834,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969584&libID=4294969584,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380009-06,94% AV Level Silver Plan,93.35%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$400,$800,$900,"$1,800","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,0%,$900,"$1,800",0%,"$10,000","$20,000",Not Applicable,Not Applicable,$400,$0,$0,$150,$400,$0,$0,$80,62
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380008,SmartHealth Value Silver 3600,10091OR038,,ORN002,ORS002,ORF001,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969585&libID=4294969585,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380008-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$3,600","$7,200","$4,000","$8,000","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,"$4,000","$8,000",0%,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,600",$0,$0,$150,"$3,600",$0,$0,$80,63
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380008,SmartHealth Value Silver 3600,10091OR038,,ORN002,ORS002,ORF001,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969585&libID=4294969585,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380008-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$3,600","$7,200","$4,000","$8,000","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,"$4,000","$8,000",0%,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,600",$0,$0,$150,"$3,600",$0,$0,$80,64
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380008,SmartHealth Value Silver 3600,10091OR038,,ORN002,ORS002,ORF001,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969585&libID=4294969585,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380008-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,65
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380008,SmartHealth Value Silver 3600,10091OR038,,ORN002,ORS002,ORF001,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969585&libID=4294969585,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380008-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$3,600","$7,200","$4,000","$8,000","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200",0%,"$4,000","$8,000",0%,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,600",$0,$0,$150,"$3,600",$0,$0,$80,66
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380008,SmartHealth Value Silver 3600,10091OR038,,ORN002,ORS002,ORF001,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969585&libID=4294969585,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380008-04,73% AV Level Silver Plan,72.83%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$2,700","$5,400","$4,000","$8,000","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400",0%,"$4,000","$8,000",0%,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,750",$0,$0,$150,"$2,750",$0,$0,$80,67
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380008,SmartHealth Value Silver 3600,10091OR038,,ORN002,ORS002,ORF001,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969585&libID=4294969585,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380008-05,87% AV Level Silver Plan,86.77%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,"$2,000","$4,000",0%,"$10,000","$20,000",Not Applicable,Not Applicable,$900,$0,$0,$150,$900,$0,$0,$80,68
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,1,10091,OR,Individual,No,93-0245545,10091OR0380008,SmartHealth Value Silver 3600,10091OR038,,ORN002,ORS002,ORF001,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969585&libID=4294969585,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0380008-06,94% AV Level Silver Plan,94.03%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,$400,$800,$800,"$1,600","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,0%,$800,"$1,600",0%,"$10,000","$20,000",Not Applicable,Not Applicable,$400,$0,$0,$150,$400,$0,$0,$80,69
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,2,10091,OR,Individual,No,93-0245545,10091OR0390003,Balance Bronze PSN 6600,10091OR039,,ORN001,ORS004,ORF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969553&libID=4294969553,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390003-00,Standard Bronze Off Exchange Plan,61.24%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,4
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,2,10091,OR,Individual,No,93-0245545,10091OR0390003,Balance Bronze PSN 6600,10091OR039,,ORN001,ORS004,ORF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969553&libID=4294969553,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390003-01,Standard Bronze On Exchange Plan,61.24%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,5
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,2,10091,OR,Individual,No,93-0245545,10091OR0390003,Balance Bronze PSN 6600,10091OR039,,ORN001,ORS004,ORF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969553&libID=4294969553,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,2,10091,OR,Individual,No,93-0245545,10091OR0390003,Balance Bronze PSN 6600,10091OR039,,ORN001,ORS004,ORF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969553&libID=4294969553,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390003-03,Limited Cost Sharing Plan Variation,61.24%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,7
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,2,10091,OR,Individual,No,93-0245545,10091OR0390012,SmartChoice Balance Bronze 6600,10091OR039,,ORN003,ORS001,ORF001,New,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969564&libID=4294969564,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390012-00,Standard Bronze Off Exchange Plan,61.68%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,8
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,2,10091,OR,Individual,No,93-0245545,10091OR0390012,SmartChoice Balance Bronze 6600,10091OR039,,ORN003,ORS001,ORF001,New,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969564&libID=4294969564,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390012-01,Standard Bronze On Exchange Plan,61.68%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,9
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,2,10091,OR,Individual,No,93-0245545,10091OR0390012,SmartChoice Balance Bronze 6600,10091OR039,,ORN003,ORS001,ORF001,New,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969564&libID=4294969564,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390012-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,2,10091,OR,Individual,No,93-0245545,10091OR0390005,SmartHealth Balance Bronze 6600,10091OR039,,ORN002,ORS002,ORF001,Existing,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969575&libID=4294969575,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390005-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,"$6,600","$13,200",0%,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,13
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,2,10091,OR,Individual,No,93-0245545,10091OR0390005,SmartHealth Balance Bronze 6600,10091OR039,,ORN002,ORS002,ORF001,Existing,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969575&libID=4294969575,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390005-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,14
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,2,10091,OR,Individual,No,93-0245545,10091OR0390005,SmartHealth Balance Bronze 6600,10091OR039,,ORN002,ORS002,ORF001,Existing,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969575&libID=4294969575,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390005-03,Limited Cost Sharing Plan Variation,61.99%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,"$6,600","$13,200",0%,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,15
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390011,Balance Silver PSN 1500 AC,10091OR039,,ORN001,ORS004,ORF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.990163303630264,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969554&libID=4294969554,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390011-00,Standard Silver Off Exchange Plan,70.79%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$510,$310,$80,4
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,Yes,93-0245545,10091OR0490001,Dental Advantage 0/20/50,10091OR049,,ORN004,ORS003,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",No,http://www.pacificsource.com/2015-oregon-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,,10091OR0490001-00,Standard High Off Exchange Plan,86.53%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,Yes,93-0245545,10091OR0490001,Dental Advantage 0/20/50,10091OR049,,ORN004,ORS003,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$39.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.",No,http://www.pacificsource.com/2015-oregon-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,,10091OR0490001-01,Standard High On Exchange Plan,86.53%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390011,Balance Silver PSN 1500 AC,10091OR039,,ORN001,ORS004,ORF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.990163303630264,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969554&libID=4294969554,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390011-01,Standard Silver On Exchange Plan,70.79%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$510,$310,$80,5
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390011,Balance Silver PSN 1500 AC,10091OR039,,ORN001,ORS004,ORF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.990163303630264,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969554&libID=4294969554,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390011-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390011,Balance Silver PSN 1500 AC,10091OR039,,ORN001,ORS004,ORF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.990163303630264,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969554&libID=4294969554,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390011-03,Limited Cost Sharing Plan Variation,70.79%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$510,$310,$80,7
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390011,Balance Silver PSN 1500 AC,10091OR039,,ORN001,ORS004,ORF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.990163303630264,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969554&libID=4294969554,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390011-04,73% AV Level Silver Plan,73.42%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$510,$310,$80,8
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390011,Balance Silver PSN 1500 AC,10091OR039,,ORN001,ORS004,ORF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.990163303630264,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969554&libID=4294969554,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390011-05,87% AV Level Silver Plan,87.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,$0,"$1,250",$150,$500,$290,$240,$80,9
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390011,Balance Silver PSN 1500 AC,10091OR039,,ORN001,ORS004,ORF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.990163303630264,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969554&libID=4294969554,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390011-06,94% AV Level Silver Plan,93.48%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$0,$550,$150,$200,$300,$120,$80,10
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390004,Balance Silver PSN 2500 AC,10091OR039,,ORN001,ORS004,ORF009,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.989286639493681,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969555&libID=4294969555,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390004-00,Standard Silver Off Exchange Plan,68.28%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,430",$150,"$2,500",$380,$230,$80,11
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390004,Balance Silver PSN 2500 AC,10091OR039,,ORN001,ORS004,ORF009,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.989286639493681,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969555&libID=4294969555,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390004-01,Standard Silver On Exchange Plan,68.28%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,430",$150,"$2,500",$380,$230,$80,12
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390004,Balance Silver PSN 2500 AC,10091OR039,,ORN001,ORS004,ORF009,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.989286639493681,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969555&libID=4294969555,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,13
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390004,Balance Silver PSN 2500 AC,10091OR039,,ORN001,ORS004,ORF009,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.989286639493681,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969555&libID=4294969555,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390004-03,Limited Cost Sharing Plan Variation,68.28%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,430",$150,"$2,500",$380,$230,$80,14
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390004,Balance Silver PSN 2500 AC,10091OR039,,ORN001,ORS004,ORF009,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.989286639493681,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969555&libID=4294969555,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390004-04,73% AV Level Silver Plan,73.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$1,600",$20,"$1,700",$150,"$1,600",$430,$280,$80,15
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390004,Balance Silver PSN 2500 AC,10091OR039,,ORN001,ORS004,ORF009,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.989286639493681,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969555&libID=4294969555,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390004-05,87% AV Level Silver Plan,87.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,$10,"$1,250",$150,$500,$390,$240,$80,16
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390004,Balance Silver PSN 2500 AC,10091OR039,,ORN001,ORS004,ORF009,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.989286639493681,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969555&libID=4294969555,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390004-06,94% AV Level Silver Plan,93.48%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$200,$0,$550,$150,$200,$300,$120,$80,17
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390015,SmartChoice Balance Silver 1500 AC,10091OR039,,ORN003,ORS001,ORF009,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.984948962151096,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969565&libID=4294969565,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390015-00,Standard Silver Off Exchange Plan,71.36%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$430,$310,$80,18
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390015,SmartChoice Balance Silver 1500 AC,10091OR039,,ORN003,ORS001,ORF009,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.984948962151096,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969565&libID=4294969565,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390015-03,Limited Cost Sharing Plan Variation,71.36%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$430,$310,$80,21
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390015,SmartChoice Balance Silver 1500 AC,10091OR039,,ORN003,ORS001,ORF009,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.984948962151096,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969565&libID=4294969565,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390015-04,73% AV Level Silver Plan,73.42%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$430,$310,$80,22
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390015,SmartChoice Balance Silver 1500 AC,10091OR039,,ORN003,ORS001,ORF009,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.984948962151096,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969565&libID=4294969565,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390015-05,87% AV Level Silver Plan,87.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,$0,"$1,250",$150,$500,$390,$240,$80,23
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390015,SmartChoice Balance Silver 1500 AC,10091OR039,,ORN003,ORS001,ORF009,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.984948962151096,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969565&libID=4294969565,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390015-06,94% AV Level Silver Plan,93.48%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$0,$550,$150,$200,$300,$120,$80,24
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390014,SmartChoice Balance Silver 2500 AC,10091OR039,,ORN003,ORS001,ORF009,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.984188004433449,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969566&libID=4294969566,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390014-00,Standard Silver Off Exchange Plan,68.83%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,430",$150,"$2,500",$320,$230,$80,25
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390014,SmartChoice Balance Silver 2500 AC,10091OR039,,ORN003,ORS001,ORF009,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.984188004433449,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969566&libID=4294969566,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390014-01,Standard Silver On Exchange Plan,68.83%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,430",$150,"$2,500",$320,$230,$80,26
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390014,SmartChoice Balance Silver 2500 AC,10091OR039,,ORN003,ORS001,ORF009,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.984188004433449,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969566&libID=4294969566,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390014-04,73% AV Level Silver Plan,73.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$1,600",$20,"$1,700",$150,"$1,600",$430,$280,$80,29
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390014,SmartChoice Balance Silver 2500 AC,10091OR039,,ORN003,ORS001,ORF009,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.984188004433449,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969566&libID=4294969566,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390014-05,87% AV Level Silver Plan,87.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,$10,"$1,250",$150,$500,$390,$240,$80,30
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390014,SmartChoice Balance Silver 2500 AC,10091OR039,,ORN003,ORS001,ORF009,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.984188004433449,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969566&libID=4294969566,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390014-06,94% AV Level Silver Plan,93.48%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$200,$20,$550,$150,$200,$300,$120,$80,31
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390009,SmartHealth Balance Silver 1500 AC,10091OR039,,ORN002,ORS002,ORF009,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.984688928756481,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969576&libID=4294969576,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390009-00,Standard Silver Off Exchange Plan,70.74%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,"$2,500","$5,000",40%,"$7,500","$15,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$430,$310,$80,32
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390009,SmartHealth Balance Silver 1500 AC,10091OR039,,ORN002,ORS002,ORF009,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.984688928756481,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969576&libID=4294969576,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390009-01,Standard Silver On Exchange Plan,70.74%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,"$2,500","$5,000",40%,"$7,500","$15,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$430,$310,$80,33
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390009,SmartHealth Balance Silver 1500 AC,10091OR039,,ORN002,ORS002,ORF009,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.984688928756481,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969576&libID=4294969576,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390009-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,34
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390009,SmartHealth Balance Silver 1500 AC,10091OR039,,ORN002,ORS002,ORF009,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.984688928756481,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969576&libID=4294969576,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390009-03,Limited Cost Sharing Plan Variation,70.74%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,"$2,500","$5,000",40%,"$7,500","$15,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$430,$310,$80,35
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390009,SmartHealth Balance Silver 1500 AC,10091OR039,,ORN002,ORS002,ORF009,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.984688928756481,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969576&libID=4294969576,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390009-04,73% AV Level Silver Plan,72.88%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,"$2,500","$5,000",40%,"$7,500","$15,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$430,$310,$80,36
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390008,SmartHealth Balance Silver 2500 AC,10091OR039,,ORN002,ORS002,ORF009,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.983746093136647,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969577&libID=4294969577,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390008-00,Standard Silver Off Exchange Plan,68.37%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$3,000","$6,000",40%,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,430",$150,"$2,500",$500,$230,$80,39
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390008,SmartHealth Balance Silver 2500 AC,10091OR039,,ORN002,ORS002,ORF009,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.983746093136647,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969577&libID=4294969577,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390008-01,Standard Silver On Exchange Plan,68.37%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$6,450","$12,900","$6,450","$12,900","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$3,000","$6,000",40%,"$7,500","$15,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,430",$150,"$2,500",$320,$230,$80,40
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390008,SmartHealth Balance Silver 2500 AC,10091OR039,,ORN002,ORS002,ORF009,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.983746093136647,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969577&libID=4294969577,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390008-04,73% AV Level Silver Plan,72.64%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200",30%,"$2,600","$5,200",40%,"$7,500","$15,000",Not Applicable,Not Applicable,"$1,600",$20,"$1,700",$150,"$1,600",$430,$280,$80,43
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390008,SmartHealth Balance Silver 2500 AC,10091OR039,,ORN002,ORS002,ORF009,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.983746093136647,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969577&libID=4294969577,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390008-05,87% AV Level Silver Plan,86.78%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,"$1,750","$3,500","$1,750","$3,500","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,"$1,000","$2,000",20%,"$7,500","$15,000",Not Applicable,Not Applicable,$500,$0,"$1,250",$150,$500,$390,$240,$80,44
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,3,10091,OR,Individual,No,93-0245545,10091OR0390008,SmartHealth Balance Silver 2500 AC,10091OR039,,ORN002,ORS002,ORF009,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.983746093136647,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969577&libID=4294969577,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0390008-06,94% AV Level Silver Plan,93.08%,,Yes,Yes,Yes,90%,10%,,,,,,,,,,,,,,,,,$800,"$1,600",$800,"$1,600","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,$400,$800,20%,"$7,500","$15,000",Not Applicable,Not Applicable,$200,$0,$500,$150,$200,$300,$120,$80,45
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,4,10091,OR,Individual,No,93-0245545,10091OR0370003,Catastrophic PSN,10091OR037,,ORN001,ORS004,ORF003,New,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,3,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969556&libID=4294969556,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0370003-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,4
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,4,10091,OR,Individual,No,93-0245545,10091OR0370003,Catastrophic PSN,10091OR037,,ORN001,ORS004,ORF003,New,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,3,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969556&libID=4294969556,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0370003-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,5
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,4,10091,OR,Individual,No,93-0245545,10091OR0370004,SmartChoice Catastrophic,10091OR037,,ORN003,ORS001,ORF003,New,PPO,Catastrophic,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,3,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969567&libID=4294969567,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0370004-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,6
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,4,10091,OR,Individual,No,93-0245545,10091OR0370004,SmartChoice Catastrophic,10091OR037,,ORN003,ORS001,ORF003,New,PPO,Catastrophic,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,3,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969567&libID=4294969567,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0370004-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,7
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,4,10091,OR,Individual,No,93-0245545,10091OR0370002,SmartHealth Catastrophic,10091OR037,,ORN002,ORS002,ORF003,Existing,PPO,Catastrophic,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,3,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969578&libID=4294969578,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0370002-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,"$6,600","$13,200",0%,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,8
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,4,10091,OR,Individual,No,93-0245545,10091OR0370002,SmartHealth Catastrophic,10091OR037,,ORN002,ORS002,ORF003,Existing,PPO,Catastrophic,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,3,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969578&libID=4294969578,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0370002-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,"$6,600","$13,200",0%,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,9
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,5,10091,OR,Individual,No,93-0245545,10091OR0360004,PacificSource Oregon Standard Bronze Plan PSN,10091OR036,,ORN001,ORS004,ORF011,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969557&libID=4294969557,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360004-00,Standard Bronze Off Exchange Plan,58.71%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,"$5,000",$60,$70,$80,4
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,5,10091,OR,Individual,Yes,93-0245545,10091OR0480001,Dental Advantage Essentials Core,10091OR048,,ORN005,ORS005,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.00,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,No,,No,http://www.pacificsource.com/2015-oregon-individual-plan-details/,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,,10091OR0480001-01,Standard High On Exchange Plan,84.66%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,5,10091,OR,Individual,No,93-0245545,10091OR0360004,PacificSource Oregon Standard Bronze Plan PSN,10091OR036,,ORN001,ORS004,ORF011,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969557&libID=4294969557,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360004-01,Standard Bronze On Exchange Plan,58.71%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,"$5,000",$60,$70,$80,5
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,5,10091,OR,Individual,No,93-0245545,10091OR0360004,PacificSource Oregon Standard Bronze Plan PSN,10091OR036,,ORN001,ORS004,ORF011,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969557&libID=4294969557,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,5,10091,OR,Individual,No,93-0245545,10091OR0360004,PacificSource Oregon Standard Bronze Plan PSN,10091OR036,,ORN001,ORS004,ORF011,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969557&libID=4294969557,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360004-03,Limited Cost Sharing Plan Variation,58.71%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,"$5,000",$60,$70,$80,7
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,5,10091,OR,Individual,No,93-0245545,10091OR0360010,PacificSource Oregon Standard Bronze Plan SCN,10091OR036,,ORN003,ORS001,ORF011,New,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969568&libID=4294969568,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360010-00,Standard Bronze Off Exchange Plan,58.71%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,"$5,000",$60,$70,$80,8
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,5,10091,OR,Individual,No,93-0245545,10091OR0360010,PacificSource Oregon Standard Bronze Plan SCN,10091OR036,,ORN003,ORS001,ORF011,New,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969568&libID=4294969568,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360010-01,Standard Bronze On Exchange Plan,58.71%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,"$5,000",$60,$70,$80,9
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,5,10091,OR,Individual,No,93-0245545,10091OR0360010,PacificSource Oregon Standard Bronze Plan SCN,10091OR036,,ORN003,ORS001,ORF011,New,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969568&libID=4294969568,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360010-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,5,10091,OR,Individual,No,93-0245545,10091OR0360010,PacificSource Oregon Standard Bronze Plan SCN,10091OR036,,ORN003,ORS001,ORF011,New,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969568&libID=4294969568,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360010-03,Limited Cost Sharing Plan Variation,58.71%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,"$5,000",$60,$70,$80,11
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,5,10091,OR,Individual,No,93-0245545,10091OR0360006,PacificSource Oregon Standard Bronze Plan SHN,10091OR036,,ORN002,ORS002,ORF011,Existing,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969579&libID=4294969579,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360006-00,Standard Bronze Off Exchange Plan,58.71%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,"$5,000","$10,000",50%,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,"$5,000",$60,$70,$80,12
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,5,10091,OR,Individual,No,93-0245545,10091OR0360006,PacificSource Oregon Standard Bronze Plan SHN,10091OR036,,ORN002,ORS002,ORF011,Existing,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969579&libID=4294969579,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360006-01,Standard Bronze On Exchange Plan,58.71%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,"$5,000","$10,000",50%,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,"$5,000",$60,$70,$80,13
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,5,10091,OR,Individual,No,93-0245545,10091OR0360006,PacificSource Oregon Standard Bronze Plan SHN,10091OR036,,ORN002,ORS002,ORF011,Existing,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969579&libID=4294969579,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,14
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,5,10091,OR,Individual,No,93-0245545,10091OR0360006,PacificSource Oregon Standard Bronze Plan SHN,10091OR036,,ORN002,ORS002,ORF011,Existing,PPO,Bronze,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969579&libID=4294969579,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360006-03,Limited Cost Sharing Plan Variation,58.71%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$20,000","$40,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,"$5,000","$10,000",50%,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,"$5,000",$60,$70,$80,15
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360005,PacificSource Oregon Standard Silver Plan PSN,10091OR036,,ORN001,ORS004,ORF010,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969559&libID=4294969559,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360005-00,Standard Silver Off Exchange Plan,68.37%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,"$2,500",$500,$230,$80,4
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360005,PacificSource Oregon Standard Silver Plan PSN,10091OR036,,ORN001,ORS004,ORF010,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969559&libID=4294969559,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360005-01,Standard Silver On Exchange Plan,68.37%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,"$2,500",$500,$230,$80,5
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360005,PacificSource Oregon Standard Silver Plan PSN,10091OR036,,ORN001,ORS004,ORF010,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969559&libID=4294969559,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360005-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360005,PacificSource Oregon Standard Silver Plan PSN,10091OR036,,ORN001,ORS004,ORF010,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969559&libID=4294969559,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360005-03,Limited Cost Sharing Plan Variation,68.37%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,"$2,500",$500,$230,$80,7
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360005,PacificSource Oregon Standard Silver Plan PSN,10091OR036,,ORN001,ORS004,ORF010,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969559&libID=4294969559,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360005-06,94% AV Level Silver Plan,93.89%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$15,000","$30,000",Not Applicable,Not Applicable,$100,$200,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$100,$0,$650,$150,$100,$300,$130,$80,10
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360009,PacificSource Oregon Standard Gold Plan PSN,10091OR036,,ORN001,ORS004,ORF008,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969558&libID=4294969558,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360009-00,Standard Gold Off Exchange Plan,78.22%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$600,$150,"$1,300",$460,$110,$80,11
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360009,PacificSource Oregon Standard Gold Plan PSN,10091OR036,,ORN001,ORS004,ORF008,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969558&libID=4294969558,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360009-01,Standard Gold On Exchange Plan,78.22%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$600,$150,"$1,300",$460,$110,$80,12
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360009,PacificSource Oregon Standard Gold Plan PSN,10091OR036,,ORN001,ORS004,ORF008,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969558&libID=4294969558,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360009-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,13
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360009,PacificSource Oregon Standard Gold Plan PSN,10091OR036,,ORN001,ORS004,ORF008,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network is paid at non-participating benefit levels.,Yes,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969558&libID=4294969558,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360009-03,Limited Cost Sharing Plan Variation,78.22%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$600,$150,"$1,300",$460,$110,$80,14
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360011,PacificSource Oregon Standard Silver Plan SCN,10091OR036,,ORN003,ORS001,ORF010,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969570&libID=4294969570,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360011-00,Standard Silver Off Exchange Plan,68.37%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,"$2,500",$500,$230,$80,15
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360011,PacificSource Oregon Standard Silver Plan SCN,10091OR036,,ORN003,ORS001,ORF010,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969570&libID=4294969570,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360011-01,Standard Silver On Exchange Plan,68.37%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,"$2,500",$500,$230,$80,16
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360011,PacificSource Oregon Standard Silver Plan SCN,10091OR036,,ORN003,ORS001,ORF010,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969570&libID=4294969570,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360011-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,17
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360011,PacificSource Oregon Standard Silver Plan SCN,10091OR036,,ORN003,ORS001,ORF010,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969570&libID=4294969570,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360011-03,Limited Cost Sharing Plan Variation,68.37%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,"$2,500",$500,$230,$80,18
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360011,PacificSource Oregon Standard Silver Plan SCN,10091OR036,,ORN003,ORS001,ORF010,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969570&libID=4294969570,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360011-04,73% AV Level Silver Plan,72.93%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,"$2,500",$500,$230,$80,19
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360011,PacificSource Oregon Standard Silver Plan SCN,10091OR036,,ORN003,ORS001,ORF010,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969570&libID=4294969570,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360011-05,87% AV Level Silver Plan,87.09%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$15,000","$30,000",Not Applicable,Not Applicable,$750,"$1,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$20,$650,$150,$750,$660,$90,$80,20
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360011,PacificSource Oregon Standard Silver Plan SCN,10091OR036,,ORN003,ORS001,ORF010,New,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969570&libID=4294969570,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360011-06,94% AV Level Silver Plan,93.89%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$15,000","$30,000",Not Applicable,Not Applicable,$100,$200,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$100,$0,$650,$150,$100,$300,$130,$80,21
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360012,PacificSource Oregon Standard Gold Plan SCN,10091OR036,,ORN003,ORS001,ORF008,New,PPO,Gold,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969569&libID=4294969569,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360012-00,Standard Gold Off Exchange Plan,78.22%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$600,$150,"$1,300",$460,$110,$80,22
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360012,PacificSource Oregon Standard Gold Plan SCN,10091OR036,,ORN003,ORS001,ORF008,New,PPO,Gold,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969569&libID=4294969569,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360012-01,Standard Gold On Exchange Plan,78.22%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$600,$150,"$1,300",$460,$110,$80,23
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360012,PacificSource Oregon Standard Gold Plan SCN,10091OR036,,ORN003,ORS001,ORF008,New,PPO,Gold,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969569&libID=4294969569,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360012-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,24
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360012,PacificSource Oregon Standard Gold Plan SCN,10091OR036,,ORN003,ORS001,ORF008,New,PPO,Gold,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartChoice network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969569&libID=4294969569,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360012-03,Limited Cost Sharing Plan Variation,78.22%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$600,$150,"$1,300",$460,$110,$80,25
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360007,PacificSource Oregon Standard Silver Plan SHN,10091OR036,,ORN002,ORS002,ORF010,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969581&libID=4294969581,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360007-00,Standard Silver Off Exchange Plan,68.37%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,"$2,500","$5,000",30%,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,"$2,500",$500,$230,$80,26
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360007,PacificSource Oregon Standard Silver Plan SHN,10091OR036,,ORN002,ORS002,ORF010,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969581&libID=4294969581,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360007-01,Standard Silver On Exchange Plan,68.37%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,"$2,500","$5,000",30%,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,"$2,500",$500,$230,$80,27
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360007,PacificSource Oregon Standard Silver Plan SHN,10091OR036,,ORN002,ORS002,ORF010,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969581&libID=4294969581,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360007-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,28
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360007,PacificSource Oregon Standard Silver Plan SHN,10091OR036,,ORN002,ORS002,ORF010,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969581&libID=4294969581,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360007-03,Limited Cost Sharing Plan Variation,68.37%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$15,000","$30,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,"$2,500","$5,000",30%,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,"$2,500",$500,$230,$80,29
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360007,PacificSource Oregon Standard Silver Plan SHN,10091OR036,,ORN002,ORS002,ORF010,Existing,PPO,Silver,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969581&libID=4294969581,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360007-06,94% AV Level Silver Plan,93.89%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$750,"$1,500",$750,"$1,500","$15,000","$30,000",Not Applicable,Not Applicable,$100,$200,10%,$100,$200,10%,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$100,$0,$650,$150,$100,$300,$130,$80,32
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360008,PacificSource Oregon Standard Gold Plan SHN,10091OR036,,ORN002,ORS002,ORF010,Existing,PPO,Gold,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969580&libID=4294969580,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360008-00,Standard Gold Off Exchange Plan,78.22%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$1,300","$2,600",10%,"$1,300","$2,600",10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$600,$150,"$1,300",$460,$110,$80,33
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360008,PacificSource Oregon Standard Gold Plan SHN,10091OR036,,ORN002,ORS002,ORF010,Existing,PPO,Gold,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969580&libID=4294969580,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360008-01,Standard Gold On Exchange Plan,78.22%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$1,300","$2,600",10%,"$1,300","$2,600",10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$600,$150,"$1,300",$460,$110,$80,34
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360008,PacificSource Oregon Standard Gold Plan SHN,10091OR036,,ORN002,ORS002,ORF010,Existing,PPO,Gold,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969580&libID=4294969580,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360008-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,35
2015,OR,10091,SERFF,14,2015-01-22 16:02:51,6,10091,OR,Individual,No,93-0245545,10091OR0360008,PacificSource Oregon Standard Gold Plan SHN,10091OR036,,ORN002,ORS002,ORF010,Existing,PPO,Gold,Yes,Both,No,Yes,"Referral authorization is not required for the following types of services or treatment, this list of procedures and services requiring referral is subject to revision and update: Anesthesia, Assistant surgeon, Diabetic education providers, Diagnostic testing, including but not limited to lab and radiology services, nerve conduction studies, treadmill tests, ECG testing and interpretation. Consultation with a specialist that results in a charge prior to or following diagnostic testing does require a referral. However, some services may require preauthorization, Emergency care is care which cannot be delayed due to injury or sudden illness, when a delay for the time required to reach a PCP or participating hospital would mean risking permanent damage to the patient's health, Mental health and chemical dependency outpatient services. You do not need a referral for office visits to a participating mental health or chemical dependency provider, Obstetric care and delivery. You do not need a referral to access maternity and delivery care from a participating women's healthcare provider. Women's healthcare providers include obstetricians, gynecologists, physician assistants specializing in women's health, and certified nurse midwives, Physical, occupational, and speech therapy, Routine vision exams and supplies (medical eye services do require referral unless emergency eye care.), Services coordinated and provided by your PCP, Services of a chiropractor or alternative care provider, Urgent care, and Women's routine gynecological exams. You may visit your PCP or any participating women's healthcare provider without a referral for annual preventive gynecological exams.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9992,,,0,0,0,2015-01-01,,Yes,Emergency care only,Yes,"Services received from providers outside the SmartHealth network are paid at non-participating benefit levels unless sought for urgent or emergent situations, referred by primary care provider, or authorized in advance",No,http://pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294969580&libID=4294969580,http://www.exchangepay.pacificsource.com/FFE/Individual/,http://www.pacificsource.com/2015-oregon-individual-plan-details/,www.pacificsource.com,10091OR0360008-03,Limited Cost Sharing Plan Variation,78.22%,,No,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000",Not Applicable,Not Applicable,"$1,300","$2,600",10%,"$1,300","$2,600",10%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,$0,$0,50%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$600,$150,"$1,300",$460,$110,$80,36
2015,OR,28415,SERFF,5,2014-10-06 10:59:03,1,28415,OR,Individual,Yes,93-0438772,28415OR0010001,Delta Dental PPO,28415OR001,,ORN001,ORS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Covered,Yes,National Network,Yes,,,,,28415OR0010001-00,Standard Low Off Exchange Plan,70.10%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OR,28415,SERFF,5,2014-10-06 10:59:03,1,28415,OR,Individual,Yes,93-0438772,28415OR0010001,Delta Dental PPO,28415OR001,,ORN001,ORS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Covered,Yes,National Network,Yes,,,,,28415OR0010001-01,Standard Low On Exchange Plan,70.10%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OR,28415,SERFF,5,2014-10-06 10:59:03,3,28415,OR,Individual,Yes,93-0438772,28415OR0010002,Delta Dental EPO,28415OR001,,ORN001,ORS001,,Existing,EPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Covered,Yes,National Network,Yes,,,,,28415OR0010002-00,Standard High Off Exchange Plan,85.50%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$50,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OR,28415,SERFF,5,2014-10-06 10:59:03,3,28415,OR,Individual,Yes,93-0438772,28415OR0010002,Delta Dental EPO,28415OR001,,ORN001,ORS001,,Existing,EPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.00,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Covered,Yes,National Network,Yes,,,,,28415OR0010002-01,Standard High On Exchange Plan,85.50%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$50,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,1,32536,OR,Individual,No,43-2071108,32536OR0020002,ATRIO Oregon Standard Gold Plan,32536OR002,,ORN001,ORS001,ORF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Nationwide,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020002-01-ATRIO-OREGON-STANDARD-GOLD-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020002-00,Standard Gold Off Exchange Plan,,0.780197143554688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,350","$12,700",Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,"$1,300","$2,600",Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,1,32536,OR,Individual,No,43-2071108,32536OR0020002,ATRIO Oregon Standard Gold Plan,32536OR002,,ORN001,ORS001,ORF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Nationwide,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020002-01-ATRIO-OREGON-STANDARD-GOLD-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020002-01,Standard Gold On Exchange Plan,,0.780197143554688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,350","$12,700",Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,"$1,300","$2,600",Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,1,32536,OR,Individual,No,43-2071108,32536OR0020002,ATRIO Oregon Standard Gold Plan,32536OR002,,ORN001,ORS001,ORF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Nationwide,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020002-01-ATRIO-OREGON-STANDARD-GOLD-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,1,32536,OR,Individual,No,43-2071108,32536OR0020002,ATRIO Oregon Standard Gold Plan,32536OR002,,ORN001,ORS001,ORF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Nationwide,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020002-01-ATRIO-OREGON-STANDARD-GOLD-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020002-03,Limited Cost Sharing Plan Variation,,0.780197143554688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,350","$12,700",Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,"$1,300","$2,600",Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,1,32536,OR,Individual,No,43-2071108,32536OR0020003,ATRIO Gold Pioneer,32536OR002,,ORN001,ORS001,ORF001,Existing,EPO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Urgent and Emergency Care,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0020003-01-ATRIO-GOLD-PIONEER-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020003-00,Standard Gold Off Exchange Plan,,0.780197143554688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,350","$12,700",Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,"$1,300","$2,600",Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,1,32536,OR,Individual,No,43-2071108,32536OR0020003,ATRIO Gold Pioneer,32536OR002,,ORN001,ORS001,ORF001,Existing,EPO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Urgent and Emergency Care,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0020003-01-ATRIO-GOLD-PIONEER-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020003-01,Standard Gold On Exchange Plan,,0.780197143554688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,350","$12,700",Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,"$1,300","$2,600",Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,1,32536,OR,Individual,No,43-2071108,32536OR0020003,ATRIO Gold Pioneer,32536OR002,,ORN001,ORS001,ORF001,Existing,EPO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Urgent and Emergency Care,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0020003-01-ATRIO-GOLD-PIONEER-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,1,32536,OR,Individual,No,43-2071108,32536OR0020003,ATRIO Gold Pioneer,32536OR002,,ORN001,ORS001,ORF001,Existing,EPO,Gold,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Urgent and Emergency Care,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0020003-01-ATRIO-GOLD-PIONEER-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020003-03,Limited Cost Sharing Plan Variation,,0.780197143554688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,350","$12,700",Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,"$1,300","$2,600",Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,1,32536,OR,Individual,No,43-2071108,32536OR0020004,ATRIO Oregon Standard Silver Plan,32536OR002,,ORN001,ORS001,ORF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Nationwide,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020004-01-ATRIO-OREGON-STANDARD-SILVER-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020004-00,Standard Silver Off Exchange Plan,,0.680933177471161,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,350","$12,700",Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,"$2,500","$5,000",Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,1,32536,OR,Individual,No,43-2071108,32536OR0020004,ATRIO Oregon Standard Silver Plan,32536OR002,,ORN001,ORS001,ORF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Nationwide,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020004-01-ATRIO-OREGON-STANDARD-SILVER-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020004-01,Standard Silver On Exchange Plan,,0.680933177471161,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,350","$12,700",Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,"$2,500","$5,000",Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,1,32536,OR,Individual,No,43-2071108,32536OR0020004,ATRIO Oregon Standard Silver Plan,32536OR002,,ORN001,ORS001,ORF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Nationwide,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020004-01-ATRIO-OREGON-STANDARD-SILVER-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,1,32536,OR,Individual,No,43-2071108,32536OR0020004,ATRIO Oregon Standard Silver Plan,32536OR002,,ORN001,ORS001,ORF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Nationwide,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020004-01-ATRIO-OREGON-STANDARD-SILVER-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020004-03,Limited Cost Sharing Plan Variation,,0.680933177471161,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,350","$12,700",Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,"$2,500","$5,000",Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,1,32536,OR,Individual,No,43-2071108,32536OR0020004,ATRIO Oregon Standard Silver Plan,32536OR002,,ORN001,ORS001,ORF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Nationwide,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020004-01-ATRIO-OREGON-STANDARD-SILVER-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020004-04,73% AV Level Silver Plan,,0.727139830589294,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$4,250","$8,500",Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,"$2,500","$5,000",Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,1,32536,OR,Individual,No,43-2071108,32536OR0020004,ATRIO Oregon Standard Silver Plan,32536OR002,,ORN001,ORS001,ORF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Nationwide,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020004-01-ATRIO-OREGON-STANDARD-SILVER-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020004-05,87% AV Level Silver Plan,,0.869928658008575,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$1,500","$3,000",Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,$750,"$1,500",Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,1,32536,OR,Individual,No,43-2071108,32536OR0020004,ATRIO Oregon Standard Silver Plan,32536OR002,,ORN001,ORS001,ORF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Nationwide,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020004-01-ATRIO-OREGON-STANDARD-SILVER-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020004-06,94% AV Level Silver Plan,,0.938194036483765,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$750,"$1,500",Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,$100,$200,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,1,32536,OR,Individual,No,43-2071108,32536OR0020005,ATRIO Silver Pioneer,32536OR002,,ORN001,ORS001,ORF002,Existing,EPO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Urgent and Emergency Care,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0020005-01-ATRIO-SILVER-PIONEER-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020005-00,Standard Silver Off Exchange Plan,,0.680933177471161,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,350","$12,700",Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,"$2,500","$5,000",Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,19
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,1,32536,OR,Individual,No,43-2071108,32536OR0020005,ATRIO Silver Pioneer,32536OR002,,ORN001,ORS001,ORF002,Existing,EPO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Urgent and Emergency Care,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0020005-01-ATRIO-SILVER-PIONEER-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020005-01,Standard Silver On Exchange Plan,,0.680933177471161,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,350","$12,700",Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,"$2,500","$5,000",Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,1,32536,OR,Individual,No,43-2071108,32536OR0020005,ATRIO Silver Pioneer,32536OR002,,ORN001,ORS001,ORF002,Existing,EPO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Urgent and Emergency Care,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0020005-01-ATRIO-SILVER-PIONEER-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,1,32536,OR,Individual,No,43-2071108,32536OR0020005,ATRIO Silver Pioneer,32536OR002,,ORN001,ORS001,ORF002,Existing,EPO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Urgent and Emergency Care,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0020005-01-ATRIO-SILVER-PIONEER-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020005-03,Limited Cost Sharing Plan Variation,,0.680933177471161,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,350","$12,700",Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,"$2,500","$5,000",Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,1,32536,OR,Individual,No,43-2071108,32536OR0020005,ATRIO Silver Pioneer,32536OR002,,ORN001,ORS001,ORF002,Existing,EPO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Urgent and Emergency Care,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0020005-01-ATRIO-SILVER-PIONEER-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020005-04,73% AV Level Silver Plan,,0.727139830589294,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$4,250","$8,500",Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,"$2,500","$5,000",Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,23
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,1,32536,OR,Individual,No,43-2071108,32536OR0020005,ATRIO Silver Pioneer,32536OR002,,ORN001,ORS001,ORF002,Existing,EPO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Urgent and Emergency Care,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0020005-01-ATRIO-SILVER-PIONEER-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020005-05,87% AV Level Silver Plan,,0.869928658008575,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$1,500","$3,000",Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,$750,"$1,500",Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,24
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,1,32536,OR,Individual,No,43-2071108,32536OR0020005,ATRIO Silver Pioneer,32536OR002,,ORN001,ORS001,ORF002,Existing,EPO,Silver,No,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Urgent and Emergency Care,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0020005-01-ATRIO-SILVER-PIONEER-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020005-06,94% AV Level Silver Plan,,0.938194036483765,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$750,"$1,500",Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,$100,$200,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,25
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,2,32536,OR,Individual,No,43-2071108,32536OR0020006,ATRIO Oregon Standard Bronze Plan,32536OR002,,ORN001,ORS001,ORF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Nationwide,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020006-01-ATRIO-OREGON-STANDARD-BRONZE-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020006-00,Standard Bronze Off Exchange Plan,,0.583432614803314,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,4
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,2,32536,OR,Individual,No,43-2071108,32536OR0020006,ATRIO Oregon Standard Bronze Plan,32536OR002,,ORN001,ORS001,ORF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Nationwide,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020006-01-ATRIO-OREGON-STANDARD-BRONZE-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020006-01,Standard Bronze On Exchange Plan,,0.583432614803314,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,5
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,2,32536,OR,Individual,No,43-2071108,32536OR0020006,ATRIO Oregon Standard Bronze Plan,32536OR002,,ORN001,ORS001,ORF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Nationwide,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020006-01-ATRIO-OREGON-STANDARD-BRONZE-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,2,32536,OR,Individual,No,43-2071108,32536OR0020006,ATRIO Oregon Standard Bronze Plan,32536OR002,,ORN001,ORS001,ORF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Nationwide,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020006-01-ATRIO-OREGON-STANDARD-BRONZE-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020006-03,Limited Cost Sharing Plan Variation,,0.583432614803314,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,7
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,2,32536,OR,Individual,No,43-2071108,32536OR0020007,ATRIO Bronze Pioneer,32536OR002,,ORN001,ORS001,ORF003,Existing,EPO,Bronze,No,Both,No,Yes,All,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Urgent and Emergency Care,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0020007-01-ATRIO-BRONZE-PIONEER-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020007-00,Standard Bronze Off Exchange Plan,,0.583432614803314,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,8
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,2,32536,OR,Individual,No,43-2071108,32536OR0020007,ATRIO Bronze Pioneer,32536OR002,,ORN001,ORS001,ORF003,Existing,EPO,Bronze,No,Both,No,Yes,All,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Urgent and Emergency Care,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0020007-01-ATRIO-BRONZE-PIONEER-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020007-01,Standard Bronze On Exchange Plan,,0.583432614803314,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,9
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,2,32536,OR,Individual,No,43-2071108,32536OR0020007,ATRIO Bronze Pioneer,32536OR002,,ORN001,ORS001,ORF003,Existing,EPO,Bronze,No,Both,No,Yes,All,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Urgent and Emergency Care,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0020007-01-ATRIO-BRONZE-PIONEER-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,OR,32536,SERFF,6,2014-12-10 23:15:01,2,32536,OR,Individual,No,43-2071108,32536OR0020007,ATRIO Bronze Pioneer,32536OR002,,ORN001,ORS001,ORF003,Existing,EPO,Bronze,No,Both,No,Yes,All,,$0.00,Yes,,,Allows Adult and Child-Only,,No,,,0.9995,,,0,0,0,2015-01-01,,Yes,Urgent and Emergency Care,Yes,Urgent and Emergency Care,Yes,http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0020007-01-ATRIO-BRONZE-PIONEER-PLAN.pdf,https://atriohp.softheon.com/payment,www.atriohp.com,www.atriohp.com,32536OR0020007-03,Limited Cost Sharing Plan Variation,,0.583432614803314,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,11
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,1,39424,OR,Individual,No,93-0989307,39424OR1240001,Moda Health Oregon Standard Gold Plan (Connexus),39424OR124,,ORN001,ORS001,ORF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardGoldPlan_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardGoldPlan_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1240001-00,Standard Gold Off Exchange Plan,,0.782178342342377,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$600,$200,"$1,300",$500,$100,$80,4
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,1,39424,OR,Individual,No,93-0989307,39424OR1240001,Moda Health Oregon Standard Gold Plan (Connexus),39424OR124,,ORN001,ORS001,ORF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardGoldPlan_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardGoldPlan_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1240001-01,Standard Gold On Exchange Plan,,0.782178342342377,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$600,$200,"$1,300",$500,$100,$80,5
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,1,39424,OR,Individual,No,93-0989307,39424OR1240001,Moda Health Oregon Standard Gold Plan (Connexus),39424OR124,,ORN001,ORS001,ORF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardGoldPlan_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardGoldPlan_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1240001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,1,39424,OR,Individual,No,93-0989307,39424OR1240001,Moda Health Oregon Standard Gold Plan (Connexus),39424OR124,,ORN001,ORS001,ORF001,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardGoldPlan_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardGoldPlan_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1240001-03,Limited Cost Sharing Plan Variation,,0.782178342342377,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$600,$200,"$1,300",$500,$100,$80,7
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,1,39424,OR,Individual,No,93-0989307,39424OR1240002,Moda Health Oregon Standard Silver Plan (Connexus),39424OR124,,ORN001,ORS001,ORF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardSilverPlan_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardSilverPlan_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1240002-00,Standard Silver Off Exchange Plan,,0.683689296245575,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,400",$200,"$2,500",$500,$200,$80,8
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,1,39424,OR,Individual,No,93-0989307,39424OR1240002,Moda Health Oregon Standard Silver Plan (Connexus),39424OR124,,ORN001,ORS001,ORF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardSilverPlan_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardSilverPlan_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1240002-01,Standard Silver On Exchange Plan,,0.683689296245575,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,400",$200,"$2,500",$500,$200,$80,9
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,1,39424,OR,Individual,No,93-0989307,39424OR1240002,Moda Health Oregon Standard Silver Plan (Connexus),39424OR124,,ORN001,ORS001,ORF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardSilverPlan_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardSilverPlan_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1240002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$200,$0,$0,$0,$80,10
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,1,39424,OR,Individual,No,93-0989307,39424OR1240002,Moda Health Oregon Standard Silver Plan (Connexus),39424OR124,,ORN001,ORS001,ORF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardSilverPlan_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardSilverPlan_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1240002-03,Limited Cost Sharing Plan Variation,,0.683689296245575,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,400",$200,"$2,500",$500,$200,$80,11
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,1,39424,OR,Individual,No,93-0989307,39424OR1240002,Moda Health Oregon Standard Silver Plan (Connexus),39424OR124,,ORN001,ORS001,ORF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardSilverPlan_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardSilverPlan_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1240002-04,73% AV Level Silver Plan,,0.729346036911011,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,400",$200,"$2,500",$400,$100,$80,12
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,1,39424,OR,Individual,No,93-0989307,39424OR1240002,Moda Health Oregon Standard Silver Plan (Connexus),39424OR124,,ORN001,ORS001,ORF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardSilverPlan_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardSilverPlan_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1240002-05,87% AV Level Silver Plan,,0.870894372463226,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,$750,"$1,500",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$700,$20,$800,$200,$700,$500,$100,$80,13
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,1,39424,OR,Individual,No,93-0989307,39424OR1240002,Moda Health Oregon Standard Silver Plan (Connexus),39424OR124,,ORN001,ORS001,ORF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardSilverPlan_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardSilverPlan_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1240002-06,94% AV Level Silver Plan,,0.938893556594849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$12,700","$25,400",Not Applicable,Not Applicable,$100,$200,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$100,$0,$600,$200,$100,$300,$100,$80,14
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,2,39424,OR,Individual,No,93-0989307,39424OR1250001,Be Savvy (Connexus),39424OR125,,ORN001,ORS001,ORF003,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeSavvy_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeSavvy_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1250001-00,Standard Bronze Off Exchange Plan,,0.582001805305481,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",40%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,"$5,200",$0,$800,$200,"$5,200",$0,$10,$80,4
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,5,39424,OR,Individual,No,93-0989307,39424OR1280001,Be Aligned (CCN),39424OR128,,ORN002,ORS003,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAligned_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAligned_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1280001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,5,39424,OR,Individual,No,93-0989307,39424OR1280001,Be Aligned (CCN),39424OR128,,ORN002,ORS003,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAligned_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAligned_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1280001-03,Limited Cost Sharing Plan Variation,,0.690139532089233,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,700",$200,"$2,500",$400,$300,$80,7
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,5,39424,OR,Individual,No,93-0989307,39424OR1280001,Be Aligned (CCN),39424OR128,,ORN002,ORS003,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAligned_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAligned_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1280001-04,73% AV Level Silver Plan,,0.724789559841156,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500",$20,"$2,000",$200,"$1,500",$500,$400,$80,8
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,5,39424,OR,Individual,No,93-0989307,39424OR1280001,Be Aligned (CCN),39424OR128,,ORN002,ORS003,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAligned_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAligned_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1280001-05,87% AV Level Silver Plan,,0.873015463352203,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$750,$0,$500,$200,$750,$300,$200,$80,9
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,5,39424,OR,Individual,No,93-0989307,39424OR1280001,Be Aligned (CCN),39424OR128,,ORN002,ORS003,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAligned_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAligned_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1280001-06,94% AV Level Silver Plan,,0.936736166477203,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$250,$0,$350,$200,$250,$200,$40,$80,10
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,5,39424,OR,Individual,No,93-0989307,39424OR1280002,Be Aligned (Rose City),39424OR128,,ORN003,ORS002,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAlignedRC_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAlignedRC_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1280002-00,Standard Silver Off Exchange Plan,,0.690139532089233,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,700",$200,"$2,500",$400,$300,$80,11
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,5,39424,OR,Individual,No,93-0989307,39424OR1280002,Be Aligned (Rose City),39424OR128,,ORN003,ORS002,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAlignedRC_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAlignedRC_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1280002-01,Standard Silver On Exchange Plan,,0.690139532089233,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,700",$200,"$2,500",$400,$300,$80,12
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,5,39424,OR,Individual,No,93-0989307,39424OR1280002,Be Aligned (Rose City),39424OR128,,ORN003,ORS002,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAlignedRC_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAlignedRC_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1280002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,13
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,5,39424,OR,Individual,No,93-0989307,39424OR1280002,Be Aligned (Rose City),39424OR128,,ORN003,ORS002,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAlignedRC_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAlignedRC_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1280002-03,Limited Cost Sharing Plan Variation,,0.690139532089233,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,700",$200,"$2,500",$400,$300,$80,14
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,5,39424,OR,Individual,No,93-0989307,39424OR1280002,Be Aligned (Rose City),39424OR128,,ORN003,ORS002,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAlignedRC_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAlignedRC_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1280002-04,73% AV Level Silver Plan,,0.724789559841156,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500",$20,"$2,000",$200,"$1,500",$500,$400,$80,15
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,5,39424,OR,Individual,No,93-0989307,39424OR1280002,Be Aligned (Rose City),39424OR128,,ORN003,ORS002,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAlignedRC_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAlignedRC_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1280002-05,87% AV Level Silver Plan,,0.873015463352203,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$750,$0,$500,$200,$750,$300,$200,$80,16
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,5,39424,OR,Individual,No,93-0989307,39424OR1280002,Be Aligned (Rose City),39424OR128,,ORN003,ORS002,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAlignedRC_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeAlignedRC_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1280002-06,94% AV Level Silver Plan,,0.936736166477203,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,35%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$250,$0,$350,$200,$250,$200,$40,$80,17
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,6,39424,OR,Individual,No,93-0989307,39424OR1290001,Be Connected (CCN),39424OR129,,ORN002,ORS003,ORF005,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeConnected_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeConnected_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1290001-00,Standard Bronze Off Exchange Plan,,0.617556214332581,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500",35%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$4,200",$20,"$1,100",$200,"$2,500",$400,$300,$80,4
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,6,39424,OR,Individual,No,93-0989307,39424OR1290001,Be Connected (CCN),39424OR129,,ORN002,ORS003,ORF005,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeConnected_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeConnected_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1290001-01,Standard Bronze On Exchange Plan,,0.617556214332581,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500",35%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$4,200",$20,"$1,100",$200,"$2,500",$400,$300,$80,5
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,6,39424,OR,Individual,No,93-0989307,39424OR1290001,Be Connected (CCN),39424OR129,,ORN002,ORS003,ORF005,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeConnected_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeConnected_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1290001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,6,39424,OR,Individual,No,93-0989307,39424OR1290001,Be Connected (CCN),39424OR129,,ORN002,ORS003,ORF005,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeConnected_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeConnected_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1290001-03,Limited Cost Sharing Plan Variation,,0.617556214332581,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500",35%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$4,200",$20,"$1,100",$200,"$2,500",$400,$300,$80,7
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,6,39424,OR,Individual,No,93-0989307,39424OR1290002,Be Connected (Rose City),39424OR129,,ORN003,ORS002,ORF005,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeConnectedRC_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeConnectedRC_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1290002-00,Standard Bronze Off Exchange Plan,,0.617556214332581,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500",35%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$4,200",$20,"$1,100",$200,"$2,500",$400,$300,$80,8
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,6,39424,OR,Individual,No,93-0989307,39424OR1290002,Be Connected (Rose City),39424OR129,,ORN003,ORS002,ORF005,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeConnectedRC_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeConnectedRC_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1290002-01,Standard Bronze On Exchange Plan,,0.617556214332581,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500",35%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$4,200",$20,"$1,100",$200,"$2,500",$400,$300,$80,9
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,6,39424,OR,Individual,No,93-0989307,39424OR1290002,Be Connected (Rose City),39424OR129,,ORN003,ORS002,ORF005,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeConnectedRC_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeConnectedRC_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1290002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,10
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,6,39424,OR,Individual,No,93-0989307,39424OR1290002,Be Connected (Rose City),39424OR129,,ORN003,ORS002,ORF005,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeConnectedRC_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeConnectedRC_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1290002-03,Limited Cost Sharing Plan Variation,,0.617556214332581,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500",35%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$4,200",$20,"$1,100",$200,"$2,500",$400,$300,$80,11
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,6,39424,OR,Individual,No,93-0989307,39424OR1290003,Be Balanced (Connexus),39424OR129,,ORN001,ORS004,ORF005,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeBalanced_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeBalanced_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1290003-00,Standard Bronze Off Exchange Plan,,0.617556214332581,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500",35%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$4,200",$20,"$1,100",$200,"$2,500",$400,$300,$80,12
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,6,39424,OR,Individual,No,93-0989307,39424OR1290003,Be Balanced (Connexus),39424OR129,,ORN001,ORS004,ORF005,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeBalanced_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeBalanced_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1290003-01,Standard Bronze On Exchange Plan,,0.617556214332581,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500",35%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$4,200",$20,"$1,100",$200,"$2,500",$400,$300,$80,13
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,6,39424,OR,Individual,No,93-0989307,39424OR1290003,Be Balanced (Connexus),39424OR129,,ORN001,ORS004,ORF005,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeBalanced_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeBalanced_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1290003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,14
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,6,39424,OR,Individual,No,93-0989307,39424OR1290003,Be Balanced (Connexus),39424OR129,,ORN001,ORS004,ORF005,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeBalanced_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeBalanced_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1290003-03,Limited Cost Sharing Plan Variation,,0.617556214332581,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500",35%,,,,"$8,500","$17,000",Not Applicable,Not Applicable,"$4,200",$20,"$1,100",$200,"$2,500",$400,$300,$80,15
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,7,39424,OR,Individual,No,93-0989307,39424OR1300001,Be Smart (Connexus),39424OR130,,ORN001,ORS001,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeSmart_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeSmart_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1300001-00,Standard Silver Off Exchange Plan,,0.686988234519959,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",25%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,"$1,100",$200,"$3,000",$300,$100,$80,4
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,7,39424,OR,Individual,No,93-0989307,39424OR1300001,Be Smart (Connexus),39424OR130,,ORN001,ORS001,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeSmart_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeSmart_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1300001-01,Standard Silver On Exchange Plan,,0.686988234519959,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",25%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,"$1,100",$200,"$3,000",$300,$100,$80,5
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,7,39424,OR,Individual,No,93-0989307,39424OR1300001,Be Smart (Connexus),39424OR130,,ORN001,ORS001,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeSmart_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeSmart_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1300001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,7,39424,OR,Individual,No,93-0989307,39424OR1300001,Be Smart (Connexus),39424OR130,,ORN001,ORS001,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeSmart_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeSmart_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1300001-03,Limited Cost Sharing Plan Variation,,0.686988234519959,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",25%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$3,000",$20,"$1,100",$200,"$3,000",$300,$100,$80,7
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,7,39424,OR,Individual,No,93-0989307,39424OR1300001,Be Smart (Connexus),39424OR130,,ORN001,ORS001,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeSmart_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeSmart_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1300001-04,73% AV Level Silver Plan,,0.734200000762939,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",25%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,400",$200,"$1,500",$400,$300,$80,8
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,7,39424,OR,Individual,No,93-0989307,39424OR1300001,Be Smart (Connexus),39424OR130,,ORN001,ORS001,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeSmart_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeSmart_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1300001-05,87% AV Level Silver Plan,,0.874991774559021,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",25%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$700,$0,$600,$200,$700,$300,$200,$80,9
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,7,39424,OR,Individual,No,93-0989307,39424OR1300001,Be Smart (Connexus),39424OR130,,ORN001,ORS001,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeSmart_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeSmart_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1300001-06,94% AV Level Silver Plan,,0.936618804931641,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$250,$500,25%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$250,$0,$350,$200,$250,$250,$60,$80,10
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,8,39424,OR,Individual,No,93-0989307,39424OR1310001,Moda Health Oregon Standard Bronze Plan (Connexus),39424OR131,,ORN001,ORS001,ORF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardBronzePlan_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardBronzePlan_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1310001-00,Standard Bronze Off Exchange Plan,,0.587094008922577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,100",$200,"$5,000",$60,$70,$80,4
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,8,39424,OR,Individual,No,93-0989307,39424OR1310001,Moda Health Oregon Standard Bronze Plan (Connexus),39424OR131,,ORN001,ORS001,ORF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardBronzePlan_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardBronzePlan_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1310001-01,Standard Bronze On Exchange Plan,,0.587094008922577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,100",$200,"$5,000",$60,$70,$80,5
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,8,39424,OR,Individual,No,93-0989307,39424OR1310001,Moda Health Oregon Standard Bronze Plan (Connexus),39424OR131,,ORN001,ORS001,ORF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardBronzePlan_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardBronzePlan_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1310001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$200,$0,$0,$0,$80,6
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,8,39424,OR,Individual,No,93-0989307,39424OR1310001,Moda Health Oregon Standard Bronze Plan (Connexus),39424OR131,,ORN001,ORS001,ORF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardBronzePlan_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_OregonStandardBronzePlan_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1310001-03,Limited Cost Sharing Plan Variation,,0.587094008922577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,100",$200,"$5,000",$60,$70,$80,7
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,9,39424,OR,Individual,No,93-0989307,39424OR1320001,Be Bold (Connexus),39424OR132,,ORN001,ORS001,ORF007,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeBold_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeBold_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1320001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,300",$0,$0,$80,4
2015,OR,39424,SERFF,8,2015-01-16 20:59:55,9,39424,OR,Individual,No,93-0989307,39424OR1320001,Be Bold (Connexus),39424OR132,,ORN001,ORS001,ORF007,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,No,,Yes,Travel Network,No,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeBold_SBC_OR_2015.pdf,,https://www.modahealth.com/pdfs/plans/individual/ModaHealth_BeBold_OR_2015.pdf,https://www.modahealth.com/medical/formularies.shtml,39424OR1320001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$200,"$5,300",$0,$0,$80,5
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,1,56707,OR,Individual,No,93-0863097,56707OR0990002,Providence Oregon Standard Gold Plan,56707OR099,,ORN001,ORS001,ORF002,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999396775120454,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Standard-Gold-Plan-SBC-Individual-marketplace-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0990002-00,Standard Gold Off Exchange Plan,,0.795799374580383,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,"$1,300",$20,$600,$150,"$1,300",$460,$110,$80,4
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,1,56707,OR,Individual,No,93-0863097,56707OR0990002,Providence Oregon Standard Gold Plan,56707OR099,,ORN001,ORS001,ORF002,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999396775120454,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Standard-Gold-Plan-SBC-Individual-marketplace-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0990002-01,Standard Gold On Exchange Plan,,0.795799374580383,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,"$1,300",$20,$600,$150,"$1,300",$460,$110,$80,5
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,1,56707,OR,Individual,No,93-0863097,56707OR0990002,Providence Oregon Standard Gold Plan,56707OR099,,ORN001,ORS001,ORF002,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999396775120454,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Standard-Gold-Plan-SBC-Individual-marketplace-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0990002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,1,56707,OR,Individual,No,93-0863097,56707OR0990002,Providence Oregon Standard Gold Plan,56707OR099,,ORN001,ORS001,ORF002,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999396775120454,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Standard-Gold-Plan-SBC-Individual-marketplace-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0990002-03,Limited Cost Sharing Plan Variation,,0.795799374580383,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,"$1,300",$20,$600,$150,"$1,300",$460,$110,$80,7
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,2,56707,OR,Individual,No,93-0863097,56707OR0870002,Providence Oregon Standard Silver Plan,56707OR087,,ORN001,ORS001,ORF005,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999396124476669,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Standard-silver-Plan-SBC-Individual-marketplace-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0870002-00,Standard Silver Off Exchange Plan,,0.69536966085434,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,800",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,430",$150,"$2,500",$500,$230,$80,4
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,2,56707,OR,Individual,No,93-0863097,56707OR0870002,Providence Oregon Standard Silver Plan,56707OR087,,ORN001,ORS001,ORF005,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999396124476669,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Standard-silver-Plan-SBC-Individual-marketplace-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0870002-01,Standard Silver On Exchange Plan,,0.69536966085434,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,800",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,430",$150,"$2,500",$500,$230,$80,5
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,2,56707,OR,Individual,No,93-0863097,56707OR0870002,Providence Oregon Standard Silver Plan,56707OR087,,ORN001,ORS001,ORF005,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999396124476669,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Standard-silver-Plan-SBC-Individual-marketplace-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0870002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,2,56707,OR,Individual,No,93-0863097,56707OR0870002,Providence Oregon Standard Silver Plan,56707OR087,,ORN001,ORS001,ORF005,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999396124476669,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Standard-silver-Plan-SBC-Individual-marketplace-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0870002-03,Limited Cost Sharing Plan Variation,,0.69536966085434,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,800",,,"$12,800","$25,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,430",$150,"$2,500",$500,$230,$80,7
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,2,56707,OR,Individual,No,93-0863097,56707OR0870002,Providence Oregon Standard Silver Plan,56707OR087,,ORN001,ORS001,ORF005,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999396124476669,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Standard-silver-Plan-SBC-Individual-marketplace-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0870002-04,73% AV Level Silver Plan,,0.733968675136566,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$8,500","$17,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,500",$20,"$1,430",$150,"$2,500",$500,$230,$80,8
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,2,56707,OR,Individual,No,93-0863097,56707OR0870002,Providence Oregon Standard Silver Plan,56707OR087,,ORN001,ORS001,ORF005,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999396124476669,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Standard-silver-Plan-SBC-Individual-marketplace-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0870002-05,87% AV Level Silver Plan,,0.876516699790955,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",10%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$750,$20,$650,$150,$750,$510,$110,$80,9
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0140001,BridgeSpan Oregon Standard Silver Plan MyChoice Northwest,63474OR014,,ORN003,ORS001,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Silver+Plan+MyChoice+Northwest+2015/adfb6238-1a39-42ea-9f7d-b38510f03fb3?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0140001-06,94% AV Level Silver Plan,,0.938893556594849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$12,700","$25,400",Not Applicable,Not Applicable,$100,$200,10%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$100,$10,$720,$150,$100,$190,$330,$40,29
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0240001,BridgeSpan Oregon Standard Silver Plan Mid-Valley,63474OR024,,ORN005,ORS002,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Silver+Plan+Mid-Valley+2015/19ee49ef-5e4d-4c14-a05a-c0ee269fceea?version=1.5,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0240001-00,Standard Silver Off Exchange Plan,,0.683689296245575,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,$420,$600,$900,$40,30
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0240001,BridgeSpan Oregon Standard Silver Plan Mid-Valley,63474OR024,,ORN005,ORS002,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Silver+Plan+Mid-Valley+2015/19ee49ef-5e4d-4c14-a05a-c0ee269fceea?version=1.5,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0240001-01,Standard Silver On Exchange Plan,,0.683689296245575,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,$420,$600,$900,$40,31
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0240001,BridgeSpan Oregon Standard Silver Plan Mid-Valley,63474OR024,,ORN005,ORS002,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Silver+Plan+Mid-Valley+2015/19ee49ef-5e4d-4c14-a05a-c0ee269fceea?version=1.5,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0240001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$40,32
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0240001,BridgeSpan Oregon Standard Silver Plan Mid-Valley,63474OR024,,ORN005,ORS002,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Silver+Plan+Mid-Valley+2015/19ee49ef-5e4d-4c14-a05a-c0ee269fceea?version=1.5,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0240001-03,Limited Cost Sharing Plan Variation,,0.683689296245575,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,$420,$600,$900,$40,33
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0240001,BridgeSpan Oregon Standard Silver Plan Mid-Valley,63474OR024,,ORN005,ORS002,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Silver+Plan+Mid-Valley+2015/19ee49ef-5e4d-4c14-a05a-c0ee269fceea?version=1.5,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0240001-04,73% AV Level Silver Plan,,0.729346036911011,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,$420,$600,$900,$40,34
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0240001,BridgeSpan Oregon Standard Silver Plan Mid-Valley,63474OR024,,ORN005,ORS002,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Silver+Plan+Mid-Valley+2015/19ee49ef-5e4d-4c14-a05a-c0ee269fceea?version=1.5,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0240001-05,87% AV Level Silver Plan,,0.870894372463226,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,$750,"$1,500",10%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$20,$650,$150,$420,$350,$300,$40,35
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0240001,BridgeSpan Oregon Standard Silver Plan Mid-Valley,63474OR024,,ORN005,ORS002,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Silver+Plan+Mid-Valley+2015/19ee49ef-5e4d-4c14-a05a-c0ee269fceea?version=1.5,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0240001-06,94% AV Level Silver Plan,,0.938893556594849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$12,700","$25,400",Not Applicable,Not Applicable,$100,$200,10%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$100,$10,$720,$750,$100,$190,$330,$40,36
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,2,63474,OR,Individual,No,87-0388069,63474OR0030003,BridgeSpan Oregon Standard Bronze Plan Value PPO,63474OR003,,ORN001,ORS003,ORF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Bronze+Value+PPO+2015/a834df22-8871-44c1-9030-bdead112e39d?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0030003-00,Standard Bronze Off Exchange Plan,,0.587094008922577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,$420,$880,"$1,510",$40,4
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,2,63474,OR,Individual,No,87-0388069,63474OR0030003,BridgeSpan Oregon Standard Bronze Plan Value PPO,63474OR003,,ORN001,ORS003,ORF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Bronze+Value+PPO+2015/a834df22-8871-44c1-9030-bdead112e39d?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0030003-01,Standard Bronze On Exchange Plan,,0.587094008922577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,$420,$880,"$1,510",$40,5
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,2,63474,OR,Individual,No,87-0388069,63474OR0030003,BridgeSpan Oregon Standard Bronze Plan Value PPO,63474OR003,,ORN001,ORS003,ORF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Bronze+Value+PPO+2015/a834df22-8871-44c1-9030-bdead112e39d?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0030003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$40,6
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,2,63474,OR,Individual,No,87-0388069,63474OR0030003,BridgeSpan Oregon Standard Bronze Plan Value PPO,63474OR003,,ORN001,ORS003,ORF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Bronze+Value+PPO+2015/a834df22-8871-44c1-9030-bdead112e39d?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0030003-03,Limited Cost Sharing Plan Variation,,0.587094008922577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,$420,$880,"$1,510",$40,7
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0130001,BridgeSpan Oregon Standard Gold Plan Mychoice Northwest,63474OR013,,ORN003,ORS001,ORF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Gold+Plan+MyChoice+Northwest+2015/2026d666-a442-4d47-871b-7185cad14a92?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0130001-01,Standard Gold On Exchange Plan,,0.782178342342377,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$600,$150,$420,$380,$300,$40,9
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0130001,BridgeSpan Oregon Standard Gold Plan Mychoice Northwest,63474OR013,,ORN003,ORS001,ORF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Gold+Plan+MyChoice+Northwest+2015/2026d666-a442-4d47-871b-7185cad14a92?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0130001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$40,10
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0130001,BridgeSpan Oregon Standard Gold Plan Mychoice Northwest,63474OR013,,ORN003,ORS001,ORF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Gold+Plan+MyChoice+Northwest+2015/2026d666-a442-4d47-871b-7185cad14a92?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0130001-03,Limited Cost Sharing Plan Variation,,0.782178342342377,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$600,$150,$420,$380,$300,$40,11
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0230001,BridgeSpan Oregon Standard Gold Plan Mid-Valley,63474OR023,,ORN005,ORS002,ORF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Gold+Plan+Mid-Valley+2015/81be46bd-8538-4b93-9f1d-8f57982efaba?version=1.2,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0230001-00,Standard Gold Off Exchange Plan,,0.782178342342377,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$600,$150,$420,$380,$300,$40,12
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,2,56707,OR,Individual,No,93-0863097,56707OR0870002,Providence Oregon Standard Silver Plan,56707OR087,,ORN001,ORS001,ORF005,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999396124476669,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Standard-silver-Plan-SBC-Individual-marketplace-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0870002-06,94% AV Level Silver Plan,,0.949186384677887,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,,,,$200,$400,Not Applicable,Not Applicable,$100,$0,$650,$150,$100,$300,$130,$80,10
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,3,56707,OR,Individual,No,93-0863097,56707OR1000002,Providence Oregon Standard Bronze Plan,56707OR100,,ORN001,ORS001,ORF004,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999403645888227,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Standard-bronze-Plan-SBC-Individual-marketplace-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR1000002-00,Standard Bronze Off Exchange Plan,59.30%,0.592048466205597,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,"$5,000",$60,$70,$80,4
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0010002,BridgeSpan Oregon Standard Silver Plan Value PPO,63474OR001,,ORN001,ORS003,ORF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Silver+Plan+Value+PPO+2015/596fe195-ad74-4ade-8e41-2eb215a3ce21?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0010002-05,87% AV Level Silver Plan,,0.870894372463226,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,$750,"$1,500",10%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$20,$650,$150,$420,$350,$300,$40,21
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0010002,BridgeSpan Oregon Standard Silver Plan Value PPO,63474OR001,,ORN001,ORS003,ORF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Silver+Plan+Value+PPO+2015/596fe195-ad74-4ade-8e41-2eb215a3ce21?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0010002-06,94% AV Level Silver Plan,,0.938893556594849,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$12,700","$25,400",Not Applicable,Not Applicable,$100,$200,10%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$100,$10,$720,$150,$100,$190,$330,$40,22
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0140001,BridgeSpan Oregon Standard Silver Plan MyChoice Northwest,63474OR014,,ORN003,ORS001,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Silver+Plan+MyChoice+Northwest+2015/adfb6238-1a39-42ea-9f7d-b38510f03fb3?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0140001-00,Standard Silver Off Exchange Plan,,0.683689296245575,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,$420,$600,$900,$40,23
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0140001,BridgeSpan Oregon Standard Silver Plan MyChoice Northwest,63474OR014,,ORN003,ORS001,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Silver+Plan+MyChoice+Northwest+2015/adfb6238-1a39-42ea-9f7d-b38510f03fb3?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0140001-01,Standard Silver On Exchange Plan,,0.683689296245575,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,$420,$600,$900,$40,24
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0140001,BridgeSpan Oregon Standard Silver Plan MyChoice Northwest,63474OR014,,ORN003,ORS001,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Silver+Plan+MyChoice+Northwest+2015/adfb6238-1a39-42ea-9f7d-b38510f03fb3?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0140001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$40,25
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0140001,BridgeSpan Oregon Standard Silver Plan MyChoice Northwest,63474OR014,,ORN003,ORS001,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Silver+Plan+MyChoice+Northwest+2015/adfb6238-1a39-42ea-9f7d-b38510f03fb3?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0140001-03,Limited Cost Sharing Plan Variation,,0.683689296245575,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,$420,$600,$900,$40,26
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,3,56707,OR,Individual,No,93-0863097,56707OR1000002,Providence Oregon Standard Bronze Plan,56707OR100,,ORN001,ORS001,ORF004,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999403645888227,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Standard-bronze-Plan-SBC-Individual-marketplace-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR1000002-01,Standard Bronze On Exchange Plan,59.30%,0.592048466205597,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,"$5,000",$60,$70,$80,5
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,3,56707,OR,Individual,No,93-0863097,56707OR1000002,Providence Oregon Standard Bronze Plan,56707OR100,,ORN001,ORS001,ORF004,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999403645888227,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Standard-bronze-Plan-SBC-Individual-marketplace-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR1000002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,3,56707,OR,Individual,No,93-0863097,56707OR1000002,Providence Oregon Standard Bronze Plan,56707OR100,,ORN001,ORS001,ORF004,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999403645888227,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Standard-bronze-Plan-SBC-Individual-marketplace-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR1000002-03,Limited Cost Sharing Plan Variation,59.30%,0.592048466205597,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,"$5,000",$60,$70,$80,7
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,6,56707,OR,Individual,No,93-0863097,56707OR0900006,Choice 2000 Silver,56707OR090,,ORN002,ORS002,ORF001,New,EPO,Silver,No,Both,No,Yes,Specialists outside of your medical home,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997133514270289,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Choice-2000-silver-SBC-Individual-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0900006-00,Standard Silver Off Exchange Plan,,0.715080678462982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,900","$11,800",,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,580",$150,"$2,000",$560,$280,$80,4
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,6,56707,OR,Individual,No,93-0863097,56707OR0900006,Choice 2000 Silver,56707OR090,,ORN002,ORS002,ORF001,New,EPO,Silver,No,Both,No,Yes,Specialists outside of your medical home,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997133514270289,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Choice-2000-silver-SBC-Individual-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0900006-01,Standard Silver On Exchange Plan,,0.715080678462982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,900","$11,800",,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,580",$150,"$2,000",$560,$280,$80,5
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,6,56707,OR,Individual,No,93-0863097,56707OR0900006,Choice 2000 Silver,56707OR090,,ORN002,ORS002,ORF001,New,EPO,Silver,No,Both,No,Yes,Specialists outside of your medical home,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997133514270289,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Choice-2000-silver-SBC-Individual-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0900006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,6,56707,OR,Individual,No,93-0863097,56707OR0900006,Choice 2000 Silver,56707OR090,,ORN002,ORS002,ORF001,New,EPO,Silver,No,Both,No,Yes,Specialists outside of your medical home,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997133514270289,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Choice-2000-silver-SBC-Individual-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0900006-03,Limited Cost Sharing Plan Variation,,0.715080678462982,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,900","$11,800",,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,580",$150,"$2,000",$560,$280,$80,7
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,6,56707,OR,Individual,No,93-0863097,56707OR0900006,Choice 2000 Silver,56707OR090,,ORN002,ORS002,ORF001,New,EPO,Silver,No,Both,No,Yes,Specialists outside of your medical home,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997133514270289,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Choice-2000-silver-SBC-Individual-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0900006-04,73% AV Level Silver Plan,,0.736841559410095,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,050",$150,"$2,000",$540,$190,$80,8
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,6,56707,OR,Individual,No,93-0863097,56707OR0900006,Choice 2000 Silver,56707OR090,,ORN002,ORS002,ORF001,New,EPO,Silver,No,Both,No,Yes,Specialists outside of your medical home,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997133514270289,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Choice-2000-silver-SBC-Individual-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0900006-05,87% AV Level Silver Plan,,0.879287838935852,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$3,500","$7,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$500,$20,$680,$150,$500,$670,$120,$80,9
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,6,56707,OR,Individual,No,93-0863097,56707OR0900006,Choice 2000 Silver,56707OR090,,ORN002,ORS002,ORF001,New,EPO,Silver,No,Both,No,Yes,Specialists outside of your medical home,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997133514270289,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Choice-2000-silver-SBC-Individual-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0900006-06,94% AV Level Silver Plan,,0.945503532886505,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,$200,$400,Not Applicable,Not Applicable,$100,$20,$360,$150,$100,$450,$70,$80,10
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,7,56707,OR,Individual,No,93-0863097,56707OR0910006,Connect 2000 Silver,56707OR091,,ORN003,ORS003,ORF001,New,EPO,Silver,Yes,Both,No,Yes,Specialists outside of your medical neighborhood,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997060571422418,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Connect-2000-silver-SBC-Individual-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0910006-00,Standard Silver Off Exchange Plan,69.79%,0.697864055633545,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,900","$11,800",,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,580",$150,"$2,000",$560,$280,$80,4
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0050001,BridgeSpan Exchange Silver HSA Value PPO,63474OR005,,ORN001,ORS003,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Value+PPO+2015/077cd8d2-a93c-4385-8b49-186c88a9cddc?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0050001-04,73% AV Level Silver Plan,,0.723372399806976,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,160",$150,"$1,500",$0,$760,$40,8
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0050001,BridgeSpan Exchange Silver HSA Value PPO,63474OR005,,ORN001,ORS003,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Value+PPO+2015/077cd8d2-a93c-4385-8b49-186c88a9cddc?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0050001-05,87% AV Level Silver Plan,,0.870060682296753,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,$0,$680,$150,$500,$0,$590,$40,9
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0050001,BridgeSpan Exchange Silver HSA Value PPO,63474OR005,,ORN001,ORS003,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Value+PPO+2015/077cd8d2-a93c-4385-8b49-186c88a9cddc?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0050001-06,94% AV Level Silver Plan,,0.934491455554962,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$0,$500,$150,$200,$0,$500,$40,10
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0090001,BridgeSpan Exchange Silver HSA Legacy Health,63474OR009,,ORN002,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Legacy+Health+2015/074a0e97-9c22-42c5-87b7-fbc9f868e8e6?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0090001-00,Standard Silver Off Exchange Plan,,0.682320713996887,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$660,$40,11
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0150001,BridgeSpan Exchange Silver HSA MyChoice Northwest,63474OR015,,ORN003,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+MyChoice+Northwest+2015/0d0af66c-f584-45a5-b665-9b411cadf260?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0150001-04,73% AV Level Silver Plan,,0.723372399806976,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,160",$150,"$1,500",$0,$760,$40,22
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0150001,BridgeSpan Exchange Silver HSA MyChoice Northwest,63474OR015,,ORN003,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+MyChoice+Northwest+2015/0d0af66c-f584-45a5-b665-9b411cadf260?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0150001-05,87% AV Level Silver Plan,,0.870060682296753,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,$0,$680,$150,$500,$0,$590,$40,23
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0150001,BridgeSpan Exchange Silver HSA MyChoice Northwest,63474OR015,,ORN003,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+MyChoice+Northwest+2015/0d0af66c-f584-45a5-b665-9b411cadf260?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0150001-06,94% AV Level Silver Plan,,0.934491455554962,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$0,$500,$150,$200,$0,$500,$40,24
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0290001,BridgeSpan Exchange Silver HSA Willamette Valley Health Solutions,63474OR029,,ORN004,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Willamette+Valley+Health+Solutions+2015/53f7a14d-cefa-49b6-9187-0adcfa68299b?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0290001-00,Standard Silver Off Exchange Plan,,0.682320713996887,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$660,$40,25
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0290001,BridgeSpan Exchange Silver HSA Willamette Valley Health Solutions,63474OR029,,ORN004,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Willamette+Valley+Health+Solutions+2015/53f7a14d-cefa-49b6-9187-0adcfa68299b?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0290001-01,Standard Silver On Exchange Plan,,0.682320713996887,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$660,$40,26
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0290001,BridgeSpan Exchange Silver HSA Willamette Valley Health Solutions,63474OR029,,ORN004,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Willamette+Valley+Health+Solutions+2015/53f7a14d-cefa-49b6-9187-0adcfa68299b?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0290001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$40,27
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0090001,BridgeSpan Exchange Silver HSA Legacy Health,63474OR009,,ORN002,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Legacy+Health+2015/074a0e97-9c22-42c5-87b7-fbc9f868e8e6?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0090001-01,Standard Silver On Exchange Plan,,0.682320713996887,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$660,$40,12
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0090001,BridgeSpan Exchange Silver HSA Legacy Health,63474OR009,,ORN002,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Legacy+Health+2015/074a0e97-9c22-42c5-87b7-fbc9f868e8e6?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0090001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$40,13
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0090001,BridgeSpan Exchange Silver HSA Legacy Health,63474OR009,,ORN002,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Legacy+Health+2015/074a0e97-9c22-42c5-87b7-fbc9f868e8e6?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0090001-03,Limited Cost Sharing Plan Variation,,0.682320713996887,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$660,$40,14
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0090001,BridgeSpan Exchange Silver HSA Legacy Health,63474OR009,,ORN002,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Legacy+Health+2015/074a0e97-9c22-42c5-87b7-fbc9f868e8e6?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0090001-04,73% AV Level Silver Plan,,0.723372399806976,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,160",$150,"$1,500",$0,$760,$40,15
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0090001,BridgeSpan Exchange Silver HSA Legacy Health,63474OR009,,ORN002,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Legacy+Health+2015/074a0e97-9c22-42c5-87b7-fbc9f868e8e6?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0090001-05,87% AV Level Silver Plan,,0.870060682296753,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,$0,$680,$150,$500,$0,$590,$40,16
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0090001,BridgeSpan Exchange Silver HSA Legacy Health,63474OR009,,ORN002,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Legacy+Health+2015/074a0e97-9c22-42c5-87b7-fbc9f868e8e6?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0090001-06,94% AV Level Silver Plan,,0.934491455554962,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$0,$500,$150,$200,$0,$500,$40,17
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0150001,BridgeSpan Exchange Silver HSA MyChoice Northwest,63474OR015,,ORN003,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+MyChoice+Northwest+2015/0d0af66c-f584-45a5-b665-9b411cadf260?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0150001-00,Standard Silver Off Exchange Plan,,0.682320713996887,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$660,$40,18
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0150001,BridgeSpan Exchange Silver HSA MyChoice Northwest,63474OR015,,ORN003,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+MyChoice+Northwest+2015/0d0af66c-f584-45a5-b665-9b411cadf260?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0150001-01,Standard Silver On Exchange Plan,,0.682320713996887,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$660,$40,19
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0150001,BridgeSpan Exchange Silver HSA MyChoice Northwest,63474OR015,,ORN003,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+MyChoice+Northwest+2015/0d0af66c-f584-45a5-b665-9b411cadf260?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0150001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$40,20
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0150001,BridgeSpan Exchange Silver HSA MyChoice Northwest,63474OR015,,ORN003,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+MyChoice+Northwest+2015/0d0af66c-f584-45a5-b665-9b411cadf260?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0150001-03,Limited Cost Sharing Plan Variation,,0.682320713996887,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$660,$40,21
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,7,56707,OR,Individual,No,93-0863097,56707OR0910006,Connect 2000 Silver,56707OR091,,ORN003,ORS003,ORF001,New,EPO,Silver,Yes,Both,No,Yes,Specialists outside of your medical neighborhood,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997060571422418,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Connect-2000-silver-SBC-Individual-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0910006-01,Standard Silver On Exchange Plan,69.79%,0.697864055633545,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,900","$11,800",,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,580",$150,"$2,000",$560,$280,$80,5
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,7,56707,OR,Individual,No,93-0863097,56707OR0910006,Connect 2000 Silver,56707OR091,,ORN003,ORS003,ORF001,New,EPO,Silver,Yes,Both,No,Yes,Specialists outside of your medical neighborhood,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997060571422418,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Connect-2000-silver-SBC-Individual-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0910006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,7,56707,OR,Individual,No,93-0863097,56707OR0910006,Connect 2000 Silver,56707OR091,,ORN003,ORS003,ORF001,New,EPO,Silver,Yes,Both,No,Yes,Specialists outside of your medical neighborhood,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997060571422418,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Connect-2000-silver-SBC-Individual-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0910006-03,Limited Cost Sharing Plan Variation,69.79%,0.697864055633545,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,900","$11,800",,,"$11,800","$23,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,580",$150,"$2,000",$560,$280,$80,7
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,7,56707,OR,Individual,No,93-0863097,56707OR0910006,Connect 2000 Silver,56707OR091,,ORN003,ORS003,ORF001,New,EPO,Silver,Yes,Both,No,Yes,Specialists outside of your medical neighborhood,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997060571422418,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Connect-2000-silver-SBC-Individual-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0910006-04,73% AV Level Silver Plan,72.60%,0.719005823135376,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$20,"$1,050",$150,"$2,000",$540,$190,$80,8
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,7,56707,OR,Individual,No,93-0863097,56707OR0910006,Connect 2000 Silver,56707OR091,,ORN003,ORS003,ORF001,New,EPO,Silver,Yes,Both,No,Yes,Specialists outside of your medical neighborhood,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997060571422418,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Connect-2000-silver-SBC-Individual-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0910006-05,87% AV Level Silver Plan,87.30%,0.880636990070343,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$1,000","$1,000",Not Applicable,Not Applicable,$500,$20,$680,$150,$500,$820,$120,$80,9
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,7,56707,OR,Individual,No,93-0863097,56707OR0910006,Connect 2000 Silver,56707OR091,,ORN003,ORS003,ORF001,New,EPO,Silver,Yes,Both,No,Yes,Specialists outside of your medical neighborhood,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997060571422418,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Connect-2000-silver-SBC-Individual-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0910006-06,94% AV Level Silver Plan,94.50%,0.945035457611084,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,$200,$400,Not Applicable,Not Applicable,$100,$20,$360,$150,$100,$450,$70,$80,10
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,8,56707,OR,Individual,No,93-0863097,56707OR0880002,Providence Essential,56707OR088,,ORN001,ORS001,ORF012,New,EPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999420009602313,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Providence-Essential-SBC-Individual-direct-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0880002-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,4
2015,OR,56707,SERFF,8,2014-11-10 10:02:31,8,56707,OR,Individual,No,93-0863097,56707OR0880002,Providence Essential,56707OR088,,ORN001,ORS001,ORF012,New,EPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.999420009602313,,,0,0,0,2015-01-01,,Yes,Out of network benefit,Yes,National network or out of network benefit,Yes,https://healthplans.providence.org/pdfs/products-services/Documents/sbc/Individplan/Providence-Essential-SBC-Individual-direct-2015.pdf,https://fedexchange.providence.org,https://healthplans.providence.org/pdfs/products-services/Documents/u65/2015-individual-plan-overview.pdf,https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx,56707OR0880002-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,5
2015,OR,60013,SERFF,4,2014-10-06 10:59:03,1,60013,OR,Individual,Yes,93-1171647,60013OR0020002,ProCare Oregon Plan 1,60013OR002,,ORN001,ORS001,,New,EPO,Low,,Both,,,,Services that are not Dentally Appropriate are not covered.  Services that are not listed as covered in the policy are not covered.,,,,,Allows Adult and Child-Only,,,,$30.38,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,"The enrollee may seek treatment for a dental emergency from a mon-participating provider if the enrollee is 50-miles or more from the nearest participating provider?s office.  The company will reimburse the enrollee up to $100 toward covered services provided for treatment of the dental emergency, minus applicable copayments.",No,,,,,60013OR0020002-00,Standard Low Off Exchange Plan,71.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OR,60013,SERFF,4,2014-10-06 10:59:03,1,60013,OR,Individual,Yes,93-1171647,60013OR0020002,ProCare Oregon Plan 1,60013OR002,,ORN001,ORS001,,New,EPO,Low,,Both,,,,Services that are not Dentally Appropriate are not covered.  Services that are not listed as covered in the policy are not covered.,,,,,Allows Adult and Child-Only,,,,$30.38,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,"The enrollee may seek treatment for a dental emergency from a mon-participating provider if the enrollee is 50-miles or more from the nearest participating provider?s office.  The company will reimburse the enrollee up to $100 toward covered services provided for treatment of the dental emergency, minus applicable copayments.",No,,,,,60013OR0020002-01,Standard Low On Exchange Plan,71.31%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OR,60013,SERFF,4,2014-10-06 10:59:03,1,60013,OR,Individual,Yes,93-1171647,60013OR0020003,ProCare Oregon Plan 2,60013OR002,,ORN001,ORS001,,New,EPO,High,,Both,,,,Services that are not Dentally Appropriate are not covered.  Services that are not listed as covered in the policy are not covered.,,,,,Allows Adult and Child-Only,,,,$35.12,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,"The enrollee may seek treatment for a dental emergency from a mon-participating provider if the enrollee is 50-miles or more from the nearest participating provider?s office.  The company will reimburse the enrollee up to $100 toward covered services provided for treatment of the dental emergency, minus applicable copayments.",No,,,,,60013OR0020003-00,Standard High Off Exchange Plan,84.28%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OR,60013,SERFF,4,2014-10-06 10:59:03,1,60013,OR,Individual,Yes,93-1171647,60013OR0020003,ProCare Oregon Plan 2,60013OR002,,ORN001,ORS001,,New,EPO,High,,Both,,,,Services that are not Dentally Appropriate are not covered.  Services that are not listed as covered in the policy are not covered.,,,,,Allows Adult and Child-Only,,,,$35.12,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,"The enrollee may seek treatment for a dental emergency from a mon-participating provider if the enrollee is 50-miles or more from the nearest participating provider?s office.  The company will reimburse the enrollee up to $100 toward covered services provided for treatment of the dental emergency, minus applicable copayments.",No,,,,,60013OR0020003-01,Standard High On Exchange Plan,84.28%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OR,60257,SERFF,1,2014-09-12 09:45:59,1,60257,OR,Individual,Yes,47-0397286,60257OR0010001,"Delta Dental Individual PPO, EHB Certified",60257OR001,,ORN002,ORS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$40.67,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,60257OR0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OR,60257,SERFF,1,2014-09-12 09:45:59,1,60257,OR,Individual,Yes,47-0397286,60257OR0010002,"Delta Dental Individual PPO, EHB Certified",60257OR001,,ORN002,ORS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.07,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,60257OR0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OR,60257,SERFF,1,2014-09-12 09:45:59,1,60257,OR,Individual,Yes,47-0397286,60257OR0020001,"Renaissance Individual Dental PPO, EHB Certified",60257OR002,,ORN001,ORS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$42.85,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,60257OR0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OR,60257,SERFF,1,2014-09-12 09:45:59,1,60257,OR,Individual,Yes,47-0397286,60257OR0020002,"Renaissance Individual Dental PPO, EHB Certified",60257OR002,,ORN001,ORS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.76,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,60257OR0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0010001,BridgeSpan Oregon Standard Gold Plan Value PPO,63474OR001,,ORN001,ORS003,ORF002,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Gold+Plan+Value+PPO+2015/447c255a-4c23-4f24-9a0f-94c17d623fea?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0010001-00,Standard Gold Off Exchange Plan,,0.782178342342377,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$600,$150,$420,$380,$300,$40,4
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0010001,BridgeSpan Oregon Standard Gold Plan Value PPO,63474OR001,,ORN001,ORS003,ORF002,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Gold+Plan+Value+PPO+2015/447c255a-4c23-4f24-9a0f-94c17d623fea?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0010001-01,Standard Gold On Exchange Plan,,0.782178342342377,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$600,$150,$420,$380,$300,$40,5
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0010001,BridgeSpan Oregon Standard Gold Plan Value PPO,63474OR001,,ORN001,ORS003,ORF002,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Gold+Plan+Value+PPO+2015/447c255a-4c23-4f24-9a0f-94c17d623fea?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0010001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$40,6
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0010001,BridgeSpan Oregon Standard Gold Plan Value PPO,63474OR001,,ORN001,ORS003,ORF002,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Gold+Plan+Value+PPO+2015/447c255a-4c23-4f24-9a0f-94c17d623fea?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0010001-03,Limited Cost Sharing Plan Variation,,0.782178342342377,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$600,$150,$420,$380,$300,$40,7
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0130001,BridgeSpan Oregon Standard Gold Plan Mychoice Northwest,63474OR013,,ORN003,ORS001,ORF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Gold+Plan+MyChoice+Northwest+2015/2026d666-a442-4d47-871b-7185cad14a92?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0130001-00,Standard Gold Off Exchange Plan,,0.782178342342377,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$600,$150,$420,$380,$300,$40,8
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0230001,BridgeSpan Oregon Standard Gold Plan Mid-Valley,63474OR023,,ORN005,ORS002,ORF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Gold+Plan+Mid-Valley+2015/81be46bd-8538-4b93-9f1d-8f57982efaba?version=1.2,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0230001-01,Standard Gold On Exchange Plan,,0.782178342342377,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$600,$150,$420,$380,$300,$40,13
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0230001,BridgeSpan Oregon Standard Gold Plan Mid-Valley,63474OR023,,ORN005,ORS002,ORF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Gold+Plan+Mid-Valley+2015/81be46bd-8538-4b93-9f1d-8f57982efaba?version=1.2,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0230001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$40,14
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0230001,BridgeSpan Oregon Standard Gold Plan Mid-Valley,63474OR023,,ORN005,ORS002,ORF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Gold+Plan+Mid-Valley+2015/81be46bd-8538-4b93-9f1d-8f57982efaba?version=1.2,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0230001-03,Limited Cost Sharing Plan Variation,,0.782178342342377,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$600,$150,$420,$380,$300,$40,15
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0010002,BridgeSpan Oregon Standard Silver Plan Value PPO,63474OR001,,ORN001,ORS003,ORF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Silver+Plan+Value+PPO+2015/596fe195-ad74-4ade-8e41-2eb215a3ce21?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0010002-00,Standard Silver Off Exchange Plan,,0.683689296245575,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,$420,$600,$900,$40,16
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0010002,BridgeSpan Oregon Standard Silver Plan Value PPO,63474OR001,,ORN001,ORS003,ORF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Silver+Plan+Value+PPO+2015/596fe195-ad74-4ade-8e41-2eb215a3ce21?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0010002-01,Standard Silver On Exchange Plan,,0.683689296245575,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,$420,$600,$900,$40,17
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0010002,BridgeSpan Oregon Standard Silver Plan Value PPO,63474OR001,,ORN001,ORS003,ORF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Silver+Plan+Value+PPO+2015/596fe195-ad74-4ade-8e41-2eb215a3ce21?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0010002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$40,18
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0010002,BridgeSpan Oregon Standard Silver Plan Value PPO,63474OR001,,ORN001,ORS003,ORF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Silver+Plan+Value+PPO+2015/596fe195-ad74-4ade-8e41-2eb215a3ce21?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0010002-03,Limited Cost Sharing Plan Variation,,0.683689296245575,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,$420,$600,$900,$40,19
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0010002,BridgeSpan Oregon Standard Silver Plan Value PPO,63474OR001,,ORN001,ORS003,ORF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Silver+Plan+Value+PPO+2015/596fe195-ad74-4ade-8e41-2eb215a3ce21?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0010002-04,73% AV Level Silver Plan,,0.729346036911011,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,$420,$600,$900,$40,20
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0140001,BridgeSpan Oregon Standard Silver Plan MyChoice Northwest,63474OR014,,ORN003,ORS001,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Silver+Plan+MyChoice+Northwest+2015/adfb6238-1a39-42ea-9f7d-b38510f03fb3?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0140001-04,73% AV Level Silver Plan,,0.729346036911011,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,"$1,430",$150,$420,$600,$900,$40,27
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,1,63474,OR,Individual,No,87-0388069,63474OR0140001,BridgeSpan Oregon Standard Silver Plan MyChoice Northwest,63474OR014,,ORN003,ORS001,ORF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Silver+Plan+MyChoice+Northwest+2015/adfb6238-1a39-42ea-9f7d-b38510f03fb3?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0140001-05,87% AV Level Silver Plan,,0.870894372463226,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,$750,"$1,500",10%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$0,$0,50%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$750,$20,$650,$150,$420,$350,$300,$40,28
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,2,63474,OR,Individual,No,87-0388069,63474OR0160001,BridgeSpan Oregon Standard Bronze Plan MyChoice Northwest,63474OR016,,ORN003,ORS001,ORF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Bronze+MyChoice+Northwest+2015/7156eedc-5b56-4374-b1e5-d6e3993b1ca6?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0160001-00,Standard Bronze Off Exchange Plan,,0.587094008922577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,$420,$880,"$1,510",$40,8
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,2,63474,OR,Individual,No,87-0388069,63474OR0160001,BridgeSpan Oregon Standard Bronze Plan MyChoice Northwest,63474OR016,,ORN003,ORS001,ORF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Bronze+MyChoice+Northwest+2015/7156eedc-5b56-4374-b1e5-d6e3993b1ca6?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0160001-01,Standard Bronze On Exchange Plan,,0.587094008922577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,$420,$880,"$1,510",$40,9
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,2,63474,OR,Individual,No,87-0388069,63474OR0160001,BridgeSpan Oregon Standard Bronze Plan MyChoice Northwest,63474OR016,,ORN003,ORS001,ORF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Bronze+MyChoice+Northwest+2015/7156eedc-5b56-4374-b1e5-d6e3993b1ca6?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0160001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$40,10
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,2,63474,OR,Individual,No,87-0388069,63474OR0160001,BridgeSpan Oregon Standard Bronze Plan MyChoice Northwest,63474OR016,,ORN003,ORS001,ORF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Bronze+MyChoice+Northwest+2015/7156eedc-5b56-4374-b1e5-d6e3993b1ca6?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0160001-03,Limited Cost Sharing Plan Variation,,0.587094008922577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,$420,$880,"$1,510",$40,11
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,2,63474,OR,Individual,No,87-0388069,63474OR0260001,BridgeSpan Oregon Standard Bronze Plan Mid-Valley,63474OR026,,ORN005,ORS002,ORF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Bronze+Mid-Valley+2015/691952c0-9098-42d0-9533-5b35585f0b39?version=1.5,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0260001-00,Standard Bronze Off Exchange Plan,,0.587094008922577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,$420,$880,"$1,510",$40,12
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,2,63474,OR,Individual,No,87-0388069,63474OR0260001,BridgeSpan Oregon Standard Bronze Plan Mid-Valley,63474OR026,,ORN005,ORS002,ORF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Bronze+Mid-Valley+2015/691952c0-9098-42d0-9533-5b35585f0b39?version=1.5,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0260001-01,Standard Bronze On Exchange Plan,,0.587094008922577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,$420,$880,"$1,510",$40,13
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,2,63474,OR,Individual,No,87-0388069,63474OR0260001,BridgeSpan Oregon Standard Bronze Plan Mid-Valley,63474OR026,,ORN005,ORS002,ORF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Bronze+Mid-Valley+2015/691952c0-9098-42d0-9533-5b35585f0b39?version=1.5,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0260001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$40,14
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,2,63474,OR,Individual,No,87-0388069,63474OR0260001,BridgeSpan Oregon Standard Bronze Plan Mid-Valley,63474OR026,,ORN005,ORS002,ORF006,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Oregon+Standard+Bronze+Mid-Valley+2015/691952c0-9098-42d0-9533-5b35585f0b39?version=1.5,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeStandardFormularyOR2015_3919_Full_633.pdf,63474OR0260001-03,Limited Cost Sharing Plan Variation,,0.587094008922577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,$420,$880,"$1,510",$40,15
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0050001,BridgeSpan Exchange Silver HSA Value PPO,63474OR005,,ORN001,ORS003,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Value+PPO+2015/077cd8d2-a93c-4385-8b49-186c88a9cddc?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0050001-00,Standard Silver Off Exchange Plan,,0.682320713996887,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$660,$40,4
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0050001,BridgeSpan Exchange Silver HSA Value PPO,63474OR005,,ORN001,ORS003,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Value+PPO+2015/077cd8d2-a93c-4385-8b49-186c88a9cddc?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0050001-01,Standard Silver On Exchange Plan,,0.682320713996887,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$660,$40,5
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0050001,BridgeSpan Exchange Silver HSA Value PPO,63474OR005,,ORN001,ORS003,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Value+PPO+2015/077cd8d2-a93c-4385-8b49-186c88a9cddc?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0050001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$40,6
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0050001,BridgeSpan Exchange Silver HSA Value PPO,63474OR005,,ORN001,ORS003,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Value+PPO+2015/077cd8d2-a93c-4385-8b49-186c88a9cddc?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0050001-03,Limited Cost Sharing Plan Variation,,0.682320713996887,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$660,$40,7
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0290001,BridgeSpan Exchange Silver HSA Willamette Valley Health Solutions,63474OR029,,ORN004,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Willamette+Valley+Health+Solutions+2015/53f7a14d-cefa-49b6-9187-0adcfa68299b?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0290001-03,Limited Cost Sharing Plan Variation,,0.682320713996887,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$660,$40,28
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0290001,BridgeSpan Exchange Silver HSA Willamette Valley Health Solutions,63474OR029,,ORN004,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Willamette+Valley+Health+Solutions+2015/53f7a14d-cefa-49b6-9187-0adcfa68299b?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0290001-04,73% AV Level Silver Plan,,0.723372399806976,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,160",$150,"$1,500",$0,$760,$40,29
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,1,71287,OR,Individual,No,93-0798039,71287OR0420001,KP OR Gold 0/20,71287OR042,,ORN001,ORS001,ORF002,Existing,EPO,Gold,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,4,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_001_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420001-01,Standard Gold On Exchange Plan,,0.813461482524872,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,OR,68420,SERFF,9,2014-11-15 10:06:04,1,68420,OR,Individual,Yes,75-1233841,68420OR0010001,Dentegra Dental PPO Pediatric Basic Plan,68420OR001,,ORN001,ORS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$25.32,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/or/68420or0010001-15,,68420OR0010001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OR,68420,SERFF,9,2014-11-15 10:06:04,2,68420,OR,Individual,Yes,75-1233841,68420OR0010004,Dentegra Dental PPO Family Preferred Plan,68420OR001,,ORN001,ORS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.81,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/or/68420or0010004-15,,68420OR0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,$70,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OR,68420,SERFF,9,2014-11-15 10:06:04,2,68420,OR,Individual,Yes,75-1233841,68420OR0010004,Dentegra Dental PPO Family Preferred Plan,68420OR001,,ORN001,ORS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.81,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/or/68420or0010004-15,,68420OR0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,$70,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OR,68420,SERFF,9,2014-11-15 10:06:04,3,68420,OR,Individual,Yes,75-1233841,68420OR0010006,Dentegra Dental PPO Family Basic Plan,68420OR001,,ORN001,ORS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.32,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/or/68420or0010006-15,,68420OR0010006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OR,68420,SERFF,9,2014-11-15 10:06:04,3,68420,OR,Individual,Yes,75-1233841,68420OR0010006,Dentegra Dental PPO Family Basic Plan,68420OR001,,ORN001,ORS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$25.32,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/or/68420or0010006-15,,68420OR0010006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,1,71287,OR,Individual,No,93-0798039,71287OR0420001,KP OR Gold 0/20,71287OR042,,ORN001,ORS001,ORF002,Existing,EPO,Gold,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,4,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_001_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420001-00,Standard Gold Off Exchange Plan,,0.813461482524872,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,1,71287,OR,Individual,No,93-0798039,71287OR0420001,KP OR Gold 0/20,71287OR042,,ORN001,ORS001,ORF002,Existing,EPO,Gold,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,4,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_001_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,1,71287,OR,Individual,No,93-0798039,71287OR0420001,KP OR Gold 0/20,71287OR042,,ORN001,ORS001,ORF002,Existing,EPO,Gold,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,4,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_001_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420001-03,Limited Cost Sharing Plan Variation,,0.813461482524872,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,2,71287,OR,Individual,No,93-0798039,71287OR0420002,Kaiser Permanente Oregon Standard Gold Plan,71287OR042,,ORN001,ORS001,ORF004,Existing,EPO,Gold,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_003_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420002-00,Standard Gold Off Exchange Plan,,0.780197143554688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0290001,BridgeSpan Exchange Silver HSA Willamette Valley Health Solutions,63474OR029,,ORN004,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Willamette+Valley+Health+Solutions+2015/53f7a14d-cefa-49b6-9187-0adcfa68299b?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0290001-05,87% AV Level Silver Plan,,0.870060682296753,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,$0,$680,$150,$500,$0,$590,$40,30
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0290001,BridgeSpan Exchange Silver HSA Willamette Valley Health Solutions,63474OR029,,ORN004,ORS001,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Willamette+Valley+Health+Solutions+2015/53f7a14d-cefa-49b6-9187-0adcfa68299b?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0290001-06,94% AV Level Silver Plan,,0.934491455554962,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$0,$500,$150,$200,$0,$500,$40,31
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0250001,BridgeSpan Exchange Silver HSA Mid-Valley,63474OR025,,ORN005,ORS002,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Mid-Valley+2015/5ab60c5c-94a1-4844-abcc-7eec2e1418f0?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0250001-00,Standard Silver Off Exchange Plan,,0.682320713996887,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$660,$40,32
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0250001,BridgeSpan Exchange Silver HSA Mid-Valley,63474OR025,,ORN005,ORS002,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Mid-Valley+2015/5ab60c5c-94a1-4844-abcc-7eec2e1418f0?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0250001-01,Standard Silver On Exchange Plan,,0.682320713996887,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$660,$40,33
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0250001,BridgeSpan Exchange Silver HSA Mid-Valley,63474OR025,,ORN005,ORS002,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Mid-Valley+2015/5ab60c5c-94a1-4844-abcc-7eec2e1418f0?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0250001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$40,34
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0250001,BridgeSpan Exchange Silver HSA Mid-Valley,63474OR025,,ORN005,ORS002,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Mid-Valley+2015/5ab60c5c-94a1-4844-abcc-7eec2e1418f0?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0250001-03,Limited Cost Sharing Plan Variation,,0.682320713996887,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$660,$40,35
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0250001,BridgeSpan Exchange Silver HSA Mid-Valley,63474OR025,,ORN005,ORS002,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Mid-Valley+2015/5ab60c5c-94a1-4844-abcc-7eec2e1418f0?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0250001-04,73% AV Level Silver Plan,,0.723372399806976,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500",$0,"$1,160",$150,"$1,500",$0,$760,$40,36
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0250001,BridgeSpan Exchange Silver HSA Mid-Valley,63474OR025,,ORN005,ORS002,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Mid-Valley+2015/5ab60c5c-94a1-4844-abcc-7eec2e1418f0?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0250001-05,87% AV Level Silver Plan,,0.870060682296753,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,$0,$680,$150,$500,$0,$590,$40,37
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0250001,BridgeSpan Exchange Silver HSA Mid-Valley,63474OR025,,ORN005,ORS002,ORF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Silver+HSA+Mid-Valley+2015/5ab60c5c-94a1-4844-abcc-7eec2e1418f0?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0250001-06,94% AV Level Silver Plan,,0.934491455554962,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$0,$500,$150,$200,$0,$500,$40,38
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0060001,BridgeSpan Exchange Bronze HSA 100 Value PPO,63474OR006,,ORN001,ORS003,ORF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Bronze+HSA+100+Value+PPO+2015/4187c068-b6ef-4eba-b66b-b71fd9cf1937?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0060001-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,$420,$0,$0,$40,39
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0060001,BridgeSpan Exchange Bronze HSA 100 Value PPO,63474OR006,,ORN001,ORS003,ORF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Bronze+HSA+100+Value+PPO+2015/4187c068-b6ef-4eba-b66b-b71fd9cf1937?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0060001-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,$420,$0,$0,$40,40
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0060001,BridgeSpan Exchange Bronze HSA 100 Value PPO,63474OR006,,ORN001,ORS003,ORF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Bronze+HSA+100+Value+PPO+2015/4187c068-b6ef-4eba-b66b-b71fd9cf1937?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0060001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$40,41
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,4,71287,OR,Individual,No,93-0798039,71287OR0420004,Kaiser Permanente Oregon Standard Bronze Plan,71287OR042,,ORN001,ORS001,ORF012,Existing,EPO,Bronze,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_011_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420004-00,Standard Bronze Off Exchange Plan,,0.583432614803314,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,4,71287,OR,Individual,No,93-0798039,71287OR0420004,Kaiser Permanente Oregon Standard Bronze Plan,71287OR042,,ORN001,ORS001,ORF012,Existing,EPO,Bronze,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_011_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420004-01,Standard Bronze On Exchange Plan,,0.583432614803314,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,4,71287,OR,Individual,No,93-0798039,71287OR0420004,Kaiser Permanente Oregon Standard Bronze Plan,71287OR042,,ORN001,ORS001,ORF012,Existing,EPO,Bronze,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_011_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,4,71287,OR,Individual,No,93-0798039,71287OR0420004,Kaiser Permanente Oregon Standard Bronze Plan,71287OR042,,ORN001,ORS001,ORF012,Existing,EPO,Bronze,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_011_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420004-03,Limited Cost Sharing Plan Variation,,0.583432614803314,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,5,71287,OR,Individual,No,93-0798039,71287OR0420005,KP OR Gold 1000/20,71287OR042,,ORN001,ORS001,ORF003,Existing,EPO,Gold,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_002_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420005-00,Standard Gold Off Exchange Plan,,0.781846225261688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,6,71287,OR,Individual,No,93-0798039,71287OR0420006,KP OR Silver 1500/30,71287OR042,,ORN001,ORS001,ORF006,New,EPO,Silver,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_004_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,6,71287,OR,Individual,No,93-0798039,71287OR0420006,KP OR Silver 1500/30,71287OR042,,ORN001,ORS001,ORF006,New,EPO,Silver,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_004_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420006-03,Limited Cost Sharing Plan Variation,,0.705195248126984,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,6,71287,OR,Individual,No,93-0798039,71287OR0420006,KP OR Silver 1500/30,71287OR042,,ORN001,ORS001,ORF006,New,EPO,Silver,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_004_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420006-04,73% AV Level Silver Plan,,0.737502455711365,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,5,71287,OR,Individual,No,93-0798039,71287OR0420005,KP OR Gold 1000/20,71287OR042,,ORN001,ORS001,ORF003,Existing,EPO,Gold,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_002_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420005-01,Standard Gold On Exchange Plan,,0.781846225261688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,5,71287,OR,Individual,No,93-0798039,71287OR0420005,KP OR Gold 1000/20,71287OR042,,ORN001,ORS001,ORF003,Existing,EPO,Gold,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_002_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,5,71287,OR,Individual,No,93-0798039,71287OR0420005,KP OR Gold 1000/20,71287OR042,,ORN001,ORS001,ORF003,Existing,EPO,Gold,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_002_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420005-03,Limited Cost Sharing Plan Variation,,0.781846225261688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0060001,BridgeSpan Exchange Bronze HSA 100 Value PPO,63474OR006,,ORN001,ORS003,ORF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Bronze+HSA+100+Value+PPO+2015/4187c068-b6ef-4eba-b66b-b71fd9cf1937?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0060001-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,$420,$0,$0,$40,42
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0110001,BridgeSpan Exchange Bronze HSA 100 Legacy Health,63474OR011,,ORN002,ORS001,ORF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Bronze+HSA+100+Legacy+Health+2015/fefcf9d3-c12a-4433-86ad-35906fb1204a?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0110001-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,$420,$0,$0,$40,43
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0110001,BridgeSpan Exchange Bronze HSA 100 Legacy Health,63474OR011,,ORN002,ORS001,ORF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Bronze+HSA+100+Legacy+Health+2015/fefcf9d3-c12a-4433-86ad-35906fb1204a?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0110001-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,$420,$0,$0,$40,44
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0110001,BridgeSpan Exchange Bronze HSA 100 Legacy Health,63474OR011,,ORN002,ORS001,ORF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Bronze+HSA+100+Legacy+Health+2015/fefcf9d3-c12a-4433-86ad-35906fb1204a?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0110001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$40,45
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0110001,BridgeSpan Exchange Bronze HSA 100 Legacy Health,63474OR011,,ORN002,ORS001,ORF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Bronze+HSA+100+Legacy+Health+2015/fefcf9d3-c12a-4433-86ad-35906fb1204a?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0110001-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,$420,$0,$0,$40,46
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0170001,BridgeSpan Exchange Bronze HSA 100 MyChoice Northwest,63474OR017,,ORN003,ORS001,ORF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Bronze+HSA+100+MyChoice+Northwest+2015/2683e3fe-751b-4524-9899-12c264fa6730?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0170001-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,$420,$0,$0,$40,47
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0170001,BridgeSpan Exchange Bronze HSA 100 MyChoice Northwest,63474OR017,,ORN003,ORS001,ORF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Bronze+HSA+100+MyChoice+Northwest+2015/2683e3fe-751b-4524-9899-12c264fa6730?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0170001-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,$420,$0,$0,$40,48
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0170001,BridgeSpan Exchange Bronze HSA 100 MyChoice Northwest,63474OR017,,ORN003,ORS001,ORF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Bronze+HSA+100+MyChoice+Northwest+2015/2683e3fe-751b-4524-9899-12c264fa6730?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0170001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$40,49
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0170001,BridgeSpan Exchange Bronze HSA 100 MyChoice Northwest,63474OR017,,ORN003,ORS001,ORF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Bronze+HSA+100+MyChoice+Northwest+2015/2683e3fe-751b-4524-9899-12c264fa6730?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0170001-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,$420,$0,$0,$40,50
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0210001,BridgeSpan Exchange Bronze HSA 100 Willamette Valley Health Solutions,63474OR021,,ORN004,ORS001,ORF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Bronze+HSA+100+Willamette+Valley+Health+Solutions+2015/051e61aa-98fe-4b18-97d7-e777f0dff213?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0210001-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,$420,$0,$0,$40,51
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0210001,BridgeSpan Exchange Bronze HSA 100 Willamette Valley Health Solutions,63474OR021,,ORN004,ORS001,ORF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Bronze+HSA+100+Willamette+Valley+Health+Solutions+2015/051e61aa-98fe-4b18-97d7-e777f0dff213?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0210001-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,$420,$0,$0,$40,52
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0210001,BridgeSpan Exchange Bronze HSA 100 Willamette Valley Health Solutions,63474OR021,,ORN004,ORS001,ORF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Bronze+HSA+100+Willamette+Valley+Health+Solutions+2015/051e61aa-98fe-4b18-97d7-e777f0dff213?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0210001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$40,53
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0210001,BridgeSpan Exchange Bronze HSA 100 Willamette Valley Health Solutions,63474OR021,,ORN004,ORS001,ORF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Bronze+HSA+100+Willamette+Valley+Health+Solutions+2015/051e61aa-98fe-4b18-97d7-e777f0dff213?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0210001-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,$420,$0,$0,$40,54
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0270001,BridgeSpan Exchange Bronze HSA 100 Mid-Valley Mid-Valley,63474OR027,,ORN005,ORS002,ORF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Bronze+HSA+100+Mid-Valley+2015/d6b35a85-b53b-4cba-99a1-8b74f37938e1?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0270001-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,$420,$0,$0,$40,55
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0270001,BridgeSpan Exchange Bronze HSA 100 Mid-Valley Mid-Valley,63474OR027,,ORN005,ORS002,ORF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Bronze+HSA+100+Mid-Valley+2015/d6b35a85-b53b-4cba-99a1-8b74f37938e1?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0270001-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,$420,$0,$0,$40,56
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0270001,BridgeSpan Exchange Bronze HSA 100 Mid-Valley Mid-Valley,63474OR027,,ORN005,ORS002,ORF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Bronze+HSA+100+Mid-Valley+2015/d6b35a85-b53b-4cba-99a1-8b74f37938e1?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0270001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$40,57
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,3,63474,OR,Individual,No,87-0388069,63474OR0270001,BridgeSpan Exchange Bronze HSA 100 Mid-Valley Mid-Valley,63474OR027,,ORN005,ORS002,ORF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,0,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Bronze+HSA+100+Mid-Valley+2015/d6b35a85-b53b-4cba-99a1-8b74f37938e1?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0270001-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,300",$0,$0,$150,$420,$0,$0,$40,58
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,4,63474,OR,Individual,No,87-0388069,63474OR0040004,BridgeSpan Exchange Catastrophic Plan Value PPO,63474OR004,,ORN001,ORS003,ORF008,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,3,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Catastrophic+Value+PPO+2015/771dbf42-e925-48eb-a980-410dad0b71f1?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0040004-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,$420,$120,$0,$40,4
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,4,63474,OR,Individual,No,87-0388069,63474OR0040004,BridgeSpan Exchange Catastrophic Plan Value PPO,63474OR004,,ORN001,ORS003,ORF008,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,3,2015-01-01,,No,,Yes,Out of Service Area benefits are covered at in-network benefits within the provider network,Yes,www.bridgespanhealth.com/documents/10192/2189469/Catastrophic+Value+PPO+2015/771dbf42-e925-48eb-a980-410dad0b71f1?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0040004-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,$420,$120,$0,$40,5
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,4,63474,OR,Individual,No,87-0388069,63474OR0120001,BridgeSpan Exchange Catastrophic Plan Legacy Health,63474OR012,,ORN002,ORS001,ORF008,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,3,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Bronze+HSA+100+Legacy+Health+2015/fefcf9d3-c12a-4433-86ad-35906fb1204a?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0120001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,$420,$120,$0,$40,6
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,4,63474,OR,Individual,No,87-0388069,63474OR0120001,BridgeSpan Exchange Catastrophic Plan Legacy Health,63474OR012,,ORN002,ORS001,ORF008,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,3,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Bronze+HSA+100+Legacy+Health+2015/fefcf9d3-c12a-4433-86ad-35906fb1204a?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0120001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,$420,$120,$0,$40,7
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,4,63474,OR,Individual,No,87-0388069,63474OR0180001,BridgeSpan Exchange Catastrophic Plan MyChoice Northwest,63474OR018,,ORN003,ORS001,ORF008,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,3,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Catastrophic+MyChoice+Northwest+2015/f219237a-b878-4da5-90f0-1f3c109ab6e5?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0180001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,$420,$120,$0,$40,8
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,4,63474,OR,Individual,No,87-0388069,63474OR0180001,BridgeSpan Exchange Catastrophic Plan MyChoice Northwest,63474OR018,,ORN003,ORS001,ORF008,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,3,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Catastrophic+MyChoice+Northwest+2015/f219237a-b878-4da5-90f0-1f3c109ab6e5?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0180001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,$420,$120,$0,$40,9
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,4,63474,OR,Individual,No,87-0388069,63474OR0220001,BridgeSpan Exchange Catastrophic Plan Willamette Valley Health Solutions,63474OR022,,ORN004,ORS001,ORF008,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,3,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Catastrophic+Willamette+Valley+Health+Solutions+2015/863777e6-6b77-4434-bb4e-04843fd516e7?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0220001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,$420,$120,$0,$40,10
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,4,63474,OR,Individual,No,87-0388069,63474OR0220001,BridgeSpan Exchange Catastrophic Plan Willamette Valley Health Solutions,63474OR022,,ORN004,ORS001,ORF008,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,3,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Catastrophic+Willamette+Valley+Health+Solutions+2015/863777e6-6b77-4434-bb4e-04843fd516e7?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0220001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,$420,$120,$0,$40,11
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,4,63474,OR,Individual,No,87-0388069,63474OR0280001,BridgeSpan Exchange Catastrophic Plan Mid-Valley,63474OR028,,ORN005,ORS002,ORF008,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,3,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Catastrophic+Mid-Valley+2015/043e75ca-d3b1-47f2-be3a-0c9264517324?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0280001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,$420,$120,$0,$40,12
2015,OR,63474,SERFF,11,2014-12-10 23:15:01,4,63474,OR,Individual,No,87-0388069,63474OR0280001,BridgeSpan Exchange Catastrophic Plan Mid-Valley,63474OR028,,ORN005,ORS002,ORF008,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,,,,0,0,3,2015-01-01,,No,,Yes,Covered at the out of network benefit level,Yes,www.bridgespanhealth.com/documents/10192/2189469/Catastrophic+Mid-Valley+2015/043e75ca-d3b1-47f2-be3a-0c9264517324?version=1.4,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf,63474OR0280001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,000",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,$420,$120,$0,$40,13
2015,OR,68420,SERFF,9,2014-11-15 10:06:04,1,68420,OR,Individual,Yes,75-1233841,68420OR0010001,Dentegra Dental PPO Pediatric Basic Plan,68420OR001,,ORN001,ORS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$25.32,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/or/68420or0010001-15,,68420OR0010001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$65,Not Applicable,,,,,$65,Not Applicable,$65,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,1,71287,OR,Individual,Yes,93-0798039,71287OR0540001,KP OR Dental 100,71287OR054,,ORN002,ORS001,,New,EPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.51,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,,,,,71287OR0540001-00,Standard High Off Exchange Plan,86.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,1,71287,OR,Individual,Yes,93-0798039,71287OR0540001,KP OR Dental 100,71287OR054,,ORN002,ORS001,,New,EPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$34.51,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,,,,,71287OR0540001-01,Standard High On Exchange Plan,86.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,2,71287,OR,Individual,Yes,93-0798039,71287OR0540002,KP OR Dental 80H,71287OR054,,ORN002,ORS001,,New,EPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.87,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,,,,,71287OR0540002-00,Standard Low Off Exchange Plan,68.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,2,71287,OR,Individual,Yes,93-0798039,71287OR0540002,KP OR Dental 80H,71287OR054,,ORN002,ORS001,,New,EPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.87,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,,,,,71287OR0540002-01,Standard Low On Exchange Plan,68.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,2,71287,OR,Individual,No,93-0798039,71287OR0420002,Kaiser Permanente Oregon Standard Gold Plan,71287OR042,,ORN001,ORS001,ORF004,Existing,EPO,Gold,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_003_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420002-01,Standard Gold On Exchange Plan,,0.780197143554688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,2,71287,OR,Individual,No,93-0798039,71287OR0420002,Kaiser Permanente Oregon Standard Gold Plan,71287OR042,,ORN001,ORS001,ORF004,Existing,EPO,Gold,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_003_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,2,71287,OR,Individual,No,93-0798039,71287OR0420002,Kaiser Permanente Oregon Standard Gold Plan,71287OR042,,ORN001,ORS001,ORF004,Existing,EPO,Gold,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_003_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420002-03,Limited Cost Sharing Plan Variation,,0.780197143554688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,3,71287,OR,Individual,No,93-0798039,71287OR0420003,Kaiser Permanente Oregon Standard Silver Plan,71287OR042,,ORN001,ORS001,ORF007,Existing,EPO,Silver,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_005_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420003-00,Standard Silver Off Exchange Plan,,0.680933177471161,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,3,71287,OR,Individual,Yes,93-0798039,71287OR0540003,KP OR Dental 80L,71287OR054,,ORN002,ORS001,,New,EPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.11,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,,,,,71287OR0540003-00,Standard Low Off Exchange Plan,68.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,3,71287,OR,Individual,Yes,93-0798039,71287OR0540003,KP OR Dental 80L,71287OR054,,ORN002,ORS001,,New,EPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.11,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Emergency Only,Yes,Emergency Only,No,,,,,71287OR0540003-01,Standard Low On Exchange Plan,68.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,3,71287,OR,Individual,No,93-0798039,71287OR0420003,Kaiser Permanente Oregon Standard Silver Plan,71287OR042,,ORN001,ORS001,ORF007,Existing,EPO,Silver,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_005_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420003-01,Standard Silver On Exchange Plan,,0.680933177471161,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,3,71287,OR,Individual,No,93-0798039,71287OR0420003,Kaiser Permanente Oregon Standard Silver Plan,71287OR042,,ORN001,ORS001,ORF007,Existing,EPO,Silver,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_005_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,3,71287,OR,Individual,No,93-0798039,71287OR0420003,Kaiser Permanente Oregon Standard Silver Plan,71287OR042,,ORN001,ORS001,ORF007,Existing,EPO,Silver,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_005_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420003-03,Limited Cost Sharing Plan Variation,,0.680933177471161,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,3,71287,OR,Individual,No,93-0798039,71287OR0420003,Kaiser Permanente Oregon Standard Silver Plan,71287OR042,,ORN001,ORS001,ORF007,Existing,EPO,Silver,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_005_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420003-04,73% AV Level Silver Plan,,0.727139830589294,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,3,71287,OR,Individual,No,93-0798039,71287OR0420003,Kaiser Permanente Oregon Standard Silver Plan,71287OR042,,ORN001,ORS001,ORF007,Existing,EPO,Silver,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_005_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420003-05,87% AV Level Silver Plan,,0.869928658008575,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,3,71287,OR,Individual,No,93-0798039,71287OR0420003,Kaiser Permanente Oregon Standard Silver Plan,71287OR042,,ORN001,ORS001,ORF007,Existing,EPO,Silver,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,No,,No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_005_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420003-06,94% AV Level Silver Plan,,0.938194036483765,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,6,71287,OR,Individual,No,93-0798039,71287OR0420006,KP OR Silver 1500/30,71287OR042,,ORN001,ORS001,ORF006,New,EPO,Silver,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_004_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420006-00,Standard Silver Off Exchange Plan,,0.705195248126984,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,6,71287,OR,Individual,No,93-0798039,71287OR0420006,KP OR Silver 1500/30,71287OR042,,ORN001,ORS001,ORF006,New,EPO,Silver,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_004_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420006-01,Standard Silver On Exchange Plan,,0.705195248126984,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,Not Applicable,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,6,71287,OR,Individual,No,93-0798039,71287OR0420006,KP OR Silver 1500/30,71287OR042,,ORN001,ORS001,ORF006,New,EPO,Silver,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_004_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420006-05,87% AV Level Silver Plan,,0.871419370174408,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,6,71287,OR,Individual,No,93-0798039,71287OR0420006,KP OR Silver 1500/30,71287OR042,,ORN001,ORS001,ORF006,New,EPO,Silver,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_004_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420006-06,94% AV Level Silver Plan,,0.930822253227234,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,7,71287,OR,Individual,No,93-0798039,71287OR0420008,KP OR Bronze 4500/50,71287OR042,,ORN001,ORS001,ORF010,New,EPO,Bronze,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_008_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420008-00,Standard Bronze Off Exchange Plan,,0.608540594577789,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,4,85804,OR,Individual,No,93-0931709,85804OR0480001,LifeWise Oregon Standard Silver Plan Exclusive Provider 2500,85804OR048,,ORN001,ORS001,ORF005,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9928,,,0,0,0,2015-01-01,,No,,No,,No,https://www.lifewiseor.com/documents/031150_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0480001-05,87% AV Level Silver Plan,,0.869928658008575,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,4,85804,OR,Individual,No,93-0931709,85804OR0480001,LifeWise Oregon Standard Silver Plan Exclusive Provider 2500,85804OR048,,ORN001,ORS001,ORF005,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9928,,,0,0,0,2015-01-01,,No,,No,,No,https://www.lifewiseor.com/documents/031150_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0480001-06,94% AV Level Silver Plan,,0.938194036483765,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,4,85804,OR,Individual,No,93-0931709,85804OR0280003,LifeWise Oregon Standard Gold Plan 1300,85804OR028,,ORN001,ORS001,ORF011,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9945,,,0,0,0,2015-01-01,,Yes,"When you receive care from doctors and other outpatient providers outside the United States, Puerto Rico and the U.S. Virgin Islands, you will have to send us the claims yourself for Emergent care only.  Non-Emergent care is not covered.",Yes,"LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon, Washington and Alaska. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.",Yes,https://www.lifewiseor.com/documents/031344_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0280003-00,Standard Gold Off Exchange Plan,,0.780197143554688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$2,600",Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,4,85804,OR,Individual,No,93-0931709,85804OR0280003,LifeWise Oregon Standard Gold Plan 1300,85804OR028,,ORN001,ORS001,ORF011,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9945,,,0,0,0,2015-01-01,,Yes,"When you receive care from doctors and other outpatient providers outside the United States, Puerto Rico and the U.S. Virgin Islands, you will have to send us the claims yourself for Emergent care only.  Non-Emergent care is not covered.",Yes,"LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon, Washington and Alaska. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.",Yes,https://www.lifewiseor.com/documents/031344_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0280003-01,Standard Gold On Exchange Plan,,0.780197143554688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$2,600",Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,2,96383,OR,Individual,No,45-3261827,96383OR0010002,Health Republic Oregon Standard Silver Plan,96383OR001,,ORN001,ORS001,ORF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0010002-01-Health-Republic-Oregon-Standard-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/oregon-standard,http://www.healthrepublicinsurance.org,96383OR0010002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,2,96383,OR,Individual,No,45-3261827,96383OR0010002,Health Republic Oregon Standard Silver Plan,96383OR001,,ORN001,ORS001,ORF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0010002-01-Health-Republic-Oregon-Standard-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/oregon-standard,http://www.healthrepublicinsurance.org,96383OR0010002-03,Limited Cost Sharing Plan Variation,,0.680933177471161,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,$800,$150,"$2,420",$600,$0,$80,7
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,7,71287,OR,Individual,No,93-0798039,71287OR0420008,KP OR Bronze 4500/50,71287OR042,,ORN001,ORS001,ORF010,New,EPO,Bronze,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_008_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420008-01,Standard Bronze On Exchange Plan,,0.608540594577789,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,7,71287,OR,Individual,No,93-0798039,71287OR0420008,KP OR Bronze 4500/50,71287OR042,,ORN001,ORS001,ORF010,New,EPO,Bronze,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_008_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,7,71287,OR,Individual,No,93-0798039,71287OR0420008,KP OR Bronze 4500/50,71287OR042,,ORN001,ORS001,ORF010,New,EPO,Bronze,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_008_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420008-03,Limited Cost Sharing Plan Variation,,0.608540594577789,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,8,71287,OR,Individual,No,93-0798039,71287OR0420007,KP OR Silver 1750/25%/HSA,71287OR042,,ORN001,ORS001,ORF011,Existing,EPO,Silver,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance after deductible, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_006_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420007-00,Standard Silver Off Exchange Plan,,0.689034223556519,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,8,71287,OR,Individual,No,93-0798039,71287OR0420007,KP OR Silver 1750/25%/HSA,71287OR042,,ORN001,ORS001,ORF011,Existing,EPO,Silver,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance after deductible, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_006_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420007-01,Standard Silver On Exchange Plan,,0.689034223556519,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,2,85804,OR,Individual,No,93-0931709,85804OR0460002,LifeWise Exclusive Provider Silver 3000,85804OR046,,ORN001,ORS001,ORF003,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.993,,,0,0,0,2015-01-01,,No,,No,,No,https://www.lifewiseor.com/documents/031148_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0460002-01,Standard Silver On Exchange Plan,,0.704768717288971,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,2,85804,OR,Individual,No,93-0931709,85804OR0460002,LifeWise Exclusive Provider Silver 3000,85804OR046,,ORN001,ORS001,ORF003,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.993,,,0,0,0,2015-01-01,,No,,No,,No,https://www.lifewiseor.com/documents/031148_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0460002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,2,85804,OR,Individual,No,93-0931709,85804OR0460002,LifeWise Exclusive Provider Silver 3000,85804OR046,,ORN001,ORS001,ORF003,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.993,,,0,0,0,2015-01-01,,No,,No,,No,https://www.lifewiseor.com/documents/031148_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0460002-03,Limited Cost Sharing Plan Variation,,0.704768717288971,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,8,71287,OR,Individual,No,93-0798039,71287OR0420007,KP OR Silver 1750/25%/HSA,71287OR042,,ORN001,ORS001,ORF011,Existing,EPO,Silver,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance after deductible, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_006_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,8,71287,OR,Individual,No,93-0798039,71287OR0420007,KP OR Silver 1750/25%/HSA,71287OR042,,ORN001,ORS001,ORF011,Existing,EPO,Silver,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance after deductible, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_006_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420007-03,Limited Cost Sharing Plan Variation,,0.689034223556519,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,8,71287,OR,Individual,No,93-0798039,71287OR0420007,KP OR Silver 1750/25%/HSA,71287OR042,,ORN001,ORS001,ORF011,Existing,EPO,Silver,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance after deductible, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_006_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420007-04,73% AV Level Silver Plan,,0.721957385540009,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,8,71287,OR,Individual,No,93-0798039,71287OR0420007,KP OR Silver 1750/25%/HSA,71287OR042,,ORN001,ORS001,ORF011,Existing,EPO,Silver,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance after deductible, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_006_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420007-05,87% AV Level Silver Plan,,0.862879514694214,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$400,$800,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,8,71287,OR,Individual,No,93-0798039,71287OR0420007,KP OR Silver 1750/25%/HSA,71287OR042,,ORN001,ORS001,ORF011,Existing,EPO,Silver,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance after deductible, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_006_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420007-06,94% AV Level Silver Plan,,0.940118134021759,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,9,71287,OR,Individual,No,93-0798039,71287OR0420009,KP OR Bronze 4500/50/HSA,71287OR042,,ORN001,ORS001,ORF015,Existing,EPO,Bronze,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,4,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance after deductible, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_009_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420009-00,Standard Bronze Off Exchange Plan,,0.592337727546692,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,9,71287,OR,Individual,No,93-0798039,71287OR0420009,KP OR Bronze 4500/50/HSA,71287OR042,,ORN001,ORS001,ORF015,Existing,EPO,Bronze,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,4,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance after deductible, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_009_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420009-01,Standard Bronze On Exchange Plan,,0.592337727546692,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,9,71287,OR,Individual,No,93-0798039,71287OR0420009,KP OR Bronze 4500/50/HSA,71287OR042,,ORN001,ORS001,ORF015,Existing,EPO,Bronze,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,4,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance after deductible, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_009_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,9,71287,OR,Individual,No,93-0798039,71287OR0420009,KP OR Bronze 4500/50/HSA,71287OR042,,ORN001,ORS001,ORF015,Existing,EPO,Bronze,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,4,0,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance after deductible, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_009_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420009-03,Limited Cost Sharing Plan Variation,,0.592337727546692,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,10,71287,OR,Individual,No,93-0798039,71287OR0420010,KP OR Catastrophic 6600/0,71287OR042,,ORN001,ORS001,ORF016,Existing,EPO,Catastrophic,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,3,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance after deductible, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_013_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420010-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,OR,71287,SERFF,8,2014-12-10 23:15:01,10,71287,OR,Individual,No,93-0798039,71287OR0420010,KP OR Catastrophic 6600/0,71287OR042,,ORN001,ORS001,ORF016,Existing,EPO,Catastrophic,No,Both,No,Yes,"A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991496421408879,,,0,3,0,2015-01-01,2015-12-31,Yes,Emergency Services,Yes,"Student Out of Area:  20% coinsurance after deductible, $1,200 annual max benefit",No,http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/PLNSBC_KNW_20004_013_20150101_20120501_en.pdf,https://www.billerpayments.com/saml/hix/kporhb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html,www.kp.org,71287OR0420010-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,OR,85520,SERFF,1,2014-09-11 12:10:19,1,85520,OR,Individual,Yes,95-2371728,85520OR0010001,PPO MAC,85520OR001,,ORN001,ORS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$46.37,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of OR,Yes,,,,,85520OR0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OR,85520,SERFF,1,2014-09-11 12:10:19,1,85520,OR,Individual,Yes,95-2371728,85520OR0010002,PPO MAC,85520OR001,,ORN001,ORS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$37.84,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of OR,Yes,,,,,85520OR0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OR,85520,SERFF,1,2014-09-11 12:10:19,2,85520,OR,Individual,Yes,95-2371728,85520OR0010003,PPO MAC,85520OR001,,ORN001,ORS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$47.83,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of OR,Yes,,,,,85520OR0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,1,85804,OR,Individual,No,93-0931709,85804OR0260001,LifeWise Essential Gold 500,85804OR026,,ORN001,ORS001,ORF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9947,,,0,0,0,2015-01-01,,Yes,"When you receive care from doctors and other outpatient providers outside the United States, Puerto Rico and the U.S. Virgin Islands, you will have to send us the claims yourself.",Yes,LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.,Yes,https://www.lifewiseor.com/documents/029192_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0260001-00,Standard Gold Off Exchange Plan,,0.810310304164886,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,1,85804,OR,Individual,Yes,93-0931709,85804OR0440001,LifeWise Kids Dental Plan,85804OR044,,ORN001,ORS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$27.50,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"The out of country provision applies if the member is outside of the US.  For all providers, the member has to pay the provider at the time of service, and send the claim to the insurer along with any other supporting documents.  The insurer provides benefits at the out-of-network benefit level",Yes,"If the member is outside of Oregon, but still in the US, and visit a dentist not in the nationwide network, the insurer pays out of network.  Member has to pay the provider in full, and submit a claim for reimbursement.",Yes,https://www.lifewiseor.com/documents/031145_2015.pdf,,https://www.lifewiseor.com/documents/031113.pdf,,85804OR0440001-00,Standard Low Off Exchange Plan,70.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,1,85804,OR,Individual,Yes,93-0931709,85804OR0440001,LifeWise Kids Dental Plan,85804OR044,,ORN001,ORS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$27.50,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"The out of country provision applies if the member is outside of the US.  For all providers, the member has to pay the provider at the time of service, and send the claim to the insurer along with any other supporting documents.  The insurer provides benefits at the out-of-network benefit level",Yes,"If the member is outside of Oregon, but still in the US, and visit a dentist not in the nationwide network, the insurer pays out of network.  Member has to pay the provider in full, and submit a claim for reimbursement.",Yes,https://www.lifewiseor.com/documents/031145_2015.pdf,,https://www.lifewiseor.com/documents/031113.pdf,,85804OR0440001-01,Standard Low On Exchange Plan,70.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,1,85804,OR,Individual,No,93-0931709,85804OR0260001,LifeWise Essential Gold 500,85804OR026,,ORN001,ORS001,ORF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9947,,,0,0,0,2015-01-01,,Yes,"When you receive care from doctors and other outpatient providers outside the United States, Puerto Rico and the U.S. Virgin Islands, you will have to send us the claims yourself.",Yes,LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.,Yes,https://www.lifewiseor.com/documents/029192_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0260001-01,Standard Gold On Exchange Plan,,0.810310304164886,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,1,85804,OR,Individual,No,93-0931709,85804OR0260001,LifeWise Essential Gold 500,85804OR026,,ORN001,ORS001,ORF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9947,,,0,0,0,2015-01-01,,Yes,"When you receive care from doctors and other outpatient providers outside the United States, Puerto Rico and the U.S. Virgin Islands, you will have to send us the claims yourself.",Yes,LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.,Yes,https://www.lifewiseor.com/documents/029192_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0260001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,1,85804,OR,Individual,No,93-0931709,85804OR0260001,LifeWise Essential Gold 500,85804OR026,,ORN001,ORS001,ORF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9947,,,0,0,0,2015-01-01,,Yes,"When you receive care from doctors and other outpatient providers outside the United States, Puerto Rico and the U.S. Virgin Islands, you will have to send us the claims yourself.",Yes,LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.,Yes,https://www.lifewiseor.com/documents/029192_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0260001-03,Limited Cost Sharing Plan Variation,,0.810310304164886,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,1,85804,OR,Individual,No,93-0931709,85804OR0260007,LifeWise Essential Gold 1000,85804OR026,,ORN001,ORS001,ORF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9944,,,0,0,0,2015-01-01,,Yes,"When you receive care from doctors and other outpatient providers outside the United States, Puerto Rico and the U.S. Virgin Islands, you will have to send us the claims yourself.",Yes,LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.,Yes,https://www.lifewiseor.com/documents/031146_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0260007-00,Standard Gold Off Exchange Plan,,0.786960542201996,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,1,85804,OR,Individual,No,93-0931709,85804OR0260007,LifeWise Essential Gold 1000,85804OR026,,ORN001,ORS001,ORF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9944,,,0,0,0,2015-01-01,,Yes,"When you receive care from doctors and other outpatient providers outside the United States, Puerto Rico and the U.S. Virgin Islands, you will have to send us the claims yourself.",Yes,LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.,Yes,https://www.lifewiseor.com/documents/031146_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0260007-01,Standard Gold On Exchange Plan,,0.786960542201996,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,1,85804,OR,Individual,No,93-0931709,85804OR0260007,LifeWise Essential Gold 1000,85804OR026,,ORN001,ORS001,ORF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9944,,,0,0,0,2015-01-01,,Yes,"When you receive care from doctors and other outpatient providers outside the United States, Puerto Rico and the U.S. Virgin Islands, you will have to send us the claims yourself.",Yes,LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.,Yes,https://www.lifewiseor.com/documents/031146_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0260007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,1,85804,OR,Individual,No,93-0931709,85804OR0260007,LifeWise Essential Gold 1000,85804OR026,,ORN001,ORS001,ORF001,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9944,,,0,0,0,2015-01-01,,Yes,"When you receive care from doctors and other outpatient providers outside the United States, Puerto Rico and the U.S. Virgin Islands, you will have to send us the claims yourself.",Yes,LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.,Yes,https://www.lifewiseor.com/documents/031146_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0260007-03,Limited Cost Sharing Plan Variation,,0.786960542201996,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,2,85804,OR,Individual,No,93-0931709,85804OR0260004,LifeWise Essential Silver 2000,85804OR026,,ORN001,ORS001,ORF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9936,,,0,0,0,2015-01-01,,Yes,"When you receive care from doctors and other outpatient providers outside the United States, Puerto Rico and the U.S. Virgin Islands, you will have to send us the claims yourself.",Yes,LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.,Yes,https://www.lifewiseor.com/documents/029193_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0260004-00,Standard Silver Off Exchange Plan,,0.719992637634277,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,2,85804,OR,Individual,No,93-0931709,85804OR0260004,LifeWise Essential Silver 2000,85804OR026,,ORN001,ORS001,ORF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9936,,,0,0,0,2015-01-01,,Yes,"When you receive care from doctors and other outpatient providers outside the United States, Puerto Rico and the U.S. Virgin Islands, you will have to send us the claims yourself.",Yes,LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.,Yes,https://www.lifewiseor.com/documents/029193_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0260004-01,Standard Silver On Exchange Plan,,0.719992637634277,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,2,85804,OR,Individual,No,93-0931709,85804OR0260004,LifeWise Essential Silver 2000,85804OR026,,ORN001,ORS001,ORF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9936,,,0,0,0,2015-01-01,,Yes,"When you receive care from doctors and other outpatient providers outside the United States, Puerto Rico and the U.S. Virgin Islands, you will have to send us the claims yourself.",Yes,LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.,Yes,https://www.lifewiseor.com/documents/029193_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0260004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,2,85804,OR,Individual,No,93-0931709,85804OR0260004,LifeWise Essential Silver 2000,85804OR026,,ORN001,ORS001,ORF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9936,,,0,0,0,2015-01-01,,Yes,"When you receive care from doctors and other outpatient providers outside the United States, Puerto Rico and the U.S. Virgin Islands, you will have to send us the claims yourself.",Yes,LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.,Yes,https://www.lifewiseor.com/documents/029193_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0260004-03,Limited Cost Sharing Plan Variation,,0.719992637634277,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,2,95417,OR,Individual,No,42-1694349,95417OR0200001,Trillium Oregon Standard Bronze Plan Vital,95417OR020,,ORN001,ORS001,ORF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,This PPO plan will cover out-of-area services for out-of-network providers.,No,https://trilliumchp.softheon.com/SBC/SBCFiles/95417OR0200001-01.pdf,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,www.trilliumchp.com,95417OR0200001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,2,95417,OR,Individual,No,42-1694349,95417OR0200001,Trillium Oregon Standard Bronze Plan Vital,95417OR020,,ORN001,ORS001,ORF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,This PPO plan will cover out-of-area services for out-of-network providers.,No,https://trilliumchp.softheon.com/SBC/SBCFiles/95417OR0200001-01.pdf,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,www.trilliumchp.com,95417OR0200001-03,Limited Cost Sharing Plan Variation,,0.587094008922577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,2,95417,OR,Individual,No,42-1694349,95417OR0240001,Trillium Fit Catastrophic Plan,95417OR024,,ORN001,ORS001,ORF004,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,3,0,2015-01-01,,No,,Yes,This PPO plan will cover out-of-area services for out-of-network providers.,No,https://trilliumchp.softheon.com/SBC/SBCFiles/95417OR0240001-01.pdf,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,www.trilliumchp.com,95417OR0240001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,8
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,2,95417,OR,Individual,No,42-1694349,95417OR0240001,Trillium Fit Catastrophic Plan,95417OR024,,ORN001,ORS001,ORF004,New,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,3,0,2015-01-01,,No,,Yes,This PPO plan will cover out-of-area services for out-of-network providers.,No,https://trilliumchp.softheon.com/SBC/SBCFiles/95417OR0240001-01.pdf,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,www.trilliumchp.com,95417OR0240001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",100%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,9
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,7,96383,OR,Individual,No,45-3261827,96383OR0110002,KeyCare Silver Plan,96383OR011,,ORN001,ORS001,ORF011,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0110002-01-KeyCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/keycare,http://www.healthrepublicinsurance.org,96383OR0110002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,7,96383,OR,Individual,No,45-3261827,96383OR0110002,KeyCare Silver Plan,96383OR011,,ORN001,ORS001,ORF011,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0110002-01-KeyCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/keycare,http://www.healthrepublicinsurance.org,96383OR0110002-03,Limited Cost Sharing Plan Variation,69.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,070",$150,"$3,920",$210,$0,$80,11
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,7,96383,OR,Individual,No,45-3261827,96383OR0110002,KeyCare Silver Plan,96383OR011,,ORN001,ORS001,ORF011,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0110002-01-KeyCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/keycare,http://www.healthrepublicinsurance.org,96383OR0110002-04,73% AV Level Silver Plan,72.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,020",$0,"$1,270",$150,"$2,900",$290,$170,$80,12
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,7,96383,OR,Individual,No,45-3261827,96383OR0110002,KeyCare Silver Plan,96383OR011,,ORN001,ORS001,ORF011,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0110002-01-KeyCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/keycare,http://www.healthrepublicinsurance.org,96383OR0110002-05,87% AV Level Silver Plan,86.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$600,"$1,200",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$750,$0,$750,$150,"$1,350",$40,$110,$80,13
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,7,96383,OR,Individual,No,45-3261827,96383OR0110002,KeyCare Silver Plan,96383OR011,,ORN001,ORS001,ORF011,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0110002-01-KeyCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/keycare,http://www.healthrepublicinsurance.org,96383OR0110002-06,94% AV Level Silver Plan,93.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$600,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$50,$100,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$300,$0,$200,$150,$350,$40,$110,$80,14
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,8,96383,OR,Individual,No,45-3261827,96383OR0130001,CoreCare Silver Plan,96383OR013,,ORN001,ORS001,ORF012,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9847,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0130001-01-CoreCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/corecare,http://www.healthrepublicinsurance.org,96383OR0130001-00,Standard Silver Off Exchange Plan,,0.716633915901184,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$20,"$1,340",$150,"$1,410",$400,$0,$80,4
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,8,96383,OR,Individual,No,45-3261827,96383OR0130001,CoreCare Silver Plan,96383OR013,,ORN001,ORS001,ORF012,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9847,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0130001-01-CoreCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/corecare,http://www.healthrepublicinsurance.org,96383OR0130001-01,Standard Silver On Exchange Plan,,0.716633915901184,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$20,"$1,340",$150,"$1,410",$400,$0,$80,5
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,8,96383,OR,Individual,No,45-3261827,96383OR0130001,CoreCare Silver Plan,96383OR013,,ORN001,ORS001,ORF012,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9847,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0130001-01-CoreCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/corecare,http://www.healthrepublicinsurance.org,96383OR0130001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,8,96383,OR,Individual,No,45-3261827,96383OR0130001,CoreCare Silver Plan,96383OR013,,ORN001,ORS001,ORF012,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9847,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0130001-01-CoreCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/corecare,http://www.healthrepublicinsurance.org,96383OR0130001-03,Limited Cost Sharing Plan Variation,,0.716633915901184,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500",$20,"$1,340",$150,"$1,410",$400,$0,$80,7
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,8,96383,OR,Individual,No,45-3261827,96383OR0130001,CoreCare Silver Plan,96383OR013,,ORN001,ORS001,ORF012,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9847,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0130001-01-CoreCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/corecare,http://www.healthrepublicinsurance.org,96383OR0130001-04,73% AV Level Silver Plan,,0.736905872821808,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,750",$20,"$1,710",$150,"$1,410",$400,$0,$80,8
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,2,85804,OR,Individual,No,93-0931709,85804OR0260004,LifeWise Essential Silver 2000,85804OR026,,ORN001,ORS001,ORF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9936,,,0,0,0,2015-01-01,,Yes,"When you receive care from doctors and other outpatient providers outside the United States, Puerto Rico and the U.S. Virgin Islands, you will have to send us the claims yourself.",Yes,LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.,Yes,https://www.lifewiseor.com/documents/029193_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0260004-04,73% AV Level Silver Plan,,0.739996135234833,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,650","$9,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,2,85804,OR,Individual,No,93-0931709,85804OR0260004,LifeWise Essential Silver 2000,85804OR026,,ORN001,ORS001,ORF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9936,,,0,0,0,2015-01-01,,Yes,"When you receive care from doctors and other outpatient providers outside the United States, Puerto Rico and the U.S. Virgin Islands, you will have to send us the claims yourself.",Yes,LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.,Yes,https://www.lifewiseor.com/documents/029193_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0260004-05,87% AV Level Silver Plan,,0.86949098110199,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,8,96383,OR,Individual,No,45-3261827,96383OR0130002,CoreCare Gold Plan,96383OR013,,ORN001,ORS001,ORF012,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9871,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0130002-01-CoreCare-Gold-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/corecare,http://www.healthrepublicinsurance.org,96383OR0130002-00,Standard Gold Off Exchange Plan,,0.81360936164856,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,"$1,500",$150,"$1,000",$400,$200,$80,11
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,8,96383,OR,Individual,No,45-3261827,96383OR0130002,CoreCare Gold Plan,96383OR013,,ORN001,ORS001,ORF012,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9871,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0130002-01-CoreCare-Gold-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/corecare,http://www.healthrepublicinsurance.org,96383OR0130002-01,Standard Gold On Exchange Plan,,0.81360936164856,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,"$1,500",$150,"$1,000",$400,$200,$80,12
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,8,96383,OR,Individual,No,45-3261827,96383OR0130002,CoreCare Gold Plan,96383OR013,,ORN001,ORS001,ORF012,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9871,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0130002-01-CoreCare-Gold-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/corecare,http://www.healthrepublicinsurance.org,96383OR0130002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,13
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,8,96383,OR,Individual,No,45-3261827,96383OR0130002,CoreCare Gold Plan,96383OR013,,ORN001,ORS001,ORF012,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9871,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0130002-01-CoreCare-Gold-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/corecare,http://www.healthrepublicinsurance.org,96383OR0130002-03,Limited Cost Sharing Plan Variation,,0.81360936164856,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,"$1,500",$150,"$1,000",$400,$200,$80,14
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,8,96383,OR,Individual,No,45-3261827,96383OR0130003,CoreCare Platinum Plan,96383OR013,,ORN001,ORS001,ORF012,New,EPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9886,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0130003-01-CoreCare-Platinum-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/corecare,http://www.healthrepublicinsurance.org,96383OR0130003-00,Standard Platinum Off Exchange Plan,,0.897899329662323,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$500,$150,$500,$260,$240,$80,15
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,8,96383,OR,Individual,No,45-3261827,96383OR0130003,CoreCare Platinum Plan,96383OR013,,ORN001,ORS001,ORF012,New,EPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9886,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0130003-01-CoreCare-Platinum-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/corecare,http://www.healthrepublicinsurance.org,96383OR0130003-01,Standard Platinum On Exchange Plan,,0.897899329662323,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$500,$150,$500,$260,$240,$80,16
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,2,85804,OR,Individual,No,93-0931709,85804OR0260004,LifeWise Essential Silver 2000,85804OR026,,ORN001,ORS001,ORF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9936,,,0,0,0,2015-01-01,,Yes,"When you receive care from doctors and other outpatient providers outside the United States, Puerto Rico and the U.S. Virgin Islands, you will have to send us the claims yourself.",Yes,LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.,Yes,https://www.lifewiseor.com/documents/029193_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0260004-06,94% AV Level Silver Plan,,0.94189989566803,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,$400,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,2,85804,OR,Individual,No,93-0931709,85804OR0460002,LifeWise Exclusive Provider Silver 3000,85804OR046,,ORN001,ORS001,ORF003,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.993,,,0,0,0,2015-01-01,,No,,No,,No,https://www.lifewiseor.com/documents/031148_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0460002-00,Standard Silver Off Exchange Plan,,0.704768717288971,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,2,85804,OR,Individual,No,93-0931709,85804OR0460002,LifeWise Exclusive Provider Silver 3000,85804OR046,,ORN001,ORS001,ORF003,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.993,,,0,0,0,2015-01-01,,No,,No,,No,https://www.lifewiseor.com/documents/031148_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0460002-04,73% AV Level Silver Plan,,0.726029872894287,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$6,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,2,85804,OR,Individual,No,93-0931709,85804OR0460002,LifeWise Exclusive Provider Silver 3000,85804OR046,,ORN001,ORS001,ORF003,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.993,,,0,0,0,2015-01-01,,No,,No,,No,https://www.lifewiseor.com/documents/031148_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0460002-05,87% AV Level Silver Plan,,0.862334728240967,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$2,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,2,85804,OR,Individual,No,93-0931709,85804OR0460002,LifeWise Exclusive Provider Silver 3000,85804OR046,,ORN001,ORS001,ORF003,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.993,,,0,0,0,2015-01-01,,No,,No,,No,https://www.lifewiseor.com/documents/031148_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0460002-06,94% AV Level Silver Plan,,0.930405020713806,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$600,20%,,,,$600,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,3,85804,OR,Individual,No,93-0931709,85804OR0460001,LifeWise Exclusive Provider Bronze 6350,85804OR046,,ORN001,ORS001,ORF004,New,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9905,,,0,0,0,2015-01-01,,No,,No,,No,https://www.lifewiseor.com/documents/031147_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,85804OR0460001-00,Standard Bronze Off Exchange Plan,,0.619446337223053,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,3,85804,OR,Individual,No,93-0931709,85804OR0460001,LifeWise Exclusive Provider Bronze 6350,85804OR046,,ORN001,ORS001,ORF004,New,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9905,,,0,0,0,2015-01-01,,No,,No,,No,https://www.lifewiseor.com/documents/031147_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,85804OR0460001-01,Standard Bronze On Exchange Plan,,0.619446337223053,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,3,85804,OR,Individual,No,93-0931709,85804OR0460001,LifeWise Exclusive Provider Bronze 6350,85804OR046,,ORN001,ORS001,ORF004,New,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9905,,,0,0,0,2015-01-01,,No,,No,,No,https://www.lifewiseor.com/documents/031147_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,85804OR0460001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,3,85804,OR,Individual,No,93-0931709,85804OR0460001,LifeWise Exclusive Provider Bronze 6350,85804OR046,,ORN001,ORS001,ORF004,New,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9905,,,0,0,0,2015-01-01,,No,,No,,No,https://www.lifewiseor.com/documents/031147_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,85804OR0460001-03,Limited Cost Sharing Plan Variation,,0.619446337223053,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,4,85804,OR,Individual,No,93-0931709,85804OR0480001,LifeWise Oregon Standard Silver Plan Exclusive Provider 2500,85804OR048,,ORN001,ORS001,ORF005,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9928,,,0,0,0,2015-01-01,,No,,No,,No,https://www.lifewiseor.com/documents/031150_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0480001-00,Standard Silver Off Exchange Plan,,0.680933177471161,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,4,85804,OR,Individual,No,93-0931709,85804OR0480001,LifeWise Oregon Standard Silver Plan Exclusive Provider 2500,85804OR048,,ORN001,ORS001,ORF005,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9928,,,0,0,0,2015-01-01,,No,,No,,No,https://www.lifewiseor.com/documents/031150_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0480001-01,Standard Silver On Exchange Plan,,0.680933177471161,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,4,85804,OR,Individual,No,93-0931709,85804OR0480001,LifeWise Oregon Standard Silver Plan Exclusive Provider 2500,85804OR048,,ORN001,ORS001,ORF005,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9928,,,0,0,0,2015-01-01,,No,,No,,No,https://www.lifewiseor.com/documents/031150_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0480001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,4,85804,OR,Individual,No,93-0931709,85804OR0480001,LifeWise Oregon Standard Silver Plan Exclusive Provider 2500,85804OR048,,ORN001,ORS001,ORF005,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9928,,,0,0,0,2015-01-01,,No,,No,,No,https://www.lifewiseor.com/documents/031150_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0480001-03,Limited Cost Sharing Plan Variation,,0.680933177471161,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,4,85804,OR,Individual,No,93-0931709,85804OR0480001,LifeWise Oregon Standard Silver Plan Exclusive Provider 2500,85804OR048,,ORN001,ORS001,ORF005,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9928,,,0,0,0,2015-01-01,,No,,No,,No,https://www.lifewiseor.com/documents/031150_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0480001-04,73% AV Level Silver Plan,,0.727139830589294,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,4,85804,OR,Individual,No,93-0931709,85804OR0280003,LifeWise Oregon Standard Gold Plan 1300,85804OR028,,ORN001,ORS001,ORF011,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9945,,,0,0,0,2015-01-01,,Yes,"When you receive care from doctors and other outpatient providers outside the United States, Puerto Rico and the U.S. Virgin Islands, you will have to send us the claims yourself for Emergent care only.  Non-Emergent care is not covered.",Yes,"LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon, Washington and Alaska. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.",Yes,https://www.lifewiseor.com/documents/031344_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0280003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,4,85804,OR,Individual,No,93-0931709,85804OR0280003,LifeWise Oregon Standard Gold Plan 1300,85804OR028,,ORN001,ORS001,ORF011,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9945,,,0,0,0,2015-01-01,,Yes,"When you receive care from doctors and other outpatient providers outside the United States, Puerto Rico and the U.S. Virgin Islands, you will have to send us the claims yourself for Emergent care only.  Non-Emergent care is not covered.",Yes,"LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon, Washington and Alaska. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.",Yes,https://www.lifewiseor.com/documents/031344_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0280003-03,Limited Cost Sharing Plan Variation,,0.780197143554688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$2,600",Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,2,96383,OR,Individual,No,45-3261827,96383OR0010003,Health Republic Oregon Standard Gold Plan,96383OR001,,ORN001,ORS001,ORF003,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0010003-01-Health-Republic-Oregon-Standard-Gold-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/oregon-standard,http://www.healthrepublicinsurance.org,96383OR0010003-00,Standard Gold Off Exchange Plan,,0.780197143554688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$390,$150,"$1,300",$480,$80,$80,11
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,2,96383,OR,Individual,No,45-3261827,96383OR0010003,Health Republic Oregon Standard Gold Plan,96383OR001,,ORN001,ORS001,ORF003,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0010003-01-Health-Republic-Oregon-Standard-Gold-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/oregon-standard,http://www.healthrepublicinsurance.org,96383OR0010003-01,Standard Gold On Exchange Plan,,0.780197143554688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$390,$150,"$1,300",$480,$80,$80,12
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,2,96383,OR,Individual,No,45-3261827,96383OR0010003,Health Republic Oregon Standard Gold Plan,96383OR001,,ORN001,ORS001,ORF003,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0010003-01-Health-Republic-Oregon-Standard-Gold-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/oregon-standard,http://www.healthrepublicinsurance.org,96383OR0010003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,13
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,2,96383,OR,Individual,No,45-3261827,96383OR0010003,Health Republic Oregon Standard Gold Plan,96383OR001,,ORN001,ORS001,ORF003,Existing,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0010003-01-Health-Republic-Oregon-Standard-Gold-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/oregon-standard,http://www.healthrepublicinsurance.org,96383OR0010003-03,Limited Cost Sharing Plan Variation,,0.780197143554688,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$1,300",$20,$390,$150,"$1,300",$480,$80,$80,14
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,3,96383,OR,Individual,No,45-3261827,96383OR0100001,Health Republic Catastrophic Plan,96383OR010,,ORN001,ORS001,ORF004,Existing,EPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0100001-01-Catastrophic-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/catastrophic,http://www.healthrepublicinsurance.org,96383OR0100001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,4
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,3,96383,OR,Individual,No,45-3261827,96383OR0100001,Health Republic Catastrophic Plan,96383OR010,,ORN001,ORS001,ORF004,Existing,EPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0100001-01-Catastrophic-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/catastrophic,http://www.healthrepublicinsurance.org,96383OR0100001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$5,270",$0,$0,$80,5
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,4,96383,OR,Individual,No,45-3261827,96383OR0190001,PrimaryCare Bronze Plan,96383OR019,,ORN001,ORS001,ORF005,New,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98,,,0,1,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0190001-01-PrimaryCare-Bronze-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/primarycare,http://www.healthrepublicinsurance.org,96383OR0190001-00,Standard Bronze Off Exchange Plan,,0.608075439929962,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,170",$20,$0,$150,"$1,410","$1,000",$0,$80,4
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,4,96383,OR,Individual,No,45-3261827,96383OR0190001,PrimaryCare Bronze Plan,96383OR019,,ORN001,ORS001,ORF005,New,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98,,,0,1,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0190001-01-PrimaryCare-Bronze-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/primarycare,http://www.healthrepublicinsurance.org,96383OR0190001-01,Standard Bronze On Exchange Plan,,0.608075439929962,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,170",$20,$0,$150,"$1,410","$1,000",$0,$80,5
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,4,96383,OR,Individual,No,45-3261827,96383OR0190001,PrimaryCare Bronze Plan,96383OR019,,ORN001,ORS001,ORF005,New,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98,,,0,1,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0190001-01-PrimaryCare-Bronze-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/primarycare,http://www.healthrepublicinsurance.org,96383OR0190001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,4,96383,OR,Individual,No,45-3261827,96383OR0190001,PrimaryCare Bronze Plan,96383OR019,,ORN001,ORS001,ORF005,New,EPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98,,,0,1,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0190001-01-PrimaryCare-Bronze-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/primarycare,http://www.healthrepublicinsurance.org,96383OR0190001-03,Limited Cost Sharing Plan Variation,,0.608075439929962,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,170",$20,$0,$150,"$1,410","$1,000",$0,$80,7
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,5,96383,OR,Individual,No,45-3261827,96383OR0190002,PrimaryCare Silver Plan,96383OR019,,ORN001,ORS001,ORF006,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9841,,,0,3,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0190002-01-PrimaryCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/primarycare,http://www.healthrepublicinsurance.org,96383OR0190002-00,Standard Silver Off Exchange Plan,,0.708304941654205,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,750",$0,$0,$150,"$1,410",$0,$0,$80,4
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,5,96383,OR,Individual,No,45-3261827,96383OR0190002,PrimaryCare Silver Plan,96383OR019,,ORN001,ORS001,ORF006,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9841,,,0,3,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0190002-01-PrimaryCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/primarycare,http://www.healthrepublicinsurance.org,96383OR0190002-01,Standard Silver On Exchange Plan,,0.708304941654205,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,750",$0,$0,$150,"$1,410",$0,$0,$80,5
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,5,96383,OR,Individual,No,45-3261827,96383OR0190002,PrimaryCare Silver Plan,96383OR019,,ORN001,ORS001,ORF006,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9841,,,0,3,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0190002-01-PrimaryCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/primarycare,http://www.healthrepublicinsurance.org,96383OR0190002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,5,96383,OR,Individual,No,45-3261827,96383OR0190002,PrimaryCare Silver Plan,96383OR019,,ORN001,ORS001,ORF006,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9841,,,0,3,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0190002-01-PrimaryCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/primarycare,http://www.healthrepublicinsurance.org,96383OR0190002-03,Limited Cost Sharing Plan Variation,,0.708304941654205,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,750",$0,$0,$150,"$1,410",$0,$0,$80,7
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,5,96383,OR,Individual,No,45-3261827,96383OR0190002,PrimaryCare Silver Plan,96383OR019,,ORN001,ORS001,ORF006,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9841,,,0,3,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0190002-01-PrimaryCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/primarycare,http://www.healthrepublicinsurance.org,96383OR0190002-04,73% AV Level Silver Plan,,0.731377065181732,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000",$0,$0,$150,"$1,410",$0,$0,$80,8
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,5,96383,OR,Individual,No,45-3261827,96383OR0190002,PrimaryCare Silver Plan,96383OR019,,ORN001,ORS001,ORF006,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9841,,,0,3,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0190002-01-PrimaryCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/primarycare,http://www.healthrepublicinsurance.org,96383OR0190002-05,87% AV Level Silver Plan,,0.865748882293701,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500",$0,$0,$150,"$1,410",$0,$0,$80,9
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,5,85804,OR,Individual,No,93-0931709,85804OR0280002,LifeWise Oregon Standard Bronze Plan 5000,85804OR028,,ORN001,ORS001,ORF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9903,,,0,0,0,2015-01-01,,Yes,"When you receive care from doctors and other outpatient providers outside the United States, Puerto Rico and the U.S. Virgin Islands, you will have to send us the claims yourself for Emergent care only.  Non-Emergent care is not covered.",Yes,"LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon, Washington and Alaska. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.",Yes,https://www.lifewiseor.com/documents/029195_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0280002-00,Standard Bronze Off Exchange Plan,,0.583432614803314,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,5,85804,OR,Individual,No,93-0931709,85804OR0280002,LifeWise Oregon Standard Bronze Plan 5000,85804OR028,,ORN001,ORS001,ORF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9903,,,0,0,0,2015-01-01,,Yes,"When you receive care from doctors and other outpatient providers outside the United States, Puerto Rico and the U.S. Virgin Islands, you will have to send us the claims yourself for Emergent care only.  Non-Emergent care is not covered.",Yes,"LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon, Washington and Alaska. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.",Yes,https://www.lifewiseor.com/documents/029195_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0280002-01,Standard Bronze On Exchange Plan,,0.583432614803314,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,5,85804,OR,Individual,No,93-0931709,85804OR0280002,LifeWise Oregon Standard Bronze Plan 5000,85804OR028,,ORN001,ORS001,ORF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9903,,,0,0,0,2015-01-01,,Yes,"When you receive care from doctors and other outpatient providers outside the United States, Puerto Rico and the U.S. Virgin Islands, you will have to send us the claims yourself for Emergent care only.  Non-Emergent care is not covered.",Yes,"LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon, Washington and Alaska. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.",Yes,https://www.lifewiseor.com/documents/029195_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0280002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,5,85804,OR,Individual,No,93-0931709,85804OR0280002,LifeWise Oregon Standard Bronze Plan 5000,85804OR028,,ORN001,ORS001,ORF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.9903,,,0,0,0,2015-01-01,,Yes,"When you receive care from doctors and other outpatient providers outside the United States, Puerto Rico and the U.S. Virgin Islands, you will have to send us the claims yourself for Emergent care only.  Non-Emergent care is not covered.",Yes,"LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon, Washington and Alaska. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.",Yes,https://www.lifewiseor.com/documents/029195_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7918349883,85804OR0280002-03,Limited Cost Sharing Plan Variation,,0.583432614803314,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,6,85804,OR,Individual,No,93-0931709,85804OR0470001,LifeWise Exclusive Provider Bronze 5250 HSA,85804OR047,,ORN001,ORS001,ORF004,New,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,No,,No,,Yes,https://www.lifewiseor.com/documents/031149_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,85804OR0470001-00,Standard Bronze Off Exchange Plan,,0.619937121868134,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,6,85804,OR,Individual,No,93-0931709,85804OR0470001,LifeWise Exclusive Provider Bronze 5250 HSA,85804OR047,,ORN001,ORS001,ORF004,New,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,No,,No,,Yes,https://www.lifewiseor.com/documents/031149_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,85804OR0470001-01,Standard Bronze On Exchange Plan,,0.619937121868134,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,6,85804,OR,Individual,No,93-0931709,85804OR0470001,LifeWise Exclusive Provider Bronze 5250 HSA,85804OR047,,ORN001,ORS001,ORF004,New,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,No,,No,,Yes,https://www.lifewiseor.com/documents/031149_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,85804OR0470001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,OR,85804,SERFF,8,2014-12-10 23:15:01,6,85804,OR,Individual,No,93-0931709,85804OR0470001,LifeWise Exclusive Provider Bronze 5250 HSA,85804OR047,,ORN001,ORS001,ORF004,New,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes",,0.99,,,0,0,0,2015-01-01,,No,,No,,Yes,https://www.lifewiseor.com/documents/031149_2015.pdf,,https://www.lifewiseor.com/documents/008701.pdf,http://client.formularynavigator.com/Search.aspx?siteCode=7425239228,85804OR0470001-03,Limited Cost Sharing Plan Variation,,0.619937121868134,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500",0%,,,,"$10,500","$21,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,1,95417,OR,Individual,Yes,42-1694349,95417OR0090001,Trillium Bright Pediatric - Low,95417OR009,,ORN001,ORS001,,Existing,PPO,Low,,Both,,,,"All supplies or services not specifically listed as covered. General exclusions We will NOT cover: ?       Services covered under worker?s compensation or employer?s liability laws and services covered by any federal state, county, municipality or other governmental agency, except Medicaid. ? Services with respect to congenital or developmental malformations or cosmetic reasons; including but not limited to, enamel hypoplasia, fluorosis and disturbance of the temporomandibular joint. ? Services for rebuilding or maintaining chewing surfaces due to teeth out of alignment or occlusion or for stabilizing teeth. ? Services started prior to the eligibility date of this plan. ? Hypnosis, prescribed drugs, premedications or analgesia (e.g. nitrous oxide) or any other euphoric drugs. ? Hospital costs or any additional fees charged by the dentist because the patient is hospitalized. ? General anesthesia and/or IV sedation except when administered by a dentist in conjunction with covered oral surgery in his or her office. ? Experimental procedures. ? Missed or broken appointments. ? Precision attachments. ? Orthodontic services (other than those listed as covered benefits). ? Services for cosmetic reasons. ? Claims submitted more than 12 months after the date of service are not covered. ? All other services or supplies, not specifically covered.  Exclusion periods The following services are not covered during the first six months* under this plan: ? Crowns ? Replacement of an existing prosthetic device ? Cast partial, full, immediate or overdenture ? Fixed bridges or removable cast partials   *If you were covered under another health insurance plan before enrolling in this plan, you can receive credit for prior coverage. See the Credit for Prior Coverage section, on the next page .",,,,,Allows Child-Only,,,,$25.24,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide,Yes,,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,,95417OR0090001-00,Standard Low Off Exchange Plan,69.31%,,,,No,100%,,$350,Not Applicable,,,$350,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,1,95417,OR,Individual,No,42-1694349,95417OR0190001,Trillium Oregon Standard Silver Plan Vital,95417OR019,,ORN001,ORS001,ORF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,This PPO plan will cover out-of-area services for out-of-network providers.,No,https://trilliumchp.softheon.com/SBC/SBCFiles/95417OR0190001-01.pdf,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,www.trilliumchp.com,95417OR0190001-00,Standard Silver Off Exchange Plan,,0.683689296245575,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,1,95417,OR,Individual,No,42-1694349,95417OR0190001,Trillium Oregon Standard Silver Plan Vital,95417OR019,,ORN001,ORS001,ORF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,This PPO plan will cover out-of-area services for out-of-network providers.,No,https://trilliumchp.softheon.com/SBC/SBCFiles/95417OR0190001-01.pdf,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,www.trilliumchp.com,95417OR0190001-01,Standard Silver On Exchange Plan,,0.683689296245575,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,1,95417,OR,Individual,Yes,42-1694349,95417OR0090001,Trillium Bright Pediatric - Low,95417OR009,,ORN001,ORS001,,Existing,PPO,Low,,Both,,,,"All supplies or services not specifically listed as covered. General exclusions We will NOT cover: ?       Services covered under worker?s compensation or employer?s liability laws and services covered by any federal state, county, municipality or other governmental agency, except Medicaid. ? Services with respect to congenital or developmental malformations or cosmetic reasons; including but not limited to, enamel hypoplasia, fluorosis and disturbance of the temporomandibular joint. ? Services for rebuilding or maintaining chewing surfaces due to teeth out of alignment or occlusion or for stabilizing teeth. ? Services started prior to the eligibility date of this plan. ? Hypnosis, prescribed drugs, premedications or analgesia (e.g. nitrous oxide) or any other euphoric drugs. ? Hospital costs or any additional fees charged by the dentist because the patient is hospitalized. ? General anesthesia and/or IV sedation except when administered by a dentist in conjunction with covered oral surgery in his or her office. ? Experimental procedures. ? Missed or broken appointments. ? Precision attachments. ? Orthodontic services (other than those listed as covered benefits). ? Services for cosmetic reasons. ? Claims submitted more than 12 months after the date of service are not covered. ? All other services or supplies, not specifically covered.  Exclusion periods The following services are not covered during the first six months* under this plan: ? Crowns ? Replacement of an existing prosthetic device ? Cast partial, full, immediate or overdenture ? Fixed bridges or removable cast partials   *If you were covered under another health insurance plan before enrolling in this plan, you can receive credit for prior coverage. See the Credit for Prior Coverage section, on the next page .",,,,,Allows Child-Only,,,,$25.24,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide,Yes,,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,,95417OR0090001-01,Standard Low On Exchange Plan,69.31%,,,,No,100%,,$350,Not Applicable,,,$350,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,1,95417,OR,Individual,Yes,42-1694349,95417OR0110001,Trillium Bright Pediatric - High,95417OR011,,ORN001,ORS001,,Existing,PPO,High,,Both,,,,"All supplies or services not specifically listed as covered. General exclusions We will NOT cover: ?       Services covered under worker?s compensation or employer?s liability laws and services covered by any federal state, county, municipality or other governmental agency, except Medicaid. ? Services with respect to congenital or developmental malformations or cosmetic reasons; including but not limited to, enamel hypoplasia, fluorosis and disturbance of the temporomandibular joint. ? Services for rebuilding or maintaining chewing surfaces due to teeth out of alignment or occlusion or for stabilizing teeth. ? Services started prior to the eligibility date of this plan. ? Hypnosis, prescribed drugs, premedications or analgesia (e.g. nitrous oxide) or any other euphoric drugs. ? Hospital costs or any additional fees charged by the dentist because the patient is hospitalized. ? General anesthesia and/or IV sedation except when administered by a dentist in conjunction with covered oral surgery in his or her office. ? Experimental procedures. ? Missed or broken appointments. ? Precision attachments. ? Orthodontic services (other than those listed as covered benefits). ? Services for cosmetic reasons. ? Claims submitted more than 12 months after the date of service are not covered. ? All other services or supplies, not specifically covered.  Exclusion periods The following services are not covered during the first six months* under this plan: ? Crowns ? Replacement of an existing prosthetic device ? Cast partial, full, immediate or overdenture ? Fixed bridges or removable cast partials   *If you were covered under another health insurance plan before enrolling in this plan, you can receive credit for prior coverage. See the Credit for Prior Coverage section, on the next page .",,,,,Allows Child-Only,,,,$32.52,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide,Yes,,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,,95417OR0110001-00,Standard High Off Exchange Plan,84.23%,,,,No,100%,,$350,Not Applicable,,,$350,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,1,95417,OR,Individual,No,42-1694349,95417OR0190001,Trillium Oregon Standard Silver Plan Vital,95417OR019,,ORN001,ORS001,ORF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,This PPO plan will cover out-of-area services for out-of-network providers.,No,https://trilliumchp.softheon.com/SBC/SBCFiles/95417OR0190001-01.pdf,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,www.trilliumchp.com,95417OR0190001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,1,95417,OR,Individual,No,42-1694349,95417OR0190001,Trillium Oregon Standard Silver Plan Vital,95417OR019,,ORN001,ORS001,ORF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,This PPO plan will cover out-of-area services for out-of-network providers.,No,https://trilliumchp.softheon.com/SBC/SBCFiles/95417OR0190001-01.pdf,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,www.trilliumchp.com,95417OR0190001-03,Limited Cost Sharing Plan Variation,,0.683689296245575,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,1,95417,OR,Individual,Yes,42-1694349,95417OR0110001,Trillium Bright Pediatric - High,95417OR011,,ORN001,ORS001,,Existing,PPO,High,,Both,,,,"All supplies or services not specifically listed as covered. General exclusions We will NOT cover: ?       Services covered under worker?s compensation or employer?s liability laws and services covered by any federal state, county, municipality or other governmental agency, except Medicaid. ? Services with respect to congenital or developmental malformations or cosmetic reasons; including but not limited to, enamel hypoplasia, fluorosis and disturbance of the temporomandibular joint. ? Services for rebuilding or maintaining chewing surfaces due to teeth out of alignment or occlusion or for stabilizing teeth. ? Services started prior to the eligibility date of this plan. ? Hypnosis, prescribed drugs, premedications or analgesia (e.g. nitrous oxide) or any other euphoric drugs. ? Hospital costs or any additional fees charged by the dentist because the patient is hospitalized. ? General anesthesia and/or IV sedation except when administered by a dentist in conjunction with covered oral surgery in his or her office. ? Experimental procedures. ? Missed or broken appointments. ? Precision attachments. ? Orthodontic services (other than those listed as covered benefits). ? Services for cosmetic reasons. ? Claims submitted more than 12 months after the date of service are not covered. ? All other services or supplies, not specifically covered.  Exclusion periods The following services are not covered during the first six months* under this plan: ? Crowns ? Replacement of an existing prosthetic device ? Cast partial, full, immediate or overdenture ? Fixed bridges or removable cast partials   *If you were covered under another health insurance plan before enrolling in this plan, you can receive credit for prior coverage. See the Credit for Prior Coverage section, on the next page .",,,,,Allows Child-Only,,,,$32.52,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide,Yes,,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,,95417OR0110001-01,Standard High On Exchange Plan,84.23%,,,,No,100%,,$350,Not Applicable,,,$350,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,1,95417,OR,Individual,No,42-1694349,95417OR0190001,Trillium Oregon Standard Silver Plan Vital,95417OR019,,ORN001,ORS001,ORF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,This PPO plan will cover out-of-area services for out-of-network providers.,No,https://trilliumchp.softheon.com/SBC/SBCFiles/95417OR0190001-01.pdf,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,www.trilliumchp.com,95417OR0190001-04,73% AV Level Silver Plan,,0.729346036911011,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$8,500","$17,000",Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,1,95417,OR,Individual,No,42-1694349,95417OR0190001,Trillium Oregon Standard Silver Plan Vital,95417OR019,,ORN001,ORS001,ORF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,This PPO plan will cover out-of-area services for out-of-network providers.,No,https://trilliumchp.softheon.com/SBC/SBCFiles/95417OR0190001-01.pdf,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,www.trilliumchp.com,95417OR0190001-05,87% AV Level Silver Plan,,0.870894372463226,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000",Not Applicable,Not Applicable,$750,"$1,500",10%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,50%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,1,95417,OR,Individual,No,42-1694349,95417OR0190001,Trillium Oregon Standard Silver Plan Vital,95417OR019,,ORN001,ORS001,ORF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,This PPO plan will cover out-of-area services for out-of-network providers.,No,https://trilliumchp.softheon.com/SBC/SBCFiles/95417OR0190001-01.pdf,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,www.trilliumchp.com,95417OR0190001-06,94% AV Level Silver Plan,,0.943357825279236,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$1,500","$3,000",Not Applicable,Not Applicable,$50,$100,10%,,,,$100,$200,Not Applicable,Not Applicable,$0,$0,50%,,,,$100,$200,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,1,95417,OR,Individual,No,42-1694349,95417OR0180001,Trillium Oregon Standard Gold Plan Vital,95417OR018,,ORN001,ORS001,ORF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,This PPO plan will cover out-of-area services for out-of-network providers.,No,https://trilliumchp.softheon.com/SBC/SBCFiles/95417OR0180001-00.pdf,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,www.trilliumchp.com,95417OR0180001-00,Standard Gold Off Exchange Plan,,0.782178342342377,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,$0,$0,50%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,1,95417,OR,Individual,No,42-1694349,95417OR0180001,Trillium Oregon Standard Gold Plan Vital,95417OR018,,ORN001,ORS001,ORF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,This PPO plan will cover out-of-area services for out-of-network providers.,No,https://trilliumchp.softheon.com/SBC/SBCFiles/95417OR0180001-00.pdf,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,www.trilliumchp.com,95417OR0180001-01,Standard Gold On Exchange Plan,,0.782178342342377,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,$0,$0,50%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,1,95417,OR,Individual,No,42-1694349,95417OR0180001,Trillium Oregon Standard Gold Plan Vital,95417OR018,,ORN001,ORS001,ORF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,This PPO plan will cover out-of-area services for out-of-network providers.,No,https://trilliumchp.softheon.com/SBC/SBCFiles/95417OR0180001-00.pdf,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,www.trilliumchp.com,95417OR0180001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,1,95417,OR,Individual,No,42-1694349,95417OR0180001,Trillium Oregon Standard Gold Plan Vital,95417OR018,,ORN001,ORS001,ORF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,This PPO plan will cover out-of-area services for out-of-network providers.,No,https://trilliumchp.softheon.com/SBC/SBCFiles/95417OR0180001-00.pdf,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,www.trilliumchp.com,95417OR0180001-03,Limited Cost Sharing Plan Variation,,0.782178342342377,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,$0,$0,50%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,2,95417,OR,Individual,No,42-1694349,95417OR0200001,Trillium Oregon Standard Bronze Plan Vital,95417OR020,,ORN001,ORS001,ORF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,This PPO plan will cover out-of-area services for out-of-network providers.,No,https://trilliumchp.softheon.com/SBC/SBCFiles/95417OR0200001-01.pdf,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,www.trilliumchp.com,95417OR0200001-00,Standard Bronze Off Exchange Plan,,0.587094008922577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,2,95417,OR,Individual,Yes,42-1694349,95417OR0140001,Trillium Bright Family Dental - Low,95417OR014,,ORN001,ORS001,,Existing,PPO,Low,,Both,,,,"All supplies or services not specifically listed as covered.  $750 annual maximum for adult dental benefits.  The maximum out of pocket for dental benefits is $350 per member applied only to pediatric benefits/members. General exclusions We will NOT cover: ?       Services covered under worker?s compensation or employer?s liability laws and services covered by any federal state, county, municipality or other governmental agency, except Medicaid. ? Services with respect to congenital or developmental malformations or cosmetic reasons; including but not limited to, enamel hypoplasia, fluorosis and disturbance of the temporomandibular joint. ? Services for rebuilding or maintaining chewing surfaces due to teeth out of alignment or occlusion or for stabilizing teeth. ? Services started prior to the eligibility date of this plan. ? Hypnosis, prescribed drugs, premedications or analgesia (e.g. nitrous oxide) or any other euphoric drugs. ? Hospital costs or any additional fees charged by the dentist because the patient is hospitalized. ? General anesthesia and/or IV sedation except when administered by a dentist in conjunction with covered oral surgery in his or her office. ? Experimental procedures. ? Missed or broken appointments. ? Precision attachments. ? Orthodontic services (other than those listed as covered benefits). ? Services for cosmetic reasons. ? Claims submitted more than 12 months after the date of service are not covered. ? All other services or supplies, not specifically covered.  Exclusion periods The following services are not covered during the first six months* under this plan: ? Crowns ? Replacement of an existing prosthetic device ? Cast partial, full, immediate or overdenture ? Fixed bridges or removable cast partials   *If you were covered under another health insurance plan before enrolling in this plan, you can receive credit for prior coverage. See the Credit for Prior Coverage section, on the next page .",,,,,Allows Adult and Child-Only,,,,$25.24,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide,Yes,,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,,95417OR0140001-00,Standard Low Off Exchange Plan,69.31%,,,,No,100%,,$350,Not Applicable,,,$350,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,2,95417,OR,Individual,Yes,42-1694349,95417OR0140001,Trillium Bright Family Dental - Low,95417OR014,,ORN001,ORS001,,Existing,PPO,Low,,Both,,,,"All supplies or services not specifically listed as covered.  $750 annual maximum for adult dental benefits.  The maximum out of pocket for dental benefits is $350 per member applied only to pediatric benefits/members. General exclusions We will NOT cover: ?       Services covered under worker?s compensation or employer?s liability laws and services covered by any federal state, county, municipality or other governmental agency, except Medicaid. ? Services with respect to congenital or developmental malformations or cosmetic reasons; including but not limited to, enamel hypoplasia, fluorosis and disturbance of the temporomandibular joint. ? Services for rebuilding or maintaining chewing surfaces due to teeth out of alignment or occlusion or for stabilizing teeth. ? Services started prior to the eligibility date of this plan. ? Hypnosis, prescribed drugs, premedications or analgesia (e.g. nitrous oxide) or any other euphoric drugs. ? Hospital costs or any additional fees charged by the dentist because the patient is hospitalized. ? General anesthesia and/or IV sedation except when administered by a dentist in conjunction with covered oral surgery in his or her office. ? Experimental procedures. ? Missed or broken appointments. ? Precision attachments. ? Orthodontic services (other than those listed as covered benefits). ? Services for cosmetic reasons. ? Claims submitted more than 12 months after the date of service are not covered. ? All other services or supplies, not specifically covered.  Exclusion periods The following services are not covered during the first six months* under this plan: ? Crowns ? Replacement of an existing prosthetic device ? Cast partial, full, immediate or overdenture ? Fixed bridges or removable cast partials   *If you were covered under another health insurance plan before enrolling in this plan, you can receive credit for prior coverage. See the Credit for Prior Coverage section, on the next page .",,,,,Allows Adult and Child-Only,,,,$25.24,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide,Yes,,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,,95417OR0140001-01,Standard Low On Exchange Plan,69.31%,,,,No,100%,,$350,Not Applicable,,,$350,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$75,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,2,95417,OR,Individual,No,42-1694349,95417OR0200001,Trillium Oregon Standard Bronze Plan Vital,95417OR020,,ORN001,ORS001,ORF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,This PPO plan will cover out-of-area services for out-of-network providers.,No,https://trilliumchp.softheon.com/SBC/SBCFiles/95417OR0200001-01.pdf,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,www.trilliumchp.com,95417OR0200001-01,Standard Bronze On Exchange Plan,,0.587094008922577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,3,95417,OR,Individual,Yes,42-1694349,95417OR0150001,Trillium Bright Family Dental - High,95417OR015,,ORN001,ORS001,,Existing,PPO,High,,Both,,,,"All supplies or services not specifically listed as covered.  $1,000 annual maximum for adult dental benefits.  The maximum out of pocket for dental benefits is $350 per member applied only to pediatric benefits/members. General exclusions We will NOT cover: ?       Services covered under worker?s compensation or employer?s liability laws and services covered by any federal state, county, municipality or other governmental agency, except Medicaid. ? Services with respect to congenital or developmental malformations or cosmetic reasons; including but not limited to, enamel hypoplasia, fluorosis and disturbance of the temporomandibular joint. ? Services for rebuilding or maintaining chewing surfaces due to teeth out of alignment or occlusion or for stabilizing teeth. ? Services started prior to the eligibility date of this plan. ? Hypnosis, prescribed drugs, premedications or analgesia (e.g. nitrous oxide) or any other euphoric drugs. ? Hospital costs or any additional fees charged by the dentist because the patient is hospitalized. ? General anesthesia and/or IV sedation except when administered by a dentist in conjunction with covered oral surgery in his or her office. ? Experimental procedures. ? Missed or broken appointments. ? Precision attachments. ? Orthodontic services (other than those listed as covered benefits). ? Services for cosmetic reasons. ? Claims submitted more than 12 months after the date of service are not covered. ? All other services or supplies, not specifically covered.  Exclusion periods The following services are not covered during the first six months* under this plan: ? Crowns ? Replacement of an existing prosthetic device ? Cast partial, full, immediate or overdenture ? Fixed bridges or removable cast partials   *If you were covered under another health insurance plan before enrolling in this plan, you can receive credit for prior coverage. See the Credit for Prior Coverage section, on the next page .",,,,,Allows Adult and Child-Only,,,,$32.52,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide,Yes,,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,,95417OR0150001-00,Standard High Off Exchange Plan,84.23%,,,,No,100%,,$350,Not Applicable,,,$350,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OR,95417,SERFF,9,2014-12-10 23:15:01,3,95417,OR,Individual,Yes,42-1694349,95417OR0150001,Trillium Bright Family Dental - High,95417OR015,,ORN001,ORS001,,Existing,PPO,High,,Both,,,,"All supplies or services not specifically listed as covered.  $1,000 annual maximum for adult dental benefits.  The maximum out of pocket for dental benefits is $350 per member applied only to pediatric benefits/members. General exclusions We will NOT cover: ?       Services covered under worker?s compensation or employer?s liability laws and services covered by any federal state, county, municipality or other governmental agency, except Medicaid. ? Services with respect to congenital or developmental malformations or cosmetic reasons; including but not limited to, enamel hypoplasia, fluorosis and disturbance of the temporomandibular joint. ? Services for rebuilding or maintaining chewing surfaces due to teeth out of alignment or occlusion or for stabilizing teeth. ? Services started prior to the eligibility date of this plan. ? Hypnosis, prescribed drugs, premedications or analgesia (e.g. nitrous oxide) or any other euphoric drugs. ? Hospital costs or any additional fees charged by the dentist because the patient is hospitalized. ? General anesthesia and/or IV sedation except when administered by a dentist in conjunction with covered oral surgery in his or her office. ? Experimental procedures. ? Missed or broken appointments. ? Precision attachments. ? Orthodontic services (other than those listed as covered benefits). ? Services for cosmetic reasons. ? Claims submitted more than 12 months after the date of service are not covered. ? All other services or supplies, not specifically covered.  Exclusion periods The following services are not covered during the first six months* under this plan: ? Crowns ? Replacement of an existing prosthetic device ? Cast partial, full, immediate or overdenture ? Fixed bridges or removable cast partials   *If you were covered under another health insurance plan before enrolling in this plan, you can receive credit for prior coverage. See the Credit for Prior Coverage section, on the next page .",,,,,Allows Adult and Child-Only,,,,$32.52,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide,Yes,,https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx,http://www.trilliumchp.com/Marketplace/resources.php,,95417OR0150001-01,Standard High On Exchange Plan,84.23%,,,,No,100%,,$350,Not Applicable,,,$350,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,1,96383,OR,Individual,No,45-3261827,96383OR0010001,Health Republic Oregon Standard Bronze Plan,96383OR001,,ORN001,ORS001,ORF001,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0010001-01-Health-Republic-Oregon-Standard-Bronze-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/oregon-standard,http://www.healthrepublicinsurance.org,96383OR0010001-00,Standard Bronze Off Exchange Plan,,0.583432614803314,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,"$5,000",$60,$70,$80,4
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,1,96383,OR,Individual,No,45-3261827,96383OR0010001,Health Republic Oregon Standard Bronze Plan,96383OR001,,ORN001,ORS001,ORF001,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0010001-01-Health-Republic-Oregon-Standard-Bronze-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/oregon-standard,http://www.healthrepublicinsurance.org,96383OR0010001-01,Standard Bronze On Exchange Plan,,0.583432614803314,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,"$5,000",$60,$70,$80,5
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,1,96383,OR,Individual,No,45-3261827,96383OR0010001,Health Republic Oregon Standard Bronze Plan,96383OR001,,ORN001,ORS001,ORF001,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0010001-01-Health-Republic-Oregon-Standard-Bronze-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/oregon-standard,http://www.healthrepublicinsurance.org,96383OR0010001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,1,96383,OR,Individual,No,45-3261827,96383OR0010001,Health Republic Oregon Standard Bronze Plan,96383OR001,,ORN001,ORS001,ORF001,Existing,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0010001-01-Health-Republic-Oregon-Standard-Bronze-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/oregon-standard,http://www.healthrepublicinsurance.org,96383OR0010001-03,Limited Cost Sharing Plan Variation,,0.583432614803314,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000",$20,"$1,130",$150,"$5,000",$60,$70,$80,7
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,2,96383,OR,Individual,No,45-3261827,96383OR0010002,Health Republic Oregon Standard Silver Plan,96383OR001,,ORN001,ORS001,ORF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0010002-01-Health-Republic-Oregon-Standard-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/oregon-standard,http://www.healthrepublicinsurance.org,96383OR0010002-00,Standard Silver Off Exchange Plan,,0.680933177471161,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,$800,$150,"$2,420",$600,$0,$80,4
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,2,96383,OR,Individual,No,45-3261827,96383OR0010002,Health Republic Oregon Standard Silver Plan,96383OR001,,ORN001,ORS001,ORF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0010002-01-Health-Republic-Oregon-Standard-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/oregon-standard,http://www.healthrepublicinsurance.org,96383OR0010002-01,Standard Silver On Exchange Plan,,0.680933177471161,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,$800,$150,"$2,420",$600,$0,$80,5
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,2,96383,OR,Individual,No,45-3261827,96383OR0010002,Health Republic Oregon Standard Silver Plan,96383OR001,,ORN001,ORS001,ORF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0010002-01-Health-Republic-Oregon-Standard-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/oregon-standard,http://www.healthrepublicinsurance.org,96383OR0010002-04,73% AV Level Silver Plan,,0.727139830589294,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,500",$20,$800,$150,"$2,420",$600,$0,$80,8
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,2,96383,OR,Individual,No,45-3261827,96383OR0010002,Health Republic Oregon Standard Silver Plan,96383OR001,,ORN001,ORS001,ORF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0010002-01-Health-Republic-Oregon-Standard-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/oregon-standard,http://www.healthrepublicinsurance.org,96383OR0010002-05,87% AV Level Silver Plan,,0.869928658008575,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$750,"$1,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$750,$20,$440,$150,$750,$490,$110,$80,9
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,2,96383,OR,Individual,No,45-3261827,96383OR0010002,Health Republic Oregon Standard Silver Plan,96383OR001,,ORN001,ORS001,ORF002,Existing,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0010002-01-Health-Republic-Oregon-Standard-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/oregon-standard,http://www.healthrepublicinsurance.org,96383OR0010002-06,94% AV Level Silver Plan,,0.936301648616791,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$100,$200,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$100,$10,$510,$150,$100,$300,$130,$80,10
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,5,96383,OR,Individual,No,45-3261827,96383OR0190002,PrimaryCare Silver Plan,96383OR019,,ORN001,ORS001,ORF006,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9841,,,0,3,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0190002-01-PrimaryCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/primarycare,http://www.healthrepublicinsurance.org,96383OR0190002-06,94% AV Level Silver Plan,,0.944879829883575,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$500,$0,$0,$80,10
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,5,96383,OR,Individual,No,45-3261827,96383OR0190003,PrimaryCare Gold Plan,96383OR019,,ORN001,ORS001,ORF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9871,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0190003-01-PrimaryCare-Gold-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/primarycare,http://www.healthrepublicinsurance.org,96383OR0190003-00,Standard Gold Off Exchange Plan,,0.815525710582733,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,400","$4,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,400","$4,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400",$0,$0,$150,"$1,410",$0,$0,$80,11
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,5,96383,OR,Individual,No,45-3261827,96383OR0190003,PrimaryCare Gold Plan,96383OR019,,ORN001,ORS001,ORF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9871,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0190003-01-PrimaryCare-Gold-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/primarycare,http://www.healthrepublicinsurance.org,96383OR0190003-01,Standard Gold On Exchange Plan,,0.815525710582733,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,400","$4,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,400","$4,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400",$0,$0,$150,"$1,410",$0,$0,$80,12
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,5,96383,OR,Individual,No,45-3261827,96383OR0190003,PrimaryCare Gold Plan,96383OR019,,ORN001,ORS001,ORF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9871,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0190003-01-PrimaryCare-Gold-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/primarycare,http://www.healthrepublicinsurance.org,96383OR0190003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,13
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,5,96383,OR,Individual,No,45-3261827,96383OR0190003,PrimaryCare Gold Plan,96383OR019,,ORN001,ORS001,ORF007,New,EPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9871,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0190003-01-PrimaryCare-Gold-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/primarycare,http://www.healthrepublicinsurance.org,96383OR0190003-03,Limited Cost Sharing Plan Variation,,0.815525710582733,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,400","$4,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,400","$4,800",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,400",$0,$0,$150,"$1,410",$0,$0,$80,14
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,6,96383,OR,Individual,No,45-3261827,96383OR0200001,FoundationCare Silver Plan,96383OR020,,ORN002,ORS002,ORF008,New,EPO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9847,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0200001-01-FoundationCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/foundationcare,http://www.healthrepublicinsurance.org,96383OR0200001-00,Standard Silver Off Exchange Plan,70.00%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,"$6,600","$13,200",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,170",$20,$0,$150,"$2,420",$400,$0,$80,4
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,6,96383,OR,Individual,No,45-3261827,96383OR0200001,FoundationCare Silver Plan,96383OR020,,ORN002,ORS002,ORF008,New,EPO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9847,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0200001-01-FoundationCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/foundationcare,http://www.healthrepublicinsurance.org,96383OR0200001-01,Standard Silver On Exchange Plan,70.00%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,"$6,600","$13,200",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,170",$20,$0,$150,"$2,420",$400,$0,$80,5
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,6,96383,OR,Individual,No,45-3261827,96383OR0200001,FoundationCare Silver Plan,96383OR020,,ORN002,ORS002,ORF008,New,EPO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9847,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0200001-01-FoundationCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/foundationcare,http://www.healthrepublicinsurance.org,96383OR0200001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,6,96383,OR,Individual,No,45-3261827,96383OR0200001,FoundationCare Silver Plan,96383OR020,,ORN002,ORS002,ORF008,New,EPO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9847,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0200001-01-FoundationCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/foundationcare,http://www.healthrepublicinsurance.org,96383OR0200001-03,Limited Cost Sharing Plan Variation,70.00%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,"$6,600","$13,200",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,170",$20,$0,$150,"$2,420",$400,$0,$80,7
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,6,96383,OR,Individual,No,45-3261827,96383OR0200001,FoundationCare Silver Plan,96383OR020,,ORN002,ORS002,ORF008,New,EPO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9847,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0200001-01-FoundationCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/foundationcare,http://www.healthrepublicinsurance.org,96383OR0200001-04,73% AV Level Silver Plan,72.10%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,200","$10,400",0%,"$5,200","$10,400",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,170",$20,$0,$150,"$2,420",$400,$0,$80,8
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,6,96383,OR,Individual,No,45-3261827,96383OR0200001,FoundationCare Silver Plan,96383OR020,,ORN002,ORS002,ORF008,New,EPO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9847,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0200001-01-FoundationCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/foundationcare,http://www.healthrepublicinsurance.org,96383OR0200001-05,87% AV Level Silver Plan,87.70%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$1,050","$2,100","$1,050","$2,100",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100",0%,"$1,050","$2,100",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,050",$0,$0,$150,$980,$70,$0,$80,9
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,6,96383,OR,Individual,No,45-3261827,96383OR0200001,FoundationCare Silver Plan,96383OR020,,ORN002,ORS002,ORF008,New,EPO,Silver,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9847,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0200001-01-FoundationCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/foundationcare,http://www.healthrepublicinsurance.org,96383OR0200001-06,94% AV Level Silver Plan,94.70%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$500,"$1,000",$500,"$1,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,$500,"$1,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$0,$150,$460,$40,$0,$80,10
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,6,96383,OR,Individual,No,45-3261827,96383OR0200002,FoundationCare Gold Plan,96383OR020,,ORN002,ORS002,ORF009,New,EPO,Gold,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9872,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0200002-01-FoundationCare-Gold-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/foundationcare,http://www.healthrepublicinsurance.org,96383OR0200002-00,Standard Gold Off Exchange Plan,78.70%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$2,800","$5,600","$2,800","$5,600",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",0%,"$2,800","$5,600",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,800",$0,$0,$150,"$2,420",$200,$0,$80,11
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,6,96383,OR,Individual,No,45-3261827,96383OR0200002,FoundationCare Gold Plan,96383OR020,,ORN002,ORS002,ORF009,New,EPO,Gold,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9872,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0200002-01-FoundationCare-Gold-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/foundationcare,http://www.healthrepublicinsurance.org,96383OR0200002-01,Standard Gold On Exchange Plan,78.70%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$2,800","$5,600","$2,800","$5,600",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",0%,"$2,800","$5,600",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,800",$0,$0,$150,"$2,420",$200,$0,$80,12
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,6,96383,OR,Individual,No,45-3261827,96383OR0200002,FoundationCare Gold Plan,96383OR020,,ORN002,ORS002,ORF009,New,EPO,Gold,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9872,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0200002-01-FoundationCare-Gold-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/foundationcare,http://www.healthrepublicinsurance.org,96383OR0200002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,13
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,6,96383,OR,Individual,No,45-3261827,96383OR0200002,FoundationCare Gold Plan,96383OR020,,ORN002,ORS002,ORF009,New,EPO,Gold,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9872,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0200002-01-FoundationCare-Gold-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/foundationcare,http://www.healthrepublicinsurance.org,96383OR0200002-03,Limited Cost Sharing Plan Variation,78.70%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$2,800","$5,600","$2,800","$5,600",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600",0%,"$2,800","$5,600",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,800",$0,$0,$150,"$2,420",$200,$0,$80,14
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,6,96383,OR,Individual,No,45-3261827,96383OR0200003,FoundationCare Platinum Plan,96383OR020,,ORN002,ORS002,ORF009,New,EPO,Platinum,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9887,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0200003-01-FoundationCare-Platinum-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/foundationcare,http://www.healthrepublicinsurance.org,96383OR0200003-00,Standard Platinum Off Exchange Plan,91.10%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,"$1,000","$2,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$150,$960,$40,$0,$80,15
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,6,96383,OR,Individual,No,45-3261827,96383OR0200003,FoundationCare Platinum Plan,96383OR020,,ORN002,ORS002,ORF009,New,EPO,Platinum,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9887,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0200003-01-FoundationCare-Platinum-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/foundationcare,http://www.healthrepublicinsurance.org,96383OR0200003-01,Standard Platinum On Exchange Plan,91.10%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,"$1,000","$2,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$150,$960,$40,$0,$80,16
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,6,96383,OR,Individual,No,45-3261827,96383OR0200003,FoundationCare Platinum Plan,96383OR020,,ORN002,ORS002,ORF009,New,EPO,Platinum,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9887,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0200003-01-FoundationCare-Platinum-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/foundationcare,http://www.healthrepublicinsurance.org,96383OR0200003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,17
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,6,96383,OR,Individual,No,45-3261827,96383OR0200003,FoundationCare Platinum Plan,96383OR020,,ORN002,ORS002,ORF009,New,EPO,Platinum,Yes,Both,No,Yes,All,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9887,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0200003-01-FoundationCare-Platinum-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/foundationcare,http://www.healthrepublicinsurance.org,96383OR0200003-03,Limited Cost Sharing Plan Variation,91.10%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,"$1,000","$2,000",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$0,$150,$960,$40,$0,$80,18
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,7,96383,OR,Individual,No,45-3261827,96383OR0110001,KeyCare Bronze Plan,96383OR011,,ORN001,ORS001,ORF010,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0110001-01-KeyCare-Bronze-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/keycare,http://www.healthrepublicinsurance.org,96383OR0110001-00,Standard Bronze Off Exchange Plan,61.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,600","$3,200",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$70,$150,"$4,020",$450,$0,$80,4
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,7,96383,OR,Individual,No,45-3261827,96383OR0110001,KeyCare Bronze Plan,96383OR011,,ORN001,ORS001,ORF010,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0110001-01-KeyCare-Bronze-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/keycare,http://www.healthrepublicinsurance.org,96383OR0110001-01,Standard Bronze On Exchange Plan,61.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,600","$3,200",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$70,$150,"$4,020",$450,$0,$80,5
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,7,96383,OR,Individual,No,45-3261827,96383OR0110001,KeyCare Bronze Plan,96383OR011,,ORN001,ORS001,ORF010,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0110001-01-KeyCare-Bronze-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/keycare,http://www.healthrepublicinsurance.org,96383OR0110001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,7,96383,OR,Individual,No,45-3261827,96383OR0110001,KeyCare Bronze Plan,96383OR011,,ORN001,ORS001,ORF010,New,EPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,1,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0110001-01-KeyCare-Bronze-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/keycare,http://www.healthrepublicinsurance.org,96383OR0110001-03,Limited Cost Sharing Plan Variation,61.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,600","$3,200",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$5,020",$0,$70,$150,"$4,020",$450,$0,$80,7
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,7,96383,OR,Individual,No,45-3261827,96383OR0110002,KeyCare Silver Plan,96383OR011,,ORN001,ORS001,ORF011,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0110002-01-KeyCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/keycare,http://www.healthrepublicinsurance.org,96383OR0110002-00,Standard Silver Off Exchange Plan,69.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,070",$150,"$3,920",$210,$0,$80,8
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,7,96383,OR,Individual,No,45-3261827,96383OR0110002,KeyCare Silver Plan,96383OR011,,ORN001,ORS001,ORF011,New,EPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,2,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0110002-01-KeyCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/keycare,http://www.healthrepublicinsurance.org,96383OR0110002-01,Standard Silver On Exchange Plan,69.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,"$2,520",$0,"$1,070",$150,"$3,920",$210,$0,$80,9
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,8,96383,OR,Individual,No,45-3261827,96383OR0130001,CoreCare Silver Plan,96383OR013,,ORN001,ORS001,ORF012,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9847,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0130001-01-CoreCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/corecare,http://www.healthrepublicinsurance.org,96383OR0130001-05,87% AV Level Silver Plan,,0.867177963256836,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",$0,$250,$150,$990,$260,$0,$80,9
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,8,96383,OR,Individual,No,45-3261827,96383OR0130001,CoreCare Silver Plan,96383OR013,,ORN001,ORS001,ORF012,New,EPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9847,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0130001-01-CoreCare-Silver-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/corecare,http://www.healthrepublicinsurance.org,96383OR0130001-06,94% AV Level Silver Plan,,0.939593076705933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$300,$600,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$300,$0,$200,$150,$300,$110,$90,$80,10
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,8,96383,OR,Individual,No,45-3261827,96383OR0130003,CoreCare Platinum Plan,96383OR013,,ORN001,ORS001,ORF012,New,EPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9886,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0130003-01-CoreCare-Platinum-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/corecare,http://www.healthrepublicinsurance.org,96383OR0130003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,17
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,8,96383,OR,Individual,No,45-3261827,96383OR0130003,CoreCare Platinum Plan,96383OR013,,ORN001,ORS001,ORF012,New,EPO,Platinum,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9886,,,0,4,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0130003-01-CoreCare-Platinum-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/corecare,http://www.healthrepublicinsurance.org,96383OR0130003-03,Limited Cost Sharing Plan Variation,,0.897899329662323,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,$0,$500,$150,$500,$260,$240,$80,18
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,9,96383,OR,Individual,No,45-3261827,96383OR0120001,HSA Bronze Plan,96383OR012,,ORN001,ORS001,ORF013,New,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0120001-01-HSA-Bronze-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/HSA,http://www.healthrepublicinsurance.org,96383OR0120001-00,Standard Bronze Off Exchange Plan,,0.6188605427742,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",60%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$20,"$1,300",$150,"$3,000",$600,$360,$80,4
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,9,96383,OR,Individual,No,45-3261827,96383OR0120001,HSA Bronze Plan,96383OR012,,ORN001,ORS001,ORF013,New,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0120001-01-HSA-Bronze-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/HSA,http://www.healthrepublicinsurance.org,96383OR0120001-01,Standard Bronze On Exchange Plan,,0.6188605427742,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",60%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$20,"$1,300",$150,"$3,000",$600,$360,$80,5
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,9,96383,OR,Individual,No,45-3261827,96383OR0120001,HSA Bronze Plan,96383OR012,,ORN001,ORS001,ORF013,New,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0120001-01-HSA-Bronze-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/HSA,http://www.healthrepublicinsurance.org,96383OR0120001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,9,96383,OR,Individual,No,45-3261827,96383OR0120001,HSA Bronze Plan,96383OR012,,ORN001,ORS001,ORF013,New,EPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0120001-01-HSA-Bronze-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/HSA,http://www.healthrepublicinsurance.org,96383OR0120001-03,Limited Cost Sharing Plan Variation,,0.6188605427742,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",60%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000",$20,"$1,300",$150,"$3,000",$600,$360,$80,7
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,9,96383,OR,Individual,No,45-3261827,96383OR0120002,HSA Gold Plan,96383OR012,,ORN001,ORS001,ORF014,New,EPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0120002-01-HSA-Gold-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/HSA,http://www.healthrepublicinsurance.org,96383OR0120002-00,Standard Gold Off Exchange Plan,,0.785906195640564,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300",$0,"$1,300",$150,"$1,300",$130,$650,$80,8
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,9,96383,OR,Individual,No,45-3261827,96383OR0120002,HSA Gold Plan,96383OR012,,ORN001,ORS001,ORF014,New,EPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0120002-01-HSA-Gold-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/HSA,http://www.healthrepublicinsurance.org,96383OR0120002-01,Standard Gold On Exchange Plan,,0.785906195640564,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300",$0,"$1,300",$150,"$1,300",$130,$650,$80,9
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,9,96383,OR,Individual,No,45-3261827,96383OR0120002,HSA Gold Plan,96383OR012,,ORN001,ORS001,ORF014,New,EPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0120002-01-HSA-Gold-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/HSA,http://www.healthrepublicinsurance.org,96383OR0120002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,OR,96383,SERFF,7,2014-12-10 23:15:01,9,96383,OR,Individual,No,45-3261827,96383OR0120002,HSA Gold Plan,96383OR012,,ORN001,ORS001,ORF014,New,EPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Services Only,Yes,Emergency Services Only,Yes,https://www.healthrepublicinsurance.org/wp-content/uploads/2014/08/96383OR0120002-01-HSA-Gold-On-Exchange.pdf,,http://www.healthrepublicinsurance.org/our-plans/HSA,http://www.healthrepublicinsurance.org,96383OR0120002-03,Limited Cost Sharing Plan Variation,,0.785906195640564,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,300",$0,"$1,300",$150,"$1,300",$130,$650,$80,11
2015,OR,97876,SERFF,5,2014-10-06 10:59:03,3,97876,OR,Individual,Yes,95-6042390,97876OR0020003,BESTOne Dental Advantage-Gold,97876OR002,,ORN001,ORS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$52.55,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OR/2015/OR_BESTOne_Dental_Advantage-Gold_Plan.pdf,,97876OR0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OR,97876,SERFF,5,2014-10-06 10:59:03,3,97876,OR,Individual,Yes,95-6042390,97876OR0020003,BESTOne Dental Advantage-Gold,97876OR002,,ORN001,ORS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$52.55,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OR/2015/OR_BESTOne_Dental_Advantage-Gold_Plan.pdf,,97876OR0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OR,97876,SERFF,5,2014-10-06 10:59:03,3,97876,OR,Individual,Yes,95-6042390,97876OR0020004,BESTOne Dental Plus-Gold,97876OR002,,ORN001,ORS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$52.55,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OR/2015/OR_BESTOne_Dental_Plus-Gold_Plan.pdf,,97876OR0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OR,97876,SERFF,5,2014-10-06 10:59:03,3,97876,OR,Individual,Yes,95-6042390,97876OR0020004,BESTOne Dental Plus-Gold,97876OR002,,ORN001,ORS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$52.55,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OR/2015/OR_BESTOne_Dental_Plus-Gold_Plan.pdf,,97876OR0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OR,97876,SERFF,5,2014-10-06 10:59:03,4,97876,OR,Individual,Yes,95-6042390,97876OR0020005,BESTOne Dental Plus-Silver,97876OR002,,ORN001,ORS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$43.62,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OR/2015/OR_BESTOne_Dental_Plus-Silver_Plan.pdf,,97876OR0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,OR,97876,SERFF,5,2014-10-06 10:59:03,4,97876,OR,Individual,Yes,95-6042390,97876OR0020005,BESTOne Dental Plus-Silver,97876OR002,,ORN001,ORS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$43.62,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OR/2015/OR_BESTOne_Dental_Plus-Silver_Plan.pdf,,97876OR0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,OR,97876,SERFF,5,2014-10-06 10:59:03,4,97876,OR,Individual,Yes,95-6042390,97876OR0020006,BESTOne Dental Basic-Silver,97876OR002,,ORN001,ORS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$43.62,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OR/2015/OR_BESTOne_Dental_Basic-Silver_Plan.pdf,,97876OR0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,OR,97876,SERFF,5,2014-10-06 10:59:03,4,97876,OR,Individual,Yes,95-6042390,97876OR0020006,BESTOne Dental Basic-Silver,97876OR002,,ORN001,ORS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$43.62,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at the UCR level,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/OR/2015/OR_BESTOne_Dental_Basic-Silver_Plan.pdf,,97876OR0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$700,"$1,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,1,99389,OR,Individual,No,45-3321455,99389OR0240001,Oregon's Health CO-OP SiMPLE Gold Broad Network,99389OR024,,ORN001,ORS001,ORF005,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.997,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0240001-01-Oregons-Health-CO-OP-SiMPLEgold-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLEgold-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0240001-00,Standard Gold Off Exchange Plan,78.19%,0.759842216968536,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$3,380",$0,$150,$0,"$1,500",$0,$80,4
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,1,99389,OR,Individual,No,45-3321455,99389OR0240001,Oregon's Health CO-OP SiMPLE Gold Broad Network,99389OR024,,ORN001,ORS001,ORF005,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.997,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0240001-01-Oregons-Health-CO-OP-SiMPLEgold-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLEgold-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0240001-01,Standard Gold On Exchange Plan,78.19%,0.759842216968536,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$3,380",$0,$150,$0,"$1,500",$0,$80,5
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,1,99389,OR,Individual,No,45-3321455,99389OR0240001,Oregon's Health CO-OP SiMPLE Gold Broad Network,99389OR024,,ORN001,ORS001,ORF005,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.997,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0240001-01-Oregons-Health-CO-OP-SiMPLEgold-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLEgold-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0240001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,1,99389,OR,Individual,No,45-3321455,99389OR0240001,Oregon's Health CO-OP SiMPLE Gold Broad Network,99389OR024,,ORN001,ORS001,ORF005,Existing,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.997,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0240001-01-Oregons-Health-CO-OP-SiMPLEgold-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLEgold-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0240001-03,Limited Cost Sharing Plan Variation,78.19%,0.759842216968536,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$3,380",$0,$150,$0,"$1,500",$0,$80,7
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,6,99389,OR,Individual,No,45-3321455,99389OR0610001,Oregon's Health CO-OP Oregon Standard Silver Plan Select Network,99389OR061,,ORN002,ORS002,ORF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0610001-01-Oregons-Health-CO-OP-Oregon-Standard-Silver-Plan-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Silver-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0610001-05,87% AV Level Silver Plan,,0.870359539985657,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,$750,"$1,500",$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,$750,$20,$440,$150,$750,$510,$110,$80,9
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,6,99389,OR,Individual,No,45-3321455,99389OR0610001,Oregon's Health CO-OP Oregon Standard Silver Plan Select Network,99389OR061,,ORN002,ORS002,ORF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0610001-01-Oregons-Health-CO-OP-Oregon-Standard-Silver-Plan-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Silver-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0610001-06,94% AV Level Silver Plan,,0.938878417015076,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$12,700","$25,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,$100,$200,$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,$100,$0,$650,$150,$100,$300,$130,$80,10
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,2,31195,SD,Individual,No,91-1842494,31195SD0080005,"Sanford Simplicity-$5,000",31195SD008,,SDN001,SDS001,SDF008,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080005-00,Standard Bronze Off Exchange Plan,,0.613356590270996,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,000","$20,000","$14,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$13,000","$10,000","$13,000",,,,,,,,,4
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,2,31195,SD,SHOP (Small Group),No,91-1842494,31195SD0090004,"Sanford Simplicity-$3,000",31195SD009,,SDN001,SDS001,SDF008,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0090004-00,Standard Bronze Off Exchange Plan,,0.617272973060608,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",40%,,,,"$6,000","$12,000","$6,000","$12,000",,,,,,,,,4
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,1,99389,OR,Individual,No,45-3321455,99389OR0260001,Oregon's Health CO-OP SiMPLE Silver Broad Network,99389OR026,,ORN001,ORS001,ORF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9969,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0260001-01-Oregons-Health-CO-OP-SiMPLEsilver-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLEsilver-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0260001-00,Standard Silver Off Exchange Plan,70.14%,0.711547434329987,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$4,980",$0,$150,$0,"$1,930",$0,$80,8
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,1,99389,OR,Individual,No,45-3321455,99389OR0260001,Oregon's Health CO-OP SiMPLE Silver Broad Network,99389OR026,,ORN001,ORS001,ORF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9969,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0260001-01-Oregons-Health-CO-OP-SiMPLEsilver-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLEsilver-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0260001-01,Standard Silver On Exchange Plan,70.14%,0.711547434329987,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$4,980",$0,$150,$0,"$1,930",$0,$80,9
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,5,99389,OR,Individual,No,45-3321455,99389OR0570001,Oregon's Health CO-OP Oregon Standard Silver Plan Broad Network,99389OR057,,ORN002,ORS001,ORF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0570001-01-Oregons-Health-CO-OP-Oregon-Standard-Silver-Plan-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/Standard-Silver-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0570001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,5,99389,OR,Individual,No,45-3321455,99389OR0570001,Oregon's Health CO-OP Oregon Standard Silver Plan Broad Network,99389OR057,,ORN002,ORS001,ORF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0570001-01-Oregons-Health-CO-OP-Oregon-Standard-Silver-Plan-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/Standard-Silver-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0570001-03,Limited Cost Sharing Plan Variation,,0.682949244976044,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,"$2,500","$5,000",$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,500",$20,$800,$150,"$2,500",$500,$230,$80,7
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,5,99389,OR,Individual,No,45-3321455,99389OR0570001,Oregon's Health CO-OP Oregon Standard Silver Plan Broad Network,99389OR057,,ORN002,ORS001,ORF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0570001-01-Oregons-Health-CO-OP-Oregon-Standard-Silver-Plan-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/Standard-Silver-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0570001-04,73% AV Level Silver Plan,,0.728753507137299,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$12,700","$25,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,"$2,500","$5,000",$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,500",$20,$800,$150,"$2,500",$500,$230,$80,8
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,5,99389,OR,Individual,No,45-3321455,99389OR0570001,Oregon's Health CO-OP Oregon Standard Silver Plan Broad Network,99389OR057,,ORN002,ORS001,ORF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0570001-01-Oregons-Health-CO-OP-Oregon-Standard-Silver-Plan-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/Standard-Silver-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0570001-05,87% AV Level Silver Plan,,0.870359539985657,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,$750,"$1,500",$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,$750,$20,$440,$150,$750,$510,$110,$80,9
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,5,99389,OR,Individual,No,45-3321455,99389OR0570001,Oregon's Health CO-OP Oregon Standard Silver Plan Broad Network,99389OR057,,ORN002,ORS001,ORF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0570001-01-Oregons-Health-CO-OP-Oregon-Standard-Silver-Plan-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/Standard-Silver-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0570001-06,94% AV Level Silver Plan,,0.938878417015076,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$12,700","$25,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,$100,$200,$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,$100,$0,$650,$150,$100,$300,$130,$80,10
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,5,99389,OR,Individual,No,45-3321455,99389OR0550001,Oregon's Health CO-OP Oregon Standard Gold Plan Broad Network,99389OR055,,ORN002,ORS001,ORF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0550001-01-Oregons-Health-CO-OP-Oregon-Standard-Gold-Plan-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/Standard-Gold-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0550001-00,Standard Gold Off Exchange Plan,,0.781011641025543,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,"$1,300","$2,600",$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,300",$20,$390,$150,"$1,300",$460,$110,$80,11
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,1,99389,OR,Individual,No,45-3321455,99389OR0260001,Oregon's Health CO-OP SiMPLE Silver Broad Network,99389OR026,,ORN001,ORS001,ORF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9969,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0260001-01-Oregons-Health-CO-OP-SiMPLEsilver-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLEsilver-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0260001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,1,99389,OR,Individual,No,45-3321455,99389OR0260001,Oregon's Health CO-OP SiMPLE Silver Broad Network,99389OR026,,ORN001,ORS001,ORF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9969,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0260001-01-Oregons-Health-CO-OP-SiMPLEsilver-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLEsilver-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0260001-03,Limited Cost Sharing Plan Variation,70.14%,0.711547434329987,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$4,980",$0,$150,$0,"$1,930",$0,$80,11
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,1,99389,OR,Individual,No,45-3321455,99389OR0260001,Oregon's Health CO-OP SiMPLE Silver Broad Network,99389OR026,,ORN001,ORS001,ORF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9969,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0260001-01-Oregons-Health-CO-OP-SiMPLEsilver-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLEsilver-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0260001-04,73% AV Level Silver Plan,73.87%,0.744931161403656,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$4,510",$0,$150,$0,"$1,400",$0,$80,12
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,1,99389,OR,Individual,No,45-3321455,99389OR0260001,Oregon's Health CO-OP SiMPLE Silver Broad Network,99389OR026,,ORN001,ORS001,ORF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9969,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0260001-01-Oregons-Health-CO-OP-SiMPLEsilver-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLEsilver-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0260001-05,87% AV Level Silver Plan,87.81%,0.874668300151825,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000","$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$2,000",$0,$150,$0,"$1,270",$0,$80,13
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,7,99389,OR,Individual,No,45-3321455,99389OR0590001,Oregon's Health CO-OP Oregon Standard Bronze Plan Broad Network,99389OR059,,ORN001,ORS001,ORF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0590001-01-Oregons-Health-CO-OP-Oregon-Standard-Bronze-Plan-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/Standard-Bronze-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0590001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,7,99389,OR,Individual,No,45-3321455,99389OR0590001,Oregon's Health CO-OP Oregon Standard Bronze Plan Broad Network,99389OR059,,ORN001,ORS001,ORF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0590001-01-Oregons-Health-CO-OP-Oregon-Standard-Bronze-Plan-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/Standard-Bronze-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0590001-03,Limited Cost Sharing Plan Variation,,0.587094008922577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$5,000","$10,000","$5,000",$20,$90,$150,"$5,000",$60,$70,$80,7
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,1,99389,OR,Individual,No,45-3321455,99389OR0260001,Oregon's Health CO-OP SiMPLE Silver Broad Network,99389OR026,,ORN001,ORS001,ORF007,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9969,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0260001-01-Oregons-Health-CO-OP-SiMPLEsilver-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLEsilver-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0260001-06,94% AV Level Silver Plan,94.73%,0.945932030677795,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,$600,"$1,200",$600,"$1,200","$1,200","$2,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,$520,$0,$150,$0,$600,$0,$80,14
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,1,99389,OR,Individual,No,45-3321455,99389OR0310001,Oregon's Health CO-OP SiMPLE Bronze Broad Network,99389OR031,,ORN001,ORS001,ORF008,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9969,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0310001-01-Oregons-Health-CO-OP-SiMPLEbronze-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLEbronze-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0310001-00,Standard Bronze Off Exchange Plan,61.70%,0.645231962203979,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$5,140",$0,$150,$0,"$2,660",$0,$80,15
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,1,99389,OR,Individual,No,45-3321455,99389OR0310001,Oregon's Health CO-OP SiMPLE Bronze Broad Network,99389OR031,,ORN001,ORS001,ORF008,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9969,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0310001-01-Oregons-Health-CO-OP-SiMPLEbronze-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLEbronze-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0310001-01,Standard Bronze On Exchange Plan,61.70%,0.645231962203979,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$5,140",$0,$150,$0,"$2,660",$0,$80,16
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,1,99389,OR,Individual,No,45-3321455,99389OR0310001,Oregon's Health CO-OP SiMPLE Bronze Broad Network,99389OR031,,ORN001,ORS001,ORF008,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9969,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0310001-01-Oregons-Health-CO-OP-SiMPLEbronze-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLEbronze-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0310001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,17
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,1,60536,SD,Individual,No,46-0451539,60536SD0020013,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket",60536SD002,7942203176,SDN001,SDS001,SDF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14578/2015-Avera-MyPlan-2500--5500-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020013-00,Standard Silver Off Exchange Plan,,0.711994588375092,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,1,60536,SD,Individual,No,46-0451539,60536SD0020013,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket",60536SD002,7942203176,SDN001,SDS001,SDF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14578/2015-Avera-MyPlan-2500--5500-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020013-01,Standard Silver On Exchange Plan,,0.711994588375092,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,1,60536,SD,Individual,No,46-0451539,60536SD0020013,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket",60536SD002,7942203176,SDN001,SDS001,SDF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14578/2015-Avera-MyPlan-2500--5500-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020013-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,1,60536,SD,Individual,No,46-0451539,60536SD0020013,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket",60536SD002,7942203176,SDN001,SDS001,SDF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14578/2015-Avera-MyPlan-2500--5500-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020013-03,Limited Cost Sharing Plan Variation,,0.711994588375092,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,SHOP (Small Group),No,91-1842494,31195SD0090001,Sanford Simplicity-$500,31195SD009,,SDN001,SDS001,SDF006,Existing,HMO,Platinum,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0090001-01,Standard Platinum On Exchange Plan,,0.884950578212738,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$5,000","$10,000","$5,000","$10,000",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",$0,$0,40%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080001,"Sanford Simplicity-$1,500",31195SD008,,SDN001,SDS001,SDF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080001-01,Standard Gold On Exchange Plan,,0.782246828079224,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000",20%,,,,"$3,000","$6,000","$3,000","$6,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,2,60536,SD,SHOP (Small Group),No,46-0451539,60536SD0010012,"Avera $2,500 / 10% Coinsurance",60536SD001,7942203176,SDN001,SDS001,SDF003,New,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14596/2015-Avera-2500-10-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0010012-00,Standard Gold Off Exchange Plan,,0.780976831912994,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,2,60536,SD,SHOP (Small Group),No,46-0451539,60536SD0010012,"Avera $2,500 / 10% Coinsurance",60536SD001,7942203176,SDN001,SDS001,SDF003,New,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14596/2015-Avera-2500-10-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0010012-01,Standard Gold On Exchange Plan,,0.780976831912994,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,2,60536,SD,Individual,No,46-0451539,60536SD0020007,"Avera MyPlan $1,500 / 20% Coinsurance, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF008,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14575/2015-Avera-MyPlan-1500-20-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020007-01,Standard Gold On Exchange Plan,,0.788982570171356,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,2,60536,SD,Individual,No,46-0451539,60536SD0020007,"Avera MyPlan $1,500 / 20% Coinsurance, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF008,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14575/2015-Avera-MyPlan-1500-20-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,5,60536,SD,Individual,No,46-0451539,60536SD0020017,Avera MyPlan $250 / 10% Coinsurance,60536SD002,7942203176,SDN001,SDS001,SDF001,Existing,PPO,Platinum,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14589/2015-Avera-MyPlan-250-10-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020017-01,Standard Platinum On Exchange Plan,,0.880899608135223,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,5,60536,SD,Individual,No,46-0451539,60536SD0020017,Avera MyPlan $250 / 10% Coinsurance,60536SD002,7942203176,SDN001,SDS001,SDF001,Existing,PPO,Platinum,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14589/2015-Avera-MyPlan-250-10-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020017-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,3,62210,SD,Individual,No,46-0401087,62210SD1450003,Dakota Reserve 6000,62210SD145,7033112278,SDN001,SDS001,SDF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Reserve_6000_100_0_6000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1450003-03,Limited Cost Sharing Plan Variation,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,"$6,000","$12,000","$6,000",$0,$0,$400,"$5,300",$0,$0,$100,18
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,4,62210,SD,Individual,No,46-0401087,62210SD1460001,Dakota Signature Plus 1000,62210SD146,7033112278,SDN001,SDS001,SDF004,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_Plus_1000_80_20_2500_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1460001-00,Standard Gold Off Exchange Plan,,0.814041018486023,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$0,"$1,200",$400,"$1,000","$1,500",$0,$100,4
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,1,99389,OR,Individual,No,45-3321455,99389OR0310001,Oregon's Health CO-OP SiMPLE Bronze Broad Network,99389OR031,,ORN001,ORS001,ORF008,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9969,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0310001-01-Oregons-Health-CO-OP-SiMPLEbronze-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLEbronze-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0310001-03,Limited Cost Sharing Plan Variation,61.70%,0.645231962203979,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$5,140",$0,$150,$0,"$2,660",$0,$80,18
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,2,99389,OR,Individual,No,45-3321455,99389OR0290001,Oregon's Health CO-OP SiMPLE Silver HSA Broad Network,99389OR029,,ORN001,ORS001,ORF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9994,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0290001-01-Oregons-Health-CO-OP-SiMPLEsilver-HSA-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLEsilver-HSA-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0290001-00,Standard Silver Off Exchange Plan,71.70%,0.716980278491974,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$0,$0,$150,"$3,000",$0,$0,$80,4
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,2,99389,OR,Individual,No,45-3321455,99389OR0290001,Oregon's Health CO-OP SiMPLE Silver HSA Broad Network,99389OR029,,ORN001,ORS001,ORF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9994,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0290001-01-Oregons-Health-CO-OP-SiMPLEsilver-HSA-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLEsilver-HSA-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0290001-01,Standard Silver On Exchange Plan,71.70%,0.716980278491974,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$0,$0,$150,"$3,000",$0,$0,$80,5
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,2,99389,OR,Individual,No,45-3321455,99389OR0290001,Oregon's Health CO-OP SiMPLE Silver HSA Broad Network,99389OR029,,ORN001,ORS001,ORF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9994,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0290001-01-Oregons-Health-CO-OP-SiMPLEsilver-HSA-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLEsilver-HSA-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0290001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,2,99389,OR,Individual,No,45-3321455,99389OR0290001,Oregon's Health CO-OP SiMPLE Silver HSA Broad Network,99389OR029,,ORN001,ORS001,ORF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9994,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0290001-01-Oregons-Health-CO-OP-SiMPLEsilver-HSA-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLEsilver-HSA-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0290001-03,Limited Cost Sharing Plan Variation,71.70%,0.716980278491974,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$0,$0,$150,"$3,000",$0,$0,$80,7
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,2,99389,OR,Individual,No,45-3321455,99389OR0290001,Oregon's Health CO-OP SiMPLE Silver HSA Broad Network,99389OR029,,ORN001,ORS001,ORF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9994,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0290001-01-Oregons-Health-CO-OP-SiMPLEsilver-HSA-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLEsilver-HSA-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0290001-04,73% AV Level Silver Plan,73.89%,0.738942980766296,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$2,750","$5,500","$2,750","$5,500","$5,500","$11,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,"$2,750","$5,500","$2,750",$0,$0,$150,"$2,750",$0,$0,$80,8
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,2,99389,OR,Individual,No,45-3321455,99389OR0290001,Oregon's Health CO-OP SiMPLE Silver HSA Broad Network,99389OR029,,ORN001,ORS001,ORF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9994,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0290001-01-Oregons-Health-CO-OP-SiMPLEsilver-HSA-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLEsilver-HSA-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0290001-05,87% AV Level Silver Plan,87.65%,0.876513063907623,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,"$1,000","$1,000","$1,000",$0,$0,$150,"$1,000",$0,$0,$80,9
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,2,99389,OR,Individual,No,45-3321455,99389OR0290001,Oregon's Health CO-OP SiMPLE Silver HSA Broad Network,99389OR029,,ORN001,ORS001,ORF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9994,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0290001-01-Oregons-Health-CO-OP-SiMPLEsilver-HSA-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLEsilver-HSA-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0290001-06,94% AV Level Silver Plan,94.49%,0.944938838481903,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,$400,$800,$400,$800,$800,"$1,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$400,$800,$400,$0,$0,$150,$400,$0,$0,$80,10
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,3,99389,OR,Individual,No,45-3321455,99389OR0280001,Oregon's Health CO-OP SiMPLE Gold Select Network,99389OR028,,ORN002,ORS002,ORF005,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9966,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0280001-01-Oregons-Health-CO-OP-SiMPLEgold-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Gold-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0280001-00,Standard Gold Off Exchange Plan,78.19%,0.759842216968536,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$3,380",$0,$150,$0,"$1,500",$0,$80,4
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,3,99389,OR,Individual,No,45-3321455,99389OR0280001,Oregon's Health CO-OP SiMPLE Gold Select Network,99389OR028,,ORN002,ORS002,ORF005,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9966,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0280001-01-Oregons-Health-CO-OP-SiMPLEgold-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Gold-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0280001-01,Standard Gold On Exchange Plan,78.19%,0.759842216968536,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$3,380",$0,$150,$0,"$1,500",$0,$80,5
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,3,99389,OR,Individual,No,45-3321455,99389OR0280001,Oregon's Health CO-OP SiMPLE Gold Select Network,99389OR028,,ORN002,ORS002,ORF005,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9966,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0280001-01-Oregons-Health-CO-OP-SiMPLEgold-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Gold-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0280001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,3,99389,OR,Individual,No,45-3321455,99389OR0280001,Oregon's Health CO-OP SiMPLE Gold Select Network,99389OR028,,ORN002,ORS002,ORF005,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9966,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0280001-01-Oregons-Health-CO-OP-SiMPLEgold-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Gold-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0280001-03,Limited Cost Sharing Plan Variation,78.19%,0.759842216968536,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$3,380",$0,$150,$0,"$1,500",$0,$80,7
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,3,99389,OR,Individual,No,45-3321455,99389OR0270001,Oregon's Health CO-OP SiMPLE Silver Select Network,99389OR027,,ORN002,ORS002,ORF007,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9965,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0270001-01-Oregons-Health-CO-OP-SiMPLEsilver-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Silver-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0270001-00,Standard Silver Off Exchange Plan,70.14%,0.711547434329987,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$4,980",$0,$150,$0,"$1,930",$0,$80,8
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,3,99389,OR,Individual,No,45-3321455,99389OR0270001,Oregon's Health CO-OP SiMPLE Silver Select Network,99389OR027,,ORN002,ORS002,ORF007,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9965,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0270001-01-Oregons-Health-CO-OP-SiMPLEsilver-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Silver-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0270001-01,Standard Silver On Exchange Plan,70.14%,0.711547434329987,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$4,980",$0,$150,$0,"$1,930",$0,$80,9
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,3,99389,OR,Individual,No,45-3321455,99389OR0270001,Oregon's Health CO-OP SiMPLE Silver Select Network,99389OR027,,ORN002,ORS002,ORF007,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9965,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0270001-01-Oregons-Health-CO-OP-SiMPLEsilver-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Silver-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0270001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,10
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,3,99389,OR,Individual,No,45-3321455,99389OR0270001,Oregon's Health CO-OP SiMPLE Silver Select Network,99389OR027,,ORN002,ORS002,ORF007,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9965,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0270001-01-Oregons-Health-CO-OP-SiMPLEsilver-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Silver-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0270001-03,Limited Cost Sharing Plan Variation,70.14%,0.711547434329987,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$4,980",$0,$150,$0,"$1,930",$0,$80,11
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,3,99389,OR,Individual,No,45-3321455,99389OR0270001,Oregon's Health CO-OP SiMPLE Silver Select Network,99389OR027,,ORN002,ORS002,ORF007,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9965,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0270001-01-Oregons-Health-CO-OP-SiMPLEsilver-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Silver-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0270001-04,73% AV Level Silver Plan,73.87%,0.744931161403656,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$4,510",$0,$150,$0,"$1,400",$0,$80,12
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,3,99389,OR,Individual,No,45-3321455,99389OR0270001,Oregon's Health CO-OP SiMPLE Silver Select Network,99389OR027,,ORN002,ORS002,ORF007,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9965,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0270001-01-Oregons-Health-CO-OP-SiMPLEsilver-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Silver-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0270001-05,87% AV Level Silver Plan,87.81%,0.874668300151825,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000","$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$2,000",$0,$150,$0,"$1,270",$0,$80,13
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,3,99389,OR,Individual,No,45-3321455,99389OR0270001,Oregon's Health CO-OP SiMPLE Silver Select Network,99389OR027,,ORN002,ORS002,ORF007,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9965,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0270001-01-Oregons-Health-CO-OP-SiMPLEsilver-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Silver-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0270001-06,94% AV Level Silver Plan,94.73%,0.945932030677795,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,$600,"$1,200",$600,"$1,200","$1,200","$2,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,$520,$0,$150,$0,$600,$0,$80,14
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,3,99389,OR,Individual,No,45-3321455,99389OR0320001,Oregon's Health CO-OP SiMPLE Bronze Select Network,99389OR032,,ORN002,ORS002,ORF008,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9965,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0320001-01-Oregons-Health-CO-OP-SiMPLEbronze-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Bronze-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0320001-00,Standard Bronze Off Exchange Plan,61.70%,0.645231962203979,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$5,140",$0,$150,$0,"$2,660",$0,$80,15
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,3,99389,OR,Individual,No,45-3321455,99389OR0320001,Oregon's Health CO-OP SiMPLE Bronze Select Network,99389OR032,,ORN002,ORS002,ORF008,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9965,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0320001-01-Oregons-Health-CO-OP-SiMPLEbronze-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Bronze-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0320001-01,Standard Bronze On Exchange Plan,61.70%,0.645231962203979,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$5,140",$0,$150,$0,"$2,660",$0,$80,16
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,3,99389,OR,Individual,No,45-3321455,99389OR0320001,Oregon's Health CO-OP SiMPLE Bronze Select Network,99389OR032,,ORN002,ORS002,ORF008,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9965,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0320001-01-Oregons-Health-CO-OP-SiMPLEbronze-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Bronze-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0320001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,17
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,3,99389,OR,Individual,No,45-3321455,99389OR0320001,Oregon's Health CO-OP SiMPLE Bronze Select Network,99389OR032,,ORN002,ORS002,ORF008,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9965,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0320001-01-Oregons-Health-CO-OP-SiMPLEbronze-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Bronze-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0320001-03,Limited Cost Sharing Plan Variation,61.70%,0.645231962203979,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$0,$0,$0,"$5,140",$0,$150,$0,"$2,660",$0,$80,18
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,4,99389,OR,Individual,No,45-3321455,99389OR0300001,Oregon's Health CO-OP SiMPLE Silver HSA Select Network,99389OR030,,ORN002,ORS002,ORF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9993,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0300001-01-Oregons-Health-CO-OP-SiMPLEsilver-HSA-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Silver-HSA-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0300001-00,Standard Silver Off Exchange Plan,71.70%,0.716980278491974,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$0,$0,$150,"$3,000",$0,$0,$80,4
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,4,99389,OR,Individual,No,45-3321455,99389OR0300001,Oregon's Health CO-OP SiMPLE Silver HSA Select Network,99389OR030,,ORN002,ORS002,ORF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9993,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0300001-01-Oregons-Health-CO-OP-SiMPLEsilver-HSA-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Silver-HSA-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0300001-01,Standard Silver On Exchange Plan,71.70%,0.716980278491974,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$0,$0,$150,"$3,000",$0,$0,$80,5
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,4,99389,OR,Individual,No,45-3321455,99389OR0300001,Oregon's Health CO-OP SiMPLE Silver HSA Select Network,99389OR030,,ORN002,ORS002,ORF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9993,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0300001-01-Oregons-Health-CO-OP-SiMPLEsilver-HSA-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Silver-HSA-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0300001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,4,99389,OR,Individual,No,45-3321455,99389OR0300001,Oregon's Health CO-OP SiMPLE Silver HSA Select Network,99389OR030,,ORN002,ORS002,ORF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9993,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0300001-01-Oregons-Health-CO-OP-SiMPLEsilver-HSA-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Silver-HSA-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0300001-03,Limited Cost Sharing Plan Variation,71.70%,0.716980278491974,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$0,$0,$150,"$3,000",$0,$0,$80,7
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,4,99389,OR,Individual,No,45-3321455,99389OR0300001,Oregon's Health CO-OP SiMPLE Silver HSA Select Network,99389OR030,,ORN002,ORS002,ORF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9993,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0300001-01-Oregons-Health-CO-OP-SiMPLEsilver-HSA-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Silver-HSA-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0300001-04,73% AV Level Silver Plan,73.89%,0.738942980766296,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$2,750","$5,500","$2,750","$5,500","$5,500","$11,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,"$2,750","$5,500","$2,750",$0,$0,$150,"$2,750",$0,$0,$80,8
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,4,99389,OR,Individual,No,45-3321455,99389OR0300001,Oregon's Health CO-OP SiMPLE Silver HSA Select Network,99389OR030,,ORN002,ORS002,ORF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9993,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0300001-01-Oregons-Health-CO-OP-SiMPLEsilver-HSA-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Silver-HSA-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0300001-05,87% AV Level Silver Plan,87.65%,0.876513063907623,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$0,$0,$150,"$1,000",$0,$0,$80,9
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,4,99389,OR,Individual,No,45-3321455,99389OR0300001,Oregon's Health CO-OP SiMPLE Silver HSA Select Network,99389OR030,,ORN002,ORS002,ORF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,0.9993,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0300001-01-Oregons-Health-CO-OP-SiMPLEsilver-HSA-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Silver-HSA-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0300001-06,94% AV Level Silver Plan,94.49%,0.944938838481903,Yes,Yes,Yes,99%,1%,,,,,,,,,,,,,,,,,$400,$800,$400,$800,$800,"$1,600",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,0%,Not Applicable,Not Applicable,$400,$800,$400,$0,$0,$150,$400,$0,$0,$80,10
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,5,99389,OR,Individual,No,45-3321455,99389OR0570001,Oregon's Health CO-OP Oregon Standard Silver Plan Broad Network,99389OR057,,ORN002,ORS001,ORF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0570001-01-Oregons-Health-CO-OP-Oregon-Standard-Silver-Plan-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/Standard-Silver-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0570001-00,Standard Silver Off Exchange Plan,,0.682949244976044,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,"$2,500","$5,000",$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,500",$20,$800,$150,"$2,500",$500,$230,$80,4
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,5,99389,OR,Individual,No,45-3321455,99389OR0570001,Oregon's Health CO-OP Oregon Standard Silver Plan Broad Network,99389OR057,,ORN002,ORS001,ORF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0570001-01-Oregons-Health-CO-OP-Oregon-Standard-Silver-Plan-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/Standard-Silver-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0570001-01,Standard Silver On Exchange Plan,,0.682949244976044,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,"$2,500","$5,000",$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,500",$20,$800,$150,"$2,500",$500,$230,$80,5
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,5,99389,OR,Individual,No,45-3321455,99389OR0550001,Oregon's Health CO-OP Oregon Standard Gold Plan Broad Network,99389OR055,,ORN002,ORS001,ORF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0550001-01-Oregons-Health-CO-OP-Oregon-Standard-Gold-Plan-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/Standard-Gold-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0550001-01,Standard Gold On Exchange Plan,,0.781011641025543,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,"$1,300","$2,600",$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,300",$20,$390,$150,"$1,300",$460,$110,$80,12
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,5,99389,OR,Individual,No,45-3321455,99389OR0550001,Oregon's Health CO-OP Oregon Standard Gold Plan Broad Network,99389OR055,,ORN002,ORS001,ORF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0550001-01-Oregons-Health-CO-OP-Oregon-Standard-Gold-Plan-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/Standard-Gold-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0550001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,5,99389,OR,Individual,No,45-3321455,99389OR0550001,Oregon's Health CO-OP Oregon Standard Gold Plan Broad Network,99389OR055,,ORN002,ORS001,ORF003,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0550001-01-Oregons-Health-CO-OP-Oregon-Standard-Gold-Plan-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/Standard-Gold-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0550001-03,Limited Cost Sharing Plan Variation,,0.781011641025543,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,"$1,300","$2,600",$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,300",$20,$390,$150,"$1,300",$460,$110,$80,14
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,6,99389,OR,Individual,No,45-3321455,99389OR0610001,Oregon's Health CO-OP Oregon Standard Silver Plan Select Network,99389OR061,,ORN002,ORS002,ORF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0610001-01-Oregons-Health-CO-OP-Oregon-Standard-Silver-Plan-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Silver-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0610001-00,Standard Silver Off Exchange Plan,,0.682949244976044,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,"$2,500","$5,000",$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,500",$20,$800,$150,"$2,500",$500,$230,$80,4
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,6,99389,OR,Individual,No,45-3321455,99389OR0610001,Oregon's Health CO-OP Oregon Standard Silver Plan Select Network,99389OR061,,ORN002,ORS002,ORF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0610001-01-Oregons-Health-CO-OP-Oregon-Standard-Silver-Plan-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Silver-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0610001-01,Standard Silver On Exchange Plan,,0.682949244976044,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,"$2,500","$5,000",$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,500",$20,$800,$150,"$2,500",$500,$230,$80,5
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,6,99389,OR,Individual,No,45-3321455,99389OR0610001,Oregon's Health CO-OP Oregon Standard Silver Plan Select Network,99389OR061,,ORN002,ORS002,ORF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0610001-01-Oregons-Health-CO-OP-Oregon-Standard-Silver-Plan-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Silver-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0610001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,6,99389,OR,Individual,No,45-3321455,99389OR0610001,Oregon's Health CO-OP Oregon Standard Silver Plan Select Network,99389OR061,,ORN002,ORS002,ORF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0610001-01-Oregons-Health-CO-OP-Oregon-Standard-Silver-Plan-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Silver-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0610001-03,Limited Cost Sharing Plan Variation,,0.682949244976044,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,"$2,500","$5,000",$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,500",$20,$800,$150,"$2,500",$500,$230,$80,7
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,6,99389,OR,Individual,No,45-3321455,99389OR0610001,Oregon's Health CO-OP Oregon Standard Silver Plan Select Network,99389OR061,,ORN002,ORS002,ORF002,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0610001-01-Oregons-Health-CO-OP-Oregon-Standard-Silver-Plan-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/SiMPLE-Silver-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0610001-04,73% AV Level Silver Plan,,0.728753507137299,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$12,700","$25,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,30%,,,,Not Applicable,Not Applicable,"$2,500","$5,000",$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,"$2,500",$20,$800,$150,"$2,500",$500,$230,$80,8
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,2,31195,SD,SHOP (Small Group),No,91-1842494,31195SD0090004,"Sanford Simplicity-$3,000",31195SD009,,SDN001,SDS001,SDF008,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0090004-01,Standard Bronze On Exchange Plan,,0.617272973060608,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",40%,,,,"$6,000","$12,000","$6,000","$12,000",,,,,,,,,5
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,2,31195,SD,Individual,No,91-1842494,31195SD0080005,"Sanford Simplicity-$5,000",31195SD008,,SDN001,SDS001,SDF008,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080005-01,Standard Bronze On Exchange Plan,,0.613356590270996,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,000","$20,000","$14,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$13,000","$10,000","$13,000",,,,,,,,,5
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,2,31195,SD,Individual,No,91-1842494,31195SD0080005,"Sanford Simplicity-$5,000",31195SD008,,SDN001,SDS001,SDF008,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,2,31195,SD,Individual,No,91-1842494,31195SD0080005,"Sanford Simplicity-$5,000",31195SD008,,SDN001,SDS001,SDF008,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080005-03,Limited Cost Sharing Plan Variation,,0.613356590270996,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,000","$20,000","$14,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$13,000","$10,000","$13,000",,,,,,,,,7
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,2,31195,SD,Individual,No,91-1842494,31195SD0080007,"Sanford True-$5,000 Sanford Network",31195SD008,,SDN002,SDS002,SDF008,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080007-00,Standard Bronze Off Exchange Plan,,0.613356590270996,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,2,31195,SD,Individual,No,91-1842494,31195SD0080007,"Sanford True-$5,000 Sanford Network",31195SD008,,SDN002,SDS002,SDF008,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080007-01,Standard Bronze On Exchange Plan,,0.613356590270996,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,2,31195,SD,Individual,No,91-1842494,31195SD0080007,"Sanford True-$5,000 Sanford Network",31195SD008,,SDN002,SDS002,SDF008,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,2,31195,SD,Individual,No,91-1842494,31195SD0080007,"Sanford True-$5,000 Sanford Network",31195SD008,,SDN002,SDS002,SDF008,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080007-03,Limited Cost Sharing Plan Variation,,0.613356590270996,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,6,99389,OR,Individual,No,45-3321455,99389OR0560001,Oregon's Health CO-OP Oregon Standard Gold Plan Select Network,99389OR056,,ORN002,ORS002,ORF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0560001-01-Oregons-Health-CO-OP-Oregon-Standard-Gold-Plan-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/Standard-Gold-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0560001-00,Standard Gold Off Exchange Plan,,0.781011641025543,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,"$1,300","$2,600",$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,300",$20,$390,$150,"$1,300",$460,$110,$80,11
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,6,99389,OR,Individual,No,45-3321455,99389OR0560001,Oregon's Health CO-OP Oregon Standard Gold Plan Select Network,99389OR056,,ORN002,ORS002,ORF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0560001-01-Oregons-Health-CO-OP-Oregon-Standard-Gold-Plan-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/Standard-Gold-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0560001-01,Standard Gold On Exchange Plan,,0.781011641025543,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,"$1,300","$2,600",$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,300",$20,$390,$150,"$1,300",$460,$110,$80,12
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,6,99389,OR,Individual,No,45-3321455,99389OR0560001,Oregon's Health CO-OP Oregon Standard Gold Plan Select Network,99389OR056,,ORN002,ORS002,ORF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0560001-01-Oregons-Health-CO-OP-Oregon-Standard-Gold-Plan-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/Standard-Gold-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0560001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,13
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,6,99389,OR,Individual,No,45-3321455,99389OR0560001,Oregon's Health CO-OP Oregon Standard Gold Plan Select Network,99389OR056,,ORN002,ORS002,ORF003,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0560001-01-Oregons-Health-CO-OP-Oregon-Standard-Gold-Plan-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/Standard-Gold-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0560001-03,Limited Cost Sharing Plan Variation,,0.781011641025543,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,10%,,,,Not Applicable,Not Applicable,"$1,300","$2,600",$0,$0,50%,,,,$0,$0,$0,$0,,,,,,,,,,,"$1,300",$20,$390,$150,"$1,300",$460,$110,$80,14
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,7,99389,OR,Individual,No,45-3321455,99389OR0590001,Oregon's Health CO-OP Oregon Standard Bronze Plan Broad Network,99389OR059,,ORN001,ORS001,ORF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0590001-01-Oregons-Health-CO-OP-Oregon-Standard-Bronze-Plan-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/Standard-Bronze-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0590001-00,Standard Bronze Off Exchange Plan,,0.587094008922577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$5,000","$10,000","$5,000",$20,$90,$150,"$5,000",$60,$70,$80,4
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,7,99389,OR,Individual,No,45-3321455,99389OR0590001,Oregon's Health CO-OP Oregon Standard Bronze Plan Broad Network,99389OR059,,ORN001,ORS001,ORF001,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",Yes,https://www.ohcoop.org/wp-content/uploads/99389OR0590001-01-Oregons-Health-CO-OP-Oregon-Standard-Bronze-Plan-Broad-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/Standard-Bronze-Broad.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0590001-01,Standard Bronze On Exchange Plan,,0.587094008922577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$5,000","$10,000","$5,000",$20,$90,$150,"$5,000",$60,$70,$80,5
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,2,60536,SD,SHOP (Small Group),No,46-0451539,60536SD0010003,"Avera $1,000 / 20% Coinsurance",60536SD001,7942203176,SDN001,SDS001,SDF002,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14591/2015-Avera-1000-20-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0010003-00,Standard Gold Off Exchange Plan,,0.789279103279114,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,2,60536,SD,SHOP (Small Group),No,46-0451539,60536SD0010003,"Avera $1,000 / 20% Coinsurance",60536SD001,7942203176,SDN001,SDS001,SDF002,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14591/2015-Avera-1000-20-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0010003-01,Standard Gold On Exchange Plan,,0.789279103279114,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,1,60536,SD,SHOP (Small Group),No,46-0451539,60536SD0010018,"Avera $6,000 / 40% Coinsurance",60536SD001,7942203176,SDN001,SDS001,SDF004,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14599/2015-Avera-6000-40-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0010018-01,Standard Bronze On Exchange Plan,,0.610579550266266,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,000","$12,000",40%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,1,60536,SD,Individual,No,46-0451539,60536SD0020009,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket",60536SD002,7942203176,SDN001,SDS001,SDF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14581/2015-Avera-MyPlan-2500-6350-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020009-00,Standard Silver Off Exchange Plan,,0.683463633060455,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,1,60536,SD,Individual,No,46-0451539,60536SD0020009,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket",60536SD002,7942203176,SDN001,SDS001,SDF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14581/2015-Avera-MyPlan-2500-6350-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020009-01,Standard Silver On Exchange Plan,,0.683463633060455,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,1,60536,SD,Individual,No,46-0451539,60536SD0020009,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket",60536SD002,7942203176,SDN001,SDS001,SDF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14581/2015-Avera-MyPlan-2500-6350-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020009-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,1,60536,SD,Individual,No,46-0451539,60536SD0020009,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket",60536SD002,7942203176,SDN001,SDS001,SDF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14581/2015-Avera-MyPlan-2500-6350-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020009-03,Limited Cost Sharing Plan Variation,,0.683463633060455,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,1,60536,SD,Individual,No,46-0451539,60536SD0020009,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket",60536SD002,7942203176,SDN001,SDS001,SDF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14581/2015-Avera-MyPlan-2500-6350-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020009-04,73% AV Level Silver Plan,,0.728156566619873,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,2,60536,SD,Individual,No,46-0451539,60536SD0020007,"Avera MyPlan $1,500 / 20% Coinsurance, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF008,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14575/2015-Avera-MyPlan-1500-20-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020007-03,Limited Cost Sharing Plan Variation,,0.788982570171356,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,2,60536,SD,Individual,No,46-0451539,60536SD0020010,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14580/2015-Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020010-00,Standard Silver Off Exchange Plan,,0.683463633060455,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,7,60536,SD,Individual,No,46-0451539,60536SD0020023,"Avera MyPlan $5,000 / 30% Coinsurance, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF013,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14585/2015-Avera-MyPlan-5000-30-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020023-01,Standard Bronze On Exchange Plan,,0.619278430938721,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,7,60536,SD,Individual,No,46-0451539,60536SD0020023,"Avera MyPlan $5,000 / 30% Coinsurance, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF013,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14585/2015-Avera-MyPlan-5000-30-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020023-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,4,62210,SD,Individual,No,46-0401087,62210SD1460001,Dakota Signature Plus 1000,62210SD146,7033112278,SDN001,SDS001,SDF004,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_Plus_1000_80_20_2500_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1460001-01,Standard Gold On Exchange Plan,,0.814041018486023,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$0,"$1,200",$400,"$1,000","$1,500",$0,$100,5
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,4,62210,SD,Individual,No,46-0401087,62210SD1460001,Dakota Signature Plus 1000,62210SD146,7033112278,SDN001,SDS001,SDF004,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_Plus_1000_80_20_2500_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1460001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$400,$0,$0,$0,$100,6
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,8,99389,OR,Individual,No,45-3321455,99389OR0600001,Oregon's Health CO-OP Oregon Standard Bronze Plan Select Network,99389OR060,,ORN002,ORS002,ORF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0600001-01-Oregons-Health-CO-OP-Oregon-Standard-Bronze-Plan-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/Standard-Bronze-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0600001-00,Standard Bronze Off Exchange Plan,,0.587094008922577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$5,000","$10,000","$5,000",$20,$90,$150,"$5,000",$60,$70,$80,4
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,8,99389,OR,Individual,No,45-3321455,99389OR0600001,Oregon's Health CO-OP Oregon Standard Bronze Plan Select Network,99389OR060,,ORN002,ORS002,ORF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0600001-01-Oregons-Health-CO-OP-Oregon-Standard-Bronze-Plan-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/Standard-Bronze-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0600001-01,Standard Bronze On Exchange Plan,,0.587094008922577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$5,000","$10,000","$5,000",$20,$90,$150,"$5,000",$60,$70,$80,5
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,8,99389,OR,Individual,No,45-3321455,99389OR0600001,Oregon's Health CO-OP Oregon Standard Bronze Plan Select Network,99389OR060,,ORN002,ORS002,ORF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0600001-01-Oregons-Health-CO-OP-Oregon-Standard-Bronze-Plan-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/Standard-Bronze-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0600001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,6
2015,OR,99389,SERFF,7,2014-12-10 23:15:01,8,99389,OR,Individual,No,45-3321455,99389OR0600001,Oregon's Health CO-OP Oregon Standard Bronze Plan Select Network,99389OR060,,ORN002,ORS002,ORF001,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"same benefits as in network, benefits up to allowed amount and allowing balance billing by provider",No,https://www.ohcoop.org/wp-content/uploads/99389OR0600001-01-Oregons-Health-CO-OP-Oregon-Standard-Bronze-Plan-Select-Network_ver-2.pdf?8d7f07,https://ohcoop.nolatepayments.com/#/pay,https://www.ohcoop.org/wp-content/uploads/Standard-Bronze-Select.pdf?8d7f07,www.ohcoop.org/providers/rx-for-providers,99389OR0600001-03,Limited Cost Sharing Plan Variation,,0.587094008922577,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$5,000","$10,000","$5,000",$20,$90,$150,"$5,000",$60,$70,$80,7
2015,SD,11782,SERFF,1,2014-08-04 09:42:01,1,11782,SD,SHOP (Small Group),Yes,36-0883760,11782SD0040002,EHB High PPO,11782SD004,,SDN001,SDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$41.80,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,11782SD0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,11782,SERFF,1,2014-08-04 09:42:01,1,11782,SD,SHOP (Small Group),Yes,36-0883760,11782SD0040001,EHB Low PPO,11782SD004,,SDN001,SDS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.69,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,11782SD0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SD,11782,SERFF,1,2014-08-04 09:42:01,1,11782,SD,SHOP (Small Group),Yes,36-0883760,11782SD0030002,EHB High Passive,11782SD003,,SDN001,SDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$43.76,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,11782SD0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SD,11782,SERFF,1,2014-08-04 09:42:01,1,11782,SD,SHOP (Small Group),Yes,36-0883760,11782SD0030001,EHB Low Passive,11782SD003,,SDN001,SDS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.45,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,11782SD0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SD,13380,SERFF,2,2014-08-04 09:42:01,1,13380,SD,SHOP (Small Group),Yes,47-0098400,13380SD0040002,EHB High PPO,13380SD004,,SDN001,SDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$41.22,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,13380SD0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,13380,SERFF,2,2014-08-04 09:42:01,1,13380,SD,SHOP (Small Group),Yes,47-0098400,13380SD0040001,EHB Low PPO,13380SD004,,SDN001,SDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.39,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,13380SD0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SD,13380,SERFF,2,2014-08-04 09:42:01,1,13380,SD,SHOP (Small Group),Yes,47-0098400,13380SD0030002,EHB High Passive,13380SD003,,SDN001,SDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$43.16,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,13380SD0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SD,13380,SERFF,2,2014-08-04 09:42:01,1,13380,SD,SHOP (Small Group),Yes,47-0098400,13380SD0030001,EHB Low Passive,13380SD003,,SDN001,SDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.08,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,13380SD0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SD,14186,SERFF,2,2014-09-05 06:40:30,1,14186,SD,Individual,Yes,47-0397286,14186SD0010001,"Delta Dental Individual PPO, EHB Certified",14186SD001,,SDN002,SDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.12,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,14186SD0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,14186,SERFF,2,2014-09-05 06:40:30,1,14186,SD,SHOP (Small Group),Yes,47-0397286,14186SD0030001,"Renaissance Group Dental PPO, EHB Certified",14186SD003,,SDN001,SDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.71,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,14186SD0030001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,14186,SERFF,2,2014-09-05 06:40:30,1,14186,SD,SHOP (Small Group),Yes,47-0397286,14186SD0030002,"Renaissance Group Dental PPO, EHB Certified",14186SD003,,SDN001,SDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.86,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,14186SD0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SD,14186,SERFF,2,2014-09-05 06:40:30,1,14186,SD,Individual,Yes,47-0397286,14186SD0010002,"Delta Dental Individual PPO, EHB Certified",14186SD001,,SDN002,SDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.45,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,14186SD0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SD,14186,SERFF,2,2014-09-05 06:40:30,1,14186,SD,Individual,Yes,47-0397286,14186SD0020001,"Renaissance Individual Dental PPO, EHB Certified",14186SD002,,SDN001,SDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.62,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,14186SD0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SD,14186,SERFF,2,2014-09-05 06:40:30,1,14186,SD,Individual,Yes,47-0397286,14186SD0020002,"Renaissance Individual Dental PPO, EHB Certified",14186SD002,,SDN001,SDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.08,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,14186SD0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SD,19543,SERFF,2,2014-09-09 16:12:42,1,19543,SD,SHOP (Small Group),Yes,41-0808596,19543SD0010001,"Plan 1. Passive PPO, $1000 Annual Maximum, no Ortho",19543SD001,,SDN001,SDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,19543SD0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,19543,SERFF,2,2014-09-09 16:12:42,1,19543,SD,SHOP (Small Group),Yes,41-0808596,19543SD0010002,"Plan 2.  Passive PPO, $1000 Annual Maximum, Ortho",19543SD001,,SDN001,SDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,19543SD0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SD,19543,SERFF,2,2014-09-09 16:12:42,1,19543,SD,SHOP (Small Group),Yes,41-0808596,19543SD0010003,"Plan 3. Passive PPO, $1500 Annual Maximum, no Ortho",19543SD001,,SDN001,SDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,19543SD0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SD,19543,SERFF,2,2014-09-09 16:12:42,1,19543,SD,SHOP (Small Group),Yes,41-0808596,19543SD0010004,"Plan 4.  Passive PPO, $1500 Annual Maximum, Ortho",19543SD001,,SDN001,SDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,19543SD0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SD,19543,SERFF,2,2014-09-09 16:12:42,1,19543,SD,SHOP (Small Group),Yes,41-0808596,19543SD0010005,"Plan 5.  Passive PPO, $2000 Annual Maximum, Ortho",19543SD001,,SDN001,SDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,19543SD0010005-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,SD,19543,SERFF,2,2014-09-09 16:12:42,1,19543,SD,SHOP (Small Group),Yes,41-0808596,19543SD0010006,"Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho",19543SD001,,SDN001,SDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,19543SD0010006-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,SD,19543,SERFF,2,2014-09-09 16:12:42,1,19543,SD,SHOP (Small Group),Yes,41-0808596,19543SD0010007,"Plan 7. Graded Passive PPO, $1500 Annual Maximum, Ortho",19543SD001,,SDN001,SDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,19543SD0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,SD,25868,SERFF,4,2014-09-05 06:40:30,1,25868,SD,SHOP (Small Group),Yes,46-0309258,25868SD0020003,Delta Dental Small Group Low,25868SD002,,SDN001,SDS001,,Existing,Indemnity,Low,,Both,,,,EHB Pediatric coverage not available for anyone over the age of 18,,,,,Allows Adult and Child-Only,,,,$29.67,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.,Yes,http://www.deltadentalsd.com/documents/d118179.aspx?type=view,https://secure.deltadentalsd.com/ffm/default.aspx,http://www.deltadentalsd.com/documents/d118179.aspx?type=view,,25868SD0020003-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,25868,SERFF,4,2014-09-05 06:40:30,1,25868,SD,Individual,Yes,46-0309258,25868SD0010003,Delta Dental Individual & Family Low,25868SD001,,SDN001,SDS001,,Existing,Indemnity,Low,,Both,,,,EHB Pediatric coverage not available for anyone over the age of 18,,,,,Allows Adult and Child-Only,,,,$33.97,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.,Yes,http://www.deltadentalsd.com/documents/d118177.aspx?type=view,https://secure.deltadentalsd.com/ffm/default.aspx,http://www.deltadentalsd.com/documents/d118177.aspx?type=view,,25868SD0010003-00,Standard Low Off Exchange Plan,68.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,25868,SERFF,4,2014-09-05 06:40:30,1,25868,SD,Individual,Yes,46-0309258,25868SD0010003,Delta Dental Individual & Family Low,25868SD001,,SDN001,SDS001,,Existing,Indemnity,Low,,Both,,,,EHB Pediatric coverage not available for anyone over the age of 18,,,,,Allows Adult and Child-Only,,,,$33.97,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.,Yes,http://www.deltadentalsd.com/documents/d118177.aspx?type=view,https://secure.deltadentalsd.com/ffm/default.aspx,http://www.deltadentalsd.com/documents/d118177.aspx?type=view,,25868SD0010003-01,Standard Low On Exchange Plan,68.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SD,25868,SERFF,4,2014-09-05 06:40:30,1,25868,SD,SHOP (Small Group),Yes,46-0309258,25868SD0020003,Delta Dental Small Group Low,25868SD002,,SDN001,SDS001,,Existing,Indemnity,Low,,Both,,,,EHB Pediatric coverage not available for anyone over the age of 18,,,,,Allows Adult and Child-Only,,,,$29.67,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.,Yes,http://www.deltadentalsd.com/documents/d118179.aspx?type=view,https://secure.deltadentalsd.com/ffm/default.aspx,http://www.deltadentalsd.com/documents/d118179.aspx?type=view,,25868SD0020003-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SD,25868,SERFF,4,2014-09-05 06:40:30,2,25868,SD,SHOP (Small Group),Yes,46-0309258,25868SD0020004,Delta Dental Small Group High,25868SD002,,SDN001,SDS001,,Existing,Indemnity,High,,Both,,,,EHB Pediatric coverage not available for anyone over the age of 18.,,,,,Allows Adult and Child-Only,,,,$36.58,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.,Yes,http://www.deltadentalsd.com/documents/d118180.aspx?type=view,https://secure.deltadentalsd.com/ffm/default.aspx,http://www.deltadentalsd.com/documents/d118180.aspx?type=view,,25868SD0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,25868,SERFF,4,2014-09-05 06:40:30,2,25868,SD,Individual,Yes,46-0309258,25868SD0010004,Delta Dental Individual & Family High,25868SD001,,SDN001,SDS001,,Existing,Indemnity,High,,Both,,,,EHB Pediatric coverage not available for anyone over the age of 18.,,,,,Allows Adult and Child-Only,,,,$44.62,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.,Yes,http://www.deltadentalsd.com/documents/d118178.aspx?type=view,https://secure.deltadentalsd.com/ffm/default.aspx,http://www.deltadentalsd.com/documents/d118178.aspx?type=view,,25868SD0010004-00,Standard High Off Exchange Plan,85.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,25868,SERFF,4,2014-09-05 06:40:30,2,25868,SD,Individual,Yes,46-0309258,25868SD0010004,Delta Dental Individual & Family High,25868SD001,,SDN001,SDS001,,Existing,Indemnity,High,,Both,,,,EHB Pediatric coverage not available for anyone over the age of 18.,,,,,Allows Adult and Child-Only,,,,$44.62,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.,Yes,http://www.deltadentalsd.com/documents/d118178.aspx?type=view,https://secure.deltadentalsd.com/ffm/default.aspx,http://www.deltadentalsd.com/documents/d118178.aspx?type=view,,25868SD0010004-01,Standard High On Exchange Plan,85.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SD,25868,SERFF,4,2014-09-05 06:40:30,2,25868,SD,SHOP (Small Group),Yes,46-0309258,25868SD0020004,Delta Dental Small Group High,25868SD002,,SDN001,SDS001,,Existing,Indemnity,High,,Both,,,,EHB Pediatric coverage not available for anyone over the age of 18.,,,,,Allows Adult and Child-Only,,,,$36.58,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.,Yes,http://www.deltadentalsd.com/documents/d118180.aspx?type=view,https://secure.deltadentalsd.com/ffm/default.aspx,http://www.deltadentalsd.com/documents/d118180.aspx?type=view,,25868SD0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SD,26240,SERFF,1,2014-08-08 13:45:50,1,26240,SD,SHOP (Small Group),Yes,57-0523959,26240SD0010001,Group Pediatric Dental EHB,26240SD001,,SDN001,SDS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$40.49,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximums,Yes,Traditional with inside maximums,Yes,,,,,26240SD0010001-00,Standard High Off Exchange Plan,85.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,26240,SERFF,1,2014-08-08 13:45:50,1,26240,SD,SHOP (Small Group),Yes,57-0523959,26240SD0010002,Group Pediatric Dental EHB,26240SD001,,SDN001,SDS001,,New,Indemnity,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$32.74,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximums,Yes,Traditional with inside maximums,Yes,,,,,26240SD0010002-00,Standard Low Off Exchange Plan,69.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SD,26240,SERFF,1,2014-08-08 13:45:50,2,26240,SD,SHOP (Small Group),Yes,57-0523959,26240SD0020001,Group EHB Policy,26240SD002,,SDN001,SDS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$41.13,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximums,Yes,Traditional with inside maximums,Yes,,,,,26240SD0020001-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,26240,SERFF,1,2014-08-08 13:45:50,2,26240,SD,SHOP (Small Group),Yes,57-0523959,26240SD0020002,Group EHB Policy,26240SD002,,SDN001,SDS001,,New,Indemnity,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$34.09,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximums,Yes,Traditional with inside maximums,Yes,,,,,26240SD0020002-00,Standard Low Off Exchange Plan,72.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SD,28583,SERFF,3,2014-10-06 10:59:03,1,28583,SD,SHOP (Small Group),Yes,44-0308260,28583SD0010001,KCL EHB Low PPO,28583SD001,,SDN001,SDS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$40.29,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,28583SD0010001-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,28583,SERFF,3,2014-10-06 10:59:03,1,28583,SD,SHOP (Small Group),Yes,44-0308260,28583SD0010003,KCL EHB Low MAC,28583SD001,,SDN001,SDS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$30.66,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,28583SD0010003-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SD,28583,SERFF,3,2014-10-06 10:59:03,1,28583,SD,SHOP (Small Group),Yes,44-0308260,28583SD0010005,KCL Fam Low PPO,28583SD001,,SDN001,SDS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$40.29,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,28583SD0010005-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SD,28583,SERFF,3,2014-10-06 10:59:03,1,28583,SD,SHOP (Small Group),Yes,44-0308260,28583SD0010007,KCL Fam Low MAC,28583SD001,,SDN001,SDS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$30.66,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,28583SD0010007-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SD,28583,SERFF,3,2014-10-06 10:59:03,2,28583,SD,SHOP (Small Group),Yes,44-0308260,28583SD0010002,KCL EHB High PPO,28583SD001,,SDN001,SDS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$49.12,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,28583SD0010002-00,Standard High Off Exchange Plan,85.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,28583,SERFF,3,2014-10-06 10:59:03,2,28583,SD,SHOP (Small Group),Yes,44-0308260,28583SD0010004,KCL EHB High MAC,28583SD001,,SDN001,SDS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$37.91,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,28583SD0010004-00,Standard High Off Exchange Plan,85.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SD,28583,SERFF,3,2014-10-06 10:59:03,2,28583,SD,SHOP (Small Group),Yes,44-0308260,28583SD0010006,KCL Fam High PPO,28583SD001,,SDN001,SDS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$49.12,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,28583SD0010006-00,Standard High Off Exchange Plan,85.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SD,28583,SERFF,3,2014-10-06 10:59:03,2,28583,SD,SHOP (Small Group),Yes,44-0308260,28583SD0010008,KCL Fam High MAC,28583SD001,,SDN001,SDS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$37.91,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,28583SD0010008-00,Standard High Off Exchange Plan,85.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,1,31195,SD,SHOP (Small Group),No,91-1842494,31195SD0090005,"Sanford Simplicity-$5,000",31195SD009,,SDN001,SDS001,SDF007,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0090005-00,Standard Bronze Off Exchange Plan,,0.613356590270996,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,000","$20,000","$14,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$13,000","$10,000","$13,000",,,,,,,,,4
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,1,31195,SD,Individual,No,91-1842494,31195SD0080003,"Sanford Simplicity-$5,000 HDHP",31195SD008,,SDN001,SDS001,SDF008,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080003-00,Standard Bronze Off Exchange Plan,,0.586283802986145,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$6,000","$12,000","$6,000","$12,000",,,,,,,,,4
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,1,31195,SD,Individual,No,91-1842494,31195SD0080003,"Sanford Simplicity-$5,000 HDHP",31195SD008,,SDN001,SDS001,SDF008,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080003-01,Standard Bronze On Exchange Plan,,0.586283802986145,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$6,000","$12,000","$6,000","$12,000",,,,,,,,,5
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,1,31195,SD,SHOP (Small Group),No,91-1842494,31195SD0090005,"Sanford Simplicity-$5,000",31195SD009,,SDN001,SDS001,SDF007,New,HMO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0090005-01,Standard Bronze On Exchange Plan,,0.613356590270996,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,000","$20,000","$14,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$13,000","$10,000","$13,000",,,,,,,,,5
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,1,31195,SD,Individual,No,91-1842494,31195SD0080003,"Sanford Simplicity-$5,000 HDHP",31195SD008,,SDN001,SDS001,SDF008,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,1,31195,SD,Individual,No,91-1842494,31195SD0080003,"Sanford Simplicity-$5,000 HDHP",31195SD008,,SDN001,SDS001,SDF008,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080003-03,Limited Cost Sharing Plan Variation,,0.586283802986145,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$6,000","$12,000","$6,000","$12,000",,,,,,,,,7
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,1,31195,SD,Individual,No,91-1842494,31195SD0080009,"Sanford True-$5,000 HDHP Sanford Network",31195SD008,,SDN002,SDS002,SDF008,New,HMO,Bronze,No,Both,No,No,,,0,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080009-00,Standard Bronze Off Exchange Plan,,0.586283802986145,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,1,31195,SD,Individual,No,91-1842494,31195SD0080009,"Sanford True-$5,000 HDHP Sanford Network",31195SD008,,SDN002,SDS002,SDF008,New,HMO,Bronze,No,Both,No,No,,,0,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080009-01,Standard Bronze On Exchange Plan,,0.586283802986145,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,1,31195,SD,Individual,No,91-1842494,31195SD0080009,"Sanford True-$5,000 HDHP Sanford Network",31195SD008,,SDN002,SDS002,SDF008,New,HMO,Bronze,No,Both,No,No,,,0,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,1,31195,SD,Individual,No,91-1842494,31195SD0080009,"Sanford True-$5,000 HDHP Sanford Network",31195SD008,,SDN002,SDS002,SDF008,New,HMO,Bronze,No,Both,No,No,,,0,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080009-03,Limited Cost Sharing Plan Variation,,0.586283802986145,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,1,31195,SD,Individual,No,91-1842494,31195SD0080004,"Sanford Simplicity-$6,660",31195SD008,,SDN001,SDS001,SDF008,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080004-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$9,000","$18,000","$9,000","$18,000",,,,,,,,,12
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,1,31195,SD,Individual,No,91-1842494,31195SD0080004,"Sanford Simplicity-$6,660",31195SD008,,SDN001,SDS001,SDF008,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080004-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$18,000","$36,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$9,000","$18,000","$9,000","$18,000",,,,,,,,,13
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080001,"Sanford Simplicity-$1,500",31195SD008,,SDN001,SDS001,SDF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080001-00,Standard Gold Off Exchange Plan,,0.782246828079224,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000",20%,,,,"$3,000","$6,000","$3,000","$6,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,SHOP (Small Group),No,91-1842494,31195SD0090001,Sanford Simplicity-$500,31195SD009,,SDN001,SDS001,SDF006,Existing,HMO,Platinum,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0090001-00,Standard Platinum Off Exchange Plan,,0.884950578212738,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$5,000","$10,000","$5,000","$10,000",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",$0,$0,40%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,1,60536,SD,Individual,No,46-0451539,60536SD0020009,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket",60536SD002,7942203176,SDN001,SDS001,SDF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14581/2015-Avera-MyPlan-2500-6350-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020009-05,87% AV Level Silver Plan,,0.862476468086243,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,1,60536,SD,Individual,No,46-0451539,60536SD0020009,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket",60536SD002,7942203176,SDN001,SDS001,SDF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14581/2015-Avera-MyPlan-2500-6350-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020009-06,94% AV Level Silver Plan,,0.938910305500031,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,1,60536,SD,Individual,No,46-0451539,60536SD0020013,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket",60536SD002,7942203176,SDN001,SDS001,SDF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14578/2015-Avera-MyPlan-2500--5500-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020013-04,73% AV Level Silver Plan,,0.732257664203644,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,180","$10,360",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,250","$4,500",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,1,60536,SD,Individual,No,46-0451539,60536SD0020013,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket",60536SD002,7942203176,SDN001,SDS001,SDF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14578/2015-Avera-MyPlan-2500--5500-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020013-05,87% AV Level Silver Plan,,0.865615248680115,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,4,62210,SD,SHOP (Small Group),No,46-0401087,62210SD1360095,Reserve 6000,62210SD136,7033112278,SDN001,SDS001,SDF009,New,HMO,Bronze,No,Both,No,No,,30% penalty may be applied to certain covered services when rendered by non-participating providers,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Reserve_Group_6000_100_0_6000_x2.pdf,,http://www.dakotacare.com/bnefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1360095-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,"$6,000","$12,000","$6,000",$0,$0,$400,"$5,300",$0,$0,$100,6
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,4,62210,SD,SHOP (Small Group),No,46-0401087,62210SD1360095,Reserve 6000,62210SD136,7033112278,SDN001,SDS001,SDF009,New,HMO,Bronze,No,Both,No,No,,30% penalty may be applied to certain covered services when rendered by non-participating providers,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Reserve_Group_6000_100_0_6000_x2.pdf,,http://www.dakotacare.com/bnefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1360095-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,"$6,000","$12,000","$6,000",$0,$0,$400,"$5,300",$0,$0,$100,7
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,1,62210,SD,Individual,No,46-0401087,62210SD1430001,Dakota Universal 1000,62210SD143,7033112278,SDN001,SDS001,SDF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Universal_1000_80_20_2500_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1430001-00,Standard Gold Off Exchange Plan,,0.803790986537933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$200,"$1,200",$400,$300,"$2,000",$0,$100,4
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,1,62210,SD,SHOP (Small Group),No,46-0401087,62210SD1330097,Select 2000,62210SD133,7033112278,SDN001,SDS001,SDF008,New,HMO,Silver,No,Both,No,No,,30% penalty may be applied to certain covered services when rendered by non-participating providers,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Select_Group_2000_50_50_4500_x2_Rx_E.pdf,,http://www.dakotacare.com/bnefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1330097-00,Standard Silver Off Exchange Plan,,0.688023090362549,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$2,000","$4,000","$2,000",$0,"$2,500",$400,"$1,100","$1,800",$0,$100,4
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,1,62210,SD,SHOP (Small Group),No,46-0401087,62210SD1330097,Select 2000,62210SD133,7033112278,SDN001,SDS001,SDF008,New,HMO,Silver,No,Both,No,No,,30% penalty may be applied to certain covered services when rendered by non-participating providers,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Select_Group_2000_50_50_4500_x2_Rx_E.pdf,,http://www.dakotacare.com/bnefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1330097-01,Standard Silver On Exchange Plan,,0.688023090362549,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$2,000","$4,000","$2,000",$0,"$2,500",$400,"$1,100","$1,800",$0,$100,5
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,1,62210,SD,Individual,No,46-0401087,62210SD1430001,Dakota Universal 1000,62210SD143,7033112278,SDN001,SDS001,SDF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Universal_1000_80_20_2500_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1430001-01,Standard Gold On Exchange Plan,,0.803790986537933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$200,"$1,200",$400,$300,"$2,000",$0,$100,5
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,1,62210,SD,Individual,No,46-0401087,62210SD1430001,Dakota Universal 1000,62210SD143,7033112278,SDN001,SDS001,SDF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Universal_1000_80_20_2500_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1430001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$400,$0,$0,$0,$100,6
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,1,62210,SD,SHOP (Small Group),No,46-0401087,62210SD1330107,Select 6000,62210SD133,7033112278,SDN001,SDS001,SDF008,New,HMO,Bronze,No,Both,No,No,,30% penalty may be applied to certain covered services when rendered by non-participating providers,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Select_Group_6000_50_50_6600_x2_Rx_E.pdf,,http://www.dakotacare.com/bnefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1330107-00,Standard Bronze Off Exchange Plan,,0.608084678649902,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$6,000","$12,000","$6,000",$0,$600,$400,"$1,100","$1,800",$0,$100,6
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080001,"Sanford Simplicity-$1,500",31195SD008,,SDN001,SDS001,SDF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,SHOP (Small Group),No,91-1842494,31195SD0090002,"Sanford Simplicity-$1,500",31195SD009,,SDN001,SDS001,SDF001,Existing,HMO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0090002-00,Standard Gold Off Exchange Plan,,0.782246828079224,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000",20%,,,,"$3,000","$6,000","$3,000","$6,000",$0,$0,40%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,SHOP (Small Group),No,91-1842494,31195SD0090002,"Sanford Simplicity-$1,500",31195SD009,,SDN001,SDS001,SDF001,Existing,HMO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0090002-01,Standard Gold On Exchange Plan,,0.782246828079224,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000",20%,,,,"$3,000","$6,000","$3,000","$6,000",$0,$0,40%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080001,"Sanford Simplicity-$1,500",31195SD008,,SDN001,SDS001,SDF001,Existing,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080001-03,Limited Cost Sharing Plan Variation,,0.782246828079224,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000",20%,,,,"$3,000","$6,000","$3,000","$6,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,SHOP (Small Group),No,91-1842494,31195SD0090003,"Sanford Simplicity-$2,000",31195SD009,,SDN001,SDS001,SDF002,Existing,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0090003-00,Standard Silver Off Exchange Plan,,0.705296576023102,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,000","$4,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",$0,$0,40%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080002,"Sanford Simplicity-$2,500",31195SD008,,SDN001,SDS001,SDF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080002-00,Standard Silver Off Exchange Plan,,0.699748456478119,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,500","$5,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,1,60536,SD,Individual,No,46-0451539,60536SD0020013,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket",60536SD002,7942203176,SDN001,SDS001,SDF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14578/2015-Avera-MyPlan-2500--5500-Out-of-Pocket.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020013-06,94% AV Level Silver Plan,,0.938384711742401,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,2,60536,SD,Individual,No,46-0451539,60536SD0020007,"Avera MyPlan $1,500 / 20% Coinsurance, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF008,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14575/2015-Avera-MyPlan-1500-20-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020007-00,Standard Gold Off Exchange Plan,,0.788982570171356,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080002,"Sanford Simplicity-$2,500",31195SD008,,SDN001,SDS001,SDF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080002-01,Standard Silver On Exchange Plan,,0.699748456478119,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,500","$5,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,SHOP (Small Group),No,91-1842494,31195SD0090003,"Sanford Simplicity-$2,000",31195SD009,,SDN001,SDS001,SDF002,Existing,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0090003-01,Standard Silver On Exchange Plan,,0.705296576023102,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,000","$4,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",$0,$0,40%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,SHOP (Small Group),No,91-1842494,31195SD0090007,"Sanford Simplicity-$1,000",31195SD009,,SDN001,SDS001,SDF007,New,HMO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0090007-00,Standard Gold Off Exchange Plan,,0.809297680854797,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$2,000","$4,000",$0,$0,40%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080002,"Sanford Simplicity-$2,500",31195SD008,,SDN001,SDS001,SDF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080002,"Sanford Simplicity-$2,500",31195SD008,,SDN001,SDS001,SDF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080002-03,Limited Cost Sharing Plan Variation,,0.699748456478119,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,500","$5,000",40%,,,,"$5,000","$10,000","$5,000","$10,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,SHOP (Small Group),No,91-1842494,31195SD0090007,"Sanford Simplicity-$1,000",31195SD009,,SDN001,SDS001,SDF007,New,HMO,Gold,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0090007-01,Standard Gold On Exchange Plan,,0.809297680854797,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,000","$2,000",20%,,,,"$2,000","$4,000","$2,000","$4,000",$0,$0,40%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080002,"Sanford Simplicity-$2,500",31195SD008,,SDN001,SDS001,SDF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080002-04,73% AV Level Silver Plan,,0.735447406768799,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,350","$12,700","$6,350","$12,700","$1,500","$3,000",20%,,,,"$3,000","$6,000","$3,000","$6,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080002,"Sanford Simplicity-$2,500",31195SD008,,SDN001,SDS001,SDF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080002-05,87% AV Level Silver Plan,,0.871389806270599,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$6,350","$12,700","$6,350","$12,700",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080002,"Sanford Simplicity-$2,500",31195SD008,,SDN001,SDS001,SDF002,Existing,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080002-06,94% AV Level Silver Plan,,0.940972089767456,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$6,350","$12,700","$6,350","$12,700",$250,$500,20%,,,,$500,"$1,000",$500,"$1,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080006,"Sanford Simplicity-$3,500",31195SD008,,SDN001,SDS001,SDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080006-00,Standard Silver Off Exchange Plan,,0.698490560054779,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,000","$20,000","$14,000","$20,000","$3,500","$7,000",30%,,,,"$7,000","$14,000","$7,000","$14,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080006,"Sanford Simplicity-$3,500",31195SD008,,SDN001,SDS001,SDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080006-01,Standard Silver On Exchange Plan,,0.698490560054779,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,000","$20,000","$14,000","$20,000","$3,500","$7,000",30%,,,,"$7,000","$14,000","$7,000","$14,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080006,"Sanford Simplicity-$3,500",31195SD008,,SDN001,SDS001,SDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080006,"Sanford Simplicity-$3,500",31195SD008,,SDN001,SDS001,SDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080006-03,Limited Cost Sharing Plan Variation,,0.698490560054779,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$14,000","$20,000","$14,000","$20,000","$3,500","$7,000",30%,,,,"$7,000","$14,000","$7,000","$14,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080006,"Sanford Simplicity-$3,500",31195SD008,,SDN001,SDS001,SDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080006-04,73% AV Level Silver Plan,,0.730322659015656,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,600","$13,200","$6,600","$13,200","$3,000","$6,000",30%,,,,"$6,000","$12,000","$6,000","$12,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080006,"Sanford Simplicity-$3,500",31195SD008,,SDN001,SDS001,SDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080006-05,87% AV Level Silver Plan,,0.861830413341522,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,600","$13,200","$6,600","$13,200",$500,"$1,000",20%,,,,"$1,000","$2,000","$1,000","$2,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080006,"Sanford Simplicity-$3,500",31195SD008,,SDN001,SDS001,SDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080006-06,94% AV Level Silver Plan,,0.940972089767456,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$6,350","$12,700","$6,350","$12,700",$250,$500,20%,,,,$500,"$1,000",$500,"$1,000",$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080008,"Sanford True-$3,500 Sanford Network",31195SD008,,SDN002,SDS002,SDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080008-00,Standard Silver Off Exchange Plan,,0.698490560054779,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080008,"Sanford True-$3,500 Sanford Network",31195SD008,,SDN002,SDS002,SDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080008-01,Standard Silver On Exchange Plan,,0.698490560054779,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080008,"Sanford True-$3,500 Sanford Network",31195SD008,,SDN002,SDS002,SDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,24
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080008,"Sanford True-$3,500 Sanford Network",31195SD008,,SDN002,SDS002,SDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080008-03,Limited Cost Sharing Plan Variation,,0.698490560054779,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080008,"Sanford True-$3,500 Sanford Network",31195SD008,,SDN002,SDS002,SDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080008-04,73% AV Level Silver Plan,,0.730322659015656,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080008,"Sanford True-$3,500 Sanford Network",31195SD008,,SDN002,SDS002,SDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080008-05,87% AV Level Silver Plan,,0.861830413341522,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,3,31195,SD,Individual,No,91-1842494,31195SD0080008,"Sanford True-$3,500 Sanford Network",31195SD008,,SDN002,SDS002,SDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,https://hix.sanfordhealthplan.org,http://sanfordhealthplan.com/shopsanfordhealthplan/individuals/planoverviews/,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0080008-06,94% AV Level Silver Plan,,0.940972089767456,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,40%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,4,31195,SD,SHOP (Small Group),No,91-1842494,31195SD0090006,"Sanford Simplicity-$2,500",31195SD009,,SDN001,SDS001,SDF005,New,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0090006-00,Standard Silver Off Exchange Plan,,0.704849600791931,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$18,000","$12,000","$18,000","$2,500","$5,000",30%,,,,"$6,000","$12,000","$6,000","$12,000",$0,$0,40%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,SD,31195,SERFF,5,2015-01-23 12:43:55,4,31195,SD,SHOP (Small Group),No,91-1842494,31195SD0090006,"Sanford Simplicity-$2,500",31195SD009,,SDN001,SDS001,SDF005,New,HMO,Silver,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Only,Yes,Emergency or Urgent Care Only or With Plan Certification,Yes,www.Sanfordhealthplan.com/smallgroupplans,https://hix.sanfordhealthplan.org,www.Sanfordhealthplan.com/smallgroupplans,http://sanfordhealthplan.com/images/data/files/Formulary/14%20Pharmacy%20Handbook%20NGF.pdf,31195SD0090006-01,Standard Silver On Exchange Plan,,0.704849600791931,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$12,000","$18,000","$12,000","$18,000","$2,500","$5,000",30%,,,,"$6,000","$12,000","$6,000","$12,000",$0,$0,40%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,SD,34765,SERFF,6,2014-11-14 14:52:18,1,34765,SD,SHOP (Small Group),Yes,75-1233841,34765SD0020007,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,34765SD002,,SDN001,SDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.38,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/sd/34765sd0020007-15,,34765SD0020007-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,$70,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,34765,SERFF,6,2014-11-14 14:52:18,1,34765,SD,Individual,Yes,75-1233841,34765SD0010007,Dentegra Dental PPO Pediatric Basic Plan,34765SD001,,SDN001,SDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$27.17,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/sd/34765sd0010007-15,,34765SD0010007-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,$70,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,34765,SERFF,6,2014-11-14 14:52:18,1,34765,SD,Individual,Yes,75-1233841,34765SD0010007,Dentegra Dental PPO Pediatric Basic Plan,34765SD001,,SDN001,SDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$27.17,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/sd/34765sd0010007-15,,34765SD0010007-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,$70,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SD,34765,SERFF,6,2014-11-14 14:52:18,1,34765,SD,SHOP (Small Group),Yes,75-1233841,34765SD0020007,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,34765SD002,,SDN001,SDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.38,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/sd/34765sd0020007-15,,34765SD0020007-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,$70,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SD,34765,SERFF,6,2014-11-14 14:52:18,2,34765,SD,SHOP (Small Group),Yes,75-1233841,34765SD0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,34765SD002,,SDN001,SDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.38,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/sd/34765sd0020009-15,,34765SD0020009-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,$70,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,34765,SERFF,6,2014-11-14 14:52:18,2,34765,SD,Individual,Yes,75-1233841,34765SD0010009,Dentegra Dental PPO Family Basic Plan,34765SD001,,SDN001,SDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.17,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/sd/34765sd0010009-15,,34765SD0010009-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,$70,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,34765,SERFF,6,2014-11-14 14:52:18,2,34765,SD,Individual,Yes,75-1233841,34765SD0010009,Dentegra Dental PPO Family Basic Plan,34765SD001,,SDN001,SDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.17,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/sd/34765sd0010009-15,,34765SD0010009-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,$70,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SD,34765,SERFF,6,2014-11-14 14:52:18,2,34765,SD,SHOP (Small Group),Yes,75-1233841,34765SD0020009,Dentegra Dental PPO for Small Businesses Family Basic Plan,34765SD002,,SDN001,SDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$27.38,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/sd/34765sd0020009-15,,34765SD0020009-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$70,Not Applicable,,,,,$70,Not Applicable,$70,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SD,59141,SERFF,2,2014-08-04 09:42:01,1,59141,SD,SHOP (Small Group),Yes,93-0242990,59141SD0040002,EHB High PPO,59141SD004,,SDN001,SDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$41.92,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,59141SD0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,59141,SERFF,2,2014-08-04 09:42:01,1,59141,SD,SHOP (Small Group),Yes,93-0242990,59141SD0040001,EHB Low PPO,59141SD004,,SDN001,SDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.75,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,59141SD0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SD,59141,SERFF,2,2014-08-04 09:42:01,1,59141,SD,SHOP (Small Group),Yes,93-0242990,59141SD0030002,EHB High Passive,59141SD003,,SDN001,SDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$43.89,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,59141SD0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SD,59141,SERFF,2,2014-08-04 09:42:01,1,59141,SD,SHOP (Small Group),Yes,93-0242990,59141SD0030001,EHB Low Passive,59141SD003,,SDN001,SDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.52,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,59141SD0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,1,60536,SD,SHOP (Small Group),No,46-0451539,60536SD0010010,Avera $250 / 10% Coinsurance,60536SD001,7942203176,SDN001,SDS001,SDF001,Existing,PPO,Platinum,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14600/2015-Avera-250-10-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0010010-00,Standard Platinum Off Exchange Plan,,0.880899608135223,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$250,$500,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,1,60536,SD,Individual,No,46-0451539,60536SD0020006,"Avera MyPlan $1,500 / 20% Coinsurance",60536SD002,7942203176,SDN001,SDS001,SDF008,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14576/2015-Avera-MyPlan-1500-20-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020006-00,Standard Gold Off Exchange Plan,,0.788982570171356,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,1,60536,SD,Individual,No,46-0451539,60536SD0020006,"Avera MyPlan $1,500 / 20% Coinsurance",60536SD002,7942203176,SDN001,SDS001,SDF008,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14576/2015-Avera-MyPlan-1500-20-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020006-01,Standard Gold On Exchange Plan,,0.788982570171356,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,1,60536,SD,SHOP (Small Group),No,46-0451539,60536SD0010010,Avera $250 / 10% Coinsurance,60536SD001,7942203176,SDN001,SDS001,SDF001,Existing,PPO,Platinum,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14600/2015-Avera-250-10-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0010010-01,Standard Platinum On Exchange Plan,,0.880899608135223,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,$250,$500,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,1,60536,SD,SHOP (Small Group),No,46-0451539,60536SD0010018,"Avera $6,000 / 40% Coinsurance",60536SD001,7942203176,SDN001,SDS001,SDF004,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14599/2015-Avera-6000-40-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0010018-00,Standard Bronze Off Exchange Plan,,0.610579550266266,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$6,000","$12,000",40%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,1,60536,SD,Individual,No,46-0451539,60536SD0020006,"Avera MyPlan $1,500 / 20% Coinsurance",60536SD002,7942203176,SDN001,SDS001,SDF008,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14576/2015-Avera-MyPlan-1500-20-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,1,60536,SD,Individual,No,46-0451539,60536SD0020006,"Avera MyPlan $1,500 / 20% Coinsurance",60536SD002,7942203176,SDN001,SDS001,SDF008,Existing,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14576/2015-Avera-MyPlan-1500-20-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020006-03,Limited Cost Sharing Plan Variation,,0.788982570171356,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,1,62210,SD,Individual,No,46-0401087,62210SD1430002,Dakota Universal 3000,62210SD143,7033112278,SDN001,SDS001,SDF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Universal_3000_80_20_5000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1430002-06,94% AV Level Silver Plan,,0.933967471122742,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$400,$800,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,$200,$400,$200,$200,$0,$400,$200,$200,$0,$100,14
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,1,62210,SD,Individual,No,46-0401087,62210SD1430003,Dakota Universal 4000,62210SD143,7033112278,SDN001,SDS001,SDF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Universal_4000_80_20_6000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1430003-00,Standard Silver Off Exchange Plan,,0.688524425029755,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,"$4,000","$8,000","$4,000",$200,$600,$400,$300,"$2,000",$0,$100,15
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,1,62210,SD,Individual,No,46-0401087,62210SD1430003,Dakota Universal 4000,62210SD143,7033112278,SDN001,SDS001,SDF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Universal_4000_80_20_6000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1430003-01,Standard Silver On Exchange Plan,,0.688524425029755,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,"$4,000","$8,000","$4,000",$200,$600,$400,$300,"$2,000",$0,$100,16
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,1,62210,SD,Individual,No,46-0401087,62210SD1430003,Dakota Universal 4000,62210SD143,7033112278,SDN001,SDS001,SDF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Universal_4000_80_20_6000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1430003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$400,$0,$0,$0,$100,17
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,1,62210,SD,Individual,No,46-0401087,62210SD1430003,Dakota Universal 4000,62210SD143,7033112278,SDN001,SDS001,SDF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Universal_4000_80_20_6000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1430003-03,Limited Cost Sharing Plan Variation,,0.688524425029755,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,"$4,000","$8,000","$4,000",$200,$600,$400,$300,"$2,000",$0,$100,18
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,1,62210,SD,Individual,No,46-0401087,62210SD1430003,Dakota Universal 4000,62210SD143,7033112278,SDN001,SDS001,SDF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Universal_4000_80_20_6000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1430003-04,73% AV Level Silver Plan,,0.727269291877747,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,"$2,000","$4,000","$2,000",$200,"$1,000",$400,$300,"$2,000",$0,$100,19
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,2,60536,SD,Individual,No,46-0451539,60536SD0020010,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14580/2015-Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020010-01,Standard Silver On Exchange Plan,,0.683463633060455,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,2,60536,SD,Individual,No,46-0451539,60536SD0020010,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14580/2015-Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,2,60536,SD,Individual,No,46-0451539,60536SD0020010,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14580/2015-Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020010-03,Limited Cost Sharing Plan Variation,,0.683463633060455,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,2,60536,SD,Individual,No,46-0451539,60536SD0020010,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14580/2015-Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020010-04,73% AV Level Silver Plan,,0.728156566619873,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,2,60536,SD,Individual,No,46-0451539,60536SD0020010,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14580/2015-Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020010-05,87% AV Level Silver Plan,,0.862476468086243,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,2,60536,SD,Individual,No,46-0451539,60536SD0020010,"Avera MyPlan $2,500 / $6,350 Out-of-Pocket, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF009,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14580/2015-Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020010-06,94% AV Level Silver Plan,,0.938910305500031,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,2,60536,SD,Individual,No,46-0451539,60536SD0020014,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14579/2015-Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020014-00,Standard Silver Off Exchange Plan,,0.711994588375092,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,2,60536,SD,Individual,No,46-0451539,60536SD0020014,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14579/2015-Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020014-01,Standard Silver On Exchange Plan,,0.711994588375092,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,2,60536,SD,Individual,No,46-0451539,60536SD0020014,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14579/2015-Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,2,60536,SD,Individual,No,46-0451539,60536SD0020014,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14579/2015-Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020014-03,Limited Cost Sharing Plan Variation,,0.711994588375092,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,2,60536,SD,Individual,No,46-0451539,60536SD0020014,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14579/2015-Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020014-04,73% AV Level Silver Plan,,0.732257664203644,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,180","$10,360",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,250","$4,500",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,2,60536,SD,Individual,No,46-0451539,60536SD0020014,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14579/2015-Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020014-05,87% AV Level Silver Plan,,0.865615248680115,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,2,60536,SD,Individual,No,46-0451539,60536SD0020014,"Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF010,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14579/2015-Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020014-06,94% AV Level Silver Plan,,0.938384711742401,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,3,60536,SD,Individual,No,46-0451539,60536SD0020011,"Avera MyPlan $3,500",60536SD002,7942203176,SDN001,SDS001,SDF012,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14584/2015-Avera-MyPlan-3500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020011-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,3,60536,SD,SHOP (Small Group),No,46-0451539,60536SD0010011,"Avera $1,500 / 10% Coinsurance",60536SD001,7942203176,SDN001,SDS001,SDF003,New,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14592/2015-Avera-1500-10-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0010011-00,Standard Gold Off Exchange Plan,,0.787112951278687,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,3,60536,SD,SHOP (Small Group),No,46-0451539,60536SD0010011,"Avera $1,500 / 10% Coinsurance",60536SD001,7942203176,SDN001,SDS001,SDF003,New,PPO,Gold,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14592/2015-Avera-1500-10-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0010011-01,Standard Gold On Exchange Plan,,0.787112951278687,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,500","$3,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,3,60536,SD,Individual,No,46-0451539,60536SD0020011,"Avera MyPlan $3,500",60536SD002,7942203176,SDN001,SDS001,SDF012,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14584/2015-Avera-MyPlan-3500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020011-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,3,60536,SD,Individual,No,46-0451539,60536SD0020011,"Avera MyPlan $3,500",60536SD002,7942203176,SDN001,SDS001,SDF012,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14584/2015-Avera-MyPlan-3500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,3,60536,SD,SHOP (Small Group),No,46-0451539,60536SD0010014,"Avera $1,500 / 40% Coinsurance",60536SD001,7942203176,SDN001,SDS001,SDF006,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14593/2015-Avera-1500-40-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0010014-00,Standard Silver Off Exchange Plan,,0.698360085487366,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,500","$3,000",40%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,3,60536,SD,SHOP (Small Group),No,46-0451539,60536SD0010014,"Avera $1,500 / 40% Coinsurance",60536SD001,7942203176,SDN001,SDS001,SDF006,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14593/2015-Avera-1500-40-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0010014-01,Standard Silver On Exchange Plan,,0.698360085487366,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$1,500","$3,000",40%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,3,60536,SD,Individual,No,46-0451539,60536SD0020011,"Avera MyPlan $3,500",60536SD002,7942203176,SDN001,SDS001,SDF012,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14584/2015-Avera-MyPlan-3500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020011-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,3,60536,SD,Individual,No,46-0451539,60536SD0020011,"Avera MyPlan $3,500",60536SD002,7942203176,SDN001,SDS001,SDF012,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14584/2015-Avera-MyPlan-3500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020011-04,73% AV Level Silver Plan,,0.732454240322113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,3,60536,SD,Individual,No,46-0451539,60536SD0020011,"Avera MyPlan $3,500",60536SD002,7942203176,SDN001,SDS001,SDF012,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14584/2015-Avera-MyPlan-3500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020011-05,87% AV Level Silver Plan,,0.866531372070313,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,3,60536,SD,Individual,No,46-0451539,60536SD0020011,"Avera MyPlan $3,500",60536SD002,7942203176,SDN001,SDS001,SDF012,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14584/2015-Avera-MyPlan-3500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020011-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,3,60536,SD,Individual,No,46-0451539,60536SD0020024,"Avera MyPlan $6,200",60536SD002,7942203176,SDN001,SDS001,SDF012,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14587/2015-Avera-MyPlan-6200.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020024-00,Standard Bronze Off Exchange Plan,,0.585070788860321,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,200","$12,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,200","$12,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,3,60536,SD,Individual,No,46-0451539,60536SD0020024,"Avera MyPlan $6,200",60536SD002,7942203176,SDN001,SDS001,SDF012,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14587/2015-Avera-MyPlan-6200.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020024-01,Standard Bronze On Exchange Plan,,0.585070788860321,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,200","$12,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,200","$12,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,3,60536,SD,Individual,No,46-0451539,60536SD0020024,"Avera MyPlan $6,200",60536SD002,7942203176,SDN001,SDS001,SDF012,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14587/2015-Avera-MyPlan-6200.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020024-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,3,60536,SD,Individual,No,46-0451539,60536SD0020024,"Avera MyPlan $6,200",60536SD002,7942203176,SDN001,SDS001,SDF012,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14587/2015-Avera-MyPlan-6200.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020024-03,Limited Cost Sharing Plan Variation,,0.585070788860321,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,200","$12,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,200","$12,400",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,4,60536,SD,Individual,No,46-0451539,60536SD0020020,"Avera MyPlan Preferred $2,500",60536SD002,7942203176,SDN002,SDS002,SDF009,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14630/2015-Avera-MyPlan-Preferred-2500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020020-00,Standard Silver Off Exchange Plan,,0.696629703044891,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,"$2,500","$5,000",30%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,4,60536,SD,SHOP (Small Group),No,46-0451539,60536SD0010017,"Avera $4,500",60536SD001,7942203176,SDN001,SDS001,SDF007,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14598/2015-Avera-4500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0010017-00,Standard Bronze Off Exchange Plan,,0.585586369037628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,4,60536,SD,SHOP (Small Group),No,46-0451539,60536SD0010017,"Avera $4,500",60536SD001,7942203176,SDN001,SDS001,SDF007,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14598/2015-Avera-4500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0010017-01,Standard Bronze On Exchange Plan,,0.585586369037628,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",50%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,4,60536,SD,Individual,No,46-0451539,60536SD0020020,"Avera MyPlan Preferred $2,500",60536SD002,7942203176,SDN002,SDS002,SDF009,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14630/2015-Avera-MyPlan-Preferred-2500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020020-01,Standard Silver On Exchange Plan,,0.696629703044891,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,"$2,500","$5,000",30%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,4,60536,SD,Individual,No,46-0451539,60536SD0020020,"Avera MyPlan Preferred $2,500",60536SD002,7942203176,SDN002,SDS002,SDF009,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14630/2015-Avera-MyPlan-Preferred-2500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020020-02,Zero Cost Sharing Plan Variation,,1,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,4,60536,SD,Individual,No,46-0451539,60536SD0020020,"Avera MyPlan Preferred $2,500",60536SD002,7942203176,SDN002,SDS002,SDF009,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14630/2015-Avera-MyPlan-Preferred-2500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020020-03,Limited Cost Sharing Plan Variation,,0.696629703044891,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,"$2,500","$5,000",30%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,4,60536,SD,Individual,No,46-0451539,60536SD0020020,"Avera MyPlan Preferred $2,500",60536SD002,7942203176,SDN002,SDS002,SDF009,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14630/2015-Avera-MyPlan-Preferred-2500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020020-04,73% AV Level Silver Plan,,0.725945353507996,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,"$2,000","$4,000",30%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,4,60536,SD,Individual,No,46-0451539,60536SD0020020,"Avera MyPlan Preferred $2,500",60536SD002,7942203176,SDN002,SDS002,SDF009,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14630/2015-Avera-MyPlan-Preferred-2500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020020-05,87% AV Level Silver Plan,,0.863441586494446,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,"$1,000","$2,000",30%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,4,60536,SD,Individual,No,46-0451539,60536SD0020020,"Avera MyPlan Preferred $2,500",60536SD002,7942203176,SDN002,SDS002,SDF009,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14630/2015-Avera-MyPlan-Preferred-2500.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020020-06,94% AV Level Silver Plan,,0.937174499034882,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,$700,"$1,400",$700,"$1,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,20%,$350,$700,30%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,5,60536,SD,Individual,No,46-0451539,60536SD0020017,Avera MyPlan $250 / 10% Coinsurance,60536SD002,7942203176,SDN001,SDS001,SDF001,Existing,PPO,Platinum,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14589/2015-Avera-MyPlan-250-10-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020017-00,Standard Platinum Off Exchange Plan,,0.880899608135223,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,5,60536,SD,SHOP (Small Group),No,46-0451539,60536SD0010015,"Avera $3,000 / 40% Coinsurance",60536SD001,7942203176,SDN001,SDS001,SDF004,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14597/2015-Avera-3000-40-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0010015-00,Standard Silver Off Exchange Plan,,0.683652639389038,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,000","$6,000",40%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,5,60536,SD,SHOP (Small Group),No,46-0451539,60536SD0010015,"Avera $3,000 / 40% Coinsurance",60536SD001,7942203176,SDN001,SDS001,SDF004,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14597/2015-Avera-3000-40-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0010015-01,Standard Silver On Exchange Plan,,0.683652639389038,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,000","$6,000",40%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,4,62210,SD,SHOP (Small Group),No,46-0401087,62210SD1360090,Reserve 2000,62210SD136,7033112278,SDN001,SDS001,SDF009,New,HMO,Gold,No,Both,No,No,,30% penalty may be applied to certain covered services when rendered by non-participating providers,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Reserve_Group_2000_100_0_2000_x2.pdf,,http://www.dakotacare.com/bnefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1360090-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,"$2,000","$4,000","$2,000",$0,$0,$400,"$2,000",$0,$0,$100,4
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,4,62210,SD,SHOP (Small Group),No,46-0401087,62210SD1360090,Reserve 2000,62210SD136,7033112278,SDN001,SDS001,SDF009,New,HMO,Gold,No,Both,No,No,,30% penalty may be applied to certain covered services when rendered by non-participating providers,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Reserve_Group_2000_100_0_2000_x2.pdf,,http://www.dakotacare.com/bnefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1360090-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,"$2,000","$4,000","$2,000",$0,$0,$400,"$2,000",$0,$0,$100,5
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,5,60536,SD,Individual,No,46-0451539,60536SD0020017,Avera MyPlan $250 / 10% Coinsurance,60536SD002,7942203176,SDN001,SDS001,SDF001,Existing,PPO,Platinum,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14589/2015-Avera-MyPlan-250-10-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020017-03,Limited Cost Sharing Plan Variation,,0.880899608135223,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,6,60536,SD,Individual,No,46-0451539,60536SD0020012,"Avera MyPlan $5,000 / 30% Coinsurance",60536SD002,7942203176,SDN001,SDS001,SDF013,Existing,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/12063/Avera-MyPlan-5000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020012-00,Standard Bronze Off Exchange Plan,,0.619278430938721,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,6,60536,SD,SHOP (Small Group),No,46-0451539,60536SD0010016,"Avera Preferred $3,000",60536SD001,7942203176,SDN002,SDS002,SDF004,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14629/2015-Avera-Preferred-3000.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0010016-00,Standard Silver Off Exchange Plan,,0.683962464332581,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$10,000","$20,000",Not Applicable,Not Applicable,"$3,000","$6,000",30%,"$3,000","$6,000",40%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,6,60536,SD,SHOP (Small Group),No,46-0451539,60536SD0010016,"Avera Preferred $3,000",60536SD001,7942203176,SDN002,SDS002,SDF004,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14629/2015-Avera-Preferred-3000.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0010016-01,Standard Silver On Exchange Plan,,0.683962464332581,No,Yes,Yes,50%,50%,,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$10,000","$20,000",Not Applicable,Not Applicable,"$3,000","$6,000",30%,"$3,000","$6,000",40%,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,UT,18167,SERFF,2,2014-09-07 12:14:41,2,18167,UT,Individual,No,33-0617992,18167UT0010002,Molina Marketplace Silver Plan,18167UT001,,UTN001,UTS001,UTF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.984183086901531,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,18167UT0010002-03,Limited Cost Sharing Plan Variation,,0.706084549427032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$200,$400,30%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,7
2015,UT,18167,SERFF,2,2014-09-07 12:14:41,2,18167,UT,Individual,No,33-0617992,18167UT0010002,Molina Marketplace Silver Plan,18167UT001,,UTN001,UTS001,UTF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.984183086901531,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,18167UT0010002-04,73% AV Level Silver Plan,,0.739861905574799,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,"$5,200","$10,400","$1,700","$3,400",30%,,,,Not Applicable,Not Applicable,"$1,700","$3,400",$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,UT,18167,SERFF,2,2014-09-07 12:14:41,2,18167,UT,Individual,No,33-0617992,18167UT0010002,Molina Marketplace Silver Plan,18167UT001,,UTN001,UTS001,UTF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.984183086901531,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,18167UT0010002-05,87% AV Level Silver Plan,,0.87469470500946,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,"$2,250","$4,500",$250,$500,20%,,,,Not Applicable,Not Applicable,$250,$500,$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,UT,18167,SERFF,2,2014-09-07 12:14:41,2,18167,UT,Individual,No,33-0617992,18167UT0010002,Molina Marketplace Silver Plan,18167UT001,,UTN001,UTS001,UTF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.984183086901531,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,18167UT0010002-06,94% AV Level Silver Plan,,0.943551361560822,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,"$2,250","$4,500",$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,3,62210,SD,Individual,No,46-0401087,62210SD1450002,Dakota Reserve 3000,62210SD145,7033112278,SDN001,SDS001,SDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Reserve_3000_100_0_3000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1450002-00,Standard Silver Off Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$0,$0,$400,"$3,000",$0,$0,$100,8
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,3,62210,SD,Individual,No,46-0401087,62210SD1450002,Dakota Reserve 3000,62210SD145,7033112278,SDN001,SDS001,SDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Reserve_3000_100_0_3000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1450002-01,Standard Silver On Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$0,$0,$400,"$3,000",$0,$0,$100,9
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,3,62210,SD,Individual,No,46-0401087,62210SD1450002,Dakota Reserve 3000,62210SD145,7033112278,SDN001,SDS001,SDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Reserve_3000_100_0_3000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1450002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$400,$0,$0,$0,$100,10
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,3,62210,SD,Individual,No,46-0401087,62210SD1450002,Dakota Reserve 3000,62210SD145,7033112278,SDN001,SDS001,SDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Reserve_3000_100_0_3000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1450002-03,Limited Cost Sharing Plan Variation,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$0,$0,$400,"$3,000",$0,$0,$100,11
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,3,62210,SD,Individual,No,46-0401087,62210SD1450002,Dakota Reserve 3000,62210SD145,7033112278,SDN001,SDS001,SDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Reserve_3000_100_0_3000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1450002-04,73% AV Level Silver Plan,,0.738942980766296,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$2,650","$5,300",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,"$2,650","$5,300","$2,650",$0,$0,$400,"$2,650",$0,$0,$100,12
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,3,62210,SD,Individual,No,46-0401087,62210SD1450002,Dakota Reserve 3000,62210SD145,7033112278,SDN001,SDS001,SDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Reserve_3000_100_0_3000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1450002-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$0,$0,$400,"$1,000",$0,$0,$100,13
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,3,62210,SD,Individual,No,46-0401087,62210SD1450002,Dakota Reserve 3000,62210SD145,7033112278,SDN001,SDS001,SDF003,New,HMO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Reserve_3000_100_0_3000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1450002-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,$500,"$1,000",$500,$0,$0,$400,$500,$0,$0,$100,14
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,3,62210,SD,Individual,No,46-0401087,62210SD1450003,Dakota Reserve 6000,62210SD145,7033112278,SDN001,SDS001,SDF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Reserve_6000_100_0_6000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1450003-00,Standard Bronze Off Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,"$6,000","$12,000","$6,000",$0,$0,$400,"$5,300",$0,$0,$100,15
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,6,60536,SD,Individual,No,46-0451539,60536SD0020012,"Avera MyPlan $5,000 / 30% Coinsurance",60536SD002,7942203176,SDN001,SDS001,SDF013,Existing,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/12063/Avera-MyPlan-5000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020012-01,Standard Bronze On Exchange Plan,,0.619278430938721,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,6,60536,SD,Individual,No,46-0451539,60536SD0020012,"Avera MyPlan $5,000 / 30% Coinsurance",60536SD002,7942203176,SDN001,SDS001,SDF013,Existing,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/12063/Avera-MyPlan-5000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020012-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,1,62210,SD,Individual,No,46-0401087,62210SD1430002,Dakota Universal 3000,62210SD143,7033112278,SDN001,SDS001,SDF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Universal_3000_80_20_5000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1430002-00,Standard Silver Off Exchange Plan,,0.714607656002045,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$200,$800,$400,$300,"$2,000",$0,$100,8
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,1,62210,SD,Individual,No,46-0401087,62210SD1430002,Dakota Universal 3000,62210SD143,7033112278,SDN001,SDS001,SDF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Universal_3000_80_20_5000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1430002-01,Standard Silver On Exchange Plan,,0.714607656002045,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$200,$800,$400,$300,"$2,000",$0,$100,9
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,1,62210,SD,Individual,No,46-0401087,62210SD1430002,Dakota Universal 3000,62210SD143,7033112278,SDN001,SDS001,SDF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Universal_3000_80_20_5000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1430002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$400,$0,$0,$0,$100,10
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,1,62210,SD,Individual,No,46-0401087,62210SD1430002,Dakota Universal 3000,62210SD143,7033112278,SDN001,SDS001,SDF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Universal_3000_80_20_5000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1430002-03,Limited Cost Sharing Plan Variation,,0.714607656002045,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$200,$800,$400,$300,"$2,000",$0,$100,11
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,6,60536,SD,Individual,No,46-0451539,60536SD0020012,"Avera MyPlan $5,000 / 30% Coinsurance",60536SD002,7942203176,SDN001,SDS001,SDF013,Existing,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/12063/Avera-MyPlan-5000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020012-03,Limited Cost Sharing Plan Variation,,0.619278430938721,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,7,60536,SD,Individual,No,46-0451539,60536SD0020023,"Avera MyPlan $5,000 / 30% Coinsurance, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF013,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14585/2015-Avera-MyPlan-5000-30-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020023-00,Standard Bronze Off Exchange Plan,,0.619278430938721,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,7,60536,SD,SHOP (Small Group),No,46-0451539,60536SD0010013,"Avera $2,000 / 20% Coinsurance",60536SD001,7942203176,SDN001,SDS001,SDF004,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14612/2015-Avera-2000-20-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0010013-00,Standard Silver Off Exchange Plan,,0.693703711032867,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,7,60536,SD,SHOP (Small Group),No,46-0451539,60536SD0010013,"Avera $2,000 / 20% Coinsurance",60536SD001,7942203176,SDN001,SDS001,SDF004,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14612/2015-Avera-2000-20-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0010013-01,Standard Silver On Exchange Plan,,0.693703711032867,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,7,60536,SD,Individual,No,46-0451539,60536SD0020023,"Avera MyPlan $5,000 / 30% Coinsurance, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF013,New,PPO,Bronze,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14585/2015-Avera-MyPlan-5000-30-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020023-03,Limited Cost Sharing Plan Variation,,0.619278430938721,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,8,60536,SD,Individual,No,46-0451539,60536SD0020019,"Avera MyPlan $2,000 / 30% Coinsurance",60536SD002,7942203176,SDN001,SDS001,SDF009,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14577/2015-Avera-MyPlan-2000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020019-00,Standard Silver Off Exchange Plan,,0.719203412532806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,8,60536,SD,SHOP (Small Group),No,46-0451539,60536SD0010006,"Avera $2,000 / 30% Coinsurance",60536SD001,7942203176,SDN001,SDS001,SDF005,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14632/2015-Avera-2000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0010006-00,Standard Silver Off Exchange Plan,,0.70047664642334,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,8,60536,SD,SHOP (Small Group),No,46-0451539,60536SD0010006,"Avera $2,000 / 30% Coinsurance",60536SD001,7942203176,SDN001,SDS001,SDF005,Existing,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,5,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14632/2015-Avera-2000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0010006-01,Standard Silver On Exchange Plan,,0.70047664642334,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,8,60536,SD,Individual,No,46-0451539,60536SD0020019,"Avera MyPlan $2,000 / 30% Coinsurance",60536SD002,7942203176,SDN001,SDS001,SDF009,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14577/2015-Avera-MyPlan-2000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020019-01,Standard Silver On Exchange Plan,,0.719203412532806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,8,60536,SD,Individual,No,46-0451539,60536SD0020019,"Avera MyPlan $2,000 / 30% Coinsurance",60536SD002,7942203176,SDN001,SDS001,SDF009,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14577/2015-Avera-MyPlan-2000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020019-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,8,60536,SD,Individual,No,46-0451539,60536SD0020019,"Avera MyPlan $2,000 / 30% Coinsurance",60536SD002,7942203176,SDN001,SDS001,SDF009,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14577/2015-Avera-MyPlan-2000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020019-03,Limited Cost Sharing Plan Variation,,0.719203412532806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,8,60536,SD,Individual,No,46-0451539,60536SD0020019,"Avera MyPlan $2,000 / 30% Coinsurance",60536SD002,7942203176,SDN001,SDS001,SDF009,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14577/2015-Avera-MyPlan-2000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020019-04,73% AV Level Silver Plan,,0.739821970462799,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,600","$3,200",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,8,60536,SD,Individual,No,46-0451539,60536SD0020019,"Avera MyPlan $2,000 / 30% Coinsurance",60536SD002,7942203176,SDN001,SDS001,SDF009,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14577/2015-Avera-MyPlan-2000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020019-05,87% AV Level Silver Plan,,0.86927729845047,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,8,60536,SD,Individual,No,46-0451539,60536SD0020019,"Avera MyPlan $2,000 / 30% Coinsurance",60536SD002,7942203176,SDN001,SDS001,SDF009,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14577/2015-Avera-MyPlan-2000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020019-06,94% AV Level Silver Plan,,0.946691811084747,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,8,60536,SD,Individual,No,46-0451539,60536SD0020021,"Avera MyPlan $3,000 / 30% Coinsurance",60536SD002,7942203176,SDN001,SDS001,SDF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14583/2015-Avera-MyPlan-3000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020021-00,Standard Silver Off Exchange Plan,,0.683893144130707,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,8,60536,SD,Individual,No,46-0451539,60536SD0020021,"Avera MyPlan $3,000 / 30% Coinsurance",60536SD002,7942203176,SDN001,SDS001,SDF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14583/2015-Avera-MyPlan-3000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020021-01,Standard Silver On Exchange Plan,,0.683893144130707,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,8,60536,SD,Individual,No,46-0451539,60536SD0020021,"Avera MyPlan $3,000 / 30% Coinsurance",60536SD002,7942203176,SDN001,SDS001,SDF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14583/2015-Avera-MyPlan-3000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020021-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,8,60536,SD,Individual,No,46-0451539,60536SD0020021,"Avera MyPlan $3,000 / 30% Coinsurance",60536SD002,7942203176,SDN001,SDS001,SDF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14583/2015-Avera-MyPlan-3000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020021-03,Limited Cost Sharing Plan Variation,,0.683893144130707,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,8,60536,SD,Individual,No,46-0451539,60536SD0020021,"Avera MyPlan $3,000 / 30% Coinsurance",60536SD002,7942203176,SDN001,SDS001,SDF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14583/2015-Avera-MyPlan-3000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020021-04,73% AV Level Silver Plan,,0.738397479057312,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,850","$5,700",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,8,60536,SD,Individual,No,46-0451539,60536SD0020021,"Avera MyPlan $3,000 / 30% Coinsurance",60536SD002,7942203176,SDN001,SDS001,SDF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14583/2015-Avera-MyPlan-3000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020021-05,87% AV Level Silver Plan,,0.86927729845047,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,8,60536,SD,Individual,No,46-0451539,60536SD0020021,"Avera MyPlan $3,000 / 30% Coinsurance",60536SD002,7942203176,SDN001,SDS001,SDF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14583/2015-Avera-MyPlan-3000-30-Coinsurance.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020021-06,94% AV Level Silver Plan,,0.946691811084747,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,9,60536,SD,Individual,No,46-0451539,60536SD0020022,"Avera MyPlan $3,000 / 30% Coinsurance, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14582/2015-Avera-MyPlan-3000-30-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020022-00,Standard Silver Off Exchange Plan,,0.683893144130707,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,9,60536,SD,Individual,No,46-0451539,60536SD0020022,"Avera MyPlan $3,000 / 30% Coinsurance, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14582/2015-Avera-MyPlan-3000-30-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020022-01,Standard Silver On Exchange Plan,,0.683893144130707,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,9,60536,SD,Individual,No,46-0451539,60536SD0020022,"Avera MyPlan $3,000 / 30% Coinsurance, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14582/2015-Avera-MyPlan-3000-30-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020022-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,9,60536,SD,Individual,No,46-0451539,60536SD0020022,"Avera MyPlan $3,000 / 30% Coinsurance, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14582/2015-Avera-MyPlan-3000-30-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020022-03,Limited Cost Sharing Plan Variation,,0.683893144130707,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,000","$6,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,9,60536,SD,Individual,No,46-0451539,60536SD0020022,"Avera MyPlan $3,000 / 30% Coinsurance, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14582/2015-Avera-MyPlan-3000-30-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020022-04,73% AV Level Silver Plan,,0.738397479057312,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,850","$5,700",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,9,60536,SD,Individual,No,46-0451539,60536SD0020022,"Avera MyPlan $3,000 / 30% Coinsurance, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14582/2015-Avera-MyPlan-3000-30-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020022-05,87% AV Level Silver Plan,,0.86927729845047,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,9,60536,SD,Individual,No,46-0451539,60536SD0020022,"Avera MyPlan $3,000 / 30% Coinsurance, Pediatric Dental",60536SD002,7942203176,SDN001,SDS001,SDF011,New,PPO,Silver,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,2,0,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14582/2015-Avera-MyPlan-3000-30-Coinsurance-Pediatric-Dental.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020022-06,94% AV Level Silver Plan,,0.946691811084747,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$700,"$1,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$350,$700,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,10,60536,SD,Individual,No,46-0451539,60536SD0020018,"Avera MyPlan $6,600",60536SD002,7942203176,SDN001,SDS001,SDF012,Existing,PPO,Catastrophic,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14588/2015-Avera-MyPlan-6600.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020018-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,SD,60536,SERFF,6,2014-10-28 20:25:58,10,60536,SD,Individual,No,46-0451539,60536SD0020018,"Avera MyPlan $6,600",60536SD002,7942203176,SDN001,SDS001,SDF012,Existing,PPO,Catastrophic,No,Both,No,No,,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,,No,,Yes,Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.,No,https://www.avera.org/app/files/public/14588/2015-Avera-MyPlan-6600.pdf,https://www.avera.org/marketplace/payment-reminder/,https://www.avera.org/marketplace/plan-brochure/,http://www.averahealthplans.com/6-tier-drug-formulary-search/,60536SD0020018-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,1,61214,SD,Individual,Yes,95-6042390,61214SD0020001,BESTOne Child Dental Plus,61214SD002,,SDN001,SDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$40.31,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,,,61214SD0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,1,61214,SD,SHOP (Small Group),Yes,95-6042390,61214SD0010001,BEST Life Child Dental Plus,61214SD001,,SDN001,SDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$32.24,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SD/2015/SD_BEST_Life_Child_Dental_Plus_Plan.pdf,,61214SD0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,2,61214,SD,SHOP (Small Group),Yes,95-6042390,61214SD0010002,BEST Life Child Dental,61214SD001,,SDN001,SDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.97,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SD/2015/SD_BEST_Life_Child_Dental_Plan.pdf,,61214SD0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,2,61214,SD,Individual,Yes,95-6042390,61214SD0020002,BESTOne Child Dental,61214SD002,,SDN001,SDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$31.19,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,,,61214SD0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,3,61214,SD,Individual,Yes,95-6042390,61214SD0020003,BESTOne Dental Advantage-Gold,61214SD002,,SDN001,SDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$40.31,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,,,61214SD0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,3,61214,SD,SHOP (Small Group),Yes,95-6042390,61214SD0010007,BEST  Dental Premium,61214SD001,,SDN001,SDS001,,New,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$32.24,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SD/2015/SD_BESTDental_Premium_Plan.pdf,,61214SD0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,3,61214,SD,SHOP (Small Group),Yes,95-6042390,61214SD0010007,BEST  Dental Premium,61214SD001,,SDN001,SDS001,,New,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$32.24,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SD/2015/SD_BESTDental_Premium_Plan.pdf,,61214SD0010007-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,3,61214,SD,Individual,Yes,95-6042390,61214SD0020003,BESTOne Dental Advantage-Gold,61214SD002,,SDN001,SDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$40.31,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,,,61214SD0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,3,61214,SD,SHOP (Small Group),Yes,95-6042390,61214SD0010008,BEST Dental Standard-H,61214SD001,,SDN001,SDS001,,New,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$32.24,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SD/2015/SD_BESTDental_Standard-H_Plan.pdf,,61214SD0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,3,61214,SD,Individual,Yes,95-6042390,61214SD0020004,BESTOne Dental Plus-Gold,61214SD002,,SDN001,SDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$40.31,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,,,61214SD0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,3,61214,SD,Individual,Yes,95-6042390,61214SD0020004,BESTOne Dental Plus-Gold,61214SD002,,SDN001,SDS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$40.31,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,,,61214SD0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,3,61214,SD,SHOP (Small Group),Yes,95-6042390,61214SD0010008,BEST Dental Standard-H,61214SD001,,SDN001,SDS001,,New,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$32.24,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SD/2015/SD_BESTDental_Standard-H_Plan.pdf,,61214SD0010008-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,3,61214,SD,SHOP (Small Group),Yes,95-6042390,61214SD0010010,BEST Dental Choice-H,61214SD001,,SDN001,SDS001,,New,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$32.24,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SD/2015/SD_BESTDental_Choice-H_Plan.pdf,,61214SD0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,3,61214,SD,SHOP (Small Group),Yes,95-6042390,61214SD0010010,BEST Dental Choice-H,61214SD001,,SDN001,SDS001,,New,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$32.24,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SD/2015/SD_BESTDental_Choice-H_Plan.pdf,,61214SD0010010-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,4,61214,SD,SHOP (Small Group),Yes,95-6042390,61214SD0010009,BEST Dental Standard-L,61214SD001,,SDN001,SDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$24.97,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SD/2015/SD_BESTDental_Standard-L_Plan.pdf,,61214SD0010009-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,4,61214,SD,Individual,Yes,95-6042390,61214SD0020005,BESTOne Dental Plus-Silver,61214SD002,,SDN001,SDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.19,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,,,61214SD0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,4,61214,SD,Individual,Yes,95-6042390,61214SD0020005,BESTOne Dental Plus-Silver,61214SD002,,SDN001,SDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.19,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,,,61214SD0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,4,61214,SD,SHOP (Small Group),Yes,95-6042390,61214SD0010009,BEST Dental Standard-L,61214SD001,,SDN001,SDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$24.97,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SD/2015/SD_BESTDental_Standard-L_Plan.pdf,,61214SD0010009-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,4,61214,SD,SHOP (Small Group),Yes,95-6042390,61214SD0010011,BEST Dental Choice-L,61214SD001,,SDN001,SDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$24.97,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SD/2015/SD_BESTDental_Choice-L_Plan.pdf,,61214SD0010011-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,4,61214,SD,Individual,Yes,95-6042390,61214SD0020006,BESTOne Dental Basic-Silver,61214SD002,,SDN001,SDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.19,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,,,61214SD0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,4,61214,SD,Individual,Yes,95-6042390,61214SD0020006,BESTOne Dental Basic-Silver,61214SD002,,SDN001,SDS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$31.19,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,,,61214SD0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,4,61214,SD,SHOP (Small Group),Yes,95-6042390,61214SD0010011,BEST Dental Choice-L,61214SD001,,SDN001,SDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$24.97,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SD/2015/SD_BESTDental_Choice-L_Plan.pdf,,61214SD0010011-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,4,61214,SD,SHOP (Small Group),Yes,95-6042390,61214SD0010012,BEST Dental Value,61214SD001,,SDN001,SDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$24.97,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SD/2015/SD_BESTDental_Value_Plan.pdf,,61214SD0010012-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,SD,61214,SERFF,4,2014-10-28 20:25:58,4,61214,SD,SHOP (Small Group),Yes,95-6042390,61214SD0010012,BEST Dental Value,61214SD001,,SDN001,SDS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$24.97,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,,http://www.bestlife.com/pmt,http://www.bestlife.com/SD/2015/SD_BESTDental_Value_Plan.pdf,,61214SD0010012-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,1,62210,SD,SHOP (Small Group),No,46-0401087,62210SD1330107,Select 6000,62210SD133,7033112278,SDN001,SDS001,SDF008,New,HMO,Bronze,No,Both,No,No,,30% penalty may be applied to certain covered services when rendered by non-participating providers,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Select_Group_6000_50_50_6600_x2_Rx_E.pdf,,http://www.dakotacare.com/bnefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1330107-01,Standard Bronze On Exchange Plan,,0.608084678649902,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$6,000","$12,000","$6,000",$0,$600,$400,"$1,100","$1,800",$0,$100,7
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,1,62210,SD,Individual,No,46-0401087,62210SD1430001,Dakota Universal 1000,62210SD143,7033112278,SDN001,SDS001,SDF001,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Universal_1000_80_20_2500_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1430001-03,Limited Cost Sharing Plan Variation,,0.803790986537933,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$200,"$1,200",$400,$300,"$2,000",$0,$100,7
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,1,62210,SD,Individual,No,46-0401087,62210SD1430002,Dakota Universal 3000,62210SD143,7033112278,SDN001,SDS001,SDF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Universal_3000_80_20_5000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1430002-04,73% AV Level Silver Plan,,0.739422738552094,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,"$1,500","$3,000","$1,500",$200,"$1,100",$400,$300,"$2,000",$0,$100,12
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,1,62210,SD,Individual,No,46-0401087,62210SD1430002,Dakota Universal 3000,62210SD143,7033112278,SDN001,SDS001,SDF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Universal_3000_80_20_5000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1430002-05,87% AV Level Silver Plan,,0.876258671283722,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$500,$200,$300,$400,$500,$500,$0,$100,13
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,1,62210,SD,Individual,No,46-0401087,62210SD1430003,Dakota Universal 4000,62210SD143,7033112278,SDN001,SDS001,SDF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Universal_4000_80_20_6000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1430003-05,87% AV Level Silver Plan,,0.862318158149719,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,$750,"$1,500",$750,$200,$50,$400,$300,$700,$0,$100,20
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,1,62210,SD,Individual,No,46-0401087,62210SD1430003,Dakota Universal 4000,62210SD143,7033112278,SDN001,SDS001,SDF001,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Universal_4000_80_20_6000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1430003-06,94% AV Level Silver Plan,,0.930311679840088,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$400,$800,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,$250,$500,$200,$200,$0,$400,$250,$150,$0,$100,21
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,2,62210,SD,Individual,No,46-0401087,62210SD1440001,Dakota Core 1000,62210SD144,7033112278,SDN001,SDS001,SDF002,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Core_1000_50_50_3000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1440001-00,Standard Gold Off Exchange Plan,,0.786276340484619,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$0,"$2,000",$400,$400,"$2,000",$0,$100,4
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,2,62210,SD,SHOP (Small Group),No,46-0401087,62210SD1310068,Choice 1500,62210SD131,7033112278,SDN001,SDS001,SDF007,New,HMO,Gold,No,Both,No,No,,30% penalty may be applied to certain covered services when rendered by non-participating providers,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Choice_1500_50_50_2500_x2_Rx_B.pdf,,http://www.dakotacare.com/bnefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1310068-00,Standard Gold Off Exchange Plan,,0.81324577331543,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$1,500","$3,000","$1,500",$0,"$1,000",$400,$400,"$1,700",$0,$100,4
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,2,62210,SD,SHOP (Small Group),No,46-0401087,62210SD1310068,Choice 1500,62210SD131,7033112278,SDN001,SDS001,SDF007,New,HMO,Gold,No,Both,No,No,,30% penalty may be applied to certain covered services when rendered by non-participating providers,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Choice_1500_50_50_2500_x2_Rx_B.pdf,,http://www.dakotacare.com/bnefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1310068-01,Standard Gold On Exchange Plan,,0.81324577331543,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$1,500","$3,000","$1,500",$0,"$1,000",$400,$400,"$1,700",$0,$100,5
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,2,62210,SD,Individual,No,46-0401087,62210SD1440001,Dakota Core 1000,62210SD144,7033112278,SDN001,SDS001,SDF002,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Core_1000_50_50_3000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1440001-01,Standard Gold On Exchange Plan,,0.786276340484619,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$0,"$2,000",$400,$400,"$2,000",$0,$100,5
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,2,62210,SD,Individual,No,46-0401087,62210SD1440001,Dakota Core 1000,62210SD144,7033112278,SDN001,SDS001,SDF002,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Core_1000_50_50_3000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1440001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$400,$0,$0,$0,$100,6
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,2,62210,SD,SHOP (Small Group),No,46-0401087,62210SD1310102,Choice 5000,62210SD131,7033112278,SDN001,SDS001,SDF007,New,HMO,Silver,No,Both,No,No,,30% penalty may be applied to certain covered services when rendered by non-participating providers,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Choice_5000_50_50_6600_x2_Rx_B.pdf,,http://www.dakotacare.com/bnefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1310102-00,Standard Silver Off Exchange Plan,,0.68043440580368,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$5,000","$10,000","$5,000",$0,"$1,000",$400,$400,"$1,700",$0,$100,6
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,2,62210,SD,SHOP (Small Group),No,46-0401087,62210SD1310102,Choice 5000,62210SD131,7033112278,SDN001,SDS001,SDF007,New,HMO,Silver,No,Both,No,No,,30% penalty may be applied to certain covered services when rendered by non-participating providers,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Choice_5000_50_50_6600_x2_Rx_B.pdf,,http://www.dakotacare.com/bnefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1310102-01,Standard Silver On Exchange Plan,,0.68043440580368,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$5,000","$10,000","$5,000",$0,"$1,000",$400,$400,"$1,700",$0,$100,7
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,2,62210,SD,Individual,No,46-0401087,62210SD1440001,Dakota Core 1000,62210SD144,7033112278,SDN001,SDS001,SDF002,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Core_1000_50_50_3000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1440001-03,Limited Cost Sharing Plan Variation,,0.786276340484619,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$0,"$2,000",$400,$400,"$2,000",$0,$100,7
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,2,62210,SD,Individual,No,46-0401087,62210SD1440002,Dakota Core 2500,62210SD144,7033112278,SDN001,SDS001,SDF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Core_2500_50_50_5000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1440002-00,Standard Silver Off Exchange Plan,,0.715261816978455,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$2,500","$5,000","$2,500",$0,"$2,300",$400,$400,"$2,000",$0,$100,8
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,2,62210,SD,Individual,No,46-0401087,62210SD1440002,Dakota Core 2500,62210SD144,7033112278,SDN001,SDS001,SDF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Core_2500_50_50_5000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1440002-01,Standard Silver On Exchange Plan,,0.715261816978455,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$2,500","$5,000","$2,500",$0,"$2,300",$400,$400,"$2,000",$0,$100,9
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,2,62210,SD,Individual,No,46-0401087,62210SD1440002,Dakota Core 2500,62210SD144,7033112278,SDN001,SDS001,SDF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Core_2500_50_50_5000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1440002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$400,$0,$0,$0,$100,10
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,2,62210,SD,Individual,No,46-0401087,62210SD1440002,Dakota Core 2500,62210SD144,7033112278,SDN001,SDS001,SDF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Core_2500_50_50_5000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1440002-03,Limited Cost Sharing Plan Variation,,0.715261816978455,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$2,500","$5,000","$2,500",$0,"$2,300",$400,$400,"$2,000",$0,$100,11
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,5,62210,SD,Individual,No,46-0401087,62210SD1470002,Dakota Signature 3000,62210SD147,7033112278,SDN001,SDS001,SDF005,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_3000_50_50_4000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1470002-06,94% AV Level Silver Plan,,0.941455125808716,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$250,$500,$250,$0,$250,$400,$250,$0,$250,$100,14
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,5,62210,SD,Individual,No,46-0401087,62210SD1470003,Dakota Signature 5000,62210SD147,7033112278,SDN001,SDS001,SDF005,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_5000_50_50_6600_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1470003-00,Standard Bronze Off Exchange Plan,,0.602744817733765,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$5,000","$10,000","$5,000",$0,"$1,100",$400,"$5,000",$0,$150,$100,15
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,5,62210,SD,Individual,No,46-0401087,62210SD1470003,Dakota Signature 5000,62210SD147,7033112278,SDN001,SDS001,SDF005,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_5000_50_50_6600_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1470003-01,Standard Bronze On Exchange Plan,,0.602744817733765,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$5,000","$10,000","$5,000",$0,"$1,100",$400,"$5,000",$0,$150,$100,16
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,5,62210,SD,Individual,No,46-0401087,62210SD1470003,Dakota Signature 5000,62210SD147,7033112278,SDN001,SDS001,SDF005,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_5000_50_50_6600_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1470003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$400,$0,$0,$0,$100,17
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,5,62210,SD,Individual,No,46-0401087,62210SD1470003,Dakota Signature 5000,62210SD147,7033112278,SDN001,SDS001,SDF005,New,HMO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_5000_50_50_6600_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1470003-03,Limited Cost Sharing Plan Variation,,0.602744817733765,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$5,000","$10,000","$5,000",$0,"$1,100",$400,"$5,000",$0,$150,$100,18
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,6,62210,SD,Individual,No,46-0401087,62210SD1480001,Dakota Basic 3000,62210SD148,7033112278,SDN001,SDS001,SDF006,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Basic_0_50_50_3000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1480001-00,Standard Gold Off Exchange Plan,,0.793008863925934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,"$3,000",$400,$0,"$1,700","$1,300",$100,4
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,4,27619,UT,Individual,No,45-3174628,27619UT0010006,Arches Preferred Care - Know Your Cost Basic Wellness,27619UT001,,UTN002,UTS002,UTF007,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10006.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10006.pdf,www.archeshealth.org/pharmacy,27619UT0010006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,4,27619,UT,Individual,No,45-3174628,27619UT0010006,Arches Preferred Care - Know Your Cost Basic Wellness,27619UT001,,UTN002,UTS002,UTF007,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10006.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10006.pdf,www.archeshealth.org/pharmacy,27619UT0010006-03,Limited Cost Sharing Plan Variation,70.85%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",40%,"$3,000","$6,000",40%,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$910,$0,$150,"$3,000",$120,$240,$80,7
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,4,27619,UT,Individual,No,45-3174628,27619UT0010006,Arches Preferred Care - Know Your Cost Basic Wellness,27619UT001,,UTN002,UTS002,UTF007,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10006.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10006.pdf,www.archeshealth.org/pharmacy,27619UT0010006-04,73% AV Level Silver Plan,73.29%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,"$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",40%,"$2,500","$5,000",40%,Not Applicable,Not Applicable,"$2,500","$5,000","$2,000","$1,100",$240,$150,"$2,000",$170,$370,$80,8
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,4,27619,UT,Individual,No,45-3174628,27619UT0010006,Arches Preferred Care - Know Your Cost Basic Wellness,27619UT001,,UTN002,UTS002,UTF007,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10006.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10006.pdf,www.archeshealth.org/pharmacy,27619UT0010006-05,87% AV Level Silver Plan,86.10%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,"$2,250","$4,500",,,,,,,,,,,,,,,,,,,,,$0,$0,40%,$0,$0,40%,Not Applicable,Not Applicable,$0,$0,$0,"$1,810",$280,$150,$0,$250,$560,$80,9
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,4,27619,UT,Individual,No,45-3174628,27619UT0010006,Arches Preferred Care - Know Your Cost Basic Wellness,27619UT001,,UTN002,UTS002,UTF007,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10006.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10006.pdf,www.archeshealth.org/pharmacy,27619UT0010006-06,94% AV Level Silver Plan,94.30%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$600,"$1,200",$600,"$1,200",Not Applicable,Not Applicable,$600,"$1,200",,,,,,,,,,,,,,,,,,,,,$0,$0,40%,$0,$0,40%,Not Applicable,Not Applicable,$0,$0,$0,$560,$40,$150,$0,$180,$420,$80,10
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,5,27619,UT,Individual,No,45-3174628,27619UT0010002,Arches Secure WELLth - Enhanced,27619UT001,,UTN001,UTS001,UTF003,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10002.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10002.pdf,www.archeshealth.org/pharmacy,27619UT0010002-00,Standard Silver Off Exchange Plan,70.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,"$1,500","$3,000","$1,500",$20,"$1,730",$150,"$1,500",$530,$310.00,$80,4
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,5,27619,UT,Individual,No,45-3174628,27619UT0010002,Arches Secure WELLth - Enhanced,27619UT001,,UTN001,UTS001,UTF003,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10002.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10002.pdf,www.archeshealth.org/pharmacy,27619UT0010002-01,Standard Silver On Exchange Plan,70.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,"$1,500","$3,000","$1,500",$20,"$1,730.00",$150,"$1,500",$530,$310.00,$80,5
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,5,27619,UT,Individual,No,45-3174628,27619UT0010002,Arches Secure WELLth - Enhanced,27619UT001,,UTN001,UTS001,UTF003,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10002.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10002.pdf,www.archeshealth.org/pharmacy,27619UT0010002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,2,62210,SD,Individual,No,46-0401087,62210SD1440002,Dakota Core 2500,62210SD144,7033112278,SDN001,SDS001,SDF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Core_2500_50_50_5000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1440002-04,73% AV Level Silver Plan,,0.739191114902496,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$2,500","$5,000","$2,500",$0,"$1,500",$400,$400,"$2,000",$0,$100,12
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,2,62210,SD,Individual,No,46-0401087,62210SD1440002,Dakota Core 2500,62210SD144,7033112278,SDN001,SDS001,SDF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Core_2500_50_50_5000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1440002-05,87% AV Level Silver Plan,,0.871959924697876,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$1,250","$2,500",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$750,"$1,500",$750,$0,$500,$400,$400,$850,$0,$100,13
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,2,62210,SD,Individual,No,46-0401087,62210SD1440002,Dakota Core 2500,62210SD144,7033112278,SDN001,SDS001,SDF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Core_2500_50_50_5000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1440002-06,94% AV Level Silver Plan,,0.93520188331604,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$250,$500,$250,$0,$250,$400,$250,$250,$0,$100,14
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,2,62210,SD,Individual,No,46-0401087,62210SD1440003,Dakota Core 4000,62210SD144,7033112278,SDN001,SDS001,SDF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Core_4000_50_50_6000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1440003-00,Standard Silver Off Exchange Plan,,0.683405518531799,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$4,000","$8,000","$4,000",$0,"$1,600",$400,$400,"$2,000",$0,$100,15
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,2,62210,SD,Individual,No,46-0401087,62210SD1440003,Dakota Core 4000,62210SD144,7033112278,SDN001,SDS001,SDF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Core_4000_50_50_6000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1440003-01,Standard Silver On Exchange Plan,,0.683405518531799,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$4,000","$8,000","$4,000",$0,"$1,600",$400,$400,"$2,000",$0,$100,16
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,2,62210,SD,Individual,No,46-0401087,62210SD1440003,Dakota Core 4000,62210SD144,7033112278,SDN001,SDS001,SDF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Core_4000_50_50_6000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1440003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$400,$0,$0,$0,$100,17
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,2,62210,SD,Individual,No,46-0401087,62210SD1440003,Dakota Core 4000,62210SD144,7033112278,SDN001,SDS001,SDF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Core_4000_50_50_6000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1440003-03,Limited Cost Sharing Plan Variation,,0.683405518531799,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$4,000","$8,000","$4,000",$0,"$1,600",$400,$400,"$2,000",$0,$100,18
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,2,62210,SD,Individual,No,46-0401087,62210SD1440003,Dakota Core 4000,62210SD144,7033112278,SDN001,SDS001,SDF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Core_4000_50_50_6000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1440003-04,73% AV Level Silver Plan,,0.72800874710083,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$2,500","$5,000","$2,500",$0,"$2,000",$400,$400,"$2,000",$0,$100,19
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,2,62210,SD,Individual,No,46-0401087,62210SD1440003,Dakota Core 4000,62210SD144,7033112278,SDN001,SDS001,SDF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Core_4000_50_50_6000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1440003-05,87% AV Level Silver Plan,,0.864076852798462,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$1,250","$2,500",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$0,$250,$400,$400,$850,$0,$100,20
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,2,62210,SD,Individual,No,46-0401087,62210SD1440003,Dakota Core 4000,62210SD144,7033112278,SDN001,SDS001,SDF002,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Core_4000_50_50_6000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1440003-06,94% AV Level Silver Plan,,0.947204649448395,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$400,$800,,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$200,$400,$200,$0,$200,$400,$200,$200,$0,$100,21
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,3,62210,SD,Individual,No,46-0401087,62210SD1450001,Dakota Reserve 2000,62210SD145,7033112278,SDN001,SDS001,SDF003,New,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Reserve_2000_100_0_2000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1450001-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,"$2,000","$4,000","$2,000",$0,$0,$400,"$2,000",$0,$0,$100,4
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,3,62210,SD,SHOP (Small Group),No,46-0401087,62210SD1350074,Ultra 1500,62210SD135,7033112278,SDN001,SDS001,SDF007,New,HMO,Gold,No,Both,No,No,,30% penalty may be applied to certain covered services when rendered by non-participating providers,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Ultra_Group_1500_50_50_2500_x2_Rx_B.pdf,,http://www.dakotacare.com/bnefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1350074-00,Standard Gold Off Exchange Plan,,0.808059453964233,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$1,500","$3,000","$1,500",$200,$800,$400,$300,"$1,400",$0,$100,4
2015,SD,80261,SERFF,2,2014-08-04 09:42:01,1,80261,SD,SHOP (Small Group),Yes,35-0472300,80261SD0010005,Lincoln DentalConnect?,80261SD001,,SDN001,SDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$31.53,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,80261SD0010005-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SD,80261,SERFF,2,2014-08-04 09:42:01,1,80261,SD,SHOP (Small Group),Yes,35-0472300,80261SD0010006,Lincoln DentalConnect?,80261SD001,,SDN001,SDS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.36,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,80261SD0010006-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,SD,80261,SERFF,2,2014-08-04 09:42:01,1,80261,SD,SHOP (Small Group),Yes,35-0472300,80261SD0010007,Lincoln DentalConnect?,80261SD001,,SDN001,SDS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.66,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,80261SD0010007-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,SD,80261,SERFF,2,2014-08-04 09:42:01,2,80261,SD,SHOP (Small Group),Yes,35-0472300,80261SD0010004,Lincoln DentalConnect?,80261SD001,,SDN001,SDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.36,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,80261SD0010004-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,80261,SERFF,2,2014-08-04 09:42:01,2,80261,SD,SHOP (Small Group),Yes,35-0472300,80261SD0010008,Lincoln DentalConnect?,80261SD001,,SDN001,SDS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.99,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,80261SD0010008-00,Standard High Off Exchange Plan,86.90%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,UT,14948,SERFF,4,2014-11-15 10:06:04,1,14948,UT,Individual,Yes,86-0672505,14948UT0010002,DeltaCare USA Pediatric Preferred Plan,14948UT001,,UTN001,UTS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Child-Only,,,,$13.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ut/14948ut0010002-15,,14948UT0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,UT,14948,SERFF,4,2014-11-15 10:06:04,1,14948,UT,Individual,Yes,86-0672505,14948UT0010002,DeltaCare USA Pediatric Preferred Plan,14948UT001,,UTN001,UTS001,,Existing,HMO,High,,Both,,,,,,,,,Allows Child-Only,,,,$13.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ut/14948ut0010002-15,,14948UT0010002-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,UT,14948,SERFF,4,2014-11-15 10:06:04,1,14948,UT,Individual,Yes,86-0672505,14948UT0010001,DeltaCare USA Pediatric Basic Plan,14948UT001,,UTN001,UTS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$11.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ut/14948ut0010001-15,,14948UT0010001-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,UT,14948,SERFF,4,2014-11-15 10:06:04,1,14948,UT,Individual,Yes,86-0672505,14948UT0010001,DeltaCare USA Pediatric Basic Plan,14948UT001,,UTN001,UTS001,,Existing,HMO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$11.49,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ut/14948ut0010001-15,,14948UT0010001-01,Standard Low On Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,3,62210,SD,SHOP (Small Group),No,46-0401087,62210SD1350074,Ultra 1500,62210SD135,7033112278,SDN001,SDS001,SDF007,New,HMO,Gold,No,Both,No,No,,30% penalty may be applied to certain covered services when rendered by non-participating providers,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Ultra_Group_1500_50_50_2500_x2_Rx_B.pdf,,http://www.dakotacare.com/bnefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1350074-01,Standard Gold On Exchange Plan,,0.808059453964233,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$1,500","$3,000","$1,500",$200,$800,$400,$300,"$1,400",$0,$100,5
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,3,62210,SD,Individual,No,46-0401087,62210SD1450001,Dakota Reserve 2000,62210SD145,7033112278,SDN001,SDS001,SDF003,New,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Reserve_2000_100_0_2000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1450001-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,"$2,000","$4,000","$2,000",$0,$0,$400,"$2,000",$0,$0,$100,5
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,3,62210,SD,Individual,No,46-0401087,62210SD1450001,Dakota Reserve 2000,62210SD145,7033112278,SDN001,SDS001,SDF003,New,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Reserve_2000_100_0_2000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1450001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$400,$0,$0,$0,$100,6
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,3,62210,SD,SHOP (Small Group),No,46-0401087,62210SD1350120,Ultra 5000,62210SD135,7033112278,SDN001,SDS001,SDF007,New,HMO,Silver,No,Both,No,No,,30% penalty may be applied to certain covered services when rendered by non-participating providers,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Ultra_Group_5000_50_50_6600_x2_Rx_B.pdf,,http://www.dakotacare.com/bnefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1350120-00,Standard Silver Off Exchange Plan,,0.686273455619812,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$5,000","$10,000","$4,500",$200,$0,$400,$300,"$1,400",$0,$100,6
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,3,62210,SD,SHOP (Small Group),No,46-0401087,62210SD1350120,Ultra 5000,62210SD135,7033112278,SDN001,SDS001,SDF007,New,HMO,Silver,No,Both,No,No,,30% penalty may be applied to certain covered services when rendered by non-participating providers,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Ultra_Group_5000_50_50_6600_x2_Rx_B.pdf,,http://www.dakotacare.com/bnefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1350120-01,Standard Silver On Exchange Plan,,0.686273455619812,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$5,000","$10,000","$4,500",$200,$0,$400,$300,"$1,400",$0,$100,7
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,3,62210,SD,Individual,No,46-0401087,62210SD1450001,Dakota Reserve 2000,62210SD145,7033112278,SDN001,SDS001,SDF003,New,HMO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Reserve_2000_100_0_2000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1450001-03,Limited Cost Sharing Plan Variation,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,"$2,000","$4,000","$2,000",$0,$0,$400,"$2,000",$0,$0,$100,7
2015,UT,18167,SERFF,2,2014-09-07 12:14:41,1,18167,UT,Individual,No,33-0617992,18167UT0010001,Molina Marketplace Gold Plan,18167UT001,,UTN001,UTS001,UTF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.995456148308123,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,18167UT0010001-03,Limited Cost Sharing Plan Variation,,0.797688841819763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,UT,18167,SERFF,2,2014-09-07 12:14:41,2,18167,UT,Individual,No,33-0617992,18167UT0010002,Molina Marketplace Silver Plan,18167UT001,,UTN001,UTS001,UTF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.984183086901531,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,18167UT0010002-00,Standard Silver Off Exchange Plan,,0.706084549427032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$200,$400,30%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,4
2015,UT,18167,SERFF,2,2014-09-07 12:14:41,2,18167,UT,Individual,No,33-0617992,18167UT0010002,Molina Marketplace Silver Plan,18167UT001,,UTN001,UTS001,UTF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.984183086901531,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,18167UT0010002-01,Standard Silver On Exchange Plan,,0.706084549427032,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200","$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$200,$400,30%,,,,Not Applicable,Not Applicable,$200,$400,,,,,,,,,,,,,,,,,,,5
2015,UT,18167,SERFF,2,2014-09-07 12:14:41,2,18167,UT,Individual,No,33-0617992,18167UT0010002,Molina Marketplace Silver Plan,18167UT001,,UTN001,UTS001,UTF002,Existing,HMO,Silver,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.984183086901531,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/silver/Pages/silver.aspx?year=2015,18167UT0010002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,3,62210,SD,Individual,No,46-0401087,62210SD1450003,Dakota Reserve 6000,62210SD145,7033112278,SDN001,SDS001,SDF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Reserve_6000_100_0_6000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1450003-01,Standard Bronze On Exchange Plan,,0.592071235179901,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,0%,,,,Not Applicable,Not Applicable,"$6,000","$12,000","$6,000",$0,$0,$400,"$5,300",$0,$0,$100,16
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,3,62210,SD,Individual,No,46-0401087,62210SD1450003,Dakota Reserve 6000,62210SD145,7033112278,SDN001,SDS001,SDF003,New,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Reserve_6000_100_0_6000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1450003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$400,$0,$0,$0,$100,17
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,4,62210,SD,Individual,No,46-0401087,62210SD1460001,Dakota Signature Plus 1000,62210SD146,7033112278,SDN001,SDS001,SDF004,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_Plus_1000_80_20_2500_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1460001-03,Limited Cost Sharing Plan Variation,,0.814041018486023,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$0,"$1,200",$400,"$1,000","$1,500",$0,$100,7
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,4,62210,SD,Individual,No,46-0401087,62210SD1460002,Dakota Signature Plus 3000,62210SD146,7033112278,SDN001,SDS001,SDF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_Plus_3000_80_20_5000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1460002-00,Standard Silver Off Exchange Plan,,0.708109676837921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$0,$800,$400,"$1,100","$1,900",$0,$100,8
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,4,62210,SD,Individual,No,46-0401087,62210SD1460002,Dakota Signature Plus 3000,62210SD146,7033112278,SDN001,SDS001,SDF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_Plus_3000_80_20_5000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1460002-01,Standard Silver On Exchange Plan,,0.708109676837921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$0,$800,$400,"$1,100","$1,900",$0,$100,9
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,4,62210,SD,Individual,No,46-0401087,62210SD1460002,Dakota Signature Plus 3000,62210SD146,7033112278,SDN001,SDS001,SDF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_Plus_3000_80_20_5000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1460002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$400,$0,$0,$0,$100,10
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,4,62210,SD,Individual,No,46-0401087,62210SD1460002,Dakota Signature Plus 3000,62210SD146,7033112278,SDN001,SDS001,SDF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_Plus_3000_80_20_5000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1460002-03,Limited Cost Sharing Plan Variation,,0.708109676837921,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$0,$800,$400,"$1,100","$1,900",$0,$100,11
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,4,62210,SD,Individual,No,46-0401087,62210SD1460002,Dakota Signature Plus 3000,62210SD146,7033112278,SDN001,SDS001,SDF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_Plus_3000_80_20_5000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1460002-04,73% AV Level Silver Plan,,0.738248705863953,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,"$2,000","$4,000","$2,000",$0,"$1,000",$400,"$1,100","$1,900",$0,$100,12
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,4,62210,SD,Individual,No,46-0401087,62210SD1460002,Dakota Signature Plus 3000,62210SD146,7033112278,SDN001,SDS001,SDF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_Plus_3000_80_20_5000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1460002-05,87% AV Level Silver Plan,,0.860459566116333,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,$750,"$1,500",$750,$0,$750,$400,$750,$750,$0,$100,13
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,4,62210,SD,Individual,No,46-0401087,62210SD1460002,Dakota Signature Plus 3000,62210SD146,7033112278,SDN001,SDS001,SDF004,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_Plus_3000_80_20_5000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1460002-06,94% AV Level Silver Plan,,0.941068530082703,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,$250,$500,$250,$0,$250,$400,$250,$250,$0,$100,14
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,5,62210,SD,Individual,No,46-0401087,62210SD1470001,Dakota Signature 1000,62210SD147,7033112278,SDN001,SDS001,SDF005,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_1000_50_50_2500_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1470001-00,Standard Gold Off Exchange Plan,,0.787405729293823,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$0,"$1,500",$400,"$1,000",$0,"$1,500",$100,4
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,5,62210,SD,Individual,No,46-0401087,62210SD1470001,Dakota Signature 1000,62210SD147,7033112278,SDN001,SDS001,SDF005,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_1000_50_50_2500_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1470001-01,Standard Gold On Exchange Plan,,0.787405729293823,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$0,"$1,500",$400,"$1,000",$0,"$1,500",$100,5
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,5,62210,SD,Individual,No,46-0401087,62210SD1470001,Dakota Signature 1000,62210SD147,7033112278,SDN001,SDS001,SDF005,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_1000_50_50_2500_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1470001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$400,$0,$0,$0,$100,6
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,5,62210,SD,Individual,No,46-0401087,62210SD1470001,Dakota Signature 1000,62210SD147,7033112278,SDN001,SDS001,SDF005,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_1000_50_50_2500_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1470001-03,Limited Cost Sharing Plan Variation,,0.787405729293823,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$0,"$1,500",$400,"$1,000",$0,"$1,500",$100,7
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,5,62210,SD,Individual,No,46-0401087,62210SD1470002,Dakota Signature 3000,62210SD147,7033112278,SDN001,SDS001,SDF005,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_3000_50_50_4000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1470002-00,Standard Silver Off Exchange Plan,,0.69199937582016,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$0,"$1,000",$400,"$3,000","$1,000",$0,$100,8
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,5,62210,SD,Individual,No,46-0401087,62210SD1470002,Dakota Signature 3000,62210SD147,7033112278,SDN001,SDS001,SDF005,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_3000_50_50_4000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1470002-01,Standard Silver On Exchange Plan,,0.69199937582016,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$0,"$1,000",$400,"$3,000","$1,000",$0,$100,9
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,5,62210,SD,Individual,No,46-0401087,62210SD1470002,Dakota Signature 3000,62210SD147,7033112278,SDN001,SDS001,SDF005,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_3000_50_50_4000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1470002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$400,$0,$0,$0,$100,10
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,5,62210,SD,Individual,No,46-0401087,62210SD1470002,Dakota Signature 3000,62210SD147,7033112278,SDN001,SDS001,SDF005,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_3000_50_50_4000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1470002-03,Limited Cost Sharing Plan Variation,,0.69199937582016,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$0,"$1,000",$400,"$3,000","$1,000",$0,$100,11
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,5,62210,SD,Individual,No,46-0401087,62210SD1470002,Dakota Signature 3000,62210SD147,7033112278,SDN001,SDS001,SDF005,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_3000_50_50_4000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1470002-04,73% AV Level Silver Plan,,0.72380131483078,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,"$2,000","$4,000","$2,000",$0,"$1,500",$400,"$2,000",$0,"$1,500",$100,12
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,5,62210,SD,Individual,No,46-0401087,62210SD1470002,Dakota Signature 3000,62210SD147,7033112278,SDN001,SDS001,SDF005,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,3,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Signature_3000_50_50_4000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1470002-05,87% AV Level Silver Plan,,0.869628369808197,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$1,250","$2,500",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$750,"$1,500",$750,$0,$500,$400,$750,$0,$500,$100,13
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,6,62210,SD,Individual,No,46-0401087,62210SD1480001,Dakota Basic 3000,62210SD148,7033112278,SDN001,SDS001,SDF006,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Basic_0_50_50_3000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1480001-01,Standard Gold On Exchange Plan,,0.793008863925934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,"$3,000",$400,$0,"$1,700","$1,300",$100,5
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,6,62210,SD,Individual,No,46-0401087,62210SD1480001,Dakota Basic 3000,62210SD148,7033112278,SDN001,SDS001,SDF006,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Basic_0_50_50_3000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1480001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$400,$0,$0,$0,$100,6
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,6,62210,SD,Individual,No,46-0401087,62210SD1480001,Dakota Basic 3000,62210SD148,7033112278,SDN001,SDS001,SDF006,New,HMO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Basic_0_50_50_3000_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1480001-03,Limited Cost Sharing Plan Variation,,0.793008863925934,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,"$3,000",$400,$0,"$1,700","$1,300",$100,7
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,6,62210,SD,Individual,No,46-0401087,62210SD1480002,Dakota Basic 6600,62210SD148,7033112278,SDN001,SDS001,SDF006,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Basic_0_50_50_6600_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1480002-00,Standard Silver Off Exchange Plan,,0.711068749427795,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,"$3,750",$400,$0,"$1,700","$1,800",$100,8
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,6,62210,SD,Individual,No,46-0401087,62210SD1480002,Dakota Basic 6600,62210SD148,7033112278,SDN001,SDS001,SDF006,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Basic_0_50_50_6600_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1480002-01,Standard Silver On Exchange Plan,,0.711068749427795,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,"$3,750",$400,$0,"$1,700","$1,800",$100,9
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,6,62210,SD,Individual,No,46-0401087,62210SD1480002,Dakota Basic 6600,62210SD148,7033112278,SDN001,SDS001,SDF006,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Basic_0_50_50_6600_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1480002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$400,$0,$0,$0,$100,10
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,6,62210,SD,Individual,No,46-0401087,62210SD1480002,Dakota Basic 6600,62210SD148,7033112278,SDN001,SDS001,SDF006,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Basic_0_50_50_6600_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1480002-03,Limited Cost Sharing Plan Variation,,0.711068749427795,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,"$3,750",$400,$0,"$1,700","$1,800",$100,11
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,6,62210,SD,Individual,No,46-0401087,62210SD1480002,Dakota Basic 6600,62210SD148,7033112278,SDN001,SDS001,SDF006,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Basic_0_50_50_6600_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1480002-04,73% AV Level Silver Plan,,0.73872035741806,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,"$3,750",$400,$0,"$1,700","$1,800",$100,12
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,6,62210,SD,Individual,No,46-0401087,62210SD1480002,Dakota Basic 6600,62210SD148,7033112278,SDN001,SDS001,SDF006,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Basic_0_50_50_6600_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1480002-05,87% AV Level Silver Plan,,0.862080037593842,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,"$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,"$1,500",$400,$0,$950,$550,$100,13
2015,SD,62210,SERFF,4,2015-04-22 14:50:56,6,62210,SD,Individual,No,46-0401087,62210SD1480002,Dakota Basic 6600,62210SD148,7033112278,SDN001,SDS001,SDF006,New,HMO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Non-emergency care requires preauthorization,Yes,Preauthorization is required,Yes,http://sbc.dakotacare.com/pdfs/Dakota_Basic_0_50_50_6600_x2.pdf,,http://www.dakotacare.com/benefitsummaries/index.cfm,http://www.dakotacare.com/toolsresources/pharmacyservices/,62210SD1480002-06,94% AV Level Silver Plan,,0.939066231250763,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,50%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,$500,$400,$0,$250,$250,$100,14
2015,SD,80261,SERFF,2,2014-08-04 09:42:01,1,80261,SD,SHOP (Small Group),Yes,35-0472300,80261SD0010001,Lincoln DentalConnect?,80261SD001,,SDN001,SDS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$37.24,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,80261SD0010001-00,Standard High Off Exchange Plan,85.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,SD,80261,SERFF,2,2014-08-04 09:42:01,1,80261,SD,SHOP (Small Group),Yes,35-0472300,80261SD0010002,Lincoln DentalConnect?,80261SD001,,SDN001,SDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.97,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,80261SD0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,SD,80261,SERFF,2,2014-08-04 09:42:01,1,80261,SD,SHOP (Small Group),Yes,35-0472300,80261SD0010003,Lincoln DentalConnect?,80261SD001,,SDN001,SDS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.09,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,80261SD0010003-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,UT,14948,SERFF,4,2014-11-15 10:06:04,2,14948,UT,Individual,Yes,86-0672505,14948UT0010004,DeltaCare USA Preferred Plan for Families,14948UT001,,UTN001,UTS001,,New,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.99,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ut/14948ut0010004-15,,14948UT0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,UT,14948,SERFF,4,2014-11-15 10:06:04,2,14948,UT,Individual,Yes,86-0672505,14948UT0010004,DeltaCare USA Preferred Plan for Families,14948UT001,,UTN001,UTS001,,New,HMO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.99,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ut/14948ut0010004-15,,14948UT0010004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,UT,14948,SERFF,4,2014-11-15 10:06:04,3,14948,UT,Individual,Yes,86-0672505,14948UT0010006,DeltaCare USA Basic Plan for Families,14948UT001,,UTN001,UTS001,,New,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$13.99,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ut/14948ut0010006-15,,14948UT0010006-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,UT,14948,SERFF,4,2014-11-15 10:06:04,3,14948,UT,Individual,Yes,86-0672505,14948UT0010006,DeltaCare USA Basic Plan for Families,14948UT001,,UTN001,UTS001,,New,HMO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$13.99,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,No,No,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ut/14948ut0010006-15,,14948UT0010006-01,Standard Low On Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,UT,18167,SERFF,2,2014-09-07 12:14:41,1,18167,UT,Individual,No,33-0617992,18167UT0010001,Molina Marketplace Gold Plan,18167UT001,,UTN001,UTS001,UTF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.995456148308123,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,18167UT0010001-00,Standard Gold Off Exchange Plan,,0.797688841819763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,UT,18167,SERFF,2,2014-09-07 12:14:41,1,18167,UT,Individual,No,33-0617992,18167UT0010001,Molina Marketplace Gold Plan,18167UT001,,UTN001,UTS001,UTF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.995456148308123,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,18167UT0010001-01,Standard Gold On Exchange Plan,,0.797688841819763,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,UT,18167,SERFF,2,2014-09-07 12:14:41,1,18167,UT,Individual,No,33-0617992,18167UT0010001,Molina Marketplace Gold Plan,18167UT001,,UTN001,UTS001,UTF001,Existing,HMO,Gold,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.995456148308123,,,0,0,0,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,http://www.molinahealthcare.com/members/ut/en-US/hp/marketplace/plans/gold/Pages/gold.aspx?year=2015,18167UT0010001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,UT,18167,SERFF,2,2014-09-07 12:14:41,3,18167,UT,Individual,No,33-0617992,18167UT0010003,Molina Marketplace Bronze Plan,18167UT001,,UTN001,UTS001,UTF003,Existing,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.993694251526807,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,18167UT0010003-00,Standard Bronze Off Exchange Plan,,0.61972439289093,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,4
2015,UT,18167,SERFF,2,2014-09-07 12:14:41,3,18167,UT,Individual,No,33-0617992,18167UT0010003,Molina Marketplace Bronze Plan,18167UT001,,UTN001,UTS001,UTF003,Existing,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.993694251526807,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,18167UT0010003-01,Standard Bronze On Exchange Plan,,0.61972439289093,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,5
2015,UT,18167,SERFF,2,2014-09-07 12:14:41,3,18167,UT,Individual,No,33-0617992,18167UT0010003,Molina Marketplace Bronze Plan,18167UT001,,UTN001,UTS001,UTF003,Existing,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.993694251526807,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,18167UT0010003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,6
2015,UT,18167,SERFF,2,2014-09-07 12:14:41,3,18167,UT,Individual,No,33-0617992,18167UT0010003,Molina Marketplace Bronze Plan,18167UT001,,UTN001,UTS001,UTF003,Existing,HMO,Bronze,No,Both,No,Yes,All but OBGYN,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.993694251526807,,,0,0,3,2015-01-01,,No,Urgent and emergent are covered,No,Urgent and emergent are covered,No,http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,https://billpay.molinahealthcare.com/Payment/Login,http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/bronze/Pages/bronze.aspx?year=2015,18167UT0010003-03,Limited Cost Sharing Plan Variation,,0.61972439289093,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,"$6,600","$13,200",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,7
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,1,27619,UT,Individual,No,45-3174628,27619UT0010010,Arches Preferred Care - Know Your Cost 250 5/40,27619UT001,,UTN002,UTS002,UTF007,Existing,HMO,Gold,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10010.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10010.pdf,www.archeshealth.org/pharmacy,27619UT0010010-00,Standard Gold Off Exchange Plan,81.10%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000",Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,$250,$500,20%,$250,$500,20%,Not Applicable,Not Applicable,$250,$500,$250,"$1,810",$120,$150,$250,$250,$240,$80,4
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,1,27619,UT,Individual,No,45-3174628,27619UT0010010,Arches Preferred Care - Know Your Cost 250 5/40,27619UT001,,UTN002,UTS002,UTF007,Existing,HMO,Gold,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10010.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10010.pdf,www.archeshealth.org/pharmacy,27619UT0010010-01,Standard Gold On Exchange Plan,81.10%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000",Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,$250,$500,20%,$250,$500,20%,Not Applicable,Not Applicable,$250,$500,$250,"$1,810",$120,$150,$250,$250,$240,$80,5
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,1,27619,UT,Individual,No,45-3174628,27619UT0010010,Arches Preferred Care - Know Your Cost 250 5/40,27619UT001,,UTN002,UTS002,UTF007,Existing,HMO,Gold,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10010.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10010.pdf,www.archeshealth.org/pharmacy,27619UT0010010-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,1,27619,UT,Individual,No,45-3174628,27619UT0010010,Arches Preferred Care - Know Your Cost 250 5/40,27619UT001,,UTN002,UTS002,UTF007,Existing,HMO,Gold,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10010.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10010.pdf,www.archeshealth.org/pharmacy,27619UT0010010-03,Limited Cost Sharing Plan Variation,81.10%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000",Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,$250,$500,20%,$250,$500,20%,Not Applicable,Not Applicable,$250,$500,$250,"$1,810",$120,$150,$250,$250,$240,$80,7
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,2,27619,UT,Individual,No,45-3174628,27619UT0010011,Arches Classic - Low Deductible 500 20/60,27619UT001,,UTN001,UTS001,UTF003,Existing,HMO,Gold,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10011.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10011.pdf,www.archeshealth.org/pharmacy,27619UT0010011-00,Standard Gold Off Exchange Plan,80.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$500,$20,"$1,350",$150,$500,$580,$240,$80,4
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,2,27619,UT,Individual,No,45-3174628,27619UT0010011,Arches Classic - Low Deductible 500 20/60,27619UT001,,UTN001,UTS001,UTF003,Existing,HMO,Gold,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10011.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10011.pdf,www.archeshealth.org/pharmacy,27619UT0010011-01,Standard Gold On Exchange Plan,80.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$500,$20,"$1,350",$150,$500,$580,$240,$80,5
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,2,27619,UT,Individual,No,45-3174628,27619UT0010011,Arches Classic - Low Deductible 500 20/60,27619UT001,,UTN001,UTS001,UTF003,Existing,HMO,Gold,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10011.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10011.pdf,www.archeshealth.org/pharmacy,27619UT0010011-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,2,27619,UT,Individual,No,45-3174628,27619UT0010011,Arches Classic - Low Deductible 500 20/60,27619UT001,,UTN001,UTS001,UTF003,Existing,HMO,Gold,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10011.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10011.pdf,www.archeshealth.org/pharmacy,27619UT0010011-03,Limited Cost Sharing Plan Variation,80.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,$500,"$1,000",$500,$20,"$1,350",$150,$500,$580,$240,$80,7
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,2,27619,UT,Individual,No,45-3174628,27619UT0010015,Arches Classic - Low Deductible 500 20/60 Plus,27619UT001,,UTN001,UTS001,UTF003,New,POS,Gold,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,Yes,www.archeshealth.org/SBC/10015.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10015.pdf,www.archeshealth.org/pharmacy,27619UT0010015-00,Standard Gold Off Exchange Plan,80.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$20,"$1,350",$150,$500,$580,$240,$80,8
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,2,27619,UT,Individual,No,45-3174628,27619UT0010015,Arches Classic - Low Deductible 500 20/60 Plus,27619UT001,,UTN001,UTS001,UTF003,New,POS,Gold,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,Yes,www.archeshealth.org/SBC/10015.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10015.pdf,www.archeshealth.org/pharmacy,27619UT0010015-01,Standard Gold On Exchange Plan,80.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$20,"$1,350",$150,$500,$580,$240,$80,9
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,2,27619,UT,Individual,No,45-3174628,27619UT0010015,Arches Classic - Low Deductible 500 20/60 Plus,27619UT001,,UTN001,UTS001,UTF003,New,POS,Gold,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,Yes,www.archeshealth.org/SBC/10015.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10015.pdf,www.archeshealth.org/pharmacy,27619UT0010015-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,2,27619,UT,Individual,No,45-3174628,27619UT0010015,Arches Classic - Low Deductible 500 20/60 Plus,27619UT001,,UTN001,UTS001,UTF003,New,POS,Gold,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,Yes,www.archeshealth.org/SBC/10015.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10015.pdf,www.archeshealth.org/pharmacy,27619UT0010015-03,Limited Cost Sharing Plan Variation,80.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000","$1,500","$3,000",$500,$20,"$1,350",$150,$500,$580,$240,$80,11
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,2,27619,UT,Individual,No,45-3174628,27619UT0010019,Arches Preferred Care - Enhanced 1000 5/40,27619UT001,,UTN002,UTS002,UTF007,New,HMO,Gold,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10019.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10019.pdf,www.archeshealth.org/pharmacy,27619UT0010019-00,Standard Gold Off Exchange Plan,79.60%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,"$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,"$1,000","$2,000",20%,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$10,"$1,250",$150,"$1,000",$220,$220,$80,12
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,2,27619,UT,Individual,No,45-3174628,27619UT0010019,Arches Preferred Care - Enhanced 1000 5/40,27619UT001,,UTN002,UTS002,UTF007,New,HMO,Gold,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10019.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10019.pdf,www.archeshealth.org/pharmacy,27619UT0010019-01,Standard Gold On Exchange Plan,79.60%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,"$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,"$1,000","$2,000",20%,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$10,"$1,250",$150,"$1,000",$220,$220,$80,13
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,2,27619,UT,Individual,No,45-3174628,27619UT0010019,Arches Preferred Care - Enhanced 1000 5/40,27619UT001,,UTN002,UTS002,UTF007,New,HMO,Gold,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10019.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10019.pdf,www.archeshealth.org/pharmacy,27619UT0010019-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,14
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,2,27619,UT,Individual,No,45-3174628,27619UT0010019,Arches Preferred Care - Enhanced 1000 5/40,27619UT001,,UTN002,UTS002,UTF007,New,HMO,Gold,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10019.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10019.pdf,www.archeshealth.org/pharmacy,27619UT0010019-03,Limited Cost Sharing Plan Variation,79.60%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,"$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,"$1,000","$2,000",20%,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$10,"$1,250",$150,"$1,000",$220,$220,$80,15
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,3,27619,UT,Individual,No,45-3174628,27619UT0010007,Arches Classic - Know Your Costs,27619UT001,,UTN001,UTS001,UTF006,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10007.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10007.pdf,www.archeshealth.org/pharmacy,27619UT0010007-00,Standard Silver Off Exchange Plan,70.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000","$2,500",$920,$90,$150,"$2,500",$340,$230,$80,4
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,3,27619,UT,Individual,No,45-3174628,27619UT0010007,Arches Classic - Know Your Costs,27619UT001,,UTN001,UTS001,UTF006,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10007.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10007.pdf,www.archeshealth.org/pharmacy,27619UT0010007-01,Standard Silver On Exchange Plan,70.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000","$2,500",$920,$90,$150,"$2,500",$340,$230,$80,5
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,3,27619,UT,Individual,No,45-3174628,27619UT0010007,Arches Classic - Know Your Costs,27619UT001,,UTN001,UTS001,UTF006,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10007.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10007.pdf,www.archeshealth.org/pharmacy,27619UT0010007-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,3,27619,UT,Individual,No,45-3174628,27619UT0010007,Arches Classic - Know Your Costs,27619UT001,,UTN001,UTS001,UTF006,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10007.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10007.pdf,www.archeshealth.org/pharmacy,27619UT0010007-03,Limited Cost Sharing Plan Variation,70.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000","$2,500",$920,$90,$150,"$2,500",$340,$230,$80,7
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,3,27619,UT,Individual,No,45-3174628,27619UT0010007,Arches Classic - Know Your Costs,27619UT001,,UTN001,UTS001,UTF006,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10007.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10007.pdf,www.archeshealth.org/pharmacy,27619UT0010007-04,73% AV Level Silver Plan,73.64%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,"$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,Not Applicable,Not Applicable,"$2,000","$4,000","$2,000","$1,100",$180,$150,"$2,000",$420,$280,$80,8
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,3,27619,UT,Individual,No,45-3174628,27619UT0010007,Arches Classic - Know Your Costs,27619UT001,,UTN001,UTS001,UTF006,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10007.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10007.pdf,www.archeshealth.org/pharmacy,27619UT0010007-05,87% AV Level Silver Plan,87.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,"$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,$0,"$1,790",$210,$150,$0,$500,$420,$80,9
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,3,27619,UT,Individual,No,45-3174628,27619UT0010007,Arches Classic - Know Your Costs,27619UT001,,UTN001,UTS001,UTF006,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10007.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10007.pdf,www.archeshealth.org/pharmacy,27619UT0010007-06,94% AV Level Silver Plan,93.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,$750,"$1,500",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,$0,$720,$30,$150,$0,$370,$380,$80,10
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,3,27619,UT,Individual,No,45-3174628,27619UT0010013,Arches Preferred Care - Know Your Cost,27619UT001,,UTN002,UTS002,UTF007,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10013.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10013.pdf,www.archeshealth.org/pharmacy,27619UT0010013-00,Standard Silver Off Exchange Plan,71.27%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,500","$13,000","$6,500","$13,000",Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",40%,"$3,000","$6,000",40%,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$910,$0,$150,"$3,000",$120,$240,$80,11
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,3,27619,UT,Individual,No,45-3174628,27619UT0010013,Arches Preferred Care - Know Your Cost,27619UT001,,UTN002,UTS002,UTF007,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10013.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10013.pdf,www.archeshealth.org/pharmacy,27619UT0010013-01,Standard Silver On Exchange Plan,71.27%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,500","$13,000","$6,500","$13,000",Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",40%,"$3,000","$6,000",40%,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$910,$0,$150,"$3,000",$120,$240,$80,12
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,3,27619,UT,Individual,No,45-3174628,27619UT0010013,Arches Preferred Care - Know Your Cost,27619UT001,,UTN002,UTS002,UTF007,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10013.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10013.pdf,www.archeshealth.org/pharmacy,27619UT0010013-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,13
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,3,27619,UT,Individual,No,45-3174628,27619UT0010013,Arches Preferred Care - Know Your Cost,27619UT001,,UTN002,UTS002,UTF007,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10013.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10013.pdf,www.archeshealth.org/pharmacy,27619UT0010013-03,Limited Cost Sharing Plan Variation,71.27%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,500","$13,000","$6,500","$13,000",Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",40%,"$3,000","$6,000",40%,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$910,$0,$150,"$3,000",$120,$240,$80,14
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,3,27619,UT,Individual,No,45-3174628,27619UT0010013,Arches Preferred Care - Know Your Cost,27619UT001,,UTN002,UTS002,UTF007,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10013.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10013.pdf,www.archeshealth.org/pharmacy,27619UT0010013-04,73% AV Level Silver Plan,73.99%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400",Not Applicable,Not Applicable,"$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",40%,"$2,600","$5,200",40%,Not Applicable,Not Applicable,"$2,600","$5,200","$2,000","$1,100",$240,$150,"$2,000",$170,$370,$80,15
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,3,27619,UT,Individual,No,45-3174628,27619UT0010013,Arches Preferred Care - Know Your Cost,27619UT001,,UTN002,UTS002,UTF007,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10013.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10013.pdf,www.archeshealth.org/pharmacy,27619UT0010013-05,87% AV Level Silver Plan,87.80%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000",Not Applicable,Not Applicable,"$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,$0,$0,40%,$0,$0,40%,Not Applicable,Not Applicable,$0,$0,$0,"$1,720",$280,$150,$0,$250,$560,$80,16
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,3,27619,UT,Individual,No,45-3174628,27619UT0010013,Arches Preferred Care - Know Your Cost,27619UT001,,UTN002,UTS002,UTF007,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10013.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10013.pdf,www.archeshealth.org/pharmacy,27619UT0010013-06,94% AV Level Silver Plan,94.50%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$600,"$1,200",$600,"$1,200",Not Applicable,Not Applicable,$600,"$1,200",,,,,,,,,,,,,,,,,,,,,$0,$0,40%,$0,$0,40%,Not Applicable,Not Applicable,$0,$0,$0,$560,$40,$150,$0,$180,$420,$80,17
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,4,27619,UT,Individual,No,45-3174628,27619UT0010006,Arches Preferred Care - Know Your Cost Basic Wellness,27619UT001,,UTN002,UTS002,UTF007,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10006.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10006.pdf,www.archeshealth.org/pharmacy,27619UT0010006-00,Standard Silver Off Exchange Plan,70.85%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",40%,"$3,000","$6,000",40%,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$910,$0,$150,"$3,000",$120,$240,$80,4
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,4,27619,UT,Individual,No,45-3174628,27619UT0010006,Arches Preferred Care - Know Your Cost Basic Wellness,27619UT001,,UTN002,UTS002,UTF007,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10006.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10006.pdf,www.archeshealth.org/pharmacy,27619UT0010006-01,Standard Silver On Exchange Plan,70.85%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000",Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",40%,"$3,000","$6,000",40%,Not Applicable,Not Applicable,"$3,000","$6,000","$3,000",$910,$0,$150,"$3,000",$120,$240,$80,5
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,5,27619,UT,Individual,No,45-3174628,27619UT0010002,Arches Secure WELLth - Enhanced,27619UT001,,UTN001,UTS001,UTF003,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10002.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10002.pdf,www.archeshealth.org/pharmacy,27619UT0010002-03,Limited Cost Sharing Plan Variation,70.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,"$1,500","$3,000","$1,500",$20,"$1,730.00",$150,"$1,500",$530,$310.00,$80,7
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,5,27619,UT,Individual,No,45-3174628,27619UT0010002,Arches Secure WELLth - Enhanced,27619UT001,,UTN001,UTS001,UTF003,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10002.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10002.pdf,www.archeshealth.org/pharmacy,27619UT0010002-04,73% AV Level Silver Plan,72.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",30%,,,,Not Applicable,Not Applicable,"$1,300","$2,600","$1,300",$20,"$1,790.00",$150,"$1,300",$460,$320,$80,8
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,5,27619,UT,Individual,No,45-3174628,27619UT0010002,Arches Secure WELLth - Enhanced,27619UT001,,UTN001,UTS001,UTF003,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10002.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10002.pdf,www.archeshealth.org/pharmacy,27619UT0010002-05,87% AV Level Silver Plan,86.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,"$2,250","$4,500",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,$0,$20,"$2,180",$150,$0,$500,$420,$80,9
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,5,27619,UT,Individual,No,45-3174628,27619UT0010002,Arches Secure WELLth - Enhanced,27619UT001,,UTN001,UTS001,UTF003,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10002.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10002.pdf,www.archeshealth.org/pharmacy,27619UT0010002-06,94% AV Level Silver Plan,94.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,$500,$150,$0,$250,$250,$80,10
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,5,27619,UT,Individual,No,45-3174628,27619UT0010014,Arches Secure WELLth - Enhanced Plus,27619UT001,,UTN001,UTS001,UTF003,New,POS,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Medically Necessary,Yes,www.archeshealth.org/SBC/10014.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10014.pdf,www.archeshealth.org/pharmacy,27619UT0010014-00,Standard Silver Off Exchange Plan,70.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000","$1,500",$20,"$1,730",$150,"$1,500",$530,$310.00,$80,11
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,5,27619,UT,Individual,No,45-3174628,27619UT0010014,Arches Secure WELLth - Enhanced Plus,27619UT001,,UTN001,UTS001,UTF003,New,POS,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Medically Necessary,Yes,www.archeshealth.org/SBC/10014.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10014.pdf,www.archeshealth.org/pharmacy,27619UT0010014-01,Standard Silver On Exchange Plan,70.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000","$1,500",$20,"$1,730.00",$150,"$1,500",$530,$310.00,$80,12
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,5,27619,UT,Individual,No,45-3174628,27619UT0010014,Arches Secure WELLth - Enhanced Plus,27619UT001,,UTN001,UTS001,UTF003,New,POS,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Medically Necessary,Yes,www.archeshealth.org/SBC/10014.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10014.pdf,www.archeshealth.org/pharmacy,27619UT0010014-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,13
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,5,27619,UT,Individual,No,45-3174628,27619UT0010014,Arches Secure WELLth - Enhanced Plus,27619UT001,,UTN001,UTS001,UTF003,New,POS,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Medically Necessary,Yes,www.archeshealth.org/SBC/10014.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10014.pdf,www.archeshealth.org/pharmacy,27619UT0010014-03,Limited Cost Sharing Plan Variation,70.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$3,000","$6,000","$4,500","$9,000","$1,500",$20,"$1,730.00",$150,"$1,500",$530,$310.00,$80,14
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,5,27619,UT,Individual,No,45-3174628,27619UT0010014,Arches Secure WELLth - Enhanced Plus,27619UT001,,UTN001,UTS001,UTF003,New,POS,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Medically Necessary,Yes,www.archeshealth.org/SBC/10014.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10014.pdf,www.archeshealth.org/pharmacy,27619UT0010014-04,73% AV Level Silver Plan,72.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",30%,,,,"$2,600","$5,200","$3,900","$7,800","$1,300",$20,"$1,790.00",$150,"$1,300",$460,$320,$80,15
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,5,27619,UT,Individual,No,45-3174628,27619UT0010014,Arches Secure WELLth - Enhanced Plus,27619UT001,,UTN001,UTS001,UTF003,New,POS,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Medically Necessary,Yes,www.archeshealth.org/SBC/10014.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10014.pdf,www.archeshealth.org/pharmacy,27619UT0010014-05,87% AV Level Silver Plan,86.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$6,750","$13,500",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,$0,$0,$0,$0,$0,$20,"$2,180",$150,$0,$500,$420,$80,16
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,5,27619,UT,Individual,No,45-3174628,27619UT0010014,Arches Secure WELLth - Enhanced Plus,27619UT001,,UTN001,UTS001,UTF003,New,POS,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Medically Necessary,Yes,www.archeshealth.org/SBC/10014.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10014.pdf,www.archeshealth.org/pharmacy,27619UT0010014-06,94% AV Level Silver Plan,94.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$1,000","$2,000","$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,$0,$0,$0,$0,$0,$0,$500,$150,$0,$250,$250,$80,17
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,5,27619,UT,Individual,No,45-3174628,27619UT0010021,Arches Secure WELLth - Elevated 100% AD,27619UT001,,UTN001,UTS001,UTF001,New,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10021.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10021.pdf,www.archeshealth.org/pharmacy,27619UT0010021-00,Standard Silver Off Exchange Plan,68.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,"$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,"$3,500","$7,000","$3,500",$0,$0,$150,"$3,500",$0,$0,$80,18
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,5,27619,UT,Individual,No,45-3174628,27619UT0010021,Arches Secure WELLth - Elevated 100% AD,27619UT001,,UTN001,UTS001,UTF001,New,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10021.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10021.pdf,www.archeshealth.org/pharmacy,27619UT0010021-01,Standard Silver On Exchange Plan,68.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,"$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,"$3,500","$7,000","$3,500",$0,$0,$150,"$3,500",$0,$0,$80,19
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,5,27619,UT,Individual,No,45-3174628,27619UT0010021,Arches Secure WELLth - Elevated 100% AD,27619UT001,,UTN001,UTS001,UTF001,New,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10021.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10021.pdf,www.archeshealth.org/pharmacy,27619UT0010021-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,20
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,5,27619,UT,Individual,No,45-3174628,27619UT0010021,Arches Secure WELLth - Elevated 100% AD,27619UT001,,UTN001,UTS001,UTF001,New,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10021.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10021.pdf,www.archeshealth.org/pharmacy,27619UT0010021-03,Limited Cost Sharing Plan Variation,68.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,"$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,"$3,500","$7,000","$3,500",$0,$0,$150,"$3,500",$0,$0,$80,21
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,5,27619,UT,Individual,No,45-3174628,27619UT0010021,Arches Secure WELLth - Elevated 100% AD,27619UT001,,UTN001,UTS001,UTF001,New,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10021.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10021.pdf,www.archeshealth.org/pharmacy,27619UT0010021-04,73% AV Level Silver Plan,73.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,Not Applicable,Not Applicable,"$2,750","$5,500",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,Not Applicable,Not Applicable,"$2,750","$5,500","$2,750",$0,$0,$150,"$2,750",$0,$0,$80,22
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,5,27619,UT,Individual,No,45-3174628,27619UT0010021,Arches Secure WELLth - Elevated 100% AD,27619UT001,,UTN001,UTS001,UTF001,New,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10021.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10021.pdf,www.archeshealth.org/pharmacy,27619UT0010021-05,87% AV Level Silver Plan,87.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,"$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,"$1,000","$2,000","$1,000",$0,$0,$150,"$1,000",$0,$0,$80,23
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,5,27619,UT,Individual,No,45-3174628,27619UT0010021,Arches Secure WELLth - Elevated 100% AD,27619UT001,,UTN001,UTS001,UTF001,New,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10021.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10021.pdf,www.archeshealth.org/pharmacy,27619UT0010021-06,94% AV Level Silver Plan,94.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,Not Applicable,Not Applicable,$400,$800,,,,,,,,,,,,,,,,,,,,,$400,$800,0%,,,,Not Applicable,Not Applicable,$400,$800,$400,$0,$0,$150,$400,$0,$0,$80,24
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,6,27619,UT,Individual,No,45-3174628,27619UT0010003,Arches Secure WELLth - Know Your Cost,27619UT001,,UTN001,UTS001,UTF006,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10003.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10003.pdf,www.archeshealth.org/pharmacy,27619UT0010003-00,Standard Silver Off Exchange Plan,69.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,"$1,500","$3,000","$1,500","$1,600",$180,$150,"$1,500",$460,$310,$80,4
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,6,27619,UT,Individual,No,45-3174628,27619UT0010003,Arches Secure WELLth - Know Your Cost,27619UT001,,UTN001,UTS001,UTF006,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10003.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10003.pdf,www.archeshealth.org/pharmacy,27619UT0010003-01,Standard Silver On Exchange Plan,69.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,"$1,500","$3,000","$1,500","$1,600",$180,$150,"$1,500",$460,$310,$80,5
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,6,27619,UT,Individual,No,45-3174628,27619UT0010003,Arches Secure WELLth - Know Your Cost,27619UT001,,UTN001,UTS001,UTF006,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10003.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10003.pdf,www.archeshealth.org/pharmacy,27619UT0010003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,6,27619,UT,Individual,No,45-3174628,27619UT0010003,Arches Secure WELLth - Know Your Cost,27619UT001,,UTN001,UTS001,UTF006,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10003.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10003.pdf,www.archeshealth.org/pharmacy,27619UT0010003-03,Limited Cost Sharing Plan Variation,69.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,"$1,500","$3,000","$1,500","$1,600",$180,$150,"$1,500",$460,$310,$80,7
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,6,27619,UT,Individual,No,45-3174628,27619UT0010003,Arches Secure WELLth - Know Your Cost,27619UT001,,UTN001,UTS001,UTF006,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10003.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10003.pdf,www.archeshealth.org/pharmacy,27619UT0010003-04,73% AV Level Silver Plan,73.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,"$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",30%,,,,Not Applicable,Not Applicable,"$1,300","$2,600","$1,300","$1,790",$180,$150,"$1,300",$130,$320,$80,8
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,6,27619,UT,Individual,No,45-3174628,27619UT0010003,Arches Secure WELLth - Know Your Cost,27619UT001,,UTN001,UTS001,UTF006,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10003.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10003.pdf,www.archeshealth.org/pharmacy,27619UT0010003-05,87% AV Level Silver Plan,87.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,Not Applicable,Not Applicable,"$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,$0,"$1,790",$210,$150,$0,$100,$420,$80,9
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,6,27619,UT,Individual,No,45-3174628,27619UT0010003,Arches Secure WELLth - Know Your Cost,27619UT001,,UTN001,UTS001,UTF006,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,3,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10003.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10003.pdf,www.archeshealth.org/pharmacy,27619UT0010003-06,94% AV Level Silver Plan,94.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$600,"$1,200",,,Not Applicable,Not Applicable,$600,"$1,200",,,,,,,,,,,,,,,,,,,,,$0,$0,30%,,,,Not Applicable,Not Applicable,$0,$0,$0,$570,$30,$150,$0,$50,$420,$80,10
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,7,27619,UT,Individual,No,45-3174628,27619UT0010008,Arches Classic - Enhanced,27619UT001,,UTN001,UTS001,UTF009,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,2,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10008.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10008.pdf,www.archeshealth.org/pharmacy,27619UT0010008-00,Standard Silver Off Exchange Plan,71.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,"$2,500","$5,000","$2,500",$20,$950,$150,"$2,500",$340,$160,$80,4
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,7,27619,UT,Individual,No,45-3174628,27619UT0010008,Arches Classic - Enhanced,27619UT001,,UTN001,UTS001,UTF009,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,2,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10008.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10008.pdf,www.archeshealth.org/pharmacy,27619UT0010008-01,Standard Silver On Exchange Plan,71.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,"$2,500","$5,000","$2,500",$20,$950,$150,"$2,500",$340,$160,$80,5
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,7,27619,UT,Individual,No,45-3174628,27619UT0010008,Arches Classic - Enhanced,27619UT001,,UTN001,UTS001,UTF009,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,2,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10008.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10008.pdf,www.archeshealth.org/pharmacy,27619UT0010008-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,7,27619,UT,Individual,No,45-3174628,27619UT0010008,Arches Classic - Enhanced,27619UT001,,UTN001,UTS001,UTF009,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,2,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10008.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10008.pdf,www.archeshealth.org/pharmacy,27619UT0010008-03,Limited Cost Sharing Plan Variation,71.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,"$2,500","$5,000","$2,500",$20,$950,$150,"$2,500",$340,$160,$80,7
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,7,27619,UT,Individual,No,45-3174628,27619UT0010008,Arches Classic - Enhanced,27619UT001,,UTN001,UTS001,UTF009,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,2,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10008.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10008.pdf,www.archeshealth.org/pharmacy,27619UT0010008-04,73% AV Level Silver Plan,73.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,"$2,000","$4,000","$2,000",$20,"$1,050",$150,"$2,000",$370,$190,$80,8
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,7,27619,UT,Individual,No,45-3174628,27619UT0010008,Arches Classic - Enhanced,27619UT001,,UTN001,UTS001,UTF009,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,2,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10008.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10008.pdf,www.archeshealth.org/pharmacy,27619UT0010008-05,87% AV Level Silver Plan,87.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,"$2,250","$4,500",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,$0,$20,"$1,450",$150,$0,$500,$280,$80,9
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,7,27619,UT,Individual,No,45-3174628,27619UT0010008,Arches Classic - Enhanced,27619UT001,,UTN001,UTS001,UTF009,Existing,HMO,Silver,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,2,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10008.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10008.pdf,www.archeshealth.org/pharmacy,27619UT0010008-06,94% AV Level Silver Plan,94.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,$500,"$1,000",,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,$500,$150,$0,$310,$200,$80,10
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,8,27619,UT,Individual,No,45-3174628,27619UT0010005,Arches Classic - Elevated 5000 25/75,27619UT001,,UTN001,UTS001,UTF003,Existing,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,1,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10005.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10005.pdf,www.archeshealth.org/pharmacy,27619UT0010005-00,Standard Bronze Off Exchange Plan,60.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,"$5,000","$10,000","$5,000",$20,$900,$150,"$5,000",$30,$60,$80,4
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,8,27619,UT,Individual,No,45-3174628,27619UT0010005,Arches Classic - Elevated 5000 25/75,27619UT001,,UTN001,UTS001,UTF003,Existing,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,1,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10005.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10005.pdf,www.archeshealth.org/pharmacy,27619UT0010005-01,Standard Bronze On Exchange Plan,60.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,"$5,000","$10,000","$5,000",$20,$900,$150,"$5,000",$30,$60,$80,5
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,8,27619,UT,Individual,No,45-3174628,27619UT0010005,Arches Classic - Elevated 5000 25/75,27619UT001,,UTN001,UTS001,UTF003,Existing,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,1,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10005.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10005.pdf,www.archeshealth.org/pharmacy,27619UT0010005-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,8,27619,UT,Individual,No,45-3174628,27619UT0010005,Arches Classic - Elevated 5000 25/75,27619UT001,,UTN001,UTS001,UTF003,Existing,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,1,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10005.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10005.pdf,www.archeshealth.org/pharmacy,27619UT0010005-03,Limited Cost Sharing Plan Variation,60.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,Not Applicable,Not Applicable,"$5,000","$10,000","$5,000",$20,$900,$150,"$5,000",$30,$60,$80,7
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,8,27619,UT,Individual,No,45-3174628,27619UT0010017,Arches Preferred Care - Basic Coverage 5000 5/40,27619UT001,,UTN002,UTS002,UTF004,Existing,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,3,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10017.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10017.pdf,www.archeshealth.org/pharmacy,27619UT0010017-00,Standard Bronze Off Exchange Plan,59.30%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,"$5,000","$10,000",40%,Not Applicable,Not Applicable,"$5,000","$10,000","$5,000",$10,$900,$150,"$5,000",$20,$60,$80,8
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,8,27619,UT,Individual,No,45-3174628,27619UT0010017,Arches Preferred Care - Basic Coverage 5000 5/40,27619UT001,,UTN002,UTS002,UTF004,Existing,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,3,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10017.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10017.pdf,www.archeshealth.org/pharmacy,27619UT0010017-01,Standard Bronze On Exchange Plan,59.30%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,"$5,000","$10,000",40%,Not Applicable,Not Applicable,"$5,000","$10,000","$5,000",$10,$900,$150,"$5,000",$20,$60,$80,9
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,8,27619,UT,Individual,No,45-3174628,27619UT0010017,Arches Preferred Care - Basic Coverage 5000 5/40,27619UT001,,UTN002,UTS002,UTF004,Existing,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,3,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10017.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10017.pdf,www.archeshealth.org/pharmacy,27619UT0010017-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,8,27619,UT,Individual,No,45-3174628,27619UT0010017,Arches Preferred Care - Basic Coverage 5000 5/40,27619UT001,,UTN002,UTS002,UTF004,Existing,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,3,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10017.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10017.pdf,www.archeshealth.org/pharmacy,27619UT0010017-03,Limited Cost Sharing Plan Variation,59.30%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,"$5,000","$10,000",40%,Not Applicable,Not Applicable,"$5,000","$10,000","$5,000",$10,$900,$150,"$5,000",$20,$60,$80,11
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,8,27619,UT,Individual,No,45-3174628,27619UT0010024,Arches Classic - Basic Coverage 4000 50/100,27619UT001,,UTN001,UTS001,UTF005,New,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,1,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10024.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10024.pdf,www.archeshealth.org/pharmacy,27619UT0010024-00,Standard Bronze Off Exchange Plan,59.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,"$4,000","$8,000","$4,000",$20,"$1,630",$150,"$4,000",$180,$160,$80,12
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,8,27619,UT,Individual,No,45-3174628,27619UT0010024,Arches Classic - Basic Coverage 4000 50/100,27619UT001,,UTN001,UTS001,UTF005,New,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,1,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10024.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10024.pdf,www.archeshealth.org/pharmacy,27619UT0010024-01,Standard Bronze On Exchange Plan,59.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,"$4,000","$8,000","$4,000",$20,"$1,630",$150,"$4,000",$180,$160,$80,13
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,8,27619,UT,Individual,No,45-3174628,27619UT0010024,Arches Classic - Basic Coverage 4000 50/100,27619UT001,,UTN001,UTS001,UTF005,New,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,1,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10024.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10024.pdf,www.archeshealth.org/pharmacy,27619UT0010024-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,14
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,8,27619,UT,Individual,No,45-3174628,27619UT0010024,Arches Classic - Basic Coverage 4000 50/100,27619UT001,,UTN001,UTS001,UTF005,New,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,1,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10024.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10024.pdf,www.archeshealth.org/pharmacy,27619UT0010024-03,Limited Cost Sharing Plan Variation,59.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,000",,,Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",50%,,,,Not Applicable,Not Applicable,"$4,000","$8,000","$4,000",$20,"$1,630",$150,"$4,000",$180,$160,$80,15
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,8,27619,UT,Individual,No,45-3174628,27619UT0010023,Arches Personal Primary Access,27619UT001,,UTN001,UTS003,UTF004,New,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10023.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10023.pdf,www.archeshealth.org/pharmacy,27619UT0010023-00,Standard Bronze Off Exchange Plan,61.00%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,500","$13,000","$6,500","$13,000",Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,"$5,000","$10,000",50%,Not Applicable,Not Applicable,"$5,000","$10,000","$5,000",$10,"$1,130",$150,"$5,000",$20,$70,$80,16
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,8,27619,UT,Individual,No,45-3174628,27619UT0010023,Arches Personal Primary Access,27619UT001,,UTN001,UTS003,UTF004,New,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10023.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10023.pdf,www.archeshealth.org/pharmacy,27619UT0010023-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,500","$13,000","$6,500","$13,000",Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,"$5,000","$10,000",50%,Not Applicable,Not Applicable,"$5,000","$10,000","$5,000",$10,"$1,130",$150,"$5,000",$20,$70,$80,17
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,8,27619,UT,Individual,No,45-3174628,27619UT0010023,Arches Personal Primary Access,27619UT001,,UTN001,UTS003,UTF004,New,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10023.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10023.pdf,www.archeshealth.org/pharmacy,27619UT0010023-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,18
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,8,27619,UT,Individual,No,45-3174628,27619UT0010023,Arches Personal Primary Access,27619UT001,,UTN001,UTS003,UTF004,New,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10023.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10023.pdf,www.archeshealth.org/pharmacy,27619UT0010023-03,Limited Cost Sharing Plan Variation,61.00%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,500","$13,000","$6,500","$13,000",Not Applicable,Not Applicable,"$6,500","$13,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",50%,"$5,000","$10,000",50%,Not Applicable,Not Applicable,"$5,000","$10,000","$5,000",$10,"$1,130",$150,"$5,000",$20,$70,$80,19
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,9,27619,UT,Individual,No,45-3174628,27619UT0010001,Arches Secure WELLth - Basic 100% AD,27619UT001,,UTN001,UTS001,UTF001,Existing,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10001.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10001.pdf,www.archeshealth.org/pharmacy,27619UT0010001-00,Standard Bronze Off Exchange Plan,59.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,"$6,000","$12,000","$6,000",$0,$0,$150,"$5,270",$0,$0,$80,4
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,9,27619,UT,Individual,No,45-3174628,27619UT0010001,Arches Secure WELLth - Basic 100% AD,27619UT001,,UTN001,UTS001,UTF001,Existing,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10001.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10001.pdf,www.archeshealth.org/pharmacy,27619UT0010001-01,Standard Bronze On Exchange Plan,59.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,"$6,000","$12,000","$6,000",$0,$0,$150,"$5,270",$0,$0,$80,5
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,9,27619,UT,Individual,No,45-3174628,27619UT0010001,Arches Secure WELLth - Basic 100% AD,27619UT001,,UTN001,UTS001,UTF001,Existing,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10001.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10001.pdf,www.archeshealth.org/pharmacy,27619UT0010001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,9,27619,UT,Individual,No,45-3174628,27619UT0010001,Arches Secure WELLth - Basic 100% AD,27619UT001,,UTN001,UTS001,UTF001,Existing,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10001.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10001.pdf,www.archeshealth.org/pharmacy,27619UT0010001-03,Limited Cost Sharing Plan Variation,59.20%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,Not Applicable,Not Applicable,"$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,Not Applicable,Not Applicable,"$6,000","$12,000","$6,000",$0,$0,$150,"$5,270",$0,$0,$80,7
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,9,27619,UT,Individual,No,45-3174628,27619UT0010012,Arches Secure WELLth - Elevated 50% AD,27619UT001,,UTN001,UTS001,UTF002,Existing,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10012.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10012.pdf,www.archeshealth.org/pharmacy,27619UT0010012-00,Standard Bronze Off Exchange Plan,61.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",50%,,,,Not Applicable,Not Applicable,"$2,600","$5,200","$2,500",$0,"$2,390",$150,"$2,500",$0,"$1,060",$80,8
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,9,27619,UT,Individual,No,45-3174628,27619UT0010012,Arches Secure WELLth - Elevated 50% AD,27619UT001,,UTN001,UTS001,UTF002,Existing,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10012.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10012.pdf,www.archeshealth.org/pharmacy,27619UT0010012-01,Standard Bronze On Exchange Plan,61.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",50%,,,,Not Applicable,Not Applicable,"$2,600","$5,200","$2,500",$0,"$2,390.00",$150,"$2,500",$0,"$1,060.00",$80,9
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,9,27619,UT,Individual,No,45-3174628,27619UT0010012,Arches Secure WELLth - Elevated 50% AD,27619UT001,,UTN001,UTS001,UTF002,Existing,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10012.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10012.pdf,www.archeshealth.org/pharmacy,27619UT0010012-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,10
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,9,27619,UT,Individual,No,45-3174628,27619UT0010012,Arches Secure WELLth - Elevated 50% AD,27619UT001,,UTN001,UTS001,UTF002,Existing,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,0.9912,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10012.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10012.pdf,www.archeshealth.org/pharmacy,27619UT0010012-03,Limited Cost Sharing Plan Variation,61.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",50%,,,,Not Applicable,Not Applicable,"$2,600","$5,200","$2,500",$0,"$2,390.00",$150,"$2,500",$0,"$1,060.00",$80,11
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,10,27619,UT,Individual,No,45-3174628,27619UT0010016,Arches Preferred Care - Basic Wellness 5000 5/40,27619UT001,,UTN002,UTS002,UTF004,Existing,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10016.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10016.pdf,www.archeshealth.org/pharmacy,27619UT0010016-00,Standard Bronze Off Exchange Plan,59.30%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,"$5,000","$10,000",40%,Not Applicable,Not Applicable,"$5,000","$10,000","$5,000",$10,$900,$150,"$5,000",$20,$60,$80,4
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,10,27619,UT,Individual,No,45-3174628,27619UT0010016,Arches Preferred Care - Basic Wellness 5000 5/40,27619UT001,,UTN002,UTS002,UTF004,Existing,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10016.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10016.pdf,www.archeshealth.org/pharmacy,27619UT0010016-01,Standard Bronze On Exchange Plan,59.30%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,"$5,000","$10,000",40%,Not Applicable,Not Applicable,"$5,000","$10,000","$5,000",$10,$900,$150,"$5,000",$20,$60,$80,5
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,10,27619,UT,Individual,No,45-3174628,27619UT0010016,Arches Preferred Care - Basic Wellness 5000 5/40,27619UT001,,UTN002,UTS002,UTF004,Existing,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10016.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10016.pdf,www.archeshealth.org/pharmacy,27619UT0010016-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,$0,$0,$0,$0,$0,$150,$0,$0,$0,$80,6
2015,UT,27619,SERFF,8,2015-01-22 16:02:51,10,27619,UT,Individual,No,45-3174628,27619UT0010016,Arches Preferred Care - Basic Wellness 5000 5/40,27619UT001,,UTN002,UTS002,UTF004,Existing,HMO,Bronze,Yes,Both,No,No,,See SPD,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,1,,,0,0,3,2015-01-01,2015-12-31,Yes,Urgent or Emergency,Yes,Urgent or Emergency,No,www.archeshealth.org/SBC/10016.pdf,https://ssoprod.healthplan.com/sp/ACS.saml2,www.archeshealth.org/productbrochure/10016.pdf,www.archeshealth.org/pharmacy,27619UT0010016-03,Limited Cost Sharing Plan Variation,59.30%,,Yes,Yes,Yes,60%,40%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,"$5,000","$10,000",40%,Not Applicable,Not Applicable,"$5,000","$10,000","$5,000",$10,$900,$150,"$5,000",$20,$60,$80,7
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,5,34541,UT,Individual,No,87-0388069,34541UT0030001,BridgeSpan Exchange Bronze HSA,34541UT003,,UTN001,UTS001,UTF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0030001-01,Standard Bronze On Exchange Plan,,0.589279532432556,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$0,$680,$150,"$4,580",$180,$0,$40,16
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,5,34541,UT,Individual,No,87-0388069,34541UT0030001,BridgeSpan Exchange Bronze HSA,34541UT003,,UTN001,UTS001,UTF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0030001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$40,17
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,5,34541,UT,Individual,No,87-0388069,34541UT0030001,BridgeSpan Exchange Bronze HSA,34541UT003,,UTN001,UTS001,UTF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0030001-03,Limited Cost Sharing Plan Variation,,0.589279532432556,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$0,$680,$150,"$4,580",$180,$0,$40,18
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,1,38927,UT,Individual,No,87-0345631,38927UT0300003,Altius Bronze $15 Copay Peak Preference,38927UT030,,UTN002,UTS002,UTF008,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51609,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300003-00,Standard Bronze Off Exchange Plan,61.20%,,Yes,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",30%,"$6,500","$13,000",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,1,38927,UT,Individual,No,87-0345631,38927UT0300003,Altius Bronze $15 Copay Peak Preference,38927UT030,,UTN002,UTS002,UTF008,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51609,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300003-01,Standard Bronze On Exchange Plan,61.20%,,Yes,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",30%,"$6,500","$13,000",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,1,38927,UT,Individual,No,87-0345631,38927UT0300003,Altius Bronze $15 Copay Peak Preference,38927UT030,,UTN002,UTS002,UTF008,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51609,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,1,38927,UT,Individual,No,87-0345631,38927UT0300003,Altius Bronze $15 Copay Peak Preference,38927UT030,,UTN002,UTS002,UTF008,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51609,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300003-03,Limited Cost Sharing Plan Variation,61.20%,,Yes,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",30%,"$6,500","$13,000",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,2,38927,UT,Individual,No,87-0345631,38927UT0310003,Altius Bronze $20 Copay,38927UT031,,UTN001,UTS001,UTF018,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51631,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310003-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,2,38927,UT,Individual,No,87-0345631,38927UT0310003,Altius Bronze $20 Copay,38927UT031,,UTN001,UTS001,UTF018,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51631,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310003-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,2,38927,UT,Individual,No,87-0345631,38927UT0310003,Altius Bronze $20 Copay,38927UT031,,UTN001,UTS001,UTF018,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51631,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,1,34541,UT,Individual,No,87-0388069,34541UT0040001,BridgeSpan Exchange Catastrophic,34541UT004,,UTN001,UTS001,UTF008,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in-network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0040001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$4,680",$120,$0,$40,4
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,1,34541,UT,Individual,No,87-0388069,34541UT0040001,BridgeSpan Exchange Catastrophic,34541UT004,,UTN001,UTS001,UTF008,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in-network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0040001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,"$6,600",$0,$0,$150,"$4,680",$120,$0,$40,5
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,2,34541,UT,Individual,No,87-0388069,34541UT0010001,BridgeSpan Exchange Gold,34541UT001,,UTN001,UTS001,UTF002,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0010001-00,Standard Gold Off Exchange Plan,,0.781266510486603,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,300","$6,600",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,000",$0,"$2,300",$150,"$1,000",$360,"$1,430",$80,4
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,2,34541,UT,Individual,No,87-0388069,34541UT0010001,BridgeSpan Exchange Gold,34541UT001,,UTN001,UTS001,UTF002,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0010001-01,Standard Gold On Exchange Plan,,0.781266510486603,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,300","$6,600",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,000",$0,"$2,300",$150,"$1,000",$360,"$1,430",$80,5
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,2,34541,UT,Individual,No,87-0388069,34541UT0010001,BridgeSpan Exchange Gold,34541UT001,,UTN001,UTS001,UTF002,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0010001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$40,6
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,2,34541,UT,Individual,No,87-0388069,34541UT0010001,BridgeSpan Exchange Gold,34541UT001,,UTN001,UTS001,UTF002,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0010001-03,Limited Cost Sharing Plan Variation,,0.781266510486603,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,300","$6,600",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,000",$0,"$2,300",$150,"$1,000",$360,"$1,430",$80,7
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,2,34541,UT,Individual,No,87-0388069,34541UT0020001,BridgeSpan Exchange Silver,34541UT002,,UTN001,UTS001,UTF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0020001-00,Standard Silver Off Exchange Plan,,0.6824010014534,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,000",$20,$850,$150,"$3,000",$440,$90,$40,8
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,2,34541,UT,Individual,No,87-0388069,34541UT0020001,BridgeSpan Exchange Silver,34541UT002,,UTN001,UTS001,UTF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0020001-01,Standard Silver On Exchange Plan,,0.6824010014534,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,000",$20,$850,$150,"$3,000",$440,$90,$40,9
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,2,34541,UT,Individual,No,87-0388069,34541UT0020001,BridgeSpan Exchange Silver,34541UT002,,UTN001,UTS001,UTF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0020001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$40,10
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,2,34541,UT,Individual,No,87-0388069,34541UT0020001,BridgeSpan Exchange Silver,34541UT002,,UTN001,UTS001,UTF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0020001-03,Limited Cost Sharing Plan Variation,,0.6824010014534,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$3,000",$20,$850,$150,"$3,000",$440,$90,$40,11
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,2,34541,UT,Individual,No,87-0388069,34541UT0020001,BridgeSpan Exchange Silver,34541UT002,,UTN001,UTS001,UTF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0020001-04,73% AV Level Silver Plan,,0.731018602848053,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$20,$450,$150,"$3,440",$440,$0,$40,12
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,7,38927,UT,Individual,No,87-0345631,38927UT0310011,Altius Silver $5 Copay 2750,38927UT031,,UTN001,UTS001,UTF006,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51629,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310011-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,7,38927,UT,Individual,No,87-0345631,38927UT0310011,Altius Silver $5 Copay 2750,38927UT031,,UTN001,UTS001,UTF006,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51629,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310011-03,Limited Cost Sharing Plan Variation,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,7,38927,UT,Individual,No,87-0345631,38927UT0310011,Altius Silver $5 Copay 2750,38927UT031,,UTN001,UTS001,UTF006,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51629,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310011-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,7,38927,UT,Individual,No,87-0345631,38927UT0310011,Altius Silver $5 Copay 2750,38927UT031,,UTN001,UTS001,UTF006,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51629,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310011-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,7,38927,UT,Individual,No,87-0345631,38927UT0310011,Altius Silver $5 Copay 2750,38927UT031,,UTN001,UTS001,UTF006,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51629,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310011-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,8,38927,UT,Individual,No,87-0345631,38927UT0300011,Altius Silver $5 Copay 2750 Peak Preference,38927UT030,,UTN002,UTS002,UTF012,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51606,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300011-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$5,750","$11,500","$6,250","$12,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$5,250","$10,500",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,8,38927,UT,Individual,No,87-0345631,38927UT0300011,Altius Silver $5 Copay 2750 Peak Preference,38927UT030,,UTN002,UTS002,UTF012,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51606,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300011-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$5,750","$11,500","$6,250","$12,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$5,250","$10,500",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,8,38927,UT,Individual,No,87-0345631,38927UT0300011,Altius Silver $5 Copay 2750 Peak Preference,38927UT030,,UTN002,UTS002,UTF012,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51606,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300011-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,8,38927,UT,Individual,No,87-0345631,38927UT0300011,Altius Silver $5 Copay 2750 Peak Preference,38927UT030,,UTN002,UTS002,UTF012,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51606,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300011-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$5,750","$11,500","$6,250","$12,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$5,250","$10,500",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,8,38927,UT,Individual,No,87-0345631,38927UT0300011,Altius Silver $5 Copay 2750 Peak Preference,38927UT030,,UTN002,UTS002,UTF012,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51606,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300011-04,73% AV Level Silver Plan,72.40%,,Yes,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$3,900","$7,800","$5,000","$10,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$4,500","$9,000",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,8,38927,UT,Individual,No,87-0345631,38927UT0300011,Altius Silver $5 Copay 2750 Peak Preference,38927UT030,,UTN002,UTS002,UTF012,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51606,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300011-05,87% AV Level Silver Plan,86.20%,,Yes,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$1,800","$3,600","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,"$1,500","$3,000",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,8,38927,UT,Individual,No,87-0345631,38927UT0300011,Altius Silver $5 Copay 2750 Peak Preference,38927UT030,,UTN002,UTS002,UTF012,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51606,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300011-06,94% AV Level Silver Plan,93.00%,,Yes,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,950","$2,900",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,25%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,2,34541,UT,Individual,No,87-0388069,34541UT0020001,BridgeSpan Exchange Silver,34541UT002,,UTN001,UTS001,UTF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0020001-05,87% AV Level Silver Plan,,0.864171087741852,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,$20,"$1,350",$150,$500,$440,$590,$40,13
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,2,34541,UT,Individual,No,87-0388069,34541UT0020001,BridgeSpan Exchange Silver,34541UT002,,UTN001,UTS001,UTF002,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0020001-06,94% AV Level Silver Plan,,0.938938796520233,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,$500,$20,$200,$150,$500,$440,$200,$40,14
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,9,38927,UT,Individual,No,87-0345631,38927UT0300001,Altius Gold $0 Copay Peak Preference,38927UT030,,UTN002,UTS002,UTF010,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51600,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,9,38927,UT,Individual,No,87-0345631,38927UT0300001,Altius Gold $0 Copay Peak Preference,38927UT030,,UTN002,UTS002,UTF010,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51600,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300001-03,Limited Cost Sharing Plan Variation,78.10%,,No,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,"$2,000","$4,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,10,38927,UT,Individual,No,87-0345631,38927UT0310001,Altius Gold $5 Copay,38927UT031,,UTN001,UTS001,UTF011,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51622,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310001-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,10,38927,UT,Individual,No,87-0345631,38927UT0310001,Altius Gold $5 Copay,38927UT031,,UTN001,UTS001,UTF011,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51622,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310001-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,10,38927,UT,Individual,No,87-0345631,38927UT0310001,Altius Gold $5 Copay,38927UT031,,UTN001,UTS001,UTF011,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51622,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,10,38927,UT,Individual,No,87-0345631,38927UT0310001,Altius Gold $5 Copay,38927UT031,,UTN001,UTS001,UTF011,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51622,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310001-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,Not Applicable,20%,,,,$500,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,3,34541,UT,Individual,No,87-0388069,34541UT0160001,"BridgeSpan Exchange Gold with Dental, Vision, and IAP",34541UT016,,UTN001,UTS001,UTF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9078,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0160001-00,Standard Gold Off Exchange Plan,,0.781266510486603,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,300","$6,600",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,$420,$440,$600,$40,4
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,3,34541,UT,Individual,No,87-0388069,34541UT0160001,"BridgeSpan Exchange Gold with Dental, Vision, and IAP",34541UT016,,UTN001,UTS001,UTF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9078,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0160001-01,Standard Gold On Exchange Plan,,0.781266510486603,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,300","$6,600",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,$420,$440,$600,$40,5
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,3,34541,UT,Individual,No,87-0388069,34541UT0160001,"BridgeSpan Exchange Gold with Dental, Vision, and IAP",34541UT016,,UTN001,UTS001,UTF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9078,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0160001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$40,6
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,3,34541,UT,Individual,No,87-0388069,34541UT0160001,"BridgeSpan Exchange Gold with Dental, Vision, and IAP",34541UT016,,UTN001,UTS001,UTF002,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9078,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0160001-03,Limited Cost Sharing Plan Variation,,0.781266510486603,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,300","$6,600",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,000",$20,"$1,250",$150,$420,$440,$600,$40,7
2015,UT,40335,SERFF,4,2015-02-17 11:12:06,1,40335,UT,Individual,Yes,20-4023720,40335UT0010001,EMI Health Choice PPO (High),40335UT001,,UTN001,UTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$8.22,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,PPO network or out-of-network coverage at PPO fee,Yes,http://emihealth.com/file/D842B68E-3174-4BD8-968E-54E3965B64D9,http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx,http://emihealth.com/file/D842B68E-3174-4BD8-968E-54E3965B64D9,,40335UT0010001-00,Standard High Off Exchange Plan,87.00%,,,,Yes,55%,45%,$350,$700,$350,$700,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,$75,,$50,$150,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,UT,40335,SERFF,4,2015-02-17 11:12:06,1,40335,UT,Individual,Yes,20-4023720,40335UT0010001,EMI Health Choice PPO (High),40335UT001,,UTN001,UTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$8.22,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,PPO network or out-of-network coverage at PPO fee,Yes,http://emihealth.com/file/D842B68E-3174-4BD8-968E-54E3965B64D9,http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx,http://emihealth.com/file/D842B68E-3174-4BD8-968E-54E3965B64D9,,40335UT0010001-01,Standard High On Exchange Plan,87.00%,,,,Yes,55%,45%,$350,$700,$350,$700,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,$75,,$50,$150,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,UT,40335,SERFF,4,2015-02-17 11:12:06,2,40335,UT,Individual,Yes,20-4023720,40335UT0030001,EMI Health Choice PPO,40335UT003,,UTN001,UTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$7.73,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,PPO network or out-of-network coverage at PPO fee,Yes,http://emihealth.com/file/55A7B413-A798-4EF8-876B-59714B2899E3,http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx,http://emihealth.com/file/55A7B413-A798-4EF8-876B-59714B2899E3,,40335UT0030001-00,Standard High Off Exchange Plan,87.00%,,,,Yes,60%,40%,$350,$700,$350,$700,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,$75,,$50,$150,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,UT,40335,SERFF,4,2015-02-17 11:12:06,2,40335,UT,Individual,Yes,20-4023720,40335UT0030001,EMI Health Choice PPO,40335UT003,,UTN001,UTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$7.73,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,PPO network or out-of-network coverage at PPO fee,Yes,http://emihealth.com/file/55A7B413-A798-4EF8-876B-59714B2899E3,http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx,http://emihealth.com/file/55A7B413-A798-4EF8-876B-59714B2899E3,,40335UT0030001-01,Standard High On Exchange Plan,87.00%,,,,Yes,60%,40%,$350,$700,$350,$700,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,$75,,$50,$150,,$75,$225,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,4,34541,UT,Individual,No,87-0388069,34541UT0170001,BridgeSpan Exchange Silver+,34541UT017,,UTN001,UTS001,UTF003,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0170001-00,Standard Silver Off Exchange Plan,,0.716342747211456,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$570,$580,$40,4
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,4,34541,UT,Individual,No,87-0388069,34541UT0170001,BridgeSpan Exchange Silver+,34541UT017,,UTN001,UTS001,UTF003,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0170001-01,Standard Silver On Exchange Plan,,0.716342747211456,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$570,$580,$40,5
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,4,34541,UT,Individual,No,87-0388069,34541UT0170001,BridgeSpan Exchange Silver+,34541UT017,,UTN001,UTS001,UTF003,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0170001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,$0,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$40,6
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,4,34541,UT,Individual,No,87-0388069,34541UT0170001,BridgeSpan Exchange Silver+,34541UT017,,UTN001,UTS001,UTF003,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0170001-03,Limited Cost Sharing Plan Variation,,0.716342747211456,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,500",$20,"$1,730",$150,"$1,500",$570,$580,$40,7
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,4,34541,UT,Individual,No,87-0388069,34541UT0170001,BridgeSpan Exchange Silver+,34541UT017,,UTN001,UTS001,UTF003,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0170001-04,73% AV Level Silver Plan,,0.738827288150787,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",30%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,"$1,250",$20,"$1,800",$150,"$1,250",$570,$660,$40,8
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,4,34541,UT,Individual,No,87-0388069,34541UT0170001,BridgeSpan Exchange Silver+,34541UT017,,UTN001,UTS001,UTF003,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0170001-05,87% AV Level Silver Plan,,0.868176937103271,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$500,$20,"$1,250",$150,$500,$570,$880,$40,9
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,4,34541,UT,Individual,No,87-0388069,34541UT0170001,BridgeSpan Exchange Silver+,34541UT017,,UTN001,UTS001,UTF003,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0170001-06,94% AV Level Silver Plan,,0.935089290142059,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$400,$800,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$20,$400,$150,$200,$570,$400,$40,10
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,5,34541,UT,Individual,No,87-0388069,34541UT0180001,BridgeSpan Exchange Silver HSA,34541UT018,,UTN001,UTS001,UTF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0180001-00,Standard Silver Off Exchange Plan,,0.682320713996887,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$660,$40,4
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,5,34541,UT,Individual,No,87-0388069,34541UT0180001,BridgeSpan Exchange Silver HSA,34541UT018,,UTN001,UTS001,UTF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0180001-01,Standard Silver On Exchange Plan,,0.682320713996887,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$660,$40,5
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,5,34541,UT,Individual,No,87-0388069,34541UT0180001,BridgeSpan Exchange Silver HSA,34541UT018,,UTN001,UTS001,UTF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0180001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$40,6
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,5,34541,UT,Individual,No,87-0388069,34541UT0180001,BridgeSpan Exchange Silver HSA,34541UT018,,UTN001,UTS001,UTF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0180001-03,Limited Cost Sharing Plan Variation,,0.682320713996887,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$2,000",$0,"$1,060",$150,"$2,000",$0,$660,$40,7
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,5,34541,UT,Individual,No,87-0388069,34541UT0180001,BridgeSpan Exchange Silver HSA,34541UT018,,UTN001,UTS001,UTF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0180001-04,73% AV Level Silver Plan,,0.723372399806976,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,"$1,250",$20,"$1,800",$150,"$1,250",$570,$660,$40,8
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,5,34541,UT,Individual,No,87-0388069,34541UT0180001,BridgeSpan Exchange Silver HSA,34541UT018,,UTN001,UTS001,UTF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0180001-05,87% AV Level Silver Plan,,0.865777254104614,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$500,$20,"$1,250",$150,$500,$570,$880,$40,9
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,5,34541,UT,Individual,No,87-0388069,34541UT0180001,BridgeSpan Exchange Silver HSA,34541UT018,,UTN001,UTS001,UTF005,New,PPO,Silver,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0180001-06,94% AV Level Silver Plan,,0.934491455554962,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,10%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$200,$20,$400,$150,$200,$570,$400,$40,10
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,5,34541,UT,Individual,No,87-0388069,34541UT0190001,BridgeSpan Exchange Bronze HSA+,34541UT019,,UTN001,UTS001,UTF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0190001-00,Standard Bronze Off Exchange Plan,,0.604940593242645,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$3,750",$0,"$1,770",$150,"$2,300",$0,"$1,510",$40,11
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,5,34541,UT,Individual,No,87-0388069,34541UT0190001,BridgeSpan Exchange Bronze HSA+,34541UT019,,UTN001,UTS001,UTF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0190001-01,Standard Bronze On Exchange Plan,,0.604940593242645,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$3,750",$0,"$1,770",$150,"$2,300",$0,"$1,510",$40,12
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,5,34541,UT,Individual,No,87-0388069,34541UT0190001,BridgeSpan Exchange Bronze HSA+,34541UT019,,UTN001,UTS001,UTF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0190001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$150,$0,$0,$0,$40,13
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,5,34541,UT,Individual,No,87-0388069,34541UT0190001,BridgeSpan Exchange Bronze HSA+,34541UT019,,UTN001,UTS001,UTF007,New,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0190001-03,Limited Cost Sharing Plan Variation,,0.604940593242645,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500",50%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,"$3,750",$0,"$1,770",$150,"$2,300",$0,"$1,510",$40,14
2015,UT,34541,SERFF,2,2014-09-07 12:14:41,5,34541,UT,Individual,No,87-0388069,34541UT0030001,BridgeSpan Exchange Bronze HSA,34541UT003,,UTN001,UTS001,UTF006,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.985,,,0,0,0,2015-01-01,,Yes,Members traveling outside the United States receive coverage for the same benefits as inside the United States.,Yes,Covered at in network benefits,Yes,www.bridgespanhealth.com,www.bridgespanhealth.com,www.bridgespanhealth.com,http://fm.formularynavigator.com/MemberPages/pdf/StateExchangeFormularyEssentialOR-ID-UT2015_3918_Full_631.pdf?,34541UT0030001-00,Standard Bronze Off Exchange Plan,,0.589279532432556,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,"$5,000",$0,$680,$150,"$4,580",$180,$0,$40,15
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,2,38927,UT,Individual,No,87-0345631,38927UT0310003,Altius Bronze $20 Copay,38927UT031,,UTN001,UTS001,UTF018,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51631,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310003-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,3,38927,UT,Individual,No,87-0345631,38927UT0310004,Altius Bronze HSA Eligible,38927UT031,,UTN001,UTS001,UTF009,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51632,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310004-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,3,38927,UT,Individual,No,87-0345631,38927UT0310004,Altius Bronze HSA Eligible,38927UT031,,UTN001,UTS001,UTF009,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51632,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310004-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,3,38927,UT,Individual,No,87-0345631,38927UT0310004,Altius Bronze HSA Eligible,38927UT031,,UTN001,UTS001,UTF009,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51632,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,6
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,3,38927,UT,Individual,No,87-0345631,38927UT0310004,Altius Bronze HSA Eligible,38927UT031,,UTN001,UTS001,UTF009,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51632,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310004-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,4,38927,UT,Individual,No,87-0345631,38927UT0300004,Altius Bronze HSA Eligible Peak Preference,38927UT030,,UTN002,UTS002,UTF016,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51610,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300004-00,Standard Bronze Off Exchange Plan,58.30%,,Yes,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$6,400","$12,800","$6,400","$12,800",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,"$6,000","$12,000",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,4,38927,UT,Individual,No,87-0345631,38927UT0300004,Altius Bronze HSA Eligible Peak Preference,38927UT030,,UTN002,UTS002,UTF016,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51610,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300004-01,Standard Bronze On Exchange Plan,58.30%,,Yes,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$6,400","$12,800","$6,400","$12,800",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,"$6,000","$12,000",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,4,38927,UT,Individual,No,87-0345631,38927UT0300004,Altius Bronze HSA Eligible Peak Preference,38927UT030,,UTN002,UTS002,UTF016,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51610,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,6
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,4,38927,UT,Individual,No,87-0345631,38927UT0300004,Altius Bronze HSA Eligible Peak Preference,38927UT030,,UTN002,UTS002,UTF016,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51610,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300004-03,Limited Cost Sharing Plan Variation,58.30%,,Yes,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$6,400","$12,800","$6,400","$12,800",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",30%,"$6,000","$12,000",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,5,38927,UT,Individual,No,87-0345631,38927UT0310002,Altius Silver $10 Copay,38927UT031,,UTN001,UTS001,UTF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51623,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310002-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,5,38927,UT,Individual,No,87-0345631,38927UT0310002,Altius Silver $10 Copay,38927UT031,,UTN001,UTS001,UTF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51623,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310002-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,5,38927,UT,Individual,No,87-0345631,38927UT0310002,Altius Silver $10 Copay,38927UT031,,UTN001,UTS001,UTF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51623,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,5,38927,UT,Individual,No,87-0345631,38927UT0310002,Altius Silver $10 Copay,38927UT031,,UTN001,UTS001,UTF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51623,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310002-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,5,38927,UT,Individual,No,87-0345631,38927UT0310002,Altius Silver $10 Copay,38927UT031,,UTN001,UTS001,UTF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51623,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310002-04,73% AV Level Silver Plan,72.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,Not Applicable,30%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,5,38927,UT,Individual,No,87-0345631,38927UT0310002,Altius Silver $10 Copay,38927UT031,,UTN001,UTS001,UTF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51623,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310002-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,5,38927,UT,Individual,No,87-0345631,38927UT0310002,Altius Silver $10 Copay,38927UT031,,UTN001,UTS001,UTF002,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51623,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310002-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,Not Applicable,10%,,,,"$1,000",Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,6,38927,UT,Individual,No,87-0345631,38927UT0300002,Altius Silver $10 Copay Peak Preference,38927UT030,,UTN002,UTS002,UTF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51601,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300002-00,Standard Silver Off Exchange Plan,68.10%,,No,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$6,400","$12,800","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$5,500","$11,000",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",Not Applicable,30%,Not Applicable,Not Applicable,45%,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,6,38927,UT,Individual,No,87-0345631,38927UT0300002,Altius Silver $10 Copay Peak Preference,38927UT030,,UTN002,UTS002,UTF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51601,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300002-01,Standard Silver On Exchange Plan,68.10%,,No,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$6,400","$12,800","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$5,500","$11,000",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",Not Applicable,30%,Not Applicable,Not Applicable,45%,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,6,38927,UT,Individual,No,87-0345631,38927UT0300002,Altius Silver $10 Copay Peak Preference,38927UT030,,UTN002,UTS002,UTF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51601,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,6,38927,UT,Individual,No,87-0345631,38927UT0300002,Altius Silver $10 Copay Peak Preference,38927UT030,,UTN002,UTS002,UTF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51601,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300002-03,Limited Cost Sharing Plan Variation,68.10%,,No,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$6,400","$12,800","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$5,500","$11,000",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000",Not Applicable,30%,Not Applicable,Not Applicable,45%,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,6,38927,UT,Individual,No,87-0345631,38927UT0300002,Altius Silver $10 Copay Peak Preference,38927UT030,,UTN002,UTS002,UTF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51601,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300002-04,73% AV Level Silver Plan,72.40%,,No,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$4,850","$9,700","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",30%,"$4,800","$9,600",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,Not Applicable,30%,Not Applicable,Not Applicable,45%,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,6,38927,UT,Individual,No,87-0345631,38927UT0300002,Altius Silver $10 Copay Peak Preference,38927UT030,,UTN002,UTS002,UTF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51601,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300002-05,87% AV Level Silver Plan,86.20%,,No,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$1,800","$3,600","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,"$1,500","$3,000",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,30%,Not Applicable,Not Applicable,45%,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,6,38927,UT,Individual,No,87-0345631,38927UT0300002,Altius Silver $10 Copay Peak Preference,38927UT030,,UTN002,UTS002,UTF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51601,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300002-06,94% AV Level Silver Plan,93.00%,,No,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,950","$2,900",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,$0,$0,25%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,Not Applicable,10%,Not Applicable,Not Applicable,25%,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,7,38927,UT,Individual,No,87-0345631,38927UT0310011,Altius Silver $5 Copay 2750,38927UT031,,UTN001,UTS001,UTF006,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51629,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310011-00,Standard Silver Off Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,7,38927,UT,Individual,No,87-0345631,38927UT0310011,Altius Silver $5 Copay 2750,38927UT031,,UTN001,UTS001,UTF006,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.coventryone.com/UT51629,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0310011-01,Standard Silver On Exchange Plan,68.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,9,38927,UT,Individual,No,87-0345631,38927UT0300001,Altius Gold $0 Copay Peak Preference,38927UT030,,UTN002,UTS002,UTF010,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51600,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300001-00,Standard Gold Off Exchange Plan,78.10%,,No,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,"$2,000","$4,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,UT,38927,SERFF,5,2014-10-06 10:59:03,9,38927,UT,Individual,No,87-0345631,38927UT0300001,Altius Gold $0 Copay Peak Preference,38927UT030,,UTN002,UTS002,UTF010,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes",,1,,,0,0,0,2015-01-01,,No,,No,,No,http://www.coventryone.com/UT51600,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/HMOpeakprefUT2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,38927UT0300001-01,Standard Gold On Exchange Plan,78.10%,,No,Yes,Yes,65%,35%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,"$2,000","$4,000",40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,Not Applicable,Not Applicable,40%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,UT,40335,SERFF,4,2015-02-17 11:12:06,3,40335,UT,Individual,Yes,20-4023720,40335UT0020001,EMI Health Advantage Co-Pay,40335UT002,,UTN002,UTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$7.87,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,PPO network or out-of-network coverage at PPO fee,Yes,http://emihealth.com/file/92E60577-F7D4-4B3E-B61B-254CEF960AA3,http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx,http://emihealth.com/file/92E60577-F7D4-4B3E-B61B-254CEF960AA3,,40335UT0020001-00,Standard High Off Exchange Plan,87.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,UT,40335,SERFF,4,2015-02-17 11:12:06,3,40335,UT,Individual,Yes,20-4023720,40335UT0020001,EMI Health Advantage Co-Pay,40335UT002,,UTN002,UTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$7.87,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,PPO network or out-of-network coverage at PPO fee,Yes,http://emihealth.com/file/92E60577-F7D4-4B3E-B61B-254CEF960AA3,http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx,http://emihealth.com/file/92E60577-F7D4-4B3E-B61B-254CEF960AA3,,40335UT0020001-01,Standard High On Exchange Plan,87.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$25,$75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,UT,40335,SERFF,4,2015-02-17 11:12:06,4,40335,UT,Individual,Yes,20-4023720,40335UT0110001,EMI Health EHB Pediatric Plan ? Advantage Network,40335UT011,,UTN002,UTS001,,Existing,EPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$9.40,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,,Yes,http://emihealth.com/file/6405A066-165E-4678-92BC-EAB03CC9C3DB,http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx,http://emihealth.com/file/6405A066-165E-4678-92BC-EAB03CC9C3DB,,40335UT0110001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,UT,40335,SERFF,4,2015-02-17 11:12:06,4,40335,UT,Individual,Yes,20-4023720,40335UT0110001,EMI Health EHB Pediatric Plan ? Advantage Network,40335UT011,,UTN002,UTS001,,Existing,EPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$9.40,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,,Yes,http://emihealth.com/file/6405A066-165E-4678-92BC-EAB03CC9C3DB,http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx,http://emihealth.com/file/6405A066-165E-4678-92BC-EAB03CC9C3DB,,40335UT0110001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,UT,40335,SERFF,4,2015-02-17 11:12:06,4,40335,UT,Individual,Yes,20-4023720,40335UT0120001,EMI Health EHB Pediatric Plan ? Premier Network,40335UT012,,UTN001,UTS001,,Existing,EPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$11.50,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,,Yes,http://emihealth.com/file/504558C0-9420-4653-80B3-38CAE4EC5174,http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx,http://emihealth.com/file/504558C0-9420-4653-80B3-38CAE4EC5174,,40335UT0120001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,UT,40335,SERFF,4,2015-02-17 11:12:06,4,40335,UT,Individual,Yes,20-4023720,40335UT0120001,EMI Health EHB Pediatric Plan ? Premier Network,40335UT012,,UTN001,UTS001,,Existing,EPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$11.50,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,No,,Yes,http://emihealth.com/file/504558C0-9420-4653-80B3-38CAE4EC5174,http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx,http://emihealth.com/file/504558C0-9420-4653-80B3-38CAE4EC5174,,40335UT0120001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,$0,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,UT,42757,SERFF,2,2014-09-07 12:14:41,1,42757,UT,Individual,Yes,95-6042390,42757UT0020001,BESTOne Child Dental Plus,42757UT002,,UTN001,UTS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$23.87,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,http://www.bestlife.com/UT/2015/UT_BESTOne_Child_Dental_Plus_Plan.pdf,http://www.bestlife.com/pmt,http://www.bestlife.com/UT/2015/UT_BESTOne_Child_Dental_Plus_Plan.pdf,,42757UT0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$35,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,UT,42757,SERFF,2,2014-09-07 12:14:41,1,42757,UT,Individual,Yes,95-6042390,42757UT0020002,BESTOne Child Dental,42757UT002,,UTN001,UTS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$19.44,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,http://www.bestlife.com/UT/2015/UT_BESTOne_Child_Dental_Plan.pdf,http://www.bestlife.com/pmt,http://www.bestlife.com/UT/2015/UT_BESTOne_Child_Dental_Plan.pdf,,42757UT0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,UT,42757,SERFF,2,2014-09-07 12:14:41,2,42757,UT,Individual,Yes,95-6042390,42757UT0020003,BESTOne Dental Advantage-High,42757UT002,,UTN001,UTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.87,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,http://www.bestlife.com/UT/2015/UT_BESTOne_Dental_Advantage-High_Plan.pdf,http://www.bestlife.com/pmt,http://www.bestlife.com/UT/2015/UT_BESTOne_Dental_Advantage-High_Plan.pdf,,42757UT0020003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$35,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,UT,42757,SERFF,2,2014-09-07 12:14:41,2,42757,UT,Individual,Yes,95-6042390,42757UT0020003,BESTOne Dental Advantage-High,42757UT002,,UTN001,UTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.87,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,http://www.bestlife.com/UT/2015/UT_BESTOne_Dental_Advantage-High_Plan.pdf,http://www.bestlife.com/pmt,http://www.bestlife.com/UT/2015/UT_BESTOne_Dental_Advantage-High_Plan.pdf,,42757UT0020003-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$35,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,UT,42757,SERFF,2,2014-09-07 12:14:41,2,42757,UT,Individual,Yes,95-6042390,42757UT0020004,BESTOne Dental Plus-High,42757UT002,,UTN001,UTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.87,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,http://www.bestlife.com/UT/2015/UT_BESTOne_Dental_Plus-High_Plan.pdf,http://www.bestlife.com/pmt,http://www.bestlife.com/UT/2015/UT_BESTOne_Dental_Plus-High_Plan.pdf,,42757UT0020004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$35,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,UT,42757,SERFF,2,2014-09-07 12:14:41,2,42757,UT,Individual,Yes,95-6042390,42757UT0020004,BESTOne Dental Plus-High,42757UT002,,UTN001,UTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.87,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,http://www.bestlife.com/UT/2015/UT_BESTOne_Dental_Plus-High_Plan.pdf,http://www.bestlife.com/pmt,http://www.bestlife.com/UT/2015/UT_BESTOne_Dental_Plus-High_Plan.pdf,,42757UT0020004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$35,Not Applicable,,,,,$35,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,UT,42757,SERFF,2,2014-09-07 12:14:41,2,42757,UT,Individual,Yes,95-6042390,42757UT0020005,BESTOne Dental Plus-Low,42757UT002,,UTN001,UTS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.44,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,http://www.bestlife.com/UT/2015/UT_BESTOne_Dental_Plus-Low_Plan.pdf,http://www.bestlife.com/pmt,http://www.bestlife.com/UT/2015/UT_BESTOne_Dental_Plus-Low_Plan.pdf,,42757UT0020005-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,UT,42757,SERFF,2,2014-09-07 12:14:41,2,42757,UT,Individual,Yes,95-6042390,42757UT0020005,BESTOne Dental Plus-Low,42757UT002,,UTN001,UTS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.44,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,http://www.bestlife.com/UT/2015/UT_BESTOne_Dental_Plus-Low_Plan.pdf,http://www.bestlife.com/pmt,http://www.bestlife.com/UT/2015/UT_BESTOne_Dental_Plus-Low_Plan.pdf,,42757UT0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,UT,42757,SERFF,2,2014-09-07 12:14:41,2,42757,UT,Individual,Yes,95-6042390,42757UT0020006,BESTOne Dental Basic-Low,42757UT002,,UTN001,UTS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.44,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,http://www.bestlife.com/UT/2015/UT_BESTOne_Dental_Basic-Low_Plan.pdf,http://www.bestlife.com/pmt,http://www.bestlife.com/UT/2015/UT_BESTOne_Dental_Basic-Low_Plan.pdf,,42757UT0020006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,UT,42757,SERFF,2,2014-09-07 12:14:41,2,42757,UT,Individual,Yes,95-6042390,42757UT0020006,BESTOne Dental Basic-Low,42757UT002,,UTN001,UTS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$19.44,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Reimbursement at UCR,Yes,http://www.bestlife.com/UT/2015/UT_BESTOne_Dental_Basic-Low_Plan.pdf,http://www.bestlife.com/pmt,http://www.bestlife.com/UT/2015/UT_BESTOne_Dental_Basic-Low_Plan.pdf,,42757UT0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,$350,$700,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,UT,46958,SERFF,4,2015-01-22 16:02:51,1,46958,UT,Individual,Yes,39-1263473,46958UT0470001,Humana Dental Smart Choice Basic,46958UT047,,UTN001,UTS001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.20,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,"Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.",Yes,,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,www.humana.com,,46958UT0470001-01,Standard Low On Exchange Plan,70.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,1,56764,UT,Individual,No,20-8411422,56764UT0010004,Humana Silver 4600/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344680,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335840,http://apps.humana.com/marketing/documents.asp?file=2323854,56764UT0010004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,1,56764,UT,Individual,No,20-8411422,56764UT0010004,Humana Silver 4600/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344680,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335840,http://apps.humana.com/marketing/documents.asp?file=2323854,56764UT0010004-03,Limited Cost Sharing Plan Variation,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030017,Select Care HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible),68781UT003,,UTN001,UTS001,UTF008,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_silver_3500_hsa_no_coinsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_silver_3500_hsa_no_coinsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030017-04,73% AV Level Silver Plan,,0.732454240322113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,84
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010010,Select Value Preference Bronze 5000,68781UT001,,UTN003,UTS003,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_bronze_500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_bronze_500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,32
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010010,Select Value Preference Bronze 5000,68781UT001,,UTN003,UTS003,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_bronze_500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_bronze_500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010010-03,Limited Cost Sharing Plan Variation,,0.603495538234711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0010004,Select Value Preference Gold 500 w/no deductible for office visits,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0010004,Select Value Preference Gold 500 w/no deductible for office visits,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010004-03,Limited Cost Sharing Plan Variation,,0.794067025184631,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0030002,Select Care Preference Gold 250 w/office deductible waiver,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_250_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_250_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,30
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0030002,Select Care Preference Gold 250 w/office deductible waiver,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_250_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_250_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030002-03,Limited Cost Sharing Plan Variation,,0.811156451702118,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0030011,Select Care Preference Bronze 5350 w/4 deductible-free office visits,68781UT003,,UTN001,UTS001,UTF004,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_bronze_5350_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_bronze_5350_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030011-00,Standard Bronze Off Exchange Plan,,0.611545562744141,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,350","$10,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,4,68781,UT,Individual,No,87-0409820,68781UT0030012,Select Care Preference Silver 3800 Copay Plan,68781UT003,,UTN001,UTS001,UTF005,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,5,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_3800_copay,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_3800_copay,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030012-01,Standard Silver On Exchange Plan,71.59%,0.715853273868561,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,800","$7,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$2,500",Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010016,Select Value HealthSave Bronze 3500 (HSA Qualified),68781UT001,,UTN003,UTS003,UTF007,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_bronze_3500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_bronze_3500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,20
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010016,Select Value HealthSave Bronze 3500 (HSA Qualified),68781UT001,,UTN003,UTS003,UTF007,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_bronze_3500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_bronze_3500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010016-03,Limited Cost Sharing Plan Variation,,0.615942656993866,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,21
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0130010,Select Med Preference Benchmark Bronze 5000,68781UT013,,UTN002,UTS002,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_benchmark_bronze_5000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_benchmark_bronze_5000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0130010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,24
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0130010,Select Med Preference Benchmark Bronze 5000,68781UT013,,UTN002,UTS002,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_benchmark_bronze_5000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_benchmark_bronze_5000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0130010-03,Limited Cost Sharing Plan Variation,,0.603495538234711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010001,Select Value Preference Gold 250,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_250,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_250,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010001-01,Standard Gold On Exchange Plan,,0.804468274116516,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020010,Select Med Preference Bronze 5000,68781UT002,,UTN002,UTS002,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_bronze_5000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_bronze_5000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020010-00,Standard Bronze Off Exchange Plan,,0.603495538234711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,60
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010003,Select Value Preference Gold 500,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010003-01,Standard Gold On Exchange Plan,,0.788360893726349,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0030009,Select Care Preference Silver 2500 w/4 deductible-free office visits,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_2500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_2500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030009-00,Standard Silver Off Exchange Plan,71.26%,0.712623178958893,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0120010,Select Value Preference Benchmark Bronze 5000,68781UT012,,UTN003,UTS003,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_benchmark_bronze_5000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_benchmark_bronze_5000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0120010-01,Standard Bronze On Exchange Plan,,0.603495538234711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,3,10207,VA,Individual,No,52-1358219,10207VA0410001,"HealthyBlue Gold $1,500",10207VA041,,VAN003,VAS001,VAF007,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,All covered services out of network only,Yes,All covered services,Yes,http://content.carefirst.com/sbc/HCNVBN7NRXXVBN7CN012015.pdf,,,www.carefirst.com/acarx,10207VA0410001-00,Standard Gold Off Exchange Plan,81.97%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,450","$6,900",,,"$3,450","$6,900",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$400,$800,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$450,$0,$30,"$1,220",$0,$0,$0,4
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,3,10207,VA,Individual,No,52-1358219,10207VA0410001,"HealthyBlue Gold $1,500",10207VA041,,VAN003,VAS001,VAF007,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,All covered services out of network only,Yes,All covered services,Yes,http://content.carefirst.com/sbc/HCNVBN7NRXXVBN7CN012015.pdf,,,www.carefirst.com/acarx,10207VA0410001-01,Standard Gold On Exchange Plan,81.97%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,450","$6,900",,,"$3,450","$6,900",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$400,$800,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$450,$0,$30,"$1,220",$0,$0,$0,5
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,3,10207,VA,Individual,No,52-1358219,10207VA0410001,"HealthyBlue Gold $1,500",10207VA041,,VAN003,VAS001,VAF007,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,All covered services out of network only,Yes,All covered services,Yes,http://content.carefirst.com/sbc/HCNVBN7NRXXVBN7CN012015.pdf,,,www.carefirst.com/acarx,10207VA0410001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$30,$0,$0,$0,$0,6
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,3,10207,VA,Individual,No,52-1358219,10207VA0410001,"HealthyBlue Gold $1,500",10207VA041,,VAN003,VAS001,VAF007,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,All covered services out of network only,Yes,All covered services,Yes,http://content.carefirst.com/sbc/HCNVBN7NRXXVBN7CN012015.pdf,,,www.carefirst.com/acarx,10207VA0410001-03,Limited Cost Sharing Plan Variation,81.97%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,450","$6,900",,,"$3,450","$6,900",Not Applicable,Not Applicable,"$1,500","$3,000",0%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$400,$800,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,500",$450,$0,$30,"$1,220",$0,$0,$0,7
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,1,56764,UT,Individual,No,20-8411422,56764UT0010004,Humana Silver 4600/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344680,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335840,http://apps.humana.com/marketing/documents.asp?file=2323854,56764UT0010004-00,Standard Silver Off Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,1,56764,UT,Individual,No,20-8411422,56764UT0010004,Humana Silver 4600/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344680,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335840,http://apps.humana.com/marketing/documents.asp?file=2323854,56764UT0010004-01,Standard Silver On Exchange Plan,,0.688010096549988,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,600","$9,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,1,56764,UT,Individual,No,20-8411422,56764UT0010004,Humana Silver 4600/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344680,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335840,http://apps.humana.com/marketing/documents.asp?file=2323854,56764UT0010004-04,73% AV Level Silver Plan,,0.725208818912506,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,250","$6,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,1,56764,UT,Individual,No,20-8411422,56764UT0010004,Humana Silver 4600/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344680,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335840,http://apps.humana.com/marketing/documents.asp?file=2323854,56764UT0010004-05,87% AV Level Silver Plan,,0.863511264324188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$1,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$900,"$1,800",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,1,56764,UT,Individual,No,20-8411422,56764UT0010004,Humana Silver 4600/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF003,Existing,HMO,Silver,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344680,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335840,http://apps.humana.com/marketing/documents.asp?file=2323854,56764UT0010004-06,94% AV Level Silver Plan,,0.939613163471222,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,1,56764,UT,Individual,No,20-8411422,56764UT0010005,Humana Gold 2500/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344628,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335892,http://apps.humana.com/marketing/documents.asp?file=2323854,56764UT0010005-00,Standard Gold Off Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,1,56764,UT,Individual,No,20-8411422,56764UT0010005,Humana Gold 2500/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344628,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335892,http://apps.humana.com/marketing/documents.asp?file=2323854,56764UT0010005-01,Standard Gold On Exchange Plan,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,1,56764,UT,Individual,No,20-8411422,56764UT0010005,Humana Gold 2500/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344628,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335892,http://apps.humana.com/marketing/documents.asp?file=2323854,56764UT0010005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,1,56764,UT,Individual,No,20-8411422,56764UT0010005,Humana Gold 2500/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF004,Existing,HMO,Gold,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344628,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335892,http://apps.humana.com/marketing/documents.asp?file=2323854,56764UT0010005-03,Limited Cost Sharing Plan Variation,,0.782948732376099,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,1,56764,UT,Individual,No,20-8411422,56764UT0010006,Humana Platinum 1000/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344641,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335905,http://apps.humana.com/marketing/documents.asp?file=2323854,56764UT0010006-00,Standard Platinum Off Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,1,56764,UT,Individual,No,20-8411422,56764UT0010006,Humana Platinum 1000/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344641,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335905,http://apps.humana.com/marketing/documents.asp?file=2323854,56764UT0010006-01,Standard Platinum On Exchange Plan,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,1,56764,UT,Individual,No,20-8411422,56764UT0010006,Humana Platinum 1000/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344641,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335905,http://apps.humana.com/marketing/documents.asp?file=2323854,56764UT0010006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,1,56764,UT,Individual,No,20-8411422,56764UT0010006,Humana Platinum 1000/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF004,Existing,HMO,Platinum,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344641,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335905,http://apps.humana.com/marketing/documents.asp?file=2323854,56764UT0010006-03,Limited Cost Sharing Plan Variation,,0.905480265617371,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",35%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,2,56764,UT,Individual,No,20-8411422,56764UT0010003,Humana Bronze 4850/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344602,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335827,http://apps.humana.com/marketing/documents.asp?file=2323854,56764UT0010003-00,Standard Bronze Off Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,2,56764,UT,Individual,No,20-8411422,56764UT0010003,Humana Bronze 4850/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344602,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335827,http://apps.humana.com/marketing/documents.asp?file=2323854,56764UT0010003-01,Standard Bronze On Exchange Plan,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,2,56764,UT,Individual,No,20-8411422,56764UT0010003,Humana Bronze 4850/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344602,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335827,http://apps.humana.com/marketing/documents.asp?file=2323854,56764UT0010003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,2,56764,UT,Individual,No,20-8411422,56764UT0010003,Humana Bronze 4850/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF002,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344602,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335827,http://apps.humana.com/marketing/documents.asp?file=2323854,56764UT0010003-03,Limited Cost Sharing Plan Variation,,0.614312052726746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,850","$9,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,3,56764,UT,Individual,No,20-8411422,56764UT0010002,Humana Bronze 6300/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344615,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335814,http://apps.humana.com/marketing/documents.asp?file=2323789,56764UT0010002-00,Standard Bronze Off Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,3,56764,UT,Individual,No,20-8411422,56764UT0010002,Humana Bronze 6300/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344615,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335814,http://apps.humana.com/marketing/documents.asp?file=2323789,56764UT0010002-01,Standard Bronze On Exchange Plan,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,3,56764,UT,Individual,No,20-8411422,56764UT0010002,Humana Bronze 6300/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344615,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335814,http://apps.humana.com/marketing/documents.asp?file=2323789,56764UT0010002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,3,56764,UT,Individual,No,20-8411422,56764UT0010002,Humana Bronze 6300/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF001,Existing,HMO,Bronze,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,0,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344615,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335814,http://apps.humana.com/marketing/documents.asp?file=2323789,56764UT0010002-03,Limited Cost Sharing Plan Variation,,0.581636846065521,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,7,56764,UT,Individual,No,20-8411422,56764UT0010001,Humana Basic 6600/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344589,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335801,http://apps.humana.com/marketing/documents.asp?file=2323789,56764UT0010001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,UT,56764,SERFF,2,2014-09-09 16:12:42,7,56764,UT,Individual,No,20-8411422,56764UT0010001,Humana Basic 6600/Salt Lake City HMOx,56764UT001,,UTN001,UTS001,UTF001,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9898,,,0,0,3,2015-01-01,,Yes,Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.,Yes,Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.,No,http://apps.humana.com/marketing/documents.asp?file=2344589,www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage,http://apps.humana.com/marketing/documents.asp?file=2335801,http://apps.humana.com/marketing/documents.asp?file=2323789,56764UT0010001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010001,Select Value Preference Gold 250,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_250,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_250,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010001-00,Standard Gold Off Exchange Plan,,0.804468274116516,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010008,Select Value Preference Silver 2500,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_2500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_2500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010008-01,Standard Silver On Exchange Plan,,0.689096033573151,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020010,Select Med Preference Bronze 5000,68781UT002,,UTN002,UTS002,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_bronze_5000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_bronze_5000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020010-01,Standard Bronze On Exchange Plan,,0.603495538234711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,61
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0030007,Select Care Preference Gold 1000 w/no deductible for office visits,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_1000_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_1000_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,38
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0030007,Select Care Preference Gold 1000 w/no deductible for office visits,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_1000_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_1000_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030007-03,Limited Cost Sharing Plan Variation,,0.818034648895264,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$500,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0020009,Select Med Preference Silver 2500 w/4 deductible-free office visits,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_2500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_2500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020009-05,87% AV Level Silver Plan,87.01%,0.870065748691559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,15%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,4,68781,UT,Individual,No,87-0409820,68781UT0030012,Select Care Preference Silver 3800 Copay Plan,68781UT003,,UTN001,UTS001,UTF005,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,5,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_3800_copay,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_3800_copay,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030012-06,94% AV Level Silver Plan,93.71%,0.93706750869751,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,5%,,,,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010017,Select Value HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible),68781UT001,,UTN003,UTS003,UTF008,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_silver_3500_hsa_no_coinsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_silver_3500_hsa_no_coinsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,24
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010017,Select Value HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible),68781UT001,,UTN003,UTS003,UTF008,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_silver_3500_hsa_no_coinsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_silver_3500_hsa_no_coinsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010017-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010001,Select Value Preference Gold 250,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_250,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_250,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010001,Select Value Preference Gold 250,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_250,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_250,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010001-03,Limited Cost Sharing Plan Variation,,0.804468274116516,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010003,Select Value Preference Gold 500,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010003-00,Standard Gold Off Exchange Plan,,0.788360893726349,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010003,Select Value Preference Gold 500,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010003,Select Value Preference Gold 500,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010003-03,Limited Cost Sharing Plan Variation,,0.788360893726349,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010005,Select Value Preference Silver 1000,68781UT001,,UTN003,UTS003,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010005-00,Standard Silver Off Exchange Plan,,0.697579860687256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010005,Select Value Preference Silver 1000,68781UT001,,UTN003,UTS003,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010005-01,Standard Silver On Exchange Plan,,0.697579860687256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010005,Select Value Preference Silver 1000,68781UT001,,UTN003,UTS003,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010005,Select Value Preference Silver 1000,68781UT001,,UTN003,UTS003,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010005-03,Limited Cost Sharing Plan Variation,,0.697579860687256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010005,Select Value Preference Silver 1000,68781UT001,,UTN003,UTS003,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010005-04,73% AV Level Silver Plan,,0.735162734985352,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010005,Select Value Preference Silver 1000,68781UT001,,UTN003,UTS003,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010005-05,87% AV Level Silver Plan,,0.86578643321991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,15%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010005,Select Value Preference Silver 1000,68781UT001,,UTN003,UTS003,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010005-06,94% AV Level Silver Plan,,0.946797907352448,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,5%,,,,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010006,Select Value Preference Gold 1000,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010006-00,Standard Gold Off Exchange Plan,,0.783298194408417,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010006,Select Value Preference Gold 1000,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010006-01,Standard Gold On Exchange Plan,,0.783298194408417,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010006,Select Value Preference Gold 1000,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010006,Select Value Preference Gold 1000,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010006-03,Limited Cost Sharing Plan Variation,,0.783298194408417,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010008,Select Value Preference Silver 2500,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_2500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_2500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010008-00,Standard Silver Off Exchange Plan,,0.689096033573151,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010008,Select Value Preference Silver 2500,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_2500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_2500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,25
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010008,Select Value Preference Silver 2500,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_2500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_2500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010008-03,Limited Cost Sharing Plan Variation,,0.689096033573151,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010008,Select Value Preference Silver 2500,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_2500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_2500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010008-04,73% AV Level Silver Plan,,0.738673806190491,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010008,Select Value Preference Silver 2500,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_2500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_2500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010008-05,87% AV Level Silver Plan,,0.86578643321991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,15%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010008,Select Value Preference Silver 2500,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_2500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_2500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010008-06,94% AV Level Silver Plan,,0.946797907352448,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,5%,,,,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010010,Select Value Preference Bronze 5000,68781UT001,,UTN003,UTS003,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_bronze_500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_bronze_500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010010-00,Standard Bronze Off Exchange Plan,,0.603495538234711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0010010,Select Value Preference Bronze 5000,68781UT001,,UTN003,UTS003,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_bronze_500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_bronze_500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010010-01,Standard Bronze On Exchange Plan,,0.603495538234711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020001,Select Med Preference Gold 250,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_250,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_250,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020001-00,Standard Gold Off Exchange Plan,,0.804468274116516,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020001,Select Med Preference Gold 250,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_250,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_250,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020001-01,Standard Gold On Exchange Plan,,0.804468274116516,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020001,Select Med Preference Gold 250,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_250,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_250,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,36
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020001,Select Med Preference Gold 250,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_250,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_250,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020001-03,Limited Cost Sharing Plan Variation,,0.804468274116516,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020003,Select Med Preference Gold 500,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020003-00,Standard Gold Off Exchange Plan,,0.788360893726349,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,38
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020003,Select Med Preference Gold 500,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020003-01,Standard Gold On Exchange Plan,,0.788360893726349,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,39
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020003,Select Med Preference Gold 500,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,40
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020003,Select Med Preference Gold 500,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020003-03,Limited Cost Sharing Plan Variation,,0.788360893726349,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,41
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020005,Select Med Preference Silver 1000,68781UT002,,UTN002,UTS002,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020005-00,Standard Silver Off Exchange Plan,,0.697579860687256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,42
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020005,Select Med Preference Silver 1000,68781UT002,,UTN002,UTS002,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020005-01,Standard Silver On Exchange Plan,,0.697579860687256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,43
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020005,Select Med Preference Silver 1000,68781UT002,,UTN002,UTS002,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,44
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020005,Select Med Preference Silver 1000,68781UT002,,UTN002,UTS002,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020005-03,Limited Cost Sharing Plan Variation,,0.697579860687256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,45
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020005,Select Med Preference Silver 1000,68781UT002,,UTN002,UTS002,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020005-04,73% AV Level Silver Plan,,0.735162734985352,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,46
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020005,Select Med Preference Silver 1000,68781UT002,,UTN002,UTS002,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020005-05,87% AV Level Silver Plan,,0.86578643321991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,15%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,47
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020005,Select Med Preference Silver 1000,68781UT002,,UTN002,UTS002,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020005-06,94% AV Level Silver Plan,,0.946797907352448,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,5%,,,,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,48
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020006,Select Med Preference Gold 1000,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020006-00,Standard Gold Off Exchange Plan,,0.783298194408417,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,49
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020006,Select Med Preference Gold 1000,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020006-01,Standard Gold On Exchange Plan,,0.783298194408417,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,50
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020006,Select Med Preference Gold 1000,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,51
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020006,Select Med Preference Gold 1000,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020006-03,Limited Cost Sharing Plan Variation,,0.783298194408417,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,52
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020008,Select Med Preference Silver 2500,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_2500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_2500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020008-00,Standard Silver Off Exchange Plan,,0.689096033573151,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,53
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020008,Select Med Preference Silver 2500,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_2500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_2500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020008-01,Standard Silver On Exchange Plan,,0.689096033573151,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,54
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020008,Select Med Preference Silver 2500,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_2500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_2500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,55
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020008,Select Med Preference Silver 2500,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_2500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_2500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020008-03,Limited Cost Sharing Plan Variation,,0.689096033573151,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,56
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020008,Select Med Preference Silver 2500,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_2500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_2500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020008-04,73% AV Level Silver Plan,,0.738673806190491,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,57
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020008,Select Med Preference Silver 2500,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_2500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_2500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020008-05,87% AV Level Silver Plan,,0.86578643321991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,15%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,58
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020008,Select Med Preference Silver 2500,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_2500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_2500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020008-06,94% AV Level Silver Plan,,0.946797907352448,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,5%,,,,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,59
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020010,Select Med Preference Bronze 5000,68781UT002,,UTN002,UTS002,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_bronze_5000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_bronze_5000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,62
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0020010,Select Med Preference Bronze 5000,68781UT002,,UTN002,UTS002,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_bronze_5000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_bronze_5000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020010-03,Limited Cost Sharing Plan Variation,,0.603495538234711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,63
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030001,Select Care Preference Gold 250,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_250,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_250,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030001-00,Standard Gold Off Exchange Plan,,0.804468274116516,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,64
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030001,Select Care Preference Gold 250,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_250,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_250,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030001-01,Standard Gold On Exchange Plan,,0.804468274116516,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,65
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,4,10207,VA,Individual,No,52-1358219,10207VA0400001,"BlueChoice Plus Bronze $5,500",10207VA040,,VAN004,VAS001,VAF006,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,All covered services out of network only,Yes,All covered services,Yes,http://content.carefirst.com/sbc/BTPVBN5NRXCVBN5CN012015.pdf,,,www.carefirst.com/acarx,10207VA0400001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$30,$0,$0,$0,$0,6
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,4,10207,VA,Individual,No,52-1358219,10207VA0400001,"BlueChoice Plus Bronze $5,500",10207VA040,,VAN004,VAS001,VAF006,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,All covered services out of network only,Yes,All covered services,Yes,http://content.carefirst.com/sbc/BTPVBN5NRXCVBN5CN012015.pdf,,,www.carefirst.com/acarx,10207VA0400001-03,Limited Cost Sharing Plan Variation,61.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$6,350","$12,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$6,350","$12,700",Not Applicable,Not Applicable,"$5,250",$0,$0,$30,"$5,210",$0,$0,$0,7
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,4,10207,VA,Individual,No,52-1358219,10207VA0400002,"BlueChoice Plus Silver $2,500",10207VA040,,VAN004,VAS001,VAF006,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,All covered services out of network only,Yes,All covered services,Yes,http://content.carefirst.com/sbc/BTPVBN6NRXXVBN6CN012015.pdf,,,www.carefirst.com/acarx,10207VA0400002-00,Standard Silver Off Exchange Plan,70.18%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$6,350","$12,700",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$400,$800,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,525",$0,$545,$30,"$2,730",$360,$0,$0,8
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,4,10207,VA,Individual,No,52-1358219,10207VA0400002,"BlueChoice Plus Silver $2,500",10207VA040,,VAN004,VAS001,VAF006,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,All covered services out of network only,Yes,All covered services,Yes,http://content.carefirst.com/sbc/BTPVBN6NRXXVBN6CN012015.pdf,,,www.carefirst.com/acarx,10207VA0400002-01,Standard Silver On Exchange Plan,70.18%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$6,350","$12,700",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$400,$800,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,525",$0,$545,$30,"$2,730",$360,$0,$0,9
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,4,10207,VA,Individual,No,52-1358219,10207VA0400002,"BlueChoice Plus Silver $2,500",10207VA040,,VAN004,VAS001,VAF006,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,All covered services out of network only,Yes,All covered services,Yes,http://content.carefirst.com/sbc/BTPVBN6NRXXVBN6CN012015.pdf,,,www.carefirst.com/acarx,10207VA0400002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$30,$0,$0,$0,$0,10
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,4,10207,VA,Individual,No,52-1358219,10207VA0400002,"BlueChoice Plus Silver $2,500",10207VA040,,VAN004,VAS001,VAF006,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,All covered services out of network only,Yes,All covered services,Yes,http://content.carefirst.com/sbc/BTPVBN6NRXXVBN6CN012015.pdf,,,www.carefirst.com/acarx,10207VA0400002-03,Limited Cost Sharing Plan Variation,70.18%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$6,350","$12,700",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$400,$800,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$2,525",$0,$545,$30,"$2,730",$360,$0,$0,11
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,4,10207,VA,Individual,No,52-1358219,10207VA0400002,"BlueChoice Plus Silver $2,500",10207VA040,,VAN004,VAS001,VAF006,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,All covered services out of network only,Yes,All covered services,Yes,http://content.carefirst.com/sbc/BTPVBN6NRXXVBN6CN012015.pdf,,,www.carefirst.com/acarx,10207VA0400002-04,73% AV Level Silver Plan,73.91%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$5,200","$10,400",Not Applicable,Not Applicable,"$1,600","$3,200",20%,,,,"$3,500","$7,000",Not Applicable,Not Applicable,$400,$800,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,625",$0,$725,$30,"$2,000",$400,$108,$0,12
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,4,10207,VA,Individual,No,52-1358219,10207VA0400002,"BlueChoice Plus Silver $2,500",10207VA040,,VAN004,VAS001,VAF006,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,All covered services out of network only,Yes,All covered services,Yes,http://content.carefirst.com/sbc/BTPVBN6NRXXVBN6CN012015.pdf,,,www.carefirst.com/acarx,10207VA0400002-05,87% AV Level Silver Plan,87.86%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$2,250","$4,500",Not Applicable,Not Applicable,$0,$0,20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$10,"$1,045",$30,$0,$280,$270,$0,13
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0010011,Select Value Preference Bronze 5350 w/4 deductible-free office visits,68781UT001,,UTN003,UTS003,UTF004,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_bronze_500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_bronze_500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010011-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0010011,Select Value Preference Bronze 5350 w/4 deductible-free office visits,68781UT001,,UTN003,UTS003,UTF004,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_bronze_500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_bronze_500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010011-03,Limited Cost Sharing Plan Variation,,0.611545562744141,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,350","$10,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,4,68781,UT,Individual,No,87-0409820,68781UT0030012,Select Care Preference Silver 3800 Copay Plan,68781UT003,,UTN001,UTS001,UTF005,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,5,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_3800_copay,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_3800_copay,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030012-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,4,68781,UT,Individual,No,87-0409820,68781UT0030012,Select Care Preference Silver 3800 Copay Plan,68781UT003,,UTN001,UTS001,UTF005,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,5,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_3800_copay,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_3800_copay,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030012-03,Limited Cost Sharing Plan Variation,71.59%,0.715853273868561,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,800","$7,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$2,500",Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010017,Select Value HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible),68781UT001,,UTN003,UTS003,UTF008,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_silver_3500_hsa_no_coinsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_silver_3500_hsa_no_coinsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010017-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030001,Select Care Preference Gold 250,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_250,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_250,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,66
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030001,Select Care Preference Gold 250,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_250,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_250,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030001-03,Limited Cost Sharing Plan Variation,,0.804468274116516,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,67
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030003,Select Care Preference Gold 500,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030003-00,Standard Gold Off Exchange Plan,,0.788360893726349,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,68
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030003,Select Care Preference Gold 500,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030003-01,Standard Gold On Exchange Plan,,0.788360893726349,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,69
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030003,Select Care Preference Gold 500,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,70
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030003,Select Care Preference Gold 500,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030003-03,Limited Cost Sharing Plan Variation,,0.788360893726349,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,71
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030005,Select Care Preference Silver 1000,68781UT003,,UTN001,UTS001,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030005-00,Standard Silver Off Exchange Plan,,0.697579860687256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,72
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030005,Select Care Preference Silver 1000,68781UT003,,UTN001,UTS001,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030005-01,Standard Silver On Exchange Plan,,0.697579860687256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,73
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030005,Select Care Preference Silver 1000,68781UT003,,UTN001,UTS001,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,74
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030005,Select Care Preference Silver 1000,68781UT003,,UTN001,UTS001,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030005-03,Limited Cost Sharing Plan Variation,,0.697579860687256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,75
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030005,Select Care Preference Silver 1000,68781UT003,,UTN001,UTS001,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030005-04,73% AV Level Silver Plan,,0.735162734985352,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,76
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030005,Select Care Preference Silver 1000,68781UT003,,UTN001,UTS001,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030005-05,87% AV Level Silver Plan,,0.86578643321991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,15%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,77
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030005,Select Care Preference Silver 1000,68781UT003,,UTN001,UTS001,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030005-06,94% AV Level Silver Plan,,0.946797907352448,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,5%,,,,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,78
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030006,Select Care Preference Gold 1000,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030006-00,Standard Gold Off Exchange Plan,,0.783298194408417,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,79
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030006,Select Care Preference Gold 1000,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030006-01,Standard Gold On Exchange Plan,,0.783298194408417,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,80
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030006,Select Care Preference Gold 1000,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,81
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030006,Select Care Preference Gold 1000,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030006-03,Limited Cost Sharing Plan Variation,,0.783298194408417,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,82
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030008,Select Care Preference Silver 2500,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_2500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_2500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030008-00,Standard Silver Off Exchange Plan,,0.689096033573151,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,83
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030008,Select Care Preference Silver 2500,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_2500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_2500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030008-01,Standard Silver On Exchange Plan,,0.689096033573151,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,84
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030008,Select Care Preference Silver 2500,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_2500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_2500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,85
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030008,Select Care Preference Silver 2500,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_2500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_2500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030008-03,Limited Cost Sharing Plan Variation,,0.689096033573151,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,86
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030008,Select Care Preference Silver 2500,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_2500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_2500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030008-04,73% AV Level Silver Plan,,0.738673806190491,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,87
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030008,Select Care Preference Silver 2500,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_2500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_2500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030008-05,87% AV Level Silver Plan,,0.86578643321991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,15%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,88
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030008,Select Care Preference Silver 2500,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_2500,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_2500,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030008-06,94% AV Level Silver Plan,,0.946797907352448,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,5%,,,,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,89
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030010,Select Care Preference Bronze 5000,68781UT003,,UTN001,UTS001,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_bronze_5000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_bronze_5000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030010-00,Standard Bronze Off Exchange Plan,,0.603495538234711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,90
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030010,Select Care Preference Bronze 5000,68781UT003,,UTN001,UTS001,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_bronze_5000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_bronze_5000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030010-01,Standard Bronze On Exchange Plan,,0.603495538234711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,91
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030010,Select Care Preference Bronze 5000,68781UT003,,UTN001,UTS001,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_bronze_5000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_bronze_5000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,92
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,1,68781,UT,Individual,No,87-0409820,68781UT0030010,Select Care Preference Bronze 5000,68781UT003,,UTN001,UTS001,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_bronze_5000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_bronze_5000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030010-03,Limited Cost Sharing Plan Variation,,0.603495538234711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,93
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0010002,Select Value Preference Gold 250 w/no deductible for office visits,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_250_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_250_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010002-00,Standard Gold Off Exchange Plan,,0.811156451702118,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0010002,Select Value Preference Gold 250 w/no deductible for office visits,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_250_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_250_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010002-01,Standard Gold On Exchange Plan,,0.811156451702118,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0010002,Select Value Preference Gold 250 w/no deductible for office visits,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_250_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_250_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0010002,Select Value Preference Gold 250 w/no deductible for office visits,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_250_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_250_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010002-03,Limited Cost Sharing Plan Variation,,0.811156451702118,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0020007,Select Med Preference Gold 1000 w/no deductible for office visits,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_1000_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_1000_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020007-01,Standard Gold On Exchange Plan,,0.818034648895264,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$500,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,4,68781,UT,Individual,No,87-0409820,68781UT0010012,Select Value Preference Silver 3800 Copay Plan,68781UT001,,UTN003,UTS003,UTF005,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,5,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_3800_copay,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_3800_copay,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010012-06,94% AV Level Silver Plan,93.71%,0.93706750869751,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,5%,,,,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0120010,Select Value Preference Benchmark Bronze 5000,68781UT012,,UTN003,UTS003,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_benchmark_bronze_5000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_benchmark_bronze_5000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0120010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0120010,Select Value Preference Benchmark Bronze 5000,68781UT012,,UTN003,UTS003,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_benchmark_bronze_5000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_benchmark_bronze_5000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0120010-03,Limited Cost Sharing Plan Variation,,0.603495538234711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0010004,Select Value Preference Gold 500 w/no deductible for office visits,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010004-00,Standard Gold Off Exchange Plan,,0.794067025184631,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0010004,Select Value Preference Gold 500 w/no deductible for office visits,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010004-01,Standard Gold On Exchange Plan,,0.794067025184631,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0010007,Select Value Preference Gold 1000 w/no deductible for office visits,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_1000_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_1000_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010007-00,Standard Gold Off Exchange Plan,,0.818034648895264,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$500,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0010007,Select Value Preference Gold 1000 w/no deductible for office visits,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_1000_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_1000_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010007-01,Standard Gold On Exchange Plan,,0.818034648895264,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$500,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0010007,Select Value Preference Gold 1000 w/no deductible for office visits,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_1000_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_1000_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0010007,Select Value Preference Gold 1000 w/no deductible for office visits,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_gold_1000_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_gold_1000_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010007-03,Limited Cost Sharing Plan Variation,,0.818034648895264,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$500,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0020002,Select Med Preference Gold 250 w/no deductible for office visits,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_250_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_250_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020002-00,Standard Gold Off Exchange Plan,,0.811156451702118,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0020002,Select Med Preference Gold 250 w/no deductible for office visits,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_250_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_250_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020002-01,Standard Gold On Exchange Plan,,0.811156451702118,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0020002,Select Med Preference Gold 250 w/no deductible for office visits,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_250_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_250_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0020002,Select Med Preference Gold 250 w/no deductible for office visits,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_250_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_250_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020002-03,Limited Cost Sharing Plan Variation,,0.811156451702118,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0020004,Select Med Preference Gold 500 w/no deductible for office visits,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020004-00,Standard Gold Off Exchange Plan,,0.794067025184631,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0020004,Select Med Preference Gold 500 w/no deductible for office visits,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020004-01,Standard Gold On Exchange Plan,,0.794067025184631,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0020004,Select Med Preference Gold 500 w/no deductible for office visits,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0020004,Select Med Preference Gold 500 w/no deductible for office visits,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020004-03,Limited Cost Sharing Plan Variation,,0.794067025184631,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0020007,Select Med Preference Gold 1000 w/no deductible for office visits,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_1000_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_1000_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020007-00,Standard Gold Off Exchange Plan,,0.818034648895264,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$500,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0020007,Select Med Preference Gold 1000 w/no deductible for office visits,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_1000_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_1000_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,26
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0020007,Select Med Preference Gold 1000 w/no deductible for office visits,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_gold_1000_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_gold_1000_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020007-03,Limited Cost Sharing Plan Variation,,0.818034648895264,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$500,Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0030002,Select Care Preference Gold 250 w/office deductible waiver,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_250_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_250_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030002-00,Standard Gold Off Exchange Plan,,0.811156451702118,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,28
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0030002,Select Care Preference Gold 250 w/office deductible waiver,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_250_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_250_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030002-01,Standard Gold On Exchange Plan,,0.811156451702118,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0030004,Select Care Preference Gold 500 w/no deductible for office visits,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030004-00,Standard Gold Off Exchange Plan,,0.794067025184631,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0030004,Select Care Preference Gold 500 w/no deductible for office visits,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030004-01,Standard Gold On Exchange Plan,,0.794067025184631,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0030004,Select Care Preference Gold 500 w/no deductible for office visits,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,34
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0030004,Select Care Preference Gold 500 w/no deductible for office visits,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030004-03,Limited Cost Sharing Plan Variation,,0.794067025184631,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,35
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0030007,Select Care Preference Gold 1000 w/no deductible for office visits,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_1000_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_1000_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030007-00,Standard Gold Off Exchange Plan,,0.818034648895264,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$500,Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,2,68781,UT,Individual,No,87-0409820,68781UT0030007,Select Care Preference Gold 1000 w/no deductible for office visits,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Gold,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_gold_1000_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_gold_1000_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030007-01,Standard Gold On Exchange Plan,,0.818034648895264,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$500,Not Applicable,,,,,,,,,,,,,,,,,,,37
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0010009,Select Value Preference Silver 2500 w/4 deductible-free office visits,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_2500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_2500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010009-00,Standard Silver Off Exchange Plan,71.26%,0.712623178958893,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0010009,Select Value Preference Silver 2500 w/4 deductible-free office visits,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_2500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_2500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010009-01,Standard Silver On Exchange Plan,71.26%,0.712623178958893,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0010009,Select Value Preference Silver 2500 w/4 deductible-free office visits,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_2500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_2500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0010009,Select Value Preference Silver 2500 w/4 deductible-free office visits,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_2500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_2500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010009-03,Limited Cost Sharing Plan Variation,71.26%,0.712623178958893,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0010009,Select Value Preference Silver 2500 w/4 deductible-free office visits,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_2500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_2500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010009-04,73% AV Level Silver Plan,73.40%,0.727417528629303,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0010009,Select Value Preference Silver 2500 w/4 deductible-free office visits,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_2500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_2500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010009-05,87% AV Level Silver Plan,87.01%,0.870065748691559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,15%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0010009,Select Value Preference Silver 2500 w/4 deductible-free office visits,68781UT001,,UTN003,UTS003,UTF002,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_2500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_2500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010009-06,94% AV Level Silver Plan,94.70%,0.946996092796326,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,5%,,,,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0010011,Select Value Preference Bronze 5350 w/4 deductible-free office visits,68781UT001,,UTN003,UTS003,UTF004,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_bronze_500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_bronze_500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010011-00,Standard Bronze Off Exchange Plan,,0.611545562744141,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,350","$10,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0010011,Select Value Preference Bronze 5350 w/4 deductible-free office visits,68781UT001,,UTN003,UTS003,UTF004,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_bronze_500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_bronze_500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010011-01,Standard Bronze On Exchange Plan,,0.611545562744141,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,350","$10,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0020009,Select Med Preference Silver 2500 w/4 deductible-free office visits,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_2500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_2500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020009-00,Standard Silver Off Exchange Plan,71.26%,0.712623178958893,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0020009,Select Med Preference Silver 2500 w/4 deductible-free office visits,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_2500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_2500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020009-01,Standard Silver On Exchange Plan,71.26%,0.712623178958893,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0020009,Select Med Preference Silver 2500 w/4 deductible-free office visits,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_2500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_2500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0020009,Select Med Preference Silver 2500 w/4 deductible-free office visits,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_2500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_2500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020009-03,Limited Cost Sharing Plan Variation,71.26%,0.712623178958893,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0020009,Select Med Preference Silver 2500 w/4 deductible-free office visits,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_2500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_2500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020009-04,73% AV Level Silver Plan,73.40%,0.727417528629303,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0020009,Select Med Preference Silver 2500 w/4 deductible-free office visits,68781UT002,,UTN002,UTS002,UTF002,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_2500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_2500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020009-06,94% AV Level Silver Plan,94.70%,0.946996092796326,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,5%,,,,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0020011,Select Med Preference Bronze 5350 w/4 deductible-free office visits,68781UT002,,UTN002,UTS002,UTF004,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_bronze_5350_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_bronze_5350_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020011-00,Standard Bronze Off Exchange Plan,,0.611545562744141,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,350","$10,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0020011,Select Med Preference Bronze 5350 w/4 deductible-free office visits,68781UT002,,UTN002,UTS002,UTF004,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_bronze_5350_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_bronze_5350_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020011-01,Standard Bronze On Exchange Plan,,0.611545562744141,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,350","$10,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0020011,Select Med Preference Bronze 5350 w/4 deductible-free office visits,68781UT002,,UTN002,UTS002,UTF004,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_bronze_5350_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_bronze_5350_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020011-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,24
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0020011,Select Med Preference Bronze 5350 w/4 deductible-free office visits,68781UT002,,UTN002,UTS002,UTF004,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_bronze_5350_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_bronze_5350_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020011-03,Limited Cost Sharing Plan Variation,,0.611545562744141,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,350","$10,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0030009,Select Care Preference Silver 2500 w/4 deductible-free office visits,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_2500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_2500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030009-01,Standard Silver On Exchange Plan,71.26%,0.712623178958893,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0030009,Select Care Preference Silver 2500 w/4 deductible-free office visits,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_2500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_2500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030009-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,28
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0030009,Select Care Preference Silver 2500 w/4 deductible-free office visits,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_2500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_2500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030009-03,Limited Cost Sharing Plan Variation,71.26%,0.712623178958893,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0030009,Select Care Preference Silver 2500 w/4 deductible-free office visits,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_2500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_2500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030009-04,73% AV Level Silver Plan,73.40%,0.727417528629303,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0030009,Select Care Preference Silver 2500 w/4 deductible-free office visits,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_2500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_2500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030009-05,87% AV Level Silver Plan,87.01%,0.870065748691559,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,15%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0030009,Select Care Preference Silver 2500 w/4 deductible-free office visits,68781UT003,,UTN001,UTS001,UTF002,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_2500_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_2500_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030009-06,94% AV Level Silver Plan,94.70%,0.946996092796326,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,5%,,,,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0030011,Select Care Preference Bronze 5350 w/4 deductible-free office visits,68781UT003,,UTN001,UTS001,UTF004,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_bronze_5350_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_bronze_5350_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030011-01,Standard Bronze On Exchange Plan,,0.611545562744141,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,350","$10,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0030011,Select Care Preference Bronze 5350 w/4 deductible-free office visits,68781UT003,,UTN001,UTS001,UTF004,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_bronze_5350_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_bronze_5350_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030011-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,35
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,3,68781,UT,Individual,No,87-0409820,68781UT0030011,Select Care Preference Bronze 5350 w/4 deductible-free office visits,68781UT003,,UTN001,UTS001,UTF004,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,4,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_bronze_5350_no_ded,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_bronze_5350_no_ded,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030011-03,Limited Cost Sharing Plan Variation,,0.611545562744141,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,350","$10,700",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,4,68781,UT,Individual,No,87-0409820,68781UT0010012,Select Value Preference Silver 3800 Copay Plan,68781UT001,,UTN003,UTS003,UTF005,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,5,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_3800_copay,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_3800_copay,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010012-00,Standard Silver Off Exchange Plan,71.59%,0.715853273868561,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,800","$7,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$2,500",Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,4,68781,UT,Individual,No,87-0409820,68781UT0010012,Select Value Preference Silver 3800 Copay Plan,68781UT001,,UTN003,UTS003,UTF005,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,5,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_3800_copay,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_3800_copay,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010012-01,Standard Silver On Exchange Plan,71.59%,0.715853273868561,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,800","$7,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$2,500",Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,4,68781,UT,Individual,No,87-0409820,68781UT0010012,Select Value Preference Silver 3800 Copay Plan,68781UT001,,UTN003,UTS003,UTF005,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,5,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_3800_copay,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_3800_copay,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010012-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,4,68781,UT,Individual,No,87-0409820,68781UT0010012,Select Value Preference Silver 3800 Copay Plan,68781UT001,,UTN003,UTS003,UTF005,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,5,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_3800_copay,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_3800_copay,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010012-03,Limited Cost Sharing Plan Variation,71.59%,0.715853273868561,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,800","$7,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$2,500",Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,4,68781,UT,Individual,No,87-0409820,68781UT0010012,Select Value Preference Silver 3800 Copay Plan,68781UT001,,UTN003,UTS003,UTF005,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,5,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_3800_copay,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_3800_copay,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010012-04,73% AV Level Silver Plan,73.94%,0.739391088485718,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,100","$6,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,4,68781,UT,Individual,No,87-0409820,68781UT0010012,Select Value Preference Silver 3800 Copay Plan,68781UT001,,UTN003,UTS003,UTF005,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,5,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_silver_3800_copay,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_silver_3800_copay,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010012-05,87% AV Level Silver Plan,86.76%,0.867556214332581,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,15%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,4,68781,UT,Individual,No,87-0409820,68781UT0020012,Select Med Preference Silver 3800 Copay Plan,68781UT002,,UTN002,UTS002,UTF005,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,5,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_3800_copay,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_3800_copay,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020012-00,Standard Silver Off Exchange Plan,71.59%,0.715853273868561,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,800","$7,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$2,500",Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,4,68781,UT,Individual,No,87-0409820,68781UT0020012,Select Med Preference Silver 3800 Copay Plan,68781UT002,,UTN002,UTS002,UTF005,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,5,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_3800_copay,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_3800_copay,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020012-01,Standard Silver On Exchange Plan,71.59%,0.715853273868561,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,800","$7,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$2,500",Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,4,68781,UT,Individual,No,87-0409820,68781UT0020012,Select Med Preference Silver 3800 Copay Plan,68781UT002,,UTN002,UTS002,UTF005,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,5,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_3800_copay,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_3800_copay,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020012-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,4,68781,UT,Individual,No,87-0409820,68781UT0020012,Select Med Preference Silver 3800 Copay Plan,68781UT002,,UTN002,UTS002,UTF005,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,5,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_3800_copay,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_3800_copay,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020012-03,Limited Cost Sharing Plan Variation,71.59%,0.715853273868561,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,800","$7,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$2,500",Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,4,68781,UT,Individual,No,87-0409820,68781UT0020012,Select Med Preference Silver 3800 Copay Plan,68781UT002,,UTN002,UTS002,UTF005,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,5,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_3800_copay,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_3800_copay,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020012-04,73% AV Level Silver Plan,73.94%,0.739391088485718,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,100","$6,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,4,68781,UT,Individual,No,87-0409820,68781UT0020012,Select Med Preference Silver 3800 Copay Plan,68781UT002,,UTN002,UTS002,UTF005,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,5,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_3800_copay,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_3800_copay,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020012-05,87% AV Level Silver Plan,86.76%,0.867556214332581,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,15%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,4,68781,UT,Individual,No,87-0409820,68781UT0020012,Select Med Preference Silver 3800 Copay Plan,68781UT002,,UTN002,UTS002,UTF005,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,5,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_silver_3800_copay,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_silver_3800_copay,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020012-06,94% AV Level Silver Plan,93.71%,0.93706750869751,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,5%,,,,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,4,68781,UT,Individual,No,87-0409820,68781UT0030012,Select Care Preference Silver 3800 Copay Plan,68781UT003,,UTN001,UTS001,UTF005,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,5,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_3800_copay,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_3800_copay,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030012-00,Standard Silver Off Exchange Plan,71.59%,0.715853273868561,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,800","$7,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$2,500",Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,4,68781,UT,Individual,No,87-0409820,68781UT0030012,Select Care Preference Silver 3800 Copay Plan,68781UT003,,UTN001,UTS001,UTF005,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,5,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_3800_copay,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_3800_copay,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030012-04,73% AV Level Silver Plan,73.94%,0.739391088485718,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,100","$6,200",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,20%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,4,68781,UT,Individual,No,87-0409820,68781UT0030012,Select Care Preference Silver 3800 Copay Plan,68781UT003,,UTN001,UTS001,UTF005,Existing,HMO,Silver,Yes,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,5,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_silver_3800_copay,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_silver_3800_copay,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030012-05,87% AV Level Silver Plan,86.76%,0.867556214332581,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,15%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010014,Select Value HealthSave Silver 1500 (HSA Qualified),68781UT001,,UTN003,UTS003,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_silver_1500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_silver_1500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010014-00,Standard Silver Off Exchange Plan,,0.712389051914215,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010014,Select Value HealthSave Silver 1500 (HSA Qualified),68781UT001,,UTN003,UTS003,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_silver_1500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_silver_1500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010014-01,Standard Silver On Exchange Plan,,0.712389051914215,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010014,Select Value HealthSave Silver 1500 (HSA Qualified),68781UT001,,UTN003,UTS003,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_silver_1500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_silver_1500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010014,Select Value HealthSave Silver 1500 (HSA Qualified),68781UT001,,UTN003,UTS003,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_silver_1500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_silver_1500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010014-03,Limited Cost Sharing Plan Variation,,0.712389051914215,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010014,Select Value HealthSave Silver 1500 (HSA Qualified),68781UT001,,UTN003,UTS003,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_silver_1500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_silver_1500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010014-04,73% AV Level Silver Plan,,0.734175145626068,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010014,Select Value HealthSave Silver 1500 (HSA Qualified),68781UT001,,UTN003,UTS003,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_silver_1500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_silver_1500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010014-05,87% AV Level Silver Plan,,0.861003518104553,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$350,$875,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010014,Select Value HealthSave Silver 1500 (HSA Qualified),68781UT001,,UTN003,UTS003,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_silver_1500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_silver_1500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010014-06,94% AV Level Silver Plan,,0.935191214084625,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$250,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010015,Select Value HealthSave Silver 2000 (HSA Qualified),68781UT001,,UTN003,UTS003,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_silver_2000_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_silver_2000_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010015-00,Standard Silver Off Exchange Plan,,0.685520052909851,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010015,Select Value HealthSave Silver 2000 (HSA Qualified),68781UT001,,UTN003,UTS003,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_silver_2000_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_silver_2000_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010015-01,Standard Silver On Exchange Plan,,0.685520052909851,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010015,Select Value HealthSave Silver 2000 (HSA Qualified),68781UT001,,UTN003,UTS003,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_silver_2000_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_silver_2000_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010015-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010015,Select Value HealthSave Silver 2000 (HSA Qualified),68781UT001,,UTN003,UTS003,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_silver_2000_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_silver_2000_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010015-03,Limited Cost Sharing Plan Variation,,0.685520052909851,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010015,Select Value HealthSave Silver 2000 (HSA Qualified),68781UT001,,UTN003,UTS003,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_silver_2000_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_silver_2000_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010015-04,73% AV Level Silver Plan,,0.73095965385437,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010015,Select Value HealthSave Silver 2000 (HSA Qualified),68781UT001,,UTN003,UTS003,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_silver_2000_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_silver_2000_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010015-05,87% AV Level Silver Plan,,0.861003518104553,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$350,$875,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010015,Select Value HealthSave Silver 2000 (HSA Qualified),68781UT001,,UTN003,UTS003,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_silver_2000_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_silver_2000_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010015-06,94% AV Level Silver Plan,,0.932928681373596,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$250,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,17
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010016,Select Value HealthSave Bronze 3500 (HSA Qualified),68781UT001,,UTN003,UTS003,UTF007,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_bronze_3500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_bronze_3500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010016-00,Standard Bronze Off Exchange Plan,,0.615942656993866,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010016,Select Value HealthSave Bronze 3500 (HSA Qualified),68781UT001,,UTN003,UTS003,UTF007,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_bronze_3500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_bronze_3500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010016-01,Standard Bronze On Exchange Plan,,0.615942656993866,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,19
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010017,Select Value HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible),68781UT001,,UTN003,UTS003,UTF008,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_silver_3500_hsa_no_coinsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_silver_3500_hsa_no_coinsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010017-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010017,Select Value HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible),68781UT001,,UTN003,UTS003,UTF008,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_silver_3500_hsa_no_coinsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_silver_3500_hsa_no_coinsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010017-04,73% AV Level Silver Plan,,0.732454240322113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,26
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010017,Select Value HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible),68781UT001,,UTN003,UTS003,UTF008,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_silver_3500_hsa_no_coinsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_silver_3500_hsa_no_coinsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010017-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,27
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010017,Select Value HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible),68781UT001,,UTN003,UTS003,UTF008,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_silver_3500_hsa_no_coinsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_silver_3500_hsa_no_coinsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010017-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,28
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010018,Select Value HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible),68781UT001,,UTN003,UTS003,UTF008,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_bronze_5500_hsa_no_coinsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_bronze_5500_hsa_no_coinsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010018-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,29
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010018,Select Value HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible),68781UT001,,UTN003,UTS003,UTF008,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_bronze_5500_hsa_no_coinsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_bronze_5500_hsa_no_coinsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010018-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,30
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010018,Select Value HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible),68781UT001,,UTN003,UTS003,UTF008,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_bronze_5500_hsa_no_coinsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_bronze_5500_hsa_no_coinsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010018-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,31
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010018,Select Value HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible),68781UT001,,UTN003,UTS003,UTF008,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_healthsave_bronze_5500_hsa_no_coinsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_healthsave_bronze_5500_hsa_no_coinsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010018-03,Limited Cost Sharing Plan Variation,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,32
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020014,Select Med HealthSave Silver 1500 (HSA Qualified),68781UT002,,UTN002,UTS002,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_silver_1500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_silver_1500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020014-00,Standard Silver Off Exchange Plan,,0.712389051914215,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,33
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020014,Select Med HealthSave Silver 1500 (HSA Qualified),68781UT002,,UTN002,UTS002,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_silver_1500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_silver_1500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020014-01,Standard Silver On Exchange Plan,,0.712389051914215,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,34
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020014,Select Med HealthSave Silver 1500 (HSA Qualified),68781UT002,,UTN002,UTS002,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_silver_1500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_silver_1500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,35
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020014,Select Med HealthSave Silver 1500 (HSA Qualified),68781UT002,,UTN002,UTS002,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_silver_1500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_silver_1500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020014-03,Limited Cost Sharing Plan Variation,,0.712389051914215,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,36
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020014,Select Med HealthSave Silver 1500 (HSA Qualified),68781UT002,,UTN002,UTS002,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_silver_1500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_silver_1500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020014-04,73% AV Level Silver Plan,,0.734175145626068,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,37
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020014,Select Med HealthSave Silver 1500 (HSA Qualified),68781UT002,,UTN002,UTS002,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_silver_1500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_silver_1500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020014-05,87% AV Level Silver Plan,,0.861003518104553,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$350,$875,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,38
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020014,Select Med HealthSave Silver 1500 (HSA Qualified),68781UT002,,UTN002,UTS002,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_silver_1500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_silver_1500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020014-06,94% AV Level Silver Plan,,0.935191214084625,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$250,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,39
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020015,Select Med HealthSave Silver 2000 (HSA Qualified),68781UT002,,UTN002,UTS002,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_silver_2000_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_silver_2000_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020015-00,Standard Silver Off Exchange Plan,,0.685520052909851,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,40
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020015,Select Med HealthSave Silver 2000 (HSA Qualified),68781UT002,,UTN002,UTS002,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_silver_2000_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_silver_2000_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020015-01,Standard Silver On Exchange Plan,,0.685520052909851,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,41
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020015,Select Med HealthSave Silver 2000 (HSA Qualified),68781UT002,,UTN002,UTS002,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_silver_2000_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_silver_2000_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020015-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,42
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020015,Select Med HealthSave Silver 2000 (HSA Qualified),68781UT002,,UTN002,UTS002,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_silver_2000_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_silver_2000_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020015-03,Limited Cost Sharing Plan Variation,,0.685520052909851,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,43
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020015,Select Med HealthSave Silver 2000 (HSA Qualified),68781UT002,,UTN002,UTS002,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_silver_2000_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_silver_2000_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020015-04,73% AV Level Silver Plan,,0.73095965385437,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,44
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020015,Select Med HealthSave Silver 2000 (HSA Qualified),68781UT002,,UTN002,UTS002,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_silver_2000_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_silver_2000_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020015-05,87% AV Level Silver Plan,,0.861003518104553,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$350,$875,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,45
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020015,Select Med HealthSave Silver 2000 (HSA Qualified),68781UT002,,UTN002,UTS002,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_silver_2000_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_silver_2000_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020015-06,94% AV Level Silver Plan,,0.932928681373596,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$250,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,46
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030017,Select Care HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible),68781UT003,,UTN001,UTS001,UTF008,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_silver_3500_hsa_no_coinsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_silver_3500_hsa_no_coinsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030017-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,86
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,5,10207,VA,Individual,No,52-1358219,10207VA0380004,"BlueChoice Young Adult $6,600",10207VA038,,VAN002,VAS001,VAF004,New,HMO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHAVCN9NRXCVCN9CN012015.pdf,,,www.carefirst.com/acarx,10207VA0380004-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,$0,$0,Not Applicable,Not Applicable,"$5,250",$0,$0,$30,"$5,210",$0,$0,$0,5
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,6,10207,VA,Individual,No,52-1358219,10207VA0380003,"BlueChoice Gold $1,000",10207VA038,,VAN001,VAS001,VAF006,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHAVCN7QRXCVCN7CN012015.pdf,,,www.carefirst.com/acarx,10207VA0380003-00,Standard Gold Off Exchange Plan,78.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,$0,$0,Not Applicable,Not Applicable,"$2,000",$0,$322,$30,"$1,570",$0,$0,$0,4
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,6,10207,VA,Individual,No,52-1358219,10207VA0380003,"BlueChoice Gold $1,000",10207VA038,,VAN001,VAS001,VAF006,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHAVCN7QRXCVCN7CN012015.pdf,,,www.carefirst.com/acarx,10207VA0380003-01,Standard Gold On Exchange Plan,78.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,$0,$0,Not Applicable,Not Applicable,"$2,000",$0,$322,$30,"$1,570",$0,$0,$0,5
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,6,10207,VA,Individual,No,52-1358219,10207VA0380003,"BlueChoice Gold $1,000",10207VA038,,VAN001,VAS001,VAF006,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHAVCN7QRXCVCN7CN012015.pdf,,,www.carefirst.com/acarx,10207VA0380003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$30,$0,$0,$0,$0,6
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,6,10207,VA,Individual,No,52-1358219,10207VA0380003,"BlueChoice Gold $1,000",10207VA038,,VAN001,VAS001,VAF006,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHAVCN7QRXCVCN7CN012015.pdf,,,www.carefirst.com/acarx,10207VA0380003-03,Limited Cost Sharing Plan Variation,78.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,$0,$0,Not Applicable,Not Applicable,"$2,000",$0,$322,$30,"$1,570",$0,$0,$0,7
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,7,10207,VA,Individual,No,52-1358219,10207VA0390001,"BlueChoice HSA Bronze $4,000",10207VA039,,VAN001,VAS001,VAF005,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHHVCN5NRXCVCN5EN012015.pdf,,,www.carefirst.com/acarx,10207VA0390001-00,Standard Bronze Off Exchange Plan,60.15%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,$0,$0,Not Applicable,Not Applicable,"$4,000",$0,$372,$30,"$4,000",$30,$249,$0,4
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,7,10207,VA,Individual,No,52-1358219,10207VA0390001,"BlueChoice HSA Bronze $4,000",10207VA039,,VAN001,VAS001,VAF005,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHHVCN5NRXCVCN5EN012015.pdf,,,www.carefirst.com/acarx,10207VA0390001-01,Standard Bronze On Exchange Plan,60.15%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,$0,$0,Not Applicable,Not Applicable,"$4,000",$0,$372,$30,"$4,000",$30,$249,$0,5
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,7,10207,VA,Individual,No,52-1358219,10207VA0390001,"BlueChoice HSA Bronze $4,000",10207VA039,,VAN001,VAS001,VAF005,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHHVCN5NRXCVCN5EN012015.pdf,,,www.carefirst.com/acarx,10207VA0390001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$30,$0,$0,$0,$0,6
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,7,10207,VA,Individual,No,52-1358219,10207VA0390001,"BlueChoice HSA Bronze $4,000",10207VA039,,VAN001,VAS001,VAF005,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHHVCN5NRXCVCN5EN012015.pdf,,,www.carefirst.com/acarx,10207VA0390001-03,Limited Cost Sharing Plan Variation,60.15%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,$0,$0,Not Applicable,Not Applicable,"$4,000",$0,$372,$30,"$4,000",$30,$249,$0,7
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,7,10207,VA,Individual,No,52-1358219,10207VA0390002,"BlueChoice HSA Bronze $6,000",10207VA039,,VAN001,VAS001,VAF004,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHHVCN5QRXCVCN5FN012015.pdf,,,www.carefirst.com/acarx,10207VA0390002-00,Standard Bronze Off Exchange Plan,59.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,$0,$0,Not Applicable,Not Applicable,"$5,250",$0,$0,$30,"$5,210",$0,$0,$0,8
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,8,10207,VA,Individual,No,52-1358219,10207VA0380002,BlueChoice Gold $0,10207VA038,,VAN001,VAS001,VAF005,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHAVCN7NRXXVCN7CN012015.pdf,,,www.carefirst.com/acarx,10207VA0380002-00,Standard Gold Off Exchange Plan,79.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,"$1,572",$30,$0,$160,$981,$0,4
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,8,10207,VA,Individual,No,52-1358219,10207VA0380002,BlueChoice Gold $0,10207VA038,,VAN001,VAS001,VAF005,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHAVCN7NRXXVCN7CN012015.pdf,,,www.carefirst.com/acarx,10207VA0380002-01,Standard Gold On Exchange Plan,79.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,"$1,572",$30,$0,$160,$981,$0,5
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020016,Select Med HealthSave Bronze 3500 (HSA Qualified),68781UT002,,UTN002,UTS002,UTF007,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_bronze_3500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_bronze_3500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020016-00,Standard Bronze Off Exchange Plan,,0.615942656993866,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,47
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020016,Select Med HealthSave Bronze 3500 (HSA Qualified),68781UT002,,UTN002,UTS002,UTF007,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_bronze_3500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_bronze_3500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020016-01,Standard Bronze On Exchange Plan,,0.615942656993866,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,48
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020016,Select Med HealthSave Bronze 3500 (HSA Qualified),68781UT002,,UTN002,UTS002,UTF007,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_bronze_3500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_bronze_3500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,49
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020016,Select Med HealthSave Bronze 3500 (HSA Qualified),68781UT002,,UTN002,UTS002,UTF007,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_bronze_3500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_bronze_3500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020016-03,Limited Cost Sharing Plan Variation,,0.615942656993866,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,50
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020017,Select Med HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible),68781UT002,,UTN002,UTS002,UTF008,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_silver_3500_hsa_no_coninsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_silver_3500_hsa_no_coninsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020017-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,51
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020017,Select Med HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible),68781UT002,,UTN002,UTS002,UTF008,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_silver_3500_hsa_no_coninsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_silver_3500_hsa_no_coninsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020017-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,52
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020017,Select Med HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible),68781UT002,,UTN002,UTS002,UTF008,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_silver_3500_hsa_no_coninsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_silver_3500_hsa_no_coninsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,53
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020017,Select Med HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible),68781UT002,,UTN002,UTS002,UTF008,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_silver_3500_hsa_no_coninsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_silver_3500_hsa_no_coninsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020017-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,54
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020017,Select Med HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible),68781UT002,,UTN002,UTS002,UTF008,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_silver_3500_hsa_no_coninsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_silver_3500_hsa_no_coninsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020017-04,73% AV Level Silver Plan,,0.732454240322113,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,55
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020017,Select Med HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible),68781UT002,,UTN002,UTS002,UTF008,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_silver_3500_hsa_no_coninsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_silver_3500_hsa_no_coninsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020017-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,56
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020017,Select Med HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible),68781UT002,,UTN002,UTS002,UTF008,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_silver_3500_hsa_no_coninsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_healthsave_silver_3500_hsa_no_coninsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020017-06,94% AV Level Silver Plan,,0.932734072208405,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,57
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020018,Select Med HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible),68781UT002,,UTN002,UTS002,UTF008,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_bronze_5500_hsa_no_coninsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_bronze_5500_hsa_no_coninsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020018-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,58
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020018,Select Med HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible),68781UT002,,UTN002,UTS002,UTF008,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_bronze_5500_hsa_no_coninsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_bronze_5500_hsa_no_coninsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020018-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,59
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020018,Select Med HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible),68781UT002,,UTN002,UTS002,UTF008,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_bronze_5500_hsa_no_coninsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_bronze_5500_hsa_no_coninsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020018-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,60
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020018,Select Med HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible),68781UT002,,UTN002,UTS002,UTF008,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_bronze_5500_hsa_no_coninsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_healthsave_bronze_5500_hsa_no_coninsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020018-03,Limited Cost Sharing Plan Variation,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,61
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030014,Select Care HealthSave Silver 1500 (HSA Qualified),68781UT003,,UTN001,UTS001,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_silver_1500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_silver_1500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030014-00,Standard Silver Off Exchange Plan,,0.712389051914215,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,62
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030014,Select Care HealthSave Silver 1500 (HSA Qualified),68781UT003,,UTN001,UTS001,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_silver_1500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_silver_1500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030014-01,Standard Silver On Exchange Plan,,0.712389051914215,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,63
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030014,Select Care HealthSave Silver 1500 (HSA Qualified),68781UT003,,UTN001,UTS001,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_silver_1500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_silver_1500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030014-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,64
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030014,Select Care HealthSave Silver 1500 (HSA Qualified),68781UT003,,UTN001,UTS001,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_silver_1500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_silver_1500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030014-03,Limited Cost Sharing Plan Variation,,0.712389051914215,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,65
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030014,Select Care HealthSave Silver 1500 (HSA Qualified),68781UT003,,UTN001,UTS001,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_silver_1500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_silver_1500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030014-04,73% AV Level Silver Plan,,0.734175145626068,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,66
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030014,Select Care HealthSave Silver 1500 (HSA Qualified),68781UT003,,UTN001,UTS001,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_silver_1500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_silver_1500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030014-05,87% AV Level Silver Plan,,0.861003518104553,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$350,$875,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,67
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030014,Select Care HealthSave Silver 1500 (HSA Qualified),68781UT003,,UTN001,UTS001,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_silver_1500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_silver_1500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030014-06,94% AV Level Silver Plan,,0.935191214084625,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$250,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,68
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030015,Select Care HealthSave Silver 2000 (HSA Qualified),68781UT003,,UTN001,UTS001,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_silver_2000_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_silver_2000_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030015-00,Standard Silver Off Exchange Plan,,0.685520052909851,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,69
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030015,Select Care HealthSave Silver 2000 (HSA Qualified),68781UT003,,UTN001,UTS001,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_silver_2000_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_silver_2000_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030015-01,Standard Silver On Exchange Plan,,0.685520052909851,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,70
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030015,Select Care HealthSave Silver 2000 (HSA Qualified),68781UT003,,UTN001,UTS001,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_silver_2000_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_silver_2000_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030015-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,71
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030015,Select Care HealthSave Silver 2000 (HSA Qualified),68781UT003,,UTN001,UTS001,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_silver_2000_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_silver_2000_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030015-03,Limited Cost Sharing Plan Variation,,0.685520052909851,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,72
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030015,Select Care HealthSave Silver 2000 (HSA Qualified),68781UT003,,UTN001,UTS001,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_silver_2000_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_silver_2000_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030015-04,73% AV Level Silver Plan,,0.73095965385437,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,73
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030015,Select Care HealthSave Silver 2000 (HSA Qualified),68781UT003,,UTN001,UTS001,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_silver_2000_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_silver_2000_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030015-05,87% AV Level Silver Plan,,0.861003518104553,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$350,$875,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,74
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030015,Select Care HealthSave Silver 2000 (HSA Qualified),68781UT003,,UTN001,UTS001,UTF006,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_silver_2000_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_silver_2000_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030015-06,94% AV Level Silver Plan,,0.932928681373596,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$250,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,75
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030016,Select Care HealthSave Bronze 3500 (HSA Qualified),68781UT003,,UTN001,UTS001,UTF007,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_bronze_3500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_bronze_3500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030016-00,Standard Bronze Off Exchange Plan,,0.615942656993866,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,76
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030016,Select Care HealthSave Bronze 3500 (HSA Qualified),68781UT003,,UTN001,UTS001,UTF007,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_bronze_3500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_bronze_3500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030016-01,Standard Bronze On Exchange Plan,,0.615942656993866,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,77
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030016,Select Care HealthSave Bronze 3500 (HSA Qualified),68781UT003,,UTN001,UTS001,UTF007,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_bronze_3500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_bronze_3500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,78
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030016,Select Care HealthSave Bronze 3500 (HSA Qualified),68781UT003,,UTN001,UTS001,UTF007,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_bronze_3500_hsa,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_bronze_3500_hsa,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030016-03,Limited Cost Sharing Plan Variation,,0.615942656993866,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,79
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030017,Select Care HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible),68781UT003,,UTN001,UTS001,UTF008,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_silver_3500_hsa_no_coinsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_silver_3500_hsa_no_coinsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030017-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,80
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030017,Select Care HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible),68781UT003,,UTN001,UTS001,UTF008,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_silver_3500_hsa_no_coinsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_silver_3500_hsa_no_coinsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030017-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,81
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030017,Select Care HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible),68781UT003,,UTN001,UTS001,UTF008,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_silver_3500_hsa_no_coinsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_silver_3500_hsa_no_coinsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,82
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030017,Select Care HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible),68781UT003,,UTN001,UTS001,UTF008,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_silver_3500_hsa_no_coinsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_silver_3500_hsa_no_coinsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030017-03,Limited Cost Sharing Plan Variation,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,83
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030017,Select Care HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible),68781UT003,,UTN001,UTS001,UTF008,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_silver_3500_hsa_no_coinsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_silver_3500_hsa_no_coinsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030017-05,87% AV Level Silver Plan,,0.876513063907623,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,85
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030018,Select Care HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible),68781UT003,,UTN001,UTS001,UTF008,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_bronze_5500_hsa_no_coinsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_bronze_5500_hsa_no_coinsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030018-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,87
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030018,Select Care HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible),68781UT003,,UTN001,UTS001,UTF008,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_bronze_5500_hsa_no_coinsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_bronze_5500_hsa_no_coinsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030018-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,88
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030018,Select Care HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible),68781UT003,,UTN001,UTS001,UTF008,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_bronze_5500_hsa_no_coinsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_bronze_5500_hsa_no_coinsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030018-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,89
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030018,Select Care HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible),68781UT003,,UTN001,UTS001,UTF008,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_healthsave_bronze_5500_hsa_no_coinsurance,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_healthsave_bronze_5500_hsa_no_coinsurance,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030018-03,Limited Cost Sharing Plan Variation,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,90
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010019,Select Value Millennial 6600 (Catastrophic Plan),68781UT001,,UTN003,UTS003,UTF008,Existing,HMO,Catastrophic,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,3,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_millennial_6350_catastrophic,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_millennial_6350_catastrophic,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010019-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,91
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0010019,Select Value Millennial 6600 (Catastrophic Plan),68781UT001,,UTN003,UTS003,UTF008,Existing,HMO,Catastrophic,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,3,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_millennial_6350_catastrophic,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_millennial_6350_catastrophic,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0010019-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,92
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020019,Select Med Millennial 6600 (Catastrophic Plan),68781UT002,,UTN002,UTS002,UTF008,Existing,HMO,Catastrophic,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,3,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_millennial_6350_catastropic,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_millennial_6350_catastropic,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020019-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,93
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0020019,Select Med Millennial 6600 (Catastrophic Plan),68781UT002,,UTN002,UTS002,UTF008,Existing,HMO,Catastrophic,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,3,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_millennial_6350_catastropic,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_millennial_6350_catastropic,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0020019-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,94
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030019,Select Care Millennial 6600 (Catastrophic Plan),68781UT003,,UTN001,UTS001,UTF008,Existing,HMO,Catastrophic,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,3,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_millennial_6350_catastrophic,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_millennial_6350_catastrophic,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030019-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,95
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,5,68781,UT,Individual,No,87-0409820,68781UT0030019,Select Care Millennial 6600 (Catastrophic Plan),68781UT003,,UTN001,UTS001,UTF008,Existing,HMO,Catastrophic,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.9882,,,0,3,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_millennial_6350_catastrophic,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_millennial_6350_catastrophic,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0030019-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,96
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0120005,Select Value Preference Benchmark Silver 1000,68781UT012,,UTN003,UTS003,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_benchmark_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_benchmark_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0120005-00,Standard Silver Off Exchange Plan,,0.697579860687256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0120005,Select Value Preference Benchmark Silver 1000,68781UT012,,UTN003,UTS003,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_benchmark_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_benchmark_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0120005-01,Standard Silver On Exchange Plan,,0.697579860687256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0120005,Select Value Preference Benchmark Silver 1000,68781UT012,,UTN003,UTS003,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_benchmark_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_benchmark_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0120005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0120005,Select Value Preference Benchmark Silver 1000,68781UT012,,UTN003,UTS003,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_benchmark_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_benchmark_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0120005-03,Limited Cost Sharing Plan Variation,,0.697579860687256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0120005,Select Value Preference Benchmark Silver 1000,68781UT012,,UTN003,UTS003,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_benchmark_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_benchmark_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0120005-04,73% AV Level Silver Plan,,0.735162734985352,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0120005,Select Value Preference Benchmark Silver 1000,68781UT012,,UTN003,UTS003,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_benchmark_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_benchmark_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0120005-05,87% AV Level Silver Plan,,0.86578643321991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,15%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0120005,Select Value Preference Benchmark Silver 1000,68781UT012,,UTN003,UTS003,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_benchmark_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_benchmark_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0120005-06,94% AV Level Silver Plan,,0.946797907352448,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,5%,,,,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0140005,Select Care Preference Benchmark Silver 1000,68781UT014,,UTN001,UTS001,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_benchmark_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_benchmark_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0140005-05,87% AV Level Silver Plan,,0.86578643321991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,15%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,31
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,4,10207,VA,Individual,No,52-1358219,10207VA0400002,"BlueChoice Plus Silver $2,500",10207VA040,,VAN004,VAS001,VAF006,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,All covered services out of network only,Yes,All covered services,Yes,http://content.carefirst.com/sbc/BTPVBN6NRXXVBN6CN012015.pdf,,,www.carefirst.com/acarx,10207VA0400002-06,94% AV Level Silver Plan,93.66%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$2,250","$4,500",Not Applicable,Not Applicable,$0,$0,10%,,,,$100,$200,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$522,$30,$0,$0,$135,$0,14
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,5,10207,VA,Individual,No,52-1358219,10207VA0380004,"BlueChoice Young Adult $6,600",10207VA038,,VAN002,VAS001,VAF004,New,HMO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHAVCN9NRXCVCN9CN012015.pdf,,,www.carefirst.com/acarx,10207VA0380004-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,$0,$0,Not Applicable,Not Applicable,"$5,250",$0,$0,$30,"$5,210",$0,$0,$0,4
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0120010,Select Value Preference Benchmark Bronze 5000,68781UT012,,UTN003,UTS003,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_value_preference_benchmark_bronze_5000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_value_preference_benchmark_bronze_5000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0120010-00,Standard Bronze Off Exchange Plan,,0.603495538234711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0130005,Select Med Preference Benchmark Silver 1000,68781UT013,,UTN002,UTS002,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_benchmark_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_benchmark_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0130005-00,Standard Silver Off Exchange Plan,,0.697579860687256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0130005,Select Med Preference Benchmark Silver 1000,68781UT013,,UTN002,UTS002,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_benchmark_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_benchmark_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0130005-01,Standard Silver On Exchange Plan,,0.697579860687256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0130005,Select Med Preference Benchmark Silver 1000,68781UT013,,UTN002,UTS002,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_benchmark_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_benchmark_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0130005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0130005,Select Med Preference Benchmark Silver 1000,68781UT013,,UTN002,UTS002,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_benchmark_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_benchmark_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0130005-03,Limited Cost Sharing Plan Variation,,0.697579860687256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0130005,Select Med Preference Benchmark Silver 1000,68781UT013,,UTN002,UTS002,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_benchmark_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_benchmark_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0130005-04,73% AV Level Silver Plan,,0.735162734985352,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0130005,Select Med Preference Benchmark Silver 1000,68781UT013,,UTN002,UTS002,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_benchmark_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_benchmark_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0130005-05,87% AV Level Silver Plan,,0.86578643321991,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$750,15%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,15%,,,,Not Applicable,Not Applicable,$100,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0130005,Select Med Preference Benchmark Silver 1000,68781UT013,,UTN002,UTS002,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_benchmark_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_benchmark_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0130005-06,94% AV Level Silver Plan,,0.946797907352448,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,5%,,,,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0130010,Select Med Preference Benchmark Bronze 5000,68781UT013,,UTN002,UTS002,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_benchmark_bronze_5000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_benchmark_bronze_5000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0130010-00,Standard Bronze Off Exchange Plan,,0.603495538234711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0130010,Select Med Preference Benchmark Bronze 5000,68781UT013,,UTN002,UTS002,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_med_preference_benchmark_bronze_5000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_med_preference_benchmark_bronze_5000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0130010-01,Standard Bronze On Exchange Plan,,0.603495538234711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0140005,Select Care Preference Benchmark Silver 1000,68781UT014,,UTN001,UTS001,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_benchmark_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_benchmark_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0140005-00,Standard Silver Off Exchange Plan,,0.697579860687256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,26
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0140005,Select Care Preference Benchmark Silver 1000,68781UT014,,UTN001,UTS001,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_benchmark_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_benchmark_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0140005-01,Standard Silver On Exchange Plan,,0.697579860687256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,27
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0140005,Select Care Preference Benchmark Silver 1000,68781UT014,,UTN001,UTS001,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_benchmark_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_benchmark_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0140005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,28
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0140005,Select Care Preference Benchmark Silver 1000,68781UT014,,UTN001,UTS001,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_benchmark_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_benchmark_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0140005-03,Limited Cost Sharing Plan Variation,,0.697579860687256,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,29
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0140005,Select Care Preference Benchmark Silver 1000,68781UT014,,UTN001,UTS001,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_benchmark_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_benchmark_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0140005-04,73% AV Level Silver Plan,,0.735162734985352,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,$250,Not Applicable,,,,,,,,,,,,,,,,,,,30
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0140005,Select Care Preference Benchmark Silver 1000,68781UT014,,UTN001,UTS001,UTF001,Existing,HMO,Silver,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_benchmark_silver_1000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_benchmark_silver_1000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0140005-06,94% AV Level Silver Plan,,0.946797907352448,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,5%,,,,Not Applicable,Not Applicable,$0,Not Applicable,,,,,,,,,,,,,,,,,,,32
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0140010,Select Care Preference Benchmark Bronze 5000,68781UT014,,UTN001,UTS001,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_benchmark_bronze_5000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_benchmark_bronze_5000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0140010-00,Standard Bronze Off Exchange Plan,,0.603495538234711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,33
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0140010,Select Care Preference Benchmark Bronze 5000,68781UT014,,UTN001,UTS001,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_benchmark_bronze_5000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_benchmark_bronze_5000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0140010-01,Standard Bronze On Exchange Plan,,0.603495538234711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,34
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0140010,Select Care Preference Benchmark Bronze 5000,68781UT014,,UTN001,UTS001,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_benchmark_bronze_5000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_benchmark_bronze_5000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0140010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,35
2015,UT,68781,SERFF,10,2014-11-14 14:52:18,6,68781,UT,Individual,No,87-0409820,68781UT0140010,Select Care Preference Benchmark Bronze 5000,68781UT014,,UTN001,UTS001,UTF003,Existing,HMO,Bronze,No,Both,No,No,,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.",$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,2015-12-31,Yes,Urgent and emergency care only,Yes,Urgent and emergency care only,No,http://www.selecthealth.org/sbc/default.aspx?plan=ut_select_care_preference_benchmark_bronze_5000,selecthealth.org/ffmpayment/medical.aspx,http://www.selecthealth.org/plan-brochure.aspx?plan=ut_select_care_preference_benchmark_bronze_5000,https://myhealth.intermountainhealthcare.org/myhealth/RXEOB/RxEOBServlet?parm=public006,68781UT0140010-03,Limited Cost Sharing Plan Variation,,0.603495538234711,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$5,000","$10,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,Not Applicable,25%,,,,Not Applicable,Not Applicable,"$1,000",Not Applicable,,,,,,,,,,,,,,,,,,,36
2015,UT,68809,SERFF,3,2014-09-08 09:42:37,1,68809,UT,Individual,Yes,91-1857813,68809UT0010001,Smile for Kids Low Plan,68809UT001,,UTN001,UTS001,,Existing,PPO,Low,,Both,,,,Please see the Schedule of Benefits for limitations and exclusions.,,,,,Allows Child-Only,,,,$14.83,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.",Yes,www.premierlife.com/uthealthreform,www.premierlife.com/payment,www.premierlife.com/uthealthreform,,68809UT0010001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,UT,68809,SERFF,3,2014-09-08 09:42:37,1,68809,UT,Individual,Yes,91-1857813,68809UT0010001,Smile for Kids Low Plan,68809UT001,,UTN001,UTS001,,Existing,PPO,Low,,Both,,,,Please see the Schedule of Benefits for limitations and exclusions.,,,,,Allows Child-Only,,,,$14.83,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.",Yes,www.premierlife.com/uthealthreform,www.premierlife.com/payment,www.premierlife.com/uthealthreform,,68809UT0010001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,UT,68809,SERFF,3,2014-09-08 09:42:37,2,68809,UT,Individual,Yes,91-1857813,68809UT0010002,Smile for Kids PLUS Low Plan,68809UT001,,UTN001,UTS001,,Existing,PPO,Low,,Both,,,,Please see the Schedule of Benefits for limitations and exclusions.,,,,,Allows Child-Only,,,,$30.09,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers",Yes,www.premierlife.com/uthealthreform,www.premierlife.com/payment,www.premierlife.com/uthealthreform,,68809UT0010002-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,UT,68809,SERFF,3,2014-09-08 09:42:37,2,68809,UT,Individual,Yes,91-1857813,68809UT0010002,Smile for Kids PLUS Low Plan,68809UT001,,UTN001,UTS001,,Existing,PPO,Low,,Both,,,,Please see the Schedule of Benefits for limitations and exclusions.,,,,,Allows Child-Only,,,,$30.09,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers",Yes,www.premierlife.com/uthealthreform,www.premierlife.com/payment,www.premierlife.com/uthealthreform,,68809UT0010002-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,UT,68809,SERFF,3,2014-09-08 09:42:37,3,68809,UT,Individual,Yes,91-1857813,68809UT0010003,PPO Family Plan with EHB,68809UT001,,UTN001,UTS001,,Existing,PPO,Low,,Both,,,,Please see the Schedule of Benefits for limitations and exclusions.,,,,,Allows Adult and Child-Only,,,,$14.83,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers",Yes,www.premierlife.com/uthealthreform,www.premierlife.com/payment,www.premierlife.com/uthealthreform,,68809UT0010003-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,UT,68809,SERFF,3,2014-09-08 09:42:37,3,68809,UT,Individual,Yes,91-1857813,68809UT0010003,PPO Family Plan with EHB,68809UT001,,UTN001,UTS001,,Existing,PPO,Low,,Both,,,,Please see the Schedule of Benefits for limitations and exclusions.,,,,,Allows Adult and Child-Only,,,,$14.83,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers",Yes,www.premierlife.com/uthealthreform,www.premierlife.com/payment,www.premierlife.com/uthealthreform,,68809UT0010003-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,UT,68809,SERFF,3,2014-09-08 09:42:37,3,68809,UT,Individual,Yes,91-1857813,68809UT0010004,PLUS Family Plan with EHB,68809UT001,,UTN001,UTS001,,Existing,PPO,Low,,Both,,,,Please see the Schedule of Benefits for limitations and exclusions.,,,,,Allows Adult and Child-Only,,,,$14.83,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers",Yes,www.premierlife.com/uthealthreform,www.premierlife.com/payment,www.premierlife.com/uthealthreform,,68809UT0010004-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,UT,68809,SERFF,3,2014-09-08 09:42:37,3,68809,UT,Individual,Yes,91-1857813,68809UT0010004,PLUS Family Plan with EHB,68809UT001,,UTN001,UTS001,,Existing,PPO,Low,,Both,,,,Please see the Schedule of Benefits for limitations and exclusions.,,,,,Allows Adult and Child-Only,,,,$14.83,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers",Yes,www.premierlife.com/uthealthreform,www.premierlife.com/payment,www.premierlife.com/uthealthreform,,68809UT0010004-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,UT,68809,SERFF,3,2014-09-08 09:42:37,4,68809,UT,Individual,Yes,91-1857813,68809UT0010005,PPO Family Plan with EHB PLUS,68809UT001,,UTN001,UTS001,,Existing,PPO,Low,,Both,,,,Please see the Schedule of Benefits for limitations and exclusions,,,,,Allows Adult and Child-Only,,,,$30.09,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the usual, customary, and reasonable amount in each geographic area as determined by Premier Access using industry data.",Yes,www.premierlife.com/uthealthreform,www.premierlife.com/payment,www.premierlife.com/uthealthreform,,68809UT0010005-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,UT,68809,SERFF,3,2014-09-08 09:42:37,4,68809,UT,Individual,Yes,91-1857813,68809UT0010005,PPO Family Plan with EHB PLUS,68809UT001,,UTN001,UTS001,,Existing,PPO,Low,,Both,,,,Please see the Schedule of Benefits for limitations and exclusions,,,,,Allows Adult and Child-Only,,,,$30.09,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the usual, customary, and reasonable amount in each geographic area as determined by Premier Access using industry data.",Yes,www.premierlife.com/uthealthreform,www.premierlife.com/payment,www.premierlife.com/uthealthreform,,68809UT0010005-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,UT,68809,SERFF,3,2014-09-08 09:42:37,4,68809,UT,Individual,Yes,91-1857813,68809UT0010006,PLUS Family Plan with EHB PLUS,68809UT001,,UTN001,UTS001,,Existing,PPO,Low,,Both,,,,Please see the Schedule of Benefits for limitations and exclusions,,,,,Allows Adult and Child-Only,,,,$30.09,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the usual, customary, and reasonable amount in each geographic area as determined by Premier Access using industry data.",Yes,www.premierlife.com/uthealthreform,www.premierlife.com/payment,www.premierlife.com/uthealthreform,,68809UT0010006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,UT,68809,SERFF,3,2014-09-08 09:42:37,4,68809,UT,Individual,Yes,91-1857813,68809UT0010006,PLUS Family Plan with EHB PLUS,68809UT001,,UTN001,UTS001,,Existing,PPO,Low,,Both,,,,Please see the Schedule of Benefits for limitations and exclusions,,,,,Allows Adult and Child-Only,,,,$30.09,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,"The out of network benefit is limited to the usual, customary, and reasonable amount in each geographic area as determined by Premier Access using industry data.",Yes,www.premierlife.com/uthealthreform,www.premierlife.com/payment,www.premierlife.com/uthealthreform,,68809UT0010006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,UT,71246,SERFF,3,2014-11-15 10:06:04,1,71246,UT,Individual,Yes,94-2761537,71246UT0010002,Delta Dental PPO Pediatric Preferred Plan,71246UT001,,UTN001,UTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$13.12,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ut/71246ut0010002-15,,71246UT0010002-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,UT,71246,SERFF,3,2014-11-15 10:06:04,1,71246,UT,Individual,Yes,94-2761537,71246UT0010002,Delta Dental PPO Pediatric Preferred Plan,71246UT001,,UTN001,UTS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$13.12,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ut/71246ut0010002-15,,71246UT0010002-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,UT,71246,SERFF,3,2014-11-15 10:06:04,1,71246,UT,Individual,Yes,94-2761537,71246UT0010001,Delta Dental PPO Pediatric Basic Plan,71246UT001,,UTN001,UTS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$9.71,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ut/71246ut0010001-15,,71246UT0010001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,UT,71246,SERFF,3,2014-11-15 10:06:04,1,71246,UT,Individual,Yes,94-2761537,71246UT0010001,Delta Dental PPO Pediatric Basic Plan,71246UT001,,UTN001,UTS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$9.71,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ut/71246ut0010001-15,,71246UT0010001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,UT,71246,SERFF,3,2014-11-15 10:06:04,2,71246,UT,Individual,Yes,94-2761537,71246UT0010004,Delta Dental PPO Preferred Plan for Families,71246UT001,,UTN001,UTS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.77,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ut/71246ut0010004-15,,71246UT0010004-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,UT,71246,SERFF,3,2014-11-15 10:06:04,2,71246,UT,Individual,Yes,94-2761537,71246UT0010004,Delta Dental PPO Preferred Plan for Families,71246UT001,,UTN001,UTS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$28.77,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ut/71246ut0010004-15,,71246UT0010004-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,UT,71246,SERFF,3,2014-11-15 10:06:04,3,71246,UT,Individual,Yes,94-2761537,71246UT0010006,Delta Dental PPO Basic Plan for Families,71246UT001,,UTN001,UTS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.00,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ut/71246ut0010006-15,,71246UT0010006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,UT,71246,SERFF,3,2014-11-15 10:06:04,3,71246,UT,Individual,Yes,94-2761537,71246UT0010006,Delta Dental PPO Basic Plan for Families,71246UT001,,UTN001,UTS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.00,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/ut/71246ut0010006-15,,71246UT0010006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,UT,72660,SERFF,3,2014-11-15 10:06:04,1,72660,UT,Individual,Yes,75-1233841,72660UT0010001,Dentegra Dental PPO Pediatric Basic Plan,72660UT001,,UTN001,UTS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$10.04,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ut/72660ut0010001-15,,72660UT0010001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,UT,72660,SERFF,3,2014-11-15 10:06:04,1,72660,UT,Individual,Yes,75-1233841,72660UT0010001,Dentegra Dental PPO Pediatric Basic Plan,72660UT001,,UTN001,UTS001,,New,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$10.04,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ut/72660ut0010001-15,,72660UT0010001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,UT,72660,SERFF,3,2014-11-15 10:06:04,2,72660,UT,Individual,Yes,75-1233841,72660UT0010006,Dentegra Dental PPO Family Basic Plan,72660UT001,,UTN001,UTS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.36,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ut/72660ut0010006-15,,72660UT0010006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,UT,72660,SERFF,3,2014-11-15 10:06:04,2,72660,UT,Individual,Yes,75-1233841,72660UT0010006,Dentegra Dental PPO Family Basic Plan,72660UT001,,UTN001,UTS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.36,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/ut/72660ut0010006-15,,72660UT0010006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,UT,80251,SERFF,2,2014-09-09 16:12:42,1,80251,UT,Individual,Yes,95-2371728,80251UT0010001,Co-Pay,80251UT001,,UTN001,UTS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$13.47,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Utah,Yes,,,,,80251UT0010001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,UT,80251,SERFF,2,2014-09-09 16:12:42,1,80251,UT,Individual,Yes,95-2371728,80251UT0010002,Co-Pay,80251UT001,,UTN001,UTS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$17.44,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Utah,Yes,,,,,80251UT0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,UT,80251,SERFF,2,2014-09-09 16:12:42,2,80251,UT,Individual,Yes,95-2371728,80251UT0010003,PPO MAC,80251UT001,,UTN001,UTS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$19.97,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Utah,Yes,,,,,80251UT0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,UT,80251,SERFF,2,2014-09-09 16:12:42,2,80251,UT,Individual,Yes,95-2371728,80251UT0010004,PPO MAC,80251UT001,,UTN001,UTS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$15.42,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Utah,Yes,,,,,80251UT0010004-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,UT,80251,SERFF,2,2014-09-09 16:12:42,3,80251,UT,Individual,Yes,95-2371728,80251UT0010005,PPO MAC,80251UT001,,UTN001,UTS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$20.20,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Utah,Yes,,,,,80251UT0010005-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,UT,80251,SERFF,2,2014-09-09 16:12:42,3,80251,UT,Individual,Yes,95-2371728,80251UT0010006,PPO MAC,80251UT001,,UTN001,UTS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$16.05,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Any service received outside of the state of Utah,Yes,,,,,80251UT0010006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$100,$300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,UT,87169,SERFF,2,2014-09-09 16:12:42,1,87169,UT,Individual,Yes,47-0397286,87169UT0010001,"Delta Dental Individual PPO, EHB Certified",87169UT001,,UTN002,UTS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$30.86,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,87169UT0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,UT,87169,SERFF,2,2014-09-09 16:12:42,1,87169,UT,Individual,Yes,47-0397286,87169UT0010002,"Delta Dental Individual PPO, EHB Certified",87169UT001,,UTN002,UTS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.25,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,87169UT0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,UT,87169,SERFF,2,2014-09-09 16:12:42,1,87169,UT,Individual,Yes,47-0397286,87169UT0020001,"Renaissance Individual Dental PPO, EHB Certified",87169UT002,,UTN001,UTS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$37.08,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,87169UT0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,UT,87169,SERFF,2,2014-09-09 16:12:42,1,87169,UT,Individual,Yes,47-0397286,87169UT0020002,"Renaissance Individual Dental PPO, EHB Certified",87169UT002,,UTN001,UTS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.07,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,87169UT0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,1,10207,VA,SHOP (Small Group),No,52-1358219,10207VA0550002,"BlueChoice HMO Referral HSA/HRA $4,000",10207VA055,,VAN001,VAS001,VAF003,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists require referral except covered services rendered by a contracting obstetrician/gynecologist; covered services rendered at contracting provider radiologist offices; covered services rendered by a contracting provider laboratory; and covered services rendered by a contracting provider ophthalmologist.,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996906991040416,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BCHVC55ARXCVCA5CN012015.pdf,,,www.carefirst.com/acarx,10207VA0550002-00,Standard Bronze Off Exchange Plan,61.18%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,$0,$0,Not Applicable,Not Applicable,"$4,000",$20,$660,$150,"$4,000",$150,$60,$80,4
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,1,10207,VA,Individual,No,52-1358219,10207VA0380001,"BlueChoice Silver $2,000",10207VA038,,VAN001,VAS001,VAF006,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHAVCN6NRXCVCN6DN012015.pdf,,,www.carefirst.com/acarx,10207VA0380001-00,Standard Silver Off Exchange Plan,69.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,$0,$0,Not Applicable,Not Applicable,"$2,000",$15,$645,$30,"$2,000",$390,$176,$0,4
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,1,10207,VA,Individual,No,52-1358219,10207VA0380001,"BlueChoice Silver $2,000",10207VA038,,VAN001,VAS001,VAF006,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHAVCN6NRXCVCN6DN012015.pdf,,,www.carefirst.com/acarx,10207VA0380001-01,Standard Silver On Exchange Plan,69.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,$0,$0,Not Applicable,Not Applicable,"$2,000",$15,$645,$30,"$2,000",$390,$176,$0,5
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,1,10207,VA,SHOP (Small Group),No,52-1358219,10207VA0550002,"BlueChoice HMO Referral HSA/HRA $4,000",10207VA055,,VAN001,VAS001,VAF003,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists require referral except covered services rendered by a contracting obstetrician/gynecologist; covered services rendered at contracting provider radiologist offices; covered services rendered by a contracting provider laboratory; and covered services rendered by a contracting provider ophthalmologist.,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996906991040416,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BCHVC55ARXCVCA5CN012015.pdf,,,www.carefirst.com/acarx,10207VA0550002-01,Standard Bronze On Exchange Plan,61.18%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,$0,$0,Not Applicable,Not Applicable,"$4,000",$20,$660,$150,"$4,000",$150,$60,$80,5
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,1,10207,VA,SHOP (Small Group),No,52-1358219,10207VA0420002,"BlueChoice HMO HSA/HRA $2,000",10207VA042,,VAN002,VAS001,VAF003,Existing,HMO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996906796737693,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHHVC56ARXCVCA6CN012015.pdf,,,www.carefirst.com/acarx,10207VA0420002-00,Standard Silver Off Exchange Plan,70.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,$0,$0,Not Applicable,Not Applicable,"$4,000",$20,$660,$150,"$4,000",$150,$60,$80,6
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,1,10207,VA,Individual,No,52-1358219,10207VA0380001,"BlueChoice Silver $2,000",10207VA038,,VAN001,VAS001,VAF006,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHAVCN6NRXCVCN6DN012015.pdf,,,www.carefirst.com/acarx,10207VA0380001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$30,$0,$0,$0,$0,6
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,1,10207,VA,Individual,No,52-1358219,10207VA0380001,"BlueChoice Silver $2,000",10207VA038,,VAN001,VAS001,VAF006,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHAVCN6NRXCVCN6DN012015.pdf,,,www.carefirst.com/acarx,10207VA0380001-03,Limited Cost Sharing Plan Variation,69.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,$0,$0,Not Applicable,Not Applicable,"$2,000",$15,$645,$30,"$2,000",$390,$176,$0,7
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,1,10207,VA,SHOP (Small Group),No,52-1358219,10207VA0420002,"BlueChoice HMO HSA/HRA $2,000",10207VA042,,VAN002,VAS001,VAF003,Existing,HMO,Silver,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996906796737693,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHHVC56ARXCVCA6CN012015.pdf,,,www.carefirst.com/acarx,10207VA0420002-01,Standard Silver On Exchange Plan,70.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,$0,$0,Not Applicable,Not Applicable,"$4,000",$20,$660,$150,"$4,000",$150,$60,$80,7
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,1,10207,VA,SHOP (Small Group),No,52-1358219,10207VA0430003,"BlueChoice HMO $1,000",10207VA043,,VAN002,VAS001,VAF003,Existing,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996906813471746,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHHVC57CRXCVCA7AN012015.pdf,,,www.carefirst.com/acarx,10207VA0430003-00,Standard Gold Off Exchange Plan,78.47%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,$0,$0,Not Applicable,Not Applicable,"$1,000",$20,"$1,010",$150,"$1,000",$360,$360,$80,8
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,1,10207,VA,Individual,No,52-1358219,10207VA0380001,"BlueChoice Silver $2,000",10207VA038,,VAN001,VAS001,VAF006,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHAVCN6NRXCVCN6DN012015.pdf,,,www.carefirst.com/acarx,10207VA0380001-04,73% AV Level Silver Plan,72.77%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800",20%,,,,$0,$0,Not Applicable,Not Applicable,"$1,400",$15,$765,$30,"$1,400",$460,$204,$0,8
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,1,10207,VA,Individual,No,52-1358219,10207VA0380001,"BlueChoice Silver $2,000",10207VA038,,VAN001,VAS001,VAF006,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHAVCN6NRXCVCN6DN012015.pdf,,,www.carefirst.com/acarx,10207VA0380001-05,87% AV Level Silver Plan,87.67%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$522,$30,$0,$0,$135,$0,9
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,1,10207,VA,SHOP (Small Group),No,52-1358219,10207VA0430003,"BlueChoice HMO $1,000",10207VA043,,VAN002,VAS001,VAF003,Existing,HMO,Gold,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996906813471746,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHHVC57CRXCVCA7AN012015.pdf,,,www.carefirst.com/acarx,10207VA0430003-01,Standard Gold On Exchange Plan,78.47%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",20%,,,,$0,$0,Not Applicable,Not Applicable,"$1,000",$20,"$1,010",$150,"$1,000",$360,$360,$80,9
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,1,10207,VA,Individual,No,52-1358219,10207VA0380001,"BlueChoice Silver $2,000",10207VA038,,VAN001,VAS001,VAF006,New,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHAVCN6NRXCVCN6DN012015.pdf,,,www.carefirst.com/acarx,10207VA0380001-06,94% AV Level Silver Plan,93.22%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$522,$30,$0,$0,$135,$0,10
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,2,10207,VA,Individual,No,52-1358219,10207VA0410002,HealthyBlue Platinum $0,10207VA041,,VAN003,VAS001,VAF008,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,$200,0,0,0,2015-01-01,,Yes,All covered services out of network only,Yes,All covered services,Yes,http://content.carefirst.com/sbc/HCUVBN8NRXXVBN8CN012015.pdf,,,www.carefirst.com/acarx,10207VA0410002-00,Standard Platinum Off Exchange Plan,89.83%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$150,$0,$30,$0,$0,$244,$0,4
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,2,10207,VA,SHOP (Small Group),No,52-1358219,10207VA0440004,BlueChoice Advantage 90%/70%,10207VA044,,VAN003,VAS001,VAF003,Existing,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99690682854481,,,0,0,0,2015-01-01,,Yes,All covered services out of network only,Yes,All covered services,Yes,http://content.carefirst.com/sbc/BAVVB58DRXXVB08AN012015.pdf,,,www.carefirst.com/acarx,10207VA0440004-00,Standard Platinum Off Exchange Plan,90.26%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$3,500","$7,000",Not Applicable,Not Applicable,$0,$0,10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,"$1,010",$150,"$1,000",$360,$360,$80,4
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,2,10207,VA,SHOP (Small Group),No,52-1358219,10207VA0440004,BlueChoice Advantage 90%/70%,10207VA044,,VAN003,VAS001,VAF003,Existing,POS,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99690682854481,,,0,0,0,2015-01-01,,Yes,All covered services out of network only,Yes,All covered services,Yes,http://content.carefirst.com/sbc/BAVVB58DRXXVB08AN012015.pdf,,,www.carefirst.com/acarx,10207VA0440004-01,Standard Platinum On Exchange Plan,90.26%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$3,500","$7,000",Not Applicable,Not Applicable,$0,$0,10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,"$1,000",$20,"$1,010",$150,"$1,000",$360,$360,$80,5
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,2,10207,VA,Individual,No,52-1358219,10207VA0410002,HealthyBlue Platinum $0,10207VA041,,VAN003,VAS001,VAF008,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,$200,0,0,0,2015-01-01,,Yes,All covered services out of network only,Yes,All covered services,Yes,http://content.carefirst.com/sbc/HCUVBN8NRXXVBN8CN012015.pdf,,,www.carefirst.com/acarx,10207VA0410002-01,Standard Platinum On Exchange Plan,89.83%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$150,$0,$30,$0,$0,$244,$0,5
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,2,10207,VA,Individual,No,52-1358219,10207VA0410002,HealthyBlue Platinum $0,10207VA041,,VAN003,VAS001,VAF008,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,$200,0,0,0,2015-01-01,,Yes,All covered services out of network only,Yes,All covered services,Yes,http://content.carefirst.com/sbc/HCUVBN8NRXXVBN8CN012015.pdf,,,www.carefirst.com/acarx,10207VA0410002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$30,$0,$0,$0,$0,6
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,2,10207,VA,Individual,No,52-1358219,10207VA0410002,HealthyBlue Platinum $0,10207VA041,,VAN003,VAS001,VAF008,New,POS,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,$200,0,0,0,2015-01-01,,Yes,All covered services out of network only,Yes,All covered services,Yes,http://content.carefirst.com/sbc/HCUVBN8NRXXVBN8CN012015.pdf,,,www.carefirst.com/acarx,10207VA0410002-03,Limited Cost Sharing Plan Variation,89.83%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$150,$0,$30,$0,$0,$244,$0,7
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,4,10207,VA,Individual,No,52-1358219,10207VA0400001,"BlueChoice Plus Bronze $5,500",10207VA040,,VAN004,VAS001,VAF006,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,All covered services out of network only,Yes,All covered services,Yes,http://content.carefirst.com/sbc/BTPVBN5NRXCVBN5CN012015.pdf,,,www.carefirst.com/acarx,10207VA0400001-00,Standard Bronze Off Exchange Plan,61.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$6,350","$12,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$6,350","$12,700",Not Applicable,Not Applicable,"$5,250",$0,$0,$30,"$5,210",$0,$0,$0,4
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,4,10207,VA,Individual,No,52-1358219,10207VA0400001,"BlueChoice Plus Bronze $5,500",10207VA040,,VAN004,VAS001,VAF006,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,All covered services out of network only,Yes,All covered services,Yes,http://content.carefirst.com/sbc/BTPVBN5NRXCVBN5CN012015.pdf,,,www.carefirst.com/acarx,10207VA0400001-01,Standard Bronze On Exchange Plan,61.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$6,350","$12,700",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",20%,,,,"$6,350","$12,700",Not Applicable,Not Applicable,"$5,250",$0,$0,$30,"$5,210",$0,$0,$0,5
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,7,10207,VA,Individual,No,52-1358219,10207VA0390002,"BlueChoice HSA Bronze $6,000",10207VA039,,VAN001,VAS001,VAF004,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHHVCN5QRXCVCN5FN012015.pdf,,,www.carefirst.com/acarx,10207VA0390002-01,Standard Bronze On Exchange Plan,59.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,$0,$0,Not Applicable,Not Applicable,"$5,250",$0,$0,$30,"$5,210",$0,$0,$0,9
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,7,10207,VA,Individual,No,52-1358219,10207VA0390002,"BlueChoice HSA Bronze $6,000",10207VA039,,VAN001,VAS001,VAF004,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHHVCN5QRXCVCN5FN012015.pdf,,,www.carefirst.com/acarx,10207VA0390002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$30,$0,$0,$0,$0,10
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,7,10207,VA,Individual,No,52-1358219,10207VA0390002,"BlueChoice HSA Bronze $6,000",10207VA039,,VAN001,VAS001,VAF004,New,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHHVCN5QRXCVCN5FN012015.pdf,,,www.carefirst.com/acarx,10207VA0390002-03,Limited Cost Sharing Plan Variation,59.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",0%,,,,$0,$0,Not Applicable,Not Applicable,"$5,250",$0,$0,$30,"$5,210",$0,$0,$0,11
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,7,10207,VA,Individual,No,52-1358219,10207VA0390003,"BlueChoice HSA Silver $1,300",10207VA039,,VAN001,VAS001,VAF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHHVCN6NRXCVCN6FN012015.pdf,,,www.carefirst.com/acarx,10207VA0390003-00,Standard Silver Off Exchange Plan,69.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,$0,$0,Not Applicable,Not Applicable,"$1,300",$0,$790,$30,"$1,300",$120,$694,$0,12
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,7,10207,VA,Individual,No,52-1358219,10207VA0390003,"BlueChoice HSA Silver $1,300",10207VA039,,VAN001,VAS001,VAF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHHVCN6NRXCVCN6FN012015.pdf,,,www.carefirst.com/acarx,10207VA0390003-01,Standard Silver On Exchange Plan,69.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,$0,$0,Not Applicable,Not Applicable,"$1,300",$0,$790,$30,"$1,300",$120,$694,$0,13
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,7,10207,VA,Individual,No,52-1358219,10207VA0390003,"BlueChoice HSA Silver $1,300",10207VA039,,VAN001,VAS001,VAF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHHVCN6NRXCVCN6FN012015.pdf,,,www.carefirst.com/acarx,10207VA0390003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$30,$0,$0,$0,$0,14
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,7,10207,VA,Individual,No,52-1358219,10207VA0390003,"BlueChoice HSA Silver $1,300",10207VA039,,VAN001,VAS001,VAF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHHVCN6NRXCVCN6FN012015.pdf,,,www.carefirst.com/acarx,10207VA0390003-03,Limited Cost Sharing Plan Variation,69.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,$0,$0,Not Applicable,Not Applicable,"$1,300",$0,$790,$30,"$1,300",$120,$694,$0,15
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,7,10207,VA,Individual,No,52-1358219,10207VA0390003,"BlueChoice HSA Silver $1,300",10207VA039,,VAN001,VAS001,VAF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHHVCN6NRXCVCN6FN012015.pdf,,,www.carefirst.com/acarx,10207VA0390003-04,73% AV Level Silver Plan,73.48%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$900,"$1,800",20%,,,,$0,$0,Not Applicable,Not Applicable,$900,$0,$870,$30,$900,$200,$710,$0,16
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,7,10207,VA,Individual,No,52-1358219,10207VA0390003,"BlueChoice HSA Silver $1,300",10207VA039,,VAN001,VAS001,VAF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHHVCN6NRXCVCN6FN012015.pdf,,,www.carefirst.com/acarx,10207VA0390003-05,87% AV Level Silver Plan,87.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,"$1,049",$30,$0,$40,$702,$0,17
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,7,10207,VA,Individual,No,52-1358219,10207VA0390003,"BlueChoice HSA Silver $1,300",10207VA039,,VAN001,VAS001,VAF005,New,HMO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHHVCN6NRXCVCN6FN012015.pdf,,,www.carefirst.com/acarx,10207VA0390003-06,94% AV Level Silver Plan,93.22%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,$522,$30,$0,$0,$135,$0,18
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,8,10207,VA,Individual,No,52-1358219,10207VA0380002,BlueChoice Gold $0,10207VA038,,VAN001,VAS001,VAF005,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHAVCN7NRXXVCN7CN012015.pdf,,,www.carefirst.com/acarx,10207VA0380002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$30,$0,$0,$0,$0,6
2015,VA,10207,SERFF,13,2014-09-09 16:12:42,8,10207,VA,Individual,No,52-1358219,10207VA0380002,BlueChoice Gold $0,10207VA038,,VAN001,VAS001,VAF005,New,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.997034049036316,,,0,0,0,2015-01-01,,Yes,Emergency Services only,Yes,Emergency Services only,Yes,http://content.carefirst.com/sbc/BHAVCN7NRXXVCN7CN012015.pdf,,,www.carefirst.com/acarx,10207VA0380002-03,Limited Cost Sharing Plan Variation,79.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,$0,$0,Not Applicable,Not Applicable,$0,$0,30%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,"$1,572",$30,$0,$160,$981,$0,7
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,1,12028,VA,Individual,No,46-0674828,12028VA0010001,Innovation Health Aetna-INOVA Bronze $25 Copay,12028VA001,,VAN001,VAS001,VAF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010001-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,1,12028,VA,Individual,No,46-0674828,12028VA0010001,Innovation Health Aetna-INOVA Bronze $25 Copay,12028VA001,,VAN001,VAS001,VAF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010001-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,1,12028,VA,Individual,No,46-0674828,12028VA0010001,Innovation Health Aetna-INOVA Bronze $25 Copay,12028VA001,,VAN001,VAS001,VAF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,1,12028,VA,Individual,No,46-0674828,12028VA0010001,Innovation Health Aetna-INOVA Bronze $25 Copay,12028VA001,,VAN001,VAS001,VAF001,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010001-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,2,12028,VA,Individual,No,46-0674828,12028VA0010019,Innovation Health Aetna-INOVA Bronze Deductible Only HSA,12028VA001,,VAN001,VAS001,VAF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010019-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,2,12028,VA,Individual,No,46-0674828,12028VA0010019,Innovation Health Aetna-INOVA Bronze Deductible Only HSA,12028VA001,,VAN001,VAS001,VAF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010019-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,2,12028,VA,Individual,No,46-0674828,12028VA0010019,Innovation Health Aetna-INOVA Bronze Deductible Only HSA,12028VA001,,VAN001,VAS001,VAF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010019-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,2,12028,VA,Individual,No,46-0674828,12028VA0010019,Innovation Health Aetna-INOVA Bronze Deductible Only HSA,12028VA001,,VAN001,VAS001,VAF002,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010019-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,3,12028,VA,Individual,No,46-0674828,12028VA0010015,Innovation Health Aetna-INOVA Silver $10 Copay,12028VA001,,VAN001,VAS001,VAF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010015-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,3,12028,VA,Individual,No,46-0674828,12028VA0010015,Innovation Health Aetna-INOVA Silver $10 Copay,12028VA001,,VAN001,VAS001,VAF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010015-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,3,12028,VA,Individual,No,46-0674828,12028VA0010015,Innovation Health Aetna-INOVA Silver $10 Copay,12028VA001,,VAN001,VAS001,VAF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010015-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,3,12028,VA,Individual,No,46-0674828,12028VA0010015,Innovation Health Aetna-INOVA Silver $10 Copay,12028VA001,,VAN001,VAS001,VAF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010015-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,3,12028,VA,Individual,No,46-0674828,12028VA0010015,Innovation Health Aetna-INOVA Silver $10 Copay,12028VA001,,VAN001,VAS001,VAF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010015-04,73% AV Level Silver Plan,72.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,3,12028,VA,Individual,No,46-0674828,12028VA0010015,Innovation Health Aetna-INOVA Silver $10 Copay,12028VA001,,VAN001,VAS001,VAF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010015-05,87% AV Level Silver Plan,86.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,200","$4,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,3,12028,VA,Individual,No,46-0674828,12028VA0010015,Innovation Health Aetna-INOVA Silver $10 Copay,12028VA001,,VAN001,VAS001,VAF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010015-06,94% AV Level Silver Plan,93.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,4,12028,VA,Individual,No,46-0674828,12028VA0010025,Innovation Health Aetna-INOVA Silver $5 Copay 2750,12028VA001,,VAN001,VAS001,VAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010025-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,4,12028,VA,Individual,No,46-0674828,12028VA0010025,Innovation Health Aetna-INOVA Silver $5 Copay 2750,12028VA001,,VAN001,VAS001,VAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010025-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,4,12028,VA,Individual,No,46-0674828,12028VA0010025,Innovation Health Aetna-INOVA Silver $5 Copay 2750,12028VA001,,VAN001,VAS001,VAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010025-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,4,12028,VA,Individual,No,46-0674828,12028VA0010025,Innovation Health Aetna-INOVA Silver $5 Copay 2750,12028VA001,,VAN001,VAS001,VAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010025-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,4,12028,VA,Individual,No,46-0674828,12028VA0010025,Innovation Health Aetna-INOVA Silver $5 Copay 2750,12028VA001,,VAN001,VAS001,VAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010025-04,73% AV Level Silver Plan,72.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,4,12028,VA,Individual,No,46-0674828,12028VA0010025,Innovation Health Aetna-INOVA Silver $5 Copay 2750,12028VA001,,VAN001,VAS001,VAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010025-05,87% AV Level Silver Plan,86.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,4,12028,VA,Individual,No,46-0674828,12028VA0010025,Innovation Health Aetna-INOVA Silver $5 Copay 2750,12028VA001,,VAN001,VAS001,VAF006,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010025-06,94% AV Level Silver Plan,93.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,5,12028,VA,Individual,No,46-0674828,12028VA0010022,Innovation Health Aetna-INOVA Gold $5 Copay,12028VA001,,VAN001,VAS001,VAF004,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010022-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,$500,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,5,12028,VA,Individual,No,46-0674828,12028VA0010022,Innovation Health Aetna-INOVA Gold $5 Copay,12028VA001,,VAN001,VAS001,VAF004,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010022-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,$500,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,5,12028,VA,Individual,No,46-0674828,12028VA0010022,Innovation Health Aetna-INOVA Gold $5 Copay,12028VA001,,VAN001,VAS001,VAF004,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010022-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,5,12028,VA,Individual,No,46-0674828,12028VA0010022,Innovation Health Aetna-INOVA Gold $5 Copay,12028VA001,,VAN001,VAS001,VAF004,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010022-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,$500,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,6,12028,VA,Individual,No,46-0674828,12028VA0010007,Innovation Health Aetna-INOVA Catastrophic 100%,12028VA001,,VAN001,VAS001,VAF003,Existing,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010007-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,12028,SERFF,7,2014-12-12 12:37:36,6,12028,VA,Individual,No,46-0674828,12028VA0010007,Innovation Health Aetna-INOVA Catastrophic 100%,12028VA001,,VAN001,VAS001,VAF003,Existing,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,0.999999007154071,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://www.innovation-health.com/individuals-families-exchange-2015/,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,12028VA0010007-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,4,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140055,Silver Piedmont Preferred 3000/35/60,15668VA014,7205839435,VAN001,VAS001,VAF003,New,PPO,Silver,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9961,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140055-01,Standard Silver On Exchange Plan,71.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$12,000",Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,4,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140057,Silver Piedmont Preferred 4000/35/60,15668VA014,7205839435,VAN001,VAS001,VAF003,New,PPO,Silver,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.996,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140057-00,Standard Silver Off Exchange Plan,71.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$12,000",Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140045,Gold Piedmont Preferred 1250/30/50,15668VA014,7205839435,VAN001,VAS001,VAF002,New,PPO,Gold,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9966,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140045-00,Standard Gold Off Exchange Plan,79.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,250","$2,500",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,Individual,No,31-1592932,15668VA0130035,Silver Preferred 2500/35/60,15668VA013,7205839435,VAN001,VAS001,VAF002,New,PPO,Silver,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9975,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130035-00,Standard Silver Off Exchange Plan,,0.705024778842926,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$250,$500,35%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,Individual,No,31-1592932,15668VA0130035,Silver Preferred 2500/35/60,15668VA013,7205839435,VAN001,VAS001,VAF002,New,PPO,Silver,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9975,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130035-01,Standard Silver On Exchange Plan,,0.705024778842926,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$250,$500,35%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140045,Gold Piedmont Preferred 1250/30/50,15668VA014,7205839435,VAN001,VAS001,VAF002,New,PPO,Gold,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9966,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140045-01,Standard Gold On Exchange Plan,79.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,250","$2,500",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,Individual,No,31-1592932,15668VA0130037,Silver Preferred 3400/35/60,15668VA013,7205839435,VAN001,VAS001,VAF002,New,PPO,Silver,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9975,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130037-05,87% AV Level Silver Plan,,0.864871501922607,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,600","$3,200",,,"$10,800","$21,600",Not Applicable,Not Applicable,$900,"$1,800",20%,,,,"$6,800","$13,600",Not Applicable,Not Applicable,$200,$400,35%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,24
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,Individual,No,31-1592932,15668VA0130037,Silver Preferred 3400/35/60,15668VA013,7205839435,VAN001,VAS001,VAF002,New,PPO,Silver,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9975,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130037-06,94% AV Level Silver Plan,,0.932921767234802,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,"$10,800","$21,600",Not Applicable,Not Applicable,$350,$700,20%,,,,"$6,800","$13,600",Not Applicable,Not Applicable,$150,$300,35%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,25
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1180001,OptimaFit Bronze 3750 HSA,20507VA118,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,0,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1006|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1180001-03,Limited Cost Sharing Plan Variation,,0.597368359565735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,29
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1180002,OptimaFit Bronze 4250 HSA,20507VA118,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,0,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1007|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1180002-00,Standard Bronze Off Exchange Plan,,0.588649094104767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,34
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1180002,OptimaFit Bronze 4250 HSA,20507VA118,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,0,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1007|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1180002-01,Standard Bronze On Exchange Plan,,0.588649094104767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,35
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1180002,OptimaFit Bronze 4250 HSA,20507VA118,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,0,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1007|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1180002-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,36
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1180002,OptimaFit Bronze 4250 HSA,20507VA118,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,0,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1007|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1180002-03,Limited Cost Sharing Plan Variation,,0.588649094104767,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,37
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1180003,OptimaFit Bronze 4750 HSA,20507VA118,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,0,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1008|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1180003-00,Standard Bronze Off Exchange Plan,,0.580836057662964,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,38
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1180003,OptimaFit Bronze 4750 HSA,20507VA118,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,0,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1008|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1180003-01,Standard Bronze On Exchange Plan,,0.580836057662964,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,39
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1180003,OptimaFit Bronze 4750 HSA,20507VA118,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,0,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1008|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1180003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,40
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1180003,OptimaFit Bronze 4750 HSA,20507VA118,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,0,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1008|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1180003-03,Limited Cost Sharing Plan Variation,,0.580836057662964,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,41
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1190002,OptimaFit 6600,20507VA119,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1009|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1190002-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,42
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,Individual,No,31-1592932,15668VA0130039,Bronze 4000,15668VA013,7205839435,VAN001,VAS001,VAF003,New,PPO,Bronze,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9967,,$250,0,0,3,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130039-00,Standard Bronze Off Exchange Plan,,0.618396639823914,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",35%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140035,Gold Partners Basic 0/30/50,15668VA014,7205839435,VAN001,VAS001,VAF002,New,PPO,Gold,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9967,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140035-00,Standard Gold Off Exchange Plan,81.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,30%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,VA,16064,SERFF,9,2014-11-13 16:11:17,1,16064,VA,Individual,Yes,54-0357120,16064VA1250003,Anthem Dental Pediatric,16064VA125,,VAN001,VAS001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$22.89,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/va/f0/s0/t0/pw_e213909.pdf,,,,16064VA1250003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,16064,SERFF,9,2014-11-13 16:11:17,1,16064,VA,SHOP (Small Group),Yes,54-0357120,16064VA1280003,Anthem Dental Pediatric,16064VA128,,VAN001,VAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$22.89,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/va/f0/s0/t0/pw_e213909.pdf,,,,16064VA1280003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,16064,SERFF,9,2014-11-13 16:11:17,1,16064,VA,Individual,Yes,54-0357120,16064VA1310003,Anthem Dental Pediatric,16064VA131,,VAN001,VAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$22.89,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/va/f0/s0/t0/pw_e213909.pdf,,,,16064VA1310003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,16064,SERFF,9,2014-11-13 16:11:17,2,16064,VA,SHOP (Small Group),Yes,54-0357120,16064VA1240003,Anthem Dental Family,16064VA124,,VAN001,VAS001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.37,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/va/f0/s0/t0/pw_e213907.pdf,,,,16064VA1240003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,16064,SERFF,9,2014-11-13 16:11:17,2,16064,VA,Individual,Yes,54-0357120,16064VA1270003,Anthem Dental Family,16064VA127,,VAN001,VAS001,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.37,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/va/f0/s0/t0/pw_e213907.pdf,,,,16064VA1270003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,16064,SERFF,9,2014-11-13 16:11:17,2,16064,VA,SHOP (Small Group),Yes,54-0357120,16064VA1240004,Anthem Dental Family Enhanced,16064VA124,,VAN001,VAS001,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.72,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/va/f0/s0/t0/pw_e213908.pdf,,,,16064VA1240004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,13756,SERFF,5,2015-01-16 20:59:55,1,13756,VA,SHOP (Small Group),Yes,86-0307623,13756VA0210001,Smile for Health Family C80A80,13756VA021,,VAN001,VAS001,,New,PPO,High,,Both,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$25.72,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,https://www.unitedconcordia.com/docs/hcr/benefits-summary-va-sfh-family-c80a80-ppo.pdf,,https://www.unitedconcordia.com/docs/hcr/plan-brochure-va-sfhfamily-premier.pdf,,13756VA0210001-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,13756,SERFF,5,2015-01-16 20:59:55,1,13756,VA,SHOP (Small Group),Yes,86-0307623,13756VA0210001,Smile for Health Family C80A80,13756VA021,,VAN001,VAS001,,New,PPO,High,,Both,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$25.72,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,https://www.unitedconcordia.com/docs/hcr/benefits-summary-va-sfh-family-c80a80-ppo.pdf,,https://www.unitedconcordia.com/docs/hcr/plan-brochure-va-sfhfamily-premier.pdf,,13756VA0210001-01,Standard High On Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,13756,SERFF,5,2015-01-16 20:59:55,2,13756,VA,SHOP (Small Group),Yes,86-0307623,13756VA0220001,Smile for Health Family C60A60,13756VA022,,VAN001,VAS001,,New,PPO,Low,,Both,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$21.12,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,https://www.unitedconcordia.com/docs/hcr/benefits-summary-va-sfh-family-c60a60-ppo.pdf,,https://www.unitedconcordia.com/docs/hcr/plan-brochure-va-sfhfamily-value.pdf,,13756VA0220001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,13756,SERFF,5,2015-01-16 20:59:55,2,13756,VA,SHOP (Small Group),Yes,86-0307623,13756VA0220001,Smile for Health Family C60A60,13756VA022,,VAN001,VAS001,,New,PPO,Low,,Both,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$21.12,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,https://www.unitedconcordia.com/docs/hcr/benefits-summary-va-sfh-family-c60a60-ppo.pdf,,https://www.unitedconcordia.com/docs/hcr/plan-brochure-va-sfhfamily-value.pdf,,13756VA0220001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,13756,SERFF,5,2015-01-16 20:59:55,3,13756,VA,SHOP (Small Group),Yes,86-0307623,13756VA0230001,Smile for Health Family C60A50,13756VA023,,VAN001,VAS001,,New,PPO,Low,,Both,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$21.12,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,https://www.unitedconcordia.com/docs/hcr/benefits-summary-va-sfh-family-c60a50-ppo.pdf,,https://www.unitedconcordia.com/docs/hcr/plan-brochure-va-sfhfamily-lean.pdf,,13756VA0230001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,13756,SERFF,5,2015-01-16 20:59:55,3,13756,VA,SHOP (Small Group),Yes,86-0307623,13756VA0230001,Smile for Health Family C60A50,13756VA023,,VAN001,VAS001,,New,PPO,Low,,Both,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$21.12,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,https://www.unitedconcordia.com/docs/hcr/benefits-summary-va-sfh-family-c60a50-ppo.pdf,,https://www.unitedconcordia.com/docs/hcr/plan-brochure-va-sfhfamily-lean.pdf,,13756VA0230001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,13756,SERFF,5,2015-01-16 20:59:55,4,13756,VA,SHOP (Small Group),Yes,86-0307623,13756VA0250001,Smile for Health Certified Basic Option Plus (90-50-50),13756VA025,,VAN001,VAS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$3.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,13756VA0250001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,13756,SERFF,5,2015-01-16 20:59:55,5,13756,VA,SHOP (Small Group),Yes,86-0307623,13756VA0270001,Smile for Health Certified High Option Plus (100-50-50),13756VA027,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$7.35,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,13756VA0270001-00,Standard High Off Exchange Plan,84.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,13756,SERFF,5,2015-01-16 20:59:55,6,13756,VA,SHOP (Small Group),Yes,86-0307623,13756VA0290001,Smile for Health Certified Low Option Plus (100-100-100),13756VA029,,VAN001,VAS001,,New,PPO,Low,,Off the Exchange,,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers? Compensation or employer?s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company?s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,Allows Adult and Child-Only,,,,$3.68,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Same Coverage as In-Service,Yes,,,,,13756VA0290001-00,Standard Low Off Exchange Plan,71.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$350,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,Individual,No,31-1592932,15668VA0130031,Gold Preferred 750/30/50,15668VA013,7205839435,VAN001,VAS001,VAF001,New,PPO,Gold,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.998,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130031-00,Standard Gold Off Exchange Plan,,0.811584532260895,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$7,500","$15,000",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$200,$400,25%,,,,$400,$800,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140031,Platinum Piedmont Preferred 0/20,15668VA014,7205839435,VAN001,VAS001,VAF001,New,PPO,Platinum,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.997,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140031-00,Standard Platinum Off Exchange Plan,88.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140031,Platinum Piedmont Preferred 0/20,15668VA014,7205839435,VAN001,VAS001,VAF001,New,PPO,Platinum,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.997,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140031-01,Standard Platinum On Exchange Plan,88.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,Individual,No,31-1592932,15668VA0130031,Gold Preferred 750/30/50,15668VA013,7205839435,VAN001,VAS001,VAF001,New,PPO,Gold,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.998,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130031-01,Standard Gold On Exchange Plan,,0.811584532260895,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$7,500","$15,000",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$200,$400,25%,,,,$400,$800,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,Individual,No,31-1592932,15668VA0130031,Gold Preferred 750/30/50,15668VA013,7205839435,VAN001,VAS001,VAF001,New,PPO,Gold,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.998,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130031-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140033,Platinum Piedmont Preferred 200/20/25,15668VA014,7205839435,VAN001,VAS001,VAF001,New,PPO,Platinum,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.997,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140033-00,Standard Platinum Off Exchange Plan,88.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$400,20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140033,Platinum Piedmont Preferred 200/20/25,15668VA014,7205839435,VAN001,VAS001,VAF001,New,PPO,Platinum,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.997,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140033-01,Standard Platinum On Exchange Plan,88.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$400,20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,Individual,No,31-1592932,15668VA0130031,Gold Preferred 750/30/50,15668VA013,7205839435,VAN001,VAS001,VAF001,New,PPO,Gold,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.998,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130031-03,Limited Cost Sharing Plan Variation,,0.811584532260895,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$7,500","$15,000",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$200,$400,25%,,,,$400,$800,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140037,Gold Piedmont Preferred 450/30/50,15668VA014,7205839435,VAN001,VAS001,VAF002,New,PPO,Gold,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9967,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140037-00,Standard Gold Off Exchange Plan,81.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$8,000","$16,000",Not Applicable,Not Applicable,$450,$900,20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,Individual,No,31-1592932,15668VA0130033,Gold Advantage 1000/30/50,15668VA013,7205839435,VAN001,VAS001,VAF001,New,PPO,Gold,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.998,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130033-00,Standard Gold Off Exchange Plan,,0.811045706272125,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,25%,,,,$400,$800,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,Individual,No,31-1592932,15668VA0130033,Gold Advantage 1000/30/50,15668VA013,7205839435,VAN001,VAS001,VAF001,New,PPO,Gold,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.998,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130033-01,Standard Gold On Exchange Plan,,0.811045706272125,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,25%,,,,$400,$800,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140037,Gold Piedmont Preferred 450/30/50,15668VA014,7205839435,VAN001,VAS001,VAF002,New,PPO,Gold,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9967,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140037-01,Standard Gold On Exchange Plan,81.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$8,000","$16,000",Not Applicable,Not Applicable,$450,$900,20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140041,Gold Piedmont Preferred 750/30/50,15668VA014,7205839435,VAN001,VAS001,VAF002,New,PPO,Gold,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9967,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140041-00,Standard Gold Off Exchange Plan,80.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$8,000","$16,000",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,Individual,No,31-1592932,15668VA0130033,Gold Advantage 1000/30/50,15668VA013,7205839435,VAN001,VAS001,VAF001,New,PPO,Gold,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.998,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130033-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,Individual,No,31-1592932,15668VA0130033,Gold Advantage 1000/30/50,15668VA013,7205839435,VAN001,VAS001,VAF001,New,PPO,Gold,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.998,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130033-03,Limited Cost Sharing Plan Variation,,0.811045706272125,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000",Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$200,$400,25%,,,,$400,$800,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140041,Gold Piedmont Preferred 750/30/50,15668VA014,7205839435,VAN001,VAS001,VAF002,New,PPO,Gold,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9967,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140041-01,Standard Gold On Exchange Plan,80.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$8,000","$16,000",Not Applicable,Not Applicable,$750,"$1,500",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140049,Gold Piedmont Preferred 2000/25/40,15668VA014,7205839435,VAN001,VAS001,VAF002,New,PPO,Gold,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9965,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140049-00,Standard Gold Off Exchange Plan,80.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,Individual,No,31-1592932,15668VA0130035,Silver Preferred 2500/35/60,15668VA013,7205839435,VAN001,VAS001,VAF002,New,PPO,Silver,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9975,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130035-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,Individual,No,31-1592932,15668VA0130035,Silver Preferred 2500/35/60,15668VA013,7205839435,VAN001,VAS001,VAF002,New,PPO,Silver,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9975,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130035-03,Limited Cost Sharing Plan Variation,,0.705024778842926,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$250,$500,35%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140049,Gold Piedmont Preferred 2000/25/40,15668VA014,7205839435,VAN001,VAS001,VAF002,New,PPO,Gold,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9965,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140049-01,Standard Gold On Exchange Plan,80.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140051,Gold Piedmont Complete 3000/25/40,15668VA014,7205839435,VAN001,VAS001,VAF002,New,PPO,Gold,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9965,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140051-00,Standard Gold Off Exchange Plan,80.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,Individual,No,31-1592932,15668VA0130035,Silver Preferred 2500/35/60,15668VA013,7205839435,VAN001,VAS001,VAF002,New,PPO,Silver,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9975,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130035-04,73% AV Level Silver Plan,,0.731255412101746,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$2,400","$4,800",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$250,$500,35%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,Individual,No,31-1592932,15668VA0130035,Silver Preferred 2500/35/60,15668VA013,7205839435,VAN001,VAS001,VAF002,New,PPO,Silver,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9975,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130035-05,87% AV Level Silver Plan,,0.864871501922607,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,600","$3,200",,,"$12,700","$25,400",Not Applicable,Not Applicable,$900,"$1,800",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$200,$400,35%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140051,Gold Piedmont Complete 3000/25/40,15668VA014,7205839435,VAN001,VAS001,VAF002,New,PPO,Gold,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9965,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140051-01,Standard Gold On Exchange Plan,80.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$3,000","$6,000",0%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,17
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,Individual,No,31-1592932,15668VA0130035,Silver Preferred 2500/35/60,15668VA013,7205839435,VAN001,VAS001,VAF002,New,PPO,Silver,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9975,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130035-06,94% AV Level Silver Plan,,0.932921767234802,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$650,"$1,300",,,"$12,700","$25,400",Not Applicable,Not Applicable,$350,$700,20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$150,$300,35%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,Individual,No,31-1592932,15668VA0130037,Silver Preferred 3400/35/60,15668VA013,7205839435,VAN001,VAS001,VAF002,New,PPO,Silver,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9975,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130037-00,Standard Silver Off Exchange Plan,,0.694917559623718,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,400","$10,800",,,"$10,800","$21,600",Not Applicable,Not Applicable,"$3,400","$6,800",20%,,,,"$6,800","$13,600",Not Applicable,Not Applicable,$250,$500,35%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,Individual,No,31-1592932,15668VA0130037,Silver Preferred 3400/35/60,15668VA013,7205839435,VAN001,VAS001,VAF002,New,PPO,Silver,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9975,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130037-01,Standard Silver On Exchange Plan,,0.694917559623718,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,400","$10,800",,,"$10,800","$21,600",Not Applicable,Not Applicable,"$3,400","$6,800",20%,,,,"$6,800","$13,600",Not Applicable,Not Applicable,$250,$500,35%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,Individual,No,31-1592932,15668VA0130037,Silver Preferred 3400/35/60,15668VA013,7205839435,VAN001,VAS001,VAF002,New,PPO,Silver,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9975,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130037-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,Individual,No,31-1592932,15668VA0130037,Silver Preferred 3400/35/60,15668VA013,7205839435,VAN001,VAS001,VAF002,New,PPO,Silver,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9975,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130037-03,Limited Cost Sharing Plan Variation,,0.694917559623718,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,400","$10,800",,,"$10,800","$21,600",Not Applicable,Not Applicable,"$3,400","$6,800",20%,,,,"$6,800","$13,600",Not Applicable,Not Applicable,$250,$500,35%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,1,15668,VA,Individual,No,31-1592932,15668VA0130037,Silver Preferred 3400/35/60,15668VA013,7205839435,VAN001,VAS001,VAF002,New,PPO,Silver,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9975,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130037-04,73% AV Level Silver Plan,,0.731194317340851,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$10,800","$21,600",Not Applicable,Not Applicable,"$2,350","$4,700",20%,,,,"$6,800","$13,600",Not Applicable,Not Applicable,$250,$500,35%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,23
2015,VA,16064,SERFF,9,2014-11-13 16:11:17,2,16064,VA,Individual,Yes,54-0357120,16064VA1270004,Anthem Dental Family Enhanced,16064VA127,,VAN001,VAS001,,New,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.72,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/va/f0/s0/t0/pw_e213908.pdf,,,,16064VA1270004-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,16064,SERFF,9,2014-11-13 16:11:17,2,16064,VA,Individual,Yes,54-0357120,16064VA1330003,Anthem Dental Family,16064VA133,,VAN001,VAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.37,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/va/f0/s0/t0/pw_e213907.pdf,,,,16064VA1330003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,VA,16064,SERFF,9,2014-11-13 16:11:17,2,16064,VA,SHOP (Small Group),Yes,54-0357120,16064VA1300003,Anthem Dental Family,16064VA130,,VAN001,VAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.37,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/va/f0/s0/t0/pw_e213907.pdf,,,,16064VA1300003-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,VA,16064,SERFF,9,2014-11-13 16:11:17,2,16064,VA,SHOP (Small Group),Yes,54-0357120,16064VA1300004,Anthem Dental Family Enhanced,16064VA130,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.72,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/va/f0/s0/t0/pw_e213908.pdf,,,,16064VA1300004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,VA,16064,SERFF,9,2014-11-13 16:11:17,2,16064,VA,Individual,Yes,54-0357120,16064VA1330004,Anthem Dental Family Enhanced,16064VA133,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.72,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,http://www.anthem.com/agent/va/f0/s0/t0/pw_e213908.pdf,,,,16064VA1330004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,$25,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140035,Gold Partners Basic 0/30/50,15668VA014,7205839435,VAN001,VAS001,VAF002,New,PPO,Gold,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9967,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140035-01,Standard Gold On Exchange Plan,81.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,30%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1170001,OptimaFit Gold 1000 25,20507VA117,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,4,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1003|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1170001-01,Standard Gold On Exchange Plan,80.60%,0.768324792385101,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1170001,OptimaFit Gold 1000 25,20507VA117,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,4,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1003|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1170001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1170001,OptimaFit Gold 1000 25,20507VA117,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,4,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1003|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1170001-03,Limited Cost Sharing Plan Variation,80.60%,0.768324792385101,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,Individual,No,31-1592932,15668VA0130039,Bronze 4000,15668VA013,7205839435,VAN001,VAS001,VAF003,New,PPO,Bronze,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9967,,$250,0,0,3,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130039-01,Standard Bronze On Exchange Plan,,0.618396639823914,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",35%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,Individual,No,31-1592932,15668VA0130039,Bronze 4000,15668VA013,7205839435,VAN001,VAS001,VAF003,New,PPO,Bronze,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9967,,$250,0,0,3,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130039-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140039,Gold Partners Preferred 500/30/50,15668VA014,7205839435,VAN001,VAS001,VAF002,New,PPO,Gold,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9967,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140039-00,Standard Gold Off Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140039,Gold Partners Preferred 500/30/50,15668VA014,7205839435,VAN001,VAS001,VAF002,New,PPO,Gold,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9967,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140039-01,Standard Gold On Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,Individual,No,31-1592932,15668VA0130039,Bronze 4000,15668VA013,7205839435,VAN001,VAS001,VAF003,New,PPO,Bronze,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9967,,$250,0,0,3,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130039-03,Limited Cost Sharing Plan Variation,,0.618396639823914,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",35%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,Individual,No,31-1592932,15668VA0130041,Bronze 5000,15668VA013,7205839435,VAN001,VAS001,VAF004,New,PPO,Bronze,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9965,,$250,0,0,3,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130041-00,Standard Bronze Off Exchange Plan,,0.606311500072479,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140043,Gold Partners Preferred 1000/30/50,15668VA014,7205839435,VAN001,VAS001,VAF002,New,PPO,Gold,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9966,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140043-00,Standard Gold Off Exchange Plan,80.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140043,Gold Partners Preferred 1000/30/50,15668VA014,7205839435,VAN001,VAS001,VAF002,New,PPO,Gold,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9966,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140043-01,Standard Gold On Exchange Plan,80.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,500","$5,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,Individual,No,31-1592932,15668VA0130041,Bronze 5000,15668VA013,7205839435,VAN001,VAS001,VAF004,New,PPO,Bronze,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9965,,$250,0,0,3,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130041-01,Standard Bronze On Exchange Plan,,0.606311500072479,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,Individual,No,31-1592932,15668VA0130041,Bronze 5000,15668VA013,7205839435,VAN001,VAS001,VAF004,New,PPO,Bronze,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9965,,$250,0,0,3,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130041-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140047,Gold Partners Preferred 1500/25/40,15668VA014,7205839435,VAN001,VAS001,VAF002,New,PPO,Gold,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9965,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140047-00,Standard Gold Off Exchange Plan,80.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140047,Gold Partners Preferred 1500/25/40,15668VA014,7205839435,VAN001,VAS001,VAF002,New,PPO,Gold,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9965,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140047-01,Standard Gold On Exchange Plan,80.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,Individual,No,31-1592932,15668VA0130041,Bronze 5000,15668VA013,7205839435,VAN001,VAS001,VAF004,New,PPO,Bronze,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9965,,$250,0,0,3,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130041-03,Limited Cost Sharing Plan Variation,,0.606311500072479,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,Individual,No,31-1592932,15668VA0130043,Bronze HSA 4000,15668VA013,7205839435,VAN001,VAS001,VAF006,New,PPO,Bronze,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9968,,,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130043-00,Standard Bronze Off Exchange Plan,,0.609844267368317,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",25%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,Individual,No,31-1592932,15668VA0130043,Bronze HSA 4000,15668VA013,7205839435,VAN001,VAS001,VAF006,New,PPO,Bronze,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9968,,,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130043-01,Standard Bronze On Exchange Plan,,0.609844267368317,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",25%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,Individual,No,31-1592932,15668VA0130043,Bronze HSA 4000,15668VA013,7205839435,VAN001,VAS001,VAF006,New,PPO,Bronze,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9968,,,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130043-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,14
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,Individual,No,31-1592932,15668VA0130043,Bronze HSA 4000,15668VA013,7205839435,VAN001,VAS001,VAF006,New,PPO,Bronze,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9968,,,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130043-03,Limited Cost Sharing Plan Variation,,0.609844267368317,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",25%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,Individual,No,31-1592932,15668VA0130045,Bronze HSA 5000,15668VA013,7205839435,VAN001,VAS001,VAF007,New,PPO,Bronze,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9967,,,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130045-00,Standard Bronze Off Exchange Plan,,0.596530377864838,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",15%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,Individual,No,31-1592932,15668VA0130045,Bronze HSA 5000,15668VA013,7205839435,VAN001,VAS001,VAF007,New,PPO,Bronze,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9967,,,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130045-01,Standard Bronze On Exchange Plan,,0.596530377864838,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",15%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,Individual,No,31-1592932,15668VA0130045,Bronze HSA 5000,15668VA013,7205839435,VAN001,VAS001,VAF007,New,PPO,Bronze,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9967,,,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130045-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,18
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,2,15668,VA,Individual,No,31-1592932,15668VA0130045,Bronze HSA 5000,15668VA013,7205839435,VAN001,VAS001,VAF007,New,PPO,Bronze,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9967,,,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130045-03,Limited Cost Sharing Plan Variation,,0.596530377864838,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",15%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,19
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,3,15668,VA,Individual,No,31-1592932,15668VA0130029,Catastrophic 6600,15668VA013,7205839435,VAN001,VAS001,VAF005,New,PPO,Catastrophic,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9931,,,0,0,3,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130029-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,3,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140053,Silver Partners Basic 2000/35/60,15668VA014,7205839435,VAN001,VAS001,VAF003,New,PPO,Silver,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9961,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140053-00,Standard Silver Off Exchange Plan,71.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,3,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140053,Silver Partners Basic 2000/35/60,15668VA014,7205839435,VAN001,VAS001,VAF003,New,PPO,Silver,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9961,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140053-01,Standard Silver On Exchange Plan,71.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000",Not Applicable,Not Applicable,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,3,15668,VA,Individual,No,31-1592932,15668VA0130029,Catastrophic 6600,15668VA013,7205839435,VAN001,VAS001,VAF005,New,PPO,Catastrophic,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9931,,,0,0,3,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0130029-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$26,400","$52,800",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,4,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140055,Silver Piedmont Preferred 3000/35/60,15668VA014,7205839435,VAN001,VAS001,VAF003,New,PPO,Silver,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9961,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140055-00,Standard Silver Off Exchange Plan,71.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$12,000",Not Applicable,Not Applicable,"$3,000","$6,000",20%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,4,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140057,Silver Piedmont Preferred 4000/35/60,15668VA014,7205839435,VAN001,VAS001,VAF003,New,PPO,Silver,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.996,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140057-01,Standard Silver On Exchange Plan,71.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$12,000",Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$0,$0,25%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,5,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140063,Gold HSA Complete 2000,15668VA014,7205839435,VAN001,VAS001,VAF005,New,PPO,Gold,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,Yes,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9965,,,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140063-00,Standard Gold Off Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,5,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140063,Gold HSA Complete 2000,15668VA014,7205839435,VAN001,VAS001,VAF005,New,PPO,Gold,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,Yes,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9965,,,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140063-01,Standard Gold On Exchange Plan,,0.788134455680847,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",0%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,5,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140065,Silver HSA Preferred 2000,15668VA014,7205839435,VAN001,VAS001,VAF006,New,PPO,Silver,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,Yes,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.996,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140065-00,Standard Silver Off Exchange Plan,68.50%,0.681702136993408,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,5,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140065,Silver HSA Preferred 2000,15668VA014,7205839435,VAN001,VAS001,VAF006,New,PPO,Silver,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,Yes,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.996,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140065-01,Standard Silver On Exchange Plan,68.50%,0.681702136993408,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,5,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140067,Silver HSA Preferred 2500,15668VA014,7205839435,VAN001,VAS001,VAF006,New,PPO,Silver,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,Yes,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9959,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140067-00,Standard Silver Off Exchange Plan,68.30%,0.680228054523468,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$10,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,5,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140067,Silver HSA Preferred 2500,15668VA014,7205839435,VAN001,VAS001,VAF006,New,PPO,Silver,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,Yes,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9959,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140067-01,Standard Silver On Exchange Plan,68.30%,0.680228054523468,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$10,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,5,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140069,Silver HSA Complete 3000,15668VA014,7205839435,VAN001,VAS001,VAF005,New,PPO,Silver,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,Yes,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9962,,,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140069-00,Standard Silver Off Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,5,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140069,Silver HSA Complete 3000,15668VA014,7205839435,VAN001,VAS001,VAF005,New,PPO,Silver,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,Yes,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9962,,,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140069-01,Standard Silver On Exchange Plan,,0.716980278491974,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",0%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,5,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140071,Silver HSA Complete 3500,15668VA014,7205839435,VAN001,VAS001,VAF005,New,PPO,Silver,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,Yes,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140071-00,Standard Silver Off Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,5,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140071,Silver HSA Complete 3500,15668VA014,7205839435,VAN001,VAS001,VAF005,New,PPO,Silver,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,Yes,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.996,,,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140071-01,Standard Silver On Exchange Plan,,0.688423931598663,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",0%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,5,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140073,Bronze HSA Preferred 4000,15668VA014,7205839435,VAN001,VAS001,VAF006,New,PPO,Bronze,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,Yes,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9953,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140073-00,Standard Bronze Off Exchange Plan,61.60%,0.612914860248566,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,5,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140073,Bronze HSA Preferred 4000,15668VA014,7205839435,VAN001,VAS001,VAF006,New,PPO,Bronze,Yes,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,Yes,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9953,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140073-01,Standard Bronze On Exchange Plan,61.60%,0.612914860248566,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,5,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140075,Bronze HSA Complete 5500,15668VA014,7205839435,VAN001,VAS001,VAF005,New,PPO,Bronze,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,Yes,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9953,,,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140075-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,5,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140075,Bronze HSA Complete 5500,15668VA014,7205839435,VAN001,VAS001,VAF005,New,PPO,Bronze,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,Yes,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9953,,,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140075-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,6,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140059,Bronze Partners Basic 4000,15668VA014,7205839435,VAN001,VAS001,VAF004,New,PPO,Bronze,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9951,,$250,0,0,3,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140059-00,Standard Bronze Off Exchange Plan,,0.619481444358826,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,6,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140059,Bronze Partners Basic 4000,15668VA014,7205839435,VAN001,VAS001,VAF004,New,PPO,Bronze,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9951,,$250,0,0,3,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140059-01,Standard Bronze On Exchange Plan,,0.619481444358826,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",40%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,7,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140061,Bronze Partners Complete 6350/40/65,15668VA014,7205839435,VAN001,VAS001,VAF005,New,PPO,Bronze,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9951,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140061-00,Standard Bronze Off Exchange Plan,,0.612634301185608,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,15668,SERFF,9,2014-09-09 16:12:42,7,15668,VA,SHOP (Small Group),No,31-1592932,15668VA0140061,Bronze Partners Complete 6350/40/65,15668VA014,7205839435,VAN001,VAS001,VAF005,New,PPO,Bronze,No,Both,No,No,,Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.,,No,No,,Allows Adult and Child-Only,,Yes,"Depression, Diabetes, Pregnancy",,0.9951,,$250,0,0,0,2015-01-01,,No,,Yes,"If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.",No,http://www.pchp.net/index.php/marketplace/summary-of-benefits.html,http://www.pchp.net/index.php/marketplace/enrollment-and-payment.html,http://www.pchp.net/index.php/marketplace/plan-brochures.html,http://www.pchp.net/index.php/marketplace/prescription-drug-formulary.html,15668VA0140061-01,Standard Bronze On Exchange Plan,,0.612634301185608,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700",0%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1170001,OptimaFit Gold 1000 25,20507VA117,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,4,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1003|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1170001-00,Standard Gold Off Exchange Plan,80.60%,0.768324792385101,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$250,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1170002,OptimaFit Silver 3500 25 20,20507VA117,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,4,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1004|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1170002-00,Standard Silver Off Exchange Plan,69.40%,0.65919440984726,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$150,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1170002,OptimaFit Silver 3500 25 20,20507VA117,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,4,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1004|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1170002-01,Standard Silver On Exchange Plan,69.40%,0.65919440984726,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$150,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1170002,OptimaFit Silver 3500 25 20,20507VA117,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,4,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1004|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1170002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1170002,OptimaFit Silver 3500 25 20,20507VA117,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,4,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1004|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1170002-03,Limited Cost Sharing Plan Variation,69.40%,0.65919440984726,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$150,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1170002,OptimaFit Silver 3500 25 20,20507VA117,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,4,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1004|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1170002-04,73% AV Level Silver Plan,72.90%,0.704827129840851,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$150,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1170002,OptimaFit Silver 3500 25 20,20507VA117,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,4,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1004|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1170002-05,87% AV Level Silver Plan,86.30%,0.84541130065918,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$150,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1170002,OptimaFit Silver 3500 25 20,20507VA117,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,4,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1004|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1170002-06,94% AV Level Silver Plan,93.80%,0.932314991950989,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$150,$150,50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1190001,OptimaFit Bronze 6000,20507VA119,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,4,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1005|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1190001-00,Standard Bronze Off Exchange Plan,61.90%,0.597274720668793,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,22
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1190001,OptimaFit Bronze 6000,20507VA119,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,4,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1005|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1190001-01,Standard Bronze On Exchange Plan,61.90%,0.597274720668793,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,23
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1190001,OptimaFit Bronze 6000,20507VA119,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,4,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1005|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1190001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,24
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1190001,OptimaFit Bronze 6000,20507VA119,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,4,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1005|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1190001-03,Limited Cost Sharing Plan Variation,61.90%,0.597274720668793,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,25
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1180001,OptimaFit Bronze 3750 HSA,20507VA118,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,0,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1006|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1180001-00,Standard Bronze Off Exchange Plan,,0.597368359565735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,26
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1180001,OptimaFit Bronze 3750 HSA,20507VA118,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,0,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1006|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1180001-01,Standard Bronze On Exchange Plan,,0.597368359565735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,450","$12,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,27
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1180001,OptimaFit Bronze 3750 HSA,20507VA118,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,$250,0,0,0,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1006|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1180001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,28
2015,VA,20507,SERFF,14,2014-11-15 10:06:04,1,20507,VA,Individual,No,54-1283337,20507VA1190002,OptimaFit 6600,20507VA119,7487657612,VAN001,VAS001,VAF001,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,emergency only,Yes,emergency only,No,http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1009|False|1,https://optima.benefitalign.com/Optima/Application/FFMInitialPayment,http://public.optimahealth.com/exchangesbc/012015HIXBrochureIFP1.pdf,http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf,20507VA1190002-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,43
2015,VA,24832,SERFF,3,2014-09-09 16:12:42,1,24832,VA,Individual,Yes,47-0397286,24832VA0010001,"Delta Dental Individual PPO, EHB Certified",24832VA001,,VAN002,VAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.73,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,24832VA0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,24832,SERFF,3,2014-09-09 16:12:42,1,24832,VA,SHOP (Small Group),Yes,47-0397286,24832VA0030001,"Renaissance Group Dental PPO, EHB Certified",24832VA003,,VAN001,VAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$32.66,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,24832VA0030001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,24832,SERFF,3,2014-09-09 16:12:42,1,24832,VA,SHOP (Small Group),Yes,47-0397286,24832VA0030002,"Renaissance Group Dental PPO, EHB Certified",24832VA003,,VAN001,VAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.65,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,24832VA0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,24832,SERFF,3,2014-09-09 16:12:42,1,24832,VA,Individual,Yes,47-0397286,24832VA0010002,"Delta Dental Individual PPO, EHB Certified",24832VA001,,VAN002,VAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.71,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,24832VA0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,24832,SERFF,3,2014-09-09 16:12:42,1,24832,VA,Individual,Yes,47-0397286,24832VA0020001,"Renaissance Individual Dental PPO, EHB Certified",24832VA002,,VAN001,VAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.65,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,24832VA0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,VA,24832,SERFF,3,2014-09-09 16:12:42,1,24832,VA,Individual,Yes,47-0397286,24832VA0020002,"Renaissance Individual Dental PPO, EHB Certified",24832VA002,,VAN001,VAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.94,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,24832VA0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,VA,31319,SERFF,3,2014-09-09 16:12:42,1,31319,VA,SHOP (Small Group),Yes,54-0844477,31319VA0020011,Delta Dental Small Group Exchange Certified Pediatric Plan - Basic (Contributory),31319VA002,,VAN001,VAS001,,New,POS,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,No,,$25.87,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide coverage from the Delta Dental system of networks,Yes,,,,,31319VA0020011-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,68%,32%,$350,$700,$350,$700,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,$50,$150,,$50,$150,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,31319,SERFF,3,2014-09-09 16:12:42,1,31319,VA,SHOP (Small Group),Yes,54-0844477,31319VA0020012,Delta Dental Small Group Exchange Certified Pediatric Plan - Basic (Voluntary),31319VA002,,VAN001,VAS001,,New,POS,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,No,,$31.84,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide coverage from the Delta Dental system of networks,Yes,,,,,31319VA0020012-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,68%,32%,$350,$700,$350,$700,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,$50,$150,,$50,$150,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,31319,SERFF,3,2014-09-09 16:12:42,1,31319,VA,SHOP (Small Group),Yes,54-0844477,31319VA0020015,Delta Dental PPO Plus Premier Exchange Certified Family Plan - (Contributory),31319VA002,,VAN001,VAS001,,New,POS,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,No,,$36.46,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide coverage from the Delta Dental system of networks,Yes,,,,,31319VA0020015-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,68%,32%,$350,$700,$350,$700,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,$50,$150,,$50,$150,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,VA,31319,SERFF,3,2014-09-09 16:12:42,1,31319,VA,SHOP (Small Group),Yes,54-0844477,31319VA0020016,Delta Dental PPO Plus Premier Exchange Certified Family Plan - (Voluntary),31319VA002,,VAN001,VAS001,,New,POS,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,No,,$37.55,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide coverage from the Delta Dental system of networks,Yes,,,,,31319VA0020016-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,68%,32%,$350,$700,$350,$700,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,$50,$150,,$50,$150,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,VA,31319,SERFF,3,2014-09-09 16:12:42,2,31319,VA,SHOP (Small Group),Yes,54-0844477,31319VA0020013,Delta Dental Small Group Exchange Certified Pediatric Plan - Preferred (Contributory),31319VA002,,VAN001,VAS001,,New,POS,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$34.19,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide coverage from the Delta Dental system of networks,Yes,,,,,31319VA0020013-00,Standard High Off Exchange Plan,85.00%,,,,Yes,68%,32%,$350,$700,$350,$700,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,$50,$150,,$50,$150,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,31319,SERFF,3,2014-09-09 16:12:42,2,31319,VA,SHOP (Small Group),Yes,54-0844477,31319VA0020014,Delta Dental Small Group Exchange Certified Pediatric Plan - Preferred (Voluntary),31319VA002,,VAN001,VAS001,,New,POS,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$42.10,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide coverage from the Delta Dental system of networks,Yes,,,,,31319VA0020014-00,Standard High Off Exchange Plan,85.00%,,,,Yes,68%,32%,$350,$700,$350,$700,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,$50,$150,,$50,$150,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,31319,SERFF,3,2014-09-09 16:12:42,2,31319,VA,SHOP (Small Group),Yes,54-0844477,31319VA0020017,Delta Dental PPO Plus Premier Exchange Certified Family Plan - Preferred (Contributory),31319VA002,,VAN001,VAS001,,New,POS,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$36.46,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide coverage from the Delta Dental system of networks,Yes,,,,,31319VA0020017-00,Standard High Off Exchange Plan,85.00%,,,,Yes,68%,32%,$350,$700,$350,$700,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,$50,$150,,$50,$150,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,VA,31319,SERFF,3,2014-09-09 16:12:42,2,31319,VA,SHOP (Small Group),Yes,54-0844477,31319VA0020018,Delta Dental PPO Plus Premier Exchange Certified Family Plan - Preferred (Voluntary),31319VA002,,VAN001,VAS001,,New,POS,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$37.55,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide coverage from the Delta Dental system of networks,Yes,,,,,31319VA0020018-00,Standard High Off Exchange Plan,85.00%,,,,Yes,68%,32%,$350,$700,$350,$700,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,$50,$150,,$50,$150,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,VA,31319,SERFF,3,2014-09-09 16:12:42,2,31319,VA,SHOP (Small Group),Yes,54-0844477,31319VA0020019,Delta Dental PPO Plus Premier Exchange Certified Pediatric Amendment (Contributory),31319VA002,,VAN001,VAS001,,New,POS,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$3.38,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide coverage from the Delta Dental system of networks,Yes,,,,,31319VA0020019-00,Standard High Off Exchange Plan,85.00%,,,,Yes,68%,32%,$350,$700,$350,$700,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,$50,$150,,$50,$150,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,VA,31319,SERFF,3,2014-09-09 16:12:42,2,31319,VA,SHOP (Small Group),Yes,54-0844477,31319VA0020020,Delta Dental PPO Plus Premier Exchange Certified Pediatric Amendment (Voluntary),31319VA002,,VAN001,VAS001,,New,POS,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$4.14,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide coverage from the Delta Dental system of networks,Yes,,,,,31319VA0020020-00,Standard High Off Exchange Plan,85.00%,,,,Yes,68%,32%,$350,$700,$350,$700,$350,$700,$350,$700,,,,,,,,,,,,,,,,,$50,$150,,$50,$150,,$50,$150,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,VA,34587,SERFF,4,2014-09-09 16:12:42,1,34587,VA,SHOP (Small Group),Yes,42-0127290,34587VA0060001,Principal Plan Dental 70,34587VA006,,VAN001,VAS001,,New,PPO,Low,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$33.54,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,34587VA0060001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,34587,SERFF,4,2014-09-09 16:12:42,1,34587,VA,SHOP (Small Group),Yes,42-0127290,34587VA0060002,Principal Plan Dental 80,34587VA006,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$35.98,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,34587VA0060002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,35801,SERFF,2,2014-09-09 16:12:42,1,35801,VA,SHOP (Small Group),Yes,93-0242990,35801VA0040002,EHB High PPO,35801VA004,,VAN001,VAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.88,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com`,standard.com`,standard.com`,,35801VA0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,9,38234,VA,Individual,No,06-6033492,38234VA0060031,Aetna Coastal VA HP Gold $5 Copay,38234VA006,,VAN001,VAS001,VAF007,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060031-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,$500,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,10,38234,VA,Individual,No,06-6033492,38234VA0060049,Aetna Whole Health Gold $5 Copay,38234VA006,,VAN002,VAS002,VAF016,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060049-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,$500,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,10,38234,VA,Individual,No,06-6033492,38234VA0060049,Aetna Whole Health Gold $5 Copay,38234VA006,,VAN002,VAS002,VAF016,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060049-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,$500,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,10,38234,VA,Individual,No,06-6033492,38234VA0060049,Aetna Whole Health Gold $5 Copay,38234VA006,,VAN002,VAS002,VAF016,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060049-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,10,38234,VA,Individual,No,06-6033492,38234VA0060049,Aetna Whole Health Gold $5 Copay,38234VA006,,VAN002,VAS002,VAF016,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060049-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,$500,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,VA,35801,SERFF,2,2014-09-09 16:12:42,1,35801,VA,SHOP (Small Group),Yes,93-0242990,35801VA0040001,EHB Low PPO,35801VA004,,VAN001,VAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.74,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com`,standard.com`,standard.com`,,35801VA0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,40308,SERFF,17,2015-02-13 14:34:18,1,40308,VA,SHOP (Small Group),Yes,53-0078070,40308VA0330002,BlueDental Preferred,40308VA033,,VAN010,VAS002,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$7.66,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,No,,,http://carefirst.cgx.com/SOS/Backend/SearchPDF.aspx?DocumentName=CST1976,,40308VA0330002-00,Standard High Off Exchange Plan,86.94%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,$180,,,,,$120,$360,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,VA,40308,SERFF,17,2015-02-13 14:34:18,1,40308,VA,SHOP (Small Group),Yes,53-0078070,40308VA0340002,BlueDental Traditional,40308VA034,,VAN011,VAS002,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$8.23,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,No,,,http://carefirst.cgx.com/SOS/Backend/SearchPDF.aspx?DocumentName=CST1975,,40308VA0340002-00,Standard High Off Exchange Plan,84.73%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$120,$360,,,,,Not Applicable,Not Applicable,$120,$360,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,VA,40308,SERFF,17,2015-02-13 14:34:18,1,40308,VA,Individual,No,53-0078070,40308VA0250001,"BluePreferred HSA Bronze $3,500",40308VA025,,VAN001,VAS001,VAF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99743536943784,,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,Yes,http://content.carefirst.com/sbc/BPHVBN5NRXCVBN5EN012015.pdf,,,www.carefirst.com/acarx,40308VA0250001-03,Limited Cost Sharing Plan Variation,61.16%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,"$3,500",$0,$350,$30,"$3,500",$30,$322,$0,7
2015,VA,40308,SERFF,17,2015-02-13 14:34:18,2,40308,VA,Individual,No,53-0078070,40308VA0240001,BluePreferred Platinum $0,40308VA024,,VAN001,VAS001,VAF004,Existing,PPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99743536943784,,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,Yes,http://content.carefirst.com/sbc/BPPVBN8NRXXVBN8DN012015.pdf,,,www.carefirst.com/acarx,40308VA0240001-00,Standard Platinum Off Exchange Plan,88.16%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"$3,600","$7,200",Not Applicable,Not Applicable,$0,$0,10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$528,$30,$0,$160,$711,$0,4
2015,VA,40308,SERFF,17,2015-02-13 14:34:18,2,40308,VA,SHOP (Small Group),No,53-0078070,40308VA0270007,BluePreferred PPO 100%/80%,40308VA027,,VAN001,VAS001,VAF003,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996116965054006,,,0,0,0,2015-01-01,,Yes,All covered services,Yes,All covered services,Yes,http://content.carefirst.com/sbc/BPPVB58CRXXVB08HN012015.pdf,,,www.carefirst.com/acarx,40308VA0270007-00,Standard Platinum Off Exchange Plan,89.44%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$20,$0,$150,$0,$600,$0,$80,4
2015,VA,40308,SERFF,17,2015-02-13 14:34:18,2,40308,VA,Individual,Yes,53-0078070,40308VA0320002,BlueDental Preferred,40308VA032,,VAN010,VAS002,,New,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$5.93,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,Yes,,,www.carefirst.com/bluedentalpreferredlowoptionva,,40308VA0320002-01,Standard Low On Exchange Plan,70.22%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$200,$600,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,40308,SERFF,17,2015-02-13 14:34:18,2,40308,VA,Individual,Yes,53-0078070,40308VA0320004,BlueDental Preferred,40308VA032,,VAN010,VAS002,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$5.93,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,Yes,,,www.carefirst.com/bluedentalpreferredlowoptionva,,40308VA0320004-00,Standard Low Off Exchange Plan,70.22%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$200,$600,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,40308,SERFF,17,2015-02-13 14:34:18,2,40308,VA,SHOP (Small Group),No,53-0078070,40308VA0270007,BluePreferred PPO 100%/80%,40308VA027,,VAN001,VAS001,VAF003,Existing,PPO,Platinum,Yes,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996116965054006,,,0,0,0,2015-01-01,,Yes,All covered services,Yes,All covered services,Yes,http://content.carefirst.com/sbc/BPPVB58CRXXVB08HN012015.pdf,,,www.carefirst.com/acarx,40308VA0270007-01,Standard Platinum On Exchange Plan,89.44%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000",Not Applicable,Not Applicable,$0,$0,0%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$20,$0,$150,$0,$600,$0,$80,5
2015,VA,40308,SERFF,17,2015-02-13 14:34:18,2,40308,VA,Individual,No,53-0078070,40308VA0240001,BluePreferred Platinum $0,40308VA024,,VAN001,VAS001,VAF004,Existing,PPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99743536943784,,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,Yes,http://content.carefirst.com/sbc/BPPVBN8NRXXVBN8DN012015.pdf,,,www.carefirst.com/acarx,40308VA0240001-01,Standard Platinum On Exchange Plan,88.16%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"$3,600","$7,200",Not Applicable,Not Applicable,$0,$0,10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$528,$30,$0,$160,$711,$0,5
2015,VA,40308,SERFF,17,2015-02-13 14:34:18,2,40308,VA,Individual,No,53-0078070,40308VA0240001,BluePreferred Platinum $0,40308VA024,,VAN001,VAS001,VAF004,Existing,PPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99743536943784,,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,Yes,http://content.carefirst.com/sbc/BPPVBN8NRXXVBN8DN012015.pdf,,,www.carefirst.com/acarx,40308VA0240001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,$0,$0,$0,$30,$0,$0,$0,$0,6
2015,VA,40308,SERFF,17,2015-02-13 14:34:18,2,40308,VA,Individual,No,53-0078070,40308VA0240001,BluePreferred Platinum $0,40308VA024,,VAN001,VAS001,VAF004,Existing,PPO,Platinum,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99743536943784,,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,Yes,http://content.carefirst.com/sbc/BPPVBN8NRXXVBN8DN012015.pdf,,,www.carefirst.com/acarx,40308VA0240001-03,Limited Cost Sharing Plan Variation,88.16%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"$3,600","$7,200",Not Applicable,Not Applicable,$0,$0,10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,20%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,$0,$0,$528,$30,$0,$160,$711,$0,7
2015,VA,42808,SERFF,5,2014-09-09 16:12:42,1,42808,VA,SHOP (Small Group),Yes,13-5123390,42808VA0200002,Guardian Pediatric Advantage,42808VA020,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$23.16,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,42808VA0200002-00,Standard High Off Exchange Plan,84.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,42808,SERFF,5,2014-09-09 16:12:42,1,42808,VA,SHOP (Small Group),Yes,13-5123390,42808VA0210002,Guardian Pediatric Essentials,42808VA021,,VAN001,VAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$17.05,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,42808VA0210002-00,Standard Low Off Exchange Plan,71.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,42808,SERFF,5,2014-09-09 16:12:42,2,42808,VA,SHOP (Small Group),Yes,13-5123390,42808VA0230002,Guardian Family Advantage,42808VA023,,VAN001,VAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.16,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,42808VA0230002-00,Standard High Off Exchange Plan,84.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,42808,SERFF,5,2014-09-09 16:12:42,2,42808,VA,SHOP (Small Group),Yes,13-5123390,42808VA0230002,Guardian Family Advantage,42808VA023,,VAN001,VAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.16,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,42808VA0230002-01,Standard High On Exchange Plan,84.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,42808,SERFF,5,2014-09-09 16:12:42,2,42808,VA,SHOP (Small Group),Yes,13-5123390,42808VA0250002,Guardian Family Essentials,42808VA025,,VAN001,VAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.05,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,42808VA0250002-00,Standard Low Off Exchange Plan,71.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,VA,42808,SERFF,5,2014-09-09 16:12:42,2,42808,VA,SHOP (Small Group),Yes,13-5123390,42808VA0250002,Guardian Family Essentials,42808VA025,,VAN001,VAS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.05,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,42808VA0250002-01,Standard Low On Exchange Plan,71.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,VA,35801,SERFF,2,2014-09-09 16:12:42,1,35801,VA,SHOP (Small Group),Yes,93-0242990,35801VA0030002,EHB High Passive,35801VA003,,VAN001,VAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$43.20,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com`,standard.com`,standard.com`,,35801VA0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,VA,35801,SERFF,2,2014-09-09 16:12:42,1,35801,VA,SHOP (Small Group),Yes,93-0242990,35801VA0030001,EHB Low Passive,35801VA003,,VAN001,VAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.87,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com`,standard.com`,standard.com`,,35801VA0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,12,38234,VA,Individual,No,06-6033492,38234VA0060047,Aetna Whole Health Catastrophic 100%,38234VA006,,VAN002,VAS002,VAF015,New,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060047-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,12,38234,VA,Individual,No,06-6033492,38234VA0060047,Aetna Whole Health Catastrophic 100%,38234VA006,,VAN002,VAS002,VAF015,New,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060047-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,1,38234,VA,Individual,No,06-6033492,38234VA0060025,Aetna Coastal VA HP Bronze $25 Copay,38234VA006,,VAN001,VAS001,VAF004,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060025-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,1,38234,VA,Individual,No,06-6033492,38234VA0060025,Aetna Coastal VA HP Bronze $25 Copay,38234VA006,,VAN001,VAS001,VAF004,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060025-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,1,38234,VA,Individual,No,06-6033492,38234VA0060025,Aetna Coastal VA HP Bronze $25 Copay,38234VA006,,VAN001,VAS001,VAF004,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060025-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,1,38234,VA,Individual,No,06-6033492,38234VA0060025,Aetna Coastal VA HP Bronze $25 Copay,38234VA006,,VAN001,VAS001,VAF004,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060025-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,2,38234,VA,Individual,No,06-6033492,38234VA0060027,Aetna Coastal VA HP Bronze Deductible Only HSA,38234VA006,,VAN001,VAS001,VAF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060027-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,2,38234,VA,Individual,No,06-6033492,38234VA0060027,Aetna Coastal VA HP Bronze Deductible Only HSA,38234VA006,,VAN001,VAS001,VAF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060027-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,2,38234,VA,Individual,No,06-6033492,38234VA0060027,Aetna Coastal VA HP Bronze Deductible Only HSA,38234VA006,,VAN001,VAS001,VAF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060027-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,2,38234,VA,Individual,No,06-6033492,38234VA0060027,Aetna Coastal VA HP Bronze Deductible Only HSA,38234VA006,,VAN001,VAS001,VAF005,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060027-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,3,38234,VA,Individual,No,06-6033492,38234VA0060043,Aetna Whole Health Bronze $25 Copay,38234VA006,,VAN002,VAS002,VAF013,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060043-00,Standard Bronze Off Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,3,38234,VA,Individual,No,06-6033492,38234VA0060043,Aetna Whole Health Bronze $25 Copay,38234VA006,,VAN002,VAS002,VAF013,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060043-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,3,38234,VA,Individual,No,06-6033492,38234VA0060043,Aetna Whole Health Bronze $25 Copay,38234VA006,,VAN002,VAS002,VAF013,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060043-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,3,38234,VA,Individual,No,06-6033492,38234VA0060043,Aetna Whole Health Bronze $25 Copay,38234VA006,,VAN002,VAS002,VAF013,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060043-03,Limited Cost Sharing Plan Variation,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,4,38234,VA,Individual,No,06-6033492,38234VA0060045,Aetna Whole Health Bronze Deductible Only HSA,38234VA006,,VAN002,VAS002,VAF014,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060045-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,4,38234,VA,Individual,No,06-6033492,38234VA0060045,Aetna Whole Health Bronze Deductible Only HSA,38234VA006,,VAN002,VAS002,VAF014,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060045-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,4,38234,VA,Individual,No,06-6033492,38234VA0060045,Aetna Whole Health Bronze Deductible Only HSA,38234VA006,,VAN002,VAS002,VAF014,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060045-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,4,38234,VA,Individual,No,06-6033492,38234VA0060045,Aetna Whole Health Bronze Deductible Only HSA,38234VA006,,VAN002,VAS002,VAF014,New,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060045-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,5,38234,VA,Individual,No,06-6033492,38234VA0060033,Aetna Coastal VA HP Silver $10 Copay,38234VA006,,VAN001,VAS001,VAF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060033-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,5,38234,VA,Individual,No,06-6033492,38234VA0060033,Aetna Coastal VA HP Silver $10 Copay,38234VA006,,VAN001,VAS001,VAF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060033-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,5,38234,VA,Individual,No,06-6033492,38234VA0060033,Aetna Coastal VA HP Silver $10 Copay,38234VA006,,VAN001,VAS001,VAF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060033-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,5,38234,VA,Individual,No,06-6033492,38234VA0060033,Aetna Coastal VA HP Silver $10 Copay,38234VA006,,VAN001,VAS001,VAF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060033-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,5,38234,VA,Individual,No,06-6033492,38234VA0060033,Aetna Coastal VA HP Silver $10 Copay,38234VA006,,VAN001,VAS001,VAF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060033-04,73% AV Level Silver Plan,72.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,5,38234,VA,Individual,No,06-6033492,38234VA0060033,Aetna Coastal VA HP Silver $10 Copay,38234VA006,,VAN001,VAS001,VAF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060033-05,87% AV Level Silver Plan,86.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,200","$4,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,5,38234,VA,Individual,No,06-6033492,38234VA0060033,Aetna Coastal VA HP Silver $10 Copay,38234VA006,,VAN001,VAS001,VAF008,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060033-06,94% AV Level Silver Plan,93.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,6,38234,VA,Individual,No,06-6033492,38234VA0060035,Aetna Coastal VA HP Silver $5 Copay 2750,38234VA006,,VAN001,VAS001,VAF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060035-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,6,38234,VA,Individual,No,06-6033492,38234VA0060035,Aetna Coastal VA HP Silver $5 Copay 2750,38234VA006,,VAN001,VAS001,VAF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060035-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,6,38234,VA,Individual,No,06-6033492,38234VA0060035,Aetna Coastal VA HP Silver $5 Copay 2750,38234VA006,,VAN001,VAS001,VAF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060035-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,6,38234,VA,Individual,No,06-6033492,38234VA0060035,Aetna Coastal VA HP Silver $5 Copay 2750,38234VA006,,VAN001,VAS001,VAF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060035-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,6,38234,VA,Individual,No,06-6033492,38234VA0060035,Aetna Coastal VA HP Silver $5 Copay 2750,38234VA006,,VAN001,VAS001,VAF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060035-04,73% AV Level Silver Plan,72.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,6,38234,VA,Individual,No,06-6033492,38234VA0060035,Aetna Coastal VA HP Silver $5 Copay 2750,38234VA006,,VAN001,VAS001,VAF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060035-05,87% AV Level Silver Plan,86.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,6,38234,VA,Individual,No,06-6033492,38234VA0060035,Aetna Coastal VA HP Silver $5 Copay 2750,38234VA006,,VAN001,VAS001,VAF009,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060035-06,94% AV Level Silver Plan,93.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,7,38234,VA,Individual,No,06-6033492,38234VA0060051,Aetna Whole Health Silver $10 Copay,38234VA006,,VAN002,VAS002,VAF017,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060051-00,Standard Silver Off Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,7,38234,VA,Individual,No,06-6033492,38234VA0060051,Aetna Whole Health Silver $10 Copay,38234VA006,,VAN002,VAS002,VAF017,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060051-01,Standard Silver On Exchange Plan,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,7,38234,VA,Individual,No,06-6033492,38234VA0060051,Aetna Whole Health Silver $10 Copay,38234VA006,,VAN002,VAS002,VAF017,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060051-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,7,38234,VA,Individual,No,06-6033492,38234VA0060051,Aetna Whole Health Silver $10 Copay,38234VA006,,VAN002,VAS002,VAF017,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060051-03,Limited Cost Sharing Plan Variation,68.40%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,7,38234,VA,Individual,No,06-6033492,38234VA0060051,Aetna Whole Health Silver $10 Copay,38234VA006,,VAN002,VAS002,VAF017,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060051-04,73% AV Level Silver Plan,72.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,7,38234,VA,Individual,No,06-6033492,38234VA0060051,Aetna Whole Health Silver $10 Copay,38234VA006,,VAN002,VAS002,VAF017,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060051-05,87% AV Level Silver Plan,86.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,200","$4,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,7,38234,VA,Individual,No,06-6033492,38234VA0060051,Aetna Whole Health Silver $10 Copay,38234VA006,,VAN002,VAS002,VAF017,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060051-06,94% AV Level Silver Plan,93.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,$0,10%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,8,38234,VA,Individual,No,06-6033492,38234VA0060053,Aetna Whole Health Silver $5 Copay 2750,38234VA006,,VAN002,VAS002,VAF018,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060053-00,Standard Silver Off Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,8,38234,VA,Individual,No,06-6033492,38234VA0060053,Aetna Whole Health Silver $5 Copay 2750,38234VA006,,VAN002,VAS002,VAF018,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060053-01,Standard Silver On Exchange Plan,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,8,38234,VA,Individual,No,06-6033492,38234VA0060053,Aetna Whole Health Silver $5 Copay 2750,38234VA006,,VAN002,VAS002,VAF018,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060053-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,8,38234,VA,Individual,No,06-6033492,38234VA0060053,Aetna Whole Health Silver $5 Copay 2750,38234VA006,,VAN002,VAS002,VAF018,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060053-03,Limited Cost Sharing Plan Variation,68.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,8,38234,VA,Individual,No,06-6033492,38234VA0060053,Aetna Whole Health Silver $5 Copay 2750,38234VA006,,VAN002,VAS002,VAF018,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060053-04,73% AV Level Silver Plan,72.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,8,38234,VA,Individual,No,06-6033492,38234VA0060053,Aetna Whole Health Silver $5 Copay 2750,38234VA006,,VAN002,VAS002,VAF018,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060053-05,87% AV Level Silver Plan,86.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,8,38234,VA,Individual,No,06-6033492,38234VA0060053,Aetna Whole Health Silver $5 Copay 2750,38234VA006,,VAN002,VAS002,VAF018,New,PPO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060053-06,94% AV Level Silver Plan,93.30%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,9,38234,VA,Individual,No,06-6033492,38234VA0060031,Aetna Coastal VA HP Gold $5 Copay,38234VA006,,VAN001,VAS001,VAF007,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060031-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,$500,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,9,38234,VA,Individual,No,06-6033492,38234VA0060031,Aetna Coastal VA HP Gold $5 Copay,38234VA006,,VAN001,VAS001,VAF007,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060031-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,$500,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,9,38234,VA,Individual,No,06-6033492,38234VA0060031,Aetna Coastal VA HP Gold $5 Copay,38234VA006,,VAN001,VAS001,VAF007,New,PPO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060031-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,11,38234,VA,Individual,No,06-6033492,38234VA0060029,Aetna Coastal VA HP Catastrophic 100%,38234VA006,,VAN001,VAS001,VAF006,New,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060029-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,38234,SERFF,7,2014-12-12 12:37:36,11,38234,VA,Individual,No,06-6033492,38234VA0060029,Aetna Coastal VA HP Catastrophic 100%,38234VA006,,VAN001,VAS001,VAF006,New,PPO,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://www.aetna.com/individuals-families/health-insurance-exchange/virginia-health-insurance-exchange-2015.html,http://client.formularynavigator.com/Search.aspx?siteCode=5317259706,38234VA0060029-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,40308,SERFF,17,2015-02-13 14:34:18,1,40308,VA,SHOP (Small Group),No,53-0078070,40308VA0260003,"BluePreferred PPO HSA/HRA $4,000",40308VA026,,VAN001,VAS001,VAF003,Existing,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996115638148979,,,0,0,0,2015-01-01,,Yes,All covered services,Yes,All covered services,Yes,http://content.carefirst.com/sbc/BPHVB55ARXCVBA5EN012015.pdf,,,www.carefirst.com/acarx,40308VA0260003-00,Standard Bronze Off Exchange Plan,60.85%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$20,$990,$150,"$4,000",$130,$120,$80,4
2015,VA,40308,SERFF,17,2015-02-13 14:34:18,1,40308,VA,Individual,Yes,53-0078070,40308VA0320001,BlueDental Preferred,40308VA032,,VAN010,VAS002,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$7.35,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,Yes,,,www.carefirst.com/bluedentalpreferredhighoptionva,,40308VA0320001-01,Standard High On Exchange Plan,86.94%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,$180,,,,,$120,$360,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,40308,SERFF,17,2015-02-13 14:34:18,1,40308,VA,Individual,No,53-0078070,40308VA0250001,"BluePreferred HSA Bronze $3,500",40308VA025,,VAN001,VAS001,VAF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99743536943784,,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,Yes,http://content.carefirst.com/sbc/BPHVBN5NRXCVBN5EN012015.pdf,,,www.carefirst.com/acarx,40308VA0250001-00,Standard Bronze Off Exchange Plan,61.16%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,"$3,500",$0,$350,$30,"$3,500",$30,$322,$0,4
2015,VA,40308,SERFF,17,2015-02-13 14:34:18,1,40308,VA,SHOP (Small Group),Yes,53-0078070,40308VA0330001,BlueDental Preferred,40308VA033,,VAN010,VAS002,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$7.66,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,Yes,,,http://carefirst.cgx.com/SOS/Backend/SearchPDF.aspx?DocumentName=CST1976,,40308VA0330001-01,Standard High On Exchange Plan,86.94%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,$180,,,,,$120,$360,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,40308,SERFF,17,2015-02-13 14:34:18,1,40308,VA,SHOP (Small Group),Yes,53-0078070,40308VA0340001,BlueDental Traditional,40308VA034,,VAN011,VAS002,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$8.23,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,Yes,,,http://carefirst.cgx.com/SOS/Backend/SearchPDF.aspx?DocumentName=CST1975,,40308VA0340001-01,Standard High On Exchange Plan,84.73%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$120,$360,,,,,Not Applicable,Not Applicable,$120,$360,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,40308,SERFF,17,2015-02-13 14:34:18,1,40308,VA,Individual,No,53-0078070,40308VA0250001,"BluePreferred HSA Bronze $3,500",40308VA025,,VAN001,VAS001,VAF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99743536943784,,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,Yes,http://content.carefirst.com/sbc/BPHVBN5NRXCVBN5EN012015.pdf,,,www.carefirst.com/acarx,40308VA0250001-01,Standard Bronze On Exchange Plan,61.16%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,"$7,000","$14,000",Not Applicable,Not Applicable,"$3,500",$0,$350,$30,"$3,500",$30,$322,$0,5
2015,VA,40308,SERFF,17,2015-02-13 14:34:18,1,40308,VA,Individual,Yes,53-0078070,40308VA0320003,BlueDental Preferred,40308VA032,,VAN010,VAS002,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$7.35,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,Yes,,,www.carefirst.com/bluedentalpreferredhighoptionva,,40308VA0320003-00,Standard High Off Exchange Plan,86.94%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,$180,,,,,$120,$360,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,40308,SERFF,17,2015-02-13 14:34:18,1,40308,VA,SHOP (Small Group),No,53-0078070,40308VA0260003,"BluePreferred PPO HSA/HRA $4,000",40308VA026,,VAN001,VAS001,VAF003,Existing,PPO,Bronze,Yes,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.996115638148979,,,0,0,0,2015-01-01,,Yes,All covered services,Yes,All covered services,Yes,http://content.carefirst.com/sbc/BPHVB55ARXCVBA5EN012015.pdf,,,www.carefirst.com/acarx,40308VA0260003-01,Standard Bronze On Exchange Plan,60.85%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",30%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,"$4,000",$20,$990,$150,"$4,000",$130,$120,$80,5
2015,VA,40308,SERFF,17,2015-02-13 14:34:18,1,40308,VA,Individual,No,53-0078070,40308VA0250001,"BluePreferred HSA Bronze $3,500",40308VA025,,VAN001,VAS001,VAF004,Existing,PPO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99743536943784,,,0,0,0,2015-01-01,,Yes,All Covered Services,Yes,All Covered Services,Yes,http://content.carefirst.com/sbc/BPHVBN5NRXCVBN5EN012015.pdf,,,www.carefirst.com/acarx,40308VA0250001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,$0,$30,$0,$0,$0,$0,6
2015,VA,44721,SERFF,3,2014-09-09 16:12:42,1,44721,VA,SHOP (Small Group),Yes,35-0472300,44721VA0010001,Lincoln DentalConnect?,44721VA001,,VAN001,VAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.18,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,44721VA0010001-00,Standard High Off Exchange Plan,84.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,44721,SERFF,3,2014-09-09 16:12:42,1,44721,VA,SHOP (Small Group),Yes,35-0472300,44721VA0010002,Lincoln DentalConnect?,44721VA001,,VAN001,VAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.54,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,44721VA0010002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,44721,SERFF,3,2014-09-09 16:12:42,1,44721,VA,SHOP (Small Group),Yes,35-0472300,44721VA0010003,Lincoln DentalConnect?,44721VA001,,VAN001,VAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.67,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,44721VA0010003-00,Standard Low Off Exchange Plan,69.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,VA,44721,SERFF,3,2014-09-09 16:12:42,1,44721,VA,SHOP (Small Group),Yes,35-0472300,44721VA0010005,Lincoln DentalConnect?,44721VA001,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.61,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,44721VA0010005-00,Standard High Off Exchange Plan,84.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,VA,44721,SERFF,3,2014-09-09 16:12:42,1,44721,VA,SHOP (Small Group),Yes,35-0472300,44721VA0010006,Lincoln DentalConnect?,44721VA001,,VAN001,VAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.57,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,44721VA0010006-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,VA,44721,SERFF,3,2014-09-09 16:12:42,1,44721,VA,SHOP (Small Group),Yes,35-0472300,44721VA0010007,Lincoln DentalConnect?,44721VA001,,VAN001,VAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.66,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,44721VA0010007-00,Standard Low Off Exchange Plan,69.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,VA,44721,SERFF,3,2014-09-09 16:12:42,2,44721,VA,SHOP (Small Group),Yes,35-0472300,44721VA0010004,Lincoln DentalConnect?,44721VA001,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.61,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,44721VA0010004-00,Standard High Off Exchange Plan,86.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,44721,SERFF,3,2014-09-09 16:12:42,2,44721,VA,SHOP (Small Group),Yes,35-0472300,44721VA0010008,Lincoln DentalConnect?,44721VA001,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.25,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,44721VA0010008-00,Standard High Off Exchange Plan,86.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,51207,SERFF,2,2014-09-09 16:12:42,1,51207,VA,SHOP (Small Group),Yes,36-0883760,51207VA0040002,EHB High PPO,51207VA004,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.76,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,51207VA0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,51207,SERFF,2,2014-09-09 16:12:42,1,51207,VA,SHOP (Small Group),Yes,36-0883760,51207VA0040001,EHB Low PPO,51207VA004,,VAN001,VAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.68,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,51207VA0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730018,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS013,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99112979253728,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730018-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730018,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS013,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99112979253728,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730018-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730019,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS015,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99113245588133,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730019-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730019,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS015,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99113245588133,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730019-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730022,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS018,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991136153280438,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730022-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730022,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS018,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991136153280438,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730022-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,23
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730023,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS019,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991131088828455,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730023-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,24
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730023,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS019,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991131088828455,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730023-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,25
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730024,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS020,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991132597190452,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730024-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,26
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730024,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS020,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991132597190452,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730024-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,27
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730025,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS002,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989597615014089,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730025-00,Standard Silver Off Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,Individual,No,54-1356687,88380VA0720016,Anthem HealthKeepers Bronze X 15 for HSA,88380VA072,,VAN002,VAS001,VAF002,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G9S,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720016-00,Standard Bronze Off Exchange Plan,,0.58153623342514,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",15%,"$6,000","$12,000",15%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,Individual,No,54-1356687,88380VA0720016,Anthem HealthKeepers Bronze X 15 for HSA,88380VA072,,VAN002,VAS001,VAF002,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G9S,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720016-01,Standard Bronze On Exchange Plan,,0.58153623342514,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",15%,"$6,000","$12,000",15%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730025,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS002,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989597615014089,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730025-01,Standard Silver On Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730020,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS016,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99113459367838,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730020-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730020,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS016,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.99113459367838,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730020-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,19
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730021,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS017,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991130548125387,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730021-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730021,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS017,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991130548125387,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730021-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730027,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS006,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989594323085329,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730027-00,Standard Silver Off Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730027,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS006,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989594323085329,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730027-01,Standard Silver On Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730028,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS009,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989591735352568,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730028-00,Standard Silver Off Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730028,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS009,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989591735352568,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730028-01,Standard Silver On Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730029,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS012,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989593476816938,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730029-00,Standard Silver Off Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730029,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS012,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989593476816938,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730029-01,Standard Silver On Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730030,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS013,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989591472856128,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730030-00,Standard Silver Off Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,14
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730030,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS013,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989591472856128,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730030-01,Standard Silver On Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,15
2015,VA,51207,SERFF,2,2014-09-09 16:12:42,1,51207,VA,SHOP (Small Group),Yes,36-0883760,51207VA0030002,EHB High Passive,51207VA003,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$43.07,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,51207VA0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730031,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS015,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989594599256057,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730031-00,Standard Silver Off Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,16
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730031,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS015,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989594599256057,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730031-01,Standard Silver On Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730032,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS016,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989597106662693,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730032-00,Standard Silver Off Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,18
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730032,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS016,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989597106662693,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730032-01,Standard Silver On Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,19
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730033,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS017,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989592359631891,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730033-00,Standard Silver Off Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,20
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730033,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS017,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989592359631891,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730033-01,Standard Silver On Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730034,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS018,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98959893667143,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730034-00,Standard Silver Off Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,22
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730034,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS018,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98959893667143,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730034-01,Standard Silver On Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,23
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730035,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS019,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989592994285443,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730035-00,Standard Silver Off Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,24
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730035,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS019,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989592994285443,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730035-01,Standard Silver On Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,25
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730036,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS020,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989594763946206,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730036-00,Standard Silver Off Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,26
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730036,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS020,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989594763946206,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730036-01,Standard Silver On Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,27
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730037,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS002,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986512878669105,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730037-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,4
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,Individual,No,54-1356687,88380VA0720017,Anthem HealthKeepers Bronze X 5500 25,88380VA072,,VAN002,VAS001,VAF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G9U,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720017-00,Standard Bronze Off Exchange Plan,59.80%,0.600426018238068,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",25%,"$5,500","$11,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,51207,SERFF,2,2014-09-09 16:12:42,1,51207,VA,SHOP (Small Group),Yes,36-0883760,51207VA0030001,EHB Low Passive,51207VA003,,VAN001,VAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.79,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,51207VA0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,VA,54965,SERFF,7,2014-09-09 16:12:42,1,54965,VA,Individual,Yes,54-1808292,54965VA0020001,Select Plan Kids,54965VA002,,VAN001,VAS001,,Existing,HMO,Low,,Both,,,,Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.,,,,,Allows Child-Only,,,,$14.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/va14dobiped-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia,,54965VA0020001-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,54965,SERFF,7,2014-09-09 16:12:42,1,54965,VA,SHOP (Small Group),Yes,54-1808292,54965VA0040001,Select Plan Kids,54965VA004,,VAN001,VAS001,,Existing,HMO,Low,,Off the Exchange,,,,Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.,,,,,Allows Child-Only,,,,$14.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/va14dobshopped-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia,,54965VA0040001-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,54965,SERFF,7,2014-09-09 16:12:42,1,54965,VA,SHOP (Small Group),Yes,54-1808292,54965VA0040001,Select Plan Kids,54965VA004,,VAN001,VAS001,,Existing,HMO,Low,,Off the Exchange,,,,Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.,,,,,Allows Child-Only,,,,$14.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/va14dobshopped-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia,,54965VA0040001-01,Standard Low On Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,54965,SERFF,7,2014-09-09 16:12:42,1,54965,VA,Individual,Yes,54-1808292,54965VA0020001,Select Plan Kids,54965VA002,,VAN001,VAS001,,Existing,HMO,Low,,Both,,,,Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.,,,,,Allows Child-Only,,,,$14.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/va14dobiped-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia,,54965VA0020001-01,Standard Low On Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,54965,SERFF,7,2014-09-09 16:12:42,1,54965,VA,Individual,Yes,54-1808292,54965VA0030001,Access PPO Kids,54965VA003,,VAN002,VAS002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$22.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/va14pcoviped-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia,,54965VA0030001-00,Standard Low Off Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,VA,54965,SERFF,7,2014-09-09 16:12:42,1,54965,VA,SHOP (Small Group),Yes,54-1808292,54965VA0050001,Access PPO Kids,54965VA005,,VAN002,VAS002,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$22.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/va14pcovshopped-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia,,54965VA0050001-00,Standard Low Off Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,VA,54965,SERFF,7,2014-09-09 16:12:42,1,54965,VA,SHOP (Small Group),Yes,54-1808292,54965VA0050001,Access PPO Kids,54965VA005,,VAN002,VAS002,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$22.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/va14pcovshopped-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia,,54965VA0050001-01,Standard Low On Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,VA,54965,SERFF,7,2014-09-09 16:12:42,1,54965,VA,Individual,Yes,54-1808292,54965VA0030001,Access PPO Kids,54965VA003,,VAN002,VAS002,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$22.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/va14pcoviped-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia,,54965VA0030001-01,Standard Low On Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,VA,54965,SERFF,7,2014-09-09 16:12:42,2,54965,VA,Individual,Yes,54-1808292,54965VA0020002,Select Plan,54965VA002,,VAN001,VAS001,,Existing,HMO,Low,,Both,,,,Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.,,,,,Allows Adult and Child-Only,,,,$14.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/va14dobifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia,,54965VA0020002-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,54965,SERFF,7,2014-09-09 16:12:42,2,54965,VA,SHOP (Small Group),Yes,54-1808292,54965VA0040002,Select Plan,54965VA004,,VAN001,VAS001,,Existing,HMO,Low,,Both,,,,Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.,,,,,Allows Adult and Child-Only,,,,$14.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/va14dobshopfam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia,,54965VA0040002-00,Standard Low Off Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,54965,SERFF,7,2014-09-09 16:12:42,2,54965,VA,SHOP (Small Group),Yes,54-1808292,54965VA0040002,Select Plan,54965VA004,,VAN001,VAS001,,Existing,HMO,Low,,Both,,,,Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.,,,,,Allows Adult and Child-Only,,,,$14.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/va14dobshopfam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia,,54965VA0040002-01,Standard Low On Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,54965,SERFF,7,2014-09-09 16:12:42,2,54965,VA,Individual,Yes,54-1808292,54965VA0020002,Select Plan,54965VA002,,VAN001,VAS001,,Existing,HMO,Low,,Both,,,,Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.,,,,,Allows Adult and Child-Only,,,,$14.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",Yes,"Emergency pain treatment only if 50 miles away from home ZIP code, up to $100",No,https://www.dominiondental.com/files/plan/FEDVIP/va14dobifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia,,54965VA0020002-01,Standard Low On Exchange Plan,71.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,54965,SERFF,7,2014-09-09 16:12:42,2,54965,VA,Individual,Yes,54-1808292,54965VA0030002,Access PPO,54965VA003,,VAN002,VAS002,,Existing,PPO,Low,,Both,,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,,,,Allows Adult and Child-Only,,,,$22.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/va14pcovifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia,,54965VA0030002-00,Standard Low Off Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,VA,54965,SERFF,7,2014-09-09 16:12:42,2,54965,VA,SHOP (Small Group),Yes,54-1808292,54965VA0050002,Access PPO,54965VA005,,VAN002,VAS002,,Existing,PPO,Low,,Both,,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,,,,Allows Adult and Child-Only,,,,$22.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/va14pcovshopfam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia,,54965VA0050002-00,Standard Low Off Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,VA,54965,SERFF,7,2014-09-09 16:12:42,2,54965,VA,SHOP (Small Group),Yes,54-1808292,54965VA0050002,Access PPO,54965VA005,,VAN002,VAS002,,Existing,PPO,Low,,Both,,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,,,,Allows Adult and Child-Only,,,,$22.95,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/va14pcovshopfam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia,,54965VA0050002-01,Standard Low On Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,VA,54965,SERFF,7,2014-09-09 16:12:42,2,54965,VA,Individual,Yes,54-1808292,54965VA0030002,Access PPO,54965VA003,,VAN002,VAS002,,Existing,PPO,Low,,Both,,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,,,,Allows Adult and Child-Only,,,,$22.95,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Standard Out of Network PPO Benefits,Yes,Standard Out of Network PPO Benefits,Yes,https://www.dominiondental.com/files/plan/FEDVIP/va14pcovifam-hix.pdf,,https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia,,54965VA0030002-01,Standard Low On Exchange Plan,71.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$200,,,,,$100,$200,$100,$200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,VA,66599,SERFF,2,2014-09-09 16:12:42,1,66599,VA,SHOP (Small Group),Yes,47-0098400,66599VA0040002,EHB High PPO,66599VA004,,VAN001,VAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$39.21,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,66599VA0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,66599,SERFF,2,2014-09-09 16:12:42,1,66599,VA,SHOP (Small Group),Yes,47-0098400,66599VA0040001,EHB Low PPO,66599VA004,,VAN001,VAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.41,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,66599VA0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,66599,SERFF,2,2014-09-09 16:12:42,1,66599,VA,SHOP (Small Group),Yes,47-0098400,66599VA0030002,EHB High Passive,66599VA003,,VAN001,VAS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$42.48,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,66599VA0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,VA,66599,SERFF,2,2014-09-09 16:12:42,1,66599,VA,SHOP (Small Group),Yes,47-0098400,66599VA0030001,EHB Low Passive,66599VA003,,VAN001,VAS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$24.45,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,66599VA0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,VA,72006,SERFF,5,2014-09-09 16:12:42,1,72006,VA,SHOP (Small Group),Yes,13-5581829,72006VA0160001,EHB Basic Dental Plan (Low),72006VA016,,VAN001,VAS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but when paired with one of MetLife?s group certificates, the amount paid by the Plan upon claims adjudication will be greater of either the traditional group certificate or the EHB certificate.",,,,,Allows Child-Only,,,,$20.76,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48061,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48060,,72006VA0160001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,72006,SERFF,5,2014-09-09 16:12:42,1,72006,VA,SHOP (Small Group),Yes,13-5581829,72006VA0160001,EHB Basic Dental Plan (Low),72006VA016,,VAN001,VAS001,,Existing,PPO,Low,,Both,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but when paired with one of MetLife?s group certificates, the amount paid by the Plan upon claims adjudication will be greater of either the traditional group certificate or the EHB certificate.",,,,,Allows Child-Only,,,,$20.76,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48061,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=48060,,72006VA0160001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,72006,SERFF,5,2014-09-09 16:12:42,2,72006,VA,SHOP (Small Group),Yes,13-5581829,72006VA0170001,EHB Enhanced Dental Plan (High),72006VA017,,VAN002,VAS001,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Child-Only,,,,$25.64,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49130,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49129,,72006VA0170001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,72006,SERFF,5,2014-09-09 16:12:42,3,72006,VA,SHOP (Small Group),Yes,13-5581829,72006VA0180001,Family Basic Dental Plan (Low),72006VA018,,VAN003,VAS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.76,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49132,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49131,,72006VA0180001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,72006,SERFF,5,2014-09-09 16:12:42,4,72006,VA,SHOP (Small Group),Yes,13-5581829,72006VA0190001,Family Enhanced Dental Plan (High),72006VA019,,VAN004,VAS001,,Existing,PPO,High,,On the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.64,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49134,,https://eforms.metlife.com/wcm8/OIDAction.do?OID=49133,,72006VA0190001-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$50,$150,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,72804,SERFF,4,2014-09-09 16:12:42,1,72804,VA,SHOP (Small Group),Yes,81-0170040,72804VA0010001,Assurant Dental ACAFFO High,72804VA001,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$44.76,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same Coverage as in Service Area.,Yes,,,,,72804VA0010001-00,Standard High Off Exchange Plan,85.10%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,72804,SERFF,4,2014-09-09 16:12:42,2,72804,VA,SHOP (Small Group),Yes,81-0170040,72804VA0010002,Assurant Dental ACAFFO Low,72804VA001,,VAN001,VAS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$37.25,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same Coverage as in Service Area,Yes,,,,,72804VA0010002-00,Standard Low Off Exchange Plan,69.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$90,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,72869,SERFF,3,2014-09-09 16:12:42,1,72869,VA,SHOP (Small Group),Yes,57-0523959,72869VA0010001,Group Pediatric Dental EHB,72869VA001,,VAN001,VAS001,,New,Indemnity,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$49.17,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,72869VA0010001-00,Standard High Off Exchange Plan,86.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,72869,SERFF,3,2014-09-09 16:12:42,1,72869,VA,SHOP (Small Group),Yes,57-0523959,72869VA0010002,Group Pediatric Dental EHB,72869VA001,,VAN001,VAS001,,New,Indemnity,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$40.54,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,72869VA0010002-00,Standard Low Off Exchange Plan,71.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,77146,SERFF,6,2014-09-11 12:10:19,1,77146,VA,SHOP (Small Group),Yes,41-0808596,77146VA0010001,"Plan 1. Passive PPO, $1000 Annual Maximum, no Ortho",77146VA001,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,77146VA0010001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,77146,SERFF,6,2014-09-11 12:10:19,1,77146,VA,SHOP (Small Group),Yes,41-0808596,77146VA0010002,"Plan 2.  Passive PPO, $1000 Annual Maximum, Ortho",77146VA001,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,77146VA0010002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,77146,SERFF,6,2014-09-11 12:10:19,1,77146,VA,SHOP (Small Group),Yes,41-0808596,77146VA0010003,"Plan 3. Passive PPO, $1500 Annual Maximum, no Ortho",77146VA001,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,77146VA0010003-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,VA,77146,SERFF,6,2014-09-11 12:10:19,1,77146,VA,SHOP (Small Group),Yes,41-0808596,77146VA0010004,"Plan 4.  Passive PPO, $1500 Annual Maximum, Ortho",77146VA001,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,77146VA0010004-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,VA,77146,SERFF,6,2014-09-11 12:10:19,1,77146,VA,SHOP (Small Group),Yes,41-0808596,77146VA0010005,"Plan 5.  Passive PPO, $2000 Annual Maximum, Ortho",77146VA001,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,77146VA0010005-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,VA,77146,SERFF,6,2014-09-11 12:10:19,1,77146,VA,SHOP (Small Group),Yes,41-0808596,77146VA0010006,"Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho",77146VA001,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,77146VA0010006-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,VA,77146,SERFF,6,2014-09-11 12:10:19,1,77146,VA,SHOP (Small Group),Yes,41-0808596,77146VA0010007,"Plan 7. Graded Passive PPO, $1000 Annual Maximum, Ortho",77146VA001,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.03,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,77146VA0010007-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,VA,77146,SERFF,6,2014-09-11 12:10:19,1,77146,VA,SHOP (Small Group),Yes,41-0808596,77146VA0010008,"Plan 8. MAC PPO, $1000 Annual Maximum, no Ortho",77146VA001,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,77146VA0010008-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,VA,77146,SERFF,6,2014-09-11 12:10:19,1,77146,VA,SHOP (Small Group),Yes,41-0808596,77146VA0010009,"Plan 9. MAC PPO, $1500 Annual Maximum, Ortho",77146VA001,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,77146VA0010009-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12
2015,VA,77146,SERFF,6,2014-09-11 12:10:19,1,77146,VA,SHOP (Small Group),Yes,41-0808596,77146VA0010010,"Plan 10. Graded MAC PPO, $1000 Annual Maximum, no Ortho",77146VA001,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.18,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Benefits are same in and out of network,Yes,,,,,77146VA0010010-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,Not Applicable,Not Applicable,,,Not Applicable,Not Applicable,$350,$700,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,$150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,13
2015,VA,78800,SERFF,2,2014-09-09 16:12:42,1,78800,VA,SHOP (Small Group),Yes,44-0308260,78800VA0010001,KCL EHB Low PPO,78800VA001,,VAN001,VAS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$46.20,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,78800VA0010001-00,Standard Low Off Exchange Plan,69.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,78800,SERFF,2,2014-09-09 16:12:42,1,78800,VA,SHOP (Small Group),Yes,44-0308260,78800VA0010003,KCL EHB Low MAC,78800VA001,,VAN001,VAS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$34.52,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,78800VA0010003-00,Standard Low Off Exchange Plan,69.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,78800,SERFF,2,2014-09-09 16:12:42,1,78800,VA,SHOP (Small Group),Yes,44-0308260,78800VA0010005,KCL Fam Low PPO,78800VA001,,VAN001,VAS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$46.20,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,78800VA0010005-00,Standard Low Off Exchange Plan,69.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,VA,78800,SERFF,2,2014-09-09 16:12:42,1,78800,VA,SHOP (Small Group),Yes,44-0308260,78800VA0010007,KCL Fam Low MAC,78800VA001,,VAN001,VAS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$34.52,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,78800VA0010007-00,Standard Low Off Exchange Plan,69.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$125,Not Applicable,,,,,$125,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,VA,78800,SERFF,2,2014-09-09 16:12:42,2,78800,VA,SHOP (Small Group),Yes,44-0308260,78800VA0010002,KCL EHB High PPO,78800VA001,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$57.30,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,78800VA0010002-00,Standard High Off Exchange Plan,86.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,78800,SERFF,2,2014-09-09 16:12:42,2,78800,VA,SHOP (Small Group),Yes,44-0308260,78800VA0010004,KCL EHB High MAC,78800VA001,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$44.15,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,78800VA0010004-00,Standard High Off Exchange Plan,86.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,78800,SERFF,2,2014-09-09 16:12:42,2,78800,VA,SHOP (Small Group),Yes,44-0308260,78800VA0010006,KCL Fam High PPO,78800VA001,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$57.30,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,78800VA0010006-00,Standard High Off Exchange Plan,86.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,VA,78800,SERFF,2,2014-09-09 16:12:42,2,78800,VA,SHOP (Small Group),Yes,44-0308260,78800VA0010008,KCL Fam High MAC,78800VA001,,VAN001,VAS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$44.15,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,78800VA0010008-00,Standard High Off Exchange Plan,86.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,Individual,No,54-1356687,88380VA0720015,Anthem HealthKeepers Catastrophic X 6600 0,88380VA072,,VAN002,VAS001,VAF015,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G9R,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720015-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,"$6,600","$13,200",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730013,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS002,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991135027453372,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730013-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730013,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS002,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991135027453372,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730013-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,Individual,No,54-1356687,88380VA0720015,Anthem HealthKeepers Catastrophic X 6600 0,88380VA072,,VAN002,VAS001,VAF015,Existing,HMO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G9R,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720015-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,"$6,600","$13,200",0%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730014,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS005,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991127202282858,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730014-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730014,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS005,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991127202282858,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730014-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730015,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS006,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991132221637498,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730015-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730015,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS006,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991132221637498,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730015-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730016,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS009,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991130015889495,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730016-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730016,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS009,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991130015889495,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730016-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,11
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730017,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS012,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991131500387523,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730017-00,Standard Gold Off Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,12
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,1,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730017,Anthem HealthKeepers Gold  Pathway X POS 500 20 5000 Plus,88380VA073,,VAN002,VAS012,VAF001,Existing,POS,Gold,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.991131500387523,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCQ,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730017-01,Standard Gold On Exchange Plan,79.40%,0.803020238876343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",$500,"$1,500",20%,,,,"$1,000","$2,000","$1,500","$3,500",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730026,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS005,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989588434683165,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730026-00,Standard Silver Off Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,Individual,No,54-1356687,88380VA0720016,Anthem HealthKeepers Bronze X 15 for HSA,88380VA072,,VAN002,VAS001,VAF002,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G9S,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720016-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,Individual,No,54-1356687,88380VA0720016,Anthem HealthKeepers Bronze X 15 for HSA,88380VA072,,VAN002,VAS001,VAF002,Existing,HMO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G9S,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720016-03,Limited Cost Sharing Plan Variation,,0.58153623342514,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000",15%,"$6,000","$12,000",15%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,2,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730026,Anthem HealthKeepers Silver  Pathway X POS 2000 30 5500 Plus,88380VA073,,VAN002,VAS005,VAF001,Existing,POS,Silver,Yes,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.989588434683165,,$500,0,0,3,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCC,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730026-01,Standard Silver On Exchange Plan,69.63%,0.715261697769165,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000",30%,,,,"$4,000","$8,000","$6,000","$12,000",$0,$0,30%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,Individual,No,54-1356687,88380VA0720017,Anthem HealthKeepers Bronze X 5500 25,88380VA072,,VAN002,VAS001,VAF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G9U,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720017-01,Standard Bronze On Exchange Plan,59.80%,0.600426018238068,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",25%,"$5,500","$11,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730037,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS002,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986512878669105,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730037-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,5
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730038,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS005,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986500987818442,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730038-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,6
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,Individual,No,54-1356687,88380VA0720017,Anthem HealthKeepers Bronze X 5500 25,88380VA072,,VAN002,VAS001,VAF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G9U,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720017-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,Individual,No,54-1356687,88380VA0720017,Anthem HealthKeepers Bronze X 5500 25,88380VA072,,VAN002,VAS001,VAF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,2,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G9U,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720017-03,Limited Cost Sharing Plan Variation,59.80%,0.600426018238068,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",25%,"$5,500","$11,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730038,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS005,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986500987818442,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730038-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,7
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730039,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS006,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986508613543193,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730039-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,8
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730039,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS006,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986508613543193,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730039-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,9
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730040,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS009,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986505261811274,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730040-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,10
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730040,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS009,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986505261811274,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730040-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,11
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730041,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS012,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986507516719523,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730041-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,12
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730041,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS012,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986507516719523,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730041-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,13
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730042,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS013,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986504918958822,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730042-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,14
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730042,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS013,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986504918958822,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730042-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,15
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730043,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS015,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98650897961717,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730043-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,16
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730043,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS015,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.98650897961717,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730043-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,17
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730044,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS016,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986512223573036,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730044-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,18
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730044,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS016,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986512223573036,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730044-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,19
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730045,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS017,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986506069617948,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730045-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,20
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730045,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS017,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986506069617948,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730045-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,21
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730046,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS018,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986514595835378,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730046-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,22
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730046,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS018,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986514595835378,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730046-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,23
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730047,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS019,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986506893570822,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730047-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,24
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730047,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS019,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986506893570822,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730047-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,25
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730048,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS020,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986509186227883,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730048-00,Standard Bronze Off Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,26
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,3,88380,VA,SHOP (Small Group),No,54-1356687,88380VA0730048,Anthem HealthKeepers Bronze  Pathway X POS 5500 0 5500 Plus w HSA,88380VA073,,VAN002,VAS020,VAF002,Existing,POS,Bronze,No,Both,No,Yes,"All but Primary Care Physicians, OBGYNs and Emergency Care",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,0.986509186227883,,,0,0,0,2015-01-01,2015-12-31,Yes,Follows OON Coverage,Yes,Follows OON Coverage,No,http://www.sbc.anthem.com/dps/CCD1NCL,,http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e202875.pdf,www.anthem.com/VASelectdrugtier4,88380VA0730048-01,Standard Bronze On Exchange Plan,,0.610353112220764,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$13,750","$27,500","$19,250","$38,500",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000",0%,,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,27
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,4,88380,VA,Individual,No,54-1356687,88380VA0720018,Anthem HealthKeepers Bronze X 4500 35,88380VA072,,VAN002,VAS001,VAF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G9W,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720018-00,Standard Bronze Off Exchange Plan,60.88%,0.612584471702576,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",35%,"$4,500","$9,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,4,88380,VA,Individual,No,54-1356687,88380VA0720018,Anthem HealthKeepers Bronze X 4500 35,88380VA072,,VAN002,VAS001,VAF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G9W,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720018-01,Standard Bronze On Exchange Plan,60.88%,0.612584471702576,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",35%,"$4,500","$9,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,4,88380,VA,Individual,No,54-1356687,88380VA0720018,Anthem HealthKeepers Bronze X 4500 35,88380VA072,,VAN002,VAS001,VAF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G9W,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720018-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,4,88380,VA,Individual,No,54-1356687,88380VA0720018,Anthem HealthKeepers Bronze X 4500 35,88380VA072,,VAN002,VAS001,VAF003,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G9W,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720018-03,Limited Cost Sharing Plan Variation,60.88%,0.612584471702576,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",35%,"$4,500","$9,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,5,88380,VA,Individual,No,54-1356687,88380VA0720019,Anthem HealthKeepers Bronze X 4000 20,88380VA072,,VAN002,VAS001,VAF016,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G9Y,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720019-00,Standard Bronze Off Exchange Plan,59.86%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,"$4,000","$8,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,5,88380,VA,Individual,No,54-1356687,88380VA0720019,Anthem HealthKeepers Bronze X 4000 20,88380VA072,,VAN002,VAS001,VAF016,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G9Y,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720019-01,Standard Bronze On Exchange Plan,59.86%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,"$4,000","$8,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,5,88380,VA,Individual,No,54-1356687,88380VA0720019,Anthem HealthKeepers Bronze X 4000 20,88380VA072,,VAN002,VAS001,VAF016,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G9Y,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720019-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,5,88380,VA,Individual,No,54-1356687,88380VA0720019,Anthem HealthKeepers Bronze X 4000 20,88380VA072,,VAN002,VAS001,VAF016,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1G9Y,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720019-03,Limited Cost Sharing Plan Variation,59.86%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,"$4,000","$8,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,6,88380,VA,Individual,No,54-1356687,88380VA0890001,Anthem HealthKeepers Bronze X POS 4000 20,88380VA089,,VAN002,VAS007,VAF018,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GA0,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890001-00,Standard Bronze Off Exchange Plan,59.86%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,"$4,000","$8,000",50%,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,6,88380,VA,Individual,No,54-1356687,88380VA0890001,Anthem HealthKeepers Bronze X POS 4000 20,88380VA089,,VAN002,VAS007,VAF018,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GA0,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890001-01,Standard Bronze On Exchange Plan,59.86%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,"$4,000","$8,000",50%,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,6,88380,VA,Individual,No,54-1356687,88380VA0890001,Anthem HealthKeepers Bronze X POS 4000 20,88380VA089,,VAN002,VAS007,VAF018,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GA0,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,6,88380,VA,Individual,No,54-1356687,88380VA0890001,Anthem HealthKeepers Bronze X POS 4000 20,88380VA089,,VAN002,VAS007,VAF018,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GA0,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890001-03,Limited Cost Sharing Plan Variation,59.86%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,"$4,000","$8,000",50%,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,6,88380,VA,Individual,No,54-1356687,88380VA0890004,Anthem HealthKeepers Bronze X POS 4000 20,88380VA089,,VAN002,VAS018,VAF018,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GA0,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890004-00,Standard Bronze Off Exchange Plan,59.86%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,"$4,000","$8,000",50%,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,6,88380,VA,Individual,No,54-1356687,88380VA0890004,Anthem HealthKeepers Bronze X POS 4000 20,88380VA089,,VAN002,VAS018,VAF018,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GA0,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890004-01,Standard Bronze On Exchange Plan,59.86%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,"$4,000","$8,000",50%,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,6,88380,VA,Individual,No,54-1356687,88380VA0890004,Anthem HealthKeepers Bronze X POS 4000 20,88380VA089,,VAN002,VAS018,VAF018,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GA0,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890004-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,10
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,6,88380,VA,Individual,No,54-1356687,88380VA0890004,Anthem HealthKeepers Bronze X POS 4000 20,88380VA089,,VAN002,VAS018,VAF018,Existing,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GA0,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890004-03,Limited Cost Sharing Plan Variation,59.86%,,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200","$15,000","$30,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,"$4,000","$8,000",50%,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,7,88380,VA,Individual,No,54-1356687,88380VA0720020,Anthem HealthKeepers Bronze X 25 for HSA,88380VA072,,VAN002,VAS001,VAF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GA2,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720020-00,Standard Bronze Off Exchange Plan,61.19%,0.616434276103973,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,200","$12,400","$6,200","$12,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500",25%,"$3,750","$7,500",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,7,88380,VA,Individual,No,54-1356687,88380VA0720020,Anthem HealthKeepers Bronze X 25 for HSA,88380VA072,,VAN002,VAS001,VAF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GA2,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720020-01,Standard Bronze On Exchange Plan,61.19%,0.616434276103973,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,200","$12,400","$6,200","$12,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500",25%,"$3,750","$7,500",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,7,88380,VA,Individual,No,54-1356687,88380VA0720020,Anthem HealthKeepers Bronze X 25 for HSA,88380VA072,,VAN002,VAS001,VAF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GA2,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720020-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,7,88380,VA,Individual,No,54-1356687,88380VA0720020,Anthem HealthKeepers Bronze X 25 for HSA,88380VA072,,VAN002,VAS001,VAF001,Existing,HMO,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GA2,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720020-03,Limited Cost Sharing Plan Variation,61.19%,0.616434276103973,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,200","$12,400","$6,200","$12,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500",25%,"$3,750","$7,500",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,8,88380,VA,Individual,No,54-1356687,88380VA0720021,Anthem HealthKeepers Silver X 3350 15,88380VA072,,VAN002,VAS001,VAF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GA4,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720021-00,Standard Silver Off Exchange Plan,68.06%,0.687726259231567,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,150","$10,300","$5,150","$10,300",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,350","$6,700",15%,"$3,350","$6,700",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,8,88380,VA,Individual,No,54-1356687,88380VA0720021,Anthem HealthKeepers Silver X 3350 15,88380VA072,,VAN002,VAS001,VAF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GA4,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720021-01,Standard Silver On Exchange Plan,68.06%,0.687726259231567,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,150","$10,300","$5,150","$10,300",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,350","$6,700",15%,"$3,350","$6,700",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,8,88380,VA,Individual,No,54-1356687,88380VA0720021,Anthem HealthKeepers Silver X 3350 15,88380VA072,,VAN002,VAS001,VAF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GA4,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720021-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,8,88380,VA,Individual,No,54-1356687,88380VA0720021,Anthem HealthKeepers Silver X 3350 15,88380VA072,,VAN002,VAS001,VAF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GA4,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720021-03,Limited Cost Sharing Plan Variation,68.06%,0.687726259231567,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,150","$10,300","$5,150","$10,300",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,350","$6,700",15%,"$3,350","$6,700",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,8,88380,VA,Individual,No,54-1356687,88380VA0720021,Anthem HealthKeepers Silver X 3350 15,88380VA072,,VAN002,VAS001,VAF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GA4,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720021-04,73% AV Level Silver Plan,72.05%,0.727059781551361,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,200","$8,400","$4,200","$8,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700",15%,"$2,350","$4,700",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,8,88380,VA,Individual,No,54-1356687,88380VA0720021,Anthem HealthKeepers Silver X 3350 15,88380VA072,,VAN002,VAS001,VAF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GA4,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720021-05,87% AV Level Silver Plan,86.03%,0.863613545894623,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,450","$2,900","$1,450","$2,900",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",15%,$750,"$1,500",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,8,88380,VA,Individual,No,54-1356687,88380VA0720021,Anthem HealthKeepers Silver X 3350 15,88380VA072,,VAN002,VAS001,VAF004,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GA4,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720021-06,94% AV Level Silver Plan,93.14%,0.933396518230438,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$600,"$1,200",$600,"$1,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,15%,$200,$400,45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,9,88380,VA,Individual,No,54-1356687,88380VA0720022,Anthem HealthKeepers Silver X 2600 20,88380VA072,,VAN002,VAS001,VAF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GA9,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720022-00,Standard Silver Off Exchange Plan,68.02%,0.686666965484619,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,950","$11,900","$5,950","$11,900",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",20%,"$2,600","$5,200",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,9,88380,VA,Individual,No,54-1356687,88380VA0720022,Anthem HealthKeepers Silver X 2600 20,88380VA072,,VAN002,VAS001,VAF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GA9,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720022-01,Standard Silver On Exchange Plan,68.02%,0.686666965484619,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,950","$11,900","$5,950","$11,900",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",20%,"$2,600","$5,200",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,9,88380,VA,Individual,No,54-1356687,88380VA0720022,Anthem HealthKeepers Silver X 2600 20,88380VA072,,VAN002,VAS001,VAF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GA9,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720022-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,9,88380,VA,Individual,No,54-1356687,88380VA0720022,Anthem HealthKeepers Silver X 2600 20,88380VA072,,VAN002,VAS001,VAF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GA9,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720022-03,Limited Cost Sharing Plan Variation,68.02%,0.686666965484619,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,950","$11,900","$5,950","$11,900",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200",20%,"$2,600","$5,200",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,9,88380,VA,Individual,No,54-1356687,88380VA0720022,Anthem HealthKeepers Silver X 2600 20,88380VA072,,VAN002,VAS001,VAF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GA9,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720022-04,73% AV Level Silver Plan,72.16%,0.726548612117767,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,"$2,500","$5,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,9,88380,VA,Individual,No,54-1356687,88380VA0720022,Anthem HealthKeepers Silver X 2600 20,88380VA072,,VAN002,VAS001,VAF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GA9,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720022-05,87% AV Level Silver Plan,86.10%,0.863523662090302,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,450","$2,900","$1,450","$2,900",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",20%,$750,"$1,500",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,9,88380,VA,Individual,No,54-1356687,88380VA0720022,Anthem HealthKeepers Silver X 2600 20,88380VA072,,VAN002,VAS001,VAF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,3,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GA9,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720022-06,94% AV Level Silver Plan,93.25%,0.934056639671326,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$600,"$1,200",$600,"$1,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,$200,$400,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,10,88380,VA,Individual,No,54-1356687,88380VA0720023,Anthem HealthKeepers Silver X 2250 20,88380VA072,,VAN002,VAS001,VAF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GAE,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720023-00,Standard Silver Off Exchange Plan,68.81%,0.690981209278107,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",20%,"$2,250","$4,500",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,10,88380,VA,Individual,No,54-1356687,88380VA0720023,Anthem HealthKeepers Silver X 2250 20,88380VA072,,VAN002,VAS001,VAF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GAE,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720023-01,Standard Silver On Exchange Plan,68.81%,0.690981209278107,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",20%,"$2,250","$4,500",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,10,88380,VA,Individual,No,54-1356687,88380VA0720023,Anthem HealthKeepers Silver X 2250 20,88380VA072,,VAN002,VAS001,VAF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GAE,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720023-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,10,88380,VA,Individual,No,54-1356687,88380VA0720023,Anthem HealthKeepers Silver X 2250 20,88380VA072,,VAN002,VAS001,VAF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GAE,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720023-03,Limited Cost Sharing Plan Variation,68.81%,0.690981209278107,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500",20%,"$2,250","$4,500",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,10,88380,VA,Individual,No,54-1356687,88380VA0720023,Anthem HealthKeepers Silver X 2250 20,88380VA072,,VAN002,VAS001,VAF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GAE,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720023-04,73% AV Level Silver Plan,72.01%,0.723188698291779,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",20%,"$2,100","$4,200",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,10,88380,VA,Individual,No,54-1356687,88380VA0720023,Anthem HealthKeepers Silver X 2250 20,88380VA072,,VAN002,VAS001,VAF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GAE,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720023-05,87% AV Level Silver Plan,86.04%,0.861585915088654,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,450","$2,900","$1,450","$2,900",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",20%,$700,"$1,400",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,10,88380,VA,Individual,No,54-1356687,88380VA0720023,Anthem HealthKeepers Silver X 2250 20,88380VA072,,VAN002,VAS001,VAF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GAE,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720023-06,94% AV Level Silver Plan,93.29%,0.933458387851715,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$600,"$1,200",$600,"$1,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,$200,$400,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,11,88380,VA,Individual,No,54-1356687,88380VA0720024,Anthem HealthKeepers Silver X 2000 20,88380VA072,,VAN002,VAS001,VAF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GAK,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720024-00,Standard Silver Off Exchange Plan,68.04%,0.70779812335968,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,900","$11,800","$5,900","$11,800",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,"$2,000","$4,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,11,88380,VA,Individual,No,54-1356687,88380VA0720024,Anthem HealthKeepers Silver X 2000 20,88380VA072,,VAN002,VAS001,VAF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GAK,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720024-01,Standard Silver On Exchange Plan,68.04%,0.70779812335968,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,900","$11,800","$5,900","$11,800",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,"$2,000","$4,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,11,88380,VA,Individual,No,54-1356687,88380VA0720024,Anthem HealthKeepers Silver X 2000 20,88380VA072,,VAN002,VAS001,VAF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GAK,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720024-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,11,88380,VA,Individual,No,54-1356687,88380VA0720024,Anthem HealthKeepers Silver X 2000 20,88380VA072,,VAN002,VAS001,VAF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GAK,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720024-03,Limited Cost Sharing Plan Variation,68.04%,0.70779812335968,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,900","$11,800","$5,900","$11,800",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,"$2,000","$4,000",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,11,88380,VA,Individual,No,54-1356687,88380VA0720024,Anthem HealthKeepers Silver X 2000 20,88380VA072,,VAN002,VAS001,VAF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GAK,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720024-04,73% AV Level Silver Plan,72.08%,0.746060729026794,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",20%,"$1,750","$3,500",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,11,88380,VA,Individual,No,54-1356687,88380VA0720024,Anthem HealthKeepers Silver X 2000 20,88380VA072,,VAN002,VAS001,VAF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GAK,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720024-05,87% AV Level Silver Plan,86.23%,0.874556839466095,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,300","$2,600","$1,300","$2,600",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",20%,$700,"$1,400",50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,11,88380,VA,Individual,No,54-1356687,88380VA0720024,Anthem HealthKeepers Silver X 2000 20,88380VA072,,VAN002,VAS001,VAF007,Existing,HMO,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GAK,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720024-06,94% AV Level Silver Plan,93.06%,0.934129476547241,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$600,"$1,200",$600,"$1,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,$200,$400,50%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,12,88380,VA,Individual,No,54-1356687,88380VA0890002,Anthem HealthKeepers Silver X POS 2000 20,88380VA089,,VAN002,VAS007,VAF020,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GAQ,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890002-00,Standard Silver Off Exchange Plan,68.04%,0.70779812335968,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,900","$11,800","$5,900","$11,800","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,"$2,000","$4,000",50%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,12,88380,VA,Individual,No,54-1356687,88380VA0890002,Anthem HealthKeepers Silver X POS 2000 20,88380VA089,,VAN002,VAS007,VAF020,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GAQ,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890002-01,Standard Silver On Exchange Plan,68.04%,0.70779812335968,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,900","$11,800","$5,900","$11,800","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,"$2,000","$4,000",50%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,12,88380,VA,Individual,No,54-1356687,88380VA0890002,Anthem HealthKeepers Silver X POS 2000 20,88380VA089,,VAN002,VAS007,VAF020,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GAQ,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,12,88380,VA,Individual,No,54-1356687,88380VA0890002,Anthem HealthKeepers Silver X POS 2000 20,88380VA089,,VAN002,VAS007,VAF020,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GAQ,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890002-03,Limited Cost Sharing Plan Variation,68.04%,0.70779812335968,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,900","$11,800","$5,900","$11,800","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,"$2,000","$4,000",50%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,3,95185,VA,Individual,No,52-0954463,95185VA0530007,KP VA Bronze 4500/50/HSA/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF010,Existing,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,4,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530007-03,Limited Cost Sharing Plan Variation,,0.593425035476685,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,14
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,3,95185,VA,Individual,No,52-0954463,95185VA0530008,KP VA Bronze 5000/30%/HSA/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF011,Existing,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530008-00,Standard Bronze Off Exchange Plan,,0.588992476463318,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,15
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,3,95185,VA,Individual,No,52-0954463,95185VA0530008,KP VA Bronze 5000/30%/HSA/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF011,Existing,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530008-01,Standard Bronze On Exchange Plan,,0.588992476463318,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,16
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,3,95185,VA,Individual,No,52-0954463,95185VA0530008,KP VA Bronze 5000/30%/HSA/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF011,Existing,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,17
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,3,95185,VA,Individual,No,52-0954463,95185VA0530008,KP VA Bronze 5000/30%/HSA/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF011,Existing,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530008-03,Limited Cost Sharing Plan Variation,,0.588992476463318,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,18
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,4,95185,VA,Individual,No,52-0954463,95185VA0530006,KP VA Bronze 4500/50/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF008,Existing,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530006-00,Standard Bronze Off Exchange Plan,,0.600537419319153,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,4,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500008,KP VA Silver 1250/35/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF017,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500008-00,Standard Silver Off Exchange Plan,,0.713346123695374,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000","$1,250","$2,500",20%,,,,Not Applicable,Not Applicable,"$1,250","$2,500",$0,$0,100%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,4,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500008,KP VA Silver 1250/35/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF017,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500008-01,Standard Silver On Exchange Plan,,0.713346123695374,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000","$1,250","$2,500",20%,,,,Not Applicable,Not Applicable,"$1,250","$2,500",$0,$0,100%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,4,95185,VA,Individual,No,52-0954463,95185VA0530006,KP VA Bronze 4500/50/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF008,Existing,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530006-01,Standard Bronze On Exchange Plan,,0.600537419319153,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,4,95185,VA,Individual,No,52-0954463,95185VA0530006,KP VA Bronze 4500/50/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF008,Existing,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,12,88380,VA,Individual,No,54-1356687,88380VA0890002,Anthem HealthKeepers Silver X POS 2000 20,88380VA089,,VAN002,VAS007,VAF020,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GAQ,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890002-04,73% AV Level Silver Plan,72.08%,0.746060729026794,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",20%,"$1,750","$3,500",50%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,12,88380,VA,Individual,No,54-1356687,88380VA0890002,Anthem HealthKeepers Silver X POS 2000 20,88380VA089,,VAN002,VAS007,VAF020,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GAQ,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890002-05,87% AV Level Silver Plan,86.23%,0.874556839466095,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,300","$2,600","$1,300","$2,600","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",20%,$700,"$1,400",50%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,12,88380,VA,Individual,No,54-1356687,88380VA0890002,Anthem HealthKeepers Silver X POS 2000 20,88380VA089,,VAN002,VAS007,VAF020,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GAQ,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890002-06,94% AV Level Silver Plan,93.06%,0.934129476547241,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$600,"$1,200",$600,"$1,200","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,$200,$400,50%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,12,88380,VA,Individual,No,54-1356687,88380VA0890005,Anthem HealthKeepers Silver X POS 2000 20,88380VA089,,VAN002,VAS018,VAF020,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GAQ,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890005-00,Standard Silver Off Exchange Plan,68.04%,0.70779812335968,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,900","$11,800","$5,900","$11,800","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,"$2,000","$4,000",50%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,5,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500012,KP VA Bronze 4500/50/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF018,Existing,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500012-00,Standard Bronze Off Exchange Plan,,0.613166034221649,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,4
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,5,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500012,KP VA Bronze 4500/50/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF018,Existing,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500012-01,Standard Bronze On Exchange Plan,,0.613166034221649,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",40%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,5
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,5,95185,VA,Individual,No,52-0954463,95185VA0530009,KP VA Catastrophic 6600/0/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF009,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,3,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530009-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,6,95185,VA,Individual,No,52-0954463,95185VA0530010,KP VA Platinum 0/10/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF001,New,HMO,Platinum,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,4,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530010-00,Standard Platinum Off Exchange Plan,,0.899488031864166,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,6,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500003,KP VA Platinum 1250/10/HRA/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF020,Existing,HMO,Platinum,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,No,Yes,$625.00,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500003-00,Standard Platinum Off Exchange Plan,,0.888768374919891,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",0%,,,,Not Applicable,Not Applicable,"$1,250","$2,500",,,,,,,,,4
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,6,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500003,KP VA Platinum 1250/10/HRA/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF020,Existing,HMO,Platinum,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,No,Yes,$625.00,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500003-01,Standard Platinum On Exchange Plan,,0.888768374919891,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",0%,,,,Not Applicable,Not Applicable,"$1,250","$2,500",,,,,,,,,5
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,6,95185,VA,Individual,No,52-0954463,95185VA0530010,KP VA Platinum 0/10/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF001,New,HMO,Platinum,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,4,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530010-01,Standard Platinum On Exchange Plan,,0.899488031864166,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,6,95185,VA,Individual,No,52-0954463,95185VA0530010,KP VA Platinum 0/10/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF001,New,HMO,Platinum,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,4,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,6,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500006,KP VA Gold 1250/0%/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF016,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500006-00,Standard Gold Off Exchange Plan,,0.780899941921234,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",0%,,,,Not Applicable,Not Applicable,"$1,250","$2,500",,,,,,,,,6
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,6,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500006,KP VA Gold 1250/0%/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF016,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500006-01,Standard Gold On Exchange Plan,,0.780899941921234,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",0%,,,,Not Applicable,Not Applicable,"$1,250","$2,500",,,,,,,,,7
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,12,88380,VA,Individual,No,54-1356687,88380VA0890005,Anthem HealthKeepers Silver X POS 2000 20,88380VA089,,VAN002,VAS018,VAF020,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GAQ,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890005-01,Standard Silver On Exchange Plan,68.04%,0.70779812335968,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,900","$11,800","$5,900","$11,800","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,"$2,000","$4,000",50%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,12,88380,VA,Individual,No,54-1356687,88380VA0890005,Anthem HealthKeepers Silver X POS 2000 20,88380VA089,,VAN002,VAS018,VAF020,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GAQ,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890005-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,13
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,12,88380,VA,Individual,No,54-1356687,88380VA0890005,Anthem HealthKeepers Silver X POS 2000 20,88380VA089,,VAN002,VAS018,VAF020,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GAQ,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890005-03,Limited Cost Sharing Plan Variation,68.04%,0.70779812335968,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$5,900","$11,800","$5,900","$11,800","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,"$2,000","$4,000",50%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,12,88380,VA,Individual,No,54-1356687,88380VA0890005,Anthem HealthKeepers Silver X POS 2000 20,88380VA089,,VAN002,VAS018,VAF020,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GAQ,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890005-04,73% AV Level Silver Plan,72.08%,0.746060729026794,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",20%,"$1,750","$3,500",50%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,15
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,12,88380,VA,Individual,No,54-1356687,88380VA0890005,Anthem HealthKeepers Silver X POS 2000 20,88380VA089,,VAN002,VAS018,VAF020,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GAQ,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890005-05,87% AV Level Silver Plan,86.23%,0.874556839466095,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$1,300","$2,600","$1,300","$2,600","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$700,"$1,400",20%,$700,"$1,400",50%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,16
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,12,88380,VA,Individual,No,54-1356687,88380VA0890005,Anthem HealthKeepers Silver X POS 2000 20,88380VA089,,VAN002,VAS018,VAF020,Existing,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,5,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GAQ,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890005-06,94% AV Level Silver Plan,93.06%,0.934129476547241,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$600,"$1,200",$600,"$1,200","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$200,$400,20%,$200,$400,50%,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,17
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,13,88380,VA,Individual,No,54-1356687,88380VA0720025,Anthem HealthKeepers Gold X 1000 15,88380VA072,,VAN002,VAS001,VAF017,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GB0,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720025-00,Standard Gold Off Exchange Plan,78.02%,0.786293804645538,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,100","$8,200","$4,100","$8,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",15%,"$1,000","$2,000",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,13,88380,VA,Individual,No,54-1356687,88380VA0720025,Anthem HealthKeepers Gold X 1000 15,88380VA072,,VAN002,VAS001,VAF017,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GB0,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720025-01,Standard Gold On Exchange Plan,78.02%,0.786293804645538,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,100","$8,200","$4,100","$8,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",15%,"$1,000","$2,000",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,13,88380,VA,Individual,No,54-1356687,88380VA0720025,Anthem HealthKeepers Gold X 1000 15,88380VA072,,VAN002,VAS001,VAF017,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GB0,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720025-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,13,88380,VA,Individual,No,54-1356687,88380VA0720025,Anthem HealthKeepers Gold X 1000 15,88380VA072,,VAN002,VAS001,VAF017,Existing,HMO,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,Yes,Emergency/Urgent Care Only,Yes,Emergency/Urgent Care Only,No,http://www.sbc.anthem.com/dps/CCD1GB0,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0720025-03,Limited Cost Sharing Plan Variation,78.02%,0.786293804645538,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,100","$8,200","$4,100","$8,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",15%,"$1,000","$2,000",45%,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,14,88380,VA,Individual,No,54-1356687,88380VA0890003,Anthem HealthKeepers Gold X POS 1000 15,88380VA089,,VAN002,VAS007,VAF023,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GB2,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890003-00,Standard Gold Off Exchange Plan,78.02%,0.786293804645538,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,100","$8,200","$4,100","$8,200","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",15%,"$1,000","$2,000",45%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,14,88380,VA,Individual,No,54-1356687,88380VA0890003,Anthem HealthKeepers Gold X POS 1000 15,88380VA089,,VAN002,VAS007,VAF023,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GB2,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890003-01,Standard Gold On Exchange Plan,78.02%,0.786293804645538,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,100","$8,200","$4,100","$8,200","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",15%,"$1,000","$2,000",45%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,14,88380,VA,Individual,No,54-1356687,88380VA0890003,Anthem HealthKeepers Gold X POS 1000 15,88380VA089,,VAN002,VAS007,VAF023,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GB2,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,14,88380,VA,Individual,No,54-1356687,88380VA0890003,Anthem HealthKeepers Gold X POS 1000 15,88380VA089,,VAN002,VAS007,VAF023,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GB2,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890003-03,Limited Cost Sharing Plan Variation,78.02%,0.786293804645538,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,100","$8,200","$4,100","$8,200","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",15%,"$1,000","$2,000",45%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,14,88380,VA,Individual,No,54-1356687,88380VA0890006,Anthem HealthKeepers Gold X POS 1000 15,88380VA089,,VAN002,VAS018,VAF023,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GB2,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890006-00,Standard Gold Off Exchange Plan,78.02%,0.786293804645538,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,100","$8,200","$4,100","$8,200","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",15%,"$1,000","$2,000",45%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,14,88380,VA,Individual,No,54-1356687,88380VA0890006,Anthem HealthKeepers Gold X POS 1000 15,88380VA089,,VAN002,VAS018,VAF023,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GB2,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890006-01,Standard Gold On Exchange Plan,78.02%,0.786293804645538,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,100","$8,200","$4,100","$8,200","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",15%,"$1,000","$2,000",45%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,2,99663,VA,Individual,No,54-1576305,99663VA0140008,Coventry Bronze $30 Copay Bon Secours,99663VA014,,VAN003,VAS003,VAF002,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51222,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140008-03,Limited Cost Sharing Plan Variation,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,12,99663,VA,Individual,No,54-1576305,99663VA0140042,Coventry Silver $5 Copay 2750 Southside,99663VA014,,VAN005,VAS005,VAF018,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51262,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140042-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,600","$9,200","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$4,500","$9,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,12,99663,VA,Individual,No,54-1576305,99663VA0140042,Coventry Silver $5 Copay 2750 Southside,99663VA014,,VAN005,VAS005,VAF018,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51262,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140042-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,"$1,500","$3,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,13,99663,VA,Individual,No,54-1576305,99663VA0140006,Coventry Gold $0 Copay Bon Secours,99663VA014,,VAN003,VAS003,VAF010,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51227,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140006-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,200","$8,400","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$0,20%,$0,$0,40%,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,13,99663,VA,Individual,No,54-1576305,99663VA0140006,Coventry Gold $0 Copay Bon Secours,99663VA014,,VAN003,VAS003,VAF010,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51227,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140006-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,13,99663,VA,Individual,No,54-1576305,99663VA0140006,Coventry Gold $0 Copay Bon Secours,99663VA014,,VAN003,VAS003,VAF010,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51227,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140006-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,200","$8,400","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$0,20%,$0,$0,40%,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,7,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0450001,Balance Blue PPO 1000,31274WV045,,WVN001,WVS001,WVF006,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0450001-01,Standard Gold On Exchange Plan,,0.781470477581024,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,8,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0450002,Balance Blue PPO 2000,31274WV045,,WVN001,WVS001,WVF006,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0450002-00,Standard Silver Off Exchange Plan,,0.693569660186768,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,4
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,Individual,No,55-0624615,31274WV0330004,Shared Cost Blue PPO 1000,31274WV033,,WVN001,WVS001,WVF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,Individual,No,55-0624615,31274WV0330004,Shared Cost Blue PPO 1000,31274WV033,,WVN001,WVS001,WVF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330004-03,Limited Cost Sharing Plan Variation,,0.79634553194046,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,14,88380,VA,Individual,No,54-1356687,88380VA0890006,Anthem HealthKeepers Gold X POS 1000 15,88380VA089,,VAN002,VAS018,VAF023,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GB2,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890006-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,10
2015,VA,88380,SERFF,21,2015-04-22 14:50:56,14,88380,VA,Individual,No,54-1356687,88380VA0890006,Anthem HealthKeepers Gold X POS 1000 15,88380VA089,,VAN002,VAS018,VAF023,Existing,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,1,,,0,0,0,2015-01-01,,No,TradPar BlueCard w OON cost share,No,TradPar BlueCard w OON cost share,Yes,http://www.sbc.anthem.com/dps/CCD1GB2,https://shop.anthem.com/sales/eox/payment/landing/va,http://file.anthem.com/03268VAMENAHK.pdf,www.anthem.com/VASelectdrugtier4,88380VA0890006-03,Limited Cost Sharing Plan Variation,78.02%,0.786293804645538,Yes,Yes,Yes,70%,30%,,,,,,,,,,,,,,,,,"$4,100","$8,200","$4,100","$8,200","$12,000","$24,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000",15%,"$1,000","$2,000",45%,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,1,95185,VA,Individual,No,52-0954463,95185VA0530001,KP VA Gold 0/20/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF001,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,4,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530001-00,Standard Gold Off Exchange Plan,,0.814433693885803,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,1,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500001,KP VA Platinum 0/20/Dental/Ped Dental/Sig,95185VA050,,VAN001,VAS001,VAF012,Existing,HMO,Platinum,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500001-00,Standard Platinum Off Exchange Plan,,0.903622090816498,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,"$1,500","$3,000",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,1,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500001,KP VA Platinum 0/20/Dental/Ped Dental/Sig,95185VA050,,VAN001,VAS001,VAF012,Existing,HMO,Platinum,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500001-01,Standard Platinum On Exchange Plan,,0.903622090816498,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,"$1,500","$3,000",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,1,95185,VA,Individual,No,52-0954463,95185VA0530001,KP VA Gold 0/20/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF001,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,4,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530001-01,Standard Gold On Exchange Plan,,0.814433693885803,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,1,95185,VA,Individual,No,52-0954463,95185VA0530001,KP VA Gold 0/20/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF001,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,4,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,1,95185,VA,Individual,No,52-0954463,95185VA0530001,KP VA Gold 0/20/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF001,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,4,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530001-03,Limited Cost Sharing Plan Variation,,0.814433693885803,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,2,95185,VA,Individual,No,52-0954463,95185VA0530002,KP VA Gold 1000/20/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF002,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530002-00,Standard Gold Off Exchange Plan,,0.781146109104156,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,2,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500004,KP VA Gold 0/20/Dental/Ped Dental/Sig,95185VA050,,VAN001,VAS001,VAF014,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,3,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500004-00,Standard Gold Off Exchange Plan,,0.816899716854095,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,2,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500004,KP VA Gold 0/20/Dental/Ped Dental/Sig,95185VA050,,VAN001,VAS001,VAF014,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,3,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500004-01,Standard Gold On Exchange Plan,,0.816899716854095,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,2,95185,VA,Individual,No,52-0954463,95185VA0530002,KP VA Gold 1000/20/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF002,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530002-01,Standard Gold On Exchange Plan,,0.781146109104156,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,2,95185,VA,Individual,No,52-0954463,95185VA0530002,KP VA Gold 1000/20/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF002,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,2,95185,VA,Individual,No,52-0954463,95185VA0530002,KP VA Gold 1000/20/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF002,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530002-03,Limited Cost Sharing Plan Variation,,0.781146109104156,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,2,95185,VA,Individual,No,52-0954463,95185VA0530003,KP VA Silver 1500/30/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530003-00,Standard Silver Off Exchange Plan,,0.701608300209045,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,2,95185,VA,Individual,No,52-0954463,95185VA0530003,KP VA Silver 1500/30/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530003-01,Standard Silver On Exchange Plan,,0.701608300209045,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,2,95185,VA,Individual,No,52-0954463,95185VA0530003,KP VA Silver 1500/30/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,2,95185,VA,Individual,No,52-0954463,95185VA0530003,KP VA Silver 1500/30/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530003-03,Limited Cost Sharing Plan Variation,,0.701608300209045,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,2,95185,VA,Individual,No,52-0954463,95185VA0530003,KP VA Silver 1500/30/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530003-04,73% AV Level Silver Plan,,0.731747090816498,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,2,95185,VA,Individual,No,52-0954463,95185VA0530003,KP VA Silver 1500/30/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530003-05,87% AV Level Silver Plan,,0.867990612983704,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,13
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,2,95185,VA,Individual,No,52-0954463,95185VA0530003,KP VA Silver 1500/30/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530003-06,94% AV Level Silver Plan,,0.931547224521637,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,2,95185,VA,Individual,No,52-0954463,95185VA0530004,KP VA Silver 2500/30/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530004-00,Standard Silver Off Exchange Plan,,0.685792088508606,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,2,95185,VA,Individual,No,52-0954463,95185VA0530004,KP VA Silver 2500/30/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530004-01,Standard Silver On Exchange Plan,,0.685792088508606,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,2,95185,VA,Individual,No,52-0954463,95185VA0530004,KP VA Silver 2500/30/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530004-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,17
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,2,95185,VA,Individual,No,52-0954463,95185VA0530004,KP VA Silver 2500/30/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530004-03,Limited Cost Sharing Plan Variation,,0.685792088508606,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$2,500","$5,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,18
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,2,95185,VA,Individual,No,52-0954463,95185VA0530004,KP VA Silver 2500/30/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530004-04,73% AV Level Silver Plan,,0.731747090816498,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$250,$500,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,2,95185,VA,Individual,No,52-0954463,95185VA0530004,KP VA Silver 2500/30/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530004-05,87% AV Level Silver Plan,,0.867990612983704,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,2,95185,VA,Individual,No,52-0954463,95185VA0530004,KP VA Silver 2500/30/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530004-06,94% AV Level Silver Plan,,0.931547224521637,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,21
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,3,95185,VA,Individual,No,52-0954463,95185VA0530005,KP VA Silver 1750/25%/HSA/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530005-00,Standard Silver Off Exchange Plan,,0.689185261726379,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,3,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500002,KP VA Platinum 500/20/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF013,Existing,HMO,Platinum,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500002-00,Standard Platinum Off Exchange Plan,,0.883847415447235,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,"$1,500","$3,000",$500,"$1,000",0%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,3,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500002,KP VA Platinum 500/20/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF013,Existing,HMO,Platinum,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500002-01,Standard Platinum On Exchange Plan,,0.883847415447235,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,Not Applicable,Not Applicable,"$1,500","$3,000",$500,"$1,000",0%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,3,95185,VA,Individual,No,52-0954463,95185VA0530005,KP VA Silver 1750/25%/HSA/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530005-01,Standard Silver On Exchange Plan,,0.689185261726379,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,3,95185,VA,Individual,No,52-0954463,95185VA0530005,KP VA Silver 1750/25%/HSA/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,3,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500005,KP VA Gold 1000/30/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF015,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500005-00,Standard Gold Off Exchange Plan,,0.781351864337921,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,"$3,500","$7,000","$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,"$1,000","$2,000",$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,3,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500005,KP VA Gold 1000/30/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF015,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500005-01,Standard Gold On Exchange Plan,,0.781351864337921,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,Not Applicable,Not Applicable,"$3,500","$7,000","$1,000","$2,000",10%,,,,Not Applicable,Not Applicable,"$1,000","$2,000",$0,$0,10%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,3,95185,VA,Individual,No,52-0954463,95185VA0530005,KP VA Silver 1750/25%/HSA/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530005-03,Limited Cost Sharing Plan Variation,,0.689185261726379,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500",25%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,3,95185,VA,Individual,No,52-0954463,95185VA0530005,KP VA Silver 1750/25%/HSA/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530005-04,73% AV Level Silver Plan,,0.732318162918091,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,8
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,3,95185,VA,Individual,No,52-0954463,95185VA0530005,KP VA Silver 1750/25%/HSA/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530005-05,87% AV Level Silver Plan,,0.873120844364166,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,9
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,3,95185,VA,Individual,No,52-0954463,95185VA0530005,KP VA Silver 1750/25%/HSA/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF003,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530005-06,94% AV Level Silver Plan,,0.940587222576141,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,5%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,10
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,3,95185,VA,Individual,No,52-0954463,95185VA0530007,KP VA Bronze 4500/50/HSA/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF010,Existing,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,4,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530007-00,Standard Bronze Off Exchange Plan,,0.593425035476685,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,11
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,3,95185,VA,Individual,No,52-0954463,95185VA0530007,KP VA Bronze 4500/50/HSA/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF010,Existing,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,4,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530007-01,Standard Bronze On Exchange Plan,,0.593425035476685,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,12
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,3,95185,VA,Individual,No,52-0954463,95185VA0530007,KP VA Bronze 4500/50/HSA/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF010,Existing,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,4,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,13
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,4,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500009,KP VA Silver 2000/35/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF017,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500009-00,Standard Silver Off Exchange Plan,,0.696757197380066,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000","$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$0,$0,100%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,4,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500009,KP VA Silver 2000/35/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF017,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500009-01,Standard Silver On Exchange Plan,,0.696757197380066,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000","$2,000","$4,000",20%,,,,Not Applicable,Not Applicable,"$2,000","$4,000",$0,$0,100%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,4,95185,VA,Individual,No,52-0954463,95185VA0530006,KP VA Bronze 4500/50/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF008,Existing,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530006-03,Limited Cost Sharing Plan Variation,,0.600537419319153,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,500","$9,000",20%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$500,"$1,000",50%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,5,95185,VA,Individual,No,52-0954463,95185VA0530009,KP VA Catastrophic 6600/0/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF009,Existing,HMO,Catastrophic,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,0,3,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530009-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,6,95185,VA,Individual,No,52-0954463,95185VA0530010,KP VA Platinum 0/10/Dental/Ped Dental,95185VA053,,VAN001,VAS001,VAF001,New,HMO,Platinum,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,$0.00,No,,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pain Management",,0.988333672260478,,,4,0,0,2015-01-01,,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvahb,https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/virginia-health-plan-coverage-and-costs.html,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0530010-03,Limited Cost Sharing Plan Variation,,0.899488031864166,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,0%,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,6,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500007,KP VA Gold 1500/30/HSA/HRA/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF017,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,Yes,Yes,$750.00,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500007-00,Standard Gold Off Exchange Plan,,0.794489562511444,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,"$1,500","$3,000",,,,,,,,,8
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,6,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500007,KP VA Gold 1500/30/HSA/HRA/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF017,Existing,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,Yes,Yes,$750.00,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500007-01,Standard Gold On Exchange Plan,,0.794489562511444,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,Not Applicable,Not Applicable,"$1,500","$3,000",,,,,,,,,9
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,7,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500010,KP VA Silver 1500/30/HSA/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF017,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500010-00,Standard Silver Off Exchange Plan,,0.683786988258362,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,"$1,500","$3,000",,,,,,,,,4
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,7,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500010,KP VA Silver 1500/30/HSA/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF017,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500010-01,Standard Silver On Exchange Plan,,0.683786988258362,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,Not Applicable,Not Applicable,"$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,Not Applicable,Not Applicable,"$1,500","$3,000",,,,,,,,,5
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,7,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500011,KP VA Silver 2500/30/HSA/HRA/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF017,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,Yes,Yes,$500.00,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500011-00,Standard Silver Off Exchange Plan,,0.695233464241028,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,6
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,7,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500011,KP VA Silver 2500/30/HSA/HRA/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF017,Existing,HMO,Silver,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,Yes,Yes,$500.00,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500011-01,Standard Silver On Exchange Plan,,0.695233464241028,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",20%,,,,Not Applicable,Not Applicable,"$2,500","$5,000",,,,,,,,,7
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,8,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500013,KP VA Bronze 3500/20%/HSA/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF018,Existing,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500013-00,Standard Bronze Off Exchange Plan,,0.609161138534546,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,"$3,500","$7,000",,,,,,,,,4
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,8,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500013,KP VA Bronze 3500/20%/HSA/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF018,Existing,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500013-01,Standard Bronze On Exchange Plan,,0.609161138534546,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000",20%,,,,Not Applicable,Not Applicable,"$3,500","$7,000",,,,,,,,,5
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,8,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500014,KP VA Bronze 4500/20/HSA/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF018,Existing,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500014-00,Standard Bronze Off Exchange Plan,,0.59254777431488,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,6
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,6,99663,VA,Individual,No,54-1576305,99663VA0140034,Coventry Bronze Deductible Only HSA Southside,99663VA014,,VAN004,VAS004,VAF006,New,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51246,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140034-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,6,99663,VA,Individual,No,54-1576305,99663VA0140034,Coventry Bronze Deductible Only HSA Southside,99663VA014,,VAN004,VAS004,VAF006,New,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51246,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140034-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,2,97927,VA,Individual,Yes,52-2016912,97927VA0030004,DentaQuest Choice PPO  Family High,97927VA003,7700889935,VAN002,VAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$71.26,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Will process only translated claims.,Yes,Emergency Only. In excess of 50 miles from nearest provider.,Yes,http://www.Dentaquest.com/marketplace/va,https://paydirect.dentaquest.com,http://www.Dentaquest.com/marketplace/va,,97927VA0030004-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,1,99663,VA,Individual,No,54-1576305,99663VA0140031,Coventry Bronze $25 Copay,99663VA014,,VAN001,VAS001,VAF001,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51200,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140031-00,Standard Bronze Off Exchange Plan,61.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,2,99663,VA,Individual,No,54-1576305,99663VA0140008,Coventry Bronze $30 Copay Bon Secours,99663VA014,,VAN003,VAS003,VAF002,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51222,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140008-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,14,99663,VA,Individual,No,54-1576305,99663VA0140009,Coventry Gold $0 Copay Southside,99663VA014,,VAN005,VAS005,VAF011,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51249,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140009-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,200","$8,400","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$0,20%,$0,$0,40%,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,2,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0440031,Shared Cost Blue PPO 750,31274WV044,,WVN001,WVS001,WVF006,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0440031-01,Standard Gold On Exchange Plan,,0.813427150249481,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",30%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0420031,Shared Cost Blue PPO 1000,31274WV042,,WVN001,WVS001,WVF006,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0420031-00,Standard Gold Off Exchange Plan,,0.818418741226196,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,7,99663,VA,Individual,No,54-1576305,99663VA0140039,Coventry Silver $10 Copay,99663VA014,,VAN001,VAS001,VAF013,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51212,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140039-00,Standard Silver Off Exchange Plan,68.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,7,99663,VA,Individual,No,54-1576305,99663VA0140039,Coventry Silver $10 Copay,99663VA014,,VAN001,VAS001,VAF013,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51212,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140039-01,Standard Silver On Exchange Plan,68.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,7,99663,VA,Individual,No,54-1576305,99663VA0140039,Coventry Silver $10 Copay,99663VA014,,VAN001,VAS001,VAF013,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51212,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140039-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,7,99663,VA,Individual,No,54-1576305,99663VA0140039,Coventry Silver $10 Copay,99663VA014,,VAN001,VAS001,VAF013,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51212,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140039-03,Limited Cost Sharing Plan Variation,68.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$4,000","$8,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,7,99663,VA,Individual,No,54-1576305,99663VA0140039,Coventry Silver $10 Copay,99663VA014,,VAN001,VAS001,VAF013,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51212,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140039-04,73% AV Level Silver Plan,72.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$500,"$1,000",30%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,7,99663,VA,Individual,No,54-1576305,99663VA0140039,Coventry Silver $10 Copay,99663VA014,,VAN001,VAS001,VAF013,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51212,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140039-05,87% AV Level Silver Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,200","$4,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,"$1,000",10%,,,,$0,"$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,7,99663,VA,Individual,No,54-1576305,99663VA0140039,Coventry Silver $10 Copay,99663VA014,,VAN001,VAS001,VAF013,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51212,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140039-06,94% AV Level Silver Plan,93.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,$0,"$1,000",10%,,,,$0,"$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,8,99663,VA,Individual,No,54-1576305,99663VA0140040,Coventry Silver $10 Copay 2750,99663VA014,,VAN001,VAS001,VAF014,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51219,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140040-00,Standard Silver Off Exchange Plan,68.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,8,99663,VA,Individual,No,54-1576305,99663VA0140040,Coventry Silver $10 Copay 2750,99663VA014,,VAN001,VAS001,VAF014,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51219,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140040-01,Standard Silver On Exchange Plan,68.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,8,99663,VA,Individual,No,54-1576305,99663VA0140040,Coventry Silver $10 Copay 2750,99663VA014,,VAN001,VAS001,VAF014,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51219,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140040-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,8,99663,VA,Individual,No,54-1576305,99663VA0140040,Coventry Silver $10 Copay 2750,99663VA014,,VAN001,VAS001,VAF014,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51219,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140040-03,Limited Cost Sharing Plan Variation,68.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",40%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,8,99663,VA,Individual,No,54-1576305,99663VA0140040,Coventry Silver $10 Copay 2750,99663VA014,,VAN001,VAS001,VAF014,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51219,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140040-04,73% AV Level Silver Plan,72.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,8,99663,VA,Individual,No,54-1576305,99663VA0140040,Coventry Silver $10 Copay 2750,99663VA014,,VAN001,VAS001,VAF014,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51219,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140040-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500",10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,8,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500014,KP VA Bronze 4500/20/HSA/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF018,Existing,HMO,Bronze,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500014-01,Standard Bronze On Exchange Plan,,0.59254777431488,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,Not Applicable,Not Applicable,"$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000",30%,,,,Not Applicable,Not Applicable,"$4,500","$9,000",,,,,,,,,7
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,9,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500015,KP VA GOLD 500/20/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF018,New,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500015-00,Standard Gold Off Exchange Plan,,0.815223574638367,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,"$3,000","$6,000",$500,"$1,000",0%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,VA,95185,SERFF,20,2015-02-18 11:10:32,9,95185,VA,SHOP (Small Group),No,52-0954463,95185VA0500015,KP VA GOLD 500/20/Dental/Ped Dental,95185VA050,,VAN001,VAS001,VAF018,New,HMO,Gold,No,Both,Yes,Yes,"Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,No,No,,Allows Adult and Child-Only,,No,"Asthma, Diabetes, Pain Management",,0.98856740332091,,,0,0,0,2015-01-01,2015-12-31,Yes,Emergency Care Only,Yes,Emergency Care Only,No,http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage,https://www.billerpayments.com/saml/hix/kpvibp,https://businessnet.kaiserpermanente.org/health/plans,https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_hmo_formulary.pdf,95185VA0500015-01,Standard Gold On Exchange Plan,,0.815223574638367,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,Not Applicable,Not Applicable,"$3,000","$6,000",$500,"$1,000",0%,,,,Not Applicable,Not Applicable,$500,"$1,000",$0,$0,0%,,,,Not Applicable,Not Applicable,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,VA,97762,SERFF,9,2014-11-14 14:52:18,1,97762,VA,Individual,Yes,75-1233841,97762VA0010004,Dentegra Dental PPO Family Preferred Plan,97762VA001,,VAN001,VAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.47,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/va/97762va0010004-15,,97762VA0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,97762,SERFF,9,2014-11-14 14:52:18,1,97762,VA,SHOP (Small Group),Yes,75-1233841,97762VA0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,97762VA002,,VAN001,VAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$13.24,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/va/97762va0020001-15,,97762VA0020001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,97762,SERFF,9,2014-11-14 14:52:18,1,97762,VA,SHOP (Small Group),Yes,75-1233841,97762VA0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,97762VA002,,VAN001,VAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$13.24,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/va/97762va0020001-15,,97762VA0020001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,97762,SERFF,9,2014-11-14 14:52:18,1,97762,VA,Individual,Yes,75-1233841,97762VA0010004,Dentegra Dental PPO Family Preferred Plan,97762VA001,,VAN001,VAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.47,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/va/97762va0010004-15,,97762VA0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,97762,SERFF,9,2014-11-14 14:52:18,2,97762,VA,Individual,Yes,75-1233841,97762VA0010006,Dentegra Dental PPO Family Basic Plan,97762VA001,,VAN001,VAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$13.14,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/va/97762va0010006-15,,97762VA0010006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,97762,SERFF,9,2014-11-14 14:52:18,2,97762,VA,SHOP (Small Group),Yes,75-1233841,97762VA0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,97762VA002,,VAN001,VAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$13.24,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/va/97762va0020006-15,,97762VA0020006-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,97762,SERFF,9,2014-11-14 14:52:18,2,97762,VA,SHOP (Small Group),Yes,75-1233841,97762VA0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,97762VA002,,VAN001,VAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$13.24,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/va/97762va0020006-15,,97762VA0020006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,97762,SERFF,9,2014-11-14 14:52:18,2,97762,VA,Individual,Yes,75-1233841,97762VA0010006,Dentegra Dental PPO Family Basic Plan,97762VA001,,VAN001,VAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$13.14,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/va/97762va0010006-15,,97762VA0010006-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,97762,SERFF,9,2014-11-14 14:52:18,3,97762,VA,Individual,Yes,75-1233841,97762VA0010001,Dentegra Dental PPO Pediatric Basic Plan,97762VA001,,VAN001,VAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$13.14,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/va/97762va0010001-15,,97762VA0010001-00,Standard Low Off Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,97762,SERFF,9,2014-11-14 14:52:18,3,97762,VA,SHOP (Small Group),Yes,75-1233841,97762VA0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,97762VA002,,VAN001,VAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.60,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/va/97762va0020004-15,,97762VA0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,97762,SERFF,9,2014-11-14 14:52:18,3,97762,VA,SHOP (Small Group),Yes,75-1233841,97762VA0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,97762VA002,,VAN001,VAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.60,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/va/97762va0020004-15,,97762VA0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,97762,SERFF,9,2014-11-14 14:52:18,3,97762,VA,Individual,Yes,75-1233841,97762VA0010001,Dentegra Dental PPO Pediatric Basic Plan,97762VA001,,VAN001,VAS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$13.14,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/va/97762va0010001-15,,97762VA0010001-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$60,Not Applicable,,,,,$60,Not Applicable,$60,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,1,97927,VA,Individual,Yes,52-2016912,97927VA0010001,DentaQuest EPO Pediatric High,97927VA001,7700889935,VAN001,VAS001,,Existing,EPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$47.91,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.Dentaquest.com/marketplace/va,https://paydirect.dentaquest.com,http://www.Dentaquest.com/marketplace/va,,97927VA0010001-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,1,97927,VA,Individual,Yes,52-2016912,97927VA0010001,DentaQuest EPO Pediatric High,97927VA001,7700889935,VAN001,VAS001,,Existing,EPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$47.91,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.Dentaquest.com/marketplace/va,https://paydirect.dentaquest.com,http://www.Dentaquest.com/marketplace/va,,97927VA0010001-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,1,97927,VA,Individual,Yes,52-2016912,97927VA0010002,DentaQuest EPO Pediatric Low,97927VA001,7700889935,VAN001,VAS001,,Existing,EPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$36.50,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.Dentaquest.com/marketplace/va,https://paydirect.dentaquest.com,http://www.Dentaquest.com/marketplace/va,,97927VA0010002-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,1,97927,VA,Individual,Yes,52-2016912,97927VA0010002,DentaQuest EPO Pediatric Low,97927VA001,7700889935,VAN001,VAS001,,Existing,EPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$36.50,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.Dentaquest.com/marketplace/va,https://paydirect.dentaquest.com,http://www.Dentaquest.com/marketplace/va,,97927VA0010002-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,1,97927,VA,Individual,Yes,52-2016912,97927VA0030001,DentaQuest Choice PPO Pediatric Low,97927VA003,7700889935,VAN002,VAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$55.99,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Will process only translated claims.,Yes,Emergency Only. In excess of 50 miles from nearest provider.,Yes,http://www.Dentaquest.com/marketplace/va,https://paydirect.dentaquest.com,http://www.Dentaquest.com/marketplace/va,,97927VA0030001-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,1,97927,VA,Individual,Yes,52-2016912,97927VA0030001,DentaQuest Choice PPO Pediatric Low,97927VA003,7700889935,VAN002,VAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$55.99,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Will process only translated claims.,Yes,Emergency Only. In excess of 50 miles from nearest provider.,Yes,http://www.Dentaquest.com/marketplace/va,https://paydirect.dentaquest.com,http://www.Dentaquest.com/marketplace/va,,97927VA0030001-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,1,97927,VA,Individual,Yes,52-2016912,97927VA0030002,DentaQuest Choice PPO Pediatric High,97927VA003,7700889935,VAN002,VAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$71.26,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Will process only translated claims.,Yes,Emergency Only. In excess of 50 miles from nearest provider.,Yes,http://www.Dentaquest.com/marketplace/va,https://paydirect.dentaquest.com,http://www.Dentaquest.com/marketplace/va,,97927VA0030002-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,1,97927,VA,Individual,Yes,52-2016912,97927VA0030002,DentaQuest Choice PPO Pediatric High,97927VA003,7700889935,VAN002,VAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$71.26,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Will process only translated claims.,Yes,Emergency Only. In excess of 50 miles from nearest provider.,Yes,http://www.Dentaquest.com/marketplace/va,https://paydirect.dentaquest.com,http://www.Dentaquest.com/marketplace/va,,97927VA0030002-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,2,97927,VA,Individual,Yes,52-2016912,97927VA0010003,DentaQuest EPO Family High,97927VA001,7700889935,VAN001,VAS001,,New,EPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$47.91,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.Dentaquest.com/marketplace/va,https://paydirect.dentaquest.com,http://www.Dentaquest.com/marketplace/va,,97927VA0010003-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,2,97927,VA,SHOP (Small Group),Yes,52-2016912,97927VA0020003,DentaQuest EPO Family High,97927VA002,7700889935,VAN001,VAS001,,Existing,EPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/va/,https://paydirect.dentaquest.com,http://www.dentaquest.com/marketplace/va/,,97927VA0020003-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,2,97927,VA,SHOP (Small Group),Yes,52-2016912,97927VA0020003,DentaQuest EPO Family High,97927VA002,7700889935,VAN001,VAS001,,Existing,EPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$30.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/va/,https://paydirect.dentaquest.com,http://www.dentaquest.com/marketplace/va/,,97927VA0020003-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,2,97927,VA,Individual,Yes,52-2016912,97927VA0010003,DentaQuest EPO Family High,97927VA001,7700889935,VAN001,VAS001,,New,EPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$47.91,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.Dentaquest.com/marketplace/va,https://paydirect.dentaquest.com,http://www.Dentaquest.com/marketplace/va,,97927VA0010003-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,2,97927,VA,Individual,Yes,52-2016912,97927VA0010004,DentaQuest EPO Family Low,97927VA001,7700889935,VAN001,VAS001,,New,EPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.50,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.Dentaquest.com/marketplace/va,https://paydirect.dentaquest.com,http://www.Dentaquest.com/marketplace/va,,97927VA0010004-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,2,97927,VA,SHOP (Small Group),Yes,52-2016912,97927VA0020004,DentaQuest EPO Family Low,97927VA002,7700889935,VAN001,VAS001,,Existing,EPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.27,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/va/,https://paydirect.dentaquest.com,http://www.dentaquest.com/marketplace/va/,,97927VA0020004-00,Standard Low Off Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,2,97927,VA,SHOP (Small Group),Yes,52-2016912,97927VA0020004,DentaQuest EPO Family Low,97927VA002,7700889935,VAN001,VAS001,,Existing,EPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$23.27,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.dentaquest.com/marketplace/va/,https://paydirect.dentaquest.com,http://www.dentaquest.com/marketplace/va/,,97927VA0020004-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,2,97927,VA,Individual,Yes,52-2016912,97927VA0010004,DentaQuest EPO Family Low,97927VA001,7700889935,VAN001,VAS001,,New,EPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$36.50,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Emergency Only. In excess of 50 miles from nearest provider.,No,http://www.Dentaquest.com/marketplace/va,https://paydirect.dentaquest.com,http://www.Dentaquest.com/marketplace/va,,97927VA0010004-01,Standard Low On Exchange Plan,70.30%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,$300,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,2,97927,VA,Individual,Yes,52-2016912,97927VA0030003,DentaQuest Choice PPO  Family Low,97927VA003,7700889935,VAN002,VAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$55.99,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Will process only translated claims.,Yes,Emergency Only. In excess of 50 miles from nearest provider.,Yes,http://www.Dentaquest.com/marketplace/va,https://paydirect.dentaquest.com,http://www.Dentaquest.com/marketplace/va,,97927VA0030003-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,2,97927,VA,SHOP (Small Group),Yes,52-2016912,97927VA0040003,DentaQuest Choice PPO  Family Low,97927VA004,7700889935,VAN002,VAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$37.27,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Will process only translated claims.,Yes,Emergency Only. In excess of 50 miles from nearest provider.,Yes,http://www.dentaquest.com/marketplace/va/,https://paydirect.dentaquest.com,http://www.dentaquest.com/marketplace/va/,,97927VA0040003-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,2,97927,VA,SHOP (Small Group),Yes,52-2016912,97927VA0040003,DentaQuest Choice PPO  Family Low,97927VA004,7700889935,VAN002,VAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$37.27,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Will process only translated claims.,Yes,Emergency Only. In excess of 50 miles from nearest provider.,Yes,http://www.dentaquest.com/marketplace/va/,https://paydirect.dentaquest.com,http://www.dentaquest.com/marketplace/va/,,97927VA0040003-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,2,97927,VA,Individual,Yes,52-2016912,97927VA0030003,DentaQuest Choice PPO  Family Low,97927VA003,7700889935,VAN002,VAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$55.99,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Will process only translated claims.,Yes,Emergency Only. In excess of 50 miles from nearest provider.,Yes,http://www.Dentaquest.com/marketplace/va,https://paydirect.dentaquest.com,http://www.Dentaquest.com/marketplace/va,,97927VA0030003-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,2,97927,VA,Individual,Yes,52-2016912,97927VA0030004,DentaQuest Choice PPO  Family High,97927VA003,7700889935,VAN002,VAS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$71.26,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Will process only translated claims.,Yes,Emergency Only. In excess of 50 miles from nearest provider.,Yes,http://www.Dentaquest.com/marketplace/va,https://paydirect.dentaquest.com,http://www.Dentaquest.com/marketplace/va,,97927VA0030004-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,2,97927,VA,SHOP (Small Group),Yes,52-2016912,97927VA0040004,DentaQuest Choice PPO  Family High,97927VA004,7700889935,VAN002,VAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$48.14,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Will process only translated claims.,Yes,Emergency Only. In excess of 50 miles from nearest provider.,Yes,http://www.dentaquest.com/marketplace/va/,https://paydirect.dentaquest.com,http://www.dentaquest.com/marketplace/va/,,97927VA0040004-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10
2015,VA,97927,SERFF,5,2014-09-11 12:10:19,2,97927,VA,SHOP (Small Group),Yes,52-2016912,97927VA0040004,DentaQuest Choice PPO  Family High,97927VA004,7700889935,VAN002,VAS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$48.14,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Will process only translated claims.,Yes,Emergency Only. In excess of 50 miles from nearest provider.,Yes,http://www.dentaquest.com/marketplace/va/,https://paydirect.dentaquest.com,http://www.dentaquest.com/marketplace/va/,,97927VA0040004-01,Standard High On Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,$150,,,,,$100,$300,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,11
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,1,99663,VA,Individual,No,54-1576305,99663VA0140031,Coventry Bronze $25 Copay,99663VA014,,VAN001,VAS001,VAF001,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51200,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140031-01,Standard Bronze On Exchange Plan,61.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,1,99663,VA,Individual,No,54-1576305,99663VA0140031,Coventry Bronze $25 Copay,99663VA014,,VAN001,VAS001,VAF001,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51200,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140031-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,1,99663,VA,Individual,No,54-1576305,99663VA0140031,Coventry Bronze $25 Copay,99663VA014,,VAN001,VAS001,VAF001,New,POS,Bronze,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51200,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140031-03,Limited Cost Sharing Plan Variation,61.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500",0%,,,,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,2,99663,VA,Individual,No,54-1576305,99663VA0140008,Coventry Bronze $30 Copay Bon Secours,99663VA014,,VAN003,VAS003,VAF002,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51222,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140008-00,Standard Bronze Off Exchange Plan,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,2,99663,VA,Individual,No,54-1576305,99663VA0140008,Coventry Bronze $30 Copay Bon Secours,99663VA014,,VAN003,VAS003,VAF002,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51222,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140008-01,Standard Bronze On Exchange Plan,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,12,99663,VA,Individual,No,54-1576305,99663VA0140042,Coventry Silver $5 Copay 2750 Southside,99663VA014,,VAN005,VAS005,VAF018,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51262,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140042-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,13,99663,VA,Individual,No,54-1576305,99663VA0140006,Coventry Gold $0 Copay Bon Secours,99663VA014,,VAN003,VAS003,VAF010,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51227,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140006-00,Standard Gold Off Exchange Plan,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,200","$8,400","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$0,20%,$0,$0,40%,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,Individual,No,55-0624615,31274WV0330002,Shared Cost Blue PPO 4750,31274WV033,,WVN001,WVS001,WVF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330002-00,Standard Silver Off Exchange Plan,,0.699447989463806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,750","$9,500",20%,,,,"$9,500","$19,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,2,31274,WV,Individual,No,55-0624615,31274WV0330001,Shared Cost Blue PPO 5000,31274WV033,,WVN001,WVS001,WVF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330001-01,Standard Bronze On Exchange Plan,,0.619656085968018,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,2,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0420041,Shared Cost Blue PPO 500,31274WV042,,WVN001,WVS001,WVF006,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0420041-01,Standard Platinum On Exchange Plan,,0.90439760684967,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,4,31274,WV,Individual,No,55-0624615,31274WV0340001,Health Savings Blue PPO 3000,31274WV034,,WVN001,WVS001,WVF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,2015-12-31,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0340001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,3,99663,VA,Individual,No,54-1576305,99663VA0140011,Coventry Bronze $30 Copay Southside,99663VA014,,VAN005,VAS005,VAF003,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51244,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140011-00,Standard Bronze Off Exchange Plan,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,3,99663,VA,Individual,No,54-1576305,99663VA0140011,Coventry Bronze $30 Copay Southside,99663VA014,,VAN005,VAS005,VAF003,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51244,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140011-01,Standard Bronze On Exchange Plan,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,3,99663,VA,Individual,No,54-1576305,99663VA0140011,Coventry Bronze $30 Copay Southside,99663VA014,,VAN005,VAS005,VAF003,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51244,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140011-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,3,99663,VA,Individual,No,54-1576305,99663VA0140011,Coventry Bronze $30 Copay Southside,99663VA014,,VAN005,VAS005,VAF003,Existing,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51244,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140011-03,Limited Cost Sharing Plan Variation,61.50%,,Yes,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",0%,"$6,250","$12,500",0%,"$12,500","$25,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,4,99663,VA,Individual,No,54-1576305,99663VA0140032,Coventry Bronze Deductible Only HSA,99663VA014,,VAN001,VAS001,VAF004,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51202,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140032-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,4,99663,VA,Individual,No,54-1576305,99663VA0140032,Coventry Bronze Deductible Only HSA,99663VA014,,VAN001,VAS001,VAF004,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51202,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140032-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,4,99663,VA,Individual,No,54-1576305,99663VA0140032,Coventry Bronze Deductible Only HSA,99663VA014,,VAN001,VAS001,VAF004,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51202,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140032-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,4,99663,VA,Individual,No,54-1576305,99663VA0140032,Coventry Bronze Deductible Only HSA,99663VA014,,VAN001,VAS001,VAF004,New,POS,Bronze,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51202,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140032-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,5,99663,VA,Individual,No,54-1576305,99663VA0140033,Coventry Bronze Deductible Only HSA Bon Secours,99663VA014,,VAN002,VAS002,VAF005,New,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51224,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140033-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,5,99663,VA,Individual,No,54-1576305,99663VA0140033,Coventry Bronze Deductible Only HSA Bon Secours,99663VA014,,VAN002,VAS002,VAF005,New,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51224,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140033-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,5,99663,VA,Individual,No,54-1576305,99663VA0140033,Coventry Bronze Deductible Only HSA Bon Secours,99663VA014,,VAN002,VAS002,VAF005,New,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51224,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140033-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,5,99663,VA,Individual,No,54-1576305,99663VA0140033,Coventry Bronze Deductible Only HSA Bon Secours,99663VA014,,VAN002,VAS002,VAF005,New,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51224,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140033-03,Limited Cost Sharing Plan Variation,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,6,99663,VA,Individual,No,54-1576305,99663VA0140034,Coventry Bronze Deductible Only HSA Southside,99663VA014,,VAN004,VAS004,VAF006,New,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51246,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140034-00,Standard Bronze Off Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,6,99663,VA,Individual,No,54-1576305,99663VA0140034,Coventry Bronze Deductible Only HSA Southside,99663VA014,,VAN004,VAS004,VAF006,New,POS,Bronze,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51246,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140034-01,Standard Bronze On Exchange Plan,58.40%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600",0%,,,,"$12,600","$25,200",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,8,99663,VA,Individual,No,54-1576305,99663VA0140040,Coventry Silver $10 Copay 2750,99663VA014,,VAN001,VAS001,VAF014,New,POS,Silver,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51219,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140040-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,,,,"$7,500","$15,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,9,99663,VA,Individual,No,54-1576305,99663VA0140007,Coventry Silver $10 Copay Bon Secours,99663VA014,,VAN003,VAS003,VAF015,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51233,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140007-00,Standard Silver Off Exchange Plan,68.20%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,$500,"$1,000",40%,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,9,99663,VA,Individual,No,54-1576305,99663VA0140007,Coventry Silver $10 Copay Bon Secours,99663VA014,,VAN003,VAS003,VAF015,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51233,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140007-01,Standard Silver On Exchange Plan,68.20%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,$500,"$1,000",40%,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,9,99663,VA,Individual,No,54-1576305,99663VA0140007,Coventry Silver $10 Copay Bon Secours,99663VA014,,VAN003,VAS003,VAF015,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51233,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140007-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,WV,17919,SERFF,3,2014-09-02 11:19:24,1,17919,WV,Individual,Yes,47-0397286,17919WV0010001,"Delta Dental Individual PPO, EHB Certified",17919WV001,,WVN002,WVS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$26.79,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,17919WV0010001-00,Standard High Off Exchange Plan,85.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,17919,SERFF,3,2014-09-02 11:19:24,1,17919,WV,SHOP (Small Group),Yes,47-0397286,17919WV0030001,"Renaissance Group Dental PPO, EHB Certified",17919WV003,,WVN001,WVS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$27.31,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,17919WV0030001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,17919,SERFF,3,2014-09-02 11:19:24,1,17919,WV,SHOP (Small Group),Yes,47-0397286,17919WV0030002,"Renaissance Group Dental PPO, EHB Certified",17919WV003,,WVN001,WVS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.26,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,17919WV0030002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,17919,SERFF,3,2014-09-02 11:19:24,1,17919,WV,Individual,Yes,47-0397286,17919WV0010002,"Delta Dental Individual PPO, EHB Certified",17919WV001,,WVN002,WVS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$20.85,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,17919WV0010002-00,Standard Low Off Exchange Plan,70.00%,,,,Yes,25%,75%,$350,$700,$350,$700,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,17919,SERFF,3,2014-09-02 11:19:24,1,17919,WV,Individual,Yes,47-0397286,17919WV0020001,"Renaissance Individual Dental PPO, EHB Certified",17919WV002,,WVN001,WVS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.77,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,17919WV0020001-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WV,17919,SERFF,3,2014-09-02 11:19:24,1,17919,WV,Individual,Yes,47-0397286,17919WV0020002,"Renaissance Individual Dental PPO, EHB Certified",17919WV002,,WVN001,WVS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$23.10,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Emergency Services Only,Yes,Same Benefit Level,Yes,,,,,17919WV0020002-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,1,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0410031,Health Savings Blue PPO 1500,31274WV041,,WVN001,WVS001,WVF008,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0410031-00,Standard Gold Off Exchange Plan,,0.781938672065735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0440033,Shared Cost Blue PPO 1500,31274WV044,,WVN001,WVS001,WVF006,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0440033-00,Standard Gold Off Exchange Plan,,0.7990562915802,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,000","$6,000","$4,500","$9,000",,,,,,,,,8
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,Individual,No,55-0624615,31274WV0330002,Shared Cost Blue PPO 4750,31274WV033,,WVN001,WVS001,WVF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330002-04,73% AV Level Silver Plan,,0.722866296768188,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,000","$8,000",20%,,,,"$9,500","$19,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,Individual,No,55-0624615,31274WV0330002,Shared Cost Blue PPO 4750,31274WV033,,WVN001,WVS001,WVF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330002-05,87% AV Level Silver Plan,,0.87159663438797,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$9,500","$19,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0440033,Shared Cost Blue PPO 1500,31274WV044,,WVN001,WVS001,WVF006,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0440033-01,Standard Gold On Exchange Plan,,0.7990562915802,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",20%,,,,"$3,000","$6,000","$4,500","$9,000",,,,,,,,,9
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,9,99663,VA,Individual,No,54-1576305,99663VA0140007,Coventry Silver $10 Copay Bon Secours,99663VA014,,VAN003,VAS003,VAF015,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51233,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140007-03,Limited Cost Sharing Plan Variation,68.20%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,$500,"$1,000",40%,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,9,99663,VA,Individual,No,54-1576305,99663VA0140007,Coventry Silver $10 Copay Bon Secours,99663VA014,,VAN003,VAS003,VAF015,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51233,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140007-04,73% AV Level Silver Plan,72.20%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$5,050","$10,100","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$5,000","$10,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,$500,"$1,000",40%,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,9,99663,VA,Individual,No,54-1576305,99663VA0140007,Coventry Silver $10 Copay Bon Secours,99663VA014,,VAN003,VAS003,VAF015,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51233,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140007-05,87% AV Level Silver Plan,86.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,"$1,500","$3,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$0,"$1,000",30%,$0,"$1,000",40%,$0,"$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,9,99663,VA,Individual,No,54-1576305,99663VA0140007,Coventry Silver $10 Copay Bon Secours,99663VA014,,VAN003,VAS003,VAF015,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51233,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140007-06,94% AV Level Silver Plan,93.10%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,$0,$0,20%,"$11,500","$23,000",Not Applicable,Not Applicable,$0,"$1,000",10%,$0,"$1,000",20%,$0,"$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,10,99663,VA,Individual,No,54-1576305,99663VA0140010,Coventry Silver $10 Copay Southside,99663VA014,,VAN005,VAS005,VAF016,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51255,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140010-00,Standard Silver Off Exchange Plan,68.20%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,$500,"$1,000",40%,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,10,99663,VA,Individual,No,54-1576305,99663VA0140010,Coventry Silver $10 Copay Southside,99663VA014,,VAN005,VAS005,VAF016,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51255,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140010-01,Standard Silver On Exchange Plan,68.20%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,$500,"$1,000",40%,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,10,99663,VA,Individual,No,54-1576305,99663VA0140010,Coventry Silver $10 Copay Southside,99663VA014,,VAN005,VAS005,VAF016,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51255,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140010-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,10,99663,VA,Individual,No,54-1576305,99663VA0140010,Coventry Silver $10 Copay Southside,99663VA014,,VAN005,VAS005,VAF016,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51255,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140010-03,Limited Cost Sharing Plan Variation,68.20%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$6,600","$13,200","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$6,000","$12,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,$500,"$1,000",40%,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,10,99663,VA,Individual,No,54-1576305,99663VA0140010,Coventry Silver $10 Copay Southside,99663VA014,,VAN005,VAS005,VAF016,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51255,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140010-04,73% AV Level Silver Plan,72.20%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$5,050","$10,100","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$3,750","$7,500",30%,"$5,000","$10,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$500,"$1,000",30%,$500,"$1,000",40%,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,8
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,10,99663,VA,Individual,No,54-1576305,99663VA0140010,Coventry Silver $10 Copay Southside,99663VA014,,VAN005,VAS005,VAF016,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51255,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140010-05,87% AV Level Silver Plan,86.00%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,30%,"$1,500","$3,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,$0,"$1,000",30%,$0,"$1,000",40%,$0,"$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,9
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,10,99663,VA,Individual,No,54-1576305,99663VA0140010,Coventry Silver $10 Copay Southside,99663VA014,,VAN005,VAS005,VAF016,Existing,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51255,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140010-06,94% AV Level Silver Plan,93.10%,,No,Yes,Yes,75%,25%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,$0,$0,10%,$0,$0,20%,"$11,500","$23,000",Not Applicable,Not Applicable,$0,"$1,000",10%,$0,"$1,000",20%,$0,"$2,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,11,99663,VA,Individual,No,54-1576305,99663VA0140041,Coventry Silver $5 Copay 2750 Bon Secours,99663VA014,,VAN003,VAS003,VAF017,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51240,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140041-00,Standard Silver Off Exchange Plan,68.20%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,400","$12,800","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,11,99663,VA,Individual,No,54-1576305,99663VA0140041,Coventry Silver $5 Copay 2750 Bon Secours,99663VA014,,VAN003,VAS003,VAF017,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51240,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140041-01,Standard Silver On Exchange Plan,68.20%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,400","$12,800","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,11,99663,VA,Individual,No,54-1576305,99663VA0140041,Coventry Silver $5 Copay 2750 Bon Secours,99663VA014,,VAN003,VAS003,VAF017,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51240,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140041-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,11,99663,VA,Individual,No,54-1576305,99663VA0140041,Coventry Silver $5 Copay 2750 Bon Secours,99663VA014,,VAN003,VAS003,VAF017,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51240,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140041-03,Limited Cost Sharing Plan Variation,68.20%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,400","$12,800","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,11,99663,VA,Individual,No,54-1576305,99663VA0140041,Coventry Silver $5 Copay 2750 Bon Secours,99663VA014,,VAN003,VAS003,VAF017,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51240,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140041-04,73% AV Level Silver Plan,72.60%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,600","$9,200","$5,200","$10,400",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",30%,"$4,500","$9,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,11,99663,VA,Individual,No,54-1576305,99663VA0140041,Coventry Silver $5 Copay 2750 Bon Secours,99663VA014,,VAN003,VAS003,VAF017,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51240,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140041-05,87% AV Level Silver Plan,86.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,30%,"$1,500","$3,000",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,11,99663,VA,Individual,No,54-1576305,99663VA0140041,Coventry Silver $5 Copay 2750 Bon Secours,99663VA014,,VAN003,VAS003,VAF017,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51240,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140041-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,10%,$0,$0,20%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,12,99663,VA,Individual,No,54-1576305,99663VA0140042,Coventry Silver $5 Copay 2750 Southside,99663VA014,,VAN005,VAS005,VAF018,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51262,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140042-00,Standard Silver Off Exchange Plan,68.20%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,400","$12,800","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,12,99663,VA,Individual,No,54-1576305,99663VA0140042,Coventry Silver $5 Copay 2750 Southside,99663VA014,,VAN005,VAS005,VAF018,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51262,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140042-01,Standard Silver On Exchange Plan,68.20%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,400","$12,800","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,12,99663,VA,Individual,No,54-1576305,99663VA0140042,Coventry Silver $5 Copay 2750 Southside,99663VA014,,VAN005,VAS005,VAF018,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51262,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140042-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,$0,$0,0%,$0,$0,$0,$0,,,,,,,,,6
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,12,99663,VA,Individual,No,54-1576305,99663VA0140042,Coventry Silver $5 Copay 2750 Southside,99663VA014,,VAN005,VAS005,VAF018,New,POS,Silver,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51262,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140042-03,Limited Cost Sharing Plan Variation,68.20%,,Yes,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$6,400","$12,800","$6,600","$13,200",Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500",30%,"$5,750","$11,500",40%,"$11,500","$23,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,4,31274,WV,Individual,No,55-0624615,31274WV0340002,Health Savings Blue PPO 2500,31274WV034,,WVN001,WVS001,WVF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,2015-12-31,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0340002-01,Standard Silver On Exchange Plan,70.00%,0.716210186481476,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,4,31274,WV,Individual,No,55-0624615,31274WV0340002,Health Savings Blue PPO 2500,31274WV034,,WVN001,WVS001,WVF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,2015-12-31,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0340002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,10
2015,WV,96480,SERFF,3,2014-09-02 11:19:24,2,96480,WV,SHOP (Small Group),Yes,13-5123390,96480WV0070002,Guardian Family Advantage,96480WV007,,WVN001,WVS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.89,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,96480WV0070002-01,Standard High On Exchange Plan,83.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,96480,SERFF,3,2014-09-02 11:19:24,2,96480,WV,SHOP (Small Group),Yes,13-5123390,96480WV0090002,Guardian Family Essentials,96480WV009,,WVN001,WVS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,96480WV0090002-00,Standard Low Off Exchange Plan,69.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WV,96480,SERFF,3,2014-09-02 11:19:24,2,96480,WV,SHOP (Small Group),Yes,13-5123390,96480WV0090002,Guardian Family Essentials,96480WV009,,WVN001,WVS001,,New,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,96480WV0090002-01,Standard Low On Exchange Plan,69.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,14,99663,VA,Individual,No,54-1576305,99663VA0140009,Coventry Gold $0 Copay Southside,99663VA014,,VAN005,VAS005,VAF011,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51249,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140009-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,200","$8,400","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$0,20%,$0,$0,40%,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,14,99663,VA,Individual,No,54-1576305,99663VA0140009,Coventry Gold $0 Copay Southside,99663VA014,,VAN005,VAS005,VAF011,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51249,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140009-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,$0,$0,$0,$0,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,$0,$0,0%,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,14,99663,VA,Individual,No,54-1576305,99663VA0140009,Coventry Gold $0 Copay Southside,99663VA014,,VAN005,VAS005,VAF011,Existing,POS,Gold,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51249,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140009-03,Limited Cost Sharing Plan Variation,78.00%,,No,Yes,Yes,80%,20%,,,,,,,,,,,,,,,,,"$4,200","$8,400","$6,000","$12,000",Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,250","$2,500",20%,"$3,500","$7,000",40%,"$6,750","$13,500",Not Applicable,Not Applicable,$0,$0,20%,$0,$0,40%,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,15,99663,VA,Individual,No,54-1576305,99663VA0140038,Coventry Gold $5 Copay,99663VA014,,VAN001,VAS001,VAF012,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51205,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140038-00,Standard Gold Off Exchange Plan,78.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,$500,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,15,99663,VA,Individual,No,54-1576305,99663VA0140038,Coventry Gold $5 Copay,99663VA014,,VAN001,VAS001,VAF012,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51205,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140038-01,Standard Gold On Exchange Plan,78.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,$500,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,15,99663,VA,Individual,No,54-1576305,99663VA0140038,Coventry Gold $5 Copay,99663VA014,,VAN001,VAS001,VAF012,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51205,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140038-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,6
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,15,99663,VA,Individual,No,54-1576305,99663VA0140038,Coventry Gold $5 Copay,99663VA014,,VAN001,VAS001,VAF012,New,POS,Gold,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51205,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140038-03,Limited Cost Sharing Plan Variation,78.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,650","$11,300",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,"$1,400","$2,800",20%,,,,"$6,750","$13,500",Not Applicable,Not Applicable,$250,$500,20%,,,,$500,"$1,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,16,99663,VA,Individual,No,54-1576305,99663VA0140035,Coventry Catastrophic 100% Bon Secours,99663VA014,,VAN002,VAS002,VAF007,New,POS,Catastrophic,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51226,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140035-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,16,99663,VA,Individual,No,54-1576305,99663VA0140035,Coventry Catastrophic 100% Bon Secours,99663VA014,,VAN002,VAS002,VAF007,New,POS,Catastrophic,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51226,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSBonSecoursVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140035-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,17,99663,VA,Individual,No,54-1576305,99663VA0140036,Coventry Catastrophic 100% Southside,99663VA014,,VAN004,VAS004,VAF008,New,POS,Catastrophic,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51248,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140036-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,17,99663,VA,Individual,No,54-1576305,99663VA0140036,Coventry Catastrophic 100% Southside,99663VA014,,VAN004,VAS004,VAF008,New,POS,Catastrophic,Yes,Both,No,Yes,"This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51248,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSSouthsideVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140036-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,18,99663,VA,Individual,No,54-1576305,99663VA0140037,Coventry Catastrophic Plan 100%,99663VA014,,VAN001,VAS001,VAF009,New,POS,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51204,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140037-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,VA,99663,SERFF,7,2014-11-14 14:52:18,18,99663,VA,Individual,No,54-1576305,99663VA0140037,Coventry Catastrophic Plan 100%,99663VA014,,VAN001,VAS001,VAF009,New,POS,Catastrophic,Yes,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Heart Disease, Diabetes",,1,,,0,0,0,2015-01-01,,No,,Yes,Covered With Limitations.,No,http://coventryone.com/VA51204,https://ssoprod.healthplan.com/sp/ACS.saml2,http://www.coventryone.com/POSVA2015,http://client.formularynavigator.com/Search.aspx?siteCode=5312228803,99663VA0140037-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,500","$27,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,1,31274,WV,Individual,No,55-0624615,31274WV0320001,Major Events Blue PPO 6600,31274WV032,,WVN001,WVS001,WVF001,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,3,3,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0320001-00,Standard Catastrophic Off Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,4
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,1,31274,WV,Individual,No,55-0624615,31274WV0320001,Major Events Blue PPO 6600,31274WV032,,WVN001,WVS001,WVF001,Existing,PPO,Catastrophic,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,3,3,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0320001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$6,600","$13,200",0%,,,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,5
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,1,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0410031,Health Savings Blue PPO 1500,31274WV041,,WVN001,WVS001,WVF008,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0410031-01,Standard Gold On Exchange Plan,,0.781938672065735,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,1,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0410011,Health Savings Blue PPO 4000,31274WV041,,WVN001,WVS001,WVF007,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0410011-00,Standard Bronze Off Exchange Plan,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,1,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0410011,Health Savings Blue PPO 4000,31274WV041,,WVN001,WVS001,WVF007,Existing,PPO,Bronze,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0410011-01,Standard Bronze On Exchange Plan,,0.615120470523834,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000",20%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,1,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0430021,Health Savings Blue PPO 2000,31274WV043,,WVN001,WVS001,WVF007,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0430021-00,Standard Silver Off Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,1,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0430021,Health Savings Blue PPO 2000,31274WV043,,WVN001,WVS001,WVF007,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0430021-01,Standard Silver On Exchange Plan,,0.71393358707428,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,9
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,1,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0430012,Health Savings Blue PPO 5000,31274WV043,,WVN001,WVS001,WVF007,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0430012-00,Standard Bronze Off Exchange Plan,,0.593480467796326,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,10
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,1,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0430012,Health Savings Blue PPO 5000,31274WV043,,WVN001,WVS001,WVF007,New,PPO,Bronze,No,Both,No,No,,,,Yes,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0430012-01,Standard Bronze On Exchange Plan,,0.593480467796326,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",20%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,2,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0420041,Shared Cost Blue PPO 500,31274WV042,,WVN001,WVS001,WVF006,Existing,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0420041-00,Standard Platinum Off Exchange Plan,,0.90439760684967,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,2,31274,WV,Individual,No,55-0624615,31274WV0330001,Shared Cost Blue PPO 5000,31274WV033,,WVN001,WVS001,WVF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330001-00,Standard Bronze Off Exchange Plan,,0.619656085968018,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,2,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0440031,Shared Cost Blue PPO 750,31274WV044,,WVN001,WVS001,WVF006,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0440031-00,Standard Gold Off Exchange Plan,,0.813427150249481,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$750,"$1,500",30%,,,,"$1,500","$3,000",Not Applicable,Not Applicable,,,,,,,,,6
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,2,31274,WV,Individual,No,55-0624615,31274WV0330001,Shared Cost Blue PPO 5000,31274WV033,,WVN001,WVS001,WVF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,2,31274,WV,Individual,No,55-0624615,31274WV0330001,Shared Cost Blue PPO 5000,31274WV033,,WVN001,WVS001,WVF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330001-03,Limited Cost Sharing Plan Variation,,0.619656085968018,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000",40%,,,,"$10,000","$20,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,Individual,No,55-0624615,31274WV0330002,Shared Cost Blue PPO 4750,31274WV033,,WVN001,WVS001,WVF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330002-01,Standard Silver On Exchange Plan,,0.699447989463806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,750","$9,500",20%,,,,"$9,500","$19,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,5
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0420031,Shared Cost Blue PPO 1000,31274WV042,,WVN001,WVS001,WVF006,Existing,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0420031-01,Standard Gold On Exchange Plan,,0.818418741226196,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000","$3,000","$6,000",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0440041,Shared Cost Blue PPO 100,31274WV044,,WVN001,WVS001,WVF006,New,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0440041-00,Standard Platinum Off Exchange Plan,,0.916011869907379,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,20%,,,,$200,$400,$300,$600,,,,,,,,,6
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,Individual,No,55-0624615,31274WV0330002,Shared Cost Blue PPO 4750,31274WV033,,WVN001,WVS001,WVF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,Individual,No,55-0624615,31274WV0330002,Shared Cost Blue PPO 4750,31274WV033,,WVN001,WVS001,WVF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330002-03,Limited Cost Sharing Plan Variation,,0.699447989463806,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,750","$9,500",20%,,,,"$9,500","$19,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,7
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0440041,Shared Cost Blue PPO 100,31274WV044,,WVN001,WVS001,WVF006,New,PPO,Platinum,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0440041-01,Standard Platinum On Exchange Plan,,0.916011869907379,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,20%,,,,$200,$400,$300,$600,,,,,,,,,7
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,Individual,No,55-0624615,31274WV0330002,Shared Cost Blue PPO 4750,31274WV033,,WVN001,WVS001,WVF004,Existing,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330002-06,94% AV Level Silver Plan,,0.938876569271088,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,$100,$200,10%,,,,"$9,500","$19,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,10
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,Individual,No,55-0624615,31274WV0330003,Shared Cost Blue PPO 500,31274WV033,,WVN001,WVS001,WVF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330003-00,Standard Gold Off Exchange Plan,,0.789091169834137,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,11
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,Individual,No,55-0624615,31274WV0330003,Shared Cost Blue PPO 500,31274WV033,,WVN001,WVS001,WVF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330003-01,Standard Gold On Exchange Plan,,0.789091169834137,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,12
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,Individual,No,55-0624615,31274WV0330003,Shared Cost Blue PPO 500,31274WV033,,WVN001,WVS001,WVF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330003-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,13
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,Individual,No,55-0624615,31274WV0330003,Shared Cost Blue PPO 500,31274WV033,,WVN001,WVS001,WVF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330003-03,Limited Cost Sharing Plan Variation,,0.789091169834137,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000",Not Applicable,Not Applicable,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,14
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,Individual,No,55-0624615,31274WV0330004,Shared Cost Blue PPO 1000,31274WV033,,WVN001,WVS001,WVF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330004-00,Standard Gold Off Exchange Plan,,0.79634553194046,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,15
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,Individual,No,55-0624615,31274WV0330004,Shared Cost Blue PPO 1000,31274WV033,,WVN001,WVS001,WVF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330004-01,Standard Gold On Exchange Plan,,0.79634553194046,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,16
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,Individual,No,55-0624615,31274WV0330005,Shared Cost Blue PPO 1500,31274WV033,,WVN001,WVS001,WVF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330005-00,Standard Gold Off Exchange Plan,,0.78404176235199,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,19
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,Individual,No,55-0624615,31274WV0330005,Shared Cost Blue PPO 1500,31274WV033,,WVN001,WVS001,WVF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330005-01,Standard Gold On Exchange Plan,,0.78404176235199,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,20
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,Individual,No,55-0624615,31274WV0330005,Shared Cost Blue PPO 1500,31274WV033,,WVN001,WVS001,WVF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330005-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,21
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,3,31274,WV,Individual,No,55-0624615,31274WV0330005,Shared Cost Blue PPO 1500,31274WV033,,WVN001,WVS001,WVF004,Existing,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330005-03,Limited Cost Sharing Plan Variation,,0.78404176235199,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,22
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,4,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0420021,Shared Cost Blue PPO 1750,31274WV042,,WVN001,WVS001,WVF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0420021-00,Standard Silver Off Exchange Plan,,0.716942489147186,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,"$3,500","$7,000","$5,250","$10,500",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,4,31274,WV,Individual,No,55-0624615,31274WV0340001,Health Savings Blue PPO 3000,31274WV034,,WVN001,WVS001,WVF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,2015-12-31,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0340001-00,Standard Bronze Off Exchange Plan,,0.617272973060608,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,4,31274,WV,Individual,No,55-0624615,31274WV0340001,Health Savings Blue PPO 3000,31274WV034,,WVN001,WVS001,WVF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,2015-12-31,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0340001-01,Standard Bronze On Exchange Plan,,0.617272973060608,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,4,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0420021,Shared Cost Blue PPO 1750,31274WV042,,WVN001,WVS001,WVF006,Existing,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0420021-01,Standard Silver On Exchange Plan,,0.716942489147186,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,750","$3,500",30%,,,,"$3,500","$7,000","$5,250","$10,500",$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,4,31274,WV,Individual,No,55-0624615,31274WV0340001,Health Savings Blue PPO 3000,31274WV034,,WVN001,WVS001,WVF002,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,2015-12-31,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0340001-03,Limited Cost Sharing Plan Variation,,0.617272973060608,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",40%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,4,31274,WV,Individual,No,55-0624615,31274WV0340002,Health Savings Blue PPO 2500,31274WV034,,WVN001,WVS001,WVF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,2015-12-31,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0340002-00,Standard Silver Off Exchange Plan,70.00%,0.716210186481476,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,8
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,4,31274,WV,Individual,No,55-0624615,31274WV0340002,Health Savings Blue PPO 2500,31274WV034,,WVN001,WVS001,WVF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,2015-12-31,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0340002-03,Limited Cost Sharing Plan Variation,70.00%,0.716210186481476,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,11
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,4,31274,WV,Individual,No,55-0624615,31274WV0340002,Health Savings Blue PPO 2500,31274WV034,,WVN001,WVS001,WVF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,2015-12-31,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0340002-04,73% AV Level Silver Plan,73.00%,0.736075758934021,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,12
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,4,31274,WV,Individual,No,55-0624615,31274WV0340002,Health Savings Blue PPO 2500,31274WV034,,WVN001,WVS001,WVF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,2015-12-31,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0340002-05,87% AV Level Silver Plan,87.00%,0.874960958957672,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,13
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,4,31274,WV,Individual,No,55-0624615,31274WV0340002,Health Savings Blue PPO 2500,31274WV034,,WVN001,WVS001,WVF005,Existing,PPO,Silver,Yes,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,2015-12-31,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0340002-06,94% AV Level Silver Plan,94.00%,0.941233038902283,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$750,"$1,500",,,"$7,000","$14,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$100,$200,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,,,,,,,,,14
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,4,31274,WV,Individual,No,55-0624615,31274WV0340003,Health Savings Blue PPO 1300,31274WV034,,WVN001,WVS001,WVF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,2015-12-31,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0340003-00,Standard Gold Off Exchange Plan,,0.806593358516693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,300","$4,600",,,"$4,600","$9,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,,,,,,,,,15
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,4,31274,WV,Individual,No,55-0624615,31274WV0340003,Health Savings Blue PPO 1300,31274WV034,,WVN001,WVS001,WVF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,2015-12-31,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0340003-01,Standard Gold On Exchange Plan,,0.806593358516693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,300","$4,600",,,"$4,600","$9,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,,,,,,,,,16
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,4,31274,WV,Individual,No,55-0624615,31274WV0340003,Health Savings Blue PPO 1300,31274WV034,,WVN001,WVS001,WVF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,2015-12-31,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0340003-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,17
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,4,31274,WV,Individual,No,55-0624615,31274WV0340003,Health Savings Blue PPO 1300,31274WV034,,WVN001,WVS001,WVF005,Existing,PPO,Gold,No,Both,No,No,,,$0.00,Yes,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,2015-12-31,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0340003-03,Limited Cost Sharing Plan Variation,,0.806593358516693,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,300","$4,600",,,"$4,600","$9,200",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600",10%,,,,"$2,600","$5,200",Not Applicable,Not Applicable,,,,,,,,,18
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,5,31274,WV,Individual,No,55-0624615,31274WV0350002,Comprehensive Care Blue PPO 1500,31274WV035,,WVN001,WVS001,WVF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0350002-00,Standard Silver Off Exchange Plan,,0.692541062831879,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,WV,52120,SERFF,3,2014-09-04 06:14:21,1,52120,WV,SHOP (Small Group),Yes,35-0472300,52120WV0010001,Lincoln DentalConnect?,52120WV001,,WVN001,WVS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$28.98,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,52120WV0010001-00,Standard High Off Exchange Plan,84.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,52120,SERFF,3,2014-09-04 06:14:21,1,52120,WV,SHOP (Small Group),Yes,35-0472300,52120WV0010002,Lincoln DentalConnect?,52120WV001,,WVN001,WVS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$22.27,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,52120WV0010002-00,Standard Low Off Exchange Plan,69.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,52120,SERFF,3,2014-09-04 06:14:21,1,52120,WV,SHOP (Small Group),Yes,35-0472300,52120WV0010003,Lincoln DentalConnect?,52120WV001,,WVN001,WVS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$18.45,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,52120WV0010003-00,Standard Low Off Exchange Plan,69.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WV,52120,SERFF,3,2014-09-04 06:14:21,1,52120,WV,SHOP (Small Group),Yes,35-0472300,52120WV0010005,Lincoln DentalConnect?,52120WV001,,WVN001,WVS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.03,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,52120WV0010005-00,Standard High Off Exchange Plan,84.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$25,Not Applicable,,,,,$25,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WV,52120,SERFF,3,2014-09-04 06:14:21,1,52120,WV,SHOP (Small Group),Yes,35-0472300,52120WV0010006,Lincoln DentalConnect?,52120WV001,,WVN001,WVS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$19.27,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,52120WV0010006-00,Standard Low Off Exchange Plan,69.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8
2015,WV,52120,SERFF,3,2014-09-04 06:14:21,1,52120,WV,SHOP (Small Group),Yes,35-0472300,52120WV0010007,Lincoln DentalConnect?,52120WV001,,WVN001,WVS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.53,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,52120WV0010007-00,Standard Low Off Exchange Plan,69.40%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9
2015,WV,52120,SERFF,3,2014-09-04 06:14:21,2,52120,WV,SHOP (Small Group),Yes,35-0472300,52120WV0010004,Lincoln DentalConnect?,52120WV001,,WVN001,WVS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$25.17,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,52120WV0010004-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,52120,SERFF,3,2014-09-04 06:14:21,2,52120,WV,SHOP (Small Group),Yes,35-0472300,52120WV0010008,Lincoln DentalConnect?,52120WV001,,WVN001,WVS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$29.15,,Estimated Rate,,0,0,0,2015-01-01,,No,,No,,Yes,,,,,52120WV0010008-00,Standard High Off Exchange Plan,86.20%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,53843,SERFF,5,2014-11-15 10:06:04,1,53843,WV,SHOP (Small Group),Yes,75-1233841,53843WV0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,53843WV002,,WVN001,WVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.55,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/wv/53843wv0020001-15,,53843WV0020001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,53843,SERFF,5,2014-11-15 10:06:04,1,53843,WV,Individual,Yes,75-1233841,53843WV0010001,Dentegra Dental PPO Pediatric Basic Plan,53843WV001,,WVN001,WVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$12.70,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/wv/53843wv0010001-15,,53843WV0010001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,53843,SERFF,5,2014-11-15 10:06:04,1,53843,WV,Individual,Yes,75-1233841,53843WV0010001,Dentegra Dental PPO Pediatric Basic Plan,53843WV001,,WVN001,WVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$12.70,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/wv/53843wv0010001-15,,53843WV0010001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,53843,SERFF,5,2014-11-15 10:06:04,1,53843,WV,SHOP (Small Group),Yes,75-1233841,53843WV0020001,Dentegra Dental PPO for Small Businesses Pediatric Basic Plan,53843WV002,,WVN001,WVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.55,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/wv/53843wv0020001-15,,53843WV0020001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,53843,SERFF,5,2014-11-15 10:06:04,2,53843,WV,SHOP (Small Group),Yes,75-1233841,53843WV0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,53843WV002,,WVN001,WVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.02,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/wv/53843wv0020004-15,,53843WV0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,53843,SERFF,5,2014-11-15 10:06:04,2,53843,WV,Individual,Yes,75-1233841,53843WV0010004,Dentegra Dental PPO Family Preferred Plan,53843WV001,,WVN001,WVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$15.88,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/wv/53843wv0010004-15,,53843WV0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,53843,SERFF,5,2014-11-15 10:06:04,2,53843,WV,Individual,Yes,75-1233841,53843WV0010004,Dentegra Dental PPO Family Preferred Plan,53843WV001,,WVN001,WVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$15.88,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/wv/53843wv0010004-15,,53843WV0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,53843,SERFF,5,2014-11-15 10:06:04,2,53843,WV,SHOP (Small Group),Yes,75-1233841,53843WV0020004,Dentegra Dental PPO for Small Businesses Family Preferred Plan,53843WV002,,WVN001,WVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$22.02,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/wv/53843wv0020004-15,,53843WV0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$55,Not Applicable,,,,,$55,Not Applicable,$55,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,53843,SERFF,5,2014-11-15 10:06:04,3,53843,WV,SHOP (Small Group),Yes,75-1233841,53843WV0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,53843WV002,,WVN001,WVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.55,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/wv/53843wv0020006-15,,53843WV0020006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,53843,SERFF,5,2014-11-15 10:06:04,3,53843,WV,Individual,Yes,75-1233841,53843WV0010006,Dentegra Dental PPO Family Basic Plan,53843WV001,,WVN001,WVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$12.70,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/wv/53843wv0010006-15,,53843WV0010006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,53843,SERFF,5,2014-11-15 10:06:04,3,53843,WV,Individual,Yes,75-1233841,53843WV0010006,Dentegra Dental PPO Family Basic Plan,53843WV001,,WVN001,WVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$12.70,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.dentegra.com/hx/checkout,dentegra.com/hcx/wv/53843wv0010006-15,,53843WV0010006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,53843,SERFF,5,2014-11-15 10:06:04,3,53843,WV,SHOP (Small Group),Yes,75-1233841,53843WV0020006,Dentegra Dental PPO for Small Businesses Family Basic Plan,53843WV002,,WVN001,WVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$17.55,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,dentegra.com/hcx/wv/53843wv0020006-15,,53843WV0020006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,$50,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,55565,SERFF,1,2014-08-11 09:11:26,1,55565,WV,SHOP (Small Group),Yes,36-0883760,55565WV0040002,EHB High PPO,55565WV004,,WVN001,WVS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.19,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,55565WV0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,5,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0440022,Shared Cost Blue PPO 2000,31274WV044,,WVN001,WVS001,WVF006,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0440022-00,Standard Silver Off Exchange Plan,,0.705971419811249,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,5,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0440022,Shared Cost Blue PPO 2000,31274WV044,,WVN001,WVS001,WVF006,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0440022-01,Standard Silver On Exchange Plan,,0.705971419811249,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",30%,,,,"$4,000","$8,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,5,31274,WV,Individual,No,55-0624615,31274WV0350002,Comprehensive Care Blue PPO 1500,31274WV035,,WVN001,WVS001,WVF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0350002-01,Standard Silver On Exchange Plan,,0.692541062831879,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,5,31274,WV,Individual,No,55-0624615,31274WV0350002,Comprehensive Care Blue PPO 1500,31274WV035,,WVN001,WVS001,WVF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0350002-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,5,31274,WV,Individual,No,55-0624615,31274WV0350002,Comprehensive Care Blue PPO 1500,31274WV035,,WVN001,WVS001,WVF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0350002-03,Limited Cost Sharing Plan Variation,,0.692541062831879,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,5,31274,WV,Individual,No,55-0624615,31274WV0350002,Comprehensive Care Blue PPO 1500,31274WV035,,WVN001,WVS001,WVF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0350002-04,73% AV Level Silver Plan,,0.735553801059723,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$1,500","$3,000",20%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,5,31274,WV,Individual,No,55-0624615,31274WV0350002,Comprehensive Care Blue PPO 1500,31274WV035,,WVN001,WVS001,WVF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0350002-05,87% AV Level Silver Plan,,0.878804564476013,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,$500,"$1,000",10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,5,31274,WV,Individual,No,55-0624615,31274WV0350002,Comprehensive Care Blue PPO 1500,31274WV035,,WVN001,WVS001,WVF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0350002-06,94% AV Level Silver Plan,,0.940599381923676,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$12,700","$25,400",Not Applicable,Not Applicable,$100,$200,10%,,,,"$3,000","$6,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,6,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0440051,Shared Cost Blue PPO 3000,31274WV044,,WVN001,WVS001,WVF006,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0440051-00,Standard Silver Off Exchange Plan,,0.71344518661499,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",80%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,6,31274,WV,Individual,No,55-0624615,31274WV0350001,Comprehensive Care Blue PPO 4000,31274WV035,,WVN001,WVS001,WVF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0350001-00,Standard Bronze Off Exchange Plan,,0.619934737682343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,000","$8,000",50%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$250,$500,50%,,,,$0,$0,$250,$500,,,,,,,,,,,,,,,,,,,4
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,6,31274,WV,Individual,No,55-0624615,31274WV0350001,Comprehensive Care Blue PPO 4000,31274WV035,,WVN001,WVS001,WVF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0350001-01,Standard Bronze On Exchange Plan,,0.619934737682343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,000","$8,000",50%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$250,$500,50%,,,,$0,$0,$250,$500,,,,,,,,,,,,,,,,,,,5
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,6,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0440051,Shared Cost Blue PPO 3000,31274WV044,,WVN001,WVS001,WVF006,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0440051-01,Standard Silver On Exchange Plan,,0.71344518661499,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000",80%,,,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,6,31274,WV,Individual,No,55-0624615,31274WV0350001,Comprehensive Care Blue PPO 4000,31274WV035,,WVN001,WVS001,WVF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0350001-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,6,31274,WV,Individual,No,55-0624615,31274WV0350001,Comprehensive Care Blue PPO 4000,31274WV035,,WVN001,WVS001,WVF003,Existing,PPO,Bronze,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0350001-03,Limited Cost Sharing Plan Variation,,0.619934737682343,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400",Not Applicable,Not Applicable,"$4,000","$8,000",50%,,,,"$8,000","$16,000",Not Applicable,Not Applicable,$250,$500,50%,,,,$0,$0,$250,$500,,,,,,,,,,,,,,,,,,,7
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,7,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0450001,Balance Blue PPO 1000,31274WV045,,WVN001,WVS001,WVF006,New,PPO,Gold,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0450001-00,Standard Gold Off Exchange Plan,,0.781470477581024,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000",Not Applicable,Not Applicable,"$1,000","$2,000",20%,,,,"$2,000","$4,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,4
2015,WV,96480,SERFF,3,2014-09-02 11:19:24,1,96480,WV,SHOP (Small Group),Yes,13-5123390,96480WV0100002,Guardian Pediatric Advantage,96480WV010,,WVN001,WVS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$21.89,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,96480WV0100002-00,Standard High Off Exchange Plan,83.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,96480,SERFF,3,2014-09-02 11:19:24,1,96480,WV,SHOP (Small Group),Yes,13-5123390,96480WV0110002,Guardian Pediatric Essentials,96480WV011,,WVN001,WVS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$16.55,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,96480WV0110002-00,Standard Low Off Exchange Plan,69.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$150,Not Applicable,,,,,$150,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,96480,SERFF,3,2014-09-02 11:19:24,2,96480,WV,SHOP (Small Group),Yes,13-5123390,96480WV0070002,Guardian Family Advantage,96480WV007,,WVN001,WVS001,,New,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$21.89,,Guaranteed Rate,,0,0,0,2015-01-01,,No,,Yes,Coverage is available outside of the service area.,Yes,http://www.guardianlife.com/small-business-exchanges/,,http://www.guardianlife.com/small-business-exchanges/,,96480WV0070002-00,Standard High Off Exchange Plan,83.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$50,Not Applicable,,,,,$50,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,8,31274,WV,Individual,No,55-0624615,31274WV0330006,Shared Cost Blue PPO 2500,31274WV033,,WVN001,WVS001,WVF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.  .",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330006-00,Standard Silver Off Exchange Plan,,0.718074500560761,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,4
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,8,31274,WV,Individual,No,55-0624615,31274WV0330006,Shared Cost Blue PPO 2500,31274WV033,,WVN001,WVS001,WVF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.  .",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330006-01,Standard Silver On Exchange Plan,,0.718074500560761,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,5
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,8,31274,WV,SHOP (Small Group),No,55-0624615,31274WV0450002,Balance Blue PPO 2000,31274WV045,,WVN001,WVS001,WVF006,New,PPO,Silver,No,Both,No,No,,,,No,No,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9981,,,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://www.discoverhighmark.com/,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0450002-01,Standard Silver On Exchange Plan,,0.693569660186768,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000",20%,,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,5
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,8,31274,WV,Individual,No,55-0624615,31274WV0330006,Shared Cost Blue PPO 2500,31274WV033,,WVN001,WVS001,WVF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.  .",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,6
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,8,31274,WV,Individual,No,55-0624615,31274WV0330006,Shared Cost Blue PPO 2500,31274WV033,,WVN001,WVS001,WVF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.  .",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330006-03,Limited Cost Sharing Plan Variation,,0.718074500560761,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,600","$13,200",,,"$13,200","$26,400",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,7
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,8,31274,WV,Individual,No,55-0624615,31274WV0330006,Shared Cost Blue PPO 2500,31274WV033,,WVN001,WVS001,WVF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.  .",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330006-04,73% AV Level Silver Plan,,0.738287389278412,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,"$13,200","$26,400",Not Applicable,Not Applicable,"$2,500","$5,000",20%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,8
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,8,31274,WV,Individual,No,55-0624615,31274WV0330006,Shared Cost Blue PPO 2500,31274WV033,,WVN001,WVS001,WVF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.  .",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330006-05,87% AV Level Silver Plan,,0.869611859321594,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$13,200","$26,400",Not Applicable,Not Applicable,$750,"$1,500",10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,9
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,8,31274,WV,Individual,No,55-0624615,31274WV0330006,Shared Cost Blue PPO 2500,31274WV033,,WVN001,WVS001,WVF004,New,PPO,Silver,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.  .",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0330006-06,94% AV Level Silver Plan,,0.937491178512573,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$500,"$1,000",,,"$13,200","$26,400",Not Applicable,Not Applicable,$100,$200,10%,,,,"$5,000","$10,000",Not Applicable,Not Applicable,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,10
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,9,31274,WV,Individual,No,55-0624615,31274WV0470001,Balance Blue PPO 500,31274WV047,,WVN001,WVS001,WVF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0470001-00,Standard Gold Off Exchange Plan,,0.800466656684875,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,4
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,9,31274,WV,Individual,No,55-0624615,31274WV0470001,Balance Blue PPO 500,31274WV047,,WVN001,WVS001,WVF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0470001-01,Standard Gold On Exchange Plan,,0.800466656684875,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,5
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,9,31274,WV,Individual,No,55-0624615,31274WV0470001,Balance Blue PPO 500,31274WV047,,WVN001,WVS001,WVF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0470001-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0,$0,,,$0,$0,$0,$0,,,,,,,,,,,,,,,,,,,,,$0,$0,0%,,,,$0,$0,$0,$0,,,,,,,,,6
2015,WV,31274,SERFF,10,2015-01-22 16:02:51,9,31274,WV,Individual,No,55-0624615,31274WV0470001,Balance Blue PPO 500,31274WV047,,WVN001,WVS001,WVF004,New,PPO,Gold,No,Both,No,No,,,$0.00,No,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,0.9974,,$200,0,0,0,2015-01-01,,Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,"Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.",Yes,https://www.highmark.com/sbc/bcbswv,https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment,http://discoverhighmark.com/individuals-families/content/pdfs/Product_Brochure_WV_SinglePage.pdf,http://client.formularynavigator.com/clients/highmark/commercial.html,31274WV0470001-03,Limited Cost Sharing Plan Variation,,0.800466656684875,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000",Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,$500,"$1,000",20%,,,,"$1,000","$2,000",Not Applicable,Not Applicable,,,,,,,,,7
2015,WV,47107,SERFF,2,2014-09-09 16:12:42,1,47107,WV,SHOP (Small Group),Yes,42-0127290,47107WV0040001,Principal Plan Dental 70,47107WV004,,WVN001,WVS001,,New,PPO,Low,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$24.00,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,47107WV0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,47107,SERFF,2,2014-09-09 16:12:42,1,47107,WV,SHOP (Small Group),Yes,42-0127290,47107WV0040002,Principal Plan Dental 80,47107WV004,,WVN001,WVS001,,New,PPO,High,,Off the Exchange,,,,Only services listed in the contract are covered.,,,,,Allows Adult and Child-Only,,,,$25.64,,Estimated Rate,,0,0,0,2015-01-01,,Yes,Same as any other,Yes,Same as any other,Yes,,,,,47107WV0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,47152,SERFF,4,2014-09-05 06:40:30,1,47152,WV,SHOP (Small Group),Yes,44-0308260,47152WV0010001,KCL EHB Low PPO,47152WV001,,WVN001,WVS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$35.01,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,47152WV0010001-00,Standard Low Off Exchange Plan,70.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,47152,SERFF,4,2014-09-05 06:40:30,1,47152,WV,SHOP (Small Group),Yes,44-0308260,47152WV0010003,KCL EHB Low MAC,47152WV001,,WVN001,WVS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$23.32,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,47152WV0010003-00,Standard Low Off Exchange Plan,70.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,47152,SERFF,4,2014-09-05 06:40:30,1,47152,WV,SHOP (Small Group),Yes,44-0308260,47152WV0010005,KCL Fam Low PPO,47152WV001,,WVN001,WVS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$35.01,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,47152WV0010005-00,Standard Low Off Exchange Plan,70.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WV,47152,SERFF,4,2014-09-05 06:40:30,1,47152,WV,SHOP (Small Group),Yes,44-0308260,47152WV0010007,KCL Fam Low MAC,47152WV001,,WVN001,WVS001,,New,PPO,Low,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$23.32,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,47152WV0010007-00,Standard Low Off Exchange Plan,70.80%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$75,Not Applicable,,,,,$75,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WV,47152,SERFF,4,2014-09-05 06:40:30,2,47152,WV,SHOP (Small Group),Yes,44-0308260,47152WV0010002,KCL EHB High PPO,47152WV001,,WVN001,WVS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$42.01,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,47152WV0010002-00,Standard High Off Exchange Plan,84.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,47152,SERFF,4,2014-09-05 06:40:30,2,47152,WV,SHOP (Small Group),Yes,44-0308260,47152WV0010004,KCL EHB High MAC,47152WV001,,WVN001,WVS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Child-Only,,,,$28.82,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,47152WV0010004-00,Standard High Off Exchange Plan,84.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,47152,SERFF,4,2014-09-05 06:40:30,2,47152,WV,SHOP (Small Group),Yes,44-0308260,47152WV0010006,KCL Fam High PPO,47152WV001,,WVN001,WVS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$42.01,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,47152WV0010006-00,Standard High Off Exchange Plan,84.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WV,47152,SERFF,4,2014-09-05 06:40:30,2,47152,WV,SHOP (Small Group),Yes,44-0308260,47152WV0010008,KCL Fam High MAC,47152WV001,,WVN001,WVS001,,New,PPO,High,,Off the Exchange,,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,,,,Allows Adult and Child-Only,,,,$28.82,,Estimated Rate,,0,0,0,2015-01-01,,No,,Yes,Same as in-network service there are no limits,Yes,,,,,47152WV0010008-00,Standard High Off Exchange Plan,84.60%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WV,55565,SERFF,1,2014-08-11 09:11:26,1,55565,WV,SHOP (Small Group),Yes,36-0883760,55565WV0040001,EHB Low PPO,55565WV004,,WVN001,WVS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$17.22,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,55565WV0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,55565,SERFF,1,2014-08-11 09:11:26,1,55565,WV,SHOP (Small Group),Yes,36-0883760,55565WV0030002,EHB High Passive,55565WV003,,WVN001,WVS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.68,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,55565WV0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WV,55565,SERFF,1,2014-08-11 09:11:26,1,55565,WV,SHOP (Small Group),Yes,36-0883760,55565WV0030001,EHB Low Passive,55565WV003,,WVN001,WVS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.44,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,rsli.com,rsli.com,rsli.com,,55565WV0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WV,63300,SERFF,2,2014-09-04 06:14:21,1,63300,WV,SHOP (Small Group),Yes,47-0098400,63300WV0040002,EHB High PPO,63300WV004,,WVN001,WVS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$33.72,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,63300WV0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,63300,SERFF,2,2014-09-04 06:14:21,1,63300,WV,SHOP (Small Group),Yes,47-0098400,63300WV0040001,EHB Low PPO,63300WV004,,WVN001,WVS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$16.98,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,63300WV0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,63300,SERFF,2,2014-09-04 06:14:21,1,63300,WV,SHOP (Small Group),Yes,47-0098400,63300WV0030002,EHB High Passive,63300WV003,,WVN001,WVS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.19,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,63300WV0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WV,63300,SERFF,2,2014-09-04 06:14:21,1,63300,WV,SHOP (Small Group),Yes,47-0098400,63300WV0030001,EHB Low Passive,63300WV003,,WVN001,WVS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.14,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,ameritas.com,ameritas.com,ameritas.com,,63300WV0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WV,67072,SERFF,2,2014-09-04 06:14:21,1,67072,WV,SHOP (Small Group),Yes,93-0242990,67072WV0040002,EHB High PPO,67072WV004,,WVN001,WVS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$34.29,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,67072WV0040002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,67072,SERFF,2,2014-09-04 06:14:21,1,67072,WV,SHOP (Small Group),Yes,93-0242990,67072WV0040001,EHB Low PPO,67072WV004,,WVN001,WVS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$17.27,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,67072WV0040001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,67072,SERFF,2,2014-09-04 06:14:21,1,67072,WV,SHOP (Small Group),Yes,93-0242990,67072WV0030002,EHB High Passive,67072WV003,,WVN001,WVS001,,Existing,PPO,High,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$35.79,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,67072WV0030002-00,Standard High Off Exchange Plan,85.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WV,67072,SERFF,2,2014-09-04 06:14:21,1,67072,WV,SHOP (Small Group),Yes,93-0242990,67072WV0030001,EHB Low Passive,67072WV003,,WVN001,WVS001,,Existing,PPO,Low,,Off the Exchange,,,,,,,,,Allows Adult and Child-Only,,,,$21.50,,Estimated Rate,,0,0,0,2015-01-01,2016-01-01,Yes,"We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.",Yes,"Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas? online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on ?Find a Provider.?",Yes,standard.com,standard.com,standard.com,,67072WV0030001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,Not Applicable,Not Applicable,,,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WV,75441,SERFF,2,2014-09-04 06:14:21,1,75441,WV,SHOP (Small Group),Yes,57-0523959,75441WV0010001,Group Pediatric Dental EHB Rider,75441WV001,,WVN001,WVS001,,New,PPO,High,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$24.65,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,75441WV0010001-00,Standard High Off Exchange Plan,83.50%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$0,Not Applicable,,,,,$0,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,75441,SERFF,2,2014-09-04 06:14:21,1,75441,WV,SHOP (Small Group),Yes,57-0523959,75441WV0010002,Group Pediatric Dental EHB Rider,75441WV001,,WVN001,WVS001,,New,PPO,Low,,Off the Exchange,,,,,,,,,Allows Child-Only,,,,$20.27,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Traditional with inside maximum limits,Yes,Traditional with inside maximum limits,Yes,,,,,75441WV0010002-00,Standard Low Off Exchange Plan,68.70%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,76526,SERFF,7,2014-11-15 10:06:04,1,76526,WV,SHOP (Small Group),Yes,55-0523124,76526WV0020002,Delta Dental PPO?Pediatric Preferred Plan for Small Businesses,76526WV002,,WVN001,WVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.33,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/wv/76526wv0020002-15,,76526WV0020002-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,76526,SERFF,7,2014-11-15 10:06:04,1,76526,WV,Individual,Yes,55-0523124,76526WV0010002,Delta Dental PPO Pediatric Preferred Plan,76526WV001,,WVN001,WVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$15.88,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/wv/76526wv0010002-15,,76526WV0010002-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,76526,SERFF,7,2014-11-15 10:06:04,1,76526,WV,Individual,Yes,55-0523124,76526WV0010002,Delta Dental PPO Pediatric Preferred Plan,76526WV001,,WVN001,WVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Child-Only,,,,$15.88,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/wv/76526wv0010002-15,,76526WV0010002-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,76526,SERFF,7,2014-11-15 10:06:04,1,76526,WV,SHOP (Small Group),Yes,55-0523124,76526WV0020002,Delta Dental PPO?Pediatric Preferred Plan for Small Businesses,76526WV002,,WVN001,WVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.33,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/wv/76526wv0020002-15,,76526WV0020002-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,76526,SERFF,7,2014-11-15 10:06:04,1,76526,WV,SHOP (Small Group),Yes,55-0523124,76526WV0020001,Delta Dental PPO?Pediatric Basic Plan for Small Businesses,76526WV002,,WVN001,WVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$12.70,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/wv/76526wv0020001-15,,76526WV0020001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WV,76526,SERFF,7,2014-11-15 10:06:04,1,76526,WV,Individual,Yes,55-0523124,76526WV0010001,Delta Dental PPO Pediatric Basic Plan,76526WV001,,WVN001,WVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$12.70,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/wv/76526wv0010001-15,,76526WV0010001-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6
2015,WV,76526,SERFF,7,2014-11-15 10:06:04,1,76526,WV,Individual,Yes,55-0523124,76526WV0010001,Delta Dental PPO Pediatric Basic Plan,76526WV001,,WVN001,WVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Child-Only,,,,$12.70,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/wv/76526wv0010001-15,,76526WV0010001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WV,76526,SERFF,7,2014-11-15 10:06:04,1,76526,WV,SHOP (Small Group),Yes,55-0523124,76526WV0020001,Delta Dental PPO?Pediatric Basic Plan for Small Businesses,76526WV002,,WVN001,WVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$12.70,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/wv/76526wv0020001-15,,76526WV0020001-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7
2015,WV,76526,SERFF,7,2014-11-15 10:06:04,2,76526,WV,SHOP (Small Group),Yes,55-0523124,76526WV0020004,Delta Dental PPO Preferred Plan for Families for Small Businesses,76526WV002,,WVN001,WVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.33,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/wv/76526wv0020004-15,,76526WV0020004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,76526,SERFF,7,2014-11-15 10:06:04,2,76526,WV,Individual,Yes,55-0523124,76526WV0010004,Delta Dental PPO Preferred Plan for Families,76526WV001,,WVN001,WVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$15.88,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/wv/76526wv0010004-15,,76526WV0010004-00,Standard High Off Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,76526,SERFF,7,2014-11-15 10:06:04,2,76526,WV,Individual,Yes,55-0523124,76526WV0010004,Delta Dental PPO Preferred Plan for Families,76526WV001,,WVN001,WVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$15.88,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/wv/76526wv0010004-15,,76526WV0010004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,76526,SERFF,7,2014-11-15 10:06:04,2,76526,WV,SHOP (Small Group),Yes,55-0523124,76526WV0020004,Delta Dental PPO Preferred Plan for Families for Small Businesses,76526WV002,,WVN001,WVS001,,Existing,PPO,High,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$16.33,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/wv/76526wv0020004-15,,76526WV0020004-01,Standard High On Exchange Plan,83.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$40,Not Applicable,,,,,$40,Not Applicable,$40,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,76526,SERFF,7,2014-11-15 10:06:04,3,76526,WV,SHOP (Small Group),Yes,55-0523124,76526WV0020006,Delta Dental PPO Basic Plan for Families for Small Businesses,76526WV002,,WVN001,WVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$12.70,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/wv/76526wv0020006-15,,76526WV0020006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,76526,SERFF,7,2014-11-15 10:06:04,3,76526,WV,Individual,Yes,55-0523124,76526WV0010006,Delta Dental PPO Basic Plan for Families,76526WV001,,WVN001,WVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$12.70,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/wv/76526wv0010006-15,,76526WV0010006-00,Standard Low Off Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
2015,WV,76526,SERFF,7,2014-11-15 10:06:04,3,76526,WV,Individual,Yes,55-0523124,76526WV0010006,Delta Dental PPO Basic Plan for Families,76526WV001,,WVN001,WVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$12.70,,Estimated Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,www.deltadentalins.com/hx/checkout,deltadentalins.com/hcx/wv/76526wv0010006-15,,76526WV0010006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,76526,SERFF,7,2014-11-15 10:06:04,3,76526,WV,SHOP (Small Group),Yes,55-0523124,76526WV0020006,Delta Dental PPO Basic Plan for Families for Small Businesses,76526WV002,,WVN001,WVS001,,Existing,PPO,Low,,Both,,,,,,,,,Allows Adult and Child-Only,,,,$12.70,,Guaranteed Rate,,0,0,0,2015-01-01,2015-12-31,No,,Yes,Nationwide Coverage,Yes,,,deltadentalins.com/hcx/wv/76526wv0020006-15,,76526WV0020006-01,Standard Low On Exchange Plan,69.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$45,Not Applicable,,,,,$45,Not Applicable,$45,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
2015,WV,94562,SERFF,2,2014-09-04 06:14:21,1,94562,WV,SHOP (Small Group),Yes,13-5581829,94562WV0080001,EHB Basic Dental Plan (Low),94562WV008,,WVN001,WVS001,,New,PPO,Low,,Off the Exchange,,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,Allows Child-Only,,,,$15.89,,Guaranteed Rate,,0,0,0,2015-01-01,,Yes,Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.,Yes,The PPO plan has an indemnity schedule of benefits for out of service area coverage.,Yes,,,,,94562WV0080001-00,Standard Low Off Exchange Plan,70.00%,,,,No,100%,,$350,$700,,,Not Applicable,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,$100,Not Applicable,,,,,$100,Not Applicable,Not Applicable,Not Applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4